Urology Journal
Volume:15 Issue: 6, Nov-Dec 2018

Insufficient alleviation of pain after percutaneous nephrolithotomy causes patient dissatisfaction and generates additional morbidity factors by preventing early mobilization. This study investigated the effects of bupivacaine infiltration with two different doses around the nephrostomy tract after percutaneous nephrolithotomy. Patients who underwent subcostal single entrance percutaneous nephrolithotomy were randomly divided into 3 groups of 20 patients. While the first and second group were planned to receive bupivacaine at rates of 0.5% and 0.25% respectively, the third group was planned to receive a placebo agent to preserve the doubly blinded nature of the study. A statistically significant difference was found in the number of patients using tramadole. The frequency of analgesic administration was found lower in the two groups that received bupivacaine in comparison to the group that did not, while the time of the first analgesic administration in the group that received high dose bupivacaine was significantly later than the other groups. Although there was no difference between the groups in terms of total amount of analgesic usage, patients who received higher concentrations of bupivacaine were likely to require
a lower amount of narcotic agent. The frequency of analgesic administration decreased significantly in patients of both groups that received bupivacaine. Moreover, by administering bupivacaine at a 0.5% rate, fewer patients (50%) required narcotic analgesia and the first time of analgesic administration was found to be significantly later. Administering bupivacaine at a 0.5% rate around the nephrostomy tract after surgery was demonstrated to be more effective.

To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneous
nephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative and
postoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P < .05). The stone-free status and complication rates were similar between the two groups (P > .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P < .05). F-URS is less painful than mini-PNL for the treatment of 1- to 2-cm renal stones. However, the stone free rate is similar between the two procedures while mini-PNL is superior in terms of fluoroscopy, operation, hospitalization and return to work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones

Comparison of efficiency and reliability of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of multicalyceal and multiple renal stones in the same renal unit. Between 2011 and 2015, records of patients who underwent surgery for renal stone were retrospectively reviewed. Patients who had multiple stones located in different calices in the same renal unit were included. The patients that underwent PNL and RIRS were defined as Group I and Group II, respectively. Patient criteria (age,sex); the stone characteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complication rates of groups were evaluated between the treatment groups. There were no significant differences in terms of age, gender, BMI, laterality, number of stones, number of stone localization, hounsfield units and surface area characteristics of the stone between the PNL (n = 47) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P = .080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or 2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) in Group I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P = .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P < .001, P < .001 and P < .001, respectively). RIRS is more effective and more reliable procedure than PNL with higher stone-free and lower complication rates in treatment of multicalyceal and multiple stone in the same renal unit.

To evaluate the management of prolonged indwelling ureteral stents and the newly developed KUB (kidney, ureter, and bladder) grading system for the classification of encrusted stents in urolithiasis. This study involved 69 patients that had indwelling and forgotten ureteral stents for more than 6 months after urolithiasis treatment. They were categorized into 4 groups based on indwelling time and were reviewed retrospectively. Patients whose ureteral stent could not be removed with simple cystoscopy were graded according to stone surface area and the KUB system. The mean stent indwelling time was 23.1 months. Stone burden in KUB and, in proportion to that, total KUB (T) score showed increased association that was directly proportional to indwelling time (p < 0.001, p = 0.008). Surgical intervention was required in 73.9% of patients. Among patients requiring surgery, 78.4% were treated in a single session and multi-modal interventions were performed in 70.5%. K score ? 3 was found to be associated with multiple surgery requirements (odds ratio [OR];11.25, %95 confidence interval [CI]:2.132-59.375),
multi-modal procedure requirements (OR;16.50, %95 CI:3.434-79.826 ), and lower stone-free rates (p = 0.04). B
score ? 3 was associated with multi-modal procedure requirements (OR;8.90, %95 CI:1.052-75.462). U score ? 3
and T score ? 9 were associated with an operating time >180 minutes (p < 0.001, p = 0.008). Prolonged indwelling time of the ureteral stent in urolithiasis is associated with increased encrustation and stone burden. Since the KUB system specifies stone burden and its particular localization, it can be used as a simple, convenient method for the planning treatment of encrusted ureteral stents

Some urologists used the extraction strings for removal of ureteral stent without cystoscopy. While some urologists may have concern about perceived risks, including accidental dislodgement, infection, renal?colic?and lower urinary tract symptoms. Therefore, we performed a retrospective study to help address this conflict. Patients who had an indwelling ureteral stent with(n=58) or without(n=82) extraction strings inserted after ureteroscopy for unilateral ureteral stones were enrolled. For ureteral stent removal, the strings were pulled by physician, no string-stents were removed by cystoscopic. Postoperative morbidity was assessed. Patients' medical expense due to postoperative morbidity was collected. Patients with extraction string had shorter stent dwell time((5.3±1.8 versus 11.2±3.2 day, P= .001) and less cost (8.97±3.07 versus 455±0 CNY, P = .001)) for ureteral stent removal. However, six patients with extraction string had an accidental dislodgement, additional medical expenses were 345±137.9 CNY. There was no difference in the cost due to urinary tract infection, renal?colic?and LUTS between the two groups. The overall cost in patients without an extraction string was significantly more than in patients with an extraction string (86.7±167.7 versus 507.9±147.8 CNY, p =.008). Despite an increase in stent dislodgement related risks to the extraction string, it results in significant cost savings for patients, and most of patients remove with extraction strings might benefit from it

To assess the oncologic results of our robot-assisted laparoscopic prostatectomy (RALP) cases and investigate whether the learning curve (LC) affects the oncological outcomes. Between March 2015 and September 2017, 111 patients underwent RALP by a single surgeon in our clinic. The learning curve was analyzed using the moving average method. We compared the rate of positive surgical margins(PSM) and oncological outcomes, operation times, hematocrit changes and duration of hospitalization among the patients during and after the LC. Complications were also noted according to Clavien system. LC analysis using the moving average method showed that the LC stabilized between cases 51–60. So, patients were classified into two groups; 1-50 cases (Group 1) and 51-111 cases (Group 2). PSM rates were 36% for group 1 and 18% for group 2, and statistically different (p=0,032). Extracapsular invasion (ECI) was significantly higher in group 1 (56,5%) than in group 2 (29,5%) (p=0,005). Multiple logistic regression analysis revealed that presence of ECI was an independent factor for PSM associated with the groups (OR: 2.512; 95% CI: 1.055-5.979). Both operation time and duration of postoperative hospitalization were significantly reduced from group 1 to group 2. A total of 11 patients (10%) had complications and one of them (0,9%) required surgical intervention. We can conclude that at least 50 RALP cases are needed to gain proficiency even for an experienced surgeon in laparoscopic radical prostatectomy. Our study demonstrates that surgeons experience can affect the perioperative variables but the LC does not affect PSM status in RALP

The study objective was to evaluate the safety and efficacy of mini-laparoscopic pyeloplasty (mLP) in an adult population and to demonstrate the functional and cosmetic results. Data for 29 patients (19 men and 10 women) undergoing mLP for ureteropelvic junction obstruction (UPJO) from May 2014 to December 2016 in Turkey were collected in this prospective study. Inclusion criteria were age ? 18 years, body mass index (BMI) ? 30 kg/m2 and primary UPJO, and no previous surgery on the affected kidney or previous abdominal surgery. Postoperative Visual Analogue Scale scores and the Patient Scar Assessment Questionnaire (PSAQ) were used. Demographic data, perioperative parameters, complications, and postoperative functional and cosmetic results were recorded. All statistical analyses were done by SPSS software. P value of <05 was considered statistically significant. Twenty-nine adults with a mean age of 29.4 ± 10.2 years (19–38 years) were included. The patients’ mean BMI was 22.4 ± 4.3 kg/m2 (a range of 16–29 kg/m2). The procedures were performed using three ports (one 5 mm port for the camera and two 3 mm ports). Mean operative time was 119 ± 28.5 minutes (85–144 minutes). Major complications were not observed, as per the Clavien-Dindo classification of surgical complications (grades IV–V). The mean VAS score was 1.2 ± 0.2 points. Functional obstruction was reported in one patient on renal scintigraphy at 12 months postoperatively. The success rate of mLP was 97%. The minimum and maximum PSAQ scores at month 3 postoperatively were 24 and 86, respectively. All the patients were satisfied with the intervention and with their cosmetic results. mLP is a safe, effective and feasible treatment method for UPJO in adult patients. This treatment modality offers excellent cosmetic and functional results following treatment for UPJO

We discuss the safety and perioperative outcomes of a 2-week interval between prostate biopsy and laparoscopic radical prostatectomy (LRP). We retrospectively reviewed the medical records of 182 patients with prostate cancer (PCa) who underwent transperitoneal LRP 2 weeks after prostate biopsy between 2012 and 2015. We evaluated the following perioperative outcomes: operative time, estimated blood loss (EBL), infection, conversion to open surgery, positive surgery margins (PSM), and complications. We also reviewed studies discussing a shorter interval between biopsy and LRP in peer-reviewed publications. The mean operative time and EBL were 100.2 min and 82.2 ml, respectively. There were no rectal injuries or conversions to open surgery, totally 19 (10.4%) patients experienced complications (Clavien-Dindo Grade I and II): fever occurred in six patients (3.3%), urinary leak in four (2.2%), incomplete paralytic ileus in four (2.2%), deep vein thrombosis in two (1.1%), and postoperative anemia in four. The average bedrest time after surgery was 2.5 days. PSM was detected in twenty-one patients (11.5%) . 167 patients (91.7%) recovered continence.
Follow-up ranged from 13-37 months, the biochemical recurrence (BCR) rate was 10.4% (19/182).The seven peer-reviewed studies we reviewed that a shorter interval was safe and did not influence surgical outcomes. Our study shows that a 2-week interval between biopsy and LRP is safe and does not negatively affect surgical outcomes

Urothelial carcinoma of the upper urinary tract (UUTUC) is a rare genitourinary tumor. Pre-operative lymphocyte-to-monocyte ratio (LMR) is associated with worse outcome in several malignancies. The aim of this study was to determine the prognostic value of pre-operative LMR in UUTUC. A historical cohort of 100 UUTUC patients was recruited from January 1990 to June 2011. The counts of peripheral lymphocyte and monocyte were retrieved, and the LMR was calculated by dividing lymphocyte count by monocyte count. Receiver operating characteristic curve (ROC) analysis, Log-rank test and Cox proportional hazards regression models were used for univariate and multivariate analyses to evaluate the
associations of LMR with overall survival (OS) and disease-free survival (DFS). Univariate analysis revealed that low level of LMR (? 3.0) was significantly associated with worse OS (P = .024) but not DFS (P = .993). Multivariate Cox proportional hazard analysis showed that low level of LMR was a significantly independent predictor for worse OS (hazard ratio = 0.366, 95% confident interval: 0.180-0.744). Based on the results of multivariate analysis, the rates of OS at 5 years developed by the prognostic model were as
follows: low risk, 88.0%, intermediate risk, 44.0%, and high risk, 13.0%, respectively. The pre-operative LMR serves an independent prognostic biomarker in UUTUC. The prognostic model based on the LMR and pathologic factors can be available in selection of high risk patients for further aggressive therapy.

To determine if there is a correlation between the newly proposed Gleason grading system by the International Society of Urological Pathology and the Cancer of the Prostate Risk Assessment (CAPRA) score.
Material and The records of all patients that underwent radical prostatectomy at our hospital between 2007 and 2013 were retrospectively reviewed. The study parameters included patient demographics, the percentage of pre-operative prostate biopsies positive for PCa, biopsy Gleason Score (GS), and pre- and post-operative PSA values. The study included 146 patients with complete medical records and follow-up data. Mean age of the patients
was 66.6 ± 6.08 years. According to the newly proposed Gleason grading system, 97 (66.4%) patients were grade 1, 20 (13.7%) were grade 2, 8 (5.5%) were grade 3, 11 (7.5%) were grade 4, and 10 (6.8%) were grade 5. The distribution of CAPRA scores was as follows: 1: n = 43 (29.5%); 2: n = 53 (36.3%); 3: n = 22 (15.1%); 4: n = 14 (9.6%); 5: n = 8 (5.5%); 6: n = 4 (2.7%); 7: n = 1 (0.7%); 8: n = 1 (0.7%). Correlation analysis showed that the
CAPRA score was significantly correlated with GS based on the newly proposed Gleason grading system (Correlation
Coefficient=0.361, P < 0.001). As a strong correlation was noted between these 2 independent grading systems, we think clinicians that seek to predict the prognosis in PCa patients should take into consideration both the newly proposed ISUP grading system and the CAPRA score.

This study aimed to examine the short- and long-term complications of thermocautery-assisted circumcisions. A total of 1780 children who consecutively underwent thermocautery-assisted circumcisions from May 2014 to May 2016 in Yuksekova State Hospital in Turkey were included in this study. Thesechildren were classified into perioperative, early postoperative, and long-term complication groups. In addition, the age groups were compared in terms of complications. The patient age and surgical duration means were 4.16 ± 3.805 years old and 6.14 ± 1.703 minutes, respectively. Complications were observed in twelve patients, or 0.6% of the whole observation set. One patient exhibited bleeding and was included in the perioperative complications group. Four patients were included in the early postoperative complications group; three of them had bleeding and one had an infection. Finally, three patients had trapped penises, two patients had meatitis, one patient had a delayed wound healing issue, and one had
a glans-skin bridge. These seven patients fell into the long-term complications group. The patients younger than 3 years old had significantly higher complication rates when compared to the older patients, and this comparison was statistically significant (P = 0.001). The results showed that thermocautery-assisted circumcision is a safe and efficient surgical technique for use in children

To compare the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) combination therapy to single-agent antibiotic therapy for the resolution of symptoms during two restricted activity days in patients with acute uncomplicated cystitis (AUC) We performed a prospective, randomized control pilot study. A total of 55 patients were enrolled. Group I (n=28) was treated with cepodoxime (100 mg twice per day), and Group II (n=27) was treated with cepodoxime (100 mg) and aceclofenac (100 mg) twice per day; both groups were treated for three days. Upon dysuria after each administration, the participants entered a value on a numerical pain scale. The primary outcome was whether there were any differences in the decrease rate in pain scale between the two groups. The average age of the 55 patients was 49.9 ± 13.5 years, and prior to the clinical visit, the patients ex perienced an average of 2.4 ± 2.2 days of dysuria symptoms. The average numerical pain scale score for dysuria was 4.98 ± 2.18. Thirty-four patients (61.8%) showed positive culture results, and E. coli was the most commonly found bacteria, cultured in 32 patients. Fifty-one patients visited the clinic on day 7, and 42 (76.4%) reported symptom improvement, while nine patients (16.3%) had persistent symptoms. The follow-up numerical pain score was 0.39 ± 1.02 points. The pain score was dramatically decreased after medication. No difference was observed in the magnitude of the pain scale reduction between the two groups (P = 0.134). However, group II showed faster symptom resolution (P = 0.035) at the third administration (day 1.5). Combination therapy with NSAIDs and antibiotics for AUC patients can improve symptoms faster during two restricted activity days when patients have difficulty performing daily living activities

PRESIDEN study is a large study to analyze the erectile dysfunction (ED) incidence in Spanish population. The present study is a pilot sub-analysis from PRESIDEN to determine if ED or plasma testosterone (TST) level in controlled hypertensive patients may be associated with comorbidities and/or plasma nitrite+nitrate and antioxidant capacity. Forty-four hypertensive individuals were aleatory selected from PRESIDEN study, matching by age (28 showing ED and 16 without ED). Diabetes was present in 28.57% of ED patients and in 18.75% of patients without ED. In patients with and without ED, increasing age showed tendency of higher frequency of an additional comorbidity (diabetes or dyslipemia) (P = .09). Apparently, plasma TST levels were lower in older ED patients compared to younger patients with and without ED, although it did not reach statistical significance (P = .69). Older ED patients also showed lower TST levels than older patients without ED, although it was not statistical significant (16.15 ± 2.84 vs 13.91
± 2.77; P = .69). Dyslipidemia was showed by 52.17% with lower TST (? nmol/L) while 23.80% of patients with plasma TST levels > 15 nmol/L had dyslipidemia. The percentage of ED patients was similar between patients with low and high TST levels. More ED hypertensive patients seem to show two comorbidities (diabetes and dyslipidemia) than hypertensive
patients without ED. Younger patients with ED tended to show more commonly diabetes than older ED patients. Plasma TST levels were not associated with more prevalence of ED but lower plasma TST levels showed tendency to higher prevalence of dyslipidemia

To histopathologically and biochemically evaluate the hypothesis that tadalafil increases the uptake of a second medication into the prostate tissue by increasing the blood supply in the prostate. Forty 12-week-old Sprague Dawley male rats were equally divided into 5 groups and were administered drugs orally as follows: Group 1 – no drugs, Group 2 – 10 days of finasteride, Group 3 – 10 days of finasteride + tadalafil, Group 4 – 30 days of finasteride, and Group 5 – 30 days of finasteride + tadalafil. At the end of 10 days of drug administration in Group1, 2, and 3, and at the end of 30 days of drug administration in Group 4 and 5,
blood samples were collected from rats and analyzed for serum androgen levels. In addition, prostate tissues were removed for histological examination. The mean DHT level as well as the minimum and maximum epithelial thicknesses in Group 3 were lower than those in Group 2. However, there was no statistical significant difference (P = 0.989, P = 0.176, and P = 0.070, respectively). The mean DHT level as well as the minimum and maximum epithelial thicknesses in Group 5 were lower than those in Group 4. However, there was no statistical significant difference (P = 0.984, P = 0.147, and P
= 0.478, respectively). The mean minimum and maximum epithelial thicknesses in Group 3 and Group 4 were not statistically different (P = 0.488 and P = 0.996, respectively). The similarity of the mean minimum and maximum epithelial thickness in Group 3 and Group 4 may be indicate that the combination therapy provides an early histological effect. However, the fact that there was no statistical significant difference between Group 2 and Group 3, and between Group 4 and Group 5, in terms of the mean DHT level and minimum-maximum epithelial thicknesses suggests that longer term studies with more rats are necessary to test the validity of our hypothesis.

To assessment the safety of concurrent repair of inguinal hernia (IH) with mesh application during transperitoneal robotic-assisted radical prostatectomy(RARP). Data of 20 patients (totally 25 procedures) who performed concurrent IH repair with mesh application during RARP were retrospectively enrolled in this study. Preoperative patient characteristics, intra and postoperative parameters (pathological Gleason grade, prostate volume at surgical specimen, operative time, herniorrhaphy time, estimated blood loss, complications, time of hospitalization, catheterization, and drainage) were evaluated. Standard PSA control and postoperative complications of mesh application such as hernia
recurrence, mesh infection, seroma formation and groin pain were evaluated at every follow-up visits (every three in the first year, then every 6 months in years 2 to 5 and annually thereafter. The mean age was 66 ± 8 years in our population. Fifteen (60 %) patients had a unilateral hernia and 5 (40%) patients had bilateral hernias. The mean operative time was 139 ± 21minutes and estimated mean blood loss was 108 ± 76 mL. The mean duration of IH repair in patients which was 27 ± 5 (range: 17- 40) minutes. The mean time of drainage, hospitalization, and catheterization were 2.5 ± 0.8 days (range: 2-6), 4 ± 0.9 days (range: 2-7) and 8.2 ± 1.9 days (range: 7-14), respectively. We did not observe any intra-operative complication due to RARP or
IH repair. Wound evisceration at camera port site developed in only a patient on postoperative day 20. Our median follow-up time was 13 months and we did not observe mesh infection or hernia recurrence during follow-up. Concurrent IH repair with RARP procedure seem to be easy to perform, effective and safe procedure

The aim of the present study was to show the protective effect of pulsed magnetic field (PMF) application and melatonin administration on damage in testis in a one-sided torsion detorsion induced rat model using testicular scintigraphy with 99mTc pertechnetate, PET/CT with 18F-FDG and histopathological methods. Sixty male rats were used in the study; 30 rats were randomly divided into five groups for one day applications of sham control, torsion, melatonin, pulsed magnetic field (PMF) and melatonin plus PMF. Similarly, for one week group, the other 30 rats were divided into the same five group (n=6), but the animals were sacrificed after one week. Rats were exposed to 50 Hz, 1 mT PMF for two hours. PET/CT with 37 MBq 18F-FDG and testicular scintigraphy with and 37 MBq 99mTc pertechnetate examinations were carried out, and testicular tissue was examined using histopathological methods. In one day treatment, melatonin administration significantly increased perfusion and glucose metabolism compared to torsion group (p<0.01). Perfusion and glucose metabolism was also higher in the PMF and melatonin plus PMF groups than torsion group (p<0.01). In one week treatment, melatonin administration resulted in a significant higher perfusion rate and glucose metabolism rate compared to torsion group (p<0.01 and p<0.001, respectively). In addition, perfusion and glucose metabolism significantly increased in PMF and melatonin plus PMF groups compared to torsion group (p<0.01 and p<0.001, respectively). Furthermore, caspase-3 immunoreactivity and pathological changes increased in the torsion group (p<0.05). Melatonin and melatonin plus PMF treatment reduced the rate of immunoreactivity and pathological findings compared to the torsion group (p<0.05). According to these results it can be concluded that PMF application had a therapeutic benefit as effective as melatonin administering. In addition, it was indicated that PET/CT with 18F-FDG and testicular scintigraphy with 99mTc pertechnetate could be efficiently used in determining the treatment efficiency in testicular torsion.

We report a female patient diagnosed with retrocaval ureter (RCU) after ureteral reimplantation for vesicoureteral reflux (VUR). She was diagnosed as right grade IV VUR with breakthrough urinary tract infections, and underwent ureteral reimplantation with Cohen cross-trigonal technique. Thereafter, she developed severe right hydronephrosis associated with RCU, which was presumably due to caudal traction of right ureter at ureteral reimplantation. She
underwent uretero-ureterostomy anterior to the inferior vena cava, and recovered well. Detailed evaluation for upper urinary tract is mandatory for high grade VUR, and Cohen technique should be avoided for VUR associated with RCU

Spontaneous Retroperitoneal hemorrhage in pregnancy is a rare condition. Renal angiomyolipoma (RA) is the most common cause of this hemorrhage. To the best of our knowledge, this is the first reported case of Wunderlich syndrome (WS) due to renal cell carcinoma (RCC) diagnosed in the second trimester of pregnancy.