Effective radiation exposure evaluation during a one year follow-up of urolithiasis patients after extracorporeal shock wave lithotripsy.

INTRODUCTION: To determine and evaluate the effective radiation exposure during a one year follow-up of urolithiasis patients following the SWL (extracorporeal shock wave lithotripsy) treatment. MATERIAL AND METHODS: Total Effective Radiation Exposure (ERE) doses for each of the 129 patients: 44 kidney stone patients, 41 ureter stone patients, and 44 multiple stone location patients were calculated by adding up the radiation doses of each ionizing radiation session including images (IVU, KUB, CT) throughout a one year follow-up period following the SWL. RESULTS: Total mean ERE values for the kidney stone group was calculated as 15, 91 mSv (5.10-27.60), for the ureter group as 13.32 mSv (5.10-24.70), and in the multiple stone location group as 27.02 mSv (9.41-54.85). There was no statistically significant differences between the kidney and ureter groups in terms of the ERE dose values (p = 0.221) (p >0.05). In the comparison of the kidney and ureter stone groups with the multiple stone location group; however, there was a statistically significant difference (p = 0.000) (p <0.05). CONCLUSIONS: ERE doses should be a factor to be considered right at the initiation of any diagnostic and/or therapeutic procedure. Especially in the case of multiple stone locations, due to the high exposure to ionized radiation, different imaging modalities with low dose and/or totally without a dose should be employed in the diagnosis, treatment, and follow-up bearing the aim to optimize diagnosis while minimizing the radiation dose as much as possible.

Management of patients with retroperitoneal tumors and a review of the literature.

BACKGROUND: Retroperitoneal tumors (RTs) develop insidiously and are generally seen as large masses, and 50% of RTs are larger than 20 cm at the time of diagnosis. In this article, we share our experience of 5 years of surgical management of RTs. METHODS: We evaluated 28 RT cases operated on in three education hospitals in Turkey from January 2008 onwards, with regard to patients' demographic characteristics, complaints, weight loss figures, the location and size of the tumor, blood transfusion, intra-operational time, metastases (in malignant cases), additional organ resection, histological grade, local recurrences, average life expectancy, and post-operative treatment methods. RESULTS: The mean age of the patients was 49 years (range, 18 to 78 years). Twenty (71.43%) were female, and 8 (28.57%) were male. The primary complaint was abdominal pain in 18 patients (64.28%). CT scans were performed in 17 (61%) patients, 10 (35.4%) underwent abdominal MR imaging, and 1 (3.6%) underwent both abdominal CT and abdominal MR imaging. A mass was palpated in the pelvis (suprapubic region) in seven (25%) of the patients during physical examination. The largest tumors were detected in the left lumbar area. The mean tumor size was 12.78 cm (range, 2 to 30 cm). The mean intra-operational time was 192 min (range, 70 to 380 min). The mean hospitalization period was 11 days (range, 8 to 23 days). Seven (25%) patients were reported to have benign tumors, while 21 (75%) were reported to have malignant tumors. The most frequently seen malignant pathology was liposarcoma (eight cases; 38.09%) followed by leiomyosarcoma (five cases; 23.8%) and malignant fibrous histiocytoma (four cases; 19.04%). The earliest local recurrence was detected in the 12th month and the latest in the 28th month. A total of 11 (52.3%) of the total of 21 malignant cases experienced local recurrence within 3 years. The 3-year average life expectancy was 85.7% in the 18 malignant cases. CONCLUSIONS: Due to the low response rate of all but two types of RT to chemotherapy, the best remaining treatment option is surgery with wide resection margins, whereby all macroscopic traces of tumor are removed.

A Comparison of 2 Percutaneous Nephrolithotomy Techniques for the Treatment of Pediatric Kidney Stones of Sizes 10-20 mm: Microperc vs Miniperc.

OBJECTIVE: To compare outcomes of micro-percutaneous nephrolithotomy (PNL; microperc) with mini-PNL (miniperc) in the treatment of pediatric renal stones of sizes 10-20 mm. MATERIALS AND METHODS: Patients aged <18 years who underwent PNL for renal stones of sizes 10-20 mm between August 2011 and March 2014 in 3 referral centers were reviewed retrospectively. Patients were evaluated in the following 2 groups: microperc (group 1) and miniperc (group 2). Demographics and perioperative parameters (fluoroscopy and operation time, hemoglobin drop, and stone-free and complication rates) were retrospectively analyzed. RESULTS: A total of 119 patients were evaluated, including group 1 (n = 56) for microperc and group 2 (n = 63) for miniperc. We found mean stone sizes as 13.4 ± 3.4 and 14.8 ± 3.7 mm in the groups, respectively (P = .046). Mean operation and fluoroscopy times were 57.1 ± 31.2 minutes and 132.4 ± 92.5 seconds in the microperc group and 68.9 ± 36.7 minutes and 226.2 ± 166.2 seconds in the miniperc group, respectively (P = .110 and P <.001). Stone-free rates were similar in both groups (82.1% vs 87.3%; P = .433 and 92.8% vs 93.6%; P = 0673) on postoperative day 1 and at first-month follow-up. The mean hemoglobin drop in group 2 differed from that in group 1 significantly (P <.001). The difference of average hospitalization times was statistically significant (43.0 ± 15.4 vs 68.5 ± 31.7 hours; P <.001). CONCLUSION: Our outcomes show that microperc may be preferred as an alternative to mini-PNL for the treatment of pediatric kidney stones of sizes 10-20 mm with comparable success and complication rates, as well as shorter hospitalization and fluoroscopy times.

Treatment of symptomatic lower pole stones of a kidney with partial nephrectomy using micropercutaneous nephrolithotomy technique.

We present the treatment of lower pole stones of a 62-year-old male patient with a history of open partial nephrectomy due to renal angiomyolipoma and renal stones. He was successfully treated with micropercutaneous nephrolithotomy technique under spinal anesthesia in spite of fibrotic and scar tissue due to previous open surgery. The patient was stone-free and was discharged after a 24-hour hospitalization period. There is not any published report of micropercutaneous nephrolithotomy in a partial nephrectomized kidney before. In this report, we suggest that microperc technique may be considered for challenging conditions in case of failed retrograde intrarenal surgery.

Comparison of the efficacy of diclofenac, acupuncture, and acetaminophen in the treatment of renal colic.

OBJECTIVE: The objective is to compare the analgesic effects of diclofenac, acetaminophen, and acupuncture in urolithiasis-driven renal colic pain relief. METHODS: Renal colic patients were divided randomly into 3 groups. Patients in group I (n = 40) were treated with intravenous acetaminophen, those in group II (n = 41) with acupuncture, and those in group III (n = 40) with a 75-mg intramuscular injection diclofenac sodium. Visual analogue scale (VAS) and verbal rating scale (VRS) were used to assess pain intensity after 10, 30, 60, and 120 minutes. RESULTS: No significant differences in baseline VAS or VRS were found with regard to age or sex. After 10 minutes, all 3 groups experienced a significant decrease in VAS and VRS scores, with the most drastic decrease occurring in group II. After 30 minutes, there was a significantly higher decrease in group III than in group I (P = .001). After 60 minutes, mean VAS scores of groups I and III (P = .753) were similar. The mean VAS score of group III was lower than that of group II (P = .013). After 120 minutes, the difference in the VAS scores was (P = .000) between groups I and II and between groups II and III. Yet, the VAS evaluation made after 120 minutes revealed statistically similar outcomes for groups I and III (P = .488). The statistical findings for VRS evaluations made after 10, 30, 60, and 120 were similar to those for VAS. CONCLUSIONS: In renal colic patients with a possible nonsteroidal anti-inflammatory drug and acetaminophen side effect risk, acupuncture emerges as an alternative treatment modality.

Is Micropercutaneous Nephrolithotomy Technique Really Efficacicous for the Treatment of Moderate Size Renal Calculi? Yes.

OBJECTIVE: To present our clinical experiences with micropercutaneous nephrolithotomy in the treatment of moderate-sized renal calculi from a single center. METHODS: We retrospectively evaluated the patients with moderate-sized renal calculi who underwent micro-percutaneous nephrolithotomy between December 2012 and Septermber 2013. RESULTS: A total of 68 patients and 70 renal units underwent microperc procedure. Mean age of patients was 41.4 ± 18.8. The mean stone size was 122 ± 83 mm(2). The operations were performed under spinal anesthesia in 89.7% of the patients. Stone-free rate was 95.7 % (67/70). Clinically significant residual fragments were observed in three patients. The average duration of operation and mean fluoroscopy time was 40 ± 23 min and 108 ± 72 s, respectively. The mean postoperative drop in hemoglobin was 0.95 ± 0.7 while no patient required blood transfusion. Patients were discharged after an average hospitalization time of 27.5 ± 12.4 h. A total of 4 complications (5.7%), including urinary tract infection (Clavien I) in one patient and renal colics requiring stent insertion (Clavien IIIa) in three patients, were observed postoperatively. CONCLUSION: Microperc technique is safe, feasible, and efficacious. We suggest that micro-percutaneous nephrolithotomy should be considered for the treatment of moderate-sized renal stones as an alternative to SWL and RIRS failures and also may be considered even primarily.

Comparison of flexible ureterorenoscopy and micropercutaneous nephrolithotomy in the treatment for moderately size lower-pole stones.

PURPOSE: To present a retrospective comparative clinical study of micropercutaneous nephrolithotomy (microperc) versus flexible ureterorenoscopy (F-URS) in treatment of moderate-size lower-pole stones (LPSs). METHODS: We retrospectively reviewed data on patients with isolated LPSs ≤2 cm in diameter treated with F-URS and/or microperc in two referral centers. Patients were divided into two groups by treatment modality: F-URS (Group 1) and microperc (Group 2). Demographics and perioperative parameters were analyzed. RESULTS: A total of 127 patients with isolated LPSs were treated via F-URS (Group 1, n = 59) and microperc (Group 2, n = 68). Mean patient age in microperc group was slightly lower than in F-URS group (p = 0.112). We found no statistically significant difference in terms of either the size or number of stones in two groups (p = 0.113 and p = 0.209, respectively). Operative time was shorter in microperc, whereas fluoroscopy time was shorter in F-URS (60.1 ± 26.2 vs. 46.2 ± 24.3 min, p < 0.001; and 28.3 ± 19.1 vs. 108.9 ± 65.2 s, p < 0.001). Mean fall in hemoglobin level was statistically significantly lower in F-URS and hospitalization time was also significantly shorter in F-URS (0.68 ± 0.51 vs. 1.29 ± 0.88 mg/dL, p < 0.001; and 23.0 ± 58.1 vs. 33.8 ± 17.2 h, p < 0.001, respectively). Stone-free rates (SFRs) were 74.5 % (44/59) in Group 1 and 88.2 % (60/68) in Group 2 (p < 0.001). CONCLUSIONS: We found that microperc was safe and efficacious when used to treat moderate-size LPSs and may be considered as an alternative to F-URS, affording a higher SFR. Our study supports the notion that microperc should play an increasing role in treatment of LPSs.

Is micro-percutaneous nephrolithotomy surgery technically feasible and efficient under spinal anesthesia?

The objective of the study was to present the clinical and operative effects of two types of anesthesia on micro-percutaneous nephrolithotomy ("microperc"). We retrospectively reviewed 116 patients who underwent microperc between August 2011 and September 2013. Patients were sorted into one of the two groups according to the type of anesthesia received: general (Group 1, n:53) or spinal (Group 2, n:63). Perioperative variables (age, stone size, location) and outcomes (operation time, success, complication rate) were evaluated and compared. Although there was a statistically significant difference in the mean age of patients (30.3 ± 22.1 vs. 45.8 ± 14.6, respectively, p < 0.001), mean body mass indexes were similar (p = 0.689). There was no substantial difference in terms of sizes and localizations of stones in the two groups (p = 0.970 and p = 0.795). While a significant difference was found in comparison of operative times (59.62 ± 32.56 vs. 40.98 ± 26.45 min, p < 0.001), there was no statistically significant difference in mean fluoroscopy times (124.92 ± 84.2 vs. 105.2 ± 61.0 s, p = 0.441). Stone-free rates were similar (90.5% vs. 93.6%, p = 0.297). We found no statistical differences between the two groups with respect to mean hemoglobin drop and hospitalization time (p = 0.015 and p = 0.917, respectively). The complication rates and analog pain scores were also similar (p = 0.543 and p = 0.365). Our results show that microperc is a feasible surgical modality in the treatment of kidney stone disease under both spinal and general anesthesia. Spinal anesthesia may be considered for patients at a high risk for general anesthesia, and also may be an alternative for patients who are concerned about and/or fearful of general anesthesia.

Does the presence of hydronephrosis have effects on micropercutaneous nephrolithotomy?

PURPOSE: To evaluate the effects of presence of hydronephrosis on micropercutaneous nephrolithotomy (micro-PNL) surgery. PATIENTS AND METHODS: A retrospective analysis of 112 patients who underwent microperc surgery between December 2012 and April 2014 was performed. Patients were evaluated in two groups according to whether the presence of hydronephrosis. Stone size and location, fluoroscopy and operation time, stone-free rates and patient-related parameters were prospectively recorded into a centralized computer-generated system. RESULTS: A total of 58 patients in Group 1 with hydronephrosis and 54 patients in Group 2 with no hydronephrosis were analyzed. There was no statistically significant difference in terms of stone sizes and body mass indexes (BMI) in comparison of groups (155.2 ± 93.06 vs. 143.70 ± 70.77 mm(2), p = 0.856 and 27.6 ± 4.2 vs. 26.7 ± 3.2 kg/m(2), p = 0.625). The success rates were similar (91.3 vs. 92.5%, p = 0.341). While the mean operation time and fluoroscopy time in Group 1 were 44.2 ± 23.62 min and 105.3 ± 47 s, it was 38.8 ± 26.4 min and 112.53 ± 68.3 s in Group 2, but there was no statistical difference in comparison of both groups. The mean attempts of percutan puncture were 1.35 ± 0.47 in Group 1 and 1.76 ± 0.31 in Group 2 (p = 0.185). We also found no statistical differences regarding mean hemoglobin change and hospitalization time, respectively (p = 0.685 and p = 0753). In comparison of grades of hydronephrosis, there was no statistically significant difference in subgroups analysis. CONCLUSIONS: The presence of hydronephrosis does not affect success rates and operative time in micro-PNL procedures significantly. Micropercutaneous nephrolithotomy is technically feasible and efficacious both in hydronephrotic and non-hydronephrotic kidneys.

Bladder cancer invasion predictability based on preoperative neutrophil-lymphocyte ratio.

An increased pretreatment neutrophil-lymphocyte ratio (NLR) is associated with poor prognosis in colorectal, gastric, and ovarian cancer; malignant mesothelioma; and renal cell carcinoma. The present study aims to define the predictive value of preoperative peripheral blood count NLR in non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive disease (MIBC) patients. There were in total 291 patients, 241 males and 50 females. Out of these, 156 male and 36 female patients were in the NMIBC group and 85 male and 14 female patients in the MIBC group. In the NMIBC group, 172 patients had low-grade and 20 high-grade papillary urothelial carcinoma. The mean age of the patients in the NMIBC group was 64 ± 13, ranging from 27 to 97. The mean age of the patients in MIBC group was 70.5 ± 10, ranging from 27 to 95. A statistically significant relation between patient ages and tumor invasiveness was determined (p = 0.023, 95 % confidence interval (CI) 63.3-66.7). The mean tumor size of the NMIBC group was 2.1 ± 1.09 (cm) (range 0.5-8), and of MIBC group 3.6 ± 1.5 (cm) (range 0.8-9). There was a statistically significant relation between the tumor size and invasiveness (p = 0.002, 95 % CI 2.8-4.4). In the NIMBC group, 149 (77.6 %) of them have NLR ≤ 2.5 and 43 (22.4 %) have NLR > 2.5. Also, in MIBC, 67 (67.7 %) of them have NLR ≤ 2.5 and 32 (32.3 %) have NLR > 2.5. The mean NLR in the NMIBC group was 2.4 ± 0.1 (range 0.08-6.49, 95 % CI 1.52-2.71) and in the MIBC 2.9 ± 0.2 (range 0.08-16.72, 95 % CI 1.67-2.97). In terms of NLR, there was a statistically significant difference between the NMIBC and MIBC groups (p = 0.028). Platelet-lymphocyte ratio (PLR) of the two groups was also analyzed. The PLR of the NMIBC group was 12.8 ± 15.1 (range 3.38-19.1) and of the MIBC 13.6 ± 8.78 (range 0.18-63), yet there was not any statistically significant difference (p = 0.810, 95 % CI 11.4-14.8) (Table 1). The correlation tests revealed a positive correlation between the age (r = 0.144, p = 0.024), tumor size (r = 0.193, p = 0.02), and tumor invasiveness NLR (r = 0.138, p = 0.031). NLR can be used to determine tumor invasiveness as a cost-effective, common, and simple biomarker in bladder cancer (BC).

Tubeless percutaneous nephrolithotomy: yes but when? A multicentre retrospective cohort study.

The aim of our study is to determine the predictive factors for placement of percutaneous nephrostomy tube (PNT) in percutaneous nephrolithotomy (PCNL) procedure and to evaluate the optimal cutoff points of the predictive factors. 229 patients, who had undergone percutaneous nephrolithotomy operation between February 2009 and February 2013 were reviewed retrospectively. Five patients were excluded from the study because of solitary kidney. All characteristics of 224 patients, stones and operative data were investigated. Patient and stone-related factors, such as age, BMI, history of previous surgery or SWL, characteristics of the stone, renal parenchymal thickness (RPT), as well as procedural factors, such as percutaneous access number and location were analyzed by univariate and multivariate tests. The continuous variables were analyzed using Receiver operating characteristic curve analysis. There were no differences in sex, age, BMI and hemoglobin decrease between the groups. Previous operation status, RPT, stone size, multiplicity of the stone, stone localization, blood transfusion presence, access points, access number and operation time were found statistically different according to univariate analysis. Multivariate analysis showed that RPT, operation time and stone size were the independent factors that affected the PNT insertion. For RPT, operation time and stone size, the optimal cutoff points for insertion PNT were 13.75 mm, 75.5 min and 890 mm(2), respectively. Tubeless PCNL should be chosen in patients with stone area less than 890 mm(2), and parenchymal thickness thicker than 13.75 mm and procedure with operation period <75.5 min.

Initial experience of micro-percutaneous nephrolithotomy in the treatment of renal calculi in 140 renal units.

The aim of this study was to investigate the effectiveness and reliability of the micro-percutaneous nephrolithotomy (PNL) method for the management of kidney stones. We performed a retrospective analysis of 136 patients (140 renal units) who underwent micro-PNL for renal stones between September 2011 and February 2013 in four referral hospitals in Turkey. The selection of treatment modality was primarily based on factors such as stone size and location. In this study, we analyzed patient- and procedure-related factors. The mean age of patients in this study was 28.7 ± 20.6 (1-69) years, and the mean stone size was 15.1 ± 5.15 (6-32) mm. Conversion to mini-PNL was required in 12 patients. All interventions were performed with the patient in the prone position, except for the 3-year-old patient with the pelvic kidney who was placed in the supine position. The mean hospital stay was 1.76 ± 0.65 (1-4) days, and the mean drop in the hemoglobin level was 0.87 ± 0.84 (0-4.1) mg/dL. One of our patients required transfusion. Ureteral J stent was implanted in nine (6.43 %) patients because of residual stones. Seven (6.43 %) patients complained of postoperative renal colic which was managed conservatively. Abdominal distension related to extravasation of the irrigation fluid was observed in three patients (2.19 %). There were no other postoperative complications. An overall success rate of 82.14 % was achieved. Micro-PNL can be effectively and safely used for small and moderate kidney stones resistant to shock wave lithotripsy or as an alternative to other minimally invasive treatment methods.

A new hemostatic agent (Ankaferd Blood Stopper(®)) in tubeless percutaneous nephrolithotomy: a prospective randomized study.

PURPOSE: The present study evaluates the efficiency and reliability of a hemostatic agent ABS (Ankaferd Blood Stopper(®)) in tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: A total of 90 patients were divided into two subgroups. The first group had ABS applied during the intervention, whereas the control group underwent regular tubeless PCNL in this prospective randomized study. Age, stone size, operative time, postoperative hemoglobin change, renal parenchyma thickness, postoperative ureteral catheter removal time, access number, nephroscope time, blood transfusion rate, serum creatinine change, complication rate, visual analogue scale (VAS), and hospitalization time were compared between the two groups. RESULTS: Preoperative and postoperative data obtained from both groups were compared. No statistically meaningful differences were found related to variables of mean age, stone size, access number, serum creatinine change, operative time, renal parenchyma thickness, VAS scores, and hospitalization period. Whereas the nephroscope time (minutes) was longer in the ABS group (Group 1 [G1]:3, 33±1, 72 vs G2:2, 62±1, 43, P=0.035), hemoglobin (Hb) decrease, and urine clarity time were statistically lower compared with the control group. Hb decrease was (mg/dL) (G1: 1.40±1.04 vs G2: 1.84±1.15, P=0.034), and urine clarity time was (hour) (G1: 9.60±5.50 vs G2: 11.95±4.71, P=0.012), respectively. Complications were encountered in three (6.6%) patients of the ABS group and in four (8.8%) of the control group. CONCLUSION: ABS is an efficient and reliable hemostatic agent in tubeless PCNL. Comparative studies are needed, however, with other hemostatic agents that might be applied in tubeless PCNL.

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.

Micropercutaneous nephrolithotomy (microperc) in a two-year-old with the 'all-seeing needle'.

This paper presents the use of the single-step micropercutaneous nephrolithotomy (microperc) procedure for the treatment of a 13-mm renal stone using a 4.85-Fr 'all-seeing needle' in a 2-year-old toddler. In the current literature to date, this is the youngest case. Moreover, the advantages and reliability of this technique in toddler renal stone treatment are also evaluated.

An alternative treatment for high-burden ureteral stones: percutaneous antegrade ureteroscopy.

The treatment of large proximal ureteral stones continues to be controversial. We evaluated the antegrade percutaneous approaches for the proximal ureteral stones in our clinic. In this study, 73 percutaneous antegrade ureteroscopy (PAU) operations applied to proximal ureteral stones between February 2005 and December 2009 were included. The stones were located between ureteropelvic junction and 4th lumbar vertebra. PAUs were applied through appropriate calyx with the patients in prone position. During operations, amplatz dilatators were used for dilatation, and pneumatic lithotripter was used for stone fragmentation. Patients were evaluated according to their success rate, complications, hospitalization period, and preference of drainage tube etc. Patients' mean age was 52.21 years, the mean stone diameter was 19.47 mm (range 15-25), the mean stone burden was 283.76 ± 49.12 mm(2) (mean ± SD) (range 188.5-392.7) and the mean hospitalization time 1.69 days. Single access done in 68 patients and two accesses were needed in 5 patients. Sixty-eight patients (93.1%) became stone-free. Nephrostomy tubes were placed in 12 patients after operation, while tubeless approach was preferred in 61 patients. Complications were seen in five patients. There were not any complications reported during the follow-up period. PAU is an effective and safe treatment modality if appropriate calyx access was performed. The possibility of renal stone treatment in the same session is an important advantage of this modality.

Effects of vardenafil on testicular torsion/detorsion damage: an experimental study in pigs.

PURPOSE: To investigate the effects of vardenafil HCl on testicular germ cell apoptosis and the expressions of iNOS and eNOS within the bilateral testes after unilateral torsion/detorsion (T/D) in a pig model. METHODS: 12 male pigs weighing 50-55 kg were divided randomly into three groups (n = 4). Sham operation and T/D was performed in groups 1 and 2, respectively. Group 3 underwent T/D and received vardenafil (0.4 mg/kg) orally 45 min before detorsion. The testes were left in torsion for 2 h. In all groups, both testes were removed 8 h after the operation for histopathological analysis. RESULTS: Except for group 1, the histopathologic parameters of the ipsilateral testes were higher than in the contralateral testes, and this difference was statistically significant (p < 0.05). Testicular ischemia/reperfusion (I/R) (group 2) resulted in marked increases in germ cell apoptosis, iNOS and eNOS in the ischemic testes compared to the sham-operated group. The pigs treated with vardenafil (group 3) also showed significantly increased apoptotic cells, iNOS and eNOS levels compared to the sham-operated group. CONCLUSIONS: The results suggest that vardenafil HCl worsened histopathological changes related to oxidative stress in testicular injury and had no protective effect on testicular I/R injury in pigs.

The acute effects of increased intra-abdominal pressure on testicular tissue: an experimental study in pigs.

OBJECTIVES: To evaluate the acute effects of increased intra-abdominal pressure (IAP) on testicular germ cell apoptosis and the expressions of endothelial nitric oxide synthase (eNOS), inducible nitric-oxide synthase (iNOS), and Johnson's scores in testicular tissue. MATERIALS AND METHODS: Twelve male pigs weighing 52 to 55 kg were divided into 2 groups as group 1 (n = 6; gasless [control]) and group 2 (n = 6; 20 mm Hg IAP with CO(2) pneumoperitoneum for 4 hours). In the second group, left laparoscopic nephrectomy was performed during the CO(2) insufflation period. The right testes of pigs were removed. Testicular germ cell apoptosis, expressions of eNOS and iNOS, and Johnson's scores were evaluated for each group. RESULTS: The control group (group 1) exhibited low apoptotic cell level and low iNOS and eNOS level in testes. IAP (group 2) resulted in marked increases in germ cell apoptosis, eNOS, and iNOS compared with the control group (group 1) (P <.05). However, no significant difference was noted in Johnson's scores between the 2 groups (P >.05). Moreover, Leydig cell hyperplasia, congestion, and necrosis, which were not documented in the control group, were seen in the study group. CONCLUSIONS: The purpose of the present study was to evaluate whether IAP could affect germ cell apoptosis and NOS concentrations in the testes after laparoscopic procedures in an animal model. In such an animal model simulating laparoscopic procedures, we demonstrated that high-pressure and long-lasting CO(2) insufflation cause testicular changes in the acute period.

Shock wave lithotripsy for distal ureteric stones: supine or prone.

Shock wave lithotripsy (SWL) has become the preferred first-line approach to most patients with symptomatic urolithiasis. The purpose of this study is to assess the ideal patient position during SWL for the treatment of distal ureter stones. A total of 342 patients included in this retrospective study. 148 (108 men, 40 women) patients were included in the first group and were treated in supine position. The remaining 194 (143 men, 51 women) patients were included to second group and were treated in prone position. This study designed retrospectively. The procedure was accepted as a success if the patient was stone free or had only clinically insignificant fragments (≤3 mm) for 3 months or more after the last SWL session. Before SWL, the mean is one area in the first group was 61.32 mm2 while the mean stone area in the second group was 59.04 mm2 (p = 0.208). Mean energy, Mean energy maximum and mean number of applied shock waves of the first group was 4.65, 3.19 and 3,960, respectively. The same parameters in second group were 4.26, 3.03 and 2,953, respectively. These results show that there are statistically significant differences between two groups with respect to mean energy, mean energy maximum and mean number of applied shock waves (p = 0.003, p = 0.010, p = 0.000, respectively). Success rate was 85.1% in group 1 and 72.7% in group 2 (p = 0.006). Our results suggest that supine position is effective and better than prone position for SWL in patients with distal ureteric stones.