Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study.

Objective: To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS). Methods: Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [-] 87 patients). Then all UAS+ patients (n=481) were subdivided according to UAS calibration: 9.5-11.5 Fr, 10-12 Fr, 11-13 Fr, and 13-15 Fr. Primary outcomes of the study were the success and complications of RIRS. Results: Stone-free rate of UAS+ patients (86.2%) was significantly higher than UAS- patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5-11.5 Fr: 66.7%; 10-12 Fr: 87.0%; 11-13 Fr: 90.6%; 13-15 Fr: 100%; p<0.001). Postoperative complications of UAS+ patients (11.5%) were significantly lower than UAS- patients (27.6%) (p=0.01). Complications (8.7%) with 9.5-11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant (p=0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314-10.162; OR 4.443, 95% CI 1.350-14.552; OR 4.107, 95% CI 1.366-12.344, respectively). Conclusion: Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.

Effect of Tadalafil on Prevention of Urethral Stricture After Urethral Injury: An Experimental Study.

OBJECTIVE: To evaluate the preventive effect of phosphodiesterase type 5 inhibitor (tadalafil) on the formation of urethral stricture after urethral injury. MATERIALS AND METHODS: A total of 28, 4-month-old male New Zealand rabbits were included and divided into 3 groups. Group 1 was a sham group with 8 rabbits that underwent only urethroscopy. Group 2 was a nontreatment group with 10 rabbits that underwent urethral electrocoagulation without any treatment. Group 3 was the treatment group with 10 rabbits that underwent urethral electrocoagulation with systemic tadalafil treatment. After 30 days of follow-up, urethroscopy and retrograde urethrography were performed to evaluate the morphological changes in the urethra. The urethra tissues were examined with standard light microscopy by a histologist, and apoptosis was evaluated by the terminal dUTP nick end-labeling assay. RESULTS: Urethral diameters in group 1, group 2, and group 3 were 9.14 ± 0.73 mm, 3.52 ± 1.2 mm, and 7.68 ± 1.14 mm, respectively. The differences in urethral diameters were statistically significant between groups (P < .01). Collagen deposition in submucosal connective tissue was significantly less in the tadalafil group vs the nontreatment group. The numbers of apoptotic cells in submucosal connective tissue were also quantitatively higher in urethral stricture groups compared to the sham group. CONCLUSION: Tadalafil treatment had a protective effect against the formation of urethral stricture in rabbit model. This treatment can be a promising opportunity for urethral stricture and must be supported by clinical studies.

Can non-urological doctors play a role in early prostate cancer detection?

PURPOSE: To evaluate the awareness of non-urological doctors for their role in evaluating prostate cancer (Pca) in scientific manner which may be a possible probability for late diagnosis of Pca. MATERIALS AND METHODS: A total of 936 non-urological specialists working in 1 university and 4 education and research hospital who were able to evaluate male patients over 50 years of age were included to the survey. A face to face questionnaire had been administered to all participants. RESULTS: A total of 92 (9.8%) participants were evaluating prostate-specific antigen (PSA) level to all their elderly male patients while 404 (43.2%) participants had never made this evaluation. Among the participants who were evaluating PSA, none was performing an informed decision making consult and even they did not have any idea about the meaning of this strategy. About the criteria for urological consultation, 56 (6%) reported that they consult all their elderly male patients, whereas 880 (94%) answered that they perform consultation if their patients has sought help for any urological symptom. CONCLUSION: Urologists must remind the non-urological specialists that their approaches to Pca evaluation may change mortality rates of this disease and give them proper information about the scientific evaluation of Pca. This may help us to decrease the mortality rates of Pca.

Prevalence of nocturnal enuresis and associated factors in schoolchildren in Western Turkey.

INTRODUCTION: The prevalence of nocturnal enuresis (NE) in pediatric populations varies between 1% to 20%. The aim of this study was to determine the prevalence of NE in schoolchildren living in Tekirdag, a city in Western Turkey. MATERIALS AND METHODS: We distributed a questionnaire to 11324 schoolchildren aged 7 to 14 years who were living in Tekirdag. The questionnaires were filled in by the children's parents. The main study endpoints were the prevalence of NE, and its association with sociodemographic factors of the children and their parents. RESULTS: The results from 9210 children (81.4%) who returned fully completed questionnaires were included in the study. The prevalence of NE was 7.5%. Another 579 children (6.2%) had NE that had resolved at the time of study. Prevalence rates decreased with increasing age, reaching 1.4% by age 14 years. NE was more prevalent among boys than girls, but the rates became similar by age 12 years. There was a strong relationship between NE and family history of childhood NE. More than half of the parents who had a child with NE were using traditional techniques for treatment. CONCLUSIONS: The prevalence of NE in schoolchildren in Tekirdag, a city in Western Turkey was 7.5%. Having a family history of childhood NE was the one of main risk factors for NE.

Case report: good prognosis in leiomyosarcoma of the kidney.

Sarcomas represent 1-2% of all malignant renal tumors in adults, with an incidence that increases with advancing age. Renal sarcoma is less common, but more lethal than sarcoma of any other genitourinary site. The common signs and symptoms associated with renal sarcoma in adults include palpable mass, abdominal or flank pain and hematuria similar to those seen with large, rapidly growing renal cell carcinomas. Usually, radical nephrectomy remains the treatment of choice for these tumors, which exhibits an aggressive biological behavior and an unfavorable prognosis. We describe an unusual case of renal leiomyosarcoma that underwent nephron sparing surgery, in a 55-year-old white woman, who had a renal mass for 3 years. The size of the renal mass did not change during this period and no distant metastasis occurred. The patient is still alive without any symptoms of relapse.

A new suture technique for anastomosis in radical retropubic prostatectomy and early removal of urethral catheter.

INTRODUCTION: A modified suture technique for urethro-vesical anastomosis during radical retropubic prostatectomy was developed and utilized in a cohort of patients. Comparative analysis of postoperative outcome was performed with a previous group of patients who had an anastomosis with the conventional technique. MATERIAL AND METHODS: A consecutive group of patients who underwent radical retropubic prostatectomy in our department with the diagnosis of localized prostate cancer was included in this retrospective study. Urethro-vesical anastomosis was performed either with the new or conventional method (CM). Outcome data of these two different patient sets were compared. RESULTS: One-hundred and one consecutive patients (mean age of 61.9 years) who were operated by either one of the two anastomotic suture techniques composed our study group. The mean follow-up period was 18 months (min: 12-max: 24). Urethro-vesical "U" (UVU) suture was performed in 51 patients, and CM in 50 patients. Foley catheter was removed at postoperative fourth day in 33 (64.7%) and 18 (36%) patients in UVU and CM groups, respectively (p < 0.01). Incontinence rate was significantly lower in the UVU group at postoperative first year (p < 0.0005). Anastomotic strictures were observed in only 1.9% of the cases in UVU group, compared to 4% in CM group. CONCLUSION: Outcome data from our patient group indicate that UVU suture may allow a high quality urethro-vesical anastomosis with a very favorable outcome in terms of early catheter removal, high continence and low stricture formation rates in patients undergoing radical retropubic prostatectomy. Further validation of these results requires a prospective randomized trial.