Tahsin Turunc

Factors Affecting Complication Rates of Ureteroscopic Lithotripsy in Children: Results of Multi-Institutional Retrospective Analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society

PURPOSE We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. MATERIALS AND METHODS We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS A total of 367 females and 265 males were studied. Mean±SD patient age was 90.2±51.4 months (range 4 to 204). Mean±SD stone size, operative time and postoperative hospital stay were 8.9±4.7 mm, 45.8±23.8 minutes and 1.8±2.8 days, respectively. At a mean±SD followup of 13.3±17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. CONCLUSIONS Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.

Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study

OBJECTIVE To perform conventional and microdissection testicular sperm extraction (TESE) at the same session and compare their effectiveness. DESIGN Prospective comparative study. SETTING University hospital setting. PATIENT(S) The study included 335 patients with nonobstructive azoospermia. INTERVENTION(S) Microdissection TESE was performed to 77 patient with atrophic testes. An additional 258 patients underwent conventional TESE using three incisions on three quadrants of the testis (upper, middle, and lower). Microdissection TESE was performed by enlarging the middle incision vertically when no spermatozoa could be detected using the conventional technique. MAIN OUTCOME MEASURE(S) Sperm retrieval, fertilization, clinical pregnancy rate (PR), and live birth rate were evaluated. The relation between sperm retrieval rate and FSH level and testis volume was also investigated. RESULT(S) Spermatozoa was detected in 33.7% of patients using conventional TESE. The spermatozoa detected increased to 50.8% using microdissection TESE. The increase was statistically significant. In the primary microdissection TESE group, the surgical retrieval rate was 20.8%. The overall sperm retrieval rate was 43.9%. There was a significant relation between the sperm retrieval rate and testis volume, whereas there was no relation between sperm retrieval rate and FSH levels. The overall fertilization rate, clinical PR, and live birth rate were 57.1%, 50.4%, 36.4%, respectively. CONCLUSION(S) Conventional TESE combined with microdissection TESE can be used in selected patients. Sperm retrieval rate of TESE can be low in patients with atrophic testes.

The Effect of Prior Varicocelectomy in Patients With Nonobstructive Azoospermia on Intracytoplasmic Sperm Injection Outcomes: A Retrospective Pilot Study

OBJECTIVES To examine our retrospective data on the outcomes of intracytoplasmic sperm injection (ICSI) and to determine whether a history of varicocele repair in men with nonobstructive azoospermia (NOA) undergoing an ICSI cycle was optimizing or not. METHODS This retrospective study was conducted on Baskent University Department of Obstetrics and Gynecology, IVF Unit, and Department of Urology. Infertile couples suffering from NOA scheduled to an ICSI cycle, which was controlled ovarian hyperstimulation with a gonadotropin or gonadotrophin-releasing hormone-agonist protocol, selected for the study were divided into 2 groups: group 1 (n = 31) included NOA patients who had undergone prior varicocele repair, and group 2 (n = 65) included NOA patients who had not undergone varicocele repair. RESULTS There was a significant difference between the 2 groups considering the sperm retrieval rate, which was higher in the varicocele repair group (sperm retrieval rate 60.81% and 38.46% respectively, P = .01). The clinical pregnancy rate and live birth rate were significantly higher in the varicocelectomy group (74.2% vs 52.3% and 64.5% vs 41.5%, respectively, P <.05). CONCLUSIONS Varicocele repair in NOA might be considered in patients undergoing ICSI cycle.

Percutaneous nephrolithotomy under general versus combined spinal-epidural anesthesia.

PURPOSE We analyzed the results of patients who underwent percutaneous nephrolithotomy (PCNL) for management of kidney stone disease under combined spinal-epidural anesthesia and compared surgical parameters and outcomes with a matched control group who underwent PCNL under general anesthesia. PATIENTS AND METHODS A total of 82 patients were studied in two groups. Group 1 (n = 45) consisted of the patients who underwent general anesthesia, and group 2 (n = 37) comprised those who received combined spinal-epidural anesthesia. RESULTS The mean ages of patients in groups 1 and 2 were 45 +/- 15 and 44 +/- 15 years, respectively. The mean areas of the stones in groups 1 and 2 were 734 +/- 386 mm(2) and 731 +/- 394 mm(2), respectively. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, operative time, irrigation fluids, fluoroscopy time, delta hemoglobin, and hospitalization time (P = 0.439). At the end of the surgery, stone-free rates were 76% in group 1 and 81% in group 2; clinically insignificant residue fragments rates were 24% in group 1 and 19% in group 2. The difference was statistically insignificant between the groups (P = 0.543). CONCLUSIONS We consider that combined spinal-regional anesthesia is a feasible technique in PCNL operations because the efficacy and safety were not affected. Further investigations with larger series are needed.

Long-Term Renal Function and Stone Recurrence After Percutaneous Nephrolithotomy in Patients with Renal Insufficiency

PURPOSE We analyzed long-term results after percutaneous nephrolithotomy (PCNL) in patients with impaired renal function. PATIENTS AND METHODS Nineteen (6.3%) of 300 patients who underwent PCNL had serum creatinine values above 1.4 mg/dL before surgery and were considered to have impaired renal function. Success rate of operation, recurrence rate, and renal functional status were evaluated. RESULTS Mean follow-up time was 51.1 +/- 10.1 months. Sixteen patients completed the study, but three patients were lost to follow-up. The results of the operation were as follows: stone free in 50%, clinically insignificant residual fragments in 25%, and clinically significant residual fragments in 25% of the patients. Mean serum creatinine value was 2.30 +/- 0.56 mg/dL before surgery and 2.67 +/- 1.41 mg/dL at the end of follow-up (p = 0.386). Creatinine values decreased to normal range in six patients (37.5%). Six patients (37.5%) had stable renal function (creatinine: 1.4-4 mg/dL). Creatinine values increased (>4 mg/dL) in four patients (25%) who required renal replacement therapy. Three new patients progressed to end-stage renal failure. These three had insulin-dependent type II diabetes mellitus and one also had solitary kidney and atherosclerosis. Two patients (12.5%) had recurrences, one of these had hypercalciuria, and the other had infection stone. CONCLUSION Our results indicated that most patients presenting with kidney-stone disease and renal insufficiency experience improvement or stabilization of renal function after PCNL. The patients with solitary kidney and those with conditions such as diabetes and atherosclerosis might be at greater risk for deterioration of renal function. Patients with metabolic abnormalities and infection stones might be at higher risk for recurrence.

Factors Affecting the Success of Ureteroscopy in Management of Ureteral Stone Diseases in Children

PURPOSE We retrospectively investigated the factors that affect the success of rigid ureteroscopy in the pediatric population for the management of pediatric ureteral stones. PATIENTS AND METHODS We present a retrospective review of 61 consecutive pediatric patients who underwent 66 rigid ureteroscopy procedures for ureteral stone management. The effects of sex, age, stone diameter, stone localization, and degree of associated ureterohydronephrosis (UHN) on the success of ureteroscopy were evaluated. RESULTS The mean age of the patients was 8.1 years (range 6 mos-16 yrs). The average stone diameter was 8.22 mm (range 4-20 mm). In 56 cases (84.8%), all of the stones were extracted. In five (7.6%) cases, clinically significant residual fragments were detected and extracted by second-look ureteroscopy. In five cases (7.6%), the operations ended in failure. The final stone clearance rate after ureteroscopic stone treatment was higher in lower ureteral stones then in middle and upper ureteral stones; thus, the difference was statistically significant (P = 0.011). Also, there is a significant negative correlation between stone size and success rate (P = 0.007). The final stone clearance rate after ureteroscopic stone treatment was higher in patients with no and mild UHN than in patients with moderate and severe UHN, but the difference was statistically insignificant (P = 0.118). Statistical analyses revealed no significant relationship between success rates with regard to the sex and age of the patients (P = 0.643 for sex, P = 0.390 for age). CONCLUSION The stone localization and stone size are the factors that affect the success of the procedure.

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.

Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: a single centre experience

We aimed to investigate sperm retrieval rates (SRR) by testicular sperm extraction (TESE), factors affecting SRR, and fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and live birth rate (LBR) in patients with presumed Sertoli‐cell‐only syndrome in testis biopsy (SCOS). We retrospectively evaluated files of 134 patients with SCOS who underwent TESE. Group I were patients in whom spermatozoa were retrieved and Group II were patients in whom no spermatozoa could be retrieved. SRR, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), and testosterone levels, and the volume of testicles were compared between groups. In addition, FR, IR, CPR and LBR were determined. Sperm retrieval was achieved in 37 (27.6%) patients (Group I), and the remaining 97 (72.4%) patients made Group II. There were no significant differences in age, infertility time, testicular volume, serum FSH, LH and testosterone levels between Groups I and II (p > 0.05). Intracytoplasmic sperm injection (ICSI) was performed in 36 patients. FR, IR, and CPR were 60.86 ± 23.03, 36.53 ± 41.78 and 51.3% respectively. Cycle and patient based LBRs were 37.8 and 45.1% respectively. SRR in SCOS is lower than patients with non‐obstructive azoospermia (NOA) in general. No parameters to predict spermatozoa retrieval were determined. In patients with SCOS, ICSI achieves similar live birth rate to other patients with NOA.

Effects of Selective Alpha-1-Adrenergic Receptor Blockers on Bladder Weight

Introduction: This study was undertaken to investigate the effects of two different α1-adrenergic blockers on bladder hypertrophy using ultrasound-estimated bladder weight (UEBW) and to assess the relation between changes in UEBW and other objective and subjective parameters of disease severity in patients with benign prostatic hyperplasia (BPH). Materials and Methods: 41 men were enrolled in the study and they were subjected to either watchful waiting (group 1) or α1-adrenergic receptor blocker therapy (group 2 with alfuzosin; group 3 with tamsulosin). The patients were investigated by symptom evaluation using the International Prostate Symptom Score (IPSS) and quality of life score (QOL), uroflowmetry and UEBW. The parameters were assessed again 3 months after initiation of treatment and compared with the initial values. Results: While the mean UEBW increased in group 1 (42.2 ± 10.3 to 52.5 ± 12.2 g), it decreased in both the other groups that received α-blocker therapy (61.3 ± 18.7 to 41.1 ± 13.2 and 59.4 ± 17.2 to 43.5 ± 17.6 g, respectively). In groups 2 and 3, the mean UEBW, post-void residual urine, IPSS and QOL values decreased, and the mean maximum flow rate increased. All of the changes in group 2 and all except QOL in group 3 were statistically significant (p < 0.05). The changes correlated well with each other with regard to treatment success. The highest decreases in UEBW were encountered in patients with heavier bladders. Conclusions: UEBW decreases with α1-adrenergic receptor blockers. When used together with the other objective and subjective parameters, UEBW is a promising quantitative parameter as a follow-up tool and can be useful in monitoring the therapeutic effects of α1-adrenergic receptor blockers.

Adult cystic nephroma: A case report and a review of the literature

A 23-year old women who underwent radical nephrectomy due to right renal mass is presented. The histopathological examination is reported as adult cystic nephroma, a rare benign lesion of the kidney. The epidemiology, differential diagnosis, histopathological features, and treatment alternatives are discussed and the literature is reviewed.