Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children. METHODS: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation. RESULTS: The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90). CONCLUSIONS: This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.

Long-term follow-up of trigonoplasty antireflux operation.

BACKGROUND: Open trigonoplasty antireflux operation has been associated with promising results. However, its success in controlling reflux has not been evaluated in the long term. METHODS: All patients who underwent trigonoplasty for vesicoureteral reflux by one surgeon from 2004 to 2014 were included. Preoperative evaluations included direct radionuclide cystography (DRNC) or voiding cystourethrography, urine analysis and culture and abdominal sonography. Urodynamic study and cystoscopy was performed in selected patients. Trigonoplasty was done by a modified Gil-Verent method. The latest available patients' DRNCs were used to judge for reflux relapse. RESULTS: Ninety-one patients, 142 refluxing units; median (range) age, 10.5 (1-45) years; M/F, (11/80) were followed for 18 to 135 months. Reflux resolution rate was 73.6% for patients and 75.4% for refluxing units. Relapse was associated with reflux grade (67% in grade V), ureteral orifice appearance (40% in golf hole/stadium), and patients with a history of pyelonephritis. Multivariable model based on the above variables had less than 10% sensitivity in predicting relapse. CONCLUSIONS: Trigonoplasty success rate can decrease with long-term follow-up.

What is the impact of extracorporeal shock wave lithotripsy on semen parameters? A systematic review and meta-analysis.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is an important tool for the management of urolithiasis. The effects of shockwaves on tissues are established. The aim of this meta-analysis is to evaluate the microscopic semen characteristics of young men before and after ESWL treatment for lower ureteral calculi. METHODS: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included six trials that investigated the effects of ESWL on semen parameters, including sperm concentration, motility, and hematospermia. Meta-analyses were performed using fixed and random-effects models with tests for publication bias and heterogeneity. RESULTS: Significant worsening was detected in sperm concentration and motility after ESWL between case and control groups (mean difference -17.23, 95% confidence interval -22.53 to -11.93, p<0.00001, mean difference -10.82, 95% confidence interval -18.56 to -3.07, p = 0.006). Rate of microscopic and macroscopic hematospermia was significantly higher after ESWL between case and control groups [risk ratio (RR) 40.00, 95% confidence interval 10.11-158.30, p<0.00001, RR 14.33, 95% confidence interval 2.82-72.90, p = 0.001]. All parameters recovered after 3 months. CONCLUSIONS: This study showed sperm concentration, motility, and rate of hematospermia (microscopic and macroscopic) were affected by ESWL that was used for the treatment of lower ureteral stone. Long-term studies with a focus on male fertility (i.e., pregnancy rates) after ESWL are warranted.