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ABSTRACT: To evaluate the factors that may effect urinary leakage following percutaneous nephrolithotomy (PCNL).
Four hundred and thirty-three patients who underwent PCNL were reviewed retrospectively. The factors that may lead to leakage after surgery were analyzed as categorized into four groups according to individual variables (age, sex, body mass index); renal factors (previous surgery, extracorporeal shock wave lithotripsy history, presence of hydronephrosis); stone burden; and surgical features (access number, type of dilatation, presence of nephrostomy catheter). These data were compared for the presence and duration of urinary leakage.
There was no statistically significant correlation between individual factors and both the presence of leak (POL) and the duration of leak (DOL) (P > 0.05). Among renal factors, only presence and degree of hydronephrosis was significantly correlated with POL (P < 0.001) and DOL (P < 0.001). The mean cumulative stone burden neither had impact on POL nor correlated with DOL (P > 0.05). Among surgical factors, dilatation with a Nephromax dilator significantly increased incidence of POL when compared with an Amplatz dilator (P < 0.001), yet did not change DOL. Using an internal ureteral stent significantly decreased incidence of POL and DOL (P < 0.001). DOL increased with catheter diameter and stay time (P < 0.05).
Several yet simple factors appear to be effective in postoperative urine leakage from the access sites after percutaneous stone surgery. Precautions may also be simple if these factors are considered preoperatively.
World Journal of Urology 12/2011; 29(6):761-6. · 2.41 Impact Factor
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Hasan Serkan Dogan,
Bulent Onal,
Nihat Satar,
Cem Aygun,
Mesut Piskin,
Orhan Tanriverdi,
Serhat Gurocak,
Levent Mert Gunay,
Berk Burgu,
Ender Ozden, [......],
Veli Yalcin,
Mehmet Kilinc,
Kaya Horasanli,
Mustafa Ozgur Tan,
Tarkan Soygur,
Saban Sarikaya,
Hakan Kilicarslan,
Burak Turna,
Hasan Erdal Doruk,
Serdar Tekgul
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ABSTRACT: We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi.
We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates.
A total of 367 females and 265 males were studied. Mean±SD patient age was 90.2±51.4 months (range 4 to 204). Mean±SD stone size, operative time and postoperative hospital stay were 8.9±4.7 mm, 45.8±23.8 minutes and 1.8±2.8 days, respectively. At a mean±SD followup of 13.3±17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate.
Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.
The Journal of urology 09/2011; 186(3):1035-40. · 4.02 Impact Factor
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ABSTRACT: Abstract Purpose: To evaluate the outcome of subureteral injections by using calcium hydroxyapatite (CaHa), dextranomer/hyaluronic acid copolymer (Dx/HA), and polydimethylsiloxane (PDS) in patients with end-stage renal failure (ESRF) who have vesicoureteral reflux (VUR). Patients and Methods: One hundred-one patients (166 renal units) with ESRF secondary to VUR were included in this retrospective study. The reflux was bilateral in 65 of the cases. CaHa, Dx/HA and PDS were used in 57, 26, and 18 patients, respectively. All patients were reviewed with regard to age, sex, reflux grade, type of injected materials, injectable agent volume, and outcome. Results: The reflux resolved completely in 30 patients (50/96 renal units, 52.1%), in 17 patients (27/44 renal units, 61.4%), and in 4 patients (5/26 renal units, 19.2%) with CaHa, Dx/HA, and PDS, respectively. Regression rates of reflux to grade I with these agents in the same order were 3.1% (2 patients, 3/96 renal units), 4.5% (1 patient, 2/44 renal units), and 11.5% (2 patients, 3/26 renal units). Thus, the overall success rate were noted as 55.2%, 65.9%, and 30.7%, respectively. There was no difference among these three injectables with regard to overall success rates (P=0.062). No significant correlation with age, reflux grade, agent volume, and significant difference with sex were observed (P>0.05). Conclusions: In this group of patients, the success rate of the subureteral injection treatment does not appear to be affected by the type of the injectable agent. In addition, the cure rates were independent from the individual factors, reflux grades, and injected volumes.
Journal of endourology / Endourological Society 05/2011; 25(5):831-5. · 1.75 Impact Factor
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ABSTRACT: We evaluated the clinical presentation, diagnosis and management of patients presenting with emphysematous pyelonephritis (EP).
The clinical data of 24 EP patients diagnosed between 2000 and 2009 were retrospectively reviewed. The management strategies were discussed according to the severity of condition at presentation.
The mean age of the patients was 61.8 years. Diabetes mellitus was detected in 21 (87.5%) of them. Escherichia coli was the predominant pathogen. There were 6 patients (25%) who recovered with antibiotic treatment only (mild). Percutaneous drainage in addition to antimicrobial chemotherapy was necessary in 13 cases (54%) (moderate). The remaining 5 patients (21%) were treated by nephrectomy (severe).
EP is a serious infection that can display a fatal progression despite ablative treatment but there are also some cases with mild or moderate severity that can be successfully treated without nephrectomy.
Urologia Internationalis 01/2011; 86(4):444-7. · 0.99 Impact Factor
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ABSTRACT: Ureteral avulsion due to lumbar disc surgery is a rare complication and to our knowledge, only a few cases have been reported in the literature. A 43-year-old woman was admitted to our clinic with right lumbar pain following spinal surgery for discopathy. Complete right ureteral avulsion was detected and successfully treated by end-to-end anastomosis of the ureter with an internal double J stent.
The Canadian Journal of Urology 12/2010; 17(6):5478-9. · 0.64 Impact Factor
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ABSTRACT: We retrospectively analyzed the results of percutaneous nephrolithotomy operations for treatment of staghorn kidney stone disease in elderly patients and compared surgical parameters and outcomes with a control group of young adult patients.
Between 2002 and 2010, 300 consecutive patients underwent percutaneous nephrolithotomy operation for treatment of staghorn kidney stone disease. Forty-five of the patients were older than 65 years and considered to be in elderly group. Thirty-seven of the patients were between the ages 18 and 36 years and considered to be the control group. Surgical parameters and outcomes were compared between groups.
There were no significant differences between groups for stone area, operation time, difference in hemoglobin levels before and after surgery, blood transfusion rate, and length of hospital (P = 0.230, P = 0.106, P = 0.395, P = 0.691, and P = 0.690, respectively). Success rates after the operations were 53% in elderly group and 38% in young adult group. The difference for the outcomes of the operations was statistically insignificant (P = 0.365). Thirty-three (73%) of the patients had associated comorbid diseases in elderly group, while no patients had any comorbid disease in control group. Statistical analyses revealed no significant relation between the presence of comorbid diseases or ipsilateral renal surgery with success rate of the operation in the elderly group (P = 0.26 and P = 0.222, respectively).
The management of kidney stone disease by percutaneous nephrolithotomy in elderly patients is an adequate treatment modality even in the presence of complete staghorn calculi, comorbid diseases or previous ipsilateral renal surgery.
International Urology and Nephrology 12/2010; 43(3):639-43. · 1.47 Impact Factor
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Urology 09/2010; 76(3):e1. · 2.43 Impact Factor
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ABSTRACT: To investigate the relationship between maspin expression and prognostic parameters in renal cell carcinoma (RCC) with relevance to vascular endothelial growth factor (VEGF) expression and microvessel density.
One-hundred twenty-four patients with RCC of varying histologic types who underwent radical or partial nephrectomy were studied. The mean age of the patients was 59.4 years (range, 28-84). Maspin, VEGF, and microvessel density were studied by the universal avidin-biotin complex peroxidase method. Sections of 5-μm thickness were taken from paraffin blocks for immunohistochemical study. Cytoplasmic and/or nuclear staining were scored for maspin as negative and positive for all tumor cells.
Cytoplasmic maspin expression was positive in 51 (41.1%) patients. Nuclear maspin expression was not seen in any of the materials. Maspin expression decreased as tumor size increased (P = .036) without any specific relation to tumor subtypes (P = .583), and decreased as the pathologic stages increased without reaching statistical significance (P = .053). There were no correlations between maspin positivity and either VEGF expression or microvessel density.
In RCC, maspin expression is reduced with increased tumor size. Studies with larger series may be contributory in defining the role of maspin expression in RCC. Moreover, regulation of maspin expression genes appears to have the potential to lead to new treatment approaches.
Urology 09/2010; 76(3):765.e8-13. · 2.43 Impact Factor
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ABSTRACT: We retrospectively investigated the factors that affect the success of rigid ureteroscopy in the pediatric population for the management of pediatric ureteral stones.
We present a retrospective review of 61 consecutive pediatric patients who underwent 66 rigid ureteroscopy procedures for ureteral stone management. The effects of sex, age, stone diameter, stone localization, and degree of associated ureterohydronephrosis (UHN) on the success of ureteroscopy were evaluated.
The mean age of the patients was 8.1 years (range 6 mos-16 yrs). The average stone diameter was 8.22 mm (range 4-20 mm). In 56 cases (84.8%), all of the stones were extracted. In five (7.6%) cases, clinically significant residual fragments were detected and extracted by second-look ureteroscopy. In five cases (7.6%), the operations ended in failure. The final stone clearance rate after ureteroscopic stone treatment was higher in lower ureteral stones then in middle and upper ureteral stones; thus, the difference was statistically significant (P = 0.011). Also, there is a significant negative correlation between stone size and success rate (P = 0.007). The final stone clearance rate after ureteroscopic stone treatment was higher in patients with no and mild UHN than in patients with moderate and severe UHN, but the difference was statistically insignificant (P = 0.118). Statistical analyses revealed no significant relationship between success rates with regard to the sex and age of the patients (P = 0.643 for sex, P = 0.390 for age).
The stone localization and stone size are the factors that affect the success of the procedure.
Journal of endourology / Endourological Society 08/2010; 24(8):1273-7. · 1.75 Impact Factor
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ABSTRACT: To evaluate the efficacy of shockwave lithotripsy (SWL) with a third-generation SWL machine in the pediatric age group and to determine the effects of stone burden and the degree of hydronephrosis on the results.
Two hundred and sixty children with urinary system stones were treated with Siemens Lithostar Modularis Uro-Plus. The patients were divided into three groups according to stone burden (group 1: <100 mm(2); group 2: 101-200 mm(2); group 3: >200 mm(2)) and into four groups according to the degree of hydronephrosis (group 0: absent; group 1: mild; group 2: moderate; group 3: severe). These groups were compared in terms of the success rate of SWL.
Two hundred and seventy-nine renoureteral units of 260 patients were treated with 402 SWL sessions. The average stone burden was 98.2 mm(2) (range: 11-525). The overall success rate was 87.5%. According to stone burden, the success rate was 93.1% in group 1, 85.5% in group 2, and 60% in group 3 (p < 0.001). According to the degree of hydronephrosis, the success rate was 93.8% in group 0, 89.6% in group 1, 73.3% in group 2, and 64.3% in group 3 (p < 0.001). The average energy, number of shockwaves, number of sessions, retreatment rate, auxiliary procedure rate, and overall efficacy quotient were 1.76 units, 2260, 1.4, 33%, 8.2%, and 0.62, respectively.
SWL is an effective treatment method in selected patients in pediatric age group. However, percutaneous nephrolithotomy can be the first alternative for stones larger than 200 mm(2). It should also be kept in mind that the success rate of SWL decreases when the degree of hydronephrosis increases.
Journal of endourology / Endourological Society 06/2010; 24(6):1037-41. · 1.75 Impact Factor
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ABSTRACT: To evaluate the role of video-urodynamic examination prior to renal transplantation.
Sixty-four kidney transplant recipients were included into the study. All patients underwent video-urodynamic examination and separate uroflowmetry. Results were evaluated based on daily mean amount of urine, duration of chronic renal failure and presence of diabetes mellitus.
Thirty-five (54.6%) patients showed video-urodynamic abnormalities. The mean detrusor capacity was 234 ml, the mean detrusor compliance was 17.5 cm H(2)O/ml, the mean maximum detrusor pressure was 61.9 cm H(2)O and the mean Q (max) was 13.8 ml/s in all patients. Vesicoureteral reflux was detected in 15 (23%) patients. The mean detrusor compliance and detrusor capacity significantly decreased as the daily amount of urine decreased and as the duration of chronic renal failure increased. Also, there was no significant relation between presence of diabetes mellitus and detrusor capacity and detrusor compliance.
Video-urodynamic studies before renal transplantation provide earlier diagnosis of lower tract abnormalities, which are likely to cause graft dysfunction.
International Urology and Nephrology 05/2010; 42(4):903-7. · 1.47 Impact Factor
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ABSTRACT: To evaluate the results of end-stage renal failure in transplanted cases due to vesicoureteral reflux after a subureteric injection of calcium hydroxyapatite (Coaptite).
Twenty-three patients (39 renal units) with end-stage renal failure secondary to vesicoureteral reflux were included. Reflux was bilateral in 16 cases and unilateral in 7 of the cases. There were 3 degrees of reflux according to the distribution of renal units. They were low-grade reflux (grades 1 and 2; n=10); medium-grade reflux (grade 3; n=23); and high-grade reflux (grades 4 and 5; n=6).
Reflux resolved completely in 17 patients (28 renal units; 71.8%). There was a regression to grade 1 in 3 patients (5 renal units; 12.8%). Twenty-one patients underwent renal transplant; however, 2 of the patients were excluded from the study as it was not possible to monitor them after transplant. Within an approximately 18.6 month follow-up (range, 3-36 months), 1 of the cases had acute, and 3 of the cases had chronic rejection.
Successful results can be achieved in reflux treatment by an injection of subureteric calcium hydroxyapatite before transplant in patients with end-stage renal failure that developed secondary to vesicoureteral reflux.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 03/2010; 8(1):45-8.
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ABSTRACT: To perform conventional and microdissection testicular sperm extraction (TESE) at the same session and compare their effectiveness.
Prospective comparative study.
University hospital setting.
The study included 335 patients with nonobstructive azoospermia.
Microdissection TESE was performed to 77 patient with atrophic testes. An additional 258 patients underwent conventional TESE using three incisions on three quadrants of the testis (upper, middle, and lower). Microdissection TESE was performed by enlarging the middle incision vertically when no spermatozoa could be detected using the conventional technique.
Sperm retrieval, fertilization, clinical pregnancy rate (PR), and live birth rate were evaluated. The relation between sperm retrieval rate and FSH level and testis volume was also investigated.
Spermatozoa was detected in 33.7% of patients using conventional TESE. The spermatozoa detected increased to 50.8% using microdissection TESE. The increase was statistically significant. In the primary microdissection TESE group, the surgical retrieval rate was 20.8%. The overall sperm retrieval rate was 43.9%. There was a significant relation between the sperm retrieval rate and testis volume, whereas there was no relation between sperm retrieval rate and FSH levels. The overall fertilization rate, clinical PR, and live birth rate were 57.1%, 50.4%, 36.4%, respectively.
Conventional TESE combined with microdissection TESE can be used in selected patients. Sperm retrieval rate of TESE can be low in patients with atrophic testes.
Fertility and sterility 02/2010; 94(6):2157-60. · 3.97 Impact Factor
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ABSTRACT: We analyzed long-term results after percutaneous nephrolithotomy (PCNL) in patients with impaired renal function.
Nineteen (6.3%) of 300 patients who underwent PCNL had serum creatinine values above 1.4 mg/dL before surgery and were considered to have impaired renal function. Success rate of operation, recurrence rate, and renal functional status were evaluated.
Mean follow-up time was 51.1 +/- 10.1 months. Sixteen patients completed the study, but three patients were lost to follow-up. The results of the operation were as follows: stone free in 50%, clinically insignificant residual fragments in 25%, and clinically significant residual fragments in 25% of the patients. Mean serum creatinine value was 2.30 +/- 0.56 mg/dL before surgery and 2.67 +/- 1.41 mg/dL at the end of follow-up (p = 0.386). Creatinine values decreased to normal range in six patients (37.5%). Six patients (37.5%) had stable renal function (creatinine: 1.4-4 mg/dL). Creatinine values increased (>4 mg/dL) in four patients (25%) who required renal replacement therapy. Three new patients progressed to end-stage renal failure. These three had insulin-dependent type II diabetes mellitus and one also had solitary kidney and atherosclerosis. Two patients (12.5%) had recurrences, one of these had hypercalciuria, and the other had infection stone.
Our results indicated that most patients presenting with kidney-stone disease and renal insufficiency experience improvement or stabilization of renal function after PCNL. The patients with solitary kidney and those with conditions such as diabetes and atherosclerosis might be at greater risk for deterioration of renal function. Patients with metabolic abnormalities and infection stones might be at higher risk for recurrence.
Journal of endourology / Endourological Society 02/2010; 24(2):305-8. · 1.75 Impact Factor
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ABSTRACT: To examine our retrospective data on the outcomes of intracytoplasmic sperm injection (ICSI) and to determine whether a history of varicocele repair in men with nonobstructive azoospermia (NOA) undergoing an ICSI cycle was optimizing or not.
This retrospective study was conducted on Baskent University Department of Obstetrics and Gynecology, IVF Unit, and Department of Urology. Infertile couples suffering from NOA scheduled to an ICSI cycle, which was controlled ovarian hyperstimulation with a gonadotropin or gonadotrophin-releasing hormone-agonist protocol, selected for the study were divided into 2 groups: group 1 (n = 31) included NOA patients who had undergone prior varicocele repair, and group 2 (n = 65) included NOA patients who had not undergone varicocele repair.
There was a significant difference between the 2 groups considering the sperm retrieval rate, which was higher in the varicocele repair group (sperm retrieval rate 60.81% and 38.46% respectively, P = .01). The clinical pregnancy rate and live birth rate were significantly higher in the varicocelectomy group (74.2% vs 52.3% and 64.5% vs 41.5%, respectively, P <.05).
Varicocele repair in NOA might be considered in patients undergoing ICSI cycle.
Urology 11/2009; 75(1):83-6. · 2.43 Impact Factor
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ABSTRACT: We analyzed the results of patients who underwent percutaneous nephrolithotomy (PCNL) for management of kidney stone disease under combined spinal-epidural anesthesia and compared surgical parameters and outcomes with a matched control group who underwent PCNL under general anesthesia.
A total of 82 patients were studied in two groups. Group 1 (n = 45) consisted of the patients who underwent general anesthesia, and group 2 (n = 37) comprised those who received combined spinal-epidural anesthesia.
The mean ages of patients in groups 1 and 2 were 45 +/- 15 and 44 +/- 15 years, respectively. The mean areas of the stones in groups 1 and 2 were 734 +/- 386 mm(2) and 731 +/- 394 mm(2), respectively. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, operative time, irrigation fluids, fluoroscopy time, delta hemoglobin, and hospitalization time (P = 0.439). At the end of the surgery, stone-free rates were 76% in group 1 and 81% in group 2; clinically insignificant residue fragments rates were 24% in group 1 and 19% in group 2. The difference was statistically insignificant between the groups (P = 0.543).
We consider that combined spinal-regional anesthesia is a feasible technique in PCNL operations because the efficacy and safety were not affected. Further investigations with larger series are needed.
Journal of endourology / Endourological Society 08/2009; 23(11):1835-8. · 1.75 Impact Factor
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ABSTRACT: To determine the changes in number and morphology of interstitial cells of Cajal (ICC)-like cells (ICC-LC) at the ureteropelvic junction (UPJ) of rats after experimental distal ureteral obstruction.
Of a total of 109 rats, 20 served as controls (C), 20 underwent sham-operations (SH) and 69 were in the study (S) groups. The UPJs were extracted initially in the C and SH groups, and 7, 14, 30, 60 and 90 days after ligation of the distal ureter in the study groups (S1, S2, S3, S4 and S5, respectively). The sections stained by c-kit anticore were studied under a light microscope.
The mean number of ICC-LC was 4.55+/-2.21 in C, 5.15+/-3.51 in SH, 7.40+/-6.88 in S1, 21.16+/-19.03 in S2, 12.63+/-8.16 in S3, 10.40+/-5.09 in S4, and 10.9+/-6.33 in S5. There was a statistically significant increase in ICC-LC in the study groups, except S1, compared to the C and SH groups. No significant difference was detected in Cajal cell morphology and distribution pattern between groups.
Based on the changes in number of ICC-LC at the UPJ after obstruction of the distal ureter compared with the limited data available in the literature, we suggest that ICC-LC have a close relationship with motility of the ureter.
Journal of pediatric urology 02/2009; 5(4):269-73. · 1.38 Impact Factor
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ABSTRACT: CASE REPORT: We report a case of simultaneous injury of right external iliac artery and vein by a needle carrier that was inserted from the suprapubic area down to the vaginal lumen during anterior vaginal wall sling procedure. DISCUSSION: The risk factors and measures to be taken to avoid this life threatening complication are discussed.
International Urogynecology Journal 02/2009; 20(8):1003-5. · 1.83 Impact Factor
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ABSTRACT: Cajal cells have been defined as pacemakers in the gastrointestinal tract, and have recently been reported in the urogenital tract. In this study, the effects of experimental obstruction of the vas deferens on Cajal-like cells in rats were investigated.
Ninety rats were divided into study (S), sham-operated (SH) and control (C) groups. The vasa deferentia were removed at the beginning of the study in the C group and in the 1st, 2nd and 3rd months after distal vas deferens ligation in the SH and S groups (S1, S2 and S3 consecutively). The sections stained with c-kit antibody were studied under a light microscope to determine the number and morphology of Cajal-like cells in the submucosal and muscular layers.
There were no statistically significant differences between the C, S1 and S2 groups despite a higher mean in S1. The decrease in the mean values for the submucosal and muscular layers in S3 was statistically significant compared to the C group. No morphologically significant difference was detected under a light microscope after obstruction.
The increase in Cajal-like cells in the early phase, although insignificant, might be associated with increased motility to overcome the obstruction, whereas the significant decrease in the late phase might be a sign of disordered motility.
Urologia Internationalis 02/2009; 83(1):86-91. · 0.99 Impact Factor
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ABSTRACT: To review our experiences with percutaneous nephrolithotomy in children with complex renal calculi.
We retrospectively analyzed the records of 31 children with complex renal calculi who were treated by percutaneous nephrolithotomy at 2 hospitals of our university between June 2003 and June 2008. The mean age of the patients was 10.4 years (range 22 months to 15 years). Three patients were aged < or =5 years. Stone clearance and complications were recorded.
The mean operating time (time from insertion of the ureteral catheter to placement of a nephrostomy tube) was 87.4 (range 50-180) min. In 2 patients the procedures were staged because of a large residual stone load. The extent of percutaneous tract dilation was undertaken taking patient age and the presence of hydronephrosis into consideration. Complete stone clearance with percutaneous nephrolithotomy was achieved in 21 (67.7%) of 31 patients. Adding extracorporeal lithotripsy increased total clearance to 24/31 (77.4%). The most common complication was bleeding that necessitated blood transfusion (7/31, 22.5%).
Percutaneous nephrolithotomy is as safe and effective in children as it is in adults. The clearance rate can be increased with dual therapy. Tract dilation should be tailored according to patient age and the extent of hydronephrosis.
Urologia Internationalis 01/2009; 83(4):416-9. · 0.99 Impact Factor
