Increased Plasma Ignition Distance Practice may Prevent the Obturator Reflex Occurrences and Compare of its Effectiveness Versus Obturator Block: A Prospective, Randomized, Controlled Study.

OBJECTIVE: To compare the ability of the obturator nerve block (ONB) and increased plasma ignition distance practice (IPDP) techniques to inhibit obturator nerve reflex (ONR) occurring with bipolar transurethral resection of the bladder. METHODS: Sixty patients who had a tumor placed at the lateral sidewall or had a tumor in another part of the bladder along with the lateral wall were randomly enrolled. Cystoscopic and ultrasonographic examinations and a computerized tomography scanning of the urinary bladder were used to determine the ONB side. Group 1 consisted of patients who had the ONB procedure. Group 2 consisted of patients who had IPIDP. The severity of the ONR was classified as severe, mild, and very mild. The study's primary endpoint was ONR occurrences and successful completion of the surgery. The secondary endpoints were bleeding and bladder perforation. RESULTS: There was a significant difference in the occurrence of ONR between the two groups (P = 0.0011). However, there was no significant difference between the two groups in the ability to resect the tumor and complete the surgery (P = .764). There was no correlation between the ONR and the tumor size (P = 0.478). CONCLUSION: Our study concluded that both ONB and IPIDP have comparable results, especially in resecting tumors and completing the operation. IPIDP has some advantages over ONB, such as shorter operative time, lower total costs, and less trained personnel requirements.

The efficiency of oxerutin on apoptosis and kidney function in rats with renal ischemia reperfusion injury.

BACKGROUND: Background: Renal ischemia-reperfusion injury (RIRI) is the most frequent cause of acute renal failure in clinical conditions such as trauma and shock as well as renal surgeries. Oxerutin is a member of the flavonoid family and possesses antioxidant properties. The aim of this study was to investigate whether oxerutin has protective effects on RIRI. METHODS: Twenty-eight male Wistar albino rats were randomly divided into three groups: sham control group (n=8), RIRI group (n=10), and RIRI + oxerutin group (n=10). RIRI was achieved by clamping the left renal artery for 30 min, followed 1-h reperfusion period. Thereafter, blood samples and left kidney tissue samples were taken for histopathological and biochemical examination. Blood urea nitrogen (BUN), urea, creatinine, and cystatin C levels, which are indicators of kidney function, as well as tumor necrosis factor-alpha, which is an indicator of inflammation were analyzed in blood samples. Total antioxidant status and total oxidant status (TOS), which are indicators of oxidative stress were analyzed on renal tissues. The apoptotic index, an indicator of kidney damage, as well as histopathological changes were evaluated on renal tissues. RESULTS: The apoptotic index, TOS, tumor necrosis factor-alpha, BUN, and urea levels were lower in the RIRI + oxerutin group than in the RIRI group (p<0.05). The results demonstrated that the histopathological and biochemical properties of oxerutin protected rats from RIRI. CONCLUSION: The findings obtained in this study show that prophylactic administration of oxerutin has protective effects on apoptosis and renal failure caused by RIRI. Therefore, oxerutin can be used as an effective prophylactic agent in the treatment of RIRI.

Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study.

To assess the efficacy and morbidity of the holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia. The study included 60 (55%) and 49 (45%) patients who underwent laser and bipolar enucleation of the prostate respectively. According to the perioperative data, except for length of hospital stay and enucleated prostate weight, all the remaining parameters were similar between the groups. There were significant differences between the preoperative and the postoperative third and 12th month voiding parameters in both groups. In the laser group, the maximum urine flow rate value was better than the bipolar group at the postoperative third and 12th months. However, we did not find any statistically significant difference between the groups in terms of the serum prostate-specific antigen level, International Prostate Symptom Score and postvoid residual urine volume at the postoperative third and 12th months. Our results show that both laser and bipolar techniques are effective minimally invasive surgical treatment options for men with benign prostatic hyperplasia. When compared to bipolar technique, laser technique provides shorter hospital stay, more prostatic tissue enucleation and better maximum urine flow rate values.

Protective Effects of Quercetin on Oxidative Stress-Induced Tubular Epithelial Damage in the Experimental Rat Hyperoxaluria Model.

Background and Objectives: The most common kidney stones are calcium stones and calcium oxalate (CaOx) stones are the most common type of calcium stones. Hyperoxaluria is an essential risk factor for the formation of these stones. Quercetin is a polyphenol with antioxidant, anti-inflammatory, and many other physiological effects. The aim of this study was to investigate the protective effect of quercetin in hyperoxaluria-induced nephrolithiasis. Materials and Methods: Male Wistar-Albino rats weighing 250-300 g (n = 24) were randomized into three groups: Control (n = 8), ethylene glycol (EG) (n = 8), and EG + quercetin (n = 8). One percent EG-water solution was given to all rats except for the control group as drinking water for five weeks. Quercetin-water solution was given to the EG + quercetin group by oral gavage at a dose of 10 mg/kg/day. Malondialdehyde (MDA), catalase (CAT), urea, calcium, and oxalate levels were analyzed in blood and urine samples. Histopathological assessments and immunohistochemical analyses for oxidative stress and inflammation indicators p38 mitogen-activated protein kinase (p38-MAPK) and nuclear factor kappa B (NF-kB) were performed on renal tissues. Results: The MDA levels were significantly lower in the quercetin-treated group than in the EG-treated group (p = 0.001). Although CAT levels were higher in the quercetin-treated group than the EG-administered group, they were not significantly different between these groups. The expression of p38 MAPK was significantly less in the quercetin-treated group than the EG group (p < 0.004). There was no statistically significant difference between the quercetin and EG groups in terms of NF-kB expression. Conclusions: We conclude that hyperoxaluria activated the signaling pathways, which facilitate the oxidative processes leading to oxalate stone formation in the kidneys. Our findings indicated that quercetin reduced damage due to hyperoxaluria. These results imply that quercetin can be considered a therapeutic agent for decreasing oxalate stone formation, especially in patients with recurrent stones due to hyperoxaluria.

Costovertebral angle as a novel tool for predicting the thoracic complication risk following percutaneous nephrolithotomy requiring supracostal access.

INTRODUCTION: The objective of this study was to determine whether the costovertebral angle (CVA) and other factors can predict the risk of thoracic complications following percutaneous nephrolithotomy (PCNL). METHODS: The data of patients who underwent prone PCNL with supracostal access at Suleyman Demirel University Hospital between January 2015 and December 2019 were retrospectively reviewed. Patients' demographics information (age, sex, body mass index [BMI], stone size, and stone location), operative data (supracostal access site, renal puncture site, and laterality), and postoperative thoracic complications (pleural injury) were evaluated. The CVA was measured on preoperative posteroanterior chest X-ray images. The mean CVA of patients with and without thoracic complications was evaluated. RESULTS: A total of 89 patients (mean age 46.12±15.66 years; 59 men and 30 women) with supracostal access were included in the study. Thoracic complications occurred in 17 (19.1%) patients. Nine (52.9%) hemothorax cases, five (29.4%) pneumothorax cases, and three (17.7%) urinothorax cases were detected. There was a statistically significant difference in the complication rate compared to the percutaneous access site (10th-11th supracostal vs. 11th-12th supracostal, p=0.004). The mean CVA was significantly lower in patients with complications (45.47±3.59) than in those without complications (53.26±5.98) (p=0.000). No association was found (p>0.05) with age, sex, BMI, laterality, stone surface area, and access site among patients with and without thoracic complications. CONCLUSIONS: Preoperative CVA can be an effective tool in predicting the risk of postoperative thoracic complications.

Can we Predict Preoperative Tumor Aggressivity with Hemogram Parameters in Renal Cell Carcinoma? a Novel Calculation Method.

We aim to investigate the prognostic significance of the hemoglobin X lymphocyte / neutrophil ratio (HLNR) and hemoglobin x lymphocyte / platelet ratio (HLPR) with tumor aggressivity in patients with renal cell carcinoma. We retrospectively analyzed 127 patients' data who had diagnosed as renal cell carcinoma between 2008 and 2019 in Suleyman Demirel University Hospital. Tumor and patient characteristics, hemoglobin, neutrophil, lymphocyte, platelet values HLNR and HLPR were calculated in preoperative hemogram parameters. The relationship between tumor pathological stage, Fuhrman nuclear grade and tumor necrosis with HLPR and HLNR analyzed with statistically. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLNR. P values are 0.003, 0.012 and 0.015 respectively. HLNR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLPR. P values are 0.001, 0.014 and 0.047 respectively. HLPR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. High pathological stage, high Fuhrman nuclear grade and existence of tumor necrosis are associates with preoperative low HLNR and low HLPR in renal cell carcinoma patients. They can be used as prognostic markers in patients with renal mass preoperatively.

Management of vesicovaginal fistulas after gynecologic surgery.

OBJECTIVE: In developed nations, surgery, especially gynecologic procedures, is the major cause of vesicovaginal fistulas (VVFs). We retrospectively evaluated our treatment modalities for VVF repair caused by a gynecologic surgery, and discussed the reasons of selecting certain surgical techniques and their outcomes. MATERIALS AND METHODS: We compared the surgical procedure preferences of surgeons and their results with patient and surgeon characteristics for the management of VVFs after an inciting gynecologic surgery in Süleyman Demirel University Hospital, Isparta over a 10-year period. The surgical procedures were undertaken in departments of urology and obstetrics and gynecology. RESULTS: Abdominal repair was chosen for 65%, vaginal repair for 25%, and laparoscopic repair for 10% of patients. For the 75% of the patients that urologists operated, they chose the abdominal route. The mean parity number of patients who underwent abdominal repair was lower than that for vaginal repairs (p<0.05). For the patients managed with the vaginal route, 20% had a Martius flap, and 80% had a simple excision and repair. For patients operated via the abdominal route, 18% needed omental flap; no tissue interposition was used for the rest. The mean hospitalization time was less in patients managed with transvaginal repair (3.4 days) compared with transabdominal repair (9.2 days) (p<0.05). CONCLUSION: The choice of repair method depends on surgeon's training (gynecology vs. urology). The vaginal route should be the first choice because it does not compromise the success rate and the mean hospitalization time is less. For the transvaginal approach, access to the lesion is the most important factor for the success of the procedure. No flap is needed for tissues that appear well vascularized.

Protective impact of resveratrol in experimental rat model of hyperoxaluria.

PURPOSE: Resveratrol (RES) is a polyphenol with antioxidant, anti-inflammatory, and many other physiological effects on tissues. In the present study, the effect of resveratrol in hyperoxaluria driven nephrolithiasis/nephrocalcinosis is investigated. METHODS: Wistar-Albino rats of 250-300 g (male, n = 24) were included in the present study. The rats were randomized into three groups: Group 1 consisted of the controls (n = 8), Group 2 of hyperoxaluria (1% ethylene glycol (EG), n = 8), and Group 3 of the treatment (1% EG + 10 mg/kg of RES, n = 8) group. At the beginning and fifth week of the study, two rats from each group were placed in metabolic cages for 24 h and their urine was collected. At the end of the study, the rats were killed and their blood was collected from the vena cava inferior. The right kidneys of the rats were used for biochemical and the left ones for immunohistochemical analyzes. Malondialdehyde (MDA), catalase, urea, calcium, oxalate, and creatinine clearance were studied in the blood, urine, and kidney tissues. Moreover, routine histological evaluation, and p38-MAPK and NFkB immunohistochemical analyses were conducted. RESULTS: In the hyperoxaluria group, urinary oxalate levels were higher than the control group; yet, lower in the treatment group compared to hyperoxaluria group (p < 0.05). Serum MDA levels in the hyperoxaluria group were higher than the control group; but in the treatment group it is lower than the hyperoxaluria group (p < 0.05). P38 MAPK activity was higher in the hyperoxaluria group compared to the control (p < 0.05). However, in terms of p38 MAPK activity, there were no statistically significant difference between hyperoxaluria and the treatment group (p < 0.069). Whereas NFkB activity in the hyperoxaluria group is higher than the control (p < 0.001), no statistically significant difference was observed with the treatment group. CONCLUSIONS: In the present study, resveratrol was seen to prevent hyperoxaluria. With preventing oxidative stress factors and Randall plaque formation caused by free oxygen radicals, resveratrol can be an alternative treatment option that can increase the success rate in preventing stone recurrence in the future.

Comparison of shockwave frequencies of 30 and 60 shocks per minute for kidney stones: a prospective randomized study.

OBJECTIVE: One of the factors that determines the treatment success of shockwave lithotripsy (SWL) is the frequency of the shockwaves during the procedure. This study compared the efficacy and pain perception of shockwave frequencies at 30 versus 60 shocks/min for kidney stones. MATERIALS AND METHODS: From August 2013 to May 2015, 160 patients with solitary, radiopaque kidney stones were randomized to SWL at 30 shocks/min (group 1) or 60 shocks/min (group 2), with 80 patients in each group. The primary outcome measure was success rate at 3 months after the last SWL session. The secondary outcome measure was pain perception during the procedures. RESULTS: Of the 160 randomized patients, data for a total of 148 patients (74 patients in group 1 and 74 patients in group 2) were analyzed, after the exclusion of the patients lost to follow-up or who required secondary intervention within 3 months. There was no statistically significant difference between the two groups in terms of the success rate at 3 months (68.9% vs 71.6%, p = .719). However, the mean visual analogue scale scores of all the sessions were significantly higher in group 1 than in group 2 (5.83 vs 4.06, p < .05). Stone location, especially the lower calyceal location, was the only significant negative predictor for success according to multivariate logistic regression analysis. CONCLUSIONS: The success rate was similar between these two frequencies. However, pain perception was significantly higher at 30 than at 60 shocks/min.

Where do patients go for treatment of urethritis?

BACKGROUND: Urethritis is characterized by urethral inflammation, and it can result from both infectious and noninfectious conditions. Physicians and other health care providers play a critical role in preventing and treating urethritis. OBJECTIVES: The aim of this study was to describe and identify predictors of health care seeking behavior among men with urethritis. PATIENTS AND METHODS: In total, 98 male patients aged between 16 to 52 years-of-age (mean 30.9 ± 8.0 years), who attended our clinic with symptoms of urethritis, were included in the study. We conducted face-to-face interviews with the patients using a 9-item survey questionnaire. Patients were divided into three groups according to their level of education as follows: group I (n = 44), elementary school; group II (n = 38), high school; and group III (n = 16), university. RESULTS: Among the 98 patients evaluated, the source of treatment was physicians in 44 patients (44.9%), drugstores in 38 cases (38.77%), and friends in 16 patients (16.32%). There was a statistically significant difference found between the groups according to the source of treatment (P < 0.001). The most common factors associated with seeking care from other sources, rather than physicians, were economic reasons in 19 patients (35.18%), confidentiality concerns in 24 (44.4%), and ease of access in 11 patients (20.37%). CONCLUSIONS: A substantial proportion of patients with urethritis sought help from other sources, rather than physicians. The results of our study show that the patients with higher levels of education were more likely to seek help from health care services. It is important to promote the public's knowledge through informative studies and educational materials in order to encourage patients to seek rapid and effective treatment from proper sources.

Cancer detection rates of different prostate biopsy regimens in patients with renal failure.

We aimed to evaluate the cancer detection rates of 6-, 10-, 12-core biopsy regimens and the optimal biopsy protocol for prostate cancer diagnosis in patients with renal failure. A total of 122 consecutive patients with renal failure underwent biopsy with age-specific prostate-specific antigen (PSA) levels up to 20 ng/mL. The 12-core biopsy technique (sextant biopsy + lateral base, lateral mid-zone, lateral apex, bilaterally) performed to all patients. Pathology results were examined separately for each sextant, 10-core that exclude parasagittal mid-zones from 12-cores (10a), 10-core that exclude apex zones from 12-cores (10b) and 12-core biopsy regimens. Of 122 patients, 37 (30.3%) were positive for prostate cancer. The cancer detection rates for sextant, 10a, 10b and 12 cores were 17.2%, 29%, 23.7% and 30.7%, respectively. Biopsy techniques of 10a, 10b and 12 cores increased the cancer detection rates by 40%, 27.5% and 43.2% among the sextant technique, respectively. Biopsy techniques of 10a and 12 cores increased the cancer detection rates by 17.1% and 21.6% among 10b biopsy technique, respectively. There were no statistical differences between 12 core and 10a core about cancer detection rate. Adding lateral cores to sextant biopsy improves the cancer detection rates. In our study, 12-core biopsy technique increases the cancer detection rate by 5.4% among 10a core but that was not statistically different. On the other hand, 12-core biopsy technique includes all biopsy regimens. We therefore suggest 12-core biopsy or minimum 10-core strategy incorporating six peripheral biopsies with elevated age- specific PSA levels up to 20 ng/mL in patients with renal failure.

Management and outcomes of penile fracture: 10 years' experience from a tertiary care center.

OBJECTIVES: To evaluate our experience on diagnosis and management of penile fractures. MATERIALS AND METHODS: This retrospective study included 31 patients who were treated for penile fracture between 2002 and 2012. We analyzed the etiology of penile fracture, concomitant pathologies such as urethral injury, deep or superficial dorsal vein ruptures, treatment modalities (surgery or conservative treatment) and complications of treatment modalities. RESULTS: The mean age of the patients was 32 years (range, 23-47 years). In 27 patients (87%), the cause of penile fracture was sexual intercourse. Patients presented with swelling, pain and popping or cracking sound in penis. The diagnosis of penile fracture was established clinically in all of the patients. There were no urethral injuries or dorsal vein ruptures. Ten patients who refused surgical treatment were treated conservatively and remaining 21 patients with early surgical intervention. Among conservatively treated patients, two suffered from erectile dysfunction, two from painful erection and another two from penile curvature. No serious complications such as erectile dysfunction, penile curvature or painful erection were observed in surgically treated patients. CONCLUSION: Penile fracture can be diagnosed easily with history and physical examination, and favorable functional results can be achieved with early surgical repair.

The effect of micronized purified flavonoid fraction on the prevention of testicular pathologies in adolescent rats with experimentally induced varicocele.

PURPOSE: We investigated the effect of micronized purified flavonoid fraction on the prevention of testicular pathologies following varicocele induction. MATERIALS AND METHODS: A total of 66 adolescent (6-week-old) male Wistar rats were included in study. Rats were divided into 7 groups, including group 1--control, group 2--sham operation, group 3--left varicocele induced, group 4--varicocele induced, varicocelectomy done 4 weeks later and micronized purified flavonoid fraction administered for 4 weeks, group 5--varicocele induced and micronized purified flavonoid fraction administered for 8 weeks, group 6--varicocele induced and beginning 4 weeks later micronized purified flavonoid fraction administered for 4 weeks, and group 7--varicocele induced and varicocelectomy done 4 weeks later. Before sacrifice bilateral real-time testicular microvascular perfusion of all rats was measured using the PeriFlux System 5000 PF 5010 LDPM Unit (Perimed, Järfälla, Sweden). All testes were graded according to the Johnsen scoring system. To assess apoptosis caspase-3 levels were measured. RESULTS: Testicular weight in group 3 was markedly decreased and the extent of seminiferous tubular damage was significantly increased compared with the other groups. Bilateral testicular blood flow and the number of apoptotic germ cells were greater in group 3. Significantly higher Johnsen scores and a meaningful decrease in the apoptotic index were detected in groups 4 to 7 compared with group 3. CONCLUSIONS: We observed favorable effects of micronized purified flavonoid fraction on the regression of testicular damage secondary to varicocele.

Management of symptomatic ureteral calculi complicating pregnancy.

OBJECTIVE: To review our experiences with management of symptomatic ureteral calculi complicating pregnancy. METHODS: Between January 2001 and December 2011, 57 pregnant women were treated for symptomatic ureteral stones. The medical records of these patients were reviewed retrospectively. RESULTS: The mean patient age was 24 (range 17-37) years and gestational age at presentation was 26 weeks (range 12-38). Most of the cases (60%) occurred in the third trimester. Flank pain was the most common presenting symptom (90%). Ultrasonography was the initial test confirming diagnosis. With conservative management, spontaneous passing of stones was noted in 13 cases (22.8%). In 10 patients (17.5%), symptomatic relief occurred without spontaneous passing of stones until the end of pregnancy. Invasive management was required in 34 patients (59.6%) because of persistent pain and/or ureteral obstruction. In 29 patients, ureteral calculi were treated successfully by ureteroscopy. Stones were extracted by pneumatic lithotripsy or forceps. In 5 patients, only double-J stent was inserted during ureteroscopy as a result of unreached or migrated stone. The majority of patients (58.8%) had lower ureteric calculi. The mean size of the stones retrieved was 7 mm (range 4-13 mm). Minor complications like ureteric edema, mild ureteric laceration, or bleeding were seen in 5 patients. Three patients had a urinary tract infection and 3 complained of stent-induced bladder irritation; uterine contraction was observed after the procedure in 1 patient, but no serious obstetric or urologic complications were observed in any case. CONCLUSION: When conservative treatment fails, ureteroscopy is an effective and safe therapeutic option in symptomatic ureteral calculi complicating pregnancy.

The effect of cadmium toxicity on renal nitric oxide synthase isoenzymes.

The aim of this study was to assess the cadmium (Cd) toxicity on renal nitric oxide synthase (NOS) isoenzymes. The study was carried out on 18 inbred male (Cd group: 10 and control group: 8) Wistar rats. Cd group received drinking water containing 15 mg/L Cd for 30 days; and at the end of the 30 days, plasma Cd was analysed. One kidney was snap frozen to assess the endothelial NOS (eNOS), inducible NOS (iNOS) and neuronal NOS (nNOS) expressions by Western blot analyses, and the other kidney was preserved for histopathological examination. Plasma Cd levels were significantly elevated in the Cd group. The Western blot analyses found higher levels of eNOS, iNOS and nNOS in the Cd group but only eNOS and nNOS levels were statistically significant. There was no difference in pathological assessment of the renal tissues. Cd toxicity increases NOS isoenzyme levels and may affect renal physiology.

Bilateral hydronephrosis secondary to cystocele.

A 75-year-old patient applied to the urology clinic with a cystocele and ultrasonography of urinary tract evidencing bilateral grade III hydronephrosis. She didn't complain about any urination problem. Gynecologic examination showed a marked cystocele throughout its entire extension on the anterior wall of vagina. The excretory urography confirmed the presence of bilateral hydronephrosis and 'narrowing distal ureters.' An anterior colporrhaphy and tension-free vaginal tape procedure were performed without any complication. At the third month of the follow-up, regression in hydronephrosis was observed and there was no urinary complaint. In women presenting dilatation of upper urinary tract, pelvic organ prolapses must be kept in mind and a convenient examination is the key point to rule it out. Unnoticed cases can lead to a wrong diagnosis and redundant surgery.

Effects of melatonin on lipid peroxidation and antioxidant enzymes in streptozotocin-induced diabetic rat testis.

AIM: To examine the effects of melatonin treatment on lipid peroxidation (LPO) and the activities of antioxidant enzymes in the testicular tissue of streptozotocin (STZ)-induced diabetic rats. METHODS: Twenty-six male rats were randomly divided into three groups as follows: group I, control, non-diabetic rats (n = 9); group II, STZ-induced, untreated diabetic rats (n = 8); group III, STZ-induced, melatonin-treated (dose of 10 mg/kg . day) diabetic rats (n = 9). Following 8-week melatonin treatment, all rats were anaesthetized and then were killed to remove testes from the scrotum. RESULTS: As compared to group I, in rat testicular tissues of group II , increased levels of malondialdehyde (MDA) (P < 0.01) and superoxide dismutase (SOD) (P < 0.01) as well as decreased levels of catalase (CAT) (P < 0.01) and glutathione peroxidase (GSH-Px) (P > 0.05) were found. In contrast, as compared to group II, in rat testicular tissues of group III, levels of MDA decreased (but this decrease was not significant, P > 0.05) and SOD (P < 0.01) as well as CAT (P < 0.05) increased. GSH-Px was not influenced by any of the treatment. Melatonin did not significantly affect the elevated glucose concentration of diabetic group. At the end of the study, there was no significant difference between the melatonin-treated group and the untreated group by means of body and testicular weight. CONCLUSION: Diabetes mellitus increases oxidative stress and melatonin inhibits lipid peroxidation and might regulate the activities of antioxidant enzymes of diabetic rat testes.

Risk factors for the formation of a steinstrasse after shock wave lithotripsy.

INTRODUCTION: We studied the various stone, renal, and therapy factors that could affect steinstrasse formation after shock wave lithotripsy (SWL) to define their predictive value. PATIENTS AND METHODS: Between May 1999 and September 2002, 563 patients were treated with a Stonelight V3 lithotriptor. A steinstrasse was recorded in 46 patients. All patient data, stone and renal characteristics, and data of SWL were reviewed. Statistical analyses of patients, stones, and therapy characteristics in correlation with the incidence of steinstrasse formation were performed to assign factors that had a significant impact on the formation of this complication. RESULTS: The overall incidence of a steinstrasse was 8.17%. The steinstrasse was in the pelvic ureter in 84.3% of the cases, in the iliac ureter in 7.84% of them, and in pelvic and iliac ureter in 7.84% of the patients. The incidence of a steinstrasse significantly correlated with stone size and site. The incidence rates of a steinstrasse in renal stones <1 cm, 1-2 cm, and >2 cm were 4.46, 15.87, and 24.3% respectively. The incidence rates of this complication in ureteral stones <1 cm and 1-2 cm were 3.37 and 9.52%, respectively. The incidence rates of a steinstrasse in stones located in upper calices, middle calices, lower calices, and renal pelvis were 6.12, 10.52, 6.36, and 19.32%, respectively. CONCLUSIONS: Stone size and site are the significant factors predicting the formation of a steinstrasse. If a patient has a high probability of steinstrasse formation, close follow-up with early intervention or prophylactic pre-SWL ureteral stenting is indicated.

Dermoid cyst in bony pelvis that coexists with pheochromocytoma: report of a case and review of the literature.

A 42-year-old man presented with right lower quadrant abdominal pain and dysuria. The bladder was displaced to the right side of the pelvis in excretory urography. Abdominal CT revealed a mass in right adrenal gland, measuring 8 cm in diameter. There was also a cystic mass; filling left half of the bony pelvis and displacing bladder to the right, measuring 14.5 x 10, 5 x 7 cm. The patient underwent right adrenalectomy and pelvic mass excision. Pathologic examination showed that the adrenal mass was pheochromocytoma and pelvic mass was dermoid cyst. This case is the first one in literature that an intrapelvic dermoid cyst is not derived from an organ coexists with pheochromocytoma.