Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy

BACKGROUND: Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon. Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure. CASE REPORT: We present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation. CONCLUSION: Although considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation

Single session endoscopic management of intrinsic ureteropelvic junction obstruction and concomitant renal stone disease in a child: a case report

BACKGROUND: Percutaneous nephrolithotomy is a well known therapeutic modality for stone diseases of childhood. Antegrade and retrograde endopyelotomies are also well defined options of treatment for secondary ureteropelvic junction obstruction. Yet there are few reports regarding endoscopic therapy of intrinsic ureteropelvic junction obstruction. To our knowledge, there exist only a few reports of endosurgical treatment of children with stone disease and with concomitant intrinsic ureteropelvic junction obstruction, in the literature. CASE PRESENTATION: We present the endoscopic management of stone disease and concomitant intrinsic ureteropelvic junction obstruction of a child in one session. CONCLUSION: Percutaneous nephrolithotomy and antegrade endopyelotomy is combined safely with successful outcome in a child

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Impact Of Uterine Weight On The Surgical Outcomes Of Vaginal Hysterectomy

Objective: The aim of this research was to determine the association between uterine weight and surgical outcomes of vaginal hysterectomies (VHs). Materials and Methods: This retrospective cohort study was conducted through a residency training program for performing VH operations (N = 87) in the Hacettepe University Hospital, Sihhiye/Ankara, Turkey. VHs performed for benign gynecologic conditions were included in the study. The patients were divided into 2 groups: (1) uterine weight = 100 g. Clinical characteristics, demographic features, surgical characteristics, and operative complications were compared between the groups. Results: There were 57 patients (65.5%) in group 1 (uterine weight = 100 g). Mean uterine weights were 61.56 +/- 17.98 g in group 1 and 146.30 +/- 45.16 g in group 2. There was no statistically significant difference between the groups in terms of surgical procedures performed concomitantly. A statistically significant difference was found between the groups in terms of age (59.35 +/- 9.95 for group 1 and 47.37 +/- 3.64 for group 2; p < 0.001). In group 2, the following were statistically significantly higher: mean operation time (p < 0.001); delta Hb (p < 0.001); blood loss (p < 0.001); surgical complications (p < 0.005); mean total hospital stay (p < 0.001); analgesic needs (p < 0.001); blood transfusions (p < 0.02); and readmissions to the hospital (p < 0.001). Conclusions: All patients should be evaluated and scanned prior to VH to determine uterine size and weight in order to choose the best surgical approach.WoSScopu

Evaluation of colposcopy after the addition of human papillomavirus testing to the Turkish cervical cancer screening program

Abstract Objective To evaluate colposcopy performance following the human papillomavirus (HPV) DNA screening program in Turkey. Methods Women aged 30–65 years are screened for cervical cancer every 5 years, with individuals positive for HPV 16 and/or 18 or other high‐risk HPV types with abnormal cytology referred for colposcopy. Both HPV test and cytology are obtained at the same visit. If HPV is negative, cytology will not be assessed. However, if HPV is positive, both cytology and HPV genotyping will be performed. Colposcopy‐require was defined as HPV 16/18 positivity or abnormal smear results with any hrHPV positivity, and the remaining patients (normal smear with hrHPV positivity other than HPV 16/18) were grouped as colposcopy non‐required. National data on colposcopy outcomes and unnecessary performance rates in February 2018–2019 were evaluated via a questionnaire. Results A total of 9808 patients were included, divided based on colposcopy requirement: 5751 (58.6%) patients required colposcopy and 4057 (41.4%) did not. Unnecessary colposcopy was performed on 90.1% of the non‐required group (3657 of 4057 patients). In the colposcopy‐required group, 4455 patients (79.9%) underwent punch biopsy; 3194 (57.1%), endocervical curettage (ECC); and 421 (7.5%), “see and treat” in the non‐required group, the results were 2790 (76.3%), 1957 (53.2%), and 211 (5.7%), respectively. A total of 746 cervical intraepithelial neoplasia (CIN)‐3 isolates were detected, including 702 using existing screening and triage with 94.1% sensitivity (702/746). Multiple biopsies were taken in 69.8% (n = 3110) of patients from the colposcopy‐required group and 63.7% (n = 1777) from the non‐required group. The ECC samples included 19 cervical cancers and 212 ≥CIN‐3 lesions in the colposcopy‐required group, and four cancers and 41 ≥CIN‐3 lesions in the non‐required group. The proportion of ≥CIN‐3 lesions detected by ECC only was 4.7% (35 of 746 ≥CIN‐3 lesions). Conclusion Our results showed high rates of unnecessary colposcopies, and a high percentage of multiple and random punch biopsies and ECC