Purpose. To evaluate the safety and efficacy of RIRS for the treatment of multiple unilateral intrarenal stones smaller than 20 mm. Methods. Between March 2007 and April 2013, patients with multiple intrarenal stones smaller than 20 mm were treated with RIRS and evaluated retrospectively. Each patient was evaluated for stone number, stone burden (cumulative stone length), operative time, SFRs, and complications. Results. 173 intrarenal stones in 48 patients were included. Mean age, mean number of stones per patient, mean stone burden, and mean operative time were 40.2 ± 10.9 years (23–63), 3.6 ± 3.0 (2–18), 22.2 ± 8.4 mm (12–45), and 60.3 ± 22.0 minutes (30–130), respectively. The overall SFR was 91.7%. SFRs for patients with a stone burden less and greater than 20 mm were 100% (23/23) and 84% (21/25), respectively (χ 2 = 26.022, P < 0.001). Complications occurred in six (12.5%–6/48) patients, including urinary tract infection or high-grade fever >38.5°C in three cases, prolonged hematuria in two cases, and ureteral perforation in one case, all of whom were treated conservatively. No major complications occurred. Conclusions. RIRS is an effective treatment option in patients with multiple unilateral intrarenal stones especially when the total stone burden is less than 20 mm.

Contralateral adrenal metastases from renal cell carcinomas are not commonly seen. To our knowledge, we are presenting the first case of extraadrenal metastasis in the English literature, from the contralateral RCC 6 months after radical nephrectomy. Patient was treated with robotic right adrenalectomy for continuous growing of a de novo right adrenal mass of 6 × 4 × 3 cm in diameter. Tissue between vena cava, renal capsule, and inferior diaphragmatic surface was removed en block. Pathological evaluation revealed renal cell carcinoma within the fatty tissue abutting the adrenal capsule from outside with negative surgical margins. Our experience dictates that removing adrenal tissue only after identifying the adrenal borders may sometimes result in insufficient tumor removal. Therefore, adrenal containing tissue within the anatomic boundaries should be removed en block, if surgical removal is planned for metachronous tumor metastasis in the treatment of renal cell carcinoma.

A majority of foreign objects ingested pass through the gastrointestinal tract without any complications. Sometimes, complications such as perforation and adhesions of the neighboring organs occur and surgical treatment becomes necessary. We report the case of a 22-year-old female who was admitted with right flank pain. Past medical history revealed that the patient had accidentally swallowed a headscarf pin 11 months earlier. A computed tomography scan confirmed the swallowed foreign body posterior to and around the ileocecal region. The headscarf pin, causing stenosis and proximal ureteral dilatation, was removed surgically. To the authors' knowledge there has been no previous report of such ureteral obstruction published in the English literature.

The aim of the present study is to evaluate the presence of ghrelin and orexin in the testicular tissue of patients who have undergone microscopic testicular sperm extraction (micro‐TESE) due to idiopathic non‐obstructive azoospermia. Seventy azoospermic cases were included in this study; serum hormone levels were measured and genetic investigations were performed. The patients were divided into two groups: micro‐TESE (+) and micro‐TESE (−). The number of Leydig cells and stained cells in the seminiferous tubules were counted under a light microscope, and we analyzed ghrelin and orexin activity. The relationship between serum hormone levels and ghrelin and orexin distributions in testicular tissue was evaluated according to micro‐TESE results. While sperm was found in 33 cases (47.1%), micro‐TESE was negative in 37 cases (52.9%). Peptide hormone activity in testicular tissue was higher in micro‐TESE (+) cases. However, interstitial orexin (p = 0.038) and ghrelin (p = 0.002) activity showed statistically meaningful differences. Many different peptides, genes, and other unknown mechanisms play important roles in testicular function. In particular, the peptides orexin and ghrelin may play regulatory roles in testicular function in humans.

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Amaç: Sistoskopi üroloji pratiğinde en sık yapılan girişimlerden biridir. Gelişen teknolojiyle beraber fleksibl aletlerin kullanımı artmıştır. Böylece işlemler daha konforlu ve daha az ağrılı hale gelmiştir. Fleksibl sistoskopide uygulanan lokal anestezinin süresi, lokal anestezik madde miktarı ve şekli ile ilgili net bir fikir birliği yoktur. Bu çalışmanın amacı; fleksibl sistoskopi yapılan erkek hastalarda hissedilen ağrının kontrolünde lokal anestezik ajan olan prilokain kullanımının lubrikan etkisi de olan lidokain jel kullanımına üstün olup olmadığını ortaya koymaktır. Yöntemler: Çalışmaya Ocak 2012-Aralık 2012 tarihleri arasında fleksibl sistoskopi yapılan 70 erkek hasta dahil edildi. Çalışmayla ilgili bilgilendirme ve yazılı onam alındıktan sonra hastalar 2 gruba ayrıldı. Grup 1'deki 34 hastaya, %2'lik 10 mL lidokain jel lubrikan etki açısından fleksibl sistoskop üzerine sürülerek sistoskopi işlemi hemen yapıldı. Grup 2'deki 36 hastaya, 20 mL %2'lik prilokain üretral yoldan verildi ve 15 dakika sonra sistoskopi işlemi gerçekleştirildi. Sistoskopiden hemen sonra vizuel analog ağrı skalası (VAS) sorgulaması yapılarak kaydedildi. Bulgular: Gruplar arasında yaş ile ilgili istatistiksel fark izlenmezken (p=0,218), sistoskopi süreleri açısından anlamlı fark vardı (p=0,027) ve işlem süresi grup I'de daha uzundu. Grup I'de VAS skorları anlamlı derecede daha yüksekti (p=0,001). Daha sonra her iki grup sistoskopi endikasyonlarına göre 2 alt gruba ayrıldı. Her iki grupta da terapötik amaçlı sistoskopi yapılan hastaların VAS skoru diagnostik sistoskopi yapılanlara göre istatistiksel olarak anlamlı fark göstermekteydi (p=0,001; p=0,009). Sonuç: Çalışmamızda üretraya instile edilen ve sistoskopi öncesi üretrada 15 dakika bekletilen prilokainin özellikle genç erkeklerde konforlu bir lokal anestezik etki gösterdiğini gözlemledik.