Vesicourethral anastomosis including rhabdosphincter in retropubic radical prostatectomy: Technique and results

Objective: Retropubic radical prostatectomy (RRP) is still widely used in clinical practice in localized prostate cancer because of its high oncological success. The aim of this study was to define the continence status in patients where rhabdosphincter was included in the vesicourethral anastomosis. Materials and methods: Between November 2004 and September 2010, 90 cases who underwent RRP by the same surgeon in our clinic were taken into the study. In all cases vesicourethral anastomosis was performed include the rhabdosphincter. The anastomosis was performed with mean 2.9 (0-7) interrupted no 2-0 vicryl sutures, depending on the angulation of symphysis pubis and pelvic cavity. Pad test was performed to all patients at 1, 3, 6 and 12 months postoperatively. We defined patients as ‘continent’ when they no need pad, as ‘mild incontinence’ when they use only one pad daily, as ‘moderate incontinence’ when they use two or three pads daily and as ‘severe incontinence’ when they use more than three pads daily. Results: Preoperative total PSA value was 12.2 ng/ml (range: 2.7-84 ng/ml). Preoperative prostate biopsy results were found that Gleason scores were 5, 6, 7 and 8 in 7, 53, 21, 9 patients, respectively. Mean operation and urethral catheter removal time was 103 minutes (60-200) and 14,6 days (9-28), respectively. Mean hospital stay was 4.6 days (2-20). According to results of postoperative pad tests, 38 (42.2%), 48 (53.3%), 55 (61.1%) and 75 (83.3%) patients were defined as continent in first, third, sixth and twelfth months, respectively. Conclusions: We think that, our novel technique of vesicourethral anastomosis in standard RRP provides more optimal urethral position during fixation of pelvic floor and urethra, protect caudal retraction, preserve functional urethral length. Also strong full thickness stitch on urethra provides better urinary continence by hanging urethra in our patients. Although our early continence rate is better, our long term continence rate is similar to literature

Determining Residual Shear Strength With Reversal Shear Box Test

Tez (Yüksek Lisans) -- İstanbul Teknik Üniversitesi, Fen Bilimleri Enstitüsü, 2009Thesis (M.Sc.) -- İstanbul Technical University, Institute of Science and Technology, 2009Bu çalışma kapsamında kalıcı kayma mukavemeti parametrelerini belirleyebilmek için farklı kıvam limitlerine ve kil yüzdelerine sahip örselenmemiş zemin numuneleri üzerinde farklı gerilmeler altında tekrarlı kesme kutusu deneyleri yapılmıştır. Deneyler sonucunda elde edilen kalıcı kayma mukavemeti açılarının zeminlerin endeks özellikleri ile ilişkileri incelenmiştir. Pratik amaçlar doğrultusunda, kalıcı kayma mukavemeti açısını zeminlerin endeks özelliklerine bağlı olarak kolayca tahmin edebilmek için korelasyonlar geliştirilmiştir. Ayrıca tekrarlı kesme kutusu sonucuyla karşılaştırma yapmak amacıyla bir zemin numunesi üzerinde halka kesme deneyi gerçekleştirilmiştir. Deney yönteminin farklı olmasından dolayı yapılan tekrarlı kesme kutusu deney sonucunun halka kesme deneyinden büyük olduğu görülmüştür. Diğer yandan, kalıcı kayma mukavemeti açısının artan likit limit, plastisite indisi ve A hattına uzaklıkla likit limitin toplamı ile azaldığı ve bu ilişkilerin yüksek korelasyon katsayısına sahip olduğu belirlenmiştir. Deney sonuçları ile literatürdeki çalışmalar karşılaştırıldığında mühendislik açısından yeter yakınsaklığı sağlamakta olduğu görülmüştür.In this study, reversal shear box tests were carried out on undisturbed soil samples having different consistency limits and clay fractions in different effective normal stress value to determine the residual shear strength parameters. Residual shear strength angles of soils were determined from reversal shear box tests. The relationships between residual shear strength angles and index properties of soils were searched. For pratical aims, the correlations of the relationships were developed to determine residual shear strength angles due to the index properties of soils. Additionally, ring shear test was carried out on the one soil sample for comparing the results obtained from the reversal shear box test. The result of reversal shear box test was higher than ring shear test result because of different test types. Furthermore, it was observed that residual shear strength angle was decreasing while liquid limit, plasticity index and the total of liquid limit and distance to the A line were increasing. Also, the coefficients of these relationships were high. The comparison of the results with the exampes given in the literature was in a good agreement.Yüksek LisansM.Sc

Assessment of clinical features and renal functions in Coronavirus disease-19: A retrospective analysis of 96 patients

Background The most common extra pulmonary organ dysfunction in acute respiratory distress syndrome is acute kidney injury. Current data so far indicate low incidence of AKI in Covid-19 disease. Objective In this retrospective study, we analysed the clinical features of patients diagnosed with Covid-19 and investigated the effect of Covid-19 on kidney function. Methods Ninety-six patients diagnosed with Covid-19 were included in our study. Demographic features (Age, gender, co-morbidities), symptoms, thorax CT findings, Covid-19 PCR results and laboratory findings were recorded. The clinical features of the patients were analysed and kidney function values before Covid-19 diagnosis were compared with kidney function values after Covid-19 diagnosis. Results Most presenting symptom was fever (51%). Most accompanying co-morbidity was hypertension (56%). According to laboratory findings; ferritin, D-dimer and C-reactive protein levels were statistically significantly higher in ARDS group than severe pneumonia and pneumonia group (P = .002,P = .001 andP < .001, respectively). Also lymphocyte levels were statistically significantly lower in ARDS group than severe pneumonia and pneumonia group (P = .042). According to KDIGO criteria 3 (3.1%) patients had AKI during the hospital stay. For all patients, there was statistically significant difference between basal, 1st, 5th and 10th day BUN and SCr levels (P = .024 andP = .018, respectively). For severe pneumonia group there was statistically significant difference between basal, 1st, 5th and 10th day SCr levels (P = .045). Conclusion Our study demonstrated that Covid-19 can cause renal impairment both with pneumonia and ARDS. A large-scale prospective randomised studies are needed to reach final judgement about this topic

What is the correct staging and treatment strategy for locally advanced prostate cancer extending to the bladder?

In locally advanced prostate cancer with bladder invasion, frequently encountered problems such as bleeding, urinary retention, hydronephrosis, and pain create distress for the patients. Therefore patients’ quality of life is disrupted and duration of hospitalization is prolonged. Relevant literature about accurate staging and treatment of locally advanced prostate cancer with bladder invasion was investigated. Locally advanced prostate cancer can present as a large-volume aggressive tumor extending beyond boundaries of prostate gland, and involving neighboring structures which can be involved as recurrence(s) following initial local therapy. Survival times of these patients can range between 5 and 8 years. Their common characteristics are adverse and severe local symptoms unfavorably affecting quality of life Control of local symptoms and their effective palliation are independent clinical targets influencing survival outcomes of these patients. The treatment outcomes of locally advanced prostate cancer into the bladder are currently debatable. Although in the current TNM classification, it is defined in T4a, we think that this may be categorized as a subgroup of T3 and thus encourage surgeons for the indication of radical surgeries (radical prostatectomy, radical cystoprostatectomy) in selected patient populations after discussing issues concerning consequences of the treatment alternatives, and expectations with the patients. Cystoprostatectomy followed by immediate androgen deprivation therapy may be a feasible option for selected patients with previously untreated prostate cancer involving the bladder neck because of excellent local control and long term survival

Treatment of tuberculous ureteritis. What is the appropriate time for invasive treatment? A case report and review of literature

We report a case of isolated distal ureter tuberculosis who presented with irritative voiding symptoms treated with sole medical therapy and discuss the clinical, imaging, diagnostic and therapeutical features. In case of irritative voiding symptoms and radiological presentation of ureteral pathologies, genitourinary tuberculosis should be considered in the differential diagnosis. We believe that medical therapy should be the main option before the invasive procedures

The relationships between metabolic syndrome, erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia

WOS: 000360378600002PubMed ID: 26328190Amaç: Benign prostat hiperplazisi (BPH) nedeni ile alt üriner sistem semptomları (AÜSS) olan hastalarda, erektil disfonksiyon (ED) ve metabolik sendrom (MetS) arasındaki ilişkinin belirlenmesi amaçlanmıştır. Gereç ve yöntemler: Polikliniğimize BPH’ya bağlı AÜSS nedeniyle başvuran 40 yaş üstü 78 hasta çalışmaya kabul edildi. Hastalara AÜSS ve ED değerlendirilmesi için sırası ile uluslararası prostat semptom skoru (IPSS), Uluslararası erektil fonksiyon indeksi (IIEF-5) formları dolduruldu. MetS tanısı için the National Cholesterol Education Program Adult Treatment Panel III kriteri kullanıldı. AÜSS, IPSS’a göre hafif, orta ve şiddetli olarak, ED ise IIEF-5 skoruna göre ise hafif, orta-hafif, orta, şiddetli gruplarına ayrılarak incelendi. Bu üç durumun birbirleri ile ve yaşa göre ilişkilerin değerlendirilmesinde Student’s t test, Mann-Whitney U, ANOVA, ki-kare, Fisher Exact testi ve Pearson korelasyon analizi kullanıldı. P0.05). There was a positive correlation with age and severity of LUTS but this relationship was not found to be statistically significant (p>0.05). Mean age of the patients with ED was significantly higher than those without (p<0.001). A statistically significant relationship was not observed between the mean IPSS scores and the severity of LUTS with Mets. However, we observed a weakly positive correlation between triglyceride levels and IPSS. Mean IIEF-5 scores of the patients with MetS were significantly lower than those of the patients without MetS. Severity of ED in the patients with MetS was significantly higher than patients without MetS. The percentage of ED in patients with severe LUTS was found to be statistically higher than other patients with mild, and moderate LUTS. In addition, we found a low degree of negative correlation between IPSS and IIEF-5 scores. Conclusion: In patients with LUTS as a consequence of BPH, when severity of symptoms increases, frequency of MetS increases proportionally and severe ED is observed much more frequently

Lower pole renal cut injury due to the iliac wing fracture: A rare case report

The most frequent causes of blunt genitourinary injuries are falls from heights, motor vehicle accidents and sports injuries. Firearm injuries and penetrating stab wounds are also frequently encountered. Skeletal system traumas in the vicinity of the urogenital system can cause urological organ injuries. Though rarely, renal traumas can be dependent on the kinetic energy of the trauma and the retroperitoneal movement capacity of the kidneys and cannot be explained with the proximity of the kidney to the skeletal system. In cases with high-energy decelerations, renal pedicle and ureteropelvic junction traumas are more frequently observed. Herein, we presented a grade 3 left kidney lower pole injury developed secondary to A2 type pelvic fracture following a high energy deceleration trauma. It should not be forgotten that especially in this type of fractures, injuries of the lower renal pole can occur

Extraintestinal gastrointestinal stromal tumor of undetermined origin: Is the mass resection a wrong approach? A case report and review of the literature

Gastrointestinal stromal tumor (GIST) was first defined by Mazur et al. in 1983. GIST is evaluated among tumoral lesions that can be acquired or congenital. Those not associated with gastrointestinal system are termed as extragastrointestinal stromal tumor (EGIST). EGISTs can develop on intraperitoneal spaces as omentum, mesenterium and gallbladder and they can occur on retroperitoneum, extraperitoneal (prostate) and intrapelvic organs. Herein, we present a case with EGIST in a 65-year-old male patient located in intrapelvic and retroprostatic area which had no connection with gastrointestinal system as assessed by radiological methods and we discuss its treatment. We reviewed the literature and observed that ours is the first case report on a patient in which the mass was only extirpated rather than performing radical surgery. He is still at the 2. year of his follow-up period without any disease recurrence

Contralateral tumor seeding of renal cell carcinoma mimicking late metastasis of liver after laparoscopic nephrectomy: A case report with review of the literature

Laparoscopic surgery has been increasingly used every day in the management of urologic malignancies. Even though it seems as a minimally invasive surgery, during these interventions tumor seeding, as seen in open surgery, confronts us as a rarely seen serious risk. Herein, we have reported a case who demonstrated peritoneal tumor implantation at 12 month postoperative follow up after laparoscopic radical nephrectomy (LRN) performed for Furhman grade 1 (T2N0M0) renal cell cancer