Comparing of different methods for prevention stone migration during ureteroscopic lithotripsy.

AIM: To compare the effectiveness of Stone Cone™, PercSys and lidocaine jelly instillation to prevent stone migration during ureterorenoscopy (URS). MATERIALS AND METHODS: One hundred patients who underwent URS for proximal ureteral stones between 2007 and 2012 were evaluated prospectively. The patients were divided into four groups consecutively. The control group (Group I) consisted of the 25 consecutive patients, in whom no device or method was used to prevent stone migration. Group II consisted of 25 patients treated with the Stone Cone, group III consisted of 25 patients treated with PercSys, and group IV consisted of 25 patients treated with lidocaine jelly instillation. RESULTS: The migration rates were 4.5% in group II, 8.7% in group III, 21.7% in group IV, and 31.8% in group I. The migration rate was found to be statistically significantly lower in the groups treated with the Stone Cone and PercSys compared to the control group (p = 0.014, p = 0.048). However, there was no statistically significant difference between the lidocaine jelly group and the control group in terms of migration rates (p = 0.444). CONCLUSIONS: Our results suggested that the Stone Cone and PercSys were the most successful methods with significantly low migration rates (4.5 and 8.7%, respectively).

Challenging Diagnosis of Abdominal Actinomycosis: A Case Report of a 59-Year-Old Male With Acute Appendicitis-Like Presentation.

Abdominal actinomycosis, a rare and often misdiagnosed condition caused by Actinomyces israelii, typically a commensal organism in the oral cavity and gastrointestinal tract, can become pathogenic, leading to chronic granulomatous infections that mimic various abdominal pathologies, including malignancies. We present a case of a 59-year-old male with coronary artery disease and type 2 diabetes who presented with severe abdominal pain, initially diagnosed as acute appendicitis. During exploratory laparotomy, an ileocecal band mimicking a congenital anomaly was discovered. Histopathological examination confirmed abdominal actinomycosis, revealing clusters of Actinomyces bacteria surrounded by acute inflammatory cells. The patient was successfully treated with surgical intervention and prolonged penicillin therapy, with no recurrence during a four-month follow-up. This case highlights the diagnostic challenges posed by abdominal actinomycosis and emphasizes the importance of considering it in the differential diagnosis of abdominal masses and appendicitis-like symptoms.

Gastric and Pancreatic Ectopic Mucosa in the Gallbladder: A Unique Mimicker of Polypoid Lesions.

A 46-year-old woman with upper quadrant pain and nausea, diagnosed with cholelithiasis, underwent cholecystectomy. A 0.7 cm polypoid lesion in the gallbladder showed mostly heterotopic gastric mucosa with antral and oxyntic glands and foveolar epithelium. A focal area of the heterotopic pancreas, comprising acini and ducts with positive trypsin staining but no islet cells, was found. Additional findings included minimal inflammation, an adenomyoma on the opposite wall, and black gallstones, leading to a diagnosis of a heterotopic polyp. This case underscores the importance of thorough histopathological examination in diagnosing rare heterotopic tissues in the gallbladder, preventing misdiagnosis with malignant entities.

A Rare Case of Intravascular Lobular Capillary Hemangioma Mimicking a Testicular Tumor: Diagnostic Challenges.

Intravascular lobular capillary hemangioma (ILCH), also known as intravenous pyogenic granuloma, is a benign vascular lesion with a distinctive lobular arrangement of capillaries. It is typically confined to the head, neck, and upper extremities, and its occurrence in the testicular region is exceedingly rare. Here, we present a case of a 68-year-old male who was initially diagnosed with a testicular tumor based on imaging studies but was later found to have an ILCH located in the epididymis. This case underscores the diagnostic challenges posed by this rare entity due to its unusual presentation and mimicking of malignant conditions.

Correlation of Postoperative Outcomes According to the Amount of Prostatic Tissue Removed in Patients Undergoing Transurethral Resection of the Prostate.

OBJECTIVE: The present study assesses the effect of the proportion of tissue resected during transurethral resections of the prostate (TUR-P) on lower urinary tract symptoms (LUTS) and other parameters in patients with a benign prostatic obstruction (BPO). MATERIALS AND METHODS: Forty-three patients who underwent TUR-P between 2018 and 2021 were assessed prospectively. The patients were divided into two groups according to the percentage of tissue removed (group 1 <30%, group 2 >30% resection). Age, prostate volume, amount of resected tissue, operative time, length of hospital stay, duration of catheterization, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and serum prostate-specific antigen (PSA) (ng/dl) at preoperative and postoperative three months were recorded. RESULTS: The percentage of tissue removed was 22.2% vs. 48.4% (p = 0.001), IPSS reduction was 77.7% vs. 83.3% (p = 0.048), QoL improvement was 77.2% vs. 84.8% (p = 0.133), Qmax increase was 171.3% vs. 193.5% (p = 0.032), and serum PSA decrease was 56.4% vs. 69.2% (p = 0.049) in groups 1 and 2, respectively. In addition, the operative time was 38.5 vs. 53.6 min (p = 0.001), the length of hospital stay was 2.0 vs. 2.4 days (p = 0.001), and the duration of catheterization average was 4.1 vs. 4.9 days (p = 0.002). CONCLUSION: Resections of at least 30% of prostatic tissue can provide a significant improvement in the symptoms and parameters related to benign prostatic obstruction, while resections of less than 30% of prostatic tissue can effectively reduce urinary symptoms and improve the quality of life in older adult patients with comorbidities who require shorter operating times.

Clinical Outcomes of Prostatic Artery Embolization in Patients with Benign Prostatic Hyperplasia: A Prospective Clinical Study.

OBJECTIVE: To determine the clinical outcomes of prostatic artery embolization applied to patients with Material and methods: The study includes 30 patients diagnosed with benign prostatic hyperplasia in the urology clinic between 2012 and 2016, for whom anesthesia was contraindicated due to advanced age and comorbidities and who underwent prostatic artery embolization. These patients were evaluated before the procedure and in the 1st, 3rd, 6th, and 12th months after the procedure. RESULTS: The mean prostate volume of the patients was 68 cm3 before the procedure and 45 cm3 12 monthsafter the procedure. A statistically significant decrease was observed (P = .001). The mean prostate-specific antigen value was 4.9 ng/dL before the procedure and 2.8 ng/dL 12 months after the procedure (P = .008). The mean Qmax value was 0 mL/s before the procedure and 12 mL/s 12 months after the procedure (P = .001). The mean international prostatic symptom scores value was 35 before and 16 twelve months after the proce-dure (P = .001). While the international index of erectile function value was 8.25 before the procedure, it was8.46 12 months after the procedure (P = .32). The quality of life index value was measured as 3.02 before theprocedure and 3.09 twelve months after the procedure; a statistically significant difference was determined (P = .027). CONCLUSION: Prostatic artery embolization, which is a minimally invasive procedure, can be applied as a safe and effective method to patients with benign prostatic hyperplasia who cannot tolerate anesthesia due to advanced age and comorbidities.

Comparison of the patient's satisfaction underwent penile prosthesis; Malleable versus Ambicor: Single center experience.

OBJECTIVE: To compare the surgical results, complications, and satisfaction levels of patients who underwent malleable penile prosthesis implantation (M-PPI) and Ambicor penile prosthesis implantation (A-PPI). MATERIAL AND METHODS: One hundred forty two patients who underwent penile prosthesis implantation [M-PPI (Promedon- Tube®, Cordoba, Argentina): 81, and A-PPI (American Medical Systems, Minnesota, USA): 61] between 2013-2018 were evaluated retrospectively. Patients' age, body mass index, smoking history, etiological factors, modified "Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Questionnaire" scores, shortening of the penis, and complications were recorded. RESULTS: The patients who performed A-PPI implantation were younger (56.27 ± 10.81 vs. 51.47 ± 11.79, p = 0.009). The EDITS scores of 31(38.2%) patients who underwent M-PPI and 44 (72.4%) patients who underwent A-PPI were available. It was observed that the scores on the following questions were statistical significantly higher in the A-PPI group: "Overall, are you satisfied with your penile prosthesis?, How much of your expectations did penile prosthesis meet?, How often do you use your penile prosthesis?" (p = 0.05, p = 0.048, p = 0.038). No difference was observed between the groups in terms of the scores on the other three questions (p = 0.447, p = 0.326, p = 0.365). A 61.3% of patients in MPPI (19/31) group, and 56.8% of patients in A-PPI (25/44) group stated penile shortening (p = 0.417). Mean shortening was reported as 2.1 ± 0.45 cm, and 2.12 ± 0.52 cm, in M-PPI and A-PPI groups, respectively (p = 0.90). CONCLUSION: It is remarkable that the patients who underwent A-PPI experienced higher satisfaction with their prosthesis. Even though it has not been evidenced in the current literature data, patients who have had either M-PPI or A-PPI should be informed about the risk of penile shortening.

Influence of COVID-19 pandemic on sexuality: a cross-sectional study among couples in Turkey.

Coronavirus disease 2019 (COVID-19) pandemic has been continuing to affect the lives of all people globally. It has been shown that restrictions due to changes in lifestyles lead to mental health problems. This study aims to investigate the effect of COVID-19 pandemic on couples' sexuality. A total of 245 volunteers (148 men and 97 women) were enrolled in the study. Generalized Anxiety Disorder-7, Patient Health Questionnaire, Perceived Stress Scale were administered to screen anxiety and depression symptoms. International Index of Erectile Function (IIEF-15) and Female Sexual Function Index (FSFI) along with self-constructed sexual behavior questionnaire were administered to participants, in order to evaluate sexual functions and behavioral changes during the pandemic. Sexual function scores (IIEF erectile function domain and total FSFI) during pandemic (24.55 ± 5.79 and 24.87 ± 7.88, respectively) were lower compared to the prepandemic period (26.59 ± 4.51 and 26.02 ± 6.22, respectively) (p = 0.001 and p = 0.027, respectively). During pandemic compared to prepandemic period, the frequency of sexual intercourse decreased in men (p = 0.001) and women (p = 0.001) while sexual avoidance and solitary sexual approach behaviors (masturbation or watching sexual content videos, etc.) increased in men (p = 0.001) and women (p = 0.022). However, the couples that spent more time together during the pandemic reported better sexual function scores (men; p = 0.001, women; p = 0.006). Although this is the first study evaluating couples from Turkey with a convenience sample, further studies with a greater number may better elucidate the effects of this pandemic on sexuality.

Verapamil attenuates renal tubular apoptosis in response to partial unilateral ureteral obstruction.

INTRODUCTION: Partial unilateral ureteral obstruction (PUUO) is the type of obstruction that is most often encountered in pediatric clinical practice. The majority of our knowledge on PUUO has been derived from experimental studies and the effects of PUUO on the kidney have still been a source of continual investigation. MATERIAL AND METHODS: In the present study, renal expression of p53, Fas and PCNA were examined in rabbits with long-term (4 weeks) partial obstruction. Additionally, the effect of calcium channel blocker on pronounced apoptotic changes were evaluated. RESULTS: Immunohistochemistry results revealed that PUUO for 4 weeks caused an upregulation of p53 to 55.2 +/- 2% and Fas to 30.1 +/- 1.1%, whereas verapamil challenge attenuated the expression of these two apoptotic markers (p53: 15.9 +/- 1.8%; Fas: 18.2 +/- 1.4%, p < 0.05). Importantly, PCNA activity was also increased in response to PUUO. However, verapamil treatment after onset of obstruction caused a markedly decrease in the expression of PCNA (42.9 +/- 10.8% vs. 9.6 +/- 2.1%, PUUO, PUUO + verapamil; respectively, p < 0.05). CONCLUSION: The expression of p53, Fas and PCNA molecules is associated with long-term partial ureteral obstruction, whereas verapamil seems to be a protective agent against apoptotic changes.

The use of artificial neural networks in decision support in vesicoureteral reflux treatment.

AIM: To develop a prediction model based on artificial neural networks (ANN) for the treatment selection in vesicoureteral reflux (VUR). METHODS: A total of 96 children with VUR (145 ureteric units (UU)) were treated at our institution during 2004-2006. An ANN based on quick propagation architecture was created with the commercially available software package. The patients' age and sex, the cause and grade of VUR, the affected ureter, the type of treatment (conservative, subureteric injection, or open surgery), existence of renal scar on DMSA, follow-up times and the number of injections were used as variables. These data were also transferred to a statistical software package and regression analysis was done. RESULTS: In all, 105 UU showed no reflux, 5 UU showed improvements in reflux grade (considered only in the conservative management group), and the remaining 35 UU showed persistence. In the training group (n = 99), ANN showed 98.5% sensitivity, 92.5% specificity, 97% positive predictive value, and 96% negative predictive value in predicting treatment outcome. CONCLUSIONS: We have demonstrated that ANN can accurately predict the resolution of VUR, and thus could be useful in daily clinical practice. This approach would allow urologists to aid in the decision-making process of VUR treatment.

Primary synovial sarcoma of the kidney: use of PET/CT in diagnosis and follow-up.

Primary renal synovial sarcoma is a rarely seen renal neoplasm. An experienced uropathologist is needed to make the pathological diagnosis. A patient, operated on with a prediagnosis of renal cell carcinoma, the pathology of which was reported as synovial sarcoma, is presented in this article. 18F-fluoro-deoxyglucose positron emission tomography and computed tomography were performed preoperatively and in the postoperative follow-up to detect the primary tumor and lymph node metastases.

Verapamil prevents the apoptotic and hemodynamic changes in response to unilateral ureteral obstruction.

INTRODUCTION: Obstruction of the urinary tract has marked effects on renal blood flow, glomerular filtration rate (GFR), and tubular function. Moreover, ureteral obstruction results in an injury response that can progress to irreversible renal fibrosis and tubular atrophy by apoptosis. METHODS: We examined the effect of a calcium channel blocker (verapamil) on renal functions and the abundance of apoptotic (p53, Fas, proliferating cell nuclear antigen [PCNA]) markers 1 week after Unilateral Ureteral Obstruction (UUO). RESULTS: Immunohistochemistry studies revealed that UUO was markedly associated with up-regulation in the expression of p53 (1550 +/- 82 vs 100 +/- 23%), Fas (657 +/- 48 vs 100 +/- 31%), and proliferating cell nuclear antigen (945 +/- 70 vs 100 +/- 17% of sham levels). Administration of verapamil normalized the up-regulation of apoptotic markers p53 (724 +/- 116 vs 1550 +/- 82%); Fas (162 +/- 38 vs 657 +/- 48%) and PCNA (353 +/- 54 vs 945 +/- 70%). Furthermore, tubular diameter, as an important marker for detecting tubular atrophy was significantly decreased compared to those in UUO rabbits. The percent area of interstitial fibrosis in UUO kidneys was significantly greater than that in Verapamil-treated kidneys. Importantly, Verapamil reduced the development of interstitial fibrosis in UUO rabbits. We measured the GFR and renal blood flow in UUO. Short-term Verapamil challenge partially prevented the decrease in GFR (non-treated UUO: 62 +/- 14; Verapamil + UUO: 119 +/- 7; Sham: 127 +/- 23 microL x min(-1) x kg body wt(-1), P < 0.05) and renal blood flow (non-treated UUO: 1.1 +/- 0.4; Verapamil + UUO: 5.0 +/- 0.2; sham: 6.3 +/- 0.2 mL x min(-1) x kg body wt(-1), P < 0.05). CONCLUSION: Verapamil significantly prevents impairment in renal function and also prevents the up-regulation of p53, Fas, and PCNA during UUO, demonstrating a marked renoprotective effect of Verapamil treatment in conditions with urinary tract obstruction.

Primary primitive neuroectodermal tumor of the kidney: a case report.

There are nearly 50 PNET cases in the literature with primary renal localization. The mean age for renal PNET is 28 but it can be seen in a wide range between 4 and 69 years. In this atypical localization PNET may be mistaken with a variety of small round cell tumors, particularly with blastema predominant Wilms' tumor and due to its distinctive prognostic and therapeutic features differential diagnosis is very important. Immunohistochemical studies are useful in discriminating PNET from other renal small round cell tumors. Renal PNETs tend to metastasize at early stages and they have a high rate of recurrence. Our case is a 45-year-old male presented with left flank pain and hematuria. In computerized tomography a mass in left kidney was observed and nephrectomy was performed. Histopathologic examination revealed a small round cell tumor with rosettes and pseudorosettes. Immunohistochemically the lesion was diffuse strong positive with CD99 and NSE, negative with LCA, pancytokeratin, vimentin, desmin, smooth muscle actin, chromogranine A and S-100. At the time of diagnosis the pathologic stage of the tumor was T1aN0Mx. The patient did not take any further therapy and in 1-year follow-up no local recurrence or distant metastasize occurred.

Thermochemotherapy in adjuvant treatment of primary high risk non muscle invasive bladder cancers: Single center results.

OBJECTIVE: To evaluate the results of Thermochemotherapy in adjuvant treatment of primary high risk non-muscle invasive bladder cancer in our center. METHODS: The study included 26 patients with an age of 51-78 years (mean: 62.4 years). All patients had transurethral tumor resection (TURB) after being diagnosed with a primary bladder tumor and were pathologically diagnosed with non-muscle invasive urothelial carcinoma. Thermochemotherapy (TCT) applications were performed via the Synergo® system SB-TS 101. RESULTS: Of the study participants, 13 patients had T1 Grade III, six patients had T1Grade III CIS (+), four patients had Ta Grade III, and three patients Ta Grade II multiple > 5 cm tumor. In all patients, six weeks plus six months protocol were completed. All patients completed the follow-up protocol. With a median follow-up time of 16.4 months (range: 6 - 48 months), recurrent urothelial carcinoma was identified in three patients. With a median follow-up time of 16.4 months, the recurrence-free survival was 88.4% in 26 patients included in the study. CONCLUSIONS: The obtained data suggest that the TCT method can be used effectively and safely in non-muscle invasive bladder cancers of primary high-risk. Prospective randomized studies will shed light on this subject which are BCG vs TCT in primary high risk patients and second course BCG vs TCT in the BCG insufficient patients.

Serum prolidase activity as a marker of osteoporosis in type 2 diabetes mellitus.

OBJECTIVES: Prolidase is a specific imidodipeptidase involved in collagen degradation. The increase in the enzyme activity is believed to be correlated with the increased intensity of collagen degradation This study aimed to evaluate serum prolidase activity and urinary deoxypyridinoline cross links in type 2 diabetic subjects with and without osteoporosis assessed by bone mineral density. DESIGN AND METHODS: Seventy-five patients (54 F/21 M) with type 2 DM and 43 age and gender matched healthy subjects (30 F/13 M) were recruited for this study. Serum prolidase activity was assessed with colorimetric determination. Urinary deoxypyridinoline (Dpy) was determined with electrochemiluminesence immunoassay. RESULTS: Serum prolidase activity was significantly lower in patients with type 2 DM than in the healthy controls (mean +/- SEM; 43.3 +/- 1.4 U/L and 53.3 +/- 2.2 U/L respectively, p: 0.000). Non osteoporotic diabetic patients had lower serum prolidase activity (median: 25th-75th percentiles; 39.5: 30.3-50.5 U/L) than osteoporotic diabetic patients (50.0: 41.8-56.3 U/L, p: 0.030) and healthy controls (52.0: 43.0-58.0 U/L, p: 0.004). Urinary Dpy excretion was not different between osteoporotic and nonosteoporotic diabetic patients. However it was lower in both diabetic groups than the healthy controls. We did not observe a statistically significant difference between the serum prolidase activity of dislipidemic/normolipidemic, hypertensive/normotensive, obese/nonobese, insulin/OAD treated, poorly/well-controlled patients and patients with/without diabetic nephropathy and retinopathy (p > 0.05). CONCLUSION: This study shows a significant decrease in serum prolidase activity in patients affected with type 2 DM, which may be interpreted as evidence of decreased bone resorption. Our data also suggest that serum prolidase activity may be a better marker of osteoporosis in diabetic state than Dpy.

Evaluation of heat shock protein 70 expression in renal parenchyma subjected to shockwave lithotripsy.

PURPOSE: In this experimental study in a rabbit model, renal parenchymal heat shock protein 70 (hsp70) levels were assessed in an attempt to evaluate the traumatic effects of high-energy shockwaves (HESW), which have been found to induce transient ischemia during the procedure. MATERIALS AND METHODS: Eighteen white New Zealand rabbits, each weighing 3 to 5 kg, were included in the study. The animals were divided into three groups, and various numbers of shockwaves (1000, 1500, or 2000) were applied to the same kidney of all animals under fluoroscopic localization with a Stonelith V5 lithotripter. Untreated contralateral kidneys were evaluated as controls. Following HESW application, the treated and untreated kidneys were removed surgically after 24 hours or 7 days. Tissue hsp70 levels were assessed by an immunohistochemistry method. RESULTS: During early follow-up (24 hours), both treated and untreated kidneys demonstrated moderate to severe hsp70 positivity. The number of positive tubules increased as the number of shockwaves increased, and positivity became more evident, possibly because of a higher degree of tissue damage. Contralateral kidneys demonstrated a limited degree of hsp70 positivity, although it was not as evident as in the treated kidneys. Assessment of tissue hsp70 levels during late follow-up (7 days) demonstrated moderate or limited degrees of positivity in the treated kidneys. Limited or no positivity could be demonstrated in the untreated kidneys during this period. CONCLUSIONS: Taking the known traumatic effects of HESW and the results of this study into account, the increasing positivity of hsp70 in parallel with the increasing number of shockwaves led us to think about a possible limited degree of ischemia induced by this procedure, as the traumatic effects of HESW were pronounced, as judged by tissue hsp70 positivity.

Triglycerides predict plasma fibronectin in children with type I diabetes mellitus rather than diabetes.

Fibronectins are adhesive proteins considered as markers of endothelial activation. Plasma fibronectin levels in diabetes mellitus (DM) have been found to be associated with atherosclerotic risk factors. This study was carried out to investigate plasma fibronectin and its relation with serum lipids, apolipoproteins AI, B100 and lp(a) in diabetic children. 35 children (19F/16M) with type I DM and 30 non-diabetic age and gender-matched controls were enrolled. Apolipoprotein and fibronectin concentrations were determined with nephelometric methods. Plasma fibronectin levels of the children with type I DM and the control group are not statistically different. HbA1c and triglycerides concentration are found to be significant predictors of plasma fibronectin in diabetic children, while effect of plasma cholesterol, apolipoprotein AI, B100 and lp(a) are insignificant. Diabetic children with triglycerides 1.13 mmol/l have elevated plasma fibronectin (median, 25th-75th percentiles; 29.6, 8.3-40.8 mg/dL) compared to the diabetic > or = 19.9, 8.6-30.7 mg/dL, p < 0.05) and non-diabetic children (16.6, 12.7-32.4 mg/dL, p < 0.01) with triglycerides < 1.13 mmol/L. On the other hand plasma fibronectin concentrations of diabetic and non-diabetic children with high triglycerides are not significantly different. In conclusion our data does not support the concept that plasma fibronectin is elevated in type I diabetes mellitus at least in children, but high plasma triglycerides secondary to diabetes or not is associated with higher FNp concentrations which may have implications on atherogenesis. Plasma cholesterol, apolipoproteins AI, B100 and lp(a) are not significant determinants of FNp in type I diabetic children.

Chemical cystitis developed in experimental animals model: Topical effect of intravesical ozone application to bladder.

AIMS: To demonstrate the effects of intravesical ozone treatment on inflammation and epithelial cell damage in chemical cystitis animal model. MATERIALS AND METHODS: A total of 30 New Zealand rabbits were divided into six groups. Cystitis was conducted with transurethral intravesical hydrochloric acid instillation on the subjects in Groups IA, IB, IIA, and IIB. Then, Group IA-IB subjects were transurethrally administered intravesical ozone therapy twice a week, while Group IIA-IIB subjects were only given intravesical isotonic NaCl instillation. Group IIIA-IIIB subjects were administered intravesical isotonic NaCl instillation without conducting chemical cystitis in order to create the same stress. Treatment schemes of all groups were arranged in the same manner. Following a 3-week (early period) and 6-week (late period) therapy, the rabbits were sacrificed and histopathologic investigations were carried out in order to demonstrate changes in the urinary bladder. RESULTS: In our study, we observed that the basal membrane and mucosal integrity were maintained, inflammatory cells were suppressed in Group IA-IB (Early and late period), which received ozone therapy. However, it was also observed that mucosal integrity was spoiled, numerous inflammatory cells were accumulated in Group IIA-IIB, which was administered isotonic NaCl. CONCLUSION: Due to its low cost and minimal side effects; ozone therapy could be a new therapeutic approach in the treatment of interstitial cystitis.

Comparison of the complications and the cost of open and laparoscopic radical nephrectomy in renal tumors larger than 7 centimeters.

PURPOSE: To compare the complications and the cost analysis of open radical nephrectomy (ORN) versus laparoscopic radical nephrectomy (LRN) in patients with renal tumors larger than 7 centimeters (cm). MATERIALS AND METHODS: A retrospective analysis was performed in 173 patients (ORN group, n = 140; LRN group, n = 33) who underwent surgery for kidney tumors between 2008 and 2011. Patients' age, tumor size, pre-operative surgical risk score (American Society of Anesthesiologists score), duration of hospitalization, complications and the costs of hospitalization were recorded. The complications in ORN group and LRN group were specified with Modified Clavien System in five grades. RESULTS: The mean age was found 58.52 ± 13.74 years in ORN group, and 58.15 ± 12.81 years in LRN group (P = .847). Post-operative pain necessitating analgesics was observed in all patients (100%) after early post-operative period in both groups (Grade 1 complications). Blood transfusions were required in 51 patients (36.42%) in the ORN group, and 7 (21.21%) patients in the LRN group (Grade 2 complications) (P = .185). Grade 3 complication was not observed in each groups. Grade 4 complications were occurred in 6 (4.28%) patients [aortic injury, acute tubular necrosis, the need for dialysis, respiratory arrest (2), atrial fibrillation] in the ORN group, and in 1 (3.03%) patient (pulmonary embolism) in the LRN group. Grade 5 complication was occurred in 1 (0.71%) patient (death) in the ORN group. By the cost analysis, the average cost of ORN group was €1328, whereas €1508 in LRN group (P < .05). CONCLUSION: Laparoscopy is used in many clinics with an increasing frequency because of the improved patient comfort, better cosmetic results, less post-operative pain, lower transfusion rates, and early return to the daily activities. Besides these advantages, the negligible difference in the costs compared to the open surgery (mean difference = €180 per case) makes it even more attractive.

Comparison of demographic data in patients undergoing Percutaneous Nephrolithotomy in Southeastern Anatolia and the Black Sea region: A multicenter study.

OBJECTIVE: The aim of this study was to compare demographic data in adult patients undergoing percutaneous nephrolithotomy (PNL) for kidney stone disease in university hospitals from Southeastern Anatolia and the Black Sea regions. MATERIAL AND METHODS: The demographic data of 535 (53.3%) patients undergoing PNL from Gaziantep University, Department of Urology (GAUN group), and 468 (46.6%) patients undergoing PNL from Ondokuz Mayis University, Department of Urology (OMU group) were evaluated retrospectively. Patients' gender, mean age, stone laterality, and size and results of the stone analyses were compared. RESULTS: The mean patient ages were 40.94±13.33 (17-81) and 48.03±13.95 (17-81) years in the GAUN and OMU Groups, respectively, (p=0.0001). The mean stone size was 716.01±449.60 (100-3000) mm(2) and 612.7±445.87 (65-3220) mm(2) in the GAUN and OMU Groups, respectively (p= 0.0001). There were no statistically significant differences between the groups with respect to stone laterality (p=0.196), and gender of the patients (p=0.65). Stone analysis revealed that the distribution of stone composition was as follows in the GAUN group: Ca oxalate (90.19%), cystine (7.84%), uric acid (5.88%), and struvite (1.96%). In the OMU group, the stone composition was as follows: Ca oxalate (86.84%), cystine (1.34%), uric acid (13.15%), and struvite (9.21%). CONCLUSION: The incidence of kidney stone disease varies throughout Turkey based on etiological factors, and a higher incidence of kidney stone disease is observed in the Southeastern Anatolia region endemically. Lower mean ages and higher stone sizes in patients undergoing PNL in southeastern Anatolia suggest that geographic factors can affect stone disease.