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Objective: To assess inter-observer reliability and reproducibility of CROES, Guy’s and S.T.O.N.E. nephrolithometry scoring systems (NSS). Material and Methods: A total of 128 patients who underwent percutaneous nephrolithotomy (PNL) between January 2019 and January 2021 were included in the study. Calculation of the CROES, S.T.O.N.E, and Guy’s NSSs was made by three independent urologists with different academic levels. These were; a very experienced (>500 PCNL cases) endourologist (Rater 1), a urologist who had just finished (>100 PCNL cases) their urology education (Rater 2) and a 3rd year urology resident who had never performed a PCNL operation (Rater 3). All were blinded to the procedure outcomes. Results: An excellent correlation was found between three raters for Guy and S.T.O.N.E. scoring systems (kappa value 0.810-0.962). However, for the CROES score there is an excellent correlation between Rater 1 and Rater 2, but there were good correlations between Rater 1 vs Rater 3 and Rater 2 vs Rater 3 (kappa values 0.910 and 0.698-0.721 respectively). The highest correlation was between Rater 1 and Rater 2 for Guy score (kappa value 0.962) (Table 3). All intra-class correlations were statistically significant (p<0.001). The highest intra-class correlations were seen for the S.T.O.N.E. score (ICC: 0.980). Conclusion: The present study revealed that all three NSS frequently used in current urology practice have reproducible and reliable results. Additionally, we believe that the application of CROES NSS by more experienced clinicians will be effective in obtaining clearer results. [ABSTRACT FROM AUTHOR]

Introduction: Aim of this study was to evaluate the impact of urinary incontinence (UI) treatment on female and male sexual functions. Methods: Sexually active women, who were diagnosed with UI and treated by surgically and/or medically between December 2017 and July 2018, were enrolled into the study, prospectively. Patients' demographic properties were evaluated, and patients filled out Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) and Female Sexual Function Index (FSFI) forms. Moreover, partner's age, BMI and sexual status (IIEF-5 score: International Index of Erectile Function) were noted. Trans obturator tape (TOT) operation was performed in patients with stress UI. Patients with UUI underwent anticholinergic treatment. In patients with mixed UI, TOT operation was applied who had evident stress component and then anticholinergic treatment was initiated, if necessary. The patients filled out UDI-6, IIQ-7 and FSFI questionnaires at the 3rd month of initial therapy and patients' partners filled out IIEF-5 form. Results: Forty-two women with UI and their partners were included in the study. Number of sexual intercourses per month was significantly increased after the treatment of UI (3.3/month vs. 5.2/month, p:0.001). Pre-treatment FSFI score was 18.9 in average; and after UI was treated, FSFI score was increased to 24.9 (p=0.001). Moreover, we found significant improvement in IIEF score of partners, after the treatment of female UI (18.5 vs. 22.5, p=0.001). Discussion and Conclusion: Our findings have showed that, treatment of UI in women significantly improved quality of life and sexual function in women and sexual activity in their partners. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Reconstructive Urology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Reconstructive Urology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of study was to compare the efficiency and safety of standard percutaneous nephro- lithotomy (sPNL) and miniaturized percutaneous nephrolithotomy (mPNL) in lower calyx and/or pelvic stones smaller than three centimeters. Material and methods: From October 2010 to August 2015, 108 mPNL and 176 sPNL procedures were performed for renal stones smaller than three cm and located in the lower calyx and/or renal pelvis. All patients were evaluated preoperatively with intravenous pyelography and/or computed tomography. Intraoperative parameters, post-operative results and complications were recorded. Postoperative success was defined as complete stone clearance and/or clinically insignificant residual fragments at 3rd month. Results: Preoperative characteristics were similar between sPNL and mPNL groups except previous renal stone operation history and gender. The mean operation time was significantly shorter in the sPNL group (p<0.001). The mean hemoglobin drop was significantly less in the mPNL group (p=0.001), we found a 1.27±1.4 and 0.5±1.3 decrease in mean hemoglobin levels (mg/dL) in the sPNL and mPNL groups, respectively. Transfusion rate was 1.9% in mPNL and 5.6% in sPNL groups, and the difference was statistically significant (p=0.048). Only one patient in the sPNL group needed angiography and embolization. Postoperative JJ stent insertion rate was significantly higher in the mPNL group (p=0.03). Conclusion: Both sPNL and mPNL are safe and effective surgical procedures for lower calyx and/or pelvis stones smaller than 3 cm. However, use of smaller caliber instruments was associated with a lesser hemoglobin drop and need for transfusion. [ABSTRACT FROM AUTHOR]

In this study, we discuss the place of robotic surgery in urology in the light of the current technological developments. Within the past 15 years, unprecedented advances have been experienced in robotic surgery. Urology has been played an active role in these developments. Owing to innovations of robotic surgery, some technical limitations of conventional laparoscopy have been overcome. Especially, some technical limitations of conventional laparoscopic surgery requiring reconstruction and operational challenges have significantly been solved. Despite these superior advantages, high cost of the method is the most important disadvantage. In the literature, the cost-effectiveness is the main point of discussions about robotic surgery. In the future, if the cost problem is resolved, robotic surgery will be the gold standard of treatment for the operations, such as partial nephrectomy, pyeloplasty, radical prostatectomy and radical cystectomy, which require more complex reconstruction. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the concordance between the Gleason Scores (GS) of prostate biopsy and radical prostatectomy specimens. Methods: Prostate biopsy was performed in 1135 patients with the suspicion of prostate cancer in our clinic between 2008 and 2012. A total of 366 patients were diagnosed with prostate cancer. Radical prostatectomy was performed in 73 of these patients and GS of pathology specimens were included in this study for comparison. The patients were divided into three groups (low intermediate- and high-risk patients) according to the D'amico risk classification for prostate cancer. Results: The median age of the patients was 64.2±6.1 years (54-73). The mean prostate specific antigen level was 20.34 ng/mL and the mean biopsy core number was 12±0.58. A statistically significant concordance was detected between the GS of biopsy specimens and radical prostatectomy materials in 65.7% of patients (p<0.01). There were 40 patients in the low-risk group, however, 8 (20%) of them were identified to be intermediate-risk patients and one (2.5%) was found to be a high-risk patient after radical prostatectomy. Conclusion: Concordance between the GS of prostate biopsy and radical prostatectomy materials are important for selection of the appropriate treatment. [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]

Aim: To evaluate safety and efficiency of laparoscopic partial nephrectomy for renal tumors larger than 4 cm. Methods: We retrospectivelly evaluated the medical records of 65 patients who underwent laparascopic partial nephrectomy between May 2009 and June 2013 in our clinic. The patients were divided into two groups according to tumor size. Patients with a tumor <4 cm and >4 cm were included in group 1 (n=45) and group 2 (n=20), respectively. Demographic, perioperative and postoperative parameters were compared between the groups. Histopathological examination and surgical margin status were also evaluated. Results: The mean age of the patients was 59.2±10.9 (range: 26-81) years. The mean tumor size and the mean RENAL nephrometry score were significantly higher in group 2 than in group 1. The mean operation time and warm ischemia time were similar between groups but estimated blood loss and transfusion requirement were significantly higher in group 2. Convertion to open surgery was seen two patients in group 2 and one patient in group 1. Only one patient underwent radical nephrectomy for uncontrolled bleeding in group 2. There was no difference in preoperative and 3-month postoperative serum creatinine levels between the groups. The incidence of positive surgical margin was 0% and 5% in group 1 and group 2, respectively. Conclusion: Laparoscopic partial nephrectomy for renal tumors is an effective and feasible procedure with acceptable oncologic results. However, tranfusion rate and requiremet of pelvicaliceal system repair were more common in patients with tumor >4 cm. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of preoperative radiological and postoperative pathological findings on survival of patients after radical nephrectomy because of renal cell carcinoma (RCC). Material and methods: We performed 159 consecutive radical nephrectomy between December 2007 and January 2014. We evaluated age, gender, complaints, operation time, comorbidity, computed tomography (CT) and magnetic resonance graphy (MRG) results. Size of the mass, lymph node involvement, renal vein invasion, and presence of metastases were investigated. During histopathological examination, especially, pathological diagnosis, subtypes of RCC, lymph node involvement, lymphovascular, perineural invasion, and capsular, renal pelvis invasion, and renal vein involvement were sought. Follow-up periods of the patients were determined based on dates of death of the patients, and the study period. Results: RCC was seen in 124 (78%) of patients. Mean estimated suvival of RCC patients was 60 months and 5 year survival was 64%. Tumor size greater than 6.5 cm, lymph node involvement (p=0.006) and metastasis in radiological results (p<0.001), lymphovascular invasion (p=0.015) and stage of disease (p<0.001) found to be significantly affecting the survival. Lymph node involvement in radiological results (p=0.0089; HR: 4.6; Cl 95%: 1.4753 -14.3523) and stage of the disease (p=0.0129; HR: 1.6; Cl 95%: 1.1087-2.3461) were affecting the survival independently. Conclusion: We found radiological lymph node involvement and stage of the disease as independent factors affecting the survival of RCC patients after radical nephrectomy. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Urology is the property of Turkish Association of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To present the first 24 laparoscopic adrenalectomies performed in our clinic because of an ad renal mass. Material and methods: The medical files of 24 patients who underwent laparoscopic adrenalectomy between December 2008 and March 2013 at Haseki Teaching and Research Hospital were analyzed retrospectively. The demographic characteristics of the patients were recorded. Lateral transperitoneal laparoscopic adrenalectomy was performed in all patients. The operation time was defined as the interval between the first incision of the skin and closure of the skin. Intraoperative complications, estimated blood loss and hospital stays of the patients were evaluated. Final pathologies were recorded. Results: The mean age of the patients was 44.2±8.58 years (range: 29-66 years). Nine patients were female and 15 were male. A total of 24 masses were identified in the right (n=ll), and left (n=13) adrenal glands masses were identified., Eighteen patients (75%) had no symptoms, and the masses were identified incidentally. The mean operation time was 144±46.1 minutes (range: 90-320 minutes), and the mean blood loss was 74+12.3 mL (range: 50-130 mL). None of the patients required a blood transfusion. In one patient, liver injury was identified intraoperatively due to traction. The mean duration of hospitalization was 2.9±1.1 days (range: 2-5 days). Adrenocortical adenoma and pheochromocytoma were the most common pathologies. Conclusion: Laparoscopic adrenalectomy is a safe and effective method for the treatment of adrenal masses with low complication rates. [ABSTRACT FROM AUTHOR]

Objective: In obese patients, the management of renal calculi presents a number of challenges for urologists. In this study, we aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy (PNL) procedure in obese and morbidly obese patients. Material and methods: We retrospectively reviewed the medical files of 2360 patients treated with PNL between March 2002 and April 2013. The patients were stratified into four groups according to the World Health Organization (WHO) classification of body mass index (BMI): <25 kg/m2 (average), 25-29.9 kg/m2 (overweight), 30-39.9 kg/m2 (obese), and >40 kg/m2 (morbidly obese). Patients under 18 years of age and those with a body mass index under 18 kg/m2 were excluded from the study. Intra-, and postoperative out comes of PNL were compared between groups. Results: A total of 2102 patients with a mean age of 43±13.62 years were enrolled in the study. The mean stone size, mean number of stones, staghorn stone rate and history of previous shock wave lithotripsy were similar in all groups. The overall stone-free rate was 82 percent. The mean operation time was longer in the morbidly obese group but it was not significantly different from that in the other groups. No differences were observed in hospital stay, complication or stone-free rate among four study groups. Conclusion: Percutaneous nephrolithotomy is a safe and effective treatment for renal stone disease. Body mass index does not affect the success or complication rate in PNL. [ABSTRACT FROM AUTHOR]

The optimal treatment of lower pole stone in kidney is controversial. Shock wave lithotripsy (SWL), flexible ureterorenoscopy (F-URS) or retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomi (PNL) are widely used therapeutic options for lower pole stone. Open surgery and laparoscopic surgery are rarely used modalities. The goal of the treatment is to achieve stone clearance taking into account the clinical features of the patient and urinary system stone properties. Pelvicaliceal anatomical properties influence selection of therapeutic options and success of the treatment. Presence or absence of hydronephrosis, length and width of caliceal neck, association between ureter and pelvicaliceal system are important anatomical factors. Today, SWL is first-line treatment modality for kidney stones smaller than 20 mm and PNL for kidney stones larger than 20 mm. Flexible ureterorenoscopy is used for lower pole stones resistant to SWL. In this review, we aimed to explore the treatment approaches for patients with lower pole renal stone in the light of the current literature. [ABSTRACT FROM AUTHOR]

The optimal treatment of lower pole stone in kidney is controversial. Shock wave lithotripsy (SWL), flexible ureterorenoscopy (F-URS) or retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomi (PNL) are widely used therapeutic options for lower pole stone. Open surgery and laparoscopic surgery are rarely used modalities. The goal of the treatment is to achieve stone clearance taking into account the clinical features of the patient and urinary system stone properties. Pelvicaliceal anatomical properties influence selection of therapeutic options and success of the treatment. Presence or absence of hydronephrosis, length and width of caliceal neck, association between ureter and pelvicaliceal system are important anatomical factors. Today, SWL is first-line treatment modality for kidney stones smaller than 20 mm and PNL for kidney stones larger than 20 mm. Flexible ureterorenoscopy is used for lower pole stones resistant to SWL. In this review, we aimed to explore the treatment approaches for patients with lower pole renal stone in the light of the current literature. [ABSTRACT FROM AUTHOR]

Urinary tract stone disease is one of the most common pathology in urology practice. Surgical procedures are important treatment modality for stone disease. By the development of technology and increasing experience in surgery, today, most of the stone surgeries are performed as endoscopic procedures. Despite all these advantages, stone may remain in the urinary system. After operation, stone remnants may decrease the life quality of patients by impairing the normal physiology of the urinary system and by causing symptoms. For this reason, patients with residual stones should be informed about their illness and, the conservative methods should be explained. As in all patients with urinary stone disease, metabolic evaluation should be performed and, if a preventable reason is found, medical treatment should be initiated. Besides conservative methods and medical treatment, more treatment modalities are needed in the management of residual stones in some patients. Shock wave lithotripsy and secondary surgical procedure are the most appropriate treatment approaches in such cases. Open surgery, percutaneous nephrolithotomy, retrograde intrarenal surgery or ureterorenoscopy may be performed taking into consideration factors as stone location, size and composition as well as urinary system anatomy and existence of comorbidity. [ABSTRACT FROM AUTHOR]

Urinary tract stone disease is endemic in our country with an incidence of 15%. Bladder stones account for 5% of all urinary tract stones. Muscle-nerve disorders causing inadequate emptying of the bladder obstructions that prevent the outflow of urine and metabolic disorders are the main etiological factors in bladder stone formation. Patients with bladder stones are usually admitted to hospitals with pain, bleeding, recurrent urinary tract infections and lower urinary tract symptoms. In this case report, our aim was to present a patient with paraplegia caused by falling from height who underwent bladder stone surgery for multiple bladder stones that were incidentally diagnosed [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Percutaneous Nephrolithotomy for Isolated Calyceal Stones: How Important Is the Stone Location?" which appeared in the 2015 issue.