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    Factors Affecting Complication Rates of Ureteroscopic Lithotripsy in Children: Results of Multi-Institutional Retrospective Analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society
    (ELSEVIER SCIENCE INC, 2011) Dogan, Hasan Serkan; Onal, Bulent; Satar, Nihat; Aygun, Cem; Piskin, Mesut; Tanriverdi, Orhan; Gurocak, Serhat
    Purpose: We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. Materials and Methods: We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. Results: A total of 367 females and 265 males were studied. Mean +/- SD patient age was 90.2 +/- 51.4 months (range 4 to 204). Mean +/- SD stone size, operative time and postoperative hospital stay were 8.9 +/- 4.7 mm, 45.8 +/- 23.8 minutes and 1.8 +/- 2.8 days, respectively. At a mean +/- SD followup of 13.3 +/- 17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. Conclusions: Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.
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    Radiologic findings of a traumatic urethral diverticulum with stones in an infertile male patient
    (TURKISH SOC RADIOLOGY, 2011) Ozbek, Orhan; Piskin, Mesut; Koc, Osman; Kadiyoran, Cengiz; Ozbek, Seda; Odev, Kemal
    Urethral diverticulum is rarely encountered in male patients. Although postmicturition dribble, pain and infection are usually present, infertility is rarely reported in urethral diverticulum. We present a case with urethral diverticulum associated with infertility, which was diagnosed radiologically.
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    Simultaneous Bilateral Percutaneous Nephrolithotomy in Children: No Need to Delay
    (MARY ANN LIEBERT INC, 2011) Guven, Selcuk; Ozturk, Ahmet; Arslan, Mehmet; Istanbulluoglu, Okan; Piskin, Mesut; Kilinc, Mehmet
    Background and Purpose: Children with bilateral kidney stones are generally treated using staged percutaneous nephrolithotomy (PCNL). Reports related to simultaneous bilateral PCNL (SBPCNL) in children are scarce. We aimed to evaluate the efficacy and safety of SBPCNL in children. Patients and Methods: The children who underwent SBPCNL applications between January 2007 and February 2010 in our clinic were evaluated. Patient data were collected from the retrospective reviews of hospital records. Results: SBPCNL was conducted in five patients for bilateral renal stones. The mean age of the patients was 6.28 years (range 0.75-15 y), and the mean follow-up was 10.6 months (range 1-36 mos). The mean renal stone burden was 19 mm (range 11-22 mm). Four children underwent bilateral standard PCNL, and one child underwent bilateral tubeless PCNL. The mean duration of SBPCNL was 75 minutes (range 55-120 min), and the hospitalization time was 4 days (range 2-5 d). No blood transfusion was necessary in any patient. Except for the patient with complex renal stones, all patients were stone free after the intervention, and none needed a conversion to open surgery. Conclusion: SBPCNL is a safe and effective procedure in children if they are selected properly and if the surgeon has sufficient experience with the procedure. More studies with a higher number of participants are needed, however, for further evaluation of the procedure.
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    Totally Tubeless Percutaneous Nephrolithotomy: Is It Safe and Effective in Preschool Children?
    (MARY ANN LIEBERT, INC, 2010) Ozturk, Ahmet; Guven, Selcuk; Kilinc, Mehmet; Topbas, Emrah; Piskin, Mesut; Arslan, Mehmet
    Background and Purpose: After the introduction of tubeless percutaneous nephrolithotomy (PNL), many studies conducted in adult patients have confirmed its efficacy and safety. There are limited studies reporting that tubeless PNL can be safely applied in children, however. Furthermore, there are no reports that evaluate the use of totally tubeless PNL in children. The present study evaluates the results of totally tubeless PNL in preschool children. Patients and Methods: The data of children seen in our clinic who were considered suitable for totally tubeless PNL were analyzed. Of 16 children, 8 patients underwent totally tubeless PNL (group 1) and 8 standard PNL (group 2). The two groups of patients were compared with regard to length of hospitalization, analgesic requirements, transfusion rates, hemoglobin (Hb) decrease, and immediate, early, and late complications. Results: The mean ages of the patients were 56.6 months (9-84 mos) and 56.0 months (5-84 mos), and the mean follow-up was 21.5 months (3-44 mos) and 43.4 months (36-54 mos) in groups 1 and 2, respectively. Both groups were similar with regard to age, stone size, Hb change, and complications. Although operation duration, hospitalization period, and analgesic requirement were less in the totally tubeless PNL group, these differences were not statistically significant. Conclusions: The latest application of PNL, totally tubeless PNL, is also a safe and effective procedure in very small children if they are selected properly and if the surgeon has sufficient experience with the procedure. More studies with a higher number of participants are needed, however, to confirm that totally tubeless PNL increases the comfort of pediatric patients, decreases their hospitalization period, and is more economical.