Mut Safak

Does Lower-Pole Caliceal Anatomy Predict Stone Clearance after Shock Wave Lithotripsy for Primary Lower-Pole Nephrolithiasis?

Aim: In order to have an idea about the success rates after extracorporeal shock wave lithotripsy (SWL) in patients with lower-pole stones, we reviewed the caliceal anatomy of the patients treated in our clinic. Patients and Methods: One hundred and ninety-eight patients having at least a 3-month follow-up period, with a single stone located in the lower pole, were included. Lower infundibulopelvic angle (LIP-A), infundibular width, and infundibular length were measured from standard intravenous urograms taken before initial ESWL. Results: One hundred and thirty patients (65%) were male, and 68 patients (35%) were female. We found no impact of age, sex, and affected side on the results of ESWL. The overall stone-free rate was 61.1% after 3 months of follow-up. The stone-free rates were 47.8 and 81.4% in patients with an acute (<70°) and an obtuse (≧70°) LIP-A, respectively (p = 0.007). Taking the infundibular width into consideration, the stone-free rates were 85.4 and 43.2% for favorable and unfavorable angles and widths (p = 0.003). However, infundibular length and stone sizes were not found to have important effects on a stone-free status (p = 0.546 and p = 0.283). Conclusion: We conclude that LIP-A (≧70°) has the greatest impact on the clearance of residual fragments produced by SWL.

Clinical experience with inflatable and malleable penile implants in 104 patients

Penile prosthesis was implanted for erectile impotence of mainly organic origin in 104 patients. The AMS Dynaflex penile prosthesis was inserted in 39 cases, the AMS Malleable 600 prosthesis in 61 and the AMS Ultrex Plus prosthesis in 4. In 1 patient receiving a malleable prosthesis both rods had to be removed owing to erosion into the urethra and reimplantation was performed at the same operation. Only 1 patient who underwent implantation of the Dynaflex device had mechanical failure that necessitated surgical revision. After implantation of the new prosthesis both patients had satisfactory intercourse. One Dynaflex penile prosthesis, implanted into a juvenile-onset diabetic, became infected and required removal. Another complication was secondary to spontaneous erosion (noninfected) in 1 patient with malleable prosthesis who suffered loss of only one rod and who is still satisfied with the result. The overall complication rate in our series has been approximately 4%. The rest of the patients report satisfaction with the ability to move the penis voluntarily permitting normal sexual activities as well as normal appearance in the flaccid position. According to our experience, careful preoperative assessment from the views of both patient and device selection along with patient education, and strictly obeying the rules of sterility during implantation and applying systemic and local antimicrobial prophylaxis are essential in obtaining a successful result in prosthesis implantation for the individual patient.

371 bladder calculi in a benign prostatic hyperplasia patient

We describe a patient with 371 bladder calculi secondary to benign prostatic hyperplasia. To our knowledge this patient had one of the highest numbers of the bladder calculi reported.

Bilateral Leydig cell tumors with unilateral cryptorchidism. Case report.

Bilateral leydig cell tumors of testes are very rare. There is no evidence from literature that in the cryptorchid man, bilateral leydig cell tumors are prone to develop. We report a man with bilateral leydig cell tumors in association with unilateral cryptorchidism.

Intrarenal Lipoma: Report of a Case

We recently had the opportunity to study a case of renal lipoma. Pure intrarenal lipomas are very infrequent among all of the renal tumors and computed tomography is the only means of showing the fatty nature of such masses with its contrast discrimination property.

Management of Ureterosigmoidal Anastomotic Stricture by Balloon Dilatation

Ureterosigmoidal anastomotic stricture is seen in nearly half of the patients who had ureterosigmoidostomy. Many of these patients are in need of reoperation. Balloon dilatation via percutaneous nephrostomy is an alternative method which avoids reoperation.

Ureteral displacement due to congenital psoas muscle hypertrophy.

We describe a patient with a laterally deviated ureter that was inappropriately diagnosed as a retroperitoneal mass before computed tomography was performed.

Vas Deferens Calculus

We describe a patient with a radiopaque calculus in the vas deferens that was inappropriately diagnosed as a ureteral calculus.