Güçlü Gürlen

This study aimed to identify predictive factors for the formation of steinstrasse following extracorporeal shock wave lithotripsy (SWL) in patients with me

Purpose To evaluate and compare the efficacy and safety of retrograde intrarenal surgery (RIRS) and Mini-percutaneous nephrolithotomy (PCNL) in treating pediatric patients with solitary kidneys harboring medium-sized (1–2 cm) kidney stones. Methods This study was conducted retrospectively. The two groups were compared in terms of surgical and postoperative parameters. Renal function was assessed both preoperatively and at the third month following surgery. Results The mean age of patients in the mini-PCNL group was 13.5 ± 3.6 years, whereas that in the RIRS group was 10.7 ± 3.9 years (p = 0.772). The duration of fluoroscopy was significantly longer in the mini-PCNL group (126 ± 46.8 s) than in the RIRS group (55.3 ± 32.6 s) (p < 0.001). Conversely, the RIRS group had a longer operative time (58.3 ± 28.1 min) than did the mini-PCNL group (40.4 ± 19.2 min) (p = 0.028). At the one-month follow-up, stone-free rates were markedly higher in the mini-PCNL group (97.5%) than in the RIRS group (80.6%) (p < 0.001). There was no significant change in renal function following both surgeries. Conclusions Mini-PCNL demonstrated superior outcomes in terms of stone clearance, reduced operative duration, and a lower need for subsequent procedures. In contrast, RIRS was associated with reduced fluoroscopy exposure and minimal blood loss, although it necessitated more frequent use of supplementary interventions.

Purpose We aimed to determine differences in treatment and management of forgotten ureteral stents between adult and pediatric patients. Methods The records of patients treated for forgotten ureteral stents were retrospectively evaluated. Reasons for stent placement, duration of stenting, stent fragmentation status, types and numbers of surgeries performed for stent removal, length of hospital stay, complications, and treatments were recorded. Results There were 43 (37%) patients in the pediatric group and 72 (63%) patients in the adult group. Mean age in the pediatric group was 7.65 ± 4.01 years, while it was 53.18 ± 18.29 years in the adult group. Hydronephrosis and hematuria rates were significantly higher in the adult group (40.3% vs. 20.9, p = 0.033; 33.3% vs. 16.3%, p = 0.046, respectively), whereas fever and sepsis rates were significantly higher in the pediatric patient group (39.5% vs. 12.5%, p = 0.001; 11.6% vs. 1.4%, p = 0.027, respectively). In terms of removal method, endoscopic cystolithotripsy and percutaneous nephrolithotomy (37.2%) were the methods most frequently applied in the pediatric group, and ureteroscopic lithotripsy (34.7%) was used in adults. Conclusions Forgotten ureteral stents can cause life-threatening complications in both pediatric and adult patients due to encrustation and stone formation. Endourological surgeries can be safely performed for treatment in both groups.

Background: The aim of this study was to evaluate the efficacy of bariatric surgery (BS) by evaluating preoperative and postoperative sexual functions in obese men undergoing BS. Materials and Methods: Male patients who underwent BS due to obesity between January 2013 and September 2021 were included in this observational study. Patients underwent standardized laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. For sexual function, the International Index of Erectile Function (IIEF) inquiry form was filled in before, and one year after BS. In addition, the age, Body Mass Index (BMI) and Female Sexual Function Index (FSFI) scores of the female partners were recorded before and after the operation. Follow-up weight, waist circum-ference, serum biochemistry and hormone values of the patients were re-evaluated in the 6-12 month period after the operation. Results: A total of 1027 patients were included in the study. The mean age of the male patients was 37.33±12.40 years, and the mean preoperative BMI was 38.51±3.98kg/m2 (35.20-49.80). The pos-toperative follow-up period of the patients was 9.72±2.98 months. There was a significant increase in the IIEF (all sub-dimensions) scores of the patients after the operation (p<0.001 for each). An increase in FSFI scores was found in female partners after surgery (21.67±6.78 vs. 27.55±5.48; p<0.001). The change in IIEF-EF scores was moderately inversely correlated with partner BMI, mo-derately correlated with vitamin D levels, and linearly correlated with testosterone levels (p=0.034, r=-0.434; p=0.012, r=0.537 and p=0.027, r=0.476, respectively). Conclusions: BS provides a significant increase in the sexual functions of obese men. This increase shows a significant relationship with partner BMI and vitamin D levels.

Background Studies evaluating lower urinary tract symptoms (LUTS) and sexual functions after holmium laser enucleation of prostate (HoLEP) are very limited. Aims To evaluate both the LUTS voiding and storage functions of patients after HoLEP operation and to examine its effect on postoperative sexual functions. Methods The data of male patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between May 2019 and February 2022 were evaluated. The International Prostate Symptom Index (IPSS) was used for questioning LUTS. The International Erectile Function Index-Erectile Function (IIEF-EF) section was completed to evaluate erectile functions and Male Sexual Health Questionnaire-Ejaculation function (MSHQ-EjD) was completed to evaluate ejaculation functions. Results A total of 427 patients were included in the study. A significant improvement was found in IPSS total, storage, and voiding scores at the 3rd month follow-ups of the patients after HoLEP. While improvement was detected in the erectile functions of the patients (p < 0.001), a significant decrease was found in MSHQ-EjD scores (15.97 ± 2.26 vs. 11.02 ± 3.69; p = 0.002). More than 50% reduction in IPSS scores was found in 85.48% (365/427) of the patients. It was determined that the patients who did not benefit from the treatment had higher preoperative IPSS-storage symptoms (p = 0.001), lower IIEF-EF scores (p < 0.001), and higher PVRs (p = 0.001). Conclusions HoLEP is an effective method that can be used safely and effectively in the treatment of LUTS due to BPH. While both storage and voiding functions of the patients improve, there is no worsening in erectile functions, but deterioration in ejaculation functions can be observed.

This study aimed to determine the effectiveness of extracorporeal shockwave lithotripsy (SWL) performed in the early period (within the first 24 hours). Data of patients who underwent SWL with a diagnosis of unilateral radiopaque 5 to 10 mm upper ureteral stones were retrospectively examined. Patients were divided into 2 groups. Group 1 (early SWL) consisted of patients with SWL performed within 24 hours after the onset of colic pain (P = .026) and the time to the stone-free state was shorter (11 vs 15.4 days P = .044). SFR within 1 month was higher in the early SWL group (85.5% vs 71.8% P = .036). In multivariate analysis, stone size, Hounsfield Units, and early SWL were predictive factors for SWL success. Performing SWL within the first 24 hours is highly effective in patients with symptomatic 5 to 10 mm upper ureteral stones.

Objective: In this study, the aim was to compare the results of mini and standard percutaneous nephrolithotomy (PCNL) for the treatment of pediatric kidney stones. Materials and Methods: Data for 128 patients < 18 years of age who underwent mini and standard PCNL due to pediatric kidney stones were retrospectively examined. Patients were divided into two groups: mini-PCNL (16-20 Fr) and standard PCNL (26 Fr). Surgery time, number of punctures to the pelvicalyceal system, hospital stay, postoperative hemoglobin drop, complications and stone-free status (SFR) were compared between the groups. Additional surgical intervention (double-J stent, ureterorenoscopy, secondary PCNL) performed after the surgery was recorded. The absence of residual stones or < 3 mm residual stones on kidney, ureter and bladder radiography (KUB) and ultrasonography (USG) performed in the third postoperative month were accepted as success criteria. Results: There were 32 (43.8%) patients in the mini-PCNL group and 41 (56.2%) patients in the standard PCNL group. The mean age was 9.3 ± 4.1 years in the mini-PCNL group and 10.1 ± 5.4 years in the standard PCNL group. Mean stone size in the mini-PCNL group was 2.1 ± 1.2; while for standard PCNL it was 2.3 ± 1.4. The mean surgery time was statistically significantly higher in the mini-PCNL group (p = 0.005). There was no difference between the groups in terms of intraoperative double J stent use, postoperative complications and SFR. A double J stent was inserted in two patients in the mini-PCNL group and in one patient in the standard PCNL group due to urine leakage from the nephrostomy tract in the postoperative period. Although the postoperative hemoglobin drop was found to be significantly higher in standard PCNL (p = 0.001), hematuria and blood transfusion rates were low in both groups. Mean hospital stay was shorter in the mini-PCNL group compared to standard PCNL (3.6 ± 1.2 days vs. 2.5 ± 1.1; p = 0.018). Conclusions: Although mini-PCNL has longer surgery time compared to standard PCNL, it should be preferred for the treatment of pediatric kidney stones due to advantages such as similar success and complication rates to standard PCNL, short hospital stay and less postoperative hemoglobin drop.

Introduction: We aimed to present our single incision two-lobe technique, which we developed in our own clinic and performed by a single surgeon and to compare the results of this technique with the results of Gilling's 3-lobe technique, which we applied before. Material Method: HOLEP was performed in 200 patients with medically resistant lower urinary tract symptoms (LUTS) and BPH, regardless of prostate size, between December 2018 and August 2022 in our urology clinic. All operations in the study were performed by a single surgeon who had completed the HoLEP learning curve, was well versed in endoscopic surgery, and had high experience. The classical Gilling 3-lobe method was preferred in the first hundred cases after the cases in the first fifty cases learning curve (Group 1, n=100). Due to some difficulties in the technique after the experience in the first hundred cases, the single incision two-lobe technique, which was created by referencing and modifying Scoffone's en bloc no touch technique, was used in the next hundred cases (Group 2, n=100). Results: The average age of a total of 54 patients who underwent surgery due to a retroperitoneal mass was 53.8±10.0 years. While 15 (27.8%) of 54 patients with a retroperitoneal mass were diagnosed incidentally, 39 (72.2%) patients were diagnosed symptomatically. The final pathological outcome of all relapsed patients was liposarcoma. The average operation time was 178.7±85.4 minutes. The average length of stay of the patients was 6.2±3.1 days. Additionally, all of these patients had organ resection. In the Kaplan-Meier survival analysis, it was found that surgical margin had a statistically significant effect on average survival (p<0.001). Conclusion: In our modified single-incision two-lobe technique, the eneculation time and probe residence time are shorter than the classical gilling method.