Safety and Efficacy of Live Retrograde Intrarenal Surgery in Patients with Kindey Stone: Outcomes from a Boutique Course Series Which Complies with the Live Surgery Event Policies.

BACKGROUND: Live surgery events (LSEs) are frequently organized for sharing the surgical experiences with surgeons at the beginning of their learning curves. The aim of this study was to investigate whether the outcomes and complication rates of patients underwent retrograde intrarenal surgery (RIRS) at LSEs are comparable with regular cases. METHODS: Ten courses were organized during 2017-2022. Data of 32 patients who operated in the LSEs were 1:3 matched (for stone burden and surgeon) with the data of patients who underwent regular RIRS within the course periods at the same centers (n = 96). All courses took place in concordance with the latest LSE policies. The primary outcomes were stone-free and complication rates. Fluoroscopy and operation times were the secondary outcomes. RESULTS: Stone-free rates of the groups were similar (84% in LSE and 79% in control group; p = 0.520). Similarly, there were no differences in complication rates (p = 0.428) and fluoroscopy time (p = 0.477). Duration of the LSE cases (82.24 ± 31.12 min) was slightly but insignificantly longer than regular cases (73.77 ± 20.89 min, p = 0.092). Moreover, guest surgeons tend to have longer operation time with statistically insignificant prolongation (74.92 ± 30.43 min for host, 89.52 ± 28.34 min for guest surgeons, p = 0.064). CONCLUSIONS: RIRS can be performed without jeopardizing operation efficiency and patient safety in LSEs. If surgeon is not familiar with operating room set-up or staff, live surgery must be performed by host surgeon to avoid extended operating time.

Safety and Efficacy of Live Retrograde Intrarenal Surgery in Patients with Kindey Stone: Outcomes from a Boutique Course Series Which Complies with the Live Surgery Event Policies

Background: Live surgery events (LSEs) are frequently organized for sharing the surgical experiences with surgeons at the beginning of their learning curves. The aim of this study was to investigate whether the outcomes and complication rates of patients underwent retrograde intrarenal surgery (RIRS) at LSEs are comparable with regular cases. Methods: Ten courses were organized during 2017–2022. Data of 32 patients who operated in the LSEs were 1:3 matched (for stone burden and surgeon) with the data of patients who underwent regular RIRS within the course periods at the same centers (n = 96). All courses took place in concordance with the latest LSE policies. The primary outcomes were stone-free and complication rates. Fluoroscopy and operation times were the secondary outcomes. Results: Stone-free rates of the groups were similar (84% in LSE and 79% in control group; p = 0.520). Similarly, there were no differences in complication rates (p = 0.428) and fluoroscopy time (p = 0.477). Duration of the LSE cases (82.24 ± 31.12 min) was slightly but insignificantly longer than regular cases (73.77 ± 20.89 min, p = 0.092). Moreover, guest surgeons tend to have longer operation time with statistically insignificant prolongation (74.92 ± 30.43 min for host, 89.52 ± 28.34 min for guest surgeons, p = 0.064). Conclusions: RIRS can be performed without jeopardizing operation efficiency and patient safety in LSEs. If surgeon is not familiar with operating room set-up or staff, live surgery must be performed by host surgeon to avoid extended operating time (AU)

In-vivo or in-vitro stone attenuation: what is more valuable for the prediction of renal stone composition in non-contrast-enhanced abdominal computed tomography?

OBJECTIVES: To compare the efficacy of in-vivo and in-vitro stone attenuation in the prediction of stone composition using non-contrast-enhanced abdominal computed tomography (NCCT). METHODS: This study included a total of 104 patients with renal stones who received percutaneous nephrolithotomy treatment for renal stones between December 2016 and December 2019 and underwent NCCT before the procedure. Preoperative (in-vivo) and postoperative (in-vitro) kidney stone attenuations were compared using the NCCT images of the patients. Renal stone fragments were analysed with the infrared spectrophotometer method. RESULTS: The mean age of the 104 patients was 49.5 (interquartile range: 37-61) years. According to the receiver operating characteristics analysis, the cut-off values for the prediction of uric acid stones were determined to be 556 HU for the in-vivo and 774 HU for the in-vitro attenuation measurement. Sensitivity and specificity were 100% and 96.6%, respectively, for the in-vivo and 90.9 and 91%, respectively, for the in-vitro images. The cut-off values for the prediction of calcium stones were determined to be 824 HU and 1065 HU for the in-vivo and in-vitro attenuation measurements, respectively. Sensitivity and specificity were 97.3 and 96% for the in-vivo and 96 and 96% for the in-vitro images. CONCLUSIONS: In-vivo stone attenuation measurement in NCCT was slightly superior to in-vitro measurement due to the reduction in the composition and size of the stone. Our findings show that NCCT in-vivo stone attenuation might differentiate uric acid and calcium stones from the other stone types.

The association between ureteral wall thickness and need for additional procedures after primary ureteroscopy in patients with ureteral stones above the iliac crest.

PURPOSE: To examine the parameters affecting the need for additional procedures in the primary ureteroscopy treatment in patients with ureteral stones above the iliac crest level. METHODS: Seventy-one patients were included in the study who were ≥ 18 years old and had undergone ureteroscopy (URS) for ureteral stones above the iliac crest level between 2018-2020 and had a non-contrast-enhanced abdominal computed tomography before the procedures were included in the study. Patients and stone characteristics were prospectively collected. The results were evaluated six weeks after URS. The absence of any residual fragment was thought to indicate stone-free status. The patients with failure were referred for the additional procedures. RESULTS: The median patient age was 51 years [interquartile range (IQR): 18-66]. The median transverse stone diameter was 9.5 mm (IQR: 7.1-11.4), and the median ureteral wall thickness (UWT) was 5.8 mm (IQR: 4.3-6.5). In the univariate analysis, UWT (p < 0.001), presence of multiple stones (p = 0.008), and stone length (p = 0.022) affected stone-free status. The multivariate analysis revealed UWT as the only independent factor affecting the need for additional procedures after URS (p = 0.028). In the receiver operating characteristic curve analysis, the best threshold value for UWT according to the outcomes was identified as 5.8 mm. CONCLUSION: Ureteral wall thickness was the only independent parameter determining the need for additional procedures and affecting the treatment outcomes after the URS procedure.

Comparison of split-cuff nipple and modified Lich-Gregoir ureteroneocystostomy in iatrogenic distal ureteral injuries: tertiary care center experience.

PURPOSE: In this study, we aimed to compare the results of split-cuff nipple and modified Lich-Gregoir ureteroneocystostomy, which are the most commonly used techniques in stage ≥ 3 iatrogenic distal ureteral injuries. METHODS: The files of patients who were treated for iatrogenic distal ureteral injuries in our clinic between January 2013 and January 2019 were retrospectively reviewed. A total of 60 patients who underwent either intra-vesical split-cuff nipple ureteroneocystostomy (Group A) or extra-vesical modified Lich-Gregoir ureteroneocystostomy (Group B) operations were included in the study. The success of ureteroneocystostomy was defined as no additional surgery requirement, no progression of hydronephrosis on imaging, and normal contrast transition on imaging. RESULTS: Thirty-four patients underwent split-cuff nipple and 26 patients underwent modified Lich-Gregoir ureteroneocystostomy. The treatment was successful in 53 (88.3%) patients and failed in seven (11.7%). Complications occurred in 19 (31.7%) patients, of whom 14 (23.3%) had minor and five (8.3%) had major complications. The rate of postoperative complications was significantly higher in Group A than in Group B (p = 0.019). There was no significant difference between Group A and Group B in terms of the success ratio (p = 1), rate of major complications (p = 0.372), and postoperative hospitalization times (p = 0.254). CONCLUSION: In this study, a higher complication rate was found in patients with iatrogenic ureteral injuries who underwent ureteroneocystostomy with the split-cuff ureteral nipple technique compared to those who underwent this operation with the modified Lich-Gregoir technique. However, no significant difference was observed between these two techniques in terms of treatment success and major complications.

Comparison of Laparoscopic and Open Ureterolysis for Retroperitoneal Fibrosis: Results from a Tertiary Referral Center.

Objectives: To compare the surgical outcomes of open and laparoscopic ureterolysis procedures in patients requiring surgical treatment for ureteral obstruction caused by retroperitoneal fibrosis (RPF). Materials: This study was designed retrospectively. The clinical records of patients who underwent ureterolysis between January 2005 and April 2019 because of ureteral obstruction caused by RPF were examined. According to the type of surgery, the patients were divided into two groups as Group 1 (open ureterolysis) and Group 2 (laparoscopic ureterolysis). Demographic features, preoperative-postoperative renal functions, duration of follow-up with ureteral stents, and perioperative-postoperative complications were examined. The requirement of ureteral stent placement during the follow-up period was accepted as unsuccessful ureterolysis. Results: Ureterolysis was performed in 13 patients and 23 renal units. Eleven of these patients were men and two were women. The median age of the patients was 54 (44-68) years. There were six patients and 12 renal units in Group 1 and seven patients and 11 renal units in Group 2. Postoperatively, a total of four patients (30%) had minor complications (Clavien-Dindo 1-2) and one patient had a major complication (Clavien-Dindo 3a). Ureterolysis was determined to be effective in 21 of the renal units (91%) [11/12 (92%) in Group 1 vs 10/11 (91%) in Group 2]. No statistically significant difference was found between the groups in terms of the success and complication rates (p = 1 and p = 0.529, respectively). Postoperative hospitalization length and recovery time to return to normal preoperative activities were significantly shorter in Group 2 than in Group 1 (p = 0.011 and p = 0.041, respectively). Conclusions: The success and complication rates were similar between the open and laparoscopic methods for ureterolysis. Laparoscopic approach was advantageous over open approach in terms of postoperative hospitalization length and recovery time to return to normal preoperative activities.

Penile fracture: Tertiary care center experience and long-term complications after immediate repair.

BACKGROUND: In the literature, there is not sufficient data on factors affecting the development of complications in patients with penile fracture after early surgical intervention. OBJECTIVES: To investigate the predictors of long-term complications in patients who underwent immediate surgical repair for penile fracture. MATERIALS/METHODS: This clinical study included a total of 31 cases of penile fracture in which surgical treatment was performed within the first 24 h and penile fracture was confirmed during the operation. The patients with and without late complications were compared in terms of parameters such as age, tear size of the tunica albuginea of the penis, bilateral involvement of the corpora cavernosa involvement, urethral injuries, and duration from penile fracture to surgery. RESULTS: The median age of the patients was 42 years (interquartile range: 34-51 years). The median time from penile fracture to surgery was 13 h (8-18 h). The median tear size was 16 mm (11-21 mm). Late complications were seen in 13 (41.9%) patients in the post-operative period. Erectile dysfunction developed in five (16.1%) patients in the post-operative period. There was no statistically significant relationship between age, tear size, time from penile fracture to surgery, and bilateral corporeal involvement in terms of erectile dysfunction development. Painful erections, penile deviations, urethral strictures, tunical scars, and re-fracture were the other late complications. There was a significant relationship between the development of any complication and time from penile fracture to surgery (p = 0.028) and tear size (p = 0.031). In the receiver operating characteristic analysis of complication development, the cut-off value for the time from penile fracture to surgery was 13.5 h. DISCUSSION AND CONCLUSION: We found that the longer time interval between penile fracture and surgery worsened the patient outcomes. In addition, tear size was determined to be a predictor for long-term complications. In our opinion, early treatment of penile fracture can prevent severe complications in these cases.

Relationship between the types of urinary incontinence, handgrip strength, and pelvic floor muscle strength in adult women.

AIM: To investigate the relationship between handgrip strength with types of urinary incontinence (UI) and pelvic floor muscle strength (PFMS) in women. METHODS: Ninety-two women, who presented to the geriatric and urology outpatient clinics complaining of UI between July 2019 and February 2020 and had indicated to undergo urodynamic assessment after basic neurourological evaluation, were included in this cross-sectional study. The presence and types of UI were identified by clinical examination and urodynamic studies. Demographic parameters, anthropometric data, comorbidities and medications were recorded. The International Consultation on Incontinence Questionnaire-Short Form was applied. Handgrip strength (HGS) was measured by a hand dynamometer. The PFMS was subjectively assessed via vaginal digital palpation and measured quantitatively by the vaginal probe of the perineometer. RESULTS: Thirty-eight urodynamic stress, 28 detrusor overactivity, 26 urodynamic mixed UI patients were reported. Perineometer measurements were significantly lower in the urodynamic stress UI group compared to the other two groups (p = 0.020). There was no relationship between the types of urinary incontinence and HGS. However, a positive correlation was found between PFMS and HGS (p = 0.045, r = 0.298). CONCLUSION: The positive correlation between HGS and PFMS indicates that low HGS may be a marker for PFMS weakness. Furthermore, the association between sarcopenia and UI may be explained by this condition.

Ureteral wall thickness is an independent parameter affecting the success of extracorporeal shock wave lithotripsy treatment in ureteral stones above the iliac crest.

BACKGROUND: To investigate the relationship between ureteral wall thickness (UWT) and other variables of patients who underwent extracorporeal shock wave lithotripsy (SWL) in the primary treatment of the ureteral stone above the iliac crest level. MATERIAL AND METHODS: A total of 147 patients aged 18 years and older, who underwent SWL in our clinic between December 2016 and December 2019 for the treatment of ureteral stones above the iliac crest level and had non-contrast enhanced abdominal computed tomography scans before the procedure were included in the clinical study. The results were evaluated at 3 months after SWL. The absence of residual fragments was considered as stone-free status, and the existence of any size residual fragment was considered as treatment failure. RESULTS: In our study, the mean age of the patients was 42.4 ± 12.8 years, and the stone-free rate was 92.5%. The median transverse stone size was 7.5 mm (min 2.8-max 15), and the median UWT was 4.2 mm (1-8.7). In the multivariate analysis, UWT (P = .002) and multiple stone presence (P = .027) were found to be independent factors affecting stone-free status. In the receiver operating characteristic curve analysis, the optimal threshold value for UWT was determined as 5.25 mm. CONCLUSIONS: We found that UWT was the most important independent variable associated with increased failure in SWL treatment. The presence of multiple stones was another independent factor that increased the failure rates. Using SWL technology through experience accumulated with the mechanical hardware of the machine, we can select patients who are more suitable for this treatment and improve treatment outcomes.

Do urinary mast cell mediators predict immune response to BCG in patients with primary high-grade non-muscle invasive bladder cancer?

BACKGROUND: Mast cells play a critical role in cancer-associated immunity. We aimed to determine the predictive value of urinary mast cell mediators in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. METHODS: In this prospective study, 19 patients who received immunotherapy because of NMIBC (Group 1) and 19 healthy participants (Group 2) were enrolled. Urine samples were collected to assay N-methylhistamine, histamine, and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and 4 weeks after the sixth instillation in Group 1 and at a single visit in Group 2. The changes in urinary markers because of BCC response, BCG instillation, and the presence of NMIBC were assessed. RESULTS: The average age was 56.1 ± 10.5 years in Group 1 and 52.6 ± 9.7 years in Group 2. Fourteen patients had high-grade Ta tumours and five had T1 tumours. While 12 patients had responded to the BCG, seven patients did not respond to the BCG. There was no correlation between mast cell mediators and BCG response. The N-methylhistamine and histamine levels significantly increased with the onset of immunotherapy, and N-methylhistamine levels significantly decreased when immunotherapy was terminated (P < .05). The pre-BCG estimated marginal mean values of N-methylhistamine were significantly higher in Group 1 than in Group 2 (P < .05). CONCLUSIONS: Our study is the first to identify the changes in mast cell mediators with the onset of immunotherapy and in presence of bladder cancer. However, these mediators cannot predict patients' response to immunotherapy.

Villous Adenoma Arising in the Urethra of a Female with Bladder Augmentation History: A Case Report and Review of the Literature.

Villous adenomas (VAs) in the female urethra are rare with only seven cases in the English literature to our knowledge. In patients with bladder augmentation cystoplasty, the neoplasia development risk increases and most of these develop in the neobladder or anastomosis line. Only two cases of VA developing from the native bladder mucosa have been reported. Physical examination of a 76-year-old female who had a history of augmentation cystoplasty revealed a caruncula-like structure protruding from the urethral meatus. The urinary USG showed that the lesion had no relation with the bladder. The lesion was excised. Microscopically, it consisted of villous structures covered with pseudostratified intestinal type epithelium. Low-grade dysplasia was present in the epithelium but high-grade dysplasia or in-situ/invasive carcinoma was not observed. Immunohistochemical study showed positivity for CK7, CK20, EMA, CEA and CDX2. The case was reported as VA of the urethra. We presented the first VA case arising in the urethra of a female patient with intestinal bladder augmentation. Excision is curative for pure VAs. Transformation to carcinoma or recurrence has not been reported. However, in one third of the cases, a malignant tumor may accompany the lesion. Therefore, all excision material should be examined carefully. Routine endoscopic follow-up should be performed in cases with bladder augmentation.

Clinical outcomes of radical surgery in patients with renal carcinoma and associated venous thrombosis: Single-centre experience in a tertiary care institution.

BACKGROUND: Renal carcinoma and associated venous thrombosis cause specific perioperative and postoperative challenges. We aimed to evaluate the factors affecting clinical outcomes in patients undergoing radical surgery because of renal carcinoma and associated venous thrombosis. MATERIALS AND METHODS: Hospital records were retrospectively reviewed to identify patients with renal carcinoma and associated venous thrombosis treated with radical surgery between 2006 and 2019. Preoperative, perioperative, and postoperative findings were analysed to determine the associations between clinical and survival outcomes. Overall and disease-free survival were analysed by the Kaplan-Meier method. Other associated prognostic variables were assessed using univariate and multivariate Cox regression analyses. RESULTS: Thirty-three patients with renal carcinoma and associated venous thrombosis were enrolled for this study. There were 15 (45.4%) patients with level I, five (15.2%) with level II, eight (24.2%) with level III, and five (15.2%) with level IV venous thrombosis according to the Mayo Clinic classification system. The median follow-up was 35.6 months. In the univariate analysis, increased tumour size was associated with poor overall and disease-free survival. Preoperative clinic M1 disease was associated with poor overall survival. A high Mayo Clinic thrombus level was associated with poor disease-free survival. In the multivariate analysis, only tumour size and clinic M1 disease were independently correlated with poor overall survival. No independent statistically significant association was detected between thrombus level and survival outcomes. CONCLUSIONS: Although the thrombus level was not associated with overall and disease-free survival, tumour size and clinic M1 disease were found to have an independent prognostic impact on overall survival.

Comparison of a Modified Antegrade and Retrograde Ureteral Double-J Stenting Techniques during Laparoscopic and Robotic Pyeloplasty.

INTRODUCTION: To compare the effect of a modified antegrade and retrograde double-J stenting techniques on stenting and operation time in patients who underwent laparoscopic or robotic pyeloplasty. METHODS: A total of 74 patients undergoing transperitoneal laparoscopic or robotic pyeloplasty were enrolled into this study. The antegrade (Group 1) and retrograde (Group 2) techniques were compared for operation time, stenting time, complication, and reoperation rates. RESULTS: There were 41 and 33 patients in Groups 1 and 2, respectively. Both groups were similar in terms of age, side, and gender distribution. The mean operation times were 122.4 and 139.7 min in Groups 1 and 2, respectively (p < 0.001). The stenting times were 2.39 and 14.15 min in Groups 1 and 2, respectively (p < 0.001). The reoperation and complication rates were 7.3 and 6%, respectively, and similar for both groups (p = 1). CONCLUSIONS: Our new technique significantly shortens the duration of laparoscopic and robotic pyeloplasty without compromising success and complication rates.

The real-life management of overactive bladder: Turkish Continence Society multicenter prospective cohort study with short-term outcome.

INTRODUCTION: Turkish Continence Society aimed to analyze how overactive bladder (OAB) is being managed in routine practice by the urologists in Turkey. MATERIAL AND METHODS: Fourteen urology departments were randomly selected to represent the whole population in this multicenter study. An online data entry and storage software was created for patient recruitment and data assessment. A survey including demographic data, daily habits, lower urinary tract symptoms, and Turkish-validated OAB-V8 and ICIQ-SF questionnaires were completed by all patients. Second part of the survey, including the questions about clinical evaluation and management of the patient, was completed by the treating physician. RESULTS: A total of 507 patients (394 female and 113 male) were included. Behavioral therapy was recommended to 73.2% of female and 81.4% of male patients although bladder diary was requested for 59.5% and 52.7% of the female and male patients, respectively. In the first visit, 86.1% of the female and 89.3% of the male patients were given antimuscarinics (P = .431). Antimuscarinic-related side effects occurred in 94.9% and 88.9% of the female and male patients, respectively (P = .937). However, the rate of medical treatment change due to antimuscarinic-related side effects was only 1.7% in female and 4.8% in male patients at the end of 4 months. CONCLUSIONS: Behavioral therapy and antimuscarinics were the preferred initial treatment modalities of OAB in concordance with the guidelines. Despite guideline recommendations, bladder diaries were not utilized in half of the patients. Insufficient efficacy appeared to be the main reason for treatment modification.

Trifecta Outcomes of Laparoscopic Partial Nephrectomy for T1a and T1b Renal Tumors: A Single-Center Experience in a Tertiary Care Institution.

Objective: To assess the effectiveness and safety of laparoscopic partial nephrectomy (LPN) in T1a and T1b renal tumors using "Trifecta" in partial nephrectomy and determine the predictive factors in respect to the criteria that constitute Trifecta. Materials and Methods: We retrospectively analyzed the data harvested from the patients who underwent LPN for T1a or T1b tumors. Preoperative, perioperative, and postoperative outcomes were evaluated and analyzed. Patients who had grade <2 Clavien complications, negative surgical margins, and minimal renal function deterioration (warm ischemia time [WIT] ≤25 minutes and ≤15% postoperative estimated glomerular filtration rate [eGFR] decrease) were acccepted to fit the strict Trifecta outcomes. Multivariate analysis was done using logistic regression test to determine the predictive factors affecting Trifecta. Results: A total of 128 patients underwent LPN. Of these, 65 (50.8%) patients had cT1a and 63 (49.2%) patients had cT1b renal tumors. The mean age was 55.8 (24-85) years. Mean operative time was 143.6 (100-200) minutes. A total of five (3.9%) patients had positive surgical margins. Mean WIT was 22.1 minutes. Ten patients (7.8%) had a >15% decrease in eGFR after surgery. Complications were observed in 11 (8.6%) patients. A total of 78 (60.9%) patients had strict trifecta outcomes. Tumor size was found to be a predictive factor affecting Trifecta at multivariate analysis. Conclusions: LPN procedure has been shown to demonstrate improved strict Trifecta outcomes in patients with T1a and T1b renal tumors. Only the tumor size was found to be a predictive factor regarding the Trifecta criteria.

Clavien System Classification of Complications Developed following Laparoscopic Urological Operations Applied in our Clinic.

OBJECTIVES: We analyzed the complications of laparoscopic surgery using Clavien system classification on 396 urological procedures performed at our institution between 2005-2009. METHODS: A retrospective analysis was performed, focusing on complications associated with 396 laparoscopic surgeries performed between 2005 and 2009, which included radical and simple nephrectomy (n=188), partial nephrectomy (n=29), pyeloplasty (n=78), sacrocolpopexy (n=16) and radical prostatectomy (n=85). Complication data were tabulated according to the case number, procedure type, patient age, the American Society of Anesthesiologists score (ASA), Clavien classification system and annual complication rate during this study. Statistical analysis was performed with Fisher's exact and chi-square tests. RESULTS: A total of 75 patients had complications during the study period. Thus, the total postoperative complication rate was 18.9%. When sub-stratified to various surgical procedures, complication rates were: laparoscopic radical and simple nephrectomy (11.1%), laparoscopic partial nephrectomy (37.9%), laparoscopic pyeloplasty (15.3%), laparoscopic sacrocolpopexy (18.7%) and laparoscopic radical prostatectomy (32.9%). When the complications were classified according to Clavien Classification System stage 1, 2, 3, 4, 5, complication rate was observed in 11.6%, 13.8%, 1.2%, 1%, and 0% of patients, respectively. A correlation was not identified between ASA score and complication rate (p=0.02). CONCLUSION: The data presented here would enable us to compare our complication rates objectively with world literature.

Laparoscopic Treatment of the Isolated Renal Hydatid Cyst: Long-Term Outcomes from a Single Institution.

OBJECTIVE: To determine the effectiveness of treatment via laparoscopic approach and to present the long-term outcomes in patients with isolated renal hydatid cyst. MATERIALS AND METHODS: We reviewed the data of 11 patients who underwent laparoscopic treatment for isolated renal hydatid cyst between March 2004 and January 2017. Demographic characteristics and clinical, laboratory, and radiological findings of cases were examined. Mann-Whitney U and t-test were used in statistical analysis. RESULTS: The mean age of the patients was 36.7 years (25-51). The common complaint of the patients was lumbar pain and 9 patients had a palpable mass. It was identified that serologic evaluation of Echinococcus granulosus was positive in 5 patients. The mean cyst size was determined as 72 mm (40-150). The mean operation time was 128 minutes (120-150) while the length of hospital stay was 4 days (3-13). Perioperative major complication was not observed in any of the patients. The levels of hematocrit and creatinine were measured, 37.8 (26-43) and 0.93 (0.5-1.3), respectively, in the postoperative period, while these levels were 39 (26-45) and 0.90 (0.5-1.3) in the preoperative period and there was no statistically significant difference (P > .05). The mean follow-up time was 84 months (40-166). No relapses were observed in any patients. CONCLUSIONS: The treatment of renal hydatid cyst disease with laparoscopic approach is a safe and effective method. There was no recurrence in any of the patients in the long-term period. Further studies including a large series of patients are needed.

The Clinical Effect of Bipolar and Monopolar Transurethral Resection of the Prostate More Than 60 Milliliters.

OBJECTIVE: To compare the effect, safety, and complication rates of monopolar vs bipolar transurethral prostate resection (TURP) in patients with prostate gland larger than 60 mL. PATIENTS AND METHODS: Patients with prostate gland larger than 60 mL who were scheduled for surgery because of benign prostatic hyperplasia were randomized into bipolar or monopolar TURP arms via software program with a 1:1 ratio. Preoperatively and postoperative sixth hour and first day, hemoglobin and serum sodium levels were measured. International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QoL), and International Index of Erectile Function scores were determined, and maximal flow rate and residual urine volume were calculated in the preoperative period and postoperative sixth month. Postoperative clot formation, blood transfusion rates, and other complications were recorded on a database. RESULTS: Of 81 patients included in the study, 45 (55.5%) underwent monopolar and 36 (44.5%) underwent bipolar TURP (M-TURP and B-TURP groups, respectively). The only statistically significant change between the preoperative and the postoperative variables was detected in sodium levels, which were -5.0 mmol/L and -1.2 mmol/L in the M-TURP and B-TURP groups, respectively (P = .001). Although 2 of the patients in the M-TURP group experienced transurethral resection syndrome, none of the patients in the B-TURP group experienced this complication (P = .584). CONCLUSION: Bipolar and monopolar TURP showed similar effect and safety in patients with prostate glands larger than 60 mL. The only significant difference between the 2 groups was the greater decrease in serum sodium levels in the M-TURP group.

Risk Factors for Women to Have Urodynamic Stress Urinary Incontinence at A Turkish Tertiary Referral Center: A Multivariate Analysis Study.

PURPOSE: To investigate the risk factors in women with urodynamic stress urinary incontinence (USTIC) at a Turkish tertiary referral center. MATERIALS AND METHODS: The urodynamic records of 3038 consecutive women were analyzed between 1990 and 2011. The patients who had etiological factor of neurologic disease were excluded. There were 1187 women who had USTIC after urodynamic investigation and 274 women who had no incontinence symptoms were included in the study. Multivariate analyses were done using logistic regression test to determine the risk factors for USTIC. RESULTS: The mean age was 50.1 years (range, 86-18). Increased age, vaginal delivery, cesarean section, anterior prolapse existence in physical examination, previous anti-incontinence surgery, and previous pelvic organ prolapse surgery was found to be significant risk factors for USTIC at multivariate analyses. CONCLUSION: There are risk factors for women to have USTIC. Increased age, having vaginal delivery, having cesarean section, anterior prolapse, previous anti-incontinence surgery and previous prolapse surgery were found to be risk factors for women to have USTIC at this study.

Transvaginal repair using acellular collagen biomesh for the treatment of anterior prolapse.

PURPOSE: To determine the results and satisfaction of the patients underwent transvaginal repair of cystocele in our clinic. MATERIALS AND METHODS: From January 2006 to October 2010, 15 patients with a mean age of 64 years (ranged 47-85 years) underwent transvaginal cystocele repair using acellular collagen biomesh. The patients were presented with vaginal mass in 10, dyspareunia and urge incontinence in 5 while 4 of them had both stress and urge incontinence. Grade 4 cystocele was determined in 2 patients, grade 3 in 9 and grade 2 in 4. Concomitant transobturator tape (TOT) was performed in 4 patients. Patient satisfactions were determined after the operation. RESULTS: The mean follow-up time was 23.5 (12-60) months. There was no postoperative complication in early follow- up period. Cystocele was recurrent in 1 patient. The success rate was 93.4%. Urinary incontinence was continued in 1 patient after TOT. Nearly all of the patients (14/15) were satisfied from the operation. CONCLUSION: Transvaginal cystocele repair with using acellular collagen biomesh appears to be a safe and effective method. Further prospective and randomized controlled studies including large series of patients are needed.