Objective: Management of nephrolithiasis during pregnancy can be challenging because of the potential risks to the mother and fetus. Diagnosis and treatment can be a dilemma owing to the anatomical and physi-ological changes, besides the limitation in the use of X-rays. The aim of this article was to identify any case series or case reports where percutaneous nephrolithotomy (PCNL) was used as a treatment modality for nephrolithiasis in pregnancy.Material and methods: A review of the literature was performed using Medline, EMBASE, CINAHL, and Scopus from 1990 to October 2019. A search was conducted using the following search terms: “urolithiasis,” “renal stones,” “stone disease,” “kidney stones,” “pregnancy,” “pregnant,” “percutaneous nephrolithotomy,” “PNL,” and “PCNL.” The initial search strategy retrieved 52 articles, but after going through them, only 7 were suitable for inclusion in this review.Results: Overall, seven studies reported regarding 16 patients who underwent PCNL procedure during pregnancy. The patients were aged 18–34 years and had the procedure between 11 and 32 weeks of gestation. Most stones were in the renal pelvis or pelvic-ureteric junction and sized 8–40 mm, with the most common indication for the intervention being refractory pain. Most treatments used ultrasound guidance, and X-ray fluoroscopy was employed only in two cases. No complications occurred to the mother or fetus in any of the case reports, suggesting that PCNL is a safe and feasible treatment for patients with persistent symptoms when conservative treatment has failed.Conclusion: All the reported cases of PCNL achieved stone-free status with no complications. Although PCNL has been evidenced to be safe, it must be performed by experienced endourologists after careful con-sultation with the obstetricians. Patient counseling and multidisciplinary team decision-making are para-mount in such complex scenarios
|
Objective: Holmium laser enucleation of the prostate (HoLEP) is an established method for treating benign prostatic obstruction. Nonetheless, its steep learning curve limits its wide distribution. The purpose of the present study was to demonstrate the impact of laparoscopic experience on HoLEP learning curve by evalu-ating the association between learning curves of surgeons performing both laparoscopy and HoLEP surgery.Material and methods: A questionnaire was prepared to identify surgeon’s experience on laparoscopy and HoLEP, as well as their learning curves. This questionnaire was then distributed via e-mail to 110 urologists who are actively involved in endourology/laparoscopy.Results: Of the 110 urologists, 80 (72.7%) responded and completed the questionnaire. Of the 80 surgeons, 47 (58.8%) reported that they had completed the HoLEP learning curve with <20 cases. Moreover, 33 (41.2%) reported that they were able to complete the learning curve by performing >20 cases. Completion of the HoLEP learning curve in <20 cases was reached at 1.3%, 13.8%, and 43.8% by beginner, moderate skilled, and experienced laparoscopists, respectively (p<0.001).Conclusion: Laparoscopic experience appears to be beneficial for surgeons while learning HoLEP. Highly experienced laparoscopic surgeons have a shorter HoLEP learning curve.
|
Objective: Pediatric urolithiasis is a globally growing problem. The composition and frequency of urinary tract stones vary not only among different countries, but across various regions in a country. Hence, we aimed to identify the types and frequencies of urinary tract stones in children from our region (Inner West-ern Anatolian part of Turkey), and to compare our findings with the results from other regions in our country.Material and methods: In this retrospective analysis of 53 pediatric urolithiasis cases that were treated in our hospital between 2009 and 2019, the demographic data, clinical course, radiological and metabolic find-ings, the recurrence rate, and the composition of the stones were evaluated.Results: The mean age of the patients was 5.9±4.6 (0.5–18) years, and there were 30 (56.6%) girls and 23 (43.4%) boys. An analysis of the composition of the stones revealed that the majority (85%) consisted of calcium oxalate. The highest risk of recurrence and the need for multiple shockwave lithotripsy (SWL) sessions or surgical intervention appeared to be related with the presence of whewellite stones, which are the most challenging stones in childhood.Conclusion: According the study results, the urinary stone types vary across different regions in our coun-try, and the frequency of uric acid stones decreased going westward, while the frequency of oxalate stones increased. We conclude that this difference in the frequency of the type of urinary stones might reflect the regional dietary habits. Regional frequency and etiology studies for the types of urolithiasis may facilitate the approach to the treatment of urolithiasis.
|
Objective: Infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB) can range from asymptomatic bacteriuria and febrile or non-febrile urinary tract infection (UTI) to sepsis. Cleaning of rectal mucosa with topical antiseptics such as povidone iodine or chlorhexidine before the pro-cedure are alternative prophylaxis methods. We aimed to investigate the effects of these two different topical antiseptic agents on infectious complications and their superiority to each other.Material and methods: The study was conducted with 200 patients. Rectal mucosa cleansings were per-formed in 50 patients with povidone iodine and 49 patients with chlorhexidine. The remaining 101 patients did not receive any antiseptic treatment. The results were examined according to the hospital admissions or hospitalization for the first 30 days after the procedure due to UTI, body temperature >38.5°C, sepsis, hematuria, rectal bleeding, and urinary retention.Results: The mean age of study population was 63.3±7.26 years, and the mean prostate specific antigen value was 13.96±29.5 ng/mL. Acute prostatitis occurred in 14 patients (7%), 9 of whom were hospitalized due to sepsis after TRUS-PB. Statistically significant less acute prostatitis was observed in those patients who were treated with topical rectal antisepsis (topical rectal antisepsis 2% vs. no rectal antisepsis 12.1%, p=0.01). Chlorhexidine and povidone iodine were not superior to each other in terms of inhibiting the devel-opment of acute prostatitis (chlorhexidine 2% vs. povidone iodine 2%, p=1.00).Conclusion: Rectal mucosal cleansing with chlorhexidine or povidone iodine before TRUS-PB prevented the development of sepsis due to acute prostatitis. We recommend that this effective method, which is easy to apply, cheap, reliable, easily tolerated should be used in all prostate biopsy practice.
|
In this rapid review, we aimed to evaluate the effect of coronavirus disease 2019 (COVID-19) on renal functions and mortality of patients with kidney diseases. We searched MEDLINE, The Cochrane Library, Scopus, Embase, Web of Science, UpToDate, and TRIP databases using the following keywords: COVID-19, COVID19, 2019-nCoV, 2019-CoV, coronavirus, SARS-nCoV-2, urology, cancer, bladder, prostate, kidney, trauma, stone, neurogenic, and reconstructive. The initial search resulted in 495 records. After the primary screening of titles, abstracts, and full texts and removing duplicates, 10 articles were selected and included in this rapid review. Moreover, we performed meta-analysis of binary data for the outcomes with sufficient data. Owing to a high level of heterogeneity because of different study designs and contexts, we used a random model for the meta-analysis. Only 5 studies were eligible for the meta-analysis. In these studies, comprising 964 COVID-19 positive patients, the cumulative event rate of acute kidney injury (AKI) was 7.1% (95% confidence interval: 1.8%–24.5%, p<0.001, I2=92.4). Based on the qualitative synthesis of the 10 included studies, patients with COVID-19 and kidney diseases had higher risk of in-hospital mortality. If AKI occurs because of the novel coronavirus, the mortality rate will be very high. Therefore, we need further investigations and more studies to recognize the extent and the cause of renal involvement in COVID-19.
|
Objective: Prostatic abscesses (PAs) are an uncommon urologic presentation with widely varying approaches in their diagnoses and management. This study, therefore, aims to systematically review the literature of PAs to identify common clinical presentations, evaluate currently utilized diagnostic and treatment modalities, and assess their outcomes. Material and methods: A systematic review of the literature was performed using the MEDLINE and EMBASE databases, from January 1968 to June 2019. Outcome measures extracted from identified articles included age, the underlying disease, identified pathogens, diagnostic tool utilized, treatment used, and various subsequent clinical outcomes. Results: The literature search yielded 683 articles, with a final twelve included in the review, representing a total of 210 patients. Transrectal ultrasonography (TRUS) was the most commonly used imaging tool used to identify PAs in all twelve studies. The PAs were treated with conservative antibiotic treatment in seven studies. Transurethral resection of the prostatic abscess (TURP) was utilized in eight studies with an average abscess size of 3.87 cm (3.0-4.0 cm) and with an average hospital stay of 10.22 days in those undergoing TURP. Transperineal aspiration was seen in five studies and offered a less invasive treatment modality. Finally, TRUS-guided needle aspiration was seen in seven studies with an average hospital stay of 23.25 days. This was the longest of any identified modalities with an additional high rate of abscess recurrence. Conclusion: Diagnosis and treatment practices of PAs remain widely varied in the literature due to a lack of clear guidelines. Based on the current evidence, we provide recommendations of treatment based on abscess size, patient age, and clinical condition. While smaller abscesses may be suited to antibiotic or TRUS-guided aspiration, transurethral approaches should be considered for larger and more complex abscesses. However, the current evidence remains poor with further research required to determine the optimum treatment modalities for patients.
|
Objective: Guidelines recommend 4 weeks of thromboembolic prophylaxis in patients who undergo major surgery for solid malignancies. However, there are limited head-to-head comparisons of risk of venous thromboembolic complications in patients with and without cancer undergoing similar surgical procedures. The purpose of this study was to compare risk of venous thromboembolic complications following major renal surgery and cystectomy between patients with and without cancer at the time of surgery. Material and methods: In the nationwide Danish National Patient Registry, which captures all hospital contacts, including surgical procedures, we identified 8,645 patients who underwent major renal surgery (4,273 without cancer and 4,372 with cancer) and 2,164 patients who underwent cystectomy (359 without cancer and 1,805 with cancer) in 2000–2009. The rate of venous thromboembolic events within 6 months from surgery was compared for patients with and without cancer after stratification on organ using Chisquared test. Results: There was no difference in the rate of venous thromboembolic complications within the first 6 months after major renal surgery (0.4% and 0.3% [p=0.91]) or cystectomy (1.3% and 0.8% [p=0.44]) for patients with and without cancer. The cost for 28 days of Tinzaparin 4.500 IE administered by the patient was €112, whereas the cost if administered by a community nurse was €1.988. Conclusions: Our study questions the different recommendations in thromboembolic prophylaxis between patients with and without cancer after major renal surgery and cystectomy.
|
Objective: Microscope-assisted vasovasostomy (MAVV) is a standard procedure used to reverse vasectomies. Robotic surgery has been established primarily for technically demanding urological procedures and has also been recently implemented in male reproductive surgery. We aimed to review the current evidence of robot-assisted vasovasostomy (RAVV) and robot-assisted vasoepididymostomy (RAVE).
Material and methods: We performed a systematic literature review using PubMed to identify relevant original articles. We identified 2017 records through database search, and after removing duplicates, 782 records remained for further analysis.
Results: In total, 12 human and three animal studies were selected. Reported vasal patency rate ranges were 88%–100% for RAVVs and 55%–61% for RAVEs. The sperm count and postoperative pregnancy rates of RAVV ranged between 8.4 × 106–120 × 106 sperm/mL and 65%, respectively. Finally, procedure times in the human studies, recorded for extracorporeal RAVVs and RAVEs ranged from 97 to 238 minutes.
Conclusion: Robot-assisted vasal reversal is feasible with similar patency rates as for the microsurgical approach and showing comparable outcomes. Additional benefits of this technique include improved vision and movement precision.
|
Objective: The objective of this study was to evaluate the urofl owmetry test results performed for normal and urgent desire to void and their correlation with International Prostate Symptom Score (IPSS) values in adult male patients having lower urinary tract symptoms (LUTS) complaints.
Material and methods: In this prospective study, a total of 83 patients were included. With a normal desire to void, maximum fl owrate (Qmax)-normal, average fl owrate (Qaverage)-normal, and void volume (VV)-normal values were obtained. Residual urine volume was examined by suprapubic ultrasound within 5 minutes following urofl owmetry, and calculated. The maximum bladder volume (MBV)-normal value was calculated by adding the residual-normal volume and VV-normal values. The same procedures were repeated the next day with the sensation of urgency, Qmax-urgency, Qaverage-urgency, VV-urgency, residue-urgency, MBV-urgency values were obtained.
Results: Statistically significant difference was determined for all parameters, and higher values were obtained in the urgency group for all parameters (p<0.05). A correlation analysis was performed for the Qmax-normal and Qmax-urgency values and the IPSS. Both parameters were not statistically significantly correlated with IPSS, but the correlation coefficient of Qmax-urgency was found to be higher than Qmax-normal (p=0.85, Correlation Coefficient=-0.022 for Qmax-normal and IPSS; and p=0.069, Correlation Coefficient=-0.214 for Qmax-urgency and IPSS, respectively).
Conclusion: Our study is the first study examining the effect of bladder sensitivity on urofl owmetry parameters in male patients having LUTS. More reliable results might be obtained in adult male patients with LUTS complaints when the urofl owmetry test is performed with a feeling of urgency to void. Our results need to be supported by more objective criteria, rather than subjective criteria such as IPSS.
|
tive bulbar urethral strictures and analyze the short-term outcomes.
Material and methods: We retrospectively evaluated a prospectively maintained database of patients with near-obliterative bulbar urethral strictures (>2 cm), who underwent double-face augmentation urethroplasty. The patients’ demographic characteristics, clinical data, and data regarding the investigations conducted were analyzed. Near-obliterative urethral stricture was defined as lumen <6 Fr. Double-face urethroplasty was performed using a ventral approach, during which dorsal inlay and ventral onlay buccal mucosal graft (BMG) augmentation were performed. A successful outcome was defined as normal voiding without the need for any instrumentation to improve the urinary fl ow rate.
Results: A total of 37 patients with a mean age of 50±11.7 years, who underwent this procedure were included in the study. The mean stricture length was 5.2±0.95 cm. The mean length of the dorsal inlay BMG augmentation was 3.1±0.5 cm and that of the ventral onlay BMG augmentation was 6.3±1.2 cm. Post-void dribbling (18.9%) was the most commonly reported complication. The maximum fl ow rates and symptom scores significantly improved in both groups compared with the preoperative parameters (p<0.001). The incidence of both erectile dysfunction and ejaculatory failure was reported in 6 (16.2%) patients; respectively. The overall success rate was 86.5% at a median follow-up period of 36 months (IQR: 26.5–43).
Conclusion: Double-face augmentation urethroplasty is a safe and feasible option for near-obliterative bulbar urethral strictures, and our study showed satisfactory short-term outcomes for the same.
|
