Giant Ectopic Ureter Mimicking Pelvic Organ Prolapse: A Case Report

Ectopic ureter is one of the most common urinary tract anomalies. We, herein, present a case of a giant ureter with ectopic orifice, mimicking pelvic organ prolapse, which is the first in the literature. A 59-year-old female patient presenting with frequently recurrent urinary tract infection had grade 3 pelvic organ prolapse. On examination, the organ producing the appearance of prolapse was found to be a right ureter of giant size and was obstructed by a large stone at the distal segment. The proximal end of the ureter ended blindly. After exploration, the stone was removed, the ureter was detached from the urethra, and the lumen was tied off and cut 5 cm proximally. At 6 months postoperatively, the patient is being followed up without any clinical problems. In such cases with nonfunctioning renal segment draining proximally, the chance of cure can be obtained without a need for a comprehensive intervention such as total abdominal ureterectomy

Can High Preoperative Neutrophil-lymphocyte Ratio Predict the Recurrence and Progression Risk of Non-muscle-invasive Bladder Tumors?

WOS: 000469807700001Objective: Neutrophil-lymphocyte ratio (NLR) is a well-known, cost-effective biomarker of inflammatory conditions, and its protumor effect has been shown in different types of cancers. In this study, we aimed to evaluate the relationship between blood parameters, especially NLR, with the risk of progression and recurrence in non-muscle-invasive bladder tumors (NMIBT). Materials and Methods: Seventy-six patients were included in the study. Patients were divided into low, moderate and high-risk groups according to the risk of progression and recurrence. The preoperative blood parameters of the patients were recorded from the patient files and the NLR of each patient was calculated. These parameters were compared in terms of progression and recurrence risk groups. P values less than 0.05 were accepted statistically significant. Results: Neutrophil-lymphocyte ratio was significantly higher in the high-risk group in both the progression and recurrence risk groups than in the low and moderate risk groups (p<0.001). In addition, according to the post hoc results, the NLR values in the high-moderate and moderate-low risk groups showed significant differences (high-moderate and moderate-low values in terms of risk of recurrence were 4.66 vs 3.67 and 3.67 vs 2.88, respectively, p<0.001; high-moderate and moderate-low values in terms of risk of progression were 4.72 vs 3.68 and 3.68 vs 2.92, respectively, p<0.001). Conclusion: In our study, we found that groups with high risk of recurrence and progression had higher NLR values in patients with NMIBT. NLR, which is cheap, rapid and routinely applied in preoperative evaluation, is a promising biomarker in the prognostic classification of bladder tumors. Well-designed, large-scale prospective studies with long-term follow-up are needed to determine the role of NLR in this issue

Evaluation of Lower Urinary Tract Functions in Diabetic Patients

WOS: 000461022400010Objective: In this study, we aimed to investigate the effect of diabetes-related metabolic changes and chronic complications on lower urinary tract (LUT) functions. Materials and Methods: The study included 286 adult patients with type 1 and type 2 diabetes mellitus (DM). All patients' demographic data, diabetes-specific history, laboratory and physical examination findings were recorded. All the data were compared with uroflowmetric parameters and the scores of questionnaires used for evaluation of LUT symptoms and functions. Results: In the presence of diabetic peripheral neuropathy (DPN), average urinary flow rate (Q(ave)) International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score and the Overactive Bladder-questionnaire Short Form (OAB-q SF) score were significantly affected. In the presence of stage 3 or over diabetic nephropathy (DN), ICIQ-SF score was significantly higher. Also, in elderly group,Q(ave) and OAB-q SF score were significantly affected. The Q(ave) was lower both in patients who underwent any surgery due to diabetic complications and in patients with DM-related diseases. Q(ave), and OAB-q SF score were significantly lower in males. Type 2 DM was associated with postvoid residual (PVR) increase and Q(ave) decrease. Poor glycemic control was associated with lower OAB-q SF score. Finally, vitamin D deficiency was found to be associated with an increase in PVR volume. Conclusion: The present study showed that DPN, stage 3 or over DN, aging, DM-related diseases and surgeries, male gender, type 2 DM, poor glycemic control and vitamin D deficiency cause a tendency to develop any kind of LUT dysfunction

The effect of Hydrodistension in combination with Pentosan Polysulfate on treatment outcomes and compliance in the treatment of bladder pain syndrome

WOS: 000464434700036PubMed ID: 30881421Objective: In the present study, we investigated the efficacy of bladder hydrodistension combined with pentosan polysulfate (PPS) treatment in interstitial cystitis (IC)/bladder pain syndrome (BPS). Methods: In this study, 339 patients diagnosed with IC/BPS were categorized into two groups. The first group only received 300 mg/day PPS, while the second group received 300 mg/day PPS following bladder hydrodistension. The results were evaluated at the 3rd, 6th, and 12th months after the first dose using the interstitial cystitis symptom index (ICS!), international cystitis problem index (ICPI), visual analog scale (VAS), and female sexual function index (FSFI). Results: PPS treatment started just after hydrodistension was significantly more effective than PPS treatment alone and combined treatment significantly reduced the rate of non-compliance such that, at the end of the 3rd month, 12.1% patients in Group-1 did not continue their treatment whereas only 1.9% of patients in Group-2 did not continue. Conclusions: The study results indicate that PPS treatment started just after hydrodistension yields significantly better results in terms of both symptom improvement and treatment compliance in patients with IC/BPS

A new technique in the treatment of ureteroenteric anastomosis stricture: Repair of ureteroenteric anastomosis stricture with low lombotomy incision (retroperitoneal approach)

WOS:000633508400001PubMed: 33743548Introduction and aim Ureteroenteric anastomosis stricture (UEAS) is one of the complications of urinary diversion and may lead to serious consequences. in this study, we evaluated our UEAS revision technique outcomes performed with a low lombotomy incision in the lateral decubitus position. Materials and methods Eleven patients who underwent surgical repair due to isolated right UEAS between January 2010 and June 2019 were included in the study. Anastomosis stricture was confirmed by ultrasonography, computed tomography or magnetic resonance urography techniques. Ultrasonography was used to detect hydronephrosis, which is a finding secondary to stricture. However, opaque urography imaging methods were used to confirm the definitive diagnosis of the stricture. Demographic and clinical data, preoperative and postoperative 3rd month serum creatinine, estimated glomerular filtration rate (eGFR) and dynamic renal scintigraphy data of patients were evaluated. Results The mean operation time was 49.7 +/- 9.3 minutes. No perioperative complications were observed. While the overall stricture rate was 11.4%, the isolated right-sided stricture rate was 5.7%. Preoperative and postoperative serum creatinine values were similar. Preoperative eGFR value was 58.8 +/- 12.9 mL/min/1.73 m(2) and postoperative value was 53.5 +/- 11.5 mL/min/1.73 m(2). T1/2 level decreased in postoperative period (22.3 +/- 8.2 min vs 15.1 +/- 4.3 min). Conclusions Open revision of the UEAS with retroperitoneal approach provides lower morbidity rates and shorter hospitalisation time compared to other methods. The retroperitoneal approach is the main advantage of this technique and prevents morbidity caused by other techniques performed intraperitoneally and owing to it is an open technique, it can be easily applied in isolated right-sided UEAS

Comparison of percutaneous nephrostomy and double J stent in symptomatic pregnancy hydronephrosis treatment

WOS: 000431261100030PubMed ID: 29714462Background/aim: We aimed to compare the success rate of percutaneous nephrostomy (PCN) and double J stenting (DJS) in the treatment of symptomatic pregnancy hydronephrosis. Materials and methods: Diagnosis and grading of hydronephrosis were performed by urinary ultrasound (USG) and Doppler mode was used for evaluation of renal arterial resistivity index (RI). Patients were divided into two groups according to the method used for the treatment of hydronephrosis: group A (PCN, n = 38) and group B (DJS, n = 46). A P value < 0.05 was considered significant. Results: The number of patients requiring second intervention was higher in group B (P = 0.0018) and time to secondary intervention was significantly earlier in group B also (P = 0.0025). The number of tertiary intervention was again higher in group B (5/16 vs. 1/6) and the need for tertiary intervention was higher in patients who underwent DJS implantation as a secondary intervention than those who underwent PCN (5/11 vs. 1/11, P = 0.0012). The time to tertiary intervention was longer in patients with PCN than in those with DJS (P = 0.0048). Conclusion: PCN may be preferred to DJS in symptomatic pregnancy hydronephrosis because it requires fewer re-interventions after longer times

Artificial urinary sphincter implantation: what do patients and urologists face?

WOS: 000301993300006Aim: To investigate the main problems faced by patients undergoing artificial urinary sphincter (AUS) implantation and the important factors that the surgeon should take into consideration in predicting these problems. Postprostatectomy incontinence continues to be a complication that most severely impairs the quality of life. Materials and methods: Of 82 initial patients, 64 patients with complete data who responded positively to the invitation for examination were divided into 3 groups: patients with implant-tissue interaction, patients with no problems, and those with mechanical failure. Univariate analysis, Student's t-test, Pearson's chi-square test, logistic regression, and Kaplan-Meier analysis were used in this study. Results: Of the 64 patients, 20 (31.2%) were reoperated on with a mean follow-up of 62 (range: 1-120) months. It was found that the risk of urethral erosion was higher in patients with obesity (P = 0.04), diabetes (P < 0.0001), radical prostatectomy (P < 0.0001), and adjuvant radiotherapy (P < 0.0001), and in those with the suspicion of urethral stricture who would undergo sphincter implantation within at least 3 months after the latest surgical treatment of urethral stricture, compared to other patients (P < 0.0001). Additionally, we found that surgical experience also had a strong effect on the risk of urethral erosion. Conclusion: Given increasing medicolegal awareness, patients should be informed of the possible need for reoperation, and those in the specific patient groups mentioned above should particularly be notified of a higher risk before implantation of an AUS