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    Evaluation of Factors Affecting Success Rate in Percutaneous Nephrolithotomy: A Five-Year Experience
    (Galenos Publ House, 2023) Yilmaz, Sevgin; Topcuoglu, Murat; Demirel, Fuat
    Objective: To analyze the parameters that are believed to impact the success rate in patients undergoing percutaneous nephrolithotomy and to determine the factors that have a significant effect. Materials and Methods: Success rates of 508 patients who underwent percutaneous nephrolithotomy were determined over a five-year period. Evaluation was performed with the medical history, non-contrast computerized tomography, and clinical research form in the first, third, and sixth months postoperatively. Patient characteristics, stone characteristics, and operation details were analyzed, and their effects on success were investigated. In the evaluation of the success rate, the results of the first month, were considered. Results: No significant difference was shown between the successful and unsuccessful groups in terms of demographic features. Morbidities such as body mass index, hypertension, diabetes mellitus, hyperlipidemia, and heart disease had no effect on success. Solitary kidney or congenital renal anomaly, degree of hydronephrosis, and high preoperative serum urea creatinine levels did not have a significant impact on the success rate. Significant effects of parameters such as stone volume greater than 15 cm2, complex stones, infection and cystine stones, intraoperative complication rate, and operation time on success were investigated (p<0.001, p=0.038, p=0.014, p=0.010, p=0.022, p=0.030, respectively). Success rates decreased statistically in cases with accompanying macroscopic hematuria (p=0.032). Previous surgery, extracorporeal shock wave lithotripsy history, and multifocal access had no effect however surgical experience increased the success rate (p=0.036). Conclusion: The success rates in percutaneous nephrolithotomy can be enhanced by examining the factors that may have an impact and taking necessary precautions relevant to these factors.
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    The effect untreated right subclinical varicocele on the outcomes of contralateral left clinical varicocelectomy in infertile patients
    (Pagepress Publ, 2023) Yilmaz, Sevgin; Topcuoglu, Murat; Cakan, Murat; Akkoc, Ali; Ucar, Murat
    Purpose: The management of infertile patients with unilateral subclinical varicocele (SCV) and contralateral clinical varicocele (CV) remains controversial. We aimed to evaluate the effect of untreating SCV on the outcome of contralateral clinical varicocelectomy in infertile patients with oligoasthenozoospermia (OA). Materials and methods: Infertile patients with the diagnosis of OA who underwent left varicocelectomy were retrospectively evaluated. While all patients in the study had left clinical varicocele (LCV), some patients had concomitant right SCV. Patients were divided into two groups according to the presence or absence of a right SCV accompanying LCV as group 1; (LCV n = 104) or group 2; (LCV with right SCV, n = 74). Patients were evaluated with spermiogram parameters, pregnancy rates and serum levels of follicle stimulating hormone, luteinizing hormone, total testosterone at the first year of the follow-up. Results: The mean sperm concentration increased significantly in both groups. However, group 1 showed significantly greater improvement than group 2. The ratio of progressive motile sperm in group 1 was increased significantly whereas no significant change was shown in group 2. Both the spontaneous pregnancy rate and the pregnancy rate with ART were statistically lower in the group of patients with right SCV. No statistically significant difference was detected in serum hormone levels in both groups after varicocelectomy operations. Conclusions: Untreated right SCV may have adverse impact on the outcomes of left clinical varicocelectomy. In this context, the right testis can be considered in terms of treatment in patients with right SCV accompanying left CV.