The effect of mass functionality on laparoscopic adrenalectomy outcomes.

PURPOSE: This study aimed to determine the effect of adrenal mass functionality and different hormone subtypes synthesized by the adrenal masses on laparoscopic adrenalectomy (LA) outcomes. MATERIALS AND METHODS: The study included 298 patients, 154 of whom were diagnosed with nonfunctional masses. In the functional group, 33, 62, and 59 patients had Conn syndrome, Cushing's syndrome, and pheochromocytoma, respectively. The variables were analyzed between the functional and nonfunctional groups and then compared among functional masses through subgroup analysis. RESULTS: The incidence of diabetes mellitus, hypertension, and obesity, blood loss, and length of hospital stay (LOH) were significantly higher in the functional group than in the nonfunctional group. In the subgroup analysis, patients with pheochromocytoma had significantly lower body mass index but significantly higher mass size, blood loss, and LOH than the other two groups. A positive correlation was found between mass size and blood loss in patients with pheochromocytoma (p ≤ 0.001, r = 0.761). However, no significant difference in complications was found among the groups. CONCLUSIONS: In this study, patients with functional adrenal masses had higher comorbidity rates and American Society of Anesthesiologists scores. Moreover, blood loss and LOH were longer on patients with functional adrenal masses who underwent LA. Mass size, blood loss, and LOH in patients with pheochromocytoma were significantly longer than those in patients with other functional adrenal masses. Thus, mass functionality did not increase the complications.

Prognostic value of estrogen receptors in patients who underwent prostatectomy for non­metastatic prostate cancer.

Estrogen receptors in prostate cancer (PCa) are a subject of debate. The aim of the present study was to investigate whether estrogen receptor-α (ERα) and estrogen receptor-ß (ERß) impact the biochemical recurrence (BCR) of non-metastatic PCa after surgery. Following the application of the exclusion criteria, data from 108 patients who underwent laparoscopic radical prostatectomy between January 2011 and December 2019 were retrospectively evaluated. A total of 36 patients with BCR constituted the BCR group. The control group was formed using the Propensity Score Matching (PSM) method with a 1:2 ratio, including parameters with well-studied effects on BCR. The median follow-up time was 74.3 (range, 30-127.5) months in the BCR group and 66.6 (range, 31.5-130) months in the control group. Pathology specimens from the two groups were immunohistochemically stained with ERα and ERß antibodies. Logistic regression analysis and survival analysis were performed. No differences in clinicopathological characteristics were detected between the two groups. The patients with ERα(-)/ERß(+) staining results had a significantly fewer BCRs than other patients (P=0.024). In the logistic regression analysis, patients with ERα(-)/ERß(+) PCa also had a significantly lower risk of recurrence (P=0.048). In the survival analysis, the 5-year BCR-free survival rate of patients with ERα(-)/ERß(+) PCa was higher than that of other patients (85.7 vs. 66.1%; P=0.031). Excluding the effects of well-studied risk factors for recurrence by the PSM method, the present study showed that ERα and ERß have prognostic value for non-metastatic PCa. The 5-year BCR-free survival rate is significantly higher in patients whose PCa tissue has ERα(-)/ERß(+) staining results.

Should We Hesitate to Perform Laparoscopic Adrenalectomy for Pheochromacytomas Larger Than 5 cm in Diameter with No Pre-Operative Suspicious Criteria for Malignancy?

Objectives: We aimed to compare the outcomes of patients who underwent laparoscopic adrenalectomy (LA) for pheochromacytoma (PHE) ≥5 cm versus <5 cm in diameter. Methods: Demographic variables, tumor characteristics, perioperative, and post-operative outcomes were evaluated retrospectively and compared between groups. Results: Between February 2008 and August 2020, 54 patients (27 female and 27 male) enrolled to the study and divided into two groups according to the tumor size as group L ≥5 cm (28 patients) and group S as <5 cm (26 patients). Groups compared in the aspect of American Society of Anesthesiologists scores, body mass index, tumor locations, ratio of elder (≥60-years-old) patients, and gender ratio were similar between groups S and L (p=0.572, p=0.516, p=0.6, p=0.331, and p=0.207, respectively). Mean duration of surgery (p=0.266), mean estimated blood loss (p=0.587), and mean length of hospital stay (p=0.374) were similar between groups. Difference between maximum and pre-operative systolic pressure and the difference between maximum and pre-operative diastolic pressure were similar between S and L groups (p=0.852 and p=0.526, respectively). Patients whose systolic blood pressure >160 mmHg, systolic blood pressure >30% of baseline, and heart rate >110 (p=0.307, p=0.609, and p=0.296) were similar. Diastolic blood pressure <30%, there is a difference between groups in favor of group L, but not statistically different (p=0.077). Conclusion: It is necessary to work in coordination with endocrinologists and anesthesiologists and LA for PHE should be performed in experienced medical centers regardless of tumor size with multidisciplinary approach.

The Differences Between the Right and Left Side Laparoscopic Donor Nephrectomy Outcomes: A Comparative Analysis of Single-Center Outcomes.

OBJECTIVE: This study aimed to compare the right and left side laparoscopic donor nephrectomy (LDN) outcomes of a single center. MATERIALS AND METHODS: The outcomes of patients who underwent LDN in our clinic between 2008 and 2020 were evaluated retrospectively. Two groups were consisted according to the side of the donor kidney. The gender, age, body mass index, duration of operation, amount of bleeding, warm ischemia time, drain removal time, and duration of hospitalization and complications were compared between groups. RESULTS: A total of 314 patients were included in the study. Sixty-six patients underwent right LDN and 248 underwent left LDN. There was no difference between groups in terms of age, duration of operation, amount of bleeding, warm ischemia time, and complications (p>0.05). However, drain removal time and duration of hospitalization were longer in the left LDN group (p<0.05). CONCLUSIONS: The right LDN had similar intraoperative outcomes with the left LDN. However, failure on meticulous dissection of the lymphatic structures during left LDN might cause chylous drainage and prolonged hospitalization time.

Laparoscopic ureterolithotomy; an equally effective and a sensible alternative to flexible ureterorenoscopy in the management of large ureteral stones in terms of effectivity and cost.

OBJECTIVES: We aimed to understand whether laparoscopic ureterolithotomy (LU) is a good alternative to flexible ureterorenoscopic lithotripsy (FURS) by comparing these techniques concerning cost-effectiveness. METHODS: We analysed 79 patients with upper ureteral stones larger than 1.5 cm underwent FURS or LU concerning cost-effectiveness analysis. The data including age, body mass index (BMI), stone size, operation time, hospitalisation time, complications and stone-free rates of 15th day and 3rd months. We audited the costs of FURS and LU and compared them concerning cost-effectiveness. RESULTS: There was not any statistically significant difference between the two groups with regard to age, BMI, stone size, stone-free rates at the 3rd month, and complication rates, (p>0.05). The operation times were statistically lower in the FURS than in the LU (61.5±24.3 min and 140.9±49.1 min, respectively, p<0.05). The stone-free rate at the 15th day was lower in the FURS group than in the LU group (31 (81.6%) and 41 (100%), respectively, p<0.05) (Table   I). However, this statistical difference disappears at 3 months (p>0.05). The mean costs of FURS and LU were $194.2±12.4 and $179.2±58.5, respectively (p<0.001). CONCLUSION: FURS is equally effective to LU in terms of stone-free rates. The cost of FURS is higher statistically than LU. FURS is shown as the first choice for the upper ureteral stones larger than 10 mm in size, if the laparoscopic experience is in high-level situations in that clinic, LU may be a suitable alternative to FURS, especially for challenging cases.

OBJETIVOS: El objetivo es determinar si la ureterolitectomia laparoscópica (UL) es una buena alternativa a la ureterorenoscopia flexible con litotricia (URSF) a través de la comparación de ambas técnicas en lo que a coste y efectividad radica.MÉTODOS: Analizamos 79 pacientes con litiasis ureterales proximales de más de 1,5 cm que recibieron URSF o UL en relación a coste-efectividad. Los datos recogidos incluyeron edad, IMC, tamaño de la litiasis, tiempo de la cirugía, tiempo de hospitalización, complicaciones y tasa libres de litiasis a los 15 días y 3 meses de la cirugía. Auditamos los costes de las URSF y UL y se compararon en relación a coste-efectividad. RESULTADOS: No hubo diferencias estadísticamente significativas entre los grupos en relación a la edad, IMC, tamaño de la litiasis, tasa libre de litiasis a los 3 meses y complicaciones (p>0,05). Los tiempos quirúrgicos fueron estadísticamente menores en URSF en comparación a UL (61,5±24,3 min y 140,9±49,1 min, respectivamente, (pz0,05). La tasa libre de litiasis a los 15 días fue mas baja en el grupo de URSF que UL (31 (81,6%) y 41 (100%), respectivamente, p <0,05](Tabla I).Aunque la diferencia estadística desaparece a los 3 meses (p>0,05). El coste medio de URSF y UL fue de $194,2 ± 12,4 y $ 179,2 ± 58,5, respectivamente (pCONCLUSIÓN: URSF es igualmente efectiva que UL en términos de tasa libre de litiasis. Los costes de URSF es más alto que UL. URSF es la primera opción en el tratamiento de litiasis de más de 1 cm en uréter proximal. En caso de experiencia laparoscópica de alto nivel, UL puede sustituir a URSF, especialmente en casos difíciles.

Is laparoscopic adrenalectomy for pheochromocytoma safe and effective in geriatric patients?

OBJECTIVES: The study aimed to assess the haemodynamic changes of laparoscopic adrenalectomy (LA) in geriatric patients with pheochromocytoma (PHEO). To the best of our knowledge, this is the first study to evaluate the haemodynamic outcomes of LA in this patient population. METHODS: Data of 350 patients who underwent single-side transperitoneal LA between 2000 and 2020 were reviewed retrospectively. Patients with a histopathological diagnosis of PHEO were included in the study and classified into two groups according to their ages at the date of surgery. Patients older than 65 years were accepted as elderly according to the World Health Organisation (WHO) recommendations. RESULTS: A total of 54 patients underwent LA for PHEO. Fifteen patients were enrolled in the elderly and 39 in the young groups. There were no significant differences in terms of the operation site (0.564), tumour size (0.878), perioperative results such as mean anaesthesia; operation times, blood loss and haemodynamic changes. There were no significant differences in mean hospitalisation and intensive care unit times. One patient in both groups had grade 1 complication according to Clavien Dindo classification (prolonged ileus, managed with medical treatment and transfusion during surgery, respectively). CONCLUSION: Young and elderly patients had similar outcomes in terms of haemodynamic changes that occurred with LA. LA in elderly patients with PHEO is as safe and effective as in younger patients.

Is 6 cm Diameter an Upper Limit for Adrenal Tumors to Perform Laparoscopic Adrenalectomy?

Background: We aimed to compare the results of patients who underwent laparoscopic adrenalectomy (LA) for masses ≥6 cm versus <6 cm in diameter in our tertiary referral university hospital. Materials and Methods: Three hundred thirty consecutive patients were divided into two groups according to tumor size (≥6 and <6 cm in diameter). Demographic variables, body mass index (BMI), lesion localization (right/left), tumor diameter, pathological diagnosis and surgical outcomes, including operation time, estimated blood loss (EBL), conversion to open surgery, complications, and length of hospital stay were compared between groups. Results: Between February 2008 and March 2020, 53 patients (29 male-24 female) with ≥6 cm (L group) adrenal tumor and 277 patients (105 male-172 female) with <6 cm tumor (S group) underwent transperitoneal LA. One hundred sixty-eight (50.9%) tumors localized on the left side. In L group mean tumor size in female and male patients was 87.5 ± 40.8 mm (range 50-225 mm) and 67.3 ± 18.4 mm (range 10-100 mm), respectively (P < .05). Age, American Society of Anesthesiology scores, BMI, and mean operation time were similar between groups (P > .05). Postoperative complications were more often in L group (P = .005). EBL in group L and group S was 86 ± 70.4 mL (range 10-500 mL) and 55 ± 44.2 mL (range 10-300 mL), respectively (P = .003). Length of hospital stay in group L and group S was 3.7 ± 3.5 days (range 1-26) and 3 ± 1.6 days (range 1-9), respectively (P = .086). Significant variables in multivariate analysis, including gender (male), EBL, and postoperative complication rate, were entered into multivariate regression analysis, which presented that EBL and postoperative complication rates were independent significants for the L group. Conclusion: Six centimeters should not be considered as an upper limit of transperitoneal lateral LA and may be safely performed in centers with experience. Further studies are needed to confirm our data.

Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time.

INTRODUCTION: To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. METHODS: Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. RESULTS: HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. CONCLUSION: LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

Laparoscopic versus open radical cystectomy in the treatment of locally advanced T3 and T4 bladder cancer: Perioperative and Mid-term oncological outcomes.

OBJECTIVE: In this study, we aim to compare the perioperative and midterm oncological outcomes in patients with advanced bladder cancer and those who had laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC). MATERIAL AND METHODS: We retrospectively reviewed medical records of patients who underwent LRC or ORC in a single center between 2008 and 2014 with a pathological diagnosis of pT3 and pT4 bladder cancer. Thirty-five and 39 patients were included in the study as part of the LRC and ORC groups, respectively. RESULTS: There was no statistically significant difference between the two groups in terms of disease-free survival (LRC, 39.8±4.86 months; ORC, 45.47±8.92 months, P=0.896). Average estimated blood loss and length of hospitalization were significantly less in the LRC group. The overall survival rates of patients at 1, 2, and 3 years were 73%, 46%, and 46% in the ORC group and 78%, 65%, and 40% in the LRC group, respectively, and there was no statistically significant difference between the two groups. One patient in the ORC group experienced rectal injury in the form of a serosal tear, which was repaired primarily without any postoperative sequelae. There were no conversions in the laparoscopic group. Similarly, in 1 patient, rectal serosal tear was repaired preoperatively. CONCLUSION: Our study showed that LRC provides midterm oncological outcomes similar to ORC in the treatment of locally advanced T3 and T4 bladder cancer. However, long-term oncological and functional outcomes are required.

Challenging risk factors for right and left laparoscopic adrenalectomy: A single centre experience with 272 cases

ABSTRACT Purpose This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. Materials and Methods A total of 272 patient's medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. Results 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the first 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. Conclusions During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.

Challenging risk factors for right and left laparoscopic adrenalectomy: A single centre experience with 272 cases.

PURPOSE: This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. MATERIALS AND METHODS: A total of 272 patient's medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. RESULTS: 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the fi rst 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. CONCLUSIONS: During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.

Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes.

BACKGROUND: Penile plication techniques with or without degloving offer a minimally invasive option for the treatment of penile curvature. AIM: To review the outcomes of penile plication surgery and patient satisfaction with and without degloving of the penis. METHODS: We conducted a retrospective analysis of 52 patients who underwent penile plication for the treatment of Peyronie disease or congenital penile curvature. OUTCOMES: Surgical success rates, complications, and patient satisfaction determined with the Treatment Benefit Scale were compared between groups. RESULTS: The overall surgical success rate was 92.3% at a mean follow-up of 18.84 ± 23.51 months. There were no intraoperative complications. In the degloving group, 42.6% of patients were greatly satisfied and 42.6% had better outcomes; in the without degloving group, 61.5% of patients were greatly satisfied and 30.8% had better outcomes. Comparison of outcomes was not statistically significant between groups. CLINICAL IMPLICATIONS: The results of the present study indicate the two techniques can be used for penile plication. CONCLUSION: With or without degloving, penile plication is safe and effective and provides high patient satisfaction. Kadirov R, Coskun B, Kaygisiz O, et al. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017;5:e142-e147.

Open vs Laparoscopic Simple Prostatectomy: A Comparison of Initial Outcomes and Cost.

INTRODUCTION: We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP). PATIENTS AND METHODS: A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically. RESULTS: No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Qmax), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. CONCLUSION: The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount, and Qmax values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.

Comparison of ureteroscopic laser lithotripsy with laparoscopic ureterolithotomy for large proximal and mid-ureter stones.

OBJECTIVES: To compare the effectiveness and complications of ureteroscopic laser lithotripsy with laparoscopic ureter laparoscopic ureterolithotomy in mid- or proximal portion of large ureteral stones. MATERIAL AND METHODS: We reviewed patients with large (>15 mm) ureteral stone and those who underwent ureteroscopic laser lithotripsy (URS group) or laparoscopic ureterolithotomy (LU group). The first attempt was considered successful in patients who had residual fragments smaller than 2 mm and no conversion of the primary procedure to another. RESULTS: Sixty patients (URS group 29, LU group 31) met inclusion criteria. FURS was used as an adjunctive procedure in one patient for URS group and in two patients for LU group in the same season. LU had a higher success rate and the first-day stone-free rate when compared with URS. Number of procedures was also significantly higher in URS group. There was no difference in stone-free rates at the first and third months, and length of hospitalization and operation were higher in the LU group. Only two patients in the LU group and one patient in the URS group had major complications. CONCLUSIONS: Laparoscopy is an effective option of large proximal and mid-ureter stone treatment; however, URS provides similar stone-free rates at three months as a minimal invasive procedure.

Public awareness of testicular cancer and self-examination in Turkey: a multicenter study of Turkish Urooncology Society.

BACKGROUND: Testicular self-examination is the easiest and cheapest way to scan testicular cancer. However, the public awareness about testicular self-examination is very low. We aimed to investigate the public awareness of Turkish people about testicular cancer and testicular self-examination. METHODS: We performed a survey consisting of 10 questions concerning testicular cancer and testicular self-examination in 799 students in the first year of 12 different medical schools. Aiming for a common method of data collection, the questionnaires were administered to the students during a class just before the lesson started. The whole data from all of the centers were pooled in a common data-base file. RESULTS: Eighty-nine (11.1%) of the participants reported that they had knowledge about testicular cancer, but only 11 (1.4%) of them answered all the questions about testicular cancer correctly. Eight (1%) of the participants reported that they had been performing testicular self-examination routinely once a month. Four (0.5%) of them were both well informed about testicular cancer and had been performing testicular self-examination once a month as suggested. CONCLUSION: The present study showed that awareness on testicular cancer and testicular self-examination is very low and suggests a need for efforts in Turkey to increase public awareness and education.

What is the adequacy of biopsies for prostate sampling?

OBJECTIVE: To investigate the adequacy of the samples obtained by prostate biopsies and the factors those could affect this adequacy. MATERIALS AND METHODS: Three hundred seventy-eight patients who underwent transrectal ultrasound guided biopsy have been included into the study. The biopsy samples have been retrospectively reviewed in terms of presence of prostatic glandular elements and prostatic tissue. Factors which may affect the presence of glandular elements have been investigated. RESULTS: The mean age, PSA level, and prostate volume were 65 ± 8.1 years, 13.6 ± 17.8 ng/ml, and 52.5 ± 29.8 ml, respectively. Overall cancer detection rate was 25.3%. The highest incidence of absence of prostatic glandular elements was detected at apical (21.8%) and far lateral (21.5%) biopsy samples. The overall rate of absence of glandular elements was 0.16. Absence of glandular elements in at least 1 sample of the biopsy set was detected in 50% of patients. This figure was 27.8% and 16.1% for the absence of glands in at least 3 and 5 samples of the biopsy set, respectively. These results have also been found to be operator-dependent. For patients with PSA between 4 and 10 ng/ml, we found that cancer detection rate was lower in patients with absence of glandular elements. When the possible factors were analyzed, age, PSA, prostate volume, findings of prostate examination, and presence of cancer were not found to be effective on these parameters, whereas the most important factor was the biopsy localization. CONCLUSION: Our study showed that prostatic glandular elements, which are keys for histological diagnosis, were absent in a significant number of prostatic biopsy samples and patients. This inadequacy was most prominent in apical and far lateral biopsy specimens and found to be operator-dependent.

Treatment of retrocaval ureter by pure laparoscopic pyelopyelostomy: experience on 4 patients.

OBJECTIVES: To present our experience and the feasibility of pure laparoscopic pyelopyelostomy for treatment of retrocaval ureter (RCU). METHODS: RCU was detected in 4 male (ages: 4, 16, 36, 48) patients, with complaints of flank pain. In all the patients, Type 1 RCU was present and the right ureter was involved. All patients underwent intraoperative retrograde pyelography before laparoscopy. The patients were operated upon using the transperitoneal approach in the lateral decubitis position, with two 10 mm and two 5 mm ports. After the ureter was released from the superior and inferior parts of the inferior vena cava, the dilated renal pelvis was transected and the ureter was brought in an anterolateral position to the vena cava. After the completion of the posterior wall anastomosis of pyelopyelostomy with 4-0 polyglactin sutures in a continuous manner, a double-J-stent was placed and the anterior wall was anastomosed in a watertight manner. A drain was placed in the operative area and the operation was completed. RESULTS: Mean operation time was 210 minutes. No intraoperative complications occurred. In one patient, antegrade double-J-stent placement failed, and the stent was therefore placed in the retrograde way without any complications. Postsurgery, the urethral catheter was removed on the first day, and the drain on the second. All patients were discharged 48 hours after surgery. The third month postoperative follow-up confirmed that the anastomoses were patent and patients were symptom-free. CONCLUSIONS: Pure laparoscopic pyelopyelostomy seems technically feasible and reliable for RCU treatment. Our experience showed that laparoscopy should be the standard treatment option for such patients.

Cardiac and caval invasion of left adrenocortical carcinoma.

Adrenocortical carcinoma (ACC) is a rare and highly malignant neoplasm. We present the case of a 51-year-old male patient with a left-sided ACC admitted to hospital with ipsilateral flank pain, weight loss, difficulty in breathing, abdominal discomfort and swelling and bilateral leg edema. Thoracoabdominal computed tomography revealed a huge adrenal mass with obvious tumor thrombus involvement of the inferior vena cava and right atrium. This is the first report describing caval and opposite side renal vein invasion of a left-sided ACC treated with grafting of the vessels. Histopathological examination of the tumors confirmed the diagnosis of ACC. Postoperative recovery was uneventful. The patient received an adrenolytic agent, mitotane, postoperatively and is alive with no evidence of recurrence after 2 years of follow-up.

Genetic evaluation of von Hippel-Lindau disease for early diagnosis and improved prognosis.

von Hippel-Lindau disease (VHL) is a rare autosomal-dominant disorder in which affected individuals develop tumors in a number of locations. It occurs at a frequency of one per 36,000 population. Metastatic renal cell carcinoma (RCC) remains the leading cause of mortality in patients with clear cell RCC arising from mutations in the VHL tumor suppressor. RCC is the presenting feature in only 10% of VHL patients. VHL patients can present with a number of other renal lesions, such as hemangiomas and benign adenomas, in addition to simple cysts and RCC. We have investigated VHL gene mutations in familial RCC. The study cohort consisted of four patients with synchronous VHL and RCC and 31 kindreds. Analysis of the chromosomes was performed by the Moorehead method. Although none of the kindreds investigated had clinical evidence of VHL disease, 22 were found to have a VHL gene mutation consisting of deletions on the short arm of chromosomes 3, 17, and 19. Detailed clinical examination of the 22 kindreds with a VHL mutation revealed cerebellar hemangioblastoma (three kindreds), meningioma (two) and renal cell carcinoma (five). No VHL gene mutation was detected in nine kindreds. The prevalence of VHL gene mutations was 70.9% in the familial RCC kindreds. As a result of this study, the kindreds of patients with synchronous VHL and RCC have undergone molecular genetic testing and should be investigated for associated disorders.

Association of vitamin D receptor gene Taq I polymorphism with recurrent urolithiasis in children.

OBJECTIVE: Urolithiasis has a strong familial component. However, to date, no specific genetic abnormality has been identified. It has been reported that allelic variation in the vitamin D receptor (VDR) gene may affect calcium absorption and excretion. Urolithiasis is a multifactorial disease in which both genetic and environmental factors have an effect on onset and severity of disease. In the present study, the role of Taq I polymorphism of vitamin D receptor gene in urolithiasis was studied. METHODS: Eighty children with calcium stone disease (40 with single episode of stone disease and 40 with recurrence) and 40 controls were enrolled. Polymorphic sites were amplified by polymerase chain reaction, digested with Taq I restriction enzymes and analyzed by gel electrophoresis. Allelic or genotypic frequencies were calculated and associations between them and the presence of hypercalciuria, family history and stone recurrence were evaluated. RESULTS: Incidence of Taq I tt genotypes was significantly higher in patients with recurrent calcium-stone disease compared to the controls. In addition, the frequency of the 't' allele was higher in recurrent calcium-stone formers. Taq I t allele was found to be associated with increased risk of recurrence. No association between Taq I polymorphism and a positive family history was found in the present study. The frequency of hypercalciuria was higher in patients with the 'tt' genotype. CONCLUSION: Taq I t allele of the VDR gene may be a risk factor for severe urolithiasis and recurrent stone disease.