Fracture With Urethral Injury: Evaluation by Retrograde Urethrogram

Penil fraktür nadir görülen bir durumdur. Penis ereksiyonu esnasında oluşan travma sonucu öncelikle korpus kavernozum rüptürü oluşur ve bu esnada korpus spongiozum ve üretra da etkilenebilir. 35 yaşında erkek hasta cinsel ilişki sırasında oluşan künt travma sonrasında akut penil ağrı, penil şişlik ve hematüri ile acil servise başvurdu. Acil retrograd üretrogram çekiminde verilen opak maddenin penil üretradan kavernoz yapılara ekstravaze olduğu (nadir görülen) izlendi. Penil üretradaki ve kavernöz yapılardaki parsiyel rüptür cerrahi olarak onarıldı. Hastanın post-operatif 3. aydaki takibinde, komplikasyonun olmadığı ve hastanın ereksiyonunun ve işeme fonksiyonunun normal olduğu gözlendi. Üretral yaralanma şüphesi olan penil fraktur olgularında retrograd üretrogram tanı koyduru cudurPenile fracture is a rare condition. It primarily involves the rupture of the corpus cavernosum during erection, which may also affect the corpus spongiosum and urethra. We describe the case of a 35-year-old man who presented with acute penile pain, penile swelling, and a hematuria after a blunt trauma during sexual intercourse. The emergency retrograde urethrogram revealed a rare condition, extravasation of the opaque material from the penile urethra into the cavernous structure. The partial rupture of the corpus cavernosum with urethral disruption was repaired surgically. At the 3-month postoperative follow-up control, no complications were reported by the patient who has had both normal erectile and voiding functions. In cases of penile fracture with suspected urethral injury, retrograde urethrogram can be used for definitive diagnosi

Midline Prostatic Cyst Marsupialization Using Holmium Laser

Many of the prostatic cysts are asymptomatic and only 5% are symptomatic (Hamper et al., 1990; Higashi et al., 1990). These symptoms include pelvic pain, hematospermia, infertility, voiding dysfunction, prostatitis-like syndrome, and painful ejaculation. Treatment of prostatic cysts includes TRUSG guided drainage, endoscopic transurethral resection, and in some cases even open surgery. In the literature, endoscopic interventions use marsupialization of the midline prostatic cyst with transurethral resection (TUR) or transurethral incision with endoscopic urethrotomy (Dik et al., 1996; Terris, 1995). Holmium: YAG laser was employed for the marsupialization of the cyst wall in midline prostatic cyst treatment for the first time in the present study. Symptoms, treatment, and follow-up are presented in this paper

Two-glove-finger-balloon Dissection of Retroperitoneal Space for Laparoscopic Urology

We present our experience in retroperitoneal interventions with 2 catheter mounted glove fingers through 2 access points. Methods: Patients were placed in the lateral decubitus position, and the retroperitoneum was accessed by blunt dissection through a 10-mm transverse skin incision on the posterior axillary line. Another incision was performed through the anterior axillary line, and the surgeon inserted his finger to dissect the muscle layers in the retroperitoneum to develop an initial space to place the glove finger balloon, which was attached to a 14-F Nelaton catheter. Results: This technique was performed on 32 patients. The mean operation time was 57.4 ± 26.7 minutes. A satisfactory retroperitoneal space for the operation was provided and both balloons inflated to 500 mL. No complications were observed. Conclusion: Retroperitoneal laparoscopy using 2 balloons is a safe, cheap, effective minimally invasive procedure, and we believe that the technique described above both decreases both the operation time and cost

NECROTISING ENDOCARDITIS OF MITRAL VALVE DUE TO STAPHYLOCOCCUS LUGDUNENSIS

Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S.lugdunensis endocarditis. In this report the first case of S.lugdunensis endocarditis from Turkey was presented. A 37 years-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S.lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbactam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12(th) day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21(st) day of the therapy (9(th) day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9(th) weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S.lugdunensis

Increased concentration of soluble CD40 ligand in preeclampsia

Preeclampsia has been associated with increased platelet activation detected before disease onset. Platelets are involved in hemostasis and also directly initiate an inflammatory response of the vessel wall. Inappropriate activation of platelets may be involved in pathogenesis in preeclampsia by promoting coagulation and thrombosis, and also as a mediator of inflammation. Platelets may release inflammatory mediators such as soluble CD40 ligand. The plasma level of soluble CD40 ligand was investigated during preeclamptic (n =20) and normal pregnancies (n = 20) to emphasize inflammatory response in preeclampsia. The mean soluble CD40 ligand levels were 1.08 +/- 0.43 ng/mL in patients with preeclampsia and 0.76 +/- 0.24 ng/mL in healthy pregnant women, which was statistically significant (P =. 01). To clarify whether inflammation may cause inappropriate endothelial cell activation or inappropriate endothelial cell activation may start this inflammatory response, future studies are needed in a larger study population

Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children

WOS: 000451374800039PubMed ID: 29779995Background Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. Objectives To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. Study design Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups. Results Mean age was 6.46 +/- 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI Table Predictive factors for FUTI. occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI. Discussion The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL. Conclusions Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [1030-24135]Bulent Onal was supported by Scientific Research Projects Coordination Unit of Istanbul University. Project number 1030-24135

Factors Affecting Complication Rates of Ureteroscopic Lithotripsy in Children: Results of Multi-Institutional Retrospective Analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society

WOS: 000293688300097PubMed ID: 21784482Purpose: We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. Materials and Methods: We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. Results: A total of 367 females and 265 males were studied. Mean +/- SD patient age was 90.2 +/- 51.4 months (range 4 to 204). Mean +/- SD stone size, operative time and postoperative hospital stay were 8.9 +/- 4.7 mm, 45.8 +/- 23.8 minutes and 1.8 +/- 2.8 days, respectively. At a mean +/- SD followup of 13.3 +/- 17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. Conclusions: Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality