Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.

Depression, LUTS and ED Relation in Elderly Men.

Objectives: Depression unfortunately, remains an under-recognized and misdiagnosed condition, especially in the aging population. We aimed to research the relation of depression, LUTS and ED in elderly men. Methods: In this prospective study, 364 elder male patients were evaluated. For depression research in patients, Beck's Depression Index (BDI) was used. Lower urinary tract symptoms of patients were evaluated by International prostatic symptoms score (IPSS) examination form and Erection quality was evaluated with International Index of Erectile Function (IIEF 5-15) examination form. According to evaluation results, patients were assigned as Group 0: Mild LUTS and no ED (IPSS<7 - IIEF>26), Group 1: Patients describing only moderate and severe LUTS, Group 2: Patients describing only ED (IIEF<26), Group 3: Patients describing both LUTS and ED (IPSS>7 - IIEF<26). Results: A significant difference was observed between depression states of patients and their LUTS and IIEFs. Depression risk for the Group 3 was monitored to increase by 5.4 fold (p=0.012) according to the Group 0. Conclusions: ED, LUTS and depression are all common conditions that accompany aging and significantly negatively impact quality of life. So this patient group can be treated more successful by a multidisciplinary approach.

Urachal Cancer in a 47-Year-Old Patient: A Case Report and Literature Review.

Aims: Urachal cancer is an uncommon neoplasm associated with poor prognosis. No concensus has been reached regarding diagnostic criteria so far. The management of urachal carcinoma is controversial, too. In this case presentation, we reported a 47 year old female with urachal cancer and treatment approach discussed with published literature. Presentation of Case: A 47-year-old female patient was admitted with abdominal pain and hematuria. A soft mass was noticed under her navel. Computerized tomography revealed a tumor which is a cystic lesion arising from the urachus and a solid mass component at the urinary bladder dome. The tumor was removed by partial cycectomy. Histological examination showed urachal adenocarcinoma (colonic type and well differentiated), which had invaded the urinary bladder. The patient has been followed up without a recurrence for the next 6 months. Discussion: Urachal carcinoma is a rare type of, approximately 0.5 to 2%, bladder neoplasms. The pathogenesis of urachal tumours is not fully understood, so far. Currently, the most effective treatment of localized urachal cancer is cystectomy. It is unclear whether lymphadenectomy or chemotherapy is usefull for the patients with urachal carcinoma. Conclusion: Regarding the treatment of urachal cancer, surgery remains the mainstay of therapy. Moreover, the achievement of a complete urachectomy, including umbilectomy and negative surgical margins, is critical for low-stage, localized, welldifferentiated urachal cancer.