How to Deal With Hemophilia C in Endoscopic Urologic Surgery: Lessons Learned From a Transurethral Resection of Bladder Tumor Case.

Factor XI deficiency (hemophilia C or Rosenthal syndrome) is an inherited rare disorder that leads to abnormal bleeding due to the paucity of the protein named factor XI, which plays a role in the blood clotting cascade. A 42-year-old male was referred to the urology outpatient clinic with macroscopic hematuria. The patient was scheduled for a repeat transurethral resection of a bladder tumor (TURBT). Preoperative coagulation parameters were as follows: the international normalized ratio (INR) was 0.95 (0.85-1.2), the prothrombin time was 10.9 seconds (10-15), and the partial thromboplastin time was 43.7 seconds (21-36). On the second postoperative day, he developed pelvic pain and discomfort. An abdominal CT revealed a 10 cm mass consistent with clot retention. The patient received two units of erythrocyte suspension and six units of fresh frozen plasma to prevent the depletion of hemoglobin and control urinary bleeding. The patient was discharged with a good recovery from the hospital three days after the second surgery. Hematologic disorders are rare but might have fatal consequences following surgery if unnoticed at the earliest stage. Clinicians must consider that patients with a history of unusual bleeding or borderline coagulation parameters might have an underlying hematological disorder and perform a further evaluation.

Could retrograde intrarenal surgery be a safe and effective alternative to mini-percutaneous nephrolithotomy in the management of relatively large (20-30 mm) stones? A critical evaluation.

PURPOSE: To compare the outcomes of mini-percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones sizing 2-3 cm. METHODS: A total of 566 patients from 6 institutions who underwent mPCNL (n = 440) and RIRS (n = 126) procedures were enrolled in our study. The retrospective patient cohort was reviewed and compared. Binary logistic regression analysis was performed to determine factors predicting success in the RIRS group. RESULTS: The stone-free rates were 91.1 and 77% for the mPCNL and RIRS groups, respectively (p < 0.001). The auxiliary procedure rates were 4.5 and 39.7% in the mPCNL and RIRS groups, respectively (p < 0.001). Mean values of hemoglobin decrease, fluoroscopy time, and hospitalization time were significantly higher in the mPCNL group (p < 0.001). While the Clavien grade 1-2 complication rates were 10.9 and 34.1% (p < 0.001) in two groups, these values were 2.7 and 1.6% (p = 0.539), respectively, for Clavien grade 3-4 complication rates. Although three patients in the mPCNL group received blood transfusions, none of the patients in the RIRS groups were transfused. The stone location and stone density parameters were found to be the independent predictive factors for RIRS success. CONCLUSIONS: mPCNL provided a higher stone-free rate, less need for the auxiliary procedure, and lower complication rates compared to RIRS in patients with 2-3 cm stones. Blood loss, radiation exposure, and a hospital stay of mPCNL can be significantly reduced with the RIRS technique in selected patients.