External validation and comparison of current scoring systems in retrograde intrarenal surgery: Multi-institutional study with 949 patients.

OBJECTIVES: To externally validate and compare Resorlu-Unsal stone score (RUSS), modified Seoul National University Renal Stone Complexity Score(S-ReSC), Ito's nomogram, and Retrograde Intra-Renal Surgery (R.I.R.S.) scoring systems for predicting capabilities of both the stone-free status and complications in a multi-institutional study. MATERIALS AND METHODS: We performed a retrospective analysis of 949 patients who underwent flexible ureterorenoscopy (f-URS) and laser lithotripsy for renal stones in two institutions between March-2015 and June-2020. The RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S. scores were calculated for each patient by the same surgeon on imaging methods. Results were compared for their predictive capability of stone-free status and complications. RESULTS: Of 949 patients 603 were male and 346 were female with a mean age of 47.2 ± 14.3 (range 2-84 years). Mean stone burden was 102.6 ± 42.2 (48-270 mm2 ). All nomograms predicted stone-free status (Area Under Curve (AUC) were 0.689, 0.657, 0.303, and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286, and 0.664 for RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito's nomogram was able to predict Clavien ≥2 complications. CONCLUSION: All four scoring systems (RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S.) could predict stone-free status after f-URS, however, the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post-operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.

Effect of histopathologic characteristics on pseudocapsular invasion in the case of partial nephrectomy for renal tumours.

OBJECTIVE: It is aimed to define the existence of pseudocapsular structure on renal tumours, illuminate the relation between pseudocapsular invasion and Fuhrman grade histological type that are among histopathologic prognostic risk factors and determine the relation between surgical margin positivity and existence of pseudocapsular invasion. Sequential partial nephrectomy series and relevant pathological preparations were retrospectively reviewed in order to evaluate these issues. METHODS: The study includes 123 patients diagnosed with T1 renal tumour and treated with partial nephrectomy in between January 2007 and June 2016. Benign angiomyolipoma was excluded due to complete non-existence of pseudocapsule. 99 T1 patients diagnosed with renal cell cancer whose pathological slides can be duly analysed were included in the study. Clinical and pathological details were evaluated for all patients. Existence of pseudocapsule was revealed for all patients. Pseudocapsule invasion was classified by existence of expansive and infiltrative type and non-existence of pseudocapsule invasion. The groups have been assessed by their histopathologic characteristics. RESULTS: Compared to the group in which pseudocapsular invasion was not detected, clear-cell histological subtype was observed more frequently in a statistically significant way in the group with expansive pseudocapsular invasion and infiltrative pseudocapsular invasion respectively (p = 0.017 and p < 0.001). Pathological tumour sizes were found out to be statistically similar (p = 0.874). There was not a statistically significant difference in terms of Fuhrman grade (p = 0.220). There was not a statistically significant difference in terms of surgical positive margin (p = 0.609). CONCLUSION: It was indicated in our study that only the histological subtype affected pseudocapsular invasion in group of patients treated with partial nephrectomy but tumour size, tumour stage, tumour location as well as endophytic and exophytic character did not affect invasion. It has also been revealed that surgical margin positivity is not correlated with pseudocapsular invasion.

Do the etiological factors in artificial urinary sphincter reimplantation cases affect success and complications?

Background/aim: The artificial urinary sphincter (AUS) is still one of the best options for incontinence treatment. It may also have an advantage for revision or reimplantation in the management of complications. In this study we aimed to discuss the etiological factors for AUS reimplantation and effects of these etiological factors on success rates, patient satisfaction rates, time to reimplantation surgery, and complications Materials and methods: Data from 30 patients for whom AUS reimplantation was performed were analyzed retrospectively. Incontinence due to fluid loss from the cuff or reservoir balloon, inability of the cuff to adequately compress the urethra, and devices that were thought to have completed their lifespans were defined as mechanical reasons while incontinence caused by conditions such as cuff erosion and infection were defined as nonmechanical reasons. Patients who went through reimplantation due to mechanical and nonmechanical causes were included in Group 1 and Group 2, respectively. Success rates, patient satisfaction rates, time between the implantation of the first and second AUS, and complications were compared between the groups. Results: The mean follow-up period was 79 (3­308) months for patients who went through primary AUS implantation due to postprostatectomy incontinence. Our success rates were found as 75% and 66% in Group 1 and Group 2, respectively. The differences between the groups in terms of success and patient satisfaction rates were not statistically significant, while the time to reimplantation was longer in Group 1 and statistically significant. Conclusion: Reasons for AUS reimplantation may affect the success and patient satisfaction rates. Our success rates of AUS performed for nonmechanical reasons were slightly lower, but not statistically significantly so. AUS reimplantation may take a longer time if mechanical failure is detected.

Does Tadalafil Increase The Uptake of Finasteride into Prostate Tissue? A Biochemical and Histological Evaluation in Rats.

PURPOSE: To histopathologically and biochemically evaluate the hypothesis that tadalafil increases the uptake of a second medication into the prostate tissue by increasing the blood supply in the prostate. METHODS: Forty 12-week-old Sprague Dawley male rats were equally divided into 5 groups and were administered drugs orally as follows: Group 1 - no drugs, Group 2 - 10 days of finasteride, Group 3 - 10 days of finasteride + tadalafil, Group 4 - 30 days of finasteride, and Group 5 - 30 days of finasteride + tadalafil. At the end of 10 days of drug administration in Group1, 2, and 3, and at the end of 30 days of drug administration in Group 4 and 5,blood samples were collected from rats and analyzed for serum androgen levels. In addition, prostate tissues were removed for histological examination. RESULTS: The mean DHT level as well as the minimum and maximum epithelial thicknesses in Group 3 were lower than those in Group 2. However, there was no statistical significant difference (P = 0.989, P = 0.176, and P = 0.070, respectively). The mean DHT level as well as the minimum and maximum epithelial thicknesses in Group 5 were lower than those in Group 4. However, there was no statistical significant difference (P = 0.984, P = 0.147, and P= 0.478, respectively). The mean minimum and maximum epithelial thicknesses in Group 3 and Group 4 were not statistically different (P = 0.488 and P = 0.996, respectively). CONCLUSION: The similarity of the mean minimum and maximum epithelial thickness in Group 3 and Group 4 may be indicate that the combination therapy provides an early histological effect. However, the fact that there was no statistical significant difference between Group 2 and Group 3, and between Group 4 and Group 5, in terms of the mean DHT level and minimum-maximum epithelial thicknesses suggests that longer term studies with more rats are necessary to test the validity of our hypothesis.

Posttraumatic High-Flow Nonischemic Priapism.

Priapism is an uncommon disorder, and nonischemic priapism is seen less frequently in children, generally after trauma. Although it seems to be an advantage that urgent intervention is not required because of no cavernous ischemia, it is likely to be misdiagnosed because of the asymptomatic potential. We aimed to present a case of posttraumatic nonischemic priapism.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Methods in Treatment of Upper Calyceal Stones of 10-20 mm.

OBJECTIVE: To compare the success and complication rates and advantages and disadvantages of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) methods for the upper calyceal renal stones between 10 and 20 mm. MATERIALS AND METHODS: The files of 124 patients who had upper calyceal renal stones in diameter 10-20 mm were analyzed retrospectively. Sixty-one patients were randomized as Group 1 and 63 as Group 2. The parameters as success and complication rates, fluoroscopy and operation times, preoperative and postoperative hemogram (Hb) levels, and need of blood transfusion were saved and then groups compared. Complication rates and need of second procedure numbers between groups were evaluated according to modified Clavien classification. RESULTS: Demographic features and success and complication rates between groups were similar. Hospitalization time was 1.0 ± 0.1 day for Group 1 and 2.3 ± 1.4 days for Group 2. When preoperative and postoperative Hb difference was evaluated, 0.1 ± 0.3 mg/dL decrease was noticed for Group 1 and 1.6 ± 0.8 mg/dL decrease for Group 2. Mean operation time for Group 1 was 53.6 ± 15.1 minutes and mean fluoroscopy time was 20.1 ± 8.9 seconds for Group 1; for Group 2, these values were 67.8 ± 16.2 minutes and 53 ± 15.0 seconds, respectively. As a result, mean operation time and fluoroscopy time, hospitalization time, and Hb decrease levels were found less and as statistically significant for Group 1. CONCLUSION: RIRS and PNL methods both have the same success and complication rates for upper calyceal renal stones between 10 and 20 mm. However, we think that RIRS method should be preferred for suitable patients because it is a more noninvasive method and has advantages of some operation parameters over PNL.

Comparison of Flexible Ureterorenoscopy and Laparoscopic Ureterolithotomy Methods for Proximal Ureteric Stones Greater Than 10 mm.

OBJECTIVE: To examine the outcomes and to compare the effectiveness of laparoscopic ureterolithotomy and flexible URS in patients with proximal ureteral stones greater than 10 mm in diameter. MATERIAL AND METHODS: A total of 150 patients who were performed laparoscopic ureterolithotomy and flexible URS because of uretral stones in our urology clinic between January 2010 and June 2015, were analyzed retrospectively. We constituted two groups; 70 patients who were performed laparoscopic ureterolithotomy were included in group I while flexible URS-performed 80 patients in group II. Success rates and complications of the group I and II were compared. RESULTS: Success rates were 95.7% and 90% in group I and II respectively. There was no significant difference between the groups in terms of "success-rates". No statistically and clinically significant complications occurred in both groups. CONCLUSION: Laparoscopic ureterolithotomy and flexible URS methods are effective and reliable with proper indications in treatment of proximal ureteral stones. However, when considered short operational and hospitalization times and the management of the situations that require secondary interventions, we suggest that flexible URS is a minimally invasive method and it may be the first choice in the treatment of proximal ureteral stones.

Comparison of Dilation Methods in Percutaneous Nephrolithotomy: Which One Is More Successful?

OBJECTIVE: Creation of the access tract is an important step in percutaneous nephrolithotomy (PNL). In this study, we compared the efficiency and safety of Amplatz, Alken, and balloon dilation methods in the creation of the access tract. MATERIALS AND METHODS: Data from 487 PNL patients admitted to 517 renal units in 3 centers were analyzed. The Amplatz (280 patients), Alken (142 patients), and balloon (95 patients) dilation methods were compared for their success, duration of the dilation, injury to the collecting system, durations of fluoroscopy and surgery, stone-free and complication rates, pre- and postoperative hematocrit levels, and need for blood transfusion. RESULTS: The dilation methods did not significantly differ with respect to patient demographic data, mean stone area, decrease in hematocrit, need for blood transfusion, unsuccessful tract dilation, injury to the collecting system, stone-free rate, and rate of postoperative complications. The mean fluoroscopy times during Amplatz, Alken, and balloon dilation were 288.52 ± 164.67, 287.34 ± 164.99, and 169.23 ± 21 seconds, respectively. The mean duration of surgery was 96.48 ± 46.07, 94.72 ± 42.25, and 78 ± 25.96 minutes, respectively. The duration of tract creation was 328.67 ± 172.99, 325.14 ± 175.70, and 203.50 ± 32.76 seconds, respectively. The durations of surgery and tract creation were significantly shorter in the balloon dilation group. CONCLUSION: None of the dilation methods was significantly superior in terms of surgical success, efficiency, or safety. Although balloon dilation was advantageous with respect to time parameters, the role of surgical experience should not be ignored.

Incidence of renal carcinoma in non-functioning kidney due to renal pelvic stone disease.

The objective of This study was to report our pathological findings in nephrectomy specimens from patients treated for non-functioning hydronephrotic kidney due to renal pelvic stone disease. A total of 97 patients who underwent nephrectomy for non-functioning hydronephrotic kidneys between January, 2011 and June, 2014 were retrospectively reviewed. A non-functioning kidney was defined as one having paper-thin parenchyma on urinary ultrasound or computed tomography, exhibiting no contrast visualization in the collecting duct system on intravenous urography and having a split renal function of <10% on nuclear renal function studies. Following pathological evaluation, 9 patients were diagnosed with xanthogranulomatous pyelonephritis, 9 with malignant tumors and 79 with chronic pyelonephritis. Of the patients with chronic pyelonephritis, 2 also had renal adenomas. The malignant tumors included 3 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC), 3 renal cell carcinomas (RCC) (1 sarcomatoid, 1 papillary and 1 clear cell RCC), whereas 1 patient had concurrent RCC and TCC. In conclusion, non-functioning kidneys, particularly those with kidney stones, should be managed as possible malignancies, due to the higher incidence of malignant tumors in such patients compared with the normal population.

Hair coil penile tourniquet syndrome in an unusual age.

Penile tourniquet syndrome (PTS), a rare urologic emergency, may lead to undesirable results including necrosis and amputation of penis, if not diagnosed and treated appropriately. Sometimes these injuries may be accepted as a forensic case. Miscellaneous objects used for strangulation can be metallic or nonmetallic. Of all ages, the most vulnerable period is infancy. Telogen effluvium is the most common cause of PTS in infants who are 0-6 years old. In the literature, telogen effluvium as a reason of PTS was not found except for this age group. Therefore, we aimed to present a boy who is 8 years old diagnosed as PTS because of his mother's hair coil.

The effectiveness of flexible ureterorenoscopy for opaque and non-opaque renal stones.

PURPOSE: To evaluate the treatment success rate of flexible ureterorenoscopy (URS) for opaque and non-opaque renal stones. MATERIALS AND METHODS: Ninety-four patients, who underwent flexible URS for renal stones between October 2012 and January 2014, were included. The patients were divided into two groups according to stone radiolucency. The patients were evaluated with preoperative and postoperative (at the weeks 4) computed tomography. Success of the treatment was defined as stone-free status and residual fragments < 4 mm. RESULTS: Success of the treatment was observed in 79 (84%) patients. Sex, stone size, and stone location were factors affecting treatment success. Seventy-five (79.8%) patients had opaque stones, and 19 (20.2%) had non-opaque stones. The treatment success rates for opaque and non-opaque stones were 86.6% and 73.6%, respectively (P = .167). Flexible URS was a successful modality with acceptable morbidity to treat renal stones. CONCLUSION: These results show that radiolucent and opaque stones can be effectively treated by flexible URS.