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WOS:000730954400001 PMID: 34913804 Introduction We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN). Materials and Methods We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins. Results A total of 1070 patients with a mean age 56.11 +/- 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001). Conclusion TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.

Primer mesane endometriozisi nadirdir ve sebebi tam olarak bilinememektedir. Bu makalede primer mesane endometriozisi nedeniyle transüretral rezeksiyon uygulanmış 37 yaşındaki bir bayan hastayı sunuyoruz. Hastanın başvuru şikâyetleri 4 aydır menstrüel siklusla ilişkili hematüri, disüri ve pollaküriydi. Kliniğimizde yapılan sistoskopik ve radyolojik değerlendirme sonrasında kitlenin transüretral olarak rezeksiyonuna karar verildi. Operasyonda 23*21 mm’lik solid kitle eksize edildi. Hastanın sistoskopi ile yapılan postoperatif izleminde 6. aya dek nüks izlenmedi., Primary bladder endometriosis is rare and the cause is not fully known. In this article, we present a 37-year-old female patient who underwent transurethral resection for primary bladder endometriosis. The patient’s complaints were hematuria, dysuria and pollakuria associated with menstrual cycle for 4 months. After cystoscopic and radiological evaluation in our clinic, transurethral resection of the mass was decided. A 23*21 mm diameter solid bladder mass was excised by transurethral resection. In the postoperative follow-up of the patient by cystoscopy, no recurrence was observed until 6 months.

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.

Introduction To determine the factors affecting the success of distal hypospadias repair in adults. Material and methods Medical records of adult patients who underwent distal hypospadias repair in our clinic were reviewed. Patient's age, external urethral meatus location, hypospadias status, anesthesia type, diversion type, nelaton diameter and surgeons were recorded as factors affecting surgery success. Only patients, operated with tubularisation incised plate urethroplasty (TIPU) technique, were included. Results were classified as successful, stricture, fistula and slough. We compared the factors affecting the success. SPSS 16.0 were used for statistical assessment and logistic regression analysis was used to determine success. p Results One hundred and eight patients underwent distal hypospadias repair in our clinic. Mean age was 21.44 ± 2.0. 38 patients had distal penile, 67 patients had subcoronal, 2 patients had coronal and 1 patient had glandular hypospadias. Eighty eight patients had primary, 12 secondary, 5 tertiary and 3 cripple hypospadias. Seventy eight patients underwent TIPU under local anesthesia, and 30 patients underwent under spinal anesthesia. Suprapubic catheter was used in 92 patients and transurethral catheter was used in 16 patients. Sixteen different surgeons performed the operations. Seventy operations were successful. Three stricture, 24 fistula, and 11 slough were determined. Overall success rate was 64.81%. Patient's age, external urethral meatus location, anesthesia type, diversion type, nelaton diameter and the surgeon difference did not affected surgical outcomes. Only hypospadias status (primary/redo) affected the success (p = 0.037). Conclusion The only factor affecting surgical outcomes of distal hypospadias repair in adults seems to be hypospadias status. It might be due to the lack of second layer in the redo operations.

Objectives Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR. Methods Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0–50 mL, Group 2: 51–100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference. Results Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P 400 mL, PVR after uroflowmetry was different, but random PVR was similar (P

espanolIntroduccion El objetivo del presente estudio fue evaluar la relacion entre la longitud del pene y los parametros somatometricos, especialmente la caquexia. Materiales y metodos El peso y la altura de todos los pacientes fueron medidos y registrados por un especialista en medicina interna. Los estados flacidos y estirados del pene se midieron a partir del hueso pubico hasta la punta del glande a lo largo del dorso del pene, utilizando una regla metrica rigida, por un unico especialista en urologia. Los pacientes con anormalidades urogenitales fueron excluidos del estudio. Se registraron la longitud del pene, la edad, el peso y las alturas. El indice de masa corporal (IMC) se calcula como el cociente entre el peso y el cuadrado de la altura. Los pacientes fueron divididos en 3 grupos segun el IMC: caquexia, peso normal y obesidad. Se definieron los grupos: Grupo 1: caquexia, IMC 30. Se calcularon las longitudes del pene media y mediana. Estos 3 grupos fueron evaluados en terminos de si habia diferencia entre la longitud del pene flacido y estirado. Tambien se determino la correlacion entre el peso, la altura y la longitud del pene. Los analisis estadisticos se realizaron con el programa SPSS® para Windows ver. 16.0 (SPSS Inc., Chicago, IL, EE.UU.). La significacion estadistica se establecio en p Resultados Ciento veinticuatro pacientes fueron incluidos en el estudio. Catorce pacientes estaban en el grupo de la caquexia. Cincuenta y seis pacientes estaban en el grupo de peso normal. Cincuenta y cuatro pacientes estaban en el grupo obeso. Ambas longitudes del pene flacido y estiradas fueron estadisticamente diferentes en estos grupos (p Conclusion El presente estudio es el primero en evaluar la relacion entre la caquexia y la longitud del pene. Como resultado, la caquexia puede ser una ventaja para la longitud del pene. EnglishIntroduction The aim of the present study was to assess the relationship between penile length and somatometric parameters, especially cachexia. Material and methods Weight and heights of all patients were measured and recorded by an internal medicine specialist. Flaccid and stretched states of penis were measured from pubic bone to tip of glans along the dorsum of the penis using a rigid metric ruler by a single urology specialist. Patients with urogenital abnormalities were excluded from the study. Penile length, age, weight and height values were recorded. Body mass index (BMI) was computed as the ratio of weight to the square of height. Patients were divided into three groups according to BMI cachexia, normal weight and obesity. Groups were defined: Group 1: Cachexia, BMI 30. Mean and median penile lengths were calculated. These three groups were evaluated in terms of whether there is a difference between flaccid and stretched penile length. Also correlation between weight, height and penile length was determined. Statistical analyses were performed using the SPSS for windows ver. 16.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was set at p Results One hundred and twenty four patients enrolled in the study. Fourteen patients were in the cachectic group. Fifty six patients were in the normal weight group. Fifty four patients were in the obese group. Both flaccid and stretched penile lengths were statistically different in these groups (p Conclusion The present study is the first one assessing the relationship between cachexia and penile length. As a result, cachexia may be an advantage for penile length.

Objective To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). Materials and Methods PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. Results 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. Conclusion Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

Introduction Our aim was to assess our TIP urethroplasty results in adults with local anaesthesia. Materials and methods Medical records of adult patients who underwent TIP urethroplasty due to distal hypospadias in our clinic between April 2006 and May 2013 were reviewed. Patient's age, external urethral location, preoperative calibration size of urethra, primary or secondary or more, circumsized or uncircumsized conditions were recorded. The records were categorized as circumcised–uncircumcised, urethral stent calibration 16 Fr and above or 14 Fr and below, primer or seconder and above, special group or the others. SPSS 16.0 were used for statistical assessment and chi-square test was used to determine success. p Results 51 patients underwent distal hipospadias repair under local anaesthesia in our clinic between April 2006 and May 2013. Mean age was 21.3. 24 patients had coronal, 26 patients had subcoronal, 1 patient had glanuler hypospadias. 40 patients were primary, 7 secondary, 4 tertiary. 38 patients were circumsized. 13 patients were uncircumsized. Mean preoperative calibration was 14.8 Fr, mean urethral stent calibre was 15, 1 Fr, mean stent duration time was 5.9 day. Suprapubic catheter was used for drainage at 48 patients. 22(52.3%) were successful, 20(47.6%) were unsuccessful of 42 patients with follow up. 13 patients that had fistula underwent fistula repair after 3 months later under local anaesthesia. 2 patients had stricture and they underwent meatotomy and dilatation. On one patient, second TIP urethoplasty operation was performed because the first operation was unsuccessful. Operation was very successful and it upgraded our over all success to 90.4%. An optimal group as primary, uncircumcised, 16 Fr neourethra was formed and were compared with the other groups. Success rate between optimal group and others was not different statistically. Conclusion Our success rate was similar to literature. This survey reveals that distal hypospadias repair can be performed under local anaesthesia.

Introduction Our aim was to evaluate and share our urethrocutaneus fistula repair results in adult patients who had been operated for hypospadias in their childhood. Material and methods The data of totally 48 patients who had been treated for urethrocutaneous fistula after hypospadias surgery in our department from May 2008 to January 2015 analyzed retrospectively. Patients’ age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. All patients were controlled three months after the repair for surgical outcomes. Results Fistula repair performed in 45 patients. Mean age was 21.46 (20–26). Nineteen patients (42.2%) underwent first hypospadias surgery under the age of 7 years; 8 patients (17.7%) between 7 and 15 years, 18 patients between 15 and 20 years. Tubularized incised plate urethroplasty (TIPU) was performed in 40 patients (88.9%), extragenital tissue was used in 5 patients (11.1%). Twenty two patients (48.9%) had 1 or 2 operations, 17 patients (37.8%) had 3–5 operations and 6 patients (13.3%) had 6 or more operations. Thirteen (28.9%) coronal, 24 (53.3%) subcoronal, 6 (13.3%) penile and 2 (4.4%) penoscrotal fistulas were observed. While a single fistula was observed in 35 patients, multiple fistulas were seen in 10 patients. A fistula diameter les than 5 mm was detected in 37 patients, and larger than 5 mm in 8 patients. Fistula recurrence was observed in 3 patients at follow-up examinations carried out at 3 months postoperatively. The number of operations was more than 5, the fistula diameter was larger than 5 mm and the fistulas were coronal in all three recurrent fistulas. Conclusion According to our results fistula size, previous surgery and well-vascularised, one or two layer tissue were the important factors in the success of fistula repair after hypospadias surgery.

Objectives: We aimed to evaluate the circumcision status and complications, and the value of penile visibility index in predicting circumcision complications among elementary school children. Patients and Methods: Elementary school students were evaluated with physical exam in terms of circumcision complications. Visible penile length/stretched penile length ratio was calculated for each subject and recorded as penile visibility index (PVI). Data were assessed with SPSS 15.0 software. Results: Average age was 9.04 (5 - 14) years. Circumcision complications were detected in 84 of 361 circumcised subjects (23.2%). There was no relationship between age at circumcision and complications (p > 0.05). Concealed penis was detected in 3.6% of all subjects. Mean PVI was significantly different between cases with and without glanular adhesion, and between cases with and without residual prepuce. On the overall, mean PVI in complication and no complication groups were 0.52 and 0.59 respectively, and the difference was statistically significant (p

Inflatable penile prosthesis (IPP) implantation is a successful method for treatment of erectile dysfunction. IPP placements have rare complications. In this paper, we present a highly unusual case of an inguinal hernia as a short-term complication of a 3-piece IPP implantation. The patient was a 55-year-old man with erectile dysfunction due to diabetes mellitus. He presented 3 weeks after implantation with a strong cough. On exploration, the reservoir was seen in direct inguinal hernia sac. After removing the reservoir from the sac, the hernia was repaired with mesh and the reservoir was placed in the space of Retzius again. The patient is symptom free at follow-up.

Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury.Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis.Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p 0.05, ESW + OT vs. ESW).OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

Objective To determine possible acute kidney injury with new marker neutrophil gelatinase-associated lipocalin (NGAL) in urine and to show the relationship between changes of this marker and conventional markers in patients undergoing shock wave lithotripsy (SWL). Methods In patients with kidney stones, serum urea, creatinine, urine microalbumin, and NGAL levels were determined before SWL and at the first, second, and seventh days after SWL. In addition, patients who had undergone SWL were evaluated with Technetium-99m (Tc99m)-dimercaptosuccinic acid (DMSA) and Tc99m-diethylenetriaminepenta acetate renal scintigraphy 1 week before and 3 months after SWL. Results and Limitations Forty patients were included in the study. All patients had a single stone in the kidney with an average size of 9.25 mm (range 5–15). No statistical change was found in the levels of average serum urea and creatinine levels, urine microglobulin, and NGAL levels, which were measured before SWL and after SWL. No significant difference was identified in urine NGAL and microalbumin levels of the groups, which were separated by shock wave number and shock energy amount on the first, second, and seventh days after SWL. In the high-energy SWL group, 3 patients had a statistical decrease in their differential kidney function measured with Tc99m difference between differential function rates of the kidney before and after SWL (DMSA) after 3 months after SWL. Conclusion Our study found that, using both new and conventional parameters in the acute stage and 3 months later, SWL treatment does not cause acute kidney damage.

The objective is to compare immediate and delayed SWL as a treatment for ureter stones between 5 and 20 mm. Patients who applied to the emergency department with single, radio opaque ureteric stone of 5-20 mm size were included in the study. Patients were randomized into immediate and delayed SWL groups. SWL were carried out after pain relief in the delayed group. Maximum of three SWL sessions were applied to the patients with stones of 5 mm or bigger in diameter, leaving at least 3 days interval in-between. Stone-free rate after first session was similar in two groups. When CIRF was also considered as success, the success rate of SWL in the immediate SWL group was higher after first session (p = 0.02). Immediate SWL had a greater success rate in upper ureteric stones (p = 0.019). Overall average time required for elimination of stones was shorter in immediate SWL group than delayed SWL group (p = 0.033). The success rate after first SWL session (including CIRF) was 59 % for patients with chronic pain in the delayed group and 100 % for patients with acute pain in the immediate group. According to the hydronephrosis grade, success rates were 71 and 44.4 % for patients with grade 1 or no hydronephrosis in the immediate SWL group, and for patients with grade 2 or larger hydronephrosis in the delayed SWL group, respectively, after first SWL session. Immediate SWL insures stone-free status in a shorter time in cases with renal colicky pain and ureteral stones, particularly upper ureteral stones.

Introduction: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. Materials and Methods: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level(>4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume, biopsy results and PSA levels were recorded. Results: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. Conclusion: Nodule is the most important finding in DRE for cancer detection. Only an asymmetric prostate itself does not mean malignity.

Objectives: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. Methods: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an ‘Assesment Questionnaire for Scrotal Pain’ both before and after the surgery. Results: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. Conclusions: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.

The histopathological report of the biopsy material retrieved from hyperemic areas of the bladder during control cystoscopy of a 70-year-old man who had a bladder cancer diagnosis three years previously, indicated the presence of a carcinoma in situ (CIS). Intravesical immunotherapy treatment was initiated. After severe symptoms of dysuria emerging during intravesical immunotherapy with BCG, the immunotherapy treatment dosage was lowered. His treatment was then discontinued due to the progression of symptoms. A biopsy was performed due to higher prostate spesific antigen (PSA) and digital rectal examination abnormalities which indicated granulomatous prostatitis. An antituberculosis treatment was initiated because the PPD test result was 25 mm and the QuantiFERON test was positive. After one month, the patient’s PSA levels were reduced, and his clinical status improved. The symptoms of severe dysuria, sterile pyuria, abnormal digital rectal examination findings and high PSA levels during intravesical BCG treatment should remind us diagnosis of granulomatous prostatitis. It should not be forgotten that diagnosis of granulomatous prostatitis was established histopathologically, and the patient benefited from medical treatment.

The dorsal nerve block of the penis during circumcision has not been standardized and the effectiveness of the block can be changeable. The aim of this study was to determine which technique is more suitable for blocking sensory innervations of penis. This prospective study was done on adults who voluntarily applied to be circumcised. Patients were randomized into three distinctive groups; first, just circular infiltration; second, circular plus dorsal penile infiltration; and third, circular plus ventral upward infiltration. Sensation was tested using pinprick sensory testing before and after infiltration. The total duration of the procedure was recorded. In total, 89 adult uncircumcised men were included into the study. The average age of men was 21.4 (min: 20; max: 25). The average operation time in the third group was significantly shorter. The sensation distribution, especially around the frenulum sensitivity results were in the first minute 100, 81.3, 72.4 %; in the third minute 85.7, 37.5, 20.7 %; and in the fifth minute 57.1, 18.8, and 0 % for the first, second, and third group, respectively. In the fifth minute, there was no sensitivity for any patients in the third group and it was significant. Circular plus ventral upward anesthesia is an easy and feasible technique for local anesthesia in circumcision.

The objective of the study is to investigate the effect of doxazosin, administered to the subjects who underwent SWL due to upper ureteral stones, on therapeutic outcomes. The study enrolled the patients with a radio-opaque stone ≥5 mm in upper ureter. Patients were randomized into two groups: the first group underwent SWL following the diagnosis and they were recommended to receive oral hydration. The second group underwent SWL after initiating alpha blocker (doxazosin controlled-release tablet 4 mg/day) and drug therapy was continued until that the patient has been stone free. Parameters of SWL procedure, Steinstrasse, pain score at admission, time to stone passage, the complications developed, the additional procedures that were administered and number of hospital visits done due to pain during the treatment were recorded. A total of 79 patients were enrolled to the study. The subjects evaluated included 35 patients, who received an alpha blocker and 44 patients who did not receive an alpha blocker. For both groups, the level of energy applied per SWL session, the diameter of the stone, the number of hospital visits done due to pain, pain score and the need for analgesia were found to be similar (p > 0.05). The group of doxazosin was more advantageous in terms of stone-free rate, the need for additional procedures and Steinstrasse (p < 0.05). In conclusion, the addition of doxazosin to SWL therapy administered for upper ureteral stones reduces Steinstrasse, and thereby, the need for additional procedures and increases post-treatment stone-free rate. A positive effect of doxazosin on the time to stone passage was not shown.

The purpose of this study was to examine the effectiveness and safety of percutaneous nephrolithotomy with ultrasonography-guided renal access in the flank position without the use of fluoroscopy in any stage of the procedure. Percutaneous nephrolithotomy was performed in flank position under the guidance of ultrasound (USG) without the use of fluoroscopy between December 2008 and January 2010 on 43 patients who had kidney stones bigger than 20 mm. Access to the kidney’s proper calyx was achieved by dilatation through the guide wire placed after insertion of the needle through the needle director under the guidance of transrectal ultrasound probe placed on the patient’s flank area. A convex USG probe was used for imaging during dilatation and lithotripsy instead of fluoroscopy. Access to the targeted calyx was achieved successfully in all patients (100%). The percentage stone free rate was 86.1% (37 patients). Residual stones were detected in six patients. Their dimensions ranged from 5 to 12 mm. The mean stone diameter was 29 (20–41) mm, duration of surgery was 87.1 ± 43.2 (55–210) min and duration of hospital stay was 3.1 (2–8) days. Blood transfusions were given to two patients; none of the patients had major intraoperative or postoperative complications. In comparison with standard percutaneous nephrolithotomy, percutaneous nephrolithotomy in flank position under ultrasonographic imaging instead of using fluoroscopy seems to be safe and effective. This procedure has to be limited to selected cases with one or maximum two big stones in the pelvis or in a single calyx in absence of complex intrarenal anatomy. Both surgical team and the patients were protected from the harmful effects of radiation. Regarding anesthesia, flank position is more comfortable for the patient than prone position.

Purpose To investigate the prevalance of constipation among children presenting with bedwetting. Material and Methods Charts of children applying with only bedwetting complaint were evaluated. Those with daytime voiding symptoms and urinary tract infections were excluded. Symptoms of voiding dysfunction were sought with detailed history. Parents were given questionnaires designed to reveal constipation according to Rome III criteria, and they were filled after at least one month of observation without any treatment. Diagnosis of constipation was made when direct graph revealed an intestinal fullness obscuring the rectal image and/or when the symptoms fulfilled the Rome III criteria. Results A total of 88 patients were evaluated (female:24, male:64, mean age: 8.65 yrs). Primary and secondary enuresis nocturna (EN) was diagnosed in 79 and 9 patients respectively. Constipation was diagnosed in 62% and 67% of the patients with primary and secondary EN respectively. Daytime irritative symptoms coexisted in 20.5% of the cases, and when these cases were excluded, constipation existed in 53.2% of the cases with primary monosymptomatic enuresis nocturna. This is a higher rate than the similar population according to the literature. Conclusions A significant rate of constipation coexist in patients presenting with bedwetting, and these cases should not be labelled as monosymptomatic nocturnal enuretics. This subgroup of patients should be identified as cases with elimination dysfunction and treated accordingly. Lack of daytime voiding symptoms do not exclude defecation disorders.

PURPOSE The causal relationship between circumcision and meatal strictures is controversial. We reviewed our data and assessed the roles of possible etiologic factors. MATERIAL AND METHODS Seventy six patients who underwent circumcision both for traditional and medical reasons at the department of Urology between 2004 and 2006 were included in the study. Meatal calibrations were achieved using lubricated polyethyhlene tubes by the same surgeon, such that the largest caliber tube that did not stretch the external meatus and fossa navicularis represented the meatal size. Postoperative meatal caliber was assessed at 1 to 3 months (mean:1.4) after the circumcision. Circumcision techniques were categorized with respect to the competence of phrenular artery. Circumferential incision was made at a more proximal level on the ventral aspect of the penis and no cautery to, or ligation of phrenular artery was performed in those who underwent phrenulum-sparing circumcisions. The influence of phrenulum sparing, diapers and preoperative gonadotropin treatment on the postoperative percent change in meatal calibration was assessed statistically. RESULTS Mean patient age was 35.4 months (range 1 to 102). Pre and postoperative mean meatal calibers were 10.53F and 10.11F respectively. Overall decrease in meatal caliber (3.98%) was statistically significant (p=0.0001). Preoperative gonadotropins, although statistically insignificant, seemed to have a protective effect. Phrenulum sparing did not prevent meatal downsizing (p=0.005). Having diapers seemed to be a greater risk factor for meatal strictures (p=0.001). CONCLUSIONS Decrease in meatal caliber as early as 1 to 3 months after circumcision is statistically significant, though clinical importance of this decrease is yet to be determined.