The objective of the study was to ascertain whether flexible ureteroscopy with holmium laser lithotripsy and/or extraction of stone fragments is as effective in obese patients as in non-obese patients. The patients were divided into four groups (group 1: normal weight = 79 procedures, group 2: overweight = 123 procedures, group 3: obese = 87 procedures, and group 4: morbidly obese = 20 procedures) according to BMI cohorts. Patient charts were retrospectively reviewed and relevant data collected. A total of 309 operations were included in the present study. The overall mean ± SD (range) age was 41 ± 12 years (18-82), BMI 29 ± 6 kg/m(2) (18-52), operative time 64 ± 29 min (20-200), hospital stay 25 ± 11 h (4-168), stone number 3 ± 2 (1-15), stone burden 21 ± 14 mm (4-98), and internal stenting time 26 ± 8 days (2-60). Mean stone size was 10 ± 6, 9 ± 5, 11 ± 8, and 11 ± 8 mm for groups 1 through 4, respectively. There were no differences among groups regarding patients and stone characteristics, and perioperative parameters including patient age, operative time, hospital stay, and complications. Overall SFRs were similar between groups (81, 87, 87.4, and 85%, respectively; χ(2)=3.304, p=0.770) as were the complication rates (12-16%). Our contemporary Retrograde Intrarenal Surgery (RIRS) series showed that operative times, hospital stays, ancillary equipment use (internal stent, basket, etc.), SFRs, and complication rates were independent of BMI. Therefore, RIRS can be performed as efficiently and efficaciously in obese patients as in non-obese patients.

Purpose. We aimed to compare and evaluate the outcomes and complications of two endoscopic treatment procedures, semirigid ureteroscopy (SR-URS) and flexible ureteroscopy (F-URS), in the treatment of proximal ureteral stones (PUS). Methods. SR-URS (group 1) was done on 68 patients whereas 64 patients underwent F-URS (group 2) for the treatment of PUS. Success rate was defined as the absence of stone fragments or presence of asymptomatic insignificant residual fragments < 2 mm. Outcomes and complications were recorded. Results. The differences were statistically not significant in age, gender, body mass index (BMI), and stone characteristics between groups. Mean ureteral stone size was 9.1 ± 0.4 mm and 8.9 ± 0.5 mm for groups 1 and 2. Mean operative time was 34.1 ± 1.5 min and 49.4 ± 2.3 min for groups 1 and 2 (p = 0.001). SFRs were 76.5% and 87.5% for groups 1 and 2 (p = 0.078). Two major complications (ureteral avulsion and ureteral rupture) occurred in group 1. Conclusion. F-URS is safer and less invasive than SR-URS in patients with PUS. There is no statistically significant difference in the efficacy of either technique. Nonetheless we recommend F-URS in the management of PUS as a first-line treatment option in select cases of proximal ureteral calculi.

Intravascular papillary endothelial hyperplasia (IPEH, Masson's Tumor) of the kidney is an unusual, benign vascular lesion. A rare case of recurrent IPEH in the kidney was presented in this article. A 50-year-old male with a diagnosis of a suspicious mass in the left kidney was referred to our center for robotic partial nephrectomy. Robotic zero ischemia partial nephrectomy was performed due to the suspicion of a renal malignancy. On the basis of the histopathological results, the patient was diagnosed as IPEH. A urinary ultrasound was performed on the 3 rd postoperative month and a hyper echoic solid lesion, which was in the same localization, was detected. Due to the previous atypical pathological result, computed tomography (CT) guided fine-needle aspiration biopsy from the left renal mass was performed but malignant cytology was not confirmed with this biopsy. On follow-up CT done 6 months later, a persistent suspicious left renal mass, measuring 40 x 30 cm in size was detected with no change in its dimensions and appearance. Additionally, magnetic resonance imaging (MRI) scan revealed a bone lesion of 15 x 10 mm in the left hip, which was not present on previous MRI/CT scans. In view of the solid masses in the left kidney, and left hip on CT and MRI scan suspicious for a probably metastatic renal neoplasm, left radical nephrectomy via a left subcostal transperitoneal incision was performed. The ultimate pathological report of the patient was also supported the diagnosis of Masson's tumor and any renal malignancy was not encountered The patient was discharged on the 4 th postoperative day and has been followed up for 4 months without any problems. In this case, we discuss the clinical features, histopathological characteristics, and the management of Masson's tumor of the kidney in the light of the current literature.

Purpose. To ascertain whether retrograde intrarenal surgery (RIRS) is as effective in patients treated previously with open renal stone surgery (ORSS) on the same kidney as in patients with no previous ORSS. Methods. There were 32 patients with renal stones who had previous ORSS and were treated with RIRS in the study group (Group 1). A total of 38 patients with renal stones who had no previous ORSS and were treated with RIRS were selected as the control group (Group 2). Recorded data regarding preoperative characteristics of the patients, stone properties, surgical parameters, outcomes, SFRs (no fragments or small fragments <4 mm), and complications between groups were compared. Results. Mean age, mean BMI, mean hospital stay, and mean operative time were not statistically different between groups. Mean stone size (10.1 ± 5.6 versus 10.3 ± 4.2; p = 0.551) and mean stone burden (25.4 ± 14.7 versus 23.5 ± 9.9; p = 0.504) were also similar between groups. After the second procedures, SFRs were 100% and 95% in groups 1 and 2, respectively (p = 0.496). No major perioperative complications were seen. Conclusion. RIRS can be safely and effectively performed with acceptable complication rates in patients treated previously with ORSS as in patients with no previous ORSS.

There is wide consensus that ongoing deforestation contributes to global warming and poses a threat to species diversity. Less understood is whether the practice of creating plantations might also erode genetic diversity and undermine the genetic structure of tree populations. We tested these hypotheses in natural and planted populations of Pinus brutia Ten. subsp. brutia and Cupressus sempervirens L. var. horizontalis (Mill.), 2 important forestry species in the Mediterranean region. We used plant material from 3 different bioclimatic regions in Syria. Using RAPD markers, we evaluated the genetic diversity and structure of 12 populations of P. brutia (6 natural, 6 planted) and 9 populations of C. sempervirens (3 natural, 6 planted). Expected heterozygosity (H e ) and percentage of polymorphic loci (PPL) were high in both species (P. brutia: H e = 0.241, PPL = 81.2%; C. sempervirens: H e = 0.241, PPL = 78.8%). In accordance with our assumptions, plantations of P. brutia manifested significant reduction in mean genetic diversity; this result, however, was not revealed in C. sempervirens. Analysis of molecular variance (AMOVA) demonstrated that the genetic structure of plantations differed from that of natural populations. Interestingly, plantations of both species harbored more genetic differentiation among them than natural populations. The partitions created by AMOVA also showed a significant differentiation between 2 groups, natural populations versus plantations in the 2 species, and among bioclimatic regions only in C. sempervirens. This result was corroborated by cluster analyses, which indicated a closer relationship among populations from the same geographic region. Genetic distance was positively related to geographic distance only in natural populations of P. brutia. Plantations in our research showed a significant reduction in genetic diversity, particularly in P. brutia, and stronger among-population genetic differentiation compared to natural populations. We recommend that forest management incorporates genetic diversity and differentiation as an important criterion for selecting appropriate tree stock material.