Urology Journal

Purpose: To compare outcomes of super mini percutaneous nephrolithotomy (smPCNL) with extracorporeal shock wave lithotripsy (ESWL) for stones 1-2 cm.

Materials and methods: After receiving ethics committee approval for this study (Date: 10/09/2021 Decision No: 2021/10-01), the files of patients who underwent smPCNL and ESWL for kidney stones between January 2017 and June 2021 by the Urology Department of Van YYU Dursun Odabaşı
Medical Center were retrospectively scanned. A total of 300 patients' data were scanned retrospectively. After applying the exclusion criteria and omitting ESWL patients whose sessions were not completed, a total of 159 patients, including 82 in the ESWL group and 77 in the smPCNL group, were included in our study.

Results: The mean age in the ESWL group was 6.72 ± 3.71, and the mean age in the smPCNL group was 6.63 ± 3.59 (range: 1-18 years). There was no significant difference in the age profile between the groups (p = .87). Regarding the direction of the stone procedure in the smPCNL group, the procedure was performed on the right side in 42 patients (54.54%) and on the left side in 35 patients (45.46%). In the ESWL group, the procedure was performed on the right side in 38 patients (46.35%) and on the left side in 44 patients (53.65%). No statistically significant difference was found between the groups in terms of side direction (p = .38). The mean body mass index (BMI) in the ESWL group was 20.10 ± 2.01, while it was 20.23 ± 2.05 in the smPCNL group. No statistically significant difference was observed between the two groups in terms of BMI (p =.68). The mean stone size in the ESWL group was calculated as 13.74 ± 1.91 mm (10-20 mm) and 149.75 ± 45.46 mm², which would provide more accurate results. The mean value in the smPCNL group was 14.06 ± 2.6 mm (10-20 mm) and 150.87 ± 50.34 mm². No statistically significant difference was found between the groups in terms of stone size (p(mm)=.37, p(mm²)=.88). Among 82 patients treated with ESWL, 21 (25.6%) were stone-free after the first session, increasing to 40 (48.8%) by the end of the second session, and to 50 (61.0%) at the end of the third session. In terms of sedoanalgesia, 19 patients (23.20%) were exposed to 1 session, 16 (19.5%) were exposed to 2 sessions, and 31 (37.80%) were exposed to 3 sessions. Sixteen (19.5%) patients did not receive anesthesia. When evaluated in terms of the need for re-intervention, it was observed in 22 patients (26.8%) in the ESWL group and 4 patients (5.2%) in the smPCNL group (p = .0003). In the comparison of the stone-free rate of the smPCNL and ESWL groups, a statistically significant difference was observed in both the early and late periods (p = .001). When comparing the early and late periods of smPCNL (p = .79) and ESWL (p = .19) within their own groups, no statistical difference was observed. When smPCNL and ESWL were classified according to the Clavien-Dindo classification in terms of complications, no statistically significant difference was observed (p = .51).

Conclusion: ESWL remains the preferred first-line option for many pediatric patients due to its safety and non-invasive nature. However, smPCNL provides higher single-session stone-free rates for 10–20 mm renal stones and may reduce repeated anesthesia exposure. SmPCNL should be considered a viable first-line alternative to achieve higher stone-free rates without increasing complication risks. Prospective, multicenter randomized trials are warranted.

Purpose: This study investigated the impact of synbiotics on blood and urinary concentrations of factors related to kidney stone formation in overweight or obese patients with hyperoxaluria.

Materials and methods: A randomized double-blind clinical trial was conducted involving forty-four patients assigned to either synbiotic or placebo groups. Participants received their respective capsules twice daily for 12 weeks. Blood and 24-hour urine samples were collected at baseline and week 12 for biochemical analyses.

Results: Urinary oxalate significantly decreased in the synbiotic group compared with both baseline (P=.001) and placebo (P=.001). Other biochemical markers showed no significant differences, while urine volume increased in both groups without between-group variance.

Conclusion: Synbiotic supplementation significantly reduced urinary oxalate but did not affect other blood or urinary parameters associated with kidney stone formation.

Purpose: This preliminary study aims to evaluate the immunogenicity and local immune response triggered by the intravesical administration of Brucella abortus S19 (BAS19) in a tumor-free rat model as a potential alternative to Bacillus Calmette-Guerin (BCG) in bladder cancer immunotherapy. The primary objective is to investigate immune activation and safety in the bladder, establishing a foundation for future studies assessing its therapeutic efficacy against urothelial carcinoma.

Materials and Methods: Nineteen female Wistar albino rats received intravesical BAS19 instillations and were euthanized after 3 and 6 weeks. Blood samples and cystectomy tissues were collected. The systemic immune response was assessed using the Rose Bengal agglutination test, immunocapture agglutination test, and blood cultures. Bladder tissues were examined histopathologically and stained immunohistochemically to evaluate local immune responses, specifically analyzing the expression of CD4, CD8, TLR4, and TNF-α.

Results: Higher Brucella-specific immunocapture titers and increased epithelial inflammation were observed in rats treated with BAS19 for 6 weeks. Moreover, significantly enhanced staining of CD4+, CD8+, and TNF-α in inflammatory cells was detected in this group. TLR4 expression was observed in all BAS19-treated rats, regardless of the exposure duration.

Conclusion: Intravesical BAS19 administration in rats induced strong local immune responses via CD4+, CD8+, TNF-α, and TLR4 expression without systemic toxicity. These results suggest that BAS19 may mimic BCG’s immunological pathways, particularly through TLR4 signaling. With its safety, low cost, and immunogenicity, BAS19 emerges as a promising immunotherapeutic candidate for further bladder cancer research.

Purpose: To evaluate the effectiveness of contralateral testicular volume measurements in differentiating monorchidism from intra-abdominal viable testes in children with non-palpable testes (NPt).

Materials and Methods: The data of 179 patients who underwent surgery for undescended testes between January 2017 and January 2024 were retrospectively reviewed. The study included 33 patients with unilateral non-palpable testes. Testicular volumes were measured by ultrasonography 6-12 months prior to diagnostic laparoscopy, and the surgical findings were recorded.

Results: Diagnostic laparoscopy was performed on 33 children with non-palpable testes. For five patients, staged orchiopexy was planned due to the testes being 2 cm or more away from the internal inguinal ring. In 22 patients, inguinal orchiopexy was performed as the testes were around the internal inguinal ring (AIR). In the remaining six patients, no testes were found; the spermatic cord and vessels terminated at the internal inguinal ring (vanishing) or were atrophic (nubbin). There was a significant difference in the contralateral testicular volumes between patients with vanishing testes and those with intra-abdominal viable testes (p < 0.001). Additionally, there was a statistically significant difference in the contralateral testicular volumes between the AIR group and those with testes remote from the internal inguinal ring (RIR) (p = 0.03).

Conclusion: The preoperative ultrasonographic measurement of the contralateral testicular volume in children with a unilateral non-palpable testis can provide valuable information about the nature of the intra-abdominal testis. The presence of a hypertrophic contralateral testis can guide surgeons prior to laparoscopy and is valuable for counseling parents about potential diagnoses.

Purpose: Non-obstructive urinary retention (NOUR) is the inability to empty the bladder with no physical obstruction to urine flow. It can occur as a result of neurological disorders or be idiopathic. In younger women, it may be caused by Fowler’s syndrome (FS), a rare disorder in which the urethral sphincter fails to relax to allow urine to pass normally. This study covers both idiopathic NOUR and FS. Sacral neuromodulation (SNM) has been introduced as an effective option for patients with NOUR.

Materials and Methods: Forty-two patients (aged 17 to 61 years) suffering from refractory NOUR who had a successful first-stage SNM with the Interstim II device, and in whom the second stage was completed, were prospectively studied in the department of neurogenic bladder and neuromodulation in our hospital from February 2016 to August 2019 to evaluate the efficacy and safety of SNM.

Results: The study included forty-two women with NOUR: 20 (47%) with FS and 22 (53%) with idiopathic NOUR. Their mean age was 27.2 ± 12.4 years. Thirty-eight (90%) of them had a successful trial phase (responders) with more than 50% improvement in their voiding parameters. After continued follow-up, a clinical success rate of 79% (30 out of 38 cases) was achieved, with a median follow-up period of 28 ± 8 months. The voiding parameters of these 38 patients showed statistically significant improvement after SNM. Their post-void residual volume dropped significantly from 330 ± 77 mL to 97 ± 55 mL (P < 0.001), average voided volume increased from 60 ± 23 mL to 265 ± 99 mL (P < 0.001), and the number of clean intermittent catheterizations per day fell from 5.6 ± 1 to 1.3 ± 1.6 (P < 0.001). The total number of patients who required surgical revision was 10 (26.4%), for reasons including malfunction due to external trauma in four patients (10.5%), continuous pain in four (10.5%), and device infection in two (5%).

Conclusion: SNM is an effective and safe option for women with refractory idiopathic non-obstructive urinary retention and Fowler's syndrome.

We conducted a retrospective cross-sectional analysis of 288 complaints filed against urologists between 2017 and 2023 at the Forensic Medicine Organization in Shemiranat, Tehran.

The number of complaints increased steadily, peaking in 2023 (n = 66) and reaching a nadir in 2020 (n = 13), likely reflecting the impact of the COVID-19 pandemic. Most complainants were male (89.6%), and patients aged >60 years comprised the largest group (31.3%). Complaints were overwhelmingly directed at specialist urologists (97.6%), with subspecialists accounting for only 2.4%. Cases more frequently originated from public hospitals (66.3%) than from private institutions (33.7%).