SPORADIC BLADDER PARAGANGLIOMA: A CASE REPORT

Anemisi nedeniyle araştırılırken mesanede kitle saptanan 58 yaşındaki bayan hastadatransüretral kitle rezeksiyonu sonrasında mesane paraganglioması tanısı konulmuş veolgu literatür eşliğinde tartışılmıştır.A 58-year-old female patient was diagnosed to have a bladder mass during theinvestigating for occult anemia. Transurethral resection of the bladder tumor wasperformed which revealed paraganglioma of the bladder on the final pathologicexamination. The case and the literature was discussed

Comparison of Efficacy and Complications of Holmium Laser and Pneumatic Lithotripters Used in the Ureterorenoscopic Treatment of Proximal Ureter Stones, a Multi-Center Study of Society of Urological Surgery Aegean Study Group

Objective:The aim of this study is to compare the efficacy and complications of holmium laser and pneumatic lithotripsy used in the ureterorenoscopic treatment of proximal ureteral stones.Materials and Methods:Data of 638 patients, who underwent ureterorenoscopy (URS) due to proximal ureteral stones in different centers, were obtained from patient files. The patients were divided into two groups according to the type of lithotripter used: group 1; laser lithotripter (n=324; 50.8%) and group 2; pneumatic lithotripter (n=314; 49.2%). URS was considered successful upon determination stone-free status with the imaging methods after treatment. The effectiveness and the complications of holmium:yttrium-aluminum-garnet laser and pneumatic lithotripsy were compared.Results:The total success rate of URS was 82.6% and the complication rate was 8.1%. The mean age of patients was similar between the groups; however, the body mass index values, stone surface area and stone Hounsfield unit were significantly higher in group 1. Although the mean operative time, complication rate and the mean length of hospital stay were similar between the groups; the URS success and postoperative ureteral J stent use rates were significantly higher in group 1 and the push-back rate was significantly higher in group 2.Conclusion:If laser lithotripsy is available in a clinic, we believe that it is better to use it as the first option in the treatment of proximal ureter stones. However, considering that it is not easy to access laser lithotripters due to their high cost in Turkey, pneumatic lithotripters may be an effective and inexpensive alternative that can also be safely used in these cases

Effect of the Anesthetic Method on the Outcomes of Ureteroscopy for Proximal Ureteral Stones: A Multi-center Study of the Society of Urological Surgery Aegean Study Group

Objective:To analyze the effect of the anesthesia method (spinal and general) on the outcome of ureteroscopy (URS) in patients treated for proximal ureteral stones.Materials and Methods:Patients, who underwent URS for proximal ureteral stones at various urology clinics in Turkiye, were included in the study. The patients were divided into two groups according to the anesthesia method performed; the procedure was performed under spinal anesthesia (SA) in group 1 and general anesthesia (GA) in group 2. Patients’ demographic, perioperative data and complication rates were compared between the two groups in a retrospective manner.Results:There were 309 and 329 patients in groups 1 and 2, respectively. The mean stone area and Hounsfield unit in GA group were higher (p0.05). The rate of success of URS, which is accepted as complete stone-free status, was higher in the SA group (p=0.041).Conclusion:URS, which is used in the treatment of proximal ureteral stones, has a high success rate, independent of the anesthesia method used. It is important to keep in mind the patient’s comorbidities prior to selecting the anesthesia method and that the stone area and the Hounsfield unit are the important factors affecting the outcomes

Impact of pelvic biometric measurements and visceral obesity on complications after open radical prostatectomy

Giriş ve Amaç: Çalışmamızda bilgisayarlı tomografi (BT) kullanılarak yapılan pelvik ölçümler, visseral ve cilt altı yağ alanlarının radikal retropubik prostatektomi (RRP) üçlü başarı (kanser kontrolü, kontinans, potens) ve cerrahi sınır pozitifliklerini öngörmede fayda sağlayıp sağlamayacağını araştırmayı amaçladık. Gereç ve Yöntemler: 2005-2011 tarihleri arasında kliniğimizde lokalize prostat kanseri tanısıyla RRP yapılan ve operasyon öncesi evreleme amaçlı abdominal BT?si bulunan 270 hasta çalışmaya dahil edildi. Pelvik ölçümleri ve visseral, subkutan yağ alanı ölçümleri yapıldı. Üçlü başarı sonuçlarına ve cerrahi sınır sonuçlarına göre tek değişkenli ve çok değişkenli istatistiksel analizler yapıldı. Prostat volümü, vücut kitle indeksi ve D?Amico risk sınıflamasına göre alt grup analizleri de yapıldı. Bulgular: Yapılan tek değişkenli istatistiksel analiz sonuçlarına göre üçlü başarının gerçekleştiği hastalar daha genç, prostat spesifik antijen (PSA) değerleri daha düşük, simfizis açıları daha geniş, prostat genişliği daha dar, yumuşak doku mesafesi daha dar ve interfemoral indeksleri daha düşüktü (p<0,05). Tek değişkenli analizlere göre cerrahi sınır pozitif gelen hastalar daha yaşlı PSA değerleri daha yüksek, prostat volümleri daha küçük ve prostat genişlikleri daha dar bulunmuştur (p<0,05). Alt grup analizlerine göre üçlü başarının gerçekleştiği hastalarda; prostat volümü>60 cm3 ise yumuşak doku indeksi(yumuşak doku mesafesinin prostat derinliğine oranı) daha düşük, vücut kitle indeksi<25 kg/m2 ise interfemoral indeks (prostat genişliğinin interfemoral pelvik mesafeye oranı) ve visseral yağ alanı daha düşük, D?Amico risk sınıflamasına göre düşük risk sınıflamasında ise interfemoral indeks (prostat genişliğinin interfemoral pelvik mesafeye oranı) daha düşük olarak bulunmuştur (P < 0.05). Çok değişkenli istatistiksel analiz sonuçlarına göre üçlü başarının gerçekleştiği hasta grubunda PSA ve simfizis açısı, cerrahi sınır açısından değerlendirilen hastalarda is PSA istatistiksel olarak anlamlı bulunmuştur (P < 0.05). Sonuç ve Öneriler: Dar simfizis açısı üçlü başarı başarısızlığı için bağımsız bir risk faktörüdür. Pelvik ölçümler ve visseral yağ alanı hesaplamaları RRP öncesi planlamada faydalı olabilir. Objective: To investigate the impact of pelvic biometric measurements, visceral and subcutaneous adipose tissue areas on trifecta outcomes (cancer control, continence, and potency) and surgical magrin status after open radical retropubic prostatectomy. Method: A retrospective study was performed on 270 patients who were diagnosed as clinically localized prostate cancer between 2005-2011 and had computed tomography imaging before radical retropubic prostatectomy operations. Pelvic bony and soft tissue measurements, the area of visceral and subcutaneous adipose tissue calculations were performed. Patients were evaluated for trifecta outcomes and surgical magrin status on univariate and multivariate analyses. Subgroup analysis was performed for prostate volume, body mass index (BMI) and D'Amico risk classification. Results: The age of the patient, pre-operative prostate specific antigen value, symphysis pubis angle and the ratio of width of prostate to bony femoral width (prostate/femoral width), demonstrated significance for trifecta outcomes (P < 0.05). Soft tissue index (ratio of soft tissue width of narrowest distance between the levator muscles to apical depth of the prostate) was statistically significantly lower when prostate volume > 60 cm3 (P < 0.05). Visceral adipose tissue area and prostate/femoral width showed significance when BMI < 25 kg/cm2 (P < 0.05). In the low risk group of D?Amico classification, prostate/femoral width was significantly lower (P < 0.05). The age of the patient, pre-operative prostate specific antigen value, prostate volume and width of prostate demonstrated significance for surgical magrin status (P < 0.05). On multivariate analyses pre-operative prostate specific antigen value, symphysis pubis angle demonstrated significance for trifecta outcomes (P < 0.05) and pre-operative prostate specific antigen value demonstrated significance for surgical magrin status (P < 0.05). Conclusions: Narrow symphysis angle is an independent risk factor for trifecta failure. Pelvic biometric measurements and visceral fat area might help preoperative planning and management of radical prostatectomy