Urinary undiversion transforming an ileal conduit into an orthotopic continent neobladder: First case in our country.

Radical cystectomy (RC) with urinary diversion (UD) is still the standard treatment method for muscle-invasive bladder cancer. Type of UD is determined according to some characteristics of the patient and the tumor. Even in the most experienced hands, alternative scenarios may require an alternative diversion, including emergency UD for complications requiring immediate take down of the initial UD, tumor recurrence impacting the urinary tract or the UD, progressive impairment of renal function (in patients with a continent UD), malfunction/complications of the initial UD, and patient dislike of a stoma. We report a case of undiversion with natural history and outcome in a patient who had previously undergone RC and ileal conduit performed.

Long-term Effect of Colchicine Treatment in Preventing Urethral Stricture Recurrence After Internal Urethrotomy.

PURPOSE: Urethral stricture, known as a scar formation leading to urethral lumen stricture in sub-epithelial tissue, is the most common late complication of transurethral prostate resection (TURP). The aim of study is to evaluate efficacy of colchicine treatment in preventing urethral stricture recurrence in patients after internal urethrotomy, and to determine whether colchicine treatment had a sustained effect in decreasing stricture recurrences in patients with concomitant diseases. METHODS: Patient data with weak urine stream and/or voiding difficulty, and who had internal urethrotomy in Urology Department of Maltepe University Hospital between dates 01 January 2011 and December 2016 were collected. They were randomized to colchicine receiving, and non-receiving arms. Colchicine was given 1 g/day orally for two months, and primary efficacy point was defined as urethral stricture development in 3, 6, and 12 months after internal urethrotomy. RESULTS: The study was conducted on 84 males with the mean age of 67.7 ± 7.5 years. The mean ages of colchicine receivers and non-receivers were 68.2 ± 7.6 and 67.1 ± 7.6 years, respectively. Recurrence rate of urethral stricture was significantly lower in colchicine receivers (P = .044) than non-receivers. In overall evaluation, recurrence rate of urethral stricture was significantly low, if there was only one comorbidity (P = .006), but rates were significantly higher in presence of three (P = .010) and four (P = .040) comorbidities. No significant difference in recurrencerates was determined in patients without comorbidities or with two comorbidities (P > .05). CONCLUSION: Combination of oral colchicine with internal urethrotomy reduces recurrence rates of urethral stricturesignificantly.

The effect of smoking on spontaneous passage of distal ureteral stones.

BACKGROUND: Animal studies have shown that nicotine affects the peristalsis of the ureter. The aim of the study is to analyze the effect of smoking on spontaneous passage of distal ureteral stones. METHODS: 88 patients in whom distal ureteral stone below 10 mm diameter diagnosed with helical computerized tomography enhanced images were reviewed. Patients were grouped as either smokers (n:33) or non smokers (n:50). Follow-up for spontaneous passage of stones was limited with 4 weeks. Patients did not receive any additional medical treatment other than non-steroid anti inflammatory drugs only during painful renal colic episodes.Two groups were compared with the chi-square test in terms of passing the stone or not. Stone passage was confirmed with either the patient collecting the stone during urination or by helical CT. RESULTS: Smoking habits was present in 30(34%) patients and the frequency in both groups were similar (smokers: 23(76%) vs non-smokers: 46(79%)). Spontaneous passage of the stone was observed in 69(78%) patients. The two groups were comparable in terms of patient age, male to female ratio and stone size. Stone passage decreased as stone diameter increased. Total stone passage rates were similar in both groups (smokers: 76% vs. non-smokers: 79%) (p > 0.05). Passage of stones > 4 mm was observed in 46% and 67% of smokers and non-smokers respectively. However passage of stones with a diameter ≤ 4 mm were similar in both groups (smokers: 100% vs non-smokers: 92%) (p > 0.05). CONCLUSION: Smoking has neither a favorable nor un-favorable effect on spontaneous passage of distal ureteral stones. However, spontaneous passage rates in patients with a stone diameter > 4 mm was lower in smokers. These results should be further confirmed with studies including larger numbers of patients.

Perivesical inflammation and necrosis due to mitomycin C instillation after transurethral resection of bladder tumor: we must be vigilant!

The instillation of chemotherapeutic agents after transurethral resection of bladder tumor as an adjuvant treatment in bladder tumors is accepted as being safe if there is no associated bladder perforation. Mitomycin C (MMC) is a widely used agent for the adjuvant treatment of bladder tumors. A patient who developed MMC-induced bladder perforation and perivesical necrosis after an uneventful endoscopic tumor is presented. We suggest that the possible reason for such a complication could be deep resection at the anterior bladder wall. The treatment of the situation continued for an extended period, causing serious discomfort for the patient. Withholding immediate intravesical MMC instillation after resection of tumors on the anterior bladder wall ought to be considered in the early postoperative hours.

Percutaneous nephrolithotomy: primary patients versus patients with history of open renal surgery.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is the management choice for stones larger than 2 cm or for staghorn calculi. PCNL in secondary or tertiary patients poses some difficulties. In this study, we compared these patients with patients who were operated on for the first time. PATIENTS AND METHODS: A total of 328 PCNLs were performed between January 2003 and June 2007. One hundred and forty-two patients who had undergone open renal surgery in the past (126 secondary and 16 tertiary were compared with patients who had no previous history of open renal stone surgery. The tract was formed by balloon dilators, and in situations where it was necessary, fascial dilators were used. The operation was concluded by inserting a 14Ch Malecot nephrostomy tube in all cases. The number of tracts, operative time, transfusion rate, hospitalization time, and residual stones were recorded. RESULTS: Significant differences are not observed when the results are compared with the primary cases in terms of tract numbers (multiple tracts: 8.5% v 10.2%), operative time (2.3 v 2.2 hours) (P > 0.05), transfusion rate (540 v 495 mL) (P > 0.21), hospitalization time (4.4 v 4.2 days) (P = 0.94), complication rate (1.4% v 3%) (P > 0.05), and residual stones (5% v 3%) (P > 0.05). CONCLUSIONS: Although the anatomic positional differences of the kidney and fibrosis makes access and the procedure technically difficult in secondary or tertiary cases, PCNL can be performed with low complication and high success rates if safety rules are followed strictly. Difficult access can be overcome either by newly developed high-pressure balloons, assistance of fascial dilators, or by mechanical dilators.