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Extracorporeal shockwave lithotripsy and especially flexible ureterorenoscopy (URS) are first-choice treatments of upper ureteral and renal pelvis stones. In our study, we aimed to demonstrate that the treatment of upper ureteral and renal pelvis stones smaller than 2 cm could be performed by semirigid URS under spinal anesthesia. The data of 292 patients were retrospectively analyzed. Stones were localized in upper ureter and renal pelvis in 191 (65.4%) and 101 (34.6%) patients, respectively. The stone-free rate was found to be 72.6%. The final stone-free rate was 95.2% after additional treatments administered to 80 patients with residues. While no peri-operative complication was observed, hematuria was observed in three patients during the post-operative period, high fever was observed in 27 patients and sepsis was observed in four patients. It is a well-known fact that flexible URS is the first-choice surgical method in the treatment of upper ureteral and renal pelvis stones. In the current study, we aimed to investigate whether laser lithotripsy with semirigid URS could also be a good and cheap alternative in clinical practice, and if upper urinary tract surgeries could be performed with spinal anesthesia especially in patients with a high risk of general anesthesia. Level of evidence

Purpose: It was aimed to evaluate the results and complications of percutaneous nephrolithotomy (PCNL) in a second stage state hospital by a surgeon after Urology residency.Materials and methods: Between January 2019 and January 2020, PCNL was applied to 102 renal units in 97patients with kidney stones in a second stage state hospital. Standard PCNL was performed in all patients in the prone position with a 26 Fr rigid nephroscope and pneumatic lithotripter. The data of the patients were collected retrospectively. Success rates, length of stay, and complications were evaluated in the light of the literature.Results: The average age of 97 patients who underwent PCNL was 41.7±10.5 (8-71) and 54 (55.7%) of thesepatients were male and 43 (44.3%) were female. Access was provided to 102 renal units. 42 (41.2%) of themwere left and 60 (58.8%) were right. The mean stone surface area was 8.3±5.5 (2-34) cm2 and the numberof stones per patient was 2.4. Operation time was measured as 85>32 (40-170) minutes. The duration offluoroscopy was observed as 1.2±0.2 (0.5-9) minutes. The stone free rate was achieved in 86 (84.3%) of 102cases. Including clinically insignificant residual fragments (>4 mm), the overall success rate was 93.1%. Thehospital stay of the patients was 2.7 (1-11) days. The number of patients with major and minor complications was 21 (20.6%).Conclusion: We thought that PCNL can be applied safely and effectively in 2nd stage state hospitals withacceptable complications and success rates in line by the literature., Amaç: Bu çalışmada; uzmanlık eğitimi sonrasında perkütan nefrolitotomiyi (PNL) 2. basamak ilçe devlethastanesinde gerçekleştiren bir cerrahın başarı oranları ve karşılaşılan komplikasyonları değerlendirmekamaçlandı.Gereç ve yöntem: Ocak 2019 ile Ocak 2020 tarihleri arasında böbrek taşı olan 97 hastadaki 102 renal üniteye2. basamak devlet hastanesinde PNL uygulandı. Tüm hastalara standart PNL 26 Fr rijit nefroskop ve pnömotik litotriptör kullanılarak prone pozisyonda uygulandı. Hastaların verileri retrospektif olarak toplandı. Başarı oranları, yatış süreleri, karşılaşılan komplikasyonlar literatür eşliğinde değerlendirildi.Bulgular: PNL yapılan 97 hastanın yaş ortalaması 41,7±10,5 ve bu hastaların 54’ü (%55,7) erkek, 43’ü (%44,3)kadındı. 42’si (%41,2) sol, 60’ı (%58,8) sağ böbrek olmak üzere 102 renal üniteye giriş sağlandı. Ortalamataş yükü 8,3±5,5 cm2 ve ortalama taş sayısı 2,4 olarak tespit edildi. Operasyon süresi ortalama 85±32 dakika olarak ölçüldü. Skopi süresi ortalama 1,2±0,2 dakika olarak izlendi. Toplam 102 vakanın 86’sında (%84,3) taşsızlık sağlandı. Klinik önemsiz rezidüel fragmanlar (>4 mm) da dahil edildiğinde genel başarı oranı %93,1 idi. Hastaların hastanede kalış süresi 2,7 (1-11) gün olarak izlendi. Majör ve minör komplikasyon görülen hasta sayısı 21 (%20,6)’di.Sonuç: PNL uzmanlık eğitimi sonrası 2. basamak ilçe devlet hastanelerinde literatürle uyumlu komplikasyon ve başarı oranları ile güvenli ve etkin bir şekilde uygulanabileceğini düşünmekteyiz.

Because of the long and variable learning curve of laparoscopic surgery, before its actual application, a well-designed practical simulating instruments like laparoscopic training boxes are needed. But because of unfavourable cost-effectiveness and huge sizes of these boxes, surgeons hardly procure, and carry them. We aimed to design a new, cheap, light and handy laparoscopic training box. Our training box is made of aluminium and used with smartphone or tablet. There is no need for a power unit. Our foldable box has dimensions of 52×38×4 cm, and weighs 2.8 kg and foldable. There are 5 working ports in it. Compared to its alternatives "Fu-Lap T-Box" is much cheaper, lighter and more comfortable. In our opinion it is possible to design and use a new cheaper and portable simulator to gain more hands-on experience before the real surgery.

Unlike other inguinal hernias, hernial protrusion of the entire bladder into the scrotum, also known as a scrotal cystocele, is a relatively rare condition that generally requires emergency due to its complications [1–3]. Here, we present two cases of massive bladder herniation into the scrotum with clinical findings, preoperative radiographic images along with intraoperative findings and discuss the management of cytsocele. This study reports management of two cases of massive bladder hernia. Written informed consent was obtained from the patients. Patient identification data were not used in this case presentation. 1.1. Case 1 72-year-old male, who lives in a nursery, admitted to the emergency department with a 6-month history of swelling in the right groin and obstructive urinary tract symptoms. Body-mass index (BMI) of the patient was 34 kg/m2. His past medical record included diabetes mellitus type II, chronic obstructive pulmonary disease (COPD), essential hypertension (HT), and coronary artery disease. He was on medication with anti-diabetics, insulin, acetylsalicylic acid, amlodipine, budenoside and montelucast for his chronic diseases. On physical examination, painful swelling of 10 × 8 cm in size starting proximally and extending along the right inguinal canal was found (Fig. 1). Defective lymphatic drainage of right lower extremity was macroscopically noted as there was a significant circumference difference between lower extremities. Physical examination also approved this difference indicating the impairment of lymphatic drainage of the right lower extremity. Palpation revealed pain in the right inguinal region. The ultrasound of the same region reported as vesicle hernia within the inguinal canal and grade 3-hydronephrosis. Blood urea and creatinine levels were found to be increased. An emergency operation was planned and during the preoperative urology consultation, an urinary catheter was placed into the bladder in order to manage the urinary retention. Retrograde cystography showed a vesicle which is full of contrast material herniated to the right scrotum (Fig. 2). Contrast-enhanced CT scan revealed that the bladder was completely herniated to the right scrotum along with the 1/3 of the distal ureter (Fig. 3). Patient was hospitalized for the operation; however he lost his life due to acute myocardial infarct (AMI) during the preoperative preparations. Written informed consent was obtained from the patient's family for publication of this case report. Fig. 1 A painful inguinal swelling, 10, 8 cm in size, was found on physical examination. Fig. 2 Retrograde cystography showed a complete herniation of bladder into the scrotum along with the 1/3 of the distal ureter. Fig. 3 Contrast-enhanced CT scan revealed that the bladder was completely herniated to the right scrotum along with the 1/3 of the distal ureter. 1.2. Case 2 64-year-old male who admitted to the general surgery clinic with a 4-month history of groin pain was evaluated. BMI of the patient was 37 kg/m2. Physical examination revealed a hernia associated with protrusion of the bladder into the inguinal canal and scrotum. The patient was on medication with amlodipine (5 mg, 1 × 1) because of hypertension. Contrast-enhanced CT scan proved that the urinary bladder was herniated into the scrotum (Fig. 4). Elective operation was planned. Reduction of the protruded bladder was performed following the inguinal exploration by using prolene mesh repair. A drain was placed above prolene mesh and removed when the daily drainage decreased below to 20 cc. Since the patient was doing well without any complaints, he was discharged on the 3rd post-operative day and was invited for follow-up clinic visit after 1 week. The patient experienced no unusual or unexplained symptom, and no recurrence after repair surgery on the routine 1, 3 and 6 months of follow-up visits. Fig. 4 Contrast-enhanced CT scan revealed a complete herniation of urinary bladder into the left scrotum. 2. Discussion Urinary bladder or ureter can protrude into the inguinal canal, femoral ring, scrotum or even through the ischiorectal fossa or obturator foramen [4,5]. Even though, urinary bladder protrusion along the inguinal canal occurs in approximately 1–4% of all cases, the incidence increases to 10% in men over the age of fifty. However, massive scrotal hernias are rare. Besides, complete bladder herniation are very rare compared to incomplete bladder herniation [2,6]. Lower urinary tract obstruction, decreased bladder tone, obesity, weakness of abdominal and pelvic walls with advanced age, benign prostate enlargement and chronically distended urinary bladder may contribute to the pathophysiology of the scrotal cystocele [7,8]. In the present cases, the volume of prostate in both patients was in normal ranges. Thus, the cause of the bladder hernia is assumed to be intraabdominal pressure increase because of obesity and COPD. In general, urinary bladder hernia is classified into three groups according to the relationship between the parietal peritoneum and the protruded portion of the urinary bladder: Paraperitoneal, intraperitoneal and extraperitoneal. Presented cases were described as paraperitoneal hernia, in which extraperitoneal portion of hernia lied along medial wall of sac appeared with the obstructed lower urinary tract symptoms. This type of hernia is reported as the most common type of bladder hernia in the previous studies [9]. Massive scrotal cystocele is usually defined with voiding symptoms, involving manual compression of the hernia. The size of the scrotal mostly depends on urination, as it reduces after voiding. In our cases, both patients described voiding with manual compression of the scrotum in accordance with the previous reports [7,8]. The differential diagnosis of a painless unilateral scrotal swelling includes a hydrocele, spermatocele, varicocele (usually left sided), epididymal cyst, tumor, intestinal or omental hernia [1,2,6]. Scrotal cystocele, which involves only 1–4% of the inguinal hernias, can easily be missed during the clinical evaluation. Thus, radiological imaging plays a crucial role as an accurate diagnostic procedure and it may also help to reduce the risk of structures in the hernia sac [10,11]. CT and ultrasonography are both helpful to diagnose a scrotal cystocele, especially to evaluate the massive inguinoscrotal hernias whereas a retrograde cystogram should be performed to determine the involvement of the bladder properly [10,11]. Both CT scan and cystography were used to identify the anatomical involvement of the bladder in the scrotal hernia in our cases and they revealed a complete urinary bladder hernia fully filled with contrast material in both cases. Ureteral hernia is an uncommon, but an important disorder which causes to serious complications and requires immediate surgical treatment. However, hernia repair surgery can increase the risk of ureter injury which may lead to serious consequences [4]. In massive scrotal hernia cases, bladder can protrude with the ureter causing hydronephrosis on the affected side can herniate with the bladder or independently, and can cause ureterovesicular obstruction with hydronephrosis on the involved side [2]. Thus, grade 3 hydronephrosis in our first case and grade 2 hydronephrosis in the second case due to malposition of ureter were noted. Hydnephrosis is remarkable in our first case. Blood creatine and urea levels were increased and the patient was processing to renal failure. Urinary catheter was placed for to empty the urinary bladder. This provides two important benefits: first, the pain will relieved as the size of the hernia reduces, second, the risk of injury of urinary bladder will decrease as the bladder does not fill the entire hernia sac in the scrotum. Massive hernias are still a dilemma for surgeons since no standard approach for massive inguinoscrotal hernias including bladder was described yet in the literature. Thus, the surgeons are advised to approach carefully to these patients according to their clinical presentation. As a surgical procedure, lichtenstein technique and laparoscopic approach are presented as the most used ones [12]. Our first patient could not be operated since he died in the preparation period for surgery due to acute myocardial infarct. In the surgery of the second patient, we freed bladder from hernial sac and reduced it into the abdominal cavity. Lichtenstein technique was performed for repair of defect following the reduction since the lichtenstein open tension-free hernioplasty technique was already suggested to be the best option in such patients. The mesh is positioned in the pre-peritoneal space. The mesh decreases the tension on the weakened abdominal wall and reduces the risk of hernia recurrence [13]. The repair of an inguinoscrotal hernia including the urinary bladder is a great challenge for surgeons. The correct pre-operative management, the appropriate radiological examinations and the right surgical method chosen by the surgeon can increase the success in surgery. Surgical therapy, although it is usually challenging and demanding, seems to be the best choice for treatment of these patients as increasing their quality of life. Informed consensus is always necessary and ensures that the patient is fully aware of all the pros and cons of the possible postoperative complications [14].

WOS: 000429225000007, PubMed ID: 28618770, Purpose: The aim of this study was to evaluate the correlations between laboratory findings and ultrasonographic measurements of renal length and cortical thickness in patients receiving follow-up for chronic kidney disease (CKD). Methods: A total of 41 CKD patients (18 males and 23 females; mean age, 65.2 years; range, 42 to 85 years) with a low glomerular filtration rate who did not require renal replacement therapy were included in this prospective study. Patients were followed up with laboratory assays at bimonthly intervals and with ultrasonography performed twice a year. Renal cortical thickness, renal length, and estimated glomerular filtration rate (eGFR) values were compared using the paired-samples t test. Additionally, Pearson correlation analysis was conducted between renal length and cortical thickness measurements and eGFR values to assess kidney function. Results: At the beginning of the study and after 24 months, mean eGFR values of the 41 patients were 35.92 mL/min and 28.38 mL/min, respectively. The mean renal length was 91.29 mm at the beginning of the study and 90.24 mm at the end of the study. The mean cortical thickness was 5.76 +/- 2.05 mm at the beginning of the study and 5.28 +/- 1.99 mm at the end of the study. A statistically significant positive association was found between eGFR and mean renal length (r= 0.66, P< 0.01) and between eGFR and mean cortical thickness (r= 0.85, P< 0.01), with the latter being more prominent. Conclusion: Our study suggests that ultrasonographic cortical thickness measurements may be an important imaging technique in the follow-up care of patients with CKD.

Objectives To evaluate the potential benefits of laparoendoscopic single-site pyeloplasty over conventional laparoscopic pyeloplasty. Methods Between October 2009 and January 2012, 39 patients were enrolled in a prospective study and randomized to undergo a laparoendoscopic single-site pyeloplasty (n = 19) or conventional laparoscopic pyeloplasty (n = 20). The outcomes in the two groups were compared by using Mann-Whitney U-test and χ2-test, and considering a P-value less than 0.05 as statistically significant. Results There was no difference in blood loss (55.67 ± 6.71 vs 45.84 ± 5.22 mL, P = 0.60), transfusion rates (0% for both) and hospitalization time (2.12 ± 0.23 vs 2.06 ± 0.34 days, P = 0.72) between the laparoendoscopic single-site pyeloplasty and conventional laparoscopic pyeloplasty groups. The time to return to normal activities was shorter (8.65 ± 1.25 vs 11.53 ± 1.28 days, P = 0.01), and median operative time (195.21 ± 12.15 vs 145.62 ± 15.34 min, P = 0.001) was longer in the laparoendoscopic single-site pyeloplasty group compared with the conventional laparoscopic pyeloplasty group. No significant intraoperative or postoperative complications occurred in either group. Compared with conventional laparoscopic pyeloplasty, laparoendoscopic single-site pyeloplasty yielded better cosmetic results and patient satisfaction. The mean follow-up period was 19.7 months (4–28 months). The success rate was 95% in both the groups. Both the visual analog scale and the postoperative use of analgesics were significantly lower in patients who underwent laparoendoscopic single-site pyeloplasty. Conclusions Our findings suggest that laparoendoscopic single-site pyeloplasty can offer faster recovery and higher patient satisfaction than conventional laparoscopic pyeloplasty. Thus, this novel technique promises to become the treatment of choice in minimally-invasive management of ureteropelvic junction obstruction.

Background The aim of this study was to investigate the potential protective effect of ukrain on an experimental kidney injury model induced by ischemia and reperfusion (IR) in rats. Material and methods A total of 24 male Sprague-Dawley rats were equally and randomly separated into three groups as follows: group-1: controls (C; only laparotomy); group 2: renal ischemia-reperfusion (IR; occlusion of the renal artery for 30 min and 2 h of reperfusion); and group 3: ukrain treatment and IR applied group (U + IR; occlusion of the renal artery for 30 min and 2 h of reperfusion; ukrain was intraperitoneally administered 1 h before the IR process). Results Serum total oxidant status (TOS) and total antioxidant status (TAS) levels were measured. The oxidative stress index was determined by calculating the TOS/TAS ratio. TAS serum levels significantly increased, and TOS serum levels also prominently decreased in U + IR group, when compared with the IR group (P < 0.001). Mean NGAL level was remarkably higher in IR group, when compared with the U + IR group (P < 0.001). Caspase-3 messenger RNA (mRNA) expression level increased in IR and decreased in U + IR group (P < 0.001). Bcl-xL serum and mRNA expression levels increased in the U + IR group (P < 0.001). In addition, serum iNOS and mRNA expression levels increased in IR group and decreased in U + IR group (P < 0.001). Conclusions Data established from the present study suggest that ukrain may exhibit protective effect against IR-induced kidney injury and that antioxidant activity primarily modulates this effect. © 2016 Elsevier Inc. All rights reserved.

To evaluate the clinical value of detected prostate-specific antigen (PSA) mRNA expression levels in circulating cells in patients with prostate cancer by quantitative real-time polymerase chain reaction (qRT-PCR) and to determine the effect of surgical manipulation on hematogenous dissemination. Blood samples before, during, and after (24 h) surgery were obtained from 34 patients with prostate cancer who underwent radical prostatectomy for detecting PSA mRNA expression levels. PSA mRNA expression levels, PSA levels, and Gleason scores were then compared. PSA mRNA expression levels were detected in 14 of 34 (41%) patients, and biochemical recurrence of blood PSA was observed in 6 of 34 (17%) patients. Differences of PSA mRNA expression levels in pre-, per-, and postoperative periods were statistically significant (P

To investigate whether stone dimension is a restrictive factor for ureterorenoscopic procedures.A group of 416 patients who had undergone ureterorenoscopic pneumatic lithotripsy (URS-PL) for lower ureteral stones between January 1999 and June 2006 in our clinic had been evaluated retrospectively. Two hundred and seventy (270, 64.9%) patients were men and 146 (35.1%) were women. The mean age of the patients was 36.61 (+/- 12.43) years. Patients were grouped according to stone dimension; 193 patients with stones smaller than 1 cm being group 1 and 223 patients with stonesor = 1 cm in dimension being group 2. Stone-free rate, operative time and rate of complications of the groups were compared. Pearson's correlation test, chi2 test, Fischer's exact test and Student's t-test were used for the statistical analysis. The p value was accepted as being meaningful if p0.05.For group 1, the mean operative time was 39.19 (+/- 18.33) min. Proximal stone migration in five and false passage formation in three patients was observed. Three patients were stone-free after a second session of URS-PL. The cumulative stone-free rate was 97.4% (188/193). For group 2, the mean operative time was 48.5 (+/- 11.31) min. About 208 (93.27%) patients were stone-free after the first session and an additional eight patients became stone-free after the second session of URS-PL. False passage, ureteral perforation, ureteral avulsion and stricture were observed in four, six, one and one patients, respectively. No proximal stone migration was observed. The cumulative stone-free rate was 96.86% (216/223).The effectiveness of ureterorenoscopy (URS) in the treatment of distal ureteral stones was independent of stone dimension. However, the operative time was longer and the rate of perforation was higher in stones with a diameteror = 1 cm. On the other hand, the migration rate was higher in stones1 cm in diameter. Generally speaking, there was no meaningful effect of stone dimension on complication rates.

Polymorphism in manganese superoxide dismutase gene (Mn-SOD) is a new approach to identify its probable association with urolithiasis. Oxidative stress may be involved in the development of stone formation in the renal system. MnSOD is one of the primary enzymes that directly scavenges potential harmful oxidizing species. A valine (Val) to alanine (Ala) substitution at amino acid 16, occurring in the mitochondrial targeting sequence of the MnSOD gene, has been associated with an increase in urolithiasis risk. This study was conducted to investigate the association of MnSOD gene polymorphism with the risk of urolithiasis. We investigated the MnSOD in 66 stone-forming adults and 72 healthy volunteers. DNA was isolated from peripheral blood and genotyping was performed with PCR-based methods. Then PCR products were cut by BsaW1. Products were run on 3% agarose gel, 246 bp regions were 1-Ala-9, 164 and 82 bp products were determined as 2 Val-9. Chi-square test was used for comparison between patients and controls. In the control group the homozygote Ala allele was significantly higher than in the patient group (P < 0.01). The distribution of Ala/Val and homozygote Val alleles in the patient group was significantly higher than in the control group (P < 0.05). MnSOD genotype determination may provide a tool to identify individuals who are at risk of urolithiasis. This experiment also provides data about antioxidant status and stone formation.

We reviewed our experiences with ureteroscopic pneumatic lithotripsy (URS-PL) for the treatment of distal-ureteral stones and investigated whether failed extracorporeal shockwave lithotripsy (SWL) is a limiting factor for the ureteroscopic procedure.We retrospectively studied the medical records of 375 patients treated with URS-PL from January 1999 to September 2005 in our clinic. Of these patients, 213 were treated with URS-PL primarily (group 1), whereas the remaining 162 patients had undergone SWL unsuccessfully before URS-PL was performed (group 2). We used 9F or 9.5F rigid instruments and the Vibrolith (Elmed, Ankara, Turkey).In group 1, 206 patients (96.7%) were treated successfully with URS alone, as were 155 patients (95.6%) in group 2. Impacted stones were observed in 21 patients in group 1 (9.85%) and in 57 patients in group 2 (35.1%). The average operating time was 33.19 +/- 9.039 minutes in group 1 and 57.42 +/- 8.757 minutes in group 2. The stone-free rates of the two groups were significantly different on the first postoperative day, but this difference decreased to an insignificant level at the end of the first month.When SWL fails, URS-PL is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be effective for impacted stones.

WOS: 000406053400003, PubMed: 28073188, Purpose: Technically, obesity weakens the pelvic base muscles by causing an increase in the intraabdominal pressure and intravesical pressure due to increasing fat and it triggers the occurrence of lower urinary tract symptoms. However it is believed that weight loss will cause recovery of these symptoms. Our purpose in this study is to research about the effects of the weight loss achieved by using especially the Laparoscopic Sleeve Gastrectomy (LSG) technique of bariatric surgery which is being more and more widely used today. Materials and Methods: Out of all patients who had LSG surgery due to obesity earlier in our center during the period between April 2014 and March 2015, 22 applicable male patients were considered after a brief exclusion criteria application. Age, height, weight, and body mass index (BMI) data of these patients were recorded before the operation. International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-short from) (ICIQ-SF), Beck depression inventory (BECK) and Short form -36 (SF-36) were filled for the patients and the data were recorded. Also, the weight loss amounts and BMI decreases of the patients after the operation were recorded. Results: After the procedure, the decrease in the averages of BECK depression inventory, IPSS, ICIQ-SF and the increase in the Mental and Physical subgroup scores of SF-36 were found statistically coherent. Conclusion: The adverse effect of obesity, which is observed more and more often in today's world, on lower urinary tract symptoms and on the quality of life is undeniable. In our study, we think that the bariatric surgery made by using the LSG technique, not only causes serious amount of weight loss, but also reduces urinary dysfunction and enhances the quality of life among males.

Introduction. Transurethral resection of the prostate (TURP) is still regarded as the gold standard for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction in prostates between 30 and 80 mL. Endoscopic treatment of large prostate is not adequately discussed in literature. Our objective was to evaluate the efficacy and safety of TURP in large prostate glands (≥80 ml) in patients with BPH. Material and methods. From May 2004 to September 2012, 62 patients with high volume of BPH (≥80 ml) treated with TURP by single surgeon, were evaluated retrospectively. Perioperative and post operative full blood count and serum electrolytes, complications, operative time, weight of resected prostate tissue, time for catheter removal, and hospitalization time were recorded. Conventional TURP was performed using a standard technique. Results. The mean PSA levels and prostate volumes were 8 ±5.38 ng/ml and 90.93 ±13.95 gm, respectively. The mean operating time was 55.96 ±8.04 minutes. The mean amount of tissue resected was 52.21 ±7.59 gm. Compare with baseline, there were significant improvements in International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), and postvoiding residual urine after surgery. There was no major bleeding complication. There was no TUR syndrome or intraoper ative death. Requiring re–catheterization was detected for 3 (4.8%) patients. Transient urge incontinence was observed for 3 (4.8%) patients. Bulbar urethral stricture was developed for 2 (3.2%) patients. Conclusions. Morbidity of the TURP is decreased with the technological improvements. Conventional monopolar TURP can be effectively performed in large prostate (≥80 mL) with the experience.

Vesicoureteral reflux (VUR) is considered as a significant factor for the development of urinary tract infection, progressive renal damage or scarring, and end-stage renal failure [1]. Mild cases of VUR are likely to resolve spontaneously, but high-grade VUR may require surgical correction. Open ureteral reimplantation surgery has been extremely successful, with success rates of 95–98% in children [2]. However, open surgical repair involves in-splitting of the abdominal wall, forced retraction of the bladder and long postoperative need for indwelling catheter causing pain, bladder spasms, and longer hospital stay [3–5]. Laparoscopy is proposed to overcome these advantages of the traditional open surgery in the treatment of VUR, reflecting the advance in other fields of urologic surgery. Despite initial description in 1994, standard laparoscopic ureteral reconstructive surgery has lagged behind because of its complexity and requirement of advanced laparoscopic skills [6].

Percutaneous Nephrolithotomy PCNL is a minimally invasive method for the treatment of kidney stones and has replaced open stone surgery. However, it should be kept in mind that various complications may develop in PCNL operation like every surgical procedure and even these can be life-threatening. Although PCNL can be performed tubeless in appropriate patients, nephrostomy is routinely terminated. In this article, we discussed the brekeage of the nephrostomy catheter that we have placed after PCNL operation and our endoscopic approach to this condition which was not previously reported in the literature., Perkütan Nefrolitotomi PNL böbrek taşlarının tedavisinde minimal invaziv bir yöntem olup, günümüzde açık taş cerrahisinin yerini almıştır. Ancak her cerrahi işlem gibi PNL operasyonunda da çeşitli komplikasyonların gelişebileceği, hatta bunların hayatı tehdit edecek boyutlara ulaşabileceği unutulmamalıdır. PNL operasyonu uygun olan hastalarda tüpsüz olarak yapılabilse de rutinde nefrostomi yerleştirilerek sonlandırılmaktadır. Biz de bu yazımızda daha önce literatürde bildirilmemiş olan PNL operasyonu sonrası yerleştirdiğimiz nefrostomi kataterinin kopmasını ve bu duruma endoskopik yaklaşımımızı anlattık.

Objective: Radical prostatectomy is the standard treatment modality for localized prostate cancer. Minimally invasive surgery, especially robotic surgery, has attracted interest in the last 10 years, and open surgery has been less preferred. Among the open surgical procedures, the perineal approach is the least preferred by urologists, which may be related to their perception of its overall difficulty. In this study, we aimed to present our initial experience with learning and performing radical perineal prostatectomy (RPP) and to draw attention to this method. Material and methods: After a short training period between November 2011 and May 2013, RPP was performed on 9 patients with localized prostate cancer. The patients were evaluated as for medical, and perioperative and major postoperative complications. Results: The mean age of the patients was 60.4±5.3 (50-68) years, the mean preoperative prostate-specific antigen (PSA) value was 5.8±1.3 (4.0-7.6) ng/mL and the mean prostate volume was 38.8±7.7 (28-54) cc. The biopsy Gleason score ranged from 5 to 7. The median follow-up period was 14 (3-30) months. Anastomotic stricture did not occur in any of the patients. Of the 9 patients, 4 (44%) were immediately continent after catheter removal, while the remaining patients were continent at the end of three months. Of the 7 patients who underwent nerve-sparing surgery, 2 had postoperative spontaneous erections. Erectile function was maintained with phosphodiesterase 5 (PDE-5) inhibitor treatment in 3, and with intracavernosal injection in 1 patient. Penile prosthesis implantation was performed in 1 patient. Conclusion: RPP has been a promising procedure at the start with its favorable oncologic and functional outcomes. This method should be considered by urologists, although it has been previously perceived as a challenging surgical procedure to perform. © 2014 by Turkish Association of Urology.