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.

Surgical management of urinary stones with abnormal kidney anatomy.

In spite of the fact that urologic surgical techniques used by urologists are becoming more and more minimally invasive and easier because of developing technologies, surgical approaches for the urinary stones in kidneys with abnormal anatomy are still confusing. The objective of this article is to determine the treatment options in these kidneys. For this purpose, between 2005 and 2015, we retrospectively evaluated patients operated for urolithiasis with various congenital renal anomalies in five referral urology clinics in our country. Of the 178 patients (110 male, 60 female), 96 had horseshoe kidneys, 42 had pelvic ectopic kidneys (PEKs), and 40 had isolated rotation anomalies (IRAs) of the kidney. We evaluated the patients for stone-free rate (SFR), mean operation time, mean hospitalization time, and complication rate. In horseshoe kidney, SFRs for retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups were 72.2% and 90%, respectively. In PEKs, these rates were 83.6% and 100% for RIRS and laparoscopic pyelolithotomy, respectively. SFRs in kidneys with IRA were 75% for RIRS and 83.3% for PNL. The mean operation time for RIRS and PNL groups in horseshoe kidney was 40.5±11.2 minutes and 74.5±19.3 minutes, respectively. In PEKs, these times were 52.1±19.3 minutes and 53.1±24.3 minutes for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 48.7±14.4 minutes for RIRS and 53.2±11.3 minutes for PNL. Mean hospitalization times for RIRS and PNL groups in horseshoe kidneys were 1.4±0.7 days and 2.2±1.4 days, respectively. In PEKs, these times were 2.7±1.8 days and 1.9±0.4 days for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 1.5±0.9 days for RIRS and 1.8±0.6 days for PNL. The results of our study showed that RIRS could be used in all of types of abnormal kidneys with small- and medium-sized renal calculi safely and satisfactorily.

Which factors affect the hospital re-admission and re-hospitalization after flexible ureterorenoscopy for kidney stone?

PURPOSE: To investigate patient- and procedure-related factors associated with hospital re-admission (HR) and re-hospitalization following flexible ureteroscopy (f-URS). PATIENTS AND METHODS: The records of patients who underwent f-URS for renal stones in two reference centers between 2011 and 2015 were examined retrospectively. Patients who were re-admitted to the hospital or re-hospitalized for any reason within 30 days after hospital discharge related to the f-URS procedure were evaluated. The patient- and procedure-related factors affecting the re-admission and re-hospitalization rates were revealed using backward stepwise multiple binary logistic regression analysis. RESULTS: The study included 647 patients with a mean age of 46.1 ± 13.7 years. The mean BMI was 27.3 ± 4.6 kg/m(2), and the median ASA score was 1.85. The mean stone diameter was 14.2 ± 5.3 mm. The mean operation and fluoroscopy times were 50.2 ± 16.9 min and 43.1 ± 37.6 s, respectively. The mean hospitalization time was 1.42 ± 0.84 days, and the complication rate was 12.8 % (83/647). Overall, 523 (80.3 %) patients became stone-free, while residual fragments <4 mm were detected in 73 (11.3 %) patients. The procedure failed in 7.9 % of the cases. While 82 (12.7 %) patients were re-admitted, 31 (4.8 %) patients were re-hospitalized for further treatment. Stone-free status was an independent predictor of HR, while the stone-free status, hospitalization time, and postoperative complications all predicted re-hospitalization. CONCLUSIONS: We found that inability to achieve stone-free status predicted HR and re-hospitalization, while postoperative complication and prolonged hospitalization also predicted re-hospitalization.

Evaluation of the pathologic results of prostate biopsies in terms of age, Gleason score and PSA level: our experience and review of the literature.

OBJECTIVE: To evaluate the pathologic and clinic results of our large series of transrectal prostate biopsies in relation to Gleason score, age and PSA level. MATERIALS AND METHODS: We reviewed the pathologic results of transrectal prostate biopsies performed because of high PSA levels and abnormal digital rectal examination findings between January 2008 and February 2012. RESULTS: The pathologic result of 835 prostate biopsies was benign in 82.2% and malign in 17.8%. Furthermore in 3.7% high grade PIN (Prostatic Intraepitelial Neoplasia) or ASAP (Atypical Small Acinar Proliferation) was shown. In the interval of total PSA values between 4 and 10 ng/dl, that is thw so-called grey zone, cancer detection rate was 12.4%. There was a significant relationship between cancer detection and cancer stage at all high levels of PSA also in the grey zone. The most common Gleason score observed was 3 + 3 wirh a rate of 7.4% whereas the second most commonly observed scare was 3 + 4 with a rate of 2.5%. In the patients with abnormal digital rectal examination findings but normal PSA levels according to age the cancer detection rate was 8.7%, in patients with only high PSA levels the rate was 41.2% and in the patients with both high PSA levels and abnormal digital rectal examination findings. the rate was 49.3%. CONCLUSION: Our study underlines the relationship between age, PSA level and pathologic stage of prostate cancer and also the importance of digital rectal examination.

Retrograde intrarenal surgery in patients with isolated anomaly of kidney rotation.

The purpose of the study was to investigate feasibility of retrograde intrarenal surgery (RIRS) in patients with isolated anomaly of kidney rotation with kidney stones. We retrospectively reviewed the medical records of patients who underwent RIRS due to kidney stones in three referral hospitals. Twenty-four patients who had kidney rotation were included in this study. The patients with horseshoe kidney or pelvic kidney were not included in the study. The patients were evaluated for final success 1 month after surgery. Success was defined as stone-free or fragment smaller than 3 mm. Mean age of patients was 39.5 years (1-71 years) and male/female ratio was 3:1. Mean stone size was 13.46 mm (5-30 mm). Twelve (50 %) patients had the operation on the right side and other 12 (50 %) patients had on the left side. Eighteen (75 %) patients were stone-free after single procedure. And stone-free rate increased to 83.3 % after additional treatment procedures. When we compared the successful and failed procedures, gender, stone side and size, preoperative hydronephrosis, access sheet usage, ureteral double-J stent insertion were not statistically significant in two groups. We did not confront major complication. RIRS seems to be an effective and safe treatment option for renal stones in patients with isolated anomaly of kidney rotation.