Is the Mayo Adhesive Probability Score Predictive in Patients Undergoing Percutaneous Nephrolithotomy?

Introduction: Mayo Adhesive Probability (MAP) score was developed as a means to predict the presence of adherent perinephric fat. Our aim was to determine the predictive value of the MAP score on surgical outcomes in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively analyzed the data from 130 renal units that underwent PCNL between January 2022 and 2023. MAP scores 0-2 were classified as low, whereas MAP scores 3-5 were classified as high. The impact of the MAP score on perioperative and postoperative outcomes was studied. All statistical analyses were performed using SPSS 24.0 for Windows. Results: The median age of the patients at the time of surgery was 48 (21) years, with a female-to-male ratio of 1:1.82. The median MAP score was 2 (2), with 43.8% of patients falling into the high MAP score group. Advanced age, hypertension history, low estimated glomerular filtration rate (eGFR) levels, and low renal parenchymal thickness were significantly higher in the high MAP score group (P = .010, P = .004, P = .001, and P = .005, respectively). Female patients had a significantly higher MAP score of 0 (P = .021). Operation time, postoperative hematocrit decrease, blood transfusion rate, postoperative fever rate, hospitalization, and stone-free rates were comparable between the low and high MAP score groups (P = .535, P = .209, P = .313, P = .289, P = .281, and P = .264, respectively). Gender and eGFR levels were shown to be significant predictors of a MAP ≥3 (P = .004 and P = .003, respectively). Conclusion: The present study showed that the MAP score groups had similar perioperative and postoperative results. Low eGFR levels and the male gender were associated with MAP score ≥3. To determine the predictive MAP score value for PCNL outcomes, more prospective studies are needed.

Transrectal shear wave elastography for detection of prostate cancer.

AIM: To evaluate the value of transrectal shear-wave-elastography(SWE) to differentiate benign and malignant tissues in patients with suspected prostate cancer. MATERIALS AND METHODS: Between January and May 2019, the study was designed as a prospective clinical study. The SWE value of 504 cores measured before biopsy and the pathology result of each core were used in the statistical analysis. The SWE values of benign and malignant cores were compared according to pathology results. ROC analysis was used to calculate the best cut-off SWE value for differentiating malignancy from benign tissues. Specificity, sensitivity, negative, and positive predictive values (NPV, PPV) were also calculated for cut-off value. RESULTS: Prostate cancer was detected in 74 (14.7%) of 504 core biopsies. The mean SWE values were found significantly higher in malignant cores (71.1 kPa) than benign cores (42.3 kPa) (p < 0.001). Cores with gleason score 7 had a significantly higher SWE value than Gleason score 6 (p = 0.009). The cut-off value to differentiate malignancy and area-under-curve were calculated 35.85 kPa, 0.733, respectively. The sensitivity, specificity, NPV, and PPV were 83%, 49%, 78%, and 95%, respectively for 35.85 kPa value. CONCLUSIONS: The malignant tissues have significantly higher SWE values. Also high gleason score was shown to be associated with high SWE values. To predict the prostate cancer, the difference of SWE values of between benign and malignant tissues has high sensitivity. In the near future, to prevent unnecessary prostate biopsies, SWE will be part of the standard protocol for prostate imaging.

What Is the Ideal Treatment for 20-30 mm Kidney Stones? Comparative Outcomes of 1197 Patients.

Background: The purpose of this study is to compare the efficacy and safety of extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), mini-percutaneous nephrolithotomy (mPNL), and standard-percutaneous nephrolithotomy (stPNL) for the treatment of 20-30 mm kidney stones. Methods: The records of 1197 patients (SWL = 149, RIRS = 205, mPNL = 525, and stPNL = 318) from 8 centers were reviewed retrospectively. Four procedures were compared for stone-free rates (SFRs), auxiliary treatment, and associated complications. Results: Initial SFRs were 43.6%, 54.6%, 86.7%, and 87.7% in SWL, RIRS, mPNL, and stPNL, respectively (P < .001), whereas the final SFRs were 71.8%, 80%, 90.5%, and 89.6% (P < .001). The rate of auxiliary treatment in the groups was 38.3%, 26.8%, 5%, and 4.4%, respectively (P < .001). The initial and final SFRs in the mPNL and stPNL groups were higher than those in SWL and RIRS groups (P < .001). The rate for auxiliary treatment was lower in the mPNL and stPNL groups (P < .001). The operation time was longer in the RIRS group (P = .005). According to the Clavien-Dindo classification, the complication rate in the SWL group was lower than that in the surgical approaches (P < .001); however, no statistical difference was detected between RIRS, mPNL, and stPNL groups. mPNL and stPNL had a higher success rate than RIRS or SWL for treating 20-30 mm kidney stones. Conclusion: In the treatment of 2-3 cm renal stones, RIRS and PNL were more effective than SWL to obtain a better SFR and less auxiliary treatment rate. Compared with RIRS, mPNL and stPNL provided a higher SFR with similar complication rates.

Is there any advantage in the use of absorbable sutures in congenital penile curvature surgery performed in childhood? / ¿Existe alguna ventaja de utilizar suturas absorbibles en la cirugía de curvatura de pene congénita realizada en niños?

Objective: To compare the long-term outcomes of corporeal plication using absorbable versus nonabsorbable sutures for the treatment of congenital penile curvature in childhood.Materials and methods: Forty seven children who underwent congenital penile curvature repair between 11 and 140 months of age were included in the study. All children were operated on using the incisional plication technique and were divided into two groups: Absorbable-polyglactine (PLG, n=23, 48.93%) and nonabsorbable-polypropilen (PP, n=24, 51.06%) according to the suture material used for plication. Surgical outcomes were compared between groups.Results: Mean follow-up period was 19.02±4.66 months. There was no significant difference between the mean age of the children in two groups included in the study (PLG=41.39±34.63 months vs PP=53.66±37.42 months, p=0.250). There was no significant difference in penile straightening degree between the two groups in the postoperative follow-up (PLG=27.39±6.88 vs PP=31.08±6.38, p=0.06). Similarly, there was no significant difference between two groups in terms of postoperative curvature recurrence (p=0.681). However, palpable suture knots in the plication area was significantly higher in the PP group in the postoperative period (25.0% vs 4.3%, p=0.047).Conclusion: The use of absorbable sutures in congenital penile curvature surgery in childhood has similar success rates with the use of nonabsorbable sutures and provides lower complications that are secondary to nonabsorbable sutures. (AU)

Objetivo: Comparar los resultados a largo plazo de la plicatura corpórea utilizando suturas absorbibles vs. no absorbibles para el tratamiento de la curvatura de pene congénita en niños.Materiales y métodos: Se incluyó en el estudio a 47 niños sometidos a reparación de curvatura congénita del pene de entre 11 y 140 meses de edad. Todos los niños fueron operados utilizando la técnica de plicatura incisional, dividiéndose en dos grupos: poliglactina absorbible (PLG, n = 23, 48,93%) y polipropileno no absorbible (PP, n = 24, 51,06%), en virtud del material de sutura utilizado para la plicatura. Se compararon los resultados quirúrgicos entre los grupos.Resultados: El periodo de seguimiento medio fue de 19,02 ± 4,66 meses. No se produjo diferencia significativa en cuanto a la edad media de los niños de los dos grupos incluidos en el estudio (PLG = 41,39 ± 34,63 meses vs. PP = 53,66 ± 37,42 meses, p = 0,250). No se produjo diferencia significativa en cuanto a enderezamiento del pene entre los dos grupos durante el seguimiento posoperatorio (PLG = 27,39 ± 6,88 vs. PP = 31,08 ± 6,38, p = 0,06). De igual modo, no existió diferencia significativa entre los dos grupos en términos de recidiva posoperatoria de la curvatura (p = 0,681). Sin embargo, los nudos palpables de sutura en la zona de plicatura fueron significativamente mayores en el grupo PP en el periodo posoperatorio (25 vs. 4,3%, p = 0,047).Conclusión: El uso de suturas absorbibles en la cirugía de curvatura congénita de pene en niños tuvo tasas de éxito similares con el uso de suturas no absorbibles, aportando menores complicaciones que las secundarias a las suturas no absorbibles. (AU)

Is there any advantage in the use of absorbable sutures in congenital penile curvature surgery performed in childhood?

OBJECTIVE: To compare the long-term outcomes of corporeal plication using absorbable versus nonabsorbable sutures for the treatment of congenital penile curvature in childhood. MATERIALS AND METHODS: Forty seven children who underwent congenital penile curvature repair between 11 and 140 months of age were included in the study. All children were operated on using the incisional plication technique and were divided into two groups: Absorbable-polyglactine (PLG, n=23, 48.93%) and nonabsorbable-polypropilen (PP, n=24, 51.06%) according to the suture material used for plication. Surgical outcomes were compared between groups. RESULTS: Mean follow-up period was 19.02±4.66 months. There was no significant difference between the mean age of the children in two groups included in the study (PLG=41.39±34.63 months vs PP=53.66±37.42 months, p=0.250). There was no significant difference in penile straightening degree between the two groups in the postoperative follow-up (PLG=27.39±6.88 vs PP=31.08±6.38, p=0.06). Similarly, there was no significant difference between two groups in terms of postoperative curvature recurrence (p=0.681). However, palpable suture knots in the plication area was significantly higher in the PP group in the postoperative period (25.0% vs 4.3%, p=0.047). CONCLUSION: The use of absorbable sutures in congenital penile curvature surgery in childhood has similar success rates with the use of nonabsorbable sutures and provides lower complications that are secondary to nonabsorbable sutures.

Does ureteral access sheath affect the outcomes of retrograde intrarenal surgery: a prospective study.

OBJECTIVES: To evaluate whether or not using a ureteral access sheath (UAS) affects the perioperative outcomes after retrograde intrarenal surgery (RIRS) performed in patients with renal stones. MATERIAL AND METHODS: An observational study was carried out using data of 60 patients who underwent RIRS with the diagnosis of renal stones <2 cm between February 2017 and November 2017 at our institution. The data of the 60 patients were registered prospectively during the study period. Patients were divided into two groups based on whether a UAS was used (Group 1-30 patients) or not (Group 2-30 patients) during RIRS. Perioperative outcomes and complications were collected and analyzed. RESULTS: The stone burdens of the patients in Group 1 and in Group 2 were 76.59 mm2 and 62.19 mm2, respectively (p = .160). There was no statistically significant difference in SFR (p = 1.000), complication rates (p = .418), and operation time (p = .411) between both groups, except for the fact that postoperative pain intensity levels using the VAS were slightly higher in Group 2 (4.13 ± 2.37 vs. 5.33 ± 1.89, p = .064). CONCLUSIONS: In the present study, we showed that similar success and acceptable complication rates can be achieved without using UAS compared to using UAS during RIRS. However, using UAS may provide an advantage in reducing postoperative pain after RIRS.

Early surgical repair or conservative treatment? Comparing patients with penile fracture concerning long-term sexual functions.

BACKGROUND: To compare the patients who underwent early surgical repair of penile fracture, which is one of the urological emergencies, and patients who recovered with conservative treatment concerning long-term sexual functions. METHODS: The data of 42 patients who applied to our clinic with penile fracture between January 2010 and January 2020 were retrospectively analyzed. The patients were categorized into two groups as early operated and followed-up conservatively. The preoperative and postoperative findings of the patients were compared with the International Erectile Function Scale (IIEF-6) scores in the long-term follow-up. RESULTS: The median age of the patients was 35 (20-65) years and the median follow-up period was 52 (8-120) months. The postoperative mean IIEF-6 score of the patients was 22.98±6.52. There was no significant difference between the surgical and the conservative groups concerning postoperative complications (p=0.460). In the follow-up period, the presence of palpable plaque on the rupture area was significantly higher in the conservative group (p=0.041). However, there was no significant difference between the groups concerning IIEF-6 scores (p=0.085). CONCLUSION: Although there is no significant difference in long-term IIEF-6 scores between the two groups, the rate of palpable plaque formation is higher in patients followed-up conservatively. Therefore, early surgical repair should be considered in the foreground, especially in patients with a large rupture area.

Is combined topical-local anesthesia technique adequate for visual internal urethrotomy in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses?

BACKGROUND: To compare the effectiveness of spinal anesthesia (SA) and the combination of intraurethral topical instillation of 2% lidocaine + intraurethral local visual injection anesthesia (T + LIA) for visual internal urethrotomy (VIU) in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses. METHODS: In this study, the results of 178 patients who underwent visual internal urethrotomy for posterior urethral strictures and prostatic urethral stenoses secondary to trauma in our clinic between October 2018 and January 2020 were analyzed retrospectively. Patients were divided into two groups as combined T + LIA (n=146, 82.08%) group and SA (n=32, 17.97%) group according to the type of anesthesia used. The preoperative clinical data and postoperative results of the patients were analyzed and compared between the groups. RESULTS: The mean age of the patients was 67.99±10.87 years and the mean follow-up was 5.32±3.27 months. The median age of the patients in the T + LIA group was significantly higher than that of the patients in the SA group (p=0.033). There was no statistically significant difference between the groups regarding preoperative Q-max value (p=0.931). Similarly, the rate of postoperative improvement in the Q-max values of the patients was similar between the groups (p=0.572). The presence of postoperative complications and recurrence rates were similar between the groups (p=0.879 and p=0.904, respectively). CONCLUSION: Compared to spinal anesthesia, T + LIA anesthesia is a safe and effective technique for visual internal urethrotomy in treating traumatic posterior urethral strictures and prostatic urethral stenoses, with a high rate of success and acceptable rate of complications.

Comparison of scoring systems for predicting stone-free status and complications after retrograde intrarenal surgery.

PURPOSE: To compare the effectiveness of scoring systems in predicting stone-free rates (SFR) and complications following retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: We retrospectively analyzed 280 patients who underwent RIRS for kidney stones between 2016 and 2019. The Resorlu-Unsal Stone score (RUSS), Modified Seoul National University Renal Stone Complexity (S-ReSC) score, and R.I.R.S. scoring system score were calculated for each patient who was enrolled in the study. Subsequently, stone scoring systems were compared as to their predictive capability for SFR using receiver-operating characteristic curves. Furthermore, multivariate analysis was done to determine whether the scoring systems associated with SFR and complications. RESULTS: The median patient age was 44 (35--56). The median RUSS, S-ReSC, and R.I.R.S scores were 0 (0-1), 1(1-2), and 6 (5-7), respectively. The overall SFR was 76.7%. The R.I.R.S. scoring system was found to have a higher predictive value in predicting postoperative SFR than the other two scoring systems (p < 0.001, AUC = 0,816). RUSS, R.I.R.S. score, and stone size were found to be independent predictive factors for SFR (p = 0.049, p = 0.024, p = 0.033, respectively). Complications were observed in 3.2%(9/280) of patients. Stone scoring systems were not statistically associated with complications. Operation duration was the only independent risk factor for complications (p = 0.010). CONCLUSIONS: The R.I.R.S. scoring system was found to have a higher predictive value than RUSS and S-ReSC to predict SFR following RIRS in our study. However, none of the stone scoring systems was directly proportional to complications of RIRS.

Urinary incontinence as a cause of depression and sexual dysfunction: questionnaire-based study / Incontinencia urinaria como causa de depresión y disfunción sexual: estudio basado en cuestionarios

INTRODUCTION: Urinary incontinence is a severe and common health problem. In this study, we aimed to assess severity of sexual dysfunction and depression in patients with urinary incontinence. MATERIALS AND METHODS: The study has been conducted between 2015 and 2017. Age, body mass index, accompanying health problems, Over Active Bladder (OAB) symptom score, Type of urinary incontinence, Beck Depression Scale were assessed for all PATIENTS: International Index of Erectile Function-5 (IIEF-5) was used for male patients in order to assess sexual dysfunction. Index of Female Sexual Function (IFSF) and Female Sexual Distress Scale (FSDS) were used in female patients in order to assess sexual dysfunction. RESULTS: 33 patients have been included in the study (Male-12: Urge-10/Stress-1/Mixed-1/Female-21: Urge-10/Stress-6/Mixed-5). Mean age of all patients was 47.9 (Male-49.3/Female-47.2). Mean Body Mass Index for all patients was 23.2 (Male-25.9/Female-21.8). Mean OAB score was 24.3 for all patients (Male-27.5: Urge-28.6/Stress-17/Mixed-27/Female-22.5: Urge-24.2/Stress:21.3/Mixed-20.6). Mean Beck Depression Result for all patients was 20.9 (Male-18.5: Urge-20.2/Stress-9/Mixt-11/Female-22.4: Urge-19.1/Stress-20.3/Mixed-31.6). Mean IIEF-5 score for male patients was 39.5 (Urge-41.4/Stress-55/Mixed-5). Mean IFSF score for female patients was 19.9 (Urge-17.9/Stress-21.3/Mixed-22.4) and mean FSDS score for female patients was 22.1 (Urge-22.3/Stress-23.1/Mixed-20.8). DISCUSSION: Most of the patients that have been included in the study were diagnosed as urge incontinence. When assessing the OAB scores, they were higher in urge incontinence group. Beck depression results showed higher scores in female patients and it was higher in urge group of male patients and mixt group of female PATIENTS: Sexual dysfunction rates were found to be higher for both genders

INTRODUCCIÓN: La incontinencia urinaria es un problema de salud grave y frecuente. En este estudio se pretende evaluar la gravedad de la disfunción sexual y la depresión en pacientes con incontinencia urinaria. MATERIALES Y MÉTODOS: El estudio se ha realizado entre 2015 y 2017. Edad, índice de masa corporal, problemas de salud concomitantes, puntuación de los síntomas de vejiga hiperactiva, tipo de incontinencia urinaria y escala de depresión de Beck fueron evaluados en todos los PACIENTES: El índice internacional de la función eréctil 5 (IIEF-5) fue utilizado en los pacientes varones para determinar la disfunción sexual. El índice de la función sexual femenina (IFSF) y la escala sexual femenina de la señal de socorro (FSDS, por sus siglas en inglés) fueron utilizados en pacientes mujeres para determinar la disfunción sexual. RESULTADOS: Treinta y tres pacientes han sido incluidos en el estudio (varones: 12, ganas: 10, estrés: 1 y mixto: 1; mujeres: 21, ganas: 10, estrés: 6 y mixto: 5). La media de edad de todos los pacientes era de 47,9 (varones: 49,3 y mujeres: 47,2) años. El índice de masa corporal promedio de todos los pacientes fue de 23,2 (varones: 25,9 y mujeres: 21,8). La media de puntuación de vejiga hiperactiva en todos los pacientes fue de 24,3 (varones: 27,5, ganas: 28,6, estrés: 17 y mixto: 27; mujeres: 22,5, ganas: 24,2, estrés: 21,3 y mixto: 20,6). Los resultados de la media de Beck para la depresión de todos los pacientes fue de 20,9 (varones: 18,5, ganas: 20,2, estrés: 9 y mixto: 11; mujeres: 22,4, ganas: 19,1, estrés: 20,3 y mixto: 31,6). La puntuación media IIEF-5 para pacientes varones fue de 39,5 (ganas: 41,4, estrés: 55 y mixto: 5). La puntuación media IFSF para pacientes mujeres fue de 19,9 (ganas: 17,9, estrés: 21,3 y mixto: 22,4) y la puntuación media FSDS para pacientes mujeres fue de 22,1 (ganas: 22,3, estrés: 23,1 y mixto: 20,8). DISCUSIÓN: La mayoría de los pacientes que han sido incluidos en el estudio fueron diagnosticados con incontinencia de urgencia. A la hora de evaluar las puntuaciones de vejiga hiperactiva fueron más altos en el grupo de incontinencia. Los resultados de la media de Beck para la depresión mostraron puntuaciones más elevadas en pacientes mujeres y fue mayor en el grupo de pacientes varones con ganas y en el grupo de pacientes mujeres con mixto. Las tasas de disfunción sexual se encontraron altas en ambos sexos

Urinary incontinence as a cause of depression and sexual dysfunction: Questionnaire-based study.

INTRODUCTION: Urinary incontinence is a severe and common health problem. In this study, we aimed to assess severity of sexual dysfunction and depression in patients with urinary incontinence. MATERIALS AND METHODS: The study has been conducted between 2015 and 2017. Age, body mass index, accompanying health problems, Over Active Bladder (OAB) symptom score, Type of urinary incontinence, Beck Depression Scale were assessed for all patients. International Index of Erectile Function-5 (IIEF-5) was used for male patients in order to assess sexual dysfunction. Index of Female Sexual Function (IFSF) and Female Sexual Distress Scale (FSDS) were used in female patients in order to assess sexual dysfunction. RESULTS: 33 patients have been included in the study (Male-12: Urge-10/Stress-1/Mixed-1/Female-21: Urge-10/Stress-6/Mixed-5). Mean age of all patients was 47.9 (Male-49.3/Female-47.2). Mean Body Mass Index for all patients was 23.2 (Male-25.9/Female-21.8). Mean OAB score was 24.3 for all patients (Male-27.5: Urge-28.6/Stress-17/Mixed-27/Female-22.5: Urge-24.2/Stress:21.3/Mixed-20.6). Mean Beck Depression Result for all patients was 20.9 (Male-18.5: Urge-20.2/Stress-9/Mixt-11/Female-22.4: Urge-19.1/Stress-20.3/Mixed-31.6). Mean IIEF-5 score for male patients was 39.5 (Urge-41.4/Stress-55/Mixed-5). Mean IFSF score for female patients was 19.9 (Urge-17.9/Stress-21.3/Mixed-22.4) and mean FSDS score for female patients was 22.1 (Urge-22.3/Stress-23.1/Mixed-20.8). DISCUSSION: Most of the patients that have been included in the study were diagnosed as urge incontinence. When assessing the OAB scores, they were higher in urge incontinence group. Beck depression results showed higher scores in female patients and it was higher in urge group of male patients and mixt group of female patients. Sexual dysfunction rates were found to be higher for both genders.

Retrograde intrarenal surgery or percutaneous nephrolithotomy: Which one is more effective for 1-2 cm renal stones in pediatric patients? / Cirugía intrarrenal retrógrada o nefrolitotomía percutánea: ¿Cuál es más efectiva para litiasis de 1-2 cm en pacientes pediátricos?

INTRODUCTION: Urinary stone diseaseis less common in pediatric age group and it has anincreasing incidence. In this study, our hypothesis is toevaluate if one of the techniques, PNL or RIRS is superiorthan the other in terms of stone free status (SFR), fluoroscopytime (FT), operation time (OT), complication rate(CR), JJ stent insertion rate, and hospitalization duration(HD) in children. METHODS: Between 2013 and 2016, 74 patients(under 18 years- old) were operated for the treatmentof renal stones between 1-2cm size. 37 patientswere male (50%) and 37 of them (50%) were female.The study shows the experience of a single center. Dataof the patients who underwent (surgery) were recorded. RESULTS: SFR was not different in both groups in shortand long terms follow up, but hgb drop, FT, OT, andHD were detected to be worse in PNL group. Therewas lower complication rates for RIRS group comparing to PCNL group according to Clavien classification butgrade I complications were higher in RIRS group. CONCLUSION: Although PNL is a cheaper treatmentmethod, RIRS has less creatinine change, less FT, lessOT, less CR, less HT with similar SFR for 1-2cm renalstones in children. Long term SFR were 83.8% for RIRSand 86.5% for PCNL. RIRS is a treatment of choice inchildren with 1-2 cm renal stones as it has more advantagesbut the costs must be considered.

INTRODUCCIÓN: La enfermedad litiásica es menos frecuente en el grupo de edad pediátrica y tiene una incidencia creciente. En este estudio, nuestra hipótesis es evaluar si una de las técnicas, NLP o CIR, es superior a la otra en términos de estatus libre de litiasis,tiempo de fluoroscopia, tiempo quirúrgico, tasa de complicaciones,tasa de inserción de catéter DJ, y duración de la hospitalización en niños.MÉTODOS: Entre 2013 y 2016, 74 pacientes (por debajo de 18 años de edad) fueron intervenidos para tratamiento de litiasis entre 1-2 cm. 37 pacientes eran varones (50%) y 37 mujeres (50%). El estudio muestra la experiencia de un único centro. Se recogieron los datosde los pacientes sometidos a cirugía.RESULTADOS: La tasa de pacientes libres de litiasis no fue diferente entre los grupos a corto y largo plazo, pero el descenso de la hemoglobina, tiempo de fluoroscopia, tiempo operatorio y de hospitalización fueron peores en el grupo de NLP. Hubo una menor tasa de complicaciones en el grupo de CIR en comparación con el de NLP de acuerdo con la clasificación de Clavien, aunque las complicaciones de Grado I fuero mayores en el grupo de CIR.CONCLUSIONES: Aunque la NLP es un tratamiento más barato, la CIR tiene menor cambio de la Creatinina, menor tiempo de fluoroscopia y menor hospitalización con una tasa de libres de litiasis similar paralitiasis de 1-2 cm en niños. Las tasas de libres de litiasis a largo plazo fueron 83,9% para CIR y 86,5% para NLP. La CIR es un tratamiento de elección en niños con litiasis renales de 1-2 cm porque tiene más ventajas, pero deben considerarse los costes.

Retrograde intrarenal surgery or percutaneous nephrolithotomy: which one is more effective for 1-2 cm renal stones in pediatric patients? / Cirugía intrarrenal retrógrada o nefrolitotomía percutánea: ¿Cuál es más efectiva para litiasis de 1-2 cm en pacientes pediátricos?

Introduction: Urinary stone disease is less common in pediatric age group and it has an increasing incidence. In this study, our hypothesis is to evaluate if one of the techniques, PNL or RIRS is superior than the other in terms of stone free status (SFR), fluoroscopy time (FT), operation time (OT), complication rate (CR), JJ stent insertion rate, and hospitalization duration (HD) in children. Methods: Between 2013 and 2016, 74 patients (under 18 years- old) were operated for the treatment of renal stones between 1-2cm size. 37 patients were male (50%) and 37 of them (50%) were female. The study shows the experience of a single center. Data of the patients who underwent (surgery) were recorded. Results: SFR was not different in both groups in short and long terms follow up, but hgb drop, FT, OT, and HD were detected to be worse in PNL group. There was lower complication rates for RIRS group comparing to PCNL group according to Clavien classification but grade I complications were higher in RIRS group. Conclusion: Although PNL is a cheaper treatment method, RIRS has less creatinine change, less FT, less OT, less CR, less HT with similar SFR for 1-2cm renal stones in children. Long term SFR were 83.8% for RIRS and 86.5% for PCNL. RIRS is a treatment of choice in children with 1-2 cm renal stones as it has more advantages but the costs must be considered

Introducción: La enfermedad litiásica es menos frecuente en el grupo de edad pediátrica y tiene una incidencia creciente. En este estudio, nuestra hipótesis es evaluar si una de las técnicas, NLP o CIR, es superior a la otra en términos de estatus libre de litiasis, tiempo de fluoroscopia, tiempo quirúrgico, tasa de complicaciones, tasa de inserción de catéter DJ, y duración de la hospitalización en niños. Métodos: Entre 2013 y 2016, 74 pacientes (por debajo de 18 años de edad) fueron intervenidos para tratamiento de litiasis entre 1-2 cm. 37 pacientes eran varones (50%) y 37 mujeres (50%). El estudio muestra la experiencia de un único centro. Se recogieron los datos de los pacientes sometidos a cirugía. Resultados: La tasa de pacientes libres de litiasis no fue diferente entre los grupos a corto y largo plazo, pero el descenso de la hemoglobina, tiempo de fluoroscopia, tiempo operatorio y de hospitalización fueron peores en el grupo de NLP. Hubo una menor tasa de complicaciones en el grupo de CIR en comparación con el de NLP de acuerdo con la clasificación de Clavien, aunque las complicaciones de Grado I fuero mayores en el grupo de CIR. Conclusiones: Aunque la NLP es un tratamiento más barato, la CIR tiene menor cambio de la Creatinina, menor tiempo de fluoroscopia y menor hospitalización con una tasa de libres de litiasis similar para litiasis de 1-2 cm en niños. Las tasas de libres de litiasis a largo plazo fueron 83,9% para CIR y 86,5% para NLP. La CIR es un tratamiento de elección en niños con litiasis renales de 1-2 cm porque tiene más ventajas, pero deben considerarse los costes

Does the use of fluoroscopy really affect the success rate of retrograde intrarenal surgery?

INTRODUCTION: Fluoroscopy is used for access sheath insertion and postoperative control during retrograde intrarenal surgery (RIRS) operation but with this technique both patient and operation team are exposed to radiation. The use of fluoroscopy is disadvantage for both patient and surgeon. Considering results of recent studies, it is clearly seen that fluoroscopy doesn't affect the success and complication rates of RIRS. In this study, we aimed to compare the results of both fluoroscopy and fluoroscopy-free groups, to show if there is a significant difference. METHODS: 385 patients were included in the study and they were divided into two groups. 284 patients were in Group I where fluoroscopy was used. 101 patients were in Group II and fluoroscopy was not used The success rates of primary operation and final success rates were compared. Data from both groups were evaluated objectively using classification systems and imaging methods. RESULTS: Success rates (primary and final) were higher in Group II, and that can be attributed to experience gained over time. Complication rate was lower and success rate was higher in fluoroscopy-free group. According to multivariate analysis, It is clear that the stone dimension is the foreground of the factors that influence the success, and the effect of the stone location is also observed. CONCLUSION: When considering the comparison of success and complication rates between two groups, it is clearly understood that the use of fluoroscopy has not a positive effect on results. According to the outcomes of our study, fluoroscopy-free RIRS can be performed with safe and high success rates. This outcome also leads an important point for avoiding unnecessary radiation exposure.

Does the use of fluoroscopy really affect the success rate of retrograde intrarenal surgery? / ¿Afecta el uso de fluoroscopia a la tasa de éxitos de la cirugía intrarrenal retrograda?

Introduction: Fluoroscopy is used for access sheath insertion and postoperative control during retrograde intrarenal surgery(RIRS) operation but with this technique both patient and operation team are exposed to radiation. The use of fluoroscopy is disadvantage for both patient and surgeon. Considering results of recent studies, it is clearly seen that fluoroscopy doesn’t affect the success and complication rates of RIRS. In this study, we aimed to compare the results of both fluoroscopy and fluoroscopy-free groups, to show if there is a significant difference. Methods: 385 patients were included in the study and they were divided into two groups. 284 patients were in Group I where fluoroscopy was used. 101 patients were in Group II and fluoroscopy was not used. The success rates of primary operation and final success rates were compared. Data from both groups were evaluated objectively using classification systems and imaging methods. Results: Success rates(primary and final) were higher in Group II, and that can be attributed to experience gained over time. Complication rate was lower and success rate was higher in fluoroscopy-free group. According to multivariate analysis, It is clear that the stone dimension is the foreground of the factors that influence the success, and the effect of the stone location is also observed. Conclusion: When considering the comparison of success and complication rates between two groups, it is clearly understood that the use of fluoroscopy has not a positive effect on results. According to the outcomes of our study, fluoroscopy-free RIRS can be performed with safe and high success rates. This outcome also leads an important point for avoiding unnecessary radiation exposure

Introduccion: La fluoroscopia se utiliza para la inserción de la vaina de acceso y el control postoperatorio durante la cirugía intrarrenal retrograda (CIR) pero con esta técnica tanto el paciente como el equipo quirúrgico se exponen a radiación. El uso de fluoroscopia es una desventaja para el paciente y el cirujano. Considerando los resultados de estudios recientes, está claramente demostrado que la fluoroscopia no afecta a las tasas de éxito y complicaciones de la CIR. En este estudio, queremos comparar los resultados de los grupos con y sin fluoroscopia, para ver si existen diferencias significativas. Métodos: Se incluyeron en el estudio 385 pacientes y se dividieron en dos grupos. 284 pacientes estaban en el grupo I que utilizaba fluoroscopia. 101 pacientes se incluyeron en el grupo II en el que no se utilizó. Se compararon las tasas de éxito de la operación primaria y al final del proceso. Los datos de ambos grupos fueron evaluados objetivamente utilizando los sistemas de clasificación y las pruebas de imagen. Resultados: Las tasas de éxito (primaria y final) fueron superiores en el grupo II, y esto se puede atribuir a la experiencia ganada con el tiempo. La tasa de complicaciones fue inferior y la de éxito superior en el grupo sin fluoroscopia. De acuerdo con el análisis multivariado, está claro que el tamaño de la piedra es el factor principal que afecta al éxito, y también se aprecia el efecto de su localización. Conclusiones: Cuando se considera la comparación entre los dos grupos del éxito y las complicaciones, se entiende claramente que la utilizacion de fluoroscopia no tiene un efecto positivo en los resultados. De acuerdo con los resultados de nuestro estudio, la CIR sin fluoroscopia puede hacerse con seguridad y altas tasas de éxitos. Este resultado también lleva a un importante apoyo para evitar la exposición innecesaria a radiación

Is retrograde intrarenal surgery replacing percutaneous nephrolithotomy as surgical treatment of stone disease: our clinical experience / Está la cirugía intrarrenal retrógrada sustituyendo a la nefrolitectomía percutanea como el tratamiento de la Litiasis? Nuestra experiencia

OBJECTIVE: Urolithiasis prevalence is 2-20% according to different geographic characteristics in different populations. In this study, we aimed to present the distribution of operation numbers for both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in terms of age and stone size in order to reveal the changes over the years. METHOD: Between January 2010 and March 2016, 1814 patients were operated for the treatment of renal stones. Patients were directed to the two different operations according to the surgeons' choices: RIRS or PCNL. Prospectively collected data was retrospectively reviewed. RESULTS: In the years 2010, 2011, 2012, 2013, 2014, 2015, and 2016, the number of RIRS applied for the treatment of renal stones was 25, 87, 96, 147, 166, 174, and 66, respectively. RIRS was significantly preferred more than PCNL for stones <1.5 cm. Examining the ages, there was no different data described as above for stone sizes CONCLUSION: Despite RIRS is the new trend for treating stone disease, PCNL remains its important role for especially the larger stone sizes. RIRS is the raising trend for small sizes

OBJETIVO: La prevalencia de la litiasis está entre 2-20% de acuerdo con diferentes características geográficas en diferentes poblaciones. En este estudio, presentamos la distribución de frecuencias de la nefrolitotomía percutanea (NLPC) y la cirugía intrarrenal retrógrada (RIRS) en función de edad y tamaño de la piedra con el objetivo de analizar los cambios a lo largo de los años. MÉTODOS: Entre enero del 2010 y Marzo del 2016 1.814 pacientes fueron intervenidos para el tratamiento de litiasis renales. Los pacientes fueron dirigidos a cada una de las operaciones de acuerdo con las preferencias de los cirujanos: RIRS o NLPC. Se realizó una revisión retrospectiva de una base de datos recogida prospectivamente. RESULTADOS: En los años 2010, 2011, 2012, 2013, 2014, 2015 y 2016 el número de RIRS aplicado en el tratamiento de las litiasis renales fue de 25, 87, 96, 147, 166, 174, y 66, respectivamente. La RIRS fue la opción preferida con una frecuencia significativamente mayor que la NLPC en litiasis de <1,5cm. Examinando la edad, no había diferencias en los datos igual que lo descrito anteriormente para el tamaño del cálculo. CONCLUSIONES: Aunque la RIRS es la nueva tendencia en el tratamiento de la litiasis, la NLPC conserva su importante rol, especialmente para piedras más grandes. La RIRS es la tendencia creciente para tamaños más pequeños

Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy.

PURPOSE: To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated. MATERIALS AND METHODS: We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (? 38°C) with pyuria (? 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariatelogistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL. RESULTS: 42 (8.5%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12%) of 492 patients had a positive preoperative urine culture. 19 (32.2% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95%CI:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy. CONCLUSION: We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors forMDR infections to reduce the rate of postoperative infectious complications.

Predictive factors of bleeding among pediatric patients undergoing percutaneous nephrolithotomy.

The purpose of this study is to determine the perioperative risk factors for increased blood loss in children undergoing percutaneous nephrolithotomy (PCNL).We retrospectively reviewed the data on pediatric patients who had undergone PCNL for stone disease in our department. Blood loss estimation was quantified by measuring the changes in hematocrit plus the volume of red blood cells transfused. Univariate and multivariate linear regression analyses were performed to evaluate risk factors associated with increased blood loss after pediatric PCNL. Variables included patient, stone, and treatment parameters. The study group consisted of 105 renal units in 97 children with a median (interquartile range) age of 5 (3-9) years. On univariate linear regression analysis female gender (p = 0.030), absence of hydronephrosis (p = 0.013), increasing stone burden (p = 0.002), staghorn stone type (p = 0.013), multi-tract access (p < 0.001), and prolonged operative time (p < 0.001) were significantly associated with increased blood loss after pediatric PCNL. However, multivariate linear regression analysis demonstrated that the only independent risk factors for increased blood loss following pediatric PCNL were degree of hydronephrosis (B -1.329, 95% CI -2.451 to -0.208, p = 0.021), number of tracts (B 2.545, 95% CI 0.221-4.869, p = 0.032), and operative time (B 0.031, 95% CI 0.008-0.053, p = 0.007). Identifying pediatric patients at increased risk of bleeding following PCNL is crucial to minimize morbidity and hospital stay, and thus, the cost of treatment. Our study demonstrated that degree of hydronephrosis, number of tracts and operative time are important factors in reducing blood loss during pediatric PCNL.

Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones.

OBJECTIVE: We aimed to investigate factors related to early postoperative pain after retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS: A prospective data analysis of 250 patients who underwent RIRS due to kidney stones was performed. Postoperative pain was evaluated in all patients by using visual analogue scale (VAS). Patients with severe pain (VAS score ≥7) were separated and included in Group I (n=46). While patients without pain or with insignificant pain were included in Group II (n=204). The impact of patient-related (age, gender, renal anomalies, shock wave lithotripsy history, preoperative hydronephrosis) stone-related (stone number, side, size, location and opacity) and operation-related (preoperative and postoperative ureteral J-stenting, ureteral injury, postoperative bleeding and fever, stone-free rates, size of access sheath, and sheath indwelling time) factors on early stage postoperative pain (if any) were investigated. RESULTS: Female gender increased the risk for pain 3.6-fold (p<0.05). One millimeter increase in stone diameter increased the risk for postoperative pain 1.15-fold. Prolonged sheath time was another important factor which increased the risk for pain (p<0.05). Patients with high residual fragments were also prone to early postoperative pain. CONCLUSION: According to our results, patient-, stone-and operation-related factors associated with postoperative pain after RIRS were female gender, stone size and sheath time.

An extraordinary masturbation instrument: intravesical electrical wire cable / Un instrumento para la masturbación excepcional: cable eléctrico intravesical

There are several unusual cases in the literature with foreign bodies in bladder or urethra such as candle, needle, thermometer, animal feather, chicken bone, and wooden stick. Because of these foreign bodies there would be several complications. Pain, infection, urosepsis, and hematuria are the usually seen complications in these cases. Cases with electrical wire cables are also rarely seen. Some of the reasons for inserting foreign bodies are masturbation, feeling or presence of urethral obstruction. In this case, we aimed to present a 21-year-old male patient who was admitted to emergency clinic of Keçiören Research and Training Hospital in September 2014 with a urethral foreign body that was extending into the bladder and was used for masturbation (AU)

Hay varios casos inusuales en la literatura con cuerpos extraños en la vejiga o en la uretra tales como velas, agujas, termómetros, plumas animales, huesos de pollo, palos de madera etc. Estos objetos pueden general diversas complicaciones; las más comunes son dolor, infecciones, urosepsis o hematuria. Los casos con cables eléctricos se presentan en raras ocasiones. Alguno de los motivos por lo que se insertan cuerpos extraños pueden ser la masturbación o la sensación de obstrucción en la uretra. En esta ocasion se presenta el caso de un paciente varón de 21 años de edad que fue ingresado a la clínica de emergencia de Investigación Keçiören y el Hospital de Formación en septiembre de 2014 con un cuerpo extraño uretral que se extendía hasta la vejiga y se utilizó para la masturbación (AU)