No abstract

Objective: In this study, the outcomes of 279 cases in whom we performed retrograde intrarenal surgery (RIRS) were evaluated retrospectively. Material and methods:RIRS was performed on 279 cases with the aid of access sheath of guidewire between March 2011 and February 2015. All patients were operated in the standard lithotomy position. A hydrophilic guidewire was inserted with the aid of rigid ureterorenoscopy and we checked whether there were any residual ureteral stones and other pathologies. Fluoroscopy was used routinely in all cases. Stone fragments smaller than 3 mm were left off but those bigger than 3 mm were removed by grasper after stone fragmentation. Controls of the patients were assessed by plain films (KUB), urinary tract ultrasonography (US) and/or computed tomography (CT) 1 month after the operation. Success rate of the procedure was defined as the stone-free status or presence of residual fragments less than 3 mm.Results: 152 of the patients were male and 127 were female. The median ages of the male and female patients were 47.7 (1-86) ve 45.9 (3-79) years respectively. The median stone size was 13.5 mm (8-25). Preoperatively 34 (12.1%) patients had double-J ureteral stent. 19 (6.8%) patients were operated while they were still receiving antithrombotic and antiplatelet therapy Solitary kidney was present in 24 patients while the remaining patients had kyphoscoliosis (n=3), rotation anomaly (n=6), pelvic kidney (n=2), double collecting system (n=3), and horseshoe kidney (n=6). In 264 patients access sheath was used, in 15 patients operation was performed with the help of the guidewire. Double-J stents were inserted to 14 patients because of ureteral stricture and they underwent operation after 2 weeks later. Renal stones of 219 patients among all cases were fragmented completely and the patients were discharged as stone free (SF). Our success rate (SF or presence of clinically insignificant residual [CIRF]) was 78.4%. Stone size (p= 0.029), stone number (p= 0.01), stone location (p= 0.023) had significant influence on the stone-free rate after RIRS The mean operation and floroscopy time was 62.5 min. (40-180) and 29.8 sec (4-96), respectively. The mean hospitalization time was 26.4 hours (12-72). Double J stents were placed to 253 patients for more stone burden and ureteral edema. Any complication was not observed for all cases except perioperative developed infection for two patients. Conclusion:With advances in laser technology and flexible ureterorenoscopy, kidney stones can be treated with lower morbidity and high success rates.

Our results demonstrated that both F-URS and mPNL achieve acceptable stone-free rates in obese patients with 10-20 mm renal stones. However, complication rates were significantly lower in F-URS group.

Carcinosarcoma of the urinary bladder is a rare neoplasm that is histologically composed of malignant epithelial and mesenchymal components. The etiology of sarcomatoid tumors is unclear, but smoking and history of previous radiotherapy or chemotherapy may lead to bladder disorders and to the formation of sarcomatoid carcinoma. These neoplasms behave as highly aggressive tumors and optimal treatment is uncertain. Herein, we report a case of sarcomatoid carcinoma of urinary bladder presenting as a giant intravesical mass in a 61-year-old man complaining of macroscopic hematuria.KEY WORDS: Bladder carcinosarcoma; Urothelial carcinoma; Prognosis. had a catheter without any other remarkable finding. Laboratory test results were normal. Whole abdominal ultrasonography (USG) showed a 9 x 8 cm mass which filled the bladder. Abdominopelvic computerized tomography (CT) showed a 9 x 7 cm mass lesion, originating from the right lateral wall of the bladder and occupying the entire bladder (Figure 1). A written informed consent was obtained from the patient and cystoscopic examination was performed under general anesthesia. The mass, which originated from the bladder neck and filled the bladder, was incompletely resected. Pathological examination showed a biphasic pattern, and the result was reported as a sarcomatoid carcinoma. The epithelial component included an adenocarcinoma and squamous-cell carcinoma, whereas the sarcomatous component included a spindle-cell and chondrosarcoma. As the all resection specimen consisted of tumor tissues, we were unable to evaluate the depth of invasion. Computed tomography showed no sign of lymph node or organ metastasis. Four weeks after transurethral resection (TUR-BT), radical cystoprostatectomy, lymph node dissection, and ileal conduit surgery were performed. Cystoprostatectomy specimen had a 10 x 8.5 cm tumor in-diameter (Figure 2). After histological examination, tumor was reported as a high-grade sarcomatoid carcinoma, pT2a, pN0, pMx. The histological pattern consisted of 70% sarcomatous component (spindle-cell and chondrosarcoma), and 30% epithelial component (adenocarcinoma and squamous-cell carcinoma). All surgical margin samples and lymph nodes were reported as normal. Four days after the surgery, the patient died due to myocardial infarction.