Urology Journal

Purpose: To determine anatomical factors affecting Retrograde Intrarenal Surgery (RIRS) success in the treatment of renal lower calyx stones.
Materials and methods: The results of patients were evaluated retrospectively. The patients who have preoperative intravenous urography (IVU) and computed tomography (CT) were divided into two groups as successful (S)(N=103) and unsuccessful(U) (N=29). The anatomic characteristics such as infundibulopelvic angle (IPA), infundibular length (IL), infundibular width (IW) and pelvicaliceal height (PCH) values were compared among two groups.
Results: Mean patient age was 47±13.6 years in group S and 49.5 ±11.9 years in group U. The mean stone size was 10mm (6-54mm) in group S and 19mm (8-45mm) in group U (P < .001) Mean IPA was 85.8 ±16.9 degree in group S versus 54.7 ± 11.5 degree in group U. The mean PCH was 1.9cm (0.5-4cm) in group S versus 2.3cm (0.7-3.9cm) in group U. The mean IL were 2.7 ± 0.8 cm and 3.2±0.7cm in group S and group U, respectively. The mean IWs were 0.7 cm (0.2-2.3cm) and 0.7cm (0.3-2) in group S and group U, respectively. The differences were statistically significant for IPA, PCH, IL (P < .05) while was not statistically significant for IW (P > .05). After multivariate analyses, PCH, IPA and stone size were statistically significant factors.
Conclusion: In our study we found that IPA, PCH and stone size were significant anatomical factors affecting RIRS success in the treatment of renal lower calyx stones. The patients whose IPA, PCH and stone size valuables are unsuitable, may need multiple RIRS sessions or additional
treatment modalities.

Purpose: To compare the serum antioxidant enzyme levels between patients with urinary stone disease and healthy volunteers to determine the effect of cellular oxidative stress on urinary calcium oxalate stones formation.
Materials & Methods: A total of 51 patients with proven urinary calcium oxalate stones (female 35.3%, mean age: 49.3 years) and 37 healthy subjects (female 45.9%, mean age: 44.1 years) were included. The serum levels of antioxidant catalase, glutathione peroxidase, superoxide dismutase and lipid peroxidation were measured in serum samples taken from the peripheral venous circulation.
Results: Mean serum catalase level of patient group was insignificantly higher than healthy subjects (7.54 mmol- H2O2/mg/sec versus 6.16 mmolH2O2/mg/sec, respectively; P = .06) whereas mean superoxide dismutase level (1.56 U/ml versus 3.86 U/ml, P = .047), glutathione peroxidase level (6.70 U/ml versus 8.19 U/ml, P = .022) and lipid peroxidation level (2.35 nmol/ml versus 3.31 nmol/ml, P = .034) of patient group were significantly lower than healthy subjects. Patients with family history of urinary stone disease had significantly lower mean serum
levels of catalase (P = .037), superoxide dismutase (P = .047) and glutathione peroxidase (P = .01), compared with patients without family history.
Conclusion: The findings of this study provide evidence regarding the role of oxidative stress in the development of urinary calcium oxalate stones. Future clinical trials are necessary to elucidate the actual mechanisms of the calcium oxalate stone formation in the environment with increased oxidative stress.

Purpose: Nephrostomy tube insertion and/or a ureteral stent placement is advised when pelvi-calyceal perforations are encountered during percutaneous nephrolithotomy (PNL) nevertheless totally tubeless PNL is a possible exit strategy in percutaneous renal surgery therefore case series on the short term clinical outcomes of noninvasive management of iatrogenic pelvicalyceal perforations encountered during PNL is presented.
Patients and Methods: During retrospective analysis of 1271 PNL procedures, 25 incidents of accidental ureteral catheter/ jj stent dislodgement during first 24 post-operative hours were identified in patient who had pelvi calyceal perforations and had no nephrostomy tube (tubeless). Thirteen patients could not be re-stented nor a nephrostomy
tube could have been placed for them mainly due to patient refusal or comorbid conditions. The main outcome was rate of successful noninvasive management.
Results: Eighteen Patients bearing mucosal tears (grade I trauma) or visible peri-pelvic fat (grade II) successfully recovered without need for ureteral stenting or nephrostomy (72.0%). In seven (28.0%) cases of extension of the perforation into the peri-pelvic fat (grade III), either nephrostomy insertion or JJ stenting was needed for resolution of fever and urinoma. The major limitation was the necessity to exclude patients and manage them in the standard fashion according to clinical guidelines.
Conclusion: Iatrogenic perforations of the collecting system are quite diverse in terms of severity that result in different natural histories and not all might need urinary diversion via nephrostomy or ureteral stenting.
Low grade perforations may be successfully managed in totally tubeless fashion nevertheless further prospective investigations seem warranted.

Purpose: To investigate the therapeutic effects of the aqueous extract of Cerasus Avium stem on kidney calculi.
Materials and Methods: In this experimental study, forty-eight (48) male Wistar rats were randomly allocated into six (6) groups and were studied during a 30 day period. Group A served as normal control and Group B received 1% ethylene glycol in drinking water (EG group). C, D, E, and F Groups, received 1% ethylene glycol from day 1 and were used as prevention and treatment subjects. Rats in prevention groups of low dose (C) and high dose (D) extract, were gavaged with 200 and 400 mg/kg extract respectively from first day of the experiment and treatment
groups of low dose (E) and high dose (F) extract, were gavaged with 200 and 400 mg/kg extract respectively from the 15th day of the experiment.
Results: On the 30th days of the experiment, serum level of magnesium and potassium decreased significantly in EG group compared with A,C,D,E and F groups (P < .05), while serum level of calcium, creatinine, uric acid, sodium and urine level of calcium, creatinine, uric acid, increased significantly in EG group compared with A,C,D,E and F groups (P < .05). In the prevention and treatment groups, the number of deposits decreased significantly compared with EG group on the 30th day (P < .05).
Conclusion: Cerasus Avium stem has a therapeutic effect on calcium oxalate stones in rats with nephrolithiasis and reduces the number of calcium oxalate deposits.

Purpose: Testicular ischemia and necrosis, especially in the infant age, may result from incarcerated inguinal hernia. Duration of ischemia is a significant factor for the affected testicle. We aimed to present a case series on the conservative management in the testicular ischemia caused by incarcerated inguinal hernia.
Materials and Methods: Inguinal hernia repairs performed in between March 2009 and December 2014 were investigated retrospectively. Patients' characteristics, hernia side, incarceration, testicular ischemia and complications were recorded. Color Doppler ultrasonography was performed in the incarcerated inguinal hernia patients preoperatively and was repeated on 3 and 7 days and then at 1, 3 and 6 months postoperatively. The testicle sizes, volumes, and arterial flow patterns of them were recorded at the same time.
Results: Total 785 inguinal hernias were treated in 738 male patients, ranging from 18 days to 16 years. From all male patients, 44 (5.9%) had the IIH. There were 16 (36.3%) irreducible hernias in 44 incarcerated hernia patients. Of these 16, testicular ischemia was determined in 9 (56.2%) infants with the irreducible incarcerated hernia. Orchidopexy
procedure was performed in these patients. Testicular atrophy was occurred in two patients (22.2%). In the others, testicular volumes and perfusions were normal during follow-up (mean 8.3 ± 2.2 months).
Conclusion: Testicular ischemia resulting from incarcerated inguinal hernia may be treated conservatively without orchiectomy for the ischemic testicle and testicular ischemia may be followed with color Doppler ultrasound for at
least 6 months. The inguinal hernia repair in infants should be subject to urgent surgery rather than elective surgery. So, the testicular ischemia in infants with the inguinal hernia will be an avoidable complication.

Purpose: Many techniques have been described to correct anterior hypospadias with variable results. Anterior urethral advancement as one stage technique was first described by Ti Chang Shing in 1984. It was also used for the repair of strictures and urethrocutaneous fistulae involving distal urethra. We report our experience of using this technique with some modification for the repair of anterior hypospadias.
Materials and Methods: In the period between 2013-2015, 20 cases with anterior hypospadias including 2 cases of glanular, 3 cases of coronal, 12 cases of subcoronal and 3 cases of distal penile hypospadias were treated with anterior urethral advancement technique. Patients' age groups ranged from 18 months to 10 years. Postoperatively, patients were passing urine from tip of neomeatus with satisfactory stream during follow up period of 6 months to 2 years.
Results: There were no major complications in any of our patients except in one patient who developed meatal stenosis which was treated by periodic dilatation. Three fold urethral mobilization was sufficient in all cases.
Conclusion: Anterior urethral advancement technique is a single-stage procedure with good cosmetic results and least complications for anterior hypospadias repair in properly selected cases.

Purpose: To evaluate the effect of in vitro application of pentoxifylline (PX) on sperm parameters and ultrastructure after vitrification in asthenozoospermic patients.
Materials and methods: A total of 30 asthenozoospermic semen samples (aged 25-45 years) were divided into four groups before vitrification, after vitrification, control (without PX) and experimental (with PX). In experimental group, each sample was exposed for 30 min to 3.6mmol/l PX and the control group without any treatment apposing in 370C for 30 min. After incubation, the samples were washed and analyzed again. Vitrification was done according to straw method. Eosin-nigrosin and Papanicolaou staining were applied for assessment of sperm viability and morphology, respectively. The samples without PX and post treatment with PX were assessed by transmission electron microscopy (TEM).
Results: A significant decrease in sperm motility (P ≤ .001), morphology (11.47 ± 2.9 versus 6.73 ± 2.01) and viability (73.37 ± 6.26 versus 54.67 ± 6.73) was observed post vitrification, but sperm motility (19.85 ± 4.75 versus 32.07 ± 5.58, P ≤ .001) was increased significantly following application of PX. This drug had no significant (P >.05) detrimental neither negative effect on ultrastructure acrosome, plasma membrane and coiled tail statues of spermatozoa.
Conclusion: Vitrification had detrimental effects on sperm parameters, but PX reversed detrimental effects on sperm motility. However, PX had no alteration on ultrastructure morphology of human spermatozoa after vitrification.

We present a case of adenocarcinoma developing at the vesicocutaneous edge of a vesicostomy, 8 years after it was created, in a patient who had neurogenic bladder secondary to medullitis. The patient died 6 months after the start of surgery therapy. Although transitional and squamous cell carcinoma of a vesicostomy have been reported, to our knowledge, the presence of adenocarcinoma at the vesicostomy edge without bladder involvement has not been reported previously.

Bladder leiomyoma constitutes less than 0.5% of all bladder tumors. Until now, there have been about 250 case reports of bladder leiomyoma. We present a case of large bladder leiomyoma, that was treated successfully with transurethral resection. The patient presented to our clinic with both obstructive and irritative urinary complaints. Cystoscopy showed a mass lesion completely obstructing the bladder neck at the junction of right lateral wall and floor, which did not extend to ureteral orifices. A transurethral resection was performed at the same session
of cystoscopy. At the postoperative 3rd month control visit, the patient's obstructive symptoms were completely healed but her irritative symptoms continued. A repeat cystoscopy revealed residual tumoral tissue remaining at the floor of the previous surgical area. Transurethral resection was performed, and these tissues were completely resected. At the control visit that was 3 months after the second transurethral resection procedure, the patient was free from any urinary complaints. In conclusion, large bladder leiomyomas can be treated successfully with endoscopic approaches.

Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. During April 2013 to June in 2015, 2 patients underwent ileal ureteral substitution using a reconfigured ileal segment of Yang Monti principle in our clinical center. Some slight modifications were made and then follow-up were carried out up to 12 months. For these 2 cases, no significant intra/post-operative complications occurred. In 1 year follow up, serum creatinine (Scr) and blood urea nitrogen (BUN) of both patients decreased to normal.
Glomerular filtration rate (GFR), renogram and pyelogram showed a stable split renal function. To better understand the Yang-Monti principle and potential risks and complications, we conduct an systemic review by searching PubMed, Google Scholar and the Cochrane Library database from January 1996 through June 2016. 10 out of 644 publications were identified, which included 269 patients from cohort studies. The most usual indications for Yang-monti therapy were iatrogenic stricture and retroperitoneal fibrosis. Infection and ileus were indicated as the
main short time postoperative complications while the fistula and re- strictures happened in long-term. In general,we believe Yang-Monti Principle is a safer and efficient technique for clinical partial and complete ureteral defects if patients and potential risks could be well prepared.

Purpose: Cystoscopy is one of the most common urologic procedures. The aim of this study is to investigate the combined effect of intraurethral lidocaine gel and intraglandular injection of lidocaine 2% on pain during and after cystoscopy.
Materials & Methods: In this double-blind, parallel group randomized clinical trial, 156 patients referred for double J removal, urethral dilatation, or cystoscopy were enrolled. The patients were divided into two groups, A and B. All patients received 20 cc of intraurethral lidocaine gel 2%. In group A (N = 75), lidocaine 2% was also injected into the glans penis. The patients in group B (N = 81) only received the intraurethral lidocaine gel. Cystoscopy was performed 10 minutes later. The primary outcome of interest was measured in terms of pain score (visual analogue scale) during and 5 minutes after cystoscopy.
Results: Immediate pain score after the procedure was 3.4 ± 3 and 4.6 ± 3 in groups A and B, respectively (P = .011).
Conclusion: Based on the findings of the present study, lidocaine injection into the glans penis significantly reduced
pain perception.