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Objective To present our experience to describe diagnosis and management of symptomatic ureteric stones during pregnancy. Materials and Methods Thirty-six pregnant women with symptomatic ureteric stones were evaluated in this study. The diagnosis was done by history, physical examination, symptoms, signs, ultrasonography, or ureteroscopy if needed. Initially, conservative management was performed on all patients. When conservative treatment failed, temporizing therapies (double-J stenting or percutaneous nephrostomy [PCN]) and (ureteroscopic lithotripsy) URSL were performed on the patients. Results In 25 (69.4%) of the patients, ureteric stones was diagnosed on US. In the other 11 (30.6%) of the patients, definitive diagnosis was done by ureteroscopy in 5, and 6 of them passed their stones spontaneously. Conservative management was successful in 24 of 36 (66.6%) the patients. Temporizing therapies and URSL were required in 12 of 36 (33.4%) patients. A double-J stent was successfully placed in only 3 (8.3%) of the patients, and URSL was performed in 9 (25%). In 1 (2.7%) patient, PCN was performed because of persistent renal colic, fever, and pyonephrosis. In this patient, URSL was performed after symptoms and signs resolved, and then the percutaneous tube was removed. Conclusion If ultrasonogrpahy fails, ureteroscopy may be an alternative approach for definitive diagnosis. When conservative approach fails, URSL may be a good alternative approach for definitive treatment.

Objectives: To assess the efficacy and safety of ureteroscopic pneumatic lithotripsy for multiple ureteric stones. Materials and Methods: 36 patients with multiple ureteric stones were treated with ureteroscopic lithotripsy (URSL). A 8/9.8-Fr Wolf semirigid ureteroscope and pneumatic lithotripter were used for stone fragmentation. Results: 87 stones were treated with URSL. Successful fragmentation was achieved in 77 (88.5%) of the stones. The retreatment rate was 11.5%. The stone-free rate (SFR) of lower ureteric stones (93.3%) and middle ureteric stones (87.5%) was significantly higher compared with upper (73.3%) ureteric stones (p < 0.05). For patients with stones less than 1 cm and greater than 1 cm, the SFR was 91.5 and 75.0%, respectively (p < 0.05). Perforation occurred in 1 patient, mucosal injury occurred in 5 and stone migration in 5. No long-term complication was observed in any patient. Conclusions: Ureteroscopic pneumatic lithotripsy is still a reasonable treatment option for multiple ureteric stones. The procedure has high success rates with minimal morbidity. However, success rate can be affected by stone size and ureteric location.

Purpose: To determine the risk ratios and incidence of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients using tamsulosin, and to assess management strategies for IFIS. Methods: We performed a non-randomized, observational, prospective study, in which 594 eyes of 579 patients undergoing cataract surgery were enrolled. Surgeons were masked to the patients’ drug history. Usage or non-usage of tamsulosin, duration of tamsulosin use, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded in the patients’ theatre notes. Results: Twelve of 15 (80%) IFIS patients were taking systemic tamsulosin. Twelve of 23 (52%) patients using tamsulosin showed features of IFIS. The odds ratios (ORs) and relative risk (RR) ratios show strong positive correlations between tamsulosin use and IFIS. The ORs and RR ratios and the 95% confidence intervals (CIs) are as follows: OR 206.5 (95% CI 50.9–836.5); RR 99.3 (95% CI 30.0–327.8). There were no statistically significant differences between patients with or without IFIS, who were using tamsulosin, in terms of age or duration of tamsulosin use (p > 0.05). Seven eyes (46.6%) with IFIS were successfully managed with epinephrine. Eight eyes (53.4%) with IFIS needed iris hooks. Conclusions: Patients using tamsulosin appear to be at high risk of IFIS during cataract surgery. The occurrence of IFIS may not be affected by duration of tamsulosin use or age. Epinephrine may be effective in approximately 50% of eyes with IFIS. The iris hook procedure represents an effective management strategy in IFIS.

WOS:000380066200026 PubMed: 27286124 Purpose: Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. Materials and Methods: A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. Results: There were 60 patients in each Group. Their mean age was 35.95 +/- 15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). Conclusion: This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

To evaluate the effectiveness and safety of direct vision internal urethrotomy (DVIU) by using endoscopic scissors for incision of short (1 cm) urethral strictures in adult men.Twenty-one patients who had short bulbar urethral strictures were evaluated in this study. Endoscopic scissors was used for incision of urethral strictures in all patients. Retrograde urethrography (RGU) and maximum flow rate(Qmax)15.0 ml/s by uroflowmetry were used for the definition of recurrences.The procedure was found successful in all patients. The mean size of stricture was 0.73 cm. The mean pre-procedure Qmax was 7.9 ml/s. The mean procedure time was 10.2 min. The mean Qmax was 19.4 ml/s at the third month postoperatively. RGU was normal in all patients at the third month postoperatively. The mean follow-up was 8.1 months. Three (14.2 %) patients underwent second DVIU due to recurrence. No complication was observed during the follow-up except urinary tract infection in two (9.5 %) patients.DVIU using endoscopic scissors appears to be an effective and safe treatment modality for incision of short urethral strictures in adult men.

We investigated the efficacy of prophylactic use of single dose oral ofloxacin and trimethoprim-sulfamethoxazole regimens for transrectal prostate biopsy in 110 men. In the ofloxacin, trimethoprim-sulfamethoxazole and control groups, urinary infection was found in 2 (4.76%), 3 (6.66%) and 6 (26.08%) patients, respectively. Both of these antibiotic regimens produced a statistically significant reduction in urinary infection (p

We present our experience with combined pneumatic lithotripsy and transurethral resection of the prostate (TURP) in 52 patients with bladder stone(s) and benign prostatic hyperplasia (BPH). All stones were fragmented with the pneumatic Swiss Lithoclast. Pneumatic lithotripsy and evacuation caused a mean increase of 16 minutes in operating time. No complications, other than mild hematuria, were observed intraoperatively because of pneumatic lithotripsy. We observed early and long-term complications related to the procedure in 13% of patients. The average hospital stay was 3.2 days. The combination of pneumatic lithotripsy and TURP appears to be an effective, safe, and economical treatment method for patients with bladder stone(s) and BPH.

To investigate the role of extremely low frequency pulsed and sinusoidal electromagnetic fields on kidney tissues.Twenty-seven male Wistar albino rats were used. The rats were divided into 3 groups (n = 9): control group, sinusoidal electromagnetic field (SEMF) group, and pulsed electromagnetic field (PEMF) group. The SEMF and PEMF groups (pulse time 25 microsn, pulse frequency 50 Hz) were subjected to 1.5 mT, 50 Hz, exposure 6 hours a day, 5 days a week for 28 days in methacrylate boxes. Formalin-fixed, paraffin-embedded kidney tissue sections were stained with hematoxylin-eosin, Gomori and periodic acid-Schiff. In addition, matrix metalloproteinase-2 (MMP-2) and 9 (MMP-9), E-cadherin and collagen type IV expression levels were examined immunohistochemically.Thickening of glomerular basement membranes was evident in electromagnetic fields, especially in the SEMF group. In addition, expression levels of E-cadherin were decreased with electromagnetic field (EMF) exposure. The expression level of MMP-9 increased, and MMP-2 and collagen type IV expression levels were not altered with EMF exposure.Both EMFs changed the molecular component of the kidney adversely.

Intravesical tension-free vaginal tape and non-absorbable suture are uncommon, but important complications of anti-continence surgery. Since the foreign bodies could not be absorbed, they act as a nidus for stone formation and recurrent urinary tract infection. Today, optimal techniques for the removal of intravesical tension-free vaginal tape and non-absorbable suture have not yet been determined.1 Therefore, the management of the foreign bodies still remain an operative challenge.2 In recent years, Ho:YAG laser has been recommended for the removal of the intravesical foreign bodies.2,3 However, it is expensive and not available in most urologic centre. Herein, I would like to describing a simple technique to remove intravesical tension-free vaginal tape and non-absorbable sutures after anti-continence surgery. A 26-Fr rigid nephroscope and nephroscopic scissors are used to remove foreign bodies. Under sedoanalgesia, a 26-Fr rigid nephroscope is placed in the bladder. For removal of tension-free vaginal tape, the nephroscope is advanced through the left upper tip of the tension-free vaginal tape. Then, the left upper tip of the tension-free vaginal tape is cut with nephroscopic scissors. The same procedure is performed on the right side. To remove the suture, the nephroscope is advanced through the upper tip of the suture. The upper tip of suture is then cut with nephroscopic scissors. The same procedure is carried out on the opposite side. At the end of the procedures, the suture and tension-free vaginal tape are removed with nephroscopic forceps. The procedures take about 5 to 10 minutes. No complications are observed, except mild hematuria during the procedure. It is an outpatient procedure with minimal complication. The procedure time is minimal and the instruments are not technically difficult to maneuver by most urologists. The instruments are also available in every urological operating room. Additionally, fragmentation of stones associated with the foreign bodies can be achieved with a percutaneous rigid nephroscope and lithotripter. In contrast to the application of lasers, the procedure is cost-effective and practical. This technique is a good alternative to Ho:YAG laser for the removal of intravesical tension-free vaginal tape and non-absorbable suture after anti-continence surgery.

Objective To present an endoscopic technique for the decompression of complicated orthotopic ureterocele in adult women. Methods Five women with complicated orthotopic ureterocele were evaluated in the present study. The ureterocele was complicated by stones in 2 patients and urinary tract infection in 4. An endoscopic technique was used for the treatment of these ureteroceles. A 26F rigid nephroscope was placed into the bladder. When the ureterocele was seen in the bladder, the nephroscopic scissors was advanced through the nephroscopic channel to the ureterocele. A puncture was made on the anterior wall of the ureterocele using the nephroscopic scissors. Next, a ureteral catheter was introduced to puncture the ureterocele. Next, a window approximately 5-10 mm in diameter was opened on the wall of the ureterocele using the nephroscopic scissors. Finally, a double- J stent and urethral catheter were placed. The stones were fragmented using a pneumatic lithotripter. All the patients were evaluated with urinalysis, urine culture, ultrasonography, and voiding cystourethrography at the third month postoperatively. Results The mean procedure time was 18.4 minutes. No complication was observed during the procedure, except for mild hematuria. The mean postoperative hospital stay was 19.8 hours. All patients with stones were stone free after the procedure. No cases of postoperative urinary tract infection developed. None of these patients had de novo reflux or obstruction at 3 months postoperatively. Conclusion This technique could be an alternative treatment option for decompression of complicated orthotopic ureterocele in adult women.

To evaluate the effectiveness and safety of pneumatic lithotripsy by using a ureteroscope to treat bladder stones in children.Twenty-seven boys presenting with bladder stones underwent transurethral cystolithotripsy. The indication for transurethral cystolithotripsy was stone sizeor=2 cm. A 8/9.8F Wolf semi-rigid ureteroscope or 9.5F Storz ureteroscope and a pneumatic lithotripter were used for stone fragmentation in all patients.All patients were stone-free at 2 weeks postoperatively. The mean age was 7.6 years (range 3-14 years), and the mean stone size was 14 mm (range 8-20 mm). The operating time was 22 minutes (range 10-46 minutes). The mean hospitalization time was 1.2 days (range 1-3 days), and the mean follow-up was 13 months (range 1-32 months). No complications due to pneumatic lithotripsy other than mild hematuria were observed intraoperatively. Stone forceps were used to retrieve large stone fragments (5-6 mm in size) in 10 (37%) of the patients. After the operation, acute retention was observed in 2 (7.4%) of the patients due to failure of fragments to pass through the urethra. A second procedure was performed on these patients. Fever was observed in 2 (7.4%) of patients. No long-term complications or stone recurrences were seen in any patient.Pneumatic lithotripsy using a ureteroscope appears to be an effective and safe treatment for bladder stones in children. It is minimally invasive and involves reduced hospital stay and overall cost. However, it can cause some problems in terms of spontaneous passage. Thus it may be used as an alternative treatment option in selected patients.

We evaluated the need for routine ureteral stenting after uncomplicated ureteroscopic lithotripsy (URSL) without dilation for lower ureteral stones larger than 1 cm. A total of 43 patients underwent URSL for lower ureteral stones larger than 10 mm. They were randomized into a stented (21) or an unstented (22) group. URSL was performed by using a semirigid ureteroscope and pneumatic lithotripter without ureteral dilation. Additional forceps application (AFA) was used to remove fragmentsor =4 mm. Patients in each group were assessed for stone-free rate, stone size, operative time, AFA, hospitalization time, postoperative pain, irritative voiding symptoms, hematuria, re-hospitalization and stricture formation. The stone-free rate was 100% in each group. There were no statistical differences in the two groups regarding stone size, operative time, AFA, postoperative pain, hematuria and hospitalization time. However, irritative voiding symptoms of the stented group were significantly higher than those in the unstented group (P0.05). One patient (4.5%) in the unstented group required re-hospitalization for severe flank pain with fever (38 degrees C) compared to one patient (4.7%) in the stented group for proximal stent migration (P0.05). Stricture formation was not demonstrated in either group at 3 months follow-up excretory urography (EXU). Our results demonstrate that ureteral stenting after uncomplicated URSL without dilation for lower ureteral stones larger than 1 cm does not appear to be necessary if AFA is used to remove fragmentsor =4 mm, thereby reducing morbidity of patients and risk of re-hospitalization.

Purpose: To determine whether magnetic resonance imaging (MRI) or quantitative color-imaged morphometric analysis (MA) of the prostate gland are related to the clinical response to terazosin. Methods: Thirty-six male patients with symptomatic benign prostatic hyperplasia (BPH) with a serum prostate-specific antigen level of 4–10 ng/mL underwent MRI with body coil, transrectal prostate ultrasonography and biopsy prior to terazosin therapy. For MRI-determined stromal and non-stromal BPH, the ratio of the signal intensity of the inner gland to the obturator internus muscle was evaluated. Histologic sections were stained with hematoxylin and eosin. The MA of the specimens was performed by Samba 2000. Results of the two techniques were interpreted according to the terazosin therapy results. Results: The mean stromal percentage was 60.5 ± 18.0%. No statistically significant relationship was found between the clinical outcome of terazosin and the MRI findings. The MA results showed a significant relationship between the percentage of stroma and the percent change of the peak urinary flow rate, but not with the percent change of the international prostate symptom score after terazosin therapy (P < 0.05). Conclusion: Magnetic resonance imaging alone is not sufficient in predicting the response to terazosin therapy. Morphometric analysis of BPH tissue composition can be used in predicting the clinical outcome of terazosin therapy but it is suitable only in patients for whom prostatic biopsy is necessary in order to rule out prostate cancer.

Extracorporeal shockwave lithotripsy (SWL) is accepted as first-line therapy for kidney stones. The aim of this study was to evaluate SWL therapy in patients with congenital urinary system anomalies.A total of 120 patients with congenital urinary system anomalies and kidney stones who underwent SWL treatment were evaluated. Of these patients, 44 (37%) had horseshoe kidneys, 22 (18%) had rotation anomalies, 13 (11%) had pelvic kidneys, and 41 (34%) had ureteral duplications. The mean stone size was 2.09+/-0.71 (range 0.8-4.6) cm2, and a total of 232 sessions (1.93 sessions/patient) were applied.The overall stone-free rate after completion of the SWL treatments was 70% (84 patients). In horse shoe kidneys the stone-free rate was 68%, and sufficient fragmentation was achieved in another 21%. These values were 59% and 32%, respectively, for malrotated kidneys, 54% and 39% for pelvic kidneys, and 83% and 12% for ureteral duplications. The 10 patients in whom SWL treatment remained unsuccessful had horse-shoe kidneys (five cases), malrotated kidneys (two cases), pelvic kidney (one case), and ureteral duplication (two cases). Open surgery was performed in eight patients with renal anomalies, and ureteroendoscopic lithotripsy was performed in two patients with ureteral duplication.Shockwave lithotripsy is an effective and reliable treatment method in patients with congenital urinary system anomalies, especially when the stones are2 cm. Patients with ureteral duplication had the overall best stone-free rates. However, patients who have stonesor =3 cm in horseshoe or malrotated kidneys and duplex systems seem to be better candidates for percutaneous nephrolithotomy or open surgery.

Aim of the Study: The aim of the study is to compare the effectiveness of ESWL and ureteroscopic lithotripsy with pneumatic, ultrasonic and electrohydraulic modalities in patients with ureteral stones. Patients and Method: In this study, 1,970 patients with ureteral stones were evaluated. ESWL and ureteroscopic lithotripsies were performed in 1,580 and 484 patients, respectively. The ESWL group was treated with a Siemens Lithostar plus. Ureteroscopic lithotripsy was performed with pneumatic lithotripsy (PL), ultrasonic lithotripsy (USL) and electrohydraulic lithotripsy (EHL) in 140 (28.9%), 311 (64.3%) and 33 (6.8%) patients, respectively. 94 patients underwent both because of unsuccessful ESWL therapy. Results: In the ESWL group, the stone-free rate was 49.9% and the fragmentation rate 71.0%. These values were: 95.0 and 97.1% for FL: 88.1 and 89.4% for USL; 90.9 and 93.9% for EHL, respectively. Ureteroscopic lithotripsy has been found more effective than ESWL in the treatment of middle and lower ureteral calculi (p < 0.001) and PL has the greatest success rate within these endoscopic groups. Conclusion: ESWL therapy can be the first-line therapy in upper ureteral stones keeping the other modalities for unfragmented stones. However, ureteroscopic lithotripsy is the most effective treatment choice in lower ureteral stones no matter which kind of energy used and PL is the most effective and less complicated among the other types.

Several different techniques under direct vision have been described for the management of difficult ureteral catheterization following transurethral resection of the prostate (TURP).1–3 However, all of these tecniques require a specific material (mini ureteroscope or The Peel-away sheath, [Bard, Covington, GA]) which may not available. I would like to describing a simple technique, which does not require special material, to make ureteral catheterization easier following TURP.

Vesical diverticula frequently result from bladder outlet obstructions. However, giant vesical diverticula which cause acute abdomen or intestinal obstruction are very rare. Our review of the English medical literature found 3 cases of bladder diverticula which caused gastrointestinal symptoms. Here, we present a 57-year-old man with a giant diverticulum of the urinary bladder who complained of abdominal pain, nausea and vomiting, constipation, no passage of gas or feces, and abdominal distension for 3 d. A 20 cm x 15 cm diverticulum was observed upon laparotomy. The colonic obstruction was secondary to external compression of the rectum against the sacrum by a distended vesical diverticulum. We performed a diverticulectomy and primary closure. Twelve months postoperatively, the patient had no difficulty with voiding or defecation.

We evaluated the need for routine ureteral stenting after uncomplicated ureteroscopic lithotripsy (URSL) without dilation for lower ureteral stones larger than 1 cm. A total of 43 patients underwent URSL for lower ureteral stones larger than 10 mm. They were randomized into a stented (21) or an unstented (22) group. URSL was performed by using a semirigid ureteroscope and pneumatic lithotripter without ureteral dilation. Additional forceps application (AFA) was used to remove fragments ≥4 mm. Patients in each group were assessed for stone-free rate, stone size, operative time, AFA, hospitalization time, postoperative pain, irritative voiding symptoms, hematuria, re-hospitalization and stricture formation. The stone-free rate was 100% in each group. There were no statistical differences in the two groups regarding stone size, operative time, AFA, postoperative pain, hematuria and hospitalization time. However, irritative voiding symptoms of the stented group were significantly higher than those in the unstented group (P 38°C) compared to one patient (4.7%) in the stented group for proximal stent migration (P > 0.05). Stricture formation was not demonstrated in either group at 3 months follow-up excretory urography (EXU). Our results demonstrate that ureteral stenting after uncomplicated URSL without dilation for lower ureteral stones larger than 1 cm does not appear to be necessary if AFA is used to remove fragments ≥4 mm, thereby reducing morbidity of patients and risk of re-hospitalization.

This study investigated the efficacy and the adverse effects of sertraline in the treatment of premature ejaculation (PE). Thirty-seven patients with PE were randomly assigned to receive either sertraline or a placebo. Of them 22 were given 50 mg of sertraline per day and the other 15 patients were given an identical placebo one per day. After 4 weeks, the latency to ejaculation in the sertraline group was found to be significantly longer than that of the placebo group (p