Urology Journal

Purpose: To evaluate the effect of Amplatz sheath size used in percutaneous nephrolithotomy (PCNL) on postoperative outcomes, bleeding and renal impairment rates.

Materials and Methods: We retrospectively evaluated the records of 91 patients who had undergone PCNL. We divided the patients into 2 groups according to Amplatz sheath size (22 and 30 French [F]) used in the PCNL procedure. Groups were retrospectively compared in terms of pre- and postoperative hemoglobin and renal function, mean nephrostomy time, mean nephrostomy tube diameter, mean operative time, mean hospi­talization time and mean scopy time.

Results: Mean operative time, mean preoperative hemoglobin and serum creatinine values were similar in 2 groups. The mean stone diameter of patients in group 1 (22F) and group 2 (30F) were 38.47 ± 11.51 mm and 37.69 ± 12.33 mm, respectively. Pre- and postoperative hemoglobin (Hb) levels were 14.52 ± 1.5 g/dL and 13.51 ± 1.4 g/dL, respectively in group 1. Pre- and postoperative Hb level were 14.23 ± 1.6 g/dL and 10.73 ± 1.7 g/dL, respectively in group 2. There was a significant difference between the two groups in terms of mean scopy time (P = .023), postoperative Hb (P = .027), postoperative creatinine (P = .032), mean nephrostomy duration (P = .019), mean nephrostomy diameter (P = .028) and hospitalization time (P = .034). There was significant difference between the two groups in bleeding requiring blood transfusion (P = .023) and residual stone (P = .035).

Conclusion: The smaller the Amplatz sheath used in PCNL, the lower kidney hemorrhage and renal function impairment happens.

Purpose: To evaluate the efficacy of diode laser ablation of prostate for treating lower urinary tract symptoms (LUTS) in patients with locally advanced prostate cancer and comparing results with palli­ative transurethral resection of prostate (pTURP).

Materials and Methods: Thirty-six known cases of locally advanced prostate cancer with a maximum urinary flow rate (Qmax) of 12 mL per second or less and an International Prostate Symptom Score (IPSS) of 20 or more were included in this study. Patients were randomized into two groups. The first group underwent pTURP and for the second group diode laser ablation of prostate was done. In 6 months post-operative follow up, patients were evaluated for IPSS, post void residual (PVR) urine volume, Qmax and possible complications such as urethral stricture or urinary incontinence.

Results: Postoperatively, mean IPSS was 11.1 ± 4.1 in TURP group and 11.7 ± 3.6 in laser group (P = .64). Mean PVR was 18.4 ± 3.5 mL in TURP group and 17.7 ± 6.3 mL in laser group (P = .68). Mean Qmax in TURP and laser groups were measured 20.1 ± 4.5 mL/s and 19.4 ± 2.6 mL/s, respectively (P = .57). While there was a significant improvement in IPSS and Qmax and PVR in both groups, statisti­cal analysis did not show any significant difference postoperatively between pTURP and laser groups.

Conclusion: Diode laser ablation of prostate and pTURP, both improved significantly IPSS, PVR and Qmax. But hospital stay and post-operative catheterization time was less in laser group.

Purpose: To evaluate the correlation between aggressiveness of prostate cancer (PCa) and obesity measur­ing the periprostatic fat on magnetic resonance imaging (MRI).

Materials and Methods: One hundred eighty-four patients who had undergone radical retropubic prosta­tectomy (RRP) were analyzed retrospectively. The different fat measurements (periprostatic fat area (PFA), the subcutaneous fat thickness, the anterior and posterior abdominal fat thicknesses and anteroposterior diameter) were performed on the slices of MRI and then compared with the clinical and pathologic char­acteristics.

Results: The PFA and ratio showed a statistically significant differences (P = .019 and P = .025, respec­tively) among three groups, that is to say, more adipose were distributed in periprostatic area of the high risk patients. Seventy-one patients in clinical stage and 82 patients in Gleason score have the significant dif­ferences between pre-operation and post-operation values. In the clinical stage, the PFA and ratio showed a statistically significant differences (P = .014 and P = .037, respectively). The difference group had more periprostatic adipose than the other one (65.26 ± 9.03 vs. 64.44 ± 9.62; 87.52 ± 3.97 vs. 87.30 ± 3.96). Noth­ing but the "PFA" was significantly different between two groups (P = .017). Logistic regression analysis adjusted for age revealed a statistically significant association between the PFA, the Ratio and the risk of having high-risk disease (P = .031 and P = .024, respectively).

Purpose: To report our experience of transperitoneal laparoscopic plasty for reconstruction in patients with horseshoe kidney.

Materials and Methods: We retrospectively analyzed 12 patients with the symptomatic horseshoe kidney who presented to our institution from March 2005 to July 2008 and underwent laparoscopic reconstruction for horseshoe kidney. Computed tomography angiography was performed prior to surgery for evaluation of the anatomic variations, since preoperative knowledge is necessary for achieving reliable vascular control. Five patients had renal stones which were extracted during surgery. All laparoscopic operations were performed by the same urologist.

Results: All procedures were completed successfully and no one needed for conversion to open surgery. Mean operative time was 150 min and no major complications were observed. The average follow-up time was 28.7 months. All patients had good renal function and improved drainage with successful reconstruction.

Conclusion: Laparoscopic reconstruction has since been demonstrated to be an attractive alternative in the management of the horseshoe kidney. It provides a feasible and effective alternative to conventional manage­ment.

Purpose: To report a modified retroperitoneoscopic dismembered pyeloplasty technique and its application in the treatment of ureteropelvic junction obstruction (UPJO).

Materials and Methods: From June 2010 to March 2012, retroperitoneoscopic dismembered pyeloplasty was performed in 46 patients with UPJO. Briefly, the renal pelvis was incised in the anterior aspect instead of the lateral aspect, and proximal ureter was spatulated with incision on its posterior wall. After adequately trim­ming, two layers of ureteropelvic anastomosis respectively lay on left and right side of one laparoscopic plane other than two different planes. In our refined procedure, the difficulty of intracorporeal suturing was greatly decreased. Data from 19 months mean follow-up were analyzed to evaluate the surgical outcomes.

Results: All operations were completed without open conversion. The mean operative time, estimated blood loss, and postoperative hospitalization stay were 108 min (75 to 155 min), 30 mL (15 to 60 mL) and 4 days (2 to 9 days), respectively. No intraoperative complications were occurred. Postoperative complications included 2 cases of minor abdominal wall hematoma and 1 case of transient postoperative anastomotic leakage for 8 days, which all were successfully treated by conservative management. A mean follow-up of 19 months (12 to 36 months) was performed which showed a success rate of 97.8%. One case (2.2%) underwent open surgery for persistence UPJO two months later.

Conclusion: Our modification to the retroperitoneoscopic dismembered pyeloplasty procedure is technically feasible and reliable with low complications. It could be implemented as a useful alternative technique to great­ly decrease the difficulty of this procedure.

Purpose: To compare between hand closure and Carter-Thomason technique with respect to following parame­ters, time taken for port site closure, wound infection, wound dehiscence, seroma formation, port site herniation, and ascitic fluid leak.

Materials and Methods: In this study, 200 cases who underwent laparoscopic donor nephrectomy were selected and divided into two groups based on closure technique. First 100 cases underwent port closure by the standard hand closure technique and next 100 cases by Carter-Thomson needle technique. Subjects included in this group are healthy individuals with no co morbid illness. This might help to reduce the bias of complications arising from other than technical issue.

Results: In our study Carter-Thomason serves as a better mode of port site closure with respect to time reduced, wound and bowel related complications compared to hand closure technique.

Conclusion: In this study closure of trocar site is better with the Carter-Thomason method when compared to hand closure technique.

Purpose: The use of laparoendoscopic single-site (LESS) surgery has been increasing. The LESS procedure has been done for various urological diseases and studies have shown that it results in less pain, shorter hospi­tal stays and excellent cosmetic outcomes.

Materials and Methods: We describe our initial experience with LESS adrenalectomy without the use of the transumbilical approach. The participants were 16 consecutive patients who underwent LESS adrenalectomy using a SILS port^TM (Covidien, Mansfield, MA, USA) at Hiroshima University Hospital. Various parameters including the insufflation time, estimated blood loss, resumption of oral intake and complications were ana­lyzed.

Results: The adrenalectomy was completed successfully with no major intraoperative complications in 15 of the patients. One LESS adrenalectomy was converted to a conventional laparoscopic adrenalectomy by placement of two additional 12 mm trocars; this patient was therefore excluded from the study. The mean (range) patient age was 53.8 (35-69) years, body mass index (BMI) was 23.5 (20.7-27.2) kg/m², tumor size was 19.8 (9-45) mm, insufflation time was 188.0 (95-340) min and estimated blood loss was 36.3 (10-80) mL. In all cases articulating instruments were used for satisfactory dissection and triangulation. One bowel injury (serosal) occurred and was repaired in the open laparotomy before SILS port^TM insertion. All patients at the follow-up visit were satisfied and pleased with their scars.

Conclusion: We found LESS adrenalectomy to be apparently safe, effective and minimally invasive for ad­renal diseases. In our opinion, LESS adrenalectomy without using the transumbilical approach is feasible and easy to introduce.

Purpose: To describe the natural history of patients with nocturnal enuresis (NE) during a 10-year period and to evaluate possible impact of comorbid conditions on the persistence of NE.

Materials and Methods: Ninety-five children (male to female ratio [M:F] 65:30), aged at first visit between 6 and 21 years were included in this study. Of study subjects 75 had primary monosymptomatic nocturnal enuresis (PMNE), 3 had secondary monosymptomatic nocturnal enuresis (SMNE) and 17 had non-mono­symptomatic nocturnal enuresis (NMNE). Demographic and NE-related details were assessed from electron­ic medical records and by telephone interview at the times 3, 6, 12 months and 3, 5, 10 years after the first examination. Sixty-seven of 95 patients were enrolled, of whom 57 had PMNE (M:F ratio 39:18, mean age 9.35 ± 2.81 years, mean age at improvement 11.5 ± 4.08 years), 8 had NMNE (M:F ratio 4:4, mean age 10.1 ± 2.64 years, mean age at improvement 12.6 ± 1.68 years) and 2 had SMNE (M:F ratio 1:1, mean age 12 years, mean age at improvement 13.5 ± 2.12 years).

Results: The mean duration of follow up was 7.2 ± 2.5 years. All of the 67 children had 5 years follow up. Only 29 of 67 patients (19 with PMNE, 8 with NMNE and 2 with SMNE) had 10 years follow up and 4 of 19 with PMNE were still affected by NE. Out of 57 patients with PMNE 12 (2/12 with language disorders, 1/12 varicocele and 1/12 cryptorchidism) and out of 8 patients with NMNE 1 were still enuretic while all patients with SMNE were in remission.

Conclusion: We observed that language disorders and testicular pathology in NE children could be comor­bidities associated with persistence of NE and treatment resistance.

Purpose: We present long-term surgical experience of 102 chordee without hypospadias cases.

Materials and Methods: This retrospective study included 102 chordee without hypospadias cases who were surgically treated between 1999 and 2012. Range of patients' age was from 1 month to 31 years. Seventy-two patients were adult, and 30 were children. Mean duration of follow up was 49.3 months. The patients were categorized into 4 groups including skin tethering (group 1), fibrotic dartos and Buck's fasciae ( group 2), corporeal disproportion ( group 3) and urethral tethering (group 4) with the aid of intraoperative artificial erection, according to the structural defect.

Results: Forty patients (group 1) were successfully treated with penile degloving. Except 3 (10%) of 31 (group 2) cases, extensive resection of the fibrotic dartos and Buck's fascia was needed to straighten the penis. Corporeal disproportion was identified in 27 patients of whom 2 cases (7%) had complica­tions. One of them developed urethrocutaneous fistula, and he was treated with buccal mucosal graft urethroplasty successfully. In other one, chordee persisted after two years, and we had to do Nesbit wedge resection after tunica albuginea plication to achieve penile straightening at the same session; otherwise we avoid tunica albuginea excision or incision. Overall 96 (94%) of 102 patients were suc­cessfully treated at first operation.

Conclusion: We concluded that tunica albuginea plication is very effective for both prepubertal and postpubertal period and also in management of recurrence. We believe that, in experienced hands, early surgical correction can be done successfully in this condition.

Purpose: To evaluate the efficacy of intermittent percutaneous needle sacral nerve stimulation (IPN-SNS) in women with idiopathic overactive bladder (IOAB) treated with tolterodine.

Materials and Methods: A total of 240 female patients diagnosed with IOAB were randomized to receive tolterodine only treatment (group 1, n = 120) or tolterodine combined with IPN-SNS (group 2, n = 120). Each group included 120 participants, who were divided into subgroups depending on whether they had dry OAB (urinary frequency and urgency) or wet OAB (urinary frequency and urgency with urgency incontinence). In the treatment group, patients received percutaneous IPN-SNS plus tolterodine (2 mg once daily), while in the control group, only tolterodine (2 mg once daily) was administered for 3 months. The voiding diary and urodynamic parameters were monitored, and patients' psychological depression and anxiety scores were recorded before and after treatment.

Results: There were significantly greater improvements in the conditions of first desire to void (FDV), max­imum cystometric capacity (MCC), and daily average volumes, as well as the daily single maximum voided volumes in group 2 (P = .001) than in group 1. In addition, there were significantly greater decreases in self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores in group 2 compared with group 1 (P < .001).

Conclusion: Combined treatment with tolterodine plus IPN-SNS can not only improve the symptoms of voiding dysfunction but can also reduce the concomitant depression and anxiety in women with IOAB, there­by improving patients' quality of life.

Purpose: To describe our experience in the diagnosis and treatment of 23 patients with ureteral endometriosis.

Materials and Methods: We performed a retrospective analysis of 23 cases of ureteral endometriosis with histopathological results from 2002 to 2011.

Results: In patients with ureteral endometriosis, 23 cases were diagnosed by ultrasound, 21 by intravenous urography, 11 by retrograde urography, 16 by computed tomography, and 8 with magnetic resonance imaging. All cases were treated by operative treatment. The treatments included ureterolysis in 3 cases, partial ureteral resection and ureteroneocystostomy in 6 cases, partial ureteral resection and end-to-end ureteral anastomosis in 12 cases, and endoscopic resection of ureteral endometriosis lesion in 2 cases. All of the pathologic exam­ination results were endometriosis.

Conclusion: Our findings suggest that surgery is an effective treatment option in most patients with ureteral endometriosis exhibiting mild or moderate to severe hydronephrosis. The type of technique depends on the location and depth of the lesion.

Purpose: To examine the benefits of sexual activity on glycated hemoglobin (HbA1c)in penile prosthesis implanted patients with type 2 diabetes mellitus (DM).

Materials and Methods: Sixty-seven male subjects who had HbA1c levels of ≥ 6.5% before and could perform regular sexual activity after the implantations were enrolled. The contribution of sexual activity on glycemic control assessed by HbA1clevel as well as age, duration of DM and frequency of sexual activity were evaluated.

Results: Mean age and mean time from the surgery of the study patients was 59.9 years (range,30-82) and 22.6 months (range, 10-63), respectively. The average of penile prosthesis usage for sexual activity was 9.9 times per month (range, 2-28). Compared with the preimplantation, the absolute mean change in HbA1c after penile prosthesis implantation was found as - 0.2% (P > .05). This study also revealed that more sexual activity was associated with more reduction in HbA1c.

Conclusion: The present study demonstrated that sexual activity is associated with HbA1c reduction, which is clinically important in patients with type 2 DM after penile prosthesis implantation.

Purpose: To evaluate the impact of metabolic syndrome (MS) on erectile dysfunction (ED) and lower urinary tract symptoms (LUTS).

Materials and Methods: We included patients who had presented at the urology outpatients with LUTS or ED complaints and at the endocrinology outpatients for diabetes between May 2012 and April 2013. MS was present in 50 of the 107 patients (42.7%). The blood pressure, fasting blood sugar, serum lipid profile, triglyceride, total cholesterol, body mass index (BMI) and total prostate specific antigen (PSA) values were recorded. The international prostate symptom score (IPSS), quality of life score and international erectile function index (IIEF-5) values were determined for the patients. All patients also underwent uroflowmetry together with prostate volume and residual urine volume measurement.

Results: There was a significant negative correlation between the IPSS and IIEF scores of the patients (P < .001, r = -0.42). There was no significant difference regarding IPSS scores between patients with and without MS (P = .6), while the IIEF-5 scores were significantly lower in the MS group (P = .03).

Conclusion: We found that metabolic syndrome did not significantly affect LUTS but could significantly contribute to ED. We therefore feel patients presenting with ED complaints should also be carefully evaluated for MS.

Purpose: To evaluate the predictive power of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, testicular biopsy histology and male age were evaluated with respect to the success of sperm retrieval in a microdissection testicular sperm extraction (microTESE) procedure, pregnancy and live birth rates.

Materials and Methods: We examined the data of 131 infertile men with non-obstructive azoospermia, who have undergone microTESE operation. The men were classified into two groups based on serum follicle-stimulating hormone (FSH) levels ≤ 15 mIU/mL (group 1) and > 15 mIU/mL (group 2).

Results: Group 1 consisted of 59 patients (mean age 36.2 ± 6.2 years) and group 2 consisted of 72 (mean age 38.8 ± 7.4 years) patients. Sperm retrieval and pregnancy rates were 66.1% and 16.9% in normal FSH group, respectively. These parameters were higher than those of men with FSH > 15 (43% and 8.3%, respectively). Only 128 patients had histopathological diagnosis. Sperm was retrieved from 12/30 (40%) patients with maturation arrest, 9/29 (31.03%) patients with seminiferous tubules atrophy, 14/40 (35%) patients with sertoli cell only syndrome and 13/13 (100%) of patients with hypospermatogenesis. There was no statistically significant difference in pathological diagnosis between pregnancy and live birth rates.

Conclusion: These results demonstrate that there is a significant difference with sperm retrieval, preg­nancy rates and live birth rates comparing the FSH levels. Histopathological findings did not associate with successful microTESE, pregnancy rates and live birth rates.

Purpose: Chronic bacterial prostatitis displays a variety of symptoms (mainly local pain exhibiting vari­ability in origin and intensity). These symptoms often persist despite bacterial eradication. The purpose of this article is to exam the role of phytotherapeutic agents as complementary treatment in patients with bacterial prostatitis.

Materials and Methods: The material consisted of individuals with reported pelvic discomfort and genital pain with or without lower urinary tract symptoms (LUTS) and sexual dysfunction visiting our department from March 2009 to March 2011. Patients underwent Stamey-Meares test (several cases underwent the two glass test). Depending on history and specific symptoms urethral smear and semen cultures were additionally obtained from several patients. All patients were randomized into two groups. Subjects in the first group (72 patients) received appropriate antibiotic (according to the sensitivity test) for 15 days, while subjects in the second group (72 patients) received phytotherapeutic agents for 30 days, additionally the conventional 15 days antibiotic treatment. The response was tested using laboratory and clinical criteria.

Results: We found no statistically significant differences between the two groups regarding bacterial and symptom persistence rate, however, symptoms burden was lower in patients receiving combinational treat­ment.

Conclusion: Phytotherapeutic agents may improve pain and prostatitis related difficulty in urination. Fur­ther randomized, placebo-controlled studies are needed to substantiate safer conclusions.

Purpose: To identify factors that are significantly associated with patient satisfaction in urology and to assess the extent to which satisfaction ratings might be related to hospital and patient characteristics.

Materials and Methods: Data used in this study were obtained from 1040 randomly selected urology patients discharged from nine hospitals who responded to a mailed survey. Bivariate and multivariate techniques were used to reveal relations between patient assessments of received care, hospital and patient characteristics.

Results: Bivariate analysis showed a strong association between satisfaction scores and length of stay, provider status, work load of nurses and hospital size, with weaker findings pertaining to type of hospital (teaching versus non-teaching) and patient demographics. The multivariate analysis identified nine vari­ables which are associated with overall satisfaction. Strong factors were treatment outcome, the interper­sonal manner of medical practitioners and nurses, as well as hotel aspects like accommodation and quality of food. Variables reflecting information receiving about the undergoing treatment were not found to have a significant influence on patient satisfaction.

Conclusion: This study identified variables that are related to satisfaction in a urological setting and de­livers information about aspects of the hospital stay that are not perceived as relevant by patients. These findings support healthcare professionals with valuable information to meet needs and preferences of pa­tients in urology.