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Microsheath for Microperc: 14-Gauge Angiocath

Micropercutaneous nephrolithotomy (microperc) is the end point percutaneous nephrolithotomy (PCNL) technology for the present. In routine PCNL surgery, use of an Amplatz sheath is an important step, but in this technique, there is no Amplatz sheath. Some problems during surgery may occur because of the lack of an Amplatz sheath, which provides a tract between the skin and the collecting system. Therefore, we describe the smallest Amplatz sheath (6.6F) that is compatible with the microperc instrument and can be used during percutaneous surgery, especially in preschool pediatric patients.

An Alternative and Inexpensive Percutaneous Access Needle in Pediatric Patients

INTRODUCTION The most important factor that increases the cost of percutaneous surgery is the disposable instruments used for the surgery. In this study we present the advantages of using an intravenous cannula instead of a percutaneous access needle for renal access. TECHNICAL CONSIDERATIONS Recently, percutaneous stone surgery has grown in use in pediatric cases and is considered a minimally invasive surgery. The most important step in this surgery is access to the renal collecting systems. Although fluoroscopy has been used frequently at this stage, the use of ultrasound has recently increased. During percutaneous accesses under all types of imaging techniques, disposable 11- to 15-cm-long 18-ga needles are used. In pediatric cases, these longer needles are difficult to use. Using disposable materials in percutaneous nephrolithotomy increases the cost of the procedure. Therefore, we asserted that percutaneous access especially in pediatric cases could be performed using a 16-ga intravenous cannula (angiocath). Indeed, percutaneous access was performed successfully, especially in pediatric preschool patients. Shorter needle length, easy skin entry, comfort of manipulation, clear visualization of the metal needle on ultrasound, and wide availability can be considered advantages of this method. The angiocath is also less expensive than a percutaneous access needle. CONCLUSION Angiocath is inexpensive, easily available, and practical, and it is the shortest needle to perform percutaneous access in pediatric patients.

A Cheap Minimally Painful and Widely Usable Alternative for Retrieving Ureteral Stents

Objective: To describe a cheap, minimally painful and widely usable method for retrieving ureteral stents by using an ureteroscope. Subjects and Methods: Sixty-seven patients with ureteral stents were enrolled in this study. The patients were randomized into a cystoscopic (35 patients) and a ureteroscopic (32 patients) group. All stents were retrieved by a flexible cystoscope in the first group and by a ureteroscope in the second group under local anesthesia. Patients in each group were assessed for stented time, stent side, cause of stent placement, operative time, peroperative pain, postoperative pain, irritative voiding symptoms and hematuria. Also costs of instruments were calculated. Results: Stents were successfully retrieved in 67 patients. There were no statistical differences in the two groups regarding patient gender and age or stent side, operative time, stented time, mean operative pain score, irritative voiding symptom scores and hematuria. Total selling price was USD 20.399 for flexible instruments and USD 10.516 for rigid ones. Total maintenance price was higher in flexible instruments than in the rigid ones (USD 197.8 and 51.7 per use, respectively). Conclusion: Ureteroscopic stent retrieval is a minimally painful, safe and highly tolerable method under local anesthesia as well as flexible cystoscopic retrieval. Also, it is a cheap and widely usable method.

A New Alternative for Difficult Ureter in Adult Patients: No Need to Dilate Ureter via a Balloon or a Stent with the Aid of 4.5F Semirigid Ureteroscope

OBJECTIVE To investigate the effectivity of 4.5F ultrathin ureteroscope (UT-URS) without any need for active or passive dilation in the treatment of adult patient population in whom ureteral orifices cannot be engaged using conventional URS. MATERIALS AND METHODS Among a total of 512 adult patients who had undergone URS between April 2012 and November 2015 in our department for diagnostic or therapeutic purposes, 43 (8.4%) patients required ureteral dilation because we could not engage ureteral orifice. In adult patients in whom we could not engage ureteral orifice with 7.5F and 8F semirigid URS, we tried to complete the operation using 4.5F UT-URS without resorting to dilation. Age and gender of the patients, indication for operation, stone size, location, operative times, laterality of stone(s), stone-free rates, length of hospital stay, and complications were recorded. RESULTS Mean age of the patients was 34.5 ± 11.2 (21-66) years. The patients had undergone operations for ureteral stone (n = 39), unexplained hydronephrosis (n = 2), and ureteral stenosis (n = 2). Mean stone size was 8.2 ± 2.3 (4-18) mm. Mean operative time was 64.2 ± 13.5 minutes. In 37 of 39 patients, a complete stone-free rate (94.8%) was achieved. Mean length of hospital stay was 8.9 ± 5.8 hours. CONCLUSION It has been demonstrated that in an adult patient population in whom ureteral orifices cannot be engaged using conventional URS, ureteral access could be achieved with 4.5F UT-URS without any need for dilation. At the same time, use of 4.5F UT-URS resulted in an acceptable treatment success and lower complication rates in most of these patients without the need for a second session.

How can the operation time be shortened by reducing the tract size

1. Dede O, Sancaktutar AA, Dagguli M, Utangac M, Bas O, Penbegul N (2015) Ultra-mini-percutaneous nephrolithotomy in pediatric nephrolithiasis: both low pressure and high efficiency. J Pediatr Urol 11:253.e251–256 2. Desai J, Zeng G, Zhao Z, Zhong W, Chen W, Wu W (2013) A novel technique of ultra-mini-percutaneous nephrolithotomy: introduction and an initial experience for treatment of upper urinary calculi less than 2 cm. Biomed Res Int 2013:490793 3. Karakan T, Kilinc MF, Doluoglu OG, Yildiz Y, Yuceturk CN, Bagcioglu M, Karagoz MA, Bas O, Resorlu B (2017) The modified ultra-mini percutaneous nephrolithotomy technique and comparison with standard nephrolithotomy: a randomized prospective study. Urolithiasis 45:209–213 Dear Editor,

How can a ureteral stone cause pain without hydronephrosis

radiation and over-utilization of imaging may decrease. This score may help in performing accurate imaging modalities for diagnosis of ureteral stones also in outpatient patients. We wonder the answer of the title of the study which asks: “Can ureteral stones cause pain without causing hydronephrosis?” The findings showed that it can be possible, but how? What is the authors’ hypothesis about pain related to the ureteral stones without hydronephrosis. Can a ureteral stone itself cause pain, or not? In our daily practice we met patients with ureteral stones frequently, and when hydronephrosis disappears, pain relief improves in them. Can it be resulting from transient hydronephrosis which cannot be detected with imaging modalities?

Prevalence of enuresis nocturna among a group of primary school children living in Diyarbakır

OBJECTIVE In this study, the prevalence of enuresis nocturna (EN) was investigated among primary school children living in Diyarbakır. MATERIAL AND METHODS Five primary schools in the center of Diyarbakir and a village primary school were selected randomly. Four thousand and five hundred self-administered questionnaires were distributed to parents; 4300 were returned, and 4203 of these questionnaires were included in this study. RESULTS Of the children participating in the study, 52.2% of them were boys and 47.8% of them were girls. The mean age of the children was 8.66±1.61 (6-15) years, and the mean number of siblings was 4.03±2.06 (0-13). The prevalence of nocturnal enuresis was determined to be 25.9% (1087) among 4203 children, and it was more common in boys than in girls (27.8 and 23.7%, respectively). The rate of a positive family history in the nocturnal enuresis, and nonenuretic groups were 64.8, and 35.2%, respectively. The average number of siblings in the enuretic, and nonenuretic groups were 4.49±2.65, and 3.87±2.57, respectively Socioeconomic level of the families of enuretic children was worse than that of nonenuretic children. Enuretic children had episodes of bedwetting (92.3%) during night hours or both day and night (8.7 %).The number of bed wetting incidents per week was 4.1±2.2. A minority (5.7%) of the families believed that the condition resolved without any treatment. CONCLUSION Family history, a low socioeconomic level and an increased number of children were factors that increased the frequency of enuresis nocturna in our region.