Impact of titanium-prepared platelet-rich fibrin in type 1 fascia graft tympanoplasty on graft survival and hearing outcomes.

Background: Type 1 fascia graft tympanoplasty (T1FGT) is the mainstay surgical approach for the treatment of tympanic membrane perforations. The most widely used graft material is temporal muscle fascia, and graft take rates are reported differently. The methods to enhance graft take are still being investigated. Aim: The aim of our study was to investigate the effect of titanium-prepared platelet-rich fibrin (T-PRF) on graft take and hearing outcomes in T1FGT. Materials and Methods: Fifty-seven ears eligible for T1FGT were involved in the study and prospectively evaluated. T-PRF was applied with T1FGT in 27 ears. Thirty ears in the other group underwent only T1FGT. The patients underwent an otomicroscopic and audiometric examination in preoperative and postoperative 2nd week, 1st month, and 6th month. Both groups were evaluated in terms of hearing levels, infection, and graft take rates. Results: Two patients in the T1FGT + T-PRF group and seven patients in the T1FGT group had postoperative perforation (graft take rate: 92.6% versus 76.7%). The graft take rate was found to be increased in the T-PRF group although the difference was not statistically significant. In the T1FGT group, the percentage of infection was higher than in the T1FGT + T-PRF group. When the preoperative and postoperative 6th-month audiometry was compared, a statistically significant hearing gain was obtained for both groups. Conclusion: In the treatment of tympanic membrane perforations, T-PRF applied over the fascia graft was shown to increase graft take rates and decrease the probability of infection. Further studies with larger samples are needed to demonstrate the effects of PRF.

Vitamin B12, folate and iron levels in primary nocturnal enuresis.

OBJECTIVE: Folate, vitamin B12 and iron are important vitamin and minerals which play role in the development of nervous system. The aim of this study was looking at the presence of folate, vitamin B12 and iron deficiency among patients with Primary nocturnal enuresis (PNE) and possible relation between the delay of central nervous system (CNS) development, PNE and folate, vitamin B12 and iron states. METHODS: Consecutively applied forty patients with PNE (23 girls and 17 boys) and otherwise normal thirty control subjects (17 girls and 13 boys) were included in the study. Average ages (in range) of PNE and the control group were 9.2(6-12) years and 9.3 (6-12) years accordingly. Age, height, weight, complete blood count, blood vitamin B12, folate, ferritin and iron values of both groups were recorded and compared to each other. RESULTS: Average vitamin B12 and folate levels of patients with PNE were significantly and statistically lower compared to those of the control group. Average blood iron of patients with PNE was significantly higher than that of the control group and also average ferritin level of the PNE group was detected to be higher than the control group but this relation was statistically insignificant. CONCLUSION: Primary nocturnal enuresis is related to the delay in CNS maturation so it was thought that low vitamin B12 and folate which were found in patients with PNE may have role in the delay of CNS maturation. Additionally, further studies are needed to investigate the role of vitamin B12 and folate either alone or as combination in treatment of patients with PNE who have low vitamin B12and folate level.

Comparison of percutaneous nephrolithotomy, shock wave lithotripsy, and retrograde intrarenal surgery for lower pole renal calculi 10-20 mm.

OBJECTIVE: To compare the results of percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL), and retrograde intrarenal surgery (RIRS) for 1- to 2-cm lower pole kidney stones. PATIENTS AND METHODS: This retrospective study was based on data collected from the files of patients between January 2007 and May 2012. The files of 383 patients (221 SWL, 144 PCNL, 38 RIRS) were evaluated. The groups were compared for stone size, success rate, and complication rate using the modified Clavien grading system. RESULTS: The stone burdens of the groups were similar (p = 0.36). The success rates were 76, 94, and 73%, respectively, in SWL, PCNL, and RIRS. The highest stone-free rate was in the PNL group (p < 0.05). When the complication rates were evaluated using the Clavien grading system, they were determined to be 13% in PCNL, 3% in SWL, and 5% in RIRS. Especially GII and GIII complications were more common in the PCNL group (p < 0.05). CONCLUSION: PCNL seems to be the most successful but most invasive method. However, with relatively low complication rates, SWL and RIRS are other techniques to keep in mind. To determine the first-line treatment, prospective randomized studies with larger series are needed.

Universal newborn hearing screening; automated transient evoked otoacoustic emissions.

OBJECTIVE: The purpose of this study is to describe the results of universal newborn hearing screening (UNHS) in 2229 newborns and to assess the effectiveness of a two-stage automated transient evoked otoacoustic emission (a-TEOAE) test protocol. MATERIALS AND METHODS: Between May 2007 and January 2008, a universal newborn hearing screening program, instituting two-stage a-TEOAE, was evaluated. The hearing status of the newborns who failed the two-stage screening tests were evaluated with the auditory brainstem response (ABR) test during the diagnostic stage. The risk factors for hearing loss determined by the Joint Committee on Infant Hearing Loss (JCIH) and prematurity, consanguineous marriage, and birth type as presumptive risk factors were recorded. RESULTS: During the study period, 2229 newborns were screened. Sensorineural hearing loss (SNHL) was identified in 8 newborns. Fourteen newborns were lost to follow-up. One hundred thirty six newborns were high-risk neonatal intensive care unit (NICU) patients. The prevalence of SNHL was 2.9% (4/136) in NICU newborns, and 0.19% (4/2079) in the well-baby nursery. SNHL prevalence in the study group overall was found to be 0.36% (8/2215). Craniofacial anomalies and family history of hearing loss were found to be significantly related to SNHL in newborns. Prematurity and consanguinity that are not listed among JCIH risk factors were also found to be statistically significantly related with SNHL. CONCLUSIONS: This is the first report of a universal hearing screening program in the Eastern Black Sea region of Turkey. Two-stage a-TEOAE is an efficient and feasible hospital-based screening protocol in newborns.

Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading.

We aimed to assess the effect of spermatic vein ligation on seminal total antioxidant capacity (TAC) in patients with varicocele. Twenty infertile male patients with varicocele and 20 normal fertile men (control group) were included in the study. All the male patients were diagnosed with primary infertility and varicocele. The patients with varicocele were divided into two groups as nonpalpable (GI) (eight patients) and palpable (GII-III) (12 patients) varicocele groups. All the patients underwent microsurgical spermatic vein ligation. Seminal TAC levels and sperm parameters were evaluated in all the patients. Preoperative sperm count, sperm motility, sperm morphology and seminal TAC levels with equivalent figures 3-6 months after spermatic vein ligation and the same values of the control group were compared. There was a statistically significant increase in the total seminal antioxidant capacity level after spermatic vein ligation, and there was a statistically significant increase in the sperm count, sperm motility and spermatozoa with normal morphology. However, evaluation of the patients for varicocele grade showed a statistically significant increase in the TAC level only in the GII-III varicocele group. Spermatic vein ligation can improve the total seminal antioxidant capacity levels especially in patients with middle and high grade varicocele.

The effect of metabolic syndrome upon the success of varicocelectomy.

We aimed to investigate the impact of metabolic syndrome (MetS) on the varicocele treatment. 101 patients underwent spermatic vein ligation between 2007 and 2010 were retrospectively analyzed. Those patients were divided into two groups as without (n: 56, Group 1) or with MetS (n: 48, Group 2). All the patients underwent left microsurgical subinguinal spermatic vein ligation. Groups were compared by the improvement on sperm parameters and spontaneous pregnancy rates at a mean of 19 (±4) months followup. When sperm parameters were compared postoperatively, the significant improvement in total sperm count, motile sperm count percentage, and normal sperm percentage was reported. The groups were compared to each other and the improvement seemed significantly better in Group 1. There was no statistically significant improvement difference in the normal sperm percentage between groups. Spontaneous pregnancy rate after two years was 45% in Group 1 and 34% in Group 2 (P < 0.05). Patients with MetS and varicocele improved after surgery, but not as well as the similar group without MetS. This may help to show that MetS can be a factor for male infertility.

The comparison of standard and tubeless percutaneous nephrolithotomy procedures.

PURPOSE: To compare totally tubeless and standard percutaneous nephrolitotomy procedures on many parameters. MATERIALS AND METHODS: Percutaneous nephrolitotomy was performed on 195 patients between June 2009 and May 2012. The data of those patients were evaluated retrospectively. Totally tubeless cases were enrolled to Group 1, and Group 2 consisted of non-tubeless cases (re-entry or Foley catheter). RESULTS: Group 1 included 85 cases and group 2 a total of 110 patients. Paper tracing values for the kidney stones were 321.25 ± 102.4 mm(2) and 324.10 ± 169.5 mm(2) respectively. Mean fluoroscopy time was 4.9 ± 1.9 min and 5.08 ± 2.7 min, mean operation time was 78.8 ± 27.9 min and 81.9 ± 28.77 min and mean decrease in hematocrit was 2.6 ± 1.6 and 3.74 ± 1.9 respectively. All these comparisons were statistically significant. Length of hospitalization was 1.6 ± 1.1 and 3.5 ± 1.5 days for Groups 1 and 2 respectively. Mean superficial pain score was 5.8 ± 1.6 and 6.7 ± 1.2 respectively for both groups after 1 hour. At 6 hours, the scores changed to 3.87 ± 1.22 and 4.84 ± 1.3 respectively. The analgesic dose was 1.00 ± 0.7 and 1.53 ± 0.6 for the groups respectively at 6 hours. All the statistical differences were significant for these three parameters. CONCLUSIONS: We believe that, because of their post operative patient comfort and decreased length of hospital stay, totally tubeless procedures should be considered as an alternative to standard percutaneous nephrolitotomy.

Assessment of anti-sperm antibodies in couples after testicular sperm extraction.

PURPOSE: Testicular spermatozoa can be retrieved successfully by the testicular sperm extraction (TESE) procedure and used for intracytoplasmic sperm injection. Disruption in the blood-testis barrier can lead to the production of antisperm antibodies (ASA). The aim of this prospective study was to investigate the frequency of ASA formation in couples after TESE procedure. METHODS: Thirty-seven couples were included in the study at the Urology Clinic of the Dr. Zekai Tahir Burak Women's Health Training and Research Hospital. History, physical examination, spermiogram, and endocrine profiles were obtained for all male patients. All the male patients in this study had been diagnosed with nonobstructive azoospermia (NOA) and underwent microdissection TESE. Secondary and tertiary cases were also included in the study. Serum samples were obtained from all 74 patients before TESE, and at three and 12 months after TESE. Serum ASA levels were determined. ANOVA was performed for statistical analysis for serum Follicle-Stimulating Hormone (FSH), testosterone and testicular volume. P < 0.05 was considered significant. RESULTS: There were no differences in the testicular volumes, serum FSH and testosterone levels before and after TESE. None of the patients or their partners developed significant levels of ASA as a result of the TESE procedure. CONCLUSION: TESE procedure does not cause ASA production in either males or their female partners.

Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations.

OBJECTIVES: To evaluate iatrogenic urinary tract system injuries in obstetrics and gynecology operations and compare the results with the literature. PATIENTS AND METHODS: We examined the records of patients who had obstetric and gynecology operations at the Ministry of Health, Dr. Zekai Tahir Burak Women's Health, Training and Research Hospital between June 2007 and June 2010. All the patients who were diagnosed as having urinary system injuries in either the intraoperative or postoperative period were determined. RESULTS: During this period, 25,998 gynecologic and obstetrical operations were performed, 0.03% ureteric, 0.20% bladder, and one case of urethral injury, in a total of 0.24% urinary tract injuries were observed. The bladder was the most frequently injured organ. Total urinary tract injury rates were 0.79% (0.49% bladder, 0.24% ureteral) in gynecologic operations and 0.19% (0.18% bladder and 0.01% ureteral) in obstetric operations. CONCLUSION: Urinary system injuries are seen in approximately 1% of all gynecologic and obstetric surgeries. The complication rates observed in our patients were comparable with the other studies in the literature. A gynecologic surgeon must become familiar with the anatomy of the urinary tract and must be aware of common intraoperative and postoperative complications to decrease the risk of morbidity.

Awake caudal anesthesia for inguinal hernia operations: successful use in low birth weight neonates.

Neonates with inguinal hernia face a relatively high risk of incarcerated hernia and bowel obstruction and this therefore requires surgical treatment. Complications following general anesthesia even for minor surgery are more common in low birth weight neonates than in term neonates. Caudal epidural anesthesia without adjunct general anesthesia has been recommended for neonates to reduce the risk of postoperative complications. The successful application of awake caudal anesthesia with levobupivacaine for inguinal hernia repair in 15 low birth weight neonates is reported. Single dose caudal epidural anesthesia was administered for inguinal hernia surgery to avoid complications associated with general anesthesia. Caudal block was performed with 2.5 mg/kg body weight (BW) levobupivacaine. Caudal anesthesia can be recommended as an effective technique for avoiding postoperative anesthetic complications in low birth weight neonates.

Is Thiol/Disulphide homeostasis important in prostate cancer diagnosis? / Es importante la homeostasis del Tiol/Disulfito en el diagnóstico del cáncer de próstata?

OBJECTIVES: To assess the relationship between prostate cancer and thiol/disulphide homeostasisas an important indicator of oxidative stress. METHODS: After ethics committee approval (546/2015); 388 patients aged between 46-75 years who underwent transrectal ultrasound guided prostatebiopsy in three different centers between July 2015-2016 owing to serum prostate specific antigen (PSA) levels ≥2.5 ng/ml and/or abnormal digital rectal examination were involved in this study. The plasma levels of thiol/disulphide homeostasis parameters were compared in patients with and without prostate cancer. RESULTS: The mean age of the patients was 62.9±7 years. In patients with prostate cancer (n=130, 33.5% ) the mean plasma levels of native thiol and total thiol were lower (332.9 vs 362.1 µmol/L and 363 vs 392.6 µmol/L, p=0.001). Plasma disulphide levels were not statistically different between the groups (15 vs 15.3 µmol/L, p=0.936). In prostate cancer group; patients with Gleason score ≥7 had lower plasma native thiol levels than patients with Gleason score<7 (321.3  vs 342.6 µmol/L, p=0.029) while there were no significant differences in total thiol and disulphide levels (352.3 vs 371.9 µmol/L, ptotal Thiol =0.064 and 15.5 vs 14.6 µmol/L, pdisulphide =0.933). CONCLUSIONS: Lower plasma levels of thiol in patients with prostate cancer and high Gleason score is an oteworthy result. We believe that our results should be supported by further studies.

OBJETIVOS: Establecer la relación entre cáncer de próstata y la homeostasis del tiol/disulfito como un importante indicador de estrés oxidativo.MÉTODOS: Con la aprobacion del comité ético (546/2015), 388 pacientes entre 46 y 75 años que recibieron una biopsia transrectal prostática ecoguiada en diferentes centros entre julio 2015 y 2016 por un PSA superior a 2,5 ng/ml o tacto rectal anómalo, fueron incluidos en este estudio. Los niveles plasmáticos de la homeostasis de tiol/disulfito se compararon en pacientes con y sin cáncer de próstata. RESULTADOS: La edad media de los pacientes fue de 62,9 =/- 7 años. En pacientes con cáncer de próstata (n=130, 33,5%) el nivel plasmático de tiol nativo y tiol total fue menor (332,9 vs 362,1 µmol/L y 363 vs 392,6 µmol/L, p=0,001). Los niveles de disulfito en plasma no fueron estadísticamente diferentes entre los grupos (15 vs 15,3 µmol/L, p=0,936). En el grupo con cáncer de próstata; pacientes con Gleason 7 o más tuvieron niveles menores de tiol nativo en relación a los pacientes con Gleason menor de 7 (321,3 vs 342,6 µmol/L, p=0,029), mientras no hubo diferencias en eltiol total y los disulfitos (352,3 vs 371,9 µmol/L, ptotaltiol =0,064 y 15,5 vs 14,6 µmol/L, pdisulfito =0,933). CONCLUSIONES: Niveles bajos de tiol en pacientes con cáncer de próstata y Gleason alto es un resultado notable. Creemos que nuestros resultados deberian tenerse en cuenta para otros estudios.

Cerebral Oximetry as an Auxiliary Diagnostic Tool in the Diagnosis of Brain Death.

AIM: To investigate the efficacy of cerebral oximetry (CO) as an auxiliary diagnostic tool in brain death (BD). MATERIALS AND METHODS: This observational case-control study was performed on patients with suspected BD. Patients with diagnosis of BD confirmed by the brain death committee were enrolled as the BD group and other patients as the non-BD group. CO monitoring was performed at least 6 h, and cerebral tissue oxygen saturation (ScO2) parameters were compared. RESULTS: Mean ScO2 level in the BD group was lower than non-brain-dead patients: mean difference for right lobe = 6.48 (95% confidence interval [CI] 0.08-12.88) and for left lobe = 6.09 (95% CI -0.22-12.41). Maximum ScO2 values in the BD group were significantly lower than the non-BD group: mean difference for right lobe = 8.20 (95% CI 1.64-14.77) and for left lobe = 9.54 (95% CI 3.06-16.03). The area under the curve for right lobe maximum ScO2 was 0.69 (95% CI 0.55-0.81) and for left lobe was 0.72 (95% CI 0.58-0.84). CONCLUSION: Maximum ScO2 in brain-dead patients at CO monitoring is significantly low. However, this cannot be used to differentiate brain-dead and non-brain-dead patients. CO monitoring is therefore not an appropriate auxiliary diagnostic tool for confirming BD.

Bile duct injury complicated by bilioma after blunt liver trauma in a child.

Nonoperative management with close observation represents the standard of care for blunt liver injury, unless vital signs deteriorate or an associated injury requires emergency operation. Injuries of the biliary tract remain important concomitant lesions following liver trauma. Posttraumatic extraductal biliary collections or biliomas are rare complications of blunt abdominal traumas and only a few cases have been reported in the pediatric age group. We report a 5-year-old boy who suffered from blunt abdominal trauma that resulted in liver laceration and, eventually, bilioma formation. The patient was managed nonoperatively for liver injury. The diagnosis was confirmed by computed tomography (CT)-guided needle aspiration and percutaneous catheter drainage, which also allowed nonoperative management. The patient was symptom-free with normal liver function tests and a normal liver appearance on ultrasound examination six months after the accident. The possibility of missed bile duct injury should be considered when nonoperative management is used and close observation of the patient is necessary over a prolonged period.

The unusual mass of retrovesical space: a secondary hydatid cyst disease.

Hydatic cyst of seminal vesicles is very rarely seen. We report a case who complained of the inability to void, which developed progressively with dysuria, frequency, nocturia, and tenesmus, due to a giant retrovesical hydatid cyst that displaced the bladder and rectosigmoid region.

Can the neutrophil-to-lymphocyte ratio be used to predict recurrence and progression of non-muscle-invasive bladder cancer?

The aim of our study was to evaluate whether neutrophil-to-lymphocyte ratio (NLR) is a predictor of disease progression and recurrence in patients with primary non-muscle-invasive bladder cancer (NMIBC). This was a prospective study of 86 patients with newly diagnosed NMIBC. The patients were classified by the number of points assigned by the European Organization for Research and Treatment of Cancer risk tables. The correlation between progression score, recurrence score, age, mean platelet volume, red blood cell distribution width and NLR was assessed statistically. The same parameters were compared between the risk groups. A significant difference in NLR and age values was observed between recurrence and progression risk score groups. The relationships between NLR and recurrence and progression risk scores were no longer significant after correcting for the statistical effect of age on scores. Age was significantly different between groups after adjusting for NLR. Our study revealed that NLR and age were associated with patient age and bladder tumor progression and recurrence risk scores. After correcting for age, the significant relationship with NLR was lost, in contrast to some previous studies. We recommend that patient age should be corrected to avoid misleading results in NLR studies.

The impact of metabolic syndrome on the outcomes of transurethral resection of the prostate.

PURPOSE: To investigate the effect of metabolic syndrome (MS) and its components on the outcomes of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Fifty patients with MS and 50 without MS were enrolled for the study. Patients without MS were assigned to Group 1 and patients with MS were in Group 2. Patients were evaluated by the International Prostate Symptom Score (IPSS), Quality of Life index (QoL), maximum urine flow rate (Qmax), prostate-specific antigen level, and urinary ultrasonography. Six months after surgery, patients were again evaluated by IPSS and uroflowmetry; then comparison was made between the groups with respect to IPSS, QoL, and Qmax. RESULTS: Postoperative IPSS was determined as 11.2±0.87 in Group 1 and 12.9±0.88 in Group 2 (P<0.05). Postoperative Qmax values were determined as 18.2±0.81 and 13.9±1.12 for the two groups, respectively (P<0.05). After multivariate analyses, elevated fasting glucose (EFG) and dyslipidemia were determined to have a significant correlation with IPSS improvement. EFG and hypertension had a significant negative impact on Qmax, and hypertension and abdominal obesity had a significant correlation with QoL improvement. CONCLUSIONS: MS as a comorbidity seems to diminish the effects of TURP. Further well-designed prospective, randomized studies with larger cohorts are needed to confirm the findings of this study.

The Effect of Metabolic Syndrome on the Success and Complications of Percutaneous Nephrolitotomy.

BACKGROUND: The aim of this study was to investigate the effect of Metabolic syndrome (MetS) on the success and complications of percutaneous nephrolithotomy (PNL). METHODS: Two hundred ten patients who had undergone PNL for kidney stones in our clinic between May 2012 and May 2014 were retrospectively analyzed. The patients were divided into two groups based on whether they had diagnostic criteria for MetS. All patients had lower pole kidney stones between 15 and 20 mm. Complication rates between groups were evaluated using a modified Clavien grading system. RESULTS: Group1 was a standard PNL group and group 2 consisted of patients with MetS. Mean stone size was 293.25 ± 102.4 mm(2) for group 1 and 301.10 ± 169.5 mm(2) for group 2 (p < 0.05). Mean hospitalization days, fluoroscopy duration, and mean hematocrit loss were significantly higher in group 2. Mean operative time and need for blood transfusions were higher in group 2 but statistically insignificant. One hundred twenty five patients in group 1 (96.1%) and 72 patients in group 2 (90%) obtained stone-free state. CONCLUSIONS: Our study results reveal an increase in complications and morbidity for patients with MetS during PNL.