Treatment of renal stones with flexible ureteroscopy in preschool age children

WOS: 000336383500008PubMed ID: 24374900The aim of the study is to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in preschool age ( 4 mm, a second-stage RIRS was performed. The pre-operative, operative and post-operative data of the patients were retrospectively analyzed. A total of 65 patients with a mean age of 4.31 +/- A 1.99 years (6 months-7 years) were included in the present study. The mean stone size was 14.66 +/- A 6.12 mm (7-30 mm). The mean operative time was 46.47 +/- A 18.27 min. In 5 (7.69 %) patients, the initial procedure failed to reach the renal collecting system and ended with the insertion of a pigtail stent. The stone-free rates were 83.07 and 92.3 % after the first and second procedures, respectively. Complications were observed in 18 (27.7 %) patients and classified according to the Clavien system. Post-operative hematuria (Clavien I) occurred in 6 (9.2 %) patients, post-operative urinary tract infection with fever (Clavien II) was observed in 10 (15.4 %) patients, and ureteral wall injury (Clavien III) was noted in 2 (3 %) patients. RIRS is an effective and safe procedure that can be used to manage renal stones in preschool age children

Evaluation of sexual function in women with rheumatoid arthritis

Purpose: To evaluate the link between rheumatoid arthritis (RA) and female sexual functioning. Material and Methods: A total of 32 women with RA and 20 healthy age matched controls were enrolled in this study. The participations are asked to complete Female Sexual Function Index (FSFI), The Short form 36 (SF-36) Health Survey and Beck Depression Inventory (BDI) questionnaires. Results: The groups were comparable in terms of demographic characteristics. The women with RA represented significantly worse sexual functioning in category of desire, arousal, lubrication, orgasm, satisfaction domain and total FSFI score compared with healthy women (P = .0001, P = .0001, P = .0001, P = .0001, P = .022 and P = .0001, respectively). The mean BDI scores for the patients with RA were greater than control group (P = .036). Women with RA also had significantly lower quality of life (QoL) parameters: physical functioning, limitations due to physical health, pain, general health, vitality and limitations due to emotional problems compared with healthy women (P = .0001, P = .0001, P = .028, P = .002, P = .001 and P = .0001, respectively). Conclusion: The present study shows that a significant percent of patients with RA had sexual dysfunction and also deterioration in QoL

Evaluation of sexual function in women with rheumatoid arthritis

Purpose: To evaluate the link between rheumatoid arthritis (RA) and female sexual functioning. Material and Methods: A total of 32 women with RA and 20 healthy age matched controls were enrolled in this study. The participations are asked to complete Female Sexual Function Index (FSFI), The Short form 36 (SF-36) Health Survey and Beck Depression Inventory (BDI) questionnaires. Results: The groups were comparable in terms of demographic characteristics. The women with RA represented significantly worse sexual functioning in category of desire, arousal, lubrication, orgasm, satisfaction domain and total FSFI score compared with healthy women (P = .0001, P = .0001, P = .0001, P = .0001, P = .022 and P = .0001, respectively). The mean BDI scores for the patients with RA were greater than control group (P = .036). Women with RA also had significantly lower quality of life (QoL) parameters: physical functioning, limitations due to physical health, pain, general health, vitality and limitations due to emotional problems compared with healthy women (P = .0001, P = .0001, P = .028, P = .002, P = .001 and P = .0001, respectively). Conclusion: The present study shows that a significant percent of patients with RA had sexual dysfunction and also deterioration in QoL

Anthropometric differences in the newborns with brachial plexus palsy, clavicle fracture in pregnancies without risk factor

Amaç: Omuz distosisi açısından düşük risk taşıyan olgularda brakiyal pleksus felci, klavikula kırığı ve omuz/humerus kırığı komplikasyonları nı yaşayan yenidoğanların antropometrik verilerinden yararlanarak antenatal değerlendirmeye yönelik öngörü oluşturmak. Yöntem: Distosik doğuma neden olabilecek fetal makrozomi, maternal diyabet, maternal obezite ve gebelikte aşırı kilo alımı, omuz distosisi öyküsü, doğum indüksiyonu, epidural anestezi gibi risk faktörleri dışlandıktan sonra hastane veri tabanından retrospektif olarak çıkarılan doğum komplikasyonu olguları, aynı obstetrik ve demografik özellikleri taşıyan, ancak doğum travması yaşamayan, aynı tartı ve cinsiyette yenidoğan verileri ile birebir eşleştirildi. Bulgular: 185 yenidoğan komplikasyonu gözlendi; bunların 149 tanesi klavikula kırığı, 8 tanesi omuz ve humerus kırığı, 28 tanesi de brakiyal pleksus felci olarak sınıflandırıldı. Doğum komplikasyonu yaşanan olgularda doğumun 2. evresinin anlamlı şekilde daha uzun olduğu görüldü (p=0.01; 22.41±6.98 dakikaya karşılık 24.23±6.43 dakika). Omuz distosisi, komplikasyonların yaşandığı çalışma grubunda daha sık gözlendi (p=0.0001; sıklığı %32.97’ye karşılık %2.7). Antropometrik ölçümler açısından göğüs çevresi / baş çevresi oranları nın ROC çalışması anlamlı saptandı, oranın 0.97’den büyük olması durumunda (AUC=0.903; sensitivite %77.84, spesifisite %89.73, PPD %88.3, NPD %80.2, LR 7.58) omuz distosisi ve komplikasyonları öngörebileceği görüldü. Komplikasyonların 4000 gramın üstündeki olgularda anlamlı olarak artmaya başladığı saptandı (p=0.029). Sonuç: Doğum kanalı içinde omuzlar ve uzantıları travmaya açıktı r. İleri sürdüğümüz hipotezde neonatal antropometrik veriler komplikasyonlar ile anlamlı şekilde korele bulunmuştur. Bir öngörüde bulunmak için, antenatal dönem ve özellikle de eylem sırasında fetal baş ölçümlerinin yanı sıra ayrıca bisakromiyal çap ve göğüs çevresi ölçümleri yardımcı olabilir.Objective: To make predictions for antenatal evaluation by using anthropometric data of the newborns which undergo the complications of brachial plexus palsy, clavicle fracture and shoulder/humerus fracture in cases with low risk in terms of shoulder dystocia. Methods: After the risk factors that may cause deliveries with dystocia such as fetal macrosomia, maternal diabetes, maternal obesity and excessive weight gain during pregnancy, history of shoulder dystocia, labor induction and epidural anesthesia were ruled out, birth complication cases found in the hospital database retrospectively were matched one by one with data of the newborns which had same obstetric and demographic characteristics, same weights and genders but did not undergo labor trauma. Results: A total of 185 newborn complications were observed, and of these complications, 149 were classified as clavicle fracture, 8 as shoulder and humerus fracture, and 28 as brachial plexus palsy. It was seen that the 2nd stage of labor was significantly longer in the cases which underwent birth complication (p=0.01; 22.41±6.98 minutes vs. 24.23±6.43 minutes). Shoulder dystocia was more frequent in the study group which had complications (p=0.0001; 32.97% vs. 2.7%). In terms of anthropometric measurements, the ROC analysis of thorax circumference / head circumference ratio was significant, and it was seen that shoulder dystocia and the complications could be predicted in case that the ratio is higher than 0.97 (AUC=0.903; sensitivity 77.84%, specificity 89.73%, PPV 88.3%, NPV 80.2%, LR 7.58). It was found that the rate of complications increased significantly in cases which were above 4000 g (p=0.029). Conclusion: Shoulders and its extensions are vulnerable to trauma within birth canal. In our hypothesis, neonatal anthropometric data were significantly correlated with the complications. In order to make a prediction, bisacromial diameter and thorax circumference measurements as well as fetal head measurements may be helpful during antenatal period and labor in particular

A nationwide survey on the impact of COVID-19 pandemic on minimal invasive surgery in urology practice

Objective: The beta-coronavirus (COVID-19) pandemic has changed the clinical approach of 93% of urologists worldwide, and this situation has affected the use of laparoscopic and robot-assisted laparoscopic methods, which are known as minimally invasive surgery (MIS). This study aimed to determine the effects of the COVID-19 pandemic on MIS in urology practice at national level. Design, setting and participants: A total of 234 urologists in Turkey participated in an online survey between August 22 and September 23, 2020. Outcome measurements and statistical analysis: Descriptive statistical analyses were conducted to determine the participants’ demographic characteristics and responses to multiple-choice questions. Results: While 54% of urologists stated that they were concerned about the possibility that the patients planned to undergo MIS were carrying COVID-19 or false-negative for the virus, 51% considered that open surgery was safer than MIS in this regard. The pandemic led to a difference in the preferences of 40% of the urologists in relation to open or MIS methods, and during the pandemic, 39% of the urologists always directed their patients to open surgery. It was determined that during the pandemic, there was a statistical decrease in the intensity and weekly application of MIS methods among all surgical procedures compared to the pre-pandemic (P <.001 and P <.001, respectively). MIS was preferred for oncological operations by 97.3% of the urologists during the pandemic, with the most performed operation being radical nephrectomy (90.7%). Among oncological operations, radical prostatectomy was most frequently postponed. To prevent virus transmission during MIS, 44% of the urologists reported that they always used an additional evacuation system and 52% took additional precautions. There were a total of 27 healthcare workers who took part in MIS and tested positive for COVID-19 after the operation. Conclusions: Although the number of operations has decreased during the ongoing pandemic, MIS is a method that can be preferred due to its limited contamination and mortality in urology practice provided that safety measures are taken and guideline recommendations are followed

Perineural invasion association with tumor volume and tumor positive core locations in TRUS biopsy

Amaç: TRUS biyopsideki perinöral invazyonun (PNI) tümör pozitif olan korlar ve bu korlardaki tümör hacmi ile ilişkisini araştırmak. Gereç ve Yöntemler: TRUS biyopsi yapılan ve patoloji sonucu prostat adenokarsinomu saptanan 85 hastanın bilgileri değerlendirildi. Biyopside herhangi bir korda gözlemlenen perinöral invasyon, raporda “PNI(+)” olarak rapor edildi ve ayrıca her kordaki tümör hacmi “yüzdelik oranda” belirtildi. Hastalar patoloji raporuna göre PNI(+) ve PNI(-) olmak üzere iki gruba ayrıldı. İki grup yaş, PSA, prostat hacmi, Gleason skoru, biyopsi alınan kor sayısı, kanser pozitif kor sayısı, kanser pozitif kor lokalizasyonu, korlardaki tümör yüzdesi bulgularıyla istatistiksel olarak karşılaştırıldı. Bulgular: 85 hastanın 42’si (%49,4) PNI(+) ve 43’ü (%50,6) PNI(-) idi. Bununla beraber median PSA değeri, Gleason skoru ve tümör pozitif kor sayısı PNI(+) grupta anlamlı derecede yüksekti. Transizyonel zon hariç (P:0.217) diğer tüm korlarda PNI(+) gruptaki tümör hacmi anlamlı derecede fazlaydı (P:0.00). PNI(+) gruptaki tümör hacmi PNI(-) grubun yaklaşık 4 katı idi. Biyopsideki PNI varlığının tümör pozitif korlar ile ilişkisi değerlendirildiğinde, PNI(+) grupta Transizyonel zon hariç diğer tüm korlardaki tümör pozitifliğinin PNI(-) gruba göre anlamlı derecede yüksek olduğu tesbit edildi.Sonuç: PNI pozitifliği olan hastaların pozitif kor sayılarını ve biyopsi korlarındaki tümör hacimlerini anlamlı derecede yüksek bulduk ve bunu kantitatif olarak sunduk. Bu bulguların tedavi yöntemini ve yapılacaksa cerrahi yöntemi yönlendirecek ipuçları taşıdığını düşünmekteyiz.Objectives: To explore the association of perineural invasion with tumor positive cores and tumor volume in TRUS biopsy. Material and Methods: 85 patients, diagnosed with prostate adenocarcinoma via TRUS biopsy were evaluated. Of any observed perineural invasion in any core for each patient was reported as “PNI(+)”. Also the amount of tumor in the each core was reported by percentage. Patients were divided into two groups due to their pathology reports which were PNI(+) or PNI(-). Age, PSA, prostate volume, Gleason score, number of biopsy cores, the number of cancer-positive cores, cancer-positive core localizations, percentage of tumor in each core findings were compared statistically between two groups. Results: Of patients 42(49,4%) were PNI(+) and 43(50,6%) were PNI(-).Median PSA, gleason score and number of tumor positive cores were significantly higher in PNI(+) group. Also the percentage of tumor in each core was significantly higher in PNI(+) group (p:0.00), except transition zone (P:0.217). Approximately, tumor percentage in PNI(+) group was 4 fold of PNI(-) was. By the association between PNI and tumor positivity in the cores; tumor was being higher in whole cores in PNI(+) group then the other, except transition zone.Conclusion: It was presented quantitatively in our study that number of tumor positive biopsy cores and the percentage of tumor in that cores were significantly higher in PNI(+) group. We suppose that these findings are to be carried hints to guide treatment and surgical methods

Serum ve idrar fraktalkine düzeyinin primer kas invaziv olmayan mesane kanserinde klinik önemi

Objective: Fractalkine is a chemotactic agent that shows both tumorogenic and anti-tumorogenic activity in some cancer types. In this study, we investigated the role of fractalkine in the diagnosis, progression and recurrence of primer non-muscle-invasive bladder cancer (NMIBC) and compared it with the healthy population. Methods: Overall, 84 people that consisted of 44 cases with primary NMIBC and 40 healthy controls enrolled for this study. Blood and urine samples were collected and fractalkine levels were measured by the ELISA method. Urinary creatinine levels were calculated and urinary fractalkine levels were optimized. Demographic data, tumor stage (Ta, T1), grade (low and high), number of tumors, tumor size, recurrence and progression status of patients were recorded. NMP22 test was performed on the patient group and urine cytology was sent from the patients. Fractalkine levels and subgroup analyses were compared between two groups. Results: The mean age of patients was 63.9±11.1 and 62.3±9.6 in the control group. The mean urinary fractalkine level was7.8±0.9 ng/ml in the study group and 7.7±0.6 ng/ml in the control group; there was no statistically significant difference between the two groups (p=0.426). Mean urinary fractalkine/creatinine level was similar between the study group and control group (16.0±32.2 ng/mgCr and 11.1±7.0 ng/mgCr, respectively, p=0.781). Mean serum fractalkine level was 2.9±1.2 ng/ml in the study group and 2.9±0.7 ng/ml in the control group; there was not a statistically significant difference (p=0.183). Also, we could not find any relation of fractalkine levels with tumor size, number, recurrence and progression. NMP 22 test was positive in half of the study group and Fractalkine levels were higher in the patients that NMP22 tests were negative that was statistically significantly. Cytology was positive for 45.5% of patients, but there was not any statistical correlation between fractalkine levels and cytology. Conclusion: In this study, we did not find a significant difference concerning serum and urinary fractalkine level between the two groups. These findings do not support the use of fractalkine as a biomarker for bladder cancer diagnosis and follow-up.Amaç: Fraktalkine, bazı kanser tiplerinde hem tümörojenik hem de anti-tümoörojenik aktivite gösteren bir kemotaktik ajandır. Bu çalışmada, fraktalkinenin primer kas invaziv olmayan mesane kanserinde tanı, nüks ve progresyondaki rolünü araştırdık. Gereç ve Yöntem: Çalışmaya primer kas invaziv olmayan mesane kanseri tanısı konulan 44 hasta ve sağlıklı kontrol grubu olan 40 kişi olmak üzere toplam 84 kişi alındı. Kan ve idrar örnekleri toplandı ve fraktalkine düzeyi ELISA yöntemi ile değerlendirildi. İdrar kreatinin düzeyleri hesaplanıp idrar fractalkine düzeyi optimize edildi. Demografik veriler, tümör evresi (Ta, T1), derecesi (düşük, yüksek), sayısı, boyutu ve rekürrens, progresyon durumu kaydedildi. Fraktalkine düzeyleri ve alt grup analizleri her iki grup arasında karşılaştırıldı. Hasta grubuna NMP22 test yapıldı ve hastalardan idrar sitolojisi gönderildi. Bulgular: Hasta grubun ortalama yaşı, 63.9±11.1, kontrol grubunda ise 62.3±9.6 idi. Ortalama idrar fraktalkine düzeyi hastalarda 7.8±0.9 ng/ ml ve kontrol grubunda 7.7±0.6 ng/ml olup iki grup arasında istatistiksel anlamlı fark izlenmedi (p=0.426). Ortalama idrar fraktalkine/kreatinin değeri iki grup arasında benzerdi (sırasıyla, 16.0±32.2 ng/mgCr ve 11.1±7.0 ng/mgCr, p=0.781). Ortalama serum fraktalkine düzeyi hasta grubunda 2.9±1.2 ng/ml ve sağlıklı kontrol grubunda 2.9±0.7 ng/ml olup, iki grup arasında istatistiksel anlamlı fark izlenmedi (p=0.183). Aynı zamanda, fraktalkine düzeyi ile tümör boyutu, sayısı, nüks ve progresyon durumu arasında ilişki tespit edilmedi. Fraktalkine düzeyi NMP22 test pozitif hastalarda negatif olanlara göre istatiksel anlamlı olarak daha yüksekti. Sitoloji hastaların %45.5’inde pozitifti fakat fraktalkine değerleriyle istatiksel anlamlı bir ilişki görülmedi. Sonuç: Bu çalışmada, her iki grup arasında serum ve idrar fraktalkine düzeyi benzer bulunmuş olup, fraktalkinenin primer mesane kanserli hastalarda biomarker olarak kullanılamayacağı gösterilmiştir

A multicenter-based critical analysis of laser settings during intrarenal laser lithotripsy by the Turkish academy of urology prospective study group (ACUP study)

Objective: In this multicenter prospective study, we aimed to evaluate the use of holmium:yttrium aluminum garnet laser during retrograde intrarenal surgery for kidney stones and the relationship between laser-related parameters and procedure-related perioperative parameters. Material and methods: The 769 patients whose laser setting parameters (fiber thickness, number of shots, frequency (max.), laser power (max.), and total energy) were completely registered were included in this study program. The intraoperative ureteral lesions were evaluated using postureteroscopic lesion scale (PULS) scores and the postoperative complications with the modified Clavien-Dindo classification system. Results: The maximum levels of laser power and the frequency were used in the middle calyceal stones; the value of total energy consumed was found to be higher gain in cases with multiple stones (all parameters P < .05). There was a significant positive correlation among (mean number of shots [P < .001, r = 0.46], frequency [P = .009, r = 0.1], maximum power [P < .001, r = 0.11], total energy [P < .001, r = 0.25]), anesthesia time (P < .001, r - 0.42), surgery time (P < .001, r - 0.47), and stone size. The mean number of shots increased (P < .001, r = 0.25), and the frequency level decreased (P < .001, r = -0.17) significantly with increasing Hounsfield unit (HU) values. Again, the mean number of shots and maximum laser power increased in correlation with the increasing hospitalization time (P = .004, r = 0.09 and P = .02, r = 0.07, respectively). In addition, it was observed that higher laser subparameter values and thicker fibers were used in PULS grade 2. Conclusion: As the stone size and HU values increased, laser-setting parameters were found to show significant variability. The increase in different parameters of the laser setting was found to be associated with longer anesthesia time, surgery time, and hospitalization period and increased risk of local trauma with PULS grade