Gunshot injuries of the ureter: one centre's 15-year experience.

PURPOSE: Ureteral injury is a rare condition. It is difficult to identify the best diagnostic methods and treatment. We report our experience with penetrating ureteral injuries secondary to gunshot wounds. The methods of diagnosis and treatment options of these cases are described and discussed. MATERIALS AND METHODS: A retrospective review of ureteral injuries due to penetrating trauma between January 1990 and December 2005, in the Urology and General Surgery departments of our hospital. Ureteral injures were graded according to the AAST-OIS. We evaluated mechanism of injury, initial urinalysis, radiologic and operative procedure, associated injuries, and postoperative complications. RESULTS: A total of twenty-one (sixteen male, five female) cases of gunshot ureteral injuries were evaluated retrospectively. The median patient age was 27.85 years (16-48 years). All patients had signs and symptoms of an acute abdomen and only nine patients were evaluated radiologically. Haematuria was absent in 71.4% of patients (15 of 21). All patients had associated injuries and were evaluated from grade I to V. Grade I had none, grade II had 1 (4.76%), grade III had 3 (14.29%), grade IV had 14 (66.6%), grade V had 3 (14.29%). Ureteral stent or nephrostomy tubes were used in all primarily repaired patients. Two patients developed urinary leakage, which resolved spontaneously. CONCLUSIONS: Ureteral injury should always be borne in mind and, when suspected, the surgeon should dissect and visualize the ureter during exploration. Adequate debridment, and ureteral stenting or nephrostomy drainage are good techniques for successful treatment.

Diagnosis of urethral strictures: is retrograde urethrography still necessary?

Different methods are available in the diagnosis and treatment of urethral strictures. True diagnosis is necessary for choosing the most suitable method of treatment and to inform the patient about the method, complications, recurrence rate and costs. In this study we aimed to compare the efficiency, complications and reproducibility of retrograde urethrography with urethroscopy. The retrograde urethrographic (RGU) and urethroscopic findings of 38 male patients were evaluated. Thirty had the same findings with either technique. In 8 patients the RGU was misdiagnosing (p < 0.01). In conclusion, it has been shown that the results of RGU are misleading when it is not combined with urethroscopy and we think that it must not be a routine method in the diagnosis of urethral strictures.

The importance of visual erotic stimulation in the differential diagnosis of erectile impotence.

In this study we aimed to determine the importance of visual erotic stimulation (VES) alone, and in combination with intracavernosal papaverine injection (ICPE) in the differential diagnosis of erectile impotence. Sixty-four patients with erection problems were investigated between June 1992 and January 1994. VES could be the first investigative method in the differential diagnosis of erectile impotence. This will help us in some groups of patients with psychogenic impotence to avoid the application and complications of ICPE. In patients with insufficient erections with VES alone, ICPE must be combined with VES in order to detect the causes of psychogenic erectile impotence more correctly.

The first micturition times of the newborns whose mothers were treated with magnesium sulfate.

BACKGROUND: The aim of this study was to determine whether magnesium sulfate used for the treatment of severe pre-eclampsia or eclampsia had an effect on the first micturition time of the newborn. METHODS: The first group included 20 newborns all of whose mothers had severe pre-eclampsia or eclampsia, and all mothers had been treated with magnesium sulfate according to the Parkland Memorial Hospital eclampsia regimen. The second group included 20 newborns all of whose mothers were normal pregnants, and did not receive any drug that had an effect on the contractility of smooth muscles. The first micturition times of all newborns in two groups were determined following delivery and were compared statistically. RESULTS: All newborns urinated in the first 24 hours. There were no statistically significant differences in the micturition times between the two groups (p > 0.05). There was no residual urine after the first micturition, and none of them had any urinary tract abnormality and neurological pathology. CONCLUSIONS: From the results, it was concluded that magnesium sulfate had no effect on the first micturition time of the newborns, when applied according to the Parkland Memorial Hospital eclampsia regimen in severe pre-eclamptic or eclamptic pregnants.

The effects of GnRH analogues and antiandrogenes in preventing the gonadotoxic effects of COPP chemotherapy.

BACKGROUND: In this study we aimed to discuss whether the gonadal suppression is effective or not in preventing the gonadal toxic effects of some chemotherapeutics. METHODS: Forty Sprague-Dawley adult male rats were randomised into 4 groups, each consisting of 10. No drugs were given to the first group. The second group received GnRH agonist and antiandrogen, the third group received COPP chemotherapy protocol and the last group received COPP together with GnRH agonist and antiandrogen. Ninety days after drug application we sacrificed all rats. Total body weight, testicular weight and testicular size measurements were all recorded. All testicular tissues were examined histologically for the ratio of active seminiferous tubules. RESULTS: There was no difference in total body weight. The weight and measurements of testicular tissues were decreased in-group 3 and 4 when compared with 1 and 2. The amount of active seminiferous tubules was significantly less in the third group. CONCLUSIONS: As a conclusion we think that gonadal suppression applied during chemotherapy regimen could decrease the testicular toxic effects of chemotherapeutic but more clinical investigations needed for routine application.

Congenital anomalies of left renal vein and its clinical importance: a case report and review of literature.

Detailed knowledge of the anatomy and anomalies of renal veins is necessary for retroperitoneal surgery and venographic procedures. According to Thomas (1970, Arch. Surg. 100: 738-740), the anomalies of renal veins are more frequent than estimated. The number of surgical procedures and radiologic examinations related to the retroperitoneum are increasing, and therefore pathologic conditions of the retroperitoneal area have been discussed more frequently. We report on a retroaortic left renal vein joining the left common iliac vein, discuss the embryology and clinical importance of renal vein anomalies, and give an overview on the relevant literature.

Acute side effects of iopromide and diatrizoate in urography.

PURPOSE: In a prospective study, we compared the acute (0-2 h) side effects of ionic and nonionic contrast media in 767 patients undergoing intravenous urography. MATERIAL AND METHODS: A nonionic contrast medium (iopromide) was compared to an ionic contrast medium (diatrizoate). RESULTS: Side effects occurred in 25 patients (7.9%) receiving iopromide and in 104 patients (23.1%) receiving diatrizoate (p < 0.01). The reactions in the iopromide group were mild in 11 patients, moderate in 5, and severe in 1. The reactions were 83, 19 and 2, respectively, in the diatrizoate group. The number of reactions that required treatment was equal in the two groups (p > 0.05). CONCLUSION: At intravenous urography, iopromide induced fewer side effects compared to diatrizoate.

Endoscopic treatment of complete posterior urethral obliteration.

The management of posterior urethral obliteration remains a surgical challenge. We report our experience with 5 patients treated endoscopically for posterior urethral obliteration. We performed endoscopic reconstitution of the urethra followed by temporary self-dilation in five patients with complete short posterior urethral obliteration (less than 3 cm). Average follow-up is 31 months (21-53 months). During follow-up 4 of these patients required 1 or 2 internal urethrotomies within the first 4 to 24 months after treatment. But, any urethral stricture has not been established until the average 23.2 months (21 to 27 months). The other fifth patient has no complication at twenty-first month postoperatively. One patient had impotence after the injury. Impotence continued and total incontinence developed after the endoscopic treatment. We believe that endoscopic treatment followed by temporary self-dilation could be a reasonable alternative to open urethroplasty in patients with an impassable short stricture.