Can neutrophil-lymphocyte ratio and lymph node density be used as prognostic factors in patients undergoing radical cystectomy?

OBJECTIVE: To assessment the role of preoperative neutrophil-lymphocyte ratio and postoperative lymph node density in predicting prognosis in patients undergoing radical cystectomy for bladder cancer. MATERIAL AND METHODS: Preoperatively, neutrophil and lymphocyte counts as well as neutrophil-lymphocyte ratios were recorded in 201 patients who underwent radical cystectomy for bladder cancer. Patients with an infection were excluded. Based on the pathology reports, the number of positive lymph nodes was divided by the total number of lymph nodes to calculate lymph node density. RESULTS: The mean follow-up duration was 37.22 ± 35.922 months in patients without lymph node involvement and 27.75 ± 31.501 months in those with lymph node involvement (P = 0.015). Median lymph node density was 17% (4-80) in patients with lymph node involvement. There was no difference according to lymph node density lower than 17% and greater than 17% (P = 0.336). There was no significant difference between patients with an NLR below or above 2.5 in terms of overall survival (P = 0.702). Pathological T stage was associated with survival (P = 0.004). CONCLUSION: In patients undergoing RC for bladder cancer, lymph node density and preoperative NLR were not found to be independent predictors of prognosis.

Comparison of infection and urosepsis rates of ciprofloxacin and ceftriaxone prophylaxis before percutaneous nephrolithotomy: a prospective and randomised study.

This study aimed at determining the choice and administration duration of ideal antibiotic prophylaxis before percutaneous nephrolithotomy (PNL) operation, a treatment modality for nephrolithiasis. The study included 90 patients who had no internal problem, yet had a negative urine culture and underwent a PNL operation. We compared infection rates between ciprofloxacin and ceftriaxone groups and their subgroups. The results showed no statistical difference between ciprofloxacin and ceftriaxone groups in terms of systemic inflammatory response syndrome (SIRS) (CIP(P) = 0.306, CTX P = 0.334. As a result of this study no statistical difference was observed between ciprofloxacin and ceftriaxone in terms of SIRS. It seems, however, reasonable to choose ceftriaxone, considering antibiotic sensitivity of microorganisms and detection of three cases accepted as urosepsis in the ciprofloxacin group. As there is no difference between short, and long-term prophylactic use of these antibiotics, preference of short-term prophylaxis for patients with no risk of infection will be important to avoid inappropriate antibiotic usage.

Comparison of conventional and step-wise shockwave lithotripsy in management of urinary calculi.

PURPOSE: In this clinical study, our aim was to evaluate the results of conventional and step-wise shockwave lithotripsy (SWL) in the management of urinary calculi. PATIENTS AND METHODS: Fifty consecutive patients seen in our outpatient urology clinic were included and randomized in the clinical study. SWL was performed using a Dornier Compact Delta instrument. Treatment energy was set on 13 kV in the conventional group. In the step-wise SWL group, the patients were subjected to gradually increased (with every 500 shocks) output voltage as 11, 12, and 13 kV, respectively. The SWL session was completed with 13 kV thereafter. The maximum number of shocks in both groups was limited to 3,000. RESULTS: Twenty-five patients in the conventional group and 25 patients in the step-wise SWL were included. The mean ages in the step-wise SWL group and the conventional group were 39.9 and 41.4 years (P > 0.05), respectively. The mean stone size was 0.83 +/- 0.51 cm in the step-wise SWL group and 0.70 +/- 0.41 cm in the conventional group (P > 0.05). There was no difference between the two groups as to the localization of stones in the ureter or kidney. Also, no statistical difference was observed in the number of lithotripsy treatments between the two groups. When we compared the results of two treatment procedures 8 weeks after the initial treatment, the success rate was significantly higher in the step-wise SWL group than in the conventional group (stone-free rate 96% (24/25) v 72% (18/25), P < 0.05)). CONCLUSIONS: Step-wise SWL yielded better outcomes than conventional SWL without increased morbidity. Stepwise SWL can be considered as a management option for urinary calculi.

Epidermoid carcinoma of the lung with isolated penile metastasis.

We report a case of epidermoid-cell carcinoma of the lung that developed a metastatic lesion in the penis. A 50-year-old male patient was admitted to our hospital with bloody sputum and cough. He had a left pneumectomy and was diagnosed with epidermoid carcinoma of the lung at stage IIB (T2N1M0). He was started on an adjuvant chemotherapy protocol consisting of cisplatin and paclitaxel. He was admitted to our urology clinic with obstructive symptoms during urination and pain during penile erection. Physical examination revealed a firm, 3 cm x 2 cm palpable mass on the radix of his penis. A fine-needle aspiration biopsy of the penile mass revealed epidermoid carcinoma that was consistent with lung cancer. The patient was considered to have penile metastasis from epidermoid carcinoma of the lung.

Does previous open nephrolithotomy affect the outcome of percutaneous nephrolithotomy?

PURPOSE: To determine the effects of previous open nephrolithotomy on the results and morbidity of subsequent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Between March 2005 and January 2006, 89 patients underwent PCNL at our institution. We compared the patients who had had previous open surgery on the same kidney (group 1; n = 27) with those who had had no previous surgery (group 2; n = 62). The two groups did not differ significantly in age (45.4 v 44 years), stone burden (361.3 mm(2) v 482.4 mm(2) ), stone number, or laterality. Operative time, hospital stay, success rate, visual analog pain scores 8 hours after surgery, analgesic doses (diclofenac sodium), and intraoperative and postoperative complications were compared. RESULTS: There were no differences in operating time, postoperative analgesic doses, pain scores, intraoperative and postoperative complications, the number of accesses, or the stone-free rate. CONCLUSIONS: The morbidity and efficacy of PCNL are similar in patients who have had previous open nephrolithotomy and those having no previous surgery. Previous open surgery does not affect the success of PCNL.

Stepwise shock wave lithotripsy: results of initial study for the treatment of urinary stones in childhood.

OBJECTIVE: To assess the effectiveness of stepwise extracorporeal shock wave lithotripsy in the treatment of upper urinary stones in childhood. PATIENTS AND METHODS: Between August 1998 and August 2003, 31 patients were treated for renal or ureteric stones. All treatments were performed with Dornier Compact Delta lithotripter. The number of shock wave was limited to maximum 3000 shock waves/session. The voltage was started at 10 kV and increased stepwise to 12.75 kV. Stone clearance was assessed at 3 months. The stone free state was defined as the absence of stone fragments. RESULTS: Total 31 stones (24 renal and 7 ureteral stones) were treated. The age of the patients was median 8 (min-max: 0.8-12) years. The length of the stones was median 1 (min-max: 0.5-1.5) cm for renal stones and median 0.5 (min-max: 0.5-1) cm for ureteral stones. As an auxiliary procedure, open pyelolithotomy was required for 1 patient. The overall stone free rates for renal and ureter stones were 79% and 100%, respectively. Post-treatment insignificant hematuria was observed in all cases. CONCLUSION: Stepwise shock wave lithotripsy was an effective procedure for the treatment of urinary calculi in childhood.

Retroperitoneoscopic ureterolithotomy for the treatment of ureteral calculi.

INTRODUCTION: Most upper or middle ureteral stones are treated with shock wave lithotripsy or endoscopic techniques. In rare cases the ureteral stones are treated with open surgery after failure of first-line treatments. Retroperitoneoscopy is a minimally invasive alternative to open surgery. PATIENTS AND METHODS: Between May 1995 and January 2001, twenty-one patients underwent retroperitoneoscopic ureterolithotomy. The stones in upper and middle ureter were large and impacted (5 patients) or not fragmented after shock wave lithotripsy (16 patients). A balloon dissector was placed and infiltrated with 800 ml air in the retroperitoneal space. Three 10-mm trocars were used. The pressure was kept at 15 mm Hg by carbon dioxide insufflation. The stones were extracted from the ureter using a laparoscopic stylet. RESULTS: The stones in 17 patients were successfully removed in a median operating time of 105 (min-max 45-190) min. Urine extravasation in all cases and pnomoscrotum in 2 cases were observed as postoperative complications. The median hospital stay was 6 (min-max 3-22) days with minimal analgesic requirement. CONCLUSION: Retroperitoneoscopic ureterolithotomy is a useful and effective alternative treatment technique to open surgery when first-line treatments have failed or are unlikely to be effective.

Comparison of extraperitoneoscopic and transperitoneoscopic techniques for the treatment of bilateral varicocele.

BACKGROUND AND PURPOSE: Laparoscopic varicocelectomy has been performed in patients with bilateral varicocele. This procedure could be performed either transperitoneally or extraperitoneally. The purpose of this study was to compare the effectiveness and morbidity of the two approaches. PATIENTS AND METHODS: Twenty-one patients underwent transperitoneal repair. Twelve of them had complaints of infertility, and nine of them had pain. Eighteen patient underwent extraperitoneal repair. Twelve of them had complaints of infertility, and six of them had pain. All the patients with pain had clinical varicoceles. In each group, three patients with infertility had unilateral subclinical varicoceles. RESULTS: No significant difference was found in the duration of surgery, artery-vein discrimination, or morbidity between the extraperitoneal and transperitoneal techniques. In both approaches, the previously infertile patients who have been followed more than 6 months had significant improvement in sperm counts and motilities (P < 0.05). There were no significant differences in the improvement in the extraperitoneal and transperitoneal groups. CONCLUSION: There was no significant difference between the transperitoneal and extraperitoneal techniques in terms of effectiveness and morbidity. The difficulty in identifying the internal spermatic vein and the additional cost of the balloon dissector for the extraperitoneal technique makes us prefer transperitoneal repair.

Big bladder stones around an intravesical migrated intrauterine device.

Spontaneous migration of the intrauterine devices into the bladder and secondary stone formation are rare complications. A 33-year-old women in whom a copper T intrauterine device had been placed two years previously, presented complaining of irritative lower urinary tract symptoms. Intravesical migration of intrauterine device and big stones around it were confirmed by radiography and cystoscopy. The stones were fragmented by using electrohydraulic lithotriptor. And then all fragments of the stones and IUD were cystoscopically removed by a grasping forceps without any complication.

Electrified urinary drainage bag: an in vitro study.

An experimental study was designed to examine the effect of electrical current on bacteria-contaminating urinary drainage bags. An experimental model analogous to a urinary drainage system has been formed. Bottles containing 1,000 ml urine inoculated with Pseudomonas aeruginosa, Klebsiella pneumoniae or Escherichia coli in different experimental settings were drained with constant speed into urinary drainage bags in which platinum electrodes had been implanted. An experimental procedure involved applying an electrical current with a 12 V DC generator into bags containing urine for 24 h. Cultures were obtained separately from the bags and microorganism-inoculated bottles for 24 h and following a cessation of electrical current for another 24 h. In electrified bags, P. aeruginosa was killed in all experiments. E. coli and K. pneumoniae were eradicated at the end of 24 h. However, K. pneumoniae began to grow in increasing numbers following the cessation of the electrical current. An electrical current might decrease or eradicate the bacteria in urinary-drainage bags. This might be one of the ways to decrease the risk of in vivo cross-contamination and nosocomial infections.