The importance of hydronephrosis in percutaneous nephrolithotomy operation

Amaç: Bu çalışmanın amacı perkütan nefrolitotomi (PNL) ameliyatlarında renal hidronefroz derecesinin preoperatif, peroperatif ve postoperatif verilerle ilişkisini araştırmak ve klinik önemini incelemektir. Yöntemler: Şubat 2009 ile Şubat 2013 arasında aynı cerrah tarafından yapılan 132 PNL ameliyatı geriye dönük olarak tarandı. Hastaların demografik verileri, preoperatif böbrek özellikleri, peroperatif ve postoperatif verileri de- ğerlendirildi. Grade 1 ve 2 hidronefroz grup I; grade 3 ve 4 hidronefroz grup II olarak belirlendi. Gruplar ile preoperotif, peroperatif ve postoperatif özelliklerin farkları istatistiksel olarak karşılaştırıldı. Hidronefrozun bağımsız belirleyicilerini saptamak için multivariat analiz olarak lojistik regresyon analizi kullanıldı. Bulgular: Yaş ortalaması 46,2±13,7 yıl (8 -73) idi. Operasyon süresi ortalama 101 dakika (10-250) olarak hesaplandı. Grup I’de 56, Grup II’de 76 hastanın verileri analiz edildi. İki grup arasında yaş, cinsiyet, vücut kitle indeksi ve cerrahi tecrübe açısından fark saptanmadı. Preoperatif verilerden, opere böbrekte daha önce taş düşürme öykü- sü (p=0,012), taşın çapı (p=0,022), taşın bulunduğu kaliks sayısı (p=0,005), karşı böbrekte taş varlığı (p=0,027), renal parankim kalınlığı (p=0,026); peroperatif verilerden, operasyon süresinde (p=0,011); univaryant analizde anlamlı fark saptandı. Lojistik regresyon analizinde, opere böbrekte taş öyküsü, taşın bulunduğu kaliks sayısı, karşı böbrekte taş varlığı, operasyon süresi ile hidronefroz arasında ilişki izlendi. Sonuç: Perkütan nefrolitotomi operasyonlarında düşük dereceli hidronefrotik böbreklerde, taş çapının ve taşın bulunduğu kaliks sayısı azalması dolayısı ile operasyon süresinin kısa olması sonucunda komplikasyon daha az olacaktır.Objective: The aim of this study is to investigate the relation between hydronephrosis grade and preoperative, peroperative and postoperative data and to evaluate the clinical significance of hydronephrosis in percutaneous nephrolithotomy (PNL). Methods: One hundred and thirty-two patients who had undergone PNL operation by same surgeon between February 2009 and February 2013 were reviewed retrospectively. Patients’ characteristics, preoperative kidney status, operative data were investigated. Grade 1, 2 hydronephrosis were determined as Group I, Grade 3, 4 hydronephrosis were determined as Group II. Preoperative, peroperative and postoperative property differences between groups were compared statistically. For the multivariate analysis, logistic regression analysis was used to determine independent predictors of hydronephrosis. Results: Patients mean age was 46.2±13.7 years (8-73). Operation mean time was 101(10-250) minutes. 56 and 76 patients’ data were analyzed in Group I and Group II, respectively. There was no difference in age, gender, BMI, and surgeon experience between groups. Dropping stone history in same kidney (p=0.012), stone diameter (p=0.022), the number of calyceal stones (p=0.005), presence stone in the other kidney (p=0.027), renal parenchymal thickness (p=0.026) and operation time (p=0.011) had significantly in univariate analysis. In logistic regression model, dropping stone history in the same kidney, the number of calyceal stones, presence stone in the other kidney and operation time had a relationship with hydronephrosis. Conclusion: In PNL, patients with low-grade hydronephrosis might have decreased complication rates due to diminished operation time, which resulted in reduced number of calyceal stones and stone size

The results of two-years shock wave lithotripsy treatment in urinary system stones

Amaç: Üriner sistem taşlarında vücut dışı şok dalgası ile taş kırma (SWL) tedavisi ile başarı oranları ve başarıyı etkileyen faktörleri incelemek. Gereç ve yöntem: Şubat 2010 ile Aralık 2011 tarihleri arasında Mustafa Kemal Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı’nda üriner sistem taşları nedeni ile SWL tedavisi yapılan 101 hastaya ait bilgiler geriye dönük olarak incelendi. Hastaların cinsiyetleri, taş lokalizasyonları, taş bulunan böbrek, taş boyutları, tedavi sonuçları, taşsızlık oranları belirlendi. Bulgular: Çalışmamıza 68(%67,3) erkek, 33(%32,7) kadın olmak üzere toplam 101 üriner sistem taşı olan hasta incelendi. Böbrek taşlarının lokalizasyona göre başarı oranlarımız taş boyutundan bağımsız olarak alt kalikste %52,4, orta kalikste %68, üst kalikste %100, pelvis yerleşimli taşlarda %76,5 olarak bulundu. Çalışmamızda taş boyutlarına göre başarı oranları 100 mm2’den küçük taşlar için %73,7, 100-200 mm2 arası taşlar için %75, 200-300 mm2 arası taşlar için %25ve 300 mm2’den büyük boyutundaki taşlarda ise %50 olarak saptandı. Üreter bölgelerine göre SWL başarı oranlarımız üst üreterde %75, orta üreterde %76,9 ve alt üreterde %71,4 olarak bulundu. Sonuç: SWL’de başarı taş boyut ve lokalizasyonuna bağlıdır. Başarı oranlarımız taşın boyut ve lokalizasyonlarına göre değişmekle beraber önceki raporlarla uyumlu bulunmuştur.Objectives: To evaluate the results of the extracorporeal electro shockwave lithotripsy (SWL) therapy in urinary system stone disease and to investigate the factors that affects the success. Materials and methods: Between February 2010 and December 2011, 101 patients, who had undergone SWL due to urolithiasis in Mustafa Kemal University Medical Faculty Urology Department, were retrospectively analyzed. Gender, stone localization, the kidney side, stone size, stone free rate were recorded and investigated. Results: In our study, of 101 patients, 68 (67.3%) male and 33 (32.7%) female patients, who had complaints with urolithiasis, were analyzed. The success rates when compare the localization of the stone formation independent of stone size were found 52.4%, 68%, 100% and 76.5% at lower, middle, upper calices and pelvis of kidney, respectively. In our study, the success rate according to stone size was 73.7%, 75%, 25% and 50% in lower than 100 mm2, 100-200 mm2, 200-300 mm2 and higher than 300 mm2 in diameter, respectively. For ureteral localizations, the success rate was 75%, 76.9% and 71.4% in upper, middle and lower ureter, respectively. Conclusions: In SWL therapy, success depends on size and localization of the stone. Our success rate was altered in terms of stone size and localization similar to previous reports

Ectopic kidneys and congenital variations of their vasculatures

Amaç: Böbrek ektopilerinde damar anomalilerine sıklıkla rastlanılır. Multiple detector-row computerized tomography angiography (MDCTA), üriner sistem ve böbrek damarlarının değerlendirilmesinde günümüzde artan bir yere sahiptir. Bu çalışmamızda amacımız ektopik böbrekteki damar varyasyonlarını MDCTA kullanarak ortaya koymaktır. Gereç ve Yöntem: Hastanemize 2009 ila 2011 arasında altı ektopik böbrek hastası araştırıldı. MDCTA, dört erişkin hastaya hipertansiyon nedeniyle, bir böbrek taşı olan erişkin hastaya nefrektomi öncesi, bir çocuk hastaya ise diafram hernisi operasyon öncesi yapıldı. Bulgular: Altı hastanın 12 böbreğinin 20 renal arteri araştırıldı. İki vakanın birinin sol böbreğinde dört, diğerinde üç renal arter saptandı. Üçü ektopik biri normal olan dört böbrekte, bir ana bir de aksesuar arter saptandı. 17 ven inferior vena cava’ya, sol böbrekten çıkan bir ven sol common iliac vene, 2 sağ böbrek veni sol renal vene dökülüyorlardı. Sonuç: Günümüzde MDCTA ektopik böbreğin damarlarını değerlendirilmesinde önem kazanmıştır.Objectives: Renal vessel anomalies are more common in renal ectopia. Multiple detector- row computerized tomography angiography (MDCTA) has become increasingly important in the evaluation of the urinary system and the renal vasculature. The aim of this study is to demonstrate the variations of vascular supply of the ectopic kidneys by using MDCTA. Material and methods: Six renal ectopic kidney cases were identified among the patients admitted to our hospital between 2009 and 2011. MDCTA was planned for four adult patients due to hypertension, for one adult patient who would undergo nephrectomy due to nephrolithiasis, and for one neonatal patient who would be operated on due to diaphragmatic hernia. Results: 20 renal arteries were identified in 12 kidneys of six patients. There were four renal arteries in a left kidney and three renal arteries in another left kidneys of two cases. There were one main and one accessory arteries in four kidneys of which three were ectopic and one was normal. There were 17 veins connected to inferior vena cava, one vein of the left kidney was connected to left common iliac vein, and two veins of the right renal vein were connected to left renal vein

Is there a relation between reticular formation and storage symptoms in men

WOS: 000330900500008PubMed: 26663500ObjectiveTo reveal brainstem originated pathology in men with different types of lower urinary tract symptoms blink reflex latency times were assessed. MethodsA total of 32 men, 16 with storage and 16 with voiding symptoms, were enrolled in the study. Blink reflex latency times were analyzed through electrical stimulation of the supraorbital nerve. Two responses in the orbicularis oculi muscle were recorded: the latency times for the early ipsilateral response, R1, and the late bilateral responses, R2. ResultsThe mean ages of the patients with storage and voiding symptoms were 57.316.87 and 58.06 +/- 6.29years, respectively. the R2 latency times were significantly longer in men with storage symptoms. However, the R1 latency times were similar for the two groups. ConclusionLate blink latency times were long only in patients who had storage symptoms. An oligosynaptic path through the trigeminal nuclei, which includes one or two interneurons, is responsible for early response; however, late response is relayed through a polysynaptic path, including neurons in the reticular formation. It has also been shown that stimulation of the pontine reticular formation inhibits the micturition contraction. in some patients, storage symptoms may result from pathology that originates with the reticular formation and this pathology may lead to increases in late blink latency times. Additional studies are needed on other reflexes that are mediated through reticular formation, in order to show the possible dysfunction of the reticular formation in men with storage symptoms

The comprassion of parenchymal thickness with CT and DMSA scintigraphy in percutaneous nephrolithotomy

Amaç: Perkutanöz nefrolitotomi (PNL) büyük ve komplike renal callus tedavisinde kullanılan cerrahi yöntemlerdendir. Hemoraji PNL'nin en önemli komplikasyonlarından biri olarak bildirilmektedir. Gelişen hemorajinin böbrek parankim kalınlığı ile ilişkili olabileceğini bildiren yayınlar bulunmaktadır. Çalışmamızın amacı PNL öncesi bilgisayarlı tomografi (BT) ve Tc-99m DMSA ile ölçülen böbrek boyutları ve parankim kalınlıklarının karşılaştırılması ve aralarında korelasyon olup olmadığının saptanmasıdır. Metaryal ve metod: Çalışmaya PNL öncesi abdomen tomografileri ve Tc-99m DMSA ile renal kortikal sintigrafileri çekilmiş 16 hasta dahil edildi. Hastaların böbrek boyutları, üst, orta ve alt pollerden böbrek parankim kalınlıkları ile ortalama parankim kalınlıkları hesaplandı. Bulgular: Ortalama parankim kalınlığı BT'de sağ böbrek için 18.68±5.41 mm, sol böbrek için 17.62± 4.55 mm olarak hesaplandı. DMSA sintigrafisinde ise ortalama parankim kalınlığı sağ böbrek için 15,27±3.30 mm, sol böbrek için 16.27± 3.89 mm olarak hesaplandı. Ortalama böbrek boyutları BT'de sağ için 99.49 ± 18.92 x 46.53 ± 12 mm, sol için 95.40± 11.91x45.58± 11.23 mm olarak hesaplanırken, sintigrafide sağ için 106.66 ± 18.48x 47.36 ± 11.52 mm, sol için 104.37±18.28x 46.26±12.94 mm olarak hesaplandı. Sonuçta DMSA sintigrafisi ile BT'den ölçülen parankim kalınlığı ve böbrek boyut ölçümleri arasında anlamlı korelasyon görüldü (p <0.05). Sonuç: Gelişen teknoloji ile birlikte PNL'nin güvenilirliği ve etkinliği son iki dekatta artmıştır. Operasyon öncesinde böbrek parankimini değerlendirmede kullanılan BT ve DMSA sonuçları arasındaki anlamlı korelasyon sebebi ile DMSA sintigrafisi raporlarında böbrek boyut ve ortalama parankim kalınlığının da verilebileceğini düşünmekteyiz.Background: Percutaneous nephrolithotomy (PNL) is one of the surgical methods used in the treatment of large and complex renal callus. Hemorrhage has been reported as one of the major complications of PNL. There are publications reporting that composed hemorrhage may be associated with renal parenchymal thickness. The aim of this study is to compare the sizes and parenchymal thickness of kidneys measured by computed tomography (CT) and Tc-99m DMSA scintigraphy before PNL and determine whether there is a correlation between them. Methods: Sixteen patients who performed abdominal CT scan and Tc-99m DMSA renal cortical scintigraphy before PNL, were included to study. The patients' kidney sizes, parenchymal thicknesses from upper, middle and lower poles and mean parenchymal thicknesses were calculated. Results: The mean parenchymal thickness was calculated as 18.68&plusmn;5.41 mm for right kidney and 17.62&plusmn; 4.55 mm for left kidney on CT scan. On DMSA scintigraphy, the mean parenchymal thickness was calculated as 15,27&plusmn;3.30 mm for right kidney and 16.27&plusmn; 3.89 mm for left kidney. While the mean kidney sizes were calculated as 99.49 &plusmn; 18.92 x 46.53 &plusmn; 12 mm for right and 95.40&plusmn; 11.91x45.58&plusmn; 11.23 in left on CT scan, they were calculated as 106.66 &plusmn; 18.48x 47.36 &plusmn; 11.52 mm for right and 104.37&plusmn;18.28x 46.26&plusmn;12.94 for left on scintigraphy. As a result, a significant correlation was seen between parenchymal thicknesses and kidney sizes measured by DMSA scintigraphy and CT scan (p &lt;0.05). Conclusion: Safety and efficacy of PNL has increased in the last two decades with the advancing technology. Because of the significiant correlation between CT scan and DMSA scintigraphy results which are used to evaluate the renal parenchyma before operation, we suggest that size and mean parenchymal thickness of kidneys can be given in DMSA scintigraphy reports

Overactive bladder and pontine reticular formation

WOS: 000327925400007PubMed: 24296362Background: the etiology of overactive bladder (OAB) remains unclear. Observed neurogenic factors in the literature are limited to suprapontine or spinal pathologies. the blink reflex is a useful tool in the evaluation of brainstem functions. Blink reflex latency times were evaluated in order to reveal pathology in the brainstem. Methods: A total of 60 women, 30 patients with idiopathic OAB and 30 healthy controls, were enrolled in the study. Blink reflex latency times were analyzed by electrical stimulation of the supraorbital nerve. Two responses in the orbicularis oculi muscle, early ipsilateral response (R1) and late bilateral response (R2) latency times, were recorded. Results: Mean ages of the patients and controls were 51.9 +/- 5.3 and 49.2 +/- 6.2 years, respectively. R2 latency times were significantly higher in patients than in controls. However, R1 latency times were similar between the two groups. Conclusions:The results of the study suggest a significant relation between late blink latencytimes and OAB. An oligosynaptic path via the trigeminal nuclei is responsible for R1; however, R2 response is relayed through the reticular formation. Stimulation of pontine reticular formation inhibits micturition contraction. in some patients, idiopathic OAB may result from reticular formation-originated pathology. Additional studies on other reticular formation-mediated reflexes are needed to reveal possible dysfunction of reticular formation. Copyright (C) 2013 S. Karger AG, Base

The prevalence of external genitalia anomaly in the subjects aged between 7- 11 years old

Amaç: Bu çalışmada Hatay il merkezinde öğrenim gören ilköğretim çağındaki erkek çocuklarda dış genitaorgan bozukluğu sıklığı ve çeşitliliğinin belirlenmesi hedeflendi. Yöntem: Mustafa Kemal Üniversitesi Etik komitesi tarafından çalışma onaylandıktan sonra, il merkezindek6 adet ilköğretim okulunda öğrenim görmekte olan ve rastgele örnekleme yöntemi ile 7-11 yaş arasındaktoplam 981 erkek öğrenci çalışmaya dahil edildi. Tüm öğrenciler iki üroloji uzmanı tarafından okullarında muayene edildi ve tespit edilen dış genital organ anomalileri kaydedildi. Bulgular: Çalışmaya katılan 981 öğrencinin 126’sında (%12,8) anomali saptandı. Saptanan anomalilerinmemiş testis 60(%6,1),retraktil testis 49 (%5), inguinal herni 7(%0,7), hipospadiyas 4(%0,4), hidrose4(%0,4) ve varikosel 2(%0,2) idi. Çalışmamızda, Hatay il merkezinde ilköğretim çağındaki çocuklardagenital anomali oranını tespit etmeye çalıştık. Sonuç: Dış genital anomali oranları diğer yapılan tarama çalışmalarında birbirine yakın değerler bulunsa bile ülkemizde dış bölgelere göre farklılıklar izlenmektedir.Aim: In this study, our aim is to investigate the prevalence of external genitalia anomaly in the students who has education at primary school and living in Hatay city center. Method: After the study was approved by the Ethic Comitee of Mustafa Kemal University, 981 male students who have aged between 7-11 years old were included from six different primary schools in Hatay city center were included. All the students were examined by two different urologists in their schools in terms of external genitalia anomaly and the subjects with anomaly were recorded. Results: Anomaly was detected in 126 (12.8%) of 981 patients. Detected anomalies were undescended testis 60 (6.1%), retractile testis 49 (%5), hypospadias 4(0.4%), hydrocele 4(0.4%), varicocele 2(0.2%). Conclusion: Although there were similar rates regarding the prevalence of external genitalia anomalies between the present study and other published studies; regional differences could be seen in Turkey

Does renal parenchymal thickness affect bleeding in percutaneous nephrolithotomy ?

Aim: Blood loss is a major concern during percutaneous nephrolithotomy. The aim of this study was to evaluate the effect of access point parenchymal thickness on bleeding in percutaneous nephrolithotomy procedures. Materials and methods: In this study 85 patients who had undergone a percutaneous nephrolithotomy operation between February 2009 and July 2011 were reviewed retrospectively. All characteristics of the patients were investigated. The details of the operative procedure and the renal parenchymal thickness at the puncture site were also recorded. Blood loss was calculated during the peroperative and postoperative periods. Correlation and multivariate regression analysis were done to detect predictive factors on bleeding. Results: Of the 85 percutaneous nephrolithotomy procedures done, 12 (14.1%) patients had no diminution of hemoglobin value postoperatively and were excluded. This left 73 percutaneous nephrolithotomy procedures that were evaluated. The mean peroperative hemoglobin drop was 1.79 &plusmn; 1.17 mg/dL. Stone size, operation time, and grade of hydronephrosis were correlated with hemoglobin drop significantly (P = 0.047, P = 0.016, and P = 0.034, respectively). There was no correlation between parenchymal thickness and bleeding (P = 0.545). In multivariate regression analysis, only the operation time was found to be a statistically significant independent predictive factor for peroperative bleeding in percutaneous nephrolithotomy (P = 0.005). Conclusion: Renal parenchymal thickness and the grade of hydronephrosis do not predict peroperative hemorrhage in percutaneous nephrolithotomy procedures.Aim: Blood loss is a major concern during percutaneous nephrolithotomy. The aim of this study was to evaluate the effect of access point parenchymal thickness on bleeding in percutaneous nephrolithotomy procedures. Materials and methods: In this study 85 patients who had undergone a percutaneous nephrolithotomy operation between February 2009 and July 2011 were reviewed retrospectively. All characteristics of the patients were investigated. The details of the operative procedure and the renal parenchymal thickness at the puncture site were also recorded. Blood loss was calculated during the peroperative and postoperative periods. Correlation and multivariate regression analysis were done to detect predictive factors on bleeding. Results: Of the 85 percutaneous nephrolithotomy procedures done, 12 (14.1%) patients had no diminution of hemoglobin value postoperatively and were excluded. This left 73 percutaneous nephrolithotomy procedures that were evaluated. The mean peroperative hemoglobin drop was 1.79 &plusmn; 1.17 mg/dL. Stone size, operation time, and grade of hydronephrosis were correlated with hemoglobin drop significantly (P = 0.047, P = 0.016, and P = 0.034, respectively). There was no correlation between parenchymal thickness and bleeding (P = 0.545). In multivariate regression analysis, only the operation time was found to be a statistically significant independent predictive factor for peroperative bleeding in percutaneous nephrolithotomy (P = 0.005). Conclusion: Renal parenchymal thickness and the grade of hydronephrosis do not predict peroperative hemorrhage in percutaneous nephrolithotomy procedures

Antioxidative and anti-inflammatory effect of thymoquinone in an acute Pseudomonas Prostatitis Rat model

nacar, ahmet/0000-0001-6274-5700; Kaplan Sefil, Nebihat/0000-0003-0091-8471WOS: 000327925400016PubMed: 24008979Introduction: the aim of this study is to investigate the potential antioxidant and anti-inflammatory effects of thymoquinone (TQ) to improve acute bacterial prostatitis (ABP) induced by Pseudomonas aeruginosa. Material and Methods: A total of 42 male Wistar albino rats were divided into 7 groups as follows: control, ABP (24, 48, and 72 h), and TQ-ABP (24, 48, and 72 h). the prostate tissue samples were assayed for prostate tissue malondialdehyde (MDA) and nitric oxide (NO) levels, and catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPX) activities. Sections were examined for characteristic histological changes, and a histological scoring system was used. Results: When the ABP groups given TQ (24, 48, and 72 h) were compared to the ABP groups not given TQ, the levels of MDA and NO and the GPX activity were found to be significantly lower in the groups given TQ. Concerning SOD values, the TQ-ABP-72 group was lower in comparison with the ABP-72 and control groups, but statistically higher than the TQ-ABP-48 group (p < 0.05). Concerning CAT activity, only the TQ-ABP-72 and ABP-72 groups had a significant difference with the control group. TQ improved prostate histology significantly only in the TQ-ABP-24 group compared to the ABP-24 group (p < 0.001). Conclusion: Our study demonstrated for the first time that ABP induced by P. aeruginosa had an oxidative effect on prostate tissue and could regress following TQ administration as shown with the biochemical and histological findings. Copyright (C) 2013 S. Karger AG, Base