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Tranexamic acid, once a randomly used antifibrinolytic agent, has been in standard protocols for many specific surgeries. Studies are still needed to standardize the dose and route of tranexamic acid administration, examine its possible contributions in urological surgery, and establish a protocol for its use. To contribute to this goal, we designed a prospective, randomized, double-blind study on 75 patients with 1 control and 2 study groups (n = 25) who underwent percutaneous nephrolithotomy. Group Tranexamic acid received 10 mg/kg intravenous tranexamic acid preoperatively. And Group Irrigation received the same amount in the initial irrigation fluid. Primarily, we observed the total amount of blood transfusion and the changes in hemoglobin and hematocrit values during 2 postoperative days. Distinctively, we intraoperatively monitored hemoglobin continuously as a saturation hemoglobin value to assess the timing of the effect of tranexamic acid. Secondarily, we questioned surgical visual clarity with a standard visual score to reveal its contribution to surgical practicality, operative time, and residual fragment quantity. Our results revealed a significant difference in the reduction of hemoglobin and hematocrit change and blood transfusion in both tranexamic acid groups concerning control, especially on the second day (p = 0.003, p = 0.002, p = 0.001). Likewise, surgical visual scores were significantly better in both tranexamic acid groups (p = 0.018). In conclusion, intravenous or local administration of tranexamic acid at a dose of 10 mg/kg will be sufficient to maintain perioperative stability in hemoglobin values, use fewer blood products and provide a better visual advantage for the surgeon intraoperatively. The trial registration number is NCT05947435, and the date of registration is 07/07/2023, retrospectively registered. [ABSTRACT FROM AUTHOR]

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]

Aim of the study: To investigate success of endoscopic lithotripsy for bladder stone following stress urinary incontinance surgery and contraception surgery. Materials and methods: Charts of patients admitted in two centers between January 2006 and March 2013 were retrospectively reviewed and seven women were enrolled in our study. Patients demographic parameters including age, main complaint(s), previous surgery type, time to diagnosis were analyzed. Also operative time, hospitalisation lenght, perioperative and postoperative complication( s) were evaluated. Results: Five patients had undergone tension free vaginal tape procedure and one patient had undergone transobturator tape procedure. Median age was 62 (50-71) years. In one patient bladder stone formed around an intrauterine device. Dysuria (85%), hematuria (57%) and recurrent urinary tract infection (57%) were the main complaints. The median diagnosis time was 44.1 months. Abdominal ultrasonography and non contrast enhanced computer tomography were performed for five and two patients respectively and diagnosis was confirmed cystoscopically. Endoscopic lithotripsy using Holmium laser lithotripter or pneumatic lithotripter was used for all cases. The mean operation time was 41.2 minutes (20-70) and success was 100%. There was no intraoperative complication. Only one patient had fever higher than 38°C postoperatively and was treated by appropriate antibiotic. The median hospitalisation time was 1.57 day. Conclusion: In conclusion endoscopic lithotripsy is a safe and effective approach to manage bladder stone associated with mid-urethral synthetic slings and intrauterine devices. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare the efficacy and safety of mini-percutaneous nephrolithotomy (mPNL) and standard PNL (sPNL) in a group of patients who had a history of PNL and/or open renal surgery (secondary patients). Materials and Methods: The study included 148 patients who underwent secondary PNL between November 2016 and September 2018. The patients with kidney stone ≥2 cm were included in the study. Patients were randomly divided into two groups as mPNL and sPNL. For both groups, demographic data, stone characteristics, and operative and postoperative data were recorded prospectively. Data were analyzed at 95% confidence interval and considered significant when p value was <0.05. Results: A total of 148 (76 mPNL, 72 sPNL) patients with a history of PNL and/or open surgery were included in the study. The mean duration of operation was longer in mPNL (106.9 vs 91.2 minutes, p = 0.016). The mean duration of fluoroscopy in mPNL was shorter (4.4 vs 5.3 minutes, p = 0.021). The tubeless procedure was higher in the mPNL (21.1% vs 2.8%, p = 0.001). The hemoglobin drop was less in mPNL (0.7 vs 1.4 g/dL, p = 0.011). Duration of nephrostomy and hospitalization was longer in sPNL (p = 0.001 and p = 0.005, respectively). The success rate in the mPNL group was higher compared with the sPNL group; however, this difference was statistically insignificant (75.0% vs 72.2%, p = 0.558). Conclusion: mPNL is superior to sPNL in terms of hemoglobin drop, duration of fluoroscopy, applicability of a tubeless procedure, and duration of nephrostomy and hospitalization among secondary patients. Duration of operation was found to be longer for mPNL. Success rate was higher in the mPNL group, although not statistically significant. [ABSTRACT FROM AUTHOR]

Aim: To analyze the effect of double-J stent placement on shockwave lithotripsy (SWL) success in the treatment of relatively large (15-25 mm) upper and middle calyceal stones. Methods: A total of 167 patients who had 15-25 mm opaque upper or middle calyceal stones and scheduled for SWL were included in the study. Patients with solitary kidney, urinary system anomalies, skeletal anomalies, previous urologic surgery, severe calyceal dilatation, untreated urinary tract infection, bleeding disorder, eGFR<60 and suspected pregnancy were excluded from the study. The remaining 148 patients were randomized into two groups as stented and non-stented. Thirty-one patients whose stones could not be fragmantated despite three sessions were also excluded. A total of 117 patients (30 stented and 87 non-stented) were further analyzed. The groups were compared in terms of patient- and stone-related factors. Results: Eighty-nine (76%) patients were male and 28 (24%) were female. There was no significant difference between the groups in terms of age, gender, body mass index, stone side, stone size, skin-to-stone distance, Hounsfield unit and renal parenchymal thickness. The success rate was 70% and 51.7% in the stented and non-stented groups, respectively (p=0.31). Conclusion: Prestenting does not affect the success of SWL in the treatment of 15-25 mm upper and middle calyceal stones. [ABSTRACT FROM AUTHOR]

Purpose: The miniaturized percutaneous nephrolithotomy (mPNL) can be performed by using a very wide range of different access sheaths (14-22 Fr).It has been well known that tract size is one of the main parameters affecting the complication rates in PNL. We aimed to compare 21 Fr with 16.5 Fr mPNL tract sizes in adult patients.Material and Methods: From May 2013 to April 2018, 604 patients with kidney stone underwent mPNL in our department. The study was designed as retrospective and match-pair analysis was the preferred method for the formation of groups.  The 21 Fr mPNL cases were matched with 16.5 Fr mPNL cases at a 1:1 ratio, according to the patients' age, gender, body mass index, American Society of Anesthesiologists (ASA) score, stone characteristics (stone size, opacity and localization) and hydronephrosis. Patients with solitary kidney, renal anomalies, musculoskeletal abnormalities, and pediatric patients (< 18 years old) were excluded from the study. Both groups (21 Fr and 16.5 Fr) were compared in terms of demographics, stone characteristics, operative data and post-operative outcomes.Results: A total of 260 patients were included in the study (130; 21 Fr mPNL group and 130; 16.5 Fr mPNL group). The operation time was significantly shorter in 21 Fr group (21 Fr; 85.2±37.5, 16.5 Fr; 101.7±37.7 minutes, p: 0.001). Complete stone clearance rates were 76.9% and 62.3% in 21 Fr and 16.5 Fr mPNL, respectively (p: 0.01). There was no significant difference between the groups in terms of overall operative and post-operative complications. However, in subgroups analysis, post-operative fever was higher in 16,5 Fr mPNL (4 patients in 16.5 Fr, no patients in 21 Fr group, p: 0.044); steinstrasse, renal colic and post-operative JJ stent requirement rates were higher in 21 Fr mPNL procedure (p: 0.018, p: 0.031 and p: 0.046, respectively). The hospitalization time was significantly higher in 21 Fr (p: 0.01).Conclusions: Although 21 Fr mPNL procedure has advantages such as better success rates and shorter operation time, some post-operative complications (steinstrasse, renal colic, post-operative JJ stent requirement) are against of 21 Fr mPNL when compared with 16.5 Fr mPNL procedure. Further randomized prospective studies with larger patient volume are needed to confirm these results. [ABSTRACT FROM AUTHOR]

We aimed to compare the outcomes of mini-percutaneous nephrolithotomy (mPNL) and standard PNL techniques in the treatment of renal stones ≥ 2 cm. The study was designed as a randomized prospective study between January 2016 and April 2017. The patients with a kidney stone ≥ 2 cm were included in the study. Patients who had uncorrectable bleeding diathesis, abnormal renal anatomy, skeletal tract abnormalities, pregnant patients and pediatric patients (< 18 years old) were excluded from the study. The remaining patients were randomly divided into two groups as standard PNL and mPNL. For both group, demographic data, stone characteristics, operative data and postoperative data were recorded prospectively. The study included 160 consecutive patients who had kidney stone ≥ 2 cm. Of these, patients who met the exclusion criteria and patients who had missing data were excluded from the study. Remaining 97 patients were randomly divided into two groups as mPNL (n: 46) and standard PNL (n: 51). The mean age was 46.9 ± 13.7 and 47.4 ± 13.9 years for mPNL group and sPNL group, respectively. According to Clavien–Dindo classification, no statistical difference was detected between the groups in terms of complication rates (p 0.31). However, the rates of hemoglobin drop and transfusion rates were significantly in favour of mPNL (p 0.012 and p 0.018, respectively). Nephrostomy time and hospitalization time was found to be significantly shorter in mPNL group (p 0.017 and p 0.01, respectively). The success rate in the mPCNL group was higher than standard PNL group, however, this difference was statistically insignificant (76.5 vs 71.7%, p 0.59). Both mPNL and standard PNL are safe and effective treatment techniques for the treatment of kidney stones of ≥ 2 cm. Although there was no significant difference in success rates of both techniques; nephrostomy time, hospitalization time, bleeding and transfusion rates were in favour of mPNL. [ABSTRACT FROM AUTHOR]

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]

Objective: The aim of this study is to describe a novel transobturator midurethral sling surgery technique by using rectus abdominis fascia. Material and methods: A 54-year-old woman complaining of u rinary leakage during effort was d iagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry and measurement of residual urine volume. She was anxious about complications related to synthetic meshes. However, she was not interested in relatively morbid surgeries such as colposuspension and pubovaginal sling. Autologous transobturator midurethral sling was discussed with the patient. The patient approved the surgery and the surgery was planned. A 5 cm rectus fascia was harvested via suprapubic incision and nonabsorbable stay sutures were placed on its' both edges. Anterior vaginal incision together with paravaginal dissection was performed, as in classical transobturator sling surgery. Groin puncture and blind dissection of adipose tissue was performed. C-shaped trocars were inserted, and advanced through groin punctures and brought up to midurethral incision by finger guidance. Stay sutures were transported via C-shaped trocars to the groin puncture in both sides. Graft was positioned on the midurethral part without any tension and stay sutures were tied to create a tissue bridge on obturator membrane. Incisions were closed and vaginal tampon was placed. Patient was discharged at the first postoperative day. Results: At postoperative third and sixth months, patient was totally dry and did not have any voiding complaints. Small abdominal and vaginal incisions were clean, as well. Conclusion: Autologous transobturator midurethral sling surgery is a safe, effective and feasible surgical option for stress urinary incontinence in the era which mesh-related concerns are rising. Studies with larger volume and long-term follow up periods are needed. [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]

Background: To analyze the characteristics of the patients with diagnosis of spontaneous retroperitoneal hematoma associated with anticoagulation therapy and antiplatet therapy. Methods: From January 2006 to March 2013, 9 patients (6 from Haseki Training and Research Hospital - Urology Department and 3 from Istanbul Medical Faculty - Gynecology and Obstetric Department) were included in the study. Patients charts including sex, age, comorbidities, main complaint, and medication intake were examined. Also initial hemoglobin level, initial International Normalized Ratio level, red blood cells and fresh frozen plasma units transfused were evaluated. Results: Median age was 60 year-old. Abdominal pain and flank pain were common symptoms. Eight patients were taking only anticoagulation therapy, 2 only antiplatet therapy and 1 both anticoagulation and antiplatet therapy. Median initial hemoglobin value was 9,0 g/dL and median International Normalized Ratio level was 3.2 Patients were evaluated by abdominal ultrasonography or abdominal computer tomography. Seven patients were treated conservatively. Only one patient died because of septic shock with a mortality ratio of 11%. Conclusion: Despite benefits of anticoagulation and antiplatet theraphy these agents have serious side-affects as retroperitoneal hemorrhage in elderly patients taking multi-drug medication. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate cure rate and mid-term results of tension-free vaginal tape for recurrent stress urinary incontinence after failed transobturator tape surgery. Material and Methods Between January 2006 and December 2011, 42 women were enrolled in this study. Patient characteristics and operating parameters were recorded, and any complications were noted. All patients were followed up for at least 24 months after the second surgery. The Incontinence Impact Questionnaire and the Urinary Distress Inventory were used to identify satisfaction level. Results The mean age of the patients was 49.07 ± 8.6 years, and median period between transobturator surgery and the tension-free vaginal tape procedure was 12.8 (range 9.2-17.8) months. The cure rate was 83.3% and 76.2% at the first- and second-year follow-up visits, respectively. Intraoperative complications were transient and slight. Bladder injury in five patients and subcutaneous hematoma above the pubis in two patients were the most serious complications, but they were managed conservatively. We found the scores of the Incontinence Impact Questionnaire and Urinary Distress Inventory to be significantly lower at follow-up, compared to the preoperative assessment. De novo urgency was the most common complaint at follow-up and occurred in 11.9% of the women. Conclusions We suggest that tension-free vaginal tape is a feasible surgical option for recurrent stress urinary incontinence. Further studies with larger patient numbers and longer follow-up periods are needed to support this finding. [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]