Comparison of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy on moderate size renal pelvis stones.

To compare success and complication rates of shock wave lithotripsy (SWL), flexible ureterorenoscopy (F-URS) and percutaneous nephrolithotripsy (PNL) according to modified clavien grading system of renal pelvis stones between 1 and 2 cm. The results of 149 patients were evaluated retrospectively. Patients were divided into three groups as 52 for SWL, 47 for F-URS and 50 for PNL. Complications were evaluated by modified Clavien grading system. In the first group, stone-free rates after a mean of 2, 6 sessions was 86 % (45/52). In Group 2, this ratio was 91.4 % (43/47), and in Group 3, it was 98 % (49/50). The success rate in Group 3 was significantly higher than other groups. Complication rates for Group 1, 2 and 3 were 7.6 % (4/52), 6.3 % (3/47) and 12 % (6/50), respectively. Although PNL was the most successful technique compared with other techniques, complications were also higher in this group. Even though PNL is the most successful, it should be performed for selected patient groups and indications should be carefully evaluated.

Prospective randomized trial comparing shock wave lithotripsy and flexible ureterorenoscopy for lower pole stones smaller than 1 cm.

In this study, we aimed to compare the success and complications of flexible ureterorenoscopy (F-URS) with its advanced technology and the accomplished method of shock wave lithotripsy (SWL) in the treatment of lower pole stones smaller than 1 cm. One hundred and forty patients were randomized as 70 undergoing SWL (Group 1) and 70 undergoing F-URS (Group 2). Patients were evaluated by plain X-ray and urinary ultrasound 1 week and after 3 months following SWL. The same procedure was done for F-URS patients 1 week after surgery and after 3 months. Success rates were established the day following the procedure and after 3 months. Fragmentation less than 3 mm was considered success. Mean operative time was 44 ± 7.4 min for Group 2 and mean fluoroscopy duration was 51 ± 12 s. In F-URS group, all the patients were stone free after 3 months (100 %). Group 1 had 2.7 ± 0.4 sessions of SWL. Sixty-four patients were stone free in that group after 3 months (91.5 %). The procedure yielded significant success in FURS group, even though patients underwent SWL for 2.7 ± 0.4 sessions and F-URS for 1 session (p < 0.05). With higher success and similar complication rates, fewer sessions per treatment, and advances in technology and experience, we believe F-URS has a potential to be the first treatment option over SWL in the future.

The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones.

INTRODUCTION: In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones. METHODS: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system. RESULTS: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to be the group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12). INTERPRETATION: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches.

Efficacy and safety of propiverine and terazosine combination for one year in male patients with luts and detrusor overactivity.

PURPOSE: To evaluate the long term efficacy and safety of the use of propiverine and terazosine combination in patients with LUTS and DO by a placebo controlled study. MATERIALS AND METHODS: One hundred patients were enrolled in the study. They were randomized into two groups (each group consisted of 50 patients). Terazosine and placebo were administered to the patients in Group 1 and terazosine plus propiverine HCL was administered to Group 2. The patients were evaluated by international prostate symptom score (IPSS), the first four questions of IPSS (IPSS4), the 8th question of IPSS (quality of life-QoL), overactive bladder symptom score questionnaire (OAB-q V8), PSA test, urodynamic studies, post voiding residue (PVR). All patients were followed for one year and were reassessed for comparison. RESULTS: IPSS, IPSS4, OAB symptoms, QoL score, PVR, and Qmax scores of the groups did not differ. After one year treatment, there was significant improvement in IPSS, IPSS4, OAB symptoms, QoL and Qmax values in Group 2. No significant improvement was noted for the same parameters in Group 1. CONCLUSION: This is the first study to show long term safety and efficacy of anticholinergic therapy for patients with LUTS. In patients with OAB or DO, long term anticholinergic treatment may be regarded as a treatment option.

Comparison of percutaneous nephrolithotomy, shock wave lithotripsy, and retrograde intrarenal surgery for lower pole renal calculi 10-20 mm.

OBJECTIVE: To compare the results of percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL), and retrograde intrarenal surgery (RIRS) for 1- to 2-cm lower pole kidney stones. PATIENTS AND METHODS: This retrospective study was based on data collected from the files of patients between January 2007 and May 2012. The files of 383 patients (221 SWL, 144 PCNL, 38 RIRS) were evaluated. The groups were compared for stone size, success rate, and complication rate using the modified Clavien grading system. RESULTS: The stone burdens of the groups were similar (p = 0.36). The success rates were 76, 94, and 73%, respectively, in SWL, PCNL, and RIRS. The highest stone-free rate was in the PNL group (p < 0.05). When the complication rates were evaluated using the Clavien grading system, they were determined to be 13% in PCNL, 3% in SWL, and 5% in RIRS. Especially GII and GIII complications were more common in the PCNL group (p < 0.05). CONCLUSION: PCNL seems to be the most successful but most invasive method. However, with relatively low complication rates, SWL and RIRS are other techniques to keep in mind. To determine the first-line treatment, prospective randomized studies with larger series are needed.

Efficacy and safety of propiverine and terazosine combination for one year in male patients with luts and detrusor overactivity

Purpose To evaluate the long term efficacy and safety of the use of propiverine and terazosine combination in patients with LUTS and DO by a placebo controlled study. Materials and Methods One hundred patients were enrolled in the study. They were randomized into two groups (each group consisted of 50 patients). Terazosine and placebo were administered to the patients in Group 1 and terazosine plus propiverine HCL was administered to Group 2. The patients were evaluated by international prostate symptom score (IPSS), the first four questions of IPSS (IPSS4), the 8th question of IPSS (quality of life-QoL), overactive bladder symptom score questionnaire (OAB-q V8), PSA test, urodynamic studies, post voiding residue (PVR). All patients were followed for one year and were reassessed for comparison. Results IPSS, IPSS4, OAB symptoms, QoL score, PVR, and Qmax scores of the groups did not differ. After one year treatment, there was significant improvement in IPSS, IPSS4, OAB symptoms, QoL and Qmax values in Group 2. No significant improvement was noted for the same parameters in Group 1. Conclusion This is the first study to show long term safety and efficacy of anticholinergic therapy for patients with LUTS. In patients with OAB or DO, long term anticholinergic treatment may be regarded as a treatment option. .

Pediatric bladder rhabdomyosarcoma: report of organ sparing treatment of two cases.

Pediatric rhabdomyosarcoma cases require multimodality therapy. Here, we present two cases treated by tumor resection followed by chemotherapy, and discuss the bladder preserving treatment of this uncommon disease.

Assessment of anti-sperm antibodies in couples after testicular sperm extraction.

PURPOSE: Testicular spermatozoa can be retrieved successfully by the testicular sperm extraction (TESE) procedure and used for intracytoplasmic sperm injection. Disruption in the blood-testis barrier can lead to the production of antisperm antibodies (ASA). The aim of this prospective study was to investigate the frequency of ASA formation in couples after TESE procedure. METHODS: Thirty-seven couples were included in the study at the Urology Clinic of the Dr. Zekai Tahir Burak Women's Health Training and Research Hospital. History, physical examination, spermiogram, and endocrine profiles were obtained for all male patients. All the male patients in this study had been diagnosed with nonobstructive azoospermia (NOA) and underwent microdissection TESE. Secondary and tertiary cases were also included in the study. Serum samples were obtained from all 74 patients before TESE, and at three and 12 months after TESE. Serum ASA levels were determined. ANOVA was performed for statistical analysis for serum Follicle-Stimulating Hormone (FSH), testosterone and testicular volume. P < 0.05 was considered significant. RESULTS: There were no differences in the testicular volumes, serum FSH and testosterone levels before and after TESE. None of the patients or their partners developed significant levels of ASA as a result of the TESE procedure. CONCLUSION: TESE procedure does not cause ASA production in either males or their female partners.

Prognostic factors in metastatic prostate cancer.

OBJECTIVE: Aim of this study is to determine the prognostic value of age, serum alkaline phosphatase, pretreatment PSA level, Gleason score, and number of bone metastasis focuses. PATIENTS AND METHODS: One hundred fifty-one patients who had been followed in our clinic between years 1989 and 2006 were investigated retrospectively. RESULTS: As a result of this study, it has been detected that serum alkaline phosphatase, Gleason score, and intensity of bone metastasis are important and statistically significant prognostic factors, and affects time to progression and life time. But pretreatment PSA level, and age have been detected not to be effective in predicting time to progression and life time. CONCLUSION: Metastatic prostate cancer provides a wide spectrum for risk of death from the disease, and clinicians have long sought methods to predict the outcome accurately in individual patients. In our study, we found that high serum alkaline phosphatase, high Gleason score, and intense bone metastasis (>6) has negative impact on progression and survival.