Comparison of Intrarenal Retrograde Surgery Results Between Different Age Groups

Objective: In this study, we aimed to investigate whether there is a difference in the reliability and efficacy of the method according to age in patients divided into 3 different age groups who underwent RIRS due to kidney stones. Materials and Methods: Patients who underwent Retrograde Intra Renal Surgery (RIRS) for kidney or ureteral stone disease at the Urology Clinic of Health Sciences University Umraniye Health Application and Research Hospital between May 2017 and January 2021 were retrospectively screened, and those aged 20-80 years were included in the study. The demographic and clinical data of the patients and stone-related data were recorded. Patients aged 20-40 years were classified as Group 1, those aged 41- 60 years as Group 2, and those aged 61-80 years as Group 3. Results: After the inclusion and exclusion criteria were applied, the sample consisted of a total of 320 patients, of whom 121 (37.8%) were in Group 1, 133 (41.5%) were in Group 2, and 66 (20.6%) were in Group 3. The mean operative times and stone-free rates were similar between the groups. However, the mean hospital stay was significantly longer in Groups 3 compared to Groups 1 and 2. The minor complication rates were 2.4% in Group 1, 3% in Group 2, and 13.6% in Group 3, indicating a statistically significantly higher value in Group 3 compared to the remaining two groups (p=0.03). The major complication rates of Groups 1, 2, and 3 were 0.8%, 0.7%, and 7.5%, respectively. Accordingly, Group 3 had a significantly higher rate than Groups 1 and 2 (p=0.04). Conclusion: RIRS can be performed on the elderly with success rates comparable to other age groups. However, the elderly, who represent a higher-risk patient population with more comorbidities, have increased rates of minor and major complications both in the perioperative and postoperative periods

Safety and efficacy of PNL vs RIRS in the management of stones located in horseshoe kidneys: A critical comparative evaluation

Aim: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). Patients and methods: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. Results: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. Conclusion: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK

Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy?

Background: In patients undergoing robot-assisted radical prostatectomy (RARP), pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM) due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess effects of body mass index (BMI), comorbidities, intra-operative positioning, fluid restriction and length of surgery on the development of RM in RARP patients during the perioperative period. Subjects and Methods: The study included 52 American Society of Anesthesiologists I–II patients aged 50–80 years with BMI >25 kg/m2, who underwent RARP. Fluid therapy with normal saline (1 ml/kg/h) and 6% hydroxyethyl starch 200/05 (1 ml/kg/h) was given during the surgery. Charlson comorbidity index (CCI), operation time (OT) and Trendelenburg time (TT) were recorded. Blood samples for creatine phosphokinase (CPK), blood urea nitrogen, creatinine (Cr), aspartate aminotransferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), creatinine kinase-MB, cardiac troponin I and arterial blood gases were drawn at baseline and on 6, 12, 24 and 48 h. RM was defined by serum CPK level exceeding 5000 IU/L. Results: Seven patients met predefined criteria for RM. There were positive correlations among serum CPK and Cr, AST, ALT and LDH levels. However, there was no significant difference in BMI, OT and TT between patients with or without RM (P > 0.05). CCI scores were higher in patients with RM than those without (3.00 ± 0.58 vs. 2.07 ± 0.62; P< 0.01). No renal impairment was detected among patients with RM at the post-operative period. Conclusions: It was found that comorbid conditions are more important in the development of RM during RARP rather than BMI, OT or TT. Patients with higher comorbidity are at risk for RM development and that this should be kept in mind at follow-up and when informing patients

Methods and Rates of Punishment Implemented by Families to Enuretic Children in Turkey

Purpose Nocturnal enuresis is a serious health problem affecting a significant portion of the population. In this study, we investigated the frequency of punishment methods in nocturnal enuresis (NE) in Turkey and its relationship with other parameters. Materials and Methods A total of 501 children (301 boys and 200 girls) who were admitted to our outpatient clinic due to nocturnal enuresis were included in the study. Mean age was 9.39 years (range 5-18). Prepared questionnaire form inquiring educational status of the family, frequency and implementation and duration of punishment methods was applied to patients and families. Results At least one punishment method was applied to 291 (58.1%) of children with NE. Punishment methods of parents were detected as condemnation (257 patients, 51.3%), depriving desires of the child (120 patients, 23.9%), humiliating the child in the presence of other children (113 patients, 22.6%), reprimanding- threatening with punishment (203 patients, 40.5%). This application was found to continue for longer than 1 year in 52% of punished children. Families graduated of high school and above were found to use punishment methods significantly more than others. Conclusion According to the results of our study, a quite high proportion of enuretic children were detected to be exposed to punishment methods. Even, some parents consider that these methods are a part of nocturnal enuresis treatment. We, the doctors, should endeavor more for raising awareness of the community in order to diminish this worrisome behavior

Effect of constipation on acute urinary retention following transrectal prostate biopsy

Purpose: To evaluate the possible effect of constipation on the acute urinary retention (AUR) after transrectal ultrasound-guidedMaterials and Methods: A total of 1,167 patients with prostate-specific antigen (PSA) >4 ng/mL and/or abnormal digital rectal examination underwent a standard 12 core transrectal ultrasound-guided prostate needle biopsy in our hospital and the findings were examined prospectively. Chronic constipation (CC) was defined according to the Rome IV criteria. All cases were well evaluated with respect to clinical-histopathological factors; International Prostate Symptom Score (IPSS), prostate volume, post-voidResults: The mean age of patients was 64.63 +/- 8.31 years, the PSA level was 11.60 +/- 16.83 ng/mL, and the prostate volume was 54.66 +/- 25.44 mL. In 265 cases (22.7%), CC anamnesis was present and AUR developed in 28 (2.4%) of the cases. In the multivariate analysis for the risk of developing urinary retention, prostate volume, pre-operative IPSS, and presence of CC requiring manual maneuvers to facilitate defecation were found to be risk factors (p=0.023, 0.010, and 0.001, respectively).Conclusions: Our findings demonstrated that CC may be a critical factor in the prediction of AUR formation following TRUS PB

A randomized study to assess the efficacy of herbal product to prevent cisplatin-induced nephrotoxicity in a rat model

Objectives: This study aimed to investigate the protective effect and antioxidant activity of an herbal product that made from multiple plants in a rat model of kidney dysfunction induced by intraperitoneal cisplatin. Materials and methods: Twenty-four rats were divided into four different groups namely: Group 1 - control healthy animals without any specific medication, Group 2 - Herbal product only 5 mg/kg, Group 3 - cisplatin only and Group 4 - Herbal product 5 mg/kg + cisplatin. Results: Evaluation of our findings demonstrated a significant (p = 0.017) reduction in Catalase activities and a significant increase (p = 0.001) in renal tissue Malondialdehyde levels in cisplatin- treated rats when compared with the control group. Also, Glutathion and Glutathione peroxidase content revealed significant (p = 0.031) reduction in renal tissues of cisplatintreated rats compared with the control group. Pre-treatment of rats with the herbal product ameliorated these cisplatininduced changes of the antioxidant enzymes. No statistically significant changes were demonstrated in Superoxide dismutase activities in the tissue specimens of any group. Conclusions: This potent antioxidant herbal medicine was found to have potential antioxidant activity, which may in turn to be effective in the protection of kidney tissue resulting from cisplatin application. Therefore, much attention should be given to the possible role of natural dietary antioxidants for protecting the kidney

Impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle invasive bladder cancer patients during COVID-19 pandemic.

Purpose To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). Materials and methods A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values 147 days, OR: 4.883, P 90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. Conclusions This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines