Effective and Economical Option of Anesthesia in Retrograde Intrarenal Surgery.

Background: There is only limited data in the literature showing the effect of anesthesia methods on the success of retrograd intrarenal surgery. The aim of this study was to compare and evaluate retrograd intrarenal surgery cases performed under spinal and general anesthesia in terms of effectiveness, cost, hospitalization time and complications. Methods: A total of 337 patients who underwent retrograd intrarenal surgery due to kidney stones between 2014 and 2019 were retrospectively evaluated. In our study, the patients were divided into two groups according to the anesthesia method administered: Group 1 consisted of 172 patients who received spinal anesthesia and Group 2 comprised 165 patients administered general anesthesia. Both groups were compared in terms of demographic data, localization and size of stone, radiographic stone density, operation time, complications, need for postoperative analgesia, length of hospitalization, and stone free rate. Results: The cost of general anesthesia was significantly higher compared to that of spinal anesthesia (p < 0.001). The analgesia application administered within the first six postoperative hours was significantly higher in the general anesthesia group (p < 0.001). In other findings, there was no statistically significant difference between the two groups. Conclusion: Retrograd intrarenal surgery can be performed with similar safety and effectiveness under both general and spinal anesthesia. However, spinal anesthesia seems to be more advantageous due to the patients' lower need for analgesics in the early postoperative period and the lower cost of the anesthetics used.

The level of knowledge and awareness about prostate cancer in the Turkish male and the relevant effective factors.

OBJECTIVE: Our aim was to determine the general knowledge and awareness levels, information sources, and the state of medical check-up for prostate cancer (PCa) and relevant effective factors. MATERIAL AND METHODS: The participants were asked to answer to 14 questions of a questionnaire about age, education, economic and social condition, knowledge about PCa, state of being examined and their related factors. According to demographic characteristics of the participants, levels of awareness about PCa, sources of information, affecting factors and their interrelationships were examined. Two groups were formed according to age (<60 years, >60 years) and variations according to ages were investigated. RESULTS: Two hundred and ninety-three men with an average age of 57 years (range 40-85) were included in the study. Our findings showed that 68.3% of the participants were thinking that PCa is a frequently seen disease, 88.4% were thinking that it can be treated and 62.8% of men specified that their information sources are doctors. We also found that 60.8% of the participants had not undergone prostate examination and prostate specific antigen (PSA) control. The most reason for not having annual examinations was (44.4%) "negligence". Significantly greater number of men with higher education (high school/university) were highly informed about PCa (p=0.037). Check-up rates were statistically significantly higher among men with intermediate income (p=0.041). Curability of PCa diagnosed at an early stage was acknowledged by statistically higher number of individuals under the age 60 (p<0.05). Health control, prostate examination and/or PSA control rates were higher in men with a family history of PCa and in the group of >60 years. CONCLUSION: Although PCa has a high prevalence and mortality rates, personal and social information and sensitivity levels must be increased as it can be treated if diagnosed at an early stage. We think that social and medical impact of the disease can be decreased with the planning of effective methods based on sociocultural and economic factors.

Paratesticular Fibrous Pseudotumors.

Paratesticular fibrous pseudotumors (PFPs) are rare pathologies with quite wide and variable topographic-morphological features. It is difficult to distinguish PFPs from malignant masses. Treatment can be done by resection of the mass. We reported a young patient's findings about this rare pathology.

Is semirigid ureteroscopy sufficient in the treatment of proximal ureteral stones? When is combined therapy with flexible ureteroscopy needed?

The goals of this study were to examine cases of proximal ureteral stones in which semirigid or flexible ureteroscopes alone were insufficient for endoscopic treatment, requiring the combination of both. A total of 137 patients were retrospectively evaluated. Holmium laser was used as the energy source for stone fragmentation. Each operation was begun with a 6/7.5 Fr semirigid ureteroscope (URS), and continued with a 7.5 Fr flexible URS in those procedures that failed to reach the stone or push-up. Double J stents were inserted into those patients in whom the flexible URS failed. Shock wave lithotripsy (SWL) or a repeat ureteroscopy (after 2-4 weeks) was planned in those patients who were considered to be treated unsuccessfully. The demographic features of the patients, stone sizes, treatment outcomes, need for additional treatment, complications, and the results of the postoperative 1-month early follow-up were evaluated. The mean age of the patients (77 males and 60 females) was 38 ± 6.7 years old, the mean stone size was 12.3 ± 3.7 mm, and the number of patients with persistent hydronephrosis was 86 (62.8 %). A stone-free diagnosis was achieved in a total of 124 patients (90.5 %), using a semirigid URS in 80 patients and a flexible URS in 44 patients. Treatment using a flexible URS was administered in 38 patients (27.7 %) due to push-up, and in 6 patients (4.3 %) because of the failure to advance the semirigid URS into the ureter. The treatment failed in 13 patients (9.4 %) despite the use of both methods. Treatment using low-caliber semirigid ureteroscopy and a holmium laser is possible, regardless of the stone size, in female patients without hydronephrosis. However, the need for combined treatment with flexible ureteroscopy is increased in male patients with hydronephrosis.

The case study in the applicability of the improvements in the treatment of urinary system stone diseases in Anatolia: the last ten years with the sample of Western Black Sea region.

OBJECTIVE: The prevalence of stone diseases is high in Turkey. Thanks to the technological improvements and to the increase in the number of qualified and experienced specialists in the last thirty years, there has been an increase in the application of minimally invasive methods in the stone disease surgery. This study, with a sample survey of Western Black Sea region, aims at revealing the changes and improvements in the treatment of stone diseases in different centers in Anatolia within the last ten years. MATERIAL AND METHODS: Six centers in 4 of the provinces of the Western Black Sea Region were selected and the patients' files were retrospectively analyzed. The treatment methods that were recommended for and/or applied to the patients diagnosed with urinary stone diseases were recorded by years. The urinary stone diseases were divided into three separate groups; kidney, ureters and bladder. Treatment options were recorded into categories as open surgery, percutaneous nephrolithotripsy, retrograde intrarenal surgery, semirigid ureterorenoscopy, flexible ureterorenoscopy, and ESWL. RESULTS: A total of 26044 patients with stone diseases have been treated in the above-mentioned centers for the last 10 years. The distributions of the stone diseases in relation to their localization were as follows: - kidney stones: 9040 (34.7%), ureter stones: 15264 (58.6%), and bladder stones: 1740 (6.7%). As for the distribution of the treatment in relation to the treatment methods, it was seen that open surgery for 1032 (4%) patients, endoscopic surgery for 15038 (58%) patients, and ESWL for 9974 (38%) patients had been applied. While URS and PCNL are currently the commonly used treatment methods in the Western Black Sea Region, RIRS has begun to be used in a limited number of patients for the last 3 years. CONCLUSION: Though being a little late, the advances in endrourology offer practical applications in the Western Black Sea region as well. Although this study suggests implications for the evaluating of the periphery outcomes of the improvements in stone disease treatments, for the planning of training schemes, and for equipment planning, further research based on more data from more centers is needed to have a nation-wide perspective.

Comparison of tacrolimus with a cyclosporine microemulsion for immunosuppressive therapy in kidney transplantation.

OBJECTIVE: To compare the efficacy and side effects of a cyclosporine microemulsion and tacrolimus in immunosuppressive therapy of renal transplantation. MATERIAL AND METHODS: Between March 2003 and June 2005, the patients who had undergone kidney transplantation surgery and who were administered either basiliximab, a cyclosporine microemulsion, mycophenolate mofetil and prednisolone or basiliximab, tacrolimus, mycophenolate mofetil and prednisolone for baseline immunosuppressive therapy were recruited to our study. We evaluated the results of an 18-month follow-up period. The donors were called back weekly for a follow-up in the first month, fortnightly in the second month and then monthly for 18 months after discharge. A total of 41 patients were included in the study. The patients were evaluated as for demographic characteristics, acute rejection, cardiovascular and metabolic side effects, graft function, infections, hirsutism, gingival hyperplasia, cosmetic side effects, nephrotoxicity, drug changes and the survival rates. RESULTS: There were no significant differences among the patients with regard to age, sex, donor type, dialysis periods, preoperative and postoperative systolic blood pressures, creatinine levels, hepatotoxicity, nephrotoxicity, occurrence of diabetes mellitus and the incidence of infection. The duration of hospitalization was prolonged in the cyclosporine A group. Acute rejection emerged in 5 patients (23.8%) in the tacrolimus group and in 4 patients (20%) in the cyclosporine A group. In the cyclosporin A group, the cholesterol and triglyceride levels were significantly higher than the tacrolimus group. The cosmetic side effects (gingival hyperplasia and hirsutism) as a reason for a change in medication were only observed in the cyclosporin A group, not in the tacrolimus group. A medication change was made in 8 patients in the cyclosporine A group and in 1 patient in the tacrolimus group. No death was observed in either group. Graft loss was observed in only 1 patient in the cyclosporine A group. CONCLUSION: Regarding the cosmetic side effects and hyperlipidemia, tacrolimus was found to be superior to cyclosporine A. Where hyperlipidemia is considered to be a risk factor for cardiovascular disease, tacrolimus use should be considered as a more acceptable treatment modality. However, the immunosuppressive regimen should be evaluated individually.

Multifocality incidence and accompanying clinicopathological factors in renal cell carcinoma.

INTRODUCTION: The incidence of multifocality and associated clinicopathological factors in renal cell carcinoma were evaluated. MATERIALS AND METHODS: Clinicopathological characteristics were assessed for 122 renal cell carcinoma-pathological specimens from 121 patients. Microscopic and gross tumor pathology, incidence of multifocality as well as association between tumor grade, histological subtype, stage, size and vascular involvement were assessed. RESULTS: Multifocal renal cell carcinoma was diagnosed in 16 of 122 specimens (13.1%). Satellite lesions for 15 of 16 specimens displaying multifocality had the same histological subtype as their primary tumor. The occult multifocality rate was 11.4%. Tumor grade and stage, but not size or volume, histological subtype, and vascular involvement were significantly related to multifocality. CONCLUSIONS: Accurate staging of renal cell carcinoma appears to be essential in determining whether a patient should undergo nephron-sparing surgery or radical nephrectomy. Patients with high stage and grade should receive the highest attention after nephron-sparing surgery. Larger studies are needed to further elucidate the association between clinicopathological factors and multifocality.