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This study aimed to investigate the predictive role of serum C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) on renal mass biopsy outcomes. A total of 71 patients with suspected kidney masses who underwent renal mass biopsy procedure between January 2017 and January 2021 were retrospectively evaluated. Pathological results after the procedure were obtained and pre-procedural serum CRP and NLR levels were extracted from the patients’ data. The patients were grouped into benign and malignant pathology groups according to the histopathology results. The parameters were compared between the groups. Diagnostic role of the parameters in terms of sensitivity, specificity, and positive and negative predictive values was also determined. Additionally, Pearson correlation analysis, and univariate and multivariate cox proportional hazard regression analyses were also performed to investigate the above association with tumor diameter and pathology results, respectively. At the end of the analyses, a total of 60 patients had malignant pathology on histopathological investigations of the mass biopsy specimens, whereas the remaining 11 patients had a benign pathological diagnosis. Significantly higher CRP and NLR levels were detected in the malignant pathology group. The parameters positively correlated with the malignant mass diameter, as well. Serum CRP and NLR determined the malignant masses before the biopsy with sensitivity and specificity of 76.6 and 81.8%, and 88.3 and 45.4%, respectively. Moreover, univariate and multivariate analyses showed that serum CRP level had a significant predictive value for malignant pathology (HR: 0.998, 95% CI: 0.940–0.967, P < 0.001 and HR: 0.951, 95% CI: 0.936–0.966, P < 0.001, respectively). In conclusion, serum CRP and NLR levels were significantly different in patients with malignant pathology after renal mass biopsy compared to the patients with benign pathology. Serum CRP level, in particular, diagnosed malignant pathologies with acceptable sensitivity and specificity values. Additionally, it had a substantial predictive role in determining the malign masses prior the biopsy. Therefore, pre-biopsy serum CRP and NLR levels may be used to predict the diagnostic outcomes of renal mass biopsy in clinical practice. Further studies with larger cohorts can prove our findings in the future.

Introduction: Fluoroscopy-guided endourology procedures require proper radiation protection to minimize radiation risk. This multicenter study aimed at investigating radiation protection practice and related radiation exposure of operating team members. Materials and Methods: Six endourology centers from the South-Eastern European Group for Urolithiasis Research answered questionnaires and collected data of 315 procedures performed within a 3-months period, with simultaneous measurement of dose to staff and dose area product (DAP) to patient. A pair of calibrated personal dosimeters, one for body and one for eye-lens dose, was worn by all key staff members. Dosimeters were centrally calibrated, measured, and analyzed. Results: The annual workload ranged from 173 to 865 procedures per center. Practice of personal dose monitoring and use of radiation protection shielding was found to be inconsistent. Lead aprons and thyroid collars were used by all, whereas protective eyewear was used in only half of centers. Due to the regular use of protective aprons, the whole-body dose of all 44 monitored staff members was safely below the regulatory dose limits. Eye-lens dose of 17 (14 urologists and 3 assisting staff) was above the dosimeter detection level, and dose per procedure varied from

Objectives: With an increasing number of patients undergoing ureteroscopic surgery worldwide for stone disease, and the concomitant pressures on health care resources, we aimed to review global patterns for ureteric stenting following ureteroscopy. With a centralized electronic database, a longitudinal cohort study was designed to help define the indications for stenting, type of drainage, and methods of stent removal. Methods: This multicenter study was conducted prospectively, with centralized data acquisition by uCARE (research arm of the Société Internationale d'Urologie), and registered at ClinicalTrials.gov (NCT03567421). Along with baseline demographic data, details were entered for stone imaging characteristics, intraoperative information, including urine culture, and exit strategy for stent removal. An independent audit was undertaken to sample the accuracy of data entered across the sites. Results: In total, 2544 patients were included from 50 centers in 15 countries. There were 1969 patients with ureteric stones, and 942 with renal stones. While 41% ureteric stones were distal (median length 10mm), 52% renal stones were in the lower pole (median diameter 11 mm). The majority of patients (68.8%) were given antibiotics at induction; 20.6% were “pre-stented” before the ureteroscopy, and a high percentage were stented following ureteroscopy (91%). The majority of the stents (85.1%) were polyurethane, mean duration of stent after surgery was 27 days, and 80% of stent removals were undertaken in the operating room. Conclusion: This is one of the largest prospective global cohort studies, reflecting widespread usage of stenting, despite emerging evidence to the contrary. Stent removals may also be modified with time, as the pressure on health care resources mounts.

Resumen Introduccion y objetivos Evaluar la capacidad del endourologo para evaluar la composicion del calculo mediante la observacion de imagenes endoscopicas. Materiales y metodos Una serie de 20 videoclips de tratamientos endoscopicos de calculos urinarios que tambien estaba disponible el resultado de la espectroscopia infrarroja se cargo en un sitio de YouTube accesible solo a miembros del South Eastern Group for Urolithiasis Research (SEGUR) a quienes se les pregunto para identificar la composicion de los calculos. Resultados Un total de 32 endourologos de 9 paises diferentes participaron en el estudio. El numero promedio de detecciones correctas de participantes fue de 7.81 ± 2.68 (1–12). La precision general fue del 39% (250 de 640 predicciones). Calculos de dihidrato de oxalato de calcio se han detectado correctamente en el 69.8%, monohidrato de oxalato de calcio en el 41.8%, acido urico en el 33.3%, oxalato de calcio / acido urico en el 34.3% y cistina en el 78.1%. Las tasas de precision para estruvita (15.6%), fosfato de calcio (0%) y oxalato de calcio / fosfato de calcio (9.3%) fueron bastante bajas. Conclusiones La observacion del calculo durante el procedimiento endoscopico no fue confiable para identificar la composicion de la mayoria de los calculos, aunque los calculos de oxalato de calcio dihidrato y cistina pueden identificarse con buena precision. Sin embargo, se debe alentar la presentacion de fotos o videos de calculo intacto y su estructura interna para implementar los resultados del analisis de calculo despues de la cirugia. Los endourologos deben mejorar su capacidad de identificacion visual de los diferentes tipos de calculos.

Objective This study aims to evaluate the overall healthcare performance of our re-organized urology clinic during the COVID-19 pandemic in Turkey. Material and methods A retrospective review of our department data was conducted between March 20, 2020, and April 16, 2020. All consecutive patients who received healthcare in both urology and emergency COVID-19 clinics by urologists during this period were included. We classified our healthcare into 4 categories: 1) Standard urological outpatient clinic procedures, 2) Urological emergency procedures, 3) Standard inpatient treatment clinic procedures and specific inpatient treatment clinic procedures for COVID-19 suspected cases, and 4) Specific emergency clinic procedures for COVID-19. Epidemiologic data and patient characteristics were analyzed using independent t test and chi-square test. Results Overall, the data of 990 patients were evaluated. Of these patients, 344 were seen in standard urology outpatient clinic and 212 were transferred from COVID-19 emergency clinic and hospitalized because of suspected COVID-19 infection. In the COVID-19 emergency clinic, 361 patients were seen by urologists in different shifts. Our workload was on behalf of COVID-19 cases. In our COVID-19 experience, there were no statistically significant differences between our suspected and confirmed COVID-19 patients in terms of mean age, sex and age periods (p=0.30, p=0.77, and p=0.78, respectively). Conclusion We successfully contributed to the national COVID-19 management program. In our opinion, each department should create a customized action plan instead of a standardized approach during the COVID-19 pandemic or potential public emergencies in the future.

To determine whether there is an association between blood eosinophil count and percentage with the recurrence of nonmuscle invasive bladder cancer (NMIBC) during Bacillus Calmette-Guerin (BCG) maintenance therapy with our preliminary results. A total of 53 patients with NMIBC underwent BCG immunotherapy between January 2015 and September 2018, and met our inclusion criteria were included in the study. The parameters age, gender, smoking status, comorbidity, blood neutrophil, lymphocyte and eosinophil counts, blood eosinophil percentage, previous single postoperative intravesical chemotherapy instillation, tumor characteristic, and total and maintenance dose numbers of BCG were extracted from our medical records and compared between patients with response and with recurrence. Blood eosinophil count and percentage were significantly higher in patients with recurrence compared to patients with response (0.263 ± 0.37 vs. 0.0134 ± 0.021, p = 0.01 and 0.31 ± 0.29 vs. 0.17 ± 0.27, p = 0.01). Other parameters were similar in patients with recurrence and response. Receiver-operating characteristic analysis showed a considerable diagnostic value of blood eosinophil count and percentage in the prediction of bladder cancer recurrence during BCG immunotherapy. Blood eosinophil count and percentage in patients with NMIBC can predict the disease recurrence during the BCG immunotherapy. Our research raised new questions and assumptions about the role of eosinophils during BCG immunotherapy.

Objective To investigate the effects of flexible ureteroscopy (F-URS) on the operated side of a kidney by assessing the renal damage markers, urine neutrophil gelatinase-related lipocalin (NGAL) and serum cystatin-C (Cys-C), and overall kidney function with the measurements of standard serum creatinine and urine albumin and protein levels. Material and methods A total of 30 patients who underwent F-URS for treatment of upper urinary stone disease were prospectively evaluated. Preoperative serum urea, creatinine, and Cys-C levels were noted. Levels of urine albumin, protein, creatinine, and NGAL in spot urine samples from the operated side of a kidney obtained through the access sheath preoperatively and through the ureteral catheter 1 and 24 hours postoperatively were also measured. Preoperative and postoperative parameter levels were statistically compared. Results The patients' mean age was 46.6±15.9 years. The mean operative and fluoroscopy times were 90.67±32.5 and 3.15±1.43 minutes, respectively. The urine creatinine, albumin, protein, albumin/creatinine, and protein/creatinine levels were similar in preoperative and postoperative periods. Postoperative serum urea, creatinine, and Cys-C levels and urine NGAL and NGAL/creatinine levels were not also found with remarkable changes from the baseline levels. Conclusion F-URS is a safe therapeutic intervention in the treatment of urolithiasis, especially regarding renal damage, and functional outcomes.

Introduction and objectives Although nocturnal emission (NE) is an integral part of normal sexual function of males, little information has been documented in the literature. We aimed to assess masturbation habits and frequency of NE among virgin male religious Muslim teenagers. Materials and methods A questionnaire was administered to students staying in a religious dormitory or attending a religion course. Data of 113 male-respondents including demographic characteristics, masturbation habits and frequency of NE were collected. Results The mean age of students was 15.88 ± 1.47 (range: 13–20) years. Of the students, 46(41.4%) reported that they never masturbated and 19 (17.3%) never experienced NEs. NE frequency was not correlated with age (p = 0.092). Having NEs was not related to the time since last masturbation either (p = 0.479). Subjects watching TV more than 3 h/day had more NEs than the ones watching less (p = 0.006). Of the subjects 13.6%, 12.6% and 67% believed that masturbation is halal, permissible and forbidden by religion, respectively whereas these rates were 59.1%, 20.4% and 7.5% for NE. Conclusions Although masturbation and NE are frequent among virgin male religious Muslim teenagers, a significant proportion of young men believe that only masturbation, but not NE, is forbidden by religion. Watching TV seems to be associated with the frequency of NEs. Further studies are required to elicit the factors affecting frequency of NEs.

Background: Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation. Objective: To develop a prediction model for urinary tract cancer in patients referred with haematuria. Design, setting, and participants: A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged ≥16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded. Outcome measurements and statistical analysis: The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism. Results and limitations: The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy. Conclusions: This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation. Patient summary: We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation.

INTRODUCTION AND OBJECTIVE:Minimally invasive endourological procedures often need X-ray fluoroscopy guidance. Endourologists, may focus on their own exposure but underestimate the patient exposure...

Although the efficacy of extracorporeal shock wave lithotripsy (ESWL) has been well established within the literature, debate continues on the safety of the procedure while focusing on cellular injury and its long-term consequences. Here, we describe the role of neutrophil elastase (NE) in ESWL-related rat kidney damage and investigate the protective effects of sivelestat, an inhibitor of NE, during the early and late phases. Four groups including control, ESWL alone, ESWL with sivelestat 50 mg/kg and ESWL with treatment of 100 mg/kg, each consisting of ten rats were created. Biochemical parameters of kidney function and damage and immunohistopathological findings were compared in the early (72 h after ESWL) and late (1 week after ESWL) periods between the groups. During the early period, serum and urine creatinine levels and urine kidney injury molecule-1 (KIM-1) levels and the KIM-1/creatinine ratio increased in rats treated with ESWL compared to the control group. Furthermore, increased tissue inflammation, ductal dilatation and hemorrhage, and glomerular, tubular, and interstitial damage with increased NE staining were also detected in the ESWL treatment group. During the late phase, although urine KIM-1 levels remained stable at high levels, other parameters showed significant improvements. On the other hand, the administration of sivelestat 50 mg/kg decreased serum creatinine and urine KIM-1 and KIM-1/creatinine levels significantly in rats treated with ESWL, during the early and late periods. Significant decreases in tissue inflammation, tubular, and interstitial tissue damage were also observed during the early period. In conclusion, ESWL-related kidney tissue damage occurs primarily during the early period, and NE is involved in this process. On the other hand, the NE inhibitor sivelestat attenuated this ESWL-induced kidney damage.

BackgroundThe central role in the pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), called as coronavirus disease 2019 (COVID-19), infection is attributed to angiotensin-converting enzyme 2 (ACE-2). ACE-2 expressing respiratory system involvement is the main clinical manifestation of the infection. However, literature about the association between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and higher ACE-2 expressing kidney is very limited. In this study, we primarily aimed to investigate whether there is a kidney injury during the course of SARS-CoV-2 infection. The predictive value of kidney injury for survival was also determined.MethodsA total of 47 participants who met the inclusion criteria were included in the study. The participants were classified as ‘‘COVID-19 patients before treatment’’ ‘‘COVID-19 patients after treatment’’, ‘‘COVID-19 patients under treatment in ICU’’ and ‘‘controls’’. The parameters comorbidity, serum creatinine and cystatin C levels, CKD-EPI eGFR levels, KIM-1 and NGAL levels, urine KIM-1/creatinine and NGAL/creatinine ratios were statistically compared between the groups. The associations between covariates including kidney disease indicators and death from COVID-19 were examined using Cox proportional hazard regression analysis.ResultsSerum creatinine and cystatin C levels, urine KIM-1/creatinine levels, and CKD-EPI, CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C eGFR levels exhibited significant difference in the groups. The causes of the difference were more altered kidney function and increased acute kidney damage in COVID-19 patients before treatment and under treatment in ICU. Additionally, incidences of comorbidity and proteinuria in the urine analysis were higher in the COVID-19 patients under treatment in ICU group. Urine KIM-1/creatinine ratio and proteinuria were associated with COVID-19 specific death.ConclusionsWe found that COVID-19 patients under treatment in ICU exhibited extremely higher levels of serum cystatin C, and urine KIM-1/creatinine and urine NGAL/creatinine ratios. These results clearly described the acute kidney damage by COVID-19 using molecular kidney damage markers for the first time in the literature. Lowered CKD-EPI, CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C eGFR levels were determined in them, as well. Urine KIM-1/creatinine ratio and proteinuria were associated with COVID-19 specific death. In this regard, considering kidney function and kidney damage markers must not be ignored in the COVID-19 patients, and serial monitoring of them should be considered.

The study investigated whether there is a male reproductive system coronavirus disease‐2019 (COVID‐19) phenomenon. Thirty participants who met the inclusion criteria were enrolled in the study between April and May 2020. The participants were assigned in one of the three groups including COVID‐19 patients before and after treatment, and controls. Presence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) within the semen samples was investigated. Additionally, participant's demographics, semen parameters and serum sex hormone levels were compared between the groups. SARS‐CoV‐2 was not detected within the semen samples. Sperm morphology and serum sex hormone levels were significantly different between the groups. In the post hoc analysis, sperm morphology was significantly lower in the COVID‐19 patients. Patients before treatment had significantly lower serum FSH, LH and T levels than controls. However, patients after treatment had similar serum FSH, LH and T levels with controls and patients before treatment. In our opinion, COVID‐19 and its treatment had no specific deteriorative effect on male sexual health at a short‐time period. In the patients before treatment, decreased serum of T, FSH and LH levels was consistent with acute patient stress due to COVID‐19. Similarly, it seems that decreased sperm morphology was associated with the acute fever.

Fluoroscopy is increasingly used to guide minimally invasive endourological procedures and optimised protocols are needed to minimise radiation exposure while achieving best treatment results. This multi-center study of radiation exposure of patients was conducted by the South-Eastern European Group for Urolithiasis Research (SEGUR), in cooperation with the International Atomic Energy Agency. Seven clinical centers from the SEGUR group collected data for 325 procedures performed within a three-months period, including standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS. Data included: air kerma area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT), number of radiographic images (N) and fluoroscopy pulse rate, as well as total procedure duration, size and location of stones. Data were centrally analysed and statistically compared. Median PKA values per center varied 2-fold for RIRS (0.80–1.79 Gy cm2 ), 7.1 fold for mini-PCNL (1.39–9.90 Gy cm2 ), 7.3 fold for PCNL (2.40–17.50 Gy cm2 ), 19 fold (0.13–2.51 Gy cm2 ) for semi-rigid URS and 29-fold for flexible URS (0.10–2.90 Gy cm2 ). Lower PKA and Ka,r were associated with use of lower FT, N and lower fluoroscopy pulse rate. FT varied from 0.1 to 14 min, a small fraction of the total procedure time, ranging from 10 to 225 min. Higher N was associated with higher PKA and Ka,r. Higher median PKA in PCNL was associated with the use of supine compared to prone position. No correlation was found between the concrement size and procedure duration, FT, PKA or Ka,r. Dose values for RIRS were significantly lower compared to PCNL. The maximum Ka,r value of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT and N, using pulsed fluoroscopy and beam collimation.

The purpose of this study is to collect information on the bacterial resistance to antibiotics of bacteria isolated from urine cultures of patients treated for upper urinary tract calculi. Data of patients with urinary tract infection and urolithiasis were retrospectively reviewed to collect information on age, gender, stone size, location, hydronephrosis, procedure of stone removal and antibiotic treatment, identification and susceptibility of pathogens, symptoms, and infectious complications. A total of 912 patients from 11 centers in 7 countries (Bulgaria, Greece, Italy, North Macedonia, Spain, and Turkey) were studied. Mean age was 54 ± 16 years and M/F ratio 322/590. Out of 946 microbial isolates, the most common were E. coli, Gram-positive, KES group (Klebsiella, Enterobacter, Serratia), Proteus spp., and P. aeruginosa. Carbapenems, piperacillin/tazobactam and amikacin showed low resistance rates to E. coli (2.5%, 7%, and 3.6%) and Proteus spp. (7.7%, 16%, and 7.4%), but higher rates were observed with Klebsiella spp., P. aeruginosa, and Gram-positive. Fosfomycin had resistance rates less than 10% to E. coli, 23% to KES group, and 19% to Gram-positive. Amoxicillin/clavulanate, cephalosporins, quinolones, and TMP/SMX showed high resistance rates to most bacterial strains. High rates of antibiotic resistance were observed in patients candidate to stone treatment from South-Eastern Europe. The empirical use of antibiotics with low resistance rates should be reserved to the most serious cases to avoid the increase of multidrug resistant bacteria. Basing on our results, carbapenems, piperacillin/tazobactam, and amikacin may be a possible option for empiric treatment of urinary stone patients showing systemic symptoms.

Aims: We aimed to evaluate the durability and cost effectiveness of the latest digital flexible ureterescope by comparing it with the conventional fiberoptic one. Materials and Methods: Data of patients who underwent retrograde intrarenal surgery between January 2013 and December 2014 were collected. Fiberoptic Flex-X2 or digital Cobra vision flexible ureteroscopes were used for the procedures. The comparison of both ureteroscopes was performed in terms of patient and stone characteristics, operative outcomes, durability, and cost effectiveness. Results: A total of 105 patients were evaluated for the study. The patient and stone characteristics and operative outcomes were similar between the groups. Overall, 54 and 51 procedures were performed using Flex-X2 and Cobra vision, respectively, before they were sent for renovation. The purchase prices were USD 29,500 for Flex-X2 and USD 58,000 for Cobra vision. Costs of per case were determined as USD 549.29 for Flex-X2 and as USD 1,137.25 for Cobra vision. Per minute working time costs were USD 772.04 and 1,471.33 for Flex-X2 and Cobra vision respectively. Conclusions: The digital Cobra vision has high costs without any difference in durability as compared to Flex-X2. Moreover, it has no benefit over Flex-X2 in terms of surgical outcomes.

To determine the diagnostic value of computerized tomography (CT) in differentiating pyonephrosis from hydronephrosis on the basis of attenuation values (Hounsfield unit—HU). Data of the patients with grades 1–3 hydronephrosis on abdominopelvic CT, who underwent nephrostomy tube placement for decompression of the collecting system, were retrospectively analyzed. Patient demographics and CT findings were recorded along with the first access urine culture results. Three physicians calculated the surface areas and the attenuation values of the dilated collecting systems using the system software. Mean HU of pyonephrosis and hydronephrosis cases was compared. A total of 105 patients with the mean age of 47.7 ± 15.5 (range 20–80) were included. The interclass correlation coefficient of three physicians was 0.981 for HU measurement and 0.999 for calculation of collecting system surface area. Of the patients, 47 (44.8 %) had pyonephrosis. Mean surface areas of the collecting system were similar in patients with pyonephrosis and hydronephrosis (1481.13 ± 1562.94 vs. 1612.94 ± 2261.4 mm2, p = 0.735). Urine cultures were positive in all patients with pyonephrosis, whereas 12.7 % of hydronephrosis cases had bacterial in first access urine culture. The HU of the patients with pyonephrosis was significantly higher that that of patients with hydronephrosis (13.51 ± 13.29 vs. 4.67 ± 5.37, p = 0.0001). Having a HU of 9.21 or over diagnosed pyonephrosis accurately with 65.96 % sensitivity and 87.93 % specificity. Measuring attenuation values of the collecting system may be useful to differentiate pyonephrosis from hydronephrosis. Diagnosing pyonephrosis accurately may avoid septic complications.

Introduction The aim of this study was to demonstrate the efficacy of Instadose™, a novel dosimeter designed for radiation workers to provide a measurement of the radiation dose at any time from any computer; to determine the amount of radiation exposure during percutaneous nephrolithotomy (PNL); and to evaluate the factors that affect the amount of radiation exposed. Material and methods Two experienced surgeons wore Instadose™ on the outer part of their lead aprons during the PNL procedures performed between December 2013 and July 2014. Patient demographics and stone characteristics were noted. Factors affecting radiation dose were determined. Fluoroscopic screening time was compared with the amount of radiation in order to validate the measurements of Instadose™. Results Overall, 51 patients with a mean age of 43.41 ±18.58 (range 1–75) years were enrolled. Male to female ratio was 35/16. The amount of radiation was greater than 0.01mSv in only 19 (37.25%) cases. Stone location complexity (p = 0.380), dilation type (p = 0.584), stone size (p = 0.565), dilation size (p = 0.891) and access number (p = 0.268) were not associated with increased radiation exposure. Instadose™ measurements were correlated with fluoroscopic screening time (r = 0.519, p = 0.001). Conclusions Instadose™ is a useful tool for the measurement of radiation exposure during PNL. The advantage of measuring the amount of radiation exposure after each PNL operation is that it may aid urologists in taking appropriate precautions to minimize the risk of radiation related complications.

To compare the outcomes of these minimally invasive procedures in this patient population.The database of our institution has been retrospectively reviewed, and medical records of urolithiasis patients with a solitary kidney who underwent flexible ureteroscopy (F-URS) or extracorporeal shock wave lithotripsy (SWL) between January 2009 and December 2012 were examined. Retreatment rates, complications, changes in estimated glomerular filtration rates (eGFRs), chronic kidney disease (CKD) stages, and stone-free rates were compared between the two groups.Stones of 48 patients (mean age: 48.8±15.4, range: 14-76) with solitary kidneys were treated with SWL (n=30, 62.5%) or F-URS (n=18, 37.5%). Patient demographics and stone related parameters were similar. The most common stone location was the pelvis in the SWL group (36.6%), whereas it was the pelvis and a calix in the F-URS group (38.8%). Complications and success rates were similar in both groups, however, patients in the SWL group needed more sessions to achieve stone clearance (2.2±0.89 vs 1.06±0.24, p=0.0001). Preoperative and postoperative eGFR and CKD stage changes were also similar.Both SWL and F-URS are effective and safe techniques, which can be used for the treatment of stones in patients with solitary kidneys. However, patients treated with SWL need more sessions to achieve stone clearance.

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. (The Medical Bulletin of Haseki 2015; 53:52-6)

Background: The incidence of renal-cell carcinoma (RCC) is low during pregnancy. There are different approaches for timing of surgery and treatment modalities for RCC in pregnant women in the literature. To our knowledge, this is the first laparoscopic partial nephrectomy case in a pregnant woman. Case Presentation: Herein, we present a 34-year-old woman with a renal mass at her 14th gestational week. She was admitted to our clinic after a right renal mass was incidentally diagnosed during routine antenatal ultrasonography. MRI revealed a completely endophytic tumor of 6 × 6.5 × 6.5 cm, located in the upper half of the right kidney. We performed laparoscopic partial nephrectomy in our patient and the postoperative course was uneventful. Conclusion: This is the first presented laparoscopic partial nephrectomy case in a pregnant patient. Nephron-sparing surgeries can be performed laparoscopically in appropriate sized renal tumors in suitable pregnant patients.

Objective We aimed to determine whether the effect of prostate volume on cancer detection rates is influenced by serum prostate-specific antigen (PSA). Material and methods A total of 2465 men who underwent transrectal ultrasound-guided biopsy were retrospectively evaluated. Standard 10-core prostate biopsy was performed in all cases. Patients were divided into three groups according to the serum PSA levels: ≤10 ng/mL (Group 1), 10-20 ng/mL (Group 2) and >20 ng/mL (Group 3). In each group age, serum PSA levels and prostate volumes were compared in patients with and without prostate cancer. Results A total of 2079 patients were included in the study group. Cancer detection rates were 16%, 25%, 53% in Groups 1, 2 and 3, respectively (p=0.001). In Group 1, there was a significant difference in mean prostate volume of patients with and without prostate cancer (p=0.01). However, this difference was not seen in Group 2 or 3 (p=0.06 and p=0.08, respectively). The mean age and PSA level which are the other determinants of prostate cancer diagnosis were similar between patients with and without cancer in the Group 1, thus prostate volume was the only determinant of the diagnosis. Conclusion According to our findings, prostate volume is an important factor for prostate cancer diagnosed with prostate biopsy only in patients with a PSA level of ≤10 ng/mL.

To investigate whether atorvastatin has favorable effects on urinary metabolic risk factors associated with urolithiasis. Sixteen male Sprague–Dawley rats were randomly divided into two groups, and baseline spot and 24-h urine samples were collected. Distilled water and atorvastatin were administered to rats during 4 weeks in the control and atorvastatin groups, respectively. At the end of the experimental procedure, spot and 24-h urine samples were collected again. Citrate, oxalate, cystine, uric acid, calcium and magnesium levels were determined in 24-h urine samples. Citrate/creatinine, oxalate/creatinine, uric acid/creatinine, calcium/creatinine and magnesium/creatinine ratios were also calculated in spot urine samples. Comparison of the baseline and post-experimental levels of these parameters was made in each group. The majority of the parameters were similar before and after the experimental procedure in each group. In the atorvastatin group, uric acid and calcium levels were affected. Administration of atorvastatin was significantly decreased the levels of uric acid, whereas increased the levels of calcium (P = 0.025 and P = 0.017, respectively). Our study revealed that atorvastatin has decreasing effect on UUa levels, whereas increasing effect on UCa levels. We think it cannot certainly be deduced that atorvastatin could be beneficial on overall urinary metabolic risk factors. Contrarily, atorvastatin may lead to an increased risk of calcium stones, but when considering its UUa decreasing effect, it may help in reducing the uric acid stone recurrence.

To address various issues concerning the fate of residual fragments (and the patients carrying them), their detection, and current and future techniques to avoid them.Narrative overview of the all relevant articles retrieved from Pubmed research together with the experiences of personal practice was conducted.Clinically insignificant residual fragments (CIRFs) are defined as asymptomatic, non-obstructing residual fragments smaller than 4 mm (1.6-8) or 5 mm. CIRFs can be diagnosed with either direct endoscopic vision or using imaging modalities including ultrasonography and computerized tomography. Although ultrasonography is radiation-free, the sensitivity and specificity is relatively low when compared to non-contrast computerized tomography.The best and the easiest way to deal with residual fragments is preventing their occurrence. Although asymptomatic residual fragments can be safely followed up, symptomatic fragments should be promptly treated. Several modifications and modalities are currently available to treat the fragments occurring after different treatment options.

Data regarding the relation between premature ejaculation (PE) and post-circumcision mucosal cuff length are controversial. The aim of this study is to analyze the relation between post-circumcision mucosal cuff length/penile length ratio (MCR) and PE. After exclusion of patients with erectile dysfunction, penile deformity, history of penile surgery and severe lower urinary tract symptoms, 49 circumcised men with PE were included. The control group is constituted of 50 healthy volunteers with normal ejaculatory function. Self-estimated intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) measures of all subjects were recorded, and the MCRs of patients and controls were compared. The mean age of PE patients and controls was 35.82 ± 7.73 (range 23-54) and 38.78 ± 13.42 (range 19-71) years, respectively (P=0.183). Although mucosal cuff length was not associated with either self-estimated IELT (r=-0.185, P=0.067) or PEP (r=-0.098, P=0.336), there was a negative correlation between MCR and self-estimated IELT (r=-0.205, P=0.0001) and PEP measures (r=-0.308, P=0.002). The length of the mucosal cuff after circumcision may have an impact on ejaculatory function. Surgeons should avoid leaving excessive amount of mucosa during circumcision.

Objective: To evaluate whether renal parenchymal thickness (RPT) has an effect on the outcomes of percutaneous nephrolithotomy (PNL). Methods: We performed a retrospective analysis of 144 patients with lower pole and/or renal pelvic stones who underwent PNL. The relationship between RPT and peri- and postoperative measures was evaluated. Results: The average age was 45.94 ± 14.47 (15-76) years. The mean BMI was calculated as 27.47 ± 4.73 (16.9-44.9) kg/m2. The mean stone burden was 293 ± 126 (150-800 mm2). The mean RPT was measured as 17.33 ± 5.32 (6-35) mm. No correlation was detected between the RPT and the operation or fluoroscopy times or the duration of hospitalization (p = 0.63, 0.52, 0.08, respectively). The mean drop in hemoglobin level was 1.45 ± 1.25 (0-9) g/dl. A negative correlation was detected between hemoglobin drop and RPT (p = 0.01, r = -0.23). However, the RPT was similar in patients who did or did not require a blood transfusion (p = 0.09). The RPT was found to have no impact on success rate (p = 0.4). Conclusion: The postoperative hemoglobin drop increases in parallel with the increase in RPT. However, no relationship was detected between the RPT and blood transfusion, overall success rate or any other perioperative parameters.

OBJECTIVE Cold-knife direct vision internal urethrotomy (DVIU) is frequently used as the first-line treatment for urethral stricture disease. Although the steps of the procedure are defined in detail, the duration of catheterization and the diameter of the catheter to be used after the operation are not clearly defined. The aim of this study is to evaluate the effects of catheter dwell time and diameter on recurrence rates of urethral stricture disease after DVIU. MATERIAL AND METHODS Data of 193 consecutive treatment naive bulbar urethral stricture patients who underwent DVIU between January 2009 and June 2013 were retrospectively analyzed. Patient demographics and stricture characteristics were noted. Catheter dwell times were grouped as

To evaluate protective effects of Tutukon®, a plant derived herbal product, on the development of rat urolithiasis model. A total of 45 rats were divided into three groups namely; Group 1 (control group; drinking water + zinc disk), Group 2 (0.5 % ethylene glycol [EG] to drinking water + zinc disk) and Group 3 (study group-0.5 % EG + Tutukon + zinc disk). Moreover, zinc disks were placed into bladder of rats to serve as a nidus for stone development. Five rats from each group were killed at the end of the 1st, 2nd and 4th week. The level of bladder inflammation, the disk weights and the urine oxalate, calcium and pH values and were evaluated and compared. The inflammation scores of the pathological evaluation were not significantly different among three groups. At the end of the 28th day, weights of the zinc disks were significantly higher in Group 2 (394.4 ± 41.2) when compared to Group 1 (1517.5 ± 367.3) and Group 3 (386.2 ± 26.9) (p = 0.016). The disk weights increased gradually at 7th, 14th and 28th days in Group 1 (p = 0.018) and Group 2 (p = 0.009) while remained stable in Group 3 (p = 0.275). Urine calcium levels were not affected among three groups throughout the study period. At the end of the 28th day, while the urine oxalate levels of rats in Group 1 was lower than that of both Group 2 (p = 0.046) and Group 3 (p = 0.008); Group 2 and Group 3 had similar oxalate excretion levels (p = 0.701). However, the difference was not significant. Tutukon seems to decrease stone deposition on zinc disks implanted in the bladder of rats. The exact mechanism of this preventive effect is, however, not well understood.

There are few studies of the long-term outcome of percutaneous nephrolithotomy for staghorn calculi. We report the long-term outcome of percutaneous nephrolithotomy in patients with staghorn calculi.A total of 265 study patients (272 renal units) were followed in the long term for greater than 12 months. The estimated glomerular filtration rate was calculated using the 4-variable modification of diet in renal disease equation. Cases were staged for chronic kidney disease by National Kidney Foundation guidelines. The impact of patient and procedure related factors on renal function as well as stone recurrence was analyzed retrospectively.At a mean ± SD followup of 37.3 ± 25.4 months the chronic kidney disease stage classification was maintained in 177 patients (66.8%) while the classification of 34 (12.8%) and 54 (20.4%) had improved and deteriorated, respectively. Multivariate analysis revealed that an immediate postoperative change in the estimated glomerular filtration rate was the only factor predicting a change in renal function in the long term. Stones recurred in 73 of the 234 kidneys (31.2%) that were stone free 3 months after percutaneous nephrolithotomy. Stone size increased in 24 of the 38 kidneys (63.2%) with residual stones after intervention. Recurrent urinary infections during followup and diabetes were associated with stone recurrence and residual stone enlargement.In almost 80% of patients with staghorn stones renal function was improved or maintained after percutaneous nephrolithotomy, as documented during long-term followup. Stones recurred in a third of the patients with staghorn calculi.

We evaluated the long-term outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease.Data on 1,904 patients who underwent percutaneous nephrolithotomy between 2002 and 2011 were retrospectively collected. The estimated glomerular filtration rate for each patient was retrospectively calculated using a 4-variable modification of diet in renal disease equation. Patients were staged for chronic kidney disease by National Kidney Foundation guidelines.A total of 242 patients (12.7%) had a preoperative glomerular filtration rate of less than 60 ml per minute/1.73 m(2). Those monitored a minimum of 1 year were included in analysis. The study included 177 patients with a mean ± SD age of 54.3 ± 12.1 years. Perioperative and postoperative complications were noted in 15.2% of patients. At a mean followup of 43.4 ± 22.7 months renal function in 29.4% of patients had improved but it remained the same or deteriorated in 54.2% and 16.4%, respectively. On multivariate regression analysis diabetes and preoperative or postoperative complications predicted renal function. The stone-free rate 3 months postoperatively was 80.2% (142 of 177 cases). Stones recurred during long-term followup in 36 of these patients (25.3%). Spontaneous stone passage was detected in 12 of the 35 patients (34.2%) with residual stones but 8 (22.8%) with residual stones experienced an increase in stone size.At long-term followup renal function was maintained or improved in greater than 80% of patients with chronic kidney disease who underwent percutaneous nephrolithotomy. Stones recurred or residual stones grew in approximately 25% of these patients.

The components of metabolic syndrome, such as obesity, hypertension, and diabetes, are thought to be associated with urolithiasis. However, there are few large-scale studies that have examined the association between metabolic syndrome and urolithiasis, which prompted us to study and evaluate the relationship between metabolic syndrome components and urolithiasis in a nationwide survey, using the cross-sectional study conducted by a professional investigation company, with 2,468 enrolled participants, aged between 18 and 70 years, from 33 provinces in Turkey. Participants were interviewed face-to-face by medical faculty students. Participants with a history of urolithiasis (Group 1) were compared with participants without a history of urolithiasis (Group 2) in terms of hypertension, diabetes, body-mass index (BMI), waist size, and trouser size using Chi-square and odds ratio tests. Of the 2,468 participants, 274 (11.1%) reported a history of urinary stone disease diagnosed by a physician. The percentage of participants with hypertension along with urolithiasis was significantly higher than that in participants without urolithiasis (16.9 and 34.3%, p 0.000, OR 3.0). The percentage of participants with diabetes in groups 1 and 2 was 14.2 and 9%, respectively (p 0.001, OR 1.83). The mean BMI was 27.2 and 25.2, respectively (p 0.01). Participants with a BMI >30 had a 2.2-fold increased risk of having urolithiasis. The mean waist size was significantly greater in participants with urolithiasis (p 0.000). Those with a waist size >100 cm had a 1.87-fold increased risk of having urolithiasis. The mean trouser size was also significantly larger in those participants who were stone formers (p 0.003). The results indicate that metabolic syndrome components are important factors in the development of urolithiasis.

Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Standard monopolar transurethral resection of prostate (TURP) remains the gold standard surgical treatment of benign prostatic hyperplasia-related lower urinary tract symptoms. Plasmakinetic offers rapid tissue removal and haemostasis during resection with better vision under saline irrigation while eliminating risk of TUR syndrome. Our results show that Plasmakinetic has similar long-term results to standard TURP. OBJECTIVE • To compare long-term results of transurethral resection of prostate with PlasmaKinetic® energy (Plasmakinetic) and standard transurethral resection of prostate (TURP). PATIENTS AND METHODS • During the 2-year period between 2001 and 2002, 101 patients with lower urinary tract symptoms related to benign prostatic hyperplasia were enrolled into the study. • Patients were randomly assigned to either Plasmakinetic or standard TURP groups using computer-generated simple random tables in a 1:1 ratio. • After the publication of initial results, follow-up continued until December 2010. Patients were called by phone and invited for control at 60th and 100th months. • An International Prostate Symptom Score (IPSS) form was completed and uroflowmetry was performed to show the final status of the operation. RESULTS • Overall, 67 of 101 patients (34 patients in Plasmakinetic group and 33 patients in TURP group) completed the 100th month control. • IPSS increased to 8.5 ± 1.6 and 9.4 ± 0.9 in the Plasmakinetic group and 7.9 ± 1.3 and 8.7 ± 1.2 in the TURP group at 60 and 100 months, respectively. • Mean maximal flow rate increased to 17.2 ± 3.9 mL/s in the Plasmakinetic group and to 16.9 ± 4.1 mL/s at 12 months in the TURP group but decreased to 15.9 ± 2.5 and 15.8 ± 3.0, respectively (P= 0.34) at 100 months. • Reoperation was performed in six patients in the Plasmakinetic group and four patients in the TURP group at the end of 100th month. CONCLUSION • Our 100 months results suggest that Plasmakinetic technology can be used as a first-line treatment instead of monopolar TURP.

Clinically insignificant residual fragments (CIRFs), defined as asymptomatic, noninfectious, ≤4 mm fragments, are sometimes observed after percutaneous nephrolithotomy (PCNL). Because the natural history of these fragments is unclear, we investigated the medium-term outcome of these fragments.During a 3-year period, 430 patients underwent PCNL. Overall stone-free rate was 74.5%, and CIRFs were encountered in 22% of cases 3 months after surgery. A total of 38 patients who had CIRFs immediately after PCNL with at least 24 months of follow-up were included in the study. All patients were subjected to periodic follow-up with detailed history, clinical examination, and radiographic follow-up. Serum biochemistry together with urine metabolic evaluation was also performed.The median follow-up was 28.4±5.3 months (range 24-38 mos). Ten (26.3%) patients had a symptomatic episode that necessitated medical therapy during follow-up while others remained asymptomatic. Radiologic assessment showed an increase in the size of the fragments in 8 (21.1%) patients, while the size of the fragments was stable or decreased in 27 (71.1%) cases. Three (7.9%) patients had spontaneous stone passage. Metabolic evaluation revealed abnormalities in 10 (26.3%) patients. Stone analysis revealed magnesium ammonium phosphate in three of eight patients who had an increase in residual fragment size. Also, only two of these eight patients had a metabolic abnormality (one hypocitraturia and one hypercalciuria).Medium-term follow-up of CIRFs after PCNL revealed that progression within 2 years is relatively common. Increase in fragment size is common in patients with struvite stones, and presence of risk factors on 24-hour urine metabolic analysis does not seem to predict growth of observed fragments.

To investigate variables that affect bleeding during percutaneous nephrolithotomy (PCNL), focusing on the experience of a single surgeon.The records of 649 PCNL procedures that were performed by the same surgeon were reviewed retrospectively. The effect of surgical experience; patient and stone-related factors, including age, sex, hypertension, and diabetes, serum creatinine level, history of ipsilateral renal procedures, stone surface area and type, degree of hydronephrosis, preoperative hemoglobin level; operative factors, such as the calix of puncture, number of accesses, operative time; and intraoperative complications, such as pelvicaliceal system perforation on bleeding (described as decrease in hemoglobin level and need for blood transfusion), were investigated. For statistical assessment, univariate analyses and multivariate stepwise regression analyses were used.A 92.3% success rate was achieved after one session PCNL. The overall blood transfusion rate was 10.8%. The number of accesses, stone type, diabetes, preoperative hemoglobin level, and operative time were the most important factors for blood transfusion requirement. In the receiver operating characteristic curve, the best cutoff point of operative time was 58 minutes for the blood transfusion requirement. Multivariate stepwise regression analyses showed that there was an association between diabetes, operative time, number of accesses, and stone type with the decrease in hemoglobin levels. No correlation between surgical experience and decrease in hemoglobin level as well as blood transfusion necessity was found.Depending on the results achieved by a single surgeon, multiple access tracts, staghorn calculi, presence of diabetes, and prolonged operative time, but not surgical experience, significantly increased blood loss during PCNL.

INTRODUCTIONIschemic hepatitis (IH) is the necrosis of the centrilobular hepatocytes of liver and is secondary to liver hypoperfusion in most of the cases. The diagnosis is usually based on biochemical findings due to the absence of symptoms and signs. Although the disease course is often mild, and sometimes is even not diagnosed, the outcome is poor if the etiology of hypotension and liver anoxia is not promptly corrected.PRESENTATION OF CASEA 64-year-old patient who underwent percutaneous nephrolithotomy (PNL) for right renal pelvic stone developed acute IH at first postoperative day as a result of hemorrhage related severe hypotension. After restoring hemodynamic parameters, she completely recovered 2 weeks after the operation.DISCUSSIONIH is a frequent cause of marked serum aminotransferase elevation and most commonly occurs as a result of arterial hypoxemia and insufficient hepatic perfusion. Although no specific treatment of IH exists, stabilizing the hemodynamic parameters of the patient resolves the problem in most of the cases.CONCLUSIONThis case is presented to demonstrate that ischemic hepatitis should be kept in mind if severe hemorrhage occurs during PNL.

The worldwide prevalence and epidemiologic characteristics of urolithiasis appear to have changed in the last decade. This study aims to update the current understanding of the disease in Turkey. A representative sample, totalling 2,468 participants between 18 and 70 years of age from 33 Turkish provinces, was enrolled in this cross-sectional study conducted with a professional market investigation company. Participants were evaluated with face-to-face interviews by medical students using a standard questionnaire. Of the 2,468 participants, 274 (11.1%) reported a history of urinary stone disease diagnosed by a physician and an additional 52 (2.1%) had at least one lifetime episode of colic pain. The annual incidence of urolithiasis in 2008 was 1.7%. The male:female ratio was 1:1 in participants with urolithiasis. A family history of urolithiasis was found in 28.5% of the first-degree relatives of the stone formers, compared to 4.4% of the first-degree relatives of the stone-free participants (p = 0.01). Compared to other ethnic groups, the population of Turkish origin had a statistically significant decreased risk of urolithiasis (p = 0.006). Though not statistically significant (p > 0.05), urolithiasis showed a trend toward a geographical distribution within the country, in which southeastern Anatolia and the Aegean regions had higher frequencies compared to the Black Sea, and central Anatolian and eastern Anatolian regions. Urinary stone disease is a severe problem in Turkey, with high prevalence and incidence rates, which differ significantly between ethnic groups. Moreover, current findings demonstrate a demographic shift, with an increased prevalence of stone disease in female subjects.

We aimed to compare the outcomes of patients who were treated using digital and fiberoptic flexible ureterorenoscopy (urs) for kidney stones.Between September 2008 and December 2009, a total of 76 patients who were treated with either a conventional fiberoptic flexible ureterorenoscope (FFU) (n = 34) or digital flexible ureterorenoscope (DFU) (n = 42) were compared. All procedures were performed by the same surgeon. Preoperative, operative, and postoperative data were retrospectively analyzed.The mean stone size was 95.2 ± 61.3 mm(2) in the FFU group while it was 93.5 ± 57.1 mm(2) in DFU group (P0.05). The initial assessment of the entire pyelocaliceal system was possible in 33 of 34 (97%) cases in the FFU group and in 38 of 42 cases (90.4%) in the DFU group (P0.05). The mean operative time was significantly longer in the FFU group (54.4 ± 14.8 minutes vs 44.8 ± 17.9 minutes, P = 0.001). Flexible URS time was 46.5 ± 13.4 minutes in the FFU group while it was 38.3 ± 17.4 minutes in the DFU group (P = 0.001). Mean fragmented stone size per minute was 2.43 ± 0.81 mm(2)/min in the DFU group and 1.96 ± 0.80 mm(2)/min in the FFU group; this was statistically significant (P = 0.01). The overall stone-free rate 1 month after the procedure was 88.2% in the FFU group and 85.7% in the DFU group (P0.05). The average number of uses for FFU and DFU before repair necessity was 17 and 21, respectively.Although the DFU have more limited maneuverability, comparable success rates can be achieved with both conventional and digital instruments. On the other hand, the DFU significantly reduced the operative time compared with the conventional one.

To analyze the early outcome after single tract vs multiple tracts percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi.The records of 413 patients with staghorn calculi (223 [54%] had complete and 190 [46%] had partial) who underwent PCNL were reviewed retrospectively. A total of 244 (59%) patients were managed by single access (group 1); meanwhile, multiple accesses were necessary in 169 (41%) patients (group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Patients and stone-related factors affecting the number of accesses performed were analyzed.The mean number of percutaneous accesses was 2.42 +/- 0.74 (range 2-6) in group 2. Mean durations of fluoroscopy screening time and operative time were significantly longer in group 2 (P = 0.002, P0.0001, respectively). Supracostal access was necessary in 30.7% in group 2 and in 6.9% in group 1 (P = 0.001). Success was achieved in 70.1% in group 1 and in 81.1% for group 2 after one session of PCNL (P = 0.012). The most common complication was bleeding for both groups, and it was higher in group 2 (P0.0001). The mean preoperative and postoperative creatinine concentrations were 1.03 mg/dL and 1.08 mg/dL in group 1, and 0.9 mg/dL and 1.03 mg/dL in group 2, respectively. The mean changes in creatinine values were not statistically significant between the groups (P = 0.16).The impact of PCNL using either single or multiple access tracts on renal function is similar and of a temporary nature. PCNL with multiple accesses is a highly successful alternative with considerable complication rates in the management of staghorn calculi.

It is well known that chronic inflammation contributes to several forms of human cancer. Although several studies have investigated the association between prostatitis and prostate cancer, there is a lack of specifically designed study about male accessory gland infections (MAGI) and prostate cancer co-occurrence. We aimed to investigate this association with a case-control study in Turkish men. A total of 155 patients were enrolled to the study. After the pathological examination of the transrectal ultrasound-guided prostate biopsy specimens, patients were divided the two groups as control and prostate cancer and the presence of MAGI was determined. Of 155 patients, 145 met inclusion criteria. In the prostate cancer group, MAGI diagnose was determined in 18 of 31 patients (58.06%), while it was determined in 25 of 114 (21.93%) patients in the control group (p = .001). A significant correlation between MAGI and pathological Gleason score also revealed (p = .0001). We demonstrated that men with MAGI have increased risk for the development of prostate cancer. Moreover, in this population, most of the prostate cancers tend to be clinically significant or high grade.