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Objective:We compared the success and complication rates of retrograde intrarenal surgery (RIRS) performed with semi-rigid ureterorenoscopy (srURS) or flexible ureterorenoscopy (fURS) for isolated renal pelvic stones.Materials and Methods:A total of 247 patients who underwent RIRS with fURS (n=179; group 1) or srURS (n=68; group 2) were included in this study. Various factors related to patients, stones and surgical procedures were evaluated retrospectively.Results:There was no difference between the patient groups according to mean age (49.12±1.10 years vs 49.59±1.60 years, p=0.745), gender distribution (p=0.152), mean hounsfield unit values (941±31.41 vs 1036±44.47 p=0.077), and mean hospitalization time (3.57±0.19 days vs 4.59±0.57, p=0.224). In group 1, the mean stone size (14.5±0.73 mm vs 15.5±0.62 mm, p=0.019) was statistically lower and the operative time (79.73±3.38 min vs 70.65±8.61, p=0.041) was statistically higher than those of group 2. The overall success rate in group 1 and group 2 was 93.9% and 63.6%, respectively (p

Objectives: The aim of this study is to evaluate prediction of postoperative ureteral obstruction needing ureteral stent insertion by evaluating the resistive index (RI) values and the grade of hydronephrosis. Material and Methods: A total of 66 adult patients undergoing stentless endoscopic ureteral stone treatment (URS) between January 2018 and January 2019 were included in this prospective study. Preoperative patient and stone characteristics were noted. All patients were evaluated with renal Doppler ultrasonography study to assess degree of hydronephrosis and RI values. A renal Doppler ultrasonography was repeated at postoperative 1st, 3rd and 7th days. Changes in both RI and hydronephrosis levels before and after the procedures were noted. On the postoperative 7th day, patients were divided into two groups including obstructive and non-obstructive cases according to RI values assessed where a RI value of 0.7 was accepted as the cut-off for obstruction. The preoperative and perioperative characteristics of both groups were evaluated in a comparative manner. Results: The mean patient age was 43.6 ± 1.72 years. Significant improvements were noted in RI and grade of hydronephrosis after the operation. The grade of hydronephrosis and RI values were found to improve more significantly on postoperative 3rd day when compared to the postoperative 7th day (p < 0.01 and p < 0.01). A significant correlation was detected between the grade of hydronephrosis (>grade 2) and obstructive RI values (> 0.7) in each postoperative visits (p: 0.001). RI values (> 0.7) at postoperative seventh days were correlated with larger mean stone size, increased ureteral wall thickness, increased diameter of the ureter proximal to the stone, and longer duration of the operation. Preoperative high-grade hydronephrosis indicated obstructive RI values at postoperative seventh day (p = 0.001) Conclusion: Changes in RI values on Doppler sonography and the grade of hydronephrosis may be a guiding parameter in assessing postoperative ureteral obstruction.

Aim: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). Patients and methods: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. Results: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. Conclusion: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK.

Objective: To evaluate the level of knowledge of autonomic dysreflexia among physicians practicing in different disciplines namely anesthesia and reanimation, emergency, neurology, neurosurgery, urology, and physical medicine and rehabilitation departments. Materials and Methods: The study was conducted using a questionnaire consisting of seven questions, which was completed in a prospective manner by 95 physicians (residents and consultants) in our tertiary care hospital. Results: None of the questions asked in the questionnaire could be replied by 38 (40%) of 95 physicians in the hospital. Only one physician did reply all the questions completely. The mean value of the mark given was 2.00±2.04 for consultants and 1.10±1.37 for residents (p=0.039). Our data showed that while only 27% of the physicians have received training on autonomic dysreflexia; 18% of physicians had a previous experience with patients having autonomic dysreflexia. Conclusion: Taking the potential serious complications of autonomic dysreflexia into account, necessary information on this emergency status should be given to physicians. We believe that to reach a more precise conclusion about awareness of physicians on autonomic dysreflexia, multicenter studies with larger number of participants are certainly necessary.

Spontaneous renal or other organ ruptures secondary to anticoagulants have rarely been reported. The clinical features of renal rupture include acute flank/abdominal pain, haematuria, hypotension and shock. It can occur due to increased intraabdominal pressure during coughing. Rupture is most commonly caused by renal tumors such as angiomyolipomas. In the literature, other known causes are long-term haemodialysis, arteriosclerosis or arteritis. Wunderlich’s syndrome is an extremely dangerous complication that may cause death if not treated intensively. If the haemorrhage is self-limiting and the patient is responsive to fluid replacement, the patient can be managed conservatively. Selective angiographic embolization and emergency nephrectomy (partial or total) are the treatment options. In the literature, we found only one case that was presented as spontaneous non-traumatic renal rupture associated with coughing. In our case, total nephrectomy had to be performed, but it was not adequate.

Purpose: To evaluate the true necessity of open end ureteral catheter insertion in patients with moderate to severe pelvicalyceal system dilation treated with percutaneous nephrolithotomy (PNL) under sonographic guidance. Patients and methods: 50 cases treated with PNL under sonographic guidance in prone position for solitary obstructing renal stones were evaluated. Patients were randomly divided into two groups; Group 1: Patients in whom a open end ureteral catheter was inserted prior to the procedure; Group 2: Patients receiving no catheter before PNL. In addition to the duration of the procedure as a whole and also all relevant stages as well, radiation exposure time, hospitalization period, mean nephrostomy tube duration, mean drop in Hb levels and all intra and postoperative complications have been evaluated. Results: Mean size of the stones was 308.5 ± 133.2 mm2. Mean total duration of the PNL procedure in cases with open end ureteral catheter was significantly longer than the other cases (p < 0.001). Evaluation of the outcomes of the PNL procedures revealed no statistically significant difference between two groups regarding the stone-free rates (86% vs 84%). Additionally, there was no significant difference with respect to the duration of nephrostomy tube, hospitalization period and secondary procedures needed, complication rates as well as the post-operative Hb drop levels in both groups (p = 0.6830). Conclusions: Our results indicate that the placement of an open end ureteral catheter prior to a PNL procedure performed under sonographic access may not be indicated in selected cases presenting with solitary obstructing renal pelvic and/or calyceal stones.

Purpose: To determine the predictive value of certain radiological parameters for an objective asssessment of the presence of ure-teral stone impaction.Materials and Methods: Seventy-nine patients with a single proximal ureteral stones were retrieved from the departmental data-base. Both clinical and particularly radiological data of all cases were well evaluated on this aspect. In addition to the time period between the first colic attack and definitive management; diameter of proximal ureter and renal pelvis, longitudinal and transverse stone size, Hounsfied unit (HU) of the stone and lastly ureteral wall thickness at the impacted stone site were all carefully evaluated and noted.Results: Patients had a single proximal ureteral stone. While mean age of the cases was ranged 20 to 78 years; mean stone size was 15.62±4.26 mm. Evaluation of our data demonstrated that although there was a statistically significant correlation between ureteral wall thickness and patients age, transverse diameter of the stone, ureteral diameter just proximal to the stone, renal pelvic diameter and the duration of renal colic attacks; no correlation could be demonstrated between patients sex and the HU of the stone.Conclusions: Prediction of the presence and degree of proximal ureteral stone impaction is a challenging issue and our data indicated a highly significant correlation between ureteral wall thickness and the some certain radiological as well as clinical pa-rameters evaluated which will give an objective information about the presence of impaction which may in turn be helpful in the follow-up and also management plans of such calculi.

Objective: The effects of surgical technique on respiratory mechanics, arterial oxygenation and hemodynamics in radical prostatectomy operation were investigated. Methods: The study was planned on ASA II-III, 40-65 years old, fourty patients scheduled for radical prostatectomy under general anesthesia. They were divided into two groups: perineal and suprapubic (Group P, n = 20; Group S, n = 20). Heart rate, mean arterial blood pressure, arterial oxygen saturation (SpO2), partial pressure of end-tidal carbon dioxide (PEtCO2), Peak inspiratory pressure (PIP), plato pressure (Pplato), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2) values were evaluated at 10 minutes after induction. After the position applied for surgery in the 30.60 and 90th minutes, the Alveolar-arterial oxygen pressure gradient (P(A-a) O2), the ratio of physiologic dead space over tidal volume (VD/VT), arterial to end tidal CO2 gradient (P(a-et) CO2), static compliance (CS), dynamic compliance (CD) were assessed. Results: In the assessment of groups, there were not statistical differences about mean blood pressure, heart rate, SpO2, PetCO2, PaO2, plateau pressure, and P (A-a) values (p > 0.05). Peak inspiratory pressure was higher in Group P. Peak inspiratory pressure and plateau pressure increased with CO2 insufflation in Group P. PaCO2 and P(a-et) CO2 were higher statistically significantly in Group 0. There was no difference in terms of the PetCO2 values. VD/VT ratios were statistically significantly lower in the Group P. Conclusions: Suprapubic surgery was shown to improve oxygenation and respiratory mechanics without causing any hemodynamic side effect in radical prostatectomy operation.

Objective: To investigate the possible effects of dietary, patient and stone related factors on the clinical course of the stone disease as well as the body and renal growth status of the infants. Patients and Methods: A total of 50 children with an history of stone disease during infancy period were studied. Patient (anatomical abnormalities, urinary tract infection - UTI, associated morbidities), stone (obstruction, UTI and required interventions) and lastly dietary (duration of sole breast feeding, formula feeding) related factors which may affect the clinical course of the disease were all evaluated for their effects on the body and renal growth during long-term follow-up. Results: Mean age of the children was 2.40 ± 2.65 years. Our findings demonstrated that infants receiving longer period of breast feeding without formula addition seemed to have a higher rate of normal growth percentile values when compared with the other children. Again, higher frequency of UTI and stone attacks affected the growth status of the infants in a remarkable manner than the other cases. Our findings also demonstrated that thorough a close follow-up and appropriately taken measures; the possible growth retardation as well as renal growth problems could be avoided in children beginning to suffer from stone disease during infancy period. Conclusions: Duration of breast feeding, frequency of UTI, number of stone attacks and stone removal procedures are crucial factors for the clinical course of stone disease in infants that may affect the body as well as kidney growth during long-term follow-up.

Objectives: To evaluate the emergency management of obstructing ureteral calculi with two different techniques (SWL and URS) with an emphasis on patients life quality. Methods: A total of 80 patients presenting with acute colic pain due to a single obstructing ureteral stone were treated within 24 hours following the onset of pain with two different approaches in a randomized manner. Patients requiring DJ stent placement and/or auxiliary measures after both procedures were excluded and the remaining 65 patients were evaluated [Group1: ESWL (n = 34); Group 2: URS (n = 31)]. Patients were followed during 4-weeks period with respect to the analgesic requirement, number of renal colic attacks and emergency department visits along with the HRQOL scores. Results: While 26 patients treated with URS (83.9%) were stone-free, 24 cases in SWL were stone-free (70.6%) after 4 weeks. Evaluation of the cases during this follow-up period demonstrated that cases undergoing SWL required significantly higher amount of analgesics when compared with URS group (p < 0.001). In addition to the lower mean number of renal colic attacks and emergency department visits in URS group; both the mean HRQOL in terms of EQ-5D index and mean EQ-5D VAS values were also significantly higher in these cases when compared with the cases tretaed with SWL. Conclusions: Due to the negative impact of stone related events after emergency SWL on patients HRQOL, emergency URS may be applied more effectively with the advantages of prompt fragmentation of the calculi along with the immediate relief of obstruction and pain.

Objective: To evaluate Transobturator tape (TOT) and Burch colposuspension procedure’s effects on sexual functions and life quality. Materials and Methods: A total of 81 patients who underwent TOT (n = 49) or Burch (n = 32) with stress incontinence were included in this prospective study. Preoperatively and at postoperative 6 month follow up pad and stress tests, physical examinations, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) questionnaires were performed. Patient Global Impression of Improvement (PGI-I) questionnare was added postoperatively. Results: According to stress test, success rate was found to be 69% and 45%, in the TOT and Burch groups respectively. Pad test decreased in both groups (p < 0.05). PGI-I scores was higher in the TOT group when compared to Burch group (p = 0.031). ICIQ-SF scores were improved in both TOT (p < 0.0001) and Burch groups (p < 0.012). IUDI-6 and IIQ-7 scores improved only in TOT group. Total FSFI scores did not change in both groups but only in TOT group sexual desire improved. Total FSFI scores did not change in patients that were successful and unsuccessful according to the stress test in both TOT and Burch groups (p < 0.05). Conclusions: TOT and Burch procedures have no effect on the sexual functions. However TOT improved life quality of patients.

Objective We present two treatment modalities, selective renal angioembolization and renorraphy, in massive renal hemorrage after percutaneous nephrolithotomy (PCNL) that could not be controlled by conservative methods. Materials and Methods One thousand two-hundred patients, who had undergone PCNL between January 2003 and February 2014, were retrospectively reviewed. From these cases, we selected patients with massive post procedural bleeding that could not be taken under control by conservative methods and we reviewed their clinical course and treatment results. Results Bleeding could not controlled by conservative methods in 6 patients and, angioembolization was done succesfully. In 3 patients, angioembolization was not available. Renorraphy was performed in 2 patients and nephrectomy in 1 patient at first attempt. Renorraphy could not solve the problem of massive hemorrage and these 2 patients eventually underwent nephrectomy. Conclusion Renal angiography and embolization is an effective and safe method and renorraphy should not be the first option in massive bleeding after PCNL that can not be taken under control by conservative methods.

Objectives: To evaluate the quality of life (QoL) of the patients after extracorporeal shockwave lithotripsy (ESWL) on a treated stone size related basis. Methods: 90 patients undergoing ESWL for kidney stones were divided into three groups; Group 1 (n: 30, ≤ 10mm), Group 2 (n: 28, 11 mm- ≤ 20 mm) and Group 3 (n: 32, 20- 25 mm). During 3- months follow-up, outcome of the procedure, number of cases with emergency department visits, analgesic required, re-tretatment rates, additional procedures and the changes in the QoL were evaluated. Results: the number of emergency department visits and mean analgesic need; re-treatment rates and additional procedures were significantly higher in Group 3. Evaluation of the QoL scores in three groups showed that cases with larger stone still had lower scores during 3-month evaluation. Conclusions: Stone size could help us to predict the possible impact of ESWL on the QoL and depending on the size of the stone treated, a well planned indication and effective management possibly by an experienced urologist could limit the changes in the QoL of the patients.

ABSTRACTObjective:We aimed to evaluate the possible effects of ureteroscopic procedures on the sexual function of both genders.Materials and Methods:A total of 102 sexually active cases (60 male, 42 female) undergoing ureteroscopic procedures were included in this study. Sexual function has been evaluated in detail by using International Index of Erectile Function (IIEF) in male and Female Sexual Function Index (FSFI) forms in female cases both before and 1-month after the procedures. Pre-and postoperative data were evaluated in a comparative manner.Results:The pre-and postoperative mean IIEF scores were 57.86±2.26 and 54.57±2.48 (p=0.19) in males and the mean FSFI scores were 13.58±1.46 and 14.46±1.52 (p=0.41), respectively in females. Evaluation of these values showed that regarding the effects of this procedure on male cases although the total scores for sexual function were not influenced it was observed a significant reduction in the intercourse satisfaction sub-domain (IIEF-IS) in males (p

Objectives: To evaluate Internet usage frequency, rate of searched diseases and impact of Internet derived data on future patientphysician relationship in patients applying to an Urology Department. Methods: A well prepared questionnaire has been given to 1000 referring cases, out of which 589 accepted to participate on a volunteer basis to a face to face interview. Patients were divided into subgroups with respect to age, gender and as well as their educational and economical status. Regarding Internet, questions inquired the use of Internet, the point of view about it, opinions about healthcare system and most commonly urological diseases searched in Internet. Results: Of 589 patients participating, 38.2% reported access to the Internet; in relation to subgroup analysis of data, there was a statistically significant relationship between the use of Internet and age (p < 0.001), gender (p = 0.048), educational status (p < 0.001) and economical status of (p = 0.002) the cases evaluated. Diseasespecific information was most frequently sought: 18.2% searched for urolithiasis, 14.2% for non-cancer related kidney diseases, and 14.2% for urologic cancers. Conclusions: Younger patients with higher educational status tended to use Internet and the majority of these cases share all these information with their physicians during their visit. These findings indicate that all physicians should consider this fact seriously and make their future plans in the light of internet based activities which provides numerous advantages.

Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment modality in the minimal invasive management of urinary system stone disease. Although the majority of the complications occuring after ESWL are minor (most common ones are gross haematuria, pain, perinephritic hematoma); bacteriuria may also occur in some cases which sometimes can lead to sepsis and even metastatic abscess formation in a very rare part of the cases treated. In this rare situation infection agent spreads quickly via hematogenous route and causes abscess formation in different parts of the body. Majority of such cases usually have an underlying systemic disease like diabetes mellitus (DM), malignancy, HIV or steroid use which lead to disruption of immune system functions. Abscess formation following ESWL is extremely rare and usually limited with some case reports published in the literature. Herein, we present a diabetic case with formation of multiple abscess foci in kidney, as well as in lungs and liver following ESWL. The patient was first admitted to our emergency department with high fever and respiratory distress and misdiagnosed as metastatic tumor foci based on radiologic findings. To the best of our knowledge, our case is the first one in the literature in whom simultanous abscess formation in multiple organ systems has been documented following an otherwise uneventful ESWL.