Influence of age, menopause, pelvic muscle exercises, urethral hypermobility and concomitant surgery on the outcomes after the transobturator tape procedure (factors effecting TOT outcomes)

KUMRU, Selahattin/0000-0001-6615-7666WOS: 000319488100004Objectives: We evaluated age, menopause, Q-tip and urinary stress tests performed on an outpatient basis before the transobturator tape (TOT) procedure, preoperative Kegel exercises, and vaginal surgeries performed concomitantly with the TOT procedure for their impact on symptomatic relief and complications in patients undergoing the TOT procedure. Aim of the study: Data including age, parity, menopausal status, concomitant vaginal surgery, complications, whether or not preoperative Kegel exercises were administered and urinary (cough) stress test and Q-tip test were performed, were retrieved from the patient charts and hospital records. Material and methods: The medical records of women, who underwent the TOT procedure for SUI in the Department of Obstetrics and Gynecology in Bucak State Hospital between January 2009 and November 2012 were reviewed. Results: No significant difference was observed between patients below and at or above 50 years of age in terms of success rate and complication rate (p = 1.00 and p = 0.351, respectively). There was a tendency for menopausal women to have a higher success rate (93.3% vs. 75%), this did not reach a statistical significance (p = 0.09). Urethral hypermobility did not significantly influence the success rate and complication rate (p = 0.694). Kegel exercises did not significantly influence the success rate and complication rate (p = 0.694). Vaginal surgeries performed concomitantly with the TOT procedure did not significantly influence complication rate (p = 0.454). Conclusions: The TOT procedure brings about the high success and low complication rates. Prospective, randomized, controlled studies on a larger number of patients are needed to clearly identify factors that would raise the success rate and reduce the complication rate

Böbrek tümörlü hastalarda VHL gen mutasyonu - Üroonkoloji

Objective: This study aimed to determine VHL gene mutations and the relation of these mutations to type and pathological stage of renal tumors. Materials and methods: Forty patients (20 males, 20 females; mean age 59 years) who underwent ablative surgery for renal tumor prediagnosis between February 2009-November 2009 in of Ege University School of Medicine, Department of Urology were randomly selected. Twenty-nine of the patients underwent radical nephrectomy, 5 underwent partial nephrectomy, and 2 patients underwent laparoscopic radical nephrectomy. Four patients whose pathological outcome was not malign kidney tumor have been excluded from the study. Thirty-eight patients (21 males, 16 females; mean age 61 years) who underwent any surgeries in Department of Urology and showed no malignance suspicion in the same time period were included in control group. VHL gen mutations were analyzed preoperatively. Results: According to 2002 TNM staging, 8 (22%) patients were T1a, 11 (31%) patients were T1b, 3 (8%) patients were T2, 9 (25%) patients were T3a, 3 (8%) patients were T3b, and 2 (6%) patients were T4 stage. Twenty-eight (78%) patients were N0, 5 (14%) patients were N1, and 3 (8%) patients were N2. Five (14%) patients was at M1 stage. Histologically, 18 (50%) patients had clear cell carcinoma, 3 (8.3%) patients had chromofob cell carcinoma, and 3 (8.3%) patients had papillary cell type 1 carcinoma. Genetic analysis showed that 6 individuals had heterozygote change described previously as mutation (Q167Q and V181V linked heterozygote in 2 patients, P61P heterozygote in 2 patients, L129L heterozygote in 1 patient, and P61P heterozygote in 1 patient). None of these changes resulted in the change of aminoacids. Conclusion: VHL gene mutation was not detected in our study population, which may be result of the genetical characteristics of Turkish population or small sample size. The present study would be a pioneer for future studies on tumor tissue and VHL gene polymorphism in Turkish population.Amaç: Bu çalışma ile böbrek tümöründe VHL geninde mutasyonların ve bu mutasyonlar ile tümör tipi ve patolojik evre arasındaki ilişkinin belirlenmesi amaçlanmıştır. Gereç ve yöntem: Şubat 2009-Kasım 2009 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hastanesi Üroloji Anabilim Dalı’nda böbrek tümörü ön tanısıyla ablatif cerrahi uygulanan 40 hasta (20 erkek, 20 kadın; yaş ortalaması 59) rastgele seçildi. Hastaların 29’una açık radikal nefrektomi, 5’ine açık parsiyel nefrektomi, 2’sine ise laparoskopik radikal nefrektomi yapıldı. Patoloji sonucu malign böbrek tümörü gelmeyen 4 hasta çalışma dışı bırakıldı. Aynı dönemde üroloji kliniğinde opere edilen ve malignite kuşkusu uyandıracak bulgusu olmayan 37 hasta (21 erkek, 16 kadın; yaş ortalaması 61) kontrol grubu olarak belirlendi. Preoperatif dönemde VHL gen mutasyonları incelendi. Bulgular: Tümörlerin 2002 TNM evrelemesi; 8 (%22) hastada T1a, 11 (%31) hastada T1b, 3 (%8) hastada T2, 9 (%25) hastada T3a, 3 (%8) hastada T3b, 2 (%6) hastada ise T4 idi. Hastaların 28’i (%78) N0, 5’i (%14) N1, 3’ü (%8) ise N2 olarak değerlendirilirken, 5 (%14) hasta M1 olarak tespit edildi. Histolojik olarak 18 (%50) hastada şeffaf hücreli karsinom, 3 (%8.3) hastada kromofob hücreli karsinom, 3 (%8.3) hastada papiller tip 1 karsinom saptandı. Genetik olarak 6 hastada daha önce mutasyon olarak tanımlanmamış heterozigot değişiklik (2 hastada Q167Q ve V181V birleşik heterozigotluğu, 2 hastada P61P heterozigotluğu, 1 hastada L129L heterozigotluğu, 1 hastada P61P heterozigotluğu) görüldü. Bu değişikliklerin hiçbirisi aminoasit değişikliğine neden olmadı. Sonuç: Çalışmamızda hiçbir hastada VHL mutasyonu saptanmadı. Bu durum Türklerin genetik yapısındaki farklılığa ya da hasta sayısının az olmasına bağlanabilir. Sunulan çalışma, ilerde yapılacak tümör dokusu ve Türk popülasyonunda VHL gen polimorfizmi çalışmaları için öncü olacaktır

Which one is safer - performing a laparoscopic hysterectomy with a tissue fusion device involving diagnostic cystoscopy or traditional abdominal hysterectomy with ureteral dissection?

KUMRU, Selahattin/0000-0001-6615-7666;WOS: 000329768500003PubMed: 24501597Introduction: It still remains an unanswered question whether, in the absence of gynecological malignancy and under elective conditions, to perform abdominal hysterectomy (AH), offering a safer approach, or to perform a laparoscopic hysterectomy (LH) procedure. Aim: We aimed to compare LH operations performed with a tissue fusion device accompanied by intraoperative diagnostic cystoscopy with traditional AH operations involving bilateral ureteral dissection. Material and methods: The integrity of the ureters, ureteral peristalsis and the diameter of the ureters were examined during AH by inspection. At the end of LH, the bladder wall was systematically evaluated by cystoscopy and a jet of urine spurting was noted from both ureteral orifices. Results: The operation time was longer in patients who underwent LH + CYS (p = 0.0001). The decline in hematocrit and hemoglobin levels in the postoperative period was significantly higher in patients who underwent AH + UD (p = 0.0001 and p = 0.002, respectively). No significant difference was found between the two groups in terms of ureteral injury, bowel injury or bladder injury (p = 0.378, p = 1.000 and p = 1.000, respectively). There was no statistically significant difference between the two groups in terms of mean body temperature and postoperative blood transfusion requirements (p = 0.051 and p = 0.210, respectively). Mean parenteral analgesic requirement and length of hospital stay were significantly different between the groups (p = 0.005 and p = 0.0001). No statistically significant difference was found between the two groups in terms of postoperative cardiopulmonary complications, re-operation rate or occurrence of genitourinary fistula (p = 1.000, p = 1.000 and p = 1.000, respectively). Conclusions: We concluded that LH performed with a tissue fusion device involving diagnostic cystoscopy yields major and minor complication rates similar to safely performed AH operations preserving ureters

Erkek infertilitesinde metiyonin sentaz A2756G ve metiyonin sentaz redüktaz A66G gen polimorfizmlerinin etkisi

Objective: In this study, we investigated whether methionine synthase (MTR) A2756G and methionine synthase reductase (MTRR) A66G gene polymorphisms were related with infertility. Materials and methods: Blood samples of 117 infertile (66 azoospermia, 51 oligozoospermia) cases and 70 healthy men were collected and genotyped for MTR A2756G and MTRR A66G polymorphisms. Results: In control and study groups MTR A2756G genotypes were 64% AA, 34% AG, 1% GG and 54% AA, 39% AG, 7% GG , respectively, and the frequency of the G allele in the study group was increased compared to control group (p;lt;0.05). MTRR A66G genotypes were 9% AA, 79% AG, 13% GG in control group and 4% AA, 73% AG, 23% GG in control group without statistically significant difference (p;gt;0.05). Conclusion: MTR A2756G gene polymorphism may have an important effect on the evolution of male infertility. Finding of increased G allele frequency of study group will lead to further and larger sample-size studies.Amaç: Bu çalışmada metiyonin sentaz (MTR) ve metiyonin sentaz redüktaz (MTRR) A2756G ve A66G gen polimorfizmlerinin infertilite ile ilişkisinin olup olmadığı araştırılmıştır. Gereç ve yöntem: Bu amaçla 66 azospermi ve 51 oligozoospermi olmak üzere toplam 117 infertilite olgusu ile 70 sağlıklı bireyin kan örnekleri toplanarak MTR A2756G ve MTRR A66G genotiplendirmeleri yapılmıştır. Bulgular: Kontrol ve çalışma grubunda MTR A2756G genotipleri sırasıyla %64 AA, %34 AG, %1 GG ve %54 AA, %39 AG, %7 GG olup, G allelinin artışı kontrol grubuna oranla çalışma grubunda istatistiksel olarak anlamlı bulunmuştur (p0.05). MTRR A66G genotipleri açısından analiz edildiğinde gruplar arasında anlamlı fark gözlenmemiştir (kontrol ve çalışma grubu için sırasıyla %9 AA, %79 AG, %13 GG ve %4 AA, %73 AG, %23 GG, p>0.05). Sonuç: Erkek infertilitesi gelişiminde MTR A2756G polimorfizminde G allelin sadece hasta grubunda yüksek bulunması daha ileri ve yüksek hasta sayılı çalışmalara ışık tutacaktır