Objective: We aimed to retrospectively evaluate the effectiveness and safety of flexible ureteroscopy (f-URS), semirigid ureteroscopy (sr-URS), and shock wave lithotripsy (SWL) to treat single 11-20 mm stones in the proximal ureter. Materials and methods: Patients treated at our clinic for 11-20 mm single stones in the proximal ureter who underwent f-URS, sr-URS or SWL as initial lithotripsy methods were compared in terms of their clinical characteristics and treatment outcomes. Results: A comparison among 201 patients who had undergone f-URS, 119 patients who had undergone sr-URS, and 162 patients who had undergone SWL showed no significant baseline differences in patients’ demographic and stone characteristics. Stone-free rates on the 15th day and 3rd month were higher with f-URS (89.6% and 97%, respectively) than with sr-URS (67.2% and 94.1%, respectively) and SWL (41.4% and 79.0%, respectively; all p < 0.001). Retreatment rates were significantly higher with SWL than with the other two modalities (p < 0.001); auxiliary procedure rates were significantly lower with f-URS than with the other two modalities (p < 0.001). Treatment-related complication rate at the end of the 3rd month was lower with f-URS than with SWL (p = 0.022). Furthermore, f-URS was more effective than sr-URS for treating impacted stones. Conclusions: We found that f-URS was highly successful as an initial lithotripsy procedure for medium-sized proximal ureteral stones, and it helped achieve early stone-free outcomes with a lower need for retreatment and auxiliary procedures, lower complication rates, and higher effectiveness on the impacted stones compared with sr-URS and SWL.
<b><i>Introduction:</i></b> Due to variety of treatment alternatives for testicular tumours, parameters other than existing staging criteria are also needed. Most studies have revealed the correlation between cancer and inflammation. In this study, we aimed to investigate the value of preoperative inflammatory markers between early-stage testicular tumours and patients with advanced-stage, their relationship with tumour pathology and their importance in predicting stage. To calculate the differences between inflammatory markers, stage 1 tumours localized to the testis and advanced-stage tumours spread beyond the testis were classified into 2 groups according to tumour pathology. <b><i>Materials and Methods:</i></b> The data of 112 patients undergoing inguinal orchiectomy in between 2008 and 2018 were recorded retrospectively. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) were calculated by using the numbers of blood cell counts based systemic markers of inflammation. The differences between markers of inflammation were calculated by dividing tumours into 2 groups including early-stage and advanced- stage testicle tumours. <b><i>Results:</i></b> According to the results of preoperative inflammatory markers in predicting the stage; in the seminoma group, the difference between the median NLR (2.37 vs. 4.39, <i>p</i> = 0.012), LMR (3.80 vs. 2.40, <i>p</i> = 0.018) and SII (612 vs. 1,127, <i>p</i> = 0.009) of stage 1 and advanced stage were statistically significant, while in the non-seminoma group, only the difference between median PLR (99 vs. 154, <i>p</i> = 0.002) of stage 1 and advanced stage was statistically significant. Sensitivity and specificity of predicting advanced stage according to cut-off values of markers were 69 and 75% in NLR (3.21), 83 and 75% in LMR, and 59 and 75% in SII in the seminoma group; on the other hand, in the non-seminoma group, the sensitivity, and specificity of predicting the advanced stage of PLR cut-off (104) were 71 and 88% respectively. <b><i>Conclusions:</i></b> The clinical use of inflammatory biomarkers in testicular tumours may represent an important step in understanding germ cell tumours biology and in supporting staging criteria and prognostic criteria.
Usage of ureteral DJ stent is very common in urology practise. There are some complications according to the increased usage of ureteral DJ stent in the literature. Stent fragmentation is a rare complication of ureteral DJ stent. In this study we present a 53-year-old male patient who had previous stone surgery and a ureteral DJ stent applied to our polyclinic with complaint of 3-months-long right side pain. In the radiologic examination we observed that DJ stent was fragmented from the upper end on the right kidney. We extracted the fragmentated part of ureteral DJ stent with flexible ureterorenoscopy.
A 68-year-old man with serious cervical kyphosis and dorsolumbar scoliosis due to ankylosing spondylitis was admitted with a stone 17 mm in size in left kidney lower calyx. A percutaneous nephrolithotomy operation was decided considering the size and location of stone and the anatomical deformities of patient. The kidney was accessed through monoplaner triangulation method by giving a special position of the patient's spinal deformity and stone was successfully removed. Percutaneous nephrolithotomy is a feasible method in ankylosing spondylitis patients in case that the right position is achieved. Each patient should be assessed individually deciding on treatment methods.
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