Urological recommedations of Hadji Pasha’s, a Turkish aged doctor in Anatolia

Objective: Urinary tract conditions have been an important part of diseases from antiquity until today. Historically, many plants and herbs have been used for the treatment of urinary disorders. Methods: Celâlüddîn Hızır bin Ali el-Konevi (Hadji Pasha) is one of the most famous physician who lived in Anatolia between 13th and 14th centuries. He has written one of the most important medical books of that era, "Müntehab-ıŞifa" (solution of wellness) in Turkish. General medical information about the diseases in this book, focus on diagnosis and treatment. Results: The herbal solutions for urological disorders such as, urinary incontinence, urinary stones or erection problems are told in this section.   Conclusion: Many of the herbal medicines addressed in this book are being widely used in current medicine, but the usage of these herbals in daily urology practice is limited. In this study, we aimed to share the advices for the urological diseases and therelated herbal medicines that are named in Hadji Pasha’s book, " Müntehab-ıŞifa ", with today's physicians

A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report

A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux

The effectiveness of local steroid injection after internal urethrotomy to avoid recurrence

Objective: Local steroid injection to the stricture region after internal urethrotomy (IU) is a promising technique to avoid the recurrence, although the effectiveness and safety of this technique is still controversial. We aimed to determine the efficacy and safety of local steroids as applied with the IU procedure. Material-Method: A total of 83 patients data with urethral stricture in men were examined retrospectively. Patients classified in two groups who had steroid injection with internal urethrotomy or not. Metil prednisolone 40 mg was injected with transurethral injection needle in the stricture region at the 5, 7 and 12 o’clock sites at the same session with internal urethrotomy. Procedure was considered successful if patient did not report any voiding difficulty and maximum flow rate > 15 mL/second for a voided volume of at least 150 mL after removal of the catheter. Patient’s age, time to recurrence, previous recurrences were evaluated. Results: The mean age was 56.4 (18-83) years. Of those patients 33/83 had recurrent stenosis. Nineteen out of these 33 recurrent stenosis patients were treated with local steroid injection and 14/33 had no injection. Only two patients of the steroid treated group had recurrence. Despite that 12 patients had recurrence in the steroid non-treated group. Also the primary stenosis patients showed no recurrence at the steroid+ IU group. Conclusions: The use of local steroids with IU seems to decrease the high stricture recurrence rate following IU. When local steroids were administered with complementary intention, the disease control outcomes are encouraging. Further robust comparative effectiveness studies are now required

Is routine ureteral stenting really necessary after retrograde intrarenal surgery?

Objectives: To investigate the situations in which ureteral double-J stent should be used after retrograde intrarenal surgery (RIRS). Patients and Methods: Patients with no ureteral double-J stent after RIRS constituted Group 1, and those with double- J stent after RIRS constituted Group 2. Patients’ age and gender, renal stone characteristics (location and dimension), stone-free status, VAS score 8 hours after surgery, post-procedural renal colic attacks, length of hospitalization, requirement for re-hospitalization, time to rehospitalization and secondary procedure requirements were analyzed. Results: RIRS was performed on 162 renal units. Double-J stent was used in 121 (74.6%) of these after RIRS, but not in the other 41 (25.4%). At radiological monitoring at the first month postoperatively after RIRS, complete stone-free status was determined in 122 (75.3%) renal units, while residual stone was present in 40 (24.6%). No significant differences were observed between the groups in terms of duration of fluoroscopy (p = 0.142), operation (p = 0.108) or hospitalization times (p = 0.798). VAS values determined routinely on the evening of surgery were significantly higher in Group 1 than in Group 2 (p = 0.025). Twenty-eight (17.2%) presentations were made to the emergency clinic due to renal colic within 1 month after surgery. Double-J catheter was present in 24 (85.7%) of these patients. Conclusions: Routine double-J stent insertion after RIRS is not essential since it increases costs, morbidity and operation time

Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy.

To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated

Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy

Purpose: To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated. Materials and Methods: We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (>= 38 degrees C) with pyuria (>= 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariate logistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL. Results: 42 (8.5\%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12\%) of 492 patients had a positive preoperative urine culture. 19 (32.2\% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75\% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95\%C1:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy. Conclusion: We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors for MDR infections to reduce the rate of postoperative infectious complications