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AIMS We validated a Turkish language version of the urethral stricture surgery specific patient-reported outcome measure (USS-PROM) in men undergoing anterior urethroplasty. We also investigated changes in erectile function (EF) and quality of life (QoL) due to oral mucosa graft (OMG) harvesting. METHODS The USS-PROM captures lower urinary tract symptoms (LUTS), health related QoL (HRQoL) with EQ-5D visual analogue scale (EQ-VAS). To evaluate EF and OMG morbidity, we used International Index of Erectile Function (IIEF-5) and a self-completed questionnaire, respectively. Psychometric assessment of USS-PROM included test-retest reliability, internal consistency, criterion validity, and responsiveness. Objective evidence for urethroplasty success was demonstrated with fluoroscopic imaging and urethral calibration at post-operative six months. RESULTS Among the 101 men included during study period, 42 had complete pre- and postoperative 6th month data for analysis. The test-retest intraclass correlation was 0.79. Cronbach's α for internal consistency of the LUTS construct was 0.79. There was a significant negative correlation between total LUTS scores and peak flow rates, both preoperatively (r = −0.478) and postoperatively (r = −0.508). Mean baseline EQ-VAS increased from 70 to 84 postoperatively (P

Objective: Retropubic radical prostatectomy (RRP) is still widely used in clinical practice in localized prostate cancer because of its high oncological success. The aim of this study was to define the continence status in patients where rhabdosphincter was included in the vesicourethral anastomosis. Materials and methods: Between November 2004 and September 2010, 90 cases who underwent RRP by the same surgeon in our clinic were taken into the study. In all cases vesicourethral anastomosis was performed include the rhabdosphincter. The anastomosis was performed with mean 2.9 (0-7) interrupted no 2-0 vicryl sutures, depending on the angulation of symphysis pubis and pelvic cavity. Pad test was performed to all patients at 1, 3, 6 and 12 months postoperatively. We defined patients as ‘continent’ when they no need pad, as ‘mild incontinence’ when they use only one pad daily, as ‘moderate incontinence’ when they use two or three pads daily and as ‘severe incontinence’ when they use more than three pads daily. Results: Preoperative total PSA value was 12.2 ng/ml (range: 2.7-84 ng/ml). Preoperative prostate biopsy results were found that Gleason scores were 5, 6, 7 and 8 in 7, 53, 21, 9 patients, respectively. Mean operation and urethral catheter removal time was 103 minutes (60-200) and 14,6 days (9-28), respectively. Mean hospital stay was 4.6 days (2-20). According to results of postoperative pad tests, 38 (42.2%), 48 (53.3%), 55 (61.1%) and 75 (83.3%) patients were defined as continent in first, third, sixth and twelfth months, respectively. Conclusions: We think that, our novel technique of vesicourethral anastomosis in standard RRP provides more optimal urethral position during fixation of pelvic floor and urethra, protect caudal retraction, preserve functional urethral length. Also strong full thickness stitch on urethra provides better urinary continence by hanging urethra in our patients. Although our early continence rate is better, our long term continence rate is similar to literature.

WOS: 000376566800015 Aim: Radical prostatectomy (RP) is the gold standard treatment method for localized prostate cancer, because of its high oncological success. Iatrogenic rectal injury (IRI) during RP is rarely seen, but it may causes serious complications because of the close anatomic relationship between the prostate and rectum. Aim is to present our series about management of IRI without colostomy. Material and Method: Between June 1999 and June 2013, radical retropubic prostatectomy (RRP) was performed to 372 patients by a single surgeon. 10 cases (% 2,6) were complicated by a rectal injury during RRP. Instant rectal closure was performed in 3 layers without a diverting colostomy, at the time of surgery. Omental vascular flap was placed between rectum and vesicourethral anastomosis. Results: The clinical stages of IRI cases were T1c, T2a and T2c in 2, 3 and 5 patients, respectively. Their preoperative Gleason scores were 6, 7 and 8 in 3, 5 and 2 patient, respectively. None of the 10 had undergone previous prostatic or rectal surgery, or received preoperative radiotherapy or hormonal therapy. Discussion: Instant diagnosis and rectal wall closures by three layers are essential for successful repair. Our technique seems as a safe, minimal invasive and highly effective option for the management of IRI.

We present our minimum 1-year results with a mesh spiral-sling procedure (MSSP) for managing refractory and disabling stress urinary incontinence (SUI) in women. Thirty-four women were treated with MSSP between 2007 and 2011. Six had incomplete data and were excluded from analysis. Study cohort comprised 21 women with refractory (mean number of previous surgeries 2.2; range 1–6) and seen with primary disabling SUI. All patients had marked intrinsic sphincter deficiency (ISD) with a Valsalva leak-point pressure (VLPP)

We present our initial experience with microperc in patients with moderate-size renal calculi.A retrospective analysis of 30 patients (male 14, female 16) with moderate-size (1-3 cm) kidney stones who underwent microperc between August 2011 and July 2012 was performed. The demographic values, perioperative and postoperative measures including age, stone size and location, body mass index, operative and fluoroscopy time, hemoglobin decrease, success and complication rates were prospectively recorded into a patient entry system.The average stone size was 17.9±5.0 mm (10-30 mm). The mean age of the patients was 41.5±18.2 years (range 3-69 years). The duration of the operation was calculated as 63.5±36.8 minutes (range 20-200 min). Mean fluoroscopic screening time was 150.5±90.4 seconds (range 45-360 seconds). The patients were discharged after a mean hospitalization period of 35.5±18.6 hours (range 14-96 hours). An overall success rate of 93% (including 10% of insignificant residual fragment rate) was achieved. In the follow-up, residual stone fragments were detected in two (7%) patients. Conversion to miniperc was necessitated in three (10%) patients. The mean hemoglobin drop was found to be 1.1±0.8 mg/dL (range 0-2.8 mg/dL). Complications were observed in five (13.3%) patients.Our initial results provide that microperc is a feasible, safe, and efficacious treatment modality for moderate-size kidney stones as well as small ones with its minimally invasive nature. Technical refinements are needed to achieve better results and overcome the limitations of technique.

This review is aimed to provide an update on the surgical techniques and complications of sacrocolpopexy procedures, and determine the role of minimally invasive techniques based on the most recent evidence.The minimally invasive laparoscopic and robot-assisted alternatives to open abdominal sacrocolpopexy offer faster recovery, less complications and better cosmesis. However, this is suggested predominantly by retrospective comparative studies and no high-level evidence is available to date. Robot-assisted sacrocolpopexy (RASC) has enabled surgeons to overcome the steep learning curve associated with laparoscopic sacrocolpopexy at the expense of a higher cost. Recent data, testing its potential advantages of reduced operative time and postoperative pain, have revealed contradictory results. A novel, totally retroperitoneal sacrocolpopexy procedure aimed to eliminate complications associated with transperitoneal access may become an option in patients unsuitable for minimally invasive techniques, but warrants further investigation.The benefits of RASC must be weighed against the lack of current evidence to prove its superiority over conventional procedures in terms of faster recovery and cost-effectiveness. There is a need for better reporting of complications associated with these novel techniques and for long-term, randomized comparative data.

Objective To report our results with 1-stage reconstruction in short distal urethral strictures using circular buccal mucosa graft (cBMG). Methods The data of 19 patients (median age 41.8 years, range 25-58) operated between 2001 and 2010 were reviewed. Patients were evaluated with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography (VCUG), and intraoperative urethroscopy. Stricture was limited to the glanular urethra (≤2 cm.) in all cases and 16 patients had lichen sclerosus. Strictured urethra was resected 0.5 cm proximal to the healthy urethra and a rectangular BMG with 4-cm length and 1.5- to 2.5-cm width (depending on the length of the defect) was rolled on a 24-Fr sound that calibrated the urethra. Proximal and distal edges of the cBMG were anastomosed circumferentially to the healthy mucosa and meatus, respectively. Foley catheter was removed within 10-14 days. Voiding symptoms, uroflowmetric parameters, and cosmesis were assessed at 1, 3, and 6 months, and yearly thereafter. Results With a median follow-up of 38 months (range 12-96), 16 (84.2%) patients were cured. One patient developed early graft loss, and 2 patients developed stricture at proximal anastomotic site. Mean Q max (mL/s) increased from 7.8 ± 5.4 preoperatively to 21.8 ± 9.2 postoperatively ( P = .001), and mean AUA score decreased from 26.7 ± 3.9 preoperatively to 7.3 ± 3.8 postoperatively ( P Conclusion Our results suggest cBMG as a feasible alternative in 1-stage reconstruction of distal strictures confined to the glanular urethra because the glans penis has a good blood supply, providing an efficient circumferential graft take.

The aim of this report was to demonstrate the operative technique and assess outcomes of laparoscopic ureteroureterostomy on 3 consecutive cases diagnosed with retrocaval ureter. The presenting symptom of these cases was recurrent right flank pain and the diagnosis was established by intravenous urography. All patients were successfully treated with transperitoneal laparoscopic ureteroureterostomy using an intracorporeal suture technique with a mean operative time of 118 min. The mean blood loss was 76 cc and hospital stay 3.3 days. The minimally invasive laparoscopic surgery should be considered as the first choice of treatment for retrocaval ureter due to cosmetic advantages and early recovery.

PURPOSE: We report our experience with a Lich-Gregoir reimplantation (LGR) technique that included fixation of the ureter during detrusorraphy to preserve the integrity of the newly created submucosal tunnel, performed as an outpatient anti-reflux procedure. METHODS: Ninety-seven children (mean age: 7.9 years) with primary VUR underwent LGR between 1995 and 2008. Twenty-one had bilateral VUR, 8 had ureteral duplication, 9 had megaureter, and 13 had previous subureteric injections. Through a Pfannenstiel incision the ipsilateral ureter was mobilized up to the ureterovesical junction without disturbing ureterotrigonal integrity. A 3-5 cm detrusorotomy was extended from the ureterovesical junction towards the umbilicus, the ureter was placed on the mucosa, and detrusorraphy was performed with a loosely running 3/4-0 polyglactin suture that passed through the detrusor on one side of the incision, taking a 1-2 mm “bite” of the ureteral adventitia, and detrusor on the other side. Postoperative ultrasonograms and voiding cystograms (VCUG) were obtained at 1 and 3 months, respectively. Children were then followed up for clinical symptoms of urinary tract infection with annual ultrasonograms. RESULTS: The mean operative time was 56 min. Eighty-one percent of the children were treated as outpatients. Transient voiding difficulties occurred in 2 children with a bilateral procedure. Reflux was cured in 116 ureters (98%) with a mean follow-up of 58 months (range: 6-128). Ipsilateral obstruction was not evident during ultrasound surveillance. CONCLUSIONS: LGR is an outpatient procedure with a high success rate and a low morbidity. Integrity of the newly created submucosal tunnel is important for long-term success, which may be facilitated by our modified detrusorraphy technique.

Purpose: Reconstruction of post-prostatectomy strictures involving the fossa navicularis and external urethral meatus following benign prostatic hyperplasia treatment is challenging in terms of creating a functional and cosmetically appealing penis. We reviewed our results with the use of ventral transverse island fasciocutaneous penile flap in the reconstruction of these strictures.Materials and Methods: Between 1997 and 2007 a total of 26 men (mean age 59 years, range 49 to 76) with post-prostatectomy distal urethral strictures underwent urethral reconstruction with a ventral transverse island fasciocutaneous penile flap. All patients had undergone multiple urethral dilatations. Stricture length was less than 1.5 cm in all cases. Urethral catheter was removed within 3 weeks. Followup included an initial uroflowmetry obtained 1 month after removal of the catheter followed by re-assessment at third month. The patients were followed for urinary pattern changes and/or irritative symptoms with a mean followu...

Variations of the renal artery and vein are quite often, and its frequency is 25-40 %. The most common variation is more than one renal artery. Four and a greater number of feeding arteries of the kidney are extremely rare, seen on the left side more than the right side and the frequency is around 0.1 %. In our case, we present case in which partial nephrectomy was planned due to being 5 cm mass on right kidney and incidentally 3 hilar arteries, 1 superior polar and 1 inferior polar artery were determined during operation., Renal arter ve venin varyasyonları oldukça sık olup %25-40 sıklıkta görülür. En sık görülen varyasyon, çok sayıda renal arter olmasıdır. Böbreğin dört ve daha fazla sayıda arterle beslenmesi oldukça nadir görülür sol tarafta sağ taraftan daha fazladır ve sıklığı yaklaşık % 0.1 civarındadır. Çalışmamızda sağ böbrekte 5 cm’lik kitle nedeniyle parsiyel nefrektomi planlanan ve operasyon sırasında rastlantısal 3 adet hiler renal arter, 1 adet süperior polar ve 1 adet inferior polar arter saptanan olgu sunulmaktadır.

A rectovesical fistula (RVF) is an uncommon complication of urooncologic surgery. Although several RVFs have been reported, our case is the first reported RVF in the literature that iatrogenically occurred after transurethral resection of the bladder. A single-stage primary repair with omental flap interposition without a colostomy was successfully performed because of the persistence of the fistula during followup. After 6 months of followup, no fistula or bladder mass was detected.

INTRODUCTION AND OBJECTIVES: Urethral strictures involving the fossa navicularis and external meatus require the reconstruction of both a functional and a cosmetic outlet. We describe our experience with ventral TIFP in the management of distal urethral strictures. METHODS: Between 1997 and 2012, 46 men (mean age: 54 years) with distal urethral strictures confined to the fossa navicularis and urethral meatus underwent ventral TIFP urethroplasty with the glans cap technique. The etiology of the stricture was iatrogenic in 40 (transurethral resection of the prostate or bladder tumor) and inflammatory/ idiopathic in 6. All except 4 patients had undergone multiple previous urethral dilatations. Preoperative evaluation included uroflowmetry with residual urine volume determination, retrograde urethrography (RU) and voiding cystourethrography (VCUG), and urethrocystoscopy with a pediatric ureterorenoscope. During surgery, a subcoronal incision was made on the ventral penile skin and carried down through Buck’s fascia until the urethra. Fossa navicularis and meatus were exposed by dissecting the urethra under the glans. The strictured urethra was then incised ventrally, including the meatus. A ventral fasciocutaneous island flap was mobilized and anastomosed to the edges of the urethral incision, augmenting the urethra to admit a 24-26F sound without difficulty. Urethral catheter was removed after 2 weeks. Patients were followed for obstructive symptoms and 3 monthly uroflowmetric studies in the first year and annually thereafter. Cure was defined as patient satisfaction and the absence of any restenosis requiring additional intervention. RESULTS: Stricture length ranged between 7 to 25 mm. Mean operation time was 50 min. Flap necrosis developed in one patient with subsequent fistula formation. Cure was achieved in 43 (93.4%) men at a mean follow-up of 78 months (range: 3-144). The procedure failed in 2 patients due to lichen sclerosus, which was diagnosed after the recurrence and managed with a 2-stage buccal mucosa graft urethroplasty. The mean Qmax was increased from 7.2 ml/sec preoperatively to 19.4 ml/sec at the last follow-up visit (p1⁄40.001, Wilcoxon sign test). CONCLUSIONS: TIFP is an effective technique for the reconstruction of urethral strictures involving the fossa navicularis and external meatus. It restores a functional and cosmetic outcome with preservation of the glandular integrity. Inflammatory genital skin diseases must be carefully evaluated before surgery to achieve optimum success with this technique.

We present long-term surgical experience of 102 chordee without hypospadias cases.This retrospective study included 102 chordee without hypospadias cases who were surgically treated between 1999 and 2012. Range of patients' age was from 1 month to 31 years. Seventy-two patients were adult, and 30 were children. Mean duration of follow up was 49.3 months. The patients were categorized into 4 groups including skin tethering (group 1), fibrotic dartos and Buck's fasciae ( group 2), corporeal disproportion ( group 3) and urethral tethering (group 4) with the aid of intraoperative artificial erection, according to the structural defect.Forty patients (group 1) were successfully treated with penile degloving. Except 3 (10%) of 31 (group 2) cases, extensive resection of the fibrotic dartos and Buck's fascia was needed to straighten the penis. Corporeal disproportion was identified in 27 patients of whom 2 cases (7%) had complica­tions. One of them developed urethrocutaneous fistula, and he was treated with buccal mucosal graft urethroplasty successfully. In other one, chordee persisted after two years, and we had to do Nesbit wedge resection after tunica albuginea plication to achieve penile straightening at the same session; otherwise we avoid tunica albuginea excision or incision. Overall 96 (94%) of 102 patients were suc­cessfully treated at first operation.We concluded that tunica albuginea plication is very effective for both prepubertal and postpubertal period and also in management of recurrence. We believe that, in experienced hands, early surgical correction can be done successfully in this condition.

We report a 75-year-old female with a primary urethral malignant melanoma. A mass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4 × 2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+) malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery.

To evaluate the functional outcomes of ventral inlay labia minora graft urethroplasty (VILGU) for the management of female urethral strictures.Data of 7 consecutive women treated with VILGU between 2011 and 2013 were reviewed. Two patients had cystostomy tubes at repair, and 5 had undergone previous urethral dilations and urethrotomies. Clinical evaluation included assessment of the effect of voiding symptoms with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography, and intraoperative urethrocystoscopy using a 6.5F pediatric ureterorenoscope. Preoperative AUA symptom score and peak urinary flow rate were compared with postoperative values. Cure was defined as the absence of any restenosis requiring additional intervention with subjective patient satisfaction at the last follow-up.Mean stricture length was 1.5 cm (range, 1-2.5), and mean operative time was 95 minutes (range, 70-110). With a mean follow-up of 18.2 months (range, 3-30), cure was achieved in 6 (86%) women. At the last follow-up, mean maximum urine flow (mL/s) increased from 3.9 ± 3.1 preoperatively to 22.7 ± 8.3 postoperatively (P.001), and mean AUA symptom score decreased from 25.3 ± 5.2 preoperatively to 6.9 ± 3.7 postoperatively (P = .001). No fistulae developed after surgery. "De-novo" stress urinary incontinence was not evident in any case.VILGU effectively provides better urinary flow and significantly improves patient satisfaction in patients with female urethral stricture disease.

To compare the advantages of flexible and rigid cystoscopy-assisted ureteral catheter placement before prone percutaneous nephrolithotomy (PCNL).From March to September 2012, a total of 80 patients with kidney stones underwent PCNL by the same surgical team. The patients were randomly assigned into one of the groups according to the technique used for ureteral catheter insertion: Flexible cystoscopy (group 1, n=40) or rigid cystoscopy (group 2, n=40). Patient demographics and operation-related factors were compared. The preparation period included positioning, cystoscopy-assisted stent insertion, and patient repositioning for PCNL. In addition, discomfort scores of the operating room (OR) staff were measured.The demographic values of the groups in terms of patient sex, age, body mass index, and stone size were comparable. While the mean preparation period was calculated as 9.9±2.3 minutes in the flexible cystoscopy group, it was significantly longer (19.7±2.9 minutes) in the rigid cystoscopy group (P0.0001). In addition, the discomfort score of the OR staff was found to be significantly higher in the rigid cystoscopy group (1.1±0.9 vs 2.05±0.68, P0.0001). The rest of the operative and postoperative parameters were similar.The insertion of a ureteral catheter with a flexible cystoscope before prone PCNL shortens the preparation period and minimizes the discomfort of OR staff related to patient positioning and transfer.

Treatment of kidney stones in pelvic ectopic kidneys of children is a challenging procedure for urologists. Herein we report a case of laparoscopy-assisted “microperc” in a 3-year-old girl with a stone in her pelvic ectopic kidney. This micro-optical system is helpful in confirming the percutaneous access and provides the possibility of fragmenting the stone without the necessity of dilating the tract.

A case of left-sided ureteral quadruplication with 3 blind-ending branches detected in a 16-year-old boy was presented by its step by step diagnostic work-up and treatment plan which is the first published case in the literature.

Percutaneous nephrolithotomy (PCNL) is regarded as the gold standard for the treatment of patients with renal stones larger than 2 cm in diameter. Creating a percutaneous renal access is the initial and probably the most important step in performing a PCNL. Two primary methods of obtaining proper percutaneous renal access under fluoroscopic guidance are described: The "triangulation" and the "eye of the needle" techniques. In this article, we compare these two techniques in terms of success and complication rates.From October 2010 to May 2011, 80 patients with simple renal stones were prospectively randomized into two groups according to the percutaneous renal access technique used for PCNL. Patients in group 1 (n=40) were assigned to the eye of the needle technique, and patients in group 2 (n=40) were assigned to the triangulation method. Patients needing multiple access points were excluded from the study. The preoperative, operative, and postoperative follow-up findings were thereafter analyzed and compared.No significant difference between the two groups was detected in terms of patient demographics (mean patient age, body mass index, stone size, or stone location). The operation time, fluoroscopic screening time (FST), and duration of hospitalization were similar in both groups (P=0.52, P=0.32, P=0.26, respectively). Patients in group 1 had a larger drop in hematocrit postoperatively than patients in group 2 (7.6 ± 3.7 vs 4.8 ± 2.1, P=0.001). The blood transfusion rate (7.5%) was similar in both groups, however. Although the complication rate was higher in group 1 than group 2, no significant difference was detected (20% vs 15%, P=0.76).The present study demonstrates that PCNL can be performed safely using two different percutaneous access techniques. The two techniques studied in this trial had similar FSTs, operation and hospitalization times, success rates, and complication rates.

Epididymoorchitis caused by Brucella species is a rareinfection. Although the most common genitourinary involvementof brucellosis is epididymoorchitis, other findingsmay also occur. Clinical and serological data aresufficient for the diagnosis. We present a-34-year-oldmale admitted to our outpatient clinic with right testicularswelling and pain, high fewer, malaise, arthralgia, myalgiafor ten days and hospitalized with prediagnosis epididymoorchitis.Testicle ultrasonography showed hipoechoicright testicular mass. Tumor markers were measured andfound within the normal limits. Doxycycline and rifampicinwere administered for six weeks and recovered uneventfully.Brucella epididymoorchitis should be kept in mindfor the etiology of epididymoorchitis resistant to standardtherapeutic approach especially in our country where Brucellosisis endemic. J Clin Exp Invest 2012; 3(1): 117-120

Objective To present the feasibility and safety of fluoro-less endoscopic treatment of ureteral stones to diminish radiation exposure of the patient and operating team, and to determine circumstances where a fluoroscopic imaging is mandatory. Methods Between 2010 and 2011, 93 patients with ureteral calculi who underwent ureteroscopic treatment by experienced urologists were retrospectively evaluated. Manipulations, such as guidewire, ureteral stent insertion, and balloon dilatation were performed with visual and tactile cues. Patient demographics, need for fluoroscopic imaging, operation and fluoroscopy time, and complication and success rates were investigated. Results The mean age of patients was 34.03 ± 12.09 years (range, 9-63 years). The mean stone size was 10.64 ± 3.16 mm (range, 6-17 mm). The stones were localized in the proximal, middle, and distal segments in 11, 30, and 52 patients, respectively. The mean duration of the operation was 34.51 ± 7.94 minutes (range, 24-55 minutes). Stone-free status was achieved for 90 patients (96.77%). Fluoroscopic imaging was required for 7 patients with a mean fluoroscopy time of 9 ± 4.72 seconds (range, 4-16 seconds) for the following reasons: stone migration to the kidney (3 patients), double collecting system with 2 ureters (1 patient), and ureteral orifice stricture extending to the upper segment (1 patient). No major complications were observed, but minor complications were observed in 11 patients (11.8%). Conclusion The ureteroscopic treatment of ureteral stones can be safely and effectively performed in experienced hands, with limited or no usage of fluoroscopy except in special circumstances, such as anatomic abnormalities, upper ureteral strictures, and impacted ureteral stones leading to ureteral tortuosity, kinking, and obstruction.

It manifests itself with flank pain and usually renal involvement is detected at the time of diagnosis. Additionally, distant lymph node metastasis could also be detected. Absence of previous unilateral adrenal gland involvement, presence of pigmented lesions without any signs of endocrine disorder, and negative immunohistochemical endocrine markers are typical characteristics of primary malignant melanoma of the adrenal gland. Presence of an occult primary lesion should also be excluded by autopsy. Pluripotent neural crest cells are localized within adrenal gland medulla. They are precursors of melanocytes, neurons, glial cells of the peripheral nervous system, and adrenal chromaffin cells. Under the influence of microenvironment, and various growth factors, these multipotent cells might transform into different cell types.

Penile fracture is a remarkable but under reported urologic injury. Coitus and penile manipulations are common predisposing factors. Rupture of the superficial vein of penis is an uncommon situation that makes differential diagnosis with other penile lesions. The diagnosis in such cases is mostly after exploration. We report the cases of 34 and 49-year-old male patients with a painless hematoma after intercourse. Conservative or surgery intervention are the alternative mode of treatment.

plasties performed by a single surgeon between July 2007 and October 2010 was performed. Patients were divided into two groups based on endoscopic treatment history for urethral stricture disease at the time of urethroplasty (group 1: 0–1 treatment; group 2: 2 treatments). Only those with bulbar strictures were included, thus excluding those with pure penile and membranous strictures, as well as patients with a history of prior urethroplasty, hypospadias, lichen sclerosis, and pelvic radiation. RESULTS: During the 39 month study period, 140 men with bulbar urethral strictures met the study criteria: 50 had 0–1 previous endoscopic treatments (group 1), 51 had 2 previous endoscopic treatments (group 2), and 39 were excluded due to incomplete records. As shown in the table, repeated endoscopic treatment was strongly associated with longer strictures, more commonly extending into the penile urethra and less often amenable to anastomotic reconstruction. Repeated endoscopic treatment of bulbar urethral strictures was also associated with an 8-fold increase in the symptomatic interval between stricture diagnosis and urethroplasty. CONCLUSIONS: Repeated endoscopic treatment of bulbar strictures is associated with increased stricture complexity and a markedly prolonged duration of symptoms. These data suggest that repeated endoscopic intervention is counterproductive and should be discouraged in treatment of bulbar strictures.

Primary renal mucinous cystadenocarcinoma is a very rare lesion of kidney which originates from the metaplasia of the renal pelvic uroepithelium. Only one case with primary mucinous cystadenocarcinoma has been reported in the English literature. We report second case of mucinous cystadenocarcinoma which was radiologically classified as type-IIF Bosniak cyst in peripheral localization. We aimed to present this extreme and unusual entity with its radiological, surgical, and pathologic aspects under the light of literature.

OBJECTIVES To review our long-term results with a modified dorsal lumbotomy (DL) approach and evaluate its role as a minimally-invasive alternative for the surgical management of ureteropelvic junction obstruction (UPJO). METHODS Fifty-nine consecutive children (42 males, 17 females, median age: 5.7 years) underwent pyeloplasty with transverse DL (TDL) between 1999 and 2008. Kidney stones, solitary kidney, and bilateral UPJ obstruction was present in 6, 3, and 5 children, respectively. Forty-nine and 10 children received stented dismembered pyeloplasty and Y-V plasty, respectively. Information on the duration of surgery, length of hospital stay, length of time to return to unrestricted activity, and per/postoperative complications was recorded. Children were followed up postoperatively with urinalysis and ultrasonography (US) at first month, diuretic renogram or intravenous urography (IVU) or both at sixth month, and yearly thereafter with US and renal scintigraphy for the emergence of recurrent clinical symptoms, deterioration of differential renal function, or increase in hydronephrosis. RESULTS Median operative time was 78 minutes and median incision length ranged between 3 and 5 cm for all age groups. All children tolerated liquid diet within the evening of surgery and returned to unrestricted activity within 48 hours. Eight-eight percent of all patients were discharged within 2 days, and 88% of children operated after 2004 were discharged in less than 30 hours. Recurrent UPJO was not evident in any case with a median follow-up of 56 months. CONCLUSIONS TDL provides excellent exposure for UPJO repair with a cosmetically appealing scar while maintaining a minimal convalescence advantage. It is particularly beneficial in bilateral pyeloplasty as synchronous bilateral repair can be performed without repositioning the patient.

Hydatid cysts can be found in almost every structure in human body. Thus they can mimic numerous pathologies. Serological analyses are the best assistants in the diagnosis of hydatid cysts. But as serological investigations have limited sensitivity and specificity, they might misdirect our diagnosis. Lungs are the most common involved organ in this parasitic infection. But the brain, muscles, kidneys, bones, heart, pancreas, and rarely the retroperitoneum have also been reported to be involved. An unusual case of a sero-negative hydatid cyst located in the retroperitoneum presenting with lower urinary tract symptoms is reported in this paper.