How safe and effective is stentless laparoscopic ureterolithotomy in elderly patients?

PURPOSE: With the improvement of minimally invasive urology procedures, open surgical interventions are less common to treat ureteral calculus. Laparoscopic ureterolithotomy (LU) indications are large multiple and/or impacted ureteral calculus that may not be treated with shock-wave lithotripsy or ureterorenoscopy approaches. The aim of our study was to investigate the feasibility and safety of stentless LU in elderly patients. METHODS: Between October 2011 and December 2019, 38 geriatric patients underwent stentless transperitoneal LU for upper/mid ureteral calculi. The transperitoneal route was applied in all patients by two surgeons. No double J stent inserted in any patient. The data of all patients reviewed retrospectively. RESULTS: The average age was 64.60 ± 3.70 years. The mean calculi size was 19.42 ± 1.41 mm. Ten patients had unsuccessful shock wave lithotripsy or ureterorenoscopy history. The calculi-free rate was 100%. Clavien grade 1 complications were seen in 11 (28.9%) cases. No major perioperative and postoperative complications were encountered. The average length of hospital stay was 3.24 ± 1.53 days. CONCLUSION: The significant advances in medical technology and healthcare, lead a rising number of geriatric patients to take benefit of even complicated surgery. Although laparoscopy and its safety in the geriatric population pursues a challenge and the assessment of this procedure is hence obligatory, we think that stentless LU is safe, economical and less uncomfortable for elderly patients.

How safe and effective is laparoscopic decortication of simple renal cysts in elderly patients?

Objective: To investigate the assessment of feasibility and safety of laparoscopic decortication of simple renal cysts in elderly patients.Methods: The data of 114 patients who underwent laparoscopic decortication for simple renal cyst between October 2011 and May 2019 were retrospectively evaluated. Patients' age, gender and ASA scores; operation time; cyst size and location; complications; hospital stays and success rates of operations were recorded.Results: The mean age of the patients were 73.8 ± 8.2 years. Forty-eight (42.1%) of the patients were female and 66 (57.9%) were male. Cysts were localized on the right side in 61 (53.5%) patients and on the left side in 53 (46.5%) patients; and mean cyst size was 72.83 ± 31.13 mm. Also, they were localized on the anterior in 88 (77.2%) patients and on the posterior of the kidney in 26 (22.8%) patients. Preoperative ASA score distributions were ASA-I in 12 patients (10.5%), ASA-II in 31 patients (27.2%), ASA-III in 68 patients (59.7%), and ASA-IV in 3 patients (2.6%). Mean operative time was 41.4 ± 5.6 min. Clavien grade 1 complications were observed in 5 (10.4%) patients. Median hospitalization time was 1 day. No recurrence was occurred in any patient in the postoperative period.Conclusions: Although laparoscopic surgery has some risks and complications for elderly patients, laparoscopic decortication can be applied safely and effectively in treatment of simple renal cyst in that patient population.

Can subfoveal choroidal thickness replace subjective tests in patients using tadalafil to treat erectile dysfunction?

We aimed to determine the effect on choroidal thickness of daily 5 mg tadalafil use in patients with erectile dysfunction (ED) and to evaluate agreement between short form of International Index of Erectile Function (IIEF 1-5, 15) scores and choroidal thickness during follow-up. Enhanced depth imaging spectral domain-optical coherence tomography (EDI-OCT) was used to measure full choroidal thickness in the subfoveal area, choroidal thickness (CT) and small-choroidal-vessel-layer (SCVL) thickness. Thirty of the 45 patients included complete their follow-ups and exhibited medication continuity. Patients were divided into two groups, five (16.7%) with ED at any level at third-month follow-up, and 25 (83.3%) with no ED, and subgroup analysis was then performed. Median changes in SCVL thickness at first- and sixth-month follow-ups were 20.5 µm versus 9.0 µm (p = .001) and 23.5 µm versus 12.5 µm (p = .005) in patients without and with ED respectively. The SCVL thickness increased by 20 µm compared with the baseline level, indicating an improvement in the patient's complaints of erectile dysfunction. The level of increase in SCVL thickness can be a useful and objective guide to clinicians if they cannot be present when the IIEF questionnaire is administered.

Effect of venous reflux time on testosterone and semen parameters of infertile males after microscopic varicocelectomy.

This study aimed to search whether there is a link between reflux flow and hormonal profile. Data of 250 patients were retrospectively investigated. Pre-operative and 6th month semen analyses of these patients' results were compared with pre-operative and post-operative 6th month serum levels of testosterone. Based on the venous flow on pre-operative Doppler ultrasonography, patients were divided into two groups. Patients with a venous flow ≤4 s were assigned to Group 1 and those with a venous flow >4 s to Group 2. Venous reflux time cut-off was calculated as 4 s using ROC curve according to the increase in testosterone level. When venous reflux time was selected as approximately 4.0 s, ROC had 79.8% sensitivity and 72.8 specificity. The probability of a post-operative increase in testosterone is high in patients with a venous reflux time longer than 4 s.

Can antibiotic preference affect bleeding in percutaneous nephrolithotomy? Retrospective comparative study of two commonly used antibiotics.

OBJECTIVE: Bleeding is one of the most common and alarming complication of percutaneous nephrolithotomy (PCNL). In this study, we aimed to compare the effects of ciprofloxacin and cefuroxime on the bleeding in PCNL procedures. METHODS: The study was a retrospective analysis of 97 patients who underwent PCNL between February 2011 and June 2017. We just included the patients who had single tract lower pole PCNL for more objective evaluation of bleeding in the study. The patients were divided into two groups as ciprofloxacin group (Group-I, n:40) and cefuroxime group (Group-II, n:56) according to the type of antibiotic used in the operation. Patient age, gender, body mass index, stone size, preoperative INR, preoperative and postoperative platelet counts and difference, operative time, need for blood transfusion, postoperative fever, hospital stay, postoperative hemoglobin and hematocrit drop were analyzed. RESULTS: There was no statistically significant difference in patients' gender distribution, body mass index, preoperative INR, preoperative and postoperative platelet counts, preoperative and postoperative platelet difference, duration of operation, hospital stay, postoperative fever and need for postoperative blood transfusion between two antibiotic groups (p > 0.05). Mean patient age was 42,75±16,97 in Group-I and 35,54±14,71 in Group-II (p < 0.05). The mean stone size of Group-I and Group-II were 27,23±7,05 mm and 30,59±8,20, respectively (p < 0.05). The mean postoperative hemoglobin and hematocrit drop were significantly higher in Group-I than in Group-II. The mean hemoglobin drop was 1,73±0,95 for Group-I and 1,28±0,67 for Group-II (p < 0.05). The mean hematocrit drop was 5,17±2,76 for Group-I and 3,80±1,99 for Group-II (p < 0.05). CONCLUSION: On the basis of the results of the initial study, the antibiotic preference in patients undergoing surgery may be one of the bleeding factors during and after PCNL.

Retroperitoneal high ligation versus subinguinal varicocelectomy: Effectiveness of two different varicocelectomy techniques on the treatment of painful varicocele.

In the present study, we compared the retroperitoneal high ligation with subinguinal varicocelectomy on the treatment of painful varicocele. A total of 90 patients who underwent retroperitoneal high ligation (n = 45) and subinguinal varicocelectomy (n = 45) for painful varicocele were included in this prospective study. Varicocele in all patients was diagnosed with by physical examination and coloured Doppler ultrasonography. All the patients underwent a conservative treatment for pain for 4 weeks. Patient ages, varicocele grades, preoperative pain scores, postoperative pain scores at 6 months, duration of surgeries, complications and recurrences were recorded. Complete success rate for chronic scrotal pain was found to be 80% in retroperitoneal varicocelectomy group and 71% in subinguinal varicocelectomy group. Partial success rate was 11% for retroperitoneal varicocelectomy group and 18% for subinguinal ligation group. There was no significant difference between two groups in terms of pain and complications. However, the operation time was significantly lower in the Palomo group. Although microsurgical subinguinal varicocelectomy is the current approach for the treatment of varicocele, retroperitoneal high ligation can achieve the same pain resolution with shorter operative duration compared to loupe-assisted subinguinal varicocelectomy.

Can we Predict Preoperative Tumor Aggressivity with Hemogram Parameters in Renal Cell Carcinoma? a Novel Calculation Method.

We aim to investigate the prognostic significance of the hemoglobin X lymphocyte / neutrophil ratio (HLNR) and hemoglobin x lymphocyte / platelet ratio (HLPR) with tumor aggressivity in patients with renal cell carcinoma. We retrospectively analyzed 127 patients' data who had diagnosed as renal cell carcinoma between 2008 and 2019 in Suleyman Demirel University Hospital. Tumor and patient characteristics, hemoglobin, neutrophil, lymphocyte, platelet values HLNR and HLPR were calculated in preoperative hemogram parameters. The relationship between tumor pathological stage, Fuhrman nuclear grade and tumor necrosis with HLPR and HLNR analyzed with statistically. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLNR. P values are 0.003, 0.012 and 0.015 respectively. HLNR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLPR. P values are 0.001, 0.014 and 0.047 respectively. HLPR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. High pathological stage, high Fuhrman nuclear grade and existence of tumor necrosis are associates with preoperative low HLNR and low HLPR in renal cell carcinoma patients. They can be used as prognostic markers in patients with renal mass preoperatively.

Effectiveness of harmonic scalpel in laparoscopic treatment of simple renal cyst.

We retrospectively evaluated the results of Harmonic Scalpel (Ethicon, Cincinnati, Ohio) used for laparoscopic decortication of simple renal cysts (SRC). Between May 2011 and December 2014, 28 patients with symptomatic SRC (Bosniak type 1) underwent laparoscopic decortication with Harmonic Scalpel, were reviewed. All cysts were evaluated with ultrasonography and abdominal computed tomography. Symptomatic and surgical success was defined as no recurrence on computed tomography imaging and complete pain relief, respectively. The mean age of patients was 51.7±9.6 years and there were 16 female and 12 male. While a transperitoneal approach was preferred in 18 cases, a retroperitoneal approach was chosen in 10 patients. The mean cyst size and duration of operation was 8,8±2,8 (6-12) cm and 72,8±28,4 (50-110) minutes, respectively. A total of three minor complications were observed postoperatively. Mean hospital stay was 1,3±0,9 (1-3) days. After the mean 12,6±3,2 (3-24) months follow-up the radiological and symptomatic successes were 100% and 89,2%, respectively. Our results showed that laparoscopic decortication of SRC using Harmonic Scalpel is consistent with the literature and provides a reasonable complication but increases cost.

Comparison of three most frequently used alpha blocker agents in medical expulsive therapy for distal ureteral calculi, result of a retrospective observational study.

PURPOSE: In this study, we compared the effects of three agents frequently used in daily life for medical expulsive therapy. MATERIALS AND METHODS: A total of 143 patients meeting the criteria were included in the study. Patients were divided into three homogeneous drug groups which were tamsulosin group (n:48), alfuzosin group (n:47) and silodosin group (n:48). The time of stone expulsion, analgesic needs, side effects of the medicine and endoscopic intervention needs of the patients were recorded. RESULTS: The rate of stone expulsion was 70.8% (n:34) in tamsulosin group, 70.2% (n:33) in alfuzosin group, and 75% (n:36) in silodosin group. No significant difference was observed among the rates of stone expulsion in three groups, and the rates of stone expulsion were similar (p = 0.778). The duration of stone expulsion was significantly different in the groups (p = 0.012): the time of stone expulsion for tamsulosin was 2.33 ± 0.78 days longer than for Silodosin, indicating a significant difference. There was no significant difference between tamsulosin-alfuzosin and silodosin-alfuzosin (respectively p = 0.147, p = 0.925). CONCLUSIONS: The results of this study showed that medical expulsive therapy by using alpha blocker agents is safe and efficacious. This option must be kept in mind for patients who do not ask for surgery as the first-step treatment for eligible patients.

Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries?

PURPOSE: To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain. MATERIALS AND METHODS: 76 patients who underwent transperitoneal laparoscopic upper urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postoperative pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain. RESULTS: Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920). CONCLUSION: Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period.

Use and outcomes of amplatz renal dilator for treatment of urethral strictures.

INTRODUCTION: Urethral stricture disease is still a major problem in men. Many procedures are available for the treatment of urethral strictures; urethral dilatation is one of the oldest. The blind dilatation of urethral strictures may be a difficult and potentially dangerous procedure. The purpose of this study was to describe safe urethral dilatation using amplatz renal dilator and to report outcomes. MATERIALS AND METHODS: From 2010 to 2014, a total of 26 men with primary urethral strictures were managed by urethral dilatation using amplatz renal dilators. The parameters analyzed included presentation of patients, retrograde urethrography (RGU) findings, pre-and postoperative maximum flow rate (Qmax) on uroflowmetry (UF) and post-void residual urine (PVR). Patients were followed-up at 1.6 and 12 months. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guidewire and stylet over which amplatz renal dilators are introduced. RESULTS: The mean age of the patients was 57.6 (35-72) years. The median stricture length was 0.82 (0.6-1.5)cm. Pre-operative uroflowmetry showed Qmax of 7.00 (4-12) mL/sec and ultrasonography showed PVR of 75.00 (45-195)mL. Postoperatively, Qmax improved to 18.00 (15-22)mL/sec (p<0.001) at 1 month, 17.00 (13-21)mL/sec (p<0.001) at 6 months and 15.00 (12-17)mL/sec (p<0.001) at 12 months. The post-operative PVR values were 22.50 (10-60)mL (p<0.001), 30.00 (10-70)mL (p<0.001) and 30.00 (10-70) mL (p<0.001) at 1.6 12 months, respectively. The median procedure time was 15.00 (12-22) minutes. None of the patients had a recurrence during a 12-month period of follow-up. CONCLUSION: Urethral dilatation with amplatz renal dilators avoids the risks associated with blind dilatation techniques. This tecnique is a safe, easy, well-tolerated and cost-effective alternative for treatment of urethral strictures.

Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia.

PURPOSE: Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. MATERIALS AND METHODS: A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. RESULTS: There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). CONCLUSION: This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

[The value of PCR method in the species-level identification of a mucoid Salmonella sp. strain isolated from the urine culture of a case with asymptomatic nephrolithiasis]. / Nefrolitiazisli asemptomatik bir olgunun idrar kültüründen izole edilen mukoid Salmonella sp. susunun tür düzeyinde tanimlanmasinda PCR yönteminin degeri.

Colonies of the Salmonella strains usually show a smooth (S) character. Therefore, Salmonella strains producing mucoid colony are very rarely encountered in the literature. Identification of the mucoid Salmonella strains to the species level is difficult via conventional methods, since the mucus layer does not allow the bacterium to respond to the antigenic reactions. In this study we aimed to emphasize the identification of Salmonella serotypes by the polymerase chain reaction (PCR) when rough (R) or mucoid (M) Salmonella isolates are encountered in the laboratory. The urine culture of a 17-year-old female patient revealed growth of 100.000 cfu/mL gram-negative bacilli in mucoid colony morphology. The isolate was identified as Salmonella sp. by biochemical tests and Vitek 2 (bioMérieux, France) automated identification system. Agglutination tests showed negative reaction with the known antiserums. Absence of agglutination was attributed to the mucoid character of the isolate. Identification of the Salmonella sp. was confirmed by Vitek MS MALDI-TOF (bioMérieux, France) analysis method, however, the serotype of the strain could not be identified. In order to verify that the mucoid colony was Salmonella spp., species-specific PCR was performed using invA primers, and Salmonella sp. identification was verified by observing a 284 base-pair (bp) PCR amplicon. Subsequently, serogrouping was done by multiplex-PCR (mPCR), which could identify the O:B (O:4), O:C1 (O:7), O:C2-C3 (O:8), O:D (O:9, O:9,46, O:9,46,27), and O:E (O:3,10, O:3,19) somatic antigens. It was detected that the mucoid Salmonella sp. formed a band of approximately 615 bp in size and took place in group D. Another mPCR directed towards O:D1(O:9) and O:E1(3,10) somatic antigens to detect subgroups of group D mucoid Salmonella spp., revealed that the isolate formed a DNA band of approximately 624 bp in size and took place in group D1 which is usually isolated from human. Modified version of another mPCR was used to determine phase-1 flagellar antigen of common Salmonella serovars, as well as to determine the phase-1 flagellar antigen of mucoid Salmonella spp. in group D1. Thus, the isolate was serotyped as Salmonella Enteritidis (1.9,12:g,m:-). Antibiotic susceptibility test performed by disc diffusion method in line with the recommendations of CLSI, revealed that the isolate was susceptible to ampicillin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole and chloramphenicol. In conclusion, PCR is a reliable and rapid alternative method that contributes to the conventional serotyping of Salmonella when rough or mucoid strains that lack somatic and flagellar antigens, are isolated.

The effect untreated right subclinical varicocele on the outcomes of contralateral left clinical varicocelectomy in infertile patients.

PURPOSE: The management of infertile patients with unilateral subclinical varicocele (SCV) and contralateral clinical varicocele (CV) remains controversial. We aimed to evaluate the effect of untreating SCV on the outcome of contralateral clinical varicocelectomy in infertile patients with oligoasthenozoospermia (OA). MATERIALS AND METHODS: Infertile patients with the diagnosis of OA who underwent left varicocelectomy were retrospectively evaluated. While all patients in the study had left clinical varicocele (LCV), some patients had concomitant right SCV. Patients were divided into two groups according to the presence or absence of a right SCV accompanying LCV as group 1; (LCV n = 104) or group 2; (LCV with right SCV, n = 74). Patients were evaluated with spermiogram parameters, pregnancy rates and serum levels of follicle stimulating hormone, luteinizing hormone, total testosterone at the first year of the follow-up. RESULTS: The mean sperm concentration increased significantly in both groups. However, group 1 showed significantly greater improvement than group 2. The ratio of progressive motile sperm in group 1 was increased significantly whereas no significant change was shown in group 2. Both the spontaneous pregnancy rate and the pregnancy rate with ART were statistically lower in the group of patients with right SCV. No statistically significant difference was detected in serum hormone levels in both groups after varicocelectomy operations. CONCLUSIONS: Untreated right SCV may have adverse impact on the outcomes of left clinical varicocelectomy. In this context, the right testis can be considered in terms of treatment in patients with right SCV accompanying left CV.

The Effect of Potassium Citrate on Overactive Bladder Disease: A Cross-sectional Study.

OBJECTIVE: To show the effect of potassium citrate treatment on overactive bladder disease in patients with kidney stone and overactive bladder symptoms. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Department of Urology, Alanya Alaaddin Keykubat University and Department of Urology, Süleyman Demirel University, Turkey, from October 2019 to July 2020. METHODOLOGY: Patients with an indication for starting potassium citrate therapy because of kidney stone, and patients with symptoms of overactive bladder disease were included in the study. At the beginning of the treatment, the overactive bladder-version 8 form was filled and potassium citrate 10 meq 2x2 dose was started to the patients. The effect of potassium citrate on the symptoms of overactive bladder disease was demonstrated by filling the overactive bladder-version 8 form after one month of treatment. RESULTS: A total of 82 people, 36 men and 46 women, participated in the study. Potassium citrate treatment caused a significant increase in urine pH levels (p<0.001). After potassium citrate treatment, there was a significant decrease in the score of the overactive bladder-version 8 form. (p<0.001). A positive correlation was found between age and overactive bladder-version 8 score change (p = 0.004). CONCLUSION: Potassium citrate can be used in the treatment of overactive bladder disease. The effect of potassium citrate treatment on ameliorating overactive bladder symptoms is more distinct in elderly patients. Key Words: Renal stones, Potassium citrate, Overactive bladder.

Is spinal anesthesia an alternative and feasible method for proximal ureteral stone treatment?

INTRODUCTION: We investigated the clinical, operational, and pain parameters of patients who underwent semirigid ureterorenoscopy (sURS) under spinal anesthesia (SA) and general anesthesia (GA) for proximal ureter stones. MATERIAL AND METHODS: Patients treated with sURS after diagnosis of proximal ureter stones between January 2014 and May 2017 were reviewed retrospectively. The patients were divided into two groups (the SA group and the GA group) based on the type of anesthesia used. Perioperative variables and operation results were evaluated and compared. Success was defined as the patient being stone-free as observed on low-dose non-contrast computed tomography performed in the first month postoperatively. RESULTS: The SA and GA groups had 40 and 32 patients, respectively. There were no statistically significant differences between the groups in terms of age (p = 0.593), gender (p = 0.910), average stone size (p = 0.056), side (p = 0.958), or density (p = 0.337). Based on the Clavien classification system, complication rates between the two groups were similar. The postoperative visual pain scale in the SA group was statistically significantly lower (p <0.05) than in the GA group. Success rates in the SA and GA groups were found to be 90% (36/40) and 93.7% (30/32), respectively, with no significant difference between the groups (p = 0.819). CONCLUSIONS: Ureterorenoscopy, which is performed for proximal ureter stone treatment in adult patients, is a reliable surgical method that can be performed under both SA and GA. SA offers the advantage of reduced postoperative pain as compared to GA.

Comparison of Cohen and Lich-Gregoir ureteral reimplantation in the surgical management of primary unilateral vesicoureteral reflux in children.

OBJECTIVE: Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Various intravesical and extravesical techniques have been described for the surgical correction of VUR. The aim of our study was to compare the results of open intravesical and extravesical procedures for unilateral primary VUR in children. METHODS: Between January 2012 and August 2018, 38 children with primary VUR who underwent open ureteral reimplantation surgery were retrospectively reviewed. The Cohen (intravesical) and the Lich-Gregoir (extravesical) approach were grouped as groups A and B, respectively. The groups were compared for age, gender, preoperative reflux grade, presence of lower urinary tract symptoms, operation time, discomfort and pain, analgesic requirements, duration of hematuria, postoperative complications, and hospital stay. All the parameters were statistically compared. RESULTS: There were 38 patients in this study. Group A had 18 patients, and group B had 20 patients. The mean operative time was significantly shorter in group B than in group A. The mean hospital stay was also shorter in group B. The urethral foley stay period was 4.7±0.9 days 2±0 days (p = 0.000*), respectively, for group A and B. Macroscopic hematuria was seen in group A. The objective pain scale was worse after intravesical surgery. Analgesic requirements were higher in group A (p =0.131). CONCLUSION: Intravesical and extravesical ureteroneocystostomy methods are equally successful and feasible in the treatment of primary unilateral VUR. The Cohen technique is associated with a longer and more painful hospital stay, gross hematuria, and longer operative time, compared to the Lich-Gregoir technique.

P wave dispersion in patients with erectile dysfunction.

BACKGROUND AND AIMS: P wave dispersion (PWD) has been reported to be a non-invasive electrocardiographic predictor for atrial fibrillation. The aim of this study is to evaluate PWD between men with erectile dysfunction (ED) and healthy controls in order to investigate whether PWD was prolonged in patients with ED and related to severity of the disease. METHODS: This study included a total of 72 men (42 patients with ED and 30 healthy controls). Demographic data and clinical features were recorded on admission. An electrocardiographic evaluation was obtained to measure PWD values for both patients and controls. RESULTS: Maximum P wave duration was 108.5 ± 4.7 and 108.3 ± 4.3 in ED group and control group, respectively (p = 0.748). Minumum P wave duration was significantly higher in the control group than in the ED group. PWD was 48.1 ± 5.9 in the ED group. As a result, PWD was prolonged in patients with ED (48.1 ± 5.9 vs. 38.0 ± 3.9, p < 0.05). A significant negative correlation was observed between IIEF score and PWD values (p < 0.05, r = -0.662). CONCLUSIONS: Patients with ED exhibited prolonged PWD values compared with normal controls. In addition, PWD was found to be associated with severity of the disease.

The Efficacy of Ultra-thin Semi-rigid Ureteroscopy with Holmium Laser Lithotripsy in Pediatric Ureteral Stones: A Single-center Experience.

Introduction The aim of this study was to present our results regarding the feasibility and possible complications of 4.5 Fr semi-rigid ureterorenoscopy (URS) treatments in pediatric patients. Methods The files and computer records of a total of 33 pediatric patients (20 males and 13 females), who underwent URS procedures for ureteral stones > 5 mm between January 2013 and June 2017, were retrospectively reviewed. A 4.5 Fr semi-rigid ureteroscope (Ultrathin 4.5/6.5 Fr Ureterorenoscope; Richard Wolf GmbH, Knittlingen, Germany) was used for the URS procedures. For the stone-free rate evaluations, abdominopelvic ultrasound or direct radiography scans were performed one week after the surgery, and low-dose non-contrast computed tomography (CT) was performed during the first month. Results The mean age of the patients was 9.8 ± 2.8 (range 4-16) years old, and the mean ureteral stone size was 8.9 ± 1.4 (range 6-13) mm. The mean surgical duration was 45 ± 21.2 (range 30-75) minutes, and the mean hospital stay length was 1.2 (range 1-4) days. Minor complications occurred in five (15.1%) of the patients. The success rates for the first week and first month were 90.9% and 96.9%, respectively. Conclusion The endoscopic management of pediatric ureteral stones using a 4.5 Fr ureteroscope seems to be a safe and feasible treatment option with high success and low complication rates.

Clot Retention: Our Experiences with a Simple New Technique of Evacuation with a Thoracic Catheter.

INTRODUCTION: Clot retention in the urinary bladder is a very common health problem in surgical and nonsurgical cases and clot retention treatment is quite costly. OBJECTIVES: The aim of this retrospective study was to describe an alternative technique for removing tenacious and chronic clots by using a thoracic catheter technique. MATERIALS AND METHODS: Between January 2011 and June 2018, a total of 27 patients of clot retention were treated under local anesthesia with the thoracic catheter technique. RESULTS: Twenty-seven patients with a mean age of 58 years (range 45-70) were included. The etiologies of bladder clots included surgical causes and nonsurgical causes. Of the surgical causes, the most common cause was post-transurethral resection of the prostate (TURP). The nonsurgical causes were upper tract bleeding, drug-induced bleeding, post-traumatic bleeding, and haematochyluria. It was found that the thoracic catheter technique was simple and easily adoptable, with no training required. CONCLUSIONS: Clot retention in the urinary bladder is a very common problem in surgical and nonsurgical cases. Our technique is a simple, safe, fast, and effective option of clot removal from the urinary bladder and it doesn't require any added cost.