Search

Objective: The aim of this study was to determine the levels of depression, anxiety and quality of life in non-obstructive azoospermia (NOA) patients who attended our clinic., Materials and Methods: A total of 40 male patients were included in the study troubled with non-obstructive azoospermia. An etiological classification was made according to the hormone levels of the patients. The semen specimen was obtained by masturbation from the patients. Three questionnaires, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Short Form of the World Health Organization Quality of Life Questionnaire, were utilized in the study., Results: The mean age of the patients in the study was 32.75±5.22 years. The patients were classified as follows: 26 (65%) patients were idiopathic, 11 (27.5%) patients were hyper-hypo and 3 (7.5%) patients could not be reached. In this cohort, 62.5% of patients had minimal depression, 27.5% of patients had mild depression and 10% of patients had moderate depression. In addition, 97.5% of patients had minimal anxiety and 2.5% of the patients had mild anxiety. Quality of life scores of the patients were 58.75% for general health status, 70.98% for physical health status, 72.92% for psychological status, 65% for social relations and 66.25% for environmental status., Conclusion: NOA particularly affects men in terms of biological, psychological and social aspects. In order to evaluate the quality of life and psychiatric conditions patients with azoospermia, various questionnaires may be applied before infertility treatment. Thus, patients who need psychiatric support can be identified., (Copyright © 2019 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Cystoscopy is noted to be more painful in men. Research has been done to support the use of video in men to reduce pain; it would follow that video would be useful in reducing pain in women as well., Aims: The aim of this study was to evaluate the effect of watching a relaxing video during cystoscopy on the pain and anxiety levels of female patients., Design: The study was a single-center, parallel, randomized, controlled, nonblinded trial., Setting: This study was carried out in the cystoscopy unit of a training and research hospital in Turkey., Participants: Sixty female patients aged 18 years and older undergoing rigid cystoscopy for the first time and under local anesthesia., Methods: The participants were randomized into two equal groups: video and control. Data were collected with Visual Analog Scale, State-Trait Anxiety Scale, and hemodynamic parameters., Results: A statistically significant difference was found between the two groups in terms of pain levels during and after cystoscopy (p < .001). Pain levels were significantly lower in the video group during and after the procedure. A statistically significant difference was also found between the groups in terms of anxiety levels before and after cystoscopy (p < .05). Anxiety levels were significantly lower in the video group after the procedure. Satisfaction levels were higher in the video group (p < .001)., Conclusion: According to this study, watching a relaxing video during cystoscopy had a positive effect on pain, anxiety, satisfaction levels, and hemodynamic parameters of the patients., (Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objective: Extrapulmonary neuroendocrine carcinoma (EP-NEC) is a rare tumor type, and a standard therapy for EP-NEC has not yet been established. The purpose of this research was to explore the overall survival (OS) and therapeutic effects of platinum-etoposide combination therapy in EP-NEC., Methods: This retrospective study was conducted based on the medical records from January 2010 to March 2020. Eligible patients had been pathologically diagnosed with EP-NEC., Results: Forty-seven patients were included in the study. About 72.3% (n=34) of the patients were diagnosed with metastatic disease at the first diagnosis. The most common primary tumor site was the stomach. The median progression-free survival (PFS) of the patient group, who received the combination of platinum/etoposide, was 5.83 months (95% CI 4.46-7.20), whereas the median OS of the patients, who were found to have metastatic disease at the first diagnosis, was 13.6 months (95% CI 9.01-18.18). There was no difference in PFS and OS between patients with and without liver metastasis., Conclusion: The outcome of advanced EP-NECs with platinum/etoposide chemotherapy remains poor. Obviously, there is a need for new, more effective treatment options., Competing Interests: Ethics Committee Approval: The Cerrahpasa University Research Ethics Committee granted approval for this study (date: 09.09.2020, number: 117340). Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study has received no financial support. Authorship Contributions: Concept – EC, ZHT; Design – EC, ZHT; Supervision – EC, ZHT; Data collection and/or processing – EC, NSS, SD, SB, ED, KO, NSO, GA, AS, ZHT; Analysis and/or interpretation – EC, NSS, ZHT; Literature review – EC, ZHT; Writing – EC, ZHT; Critical review – EC, NSS, SD, SB, ED, KO, NSO, GA, AS, ZHT., (Copyright © by by Istanbul Provincial Directorate of Health - Available online at www.northclinist.com.)

Introduction: Immune checkpoint inhibitors have demonstrated the benefit for many cancer types, melanoma, non-small cell lung cancer, urothelial cancer, renal cell cancer, etc. Especially in advanced non-small cell lung cancer, significant improvement in survival results has been shown., Case Report: Here, we report a 66-year-old man with lung adenocarcinoma who received nivolumab for 80 cycles. Management and Outcome: Two months after discontinuing nivolumab, he developed follicular lymphoma. Pneumonitis was also accompanied, which was treated with metilprednisolon, but he died due to progressive respiratory failure., Discussion: Our clinical knowledge with checkpoint inhibitors is increasing day by day, and to the best of our knowledge, this paper presents the first case in the English literature who developed follicular lymphoma after discontinuing nivolumab in non-small cell lung cancer patient.

This study aimed to assess whether dabrafenib/trametinib and vemurafenib/cobimetinib treatments are associated with a change in skeletal muscle area (SMA) and total fat-free mass (FFM) assessed by computed tomography (CT), and to compare the efficacy and safety profile of these treatments in patients with metastatic melanoma. Thirty-one patients treated with B-Raf proto-oncogene, serine/threonine kinase/MAPK extracellular receptor kinase inhibitors were included between 2016 and 2019. Eighteen patients received dabrafenib/trametinib and remaining patients received vemurafenib/cobimetinib. CT scans were performed at baseline and at 4-6 months of follow-up to measure cross-sectional areas of SMA. FFM and skeletal muscle index (SMI) values were calculated. Of the patients, including 18 treated with dabrafenib/trametinib (58.1%) and 13 with vemurafenib/cobimetinib (41.9%); 58.1% were male, 41.9% were female and median age was 52 years. A significant decrease in SMA was observed after dabrafenib/trametinib and vemurafenib/cobimetinib treatments (P = 0.003 and P = 0.002, respectively). A significant decrease in FFM values was observed after dabrafenib/trametinib and vemurafenib/cobimetinib treatments (P = 0.003 and P = 0.002, respectively). Dose-limiting toxicity (DLT) was observed in 35.9% of the patients with sarcopenia. No significant difference was seen between the dabrafenib/trametinib and vemurafenib/cobimetinib groups in median progression-free survival (PFS) (11.9 vs. 7.3 months, respectively, P = 0.28) and in median overall survival (OS) (25.46 vs. 13.7 months, respectively, P = 0.41). Baseline sarcopenia was not significantly associated with PFS or OS (P = 0.172 and P = 0.326, respectively). We found a significant decrease in SMI values determined at 4-6 months compared to the values before treatment both in dabrafenib/trametinib and vemurafenib/cobimetinib groups. DLT was similar with both treatments. Baseline sarcopenia was not significantly associated with PFS or OS.

Objectives: In this study, we aimed to define the clinico-radiological data and treatment options for intratesticular epidermoid cysts (IEC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients that under went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded.  RESULTS: A total of 20 patients with IEC were identified.While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with pathologically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients under went partial orchiectomy (76.5%). The mean size ofthe IEC was 17.7x15.1 mm (range, 26x10 mm). IEC swere mostly located in the middle pole of the testes (10of 17 patients, 58.8%). CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest reported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs.

Objectives: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures., Methods: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups., Results: There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002)., Conclusions: Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.

Objectives: In this research, we designed a cognitive fusion(CF) prostate biopsy(PB) (CFPB) technique by examining the multiparametric MRI of prostate (MP&#95;MRI-P) images in a smart-phone near the trans-rectal ultrasound (TRUS) device, and examined the results., Methods: Between January 2011 and January 2017, a total of 344 men who had PB enrolled in this study. Group 1 had a minimum of a 12-core standard TRUS PB (TRUSPB). Group 2 had CFPB while examining the MP&#95; MRI-P images in a smartphone near the TRUS device. A minimum 12 cores + cognitive targeted 1-3 biopsy were taken. The detection of Pca and significant Pca in group 1 and 2 were evaluated and compared. Then, the effect of MP&#95;MRI-P findings on the detection of prostate cancer (Pca) and significant Pca were evaluated., Results: Group 1 and 2 included 138 and 206 patients. After the PB, 45(32.8%) and 33(23%) patients ingroup 1, and 74(35.9%) and 60(29%) patients in-group 2 were detected to have Pca and significant Pca, respectively (p=0.001 for both). Higher PIRADS caused significant detection of Pca and significant Pca (p=0.004 and 0.002). Nodule in MP&#95;MRI-P caused significant detection of Pca and significant Pca (p=0.001 and 0.001). Especially, when PSA was <10ng/ml, higher PIRADS and nodule in MP&#95;MRI-P caused significant detection of Pca and significant Pca (p=0.02 and 0.019 for PIRADS, and p=0.01 and 0.042 for nodules)., Conclusions: In the advanced hands with our new technique, the CFPB using prebiopsy MP&#95;MRI-P seems to be an effective method to detect Pca and significant Pca.

Objectives: We conducted this study to evaluate the analgesic efficacy of ultrasound guided unilateral transversus abdominis plane (TAP) block when used in combination with oral diclofenac administration during extracorporeal shock wave lithotripsy (SWL)., Design and Setting: The study is a retrospective clinical experimental study conducted in a university hospital between January 2017 and January 2018., Methods: 42 SWL eligible patients were divided into three groups. Group 1 (n: 15) received no medication due to patient's preference. Group 2 (n: 15) received 50 mg oral diclofenac 30 minutes prior to the procedure, and Group 3 (n: 12) received both oral diclofenac and unilateral ultrasound (US) guided TAP block 30 minutes before the procedure. Patient`s characteristics, SWL data and "visual analogue pain scale" (VAS) scores were collected and compared between groups., Results: A total of 44 eligible patients were included in the study. When compared between groups, patient's characteristics including age, body mass index, and SWL data including stone size, SWL number, total energy transmitted and duration of the procedure, were similar and there was no statistical significance. Between groups statistical significance was achieved in only VAS scores. Mean VAS scores in groups 1,2, and 3 were 6.3 ± 1.8, 4.3 ± 2.3, and 1.3 ± 1.0, respectively. No complication was seen in any of the groups., Conclusion: Pain relief during SWL operations is still a challenging issue for many clinicians. Our study demonstrates that, among many other anesthetic/analgesic agents and techniques described, unilateral US guided TAP block and diclofenac combination is a feasible option for pain relief during SWL procedures.

Objectives: To introduce a new technique for the placement of ureteral access sheaths (UAS) when there is failure in standard UAS placement. MATERIALS AND METHODS: Between March 2014 and June 2016, a total of 25 patients had difficulty while UAS placement during F-URS procedures. The placement of UAS in these patients was accomplished by utilizing the technique outlined in this study. The causes of difficulty in UAS placement, kinds of UAS deformation, ureteric injuries, and operation time were recorded for all procedures conducted in this study. RESULTS: The pre-operative and post-operative mean stone sizes, Hgb, urea, and creatinine levels were 10.64 (5-19)mm and 1.8 (2-4)mm (p<0.000); 13.9 (10.50-16.73)g/dL and 12.81 (9.4-16.6)g/dL (p = 0.0001); 30.73 (15-48)mg/dL and 28.83 (16- 41)mg/dL (p = 0.067); 1.07 (0.74-1.79)mg/dL and 1.10 (0.77-1.75)mg/dL (p = 0.242), respectively. The causes of difficulty in UAS placement were mainly the failure of insertion at ureteric orifice due to orifice shape and angle (not stenosis) in 18 (72%), narrow ureter in 3 (12%), twisted ureter in 3 (12%) and duplex ureter in 1 (4%) of patients. Angulation deformity with kinking was observed in 10 (40%) of operations. No buckling or kinking due to external force was noted. Providing a smooth insertion force of the F-URS accomplished insertion in patients with angulation deformities without difficulties. Mild mucosal heamorragia was observed in 16 (64%) patients. Mean operation time was 57 minutes and each operation ended with success. CONCLUSIONS: Application of UAS under direct visualization provides a safer UAS placement, makes the F-URS more applicable, and we think this technique decreases the operation time when there is difficulty in UAS placement.

Background: Cystoscopy is a safe diagnostic procedure commonly used to evaluate lower urinary tract symptoms. This can cause pain, anxiety, and dissatisfaction in patients undergoing cystoscopy., Objectives: The aim of this study was to compare the effects on pain, anxiety, and satisfaction of distraction methods used during cystoscopy., Design: Single-center, open-label, randomized, parallel-group trial., Setting: Cystoscopy unit of a training and research hospital in Turkey., Participants: Male patients ≥18 years of age who underwent rigid cystoscopy for the first time., Methods: A total of 120 male patients were recruited and randomized into four groups as music, stress ball, video, and control group. Data were collected using visual analog scale for pain and satisfaction, State-Trait Anxiety Inventory for anxiety, and hemodynamic parameters. The primary outcome was the difference with respect to pain scores among intervention groups. Other outcome measures were anxiety and satisfaction scores., Results: Pain severity during cystoscopy was found to be significantly lower in the intervention groups than the control group. In the video group, the severity of pain during cystoscopy was also found to be significantly lower than music and stress ball groups (p = 0.006, p < 0.001). After cystoscopy, anxiety levels were significantly lower and satisfaction levels were significantly higher in the intervention groups than in the control group. Anxiety levels were significantly lower in the video group than music and stress ball groups (p < 0.001, p < 0.001). Satisfaction levels were also significantly higher after cystoscopy in the video group than in the music and stress ball groups (p = 0.018, p = 0.018)., Conclusions: According to this study, distraction methods used during rigid cystoscopy were found to have a reducing effect on pain, anxiety, and dissatisfaction. As the results of the study are evaluated, video should be recommended to be the first preferred distraction method during rigid cystoscopy.

Background: Extracorporeal shock wave lithotripsy can cause pain and anxiety for patients. Despite the use of many distraction methods to reduce pain and anxiety, there is no study on the use of stress balls during lithotripsy., Aim: The aim of the study was to investigate the efficacy of use of stress balls and music therapy to reduce pain and anxiety during lithotripsy., Design: This was a single-center, parallel randomized controlled trial., Settings: The study involved the lithotripsy unit in a training and research hospital in Turkey., Participants: The study included 120 patients who had kidney or ureter stones., Methods: The patients were randomly divided into three groups. The control group (group 1) received no interference, whereas experimental groups received stress ball (group 2) and music (group 3) interventions during lithotripsy, respectively. Data were collected using the Patient Information Form, visual analog scale, and State-Trait Anxiety Inventory., Results: There was no statistically significant difference among the three groups in regard to anxiety and pain mean scores (p > .05). No statistically significant difference was found between anxiety scores before and after lithotripsy in each group (p > .05), whereas there was a statistically significant difference between pain scores during and after lithotripsy (p < .05)., Conclusion: Based on the present study, no statistically significant difference was found between the use of stress balls and music in reducing pain and anxiety during lithotripsy. Further studies are needed to evaluate the effectiveness of stress balls used during lithotripsy., (Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the success rate of percutaneous nephrolithotomy (PNL) in kidney stones over 50 milimeters., Material and Methods: Twenty-four patients with a renal stone size of >50 mm between January 2007 and December 2016 were enrolled. Stone-free and complication rates were investigated., Results: Twenty-one (87.5%) patients were male and 3 (12.5%) were female. Fifteen (62.5%) stones were located in the right, and 9 (37.5%) in the left kidney. Twenty-one (87.5%) patients were operated using single-access, and three (12.5%) patients were double-access. Thirteen (54%) patients were found to have no stone after operation and 11 (46%) patients had residual stones. Extracorporal shock wave lithotripsy was applied to 5 of 11 patients with residual stones, while flexible ureteroscopy was applied to 6 of them. After additional treatments, 8 (33.5%) patients were observed to be stone free. The stone-free rate was 87.5%. The mean operation time was 135.43 (85-240) minutes. Hemoglobin levels before and after operation were 14.8 (12-16.7) and 12.6 (9.3-15.5), respectively (p=0.001). The hospital stay was 6.04 (4-8) days. Complications were observed in four patients (16.6%)., Conclusion: PNL has high stone-free rate on staghorn type large stones compared with multiple calyceal scattered large stones., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Background: The imbalance between oxidant and reductant mechanisms creates a nidus for the etiopathogenesis of several diseases. In this study, we aimed to compare the oxidative stress (OS) parameters in patients who were diagnosed with prostate cancer (pCa), benign prostatic hyperplasia (BPH) or asymptomatic inflammatory prostatitis (AIP), according to the histopathologic examination of transrectal ultrasonographic prostate biopsy and transurethral prostate resection specimens., Objectives: In this study, we aimed to compare oxidative stress between histologically proven prostate cancer, hyperplasia and prostatitis., Material and Methods: According to histopathologic examinations, 97 patients were divided into 3 study groups: group 1: pCa (n = 30), group 2: BPH (n = 41), and group 3: AIP (n = 26). Finally, 30 patients were enrolled in a control group. MDA levels, CuZn-SOD, Se-GPx, CAT activities, and trace element levels were evaluated., Results: A statistically significant difference between prostate cancer and other groups were documented in terms of MDA activity. Contrary to AIP, a statistically significant difference has also been encountered between BPH and the control group. Decreased CuZn-SOD enzyme levels were found in PCa and BPH patients without statistical significance. Increased CAT activity was also documented in PCa, BPH and AIP patients. No significant difference in GPX activity was documented between the groups, except BPH and control group. Trace element levels were low in the patients with prostate cancer and BPH when compared with the control group., Conclusions: Despite the data regarding OS in PCa patients, there is a paucity of data regarding BPH and especially AIP patients. Our study revealed obvious oxidative stress in BPH and PCa patients as opposed to AIP. Assessing the oxidative stress in these patients may assist in the future prevention, diagnosis and also treatment. However, the question whether the presence of OS-related parameters and drugs could be used for the diagnosis or management of prostatic diseases, needs to be addressed in future larger and better studies with a more rational basis.

Objective: Robot-assisted laparoscopic prostatectomy (RALP) with suprapubic tube (SPT), compared to urethral catheter (UC) drainage, has been proposed to improve patient comfort and recovery. We sought to compare short-term outcomes for pain and morbidity after RALP with SPT vs UC drainage., Methods: Between August 2012 and 2014, 159 men underwent a RALP and prospectively completed a questionnaire addressing postoperative pain and satisfaction. Group 1 (n = 94) underwent a RALP by one surgeon who placed a UC and removed it between postoperative day (POD) 7 and 10. Group 2 (n = 65) underwent a RALP by a different surgeon who placed an SPT and UC. On POD 1, the UC was removed. On POD 9, the SPT was capped and removed on POD 11 if the patient was voiding adequately. Preoperative and intraoperative data, complications, questionnaires, and patient-reported morbidity, including unplanned telephone calls and emergency department (ED) visits, were compared between groups., Results: Patient characteristics were similar between groups. One week after surgery, the penile pain score was statistically significantly lower in Group 2 compared to Group 1 (56.9% and 79.8%, respectively, reported minimal-to-moderate pain, p = 0.003). Bladder spasms and overall pain were not significantly higher for Group 1 compared to Group 2 (p > 0.05). When asked "How big a problem has your urine storage device been?," 20.2% of patients in Group 1 reported it as a "moderate-to-big" problem compared to 10.8% in Group 2 (p > 0.05). The number of catheter-related unplanned telephone encounters did not differ between the two groups (p = 0.7), however, although not statistically significant, 4.6% of patients in Group 2 presented to the ED with catheter-related issues (p = 0.07)., Conclusion: SPT after RALP was associated with less penile pain compared to UC drainage, and modestly better patient satisfaction. There were no significant differences in bladder spasms, overall pain, and patient-reported morbidity between groups.

Objective: To assess the psychometric properties of the Arabic adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) inpatients suffering a current major depressive episode (MDE)., Method: The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" Arabic module of the HCL-32-R2 was administered to mother-tongue Arabic MDE inpatients between March 2013 and October 2014. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls., Results: In our sample (n=500, of whom, BD-I=329; BD-II=70; MDD=101), using a cut-off of 17 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=82% and specificity=77%. Area under the curve was .883; positive and negative predictive values were 93.44% and 73.23% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factors analyses. Item n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the HCL-32 loaded onto F1, though very slightly. Cronbach's alphas were F1=.86 and F2=.60., Limitations: No cross-validation with any additional validated screening tool. Inpatients only sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, or record of severity of current MDE., Conclusions: In our sample, the HCL-32 fairly discriminated between MDD and BD-I but not BD-II, therefore soliciting for replication studies for use in Arabic-speaking depressed inpatients., (Copyright © 2015. Published by Elsevier Inc.)

Purpose: Our study sought to demonstrate the effects of remote ischemic preconditioning (R-IPC) on renal function in a large animal (porcine) solitary-kidney model., Methods: Twelve pigs were assigned to two groups: Each underwent a right nephrectomy followed by a week of recovery. Group 1 (No-IPC) underwent left renal hilar clamping for 90 minutes. Group 2 underwent right and left iliac artery clamping for 10 minutes each (R-IPC), followed by left hilar clamping for 90 minutes. Serum creatinine was drawn for both groups before ischemia (preoperative), then at 6 hours, 24 hours, 3 days, and 7 days after. Kidneys were harvested at 24 hours or 7 days for histologic analysis, and the degree of acute tubular necrosis (ATN) or lymphocyte invasion was quantified., Results: Paired serum creatinine values were analyzed between time points. For Group 1, paired differences existed at 24 hours (P=0.008) but not at 3 days or 7 days. For Group 2, paired differences existed at 24 hours (P=0.006) but not at 3 days or 7 days. The mean preoperative serum creatinine level was similar between groups (P>0.05). The change in serum creatinine level was not significantly different between groups at any time point. Histologic analysis revealed rare evidence of ATN at 24 hours in Group 2, but not in Group 1. At 7 days, neither group showed ATN, and both showed 1-2+evidence of lymphocytic infiltrates., Conclusion: R-IPC in a solitary-kidney porcine model does not confer renal protection from warm ischemia either as evidenced by renal function measures or on histologic analysis.

Introduction: Unlike percutaneous radiofrequency ablation (RFA) of small renal tumors, there are limited data assessing the long-term efficacy of laparoscopic RFA. Although the ablation cannot be visualized as reliably as with cryoablation, laparoscopic RFA allows for improved mobilization and placement of probes under direct vision. We reviewed our experience with laparoscopic RFA to assess long-term oncologic outcomes., Methods: We performed a retrospective study of all patients who had undergone laparoscopic RFA for pT1a renal tumors from April 2000 to April 2010. Demographic, clinical, and radiologic data were assessed to determine indications and evidence for recurrence of disease. Radiologic recurrence was defined as any new enhancement (>10 HU) after absence of enhancement on initial negative 6-week computed tomography., Results: Data were available for 79 patients who had 111 small renal masses treated over the 10-year period. The median tumor diameter was 2.2 cm and intraoperative biopsy identified renal cell carcinoma in 77%. The median follow-up was 59 months with an estimated 5-year recurrence-free survival of 93.3%. The overall rate of complications was 8.8% with a 3.8% rate of major complications., Conclusions: Long-term experience with laparoscopic RFA demonstrates that it is a safe and effective option for the treatment of small renal tumors. Five-year oncologic outcomes appear to be comparable to extirpation.

Objectives: To examine the feasibility of retrograde intrarenal surgery (RIRS) in a porcine model., Materials and Methods: Female pigs (n = 3) were placed in a dorsal lithotomy position under general anesthesia, and stone material was inserted into the renal pelvis of the pigs. The bladder was entered with a cystoscope, and a 0.038-inch hydrophilic guidewire was passed into the renal pelvis. Following successful placement of the guidewire, a ureteral access sheath (9.5/11.5 Fr) was placed to allow for optimal visualization. A 7.5-Fr flexible ureteroscope (Karl Storz Flex-X2) and a 200-μm laser fiber were used for lithotripsy. When basketing was deemed necessary, zero-tipped nitinol stone baskets were used. Trainees then practiced all these manipulations on the model., Results: Urologists with moderate experience in advanced endourologic surgery were trained using this model. However, there were some surgical difficulties due to the urinary system anatomy of the pig. Intravaginal location of the urethra, bladder neck location of the ureters, tight ureteric orifices, tortuous ureters, longitudinally elongated renal pelvis, narrow infundibulopelvic angle and shallow calices made the passage of the instruments and maneuverability of the flexible ureteroscope more difficult than in a human model., Conclusions: Despite some difficulties, our porcine model was very effective, because all the trainees successfully practiced the RIRS manipulations on this model., (Copyright © 2013 S. Karger AG, Basel.)

Objective: To report the long-term oncological and renal function outcomes in healthy adults treated with radiofrequency ablation (RFA) for small renal masses., Materials and Methods: We retrospectively analysed the medical records of otherwise healthy patients (those with American Society of Anesthesiologists symptom score 1 or 2) with clinical T1a renal tumours who underwent RFA at our institution between March 2001 and July 2012. Radiographic follow-up with contrast imaging was performed at 6 weeks, 6 months, 1 year and annually thereafter. Local recurrence was defined as any new enhancing lesion (>10 HU) after the initial negative post-treatment computed tomography results. The estimated glomerular filtration rates (eGFRs) before and after RFA were calculated using the Cockgroft-Gault equation., Results: We performed RFA on 58 renal tumours in 52 patients. The mean tumour size was 2.2 cm with a median (interquartile range) follow-up of 60 (48-90) months. Three (5.1%) of the treated masses had tumour recurrence after initial RFA. The 5- and 10-year recurrence-free survival rate was 94.2%. There were no recurrences after 3 years. Three (5.1%) patients died during the follow-up, which gave 5- and 10-year overall survival rates of 95.7% and 91.1%. No patient developed metastatic renal cell carcinoma (RCC) and none died from RCC. Paired analysis showed that the eGFR values at a median follow-up of 40 months did not differ significantly from those before RFA., Conclusion: With long-term follow-up, RFA provides durable oncological and functional outcomes for selected T1a renal tumours in otherwise healthy patients., (© 2013 The Authors. BJU International © 2013 BJU International.)

Introduction: To compare long term glomerular filtration rate (GFR) outcomes of partial nephrectomy and radiofrequency ablation performed for renal malignancy., Materials and Methods: Renal function of 347 patients undergoing radiofrequency ablation (n = 142) or partial nephrectomy (n = 205) for renal malignancy between 1994 and 2011 were compared from a retrospective database at a single tertiary care center. Minimum 1 year of follow up was required, resulting in a mean follow up of 48.2 (SD +/- 28.2) months. Renal function was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The primary study outcome was progression of Chronic Kidney Disease (CKD) stage, calculated using the Kaplan-Meier life table method. Multivariate analysis was also conducted to determine the level of association between GFR decline and treatment modality., Results: The 5 year freedom from CKD stage progression for radiofrequency ablation and partial nephrectomy was 85.4% (95% CI 76.8%-91.1%) versus 82.1% (95% CI 73.7%-88.1%) (p = 0.06). A longer follow up interval was associated with greater GFR decline, although hypertension, diabetes, age, and tumor size were not., Conclusion: Radiofrequency ablation provides similar long term renal function preservation benefit as partial nephrectomy.

Purpose: The aim of this study is to compare the efficiency of propofol+remifentanil to propofol+alfentanil in reducing pain in patients with urinary system stones undergoing outpatient Extracorporeal Shock Wave Lithotripsy (ESWL)., Methods: In this prospective study, 30 patients, ASA (American Society of Anesthesiologist) I-II, who are 18-60 years old and undergoing Extracorporeal Shock Wave Lithotripsy for urinary system stones were included. Patients were randomly selected for either propofol+remifentanil (Group PR) or propofol+alfentanil treatment (Group PA). Propofol was given at a dose 1 mg/kg, and then 5mg doses were given to maintain a BIS (Bispectral Index) level 60-70. Remifentanil (0.2 microg/kg (-1) bolus dose and later 0.02 microgkg(-1) min(-1) infusions) was given to the group PR and alfentanil (bolus dose 7 microgkg(-1) and later with 0.7 microgkg(-1) min(-1) infusions) was given to the group PA. If needed, the patients might use 10 ig remifentanil and 50 ig alfentanil bolus doses in group PR and PA using patient controlled analgesia (PCA) device. ECG, SpO2, BIS levels and arterial blood pressures were monitored and recorded. Patients were evaluated with Ramsay Sedation Level Evaluation Scale and with Modified Aldrete Scoring System during and after the procedure. VAS was given to patients to mark their pain level on this scale at the end of the procedure., Results: The values at pre-induction and post- induction in each group were statistically different but difference did not exist between the PR and PA groups., Conclusion: We concluded that both methods may be successfully used for patients undergoing ESWL (Tab. 6, Rief. 29).

Background and Purpose: Laparoscopic surgery for ureteral stones was restricted to special cases-those with large or impacted ureteral stones. We present special cases of patients who underwent laparoscopic ureterolithotomy at various clinics in Turkey., Patients and Methods: Forty-one patients were included in the study from five urology clinics in which laparoscopic surgery was being performed. After a disease-specific history and physical examination, age and sex were recorded. The mean patient age was 41.8 years (30 men and 11 women). Urinalysis, determination of creatinine level, intravenous urography, and ultrasonography were performed. The parameters of stone size, presence of hydronephrosis, previous shockwave lithotripsy, previous ureteroscopic stone therapy, type of laparoscopic approach, operative time, ureteral incision, insertion of a Double-J stent, amount of drainage, hospitalization period, and perioperative complications were evaluated., Results: Mean ureteral stone size was 22 mm. The retroperitoneoscopic approach was preferred in 35 (85.3%) patients, while the transperitoneal approach was used in 6 (14.7%) patients. Grade I hydronephrosis was detected in 4 patients, grade 2 in 22 patients, and grade 3 in 12 patients. In six patients, a history of shockwave lithotripsy was confirmed. The ureteral wall was incised with a cold knife in 5, scissors in 16, J-hook in 3, and a monopolar or bipolar dissector in 17 patients. In six patients, a Double-J stent was inserted, while in one patient, the operation was converted to an open procedure. The mean operative time was 124 minutes. The mean amount of drainage was 220 ml. Mean hospitalization time was 4.8 days. In five (12.5%) of seven patients, persistent drainage was a major complication that was managed by insertion of a Double-J stent. All patients were discharged stone free., Conclusion: Increased hospitalization and operative time can be related to the large stone sizes and prolonged urine leakage. In our opinion, however, the overall success of laparoscopic ureterolithotomy makes it a feasible and effective procedure, especially for stones that could not be managed easily with ureteroscopic stone therapy.

Purpose: Simple renal cysts are asymptomatic incidental findings; however, for a small subset of benign renal cysts, patients may present with pain, hematuria, recurrent infection, pyelocaliceal obstruction, or hypertension. Laparoscopic cyst ablation is an effective minimally invasive modality for the treatment of symptomatic benign renal cysts. We describe a simple laparoscopic cyst excision technique., Materials and Methods: Between June 2003 and May 2008, 28 patients underwent laparoscopic renal cyst excision via retroperitoneal approach. In our technique, retroperitoneum and Gerota's fascia were dissected with finger blindly before insertion of the trocars to the retroperitoneal space. Following finger dissection, 3 trocars were placed and the cyst walls were excised at the level of renal cyst and base of the cysts were cauterized with electrocautery scissors., Results: Mean patients' age was 59.3 years (range, 31 to 72 years). Mean operation duration time was 46 minutes (range, 27 to 102 minutes). Symptomatic and radiological success were achieved in 26 (92.8%) and 27 (96.4%) patients, respectively, with a median follow-up of 28 months (range, 6 to 56 months). No serious complications were encountered., Conclusion: Laparoscopy is a versatile minimally invasive modality ideal for treating benign symptomatic renal cysts. According to our experience, we think that the finger assisted laparoscopic cyst excision is an easy and noninvasive procedure.

Background: We present our experience in retroperitoneal interventions with 2 catheter mounted glove fingers through 2 access points., Methods: Patients were placed in the lateral decubitus position, and the retroperitoneum was accessed by blunt dissection through a 10-mm transverse skin incision on the posterior axillary line. Another incision was performed through the anterior axillary line, and the surgeon inserted his finger to dissect the muscle layers in the retroperitoneum to develop an initial space to place the glove finger balloon, which was attached to a 14-F Nelaton catheter., Results: This technique was performed on 32 patients. The mean operation time was 57.4 +/- 26.7 minutes. A satisfactory retroperitoneal space for the operation was provided and both balloons inflated to 500 mL. No complications were observed., Conclusion: Retroperitoneal laparoscopy using 2 balloons is a safe, cheap, effective minimally invasive procedure, and we believe that the technique described above both decreases both the operation time and cost.

We report a unique anomalous renal venous drainage on a 25-year-old man who had congenital absence of the right renal vein and an aberrant venous drainage through the lower pole of the kidney into the inferior vena cava. To our knowledge, this anomaly has not been previously reported in the peer-reviewed literature. State-of-the-art imaging findings are presented.

Purpose: Cystoscopy is one of the most common examinations in urologic outpatient clinics. Various anesthetic approaches have been used to make cystoscopy more tolerable for patients. The aim of the present prospective randomized study was to evaluate the efficacy of lidocaine hydrochloride gel compared to dimethyl sulfoxide (DMSO) with lidocaine in rigid cystoscopy., Materials and Methods: Male patients requiring 17F rigid cystoscopy were eligible for inclusion in this study. A total of 140 patients were divided into two groups: group 1 (n=70) received approximately 11 mL of 2% lidocaine gel intraurethrally, while in group 2 (n=70) approximately 10 mL of 40% DMSO with an amount of lidocaine equal to that in the lidocaine gel was smeared around the scope and external urethral meatus. A penile clamp was placed for 15 minutes and 5 minutes in group 1 and group 2, respectively. Immediately after cystoscopic examination pain was scored on a 10-cm visual analog scale., Results: The mean pain scores after the procedure for group 1 and group 2 were 3.9+/-1.1 and 2.1+/-1.0, respectively. The pain scores were significantly lower for group 2 than for group 1 (P=0.015). No patients needed additional anesthetic agents or sedatives due to insufficient analgesia, and there were no serious side effects in either group., Conclusions: Our study has shown that DMSO with lidocaine gel causes significantly less delivery discomfort in the male urethra than lidocaine hydrochloride gel. The advantages of DMSO with lidocaine are the mixture takes less time to act and had lower pain scores.

Background and Purpose: Data concerning extracorporeal shock wave lithotripsy (SWL) management of small (< or = 5 mm) asymptomatic renal caliceal stones are lacking in the literature. In this study, we aimed to determine the effectiveness of SWL in a special group of patients who had very small (< or = 5 mm) asymptomatic renal caliceal stones. The group of patients consisted of pilots, gendarmes, and soldiers, such as commandos, for whom treatment was obligatory and who had to be stone free because of their military duties., Patients and Methods: We retrospectively examined SWL data and retrieved information for 84 patients with small asymptomatic renal caliceal stones. The SWL sessions were performed with a Siemens Lithostar lithotriptor. The mean age of the patients was 34 +/- 13 years. The mean stone size was 4.8 +/- 0.4 mm. The mean numbers of shockwaves and energy used were 2707 +/- 1742 and 18 +/- 2 kV, respectively. The location of stones were: 11 right upper calix, 10 right middle calix, 17 right lower calix, 13 left upper calix, 16 left middle calyx, and 17 left lower calix. Eighty-four patients underwent 101 SWL sessions. Only eight patients had second and three patients had third SWL treatments. SWL was performed five times for only one patient. All mean values were realized with an SPSS 10.0 statistical program., Results: After the first, second, and third SWL sessions, the stone-free rate was calculated as 87%, 93% and 94%, respectively. Only five patients with lower renal caliceal stones were not stone free. The reported complications were macroscopic hematuria necessitating medical attention in four patients, skin ecchymosis in seven patients, severe colic pain in two patients, and urinary-tract infection in one patient. There was no need for hospitalization for these complications., Conclusion: SWL is effective and safe in patients with very small (< or = 5 mm) asymptomatic renal caliceal stones in all locations.

Inverted papilloma (IP) of the urothelium accounts for 2.2% of urothelial neoplasms. The aim of this study was to report the results of 13 patients with urinary IP, pointing out the clinical features, presentations, treatment options and outcomes. The mean age and mean follow-up periods of the patients were 60.23 +/- 3.25 (range, 44-81) years and 30 (range, 6-42) months, respectively. There was no coexistence of urothelial carcinoma with IP at presentation. Cystoscopy showed a solitary papillary tumor in the bladders of 11 patients and solid pedunculated tumors in the remaining two patients. The site of development was the bladder in 12 cases (92%) and ureter in one (8%) case. Transurethral bladder tumor resection was performed in 12 cases. For the case with IP in the ureter, nephroureterectomy was performed. Pathologic examination demonstrated that seven of the 13 cases were of the trabecular type and six were of the glandular type. Of the 13 cases, two (7%) had recurrence, at 1 year and 1 month and 1 year and 5 months from initial resection. The male to female ratio was 5.5:1. Initial symptoms included macroscopic hematuria in five cases, microscopic hematuria in four, and dysuria and microscopic hematuria in three; one case was asymptomatic. IPs of the urinary bladder are benign tumors that can be treated successfully by transurethral resection and fulguration of the tumor bed. In addition, these lesions must be followed up closely for recurrence and malignant transformation.

Purpose: The aim of the present randomized study was to evaluate the efficacy of lidocaine gel compared with dimethylsulfoxide (DMSO) with lidocaine for transrectal ultrasonography (TRUS)-guided prostate biopsy in patients with anorectal pathologies., Patients and Methods: Sixty-two patients were randomly divided into two equal groups. Group 1 was given 10 mL of 2% lidocaine gel intrarectally 10 minutes before the biopsy. Group 2 was given 10 mL of intrarectal 40% DMSO with an amount of lidocaine equal to that in the lidocaine gel 10 minutes before the procedure. The degree of pain was rated by patients using a 10-point visual analog scale., Results: The pain scores for probe insertion were significantly lower for group 2 (3.15 +/- 1.41) than for group 1 (4.58 +/- 160) (P = 0.01). No significant differences were found between the pain scores of the two groups for biopsy-needle insertion (P = 0.62)., Conclusions: Dimethylsulfoxide with lidocaine instilled into the rectum is a simple, safe, rapid-acting, and effective method of anesthesia delivery before TRUS-guided prostate biopsy in patients with anorectal pathologies.

Background and Purpose: Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated by percutaneous aspiration with injection of sclerosant agents. Our aim was to compare the efficacy and side effects of ethanol and sodium tetradecyl sulfate (STDS) as sclerosants for symptomatic simple renal cyst., Patients and Methods: Sixty-five patients with 68 symptomatic simple renal cysts were included in this study. An 8F pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of the cyst fluid. Either 95% ethanol (N = 34) or 3% STDS (N = 34), assigned randomly, was then instilled into the empty sac. Patients recorded any flank pain on a visual analog scale and were followed up by ultrasonography for 6 to 18 months., Results: There was complete ablation of 28 (82%) and 26 (76%) cysts, partial regression of 3 (9%) and 6 (18%) cysts, and failure of treatment in 3 (9%) and 2 (6%) cysts in the ethanol and STDS groups, respectively. There was no major complication in either group. The pain caused by the injection was significantly less for the group receiving STDS (pain score 2.1 +/- 1.1 v 3.8 +/- 1.2 for ethanol; P = 0.019)., Conclusions: Ethanol and STDS are simple, noninvasive, cost-effective, and well-tolerated sclerosants for the treatment of simple renal cysts. We prefer STDS as a first choice because it causes less pain.

We report a 35-year-old male patient with chronic constipation and infertility for 4 years. Spermiogram revealed severe oligospermia. An external mass compressing the rectum was found during rectal examination and flexible rectosigmoidoscopy. Abdominal computed tomography showed a presacral cystic mass which displaced the bladder anteriorly. The cyst was completely removed with open surgery. Histopathologic analysis revealed a cystic lesion covered with squamous epithelium including polymorphonuclear leukocytes, macrophages and sperm cells. After the operation, the patient's symptoms were relieved. We considered that the constipation was caused by external compression by the vesicula seminalis cyst. In cases of constipation with infertility, vesicula seminalis cyst should be kept in mind.

Objective: To use a new vasovasostomy technique for reversal of vasectomy., Design: Case report., Setting: Clinical and academic research environment., Patient: A patient who had undergone vasectomy., Intervention: We used 4/0 prolene as a guide during anastomosis for reversal of vasectomy., Main Outcome Measure: Semen analysis., Result(s): Three months after the operation, the spermiogram showed the sperm count, the percentage of normal morphologic sperm, progressive motility, and vitality as 9 million/L, 70%, 33%, and 60%, respectively. Six months later, the spermiogram was repeated and the following results were obtained: the sperm count, the percentage of normal morphologic sperm, progressive motility, and vitality as 14 million/L, 65%, 40%, and 65%, respectively., Conclusion(s): This new technique is cost-effective, easy, cheap, and less time-consuming, and has a high success rate.

Objectives: To evaluate the efficacy of a eutectic mixture of local anesthetics (EMLA) cream compared with dimethyl sulfoxide (DMSO) with lidocaine during extracorporeal shock wave lithotripsy (ESWL) in a prospective randomized study., Methods: Of 167 patients, 85 received 10 g of EMLA cream (EMLA group) and 82 received 10 g of 40% DMSO (DMSO group) with an amount of lidocaine equal to that in the lidocaine gel, applied to the skin of the flank at the area of entry of the shock wave marked by the urologist. A second-generation lithotriptor Siemens Lithostar was used. The degree of pain was rated by the patients using a 10-point visual analog scale., Results: In 80 patients in the EMLA group (94%), the entire procedure was performed with no, minor, or tolerable pain after the application of EMLA cream (pain score 5.2 +/- 1.3). In 5 EMLA patients (6%), EWSL was interrupted because of intolerable pain. Of the 82 DMSO patients, 80 (98%) underwent the entire procedure with no, minor, or tolerable pain after the application of DMSO with lidocaine (pain score 3.7 +/- 1.1). In 2 DMSO patients (2%), EWSL was interrupted because of intolerable pain. The pain scores were significantly lower for the DMSO group than for the EMLA group (P = 0.011)., Conclusions: Our findings have indicated that the pain scores were significantly lower for the DMSO group than for the EMLA group. In addition to the local anesthetic effect of DMSO, diuretic, anti-inflammatory, muscle relaxant, and hydroxyl radical scavenger effects can be important for patients undergoing ESWL. These effects should be evaluated with new studies of patients undergoing ESWL.

Condyloma acuminata is one of the most common virally transmitted diseases. The most common sites for condyloma in males are the balanopreputial sulcus, frenulum and the glans' mucosa. Condylomata in the urethra is rarely seen occur and most often situated in the distal part of the urethra. A 24-year-male admitted to our clinic with complaint of papillary lesion at the urethral meatus and urinary retention. Physical examination revealed that multiple papillary lesions along the anterior urethra until 1 cm distance from the urethral meatus. Under the clinical diagnosis of condyloma acuminata, he was treated conservatively with radical local excision of the lesion and condyloma acuminatum was verified by histopathological examination. Four months after surgery, there has been no local or remote recurrence.

Introduction: In this study, our aim was to evaluate the effectiveness of the mucosal flap barrier (MFB) upon the incompetent ureteral orifice of an experimentally produced rabbit reflux model. The rabbit reflux model was done in the first stage of the study. This method is a new and original procedure which is different from Bischoff's and Witherington's osteoplasty techniques., Materials and Methods: We performed the mucosal flap procedure in eight 2-2.5 kg male New Zealand rabbits with experimentally produced refluxing ureters. The first stage of our study was to create refluxing ureters. Due to the upward and inward 'J' fishhook course of the intravesical ureter of rabbits, we performed two deep 12- and 4-o'clock incisions by suturing the edges of the intravesical ureter apart with catgut sutures. Additionally, to stop the tilting action of the trigonum during micturition, we performed two parallel incisions between the ureteral meatus. These parallel incisions were the authors' modifications for the rabbit reflux model and which gives long-lasting reflux for the rabbit. We checked the reflux at the end of the 3rd month and performed our new MFB antireflux procedure. This mucosal flap made a cover on the incompetent ureteral orifice. This technique is completely different from the osteoplasty techniques described by Bischoff and Witherington., Results: Four months after the MFB application, we performed intravenous urography, cystometry and cinefluorography. There was no obstruction or reflux. Two rabbits were sacrificed at the 4th month. Both flaps were fully intact without any fixation at the medial side causing obstruction. At present, 3 rabbits are still alive. We did cinefluorography and cystometry at the 15th month and there was no obstruction or reflux. We are trying to keep them alive till the end of their natural lifespan., Conclusions: During the formation of the rabbit reflux model, we observed that spontaneous reflux even at high intravesical pressures did not have high percentages as previously mentioned in the literature. But it is possible and enough to produce an experimental reflux model by using meatotomy and interureteric incisions. Moreover, in rabbits with vesicoureteral regurgitation produced by ureteral meatotomy and interureteral incisions, reflux can be eliminated the MFB procedure. This method is an easy procedure for small bladders or dilated ureters after any kind of open reimplantation applications and it could be used by pneumovesical applications in the future., (Copyright 2007 S. Karger AG, Basel.)

Transitional cell carcinoma (TCC) of the bladder is the seventh most frequent cancer of women. The possible mechanisms of local tumor recurrence are seeding and multicentricity. Distant metastases are most frequently as a result of vascular or lymphatic spread and to a lesser extent by seeding of the tumor cells with urine or transurethral instrumentation. We report a clitoral metastasis of a TCC of the bladder, which is a very unexpected and extremely rare site for metatstasis and discuss whether the possible mechanism is vascular spreading or direct seeding. To our knowledge this is the third case in the literature.

Background: The aim of the study was to evaluate the pain scores and complications of transrectal ultrasonography (TRUS)-guided prostate biopsy and to compare lithotomy position (LP) versus left lateral decubitis position (LLDP)., Methods: A total of 340 patients were referred for TRUS-guided biopsy. In group 1 (n = 170), biopsies were performed in LP (n = 170), and in group 2 (n = 170) biopsies were performed in LLDP (n = 170). In 68 patients, biopsies were repeated. We constituted two additional groups: in group 3 (n = 33) patients underwent biopsies in LP and LLDP, respectively, and in group 4 (n = 35) patients underwent biopsies in LLDP and LP, respectively. Pain score, infection rates, hematospermia, hematuria, rectal bleeding, and serious complications were compared between group 1 and group 2. Pain scores were compared between the four groups., Results: There were no differences between group 1 and group 2 for age, prostate volume, prostate-specific antigen level, biopsy time, hematuria, infection, hematospermia, and rectal bleeding. Pain scores were lower in group 2 than in group 1. Also, for LLDP, pain scores were lower in group 3 and group 4., Conclusion: The effect of position on pain scores in TRUS biopsy patients has not been previously described. Our study indicates that pain scale values are lower in LLDP than in LP., ((c) 2007 S. Karger AG, Basel.)

Introduction: During the last decades numerous prognostic factors have been studied for predicting survival of renal cell carcinoma (RCC). Platelet count has previously been reported to correlate with prognosis in RCC. The aim of the this study was to evaluate the significance of thrombocytosis in determining prognosis in patients with localized RCC who underwent radical nephrectomy., Patients and Methods: The study included 118 consecutive patients. Patients were divided into a normal platelet count group (group 1) and a thrombocytosis group (group 2) according to the preoperative platelet count. Thrombocytosis was defined as a platelet count greater than 400,000/microl. The data about stage distribution, grade, tumor size, histological subtype, hemoglobin level, Body Mass Index (BMI), age, ECOG score, gender, and survival rate of tumors between these two groups were compared. Survival estimates were compared with the Kaplan-Meier method and multivariate analysis was performed using a Cox model., Results: The mean age of the patients was 61.4 years (range 30-78), and the mean follow-up period was 52.7 +/- 19.6 months (range 9-96). Thrombocytosis was present in 23 patients (19.49%). Fourteen (60.86%) of 23 patients with thrombocytosis died of disease progression. Patients with thrombocytosis had a worse prognosis than patients without thrombocytosis (p = 0.001). Thrombocytosis was noted in 8 (10.81%) of 74 patients with stage pT1-pT2 disease and in 15 (34.09%) of 44 patients with stage pT3-pT4 disease (p = 0.004). In univariate analysis, platelet count was correlated with T stage, hemoglobin level, lymph node positivity, ECOG score, and tumor size. Controlling for established prognostic indicators of pathologic stage, tumor size, platelet count, and lymph positivity using Cox's regression test, the difference in survival between the groups remained significant (p < 0.05)., Conclusion: The platelet count can be considered a useful prognostic factor in patients with RCC who undergo radical nephrectomy., (2007 S. Karger AG, Basel)

Thromboangiitis obliterans (TAO) or Buerger's disease is a clinical syndrome characterized by the development of segmental thrombotic occlusions of the medium and small arteries of the extremities. Exception of the peripheral arteries of the extremities in TAO is very rare. Reported herein is the first case of intrarenal branch involvement of the renal artery due to TAO.

Ureteral stents have been widely used for more than two decades with different indications. Due to the widespread usage of ureteral stents, the number of possible complications of ureteral stents has increased, including stent migration, encrustation, stone formation, and fragmentation. Among these complications, ureteral stent fragmentation is rare. Herein, we present a case of spontaneous ureteral stent fragmentation and review the relevant literature.

A 45-year-old male admitted to our clinic of symptoms with moderate left flank pain and intermittant macroscopic hematuria. During the last 6 months these complaints had worsened. He had history of open retroperitoneal ureterolithotomy 2 years previously for ureteral stone. He was investigated for calculi, infection and other urinary abnormalities. Although direct urinary system graphy was normal, excretory urography revealed left ureteric obstruction. On ureteroscopy membranous band like an ureteral valve causing ureteral obstruction was observed and removed with biopsy pens without resection.

Hydatid disease is endemic in many parts of the world. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% of the cysts occur in the rest of the body. It may develop in almost any part of the body. Although hydatidosis can be present in all parts of the human body, urinary tract involvement develops in only 2-4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. In addition, there is no laboratory finding that is pathognomonic for hydatid disease except for hydatiduria. Routine blood tests are generally normal except for eosinophilia which is found in only 50% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain radiography or intravenous urography, and ultrasound or computed tomography cannot always show a hydatidosis as a specific lesion. From these reasons, sometimes it is difficult to differentiate between a unilocular hydatid cyst without mural calcification and a simple renal cyst. So, despite its rarity, hydatid disease should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We present herein a patient with isolated renal hydatid cyst mimicking a simple cyst treated successfully with complete excision., (Copyright (c) 2006 S. Karger AG, Basel.)

Isolated congenital urethrocutaneous fistula is an extremely rare congenital anomaly. Management is sometimes complex and depends on the location. We report our endoscopic treatment in a man with a urethroperineal fistula.

We report a 30-year-old female with a single ectopic ureter that opens into the bladder adjacent to the right ureter., (2006 S. Karger AG, Basel.)

Introduction: We compare the postoperative early and late complications of patients who had undergone ileal conduit (IC) urinary diversion and transureteroureterostomy (TUU) with ureterocutaneostomy (UC) urinary diversion during the same interval and by the same surgeons., Materials and Methods: Between 1992 and 2004, we performed TUU with UC urinary diversion in 27 men and 7 women (group I) and ileal conduit urinary diversion in 57 men and 10 women (group II). The mean age of the TUU with UC diversion and the ileal conduit patients was 57+/-11.2 (range 51-76) and 64+/-12.6 (range 54-76) years, and the mean follow-up was 37 (range 14-52) and 56 (range 14-72) months, respectively. The 6F or 8F stents were used routinely., Results: Of 34 TUU with UC cases 8 (23.52%) had early postoperative complications and 2 (5.88%) had early reoperation rates, whereas 11 (16.42%) of 67 ileal conduit cases had early postoperative complications and 4 (5.97%) had early reoperation. The mean hospital stay was 7 (range 5-25 day) and 11 (range 7-34 day) days for each group, respectively. Of the TUU and UC cases, 6 (17.64%) had late complications and 3 had (8.82%) late reoperation, whereas 14 conduit cases (20.89%) had late complications and 6 had (8.9%) late reoperation. Early postoperative complications were defined as those that occurred before hospital discharge or within 30 days from the date of surgery and late complications were defined as those occurring greater than 30 days from the date of surgery as previously described. In group I, the mean operative time was 170 min (range 120-325) compared with 260 min (range 170-473) in group II. The mean blood loss in group I was 474 ml (range 250-1,400) and 589 ml (range 300-1,700) in group II (p>0.05)., Conclusions: Our results suggest that patients undergoing a TUU and UC diversion have no additional risk of reoperation and the TUU with UC urinary diversion is a safe procedure with postoperative early and late complications., (Copyright (c) 2006 S. Karger AG, Basel.)

Although prostatic calculi are relatively common, the etiology of these stones is not clear. We report a case with multiple prostatic calculi causing urinary obstruction and a concomitant bladder stone. We treated these stones endoscopically. We found a lot of different sized stones endoscopically, some protruding into the urethra, some filling different cavities on the prostate. So these cavities suggest prostatic calculi may occur related to intraprostatic reflux in the congenital or acquired diverticulum of the prostatic tissue. In addition, the stone composition of the bladder and prostatic stones was the same. All of these results show that the origin of bladder and prostatic stones can be the same. This case also supports a theory of intraprostatic reflux and urine stasis.

Objectives: To search for any relation between plasma adiponectin levels and the cellular differentiation or progression of prostate cancer (PCa). PCa is becoming an increasingly important public health problem, particularly for those countries with a trend toward an aging population. Because insulin resistance in the setting of obesity is associated with the development of PCa, we hypothesized that decreased adiponectin levels might underlie the association between PCa and obesity/insulin resistance., Methods: In this study, we investigated plasma adiponectin levels in 30 patients with PCa, 41 subjects with benign prostatic obstruction, and 36 healthy individuals. The body mass index and age of the groups were similar. Patients with PCa were stratified into two groups according to the spread of the disease as organ-confined and advanced disease and into three groups according to grade (low, intermediate, and high grade determined by a Gleason sum of less than 5, between 5 and 7, and more than 7, respectively)., Results: Plasma adiponectin levels were significantly lower in the PCa group than in the benign prostatic obstruction group or controls (P < 0.001 for both). Additionally, the plasma adiponectin levels were significantly lower in the advanced disease group than in the organ-confined PCa group (P = 0.012). Significant negative associations were found between plasma adiponectin levels and prostate-specific antigen levels or biopsy Gleason scores in the PCa group. The plasma adiponectin levels of those with high-grade PCa were also significantly lower than those for both the low-grade and intermediate-grade groups (P < 0.001 for both)., Conclusions: The results of the present study imply that plasma adiponectin levels are not only lower in patients with PCa but are also negatively associated with the histologic grade and disease stage. Future prospective studies are recommended to establish any causal relation between PCa and plasma adiponectin levels.