Murat Gonen

Factors Affecting Fever Following Percutaneous Nephrolithotomy: A Prospective Clinical Study

AIM To evaluate the preoperative and intraoperative factors that might affect development of fever following percutaneous nephrolithotomy (PCNL) and to investigate the clinical significance of intraoperative microbiologic evaluation in managing postoperative infectious complications. PATIENTS AND METHODS Sixty-one consecutive patients who had undergone PCNL between October 2006 and June 2007 were prospectively recruited into the study. Preoperative urine cultures and intraoperative stone and pelvic urine cultures were obtained from all patients. Postoperatively, patients were closely monitored for fever and other signs of systemic inflammatory response syndrome. RESULTS Of 61 patients, 10 (16.8%) had at least one body temperature recorded at 38 degrees C (group 1), the remaining patients were afebrile (group 2). Fever was associated with a systemic inflammatory response syndrome in one patient (1.6%); in that patient, the antibiotic regimen was altered. There were statistically significantly more positive stone culture results for patients in group 1 than there were for patients in group 2 (5/10 versus 9/51, P < 0.05). There were statistically significantly more positive pelvic urine culture results for patients in group 1 than there were for patients in group 2 (3/10 versus 2/51, P < 0.05). Patients in group 1 also had longer operative times and larger stone burdens than did patients in group 2. CONCLUSIONS Intraoperative microbiologic evaluation may be important in postoperative antibiotic selection and should be routinely used.

Percutaneous Nephrolithotomy: Nephrostomy or Tubeless or Totally Tubeless?

OBJECTIVES To compare the feasibility and morbidity of tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) with nephrostomy tube in a single center with selected patient population. METHODS Between July 2006 and February 2008, PNL was performed in 176 patients in this retrospective study. Patients with no serious bleeding or perforation in the collecting system during the operation, stone-free status, or clinically insignificant residual fragments (<4 mm) at the end of the procedure and patients with no more than one access were enrolled in the study. Patients were categorized into 3 groups. In group 1 (n = 43), no nephrostomy or ureter catheters were placed after PNL (totally tubeless group); in group 2 (n = 41), no nephrostomy catheter was placed but antegrade J-stent was used (tubeless group), and in group 3 (n = 92), standard nephrostomy catheters were placed (standard group). Three groups were compared with respect to age, stone volume, postoperative hemoglobin change, transfusion rate, operation time, analgesic requirement, hospitalization time, and complication rates. RESULTS No significant differences were found in mean stone volume, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time and the amount of narcotic analgesic required were significantly higher in group 3 compared with the other groups (P <.05). Complications were observed in 2 (4.6%), 3 (7.3%), and 7 (7.6%) patients in groups 1, 2, and 3, respectively (P = .738). CONCLUSIONS In patients with no major intraoperative bleeding and calyceal perforation, tubeless approach is safe with decreased analgesia requirement and hospital stay.

Bladder perforation related to intrauterine device.

Intrauterine devices (IUDs) are currently one of the most popular reversible contraception methods used world wide. Uterine perforation is a rarely observed complication. The bladder is one of the organs that an IUD can migrate to because of its close proximity to the uterus. There are about 70 cases in the literature of IUDs that have migrated into the bladder. The resulting bladder perforation can be complete or partial. Here, we report 2 cases, 1 of complete migration and the other of partial migration.

Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation.

PURPOSE In this study, we present our experience using balloon and Amplatz dilatation to establish a percutaneous tract. We also discuss advantages and risk factors of both techniques. MATERIALS AND METHODS We retrospectively reviewed medical records of 229 patients who had undergone 235 percutaneous nephrolithotomy procedures. The nephrostomy tract had been dilated using a balloon (42 patients) or Amplatz (187 patients) dilator. Total operating time, preoperative and postoperative hemoglobin concentrations, number of tracts required, stone burden, blood transfusion rates, tract dilatation failures, and the cost of the dilatation system were compared between the groups. RESULTS There were no statistically significant differences in operative time (85.7+/-43.2 v 86.3+/-41.2 minutes; P=0.42), preoperative hemoglobin concentration (14.1+/-1.1 v 13.8+/-1.4 mg/dL; P= .153), postoperative hemoglobin concentration (11.6+/-1.7 v 11.2+/-1.5 mg/dL; P= .601), or blood transfusion rate (18.6% v 21.3%; P= .687) between the two groups. Also, there were no differences in failure rates between the two groups. CONCLUSIONS The Amplatz dilator is comparable with the balloon dilator with regard to efficacy, speed, and safety. The Amplatz dilator is more cost-effective than the balloon dilator. However, kidney hypermobility may be a significant problem during Amplatz dilatation.

Haemostatic role and histopathological effects of a new haemostatic agent in a rat bladder haemorrhage model: an experimental trial

To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, Ankaferd BloodStopper® (ABS; Ankaferd Drug Cosmetic Co., Istanbul, Turkey) in a rat bladder haemorrhage model. ABS is a unique combination of five plant extracts that has been used in Turkish traditional medicine as a haemostatic agent for external traumatic bleeds.

Double-J Stenting Compared with One Night Externalized Ureteral Catheter Placement in Tubeless Percutaneous Nephrolithotomy

PURPOSE We prospectively analyzed the outcome of tubeless percutaneous nephrolithotomies (PCNLs) using two different stenting techniques (i.e., externalized ureteral catheter compared with Double-J placement) without strict exclusion or inclusion criteria. PATIENTS AND METHODS Forty-six patients who were undergoing tubeless PCNL were randomized to two groups: Group 1 (tubeless PCNL with externalized ureteral catheter) and group 2 (tubeless PCNL with Double-J placement). The only exclusion criterion was presence of significant residual stones. The two groups were comparable with regard to age, sex, stone laterality, stone burden, and number of previous open renal surgeries. Factors evaluated included operative time, stent-related symptoms, analgesic requirement, postoperative pain, postoperative morbidity, hospital stay, blood loss, and success rates. RESULTS The mean operative times, mean number of accesses, percentage of supracostal accesses, mean visual analog scale scores, analgesic requirements, mean decreases in hemoglobin level, blood transfusion rates, success rates, and mean hospital stays were not statistically significant in both groups. The only statistically significant difference between groups was the postoperative stent-related symptoms. In group 2, 52.1% experienced some sort of stent-related symptoms. In most of the patients, these symptoms were not severe; however, in two of them (16.6 %), oral medication therapy with anticholinergics was needed. None of the patients in group 1 had stent-related symptoms and needed medication (P < 0.01). CONCLUSIONS Tubeless PCNL with externalized ureteral catheter is as feasible as Double-J stenting. Moreover, stent-related discomforts because of the presence of a Double-J stent and the need for postoperative cystoscopy to remove the Double-J stent can be avoided with an externalized ureteral catheter.

Efficacy of Dretler Stone Cone in the Treatment of Ureteral Stones with Pneumatic Lithotripsy

Introduction: Ureteroscopic pneumatic lithotripsy has been used to treat ureteral calculi for more than 10 years. Owing to its low price and high degree of effectiveness, it has become the most popular ureteroscopic lithotripsy device in use worldwide. The major limitation of the technique is the occurrence of proximal fragment migration during intracorporeal lithotripsy. The Dretler Stone Cone is a new device developed to prevent stone migration during ureteroscopic lithotripsy. The aim of this study was to assess the efficacy and safety of this device during ureteroscopic pneumatic lithotripsy. Patients and Methods: Twenty-three consecutive patients having ureteral stones were treated with a 10-Fr semirigid ureteroscope, a Stone Cone™ Nitinol Retrieval Device, and a pneumatic lithotriptor. In all patients Stone Cones were placed under visual guidance through the working channel of the ureteroscope. Outcomes of this device were then compared with the outcomes of 23 previous patients with stones of similar sizes and locations who had undergone ureteroscopic pneumatic lithotripsy prior to the Stone Cone being available at our clinic. Results: All patients in the study group were stone-free after the procedure. No stone fragments were noted to migrate to proximal segments. Conclusions: The Dretler Stone Cone effectively prevents proximal stone migration and facilitates stone fragmentation during pneumatic lithotripsy with no risk of ureteral injury. It has only a small extra cost.

Penile Kaposi's sarcomas in a circumcised and HIV-seronegative patient

Abstract  Kaposis sarcoma (KS) limited to penis is rare and usually observed in AIDS patients. However, in circumcised and HIV‐seronegative patients, KS confined to the penis is extremely rare. We present the case of an HIV‐seronegative and circumcised 55‐year‐old man, who presented with two reddish papules, one 5 mm in diameter on the coronal sulcus near the frenulum, and the other 2 mm in diameter on the glans penis, which were reported as a Kaposis sarcoma after excision of the lesion.

Outcome of Percutaneous Nephrolithotomy in Children Having Complex Stones

Objectives: To review our experiences with percutaneous nephrolithotomy in children with complex renal calculi. Patients and Methods: We retrospectively analyzed the records of 31 children with complex renal calculi who were treated by percutaneous nephrolithotomy at 2 hospitals of our university between June 2003 and June 2008. The mean age of the patients was 10.4 years (range 22 months to 15 years). Three patients were aged ≤5 years. Stone clearance and complications were recorded. Results: The mean operating time (time from insertion of the ureteral catheter to placement of a nephrostomy tube) was 87.4 (range 50–180) min. In 2 patients the procedures were staged because of a large residual stone load. The extent of percutaneous tract dilation was undertaken taking patient age and the presence of hydronephrosis into consideration. Complete stone clearance with percutaneous nephrolithotomy was achieved in 21 (67.7%) of 31 patients. Adding extracorporeal lithotripsy increased total clearance to 24/31 (77.4%). The most common complication was bleeding that necessitated blood transfusion (7/31, 22.5%). Conclusion: Percutaneous nephrolithotomy is as safe and effective in children as it is in adults. The clearance rate can be increased with dual therapy. Tract dilation should be tailored according to patient age and the extent of hydronephrosis.

Case report: bilateral simultaneous tubeless and stentless percutaneous nephrolithotomy.

A 39-year-old man underwent percutaneous nephrolithotomy (PCNL) for bilateral renal stone without stent and tube insertion. To our knowledge, this is the first report of bilateral simultaneous tubeless and stentless PCNL. The advantage of this technique in renal stone surgery is discussed.