Background: To investigate the relationship between ureteral wall thickness (UWT) and other variables of patients who underwent extracorporeal shock wave lithotripsy (SWL) in the primary treatment of the ureteral stone above the iliac crest level. Material and methods: A total of 147 patients aged 18 years and older, who underwent SWL in our clinic between December 2016 and December 2019 for the treatment of ureteral stones above the iliac crest level and had a non-contrast-enhanced abdominal computed tomography (NCCT) scans before the procedure were included in the clinical study. The results were evaluated at three months after SWL. The absence of residual fragments was considered as stone-free status, and the existence of any size residual fragment was considered as treatment failure. Results: In our study, the mean age of the patients was 42.4 ± 12.8 years, and the stone-free rate was 92.5%. The median transverse stone size was 7.5 mm (min 2.8 - max 15), and the median UWT was 4.2 mm (1 - 8.7). In the multivariate analysis, UWT (p = 0.002) and multiple stone presence (p = 0.027) were found to be independent factors affecting stone-free status. In the receiver operating characteristic (ROC) curve analysis, the optimal threshold value for UWT was determined as 5.25 mm. Conclusions: We found that UWT was the most important independent variable associated with increased failure in SWL treatment. The presence of multiple stones was another independent factor that increased failure rates. Using SWL technology through experience accumulated with the mechanical hardware of the machine, we can select patients who are more suitable for this treatment and improve treatment outcomes.

Introduction: This study aims to investigate the outcomes and complication rates of patients undergoing retrograde intrarenal surgery (RIRS) at the live surgery events organized as boutique course series. Materials and Methods: Eight RIRS courses were organized between November 2017 and February 2020. Data of 24 patients who were operated in the live surgery events (as LSE group) for renal stone were matched with the data of 24 substitute patients (as control group) who underwent regular RIRS on the same period at the same centers.. Results: Stone free status of groups was similar (88% in LSE and 79% in the control group; p=1). There was no significant difference in terms of complication and need for additional procedure rates, operation and fluoroscopy and hospitality times between the two groups (p=1, p=1, p=0.12, p=0.58 and p=0.94, respectively). Fifty-four % (13/24) of LSE operations were performed by guest surgeons. No statistically significant difference was found between the patients who operated by host and guest surgeons. However, the operation times of the operations performed by guest surgeons were longer than those performed by the host surgeons (96.5±28 and 66.5±30 minute, respectively, p=0.07). Conclusion: Our study is the first report on this area. RIRS live surgery can be performed with low complication and high stone-free rates without jeopardizing patient safety. If the surgeon is not familiar with the operating room set-up or staffs, the live surgery must performed by the host surgeon to avoid extended operating time.

Background: Mast cells play a critical role in tumor-associated immune pathways. We aimed to determine whether the urinary mast cell mediators predict the immune response in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. Methods: Nineteen patients who have received immunotherapy due to NMIBC and 19 healthy participants were enrolled. Urine samples were collected to assay N-methylhistamine, histamine, and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and four weeks after the sixth instillation in patients with NMIBC and at a single visit in healthy participants. Cystoscopic examinations were performed on the patient with NMIBC at three-month intervals for two years. The changes in urinary markers due to BCC response, BCG instillation, and the presence of NMIBC were assessed. Results: The average age was 56.1 ± 10.5 years in patients with NMIBC. Fourteen patients had high-grade Ta tumors, and 5 had high-grade T1 tumors. While 12 patients responded, 6 presented with recurrence and 1 with progression. There was no correlation between the levels of mast cell mediators and BCG response. The N-methylhistamine and histamine levels were increased significantly with the onset of immunotherapy, and N-methylhistamine levels were significantly decreased when immunotherapy was terminated. Pre-BCG estimated marginal means of N-methylhistamine were significantly higher in patients with NMIBC than healthy participants. Conclusions: Our study is the first study to identify the changes in mast cell mediators with the onset of immunotherapy and with the presence of bladder cancer. However, these mediators were not found to predict the patients’ response to immunotherapy.

Background: Mast cells play a critical role in tumor-associated immune pathways. We aimed to prospectively investigate the urinary mast cell mediators in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. Methods: Nineteen patients who have received immunotherapy due to NMIBC and 19 healthy participants were enrolled. Urine samples were collected to assay N-methylhistamine, histamine and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and four weeks after the sixth instillation in patients with NMIBC and at a single visit in healthy participants. Cystoscopic examinations were performed on the patient with NMIBC at three-month intervals for two years. The changes in urinary markers due to BCC response, BCG instillation, and the presence of NMIBC were assessed. Results: The average age was 56.1 ± 10.5 years in patients with NMIBC. Fourteen patients had high-grade Ta tumors, and 5 had high-grade T1 tumors. While 12 patients responded, 6 presented with recurrence and 1 with progression. There was no correlation between the levels of mast cell mediators and BCG response. The N-methylhistamine and histamine levels were increased significantly with the onset of immunotherapy and N-methylhistamine levels were decreased significantly when immunotherapy was terminated. Pre-BCG estimated marginal means of N-methylhistamine were significantly higher in patients with NMIBC than healthy participants. Conclusions: This is the first study to determine that urine histamine and N-methylhistamine levels showing the change with immunotherapy. However, these mediators were not found to predict the patients’ response to immunotherapy.

Background: Renal carcinoma and associated venous thrombosis cause-specific perioperative and postoperative challenges. We aimed to evaluate the factors affecting clinical outcomes in patients undergoing radical surgery due to renal carcinoma and associated venous thrombosis. Materials and methods: Hospital records were retrospectively reviewed to identify patients with renal carcinoma and associated venous thrombosis treated with radical surgery between 2006 and 2019. Preoperative, perioperative, and postoperative findings were analyzed to determine the associations between clinical and survival outcomes. Overall and disease-free survival was analyzed by the Kaplan-Meier method. Other associated prognostic variables were assessed using univariate and multivariate Cox regression analyses. Results: Thirty-three patients with renal carcinoma and associated venous thrombosis were enrolled for this study. There were 15 (45.4%) patients with level I, five (15.2%) with level II, eight (24.2%) with level III, and five (15.2%) with level IV venous thrombosis according to the Mayo Clinic classification system. The median follow-up was 35.6 months. In the univariate analysis, increased tumor size was associated with poor overall and disease-free survival. Preoperative clinic M1 disease was associated with poor overall survival. A high Mayo Clinic thrombus level was associated with poor disease-free survival. In the multivariate analysis, only tumor size and clinic M1 disease were independently correlated with poor overall survival. No independent statistically significant association was detected between thrombus level and survival outcomes. Conclusions: Although the thrombus level was not associated with overall and disease-free survival, tumor size and clinic M1 disease were found to have an independent prognostic impact on overall survival.