Urology Journal

Purpose: To determine the number of percutaneous nephrolithotomy (PCNL) operations which are required to achieve competence or excellence. Materials and Methods: One hundred and five consecutive PCNL operations performed by a fellow in endourology, with no previous experience in performing solo PCNL, were studied. Operation duration, stone extraction percent, stone-free rate, number of access, tubeless cases, and complications were studied in sequential groups of 15 patients as the surgeon gained experience. Results: Operation duration decreased from the mean of 95.4 minutes in the first to 15^th patients to 78.3 minutes in the 31^st to 45^th patients, and then remained unchanged. Minor complications were only observed in the first to 45^th patients. Stone extraction percent increased from the mean of 88.3% in the first to 15^th patients to 99.3% in 91^st to 105^th patients. Percentage of patients with no residual fragments decreased from 53% in the first to 15^th patients to 6.7% in the 91^st to 105^th patients. No statistically significant differences were observed in estimated blood loss or transfusion rate between sequential groups of subjects. Conclusion: An improvement in operation duration was observed, and absence of complications was achieved after 45 cases. The improvement in stone clearance was observed up to the last subjects. Competence and excellence were achieved after 45 and 105 operations, respectively.

Purpose: To evaluate the antiurolithiatic activity of Pinus eldarica fruit on induced calcium oxalate nephrolithiasis in rats. Materials and Methods: Calcium oxalate nephrolithiasis in rats was induced by administering ethylene glycol 1% for 30 days via drinking water. The prophylactic and therapeutic groups received P. eldarica fruit extract (500 and 1000 mg/kg/day) as well for 30 days and from the 14th day through the end of the experiment, respectively. The following variables were assessed; urine volume, urinary calcium excretion, and crystalluria. Finally, rats’ kidneys were histopathologically examined. Results: The aqueous extract prophylactic treatment (500 mg/kg/day) increased urinary calcium excretion. Qualitative analysis of crystalluria and histopathologic examination showed that the administered dose of extract prevented stone formation in the kidneys significantly. The prophylactic treatment did not increase urine volume in comparison with ethylene glycol. Stone formation did not decrease in the treatment group. Conclusion: This study indicates that P. eldarica fruit extract prevents calcium oxalate deposition, without producing diuresis.

Purpose: As there is paucity of data on radical prostatectomy (RP) as a primary treatment for patients with localized prostate cancer, we analyzed the trends in the RP practice in England. Materials and Methods: This study was carried out on 14 300 patients who underwent RP for carcinoma of the prostate. Database was prepared from hospital episode statistics of the Department of Health in England. National trends in RP practice were summarized as well as volume outcome analysis. Results: Annual number of RPs exponentially increased from 972 (1998 to 1999) to 3092 (2004 to 2005). Laparoscopic RPs increased from 2 to 257 over the study period. Median waiting duration increased by more than 10 days (13 days). Significant decrease in median length of hospital stay from 8 (range, 7 to 10) days to 6 (range, 5 to 8) days was observed (P < .001). More than 90% mortality was seen in patients of ≥ 60 years of age. Significant inverse correlation was found between the hospital volume (Odds Ratio: 0.40) and in-hospital mortality rate following RP. High volume surgeons (≥ 16) and high volume hospitals (≥ 26) had significantly lower mortality (Odds Ratio: 0.32) and shorter in-hospital stay in comparison to low volume surgeons and hospitals. Conclusion: There is an exponential increase in the number of RPs with an increasing trend towards laparoscopic RP in England. This study showed a significant inverse correlation between  rovider volume (hospital and surgeon) and outcome (in-hospital mortality and hospital stay) for RP in England; thus, supporting the recommendations for centralization of care for complex radical procedures, including RP.  

Purpose: To present our experience of laparoscopic ureteral reimplantation using intracorporeal ureteral tapering for management of distal ureteral stricture. Materials and Methods: Between April 2005 and October 2008, six patients, including 3 children and 3 adults, underwent laparoscopic modified Lich-Gregoir type extravesical ureteral reimplantation for distal ureteral stricture. Significant dilatations of proximal segment in these patients were repaired with intracorporeal ureteral tapering. Stricture etiologies were congenital ureterovesical megaureter and iatrogenic gynecologic injury in 4 and 2 patients, respectively. Results: Mean age of the patients was 29.3 years (range, 2 to 62 years). Mean operation time and hospital stay was 185 minutes (range, 150 to 240 minutes) and 4 days (range, 2 to 6 days), respectively. No significant complications were noted intra-operatively. Surgical procedure was performed in all the subjects laparoscopically and no conversion to open surgery happened. Postoperatively, 2 patients were complicated with febrile urinary tract infection that were managed medically. No urinary leakage occurred in early postoperative period. All the patients had patent ureterovesical junction anastomosis in follow-up imaging and recurrence of obstruction was noted in no cases. Two patients (33.3%) developed grade II vesicoureteral reflux. Conclusion: Laparoscopic ureteral reimplantation with intracorporeal tapering of distal segment may be performed safely in management of patients with distal ureteral stricture and severe dilatation of proximal segment.

Purpose: To investigate the changes in urodynamic indices following a single dose of oral tadalafil in patients with supra sacral spinal cord injury (SCI). Materials and Methods: Urodynamic study was accomplished on 20 patients with supra sacral SCI before and one hour after administration of 20 mg oral tadalafil as a single dose. Changes in the bladder capacity and compliance, maximum voiding detrusor pressure, and maximum detrusor filling pressure before and after tadalafil administration were recorded. Results: Following administration of 20 mg oral tadalafil, there was a significant increase in the bladder compliance (from 12.7 to 18.5 mL/cmH₂0, P < .001), bladder capacity (from 169.8 to 198.5 mL, P < .001), maximum voiding detrusor pressure (from 64.8 to 48.6 cmH2O, P < .001), and maximum detrusor filling pressure (from 24.3 to 14.0 cmH₂O, P < .001). Conclusion: Single dose of oral tadalafil has significant positive effects on

urodynamic indices in patients with supra sacral SCI.

Purpose: To investigate the success rate of Snodgrass method in combination with tunica vaginalis flap as the second layer for hypospadias repair. Materials and Methods: In a prospective study, 33 patients with penile hypospadias who were treated using a Tubularized Incised Plate Urethroplasty (Snodgrass method) and vascularized tunica vaginalis flap as a second layer, were evaluated. Wound infections, meatal stenosis, and urethrocutaneous fistula were considered as treatment complications. Success rates of surgery were recorded. Failure was defined as need for re-operation. Results: The mean age of the patients was 9.93 ± 4.4 years (range, 1.5 to 18 years). The mean follow-up was 8.79 ± 5.43 months (range, 6 months to 5 years). Four patients were lost to follow-up and excluded from the study. The location of hypospadias was distal penile in 17 patients (59%) and midpenile in 12 (41%). Of studied patients, 3, 2, and, 1 developed fistula, wound infection, and meatal stenosis, respectively. Two subjects with meatal stenosis and one with wound infection were managed conservatively. Conclusion: Snodgrass technique in combination with tunica vaginalis flap as a second layer is a reasonable procedure for hypospadias repair because of good cosmetic appearance and acceptable complication rates. Currently, fistula formation remains the most common complication of this technique, which often needs surgical repair.

Purpose: To compare dorsal versus ventral anterior urethral spatulation in posterior urethroplasty. Materials and Methods: In a retrospective study, we evaluated the records of 320 posterior urethroplasties which have been done in our center over a 7-year period from January 2000 to December 2006. The results of dorsal and ventral anterior urethral spatulations were compared. Results: The studied subjects consisted of 264 men and 54 prepubescent boys (≤ 15 years) with the mean age of 23 years (range, 5 to 84 years). The mean follow-up was 52 months (range, 27 to 107 months). Six o’clock (group A) and 12 o’clock (group B) anterior urethral spatulations were performed in 101 (32%) and 219 (68%) of the patients, respectively. The success rates were 96% and 87.6% in groups A and B, respectively (P = .025). There were

no urethro-rectal fistula and perineal wound infection during the follow-up period. Conclusion: Our data suggest that the dorsal anterior urethral spatulation in urethroplasty is more efficient than ventral anterior urethral spatulation in terms of treatment success outcome.

Purpose: To compare peri-operative and short-term complications of open transvesical prostatectomy (OP) as well as its functional outcomes with transurethral resection of the prostate (TURP) in management of benign prostatic hyperplasia with prostates sized 30 to 70 g. Materials and Methods: Hundred patients who were candidate for the prostate surgery with prostates between 30 to 70 g randomly underwent OP or TURP. Secondary endpoints included international prostate symptom score, residual urine volume, surgical complications, and patients’ quality of life. Patients were followed up for 6 to 12 months after the operation. Results: Fifty-one and 49 patients underwent OP and TURP, respectively. Median (interquartile range) of peak flow rate improvement was 11.1 (7.6 to 14.2) and 8.0 (2.2 to 12.6) in OP and TURP groups, respectively (P = .02). International prostate symptom score improvement did not reveal statistically significant difference between treatment groups. Re-operation due to residual prostate lobe, urethral stricture, and urinary retention was performed

in 8 patients in TURP group versus no patient in OP group (P = .006). Dysuria was more frequent in patients that underwent TURP (P < .001). Hospitalization duration was slightly longer in patients that underwent OP (P = .04). Patients’ quality of life was better in the OP group (P = .04). Conclusion: Open transvesical prostatectomy is an acceptable operation for the prostates sized 30 to 70 g. Higher peak flow rate improvement, better quality of life, less frequent dysuria, less need to re-operation, and its ease of learning make open prostatectomy a suitable option to be discussed in patients parallel to TURP.

More than 140 years have passed since the first documented planned nephrectomy. Throughout all these years, people gained significant knowledge on the renal functions and diseases, and what is more, the surgical workshop underwent considerable improvement. Initially, the kidney removal operations were performed due to ureterovaginal fistulas and renal lithiasis. Later, they were executed mainly in patients with renal tumors, whereas today, the number of these surgeries tend to decrease to the benefit of nephron sparing procedures. Current nephrectomies are more and more often performed in case of organ donation, what will probably remain the most significant indication for the kidney removal in close future. While the first surgeries were executed with classical surgical methods, nowadays, after years of studies concerning nephron sparing and minimally invasive operations, we can see surgeries carried out through natural body orifices with robotic assistance. In relation to simple surgical operation based on ligation of 3 tubular anatomic structures, we can perceive the true scope of the progress that occurred in surgery. The aim of this article is to present the evolution of indications and operating techniques utilized to remove the kidney in chronological aspect.