Gokhan Atis

Comparison of Retrograde Intrarenal Surgery and Mini-percutaneous Nephrolithotomy in Children With Moderate-size Kidney Stones: Results of Multi-institutional Analysis

OBJECTIVE To compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in children for 10- to 30-mm renal calculi by evaluating operative data, stone-free rates, and associated complications. METHODS The records of 201 pediatric patients who underwent mini-perc (n = 106) or RIRS (n = 95) for intrarenal stones of 10- to 30-mm size were reviewed retrospectively. The χ(2) test was applied to compare the success rates, postoperative complications, and blood transfusion rates, and the Mann-Whitney U test was used to compare the means of hospital stay, fluoroscopy, and operative time for mini-perc and RIRS. RESULTS The stone-free rate was 84.2% for the RIRS group and 85.8% for the mini-perc group after a single procedure (P = .745). These percentages increased to 92.6% and 94.3% with adjunctive therapies for RIRS and mini-perc, respectively. Minor complications classified as Clavien I or II occurred in 17% and 8.4% in mini-perc and RIRS, respectively. No major complications (Clavien III-V) occurred in either group. Overall complication rates in mini-perc were higher, but the differences were not statistically significant (P = .07). However, 7 patients in the mini-perc group received blood transfusions, whereas none of the children in the RIRS group were transfused (P = .015). The mean hospital stay, fluoroscopy, and operation times were significantly longer in the mini-perc group. CONCLUSION This study demonstrates that RIRS is an effective alternative to mini-perc in pediatric patients with intermediate-sized renal stones. Operative time, radiation exposure, hospital stay, and morbidities of percutaneous nephrolithotomy (PNL) can be significantly reduced with the RIRS technique.

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.

Sexual Dysfunction in Women with Clinical Hypothyroidism and Subclinical Hypothyroidism

INTRODUCTION Hypothyroidism is a common hormonal disorder in women that may affect the phases of female sexual function. AIM To investigate female sexual function in patients with clinic hypothyroidism and subclinic hypothyroidism. METHODS A total of 25 women with clinic hypothyroidism (group 4), 25 women with subclinic hypothyroidism [thyroid stimulating hormone (TSH) value <or=10 mU/L (group 2), TSH value >10 mU/L (group 3)], and 20 age matched voluntary healthy women controls (group 1) were included in the study. All the subjects were evaluated with a detailed medical and sexual history, including a female sexual function index (FSFI) questionnaire for sexual status and the Beck Depression Inventory for psychiatric assessment. MAIN OUTCOME MEASURES The levels of serum TSH, thyroid hormones, prolactin (PRL), free testosterone, estradiol, follicle-stimulating hormone, luteinizing hormone, lipid profile, and blood glucose were measured. RESULTS Female sexual dysfunction (FSD) was diagnosed in 14 of 25 patients (56%) in group 4, in 6 of 11 patients (54.6%) in group 3, in 2 of 14 patients (14.6%) in group 2, and while only 3 of 20 the control group of women (15%) had FSD (P = 0.006). The mean total FSFI scores were 23.9 in the group 4, 26.03 in the group 3, 29.2 in the group 2, and 32.30 in the control group (P < 0.0001). The mean BDI score for clinic hypothyroidic patients was significantly greater than the scores for the control group and for the group 2 (P = 0.017 and P = 0.043, respectively). The mean PRL levels for patients in group 4 and group 3 were found to be significantly higher than the level for controls (P < 0.0001), whereas other serum hormone levels were not different among groups. CONCLUSIONS A significant percent of women with clinic hypothyroidism and subclinic hypothyroidism with TSH values >10 mU/L had sexual dysfunction. Hyperprolactinemia, hyperlipidemia, and depression were associated with FSD in clinic hypothyroidism. Different than clinic hypothyroidism depression was not associated with FSD in subclinic hypothyroidism with TSH values >10 mU/L.

Retrograde Intrarenal Surgery for the Treatment of Renal Stones in Patients With a Solitary Kidney

OBJECTIVE To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of renal stones in patients with a solitary kidney. MATERIALS AND METHODS From December 2008 to March 2012, 24 patients with a solitary kidney who were treated with RIRS for renal stones were included in the study. All patients were preoperatively evaluated with urine culture, serum biochemistry, urinary ultrasonography, noncontrast computed tomography or intravenous urography, or both. The procedure was considered as successful in patients with complete stone disappearance or fragments <4 mm on computed tomography. Preoperative, operative, and postoperative data of the patients were retrospectively analyzed. The mean serum creatinine levels before and after the procedures were compared using a paired sample t-test. RESULTS The study included 24 patients with a mean age of 44.41 ± 12.15 years (range, 24-70). The mean stone size was 19.83 ± 5.90 mm (range, 10-35). The mean operative time was 55.83 ± 10.90 minutes (range, 40-75). The success rates were 83.3% and 95.8% after the first and second procedures, respectively. A pigtail stent was placed in all patients. The mean serum creatinine levels before the procedures and at 2 weeks after removal of the pigtail stents were 1.54 ± 0.55 mg/dL (range, 0.7-2.8) and 1.56 ± 0.50 mg/dL (range, 0.9-2.6), respectively (P = .92). Minor complications, classified as Clavien I or II, occurred in 4 patients (16.6%). No major complications (Clavien III-V) occurred in the study group. CONCLUSION RIRS is an effective and safe procedure that can be used to manage renal stones in patients with a solitary kidney.

Serum Adipocytokine Levels in Prostate Cancer Patients

Introduction: We estimated the circulating levels of adipocytokines such as adiponectin and leptin in nonobese nondiabetic prostate cancer (PCa) patients and compared the results with controls and benign prostate hyperplasia (BPH) patients. Material and Methods: Fifty patients with PCa, 20 patients with BPH and 50 healthy volunteers were entered into the study. Their blood samples were investigated for adipocytokines with the ELISA method. Results: Adiponectin levels were determined as 8.9 and 5.5 μg/ml for the same patients. Leptin concentration was 14.78 ng/ml in organ-confined PCa patients, and 15.24 ng/ml in advanced PCa patients. In control patients, adiponectin and leptin levels were 18.4 and 12.98 ng/ml, respectively. Conclusion: Serum adipocytokine levels of PCa patients were significantly different from those of controls and BPH patients who were not obese or diabetic. Therefore, further molecular investigation of these adipocytokines will help understand the mechanism.

The cost analysis of flexible ureteroscopic lithotripsy in 302 cases

The objective of this study was to audit the cost of flexible ureterorenoscopic lithotripsy. The data for 302 consecutive flexible ureteroscopic lithotripsy (FURSL) procedure undertaken in our department for renal stone treatment were collected retrospectively. The costs associated with performing FURSL, including the cost of ancillary equipment were analyzed. This includes the cost of the initial purchase of the ureterorenoscopes and the holmium laser equipment. The cost of flexible ureterorenoscopy for each lithotripsy procedure (for a total of 302 FURSL) was

Hyperthyroidism: A Risk Factor for Female Sexual Dysfunction

118. Additional cost of ancillary equipment including laser device, ureteral acces sheath and stone retrival catheter were

Ureteroscopic management with laser lithotripsy of renal pelvic stones.

156,

Comparison of Different Ureteroscope Sizes in Treating Ureteral Calculi in Adult Patients

231 and

Intravesical Migration of an Intrauterine Device

611, respectively. In this series, the costs of the ancillary equipment including laser exceeded the purchase and maintenance of the flexible ureteroscope. The cost of disposables rather than flexible ureteroscope itself should be considered in planning the budget.