Stone formation in prostatic urethra after potassium-titanyl-phosphate laser ablation of the prostate for benign prostatic hyperplasia.

We report three cases of stone formation at the prostatic urethra after 80 W potassium-titanyl-phosphate laser ablation of the prostate for benign prostatic hyperplasia. These complications occurred several months after the procedure. The diagnosis was made by ultrasonography, plain radiography of the kidneys, ureters, and bladder, and cystoscopy in patients who were being evaluated after presenting with irritative voiding symptoms. The patients were treated by cystolithotripsy and resection of the calcified prostatic tissue.

Stone formation from intravesical Hem-o-lok clip migration after laparoscopic radical prostatectomy.

Intravesical Hem-o-lok clip (HOLC) migration is a rare complication of prostatic surgery. We report two cases of migration of a HOLC into the bladder leading to stone formation. As such, these devices should be used with caution in the region of the vesicourethral anastomosis.

Percutaneous versus transurethral cystolithotripsy.

PURPOSE: To compare transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL) modalities performed during simultaneous transurethral resection of the prostate (TURP) in patients with prostate hyperplasia and large bladder stones. PATIENTS AND METHODS: Sixty-three patients with prostate volume >40 cc and aggregate stone size >2.5 cm were enrolled in the study between August 2003 and February 2007. TUCL (n = 38) or PCCL (n = 25) procedures were performed during simultaneous TURP. In the TUCL group, the stones were removed after fragmentation through a 23F cystolithotripter with pneumatic lithotripsy. This was followed by TURP, performed with a 26F continuous-flow resectoscope. In the PCCL group, the stones were removed through a suprapubic 30F Amplatz sheath after fragmentation. TURP was then performed with the suprapubic sheath providing continuous drainage. RESULTS: Mean age and prostate volumes of the groups were similar. Mean aggregate stone sizes were significantly larger in the PCCL group. The operative time for stone removal was significantly less in the PCCL group while time needed for TURP was statistically similar in the two groups. In the TUCL group, three patients had residual stones necessitating repeated TUCL and urethral stricture developed in three patients. CONCLUSION: The smaller caliber of the working channel during TUCL, compared with PCCL, necessitates disintegration of the stones into smaller fragments. This elongates the duration of the intervention and results in increased urethral and bladder trauma. Combined TURP and PCCL is a safer, more effective, and much faster alternative to combined TURP and TUCL in patients with large bladder stones and prostate hyperplasia.

Can lemon juice be an alternative to potassium citrate in the treatment of urinary calcium stones in patients with hypocitraturia? A prospective randomized study.

To investigate that lemon juice could be an alternative to potassium citrate in the treatment of urinary calcium stones in patients with hypocitraturia, 30 patients with hypocitraturic urinary calcium stones were enrolled into study. The patients were divided into three groups equally. Exactly 60 mEq/day fresh lemon juice ( approximately 85 cc/day) and potassium citrate (60 mEq/day) were given to the patients of first and second group, respectively. Dietary recommendations were made for the third group. Blood and 24-h urine tests were performed before treatment and repeated 3 months later. The differences between demographic datas of groups were not significant. There was no significant difference between values of blood tests performed before and after treatment in all groups. Statistically significant differences were found between pre- and post-treatment urine values in each group. Although there was no significant difference between pre-treatment citrate levels of the groups. A significant difference was found between post-treatment citrate levels of the groups. There was 2.5-, 3.5- and 0.8-fold increase in urinary citrate level of lemon juice, potassium citrate and dietary recommendation groups, respectively. Urinary calcium level was decreased only in lemon juice and potassium citrate groups after treatment. While there was no significant difference between pre- and post-treatment urinary oxalate levels in all groups, a significant decrease in urinary uric acid levels was determined in all groups. We suggest that lemon juice can be an alternative in the treatment of urinary calcium stones in patients with hypocitraturia. Additionally, dietary recommendations can increase effectiveness of the treatment.

Percutaneous nephrolithotomy (PCNL) in patients with previous open stone surgery.

OBJECTIVES: Our objective was to investigate the effects of previous open nephrolithotomy on technical features, outcomes, and morbidities of subsequent percutaneous nephrolithotomy (PCNL). METHODS: One hundred and sixty patients underwent PCNL between December 2004 and September 2006. The patients were divided into those who had previous open nephrolithotomy on the same kidney (group 1: 55 patients) and those who had no previous open surgery (group 2: 105 patients). Technical features encountered during operation and outcomes were compared between groups. RESULTS: There were no significant differences between groups with respect to mean age (group 1: 42.6 +/- 10 years vs. group 2: 45.5 +/- 9.6 years), body mass index (24.8 +/- 2.11 vs. 24.6 +/- 2.14), and stone burden (385.6 +/- 140.6 mm(2 )vs. 401.05 +/- 142 mm(2)). In group 1, 28 and 27 stones were located in the right and left kidney, respectively, whereas the location was 51 and 54 for the right and left kidney, respectively, in group 2. When the groups were compared, the mean operative time was significantly longer (155 +/- 30 min vs. 137 +/- 30 min) in group 1. But there was no significant difference with respect to requirement for secondary intervention (11% vs. 10%). Sepsis developed in two patients in group 1 and one patient in group 2. One patient in group 1 died due to septic shock. Ten (18.2%) patients in group 1 and 13 (12.4%) patients in group 2 required blood transfusion. CONCLUSIONS: When PCNL is performed after previous open nephrolithotomy, the operative time lengthens. But there is no difference with respect to success rate and morbidities.

Do microdeletions in the AZF region of the Y chromosome accompany cryptorchidism in Turkish children?

OBJECTIVE: To investigate the presence of Y chromosome microdeletions in children with cryptorchidism. MATERIALS AND METHODS: Male patients aged between 1 and 17 years, who had been diagnosed by physical examination to have cryptorchid testes, were included in the study. Microdeletions of 24 gene loci belonging to the AZF-a, AZF-b and AZF-c regions of the Y chromosome were examined by multiplex polymerase chain reaction (PCR) multiplication of the DNA sample extracted from peripheral leukocytes. RESULTS: Sixty-four patients with a mean age of 7.82+/-3.21 (range: 1-17) years were included in the study. There was unilateral cryptorchidism in 53.1% (34/64) of the patients and bilateral cryptorchidism in 46.8% (30/48) of the patients. No microdeletion of gene loci on the AZF-a, AZF-b and AZF-c regions of the Y chromosome was determined in any patient. CONCLUSION: Studies on Y chromosome microdeletions are important due to a potential for the transmission of genetic abnormalities to offspring. Assisted reproduction techniques may cause the transmission of genetic abnormalities to offspring because the physiological fertilisation mechanism is bypassed. It was found that there was probably no aetiologic correlation between microdeletions in gene loci on the AZF-a, AZF-b and AZF-c regions of the Y chromosome and cryptorchidism.

A single-nucleotide polymorphism in the matrix metalloproteinase-1 promoter enhances bladder cancer susceptibility.

OBJECTIVE: To explore the association between the promoter polymorphism (that influences the transcriptional level) of matrix metalloproteinase-1 (MMP-1, associated with tumour cell invasion and metastasis) and bladder cancer in a Turkish population. PATIENTS, SUBJECTS AND METHODS: The MMP-1 polymorphism was assessed in 102 transitional cell carcinomas of the bladder (50 Ta, 52 T2-4) and in 94 age-, smoking- and gender-matched healthy volunteers. The polymerase chain reaction (PCR) assay was used to determine the MMP-1 genotypes. Genomic DNA used for the assay was extracted from peripheral blood lymphocytes. RESULTS: The frequency of the MMP-1 2G/2G genotype, which results in the highest MMP-1 transcriptional level, was compared to that of the 1G/1G plus 1G/2G genotypes. Of the 102 cases with bladder cancer, 49 (48%) showed the 2G/2G genotype, whereas it was found in 22 of the 94 controls (23%); this difference was statistically significant (P < 0.01; odds ratio 2.79, 95% confidence interval, CI, 1.53-5.60). However, there was no significant association between the 2G/2G genotype and tumour grade and pathological stage. We assessed the interaction between smoking status (former and current smokers, by their median pack years) and 2G/2G genotype; there was a significantly increased risk in heavy smokers (P < 0.001; odds ratio 3.21; 95% CI 1.33-5.60). CONCLUSION: These results suggest that the MMP-1 promoter polymorphism might be linked to susceptibility for bladder cancer.

Combined treatment of iatrogenic rectourethral fistula with endoscopic fibrin glue application and clipping.

Rectourethral fistula (RUF) formation is a rare complication of prostatic surgery and other pelvic surgical procedures. The results of operations to correct RUF are not always satisfying, with a particular risk of recurrent breakdown or stricture formation at the site of the urethral closure. We present a case of a small RUF treated videoendoscopically with fibrin-glue application combined with endoscopic clipping.

Bone mineral density measurement in patients with recurrent normocalciuric calcium stone disease.

To investigate bone mineral densitometry findings in patients with normocalciuric urinary system stone disease, we compared 150 patients with normocalciuric calcium stone disease (group 1) and 60 subjects of a control group (group 2). The patients were compared according to bone mineral content (BMC), bone area (BA), bone mineral density (BMD), T-score and Z-score values of femur neck, total femur and lumbar spine (L2-L4) by dual energy absorptiometry. We found that 76.6% of the patients in group 1 and 20.0% in group 2 had low BMD; 11.3% of patients in group 1 had osteoporosis and 65.4% had osteopenia. In the control group, there was no osteoporosis, but 20.0% of the subjects had osteopenia. In group 1, there was hyperoxaluria in 26.0% of patients, hypocitraturia in 15.3% of patients, hyperuricosuria in 6.0% of patients, both hypocitraturia and hyperoxaluria in 8.6% of patients in a 24-h urine analysis. Urine analysis was normal in 44.0% of patients. Our results showed a severe loss of bone mass in patients with urinary system normocalciuric calcium stone disease. Thus, the necessary precautions concerning bone mass protection should be taken and the patients should be informed about this issue.