The role of extracorporeal shockwave lithotripsy in an asymptomatic special patient group with small renal calculi.

BACKGROUND AND PURPOSE: Data concerning extracorporeal shock wave lithotripsy (SWL) management of small (< or = 5 mm) asymptomatic renal caliceal stones are lacking in the literature. In this study, we aimed to determine the effectiveness of SWL in a special group of patients who had very small (< or = 5 mm) asymptomatic renal caliceal stones. The group of patients consisted of pilots, gendarmes, and soldiers, such as commandos, for whom treatment was obligatory and who had to be stone free because of their military duties. PATIENTS AND METHODS: We retrospectively examined SWL data and retrieved information for 84 patients with small asymptomatic renal caliceal stones. The SWL sessions were performed with a Siemens Lithostar lithotriptor. The mean age of the patients was 34 +/- 13 years. The mean stone size was 4.8 +/- 0.4 mm. The mean numbers of shockwaves and energy used were 2707 +/- 1742 and 18 +/- 2 kV, respectively. The location of stones were: 11 right upper calix, 10 right middle calix, 17 right lower calix, 13 left upper calix, 16 left middle calyx, and 17 left lower calix. Eighty-four patients underwent 101 SWL sessions. Only eight patients had second and three patients had third SWL treatments. SWL was performed five times for only one patient. All mean values were realized with an SPSS 10.0 statistical program. RESULTS: After the first, second, and third SWL sessions, the stone-free rate was calculated as 87%, 93% and 94%, respectively. Only five patients with lower renal caliceal stones were not stone free. The reported complications were macroscopic hematuria necessitating medical attention in four patients, skin ecchymosis in seven patients, severe colic pain in two patients, and urinary-tract infection in one patient. There was no need for hospitalization for these complications. CONCLUSION: SWL is effective and safe in patients with very small (< or = 5 mm) asymptomatic renal caliceal stones in all locations.

The Association between Urinary Incontinence and Low Back Pain and Radiculopathy in Women.

AIM: Urinary incontinence (UI) is a common dysfunction, affecting especially women of all ages. The terminology of low back pain (LBP) and radiculopathy (RP) may be misused interchangeably with each other. There are many reports of the association with LBP and incontinence but those involving compression of nerve root(as RP), has not been distinguished from isolated low back pain. This study was structured to analyse the association of UI, LBP and RP. METHODS: One hundred twenty patients were included in the study. Patients with spinal or urinary infection, tumour (spinal or others), cauda equine, pelvic operation, spinal trauma, spinal surgery, urogenital pathology were not accepted for this study. Age and weight of all patients were determined. Oswestry Disability Index (ODI) was utilised for assessment of loss of function and SEAPI incontinence index was used for urinary incontinence. All patients were examined for neurological pathology to differentiate between the LBP and RP by department of neurosurgery. Student t-test and Mann-Whitney-U tests were used for statistical significance. RESULTS: There was no statistical significance between low back pain with overall urinary incontinence (p = 0.131), urge (p = 0.103) or stress incontinence (p = 0.68), respectively. However; The statistical aspects were identified relationship between overall (p = 0.026) and urge (p = 0.001) urinary incontinence with radiculopathy. The association of urge incontinence and radiculopathy seems to show a more significant relationship. Yet there was no correlation between radiculopathy and stress incontinence (P = 0.062). CONCLUSION: Low back pain should not be regarded as a predisposing factor for urinary incontinence; however, radiculopathy has a statistically positive correlation between overall incontinence and urge incontinence.

Effectiveness of pelvic floor muscle training on symptoms and uroflowmetry parameters in female patients with overactive bladder.

BACKGROUND/AIM: To evaluate the effects of pelvic floor muscle training (PFMT) on symptoms of overactive bladder (OAB) as well as uroflowmetry parameters and functional bladder capacity. MATERIALS AND METHODS: Fifty-nine female patients with OAB symptoms were included. Patients were assessed by SEAPI-QMM, uroflowmetry, and abdominal ultrasound. A specially designed PFMT program using a Pilates ball was generated for patients. The training period was 1-h sessions twice a week for 6 weeks and aerobic home exercises to be performed at home 4 or 5 times every other day. Following training, subjects were reevaluated for body mass index, SEAPI questionnaire, and uroflowmetry. RESULTS: Initial mean SEAPI score, mean maximum and average flow rates, and mean voided volume were 9.8 ± 7.2, 29.8 ± 16.4 mL/s, 16.3 ± 8.7 mL/s, and 211.6 ± 173.5 mL, respectively. After completion of the training program, SEAPI scores improved significantly to 3.4 ± 6.4 (P < 0.05). Maximum and average flow rate results did not show significant changes, whereas voided volume seemed to have improved in conjunction with patients' symptom scores (Pearson correlation coefficient: 0.86). CONCLUSION: According to. our results, we think that proper PFMT results in increase of functional bladder capacity as well as improvement in OAB symptoms and can be recommended as first-line therapy or in conjunction with medical therapy in severe cases.

Penile prosthesis extrusion due to gonococcal infection.

Gonococcal infection of a penile prosthesis is a rare presentation of a common disease. Here we report two cases of penile prosthesis extrusion due to gonococcal infection.

Adrenal lymphangioma mimicking renal cyst: a case report and review of the literature.

We present a case of a 44-year-old female who was evaluated for left recurrent flank and abdominal pain. Abdominal ultrasonography demonstrated a large cystic mass on the upper pole of the left kidney. Magnetic resonance imaging showed a large, homogenous cystic mass measuring 8.5 × 9.5 cm with well-defined contours, being hypointense on T1-weighted images and hyperintense on T2-weighted images on the upper pole of the left kidney without a distinct plan between adrenal gland. According to clinical and radiological findings, surgical excision was carried out with a subcostal flank incision. Histologic and immunohistochemical examination demonstrates that the definite diagnosis is cystic lymphangioma of the left adrenal gland. Adrenal lymphangioma is a very rare lesion. This is the unique case of an adrenal lymphangioma considered as a renal cyst because of its radiological appearance.

Intrarenal arterial stenosis in a patient with thromboangiitis obliterans.

Thromboangiitis obliterans (TAO) or Buerger's disease is a clinical syndrome characterized by the development of segmental thrombotic occlusions of the medium and small arteries of the extremities. Exception of the peripheral arteries of the extremities in TAO is very rare. Reported herein is the first case of intrarenal branch involvement of the renal artery due to TAO.