Hakan Polat

Percutaneous versus Transurethral Cystolithotripsy

PURPOSE To compare transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL) modalities performed during simultaneous transurethral resection of the prostate (TURP) in patients with prostate hyperplasia and large bladder stones. PATIENTS AND METHODS Sixty-three patients with prostate volume >40 cc and aggregate stone size >2.5 cm were enrolled in the study between August 2003 and February 2007. TUCL (n = 38) or PCCL (n = 25) procedures were performed during simultaneous TURP. In the TUCL group, the stones were removed after fragmentation through a 23F cystolithotripter with pneumatic lithotripsy. This was followed by TURP, performed with a 26F continuous-flow resectoscope. In the PCCL group, the stones were removed through a suprapubic 30F Amplatz sheath after fragmentation. TURP was then performed with the suprapubic sheath providing continuous drainage. RESULTS Mean age and prostate volumes of the groups were similar. Mean aggregate stone sizes were significantly larger in the PCCL group. The operative time for stone removal was significantly less in the PCCL group while time needed for TURP was statistically similar in the two groups. In the TUCL group, three patients had residual stones necessitating repeated TUCL and urethral stricture developed in three patients. CONCLUSION The smaller caliber of the working channel during TUCL, compared with PCCL, necessitates disintegration of the stones into smaller fragments. This elongates the duration of the intervention and results in increased urethral and bladder trauma. Combined TURP and PCCL is a safer, more effective, and much faster alternative to combined TURP and TUCL in patients with large bladder stones and prostate hyperplasia.

Stone Formation from Intravesical Hem–o-lok Clip Migration After Laparoscopic Radical Prostatectomy

Intravesical Hem-o-lok clip (HOLC) migration is a rare complication of prostatic surgery. We report two cases of migration of a HOLC into the bladder leading to stone formation. As such, these devices should be used with caution in the region of the vesicourethral anastomosis.

Early Experience with Laparoendoscopic single-site pyeloplasty in Children

OBJECTIVE To present our initial clinical experience with laparoendoscopic single-site surgery (LESS) for ureteropelvic junction obstruction (UPJO) in the pediatric age group. MATERIAL AND METHODS Between January and December 2009, 11 consecutive pediatric patients underwent treatment of primary UPJO via a laparoscopic approach. All patients underwent LESS-pyeloplasty. Radiographic success was defined as improvement of hydronephrosis with a patent UPJ on intravenous urography, or improved drainage on diuretic renal scan. RESULTS The mean age of patients was 10 (2-17) years. Crossing lower pole vessel and severe adhesion were found in three (27%) and eight (73%) cases, respectively. The mean operating-room time was 182.5 (160-300) min, and the mean estimated blood loss, including urine, was 97.3 (80-160) mL. Mean hospital stay was 2 (1-3) days. Wound infection at port site and urinary infection occurred in one case each. All parents seem extremely satisfied with postoperative cosmetic outcome. The success rate was 100%. CONCLUSION Preliminary experience with LESS-pyeloplasty in children suggests that outcomes are comparable to conventional laparoscopic surgery but with improved cosmesis; however, a larger study is necessary to confirm these findings and to determine if there are any benefits in postoperative pain or recovery.

Transperitoneal Laparoendoscopic Single-Site Pyeloplasty: Initial Experiences

PURPOSE The purpose of this study was to present our initial clinical experience with laparoendoscopic single-site surgery (LESS) for ureteropelvic junction (UPJ) obstruction. PATIENTS AND METHODS Between May and October 2009, 14 consecutive patients underwent LESS-pyeloplasty (LESS-P) by the same surgeon at our institution. All patients underwent single port transperitoneal Anderson-Hynes laparoscopic dismembered pyeloplasty using the single incision laparoendoscopic surgery port, inserted through a transumbilical incision. Ultrasonography, intravenous urography (IVU) or diuretic renal scan was performed at the third month and semiannually thereafter. Patients were examined clinically every 3 to 6 months, depending on the symptoms. Radiographic success was defined as improvement of hydronephrosis with a patent UPJ on IVU, or improved drainage on diuretic renal scan. RESULTS Anterior crossing vessels, high insertion, and severe adhesion were found in seven (50%), five (35.7%), and two (14.3%) cases, respectively. The mean operating-room time, which includes cystoscopy with retrograde ureteral catheterization and open-end stent placement, was 204.5 minutes (range 160-300 min), and the mean estimated blood loss, including urine, was 102 mL (range 80-170 mL). Mean hospital stay was 2 days (range 1-3 d). Wound infection occurred in one patient. The mean follow-up period was 6.2 months (range, 3-8 mos). The success rate was 100%. CONCLUSION With the advent of the single port and laparoscopic instrument technology, the LESS-P, as minimally invasive surgery, would take the place of the standard laparoscopic pyeloplasty, and it may be a new choice for the management of UPJ obstruction.

Peritoneal tuberculosis and granulomatous hepatitis secondary to treatment of bladder cancer with Bacillus Calmette-Guérin.

Intravesical administration of Bacillus Calmette-Guérin is used as a treatment method in superficial bladder cancer. While it is generally well tolerated, serious side effects may develop. Granulomatous hepatitis cases have been previously reported; however, only one case with tuberculous peritonitis exists in the current literature. We hereby present two cases, one of which is the second tubercular peritonitis case following Bacillus Calmette-Guérin treatment to be reported, and the other a case with granulomatous hepatitis. Complete cure was achieved in both cases with specific therapy. In the patient who developed peritonitis, intravesical Bacillus Calmette-Guérin therapy was recommenced after antituberculosis treatment, and completed without further complications.