The results of this study showed that medical expulsive therapy by using alpha blocker agents is safe and efficacious. This option must be kept in mind for patients who do not ask for surgery as the first-step treatment for eligible patients.

Introduction Surgical treatment of pediatric kidney stones has dramatically changed in recent years due to the miniaturization of surgical instruments and the availability of intracorporeal lithotriptors. Retrograde intrarenal surgery (RIRS) technique is now considered an effective and minimally invasive procedure in renal stones. However, in the pediatric age group, the number of studies on this subject is very limited. The aim of this study was to evaluate the efficacy and safety of the RIRS in the treatment of kidney stones in children.Material and methods The data of 25 pediatric stone patients who underwent RIRS with the diagnosis of kidney stones were analyzed retrospectively. Demographic characteristics, operative data, and success rates of the patients were recorded.Results Fourteen (56%) of the cases were male and 11 (46%) were female. The mean age was 10.43 ± 4.26 (3-15) in boys and 10.18 ± 4.92 (4-16) in girls. Eleven stones (46%) were in the left kidney and 14 (56%) in the right kidney. The mean stone size was 10.08 ± 4.33 mm (4-23). Stone localizations were renal pelvis in 15 (60%) cases, upper calyx in four (16%) cases, middle calyx in five (20%) cases, and lower calyx in one (4%) case. The mean operation time was 41.20 ± 6.96 minutes (30-60), the mean duration of scope was 17.40 ± 3.85 seconds (10-30), and the mean hospital stay was 2.32 ± 0.63 days (2-4). Three patients (12%) had undergone percutaneous nephrolithotomy (PCNL), and two (8%) patients underwent shockwave lithotripsy (ESWL) before this surgery. In six (24%) patients, a double J (DJ) catheter was inserted due to stenosis at the lower end of the ureter. Body mass index (BMI) of these patients was below 18. An access sheath was implanted in six (24%) patients in the second operation. In 18 cases, the first operation was performed with a direct flexible renoscope. In all cases, a postoperative DJ catheter was inserted. Postoperative fever was observed in one (4%) patient, and ureteric steinstrasse was observed in one (4%) patient. The stone-free rate was achieved as 17% (68%) after the first operation and 100% after the second RIRS session.Conclusion RIRS appears to be an effective and reliable method in the pediatric age group. However, there is a need for multicentre studies involving more cases.

BackgroundThe purpose of this study was to determine the effectiveness of a single early instillation of mitomycin C (MMC) after transurethral resection of bladder tumor (TURBT) together with urinary alkalinization in patients with low-risk non-muscle-invasive bladder cancer (NMIBC).MethodsBetween February 2006 and November 2010, patients diagnosed as having a primary bladder tumor were randomized into standard and optimized treatment groups. The treatment groups were formed prospectively from patients with NMIBC according to results of pathological examination postoperatively, whereas the control group was formed retrospectively. Patients in the standard group (n = 11) were given intravesical MMC 40 mg in the first 6 hours after TURBT, while the patients in the optimized group (n = 15) underwent urinary alkalinization prior to MMC. In the control group (n = 23), no drug treatment was given. The patients were followed after surgery at months 3 and 12, and then annually for the first 5 years using cystoscopy and ultrasound. Time to recurrence and recurrence-free survival rates were calculated.ResultsThere were no statistically significant differences between the standard and optimized groups, between the control and optimized groups, or between the control and standard groups in terms of mean recurrence-free survival rates (P = 0.132, 0.645, and 0.173, respectively). The mean time to recurrence was 34.8 (range 28.5–41.1) months in the optimized group and 51.8 (range 44.3–59.2) months in the control group. There was no recurrence during the follow-up period in the standard group.ConclusionThe results of this preliminary study could not demonstrate the efficacy of urinary alkalinization before a single dose of early MMC following TURBT to increase the effectiveness of the MMC, so we did not continue the study further.

This study aimed to search whether there is a link between reflux flow and hormonal profile. Data of 250 patients were retrospectively investigated. Pre‐operative and 6th month semen analyses of these patients' results were compared with pre‐operative and post‐operative 6th month serum levels of testosterone. Based on the venous flow on pre‐operative Doppler ultrasonography, patients were divided into two groups. Patients with a venous flow ≤4 s were assigned to Group 1 and those with a venous flow >4 s to Group 2. Venous reflux time cut‐off was calculated as 4 s using ROC curve according to the increase in testosterone level. When venous reflux time was selected as approximately 4.0 s, ROC had 79.8% sensitivity and 72.8 specificity. The probability of a post‐operative increase in testosterone is high in patients with a venous reflux time longer than 4 s.

SUMMARY OBJECTIVE Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Various intravesical and extravesical techniques have been described for the surgical correction of VUR. The aim of our study was to compare the results of open intravesical and extravesical procedures for unilateral primary VUR in children. METHODS Between January 2012 and August 2018, 38 children with primary VUR who underwent open ureteral reimplantation surgery were retrospectively reviewed. The Cohen (intravesical) and the Lich-Gregoir (extravesical) approach were grouped as groups A and B, respectively. The groups were compared for age, gender, preoperative reflux grade, presence of lower urinary tract symptoms, operation time, discomfort and pain, analgesic requirements, duration of hematuria, postoperative complications, and hospital stay. All the parameters were statistically compared. RESULTS There were 38 patients in this study. Group A had 18 patients, and group B had 20 patients. The mean operative time was significantly shorter in group B than in group A. The mean hospital stay was also shorter in group B. The urethral foley stay period was 4.7±0.9 days 2±0 days (p = 0.000*), respectively, for group A and B. Macroscopic hematuria was seen in group A. The objective pain scale was worse after intravesical surgery. Analgesic requirements were higher in group A (p =0.131). CONCLUSION Intravesical and extravesical ureteroneocystostomy methods are equally successful and feasible in the treatment of primary unilateral VUR. The Cohen technique is associated with a longer and more painful hospital stay, gross hematuria, and longer operative time, compared to the Lich-Gregoir technique.