Posttraumatic High-Flow Nonischemic Priapism.

Priapism is an uncommon disorder, and nonischemic priapism is seen less frequently in children, generally after trauma. Although it seems to be an advantage that urgent intervention is not required because of no cavernous ischemia, it is likely to be misdiagnosed because of the asymptomatic potential. We aimed to present a case of posttraumatic nonischemic priapism.

Do the etiological factors in artificial urinary sphincter reimplantation cases affect success and complications?

Background/aim: The artificial urinary sphincter (AUS) is still one of the best options for incontinence treatment. It may also have an advantage for revision or reimplantation in the management of complications. In this study we aimed to discuss the etiological factors for AUS reimplantation and effects of these etiological factors on success rates, patient satisfaction rates, time to reimplantation surgery, and complications Materials and methods: Data from 30 patients for whom AUS reimplantation was performed were analyzed retrospectively. Incontinence due to fluid loss from the cuff or reservoir balloon, inability of the cuff to adequately compress the urethra, and devices that were thought to have completed their lifespans were defined as mechanical reasons while incontinence caused by conditions such as cuff erosion and infection were defined as nonmechanical reasons. Patients who went through reimplantation due to mechanical and nonmechanical causes were included in Group 1 and Group 2, respectively. Success rates, patient satisfaction rates, time between the implantation of the first and second AUS, and complications were compared between the groups. Results: The mean follow-up period was 79 (3­308) months for patients who went through primary AUS implantation due to postprostatectomy incontinence. Our success rates were found as 75% and 66% in Group 1 and Group 2, respectively. The differences between the groups in terms of success and patient satisfaction rates were not statistically significant, while the time to reimplantation was longer in Group 1 and statistically significant. Conclusion: Reasons for AUS reimplantation may affect the success and patient satisfaction rates. Our success rates of AUS performed for nonmechanical reasons were slightly lower, but not statistically significantly so. AUS reimplantation may take a longer time if mechanical failure is detected.

Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures-a single-center experience.

PURPOSE: To evaluate the factors affecting complication rates of flexible ureteroscopy and laser lithotripsy (FURSL). MATERIALS AND METHODS: Data on a total of 1395 patients, with 1411 renal units underwent 1571 procedures with FURSL for renal and/or proximal ureteral stones between April 2012 and January 2016, were retrospectively analyzed. Complications were assessed using the Satava and modified Clavien systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS: The mean patient age in the total procedures was 45.68 ± 14.00 years (range 2-86 years), and the mean stone size was 15.15 ± 8.32 mm (range 5-75 mm). The overall success rate was 95.6 %. A total of 209 (13.3 %) cases suffered from complications with intraoperative complications rates of 5.9 % and postoperative complication rates of 7.3 %. Univariate analysis revealed no significant difference in complication rates in respect of age, gender, body mass index, use of ureteral access sheath, operation time, bleeding disorder, solitary kidney, preoperative stenting, American Society of Anesthesiologists score, repeated procedure or location of stones (all p value >0.05). Complication rates were determined to be significantly affected by stone size (p = 0.026), multiplicity (p = 0.028) and the presence of congenital renal abnormality (p < 0.01). The only significant factor in multivariate analysis was the presence of congenital renal abnormalities (p = 0.02). CONCLUSIONS: The results of the current study indicated that stone size, stone number and the presence of congenital renal abnormalities were factors affecting complication rates after FURSL, although congenital renal abnormality was the only independent predictor among these risk factors.

Comparison of percutaneous nephrolithotomy, shock wave lithotripsy, and retrograde intrarenal surgery for lower pole renal calculi 10-20 mm.

OBJECTIVE: To compare the results of percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL), and retrograde intrarenal surgery (RIRS) for 1- to 2-cm lower pole kidney stones. PATIENTS AND METHODS: This retrospective study was based on data collected from the files of patients between January 2007 and May 2012. The files of 383 patients (221 SWL, 144 PCNL, 38 RIRS) were evaluated. The groups were compared for stone size, success rate, and complication rate using the modified Clavien grading system. RESULTS: The stone burdens of the groups were similar (p = 0.36). The success rates were 76, 94, and 73%, respectively, in SWL, PCNL, and RIRS. The highest stone-free rate was in the PNL group (p < 0.05). When the complication rates were evaluated using the Clavien grading system, they were determined to be 13% in PCNL, 3% in SWL, and 5% in RIRS. Especially GII and GIII complications were more common in the PCNL group (p < 0.05). CONCLUSION: PCNL seems to be the most successful but most invasive method. However, with relatively low complication rates, SWL and RIRS are other techniques to keep in mind. To determine the first-line treatment, prospective randomized studies with larger series are needed.

Previous open renal surgery increased vascular complications in percutaneous nephrolithotomy (PCNL) compared with primary and secondary PCNL and extracorporeal shock wave lithotripsy patients: a retrospective study.

OBJECTIVE: To evaluate the vascular complications of percutaneous nephrolithotomy (PCNL) patients who have undergone previous open surgery, PCNL and extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: 360 patients who underwent a PCNL procedure were included into the study. The patients were divided into 4 groups: group 1: primary PCNL (n = 232); group 2: previous open nephrolithotomy (n = 42); group 3: previous PCNL (n = 33); group 4: previous ESWL (n = 63). The periods of operation and fluoroscopy use of the groups were compared in terms of residual stones, with haematuria, pre-operation and post-operation first-day haemoglobin values. Patients with persistent haematuria were assessed through ultrasonography (US), Doppler US, computed tomography and angiography. RESULTS: Upon comparison of the patients' pre- and post-operative haemoglobin changes, haemoglobin was statistically higher in the previous open operation group than the others (p = 0.02). Permanent and intermittent haematuria were detected in 12 (3%) and 7 patients (1%), respectively. Angiography was done in 7 (1.94%) patients. This rate was 9.5% for group 2 and 3% for group 3. These rates were found to be statistically higher than compared to the other groups. Arteriovenous fistula (AVF) was detected in 4 of these patients and pseudoaneurysm in 1. While 1 of the patients with AVF improved spontaneously, embolisation was applied to 4 patients. Four of the patients had had a previous open operation, while 1 had had a PCNL treatment. CONCLUSIONS: Vascular complication is a rare complication of PCNL that can be successfully managed with angioembolisation. Our results indicate that previous open surgery significantly predicted the occurrence of these lesions.

Efficacy and safety of propiverine and terazosine combination for one year in male patients with luts and detrusor overactivity.

PURPOSE: To evaluate the long term efficacy and safety of the use of propiverine and terazosine combination in patients with LUTS and DO by a placebo controlled study. MATERIALS AND METHODS: One hundred patients were enrolled in the study. They were randomized into two groups (each group consisted of 50 patients). Terazosine and placebo were administered to the patients in Group 1 and terazosine plus propiverine HCL was administered to Group 2. The patients were evaluated by international prostate symptom score (IPSS), the first four questions of IPSS (IPSS4), the 8th question of IPSS (quality of life-QoL), overactive bladder symptom score questionnaire (OAB-q V8), PSA test, urodynamic studies, post voiding residue (PVR). All patients were followed for one year and were reassessed for comparison. RESULTS: IPSS, IPSS4, OAB symptoms, QoL score, PVR, and Qmax scores of the groups did not differ. After one year treatment, there was significant improvement in IPSS, IPSS4, OAB symptoms, QoL and Qmax values in Group 2. No significant improvement was noted for the same parameters in Group 1. CONCLUSION: This is the first study to show long term safety and efficacy of anticholinergic therapy for patients with LUTS. In patients with OAB or DO, long term anticholinergic treatment may be regarded as a treatment option.

Comparison of the Conventional PNL with Ecirs in the Treatment of Complete Staghorn Kidney Stones.

OBJECTIVE:  To analyse the results of conventional percutaneous nephrolithotomy (PNL) and endoscopic combined intrarenal surgery (ECIRS) in treating complete staghorn kidney calculi. STUDY DESIGN:  A comparative study. Place and Duration of the Study: Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, between January 2007 and January 2022. METHODOLOGY:  Clinical data and surgical outcomes of the adult patients who underwent conventional PNL or ECIRS were retrospectively reviewed. Two patient groups were compared regarding the fluoroscopy time, the number of access, surgical time, duration of hospitalisation, haemoglobin (Hb) reduction, complication, and stone-free rates.  Results: There were 132 renal units in the conventional PNL (Group 1) and 45 renal units in the ECIRS group (Group 2). The comparative analysis revealed that fluoroscopy time, surgical time, duration of hospital stay, number of access, and the Hb drop were significantly lower in the ECIRS group compared to the conventional PNL group. Although stone-free rates were 48.5% in Group 1 and 64.4% in Group 2, p=0.064 and p>0.05 respectively). The median value of the complication grade was 1 (1-7) in Group 1 and 1 (1-5) in Group 2, (U=2446.5, p=0.026).  Conclusion: The ECIRS is a successful and more secure surgical method for treating complete staghorn stones than PNL. KEY WORDS:  PNL, ECIRS, Staghorn, Kidney, Stone.

Does Post-COVID-19 Erectile Dysfunction Improve over Time?

BACKGROUND: Some studies have shown that there may be an increase in the frequency of erectile dysfunction after COVID-19. However, no long-term study has investigated whether this is permanent or temporary. In this study, we aimed to examine whether there was an increase in the frequency of erectile dysfunction among individuals with a history of COVID-19, and, if there was, whether their condition improved over time. MATERIALS AND METHODS: In this study, a total of 125 healthy male healthcare workers, 95 with and 30 without a history of COVID-19, were evaluated in terms of erectile function. Four study groups were formed. The first three groups consisted of individuals with a history of COVID-19 confirmed by the polymerase chain reaction (PCR) test at different times, who recovered from the disease (time elapsed since COVID-19 positivity: <6 months for Group 1, 6 to 12 months for Group 2, and >12 months for Group 3). The individuals in Group 4 did not have a history of COVID-19 diagnosis. In order to evaluate the erectile function of the participants, they were asked to complete the five-item International Index of Erectile Function questionnaire (IIEF-5). Then, statistical analyses were performed to evaluate whether there was a difference between the groups in terms of the IIEF-5 scores. RESULTS: There was a statistically significant difference between the groups in terms of the IIEF-5 scores (p < 0.001), and this difference was determined to be caused by the significantly higher IIEF-5 scores of Groups 3 and 4 compared to Group 1 (p = 0.004 and p < 0.001, respectively). In addition, the IIEF-5 score of Group 4 was statistically significantly higher than that of Group 2 (p < 0.001). However, the IIEF-5 scores did not statistically significantly differ between Groups 1 and 2, Groups 2 and 3, and Groups 3 and 4 (p > 0.999, p = 0.204, and p = 0.592, respectively). CONCLUSION: There may be deterioration in erectile function after COVID-19; however, this tends to improve over time, especially from the first year after active infection. Given that vascular, hormonal, and/or psychogenic factors may lead to the development of erectile dysfunction after COVID-19, we consider that in order to easily manage this process, it is important to determine the underlying cause, initiate appropriate treatment, and inform couples that this situation can be temporary.

The effect of metabolic syndrome upon the success of varicocelectomy.

We aimed to investigate the impact of metabolic syndrome (MetS) on the varicocele treatment. 101 patients underwent spermatic vein ligation between 2007 and 2010 were retrospectively analyzed. Those patients were divided into two groups as without (n: 56, Group 1) or with MetS (n: 48, Group 2). All the patients underwent left microsurgical subinguinal spermatic vein ligation. Groups were compared by the improvement on sperm parameters and spontaneous pregnancy rates at a mean of 19 (±4) months followup. When sperm parameters were compared postoperatively, the significant improvement in total sperm count, motile sperm count percentage, and normal sperm percentage was reported. The groups were compared to each other and the improvement seemed significantly better in Group 1. There was no statistically significant improvement difference in the normal sperm percentage between groups. Spontaneous pregnancy rate after two years was 45% in Group 1 and 34% in Group 2 (P < 0.05). Patients with MetS and varicocele improved after surgery, but not as well as the similar group without MetS. This may help to show that MetS can be a factor for male infertility.

The comparison of standard and tubeless percutaneous nephrolithotomy procedures.

PURPOSE: To compare totally tubeless and standard percutaneous nephrolitotomy procedures on many parameters. MATERIALS AND METHODS: Percutaneous nephrolitotomy was performed on 195 patients between June 2009 and May 2012. The data of those patients were evaluated retrospectively. Totally tubeless cases were enrolled to Group 1, and Group 2 consisted of non-tubeless cases (re-entry or Foley catheter). RESULTS: Group 1 included 85 cases and group 2 a total of 110 patients. Paper tracing values for the kidney stones were 321.25 ± 102.4 mm(2) and 324.10 ± 169.5 mm(2) respectively. Mean fluoroscopy time was 4.9 ± 1.9 min and 5.08 ± 2.7 min, mean operation time was 78.8 ± 27.9 min and 81.9 ± 28.77 min and mean decrease in hematocrit was 2.6 ± 1.6 and 3.74 ± 1.9 respectively. All these comparisons were statistically significant. Length of hospitalization was 1.6 ± 1.1 and 3.5 ± 1.5 days for Groups 1 and 2 respectively. Mean superficial pain score was 5.8 ± 1.6 and 6.7 ± 1.2 respectively for both groups after 1 hour. At 6 hours, the scores changed to 3.87 ± 1.22 and 4.84 ± 1.3 respectively. The analgesic dose was 1.00 ± 0.7 and 1.53 ± 0.6 for the groups respectively at 6 hours. All the statistical differences were significant for these three parameters. CONCLUSIONS: We believe that, because of their post operative patient comfort and decreased length of hospital stay, totally tubeless procedures should be considered as an alternative to standard percutaneous nephrolitotomy.

Assessment of anti-sperm antibodies in couples after testicular sperm extraction.

PURPOSE: Testicular spermatozoa can be retrieved successfully by the testicular sperm extraction (TESE) procedure and used for intracytoplasmic sperm injection. Disruption in the blood-testis barrier can lead to the production of antisperm antibodies (ASA). The aim of this prospective study was to investigate the frequency of ASA formation in couples after TESE procedure. METHODS: Thirty-seven couples were included in the study at the Urology Clinic of the Dr. Zekai Tahir Burak Women's Health Training and Research Hospital. History, physical examination, spermiogram, and endocrine profiles were obtained for all male patients. All the male patients in this study had been diagnosed with nonobstructive azoospermia (NOA) and underwent microdissection TESE. Secondary and tertiary cases were also included in the study. Serum samples were obtained from all 74 patients before TESE, and at three and 12 months after TESE. Serum ASA levels were determined. ANOVA was performed for statistical analysis for serum Follicle-Stimulating Hormone (FSH), testosterone and testicular volume. P < 0.05 was considered significant. RESULTS: There were no differences in the testicular volumes, serum FSH and testosterone levels before and after TESE. None of the patients or their partners developed significant levels of ASA as a result of the TESE procedure. CONCLUSION: TESE procedure does not cause ASA production in either males or their female partners.

Caspase-3 and VEGF immunopositivity in seminiferous tubule germ cells in cases of obstructive and non-obstructive azoospermia in smokers versus non-smokers.

PURPOSE: To investigate immunostaining pattern of caspase-3, an apoptosis marker, and vascular endothelial growth factor (VEGF), an hypoxia marker in testis biopsy specimens collected either from smoking or non-smoking patients with azoospermia. METHODS: Testis biopsy specimens were obtained from thirty seven non-smoker and thirty eight smoker patients. Using immunochemistry technique, caspase-3 and VEGF were evaluated in all intratubular spermatogenic and interstitial Leydig cells. RESULT(S): Caspase-3 expression was significantly increased in germ cells in maturation arrest specimens in smoker azoospermic patients. No statistically significant difference was present between smokers and non-smokers for caspase-3 expression in Sertoli cell. However, the VEGF immunopositive Leydig cells were statistically higher in smokers. There were no differences between groups in terms of germ cell immunopositivity. CONCLUSION: Our results support the hypothesis that increased apoptosis contributes significantly to impaired spermatogenesis. We conjecture that germ cell apoptosis may be augmented by hypoxic microenvironments and environmental toxicants in smoking azoospermic men.

Effect of histopathologic characteristics on pseudocapsular invasion in the case of partial nephrectomy for renal tumours.

OBJECTIVE: It is aimed to define the existence of pseudocapsular structure on renal tumours, illuminate the relation between pseudocapsular invasion and Fuhrman grade histological type that are among histopathologic prognostic risk factors and determine the relation between surgical margin positivity and existence of pseudocapsular invasion. Sequential partial nephrectomy series and relevant pathological preparations were retrospectively reviewed in order to evaluate these issues. METHODS: The study includes 123 patients diagnosed with T1 renal tumour and treated with partial nephrectomy in between January 2007 and June 2016. Benign angiomyolipoma was excluded due to complete non-existence of pseudocapsule. 99 T1 patients diagnosed with renal cell cancer whose pathological slides can be duly analysed were included in the study. Clinical and pathological details were evaluated for all patients. Existence of pseudocapsule was revealed for all patients. Pseudocapsule invasion was classified by existence of expansive and infiltrative type and non-existence of pseudocapsule invasion. The groups have been assessed by their histopathologic characteristics. RESULTS: Compared to the group in which pseudocapsular invasion was not detected, clear-cell histological subtype was observed more frequently in a statistically significant way in the group with expansive pseudocapsular invasion and infiltrative pseudocapsular invasion respectively (p = 0.017 and p < 0.001). Pathological tumour sizes were found out to be statistically similar (p = 0.874). There was not a statistically significant difference in terms of Fuhrman grade (p = 0.220). There was not a statistically significant difference in terms of surgical positive margin (p = 0.609). CONCLUSION: It was indicated in our study that only the histological subtype affected pseudocapsular invasion in group of patients treated with partial nephrectomy but tumour size, tumour stage, tumour location as well as endophytic and exophytic character did not affect invasion. It has also been revealed that surgical margin positivity is not correlated with pseudocapsular invasion.

Simultaneous Bilateral Quadriceps Tendon Rupture in a Patient with Diffuse Idiopathic Skeletal Hyperostosis after Minimal Trauma: Eight-Year Follow-Up.

INTRODUCTION: The purpose of this report was to describe a very rare case of simultaneous bilateral quadriceps tendon rupture seen in a patient who was diagnosed as having diffuse idiopathic skeletal hyperostosis. CASE PRESENTATION: A man aged 64 years presented to the emergency department with bilateral quadriceps tendon rupture. Surgical repair was performed with suture anchors and a stainless steel cable. His legs were immobilized in casts for six weeks. After removal of the casts, physiotherapy was started. Four months after surgery, he was able to walk with 0°-120° range of motion and active extension. He was followed up for 8 years without rerupture or other complications. CONCLUSION: Bilateral rupture of the quadriceps tendon is a rare condition and generally related to metabolic disorders. Diffuse idiopathic skeletal hyperostosis is a metabolic disorder that causes bilateral quadriceps tendon rupture, and it accounted for the differential diagnosis of the underlying condition.

Intraneural ganglion cyst of the ulnar nerve in an unusual location: A case report.

INTRODUCTION: Intraneural ganglion cysts are benign, mucinous, non-neoplastic lesions of the peripheral nerves. While the most common location of intraneural ganglion cysts is the ulnar nerve and its branches, intraneural ganglion cyst involving the superficial branch of the ulnar nerve has not yet been reported. PRESENTATION OF CASE: A-25-year-old woman presented with pain and a palpable mass in the hypothenar region of the volar side of her right hand. Her neuromuscular examination was normal. The pain was unresponsive to nonsurgical treatments. After confirming with imaging modalities, the initial diagnosis was considered as an intraneural ganglion cyst arising from superficial ulnar nerve. Excision of the ganglion and exploration of the articular branch (if seen in operation) decision was undertaken by the senior author. Whether MRI or intraoperative exploration, not identified an articular branch. DISCUSSION: Intraneural ganglion cysts of peripheral nerves may be seen in miscellaneous locations in the body. However, to our knowledge, an intraneural ganglion cyst involving the superficial branch of the ulnar nerve is unique. While a variety of theories have been proposed to enlighten the etiopathogenesis of intraneural ganglia, the latest and most affirmed is the unifying articular (synovial) theory. CONCLUSION: Intraneural ganglion cysts may be seen on the hypothenar side of the palm. The etiology and treatment of choice are closely associated with each other in this rare disorder. It is important to realize a related articular branch, otherwise the origin of cyst formation remains, and this may cause other para-articular cysts.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Methods in Treatment of Upper Calyceal Stones of 10-20 mm.

OBJECTIVE: To compare the success and complication rates and advantages and disadvantages of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) methods for the upper calyceal renal stones between 10 and 20 mm. MATERIALS AND METHODS: The files of 124 patients who had upper calyceal renal stones in diameter 10-20 mm were analyzed retrospectively. Sixty-one patients were randomized as Group 1 and 63 as Group 2. The parameters as success and complication rates, fluoroscopy and operation times, preoperative and postoperative hemogram (Hb) levels, and need of blood transfusion were saved and then groups compared. Complication rates and need of second procedure numbers between groups were evaluated according to modified Clavien classification. RESULTS: Demographic features and success and complication rates between groups were similar. Hospitalization time was 1.0 ± 0.1 day for Group 1 and 2.3 ± 1.4 days for Group 2. When preoperative and postoperative Hb difference was evaluated, 0.1 ± 0.3 mg/dL decrease was noticed for Group 1 and 1.6 ± 0.8 mg/dL decrease for Group 2. Mean operation time for Group 1 was 53.6 ± 15.1 minutes and mean fluoroscopy time was 20.1 ± 8.9 seconds for Group 1; for Group 2, these values were 67.8 ± 16.2 minutes and 53 ± 15.0 seconds, respectively. As a result, mean operation time and fluoroscopy time, hospitalization time, and Hb decrease levels were found less and as statistically significant for Group 1. CONCLUSION: RIRS and PNL methods both have the same success and complication rates for upper calyceal renal stones between 10 and 20 mm. However, we think that RIRS method should be preferred for suitable patients because it is a more noninvasive method and has advantages of some operation parameters over PNL.

Rapid communication: renal apoptosis after shockwave application in rabbit model.

PURPOSE: To identify any apoptotic effect of shockwave lithotripsy (SWL) on renal tubular and glomerular cells. MATERIALS AND METHODS: Thirty-five male New Zealand White rabbits were divided into five groups of seven rabbits each: I (control), II (sham), and III, IV, and GV (treated and sacrificed 1, 7, and 28 days after SWL, respectively). Intramuscular anesthetic agent (ketamine HCl; 20 mg/kg) and intravenous contrast medium (iohexol 300 mg of I/mL) were administered to animals in group II. The left kidneys of animals in groups III, IV, and V were exposed to 2000 shockwaves at 18 kV after administration of anesthesia and contrast medium. The animals were sacrificed on day 1, 7, or 28 after SWL, and the kidneys were removed. Apoptotic and proliferative indices of renal tubular and glomerular cells were determined by terminal deoxynucleotidyl transferase dUTP nick and label (TUNEL) and Ki-67 labeling methods, respectively, counting 1000 cells in each preparation. RESULTS: No apoptosis was detected in glomerular cells in any group. The mean apoptotic indices of the tubular cells in animals in groups I and II were 483.0 +/- 85 and 484.4 +/- 105, respectively with no significant difference between the groups. In groups III and IV, the mean apoptotic indices were 343.4 +/- 89 and 358.4 +/- 61, respectively. There were no statistically significant differences between groups III and IV and the control group. Similarly, there were no significant differences in the apoptotic indices in groups III and IV. However, the apoptotic index in group V was 821.4 +/- 57, significantly higher than in the control group. The proliferative indices of all SWL groups were lower than that of the control group. CONCLUSION: Shockwave lithotripsy has an apoptotic effect on renal tubular cells that can be detected 4 weeks after the procedures, but no apoptotic effect on glomerular cells. Treatment with SWL also attenuates the proliferation of both tubular and glomerular cells.

Comparison of Dilation Methods in Percutaneous Nephrolithotomy: Which One Is More Successful?

OBJECTIVE: Creation of the access tract is an important step in percutaneous nephrolithotomy (PNL). In this study, we compared the efficiency and safety of Amplatz, Alken, and balloon dilation methods in the creation of the access tract. MATERIALS AND METHODS: Data from 487 PNL patients admitted to 517 renal units in 3 centers were analyzed. The Amplatz (280 patients), Alken (142 patients), and balloon (95 patients) dilation methods were compared for their success, duration of the dilation, injury to the collecting system, durations of fluoroscopy and surgery, stone-free and complication rates, pre- and postoperative hematocrit levels, and need for blood transfusion. RESULTS: The dilation methods did not significantly differ with respect to patient demographic data, mean stone area, decrease in hematocrit, need for blood transfusion, unsuccessful tract dilation, injury to the collecting system, stone-free rate, and rate of postoperative complications. The mean fluoroscopy times during Amplatz, Alken, and balloon dilation were 288.52 ± 164.67, 287.34 ± 164.99, and 169.23 ± 21 seconds, respectively. The mean duration of surgery was 96.48 ± 46.07, 94.72 ± 42.25, and 78 ± 25.96 minutes, respectively. The duration of tract creation was 328.67 ± 172.99, 325.14 ± 175.70, and 203.50 ± 32.76 seconds, respectively. The durations of surgery and tract creation were significantly shorter in the balloon dilation group. CONCLUSION: None of the dilation methods was significantly superior in terms of surgical success, efficiency, or safety. Although balloon dilation was advantageous with respect to time parameters, the role of surgical experience should not be ignored.

Comparison of Flexible Ureterorenoscopy and Laparoscopic Ureterolithotomy Methods for Proximal Ureteric Stones Greater Than 10 mm.

OBJECTIVE: To examine the outcomes and to compare the effectiveness of laparoscopic ureterolithotomy and flexible URS in patients with proximal ureteral stones greater than 10 mm in diameter. MATERIAL AND METHODS: A total of 150 patients who were performed laparoscopic ureterolithotomy and flexible URS because of uretral stones in our urology clinic between January 2010 and June 2015, were analyzed retrospectively. We constituted two groups; 70 patients who were performed laparoscopic ureterolithotomy were included in group I while flexible URS-performed 80 patients in group II. Success rates and complications of the group I and II were compared. RESULTS: Success rates were 95.7% and 90% in group I and II respectively. There was no significant difference between the groups in terms of "success-rates". No statistically and clinically significant complications occurred in both groups. CONCLUSION: Laparoscopic ureterolithotomy and flexible URS methods are effective and reliable with proper indications in treatment of proximal ureteral stones. However, when considered short operational and hospitalization times and the management of the situations that require secondary interventions, we suggest that flexible URS is a minimally invasive method and it may be the first choice in the treatment of proximal ureteral stones.

Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial.

OBJECTIVE: To present the outcomes of flexible ureteroscopy (F-URS), shock wave lithotripsy (SWL), and observation in the management of asymptomatic lower calyceal stones. METHODS: A total of 150 patients with asymptomatic lower calyceal stones were randomized into F-URS (group 1), SWL (group 2), and observation (group 3) groups. The main criteria for patient enrollment were having asymptomatic single lower pole stones <1 cm. RESULTS: In F-URS, the mean stone-free rate was 92% (46 of 50). The mean number of sessions for the SWL group was 1.48 ± 0.65. Stone-free rate was 90% (45 of 50). In the observation group, patients were followed up for a mean of 21.02 ± 3.65 months. Three stones passed spontaneously without any symptoms. Pain developed in 3 patients during follow-up, and 2 of them passed a stone and responded to analgesics without further treatment. Complication rates for groups 1 and 2 were similar, but group 2 had higher Clavien grades. CONCLUSION: For asymptomatic small-sized lower calyceal stones, SWL and F-URS are established treatment modalities. However, with low auxiliary treatment rates, observation may be an option for the management of nonsymptomatic small-sized lower pole kidney stones.