Remzi Saglam

Randomized clinical trial comparing transurethral needle ablation with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: results at 18 months.

PURPOSE To compare the efficacy and safety of transurethral needle ablation (TUNA) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) during an 18-months follow-up. PATIENTS AND METHODS A series of 59 patients older than 40 years were included in this study. The entry criteria were prostate size <70 g, maximum urinary flow rate (Q(max)) <15 mL/sec, International Prostate Symptom Score (IPSS) >13, and no suspicion of prostate cancer according to the clinical or laboratory findings. Of the patients, 26 (44%) were treated with TUNA and 33 (56%) with TURP. At 3 and 18 months of follow-up, Q(max), postvoiding residual volume (PVR), IPSS, and the quality of life (QOL) score were compared with the baseline values. The results were also compared in patients undergoing TUNA v TURP. RESULTS Improvements in Q(max), PVR, IPSS, and QOL score were statistically significant for both groups at 3 and 18 months of follow-up. The increase in the mean Q(max) of the TURP group was higher than that in the TUNA group, whereas no significant differences were found in the two groups regarding improvements in IPSS and QOL score. There were no complications associated with the TUNA procedure, while 16 retrograde ejaculation, 4 erectile impairment, 2 urethral stenosis, and 1 urinary incontinence cases were observed after TURP. CONCLUSIONS The TUNA procedure is an effective and safe minimally invasive treatment with negligible adverse effect for selected patients with symptomatic BPH compared with TURP. It should be considered as an alternative treatment option for younger patients who want to preserve sexual function.

Comparison of Retrograde Intrarenal Surgery and Mini-percutaneous Nephrolithotomy in Children With Moderate-size Kidney Stones: Results of Multi-institutional Analysis

OBJECTIVE To compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in children for 10- to 30-mm renal calculi by evaluating operative data, stone-free rates, and associated complications. METHODS The records of 201 pediatric patients who underwent mini-perc (n = 106) or RIRS (n = 95) for intrarenal stones of 10- to 30-mm size were reviewed retrospectively. The χ(2) test was applied to compare the success rates, postoperative complications, and blood transfusion rates, and the Mann-Whitney U test was used to compare the means of hospital stay, fluoroscopy, and operative time for mini-perc and RIRS. RESULTS The stone-free rate was 84.2% for the RIRS group and 85.8% for the mini-perc group after a single procedure (P = .745). These percentages increased to 92.6% and 94.3% with adjunctive therapies for RIRS and mini-perc, respectively. Minor complications classified as Clavien I or II occurred in 17% and 8.4% in mini-perc and RIRS, respectively. No major complications (Clavien III-V) occurred in either group. Overall complication rates in mini-perc were higher, but the differences were not statistically significant (P = .07). However, 7 patients in the mini-perc group received blood transfusions, whereas none of the children in the RIRS group were transfused (P = .015). The mean hospital stay, fluoroscopy, and operation times were significantly longer in the mini-perc group. CONCLUSION This study demonstrates that RIRS is an effective alternative to mini-perc in pediatric patients with intermediate-sized renal stones. Operative time, radiation exposure, hospital stay, and morbidities of percutaneous nephrolithotomy (PNL) can be significantly reduced with the RIRS technique.

An unusual cause of renal colic: Hydatiduria

Hydatid disease of the urinary tract is seen rarely. Hydatiduria may be a finding of renal involvement, but it is a rare cause of renal colic. A case is reported of renal hydatid disease that was diagnosed during the investigation of renal colic. A 38‐year‐old woman presented with renal colic. She had a history of episodes of renal colic and occasional voiding of grape‐like material. No calculus was found in the urinary tract by plain film or ultrasonographic examination. The histopathologic examination of this material revealed daughter cysts that are pathognomonic for hydatid disease. Ultrasound and computed tomography confirmed this diagnosis and right nephrectomy was performed without cyst perforation or any spilling of cyst content. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively).

Extracorporeal magnetic stimulation for the treatment of stress and urge incontinence in women--results of 1-year follow-up.

Objective: To evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress and urge urinary incontinence in women. Material and Methods: A total of 35 patients with stress incontinence and 17 with urge incontinence were enrolled in this study. All patients were evaluated by means of a detailed history of incontinence, a gynecologic examination, urine culture, urinary system ultrasound and a urodynamic study. All patients were asked to keep a 3‐day voiding diary. A pad‐weighing test was done for each patient at their first visit. For treatment, the patients were seated on a special chair containing a magnetic field generator. Pelvic floor muscle stimulation was performed for 20 min (10 min at 5 Hz and 10 min at 50 Hz) twice a week for a total of 8 weeks. The mean follow‐up period was 16.8 months (range 12–32 months). A total of 44 patients completed 1 year of follow‐up and were re‐evaluated by means of voiding diary, pad‐weighing test and cystometric study. Results: Of the 44 patients, 11 (38%) with stress incontinence and 6 (40%) with urge incontinence were cured 1 year after the treatment. In addition, there was an improvement in symptoms in 12 patients (41%) in the stress group and 7 (47%) in the urge group. Pad weight was reduced from 15.4 to 5.8 g in the stress group and from 12.4 to 4.7 g in the urge group (p = 0.000 and 0.001, respectively). Mean Valsalva leak point pressure was increased from 87.3 ± 15.9 to 118.0 ± 11.0 cmH 2 O in the stress group (p = 0.000). Conclusions: Extracorporeal magnetic stimulation therapy offers a non‐invasive, effective and painless treatment for stress and urge incontinence in women.

Comparison of clinical outcome of extracorporeal shockwave lithotripsy in patients with radiopaque v radiolucent ureteral calculi.

PURPOSE To compare the efficacy of extracorporeal shockwave lithotripsy (SWL) in patients with radiopaque and radiolucent ureteral calculi. PATIENTS AND METHODS Between September 2001 and August 2002, a total of 113 consecutive patients with ureteral calculi (58 radiopaque [Group 1], 55 radiolucent [Group 2]) were treated with a Multimed 2001 trade mark lithotripter under fluoroscopic monitoring. Localization of radiolucent stones was achieved after a bolus injection of contrast medium 1 mL/kg, the shockwaves being focused just below the end of contrast column. All patients were treated on an outpatient basis under analgesia and light sedation if required. The mean follow-up was 14 (range 6-23) months. Patients were reevaluated by some combination of plain films, ultrasound scanning, and intravenous urography 3 months after the treatment. Groups were compared with ANOVA and Mann-Whitney U tests. A P value <0.05 was regarded as statistically significant. RESULTS There were no statistically significant differences in any parameter between groups. At 3 months, the success rate (stone-free status) was 87.9% in Group 1 and 89% in Group 2 (P = 0.848). Double-J catheter replacement was needed for three patients in Group 1 and for two patients in Group 2 (P = 0.693). Two patients from Group 1 and three from Group 2 underwent intracorporeal lithotripsy with ureterorenoscopy (P = 0.606). No adverse reactions to contrast medium occurred in Group 2. CONCLUSION Patients with radiolucent ureteral calculi can be treated efficiently with SWL by contrast medium injection if ultrasonic localization is not possible.

Comparative study of etofenamate and fentanyl for outpatient extracorporeal shockwave lithotripsy.

OBJECTIVE This study aimed to compare the clinical efficacy and safety of etofenamate (a non-steroidal anti-inflammatory drug) and fentanyl (an opioid analgesic) for outpatient extracorporeal shock wave lithotripsy (ESWL). MATERIAL AND METHODS 60 non-premedicated patients underwent ESWL for urinary tract calculus with the Multimed 2000 (ELMED Lithotripsy Co.. Turkey) lithotripter. None of patients had previous experience with ESWL treatment. The patients were divided into two groups. A single dose of 1 g etofenamate was given to the patients intramuscularly 25 min before ESWL in group I (n = 30) and 0.1 mg fentanyl was administered intravenously just before ESWL in group II (n = 30). At the end of the treatment a visual analogue score (VAS) of 0 (no pain) to 10 (greatest pain) was used to evaluate the pain. Blood pressure, heart rate and arterial oxygen tension (PaO2) were measured before and during the ESWL. Groups were compared according to the pain scores, stone size, number of shocks, maximum voltage achieved, duration of ESWL and incidence of side-effects of the administered drug. Data were analysed with the Mann-Whitney U-test. RESULTS No statistical differences were found between the two groups regarding achieved maximal energy levels, pain scores and number of shock waves given (p < 0.01). Satisfactory stone fragmentation was achieved in both groups. There were no changes in blood pressure or heart rate during the ESWL in either group. PaO2 was not affected in the etofenamate group, whereas a transient desaturation in two patients and giddiness in three patients were recorded in the fentanyl group. CONCLUSIONS Both etofenamate and fentanyl have clinically sufficient effects on pain, and can be used safely for outpatient ESWL procedures.Objective: This study aimed to compare the clinical efficacy and safety of etofenamate (a non-steroidal anti-inflammatory drug) and fentanyl (an opioid analgesic) for outpatient extracorporeal shock wave lithotripsy (ESWL). Material and Methods: 60 non-premedicated patients underwent ESWL for urinary tract calculus with the Multimed 2000 ’ (ELMED Lithotripsy Co., Turkey) lithotripter. None of patients had previous experience with ESWL treatment. The patients were divided into two groups. A single dose of 1 g etofenamate was given to the patients intramuscularly 25 min before ESWL in group I ( n = 30) and 0.1 mg fentanyl was administered intravenously just before ESWL in group II ( n = 30). At the end of the treatment a visual analogue score (VAS) of 0 (no pain) to 10 (greatest pain) was used to evaluate the pain. Blood pressure, heart rate and arterial oxygen tension ( P aO 2 ) were measured before and during the ESWL. Groups were compared according to the pain scores, stone size, number of shocks, maximum voltage achieved, duration of ESWL and incidence of side-effects of the administered drug. Data were analysed with the Mann-Whitney U -test. Results: No statistical differences were found between the two groups regarding achieved maximal energy levels, pain scores and number of shock waves given ( p < 0.01). Satisfactory stone fragmentation was achieved in both groups. There were no changes in blood pressure or heart rate during the ESWL in either group. P aO 2 was not affected in the etofenamate group, whereas a transient desaturation in two patients and giddiness in three patients were recorded in the fentanyl group. Conclusions: Both etofenamate and fentanyl have clinically sufficient effects on pain, and can be used safely for outpatient ESWL procedures.

Penile epidermoid cyst in an elderly patient

Although cutaneous epidermoid cysts are common lesions, penile localization of them is quite rare especially in elderly ages. A case of 70-year-old man with a rapidly growing penile epidermoid cyst that extended to under the symphysis pubis is reported. The cystic mass was excised totally and histopathologic examination revealed the epidermoid cyst. There has been no finding of recurrence for one year follow-up period.

Robot-assisted flexible ureteroscopy: an update

The role of flexible ureteroscopy (FURS) in the management of nephrolithiasis has increased due to the improved armamentarium. However, FURS still represents a challenging technique limiting its diffusion. Similar to previous experiences in laparoscopy, recently developed robotic devices may significantly compensate for the ergonomic deficiencies of FURS. Based on a short description of the history of robotic devices for laparoscopy, this article summarizes all current developments of robotic FURS. In 2008, robotic FURS was first reported using the Sensei–Magellan system designed for interventional cardiology. However, with this device the ureteroscope was only passively manipulated, which represented the main reason why this project has been discontinued after 18 clinical cases. Avicenna Roboflex™ was especially developed for FURS. It consists of a surgeon’s console and manipulator of a flexible ureterorenoscope. The console provides an adjustable seat with armrests and two manipulators of the endoscope: the right wheel enables deflection and the left horizontal joystick allows rotation as well as advancing and retracting the instrument. The speed of rotation and advancement can be regulated at the screen of the console. Using the IDEAL system for evaluation of new robotic devices, safety and efficacy of the system could be demonstrated in two multi-centric studies providing significant improved ergonomics for the surgeon (IDEAL stage 1 and 2). Future studies are necessary to determine the final role of robotic FURS.

V11-02 AVICENNA ROBOFLEX, FOR ROBOTIC ASSISTED RETROGRADE INTRARENAL LASER LITHOTRIPSY OF THE KIDNEY STONES, LARGER THAN 2 CM.

RESULTS: Access-related complications are often encountered in patients who require pre-operative anticoagulation or in whom a urinary tract infection may be identified pre-operatively. Addressing these issues preemptively is imperative to patient safety. Further, several risk factors for bowel injury may be addressed with meticulous knowledge of the patient0s anatomy pre-operatively. In certain cases, anatomic abnormalities necessitate laparoscopic or CT-guided access. Finally, the main difficulties at the time of obtaining access for PCNL are discussed at length, including inadvertent vascular access, extravasation of contrast, guidewire kinking, obstruction of the access tract by a staghorn calculus, bowel injury, and pleural injury. Inadvertent vascular access is often addressed by redirecting the guidewire into the collecting system. In rare cases, use of the access sheath, or balloon, to tamponade bleeding, may be required. Extravasation often necessitates re-puncture, while guidewire kinking may be rectified with the assistance of a rigid, open-ended catheter. Access for staghorn calculi may be achieved with the assistance of retrograde ureteroscopy, or maneuvering past the stone edge with a grasping forceps. Bowel injury should be addressed with drainage of the urinary tract separate from the bowel and broad spectrum antibiotics. Finally, pleural injury necessitates rapid identification to ensure expedient placement of a chest tube. CONCLUSIONS: Access-related complications can introduce significant morbidity to an otherwise successful PCNL. We demonstrated some crucial skills to avoid the difficulties that are often encountered at the time of obtaining access, as well as several techniques that can be used in a timely fashion to address access-related injuries.

Psoas abscess twenty-one years after ipsilateral nephrectomy

We report an unusual case of psoas abscess,which developed twenty-one years afteripsilateral nephrectomy and was caused byinfrequent pathogen, Proteus mirabilis.It was diagnosed by computed tomography andwas drained percutaneously with a nephrostomytube guided by ultrasonography.