Carotid artery intima media thickness can predict the response to phosphodiesterase 5 inhibitors in patients with moderate erectile dysfunction.

Background: Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature. Aim: We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I). Methods: A total of 274 subjects were divided into two groups: ED patients (n = 150) and controls (n = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild-moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders. Outcomes: Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED. Results: Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group (P = .021, P = .006, and P < .001, respectively). The IIEF-5 score was significantly lower in the ED group (P < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders (P = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders (P = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682-0.921) (P = .001), and the cutoff value was determined to be 0.825 mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity. Clinical Implications: Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon. Strengths and Limitations: There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist. Conclusion: CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild-moderate ED.

The effect of anesthesia type on the outcomes of percutaneous nephrolithotomy in elderly males.

Objective: To compare the anaesthesia methods in percutaneous nephrolithotomy in terms of safety and effectiveness in elderly men.Methods: Elderly male patients who had undergone percutaneous nephrolithotomy were screened retrospectively and divided into 2 groups: percutaneous nephrolithotomy under combined spino-epidural anaesthesia (Group CSEA, n = 70) and percutaneous nephrolithotomy under general anaesthesia (Group GA, n = 114). Preoperative, perioperative and postoperative outcome measures were examined.Results: Between the two groups, there was no statistically significant difference in terms of stone burden, stone location, presence of the previous operation in the same kidney, presence of staghorn stones, mean American Society of Anesthesiologists scores and presence of abnormal kidney (p > 0.05). The mean duration time in the operation room and post-anaesthesia care unit (PACU) was statistically shorter in the Group CSEA (p < 0.01). There was no significant difference between the two groups in terms of Clavien Grade 1 and above complications (p > 0.05). Stone-free rates and success rates were similar in both groups (p = 0.133 and p = 0.273, respectively).Conclusion: The type of anaesthesia does not affect the success rate and complication rate of percutaneous nephrolithotomy in elderly male patients. Patients who underwent percutaneous nephrolithotomy under CSEA needed less analgesic injection during the postoperative period. CSEA can shorten the time a patient spends in the operating room and PACU, which provides more effective use of operation room working hours.

Combined spino-epidural anaesthesia (CSEA) can be safely administered in elderly men during PNL operation without affecting surgical success. CSEA patients less occupy the operating rooms. CSEA patients' postoperative period is more comfortable because of the less painful period.

Facet Inclinations and Interfacet Angle of the Distal Radius on Posteroanterior Radiographs: Clinical Associations With 3 Carpal Pathologies.

PURPOSE: The radiographic interfacet angle (IFA), scaphoid facet inclination (SFI), and lunate facet inclination (LFI) of the distal radius were measured in patients with 3 distinct wrist pathologies to determine whether there is an association between these radiographic measurements and these conditions. METHODS: Posteroanterior wrist radiographs were compiled from patients with 3 types of common wrist pathologies (scaphoid waist fracture [n = 54], scapholunate [SL] dissociation [n = 23], and dorsal ganglion [n = 51]). The patients were all Caucasians aged 20 to 45 years who met strict radiographic criteria. The IFA, SFI, and LFI values of these patients were compared with those obtained from 400 normal wrist radiographs of subjects who met the same selection criteria. RESULTS: In men with a scaphoid waist fracture, the IFA and SFI were significantly greater than in normal men, whereas the LFI was significantly lower. In the SL dissociation group, for all patients and for subgroups stratified according to sex, the IFA and SFI were significantly lower than in the normal matched groups. In the dorsal ganglion group, differences were found in the IFA and SFI for women, but not for men. CONCLUSIONS: The facet orientations of the distal radius in patients with scaphoid fracture, SL dissociation, and dorsal ganglion differed from those in the normal population. The IFA alone is most likely to be associated with all 3 pathologies. The SFI and LFI are less likely to be associated with patients with carpal pathologies. CLINICAL RELEVANCE: Patients with a greater IFA may be susceptible to scaphoid fractures when they fall on an overstretched hand. Patients with a smaller IFA may be susceptible to SL dissociation when they fall on an overstretched hand.

Can atherogenic indices and the triglyceride-glucose index be used to predict erectile dysfunction?

Background: Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED. Aim: This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED. Methods: The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated. Outcomes: The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED. Results: According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r2 = 0.120, P < .001 between AIP and IIEF-5; r2 = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED. Clinical Implications: The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED. Strengths and Limitations: The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound. Conclusion: Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.

Investigation of Factors Related to Percutaneous Nephrolithotomy Failure in Horseshoe Kidneys and Comparison of Three Stone Scoring Systems in Prediction of Outcomes.

INTRODUCTION: We aimed to identify factors affecting percutaneous nephrolithotomy (PNL) outcomes among patients with horseshoe kidney (HSK) and assess the predictive accuracy of the Clinical Research Office of the Endourological Society (CROES), Guy's Stone Score (GSS), and S.T.O.N.E. scoring systems. METHODS: Data from 98 patients with HSK who underwent PNL between November 2010 and January 2020 were evaluated. Patients were divided into the stone-free (SF) and non-SF groups and compared according to demographic data, stone and surgical characteristics, and stone scoring systems. Multivariate logistic regression analysis was performed to identify factors associated with SF status. RESULTS: Among the included patients, 87 were male and 11 were female (mean age: 47.37 ± 14.42 years). The SF rate was 84.7% (83 patients). Group analysis identified GSS (p < 0.001), CROES score (p < 0.001), S.T.O.N.E. score (p = 0.014), stone burden (p = 0.045), and multiplicity (p < 0.001) as factors associated with SF status. Among our cohort, 10 patients developed complications. All scoring systems were significantly correlated with SF status (CROES: r = -0.442, p < 0.001; GSS: r = 0.442, p < 0.001; S.T.O.N.E.: r = 0.250, p = 0.013), while CROES score was identified as an independent factor associated with SF status (95% CI: 0.937-0.987; p = 0.003). CONCLUSIONS: PNL is an effective method for treating nephrolithiasis among patients with HSK. Moreover, stone-related factors, such as larger size, multiplicity, and complexity, were associated with procedural failure. Finally, the CROES nomogram was a better predictor of SF status compared with other scoring systems.

Comparison of a Visual Prostate Symptom Score and International Prostate Symptom Score: A Prospective Multicenter Study and Literature Review.

OBJECTIVE: To evaluate the correlation between Visual Prostate Symptom Score (VPSS) and the International Prostate Symptom Score (IPSS) and uroflowmetry parameters in men with lower urinary tract symptoms (LUTS) with literature review. METHODS: Patients were pooled from 4 different urology clinics in Turkey and divided into 3 groups according to their educational level. The scores of IPSS and the VPSS questionnaire, assistance requirement, and completion time of the questionnaires were recorded. Maximum flow rate (Qmax) and average flow rate (Qave) were determined with uroflowmetry test and the results are recorded. RESULTS: A total of 342 patients were evaluated (group 1, n = 168; group 2, n = 108; group 3, n =66). Median age of all groups was 61 (40-89). There was a significantly higher rate of the completion of VPSS than IPSS without assistance in total (P < .001). Educational level was not found as an independent factor with assistance requirement to complete VPSS while university educational level was found as an independent factor to complete IPSS (odds ratio = 9.735, P < .001).There was a significantly lower completion time for VPSS in all groups when compared to IPSS (P < .001 for all groups). Significant positive correlations were found between VPSS and IPSS questions (P < .001). There were significant negative correlations between total score and weak stream question of VPSS and Qmax and Qave, separately (P < .001). CONCLUSION: VPSS can be more practical than IPSS to evaluate LUTS in men with low educational levels and/or in large populations. Some modifications are needed to increase the availability of VPSS.

How can we predict the active surveillance candidates meeting all Epstein criteria prior to prostate biopsy to avoid overdiagnosis?

OBJECTIVE: To investigate the effectiveness of PSA, prostate volume (PV) and free-to-total PSA ratio (fPSA%) in predicting patients meeting all active surveillance criteria, including Epstein criteria. METHOD: Retrospective analysis was made of the data of 1901 men who underwent transrectal ultrasound (TRUS)-guided prostate biopsy in our clinic between January 2015 and December 2019. The active surveillance criteria were determined as Gleason score ≤6, when specified ≤2 positive cores with <50% cancer involvement in every positive core, a clinical T1c, a PSA <10ng/mL and a PSA density <0.15 ng/mL/cc. Patients who met all active surveillance criteria were included in Group 1, and other patients with prostate cancer were included in Group 2. RESULTS: The study included 336 patients with available data of age, total-free PSA levels, PV calculated by TRUS. Group 1 consisted of 82 patients and Group 2 consisted of 254 patients. PV and fPSA% were significantly higher and PSA was significantly lower in Group 1 than in Group 2. On multivariate analysis, the independent predictors were determined to be PSA and PV while fPSA% was not. CONCLUSION: By using PSA and PV in predicting patients meeting all active surveillance criteria, unnecessary biopsies and ultimately overdiagnosis can be reduced.

Free prostate-specific antigen outperforms total prostate-specific antigen as a predictor of prostate volume in patients without prostate cancer.

OBJECTIVE: In the management of benign prostatic hyperplasia (BPH), urology guide- lines recommend medical or surgical treatments according to different prostate volumes (PV). The aim of this study was to analyze the relationships between PV and age, total and free prostate specific antigen (tPSA, fPSA) and fPSA/tPSA ratio in patients without histologically proven prostate cancer. MATERIALS AND METHODS: A retrospective analysis was made of the data of 1334 patients who underwent transrectal ultra- sound (TRUS)-guided prostate biopsy between January 2016 and October 2018. A total of 438 patients with available data for age, tPSA and fPSA levels and PV calculated by TRUS were enrolled in the study. Patients with chronic prostatitis pathology in addition to BPH were also noted and evaluated as a separate group. RESULTS: There were significant correlations between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.210, r = 0.338, r = 0.548, r = 0.363 respectively). In multivariate linear regression analysis, fPSA was found to be the only predictor for PV (p < 0.001) when compared to age (p = 0.097), tPSA (p = 0.979) and fPSA/tPSA ratio (p = 0.425). In patients with chronic prostatitis pathology there were significant correla- tions between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.279, r = 0.379, r = 0.592, r = 0.359, respectively). The multivariate linear regression analysis showed a signifi- cant correlation only between PV and tPSA and fPSA/tPSA ratio but not with fPSA and age (p = 0.008, p = 0.015, p = 0.430, p = 0.484, respectively). In men with only BPH pathology there were significant correlations between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.223, r = 0.385, r = 0.520, r = 0.287, respectively) In multivariate linear regression model the significant correlation was shown only between PV and fPSA (p < 0.001). CONCLUSIONS: Although tPSA was significantly correlated with PV in patients without prostate cancer, the correlation between fPSA and PV was much stronger. However, it should be kept in mind that the efficacy of fPSA may be limited in patients with clinically unknown prostatic inflammation.

Percutaneous Nephrolithotomy via a Middle Calyx Access Is Effective in the Treatment of Lower Pole Kidney Stones: A Single-Center Study.

PURPOSE: To compare the efficacy of the middle calyx access (MCA) and lower calyx access (LCA) in the treatment of lower pole kidney stones. MATERIALS AND METHODS: The data of patients with isolated lower pole kidney stones who underwent percutaneous nephrolithotomy via MCA or LCA between 2009 and 2019 were evaluated retrospectively. Pre-, peri-, and postoperative parameters of the groups (LCA group and MCA group) were compared. A value of p < 0.05 was considered significant. RESULTS: A total of 601 patients with lower pole kidney stones were included in the study. LCA was performed for the initial tract in 400 patients, and MCA was performed in 201 patients. There were no significant differences in terms of age, gender, laterality, body mass index, previous operation history, stone burden, duration of fluoroscopy, and stone-free rate between the groups. Operation time was significantly longer in the LCA group (p = 0.041). In the LCA group, additional access was required in 50 cases, which was significantly higher than in the MCA group (p = 0.013). Clinically insignificant residual fragments (CIRF) were present in 28 patients (7%) in the first group (significantly higher vs. MCA: p = 0.044). There were no statistically significant differences in terms of overall complication and transfusion rates. CONCLUSIONS: MCA had superior outcomes in terms of operation time, CIRF rate, hemoglobin drop, and requirement of an additional tract compared to LCA. Further studies evaluating the efficacy of MCA in lower pole kidney stones should be performed to verify our results.

Importance of the Hounsfield Unit Value Measured by Computed Tomography in the Differentiation of Hydronephrosis and Pyonephrosis.

Objectives To evaluate the efficacy of the non-contrast-enhanced computed tomography (NCECT) renal pelvis Hounsfield unit (HU) values in differentiating between the hydronephrosis and pyonephrosis in dilated urinary systems. Materials and methods Patients who underwent percutaneous nephrostomy (PN) due to urinary system obstruction in the last three years were retrospectively evaluated. Pyonephrosis and hydronephrosis groups were differentiated according to the clarity of percutaneous needle aspiration. The patients' renal pelvic anteroposterior (AP) diameter, renal pelvic area, and mean HU values were measured on NCECT and compared between two groups. Results PN was performed on a total of 523 patients. The study included 159 patients and 214 renal units. Hydronephrosis was detected in 176 renal units and pyonephrosis in 38 renal units. No statistically significant difference was observed between the measured AP diameter and renal pelvic area in the two groups (28.45 ± 10.1 mm vs. 31.13 ± 14.4 mm, p = 0.36 and 658.51 ± 433.1 mm2 vs. 755.14 ± 470.6 mm2, p = 0.22, respectively). The mean HU value of the pyonephrosis group was significantly higher (2.30 ± 5.02 vs. 10.97 ± 6.68, p < 0.001). At the cut-off value of 8.46, HU had a sensitivity of 68.4% and specificity of 92.6% in the diagnosis of pyonephrosis. Conclusions It is possible to determine differential diagnosis between pyonephrosis and hydronephrosis easily and without additional cost by performing dilated renal pelvis HU measurements on NCECT.

Comparison of Guy's Stone Score and clinical research of the endourological society nomogram for predicting surgical outcomes after pediatric percutaneous nephrolithotomy: a single center study.

BACKGROUND: The aim of this study was to compare the efficacy of Guy's Stone Score (GSS) and Clinical Research of the Endourological Society (CROES) Nomogram in predicting PCNL outcomes in the pediatric patients with kidney stone. METHODS: A retrospective review of the clinical data of 120 pediatric patients who underwent PCNL between August 2004 and February 2016 was performed. Patients were grouped according to stone-free (SF) status and complication status. The patients whose history, preoperative physical examination records, biochemical analysis, imaging records were available and who did not neglect the follow-up, were included in the study. The stone size measurement and the scoring system calculation were always performed by the same surgeon. Multivariate logistic regression analysis were performed to identify the factors associated with SF status and complication status. RESULTS: CROES score was significantly higher in SF patients compared to the patients with residual stones (P=0.009), while stone burden and GSS were significantly lower (P=0.023 and P=0.025). Median hospitalization day of patients with complications was significantly higher compared to the patients without complication (P=0.005). To have stones located in multiple calyces was the only statistically significant condition when two groups were compared (P=0.014). In multivariate analysis, CROES score was the independent factor associated with SF status (OR:0.984 95% CI: 0.959-1.010 P=0.017) and to have stones located in multiple calyces was the independent factor associated with complication status (OR:0.265 95% CI:0.087-0.808 P=0.02). CONCLUSIONS: CROES nomogram is associated with the SFR while GSS is not. Both scoring systems do not have predictive accuracy on complication status. Further studies are required to make modifications in the scoring systems in the pediatric population.

Lymphocyte-to-monocyte ratio is a valuable marker to predict prostate cancer in patients with prostate specific antigen between 4 and 10 ng/dl.

OBJECTIVE: To evaluate the diagnostic value of serum inflammation markers derived from complete blood count in diagnosis of prostate cancer (PCa). METHODS: We retrospectively analyzed the data of 621 patients who underwent prostate biopsy between March 2013 and April 2018. Age, prostate specific antigen (PSA), free PSA, platelet count, neutrophil count, lymphocyte count, monocyte count, prostate volume (PV) and pathology result of the patients were recorded. Patients were grouped as benign prostatic hyperplasia (BPH), prostatitis and PCa. Patients were also grouped according to PSA values, as PSA < 4 , PSA 4-10 and PSA > 10 ng/dl. RESULTS: The mean lymphocyte-to-monocyte ratio (LMR) value of the patients with PCa was significantly lower in the entire cohort (p = 0.047). In the PSA 4-10 ng/dl range, LMR value wassignificantly lower in patients with PCa than those with BPH or prostatitis (p = 0.012). In this PSA range, free/total PSA ratio and LMR were significant factors to predict PCa. The cut-off values of LMR, free/total PSA were 3.05 and 0.15 respectively. The sensitivities, spesificities, positive predictive values (PPV) and negative predictive values using LMR cut-off, free/total PSA cut-off and their combination were assessed. Specificity and PPV of the combination group were higher (97.2%, 83.3% respectively) compared to free/total PSA cut-off group (91.6%, 76.6%) and LMR cut-off group (67.8%, 43.7%). CONCLUSIONS: LMR is a useful tool at detecting PCa especially in patients with PSA value between 4 and 10 ng/dl. The combination of free/total PSA ratio and LMR improves the diagnostic accuracy more than the use of free/total PSA ratio alone.

Percutaneous nephrolithotomy in solitary kidneys: effective, safe and improves renal functions.

BACKGROUND: To evaluate success and complication rates of endourological stone treatments and to evaluate effects of percutaneous nephrolithotomy (PCNL) on renal functions, in patients with solitary kidneys. METHODS: In our center, 3150 patients underwent PCNL between 2003 and 2017 and 142 patients underwent retrograd intrarenal surgery (RIRS) between 2013 and 2017. We retrospectively analysed the data of 82 patients with solitary kidney who underwent PCNL and of 8 patients with solitary kidney who underwent RIRS. Complications were classified according to Clavien-Dindo Classification system. Serum creatinin was measured before the procedure, on the early postoperative period and at sixth month follow-up in PCNL group. The estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation guideline. RESULTS: In the PCNL group, the initial stone-free and success rates were 82.9% and 95.1%, respectively. Complications occured in 18 (22%) patients. Transfusion was the most common complication (15.5%). One patient required JJ stenting. The stone-free rates of the patients who required multiple accesses were statistically lower than the patients who required single access (P=0.01). Transfusion rates were statistically higher in patients who required multiple accesses and who had complex stones (P=0.01 and P=0.02, respectively). GFRs calculated preoperatively, in the early and in the late period were 65.03, 62.85 (P=0.224) and 70.63 mL/min/1.73 m2 (P<0.001), respectively. At the postoperative 6th month, GFR was stable in CKD stage 1 patients and improved in CKD stage 2-4 patients (P<0.001, P<0.001 and P=0.012 respectively). In the RIRS group, 5 patients (62.5%) were stone free and the success rate was 75% (6 patients) after single procedure. Any complication did not occur in the RIRS group. CONCLUSIONS: PCNL in solitary kidney is a safe method with acceptable complication rates. Renal functions are preserved in patients with normal functioning kidney and improved in patients with renal insufficiency. RIRS may be an alternative method in selected patients with solitary kidney.

Factors Influencing Complications of Percutaneous Nephrolithotomy: A Single-Center Study.

PURPOSE: Percutaneous nephrolithotomy (PNL) is a minimally invasive procedure used for successful treatment of renal calculi. However, it is associated with various complications. We assessed the complications and their potential influencing factors in patients who had undergone PNL. MATERIALS AND METHODS: In total, 1750 patients who had undergone PNL from November 2003 to June 2011 were evaluated retrospectively. PNL complications and possible contributing risk factors (age, sex, serum creatinine level, previous operations, hydronephrosis, calculi size, localization, opacity, surgeon's experience, accessed calyxes, number of accesses, and costal entries) were determined. Receiver operating characteristic (ROC) analysis was used to investigate the cutoff values of the data. Ideal cutoff value was determined by Youden's J statistic. All the demographic and clinical variables were examined using backward stepwise logistical regression analysis. Continuous variables were categorized with logistic regression analysis according to the cutoff values. RESULTS: Complications occurred in 396 (24.4%) patients who had undergone PNL. Hemorrhage requiring blood transfusion occurred in 221 (12.6%) patients, hemorrhage requiring arterial embolization occurred in 7 (0.4%) patients, perirenal hematoma occurred in 17 (0.97%) patients, hemo-pneumothorax occurred in 32 (1.8%) patients, and colon perforation occurred in 4 (0.22%) patients. Three patients (0.06%) died of severe urosepsis, and one patient (0.02%) died of severe bleeding. The calculus size, localization, access site, number of accesses, presence of staghorn stones, surgeon's experience, and duration of the operation significantly affected the complication risk. CONCLUSION: Our retrospective evaluation of this large patient series reveals that, PNL is a very effective treatment modality for kidney stones. However, although rare, serious complications including death can occur.

[The reliability of somatosensory evoked potentials in the diagnosis of thoracic outlet syndrome]. / Somatosensoriyel uyarilmis potansiyellerin torasik çikis sendromu tanisinda güvenilirligi.

OBJECTIVES: We assessed the role of somatosensory evoked potentials (SEP) in the diagnosis of thoracic outlet syndrome. METHODS: Somatosensory evoked potentials were recorded in provocative and decompressing positions in 30 patients (28 females, 2 males; mean age 32 years; range 20 to 52 years) with a diagnosis of thoracic outlet syndrome and in 30 healthy subjects showing a similar age and sex distribution. RESULTS: All recordings yielded normal ranges in both groups. No statistically significant differences were found between the positions in which SEPs were recorded and between the patient and control groups. CONCLUSION: Our data suggest that SEPs do not give diagnostic information in the identification of thoracic outlet syndrome.

An extremely uncommon infection: Candida glabrata arthritis after total knee arthroplasty.

Prosthetic arthritis caused by Candida species is extremely rare. Of 30 such cases reported in the English literature, only 3 were due to Candida glabrata. We present herein a fourth case; to the best of our knowledge this is the first example of knee arthroplasty infection caused by C. glabrata.

Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation.

de Quervain's disease of pregnancy and lactation is usually self-limited and responds well to nonsurgical treatment. We conducted a randomized prospective study on 19 wrists of 18 patients with de Quervain's disease who were either pregnant or breast-feeding. One group had a cortisone injection into the tendon sheath and the other group used thumb spica splints. All 9 patients with injections had complete pain relief with only one late recurrence. None of the patients with splints had complete pain relief; however, at the end of the lactation period, 8 had spontaneous resolution of symptoms and 1 received a cortisone injection. de Quervain's disease of pregnancy and lactation is self-limited and can be treated successfully with cortisone injection. Splinting does not provide satisfactory pain relief.