فهرست مطالب
Urology Journal
Volume:13 Issue: 1, Jan-Feb 2016
- تاریخ انتشار: 1394/12/27
- تعداد عناوین: 17
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Pages 2471-2478PurposeWith decreased physical activity, growing sedentary lifestyle, and high fat diet, obesity has become a pandemic disease all over the world. In this review, we aim to assess the effect of obesity on prone percutaneous nephrolithotomy. (PNL) outcomes.Materials And MethodsWe performed a comprehensive review of the published articles in PubMed®, Medline, Scopus, Cochrane database from January 1, 2004 through June 31, 2015, using the key words; body mass index, obesity, morbid obesity, super obese, urolithiasis, nephrolithiasis, percutaneous nephrolithotomy and percutaneous lithotripsy. Original research articles published in English language with accessibility to the full text article were analyzed for our review.ResultsAt the end of the evaluation, we found 12 articles in English language, analyzing the effect of obesity on prone PNL outcomes. Except one study, eleven studies were evaluated in this review had a retrospective nature without randomization. Stone free status of patients was in a wide range between 49% 90% in obese patients and 41%-90% in morbid obese patients.ConclusionPNL is a safe and effective treatment modality for renal stone(s) in obese and morbid obese patients. However, effect of body mass index on PNL outcomes including operation time, fluoroscopy screening time, hospitalization time, complications and stone free status are still debatable.Keywords: kidney calculi, complications, surgery, length of stay, nephrostomy, percutaneous, adverse effects, obesity, morbid, operative time, overweight, prospective studies
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Pages 2479-2483PurposeTo compare the efficacy and safety of percutaneous nephrolithotomy (PNL) in the treatment of staghorn calculi (SC) under spinal anesthesia (SA) versus general anesthesia (GA).Materials And MethodsPatients with SC who treated with PNL from 2011 to 2014 were retrospectively reviewed. In total, 100 patients were divided into 2 groups according to anesthesia type: SA (group 1, n = 47) and GA (group 2, n = 53). Demographics, perioperative parameters, and postoperative analgesic requirements were compared between the two groups.ResultsThere was no significant difference in terms of age, sex, American Society of Anesthesiologists score, body mass index, or stone size between the two groups (P = .40, .30, .18, .20, and .5 , respectively). The mean procedure times were 84.7 and 87.5 min in the SA and GA groups, respectively (P = 68). The complication rates were similar in the SA and GA groups (19.1% vs. 13.2%, respectively; P = .421). The stone-free rates were also similar in the SA and GA groups (61.7% vs. 52.8%, respectively; P = .374). No statistically significant difference was found in analgesic requirements.ConclusionSA is a safe method without the risks of GA and may be used for conditions in which GA is contraindicated or in patients with concerns about GA. Our outcomes indicated that SC can be treated safely and effectively under SA.Keywords: kidney calculi, surgery, nephrostomy, percutaneous, adverse effects, complications, treatment outcome, anesthesia, methods
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Pages 2484-2489PurposeTo examine the outcomes and compare the effectiveness of laparoscopic ureterolithotomy and flexible ureterorenoscopy (FURS) in patients with proximal ureteral stones larger than 10 mm in diameter.Materials And MethodsIn total, 150 patients who underwent laparoscopic ureterolithotomy and FURS because of ureteral stones in our urology clinic from January 2010 to June 2015 were retrospectively analyzed. The patients were divided into 2 groups: 70 patients who underwent laparoscopic ureterolithotomy (Group 1) and 80 patients who underwent FURS (Group 2). Success rates and complications were compared.ResultsThe success rates were 95.7% and 90.0% in Groups 1 and 2, respectively; there was no statistically significant difference between the groups. No statistically or clinically significant complications occurred in either group.ConclusionLaparoscopic ureterolithotomy and FURS are both effective and reliable for the treatment of proximal ureteral stones. However, considering the shorter operation and hospitalization times and the management of situations that require secondary interventions, we suggest that FURS, as a minimally invasive method, may be the first choice in the treatment of proximal ureteral stones.Keywords: ureteral calculi, surgery, laparoscopy, adverse effects, lithotripsy, postoperative complications, ureterolithiasis, treatment outcome, ureteroscopy, methods
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Pages 2490-2495PurposeTo compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10 20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment.Materials And MethodsBetween January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times.ResultsThe average stone size for the SWL group was 14.62 ± 2.58 mm and 14.91 ± 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 ± 158.39 HU in the SWL group and 567.74 ± 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 ± 9.71 days in the SWL group and 11.59 ± 7.01 days in the RIRS group (PConclusionOne of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies.Keywords: lithotripsy, methods, kidney calculi, surgery, treatment outcome, retrospective studies, ureteroscopy
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Pages 2496-2501PurposeOur goal was to present our experience with ultrasound guided supine or prone percutaneous nephrolithotomy in three pregnant women under spinal anesthesia.Materials And MethodsThree pregnant women in the 16th, 20th and 28th weeks of pregnancy presented with symptomatic large renal stone in the first patient and multiple renal stones in the second and third patients which were unresponsive to conventional medical therapy. They requested a definitive stone treatment. The operations were done in November 2012, June 2014 and February 2015. Data was gathered prospectively. All steps of gaining access to the pyelocalyceal system including needle insertion, tract dilation, and Amplatz sheath placement were performed under ultrasonography guidance. Tract was dilated with a single shot technique. The first two procedures were performed in supine position and the third procedure was performed in lateral flank position.ResultsTwo patients were stone-free postoperatively and one patient had only an asymptomatic 4 mm residual stone. They were discharged on the 2nd postoperative day and had an uneventful postoperative course. No fever, bleeding or renal colic was noticed during postoperative hospitalization. All patients delivered their fetuses at term without any abnormality reported by the examining pediatric specialist after their birth.ConclusionUltrasonography can be used as an imaging modality guiding all steps of obtaining percutaneous access in pregnant women. Supine or flank ultrasound guided percutaneous nephrolithotomy can be offered to pregnant women in whom conservative measures fail to the patients wellbeing.Keywords: percutaneous nephrolithotomy, ultrasonography, pregnancy, supine, flank
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Pages 2501-2508PurposeUsing percutaneous nephrolithotomy (PNL), it is easy to reach stones in various parts of the kidney via a single access tract. In the current study, we set out to demonstrate that the intravenous catheter is a safe way to gain renal access, and that PNL is safe in children.Materials And MethodsWe retrospectively reviewed the medical records of patients who underwent PNL as a treatment for renal stone disease at our center between September 2013 and December 2014. There were no specific exclusion criteria. We used 14 gauge intravenous catheter for renal access in all cases.ResultsEleven of the 32 patients (34.4%) were female and 21 (65.6%) were male. The mean ± SD patient age was 4.7 ± 3.71 years (9 months-16 years). Six patients (18.7%) were infants less than 1 year of age. Fifteen of the stones (46.8%) were located in the right kidney, and 17 of the stones (53.1%) were located in the left kidney. The average stone size was 13.9 ± 4.8 mm (range, 12-28). The average duration of operation was 69.7 ± 10.4 minutes (range, 50-110), and the average duration of fluoroscopy was 2.21 ± 1.06 minutes (range, 1-6). There were complications in 5 of the cases (15.6%).ConclusionThe access and dilatation stages are quite important. We propose that the intravenous catheter is a safe and inexpensive tool for renal access in PNL in pediatric age group patients.Keywords: kidney calculi, surgery, child, minimally invasive surgical procedures, methods, nephrostomy, percutaneous, treatment outcome
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Pages 2509-2518PurposeTo analyze the relationship between nephrolithiasis and vitamin D receptor (VDR) gene BsmI (rs1544410), ApaI (rs7975232), TaqI (rs731236), Tru9I (rs757343) and FokI (r 2228570) polymorphisms in a study group from the Turkish population.Materials And MethodsNinety-eight patients with calcium oxalate kidney stones and 70 controls were enrolled in this study. Five polymorphisms of the VDR gene were studied using the Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) method.ResultsFor all polymorphisms, genotype frequencies were in line with Hardy-Weinberg equilibrium in the patients and controls. For the BsmI polymorphism, allele frequency distribution was found to differ significantly between the patients and the controls (PConclusionThe B allele of the BsmI polymorphism of the VDR gene may increase stone development risk. Further investigations are needed to improve our knowledge regarding the genetic factors affecting urinary stone development.Keywords: nephrolithiasis, genetics, mutation, humans, vitamin d3 24 hydroxylase, genetics, metabolism, hypercalcemia, hypercalciuria, nephrocalcinosis
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Pages 2519-2526PurposeThe aim of the present study was to investigate whether patients body habitus affects the operative difficulties associated with extraperitoneal laparoscopic radical prostatectomy (LRP). Therefore, the associations between body habitus and perioperative outcomes of surgery, including bleeding, operative time, and resection margins, were evaluated.Materials And MethodsBetween August 2010 and July 2012, 40 consecutive patients with preoperative magnetic resonance imaging and abdominal X-ray examinations underwent extraperitoneal LRP for localized prostate cancer at our institution. The associations between anthropometric measurements and demographics of patients, operation duration, estimated blood loss (EBL), and resection margins were analyzed retrospectively. Multivariate analyses were performed, and PResultsOn multiple regression analysis, the view of the prostatic apex (VPA) was significantly associated with EBL (P = .02), and body mass index (BMI) was significantly associated with operative time (P = .02). On multiple logistic regression analysis, protrusion of the prostate into the bladder was significantly associated with positive resection margins (P = .04).ConclusionThe findings of the present study suggest that poor VPA, protrusion of the prostate into the bladder, and high BMI were related to operative difficulties in extraperitoneal LRP. If operative difficulty is predicted preoperatively, it would be better to prepare blood for transfusion and/or special instruments (e.g. flexible scope), or switch to other therapeutic procedures.Keywords: blood loss, surgical, laparoscopy, methods, operative time, prostatectomy, prostatic neoplasms, surgery
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Pages 2527-2532PurposeTo detect the expression of vitronectin (VTN) in the tissues and blood serum of prostate cancer (PCa) patients, and evaluate its clinical significance and to evaluate the significance of the combined assay of VTN and prostate specific antigens (PSA) in PCa diagnosis.Materials And MethodsTo detect the expression of VTN as a potential marker for PCa diagnosis and prognosis, immunohistochemistry was performed on the tissues of 32 patients with metastatic PCa(PCaM), 34 patients with PCa without metastasis (PCa), and 41 patients with benign prostatic hyperplasia (BPH). The sera were then subjected to Western blot analysis. All cases were subsequently examined to determine the concentrations of PSA and VTN in the sera. The collected data were collated and analyzed.ResultsThe positive expression rates of VTN in the tissues of the BPH and PCa groups (including PCa and PCaM groups) were 75.61% and 45.45%, respectively (P = .005). VTN was more highly expressed in the sera of the BPH patients (0.83 ± 0.07) than in the sera of the PCa patients (0.65 ± 0.06) (PConclusionVTN levels in sera may be used as a potential marker of PCa for the diagnosis and assessment of disease progression and metastasis. The combined detection of VTN and PSA in sera can be clinically applied in PCa diagnosis.Keywords: cell line, tumor, prostatic neoplasms, vitronectin, metabolism, humans, biomarkers, early detection of cancer, prostate, specific antigen
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Pages 2533-2540PurposeWe investigated whether addition of amikacin to levofloxacin-based antimicrobial prophylaxis reduces febrile urinary tract infections after transrectal ultrasound-guided prostate needle biopsy (TRUSB).Materials And MethodsA total of 447 patients undergoing TRUSB were prospectively randomized into two groups. The 230 patients in Group A were given one oral dose of levofloxacin 400 mg prior to TRUSB; the 217 patients in Group B each received the same dose of levofloxacin and one 200 mg intravenous dose of amikacin. Patients characteristics were assessed prior to TRUSB and their symptoms were checked after the TRUSB.ResultsBoth regimens were well tolerated with no side effects. No statistically significant difference in patients characteristics, or in incidence of inflammation- or infection-related symptoms was seen between the two groups; nor any significant difference among those who developed fever and those who did not. Two Group A patients and one Group B patient developed febrile urinary tract infections. Accountable pathogens determined by urine and blood cultures were fluoroquinolone-resistant E.coli and extended-spectrum β-lactamase producing E.coli. All pathogens isolated were levofloxacin-resistant, amikacin-susceptible species.ConclusionAlthough the present study was under-powered by unexpectedly low overall incidence of febrile urinary tract infections, addition of one intravenous administration of amikacin to one oral administration of levofloxacin showed no advantage compared with levofloxacin alone as antimicrobial prophylaxis in TRUSB. Strikingly, all pathogens isolated from febrile patients were sensitive to amikacin in vitro. Therefore, further understanding of amikacins drug kinetics in the prostate is necessary to develop a more efficient drug delivery system for amikacin.Keywords: antibiotic prophylaxis, methods, bacterial infections, prevention, control, prostatic neoplasms, diagnosis, anti, bacterial agents, administration, dosage
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Pages 2541-2545PurposeTo compare fear of circumcision, before, immediately after, and ten days after the operation.Materials And MethodsThis was a case-control study in which participants in the operation group consisted of children admitted for circumcision at the outpatient clinics of a hospital. The Childrens Fear Scale and the Venham Picture Test were administered by face-to-face interviews.ResultsThe sample consisted of 100 boys who were circumcised and 99 who have not been circumcised yet. Childrens Fear Scale scores measured before (P = .000) and immediately after the operation (P = .000) were significantly different from scores obtained on the 10th day after the operation. Total fear scores of the Venham Picture Test of boys whose families were in the higher economic level were higher than those of boys from low-income families (PConclusionFear from circumcision does not persist; it considerably vanishes within ten days. It seems reasonable to recommend circumcision for boys six years of age or older. Pre-operative education may help boys to overcome fear originated from circumcision.Keywords: circumcision, male, psychology, health education, health knowledge, attitudes, practice, case, control studies, socioeconomic factors, child behavior
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Pages 2546-2550PurposeTo evaluate the results of transplantation from living unrelated donors (LURD) versus living related donors (LRD) with a long term follow-up of 25-30 years.Materials And MethodsFrom 1984 to 2015, a total of3716 kidney transplantations (411 LRDs and 3305 LURDs) were enrolled to the study. Long-term survival of grafts and patients as well as the association between relation state and patients or grafts surveillance were the outcomes.ResultsA total of 3716 live donor kidney transplants (LRD, n = 411; LURD, n = 3305) were carried out over this period. The mean age of donors was 28 ± 54 years in the LURD group and 34.4 ± 11.7 years in LRD (PConclusionIt seems that the outcome of LURD and LRD is comparable in terms of patient and graft survival. Therefore, transplants from LURDs may be proposed as an acceptable management for patients with end stage renal disease.Keywords: donor selection, humans, kidney transplantation, living donors, organ transplantation, risk assessment, risk factors
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Pages 2552-2561PurposeThe aims of the study were to evaluate the incidences, types of urinary incontinence (UI) and its risk factors among middle-aged and older (> 40 years) men and women visiting a general practitioner (GP).Materials And MethodsThis is a descriptive and cross-sectional comparative study using a questionnaire-based survey included 172 male and female patients who consecutively visited a primary care center in Kaunas region of Lithuania.ResultsAll 86 women (100%) and 65 men (75.58%) had symptoms of UI (PConclusionUI was common among patients aged > 40 years visiting GP and affected more women of the same age range. SUI was more prevalent among women, while more men had UUI. Age below 60, being married, pregnancy and delivery history, concomitant illnesses were significant risk factors for women SUI and older age and menopause for UUI. The only risk factor for men UUI was age over 60 years.Keywords: prevalence, risk factors, urinary incontinence, epidemiology, etiology, female, male
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Pages 2562-2568PurposeTo evaluate the effects of two preoperative treatment courses with Finasteride on intraoperative and postoperative bleeding complications and prostate blood vessel characteristics in men who underwent transurethral resection of prostate (TURP) using monopolar energy.Materials And MethodsMen scheduled for TURP were randomized into group 1 (control n = 25, no medication),group 2 and 3 (n = 20 in each, 5 mg Finasteride daily for 2 and 4 weeks before TURP; respectively). Hematocrit level in the irrigation fluid, weight of the resected prostate chips, decreases in blood hemoglobin (Hb) level 6 and 24 hours after the operation together with volume and length density of prostate vessels using stereological methods were compared.ResultsThe three groups were matched regarding preoperative demographic data, resection time and weight of the resected tissue. Men who received preoperative Finasteride (groups 2 and 3) had significantly lower hematocrit levels in irrigation fluid than control group (control, 0.59 ± 0.85, group 2, 0.25 ± 0.4, group 3, 0.175 ± 0.16; P = .028; Power = .80). However, no statistically significant difference was found in hematocrit level in irrigation fluid between groups 2 and 3 (0.25 ± 0.4 vs. 0.175 ± 0.16, 95% confidence interval (CI) = -0.28-0.42; P = .68). These values were independent of the weight of the resected tissue and resection time. There were no significant differences between the three groups in the decrease in Hb 6 hours (P = .58) and 24 hours after TURP (P = .65). The stereological and histological characteristics of blood vessels in suburethral prostate tissue were similar in all three groups.ConclusionA 2-week preoperative course of daily Finasteride seems sufficient to significantly reduce intraoperative blood loss; this effect was independent of the weight of the resected tissue and resection time. Neither the 2-week nor the 4-week presurgical Finasteride regimen could significantly decrease postoperative blood loss, and neither regimen induced significant changes in characteristics of prostate tissue blood vessels.Keywords: postoperative complications, prostatic hyperplasia, surgery, transurethral resection of prostate, methods, adverse effects, treatment outcome, hemorrhage
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Pages 2569-2575PurposeTo investigate the prevalence of simple renal cysts in an adult health-screening cohort, and to evaluate clinical characteristics, associated risk factors and the natural course.Materials And MethodsBetween April and November 2008, a thousand individuals diagnosed with simple renal cyst by ultrasonography in a check-up program were chart-reviewed for demographic clinical characteristics and cyst features. Follow-up was done via electronic patient records. Univariate and multivariate analyses to evaluate the relationship of outcomes and correlation analysis were done to measure the degree of association between parameters.ResultsThe prevalence was 7.7%. There were 123 cysts in 77 patients, followed for 3. years (mean). Individuals with cysts were older (PConclusionIn a cohort of adults undergoing a health-screening, the prevalence of simple renal cyst was found 7.7% by ultrasonography. Renal cysts were more common in males and elders, and associated with increased levels of serum creatinine and diabetes.Keywords: kidney diseases, cystic, complications, epidemiology, etiology, prevalence, Turkey