Hacı İbrahim Çimen

Re: Does Previous Extracorporeal Shock Wave Lithotripsy Affect the Performance and Outcome of Percutaneous Nephrolithotomy?: E. Yuruk, A. Tefekli, E. Sari, M. A. Karadag, A. Tepeler, M. Binbay and A. Y. Muslumanoglu J Urol 2009; 181: 663–667

of less than 0.4 ng/ml was usually regarded as normal postoperatively. Ultrasensitive assays became available only years later. Delayed vs early radiation is on all of our minds. A glimpse into the difference is found in this study, in which delayed radiation was used in most men with a PSA recurrence and associated with inferior outcomes. Whether earlier radiation is equivalent to adjuvant radiation using this study design is a matter of speculation. Regarding cause of death, the study was reported according to its original design, ie time to development of metastatic disease or death in the absence of metastasis. The table displays additional outcomes by study arm. Finally we seriously disagree with the argument not to consider radiation in this population. These study data along with those of 2 other randomized trials suggest that doing so not only risks an increased death rate and increased metastatic disease, but also a PSA recurrence 7 years sooner with its attendant anxiety and risk of additional treatments. We would consider an informed patient who can weigh his own priorities (cancer control vs possible side effects) as the ultimate arbiter of the decision.

Flouroscopy-free technique is safe and feasible in retrograde intrarenal surgery for renal stones

OBJECTIVE The aim of this study was to present outcomes of our patients who had undergone retrograde intrarenal surgery (RIRS) with fluoroscopy-free technique and evaluate the efficacy and safety of the technique. MATERIAL AND METHODS Between January 2013 and June 2015 the outcomes of 93 patients who had undergone RIRS with fluoroscopy-free technique were retrospectively evaluated. Our RIRS technique involved preoperative assessment of ureter by semi-rigid ureteroscope, inserting guidewire through semi-rigid ureteroscope, inserting ureteral access sheath over the guidewire with the visiual guidance of semi-rigid ureteroscope, passing flexible ureteroscope through the sheath, dusting the stone with holmium laser, rechecking the ureter with semi-rigid ureteroscope and inserting double J stent through semi-rigid ureteroscope. Low-dose computerized tomography scan was performed to all patients in postoperative first month and the results were classified as stone-free (absence of any fragment), clinically insignificant residual fragments (CIRF) (≤4 mm) and residual stone. RESULTS Study population consisted of 62 (66.6%) male and 31 (33.3%) female patients with a mean age of 47.8±14 (range 14-93) years. Mean stone size was 14.7±5 (7-32) mm. Median operative time was 72 (30-125) minutes. Stone-free rate was achieved in 65 (69.9%) patients while CIRF was achieved in 13 (13.9%) and residual stones were detected in 15 (16.1%) patients. Five patients (5.37%) had minor complications, including hematuria and fever. No major complications were observed. CONCLUSION Fluoroscopy-free technique is effective and safe technique in management of renal stone. Furthermore fluoroscopy-free technique can protect the surgeon from the negative effects of radiation.

Laparoscopic simple nephrectomy patient wıth situs inversus totalis and left renal hypoplasia: A case report

Situs inversus totalis (SIT) is a relatively rare anatomical condition characterized by the transposition of thoracic and abdominal organs from the normal side to the opposite position. Most reports of laparoscopic procedures in patients with SIT cite technical difficulties and longer operative times due to disorientation because of the reversed abdominal organs and necessary modification of the surgeons movements and techniques. We present a case of a patient with SIT in whom a transperitoneal laparoscopic simple nephrectomy was performed.

Letter to the Editor/ErrataComparative Effectiveness of Perineal Versus Retropubic and Minimally Invasive Radical Prostatectomy

The term “minimally invasive” radical prostatectomy is inaccurate. PRP is the least invasive method of radical prostatectomy from an objective assessment. The combined length of MIRP trocar incisions is about the same as the PRP incision, and with PRP no more than 2 fingers are inserted into the perineum at any given time. As practitioners with a large population of seasonal patients, we have a unique insight into surgical outcomes of patients who have undergone MIRP at many different hospitals and institutions in northern climes. It is our observation that postoperative incontinence and erectile dysfunction (ED) rates are substantially underreported. We maintain that MIRP is not as good as advertised, and that a renewed interest in PRP should be generated at those academic institutions committed to providing patients with the best possible surgical outcome.