Percutaneous Nephrolithotomy in Rare Bleeding Disorders: A Case Report and Review of the Literature

Surgery in patients with congenital or acquired coagulation defects has always been challenging and requires special care with a multidisciplinary approach. Percutaneous nephrolithotomy (PCNL) is a standard procedure performed in patients with kidney stones. Although prone to bleeding more than most of the widely performed surgical procedures, there are not much data regarding PCNL in patients with bleeding disorders or coagulation defects. There are only case reports or series with a small number of patients for the patients with common coagulation defects, including hemophilias. Moreover, there are no reports about PCNL in rare bleeding disorders. In this study, we reported a case referred for kidney stone treatment and diagnosed as Factor VII deficiency during preoperative evaluation. Because it is one of the rare bleeding disorders, we also reviewed the literature in this field

Importance of emergency department waiting period in Fournier's Gangrene; 10 years of experience

Background Fournier's gangrene (FG) is a disease with high mortality rate. The first diagnosis is performed in the emergency department (ED). In this study, we investigated the importance of the time period for diagnosis in the ED. Methods The data of patients who were treated for FG between 1 January 2010 and 2020 were retrospectively analysed. Waiting period of the patients in ED was calculated. Risk factor score calculations were calculated to predict FG mortality and prognosis. The effects of the ED waiting period on the duration of admission to the hospital, the number of debridements and mortality status and relationship with FG mortality risk factor scores were investigated. Results In a 10-year period, a total of 66 patients were included in the study. It was found that the median age of the patients was 56 years. ED waiting period median (IQR) was 105 (115) minutes. It was observed that there was a significant positive correlation between the ED waiting period, duration of admission to hospital (rs: 0.537, P .001) and patients mortality status (rs: 0.482, P .001). The ED waiting period was higher in patients with FG mortality. It was observed that the ED waiting period holds a diagnostic value in predicting mortality (P .001). The cut-off limit predicted for this value was determined as 136 minutes. Conclusion FG is a urological emergency. ED waiting period affects mortality rate and length of hospital stay. The earlier the diagnosis and treatment is conducted in the ED, the lower the mortality rate and length of stay in the hospital will be

The outcomes of three buccal mucosal graft urethroplasty techniques in women with urethral stricture disease

Aim The purpose of this paper is to present the outcomes of three buccal mucosal graft (BMG) urethroplasty techniques in female patients with urethral strictures. Methods We included all patients who had BMG urethroplasty for female urethral strictures (FUS) disease between January 2015 and June 2020. Patient age, comorbidities, stricture etiology, stricture length, the number of previous treatments, preoperative and postoperative uroflowmetry data, postvoid residual volumes, and the operation and postoperative course details were documented. Results A total of 34 patients were included in this study. There were 8 patients in vaginal-sparing inlay BMG, 12 for ventral onlay BMG, and 14 for Aybek-Zumrutbas (AZ) technique groups. The mean age of the study population was 56.1 years. The length of urethral strictures varied between one and 4.5 cm. All patients had a previous history of endoscopic treatment or dilatations. The preoperative mean maximal flow rate (Qmax) was 6.9 ml/s. The median postoperative follow-up time was 24.6 months. Twelve months after surgery, the mean Qmax was 25 (range: 14-32) ml/s. There were no significant complications in any patients. The success rates were 83.3% for ventral onlay BMG, 87.5% for vaginal-sparing, and 100% for AZ technique. Conclusions All three BMG urethroplasty techniques applied in this study had a success rate of over 80% in a median follow-up of approximately 2 years. In females, urethroplasty with BMG provided high rates of cure, and the recently described two techniques (vaginal-sparing inlay BMG, and AZ technique) showed promise in FUS treatment

Laparoscopic radical prostatectomy: a single surgeon's experience in 80 cases after 2 years of formal training

BackgroundTo assess the learning curve in laparoscopic radical prostatectomy (LRP) performed by a single surgeon who had a healthcare career as a surgical first assistant for 2 years in high-volume centers treating>150 cases per year.MethodsThe records of 80 LRP cases performed between October 2017 and August 2018 by a single surgeon were consecutively divided into four groups (groups A=first 20 cases, B=second 20 cases, C=third 20 cases, and D=last 20 cases). The groups were compared in terms of surgical and functional outcomes with a minimum follow-up of 6 months.ResultsClinical and surgical stages of the four groups were similar between groups. The operative time (126.85.48 min; P=0.001) and time of removal of the drain (1.65 +/- 0.93 days; P=0.029) were significantly lower in group D; however, hospitalization, catheterization time, and blood loss were similar between groups. The complication rate was low. No patient had a visceral injury, and there were no procedures needed to open conversion. The positive surgical margin (PSM) rates were similar between groups. In terms of continence and potency, all groups were similar at the 6th-month follow-up after surgery.Conclusions Our results showed that prior experience in laparoscopic surgery as a surgical first assistant in a high-volume center improves the learning curve and oncological and functional outcomes, and helps to minimize the complication rat

Prevalence of Daytime Urinary Incontinence and Related Risk Factors in Primary School Children in Turkey

PURPOSE: Urinary incontinence is one of the major urinary symptoms in children and adolescents and can lead to major distress for the affected children and their parents. In accordance with the definitions of the Standardization Committee of the International Children's Continence Society, daytime urinary incontinence (DUI) is uncontrollable leakage of urine during the day. The aim of this cross-sectional study was to investigate the prevalence and associated risk factors of DUI in Turkish primary school children. MATERIALS AND METHODS: The questionnaire, which covered sociodemographic variables and the voiding habits of the children, was completed by the parents of 2,353 children who were attending primary school in Denizli, a developing city of Turkey. The children's voiding habits were evaluated by use of the Dysfunctional Voiding and Incontinence Symptoms Score, which is a validated questionnaire. Children with a history of neurological or urological diseases were excluded. RESULTS: The participation rate was 91.9% (2,164 people). The overall prevalence of DUI was 8.0%. The incidence of DUI tended to decrease with increasing age and was not significantly different between genders (boys, 8.8%; girls, 7.3%; p=0.062). Age, maternal education level, family history of daytime wetting, settlement (urban/rural), history of constipation, urinary tract infection, and urgency were independent risk factors of DUI. CONCLUSIONS: Our findings showed that DUI is a common health problem in primary school children. In an effort to increase awareness of children's voiding problems and the risk factors for urinary dysfunction in the population, educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status