Objective. Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter.Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2.Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P=0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P=0.520).Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones.Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed.Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.;P=0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.;P=0.039).Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.

Objectives. To report our experience and present the largest series of testicular torsion cases in the inguinal canal.Material and Methods. The clinical data of 13 patients with testicular torsion in the inguinal canal treated between 2005 and 2013 were reviewed. Recorded patient age, whether the testes were palpable or not, side of the affected testes, the presence of hernia, ischemia time, and operation outcomes were assessed.Results. Patient age ranged from 8 to 70 months (29.15 ± 20.22). Mean ischemia time was 16.5 ± 21.3 hours. Accompanying inguinal hernia was present in 92% of the cases (12/13). Four of the thirteen patients (30.8%) were treated by orchiectomy because the necrosis was present after prolonged ischemia time. Nine patients (69.2%) were treated by single session orchidopexy.Conclusion. Torsion of testes in the inguinal canal is a rare disease, but with rapid diagnosis, affected testes can be salvaged, but the key factor is to keep this condition in mind.

The population of elderly adults is increasing globally, and due to metabolic changes related to advanced age, many elderly adults experience kidney stones. Flexible ureteroscopy (f-URS) is a minimally invasive procedure to treat kidney stones, but it is not free of complications. The goals of this study were to analyze the efficacy and safety of f-URS in the management of kidney stones in patients aged ≥60 years and compare the outcomes of this surgery with the outcomes of the same surgery in a younger population. We retrospectively reviewed patient data from 1750 patients who met our inclusion criteria and received f-URS at the urology clinic of our hospital from 2012 to 2017. Patients were assigned into two groups: those aged ≥60 years (Group 1, n=291) and those aged 19-59 years (Group 2, n=1459). The perioperative results were evaluated comparatively. We performed multivariable analyses for factors predicting complications. When we compared the groups on demographic attributes, we noted statistically significant differences in gender, body mass index (BMI), and American Society of Anesthesiologists scores. Stone size and operation time were higher in the ≥60-year age group (Group 1). Other stone characteristics and operative features were similar. Stone-free rates (SFR) after the first procedure were 88.0% in Group 1 and 89.2% in Group 2. SFR and success rates at three months were similar for both groups. The complication rates were similar, and multivariable regression analysis revealed the most important factor affecting the complications was the presence of residual stones in both groups. The second most important factor affecting the complication was the operation time in Group 1 and the number of stones in Group 2. In our study, there were no significant differences in terms of results and complications among elderly and young patients after f-URS except for the duration of the operation. The prolongation of operation time results in worse outcomes in terms of perioperative complications in patients aged ≥60 years. f-URS is a relatively safe and efficient procedure, with a small risk of minor complications even in the elderly population, with increased comorbidity.