Cem Aygun

Factors Affecting Complication Rates of Ureteroscopic Lithotripsy in Children: Results of Multi-Institutional Retrospective Analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society

PURPOSE We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.

Factors Affecting Complication Rates of Percutaneous Nephrolithotomy in Children: Results of a Multi-Institutional Retrospective Analysis by the Turkish Pediatric Urology Society

PURPOSE We assessed factors affecting complication rates of percutaneous nephrolithotomy in children. MATERIALS AND METHODS We retrospectively evaluated data on 1,205 renal units in 1,157 children treated with percutaneous nephrolithotomy at 16 Turkish centers between 1991 and 2012. Of the patients 28.3% had a history of urolithiasis. Complications were evaluated according to the Satava classification system and modified Clavien grading system. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS A total of 515 females and 642 males were studied. Mean ± SD patient age was 8.8 ± 4.7 years (range 4 months to 17 years). Mean ± SD stone size, operative time and postoperative hospital stay were 4.09 ± 4.06 cm(2), 93.5 ± 48.6 minutes and 5.1 ± 3.3 days, respectively. Postoperative stone-free rate was 81.6%. A total of 359 complications occurred in 334 renal units (27.7%). Complications were intraoperative in 118 cases and postoperative in 241. While univariate analysis revealed that stone history, positive urine culture, operative time, length of hospitalization, treatment success, punctured calyx and location of the stone significantly affected the complication rates (p <0.05), operative time, sheath size, mid calyceal puncture and partial staghorn formation were the statistically significant parameters affecting complication rates on multivariate logistic regression analysis. CONCLUSIONS Percutaneous nephrolithotomy is the treatment of choice for most renal calculi in children. The technique is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.

Covered metallic ureteral stent in the management of malignant ureteral obstruction: preliminary results

OBJECTIVES To evaluate the effectiveness of ureteral Dacron-covered metallic stents in the management of malignant ureteral obstruction. METHODS Covered metallic stents were placed unilaterally using a percutaneous approach in an antegrade fashion into nine ureters of 8 patients with bilateral malignant ureteral obstruction. The contralateral kidneys were drained by percutaneous nephrostomy in 7 patients. The primary diagnoses were rectal cancer in 5 patients and cervical, bladder, and prostate cancers in the remaining cases. RESULTS Covered metallic stents could be successfully placed in all patients. Only one of nine ureters was stented with a double J-stent. In a mean follow-up of 9 months (range 1 to 14), 7 of 8 patients died because of their primary disease. During the follow-up period, none of the stents were obstructed, displaced, or infected. CONCLUSIONS Dacron-covered metallic stents appear to be successful in the treatment of patients with malignant ureteral obstruction. The preliminary outcome encourages and justifies the application of this drainage method.

Anterior urethral valve as a cause of end-stage renal disease.

Abstract Although posterior urethral valves are predominant as a cause of obstructive uropathy in children, anterior urethral valves may also appear as the underlying etiologic factor in end‐stage renal disease that results from obstruction. Two cases are presented of anterior urethral valve patients that were admitted with end‐stage renal disease. The first case was successfully treated with diverticulectomy and urethral reconstruction in preparation for renal transplantation. The second case, however, had been on cystostomy drainage for 6 years and also had a contracted bladder. A more extensive lower urinary tract reconstruction was delayed. Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valve or diverticula should be considered in differential diagnosis of obstructive lesions.

Sublingual sildenafil in the treatment of erectile dysfunction: Faster onset of action with less dose

Background: The aim of the present study was to show the efficacy and safety of sublingual sildenafil and to determine whether lower doses cause the same effect with a faster onset of action in this mode of application.

Outcome of Percutaneous Nephrolithotomy in Children Having Complex Stones

Objectives: To review our experiences with percutaneous nephrolithotomy in children with complex renal calculi. Patients and Methods: 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 ≤5 years. Stone clearance and complications were recorded. Results: 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%). Conclusion: 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.

Neurofibroma of the bladder wall in von Recklinghausen's disease

Abstract Neurofibromatosis, or von Recklinghausens disease, is an autosomal dominant disease with multiple neurofibroma and café‐au‐lait spots. However, neurofibroma in the bladder wall is a rare condition in von Recklinghausens disease. A 31‐year‐old man with neurogenic voiding dysfunction due to sacral meningocele and acute urinary retention with neurofibroma of the bladder wall is presented with detailed radiologic evaluation. Patients with von Recklinghausens disease should be carefully evaluated if urological symptoms exist.

Tailored Treatment Approach for Emphysematous Pyelonephritis

Objective: We evaluated the clinical presentation, diagnosis and management of patients presenting with emphysematous pyelonephritis (EP). Patients and Methods: 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. Results: 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). Conclusions: 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.

Renal endometriosis presenting with a giant subcapsular hematoma: case report

OBJECTIVE To describe a case of renal subcapsular hematoma due to renal endometriosis. DESIGN Case report. SETTING Departments of Urology and Pathology, Baskent University Faculty of Medicine, Ankara, Turkey. PATIENT(S) A 46-year-old premenopausal woman was admitted with a left lumbar pain and mass. Ultrasonography and computerized tomography revealed a giant-sized renal subcapsular hematoma. INTERVENTION(S) Computerized tomography, percutaneous drainage catheter placement, surgical exploration, and excision of renal capsule. MAIN OUTCOME MEASURE(S) None. RESULT(S) Histopathologic examination revealed endometriosis located beneath the fibrous renal capsule. CONCLUSION(S) Renal capsular endometriosis should be kept in mind among the causes of renal subcapsular hematoma.

A case of incidentally detected Castleman's disease with retroperitoneal paravertebral localization

Castleman’s disease, or angiofollicular lymph node hyperplasia, is a fairly rare benign tumor of lymphoid origin. The expected localization is mediastinum and rarely retroperitoneum. An asymptomatic case is reported with multimodality imaging and postoperative findings. The lesion was detected incidentally on routine chest radiogram. Surgical exploration revealed a retroperitoneal mass and the mass was resected successfully through a thoracoabdominal flank incision. Castleman’s disease should be included in the list of differential diagnosis of retroperitoneal masses which are mostly malignant tumors.