Comparison of cerebral AVMs in patients undergoing surgical resection with and without prior endovascular embolization.

AIM: Brain arteriovenous malformations (AVMs) are congenital anomalies that present as intracranial hemorrhage or epilepsy. AVMs often remain clinically silent for extended periods. Although AVM treatment methods are controversial, three treatment strategies are usually combined or applied alone: surgical removal, embolization and stereotactic radiosurgery. We compared clinical and radiological outcomes in intracranial AVM patients treated via surgical resection with and without prior embolization. MATERIALS AND METHODS: Patients who did (30 patients) and did not (30 patients) undergo endovascular embolization before surgical resection at the Izmir Katip Çelebi University Atatürk Training and Research Hospital Neurosurgery Clinic from 2011 to 2019 were included in this retrospective, cohort study. Symptoms at diagnosis, comorbidities and clinical (AVM and Spetzler-Martin grade) and morphological characteristics were assessed. RESULTS: A mean one-year follow-up assessed outcomes using the modified Rankin score, and imaging studies assessed AVM obliteration post-procedure. Mean operation times for surgical resection with and without embolization were 166.50 ± 32.02 and 204.47 ± 26.66 min, respectively. Mean patient hospitalization periods for surgical resection with and without embolization were 8.43 ± 3.60 and 12.00 ± 5.51 days, respectively. CONCLUSION: Among patients who underwent surgical resection, significant operation time and hospitalization time differences were observed in favor of patients who underwent embolization, indicating that preoperative embolization is a safe and beneficial method for treating ruptured and non-ruptured AVMs.

Caregiver burden in cerebral palsy: Validity and reliability of the Turkish version of caregiver difficulties scale.

BACKGROUND: This study aims to translate the caregiver difficulties scale (CDS) into Turkish language and to reveal its reliability and validity in Turkish informal family caregivers of children with cerebral palsy (CP). METHODS: This study included 130 participants (39.9 ± 7.8 years; range 24-58 years; 106 females and 24 males). Demographic properties of participants, relationship with the care recipient, income, caregiving time, CP type and diseases of the child (e.g., epilepsy, hydrocephalus and congenital heart disease) and the caregiver were recorded. The CDS, caregiver well-being scale (CWBS), World Health Organization Quality of Life (WHOQOL-BREF) and Beck depression inventory (BDI) were used for data collection. The internal consistency of the CDS was assessed using the calculation of Cronbach's alpha coefficient. A test-retest interval of 2 weeks was used to assess the reliability. The intercorrelation of variables was evaluated using the Spearman correlation coefficient. The receiver operating characteristic (ROC) analysis was performed to find the predictive power of CDS scores for depression. RESULTS: A total of 130 family caregivers of children with CP completed the test/retest procedures. The Cronbach alpha coefficients were found as 0.878 for the test and 0.852 for the retest. Intraclass correlation coefficient (ICC) value was found between 0.83 and 0.90 for test-retest reliability of the CDS. In addition, the CDS showed a significantly strong correlation with CWBS-activities of living subscale and WHOQOL-BREF psychological, physical and environment domains, as well as a significantly moderate correlation with CWBS basic needs subscale, BDI and WHOQOL-BREF general health and social domains. CDS scores that are >46 resulted in a sensitivity of 81.48% and a specificity of 73.79% for moderate-severe depression. CONCLUSION: The Turkish version of the CDS is a valid and reliable measure for caregiver burden of family caregivers of children with CP.

3.0 Tesla MRI scanner evaluation of supratentorial major white matter tracts and central core anatomical structures of postmortem human brain hemispheres fixed by Klingler method.

Background: As an advanced imaging technique for the human brain, the importance of magnetic resonance imaging technique (MRI) is indisputable. The study aims to contribute to the literature by imaging post-mortem human brain hemispheres fixed with the Klinger method through the a 3.0 Tesla MRI Scanner and by defining the supratentorial major white matter tracts and central core anatomical structures.Methods: In our study, 10 post-mortem human brain hemisphere specimens were placed in 10% formalin solution for at least two months according to the Klingler method. The images were obtained using a 3.0 Tesla MRI Scanner. Anatomical structures were described on the T1-T2 axial, coronal, and sagittal MRI sections and compared with control images obtained from healthy humans.Results: Our examination revealed major association fibers, the basal cores and nuclei were denser, and the connections between them were clearly visible. The basal nuclei particularly were visualized more clearly compared with the normal MRI examinations. The claustrum, putamen, lateral and medial part of globus pallidus, and the caudolenticular bridges of the caudate nucleus could be clearly distinguished. The optic radiation line toward the occipital area as well as the forceps major and minor were distinct in the axial sections. Meanwhile, the imaging emphasized the importance of temporal stem, and the fibers it contained were clearly observed in the coronal sections.Conclusion: The use of hemispheres fixed using the Klinger method in post-mortem MRI examinations on brain hemispheres showed a clear separation of white matter fibers and nuclear structures.

Hydrogen Peroxide Sensors Based on Fluorescence Quenching of the 2-AminobenzimidazoleFluorophore.

The fluorescence emission of the parent 2-aminobenzimidazole (ABZ, 1), the mono- and disubstituted derivatives (2, 3), 2-aminonaphthoimidazole (4), and 4-amino dinaphthodiazepine 5 (λem = 315-400 nm) is strongly quenched in the presence of aqueous hydrogen peroxide. The quenching process is dual: for diazepine 5, quenching is dynamic at lower H2O2 concentrations with linear reduction of the fluorescence lifetime from 4.3 to 2.6 ns. At higher H2O2 concentrations, a second species appears in the absorption and emission spectra with fluorescence lifetimes of 1.3 ns, indicating the formation of a new (ground-state) hydrogen-bonded ABZ-H2O2 complex (static quenching). Sensors 1 and 2 show also dual quenching that fits with a static 1:1 and 1:2 model with K1:1 = 8(11) M-1 and K1:2 = 21(147) M-1 for 1(2). The formation of a 1:2 complex (1:(H2O2)2) is also supported by density functional theory (DFT) calculations and spectra simulations.

Craniometric Analysis of Skullbase With Magnetic Resonance Imaging in Patients With Chiari Malformation.

Basilar invagination, Platibasi, increased tentorium angle, and posterior fossa hypoplasia are the anomalies associated with Chiari malformation. When Chiari is symptomatic; tonsillary ectopenia appears to be a definitive criterion for diagnosis and treatment, the detection of additional anomaly may alter the surgical outcome. The aim of this study is to investigate the relationship between tonsillar ectopia and other anomalies.The authors retrospectively reviewed 31 cases which had Chiari Malformation at our Hospital. There were 8 men (25.8%) and 23 female (74.2%). Average age of the samples is 37.93 ±â€Š12.93 years. Seventeen patients (54.8%) had tonsillar ectopia 0 to 5 mm, 14 patients had tonsillar ectopia over 5 mm. Seven patients had syrinx (22.6%), 2 patients had mild hydrocephalus (6.5%). Six patients had surgery for the treatment. The mean length of the clivus was 39.3 mm, supraoksiput length was 40.4 mm, cerebellar hemisphere length was 61.08 mm, Mc Rae line was 33.14 mm, Twinning Line was 79.4mm, and Tentorium-Twinning line angle was 40.35°. There was no significant difference between Tonsillar ectopia, syrinks, and hydrocephalus. Basilar invagination had relationship between platibasi (6 patients had platibasi according to 2 mm criteria, 2 patients had platibasi according to 5 mm criteria (P < 0.05). Patients with syrinx had relationship between Chamberlain line (P < 0.05).In the authors' study, although there was no statistically significant difference between the tonsillary ectopia and the criteria of these anomalies, the relationship between basilar invagination and platibasi was significant.

A very easy technique of stenting for laparoscopic pyeloplasty: penbegul intravenous cannula (PICA) technique.

INTRODUCTION: Double-J stent insertion during laparoscopic pyeloplasty is a difficult and time-consuming process and several techniques were defined to perform a double-J stent with an antegrade approach. In this study we present the technique (PICA) of antegrade double-J placement during laparoscopic pyeloplasty by using 14 gauge intravenous cannula. Surgical technique: After we complete the suturing of the posterior wall of the anastomosis during laparoscopic pyeloplasty, we first puncture the abdominal wall with a 14-gauge "intravenous cannula" from a location that provides most suitable angle for inserting the double-J stent into the ureter. We remove the metal needle of the cannula, and the sheath which has an inner diameter of 5.2F remains over the abdominal wall. The double J stent is then advanced from inside the cannula sheath to the intraperitoneal area; under laparoscopic imaging the stent is gently grasped at its distal end using an atraumatic laparoscopic forceps to insert it into the ureter. The stent is then pulled down to its proximal end, and after the guidewire is removed, the proximal end of the double-J stent is placed inside the renal pelvis with an atraumatic forceps. With this technique we can apply the double-J stent in just one step. Additionaly we can use a 14-gauge IV cannula sheath as a trocar when needed during laparoscopic pyeloplasty to retract an organ or reveal an anastomosis line. COMMENTS: Our new technique of antegrade double-J placement during laparoscopic pyeloplasty by 14 gauge intravenous cannula sheath, is very easy and quick to perform.

Three Dimensional Printing and Biomaterials in the Repairment of Bone Defects; Hydroxyapatite PLA Filaments

Background/aim: Application fields of bone tissue engineering studies continue to expand. New biocompatible materials aimed to improve bone repairment and regeneration of implants are being discovered everyday by scientists, engineers, and surgeons. Our objective in this study is to combine polylactic acid which is a polymer with hydroxyapatite in the repairment of bone defects considering the increased need by medical application fields. Materials and methods: After 750 g of PLA with a diameter of 2.85 mm was granulated into minimum particles, these particles were homogenously mixed with hydroxyapatite prepared in laboratory environment. Using this mixture, HA-PLA filament with a diameter of 2.85 mm was prepared in the extrusion device in Kütahya Medical Sciences University Innovative Technology Laboratory. The temperature was 250 °C and the gearmotor speed was 9 rpm during extrusion. X-ray diffraction (XRD) analysis was made for crystal phase analyses of the produced hydroxyapatite powder, to determine the produced main phase and examine whether a minor phase occurred. Vickers microhardness test was applied on both samples to measure the endurance levels of the samples prepared with HA-PLA filament. A loading force of 10 kg was applied on the samples for 10 s. Results: Hydroxyapatite peaks in XRD spectrum of the sample presented in figures are concordant with Joint Committee on Powder Diffraction Standards, JCPDS - File Card No. 01-075-9526 and no significant minor phase was observed. For both samples, hardness value was observed to increase between 3 and 5 mm. Conclusion: Surfacing hydroxyapatite on metallic materials is possible. By similar logic, to increase durability with low cost, characteristics of biomaterials can be improved with combinations such as hydroxyapatite PLA. Thus, we found that while these materials have usage limitations due to present disadvantages when used alone, it is possible to increase their efficiency and availability through different combinations.

Truncating mutations in TAF4B and ZMYND15 causing recessive azoospermia.

BACKGROUND: Azoospermia is the absence of a measurable level of spermatozoa in the semen. It affects approximately 1% of all men, and the genetic basis of the majority of idiopathic cases is unknown. We investigated two unrelated consanguineous families with idiopathic azoospermia. In family 1, there were three azoospermic brothers and one oligozoospermic brother; and in family 2, there were three azoospermic brothers. Testis biopsy in the brothers in family 2 had led to the diagnosis of maturation arrest in the spermatid stage. METHODS: Candidate disease loci were found via linkage mapping using data from single nucleotide polymorphism genome scans. Exome sequencing was applied to find the variants at the loci. RESULTS: We identified two candidate loci in each family and homozygous truncating mutations p.R611X in TAF4B in family 1 and p.K507Sfs*3 in ZMYND15 in family 2. We did not detect any mutations in these genes in a cohort of 45 azoospermic and 15 oligozoospermic men. Expression studies for ZMYND15 showed that the highest expression was in the testis. CONCLUSIONS: Both genes are known to have roles in spermatogenesis in mice but neither has been studied in humans. To our knowledge, they are the first genes identified for recessive idiopathic spermatogenic failure in men. Assuming that recessive genes for isolated azoospermia are as numerous in men as in mice, each gene is possibly responsible for only a small fraction of all cases.

Association between neuropathic pain, pregabalin treatment, and erectile dysfunction.

INTRODUCTION: The pathophysiology of erectile dysfunction (ED) may be vasculogenic, hormonal, anatomical, neurogenic, drug-induced and/or psychogenic in origin. Neuropathic pain (NP) may facilitate ED, because it is frequently associated with anxiety, depression, and its drug, pregabalin, may also contribute ED. AIM: The objective of this study was to determine whether pregabalin treatment for patients with neuropathic pain promotes erectile dysfunction. METHODS: The study sample consisted of a total of 102 male subjects that were subdivided into three groups. Group 1 patients (n = 31) had a pre-existing diagnosis of NP and was treated with 300 mg/day of pregabalin for at least 3 months. Group 2 patients (n = 34) were diagnosed with NP for at least 3 months; however, neither were they treated with pregabalin nor did they received physical therapy throughout the study. Lastly, healthy age-matched control subjects comprised group 3 (n = 37). MAIN OUTCOME MEASURES: Patients in all groups completed the International Index for Erectile Function (IIEF) questionnaire. RESULTS: Mean age and mean body mass index did not differ significantly between each of the three groups. The cause of NP and the mean duration of having a diagnosis of NP did not differ significantly in groups 1 and 2. However, IIEF scores were significantly lower for group 1 when compared to group 2 in terms of erectile function, orgasmic function, overall satisfaction and total score. Yet groups 1 and 2 did not diverge significantly in the intercourse satisfaction and sexual desire scores. Overall IIEF scores for group 3 were significantly higher than those of group 2 except for mean erectile function scores. CONCLUSION: Taking pregabalin for the treatment of neuropathic pain poses an increased risk for developing ED in male patients. Thus, clinicians prescribing pregabalin to patients diagnosed with neuropathic pain should assess for ED before and during treatment with this medication.

Primitive robotic procedures: automotions for medical liquids in 12th century Asia minor.

In recent years, day by day, robotic surgery applications have increase their role in our medical life. In this article, we reported the discovery of the first primitive robotic applications as automatic machines for the sensitive calculation of liquids such as blood in the literature. Al-Jazari who wrote the book "Elcâmi 'Beyne'l - 'ilm ve'l - 'amel en-nâfi 'fi es-sinaâ 'ti'l - hiyel", lived in Anatolian territory between 1136 and 1206. In this book that was written in the twelfth century, Al-Jazari described nearly fifty graphics of robotic machines and six of them that were designed for medical purposes. We found that some of the robots mentioned in this book are related to medical applications. This book reviews approximately 50 devices, including water clocks, candle clocks, ewers, various automata used for amusement in drink assemblies, automata used for ablution, blood collection tanks, fountains, music devices, devices for water lifting, locks, a protractor, a boat-shaped water clock, and the gate of Diyarbakir City in south-east of Turkey, actually in northern Mesopotamia. We found that automata used for ablution and blood collection tanks were related with medical applications; therefore, we will describe these robots.

Microvascular Decompression for Hemifacial Spasm without the Use of Neuromonitoring and Fix Retraction: A Single-Center Experience.

AIM: To evaluate outcome of patients with hemifacial spasm surgically treated by microvascular decompression without the use of neuromonitoring and fix retraction. MATERIAL AND METHODS: Of the 78 patients with hemifacial spasm operated by the senior author of this study between 2016 and 2020, 60 patients who were followed up were included and retrospectively investigated. The female:male ratio was 32:28, and the mean age was 42.5 ± 11.5 years (range 23?71 years). All the patients were operated via the lateral retrosigmoid suboccipital infrafloccular approach, and no permanent retractor was employed during the procedures. Additionally, intraoperative neuromonitoring was not performed for any of the patients. RESULTS: Single vessel compression was observed in 77% of the patients, whereas 16% and 6% experienced compression in two and three vessels, respectively. Immediate recovery was achieved in 70% of the patients. Half of the remaining 30% fully recovered within 6 months?2 years. Furthermore, the complaints of 5% of the patients were alleviated, whereas no improvement was observed in 10% of the patients. One patient developed a recurrence. CONCLUSION: Microvascular decompression is a highly effective method for the treatment of hemifacial spasm. In this study, we did not resort to intraoperative neuromonitoring and observed that our postoperative complication rates were consistent with the existing literature.

Evaluation of Percutaneous Unilateral Kyphoplasty Results in Osteoporotic Vertebral Compression Fractures Using Individual 3D Printed Guide Template Support.

AIM: To compare the clinical and radiological outcomes of unilateral percutaneous kyphoplasty (PKP) surgeries performed using 3D printing technology in patients with osteoporotic compression fractures to conventional unilateral PKP surgeries. MATERIAL AND METHODS: Patients with acute painful single-level osteoporotic vertebral compression fracture (OVCF) who need surgical treatment were divided into two groups: group A (patients who had 3D template-guided PKP) and group B (patients who conventional PKP). To compare the two surgical procedures, Total Absorbed Radiation Dose (TARD), pre- and postoperative visual analog scale (VAS) scores, and Total Surgery Time (TST) were calculated and compared between groups in both surgical groups. RESULTS: A total of 44 patients with single-level OVCF who were experiencing acute pain were successfully operated on, with 22 patients in each group. TARD (2.6 ± 0.4 mGy vs. 6.1 ± 1.9 mGy, p < 0.05) and TST (12.4 ± 2.6 min vs. 20.2 ± 3.2 min, p < 0.05) differed significantly different between groups A and B. There was no statistically significant difference between the patient groups in preoperative and postoperative VAS values (p > 0.05). Cement leakage was lower in group A (3/22, 13.6%) than in group B (6/22, 27.3%) (p > 0.05). There were no neurological complications or infections in either group. CONCLUSION: When compared to the conventional procedure, the unilateral percutaneous kyphoplasty method was supported by a 3D printing guide template. By reducing operative time and radiation exposure, tt has resulted in a more effective surgical procedure for patients and a safer surgical procedure for surgeons and anaesthesiologists.

Polarity profiling of porous architectures: solvatochromic dye encapsulation in metal-organic frameworks.

Metal-organic frameworks (MOFs) have gathered significant interest due to their tunable porosity leading to diverse potential applications. In this study, we investigate the incorporation of the fluorosolvatochromic dye 2-butyl-5,6-dimethoxyisoindoline-1,3-dione ([double bond, length as m-dash]Phth) into various MOF structures as a means to assess the polarity of these porous materials. As a purely inorganic compound, zeolite Y was tested for comparison. The fluorosolvatochromic behavior of Phth, which manifests as changes in its emission spectra in response to solvent polarity, provides a sensitive probe for characterizing the local environment within the MOF pores. Through systematic variation of the MOF frameworks, we demonstrate the feasibility of using (fluoro-)solvatochromic dyes as probes for assessing the polarity gradients within MOF structures. Additionally, the fluorosolvatochromic response was studied as a function of loading amount. Our findings not only offer insights into the interplay between MOF architecture and guest molecule interactions but also present a promising approach for the rational design and classification of porous materials based on their polarity properties.

The forgotten ureteral stent in children: from diagnosis to treatment.

PURPOSE: We conducted a multicenter pediatric study of ureteral stents unintentionally left in situ. MATERIALS AND METHODS: A total of 22 patients with encrusted Double-J® ureteral stents unintentionally left in situ were treated at 4 centers between January 2007 and March 2012. Stone burdens were estimated using plain radiography and computerized tomography. Treatment decision was made based on clinical and radiological findings or stone burden. RESULTS: Nine girls and 13 boys with a mean age of 9.5 years (range 2 to 16) were analyzed. Mean indwelling time of ureteral stent was 21.7 months (range 6 to 60). Stents were inserted for the indication of urolithiasis (17 patients) and reconstructive urological intervention (5). In 2 patients stents had been placed bilaterally. Mean stent stone burden was 184 mm(2) on plain radiography and 247 mm(2) on computerized tomography, a difference that was statistically significant (p = 0.002). Shock wave lithotripsy was done in 6 cases. Endoscopic procedures were performed in all patients, including ureteroscopy in 8, simple stent removal in 7, endoscopic cystolithotripsy in 6, percutaneous nephrolithotomy in 5, retrograde intrarenal surgery in 3 and percutaneous cystolithotripsy in 2. Surgical removal of each stent required a mean of 1.5 interventions and a mean hospital stay of 4.4 days. CONCLUSIONS: At experienced centers combined endourological techniques can achieve successful and safe management of forgotten stents even in the pediatric age group. Thus, routine preprocedural tomography is a must in children with forgotten ureteral stents.

Sexuality of men with fibromyalgia: what are the factors that cause sexual dysfunction?

The purpose of the present study is to compare male patients with the fibromyalgia syndrome (FMS) with healthy individuals in terms of the sexual function. For the purposes of this study, 37 sexually active male FMS patients and 30 healthy controls were enrolled. The demographic data of the patients were recorded, and the widespread pain observed in FMS was graded with the help of the visual analogue scale (VAS 0-100 mm). Sexual function was assessed according to the international index of erectile function (IIEF) scoring system. The disease-related quality of life was measured with the help of the Short Form-36 quality of life questionnaire (SF-36 QoL). Levels of anxiety and depression observed in the patients were graded through the Hospital Anxiety and Depression Scale (HADS). Patients with FMS had significantly lower scores in each of the five domains of the IIEF in comparison with the healthy control group (p < 0.001). Patients' age and widespread pain were negatively correlated with the IIEF scores (p < 0.05). The SF-36 scores (physical functioning, role limitations due to physical problems, pain and general health perception) were observed to be positively correlated with the IIEF scores (p < 0.05). No significant relationship has been observed between the scores obtained from the domains of IIEF and the psychological status (p > 0.05). FMS leads to an impairment in the sexual function in male patients, which is especially strongly associated with the age, widespread pain and the quality of life.

Importance of Preoperative Vertical Geometric Analysis in Surgery for Anterior Communicating Artery Aneurysm.

OBJECTIVE: In this study, we analyzed the vertical geometry of the anterior communicating artery (AComA) complex with the aim to improve the surgical site orientation during aneurysm operations. Further, the geometric data that can contribute to the success of the surgical technique applied for AComA aneurysms are reported. METHODS: Computed tomography angiography data of the cerebral arteries of 100 patients who visited our clinic were analyzed. A three-dimensional examination was performed according to the Frankfurt horizontal plane (FHP) using the RadiAnt DICOM Viewer (Medixant, Poznan, Poland), and vertical measurements of the AComA complex were calculated. RESULTS: The Willis polygon values were found to be consistent with those in the literature. The mean height of the AComA complex was 30.58 ± 4.80 mm according to the FHP. CONCLUSIONS: Preoperative evaluation of the vertical geometry of the AComA complex is essential for AComA aneurysm surgery. The height of the AComA complex is a key parameter affecting intraoperative surgical site visibility. Preoperative calculation of the height of the AComA complex relative to FHP can facilitate intraoperative surgical site orientation.

Preoperatively, Which Parameter Allows Us to Predict the C5 Palsy After Cervical Open-Door Laminoplasty?

AIM: To uncover factors that can predict the development of C5 palsy before surgery by evaluating several different parameters. MATERIAL AND METHODS: A total of 177 patients who underwent surgery between 2015 and 2020 were included in the study. In total, C5 palsy was observed in 22 (12.4%) of our patients. The radiological and clinical data of the patients were retrospectively analyzed and added to the data. RESULTS: A total of 177 patients who satisfied the criteria were included in the study, among whom 117 (66.1%) and 60 (33.9%) were male and female, respectively. Patients with ossified posterior longitudinal ligament (OPLL) (92; 52.0%) needed surgery the most. C5 palsy developed in 16/92 (17.3%) patients who had surgery for OPLL. This result was statistically significant (p < 0.001). However, a significant difference in the postoperative Pavlov ratio was noted between both groups (p=0.027). The foraminal dimensions for the C5 palsy group were significantly lower than those for the non-C5 palsy group. CONCLUSION: Smaller C5 root foramina diameter measurements were the most important predictive factor for the development of C5 palsy after open-door cervical laminoplasty. Although the pathophysiology remains to be fully understood, ischemia-reperfusion injury supposedly plays a role therein.

Radiation exposure--do urologists take it seriously in Turkey?

PURPOSE: A questionnaire was administered to urologists to evaluate attitudes and behaviors about protection from radiation exposure during fluoroscopy guided endourological procedures. MATERIALS AND METHODS: The questionnaire was e-mailed to 1,482 urologists, including urology residents, specialists and urologists holding all levels of academic degrees, between May and June 2011. The questionnaire administered to study participants was composed of demographic questions, and questions on radiation exposure frequency, and the use of dosimeters and flexible protective clothes. If a respondent reported not using dosimeters or protective clothes, additional questions asked for the reason. RESULTS: Of the 1,482 questionnaires 394 (26.58%) were returned, of which 363 had completed answers. A total of 307 physicians (84.58%) were exposed to ionizing radiation, of whom 79.61% stated that they perform percutaneous nephrolithotomy at the clinic. Fluoroscopy guidance was the initial choice of 96.19% of urologists during percutaneous nephrolithotomy. Despite the common use of lead aprons (75.24%) most urologists did not use dosimeters (73.94%), eyeglasses (76.95%) or gloves (66.67%) while 46.44% always used thyroid shields during fluoroscopy. When asked why they did not use protective clothing, the most common answers were that protective clothes are not ergonomic and not practical. CONCLUSIONS: Results clearly highlight the lack of use of ionizing radiation protection devices and dosimeters during commonly performed fluoroscopy guided endourological procedures among urologists in Turkey.

Treatment of forgotten ureteral stents: how much does it really cost? A cost-effectiveness study in 27 patients.

Aim of study was to present costs of forgotten ureteral stents extraction so as to distract attentions of the urologists on this issue. Medical files of 27 accessible patients who referred to our clinics between 2001 and 2010 because of forgotten ureteral stent were retrospectively analyzed. The indwelling time of double-j stents (DJS) was calculated from the time of its insertion. Costs related to radiological investigations, all invasive, and noninvasive interventions, duration of hospital stay, and medical treatments used were calculated. These estimations were based on 2010 prices determined by Turkey Ministry of Health. Mean age of the patients was 31.2 (8-86 years) years. Mean indwelling time of ureteral DJSs was 36.7 months (14-84 months). Seventy-one [extracorporeal shock wave lithotripsy (ESWL), n = 26; invasive/noninvasive interventions, n = 32] procedures were applied for 27 patients. In six patients without incrustation, after a single session of ESWL DJSs could be removed cystoscopically. A various combination of a multimodal therapy was used for other 21 patients. Total financial burden of 27 patients was US $ 34,300. Cost of treatment was estimated to be 6.9-fold (1.8- to 21-fold) higher than an average timely stent extraction. Financial burden of the treatments increased in parallel with the duration of the stent retention (p = 0.001). Management of forgotten DJS is time consuming, difficult, complicated, risky, and costly. Therefore; financial burden, increased labour loss, and impaired quality of life brought by the application of these modalities must not be forgotten.

The efficacy and safety of ureteroscopy for ureteral calculi in pregnancy: our experience in 32 patients.

The aim of this study was to investigate the efficacy and safety of ureteroscopy (URS) in pregnant women. A retrospective analysis was performed on 32 pregnant patients referred to our center between April 2005 and November 2010 with hydronephrosis requiring surgical intervention. A semirigid URS of 9.5 F was used in all patients. The mean age of patients was 27.8 years (range 20-39), and the mean gestation duration was 24 weeks (15-34). The ultrasound findings were diagnostic of obstructive ureteral calculi in 16 (50%) patients and the mean stone diameter was 8 mm. Spinal anaesthesia was performed in 22 (68.8%) patients, while general anaesthesia was performed in 7 (21.8%) patients. Ureteric stones were found in 27 (84.3%) patients during endoscopy, 10 being distal, 9 middle and 8 proximal. There were no stones in five patients. The stones were fragmented with pneumatic lithotripsy in 8 patients and with holmium laser in 17 patients and the fragments were retracted with forceps. Of the 32 patients, 19 (59.4%) required JJ stent insertion peroperatively. There was no serious complication intraoperatively, while urinary tract infection developed in four and renal colic in two patients postoperatively. In one patient, sepsis developed postoperatively, and improved with appropriate treatment. All babies were born normally. Semirigid ureteroscopy for diagnosing and treating ureteral calculi by intracorporeal pneumatic or holmium laser lithotripsy is a safe and reasonable treatment option for pregnant patients.