Infections developing in patients undergoing liver transplantation: Recipients of living donors may be more prone to bacterial/fungal infections.

BACKGROUND/AIMS: Despite surgical advances in liver transplantation and effective prophylactic strategies, posttransplant infections are the most important cause of morbidity and mortality. Diagnosis and management of infections because of developing immunosuppression is difficult and adversely affects mortality. This study aimed to review bacterial and fungal infections in patients after liver transplantation and to reveal the resistance rates. MATERIALS AND METHODS: A total of 107 patients who underwent liver transplantation between January 2017 and February 2018 were evaluated retrospectively with regard to demographic characteristics, causes of transplantation, conditions that may lead to infection, postoperative infections, pathogens, and resistance patterns. RESULTS: Of the 107 patients who underwent liver transplantation, 48 (44.8%) had an infection. Bacterial infections were detected in 41% of the patients, and fungal infections were found in 13%. When we compared living and cadaveric transplants in terms of infection development, these rates were found to be 53% and 33%, respectively (p=0.034). No statistically significant results could be obtained when evaluating conditions such as sex, presence of underlying primary disease, Model for End-Stage Liver Disease MELD score, diabetes status, total parenteral nutrition, and risk factors for infection. CONCLUSION: After liver transplantation, infections are often seen in the first month of the postoperative period. Knowing the most common pathogens and resistance states in this process reduces infection-related deaths by providing appropriate treatment regimens at the right time.

Results of 1001 liver transplantations in 23 years: Ege University experience.

BACKGROUND/AIMS: Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. MATERIALS AND METHODS: Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). RESULTS: A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished. CONCLUSION: LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.

Subureteral Injection with Small-Size Dextranomer/Hyaluronic Acid Copolymer: Is It Really Efficient?

The aim of this study was to evaluate the clinical results of patients with vesicoureteral reflux, which were treated with subureteral injection of small-size (80-120 µm) dextranomer/hyaluronic acid copolymer (Dx/HA). Data of 75 children (105 renal units) who underwent STING procedure with small-size Dx/HA for the treatment of vesicoureteral reflux (VUR) in our clinic between 2008 and 2012 were retrospectively analyzed. Preoperative reflux grade and side, injection indication, postoperative urinary infections and urinary symptoms, voiding cystourethrogram, and renal scintigraphy results were evaluated. The success rate of the procedure was 100% in patients with grades 1 and 2 reflux, 91% in patients with grade 3 reflux, and 82.6% in patients with grade 4. Overall success rate of the treated patients was 97%. Endoscopic subureteric injection with Dx/HA procedure has become a reasonable minimally invasive alternative technique to open surgery, long-term antibiotic prophylaxis, and surveillance modalities in treatment of VUR in terms of easy application, low costs and complication rates, and high success rates. Injection material composed of small-size dextranomer microspheres seems superior to normal size Dx/HA, together with offering similar success with low cost.

Does the Intensity of Cutting Power Affect Postoperative Symptoms During Transurethral Resection with a Monopolar System?

The aim of this study was to investigate the effect of intensity of cutting power on postoperative symptoms after transurethral resection (TURP) with a monopolar system for benign prostatic hyperplasia. One hundred thirty-six men with benign prostatic obstructions undergoing elective transurethral prostatectomy were enrolled in the study. Patients were divided into three groups according to the intensity of cutting power. The cutting power intensities were 80-119 W for group 1, 120-159 W for group 2, and 160-200 W for group 3, respectively. In the postoperative period, patients were evaluated with International Prostate Symptom Score (IPSS) and quality-of-life (QoL) questionnaires. In the postoperative period, maximal flow rate (Q max), and post-voiding residue (PVR) were significantly improved in patients who had monopolar TURP performed. When compared to the other groups, the IPSS score was found to be significantly higher in group 3 at 3, 4, and 8 weeks. In addition, the QoL assessment scores for group 3 were superior at 3 weeks. The improvements of Q max and PVR were similar among the three groups (p < 0.0001). At the end of 3 months, IPSS and QoL were significantly improved in all groups. The intensity of cutting power during prostate resection with a monopolar system may affect the postoperative improvements and symptoms.

Ureteroscopy: the first-line treatment for distally located ureteral stones smaller than 10 mm.

PURPOSE: To compare the efficacy of different treatment strategies for distal ureteral stones smaller than 10 mm. MATERIAL AND METHODS: A total 127 patient were included in the study. Based on the treatment modality , patients were divided into three groups.Patients in group 1 only received conventional treatment including daily hydration of 2500 mL, ciprofloxacin, diclofenac sodium and a spasmolytic agent; group 2 patients received conventional treatment (daily hydration of 2500 mL, ciprofloxacin, diclofenac sodium and a spasmolytic agent) and tamsulosin 0.4 mg orally daily for 4 weeks; and group 3 patients underwent ureteroscopy. Patients were further subdivided into 2 categories based on maximum stone diameter: category A (less than 5 mm) and category B (5.0-9.9 mm). Following treatment, all groups were compared in terms of stone-free rate and time to expulsion. RESULTS: Following treatment, the stone-free rates for groups 1, 2 and 3 were 48.7%, 59.5% and 95.6%, respectively (P < .0001).The mean expulsion times for groups 1, 2 and 3 were 15.3 ± 5.33, 15.1 ± 5.5 and 1.95 ± 2.2 days, respectively (P < .001). Compared to the other treatments, the stone-free rate and mean expulsion time in the ureteroscopy group were significantly increased and decreased, respectively. CONCLUSION: There are several treatment options for distal ureteral stones. Based on our data,we conclude that ureterorenoscopy should be the standard of care for distal ureteral stones smaller than 10 mm.

Neurofibromatosis type 1 with bladder involvement.

Neurofibromatosis type 1 is an autosomal dominant transmitted disease with various clinical manifestations. The bladder is the most commonly affected organ in the genitourinary system. The malignant transformation of the disease is rare, and unlike malign tumors, the treatment option for benign disease is usually conservative. The size and localization of the mass determine the symptoms, most of which are usually not specific. In this paper, we aim to present a 15-year-old patient with neurofibromatosis type 1 with bladder involvement. The clinical presentation and treatment options of this disease are discussed in the light of the literature.

The use of titanium ligation clips in microsurgical subinguinal varicocelectomy.

OBJECTIVE: The aim of this study is to evaluate the use of titanium ligation clips for dilated spermatic veins in microsurgical subinguinal varicocelectomy. MATERIAL AND METHODS: In this retrospective study, eighty-four men with clinical varicocele underwent microsurgical varicocele repair. The patients were divided into two groups according to the ligation materials used for the varicocelectomy (silk sutures vs. titanium clips). Group 1 included 43 patients; these patients underwent microsurgical subinguinal varicocelectomy with the titanium clips. The 41 patients included in Group 2 underwent microsurgical subinguinal varicocelectomy with silk sutures. Microsurgical subinguinal varicocelectomy was performed in all patients. The two study groups were compared in terms of intra-operative and postoperative parameters. RESULTS: The mean age of the patients was 28.6±4.6 years, and the mean follow-up was 12.3±2.7 months. The two groups exhibited comparable improvements in sperm motility and/or concentration: 79.1% and 82.9% in Group 1 and Group 2, respectively (p>0.05). The operation time in Group 1 (titanium clip) was significantly shorter than in Group 2 (silk sutures). None of the patients experienced any intra-operative complications. There were no significant differences between Group 1 and Group 2 with regard to postoperative recurrences, ligated veins, postoperative complications and hydrocele formation, hospitalization time, the requirement for postoperative analgesia or the time until the patient could return to work. CONCLUSION: Titanium ligation clips can be used for the ligation of dilated vessels during microsurgical subinguinal varicocelectomy, and the operation time is significantly reduced with the use of titanium ligation clips.

The effect of microsurgical varicocelectomy on semen parameters in men with non-obstructive azoospermia.

INTRODUCTION: The aim of this study was to evaluate the effect of microsurgical subinguinal varicocelectomy on semen parameters in azoospermic men with clinical varicocele and to determine the predictive parameters of postoperative improvement. METHODS: Twenty-three men with non-obstructive complete azoospermia and varicocele underwent subinguinal open microsurgical varicocele repair. The outcome was assessed in terms of improvement in semen parameters after surgical repair for varicocelectomy. RESULTS: Bilateral varicocelectomy was performed on 15 patients and unilateral (left) varicocelectomy was performed on 8 patients. In the post-operative period, of the 23 patients, 7 (30.4%) had motile sperm in the ejaculate. The mean sperm concentration of these patients was 1.34 ± 2.6 × 10(6)/ml and the mean total sperm motility was 37.5 ± 15.5%. CONCLUSION: Infertile men with non-obstructive azospermia can have improvement in semen analysis after subinguinal microsurgical repair of varicoceles. Motile sperm in ejaculate were detected after microsurgical varicocele repair.

Repair of hypospadiac urethral duplication with dismembered urethroplasty.

Urethral duplication is a complex and rarely seen anomaly with three anatomic variants: epispadiac (dorsal), hypospadiac (ventral) and Y-type. Here we report an 11-year-old male patient with hypospadiac urethral duplication who presented with daytime urinary incontinence and dribbling, urethral stricture and possible obstructive uropathy. After endoscopic treatment of the stricture in the ventral (dominant) urethra, urethral reconstruction was done anastomosing the ventral (dominant) and dorsal (non-dominant atretic urethra) in a dismembered fashion.

Minimally invasive treatment of ureteral calculi in children.

A retrospective analysis was done to determine the efficacy of shock wave lithotripsy (SWL) and ureteroscopy in the treatment of paediatric ureteral calculi. We reviewed the records of 67 (35 boys, 32 girls) children (71 ureters) admitted to our clinic for treatment of ureteral calculi during 1990-2005. The initial treatment method was SWL in 80.3% (57 ureters), ureteroscopy in 11.3% (eight ureters) and open surgery in 8.5% (six ureters) of the renal units. The mean age of the patients was 10.67 +/- 4.4(1-16) years. The stone-free rates after SWL for upper, middle and lower ureteral calculi were 74.1, 100 and 75.9%, respectively. Increased stone diameter (P = 0.014) and/or burden (P = 0.002) were found to be significant factors that had an adverse affect on the stone-free rate after SWL while the success rates of SWL were independent of location. Including six patients (seven ureters) with failed SWL, a total of 14 patients (15 renal units) subjected to ureteroscopy for lower ureteral calculi yielded a stone-free rate of 93.3%. Thus, the overall stone-free rates after SWL, ureteroscopy and open surgery were found to be 75.4, 93.3 and 100%, respectively. Depending on the stone burden, SWL might be a good option for initial treatment of most ureteral calculi in children. Ureteroscopy offers a high success rate for lower ureteral calculi, including SWL failures.

Factors affecting the success rate of extracorporeal shock wave lithotripsy for renal calculi in children.

The aim of the study was to analyse factors affecting the success rate of extracorporeal shock wave lithotripsy (ESWL) in children with renal calculi. We performed a retrospective analysis reviewing records of 85 (40 female, 45 male) children (89 renal units) subjected to ESWL for treatment of renal calculi during 1990-2005 in our department. As 4 patients had bilateral calculi and 19 children (21 renal units) had renal stones at more than one different site, each location was analysed separately for convenience. The mean age of the patients was 10.3+/-4.6 (2-16) years. The stone-free rates for renal pelvis, lower, middle and upper caliceal calculi were 70, 62, 50 and 73%, respectively. A higher rate (33%) of insignificant fragments (< or = 4 mm) was noted for lower pole calculi. Increased stone diameter (P=0.0001) and burden (P=0.04) were found as the most significant factors that adversely affect the stone-free rate for pelvis renalis calculi, whereas an acutely oriented infundibulum and/or a long lower infundibulum (P=0.005) were unfavourable factors for clearance of lower caliceal stones. The stone-free rate in children with multiple calculi was 48%, while 29% of the renal units had retained fragments. ESWL is a good initial option for treatment of most of the renal calculi < 2 cm except in the presence of unfavourable lower caliceal anatomy. Increased stone burden, multiple stones, staghorn calculi, narrow lower infundibulopelvic angle and long lower infundibulum are factors that adversely affect the clearance rate.

Case report: Incidental primary transitional cell carcinoma of the prostate treated with transurethral prostatectomy only.

A 65-year-old man presented with a history of painless gross hematuria and severe obstructive symptoms. Abdominal ultrasonography and intravenous urogram revealed the absence of any disease in the urinary tract except benign prostatic hyperplasia. He underwent a transurethral resection of the prostate and was found to have incidental primary transitional cell carcinoma of the prostatic ducts localized to the gland. Radical cystoprostatectomy was offered but the patient was hypertensive, had a history of cerebrovascular accident and refused another major operation. Since also his general condition was not good enough for further therapy, he was treated with transurethral prostatectomy only. After 16 months he is still alive and free of disease.

Papillary adenoma of the prostatic urethra: report of two cases.

Papillary adenoma of the prostatic urethra is a rare cause of hematuria, hemospermia and lower urinary tract obstruction, especially in young adults. We report two cases of papillary adenoma and their endoscopic views. One of the patients had a lesion located on the verumontanum and presented with hematuria, hemospermia and symptoms of lower urinary tract obstruction. The other patient had papillary lesions located in the paramontanal gutter and presented with persistent painless hematuria. The origin of both lesions was proven to be prostatic epithelial differentiation using immunohistochemical identification of prostate-specific antigen. Papillary adenoma is believed to be benign, therefore, both lesions were carefully excised and fulgurated transurethrally.

The impact of radiological anatomy in clearance of lower calyceal stones after shock wave lithotripsy in paediatric patients.

OBJECTIVE: To determine the factors affecting stone clearance after extracorporeal shock wave lithotripsy (ESWL) in children with lower calyceal stones. MATERIALS AND METHODS: Lower pole stone clearance was reviewed in 34 patients aged between 2 and 16 years (23 boys and 11 girls) treated with ESWL between 1989 and 2001 in our clinic. Renal anatomy was determined on standard intravenous urograms. The lower infundibulopelvic angle (IPA) was measured by two different methods based either on measuring the angle between vertical pelvis axis and vertical axis of lower infundibulum or finding the angle between the ureteropelvic axis and vertical axis of lower infundibulum. RESULTS: The mean age of the patients was 12.1+/-4.16 (2-16) years. The mean stone burden was found as 96.93+/-87.13 mm(2) and the mean shock wave number per session and power as 2631.4+/-593.1 and 17.57+/-1.1 kV, respectively. The stone-free rate was 55.9%. Fifteen (44.1%) cases had residual fragments retained in lower calices after lithotripsy and are still followed. The stone clearance was found to be unrelated to stone burden and infundibulum width (p=0.44 and p=0.34, respectively). However, a significant difference was present between mean lower pole infundibular length (p=0.0032) and lower IPA measurements according to both methods between stone-free cases and others. The most remarkable factor that had a significant influence on stone clearance was an acutely oriented infundibulum defined according to IPA-ureteropelvic axis angle determination method (p=0.00001) followed by Sampaio's pelvic axis method (p=0.0001). Only 1 (5%) patient was stone-free under 40 degrees and 1 (6%) case with an angle of 45 degrees had residual fragments in the former method. Similarly none of the cases had residual fragments over 90 degrees for Sampaio's method and 90% of the stone-free cases had a more obtuse angle. Thus, we determined that a cut-off point of 40 degrees for the IPA-ureteropelvic axis method and 90 degrees for Sampaio's method was most useful to determine the clearance of lower pole fragments. CONCLUSION: The factors affecting stone clearance in paediatric patients are similar to adults.

Urethral coitus and urinary incontinence in a case of Mayer-Rokitansky syndrome: an alternative surgical procedure.

A patient with vaginal agenesis presented with complaints of urethral damage due to urethral coitus. We performed a urethrospincteric reconstruction and formation of a new vagina using the bladder flap and the urethra which was used for coitus, respectively. To the best of our knowledge, this is the first report of this procedure.

Analysis of the trace element contents of inner nucleus and outer crust parts of urinary calculi.

In this study, the lead, cadmium, nickel, and aluminum concentrations were analyzed in inner nucleus and outer crust parts of various kinds of urinary calculi, and the results obtained were statistically compared. Significant differences were found among the element concentrations in the different stone groups. In general, higher element concentrations were found in the nuclei as compared with the crust parts. In addition, some significant intra- and intercorrelations were established among the elements analyzed. The results suggest that some trace elements, including lead, cadmium, nickel, and aluminum, together with other factors may have as yet no clarified functions in the stone precipitation process in the urinary tract.