Educational Level of Laparoscopic Radical Nephrectomy Videos on YouTubeTM.

Purpose: This study aims to evaluate the educational quality and appropriateness of laparoscopic radical nephrectomy videos on YouTube using the LAParoscopicsurgery Video EducationalGuidelineS (LAP-VEGaS) criteria. It focuses on understanding the role of online resources in medical education and objectively assessing their quality. Methods: A search was conducted on YouTube™ for "laparoscopic radical nephrectomy" on August 15, 2023, leading to the selection of the first 125 videos. Videos were chosen based on length (over 1 minute), content (laparoscopic radical nephrectomy), language (English), and nonindustry sponsorship. The LAP-VEGaS criteria, encompassing 16 items under five main categories: video introduction, case presentation, procedures, outcomes, and educational content, were used for evaluation, assigning 0 or 1 point per criterion. Results: Out of 100 videos meeting the criteria, they were divided into two groups: personal uploads by expert surgeons (Group-1) and institutional uploads by hospitals and organizations (Group-2). Group-2 videos had longer durations and higher LAP-VEGaS scores. The transperitoneal approach was preferred in 88% of the videos, and 84% were right laparoscopic nephrectomies. Group-2 had significantly higher LAP-VEGaS scores (6.3 ± 2.2) compared with Group-1 (4 ± 2.1) (P < 0,001). The number of videos published over the years increased, while LAP-VEGaS scores fluctuated. Conclusion: Assessing laparoscopic radical nephrectomy videos on YouTube™ using the LAP-VEGaS criteria helped understand the role of online sources in medical education. Institutional uploads were found to be more successful in educational aspects, emphasizing the need for continuous quality review of online medical education materials. This study also guides how to evaluate and improve medical education materials on online platforms.

Early versus delayed ureterolithotripsy following obstructive acute pyelonephritis treatment.

BACKGROUND AND OBJECTIVES: There is no recommendation on the timing of ureterolithotripsy after the treatment of obstructive acute pyelonephritis (APN). The effect of early and delayed ureterolithotripsy on postoperative urinary tract infection (UTI) and other complications was investigated. METHODS: Patients who underwent ureterolithotripsy after obstructive APN treatment between February 2017 and August 2021 were divided into two groups, those operated during hospitalization and those operated within 3 months after discharge. Two groups were compared in terms of stone-free status, postoperative complications, postoperative UTI, and urosepsis rates. RESULTS: Of the 91 patients included in the study, 68 were in the early ureterolithotripsy group, while 23 patients were in the delayed ureterolithotripsy group. The postoperative UTI rate was significantly higher in patients who underwent early ureterolithotripsy (29.4% vs 8.7%, p = 0.045). Patients with postoperative UTI had a higher moderate/severe perinephric fat stranding (PFS) on non-contrast CT at hospital admission (52.2% vs 29.4%, p = 0.048). Among the laboratory parameters, white blood cells were significantly higher in the group with postoperative UTI (21604.5 vs 14728.9, p = 0.042). In the multivariate analysis, early ureterolithotripsy and moderate/severe PFS were independent predictors for postoperative UTI. In the created model, the probability of postoperative UTI after ureterolitripsy after obstructive APN treatment was 3.5% in patients without risk factors, while this rate was 51.9% in patients with both risk factors. CONCLUSION: There is no consensus on the timing of stone removal after treatment of obstructive APN. Early ureterolithoripsy and moderate/severe perinephric fat stranding on non-contrast CT are risk factors for postoperative UTI.

Primary Epithelioid Angiomyolipoma of Adrenal Gland: Case Report and Literature Review.

Angiomyolipomas (AMLs) are mesenchymal tumours derived from perivascular epithelioid cells. Although AMLs are generally known as benign and extremely rare epithelioid variants of AML, they may be potentially aggressive. Here we present an adrenal epithelioid AML and the literature review. A 64-year-old female patient was diagnosed with a left adrenal mass detected incidentally on ultrasonography. Preoperative abdominal CT (computed tomography) showed a 95×68 mm heterogeneous contrast enhancement mass lesion in the left adrenal gland. The lesion was hormone inactive in the endocrinological evaluation, and left laparoscopic adrenalectomy was performed. The patient was discharged on the 2nd postoperative day. Pathology was reported as epithelioid subtype AML. The patient has no local recurrence or metastasis in the 18-month follow-up period and imaging. Adrenal epithelioid AML is an extremely rare and potentially aggressive variant. According to the literature, open or laparoscopic adrenalectomy seems to be suitable option for disease management.

Factores de riesgo predictivos de infección del tracto urinario después de la litotricia ureteroscópica flexible / Predictive risk factors for urinary tract infection after flexible ureteroscopic lithotripsy

Objetivos: El objetivo del presente estudio fue evaluar la prevalencia de las infecciones deltracto urinario (UTI) postoperatorias después de la ureteroscopia flexible (f-URS) y determinar los factores predictivos de esas infecciones. Métodos: Se inscribieron en el estudio un total de 420 pacientes con urolitiasis que se sometieron a f-URS entre agosto de 2018 y agosto de 2019. Las características perioperatorias de los pacientes con y sin ITUUTI postoperatorias se compararon mediante análisis univariados. Los factores predictivos de las infecciones urinarias después de f-URS se determinaron mediante un análisis de regresión logística multivariante. Resultados: Cuarenta y uno (9,8%) de 420 pacientes tuvieron infección urinaria postoperatoria despuésde f-URS y esos pacientes se clasificaron como grupo 1. El grupo 2 consistió en 379 pacientes que no desarrollaron UTI postoperatorias. El porcentaje de sexofemenino fue del 58,5% frente al 42% en los grupos 1 y 2, respectivamente (p=0,042). La tasa de antecedentes de UTI preoperatoria fue del 51,2% frente al 20,8% (p<0,001) y la tasa de inserción preoperatoria de un stent doble J (DJS) del 39% frente al 17,7% en los grupos 1 y 2, respectivamente (p=0,001). Los análisis deregresión univariante mostraron que el sexo femenino (OR=1,98), los antecedentes de UTI (OR=3,99) y la inserción preoperatoria de DJS (OR=2,98) aumentaron significativamente la posibilidad de UTI postoperatoria (p<0,05). Los análisis de regresión multivariante revelaron que los antecedentes de UTI (OR=3,41, IC del95%: 1,73–6,72, p<0,001) y la inserción preoperatoria de DJS (OR=2,30, IC del 95%: 1,13–4,68,p=0,021) eran factores de riesgo independientes para las complicaciones infecciosas después de f-URS. Si ambos factores están presentes, la probabilidad de infección es del 55,2%.(AU)

Objectives: The goal of current study was to evaluate prevalence of postoperative urinary tract infections (UTI) following flexible ureteroscopy (f-URS) and to determine predictive factors for those UTIs. Methods: A total of 420 patients with urolithiasis that underwent f-URS between August 2018 and August 2019 were enrolled in the study. Peri-operative characteristics of patients with and without postoperative UTIs were compared using univariate analyses. Predictive factors for UTIs following f-URS were determined using multivariate logistic regression analysis. Results: Forty-one (9.8%) out of 420 patients had postoperative urinary infection after f-URS and those patients were classified as group 1. Group 2 consisted of 379 patients that did not develop postoperative UTIs. The percentage of female gender was 58.5% vs 42% in groups 1 and 2, respectively (p=0.042). The preoperative UTI history rate was 51.2% vs 20.8% (p<0.001)and preoperative double J stent (DJS) insertion rate 39% vs 17.7% in groups 1 and 2, respectively (p=0.001). Univariate regression analyses showed that the female gender (OR=1.98), history of UTI (OR=3.99), and preoperative DJS insertion (OR=2.98) significantly increased the possibility of postoperative UTI (p<0.05).Multivariate regression analyses revealed that history of UTI (OR=3.41, 95%CI:1.73–6.72, p<0.001) and preoperative DJS insertion (OR=2.30, 95%CI:1.13–4.68,p=0.021) were independent risk factors for infectious complications following f-URS. If both factors are present, the probability of infection is 55.2%.Conclusions: Even if f-URS is considered a safe procedure, the risk of postoperative infectious complications is far from negligible. We found that the presence of UTI history and preoperative DJS were independent risk factors for UTI after f-URS.(AU)

Effects of the different administration frequencies of teriparatide (PTH [1-34]) on new bone formation of expanded midpalatal sutures in rats: A histomorphometric and micro-computed tomography analysis.

OBJECTIVE: The aim of the study was to evaluate the effect of 4 µg/kg teriparatide administered at intermittent and continuous frequencies on bone formation in the expanded midpalatal suture region using histomorphometric and micro-computed tomography (micro-Ct) analysis. Settings and sample population: In this study, 24 Sprague Dawley male rats were used. METHODS: The experimental animals were divided into 3 groups as follows: Group 1: only maxillary expansion, Group 2: maxillary expansion with continuous teriparatide administration (2 µg in the morning and 2 µg in the evening) and Group 3: maxillary expansion with intermittent teriparatide administration (daily 4 µg/kg). The expansion appliance was fixed to maxillary incisors of all animals within the 5-day expansion period, followed by a 12-day retention phase. Animals were sacrificed at the end of the retention period, and specimens were evaluated by micro-Ct and histomorphometric analysis respectively. RESULTS: The results of the histomorphometric analysis showed that Group 3 had the highest number of osteoblasts (1042 ± 90.76) (P < .01). In addition, the results of micro-Ct analysis revealed that Group 3 had the highest bone volume/total volume (16% ± 0), bone mineral density (173.82 ± 2.6 mgHA/cm3 ) and least midpalatal suture width (0.13 ± 0.001 mm) (P < .01). Osteoblasts number and micro-Ct analysis values of Group 2 were higher than those of Group 1 but no significant differences between them (P > .01). CONCLUSION: Intermittently administered TP (4 µg/kg once a day) was seen to enhance bone formation and mineralization. In the future, it can be used in drug studies that will increase or stimulate bone formation as well as in the midpalatal suture area.

Predictive risk factors of urinary tract infection following flexible ureteroscopic lithotripsy.

OBJECTIVES: The goal of current study was to evaluate prevalence of postoperative urinary tract infections (UTI) following flexible ureteroscopy (f-URS) and to determine predictive factors for those UTIs. METHODS: A total of 420 patients with urolithiasis that underwent f-URS between August 2018 and August 2019 were enrolled in the study. Peri-operative characteristics of patients with and without postoperative UTIs were compared using univariate analyses. Predictive factors for UTIs following f-URS were determined using multivariate logistic regression analysis. RESULTS: Forty-one (9.8%) out of 420 patients had postoperative urinary infection after f-URS and those patients were classified as group 1. Group 2 consisted of 379 patients that did not develop postoperative UTIs. The percentage of female gender was 58.5% vs 42% in groups 1 and 2, respectively (p=0.042). The preoperative UTI history rate was 51.2% vs 20.8% (p<0.001) and preoperative double J stent (DJS) insertion rate 39% vs 17.7% in groups 1 and 2, respectively (p=0.001). Univariate regression analyses showed that the female gender (OR=1.98), history of UTI (OR=3.99), and preoperative DJS insertion (OR=2.98) significantly increased the possibility of postoperative UTI (p<0.05). Multivariate regression analyses revealed that history of UTI (OR=3.41, 95%CI:1.73-6.72, p<0.001) and preoperative DJS insertion (OR=2.30, 95%CI:1.13-4.68, p=0.021) were independent risk factors for infectious complications following f-URS. If both factors are present, the probability of infection is 55.2%. CONCLUSIONS: Even if f-URS is considered a safe procedure, the risk of postoperative infectious complications is far from negligible. We found that the presence of UTI history and preoperative DJS were independent risk factors for UTI after f-URS.

OBJETIVOS: El objetivo del presente estudio fue evaluar la prevalencia de las infecciones del tracto urinario (UTI) postoperatorias después de la ureteroscopia flexible (f-URS) y determinar los factores predictivos de esas infecciones. MÉTODOS: Se inscribieron en el estudio un total de420 pacientes con urolitiasis que se sometieron a f-URSentre agosto de 2018 y agosto de 2019. Las característicasperioperatorias de los pacientes con y sin ITUUTI postoperatorias se compararon mediante análisisunivariados. Los factores predictivos de las infeccionesurinarias después de f-URS se determinaron mediante unanálisis de regresión logística multivariante. RESULTADOS: Cuarenta y uno (9,8%) de 420 pacientes tuvieron infección urinaria postoperatoria después de f-URS y esos pacientes se clasificaron como grupo 1. El grupo 2 consistió en 379 pacientes que no desarrollaron UTI postoperatorias. El porcentaje de sexo femenino fue del 58,5% frente al 42% en los grupos 1 y 2, respectivamente (p=0,042). La tasa de antecedentes de UTI preoperatoria fue del 51,2% frente al 20,8% (p<0,001) y la tasa de inserción preoperatoria de un stent doble J (DJS) del 39% frente al 17,7% en los grupos 1 y 2, respectivamente (p=0,001). Los análisis de regresión univariante mostraron que el sexo femenino (OR=1,98), los antecedentes de UTI (OR=3,99) y la inserción preoperatoria de DJS (OR=2,98) aumentaron significativamente la posibilidad de UTI postoperatoria (p<0,05). Los análisis de regresión multivariante revelaron que los antecedentes de UTI (OR=3,41, IC del 95%: 1,73­6,72, p<0,001) y la inserción preoperatoria de DJS (OR=2,30, IC del 95%: 1,13­4,68, p=0,021) eran factores de riesgo independientes para las complicaciones infecciosas después de f-URS. Si ambos factores están presentes, la probabilidad de infección es del 55,2%. CONCLUSIONES: Incluso si la f-URS se considera un procedimiento seguro, el riesgo de complicaciones infecciosas postoperatorias está lejos de ser insignificante. Encontramos que la presencia de antecedentes de UTI y la DJS preoperatoria eran factores de riesgo independientes de UTI después de f-URS.

The effect of ideal urine culture time on urinary infections after flexible ureteroscopy: A match-pair case-control study.

AIMS: To investigate the effect of the ideal period (Δ-day), which is a period between the sterile urine culture and initiation of flexible ureteroscopy (f-URS), on postoperative urinary tract infections (UTI) in our tertiary referral centre. METHODS: After obtaining the approval of the local ethics committee, retrospective data were collected for all f-URS procedures performed between January 2017 and March 2019. Patients that developed UTI were matched in 1:1 proportion with patients that did not develop UTI based on their demographic and stone characteristics. The group of patients with postoperative UTI was compared with the control group. RESULTS: A total of 916 f-URS cases that had all required data were analysed. Sixty-eight patients with postoperative UTI were determined and a total of 136 patients were included in the study after match-pair. We found that if the Δ-day is longer than 2 weeks, the possibility of postoperative urinary infection rates increases with statistical significance (P = .006). According to our subgroup analysis, postoperative UTI was more common if the Δ-day >14 days. ROC curve analysis provided a 14.5-day period as a cut-off value of Δ-day for postoperative UTI. CONCLUSIONS: The present study is the first to examine the impact of the Δ-day for f-URS on postoperative UTIs. In brief, prolonging the Δ-day, especially if Δ-day >14 days, leads to an increase in the rates of postoperative UTI. We conclude that it is preferred to either perform the f-URS in the early period after the urine culture analysis or doing the urine culture analysis shortly before the surgery.

Clinical characteristics of postoperative febrile urinary tract infections after ureteroscopic lithotripsy in diabetics: Impact of glycemic control / Características clínicas de las infecciones posoperatorias del tracto urinario febril después de la litotricia ureteroscópica en diabéticos: impacto del control glucémico

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017 and April 2019, 546 patients who underwent ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p = 0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1c level were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully

OBJETIVO: La litotricia ureteroscópica (URS) es la opción estándar actual de tratamiento para cálculos renales tanto ureterales como adecuados. Aunque se sabe que es un procedimiento seguro, la infección urinaria febril posoperatoria (ITU) no es rara. Especialmente en pacientes diabéticos, la tasa de infección del tracto urinario es mayor. Por lo tanto, nuestro objetivo fue describir los factores de riesgo de IU después de la URS en diabéticos. MATERIALES Y MÉTODOS: Entre enero de 2017 y abril de 2019, se incluyeron 546 pacientes que se sometieron a litotricia ureteroscópica por cálculos ureterales y/o renales. Se realizó un análisis de pares emparejados para comparar las tasas de ITU postoperatorias entre diabéticos y no diabéticos. Revisamos retrospectivamente los registros médicos. Se realizó un análisis de regresión logística para determinar los factores de riesgo de infección urinaria postoperatoria en diabéticos. RESULTADOS: En pacientes diabéticos, la tasa de ITU postoperatoria fue del 29% (13/45). Después del análisis de pares emparejados dentro del grupo de no diabéticos, la incidencia fue del 11% (5/44) (p = 0,04). En el análisis univariado, el historial de ITU y el nivel de HbA1c fueron los factores de riesgo de ITU después de la URS en diabéticos. El historial de ITU y el nivel de HbA1c fueron los factores de riesgo independientes para desarrollar ITU postoperatoria en pacientes diabéticos. El umbral de HbA1c del 6,9% proporcionó una sensibilidad del 75% y una especificidad del 67% para predecir la infección urinaria postoperatoria en diabéticos. CONCLUSIONES: Los pacientes diabéticos tienen un mayor riesgo de desarrollar ITU postoperatoria después de la URS. Los pacientes con antecedentes de ITU y un nivel de HbA1c superior al 6,9% deben ser seguidos cuidadosamente

Clinical characteristics of postoperative febrile urinary tract infections after ureteroscopic lithotripsy in diabetics: Impact of glycemic control. / Características clínicas de las infecciones posoperatorias del tracto urinario febril después de la litotricia ureteroscópica en diabéticos: impacto del control glucémico.

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017and April 2019, 546 patients who under went ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p=0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1clevel were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully.

OBJETIVO: La litotricia ureteroscópica (URS) es la opción estándar actual de tratamiento para cálculos renales tanto ureterales como adecuados. Aunque se sabe que es un procedimiento seguro, la infección urinaria febril posoperatoria (ITU) no es rara. Especialmente en pacientes diabéticos, la tasa de infección del tracto urinario es mayor. Por lo tanto, nuestro objetivo fue describir los factores de riesgo de IU después de la URS en diabéticos. MATERIALES Y MÉTODOS: Entre enero de 2017 y abril de 2019, se incluyeron 546 pacientes que se sometieron a litotricia ureteroscópica por cálculos ureterales y/o renales. Se realizó un análisis de pares emparejados para comparar las tasas de ITU postoperatorias entre diabéticos y no diabéticos. Revisamos retrospectivamente los registros médicos. Se realizó un análisis de regresión logística para determinar los factores de riesgo de infección urinaria postoperatoria en diabéticos. RESULTADOS: En pacientes diabéticos, la tasa de ITU postoperatoria fue del 29% (13/45). Después del análisis de pares emparejados dentro del grupo de no diabéticos, la incidencia fue del 11% (5/44) (p=0,04). En el análisis univariado, el historial de ITU y el nivel de HbA1c fueron los factores de riesgo de ITU después de la URS en diabéticos. El historial de ITU y el nivel de HbA1c fueron los factores de riesgo independientes para desarrollar ITU postoperatoria en pacientes diabéticos. El umbral de HbA1c del 6,9% proporcionó una sensibilidad del 75% y una especificidad del 67% para predecir la infección urinaria postoperatoria en diabéticos. CONCLUSIONES: Los pacientes diabéticos tienen un mayor riesgo de desarrollar ITU postoperatoria después de la URS. Los pacientes con antecedentes de ITU y un nivel de HbA1c superior al 6,9% deben ser seguidos cuidadosamente.