Assessing the educational value of laparoscopic radical nephrectomy videos on YouTube®: A comparative analysis of short versus long videos.

INTRODUCTION: To evaluate the quality of laparoscopic radical nephrectomy videos and determine the extent to which they are informative and educational for healthcare professionals. PATIENTS AND METHODS: We used the YouTube® search engine to search for the term 'laparoscopic radical nephrectomy' with time filters of 4-20 min (Group 1) and >20 min (Group 2) and then sorted the results uploaded chronologically before January 2023. One hundred videos were analysed for each group. The reliability of the videos was assessed using the Journal of American Medical Association (JAMA) Benchmark Criteria and DISCERN questionnaire scores (DISCERN). Educational quality was assessed using the Global Quality Score (GQS) and a 20-item objective scoring system (OSS) for laparoscopic nephrectomy. The popularity of the videos was evaluated using the video power index (VPI). RESULTS: The mean video duration was 8.9 ± 4.3 min in Group 1 and 52.02 ± 31.09 min in Group 2 (P < 0.001). The mean JAMA (2.49 ± 0.61) and OSS scores (60 ± 12.3) were higher in Group 2 than in Group 1, while no significant difference was observed in the mean GQS (2.53 ± 0.7, 2.39 ± 0.88, respectively) between the groups (P < 0.001, P = 0.039, P = 0.131, respectively). CONCLUSION: While the standardisation of surgical videos published on YouTube® and the establishment of auditing mechanisms do not seem plausible, high total OSS, periprocedural OSS, and VPI scores, and high OSS, JAMAS, GQS and DISCERN scores in long videos indicate that such videos offer a greater contribution to education.

Ultrasound-based predictive indicators for treatment outcomes in pediatric vesicoureteral reflux.

PURPOSE: To evaluate the effectiveness of preoperative ultrasound (US) measurements in predicting pediatric vesicoureteral reflux (VUR) treatment outcomes. METHODS: This prospective study enrolled 35 patients (53 renal units) aged 1-16 years who underwent subureteric injection therapy for primary VUR between July 2020 and June 2022. Preoperative ultrasound examinations measured the bladder wall thickness at the ureteral orifice, ureteral submucosal tunnel length, distal ureteral diameter, patient demographics, VUR grade, presenting complaints, bladder-bowel dysfunction, and renal scarring, and the impact of these variables on treatment success was analyzed. RESULTS: Among the patients, 91.4% were female, with a mean age of 6.83 ± 3.84 years. A comparison between the treatment success and failure groups revealed no significant differences in the age, sex, VUR grade, laterality, bilaterality, presenting complaints, bladder-bowel dysfunction, bladder wall thickness, or distal ureteral diameter (p > 0.05). However, renal scarring occurred in 16 (38.1%) patients in the treatment success group and 10 (90.9%) in the treatment failure group (p = 0.002). The treatment failure group had shorter detrusor-to-ureteral orifice distances and smaller detrusor-ureteral orifice distance-to-distal ureteral diameter (D/U) ratios than that of the success group (p = 0.004 and p = 0.006, respectively). Patients with a detrusor-to-ureteral orifice distance < 7.4 mm had an 81.82% likelihood of treatment failure. CONCLUSION: Ultrasound measurements of the detrusor-to-ureteral orifice distance and D/U ratio proved reliable in predicting the success of endoscopic subureteric injection therapy for VUR.

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units.

INTRODUCTION AND OBJECTIVES: Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. METHODS: Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. RESULTS: The stone location was the upper pole in 28 (7.6 %) patients, the middle pole in 44 (12 %), the pelvis in 98 (26.6 %), the lower pole in 139 (37.8 %), and multiple locations in 59 (16 %) patients. A stoneless state was achieved in 277 (75.3 %) units, while 91 units (24.7 %) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p = 0.012) and stone location (OR, 3.142; p = 0.018). DISCUSSION: RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100 % success rate reported in various studies. A full stoneless state was achieved in 277 (75.3 %) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6 %. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. CONCLUSION: RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

Correlation of Postoperative Outcomes According to the Amount of Prostatic Tissue Removed in Patients Undergoing Transurethral Resection of the Prostate.

OBJECTIVE: The present study assesses the effect of the proportion of tissue resected during transurethral resections of the prostate (TUR-P) on lower urinary tract symptoms (LUTS) and other parameters in patients with a benign prostatic obstruction (BPO). MATERIALS AND METHODS: Forty-three patients who underwent TUR-P between 2018 and 2021 were assessed prospectively. The patients were divided into two groups according to the percentage of tissue removed (group 1 <30%, group 2 >30% resection). Age, prostate volume, amount of resected tissue, operative time, length of hospital stay, duration of catheterization, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and serum prostate-specific antigen (PSA) (ng/dl) at preoperative and postoperative three months were recorded. RESULTS: The percentage of tissue removed was 22.2% vs. 48.4% (p = 0.001), IPSS reduction was 77.7% vs. 83.3% (p = 0.048), QoL improvement was 77.2% vs. 84.8% (p = 0.133), Qmax increase was 171.3% vs. 193.5% (p = 0.032), and serum PSA decrease was 56.4% vs. 69.2% (p = 0.049) in groups 1 and 2, respectively. In addition, the operative time was 38.5 vs. 53.6 min (p = 0.001), the length of hospital stay was 2.0 vs. 2.4 days (p = 0.001), and the duration of catheterization average was 4.1 vs. 4.9 days (p = 0.002). CONCLUSION: Resections of at least 30% of prostatic tissue can provide a significant improvement in the symptoms and parameters related to benign prostatic obstruction, while resections of less than 30% of prostatic tissue can effectively reduce urinary symptoms and improve the quality of life in older adult patients with comorbidities who require shorter operating times.

Clinical Outcomes of Prostatic Artery Embolization in Patients with Benign Prostatic Hyperplasia: A Prospective Clinical Study.

OBJECTIVE: To determine the clinical outcomes of prostatic artery embolization applied to patients with Material and methods: The study includes 30 patients diagnosed with benign prostatic hyperplasia in the urology clinic between 2012 and 2016, for whom anesthesia was contraindicated due to advanced age and comorbidities and who underwent prostatic artery embolization. These patients were evaluated before the procedure and in the 1st, 3rd, 6th, and 12th months after the procedure. RESULTS: The mean prostate volume of the patients was 68 cm3 before the procedure and 45 cm3 12 monthsafter the procedure. A statistically significant decrease was observed (P = .001). The mean prostate-specific antigen value was 4.9 ng/dL before the procedure and 2.8 ng/dL 12 months after the procedure (P = .008). The mean Qmax value was 0 mL/s before the procedure and 12 mL/s 12 months after the procedure (P = .001). The mean international prostatic symptom scores value was 35 before and 16 twelve months after the proce-dure (P = .001). While the international index of erectile function value was 8.25 before the procedure, it was8.46 12 months after the procedure (P = .32). The quality of life index value was measured as 3.02 before theprocedure and 3.09 twelve months after the procedure; a statistically significant difference was determined (P = .027). CONCLUSION: Prostatic artery embolization, which is a minimally invasive procedure, can be applied as a safe and effective method to patients with benign prostatic hyperplasia who cannot tolerate anesthesia due to advanced age and comorbidities.

A multicenter-based critical analysis of laser settings during intrarenal laser lithotripsy by the Turkish academy of urology prospective study group (ACUP study).

OBJECTIVE: In this multicenter prospective study, we aimed to evaluate the use of holmium:yttrium-- aluminum-garnet laser during retrograde intrarenal surgery for kidney stones and the relationship between laser-related parameters and procedure-related perioperative parameters. MATERIAL AND METHODS: The 769 patients whose laser setting parameters (fiber thickness, number of shots, frequency (max.), laser power (max.), and total energy) were completely registered were included in this study program. The intraoperative ureteral lesions were evaluated using postureteroscopic lesion scale (PULS) scores and the postoperative complications with the modified Clavien-Dindo classification system. RESULTS: The maximum levels of laser power and the frequency were used in the middle calyceal stones; the value of total energy consumed was found to be higher gain in cases with multiple stones (all parameters P < .05). There was a significant positive correlation among (mean number of shots [P < .001, r » 0.46], frequency [P » .009, r » 0.1], maximum power [P < .001, r » 0.11], total energy [P < .001, r » 0.25]), anesthesia time (P < .001, r » 0.42), surgery time (P < .001, r » 0.47), and stone size. The mean number of shots increased (P < .001, r » 0.25), and the frequency level decreased (P < .001, r » -0.17) significantly with increasing Hounsfield unit (HU) values. Again, the mean number of shots and maximum laser power increased in correlation with the increasing hospitalization time (P » .004, r » 0.09 and P » .02, r » 0.07, respectively). In addition, it was observed that higher laser subparameter values and thicker fibers were used in PULS grade 2. CONCLUSION: As the stone size and HU values increased, laser-setting parameters were found to show significant variability. The increase in different parameters of the laser setting was found to be associated with longer anesthesia time, surgery time, and hospitalization period and increased risk of local trauma with PULS grade.

Evaluation of the results of laser endopyelotomy with two different technique in ureteropelvic junction obstruction.

INTRODUCTION: Failed pyeloplasty procedures are caused by large amounts of scarring, and peripelvic fibrosis. This finding has been associated with urinary extravasations to the operation, urosepsis or an excessive tissue reaction. The treatment options for secondary UPJO (Ureteropelvic Junction Obstruction) are the same with the options for primary procedures: in cases of very poor renal function, various pyeloplasty forms (open and laparoscopic), and ureterocalicostomy or sometimes nephrectomy may be considered in severe renal function loss. Whereas, endoscopic treatment can be considered in elective cases. STUDY DESIGN: A total of 46 young patients who underwent endopyelotomy due to secondary ureteropelvic obstruction between January 2013 and September 2018 were included in the study. Patients underwent semirigid URS (Ureterorenoscopy) guided laser endopyelotomy until July 2015, and the patients had flexible URS guided laser endopyelotomy since July 2015. RESULTS: The mean age of the patients was found as 17.7 ± 4.2 and 16.9 ± 5.7 years in the SURSLE (Semirigid Ureterorenoscopy Laser Endopyelotomy), and FURSLE (Flexible Ureterorenoscopy Laser Endopyelotomy) groups, respectively. Success of the procedure was confirmed in 20 (83%) patients in the SURSLE group, and 19 (86%) patients in the FURSLE group who had no obstructive symptoms based on USG, GFR and excretion curves on the renogram ordered in the 24th month. Four (16%) patients in the SURSLE group, and 3 (14%) patients in the FURSLE group were accepted as failed, their treatments were arranged for additional surgical procedures, and these patients were taken under the follow-up protocol. DISCUSSION: This is one of the first studies comparing endopyelotomy with semirigid URS and flexible URS in patients with ureteropelvic stenosis. Long-term results with a large series of patients are not known, and our approach can be considered only as an individual method. There are different treatment options in UPJO. The use of fluoroscopy has advantages in endourologic operations. Therefore, lower radiation exposure can be a rational approach for protecting a person. Similarly, providing necessary protection also for physicians and operating room personnel is essential. In our study, shorter fluoroscopy time with SURSLE provided an advantage over FURSLE in terms of radiation exposure. CONCLUSION: Of semirigid and flexible URS techniques that have no superiority over each other in terms of success, preferring semi-rigid URS guided laser endopyelotomy with lower ionizing radiation used, is more rational.

Correlation between the NGF levels and questionnaire forms in patients receiving antimuscarinic treatment and those receiving onabotulinum toxin-A injection.

OBJECTIVE: To compare nerve growth factor (NGF) levels in patients who received antimuscarinic, versus onabotulinum toxin-A (onaBoNT-A) injection, as well as to investigate whether there is a correlation between NGF levels, and 8-item overactive bladder questionnaire(OAB-V8), urogenital distress inventory (UDI)-6, and incontinence impact questionnaire (IIQ)-7 forms. MATERIAL AND METHODS: Fourty adult patients with OAB were enrolled in this prospective study. An antimuscarinic was prescribed to 20 naive patients, and onaBoNT-A injection was administered to 20 patients, who were refractory to antimuscarinics. Urine samples were obtained before, and after 3rd and 6th months of treatment, and NGF levels were measured. Symptom scores of OAB-V8, UDI-6,and IIQ-7 were recorded. RESULTS: There was no significant difference between groups in terms of the initial OAB-V8, IIQ-7, and UDI-6 scores, whereas NGF values showed no significant difference over time in onaBoNT-A group (p=0.069, p=0.069). NGF levels were significantly lower in 3rd and 6th months, in patients receiving antimuscarinic (p=0.003, p=0.007); a strong correlation was found in 3rd month between the NGF levels, OAB-V8 scores (r=0.704, p=0.001), and IIQ-7 scores (r=0.676, p=0.001), and a moderate correlation between NGF levels, and UDI-6 scores (r=0.583, p=0.007). In the 6th months, a very strong correlation was found between NGF levels, and OAB-V8 scores (r=0.811, p=0.004), and a strong correlation was found between NGF levels, and IIQ-7 scores (r=0.671, p=0.001). In onaBoNT-A group, there was no significant correlation between NGF levels, and other variables. CONCLUSION: NGF level might be a good marker to evaluate effectiveness of treatment in patients receiving antimuscarinics, owing to correlation of urinary NGF levels with symptom scores. Lack of correlation in patients receiving onaBoNT-A injection could be a result of differences in the mechanism of action.

Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study).

AIMS: To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study). METHODS: Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program ( https://acup.uroturk.org.tr/ ) created by Turkish Urology Academy for Residual Stone Study. RESULTS: A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%). CONCLUSIONS: Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.

Comparison of the micro-percutaneous neprhrolithotomy results between adult and pediatric cases: Is it safe and effective for pediatric cases?

OBJECTIVE: To compare the safety and effectivity of micro percutaneous nephrolithotomy (MicroPNL) in adults and children. MATERIAL AND METHODS: Twenty children and twenty adult patients underwent MicroPNL were evaluated prospective consecutively,between June 2016 and December 2017,who were not suitable for retrograde intrarenal surgery (RIRS).Demographic data,stone free rates,length of hospitalization,duration of the operation,fluoroscopy time,transfusion rates,requirement of double J (D-J) catheter implantation and complications were examined. RESULTS: Seventeen patients with complete data in each group were evaluated within the scope of the study. Mean age was 40.76±14.96 (18-67) years in adults and 5.38±3.84 (10 months-14 years) years in children.There were no differences found between two groups for the mean operation time, fluoroscopy time,and length of hospitalization.Total success rate was noted 94.11% in each group (p=1).While no complications were seen in adults, three complications developed in the pediatric group (p=0.07). One patient in children group had steinstrasse.In addition,intraperitoneal fluid extravasation occurred in one pediatric patient during the operation.After paracentesis,postoperative period was observed uneventful.Also,one pediatric patient had high fever due to urinary tract infection.While there was no need for perioperative D-J catheter implantation in adults,D-J catheter was implanted in 6 (35.29%) pediatric patients, due to fragmented stone burden (p= 0.007) (Table 1). CONCLUSION: According to our results, micaroPNL is safe and effective treatment option in symptomatic renal stones smaller than 2 cm, especially in adults. Unfortunately,it needs more attention due to the risk of complications in pediatric population.

Comparison of the patient's satisfaction underwent penile prosthesis; Malleable versus Ambicor: Single center experience.

OBJECTIVE: To compare the surgical results, complications, and satisfaction levels of patients who underwent malleable penile prosthesis implantation (M-PPI) and Ambicor penile prosthesis implantation (A-PPI). MATERIAL AND METHODS: One hundred forty two patients who underwent penile prosthesis implantation [M-PPI (Promedon- Tube®, Cordoba, Argentina): 81, and A-PPI (American Medical Systems, Minnesota, USA): 61] between 2013-2018 were evaluated retrospectively. Patients' age, body mass index, smoking history, etiological factors, modified "Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Questionnaire" scores, shortening of the penis, and complications were recorded. RESULTS: The patients who performed A-PPI implantation were younger (56.27 ± 10.81 vs. 51.47 ± 11.79, p = 0.009). The EDITS scores of 31(38.2%) patients who underwent M-PPI and 44 (72.4%) patients who underwent A-PPI were available. It was observed that the scores on the following questions were statistical significantly higher in the A-PPI group: "Overall, are you satisfied with your penile prosthesis?, How much of your expectations did penile prosthesis meet?, How often do you use your penile prosthesis?" (p = 0.05, p = 0.048, p = 0.038). No difference was observed between the groups in terms of the scores on the other three questions (p = 0.447, p = 0.326, p = 0.365). A 61.3% of patients in MPPI (19/31) group, and 56.8% of patients in A-PPI (25/44) group stated penile shortening (p = 0.417). Mean shortening was reported as 2.1 ± 0.45 cm, and 2.12 ± 0.52 cm, in M-PPI and A-PPI groups, respectively (p = 0.90). CONCLUSION: It is remarkable that the patients who underwent A-PPI experienced higher satisfaction with their prosthesis. Even though it has not been evidenced in the current literature data, patients who have had either M-PPI or A-PPI should be informed about the risk of penile shortening.

A neural network-based algorithm for predicting the spontaneous passage of ureteral stones.

In this study, a prototype artificial neural network model (ANN) was used to estimate the stone passage rate and to determine the effectivity of predictive factors on this rate in patients with ureteral stones. The retrospective study included a total of 192 patients with ureteral stones, comprising 128 (66.7%) men and 64 (33.3%) women. Patients were divided into two groups. Group 1 (n: 125) consisted of people who spontaneously passed their stones, Group 2 (n: 67) consisted of people who could not pass stones spontaneously. The groups were compared with regard to the relationship between input data and stone passage rate by using both ANN and standard statistical tests. To implement the ANN, the patients were randomly divided into three groups: (a) training group (n = 132), (b) validation group (n = 30), and (c) test group (n = 30). The accuracy rate of ANN in the estimation of the stone passage ratio was 99.1% in the group a, 89.9% in the group b, and 87.3% in the group c. It was revealed that certain criteria (stone size, body weight, pain score, ESR, and CRP) were relatively more significant for saving treatment cost and time and for avoiding unnecessary treatment. ANN can be highly useful for the avoidance of unnecessary interventions in patients with ureteral stones as it showed remarkably high performance in the estimation of stone passage rate (99.16%).

Comparison of the efficiency of partial versus subtotal mesh removal on urogenital distress and sexual functions after stress urinary incontinence surgery.

OBJECTIVE: To compare the efficiency of the partial mesh removal (PMR) versus subtotal mesh removal (SMR) on urogenital distress and sexual functions in patients who experienced vaginal mesh extrusion. MATERIAL AND METHODS: Between June 2014 and January 2018, 45 patients who experienced vaginal mesh extrusion following midurethral sling surgeries and therefore underwent mesh excision were evaluated retrospectively. The effectiveness of PMR and SMR was compared using the "Urinary Distress Inventory-6 (UDI-6)" and "Female Sexual Function Index (FSFI)" forms, at the 6th month postoperatively. RESULTS: Fourteen PMR-patients and 21 SMR-patients who met the study criteria were evaluated for the study. There was a significant improvement in UDI-6 scores and FSFI scores in both PMR and SMR groups at the 6th month postoperatively (p=0.001, p=0.001, p=0.001, and p=0.001, respectively). When the two groups were compared in terms of improvement rates, there was no significant difference in UDI-6 scores [(-)30.21±6.56% vs. (-)26.33±9.01%, p=0.222]. However, there was a statistically significant improvement in the FSFI scores in the SMR group [(+)83.71±14.81% vs. (+)124.42±36.82%, p=0.001]. There was no significant difference in overactive bladder symptoms between the two groups, with a decrease of 75% in the PMR group and 71.42% in the SMR group (p=0.721). Recurrent stress urinary incontinence was observed in two (14.2%) patients in the PMR group and four (19.1%) patients in the SMR group at the 6th month postoperatively (p=0.544). CONCLUSION: In cases where extrusion is developed, subtotal/total mesh removal provides a significant improvement in patients' complaints of sexual dysfunction related to extrusion.

Immunohistochemical evaluation of Cajal-like cells and Caveolin-1 levels at ureteropelvic junction obstruction. / Evaluación inmunohistoquímica de las células de Cajal-like y los niveles de Caveolina-1 en la obstrucción de la unión pieloureteral.

OBJECTIVE: To compare c-kit-positive interstitial Cajal-like cells (ICC) and Caveolin-1 protein levels as a pacemaker and signaling molecules, on ureteropelvic junction (UPJ) specimens, between two groups of pediatric patients with and without ureteropelvic junction obstruction (UPJO). METHODS: We evaluated the UPJ specimens of 45 pediatric patients operated between 2005- 2012 retrospectively. Group 1 included 37 patients who underwent dismembered pyeloplasty due to UPJO. Eight patients underwent nephrectomy by the other reasons (renal tumor, trauma etc) and had normal UPJ were accepted as Group 2. The specimens were examined immunohistochemically with CD117 and Caveolin-1 antibody. According to the total number of ICC; 0-5 cells were accepted as a few (1), 610 cells as moderate (2), and > 10 as many (3). According to the staining intensity of Caveolin-1 at muscle tissue, a subjective evaluation was performed as; mild staining (1), moderate staining (2) and strong staining (3). RESULTS: The mean value of ICC distribution was calculated 1.37 ± 0.54 in Group 1 and 2.13 ± 0.64 in Group 2 (p = 0.003), and the median value of ICC distribution was found 1 [1-3] in Group 1 and 2 [1-3] in Group 2 (p = 0.008). Median values for the intensity of staining with Caveolin-1 were found 2 [1-3] in the Group 1, and 2.5 [2-3] in the Group 2 (p = 0.025). CONCLUSIONS: A decrease in ICC and Caveolin-1 levels support that there may be a relationship between ICC and Caveolin-1 for UPJO associated with signal transduction and peristalsis in urinary system.

OBJETIVO: Comparar las células intersticiales Cajal-like, c-kit positivas, y los niveles de proteína Caveolina -1 como marcapasos y moléculas señalizadoras en piezas de unión pieloureteral (UPU) comparando dos grupos de pacientes pediátricos con o sin obstrucción de la UPU.MÉTODOS: Evaluamos retrospectivamente las piezas obtenidas en la operación de 45 pacientes pediátricos entre 2005-2012. El grupo 1 incluía 37 pacientes sometidos a pieloplastia desmembrada por estenosis de UPU. Ocho pacientes que fueron sometidos a nefrectomía por otras razones (tumor renal, traumatismo, etc) y tenían una UPU normal se incluyeron en el grupo 2. Las piezas fueron examinadas mediante inmunohistoquímica con CD117 y Caveolina-1 en el tejido muscular. Se realizó una evaluación subjetiva como: tinción leve (1), tinción moderada (2) y tinción fuerte (3). RESULTADOS: Se calculó el valor medio de la distribución de las células intersticiales de Cajal (CIC), 1,37 ± 0,54 en el Grupo 1 y 2,13 ± 0,64 en el Grupo 2 (p = 0,003), y la mediana, de 1 [1-3] en el Grupo 1 y 2 [1-3] en el Grupo 2 (p = 0,008). Los valores de la mediana para la intensidad de la tinción con Caveolina- 1 fueron de 2 [1-3] en el Grupo 1 y 2,5 [2-3] en el Grupo 2 (p = 0,025). CONCLUSIONES: Una disminución de las células intersticiales de Cajal y los niveles de Caveolina 1 apoyan que puede haber una relación entre las células intersticiales de Cajal y la Caveolina 1 en la estenosis de la UPU asociada con la transducción de la señal y el peristaltismo en el sistema urinario.

Can alpha blockers facilitate the placement of ureteral access sheaths in retrograde intrarenal surgery?

OBJECTIVE: To investigate the effects of alpha blocker treatment on the placement of ureteral access sheaths (UAS) during retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS: This study was a retrospective analysis of prospectively collected data. Patients who underwent RIRS due to renal stones between November 2015 and December 2017 were seperated into two groups. Age, gender, body mass index (BMI), stone size, laterality, hydronephrosis degree, and renal stone density were recorded. Tamsulosin (0.4 mg/day) was prescribed to the study group (n=25) 2 weeks before the operation. The control group (n=25) underwent the operation without any additional treatment. All the operations were performed using a 7.5 Fr flexible ureteroscope and 9.5/11.5 Fr (Cook, Blooming, USA) UAS. RESULTS: Two patients in the study group were excluded from the study as they suffered from dizziness and retrograde ejaculation. No statistically significant difference was found between the patients in the study group (n=23) and control group (n=25) in terms of age, gender, BMI, stone size, laterality, hydronephrosis, and renal stone density (p=0.470, p=0.536, p=0.456, p=0.102, p=0.555, p=0.732, and p=0.317, respectively). The UAS could be successfully placed on the first attempt in 15 (65.2%) patients in the study group and 11 (44%) patients in the control group during the first attempt itself. Even though the successful UAS placement rate was higher in the study group, no statistically significant values were observed (p=0.141). CONCLUSION: The data obtained from the present study showed that the use of alpha blockers prior to RIRS did not improve the UAS placement rates. It is considered that studies conducted on more patients might be able to achieve significant values.

Results of minimally invasive procedures for ESWL refractory renal stones smaller than 2 cm: A single center experience. / Resultados de los procedimientos mínimamente invasivos en litiasis renales menores de 2 cm refractarias a litotricia extracorporea. Experiencia individual en un centro.

OBJECTIVES: To evaluate the efficacyand reliability of endourological procedures in patientswith renal stones up to 2 cm that were found to be resistantto extracorporeal shock wave lithotripsy (ESWL). METHODS: 611 patients who had undergone ESWLdue to renal stones up to 2 cm at the ESWL unit of ourclinic, were retrospectively evaluated. Standard percutaneousnephrolithotomy (PNL), micro-PNL, retrogradeintrarenal surgery (RIRS) was performed on the patientswho had stones resistant to ESWL. Demographic data,stone free rate, duration of hospital stay, duration of operation,the duration of scopy, the rates of transfusion andthe complications were recorded. RESULTS: The mean age of 611 patients included tothe current study was 40.76±15.45 years, the meansize of stones was calculated as 205.47±90.5 mm2.While the renal stones were removed in 468 patients(76.59%) after ESWL, endourological procedures wereperformed in 142 patients (23.24%) who had ESWLresistant stones. Standard PNL was performed in 73patients (51.4%), RIRS was performed in 51 patients(35.91%), micro-PNL was performed in 18 patients(12.68%). The success rates after the surgical procedureswere 93.15%, 90.16% and 88.88%, respectively.No major complication was observed in patient groupswho had undergone RIRS and microPNL. CONCLUSION: The surgical approaches, which areselected according to the size and localization of stones,could provide a success rate of 98.03% in ESWLresistant stones and these procedures could be reliablyperformed with considerably lower complication rates.

OBJETIVO: Evaluar la eficacia y fiabilidad de los procedimientos endourológicos en pacientes con litiasis renal de hasta 2 cm resistentes a litotricia extracorporea por ondas de choque (LEOC).MÉTODOS: 611 pacientes que habían recibido LEOC por litiasis renales de hasta 2 cm en la unidad de litotricia de nuestra clínica fueron evaluados retrospectivamente. En los pacientes con cálculos resistentes a LEOC se realizaron nefrolitotomía percútanea estándar,micro-NLP y cirugía intrarenal retrograda (CIRR). Se registraron los datos demográficos, las tasas de pacientes libres de litiasis, duración de la estancia hospitalaria,duración de la operación, duración de la escopia, tasas de transfusiones y las complicaciones. RESULTADOS: La edad media de los pacientes incluidos en el estudio (n=611) fue 40,76±15,45 años, el tamaño medio de la litiasis 205,47±90,5 mm2. La LEOC resolvió la litiasis en 468 pacientes (76,59%) pero en 142 pacientes con litiasis resistentes a LEOC(23,24%) se realizaron intervenciones endourológicas.Se realizó NLP estándar en 73 pacientes (51,4%), CIRR en 51 (35,91%), y micro NLP en 18 (12,68%). Las tasas de éxito después de los procedimientos quirúrgicos fueron del 93,15%, 90,16% y 88,88%, respectivamente. No se observaron complicaciones mayoresen los grupos de pacientes sometidos a CIRR y micro NLP.CONCLUSIÓN: Los abordajes quirúrgicos, que son seleccionadosen función del tamaño y localización de las litiasis, pueden ofrecer una tasa de éxitos del 98,03% en litiasis resistentes a LEOC y estos procedimientos pueden ser realizados de forma fiable con una tasa de complicaciones considerablemente menor.

Colonizations on biofilm layers of D-J catheters under sterile urine conditions. / Colonización de las capas de biofilm de los catéteres doble J en condiciones de orina estéril.

OBJECTIVE: To evaluate colonizations onbiofilm layers of Double J (D-J) catheters implanted forkidney stones or ureteral stones under sterile conditions. METHODS: D-J catheters implanted between January2012 and February 2014 and removed in 0-90 days,were examined in microbiology laboratory prospectively.Fifty two patients divided into three groups regardingthe duration of the D-J catheters as; 0-30 days, 31-60days, 61-90 days. The colonization (≥1.000 colony)was reported after biofilm layer on D-J catheter was holdin culture media. The upper, middle and lower parts ofthe catheters were analyzed seperately. RESULTS: Thirty five patients had symptomatic urinarytract infection or positive urine culture after implantationwere excluded from the study. Colonization on biofilm layer was detected in 11 patients (21.15%) [Coagulase-negative staphylococci (CNS): 3, Escherichia coli (E. coli): 3, Candida species (Candida spp.): 3, Klebsiella species (Klebsiella spp.): 2]. The rates of colonization according to the duration of the catheterization were; 12.5% in 0-30 days, 18.51% in 30-60 days, 29.4% in 60-90 days (Group 1 vs 2; .696 , group 1 vs group 3; .356 , group 2 vs group 3; .401). The rates of colonization according to the location of the catheter were; 100% in upper and lower parts, 54.4% in middle part (Group 1 vs 2; .011, group 1 vs group 3; , group 2 vs group 3; .011). CONCLUSIONS: Colonization on catheters is possibleeven in the sterile urinary conditions according to thepresent findings. The risk of colonization increases 1.5times in 30-60 days and 2.5 times in 60-90 days comparedto the first 30 days. Besides the risk of colonizationincreases about 2 times in the convoluted edges ofthe catheter compared with the middle part. Thus, D-Jcatheter should be removed as soon as possible and therisk of colonization should be minimalized.

OBJETIVO: Evaluar la colonización de las capas de biofilm de los catéteres doble J (DJ) implantados por litiasis renal o ureteral bajo condiciones estériles.MÉTODOS: Los catéteres DJ implantados entre enero 2012 y febrero 2014 y retirados en 0-90 días fueron examinados de forma prospectiva en el laboratorio de microbiología. Cincuenta y dos pacientes fueron divididos en tres grupos conforme al tiempo del DJ: 0-30 días, 31-60 días y 61-90 días. La colonización (>100.000colonias) fue comunicada tras el cultivo de la capa de biofilm del catéter. Se analizaron por separado las zonas superior, media e inferior de los catéteres DJ. RESULTADOS: 35 pacientes que tenían infección urinaria sintomática o cultivo de orina positivo después del implante fueron excluidos del estudio. Se detectó colonización de la capa de biofilm en 11 pacientes (21,5%) [estafilococo coagulasa negativo (SCN): 3, Escherichia coli (E.coli): 3, Cándida especies (Cándida spp: 3, Klebsiela especies (Klebsiela spp.): 2] Las tasas de colonización de acuerdo con el tiempo de catéter fueron 12,5% en 0-30 días, 18,51% en 30-60 días, 29,4% en 60-90 días (Grupo 1 vs 2; ,696 , grupo 1 vs grupo 3; ,356, grupo 2 vs grupo 3; ,401). Las tasas de colonización de acuerdo con la localización del catéter fueron del 100% en las porciones superior e inferior y 54% en la porción media (Grupo 1 vs 2; ,011, grupo 1 vs grupo 3; , grupo 2 vs grupo 3; ,011). CONCLUSIONES: La colonización de los catéteres es posible incluso en condiciones de orina estéril de acuerdo con los hallazgos presentes. El riesgo de colonización aumenta 1,5 veces en 30-60 días y 2,5 veces en 60-90 días comparado con los primeros 30 días. Además, el riesgo de colonización aumenta unas 2 veces en los extremos espirales del catéter en comparación con la porción media. Así, los catéteres DJ deben ser retirados tan pronto como sea posible y el riesgo de colonización debe ser minimizado.

Results of minimally invasive procedures for eswl refractory renal stones smaller than 2 cm: a single center experience / Resultados de los procedimientos mínimamente invasivos en litiasis renales menores de 2 cm refractarias a litotricia extracorporea. Experiencia individual en un centro

Objectives: To evaluate the efficacy and reliability of endourological procedures in patients with renal stones up to 2 cm that were found to be resistant to extracorporeal shock wave lithotripsy (ESWL). Methods: 611 patients who had undergone ESWL due to renal stones up to 2 cm at the ESWL unit of our clinic, were retrospectively evaluated. Standard percutaneous nephrolithotomy (PNL), micro-PNL, retrograde intrarenal surgery (RIRS) was performed on the patients who had stones resistant to ESWL. Demographic data, stone free rate, duration of hospital stay, duration of operation, the duration of scopy, the rates of transfusion and the complications were recorded. Results: The mean age of 611 patients included to the current study was 40.76±15.45 years, the mean size of stones was calculated as 205.47±90.5 mm2. While the renal stones were removed in 468 patients (76.59%) after ESWL, endourological procedures were performed in 142 patients (23.24%) who had ESWL resistant stones. Standard PNL was performed in 73 patients (51.4%), RIRS was performed in 51 patients (35.91%), micro-PNL was performed in 18 patients (12.68%). The success rates after the surgical procedures were 93.15%, 90.16% and 88.88%, respectively. No major complication was observed in patient groups who had undergone RIRS and microPNL. Conclusion: The surgical approaches, which are selected according to the size and localization of stones, could provide a success rate of 98.03% in ESWL resistant stones and these procedures could be reliably performed with considerably lower complication rates

Objetivo: Evaluar la eficacia y fiabilidad de los procedimientos endourológicos en pacientes con litiasis renal de hasta 2 cm resistentes a litotricia extracorporea por ondas de choque (LEOC). Métodos: 611 pacientes que habían recibido LEOC por litiasis renales de hasta 2 cm en la unidad de litotricia de nuestra clínica fueron evaluados retrospectivamente. En los pacientes con cálculos resistentes a LEOC se realizaron nefrolitotomía percútanea estándar, micro-NLP y cirugía intrarenal retrograda (CIRR). Se registraron los datos demográficos, las tasas de pacientes libres de litiasis, duración de la estancia hospitalaria,duración de la operación, duración de la escopia, tasas de transfusiones y las complicaciones. Resultados: La edad media de los pacientes incluidos en el estudio (n=611) fue 40,76±15,45 años, el tamaño medio de la litiasis 205,47±90,5 mm2. La LEOC resolvió la litiasis en 468 pacientes (76,59%) pero en 142 pacientes con litiasis resistentes a LEOC (23,24%) se realizaron intervenciones endourológicas. Se realizó NLP estándar en 73 pacientes (51,4%), CIRR en 51 (35,91%), y micro NLP en 18 (12,68%). Las tasas de éxito después de los procedimientos quirúrgicos fueron del 93,15%, 90,16% y 88,88%, respectivamente. No se observaron complicaciones mayores en los grupos de pacientes sometidos a CIRR y micro NLP. Conclusión: Los abordajes quirúrgicos, que son seleccionados en función del tamaño y localización de las litiasis, pueden ofrecer una tasa de éxitos del 98,03% en litiasis resistentes a LEOC y estos procedimientos pueden ser realizados de forma fiable con una tasa de complicaciones considerablemente menor

Colonizations on biofilm layers of d-j catheters under sterile urine conditions / Colonización de las capas de biofilm de los catéteres doble J en condiciones de orina estéril

Objetive: To evaluate colonizations on biofilm layers of Double J (D-J) catheters implanted for kidney stones or ureteral stones under sterile conditions. Methods: -J catheters implanted between January 2012 and February 2014 and removed in 0-90 days, were examined in microbiology laboratory prospectively. Fifty two patients divided into three groups regarding the duration of the D-J catheters as; 0-30 days, 31-60 days, 61-90 days. The colonization (≥1.000 colony) was reported after biofilm layer on D-J catheter was hold in culture media. The upper, middle and lower parts of the catheters were analyzed seperately. Results:Thirty five patients had symptomatic urinary tract infection or positive urine culture after implantation were excluded from the study. Colonization on biofilm layer was detected in 11 patients (21.15%) [Coagulase-negative staphylococci (CNS): 3, Escherichia coli (E. coli): 3, Candida species (Candida spp.): 3, Klebsiella species (Klebsiella spp.): 2]. The rates of colonization according to the duration of the catheterization were; 12.5% in 0-30 days, 18.51% in 30-60 days, 29.4% in 60-90 days (Group 1 vs 2; p=0.696 , group 1 vs group 3; p=0.356 , group 2 vs group 3; p=0.401). The rates of colonization according to the location of the catheter were; 100% in upper and lower parts, 54.4% in middle part (Group 1 vs 2; p=0.011, group 1 vs group 3; p=1, group 2 vs group 3; p=0.011). Conclusions: Colonization on catheters is possible even in the sterile urinary conditions according to the present findings. The risk of colonization increases 1.5 times in 30-60 days and 2.5 times in 60-90 days compared to the first 30 days. Besides the risk of colonization increases about 2 times in the convoluted edges of the catheter compared with the middle part. Thus, D-J catheter should be removed as soon as possible and the risk of colonization should be minimalized

Objetivo: Evaluar la colonización de las capas de biofilm de los catéteres doble J (DJ) implantados por litiasis renal o ureteral bajo condiciones estériles. Métodos: Los catéteres DJ implantados entre enero 2012 y febrero 2014 y retirados en 0-90 días fueron examinados de forma prospectiva en el laboratorio de microbiología. Cincuenta y dos pacientes fueron divididos en tres grupos conforme al tiempo del DJ: 0-30 días, 31-60 días y 61-90 días. La colonización (>100.000 colonias) fue comunicada tras el cultivo de la capa de biofilm del catéter. Se analizaron por separado las zonas superior, media e inferior de los catéteres DJ. Resultados: 35 pacientes que tenían infección urinaria sintomática o cultivo de orina positivo después del implante fueron excluidos del estudio. Se detectó colonización de la capa de biofilm en 11 pacientes (21,5%) [estafilococo coagulasa negativo (SCN): 3, Escherichia coli (E.coli): 3, Cándida especies (Cándida spp: 3, Klebsiela especies (Klebsiela spp.): 2] Las tasas de colonización de acuerdo con el tiempo de catéter fueron 12,5% en 0-30 días, 18,51% en 30-60 días, 29,4% en 60-90 días (Grupo 1 vs 2; ,696 , grupo 1 vs grupo 3; ,356, grupo 2 vs grupo 3; ,401). Las tasas de colonización de acuerdo con la localización del catéter fueron del 100% en las porciones superior e inferior y 54% en la porción media (Grupo 1 vs 2; ,011, grupo 1 vs grupo 3; , grupo 2 vs grupo 3; ,011). Conclusiones: La colonización de los catéteres es posible incluso en condiciones de orina estéril de acuerdo con los hallazgos presentes. El riesgo de colonización aumenta 1,5 veces en 30-60 días y 2,5 veces en 60-90 días comparado con los primeros 30 días. Además, el riesgo de colonización aumenta unas 2 veces en los extremos espirales del catéter en comparación con la porción media. Así, los catéteres DJ deben ser retirados tan pronto como sea posible y el riesgo de colonización debe ser minimizado

Comparison of the Kelly's plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions

ABSTRACT Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence, and the daily pad use were recorded. Patients were filled "rinary Distress Inventory-6(UDI-6)", "Incontinence Impact Questionnaire 7(IIQ-7)" and "Index of Female Sexual Function(IFSI)" questionnaire forms at preoperatively, and postoperative 6th month. No usage of pads was accepted as subjective cure rate. Intraoperative, and postoperative complications were noted. Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.