Finger Asisted Laparoscopic Renal Cyst Excision:A Simple Technique

Purpose: Simple renal cysts are asymptomatic incidental findings; however, for a small subset of benign renal cysts, patients may present with pain, hematuria, recurrent infection, pyelocaliceal obstruction, or hypertension. Laparoscopic cyst ablation is an effective minimally invasive modality for the treatment of symptomatic benign renal cysts. We describe a simple laparoscopic cyst excision technique.Materials and Methods: Between June 2003 and May 2008, 28 patients underwent laparoscopic renal cyst excision via retroperitoneal approach. In our technique, retroperitoneum and Gerota’s fascia were dissected with finger blindly before insertion of the trocars to the retroperitoneal space. Following finger dissection, 3 trocars were placed and the cyst walls were excised at the level of renal cyst and base of the cysts were cauterized with electrocautery scissors.Results: Mean patients’ age was 59.3 years (range, 31 to 72 years). Mean operation duration time was 46 minutes (range, 27 to 102 minutes). Symptomatic and radiological success were achieved in 26 (92.8%) and 27 (96.4%) patients, respectively, with a median follow-up of 28 months (range, 6 to 56 months). No serious complications were encountered. Conclusion: Laparoscopy is a versatile minimally invasive modality ideal for treating benign symptomatic renal cysts. According to our experience, we think that the finger assisted laparoscopic cyst excision is an easy and noninvasive procedure

İnflamatuar kronik pelvik ağrı sendromu (Kronik prostatit evre 3A) tedavisinde antibiyotik + antiinflamatuar ve antibiyotik + alfa bloker tedavilerinin plasebo kontrollü karşılaştırılması

Kronik pelvik ağrı sendromu, etyolojisi ve patogenezi tam olarak belli olmayan ve son yıllarda giderek artan sıklıkta erkeğin karşılaştığı bir hastalıktır. Etyolojisi tam anlaşılamadığından dolayı tedavisi de oldukça tartışmalıdır.Literatürde birçok çalışma varken plasebo kontrollü çalışmalar az sayıdadır. Çalışmamızda, inflamatuar kronik pelvik ağrı sendromu tedavisinde antibiyotikle beraber kullandığımız alfa bloker ve antiinflamatuar tedavilerin etkinliğini araştırıp bunları plasebo ile karşılaştırdık. Kronik prostatit evre 3A tanısı konulan 76 hasta çalışmaya dahil edildi. Plasebo grubu 19, antibiyotik + antiinflamatuar alanlar 29 ve antibiyotik + alfa bloker alanlar 28 hastadan oluşmaktadır. Tedavi öncesi ve sonrası tüm hastalar NIH-CPSI toplam skoruna ve ağrı, işeme, yaşam kalitesi skorlarına göre tek tek değerlendirildi. Bunlardan başka ECSDF, rezidüel idrar, idrar akım hızları ve PSA değerleri karşılaştırıldı. Her üç grupta tedavi öncesi ve sonrası tüm parametreler t testi ile değerlendirildi. Her üç grupta tedavi sonrası değerler Mann Whitney -U testi ile birbirleriyle karşılaştırıldı. Hastaların yaş ortalaması 33.31 (19-51) olarak bulundu. Plasebo grubu(Grupl) tedavi öncesi ve sonrası değerleri karşılaştırıldığında ağrı, işeme ve NIH-CPSI toplam puanında ve ECSDF'da anlamlı düzelme gösterdi(p<0.05), diğer parametrelerde ise istatistiksel olarak anlamlı değişme olmadı. Grup 2'de idrar akım hızı, rezidüel idrar ve ECSDF haricinde diğer parametrelerdeki değişim istatistiksel olarak anlamlı bulundu. Grup 3'de ise tüm parametrelerde anlamlı değişim gösterildi. Her üç grup birbirleriyle karşılaştırıldığında ise grup 3'ün diğerlerinden daha anlamlı düzelme gösterdiği belirlendi. Tedaviler sonunda ciddi bir yan etki görülmedi ve hastalar tedavileri iyi tolere ettiler. Çalışmamızın sonunda kronik prostatit evre 3A tedavisinde antibiyotik ile kombine edilen alfablokör ve antiinflamatuar tedavilerinin etkili olduğunu gösterdik. Plasebonunda kısmen etkili olduğu gösterildi. Tüm tedavi protokolleri iyi tolere edildi. Alfa bloker ve antibiyotik birlikteliğinin diğer tedavilere göre daha etkili olduğu sonucuna vardık.Chronic pelvic pain syndrome is a disease of unknown etiology and pathogenesis. Recently, men have been gradually confronting with this disease. The treatment of this disease is rather discussed because of its incomplete understood etiology. While there are many studies in literature, few of them exist about placebo control group. In our study, we evaluated the effect of antibiotics together with alpha-blocker and antiinflamatory drugs; and we compared the effect of these treatments with placebo in patients with inflamatory chronic pelvic pain syndrom. Seventysix patients with diagnosed stage 3A chronic prostatitis were included in this study. Placebo group included 1 9 patients, antibiotic + antiinflamatory drug group included 29 patients, while antibiotic + alpha-blocker group composed of 28 patients. Before and after treatments all patients were evaluated separately according to NIH- CPSI total score and pain, voiding and life quality scores. In addition; IIEF, residual urine, urinary flow (Q max) and PSA values were evaluated. All parametres of the 3 groups were eveluated by t-test before and after treatments. The values of the 3 groups after treatment were compared together by Mann Whitney-U test. Patients mean age was 33.31(19-51). When we compared the pre-treatment and post treatment values of the placebo group, the pain, voiding, total NIH-CPSI score and IIEF score showed a significant improvement while there were no statistically difference in other parameters. In group 2, there were statistically significant change in all parameters except urine flow rate (Qmax), residual urine, IIEF. In group 3, all parameters showed significant change. In comparison of the 3 groups, we found that the third group showed a more significant change than the other two groups. The patients tolerated the treatment well and there were no serious side effects. In our study we found that combination of antibiotics, alpha-blockers, and antiinflamatories are effective in treatment of class 3A chronic prostatitis. The placebo has partial action. All protocols were tolerated well. Finally we concluded that alpha-blocker and antibiotic combination is found more effective than the other treatments

Ureteroscopy and Laser Lithotripsy for Treatment of Ureteral Stones in Pregnants: Single Center Experience

Objective: To report our ureteroscopic laser lithotrip­sy experiences in the treatment of symptomatic ureter stones in pregnants which do not respond to conservative treatment Methods: A total of 6 pregnants aged between 22-33 years in second or third trimester were studied. Holmium-YAG laser lithotripsy was performed with 6.5 F semirigid uretroscope. Results: The diagnosis of ureter stone was made with ab­dominal ultrasonography in 5 patients and with magnetic resonance in one patient. Adequate stone fragmentation was performed in 2 mid-ureter and 4 distal-ureter stones. J stent was applied in one patient after the fragmenta­tion process. The mean operation time was 24.8 ± 10.0 minutes after the entry of bladder with ureteroscope un­der spinal anesthesia. No urologic, anesthetic or obstetric complication was seen and all patients gave healthy birth at term. Conclusion: Fine calibrated ureteroscopes for the treat­ment of ureter stones in pregnants are fast and effective treatment modalities which decrease the operation time and remove difficulties in entering the ureter