Our experiences on retrograde intrarenal surgery

Objective: To evaluate outcomes of the cases who had undergone retrograde intrarenal surgery (RIRS) in our clinics. Methods: Outcomes of 100 cases who had undergone RIRS because of renal stones between February 2012, and May 2013 were retrospectively evaluated. Results: Study population consisted of 35 female and 65 male patients with a mean age of 36.81(1-76) years. RIRS was performed with the indication of rest double J (D-J) stent (n=1), and renal stone (n=99). Mean stone size was 15.26 (5-27) mm. Preoperatively, 61 cases (61%) had preexisting D-J stents, while 39 (39%) cases were stentless. Access sheaths were used in 86 (86%) cases, while in 14 (14%) cases the procedure was applied without using an access sheath. Mean operative, and fluoroscopy times were 52.72 (10-120) minus, and 57.32 (10-180) seconds, respectively. Postoperatively D-J stents were implanted in 88 (88%) cases, and 12 (12%) cases were stent-free. Mean hospital time was 1.3 (1-7) days. After one month postoperatively, stone-free rate was achieved in 87 (87%) patients. Clinically insignificant residual stone fragments (CIRF) 6 (6%), and residual stones 7 (7%) were also detected. The latter group consisted of cases with horseshoe kidney (n=1), pelvic kidney (n=1), and kyphoscoliosis (n=1). Also in two case procedure was terminated prematurely, because of blurring of the vision secondary to bleeding. Apart from these patients, any preoperative complication did not develop. During follow-up period, urinary tract infection developed in 3 patients with resultant renal parenchymal damage in one patient. In one patient, D-J stent migrated into ureter. Conclusion: Retrograde intrarenal surgery is an effective and safe technique in the management of renal stones

The calibration of the percutaneous nephrolithotomy instruments used in pediatric patients with renal stones

Derginizin son sayısında (2014;41(1)) basılan “Çocuklarda başlangıç perkütan nefrolitotomi deneyimimiz” başlıklı makaleyi büyük bir ilgi ve mutlulukla okudum [1]. Bilindiği gibi perkütan taş cerrahisi (PNL) hem dünyada hem de ülkemizde çok büyük oranda üroloji hekimlerinin gerçekleştirdiği bir operasyondur. Öncelikle yazarları hem bu çalışmayı sundukları için hem de çocuk cerrahisi kliniğinde sonuçları itibarıyla oldukça başarılı bir seri gerçekleştirdikleri için tebrik ediyorum. Ancak çalışmanın metodu ile ilgili önemli bir noktayı burada dile getirmek istiyorum

Ureteral Triplication and Contralateral Duplication with Vesicoureteral Reflux

Ureteral triplication is a rare congenital anomaly of the urinary tract. Since its first description, only about 100 cases have been reported in the literature. The association of ureteral triplication and contralateral duplication is even rarer. We reported a case of ureteral triplication and contralateral duplication with vesicoureteral reflux. The patient was a five-year-old girl with a history of recurrent urinary tract infections, dysuria and lower abdominal pain. Intravenous Pyelography (IVP) showed duplication of the right ureter and triplication of the left ureter. In the cystourethrogram there was vesicoureteral reflux at the lower pole of the right kidney. The patient underwent right lower to upper ureteroureterostomy and excision of the distal ureter. This is the second report of ureteral triplication in Turkey. The literature concerning this rare anomaly was reviewed

Prematür Ejakülasyon Hastalarında Mizaç ve Karakter Farklılıkları

Giriş: Prematür ejakülasyon’un etiyolojisi ile ilgili çok miktarda biyolojik ve psikolojiteorilerin olmasına karşın tartışmalar hala sürmektedir. Mizaç ve karakter envanteile prematür ejakülasyonlu hastaların kişilik yapısını araştırmayı amaçladık. Yöntem: Kırk prematür ejakülasyonlu hasta, 40 sağlıklı kontrol grubuyla eşleştirildÇalışmaya katılanlardan mizac ve karakter envanteri ve genel demografik bilgi formunu doldurması istendi. Bulgular: Toplam yenilik arayışı ve alt ölçeği keşfetme ve heyacan duyma prematür ejakülasyonlu hastalarda kontrol grubuna göre anlamlı olarak yüksek(p<0,05). Toplam zarardan kaçınma ve alt ölçeği belirsizlik korkusu prematüejakülasyonlu hastalarda kontrol grubuna göre anlamlı olarak düşük bulund(p<0,05). Beck depresyon skorun da prematür ejakülasyonlu hastalar kontrol grubundan anlamlı olarak yüksekti. Sonuç: Prematür ejakülasyonlu kişiler daha dürtüsel (heyecanlı), daha öfkeldaha heyacanlı ve zararlı davranışlara daha az yatkındılar. Mevcut bulgular prematür ejakülasyonun nörobiyolojik ve psikolojik kökenli olduğununu desteklemeğilimindedir. (Nöropsikiyatri Arşivi 2012; 49: 332-336)ntroduction: The debate on the etiology of premature ejaculation is still ongoing although there was huge amount of biological and psychological theories. We aimed to investigate the personality structure of patients with premature ejacula- ion via temperament and character inventory. Methods: Forty patients with premature ejaculation and a matched number of healthy people were included. Participants were asked to fill out a questionnaire booklet with separate sections for general demographic information and the tem- perament and character inventory. Results: Total novelty seeking scores and subscale 1 (exploration-excitability) cores in premature ejaculation patients were significantly higher than in control groups (p<0.05). Total harm avoidance scores and harm avoidance subscale 2 (fear of uncertainty) scores in premature ejaculation patients was found significantly low- er than in control group (p<0.05). Beck depression score was significantly higher in patients with premature ejaculation than in control groups. Discussion: Men with premature ejaculation are more impulsive (excitant), more empered, more excitable and less prone to harmful behavior. Current findings tend o reinforce premature ejaculation based upon combination of neurobiological and psychological reasons. (Arc&shy;hi&shy;ves of Neu&shy;ropsy&shy;chi&shy;atry 2012; 49: 332-336

The effect of urinary system ultrasound on patient satisfaction in urology outpatient practice

In some state hospitals available imaging modalities are only X-ray and ultrasonography (USG) for urology practice. Our aim was to determine the satisfactory effects of urinary system USG in urology outpatients.We prepared a questionnaire to evaluate the satisfaction levels of the patients that admitted to our clinic with flank pain. Patients filled the questionnaire after their physical examination and treatment completed. 160 patients admitted to our clinic between January 2008 and May 2008 were enrolled in this study. We apply urine analysis and urinary system X- ray to 80 of them (Group I). Additionally urinary system USG performed to the other 80 patients (Group II) besides other laboratory workup. Two groups had similar sociodemographic characteristics (p>0.05). Responses to questions about the attitudes of the doctors and the nurses were not different between two groups (p>0.05). But patients’ confidence about the diagnosis and the treatment were found to be different between two groups (p<0.05).In conclusion, patients’ satisfaction is an important parameter for evaluation of the quality of health services. According to our results, USG increases the patient’s satisfaction in urology practice. Physicians should consider patients’ demands together with their clinical experience if they appropriate for medical ethics

Deterioration of renal function in patients operated for lower urinary tract symptoms

Amaç: Alt üriner yol semptomu nedeniyle cerrahi tedavi uygulanan hastalarda böbrek fonksiyonlarındaki bozulma oranını ve bunun hasta yaşı, semptom ciddiyeti ve eşlik eden hastalıklarla ilişkisini belirlemeyi amaçladık. Gereç ve yöntem: Polikliniğimize 01/06/2001-31/03/2005 tarihleri arasında alt üriner sistem semptomları ile başvuran ve ameliyat edilen 369 hastanın kayıtları retrospektif olarak incelendi ve muayene bulguları ile laboratuvar sonuçları kaydedildi. Bulgular: Operasyon öncesi serum kreatinin değeri ?1.4 mg/dL olan hasta sayısı 315 (%85.4), >1.4 mg/dL olanların sayısı ise 54 (%14.6) idi. Kreatinin değeri ?1.4 mg/ dL olanların yaş ortalamaları 68.64±8.24 iken, kreatinin değeri >1.4 mg/dL olanların yaş ortalamaları 72.56±7.96 olarak bulundu (p<0.05). İlerleyen yaş ile serum kreatinin değerinin arttığı, böbrek fonksiyon bozukluğunun semptom skorundaki artış ile arttığı, hipertansiyon ve diyabet gibi kronik hastalıkların varlığında böbrek yetmezliği oranlarının 2.5 kat arttığı (%25.5’e karşılık %10.9) saptandı. İşeme sonrası rezidü idrar ile böbrek fonksiyon bozukluğu arasında ilişki saptanmadı. Ayrıca renal dilatasyonun serum kreatinin seviyesi yüksekliğine eşlik ettiği kaydedildi. Sonuç: Alt üriner yol semptomu olan hastalarda böbrek yetmezliğinin erken tanısı ve tedavisi için ilk başvuru anında böbrek fonksiyonlarını gösteren serum kreatinin seviyesine mutlaka bakılmalıdır.Objective: We aimed to investigate the rate of deterioration of the renal function in patients operated for lower urinary tract symptoms, the relation between this rate and patient age, symptom severity, and accompanying diseases. Materials and methods: The data of 369 patients who admitted to our clinic with lower urinary tract symptoms and operated between 01/06/2001 and 31/03/2005 were retrospectively evaluated, and the examination findings and laboratory results have recorded. Results: The preoperative serum creatinin level was &amp;#8804;1.4 mg/dL in 315 (85.4%) patients and &gt;1.4 mg/dL in 54 (14.6%) patients. The mean age of the patients with serum creatinin level &amp;#8804;1.4 mg/dL was 68.64&plusmn;8.24 years, and that of patients with serum creatinin level &gt;1.4 mg/dL was 72.56&plusmn;7.96 years (p&lt;0.05). The level of serum creatinin increased with increasing age, and the renal function was worsened with the increase of symptom score. Also, in the presence of the chronic diseases such as hypertension and diabetes, the rate of renal dysfunction increased by 2.5 times (25.5% vs. 10.9%). There was no correlation between postvoiding residue urine and renal dysfunction. Additionally, the renal dilatation accompanied the increase in the serum creatinin level. Conclusion: In the patients with with lower urinary tract symptoms, the serum creatinin level must be evaluated at the first admission for early diagnosis and treatment of renal dysfunction

Gebe ratlara farklı dozlarda uygulanan malathionun fetüs böbrek dokusu üzerine teratojenik etkileri

Bu çalışmanın amacı gebe ratlara düşük dozlarda subakut uygulanan Malathion (ML)’un fetüs böbrek dokusu üzerine teratojenik etkisini araştırmaktır. Toplam 28 Sprague-Dawley gebe rat randomize olarak her grupta 7 adet gebe rat olacak şekilde 4 gruba ayrıldı. ML’un dozuna bağlı olarak, gruplar; kontrol, ML 2.5 (2.5 mg/kg/gün dozunda oral yoldan (p.o) ML uygulandı), ML 5 (5 mg/kg/gün, p.o) ve ML 10 (10 mg/kg/gün, p.o) olmak üzere 4 gruba ayrıldı. ML uygulamsı erkekler ve dişilerin aynı ortama konulmasından itibaren başladı (çiftleşmeden itibaren). Günlük ML uygulamasına doğuma kadar devam edildi. ML’un, dozuna paralel bir şekilde gebe ratlarda böbrek dokusu ve serum enzimleri (asetilkolinesteraz (AChE), lipaz, amilaz) üzerine toksik etkiler oluşturduğu, ayrıca yavru rat böbreklerinde ise ML’un dozuna bağlı olmayarak, tüm dozlarda teratojenik etkiye neden olduğu belirlendi. Histopatolojik veriler biyokimyasal verileri doğruladı. ML’un düşük dozlarının bile hem anne hem de yavru böbrekleri üzerine toksik ve teratojenik böbrek hasarına neden olduğu sonucuna varıldı.The aim of this study was to investigate the teratogenic effects of Malathion (ML) induced by different doses on fetal kidney tissues in pregnant rats. A total of 28 Sprague-Dawley pregnant rats were randomly divided into 4 groups of 7 rats each. Depending on ML dose, four groups were formed, including (I) control, (II) ML 2.5 (ML 2.5 mg/kg/day, orally), (III) ML 5 (5 mg/kg/day, orally), and (IV) ML 10 (10 mg/kg/day, orally). ML application started when the male and female were put together (when mating started). Daily ML application was continued until birth. It was determined that in parallel with dose of ML, ML resulted in toxic effects on serum enzymes (acetyl-cholinesterase (AChE), amylase and lipase) and kidney tissues of pregnant rats, and also -regardless of ML dose in fetal kidneys- it led to teratogenic effects in all the doses. Biochemical data wasconfirmed by histopathologic data. We concluded that ML leads to kidney damage in both pregnant and fetal rats as a result of its teratogenic and toxic effects

Erkek ratlarda renal iskemi-reperfüzyon hasarına karşı elajik asitin koruyucu etkisi

The aim of this study was to evaluate the possible protective effect of ellagic acid (EA) on rats following renal ischemia–reperfusion (I/R) injury. Twenty-four Wistar rats were divided into three groups. Sham group underwent laparotomy then waited for 45 min without ischemia. I/R group were subjected to left renal ischemia for 45 minutes followed by 60 min of reperfusion. I/R+EA group were subjected to the same renal ischemia/reperfusion as the I/R group, were also given 85 mg/kg EA perorally 30 min prior to the ischemia. Malondialdehyde (MDA), total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) were determined on the blood samples and kidney tissues. Histopathological analyses were conducted on the kidney tissues. I/R damage significantly increased serum MDA levels in the I/R group when compared with Sham group. Serum TAC level was significantly lower in I/R group than I/R+EA group. A significantly increase on OSI levels and decrease on TAC levels was found in the kidneys in I/R group. In I/R + EA group, EA reversed the negative effects of I/R injury. EA pretreatment.Bu çalışmanın amacı ratlarda renal iskemi-reperfüzyon (I/R) hasarına karşı elajik asitin (EA) olası koruyucu etkisini değerlendirmektir. Yirmi dört erkek Wistar rat; Sham, I/R ve I/R+EA olmak üzere üç gruba ayrıldı. Sham grubuna laparotomi yapıldı ve iskemi uygulanmaksızın 45 dakika bekletildi. I/R grubuna 45 dakikalık sol renal iskemiyi takiben 60 dakikalık reperfüzyon uygulandı. I/R+EA grubuna da I/R grubundakilere benzer şekilde iskemi/reperfüzyon prosedürü uygulandı, fakat iskemiden 30 dakika önce ratlara 85 mg/kg EA ağızdan verildi. Kanda ve böbrek dokusunda malondialdehit (MDA), total antioksidan kapasite (TAC), total oksidan statusu (TOS) ve oksidatif stres indeksi (OSI) bakıldı. Böbrek dokusu histopatolojik yönden incelendi. Sham grubu ile kıyaslandığında I/R grubunda serum MDA düzeyi anlamlı derecede yüksek idi. Ayrıca I/R+EA grubu ile kıyaslandığında I/R grubunda serum TAC düzeyi anlamlı derecede düşük bulundu. I/R grubunda böbrek dokusunda OSI düzeyi yüksek TAC düzeyi düşük bulunurken, I/R+EA grubunda iskemi ile oluşan etkilerin EA ile düzeldiği görüldü. EA verilmesinin tubuler nekroz skorunu azaltmada etkili olduğu bulundu. Çalışmanın sonucuna göre; EA, renal I/R hasarı sonrası meydana gelen oksidatif hasarı ve oluşan histopatolojik değişiklikleri iyileştirmektedir