A New Nephrometry Score for Predicting Positive Surgical Margin After Laparoscopic Partial Nephrectomy.

PURPOSE: To introduce the KESKIN ratio as a novel predictor of positive surgical margin (PSM) after laparoscopic partial nephrectomy (PN) and to evaluate other clinical characteristics and nephrometry scores (including RENAL, PADUA, and C-index) for predicting PSM. METHODS: We retrospectively analyzed 95 patients who underwent laparoscopic PN between June 2020 and April 2023. The KESKIN ratio was defined for all patients. The KESKIN ratio, tumor and patient-related paramaters, and nephrometry scores were analyzed to predict PSM. RESULTS: Positive surgical margin was found in 12 of 95 patients (12.6%). There was no statistical difference between the PSM and negative surgical margin (NSM) groups in RENAL, PADUA, and C-index scores. Only the KESKIN ratio was found to be a statistically significant predictor of PSM in both univariate and multivariate regression analysis (p = 0.007 and p = 0.043, respectively). Mean endophytic diameter and endophytic percentage were found to be statistically significant predictors of PSM in only univariate analysis (p = 0.005 and p = 0.01, respectively). The value of 0.5 was determined as the cut-off value for the KESKIN ratio. Values higher than 0.5 indicate an increase in PSM. CONCLUSIONS: The KESKIN ratio is a novel, easily measurable, and calculable image-based parameter that can be used to predict PSM after laparascopic PN. If externally validated in a larger patient population, the KESKIN ratio may be used in future versions of the current nephrometry scoring systems for predicting the PSM.

Risk Factors of Open Surgery Conversion in Laparoscopic Partial Nephrectomy to Achieve Nephron Sparing.

OBJECTIVES: We aimed to evaluate the risk factors for the conversion from laparoscopic partial nephrectomy (LPN) to open surgery to achieve partial nephrectomy (PN). METHODS: Data from patients who underwent LPN between June 2020 and September 2023 were analyzed retrospectively. Patients in whom the PN procedure could be completed laparoscopically were recorded as the 'Fully Laparoscopic' (FL) group (n = 97), and those converted to open surgery from laparoscopy were recorded as the 'Conversion to Open' (CTO) group (n = 10). The demographic and pathologic variables were compared between groups. Regression analyses were used to define predictor factors, and receiver operating characteristic analysis was used to define the cut-off value of the surgical bleeding volume. RESULTS: Conversion to open surgery was found in 10/107 patients (9.3%). There was no statistical difference between groups in demographic and pathologic variables. Intraoperative blood loss volume, upper pole localized tumor, and posterior localized tumor were found to be statistically higher in the CTO group (p = 0.001, p = 0.001, and p = 0.043, respectively). Furthermore, these factors were only found to be statistically significant predictors of conversion to open surgery in both univariate and multivariate regression analyses. 235 cc was found to be the cut-off value of intraoperative blood loss volume for predicting conversion to open surgery (p = 0.001). CONCLUSION: Using these predictive factors in clinical practice, treatment planning will lead to the possibility of starting the treatment directly with open surgery instead of minimally invasive options, and it may also provide a chance of being prepared for the possibility of conversion to open surgery peroperatively.

Preoperative Prediction of Muscle Invasiveness in Bladder Cancer: The Role of 3D Volumetric Radiomics Using Diffusion-Weighted MRI, the VI-RADS Score, or a Combination of Both.

BACKGROUND: Bladder cancer treatment decisions hinge on detecting muscle invasion. The 2018 "Vesical Imaging Reporting and Data System" (VI-RADS) standardizes multiparametric MRI (mp-MRI) use. Radiomics, an analysis framework, provides more insightful information than conventional methods. PURPOSE: To determine how well MIBC (Muscle Invasive Bladder Cancer) and NMIBC (Non-Muscle Invasive Bladder Cancer) can be distinguished using mp-MRI radiomics features. METHODS: We conducted a study with 73 bladder cancer patients diagnosed pathologically, who underwent preoperative mp-MRI from January 2020 to July 2022. Utilizing 3D Slicer (version 4.8.1) and Pyradiomics, we manually extracted radiomic features from apparent diffusion coefficient (ADC) maps created from diffusion-weighted imaging. The LASSO approach identified optimal features, and we addressed sample imbalance using SMOTE. We developed a classification model using textural features alone or combined with VI-RADS, employing a random forest classifier with 10-fold cross-validation. Diagnostic performance was assessed using the area under the ROC curve analysis. RESULTS: Among 73 patients (63 men, 10 women; median age: 63 years), 41 had muscle-invasive and 32 had superficial bladder cancer. Muscle invasion was observed in 25 of 41 patients with VI-RADS 4 and 5 scores and 12 of 32 patients with VI-RADS 1, 2, and 3 scores (accuracy: 77.5%, sensitivity: 67.7%, specificity: 88.8%). The combined VI-RADS score and radiomics model (AUC = 0.92 ± 0.12) outperformed the single radiomics model using ADC MRI (AUC = 0.83 ± 0.22 with 10-fold cross-validation) in this dataset. CONCLUSION: Before undergoing surgery, bladder cancer invasion in muscle might potentially be predicted using a radiomics signature based on mp-MRI.

Comparison of oncological and functional results of robotic and open perineal radical prostatectomy.

OBJECTIVE: We aimed to compare the functional and oncological outcomes of patients who underwent open perineal radical prostatectomy (OPP) and robotic perineal radical prostatectomy (RPP) for prostate cancer (PCa). METHODS: The data of patients who underwent OPP and RPP from June 2016 to February 2019 due to localized PCa were analyzed. Demographic characteristics, perioperative data and oncological results of the patients were recorded. In addition, the incontinence status of the patients immediately after catheter removal and at the 3rd, 6th, and 12th months were compared. Potency status was evaluated among the patients with preoperative potency, and 12th month potency status was compared. RESULTS: A total of 135 patients were included, of whom 58 (43%) were in the OPP group and 77 (57%) were in the RPP group. The operation time was statistically significantly shorter in the OPP group (83.90 ± 15.48 vs. 110.88 ± 28.10 min, p = 0.001). The amount of bleeding was significantly lower in the RPP group (59.51 ± 22.04 vs. 74.06 ± 17.66, p = 0.002). The continence rates evaluated at the early period, 3rd, 6th, and 12th months were 40.3%, 80.5%, 87.0%, and 90.9%, respectively, for the RPP group and 36.2%, 70.7%, 86.2%, and 89.7%, for the OPP group, indicating no statistically significant difference (p > 0.05). There was no statistically significant difference in the 12th month rates of postoperative potency according to the surgical technique (p > 0.05). CONCLUSION: Although differences were observed between the OPP and RPP techniques in terms of perioperative parameters, oncological and functional results were similar.

Diagnostic value of the preoperative platelet/lymphocyte ratio and red cell distribution volume in patients with renal masses.

OBJECTIVES: Inflammatory markers indicate immune system responses. BACKGROUND: We retrospectively explored whether the platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), and red blood cell distribution width (RDW) were predictive of malignant disease. MATERIAL AND METHODS: Between 2019 and 2023, 148 patients diagnosed with malignant and benign renal tumors via imaging or biopsy were included. Of these tumors, 117 were malignant and 31 were benign. Blood samples were taken for calculation of the NLR, PLR, and RDW prior to renal biopsy or operation. RESULTS: The NLR, PLR, and RDW did not differ significantly between patients with malignant and benign renal masses (all p > 0.05). The PLR significantly increased with the T stage of malignant masses (p = 0.011). According to the T stage, the RDW cutoff was 45.7, the sensitivity was 40 %, and the specificity 82.4 %; the respective values for PLR were 134.9, 70 %, and 70.5 % (p = 0.026 and p = 0.003, respectively). CONCLUSION: The NLR, PLR, and RDW were not predictive in this study because we only included early- stage patients lacking lymph node involvement and the follow-up was short. In patients with renal cell carcinomas, the RDW and PLR increase with the tumor burden and predict poor prognosis (Tab. 5, Fig. 1, Ref. 23). Text in PDF www.elis.sk Keywords: neutrophil/lymphocyte ratio, platelet/ lymphocyte ratio, renal mass.

Effect of sexual arousal on semen parameters during abstinence.

Semen analysis and physical examination are performed while first evaluation for patients with male infertility. Alcohol, smoking and dietary habits can affect the semen parameters. This study aimed to evaluate whether semen parameters are changed with sexual arousal. After excluding, 100 patients with ages of 18-45 were included to the study. All semen analysis were performed with three days of sexual abstinence. An identified 20 min video link was determined to the patients and while the sexual abstinence were told to watch this video once a day; after 3 days abstinence semen analysis was examined again. In the detailed examination normal spermatozoa ratio (Tygerberg strict criteria), spermatozoa concentration, semen volume, total motility and progressive motility ratios were noted. When the two semen analysis from the same patient are compared, it was observed that all parameters did not change except semen volume and total motile sperm count (p < 0.001). In conclusion, to understand the effect of sexual arousal during the sexual abstinence, we need studies with high patient number and longer follow-up.

Comparison of two different grafts for the surgical treatment of peyronie's disease.

The aim of this study was to compare two different graft techniques, namely saphenous vein (SV) and buccal mucosa (BM) used together with plaque incision for the treatment of Peyronie's disease (PD) in terms of success, safety and patient and partner satisfaction. The study included 41 patients diagnosed with PD and treated with plaque incision and grafting between December 2015 and November 2019. Eighteen patients underwent plaque incision and BM grafting while the remaining 23 patients underwent plaque incision and SV grafting. Pre-operative plaque size, curvature angle, curvature start time and penis length were statistically similar between the SV and BM graft groups. No statistical difference was detected between the BM and SV graft groups in terms of the sixth- and 12th-month mean International Index of Erectile Function scores, Patient Global Impression of Improvement scores, penis lengths and final partner satisfaction rates during the follow-up period. Residual curvature was observed in three (13.1%) patients in the SV graft group and two (11.2%) patients in the BM graft group. With their high success and low side effect rates, both grafting techniques with plaque incision can be safely performed for tunical lengthening, based on the surgeon's experience.

Robot-assisted radical perineal prostatectomy: a review of 95 cases.

OBJECTIVES: To assess the early functional and oncological outcomes of a large series of patients who underwent robot-assisted radical perineal prostatectomy (RPP). MATERIALS AND METHODS: We retrospectively analysed the patients who underwent robot-assisted RPP for localized prostate cancer between November 2016 and September 2018. Patients who had locally advanced disease proven on biopsy or were suspected to have locally advanced disease on multiparametric magnetic resonance imaging and patients who had a contraindication for the exaggerated lithotomy position were not included in this study. Patient demographics, preoperative and postoperative variables, complications and follow-up times were recorded. RESULTS: A total of 95 patients were included. Their mean ± sd age was 61.5 ± 6.5 years. The median (interquartile range [IQR]) preoperative prostate-specific antigen level was 6.1 (3.7) ng/mL, the median (IQR) operating time was 140 (25) min, and the mean ± sd blood loss was 67.4 ± 17 mL. Pelvic lymph node dissection (PLND) was performed for 12 patients (12.6%). The median (IQR) hospital stay was 1 (1) days. Positive surgical margins were present in eight patients (8.4%). After catheter removal, the immediate continence rate was 41%. Continence rates were 78%, 87% and 91%, respectively, 3, 6 and 12 months after surgery. Potency rates were 49%, 69% and 77%, respectively, 3, 6 and 12 months after surgery for patients who had adequate potency preoperatively. The median (IQR) follow-up time was 13 (3.1) months. CONCLUSION: We conclude that robot-assisted RPP is a reliable and effective surgical technique that can be employed in the treatment of localized prostate cancer regardless of prostate volume, especially in patients with a history of abdominal surgery. As an additional advantage, PLND can be performed through the same incision.

Robotic perineal radical prostatectomy with high prostate volume.

BACKGROUND: Minimally invasive techniques are ever improving and are preferred more. Many techniques were developed in radical prostatectomy operations. Robotic radical prostatectomy with the perineal approach is a new technique. CASE PRESENTATION: A 66-year-old male patient presented because of lower urinary tract symptoms, a PSA value of 5.5 ng/ml was detected, prostate biopsy was performed under transrectal ultrasound guide, a Gleason 3+3 adenocarcinoma on 3/12 foci was reported at pathology. Robotic perineal radical prostatectomy (r-PRP) operation was performed in the patient who had a prostate volume of 130 cc with middle lobe and a body mass index of 32 without additional disease. The duration of operation was 140 minutes in total and the duration at the console was 95 minutes, the amount of bleeding was 85 cc and no intraoperative complication was detected. CONCLUSION: r-PRP is a technique that can be applied safely without prolonging the operation period and without additional morbidity to the patient, preserving the oncologic and functional outcomes in patients with surgical history and large prostate volume.

Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier's gangrene.

OBJECTIVE: The purpose of our study was to compare Vacuum-assisted closure (VAC) and conventional dressings in the wound therapy of Fournier's gangrene (FG). MATERIALS AND METHODS: The study evaluated 54 patients, retrospectively. Following initial removal of necrotic and devitalized tissue, in Group I patients the wounds were covered with conventional antiseptic dressings and patients continued to be treated with conventional dressings. In Group II patients VAC therapy was initiated. The collected data were compared between groups. RESULTS: The difference between two groups were statistically significant in terms of number of daily dressing (group I: 2, group II: 0,5), VAS (group I: 8, group II: 5), number of daily analgesics (group I: 4, group II: 2), number of daily narcotic analgesics (group I: 1, group II: 0), duration of mobilization per day (group I: 40, group II: 73 minutes) (p < 0.05). CONCLUSIONS: Our study does not determine that a VAC therapy is better than conventional dressings in terms of clinical outcome. However, vacuum dressing appears an effective and successful method, which offers fewer dressing changes, less pain, and greater mobility comparing to conventional dressings in the management of FG patients.

Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery.

PURPOSE: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT. MATERIALS AND METHODS: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level. At the end of 1st year, two groups were compared patient characteristics, operation time, duration of hospital stay, cure and complication rates. RESULTS: The cure rate was 84.37% 81/96) versus 83.63% (92/110) in TOT and TOT with cough test groups, respectively. Postoperatively ten patient (10/110, 9.09%) suffered voiding difficulties (> 250 ml residual urine) in TOT with cough stress test group. Five patients were discharged with transurethral catheter, whereas, in traditional TOT group, two patients (2/96, 2.1%) had transient postoperative voiding difficulty and two patients were treated with repeated catheterization for 1 week (p < 0.05). Postoperative groin pain was present in 7/96 (8%) versus 24/110 (22%) in TOT and TOT with cough test groups, respectively (p < 0.05). TOT with cough stress test group had an higher rate of complications like, retention of urine, necessitating to cut the tape, mesh erosion and pain in groin or leg. No patient had resistant voiding difficulty or prolonged urinary retention (> 1 week) in traditional TOT group. CONCLUSIONS: We believe that per-operative cough stress test leads to overtreatment of stress urinary incontinence when the complication rates were considered.

Comparison of robotic and laparoscopic partial nephrectomy for small renal tumours.

OBJECTIVE: To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal tumours. MATERIALS AND METHODS: Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20) or RPN (n = 22) by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes. RESULTS: There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001). Warm ischemia time was similar in both groups (p = 0.58). Estimated blood loss (EBL) was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin. CONCLUSIONS: RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.

The correlation between biological activity and diffusion-weighted MR imaging and ADC value in cases with prostate cancer.

PURPOSE: Firstly, we aimed to investigate the correlation among dynamic contrasted magnetic resonance (MR) images, diffusion-weighted MR images, and apparent diffusion coefficent (ADC) values in patients with prostate cancer. Secondly, we aimed to investigate the roles of these variables on clinical risk classification and the biological behavior of the prostate cancer. METHODS: A total of sixty with prostatic adenocarcinoma patients diagnosed between January 2011 and May 2013 were retrospectively included in the study. Risk classification of patients were evaluated as low-risk (Group 1) (n = 20) (Stage T1c-T2a, PSA < 10 ng/ml, Gleason Score < 7), moderate-risk (Group 2) (n = 18) (Stage T1b-T2c, PSA = 10-20 ng/ml, Gleason Score = 7) and high-risk (Group 3) (n = 22) (Stage > T3a, PSA > 20 ng/ml, Gleason Score > 7). Diffusion-weighted MR images, dynamic contrasted MR images, and ADC values of the prostates were correlated. RESULTS: ADC values of the cases in Group 3 were lower than those of the other groups (p < 0.001). ADC values of the areas without malignancy did not differ significantly between groups (p > 0.05). Biological activity of the tumor tissue was determined by GS, while a negative correlation was observed between GSs and ADC values of the patients, (p < 0.001). CONCLUSION: In tumors with higher Gleason scores, lower ADC values were obtained. These measured values can play a role in the noninvasive determination of the cellularity of the tumoral mass.

Single plus one port robotic radical prostatectomy (SPORP); Initial experience.

OBJECTIVE: This article reports on patients with early stage prostate cancer treated with single plus one port robotic radical prostatectomy (SPORP). MATERIALS AND METHODS: Since January 2014, we performed SPORP in 8 patients with localized prostate cancer. Age of patients, clinical stage, operation time, intraoperative and postoperative complications, blood loss, histopathological evaluation, postoperative continence, serum level of PSA were evaluated. RESULTS: Mean age of the 8 patients was 59.85 years. All operations were completed without conversion to standard robotic procedure or open surgery. No intra operative complications occurred. Mean operating time was 143 minutes; prostate excision 123 minutes and urethrovesical anastomosis 20 minutes. Mean blood loss was 45 ml. Preoperative Gleason scores were (3 + 4) in one patient and (3 + 3) in 7 patients. Postoperative Gleason scores were (3 + 4) in 2 patients, and (3 + 3) in 6 patients. All these 8 cases were in T1c clinical stage. Early postoperative complications were drain leakage (n = 1), atelectasis (n = 1), wound infection (n = 1) and fever (n = 1). There was no positive surgical margin. The serum level of PSA was less than 0.2 ng/ml and no other complications happened during the 4 to 12 months follow-up period. Postoperative continence and cosmetic results were excellent. CONCLUSIONS: It is relatively easy for urologists who are skilled in traditional laparoscopic and robotic surgeries to master SPORP. However long-term outcomes of this surgery need further investigations.

A rare cause of acute post renal failure: Retroperitoneal fibrosis.

Retroperitoneal fibrosis is an inflammatory process which may cause acute renal failure. In patients who admitted to emergency services with obstructive uropathy, retroperitoneal fibrosis should be considered in the differential diagnosis. We present our ten cases who admitted to emergency department with obstructive acute renal failure related to retroperitoneal fibrosis.

Partial nephrectomy in horseshoe kidney: Primary carcinoid tumor.

Primary neuroendocrine carcinoma of the kidney is a rarely observed clinical condition because neuroendocrine cells are not found in kidney parenchyma. It's not clinically and radiologically possible to distinguish from other kidney tumors. Incidence with horseshoe kidney anomaly, it should be considered as a definitive diagnosis for the patients with this condition. In this case report, we reported about a carcinoid tumor in horseshoe kidney in a 37-year-old woman.

Comparison of flexible ureterorenoscopy and mini-percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm.

To compare the outcomes of flexible ureterorenoscopy (F-URS) and mini-percutaneous nephrolithotomy (mini-PNL) in the treatment of lower calyceal stones smaller than 2 cm. Patients who underwent F-URS and mini-PNL for the treatment of lower calyceal stones smaller than 2 cm between March 2009 and December 2014 were retrospectively evaluated. Ninety-four patients were divided into two groups by treatment modality: F-URS (Group 1: 63 patients) and mini-PNL (Group 2: 31 patients). All patients were preoperatively diagnosed with intravenous pyelography or computed tomography. Success rates for F-URS and mini-PNL at postoperative first month were 85.7% and 90.3%, respectively. Operation time, fluoroscopy time, and hospitalization time for F-URS and mini-PNL patients were 44.40 min, 2.9 min, 22.4 h, and 91.9 min, 6.4 min, and 63.8 h, respectively. All three parameters were significantly shorter among the F-URS group (p < 0.001). Postoperative hemoglobin drop was significantly lower in F-URS group compared to mini-PNL group (0.39 mg/dL vs. 1.15 mg/dL, p = 0.001). A comparison of complications according to the Clavien classification demonstrated significant differences between the groups (p = 0.001). More patients in the F-URS groups require antibiotics due to urinary tract infection, and more patients in the mini-PNL group required ureteral double J catheter insertion under general anesthesia. Although both F-URS and mini-PNL have similar success rates for the treatment of lower calyceal stones, F-URS appears to be more favorable due to shorter fluoroscopy and hospitalization times; and lower hemoglobin drops. Multicenter and studies using higher patient volumes are needed to confirm these findings.

Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

OBJECTIVES: To evaluate the possible role of an hemostatic matrix on hemostasis, perioperative outcomes and complications in patients who underwent laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: Patients charts were analyzed retrospectively and their demographic characteristics, operative parameters and follow-up results were recorded. Patients were divided into two groups, according to those who used an hemostatic matrix as Group 1 (n = 41) and those who did not used as Group 2 (n = 44). Demographic characteristics of patients, tumor features, operation time, clamping of the renal vessels, ischemia time, suturing of the collecting system, perioperative hemorrhage and complications were evaluated. Histopathological results, surgical margin status, creatinine level and recurrence at the 3rd month of follow up were analyzed. Statistical analyses were performed with SPSS 17.0 and significance was set at p value of < 0.05. RESULTS: The mean RENAL nephrometry score was 5.9 ± 2.0 and the mean tumor size was 35 ± 12 mm. All patients had a single tumor and 44 of them had a tumor in the right kidney. The renal artery was clamped in 79 cases and the mean ischemia time was 20.1 ± 7 minutes. The mean tumor size and the mean RENAL nephrometry score was statistically higher in Group 1 (p: 0.016 and p < 0.001, respectively). Pelvicaliceal repair was more common in Group 1 due to deeper extension of tumors in this group (p: 0.038). In Group 1, less hemorrhage and blood transfusion requirement, with shorter ischemia and operation time was detected. CONCLUSION: The outcomes of the recent study showed that adjunctive use of an hemostatic matrix improves hemostasis and decreases hemorrhagic complications during LPN. Further prospective studies are required to assess the potential role of an hemostatic matrix in LPN.

Comparison of efficacy of laser lithotripter with ultrasonic lithotripter in mini percutaneous nephrolithotomy.

OBJECTIVE: The aim of the study was to compare the efficacy of the laser lithotripter with the ultrasonic lithotripter in mini percutaneous nephrolithotomy (miniperc). MATERIAL AND METHODS: From June 2013 to January 2014; medical records of 77 consecutive patients who underwent miniperc operation were retrospectively evaluated. Ultrasonic lithotripter was used in 22 patients (Group 1), while laser was used in 55 patients. In the laser group, 22 patients were randomly selected who had same characteristics compared to group 1 (Group 2). Success rate, total operative time, complications according to modified Clavien classification, fluoroscopy time, haemoglobin drop, hospital stays and cost analysis were assessed. Success rates were evaluated on the second postoperative day and after the first month. RESULTS: Total operative time (p = 0.635) and fluoroscopy time (p = 0.248) were not significantly different between the two groups. In the laser group, the success rate (81.8%) was notably more than in the ultrasonic lithotripter group (68.2%) but there was no statistically significance (p = 0.296). Ten reusable ultrasonic probe were used for 22 patients, due to thinness and sensitiveness of the probe. Conversely, one single laser fiber (550 micron) was used for 22 patients. When the cost analysis of lithotripsy was considered, the cost per case was 190 dollar in group 1 and 124 dollar in group 2. (p = 0.154) Complication rate, hospital stay and haemoglobin drop were similar in both groups. CONCLUSION: Laser lithotripsy seems to be more cost effective than ultrasonic lithotripsy for miniperc but larger number of patients are required to confirm this estimation.

Results of tension-free vaginal tape for recurrent stress urinary incontinence after unsuccessful transobturator tape surgery.

AIM: The aim of this study was to evaluate cure rate and mid-term results of tension-free vaginal tape for recurrent stress urinary incontinence after failed transobturator tape surgery. MATERIAL AND METHODS: Between January 2006 and December 2011, 42 women were enrolled in this study. Patient characteristics and operating parameters were recorded, and any complications were noted. All patients were followed up for at least 24 months after the second surgery. The Incontinence Impact Questionnaire and the Urinary Distress Inventory were used to identify satisfaction level. RESULTS: The mean age of the patients was 49.07 ± 8.6 years, and median period between transobturator surgery and the tension-free vaginal tape procedure was 12.8 (range 9.2-17.8) months. The cure rate was 83.3% and 76.2% at the first- and second-year follow-up visits, respectively. Intraoperative complications were transient and slight. Bladder injury in five patients and subcutaneous hematoma above the pubis in two patients were the most serious complications, but they were managed conservatively. We found the scores of the Incontinence Impact Questionnaire and Urinary Distress Inventory to be significantly lower at follow-up, compared to the preoperative assessment. De novo urgency was the most common complaint at follow-up and occurred in 11.9% of the women. CONCLUSIONS: We suggest that tension-free vaginal tape is a feasible surgical option for recurrent stress urinary incontinence. Further studies with larger patient numbers and longer follow-up periods are needed to support this finding.