Our experience of operated pediatric ureteropelvic junction obstruction patients.

AIMS: Ureteropelvic junction obstruction (UPJO) may originate from extrinsic or intrinsic causes in children. The aim of this study is to present preoperative and postoperative data of our patients operated for UPJO. METHODS: A total of 64 patients who underwent open pyeloplasty were investigated retrospectively. They were evaluated in terms of demographically, clinics, hydronephrosis, differential renal functions (DRFs), half-time tracer clearance (½TC), and histopathologic results. Patients' numerical results were stated as mean ± standard deviation (SD). RESULTS: Male gender was more prevalent (n = 47, 73.4%) and mean age at surgery was 46.87 months. UPJO was located at the left side in 56.3% (n = 36), and at the right side in 39.1% (n = 25) of patients. It was bilateral in 4.7% (n = 3). Hydronephrosis was found antenatally in 68.8% (n = 44) of patients. The mean preoperative DRF was 49.7% (21-78%) and mean postoperative DRF was 49.2% (20-56%). Mean renal scintigraphic t1/2 was >20 min for all patients. The mean AP diameter was 21.58 mm (10-62 mm). Muscular hypertrophy was the most common pathological finding, mean length of excised segment was 10.26 mm (3-40 mm). Crossing vessel (CV) was detected in 17.18% (n = 11). The CV was statistically associated with increased age of operation, left side, and female gender. Statistically significant hydronephrosis was found in non-CV patients. Re-operation was required in seven patients (7.8%). CONCLUSIONS: Intrinsic pathologies are more seen in the etiology of UPJO patients with antenatal diagnosis and this group needs operation at an earlier age. However, CV is found more commonly in patients who are diagnosed and operated at older ages.

Use of modified Makuuchi incision for surgical treatment of abdominal tumor in children. / El uso de la incisión de Makuuchi modificada en el tratamiento de tumores abdominales en niños.

OBJECTIVE: Classical transverse, verticalabdominal or thoracoabdominal incisions inpediatric patients are frequently used to removelarge abdominal tumors such as hepatoblastomaand neuroblastoma. We present our initial experienceson our patients who was operated by modifiedMakuuchi incision.MATERIALS AND METHODS: We used this incisionin 6 cases with large abdominal tumors (1 hepatoblastomaand 5 neuroblastoma and/or ganglioneuroma)between January 2019 and August 2020.RESULTS: These patients had previously receivedchemotherapy according to appropiate protocol. Theexposure of surgical field was perfect with this incisionand dissection of the tumors was easily performed.Complete removal of large abdominal tumors was successfullyachieved in the patients although the masseshave close proximity and adhesions with importantstructures and organs. There was serous collection in2 patients and it resolved spontaneously. No wound infection, hernia or wound dehiscence was observedduring a mean follow-up of 9.6 months (ranged from3 to18 months).CONCLUSION: According to our preliminary experiences,the Modified Makuuchi incision provides a niceexposure for removal of large abdominal tumors to thesurgeons and is well tolerated by children.

OBJETIVO: Las incisiones clásicastransversa, abdominal vertical o toracoabdominal enpacientes pediátricos son utilizadas frecuentementeen la escisión de tumores abdominales de gran tamañocomo el hepatoblastoma y el neuroblastoma.Presentamos nuestra experiencia inicial en pacientesoperados usando la incision de Makuuchi modificada.MATERIALES Y MÉTODOS: Usamos esta incision en6 casos con tumores abdominales de gran tamaño (1hepatoblastoma y 5 neuroblastomas y/o ganglioneuroma)entre Enero 2019 y Agosto 2020. RESULTADOS: Los pacientes recibieron quimioterapianeoadyuvante según protocolo. La exposicióndel campo quirúrgico, así como la disección del tumor,fue perfecta con esta incisión. Se logró remover la totalidadde los tumores con éxito a pesar de su proximidady adherencias a órganos vecinos. Dos pacientespresentaron colecciónes serosas que se resolvieronespontáneamente. No se observaron infecciones de herida, hernias o dehiscencia de heridas durante elperíodo de seguimiento con una media de 9.6 meses(rango de 3-18 meses). CONCLUSIONES: Según nuestra experiencia preliminar,la incisión de Makuuchi modificada ofrece alcirujano una buena exposición del campo quirúrgicopara la extirpación de tumores abdominales de grantamaño, además de ser bien tolerada por los niños.

Use of modified makuuchi incision for surgical treatment of abdominal tumor in children / Use of modified Makuuchi incision for surgical treatment of abdominal tumor in children

OBJECTİVE: Classical transverse, vertical abdominal or thoracoabdominal incisions inpediatric patients are frequently used to removelarge abdominal tumors such as hepatoblastomaand neuroblastoma. We present our initial experiences on our patients who was operated by modifiedMakuuchi incision.MATERİALS AND METHODS: We used this incisionin 6 cases with large abdominal tumors (1 hepatoblastoma and 5 neuroblastoma and/or ganglioneuroma)between January 2019 and August 2020.RESULTS: These patients had previously receivedchemotherapy according to appropiate protocol. Theexposure of surgical field was perfect with this incisionand dissection of the tumors was easily performed.Complete removal of large abdominal tumors was successfully achieved in the patients although the masseshave close proximity and adhesions with importantstructures and organs. There was serous collection in2 patients and it resolved spontaneously. No wound infection, hernia or wound dehiscence was observedduring a mean follow-up of 9.6 months (ranged from3 to18 months).CONCLUSİON: According to our preliminary experiences, the Modified Makuuchi incision provides a niceexposure for removal of large abdominal tumors to thesurgeons and is well tolerated by children. (AU)

OBJETIVO: Las incisiones clásicastransversa, abdominal vertical o toracoabdominal enpacientes pediátricos son utilizadas frecuentementeen la escisión de tumores abdominales de gran tamaño como el hepatoblastoma y el neuroblastoma.Presentamos nuestra experiencia inicial en pacientesoperados usando la incision de Makuuchi modificada.MATERIALES Y MÉTODOS: Usamos esta incision en6 casos con tumores abdominales de gran tamaño (1hepatoblastoma y 5 neuroblastomas y/o ganglioneuroma) entre Enero 2019 y Agosto 2020.RESULTADOS: Los pacientes recibieron quimioterapia neoadyuvante según protocolo. La exposicióndel campo quirúrgico, así como la disección del tumor,fue perfecta con esta incisión. Se logró remover la totalidad de los tumores con éxito a pesar de su proximidad y adherencias a órganos vecinos. Dos pacientespresentaron colecciónes serosas que se resolvieronespontáneamente. No se observaron infecciones de herida, hernias o dehiscencia de heridas durante elperíodo de seguimiento con una media de 9.6 meses(rango de 3-18 meses).CONCLUSIONES: Según nuestra experiencia preliminar, la incisión de Makuuchi modificada ofrece alcirujano una buena exposición del campo quirúrgicopara la extirpación de tumores abdominales de grantamaño, además de ser bien tolerada por los niños. (AU)

Efficiency of radiation-free retrograde intrarenal surgery (RIRS) in children and evaluation of factors affecting surgical success. / Eficiencia de la cirugía intrarenal retrograda sin radiación en niños y evaluación de los factores que afectan el éxito quirúrgico.

OBJECTIVE: To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and under went one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed. RESULTS: Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by stone size (p<0.01). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p<0.05). CONCLUSION: RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy.

OBJETIVO: Investigar los factores que afectan el éxito quirúrgico y la duración de la cirugía retrógrada intrarenal sin fluoroscopia en niños. El objetivo de este estudio fue demostrar la eficacia de la cirugía retrógrada intrarenal sin fluorosocopia en el tratamiento de litiasis en niños. MÉTODOS: Todos los procedimientos de cirugía retrógrada intrarenal fueron realizados en pacientes pediátricos en nuestra clínica entre agosto 2013 y enero 2017. Estudiamos 52 casos pediátricos con 1 litiasis en 1 riñón y recibieron una sesión. Marcamos el sistema colector renal y la litiasis se definió según ese marcaje. El tamaño y la localización de la piedra, colocación preoperatoria del doble J, la vaina de acceso y la tasa de éxito quirúrgico fueron reportadas. Los efectos de estos factores en el éxito quirúrgico y la duración de las cirugías fueron analizados. RESULTADOS: Cada paciente recibió cirugía retrógrada una vez. De éstos 52 pacientes pediátricos, 23 (44%) tenían entre 0 y 5 años (grupo 1), 12 (25%) entre 6 y 11 años (grupo 2), 16 (31%) entre11 y 17 años (Grupo 3). El éxito quirúrgico en cada grupo fue de 65%, 77% y 81% respectivamente (73% en general). El éxito quirúrgico se vió afectado sólo por el tamaño de la litiasis (p<0,01). La duración de las cirugías se vió afectada por el tamaño de la litiasis, localización de la litiasis, dilatación pasiva del uréter, y uso de la vaina de acceso (p<0,05).CONCLUSIÓN: La cirugía intrarenal retrógrada es segura y efectiva en el tratamiento de litiasis intrarenales en el paciente pediátrico. Altas tasas de éxito se consiguen con el mapeo renal sin fluoroscopia.

Modified Makuuchi incision in the surgical treatment of renal tumors: Initial results.

OBJECTIVE: To evaluate the modified Makuuchi incision in the surgical treatment of renal tumors. MATERIAL AND METHODS: A total of 29 patients with renal tumors were operated using the modified Makuuchi incision. Patients' age ranged from 48 to 72 years. Twenty-three patients were male, and 6 patients were female. Renal tumors affected the right side in 22 patients and the left side in 7 patients. Twenty-six patients underwent radical nephrectomy, while 3 patients underwent partial nephrectomy. RESULTS: A perfect exposure was achieved with this incision in the surgical field. No serious complications such as bleeding or other organ injuries happened during the surgery. Blood transfusion during surgery was unnecessary. Additional use of analgesics due to wound pain during the postoperative period was not required. Incision-related complications, such as wound infection and wound dehiscence, did not occur in the early postoperative period. Patients had no complaints about the cosmetic appearance of their abdomen due to the incision. Incisional hernia was not observed in patients. CONCLUSION: This type of incision provided a perfect exposure of the field in the surgical treatment of renal tumors.

The efficacy of Tadalafil 5mg in the treatment of lower urinary tract symptoms in patients where alpha blocker treatments have failed in terms of lower urinary tract symptoms. / Eficacia de Tadalafilo 5 mg en el tratamiento de los síntomas del tracto urinario inferior en pacientes tras fallo de los alfabloqueantes.

OBJECTIVES: To investigate the efficacy of tadalafil 5mg in patients with lower urinary tract symptoms who failed alpha blocker treatment. PATIENTS AND METHODS: Twenty-three patients were included. Patient consent was obtained after explaining the efficacy of tadalafil 5mg in lower urinary tract symptoms. Before initiating tadalafil 5mg treatment, prostate cancer and urinary tract infection in the patients were eliminated. IPSS, IIEF-5 and Qmax values were assessed before and one month after tadalafil 5mg treatment. Difference between two assessments was evaluated by the Wilcoxon method. RESULTS: After 1 month of Tadalafil 5mg treatment, IPSS decreased and IIEF-5 and Qmax increased. The difference between two assessments were statistically significant. CONCLUSION: Tadalafil 5mg once daily in the treatment of BPH/LUTS is found to be successful in patients who failed previous alpha blocker treatment.

OBJETIVOS: Investigar la eficacia de tadalafilo 5 mg en pacientes con síntomas del tracto urinario inferior (STUI) tras fallo de los alfabloqueantes. PACIENTES Y MÉTODOS: Treinta y tres pacientes fueron incluidos. Se obtuvo consentimiento informado en todos los casos tras explicarles la eficacia del tadalafilo 5 mg en el tratamiento de los STUI. Antes de iniciar el tratamiento se descartaron cáncer de próstata e infección urinaria. Se evaluaron los valores de los cuestionarios IPSS, IIEF-5 y el Q max antes del tratamiento y al mes del tratamiento. Las diferencias entre los grupos se evaluaron utilizando el método de Wilcoxon.    RESULTADOS: Después de un mes con tadalafilo 5 mg, el IPSS disminuyó, y el IIEF-5 y el Q max aumentaron. Las diferencias fueron estadísticamente significativas. CONCLUSIONES: Se ha visto que el tadalafilo 5 mg una vez al día es eficaz en el tratamiento de los STUI/HBP en pacientes con fallo previo del tratamiento con alfabloqueantes.

Eficacia de Tadalafilo 5 mg en el tratamiento de los síntomas del tracto urinario inferior en pacientes tras fallo de los alfabloqueantes / The efficacy of Tadalafil 5 mg in the treatment of lower urinary tract symptoms in patients where alpha blocker treatments have failed in terms of lower urinary tract symptoms

Objetivos: Investigar la eficacia de tadalafilo 5 mg en pacientes con síntomas del tracto urinario inferior (STUI) tras fallo de los alfabloqueantes. Pacientes y métodos: Treinta y tres pacientes fueron incluidos. Se obtuvo consentimiento informado en todos los casos tras explicarles la eficacia del tadalafilo 5 mg en el tratamiento de los STUI. Antes de iniciar el tratamiento se descartaron cáncer de próstata e infección urinaria. Se evaluaron los valores de los cuestionarios IPSS, IIEF-5 y el Q max antes del tratamiento y al mes del tratamiento. Las diferencias entre los grupos se evaluaron utilizando el método de Wilcoxon. Resultados: Después de un mes con tadalafilo 5 mg, el IPSS disminuyó, y el IIEF-5 y el Q max aumentaron. Las diferencias fueron estadísticamente significativas. Conclusiones: Se ha visto que el tadalafilo 5 mg una vez al día es eficaz en el tratamiento de los STUI/HBP en pacientes con fallo previo del tratamiento con alfabloqueantes

Objectives: To investigate the efficacy of tadalafil 5mg in patients with lower urinary tract symptoms who failed alpha blocker treatment. Patients and mehods: Twenty-three patients were included. Patient consent was obtained after explaining the efficacy of tadalafil 5mg in lower urinary tract symptoms. Before initiating tadalafil 5mg treatment, prostate cancer and urinary tract infection in the patients were eliminated. IPSS, IIEF-5 and Qmax values were assessed before and one month after tadalafil 5mg treatment. Difference between two assessments was evaluated by the Wilcoxon method. RESULTS: After 1 month of Tadalafil 5mg treatment, IPSS decreased and IIEF-5 and Qmax increased. The difference between two assessments were statistically significant. Conclusion: Tadalafil 5mg once daily in the treatment of BPH/LUTS is found to be successful in patients who failed previous alpha blocker treatment

A method that facilitates urethral catheterization after internal urethrotomy.

Internal urethrotomy is the first treatment option of the urethral stricture. Urethral catheterization may be difficult after internal urethrotomy in some patients. In this case report, we describe a method to facilitate insertion of urethral catheter in patients in whom urethral catheterization is challenging following internal urethrotomy.

Exenatide reduces oxidative stress and cell death in testis in iron overload rat model.

Glucagon-like peptide-1 (GLP-1) has been demonstrated to affect the oxidative stress status in several in vitro, in vivo and clinical studies. The aim of the present study was to evaluate the effect of a GLP-1 analogue, exenatide, on oxidative stress parameters and apoptotic markers in testicular cells in an iron overload rat model. To obtain this model, the animals were randomly divided into three groups (n=6/group). Rats in the control group received intraperitoneal injections of saline. Intraperitoneal iron dextran (60 mg/kg/day) was given to Group FE for 5 days a week for 4 weeks. The third group (Group Fe +E) was given subcutaneous injections of 10 µg/kg exenatide in two divided doses for 4 weeks in addition to iron dextran. Testes of all rats were immediately removed for immunohistochemical staining and to measure the malondialdehyde level and superoxide dismutase enzyme activity. A significant reduction was observed in caspase-8 and -3 enzyme staining in testicular stromal and endothelial cells in exenatide injected iron overloaded rats when compared with controls. Oxidative stress markers malondialdehyde levels and superoxide dismutase enzyme activities were also significantly lower in exenatide-injected rats when compared with controls. These findings indicate that exenatide may be protective against the harmful effects of iron accumulation in testis. Further studies are required to evaluate how exenatide reduces oxidative stress and cell death in iron overloaded testis tissue.

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma.

PURPOSE: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients. PATIENTS AND METHODS: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS. RESULTS: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively). CONCLUSION: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.

Retrograde intrarenal surgery by flexible ureteroscope in patients with spinal deformities.

OBJECTIVE: To present our experience with retrograde intrarenal surgery (RIRS) for managing renal stones in patients with spinal deformities. DESIGN: We retrospectively reviewed the records of patients. METHODS: We retrospectively reviewed the records of seven patients with congenital scoliosis (n = 5), spina bifida (n = 2) who had undergone RIRS for renal stones. Stone-free status was determined by CT 30 days after the procedure and was defined as the absence of stones in the kidney or residual fragments ≤1 mm. RESULTS: Mean patient age was 27 years (18-45 years), and mean stone size was 176 mm (143-340 mm). The average operative time was 38 minutes (25-53 minutes), and postoperative hospital stay was 1 day (1-2 days). A stone-free status was obtained in six (85.7 %) patients, and one patient was considered to have treatment failure. This patient was managed by a repeat RIRS. A Double-J stent was placed at the end of the procedure in all (100 %) patients. No severe complications, either from anesthesia or the surgical procedure, were observed, and no blood transfusion was reported. CONCLUSIONS: The good clearance rate with a low incidence of complications shown by the present study has demonstrated that RIRS is a safe and effective procedure for renal stones in patients with spinal deformities.

Seperation of dorsal vein complex from the urethra by blunt finger dissection during radical retropubic prostatectomy.

We present our initial experience on the isolation of dorsal vein complex by blunt finger dissection in 26 patients with localised prostate cancer who underwent open retropubic radical prostatectomy. Loss of blood was between 300 and 500 mL (mean 350 mL). Two of 26 patients (7.6%) required blood transfusion. There was no positive surgical margin at prostatic apex in the patients. Twenty four of our patients (92.4%) were continent on the 3(rd) month. Control of dorsal vein complex is very important to decrease blood loss and to improve intraoperative exposure of retropubic area in order to get negative margin of prostatic apex and to provide the urethra long enough for a nice urethrovesical anastomosis. According to our initial experience, this technique seems to provide these aims.

Comparative analysis of pedicular vascular control techniques during laparoscopic nephrectomy: en bloc stapling or separate ligation?

OBJECTIVE: To compare the safety and efficacy of en bloc stapling and separate ligation techniques for renal vascular control during laparoscopic nephrectomy. PATIENTS AND METHODS: Clinical data were collected from 60 patients who underwent laparoscopic nephrectomies using en bloc stapling (n = 27, group 1) or the separate ligation method (n = 33, group 2). Comparative analysis was carried out between the two groups, examining operative times, blood loss, intra- and postoperative complications and hospital stay. RESULTS: Compared with the separate ligation method, the en bloc hilar control technique was associated with a shorter total operating time (98 vs. 121 min, p = 0.029). However, both groups were similar in terms of estimated blood loss, hemoglobin drop, changes in creatinine level and postoperative hospital stay. The total complication rates in group 1 and 2 were 3.7 and 15.1%, respectively, with a statistically significant difference. There were no complications related to the use of the endo-GIA stapler and no patients required conversion to open surgery in group 1. In group 2, 2 patients required conversion to open surgery, including 1 due to renal vein bleeding secondary to inaccurate vascular control and the other due to bleeding from the vena cava during dissection. In addition, 1 patient had a superficial bowel injury that was repaired laparoscopically and another had a superficial liver tear that was managed without conversion or transfusion. CONCLUSION: En bloc ligation of the renal hilum is an easy and reliable technique that allows safe and fast control of the renal pedicle.

The effects of tamsulosin and alfuzosin on iris morphology: an ultrasound biomicroscopic comparison.

CONTEXT: It is well known that Alpha-1 adrenergic receptor antagonists affect the receptors in the prostate and also iris dilator muscle, leading to loss of iris muscle tone. OBJECTIVE: To compare morphological alterations of iris secondary to tamsulosin and alfuzosin use. PARTICIPANTS: Patients included in the study were grouped as follows: 16 patients treated with tamsulosin (Group 1), 14 patients treated with alfuzosin (Group 2) and 18 untreated controls (Group 3). MATERIALS AND METHODS: All patients underwent ultrasound biomicroscopic and pupillometric examination. Iris thickness was measured at the dilator muscle region (DMR; measured at half of the distance between the scleral spur and the pupillary margin) and sphincter muscle region (SMR; Standardized at 0.75 mm from the pupillary margin). DMR/SMR was also calculated for each patient. Differences among groups were analysed. Main outcome measures were DMR, SMR, DMR/SMR and pupillary diameter. RESULTS: Mean duration of treatments were 2.4 ± 0.96 years (1-4) and 2.3 ± 1.01 years (1-4) in Groups 1 and 2. Pupillary diameters were reduced in Groups 1-2 compared to Group 3 (p < 0.001, p < 0.001). The SMR was similar in Groups 1 and 2 (p: 0.114). These values were not significantly different from that of Group 3 (p: 0.196, p: 0.209). However, thickness in the DMR in Groups 1-2 were significantly lower than that of controls (Group 3) whereas there was no significant difference between Groups 1 and 2 (p: 0.041, p: 0.039 and 0.986, respectively). Mean DMR/SMR ratios were significantly lower in Groups 1-2 than that of Group 3 (p: 0.040 and p: 0.040, respectively). CONCLUSIONS: In patients using these medications, the iris seems to be thinner at the dilator muscle region, but preserving the sphincter muscle region.

Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion.

We evaluated the efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) in patients with distal ureteral stone. In addition, we tried to determine the predictive value of Hounsfield Unit (HU) of the stone in the success of MET. A total of 75 patients with a distal ureteral stone of 5-10 mm diameter were randomly divided into three groups. Group 1 (n = 25) received tamsulosin 0.4 mg/d; group 2 (n = 25) received nifedipine 10 mg/day p.o and group 3 (n = 25) received diclofenac sodium 50 mg p.o. when required. At the beginning of each treatment, the HU of the stone was also measured using a non-contrast computerized tomography in all the patients. The results were evaluated at week four. The mean age of the patients was 36.8 (range, 16-68) years. Stone expulsion was observed in 19 (76%) patients in group 1, 16 (64%) patients in group 2 and 9 (36%) patients in group 3 (pgroup1-3 = 0.004, pgroup2-3 = 0.048 and pgroup1-2 = 0.355). The mean expulsion time was 9, 9.1 and 10.3 d, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.619). The mean diclofenac sodium dose per patient was 544, 602 and 1408 mg in groups 1, 2 and 3, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.977). The mean HU of the stone in patients with and without a successful MET was 363 and 389, respectively (p = 0.462). Our results showed that MET with both nifedipine and tamsulosin provided a similar increase in the expulsion rate for distal ureteral stones. HU does not seem to be a predictive parameter for stone expulsion.

Comparison of local anesthetic effects of lidocaine versus tramadol and effect of child anxiety on pain level in circumcision procedure.

OBJECTIVE: To compare the local anesthetic effects of tramadol hydrochloride with those of lidocaine in circumcision procedures. We also investigated the effect of child anxiety on pain level. PATIENTS AND METHODS: A total of 70 children were included in this study. The children were randomized into 3 groups. Group 1 (n = 26) received lidocaine hydrochloride + epinephrine and they underwent circumcision using Ali's clamp(®). Group 2 (n = 35) received lidocaine hydrochloride + epinephrine and group 3 (n = 12) 5% tramadol. The last two groups underwent conventional circumcision. RESULTS: The mean anxiety score was 22.6. We did not find significant differences in terms of anxiety score among the groups (p = 0.761). When the pain scores of the groups during injection were compared, it was found that there were no significant differences. However, the pain score of the third group was significantly high when it was compared with the first and second group 2 and 10 min after injection. In the correlation analysis, we found a positive correlation between children's anxiety scores and the pain degree during injection (r = 0.373, p = 0.001). CONCLUSION: Tramadol may not provide effective local anesthesia in male circumcision. The child's anxiety before the circumcision seems to have a negative effect on pain level.

Safety of ESWL in elderly: evaluation of independent predictors and comorbidity on stone-free rate and complications.

AIM: Urinary stone disease affects people of all ages. With its satisfactory efficacy ranges in all age groups and lack of side-effects, extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for uncomplicated renal and proximal calculi ≤ 20 mm. In the present study, we aimed to assess the safety and efficacy of the ESWL treatment in elderly patients. METHODS: A retrospective study was carried out on patients aged over 65 years who underwent shock wave lithotripsy at our Department from 2009 to 2011, with a Siemens Lithostar electromagnetic shockwave lithotripter. A total of 231 patients (157 males, 74 females) out of 1694 (13.6%) were studied. The patients were divided into two groups (group 1 = 65-70; group 2 >70). The effect of age and other possible predicting factors (sex, stone localization and stone size) were investigated. Concomitant diseases and related complications were also evaluated. RESULTS: An overall stone-free rate (SFR) of 82.2% was found. The influence of sex on SFR was non-significant. There was no significant difference when comparing SFR between the age groups. When patients were divided into those with renal and ureteral stones, the SFR were 94.4% and 67.6% (P < 0.01), respectively. The SFR of the stone size groups, ≤ 10 mm and > 10 mm were 80% and 84.4%, respectively. Comorbidity was present in 148 patients. Complications were noted in 56 of 231 patients. Of 56 patients, 43 had minor complications and 13 major complications. CONCLUSION: ESWL seems to be an effective first-line treatment choice for urinary stones in elderly patients with careful patient selection and personalized preparation.