A novel nomogram and a simple scoring system for urinary leakage after percutaneous nephrolithotomy.

INTRODUCTION: The present study aimed to investigate the factors of prolonged urinary leakage (PUL) after percutaneous nephrolithotomy (PCNL) and develop a new and simple scoring system to predict it. PATIENTS AND METHODS: We retrospectively reviewed patients with renal stones who underwent PCNL at the University of Health Sciences Izmir Bozyaka Training and Research Hospital between April 2011 and January 2020. The patients were divided into two groups according to the presence of PUL, and their preoperative and perioperative data were compared. A multivariate regression analysis was applied to examine the relationship between perioperative descriptors and PUL, and a nomogram was developed using significant predictors. Then, the individual components of the nomogram were assigned points to form a scoring system. RESULTS: There were 92 and 840 patients in the groups with and without PUL, respectively. The results of the univariate logistic regression analysis showed that hydronephrosis grade, parenchymal thickness, duration of nephroscopy, and duration of nephrostomy catheter were significantly associated with PUL. Subsequently, a multivariate regression analysis was carried out with these four factors as possible independent risk factors of PUL after PCNL. Based on the results of this analysis, a nomogram prediction model was developed with an area under the curve value of 0.811, which was consequently used to develop a new simple score system consisting of three characteristics: parenchymal thickness (1-5 points), duration of nephroscopy (1-3 points), and hydronephrosis grade (1-3 points). CONCLUSION: A novel scoring system is a useful tool for predicting PUL in patients who have undergone percutaneous nephrolithotomy.

The comparison of perioperative outcomes between percutaneous nephrolithotomy and retrograde intrarenal surgery in elderly patients.

OBJECTIVES: In this study, we aimed to compare the outcomes and complication rates of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in elderly patients. MATERIALS AND METHODS: Between April 2011 and January 2020, patients who underwent PCNL and RIRS for renal stone in elderly patients were retrospectively evaluated. The two groups' perioperative values, stone-free rates and complication rates were compared. Post-operative complications were noted according to the Clavien scoring system. RESULTS: There were 89 and 72 patients in the PCNL and RIRS group respectively. The median age was 67 years in both the groups (P = .192). The stone size were 22.2 ± 3.5 mm and 19.9 ± 7.1 mm in the PCNL and RIRS group, respectively (P = .082). Stone-free rates were significantly higher in PCNL group (P = .021, P = .034). Also we found that overall complication and major complication rates were significantly higher in PCNL group (P = .016, P = .029). CONCLUSION: Despite there was higher stone clearance in PCNL, the complication rates were higher compared with RIRS. So RIRS might be a safe alternative treatment method to PCNL in older patients.

Flexible ureterorenoscopy and laser lithotripsy with regional anesthesia vs general anesthesia: A prospective randomized study.

PURPOSE: To compare the effect of general anesthesia (GA) and regional anesthesia (RA) on f-URS outcomes and surgeon comfort. MATERIAL AND METHODS: The study was conducted between June 2017 to January 2018 and data collection was applied in a prospective, randomized fashion. 120 patients participated in the study and were divided into RA group (n=56) and GA group (n=64). Demographic, operative and post-operative parameters of patients were analysed. The end point of this study was the effect of two anesthesia regimens on the comfort of the surgeon, and the comparability of feasibility and safety against perioperative complications. RESULTS: The study including 120 randomized patients, 14 patients were excluded from the study and completed with 106 patients (45 in RA group and 61 in GA group). No difference was detected between the two groups in terms of preoperative data. During the monitorization of operative vital signs, 3 patients in RA group experienced bradycardia, and this finding was significant when compared with GA group (p=0.041). Additionally, 2 patients in RA group experienced mucosal tears and 1 patient experienced hemorrhage during the operation, but no complications were observed in the GA group (p=0.041). Postoperative surgeon comfort evaluation revealed statistically significant results in favor of GA group (p=0.001). CONCLUSIONS: Both GA and RA are equally effective and safe anesthesia methods for f-URS procedures. However, RA group showed significantly increased likelihood of bradycardia and mucosal injury during surgery, and significantly decreased surgeon comfort during surgery.

Comparison of supine and prone miniaturized percutaneous nephrolithotomy in the treatment of lower pole, middle pole and renal pelvic stones: A matched pair analysis.

PURPOSE: We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. MATERIALS AND METHODS: 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. RESULTS: The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). CONCLUSIONS: Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.

Flexible ureterorenoscopy is associated with less stone recurrence rates over Shockwave lithotripsy in the management of 10-20 millimeter lower pole renal stone: medium follow-up results.

PURPOSE: To identify the role of shock wave lithotripsy (SWL) and flexible ureterorenoscopy (f-URS) on the stone recurrence, in the management of 10-20 millimeter lower pole stone (LPS) with medium follow-up outcomes. MATERIALS AND METHODS: The patients' charts which were treated with SWL or f-URS for LPS between January 2011 and September 2013 were analyzed, retrospectively. Patients who had a solitary 10-20mm LPS were enrolled into the study. In both procedures, patient was accepted as stone free, if complete stone clearance was achieved in the 3rd month abdominal computed tomography. Only patients with a stone free status were evaluated in follow-ups. RESULTS: The stone-free rate was 77.9% (88/113 patients) for the SWL group and 89% (114/128 patients) for the f-URS group (p=0.029). Stone recurrence was detected in 28 (35.4%) patients in SWL group and in 17 (17.2%) patients in f-URS group (p=0.009). Stone types and 24 hour urine sample results were similar between groups (p=0.123 vs p=0.197, respectively). Multivariate regression analysis revealed that f-URS procedure and absence of abnormality in 24 hour urine analysis significantly decreased stone recurrence in medium term follow-up (p=0.001 and p<0.001, respectively). CONCLUSIONS: Our study showed for the first time, that patients which underwent f-URS for LPS, faced less stone recurrence, independent from diet regimen and metabolic evaluation in medium term follow-up. Additionally, presence of abnormality in 24 hour urine analysis increase the stone recurrence risk in follow-ups.

Giant Dermoid Cyst Causing Dysphagia and Dyspnea.

Dermoid cysts are benign lesions seen in young adults. The second most common localization is the floor of the mouth. They are usually asymptomatic over years but can be symptomatic due to secondary changes or the size. Herein, we report a case of 19-year-old woman who applied to emergency service with dyspnea, dysphagia and enlarging of a mass in the submental region. The patient cannot be entubated because of the mass pushing the tongue base backward closing the laryngeal view. Elective tracheostomy was performed for providing airflow during the operation. After the operation a cystic mass fulfilled with keratin lined by keratinized stratified squamous epithelium in addition to the dermal appendages such as sweat glands and follicular structures were seen histopathologically and the case was diagnosed as dermoid cyst of the submental region. In such patients with quick enlarging of mass causing airway obstructions, the tracheostomy can be the preferable method because of the difficulties in entubation.

The Causes of Persistent and Recurrent Nasal Obstruction After Primary Septoplasty.

OBJECTIVES: Septoplasty is the most frequently performed surgical procedure in patients with nasal obstruction. However, nasal obstruction may persist or recur after septoplasty in some patients. In this study, the authors aimed to determine the causes of nasal obstruction after septoplasty. METHODS: Fifty consecutive patients who admitted to our clinic with the complaints of persistent or recurrent nasal obstruction after primary septoplasty and had revision surgery between 2011 and 2015 were included in this study. Demographic data and physical examination findings of the patients were recorded. RESULTS: There were 33 men (66%) and 17 women (34%) with a mean age of 37.3 ±â€Š10.5 (range, 21-57) years. Deviation of perpendicular plate of ethmoid bone (44%), inferior turbinate hypertrophy (36%), concha bullosa (26%), caudal septal deviation-nostril asymmetry (20%), and alar collapse (6%) were the pathologies that were unaddressed during primary surgery. The iatrogenic causes of nasal obstruction after septoplasty were collumellar retraction-nasal tip ptosis (46%), nasal synechiae (20%), nasal septal perforation (10%), and saddle-nose/flat nose deformity (10%). CONCLUSIONS: Iatrogenic deformities due to surgery and pathologies ignored during primary surgery may cause persistent/recurrent nasal obstruction after primary septoplasty. A detailed physical examination and objective tests showing the site of nasal obstruction, an extensive surgical plan that covers all diagnosed pathologies, and a careful postoperative care must be undertaken to prevent undesired postoperative results.

Sudden hearing loss associated with methylphenidate therapy.

An 8-year-old child diagnosed with attention deficit/hyperactivity disorder presented to our Department of Otolaryngology 4 days after suffering hearing loss, loss of balance, tinnitus, and fullness sensation of the left ear. Her symptoms occured with the first dose of methylphenidate. The medical history and physical examination revealed no other diseases associated with sudden hearing loss. The audiogram revealed a total hearing loss on the left ear. Stapedial reflexes, distortion product and transient-evoked otoacoustic emissions were absent in left ear. The absence of clinical, laboratory and radiological evidence of a possible cause for complaints, an association between methylphenidate and sudden hearing loss was suggested. The patient received a standard course of oral corticosteroid and hyperbaric oxygen therapy. Weekly otological and audiological examinations were performed. Conservative and medical treatments offered no relief from hearing loss. Sudden hearing loss is a serious and irreversible adverse effect of methylphenidate. Therefore, the risk of hearing loss should be taken into consideration when initiating methylphenidate therapy.

[Fracture of the glenoid fossa without mandibular condylar dislocation or fracture: two case reports]. / Mandibüler kondil çikigi ve kirigi olmaksizin glenoid fossa kirigi: Iki olgu sunumu.

The mandibular condyle region which protects the middle cranial fossa from facial and jaw traumas has an excellent osteomuscular structure. Condylar structures reduce or limit the force of trauma. Most importantly, the condylar neck is the weakest part of the mandible and is easily fractured without dislocation. Generally, this mechanism prevents condylar penetration into the middle cranial fossa; however, there are condylar penetration into the middle cranial fossa can be rarely. Glenoid fossa fractures without mandibular condylar fracture and dislocation can be made. In this article, we present two cases to assess the isolated glenoid fossa fractures of the temporal bone.

Application of ATC/DDD methodology to evaluate of antibiotic use in a general hospital in Turkey.

BACKGROUND: The aim of this study is to evaluate in-house antibiotic use in a state hospital in Turkey with its cost, using the ATC/DDD index, which is an accepted standard method. METHODS: This study was performed as a point prevalence study in a state hospital with 372 beds. All in-house patients using antibiotics on July 19, 2011 were included in the study. Indications for antibiotic use and information about the patients were recorded on special forms. Antibiotic use and cost analysis were evaluated using the ATC/DDD index, which is also suggested by the WHO to be used in similar studies. FINDINGS: 147 patients out of 308 patients who were in-house were identified to use antibiotics with appropriate indications for prophylaxis or treatment in 61% of the patients. The rate of appropriate antibiotic use was identified to be in 78%, while this rate was 38.9% in surgical clinics. The daily cost of the antibiotics consumed on the date of the study was calculated as 4104.79 TL (=2476.80 USD). DISCUSSION: The rate of inappropriate use of antibiotics seems to be high in our hospital. This will result in both increased costs and also increased nosocomial infection rates with resistant species. Infectious disease specialists should take more active roles in the in-house antibiotic use, hospitals should prepare and implement their own principles of antibiotic use, and microbiology laboratories should be used more effectively. These measures would decrease the conspicuous shortcomings in the antibiotic use.

The relationship between retinal neurodegenerative changes and overactive bladder syndrome in multiple sclerosis.

INTRODUCTION: This study aimed to compare the neuroaxonal damage of the optic nerve and retina in multiple sclerosis (MS) patients with and without overactive bladder (OAB). PATIENTS AND METHODS: We included patients with MS, divided into two groups, based on the severity of OAB symptoms, as evaluated by the OAB-V8 questionnaire. The groups were compared in terms of each dial of the Expanded Disability Status Scale (EDSS), best-corrected visual acuity, intraocular pressure, peripapillary retinal nerve fiber layer (pRNFL) thickness, macular thickness, and macular ganglion cell-inner plexiform layer (mGCIPL) thickness. RESULTS: The study involved a total of 120 eyes, 78 eyes from 43 female patients, and 42 from 22 male patients. There were 86 eyes (Group 1) with OAB-V8 score under 8 and there were 34 eyes (Group 2) with OAB-V8 score of 8 or over. EDSS median value was 1 (0-2) for Group 1 and 2 (0.8-3.3) for Group 2 (p = 0.004). A comparison of pRNFL thicknesses showed statistically significant lower average, superior, and inferior median values in Group 2. A comparison of mGCIPL thicknesses showed statistically significant lower values in Group 2 for superior, superonasal, inferotemporal, and superotemporal quadrants CONCLUSION: This study revealed, for MS patients without optic neuritis attacks, there was a higher incidence of OAB when the EDSS score was higher. There was a statistically significant relationship between the existence of OAB and thinning in both mGCIPL and pRNFL. The most relevant factor for OAB was found to be pRFNL inferior quadrant thinning.

Supine versus Prone Miniaturised Percutaneous Nephrolithotomy in Elderly Patients.

OBJECTIVE: To compare the outcomes of mini-PCNL (miniaturised percutaneous nephrolithotomy) in prone and supine positions in elderly patients. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of Urology, University of Health Sciences, Turkey, between April 2017 and January 2021. METHODOLOGY: Patients over 65 years of age were included in the study. All patients' comorbidities were recorded and charlson comorbidity index (CCI) score was calculated. The groups were compared in terms of perioperative values, stone-free rates and complication rates. Logistic regression analysis was used to evaluate risk factors for complication development. Postoperative complications were noted according to the Clavien scoring system (CSS). RESULTS: There were 54 patients in the supine mini-PCNL group and 64 in the prone mini-PCNL group. The median ages were 67 in the prone and 66 in the supine group. CCI scores were similar in both groups (p = 0.735). Stone-free and total complication rates were not statistically different in the groups (p = 0.994 and p = 0.247, respectively). However, grade 1-2 complication rates were significantly higher in the prone group (p=0.020). CCI score and stone size were significantly associated with the development of complications (p = 0.018 and p = 0.034, respectively). CONCLUSION: The present study is the first to compare the outcomes of mini-PCNL in prone and supine position in geriatric patients. Supine mini-PCNL is a potentially safer alternative treatment method for older patients with high CCI scores. Key Words: Percutaneous nephrolithotomy, Supine position, Elderly, Mini-PCNl, CCI score.

The Influence of Aging on Outcomes in Patients Undergoing Percutaneous Nephrolithotomy for Complete Staghorn Stones: A Retrospective Comparative Study.

Objective In this study, we aimed to evaluate the effect of age on the success and complications of percutaneous nephrolithotomy (PCNL) for complete staghorn renal stones. Materials and methods The files of 182 patients who underwent single-access PCNL for complete staghorn renal stones between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups according to their age: those aged <65 years were defined as Group-1 and those aged ≥65 years as Group-2. The demographic characteristics and perioperative and postoperative results were compared between the two groups. Results Among the patients with complete staghorn renal stones, 139 were in Group-1 and 43 were in Group-2. The mean age of the patients was 43.9 ±10.6 years in Group-1 and 67.8 ±2.1 years in Group-2 (p=0.001). The rate of hemoglobin drop was significantly higher in Group-1 (p=0.001). However, the blood transfusion rate was higher in Group-2 than in Group-1 (18.6% vs. 7.2%, respectively). The stone-free rate was 54.7% in Group-1 and 67.4% in Group-2 (p=0.139). As for the evaluation of the overall complication rates, 34.5% of the patients in Group-1 and 46.5% of those in Group-2 developed complications (p=0.206). According to the Clavien scoring system, the rate of minor complications was found to be 22.3% in Group-1 and 41.9% in Group-2, and the difference was statistically significant (p=0.012). The major complication rates were determined as 4.7% and 12.2% for Group-1 and Group-2, respectively (p=0.155). The number of patients with Clavien grade-2 complications was significantly higher in the elderly patient group (p=0.019). Conclusions Based on our findings, PCNL is an effective and safe method in the treatment of complete staghorn stones in elderly patients.

Does Access Location Influence Outcome of Percutaneous Nephrolithotomy in Staghorn Stones?

OBJECTIVE: To assess the effect of lower and middle calyceal accesses on the outcomes of percutaneous nephrolithotomy (PCNL) in staghorn stones. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Urology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Turkey, from April 2012 to January 2019. METHODOLOGY: Patients who underwent PCNL for staghorn stones were retrospectively analysed. The patients were grouped as Group-1 (middle calyceal access) and Group-2 (lower calyceal access). Demographic and stone characteristics (size, density), perioperative and postoperative data, and stone-free rates were compared between these two groups. Postoperative detection of > 4 mm stones was defined as residual stones. RESULTS: There were 249 patients in the study; 108 in middle calyceal access group and 141 in lower calyceal access group. The mean stone burden was 765 (524-1322) and 777 (490-1445) mm2 in group-1 and group-2, respectively (p=0.876). The number of stone-free patients was 50 (46.3%) in middle calyceal access group and 93 (66.0%) in lower calyceal access group. The rate of stone-free status was significantly higher in lower calyceal access group (p=0.002). The overall complication rate was similar between the groups (p=0.132). The binary analysis showed that stone burden, and calyx of entry were predictive factors for success. CONCLUSION: Although the choice of the calyx to be entered does not affect the complication rate in staghorn stones, the stone-free rate is significantly higher in lower calyceal access. Key Words: Percutaneous nephrolithotomy, Staghorn stones, Clavien scoring system, Calyx, Access.

Comparison of Guy's, S.T.O.N.E. and CROES Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes in Eldery Patients.

OBJECTIVE: To evaluate the efficacy and reliability of Guy's (GSS), S.T.O.N.E., and CROES scoring systems developed to predict percutaneous nephrolithotomy (PCNL) outcomes in aged patients. Study Design: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Ministry of Health University Izmir Bozyaka Training and Research Hospital and Department of Urology, Faculty of Medicine, Amasya University, Turkey, from April 2011 to January 2020. METHODOLOGY: Patients aged 65 years and over, who underwent PCNL for kidney stones, were retrospectively analysed. The patients' clinical and perioperative characteristics and the radiological features of the stones were obtained from the prospectively recorded data. GSS, S.T.O.N.E. and CROES nephrolithometry scores were calculated for each patient and their relation with stone-free status, complications, and perioperative findings were analysed. RESULTS: A total of 147 patients were included in the study. Stone-free status was achieved in 76.0% of the patients, and complications developed in 27.2%. All three scoring systems were associated with stone-free status and complication development. GSS (OR=0.213,p=0.005) and S.T.O.N.E. (OR=0.601, p=0.042) scores were detected as independent markers for stone-free status, while the CROES score was not an independent marker. Only diabetes mellitus was determined to be an independent marker for the development of complications (OR=2.375, p=0.045). CONCLUSION: PCNL is an effective and safe treatment method with high stone-free rates in the treatment of large renal stones, but care should be taken in terms of cardiac risks. The results of this study showed that GSS and S.T.O.N.E. scoring systems were effective and reliable in predicting stone-free status. Key Words: Aged, Nephrolithotomy, Percutaneous, Comorbidity, Stone-free status, Treatment outcome, Complications, Scoring systems.

Retrospective Analysis of the Factors Affecting Intraoperative and Immediate Postoperative Complications of Retrograde Intrarenal Surgery Classified by the Clavien and Satava Grading Systems.

Background: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and proximal ureteral stones at two institutions between March 2015 and June 2020. Intraoperative complications were assessed using the SCS, and postoperative complications were graded according to the MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The median stone size was determined as 13 mm (range 10-20 mm). The stone-free rate was 83.6% after the first intervention. Reprocedure was applied to 89 of the patients with residual stones and the final stone-free rate was 94.4% after reprocedure. According to SCS, the number of intraoperative events and complication incidences was 153 (16.1%). MCCS revealed postoperative complications in 121 (12.8%) patients. Major complications were observed in 18 (1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.4%, p = 0.001). Stone location, stone size, stone burden, stone number, stone density, and residual fragments were determined to be associated with the development of complications (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.002, and p < 0.001, respectively). In addition, the multivariate analysis revealed that only the presence of residual fragments was a significant predictor of complication development for the patients with Grade ≥3 complications according to MCCS (p = 0.032). However, significant predictors were stone burden (p < 0.001), stone density (p = 0.002), and fluoroscopy time (p < 0.001) for those with Grade ≥2b complications according to SCS. Conclusion: This study showed that abnormal kidney anatomy, operation time, stone burden, and residual fragments were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.