Failed insertion of ureteral access sheath during flexible ureterorenoscopy: a randomized controlled trial comparing second session flexible ureterorenoscopy or same session mini percutaneous nephrolithotomy.

PURPOSE: To compare different treatment approaches in patients with failed ureteral access sheath placement during first flexible ureterorenoscopy (f-URS) session. METHODS: Patients with kidney stones measuring 1-2 cm, presented to our urology clinic between September 2020 and September 2021, were included in the study for evaluation. The study was designed prospectively (Clinical-Trials number NCT05911945). Patients were randomized into two groups, in case of a failed ureteral access sheath placement during the first f-URS session. In group 1, JJ stent was placed for dilation and second session of f-URS was planned. In group 2, mini percutaneous nephrolithotomy (mPNL) was performed in the same session. RESULTS: Twenty-four patients were included in each group. Pre-operative demographic data and stone characteristics of the patients in each group were comparable. Operation time, fluoroscopy time, and hospital stay were significantly higher in the mini-PNL group. When SF-36 values were compared, physical function, pain, role limitation, and general health value scores were improved in both groups after treatment. The improvement in physical function and pain parameters was statistically significant in the mPNL group. In patients with failed ureteral access sheath placement, placing a JJ stent for dilation and postponing f-URS for 4-6 weeks provides the advantages of low hospitalization time for each admission, shorter fluoroscopy and operation time. CONCLUSIONS: Performing mPNL in the same session, results in better improvements in SF-36 parameters such as pain and physical function compared to f-URS. The success and complication rates of the two procedures were comparable.

Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results.

Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.

Evaluation of Satisfaction and Outcomes of Patients Who Underwent Two-Piece Inflatable Penile Prosthesis Implantation.

Introduction The aim of this study was to evaluate patient and partner satisfaction, device reliability, and complications in patients who underwent two-piece inflatable penile prosthesis (IPP) implantation. Patients and methods The data of 22 patients who underwent two-piece inflatable penile prosthesis implantation in our department between 2015 and 2018 were retrospectively analyzed, and a detailed review of all clinical reports was performed. Phone or face-to-face interviews were undertaken to assess the satisfaction rates of the patients and their partners using the modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Results The mean patient age and partner age were 57.95 ± 6.16 and 58.12 ± 6.66 years, respectively. The mean erectile dysfunction (ED) period was 5.33 ± 2.16 years, and the etiologies of erectile dysfunction were radical pelvic surgery (41%), diabetes mellitus (37%), and vascular disorders (22%). The mean operative time and postoperative hospital stay were 102 ± 29 minutes and 1.8 ± 0.66 days, respectively. Over a mean follow-up period of 29.04 ± 14.48 months, two (9%) cases underwent revision surgery due to mechanical device failure in one and infection in the other. The overall patient and partner satisfaction rates were 73% and 59%, respectively. Conclusions The two-piece inflatable penile prosthesis is an effective, reliable, and user-friendly prosthesis with acceptable complication and revision rates and provides a high level of patient and partner satisfaction in selected and fully informed patients.

Modified Autologous Transobturator Tape Surgery - A Prospective Comparison With Transobturator Tape Surgery.

OBJECTIVE: To compare modified autologous transobturator-tape (a-TOT) and transobtrator-tape (TOT) surgeries in terms of effectivity and complications. MATERIALS AND METHODS: Prospectively 117 patients (a-TOT:36,TOT:81) were enrolled in this study. A-TOT was performed with autologous fascia elongated with nonabsorbable sutures and TOT was performed with standard technique. Preoperative data regarding operative time, complications and postoperative visual analog scores (VAS) were noted. Patients were assessed 12 months after surgery. Objective cure was evaluated with cough stress test (CST) and necessity of reoperation due to failure while subjective cure was evaluated with Patient Global Impression of Improvements scale(PGI-I) and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms(ICIQ-FLUTS) questionnaire. RESULTS: The mean follow-up time was 21.5 ± 1.1 months. Preoperative demographic characteristics were similar. The mean operation time was longer in a-TOT group(P = .001).VAS at postoperative 8. and 24. hours and overall complication rates were similar for the groups. Clavien grade-3 complications occurred only in TOT group (3.7%). Objective cure rates according to CST were 97.3% and 97.6% (P = .998) and the subjective cure rates according to PGI-I were 97.3% and 92.5% (P = .664) for a-TOT and TOT groups, respectively. One patient in TOT group needed reoperation. The a-TOT group gained better improvements in total score and total QoL score of ICIQ-FLUTS (P = .028 and P = .032, respectively) as well as subscore and QoL subscore of filling and voiding sections of ICIQ-FLUTS (P = .043, P = .048,P = .034, and P = .039, respectively). CONCLUSION: The a-TOT technique has similar objective and subjective cure rates and overall complication rates furthermore better results in postoperative voiding dysfunction and de-novo filling phase symptoms when compared to TOT.

Modified autologous transobturator tape surgery - evaluation of short term results.

OBJECTIVES: The aim of this study is to evaluate the short-term outcomes of our modified autologous transobturator tape (aTOT) technique with rectus abdominis muscle fascial graft for the treatment of female stress urinary incontinence (SUI). MATERIAL AND METHODS: The data of 22 patients who underwent modified aTOT were recorded. Perioperative data regarding operative time, complications and postoperative visual analogue scores were noted. Patients were assessed 18 months after surgery. The primary endpoints of this study were the improvements in the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) subscores, one-hour pad test and cough stress test rates as an objective cure as well as the improvements in the PGI-I and ICIQ-FLUTS quality of life scores as a subjective cure. RESULTS: Mean age and the mean follow-up period were 51.7 ± 9.8 years and 20.1 ± 0.9 months, respectively. Urethral hypermobility and a positive cough stress test were detected in all the patients. Mean operative time was 43.8 ± 8.1 min. and the overall complication rate was 9%. Mean VAS scores at postoperative 24 hours were 2.6 ± 1.2. At the postoperative eighteenth month, no patient had a positive cough test and mean PGI-I score was 2 while two patients had moderate urinary incontinence according to the pad test. Pad test results, ICIQ subscores of voiding QoL, incontinence, incontinence QoL, total score and total QoL score at baseline and eighteen months after surgery were 76.9 ± 19.9, 9.6 ± 4.1, 15.5 ± 4.0, 39.5 ± 7.9, 27.9 ± 6.6, 68.4 ± 13.8 and 7.1 ± 2, 10.1 ± 2.4, 6.6 ± 2.1, 13.4 ± 4.5, 20.4 ± 4.8, 39.7 ± 9.2 respectively (p = 0.001, p = 0.004, p = 0.001, p = 0.001, p = 0.001, and p = 0.001, respectively) CONCLUSIONS: Modified aTOT is an effective and safe method with low morbidity for SUI treatment in short term.

Autologous transobturator midurethral sling.

OBJECTIVE: The aim of this study is to describe a novel transobturator midurethral sling surgery technique by using rectus abdominis fascia. MATERIAL AND METHODS: A 54-year-old woman complaining of urinary leakage during effort was diagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry and measurement of residual urine volume. She was anxious about complications related to synthetic meshes. However, she was not interested in relatively morbid surgeries such as colposuspension and pubovaginal sling. Autologous transobturator midurethral sling was discussed with the patient. The patient approved the surgery and the surgery was planned. A 5 cm rectus fascia was harvested via suprapubic incision and non-absorbable stay sutures were placed on its' both edges. Anterior vaginal incision together with paravaginal dissection was performed, as in classical transobturator sling surgery. Groin puncture and blind dissection of adipose tissue was performed. C-shaped trocars were inserted, and advanced through groin punctures and brought up to midurethral incision by finger guidance. Stay sutures were transported via C-shaped trocars to the groin puncture in both sides. Graft was positioned on the midurethral part without any tension and stay sutures were tied to create a tissue bridge on obturator membrane. Incisions were closed and vaginal tampon was placed. Patient was discharged at the first postoperative day. RESULTS: At postoperative third and sixth months, patient was totally dry and did not have any voiding complaints. Small abdominal and vaginal incisions were clean, as well. CONCLUSION: Autologous transobturator midurethral sling surgery is a safe, effective and feasible surgical option for stress urinary incontinence in the era which mesh-related concerns are rising. Studies with larger volume and long-term follow up periods are needed.

Solitary fibrous tumor/hemangiopericytoma of the penis.

Solitary fibrous tumor/hemangiopericytoma (SFT-HMP) is a rare spindle-cell mesenchymal tumor, thought to be of myofibroblastic origin. Penile SFT-HMP was mentioned in the literature in two separate case reports which were published in 2015 and 2017. We present the first case of SFT-HMP which is localized on corpus cavernosum of the penis. A 55-year-old man presented to our clinic with a small and gradually growing lesion on his penis for the past year, which recently caused difficulties during sexual intercourse. On physical examination; a well-shaped, nodular non-fluctuant, solid, painless mass, measuring 4×4 cm was palpated. Magnetic resonance imaging showed 5×5 cm mass located on the right corpus cavernosa. Under spinal anesthesia, surgical excision was performed. Pathologically, the tumor had an irregular architecture patterns and was characterized by hypercellular areas separated by thin-walled, branching vessels, lined with a single layer of flattened endothelial cells. SFT-HMP rarely occurs in genital tract and penile presentation is among the rarest. It should be classified and considered under penile masses, especially if the mass is well circumscribed, painless and slowly growing in nature. After differential diagnosis, surgical excision is mandatory.

Comparison of Flexible Ureterorenoscopy and Mini Percutaneous Nephrolithotomy in the Management of Multiple Renal Calculi in 10-30 mm Size.

PURPOSE: To evaluate the efficacy and safety of flexible ureterorenoscopy (f-URS) and mini percutaneous nephrolithotomy (mini-perc) in the management of 10-30 millimeter multiple renal stones. MATERIALS AND METHODS: The charts of patients who underwent f-URS or mini-perc for multiple kidney stones between January 2011 and July 2015 were retrospectively analyzed. Patients with multiple 10-30-mm-sized renal stones were enrolled in the study. A total of 374 patients underwent mini-perc and 85 patients met the study inclusion criteria. In the same period, f-URS was performed in 562 patients, and 163 had 10-30-mm multiple renal stones. We selected 85 patients to serve as the control group from this cohort using propensity score matching with respect to the patient's age, ASA score, number, size, and location of stones to avoid potential bias between groups. RESULTS: The mean operation time and fluoroscopy screening time (FST) was significantly longer in the mini-perc group (P = .001 and P = .001, respectively). The mean hospitalization time was 76.9±38.7 hours in the mini-perc group and 25.0±27.7 hours in the f-URS group (P = .001). Post-operative complications, according to the Clavien classification system, were significantly more frequent in the mini-perc group (P = .003). The stone-free rate was 87% in the f-URS group and 83.5% in the mini-perc group (P = .66). CONCLUSION: Our study demonstrated that f-URS and mini-perc were effective treatment options for multiple renal stones 10-30 mm in size. However, f-URS was associated with a significantly lower complication rate, shorter operation time, shorter FST, and shorter hospitalization time.

Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial.

The effects of ureteral stent diameters on ureteral stent-related symptoms were evaluated by using Turkish-validated Ureteral Stent Related Symptoms Questionnaire (USSQ). Datas on 126 patients underwent uncomplicated flexible ureterorenoscopy and 62 patients underwent uncomplicated semirigid ureteroscopy surgery without stent insertion (group 3) were collected. Patients were randomized preoperatively in a double-blind fashion to 4.8 French (group 1) and 6 French (group 2) ureteral JJ stents groups. The first follow-up visit was done at one week after surgery for all groups. Stents were removed on the third postoperative week for stented groups. The second follow-up visit was done at one week after stent removal for group 1 and group 2, and four week after surgery for group 3. Preoperative characteristics, operation time and hospitalization times were similar in both groups. Total USSQ scores were 91.9, 103.0, 44.2 at first visit and 54.3, 58.7, 28.5 at second visit in group 1, group 2, and group 3, respectively. At both first and second visits, the group 2 had significantly higher USSQ scores than the group 1 (p = 0.01 and p < 0.001, respectively). Group 1 and 2 had higher scores than group 3 at both visits. Ureteral stents are associated with poor effects on patients' comfort and high USSQ scores. Using 4.8 Fr JJ stents improves stent-related symptoms and decreases the USSQ score more than 6 Fr JJ stents. Therefore, if ureteral stent is to be used after URS, we recommend using 4.8 Fr stent.

Noninvasive treatment of intraperitoneal urinary system perforations with percutaneous placement of a peritoneal drainage catheter

Background/aim: Intraperitoneal urinary system perforation is a rare but serious complication of endoscopic urologic surgery. Percutaneous placement of a peritoneal drainage catheter is already mainly used for diagnostic purposes. We present our experience with percutaneous drainage catheters for conservative management of intraperitoneal urinary system perforations occurring during endoscopic urologic surgery with close monitorization in selected cases. Materials and methods: Urinary system perforations had developed in 21 (0.8%) of 2603 patients undergoing endoscopic urologic surgery at our department in 2014­2016. The perforation was intraperitoneal in only 5 (0.19) of all the patients. A percutaneous peritoneal drainage catheter with the guidance of ultrasonography was placed in four of the patients. Results: Conservative management by draining excess fluid with a drainage catheter percutaneously placed under close monitorization was successful in four out of five patients with urinary system perforation occurring during endoscopic urologic surgery. The remaining patient was treated successfully with open laparotomy because of fulminant evidence of peritonitis. Conclusion: Our findings and experience may suggest that conservative management of intraperitoneal urinary system perforations occurring during endoscopic urologic surgery by percutaneous drainage catheter under close monitorization is feasible in carefully selected patients.

Comparison of Single and Prolonged Fluoroquinolone Prophylaxis and Risk Factors for Infectious Complications After Transrectal Prostate Biopsy

Background: The ideal prophylaxis duration for transrectal ultrasonography-guided prostate biopsy is incompletely defined. Aims: To compare the infectious complications of transrectal ultrasonography-guided prostate biopsy with and without extended antibiotic prophylaxis. The secondary aim was to evaluate the risk factors for infectious complications. Study Design: Prospective observational study. Methods: Four hundred patients who underwent transrectal ultrasonography-guided prostate biopsy were recruited. Patients orally received either 750 mg ciprofloxacin 60 min before the procedure or 500 mg ciprofloxacin twice a day for a duration of 7 days with the initial dose administered 24 h prior to the procedure. All patients were followed-up for 4 weeks after the transrectal ultrasonography-guided prostate biopsy procedure for infectious complications. Screening of urine was carried out in all patients on the 3rd and 7th day after the procedure. Medical histories of all patients were collected prior to biopsy. Information on medical history include the following: hospitalization, urethral catheterization, or urinary tract infections within the past 12 months; antibiotic use within the last 3 months, prior urinary tract interventions, and previous transrectal ultrasonography-guided prostate biopsy and Charlson comorbidity indexes. Ultrasound-guided biopsy was carried out using General Electric's 7 MHz transrectal ultrasound device in the left decubitus position. Patients received one of the two ciprofloxacin-based prophylaxis regimens. Subsequent transrectal ultrasonography-guided prostate biopsy to all patients were followed-up for 30 days. Further follow-up of patients was carried out on the second and fourth weeks after transrectal ultrasonography-guided prostate biopsy, and symptoms, such as dysuria, rectal bleeding, fever, hematospermia, hematuria, and pollakiuria, were recorded. Results: Both groups presented similar baseline characteristics and medical history. Infectious complication rates within the 4-week follow-up were similar in both groups (single dose: 3% vs prolonged: 3%) (p>0.05). In both groups, infectious complications significantly increased than that at previous antibiotic usage (single: p=0.028; prolonged: p=0.040). Non-infectious complication ratios showed no significant variation (p>0.05). Conclusion: Pre-operative single dose of 750 mg oral ciprofloxacin compared with 7 days prolonged treatment resulted in similar infectious complication outcomes in patients undergoing transrectal ultrasonography-guided prostate biopsy. The use of antibiotics within the last 3 months increases the risk for post-transrectal ultrasonography-guided prostate biopsy infectious complications.

Comparison of miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy for moderate size renal stones in elderly patients.

Life expectancy has become longer, thus the number of elderly people who require treatment for nephrolithiasis has increased. We aimed to analyze the efficacy of flexible ureterorenoscopy (f-URS) and miniaturized percutaneous nephrolithotomy (mPNL) in the management of 10 and 30 mm renal stones in patients aged >60 years. In prospective non-randomized series, the data of patients who underwent f-URS or mPNL for kidney stones between July 2013 and July 2016 were analyzed. The procedure was accepted as successful if the patient was achieved complete stone clearance according to CT imaging between 1-3 months postoperatively. In total 60 patients and 58 patients were underwent f-URS and mPNL, respectively. The mean operation time, fluoroscopy time and hospitalization time were significantly shorter for the f-URS (p < 0.001, p < 0.001, p < 0.001, respectively). According to Clavien classification system, complication rates were not significantly different between the groups (p = 0.673). The stone-free rate was 81.7% for the f-URS group and 77.6% for the mPNL group after a single-session procedure (p = 0.747). Calcium oxalate monohydrate stones were the most common stone type in both groups. In multivariate analysis, multiple stones localization was only independent factor to predict complications. Our study had showed that both f-URS and mPNL are effective treatment modalities for 10-30-mm renal stones in elderly patients. Additionally, presence of stones in multiple location was the only predictive factor for complication development.

Shock-wave Lithotripsy for Pediatric Patients: Which Nomogram Can Better Predict Postoperative Outcomes?

OBJECTIVE: To evaluate and to compare the accuracy of the Onal and Dogan nomograms for prediction of stone-free rate after shock-wave lithotripsy (SWL) in children. MATERIALS AND METHODS: We retrospectively analyzed the medical records of children <18 years old who had been treated with SWL for kidney stone in our department between January 2014 and December 2016. A single observer reviewed the records and both Onal and Dogan nomograms were calculated and compared with respect to their predictive capability for stone-free status. RESULTS: A total of 219 patients with a mean age of 82.7 months fulfilled the study inclusion criteria. In patients who were stone free and those with residual stones after completion of the first session, the mean Onal score was 2.83 and 4.12 (P = .01), and the mean Dogan score was 120.87 and 167.44 (P = .01), respectively. In patients who were stone free and those with residual stones after the third session, the mean Onal score was 3.02 and 4.14 (P = .01), respectively. Multivariate regression analysis identified both Onal and Dogan nomograms as independent preoperative factors for SWL outcome in pediatric patients (P = .001 and P = .001) CONCLUSION: Our study demonstrates that Onal and Dogan nomograms are independent predictors of stone-free rate following SWL in pediatric patients.

Flexible ureterorenoscopy is associated with less stone recurrence rates over Shockwave lithotripsy in the management of 10-20 millimeter lower pole renal stone: medium follow-up results

ABSTRACT Purpose To identify the role of shock wave lithotripsy (SWL) and flexible ureterorenoscopy (f-URS) on the stone recurrence, in the management of 10-20 millimeter lower pole stone (LPS) with medium follow-up outcomes. Materials and Methods The patients' charts which were treated with SWL or f-URS for LPS between January 2011 and September 2013 were analyzed, retrospectively. Patients who had a solitary 10-20mm LPS were enrolled into the study. In both procedures, patient was accepted as stone free, if complete stone clearance was achieved in the 3rd month abdominal computed tomography. Only patients with a stone free status were evaluated in follow ups. Results The stone-free rate was 77.9% (88/113 patients) for the SWL group and 89% (114/128 patients) for the f-URS group (p=0.029). Stone recurrence was detected in 28 (35.4%) patients in SWL group and in 17 (17.2%) patients in f-URS group (p=0.009). Stone types and 24 hour urine sample results were similar between groups (p=0.123 vs p=0.197, respectively). Multivariate regression analysis revealed that f-URS procedure and absence of abnormality in 24 hour urine analysis significantly decreased stone recurrence in medium term follow-up (p=0.001 and p<0.001, respectively). Conclusions Our study showed for the first time, that patients which underwent f-URS for LPS, faced less stone recurrence, independent from diet regimen and metabolic evaluation in medium term follow-up. Additionally, presence of abnormality in 24 hour urine analysis increase the stone recurrence risk in follow-ups.

Flexible ureterorenoscopy is associated with less stone recurrence rates over Shockwave lithotripsy in the management of 10-20 millimeter lower pole renal stone: medium follow-up results.

PURPOSE: To identify the role of shock wave lithotripsy (SWL) and flexible ureterorenoscopy (f-URS) on the stone recurrence, in the management of 10-20 millimeter lower pole stone (LPS) with medium follow-up outcomes. MATERIALS AND METHODS: The patients' charts which were treated with SWL or f-URS for LPS between January 2011 and September 2013 were analyzed, retrospectively. Patients who had a solitary 10-20mm LPS were enrolled into the study. In both procedures, patient was accepted as stone free, if complete stone clearance was achieved in the 3rd month abdominal computed tomography. Only patients with a stone free status were evaluated in follow-ups. RESULTS: The stone-free rate was 77.9% (88/113 patients) for the SWL group and 89% (114/128 patients) for the f-URS group (p=0.029). Stone recurrence was detected in 28 (35.4%) patients in SWL group and in 17 (17.2%) patients in f-URS group (p=0.009). Stone types and 24 hour urine sample results were similar between groups (p=0.123 vs p=0.197, respectively). Multivariate regression analysis revealed that f-URS procedure and absence of abnormality in 24 hour urine analysis significantly decreased stone recurrence in medium term follow-up (p=0.001 and p<0.001, respectively). CONCLUSIONS: Our study showed for the first time, that patients which underwent f-URS for LPS, faced less stone recurrence, independent from diet regimen and metabolic evaluation in medium term follow-up. Additionally, presence of abnormality in 24 hour urine analysis increase the stone recurrence risk in follow-ups.

Supracostal access for miniaturized percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches.

In this study, we aimed to evaluate the efficiency and safety of supracostal and subcostal approaches during miniaturized percutaneous nephrolithotomy (mPNL). In two tertiary academic centers, we retrospectively analyzed the charts of patients who had undergone mPNL between January 2011 and June 2015 for the treatment of renal stones. Enrolled in the study were 49 patients who had access through the supracostal area (Group 1) and, to serve as controls, 49 patients who were accessed through the subcostal area (Group 2). To avoid potential bias between the groups, the patients were retrospectively matched one-on-one with respect to age, gender, body mass index, ASA score, and size and number of stones. The presence of upper calyx stones and distorted lower calyx anatomy were the most common reasons for performing supracostal access (57.1 and 28.6%, respectively). Access through 11-12 intercostal space was performed in 46 patients (93.9%), and the other three supracostal accesses (6.1%) were performed through the 10-11 intercostal area. The complication rates were 14.3% in Group 1 and 16.3% in Group 2 (p = 0.952). Final stone-free status had increased to 89.8 and 87.8% in Groups 1 and 2, respectively (p = 0.942). Our study demonstrated that mPNL resulted in acceptable stone-free rates whether accessed through either the supracostal or subcostal areas. Moreover, the supracostal approach with mPNL had no negative effect on any intraoperative and postoperative parameters, nor did it increase complication rates.

Comparison of STONE, CROES and Guy's nephrolithometry scoring systems for predicting stone-free status and complication rates after percutaneous nephrolithotomy in obese patients.

In this study, we aim to evaluate the accuracy of STONE (stone size, tract length, obstruction, number of involved calyces, and essence/stone density), Clinical Research Office of the Endourological Society (CROES), and Guy's nephrolithometry scoring systems (NSS) in obese patients. The charts of patients who underwent percutaneous nephrolithotomy (PNL) between June 2008 and June 2016 were retrospectively analyzed. Calculations of the STONE, CROES, and Guy's NSS were performed by a resident who was well informed regarding each NSS. Patients were classified under nine scores according to STONE, four grades according to CROES, and four grades according to Guy's NSS. In total, 248 obese patients were enrolled in the study. Stone size was significantly higher in patients without stone-free status (p = 0.001). In patients who were stone-free and those with residual stones, the mean STONE score was 9.71 and 9.23 (p = 0.160), CROES was 172 and 129 (p = 0.001), and Guy's NSS was 1.67 and 2.75 (p = 0.001). Multivariate regression analysis identified the CROES and Guy's NSS were independent factors for PNL success in obese patients (p = 0.01 and p = 0.01, respectively). The CROES and Guy's NSS showed good accuracy with PNL success (AUC = 0.777 and AUC = 0.844, respectively). None of the three NSS systems were statically associated with a complication rate (p = 0.23 for STONE, p = 0.14 for CROES, and p = 0.51 for Guy's NSS). Our study demonstrated that CROES and Guy's NSS were independent predictors of stone-free rate following PNL in obese patients. Our study also revealed that three of the NSSs were not useful for predicting PNL complications in obese patients.

Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier's gangrene.

OBJECTIVE: The purpose of our study was to compare Vacuum-assisted closure (VAC) and conventional dressings in the wound therapy of Fournier's gangrene (FG). MATERIALS AND METHODS: The study evaluated 54 patients, retrospectively. Following initial removal of necrotic and devitalized tissue, in Group I patients the wounds were covered with conventional antiseptic dressings and patients continued to be treated with conventional dressings. In Group II patients VAC therapy was initiated. The collected data were compared between groups. RESULTS: The difference between two groups were statistically significant in terms of number of daily dressing (group I: 2, group II: 0,5), VAS (group I: 8, group II: 5), number of daily analgesics (group I: 4, group II: 2), number of daily narcotic analgesics (group I: 1, group II: 0), duration of mobilization per day (group I: 40, group II: 73 minutes) (p < 0.05). CONCLUSIONS: Our study does not determine that a VAC therapy is better than conventional dressings in terms of clinical outcome. However, vacuum dressing appears an effective and successful method, which offers fewer dressing changes, less pain, and greater mobility comparing to conventional dressings in the management of FG patients.