Urinary System Stones Research Articles

Use of dual energy CT urography in evaluation of urinary stone and complex cyst.

Dual-energy computed tomography scans can provide significant benefits to the urinary system. The aim of this study is to determine the limitations and benefits of using dual energy CT urography in patients with urinary system stones and cysts. In the analysis of the images, the virtual noncontrasted images obtained from the combined nephrogenicexcretory phase and the true noncontrasted images were evaluated. The true noncontrast images were accepted as the gold standard for stone detection. Eighty-three different stones were detected in 26 of the 115 patients included in the study. Sensibilities of virtual noncontrast images in detecting urinary system stones were 66.7% and 65.4% according to the first and second radiologists, respectively. In this study, 32 hyperdense cysts were detected. According to iodine map images, there was no enhancement in 26 of 32 cysts; only 5 cysts showed minimal contrast enhancement. One patient could not decide on contrast enhancement. As a result, if CT urography is performed with dual energy, it can provide additional information in patients with urinary system disorder.

Evaluation of nephrolithometric scoring systems to predict outcomes and complications of percutaneous nephrolithotomy for staghorn stone

Background/Aim: Urinary system stone disease develops with a frequency of 1-20 % in the general population. There are various surgical methods and percutaneous nephrolithotomy (PCNL) is a commonly used treatment method, especially in large, staghorn kidney stones. Aim of this study was compare stone nomograms in forecasting operative and complicating parameters subsequent to PCNL in staghorn stones. Methods: The study analysed 66 patients with staghorn stones who underwent PCNL between 2017 and 2022, retrospectively. The researcher evaluated the Guy, S.T.O.N.E. and CROSS nephrolithotomy scores in patients using non-contrast computed tomography. The Clavien Dindo Classification was used to evaluate the surgical complication. Results: The mean stone burden, GUY, S.T.O.N.E. and CROES scores were 1114.9 ± 520.18 mm²; 3.64 ± 0.48; 10.11 ± 1.2 and 142.9 ± 31.99, respectively. Total stone-free status (SFS) was achieved in 37.9 % of the patients, while the median stone clearance rate was 93.74 (50-100). While no statistical significance was observed between GUY score and SFS, it was observed in S.T.O.N.E. and CROES scores (p = 0.020 and 0.004, respectively). ROC analysis showed that CROES and S.T.O.N.E. scoring systems and the stone burden parameter showed similar accuracy in the estimation of SFS. The results showed that only the S.T.O.N.E. score showed a significant relationship with the presence of complications (p = 0.034). Conclusion: If the percutaneous nephrolithotomy for staghorn stones in question is, current scoring systems alone couldn't be predictive for postoperative outcomes and degree of complications. Further large scale multicentre prospective studies are needful.

RETROGRADE İNTRARENAL CERRAHİ (RIRS): CERRAHİ DENEYİMİMİZ VE KLİNİK SONUÇLARIMIZ

Amaç
 Üriner sistem taş hastalıkları ülkemizde ve dünyada
 sık görülmektedir. Flexıble üreterorenoskop (flex
 URS) ilk defa 1964 yılında Marshall tarafından tanımlanmıştır
 ve ilerleyen teknoloji ile birlikte 1987 yılında
 cerrahi teknik olarak kılavuzlarda yerini almıştır. Endikasyonları
 hızla genişlemektedir. Bu çalışmamızda
 kliniğimizde retrograde intrarenal cerrahi (RIRS) uygulanan
 hastaların verileri retrospektif olarak değerlendirilmiştir.
 Gereç ve Yöntem
 Mart 2017 ile Ocak 2019 tarihleri arasında Süleyman
 Demirel Üniversitesi Tıp Fakültesi (SDÜ) üroloji kliniğinde
 RIRS yapılmış 106 hastanın demografik verileri,
 taş boyutları, lokalizasyonları, skopi süresi, taşsızlık
 oranları ve postoperatif komplikasyonlar retrospektif
 olarak değerlendirildi. İşlem sonrası tüm hastalar 4
 hafta sonra direkt üriner sistem grafisi ve bilgisayarlı
 tomografi görüntüleme yöntemleriyle değerlendirildi.
 Bulgular
 RIRS uygulanan 106 hastanın (66 erkek, 40 kadın)
 ortanca yaşı 52 (23-73) yıl olup, ortalama taş boyutu
 13,9 (7-19) mm olarak hesaplandı. Ortalama operasyon
 ve floroskopi süresi sırayla;74 (30-135) dakika,
 62 (20-136) saniyedir. İşlem öncesinde hiçbir hastada
 DJ kateteri yoktu ancak tüm hastalara işlem sonunda
 DJ kateteri yerleştirildi ve kateter 4 hafta sonra lokal
 anestezi altında çekildi. On bir (%10,3) olguda üreter
 darlığı nedeniyle, 8(%7,5) olguda da rezidü taş
 nedeniyle 2. seans yapıldı.RIRS yapılan taşların 19
 (%17,9) üst kalikste, 9(%8,4) orta kalikste, 40 (%37,7)
 alt kalikste, 38(%35,8) olguda renalpelviste olduğu
 değerlendirildi. Hastalarımızın % 82,1’ inde ilk seansta
 taşsızlık sağlandığı bulundu. İkinci seans sonrası
 taşsızlık oranı % 92,5 olarak tespit edildi. Hastaların
 ortalama yatış süreleri 1,5 gün (1-9) gündü. Beş hastada
 postoperatif dönemde üriner sistem enfeksiyonu
 gelişti. RIRS uygulanan hastalarda cerrahi ya da cerrahi
 dışı nedenle mortaliteye rastlanmadı.
 Sonuç
 RIRS, taş cerrahisinde etkinlik ve komplikasyonlar
 açısından güvenilir bir yöntemdir. Özellikle ESWL dirençli
 taşlarda, obez, kas iskelet deformiteli hastalarda,
 soliter taşlı böbrekte, gebelikte, kanama diyatezinde
 önemli cerrahi alternatifitir. Teknolojik ilerlemeler
 ile birlikte tekniğin avantajları da düşünüldüğünde
 ilerleyen zamanlarda daha aktif kullanılacağı ve yaygınlaşacağı
 görüşündeyiz.

The effect of ALPL gene polymorphism on the development of urolithiasis in the Turkish population.

Urinary system stones have a complex pathophysiology affected by environmental and genetic factors. To confirm whether ALPL gene polymorphisms are an effective universal risk factor for the development of urolithiasis, we aimed to investigate ALPL gene polymorphism in Turkish population. Our study was carried out with 187 patients with urolithiasis and 92 healthy volunteers (control group) who were not diagnosed with urolithiasis either in themselves or in their families, applied to Emergency Medicine Clinic of Health Sciences University Haydarpasa Numune Training and Research Hospital in Istanbul, Turkey between November 2021 and February 2022, prospectively. In order to evaluate the relationship between ALP gene (rs1256328) polymorphism and urolithiasis, blood samples were analyzed by quantitative Real Time PCR (qPCR) method. Male gender (OR:3.785; 95% CI:2.118-6.763; p<0.001), increased BUN level (OR:1.082; 95% CI:1.013-1.156; p=0.019), increased NLR level (OR:1.149; 95 %CI:1.033-1.277; p=0.011) and heterozygous genotype (OR:2.353; 95% CI:1.31-4.225; p=0.004) were determined as independent risk factors for the development of urolithiasis. The presence of heterozygous (CT) genotype in the ALPL rs1256328 gene region in the Turkish population is associated with an increased risk of urolithiasis. This suggests that ALPL rs1256328 gene polymorphism can be used as a genetic marker in the Turkish population.

Trends and patterns of initial percutaneous nephrolithotomy and subsequent procedures among commercially-insured US adults with urinary system stone disease: a 10-year population-based study

PurposeTo describe trends and patterns of initial percutaneous nephrolithotomy (PCNL) and subsequent procedures from 2010 to 2019 among commercially-insured US adults with urinary system stone disease (USSD).MethodsRetrospective study of administrative data from the IBM® MarketScan® Database. Eligible patients were aged 18–64 years and underwent PCNL between 1/1/2010 and 12/31/2019. Measures of interest for analysis of trends and patterns included the setting of initial PCNL (inpatient vs. outpatient), percutaneous access (1 vs. 2-step), and the incidence, time course, and type of subsequent procedures (extracorporeal shockwave lithotripsy [SWL], ureteroscopy [URS], and/or PCNL) performed up-to 3 years after initial PCNL.ResultsA total of 8,348 patients met the study eligibility criteria. During the study period, there was a substantial shift in the setting of initial PCNL, from 59.9% being inpatient in 2010 to 85.3% being outpatient by 2019 (P < 0.001). The proportion of 1 vs. 2-step initial PCNL fluctuated over time, with a low of 15.1% in 2016 and a high of 22.0% in 2019 but showed no consistent yearly trend (P = 0.137). The Kaplan–Meier estimated probability of subsequent procedures following initial PCNL was 20% at 30 days, 28% at 90 days, and 50% at 3 years, with slight fluctuations by initial PCNL year. From 2010 to 2019, the proportion of subsequent procedures accounted for by URS increased substantially (from 30.8 to 51.8%), whereas SWL decreased substantially (from 39.5 to 14.7%) (P < 0.001).ConclusionsFrom 2010 to 2019, PCNL procedures largely shifted to the outpatient setting. Subsequent procedures after initial PCNL were common, with most occurring within 90 days. URS has become the most commonly-used subsequent procedure type.

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: Our 11 years of experience

Background/Aim: Urinary system stone disease creates a significant burden on the health system. Many treatment methods are available, including extracorporeal shock wave lithotripsy (ESWL), endourological procedures, and open and laparoscopic procedures. In recent years, in parallel with technological developments, endourological devices have become more usable in the renal system. For this reason, urologists are opting for endourological procedures more frequently. ESWL is the least invasive procedure for urinary system stone disease, and it has a higher success rate in pediatric patients than in adults. In this retrospective cohort study, we analyzed the data from the pediatric cases in which we used ESWL treatment in our clinic. We aimed to reveal the effectiveness of ESWL and the factors that will increase the success rate of this procedure in light of the current literature. Methods: The files of patients aged 16 years and under who underwent ESWL at the Urology Clinic of University of Health Sciences Sanliurfa Mehmet Akif Inan Training and Research Hospital between January 2010 and December 2021 were retrospectively reviewed. Age, gender, stone area, stone localization, number of sessions, energy and frequency used, complete stone-free status, and secondary intervention requirement were recorded. The absence of stone fragments or the presence of fragments smaller than 3 mm only in imaging after ESWL was considered a success. Results: This study included 433 pediatric patients. The mean age of the patients was calculated as 12.02 (4.67) (range: 1–16) years. The most important factors affecting the number of residual stones were stone localization (P = 0.045) and size (P &lt; 0.001). When stone localization was compared according to patient age, the older patients were found to have a significantly higher rate of stones in the proximal ureter than in the lower calyx of the kidney (P = 0.045) and renal pelvis (P = 0.048). Conclusion: Although there are continual advances in other minimally invasive surgical methods today, ESWL is a treatment method that can be safely applied in pediatric patients. Stone size and stone localization are the two most important factors affecting its success rate.

Clinical Score Application for Abdominopelvic Computed Tomography Used in the Diagnosis of Renal Colic Patients

Abstract Background To develop risk scoring for the use of computed tomography (CT) imaging using the visual analog scale (VAS), physical examination, and laboratory findings of renal colic patients admitted to the emergency department (ED). Materials and Methods This is prospective observational study. Among the patients who presented to the ED with abdominal or flank pain, patients who were scheduled for CT imaging for urolithiasis were included in the study. The mean VAS pain scores, physical examination findings, laboratory parameters, and macroscopic and microscopic values in urinalysis were compared between the two groups with and without stones on CT. Results Of the 196 urolithiasis patients included in the study, 165 had ureteral stones, 76 had renal stones, and 45 had renal and ureteral stones. While the difference between the urine erythrocyte averages of the two groups was borderline significant (p = 0.04), there was a high difference between the urinary hemoglobin amounts (p &lt; 0.001). In patients with urinary system stone disease, hydronephrosis, and ureteral dilatation, hemoglobin ++ and above were more significant (p &lt; 0.001). For ureteral stones, pain intensity increased as the size increased (r = 0.34 p &lt; 0.001). White blood cells &gt; 10,000 103/mL, and C-reactive protein (CRP) ≤ 5 mg/L were more significant in patients with acute renal colic. Conclusions Although we cannot develop a clinical scoring system for renal colic patients, the meaningful results we found for urinary stone disease can be used in a newly developed scoring system. It can be used in new scoring systems in the ED using a high VAS score, presence and amount of urine hemoglobin, CRP) ≤ 5 mg/L, and creatinine value.

Are there any changes in serum renal parameters in patients undergoing ESWL therapy?

Purpose: The goal of this research was to explain the effects of ESWL on renal function (Extracorporeal Shock Wave Lithotripsy). Materials and Methods: This study was carried out retrospectively between November 2019 and October 2020, with 50 adult patients scheduled to perform an ESWL treatment because of a diagnosis of kidney stone and to completed the study protocol. In all of these patients, there was no urogenital abnormality, and none had a solitary kidney. Patients' mean age was 37.2 (between 26 and 67 years of age). Of patients, 31 (62%) were male and 19 (38%) were female. Three ESWL sessions were carried out in the patients and the time between sessions was set at 7 days. The routines collected one day before the ESWL (Routine I) protocol were repeated one day after the first session (Routine II) and one day after the end of all ESWL (Routine III) sessions. Results: There wasn’t any statistically significant difference among routines in terms of the ratio of serum electrolytes, serum creatinine, GFR and spot urine/protein. Conclusion: The findings indicate that the renal function tests do not need to assess whether ESWL leads to a tubular functional dysfunction in patients when treating upper urinary system stone disease. Keywords: Extracorporeal Shock Wave Lithotripsy (ESWL), renal stone, renal function and glomerular filtration rate (GFR)

Evaluation, management, and analysis of demographic and radiological characteristics of patients with renal colic at a tertiary hospital in Somalia.

Renal colic is a common emergency centre (EC) complaint worldwide, but its epidemiology and strategies for evaluation and treatment have been little reported in Africa. To the best of our knowledge, this is the first study aimed at evaluating the radiological investigations, management, and analysis of demographic characteristics of patients with urinary system stones who visited the EC. A 3-year retrospective study of a total of 435 patients with acute renal colic who underwent radiologic investigations was included in this study. The overall positive stone rate, stone location, size, and hydronephrosis grade were assessed. The sensitivity and specificity of ultrasound were evaluated using patients with both an ultrasound and a non-contrast CT (NCCT). The mean age of the patients was 34.7years; males accounted for 71.3% (n=310), while females were 28.7% (n=125). Urolithiasis was found in 63.4% of the cases, 71.3% of males and 28.7% of the females had a stone diagnosis (P<0001). There was no statistically significant association between age and stone diagnosis (P>0.05). The sensitivity and specificity of USG were 86.1% and 94%, respectively. Seventy-two percent of the cases had ureteral stones (29% in proximal, 25% in UVJ, 9% in mid, and 9% in distal ureter), followed by 28% having renal stones (19% calyces and 9% in renal pelvis). The mean size of the stone was 5.9±1.8, half of the cases harbour stone size <5mm, followed by 30% in 5mm-1cm. Due to the scarcity of well-equipped tertiary care hospitals and the low socioeconomic status of the patients living in Sub-Saharan Africa, Ultrasound can be the initial investigation of choice because it is safe, cheap, and may help guide diagnosis and the need for further imaging. However, NCCT remains the gold standard diagnosis of choice for acute flank pain.

Bladder augmentation in exstrophy vesicae: Long-term results of a single experienced center.

In this study, we present our long-term treatment outcomes of bladder augmentation (BA), bladder neck closure, and Mitrofanoff clean intermittent catheterization (CIC) in managing bladder exstrophy (BE). This was a retrospective medical records' review of 33 children diagnosed as born with BE, followed up at a tertiary pediatric urology clinic from 1988 to 2020. Outcomes such as surgical interventions, presence of renal calculi, hydronephrosis, and continence status were extracted. The median follow-up of the group was 18.2 (4-26) years. Urinary system stones developed in 10 (30.3%) cases about 8.9 years after BA. Stone development was two times more common in patients who underwent colocystoplasty (33.3%) than those who underwent ileocytoplasty (16.6%). The state of continence of the group was satisfactory in 26 (78.7%; excellent in 23; good in 3 cases) and unsatisfactory (wet) in 6 (18.1%) cases. At the last visit, ultrasonography revealed no hydronephrosis in 23 (69.6%) patients, and the voiding cystourethrogram demonstrated low-grade vesicoureteral reflux in 10 (30.3%) and high-grade vesicoureteral reflux in 2 (6%) patients. An elaborated plan of surgical reconstruction for classic BE can lead to satisfactory long-term urinary continence in most patients. Ultimate predictors of outcome in BE repair are difficult to ascertain. Consistently, BA, bladder neck closure, and Mitrofanoff CIC continue to stand out at a critical point in the management of those patients with classic BE. Our study demonstrated that augmentation is required to achieve acceptable dryness with high satisfactory dryness rates in BE.

The evaluation of morphology of renal pelvicalyceal system's and infundibulopelvic anatomy of kidney's lower pole in post-mortem series.

Urinary system stones are frequently encountered in the community. Together with technological developments, introduction of new treatment procedures such as extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery has further reduced morbidity, mortality and hospitalisation time of patients. In order to maximise success and to reduce complications of these procedures, it is necessary to evaluate anatomy and morphological differences of kidney collector system before the procedure. This study was conducted for the purpose of determining the morphology of the kidney collector system and the negative anatomic factors of the lower pole in autopsy cases performed in our institution. Eighty two kidney units obtained from 41 autopsy cases conducted in Faculty of Medicine Department of Forensic Medicine, Sivas Cumhuriyet University between September 2017 and September 2018 were included in the study. Percentages were found as 78% for intrarenal pelvis, 13.4% for borderline pelvis, 6.1% for extrarenal pelvis and 2.4% for pelvic nonexistence. When pelvicalyceal anatomy was evaluated, percentages were found as 32.9% for bicalyceal, 26.8% for tricalyceal, 20.7% for multicalyceal, and 19.5% for unclassified calyceality. When it was evaluated according to opening of calyces into the renal pelvis based on Sampaio classification, percentages were found as 30.5% for AI, 17.1% for type II, 28% for BI, 18.3% for BII, and 6.1% for unevaluated part. Infundibular lengths of kidney's lower pole were detected as under 3 cm in 39% and over 3 cm in 61% of all cases. Infundibulopelvic angles of kidney's lower pole were measured as under 70o in 42.7% and over 70o in 57.3% of all cases. In our study, there was no statistically significant difference between the right and left kidneys in terms of collecting system morphology and lower pole's negative anatomical factors. Only infundibular length which is one of the collecting system morphology and lower pole's negative anatomical factors were statistically shorter in females than males. There was no difference in terms of other parameters. In conclusion, the findings of this study are largely consistent with the results of similar studies. This reveals that renal collecting system morphology and negative anatomic factors in the lower pole collecting system in human are roughly similar. In clinical practice, pre-treatment computed tomography and, if necessary, magnetic resonance urography evaluation of the lower pole negative anatomic factors may contribute to gain preliminary information about both the clearance of stone fragments especially after shock wave lithotripsy and retrograde intrarenal surgery procedures and perioperative complications proactively.

Evaluation of Medical Malpractice in Urology Cases Resulting in Death

Aim: This study aimed to present 96 cases evaluated by the 1st Specialization Committee of The Council of Forensic Medicine, which included medical malpractice claims about urologists resulting in death between 2010 and 2015 and to increase the awareness of urologists about medical malpractice claims. Materials and methods: The reports prepared by the 1st Specialization Committee of The Council of Forensic Medicine between 2010–2015 were reviewed retrospectively. All of the cases treated in Urology clinics, alleged medical malpractice, and resulted in death, participated in the study. Results: In this study, 96 cases were included. It was reported that there was medical malpractice in 16 (16.7%) cases. Seventy–six of the patients (79.2%) were female; the most common age range was ≥ 60 years (n:46 47.9%); the mean age was 54,90±19,59 years. Seventy–three (76%) cases were followed up under elective conditions. Complications developed in 20 (20.8%) of the cases during their treatment course. Surgical treatment was applied in 68 (70.8%) patients. Twenty (20.8%) cases were diagnosed with urinary system stone disease and 16 (16.7%) cases with benign prostatic hyperplasia. The committee attributed malpractice to the doctors most frequently due to lack of treatment (n:6, 37.5%). Conclusion: We think that a comprehensive review of the cases with medical malpractice claims will contribute to a better understanding of these cases, the improvement of the medical service provided, and public health.

MO128: Predisposing Metabolic Factors to Urinary System Stone Formation in Patients with Autosomal Dominant Polycystic Kidney Disease

Abstract BACKGROUND AND AIMS The risk of urinary tract stone formation in patients with autosomal dominant polycystic kidney disease (ADPKD) is 20%, twice as high as in the normal population. The most important reason for this increased tendency to stone disease is thought to be anatomic changes in the kidney. To investigate metabolic factors that predispose to urinary system stone formation in individuals with ADPKD. METHOD A total of 180 volunteers who applied to our outpatient clinic between December 2019 and May 2021 were included in the study. Four groups were formed: patients with ADPKD and urinary system stones (ADPKD + STONE) (n = 42), patients with ADPKD but no stones (ADPKD + STONE FREE) (n = 43), stone patients without ADPKD (STONE) (n = 47) and healthy controls (HEALTHY) (n = 48) groups. Spot urine pH, 24-h urine volume, calcium, uric acid, oxalate, citrate, sodium and magnesium parameters were measured. STONE group data were obtained retrospectively. Along with these parameters, serum electrolyte, parathormone (PTH), ferritin, albumin, creatinine, urea and uric acid values were also compared. A P value of &amp;lt;.05 was considered significant for statistical analysis. RESULTS There was no statistically significant difference between the four groups in terms of age and gender (P &amp;gt; .05). The citrate value in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than the STONE and HEALTHY groups (P &amp;lt; .05). The citrate value in the 24-h urine was significantly lower in the STONE group than in the HEALTHY group (P &amp;lt; .05). The citrate value in 24-h urine did not differ significantly between the ADPKD + STONE and ADPKD + STONE FREE groups (P &amp;gt; .05). In the ADPKD + STONE and ADPKD + STONE-FREE groups, the 24-h urinary calcium value was significantly lower than the STONE and HEALTHY groups (P &amp;lt; .05). In the STONE group, the 24-h urinary calcium value was significantly higher than the HEALTHY group (P &amp;lt; .05). There was no significant difference in the 24-h urinary calcium value between the ADPKD + STONE and ADPKD + STONE FREE groups (P &amp;gt; .05). The uric acid level in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &amp;lt; .05). The uric acid value in the 24-h urine did not differ significantly between the ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). The uric acid value in 24-h urine did not differ significantly between the STONE and HEALTHY groups (P &amp;gt; .05). Oxalate, sodium and magnesium values in 24-h urine and 24-h urine volume did not differ significantly between the groups (P &amp;gt; .05). Urine pH value was significantly lower in the ADPKD + STONE, ADPKD + STONE-FREE and STONE groups than in the HEALTHY group (P &amp;lt; .05). The pH value did not differ significantly between ADPKD + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). Serum PTH values were significantly higher in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &amp;lt; .05). The PTH values did not differ significantly between the STONE and HEALTHY groups (P &amp;gt; .05). PTH values did not differ significantly between ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). There was no significant difference between the groups in terms of serum ferritin, sodium, potassium, calcium, phosphorus, magnesium and uric acid values (P &amp;gt; .05). CONCLUSION In our study, 24-h urine citrate level was found to be significantly lower in both ADPKD + STONE and ADPKD + STONE-FREE patients compared to the volunteers in the STONE and HEALTHY groups (P &amp;lt; .05). In conclusion, patients with ADPKD should also be evaluated for hypocitraturia in the outpatient clinic.

Effect of endoscopic urethral procedures applied after robotic radical prostatectomy on urinary incontinence: A prospective cohort pilot study.

The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used. Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group 1 rigid cystoscopy (n = 9), group 2 flexible cystoscopy (n = 7), and group 3 semi-rigid ureterorenoscopy (URS) (n = 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and 1 month after the procedure. While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p > 0.05). The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.

The Relationship Between Urinary Stone Disease and Nutrition Type in Infants

The relationship between urinary stone disease and nutrition in infants is not well known. This study investigates the relationship between breast milk, formula and supplementary foods, vitamin D usage, and family stone history with urinary system stones in children aged 3-24 months. The study included 100 infants aged 3-24 months of age with urinary tract stones and 40 healthy infants with similar age and gender as the control group. Sixty of the patients were boys, and 40 were girls; the control group consisted of 26 boys and 16 girls. There was no significant difference in only breastfeeding, breastfeeding plus formula, and formula feeding in the patients and controls. Positive family history of urolithiasis was significantly higher in the patients compared to the controls (p=0.04). While breastfeeding duration time was negatively correlated with spot urine calcium to creatinine ratio in children exclusively breastfed infants. No direct effect of nutrition type and vitamin D usage on stone formation was found in infants. It has been shown that stone formation in this age group is associated with a family history of stones. In this study, the duration of breastfeeding is negatively correlated with the spot urinary calcium to creatinine ratio.

Giant bladder stone in children

Bladder stones account for approximately 5% of all urinary system stones and are prevalent among children living in poor or rural regions due to low socioeconomic status, a diet with low protein, animal milk (goat milk), and dehydration. Herein, we report a 4 years old child with a large bladder stone of 34 × 29 × 23 mm in dimension and 62 gm in weight successfully managed with open cystolithotomy. Early diagnosis and management of bladder stones in the pediatric age group are crucial to prevent subsequent complications including recurrent urinary tract infections, excessive antimicrobial use and dissemination of antimicrobial resistance, and consequent renal insufficiency.

Predictive value of hounsfield unit in urinary system stones applied with eswl

This study claims to examine the relationship between the Housfield unit (HU) value and the success of Electro Shock Wave Lithotripsy (ESWL) treatment. Data of 142 patients were evaluated retrospectively in this cross-sectional observational study. The threshold value for stone density is calculated as 991.20 HU in the ROC analysis. The patients are seperated into two groups with respect to this value, and their demographic characteristics, stone characteristics and success rates after ESWL treatment are statistically compared. For the variables that are statistically crucial in the univariate analysis, logistic regression analysis are used as a multivariate analysis. The mean age of all patients were 45.25±11.72 years and the mean body mass index (BMI) is 28.42±3.98 kg/m2. While our stone-free rate was 66.2% in our study, the mean stone size was 11.25±3.83mm, the Hounsfield unit value was 1007.55±337.75 HU, and the stone-skin distance was 108.02±20.02mm, respectively. We observed a crucial difference in between the Housfield unit value and stone size in univariate and multivariate analyzes between the two groups, and the stone-free rate after ESWL. The Hounsfield unit value, measured by the non-contrast computed tomography method, is a parameter for the prediction in success of patients undergoing Electro Shock Wave Lithotripsy treatment. Also, stone density above 991.20 HU in patients having urinary system stone disease requires the evaluation of alternative treatments as a condition that reduces the success of the treatment.

İdrar Taşı Olan Yaşlı Hastalarda Şok Dalgası Litotripsi Sonrası Taşsızlık Oranını Etkileyen Faktörlerin Araştırılması

Aim: Urinary stone disease is an important disease seen in all age groups, including elderly patients. It can cause kidney failure and urinary infection problems. Shock wave therapy, which is the minimal invasive among the different treatment alternatives, is preferred for kidney and proximal ureteral stones smaller than 2 cm. Studies on the efficacy and safety of this treatment in elderly patients are limited. This study aimed to investigate the factors affecting the stone-free rate (SFR) in elderly patients with urinary stones after shock wave lithotripsy. Material and Methods: The data of 120 patients in the Urology department of Duzce University Faculty of Medicine between 2010 and 2018 over 65 years old who underwent extracorporeal shock wave lithotripsy (ESWL) for urinary system stone disease were evaluated retrospectively. The data obtained from these patients included sex, age, location of the stone (upper, middle, or lower calyx, renal pelvis, ureter), number of shock waves, stone size, and the need for the auxiliary procedure were analyzed. Results: Of the 120 patients, 82 (68.3%) were male and 38 (31.7%) were female. Comorbidity was present in 49 patients. An overall SFR of 65.8% (n=79) was found. The highest SFR was found in middle calyx stones with 79.3% (23 of the 29 patients). Post-ESWL auxiliary procedures were needed in 36 (30%) patients. Two patients developed subcapsular renal hematoma and pyelonephritis. Conclusion: ESWL is an appropriate even the first option for elder male with favorable stone size. Furthermore, ESWL caused acceptable morbidity in older patients.

Contrast Agent Mimicking Calculi in Entrapped Calyx. A Report of a Case

Urolithiasis is a common condition, and it represents a large number of hospital visits. Under the term infundibulopelvic dysgenesis, many conditions amongst a spectrum of congenital disorders of the pelvicalyceal system are described. Retrograde intrarenal surgery (RIRS) is an effective and safe treatment modality in the management of urinary system stone disease. Fluoroscopic imaging is a cornerstone in endourology. Herein, we present a case where we diagnosed an obstructed calyx during RIRS for renal calculi and operated on it. In this extraordinary case, contrast agent was trapped in the calyx mimicking a renal stone and that was the reason that we discovered the infundibular stenosis. The patient, 24 h after the operation, left the hospital without any complications reported.

Is pain perception different in pediatric and adult patients undergoing stone crushing procedure after the application of multimodal analgesia?

Aim: Extracorporeal shock wave lithotripsy (ESWL) is an important modality in the treatment of urinary system stone disease in children and adults. However, ESWL may be painful and stressful procedure. We aimed to examine the differences between pain perception felt during ESWL in children and adult patients after the application of multimodal analgesia. Method: Patients who underwent the stone crushing procedure under multimodal analgesia at the ESWL unit of Mersin University Hospital Urology Clinic between May 2010 and December 2010, were divided into two groups as pediatric and adult. Using the VAS form, the adult patients’ and pediatric patients' pain perception felt during ESWL, were scored and compared. Results: The difference between the mean scores of pain perception felt during ESWL were not significant for all three sessions in both groups. But the difference between the mean scores of pain perception felt during all ESWL sessions between the pediatric and adult groups were significant for all three sessions. The success rate for SWL was calculated as 83.3% for the pediatric group and 80% for the adult group. Conclusion: ESWL is a painful procedure. Our ESWL success rate is compatible with the literature. The pediatric and adult patients successfully completed the ESWL procedure with multimodal analgesia. The pain perception felt during ESWL score was higher in pediatric cases.