Purpose: To evaluate the true necessity of open end ureteral catheter insertion in patients with moderate to severe pelvicalyceal system dilation treated with percutaneous nephrolithotomy (PNL) under sonographic guidance. Patients and methods: 50 cases treated with PNL under sonographic guidance in prone position for solitary obstructing renal stones were evaluated. Patients were randomly divided into two groups; Group 1: Patients in whom a open end ureteral catheter was inserted prior to the procedure; Group 2: Patients receiving no catheter before PNL. In addition to the duration of the procedure as a whole and also all relevant stages as well, radiation exposure time, hospitalization period, mean nephrostomy tube duration, mean drop in Hb levels and all intra and postoperative complications have been evaluated. Results: Mean size of the stones was 308.5 ± 133.2 mm 2 . Mean total duration of the PNL procedure in cases with open end ureteral catheter was significantly longer than the other cases (p < 0.001). Evaluation of the outcomes of the PNL procedures revealed no statistically significant difference between two groups regarding the stone-free rates (86% vs 84%). Additionally, there was no significant difference with respect to the duration of nephrostomy tube, hospitalization period and secondary procedures needed, complication rates as well as the post-operative Hb drop levels in both groups (p = 0.6830). Conclusions: Our results indicate that the placement of an open end ureteral catheter prior to a PNL procedure performed under sonographic access may not be indicated in selected cases presenting with solitary obstructing renal pelvic and/or calyceal stones.

The aim of the study was to evaluate the possible effects of calyceal choice for renal puncture under sonographic guidance on the outcomes of percutaneous nephrolithotomy (PNL). Materials and Methods: A total of 70 patients for whom ultrasound-guided PNL was planned for 20-30-mm single renal pelvic stones were prospectively allocated to group 1 (n:35) with middle calyx entry or group 2 (n:35) with lower calyx entry. Procedure-related parameters such as duration of operation, stone-free rates, complication rates, and radiation exposure time were analyzed in detail. Results: The mean age of the patients was 45.67 ± 1.50 years and the mean stone size was 316.4 ± 17.95 mm 2. There was no significant difference regarding the age, BMI, stone burden, and the grade of hydronephrosis between the groups. Skin to collecting system distance was significantly shorter in the middle calyx entrance (p = 0.021). Total duration of the procedure was again significantly shorter in group 1 cases (74.69 ± 2.94 min) than in group 2 (84.29 ± 4.25 min) (p = 0.003). Regarding the success rates, the postoperative stone-free rate was higher in group 1 (91.4% in group 1, 80.0% in group 2, p = 0.305). Last, there was no statistically significant difference in hemoglobin reduction rates, blood transfusion requirements, and complication rates between the 2 groups. Conclusion: Getting access to the renal pelvis through the middle calyx during ultrasonic guided PNL procedure is more advantageous to lower the calyceal approach by reducing both the duration of the PNL procedure with significantly higher stone-free and comparable complication rates.

No abstract

We aimed to assess the postoperative pain after endoscopic ureter stone treatment according to the diameter of double J ureteral stents. Materials and Methods: Our prospective randomized study included 63 patients with successful operation for unilateral ureter stone and DJ ureteral stent inserted. Patients were divided into 2 subgroups as aged under 40 years and over 40 years. These subgroups were randomized into 4.8 Fr and 6 Fr ureteral DJ stent groups preoperatively in double-blind manner. Patients had pain and other complaints recorded preoperative (preop), postoperative (po) 3rd, 7th days and 1 week after stent removal. Patient pain levels were determined using the numerical pain scale (NPS). Results: For patients under 40 years of age, Group 1 had preop NPS score of 9.17±0.32, while in Group 2 this was 9.79±0.15 (p=0.099), on po 3rd day NPS scores were 2.50±0.73 and 7.36±0.45 (p<0.05), on po 7th day scores were 1.92±0.53 and 2.57±0.48 (p=0.428), and 1 week after DJ catheter removal scores were 0.08±0.08, 0.57±0.23 (p=0.087), respectively. In both groups over 40 years of age, there were no significant differences in the NPS scores at these times. There were no significant differences identified between the groups for stone size and operation duration. Conclusions: We think the use of 4.8 Fr DJ catheters after endoscopic ureter stone treatment is more appropriate for pain control in the early po period, especially for young patients under 40 years of age. Additionally, we believe there is a need for more studies related to the necessity for use of ureteral stents and the features that optimal stents should have.

Objective: To investigate the differences between urodynamic findings and history in women with urinary incontinence before surgery and clarify the need for preoperative pressure-flow studies. Materials and methods: The medical records of 1018 women who underwent urodynamic examination for urinary incontinence between 2010 and 2015 were evaluated retrospectively. Stress (n = 442), urge (n = 334) and mixed (n = 242) were classified as type urinary incontinence according to urodynamics. The voiding phase findings of the patients were examined. Results: The mean age of the patients was 47.85 ± 0.27 years. 18.4% of patients (n = 187) had voiding phase problems. Furthermore, this condition was seen in the most urge incontinence type urinary incontinence (35%). There was a statistically significant difference between the groups' voiding phase findings (p < 0.0001). The relationship between the patient's history and international consultation on incontinence questionnaire form scoring (ICIQ) and the urodynamics results showed no excellent correlation. Conclusions: Voiding phase abnormalities are not uncommon in patients with urinary incontinence. They should be considered in the evaluation of patients. Voiding phase findings may show significant differences between urodynamic data and history. Besides, the data obtained with the questionnaire forms were significantly different from the findings obtained by urodynamics. Consequently, urodynamics may change pre-operative clinical decision.