Does being performed by urologist or gynecologist affect the outcomes of women who have had sacrocolpopexy?

OBJECTIVE: To compare the outcomes of women who underwent abdominal sacrocolpopexy (ASC) by urologist and gynecologist. STUDY DESIGN: A total of 61 women underwent transabdominal sacrocolpopexy, with 31 by a urologist (Group 1) and 30 by a gynecologist (Group 2). The patients were presented with symptomatic pelvic organ prolapse (POP). The results were evaluated with Baden-Walker system and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) to assess anatomical and continence outcomes. Postoperative complications were documented based on the Dindo and Clavien Classification. Statistical analyses were done using Mann-Whitney U test and Fisher's exact test with SPSS version 21.0. RESULTS: The mean follow-up time was 21.4 (12-36) and 21.8 (12-36) months for Group 1 and Group 2, respectively (p = 0.72). The mean estimated blood loss and length of hospitalization were similar in both groups. The success rates were; 93.5% for Group 1 and 93.3% for Group 2 (p = 0.89). There was no difference in complication rates between the two groups (p > 0.05). CONCLUSION: The fact that it was administered by gynocologist or urologist does not affect the outcomes of sacrocolpopexy surgery. Similar success and complication rates were found in the patients for both groups.

The surgical technique and initial outcomes of Anatolian neobladder: a novel technique of ileal neobladder after radical cystectomy.

BACKGROUND: We describe a detailed novel step-by-step approach for creation of an ileal neobladder and compare the outcomes with standart neobladder. METHODS: Between August 2009 and January 2016, 36 consecutive patients with bladder cancer underwent radical cystectomy and orthotopic urinary diversion with an ileal neobladder. A novel technique of ileal neobladder construction, called the Anatolian neobladder, was designed by a single surgeon (ZT). Demographics and clinical data were collected. Perioperative, oncologic, and functional outcomes were reported. Complications were graded as early or late. These outcomes were compared with patients who underwent standard neobladder during this period in our center. RESULTS: The operation was technically successful in all cases. Early postoperative complications occurred in 33.3% of the patients. Daytime continence was achieved successfully in 83.3% of the patients. No patient had severe metabolic acidosis. Six patients (16.6%) died during follow-up, five due to metastatic bladder cancer and one due to a cardiac problem. There was no any statistically significant difference between novel technique and standard neobladder for oncological and functional outcomes. CONCLUSIONS: The Anatolian ileal neobladder is as feasible and safe as standard neobladder technique for urinary diversion in patients with bladder cancer undergoing radical cystectomy.

Urologic health condition of spinal cord-injured patients living in Turkey.

OBJECTIVES: To determine the urologic health condition of spinal cord-injured (SCI) patients living in Turkey, and to analyze the relationship between the prevalence of urologic health condition parameters and the patient's characteristics. METHODS: Telephone call survey was conducted with a structured questionnaire among all members of Turkish Society of Spinal Cord Injured Patients. RESULTS: Data were obtained from 300 patients. Mean age was 42 years with a male/female ratio of 2.3, while the most common cause of injury was transport (35.3%). Although 70% were aware of potential kidney and bladder problems after injury >60% of the patients were not under regular urologic follow-up. Secondary health problems experienced as being most important was urination problems (50%). Of the patients 72.7% (83% in females vs 68% in males) had urinary incontinence (UI) during last 3 months, and 64.3% used clean intermittent catheterization (CIC) (68% in males vs. 56% in females), while 73%, 57% and 26% of incontinent patients used diaper/pad, medication and condom catheter, respectively, and the use of CIC decreased with time. Surgical procedures on urinary tract were performed in 22.6% of the patients; stone surgeries were the most frequent ones. CONCLUSION: This study demonstrated that the UI rate was high among SCI patients, and more common in females with fairly good proportion of patients using incontinence medication. Main bladder management method was CIC and more prevalent in males, although the use of CIC decreased with time. Urinary stone surgery was the leading surgical procedure.

Indomethacin-induced morphologic changes in the rat urinary bladder epithelium.

OBJECTIVES: To evaluate the morphologic changes in rat urothelium induced by indomethacin. Nonsteroidal anti-inflammatory drug-induced cystitis is a poorly recognized and under-reported condition. In addition to tiaprofenic acid, indomethacin has been reported to be associated with this condition. METHODS: Three groups were established: a control group (n = 10), a high-dose group (n = 10), treated with one intraperitoneal injection of indomethacin 20 mg/kg, and a therapeutic dose group (n = 10) in which oral indomethacin was administered 3.25 mg/kg body weight daily for 3 weeks. The animals were then killed and the bladders removed for light and electron microscopic studies. RESULTS: The light microscopic findings showed some focal epithelial degeneration that was more prominent in the high-dose group. When compared with the control group, both indomethacin groups revealed statistically increased numbers of mast cells in the mucosa (P <0.0001) and penetration of lanthanum nitrate through intercellular areas of the epithelium. Furthermore, the difference in mast cell counts between the high and therapeutic dose groups was also statistically significant (P <0.0001). CONCLUSIONS: Indomethacin resulted in histopathologic findings typical of interstitial cystitis, such as leaky bladder epithelium and mucosal mastocytosis. The true incidence of nonsteroidal anti-inflammatory drug-induced cystitis in humans must be clarified by prospective clinical trials.

Early histological changes of ileal mucosa after augmentation cystoplasty.

Segments of bowel are used routinely for transplantation in various pathological conditions such as contracted bladders or poorly compliant neuropathic bladders. However, little is known how these intestinal segments adopt to a toxic environment caused by urine. Therefore, the present study was performed to determine early histological changes of ileal mucosa after augmentation cystoplasty. Seven patients with augmentation cystoplasty underwent random cold-cup biopsies of ileal segments after a mean period of 14.4 months after cystoplasty and morphological changes were evaluated using light microscopy and transmission and scanning electron microscopy. Most pronounced features were varying degrees of villous atrophy, increased numbers of Paneth and goblet cells. Severity of atrophic villous changes were not related to the length of the interval between surgery and endoscopic biopsy. These findings may be explained as adaptations of bowel tissue to counteract noxious effects of urine and to maintain its epithelial function in the bladder.

Unusual cause of early preeclampsia: bladder paraganglioma.

Ten to twenty percent of paragangliomas occur at extra-adrenal locations and less than 1% are at the urinary bladder. The most common presenting symptom of bladder paraganglioma is hypertensive attacks precipitated by micturition and hematuria. Paraganglioma of the urinary bladder occurring at pregnancy is extremely rare. We present a case of bladder paraganglioma as an unusual cause of early preeclampsia. After termination of the pregnancy, surgical resection was performed and the histopathologic diagnosis of paraganglioma confirmed. At 24 months of follow-up the patient felt well and was normotensive without any foci of paraganglioma. Although rare, paraganglioma must be considered in the differential diagnosis of early preeclampsia.

Long-term results of Burch colposuspension.

BACKGROUND: We aimed to determine the long-term results of Burch colposuspension. METHODS: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow-up charts were retrospectively reviewed from the patients' files. RESULTS: Mean follow-up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre-operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti-incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction. CONCLUSIONS: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI.

Reconstructive surgery in voiding dysfunction: experience with 69 patients.

OBJECTIVES: To present our reconstructive surgery experience with voiding dysfunction due to both neurologic and non-neurologic etiology. METHODS: From March 1993 to January 2000, 69 patients (43 men and 26 women) with voiding dysfunction underwent lower urinary tract reconstruction. Mean patient age at the time of surgery was 34. 5 years (range 9 to 75). Voiding dysfunction had a neurologic etiology in 65.2% of the patients and a non-neurologic etiology in 34.8%. Urodynamic investigation revealed poor bladder compliance in 52%, detrusor hyperreflexia in 19%, and a combination of the two in 29% of the patients. Thirteen patients (19%) had coexistent intrinsic sphincteric deficiency. A total of 56.5% of the patients had upper urinary tract deterioration. Most patients (78%) had severe urinary incontinence. Augmentation cystoplasty was performed in 60 patients. Nine patients had augmentation cystoplasty with a continent stoma. Concomitant procedures were performed in 11 patients. RESULTS: Mean follow-up was 36.6 months (range 8 to 108). Marked improvement of the upper tracts was documented in 79% of the patients in the neuropathic and 73% in the non-neuropathic group. High continence rates were achieved in both groups (82% and 94%, respectively). Intermittent catheterization rate was 88.6% in the neuropathic and 44% in the non-neuropathic groups and patient satisfaction rate was 84% and 94%, respectively. Three major complications in 2 patients required surgery. CONCLUSIONS: Surgical reconstruction to treat urinary incontinence and upper urinary tract deterioration gives satisfactory results in voiding dysfunction in the case of medical treatment failure.

Application of continent retubularized ileal stoma (Monti procedure) to an ileocecal pouch.

We describe the application of a retubularized ileal stoma (Monti procedure) to an ileocecal pouch in a patient with a spinal cord injury who required a continent urinary diversion. When constructing a continent diversion with an ileocecal pouch, this technique seems a good choice, with significant advantages over the other alternatives.

Bladder involvement in Behçet's syndrome.

PURPOSE: We report our clinical experience with Behçet's syndrome and bladder involvement. MATERIALS AND METHODS: From April 1991 through July 1996, 7 men and 1 woman 25 to 53 years old with Behçet's syndrome were evaluated for lower urinary tract symptoms (7) or hematuria (1). Of 8 patients 5 had neurological involvement. Evaluation consisted of history, physical examination, urinalysis and urine culture, excretory urography, urodynamic studies, urethrocystoscopy, bladder biopsies and histopathological examination. RESULTS: Cystoscopy revealed bladder ulcer in 1 patient and an indurated, hypervascular lesion in another with bilateral hydronephrosis. The most common urodynamic finding was detrusor overactivity. Of 4 patients with poor compliance 1 had additional sphincteric deficiency. Common histopathological features were moderate and marked thickening of bladder vessel walls. Lymphocytic vascular reaction was present in 2 patients and lymphocytic vasculitis in 1. Clamshell augmentation ileocystoplasty was performed in 3 patients, including 1 who also underwent a sphincter enhancement procedure. The remaining 5 patients received various nonsurgical treatment. CONCLUSIONS: Various types of voiding dysfunction relating to bladder and sphincteric components in both phases of micturition can be seen in Behçet's syndrome. Voiding dysfunction can be due to either neurological or direct bladder involvement. Augmentation ileocystoplasty is a good treatment option for Behçet's syndrome with severe bladder involvement.

Urologic screening for men with Behçet's syndrome.

OBJECTIVES: To establish the urologic status of men with Behcet's syndrome, because studies assessing the urologic aspect of Behçet's syndrome are rare. METHODS: During a 2.5-year period, we evaluated 104 male patients with Behçet's syndrome, 16 to 50 years old (mean 31+/-7), using a urologic questionnaire and modified Boyarsky symptom score; 44 healthy men, 20 to 46 years old (mean 29+/-7), were used as control subjects. RESULTS: The frequency of epididymitis in patients with Behçet's syndrome was 19.2% in this study. The mean irritative symptom score was 1.22+/-1.37 (significantly higher than the control group). The frequency of lower urinary tract symptoms (eg, dysuria, urgency, nocturia, terminal dribbling, and intermittency) was significantly higher in patients with Behcet's syndrome. CONCLUSIONS: In this study, the frequency of epididymitis in men with Behcet's syndrome was much higher than previously reported. Because some lower urinary tract symptoms were significantly more frequent in these patients, we conclude that screening of such patients with urologic questionnaire and symptom scoring is essential to identify those who need further urologic evaluation.

Incorporation of a fluorocarbon polymer implanted at the posterior surface of the rabbit cornea.

An implant of porous expanded polytetrafluoroethylene (PTFE) in the corneal stroma allows fast cell colonization and can become translucent. We studied the behavior of the same polymer implanted in the anterior chamber of the rabbit eye and sutured to the posterior surface of the cornea. The expanded tetrafluoroethylene was provided as 200-micron thick sheets in 3 pore diameters (20, 50 and 80 microns). Disks (5 mm) were implanted in the anterior chambers of 20 rabbits and sutured to the posterior surface of the cornea. Histological and ultrastructural studies were performed after 3 and 4 months. Quantimetry was done on TEM images to analyze the fibrillar structure of the intercellular matrix inside and around the implanted polymer. The material was well tolerated. In all cases there was mild central corneal edema, which disappeared after 1 month. Mild neovascularization occurred in five cases, decreasing after 1 month. The polymer became translucent after 8 days. Keratocytes from the corneal stroma colonized the implant via breaks in the Descemet's membrane along the sutures. Quantimetry showed three types of fibrils inside and beside the polymer. Corneal endothelial cells regenerated over the fibroblasts and the polymer. This fluorocarbon polymer implanted in the anterior chamber and sutured to the posterior surface of the cornea was well tolerated, and there was real incorporation, with keratocytes producing collagen fibrils inside the polymer and endothelial cells forming a posterior cell monolayer. This is promising for the development of a keratoprothesis with posterior fixation.

Update evaluation of benign prostatic hyperplasia: when should we offer prostatectomy?

OBJECTIVE: To investigate correlations between traditional and urodynamic criteria in the evaluation of prostatism and to try to establish an update evaluation of patients with benign prostatic hyperplasia (BPH) with the aim of preventing unnecessary prostatectomies. PATIENTS AND METHODS: The series constituted 96 patients aged 43-86 years (mean 63.41 +/- 9.25) with prostatism and BPH. All were assessed by symptom analysis, digital rectal examination, residual urine determination, uroflowmetry and further multichannel urodynamic testing (medium fill cystometry, pressure flow study). RESULTS: Residual urine determination was not a reliable criterion for selection of patients for surgery. A striking statistically significant correlation was evident when symptomatology and the results from multichannel urodynamic study were compared. No correlation was found between irritative symptoms and detrusor instability. CONCLUSION: A significant proportion (23%) of the whole patient population was classified as a urodynamically unobstructed group to which we think prostatectomy should not be offered. We recommend that a pressure-flow study is performed in all patients with BPH with dominant irritative symptoms to identify those who are unobstructed.

[Ocular lesions related to pellet pistols. Epidemiologic study of 160 patients]. / Lésions oculaires par pistolet à grenailles. Etude épidémiologique de 160 patients.

We present a retrospective study of ocular trauma related to pellet guns. During 5 years, 160 such patients were seen in our emergency unit. 80% of cases were men, and range age was 28 years. Ocular trauma circumstances was a fight in 85%. Ocular trauma was unilateral in 109 patients, and bilateral in 51 patients. We observed a complete disorganisation of the eye in 8 eyes, intraocular foreign bodies in 71 eyes, intraorbital foreign bodies without ocular lacerations in 23 eyes, and blunt trauma in 108 eyes. Final vision is poor or absent in 31 eyes.

[Ocular lesions caused by pellet guns. Epidemiological study on 160 patients]. / Lésions oculaires par pistolet à grenailles. Etude épidémiologique de 160 patients.

We present a retrospective study of ocular trauma related to pellet guns. Over a period of 5 years, 160 such patients were seen in our emergency unit. Eighty per cent of cases were men, with a mean age of 28 years. Ocular trauma was due to a fight in 85%. Ocular trauma was unilateral in 109 patients, and bilateral in 51 patients. We observed a complete disorganisation of the eye in 8 eyes, intraocular foreign bodies in 71 eyes, intraorbital foreign bodies without ocular lacerations in 23 eyes, and blunt trauma in 108 eyes. Final vision was poor or absent in 31 eyes.

[Spontaneous rupture of the ureter]. / Die Spontanruptur des Harnleiters.

It is reported on two cases with spontaneous rupture of the ureter. On checking the literature etiology, pathogenesis as well as diagnosis and treatment are discussed.