Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1–88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities

A Rare Renal Epithelial Tumor: Mucinous Cystadenocarcinoma Case Report and Review of the Literature

Primary renal mucinous cystadenocarcinoma is a very rare lesion of kidney which originates from the metaplasia of the renal pelvic uroepithelium. Only one case with primary mucinous cystadenocarcinoma has been reported in the English literature. We report second case of mucinous cystadenocarcinoma which was radiologically classified as type-IIF Bosniak cyst in peripheral localization. We aimed to present this extreme and unusual entity with its radiological, surgical, and pathologic aspects under the light of literature

The Outcomes of Laparoscopic Radical Prostatectomy

Aim: In this study, we analyzed the surgical data and indications of patients, who underwent laparoscopic radical prostatectomy (LRP) with the Heilbronn technique, according to the techniques and observed complications. Methods: Between November 2006 and September 2008, 61 patients with prostate cancer underwent LRP at Haseki Training and Research Hospital, Department of Urology. The analyzed preoperative factors were mean age, body-mass index, PSA value, prostate volume measured by transrectal ultrasonography, Gleason score, and hemoglobin levels. Mean operation time, urethrovesical anastomosis time, requirement of blood transfusion and complications were investigated. The postoperative factors such as duration of hospitalization and catheterization were also analyzed. Results: The mean operating time was 257.1±64.6 (190-460) and the mean urethrovesical anastomosis time was 47.6±12.1 (29-90) minutes. Pelvic lymphadenectomy and nerve sparing surgery were performed in 62% and 32% of the patients, respectively. Blood transfusion was needed in 36% of patients in perioperative or postoperative period. The mean hospitalization time was 4.4±1.3 days. The mean urethral catheterization time was 9.3±2.9 (5-17) days. Conclusion: The data of our series, which is one of the first large series of LRP in our country, show that LRP will evolve as an important surgical procedure in our country in the future. The advance in surgical training programs and skills should have an important role to make it a commonly used technique. (The Medical Bulletin of Haseki 2010; 48: 28-33

Efficacy of Percutaneous Nephrolithotomy in Patients with Neurogenic Bladder Dysfunction

Aim: Patients with neurogenic bladder dysfunction (NBD) are at increased risk of urolithiasis. We review our experience with percutaneous nephrolithotomy (PCNL) on this group of patients with special attention paid to the risks of surgical complications. Methods: A total of 18 cases with NBD underwent PCNL at our institution. Neurogenous lesions included traumatic spinal cord injuries in 8 cases, sequel of cerebrovascular accident in 2, meningitis in 2, polio in 4 and kyphoscoliosis in 2. Percutaneous access was achieved under fluoroscopic guidance with a patient in the prone position and tract was formed using balloon dilation system. Stone disintegration was accomplished with a pneumatic lithotripter. Results: There were 8 staghorn stones, 6 pelvi-calyceal stones, and 4 isolated renal pelvic stones. The mean operation time was 97.5±18.7 (range: 80-120) minutes and the mean hospitalization time was 3 (range: 2-5) days. Stone-free status was achieved in 13 (72.2%) renal units. 4 (22%) patients with 2 staghorn stones and 2 pelvi-calyceal stones had clinically insignificant residual fragments (CIRF). Hydropneumothorax was encountered in 1 case with kyphoscoliosis, in whom an intercostal access was necessary. Conclusion: PCNL in patients with NBD is safe and effective, with outcomes comparable to that of patients without such a disorder. (The Medical Bulletin of Haseki 2010; 48: 76-9

A Rare Anomaly of Testicular Descend: Transverse Testicular Ectopia and Review of the Literature

Crossed ectopia or transverse testicular ectopia (TTE) is an extremely rare anomaly of testicular descent in which both gonads migrate along the same inguinal canal to the hemiscrotum. Fewer than 100 cases have been reported in the literature. Most cases of TTE involve a concomitant inguinal hernia on the contralateral side. A radiological evaluation and laparoscopy are essential for appropriate diagnosis and treatment. Although a correct diagnosis is not preoperatively made in most cases, we present a 15-year-old boy in whom TTE was diagnosed by magnetic resonance imaging. A laparoscopic evaluation and treatment (orchiectomy) was uneventfully performed

The effects of percutaneous nephrolithotomy on renal function in geriatric patients in the early postoperative period

Since percutaneous nephrolithotomy (PNL) is a surgical intervention, it may show deteriorative effects on renal function in the early postoperative period. In this study, the deteriorative effects of PNL on renal function were investigated in the geriatric population, and it was compared to the non-geriatric population

Rectovesical Fistula Related to Transurethral Resection of a Bladder Lesion

A rectovesical fistula (RVF) is an uncommon complication of urooncologic surgery. Although several RVFs have been reported, our case is the first reported RVF in the literature that iatrogenically occurred after transurethral resection of the bladder. A single-stage primary repair with omental flap interposition without a colostomy was successfully performed because of the persistence of the fistula during followup. After 6 months of followup, no fistula or bladder mass was detected