Semi-rigid ureterorenoscopy in children without ureteral dilatation.

OBJECTIVES: We aimed to retrospectively review the efficiency of ureterorenoscopy (URS) applied without ureteral dilatation for evaluating pediatric ureteral pathologies. METHODS: The files of pediatric patients hospitalized in our clinic between January 2000 and June 2006 due to ureteral stone disease were reviewed and evaluated retrospectively. The ages, medical histories, physical examination results, preoperative routine blood and urinary tests, and culture results were recorded. Ureteral orifice dilatation was not needed in any of the patients. Due to the risk of mucosal trauma and edema development in the ureteral orifice and intramural ureter, 3F and 4F catheters were applied in all patients following the ureterorenoscopy. These catheters were removed 24 h after the procedure. RESULTS: The files of 54 pediatric patients with a mean age of 8.5 years (range 1-16 years) were evaluated retrospectively. While diagnostic URS was applied in 12 (22.2%) of the patients, ureteral calculi were determined in 42 (77.8%) patients and the stones were fragmented by pneumatic lithotripter. Twenty-five of the stones were localized in the lower ureter, 16 in the mid-ureter, and 3 in upper ureter. The mean stone size was found to be 7.1 mm (range 4-12). None of the stones migrated to the proximal region. In 2 patients open ureterolithotomy was applied; stones were localized in the upper ureter in both of these patients. CONCLUSIONS: Ureterorenoscopy can be successfully and safely applied without the need for ureteral dilatation in ureteral pathologies of children.

Risk factors for lower urinary tract infection and bacterial stent colonization in patients with a double J ureteral stent.

OBJECTIVE: We investigated the potential risk factors for lower urinary tract infection and bacterial stent colonization in patients with double-J stents. PATIENTS AND METHODS: A total of 195 double-J stents from 190 patients (95 men and 95 women, mean age 40.22 years) were examined. In all patients, prophylactic antimicrobial therapy was administered at the time of stenting. The stents and urine samples were removed aseptically and the proximal and distal tip segments of the stents were obtained. Three culture specimens were obtained from each stent segment and urine sample. Chi-square tests, odds ratio, and relative risk were used for the statistical analysis. RESULTS: Bacterial colonies were found in 24% (47 of 190) of the urine samples, 31% (61 of 195) of the proximal stent segments, and 34% (67 of 195) of the distal stent segments. Of the pathogens identified, Escherichia coli (34 of 47) was the most common. Diabetes mellitus (P < 0.01), chronic renal failure (P < 0.001), and pregnancy (P < 0.01) were found to be risk factors for lower urinary tract infection in patients with stents. An increased stent colonization rate was associated with implantation time, age, and female sex, but these were not statistically significant for lower urinary tract infection CONCLUSION: Diabetes mellitus, chronic renal failure, and pregnancy are associated with a higher risk of lower urinary tract infection. Therefore, patients in these categories should be monitored carefully for infectious complications.

Body mass index, body fat percentage, and the effect of body fat mass on SWL success.

OBJECTIVES: In the present study, we investigated the effects of the Body Mass Index (BMI), the Body Fat Percentage (BFP), and the Body Fat Mass (BFM) on success of SWL, prospectively. PATIENTS AND METHODS: The BMI, BFP, BFM values of patients, who were treated by SWL due to upper urinary system stone disease (pelvis renalis, upper ureter, kidney lower and upper calices) between January and December 2005 in our hospital's urolithiasis center, were measured. Patients with stones smaller than 5 mm or larger than 20 mm and patients who had a stone localized somewhere other than in the upper urinary system, were not included in the study. Patients evaluated to be clinically successful according to the SWL were put in group 1, and the other patients who were not successful were included in group 2. RESULTS: About 158 (97 male, 61 female) patients aged between 16 and 92 (mean 36.69 (+/-13.22) years), put on SWL therapy due to presence of upper urinary system stone disease, were included in the study. While the mean BMI was 23.97 +/- 0.4 in group 1 and 25.98 +/- 0.5 (P = 0.02) in group 2, BFP was 23.85 +/- 0.8 in group 1 and 29.19 +/- 1.1 (P = 0.001) in group 2, and BFM was determined to be 16.74 +/- 0.7 and 21.19 +/- 1.01 (P = 0.001) in group 2. Regarding all the parameters (BMI, BFP, BFM), the statistical analyses carried out between the groups showed significant differences. CONCLUSION: BFP and BFM parameters are also important factors along with the BMI in providing a successful SWL treatment. All the parameters should be considered regarding the success of the treatment and the patients should be informed.

Cerebrospinal fluid prostate specific antigen (CSF PSA) in prostate cancer patients with lower spine metastasis.

AIM: In this prospective study, our aim was to investigate the CSF PSA levels and CSF/Serum PSA ratios in patients with prostate cancer with lower spine metastasis. METHODS: The study involved patients with prostate cancer (n = 15), benign prostatic hyperplasia (n = 17) and non-prostatic disease (n = 9). Serum and CSF were obtained prior to spinal anesthesia for urological surgery. Total PSA levels in the serum and CSF were measured by electrochemiluminescence immunoassay. The results were tested statistically using the Mann-Whitney U test. RESULTS: The mean serum PSA levels were 20.36 ng/ml in the prostate cancer patients, 5.37 ng/ml in the BPH patients and 0.76 ng/ml non-prostatic disease. The mean CSF PSA levels in groups were 0.127, 0.051 and 0.027 ng/ml, respectively. The mean CSF PSA/serum PSA ratios in groups were 0.007, 0.018 and 0.042, respectively. This result is statistically significant (P < 0.001). CONCLUSIONS: Although mean serum PSA and CSF PSA levels in the patients with cancer of the prostate and lower spine metastasis are higher than those in the others, the mean CSF PSA/serum PSA ratio is lower. However, clinical usefulness of CSF PSA value and CSF PSA/ Serum PSA ratio can be limited because CSF PSA values are usually very low, and CSF PSA/Serum PSA ratio of 4 prostate cancer patients are as high as 1 BPH patient.

Coagulation parameters in the patients with Fournier's Gangrene.

AIM: In this prospective study, we aimed to determine the coagulation parameters in the patients with Fournier's gangrene. METHODS: The study group is consisted of 12 consecutive Fournier's gangrene patients (11 men and 1 woman) and control group is consisted of patients with periurethral abscess (n = 2), scrotal abscess (n = 4) and epididimorchitis (n = 4). Fibrinogen, protein C, protein S, antithrombin III, lupus anticoagulant, cardiolipin IgG and IgM, prothrombin time-international normalized ratio, activated partial thromboplastin time, platelet count, proaccelerin, antihemophilic globulin (FVIII), albumin, and calcium were evaluated in all subjects. Tissue specimens were taken from Fournier's gangrene patients. These specimens were tested for arterial and venous thrombosis using light microscopy. RESULTS: All of the patients with Fournier's gangrene had both arterial and venous thrombosis in tissue specimens. The levels of fibrinogen and FVIII were high, the level of protein C was low in 12 patients. Lupus Anticoagulant was positive 11 of 12 patients. CONCLUSIONS: According to our findings, we think that some coagulation parameters (FVIII, Lupus anticoagulant, protein C, fibrinogen) may be diagnostic for Fournier's gangrene.

Which Surgical Technique Should be Preferred to Repair Benign, Primary Vesicovaginal Fistulas?

PURPOSE: To evaluate and compare the outcomes of benign, primary vesicovaginal fistulas (VVFs) treated using the transabdominal transvesical technique and the transvaginal technique without tissue interposition. MATERIALS AND METHODS: A total of 53 consecutive women with VVF who were treated between September 1999 and October 2014 were evaluated retrospectively. Patients with a malignant etiology and/or prior irradiation were excluded because they required a more complex repair. In the first group, the repair was performed using the transabdominal transvesical technique (n = 28). After one of our fellows had completed his urogynecology training, he began to perform the repairs using the transvaginal technique (n = 25). All included VVF patients were treated without a tissue interposition. RESULTS: Vesicovaginal fistula repair was performed in 53 patients, with a mean age of 41.4 ± 15.2 years. There was no significant difference in terms of the patients' age, fistula size, and the number of deliveries between the groups. All cases failed in terms of conservative management. The size of the fistulas ranged from 15 to 20 mm. The admission time was between 3 days and 21 years, and it was longer in less educated patients. The success rate was 96.4% (27/28) in the transabdominal transvesical group and 100% (25/25) in the transvaginal group (P = 1.00). The hospitalization period and complications were significantly reduced in the transvaginal group (P = .00 and P = .004, respectively). No patients converted from a transvaginal to a transabdominal repair. There was only one recurrence in the transabdominal transvesical group.The patients were followed up for 1 year. CONCLUSION: Transvaginal repair of benign, primary VVFs is more advantageous than transabdominal transvesical repair. There was a significant decrease in the hospitalization period and complications rates using the transvaginal technique without tissue interposition.

Does the histopathologic pattern of the ureteropelvic junction affect the outcome of pyeloplasty.

PURPOSE: To investigate the effects of the histopathologic pattern of obstructed ureteropelvic junction (UPJ) specimens, including collagen type 3, elastin, fibrosis and Cajal cells, on the outcome of pyeloplasty. MATERIALS AND METHODS: Histopathological specimens obtained following Anderson-Hynes pyeloplasty from 52 patients with intrinsic ureteropelvic junction obstruction (UPJO) between January 2005 and January 2008 were evaluated histopathologically. Patients with extrinsic or secondary UPJO were excluded. Preoperative and postoperative radiographic evaluations were performed either via diuretic renography or intravenous pyelography, or both. Six months post-surgery the patients were divided into 2 groups, as successful surgery (group 1) and unsuccessful surgery (group 2). Histopathological findings (collagen type 3, elastin, fibrosis and Cajal cells) in each group were statistically compared. RESULTS: The study included 52 patients (21 female and 31 male). Mean age of the entire study population was 39.42 ± 14.5 years, versus 39.63 ± 14.9 years in group 1 (n = 47) and 37.4 ± 10.0 years in group 2 (n = 5). Median follow-up was 18 months. There weren't any significant differences in collagen type 3, elastin, fibrosis, or Cajal cells between the 2 groups (P > .05). CONCLUSION: The histopathologic pattern of UPJ was not a factor associated with the success of pyeloplasty. Based on the present findings, we conclude that surgical technique is more important than the histopathologic pattern of UPJ for the successful treatment of UPJO.

Erectile dysfunction rates and requests for treatment in patients attending outpatient urology clinics and those accompanying them.

BACKGROUND: Erectile dysfunction is a common sexual function disorder in men. The aim of the present study was to determine the rates of erectile dysfunction and requests for treatment in male patients refered to our outpatient urology clinics and those accompanying them who were older than 20 years. METHODS: The study comprised 2 groups: group 1 included male patients older than 20 years whom attend to the outpatient urology clinics, and group 2 included their companies whom were older than 20 years. Subjects were asked whether they had erectile dysfunction or not, if so whether they had been treated or not, if not then why, and whether they desired treatment or not at present. RESULTS: Erectile dysfunction was determined in 224 subjects (13.9%) in group 1, and 57 (8.5%) in group 2. It was found that approximately one half (49.1%) of patients with erectile dysfunction did not complain about this. The main reasons for this were failure to perceive sexual dysfunction as a problem, and shame. Of 281 men who determined to have erectile dysfunction, 71 indicated that they desired treatment. In those who did not desire treatment, the main reasons were failure to perceive it as a problem, and shame. CONCLUSIONS: These findings show that the doctor has a great responsibility in determining erectile dysfunction. Therefore discussions of sexual health should be made a routine part of doctor-patient discussions, and patients, especially those over 50, should be asked whether they have a complaint of erectile dysfunction.

Premature ejaculation rates and treatment needs in males aged 20 years and over attending urology outpatient clinic.

AIM: The purpose of this study was the assessment of the rates of premature ejaculation and desires for treatment in male patients 20 years and over attending urology outpatient clinic. METHODS: All subjects included in the study were asked whether they had a complaint of premature ejaculation; if so, whether they had sought a doctor's assistance; if not, why they had not; why they did not mention their complaint during the first visit; whether they desired treatment; and if not, why they did not. RESULTS: A total of 1608 subjects were questioned. Premature ejaculation was present in 333 (20.7%). Premature ejaculation was the primary complaint of 33 of those attending the urology outpatient clinic. The most common reasons for not seeking a doctor's assistance were failure to see the condition as a problem, and embarrassment. Fifty four (16.2%) of these patients did not desire treatment. The most common reason for not desiring treatment was regarding it as unnecessary at present, and old age. CONCLUSION: The questioning of all men aged 20 and over attending urology outpatient clinic concerning premature ejaculation will greatly increase diagnoses and treatments.

The effects of cellular telephone use on serum PSA levels in men.

BACKGROUND: The increasing use of cellular telephones is known to have harmful effects on human health. The aim of this prospective study was to determine whether cellular telephone use affected serum PSA levels in men. METHODS: Participants included 20 men with ages ranging from 22 to 65 years who had never previously used cellular telephones. Blood samples were taken prior to and 30 days after the beginning of cellular telephone use. Serum was separated from the blood samples and stored in a deep freezer until the end of the study, at which time serum free and total PSA levels were determined by tandem radioimmunoassay. The results were statistically analyzed by the Wilcoxon Paired Signed Rank Test. RESULTS: Average free and total PSA values were 2.070 ng/ml and 0.500 ng/ml before the study, and 2.0 ng/ml and 0.505 ng/ml at the end of the study, respectively. No significant difference was determined between the initial and final values (p > 0.05). CONCLUSIONS: The results indicate that cellular telephone use does not significantly affect PSA values in the short term. Nevertheless, we think that there is a need for longer-term studies on this subject.

Retrospective analysis of 135 renal trauma cases.

BACKGROUND: We review our trauma cases over the last 11 years and discuss our diagnosis and treatment modalities. METHODS: One hundred and thirty-five patients with renal injuries who had been hospitalized in the Urology and General Surgery clinics of Dicle University hospital between 1990 and 2001 were reviewed retrospectively. Patients were evaluated with regard to age, sex, cause of trauma, transport time, diagnostic methods, grade of injuries, associated organ injuries, treatments and complications. RESULTS: One hundred and forty-one renal injuries were established in 135 patients. The patients were between 5 and 65 years old; 114 (84.4%) were male and 21 (15.6%) were female. The most common cause of injuries (99 patients) was penetrating injuries. The transport time to hospital after injury was approximately 116 min. Immediate laparotomy was performed in 95 hemodynamically unstable patients. Radiological investigations were carried out in the remaining 40 patients. Most of the injuries were grade 4 (28, 19.86%) or 5 (60, 42.55%). Isolated renal injury was established in only 22 of 135 patients. Nephrorrhaphy was performed in 45 of 141 kidneys. Twelve injured kidneys were managed conservatively. Nephrectomy was performed in 66 of 141 kidneys. The remaining injured kidneys were managed with different treatment methods. Twenty-nine (21.48%) patients were lost intraoperatively or during the early postoperative period. CONCLUSION: We believe that our rates of nephrectomy and mortality were high because of the long transport time, unsuitable transport type, frequent high grade and high rate of associated organ injuries.