Femoral nerve injury after nephrectomy: A case report.

BACKGROUND: Femoral nerve injury is not a common complication of the abdominopelvic surgical procedures. OBJECTIVE: To present a case of femoral neuropathy after nephrectomy. METHODS: Case report. RESULTS: A 71-year-old female patient with a right-sided congenital hip dysplasia developed numbness, tingling and burning pain in the right thigh and muscle weakness in the right hip after the nephrectomy surgery. Neurological examination and electrodiagnostic test revealed a femoral nerve injury. Prognosis of the femoral neuropathy was good. The quadriceps muscle weakness improved within six months. CONCLUSION: Postoperative femoral neuropathy is an unexpected complication after total nephrectomy surgery. The prognosis is relatively good and early physical therapy can produce rapid recovery.

Does the modified STING method increase the success rate in the management of moderate or high-grade reflux?

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.

Virtual cystoscopy: the evaluation of bladder lesions with computed tomographic virtual cystoscopy.

PURPOSE: Our objective was to assess the accuracy of computed tomographic virtual cystoscopy (CTVC) in the detection of urinary bladder lesions. METHODS: Twenty-five patients were examined using CTVC. Bladder scanned using multislice CT at a slice thickness of 1 mm. The data were transferred to a workstation for interactive navigation using surface rendering. Findings obtained from CTVC were compared with results from conventional cystoscopy and with pathological findings. RESULTS: Thirty-eight lesions were identified. The smallest was 0.2 × 0.3 cm; the largest was 7 × 4.5 cm. Both CTVC and conventional cystoscopy were used. Conventional cystoscopy detected the same number of lesions that were detected by CTVC. On morphological examination, 26 of the lesions were polypoid, 7 were sessile and 5 were bladder wall-thickening. While one of the polypoid lesions was reported as an inverted papilloma, 2 of the 5 lesions that were identified as wall-thickening were malignant and 3 were benign. The sensitivity of using CTVC to identify neoplasias was 100%; the accuracy was 89%. CONCLUSION: Although the definitive diagnosis of some suspected urinary bladder tumours is only possible with conventional cystoscopy and biopsy, CTVC is a minimally invasive technique which provides beneficial information about urinary bladder lesions.

Metabolic evaluation in stone disease metabolic differences between the pediatric and adult patients with stone disease.

OBJECTIVE: To determine the metabolic risk factors in children and adults with stone disease and any differences between the metabolic risk factors of children and adult patients with stone disease. METHODS: Between 1999 and 2007, 285 adults with recurrent stone disease and 71 children with primary or recurrent urinary stone disease underwent metabolic evaluation in our clinic. The evaluation included blood chemistry studies and 24-hour urine collection in the pediatric and adult groups. RESULTS: The mean age of the children was 9.35 years (range: 1-14) and 42.1 years (range: 14-71) in the adult patients. Metabolic risk factors were demonstrated in 90.53% (n = 258) of the adult and 88.73% (n = 63) of the pediatric patients. Although hypercalciuria (50.5%, n = 144) was the most common metabolic risk factor in the adult group, hypocitraturia was the most common metabolic risk factor in the pediatric group (57.74%, n = 41). Furthermore, in the adult group, 136 patients had more than 1 risk factor, and in the pediatric group, 24 patients had more than 1 risk factor. CONCLUSION: Although hypocitraturia is the most common risk factor in pediatric urolithiasis patients and hypercalciuria is the most common risk factor in adult patients, all patients with stone formation should be given a limited metabolic evaluation because such patients may also have a metabolic abnormality.

Ochoa syndrome: a spectrum of urofacial syndrome.

The urofacial syndrome, also known as Ochoa syndrome, is a rare autosomal recessive condition that occurs in both genders and characterized by uropathy and facial abnormalities. Early diagnosis is crucial for the management and prognosis of urinary problems due to a dysfunctional bladder. We report 11 patients with urofacial syndrome in five families from Turkey with a median follow up of 32 months (range, 2-44 months).

Comparison of outcomes for adjustable bulbourethral male sling and artificial urinary sphincter after previous artificial urinary sphincter erosion.

OBJECTIVES: To compare the outcomes of the adjustable bulbourethral male sling and artificial urinary sphincter (AUS) in patients with recurrent postprostatectomy incontinence after previous AUS erosion. METHODS: Sixteen patients with recurrent postprostatectomy incontinence who had undergone either adjustable bulbourethral male sling placement (group 1, n = 8) or AUS implantation (group 2, n = 8) were included in the study. The preoperative evaluations included history, physical examination, International Consultation on Incontinence Questionnaire-short form, pad test, cystoscopy, and urodynamic studies. The follow-up examinations were performed at 1, 3, 6, and 12 months postoperatively and annually thereafter. RESULTS: The mean follow-up was 10 months (range 7-19) and 22 months (range 6-38) for groups 1 and 2, respectively (P = .009). Of the 16 patients, 6 were cured, 1 with the sling and 5 with the AUS (cure was defined as no pads daily); 3 were improved, 1 with the sling and 2 with the AUS (improvement was defined as no more than 2 pads daily), and 7 had treatment failure, 6 with the sling and 1 with the AUS. No intraoperative complication was seen in either group. Readjustment of sling tension was done in 4 patients who had persistent incontinence. No reoperation, excluding the readjustments, was required in group 1; however, 3 patients had transient perineal pain. The AUS was removed for recent erosion at 6 and 12 months postoperatively in 1 cured patient and 1 patient with treatment failure, respectively. Ultimately, 50% of the patients (25% with the sling and 75% with the AUS) were cured or improved. CONCLUSIONS: The results of our study have shown that AUS implantation results in better outcomes than placement of the adjustable bulbourethral male sling as secondary therapy.

Results of varicocelectomy in patients with isolated teratozoospermia.

INTRODUCTION: Isolated teratozoospermia is rarely encountered in patients with clinically palpable varicocele, and the consequences of varicocelectomy remain unclear in these cases. In the current study, we assessed the effect of varicocelectomy on sperm morphology in a series of patients with infertility. MATERIALS AND METHODS: The data obtained from 52 primary subfertile men with isolated teratozoospermia and clinical palpable varicocele were reviewed retrospectively. Varicocelectomy was performed on 29 patients, and the remaining 23 patients did not undergo any treatment (control group). The differences in sperm morphology assessed by using Kruger's strict criteria 3 months before and 12 months after varicocelectomy were taken into consideration for statistical analysis. RESULTS: One patient who underwent varicocelectomy was excluded from the study due to varicocele recurrence. Thus, data obtained from the remaining 28 patients were evaluated. Following varicocelectomy, significant improvement was detected in the ratio of normal sperm forms (p < 0.001). While there was significant improvement in the ratio of sperm cells with head defects, tail defects and immature forms (p < 0.001), the ratio of sperm with acrosome and mid-piece defects was not changed (p > 0.05). While an overall spontaneous pregnancy was achieved in 5 of the 28 (17.8%) couples in the varicocelectomy group within 12 months after operation, neither improvement in sperm morphology nor pregnancy in the patients' partners was detected in the control group. CONCLUSION: Varicocelectomy caused a significant improvement in sperm morphology, particularly in immature forms and forms with head and tail defects evaluated by Kruger's classification.

The association between personal habits and bladder cancer in Turkey.

AIMS: In this study, we analyzed the effect of Turkish coffee and black tea consumption, alcohol intake and smoking on bladder cancer. METHODS: A total of 164 patients with bladder tumors and 324 individuals without primary tumors were included in the study. The habits of coffee and tea consumption, alcohol intake and smoking were queried. RESULTS: No association was found between bladder cancer and drinking coffee (p=0.89) and tea (p=0.37), but alcohol intake was found to be associated, with an odds ratio (OR) of 1.85 (95% CI 1.15-2.96; p=0.009). While there was a relationship between bladder cancer and smoking and quitting smoking (OR: 4.84 [95% CI 2.93-8.00; p<0.001] and OR: 4.10 [95% CI 2.41-6.97; p<0.001] respectively), the associations between bladder cancer and smoking and quitting smoking were similar (OR: 1.18, 95% CI 0.74-1.86; p=0.477). Smoking<10 cigarettes a day created an OR of 2.14 (95% CI 1.11-4.12; p<0.001); 10-20 cigarettes an OR of 4.50 (95% CI 2.74-7.37; p<0.001); >20 cigarettes an OR of 14.85 (95% CI 6.83-32.27; p<0.001); smoking by inhaling the smoke an OR of 4.72 (95% CI 2.94-7.59; p<0.001), and smoking by not inhaling the smoke an OR of 3.34 (95% CI 1.75-6.38; p<0.001). The associations between bladder cancer and inhaling smoke and not inhaling smoke were similar (OR: 1.41, 95% CI 0.85-2.48; p=0.228). CONCLUSION: We found that smoking and alcohol consumption are closely connected with bladder cancer. Our data showed that not inhaling the smoke was as much associated with bladder cancer as inhaling the smoke. The association between smoking and bladder cancer lasts after quitting smoking.

Percutaneous suprapubic cystolithotripsy approach: for whom? Why?

BACKGROUND AND PURPOSE: To evaluate the success and complications of percutaneous suprapubic cystolithotripsy (PCCL) in pediatric and adult patients with neurogenic bladder. PATIENTS AND METHODS: Between 2000 and 2004, 72 patients, all male (30 children aged 2 to 7 years [mean 4.7 years] and 42 spastic paraplegic adults aged 34 to 62 years [mean 53 years]), with sterile urine underwent PCCL under general anesthesia in one sitting. An 18-gauge needle, Amplatz dilatation set, 30F Amplatz sheath, rigid nephroscope, lithotripter (pneumatic, mechanic), and stone forceps were used. Fluoroscopy was not. A suprapubic catheter was placed in the first two patients only. RESULTS: The dimensions of the stones were on average 3.2 cm (range 1-5 cm) for the pediatric patients and 5.5 cm (4-10 cm) for the adult patients. The operating time was 20 minutes (10-35 minutes). In all cases, the stones were taken out. No serious intraoperative or postoperative complications were observed. In all cases, the transurethral catheter was removed on postoperative day 5. No recurrence was observed during the follow-up period (mean 20 months). CONCLUSION: As urethral diameters are narrow in pediatric patients and adult spastic paraplegic patients in whom an endoscopic approach could not be performed, PCCL is a safe alternative with low morbidity and complication rate. The technique is also more advantageous than open surgery with regard to cosmetic outcome and length of the hospital stay.

The midterm success rates of tubularized incised plate urethroplasty in reoperative patients with distal or midpenile hypospadias.

To review the midterm results of tubularized incised plate (TIP) urethroplasty (Snodgrass method) in reoperative patients with distal or midpenile hypospadias. The results of TIP urethroplasty in 37 patients who had previously failed hypospadias repair were reviewed. Of the patients, 21 (56.8%) had coronal, 11 (29.7%) had subcoronal, and 5 (13.5%) had midpenile hypospadias. The mean age was 4.1 (2-16) years. Twenty-three patients had one operation and 14 patients had two operations previously. Of all the patients, 14 did not have a foreskin because of circumcision. The urethral plate had been disturbed in 6 patients, but there was not apparent scarring of the plate. Postoperative follow-up was 2.3 years with a range of 1.1-3.9 years. Genital examination, urethral calibration, and uroflowmetry were performed in control. Satisfaction of the families about the function and appearance of penis was also evaluated. Successful functional and cosmetic results were achieved in 29 patients (78.4%). All the families were happy with penile aesthetic appearance. The urethral plate seemed healthy at the operation in nine patients who had undergone TIP urethroplasty before and the outcomes were successful in eight of them. The operation was successful in 19/23 (82.6%) patients who had undergone one operation before and in 10/14 (71.4%) patients with two operations as well (P < 0.05). In addition, sufficient outcomes were obtained in also 11 of the 14 patients with circumcision. The success rate was higher in patients <5 years (P < 0.05). The rate was also higher during the recent period (2001-2003) since the experience we had increased (P < 0.05). TIP urethroplasty was unsatisfied in four of the six patients who had had disturbed urethral plate before and in five of eight patients who did not have sufficient amount of dartos tissue for flap to cover neourethra. Complication was observed in eight patients (21.6%): four had a pinpoint fistula, two had wound dehiscence, one had meatal stenosis, and one had mild meatal regression and a short neourethral stricture. All of these complications were repaired successfully at a later date. The mean hospital stay was 4.6 days. TIP urethroplasty provides good functional and cosmetic midterm outcomes in most of the reoperative patients with distal or midpenile hypospadias unless contraindicated by previous resection or gross scarring of the urethral plate. This procedure seems not to disturb the urethral plate and, therefore, it can be applied on reoperative patients who had undergone TIP urethroplasty before. It can also be used in a circumcised patient when there is a lack of foreskin.