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INTRODUCTION: This study aimed to identify a precise learning curve for pure retroperitoneoscopic donor nephrectomy (RDN). METHODS: Data from 172 consecutive kidney donors who underwent pure RDN between January 2010 and July 2019 were prospectively collected and evaluated. Cumulative sum (CUSUM) analysis was used for testing the operation time. Change points were determined by using the r program and BINSEG method. The cohort was divided into three groups -- group 1: competence, including the first 10 cases; group 2: 11-48 cases as proficiency; and group 3: the subsequent 124 cases as expert level. Continuous variables were evaluated using one-way ANOVA, and categorical data were evaluated using the Chi-squared test. RESULTS: Right RDN was performed in 39 (22.7%) donors. The eighth patient was converted to open surgery due to vena cava injury and excluded from the CUSUM analysis. Depending on experience in pure RDN, a significant decrease was detected in operative time (p<0.001), warm ischemia time (p=0.006), and blood loss (p<0.001). Recipient complications and graft function were found to be statistically comparable. CONCLUSIONS: In our study, the attainment of expertise in pure RDN was observed after performing 50 cases. The transperitoneal technique, which is a feasible alternative, is far more widely used than pure RDN. We believe that understanding the learning curve associated with pure RDN could facilitate the adoption of this approach as a viable alternative to the transperitoneal approach. [ABSTRACT FROM AUTHOR]

Background: Partial nephrectomy (PN) is the standard of treatment in patients with cT1 renal tumors. Current guidelines recommend PN as a standard of treatment in patients with cT1 renal tumors. However, the commonly accepted criteria for which surgical outcomes are evaluated both functionally and oncologically are not yet clear. The aim of this study was to evaluate compounding factors that affect the operative and functional outcomes for laparoscopic partial nephrectomy (LPN) in patients with cT1 renal tumors. Methods: This study was registered at NCT04213157 for patients who underwent LPN with the diagnosis of clinical T1 renal tumors. Between November 2009 and August 2018, 292 patients were included in the study. The patients were allocated into two groups according to the tumor size: T1a (n = 215) and T1b (n = 77). Demographic features, clinical tumor characteristics, and intraoperative and postoperative outcomes were analyzed. A negative surgical margin, warm ischemia time of <20 minutes, and no postoperative major complications were accepted to achieve the trifecta outcomes. Pentafecta was defined as trifecta criteria plus >90% preservation of baseline renal function (RF) and no stage upgrade of chronic kidney disease at 12 months after surgery. Univariate and multivariate analyses were used to identify factors predicting trifecta and pentafecta. Results: Preoperative variables including age, gender, and baseline RF were similar between the two groups. The warm ischemia time was 13.4 vs 15.9 minutes (P = 0.001). The positive margin rate was 0.9% vs 2.6% (P = 0.284), and the major complication rate was 3.3% vs 2.6% (P = 0.548). The achievement of the trifecta rate was 88.4% vs 75.3% (P = 0.006) and pentafecta rate was 72.6% vs 42.9% (P = 0.001). Multivariate analysis showed that tumor complexity, baseline RF, and diabetes mellitus are independent predictors of achieving pentafecta outcomes. Conclusion: LPN is an effective and reliable method for renal tumors even in T1b with satisfying surgical and functional outcomes. [ABSTRACT FROM AUTHOR]

Background: A double-pigtail ureteral stent (DPUS) can cause untoward symptoms, such as urgency, frequency, urinary incontinence, hematuria, and body pain that are bothersome to patient's quality of life (QoL). By reducing the quantity of material in the bladder, it could be reasonable to decrease stent-related symptoms (SRSs). We aimed to evaluate the tolerability of single pigtail suture stent (SPSS) with a validated questionnaire after uncomplicated retrograde semirigid ureteroscopic lithotripsy (URSL). Materials and Methods: A total of 130 patients who underwent ureteral stent placement after URSL for unilateral symptomatic ureteral stones with <15 mm diameter were randomized prospectively into two groups. Polyurethane ureteral stent (6 Fr, 24 or 26 cm) was placed in all patients, which was removed postoperatively with a mean of 14 days. There were 65 patients in both groups. All subjects completed the ureteral stent symptoms questionnaire (USSQ), which explores the SRSs. The questionnaires were conducted on the day of stent removal (at week 2) with the stent in situ and 4 weeks after removal (at week 6, poststent). The severity of SRSs and QoL were compared between the two groups. Results: SPSS was associated with perfect effect on all domains of USSQ, except from sexual and general health index scores. Pain index scores, visual analog scores (VAS), and analgesic requirements in SPSS group were found significantly low compared with those in the DPUS group. The QoL scores were significantly better in patients indwelling SPSS. Conclusion: SPSS is a potentially beneficial option to minimize ureteral SRSs after uncomplicated URSL. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effects of using 5 mg/day tadalafil on inflammatory indicators including lymphocyte to monocyte ratio (LMR) and monocyte to high-density lipoprotein ratio (MHR) in patients with erectile dysfunction (ED). Material and Methods: This retrospective study included 62 subjects that 31 patients with ED and 31 healthy controls with a normal erectile function. The patients with ED were given a daily 5 mg dose of tadalafil over eight weeks. Baseline and post-treatment erectile function was evaluated using the International Index of Erectile Function (IIEF-5). Changes in IIEF-5 score and inflammatory indicators including LMR and MHR have compared both in ED patients and with controls. Results: The patients and the controls were statistically comparable with respect to age, Diabetes Mellitus, hypertension, coronary artery disease, CRP, testosterone, serum creatinine, lipid profile, LMR, and MHR. The mean IIEF-5 score was 22.97 vs 14.32 (p=0.001) in control and patients with ED, respectively. Having been used 5 mg of tadalafil per day over 8 weeks, an increase in IIEF-5 score (p=0.001) and a decrease in the number of monocytes (p=0.008) were detected in patients with ED. However, there was no statistically significant difference found in LMR and MHR before and after the treatment. Conclusion: According to the results of this study, no significant effect was found daily use of 5mg tadalafil on inflammatory indicators including LMR and MHR. The decrease in the number of monocytes that play a key role in inflammation may have been considered a response to treatment, however, randomized prospective studies are needed to evaluate the relationship among LMR, MHR and tadalafil treatment. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the influence of different ischaemia techniques on short-term and one year renal function following laparoscopic partial nephrectomy (LPN). Materials and Methods: Data of 359 patients who underwent LPN between November 2009 and April 2018 were reviewed, retrospectively. A total of 287 patients were included in the study. Patients were divided into 4 groups according to type of ischaemia as follows: group A (n=33) was warm ischaemia time (WIT) >20 minute, group B (n=202) was WIT =20 minute, group C (n=16) was selective arterial clamping and group D (n=36) was off-clamp. Demographic data, preoperative and postoperative outcomes were compared. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Change in eGFR according to group and time was evaluated using two-way analysis of variance. P values <0.05 were adopted as significant. Results: The mean tumour size was 46, 34, 36 and 25 mm (p=0.001), and operation time was 123, 92, 100 and 79 minute (p=0.001) for groups A, B, C and D, respectively. There was no need for open surgery in any of the patients. Blood loss, intraoperative and postoperative complication rates were found to be nonsignificantly different (p>0.05) between groups. Only 4 patients in group B had positive surgical margin. The percentage of relative eGFR (% of eGFR) decline 1 year after LPN was significantly (p=0.001) higher in the ischaemic groups (A and B: 9.3% and 7.5%) compared to the zero-ischaemia groups (C and D: 5% and 3.7%). Conclusion: This study revealed that after LPN, cumulative renal function decreases to a certain extent regardless of the technique. However, it was found that cumulative renal functions are better preserved when ischaemia time is reduced to =20 min or eliminated. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic adrenalectomy (LA) is the treatment of choice for benign tumours of less than 6 cm. However, there is still an ongoing debate regarding the exact cut-off value of the tumour size. The aim of this study was to determine the effect of tumour size on intraoperative and postoperative outcomes in patients undergoing LA and also to estimate the learning curve for large adrenal tumours. Materials and Methods: The data of 102 patients who underwent LA from April 2010 to October 2018 was retrospectively analysed. The patients were allocated to 2 groups according to tumour size: <6 cm (group 1 =76) and =6 cm (group 2 =26). Both groups were compared in terms of age, gender, body mass index, tumour characteristics, operative data and complication rates. The patients were also allocated to four groups (A, B, C and D) according to the chronological order of their surgery in order to evaluate the learning curve. Results: The mean age, gender, tumour laterality and BMI were similar in both groups. Tumour size (32.7 vs 79.5 mm, p=0.001), operation time (53.3 vs 72.6 minute, p=0.001), blood loss (65.8 vs 86.35 mL, p=0.042) were significantly different between groups 1 and 2, respectively. Intraoperative and postoperative complication rates were also found to be significantly higher in group 2. The first 25 cases were sufficient to complete the initial learning curve. It showed that surgical experience increased and operation time and blood loss decreased as the mean tumour size that is managed by LA increases. Conclusion: LA is a reliable approach for the management of large adrenal tumours. However, we can conclude that the most important factor determining the safety and efficacy of LA is the surgical experience. [ABSTRACT FROM AUTHOR]

Background: Considering the increase in a number of vascular complications, right laparoscopic donor nephrectomy is less preferred due to achieving not only shorter renal vein but also longer renal artery. However, recent studies have indicated that the side of the surgery would not affect the outcomes. Aim: The aim of this study is to evaluate the outcomes and strategies to increase the safety of pure retroperitoneoscopic donor nephrectomy (RDN). Methods: We analyzed the prospectively collected medical records of 158 kidney donors who underwent RDN from January 2010 to August 2018. The patients were divided into two groups based on their side of surgery. Right- and left-sided RDNs were compared in terms of demographics, intraoperative, and postoperative data, including the development of incisional hernia (IH). The outcomes of the recipients were also evaluated. Results: Right RDN was performed in 40 (25.3%) and left RDN was performed in 118 (74.7%) donors. Operation time (P = .593), warm ischemia time (P = .271), blood loss (P = .787), and length of hospital stay (P = .908) were statistically similar in right and left RDN groups. Intraoperative and postoperative complications were statistically showed no difference between right and left RDNs. No IH was observed in any group. One-year and five-year patient survival and graft survival rates were 100% versus 97% (P = .299) and 100% versus 95% (P = .126) on both sides, respectively. Conclusion: Right RDN is an effective and safe method as on the left side. RDN has an additional advantage in the absence of IH. Experience with other retroperitoneoscopic urological interventions may have had a positive effect on the outcomes of pure RDN. [ABSTRACT FROM AUTHOR]

Leiomyomas are rare, benign and solid tumors of the kidney. Although the developments in radiological imaging methods provide early detection of kidney tumors, it is difficult to differentiate leiomyomas radiologically from other malignant renal tumors. Moreover, the definitive diagnosis of leiomyomas can only be achieved by histopathological and also immunohistochemical evaluation after surgical intervention. Immunohistochemically, positive staining with smooth muscle actin and vimentin, whereas negative staining with cytokeratin, S100, Mart1 and HMB45 are the methods used in the differential diagnosis of leiomyomas. In this case series, after preoperative radiological evaluation, two female and two male patients between 45 and 89 years of age underwent laparoscopic treatment with the diagnosis of a malignant mass in the kidney. We aimed to illustrate the clinical, radiological and histopathological relationship of four adult patients who were managed by laparoscopic approach and diagnosed with renal leiomyoma. Renal leiomyomas should be kept in mind in patients with a renal mass before definitive treatment. [ABSTRACT FROM AUTHOR]

Objective: In the present study, we aimed to investigate the short- and long-term protective effects of oral sirolimus therapy on extracorporeal shock wave lithotripsy (ESWL)-induced kidney tissue damage in an experimental rat model. Materials and Methods: Twenty-four male Spraque-Dawley rats were used in the study. A total of 1000 shock waves (SWs) were applied to the left kidney of all rats at 15 kV, 60 SW/min. Two main groups, ESWL (group 1) and ESWL sirolimus (group 2), were formed. Each group was divided into two subgroups as early (E) and late (L). Left nephrectomy was performed on the 15th day in E groups and on the 60th day in L groups. Tubular injury, interstitial changes, as well as scar formation, were scored semi-quantitatively for at least 10 cortical fields in each sample. An average score was calculated for each subject. Independent samples t-test was used for statistical analysis. The statistical significance was accepted as p<0.05. Results: The mean histopathological score was 0.08±0.94 and 0.15±0.65 (p=0.332) in group 1E and 2E and it was 0.27±0.17 in group 1L and 0.05±0.06 in group 2L, respectively (p<0.05). When group 1E and group 1L were compared, the mean score was 0.08±0.94 and 0.27±0.17, respectively (p<0.05). Furthermore, there was also a statistically significant difference in mean histopathological score between group 2E and group 2L. The mean score was 0.15±0.65 vs 0.05±0.06 (p<0.05). Conclusion: Depending on SW power and frequency, ESWL may cause significant histopathological changes in rat kidneys in the chronic period. In this experimental study, it has been thought that sirolimus treatment may have a tissue protective effect against long-term renal tissue damage. [ABSTRACT FROM AUTHOR]

Traditionally, the standard treatment of bladder-prostate rhabdomyosarcoma (BP-RMS) is being implemented to be total cystoprostatectomy and urinary diversion. However, current multimodal treatment approaches emphasize the importance of bladder-sparing surgery. In this case series, it was aimed to indicate the results of the laparoscopic bladder-sparing approach of two pediatric patients with BP RMS. They have admitted to the emergency department due to acute urinary retention (AUR). The tumors located in the prostate causing AUR were detected by Magnetic resonance imaging (MRI) and the pathological diagnosis was confirmed by biopsy. The patients were managed in a prosperous manner by implementing laparoscopic surgery with the cause of detection of a significant decrease in the size as well as the enhancement pattern of the tumors following neoadjuvant chemotherapy. No urinary incontinence, tumor recurrence or metastasis was observed at 36 and 28 months follow-up in case 1 and case 2, respectively. Laparoscopic bladder-sparing approaches may have an advantage in patients with BP RMS to decrease morbidity and mortality related to radical surgery. To our knowledge, these are the first cases of laparoscopic bladder-sparing approach in the treatment of pediatric prostate-derived embryonal RMS (PDERMS). [ABSTRACT FROM AUTHOR]

Active Surveillance (AS) is an alternative modality to radical treatment in patients with low-risk prostate cancer. There is a considerable role for AS in carefully selected patients. However the differentiation of clinically important prostate cancer from low risk disease is a major problem. Although more accurate grading was provided with the developments in prostate biopsy techniques, imaging and tumor markers still there is no standard method. This review was aimed to evaluate new developments that might affect the treatment decision in AS patients with prostate cancer. [ABSTRACT FROM AUTHOR]

Early diagnosis and treatment of üreteral obstructions are important in terms of protection of renal function. Ureteral strictures which have benign or malignant etiology, can take place a lot of intrinsic and extrinsic reasons. The primary objective is decompression of existing urinary obstruction. Treatment option should be based on according to general conditon and life expectancy of patient, etiology, length and localisation of stricture and renal function. In benign uretral stricture extensive use of endourologic, laparoscopic and robot-assisted treatment options, aplicability and treatment results were reported in various studies, the preference of minimally invasive methods have increased instead of open surgery. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the surgical and functional outcomes of laparoscopic partial nephrectomy (LPN) in patients with renal angiomyolipoma (RAML). Materials and Methods: From April 2014 to February 2018, the data of a total of 346 patients who underwent LPN were retrospectively reviewed. Twenty-one patients with final pathology report indicating RAML were included in the study. Demographic data, operative indications, intraoperative and postoperative outcomes as well as complications were evaluated. Results: Eighteen female (85.7%) and 3 male (14.3%) patients were included in this study. The mean age was 55.14±11.95 years. Of the RAMLs, 52.4% were in the right kidney and 47.6% in the left kidney. The mean tumor size was 31.38±16.72 mm and the mean RENAL Nephrometry score was 5.90±1.51 (4-10). RAML could not be differentiated from RCC in 12 patients (57.1%) by preoperative computer tomography and/or magnetic resonance images. In 4 patients, LPN was implemented by off-clamp technique whereas, in 17 patients it was implemented by global ischemia technique. The mean operation duration was 67.86±20.77 (40-110) minutes (min) and the mean estimated blood loss was 117.14±59.7 (30-220) milliliters. In 17 patients who underwent LPN by global ischemia technique, the mean warm ischemia time was 10.88±5.19 (6-22) min. According to the Modified Clavien-Dindo classification, grade 1 complications were detected in 3 patients, postoperatively. The most considerable renal functional changes were detected between preoperative and postoperative- 1st day levels. However, at the end of the first year, the difference was found to decrease. Conclusion: LPN is a safe and effective treatment option for the treatment of RAMLs that are not able to be distinguished from renal cell carcinoma radiologically. Besides the definitive treatment, the exact pathological diagnosis can be ensured by LPN. [ABSTRACT FROM AUTHOR]

The incidence of renal tumor on the allograft kidney is relatively rare. There is no standard treatment available for the management of such cases. However, if technically feasible nephron-sparing surgical approaches, whether open or minimally invasive, should be preferred for the management of these challenging cases. To our knowledge, there is no pure laparoscopic technique reported in the literature but only 3 cases of robot-assisted partial nephrectomy. In this article, we aimed to present the application of pure transperitoneal laparoscopic partial nephrectomy for the management of a renal mass on the allograft kidney. [ABSTRACT FROM AUTHOR]

Objective: Infections play an important part in post-transplantation causes of morbidity and mortality. The purpose of this study is to evaluate short-, and long-term infections encountered in after renal transplantations. Material and methods: Two hundred and thirteen cases that consisted of both living and cadaver donors, who suffered from late period renal insufficiency and had renal transplant between June 2011 and January 2016 at the Transplantation Center of Sanko University School of Medicine were included in the study. In this study the short-, and long-term infections seen in post renal transplantation were examined retrospectively. Infection types, frequency and periods of infection, infection agents and predisposing factors were determined as the examination parameters. Results: Of the 213 patients who received renal transplant, 139 were males (65.3%) and 74 were women (34.75%) and the mean age was 42±11,8 (range, 14-70) years. Twelve (5.6%) patients exited after renal transplantation. Post-transplant infections were seen in 49 patients (23.1%) within 1-6 months; in 13 patients (6.1%) within 6-12 months; and in 5 patients (2.4%) after the 12th month. The most common infections after renal transplantation were associated with urinary tract (70 patients, 34.3%). The most frequently isolated agents were E. coli (n=66; 30.9%), Kebsiella spp. (n=18; 8.4%) and Enterococci (n=18; 8.4%) respectively. The renal transplants from the cadavers were observed to contract infections 1.78 times more frequently compared to the living donors (OR=1.78, 95% CI=1.03-3.09). Conclusion: The most common complication after renal transplantation are infections. The majority of the infections are seen within the first year especially between 1-6 months. Post-transplant infections are often related to urinary system. E.coli is the most frequently isolated agent and it may be responsible for urosepsis in renal transplant patients. Infection more often seen in renal transplantations from cadavers. [ABSTRACT FROM AUTHOR]

We report the case of a patient who was admitted to the emergency department of our hospital with acute left upper quadrant abdominal pain. Computed tomography revealed perforated cholecystitis and two synchronous incidental solid mass lesions in the right kidney. The patient had situs inversus totalis anomaly. The patient was evaluated by a multidisciplinary board, and simultaneous laparoscopic cholecystectomy and laparoscopic partial nephrectomy (LPN) were planned 3 months after cholecystostomy and antibiotic therapy. After uneventful laparoscopic cholecystectomy, synchronous renal masses were successfully treated with LPN. To the best of our knowledge, this is the first case report in the literature concomitant two synchronous renal masses with situs inversus totalis, which were treated with LPN. [ABSTRACT FROM AUTHOR]

We report the case of a patient who was admitted to the emergency department of our hospital with acute left upper quadrant abdominal pain. Computed tomography revealed perforated cholecystitis and two synchronous incidental solid mass lesions in the right kidney. The patient had situs inversus totalis anomaly. The patient was evaluated by a multidisciplinary board, and simultaneous laparoscopic cholecystectomy and laparoscopic partial nephrectomy (LPN) were planned 3 months after cholecystostomy and antibiotic therapy. After uneventful laparoscopic cholecystectomy, synchronous renal masses were successfully treated with LPN. To the best of our knowledge, this is the first case report in the literature concomitant two synchronous renal masses with situs inversus totalis, which were treated with LPN. [ABSTRACT FROM AUTHOR]

Objectives: To compare the stone-free rate and complications between horseshoe and normal kidneys. Methods: Between December 1997 and June 2008, a total of 2401 patients with 2618 renal units underwent percutaneous nephrolithotomy (PCNL). During this period, we retrospectively reviewed the data of 46 patients with 50 (1.9%) renal units with horseshoe kidneys treated by PCNL. We compared the success and complication rate in horseshoe kidney and normal kidney. Results: Fifty PCNL were performed in the above-mentioned 46 patients with a mean age of 41.6 years. The average stone burden ranged from 100 to 4900 mm2 (mean, 644 ± 135 mm2). The stones were located in the renal pelvis in 13 (26%), calices in 17 (34%), and in both in 11 kidneys (22%). A single tract was used in 42 kidneys (84%), and 2 tracts were created in the remaining 8 (16%). Major complications were seen in 8 PCNL procedures (16%). A detailed comparison between horseshoe and normal kidneys showed that stone burden, operation time, stone-free rates, and auxiliary procedure rates were similar. The only statistically significant difference was detected in the number of access, which is more in normal kidneys. Logistic regression analysis did not reveal that horseshoe kidney did not have any negative effect on success after PCNL. Conclusions: Despite the anatomic abnormalities, PCNL is a safe and effective treatment option for calculi both in the horseshoe kidney and the normal kidney with the similar success and complications rates. [Copyright &y& Elsevier]

Objective: This study aims to review the parameters affecting tumour recurrence, tumour progression and cancer survival of patients with low-grade non-muscle invasive bladder cancer. Materials and Methods: We retrospectively reviewed 262 patients with primary, low-grade Ta bladder cancer. Recurrence was defined as the occurrence of a new tumour in the prostatic urethra or bladder. Tumour progression was defined as confirmed high-grade Ta, all T1 or carcinoma in situ, upper tract recurrence or progression to T2. The associations between factors that affect recurrence and progression were analysed. Results: Tumour recurrence and progression occurred in 119 (45.4%) and 25 (9.5%) patients during follow-up (median follow-up: 50.9±36.3 months), respectively. Univariate and multivariate analyses demonstrate that smoking, multiple tumours and large tumours (3 cm<) were significant. A Cox regression analysis revealed that progression was identified as a significant risk factor on survival. There was no effect of smoking on recurrence-free survival. A Kaplan-Meier analysis showed that one-, five- and ten-year progression-free survival rates were 99.6%, 88.2% and 70%, respectively. Conclusion: Multiple tumours, large tumours (>3 cm) and smoking were risk factors for recurrence and progression. Prevention of smoking and routine cystoscopic examination are essential in bladder cancer. [ABSTRACT FROM AUTHOR]

Cystic hydatid disease is an endemic disease caused by the larval form of Echinococcus spp. Isolated renal involvement is extremely rare. The treatment methods for renal hydatid disease require some form of intervention, ranging from traditional open techniques to laparoscopic techniques. Herein, we present a large hydatid cyst in the lower pole of the left kidney in a 43-year-old male patient who was treated by the 'closed cyst' method via the retroperitoneal laparoscopic approach to prevent soiling of the peritoneal cavity. To our knowledge, this is the first case of a renal hydatid cyst treated by preserving the renal parenchyma by pericystectomy via the retroperitoneoscopic laparoscopic approach in an adult patient. No complications occurred during the perioperative and postoperative periods. After 9 months of follow up, the patient was asymptomatic with no evidence of clinical recurrence. Retroperitoneoscopic laparoscopic closed cyst pericystectomy can be an alternative minimally invasive treatment technique for the treatment of renal hydatid disease. [ABSTRACT FROM AUTHOR]