Pediatrik Üriner Sistem Taş Hastalarında Micro-Perc Cerrahisinin Etkinliği

Amaç: Pediatrik hastalarda böbrek taşlarınının cerrahi tedavisinde mikro-PERC’nin etkinliğini ve güvenilirliğini araştırmayı amaçladık..Gereç ve Yöntem: Kliniğimizde Ocak 2015 - Ocak 2017 tarihleri arasında pediatrik böbrek taş hastalığı nedeniyle mikro-PERC uygulanan 32 pediatrik hastanın bilgileri retrospektif olarak değerlendirildi. Operasyon süreleri, floroskopi süresi, hastanede yatış süreleri, komplikasyon oranları ve taştan yoksunluk oranları kayıt edildi.Bulgular: Toplam 32 hastanın ortalama yaşları 5±4.1 yıl, ortalama taş boyutu ise 13.35±3.12 mm olarak hesaplandı. Operasyon süresi açısından bakıldığında 74.2±14.2 dakika iken, ortalama floroskopi süreleri 109±31.2 saniyeydi.Sonuç: Mikro-PERC gibi minimal invazif yöntemler çocuklarda etkin ve güvenilir bir tedavi yöntemidi

Tuberosklerozla ilişkili renal anjiomiyolipomun sebep olduğu intraperitoneal kanamayı taklit eden akut retroperitoneal hematom

Tuberoskleroz kompleksi (TSC) nörolojik ve dermatolojik bir hastalık olarak bilinmekteyse de; böbrekte meydana getirdiği değişiklikler nedeniyle sıklıkla karşılaşılabilmekte ve ölüme neden olabilmektedir. Biz bilateral multipl renal anjiomiyolipomu olan tuberosklerozlu bir hastayı sunmak istedik. Renal anjiomiyolipomu olan hastada spontan retroperitoneal hematom meydana geldi ve klinik takiplerinde intraperitoneal kanamayı taklit etmesiyle tanı kondu. Hemorajiyi kontrol etmek için sağ total nefrektomi yapıldı. Ancak hasta post operatif 15. gün zayıf solunum fonksiyonları nedeniyle kaybedildi.Tuberous sclerosis complex (TSC) is known as a neurological and dermatological disorder, but its renal manifestations are frequent and may cause death. We report a patient with TSC who showed bilateral multiple renal angiomyolipomas. Spontaneous retroperitoneal hematoma caused by renal angiomyolipoma that mimicking intraperitoneal hemorrhage was diagnosed in her clinical follow-up. We performed right total nephrectomy for controlling hemorrhage, but she died due to poor respiratory function, in fifteenth day postoperatively

Effects of ethanol on intracorporeal structures of the rat

Objective: Previous studies demonstrated that acute in vitro exposure of corpus cavernosal tissue to ethanol decreased its response to field stimulation and pharmacological stimulation. In the present study we investigated the effects of chronic ethanol consumption on the ultrastructure of cavernosal smooth muscle cells, elastic fibres and collagen content. Material and methods: Fourteen adult wistar rats were divided into a control group (n = 7, fed a standard diet and tap water) and an alcoholic group (n = 7, fed a standard diet and 5% (v/v) ethanol in drinking water and by increasing the ethanol concentration for every week, at the end of 6th week 30% (v/v) ethanol concentration was attained. Same dose was given until 12th week. At the end of 12th week blood samples were obtained and the ethanol concentrations were determined. The cavernosal tissues were obtained and immunohistochemical examinations were performed. Results: Immunohistochemical analysis revealed that chronic ethanol exposure markedly decreased the content of smooth muscle cells, elastic fibres and collagen type 4. Conclusion: Our findings suggest that in this animal model chronic ethanol exposure decreases the percentage of staining for smooth muscle actin, elastin, and collagen type 4 which are the key structures fundamental for erection. © Springer 2006

Bilateral multicystic renal dysplasia with potter sequence - A case with penile agenesis

WOS: 000243577200023PubMed: 17106555Hereditary renal adysplasia (HRA) is a rare autosomal dominant condition. Patients have several other anomalies including Potter facies, thoracic, cardiac, and extremity deformities. The case present dysmorphic facial features such as hypertelorism, prominent epicanthic folds, a flat and broad nose, choanal stenosis, low-set ears, and a receding chin. He had femoral bowing, hypoplastic right tibia and agenesis of the right foot. He had rich and thick skin. He had also a dysplastic empty scrotum, penile agenesis, and anal atresia. The autopsy revealed pulmonary hypoplasia, ventricular septal defect, bilateral multicystic renal dysplasia, agenesis of both ureter and bladder, intraabdominal testicles, and a single umbilical artery. The penile agenesis was first reported, and including the consanguinity in the parents might further delineate the bilateral multicystic HRA. Vater/caudal regression anomalies, Mullerian duct/aplasia, unilateral renal agenesis, and cervicothoracic somite anomalies association, and Coloboma, heart anomaly, choanal atresia, retardation, genital and ear anomalies syndrome has been considered in differential diagnosis

The role of power Doppler ultrasonography at prostate needle biopsy

Prostat kanserlerinin çoğunda hipervaskülarizasyon izlendiği Renkli Doppler Ultrasonografi (RDUS) ve PDUS ile yapılan çalışmalarda gösterilmiştir. Bu çalışmanın amacı, sistemik 10 kadran biyopsiye ek olarak PDUS ile saptanan şüpheli alanlardan alınan biyopsilerin prostat kanseri teşhisine katkısını saptamak idi. Temmuz 2002 - Nisan 2003 tarihleri arasında kliniğimizde görülen serum PSA değeri 2.5 ng/mL’nin üzerinde olan yada parmakla rektal incelemesinde (PRİ) nodul yada sertlik bulunan 52 hasta çalışmaya dahil edildi. Tüm hastalara PDUS’da artmış akım gösteren bölgelere ek olarak sistematik 10 kadran transrektal prostat iğne biyopsisi yapıldı. Sistematik olarak 10 kadrandan alınan biyopsilere ek olarak PDUS’da artmış akım gösteren 73 alandan biyopsi yapıldı. Toplam 11 hastadan alınan 65 biyopsi alanında tümör tespit edildi. PDUS kullanımı ile tümör tespit oranı %10,2 den %11,0’a çıktı. Bu artış istatistiksel olarak anlamlı değildi (p=0,75). İki hastada sadece PDUS ile alınan alanlarda tümör tespit edildi. PDUS’un birey bazında katkısı da istatistiksel olarak anlamlı değildi (p=0,80).PDUS ile tümör şüphesi olan alanlardan alınan biyopsilerin sistematik olarak 10 kadrandan alınan biyopsilere katkısının olmadığını, serum PSA düzeyleri yüksek olan yada PRİ’leri tümör lehine değerlendirilen hastalardan alınan biyopsilerde tümör tespit edilememesi durumlarında sistematik biyopsilerin tekrarlanmasının halen en geçerli yöntem olduğunu düşünmekteyiz.Introduction: Transrectal ultrasound guided prostate biopsy is the method of choice for prostate biopsy guidance. It was demonstrated that most prostate cancers in peripheral zone showed hypervascularization, in contrasts to hypovascularization of the normal peripheral zone. Color Doppler ultrasonography or power Doppler sonography may be of help in differentiating prostate cancer from benign prostatic disease by demonstrating local blood flow changes in the lesion compared to signals from surrounding tissue. Power Doppler is more sensitive to slow flow and is less angle-dependent than color Doppler imaging. In this prospective study, the role of power Doppler ultrasonography in addition to systematic 10 cores biopsy for the detection of prostate cancer was assessed. Materials and Methods: Between July 2002 and April 2003, 52 patients who have serum PSA level greater than 2.5 ng/mL or abnormal digital rectal examination included the study. All patients were examined with the 7.5 MHz end-firing probe (Hitachi EUB 525, Tokyo, Japan). Biopsies were directed into hypervascularized area detected by power doppler ultrasonography before systematic 10 cores needle biopsies were performed. No major complication during or after the procedure was seen. The impact of power Doppler, directed biopsies to prostate cancer detection rate, was analyzed using chi-square test. Mean age of patients was 63.1 (42-82). Results: In addition to 520 systematic biopsy sites from 52 patients, 73 suspicious areas detected by power Doppler ultrasonography were also biopsied. A total of 65 biopsy sites in 11 patients turned out to be adenocarcinoma of the prostate. With the use of power Doppler ultrasonography, cancer detection rate was increased to 11.0% (65/593) from 10.2% (53/520). This increase was statistically insignificant (p=0.75). In 2 patients, prostate cancer was diagnosed only in the suspicious areas detected by power Doppler ultrasonography. The contribution of power Doppler ultrasonography in that regard was also statistically insignificant (p=0.80). In a patient with prostate cancer diagnosed with systematic 10 cores needle biopsy, power Doppler ultrasonography could not detect any suspicious areas. In contrasts to suspicious areas detected with power Doppler ultrasonography, prostate cancer was diagnosed in a patient in the areas taken by systematic 10 cores needle biopsy technique. Conclusion: Targeted biopsy performed on the basis of power Doppler ultrasonography findings does not increase the detection rate of prostate cancer compared to systematic 10 cores needle biopsy technique. A second set systematic 10 cores needle biopsy seems the most reliable method in patients with high serum PSA level or suspicious digital rectal examination and negative biopsy result in the first set of biopsy

The association of Y chromosome microdeletions and infertility in patients with varicocele

Giriş: Varikosel hastalarında spermatogenezi etkileyen patolojik faktörler henüz tam olarak aydınlatılamamıştır. Bu hastalarda varikosele eşlik eden testiküler patolojilerin yanı sıra, Y kromozomunun uzun kolunda bulunan mikrodelesyonların da spermatogenezi etkilediği bilinmektedir. Y kromozom mikrodelesyonlarının, oligozoospermi ve azospermiden sorumlu olduğu gösterilmiştir. Bu çalışmada, varikoseli olan hastalarda, Y kromozom mikrodelesyonlarının infertilite gelişimine katkısının araştırılması amaçlanmıştır. Hastalar ve yöntem: Çalışmaya 18’si infertil, 14’ü fertil toplam 32 varikosel hastası dahil edilmiştir. Tüm hastaların spermiogramları yapılmış ve Y kromozomunun Azospermi Faktör-a (AZF-a), Azospermi Faktör-b (AZF-b), Azospermi Faktör-c (AZF-c) bölgeleri mikrodelesyon varlığı açısından değerlendirilmiştir.Bulgular: 3’ü azospermik olmak üzere 18 hastadan oluşan infertil grubun sperm sayısı 0-104 milyon/ml arasında değişmekte iken (ortalama 37.1 milyon/ml) 14 hastadan oluşan fertil grubun sperm sayısı 7.5-192 (ortalama 75.8) milyon/ml arasında bulunmuştur. İnfertil gruptaki hastaların 4’ünde Azospemi Faktör-a ve Azospemi Faktör-b bölgesinde mikrodelesyonlar tespit edilmiş iken fertil grupta Y kromozom mikrodelesyonuna rastlanmamıştır. Y kromozom mikrodelesyonu olan hastaların, birinin azoospermik olmak üzere ortalama sperm sayılarının 24.8 milyon/ml olduğu saptanmıştır. Sonuç: Y kromozomu mikrodelesyonları varikoselli hastalarda da görülebilen ve fertiliteyi etkileyen nedenlerden biridir. Varikoseli olan hastalarda fertilite değerlendirmesi yapılırken, Y kromozom mikrodelesyon olasılığının göz önünde bulundurulması uygun olacaktır. Özellikle post-operatif sperm sayısında artış olmayan varikoselli hastalarda, infertiliteden Y kromozom mikrodelesyonları sorumlu olabilir. Bu şekilde hem infertilite nedeni ortaya konabilecek, hem de varikoselektomi sonrası fertilitenin sağlanması için kullanılacak en uygun yardımcı üreme tekniğinin seçiminde yol gösterici olacaktır.Introduction: The pathological factors cause spermatogenesis arrest in varicocele patients still remain unknown. In these patients, both testiculopathies and Y chromosome long arm deletions affect spermatogenesis. Y chromosome microdeletions are known to be responsible for oligozoospermia and azoospermia. In this study, the relation between Y chromosome microdeletion and infertily in varicocele patients aimed to be investigated. Patients and methods:, Thirty-two varicocele patients (14 fertile and 18 infertile) were included in this study. All patients semen analysis were employed and screening for microdeletions in Azospermia Factor-a (AZF-a), Azospermia Factor-b (AZF-b), Azospermia Factor-c (AZF-c) were performed. Results: The sperm count of infertil group (3 of 18 had azoospermia) was between 0-104 million/ml (mean 37.1 million/ml), fertile group’s sperm count was between 7.5-192 million/ml (mean 75.8 million/ml). While 4 patients of infertil group had Azospermia Factor-a and Azospermia Factor-b microdeletions, no microdeletion was determined in fertile group. The mean sperm count of 4 patients with microdeletion (one azoospermic) were 24.8 million/ml. Conclusion: Y chromosome microdeletion can be found in varicocele patients and one of the reasons of infertility. When evaluate the fertility in varicocele patients, Y chromosome microdeletion suggested to be taken into consideration. Y choromosome microdeletions could be the reason of infertility in patient with varicocele whose sperm count did not increase after operation. Therefore, not only the cause of infertility would be established, but also the appropriate assisted reproductive technologies would be chosen after varicocelectomy

Can mycoplasma contribute to formation of prostate cancer?

To reveal the possible role of mycoplasmas in the etiopathogenesis of prostate cancer

A multicenter-based critical analysis of laser settings during intrarenal laser lithotripsy by the Turkish academy of urology prospective study group (ACUP study)

Objective: In this multicenter prospective study, we aimed to evaluate the use of holmium:yttrium aluminum garnet laser during retrograde intrarenal surgery for kidney stones and the relationship between laser-related parameters and procedure-related perioperative parameters. Material and methods: The 769 patients whose laser setting parameters (fiber thickness, number of shots, frequency (max.), laser power (max.), and total energy) were completely registered were included in this study program. The intraoperative ureteral lesions were evaluated using postureteroscopic lesion scale (PULS) scores and the postoperative complications with the modified Clavien-Dindo classification system. Results: The maximum levels of laser power and the frequency were used in the middle calyceal stones; the value of total energy consumed was found to be higher gain in cases with multiple stones (all parameters P < .05). There was a significant positive correlation among (mean number of shots [P < .001, r = 0.46], frequency [P = .009, r = 0.1], maximum power [P < .001, r = 0.11], total energy [P < .001, r = 0.25]), anesthesia time (P < .001, r - 0.42), surgery time (P < .001, r - 0.47), and stone size. The mean number of shots increased (P < .001, r = 0.25), and the frequency level decreased (P < .001, r = -0.17) significantly with increasing Hounsfield unit (HU) values. Again, the mean number of shots and maximum laser power increased in correlation with the increasing hospitalization time (P = .004, r = 0.09 and P = .02, r = 0.07, respectively). In addition, it was observed that higher laser subparameter values and thicker fibers were used in PULS grade 2. Conclusion: As the stone size and HU values increased, laser-setting parameters were found to show significant variability. The increase in different parameters of the laser setting was found to be associated with longer anesthesia time, surgery time, and hospitalization period and increased risk of local trauma with PULS grade