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Purpose: To evaluate the factors affecting the effectiveness, safety, and success of retrograde holmium:yttrium–aluminum–garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults. Methods: Adult patients who underwent retrograde holmium:yttrium–aluminum–garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction between January 2012 and June 2016 at our clinic were retrospectively analyzed. Success was defined as the relief of symptoms and the resolution of obstruction, as assessed via radiography. Factors affecting success were analyzed, such as the clinical characteristics, procedural outcomes, complications, and the type of ureteroscopy used in the procedure. Results: Procedural success was achieved in 29 (74.4%) out of 39 patients, with a mean age of 38.3 ± 12.3 years during a median follow-up duration of 44 (33–65) months. Failure occurred at a median of 4.5 (3–22) months. It was detected that the presence of primary obstruction, ipsilateral kidney function being >30% of normal, and the length of obstruction being <1 cm positively affected procedural success (p = 0.009, p = 0.011, and p = 0.019, respectively). In the postoperative period, two Grade I and four Grade II complications were observed according to the Clavien–Dindo classification. There was a difference only in the operation time between semirigid (24) and flexible ureteroscopes (15), with the operation time being shorter with the use of a semirigid ureteroscope than with the use of a flexible uteroscope (p < 0.001). Conclusion: Retrograde holmium:yttrium–aluminum–garnet laser endopyelotomy is a minimally invasive method that can be used effectively and safely as the primary treatment of patients with ureteropelvic obstruction, when long-term results are also taken into consideration. The decision of performing laser endopyelotomy should be made after a detailed evaluation of the characteristics of the patient as well as of the obstruction. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate ciprofloxacin resistance (CR) and extended-spectrum beta-lactamase (ESBL) positivity in the rectal flora, antibiotic prophylaxis received, and post-biopsy infectious complications in patients undergoing prostate biopsy.Material& Methods: Rectal swab samples collected from 99 patients suspected of prostate cancer two days before prostate biopsy were tested for microbial susceptibility and ESBL production. All patients were given standard ciprofloxacin and ornidazole prophylaxis. Ten days post-biopsy, the patients were contacted by phone and asked about the presence of fever and/or symptoms of urinary tract infection.Results: Escherichia coli (E.coli) was the most common isolate detected in 82 (75%) of the rectal swab samples. Ciprofloxacin resistance was detected in 33% and ESBL positivity in 22% of the isolated E.coli strains. No microorganisms other than E.coli were detected in blood, urine, and rectal swab cultures of patients who developed post-biopsy complications. CR E.coli strains also showed resistance to other antimicrobial agents. The lowest resistance rates were to amikacin (n = 2, 7.4%) and nitrofurantoin (n = 1, 3.7%). Seven patients (7.6%) developed infectious complications. There was no significant difference in probability of hospitalization between patients with CR strains (14.3%) and those with ciprofloxacin-susceptible strains (14.3% vs. 4.7%; p = 0.194). However, strains that were both CR and ESBL-positive were associated with significantly higher probability of hospitalization compared to ciprofloxacin-susceptible strains (28.6% vs. 3.8%; p = 0.009).Conclusion: The higher rate of infectious complications with CR and ESBL-positive strains suggests that the agents used for antibiotic prophylaxis should be reevaluated. It is important to consider local resistance data when using extended-spectrum agents to treat patients presenting with post-biopsy infectious complications. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to evaluate the effectiveness and safety of retrograde intrarenal surgery (RIRS)following retrograde laser endopyelotomy (rLEP) in concomitant ureteropelvic junction obstruction (UPJO) andstone disease.Materials and Methods: Patients with concomitant UPJO and renal stone disease who were first treated in ourclinic by rLEP for obstruction and then RIRS for stone disease were enrolled. Study period went from 2012 to2017. RIRS following rLEP was performed earliest at the sixth week. Patients who underwent rLEP were matchedwith those with normal anatomy at a 1:1 ratio based on the propensity scores. Additionally, clinical results werecompared in order to evaluate the effects of rLEP surgery on RIRS. Subsequently, patients who underwent RIRSfollowing rLEP were independently evaluated and factors affecting the success of sequential procedures wereinvestigated.Results: The sole difference between those that underwent RIRS following rLEP (n=27) and controls with normalanatomy that underwent RIRS was in operative times (p = .011). Evaluation of potential success factors inthe sequential rLEP-RIRS group revealed that primary etiology, obstruction length less than 1cm, smaller stonesize and presence of single stone showed significant effects (p = .047, p = .030, p = .040, p ? .001, respectively).RIRS following rLEP generated an 81.5% stone-free and, after a median follow-up time of 32 months, a 74.1%obstruction-free rate.Conclusion: RIRS following rLEP in patients with UPJO and renal stones is an effective treatment method. It canbe used safely in patients with single stones < 2cm, short obstruction lengths, and presence of primary etiology. [ABSTRACT FROM AUTHOR]