Sinasi Yavuz Onol

Micropercutaneous Nephrolithotomy in the Treatment of Moderate-Size Renal Calculi

PURPOSE We present our initial experience with microperc in patients with moderate-size renal calculi. PATIENTS AND METHODS A retrospective analysis of 30 patients (male 14, female 16) with moderate-size (1-3 cm) kidney stones who underwent microperc between August 2011 and July 2012 was performed. The demographic values, perioperative and postoperative measures including age, stone size and location, body mass index, operative and fluoroscopy time, hemoglobin decrease, success and complication rates were prospectively recorded into a patient entry system. RESULTS The average stone size was 17.9±5.0 mm (10-30 mm). The mean age of the patients was 41.5±18.2 years (range 3-69 years). The duration of the operation was calculated as 63.5±36.8 minutes (range 20-200 min). Mean fluoroscopic screening time was 150.5±90.4 seconds (range 45-360 seconds). The patients were discharged after a mean hospitalization period of 35.5±18.6 hours (range 14-96 hours). An overall success rate of 93% (including 10% of insignificant residual fragment rate) was achieved. In the follow-up, residual stone fragments were detected in two (7%) patients. Conversion to miniperc was necessitated in three (10%) patients. The mean hemoglobin drop was found to be 1.1±0.8 mg/dL (range 0-2.8 mg/dL). Complications were observed in five (13.3%) patients. CONCLUSIONS Our initial results provide that microperc is a feasible, safe, and efficacious treatment modality for moderate-size kidney stones as well as small ones with its minimally invasive nature. Technical refinements are needed to achieve better results and overcome the limitations of technique.

Female Urethral Malignant Melanoma With Vesical Invasion: A Case Report

We report a 75‐year‐old female with a primary urethral malignant melanoma. A mass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4 × 2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+) malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery.

Treatment of urethral strictures in balanitis xerotica obliterans (BXO) using circular buccal mucosal meatoplasy: experience of 15 cases.

OBJECTIVES Balanitis xerotica obliterans (BXO) related strictures involving the external urethral meatus. We reviewed our result with the use of circular mucosal graft in the reconstruction of strictures. METHODS Between March 1997 and January 2012, 15 patients underwent circular buccal mucosal urethroplasy for BXO related anterior urethral strictures. Urethral catheter was removed within 2 weeks. Follow-up included patient symptoms assessment, cosmetic outcome and uroflowmetry. RESULTS Median follow-up was 20.5 months (range 4 to 96). Mean postoperative peak urinary flow rate obtained 1 month after catheter removal was 22.4 ml per second. All patients had a normal meatus and none had recurrent stricture, chordee or erectile dysfunction. A functional and cosmetic outcome was achieved in 100% of the patients. CONCLUSIONS Circular mucosal graft technique for treatment of meatal strictures is an efficient method for the restoration of a functional and cosmetic penis.

Comparison of Flexible and Rigid Cystoscopy-Assisted Ureteral Catheter Insertion Before Percutaneous Nephrolithotomy: A Prospective Randomized Trial

BACKGROUND AND PURPOSE To compare the advantages of flexible and rigid cystoscopy-assisted ureteral catheter placement before prone percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS From March to September 2012, a total of 80 patients with kidney stones underwent PCNL by the same surgical team. The patients were randomly assigned into one of the groups according to the technique used for ureteral catheter insertion: Flexible cystoscopy (group 1, n=40) or rigid cystoscopy (group 2, n=40). Patient demographics and operation-related factors were compared. The preparation period included positioning, cystoscopy-assisted stent insertion, and patient repositioning for PCNL. In addition, discomfort scores of the operating room (OR) staff were measured. RESULTS The demographic values of the groups in terms of patient sex, age, body mass index, and stone size were comparable. While the mean preparation period was calculated as 9.9±2.3 minutes in the flexible cystoscopy group, it was significantly longer (19.7±2.9 minutes) in the rigid cystoscopy group (P<0.0001). In addition, the discomfort score of the OR staff was found to be significantly higher in the rigid cystoscopy group (1.1±0.9 vs 2.05±0.68, P<0.0001). The rest of the operative and postoperative parameters were similar. CONCLUSIONS The insertion of a ureteral catheter with a flexible cystoscope before prone PCNL shortens the preparation period and minimizes the discomfort of OR staff related to patient positioning and transfer.

Turkish validation of the urethral stricture surgery specific patient-reported outcome measure (USS-PROM) with supplemental assessment of erectile function and morbidity due to oral graft harvesting

We validated a Turkish language version of the urethral stricture surgery specific patient‐reported outcome measure (USS‐PROM) in men undergoing anterior urethroplasty. We also investigated changes in erectile function (EF) and quality of life (QoL) due to oral mucosa graft (OMG) harvesting.

Malignant Melanoma in Genito-Urinary Tract

It manifests itself with flank pain and usually renal involvement is detected at the time of diagnosis. Additionally, distant lymph node metastasis could also be detected. Absence of previous unilateral adrenal gland involvement, presence of pigmented lesions without any signs of endocrine disorder, and negative immunohistochemical endocrine markers are typical characteristics of primary malignant melanoma of the adrenal gland. Presence of an occult primary lesion should also be excluded by autopsy. Pluripotent neural crest cells are localized within adrenal gland medulla. They are precursors of melanocytes, neurons, glial cells of the peripheral nervous system, and adrenal chromaffin cells. Under the influence of microenvironment, and various growth factors, these multipotent cells might transform into different cell types.

V2-06 RECONSTRUCTION OF THE STRICTURES OF FOSSA NAVICULARIS AND URETHRAL MEATUS BY USING TRANSVERSE ISLAND FASCIOCUTANEOUS PENILE FLAP (TIFP) WITH THE GLANS CAP TECHNIQUE

INTRODUCTION AND OBJECTIVES: Urethral strictures involving the fossa navicularis and external meatus require the reconstruction of both a functional and a cosmetic outlet. We describe our experience with ventral TIFP in the management of distal urethral strictures. METHODS: Between 1997 and 2012, 46 men (mean age: 54 years) with distal urethral strictures confined to the fossa navicularis and urethral meatus underwent ventral TIFP urethroplasty with the glans cap technique. The etiology of the stricture was iatrogenic in 40 (transurethral resection of the prostate or bladder tumor) and inflammatory/ idiopathic in 6. All except 4 patients had undergone multiple previous urethral dilatations. Preoperative evaluation included uroflowmetry with residual urine volume determination, retrograde urethrography (RU) and voiding cystourethrography (VCUG), and urethrocystoscopy with a pediatric ureterorenoscope. During surgery, a subcoronal incision was made on the ventral penile skin and carried down through Buck’s fascia until the urethra. Fossa navicularis and meatus were exposed by dissecting the urethra under the glans. The strictured urethra was then incised ventrally, including the meatus. A ventral fasciocutaneous island flap was mobilized and anastomosed to the edges of the urethral incision, augmenting the urethra to admit a 24-26F sound without difficulty. Urethral catheter was removed after 2 weeks. Patients were followed for obstructive symptoms and 3 monthly uroflowmetric studies in the first year and annually thereafter. Cure was defined as patient satisfaction and the absence of any restenosis requiring additional intervention. RESULTS: Stricture length ranged between 7 to 25 mm. Mean operation time was 50 min. Flap necrosis developed in one patient with subsequent fistula formation. Cure was achieved in 43 (93.4%) men at a mean follow-up of 78 months (range: 3-144). The procedure failed in 2 patients due to lichen sclerosus, which was diagnosed after the recurrence and managed with a 2-stage buccal mucosa graft urethroplasty. The mean Qmax was increased from 7.2 ml/sec preoperatively to 19.4 ml/sec at the last follow-up visit (p1⁄40.001, Wilcoxon sign test). CONCLUSIONS: TIFP is an effective technique for the reconstruction of urethral strictures involving the fossa navicularis and external meatus. It restores a functional and cosmetic outcome with preservation of the glandular integrity. Inflammatory genital skin diseases must be carefully evaluated before surgery to achieve optimum success with this technique.

200 SINGLE-STAGE TREATMENT OF DISTAL URETHRAL STRICTURES DUE TO BALANITIS XEROTICA OBLITERANS WITH CIRCULAR BUCCAL MUCOSA GRAFT

plasties performed by a single surgeon between July 2007 and October 2010 was performed. Patients were divided into two groups based on endoscopic treatment history for urethral stricture disease at the time of urethroplasty (group 1: 0–1 treatment; group 2: 2 treatments). Only those with bulbar strictures were included, thus excluding those with pure penile and membranous strictures, as well as patients with a history of prior urethroplasty, hypospadias, lichen sclerosis, and pelvic radiation. RESULTS: During the 39 month study period, 140 men with bulbar urethral strictures met the study criteria: 50 had 0–1 previous endoscopic treatments (group 1), 51 had 2 previous endoscopic treatments (group 2), and 39 were excluded due to incomplete records. As shown in the table, repeated endoscopic treatment was strongly associated with longer strictures, more commonly extending into the penile urethra and less often amenable to anastomotic reconstruction. Repeated endoscopic treatment of bulbar urethral strictures was also associated with an 8-fold increase in the symptomatic interval between stricture diagnosis and urethroplasty. CONCLUSIONS: Repeated endoscopic treatment of bulbar strictures is associated with increased stricture complexity and a markedly prolonged duration of symptoms. These data suggest that repeated endoscopic intervention is counterproductive and should be discouraged in treatment of bulbar strictures.