Incidental detection of prostate-specific antigen-negative metastatic prostate cancer initially presented with solitary pulmonary nodule on fluorodeoxyglucose positron emission tomography/computed tomography.

A 71-year-old male patient with solitary pulmonary nodule underwent fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) showing slightly increased FDG uptake in this nodule. In addition, PET/CT detected hypermetabolic sclerotic bone lesions in the right second rib and 7(th) thoracic vertebrae, which were interpreted as possible metastases, and mildly increased FDG uptake in the prostate gland highly suspicious of malignancy. The patient's prostate-specific antigen (PSA) level was within normal range (3.8 ng/dL). The histopathological examination of the lung nodule and right second rib lesion proved metastases from prostate cancer, then the prostate biopsy-confirmed prostate adenocarcinoma. The unique feature of this case is to emphasize the importance of performing PET/CT for solitary pulmonary nodule in detecting PSA-negative metastatic prostate cancer. This case indicated that it should be kept in mind that, even if the PSA is negative, a lung metastasis of prostate cancer may be an underlying cause in patients evaluated for solitary pulmonary nodule by FDG PET/CT.

Does aging affect the outcome of percutaneous nephrolithotomy?

To investigate whether aging affects surgical outcomes by comparing the results of two patient groups undergoing PNL: those over 60 and those under 60. A retrospective screen was made for patients undergoing conventional PNL surgery for renal stones performed in two separate centers between 2010 and 2013. 520 patients included were classified into age groups: patients aged 18-59 comprised Group-1 and those aged over 60 comprised Group-2. Those between 60-69 years (sexagenarian) were assigned to Group-2a; 70-79 years (septuagenarian) to Group-2b; and 80-89 years (octogenarian) to Group-2c. Patients' demographic characteristics (accompanying comorbidities, ASA scores, body mass indices and stone size) and perioperative values (duration of surgery and hospital stay, success and complication rates) were compared between the groups. Mean stone size was similar in groups (30.1 ± 15.5 vs. 31.5 ± 15.4 mm, p = 0.379). The mean ASA value for the patients in Group-1 was 1.61; significantly lower than that in the other groups (p = 0.000). The level of accompanying comorbidities in Group-1 was significantly lower than that of the other groups (p = 0.000). The mean duration of surgery, postoperative hematocrit drop, complication and success rate were statistically similar in Groups 1 and 2 (p = 0.860, p = 0.430, p = 0.7, and p = 0.66, respectively). The duration of hospital stay was significantly shorter in the patients in Group-1 compared to those in Group-2 (p = 0.008). In experienced hands, PNL can be safely and reliably performed in the treatment of renal stones in elderly patients.

Outcomes of retrograde flexible ureteroscopy and laser lithotripsy for stone disease in patients with anomalous kidneys.

Due to the presence of structural and anatomical differences that accompany anomalous kidneys, currently available endourological modalities such as SWL and PNL may be insufficient, or additional laparoscopic assistance may be required. The present study aims to evaluate the efficacy and safety of retrograde flexible ureterorenoscopic stone treatment in patients with kidney anomalies. Over the last 3 years, 25 patients with renal stones in anomalous kidneys were consecutively treated by flexible ureterorenoscopy and holmium:YAG laser lithotripsy. Among the 25 patients, fiberoptic or digital flexible ureterorenoscopies were performed for the management of horseshoe kidneys (n = 3), cross-fused ectopic kidney (n = 1), renal ectopies [n = 13; associated with pelvic (n = 6) or lumbar kidneys (n = 7)], renal malrotations (n = 4), and duplicate ureters (n = 4). For lithotripsy, 200 or 273 µm probes were used, and for stone retraction 1.3-1.9 Fr ZeroTip baskets were used. Success was defined as the complete absence of stones as evaluated with a CT scan 1 month after the operation. The mean patient age was 39.4 ± 15.75 years, and the mean stone size was 194.64 ± 103.93 mm(2) (range 50-393). Complete stone clearance was achieved in 16 patients (64%) after a single session. Seven of the patients with residual stones underwent a second session and the remaining three patients were subsequently treated with SWL. The overall complete clearance rate was 88% (22 patients) with ancillary procedures. There were no serious postoperative complications except for one case (4%) of urosepsis. Flexible ureterorenoscopy with holmium laser lithotripsy is a safe option for the treatment of renal stones in anomalous kidneys with satisfactory success rates.

Factors affecting outcomes of percutaneous nephrolithotomy in horseshoe kidneys.

OBJECTIVE: To analyze the patient- and procedure-related factors affecting the outcomes of percutaneous nephrolithotomy (PNL) in horseshoe kidneys (HSKs). METHODS: A retrospective analysis was done of patients with stones in HSKs treated with PNL in 3 referral centers between 1998 and 2013. Demographics, along with perioperative characteristics, were evaluated in detail as to whether or not they had an effect on the success and complication rates. RESULTS: A total of 54 HSKs with calculi in 53 patients were treated with PNL. Mean stone size was 28.4 ± 19.6 mm (range, 10-120 mm). Fifty-three patients were treated through a single tract, and 1 patient required additional access. Access was directed to the upper calyx (n = 27), middle calyx (n = 17), and lower calyx (n = 10) through the intercostal (n = 23) and subcostal (n = 31) areas. Flexible nephroscopy was used in 18.5% of the procedures. Postoperative complications were observed in 9 (16.7%) of the procedures. Success rate was 66.7% after a single session of PNL and increased to 90.7% with additional treatments. Although patient demographics, preoperative imaging, and other operative measures did not have significant effect on the complication rate, stone complexity and multiplicity, in combination with flexible nephroscopy, were found to significantly affect the success rate (P = .026, P = .043, and P = .021, respectively). However, in multivariate analysis stone multiplicity was the only factor that affected success rate (P = .004). CONCLUSION: Stone parameters play an important role in achieving stone-free status in HSKs. Use of flexible nephroscopy positively affects the success rate by allowing reaching the peripherally located calices.

Clinically insignificant residual fragments after flexible ureterorenoscopy: medium-term follow-up results.

The characteristics of clinically insignificant residual fragments (CIRFs) are well described after percutaneous nephrolithonomy (PCNL) and shock wave lithotripsy (SWL). In follow-up procedures, CIRFs are associated with obstruction, infectious conditions, and recurrent stone development. In this study, we aim to determine the medium-term outcomes of CIRF. Between May 2009 and January 2013, 384 patients underwent flexible ureterorenoscopy (F-URS). In 44 patients, CIRFs were diagnosed with abdominal CT between 3 weeks and 3 months after the operation. Periodic follow-up, including clinical examination, serum biochemistry, urine culture, and radiological imaging, was performed for all patients. Also, 24 h urine analysis and stone composition were evaluated. Asymptomatic patients with stable stone sizes or patients with spontaneous clearance were classified in group 1 and patients with increasing stone sizes or those who became symptomatic were classified in group 2. The variables affecting stone recurrence between the two groups were compared. A total of 15 patients showed symptoms and/or stone development in the median 30.5 ± 8.809 months follow-up period. Additional treatment modalities-including F-URS in five patients, URS in three patients, SWL in two patients, and PCNL in one patient-were performed in 11 patients. The pre-operative stone burden and the number of patients with metabolic abnormalities were significantly higher in group 2 than in group 1. Medium-term follow-up of CIRF after F-URS demonstrated that recurrence is common within 2 years. The presence of a pre-operative high stone burden and metabolic abnormalities in 24 h urine analysis were predictive factors for stone recurrence.

Laparoscopic decortication of hilar renal cysts using LigaSure.

BACKGROUND AND OBJECTIVES: In this study, we evaluated the safety and efficacy of using the LigaSure sealing system (Valleylab, Boulder, Colorado) for laparoscopic decortication of symptomatic hilar renal cysts. METHODS: Seventeen patients underwent laparoscopic decortication of hilar renal cysts with the LigaSure system. Our study included only symptomatic, Bosniak type 1, simple and symptomatic renal cysts. The operative route, transperitoneal or retroperitoneal, was planned according to the location confirmed by computed tomography. The patients' symptoms were preoperatively and postoperatively evaluated by the Wong-Baker visual pain scale. Operative measures and radiologic outcomes were prospectively evaluated. RESULTS: The mean age of the patients was 56.4 years, and the mean follow-up period was 12.5 months. Preoperative computed tomography showed only a single cyst in 15 patients (88.2%) and showed two separate cysts in 2 cases (11.8%). The cysts were located in the perihilar region close to the vascular structure in all patients. A transperitoneal approach was used in 9 patients, and a retroperitoneal approach was used in 8 patients. The mean operative time and hospitalization time were 56.4 minutes and 1.2 days, respectively. Minor complications were observed in 3 patients. Symptomatic and radiologic success rates of 94.2% and 100%, respectively, were achieved. CONCLUSION: Laparoscopic decortication of symptomatic hilar renal cysts--first reported in the literature in this study--using the LigaSure sealing system is feasible, effective, and safe, even if the cyst is located in the perihilar area.

Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients: medial or lateral?

The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle (NVB) to correct ventral congenital penile curvatures (CPCs). The bundle was mobilized using the medial and lateral dissection technique in 21 (Group 1) and 13 (Group 2) patients, respectively. In the medial technique, Buck's fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea (TA) is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck's fascia above the urethra at the 5 and 7 o'clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients' photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 (P = 0.01). In Group 1, nine patients (42.8%) required one diamond excision, 10 (47.6%) required two diamond excisions and two (9.5%) required more than two excisions; in Group 2, six patients (46.2%) required two diamond excisions and seven patients (53.8%) required more than two diamond excisions (P = 0.019). The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.

Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy.

The micro-percutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that is performed through a 4.8 Fr all-seeing needle. We aimed to measure the intrarenal pelvic pressure (IPP) during microperc and compare it with the levels of conventional PNL. A total of 20 patients with 1- to 3-cm renal calculi resistant to shock wave lithotripsy were treated either with microperc (Group-1, n: 10) or conventional PNL (Group-2, n: 10) by the same surgical team. The IPP was measured during different stages (entrance into the collecting system, stone fragmentation, and before termination) of the procedures by an urodynamic machine using the 6 Fr ureteral catheter. All the variables were statistically compared between the two groups. The demographic values of the patients were similar. The operation time and duration of hospitalization were significantly prolonged in conventional PNL group (p = 0.034, p = 0.01, respectively). The mean drop in hematocrit levels was significantly lower in microperc group (3.5 ± 1.5 vs. 1.8 ± 0.8; p = 0.004). The IPP was significantly higher in microperc group during all steps of the procedure. The highest level of the IPP was measured as 30.3 ± 3.9 and 20.1 ± 3.1 mmHg in Group 1 and Group 2, respectively (p < 0.0001). However, the complication and success rates were found comparable. In conclusion, we demonstrate that the level of IPP is significantly increased during microperc compared to conventional PNL. Microperc should be used cautiously in cases with impaired drainage of the collecting system.

Previous shock-wave lithotripsy treatment does not impact the outcomes of flexible ureterorenoscopy.

OBJECTIVE: Shock-wave lithotripsy (SWL) is the first-line treatment for the active removal of small and medium-sized kidney stones. Flexible ureterorenoscopy (fURS) is recommended after failed SWL treatment. The aim of this retrospective analysis is to evaluate whether prior unsuccessful SWL treatments affect the outcomes of fURS. MATERIAL AND METHODS: Data from 206 patients who underwent fURS for the treatment of renal stones between September 2009 and January 2011 were collected, and the patients were divided into two groups according to their previous SWL treatment. The patient demographics, stone characteristics, operation and fluoroscopy times, stone-free rates and complications were compared. RESULTS: Of the patients, 114 (55.3%) did not undergo SWL prior to fURS (Group 1), whereas 92 (44.6%) completed a minimum of 3 sessions of SWL and waited at least 2 weeks before the fURS operation (Group 2). Although the mean stone number was higher in Group 2, this difference was not significant (p=0.06). The mean operation (p=0.12) and fluoroscopy times (p=0.69) were similar between the groups. The mean operation time per mm(2) stone and fluoroscopy time per mm(2) stone were not significantly different (p=0.64 and p=0.76, respectively). The length of the hospitalization and the overall complication rates were similar. After the third postoperative month, the stone-free rates were not different between the groups (82.5% and 86.9%, respectively, p=0.38). CONCLUSION: The stone-free and complication rates of fURS were not affected by previous SWL therapy.

Preoperative evaluation of pediatric kidney stone prior to percutaneous nephrolithotomy: is computed tomography really necessary?

The objective of the study was to investigate the precise role of computed tomography (CT) in preoperative radiologic evaluation and surgical planning of kidney stone in children prior to percutaneous nephrolithotomy (PNL). A total of 113 pediatric patients (aged ≤18 years) undergoing PNL for renal stone(s) in three referral hospitals between March 2010 and August 2012 were retrospectively evaluated. Depending on the preoperative radiologic evaluation, patients were divided into two groups. Those evaluated with CT were classified as group-1 (n = 50) and the remaining cases undergoing intravenous urography (IVU) examination were classified as group-2 (n = 63). Patient- and procedure-related variables and perioperative measures were compared between the groups. The mean age, stone size and localization were similar in both groups (p = 0.07, p = 0.57, p = 0.6, respectively). Although the postoperative hemoglobin drop was found to be significantly higher in group-2 (1.5 ± 1.3 vs. 0.9 ± 0.6 g/dL, p = 0.005), the mean operation time, fluoroscopic screening time, access number, overall success and complication rates were comparable (p = 0.06, p = 0.94, p = 0.75, p = 041, and p = 0.41, respectively). However, the mean hospitalization time was significantly prolonged in group-2 than in group-1 (p = 0.03). Our findings clearly demonstrate that, despite the key role of preoperative CT in particular patients with anatomically abnormal kidneys, IVU is a valuable alternative imaging modality with comparable radiation doses in children.

Effect of the body mass index on outcomes of flexible ureterorenoscopy.

The aim of the study to compare outcomes of flexible ureterorenoscopy in patients with different body mass index (BMI) scores and to explore whether the BMI has an effect on outcomes of RIRS. Five hundred and two patients who underwent flexible URS in 3 centers between 2008 and 2012 for the management of single upper urinary tract calculi were retrospectively reviewed. Patients were categorized as normal weight BMI 18.5 to 24.99 kg/m(2), overweight 25 to 29.99 kg/m(2), obese 30 to 39.99 kg/m(2) and morbid obese >40 kg/m(2).The groups were assessed in terms of demographic parameters including age, gender, stone size, intraoperative and postoperative variables. The mean patient age was 41.3 ± 15.51 (18-81) years and with an average BMI 26.68 ± 5.2 kg/m(2) (16.64-55.15 kg/m²). Of the patients, 43.2 % had normal weight (NW), 32.2 % were overweight (OW), 21.9 % were obese (O) and 2.5 % were morbidly obese (MO). Stone-free rates after single procedure in NW, OW, O, MO groups were 60.8, 61.7, 73.6, 61.5 %, respectively (p = 0.079). Overall targeted stone-free rates were also similar in four groups (88.9, 90.1, 93.6, 90.4 %, p = 0.586). There were no statistically significant differences in the frequency of complications and mean hospitalization time among the groups (p > 0.05). In conclusion, this study demonstrated that flexible URS is a valuable option for the treatment of kidney stone in both obese and non-obese patients. BMI did not influence the postoperative outcomes.

Comparison of shockwave lithotripsy and microperc for treatment of kidney stones in children.

PURPOSE: We aimed to compare the outcomes of microperc and shockwave lithotripsy (SWL) for treatment of kidney stones in children. PATIENTS AND METHODS: The medical records of 145 patients under the age of 15 years with opaque and single kidney stones treated with either SWL or microperc were retrospectively reviewed. Both groups were compared in terms of fluoroscopy and operative time, re-treatment, complications, success rate, and secondary and total number of procedures. RESULTS: Microperc and SWL were performed on 37 and 108 pediatric patients, respectively. The mean age of the patients was 5.91±4.03 years (1-15) and 8.43±4.84 (1-15) years in the SWL and microperc groups, respectively (P=0.004). The mean stone size was 11.32±2.84 (5-20) mm in the SWL group and 14.78±5.39 (6-32) mm in the microperc group (P<0.001). In the SWL group, 31 (28.7%) patients underwent a second SWL session and 6 (5%) had a third session. Finally, 95 (88%) patients were stone free at the end of the SWL sessions. In the microperc group, the stone-free rate was 89.2% in a single session (P=0.645). The mean duration of hospitalization was 49.2±12.3 (16-64) hours in the microperc group and 8.4±2.3 (6-10) hours per one session in the SWL group (P<0.001). The fluoroscopy time was significantly longer in the microperc group compared with the SWL group (147.3±95.3 seconds vs 59.6±25.9 seconds, P<0.001). The rate of requirement for an auxiliary procedure was higher in the SWL group than in the microperc group. The overall complication rates for the microperc and SWL groups were 21.6% and 16.7%, respectively (P=0.498). CONCLUSIONS: The results of our study demonstrate that microperc provides a similar stone-free rate and a lower additional treatment rate compared with SWL in the treatment of kidney stone disease in children.

Who should we trust in screening for lower urinary tract dysfunction in children: the parents or the child?

OBJECTIVE: To investigate whether the child's and the parents' reports about lower urinary tract symptoms (LUTS) are reliable and correlate with each other. MATERIALS AND METHODS: A validated questionnaire, the International Consultation on Incontinence Questionnaire Pediatric Lower Urinary Tract Symptoms, including both children and parent versions, was completed by children (age 5-18 years) with and without LUTS (control) and their parents without assistance. All children were investigated with detailed history, bladder diary, urinalysis, and flowmetry with postvoid residual urine volume measurement. The data were stratified into 3 age groups (5-9, 10-13, and 14-18 years). The reliability of both versions was evaluated using Cronbach's α and ≥0.7 indicated acceptability. The correlation between the children's and parents' reports for each question was evaluated using Spearman correlation coefficients. The receiver operating characteristic curve was used to define the cutoff points, and the sensitivity and specificity were calculated. The principal component analysis method was used to explain the construct validity. RESULTS: A total of 272 children (147 with and 125 without LUTS) and their parents completed the questionnaire. The children and parent versions of the questionnaire were both reliable (Cronbach's α 0.709 and 0.710, respectively). The sensitivity and specificity was 82.4% and 80.0% for the children version and 87.8% and 78.4% for the parent version, respectively. The reliability and acceptability of the children's reports were insufficient for the 5-9 year age group, and the parents' answers were unreliable for the 10-13 year age group. The correlation between the parent and children reports was the lowest for the 10-13 year age group. CONCLUSION: The alteration in the reliability in the different age groups suggests that the combination of the parent and children versions is most appropriate for screening children with LUTS.

The all-seeing needle instead of the Veress needle in pediatric urologic laparoscopy.

PURPOSE: To investigate the feasibility of the all-seeing needle for safe entry and creation of pneumoperitoneum in pediatric urologic laparoscopy. PATIENTS AND METHODS: A total of 14 children underwent various transperitoneal urologic laparoscopic procedures. The all-seeing needle, which is 4.85F in diameter, was used for safe entry into the abdominal cavity at the site of the umblicus in all cases. The microoptic was integrated with the light system and connected via a zoom ocular enabling direct visualization of the layers between the skin and the peritoneal cavity. Once the intraperitoneal access was obtained, CO2 pneumoperitoneum was created from one port of the three-way connector attached to the proximal part of the needle. Then the laparoscopic trocars were placed under vision of the microoptical system. RESULTS: Mean age of the children was 4.5 ± 2.9 years. In all children, the all-seeing needle was safely introduced into the abdominal cavity under direct vision. Then, CO2 pneumoperitoneum was succesfully performed. The mean time for optical puncture was calculated as 1.1 ± 0.8 minutes. No complication was encountered during the introduction of the needle, creation of the pneumoperitoneum, and placement of the trocars. CONCLUSIONS: The all-seeing needle appears to be beneficial in safe entry and for creating pneumoperitoneum in laparoscopic pediatric urology cases. It eliminates the disadvantages of the Veress needle, which is blunt insertion, and may possibly prevent complications.

Parenchymal thickness: does it have an impact on outcomes of percutaneous nephrolithotomy?

OBJECTIVE: To evaluate whether renal parenchymal thickness (RPT) has an effect on the outcomes of percutaneous nephrolithotomy (PNL). METHODS: We performed a retrospective analysis of 144 patients with lower pole and/or renal pelvic stones who underwent PNL. The relationship between RPT and peri- and postoperative measures was evaluated. RESULTS: The average age was 45.94 ± 14.47 (15-76) years. The mean BMI was calculated as 27.47 ± 4.73 (16.9-44.9) kg/m(2). The mean stone burden was 293 ± 126 (150-800 mm(2)). The mean RPT was measured as 17.33 ± 5.32 (6-35) mm. No correlation was detected between the RPT and the operation or fluoroscopy times or the duration of hospitalization (p = 0.63, 0.52, 0.08, respectively). The mean drop in hemoglobin level was 1.45 ± 1.25 (0-9) g/dl. A negative correlation was detected between hemoglobin drop and RPT (p = 0.01, r = -0.23). However, the RPT was similar in patients who did or did not require a blood transfusion (p = 0.09). The RPT was found to have no impact on success rate (p = 0.4). CONCLUSION: The postoperative hemoglobin drop increases in parallel with the increase in RPT. However, no relationship was detected between the RPT and blood transfusion, overall success rate or any other perioperative parameters.

Comparison of flexible and rigid cystoscopy-assisted ureteral catheter insertion before percutaneous nephrolithotomy: a prospective randomized trial.

BACKGROUND AND PURPOSE: To compare the advantages of flexible and rigid cystoscopy-assisted ureteral catheter placement before prone percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: From March to September 2012, a total of 80 patients with kidney stones underwent PCNL by the same surgical team. The patients were randomly assigned into one of the groups according to the technique used for ureteral catheter insertion: Flexible cystoscopy (group 1, n=40) or rigid cystoscopy (group 2, n=40). Patient demographics and operation-related factors were compared. The preparation period included positioning, cystoscopy-assisted stent insertion, and patient repositioning for PCNL. In addition, discomfort scores of the operating room (OR) staff were measured. RESULTS: The demographic values of the groups in terms of patient sex, age, body mass index, and stone size were comparable. While the mean preparation period was calculated as 9.9±2.3 minutes in the flexible cystoscopy group, it was significantly longer (19.7±2.9 minutes) in the rigid cystoscopy group (P<0.0001). In addition, the discomfort score of the OR staff was found to be significantly higher in the rigid cystoscopy group (1.1±0.9 vs 2.05±0.68, P<0.0001). The rest of the operative and postoperative parameters were similar. CONCLUSIONS: The insertion of a ureteral catheter with a flexible cystoscope before prone PCNL shortens the preparation period and minimizes the discomfort of OR staff related to patient positioning and transfer.

Is the percutaneous nephrolithotomy procedure complicated in patients with anterior caliceal stones?

OBJECTIVES: It was the aim of this study to evaluate and compare the outcomes of percutaneous nephrolithotomy (PNL) for the treatment of posterior and anterior caliceal stones. PATIENTS AND METHODS: We performed a retrospective analysis of 86 patients with isolated caliceal stones who underwent PNL between 2011 and 2012. The patients were classified into two groups according to the localization of the stone, either in the anterior (group 1, n = 41) or posterior (group 2, n = 45) calyx, on axial plane computed tomography. RESULTS: The mean age, male/female ratio and stone size and location were similar in both groups. Fluoroscopy, operation time and duration of hospitalization were also similar between groups. Patients in group 1 had a greater postoperative hemoglobin drop than patients in group 2. Blood transfusion was required for 5 patients in group 1 and for 4 patients in group 2. In addition, open conversion was required for 2 patients in group 1 during the early postoperative period because of extensive bleeding. Hemodynamics were stabilized with angioembolization in 2 patients with prolonged hematuria in group 1. The overall success and complication rates were similar in both groups. CONCLUSION: Although the postoperative hemoglobin drop did not significantly differ between groups, hemorrhaging was more severe in patients with anterior caliceal stones than in those with posterior caliceal stones.

Selection of authors, titles and writing a manuscript abstract.

Title of the study, authors list and abstract are not only the most widely read parts in an article but also determine whether the remaining sections are worth to be read. The first author in an article should be the planner and performer of the research. Researchers who have actively conducted the study and written the manuscript should be sorted in the authors list according to the importance of their individual contribution. However, researchers who do not directly contribute to the study but take part in data collection process should not be included in the ideal authors list. The title should be comprised of a brief statement or one or two short sentences that best reflect the original and gripping aspects of the study. On the other hand, abstract should provide answers to the following questions in advance of reading the full text: Why this study was performed?, What was the procedure?, What was found?, and What were the outcomes? In this manuscript, writing of an abstract was reviewed in addition to author and title selection.

Balanced chromosomal translocation of chromosomes 6 and 7: a rare male factor of spontaneous abortions.

BACKGROUND: Carriers of structural chromosomal rearrangements such as Robertsonian or reciprocal translocations have an increased risk of spontaneous abortion and producing offspring with genetic abnormalities. CASE REPORT: We report a man with balanced chromosomal translocations located at 6p22, and 7q22. His wife has a history of four spontaneous abortions. CONCLUSION: Couples with a history of abortions should be investigated cytogenetically, after other causes of miscarriages are excluded. The possibility of spontaneous abortions can be reduced with preimplantation genetic diagnosis (PGD) before embryo transfer.

The role of microperc in the treatment of symptomatic lower pole renal calculi.

BACKGROUND AND PURPOSE: The treatment of symptomatic lower pole (LP) calculi poses a challenge because of lower clearance rates. We present our experience with microperc in the treatment of LP renal calculi. PATIENTS AND METHODS: We retrospectively evaluated the symptomatic patients with LP renal calculi who underwent microperc between August 2011 and June 2012 from two referral hospitals. Patients were included only in cases of failure after shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) and according to patient preference. The percutaneous renal access was performed using the 4.8F "all-seeing needle" with C-arm fluoroscopy or ultrasonographic guidance with the patient in the prone position. Stone disintegration was established using a 200 µm holmium:yttrium-aluminum-garnet laser fiber. RESULTS: A total of 21 patients (mean age 37.3 ± 20.1 years) with LP stone underwent microperc. The mean body mass index was 28.6 ± 6.0 kg/m(2), and the mean stone size was 17.8 ± 5.9 (9-29) mm. The duration of surgery and fluoroscopic screening was 62.8 ± 25.2 minutes and 150.5 ± 92.8 seconds, respectively. The patients were discharged after a mean 37.5 ± 14.4 hours of hospitalization time. The mean hemoglobin drop was 0.8 ± 0.6 (0.1-2.3) g/dL. Conversion to miniperc was necessitated in one patient with loss of vision. Stone-free status was achieved in 18 (85.7%) patients. Clinically insignificant residual fragments were observed in only one (4.8%). The procedure failed in two (9.5%) patients. A total of two minor complications (renal colic necessitating stent insertion and urinary tract infection) were observed postoperatively, none severe. CONCLUSION: Microperc is a feasible and efficient treatment modality for symptomatic LP calculi. Our results provide that microperc might take a part in case of SWL and RIRS failures or as an alternative to percutaneous nephrolithotomy or RIRS in the management of symptomatic LP calculi.