Patients who received sleeve gastrectomy have lower plasma osteopontin levels than those who did not.

BACKGROUND: The aim of this study was to compare metabolic parameters, plasma Osteopontin (OPN) and Hepatocyte Growth Factor (HGF) levels between Sleeve Gastrectomy (SG) patients in their 6th post-operation month and healthy control patients. METHODS: Height, weight, Body Mass Index (BMI) and laboratory parameters of 58 SG patients aged 18‒65 years (Group 1) and 46 healthy control patients (Group 2) were compared. In addition, preoperative and postoperative sixth-month BMI and laboratory parameters of the patients in Group 1 were compared. RESULTS: The mean age and gender distributions of the groups were similar (p > 0.05). Mean BMI was 28.9 kg/m2 in Group 1 and 27 kg/m2 in Group 2 (p < 0.01). While plasma HGF levels were similar between both groups, plasma OPN levels were higher in Group 2 (p < 0.001). Fasting plasma glucose, total cholesterol, triglyceride, fasting plasma insulin and insulin resistance values were higher in Group 1, while alanine aminotransferase and aspartate aminotransferase levels were higher in Group 2 (p < 0.05). There was a strong correlation between plasma HGF and OPN levels in Group 1, but not in Group 2 (Rho = 0.805, p < 0.001). CONCLUSION: OPN and HGF are promising biomarkers that can be used to better understand and detect problems related to obesity. The fact that patients in the early post-SG period had lower plasma OPN and similar plasma HGF compared to non-surgical patients of similar age and gender with higher BMI may be another favorable and previously unknown metabolic effect of SG.

TyG index is positively associated with HOMA-IR in cholelithiasis patients with insulin resistance: Based on a retrospective observational study.

BACKGROUND/OBJECTIVE: Cholelithiasis is a common disease but pose significant global health and financial burdens. Mechanisms of the disease are associated with insulin resistance (IR), obesity, metabolic syndrome, and type 2 diabetes. Insulin resistance is commonly observed in cholelithiasis patients. More recently, the triglyceride-glucose (TyG) index has been proposed as an alternative marker of insulin resistance. In our study we aimed to understand whether the TyG index is correlated with HOMA-IR in cholelithiasis patients. And also we aimed the predict a cutoff value for determining insulin resistance in cholelithiasis patients. METHODS: A total of 184 cholelithiasis patients were matched in terms of age, gender, and BMI. They were divided into two groups based on their Homa IR levels (IR and Non-IR group). This study was a retrospective, observational study and clinical data was obtained from electronic medical records. Cutoff value for Tyg index was established through ROC Analysis. Binary Logistic Regression was used to identify factors affecting insulin resistance. RESULTS: A significant cutoff value was found for the TyG index in determining the presence of insulin resistance. Having a TyG index of ≥8.71 indicates the presence of insulin resistance. The sensitivity was 68.48%, the specificity was 58.70%. Binary Logistic Regression analyses showed that an increase in Tyg Index, waist circumference and waist-to-height ratio values increases the risk of insulin resistance by 2.705 (p = 0.001), 1.032 (p = 0.029), and 334.057 (p = 0.012) times respectively. CONCLUSION: Our study indicated that TyG index is positively correlated with HOMA-IR. TyG index was found as a risk factor for insulin resistance.

Matching-adjusted indirect comparison (MAIC) results confirmed by head-to-head trials: a case study in psoriasis.

BACKGROUND: Head-to-head comparisons through randomized controlled trials (RCTs) provide high-quality evidence to inform healthcare decisions. In their absence, indirect comparisons are often performed; however, evidence is limited on how valid matching-adjusted indirect comparison (MAIC)-based comparative efficacy estimates are vs. RCT-based estimates. OBJECTIVES: Compare MAIC and RCT results of guselkumab vs. secukinumab and ixekizumab to provide insight into the validity of results generated using MAIC methods. METHODS: Previously reported results from MAICs of guselkumab vs. secukinumab and ixekizumab were compared with results from ECLIPSE and IXORA-R RCTs based on risk differences between Psoriasis Area and Severity Index (PASI) 90 response rates. RESULTS: Risk difference (95% confidence interval) in PASI 90 response rates at week 48 for guselkumab vs. secukinumab was 14.4% (9.4%; 19.4%) in ECLIPSE and 9.4% (4.7%; 14.0%) in the MAIC. The risk difference at week 24 for guselkumab vs. ixekizumab was 0.0% (-5.4%; 5.4%) in IXORA-R and 0.7% (-5.1%; 6.4%) in the MAIC. CONCLUSIONS: Comparative efficacy results were consistent between MAICs and RCTs of guselkumab vs. secukinumab and ixekizumab. This analysis demonstrates that MAIC methods can provide valid relative treatment effect estimates when direct comparisons are lacking, particularly when trials with similar designs and patient populations inform the analysis.

Predictive value of serum sodium level in determining perforated appendicitis.

BACKGROUND: The aim of the study was to investigate the predictive value of hyponatremia as a new biochemical marker for the early and accurate preoperative diagnosis of complicated appendicitis in the adult population. METHODS: 732 patients who were operated for acute appendicitis (AA) and diagnosed as perforation intraoperatively were evaluated retrospectively. Serum sodium, C-reactive protein (CRP), and leukocyte levels of patients with perforated and nonperforated appendicitis were compared. RESULTS: Perforated appendicitis patients had statistically lower serum Na values (p<0.001). Similarly, patients without perforated appendicitis had higher serum CRP values (p<0.001). In patients diagnosed with perforated AA, the sensitivity of plasma sodium concentration was 63%, and the specificity was 66%. The threshold value of plasma sodium concentration ≤137.5 mEq/L had the best possible sensitivity and specificity. CONCLUSION: Hyponatremia is a new marker of perforated appendicitis and therefore, serum sodium level measurement should be considered in patients with a clinical presentation consistent with appendicitis if complications are suspected.

Predictive Value of Preoperative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratio in Determining the Stage of Colon Tumors.

Introduction Biomarkers such as the neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are associated with the colon tumor stage and prognosis. Therefore, in our study, we investigated whether these biomarkers are important in determining the colon cancer stage. Materials and methods The outcomes in 268 patients operated on with the diagnosis of colon cancer between January 2011 and March 2019 were retrospectively analyzed. The relationship of the stage of the patients with the NLR or PLR was evaluated. In addition, according to the stage of colorectal tumors, stage I and other stages (stages II, III, and IV) were compared in terms of NLR and PLR. Groups that had lymph node (LN) metastasis were compared with those that did not. Finally, groups with and without metastasis were also compared. Results In our cohort, 144 patients (57.6%) were male, and 84 (42.4%) were female. The mean age was found to be 68.28 ±12.71 years. The patients were evaluated according to their stages: 26 patients were stage I, 78 patients were stage II, 75 patients were stage III, and 19 patients were stage IV. There was a significant difference in NLR values between the groups (p: 0.05). Also, 104 patients were LN-negative (stages I-II), and 94 patients were LN-positive (stages III-IV). When PLR was compared between the two groups, no significant difference was found between tumor stages and these values (p: 0.099). However, there was a significant difference in NLR values (p: 0.034). Conclusion  Based on our findings, it has been concluded that increased PLR may not be associated with the colon cancer stage. However, the increase in NLR was found to be correlated with tumor stage and LN metastasis.

Ability of ESWL nomograms to predict stone-free rate in children.

INTRODUCTION: We aimed to evaluate whether the pediatric extracorporeal shock wave lithotripsy (ESWL) nomograms can predict stone-free status in children effectively and whether they are applicable to our series. We hypothesize that two current nomograms predicting successful treatment with ESWL in pediatric patients are valid. STUDY DESIGN: We evaluated 415 renal units (children <18 years) with eligible data who received ESWL treatment for upper urinary tract stones. Children's age, gender, stone size, stone surface area, stone location and history of previous intervention were recorded. Children with no residual fragments after ESWL treatment were designated as stone-free. The nomograms described by Dogan and Onal were implemented to our series for the prediction of stone-free status. RESULTS: Mean age of children was 64.7 ± 57.2 months. Male to female ratio was 219:196.78.8% (327) of children had single stone. Mean stone size was 10.0 ± 3.7 mm and mean stone surface area was 380.0 ± 72.2 mm2. Our stone-free rate after single ESWL session was 52.5% (218/415). Mean residual stone size and stone surface area after single session was 6.4 ± 3.3 mm and 36.0 ± 44.2 mm2 respectively. There were no significant difference between stone-free children and children with residual fragments regarding gender, age and history of previous intervention. Mean stone size and stone surface area in stone-free children were lower and lower pole stones had the lowest stone-free rate (p < 0.05). Area under curve for Dogan and Onal nomogram were 0.628 and 0.580 respectively in ROC analysis (0.05). The agreement between Dogan and Onal score was moderate in our series. In multivariate analysis only stone surface area and Dogan score found to be independent predictors of stone-free status (p < 0.05). DISCUSSION: Only one study has assessed both nomograms in the literature. Both nomograms are reported to be independent predictors of stone free status. ROC analysis in our study revealed fair accuracy for both nomograms with higher area under curve for Dogan nomogram. Higher accuracy for both nomograms were reported by other authors. These nomograms offer practical data but more effective tools are needed to be developed for the prediction of stone-free status in pediatric ESWL. CONCLUSIONS: Stone size and stone surface area are associated with stone clearance. Dogan and Onal nomograms can be useful in prediction of stone-free status in children. Dogan nomogram is superior to Onal nomogram.

The role of the lactate level in determining the risk rates of small bowel resection in incarcerated hernias.

BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS: A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS: Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION: In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.

Effect of cultivar and season on the robustness of PLS models for soluble solid content prediction in apricots using FT-NIRS.

FT-NIR models were developed for the non-destructive prediction of soluble solid content (SSC), titratable acidity (TA), firmness and weight of two commercially important apricot cultivars, "Hacihaliloglu" and "Kabaasi" from Turkey. The models constructed for SSC prediction gave good results. We could also establish a model which can be used for rough estimation of the apricot weight. However, it could not be possible to predict accurately TA and firmness of the apricots with FT-NIR spectroscopy. The study was further extended over 3 years for the SSC prediction. Validation of the both mono and multi-cultivar models showed that model performances may exhibit important variations across different harvest seasons. The robustness of the models was improved when the data of two or three seasons were used. It was concluded that in order to developed reliable SSC prediction models for apricots the spectral data should be collected over several harvest seasons.

Rapid, simultaneous and non-destructive assessment of the moisture, water activity, firmness and SO2 content of the intact sulphured-dried apricots using FT-NIRS and chemometrics.

The potential of using FT-NIR spectroscopy for the rapid and non-destructive measurement of the moisture, water activity, firmness and SO2 content of the intact sulphured-dried apricots (SDA) was investigated for the first time in the literature. The partial least squares regression (PLS-R) models constructed using FT-NIR spectra were very successful in predicting the moisture content (R2p = 0.986, RMSEP = 1.22%, RPD = 9.15) and water activity (R2p = 0.987, RMSEP = 0.016, RPD = 9.37) of SDAs. Satisfactory results were also obtained for the models developed for the prediction of the firmness (R2p = 0.845, RMSEP = 0.445, RPD = 2.55) and SO2 content (R2p = 0.804, RMSEP = 349 mg kg-1, RPD = 2.27). These results clearly demonstrate that the major quality parameters of SDA can be simultaneously measured in a short time by FT-NIR spectroscopy without any need for the sample preparation or skilled laboratory personnel.

Do Meteorological Changes Have an Effect on The Occurence of Spontaneous Pneumothorax?

OBJECTIVES: Spontaneous pneumothorax refers to the leakage of air into the space between the parietal and the visceral layers of the pleura. It occurs with or without a known lung disease. We aimed to investigate the effects of atmospheric pressure, humidity, and temperature changes on the incidence of spontaneous pneumothorax (SP). MATERIAL AND METHODS: This study included 551 patients with spontaneous pneumothorax retrospectively screened between January 2009 and December 2013. The medical data of the patients were accessed via their medical records on the hospital automation system. The atmospheric pressure, temperature, humidity rate, amount of precipitation, and wind velocity on the day of spontaneous pneumothorax were obtained from the data provided by the general directorate of meteorology. The three consecutive days on which at least 2 cases of SP presented were collectively considered as a cluster. The study data were analyzed with the SPSS version 15 software package, using the Chi-square and the Student's t tests. A p value less than 0.05 was considered statistically significant. RESULTS: Of the 552 patients included in the study, 89.3% had primary spontaneous pneumothorax and 10.7% had secondary spontaneous pneumothorax. Ninety-two percent of the patients were male and 8% were female. The mean age was 24 years. Clustering was observed in 71.7% of the study population. No significant differences were observed between yearly and monthly SP incidences. There were, however, differences between the days with SP and the days without SP with respect to atmospheric pressure, ambient temperature, wind velocity, and humidity rate. The differences between the atmospheric pressures were not statistically significant, although the differences between the ambient temperature and the humidity rate were statistically significant (p≤ 0.05). CONCLUSION: We determined that the changes in the ambient temperature and the humidity rate affected the rate of spontaneous pneumothorax by altering the meteorological conditions.

Comparison of modified Limberg flap transposition and lateral advancement flap transposition with Burow's triangle in the treatment of pilonidal sinus disease.

BACKGROUND: Although many options exist for surgical treatment of pilonidal sinus disease (PSD), consensus has not yet been achieved, as all surgical methods have various rates of complications, postoperative infection, and recurrence. METHODS: This study was a prospective, randomized, clinical trial, and was conducted with consecutive 100 patients admitted to Ankara Military Hospital General Surgery Service for treatment of PSD from May 2013 to August 2013. This study compared two surgical treatments for PSD: modified Limberg flap transposition and lateral advancement flap transposition with Burow's triangle. The patients received surgical treatment with either modified Limberg flap transposition (n = 50) or lateral advancement flap transposition with Burow's triangle (n = 50). Clinical healing period, length of hospital stay, operative time, postoperative complications including recurrence, wound dehiscence, and surgical site infection, as noted during postoperative follow-up period; Visual Analog Scale scores for pain. RESULTS: The mean follow-up period was 12 months. No significant differences were observed between the 2 groups in length of hospital stay (P = .515), operative time (P = .175), wound dehiscence (P = .645), and Visual Analog Scale pain scores (P = .112). The mean operative times were 42.5 minutes in the modified Limberg group and 40.0 minutes in the lateral advancement group. CONCLUSIONS: Although lateral advancement flap transposition with Burow's triangle is used less often than modified Limberg flap transposition, we could not determine a parameter that was statistically different such as operative time, postoperative complication, or the length of hospital stay. Hence, the lateral advancement flap is as viable an option as other more preferable techniques in the treatment of PSD, which particularly settled on the upper segment without a deep natal cleft.

Spinal anesthesia is an efficient and safe anesthetic method for percutaneous nephrolithotomy.

OBJECTIVE: To investigate the effect of spinal anesthesia (SA) vs general anesthesia (GA) administration on the safety and efficiency of percutaneous nephrolithotomy (PCNL). METHODS: We retrospectively evaluated 1478 patients who underwent PCNL in our clinic between 2004 and 2011. We excluded the patients with bilateral PCNL, renal abnormality, or solitary kidney. The remaining 1004 adult patients were divided into 2 groups according to anesthesia administration as GA (n = 564) or SA (n = 440). The groups were compared according to operative and postoperative properties. Complications of PCNL were evaluated according to the modified Clavien classification. Independent t test, chi-square test, and analysis of covariance were used for the comparison of groups. RESULTS: The durations of hospitalization, operation, and fluoroscopy of patients in the SA group were significantly shorter than that of the patients in the GA group (P <.01). The number of patients with postoperative requirement of narcotic analgesic and blood transfusion was significantly higher in the GA group (P <.01). The GA group had more grades 2, 3a, 3b, and 4b complications according to modified Clavien classification (P <.05). The significant differences in postoperative analgesic requirement and hospitalization duration between the groups did not affect postoperative urinary drainage (P <.01; adjusted r(2) = 0.064). CONCLUSION: PCNL with SA demonstrated shorter hospitalization, operation, and fluoroscopy durations. GA has some disadvantages as a greater requirement of narcotic analgesic and greater frequency of major complications. SA administration is a safe and effective method in appropriately selected patients with PCNL.

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.

Tubeless percutaneous nephrolithotomy is effective and safe in short- and long-term urinary drainage.

We aimed to investigate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) with ureteral catheter or double-J stent in comparison with standard PCNL in our study. We retrospectively evaluated 707 of 1,469 patients with stone area under 800 mm(2) and only one subcostal nephrostomy access that was underwent PCNL between March 2004 and October 2011 in our clinic. Patients with 14F nephrostomy tube (Malecot or Re-entry catheter), with ureteral stent and with antegrade double-J stent were included into Group 1 (n = 180), Group 2 (n = 148) and Group 3 (n = 120), respectively. The mean hospitalization time of patients in Group 1 was significantly longer. The mean VAS was significantly higher in Group 1. On the other hand the mean fluoroscopy and operation time of patients in Group 2 were significantly shorter in comparison with other groups. Number of patients with postoperative transfusion requirement was significantly higher in Group 1. The number of patients with postoperative narcotic analgesic requirement was also significantly higher in Group 1. The most frequent complication in our study was prolonged drainage. The postoperative complications were seen more frequently in Group 1. Both ureter catheter and double j stent were more comfortable, effective and safe in urinary drainage following PCNL with single sub-costal access. On the other hand, double-J stent has a disadvantage as requirement additional cystoscopy for removal. We suggest ureter catheter or double-J stent to preserve short- and long-term urinary drainage.

The effect of diabetes mellitus on α1-adrenergic receptor subtypes in the bladder of rats.

OBJECTIVE: To detect the possible alterations on density or sensitivity of α1-adrenergic subtypes in diabetic bladder by reverse transcriptase-polymerase chain reaction technology and in vitro studies. METHODS: Experimental diabetes was induced by administration of streptozotocin with a single injection through the tail vein. Rats were divided into control and diabetic groups. Contractile responses of bladder strips from each group were obtained for postassium chloride, adenosine triphosphate, and electrical field stimulation (0.5-32 Hz) in organ bath. Electrical field stimulation responses of strips were evaluated in the presence of PPADS (nonselective P2 antagonist), atropine (cholinergic antagonist), 5 MU (α-1a-adrenergic antagonist), BMY-7378 (α-1d-adrenergic antagonist), and finally CED (α-1b-adrenergic antagonist). mRNA expression of α1-adrenergic subtypes was determined for each group. RESULTS: The difference between contractile responses related to electrical field stimulation with incubation with PPADS, atropine, 5 MU, BMY-7378, and CED, respectively, was not significant in the control and diabetic groups (P > .05). The electrical field stimulation responses of strips at 0.5-2 Hz without incubation were significantly different between the control and diabetic groups (P < .05). The contractile responses of strips with PPADS + atropine + 5 MU and BMY-7378 incubations in the diabetic group were significantly lower than in the control group in all doses (P < .05), The mRNA expression of α-1a-adrenergic in the diabetic group was significantly lower than in the control group (P < .05). No change was found in the expression of mRNA of α-1b-adrenergic. CONCLUSION: These results support the probability of changes in presynaptic and autonomic receptor sensitivity. We believe that α-1a-adrenergic and α-1d-adrenergic subtypes should be kept in mind in the treatment of diabetic cystopathy.

Effect of simple malrotation on percutaneous nephrolithotomy: a matched pair multicenter analysis.

PURPOSE: In this multicenter study we compared the outcome of percutaneous nephrolithotomy in patients with and without malrotated kidneys. MATERIALS AND METHODS: A total of 44 patients (group 1) at 6 institutions who underwent percutaneous nephrolithotomy for kidneys with simple malrotation were enrolled in our study. Attending physicians in our group also provided the same number of cases of percutaneous nephrolithotomy done for nonmalrotated (normal) kidneys (group 2). Group 2 patients were selected by match pairing. Operative and postoperative data on the 2 groups were compared using the chi-square, Student t and Fisher exact tests. RESULTS: As a result of match pairing, the 2 groups were similar in age, gender, body mass index, and stone size and site. Mean ± SD stone size was 5.9 ± 3.5 cm(2) in group 1. Multiple access attempts were required in 9 (20.5%) and 7 cases (15.9%) in groups 1 and 2, respectively (p >0.05). Mean fluoroscopy time was 7.0 ± 3.9 minutes in the malrotated kidney group and 7.3 ± 4.5 minutes in the nonmalrotated kidney group (p >0.05). The mean hemoglobin decrease after percutaneous nephrolithotomy was significantly higher in group 1 (-1.9 vs -1.3 gm/dl, p = 0.008) but the blood transfusion rate was similar in the 2 groups. The procedure success rate in groups 1 and 2 was 77.3% and 79.5%, respectively (p >0.05). CONCLUSIONS: Percutaneous nephrolithotomy is safe and effective even in patients with larger kidney stones and malrotated kidneys.

Successful percutaneous nephrolithotomy in children: multicenter study on current status of its use, efficacy and complications using Clavien classification.

PURPOSE: In this multicenter study we aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy in children with respect to different features and using the Clavien classification system. MATERIALS AND METHODS: Percutaneous nephrolithotomies performed in children at 3 urology departments between March 2006 and May 2010 were included in the study. Results are presented for complex/simple renal stones, tubeless/totally tubeless percutaneous nephrolithotomy, simultaneous bilateral percutaneous nephrolithotomy, instrument size and age groups. Patients were divided into 3 distinct groups, infants and toddlers (3 years or younger, group 1), preschool children (4 to 7 years, group 2) and school children (8 to 16 years, group 3). Perioperative complications are presented according to the modified Clavien classification system. RESULTS: A total of 140 percutaneous nephrolithotomies were performed in 130 patients (41.5% female, mean age 10.17 years). There were 23, 25 and 92 renal units in groups 1, 2 and 3, respectively. Pediatric instruments were used in 60 renal units and adult-sized instruments in 80. General assessment of complications showed Clavien grade I complications in 17 patients, II in 4, IIIa in 11 and IIIb in 7. There were no grade IV or V complications. CONCLUSIONS: Percutaneous nephrolithotomy can be applied safely in children of varying ages, even infants. Complications, as assessed with Clavien classification, are comparable to those seen in adults provided there is enough experience with the technique.

Effect of sildenafil citrate on penile weight and physiology of cavernous smooth muscle in a post-radical prostatectomy model of erectile dysfunction in rats.

OBJECTIVES: To evaluate the gross morphometric changes and in vitro responses of the corpus cavernosus of rats treated with sildenafil citrate after cavernous neurotomy. METHODS: The animals were divided into 3 groups. Group 1 consisted of sham-operated rats (n = 16); group 2 consisted of rats that underwent bilateral cavernous neurotomy (BCN) (n = 16); and group 3 consisted of rats that underwent unilateral cavernous neurotomy (UCN) (n = 16). Each group of rats was further classified into 2 subgroups according to whether or not they received sildenafil treatment. The rats were killed on postoperative day 14, and penectomy was performed. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL), and organ-bath studies were evaluated by Phenylephrine (Phe), acetylcholine (Ach), sodium nitroprusside (SNP), and electrical field stimulation (EFS) responses. RESULTS: Penile weight in the BCN group was significantly lower than that of sham-treated group. UCN allowed much more preservation of penile weight compared with that in the sham-treated group. Sildenafil citrate treatment had positive effects on penile weight of both BCN (P = .003) and UCN (P = .004) groups. BCN increased smooth muscle apoptosis when compared with the sham or UCN group. Sildenafil citrate had a positive effect on the apoptotic index. In the BCN group, responses to Phe, Ach, SNP, and EFS decreased significantly, and sildenafil treatment corrected the responses to Phe, Ach, and SNP. CONCLUSIONS: Our experimental study results support that early and daily sildenafil citrate treatment has a protective affect on the adrenergic and cholinergic systems, which play a role in erectile function.

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.

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.