Search

The objective of this study was to audit the costs of retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (microperc) and compare them in terms of cost-effectiveness. We performed a retrospective analysis of 63 patients who underwent microperc and 48 patients who underwent RIRS. The cases, performed between first use and first repair, were used for this initial study. The costs associated with performing RIRS and microperc, including the costs of devices, disposables, hospitalization, and additional required treatments, were audited. The main perioperative and postoperative parameters were collected, including operation time, JJ stent requirements, used disposables, stone-free rates, and complications. Statistical analyses of the means of continuous variables were performed using Student's t test and the Mann-Whitney U test. Categorical variables were analyzed using Chi-squared tests. The mean cost of RIRS was $917.13 ± 73.62 and the mean cost of microperc was $831.58 ± 79.51; this difference was statistically significant (p < 0.001). The mean operation time of the RIRS group was significantly shorter than the microperc group (55.62 ± 19.62 min and 98.50 ± 29.64 min, respectively, p < 0.001). The assessment of required additional treatment showed that it was significantly higher in the RIRS group than the microperc group (p = 0.02). The stone-free rate for RIRS was 66.6 and 80.9 % for microperc; this difference was not statistically significant (p = 0.12). In our series, the use of microperc is less expensive than RIRS due to additional required treatments and ancillary equipment in RIRS. RIRS is more effective than microperc in terms of operation time and more effective use of operation rooms.

We evaluated the association between the mean platelet volume (MPV) and monocyte/lymphocyte ratio (MLR) with brucella-caused epididymo-orchitis to determine if they could be used to differentiate between brucella and non-brucella epididymo-orchitis. The charts of 88 patients with non-brucella and 14 patients with brucella epididymo-orchitis were retrospectively reviewed. Brucellosis was diagnosed by isolating Brucella spp from a blood culture or from a serum agglutination titer ≥ 1:160 along with accompanying clinical findings. The patients with brucella epididymo-orchitis were significantly more likely to have a lower MPV and a higher MLR than those with non-brucella epididymo-orchitis. Using a MPV cut-off level of less than 9.25 fl to differentiate brucella from non-brucella epididymo-orchitis gives a sensitivity of 78.6%, a specifity of 78.4%, a positive predictive value of 36.7% and a negative predictive value of 95.8%. Using a MLR cut-off level of greater than 0.265 to differentiate brucella from non-brucella epididymo-orchitis gives a sensitivity of 71.4%, a specifity of 65.9%, a positive predictive value of 25% and a negative predictive value of 93.5.%. MPV and MLR values may assist in differentiating between brucella and non-brucella epididymo-orchitis.

Introduction: Endometriosis can be defined as the presence of endometrial glandular and stromal tissue outside the uterus. Affected sites of endometriosis can even be the urinary tract. Here, we present the case of a 30-year-old woman with right ureteral endometriosis. This case was important due to the unusual localization and no signs of the disease except for hydroureteronephrosis., Case Presentation: A 30-year-old Caucasian woman with para 2 was admitted to our department for right side flank pain, dysuria and suprapubic pain. She had no complaints of vaginal discharge, bleeding or painful menstruation. Her menstrual cycles were normal and lasting for three to four days. She did not have a history of any surgical interventions. A physical examination revealed a right side costovertebral angle and suprapubic tenderness. Laboratory test results including a complete blood count, serum biochemical analysis, urine analysis and urine culture were normal. Urinary ultrasonography showed right side hydroureteronephrosis with renal cortical thinning. We suspected a right ureteral stone obstructing the ureter and a computed tomography scan was performed. The computed tomography scan revealed similar right side hydroureteronephrosis with obstruction of the ureter. No signs of stone were observed on the scan. Retrograde pyelography and diagnostic ureterorenoscopy were performed and they showed a focal stricture with a length of approximately 3 cm at the distal ureteral part and secondary hydroureteronephrosis. Open partial ureterectomy and ureteroneocystostomy with Boari flap were performed. The pathologic specimen of her ureter demonstrated intrinsic endometriosis of the right ureter with endometrial glandular cells and stromal tissue., Conclusions: Clinicians should suspect ureteral endometriosis in premenopausal women with unilateral or bilateral distal ureteral obstruction of uncertain cause. The main goals of the treatment should be preservation of renal function, relief of obstruction and prevention of recurrence.

Objectives: To determine the effect of type 2 diabetes mellitus (T2DM) as a major risk factor for severe erectile dysfunction (ED) in patients with metabolic syndrome (MS)., Methods: The study included 93 patients aged 30-70 years who had MS and ED. MS patients were divided into 2 groups: 37 patients with neither T2DM nor abnormal fasting glucose level (group 1) and 56 patients with T2DM (group 2). The severity of ED was determined according to the first 5-question version of the International Index of Erectile Function (IIEF-5). The MS was defined according to the 2005 International Diabetes Federation consensus definition. Logistic regression analysis, t test, and chi(2) tests were used to investigate the impact of T2DM on ED severity., Results: The mean age of the patients was 55.5 years (P = .313). Eleven patients in group 1 (29.7%) and 42 patients in group 2 (75%) had severe ED (IIEF-5 score

Aims: To evaluate whether transient renal artery clamping and external renal hypothermia cause any detrimental effect on the remaining renal parenchyma after nephron-sparing surgery with the use of (99m)Tc-DMSA-SPECT., Methods: Twenty-eight patients with a unilateral renal mass but a normal contralateral kidney underwent nephron-sparing surgery. Serum biochemistry, 24-hour urinary creatinine clearance and absolute uptakes of the injected dose (%ID) of both kidneys as measured by renal (99m)Tc-DMSA-SPECT were compared preoperatively and in the 3rd postoperative month. (99m)Tc-DMSA uptakes in the contralateral kidney were used as controls., Results: The average tumor size and mean renal artery clamping time were 37.4 +/- 11.3 (range 25-68) mm and 53.7 +/- 13 (range 38-90) min, respectively. Pre- and postoperative mean absolute uptakes of %ID in the remaining parenchyma of the operated kidneys were 15.13 +/- 3.30 and 14.74 +/- 3.38%, respectively (p = 0.052). In the contralateral kidneys, there was also no significant difference between the two studies (18.82 +/- 6.26 vs. 19.14 +/- 7.19%, respectively; p = 0.546). Likewise, there was no statistically significant difference between pre- and postoperative serum creatinine (p = 0.179) and creatinine clearance values (p = 0.108)., Conclusion: Renal artery clamping and external cooling during nephron-sparing surgery have no demonstrable harmful effects on the renal parenchyma as measured by (99m)Tc-DMSA-SPECT analysis., ((c) 2009 S. Karger AG, Basel.)

Aim: The aim of this study was to evaluate the hemodynamics of varicocele using Doppler ultrasonography and scrotal scintigraphy, and to compare the value of these two methods in the prediction of seminal improvement after varicocelectomy., Materials and Methods: A total of 40 men with left sided varicocele presented for surgery because of infertility of at least one year in duration. Preoperative and postoperative sperm counts and per cent motility were obtained. Dynamic scrotal scintigraphy and Doppler ultrasonography were performed in all patients. Three perfusion patterns according to the time-activity curves (TAC) generated from scrotal perfusion images were defined. Type 1: radioactivity shows faster accumulation and maintenance of a higher level on the left side than on the right side. Type 2: time-activity curve rises gradually to a higher level on the left than on the right. Type 3: time-activity curve increases symmetrically and slowly on both sides. The relationship between preoperative TAC patterns and postoperative seminal findings, and preoperative Doppler grades and postoperative seminal findings were investigated., Results: Improvement in total motile sperm counts was not statistically significant (37.8% +/- 3.2% versus 45.2% +/- 8.5%) (p = 0.751). Following varicocelectomy, sperm concentration (million sperm per ml) increased from 16.9 +/- 3.3 to 26.6 +/- 8.6 (p = 0.015). According to the Doppler examinations, postoperative improvement in sperm concentration was demonstrated in patients with grade 1 varicocele (66%). Scintigraphic evaluation showed improvement in patients showing TAC-2 and TAC-3 patterns (63%)., Conclusion: Local hemodynamics of varicoceles demonstrated by scintigraphy and Doppler seemed to be different. Grade 1, TAC-2 and TAC-3 patients may be better candidates for varicocelectomy. Scintigraphy and Doppler ultrasonography showed similar success rates in the prediction of improvement following varicocelectomy in the present study.

Despite being the most common forms of benign ureteral neoplasms, ureteral fibroepithelial polyps are rare and their etiology is still unknown. To our knowledge, we report the fourth case of bilateral fibroepithelial polyps in the English literature with a discussion of clinical features and etiology.

Aim: Pyeloplasty is a widely accepted method for the treatment of ureteropelvic junction obstruction (UPJO). Surgery has long been thought to affect postoperative renal function. However, controversies still exist on the functional studies that can be used to indicate which renal units will benefit from surgery. In this study, the correlation between differential renal function (DRF) and other preoperative parameters was examined to determine which parameter more accurately predicts recovery of renal function in adult obstructed kidneys., Materials & Methods: In this study, the authors evaluated 32 patients with UPJO. In all patients, standart diuretic Tc-99m DTPA renal scans were performed preoperatively and 6 months after surgery. Patients were divided into two groups according to the preoperative DRF (> or = 30%, n = 22, group I and < 30%, n = 10, group II). Second type classification was made according to the postoperative DRF improvement as improved (group A, n = 13) and not improved (group B, n = 19). These groups were then compared regard to variables which were defined as symptoms, age at operation and ultrasonographic findings. We also evalulated whether preoperative parenchymal function is important to predict improvement in drainage half-time (T1/2)., Results: While preoperative drainage half-time was 39.6 +/- 15.9 minutes, postoperative half-time decreased to 16.9 +/- 6.8 minutes (p < 0.001). The mean DRF did not improved significantly after surgery compared with preoperative values (32.03 +/- 9.42% versus 36.16 +/- 9.60%). When comparing the patients with preoperative DRF > or = 30% (group I, DRF 38 +/- 0.8%) to those who had an initial DRF below 30% (group II, DRF 22.8 +/- 5.2%), postoperative DRF was 41.22 +/- 5.72 in group I and 25.00 +/- 6.22 in group II. The difference was significant (p < 0.01). The patients in group I and II showed improvement in 50% and 20%, respectively. Age, clinical presentation and ultrasonographic findings did not affect functional outcome after pyeloplasty. We could not find any correlation between preoperative DRF and the degree of improvement in T1/2., Conclusion: Renal function improves after pyeloplasty with regard to the initial level of split renal function in adult obstructed kidneys. Improvement may not be observed especially in patients with DRF less than 30%.

Objective: To attempt to predict the success rate of sildenafil citrate in erectile dysfunction patients using penile Doppler ultrasonography (PDU) measurements of peak arterial velocity and end diastolic velocity., Material and Methods: A total of 212 patients (age range 27-76 years) with vascular pathologies were included in the study. Following a PDU test, the patients were divided into arterial insufficiency, veno-occlusive dysfunction and mixed vascular pathology groups. Subsequently, patients were given sildenafil citrate 50 mg and re-evaluated 1 month later to determine its efficacy. If it was ineffective, the dose was increased to 100 mg and patients were reassessed. Arterial insufficiency and veno-occlusive dysfunction patients were classified into mild, moderate and severe groups depending on peak systolic and end diastolic velocities., Results: The overall response rate in patients with arterial insufficiency was 74.5%, regardless of the degree of arterial insufficiency or the dose of sildenafil. The severe arterial insufficiency group had a much better response to 100 mg compared to 50 mg doses of sildenafil. Although the 50 mg sildenafil dose was effective in patients with minimal veno-occlusive dysfunction, 100 mg was better than 50 mg to achieve adequate erection in the mild and severe veno-occlusive dysfunction groups., Conclusions: Sildenafil was ineffective in patients with severe arterial and venous insufficiency. PDU and a simple classification of PDU velocity measurements can provide some important clues to the prognosis of treatment and avoid overtreatment and unnecessary office visits.

We report a rare benign renal tumor, the cystic nephroma (CN) in a 35-year old man. CN should be considered in the differential diagnosis when clinical and radiological examinations reveals a multilocular cystic renal mass, but histopathological examination is the unique diagnostic mean.

Background: The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno-occlusive dysfunction., Methods: Eighty-seven consecutive patients were allocated into three groups as psychogenic, arterial and venous erectile dysfunction after investigations. Nocturnal penile tumescence recording parameters between psychogenic and vascular erectile dysfunction and arterial and veno-occlusive dysfunction were compared. Mann-Whitney U-test, Pearson's chi2 test and correlation coefficient tests were used for statistical analysis., Results: Depending on intracavernous injection, penile Doppler ultrasonography and cavernosometry tests, 37 patients (43%) had psychogenic impotence while 50 (57%) had organic pathologies. Of the 50 patients diagnosed with vascular impotence, 29 (48%) had arterial failure and 21 (42%) had veno-occlusive dysfunction. Nocturnal penile tumescence recording revealed psychogenic erectile dysfunction in 34 patients (39%) and vascular erectile dysfunction in 53 patients (61%). Nocturnal penile tumescence recording has been regarded as the gold standard and, in our series, it showed 90.6% sensitivity and 88.2% specificity in differentiating the cause of erectile dysfunction. Values of rigidity activity unit and tumescence activity unit were significantly higher in patients with psychogenic impotence (P < 0.001), when compared with vascular impotence. In patients with a vascular cause, no difference was found between arterial failure and veno-occlusive dysfunction with regard to tip tumescence activity unit, base tumescence activity unit, tip rigidity activity unit, base rigidity activity unit and erection time (P > 0.001). However, patients with arterial failure had less erection than patients with veno-occlusive dysfunction (P < 0.001)., Conclusion: New recording parameters of nocturnal penile tumescence can differentiate organic and psychogenic erectile dysfunction more precisely. However, these recording parameters cannot distinguish subgroups with a vascular cause of erectile dysfunction.

Purpose: The aim of this study was to evaluate the efficacy of sildenafil and success of treatment in particular etiological causes in erectile dysfunction lasting more than 3 months., Material and Methods: A total of 141 patients between 27 and 78 years old without any cardiac compromise, despite controversial, which precludes sildenafil (Viagra) treatment, were included in this study. All patients had only International Index of Erectile Capacity Form (IIEF) for pre-treatment evaluation and 50 mg sildenafil was started. Patients were assessed monthly for 6 months thereafter. Erectile capacity changes were questioned by IIEF on each follow-up and 100 mg sildenafil was given in patients without a response and monthly follow-up was scheduled. All patients had SMA-12, hormonal analyses and penile colour Doppler ultrasonography during the treatment course. The difference between IIEF score of each patient was displayed by Paired-t test and p-values less than 0.05 was applied as significant., Results: The average beginning IIEF score of 141 patients was 11.80 +/- 0.47 [6-22], and increased to 20.70 +/- 0.62 [6-30] after a month of 50 mg sildenafil treatment. The mean increase was 75.4% and found to be significant (p = 0.000, p < 0.05). The average IIEF scores were recorded as 22.57 +/- 0.69 after 3, and 22.12 +/- 0.24 after 6 months. There was no difference between these values and 2nd month controls (P3 month = 0.5675, P6 month = 0.6138, p > 0.05). A positive response was recorded in 102 patients (72.3%) and 39 (27.7%) patients were unresponsive. Doubled doses of sildenafil (100 mg) was effective in additional 17 patients. After overall treatment, 119 (84.4%) patients had benefit from sildenafil. Penile Doppler ultrasonography displayed arterial insufficiency in 79 (56.03%), veno-occlusive dysfunction in 14 (9.93%), mixt vascular pathology in 14 (9.93%) patients. Normal ultrasonographic findings in 32 patients (22.7%) were classified as psychogenic dysfunction. Among the organic causes, sildenafil was found to be most effective in arterial insufficiency group., Conclusion: Sildenafil is a successful management modality in erectile dysfunction with minimal pre-treatment evaluation. As far as etiological causes concerned, sildenafil was found to be most effective in arterial insufficiency group and psychogenic group. The efficacy of sildenafil treatment has not been changed with the treatment time, since IIEF scores were stable during follow-up controls.