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    The All-Seeing Needle Instead of the Veress Needle in Pediatric Urologic Laparoscopy
    (Mary Ann Liebert, Inc, 2013) Silay, Mesrur Selcuk; Tepeler, Abdulkadir; Sancaktutar, Ahmet Ali; Kilincaslan, Huseyin; Altay, Bulent; Erdem, Mehmet Remzi; Hatipoglu, Namik Kemal
    Purpose: To investigate the feasibility of the all-seeing needle for safe entry and creation of pneumoperitoneum in pediatric urologic laparoscopy. Patients and Methods: A total of 14 children underwent various transperitoneal urologic laparoscopic procedures. The all-seeing needle, which is 4.85F in diameter, was used for safe entry into the abdominal cavity at the site of the umblicus in all cases. The microoptic was integrated with the light system and connected via a zoom ocular enabling direct visualization of the layers between the skin and the peritoneal cavity. Once the intraperitoneal access was obtained, CO2 pneumoperitoneum was created from one port of the three-way connector attached to the proximal part of the needle. Then the laparoscopic trocars were placed under vision of the microoptical system. Results: Mean age of the children was 4.52.9 years. In all children, the all-seeing needle was safely introduced into the abdominal cavity under direct vision. Then, CO2 pneumoperitoneum was succesfully performed. The mean time for optical puncture was calculated as 1.1 +/- 0.8 minutes. No complication was encountered during the introduction of the needle, creation of the pneumoperitoneum, and placement of the trocars. Conclusions: The all-seeing needle appears to be beneficial in safe entry and for creating pneumoperitoneum in laparoscopic pediatric urology cases. It eliminates the disadvantages of the Veress needle, which is blunt insertion, and may possibly prevent complications.
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    Are small residual stone fragments really insignificant in children?
    (W B Saunders Co-Elsevier Inc, 2013) Dincel, Nida; Resorlu, Berkan; Unsal, Ali; Tepeler, Abdulkadir; Silay, Mesrur Selcuk; Armagan, Abdullah; Diri, Akif
    Objectives: To assess the significance of asymptomatic residual stone fragments of less than 4 mm (clinically insignificant residual fragments [CIRFs]) after shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) in children. Patients and Methods: Eighty-five children were followed up for 6 to 50 months (median 22). Outcomes measured were fragment re-growth, stone events (emergency department visits, hospitalization, or additional interventions) and spontaneous fragment passage. Results: During follow-up, 22 children (25.8%) passed residual fragments spontaneously. Highest spontaneous passage rate was found for renal pelvis stones and the lowest for the lower pole stones (57.1% vs. 16.1%; p<0.001). When the number of the fragments increased, the chance of the spontaneous passage decreased (30% vs 20%; p<0.05). Symptomatic episodes including renal colic, hematuria, or urinary tract infection were documented in 34 (40%) patients, and re-growth of fragments was observed in 18 (21.2%). Stone size had no significant effect on spontaneous passage (p=0.079), stone growth (p=0.528), and symptomatic episodes (p=0.402). Twenty-five patients (29.4%) required secondary intervention for stone re-growth or stone related events and the remaining 20 patients (23.5%) needed medical treatment for bothersome symptoms or complications. Conclusions: Our results suggest that 40% of children with CIRFs will become symptomatic and 20% will develop stone re-growth over the following 6 months. Only one fifth of the fragments will pass spontaneously without any complications. Therefore, the use of the term CIRF is not appropriate for postoperative residual fragments in children. (c) 2013 Elsevier Inc. All rights reserved.
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    A Comparison of 2 Percutaneous Nephrolithotomy Techniques for the Treatment of Pediatric Kidney Stones of Sizes 10-20 mm: Microperc vs Miniperc
    (Elsevier Science Inc, 2015) Karatag, Tuna; Tepeler, Abdulkadir; Silay, Mesrur Selcuk; Bodakci, Mehmet Nuri; Buldu, Ibrahim; Daggulli, Mansur; Hatipoglu, Namik Kemal
    OBJECTIVE To compare outcomes of micro-percutaneous nephrolithotomy (PNL; microperc) with mini-PNL (miniperc) in the treatment of pediatric renal stones of sizes 10-20 mm. MATERIALS AND METHODS Patients aged <18 years who underwent PNL for renal stones of sizes 10-20 mm between August 2011 and March 2014 in 3 referral centers were reviewed retrospectively. Patients were evaluated in the following 2 groups: microperc (group 1) and miniperc (group 2). Demographics and perioperative parameters (fluoroscopy and operation time, hemoglobin drop, and stone-free and complication rates) were retrospectively analyzed. RESULTS A total of 119 patients were evaluated, including group 1 (n = 56) for microperc and group 2 (n = 63) for miniperc. We found mean stone sizes as 13.4 +/- 3.4 and 14.8 +/- 3.7 mm in the groups, respectively (P = .046). Mean operation and fluoroscopy times were 57.1 +/- 31.2 minutes and 132.4 +/- 92.5 seconds in the microperc group and 68.9 +/- 36.7 minutes and 226.2 +/- 166.2 seconds in the miniperc group, respectively (P = .110 and P <. 001). Stone-free rates were similar in both groups (82.1% vs 87.3%; P = .433 and 92.8% vs 93.6%; P = 0673) on postoperative day 1 and at first-month follow-up. The mean hemoglobin drop in group 2 differed from that in group 1 significantly (P <. 001). The difference of average hospitalization times was statistically significant (43.0 +/- 15.4 vs 68.5 +/- 31.7 hours; P <. 001). CONCLUSION Our outcomes show that microperc may be preferred as an alternative to mini-PNL for the treatment of pediatric kidney stones of sizes 10-20mmwith comparable success and complication rates, as well as shorter hospitalization and fluoroscopy times. (C) 2015 Elsevier Inc.
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    Initial experience of micro-percutaneous nephrolithotomy in the treatment of renal calculi in 140 renal units
    (Springer, 2014) Hatipoglu, Namik Kemal; Tepeler, Abdulkadir; Buldu, Ibrahim; Atis, Gokhan; Bodakci, Mehmet Nuri; Sancaktutar, Ahmet Ali; Silay, Mesrur Selcuk
    The aim of this study was to investigate the effectiveness and reliability of the micro-percutaneous nephrolithotomy (PNL) method for the management of kidney stones. We performed a retrospective analysis of 136 patients (140 renal units) who underwent micro-PNL for renal stones between September 2011 and February 2013 in four referral hospitals in Turkey. The selection of treatment modality was primarily based on factors such as stone size and location. In this study, we analyzed patient- and procedure-related factors. The mean age of patients in this study was 28.7 +/- A 20.6 (1-69) years, and the mean stone size was 15.1 +/- A 5.15 (6-32) mm. Conversion to mini-PNL was required in 12 patients. All interventions were performed with the patient in the prone position, except for the 3-year-old patient with the pelvic kidney who was placed in the supine position. The mean hospital stay was 1.76 +/- A 0.65 (1-4) days, and the mean drop in the hemoglobin level was 0.87 +/- A 0.84 (0-4.1) mg/dL. One of our patients required transfusion. Ureteral J stent was implanted in nine (6.43 %) patients because of residual stones. Seven (6.43 %) patients complained of postoperative renal colic which was managed conservatively. Abdominal distension related to extravasation of the irrigation fluid was observed in three patients (2.19 %). There were no other postoperative complications. An overall success rate of 82.14 % was achieved. Micro-PNL can be effectively and safely used for small and moderate kidney stones resistant to shock wave lithotripsy or as an alternative to other minimally invasive treatment methods.
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    INITIAL REPORT OF 'MICROPERC' IN THE TREATMENT OF PAEDIATRIC KIDNEY STONES
    (Mary Ann Liebert, Inc, 2012) Silay, Mesrur Selcuk; Tepeler, Abdulkadir; Atis, Gokhan; Piskin, Mesut; Sancaktutar, Ahmet Ali; Gurbuz, Cenk; Penbegül, Necmettin
    [Abstract Not Available]
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    Initial report of microperc in the treatment of pediatric nephrolithiasis
    (W B Saunders Co-Elsevier Inc, 2013) Silay, Mesrur Selcuk; Tepeler, Abdulkadir; Atis, Gokhan; Sancaktutar, Ahmet Ali; Piskin, Mesut; Gurbuz, Cenk; Penbegül, Necmettin
    Background/Purpose: To report the first technical feasibility and safety of microperc in the treatment of pediatric nephrolithiasis. Methods: A multicenter prospective trial was initiated and microperc was performed in 19 children from four different centers. In all cases, 4.85-Fr all-seeing needle was used to access the collecting system under direct vision. Stone fragmentation was performed using a 200-mu m holmium: YAG laser fiber either through the same needle sheath or an 8-Fr microsheath. Patient-and procedure-related factors and perioperative and postoperative parameters were analyzed. Results: The mean age of the children was 7.5 +/- 4.4 years. Mean stone size was 14.8 +/- 6.8 mm. Conversion to Mini-PNL was required in two patients because of optical default in one and the high stone burden in the other. The mean hospital stay was 1.8 +/- 0.8 days and the mean hemoglobin decrease was 0.1 mg/dl. The overall stone-free rate at 1 month was 89.5%. In one patient with obstructed ureteropelvic junction, intravasation of the irrigation fluid has led to abdominal distention and managed with percutaneous drainage intraoperatively. No other postoperative complication was recorded and no ancillary procedure was required. Conclusions: Microperc is a safe and effective procedure in the treatment of pediatric kidney stones. (C) 2013 Elsevier Inc. All rights reserved.
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    KNOWLEDGE AND ATTITUDE OF EUROPEAN UROLOGY RESIDENTS ABOUT IONIZING RADIATION
    (Mary Ann Liebert, Inc, 2012) Soylemez, Haluk; Sancaktutar, Ahmet Ali; Silay, Mesrur Selcuk; Penbegül, Necmettin; Bozkurt, Yasar; Atar, Murat; Altunoluk, Bulent
    [Abstract Not Available]
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    Knowledge and Attitude of European Urology Residents About Ionizing Radiation
    (Elsevier Science Inc, 2013) Soylemez, Haluk; Sancaktutar, Ahmet Ali; Silay, Mesrur Selcuk; Penbegül, Necmettin; Bozkurt, Yasar; Atar, Murat; Altunoluk, Bulent
    OBJECTIVE To evaluate the attitude and knowledge of urology residents concerning ionizing radiation, we undertook a survey of European urology residents. METHODS The questionnaire was sent to 1184 urology residents within the database of the European Society of Residents in Urology (ESRU) by e-mail between November 2011 and January 2012. The questionnaire was composed of demographic questions and questions about the frequency of radiation exposure and use of radiation safety measures during fluoroscopy-guided endourologic procedures. In addition, there were questions about education programs and respondents' knowledge about diagnostic imaging modalities. RESULTS A total of 124 questionnaires were returned from urology residents in 20 different European countries. All of the respondents reported that they were routinely exposed to ionizing radiation, and 69 (72.5%) were exposed more than 3 times per week. Despite the common but not sufficient use of lead aprons (75%), use of other radiation protection measures was very low. Although 55% of the respondents had attended an education program in Europe about radiation safety, attendance was highest in Poland (82.6%). The level of knowledge about ionizing radiation was low among urology residents, and approximately half of responders had no idea that commonly used imaging modalities have a fatal cancer risk. CONCLUSION The results of this study showed the lack of knowledge and awareness about the importance of ionizing radiation protection among urology residents in Europe. We therefore suggest radiation safety courses in every step of medical life for doctors, especially for endourologists. UROLOGY 81: 30-36, 2013. (c) 2013 Elsevier Inc.
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    Knowledge and Attitude of European Urology Residents About Ionizing Radiation REPLY
    (Elsevier Science Inc, 2013) Soylemez, Haluk; Sancaktutar, Ahmet Ali; Silay, Mesrur Selcuk; Penbegül, Necmettin; Bozkurt, Yasar; Atar, Murat; Altunoluk, Bulent
    [Abstract Not Available]
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    Preoperative evaluation of pediatric kidney stone prior to percutaneous nephrolithotomy: is computed tomography really necessary?
    (Springer, 2013) Tepeler, Abdulkadir; Sancaktutar, Ahmet Ali; Taskiran, Mehmet; Silay, Mesrur Selcuk; Bodakci, Mehmet Nuri; Akman, Tolga; Tanriverdi, Orhan
    The objective of the study was to investigate the precise role of computed tomography (CT) in preoperative radiologic evaluation and surgical planning of kidney stone in children prior to percutaneous nephrolithotomy (PNL). A total of 113 pediatric patients (aged a parts per thousand currency sign18 years) undergoing PNL for renal stone(s) in three referral hospitals between March 2010 and August 2012 were retrospectively evaluated. Depending on the preoperative radiologic evaluation, patients were divided into two groups. Those evaluated with CT were classified as group-1 (n = 50) and the remaining cases undergoing intravenous urography (IVU) examination were classified as group-2 (n = 63). Patient- and procedure-related variables and perioperative measures were compared between the groups. The mean age, stone size and localization were similar in both groups (p = 0.07, p = 0.57, p = 0.6, respectively). Although the postoperative hemoglobin drop was found to be significantly higher in group-2 (1.5 +/- A 1.3 vs. 0.9 +/- A 0.6 g/dL, p = 0.005), the mean operation time, fluoroscopic screening time, access number, overall success and complication rates were comparable (p = 0.06, p = 0.94, p = 0.75, p = 041, and p = 0.41, respectively). However, the mean hospitalization time was significantly prolonged in group-2 than in group-1 (p = 0.03). Our findings clearly demonstrate that, despite the key role of preoperative CT in particular patients with anatomically abnormal kidneys, IVU is a valuable alternative imaging modality with comparable radiation doses in children.
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    The Role of Microperc in the Treatment of Symptomatic Lower Pole Renal Calculi
    (Mary Ann Liebert, Inc, 2013) Tepeler, Abdulkadir; Armagan, Abdullah; Sancaktutar, Ahmet Ali; Silay, Mesrur Selcuk; Penbegül, Necmettin; Akman, Tolga; Hatipoglu, Namik Kemal
    Background and Purpose: The treatment of symptomatic lower pole (LP) calculi poses a challenge because of lower clearance rates. We present our experience with microperc in the treatment of LP renal calculi. Patients and Methods: We retrospectively evaluated the symptomatic patients with LP renal calculi who underwent microperc between August 2011 and June 2012 from two referral hospitals. Patients were included only in cases of failure after shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) and according to patient preference. The percutaneous renal access was performed using the 4.8F all-seeing needle with C-arm fluoroscopy or ultrasonographic guidance with the patient in the prone position. Stone disintegration was established using a 200 mu m holmium: yttrium-aluminum-garnet laser fiber. Results: A total of 21 patients (mean age 37.3 +/- 20.1 years) with LP stone underwent microperc. The mean body mass index was 28.6 +/- 6.0 kg/m(2), and the mean stone size was 17.8 +/- 5.9 (9-29) mm. The duration of surgery and fluoroscopic screening was 62.8 +/- 25.2 minutes and 150.5 +/- 92.8 seconds, respectively. The patients were discharged after a mean 37.5 +/- 14.4 hours of hospitalization time. The mean hemoglobin drop was 0.8 +/- 0.6 (0.1-2.3) g/dL. Conversion to miniperc was necessitated in one patient with loss of vision. Stone-free status was achieved in 18 (85.7%) patients. Clinically insignificant residual fragments were observed in only one (4.8%). The procedure failed in two (9.5%) patients. A total of two minor complications (renal colic necessitating stent insertion and urinary tract infection) were observed postoperatively, none severe. Conclusion: Microperc is a feasible and efficient treatment modality for symptomatic LP calculi. Our results provide that microperc might take a part in case of SWL and RIRS failures or as an alternative to percutaneous nephrolithotomy or RIRS in the management of symptomatic LP calculi.