Murat Tolga Gulpinar

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception.

Abstract Objectives: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient’s pain control, anxiety levels, and satisfaction. Patients and methods: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed. Results: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. Conclusion: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

Retrograde intrarenal surgery in pediatric patients.

Urinary tract stone disease is seen at a level of 1%-2% in childhood (< 18 years). In recent years, however, there has been a marked increased in pediatric stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to todays advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques.

Urothelial neoplasm of the bladder in childhood and adolescence: a rare disease

ABSTRACT Purpose: Bladder tumors are rare in children and adolescents. For this reason, the diagnosis is sometimes delayed in pediatric patients. We aimed to describe the diagnosis, treatment, and follow-up methods of bladder urothelial neoplasms in children and adolescents. Materials and Methods: We carried out a retrospective multicenter study involving patients who were treated between 2008 and 2014. Eleven patients aged younger than 18 years were enrolled in the study. In all the patients, a bladder tumor was diagnosed using ultrasonography and was treated through transurethral resection of the bladder (TURBT). Results: Nine of the 11 patients (82%) were admitted with gross hematuria. The average delay in diagnosis was 3 months (range, 0–16 months) until the ultrasonographic diagnosis was performed from the first episodes of macroscopic hematuria. A single exophytic tumor (1–4cm) was present in each patient. The pathology of all patients was reported as superficial urothelial neoplasm: two with papilloma, one with papillary urothelial neoplasm of low malignant potential (PUNLMP), four with low grade pTa, and four with low grade pT1. No recurrence was observed during regular cystoscopic and ultrasonographic follow-up. Conclusions: Regardless of the presence of hematuria, bladder tumors in children are usually not considered because urothelial carcinoma in this population is extremely rare, which causes a delay in diagnosis. Fortunately, the disease has a good prognosis and recurrences are infrequent. Cystoscopy may be unnecessary in the follow-up of children with bladder tumors. We believe that ultrasonography is sufficient in follow-up.

Do Hypertension, diabetes mellitus and obesity increase the risk of severity of nephrolithiasis?

Objective: In this study we planned to investigate the relationship between presence of kidney stones and stone burden with hypertension (HT), diabetes mellitus (DM) and body mass index (BMI). Methods: A total of 574 patients were included in the study. None of the patients had a history of stones. The 121 patients with kidney stone identified on ultrasound evaluation and the 453 patients with no stones were compared in terms of HT, BMI and DM. The stone burden of 121 patients with diagnosed stones was compared in terms of the same variables. Results: Of the 121 patients with kidney stones 30 (24.7%) had HT, while 66 (14.5%) of the 453 patients without stones had HT (p=0.007). BMI values of those with and without stones were 27.2 ± 4.93 kg/m2 and 25.29 ± 4.12 kg/m2, respectively (p<0.001). Twenty-five (20.6%) of the patients with stones diagnosed by ultrasound had DM, while 49 (10.8%) of those without stones had DM (p=0.004). When comparing patients with and without kidney stones, logistic regression analysis revealed that DM (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.17 to 3.63, p=0.013) and BMI (OR 1.08, CI 1.03 to 1.13, p=0.003) were independently associated with presence of stones. No significant relationship was found between the same variables and cumulative stone diameter (CSD) and stone surface area (SA) evaluated for stone burden. Conclusions: While diabetes mellitus, Hypertension and increased Body Mass Index may add to the possibility of stone formation, they did not affect stone burden.

Accuracy of Unenhanced Computerized Tomography Interpretation by Urologists in Patients with Acute Flank Pain

Purpose: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. Materials and Methods: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. Results: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [κ]: 0.904), categorical stone size (κ: 0.81), the location of calculus (κ: 0.88), and hydronephrosis (κ: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (κ: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. Conclusion: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.

The association of urolithiasis and androgenetic alopecia

Abstract Objectives: The objective of this study is to investigate whether patients with androgenetic alopecia were at risk in terms of urinary system stone disease. Patients and methods: Patients with no baldness (Hamilton–Norwood Scala [HNS] stage I) were categorized as Group I, those with hair loss in the frontal region (HNS stages II, III, IIIa, and IVa) as Group II, those with hair loss in the vertex region (HNS stage III-vertex, V) as Group III and those with hair loss in both vertex and frontal regions (HNS stages IV, Va, VI, and VII) as Group IV. Patients in all groups were compared in terms of presence of stone, and the presence of any association between alopecia and urolithiasis, with common etiological risk factors, was investigated. Results: Three hundred and two male patients were included in the study. The presence of urolithiasis was detected in 28.9% of patients in Group I; 26.5% of Group II; 36.9% of Group III; and 44.4% of Group IV (p = 0.085). Among patients aged under 60, urinary stone disease was detected in 30.8% of patients in Group I; 26.4% of Group II; 41.2% of Group III; and 53.8% of Group IV (p = 0.001). In patients aged over 60, urolithiasis was detected in 12.5% of patients in Group I; 26.9% of Group II; 32.2% of Group III; and 37.8% of Group IV (p = 0.371). Conclusions: We determined a significant correlation between vertex pattern and total alopecia with urolithiasis in patients younger than 60 years old.

The relationship between platelet–lymphocyte ratio and severity of erectile dysfunction

The prognostic importance of platelet–lymphocyte ratio (PLR) is already known for various artery diseases. In this study, the relationship between PLR and severity of erectile dysfunction (ED) is examined in patients with impotence. The data from patients suffering from erection problems was screened retrospectively. Detailed medical history, age, International Index of Erectile Function‐5 (IIEF‐5) scores, fasting blood glucose, lipid, whole blood count, and hormone profile values were examined. Patients with no ED were selected as the control group. All men answered the IIEF‐5 questions and were then classified according to their scores. Patients were determined to have severe ED (scores 5–7), moderate ED (scores 8–16), or mild ED (scores 17–21). An IIEF‐5 score greater than 21 was accepted for the control group. The PLR values from both patient and control groups were evaluated. Demographic data were similar in both groups. Mean PLR value was 104 in control and 118 in the patient group (p < 0.001). PLR value increased depending on the severity of ED. Mean PLR values were 108 in mild, 116 in moderate, and 130 in severe ED groups. Compared with the control group, this value was statistically significant for patients with moderate and severe ED (p = 0.04 and p < 0.001). PLR showed weak negative but significant correlation with IIEF‐5 scores (r = −0.27 and p < 0.001). The PLR value was found to be higher in patients with ED. PLR value may be related to ED and its severity in patients with impotence.

Time to say good bye to shockwave lithotripsy

We read with great interest the recent article by Kruck et al. [1] on the comparative study of minimally invasive percutaneous nephrolithotomy (MIP), retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) in renal stone treatment. In this article, authors compared clinical outcome, complications, stone-free rate (SFR) and stonefree survival with regard to stone size and localization. They concluded the significant advantages of the MIP and RIRS procedures for increased SFRs, lower risk of stone persistence and prolonged stone-free survival compared with SWL. We congratulate the authors for their work and thank them for bringing this debatable topic to our attention; however, we feel that some issues described in their paper need further discussion. Over the last decade, with the miniaturization of instruments in percutaneous nephrolithotomy and technological improvements in flexible ureteroscopes, working instruments and laser technology, RIRS, MIP and microperc techniques have become more attractive procedures for the treatment of nonbulky renal urolithiasis [2, 3]. Furthermore, in the recent years, there has been an increasing realization that the SWL has unpredictable and unfavorable results when comparing with other minimally invasive methods [4–6]. On a comparative study of RIRS and SWL, El-Nahas et al. [4] concluded the significant advantages of the RIRS procedure for higher stone-free rate and lower retreatment rate for the management of medium sized lower pole renal stones. Another three comparative studies, evaluating the outcomes of PNL and SWL, showed that the success rate was statistically higher, and retreatment or auxiliary procedures were less for PNL compared with SWL [5–7]. But in all these studies, PNL or RIRS was associated with an increased risk of complications compared with SWL. Similar results were reported in the present study by Kruck et al. [1]. Despite publishing these studies and clinical treatment guidelines, there are no universally accepted paradigms to treat renal stones, due to absence of robustly designed randomized controlled trials [8, 9]. Until the publishing of welldesigned randomized prospective large series examining the efficacy and safety of minimally invasive treatments, SWL will be the most valuable treatment option because of its noninvasive nature, low morbidity rate and high patient acceptance [3]. Therefore, current EAU guidelines recommend SWL remains the method of first choice for stones \2 cm within the renal pelvis, upper or middle calices and for stones\1.5 cm within lower pole calices [9].

Does Preoperative Use of Dutasteride Decrease Bleeding During Open Prostatectomy

PURPOSE To investigate whether use of dutasteride, a 5-alpha reductase inhibitor, for at least four weeks preoperatively affected the blood loss during open prostatectomy (OP). MATERIALS AND METHODS Retrospective analysis was made of the data of 110 patients who had undergone OP. Group I comprised 50 patients that used dutasteride for 4 weeks preoperatively, and Group II comprised 60 patients that did not use the drug. The groups were compared in respect of age, total prostate specific antigen (TPSA) levels, prostate volumes, preoperative hemoglobin (Hgb) and hematocrit (Hct) levels, postoperative reduction of Hgb and Hct, percentage reduction in Hgb and Hct, and the administration of postoperative blood products. RESULTS No differences were determined between the two groups in respect of prostate volumes, TPSA, preoperative Hgb and Hct levels (P = .813, P = .978, P = .422, P =.183, respectively). Postoperative Hgb reduction was 2.19 ± 1.36 g/dL in Group I, and 2.5 ± 1.47 g/dL in Group II (P = .260). Hgb reduction was calculated as 16.4 ± 9.7% in Group I and 17.6 ± 9.7% in Group II (P = .505). Reductions in Hct were 5.8 ± 3.7% in Group I, and 7.3 ± 4.4% in Group II, and percent reductions were 14.8 ± 9.4% in Group I and 17.3 ± 10.2% in Group II (P = .068, P = .182, respectively). CONCLUSION The use of dutasteride before OP did not affect blood loss during surgery, therefore surgery should not be delayed for the administration of dutasteride to patients.

Categorization of ureteroscopy complications and investigation of associated factors by using the modified Clavien classification system.

BACKGROUND/AIM The purpose of the present study was to review the complications of ureteroscopy (URS) by using the modified Clavien classification system (MCCS) and to investigate the factors associated with complications. MATERIALS AND METHODS Data regarding 811 patients who underwent URS for ureteral calculus were analyzed. Peroperative and postoperative complications were recorded. The patients were divided into seven groups depending on the severity of the complications. The association of sex, stone size, number, and localization with each MCCS grade was also evaluated. RESULTS The average age was 45 years. The success of the procedure after one session was 93.5%. Complications were recorded in 57.9% of the patients. According to the MCCS, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were documented in 29.8%, 7.1%, 8.6%, 11%, 0%, 1.2%, and 0% of the patients, respectively. The factors associated with the complications graded by MCCS were sex, stone size, number of stones, and localization. In addition, in multivariate analysis, history of previous surgeries for urolithiasis, orifice dilatation, and instrument size were associated with complications. CONCLUSION According to MCCS, sex, history of previous surgeries for urolithiasis, orifice dilatation, size of the instrument, stone size, number of stones, and localization are associated with different grades of complications in URS.