Handan Cakmakci, M.D.Department of Radiology

Dokuz Eylul University Faculty of MedicineIzmir, Turkey

References

1. Alaygut D, Soylu A, Kasap B, et al. The relationships between renalcompensatory hypertrophy etiologic factors and anthropometricdevelopment in the pediatric age group [e-pub ahead of print].Urology. doi: 10.1016/j.urology.2013.03.024, accessed May 12, 2013.

2. Garg M, Singh V, Sankhwar S, et al. Re: Alaygut D et al.: Therelationships between renal compensatory hypertrophy etiologicfactors and anthropometric development in the pediatric age group.Urology. 2013;82.:1189-1190.

Re: Abdulwahed et al.: Sensitivity andSpecificity of Ultrasonography in PredictingEtiology of Azoospermia (Urology 2013;81:967-971)

TO THE EDITOR:

We congratulate the authors for describing the ultraso-nographic features of obstructive and functional azoo-spermia. The authors contend that ultrasonography canpossibly replace testicular biopsy in some men withazoospermia. However, the authors have used criteriasuch as evidence of prostatitis, epididymitis, small sizeprostate, and small size seminal vesicles for differentiatingobstructive with functional azoospermia. Most of thesecriteria are poorly defined in the published data anddifficult to evaluate.

We would like to know how the sensitivity and spec-ificity were calculated. The authors have describedmultiple findings on ultrasonography. Which parameteror combinations of finding were taken to calculate thesevalues? We should remember that ultrasonography is anoperator-dependant investigation and prone to error.Therefore, it may be difficult to interpret this test resultwith confidence.

Apul Goel, M.B.B.S., M.S., M.Ch. (Urology)D.N.B. (Urology)

Sagorika Paul, M.B.B.S., M.S. (General Surgery)Ved Prakash Verma, M.B.B.S., M.S. (General Surgery)

Department of UrologyKing George’s Medical University

Chowk, Lucknow, Uttar Pradesh, India

Reply by the Authors

TO THE EDITOR:

We agree that sonographic findings are suggestive ratherthan diagnostic to pathologic diagnoses such as prostatitisand epididymitis and might be prone to error.

UROLOGY 82 (5), 2013

In this study, we aimed to demonstrate how close is thediagnostic yield of ultrasound to the more accurate butinvasive testicular biopsy in differentiating obstructivefrom functional azoospermia.

Concerning calculation of the sensitivity and speci-ficity of scrotal and transrectal ultrasound in the presentstudy, the radiologist e who was blinded to the results ofbiopsy e was asked not only to collect ultrasound findingsbut also suggest a diagnosis and the nature of azoospermiawhether obstructive or functional in each case on thebasis of the findings of scrotal and transrectal ultrasoundseparately.

Comparing the radiological suggested nature of azoo-spermia e in each ultrasound modality e with the sureresults of histopathologic diagnosis of testicular biopsyallows detecting true and false, positive and negativediagnosis, and consequently the sensitivity and specificityof each technique separately.

Ehab ElGanainy, M.D.Department of Urology

Assiut UniversityAssiut, Egypt

Re: Safwat et al.: Percutaneous SuprapubicStone Extraction for Posterior UrethralStones in Children: Efficacy and Safety(Urology 2013;82:448-450)

TO THE EDITOR:

We read the article with interest and appreciate theauthors for describing the use of minimally invasivetreatment modality in children for posterior urethralstones. We have some comments regarding the study.

The authors have mentioned that in 45 of the 54patients, stone was removed intact with a 3-mm skinincision. The mentioned stone size was ranged from 0.8to 1.9 cm. It is quite difficult to remove a stone of thissize along with flanges of hemostat through a 3 mm skinincision, and forceful retrieval will increase the sizeof incision. In addition, the authors should clarifythat either they attempted for intact removal of stones inall patients or they choose any criteria such as stonesize or hardness for fragmentation. Discussion about themean stone size in patients in whom intact removalwas possible will give a better idea about the cutoff sizeof stones for intact removal by this technique.

Sometimes, in impacted stones, push back of stones inbladder is not possible and in situ fragmentation mightrequire. In the study by Maheshwari and Shah,1 in 18 ofthe 42 patients who presented with symptomatic urethralcalculi, attempted push back was failed.1 They concludethat intracorporeal intraurethral holmium lasertripsy is afeasible, safe, and effective modality for impacted maleurethral stones.1 However, the authors’ approach is a

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