Tufan Çiçek

Percutaneous Nephrolithotomy: Nephrostomy or Tubeless or Totally Tubeless?

OBJECTIVES To compare the feasibility and morbidity of tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) with nephrostomy tube in a single center with selected patient population. METHODS Between July 2006 and February 2008, PNL was performed in 176 patients in this retrospective study. Patients with no serious bleeding or perforation in the collecting system during the operation, stone-free status, or clinically insignificant residual fragments (<4 mm) at the end of the procedure and patients with no more than one access were enrolled in the study. Patients were categorized into 3 groups. In group 1 (n = 43), no nephrostomy or ureter catheters were placed after PNL (totally tubeless group); in group 2 (n = 41), no nephrostomy catheter was placed but antegrade J-stent was used (tubeless group), and in group 3 (n = 92), standard nephrostomy catheters were placed (standard group). Three groups were compared with respect to age, stone volume, postoperative hemoglobin change, transfusion rate, operation time, analgesic requirement, hospitalization time, and complication rates. RESULTS No significant differences were found in mean stone volume, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time and the amount of narcotic analgesic required were significantly higher in group 3 compared with the other groups (P <.05). Complications were observed in 2 (4.6%), 3 (7.3%), and 7 (7.6%) patients in groups 1, 2, and 3, respectively (P = .738). CONCLUSIONS In patients with no major intraoperative bleeding and calyceal perforation, tubeless approach is safe with decreased analgesia requirement and hospital stay.

Bladder perforation related to intrauterine device.

Intrauterine devices (IUDs) are currently one of the most popular reversible contraception methods used world wide. Uterine perforation is a rarely observed complication. The bladder is one of the organs that an IUD can migrate to because of its close proximity to the uterus. There are about 70 cases in the literature of IUDs that have migrated into the bladder. The resulting bladder perforation can be complete or partial. Here, we report 2 cases, 1 of complete migration and the other of partial migration.

Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation.

PURPOSE In this study, we present our experience using balloon and Amplatz dilatation to establish a percutaneous tract. We also discuss advantages and risk factors of both techniques. MATERIALS AND METHODS We retrospectively reviewed medical records of 229 patients who had undergone 235 percutaneous nephrolithotomy procedures. The nephrostomy tract had been dilated using a balloon (42 patients) or Amplatz (187 patients) dilator. Total operating time, preoperative and postoperative hemoglobin concentrations, number of tracts required, stone burden, blood transfusion rates, tract dilatation failures, and the cost of the dilatation system were compared between the groups. RESULTS There were no statistically significant differences in operative time (85.7+/-43.2 v 86.3+/-41.2 minutes; P=0.42), preoperative hemoglobin concentration (14.1+/-1.1 v 13.8+/-1.4 mg/dL; P= .153), postoperative hemoglobin concentration (11.6+/-1.7 v 11.2+/-1.5 mg/dL; P= .601), or blood transfusion rate (18.6% v 21.3%; P= .687) between the two groups. Also, there were no differences in failure rates between the two groups. CONCLUSIONS The Amplatz dilator is comparable with the balloon dilator with regard to efficacy, speed, and safety. The Amplatz dilator is more cost-effective than the balloon dilator. However, kidney hypermobility may be a significant problem during Amplatz dilatation.

Effects of Vardenafil on Testicular Torsion/Detorsion Damage: An Experimental Study in Pigs

Purpose: To investigate the effects of vardenafil HCl on testicular germ cell apoptosis and the expressions of iNOS and eNOS within the bilateral testes after unilateral torsion/detorsion (T/D) in a pig model. Methods: 12 male pigs weighing 50–55 kg were divided randomly into three groups (n = 4). Sham operation and T/D was performed in groups 1 and 2, respectively. Group 3 underwent T/D and received vardenafil (0.4 mg/kg) orally 45 min before detorsion. The testes were left in torsion for 2 h. In all groups, both testes were removed 8 h after the operation for histopathological analysis. Results: Except for group 1, the histopathologic parameters of the ipsilateral testes were higher than in the contralateral testes, and this difference was statistically significant (p < 0.05). Testicular ischemia/reperfusion (I/R) (group 2) resulted in marked increases in germ cell apoptosis, iNOS and eNOS in the ischemic testes compared to the sham-operated group. The pigs treated with vardenafil (group 3) also showed significantly increased apoptotic cells, iNOS and eNOS levels compared to the sham-operated group. Conclusions: The results suggest that vardenafil HCl worsened histopathological changes related to oxidative stress in testicular injury and had no protective effect on testicular I/R injury in pigs.

Bilateral simultaneous totally tubeless percutaneous nephrolithotomy: preliminary report of six cases.

PURPOSE To evaluate the feasibility and safety of bilateral simultaneous tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS From August 2007 to January 2008, six patients underwent bilateral simultaneous totally tubeless PCNL. Patients who needed more than one access, who had significant intraoperative bleeding, and who had pelvicaliceal system perforations or a residual stone were excluded from the study group. Preliminary results were analyzed in six patients. RESULTS Five men and one woman patient with a mean age of 50.1 years underwent a bilateral totally tubeless procedure. The mean stone burden was 524.5 mm(2) (range 100 mm(2)-1800 mm(2)). The mean drop in hemoglobin was 1.55 g/dL (range 0.6-2.6 g/dL). No blood transfusion was necessary in any patient. The mean hospitalization time was 1.8 days (range 1-4 d). A complications was encountered in one patient; the patient had anuria postoperatively for 16 hours, which resolved after the insertion of bilateral Double-J stents. CONCLUSIONS Bilateral simultaneous tubeless PCNL procedure should be kept in mind for selected patients. Prospective randomized studies with large series are necessary for further evaluation of the procedure.

Case report: bilateral simultaneous tubeless and stentless percutaneous nephrolithotomy.

A 39-year-old man underwent percutaneous nephrolithotomy (PCNL) for bilateral renal stone without stent and tube insertion. To our knowledge, this is the first report of bilateral simultaneous tubeless and stentless PCNL. The advantage of this technique in renal stone surgery is discussed.

Skin-to-Stone Distance Has No Impact on Outcomes of Percutaneous Nephrolithotomy

Objective: Skin-to-stone distance (SSD) is a stronger factor than body mass index in predicting the success of shock wave lithotripsy. We aimed to evaluate the impact of SSD on outcomes of percutaneous nephrolithotomy (PCNL). Materials and Methods: The medical records of 1,280 patients who had undergone PCNL between April 2007 and February 2012 were evaluated retrospectively. 192 patients who had had preoperative non-contrasted computed tomography and single renal access were included the study. According to this median SSD value, patients were divided into two groups: group 1 (SSD ≤94 mm) (n = 92) and group 2 (SSD >94 mm) (n = 90). The groups were compared according to operative and postoperative parameters. Results: We found no significant differences between the two groups with regard to stone-free rate, operation time, fluoroscopy time, hospitalization time, visual analog score of pain, stone burden, transfusion rates and complication rates. On the other hand, the mean body mass index of group 1 was significantly lower than that of group 2 (p < 0.05). Conclusions: In this retrospective review of patients undergoing PCNL, we found that SSD has no impact on operative and postoperative outcomes. These results were in accordance with the safety of PCNL in obese patients.

A New Hemostatic Agent (Ankaferd Blood Stopper®) in Tubeless Percutaneous Nephrolithotomy: A Prospective Randomized Study

PURPOSE The present study evaluates the efficiency and reliability of a hemostatic agent ABS (Ankaferd Blood Stopper(®)) in tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS A total of 90 patients were divided into two subgroups. The first group had ABS applied during the intervention, whereas the control group underwent regular tubeless PCNL in this prospective randomized study. Age, stone size, operative time, postoperative hemoglobin change, renal parenchyma thickness, postoperative ureteral catheter removal time, access number, nephroscope time, blood transfusion rate, serum creatinine change, complication rate, visual analogue scale (VAS), and hospitalization time were compared between the two groups. RESULTS Preoperative and postoperative data obtained from both groups were compared. No statistically meaningful differences were found related to variables of mean age, stone size, access number, serum creatinine change, operative time, renal parenchyma thickness, VAS scores, and hospitalization period. Whereas the nephroscope time (minutes) was longer in the ABS group (Group 1 [G1]:3, 33±1, 72 vs G2:2, 62±1, 43, P=0.035), hemoglobin (Hb) decrease, and urine clarity time were statistically lower compared with the control group. Hb decrease was (mg/dL) (G1: 1.40±1.04 vs G2: 1.84±1.15, P=0.034), and urine clarity time was (hour) (G1: 9.60±5.50 vs G2: 11.95±4.71, P=0.012), respectively. Complications were encountered in three (6.6%) patients of the ABS group and in four (8.8%) of the control group. CONCLUSION ABS is an efficient and reliable hemostatic agent in tubeless PCNL. Comparative studies are needed, however, with other hemostatic agents that might be applied in tubeless PCNL.

Tubeless and Stentless Percutaneous Nephrolithotomy in Patients Requiring Supracostal Access

Purpose: To evaluate the feasibility and safety of supracostal access in tubeless and stentless percutaneous nephrolithotomy (PCNL). Patients and Methods: From March 2005 to June 2007, 10 patients underwent tubeless and stentless PCNL via supracostal access. Patients requiring more than 2 percutaneous tracts, or those with significant intraoperative bleeding were excluded from the study. Perioperative and postoperative outcomes for these patients (the study group) were compared with those of a similar number of patients who underwent unilateral PCNL via an intercostal approach with routine placement of a nephrostomy tube before March 2005 (the control group). The 2 groups had a comparable demographic data. Results: Patients undergoing tubeless and stentless PCNL required less analgesia (p = 0.001) and were discharged earlier (p = 0.000) than were those in the control group. The difference in the mean decrease in hemoglobin concentration was not statistically significant. Conclusions: Supracostal access in tubeless and stentless PCNL appears to be safe and feasible, offering the advantages of a lower need for analgesia and a shorter hospital stay without increasing thoracic complications.

Use of cutting balloon in the treatment of urethral stricture: a novel technique.

The peripheral cutting balloon has been used to treat various nonvascular strictures as well as vascular stenosis. In this article, we describe for the first time the use of the cutting balloon in the treatment of patients with urethral stricture. Four patients with bulbar urethral stricture were included in the study. All strictures were successfully dilated with the cutting balloon, and patients were free of symptoms at 6-month follow-up. Cutting-balloon dilatation is a safe, easy-to-perform, and effective treatment for patients with tight urethral strictures.