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Paediatric Urolithiasis

Sarica, K.

Article | 2009 | European Urological Review4 ( 2 ) , pp.83 - 86

Management of paediatric urinary stones is still a challenge. The desired outcome is complete clearance of stones, preservation of renal function and prevention of stone recurrence. Improvements in technology and growing experience have resulted in greater acceptance of minimally invasive techniques, and currently urologists can use the whole spectrum of stone management alternatives in children as well as in adults. Shock-wave lithotripsy (SWL) is the first choice for upper tract calculi, while other minimally invasive methods have more specific indications. Although SWL is safe and efficient in the treatment of both renal and uret . . .eral stones, ureteroscopy and percutaneous nephrolithotomy (PCNL), in expert hands, can be successfully applied in appropriate cases. With judicious application of these treatment modalities, excellent stone-free rates with minimal morbidity can be obtained. In patients with anatomical abnormalities, open surgery is preferred. Stone-related factors, collecting system anatomy, presence of obstruction and/or infection of the urinary tract should be considered in all cases. © Touch Briefings 2009 Daha fazlası Daha az

Reply by the Authors

Sarica, K. | Yencilek, F. | Eryildirim, B. | Kuyumcuoglu, U.

Letter | 2009 | Urology74 ( 6 ) , pp.1378 - 1379

[No abstract available]

Reply -

Tanriverdi, O. | Sarica, K.

Note | 2011 | Urology78 ( 3 ) , pp.521 - 522

[No abstract available]

Prevention of shockwave induced functional and morphological alterations: An overwiew

Sarica, K. | Yencilek, F.

Review | 2008 | Archivio Italiano di Urologia e Andrologia80 ( 1 ) , pp.27 - 33

Experimental as well as clinical findings reported in the literature suggest that treatment with shock wave lithotripsy (SWL) causes renal parenchymal damage mainly by generating free radicals through ischaemia /reperfusion injury mechanism. Although SWL-induced renal damage is well tolerated in the majority of healthy cases with no permanent functional and/or morphologic side effects, a subset of patients with certain risk factors requires close attention on this aspect among which the ones with pre-existing renal disorders, urinary tract infection, previous lithotripsy history and solitary kidneys could be mentioned. It is clear t . . .hat in such patients lowering the number of shock waves (per session) could be beneficial and has been applied by the physicians as the first practical step of diminishing SWL induced parenchymal damage. On the other hand, taking the injurious effects of high energy shock wave (HESW) induced free radical formation on renal parenchyma and subsequent histopathologic alterations into account, physicians searched for some protective agents in an attempt to prevent or at least to limit the extent of the functional as well as the morphologic alterations. Among these agents calcium channel blocking agents (verapamil and nifedipine), antioxidant agents (allopurinol, vitamin E and selenium) and potassium citrate have been used to minimize these unestimated adverse effects. Additionally, therapeutic application of these agents on reducing stone recurrence particularly after SWL will gain more importance in the future in order to limit new stone formation in these cases. Lastly, as experimental and clinical studies have demonstrated, combination of anti-oxidants with free radical scavengers may provide superior renal protection against shock wave induced trauma. However, we believe that further investigations are certainly needed to determine the dose-response relationship between the damaging effects of SWL application and the protective role of these agents Daha fazlası Daha az

Reply by the authors -

Erturhan, S. | Bayrak, O. | Sarica, K.

Letter | 2013 | Urology81 ( 6 ) , pp.1381 - 1382

[No abstract available]

Can the Hounsfield unit predict the success of medically expulsive therapy?

Erturhan, S. | Bayrak, O. | Mete, A. | Seckiner, I. | Urgun, G. | Sarica, K.

Article | 2013 | Journal of the Canadian Urological Association7 ( 11.12.2020 ) , pp.1381 - 1382

Background: We investigate the predictability of medical expulsive therapy (MET) success with alpha blockers based on Hounsfield unit (HU) values and Hounsfield density (HD) values measured by computed tomography (CT) for distal ureteral stones. Methods: Between July 2011 and May 2012, 44 patients (19 female and 25 male) with 5- to 10-mm stones in the distal ureters were included in this randomized prospective study. Non-contrast CT examinations were performed in these patients. HU and HD values of stones were calculated. Doxazosine, 4 mg/day orally, was administered as a single dose to all patients for MET. Results: Patients were d . . .ivided into 2 groups. Group 1 included 18 patients (43.9%) with dropped stones with MET. Group 2 included 23 patients (56.1%) with no stone passage with MET. In Group 1, the mean stone size was 7.7 mm, the mean HU was 507, and the HD was 53.04/mm. In Group 2, the mean stone size was 8.25 mm, the mean HU was 625, and the mean HD was 61.54/mm. The HU and HD values in Group 2 were higher than in Group 1. However, there was no statistically significant difference (p = 0.85 and 0.93 for HU and HD, respectively). Interpretation: We found that HU and HD values cannot be used to predict the chances of success for MET. Although the sample size is appropriate for the study, further comparative studies involving more patients are warranted. © 2013 Canadian Urological Association Daha fazlası Daha az

Hyperoxaluria-induced tubular ischemia: The effects of verapamil and vitamin e on apoptotic changes with an emphasis on renal papilla in rat model

Tanriverdi, O. | Telci, D. | Aydin, M. | Ekici, I.D. | Miroglu, C. | Sarica, K.

Article | 2012 | Urological Research40 ( 1 ) , pp.17 - 25

An experimental study in rats was performed to evaluate the presence and the degree of both tubular apoptotic changes and crystallization at cortical, medullar and papillary regions of the kidney during hyperoxaluric phase and assess the possible protective effects of vitamin E and verapamil on these pathologic changes (particularly in papillary part of the affected kidneys). A total of 32 rats have been included into the study program. Hyperoxaluria was induced by continuous administration of ethylene glycol (0.75%). In addition to hyperoxaluria induction, animals in Groups 2 and 3 did receive a calcium channelblocking agent (verap . . .amil) and vitamin E, respectively. Histologic alterations of the kidneys including crystal formation together with apoptotic changes were evaluated on days 1, 14 and 28, respectively. Both apoptotic changes and the presence and degree of crystallization were assessed separately in renal cortical region, medulla and particularly papillary parts of the removed kidneys. Although verapamil did well limit the degree of crystal formation and apoptosis and brought it to the same levels observed in control group animals in all parts of the kidneys during intermediate phase, addition of vitamin E was failed to show the same protective effect during both intermediate and late phase evaluations. As demonstrated in our study, the limitation of both crystal deposition and apoptotic changes might be instituted by calcium channel-blocking agents. Clinical application of such agents in the prophylaxis of stone disease might limit the formation of urinary calculi, especially in recurrent stone formers. © Springer-Verlag 2011 Daha fazlası Daha az

Current situation of renal stone treatment: A cross-sectional survey from İstanbul

Gürbüz, C. | Öztürk, M.I. | Koca, O. | Yildirim, A. | Ateş, F. | Eryildirim, B. | Sarica, K.

Article | 2011 | Turk Uroloji Dergisi37 ( 3 ) , pp.252 - 256

Objective: In this study, the adequacy of technical equipment used in the treatment of renal stone along with treatment approaches was evaluated. Materials and methods: Between January 2010 and June 2010, 106 urology residents and specialists practicing in 10 different urology departments of training hospitals in İstanbul were asked to fill a questionnaire to evaluate the adequacy of necessary equipment and the treatment approaches for the treatment of renal stone. Results: Eighty percent of the physicians who participated in the study treated at least 8 patients with renal stone per month. While all participating clinics had rigid . . .nephro-scope, flexible ureterorenoscopy and electroshock wave lithotriptor were available in 41% and 49% of the clinics, respectively. The preferred radiologic evaluation before percutaneous nephrolithotomy (PNL) was intravenous pyelography, and abdominopelvic computed tomography in 72% and 69%, respectively. Tubeless PNL was not preferred by 71% of the participants. The first choice of treatment for coraliform stone was PNL and open surgery in 71% and 26% of participants, respectively. Fifty-four percent of the participants stated that PNL was applied for patients older than 12 years old. Retrograde intrarenal surgery was suggested by 26% of the participants for the treatment of symptomatic lower calix stone. Conclusion: It is encouraging that PNL application is performed in all clinics involved in this study, however, training hospitals should be more equipped Daha fazlası Daha az

Does child's age affect interval to stone-free status after SWL? A critical analysis

Göktaş, C. | Akça, O. | Horuz, R. | Gökhan, O. | Albayrak, S. | Sarica, K.

Article | 2012 | Urology79 ( 5 ) , pp.1138 - 1142

Objective: To evaluate the success rates and complications of extracorporeal shock wave lithotripsy (ESWL) in children with renal stones in an age-dependant manner. Methods: From 2006 to 2010, 164 children (male/female ratio 1:3) with renal calculi have been treated with ESWL (PiezoLith3000 lithotripter). The children were divided into 2 age groups: group 1, 0-6 years old (n = 133); and group 2, 7-15 years (n = 31). The patient- and treatment-related parameters were recorded for comparative evaluation. The success of ESWL in terms of the stone-free rates, additional procedures, and complications were comparatively evaluated. The dat . . .a were analyzed statistically. Results: The mean age of groups 1 and 2 was 28 ± 18 months (range 4-71) and 119 ± 28 months (range 73-178), respectively. Although general anesthesia was used for all patients in group 1, 29% of the patients were treated under neuroleptic anesthesia in group 2. During the 3-month follow-up period, the complete stone-free rate was 94.7% (126 of 133), and treatment was unsuccessful in 7 patients (5.3%) in group 1. The corresponding data were 87% (27 of 31; P =.222) and 4 (13%; P =.089) in group 2. The stone-free rate after the first session was 67.6% (90 of 133) and 38.7% (12 of 31) in groups 1 and 2, respectively (P =.004). The mean number of ESWL sessions applied was 1.6 (range 1-5) and 2.9 (range 1-6) in groups 1 and group 2, respectively (P =.0001). No major complications were noted. Conclusion: Our results have demonstrated that ESWL is highly successful in the management of renal calculi in children. Compared the outcomes by age, the younger children become stone free more quickly than the older children with fewer ESWL sessions. © 2012 Elsevier Inc Daha fazlası Daha az

Current situation of ureteral stone diagnosis and treatment: A cross-sectional survey from Istanbul

Öztürk, M.I. | Gürbüz, C. | Koca, O. | Sarica, K. | Şenkul, T. | Yildirim, A. | Eryildirim, B.

Article | 2010 | Turk Uroloji Dergisi36 ( 2 ) , pp.125 - 131

Objective: The prevalence of urinary system stone disease is 1-13% worldwide with a steady increase parallel to the increasing modern life style. Turkey is among the countries where the disease is endemic. In this study adequacy of technical equipment used in diagnosis and treatment of ureteral stone along with treatment approaches were evaluated. Materials and methods: A total of 106 urology residents and specialists practicing in 10 different urology departments of training hospitals in Istanbul were asked to fill a questionnaire to evaluate the adequacy of necessary equipment and the treatment approaches in terms of diagnosis and . . . treatment of ureteral calculi. Results: More than 6 patients per month have been evaluated by the 78% of physicians participated to the study. All physicians had rigid ureterorenoscope and pneumatic lithotriptor in their clinics. While plain radiography of urinary system was the inital imaging choice for 63% of these physicians for patients with renal colic; 14% of them stated that they have to use a different imaging technique other than they aimed due to technical availability. For medical expulsive treatment 90% of the doctors were using alpha-blockers among which tamsulosin was the most commonly preferred one. Conclusion: Technical systems necessary for an efficient ureteral stone management seems to be adequate in clinics of physicians involved in this study. Answers given to questions regarding the diagnosis and treatment of ureteral stones were generally compatible with the existing literature data Daha fazlası Daha az

Role of Overweight Status on Stone-forming Risk Factors in Children: A Prospective Study

Sarica, K. | Eryildirim, B. | Yencilek, F. | Kuyumcuoglu, U.

Article | 2009 | Urology73 ( 5 ) , pp.1003 - 1007

Objectives: To evaluate the possible role of being overweight on stone-forming risk factors in children. Methods: A total of 94 children (43 boys and 51 girls, male/female ratio 1:1.8) who were taking no medication or dietary modifications before treatment were included in the study. After a detailed stone disease history, the systolic and diastolic blood pressures were precisely measured and recorded for all patients. The body mass index, 24-hour urine values, and serum stone-forming risk parameters were evaluated in 44 overweight (17 boys and 27 girls; group 1) and 50 normal (26 boys and 24 girls; group 2) children. The results of . . . each group were compared using the Wilcoxon rank sum test. Results: The evaluation of the stone-forming risk factors in both groups revealed that the overweight status might be responsible for the increased excretion of these substances in such children. Most of the children in group 1 demonstrated hypocitraturia and hyperoxaluria (9/44, 20.5%) compared with the patients in group 2. Although the mean urinary oxalate level was 0.74 ± 0.81 mg/kg/24 h for boys and 0.69 ± 0.72 mg/kg/24 h for girls in group 1, relatively lower values were noted in group 2 (0.42 ± 0.52 and 0.45 ± 0.57 mg/kg/24 h for the boys and girls, respectively). Similarly, the children in group 1 had elevated mean urinary calcium and lower citrate excretion compared with the group 2 patients. Conclusions: Overweight status in children might be associated with an elevated risk of stone formation in both sexes owing to the alterations in urine composition. Obese children could be more prone to stone formation, and they should be evaluated and followed up for this aspect. Crown Copyright © 2009 Daha fazlası Daha az

Efficacy of medical expulsive treatment with doxazosin in pediatric patients

Erturhan, S. | Bayrak, O. | Sarica, K. | Seckiner, I. | Baturu, M. | Sen, H.

Article | 2013 | Urology81 ( 3 ) , pp.640 - 643

Objective: To evaluate the possible efficacy of an ?1 blocker (doxazosin) therapy on the management and disease course in pediatric patients with distal ureteral stones. Materials and Methods: A total of 45 patients (24 boys and 21 girls) with a single lower ureteral stone were included in the study program. Their age range was 3-15 years (mean 6.65 ± 3.78). The children were randomized into 2 main groups: group 1 (n = 21), who received only ibuprofen 20 mg/kg/d divided into 2 equal doses for pain control during follow-up; and group 2 (n = 24), who received, in addition to ibuprofen, 0.03 mg/kg/d doxazosin once daily, before bed. Re . . .sults: The stone expulsion rate was 28.5% (6 of 21) in group 1 and 70.8% (17 of 24) in group 2 (P = .001). The number of daily colic attacks and stone expulsion time clearly demonstrated the advantage of doxazosin, with a statistically significant diminished number of pain attacks (P = .04) and shorter stone expulsion period (P =.001). Stones <5 mm were expulsed at greater rates than stones 5-10 mm in group 2 (P =.046). Also children aged <6 years passed the stones with significantly greater rates than children aged ?7 years (P =.008). Conclusion: The use of ?-adrenergic blocker agents could have certain advantages in attempts to render children stone free within a shorter period, which would inevitably diminish the number of colic attacks and the need for analgesic usage. © 2013 Elsevier Inc. All Rights Reserved Daha fazlası Daha az

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