Objective: To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones greater than 2 cm and to compare its results with those of percutaneous nephrolithotomy (PCNL). Material and methods:We retrospectively analyzed a total of 143 patients: 86 patients (53 males and 33 females) who underwent PCNL and 57 patients (37 males and 20 females) who underwent RIRS between October 2009 and October 2013. Results:The mean duration of operation was 100.26±33.26 min in the RIRS group and 75.55±21.5 min in the PCNL group (p<0.001). The hospital stay was significantly shorter in the RIRS group (1.56±0.8 vs. 4.57±2.1 days in the RIRS and PCNL groups, respectively; p<0.001). Stone-free rates after one session were 66.6% and 91.8% of the RIRS and PCNL groups, respectively. The stone-free rate of the RIRS group improved to 87.7% after the second session. Blood transfusions were required in two patients in the PCNL group. Complication rates were higher in the PCNL group. Conclusion:This study revealed that RIRS can be an alternative to PCNL in the treatment of kidney stones with a diameter of 2-4 cm especially in patients with comorbidities.

& We reviewed records from patients who underwent two different microsurgical varicocelectomy methods: 147 (high inguinal (MHIV) and 65 sub-inguinal (MSIV) microsurgery) to compare the therapeutic activity and complications. Patients who had 2 different microsurgical varicocelectomies were compared according to preoperative connected vein, number of designated arteries, postoperative semen and improvement degree in hormone parameters, increased ratio related with pregnancy and complications. The ratio of improvement of postoperative semen parameters in patients where MHIV and MSIV were performed was, 42% and 38% (p > 0.05). Pregnancy was achieved in MHIV at a ratio of 41% (34=82) and 33% (22=65) in MSIV (p > 0.05). There was no significant difference according to mean operation periods, the vein connected between the groups. The number of testicular arteries were significantly higher than the ones in MHIV (p < 0.01). However, as a postoperative complication, hydrocele was not seen in any of the patients, while relapses occurred in 1 MHIV and 2 MSIV patients. MHIV and MSIV techniques are effective methods to treat varicocele. However, the excess number of connected veins due to the anatomic feature of MSIV increases the possibility of relapses and the technical difficulty during surgical intervention.

Left renal vein entrapment is not a rare entity and renal nutcracker phenomenon might be underdiagnosed.

Objectives: Our aim was to investigate the role of simultaneous apparent diffusion coefficient (ADC) measurement and diffusion-weighted MRI (DWMRI) in the diagnosis and differentiation of bladder masses. Methods: Weexamined 45 patients presenting with hematuria by dynamic and diffusion MRI (at b100, b600, b1000 gradients) and cystoscopy. Thirty healthy volunteers without hematuria were also included in the study. Results from imaging techniques were compared to cystoscopic and histopathologic findings. The ADC values of benign and malignant bladder masses, and bladder tissue in healthy subjects were measured and compared with each other. Results: The mean ADC values of benign (n = 10) and malignant lesions (n = 35) were significantly lower than the mean ADC values of adjacent bladder walls and bladder walls of healthy subjects at all 3 gradients (p < 0.05). However, no significant difference was detected between benign and malignant lesions (p > 0.05). Mean ADC values of invasive tumors were significantly lower than superficial malignancies at b600 and b1000 gradients. The mean ADC values of transitional cell tumors were significantly higher than squamous cell tumors at b100 and b600 gradients. Conclusion: Simultaneous measurement ofADC and DWMRI provided useful information in the diagnosis, staging and histopathological classification of bladder tumors.

Objective. Bladder tumors are among the most common types of malignant neoplasms of the urinary tract. The purpose of this study was to evaluate the potential value of 3-dimensional (3D) sonography and sonographic cystoscopy in detection of bladder tumors. Methods. Thirty-one patients with suspected or known bladder tumors were included this study. All patients underwent 3D sonography and conventional cystoscopy within 15 days. The number, size, location, and morphologic features of the lesions were evaluated on gray scale, 3D virtual, and multiplanar reconstruction images obtained from the patients. The results of 3D sonographic cystoscopy were compared with the findings from conventional cystoscopy, which was considered the reference standard. Results. Twenty-eight (90.3%) of 31 3D virtual sonographic cystoscopic studies had good or excellent image quality. Conventional cystoscopy revealed 47 lesions in 22 of 28 patients; 3D sonographic virtual cystoscopy showed 41 (87.2%) of 47 lesions. Three-dimensional virtual sonography alone had sensitivity of 96.2%, specificity of 70.6%, a positive predictive value of 93.9%, and a negative predictive value of 80% for tumor detection. The combination of gray scale sonography, multiplanar reconstruction, and 3D virtual sonography had sensitivity of 96.4%, specificity of 88.8%, a positive predictive value of 97.6%, and a negative predictive value of 84.2% for tumor detection. Conclusions. Three-dimensional sonography is a promising alternative noninvasive technique for use in detection of bladder tumors, their localization, and perivesical spreading. The location, size, and morphologic features of the tumors shown on 3D sonography agreed well with the findings of conventional cystoscopy. Key words: bladder; neoplasm; sonography; 3-dimensional virtual cystoscopy. Radiology (E.K., A.K., A.K.P., H.A.) ladder tumors are among the most common neoplasms of the urinary tract, accounting for 6% of all malignancies in men and 2% of those in women. 1 In the United States, it is the 7th leading cause of cancer death in men and the 10th in women. Received June 25, 2007, from the Departments of2 A patient with a bladder tumor usually has hematuria, and the initial evaluations are a cytologic analysis of urine and cystoscopy with or without a biopsy.3 The role of crosssectional imaging in the initial evaluation of bladder cancer is limited, and computed tomography (CT) and magnetic resonance (MR) imaging are usually performed to evaluate extravesical extension or to stage the tumor. 3,4