Safety of Upper Pole Puncture in Percutaneous Nephrolithotomy with the Guidance of Ultrasonography versus Fluoroscopy: A Comparative Study.

INTRODUCTION: The aim of this study was to compare the safety of ultrasonography-guided (UG) puncture and fluoroscopy-guided (FG) upper pole access (UPA) in percutaneous nephrolithotomy (PCNL). METHODS: Consecutive patients with a solitary UPA were enrolled into the study from 2012 to 2020 and analyzed in a retrospective manner. In total, 177 patients were divided into 2 groups according to the method during the puncture phase of the access: FG (n = 105) and UG (n = 72). The UG and FG groups were compared in terms of complications (i.e., pleural injury and blood transfusion rate) and surgical outcomes. RESULTS: Gender, side, grade of hydronephrosis, type of access (i.e., supracostal vs. subcostal), Guy's stone score, age, stone diameter, skin-to-stone distance, and stone density were similar in the 2 groups (p > 0.05). Only in 25.9% of cases, UPA was done using a subcostal approach. The overall complication rates were similar between the groups (p > 0.178). For the UG and FG groups, the rate of pleural injury (8.5 vs. 4.1%) and the blood transfusion rate (8.5 vs. 2.8%) were also similar (p > 0.05). The fluoroscopy time and mean hemoglobin drop were significantly lower in the UG group than in the FG group (134.2 vs. 82.2 s, respectively, p = 0.001; 20.8 ± 9.8 vs. 16.8 ± 7.9 g/L, respectively, p = 0.001). Stone-free rate (SFR) was also similar in the FG and UG groups (77.1 vs. 75.0%, respectively, p = 0.742). CONCLUSION: While it is commonly expected that the complication rates are lower in UG puncture for UPA in PCNL than they are in FG puncture, the present study failed to show this difference. However, the radiation exposure time seemed to be lower in UG puncture than FG puncture and had a similar stone-free rate (SFR) for UPA in PCNL.

Comparison of Middle and Lower Calyceal Access for Renal Pelvis Stone in Percutaneous Nephrolithotomy: A Prospective Randomized Study.

OBJECTIVE: The aim of the study was to evaluate the possible effects of calyceal choice for renal puncture under sonographic guidance on the outcomes of percutaneous nephrolithotomy (PNL). MATERIALS AND METHODS: A total of 70 patients for whom ultrasound-guided PNL was planned for 20-30-mm single renal pelvic stones were prospectively allocated to group 1 (n:35) with middle calyx entry or group 2 (n:35) with lower calyx entry. Procedure-related parameters such as duration of operation, stone-free rates, complication rates, and radiation exposure time were analyzed in detail. RESULTS: The mean age of the patients was 45.67 ± 1.50 years and the mean stone size was 316.4 ± 17.95 mm2. There was no significant difference regarding the age, BMI, stone burden, and the grade of hydronephrosis between the groups. Skin to collecting system distance was significantly shorter in the middle calyx entrance (p = 0.021). Total duration of the procedure was again significantly shorter in group 1 cases (74.69 ± 2.94 min) than in group 2 (84.29 ± 4.25 min) (p = 0.003). Regarding the success rates, the postoperative stone-free rate was higher in group 1 (91.4% in group 1, 80.0% in group 2, p = 0.305). Last, there was no statistically significant difference in hemoglobin reduction rates, blood transfusion requirements, and complication rates between the 2 groups. CONCLUSION: Getting access to the renal pelvis through the middle calyx during ultrasonic guided PNL procedure is more advantageous to lower the calyceal approach by reducing both the duration of the PNL procedure with significantly higher stone-free and comparable complication rates.

Safety and efficacy of PNL vs RIRS in the management of stones located in horseshoe kidneys: A critical comparative evaluation.

AIM: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). PATIENTS AND METHODS: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. RESULTS: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. CONCLUSION: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK.

Impaction and Prediction: Does Ureteral Wall Thickness Affect the Success of Medical Expulsive Therapy in Pediatric Ureteral Stones?

OBJECTIVE: The study aimed to evaluate the predictive value of ureteral wall thickness (UWT) and stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in pediatric upper ureteral stones. PATIENTS AND METHODS: A total of 35 children receiving MET ureteral stones (<10 mm) were evaluated. Patients were divided into 2 subgroups where MET was successful in 18 children (51.4%) and unsuccessful in 17 children (48.6%). Prior to management, stone size, stone density (in Hounsfield unit), degree of hydronephrosis, and UWT were evaluated with patient demographics and recorded. The possible predictive value of these parameters in success rates and time to stone expulsion were evaluated in a comparative manner between the 2 groups. RESULTS: The overall mean patient age and stone size values were 5.40 ± 0.51 years and 6.24 ± 0.28 mm, respectively. Regarding the predictive values of these parameters for the success of MET, while stone size and UWT were found to be highly predictive for MET success, patients age, body mass index, stone density, and degree of hydronephrosis had no predictive value on this aspect. CONCLUSIONS: Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in pediatric ureteral stones in an effective manner. With this approach, unnecessary use of these drugs that may cause a delay in removing the stone will be avoided, and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized.

Renal access in PNL under sonographic guidance: Do we really need to insert an open end ureteral catheter in dilated renal systems? A prospective randomized study.

PURPOSE: To evaluate the true necessity of open end ureteral catheter insertion in patients with moderate to severe pelvicalyceal system dilation treated with percutaneous nephrolithotomy (PNL) under sonographic guidance. PATIENTS AND METHODS: 50 cases treated with PNL under sonographic guidance in prone position for solitary obstructing renal stones were evaluated. Patients were randomly divided into two groups; Group 1: Patients in whom a open end ureteral catheter was inserted prior to the procedure; Group 2: Patients receiving no catheter before PNL. In addition to the duration of the procedure as a whole and also all relevant stages as well, radiation exposure time, hospitalization period, mean nephrostomy tube duration, mean drop in Hb levels and all intra and postoperative complications have been evaluated. RESULTS: Mean size of the stones was 308.5 ± 133.2 mm2. Mean total duration of the PNL procedure in cases with open end ureteral catheter was significantly longer than the other cases (p < 0.001). Evaluation of the outcomes of the PNL procedures revealed no statistically significant difference between two groups regarding the stone-free rates (86% vs 84%). Additionally, there was no significant difference with respect to the duration of nephrostomy tube, hospitalization period and secondary procedures needed, complication rates as well as the post-operative Hb drop levels in both groups (p = 0.6830). CONCLUSIONS: Our results indicate that the placement of an open end ureteral catheter prior to a PNL procedure performed under sonographic access may not be indicated in selected cases presenting with solitary obstructing renal pelvic and/or calyceal stones.

The effect of surgical technique on hemodynamics, arterial oxygenation and pulmonary mechanics in radical prostatectomy operations.

OBJECTIVE: The effects of surgical technique on respiratory mechanics, arterial oxygenation and hemodynamics in radical prostatectomy operation were investigated. METHODS: The study was planned on ASA II-III, 40-65 years old, fourty patients scheduled for radical prostatectomy under general anesthesia. They were divided into two groups: perineal and suprapubic (Group P, n = 20; Group S, n = 20). Heart rate, mean arterial blood pressure, arterial oxygen saturation (SpO2), partial pressure of end-tidal carbon dioxide (PEtCO2), Peak inspiratory pressure (PIP), plato pressure (Pplato), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2) values were evaluated at 10 minutes after induction. After the position applied for surgery in the 30.60 and 90th minutes, the Alveolar-arterial oxygen pressure gradient (P(A-a) O2), the ratio of physiologic dead space over tidal volume (VD/VT), arterial to end tidal CO2 gradient (P(a-et) CO2), static compliance (CS), dynamic compliance (CD) were assessed. RESULTS: In the assessment of groups, there were not statistical differences about mean blood pressure, heart rate, SpO2, PetCO2, PaO2, plateau pressure, and P (A-a) values (p > 0.05). Peak inspiratory pressure was higher in Group P. Peak inspiratory pressure and plateau pressure increased with CO2 insufflation in Group P. PaCO2 and P(a-et) CO2 were higher statistically significantly in Group 0. There was no difference in terms of the PetCO2 values. VD/VT ratios were statistically significantly lower in the Group P. CONCLUSIONS: Suprapubic surgery was shown to improve oxygenation and respiratory mechanics without causing any hemodynamic side effect in radical prostatectomy operation.

Medical Expulsive Therapy Following Shock Wave Lithotripsy in Ureteral Calculi: An Effective Approach for the Improvement of Health-Related Quality of Life.

OBJECTIVE: To evaluate the possible effects of medical expulsive therapy (MET) on the health-related quality of life (HRQOL) of patients undergoing shock wave lithotripsy (SWL) for ureteric stones. METHODS: Eighty patients treated with SWL for ureteric stones were included in this study. Patients were divided into 2 groups; Group 1 received medical therapy only for colic pain and Group 2 received MET in addition to medical therapy. Patients requiring DJ stenting and auxiliary measures after SWL procedure were excluded. The remaining 54 patients were further evaluated (Group 1: n = 26, Group 2: n = 28) and followed up during the 4-week period for analgesic requirement, number of renal colic attacks, emergency department (ED) visits and the HRQOL scores by using EQ-5D index and EQ-5D visual analogue scale (VAS) values. RESULTS: During the 4-week follow-up period, cases undergoing SWL only required significantly higher amount of analgesics. In addition to the lower number of renal colic attacks and ED visits, EQ-5D index and EQ-5D VAS values also demonstrated higher mean values in patients undergoing SWL + MET. CONCLUSION: In addition to the increased spontaneous stone passage rates, MET following SWL for ureteral calculi could increase the HRQOL scores by lowering the number of both renal colic attacks and ED visits along with decreased analgesic need.

Does Transient Cessation of Antiplatelet Medication Prior to Shock Wave Lithotripsy Have Any Safety Concern: Evaluation of the Short Term Safety Results.

OBJECTIVE: The study aimed to evaluate the true safety of transient cessation of the antiplatelet medication before extracorporeal shock wave lithotripsy (SWL) on bleeding-related complications. PATIENTS AND METHODS: Forty cases undergoing SWL for renal pelvic stones were included and depending on the use of antiplatelet medication they were divided into 2 groups namely: group 1, cases under antiplatelet medication in whom the medication was stopped before ESWL; and group 2, cases without any antiplatelet medication. Comparative evaluation of patient, stone and treatment-related parameters were done in both groups. RESULTS: Although microscopic hematuria was present in all cases, the incidence of macroscopic hematuria was higher in cases undergoing antiplatelet medication when compared with the other cases. Regarding the microscopic hematuria again, the mean number erythrocytes per field of analysis was significantly higher in group 1 cases. The mean value of the hematoma size was similar in both groups. CONCLUSION: Our findings indicate that SWL can be applied safely in patients under antiplatelet therapy following the cessation of medication for a certain period of time. However, among the cases treated with this concept in our study, we clearly observed that the incidence of procedure-related hematoma formation and macroscopic hematuria were more common in such cases than in the normal ones.

The effects of stress incontinence surgery on sexual function and life quality of women.

OBJECTIVE: To evaluate Transobturator tape (TOT) and Burch colposuspension procedure's effects on sexual functions and life quality. MATERIALS AND METHODS: A total of 81 patients who underwent TOT (n = 49) or Burch (n = 32) with stress incontinence were included in this prospective study. Preoperatively and at postoperative 6 month follow up pad and stress tests, physical examinations, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) questionnaires were performed. Patient Global Impression of Improvement (PGI-I) questionnare was added postoperatively. RESULTS: According to stress test, success rate was found to be 69% and 45%, in the TOT and Burch groups respectively. Pad test decreased in both groups (p < 0.05). PGI-I scores was higher in the TOT group when compared to Burch group (p = 0.031). ICIQ-SF scores were improved in both TOT (p < 0.0001) and Burch groups (p < 0.012). IUDI-6 and IIQ-7 scores improved only in TOT group. Total FSFI scores did not change in both groups but only in TOT group sexual desire improved. Total FSFI scores did not change in patients that were successful and unsuccessful according to the stress test in both TOT and Burch groups (p < 0.05). CONCLUSIONS: TOT and Burch procedures have no effect on the sexual functions. However TOT improved life quality of patients.

Factors affecting the course of body and kidney growth in infants with urolithiasis: A critical long-term evaluation.

OBJECTIVE: To investigate the possible effects of dietary, patient and stone related factors on the clinical course of the stone disease as well as the body and renal growth status of the infants. PATIENTS AND METHODS: A total of 50 children with an history of stone disease during infancy period were studied. Patient (anatomical abnormalities, urinary tract infection - UTI, associated morbidities), stone (obstruction, UTI and required interventions) and lastly dietary (duration of sole breast feeding, formula feeding) related factors which may affect the clinical course of the disease were all evaluated for their effects on the body and renal growth during long-term follow-up. RESULTS: Mean age of the children was 2.40 ± 2.65 years. Our findings demonstrated that infants receiving longer period of breast feeding without formula addition seemed to have a higher rate of normal growth percentile values when compared with the other children. Again, higher frequency of UTI and stone attacks affected the growth status of the infants in a remarkable manner than the other cases. Our findings also demonstrated that thorough a close follow-up and appropriately taken measures; the possible growth retardation as well as renal growth problems could be avoided in children beginning to suffer from stone disease during infancy period. CONCLUSIONS: Duration of breast feeding, frequency of UTI, number of stone attacks and stone removal procedures are crucial factors for the clinical course of stone disease in infants that may affect the body as well as kidney growth during long-term follow-up.

Emergency management of ureteral stones: Evaluation of two different approaches with an emphasis on patients' life quality.

OBJECTIVES: To evaluate the emergency management of obstructing ureteral calculi with two different techniques (SWL and URS) with an emphasis on patients life quality. METHODS: A total of 80 patients presenting with acute colic pain due to a single obstructing ureteral stone were treated within 24 hours following the onset of pain with two different approaches in a randomized manner. Patients requiring DJ stent placement and/or auxiliary measures after both procedures were excluded and the remaining 65 patients were evaluated [Group1: ESWL (n = 34); Group 2: URS (n = 31)]. Patients were followed during 4-weeks period with respect to the analgesic requirement, number of renal colic attacks and emergency department visits along with the HRQOL scores. RESULTS: While 26 patients treated with URS (83.9%) were stone-free, 24 cases in SWL were stone-free (70.6%) after 4 weeks. Evaluation of the cases during this follow-up period demonstrated that cases undergoing SWL required significantly higher amount of analgesics when compared with URS group (p < 0.001). In addition to the lower mean number of renal colic attacks and emergency department visits in URS group; both the mean HRQOL in terms of EQ-5D index and mean EQ-5D VAS values were also significantly higher in these cases when compared with the cases tretaed with SWL. CONCLUSIONS: Due to the negative impact of stone related events after emergency SWL on patients HRQOL, emergency URS may be applied more effectively with the advantages of prompt fragmentation of the calculi along with the immediate relief of obstruction and pain.

Evaluation of sexual function in patients submitted to ureteroscopic procedures.

OBJECTIVE: We aimed to evaluate the possible effects of ureteroscopic procedures on the sexual function of both genders. MATERIALS AND METHODS: A total of 102 sexually active cases (60 male, 42 female) undergoing ureteroscopic procedures were included in this study. Sexual function has been evaluated in detail by using International Index of Erectile Function (IIEF) in male and Female Sexual Function Index (FSFI) forms in female cases both before and 1-month after the procedures. Pre-and postoperative data were evaluated in a comparative manner. RESULTS: The pre-and postoperative mean IIEF scores were 57.86 ± 2.26 and 54.57 ± 2.48 (p = 0.19) in males and the mean FSFI scores were 13.58 ± 1.46 and 14.46 ± 1.52 (p = 0.41), respectively in females. Evaluation of these values showed that regarding the effects of this procedure on male cases although the total scores for sexual function were not influenced it was observed a significant reduction in the intercourse satisfaction subdomain (IIEF-IS) in males (p < 0.05). In female cases however, unlike the male cases no statistically significant alterations with respect to these scores were noted (p = 0.418). CONCLUSION: Ureteroscopic interventions could have some adverse effects on the sexual function particularly in male cases. However, it is clear that further prospective studies in both genders with large population of cases are certainly needed in order to outline this unresolved but important subject.

Stone size and quality of life: A critical evaluation after extracorporeal shock wave lithotripsy.

OBJECTIVES: To evaluate the quality of life (QoL) of the patients after extracorporeal shockwave lithotripsy (ESWL) on a treated stone size related basis. METHODS: 90 patients undergoing ESWL for kidney stones were divided into three groups; Group 1 (n: 30, ≤ 10 mm), Group 2 (n: 28, 11 mm- ≤ 20 mm) and Group 3 (n: 32, 20- 25 mm). During 3- months follow-up, outcome of the procedure, number of cases with emergency department visits, analgesic required, re-tretatment rates, additional procedures and the changes in the QoL were evaluated. RESULTS: the number of emergency department visits and mean analgesic need; re-treatment rates and additional procedures were significantly higher in Group 3. Evaluation of the QoL scores in three groups showed that cases with larger stone still had lower scores during 3-month evaluation. CONCLUSIONS: Stone size could help us to predict the possible impact of ESWL on the QoL and depending on the size of the stone treated, a well planned indication and effective management possibly by an experienced urologist could limit the changes in the QoL of the patients.

Comparison of the efficacy of isosorbide mononitrate and doxazosin in the treatment of lower urinary tract symptoms and benign prostatic hyperplasia: a randomized clinical trial.

OBJECTIVE: We aimed to compare the efficacy of isosorbide mononitrate and doxazosin in the treatment of lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: 80 patients with LUTS were included in this randomized clinical study. All patients were evaluated with uroflowmetry, post-void residual (PVR) urine, prostate volume, International Prostate Symptom Score (IPSS), serum PSA, urinalysis and culture. 40 patients were prescribed doxazosin for 4 weeks, another 40 were prescribed isosorbide mononitrate for 4 weeks. Urologic re-evaluation was done at the end of the study. RESULTS: 74 patients completed the study. The mean age of patients was 59.6 ± 0.7 years, the mean PSA value was 1.7 ± 0.1 ng/ml and the mean prostate volume was 41.9 ± 1.7 ml. Doxazosin markedly improved IPSS (from 16.2 ± 0.7 to 9.5 ± 0.5), maximum urinary flow rate (from 10.9 ± 0.7 to 12.8 ± 0.6 ml/s) and PVR urine (from 68.1 ± 9.4 to 39.0 ± 4.4 ml) (p < 0.0001, p < 0.0001, p = 0.0004, respectively). Isosorbide only improved IPSS (from 16.5 ± 0.9 to 14.6 ± 0.8) (p = 0.032). CONCLUSIONS: Daily administration of isosorbide does not seem to be an alternative to α-blocker therapy. Controlled, randomized novel studies are required to establish that whether nitric oxide donors are an effective alternative in LUTS treatment.

A rare complication of ESWL: focal metastatic multiple organ abscesses in a horseshoe kidney.

Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment modality in the minimal invasive management of urinary system stone disease. Although the majority of the complications occuring after ESWL are minor (most common ones are gross haematuria, pain, perinephritic hematoma); bacteriuria may also occur in some cases which sometimes can lead to sepsis and even metastatic abscess formation in a very rare part of the cases treated. In this rare situation infection agent spreads quickly via hematogenous route and causes abscess formation in different parts of the body. Majority of such cases usually have an underlying systemic disease like diabetes mellitus (DM), malignancy, HIV or steroid use which lead to disruption of immune system functions. Abscess formation following ESWL is extremely rare and usually limited with some case reports published in the literature. Herein, we present a diabetic case with formation of multiple abscess foci in kidney, as well as in lungs and liver following ESWL. The patient was first admitted to our emergency department with high fever and respiratory distress and misdiagnosed as metastatic tumor foci based on radiologic findings. To the best of our knowledge, our case is the first one in the literature in whom simultanous abscess formation in multiple organ systems has been documented following an otherwise uneventful ESWL.

The importance of Internet usage for urologic patients.

OBJECTIVES: To evaluate Internet usage frequency, rate of searched diseases and impact of Internet derived data on future patient physician relationship in patients applying to an Urology Department. METHODS: A well prepared questionnaire has been given to 1000 referring cases, out of which 589 accepted to participate on a volunteer basis to a face to face interview. Patients were divided into subgroups with respect to age, gender and as well as their educational and economical status. Regarding Internet, questions inquired the use of Internet, the point of view about it, opinions about healthcare system and most commonly urological diseases searched in Internet. RESULTS: Of 589 patients participating, 38.2% reported access to the Internet; in relation to subgroup analysis of data, there was a statistically significant relationship between the use of Internet and age (p < 0.001), gender (p = 0.048), educational status (p < 0.001) and economical status of (p = 0.002) the cases evaluated. Disease specific information was most frequently sought: 18.2% searched for urolithiasis, 14.2% for non-cancer related kidney diseases, and 14.2% for urologic cancers. CONCLUSIONS: Younger patients with higher educational status tended to use Internet and the majority of these cases share all these information with their physicians during their visit. These findings indicate that all physicians should consider this fact seriously and make their future plans in the light of internet based activities which provides numerous advantages.

Comparison of Two Centers' Experience in Pediatric Supine and Prone Miniaturized Percutaneous Nephrolithotomy with Propensity Match Analysis.

Introduction: Percutaneous nephrolithotomy (PNL) is the treatment of choice in children with complex and large stones. With the experience gained from adult practice, supine PNL is increasingly performed in children as well. We aimed to evaluate the comparative results of prone and supine mini-PNL (m-PNL) performed for large/complex stones in children. Patients and Methods: The study included children who underwent supine and prone m-PNL at two centers between September 2019 and 2022. Patients were divided into two groups with a 1:1 ratio to index supine m-PNL and prone m-PNL cases for the size, number, location of the stones, degree of hydronephrosis, and age. Operative related parameters, success, and complication rates are being discussed on a procedure-based manner. Results: Forty-two patients (21 supine and 21 prone) were included. The mean age was 9.6 ± 4 years and mean stone size was 28.8 ± 13.6 mm. Regarding the operative data, the mean duration of procedure time was 65.7 ± 17.8 minutes in supine group, whereas 86.9 ± 19.0 minutes in prone group (p = 0.001). Fluoroscopy time was shorter in supine group (p = 0.027). Tubeless PNL was performed in 11 cases of prone group (52%), whereas this number was 18 (86.7%) in supine group (p = 0.019). Stone-free rates were similar in both groups (supine m-PNL: 90.5%, prone m-PNL: 85.7%, p = 0.634). Complications were minor in nature in most of the cases of both groups, which resolved with supportive measures in a short period of time. However, there was a statistically significant difference regarding the location and number accesses between two groups (p = 0.008). Simultaneous flexible ureterorenoscopy was performed in eight patients in the supine PNL group (<0.001). Conclusions: Our current findings and the highly limited data reported in the literature indicate that as an established minimal invasive treatment alternative m-PNL procedure in supine position can also be performed with similar success and complication rates in pediatric population.

Minipercutaneous Nephrolithotomy in the Management of Large and Complex Renal Calculi in Children: How Effective Is It?

Purpose: To evaluate the efficacy and safety of minipercutaneous nephrolithotomy (PCNL) in the management of large and complex calculi in children. Patients and Methods: From May 2017 to April 2021, a total of 41 pediatric cases were diagnosed with large/complex renal stones (partial-total staghorn) and following a detailed biochemical evaluation and thorough radiological examination (plain abdominal radiograph, urinary ultrasound, noncontrast and/or computed tomography), all cases underwent mini-PCNL procedure for the minimal invasive management of these calculi. Preoperative, intraoperative, and postoperative data were analyzed and reported in detail. Results: A total of 41 procedures were performed in 26 boys and 15 girls (male/female = 1.73). While the age of the kids ranged from 2.5 to 10 years (mean 6.74 ± 2.76), mean size of the stones was 16.28 ± 3.43 mm (range 11-24) with a mean stone density value of 816 HU (range 550-1350). Evaluation of the success rates in terms of complete stone clearance on postoperative day 1 revealed that while 73.2% (30/41), residual fragments have been noted in 11 cases (26.8%). Size of the residual fragments ranged from 2 to 7 mm (mean 4.3). Of those children, 10 cases required flexible ureteroscopy for stone removal, and in 1 case, placement of Double-J was adequate for spontaneous passage. During a 3-month follow-up, the stone-free rate (SFR) increased to 100% without any residual fragment left. Conclusions: Mini-PCNL with holmium laser lithotripsy is an effective and safe treatment alternative in the minimal invasive management of large/complex kidney stones in children with high SFRs.

Does the use of doxazosin influence the success of SWL in the treatment of upper ureteral stones? A multicenter, prospective and randomized study.

The objective of the study is to investigate the effect of doxazosin, administered to the subjects who underwent SWL due to upper ureteral stones, on therapeutic outcomes. The study enrolled the patients with a radio-opaque stone ≥5 mm in upper ureter. Patients were randomized into two groups: the first group underwent SWL following the diagnosis and they were recommended to receive oral hydration. The second group underwent SWL after initiating alpha blocker (doxazosin controlled-release tablet 4 mg/day) and drug therapy was continued until that the patient has been stone free. Parameters of SWL procedure, Steinstrasse, pain score at admission, time to stone passage, the complications developed, the additional procedures that were administered and number of hospital visits done due to pain during the treatment were recorded. A total of 79 patients were enrolled to the study. The subjects evaluated included 35 patients, who received an alpha blocker and 44 patients who did not receive an alpha blocker. For both groups, the level of energy applied per SWL session, the diameter of the stone, the number of hospital visits done due to pain, pain score and the need for analgesia were found to be similar (p > 0.05). The group of doxazosin was more advantageous in terms of stone-free rate, the need for additional procedures and Steinstrasse (p < 0.05). In conclusion, the addition of doxazosin to SWL therapy administered for upper ureteral stones reduces Steinstrasse, and thereby, the need for additional procedures and increases post-treatment stone-free rate. A positive effect of doxazosin on the time to stone passage was not shown.

Oxytocin immunoreactivity in the corpus cavernosum of patients with erectile dysfunction.

OBJECTIVES: Oxytocin is released by the posterior pituitary gland during male orgasm. Additionally, the presence of an oxytocin receptor gene and protein expression in human corpus cavernosum is demonstrated, and it has contractile activity on the smooth muscle of the animal and human corpus cavernosum in vitro. The aim of this study was to investigate the immunoreactivity of oxytocin in corpus cavernosum of patients with organic erectile dysfunction and to compare it with healthy controls. METHODS: Cavernous biopsies were obtained from 31 patients with erectile dysfunction and 11 patients without erectile dysfunction. Oxytocin immunohistochemistry was performed using the streptavidin-biotin immunoperoxidase staining on all cases. Intensity and proportion of stained cells were added for the immunoreactivity score. RESULTS: The mean ages of patients with erectile dysfunction and controls were 41.47 ± 2.08 and 36.50 ± 3.35 years, respectively (p > 0.05). Oxytocin expression was detected in smooth muscle as well as in endothelial cells in both groups. The mean oxytocin immunoreactivity score values of patients with erectile dysfunction and controls were also 2.16 ± 0.12 and 2.30 ± 0.21, respectively (p > 0.05). There was no significant difference in immunoreactivity scores both in arterial and cavernosal failure and also in smoker and nonsmoker groups (p > 0.05). Immunoreactivity scores were not statistically significantly different between patients with concomitant medical disorders and patients with no other medical disorder (p > 0.05). CONCLUSION: We detected oxytocin immunoreactivity in male corpus cavernosum, but staining was not different between patients with erectile dysfunction and controls. However, further studies are necessary to reach a final conclusion regarding the effects of oxytocin on corpus cavernosum.