Ender Ozden

Antibiotic Prophylaxis in Percutaneous Nephrolithotomy: Prospective Study in 81 Patients

PURPOSE To compare single-dose and short-course antibiotic prophylaxis protocols in percutaneous nephrolithotomy. PATIENTS AND METHODS Eighty-one patients with sterile urine preoperatively who underwent percutaneous nephrolithotomy were divided into two groups. The first group (N = 43) received a single intravenous dose of antibiotic (200 mg of ofloxacin) during anesthetic induction, and the second group (N = 38) received treatment doses of antibiotic (400 mg of ofloxacin per day) until the nephrostomy catheter was removed. The two groups were identical according to demographic and treatment characteristics. For each patient, microbiologic evaluation of extracted stones and urine samples was done. If patients developed fever in the postoperative period, blood and urine cultures were taken. Factors that might have affected the development of postoperative fever and infection were analyzed. RESULTS Nine patients in the first group had postoperative fever. Three had bacteriuria, and one had bacteremia. In the second group, eight patients had fever. One had bacteriuria and bacteremia. Nineteen patients (eleven in the first group, eight in the second) had positive stone cultures. No statistical difference was observed between the two groups in terms of bacteriuria, bacteremia, positive stone cultures, or postoperative fever. The febrile patients had longer operations with the use of more irrigation fluid and longer postoperative hospital stays. CONCLUSIONS In patients whose preoperative urine cultures are sterile, short-term prophylaxis has no advantage over single-dose prophylaxis as a means of preventing infection. The duration of surgery and the amount of irrigation fluid are significant risk factors for postoperative fever.

Incidence of Acute Prostatitis Caused by Extended-spectrum β-Lactamase-producing Escherichia coli After Transrectal Prostate Biopsy

OBJECTIVES To study the clinical and bacteriologic picture of acute prostatitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli after transrectal ultrasound-guided prostate biopsy. METHODS The retrospective data from 1339 patients who had undergone transrectal ultrasound-guided biopsy from November 2003 to June 2008 were reviewed. An automatic biopsy gun with an 18-gauge needle was used to obtain 10-core biopsies for first biopsies and > or =12-core for repeat biopsies. These patients had received 500 mg ciprofloxacin orally twice daily for 5 days, beginning 24 hours before biopsy. All biopsies were performed as outpatient procedures. RESULTS Of the 1339 patients, 28 (2.1%) had acute bacterial prostatitis detected after transrectal ultrasound-guided prostate biopsy. Acute prostatitis occurred after the first biopsy in 15 patients (1.3%) and after repeat biopsy in 13 (6.8%). The patients had developed infective symptoms a mean of 3 days after transrectal ultrasound-guided prostate biopsy. Of the 28 patients, 17 (61%) had positive urine and/or blood cultures, including E. coli in 14. Of the 14 patients, 6 had acute prostatitis caused by ESBL-producing E. coli. Bacteria isolated from urine were tested for drug susceptibility to a wide range of antibiotics. All patients with ESBL-producing E. coli were treated with imipenem. The bacteria detected in these urine cultures were resistant to ciprofloxacin, ceftriaxone, sulbactam/ampicillin, and cefazolin. Imipenem and piperacillin-tazobactam were the most active agents against ESBL-producing E. coli. ESBL-producing isolates had a significant reduction in activity for most antimicrobial agents, including fluoroquinolones and amikacin. CONCLUSIONS The prompt initiation of effective antimicrobial treatment is essential in patients with ESBL-producing E. coli, and empirical decisions must be determined by knowledge of the local distribution of pathogens and their susceptibility.

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.

Tubeless Mini Percutaneous Nephrolithotomy in Infants and Preschool Children: A Preliminary Report

PURPOSE We retrospectively analyzed the outcomes of tubeless mini percutaneous nephrolithotomy in infants and preschool children, and compared them with age matched controls who underwent nephrostomy drainage. MATERIALS AND METHODS A total of 28 renal units in 26 children were operated on for stone disease using the mini percutaneous nephrolithotomy technique. Holmium laser and pneumatic lithotriptor were used for stone fragmentation. Children who underwent complete stone removal and had a clear nephrostomy tract only had a ureteral catheter placed. Those with residual stones or bleeding from the nephrostomy tract underwent nephrostomy drainage. We compared both groups with regard to patient and stone characteristics, and postoperative findings. RESULTS A total of 12 renal units had only a ureteral catheter for diversion, while 16 had nephrostomy drainage. Mean respective ages of the stentless and nephrostomy groups were 3 (range 0.58 to 6) and 3.3 years (1.5 to 6). Mean respective stone burdens were 192 (range 100 to 400) and 416 (775 to 1,380) mm2. Surgery and fluoroscopy times were shorter in the tubeless group. Complication rates were higher (6 of 14 vs 0 of 12) and duration of hospitalization was longer (4.9 [range 3 to 14] vs 3.1 days [2 to 6]) in the nephrostomy group. Stone-free rates were 91.6% in the tubeless and 78.5% in the nephrostomy groups. CONCLUSIONS Tubeless percutaneous nephrolithotomy was observed to be a safe option for selected children with stone disease. The success and safety of tubeless percutaneous nephrolithotomy depends on patient selection criteria, including low volume and infection-free stones that are removed completely without any bleeding from the access tract.

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.

Modified Clavien classification in percutaneous nephrolithotomy: assessment of complications in children.

PURPOSE Although percutaneous nephrolithotomy has been accepted as an effective minimally invasive procedure in children, there is still no consensus on how to define and stratify complications by severity. MATERIALS AND METHODS We retrospectively reviewed data of children who underwent percutaneous nephrolithotomy at our center between January 2002 and March 2010. A total of 100 procedures were performed in 94 patients with a mean age of 9.5 years. Complications were recorded according to modified Clavien classification. RESULTS Average stone burden ranged from 100 to 2,850 mm(2) (mean ± SD 507.5 ± 475). Stones were located in the renal pelvis in 32 kidneys, calices in 20, renal pelvis and calices in 31, and upper ureter in 3. Stone-free rate after a single session of percutaneous nephrolithotomy was 85%. After auxiliary procedures in 7 cases stone-free rate increased to 89%. Grade I complications were seen in 7 patients postoperatively, grade II in 19 (hematuria requiring blood transfusion in 13 and nonseptic infection requiring antibiotics in 6) and grade III in 4 (hydrohemothorax in 2 and urine leakage requiring Double-J® stent in 2). No grade IV or V complications were observed. Regression analysis showed that stone burden (OR 1.006, 95% CI 1.001-1.011; p = 0.03) and operative time (OR 1.044, 95% CI 1.011-1.077; p = 0.009) were independent risk factors for complications. CONCLUSIONS Percutaneous nephrolithotomy in children is safe, feasible and effective. Stone burden and operative time are independent risk factors for complications. The modified Clavien system provides a straightforward and validated method to classify postoperative complications.

Horseshoe kidney: does it really have any negative impact on surgical outcomes of percutaneous nephrolithotomy?

OBJECTIVES To compare the stone-free rate and complications between horseshoe and normal kidneys. METHODS Between December 1997 and June 2008, a total of 2401 patients with 2618 renal units underwent percutaneous nephrolithotomy (PCNL). During this period, we retrospectively reviewed the data of 46 patients with 50 (1.9%) renal units with horseshoe kidneys treated by PCNL. We compared the success and complication rate in horseshoe kidney and normal kidney. RESULTS Fifty PCNL were performed in the above-mentioned 46 patients with a mean age of 41.6 years. The average stone burden ranged from 100 to 4900 mm(2) (mean, 644 +/- 135 mm(2)). The stones were located in the renal pelvis in 13 (26%), calices in 17 (34%), and in both in 11 kidneys (22%). A single tract was used in 42 kidneys (84%), and 2 tracts were created in the remaining 8 (16%). Major complications were seen in 8 PCNL procedures (16%). A detailed comparison between horseshoe and normal kidneys showed that stone burden, operation time, stone-free rates, and auxiliary procedure rates were similar. The only statistically significant difference was detected in the number of access, which is more in normal kidneys. Logistic regression analysis did not reveal that horseshoe kidney did not have any negative effect on success after PCNL. CONCLUSIONS Despite the anatomic abnormalities, PCNL is a safe and effective treatment option for calculi both in the horseshoe kidney and the normal kidney with the similar success and complications rates.

Transplantation tourism: high risk for the recipients.

Yakupoglu YK, Ozden E, Dilek M, Demirbas A, Adibelli Z, Sarikaya S, Akpolat T. Transplantation tourism: high risk for the recipients. 
Clin Transplant 2010: 24: 835–838.

Experimental Unilateral Spermatic Cord Torsion: The Effect of Polypolymerase Enzyme Inhibitor on Histopathological and Biochemical Changes in the Early and Late Periods in the Ipsilateral and Contralateral Testicles

OBJECTIVES We wanted to show early and late biochemical, histopathological, and apoptotic changes caused by unilateral spermatic cord torsion in ipsilateral and contralateral testicles and the effect of the poly (adenosine triphosphate-ribose) polymerase (PARP) inhibitor, nicotinamide, on these changes in early and late periods. MATERIALS AND METHODS Forty-seven Wistar albino rats were divided into 2 major groups as early and late periods. Subsequently, each group was divided into subgroups as control, sham, torsion-detorsion (TD), TD treated with saline (TDS), and TD treated with nicotinamide (TDN). Left testicles were subjected to spermatic cord torsion for 4 hours. Thirty-minutes before detorsion, 0.2 mL saline or 10 mg/kg nicotinamide was administered intraperitoneally to the TDS and TDN groups, respectively. Bilateral orchidectomy was performed by the end of the fourth hour in early and 2 months after TD in late groups and the animals were sacrificed. Apoptosis, Johnsen Tubular Biopsy Score, and seminiferous tubule diameter (STD) were used to evaluate histopathological changes. Ischemia-reperfusion injury-related changes were assessed by levels of malondialdehyde (MDA) and total and free glutathione in serum. RESULTS There were no significant differences between groups in terms of serum MDA and total and free glutathione levels. Rats given nicotinamide had a higher number of spermatogonia in seminiferous tubules in early and late periods when compared with the untreated group (P <.05). In early and late groups, mean STD of contralateral and ipsilateral testicles were higher in rats given nicotinamide when compared with untreated groups. No significance was observed in terms of STD between early and late groups. Late groups treated with nicotinamide had less apoptosis when compared with untreated groups (P <.05). CONCLUSIONS Nicotinamide may successfully decrease ischemia-reperfusion injury in early and late periods in both testicles.

Percutaneous nephrolithotomy in pediatric age group: Assessment of effectiveness and complications.

Management of kidney stone disease in pediatric population is a challenging condition in urology practice. While the incidence of kidney stone is increasing in those group, technological innovations have conrtibuted to the development of minimally invasive treatment of urinary stone disease such as mini-percutenous nephrolitotomy (mini-PCNL), micro-PCNL, ultra mini-PCNL. In this review we tried to evaluate the effect of new teratment techniques on pediatric kidney stones.