Can we reduce secondary surgical interventions and length of hospitalization in percutaneous nephrolithotomy?

PURPOSE: To evaluate the success and complication rates of percutaneous nephrolithotomy (PNL) operations and to determine the effect of postoperative late removal of an open-end ureter catheter on hospital stay and on secondary interventions. MATERIALS AND METHODS: The records of 198 patients (97 female, 101 male) who had PNL between May 2009 and February 2012 were retrospectively reviewed. The open-end ureter catheter which was placed during the operation was removed at the end of the operation in the first 53 patients ( group 1) and 12 hours after the nephrostomy catheter in 145 patients ( group 2). RESULTS: PNL intervention was performed in 198 patients with a mean age of 40.83 ± 13.64 years and mean stone load of 9.82 ± 5.37cm2 (range 2 to 26 cm2). When clinically insignificant stone pieces < 4 mm were accepted as successful, the total success rate was 80.80 % (79.2% in group1 and 81.4% in group 2, P = .50). The hospitalization period was significantly reduced in group 2 (3.45 ± 0.95 days vs. 2.61 ± 0.65 days; P = .006). While secondary surgical intervention was not necessary in any of the patients in group 2 (0.0%), but 4 patients (7.5%) required ureterorenoscopy plus double-J stent placement following the primary procedure in group 1 (P = .006). CONCLUSION: PNL is a safe procedure with a high success rate and a short hospitalization period. There was a significant decrease in the hospitalization period and secondary surgical intervention rates with the postoperative late removal of the open-end ureter catheter.

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.

Pleural complications of pulmonary hydatid disease.

OBJECTIVE: The aim of this study was to determine the incidence and diagnostic features of pleural manifestations of pulmonary hydatid disease. METHODOLOGY: Patients with pleural pathology in association with surgery for pulmonary hydatid disease over an 8-year period were evaluated. RESULTS: Twenty-nine (6%) of 474 patients with histologically confirmed pulmonary hydatid disease had pleural abnormalities. The diagnosis was determined preoperatively in 22 patients and was based on radiographic, clinical, and/or serology findings. Bronchoscopic specimens were diagnostic in two of seven patients who had bronchoscopy. Five patients were not diagnosed until surgery. Radiographic abnormalities consisted of pleural thickening and/or free fluid without intrapleural rupture of the cysts in 21 patients. Eight patients had a hydropneumothorax. Sixteen patients had an exudative, uncomplicated effusion. The remaining patients had empyemas. All patients had resection of the pulmonary cysts, and 20 also underwent a pleurectomy. The mean length of hospital stay was 23 +/- 14 days. There was no hospital mortality. CONCLUSION: Pleural lesions associated with pulmonary hydatid disease are rare and have a variable radiographic appearance. In regions in which echinococcal disease is endemic, a high level of clinical suspicion is necessary for diagnosis and appropriate management of this condition.