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.

Is There A Difference Between Presence of Single Stone And Multiple Stones in Flexible Ureterorenoscopy And Laser Lithotripsy For Renal Stone Burden < 300mm2 ?

ABSTRACT In this study, we aim to evaluate and compare the effectiveness of flexible ureterorenoscopy (f-URS) for solitary and multiple renal stones with <300 mm2 stone burden. Patients' charts who treated with f-URS for kidney stone between January 2010 and June 2015 were reviewed, retrospectively. Patients with solitary kidney stones (n:111) were enrolled in group 1. We selected 111 patients with multiple kidney stones to serve as the control group and the patients were matched at a 1:1 ratio with respect to the patient's age, gender, body mass index and stone burden. Additionally, patients with multiple stones were divided into two groups according to the presence or abscence of lower pole stones. Stone free status was accepted as complete stone clearence and presence of residual fragments < 2 mm. According to the study design; age, stone burden, body mass index were comparable between groups. The mean operation time was longer in group 2 (p= 0.229). However, the mean fluoroscopy screening time in group 1 and in group 2 was 2.1±1.7 and 2.6±1.5 min, respectively and significantly longer in patients with multiple renal stones (P=0.043). The stone-free status was significantly higher in patients with solitary renal stones after a single session procedure (p=0.02). After third month follow up, overall success rate was 92.7% in Group 1 and 86.4% in Group 2. Our study revealed that F-URS achieved better stone free status in solitary renal stones <300 mm2. However, outcomes of F-URS were acceptable in patients with multiple stones.

Is There A Difference Between Presence of Single Stone And Multiple Stones in Flexible Ureterorenoscopy And Laser Lithotripsy For Renal Stone Burden < 300mm2 ?

In this study, we aim to evaluate and compare the effectiveness of flexible ureterorenoscopy (f-URS) for solitary and multiple renal stones with < 300 mm2 stone burden. Patients' charts who treated with f-URS for kidney stone between January 2010 and June 2015 were reviewed, retrospectively. Patients with solitary kidney stones (n:111) were enrolled in group 1. We selected 111 patients with multiple kidney stones to serve as the control group and the patients were matched at a 1:1 ratio with respect to the patient's age, gender, body mass index and stone burden. Additionally, patients with multiple stones were divided into two groups according to the presence or abscence of lower pole stones. Stone free status was accepted as complete stone clearence and presence of residual fragments < 2 mm. According to the study design; age, stone burden, body mass index were comparable between groups. The mean operation time was longer in group 2 (p= 0.229). However, the mean fluoroscopy screening time in group 1 and in group 2 was 2.1±1.7 and 2.6±1.5 min, respectively and significantly longer in patients with multiple renal stones (P=0.043). The stone-free status was significantly higher in patients with solitary renal stones after a single session procedure (p=0.02). After third month follow up, overall success rate was 92.7% in Group 1 and 86.4% in Group 2. Our study revealed that F-URS achieved better stone free status in solitary renal stones < 300 mm2. However, outcomes of F-URS were acceptable in patients with multiple stones.

Duplicated Renal System with H Shaped Ureter: An Extraordinary Anomaly.

Duplex collecting systems are the most commonly encountered anomaly of the urinary system. Complete duplex system with an H shaped ureter is a very rare situation. There are only two reported H ureter cases in the literature. Herein, we aimed to present an H shaped ureter case, which was identified while performing ureterorenoscopy to a 48-year-old female patient due to a right distal ureteral stone.

Self and partner satisfaction rates after 3 part inflatable penile prosthesis implantation.

OBJECTIVE: To evaluate and present satisfaction rates of our patients and their partners after 3 part inflatable penile prosthesis implantation. MATERIALS AND METHODS: We searched our hospital electronic data for patients who underwent inflatable penile prosthesis implantation between January 2008 and July 2013. Computer and archived file data were used to get information and reach the patients. We made telephone calls to patients and asked questionnaires about self and partner satisfaction rates. RESULTS: 36 patients underwent prosthesis implantation during the 5 year period. We were able to reach by telephone call 18 of them. The mean age of 18 patients was 55.7 ± 9.4 years and mean body mass index was 24.6 ± 2.1 kg/m2. The etiology was diabetes mellitus on 14 (77.8%) and radical pelvic surgery on 4 (22.2%) patients. 14 of 18 patients had penile Doppler ultrasound test. Doppler ultrasound demonstrated venous insufficiency in 8 and arterial insufficiency in 6 patients. Mean time from implantation to study was 20.8 ± 13.9 months. Out of 18 patients 2 had prosthesis removal operation because of infection in one patient and perforation in the other. Satisfaction rate was 88.9%, and recommendation rate was 94.4%. Causes of dissatisfaction were pain in one patient and insufficient rigidity plus shortening of the penis in the other one. Partner satisfaction rate was 94.4%. CONCLUSION: Penile Prosthesis Implantation (PPI) is the gold standard treatment of erectile dysfunction (ED) irresponsive to medical treatment. Infection and mechanical failure rates are going to be less according to the improvements in synthetic materials and coverings of the prosthesis, so patient and partner satisfaction rates will be higher.

Female sexual function after transobturator tape in women with urodynamic stress urinary incontinence.

We evaluate quality of life and sexual function before and after transobturator tape procedure (TOT) using the International Consultation on Incontinence Questionnaire (ICIQ -SF) and Female Sexual Function Index (FSFI). Between 2008 and 2013, 92 patients with stress urinary incontinence (SUI) underwent TOT procedure. A total of 81 patients were sexual active and enrolled in the study. All patients completed the Turkish translation ICIQ -SF and FSFI forms before and 1, 3, 6, 12 months after surgery. To evaluate the impact of incontinence and TOT success on sexual function, we compared patients that were dry after surgery and patients still incontinent and/or facing complication. All 81 patients completed the study protocol. The total FSFI score was 21.3 ± 7.9 and statistically significant when compare with preoperative total FSFI score (16.2 ± 7.9). The mean postoperative ICIQ -SF score (2 ± 2.9) was also significantly lower than the mean preoperative ICIQ -SF score (17.3 ± 1.8). Complications were encountered in 13 patients, including vaginal erosion (4 patients), de novo urge incontinence (4 patients), vesico-vaginal fistula (1 case), cysto-rectocele (1 case) and high postoperative residue requiring mesh excision (3 patients). Continent (n = 68) patients had a significantly better postoperative total FSFI and ICIQ -SF score against patients who had urine loss. Our study found a significant improvement of FSFI score and ICIQ -SF score after TOT operation in women with SUI. Additionally, urine loss due to complications was related with worsened FSFI score and ICIQ score compare with healthy patient's scores.

The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones.

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4 cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p > 0.05). The mean operation time was 138.40 ± 51.19 (range 70-240) min in LPL group as compared to 57.92 ± 21.12 (range 40-110) min in PNL group (p < 0.0001). There was one (3.8%) open conversion in the LPL group due to dense perirenal adhesions making the dissection difficult. The ureteropelvic junction (UPJ) obstruction concomitant to pelvic stones was successfully repaired laparoscopically in two cases. The mean drop in postoperative hemoglobin level was 0.9 ± 0.6 (range 0-2) g/dl in LPL group and 1.7 ± 1.1 (range 0-4) g/dl in PNL group (p = 0.024). Hospitalization was significantly shorter in PNL than LPL group (p = 0.0001). Stone-free rates were similar. Laparoscopic pyelolithotomy is associated with a longer operation time, is more invasive, and requires more skills when compared to PNL. However, LPL is associated with less blood loss. Laparoscopic pyelolithotomy is indicated for congenitally anomalous kidneys and especially in patients with concomitant UPJ.

Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones.

PURPOSE: We prospectively analyzed and compared the effectiveness and complications of pneumatic lithotripter with a holmium:yttrium-aluminum-garnet (Ho:YAG) laser for the ureterorenoscopic management of impacted ureteral stones. MATERIALS AND METHODS: From January 2006 to January 2008, we performed retrograde endoscopic treatment in 288 patients with ureteral stones in our clinic. The patients with impacted stones were randomized into two groups according to the lithotripter used to fragment the stone: pneumatic (n = 40) and laser (n = 40). The preoperative, operative, and post-operative follow-up findings were analyzed and compared. RESULTS: The average stone size was similar in both groups (118.8 ± 58.3 mm(2) vs. 110.7 ± 54.4 mm(2)). The calculi were located in the distal ureter in most of the patients in both groups (65% in pneumatic group and 52.5% in laser group). The operation time was significantly diminished in the laser group (P = 0.001). The stone-free rates after a single ureteroscopic procedure were 80 and 97.5% in the pneumatic and laser groups, respectively (P = 0.03). Auxiliary treatments were needed in seven patients in the pneumatic group, while only one patient in the laser group (P = 0.05) needed this treatment. After the additional procedures, a 100% success rate was achieved in both groups. The rate of double J stent insertion was significantly higher in the pneumatic group (P = 0.01). In the pneumatic group, four cases of stone up-migration and one case of post-operative stricture were seen, whereas only one case of stone up-migration was noted in the laser group. CONCLUSION: Our comparative study has shown that the use of Ho:YAG as an intracorporeal lithotripter during ureteroscopic management of impacted ureteral stones is highly efficient with high success rates, regardless of the stone location.

A prospective, randomized trial of management for asymptomatic lower pole calculi.

PURPOSE: We determined the natural course and compared the deleterious effects in kidneys of shock wave lithotripsy, percutaneous nephrolithotomy and observation for asymptomatic lower caliceal stones. MATERIALS AND METHODS: Between April 2007 and August 2008 patients with asymptomatic lower caliceal calculi were enrolled in the study. To assess stone status noncontrast abdominal helical computerized tomography was done 3 and 12 months after intervention. All patients were evaluated by dimercapto-succinic acid renal scintigraphy 6 weeks and 12 months after intervention. RESULTS: A total of 94 patients were prospectively randomized to percutaneous nephrolithotomy (31), shock wave lithotripsy (31) and observation (32). Mean +/- SD followup was 19.3 +/- 5 months (range 12 to 29). In the percutaneous nephrolithotomy group all patients were stone-free at month 12. Scintigraphy revealed a scar in 1 patient (3.2%) on month 3 followup imaging. In the shock wave lithotripsy group the stone-free rate was 54.8%. Scintigraphy revealed scarring in 5 patients (16.1%). In the observation group 7 patients (18.7%) required intervention during followup. Median time to intervention was 22.5 +/- 3.7 months (range 18 to 26). One patient (3.1%) had spontaneous stone passage. Scintigraphy did not reveal scarring in any patient. CONCLUSIONS: Stone related events were noted in more than 20% of patients with asymptomatic lower caliceal stones observed expectantly. To manage lower caliceal stones percutaneous nephrolithotomy has a significantly higher stone-free rate with less renal scarring than shock wave lithotripsy. Thus, patients with asymptomatic lower caliceal stones must be informed in detail about all management options, especially focusing on percutaneous nephrolithotomy with its outstanding outcome.

Is routine radiological surveillance mandatory after uncomplicated ureteroscopic stone removal?

PURPOSE: Stricture formation and obstruction are rare but significant complications after ureteroscopy (URS), and there are controversial studies regarding follow-up. Our study sought to determine the appropriate follow-up for patients without complications. PATIENTS AND METHODS: A total of 323 patients were treated with URS for removal of ureteric stones, and their charts were retrospectively reviewed. A semirigid ureteroscope was used in all patients, and stone disintegration was accomplished with a pneumatic lithotriptor. Postoperative evaluation included plain abdominal radiograph of the kidneys, ureters, and bladder (KUB) on day 1, intravenous urography (IVU) and/or ultrasonography at postoperative month 3 and annually thereafter in all patients. A KUB radiograph was also obtained on postoperative day (POD) 10 in patients with residual fragments. RESULTS: Complete records of 268 patients were available. The overall success rate was 95.5%. The KUB radiograph on POD 1 revealed complete stone removal in 217 (80.9%) patients, while residual fragments were seen in 40 (14.9%) patients, who were reevaluated on POD 10. Evaluation on POD 10 showed residual fragments in 15 patients, and URS was again performed in eight patients. Perioperative minor complications were observed in 18 (6.7%) patients. IVU performed in the third postoperative month showed stricture formation in two (0.7%) patients and silent obstruction in one (0.3%). No stricture formation was observed in asymptomatic patients after uncomplicated complete stone removal. After a mean follow-up of 27.4 +/- 13.7 (range 12-58) months, annual radiologic studies did not show any additional complications. CONCLUSIONS: Our results indicate that radiologic surveillance for stricture formation and obstruction is not mandatory after complete stone removal with uncomplicated URS.

Does the metabolic syndrome or its components affect the outcome of percutaneous nephrolithotomy?

PURPOSE: Metabolic syndrome is a cluster of cardiovascular disease risk factors. We assessed the impact of these medical disorders on the outcome of percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Data from 430 consecutive PCNL procedures were retrospectively reviewed. The presence of serum lipid abnormalities (SLA), hypertension (HT), diabetes (DM), and obesity was investigated. Patients were determined to have the metabolic syndrome according to the definition of the International Diabetes Federation. Success rate, need for auxiliary procedures, and major complication rates of PCNL were analyzed separately for patients with or without DM, SLA, HT, obesity, and the metabolic syndrome, and were compared. RESULTS: SLA, HT, and DM were observed in 123 (28.6%), 108 (25.1%), and 44 (10.2%) patients, respectively. Body mass index was >30 kg/m2 in 74 (17.2%) patients. Metabolic syndrome was diagnosed in 41 (9.5%) patients. An overall success rate of 96.3% for PCNL was achieved. Success rates were not significantly (P > 0.05) influenced by the presence of SLA, HT, DM, obesity, or the metabolic syndrome. Major complications were encountered in 49 (11.4%) patients and were 2.5 to 2.7 times more common in patients with DM, HT, and the metabolic syndrome. In patients with DM, auxiliary treatment alternatives were necessary in 20.5%, while they were indicated in 10.9% of patients without DM (P = 0.046). Presence of the metabolic syndrome was also associated with an increased necessity for auxiliary treatments after PCNL (P = 0.048). CONCLUSIONS: Our results indicate that the metabolic syndrome and its components (DM and HT) significantly augment auxiliary treatment and complication rates after PCNL.

Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard.

OBJECTIVES: A classification (modified Clavien system) has been proposed to grade perioperative complications. We reviewed our experience with percutaneous nephrolithotomy (PNL), grading the complications according to this new classification. METHODS: A total of 811 PNLs were performed between 2003 and 2006, and charts were retrospectively reviewed focusing on complications observed. According to the modified Clavien classification system, perioperative complications were stratified into five grades. Grade 1 defined all events that, if left untreated, would have a spontaneous resolution or needed a simple bedside intervention. Grade 2 complications required specific medication, including antibiotics and blood transfusion. Grade 3 complications necessitated surgical, endoscopic, or radiologic intervention (3a without general anesthesia, 3b under general anesthesia). Neighboring organ injuries and organ failures were classified as grade 4, and death was considered a grade 5 complication. Kidney stones treated with PNL were also classified as simple and complex and complication rates were compared. RESULTS: A total of 255 perioperative complications were observed in 237 (29.2%) patients. There were 33 grade 1 (4%), 132 grade 2 (16.3%), 54 grade 3a (6.6%), 23 grade 3b (2.8%), 9 grade 4a (1.1%), and 3 grade 4b (0.3%) complications, and 1 death (0.1%). Most complications were related to bleeding and urine leakage. Grade 2 and 3a complications were significantly more common in patients with complex renal stones. CONCLUSIONS: A graded classification scheme for reporting the complications of PNL may be useful for monitoring and reporting outcomes. However, minor modifications concerning auxiliary treatments are needed and further studies are awaited.

Lymphoma of the kidney: primary or initial manifestation of rapidly progressive systemic disease?

Primary renal lymphoma is a controversial and rare disease. There is no agreement whether or not it is an initial manifestation of a rapidly systemic disease. Most reported cases are questionable because of incomplete staging and lack of autopsy studies. Herein, we present a 71-year-old woman, initially diagnosed with primary non-Hodgkin lymphoma of the kidney, but was lost 4 months after radical nephrectomy due to systemic disease despite aggressive chemotherapy, and suggest that, the kidney of the patient was the initial presenting site of a rapidly progressive systemic disease.

Efficacy of extracorporeal shock wave lithotripsy for ureteric stones in children.

OBJECTIVES: Management of ureteral stones in children represents a challenging problem. In this study, we retrospectively analyzed our experience with extracorporeal shock wave lithotripsy (ESWL) in 192 children with ureteric stones. METHODS: Between 1990 and 2003, 192 children (

Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissors.

OBJECTIVES: To analyse the efficacy, safety and feasibility of retroperitoneal laparoscopic decortication of simple renal cysts using bipolar PlasmaKinetic scissors. METHODS: Records of 19 patients who underwent laparoscopic decortication of simple renal cysts, performed with bipolar PlasmaKinetic scissors without additional fulguration of the base or the margin of resection, were retrospectively reviewed. Long-term symptomatic and radiological outcomes were assessed. RESULTS: One single cyst was treated in fourteen (73.7%) cases, two cysts in three (15.8%) cases, three cysts in one (5.2%) case and multiple cysts in one case with autosomal dominant polycystic kidney disease. They were peripherally located in thirteen, peripelvic in three, and parenchymal in two cases. An average of 3.1 trochars were used for each procedure. The mean operating time was 82.5 +/- 16.7 min (range, 50-135). Neither open conversion nor blood transfusion was necessary. A total of six minor complications were encountered. Mean hospital stay 2.3 +/- 0.9 days (range, 1-4). After a mean follow up of 14.3 +/- 5.9 months (range, 3-24), symptomatic success was achieved in 89.5%, and radiological success was accomplished in 88.2%. An asymptomatic cyst recurrence was observed in one (5.9%) case, and one (5.9%) case with residual pain had new cyst formation at another site of the kidney. CONCLUSIONS: Retroperitoneal laparoscopic cyst decortication using bipolar PlasmaKinetic scissors is a feasible and efficient method, eliminating further fulguration of the base and the margins of the cysts. Operating times are shorter than previously published series and highly satisfactory long-term success rates are achieved.

A hybrid technique using bipolar energy in transurethral prostate surgery: a prospective, randomized comparison.

PURPOSE: We assessed the efficacy and safety of transurethral resection and vaporization with bipolar PlasmaKinetic energy. MATERIALS AND METHODS: During a 2-year period 101 men with benign prostatic hyperplasia were randomly assigned to PlasmaKinetic surgery or standard transurethral prostate resection (TURP). Patient demographics, indications for surgery, preoperative and postoperative International Prostate Symptom Score, uroflowmetry scores, operative time, catheterization duration, hospital stay and complication rates were compared. RESULTS: Complete data on 96 patients with a mean age +/- SD of 69.1 +/- 6.1 years was available at a mean followup of 18.3 +/- 6.7 months (range 12 to 23). In the PlasmaKinetic and TURP groups mean operative time was 40.3 +/- 11.4 (range 30 to 60) and 57.8 +/- 13.4 minutes (range 45 to 75), respectively (p <0.01). The mean volume of saline irrigation during the PlasmaKinetic procedure was significantly lower than that of hyperosmolar solution irrigation during TURP (p <0.05). Patients in the PlasmaKinetic and TURP groups were catheterized a mean of 2.3 +/- 0.7 (range 2 to 4) and 3.8 +/- 0.7 days (range 3 to 5), respectively (p <0.05). The mean improvement rate from baseline at month 12 in International Prostate Symptom Score and the maximal urinary flow rate was similar in the 2 groups. Severe irritative symptoms were the most common complaints after PlasmaKinetic surgery, as observed in 6 cases (12.2%). Recatheterization was necessary in 3 cases (6.1%) cases in the PlasmaKinetic group and in 1 (2.1%) in the TURP group. During followup urethral stricture formation was observed in 3 patients (6.1%) cases in the former group and in 1 (2.1%) in the latter group (p = 0.002). Reoperation was required in 2 (4.1%) and 1 (2.1%) cases in the PlasmaKinetic and TURP groups, respectively. CONCLUSIONS: : Transurethral surgery with PlasmaKinetic bipolar energy seems to be a promising alternative to prostatic tissue removal with shorter operative, catheterization and hospitalization times, although increased rates of postoperative irritative symptoms and urethral stricture formation must be further evaluated.