Predictive role of ureteral wall thickness and patient characteristics in endoscopic treatment outcomes for ureteral stricture disease following stone surgery.

PURPOSE: To evaluate the role of certain radiological parameters and patient characteristics in predicting the success of endoscopic treatment in ureteral stricture disease. METHODS: Fifty one adult patients with ureteral stricture disease (< 1 cm) after developing due to upper ureteral stones with ureteroscopic laser disintegration were included and in addition to stone and patient parameters, radiological parameters including ureteral wall thickness (UWT) at the impacted stone site were also measured on computed tomography (CT) images. Patients were divided into two groups: Group 1: Patients with endoscopic treatment success and Group 2: Patients with endoscopic treatment failure. The possible relationship between the UWT values and other radiological parameter was comparatively evaluated. RESULTS: Mean UWT value assessed at the treated stone site was significantly higher in cases unresponsive to endoscopic treatment with values of 2.77 ± 1.03 mm and 4.25 ± 1.32 mm in Group 1 and 2 respectively. A cut off value 3.55 mm for UWT was found to be highly predictive for endoscopic treatment failure. CONCLUSIONS: Our current results indicated that assessment of UWT value at the obstructing stone could be helpful enough to predict the likelihood of failure following endoscopic management of strictures with high sensitivity and specificity. Evaluation of this particular parameter could let the endourologists to look for more rational treatment alternatives with necessary measures taken on time.

Ureteral stricture formation after endoscopic removal of obstructing stones: could it be predicted with well-assessed radiological parameters?

The possible role of well-assessed radiological parameters in the prediction of ureteral stricture formation in cases with impacted obstructive ureteral calculi has been evaluated. 46 adult patients with or without ureteral stricture formation after ureteroscopic stone management were included. In addition to stone size and some certain radiological parameters including ureteral wall thickness (UWT) of the involved ureter at the impacted stone site was also measured and noted on computed tomography (CT) images. Parameters were evaluated in two subgroups of cases, namely: Group 1: patients in whom a ureteral stricture formed after endoscopic stone removal and Group 2: patients normal ureteral anatomy without any stricture formation. The possible relationship between the UWT values and degree of hydronephrosis (HN) with subsequent stricture formation was comparatively evaluated. All of the stones were proximal ureteral calculi in both groups. Both the degree of HN and proximal ureteral diameter (PUD) parenchymal was higher in cases with stricture formation. In addition, mean parenchymal thickness was lower and mean values of UWT measurements at the stone site were 3.70 ± 0.97 mm and 2.17 ± 0.26 mm in Groups 1 and 2, respectively. A cutoff value 2.49 mm for UWT was found to be highly predictive for stricture formation. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of ureteral stricture formation with high sensitivity and specificity . This evaluation along with some other radiological parameters may enable the urologists to follow such cases on this aspect with necessary measures taken.

Confirmation of negative urine culture status after appropriate antibiotic treatment prior to endourological stone procedures: Is it really necessary?

To evaluate the necessity of confirmation for a negative urine culture test outcome after an appropriate antibiotic regimen for urinary tract infection (UTI) prior to endoscopic stone removal procedures. 170 cases receiving an appropriate antibiotic treatment for culture proven UTI based on test outcomes before endoscopic stone removal were evaluated in two groups: Group 1 (n = 85) Patients in whom a second urine culture test was performed to ensure "negative urine culture" status prior to the procedures after receiving antibiotic therapy and Group 2 (n = 85). Patients receiving the same antibiotic therapy without any additional urine culture test before the procedures. Cases were comparatively evaluated with respect to the statistical significance of post-operative infective complications (fever, sepsis), duration of hospital stay and readmission rates during early post-operative period. Our findings demonstrated no significant difference regarding the rate of infective complications (presence of fever, incidence of septic findings), hospitalization period and readmission rates between the two groups. Although the presence of a negative urine status has been confirmed by urine culture test in group 1 cases, no additional urine culture test was performed with this aim in group 2 cases (negative urine culture was confirmed only with urinalysis) and the outcomes regarding the infective problems were found to be similiar. Our current findings indicate that a second urine culture test may not be a "must" if the patients receive an appropriate antibiotic regimen based on the sensitivity test outcomes for a reasonable time period.

Analysis of transurethral resection of prostate videos on YouTube™: Educational quality assessment.

BACKGROUND: Our aim was to evaluate the educational value of transurethral resection of prostate (TURP) videos on YouTube. METHODS: A comprehensive search was conducted for TURP videos on YouTube. Based on the Laparoscopic Surgery Video Educational Guidelines we created a checklist which includes 20 items for evaluation of the videos. IBM SPSS statistics was used for analysis. RESULTS: A total of 104 surgical videos were assessed. The mean view count was 15647.3 (21-324.522, SD 47556.4). Video image quality found as low for 57.7% of videos. Both staff (76%) and resident (75%) rated most of the videos low educational quality. No statistically significant difference was found between staff's total points (mean 4.35 ± SD 2.9) and resident's total points (mean 4.63 ± SD 3.3) (p: 0.761). Positive correlation was found between view count and staff's total points (r: 0.242 p < 0.05), resident's total points (r: 0.340 p < 0.01). There was also positive correlation between number of likes and staff's total points (r: 0.375 p < 0.01) and resident's total points (r: 0.466 p < 0.01). CONCLUSIONS: Most TURP surgical videos on YouTube are low quality. Higher educational quality videos with detailed explanation of the procedure are needed on this subject. We believe this study could be a guide for future high quality TURP videos.