Hakan Koyuncu

Emergency Ureteroscopic Removal of Ureteral Calculi After First Colic Attack: Is There Any Advantage?

OBJECTIVE To comparatively evaluate the efficacy of ureteroscopic stone treatment immediately after the first colic attack and in an electively planned manner. METHODS A total of 145 patients underwent semirigid ureteroscopic removal of obstructive ureteral calculi using 2 different approaches (group 1, 69 patients, and group 2, 76 patients). The 69 patients in group 1 were treated with appropriate medical therapy for a period of ≥7 days for colic pain and subsequently underwent either semirigid ureteroscopy or pneumatic lithotripsy in a planned manner. The 76 patients in group 2 underwent semirigid ureteroscopy after the first colic attack. The stone-free status, auxiliary procedures, and complications were evaluated between the 2 groups using the Mann-Whitney U test; for qualitative data, Fishers exact test was used. RESULTS Of the 145 patients who underwent semirigid ureteroscopy, the mean stone size was 11.80±3.95 mm and 8.32±2.08 mm in the 2 groups. No patient experienced a major complication during or after the procedure. The stone-free rate was 87% and 90.7% in groups 1 and 2, respectively. The mean readmission rate to the emergency department for the management of a colic attack was 3.03±2.84 in group 1; no patient in group 2 required readmission. CONCLUSION Ureteroscopic stone removal immediately after the first colic attack in the cases of obstructive ureteral stones proved to be safe and effective. It has the main advantage of offering both immediate stone fragmentation and the relief of acute onset colic pain causing extreme discomfort.

The Evaluation of Saphenofemoral Insufficiency in Primary Adult Varicocele

The aim of this study was to evaluate the possible relationship between varicocele and saphenofemoral insufficiency in patients diagnosed with primary varicocele. A total of 70 patients with the primary diagnosis of varicocele were included into the study. A total of 30 age-matched healthy adults were also included in the study as a control group. Varicocele was diagnosed by palpation and observation of each spermatic cord in standing position before and during a valsalva maneuver. Additionally, scrotal Doppler and lower extremity venous Doppler ultrasonography were performed. Patients who were with spermatic varicose vein larger than 3.0 mm were included in the study group as a varicocele patient. At the lower extremity venous Doppler ultrasonography, a retrograde flow lasting longer than 0.5 seconds during normal breathing or at the valsalva maneuver was considered to be meaningful for saphenofemoral junction insufficiency. Thirty-six (51.35%) patients had insufficiency in saphenofemoral junction in the study group (6 [8.5%] bilateral, 30 [42.85%] unilateral) whereas 8 (26.6%) had insufficiency in the control group (2 [6.6%] bilateral, 6 [20%] unilateral insufficiency). The patients with primary varicocele had a statistically significant (P = .02) higher rate of venous insufficiency in their saphenofemoral junctions when compared with the control group. In the present study, the rate of saphenofemoral insufficiency has been found to be statistically higher in patients with primary varicocele compared with healthy men. Depending on the common presence of valvular insufficiency, we believe that the presence of varicocele should be investigated in the young population suffering from saphenofemoral junction insufficiency.

Emergent stenting after uncomplicated ureteroscopy: evaluation of 23 patients.

OBJECTIVES To evaluate the causes of emergent stent placement during the postoperative early period after uncomplicated ureteroscopy in 23 patients. METHODS Of 276 uncomplicated ureteroscopy procedures performed for the management of ureteral calculi, double-J stent placement was necessary on an emergent basis in 23 patients because of intolerable colic pain and extreme patient discomfort. All stents were inserted within 24 hours after the procedure. RESULTS Of the 23 patients requiring emergent stent placement, 14 were men and 9 were women. The stones had been located in the lower ureter in 11, mid-ureter in 6, and upper ureter in 6 patients. All patients had undergone an uncomplicated procedure with no complication evident either during or immediately after ureteroscopic stone management. The intraoperative findings for the 23 patients revealed extensive edema formation, unrecognized small stones embedded in the edematous ureteral wall, unpassed small fragments gathered at the orifice, obstructing blood clots, and kinking of the ureter. A retrospective evaluation of the operative CD recordings and radiographic findings clearly showed that a longer operative time, repeated access, management of a large stone, impacted calculi with ureteral wall edema, a mildly narrowed ureteral segment, ignored caliceal small calculi, and a recent history of urinary tract infection contributed to the need for postoperative intervention. CONCLUSIONS Ureteral catheterization, at least in the form of overnight stent placement, might prevent the formation of transient ureteral obstruction, with resultant postoperative patient discomfort and colic pain evident in selected cases.

Bilateral Single-Session Retrograde Intrarenal Surgery for the Treatment of Bilateral Renal Stones

PURPOSE The aim of the study was to evaluate the efficacy and safety of bilateral single-session retrograde intrarenal surgery in the treatment of bilateral renal stones. MATERIALS AND METHODS From December 2008 to February 2012, 42 patients who had undergone bilateral single-session retrograde intrarenal surgery (RIRS) and laser lithotripsy were included in the study. The procedures were performed in the lithotomy position on an endoscopy table under general anesthesia, beginning on the side in which the stone size was smaller. Plain abdominal radiography, intravenous urograms (IVU), renal ultrasonography (USG) and / or non-contrast tomography (CT) scans were conducted for all patients. The success rate was defined as patients who were stone-free or only had residual fragment less than 4 mm. RESULTS A total of 42 patients (28 male, 14 female) with a mean age 39.2 ± 14.2 were included in the present study. The mean stone size was 24.09 ± 6.37 mm with a mean operative time of 51.08 ± 15.22 minutes. The stone-free rates (SFR) were 92.8% and 97.6% after the first and second procedures, respectively. The average hospital stay was 1.37 ± 0.72 days. In two patients (4.7%), minor complications (Clavien I or II) were observed, whereas no major complications (Clavien III-V) or blood transfusions were noted in the studied group. CONCLUSIONS Bilateral single-session RIRS and laser lithotripsy can be performed safely and effectively with a high success rate and low complication rate in patients with bilateral renal stones.

The incidence of postoperative ileus in patients who underwent robotic assisted radical prostatectomy.

Introduction Our aim was to examine the incidence and risk factors of postoperative ileus among patients who underwent robot–assisted radical prostatectomy (RARP). Material and methods We retrospectively reviewed 239 patients who underwent RARP transperitoneally between February 2009 and December 2011. Patients switched to open surgery were excluded. We defined postoperative ileus as intolerance of a solid diet continued until the third postoperative day and beyond. By Clavien classification, we evaluated the perioperative complications that cause or contribute to postoperative ileus. Similarly, we analyzed the impact of anesthesia risk score on the incidence of postoperative ileus. Results The study included 228 patients. The mean period to tolerate solid food was 1.24 days. Only 6 patients experienced postoperative ileus, all of whom were treated with a conservative approach. The two groups differed significantly in the duration of abdominal drainage, hospital stay, modified Clavien classification, and the presence of comorbidity diabetes mellitus (P <0.5 for all factors). Multiple logistic regression analysis revealed that diabetes mellitus was an independent risk factor for postoperative ileus. Conclusions We suggest that diabetes mellitus is an independent risk factor for postoperative ileus in patients undergoing robot–assisted radical prostatectomy.

Intrarenal Surgery vs Percutaneous Nephrolithotomy in the Management of Lower Pole Stones Greater than 2 cm.

Purpose To compare the efficacy of RIRS and PNL in lower pole stones ≥2 cm. Materials and and Methods: A total of 109 patients who underwent PNL or RIRS for solitary lower pole stone between April 2009 and December 2012, were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both PNL and RIRS before the selection of the procedure. Patients decided the surgery type by themselves without being under any influences and written informed consent was obtained from all patients prior to the surgery. Patients were divided into two groups according to the patients’ preference of surgery type. Group 1 consisted of 77 patients who underwent PNL and Group 2 consisted of 32 patients treated with RIRS. Stone free statuses, postoperative complications, operative time and hospitalization time were compared in both groups. Results There was no statistical significance between the two groups in mean age, stone size, stone laterality, mean follow-up periods and mean operative times. In PNL group, stone-free rate was 96.1% at first session and 100% after the additional procedure. In Group 2, stone-free rate was 90.6% at the first procedure and 100% after the additional procedure. The final stone-free rates and operative times were similar in both groups. Conclusions RIRS should be an effective treatment alternative to PNL in lower pole stones larger than 2 cm, especially in selected patients.

Is there a correlation between intravaginal ejaculatory latency time and enuresis? An exploratory study

Introduction Premature ejaculation (PE) is the most common male sexual dysfunction. Monosymptomatic enuresis (ME) is nocturnal bed wetting, without any daytime symptoms. Recent clinical studies report an association between lifelong PE and ME. The purpose of this study was to compare the intravaginal ejaculatory time (IELT) between lifelong PE in men with and without ME. The goal was to determine if there is an association between the severity of ME and of IELT. Material and methods A total of 137 men with lifelong PE were included in this study. Subjects were asked if they had childhood ME. The characteristics and mean IELTs of patients with and without ME were compared using the students t–test, and the correlation between severity of ME and IELT was assessed with trend test. Results Of the 137 lifelong PE patients, 57 reported ME. There was a strong negative correlation in patients with ME between the severity of enuresis and IELT, with IELT being shorter in patients with severe ME. Conclusions A strong correlation between IELT and the severity of ME suggests a common underlying mechanism. Further studies are required to confirm these findings and elucidate the exact pathophysiology.

The Daily Resistive Index measurement useful tool in the estimation of the optimal time interval between two Shock Wave Lithotripsy sessions.

OBJECTIVE : To monitor the impact of Shock Wave Lithotripsy (SWL) on the renal resisive index (RI) and to investigate the potential of the RI measurement for the estimation of the optimal duration between 2 SWL sessions. MATERIAL AND METHODS Thirty patients with single pelvis renalis stone were included. Participitants were grouped according to their age as group 1 (<40 years, mean age 36.2+/-3.9 years) and group 2 (>/=40 years, mean age 55.4+/-6.5 years). RI measurement was performed in of all patients prior to SWL. After SWL, RI was monitored daily until RI returned to their pre-SWL values. RESULTS The mean stone size was 2 8.97+/-3.62 in group 1 and 10.08+/-4.67 mm in group 2 (p=0.077). Following SWL, the RI value of both goups increased and the higher RI value was measured at the 24th hour as compared with their pre-SWL values (p<0.001). In day 2 RI of the groups declined, but the differences were still statistically different from their pre-SWL RI values (p<0.001). However, on the third day, RI of group 1 was close to their pre-SWL level (p=0.143). But, in group 2, RI value returned to their pre-SWL limits on day 4 (p=0.229). CONCLUSIONS RI measurement gives important data regarding SWL related acute renal trauma and should be used as an US marker for recovery after SWL.AIMS To evaluate renal morphology, prevalence of urinary stone disease, renal perfusion and resistance to renal blood flow in patients with ankylosing spondylitis(AS). MATERIAL AND METHODS Thirty-eight patients diagnosed with AS and with normal basal renal functions, together with 38 healthy individuals matched in terms of age, sex, blood lipid profile and body mass index, were included. Total cholesterol, triglyceride, urea, creatinine and glucose levels were measured in both groups, as well as vitamin D, erythrocyte sedimentation rate (ESR) and C-reactive protein in the AS group. Renal dimensions, parenchymal echogenicity, presence of stone and renal resistive index (RRI) from the interlobular artery level were measured, and correlations with clinical and laboratory parameters were assessed. RESULTS Thirty-eight patients diagnosed with AS (age 42.4+/- 11.5, 24 male, 14 women) and a control group of 38 healthy individuals (age 41.7+/-10.8, 23 male, 15 female) were included in the study. Renal stone was present in 7 patients (18.4%) in the AS group and 4 subjects (10.5%) in the control group. There was no significant difference in prevalence of stone between the groups (p=0.516). RRI values were significantly higher in the patients with AS (0.63+/-0.06) compared with the control group (0.59+/-0.03, p=0.001). Significant correlations were determined between RRI and age, triglyceride level, body mass index and length of disease. CONCLUSIONS Renal Doppler is an important examination in early diagnosis and monitoring of renal changes in AS patients since renal complications in AS develop in the chronic and follow a subclinical course.