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Objective: Kidney stones are an important urological problem in both adults and children. They may be accompanied by metabolic disorders and genetic diseases and children make up approximately 20% of stone patients in our country. In our clinic, we evaluated the results from pre-school children 6 years of age and younger who underwent percutaneous nephrolithotomy (PNL) surgery. Material and Methods: Between March 2012 and June 2016, 54 pediatric patients aged 0-6 years were treated with PNL for stones that were larger than 2 cm or ESWL-resistant, after undergoing the appropriate tests at the Urology Department of the Harran University Faculty of Medicine. PNL operations were performed under general anesthesia. After cystoscopy in the supine position, a ureteral catheter was inserted, accompanied by C-arm fluoroscopy. Afterwards, the patients were placed in the prone position before the kidney was entered using a metal needle with a fluoroscopy attachment. We dilated the entrance with amplatzer renal dilators and entered with a 17 fr nephroscope. After the procedure, the nephrostomy catheter was placed in the renal sheath. 4 mm residual fragments remaining after the operation were accepted as clinically insignificant stone residues. Results: A total of 54 patients underwent PNL operations; 23 females and 31 males. The mean age was 3.16- 0.8. 25 left-sided and 29 right-sided procedures were used. Three patients had bilateral kidney stones; co-administration was not staged. Mean stone size was 370±45 mm2, while the mean operation time was 55 ± 21 minutes. 45 (83.3%) of the patients were stone-free after the operation. Postop, 2 (3.7%) had free fluid and ileus and 6 (11.1%) required additional blood products. They were stabilized with additional JJ stents. After a nephrostomy drain, 4 (7.4%) patients had a JJ stent inserted. Average duration of the nephrostomy was 3.1 ± 0.9 days. Conclusion: As with every age group, PNL was effective in treating stones larger than 2 cm as well as smaller ESWL-resistant specimens. Success in preschool children is practically guaranteed, with a minimally invasive surgical procedure. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmada tam tüpsüz perkutan nefrolitotomi (PNL) uygulamasıyla ilgili deneyimlerimiz aktarılmıştır. Materyal-Metod: Ocak 2010-Aralık 2012 tarihleri arasında böbrek taşı olan 140 olguda uygulanan tam tüpsüz PNL yönteminin sonuçları incelendi. Bulgular: Hastaların yaş ortalaması 47,84(5-73) idi. Ortalama operasyon süresi 88.8(45-110) dk, taş alanı ise 375.2(110-175) mm² idi. Taşsızlığa ulaşma oranımız KÖRF dahil 130(%92.8) olarak hesaplandı. PNL uyguladığımız hastalarımızdan 1 tanesinde serozal kolon yaralanması 2 hastada postoperatif perirenal hematom izlendi. Sonuç: Sonuç olarak uygun vakalarda tam tüpsüz PNL, günümüzde böbrek taşı tedavisinde taşsızlığa ulaşma noktasında standart PNL kadar güvenle uygulanabileceğini düşünmekteyiz.

Objective: The purpose of this study was to evaluate the success rate of shock wave lithotripsy (SWL) and possible effects on the anxiety status of patients. Methods: Anxiety status of 128 patients was evaluated using State and Trait Anxiety Inventory (STAI) scale. Three groups were created depending on stone condition: Group 1, completely stone-free; Group 2, asymptomatic residual fragments; and Group 3, fragments requiring additional procedures. Anxiety was evaluated comparatively according to analgesic need and emergency department referrals. Results: Mean score in all 3 groups 1 month after treatment showed significant decrease; however, this decrease was smaller in Group 3 than the other 2 groups. Pairwise evaluation of mean STAI scores revealed significant difference between Group 3 and other groups. Similarly, analgesic need and emergency department referral rate were higher in Group 3. Conclusion: Residual fragments after SWL procedure may affect the anxiety status of the treated patients due to both symptoms they experience and need for additional procedures. We believe that detailed information should be provided to patients with respect to procedure, possible complications, and potential need for additional treatment. [ABSTRACT FROM AUTHOR]

AIM: Management of kidney stone in pediatric patients is an important problem. Shock Wave Lithotripsy (SWL), mini-percutaneous nephrolithotomy (mini-PNL), micro PNL and recently developing Retrograde Intrarenal Surgery (RIRS) are the methods used in stone management. METHODS: Among from the 1047 patients who had undergone RIRS and mini-PNL in Dıskapı Yıldırım Beyazıt Training and Research Hospital, 27 patients who are younger than 17 years were included our study. The demographic, intraoperative and postoperative data of these patients and complications were evaluated retrospectively. RESULTS: For 1-2 cm diameter stones, the success for RIRS and mini-PNL were %70 and %100, respectively. For 2-3 cm diameter stones, the success for RIRS and mini-PNL were %50 and %100, respectively. There was no major complication in both groups. Scopy time, operation time, stone burden, hospital stay were different between two groups. And the difference was statistically significant. CONCLUSION: As a result RIRS and mini-PNL are effective and safe methods and they are feasible in treatment of pediatric patients. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous nephrolithotomy (PNL) is a minimally invasive procedure that is safely performed for kidney stone surgery all over the world. In our clinic, PNL surgery was first performed in March 1998. In parallel with our increasing experience, PNL has been performed in pediatric cases. In our study, PNL operations performed in pediatric patients under the age of 10 years and in those over the age of 10 years were retrospectively investigated. Methods: Patients were between 0 and 16 years of age. They were divided into 2 groups according to age: 0-10 and 11-16 years. The PNL procedure was performed under general anesthesia with C-arm fluoroscopy in the prone position. Results: Between March 1998 and December 2014, a total of 208 pediatric urinary stone patients were operated on. The PNL procedure was performed in 210 renal units, 1 of which was performed bilaterally. In the =10-year-old patient group, 98 procedures (87.5%) were stone free, while clinically insignificant residual fragments (CIRFU) were found in 13 procedures (12.5%). In the >10-year-old patient group, 88 procedures were stone free (89.79%), while clinically insignificant residual fragments were found in 9 procedures (10.2%). In the =10-year-old patient group, tubeless PNL was performed in 1 patient. In both groups combined, bleeding requiring transfusion occurred in just 1 case. A tract leak requiring a double J stent was detected in 1 patient in the =10-year-old patient group and in 2 patients in the other group. There was no other organ injury. Conclusion: PNL is a minimally invasive method and has become advantageous over open surgery because it offers higher security, particularly in experienced clinics, and procedures on pediatric patients can therefore be successfully performed. [ABSTRACT FROM AUTHOR]

The Horseshoe kidney is the most common fusion anomaly and its incidence is around 1/400. It is two times more common in males than females. Because of the urinary stasis due to the higher location of the ureteropelvic junction in horseshoe kidney, the incidence of kidney stones is high. In this study we aimed to present a laparoscopic pyelolithotomy case performed after a failed ESWL treatment in a kidney stones patient with a horseshoe kidney. [ABSTRACT FROM AUTHOR]

Objective To investigate percutaneous nephrolithotomy (PNL) results of morbid obese patients with a body mass index (BMI) of ≥40 kg/m2 by comparing with a control group of normal BMI (20-25 kg/m2). Materials and Methods Thirty patients with a BMI of ≥40 kg/m2 were randomly assigned to group 1 and 30 patients with a normal BMI (20-25 kg/m2) constituted group 2 as controls. We compared the groups with regard to baseline characteristics, intraoperative parameters, and stone-free and complication rates. Results A total of 60 patients were included in the study. Demographic data and stone burden were similar in both groups. We found no significant differences in access number and success, operative time, and stone-free and complication rates. Conclusion PNL is a safe and effective treatment even for patients with a BMI of ≥40 kg/m2. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study is to investigate the impact on male erectile function of extracorporeal shock wave lithotripsy (ESWL) performed on kidney stones. Methods: A total of 114 patients who had ESWL therapy between May-August 2012 evaluated were divided into 3 groups at the end of first month. Patients without kidney stones were in Group 1, patients who had residual fragments were in Group 2, and patients who required additional intervention were in Group 3. Patients' initial scores on the International Index of Erectile Function (IIEF)-5 questionnaire were compared with results after completing the questionnaire again at the end of first and third months. Results: Mean age of 114 patients included in the study was 41.7 (range: 20-63) years of age, mean stone size was 16.5 (range: 10-25) mm. Differences in IIEF scores before and after treatment were evaluated and there was a statistically significant reduction in erectile function after the first month in all groups. IIEF scores of patients in Group 1 and Group 2 returned to initial values at the end of 3 months, and Group 3 saw additional reduction (p=0.039). Conclusion: We have to consider the increasing of sexual disfunction which depends on performing ESWL and additonal surgical interventions after ESWL. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of percutaneous access site on the success and complication rates of isolated calyceal stones. Material and methods: We retrospectively evaluated 2700 patients who underwent percutaneous nephrolithotomy (PNL) in our clinic between October 2002 and August 2014. We selected only the patients with isolated lower, middle or upper calyceal stones and we grouped the patients according to the location of their stones. Successful operation was defined as complete stone clearence or retention of stone fragments smaller than 4 mm which do not lead to infection, obstruction or pain requiring treatment. Intraoperative and postoperative complications were also recorded. Results: Totally 360 patients underwent PNL for their isolated upper, middle and lower calyceal stones. Access sites for those patients were selected based on stone location. The stones were localized in the lower (n=304), middle (n=14), and upper (n=42) calices. There was no statistically significant difference between the groups with respect to operation and scopy times. Hemoglobin drop was seen more frequently in the upper calyceal access group, without any significant intergroup difference. Thoracic complications including hemothorax, pneumothorax and pleural effusion were more common in the upper calyceal access group (11.9%; p<0.001). Complete stone clerance was accomplished in 81.9%, 92.9% and 78.6% of the patients with lower, middle and upper calyceal stones respectively without any significant intergroup difference (p=0.537). Conclusion: PNL is an effective and safe treatment modality for isolated calyceal kidney stones and upper calyceal access causes thoracic complications more than other access sites. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous Nephrolithotomy (PNL), has been a breakthrough in urology practice; it can be performed in various centers, with high success rates and low morbidity and mortality rates. In this study, we aimed to investigate the effect of plasma creatinine levels upon the hemorrhage on PNL procedures. Material and Methods: Patients underwent PNL were categorized as having high plasma urea and creatinine levels. Patient age, stone size, gender, hematocrit levels and additional co-morbidities were recorded and a matching group was designed using same variables. Group 1 consisted of patients with high creatinine levels and Group 2 consisted of normal creatinine levels. Body mass index, stone size, hematocrit levels, plasma creatinine levels before and after the operation, coagulation parameter (aPTT, INR), number of access tracts, operative time, preoperative platelet number, stone free rates and transfusion rates were recorded and compared. Results: Mean plasma creatinine levels were 2,11 ± 0,44 and 0,98 ± 0,27 for Groups 1 and 2, respectively. For Groups 1 and 2, stone sizes were 29,41 ± 3,83 mm, and 29,49 ± 2,99 (p=0,317). Mean peroperative hematocrit levels were 44,88 ± 5,61 and 47,51 ± 4,61 (p=0,381) for Groups 1 and 2, respectively. Those levels were 30,27 ± 7,01 and 37,74 ± 7,11 (p=0,044) for Groups 1 and 2 post operatively. Conclusion: In conclusion, having high levels of plasma creatinine preoperatively for PNL was seen to be a risk factor for hemorrhage. If a patient has high creatinine levels preoperatively, he/she may be more prone to bleeding after PNL. [ABSTRACT FROM AUTHOR]

Objective: The developments in the endourological treatments of urinary system stone diseases led to the discussions about the first choice treatment methods. We have evaluated the results of extracorporeal shock wave treatments being applied in our clinics for the lower pole stones which has the most of the those discussions. Methods: The records of 271 stone patients who were applied ESWL according to CT results between January 2013 and July 2013 to our clinics were examined. In the controls after the procedure, who could not be evaluated with the non-contrast computerized tomography (CT) and ESWL treatment not completed, were excluded from the study. 52 patients with lower pole stone in total were divided into two according to the success of the ESWL treatment. ESWL success or unsuccessful groups, the size of the stone, density of the stone and the distance between the stone and skin was recorded by examining the abdominal non-contrast computed tomography (CT) of the patient. Results: Of all, 28 of the patients in the study (54%) were male and 24 of them (46%) were female. The average age was 46±12.3 (21-73) years. Among the 52 patients included in the study after ESWL treatment, the stones of the 24 patients (46.2%) were successfully treated. ESWL treatment was unsuccessful in total 28 patients (53.8%). The average size of the stone was 9.8 mm (6-17 mm), the distance between the stone and the skin was 93 mm in average (50-140). The stone density was measured as 845 HU (353-1600). Conclusion: The ESWL treatment is still a noninvasive and successful method for the lower pole kidney stones. While the ESWL success is being determined, the imaging method chosen is important, the use of abdominal CT provides accurate evaluation. The higher success rates of minimal invasive surgery methods is promising and might change the treatment methods in the future. [ABSTRACT FROM AUTHOR]

Aim: To demonstrate the feasibility of retrograde intrarenal surgery (RIRS) in pediatric age group. Methods: Data of patients who underwent RIRS for the treatment of kidney stones were retrospectively analyzed. The procedure was performed using 7.5 Fr FlexX™ 2 flexible ureterorenoscope in all patients. Ureteral access sheath was not used in any patients. A double-j stent was inserted and the procedure was delayed for 2 weeks whenever access to the ureter was not possible. The stones were fragmented using laser and fragments smaller than 2 mm were left for spontaneous passage. Postoperative success was evaluated using ultrasonography and kidney, ureter and bladder (KUB) x-ray. Results: 14 patients with a mean age of 7.5±2.47 (range: 3-12) years were included. Male to female ratio was 8/6 and six patients had a stone on the right side. The mean stone size was 12.3±3.49 (range: 8-20) mm. Of the patients, 10 had a history of unsuccessful shock wave lithotripsy (SWL) treatment. Mean operation and fluoroscopy screening times were 33.5±6.9 (range: 25-45) and 45.3±15.4 (range: 30-75) minutes, respectively. The median hospital stay was 1.07±0.2 (range: 1-2) days. No major complications were noticed during the operation. Double-J stents were removed on the 2nd postoperative week and all patients were stone-free during the follow-up. Conclusion: RIRS can be performed safely and efficaciously in pediatric patients. [ABSTRACT FROM AUTHOR]

Objective: Shock-wave lithotripsy (SWL) is the first-line treatment for the active removal of small and medium-sized kidney stones. Flexible ureterorenoscopy (fURS) is recommended after failed SWL treatment. The aim of this retrospective analysis is to evaluate whether prior unsuccessful SWL treatments affect the outcomes of fURS. Material and methods: Data from 206 patients who underwent fURS for the treatment of renal stones between September 2009 and January 2011 were collected, and the patients were divided into two groups according to their previous SWL treatment. The patient demographics, stone characteristics, operation and fluoroscopy times, stone-free rates and complications were compared. Results: Of the patients, 114 (55.3%) did not undergo SWL prior to fURS (Group 1), whereas 92 (44.6%) completed a minimum of 3 sessions of SWL and waited at least 2 weeks before the fURS operation (Group 2). Although the mean stone number was higher in Group 2, this difference was not significant (p=0.06). The mean operation (p=0.12) and fluoroscopy times (p=0.69) were similar between the groups. The mean operation time per mm2 stone and fluoroscopy time per mm2 stone were not significantly different (p=0.64 and p=0.76, respectively). The length of the hospitalization and the overall complication rates were similar. After the third postoperative month, the stone-free rates were not different between the groups (82.5% and 86.9%, respectively, p=0.38). Conclusion: The stone-free and complication rates of fURS were not affected by previous SWL therapy. [ABSTRACT FROM AUTHOR]

Objective: To share our experience with retrograde intrarenal surgery (RIRS) done in patients with horseshoe kidney anomaly. Materials and Methods: Data from 107 patients who underwent RIRS for kidney stones between 2013 and 2016 in our clinic was retrospectively analyzed and 6 patients with horseshoe kidney anomaly detected on computed tomography (CT) were included in the study. Achieving stone-free status or having residual stones of ≤4 mm were considered operational success. Results: The mean age of the patients was 44.5±6.7 years. Four patients were male (66.6%) and two were female (33.3%). The mean stone size was 14.5±4.1 (10-22) mm. Three patients had pelvis stones (50%) and the rest 3 (50%) had lower calyx stones. Two patients (33.3%) were found to be stone-free on post-operative non-contrast CT results. Conclusion: RIRS should be performed by experienced surgeons in patients with horseshoe kidney. [ABSTRACT FROM AUTHOR]

Hounsfield units (HU) provides a quantitative assessment of stone density in the urogenital tract on non-contrast computed tomography (NCCT) and has the ability to predict treatment success. The difference in HU (HUdiff) value was measured on NCCT in two patients. Our opinion is that HUdiff can predict stone composition before treatment. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to evaluate, the efficacy of surgical methods and the factors affecting the residual stone rate by scrutinizing retrospectively the patients who had undergone renal stone surgery. Material and methods: Records of 109 cases of kidney stones who had been surgically treated between January 2010, and July 2013 were reviewed. Patients were divided into three groups in terms of surgical treatment; open stone surgery, percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS). Patients' history, physical examination, biochemical and radiological images and operative and postoperative data were recorded. Results: The patients had undergone PNL (n=74; 67.9%), RIRS (n=22;20.2%), and open renal surgery (n=13; 11.9%). The mean and median ages of the patients were 46±9, 41 (21-75) and, 42 (23-67) years, respectively. The mean stone burden was 2.6±0.7 cm² in the PNL, 1.4±0.1 cm² in the RIRS, and 3.1±0.9 cm² in the open surgery groups. The mean operative times were 126±24 min in the PNL group, 72±12 min in the RIRS group and 82±22 min in the open surgery group. The duration of hospitalisation was 3.1±0.2 days, 1.2±0.3 days and 3.4±1.1 days respectively. While the RIRS group did not need blood transfusion, in the PNL group blood transfusions were given in the PNL (n=18), and open surgery (n=2) groups. Residual stones were detected in the PNL (n=22), open surgery (n=2), and RIRS (n=5) groups. Conclusion: PNL and RIRS have been seen as safe and effective methods in our self application too. However, it should not be forgotten that as a basical method, open surgery may be needed in cases of necessity. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous nephrolithotomy (PNL) is the firstline treatment for large and complex renal calculi. In this study, we aimed to compare the efficacy and safety of the totally tubeless PNL versus the standard PNL. Methods: Between January 2012 and July 2013, 73 selected patients were treated standard or totally tubeless PNL, nephrostomy tube and ureteral stent was not placed at the end of the operation in 35 (39.7%) (Group 1) of them and 38 (43.1%) (Group 2) patient underwent standard PNL. Stone disintegration was performed with a pneumatic lithotripter. We retrospectively compared patient and stone characteristics, operation time, duration of hospitalization, analgesia requirements, stone-free rate, operative findings, blood loss, and perioperative complications between two groups. Results: The mean operation time, excluding the preparation course, was 38,3±15,4 minutes vs 51,2±12,9 minutes and mean fluoroscopy time was 4,5±2,4 minutes vs 4,8±2,1 minutes, respectively. No significant intraoperative complication or indication additional access or second-look PNL due to residual stones was observed. In both groups none of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Blood transfusion was needed only in a patient vs two patients for group 1 and 2, respectively. There were no significant differences in preoperative patient characteristics, postoperative complications between two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with other group. Conclusion: Absence of the nephrostomy tube and ureteral stent may help in keeping the patient comfortable after the operation and reduction in the analgesia requirement and length of hospital stay. We believe totally tubeless PNL is safe and effective management option in properly selected cases. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare demographic data in adult patients undergoing percutaneous nephrolithotomy (PNL) for kidney stone disease in university hospitals from Southeastern Anatolia and the Black Sea regions. Material and methods: The demographic data of 535 (53.3%) patients undergoing PNL from Gaziantep University, Department of Urology (GAUN group), and 468 (46.6%) patients undergoing PNL from Ondokuz Mayıs University, Department of Urology (OMU group) were evaluated retrospectively. Patients' gender, mean age, stone laterality, and size and results of the stone analyses were compared. Results: The mean patient ages were 40.94±13.33 (17-81) and 48.03±13.95 (17-81) years in the GAUN and OMU Groups, respectively, (p=0.0001). The mean stone size was 716.01±449.60 (100-3000) mm² and 612.7±445.87 (65-3220) mm² in the GAUN and OMU Groups, respectively (p=0.0001). There were no statistically significant differences between the groups with respect to stone laterality (p=0.196), and gender of the patients (p=0.65). Stone analysis revealed that the distribution of stone composition was as follows in the GAUN group: Ca oxalate (90.19%), cystine (7.84%), uric acid (5.88%), and struvite (1.96%). In the OMU group, the stone composition was as follows: Ca oxalate (86.84%), cystine (1.34%), uric acid (13.15%), and struvite (9.21%). Conclusion: The incidence of kidney stone disease varies throughout Turkey based on etiological factors, and a higher incidence of kidney stone disease is observed in the Southeastern Anatolia region endemically. Lower mean ages and higher stone sizes in patients undergoing PNL in southeastern Anatolia suggest that geographic factors can affect stone disease. [ABSTRACT FROM AUTHOR]

Aim: In this study, we evaluated the results of 2300 patients who underwent percutaneous nephrolithotomy (PNL) between March 2002 and April 2013. Methods: In our clinic, a total of 2300 PNL operations were performed between March 2002 - April 2013. Demographic characteristics (age, gender), body mass index, stone features (side, size, location), clinical characteristics of the urinary tract (renal anomaly, previous surgery, previous extracorporeal shock wave lithotripsy), operation parameters (duration of the intervention and fuoroscopy, number of access, location of access, transfusion, complications), post-operative data (length of hospital stay, transfusion, complications, stone-free) were recorded on PNL forms. The data were analyzed retrospectively. Results: Of all the PNL operations, 1225 (53.2%) were left-sided, 1074 (46.6%) were right-sided and 1 was bilateral. The mean age of the subjects was 43.5 (7-83) years and the mean body mass index was 26.6 kg/m2 (12-51). A total of 46 (2%) cases had renal anomalies. There were 16 patients with horseshoe kidney. More than one accesses was performed in 18.6% of the patient and intercostal access was done in 9.8%. Perioperative and postoperative transfusion rates were 1.4% and 2.9%, respectively. The mean stone size was 7.5±4.1 cm2. Stone-free (SF) rate was 65.1% and success rate was 78.5%. Conclusion: With increasing experience and advances in endourology, PNL is being widely performed with low morbidity and high success in our country as in the world. (The Medical Bul le tin of Ha se ki 2013; 51: 19-24) [ABSTRACT FROM AUTHOR]

Objective: To evaluate outcomes of the cases who had undergone retrograde intrarenal surgery (RIRS) in our clinics. Methods: Outcomes of 100 cases who had undergone RIRS because of renal stones between February 2012, and May 2013 were retrospectively evaluated. Results: Study population consisted of 35 female and 65 male patients with a mean age of 36.81(1-76) years. RIRS was performed with the indication of rest double J (D-J) stent (n=1), and renal stone (n=99). Mean stone size was 15.26 (5-27) mm. Preoperatively, 61 cases (61%) had preexisting D-J stents, while 39 (39%) cases were stentless. Access sheaths were used in 86 (86%) cases, while in 14 (14%) cases the procedure was applied without using an access sheath. Mean operative, and fluoroscopy times were 52.72 (10-120) minus, and 57.32 (10-180) seconds, respectively. Postoperatively D-J stents were implanted in 88 (88%) cases, and 12 (12%) cases were stent-free. Mean hospital time was 1.3 (1-7) days. After one month postoperatively, stone-free rate was achieved in 87 (87%) patients. Clinically insignificant residual stone fragments (CIRF) 6 (6%), and residual stones 7 (7%) were also detected. The latter group consisted of cases with horseshoe kidney (n=1), pelvic kidney (n=1), and kyphoscoliosis (n=1). Also in two case procedure was terminated prematurely, because of blurring of the vision secondary to bleeding. Apart from these patients, any preoperative complication did not develop. During follow-up period, urinary tract infection developed in 3 patients with resultant renal parenchymal damage in one patient. In one patient, D-J stent migrated into ureter. Conclusion: Retrograde intrarenal surgery is an effective and safe technique in the management of renal stones. [ABSTRACT FROM AUTHOR]

Urolithiasis is one of the most common urinary tract disorders in childhood and the prevalance of the disease increases in last decade. An important feature of childhood urolithiasis is presence of the underlying cause of methabolic and anatomic disorders. Interventions of the underlying causes are reduces morbidity due to this disease. Characteristics of urolitiasis in children, as well as diagnostic and therapeutic approaches were evaluated in this report. [ABSTRACT FROM AUTHOR]

Objective: In this study, we compared our experience using balloon and amplatz dilatation in percutaneous nephrolithotomy (PCNL). We also evaluated peri-operative and postoperative variables, including success rates. Material and methods: Two hundred renal stone patients (123 men/77 women) underwent PCNL at the Urology Clinic of İzmir Atatürk Training and Researching Hospital from September 2005 to May 2011. The nephrostomy tract was dilated using a balloon (128 patients) or amplatz (72 patients) dilator. The groups were compared by age, total operating time, treatment success rate, retreatment rate, pre- and postoperative hematocrit values, the mean decrease in hematocrit values, blood transfusion rate, stone burden, tract dilatation failure, hospital stay and nephrostomy removal times, stone localization, previous stone operation and the cost of the dilatation system. Results: There was no statistically significant difference in the operative time (97.9±45.3 minutes in balloon group vs. 98.5±43.4 minutes in amplatz group; p=0.43), preoperative hematocrit value (39.04±4.21 vs. 38.94±4.49; p=0.87), postoperative hematocrit value (32.74±4.86 vs. 32.48±5.43; p=0.73), hematocrit decrease (6.30±2.60 vs. 6.45±2.64; p=0.68), blood transfusion rate (15.6% vs. 16.7%; p=0.84) or treatment success rate (78.9% vs. 79.2%; p=0.96) between balloon and amplatz groups. Differences in other variables were also not observed between the two groups. Conclusion: The balloon dilator and amplatz dilator have similar results with regard to efficacy, speed, and safety. However, the cost of the balloon dilator is higher than that of the amplatz dilator. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to present the data on totally tubeless nephrolitotomy (PNL) outcomes undergone in our clinic. Materials and Methods: We retrospectively analyzed 140 patients undergone totally tubeless PNL in our clinic between January 2010 and December 2012. Results: Mean patient age was 47,84 (5-73). Mean operative time was 88,8 (45-110) minutes where mean stone area was 375,3 (110-175) mm2. 92,8% was our stone free rate. Remaining 10 patients had undergone ureterorenoscopy for ureteral stones. Two patients having non-opaque stones had residual kidney stones and treated by SWL. 8 patients (%5,7) needed blood transfusion, 2 patients needed perirenal hematoma and treated conservatively. No patients needed additional treatment or encountered vascular complications. One patient encountered serozal colon injury and treated conservatively. Conclusion: With regard to patient comfort, shorter hospital stay, low analgesic requirement, totally tubeless PNL gained popularity. We believe totally tubeless PNL may be used in suitable cases. [ABSTRACT FROM AUTHOR]

Objectives: It was aimed to evaluate the effectiveness of combined use of ultrasonography (US) and plain radiography (PR) in the postoperative follow-up of patients undergoing retrograde intrarenal surgery (RIRS). Materials and methods: The charts of 207 patients who underwent RIRS for renal stones in a 3-years-period were retrospectively reviewed. Fifty-eight patients were included to study who were evaluated with combination of urinary US, PR and computed tomography (CT) at 1 month after surgery. Results: Of 58 procedures with perioperative complete stone fragmentation, 49 were completely stone-free (84.4%), while fragments (≥ 3 mm) were observed in 9 patients and hydronephrosis was detected in 5 patients (8.6%) on the CT. Of the 9 residual stones and 5 hydronephrosis, the radiologists truly diagnosed 6 stones (66.6%) and 5 hydronephrosis (100%) by using the combination of US and PR. The sensitivity, specificity, positive and negative predictive values of US and PR for detecting presence of residual stone and hydronephrosis were 66.6% and 100%, 98% and 98%, 85.7% and 83.3%, 94.2% and 100%, respectively. Conclusions: A combination of urinary US and plain film has clear advantages about lack of radiation exposure over CT scan and it is a highly specific and sensitive test for detecting hydronephrosis. However this procedure has limited accuracy for detecting small residual stones, so we believe that CT scan is only necessary when patient has persistent pain or sonographic evidence of hydronephrosis is present. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to describe the external anatomical landmarks and angles as a training guide for urologists in the performance of percutaneous nephrolithotomy (PCNL) in the prone position. Materials and Methods: Between 2006 and 2008, 50 patients (including 10 resident cases) undergoing PCNL met the study criteria. The inclusion criteria consisted of patients with renal stones scheduled for a lower calyceal puncture PCNL where the number of attempts to access the calyx ≤ 3, and clear urine was seen draining from the needle. The exclusion criteria consisted of previous ipsilateral kidney surgery, severe hydronephrosis, anomalies of the renal or skeletal systems, BMI>30 kg/m2, upper/middle calyceal puncture and age ≤18. Several anatomical landmarks and angles were measured, recorded and analyzed. Results: The mean length of (Pi) was 10.1±1.7 cm (range 7-14), (Pe ) was 9.9±1.7 cm (range 6-13), (a) was 11.2±2.8 cm (range 5.5-17), (b) was 5.3±2.3 cm (range 1.5-11 cm), (x) was 5.1±1.9 cm (range 1-8), (x1) was 3.3±1.7 cm (range 1.5-8.2), (y) was 7.1±1.7 cm (range 3.3-11.6), (y1) was 3.8±1.6 cm (range 1-9) and (t) was 4.9±1.7 cm (range 3-9). The mean angle for (α) was 49±13º (range 30-70º), (β) was 41±13º (range 20-70º) and (γ) was 61±13º (range 28-80º). In resident cases, the median number of attempts was 1 (range 1-3), the median overall time for successful access was 7.25 minutes (range 2-12) and the median fl uoroscopy time was 62.5 seconds (range 30-150). Conclusion: A knowledge of these anatomical landmarks and angles may increase the capacity of urologists to repetitively perform the precise task of percutaneous access of the lower calyceal during PCNL. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate the effect of a prilocaine 2% injection on the acute management of pain after a lower caliceal puncture during a percutaneous nephrolithotomy. Materials and Methods: In this prospective randomized study, which was conducted between March, 2009 and April, 2010, 100 patients who underwent percutaneous nephrolithotomy (PCNL) were enrolled in this study. In group 1, 10 ml of saline was infiltrated. In group 2, after the operation, 10 ml of prilocaine 2% was infiltrated into the layers instead of saline. The postoperative VAS scores at 2, 4 and 24 hours and the additional analgesia requests were noted and evaluated. As a rescue analgesia, meperidine 1 mg/kg was administered intramuscularly if necessary. Results: All of the patients requested additional analgesia within 2 hours of the operation. In 4 hours, however, 38 patients (76%) in group 1 and 14 patients (28%) in group 2 requested an additional analgesic. This difference was strongly significant (p=0.000). In 24 hours, 7 (14%) and 4 (8%) patients request additional analgesia in groups 1 and 2, respectively, which was not statistically significant (p=0.33). Conclusion: The results of our prospective randomized study suggest that the infiltration of prilocaine 2% near the nephrostomy tract has an effect on the acute management of pain after a lower caliceal puncture during PCNL. [ABSTRACT FROM AUTHOR]

Objective: In this study, the adequacy of technical equipment used in the treatment of renal stone along with treatment approaches was evaluated. Materials and methods: Between January 2010 and June 2010, 106 urology residents and specialists practicing in 10 different urology departments of training hospitals in Istanbul were asked to fill a questionnaire toevaluate the adequacy of necessary equipment and the treatment approaches for the treatment of renal stone. Results: Eighty percent of the physicians who participated in the study treated at least 8 patients with renal stone per month. While all participating clinics had rigid nephroscope, flexible ureterorenoscopy and electroshock wave lithotriptor were available in 41% and 49% of the clinics, respectively. The preferred radiologic evaluation before percutaneous nephrolithotomy (PNL) was intravenous pyelography, and abdominopelvic computed tomography in 72% and 69%, respectively. Tubeless PNL was not preferred by 71% of the participants. The first choice of treatment for coraliform stone was PNL and open surgeryin 71% and 26% of participants, respectively. Fifty-four percent of the participants stated that PNL was applied for patients older than 12 years old. Retrograde intrarenal surgery was suggested by 26% of the participants for the treatment of symptomatic lower calix stone.Conclusion: It is encouraging that PNL application is performed in all clinics involved in this study, however, training hospitals should be more equipped. [ABSTRACT FROM AUTHOR]

Kidney stone formation has a multifactorial pathology involving the interaction of genetic and environmental factors. There is increased risk of stone formation in the relatives of idiopathic stone patients, which can be explained up to 60% by genetic factors. 30-60% of the patients with calcium oxalate (CaOx) stones are proved to have hypercalciuria. The most important factor in the active calcium absorption is 1,25-dihidroxy vitamin D, which is also known as calcitriol. Calcitriol has indirect effects on bone and kidney in addition to its role in intestinal calcium absorption. Therefore vitamin D has a central role in the control of endocrine system, bone and calcium homeostasis. Calcitriol mediates its genomic activities via vitamin D receptor (VDR). There are lots of polymorphisms identified in the VDR locus, the most widely studied ones are ApaI, EcoRV, BsmI, TaqI, FokI and Tru9I. There are ethnic variations in the distribution of VDR polymorphisms. The outcomes of the ethnic variations are not easy to understand due to differences in dietary habits and environmental factors among ethnic groups. In addition to that, there are different genetic backgrounds on which VDR polymorphisms interact with each other and with variants of other genes. Therefore it is important to identify the haplotype stuructures of VDR polymorphisms in different ethnic groups. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of the gravity-related radiographic features on the success rate of extracorporeal shock wave lithotripsy (SWL) in renal stones. Materials and methods: A total of 79 patients (mean age 47.34±12.9 year) who underwent SWL due to renal pelvis stones (mean area 162.58±130.31 mm²) between 2005 and 2008 were enrolled. Three angles on the pretreatment excretory urography were measured; the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle 1), lower pole infundibular axis and main axis of pelvis-ureteropelvic junction point (angle 2), and lower pole infundibular axis and perpendicular line (angle 3). Age, number of session, stone burden, numbers of shock waves, and presence of hydronephrosis were defined for all patients. The significant predictors of stone-free rate after the application of SWL was defined. Results: The success rate was 53.2%. All angles, number of sessions, stones burden, and number of shock waves were significant predictors of stone free rate. However, age, sex and the presence of hydronephrosis did not show similar effects. Conclusions: Gravity-related factors have significant role on the stone-free rate in patients treated with SWL for renal pelvis stones. These radiographic parameters may be used to determine the patients who will benefit from SWL. [ABSTRACT FROM AUTHOR]

Objective: The urine flow, which is also called ureteric jet, can be demonstrated by Doppler ultrasound at the ureterovesical junction (UVJ). The aim of this study was to evaluate the flow pattern changes of the urine at the UVJ in patients with nonobstructive nephrolithiasis. Materials and methods: Twenty-four patients with uncomplicated renal calculi were included in this prospective study. Transabdominal color Doppler ultrasonography was performed to evaluate the UVJ of 24 patients and 31 healthy volunteers as the control group. Results: Although there was a slight increase in the duration of the ureteric jet, peak velocity, and frequency of the jet flow in patients with nephrolithiasis; the difference between groups was not statistically significant (p>0.05 for all). However, when normal and abnormal (with calculi) sides of the same patient were compared, ureteric jet flow patterns were predominant in monophasic form at the side with calculi. The jet spectrum pattern was monophasic, biphasic, and triphasic in 26, 2, and 2 abnormal sides respectively, while these figures were 13, 32, and 13 for normal sides (p<0.05 for all patterns). Spectral form of the both sides of patient group was significantly different from that of the control group (p<0.0001). Conclusion: The assessment of color Doppler pattern of ureteric jet flow at the UVJ is valuable in the diagnosis of nonobstructive nephrolithiasis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the role of coronary artery calcification score (Agatston score) in the prediction of renal calculi composition. Materials and methods: Thirty patients with renal calculi were included in the study. Agatston score and renal calculi volumes were calculated by means of computed tomography without contrast enhancement. Additionally, serum sodium, potassium, chlor, urea, creatine, total and ionized calcium, phosphore; 24-hour urinary potassium, chlor, urea, creatine, uric acid, calcium and phosphor; spot urinary calcium and chlor levels were obtained. Agatston scores were calculated by the use of traditional cut-off level of 130 Haunsfield units (HU). Agatston scores, biochemical parameters, and postoperative renal calculi analysis results were compared. Results: There was not any statistically significant relationship between Agatston scores, biochemical parameters and renal calculi analysis results (p>0.05). Conclusion: According to our methods, Agatston score is not able to predict the renal calculi composition. We suggest that Agatston score could be used in the prediction of renal calculi composition if the cut-off level would be elevated close to the level of bone density (1000 HU) by a software program. [ABSTRACT FROM AUTHOR]

Stone formation is a complex process, mainly because stone disease is a polygenic, multifactorial disorder that involves an interrelationship between the kidney, bone, and intestine. Although great progress has been made in recent years to delineate the exact processes that lead to the formation of renal calculi, there are many incompletely answered questions regarding pathogenesis of stone formation. There are distinct stone phenotypes and the cascade of events leading to kidney stone formation varies depending on this phenotype. Different mechanisms of stone formation have been described for numerous stone types and clinical situations. Herein, we reviewed the current knowledge about the basic pathophysiologic theories involved in the formation of different renal calculi. [ABSTRACT FROM AUTHOR]

Hypercalcemia is a known but rare complication of sarcoidosis. We report a case of sarcoidosis presenting with hypercalcemia and renal failure Twenty two years old woman admitted to hospital with recurrent loin pain. Abdominal ultrasonography showed medullary nephrocalcinosis . Labarotory analysis revealed persistent hypercalcemia and renal insufficiency. PTH level was suppressed. Bilateral lymphadenopathy seen in Chest x-ray, reported as mediastinal adenopathy in CT scan. Serum ACE level was elevated. Renal biopsy revealed tubular obstruction with oxalate crystals. Trans-bronchial lymph node biopsy was non-diagnostic. Corticosteroid treatment was started with suspicion of sarcoidosis and creatinine level decreased gradually to 3 mg/dl. Sarcoidosis without pulmonary symptoms should be suspected in patients with non-parathyroid associated hypercalcemia. Early diagnosis and appropriate treatment may prevent development of nephrocalcinosis and renal failure. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy is widely accepted and effective treatment modality for renal stone disease. When compared with other surgical interventions such as open renal surgery, percutaneous nephrolithotomy has lower morbidity and postoperative patient discomfort, so percutaneous nephrolithotomy mostly replaced open surgery in most of the urology clinics in Turkey and worldwide. In this review it is aimed to discuss indications and limitations of percutaneous nephrolithotomy that mean the proper patient selection and also to discuss important points of surgical technique and devices for intrarenal lithotripsy and instruments for kidney drainage after the procudure that all will offer the physicians successfull outcome. [ABSTRACT FROM AUTHOR]

Amaç: Böbreğin skuamöz hücreli karsinomu (SCC) literatürde sınırlı sayıda olgunun bildirildiği nadir görülen malignitelerden biridir. Hastalık agresif seyir gösterme eğilimde olup çoğunlukla böbrek taşı zemininde gelişmektedir. Tanıda altın standart bilgisayarlı tomografidir (BT). Bu olgu sunumunda böbrekte izlenen kitle ve olası uzak metastazını değerlendirmek amacı ile çekilen pozitron emisyon tomografi/bilgisayarlı tomografi (PET)/BT bulgularını sunmayı amaçladık. Olgu: Elli dokuz yaşında erkek hasta. Sol böbrekte taş öyküsü bilinen hastanın takiplerinde yüksek ateş şikayeti olması üzerine dış merkezde tetkiklerinde lökosit, C-reaktif protein yüksekliği saptanmış, hastaya semptomatik tedavisi düzenlenerek operasyon için merkezimize yönlendirilmiş. Kontrastlı batın BT'de sol böbrekte, staghorn taşı çevresinde renal pelvis ve proksimal üreteri dolduran ve kortekse uzanan yaklaşık 3x7x4 cm boyutlu, heterojen kontrast tutulumu gösteren belirsiz sınırlı alan izlenmiş, ayırıcı tanıda transisyonel hücreli karsinom, tüberküloz, ksantogranülomatöz pyelonefrit düşünülmüş. Batın BT'de ayrıca nekrotik lenf nodları ve peritonda nodüller gözlenmiş. PET/BT'de böbrek üst pol seviyesinden başlayarak sol paraaortik alanda en büyüğü hilus seviyesinde yaklaşık 27x16 mm boyutlara ulaşan hipermetabolik lenf nodları (SUVmax: 16,9), böbrek hilusunda sınırları böbrek parankiminden yer yer ayrılamayan, hilusta yerleşimli staghorn taşı çevreleyen, yaklaşık 60x35 mm boyutlarında heterojen florodeoksiglukoz (FDG) tutulumunun izlendiği kitle lezyon gözlendi (SUVmax: 18,8). Sol böbrek gerota fasyasında anterior yerleşimli fasya üzerinde nodüler hipermetabolik kalınlık artışı saptandı (SUVmax: 7,3). Sağ böbrek kontrastlı BT'de izlendiği gibi pelvik girimde ektopik ve malrote görünümdeydi, içerisinde pelvik yerleşimli yaklaşık 10 mm çaplı kalsifik kalkül mevcuttu. Bunun haricinde; belirgin bir özellik saptanmadı. Histopatolojik değerlendirme önerilen hastadan yapılan böbrek biyopsisinde skuamöz hücreli karsinom tanısı kondu. Bulguların ön planda taşa sekonder irritasyon nedeniyle olduğu düşünüldü ve hastaya nefroüreterektomi planlandı. Sonuç: Böbrek tümörlerinin çoğu transisyonel hücreli tümörlerdir. Renal skuamöz hücreli karsinomu (SCC) nadir görülen bir malignite olup cerrahi sonrası adjuvan tedavi kombinasyonları önerilmektedir. Böbrek tümörlerinde PET/BT'nin yeri idrar retansiyonu ve FDG afinitesinin heterojen olması nedeniyle sınırlı olmakla birlikte renal SCC ayrı olarak değerlendirilmelidir. FDG afinitesi nedeniyle seçili olgularda lezyon karakterizasyonu amacı ve uzak metastazı belirlemede kullanılabilir. [ABSTRACT FROM AUTHOR]

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Hydatid cyst is an endemic disease in several regions of the world. Renal involvement is rare. Association with kidney stones is even less likely. We report a case with isolated renal hydatid disease mimicking a non-opaque kidney stone. [ABSTRACT FROM AUTHOR]