Introduction: Chronic kidney disease (CKD) is a major health issue worldwide, which leads to end-stage renal failure and cardiovascular events. Neutrophil to lymphocyte ratio (NLR) is a surrogate marker of inflammation and has been widely studied in malignancies, hypertension, heart diseases, and vascular diseases. In this study, we aimed to investigate if NLR represents renal reserve and function after partial or radical nephrectomy.Methods: We conducted a retrospective study consists of patients who had undergone radical/partial nephrectomy in our hospital and/or who admitted to urology and nephrology clinics as an outpatient. Patients were divided into four groups: Group 1 (n = 46): Healthy controls; Group 2 (n = 50): Patients who had undergone unilateral partial nephrectomy; Group 3 (n = 46): Patients who had gone unilateral nephrectomy; Group 4 (n = 82): Patients who had CKD.Results: The mean NLR of each group was as follows: Group 1: 2.14 ± 0.73; Group 2: 3.52 ± 3.74; Group 3: 3.64 ± 3.52, and Group 4: 3.53 ± 2.30. NLR was lower in Group 1 compared to other groups but statistically significant difference was observed only between Group 1 (control) and Group 4 (CKD), 2.14 ± 0.73 versus 3.53 ± 2.30 (p = .005). In non-parametric correlation analysis NLR was found negatively correlated with GFR and positively correlated CKD stage (p = .028 for both correlations).Conclusions: The NLR may constitute a practical predictor of CKD besides Cr in patients who had undergone partial or radical nephrectomy.
Objective: The aim of our study was to investigate emphasis of urinary pH in patients with prostate cancer. Methods: Patients, who underwent 12-core prostate biopsy because of prostate-specific antigen elevation and suspicious digital rectal examination, were retrospectively reviewed. According to pathology, patients with prostate cancer were classified as group 1, and patients with benign prostatic hyperplasia were classified as group 2. Primary endpoint of this study was the urine pH. The age of two groups and urine pH were compared with each other. Student t test and Mann–Whitney U test were used for the intergroup analysis of continuous variables. A cut-off value for urine pH was determined with a receiver operating characteristic curve. p < 0.05 was considered as statistically significant. Results: There were 119 patients in group 1 and 99 patients in group 2. When urine pHs of both groups were compared, group 1 and group 2 were 5.1 ± 0.45 and 5.5 ± 0.79, respectively (p = 0.0001). The cut-off value determined by receiver operating characteristic curve analysis for urine pH was 5.2 (sensitivity: 42%, specificity: 79%, area under the curve: 0.61; 95% CI: [0.53, 0.68]; p = 0.003). Conclusion: Acidic urine pH may be important for predicting prostate cancer according to this study.
A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.
Due to its high cost-effectiveness, intrauterine device (IUD) is one of the widely used contraception methods worldwide. Intravesical migration of an IUD via perforation of the uterus and bladder is very rare. Endoscopic approach is recommended in the treatment, but open surgery may also be needed rarely. In this report, we present the case of a 37-yearold female who was misdiagnosed radiologically with bladder stone, but later on, it was understood that an IUD migrated to the bladder and resulted in stone formation. Laser lithotripsy was performed, and the migrated IUD was unearthed. Removal of the IUD with cystoscopic forceps was unsuccessful. Postoperative pelvic computed tomography revealed that a part of the IUD was outside the bladder. At the next operation session, laparoscopic removal of the IUD was applied. The patient was followed up for 5 days with a Foley catheter and discharged after performing cystography, assuring us that the bladder contours were normal.Keywords Bladder . Bladder stone . Endoscopic surgical procedures . Intrauterine device migrations Case HistoryA 37-year-old female was admitted to our urology outpatient clinic with complaints of suprapubic pain, polyuria, and urgency for the past 8 months. From her medical history, we have been informed that despite administration of an intrauterine device (IUD) 6 years ago, she had ectopic pregnancy 4 years ago and therefore she was applied with laparoscopic salpingectomy in a tertiary health-care center, and doctors told her they removed the IUD at the same operation. Her family history was unremarkable and physical examination was normal. Abundant leukocytes, erythrocytes, and crystals were detected at urinalysis. An opacity of 1.5×2 cm in size was viewed in the pelvic region of the urinary tract X-ray. It was reported as a bladder stone at pelvic ultrasonography. Cystoscopic stone fragmentation was planned. However, at cystoscopic examination, it appeared that the opacity which was radiologically considered bladder stone was indeed an intravesical encrusted foreign body entering the bladder lumen from the posterior wall (Fig. 1). Laser lithotripsy was performed and the migrated IUD was unearthed. Removal of the IUD with cystoscopic forceps was attempted, but the IUD was stuck firmly to the bladder wall. Postoperative pelvic computed tomography (CT) revealed that about 1 cm of the IUD was outside the bladder (Fig. 2). At the next operation session, laparoscopic removal of the IUD that was not associated with the uterus anymore was applied. The patient was followed up for 5 days with a Foley catheter, and hematuria was not developed within this early postoperative period. The patient was discharged after performing cystography, assuring us that the bladder contours were normal. DiscussionIUD is a contraceptive method that is widely used worldwide because of its efficacy, reliability, economy, and
Objective: To determine if there is a difference between postoperative urinary infection rates after retrograde intra-renal surgery (RIRS) when ureteral access sheath (UAS) was used or not used. Materials and methods: We retrospectively analyzed the medical records of all patients who underwent RIRS at our institution between January 2016 and October 2018. Results: 129 patients were included in the study. The mean age of the patients was 48.8 ± 12.1 years; 94 patients were male and 35 were female. The mean stone size (largest diameter), stone attenuation and stone volume were 15.3 ± 5.8 mm, 1038 ± 368 HU and 1098 ± 1031 mm3, respectively. Out of 129 patients, 81 were treated by using UAS (Group 1) and 48 were treated without use of UAS (Group 2). There was no statistically significant difference between the two groups in terms of post-operative infection (p = 0.608). However, the operative time of patients with post-operative infection was statistically higher than the other patients; 88.35 ± 22.5 min versus 59.37 ± 22.1 min (p = 0.017). In multivariate regression analysis, operation time (p = 0.02, r = 1.07) was found to be the sole predictor of post-operative infection. Conclusions: Using UAS during RIRS might reduce the intrarenal pressure and also has several advantages. However not prolonging the operation time too much could be of higher importance than UAS use in terms of preventing post-operative infection after RIRS.
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