A novel surgical technique for extraperitoneal radical prostatectomy with using 3 trocars: Results after 154 cases. / Una novedosa técnica para la prostatectomía radical extraperitoneal con 3 trocares: resultados después de 154 casos.

OBJECTIVES: Recently laparoscopic radical prostatectomy (LRP) is a minimally invasive surgical option for prostate cancer (PCa) treatment in the lack of robot. To eliminate numbers of trocars and to modify surgical technique can make the LRP procedure easier. We aimed to introduce our novel approach on LRP by using just only 3 trocars and to compare conventional extraperitoneal LRP (eLRP) with 3 trocars eLRP. METHODS: Of the 223 PCa patients undergone eLRP were divided into 2 groups as Group 1 (n=69) consisted of conventional eLRP, Group 2 (n=154) consisted of consecutive 3 trocars eLRP. Demographic, operative, postoperative, and short-term follow-up data including functional results were analysed. RESULTS: Mean follow-up was 10.9±5.1 months. Preoperative and demographic parameters were comparable between the groups. Mean operative time, intraoperative used carbon dioxide (CO2) gas, and hospital stay were significantly shorter in Group 2 (for all parameters p<0.001). Haemoglobin decrease was also less in Group 2 without statistical significance. Oncologic and functional results were similar. There was no major complication in Group 2. CONCLUSIONS: According to our results 3 trocars eLRP can be performed safely and effectively in experienced hands. Haemorrhage, operative time, CO2 usage, and hospital stay could be shortened with our novel approach.

OBJETIVOS:  Recientemente, la prostatectomía radical laparoscópica (PRL) es una opción mínimamente invasiva para el tratamiento del cáncer de próstata (CaP) cuando no existe la robótica. Eliminar el numero de trocares y modificar la técnica quirúrgica, puede hacer la PRL un procedimiento fácil. Nuestro objetivo es introducir nuestra nueva técnica para la PRL utilizando solo 3 trocares y compararla con la PRL tradicional. MÉTODOS: De los 223 pacientes con cáncer de próstata que recibieron una PRL extraperitoneal se dividieron en 2 grupos: Grupo 1 (n=69) consistió en la PRL convencional; Grupo 2 (n=154) PRL con 3 trocares. Datos demográficos, quirúrgicos, postoperatorios, seguimiento y resultados funcionales fueron analizados. RESULTADOS: La mediana de seguimiento fue de 10,9±5,1meses. Las variables preoperatorias y demográficas fueron comparables entre ambos grupos. El tiempo medio de cirugía, el uso intraoperatorio de CO2 y la estancia hospitalaria fueron menores en el Grupo 2 (para todos los parámetros pde hemoglobina fue menor también en el grupo 2 sin significación estadística. Los resultados funcionales y oncológicos fueron similares. No hubo complicaciones mayores en el Grupo 2. CONCLUSIONES: De acuerdo con nuestros resultados la PRL extraperitoneal con 3 trocares se puede realizar de forma segura y efectiva en manos expertas. El sangrado intraoperatorio, tiempo quirúrgico y el uso de CO2 se pueden acortar con el uso de esta técnica.

Comparison of synchronous bilateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy: results of a multicenter study.

BACKGROUND: Different techniques for laparoscopic adrenalectomy have been proposed with the lateral transperitoneal approach and posterior retroperitoneal approach being the two more frequently minimally invasive surgeries in most of the clinics. There are no sufficient studies in which the results of lateral transperitoneal and posterior retroperitoneal approaches in synchronous bilateral laparoscopic adrenalectomy have been compared. In the current study, we aimed to report our multicenter results of the lateral transperitoneal and posterior retroperitoneal synchronous bilateral laparoscopic adrenalectomy experience in patients who had different bilateral adrenal pathologies and to compare the outcomes of these two different operative procedures. METHODS: Between 2012 and 2018, a total of 52 patients with a mean age of 43.5 years underwent simultaneous bilateral laparoscopic adrenalectomy at 6 different centers. Twenty-seven and 25 patients underwent bilateral lateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy, respectively. Patients' age, gender, body max index, operative indications, mass size, operation time, blood loss, length of hospitalization, intraoperative and postoperative complications and pathology reports were analyzed. RESULTS: Synchronous bilateral transperitoneal group was younger than synchronous posterior retroperitoneal group (37 years vs. 50.4 years.) (p: 0.001). Posterior retroperitoneal group had significantly decreased operating time and less blood loss than transperitoneal group. No significant difference was found with regard to postoperative hospital stay, perioperative and postoperative complications between two groups. Majority of the histopathological results were adrenal hyperplasia associated with Cushing's disease (61.5%). Less frequent pathological results were adrenal adenoma and pheochromocytoma (15.4% and 13.5%, respectively). During the follow-up period, no recurrence or disease-related mortality was observed in the patients. CONCLUSION: Our results shows that shorter operative time and less bleeding can be achieved with posterior retroperitoneal approach in synchronous bilateral laparoscopic adrenalectomy. In our series, intraoperative and postoperative complication rates were similar between both surgical approaches.

Response to duloxetine and gabapentin combination of a patient who has chronical orchialgia with bilateral tubular ectasia of rete testis and multiple epididymal cysts.

Tubular ectasia of rete testis (TERT) is a rarely seen benign condition of testis which can cause chronic orchalgia. TERT appears as an anechoic lesion in ultrasonography. However magnetic resonance imaging is a more sophisticated diagnostic tool. TERT is commonly associated with epididymal cysts. Generally a conservative treatment approach is preferred. In some cases surgery is required. In our case, 54-year-old male patient had bilateral TERT associated with bilateral multiple epididymal cysts. He had chronic testicular pain which did not respond to first- line conservative treatments. After use of duloxetine (60 mg PO) plus gabapentine (400 mg PO) combination as a second-line conservative treatment, the patient dramatically responded to this treatment. The patients who have chronic testicular pain caused by bilateral TERT and multiple epididymal cysts may be treated with combination of duloxetine (60 mg PO) plus gabapentine (400 mg PO) combination.

Oxidative stress parameters in patients with prostate cancer, benign prostatic hyperplasia and asymptomatic inflammatory prostatitis: A prospective controlled study.

BACKGROUND: The imbalance between oxidant and reductant mechanisms creates a nidus for the etiopathogenesis of several diseases. In this study, we aimed to compare the oxidative stress (OS) parameters in patients who were diagnosed with prostate cancer (pCa), benign prostatic hyperplasia (BPH) or asymptomatic inflammatory prostatitis (AIP), according to the histopathologic examination of transrectal ultrasonographic prostate biopsy and transurethral prostate resection specimens. OBJECTIVES: In this study, we aimed to compare oxidative stress between histologically proven prostate cancer, hyperplasia and prostatitis. MATERIAL AND METHODS: According to histopathologic examinations, 97 patients were divided into 3 study groups: group 1: pCa (n = 30), group 2: BPH (n = 41), and group 3: AIP (n = 26). Finally, 30 patients were enrolled in a control group. MDA levels, CuZn-SOD, Se-GPx, CAT activities, and trace element levels were evaluated. RESULTS: A statistically significant difference between prostate cancer and other groups were documented in terms of MDA activity. Contrary to AIP, a statistically significant difference has also been encountered between BPH and the control group. Decreased CuZn-SOD enzyme levels were found in PCa and BPH patients without statistical significance. Increased CAT activity was also documented in PCa, BPH and AIP patients. No significant difference in GPX activity was documented between the groups, except BPH and control group. Trace element levels were low in the patients with prostate cancer and BPH when compared with the control group. CONCLUSIONS: Despite the data regarding OS in PCa patients, there is a paucity of data regarding BPH and especially AIP patients. Our study revealed obvious oxidative stress in BPH and PCa patients as opposed to AIP. Assessing the oxidative stress in these patients may assist in the future prevention, diagnosis and also treatment. However, the question whether the presence of OS-related parameters and drugs could be used for the diagnosis or management of prostatic diseases, needs to be addressed in future larger and better studies with a more rational basis.

Laparoscopic stepwise-cut double initial stay suture pyeloplasty: our novel surgical technique.

OBJECTIVE: To describe a novel surgical technique, laparoscopic stepwise-cut double initial stay suture (LASDISS) pyeloplasty for ureteropelvic junction obstruction (UPJO). Additionally, we evaluated the safety and short-term results. MATERIALS AND METHODS: This was a nonrandomized study with a series of 6 patients with UPJO, operated on between March 2012 and August 2013. Perioperative and short-term outcomes were evaluated. In brief, a "T shape cut" was performed from the dilated pelvis to the ureter. The initial stay suture was placed between the lower edge of the pelvis and the distal end of the spatulated anterolateral part of the ureter. The pelvis was closed with a continuous suture starting from the opened upper edge of the pelvis that was secured after leaving enough space for ureteral anastomosis. The second initial stay suture was placed after passing the ureter and pelvis two times. The dilated part of the renal pelvis and the stenotic segment were excised. A double-J stent was inserted. The remaining space between the two initial sutures was closed with these continuous sutures. RESULTS: We performed the LASDISS pyeloplasty technique in all cases. Median operation time was 177 minutes (range, 100-290 minutes). Mean follow-up was 7.5 months (range, 3-18 months). The mean pre- and postoperative split renal function on diuretic renography was 33% (range, 25%-56%) and 42% (range, 30%-52%), respectively. CONCLUSIONS: The LASDISS pyeloplasty surgical technique represents a safe and effective option in surgical treatment of UPJO.

Planning and designing of an ideal animal laboratory set up for surgical training.

PURPOSE OF REVIEW: A well planned, well designed, well constructed, properly maintained and managed surgery room is an important element of an animal laboratory. RECENT FINDINGS: The design and size of an ideal animal laboratory surgery room setup depends on the scope of institutional mission of research activities, the animals to be housed and the physical relationship to the rest of the institution. Building materials for animal facilities should be selected to facilitate efficient and hygienic operation. Durable, moisture and vermin-proof, fire-resistant, seamless materials are most desirable for interior surfaces. The key components for planning and designing of an ideal animal laboratory setup mainly include surgeon preparation and scrubbing, animal preparation and premedication, surgical operation room, postoperative recovery, surgical supply storage and the surgical support area. SUMMARY: This article describes the principles of planning and designing of an ideal animal laboratory setup for surgical training. Because all survival surgery performed on animals must be done under aseptic conditions, the principal components of a well designed animal surgery room are not too different than that designed for humans.

Age-related prevalence of diabetes mellitus, cardiovascular disease and anticoagulation therapy use in a urolithiasis population and their effect on outcomes: the Clinical Research Office of the Endourological Society Ureteroscopy Global Study.

PURPOSE: This study examined the prevalence of risk factors for urological stone surgery and their possible influence on outcome and complications following ureteroscopy (URS). METHODS: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study collected prospective data on consecutive patients with urinary stones treated with URS at centers around the world for 1 year. The prevalence of common comorbidities and anticoagulation therapy and their relationship with complications and age were examined. RESULTS: Of 11,719 patients, 2,989 patients (25.8%) had cardiovascular disease, including 22.6% with hypertension, and 1,266 patients (10.9%) had diabetes mellitus. Approximately six percent of patients were receiving oral anticoagulation therapy, including aspirin (3.7%) and clopidogrel (0.8%). The prevalence of hypertension and diabetes mellitus and the proportion of patients receiving anticoagulant medication and/or antidiabetes treatment increased with age. Elderly were more likely to develop a postoperative complication when they had diabetes, a cardiovascular disease or received anticoagulation therapy. Post-operative bleeding was higher in patients receiving anticoagulants than those not receiving them (1.1 vs. 0.4%; p < 0.01). Patients with risk factors for stone formation had more complications than those without (4.9 vs. 3.0%, p < 0.001). CONCLUSIONS: This is the first study confirming in a global population that URS can effectively and safely be performed in a population with high comorbidity. The risk of a complication was highest among elderly patients presenting with comorbidities.

In vivo porcine model for practicing retrograde intrarenal surgery.

OBJECTIVES: To examine the feasibility of retrograde intrarenal surgery (RIRS) in a porcine model. MATERIALS AND METHODS: Female pigs (n = 3) were placed in a dorsal lithotomy position under general anesthesia, and stone material was inserted into the renal pelvis of the pigs. The bladder was entered with a cystoscope, and a 0.038-inch hydrophilic guidewire was passed into the renal pelvis. Following successful placement of the guidewire, a ureteral access sheath (9.5/11.5 Fr) was placed to allow for optimal visualization. A 7.5-Fr flexible ureteroscope (Karl Storz Flex-X2) and a 200-µm laser fiber were used for lithotripsy. When basketing was deemed necessary, zero-tipped nitinol stone baskets were used. Trainees then practiced all these manipulations on the model. RESULTS: Urologists with moderate experience in advanced endourologic surgery were trained using this model. However, there were some surgical difficulties due to the urinary system anatomy of the pig. Intravaginal location of the urethra, bladder neck location of the ureters, tight ureteric orifices, tortuous ureters, longitudinally elongated renal pelvis, narrow infundibulopelvic angle and shallow calices made the passage of the instruments and maneuverability of the flexible ureteroscope more difficult than in a human model. CONCLUSIONS: Despite some difficulties, our porcine model was very effective, because all the trainees successfully practiced the RIRS manipulations on this model.

Evaluation of applied laparoscopic urology course using validated checklist.

BACKGROUND AND OBJECTIVES: The objectives of this study were to investigate the effectiveness of the applied laparoscopic urology course using a validated checklist and to determine any differences in laparoscopic skills achieved by the participants at the end of the course period based on whether they began their training in a dry or wet laboratory. METHODS: To facilitate the mastering of challenging laparoscopic skills by urologists, a unique 3-day mini-training program was established at the Gulhane Military Academy of Medicine, Surgical Research Center, Ankara, Turkey. Only 30 trainees were accepted in each course, and they were divided into 3 subgroups. The primary outcome of the study was the changes in the performance and task accomplishment duration of the trainees at the beginning compared with the end of the course. The secondary outcome was any differences in the basic skills of the trainees based on whether they started their training in the dry or wet laboratory. RESULTS: The overall laparoscopic skills, which were evaluated by use of a standardized laparoscopic suturing task score, significantly improved (18.8 to 26.0, P < .001), and the time needed for task accomplishment decreased throughout the course (9.5 minutes to 5.25 minutes, P = .002). With respect to the course design, laparoscopic skills scores and the times needed for task accomplishment showed no statistically significant changes at the end of the course despite the fact that the trainees had started their training at different stages. CONCLUSION: The applied short-term laparoscopy course was shown to be an effective format particularly for achieving laparoscopic skills in which suturing and knotting are essential. This is mainly achieved through close cooperation in dry and wet laboratories.

Association between gene polymorphism of manganese superoxide dismutase and prostate cancer risk.

Manganese superoxide dismutase (MnSOD) is the most effective antioxidant enzyme in mitochondria and protects cells from reactive oxygen species-induced oxidative damage. The aim of this study was to investigate the association between MnSOD Ala-9 Val gene polymorphism and prostate cancer (PCa) risk in Turkish men with prostate cancer. 33 patients with PCa and 81 control individuals were included in the study. We observed an association between MnSOD Ala/Ala frequency and a higher PCa risk. In addition, we found that the increased risk of early-onset PCa (under age of 65) in the men homozygous for Ala allele was higher than the men homozygous for Val allele. However, we determined that MnSOD Ala-9 Val genotype was not associated with the aggressiveness of the disease. The results of our study suggest that MnSOD Ala/Ala genotype may influence on early-onset of PCa patients, but no effect on subsequent development of the disease in Turkish men. However, our study has a limitation that is small numbers of individuals for cases and controls. Therefore, the presented study limited our statistical power to fully investigate the gene polymorphism on cancer risk.

The acute effects of increased intra-abdominal pressure on testicular tissue: an experimental study in pigs.

OBJECTIVES: To evaluate the acute effects of increased intra-abdominal pressure (IAP) on testicular germ cell apoptosis and the expressions of endothelial nitric oxide synthase (eNOS), inducible nitric-oxide synthase (iNOS), and Johnson's scores in testicular tissue. MATERIALS AND METHODS: Twelve male pigs weighing 52 to 55 kg were divided into 2 groups as group 1 (n = 6; gasless [control]) and group 2 (n = 6; 20 mm Hg IAP with CO(2) pneumoperitoneum for 4 hours). In the second group, left laparoscopic nephrectomy was performed during the CO(2) insufflation period. The right testes of pigs were removed. Testicular germ cell apoptosis, expressions of eNOS and iNOS, and Johnson's scores were evaluated for each group. RESULTS: The control group (group 1) exhibited low apoptotic cell level and low iNOS and eNOS level in testes. IAP (group 2) resulted in marked increases in germ cell apoptosis, eNOS, and iNOS compared with the control group (group 1) (P <.05). However, no significant difference was noted in Johnson's scores between the 2 groups (P >.05). Moreover, Leydig cell hyperplasia, congestion, and necrosis, which were not documented in the control group, were seen in the study group. CONCLUSIONS: The purpose of the present study was to evaluate whether IAP could affect germ cell apoptosis and NOS concentrations in the testes after laparoscopic procedures in an animal model. In such an animal model simulating laparoscopic procedures, we demonstrated that high-pressure and long-lasting CO(2) insufflation cause testicular changes in the acute period.

Extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy in a patient with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) patients represent a challenge to all physicians, as they do for anesthetists and urologists, when they develop symptomatic stones in the urinary tract. We recently treated an OI patient with renal pelvic stone by extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy (PCNL). To our knowledge, this combined treatment modality has not been reported previously in OI. An 18-year-old paraplegic girl with OI presented to our urology department because of right-sided flank pain. She pointed out that she had right kidney stone for the previous 2 years, and because of risks of general anesthesia and surgical procedures, surveillance was recommended. Intravenous pyelography was performed and an 11.9-mm stone at the pelvis of the right kidney and grade 1-2 hydronephrosis at the same side with normal kidney functions and severe left-sided scoliosis were detected. After explanation of risks of the treatment modality and general anesthesia to the patient, extraperitoneal laparoscopy-assisted PCNL was performed. No complications occurred due to general anesthesia or surgical procedure. The operation time was 95 min and no blood transfusion was required. The nephrostomy tube and retroperitoneal drain were removed 2 and 3 days after the procedure, respectively. The patient was doing well at a follow-up of 6 months. Extraperitoneal laparoscopy-assisted PCNL approach may decrease the risk of surgery as an alternative treatment modality for OI patients. Such cases should be operated on at centers with significant experience in the field of endourology, where all the equipment and specialized personnel are readily available.

The cold knife: a new laparoscopic instrument for ureteropelvic junction incision.

OBJECTIVE: The use of laparoscopic scissors or blades in laparoscopic nondismembered pyeloplasty is quite common; however, the incision made using these tools may cause difficulties for the surgeon. We developed an efficient, safe, reusable, and inexpensive instrument to incise the pelvis and ureter during laparoscopic pyeloplasty. The aim of the present study was to evaluate the new laparoscopic instrument designed for pelvic and ureteric incisions. MATERIALS AND METHODS: The cold knife consists of an internal urethrotome that is transformed into an endoscopic instrument that can be inserted easily through a 5-mm-diameter trocar. It has a manual retraction system that enables a stand-by position for added protection when no incisions are being made. The new tool was trialed in laparoscopic Y-V pyeloplasty. Data regarding perioperative parameters and outcomes were collected and analyzed. RESULTS: Eight patients participated in the present study. All patients underwent Y-V pyeloplasty using a three-port retroperitoneal access. Mean operative time was 166.2 minutes (range: 100-300). There were no complications during the procedures. CONCLUSIONS: Laparoscopic cold knife for laparoscopic pyeloplasty is a simple, safe, reusable, and inexpensive instrument with a low maintenance cost.

Finger assisted laparoscopic renal cyst excision: a simple technique.

PURPOSE: Simple renal cysts are asymptomatic incidental findings; however, for a small subset of benign renal cysts, patients may present with pain, hematuria, recurrent infection, pyelocaliceal obstruction, or hypertension. Laparoscopic cyst ablation is an effective minimally invasive modality for the treatment of symptomatic benign renal cysts. We describe a simple laparoscopic cyst excision technique. MATERIALS AND METHODS: Between June 2003 and May 2008, 28 patients underwent laparoscopic renal cyst excision via retroperitoneal approach. In our technique, retroperitoneum and Gerota's fascia were dissected with finger blindly before insertion of the trocars to the retroperitoneal space. Following finger dissection, 3 trocars were placed and the cyst walls were excised at the level of renal cyst and base of the cysts were cauterized with electrocautery scissors. RESULTS: Mean patients' age was 59.3 years (range, 31 to 72 years). Mean operation duration time was 46 minutes (range, 27 to 102 minutes). Symptomatic and radiological success were achieved in 26 (92.8%) and 27 (96.4%) patients, respectively, with a median follow-up of 28 months (range, 6 to 56 months). No serious complications were encountered. CONCLUSION: Laparoscopy is a versatile minimally invasive modality ideal for treating benign symptomatic renal cysts. According to our experience, we think that the finger assisted laparoscopic cyst excision is an easy and noninvasive procedure.

Experiences in laparoscopic removal of upper ureteral stones: multicenter analysis of cases, based on the TurkUroLap Group.

BACKGROUND AND PURPOSE: Laparoscopic surgery for ureteral stones was restricted to special cases-those with large or impacted ureteral stones. We present special cases of patients who underwent laparoscopic ureterolithotomy at various clinics in Turkey. PATIENTS AND METHODS: Forty-one patients were included in the study from five urology clinics in which laparoscopic surgery was being performed. After a disease-specific history and physical examination, age and sex were recorded. The mean patient age was 41.8 years (30 men and 11 women). Urinalysis, determination of creatinine level, intravenous urography, and ultrasonography were performed. The parameters of stone size, presence of hydronephrosis, previous shockwave lithotripsy, previous ureteroscopic stone therapy, type of laparoscopic approach, operative time, ureteral incision, insertion of a Double-J stent, amount of drainage, hospitalization period, and perioperative complications were evaluated. RESULTS: Mean ureteral stone size was 22 mm. The retroperitoneoscopic approach was preferred in 35 (85.3%) patients, while the transperitoneal approach was used in 6 (14.7%) patients. Grade I hydronephrosis was detected in 4 patients, grade 2 in 22 patients, and grade 3 in 12 patients. In six patients, a history of shockwave lithotripsy was confirmed. The ureteral wall was incised with a cold knife in 5, scissors in 16, J-hook in 3, and a monopolar or bipolar dissector in 17 patients. In six patients, a Double-J stent was inserted, while in one patient, the operation was converted to an open procedure. The mean operative time was 124 minutes. The mean amount of drainage was 220 ml. Mean hospitalization time was 4.8 days. In five (12.5%) of seven patients, persistent drainage was a major complication that was managed by insertion of a Double-J stent. All patients were discharged stone free. CONCLUSION: Increased hospitalization and operative time can be related to the large stone sizes and prolonged urine leakage. In our opinion, however, the overall success of laparoscopic ureterolithotomy makes it a feasible and effective procedure, especially for stones that could not be managed easily with ureteroscopic stone therapy.

Two-glove-finger-balloon dissection of retroperitoneal space for laparoscopic urology.

BACKGROUND: We present our experience in retroperitoneal interventions with 2 catheter mounted glove fingers through 2 access points. METHODS: Patients were placed in the lateral decubitus position, and the retroperitoneum was accessed by blunt dissection through a 10-mm transverse skin incision on the posterior axillary line. Another incision was performed through the anterior axillary line, and the surgeon inserted his finger to dissect the muscle layers in the retroperitoneum to develop an initial space to place the glove finger balloon, which was attached to a 14-F Nelaton catheter. RESULTS: This technique was performed on 32 patients. The mean operation time was 57.4 +/- 26.7 minutes. A satisfactory retroperitoneal space for the operation was provided and both balloons inflated to 500 mL. No complications were observed. CONCLUSION: Retroperitoneal laparoscopy using 2 balloons is a safe, cheap, effective minimally invasive procedure, and we believe that the technique described above both decreases both the operation time and cost.

Laparoscopy-assisted tubeless percutaneous nephrolithotomy in previously operated ectopic pelvic kidney with fragmented J-J stent.

Nephrolithiasis management within an ectopic kidney presents a challenge to the urologists. Several treatment modalities are possible in this group of patients. Although percutaneous nephrolithotomy (PNL) is an accepted treatment modality in anatomically normal kidneys, ectopic pelvic kidneys require a different and more complicated approach for PNL. We recently treated a 24-year-old patient with calculus and an encrusted J-J stent fragment in pelvic ectopic kidney with a previous history of open pyelolithotomy. Laparoscopy-assisted tubeless percutaneous nephrolithotomy was performed. The technique and the patient characteristics are reported.

Increased oxidative/nitrosative stress and decreased antioxidant enzyme activities in prostate cancer.

OBJECTIVES: The study was aimed to evaluate the oxidative/nitrosative stress status in prostate cancer (CaP) and benign prostatic hyperplasia (BPH). DESIGN AND METHODS: 312 men from two different populations were included: 163 men from Macedonia (73 CaP patients, 67 BPH patients and 23 control subjects) and 149 men from Turkey (34 prostate cancer patients, 100 BPH patients and 15 control subjects). We measured erythrocyte malondialdehyde (MDA) levels, erythrocyte activities of superoxide dismutase (CuZn-SOD), glutathione peroxidase (GPX) and catalase (CAT); plasma nitrite/nitrate (NO(2)(-)/NO(3)(-)), cGMP and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels. RESULTS: A similar pattern of alteration in the oxidative/nitrosative stress-related parameters was found in both, Macedonian and Turkish studied samples: higher MDA concentrations with lower GPX and CuZn-SOD activities in CaP patients versus controls and BPH groups. The CAT activity was decreased in the CaP patients versus controls in the Turkish studied sample. Furthermore, CaP patients had increased plasma NO(2)(-)/NO(3)(-) and cGMP levels versus controls and BPH groups in both studied samples. CONCLUSIONS: This study has confirmed an imbalance in the oxidative stress/antioxidant status and revealed an altered nitrosative status in prostate cancer patients.

Percutaneous management of ureteral injuries that are diagnosed late after cesarean section.

OBJECTIVE: We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). MATERIALS AND METHODS: Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 +/- 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetition of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. RESULTS: Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). CONCLUSION: Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable.