The Efficacy of Guy's Stone Score for Predicting the Stone-Free and Complication Rates in Children Treated by Percutaneous Nephrolithotomy.

Introduction: To determine the efficacy of Guy's stone score (GSS) for predicting stone-free and complication rates after percutaneous nephrolithotomy (PCNL) in children. Patients and Methods: A total of 197 renal units (RUs) in 173 children (≤17 years) who referred to our clinic were included in our study. RUs with stones were classified as four groups according to GSS. The results were designated as stone free or as having residual stones. Complications were evaluated according to GSS, the Satava, and modified Clavien grading system. All parameters were evaluated by using univariate and multivariate analysis. Results: The median age of patients was 6 years (1-17 years). Stone-free status was 77% and complication rate was 17%. Stone-free rate was established 89% for group 1, 78% for group 2, 75% for group 3, and 57% for group 4. There was a positive association between GSS and stone-free status (p = 0.02). No relationship was found between GSS and the complication rate (p = 0.42). In multivariate analysis, GSS was the only independent factor for predicting stone-free status. Conclusion: Current study revealed that GSS has a predictive ability for stone-free status; however, GSS is insufficient for predicting complications after pediatric PCNL. Even though, GSS does not fully reflect the characteristics of the pediatric population, we believe that it might provide useful insights for clinicians when recommending and discussing treatment options for children with urolithiasis.

The relationship between human leukocyte antigens (HLA) and renal cell carcinoma.

Etiologies of Renal Cell Carcinoma (RCC) are not clear despite of the fact that many risk factors have been suggested. Especially in high stages RCC can affect the immune system in various ways. Human Leukocyte Antigens (HLA) may play a complementary role in the activation between the tumor and immunity. Our aim was to determine the existence of the relationship between HLA system and RCC. By using the standard microlymphocytotoxic method of Terasaki in our study, the HLA A, B, DR and DQ antigen types of 20 patients with RCC Stage T1 and T2 were compared with the control group consisting of healthy 30 people. In our RCC patient group, HLA-A23(9) and DQ7(3) antigens were significantly higher than the control group statistically (p=0.005, p=0.0028; respectively). HLA-A10, DQ1, DR10 and B44 antigens were significantly higher in the control group than the patient group (p=0.011; for all).The findings made us suggest that the people, carrying the antigens which were detected in the patient group, were at high risk for RCC and the people, carrying the protective antigens that were detected in the control group were at less risk for RCC. There may be a dramatic regression for the patients who underwent immunotherapy and HLA expression, which is known to play role in tumor biology, may direct the effects of immunotherapeutic agents. Immunologic description and destruction is avoided in case of change or disappearance of HLA expression by cancer cells. Further investigations which will be performed in our population in the future will be more illuminating to confirm those results. We have concluded that, HLA profiles may be evaluated for detection the people at risk of RCC, the prognosis of the patients and their treatments.

Assessment of the continence status and patients' satisfaction after retropubic radical prostatectomy: a questionnaire based study.

OBJECTIVE: The aim of this study was to assess the continence status and patients' satisfaction after retropubic radical prostatectomy by a self-administered questionnaire composed of 12 questions. MATERIALS AND METHODS: In total, 143 patients who underwent RRP operation at our department from 1992 to 2000 with a minimum 6 months of follow-up were assessed. Seventy two patients participated in the study. The continence status was classified as follows; patients who did not leak were considered as "continent", those who had leakage that occurred less frequent than or equal to once a day were regarded as "socially continent", and those who had more than once a day leakage were regarded as "incontinent". The correlation between urinary leakage, patients' satisfaction and pre-operative, peri-operative and post-operative factors were investigated. Univariate and multivariate analyses were done using Fisher's exact, chi-square, Student's-t and logistic regression tests. RESULTS: The mean age of patients at surgery was 63.9 years (49-76) with a follow-up period of 37.1 months (6-97). Of these patients, 44% were continent, 48% were socially continent, 8% were incontinent. A total of 64 of 72 patients (89%) were satisfied with their final continence status, and 63 (87%) patients accepted to undergo the same surgery again if it is indicated. Pre-, peri- and post-operative factors did not influence the urinary leakage rates. Patients with nocturnal leakage, urgency, decreased urinary flow and patients who use pad (-s) were significantly less satisfied on univariate analysis, while only nocturnal leakage had a significant impact on patients' satisfaction on multivariate analysis. CONCLUSION: Urinary leakage and patients' satisfaction rates after RRP were 56% and 89%, respectively. None of the factors could predict the post-operative continence status. When evaluating the patients' satisfaction, only nocturnal leakage was found to have an adverse affect on multivariate analyses.