Ahmet Ali Sancaktutar

Initial report of microperc in the treatment of pediatric nephrolithiasis

BACKGROUND/PURPOSE To report the first technical feasibility and safety of microperc in the treatment of pediatric nephrolithiasis. METHODS A multicenter prospective trial was initiated and microperc was performed in 19 children from four different centers. In all cases, 4.85-Fr all-seeing needle was used to access the collecting system under direct vision. Stone fragmentation was performed using a 200-μm holmium: YAG laser fiber either through the same needle sheath or an 8-Fr microsheath. Patient- and procedure-related factors and perioperative and postoperative parameters were analyzed. RESULTS The mean age of the children was 7.5 ± 4.4 years. Mean stone size was 14.8 ± 6.8mm. Conversion to Mini-PNL was required in two patients because of optical default in one and the high stone burden in the other. The mean hospital stay was 1.8 ± 0.8 days and the mean hemoglobin decrease was 0.1 mg/dl. The overall stone-free rate at 1 month was 89.5%. In one patient with obstructed ureteropelvic junction, intravasation of the irrigation fluid has led to abdominal distention and managed with percutaneous drainage intraoperatively. No other postoperative complication was recorded and no ancillary procedure was required. CONCLUSIONS Microperc is a safe and effective procedure in the treatment of pediatric kidney stones.

Comparison of Shockwave Lithotripsy and Microperc for Treatment of Kidney Stones in Children

PURPOSE We aimed to compare the outcomes of microperc and shockwave lithotripsy (SWL) for treatment of kidney stones in children. PATIENTS AND METHODS The medical records of 145 patients under the age of 15 years with opaque and single kidney stones treated with either SWL or microperc were retrospectively reviewed. Both groups were compared in terms of fluoroscopy and operative time, re-treatment, complications, success rate, and secondary and total number of procedures. RESULTS Microperc and SWL were performed on 37 and 108 pediatric patients, respectively. The mean age of the patients was 5.91±4.03 years (1-15) and 8.43±4.84 (1-15) years in the SWL and microperc groups, respectively (P=0.004). The mean stone size was 11.32±2.84 (5-20) mm in the SWL group and 14.78±5.39 (6-32) mm in the microperc group (P<0.001). In the SWL group, 31 (28.7%) patients underwent a second SWL session and 6 (5%) had a third session. Finally, 95 (88%) patients were stone free at the end of the SWL sessions. In the microperc group, the stone-free rate was 89.2% in a single session (P=0.645). The mean duration of hospitalization was 49.2±12.3 (16-64) hours in the microperc group and 8.4±2.3 (6-10) hours per one session in the SWL group (P<0.001). The fluoroscopy time was significantly longer in the microperc group compared with the SWL group (147.3±95.3 seconds vs 59.6±25.9 seconds, P<0.001). The rate of requirement for an auxiliary procedure was higher in the SWL group than in the microperc group. The overall complication rates for the microperc and SWL groups were 21.6% and 16.7%, respectively (P=0.498). CONCLUSIONS The results of our study demonstrate that microperc provides a similar stone-free rate and a lower additional treatment rate compared with SWL in the treatment of kidney stone disease in children.

Ultra-mini-percutaneous nephrolithotomy in pediatric nephrolithiasis: Both low pressure and high efficiency

INTRODUCTION The management of urolithiasis in children differs from adults because of anatomic and metabolic abnormalities. At present, various minimally invasive and invasive treatment strategies have been recommended to treat urinary tract Stones, including shock wave lithotripsy (SWL), standard percutaneous nephrolithotomy (PNL), mini-PNL, retrograde intrarenal surgery (RIRS), micro-PNL, and a new technique termed ultra-mini PNL (UMP). UMP is a new method for the treatment of kidney stones. The main difference between UMP and standard PNL or mini-PNL lies in the small access sheath and in its design. A 9.5F pediatric compact cystoscope was used (Figure). A major advantage of UMP is that it provides similar stone-free rates when compared with standard PNL, with lower intrarenal pressure than micro-PNL. OBJECTIVE The aim of the study was to determine the applicability and safety of UMP in the treatment of pediatric kidney stones. PATIENTS AND METHODS We retrospectively reviewed the files of 39 kidney stones in children who had undergone UMP between May 2011 and October 2014. The indications for UMP included stones resistant to SWL, stones requiring repeated sessions of SWL, and stones size larger than 20 mm. RESULTS The study included 17 females and 22 males, with a mean age of 5.8 ± 4.6 years. The mean hemoglobin loss was 0.9 ± 0.6 mg/dL and none of the patients required a blood transfusion. The complication rate of the PNL procedure was 15.3% (n = 6). Complete clearance was achieved in 32 patients (82%) with UMP monotherapy, which increased to 34% (87.1%) 4 weeks after the operation. DISCUSSION Management of urolithiasis necessitates a balance between stone clearance and morbidity related to the procedure. SWL often leads to persistent residual stones. The developing RIRS can minimize the risks associated with bleeding and visceral injury, but sometimes the abnormal pelvicaliceal anatomy and poor imaging of the flexible ureteroscopy may impact its success rate and applications. It has been reported that PNL can be performed safely and effectively to achieve a higher stone-free rate; however, it has serious complications such as bleeding that requires blood transfusion in 11-14% of the cases with increased risk of kidney loss. The recent development of smaller sheaths allows tract formation with minimal damage to the renal parenchyma, thereby reducing procedure-related morbidity without diminishing its therapeutic efficacy. CONCLUSION The most important advantage of this surgical technique that has been developed is similar stone-free rates to standard PNL and lower intrarenal pressure than micro-PNL. Our experience supports that UMP is safe and effective for the management of renal stones in children.

Relationship between mean platelet volume and varicocele: a preliminary study.

OBJECTIVE To examine the relationship between the mean platelet volume (MPV) and varicocele to clarify the etiopathogenesis of varicocele. METHODS MPV levels were measured in 60 varicocele subjects (group I) and 57 healthy controls (group II) from 2009-2010. Ages were similar between the 2 groups. The diagnosis of varicocele was based on the findings from both physical examination and color Doppler ultrasound. RESULTS The average patient age at the time of examination was 28.12 ± 6.4 years in group I and 28.10 ± 5.8 in group II. MPV levels were statistically significantly higher in group I than in group II (P < .001). Positive correlations were found between MPV and varicocele grade as between MPV and diameter of left spermatic vein (P < .05). CONCLUSION The increase in MPV is independent of the disease, and the increase in varicocele grade is associated with higher MPV in varicocele patients. On the basis of the importance of the vascular component in the pathophysiology of varicocele, we would suggest conducting more studies with platelets in varicocele patients.

Varicocele among healthy young men in Turkey; prevalence and relationship with body mass index

AIM Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes related to male infertility. This study aimed to investigate the correlation between varicocele and somatometric parameters. We also aimed to determine prevalence and treatment ratio of this disorder among healthy young Turkish men. MATERIALS AND METHODS A total of 2061 young men aged from 19 to 34 years was enrolled and cross sectionally evaluated for status of varicocele. Body mass index was calculated. Patients were categorized as normal weight, overweight and obese using by National Institutes of Health criteria. Patients underwent physical examinations for the presence and grade of varicocele. If the varicocele was found and previously submitted to different treatment modalities, the age of treatment and outcomes were recorded. RESULTS Varicocele was present in 498 men (24.2%). The mean age of the participants was 22.7 ± 1.8 years, and the median BMI was 22.8 ± 2.0 kg/m². There were no significant differences in age, height, weight and BMI among the patients with different grades of varicocele (p > 0.05). Although no significant difference was found in varicocele prevalence between normal weight and over-weight participants (p > 0.05), obese participants had significantly lower varicocele prevalence compared with normal or over weight participants (p = 0.006). A total of 49 men had scrotal pain and the treatment ratio was only 2.8%. CONCLUSION Prevalence of varicocele was found in about 24% of healthy young Turkish population. Participants with varicocele had significantly lower BMI values compared with those without varicocele. Our findings supported the hypothesis that individuals with a greater BMI may have advantages in relieving the varicocele, but further studies are required to clarify this issue. Additionally treatment ratio was low among young men with varicocele.

Microsheath for Microperc: 14-Gauge Angiocath

Micropercutaneous nephrolithotomy (microperc) is the end point percutaneous nephrolithotomy (PCNL) technology for the present. In routine PCNL surgery, use of an Amplatz sheath is an important step, but in this technique, there is no Amplatz sheath. Some problems during surgery may occur because of the lack of an Amplatz sheath, which provides a tract between the skin and the collecting system. Therefore, we describe the smallest Amplatz sheath (6.6F) that is compatible with the microperc instrument and can be used during percutaneous surgery, especially in preschool pediatric patients.

Radiation Exposure—Do Urologists Take it Seriously in Turkey?

PURPOSE A questionnaire was administered to urologists to evaluate attitudes and behaviors about protection from radiation exposure during fluoroscopy guided endourological procedures. MATERIALS AND METHODS The questionnaire was e-mailed to 1,482 urologists, including urology residents, specialists and urologists holding all levels of academic degrees, between May and June 2011. The questionnaire administered to study participants was composed of demographic questions, and questions on radiation exposure frequency, and the use of dosimeters and flexible protective clothes. If a respondent reported not using dosimeters or protective clothes, additional questions asked for the reason. RESULTS Of the 1,482 questionnaires 394 (26.58%) were returned, of which 363 had completed answers. A total of 307 physicians (84.58%) were exposed to ionizing radiation, of whom 79.61% stated that they perform percutaneous nephrolithotomy at the clinic. Fluoroscopy guidance was the initial choice of 96.19% of urologists during percutaneous nephrolithotomy. Despite the common use of lead aprons (75.24%) most urologists did not use dosimeters (73.94%), eyeglasses (76.95%) or gloves (66.67%) while 46.44% always used thyroid shields during fluoroscopy. When asked why they did not use protective clothing, the most common answers were that protective clothes are not ergonomic and not practical. CONCLUSIONS Results clearly highlight the lack of use of ionizing radiation protection devices and dosimeters during commonly performed fluoroscopy guided endourological procedures among urologists in Turkey.

Role of Ultrasonography in Percutaneous Renal Access in Patients With Renal Anatomic Abnormalities

OBJECTIVE To present our experience regarding the feasibility, safety, and efficacy of ultrasound (US)-guided percutaneous nephrolithotomy in anatomically abnormal kidneys. MATERIALS AND METHODS We performed US-guided percutaneous nephrolithotomy in 15 patients with anatomically abnormal kidneys and renal calculi. Of the 15 patients, 5 had horseshoe kidneys, 5 had rotation anomalies, 2 had kyphoscoliosis, and 3 had scoliosis. The stone size, number of access tracts, operative time, hospitalization duration, rate of stone clearance, and complication rate were recorded. Percutaneous access was achieved with US guidance in the operating room by the urologist. RESULTS Successful renal access was obtained by the surgeon using US guidance in all patients, and a single access was obtained in all cases. Of the 15 patients, 8 were females, and 7 were males; 8 patients had solitary stones, and 7 had multiple calculi. The renal calculi were on the right in 7 patients and on the left in 8. Three patients had previously undergone unsuccessful shock wave lithotripsy. Complete stone clearance was achieved in 13 patients. The mean operative time was 54.2 minutes. No patient required a blood transfusion because of bleeding. Urinary tract infections occurred in 2 patients, who were treated with antibiotics. A double-J catheter was not inserted in any patient; however, a ureteral catheter was used in 3 patients for 1 day. None of the patients had any major complications during the postoperative period. The stone-free rate was 87%, and 2 patients had clinically insignificant residual fragments. CONCLUSION Our results have demonstrated that US-guided percutaneous nephrolithotomy can be performed feasibly, safely, and effectively in anatomically abnormal kidneys.

Comparison of pneumatic and laser lithotripsy in the treatment of pediatric ureteral stones

OBJECTIVE To compare the effectiveness and safety of pneumatic and holmium:YAG laser lithotripters in the treatment of pediatric ureterolithiasis. PATIENTS AND METHODS Medical records of patients treated using pneumatic (PL) (n = 29) or laser (LL) (n = 35) lithotripter between 2009 and 2011 were retrospectively analysed. The patients were evaluated with respect to age, gender, stone size, complications, and stone-free rates 1 month after the operation. RESULTS For the PL and LL groups, mean ages (8.8 ± 3.4 and 8.3 ± 3.5 years), male/female ratios (19:10 and 22:13) and stone locations were similar (p > 0.05). Mean stone sizes were 55.6 mm2 and 47.6 mm2 in the PL and LL group, respectively, with no statistically significant difference (p = 0.850). Mean operative times were 20.5 min in the PL group and 25.2 min in the LL group, with a statistically significant difference (p = 0.020). Stone-free rates 1 month after intervention were 79% in the PL group and 97% in the LL group (p = 0.022). Stone migration was detected in the PL group (n = 6) and in the LL group (n = 1). No major complication was found in either group. CONCLUSION In the ureteroscopic treatment of pediatric ureterolithiasis, both pneumatic and laser lithotripters are effective and successful. However, laser lithotripsy has a higher stone-free rate and lower complication rate.

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception.

Abstract Objectives: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient’s pain control, anxiety levels, and satisfaction. Patients and methods: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed. Results: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. Conclusion: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.