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Purpose: Previous meta-analyses that compared the outcome of laparoendoscopic single-site adrenalectomy (LESSA) and conventional laparoscopic adrenalectomy (CLA) have not shown consistent results. The aim of this meta-analysis was to reassess current evidence regarding the efficacy and safety of LESSA versus CLA. Materials and Methods: A literature search of PubMed, Embase, Medline, and the Cochrane Library was performed to identify eligible articles up until September 2015. Quantitative variables were calculated using the weighted mean differences (WMDs), and qualitative variables were pooled using odds ratios (ORs). Results: Ten retrospective studies, including a total of 704 cases, were identified. Patients in the LESSA group benefitted from shorter length of hospital stay (95% confidence interval [CI]: -1.27 to -0.36, WMD: -0.81, P < .001) and better postoperative pain scores (95% CI: -1.51 to -0.99, WMD: 1.25, P < .001). There was no significant difference between the two techniques in operative time, estimated blood loss, resumption of oral intake, dose of analgesic required, perioperative complications, conversion, transfusion, or pain medications required. Conclusion: Based on current evidence, LESSA appear to be a safe and feasible alternative to CLA with a shorter length of hospital stay and lower postoperative pain scores in certain patients. We await high-quality, double-blind randomized clinical trials with long-term follow-up to confirm and update the findings of this analysis; future studies should focus on failure of technique, cosmesis, and cost. [ABSTRACT FROM AUTHOR]

Purpose: To compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10-20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment.Materials and Methods: Between January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times.Results: The average stone size for the SWL group was 14.62 ± 2.58 mm and 14.91 ± 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 ± 158.39 HU in the SWL group and 567.74 ± 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 ± 9.71 days in the SWL group and 11.59 ± 7.01 days in the RIRS group (P < .001).Conclusion: One of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies.&nbsp. [ABSTRACT FROM AUTHOR]

Purpose: Using percutaneous nephrolithotomy (PNL), it is easy to reach stones in various parts of the kidney via a single access tract. In the current study, we set out to demonstrate that the intravenous catheter is a safe way to gain renal access, and that PNL is safe in children.Materials and Methods: We retrospectively reviewed the medical records of patients who underwent PNL as a treatment for renal stone disease at our center between September 2013 and December 2014. There were no specific exclusion criteria. We used 14 gauge intravenous catheter for renal access in all cases.Results: Eleven of the 32 patients (34.4%) were female and 21 (65.6%) were male. The mean ± SD patient age was 4.7 ± 3.71 years (9 months-16 years). Six patients (18.7%) were infants less than 1 year of age. Fifteen of the stones (46.8%) were located in the right kidney, and 17 of the stones (53.1%) were located in the left kidney. The average stone size was 13.9 ± 4.8 mm (range, 12-28). The average duration of operation was 69.7 ± 10.4 minutes (range, 50-110), and the average duration of fluoroscopy was 2.21 ± 1.06 minutes (range, 1-6). There were complications in 5 of the cases (15.6%).Conclusion: The access and dilatation stages are quite important. We propose that the intravenous catheter is a safe and inexpensive tool for renal access in PNL in pediatric age group patients. [ABSTRACT FROM AUTHOR]

Objective: To examine the outcomes and to compare the effectiveness of laparoscopic ureterolithotomy and flexible URS in patients with proximal ureteral stones greater than 10 mm in diameter.Material and Methods: A total of 150 patients who were performed laparoscopic ureterolithotomy and flexible URS because of uretral stones in our urology clinic between January 2010 and June 2015, were analyzed retrospectively. We constituted two groups; 70 patients who were performed laparoscopic ureterolithotomy were included in group I while flexible URS-performed 80 patients in group II. Success rates and complications of the group I and II were compared.Results: Success rates were 95.7% and 90% in group I and II respectively. There was no significant difference between the groups in terms of "success-rates". No statistically and clinically significant complications occurred in both groups.Conclusion: Laparoscopic ureterolithotomy and flexible URS methods are effective and reliable with proper indications in treatment of proximal ureteral stones. However, when considered short operational and hospitalization times and the management of the situations that require secondary interventions, we suggest that flexible URS is a minimally invasive method and it may be the first choice in the treatment of proximal ureteral stones. [ABSTRACT FROM AUTHOR]

Purpose: We investigated whether addition of amikacin to levofloxacin-based antimicrobial prophylaxis reduces febrile urinary tract infections after transrectal ultrasound-guided prostate needle biopsy (TRUSB). Materials and Methods: A total of 447 patients undergoing TRUSB were prospectively randomized into two groups. The 230 patients in Group A were given one oral dose of levofloxacin 400 mg prior to TRUSB; the 217 patients in Group B each received the same dose of levofloxacin and one 200 mg intravenous dose of amikacin. Patients' characteristics were assessed prior to TRUSB and their symptoms were checked after the TRUSB. Results: Both regimens were well tolerated with no side effects. No statistically significant difference in patients' characteristics, or in incidence of inflammation- or infection-related symptoms was seen between the two groups; nor any significant difference among those who developed fever and those who did not. Two Group A patients and one Group B patient developed febrile urinary tract infections. Accountable pathogens determined by urine and blood cultures were fluoroquinolone-resistant E.coli and extended-spectrum β-lactamase-producing E.coli. All pathogens isolated were levofloxacin-resistant, amikacin-susceptible species. Conclusion: Although the present study was under-powered by unexpectedly low overall incidence of febrile urinary tract infections, addition of one intravenous administration of amikacin to one oral administration of levofloxacin showed no advantage compared with levofloxacin alone as antimicrobial prophylaxis in TRUSB. Strikingly, all pathogens isolated from febrile patients were sensitive to amikacin in vitro. Therefore, further understanding of amikacin's drug kinetics in the prostate is necessary to develop a more efficient drug delivery system for amikacin. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of two preoperative treatment courses with Finasteride on intraoperative and postoperative bleeding complications and prostate blood vessel characteristics in men who underwent transurethral resection of prostate (TURP) using monopolar energy.Materials and Methods: Men scheduled for TURP were randomized into group 1 (control n = 25, no medication), group 2 and 3 (n = 20 in each, 5 mg Finasteride daily for 2 and 4 weeks before TURP; respectively). Hematocrit level in the irrigation fluid, weight of the resected prostate chips, decreases in blood hemoglobin (Hb) level 6 and 24 hours after the operation together with volume and length density of prostate vessels using stereological methods were compared.Results: The three groups were matched regarding preoperative demographic data, resection time and weight of the resected tissue. Men who received preoperative Finasteride (groups 2 and 3) had significantly lower hematocrit levels in irrigation fluid than control group (control, 0.59 ± 0.85, group 2, 0.25 ± 0.4, group 3, 0.175 ± 0.16; P = .028; Power = .80). However, no statistically significant difference was found in hematocrit level in irrigation fluid between groups 2 and 3 (0.25 ± 0.4 vs. 0.175 ± 0.16, 95% confidence interval (CI) = -0.28-0.42; P = .68). These values were independent of the weight of the resected tissue and resection time. There were no significant differences between the three groups in the decrease in Hb 6 hours (P = .58) and 24 hours after TURP (P = .65). The stereological and histological characteristics of blood vessels in suburethral prostate tissue were similar in all three groups.Conclusion: A 2-week preoperative course of daily Finasteride seems sufficient to significantly reduce intraoperative blood loss; this effect was independent of the weight of the resected tissue and resection time. Neither the 2-week nor the 4-week presurgical Finasteride regimen could significantly decrease postoperative blood loss, and neither regimen induced significant changes in characteristics of prostate tissue blood vessels. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to investigate whether patients' body habitus affects the operative difficulties associated with extraperitoneal laparoscopic radical prostatectomy (LRP). Therefore, the associations between body habitus and perioperative outcomes of surgery, including bleeding, operative time, aresectionmargins, were evaluated. Materials and Methods: Between August 2010 and July 2012, 40 consecutive patients with preoperative magnetic resonance imaging and abdominal X-ray examinations underwen extraperitoneal LRP for localized prostate cancer at our institution. The associations between anthropometric measurements and demographics of patients, operation duration, estimated blood loss (EBL), and resection margins were analyzed retrospectively. Multivariate analyses were performed, and P < .05 was considered significant. Results: On multiple regression analysis, the view of the prostatic apex (VPA) was significantly associated with EBL (P = .02), and body mass index (BMI) was significantly associated with operative time (P = .02). On multiple logistic regression analysis, protrusion of the prostate into the bladder was significantly associated with positive resection margins (P = .04). Conclusion: The findings of the present study suggest that poor VPA, protrusion of the prostate into the bladder, and high BMI were related to operative difficulties in extraperitoneal LRP. If operative difficulty is predicted preoperatively, it would be better to prepare blood for transfusion and/or special instruments (e.g. flexible scope), or switch to other therapeutic procedures. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of percutaneous nephrolithotomy (PNL) in the treatment of staghorn calculi (SC) under spinal anesthesia (SA) versus general anesthesia (GA).Materials and Methods: Patients with SC who treated with PNL from 2011 to 2014 were retrospectively reviewed. In total, 100 patients were divided into 2 groups according to anesthesia type: SA (group 1, n = 47) and GA (group 2, n = 53). Demographics, perioperative parameters, and postoperative analgesic requirements were compared between the two groups.Results: There was no significant difference in terms of age, sex, American Society of Anesthesiologists score, body mass index, or stone size between the two groups (P = .40, .30, .18, .20, and .50, respectively). The mean procedure times were 84.7 and 87.5 min in the SA and GA groups, respectively (P = .68). The complication rates were similar in the SA and GA groups (19.1% vs. 13.2%, respectively; P = .421). The stone-free rates were also similar in the SA and GA groups (61.7% vs. 52.8%, respectively; P = .374). No statistically significant difference was found in analgesic requirements.Conclusion: SA is a safe method without the risks of GA and may be used for conditions in which GA is contraindicated or in patients with concerns about GA. Our outcomes indicated that SC can be treated safely and effectively under SA. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare the outcomes of benign, primary vesicovaginal fistulas (VVFs) treated using the transabdominal transvesical technique and the transvaginal technique without tissue interposition.Materials and Methods: A total of 53 consecutive women with VVF who were treated between September 1999 and October 2014 were evaluated retrospectively. Patients with a malignant etiology and/or prior irradiation were excluded because they required a more complex repair. In the first group, the repair was performed using the transabdominal transvesical technique (n = 28). After one of our fellows had completed his urogynecology training, he began to perform the repairs using the transvaginal technique (n = 25). All included VVF patients were treated without a tissue interposition.Results: Vesicovaginal fistula repair was performed in 53 patients, with a mean age of 41.4 ± 15.2 years. There was no significant difference in terms of the patients' age, fistula size, and the number of deliveries between the groups. All cases failed in terms of conservative management. The size of the fistulas ranged from 15 to 20 mm. The admission time was between 3 days and 21 years, and it was longer in less educated patients. The success rate was 96.4% (27/28) in the transabdominal transvesical group and 100% (25/25) in the transvaginal group (P = 1.00). The hospitalization period and complications were significantly reduced in the transvaginal group (P = .00 and P = .004, respectively). No patients converted from a transvaginal to a transabdominal repair. There was only one recurrence in the transabdominal transvesical group.The patients were followed up for 1 year.Conclusion: Transvaginal repair of benign, primary VVFs is more advantageous than transabdominal transvesical repair. There was a significant decrease in the hospitalization period and complications rates using the transvaginal technique without tissue interposition. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical efficacy of bladder hydrodistention and intravesical sodium hyaluronate in the treatment of interstitial cystitis (IC). Materials and Methods: Twenty-one patients with IC received intravesical sodium hyaluronate therapy under nerve block or intravenous anesthesia. Bladders were perfused with 100 cmH2O perfusion pressure and expanded for 10 min and were later injected with 40 mg/50 mL sodium hyaluronate through the catheter. After 1 h, the perfusion fluid was released. Perfusion was applied once per week, 4 to 6 times as a course of treatment. Results: Under anesthesia, the average bladder capacity was 191.62 ± 88.67 mL, and after bladder expansion, the bladder capacity reached 425.33 ± 79.83 mL (P = .000). There were 2 suspected bladder ruptures after bladder expansion at 6.5 min and 7.2 min. After 10 min of bladder expansion, there were 19 cases of significantly gross hematuria. After treatment, the catheters of 17 patients were removed at 24 h; for the 2 cases of hematuria, catheters were removed at 72 h and for the 2 cases of suspected bladder rupture, catheters were removed after 4 days. After catheter removal, the pain threshold significantly decreased, and the maximum urinary output increased slightly. Compared with values before treatment, the day before the second injection of sodium hyaluronate, the frequency of urination decreased significantly (32.8 vs. 18.5 times/24 h), the maximum urinary output increased significantly (86.7 vs. 151.9 mL), the pain decreased significantly (8.7 vs. 3.0), and the O'Leary-Sant IC score and quality of life score were significantly decreased (30.0 vs. 17.0 and 5.9 vs. 2.4, respectively) (P = .000). Conclusion: Bladder hydrodistention under anesthesia for patients with severe intractable IC produces immediate effectiveness; sodium hyaluronic infusion can alleviate frequent urination and pain, and the efficacy was positively correlated with the duration of treatment. [ABSTRACT FROM AUTHOR]

Purpose: Testicular sperm extraction (TESE) for intracytoplasmic sperm injection (ICSI) was first introduced for the treatment of non-obstructive azoospermia. This study was conducted to detect predictive factors affecting the success of microTESE.Materials and Methods: We retrospectively evaluated the results of 191 cases who underwent microTESE. For each patient, the testicular volume, endocrine profile [follicle stimulating hormone (FSH), luteinizing hormone (LH), free testosterone (FT), total testosterone (TT)], serum inhibin B level, karyotype analysis, and Y chromosome microdeletions were recorded, and all data were analyzed to detect any predictors. The receiver operating characteristic curve, two-sample t-test and regression analysis were used for the statistical analysis.Results: The mean age of the patients was 34.4 ± 5.6 years. Sperm retrieval was successful in 104 (54.5%) patients, and there was no sperm in 87 (45.5%). Seven factors including, testicular size, Johnson score, Y chromosome microdeletion, and serum FSH, LH, FT and TT levels were different between the successful and unsuccessful groups. Six patients had Klinefelter syndrome, and ten patients (5.2%) had a Y chromosome microdeletion (5 AZF-c, 1 AZF-b, 2 AZF-bc, 1 AZF-abc, and 1 AZF-ac). The Johnson score, TT level, family history and Y chromosome microdeletions were determined to be independent predictive factors for sperm found. According to the testicular histology, the sperm-found ratios were 36%, 48.6%, and 95.5% in the sertoli cell only syndrome, maturation arrest, and hypospermatogenesis groups, respectively.Conclusion: According to our results, the Johnson score, TT level, family history-related infertility, and Y chromosome microdeletions were determined to be independent predictive factors for sperm found. [ABSTRACT FROM AUTHOR]

Purpose: Transurethral resection of the prostate (TURP) is considered gold standard for surgical treatment of benign prostatic hyperplasia (BPH). In this study, we aimed to compare post-operative clinical outcomes and adverse effects between monopolar and bipolar TURPs.Materials and Methods: The study included 590 patients who underwent TURP by a single urologist (E.H.) between June 2006 and June 2014 with a diagnosis of BPH. Patients were divided into two groups as monopolar TURP (group 1, n = 300) and bipolar TURP (group 2, n = 290). Patients receiving oral anticoagulants or aspirin and those with prostate cancer diagnosis were not included in the study. Data regarding pre-operative age, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post voiding residual urine volume (PVR), serum prostate specific antigen (PSA) levels and prostate volume (Vp) of the patients were gathered from medical records. Groups were compared in terms of catheterization, operation time, hemoglobin (Hb) decrease, and IPSS, Qmax, and PVR values at post-operative 12th month follow-up visit.Results: From pre-operative to post-operative period, IPSS, Qmax and PVR showed significant improvements within both groups (P < .001). When groups were compared with each other, bipolar TURP group had significantly lesser catheterization time and hemoglobin decrease than monopolar TURP group, while no significant differences were detected regarding all other variables.Conclusion: Bipolar and monopolar TURPs are both effective and safe treatment modality for BPH. Bipolar TURP is superior to conventional monopolar TURP in terms of catheterization time and Hb decrease. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively evaluate our institutional experience with non-hilar-clamping simple enucleation (SE) and enucleoresection (ER) for the treatment of exophytic renal tumors regarding their oncological outcomes.Materials and Methods: We retrospectively evaluated patients treated between 2006 and 2013 for clinical exophytic T1-T2a renal tumors using open nephron-sparing surgery.Results: A total of 33 patients underwent SE and 39 underwent ER. The mean tumor size was 38.7 mm. None of the patients had positive surgical margins. No local recurrences were observed during the postoperative follow-up period (mean 40.7 ± 23.4 months); however, ipsilateral adrenal and contralateral kidney metastasis was detected in one of the patients. There was no statistically significant difference in the R.E.N.A.L Nephrometry Score, operative time, or intraoperative blood loss in the non-hilar-clamping SE and ER groups (P > .05). During the third postoperative month, the estimated glomerular filtration rate (eGFR) levels in the SE group were significantly reduced compared with the preoperative eGFR levels (P = .046).Conclusion: SE and ER with non-hilar clamping are safe, acceptable approaches for treating exophytic renal tumors. [ABSTRACT FROM AUTHOR]

Purpose: Single-port laparoscopic varicocelectomy has recently been introduced. As an instrument with three ports was too large for use in children, a modified technique using a single incision with two trocars was attempted in our department. This study was designed to compare the new method with the traditional laparoscopic method involving three ports. Materials and Methods: Twelve boys with a total of 14 varicoceles were admitted for laparoscopic varicocelectomy through a single incision with two trocars. Thirty-two patients with 33 varicoceles were treated using traditional three-port laparoscopy, and were reviewed as controls. Data were collected to compare the two groups. Results: All procedures were completed successfully in both groups. There were no significant differences in terms of patients' age, operative time, blood loss, analgesic requirement, hospital stay, and complications. Conclusion: The technique of laparoscopic varicocelectomy through a single incision with two trocars is safe, effective, and cosmetically acceptable. [ABSTRACT FROM AUTHOR]

Purpose: To compare the use of lubricant gel with lidocaine versus lubricant gel without anesthetic in flexible cystoscopy in terms of pain and tolerability. Materials and Methods: In this observational non-randomized study, 72 patients were divided into two groups. Group 1 included 38 patients in whom lidocaine gel 2% was used and group 2 included 34 patients in whom lubricant gel without anesthetic was administered. The main variables analyzed were score in visual analogue scale (VAS) and score in Spanish Pain Questionnaire (SPQ). Student's t-test and Chi-square test were used to compare differences between 2 groups. The P values < .05% were considered statistically significant. Results: Mean age of patients in group 1 was 64.50 ± 12.39 years and 67.79 ± 10.87 years in group 2 (P = .23). The distribution according to sex was 29 men and 9 women in group 1 and 25 men and 9 women in group 2 (P = .78). The total VAS score was 2.21 ± 2.05 in group 1 versus 1.59 ± 1.61 in group 2 (P = .16). In the SPQ, the current intensity value was 1.82 ± 0.86 in group 1 versus 1.53 ± 0.74 in group 2 (P = .14), and the total intensity value was 1.92 ± 1.86 in group 1 versus 1.03 ± 1.75 in group 2 (P = .04). The cost of gel with lidocaine is 1.25 euro and gel without anesthetic 0.22 euro. Conclusion: The use of lidocaine gel does not produce benefit in terms of pain relief in flexible cystoscopy and also is costly. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to compare safety, efficacy and cosmetic outcome between standard laparoscopic live donor nephrectomy (sLDN) and minilaparoscopic donor nephrectomy (mLDN) in a randomized clinical trial. Materials and Methods: From March 2012 to June 2013, 100 consecutive kidney donors were randomly assigned to two equal groups for laparoscopic donor nephrectomy. mLDN: Six to eight centimeters Pfannenstiel incision was made slightly above pubis symphysis and 11 millimeters trocar was fixed through exposed fascia using open technique. Five mm port was placed under direct vision at the umbilicus for camera insertion and two 3.5 mm ports were placed in subxiphoid and paraumbilical area. sLDN: Ten mm port was placed at umbilicus using open access technique for camera insertion. Five mm trocar for grasping and 11 mm trocar for vascular clipping were placed at subxiphoid and paraumbilical areas under direct vision, respectively. The second 5 mm trocar was placed in suprapubic area. Cosmetic appearance was assessed three months after surgery by using the Patient Scar Assessment Questionnaire (PSAQ). Results: Demographic data of the patients was not significantly different between two groups. Total operative time and ischemic time was nearly similar in both groups (104 ± 21 vs. 114 ± 24 min; P = .327 and 4.03 vs. 4.07 min; P = .592). There were no cases of conversion to open surgery. Mean hospital stay was similar between the two groups [2.1 (2-5) vs. 2.4 (2-5) days; P = .346]. Kidney graft function assessed by serum creatinine values (mg/dL) of recipients, was equivalent in both groups (1.58 vs. 1.86: P = .206). Mean appearance score (34 vs. 29) and consciousness score (22 vs. 18) in PSAQ showed significantly better results in the mLDN group. Conclusion: Our experience in this study revealed that peri- and post-operative findings were comparable between sLDN and mLDN, but mLDN has significant better cosmetic appearance than standard laparoscopic approach. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the use of a dorsal island penile fasciocutaneous flap in the management of resistant fossa navicularis strictures in circumcised West African men. Materials and Methods: From January 2004 to December 2013 there were twenty-one patients with fossa navicularis strictures (FNS) with or without meatal stenosis who underwent urethroplasty using a previously described technique and a dorsal island penile fasciocutaneous flap. The average patient follow-up was 25.9 months. Results: Urethral catheterization was the most common cause of FNS. All of the patients had successful urethral function and acceptable cosmetic results. One patient had partial dorsolateral skin necrosis that healed with conservative measures. All patients, including the five patients with meatal stenosis, retained the natural shape of the external meatus and hada natural urine stream. Conclusion: The penile cap technique uses a dorsal island fasciocutaneous flap and provides satisfactory functional and cosmetic outcomes in the management of fossa navicularis and meatal strictures. [ABSTRACT FROM AUTHOR]

Purpose: Contrast-enhanced ultrasound (CEUS) allows for real-time examination of signal intensity changes in a region of interest (ROI) and quantification of contrast agent kinetics. This study assessed the predictive ability of time-intensity curve (TIC) parameters for local tumor invasion and T stage of renal cell carcinoma (RCC).Materials and Methods: Renal tumors in 41 patients were examined by CEUS. Thirty-two met the inclusion criteria, with a total of 33 tumors (27 clear cell, 4 chromophobe, and 2 papillary type I). Nineteen (57.6%) tumors were included in group A (stages pT1 and pT2) and 14 (42.4%) in group B (stage pT3). ROIs were established as: whole tumor (TuW); tumor area with the highest signal intensity (TuMAX) and renal cortex (Ref). The TIC param­eters for each ROI were calculated as below: peak signal intensity, time to peak (TTP), rise time (RT), and mean transit time (MTT). They were analyzed as a whole value for each ROI and as a ratio between the different ROIs.Results: There were significant differences between the tumors invading and not invading the renal sinus fat for TTP (TuW/Ref) [0.98 (0.67-1.25) vs. 1.18 (1.08-1.3), P < .05]. For differentiation between groups A and B, the following ratios were proven as predictors by univariate regression analysis: TTP (TuMAX/TuW); MTT (Tu­MAX/TuW); RT (TuMAX/TuW) (P = .03, P = .01 and P = .02, respectively). The value derived from the Receiver Operating Characteristic (ROC) curve for RT (TuMAX/TuW) was 0.8 with sensitivity = 78.6%, specificity = 89.5%, and cutoff value of > 0.91.Conclusion: TIC parameters were predictors of locally noninvasive and invasive RCC. [ABSTRACT FROM AUTHOR]

Purpose: To analyze and compare surgical, oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) in patients with and without previous transurethral resection of the prostate (TURP). Materials and Methods: In total, 785 men underwent LRP at our institution from January 2002 to December 2012. TURP had been performed previously in 35 of these patients (TURP group). A matched-pair analysis identified 35 additional men without previous TURP who exhibited equivalent clinicopathological characteristics to serve as a control group. Perioperative complications and surgical, functional, and oncological outcomes were compared between the two groups. Results: The groups were similar in age, body mass index, serum prostate-specific antigen level, and pre- and post-operative Gleason scores. Patients in the TURP group had greater blood loss (231 vs. 139 mL), longer operative times (262 vs. 213 min), a greater probability of transfusion (8.6% vs. 0%), and a higher rate of complications (37.1% vs. 11.4%) compared with the control group. The positive surgical margin rate was higher in the TURP group, but this difference was not statistically significant (P = .179). The continence rates at one year after surgery were similar, but a lower continence rate was identified in the TURP group (42.9% vs. 68.6%) at 3 months. Biochemical recurrence developed in 17.1% and 11.4% of the patients in the TURP and control groups, respectively, after a mean follow-up of 57.6 months. Conclusion: LRP is feasible but challenging after TURP. LRP entails longer operating times, greater blood loss, higher complication rates and worse short-term continence outcomes. However, the radical nature of this cancer surgery is not compromised. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effect of routine sampling anterior apical cores in the initial prostate biopsy among patients that 14-cores of prostate biopsy (PB) planned. Materials and Methods: Five-hundred twenty-eight patients with increased prostate-specific antigen (PSA) levels and/or abnormal digital rectal examination underwent transrectal ultrasound and initial PB between November 2012 and October 2013. We performed routine 12-cores extended PB, plus 2 anterior apex samples that were taken from the junction of urethra and apex of the prostate. Site-specific and unique cancer detection rate, tumor characteristics, the presence of clinically insignificant prostate cancer (PCa) (clinical stage ≤ T1, serum PSA level of < 10 ng/mL, biopsy Gleason score ≤ 6, number of positive biopsy cores = 3 and no core with > 50% involvement) and biopsy-related pain were evaluated. Results: PCa was detected in 147 of 451 patients (32.6%). The lateral base of the prostate was the most affected area with 128 of 451 patients (28.3%), followed by unique cancer detection, with 17 of 40 patients (43.5%). Anterior apex (n = 6) was in third place after the lateral apex (n = 8). The patients diagnosed by anterior apex cores were all clinically insignificant PCa. The cancer diagnosis rate would be 31% if 12-cores biopsy was used, but the rate was found to be 32.6% in 14-cores biopsy (P = .016). Average biopsy pain, right anterior apex biopsy pain, and left anterior apex biopsy pain were found to register at 0.61, 1.06 and 1.08 points in the visual analog scale pain score, respectively. When right and left anterior apex biopsy pain is compared to average biopsy pain, the pain level was found to be statistically significantly higher in the biopsies of right and left anterior apex (P = .040 and P = .042, respectively). Conclusion: The gold standard for the diagnosis of PCa is at least 8 cores PB. According to our results, although most PCa diagnosis is carried out with 14-cores PB, it should not be forgotten that these patients might have clinically insignificant PCa. [ABSTRACT FROM AUTHOR]

Purpose: To present our results of laparoscopic upper pole heminephrectomy in adult patients with duplex kidney. Materials and Methods: A total of 10 patients with an age range of 27 to 54 years old underwent laparoscopic upper pole heminephrectomy for complete duplication of the renal collecting system. The key point of the technique included the placement of a catheter in the normal ureter at the beginning of the procedure. The patient was positioned in a 45-90 degrees lateral decubitus position and a 4-port transperitoneal or 3-port retroperitoneal technique was applied followed by the mobilization of the upper pole ureter away from the renal hilum. Afterwards, the vasculature supplying the upper pole was precisely identified and ligated. Followed by transection of the ureter and its transposition cephalad to the hilum, the upper pole moiety was fully transected using the harmonic scalpel. Results: Eight patients were operated on using the transperitoneal approach and 2 using the retroperitoneal technique. One patient required preoperative percutaneous drainage due to pyonephrosis. The operation time ranged between 150 to 350 min with minimal blood loss (0-200 mL). Hemostasis was achieved with an Argon laser in one patient. The lower pole calyceal system was perforated in one patient and repaired intracorporally. No major intraoperative complications occurred. All of the patients except two had their drains removed in 72 h after the operation and were generally discharged on postoperative day 3. Conclusion: Laparoscopic upper pole heminephrectomy for an ectopic ureter is safe and reproducible and offers benefits of laparoscopic surgery even in patients with complicated urinary tract infection. [ABSTRACT FROM AUTHOR]

Purpose: The prostate cancer (PCa) treatment is multimodal. Thus multidisciplinary team management (MDTM) decision-making process appears as a tool to answer all aspects of PCa treatment. Our aim was to evaluate the reproducibility of therapeutic decisions made at MDTM. Materials and Methods: We compared therapeutic decisions of PCa by presenting the same file of patient under a fake identity after 6 to 12 months from the first presentation. Forty-nine files of radical prostatectomy (RP) (28 pT2, 21 pT3) performed for clinical localized PCa were represented at MDTM which included urologist, oncologist, pathologist and radiologist. Analysis of therapeutic decisions comprised criteria such as: TNM stage, Gleason score, margin status and comorbidities. The reproducibility was assessed statistically by Kappa coefficient. Results: Study subjects included 49 patients who underwent radical prostatectomy (RP). The mean age was similar in pT2 and pT3 groups (P = .09). The mean serum PSA value was 8.32 ng/mL (range, 3.56-19.5) in pT2 group and 9.4 ng/mL (range, 3.8-22) in pT3 group. The margin status in pT2 and pT3 groups was positive in 25.0% and 47.6%, respectively. The decisions made at first and second MDTM for pT2 group were the same in 100% of cases with a perfect kappa coefficient (k = 1). In the group of pT3 (n = 21), the decisions were different in 33% at the second MDTM in comparison to the first MDTM. Especially for pT3b only 29% were reproducible decision with a slight agreement (k = 0.1). Concerning pT3a, 86% of the decisions were reproducible with a substantial agreement (k = 0.74). Conclusion: We showed a reliability and reproducibility of decision made at MDTM when guidelines are well defined. The therapeutic attitudes were less reproducible in locally advanced PCa but decision concerning those cases should be made in the setting of guidelines. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy of a novel anesthetic technique called iliohypogastric nerve block (INB) for pain control in patients undergoing prostate biopsy. Materials and Methods: A total of 59 consecutive patients who underwent transrectal ultrasound guided prostates biopsies were included in the study. Patients were randomized into four groups: (1) control, no method of anesthesia was administered, (2) intrarectal prilocaine-lidocaine cream application, (3) INB and (4) INB + intrarectal prilocaine-lidocaine cream application (combined group). Patients were asked to use a scale of 0-10 in a Visual Analogue Scale (VAS) questionnaire about pain during probe insertion (VAS 1) and prostate biopsy (VAS 2). Results: The mean VAS 1 and VAS 2 scores were 0.7 and 4.9 for controls, 0.5 and 1.8 for INB, 0.5 and 2.6 for the intrarectal cream group, and 0.4 and 1.8 for the combined group. The mean VAS 1 scores were not different between groups. However, the mean VAS 2 scores were significantly lower in INB, prilocaine-lidocaine cream and combined groups compared to the control group (P < .001). In addition, the INB group had significantly lower VAS 2 scores compared to the cream application group (P = .03). On the other hand, there was no difference between the INB and combined groups (P = .8). Conclusion: Any form of anesthesia was superior to none. However, INB alone seemed to be superior to prilocaine-lidocaine cream application in patients undergoing prostate biopsy. Addition of prilocaine-lidocaine cream application to INB may not provide better analgesia. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively determine predictors of urinary continence (UC) recovery in clinically high-risk prostate cancer (PCa) patients treated with modified radical prostatectomy (RP). Materials and Methods: A total of 184 patients with clinically high-risk PCa who underwent modified RP in a single Chinese center were retrospectively reviewed. Pelvic floor muscle training with biofeedback was routinely performed after catheter removal. UC was defined as wearing 0 or 1 protective pad daily. Univariate and multivariate Cox regression analyses were performed to determine the predictors of UC recovery. Results: The median age at surgery was 69.5 years (range 48-82), and the median follow-up duration was 40 months (range 12-111). Only 40 patients (21.7%) received a nerve-sparing procedure. For patients with restored UC, the median time to continence was 1 month (range 1-24). UC recovery at 1 month, 6 months, 12 months and the most recent follow-up was observed in 99 (53.8%), 158 (85.9%), 171 (92.9%) and 174 (94.6%) patients, respectively. Multivariate Cox regression analysis showed that patient age < 70 years (hazard ratio 1.684, P = .003) and smaller prostate volume (hazard ratio 0.989, P = .036), but not the surgical approach or treatment with a nerve-sparing procedure, independently predicted UC recovery. Conclusion: Age < 70 years and smaller prostate volume were independent predictors of UC recovery in clinically high-risk PCa patients. The adverse factors of high-risk disease were not significantly associated with UC recovery. These results may help surgeons preoperatively counsel patients regarding expected UC outcomes following RP. [ABSTRACT FROM AUTHOR]

Purpose: To compare the quality of life (QoL) of renal cancer patients following laparoscopic and open radical nephrectomy. Materials and Methods: Seventy-two (64.9%) patients who were treated with open radical nephrectomy (ORN group) and 39 (35.1%) patients who were treated with laparoscopic radical nephrectomy (LRN group) were included in this study. QoL was evaluated by Short Form-36 (SF-36) physical domain scores obtained before surgery, 1 and 6 months after surgery. Analgesic requirement and visual analog scale (VAS) pain scores following surgeries were recorded. Results: The demographic features of the groups were similar. There was a significant difference in tumor size between the ORN group (71.59 ± 29.83 mm) and LRN group (57.08 ± 19.33 mm) (P = .011). In the LRN group there was less blood loss, a lower transfusion rate, earlier ambulation, more rapid convalescence and shorter hospitalization; however, the difference in surgical duration between the ORN group (122.86 ± 36.8 min) and LRN group (140.17 ± 50.71 min) was not significant (P = .383). Analgesic requirement and VAS pain scores were similar in both groups. In terms of SF-36 physical domain scores, the general health perception score in the LRN group was higher than that in the ORN group at pre-surgery, 1 and 6 months after surgery. SF-36 physical functioning and general health perception scores in both groups were significantly lower in 1 month after surgery and were higher in 6 months after surgery, as compare to before surgery. Bodily pain scores in LRN group did not change significantly after surgery (P = .376). Conclusion: LRN exhibited some technical advantages, including less blood loss, shorter hospitalization and more rapid recovery. Although the ORN patients had relatively larger tumors, analgesic requirement, postoperative complications, body pain, and physical functioning weren't significantly different between the groups. QoL was higher 6 months after surgery than before surgery in both groups. [ABSTRACT FROM AUTHOR]

Purpose: Although laparoscopic partial nephrectomy (LPN) has been increasingly adopted in the treatment of small localized renal tumor, technical changes remain nowadays. The current study aimed to evaluate the safety and efficacy of the novel QUILL™ Self-Retaining System (SRS) for renorrhaphy during LPN. Materials and Methods: Sixty-eight patients with kidney neoplasm that accepted LPN at the Peking Union Medical College Hospital from July 2010 to March 2013 were retrospectively analyzed. Thirty-five patients who received renal sutures with QUILL™ SRS constituted group 1. The control group (group 2) composed of 33 patients who received standard absorbable Vicryl sutures by the same surgeon. Renorrhaphy was performed in both groups using two layers, with a closure of the deep vessels and collecting system, followed by a running closure of the renal capsule. The demographic and perioperative parameters [gender, laterality of the tumor, body mass index (BMI), tumor size, standardized nephrometry scoring system (R.E.N.A.L. Nephrometry Score)], estimated blood loss and warm ischemic time (WIT)) were compared between the groups. Risk factors of WIT and blood loss were analyzed using logistic regression analysis. Results: Renorrhaphy was successfully completed in both groups. The baseline data of two groups did not differ significantly. Logistic regression analysis showed WIT decreased when the QUILL™ SRS was used (21.8 ± 3.5 min vs. 25.6 ± 4.0 min; β = -4.109, P < .001). Suture methods were an independent predictor of WIT rather than blood loss (115.7 ± 57.9 mL vs. 137.9 ± 68.5 mL; P = .329). Conclusion: QUILL™ SRS can be effectively and safely used for renorrhaphy during LPN with the potential advantage of shortening WIT. [ABSTRACT FROM AUTHOR]

Purpose: The control of the Dorsal Venous Complex (DVC) is crucial to the recovery of urinary continence during Laparoscopic Radical Prostatectomy (LRP). The size of DVC may affect the venous control. We developed a trick to simplify the suturing of the DVC. Materials and Methods: Forty-seven patients with localized prostate cancer were divided into two groups: group 1 (n = 24) underwent LRP with a conventional ligature of DVC, and in group 2 (n = 23) the venous control was done with "Narrowing" of DVC technique (N-DVC). Our technique involves maintaining pressure on a metallic urethral sound inserted into the urethra, just at the time of ligature. The width of DVC in group 2 was measured before and after applying the technique. The numbers of attempts to place the stitch adequately were recorded and compared in both groups. The demographic and perioperative data, perioperative data and results were compared retrospectively. Results: Operation time, estimated blood loss, prostate weight, positive surgical margins rates and potency results showed no significant differences between the groups. The immediate 1-month, and 3-month continence rates were significantly greater in group 2 (30.4% vs. 12.5%, P = .048; 73.9% vs. 50%, P = .037, respectively). For all patients in group 2, width of DVC decreased and the ligation stitch was effective at the first attempt. In 37.5% of patients in group 1, the controlling of the DVC was obtained in more than one attempt. Conclusion: The N-DVC simplifies the control of DVC during LRP and may contribute to the early recovery of continence. [ABSTRACT FROM AUTHOR]

Purpose: We present long-term surgical experience of 102 chordee without hypospadias cases. Materials and Methods: This retrospective study included 102 chordee without hypospadias cases who were surgically treated between 1999 and 2012. Range of patients' age was from 1 month to 31 years. Seventy-two patients were adult, and 30 were children. Mean duration of follow up was 49.3 months. The patients were categorized into 4 groups including skin tethering (group 1), fibrotic dartos and Buck's fasciae ( group 2), corporeal disproportion ( group 3) and urethral tethering (group 4) with the aid of intraoperative artificial erection, according to the structural defect. Results: Forty patients (group 1) were successfully treated with penile degloving. Except 3 (10%) of 31 (group 2) cases, extensive resection of the fibrotic dartos and Buck's fascia was needed to straighten the penis. Corporeal disproportion was identified in 27 patients of whom 2 cases (7%) had complications. One of them developed urethrocutaneous fistula, and he was treated with buccal mucosal graft urethroplasty successfully. In other one, chordee persisted after two years, and we had to do Nesbit wedge resection after tunica albuginea plication to achieve penile straightening at the same session; otherwise we avoid tunica albuginea excision or incision. Overall 96 (94%) of 102 patients were successfully treated at first operation. Conclusion: We concluded that tunica albuginea plication is very effective for both prepubertal and postpubertal period and also in management of recurrence. We believe that, in experienced hands, early surgical correction can be done successfully in this condition. [ABSTRACT FROM AUTHOR]

Purpose: The use of laparoendoscopic single-site (LESS) surgery has been increasing. The LESS procedure has been done for various urological diseases and studies have shown that it results in less pain, shorter hospital stays and excellent cosmetic outcomes. Materials and Methods: We describe our initial experience with LESS adrenalectomy without the use of the transumbilical approach. The participants were 16 consecutive patients who underwent LESS adrenalectomy using a SILS port™ (Covidien, Mansfield, MA, USA) at Hiroshima University Hospital. Various parameters including the insufflation time, estimated blood loss, resumption of oral intake and complications were analyzed. Results: The adrenalectomy was completed successfully with no major intraoperative complications in 15 of the patients. One LESS adrenalectomy was converted to a conventional laparoscopic adrenalectomy by placement of two additional 12 mm trocars; this patient was therefore excluded from the study. The mean (range) patient age was 53.8 (35-69) years, body mass index (BMI) was 23.5 (20.7-27.2) kg/m², tumor size was 19.8 (9-45) mm, insufflation time was 188.0 (95-340) min and estimated blood loss was 36.3 (10-80) mL. In all cases articulating instruments were used for satisfactory dissection and triangulation. One bowel injury (serosal) occurred and was repaired in the open laparotomy before SILS port™ insertion. All patients at the follow-up visit were satisfied and pleased with their scars. Conclusion: We found LESS adrenalectomy to be apparently safe, effective and minimally invasive for adrenal diseases. In our opinion, LESS adrenalectomy without using the transumbilical approach is feasible and easy to introduce. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of diode laser ablation of prostate for treating lower urinary tract symptoms (LUTS) in patients with locally advanced prostate cancer and comparing results with palliative transurethral resection of prostate (pTURP). Materials and Methods: Thirty-six known cases of locally advanced prostate cancer with a maximum urinary flow rate (Qmax) of 12 mL per second or less and an International Prostate Symptom Score (IPSS) of 20 or more were included in this study. Patients were randomized into two groups. The first group underwent pTURP and for the second group diode laser ablation of prostate was done. In 6 months post-operative follow up, patients were evaluated for IPSS, post void residual (PVR) urine volume, Qmax and possible complications such as urethral stricture or urinary incontinence. Results: Postoperatively, mean IPSS was 11.1 ± 4.1 in TURP group and 11.7 ± 3.6 in laser group (P = .64). Mean PVR was 18.4 ± 3.5 mL in TURP group and 17.7 ± 6.3 mL in laser group (P = .68). Mean Qmax in TURP and laser groups were measured 20.1 ± 4.5 mL/s and 19.4 ± 2.6 mL/s, respectively (P = .57). While there was a significant improvement in IPSS and Qmax and PVR in both groups, statistical analysis did not show any significant difference postoperatively between pTURP and laser groups. Conclusion: Diode laser ablation of prostate and pTURP, both improved significantly IPSS, PVR and Qmax. But hospital stay and post-operative catheterization time was less in laser group. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the long-term clinical effects of sigmoidrectal pouch for urinary diversion. Materials and Methods: A total of 45 patients, including 40 males and 5 females, underwent sigmoid-rectal pouch procedure. The patients aged from 38 to 70 years with a mean age of 59 years. The postoperative follow-up ranged from 6 months to 19 years with an average of 6 years. Postoperative continence and voiding were analyzed, urinary reservoir pressure was measured and the complications of upper urinary tract were determined. The index of quality of life (QoL) in the International Prostate Symptom Score (IPSS) was used to evaluate the degree of satisfaction to urinate. Results: Forty patients had slight incontinence in the early postoperative stage and could control urination well 30 days postoperatively. The volume of pouch was 270-600 mL with an average of 375 mL. The basic pressure during filling period was 6-20 cmH2O with an average 15 cmH2O, the maximum filling pressure was 15-30 cmH2O with an average 26 cmH2O. The compliance of sigmoid-rectal pouch was fine with an average of 30 (range 18-40) mL/ cmH2O. There were no severe complications such as hyperchloremic acidosis or retrograde pyelonephritis. Six patients had slight hydronephrosis. The index of QoL were 0-2 in 20 patients, 3 in five patients and 4 in two patients. Conclusion: The sigmoid-rectal pouch operation was simple and acceptable by surgeons and patients. It may be an ideal urinary diversion for patients with muscle-invasive bladder cancer, especially for patients on whom urethrectomy should be done. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in modified supine position percutaneous nephrolithotomy (PCNL). Materials and Methods: A total of 320 PCNL in a total of 291 patients were performed between October 2008 and July 2011. There were no specific exclusion criteria. Patients with kidney anomalies or solitary kidney, with history of renal surgery or extracorporeal shockwave lithotripsy (SWL), those with staghorn calculi or needing more than one access, were eligible for inclusion. Data collected included patient demographics and stone characteristics, access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions. Results: Mean stone size was 38 mm (16-110 mm). The mean time access was 2.1 min (range 0.7-6.2 min). Tract dilatation fluoroscopy time was 25 ± 17 sec. The targeted calix could be entered with a success rate of 97.81%. The mean hemoglobin decrease was -1.17 g/dL ± 0.84. There were no visceral, pleural, collecting systems or vascular injuries. Major complications included, transfusion in 4 (1.25%) patients, pseudoaneurysm with persistent bleeding necessitating nephrectomy in 1 (0.3%) patient and two deaths (0.62%) after surgery. There was no significant difference in successful access and complications between patients with and without previous open surgery and in those with or without staghorn stones (P > .05). Conclusion: The use of one shot and modified supine position combines the advantages of these both methods including less radiation exposure and shorter access and operative time. The one shot dilation is safe, easy to learn, cost effective and offers a potential alternative to the standard devices particularly in developing countries. [ABSTRACT FROM AUTHOR]

Purpose: We report our experience of minimally invasive partial nephrectomy without ischemia using a microwave tissue coagulator (MTC) for hand-assisted laparoscopic partial nephrectomy (HALPN), conventional laparoscopic partial nephrectomy (CLPN), and laparoendoscopic single-site surgery for partial nephrectomy (LESSPN). We retrospectively compared the results of these techniques to better define the individual role and the benefits. Materials and Methods: From July 2005 to September 2012, 28 patients with small and exophytic renal tumors underwent HALPN (n = 12), CLPN (n = 10) and LESSPN (n = 6). In these procedures, the surgeon used an MTC for circumferential coagulation around the tumor. After coagulation, the tumor was resected without renal pedicle clamping. Results: The mean operative time was 259, 194 and 174 min for the HALPN, CLPN and LESSPN groups respectively. Two patients (one in HALPN group and one in LESSPN group) converted to laparotomy due to an inability to maintain hemostasis; however, there were no conversions to ischemic partial nephrectomy or radical nephrectomy. No differences between HALPN, CLPN and LESSPN were noted in terms of estimated blood loss, measured analgesic requirements, outcomes, or complications. Conclusion: We believe that these techniques are feasible and that they minimize the risk of unexpected collateral thermal damage by appropriate MTC needle puncture. When deciding to use HALPN, CLPN or LESSPN, our findings suggest that the choice of surgical approach should depend on the patient's individual circumstance. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to evaluate the effect of neat semen vitrification on human sperm vital parameters and DNA integrity in men with normal and abnormal sperm parameters. Materials and Methods: Semen samples were 17 normozoospermic samples and 17 specimens with abnormal sperm parameters. Semen analysis was performed according to World Health Organization (WHO) criteria. Then, the smear was provided from each sample and fixed for terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. Vitrification of neat semen was done by plunging cryoloops directly into liquid nitrogen and preserved for 7 days. The samples were warmed and re-evaluated for sperm parameters as well as DNA integrity. Besides, the correlation between sperm parameters and DNA fragmentation was assessed pre- and post vitrification. Results: Cryopreserved spermatozoa showed significant decrease in sperm motility, viability and normal morphology after thawing in both normal and abnormal semen. Also, the rate of sperm DNA fragmentation was significantly higher after vitrification compared to fresh samples in normal (24.76 ± 5.03 and 16.41 ± 4.53, P = .002) and abnormal (34.29 ± 10.02 and 23.5 ± 8.31, P < .0001), respectively. There was negative correlation between sperm motility and sperm DNA integrity in both groups after vitrification. Conclusion: Vitrification of neat ejaculates has negative impact on sperm parameters as well as DNA integrity, particularly among abnormal semen subjects. It is, therefore, recommend to process semen samples and vitrify the sperm pellets. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and postoperative morbidity of percutaneous no-scalpel vasectomy (NSV) via one puncture in China. Materials and Methods: A total of 150 men visiting outpatient clinic of the surgery department of urology, Huashan Hospital and its Baoshan branch of Fudan University, opted for percutaneous NSV with local anesthesia. The clinical data of 150 who underwent modified NSV (MNSV) were retrospectively compared with those of 120 patients who underwent standard NSV (SNSV). The results and follow-up were recorded. Results: The reviewed average operative time was 9.8 min (range 8 to 20 min). Average incisional length was 5 mm (range 4 to 8 mm). Patients reported complete recovery in an average of 8.5 days (range 4 to 14 days). The complication rates were extremely low with this modified technique. Only one case of late healed incision was observed (0.67%). Conclusion: Percutaneous NSV via one puncture was proved to be a painless and effective form of permanent contraception with an extremely low complication rate. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy of laparoscopic and open ureterolithotomy in patients with ureteral stones. Materials and Methods: Patients who had undergone open or laparoscopic ureterolithotomy between 2001 and 2013 in our clinic were enrolled in the study. Ureterolithotomy was performed due to the following reasons: failure to position the patient for ureteroscopy,unreachable stone with ureteroscopy also use of balloon dilatation, high stone volume, and the need for removal of kidney stones at the same session.. The patients' demographic data, the volume of the stones, the duration of the operation and the hospital stay, the amount of analgesics administered after the operation, and the need for another procedure were compared. Results: Of study subjects 32 patients had undergone open and 20 patients had undergone laparoscopic ureterolithotomy. When the two groups were compared, there was no statistically significant difference with regard to the mean age (44.5-44 years), the body mass index (26-24.7 kg/m²), the stone volume (420-580 mm³), the duration of operation (122-123 min), the need for another procedure and complications. The mean amount of analgesics administered after the operation (3.6 and 1.81 doses, P = .02) and the mean hospital stay (6.1 and 2.9 days, P = .01) were significantly lower in the laparoscopic ureterolithotomy group. Conclusion: Laparoscopic ureterolithotomy is a good alternative with less need for analgesia and a shorter hospital stay when compared with open ureterolithotomy. [ABSTRACT FROM AUTHOR]

Purpose: A major concern when performing laparoscopic partial nephrectomy (LPN) is potential postoperative renal dysfunction. The objective of this study was to compare the effects of LPN with selective renal parenchymal clamping (SRPC) (LPNSRPC) and LPN using microwave tissue coagulation (MTC) (LPNMTC) on postoperative renal function. Materials and Methods: This study included 12 patients (5 men and 7 women) who underwent LPNSRPC (n = 6) or LPNMTC (n = 6) for exophytic tumors. Renal scanning with technetium- 99m diethylenetriaminepentaacetic acid (Tc-99m DTPA) was performed preoperatively and postoperatively at 1 month in all patients. Results: The mean tumor size, surgical duration, and intraoperative blood loss were similar in both groups. In the LPNMTC group, although not significant, the mean postoperative glomerular filtration rate (GFR) values in the affected kidneys were decreased compared to the preoperative values. When evaluating the affected renal function by split function (SF), the mean postoperative SF in the affected kidneys was significantly decreased compared to the preoperative value. In the LPNSRPC group, the mean postoperative GFR and SF in the affected kidneys were not significantly changed compared with the preoperative values Conclusion: Our preliminary experience demonstrates that LPNSRPC facilitates maximal nephron-sparing surgery without collateral thermal damage causing renal impairment. [ABSTRACT FROM AUTHOR]

Purpose: Due to the negative impact of radiation on the patient and the surgical team during percutaneous nephrolithotomy (PCNL), we aimed to evaluate success rate and complications of blind access for PCNL using lumbar notch landmark and compare with conventional fluoroscopy- guided access. Materials and Methods: In a clinical trial, 100 patients who were candidate for PCNL, were randomly assigned into blind group (1) and fluoroscopy-guided group (2). In group 1 the lumbar notch was used to guide percutaneous access and in group 2 fluoroscopy performed after needle insertion, Amplatz placement and at the end of surgery. If the access failed, we would repeat puncturing up to 5 times. In group 2, access was achieved using full fluoroscopy guidance. All patients underwent postoperative assessment including kidney-ureter-bladder X-ray and ultrasonography. Results: Both mean access time and mean operation time were statically similar in group 1 and group 2 (3.3 ± 0.5 vs. 3.6 ± 0.7 min and 35.2 ± 4.6 vs. 38.9 ± 4.1 min, respectively). A successful puncture was achieved in 86% and 94% of the patients in groups 1 and 2, respectively (P = .18). Total success rate of procedure was 80% and 88% of the patients in groups 1 and 2, respectively (P = .27). Conclusion: According to this study, it seems that blind access is a safe and effective PCNL method, and we recommend employment of this technique by skilled endourologist in urology centers especially for patient with large hydronephrotic kidney. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the recurrence rates of patients with bladder tumors on the lateral wall undergoing transurethral resection of bladder tumor(TUR-BT) with or without obturator nerve block (ONB) and to investigate the impact of ONB on the effective tumor resection on the lateral bladder wall. Materials and Methods: All patients who underwent TUR-BT under spinal anesthesia within the three-year study period in the study center were reviewed retrospectively. Among these, 68 patients who had been diagnosed with de novo lateral bladder wall tumor and included in low risk group 1n accord with European Organization for Research and Treatment of Cancer (EORTC) classification, undergone complete resection were enrolled into the study. Group 1 (36 patients who underwent TUR-BT with only spinal anesthesia) and group 2 (32 patients who underwent TUR-BT with spinal anesthesia plus ONB) were evaluated with respect to tumor recurrence rates and disease-free time to recurrence, if any. Results: Follow-up periods (range, 19 to 41 months for group 1 and 19 to 39 months for group 2) and overall recurrence rates (group 1, 27.8% and group 2, 18.8%) were also found to be similar. Mean time to recurrence was significantly higher in group 2 (15 ± 5.5 months) than in group 1 (7.8 ± 4.5 months) (P = .009) Conclusion: ONB employed in addition to spinal anesthesia in TUR-BT involving the lateral wall can prolong time to recurrence and increase the chance to lengthen disease-free survival in low-risk superficial bladder tumors. [ABSTRACT FROM AUTHOR]

Purpose: To compare the complications and the cost analysis of open radical nephrectomy (ORN) versus laparoscopic radical nephrectomy (LRN) in patients with renal tumors larger than 7 centimeters (cm). Materials and Methods: A retrospective analysis was performed in 173 patients (ORN group, n = 140; LRN group, n = 33) who underwent surgery for kidney tumors between 2008 and 2011. Patients' age, tumor size, pre-operative surgical risk score (American Society of Anesthesiologists score), duration of hospitalization, complications and the costs of hospitalization were recorded. The complications in ORN group and LRN group were specified with Modified Clavien System in five grades. Results: The mean age was found 58.52 ± 13.74 years in ORN group, and 58.15 ± 12.81 years in LRN group (P = .847). Post-operative pain necessitating analgesics was observed in all patients (100%) after early post-operative period in both groups (Grade 1 complications). Blood transfusions were required in 51 patients (36.42%) in the ORN group, and 7 (21.21%) patients in the LRN group (Grade 2 complications) (P = .185). Grade 3 complication was not observed in each groups. Grade 4 complications were occurred in 6 (4.28%) patients [aortic injury, acute tubular necrosis, the need for dialysis, respiratory arrest (2), atrial fibrillation] in the ORN group, and in 1 (3.03%) patient (pulmonary embolism) in the LRN group. Grade 5 complication was occurred in 1 (0.71%) patient (death) in the ORN group. By the cost analysis, the average cost of ORN group was €1328, whereas €1508 in LRN group (P < .05). Conclusion: Laparoscopy is used in many clinics with an increasing frequency because of the improved patient comfort, better cosmetic results, less post-operative pain, lower transfusion rates, and early return to the daily activities. Besides these advantages, the negligible difference in the costs compared to the open surgery (mean difference = €180 per case) makes it even more attractive. [ABSTRACT FROM AUTHOR]

13 to 70 years) who underwent 582 PCNL from March 2004 to October 2011 in our department. Results: Of participants, 89.6% experienced less than 3 puncture times; 2 patients (0.4%) experienced puncture failures; percentage of single or multiple tracts was 89.7% and 10.3%, respectively, 55 patients (9.5%) needed auxiliary measures after one PCNL (24 second PCNL and 31 extracorporeal shock wave lithotripsy). The mean operative time was 82.3 min (range, 45-190 min). The stone free rate was 90.5%. Thirty five patients (6.0%) had postoperative fever and responded to antibiotics. Three patients (0.5%) developed pleural effusion and recovered after closed drainage of thoracic cavity. Thirteen patients (2.2%) needed blood transfusion. Twelve patients (2.1%) developed septic shock and were given anti-shock therapy. Two patients (0.3%) needed angiographic renal embolization or nephrectomy. Conclusion: With its high success rate for achieving access to the targeted calyx and high stone clearance rate, the guidance of ultrasonography and fluoroscopy should be the first option in PCNL. [ABSTRACT FROM AUTHOR]

Purpose: We report the results of pediatric retroperitoneoscopic renal ablative surgeries, which were performed with only three trocars. Materials and Methods: We retrospectively reviewed the charts of children who underwent laparoscopic urological procedures on the upper urinary tract at our institution between 2006 and 2012. These procedures consisted of nephrectomies, nephroureterectomies and heminephroureterectomies. The operations were performed retroperitoneoscopically with three trocars. The specimens were removed intact through the primary trocar site. Results: A total of 30 retroperitoneoscopic ablative surgeries were performed in 13 girls and 17 boys. The mean patient age was 7.8 ± 4.3 years (range, 1-14 years). The interventions consisted of nephrectomy in 10 cases (33.3%), nephroureterectomy in 17 cases (56.6%) and heminephroureterectomy in 3 (10%) cases. The open conversion rate was 3.3% (1/30). The difference between the initial 10 cases and the latter 20 cases, in terms of mean operative time, was statistically significant (144.5 vs. 115.78 minutes, respectively, P = .031). Apart from 3 nephroureterectomies, all of the procedures (86.6%) were completed successfully using three trocars only, without the need for a separate extraction incision. The patients were hospitalized for a mean duration of 2.2 days (range, 2-4 days). None of the patients required blood transfusion. We did not encounter any major perioperative or postoperative complication. Conclusion: Retroperitoneoscopic renal ablative surgery is a safe and effective treatment alternative for a variety of upper urinary tract disorders in children. [ABSTRACT FROM AUTHOR]

Purpose: To present the safety and surgical outcomes of the initial series of mini-laparoscopic live donor nephrectomy and graft outcomes in related recipients. Materials and Methods: From January 2012 through July 2012, fifty patients underwent minilaparoscopic live donor nephrectomy. Two 3.5 mm trocars were inserted above and lateral to the umbilicus for grasping and scissoring. One 5 mm trocar with a camera was inserted in the umbilicus and an 11 mm trocar was inserted through fascia from a 6-8 cm Pfannenstiel incision for bipolar coagulation, kidney extraction, and vascular clip applier. Results: Mean age of donors was 28 ± 4.2 (range, 21-39) years. Mean operative time from trocar insertion was 145.8 (range, 85-210) minutes. No major perioperative or postoperative complications occurred. The average decrease in hemoglobin level was 1.14 (range, 0.32-1.8) mg/dL and no one required blood transfusion. Mean warm ischemia time was 4.41 (range, 2.35- 9) minutes. Mean hospital stay was 2.2 (range, 2-5) days. Mean follow-up time of the recipients was 215 (range, 130-270) days. The mean serum creatinine level of the recipients at discharge time and the last follow-up visit was 1.38 mg/dL and 1.22 mg/dL, respectively. Conclusions: While the primary purpose of this technique is to make donor nephrectomy less invasive and more cosmetic, it is also comfortable for the laparoscopist surgeons because it is nearly similar to standard laparoscopy. A randomized controlled trial with a large sample size, long-term follow-up, and comparison with standard laparoscopy are necessary to present more definitive data about this technique. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the long-term results of adult circumcisions performed by plastic clamp technique as well as the effects on sexual function. Materials and Methods: A total of 186 adult males with the mean age of 21.2 ± 2.8 years who presented to our clinic for circumcision between February 2007 and January 2010 were included in the study. Safety and acceptability of circumcision with plastic clamp technique as well as its effects on sexual functions were analyzed with a mean follow-up period of 30.4 ±14.2 months (range, 12 to 52 months). Results: The mean duration of circumcision and removal of the clamp were 3.1 ± 1.1 minutes and 16±7 seconds, respectively. The total complication rate was 2.15%. Wound dehiscence (1.07%), infection (0.54%), and bleeding (0.54%) were the encountered complications. Complete wound healing was observed at a mean of 25.5±4.6 days. We did not encounter any penile deformity or other long-term complications. Circumcision did not adversely affect the sexual drive or ejaculation based on the brief male sexual function inventory scores. Erectile function and overall satisfaction improved following circumcision. Conclusion: Circumcision performed by plastic clamp technique in adult males had a low early complication rate with no long-term complications and caused improvement in some of the sexual functions. We suggest the utilization of this technique as an easy and a safe way of circumcising adult males. [ABSTRACT FROM AUTHOR]

Purpose: To report out initial experience with laparoendoscopic single-site (LESS) nephrectomy using a GelPOINT single port and standard laparoscopic instruments. Materials and Methods: Laparoendoscopic single-site transperitoneal nephrectomy was done for 6 adult patients with a poorly functioning small or hydronephrotic kidney. The procedure was done with the GeIPOINT system, which consisted of a wound retractor (Alexis) and GeISeal cap Standard laparoscopic instruments were used and the renal pedicle was controlled with 10-mm Hem-o-Lok clips. Results: The participants were 3 men and 3 women with the median age of 29.5 years. Laparoendoscopic single-site nephrectomy was successfully done in all the patients without any major complications. Median operation time was 110 minutes (range, 90 to 130 minutes). There was no need for blood transfusion in any patient. The recovery phase was uneventful and all the patients were discharged after a median hospital stay of 2.5 days (range, 2 to 3 days). Renal function remained stable in all the patients after the operation. The incision site healed well on postoperative follow-up. Conclusion: Our initial experience with LESS nephrectomy was successful with the use of a Gel-POINT single port and standard laparoscopic instruments. This report may remove barriers to further work with the LESS technique and may offer a strategy to help surgeons gain experience with this novel technology. [ABSTRACT FROM AUTHOR]

Purpose: To measure the level of inter/intra-observer reproducibility among pathologists as far as Gleason scoring of adenocarcinoma of the prostate is concerned. Materials and Methods: A total of 101 prostate biopsy slides, diagnosed with adenocarcinoma of the prostate by five pathologists from different education centers, were exposed to Gleason scoring. Two months later, the slides were re-examined by three of the same pathologists. Thereafter, the kappa was calculated for the data provided in the first and second reports of each pathologist and compared between pathologists. Results: Inter-observer reproducibility was inappropriate, but intra-observer diagnostic reproducibility was almost perfect with a corresponding percentage of agreement of 85.2%. Conclusion: The inter-observer reproducibility was poor [ABSTRACT FROM AUTHOR]

Introduction: This systematic review was performed to determine the clinical value of percutaneous nephrolithotomy in the supine position in comparison with the convention of performing the procedure in the prone position. Materials and Methods: A systematic review of the medical literature was conducted searching for studies on percutaneous nephrolithotomy in the supine position, limited to publications appeared in the PubMed between 1980 and July 2008. Non-English articles were considered if deemed relevant by providing additional data. In the retrieved articles, reference lists were hand-searched to identify additional relevant articles. Results: There were 9 original articles on percutaneous nephrolithotomy in the supine position. Five studies were retrospective and 4 were prospective, of which only 1 was a well-designed randomized controlled trial published in 2008. The success rate of the procedure was reported between 69.6% and 95%. The risk of requiring blood transfusion was between zero and 8%. Duration of hospital stay was variable, but generally less than that in the prone position. No colon perforation was reported. Conclusion: In carefully selected patients with uncomplicated urinary calculi, percutaneous calculus removal in the supine position can yield similar outcomes to that in the prone position. [ABSTRACT FROM AUTHOR]

Purpose: To compare estimated prostate volume (PV) based on computed tomography (CT) scan and transrectal ultrasonography (TRUS) in patients with lower urinary tract symptoms (LUTS). Materials and Methods: Between January 2010 and October 2012, 107 consecutive patients with LUTS were analyzed, retrospectively. PV measures were performed by the means of ellipsoid formula (PV = π/6 [width (cm) thickness (cm) length (cm)]) from TRUS (PVTRUS) and CT (PVCT ellipsoid). In addition, PV was calculated as the sum of the area of each slice and the CT slice interval using commercial software program (PVCT 3D reconstruction). Results: Mean PVCT ellipsoid was 40.63 ± 31.06 cm3 (range, 8.34-217.46). Mean PVTRUS and PVCT 3D reconstruction were 39.20 ± 33.04 (range, 4.00-223.81) and 45.30 ± 32.98 (range, 8.90-248.30), respectively. PVCT ellipsoid was highly correlated with PVTRUS and PVCT 3D reconstruction (r = 0.935, P < .001; r = .970, P < .001, respectively). Moreover, there was very strong agreement for PV measurements with all three methods (intraclass correlation coefficient = 0.934, P < .001). Conclusion: PVCT ellipsoid is adequate method for quick volume assessment with reasonable accuracy. Therefore, we can easily predict PV by CT scan using ellipsoid formula without performing additional TRUS in patients with LUTS. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 68-year-old woman who has urothelial bladder cancer. The patient underwent cystectomy and pelvic lymphadenectomy with Bricker IC for a muscle-invasive-high grade urothelial bladder cancer. The article also discusses the staging of the pelvic lymph node dissection (PLND).