Predictive role of ureteral wall thickness and patient characteristics in endoscopic treatment outcomes for ureteral stricture disease following stone surgery.

PURPOSE: To evaluate the role of certain radiological parameters and patient characteristics in predicting the success of endoscopic treatment in ureteral stricture disease. METHODS: Fifty one adult patients with ureteral stricture disease (< 1 cm) after developing due to upper ureteral stones with ureteroscopic laser disintegration were included and in addition to stone and patient parameters, radiological parameters including ureteral wall thickness (UWT) at the impacted stone site were also measured on computed tomography (CT) images. Patients were divided into two groups: Group 1: Patients with endoscopic treatment success and Group 2: Patients with endoscopic treatment failure. The possible relationship between the UWT values and other radiological parameter was comparatively evaluated. RESULTS: Mean UWT value assessed at the treated stone site was significantly higher in cases unresponsive to endoscopic treatment with values of 2.77 ± 1.03 mm and 4.25 ± 1.32 mm in Group 1 and 2 respectively. A cut off value 3.55 mm for UWT was found to be highly predictive for endoscopic treatment failure. CONCLUSIONS: Our current results indicated that assessment of UWT value at the obstructing stone could be helpful enough to predict the likelihood of failure following endoscopic management of strictures with high sensitivity and specificity. Evaluation of this particular parameter could let the endourologists to look for more rational treatment alternatives with necessary measures taken on time.

Outcome of buccal mucosa urethroplasty in the management of urethral strictures.

OBJECTIVE: The objective of the study is to report the outcome of buccal mucosal urethroplasty. MATERIALS AND METHODS: The follow up data of 15 patients undergoing single stage urethroplasty from September 2010 to September 2015 were retropectively reviewed. They received buccal mucosa graft for urethroplasty. The patients were followed for complications and outcome. RESULTS: Mean age was 53.7 ± 13.6 The stricture length ranged from 3 to 6 cm (mean 4.4 ± 0.8). The success rate for buccal mucosa urethroplasty (BMU) was 67.7% at 12th month. Three patients presenting with voiding difficulty in the 3rd month and one in the next 12 months, had urethral restenosis. One patient had fistula formation at 6th month postoperatively. Five patients underwent retreatment procedures such as internal urethrotomy, urethroplasty and/or internal urethrotomy. CONCLUSIONS: The buccal mucosa is easy to obtain and handle, therefore BMU can be safely and effectively managed outside high volume institutions.

Comparison of transurethral incision of the prostate and silodosin in patients having benign prostatic obstruction in terms of retrograde ejaculation.

BACKGROUND: To compare the functional outcomes and retrograde ejaculation (RE) after transurethral incision of the prostate (TUIP) or silodosin in bladder outlet obstruction (BOO) secondary to a small prostate. METHODS: Prospectively collected data from December 2011 through December 2014 of 192 LUTS patients having fertility concerns with prostate volume smaller than 40 ml receiving either TUIP or silodosin treatment were prospectively reviewed. The treatment outcomes were evaluated and compared. RESULTS: TUIP was performed in 96 cases and silodosin 8 mg was prescribed in 96 cases. At 12th months after TUIP or continuous silodosin treatment, the decrease in mean International Prostate Symptom Score (IPSS) and postvoiding residual urine (PVR) and the improvement of mean maximal flow rate (Qmax) were significant (p = 0.000). The improvement in IPPS and Qmax was significantly higher in TUIP group compared to silodosin group (p = 0.005, p = 0.000) with a lower rate of retrograde ejaculation (RE) in TUIP group. (11/96 vs 33/96) (p = 0.000) Conclusions: Both TUIP and silodosin ensures comparable improvement in PVR, IPSS and Qmax with a lower rate of RE on the TUIP group in prostates weighing less than 40 grams suggesting that TUIP is a better choice in younger patiens seeking preservation of ejaculation with fertility concerns.

The comparative evaluation of apoptosis produced by leuprolide or orchiectomy on rat prostate tissue.

INTRODUCTION: Organisms are constantly in a balance meaning that while new cells are produced, some of the older ones die which takes place in 2 ways: necrosis or apoptosis. Apoptosis is the programmed cellular death triggered by intrinsic or extrinsic stimuli. In this study we have evaluated the apoptosis of prostate tissue generated by surgical or medical orchiectomy. MATERIAL AND METHOD: In this experimental study, we used 36 adult male rats that were evaluated in 3 groups. The first group (Group 1) consisted of 12 rats that had bilateral orchiectomy; the second group (Group 2) included 12 rats that were given leuprolide acetate and the third group (Group 3) consisted of 12 control rats. Immunohistochemical staining of the prostate of all rats was performed and the presence of glandular atrophy and apoptosis were evaluated in the three groups. The statistical differences between the two groups were evaluated by the Fisher exact test. RESULTS: Glandular atrophy was not determined in any rat of the control group, and the apoptotic staining was in the normal limits in all the control rats. In Leuprolide group, glandular atrophy was mild in 7 cases, and moderate in 3 rats. In 2 rats of the Leuprolide group, atrophy was not demonstrated. In surgical orchiectomy group, glandular atrophy was present in all cases. Atrophy was observed as cystic atrophy. Statistical analysis with the Fisher exact test revealed that glandular atrophy was statistically significantly more common in surgical orchiectomy group compared with Leuprolide group (p = 0,012). CONCLUSION: If the aim of treatment in androgen dependent prostatic adenocarcinoma or benign prostate hypertrophy is the construction of a robust apoptosis, bilateral orchiectomy generates a more powerful apoptosis compared with Leuprolide.

Safety of greenlight photoselective vaporisation of prostate in lower urinary tract symptoms due to benign prostatic hyperplasia in patients using anticoagulants due to cardiovascular comorbidities.

UNLABELLED: Lasers have been used in the management of benign prostatic hyperplasia for the last two decades. To be comparable, they should reduce or avoid the immediate and long-term complications of transurethral resection of the prostate (TURP) or open prostatectomy (OP), especially bleeding and need for blood transfusion. Although Holmium laser treatment of the prostate was compared frequently in terms of cardiovascular safety with TURP or OP, photoselective vaporisation of the prostate (PVP) was not largely evaluated. In this article we analyzed the current literature to see if there is convincing data to support the observation of some authors that use of PVP is associated with increased safety in patients on anticoagulants with cardiovascular comorbidities. With this purpose a Medline search between January 2004 to March 2013 was performed using evidence obtained from randomised trials, well-designed controlled studies without randomisation, individual cohort studies, individual case control studies and case reports RESULTS: In the last 10 years, several case-control and cohort studies have demonstrated the efficacy of PVP as well as its safety in patients with cardiovascular comorbidities using anticoagulants. The results confirmed the overall lower perioperative and postoperative morbidity of PVP, whereas the efficacy was comparable to TURP in the short term, despite a higher reoperation rate. CONCLUSION: Although it is still developing, PVP with KTP or LBO seems to be a promising alternative to both TURP and OP in terms of cardiovascular safety and in patients using anticoagulants.

The effect of inclined position on stone free rates in patients with lower caliceal stones during SWL session.

OBJECTIVE: To compare the outcomes of shock wave lithotripsy (SWL) combined with inclined position and SWL alone in patients with lower pole calyx stones. METHODS: Seven hundred forty patients who underwent SWL treatment for lower pole renal stones with a total diameter of 2 cm or less were prospectively randomized into two groups. They were comparable in terms of age, sex, and stone diameters. Patients with lower calyceal stones (4-20 mm) were randomized to SWL (368 patients) or SWL with simultaneous inclination (372 patients) with 30o head down Trendelenburg position). Shock wave and session numbers were standardized according to stone size. Additional standardized shock waves were given to patients with stone fragments determined by kidney urinary bladder film and ultrasound at weeks 1, 4, 10. RESULTS: The overall stone free rate (SFR) was 73% (268/368) in patients with SWL alone and 81% (300/372) in SWL with inclination at the end of 12th week (p = 0.015). No significant adverse events were noted in both treatment groups. CONCLUSION: Simultaneous inclination of patients during SWL session increase SFR in lower caliceal stones significantly compared to SWL treatment alone.

The histology and the proapoptotic control in the ipsilateral and the contralateral testes following unilateral vasectomy.

OBJECTIVE: The aim of this study was to enlighten both the testicular histology and the genetic aspects of the apoptotic process. Thus an experimental study was designed with a model of unilateral vasectomy. METHODS: Twenty-two adult male rats were used and 4 main groups were formed. The first (A), the second (B), the third (C), and the fourth group (D) consisted of 4, 4, 4 and 10 rats respectively. Rats in group A had sham operation while rats in other groups (B, C, D) underwent left vasectomy operation including binding of ductus deferens with a 3/0 silk and cutting a minimum of 1 cm part while preserving the vascular structure under 9x magnification. Rats undergoing unilateral vasectomy were sacrificed at the 1(st), 2(nd) and 8(th) weeks and their testicular structure and proapoptotic gene proteins were compared with that of the control group undergoing sham operation. RESULTS: We found that vasectomy gradually caused destruction and both ipsilateral and contralateral testicles were affected showing initial apoptosis. CONCLUSION: The procedure causes destruction in the testicular structure by causing bilateral intratubular germ cell necrosis, unilateral obstruction, increase in the tubular pressure and processes that are aggravated by some probable autoimmune reactions.

Bilateral ureteral stones; factors affecting treatment decision.

AIM: To evaluate certain factors that may affect the decision-making process for the rational management approach in cases presenting with bilateral ureteral stones. METHODS: A total of 153 patients presenting with bilateral ureteral stones from 6 centers were evaluated and divided in three groups. Group 1 (n:21) Patients undergoing DJ stent insertion in one ureter and ureterorenoscopic (URS) lithotripsy for the contralateral ureteral stone. Group 2 (n:91), URS lithotripsy for both ureteral stones and Group 3 (n:41) patients undergoing bilateral DJ stent insertion. The outcomes of the procedures and the relevant patient as well as stone related factors have been comparatively evaluated in three groups. RESULTS: While associated UTI rates and serum creatinine levels were significantly higher in bilateral DJ group, previous URS history was found to be significantly higher in cases undergoing bilateral URS than those undergoing bilateral DJ stenting. URS was performed significantly more often in cases with lower ureteral stones and DJ stenting seems to be more rational approach in upper ureteral stones. In patients with lower ureteral stones, larger and harder stones, endourologists tended to perform URS as the first option. CONCLUSIONS: Decision making for a rational approach in cases with bilateral ureteral stones my be challenging. Our findings demonstated that serum creatinine levels, associated UTI, location and the hardness of the stone and previous ureteroscopy anamnesis could be important factors in making a decision between JJ stenting and ureteroscopic stone extraction in emergency conditions.

Protective effect of melatonin and 1,25-dihydroxyvitamin D3 on renal ischemia-reperfusion injury in rats.

Ischemia-reperfusion (I/R) injury induces the generation of reactive oxygen species (ROS) which affect many organs. This study was designed to investigate the roles of melatonin and 1,25-dihydroxyvitamin D3 (VD3) on renal I/R injury. Thirty male Wistar albino rats were divided into five groups: group 1, control; group 2, right nephrectomy (RN) +  I/R in the contralateral kidney; group 3, melatonin + RN + I/R; group 4, VD3 + RN + I/R; and group 5, melatonin + VD3 + RN + I/R. Melatonin (10 mg/kg), VD3 (0.5 µg/kg), and melatonin plus VD3 were injected intraperitoneally for 7 days before renal I/R. After 7 days, right nephrectomy was initially performed and left renal artery was clamped for 45 min. After 45-min reperfusion, the serum and kidney tissue samples were obtained for assays. Melatonin and VD3 had an ameliorative effect on biochemical parameters such as serum creatinine (SCr) and blood urea nitrogen (BUN). Renal tissue malondialdehyde (MDA), glutathione (GSH), nitric oxide (NO) levels, and superoxide dismutase (SOD) activity were determined. Renal I/R decreased the kidney tissue GSH levels and SOD activity and increased the NO levels as compared with control group. However, melatonin and VD3 and melatonin plus VD3 treatment significantly increased the tissue GSH levels and SOD activity and decreased the NO levels compared with those of I/R group. Meanwhile, MDA levels were not different between the control and I/R groups. But, MDA levels decreased in all treated groups compared to I/R and control groups. These data support that melatonin and VD3 have beneficial effects on renal injury.

The effect of tamsulosin on pain and clearance according to ureteral stone location after shock wave lithotripsy.

BACKGROUND: Medical expulsion therapy has shown encouraging results in facilitating spontaneous clearance of ureteral stones after extracorporeal shock wave lithotripsy. However, no other study has yet determined the benefit of medical expulsion therapy for stones in different ureteral locations. OBJECTIVE: The aim of the study was to evaluate tamsulosin as adjunctive therapy to extracorporeal shock wave lithotripsy (SWL) in terms of pain clearance of stones in the upper, middle, and lower ureter. METHODS: Between June 2008 and July 2011, patients with a solitary ureteral stone that was ≥6 mm up to 15 mm and located in the upper, middle, or lower ureter undergoing SWL were evaluated. The patients were randomly allocated to a conservative treatment (group 1) and a tamsulosin treatment group (group 2). Administration of the drug was started immediately after SWL and was continued for a maximum of 28 days. Patients were evaluated for stone clearance, time to stone clearance, and number of SWL sessions. The pain intensity was evaluated by visual analog scale. RESULTS: There were 64 patients in the control group and 59 in the tamsulosin group. The average stone sizes were 10.70 (3.20) mm and 11.40 (3.01) mm (P = 0.24). Group 1 and group 2 received 2507 (984) and 2759 (775) shock waves (P = 0.86), 1.53 (0.8) and 1.49 (0.75) sessions (P = 0.85), respectively. Mean visual analog scale scores and times to clearance were 3.81 (2.74) and 2.73 (2.28) (P = 0.00) and 12.59 (8.63) days and 8.34 (7.60) days (P = 0.00), respectively, for all stones in groups 1 and 2. Only the clearance time of upper ureteral stones between groups showed statistical significance (13.54 [8.32] days vs 7.10 [6.40] days; P = 0.00). CONCLUSIONS: Tamsulosin may help in the treatment of all ureteral stones after SWL, particularly stones in the upper ureter, with a shorter time to clearance and less need for analgesic drugs.

Efficacy and safety of 120 w greenlight photoselective vaporisation of prostate in patients receiving anticoagulant drugs.

OBJECTIVE: To evaluate the efficacy and safety of photoselective prostate vapourisation with 120 w potassium titanyl phosphate laser in benign prostate hyperplasia patients receiving oral anti-coagulant therapy. METHODS: The retrospective study was conducted at Istanbul Hisar International Hosptial and comprised 63 male patients who were on anti-coagulant therapy for comorbidities and who underwent prostate vapourisation for benign prostate hyperplasia with 120 Watts potassium titanyl phosphate from November 2007 to December 2010. International Prostate Symptoms Score, Quality of Life scores, uroflowmetry pre-operatively and 3 months postoperatively were obtained. Ultrasound examination was performed for each patient to evaluate prostate and residual urine in the bladder. Plasma haemoglobin, haematocrit and International Normalised Ratio levels were also checked for patients in the pre- and post-operative period. RESULTS: The age range of the patients was from 65-89 years with a mean of 72.3 +/- 8 years. The mean prostate weight was 45 +/-17 ml (range: 40-120). Mean operation time was 54 +/- 16 minutes (25-90). The removal of urinary catheter took place 1-3 days post-operatively. None of the patients required transfusion. The International Prostate Symptoms Score was reduced (23 +/- 6 vs. 14 +/- 3) at third month after the operation. Quality of Life scores were improved from 2.2 +/- 1.1 to 4.7 +/- 1.2, and maximal urine flow rate increased from 7.8 +/- 2.3 to 16 +/- 1 in the same period. Urinary obstruction due to clot retention was observed in 1 (1.58%) patient in post-operative 3 days. Urinary retention occurred in 5 (7.98%) patients after the removal of the urinary catheter. Permanent urinary retention, peroperative bleeding and post-operative incontinence were not observed. CONCLUSION: Treatment of benign prostate hyperplasia with photoselective prostate vapourisation is effective and safe in patients receiving anti-coaguant therapy. However, patients should be monitored in early post-operative period for macroscopic haematuria and transient urinary retention.

Analysis of transurethral resection of prostate videos on YouTube™: Educational quality assessment.

BACKGROUND: Our aim was to evaluate the educational value of transurethral resection of prostate (TURP) videos on YouTube. METHODS: A comprehensive search was conducted for TURP videos on YouTube. Based on the Laparoscopic Surgery Video Educational Guidelines we created a checklist which includes 20 items for evaluation of the videos. IBM SPSS statistics was used for analysis. RESULTS: A total of 104 surgical videos were assessed. The mean view count was 15647.3 (21-324.522, SD 47556.4). Video image quality found as low for 57.7% of videos. Both staff (76%) and resident (75%) rated most of the videos low educational quality. No statistically significant difference was found between staff's total points (mean 4.35 ± SD 2.9) and resident's total points (mean 4.63 ± SD 3.3) (p: 0.761). Positive correlation was found between view count and staff's total points (r: 0.242 p < 0.05), resident's total points (r: 0.340 p < 0.01). There was also positive correlation between number of likes and staff's total points (r: 0.375 p < 0.01) and resident's total points (r: 0.466 p < 0.01). CONCLUSIONS: Most TURP surgical videos on YouTube are low quality. Higher educational quality videos with detailed explanation of the procedure are needed on this subject. We believe this study could be a guide for future high quality TURP videos.

Metabolic Syndrome is Associated with Prostate Cancer Diagnosed on Biopsy but not the Gleason Score and the Number of Cancer-Positive Cores: A Prospective Controlled Study.

OBJECTIVE: We aimed to investigate the association between metabolic syndrome (MetS) and prostate cancer (PCa) in patients undergoing prostate biopsy. MATERIALS AND METHODS: Between January 2018 and December 2022, MetS was investigated according to Adult Treatment Panel III (ATP III) criteria in men who underwent prostate biopsy with transrectal ultrasound (TRUS). Clinicopathological factors such as, digital rectal examination (DRE), prostate-specific antigen (PSA), prostate volume, waist circumference, body mass index (BMI), age, blood pressure, testosterone, lipid profiles, fasting blood glucose level, C-reactive protein (CRP) and MetS were analyzed. RESULTS: A total of 908 men underwent biopsies, of which 492 (51.5%) had MetS according to ATP III criteria. The number of patients diagnosed with PCa in biopsy was 270 (29.7%). PCa cases were significantly older, with a lower prostate volume and a higher PSA value and higher blood pressure compared to patients without PCa (p < 0.001). 146 of 416 (35.0%) patients with MetS had PCa while 124 of 492 (25.2%) patients without MetS had PCa (p < 0.001). Out of 270 patients with PCa, 174 (64.4%) had Gleason score <7 and 96 (35.6%) had Gleason score ≥7. In patients with a Gleason score ≥7, PSA, DRE(+) and core positive number were significantly higher compared to patients with Gleason score <7, while glycemia and high-density lipoprotein (HDL) cholesterol levels were significantly lower (p < 0.001). Multivariate analysis showed that age, PSA, positive DRE, prostate volume (p < 0.001), diastolic blood pressure, CRP and MetS were the only independent parameters associated with a higher risk of cancer on biopsy (p < 0.05). CONCLUSIONS: Our findings show that MetS is associated with PCa diagnosed on biopsy but not with the Gleason score and the number of cancer-positive cores. However, these results should be confirmed by larger, multicenter and prospective studies.

Effect of constipation on acute urinary retention following transrectal prostate biopsy.

PURPOSE: To evaluate the possible effect of constipation on the acute urinary retention (AUR) after transrectal ultrasound-guided prostate biopsy (TRUS PB). MATERIALS AND METHODS: A total of 1,167 patients with prostate-specific antigen (PSA) >4 ng/mL and/or abnormal digital rectal examination underwent a standard 12 core transrectal ultrasound-guided prostate needle biopsy in our hospital and the findings were examined prospectively. Chronic constipation (CC) was defined according to the Rome IV criteria. All cases were well evaluated with respect to clinical-histopathological factors; International Prostate Symptom Score (IPSS), prostate volume, post-void residue, age, body mass index, histopathological inflammation, and AUR. RESULTS: The mean age of patients was 64.63±8.31 years, the PSA level was 11.60±16.83 ng/mL, and the prostate volume was 54.66±25.44 mL. In 265 cases (22.7%), CC anamnesis was present and AUR developed in 28 (2.4%) of the cases. In the multivariate analysis for the risk of developing urinary retention, prostate volume, pre-operative IPSS, and presence of CC requiring manual maneuvers to facilitate defecation were found to be risk factors (p=0.023, 0.010, and 0.001, respectively). CONCLUSIONS: Our findings demonstrated that CC may be a critical factor in the prediction of AUR formation following TRUS PB.

Comparison of conventional radiography combined with ultrasonography versus nonenhanced helical computed tomography in evaluation of patients with renal colic.

The aim of this study is to determine whether kidneys ureters bladder X-ray (KUB) film combined with ultrasound (US) can be effectively used in evaluation of renal colic and miss stones with clinically significant size identified on nonenhanced computed tomography (NECT) in patients with urolithiasis. This retrospective study evaluated the clinical and radiological records of 300 patients at our institution undergoing KUB and/or US and/or NECT for the evaluation of renal colic from June 2007 to December 2010. Of patients with negative findings on KUB and/or US, 22 had renal stones on NECT (mean size 4.4 mm, range 3-8), 3 had lower ureteral stone (mean size 3.3 mm, range 2-5). In patients with isolated suspicious renal ectasia without stone image, two had renal stone on NECT (mean size 4 mm, range 2-6), 5 had upper ureteral stone (mean size 4.4 mm, range 4-6), 7 had middle ureteral stone (mean size 3.7 mm, range 3-4) and 14 had lower ureteral stone (mean size 4 mm, range 2-6). The cost-effective and almost radiation-free combination of KUB and US should be preferred for diagnosis of urolithiasis, as it detects most of the ureteral and renal calculi which are clinically significant.

Melatonin with 1,25-dihydroxyvitamin D3 protects against apoptotic ischemia-reperfusion injury in the rat kidney.

This study was designed to evaluate the preventive role of melatonin (Mel) and 1,25-dihydroxyvitamin D3 (VD3) in biochemical and apoptotic events leading to tissue injury and renal dysfunction after ischemia-reperfusion (I/R). Thirty male Wistar rats were divided into five groups: sham-operated, I/R, Mel + I/R, VD3 + I/R, and Mel + VD3 + I/R. The rats were intraperitoneally administered with Mel (10 mg/kg), VD3 (0.5 µg/kg), or Mel (10 mg/kg) plus VD3 (0.5 µg/kg) each day at 1 week prior to ischemia. Right nephrectomy was initially performed and left renal I/R injury was induced by 45 min of bilateral renal ischemia followed by 45 min of reperfusion. After reperfusion, kidneys and blood were obtained for histopathologic and biochemical evaluation. Mel and VD3 had an ameliorative effect on biochemical parameters such as serum creatinine, blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase, and apoptosis (caspase-3 and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling staining) in the kidneys against renal I/R injury in rats. Additionally, VD3 combined with Mel significantly reduced apoptotic and histological alterations when compared with Mel or VD3 alone. This preventive effect on renal tubular apoptosis was remarkable when Mel was combined with VD3.

Ipsilateral testicular catch-up growth rate following microsurgical inguinal adolescent varicocelectomy.

OBJECTIVE: To evaluate the ipsilateral catch-up growth rates compared to contralateral testicular growth in adolescents with varicocele undergoing microsurgical inguinal varicocelectomy. MATERIALS AND METHODS: Between December 2005 and May 2007, 39 adolescent patients with grade 2-3 varicocele admitted to our clinic with complaints of pain and/or testicular asymmetry were operated. Preoperative mean age was 14.5 ± 1.96 (9-17). Testicular volumes were assessed with ultrasound every 3 months. The available followup was 39 months. RESULTS: In our series, mean testicular preoperative volumes were 9.07 ± 3.19 mL for the right and 5.90 ± 1.74 mL for the left. Mean testicular volumes at the end of follow up were 13.97 ± 3.42 mL for the right and 12.20 ± 4.05 mL for the left. The testicular catch-up growth approximately begins after the 9th month and significant catch-up occurred in the 12-24 months (P < 0.05). CONCLUSION: Since testicular volume is the primary method of assessing testicular function in adolescents, testicular size can predict future fertility status significantly 9 months after surgical varicocele correction.

A Rare Cause of Urinary Retention Refractory to Conventional Measures: Bladder Fungoma.

Funguria is a rare condition in healthy populations but in immunocompromised patients, it is occasionally seen and can cause opportunistic urinary tract infections. Candida albicans is the most commonly isolated pathogen in fungal urinary tract infections. The standard treatment for fungal urinary tract infection is anti-fungal therapy. Sometimes when severe funguria is present, a rare entity called a fungus ball can form in the urinary tract and surgical excision may be needed for eradication. In this report, we present a 76-year-old male patient who was admitted to our clinic for anuria for two days. The patient was catheterized transurethrally and saline irrigation was performed. Candida albicans was isolated from the urine. Ultrasound showed a 4 x 2cm fungus ball in the bladder. With the open surgical removal of the fungus ball and anti-fungal therapy with fluconazole, the patient was discharged without any complications. We emphasize that in patients with risk factors, abnormal imaging, and funguria resistant to anti-fungal therapy, fungus ball may be present and surgical removal is the standard approach.

Long-term Effect of Colchicine Treatment in Preventing Urethral Stricture Recurrence After Internal Urethrotomy.

PURPOSE: Urethral stricture, known as a scar formation leading to urethral lumen stricture in sub-epithelial tissue, is the most common late complication of transurethral prostate resection (TURP). The aim of study is to evaluate efficacy of colchicine treatment in preventing urethral stricture recurrence in patients after internal urethrotomy, and to determine whether colchicine treatment had a sustained effect in decreasing stricture recurrences in patients with concomitant diseases. METHODS: Patient data with weak urine stream and/or voiding difficulty, and who had internal urethrotomy in Urology Department of Maltepe University Hospital between dates 01 January 2011 and December 2016 were collected. They were randomized to colchicine receiving, and non-receiving arms. Colchicine was given 1 g/day orally for two months, and primary efficacy point was defined as urethral stricture development in 3, 6, and 12 months after internal urethrotomy. RESULTS: The study was conducted on 84 males with the mean age of 67.7 ± 7.5 years. The mean ages of colchicine receivers and non-receivers were 68.2 ± 7.6 and 67.1 ± 7.6 years, respectively. Recurrence rate of urethral stricture was significantly lower in colchicine receivers (P = .044) than non-receivers. In overall evaluation, recurrence rate of urethral stricture was significantly low, if there was only one comorbidity (P = .006), but rates were significantly higher in presence of three (P = .010) and four (P = .040) comorbidities. No significant difference in recurrencerates was determined in patients without comorbidities or with two comorbidities (P > .05). CONCLUSION: Combination of oral colchicine with internal urethrotomy reduces recurrence rates of urethral stricturesignificantly.

Does Mild Hydronephrosis Induced by Full-Bladder Improve Outcomes in Patients Undergoing Shock Wave Lithotripsy for Lower Calyceal Stones?: A Prospective Randomized Study.

PURPOSE: To compare the outcomes, sessions and shock wave numbers in patients undergoing standard procedure shock wave lithotripsy (SWL) and patients undergoing SWL with mild hydronephrosis induced by full-bladderfollowing oral hydration before SWL procedure for lower calyceal stones. MATERIALS AND METHODS: Between January 2014- January 2016 a total of 371 patients who underwent SWL, for lower pole calyceal stones ? 2 cm, were included into the study. 127 patients were treated in the supine position (Group A), 123 in the prone position (Group B) and 121 in the prone position with full bladder and mild hydronephrosis checked by ultrasound before procedure (Group C). There were 286 men and 85 women with a mean ± SD age of 36 ± 11 yearsResults: The mean (SD) stone sizes within the group A, group B and group C were 11 mm (±3 mm), 12 mm (±4.1 mm) and 11 mm (± 3.8 mm) respectively. No significant difference was found in age (P = .18) and stone size between 3 groups (P = .07). The median interquartile range (IQR) number of shocks within the group A, group B and group C were 7600 (3855), 6500 (4300) and 6700 (4915) respectively. Significant difference was found in number of shock waves among 3 groups (P < .01). The difference between groups according to stone expulsion rate wasfound significant in all sessions (P = .01). CONCLUSION: The present study suggests that mild hydronephrotic status induced by full-bladder before SWL can lower cost and patient discomfort by decrease in number of sessions and increase in stone clearance.