Mehmet Kaba

Comparison of Outcomes After Percutaneous Nephrolithotomy of Staghorn Calculi in Those with Single and Multiple Accesses

PURPOSE To analyze the early outcome after single tract vs multiple tracts percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi. PATIENTS AND METHODS The records of 413 patients with staghorn calculi (223 [54%] had complete and 190 [46%] had partial) who underwent PCNL were reviewed retrospectively. A total of 244 (59%) patients were managed by single access (group 1); meanwhile, multiple accesses were necessary in 169 (41%) patients (group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Patients and stone-related factors affecting the number of accesses performed were analyzed. RESULTS The mean number of percutaneous accesses was 2.42 +/- 0.74 (range 2-6) in group 2. Mean durations of fluoroscopy screening time and operative time were significantly longer in group 2 (P = 0.002, P < 0.0001, respectively). Supracostal access was necessary in 30.7% in group 2 and in 6.9% in group 1 (P = 0.001). Success was achieved in 70.1% in group 1 and in 81.1% for group 2 after one session of PCNL (P = 0.012). The most common complication was bleeding for both groups, and it was higher in group 2 (P < 0.0001). The mean preoperative and postoperative creatinine concentrations were 1.03 mg/dL and 1.08 mg/dL in group 1, and 0.9 mg/dL and 1.03 mg/dL in group 2, respectively. The mean changes in creatinine values were not statistically significant between the groups (P = 0.16). CONCLUSIONS The impact of PCNL using either single or multiple access tracts on renal function is similar and of a temporary nature. PCNL with multiple accesses is a highly successful alternative with considerable complication rates in the management of staghorn calculi.

Tubeless Procedure is Most Important Factor in Reducing Length of Hospitalization After Percutaneous Nephrolithotomy: Results of Univariable and Multivariable Models

OBJECTIVES To evaluate the effects of kidney stones and patient-related parameters on the length of hospitalization (LOH), which is one important factor affecting the cost effectiveness of percutaneous nephrolithotomy (PCNL). Recently, increases in healthcare costs have highlighted the importance of evaluating the cost effectiveness of a treatment as much as its efficacy. MATERIAL AND METHOD During an 8-year period, the records of 1669 patients with renal calculi who underwent PCNL were reviewed retrospectively. Eleven patients with urosepsis were excluded from the present study. A total of 1658 patients were categorized into 2 groups (group 1 = ≤2 days; group 2 = >2 days) according to the median LOH (median = 2 days). Multivariate binary logistic regression analysis was used to detect the effects of independent variables, including the patient age, gender, body mass index, history of extracorporeal shock wave lithotripsy or open surgery, stone size and opacity, presence of hydronephrosis, and localization and number of accesses, on the LOH after PNL. RESULTS Overall success was achieved in 86.2% of cases after one session of PCNL. The mean length of hospitalization was 2.89 ± 1.66 days (range, 1-21). According to the outcome of the multivariate analysis, diabetes (P = .0001, OR = 1.67), impaired kidney function (P = .03, OR = 1.64), stone size (P = .031, OR = 1.31), number of accesses (P = .001, OR = 1.59), intercostal access (P = .001, OR = 1.79), and tubeless procedure (P = .0001, OR = 0.23) were variables influencing LOH. CONCLUSIONS The presence of diabetes, a large stone burden, intercostals access, multiple accesses, and impaired kidney function prolong the LOH after PCNL. The use of the tubeless procedure was able to diminish the LOH.

Factors Affecting the Fluoroscopic Screening Time During Percutaneous Nephrolithotomy

PURPOSE Percutaneous nephrolithotomy (PNL) is established in urology practice with routine use of fluoroscopic guidance. Herein, we retrospectively evaluated the potential factors affecting the fluoroscopic screening time (FST) during PNL. MATERIALS AND METHODS A total of 282 patients with documented FST in detail during PNL performed by one surgeon were enrolled in this study. In all cases, PNL was performed on patients in prone position under C-armed fluoroscopy unit. The correlation between the FST and patient and also stone factors, including body mass index (BMI), previous open renal surgery, characteristics and size of the stone, and presence of hydronephrosis, as well as procedural factors such as percutaneous access number and location and operation time were analyzed. RESULTS The mean age of the patients was 43 +/- 14.7 (range: 18-67) years. The mean operation time was 78.9 +/- 22.0 (range: 45-150) minutes, and the mean FST was 10.19 +/- 6.3 (range: 3-50) minutes. The mean stone size was 8.46 +/- 5.11 cm(2) (range: 2-30). The FST was significantly prolonged in patients with increased stone burden (p = 0.001) and necessitating multiple accesses procedures (p = 0.007). However, BMI of the patient, stone configuration, degree of hydronephrosis, history of open renal surgery, and access location did not have an impact on FST (p > 0.05). CONCLUSION In patients with large stones necessitating multiple accesses, FST is significantly prolonged; therefore, they have to be managed by experienced surgeons to diminish the radiation exposure. However, BMI, stone configuration, presence of hydronephrosis, history of open renal surgery, and access location did not have effect on FST in our study.

Outcomes of Retrograde Intrarenal Surgery Compared with Percutaneous Nephrolithotomy in Elderly Patients with Moderate-Size Kidney Stones: A Matched-Pair Analysis

PURPOSE The aim of our study was to evaluate the outcomes of retrograde intrarenal surgery (RIRS) in elderly patients with stones of moderate size. PATIENTS AND METHODS Between September 2008 and June 2011, a total of 28 patients over 65 years of age with single renal stones that measured 1.5 to 3 cm were treated with RIRS. The outcomes of these patients were compared with those of the patients who underwent percutaneous nephrolithotomy (PCNL) using matched-pair analysis (1:1 scenario). The matching parameters were the size and location of the stone as well as age, sex, body mass index, degree of hydronephrosis, presence of previous shockwave lithotripsy, and open surgery. SPSS version 16 was used for statistical analysis. RESULTS Stone-free rates after a single procedure were achieved in 82.1% of patients for the RIRS and 92.8% of patients for the PCNL group. The second flexible ureterorenoscopy procedure was performed for five patients in the RIRS group. Finally, stone-free rates during the third month of the follow-up period were 92.8% in the RIRS group and 96.4% in the PCNL group. The mean operative time per patient was 64.5 ± 20.9 minutes in the RIRS group after a total of 33 procedures, while it was 40.7 ± 10.7 minutes in the PCNL groups (P<0.0001). The overall complication rates for the RIRS and PCNL groups were 7.1% and 10.7%, respectively. Blood transfusions were needed in two patients in the PCNL group. Hospitalization time was significantly shorter in the RIRS group (26.5 ± 10.6 h per patient vs 60.0 ± 28.8 h; P<0.0001). In both groups, stones were most frequently composed of calcium oxalate (68.4% in the RIRS group and 77.7% in the PCNL group). CONCLUSION RIRS has a low complication rate and represents a safe and effective treatment alternative in selected geriatric patients with kidney stones of moderate size.

Levels of serum trace elements in renal cell carcinoma cases.

Trace elements which are essential components of biological structures may also be toxic when present at levels above the amounts required for biological function. In our study, trace element levels were measured with furnace atomic absorption spectrophotometry in 33 newly diagnosed renal cell carcinoma cases (preoperative) and 32 healthy controls. When compared with the control group, it was found that the levels of cadmium (Cd), lead (Pb) were higher and the levels of zinc (Zn), iron (Fe) and manganese (Mn) were lower in the patient group. These changes may be important in the formation of renal cell carcinoma, a question which should be explored with postoperative comparative studies.

Serum adenosine deaminase, catalase and carbonic anhydrase activities in patients with bladder cancer

OBJECTIVES: The relationship between adenosine deaminase and various cancers has been investigated in several studies. However, serum adenosine deaminase activity and carbonic anhydrase and catalase activities in patients with bladder cancer have not previously been reported. Therefore, the aim of this study was to measure serum adenosine deaminase, carbonic anhydrase and catalase activities in patients with bladder cancer. MATERIALS AND METHODS: Forty patients with bladder cancer and 30 healthy controls were enrolled in the study. Serum adenosine deaminase, carbonic anhydrase and catalase activities were measured spectrophotometrically. RESULTS: Serum adenosine deaminase, carbonic anhydrase and catalase activities were significantly higher in patients with bladder cancer than controls (all significant, p<0.001). CONCLUSIONS: These markers might be a potentially important finding as an additional diagnostic biochemical tool for bladder cancer.

Serum prolidase activity, oxidative stress, and antioxidant enzyme levels in patients with renal cell carcinoma

Objectives: Prolidase is a member of the matrix metalloproteinase family. It plays a vital role in collagen turnover, matrix remodeling, and cell growth. Reactive oxygen species (ROS) have been implicated in the pathogenesis of various diseases, including cancers. Oxidative stress can cause tumor angiogenesis and may be carcinogenic. However, the relationship between antioxidant capacity and various cancers has been researched in several clinical trials. In our study, we aimed to identify serum prolidase activity, oxidative stress, and antioxidant enzyme levels in patients with renal tumors and to evaluate their relationships with each other. Materials and Methods: A total of 37 male patients with renal cell cancer and with a mean age of 56.28 ± 3.1 were included in the study. The control group comprising 36 male patients (mean age 56.31 ± 2.9) was randomly selected among the volunteers. Serum samples for measurement of superoxide dismutase (SOD), glutathione peroxidase (GSHPx), glutathione-S-transferase (GST), malondialdehyde (MDA), glutathione (GSH), and prolidase levels were kept at −20°C until they were used. Results: Serum prolidase activity and MDA levels were significantly higher in renal cancer patients than in controls (all, p < 0.05), while SOD, GSHPx, and GST levels were significantly lower (p < 0.05). Conclusion: Our results indicate that increased prolidase seems to be related to increased oxidative stress along with decreased antioxidant levels in renal cancer.

Serum Levels of Trace Elements in Patients with Prostate Cancer

BACKGROUND Trace elements are major components of biological structures; however, excessive levels of these elements can be toxic. MATERIALS AND METHODS In the present study, serum levels of trace elements were measured in 30 patients with newly diagnosed as prostate cancer and 32 healthy volunteer by using furnace atomic absorption spectrophotometry. RESULTS It was found that there was an increase in serum levels of Co, Cu, Mg and Pb (p<0.05), whereas a decrease in serum levels of Fe, Mn, and Zn levels in patients with prostate cancer (p<0.05). CONCLUSIONS These changes may be important in the pathogenesis of prostate cancers; however, further prospective studies are needed to identify relationships between prostate cancer and trace elements.

Haptoglobin Levels in Turkish Patients with Bladder Cancer and its Association with Clinicopathological Features

Although alteration in the haptoglobin phenotype has been reported in patients with bladder cancer, serum haptoglobin levels have not been evaluated. We hypothesized that serum haptoglobin can be used as a biomarker. The aim of this study was to evaluate the expression of haptoglobin in bladder cancer and to determine the relationship with clinicopathological features. A total of 68 serum specimens obtained before surgery were used to investigate haptoglobin expression using the sandwich ELISA technique. Serum haptoglobin levels were higher in the patients with bladder cancer compared to healthy controls (p<0.0001). Additionally, the levels of haptoglobin protein increased with increasing tumor grades (p<0.001) and were significantly higher in patients with metastatic disease and the presence of lymphovascular involvement, lymph node metastases and increasing tumor burden (p<0.0001). This study suggests that elevated haptoglobin levels are associated with a higher stage, grade, and extent of distant metastasis and larger tumor size. Haptoglobin may therefore provide a useful diagnostic and treatment biomarker for patients with bladder cancer.

Are the urology operating room personnel aware about the ionizing radiation

ABSTRACT Purpose: We assessed and evaluated attitudes and knowledge regarding ionizing radiation of urology surgery room staff. Materials and Methods: A questionnaire was sent by e-mail to urology surgery room personnel in Turkey, between June and August 2013. The questionnaire included demographic questions and questions regarding radiation exposure and protection. Results: In total, 127 questionnaires were answered. Of them, 62 (48.8%) were nurses, 51 (40.2%) were other personnel, and 14 (11%) were radiological technicians. In total, 113 (89%) participants had some knowledge of radiation, but only 56 (44.1%) had received specific education or training regarding the harmful effects of radiation. In total, 92 (72.4%) participants indicated that they used a lead apron and a thyroid shield. In the subgroup that had received education about the harmful effects of radiation, the use ratio for all protective procedures was 21.4% (n=12); this ratio was only 2.8% (n=2) for those with no specific training; the difference was statistically significant (p=0.004). Regarding dosimeters, the use rates were 100% for radiology technicians, 46.8% for nurses, and 31.4% for other hospital personnel; these differences were statistically significant (p<0.001). No significant relationship between working period in the surgery room, number of daily fluoroscopy procedures, education, task, and use of radiation protection measures was found. Conclusions: It is clear that operating room-allied health personnel exposed to radiation do not have sufficient knowledge of ionizing radiation and they do not take sufficient protective measures.