The role of ultra-mini percutaneous nephrolithotomy in the treatment of kidney stones

OBJECTIVE

In our study we aimed to evaluate outcomes of ultra-mini-percutaneous nephrolithotomy (UMP) performed for the treatment of kidney stones.

MATERIAL AND METHODS

Between October 2014 and September 2015, a single surgeon performed UMP on a total of 49 consecutive patients with symptomatic kidney stones at our center. Pregnants, anticogulant users, patients with bleeding diathesis pyonephrosis, and partial/complete staghorn stones were excluded from the study. Patient characteristics, operative data and postoperative outcomes were assessed in detail.

RESULTS

The UMP was performed on 50 (34 right/16 left) renal units of the 48 (28 male/20 female) patients included in this study. The mean age and body mass index was 36.5 (2-83) years and 26.2 (17.6-32.8) kg/m², respectively. Mean stone size was calculated as 22.2 (10-55) mm. The mean durations of the operations and fluoroscopic examination were calculated as 65.4 (20-120) minutes and 89.4 (9-322) seconds, respectively. The mean duration of hospitalization was 1.4 (1-5) days. In 52% of the patients the procedure was terminated tubeless. Mean hemoglobin drop was 0.6 (0-3) g/dL. Our series experienced a 10% complication rate. The UMP procedure was successful in 96% of the renal units at the 1^st month control visit assessment.

CONCLUSION

The outcomes of our study have demonstrated that UMP is an effective and safe treatment modality, especially in the treatment of medium-sized renal calculi.

Combined micro-and standard percutaneous nephrolithotomy for complex renal calculi

OBJECTIVE

We aimed to present the technique of combination of standard percutaneous nephrolithotomy (PNL) with microperc for achieving higher success rates without increasing complication rates in the management of complex renal calculi.

MATERIAL AND METHODS

The patients who underwent microperc procedure as a complementary procedure to standard PNL for complex kidney stones in two reference hospitals between 2013 and 2015, were evaluated retrospectively.

RESULTS

All patients underwent a total of two accesses one for standard PNL and one for microperc. The mean stone size was measured as 54.3 mm. The procedures were completed after an average operative time of 88.2 minutes and fluoroscopy time of 5.3 minutes. Stone free status was achieved in 18 cases (78.2%) and small residual fragments (≤4 mm) were detected in 3 cases (13.1%). Complications were seen in three patients (13%) as hemorrhage in one and postoperative fever in two patients.

CONCLUSION

Despite the limitations of this study, the combination of standard PNL and microperc might reduce the complication rates and increase the success rates when treating complex kidney stones. Future prospective and comparative studies are needed.

Comparison of transperitoneal laparoscopic nephrectomy outcomes in atrophic and hydronephrotic kidneys

OBJECTIVE

To compare the results of transperitoneal laparoscopic nephrectomy in patients with atrophic and hydronephrotic kidneys.

MATERIAL AND METHODS

Clinical data were collected from 35 patients who had undergone laparoscopic nephrectomies for atrophic or hydronephrotic non-functioning kidneys between January 2010 and March 2014. Comparative analysis was carried out between the two groups examining demographic characteristics, imaging modalities, etiology, operative times, port numbers, conversion to open surgery, complications, pre-and post-operative hemoglobin and creatinine values, transfusion rates and length of hospital stays.

RESULTS

Laparoscopic nephrectomy was performed for atrophic kidneys in 20 (57%) patients and for hydronephrotic kidneys in 15 (42%) patients. In the atrophic group, 3 patients (15%) required transfusion because of bleeding but none of the patients required conversion to open surgery. In the hydronephrotic group one patient (6.6%) required transfusion and conversion to open surgery because of bleeding. Both of the groups were similar in terms of postoperative hospital stay but compared to the atrophic kidneys, hydronephrotic ones were associated with a longer total operative times (90.1 min vs. 73.6 min, p=0.03). Any serious complication (except for bleeding) and mortality were not encountered in both groups.

CONCLUSION

Laparoscopic nephrectomy is a safe and effective minimally invasive technique that can be used in atrophic and hydronephrotic non-functioning kidneys.

Flexible ureterorenoscopy results: Analysis of 279 cases

OBJECTIVE

In this study, the outcomes of 279 cases in whom we performed retrograde intrarenal surgery (RIRS) were evaluated retrospectively.

MATERIAL AND METHODS

RIRS was performed on 279 cases with the aid of access sheath of guidewire between March 2011 and February 2015. All patients were operated in the standard lithotomy position. A hydrophilic guidewire was inserted with the aid of rigid ureterorenoscopy and we checked whether there were any residual ureteral stones and other pathologies. Fluoroscopy was used routinely in all cases. Stone fragments smaller than 3 mm were left off but those bigger than 3 mm were removed by grasper after stone fragmentation. Controls of the patients were assessed by plain films (KUB), urinary tract ultrasonography (US) and/or computed tomography (CT) 1 month after the operation. Success rate of the procedure was defined as the stone-free status or presence of residual fragments less than 3 mm.

RESULTS

152 of the patients were male and 127 were female. The median ages of the male and female patients were 47.7 (1-86) ve 45.9 (3-79) years respectively. The median stone size was 13.5 mm (8-25). Preoperatively 34 (12.1%) patients had double-J ureteral stent. 19 (6.8%) patients were operated while they were still receiving antithrombotic and antiplatelet therapy Solitary kidney was present in 24 patients while the remaining patients had kyphoscoliosis (n=3), rotation anomaly (n=6), pelvic kidney (n=2), double collecting system (n=3), and horseshoe kidney (n=6). In 264 patients access sheath was used, in 15 patients operation was performed with the help of the guidewire. Double-J stents were inserted to 14 patients because of ureteral stricture and they underwent operation after 2 weeks later. Renal stones of 219 patients among all cases were fragmented completely and the patients were discharged as stone free (SF). Our success rate (SF or presence of clinically insignificant residual [CIRF]) was 78.4%. Stone size (p=0.029), stone number (p=0.01), stone location (p=0.023) had significant influence on the stone-free rate after RIRS The mean operation and floroscopy time was 62.5 min. (40-180) and 29.8 sec (4-96), respectively. The mean hospitalization time was 26.4 hours (12-72). Double J stents were placed to 253 patients for more stone burden and ureteral edema. Any complication was not observed for all cases except perioperative developed infection for two patients.

CONCLUSION

With advances in laser technology and flexible ureterorenoscopy, kidney stones can be treated with lower morbidity and high success rates.

Protective effects of erdosteine, vitamin E, and vitamin C on renal injury induced by the ischemia-reperfusion of the hind limbs in rats

BACKGROUND/AIM

To compare the protective efficacy of erdosteine and vitamins C and E against renal injury caused by hind limb ischemia-reperfusion (I/R).

MATERIALS AND METHODS

Rats were split into 4 groups: group I as the control, group II as I/R, group III as I/R + erdosteine, and group IV as I/R + vitamins C and E. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities and malondialdehyde (MDA) tissue levels were determined.

RESULTS

MDA levels were found comparable with the control group in groups II and III. However, they were considerably decreased in group IV when compared to group II (P < 0.01). Additionally, SOD, CAT, and GSH-Px activities were considerably (P < 0.05) decreased in group II. While CAT and GSH-Px activities were restored (P <0.01) by vitamin E and C treatment, SOD activity was not significantly affected. While GSH-Px activities were higher (P < 0.05) with erdosteine administration, SOD and CAT activities were unchanged.

CONCLUSION

The protective effect of vitamins C and E is higher than that of erdosteine treatment in reducing the oxidative stress after renal ischemia in this animal model.

Cancer detection rates of different prostate biopsy regimens in patients with renal failure

We aimed to evaluate the cancer detection rates of 6-, 10-, 12-core biopsy regimens and the optimal biopsy protocol for prostate cancer diagnosis in patients with renal failure. A total of 122 consecutive patients with renal failure underwent biopsy with age-specific prostate-specific antigen (PSA) levels up to 20 ng/mL. The 12-core biopsy technique (sextant biopsy + lateral base, lateral mid-zone, lateral apex, bilaterally) performed to all patients. Pathology results were examined separately for each sextant, 10-core that exclude parasagittal mid-zones from 12-cores (10a), 10-core that exclude apex zones from 12-cores (10b) and 12-core biopsy regimens. Of 122 patients, 37 (30.3%) were positive for prostate cancer. The cancer detection rates for sextant, 10a, 10b and 12 cores were 17.2%, 29%, 23.7% and 30.7%, respectively. Biopsy techniques of 10a, 10b and 12 cores increased the cancer detection rates by 40%, 27.5% and 43.2% among the sextant technique, respectively. Biopsy techniques of 10a and 12 cores increased the cancer detection rates by 17.1% and 21.6% among 10b biopsy technique, respectively. There were no statistical differences between 12 core and 10a core about cancer detection rate. Adding lateral cores to sextant biopsy improves the cancer detection rates. In our study, 12-core biopsy technique increases the cancer detection rate by 5.4% among 10a core but that was not statistically different. On the other hand, 12-core biopsy technique includes all biopsy regimens. We therefore suggest 12-core biopsy or minimum 10-core strategy incorporating six peripheral biopsies with elevated age- specific PSA levels up to 20 ng/mL in patients with renal failure.

Prostatic fluid free insulin-like growth factor-1 in relation to benign prostatic hyperplasia: a controlled study

PURPOSE

Insulin-like growth factors (IGFs) have potent mitogenic and antiapoptotic effects on prostate tissue, whereas free IGF-1 is responsible for its metabolic effects but its role in benign prostatic hyperplasia (BPH) is unclear.

MATERIAL AND METHODS

Plasma and prostatic fluid levels of free IGF-I were determined from the fasting bloods of 35 BPH cases admitted for treatment and 35 randomly selected population controls.

RESULTS

Prostatic fluid free IGF-1 concentrations did not differed significantly between two groups (P = .23). There was also no statistical difference in serum free IGF-1 levels between these groups. There was also no correlation between prostatic fluid free IGF-1 and serum prostate specific antigen (PSA) levels and prostate volume. When compared with control group, mean IPSS scores and prostate volumes of BPH group were significantly high, while mean maximum measured flow rate (Qmax) and international prostate symptom score (IPSS) and quality of life (QoL) scores were significantly low (P < .05).

CONCLUSION

Our study shows that free IGF-I is not associated with BPH risk. Further investigation is needed to elucidate the role of the free IGF-1 in BPH.

How to write an introduction section of a scientific article?

An article primarily includes the following sections: introduction, materials and methods, results, discussion, and conclusion. Before writing the introduction, the main steps, the heading and the familiarity level of the readers should be considered. Writing should begin when the experimental system and the equipment are available. The introduction section comprises the first portion of the manuscript, and it should be written using the simple present tense. Additionally, abbreviations and explanations are included in this section. The main goal of the introduction is to convey basic information to the readers without obligating them to investigate previous publications and to provide clues as to the results of the present study. To do this, the subject of the article should be thoroughly reviewed, and the aim of the study should be clearly stated immediately after discussing the basic references. In this review, we aim to convey the principles of writing the introduction section of a manuscript to residents and young investigators who have just begun to write a manuscript.

Are small residual stone fragments really insignificant in children?

OBJECTIVES

To assess the significance of asymptomatic residual stone fragments of less than 4mm (clinically insignificant residual fragments [CIRFs]) after shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) in children.

PATIENTS AND METHODS

Eighty-five children were followed up for 6 to 50months (median 22). Outcomes measured were fragment re-growth, stone events (emergency department visits, hospitalization, or additional interventions) and spontaneous fragment passage.

RESULTS

During follow-up, 22 children (25.8%) passed residual fragments spontaneously. Highest spontaneous passage rate was found for renal pelvis stones and the lowest for the lower pole stones (57.1% vs. 16.1%; p<0.001). When the number of the fragments increased, the chance of the spontaneous passage decreased (30% vs 20%; p<0.05). Symptomatic episodes including renal colic, hematuria, or urinary tract infection were documented in 34 (40%) patients, and re-growth of fragments was observed in 18 (21.2%). Stone size had no significant effect on spontaneous passage (p=0.079), stone growth (p=0.528), and symptomatic episodes (p=0.402). Twenty-five patients (29.4%) required secondary intervention for stone re-growth or stone related events and the remaining 20 patients (23.5%) needed medical treatment for bothersome symptoms or complications.

CONCLUSIONS

Our results suggest that 40% of children with CIRFs will become symptomatic and 20% will develop stone re-growth over the following 6months. Only one fifth of the fragments will pass spontaneously without any complications. Therefore, the use of the term "CIRF" is not appropriate for postoperative residual fragments in children.

Impact of percutaneous renal access technique on outcomes of percutaneous nephrolithotomy

BACKGROUND AND PURPOSE

Percutaneous nephrolithotomy (PCNL) is regarded as the gold standard for the treatment of patients with renal stones larger than 2 cm in diameter. Creating a percutaneous renal access is the initial and probably the most important step in performing a PCNL. Two primary methods of obtaining proper percutaneous renal access under fluoroscopic guidance are described: The "triangulation" and the "eye of the needle" techniques. In this article, we compare these two techniques in terms of success and complication rates.

PATIENTS AND METHODS

From October 2010 to May 2011, 80 patients with simple renal stones were prospectively randomized into two groups according to the percutaneous renal access technique used for PCNL. Patients in group 1 (n=40) were assigned to the eye of the needle technique, and patients in group 2 (n=40) were assigned to the triangulation method. Patients needing multiple access points were excluded from the study. The preoperative, operative, and postoperative follow-up findings were thereafter analyzed and compared.

RESULTS

No significant difference between the two groups was detected in terms of patient demographics (mean patient age, body mass index, stone size, or stone location). The operation time, fluoroscopic screening time (FST), and duration of hospitalization were similar in both groups (P=0.52, P=0.32, P=0.26, respectively). Patients in group 1 had a larger drop in hematocrit postoperatively than patients in group 2 (7.6 ± 3.7 vs 4.8 ± 2.1, P=0.001). The blood transfusion rate (7.5%) was similar in both groups, however. Although the complication rate was higher in group 1 than group 2, no significant difference was detected (20% vs 15%, P=0.76).

CONCLUSIONS

The present study demonstrates that PCNL can be performed safely using two different percutaneous access techniques. The two techniques studied in this trial had similar FSTs, operation and hospitalization times, success rates, and complication rates.

The effect of cadmium toxicity on renal nitric oxide synthase isoenzymes

The aim of this study was to assess the cadmium (Cd) toxicity on renal nitric oxide synthase (NOS) isoenzymes. The study was carried out on 18 inbred male (Cd group: 10 and control group: 8) Wistar rats. Cd group received drinking water containing 15 mg/L Cd for 30 days; and at the end of the 30 days, plasma Cd was analysed. One kidney was snap frozen to assess the endothelial NOS (eNOS), inducible NOS (iNOS) and neuronal NOS (nNOS) expressions by Western blot analyses, and the other kidney was preserved for histopathological examination. Plasma Cd levels were significantly elevated in the Cd group. The Western blot analyses found higher levels of eNOS, iNOS and nNOS in the Cd group but only eNOS and nNOS levels were statistically significant. There was no difference in pathological assessment of the renal tissues. Cd toxicity increases NOS isoenzyme levels and may affect renal physiology.

Dietary vitamin C and E modulates oxidative stress induced-kidney and lens injury in diabetic aged male rats through modulating glucose homeostasis and antioxidant systems

Diabetes induces oxidative stress in aged human and rat, although daily supplementation of vitamins C and E (VCE) can be beneficial to aged diabetic rats by reducing free radical production. The aim of the present study was to evaluate whether dietary VCE supplementation relieves oxidative stress in streptozotocin (STZ)-induced diabetic in aged rats. Thirty aged rats were randomly divided into three groups. The first group was used as a control. The second group was made diabetic using a single dose of intraperitoneal STZ. VCE-supplemented feed was given to aged diabetic rats constituting the third group. On the 21st day of the experiment, blood, lens and kidney samples were taken from all animals. Glutathione peroxidase (GSH-Px) activity in lens and kidney, reduced glutathione (GSH), vitamin E and β-carotene concentrations in kidney were lower in the diabetic group than in the control whereas plasma glucose, urea and creatinine, and kidney and lens peroxidation (LP) levels were higher in the diabetic group than in the control. However, kidney and lens LP levels, and plasma glucose, urea and creatinine values were decreased by VCE supplementation. Lens and kidney GSH-Px activity, kidney GSH, vitamin E and β-carotene concentrations and erythrocyte counts were increased by VCE treatment. Kidney weights, vitamin A, haemoglobin, hematocrit, leukocyte and platelets values were not changed by diabetes and/or VCE supplementation. VCE ameliorated also diabetes-induced histopathological changes in kidney. In conclusion, we observed that VCE supplementation is beneficial towards kidney and lens of aged diabetic rats by modulating oxidative and antioxidant systems.

Clinical importance of intratumoral and normal renal parenchymal inflammatory cell infiltration in renal cell carcinoma

OBJECTIVE

To assess the relationship between inflammatory cell infiltration and tumor type, stage and grade, the presence of multifocality and survival in tumors and in tumor-free normal parenchyma.

MATERIAL AND METHODS

A total of 99 patients who underwent radical nephrectomy for renal cell carcinoma (RCC) between 1995 and 2001 and were subsequently followed up were included in the study. Formalin-fixed, paraffin-embedded tissues from the patients were reassessed by a pathologist and inflammation in both tumor and normal renal tissue was scored using a five-point scale. We evaluated the relationship between these scores and tumor type, stage, grade, the presence of multifocality and survival.

RESULTS

There were positive correlations between tumor grade and both the intratumoral inflammation score (IIS) and the extratumoral inflammation score (EIS) (p=0.001 and 0.01, respectively). There were no relations between pathological stage and either the IIS or EIS. We found higher multifocality rates in patients who died because of metastasis than those who survived (p=0.002). The EIS was 1.76+/-1.54 in the non-multifocality group and 2.64+/-1.15 in the multifocality group and this difference was statistically significant (p=0.03). There was no statistically significant relationship between the IIS and multifocality. Oncocytomas and chromophobe carcinomas did not show inflammatory infiltrates in either tumors or normal renal tissue.

CONCLUSIONS

Higher EIS and IIS are associated with increasing tumor grade and a higher EIS is associated with multifocality in RCC. We propose to evaluate tumor tissue and normal renal parenchyma for the presence of inflammatory infiltration in RCC.

Extracorporeal magnetic innervation for the treatment of stress urinary incontinence: results of two-year follow-up

INTRODUCTION

Extracorporeal magnetic innervation (ExMI) is a relatively new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We aimed to evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress urinary incontinence.

MATERIALS AND METHODS

A total of 30 patients with demonstrable stress urinary incontinence were enrolled in this study. All were neurologically normal with normal urinalysis and none was pregnant. Evaluation before treatment included 3-day bladder diaries, a dynamic pad weight test, urodynamics, and a validated quality of life survey. Treatment sessions lasted 20 min, twice a week, for 6 weeks. After ExMI, all measures were repeated at follow-up including 3-day bladder diary, dynamic pad weight test, urodynamics and quality of life survey. The follow-up was done at 3, 12 and 24 months after ExMI therapy but urodynamics were performed only at first follow-up.

RESULTS

After ExMI therapy, 8 out of the 27 patients were cured (29.7%) and 13 patients were improved (48.1%) at 3 months. The cumulative success rate was 77.8%. Six patients did not show any improvement after treatment. Pad weight was reduced from 14.4 +/- 10.7 to 6.5 +/- 5.1 g. The mean score of quality of life survey at baseline was 61.6 and this increased to 75.4 at 12 weeks. The effect of ExMI approximately continued until the 1st year after therapy but gradually decreased and came close to baseline at the 2nd year after therapy.

CONCLUSION

As a result, ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI also offers a noninvasive, effective and painless treatment for women with stress urinary incontinence. Further studies are needed to address how long the therapy will continue and benefits will last and whether retreatment or continuation therapy sessions will be necessary.

Does experimental pain assessment before biopsy predict for pain during transrectal ultrasound-guided prostate biopsy?

OBJECTIVES

To evaluate whether assessment of experimental pain perception using the modified tourniquet test before a biopsy procedure could predict the pain scores during transrectal ultrasound-guided prostate biopsy. However, the relationship between the experimental pain assessment before prostate biopsy and the pain scores during the biopsy procedure has not been established.

METHODS

A total of 67 men who underwent transrectal ultrasound-guided 12-core prostate biopsy were prospectively enrolled in the study. The day before biopsy, a modified submaximal effort tourniquet test was performed on all patients. During the test, pain scores were recorded at 30, 60, 90, and 120 seconds after inflation of the blood pressure cuff. Pain scores were also recorded during probe introduction into the rectum and prostate biopsy. Pain was assessed using a visual analogue scale (VAS).

RESULTS

A significant correlation was found between the VAS scores in the tourniquet test and the VAS scores during probe introduction and the VAS scores during prostate biopsy (P <0.0001). The most significant correlation was found between the VAS scores during prostate biopsy and the VAS 60-second scores during the tourniquet test (P <0.0001, r=0.756). No significant relation was found between the VAS scores and age, prostate volume, or prostate-specific antigen level (P >0.05).

CONCLUSIONS

Our results have shown that a simple and quick tourniquet test could be useful in identifying those men who will experience greater pain during transrectal ultrasound-guided prostate biopsy. In the light of these data, additional studies will be planned to evaluate whether experimental pain assessment before the procedure could predict the analgesic potency of pain-relieving treatment during prostate biopsy.

Leptin expression in the testicular tissue of fertile and infertile men

There have been several studies about the presence of leptin in serum and testicular tissue, and none of them compares the leptin expression in the testicular tissue of fertile and infertile men. We assessed the presence of leptin expression in the testicular tissue of fertile and infertile men. 20 azoospermic infertile men were included in the study. All patients underwent testicular sperm extraction (TESE) for ICSI. For the detection of leptin, the immunohistochemistry was carried out. Intensity of immunohistochemical staining was subjectively estimated and expressed as negative (-), weak positive (+), intermediate positive (++) and strong positive (+++). Testicular tissues of 5 fertile patients, aged 50-60 years, was stained with leptin for control group. Mann-Whitney U test was used as the statistical method. There was no statistically significant difference in leptin staining between infertile patients and control group (p < 0.05). Leptin staining in tubuli seminiferi and Leydig cells were generally equal or Leydig cells were stained (+) much. This difference was not statistically significant. We found that there is leptin staining in Leydig cells and tubuli seminiferi. There is no difference in normal and infertile men for leptin staining properties in testicular tissue. This condition suggests that the effect of leptin on reproductive functions originates from a systemic effect related to central neuroendocrine system, androgen levels or spermatogenic existence rather than its direct effect on testicular tissue.

Risk Factors for the Formation of a Steinstrasse after Shock Wave Lithotripsy

INTRODUCTION

We studied the various stone, renal, and therapy factors that could affect steinstrasse formation after shock wave lithotripsy (SWL) to define their predictive value.

PATIENTS AND METHODS

Between May 1999 and September 2002, 563 patients were treated with a Stonelight V3 lithotriptor. A steinstrasse was recorded in 46 patients. All patient data, stone and renal characteristics, and data of SWL were reviewed. Statistical analyses of patients, stones, and therapy characteristics in correlation with the incidence of steinstrasse formation were performed to assign factors that had a significant impact on the formation of this complication.

RESULTS

The overall incidence of a steinstrasse was 8.17%. The steinstrasse was in the pelvic ureter in 84.3% of the cases, in the iliac ureter in 7.84% of them, and in pelvic and iliac ureter in 7.84% of the patients. The incidence of a steinstrasse significantly correlated with stone size and site. The incidence rates of a steinstrasse in renal stones <1 cm, 1-2 cm, and >2 cm were 4.46, 15.87, and 24.3% respectively. The incidence rates of this complication in ureteral stones <1 cm and 1-2 cm were 3.37 and 9.52%, respectively. The incidence rates of a steinstrasse in stones located in upper calices, middle calices, lower calices, and renal pelvis were 6.12, 10.52, 6.36, and 19.32%, respectively.

CONCLUSIONS

Stone size and site are the significant factors predicting the formation of a steinstrasse. If a patient has a high probability of steinstrasse formation, close follow-up with early intervention or prophylactic pre-SWL ureteral stenting is indicated.

What is the ratio of urethral recurrence risk after radical cystoprostatectomy for bladder cancer?

OBJECTIVE

There is always a risk of urethral recurrence after radical cystoprostatectomy in patients with bladder transitional cell cancer. Taking these risk factors of urethral recurrence into account, orthotopic neobladders or urinary diversions without using the urethra are performed. But urethral tumour recurrence occurs much less than the expected. We assessed the etiological factors that affect the urethral recurrence in orthotopic and nonorthotopic urinary diversion cases.

METHODS

Sixty-four patients with bladder cancer who underwent radical cystoprostatectomy and urinary diversion between 1994 and 2002 were included this study. Conventional risk factors effecting the selection of operation type and urethral recurrence were evaluated in these patients. Cystoscopy and biopsy were done and pathologic specimen was obtained preoperatively, and cystoscopy and urethral washout cytology were done postoperatively. Routine bladder biopsies were done in uncertain cases at follow-up. Risk factors increasing the urethral recurrence are as follows: papillary and multiple tumours, tumour invading bladder neck and trigone, extensive CIS, prostatic stromal and urethral invasion, positive surgical margin and history of upper urinary tract tumour. In 31 patients having one or more of these criteria, continent nonorthotopic urinary diversion was performed, but 33 patients without these risk factors underwent orthotopic urinary diversion. Simultaneous urethrectomy was not done in any of these patients.

RESULTS

Among the patients who underwent radical cystoprostatectomy, none was with positive surgical margin in the distal end of the prostatic urethra. In preoperative cystoscopy, tumoural mass was seen near to collum in eight patients and in the prostatic urethra in three patients. Histopathological examination of cystoprostatectomy specimen displayed transient epithelial cell carcinoma of prostatic urethra in three patients, transient epithelial cell metaplasia inside the prostate in five patients and invasion to the urothelium of bladder neck in three patients. There were not any transient epithelial cell cancer metastases in prostatic stroma in any of these patients. One patient underwent urethrectomy, since atypical cells were observed in postradical prostatectomy urethral washout cytology but there was no tumour found in pathological examination of the specimen. Therefore, urethral tumour recurrence did not occur after 25 months follow up.

CONCLUSION

These findings suggest that some of the conventional risk factors of urethral recurrence were exaggerated. We may also conclude that there is no need for prophylactic urethrectomy unless there is urethral cancer or cancer in the surgical margin. But if utilization of urethra is planned, evaluation of prostatic stroma by TUR biopsies and urethral anastomose margin by frozen section during the operation is necessary.

Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: experience and results

OBJECTIVE

To evaluate the clinical, urodynamic, functional, radiological and metabolic results of the ileal (modified Hautmann) orthotopic neobladder over 10 years of experience.

PATIENTS AND METHODS

Between January 1992 and March 2002, 124 men (mean age 62.4 years, range 44-76) with advanced bladder cancer had a radical cystoprostatectomy and urinary diversion via an ileal orthotopic neobladder (modified Hautmann). Only 40 cm of small bowel (detubularized ileum) was used to construct the reservoir, as a modification of the method described by Hautmann. All patients were followed periodically and their data recorded.

RESULTS

While no patients died during surgery six died (mortality rate was 5%) in the first 30 days afterward (two of them from causes unrelated to the urinary diversion surgery). The early reoperation rate was 14%; there were early complications not requiring surgery in 40 (34%) and later reoperation rate was required in 20.6%. The mean (range) maximum neobladder capacity was 550 (310-720) mL, the maximum intravesical pressure at maximum capacity 26.4 (11-48) cmH(2)O, and the minimum and maximum flow rates 25.2 (16-64) and 17.5 (11-30) mL/s, respectively. Day- and night-time continence rates were 92% and 90% after 4 years. While there was no electrolyte imbalance, there was mild to moderate metabolic acidosis in 58% of patients. There was no urethral tumour recurrence in any patient.

CONCLUSION

Detubularization of ileum to form a neobladder gives a more favourable low-pressure and high-capacity reservoir. Therefore, a shorter ileal segment can be used for orthotopic urinary diversion, to avoid various metabolic dysfunctions when using detubularized bowel, but the surgery is not as free of complications as the original technique.

The selection of the regional anaesthesia in the transurethral resection of the prostate (TURP) operation

BACKGROUND AND OBJECTIVES

The aim of our study was to compare the three different regional anaesthesia methods in patients who underwent transurethral resection of the prostate (TURP) and to determine the ideal anaesthesia method for TURP operation.

METHODS

Totally 77 ASA II-III patients were preloaded with 500 ml 0.9% NaCl solution before regional anaesthesia. In group E (n:27) epidural anaesthesia were achieved by applying 75 mg bupivacaine heavy + 50 microg fentanyl in the L3-L4 intervertebral space. In group SP (n:28) 15 mg bupivacaine heavy + 50 microg fentanyl were used for spinal anaesthesia (L3-L4 intervertebral space) while in group SA (n:30) 10 mg bupivacaine heavy + 50 microg fentanyl were used with saddle blockade. Systolic arterial pressure (SAP), heart rate (HR), peripheral oxygen saturation (SpO2), serum sodium measurement was recorded before and after hydration and during operation. The motor block and sensory level have been measured.

RESULTS

Intraoperative SAP values were more stable than the other groups in group SA. The decrease in HR values were significant 15 minutes after prehydration in three groups (p < 0.05). SpO2 values of the groups were stable during the operation. The time to reach the maximum block was very short in patients in Group SA (p < 0.0001). There was a statistically significant difference between the groups in terms of motor block values (p < 0.0001). No fully paralysed sample was seen in Group SA even though there was a sufficient surgical anaesthesia.

CONCLUSIONS

Saddle block has some advantages compared to spinal and epidural anaesthesia methods such as achieving adequate anaesthesia, stable haemodynami, the lower degree of motor blockage and no full blockage in patients. Saddle block is an the most optimal anaesthesia method for TURP operation.