The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux

ABSTRACT Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received. Materials and Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O'Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow's three groups contained 18 EI procedures, and each of the second fellow's 17. Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar. Conclusions: An acceptable rate of success for EI may be reached after about 20 procedures and a high success rate after about 35-40 procedures.

Photoselective vaporization of the prostate in men with a history of chronic oral anti-coagulation

PURPOSE: A considerable percentage of patients with benign prostatic hyperplasia (BPH) also have additional cardiac pathologies, which often require anticoagulant therapy. The aim of this study was to evaluate the efficacy and safety of photoselective vaporization of the prostate (PVP) for BPH in cardiac patients receiving anticoagulant therapy. MATERIALS AND METHODS: A total of 67 patients suffering from BPH and high risk cardiac pathologies were operated on using laser prostatectomy. All patients had cardiac pathologies with bleeding disorders requiring anticoagulant use, and underwent standard urologic evaluation for BPH. Patients were treated with laser prostatectomy for relief of the obstruction using the KTP/532 laser energy at 80 W. RESULTS: The mean patient age was 71.4 years (range 55-80). Mean prostate volume on transrectal ultrasonography was 73.2 mL (range 44-120). Operation time ranged from 40 to 90 min, with an average value of 55 min. The average hospital stay was 48 hours (range 12-72) and the Foley catheters were removed within 48 hours, with a mean catheterization time of 34.2 ± 5.9 hours (0-48). No patient required an additional procedure due to severe bleeding necessitating intervention during the early postoperative phase. Mean International symptoms scoring system (IPSS) values and post voiding residual volume decreased and peak urinary flow rate increased (p < 0.001). Our results showed that the mean prostate volume had decreased by 53 percent at 6 months. CONCLUSIONS: High-power photo selective laser vaporization prostatectomy is a feasible, safe, and effective alternative for the minimal invasive management of BPH, particularly in cardiac patients receiving anticoagulant therapy.