Prognostic factors for surgical margin status and recurrence in partial nephrectomy.

PURPOSE: To evaluate the prognostic factors affecting the surgical margin and recurrence in patients who underwent partial nephrectomy (PN) for renal masses. MATERIALS AND METHODS: Data of 125 patients who underwent open or laparoscopic PN because of renal mass between January 2006 and January 2019 were analysed retrospectively. Demographic data, habits, additional diseases, clinical and laboratory findings, operational data, the morphology of the tumour in computerised tomography or magnetic-resonance imaging and follow-up data were scanned and acquired via our hospital's system and archive. RESULTS: Average age was 54.4, male-female ratio was 1.55 and average tumour size was 3.31 cm. One hundred and four patients had malignant pathology and 21 were benign. Positive surgical margin (PSM) rate was 5.6% and recurrence rate was 3.2%. Average follow-up was 47.4 months. Pathological size of the tumour was larger (P = .006), warm-ischemia period was lower (P = .003) and PADUA score was higher (P = .015) in open technique. Tumour size and tumour stage were statistically higher in patients with recurrence (P = .009, P < .001, respectively). There was a significantly higher PSM ratio in mandatory indication group than elective indication group (P = .025). No statistically significant difference was observed between surgical margin positivity and tumour size, Fuhrman grades, PADUA scores, RENAL scores and C-index. (P > .05). CONCLUSION: Surgical margin positivity after PN is not significantly associated with tumour characteristics and anatomical scoring systems. Surgical indication for PN has a direct influence on PSM rates. Tumour size and stage after PN are valuable parameters in evaluating the recurrence risk.

Multidimensional Analysis of Urinary Stone Diseases in Pediatric Patients.

OBJECTIVES: Urinary tract stones are less common in children than in adults. Determining the etiology is the most important step to achieve successful treatment and prevent future recurrence. The aim of this study was to investigate the clinical characteristics and possible risk factors for urinary stone disease in pediatric patients. METHODS: The data of 126 patients with urinary stone disease who were treated in a pediatric nephrology clinic between 2000 and 2014 were analyzed retrospectively. A total 126 patients were enrolled in the study: 70 (55%) male and 56 (45%) female patients were included. The complaints, age of diagnosis, family histories, and stone location were examined. Direct urine microscopic examination, complete urinalysis, and urine culture were performed for all of the patients. Calcium, uric acid, oxalate, citrate, magnesium, and cystine levels were measured in urine collected in a 24-hour period. Serum electrolyte, blood urea nitrogen, creatinine, calcium, phosphorus, uric acid, and albumin levels were measured. Urinary ultrasound was performed. Stone analysis was conducted using the X-ray diffraction method. The mean age of the patients was 55 months (range: 1-162 months) at presentation. RESULTS: In all, 34% of the patients had a family history of urinary stone disease. The rate of previous urinary tract infection was 26%. It was determined that 34% of the patients had been taking vitamin D and 5% had been taking a high dose. Metabolic risk factors determined were: hypercalciuria in 41%, hypocitraturia in 30%, hyperoxaluria in 14%, hyperuricosuria in 10%, and cystinuria in 5%. Among the group, 81% of the patients had kidney stones, 6.5% had ureter stones, and 2.5% had bladder stones. Furthermore, it was determined that 45% of the stones were composed of calcium oxalate, 35% had calcium phosphate stones, 14.2% had uric acid stones, and 13.3% had cystine stones. In 52% of the cases, extracorporeal shock wave lithotripsy was performed, and 71% underwent surgical treatment. CONCLUSION: Metabolic evaluation and stone analysis should be performed to prevent future recurrences in children with urinary stone disease and lifelong follow-up should be emphasized.

The rarest phenomenon of flexible ureterolithotripsy: Kidney stone in supernumerary type combination with a horseshoe kidney.

The horseshoe kidney (HSK) is common and supernumerary kidney is the rarest developmental anomaly of the urogenital system. The supernumerary kidney in a HSK conjunction is extremely rare, and prevalence of it is unknown. A review of literature, there have been a few case reports about the supernumerary and HSK combination, however, none of which also had a concomitant kidney stone and obstructive pathology. Our case indicated that patient referred to flank pain and visible hematuria to our clinic, and further investigations demonstrate supernumerary kidney in a horseshoe configuration and kidney stone. Kidney stone could not be found at the first attempt because of the anatomical malformation. Retrograde pyelography showed ureteral branching and helps to define the placement of stone. This stone was fragmented with flexible ureteroscopy in the lower pole of the middle kidney in the second session. There was no stone fragments absence at the 1st-month control. This exceedingly rare type case should be evaluated meticulously on preoperative duration otherwise can be a challenge for surgeons. Visualize pelvicalyceal system under the fluoroscope is a vital step in this regard to being guidance during the procedure.

Hyperthyroidism: a risk factor for female sexual dysfunction.

INTRODUCTION: Hyperthyroidism is a common hormonal disorder in women that may cause female sexual dysfunction (FSD). AIM: To assess sexual function in women with hyperthyroidism. METHODS: A total of 40 women with clinical hyperthyroidism and 40 age-matched voluntary healthy women controls were included in the study. All the subjects were evaluated with a detailed medical and sexual history, including a Female Sexual Function Index (FSFI) questionnaire for sexual status and the Beck Depression Inventory (BDI) for psychiatric assessment. MAIN OUTCOMES MEASURES: The levels of serum thyroid-stimulating hormone (TSH), thyroid hormones, sex hormone binding globulin (SHBG), total testosterone (tT), free testosterone (fT), prolactin, estradiol, follicle-stimulating hormone, and luteinizing hormone were measured. RESULTS: The mean total FSFI scores were 24.2 ± 9.96 in the hyperthyroidic group and 29 ± 10.4 in the control group (P < 0.0001). Desire (P < 0.040), arousal (P < 0.0001), lubrication (P < 0.0001), orgasm (P < 0.0001), satisfaction (P < 0.0001), and pain (P < 0.007) domain scores were also significantly lower in women with hyperthyroidism. The mean BDI score for hyperthyroidic patients was significantly greater than the score for the control group (P < 0.0001). The mean SHBG level in the hyperthyroidic group was found to be significantly higher than the level in the controls (P < 0.0001), whereas the mean fT level in the hyperthyroidic group was lower than in the control group (P < 0.0001). The FSFI score showed a significant negative correlation with the serum SHBG (r = -0.309, P = 0.005), free triiodothyronine (r = -0.353, P = 0.006) and free tetraiodothyronine (r = -0.305, P = 0.018) levels, BDI scores (r = -0.802, P = 0.0001) and positive correlation with tT (r = 0.284, P = 0.011), fT (r = 0.407, P = 0.001), and TSH (r = 0.615, P = 0.0001) levels. CONCLUSIONS: A significant percentage of women with clinical hyperthyroidism had sexual dysfunction. Increased depressive symptoms, increased SHBG level, and decreased fT levels were all found to be associated with FSD in clinical hyperthyroidism.

Sexual dysfunction in women with clinical hypothyroidism and subclinical hypothyroidism.

INTRODUCTION: Hypothyroidism is a common hormonal disorder in women that may affect the phases of female sexual function. AIM: To investigate female sexual function in patients with clinic hypothyroidism and subclinic hypothyroidism. METHODS: A total of 25 women with clinic hypothyroidism (group 4), 25 women with subclinic hypothyroidism [thyroid stimulating hormone (TSH) value 10 mU/L (group 3)], and 20 age matched voluntary healthy women controls (group 1) were included in the study. All the subjects were evaluated with a detailed medical and sexual history, including a female sexual function index (FSFI) questionnaire for sexual status and the Beck Depression Inventory for psychiatric assessment. MAIN OUTCOME MEASURES: The levels of serum TSH, thyroid hormones, prolactin (PRL), free testosterone, estradiol, follicle-stimulating hormone, luteinizing hormone, lipid profile, and blood glucose were measured. RESULTS: Female sexual dysfunction (FSD) was diagnosed in 14 of 25 patients (56%) in group 4, in 6 of 11 patients (54.6%) in group 3, in 2 of 14 patients (14.6%) in group 2, and while only 3 of 20 the control group of women (15%) had FSD (P = 0.006). The mean total FSFI scores were 23.9 in the group 4, 26.03 in the group 3, 29.2 in the group 2, and 32.30 in the control group (P < 0.0001). The mean BDI score for clinic hypothyroidic patients was significantly greater than the scores for the control group and for the group 2 (P = 0.017 and P = 0.043, respectively). The mean PRL levels for patients in group 4 and group 3 were found to be significantly higher than the level for controls (P < 0.0001), whereas other serum hormone levels were not different among groups. CONCLUSIONS: A significant percent of women with clinic hypothyroidism and subclinic hypothyroidism with TSH values >10 mU/L had sexual dysfunction. Hyperprolactinemia, hyperlipidemia, and depression were associated with FSD in clinic hypothyroidism. Different than clinic hypothyroidism depression was not associated with FSD in subclinic hypothyroidism with TSH values >10 mU/L.

Tissue reaction of the rat urinary bladder to synthetic mesh materials.

The aim of this study was to assess urinary bladder histopathology induced by the sling materials tension-free vaginal tape (TVT), vypro mesh, and intravaginal slingplasty (IVS). Thirty rats were studied: sham-operated controls, TVT, vypro, and IVS groups. After laparotomy, a 0.5- "e 1-cm piece of mesh was implanted on the anterior bladder wall. The bladder was examined histopathologically after 12 weeks. Inflammation, foreign-body reaction, subserosal fibrosis, necrosis, and collagen deposition were graded. The Kruskal-Wallis and posthoc Dunn tests were used. The sham-operated rats showed no tissue reactions. The TVT, vypro, and IVS groups showed increased inflammation (p = 0.006, p = 0.031, p = 0.001), subserosal fibrosis (p = 0.0001), foreign-body reaction (p = 0.0001), and collagen deposition (p = 0.0001) as compared to sham. Inflammation was more intense in the IVS group as compared to the TVT and vypro groups (p = 0.041, p = 0.028). The bladder presented more increased inflammatory response to IVS than the other meshs. This may play a role in the ultimate outcomes or complications from slings.

Laparoscopic unroofing and aspiration-sclerotherapy in the management of symptomatic simple renal cysts.

Simple renal cysts are quite common in adults with an incidence that increases with age. Sclerosant treatment is very common, but the recurrence rate is high. Results are still under investigation for laparoscopic approaches and their long follow-up periods. Between 1998 and 2004, 21 patients were diagnosed with symptomatic renal cysts in our clinics. Initially, all patients underwent aspiration-sclerotherapy with 95% ethanol, the most common sclerosant, under ultrasound, fluoroscopy, or CT guidance. For those with sclerosant therapy failure, the laparoscopic unroofing method was used. Like open surgery, laparoscopic unroofing of the cyst appears to be effective by not only removing part of the cyst wall, but more importantly, by providing adequate drainage of the cyst. After sclerotherapy, 71% of the patients had recurrent pain and cyst on follow-up (at mean 14 months). This group of patients was cured with the laparoscopic unroofing method and there is still no recurrence. We emphasize the unroofing method as better than single session sclerotherapy. And also, laparoscopic unroofing of the cyst is more predictable and has better results than sclerotherapy aspiration.