Can Neoadjuvant Chemotherapy Cause Postoperative Hydronephrosis After Radical Cystectomy?

OBJECTIVE: This study's objective is to assess the effect of preoperative factors on postoperative hydroureteronephrosis (HUN) after radical cystectomy (RC) in patients with bladder cancer (BC). METHODOLOGY: Patients who underwent RC for BC between January 2019 and November 2022 and had unilateral or bilateral postoperative HUN were retrospectively analyzed. Patients without preoperative HUN but with postoperative HUN constituted the patient group, while patients without both preoperative and postoperative HUN constituted the control group, and they were compared with each other. RESULTS: Neoadjuvant chemotherapy (NAC) and postoperative metastasis were positively correlated with postoperative HUN (r = 0.238, P = 0.007, and r = 0.203, P = 0.021, respectively). Multivariate logistic regression analysis showed that the postoperative HUN was significantly associated with NAC (P = 0.048; Exp(B) = 6.896, 95% confidence interval [CI] 1.02-46.9) but not associated with the presence of metastasis (P = 0.054). Moreover, NAC increased the possibility of undergoing revision surgery (P = 0.002; Exp(B) = 26.9, 95% CI 3.2-225). CONCLUSIONS: NAC is an independent factor for impaired anastomotic healing, increased postoperative HUN, and the need for revision surgery in patients with BC.

THE DIAGNOSTIC ACCURACY OF A COMBINATION OF PREOPERATIVE 68-Ga PSMA PET/CT AND MULTIPARAMETRIC MRI IN LOCALIZED PROSTATE CANCER.

INTRODUCTION: Prostate cancer (PCa) is a common and leading course of cancer-related death in men. Although there are studies on multiparametric magnetic resonance imaging (MpMRI) with good diagnostic results in detecting clinically significant prostate cancer, new methods have been investigated due to the low positive predictive values. In this context, Prostate Specific Membrane Antigen Positron Emission Tomography (PSMA PET) emerges as an alternative imaging method to MpMRI. This study aims to compare 68Ga PSMA I&T-PET/CT and MpMRI in determining tumor location. METHODS: Preoperative MpMRI and 68Ga PSMA I&T-PET/CT scans and pathology specimens of who underwent radical prostatectomy for PCa at our clinic between 2018-2021 were retrospectively evaluated. PSMA I&T-PET/CT, MpMRI, combined imaging were compared for tumor localization according to histopathological data. RESULTS: In terms of tumor localization, MpMRI demonstrated overall accuracy rates 75.9% (p kappa (κ) 0.0001* (0.525)). 68Ga PSMA I&T-PET/CT showed 71.5% (p κ 0.0001* (0.438)). For the combined imaging approach overall accuracy rate were calculated as 79.2% (p κ 0.0001* (0.576)). Additionally, high diagnostic accuracy was achieved for the combined imaging approach, particularly in the intermediate ISUP group. Moreover, SUVmax was calculated as 6.37. CONCLUSION: The combined use of 68Ga PSMA I&T-PET/CT and MpMRI has high diagnostic rates. However, the high cost is a significant disadvantage that limits their routine combined use.

Confirmation of PSMA expression measured on [68Ga]Ga-PSMA PET/CT by immunohistochemistry in prostate adenocarcinoma.

BACKGROUND: Our aim is to determine the accuracy of [68Ga]Ga-PSMA PET/CT in showing PSMA expression in primary prostate cancer and to investigate the relationship between SUVmax and immunohistochemical PSMA expression, Gleason score, and PSA value. MATERIAL AND METHODS: We retrospectively analyzed 66 male patients who were diagnosed with primary prostate adenocarcinoma, underwent pre-treatment [68Ga]Ga-PSMA PET/CT examination for staging, and performed radical prostatectomy between March 2018-August 2020. Immunohistochemical staining was applied to the radical prostatectomy specimens of all patients to detect PSMA expression. The results were evaluated as an immunoreactive score (IRS) and a modified IRS was obtained. Gleason score groups and prostate-specific antigen (PSA) serum values of the patients were obtained from the patient files. RESULTS: The high SUVmax of primary prostate tumors was significantly correlated with a high modified IRS score (score 2; 3), high PSA value, high Gleason score, and metastasis. In correlation analysis, a positive correlation was found between SUVmax and PSA value and modified IRS score (r = 0.69, p = 0.001; r = 0.39, p = 0.001). In addition, there was a statistically significant weak correlation between PSA serum concentration and modified IRS scores (r = 0.267; p = 0.03). In regression analysis, the percentage of positive cells had a statistically significant and increasing effect on SUVmax (p = 0.031; std beta = 0.268; 95% CI = 0.231-4.596). CONCLUSIONS: In prostate adenocarcinoma, SUVmax of the primary tumor in [68Ga]Ga-PSMA PET/CT correlates with immunohistochemical PSMA expression. In addition, high SUVmax is associated with markers of poor prognoses, such as high PSMA expression, PSA value, and Gleason score.

Efficacy of perineal electrical stimulation in men with urinary incontinence after radical prostatectomy. A prospective randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of perineal electrical stimulation (ES) on anxiety, depression, incontinence-related quality of life (QoL), and clinical parameters in men with urinary incontinence (UI) after radical prostatectomy (RP). METHODS: Fifty-eight men with UI after RP were randomized into two groups using the random numbers generator as follows: Group 1 received perineal ES (n:29), and Group 2 no treatment (n:29). Perineal ES was performed in lithotomy position via a stimulation device (Enraf Myomed 632) with surface electrodes, 3 days a week, 20 min a day, for a total of 24 sessions for 8 weeks. Men were evaluated in terms of continence rates (primary outcome), incontinence severity (24 h-pad test), incontinence episodes (3-day bladder diary), anxiety-depression (HADS), QoL (IIQ-7), and improvement rates and treatment satisfaction (Likert scale) at the baseline and the end of treatment (8th week). RESULTS: A statistically significant improvement was found in all parameters except depression in Group 1, in the severity of incontinence and QoL parameters in Group 2 at the 8th week compared to the baseline values (p < 0.05). At the end of treatment; the severity of incontinence, incontinence episodes, QoL, and anxiety were significantly improved in Group 1 compared to Group 2 (p < 0.05). No difference was found between the two groups in terms of depression (p > 0.05). The continence and improvement rates and treatment satisfaction were significantly higher in Group 1 than in Group 2 (p < 0.05). CONCLUSION: Perineal ES is more effective than no treatment in men with UI after RP as an alternative ES option that is well tolerated and does not produce serious adverse events. Clinical Trial Registration: This study was registered with ClinicalTrials.gov number, NCT05236140.

The Impact of COVID-19 Pandemic on Urological Emergencies, 8 Months Results of a Multicenter Retrospective Study From Turkey.

Objectives: We aimed to reveal the change of urological emergencies during the COVID-19 pandemic compared to the same period of the previous year. Methods: The number of admissions to the emergency department (ED), admissions to the urology outpatient clinic, emergency urological consultations, and urological and emergency urological surgeries during the periods April-November-2019 and April-November-2020 were recorded. The data of the COVID-19 period were compared with the previous year. Results: While the number of admissions to the urological outpatient clinic was 160,447 during the COVID period, it was 351,809 during the non-COVID period. The number of admissions to the ED decreased from 3.2 million to 2.4. The number of admissions to the urology outpatient clinic significantly decreased by 54% during the pandemic (p=0.001). Percutaneous cystostomy performed due to acute urinary obstruction decreased by 27.96%, double J stent, nephrostomy decreased by 16.61%, and ureterorenoscopy decreased by 12.26%. Urogenital trauma also decreased. On the contrary, surgical procedures performed due to penile fracture, gross hematuria, Fournier gangrene, and testicular torsion increased. Conclusion: During the COVID-19 pandemic, a significant decrease was observed in non-COVID patients' admissions to the emergency and urology department, and in urologic surgeries.

15 and 30 W Holmium:YAG Laser Lithotriptor in Ureteroscopic Lithotripsy: Which One Is More Effective and Safe?

Background: Holmium:yttrium-aluminium-garnet (Ho:YAG) laser lithotripsy with ureteroscopy (URS) was a safe and successful treatment option for pediatric ureteral stones. We aimed to comparatively evaluate the outcomes of 15 and 30 W Ho:YAG laser lithotriptors in pediatric ureter stones. Materials and Methods: We retrospectively evaluated 55 children who underwent ureteroscopic laser lithotripsy to treat ureter stone size up to 15 mm between September 2009 and March 2020. Groups were formed according to the laser lithotriptor power 15 W (Group 15: n = 32), 30 W (Group 30: n = 23). The efficiency of laser lithotriptors was compared between the groups. Results: The age, gender, and stone characteristics (longest stone diameter, density, location and multiple stones) were similar between the groups. In the postop first month, stone-free status was achieved in all cases except one child in Group 15. The median operative time was significantly shorter in Group 30 (40 minutes) than in Group 15 (52.5 minutes) (P = .010). Clavien-Dindo class (CDC) 2 complications occurred in 2 children in both groups (P = .597). Although ureteric stenosis was observed in 1 patient in Group 15, no ureteric stenosis was seen in Group 30 during follow-up (median 16.1 months). Length of hospital stay (LoHS) and stone-free rates were similar between groups. Conclusion: URS with 15 and 30 W Ho:YAG laser lithotriptors is an effective treatment option for pediatric ureteral stones with a high success rate and low complication rates. In brief, 30 W Ho:YAG laser lithotriptors should be preferred over 15 W lithotriptors due to their shorter operative time with similar success rate.

Importance of emergency department waiting period in Fournier's Gangrene; 10 years of experience.

BACKGROUND: Fournier's gangrene (FG) is a disease with high mortality rate. The first diagnosis is performed in the emergency department (ED). In this study, we investigated the importance of the time period for diagnosis in the ED. METHODS: The data of patients who were treated for FG between 1 January 2010 and 2020 were retrospectively analysed. Waiting period of the patients in ED was calculated. Risk factor score calculations were calculated to predict FG mortality and prognosis. The effects of the ED waiting period on the duration of admission to the hospital, the number of debridements and mortality status and relationship with FG mortality risk factor scores were investigated. RESULTS: In a 10-year period, a total of 66 patients were included in the study. It was found that the median age of the patients was 56 years. ED waiting period median (IQR) was 105 (115) minutes. It was observed that there was a significant positive correlation between the ED waiting period, duration of admission to hospital (rs: 0.537, P < .001) and patients mortality status (rs: 0.482, P < .001). The ED waiting period was higher in patients with FG mortality. It was observed that the ED waiting period holds a diagnostic value in predicting mortality (P < .001). The cut-off limit predicted for this value was determined as 136 minutes. CONCLUSION: FG is a urological emergency. ED waiting period affects mortality rate and length of hospital stay. The earlier the diagnosis and treatment is conducted in the ED, the lower the mortality rate and length of stay in the hospital will be.

VI-RADS score and tumor contact length in MRI: A potential method for the detection of muscle invasion in bladder cancer.

BACKGROUND: Vesical Imaging Reporting and Data System (VI-RADS) is a useful tool for evaluating muscle layer invasion of bladder cancer (BCa) on magnetic resonance imaging (MRI). PURPOSE: To evaluate the diagnostic performance of bladder MRI to detect the muscle layer invasion of BCa using VI-RADS score and quantitative MRI parameters. METHODS: Preoperative bladder MRI was performed in 73 BCa patients. Two observers independently evaluated the MR blinded to histopathological data and classified the tumors according to VI-RADS criteria. Moreover, the quantitative parameters (maximum tumor diameter; Dmax, tumor contact length; TCL, and tumor apparent diffusion coefficient; ADC values) were independently measured by observers. The diagnostic performance of the VI-RADS score and quantitative values were evaluated by using receiver operating characteristic (ROC) analysis. Interobserver agreement was evaluated using the weighted-kappa coefficient (κ). RESULTS: For the VI-RADS score, the AUC (area under the curve) was 0.968 and accuracy was 90.4% for Observer 1, and AUC was 0.953, accuracy was 89% for Observer 2. The AUC of TCL, TCL/DMax, and ADC values was 0.918, 0.675, and 0.832. In patients with a VI-RADS score ≥ 3, when a threshold value of TCL > 19.5 mm is used as complementary to the VI-RADS score, the accuracy of MRI for Observer-1 increases 100% and 97.26% for Observer-2. There was a good-excellent agreement between the observers in assessing the VI-RADS scores and quantitative parameters. CONCLUSION: Evaluation of bladder MRI using both VI-RADS criteria and TCL is successful and highly reproducible for detecting muscle layer invasion in patients with BCa.

A cut-off value for the operation time and other risk factors in terms of the infection risk for flexible ureterorenoscopy.

OBJECTIVES: To investigate the operation time (OT) and ureteral access sheath (UAS) usage with the infection rates and to determine a cut-off value for OT. METHODS: We retrospectively analysed the data of the patients who underwent flexible ureterorenoscopy (FURS) for renal stones larger than 20 mm between 2010 and 2019. The investigated parameters were OT, UAS using, and infection status. The data were analysed by forming two groups according to whether the OT was less than 60 minutes and more, whether the UAS was used and whether an infection occurred. In addition, independent risk factors that may affect postoperative urinary infection development were also investigated by logistic regression analysis. And, a Receiver Operating Characteristic (ROC) curve analysis was applied to determine a cut-off value in OT terms, where infection rates increase more. RESULTS: A total of 575 patients were enrolled in the study. The rates of the usage of UAS and infection were greater statistically in the group for longer than 60 minutes. OT was longer statistically in the infection group than in the group without infection (94.1 ± 14.2 and 68.01 ± 23.1, for groups 1 and 2, respectively, P < .05, Table 2). OT was statistically longer in the UAS group than the unused one (79.3 ± 24.4 and 66.7 ± 22.4, for groups 1 and 2, respectively, P < .05, Table 3). ROC analyses revealed a cut-off point of 87.5 min for OT in terms of infection rate. CONCLUSION: While the infection risk increases when OT exceeds 60 minutes, FURS can be safely performed up to 87.5 minutes with 89% sensitivity and 69% specificity infection risk.

Comparison of 68Ga-PSMA-I/T PET-CT and Multiparametric MRI for Locoregional Staging of Prostate Cancer Patients: A Pilot Study.

BACKGROUND/AIM: The objective of this work was to assess the value of 68Ga-DOTAGA-(3-iodo-y)fk(Sub-KuE) positron emission tomography (68Ga-PSMA-I/T PET-CT) and multiparametric magnetic resonance imaging (mp-MRI) for preoperative staging in prostate cancer (PCa) patients who underwent radical prostatectomy (RP) by validating with postoperative histopathology data. MATERIALS AND METHODS: We prospectively investigated 30 consecutive PCa patients who had both mp-MRI and 68Ga-PSMA-I/T PET-CT before laparoscopic RP. The seminal vesicle invasion (SVI), lymph node metastasis (LNM), bladder neck invasion (BNI), and extracapsular extension (ECE) were investigated separately. The diagnostic performances of mp-MRI and 68Ga-PSMA-I/T PET-CT were assessed using histopathological results. RESULTS: Both mp-MRI and 68Ga-PSMA-I/T PET-CT were not statistically significant in the evaluation of SVI, BNI, and ECE preoperatively but had statistically significant results in the assessment of LNM. mp-MRI had higher overall sensitivity for ECE, overall specificity for SVI, ECE, and BNI, and positive predictive value for ECE, SVI, BNI. 68Ga-PSMA-I/T PET-CT had higher overall sensitivity for BNI, and negative predictive value for BNI and LNM. CONCLUSION: mp-MRI has superior specificity, sensitivity, and accuracy for assessing ECE and SVI. Both imaging modalities had similar specificity, sensitivity, and accuracy for determining BNI. However, both imaging modalities had low diagnostic accuracy for LNM on histopathology.

Is There a Correlation Between Behçet Disease and Lower Urinary Tract Symptoms?

PURPOSE: In this study, we aimed to determine the prevalence of lower urinary tract symptoms (LUTS) in patients with Behçet disease (BD) and to investigate the relationship between the severity of BD and LUTS. METHODS: Fifty-five patients with BD were included in this study from January to December 2018. All patients received a detailed urological evaluation. Additionally, BD activity was investigated using the Behçet Disease Current Activation Form. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Short Form, 8-item overactive bladder questionnaire forms, uroflowmetry, and postvoid residual urine volume were evaluated. RESULTS: The mean age of the patients was 42.6 years. The mean activity score of BD was 4.6±3.2 and the mean IPSS score was 7.3±7.3. Sex had no significant effect on the BD activity score. The BD activity score was significantly correlated with the IPSS score, frequency of daytime urination, nocturia, and urgency. It was also correlated with the presence and the severity of urinary incontinence and the effect of urinary incontinence on daily life. Peak flow rate, voided volume, and the postvoid residual urine volume were not correlated with the BD activity score. CONCLUSION: LUTS were highly prevalent in patients with BD, and the severity and current activity of BD were correlated with frequency, nocturia, urgency, and urinary incontinence. Therefore, a urological evaluation of patients with BD in whom the activity and severity of the disease is elevated should be carried out comprehensively and patients should be managed accordingly.

Female buccal mucosa graft urethroplasty: a new modified ventral onlay "AZ" technique.

INTRODUCTION AND HYPOTHESIS: To present the surgical details and the outcomes of our modified ventral onlay buccal mucosal graft (BMG) urethroplasty technique in female patients with urethral strictures. METHODS: We included the first seven female patients who had BMG urethroplasty between January 2015 and April 2019 and had at least 6 months of follow-up. Patient age, stricture length, comorbidities, number of previous treatments, pre- and postoperative uroflowmetry data, and post-void residual volumes were recorded. RESULTS: The mean patient age was 56.7 (44-80) years. The mean stricture length was 3.1 (2-4) cm. The mean postoperative follow-up time was 23 (7-48) months. The preoperative mean maximal flow rate (Qmax) was 5.1 (3.2-9.5) ml/s and post-void residual urine volume (PVR) was 84.4 (37-158) ml. At the 3rd month after surgery, mean Qmax was 31.8 (24.7-36.2) ml/s, and PVR volume was 7.1 (0-16) ml. Three patients had the postoperative 2-year follow-up, and 12th and 24th month mean Qmax values were 28 (23.6-33.2) ml/s and 28.5 (24.1-31.1) ml/s, respectively. The mean operation time was 63.8 (55-113) min. We did not observe any infection, vaginal erosion, urinary incontinence, or oral discomfort due to graft harvesting postoperatively. CONCLUSION: Female urethroplasty provides high cure rates and should be performed in case of recurrent FUS. The early and medium-term results of our modified new technique indicated that it might be used as a simple alternative to current techniques. In all of our patients, it significantly increased the flow rate and reduced PVR without any significant complications.

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.

An unusual complication of urinary stone disease: Spontaneous ureteral rupture.

Spontaneous ureter rupture (SUR) is a rare condition that can present mimicking many acute abdominal diseases. There is no probable explanation of the theoretical mechanism of spontaneous ureter rupture in the literature. Mostly calculus can cause spontaneous ureter rupture with ureteral obstruction. If left untreated, it can lead to life-threatening complications. Herein we report a case of SUR that was occurred due to urinary stone disease in a male patient who presented with abdominal pain. A non-contrast enhanced and a late phase contrast-enhanced abdominal computed tomography (CT) demonstrated the urinary stone disease and contrast extralumination from the proximal part of the left ureter. We also aimed to emphasize the clinical and CT imaging findings of SUR.

The outcomes of Kulkarni's one-stage oral mucosa graft urethroplasty in patients with panurethral stricture: a single centre experience.

PURPOSE: To present the results of our one-stage oral mucosa graft urethroplasty series for panurethral strictures. METHODS: We included the first 35 patients who had one stage oral mucosa graft urethroplasty with one side dissection of the urethra which was described by Kulkarni, between January 2015 and June 2018 and had at least 6 months follow-up. From the first case, all data were recorded prospectively and patient age, etiology of the stricture, comorbidities, previous treatments, postoperative maximal flow rate, pre and post-operative erectile function, perioperative and postoperative complications and quality of life questionnaire for this study. RESULTS: The mean patient age was 58.8 and mean stricture length was 13.6 (10-16) cm. Patients had previously 1-17 procedures. Patients had a mean peak flow rate of 25.4 ml/sec at the first postoperative visit. During the follow-up period, six patients had recurrence and managed with urethral dilation (1), direct vision internal urethrotomy (2), meatoplasty (1) and re-urethroplasty (2). The responses to the questions about satisfaction from the surgery showed that 31 (88.6%) patients were satisfied with the surgery, 33 (94.3%) would prefer this procedure again, if needed, and 31 (88.6%) patients recommended this procedure to others. When patients were grouped according to age, recurrence rate was 35.7% in patients older than 65 years and 4.8% in patients ≤ 65 years old. CONCLUSIONS: Our study showed that Kulkarni's one-stage oral mucosa graft urethroplasty technique has a high success rate. The patient satisfaction is high because of the good functional outcomes and low complication rate.

Comparison of two different suture techniques in laparoscopic partial nephrectomy

ABSTRACT Objective: To comparatively evaluate the traditional interrupted knot-tying and running suture renorrhaphy with Monocryl® in laparoscopic partial nephrectomy (LPN). Materials and Methods: A retrospective analysis of 62 consecutive patients undergoing LPN using traditional interrupted knot-tying suture renorrhaphy (Group 1; n=31) or running suture technique renorrhaphy with 2-0 monofilament polyglecaprone (Monocryl®, Ethicon) (Group 2; n=31) from December 2011 to October 2015 at the University. All patients underwent LPN performed by an experienced laparoscopic surgeon. The demographic, perioperative and postoperative parameters were compared between the groups, and the effect of both suture techniques on the warm ischemic time (WIT) and trifecta were evaluated. Results: The running suture renorrhaphy with Monocryl® reduced WIT, estimated blood lost and length of hospitalization stay significantly without increasing postoperative complication rate during LPN in comparison with interrupted knot-tying suture. Conclusion: The renorrhaphy using the running suture with Monocryl® is an effective and safe technique with the advantage of shortening WIT even in more challenging and larger tumors during LPN.

Comparison of two different suture techniques in laparoscopic partial nephrectomy.

OBJECTIVE: To comparatively evaluate the traditional interrupted knot-tying and running suture renorrhaphy with Monocryl® in laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: A retrospective analysis of 62 consecutive patients undergoing LPN using traditional interrupted knot-tying suture renorrhaphy (Group 1; n=31) or running suture technique renorrhaphy with 2-0 monofilament polyglecaprone (Monocryl®, Ethicon) (Group 2; n=31) from December 2011 to October 2015 at the University. All patients underwent LPN performed by an experienced laparoscopic surgeon. The demographic, perioperative and postoperative parameters were compared between the groups, and the effect of both suture techniques on the warm ischemic time (WIT) and trifecta were evaluated. RESULTS: The running suture renorrhaphy with Monocryl® reduced WIT, estimated blood lost and length of hospitalization stay significantly without increasing postoperative complication rate during LPN in comparison with interrupted knot-tying suture. CONCLUSION: The renorrhaphy using the running suture with Monocryl® is an effective and safe technique with the advantage of shortening WIT even in more challenging and larger tumors during LPN.

Percutaneous nephrolithotomy in children: does age matter?

PURPOSE: To compare the outcomes of percutaneous nephrolithotomy (PCNL) in 2 age groups. METHODS: Fifty-one renal units (RU) of 45 patients were operated between January 2006 and December 2010. In all patients, PCNL was performed by pediatric nephroscope of 17F size through a 20F Amplatz sheath. Patients were examined in 2 groups (Group1: ≤5 years, Group 2: >5 years) and outcomes were compared accordingly. RESULTS: The mean age was 5.95 ± 3.63 years and male-to-female ratio was 23/22. The mean stone burden, operative time, and postoperative hospital stay were 4.24 ± 2.03 cm(2), 94.30 ± 37.28 min, and 5.18 ± 2.97 days, respectively. In the postoperative period, 44 renal units (86.2%) were stone-free. Two age groups were similar regarding the postoperative hospital stay, gender distribution, stone location, stone composition, and complication rates. However, stone burden and number of access was less and stone-free rate was higher in younger age group. CONCLUSION: The stone-free rate in preschool children is at least as good as older children without an increase in complication rates. The older children (>5 years) have a higher stone burden and need multiple accesses more frequently. The complications are mostly low grade and can be managed conservatively. Our results showed that PCNL in younger children as safe and effective as in the older children and age should not be considered as a limiting factor.