Current Perspectives on Endourological Ex Vivo Stone Interventions in Kidney Transplantation: A Systematic Review.

OBJECTIVE: To conduct a systematic review (SR) of literature to assess the existing evidence concerning the success and complications of endourological ex vivo stone surgeries. METHODS: Eligible studies for inclusion focused on investigating the success and/or complications related to endourological ex vivo surgeries in donors with nephrolithiasis. A SR was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search included databases of Web of Science, PubMed, and Scopus and only article in English were included. Studies published between 2002 and 2023 included in this SR. RESULTS: After screening 1726 abstracts, this SR included 16 studies with a total of 209 patients. The mean stone size was 5.6 mm and majority of kidneys contained single stones, located in the lower calyx. After ex vivo endourological stone surgeries, the average stone-free rate was found to be 95.4%. The mean duration of ex vivo surgery was 17.3 minutes. Regarding intraoperative complications, two patients (1%) experienced mucosal injuries during pneumatic lithotripsy. As for postoperative complications, two patients (1%) experienced vascular complications. In terms of urological complications, hematuria was observed in 24 patients (11.5%), while one patient (0.5%) experienced clot formation in renal pelvis. Seven patients (3.3%) had urinary tract infections, and three patients (1.4%) developed urolithiasis during the follow-up. Additionally, one patient (0.5%) experienced complete occlusion of ureteroneocystostomy and required revision. CONCLUSION: Given the advancements in current technology and techniques, endourological ex vivo stone surgeries are increasingly recognized as an effective and safe option for donors with nephrolithiasis. TRIAL REGISTRATION: This systematic review was registered under the protocol registration number CRD42024538384/PROSPERO.

A systematic review of kidney transplantation outcomes in patients with end-stage renal disease due to childhood lower urinary tract malformations.

PURPOSE: Patients with lower urinary tract malformations (LUTM) were suspended from kidney transplantation (KT) programs in the past due to various concerns. Consequently, only a limited number of studies have explored this topic at hand. In this study, our objective was to perform a systematic review (SR) to evaluate the current evidence regarding KT outcomes as well as patient survival (PS), postoperative complications and urinary tract infections (UTI) in individuals with childhood LUTM. METHODS: The search encompassed databases of Web of Science, Medline (via PubMed), and Embase (via Scopus) to identify all studies reporting outcomes on KT for patients with LUTM. The research included articles published in English from January 1995 till September 2023. RESULTS: Of the 2634 yielded articles, 15 met the inclusion criteria, enrolling a total of 284,866 KT patients. There was significantly better 5-year graft survival (GS) in recipients with LUTM compared to the control group (RR, 1.04; 95% CI 1.02-1.06); while GS at 1-year and 10-year, and PS at 1-year, 5-year and 10-year were similar between groups. On the other hand, the postoperative UTI rate was significantly higher in the LUTM group (RR: 4.46; 95% CI 1.89-10.51). However, data on serum creatinine and estimated glomerular filtration rate on follow-up were insufficient. CONCLUSION: GS and PS rates appear to be similar in patients with childhood LUTM and those with normal lower urinary tract functions. Despite a higher postoperative UTI rate within this patient group, it appears that this has no effect on GS rates.

Factors predicting the need for surgical intervention for hydronephrosis during pregnancy: a systematic review of the literature.

PURPOSE: Symptomatic hydronephrosis in pregnancy can cause both maternal and obstetric complications. In various studies, factors predicting the need for surgical intervention have been evaluated, however these factors have not been systematically assessed yet. This systematic review analyzes published studies about hydronephrosis during pregnancy and determines the predictive factors for the need for surgical intervention for hydronephrosis during pregnancy. MATERIALS AND METHODS: A systematic review was conducted in January 2023 using the Medline, Web of Science and ScienceDirect/Scopus databases according to PRISMA guidelines. We searched these databases with the following search strategy: (intervention OR nephrostomy OR stent insertion) AND (pregnancy hydronephrosis). RESULTS: The literature review revealed 2461 potentially eligible studies. After the screening, six studies were enrolled in this review. High neutrophil-to-lymphocyte ratio, high C-reactive protein level, high white blood cell count, high creatinine levels, fever, persistent pain for more than 4 days, presence of ureteral stones more than 8 mm, high grade hydronephrosis, high fetal body weight and high delta resistive index were reported to be related with the need for surgical intervention. CONCLUSION: The rate of symptomatic hydronephrosis and requirement for surgical intervention is low during pregnancy. However, as symptomatic hydronephrosis may cause serious obstetric complications, it is important to know the parameters that can predict patients who may need surgical intervention. These results will assist gynecologists and urologists to stratify pregnant women for surgical intervention.

Is the Mayo Adhesive Probability Score Predictive in Patients Undergoing Percutaneous Nephrolithotomy?

Introduction: Mayo Adhesive Probability (MAP) score was developed as a means to predict the presence of adherent perinephric fat. Our aim was to determine the predictive value of the MAP score on surgical outcomes in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively analyzed the data from 130 renal units that underwent PCNL between January 2022 and 2023. MAP scores 0-2 were classified as low, whereas MAP scores 3-5 were classified as high. The impact of the MAP score on perioperative and postoperative outcomes was studied. All statistical analyses were performed using SPSS 24.0 for Windows. Results: The median age of the patients at the time of surgery was 48 (21) years, with a female-to-male ratio of 1:1.82. The median MAP score was 2 (2), with 43.8% of patients falling into the high MAP score group. Advanced age, hypertension history, low estimated glomerular filtration rate (eGFR) levels, and low renal parenchymal thickness were significantly higher in the high MAP score group (P = .010, P = .004, P = .001, and P = .005, respectively). Female patients had a significantly higher MAP score of 0 (P = .021). Operation time, postoperative hematocrit decrease, blood transfusion rate, postoperative fever rate, hospitalization, and stone-free rates were comparable between the low and high MAP score groups (P = .535, P = .209, P = .313, P = .289, P = .281, and P = .264, respectively). Gender and eGFR levels were shown to be significant predictors of a MAP ≥3 (P = .004 and P = .003, respectively). Conclusion: The present study showed that the MAP score groups had similar perioperative and postoperative results. Low eGFR levels and the male gender were associated with MAP score ≥3. To determine the predictive MAP score value for PCNL outcomes, more prospective studies are needed.

The Prime Time for Flexible Ureteroscopy for Large Renal Stones Is Coming: Is Percutaneous Nephrolithotomy No Longer Needed?

Advances in laser technology and surgical telescopic systems have propelled retrograde intrarenal surgery (RIRS) to the forefront as a viable alternative to percutaneous nephrolithotomy (PCNL). Currently, RIRS is being increasingly utilized as a treatment option, even for kidney stones larger than 2 cm. In this narrative review, we aimed to take a snapshot of current practice in renal stone treatment and the latest technological and technical developments and to evaluate the efficacy of RIRS in larger renal stones. With low complication rates and acceptable stone-free rates, RIRS offers patients a less invasive option with favorable outcomes. There are insufficient data comparing PCNL with RIRS using a new-generation high-power laser and suctioning ureteral access sheath (UAS). Further studies with novel lasers and UAS could provide superiority in terms of RIRS. It is crucial to take into account various patient-specific considerations, such as stone location and burden, when deciding on the appropriate treatment approach.

Medium and Long-Term Clinical Outcomes of Kidney Transplantation in Patients With Prune Belly Syndrome: A Single-Centre Experience.

OBJECTIVE: To present the medium and long-term outcomes of kidney transplantation performed in patients with Prune Belly Syndrome (PBS) which is one of the congenital anomalies of the kidney and urinary tract (CAKUT). METHODS: Thirteen kidney transplantations were performed in nine patients with PBS from January 1994 to December 2020. Demographics, surgical features, graft and patient survival rates were analyzed. Survival outcomes was compared with 106 age- and donor-type matched controls who underwent transplantation because of nonurological causes. RESULTS: The median ages of PBS patients at the time of first and second transplantation were 19 and 34 years old, respectively. One patient had postoperative Clavien grade 3a complication. Eight of 13 transplants are still functional at the last follow-up. Eight patients underwent pretransplant urological operations in preparation for kidney transplantation, while 4 patients underwent urological operations in the post-transplant period. Graft survival for PBS transplants at 5, 10, and 15 years were 90.9%, 57.7%, and 38.5%, respectively. Graft survival for control cohort at 5, 10, and 15 years were 89.9%, 80%, and 74%, respectively. The patient and graft survival rates were similar between PBS and control groups (P = .449, P = .134, respectively). CONCLUSION: This single-center study showed that the medium-term graft survival rates in patients with PBS are encouraging and comparable to non-CAKUT transplant patients, however long-term graft survival rates were found to be proportionally inferior. To help determine the reasons for long-term transplant kidney function deterioration and how to improve them we suggest that multicenter international collaboration will be needed.

Impact of Variant Histology on Clinical and Pathological Outcomes in Patients with the Upper Urinary Tract Urothelial Carcinoma.

Objectives: The objective of the study was to determine the effect of variant histology on pathological outcomes and survival in patients operated for the upper urinary tract urothelial carcinoma (UTUC). Methods: Data of 128 patients who were operated for UTUC between 2001 and 2019 were retrospectively analyzed. Patients with pure urothelial carcinoma and patients with variant histology were compared in terms of demographics, pathological outcomes, and survival. Results: The mean age of the patients was 65±11 years, female to male ratio was 30/98 and median follow-up period was 26.5 (1-176) months. Variant histology was detected in 14.8% of patients. Variant histology was found to be associated with surgical margin positivity, lymph node metastasis, presence of lymphovascular invasion, high tumor stage and grade (p=0.001, p=0.012, p=0.001, p=0.002, and p=0.009, respectively). Three-year cancer-specific and overall survival rates were 79.6% and 77.3%, respectively. There was no statistically significant relationship between variant histology with cancer-specific and overall survival (p=0.514 and p=0.515, respectively). Conclusion: Variant histology of UTUC was found to be associated with locally advanced disease, but its effect on survival could not be demonstrated.

A Rare Case of Post-pubertal Pure Yolk-sac Tumour Incidentally Diagnosed after Surgical Intervention for Fournier's Gangrene.

The testicular tumour is the most common solid malignancy in males between the ages of 15 and 35 years. Testicular tumours most commonly present with a painless testicular mass. Fournier's gangrene is necrotising fasciitis of the genital, perineal, and perianal region characterized by the microvascular thrombosis and skin necrosis, and is most commonly seen in elderly males with the comorbid conditions. To the best of our knowledge, there is no published case of testicular tumour presenting as Fournier's gangrene. Herein, we report a case of a young adult male, otherwise healthy, who presented to the emergency room with Fournier's gangrene and was found to have a metastatic post-pubertal pure yolk-sac tumour of the testis which is extremely rare in the adults. Key Words: Fournier's gangrene, Yolk sac tumour, Testicular neoplasm.

Safety of Minimally Invasive Surgical Techniques in Large Adrenal Lesions: A Single-Centre Study.

OBJECTIVE: To compare perioperative outcomes of minimally invasive surgery for ≥5 cm and <5 cm adrenal lesions. STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: Hacettepe University School of Medicine, Ankara, Turkey, between October 2007 and September 2019. METHODOLOGY: Data of 83 patients operated for adrenal lesions was collected retrospectively. Patients were categorized into two groups based on the size of the adrenal gland as <5 cm and ≥5 cm. The groups were compared in terms of perioperative outcomes. RESULTS: The median age of the patients was 51 (41-60) years, with a female-to-male ratio of 27/56. The median follow-up period was 27 (11.5-91) months. Of 83 adrenal masses, 60 (72.3%) were in the <5 cm group and 23 (27.7%) were in the ≥5 cm group. Fifteen (18.1%) patients underwent adrenalectomy for lung cancer metastasis, whereas three (3.6%) for renal cell carcinoma metastasis. The overall rate of post-operative complications was 10.8%. Post-operative complication rates were similar in each group (p=0.433). Operation time was found to be significantly higher in patients with large adrenal masses (p=0.003). CONCLUSION: Minimally invasive surgical techniques have the same perioperative results in the group with adrenal lesions ≥5 cm compared to <5 cm and may be safely employed in this group of patients. KEY WORDS: Laparoscopy, Robotic assisted laparoscopy, Adrenalectomy, Metastasectomy, Adrenal gland neoplasms.

Long term complications of penile fracture repair: Erectile dysfunction and penile curvature.

OBJECTIVE: To determine the factors that cause erectile dysfunction and penile curvature after repair of penile fracture (PF). METHODS: Data from 25 patients who underwent PF repair was retrospectively analyzed. PF was diagnosed by examining patients' medical histories and performing physical examinations. All patients underwent immediate PF repair. All patients filled out the International Index of Erectile Function (IIEF-5) form and penile curvature was examined. RESULTS: The median age of patients at the time of surgery and the median follow-up duration were 46 years (22-60 years) and 95 months (12-156 months), respectively. Two of the patients had concomitant urethral injury. At the final follow up, erectile dysfunction (ED) was present in 13 patients (52%). Among these patients, 9 patients (36%) had mild ED and 4 patients (16%) had moderate ED. With a univariate analysis, age and penile curvature were significantly associated with ED (p=0.008 and p=0.039, respectively). With a multivariate analysis, age was independently associated with ED (p=0.048, odds ratio=1.104, 95% confidence interval 1.000-1.218). The IIEF-5 scores correlated with age (p=0.009, r=0.510). Seven patients (28%) had penile curvature and one patient underwent penile plication surgery. CONCLUSION: After PF repair, age is the only risk factor for ED and penile curvature rarely requires surgical treatment.

Comparison of clamping strategies in minimally invasive partial nephrectomy for cT1 tumors.

OBJECTIVES: To determine whether artery only (AO) clamping promises any advantage over artery and vein (AV) clamping in patients undergoing partial nephrectomy with minimally invasive surgical techniques. MATERIAL AND METHODS: We retrospectively analyzed the data of 68 partial nephrectomy patients who were treated with minimally invasive techniques (robot-assisted laparoscopic or pure laparoscopic) for solitary, unilateral, cT1 renal masses during the period of 2008-2019 in a single institution. Patients were divided into two groups according to clamping strategy (AO and AV). The two groups were compared to each other in terms of perioperative outcomes and long-term functional results. RESULTS: The mean patient age and median follow-up period were 56.8 ± 10.8 years and 13.5 (9-44.5) months, respectively. Warm ischemia time, estimated blood loss, transfusion rate and length of hospital stay were similar between the two groups, while operative time was significantly higher in the AO clamping group (p = .726, p = .604, p = .675, p = .103, and p = .038, respectively). Patients who underwent AV clamping had a significantly lower estimated glomerular filtration rate (eGFR) and higher chronic kidney disease rates six months postoperatively (p = .001 and p = .044, respectively) and at the last follow-up (p = .020 and p = .048, respectively). The percentage of eGFR change at six months and the last follow-up was higher in the AV clamp group but the difference was not statistically significant (p = .056 and p = .082, respectively). CONCLUSIONS: Our findings suggest AO clamping is safe and comparable to AV clamping. In our study, AO clamping was found to be superior to AV in terms of long-term eGFR preservation.

Erectile dysfunction management: a critical appraisal of clinical practice guidelines with the AGREE II instrument.

Our study aimed to assess the methodological strengths and weaknesses of erectile dysfunction clinical practice guidelines (CPGs) for individuals using the AGREE II tool. Erectile dysfunction related CPGs were identified from three databases: the National Guideline Clearinghouse, the Guidelines International Network, and PubMed between 2000 and 2020. We designed an independent assessment for each of the erectile dysfunction related CPGs using the AGREE II tool. Four appraisers performed these assessments. The literature search identified 8 CPGs that met our inclusion criteria. The evaluation of the AGREE II domains of each individual revealed that the median scores of domains related to applicability were quite low (39%). Also, the median scores of domains related to the rigour of development and the stakeholder involvement were relatively low (53% and 63%). We determined the highest median scores in three AGREE II domains: clarity of presentation (80.5%), editorial independence (77%), and scope and purpose (89.5%). We found that the European Association of Urology (EAU), the American Urological Association (AUA), and the British Society for Sexual Medicine (BSSM) guidelines had >60% in >4 domains and that their average AGREE II scores were over 70%. In the Canadian Diabetic Association (CDA) and the Japanese Society for Sexual Medicine (JSSM) guidelines, we found that >4 domains were >60%, but their average AGREE II scores were below 70%. The British Medical Journal (BMJ), the Canadian Urologic Association (CUA), and the Malaysian Urologic Association (MUA) guidelines had >60% in <3 domains. We highly recommended EAU, AUA and BSSM guidelines, while we moderately recommended CDA and JSSM guidelines. BMJ, CUA and MUA guidelines were weakly recommended. The quality of the guidelines for erectile dysfunction was variable according to AGREE II. We noted significant deficiencies in the methodological quality of the CPGs developed by different organisations in the areas of applicability and rigour of development.

Does ureteral access sheath affect the outcomes of retrograde intrarenal surgery: a prospective study.

OBJECTIVES: To evaluate whether or not using a ureteral access sheath (UAS) affects the perioperative outcomes after retrograde intrarenal surgery (RIRS) performed in patients with renal stones. MATERIAL AND METHODS: An observational study was carried out using data of 60 patients who underwent RIRS with the diagnosis of renal stones <2 cm between February 2017 and November 2017 at our institution. The data of the 60 patients were registered prospectively during the study period. Patients were divided into two groups based on whether a UAS was used (Group 1-30 patients) or not (Group 2-30 patients) during RIRS. Perioperative outcomes and complications were collected and analyzed. RESULTS: The stone burdens of the patients in Group 1 and in Group 2 were 76.59 mm2 and 62.19 mm2, respectively (p = .160). There was no statistically significant difference in SFR (p = 1.000), complication rates (p = .418), and operation time (p = .411) between both groups, except for the fact that postoperative pain intensity levels using the VAS were slightly higher in Group 2 (4.13 ± 2.37 vs. 5.33 ± 1.89, p = .064). CONCLUSIONS: In the present study, we showed that similar success and acceptable complication rates can be achieved without using UAS compared to using UAS during RIRS. However, using UAS may provide an advantage in reducing postoperative pain after RIRS.

The SPARE score reliably predicts the conversion from open partial to radical nephrectomy.

AIM: To assess the power of nephrometry scores to predict the intraoperative conversion from partial nephrectomy (PN) to radical nephrectomy (RN). METHODS: We identified all the patients at our institution who were scheduled for PN between April 2012 and December 2017. Patients who underwent robotic or laparoscopic surgery were excluded. A total of 149 patients (94 men) who underwent open surgery and had complete data were included. The power of the R.E.N.A.L., PADUA, SPARE, and DAP scores to predict the conversion to RN, and the threshold values were assessed. In the multivariate analysis, the predictive power of the nephrometry scores was tested by separately including them in different models. RESULTS: The median age was 57 (48-67) years, while the median follow-up was 15 (7-29.5) months. The overall conversion rate was 10.7%. The optimal cut-off values for the R.E.N.A.L., PADUA, SPARE, and DAP scores were 7.5, 9.5, 5.5 and 7.5, respectively. The SPARE score had the highest area under the curve (AUC=0.807, P<0.001). In the multivariate analysis, the SPARE score had the highest odds ratio (OR 12.561; confidence interval 3.456-45.534, P<0.001]. CONCLUSION: A high SPARE score was significantly associated with the conversion to RN in patients who underwent open PN.

Minimally Invasive Partial Nephrectomy in the Era of Robotic Surgery.

OBJECTIVES: The objectives of the study were to compare the operative features, complication rates, functional, and pathological outcomes of laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN). METHODS: The demographics, perioperative, and follow-up data of patients who underwent partial nephrectomy between January 2007 and April 2020 with minimally invasive methods were retrospectively analyzed. Patients with minimum 3 months follow-up were enrolled in the present study. Perioperative and pathological outcomes were compared between the patients underwent LPN and RPN. RESULTS: A total of 85 patients (65 LPN and 20 RPN) were included in the present study. The mean patient age at the time of surgery was 56.31±10.48 years. Female-to-male ratio was 30/55. Patients in the RPN group had higher R.E.N.A.L. and PADUA scores (p=0.039 and p=0.030, respectively). Median warm ischemia time, median operation time, median intraoperative estimated blood loss, mean post-operative hemoglobin change, and median hospitalization time were similar between groups (p=0.133, p=0.753, p=0.079, p=0.882, and p=0.473, respectively). Artery-only clamping rate was significantly higher in RPN group (p=0.033). The cost of RPN was significantly greater than LPN (p<0.001). Transfusion rates, post-operative complication rates, percent of estimated glomerular filtration rate change at the last follow-up, and trifecta achievement were similar between the groups (p=0.622, p=0.238, p=0.428, and p=0.349, respectively). CONCLUSION: In this series, similar perioperative and functional outcomes were achieved by RPN compared to LPN in more complex renal masses.

Factors associated with the stone-free status after retrograde intrarenal surgery in children.

INTRODUCTION: Paediatric urolithiasis has a recurrent nature because it is frequently associated with metabolic or anatomical disorders or infectious conditions. The rising incidence of the disease with its recurrent nature emphasises the need for minimally invasive therapeutic options. In this study, we aimed to evaluate efficacy and factors affecting the success of retrograde intrarenal surgery (RIRS) in children. MATERIALS AND METHODS: Patients who underwent RIRS were evaluated retrospectively. Two different flexible ureteroscopes (F-URS) were used (7.5F F-URS and 7.95F with a 4.9F bullet-shaped tip). Irrespective of size, all residual fragments were considered as failure. Age, stone size, stone localisation, Hounsfield Unit (HU), stone-free rate (SFR) and complications were evaluated. RESULTS: Forty-six patients (29 boys and 17 girls) with a median age of 70.5 months (6-214 months) were treated with RIRS between August 2014 and November 2019. The median operative time was 60 minutes (45-120 minutes). The median follow-up was 26 months (3-65 months). Fourteen patients had lower pole and 10 patients had multiple stones. Ureteral access sheath (UAS) was used in 16 (35%) patients. SFR was 61%. The median number of general anaesthesia was 2 (min 1, max 5). Auxiliary semirigid URS, PCNL and repeat RIRS were required in 4, 6 and 5 patients, respectively. Two patients had postoperative febrile urinary tract infection (UTI) as a complication. Age was associated with post-operative febrile UTI. Presence of stones with HU lower than 700, being operated 4.9F F-URS and without UAS were associated with better SFR. CONCLUSIONS: RIRS is a minimally invasive method with low complication rates in the treatment of childhood stone disease. Higher stone-free rates are obtained in low HU stones and cases in which we used 4.9 F tip F-URS.

Changes in percutaneous approach to kidney stones in children: A single institute experience over 500 cases.

PURPOSE: The aim of this study is to identify the changes in patient age and stone sizes with technological advancement over time. METHODS: This study was conducted retrospectively with 404 patients (504 renal units) who underwent percutaneous nephrolithotomy (PCNL) between January 1997 and June 2020. Patient characteristics and trends on instrument preferences were investigated. RESULTS: Median age was 7 (1-18) years. Male to female ratio was 1.48:1 (301/203). Median stone burden was 2 cm2 (0.20-25) and median operative time was 90 minutes (20-240). The stone-free rate was 74.6%. Patients were divided into four groups according to the size of the instrument. It was found that the size of sheath used increased significantly with increasing age and stone burden. The micro-PCNL group had the shortest hospitalisation and lowest blood transfusion rate. Chronologically categorised four equal groups were compared to analyse changing patient profiles and trends. Median patient age, stone burden, operation time, sheath size, blood transfusion and complication rates decreased significantly with time. However, the use of tracts smaller than 20F and the number of patients with previous intervention increased significantly. CONCLUSION: Our study demonstrated that the patient's age and stone size at the time of initial diagnosis decrease over time while miniaturisation techniques increase in paediatric urology.

Outcomes of ureterolysis for primary retroperitoneal fibrosis: A single-center experience.

OBJECTIVE: To report our experience with ureterolysis for the management of retroperitoneal fibrosis. METHODS: The data of 25 patients who underwent ureterolysis due to primary retroperitoneal fibrosis between 2002 and 2017 were reviewed retrospectively. Initial symptoms, laterality, renal function status (initial/final), operation complications and serum creatinine levels (diagnosis/preoperative/6 months, 12 months postoperatively) were recorded. After surgery, patients were followed up by ultrasonography and serum creatinine levels. Patients with impaired results underwent furosemide renogram and/or late phase of computed tomography. Factors affecting final serum creatinine levels were evaluated. The χ2 -test was used for nominal data among groups. The level of statistical significance was set as P < 0.05. RESULTS: A total of 19 patients (76%) were operated bilaterally. The mean follow-up period was 46.2 ± 9.2 months. Among 44 operated renal units, non-functioning kidney developed in seven (15.9%). A total of 34 renal units (77.3%) did not require any additional surgical intervention, and two underwent balloon dilatation (4.5%), one (2.25%) followed with double J stent changes. Two patients developed end-stage renal disease secondary to bilateral unresolved obstruction. High final serum creatinine levels developed in eight (32%) patients without dialysis. Eight patients (32%) were treated with immunosuppressive therapy for systemic recurrence. There was a significant relationship between preoperative serum creatinine levels with final serum creatinine levels (P = 0.005). There was no statistically significant relationship between diagnosis serum creatinine levels with final serum creatinine levels and postoperative dialysis requirement (P = 0.79 and P = 0.817, respectively). CONCLUSIONS: Ureterolysis provides acceptable success with low complication rates in patients with retroperitoneal fibrosis. Preoperative high-serum creatinine levels can be considered as a risk factor for long-term renal impairment and these patients should be followed closely.

The stone crescent of Anatolia.

OBJECTIVES: To assess the largest stone composition data available and to present the variations in the stone composition according to gender and different climatic environments in Turkey. METHODOLOGY: Data for a total of 24 768 urinary stone patients from the Turkish Mineral Research and Exploration Institute were evaluated. X-ray diffraction crystallography was used for analysis and the Köppen-Trewartha classification was used to assess the climatic features of the cities. After the assessment, the cities were divided into two groups-those with a continental climate (Dc) were defined as inland areas and the others (Non-Dc) were defined as coastal areas. RESULTS: The male-to-female ratio was 2.2:1. Amongst the patients, 53.7% had pure stones, while 46.3% had mixed-type stones. The most common type of stone was calcium oxalate in both pure and mixed stone groups. Given the climate patterns, the stone ratio between regions with a Dc climate and a Non-Dc climate was approximately 2:3. Cystine and uric acid stones were observed more frequently in inland regions, while calcium oxalate, whewellite, and struvite stones were observed more frequently in coastal areas (P = .005, P < .001, P < .001, P = .002, P = .002, respectively). Calcium oxalate stones were found at a higher rate in men, while cysteine, struvite, and calcium phosphate stones were more common in women (P < .001, P = .003, P < .001, P < .001, respectively). CONCLUSION: This study provides the most comprehensive data on the stone disease in Turkey. Considering the distribution of stone disease in Turkey, the frequency of analysed stones had parallels with the temperature averages and climate features, presenting crescent-like distribution.