Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery

Purpose: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT. Materials and methods: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level. At the end of 1st year, two groups were compared patient characteristics, operation time, duration of hospital stay, cure and complication rates. Results: The cure rate was 84.37% 81/96) versus 83.63% (92/110) in TOT and TOT with cough test groups, respectively. Postoperatively ten patient (10/110, 9.09%) suffered voiding difficulties (> 250 ml residual urine) in TOT with cough stress test group. Five patients were discharged with transurethral catheter, whereas, in traditional TOT group, two patients (2/96, 2.1%) had transient postoperative voiding difficulty and two patients were treated with repeated catheterization for 1 week (p < 0.05). Postoperative groin pain was present in 7/96 (8%) versus 24/110 (22%) in TOT and TOT with cough test groups, respectively (p < 0.05). TOT with cough stress test group had an higher rate of complications like, retention of urine, necessitating to cut the tape, mesh erosion and pain in groin or leg. No patient had resistant voiding difficulty or prolonged urinary retention (> 1 week) in traditional TOT group. Conclusions: We believe that per-operative cough stress test leads to overtreatment of stress urinary incontinence when the complication rates were considered

Short Term Outcomes of Salvage Cystectomy

Purpose: Salvage cystectomy is performed when recurrences or treatment failures occur or curative treatment for bladder cancer is not possible . In this article, we aimed to present our experience of salvage cystectomies in light of current literature. Material and Methods: Folders of patients underwent salvage cystectomy between August 2011 and May 2013 were compared according to demographics, pre and post operative pathology reports, complicatons and types of urinary divertion. Results: Mean follow-up was 10,3 (3-20,8) months. When pathologies were compared by peroperative transurethral resection (TUR), 2 (18.1%) patients were T1, 8 (%72.7) patients were T2, 1 (9%) patient was T4; pathology specimens following cystectomy was T2 in 4 (36.3%), T3 in 3 (27.2%) and T4 in 4 (36.3%) patients. 1 patient had squamous cell carcinoma, 2 patients had lymph node metastasis. 1 patient suffered from bleeding, one patient sufferd from ileal extravasation, 1 suffered from urine extravasation and one patient suffered from infection in early postoperative period (<90 days). 2 patients had anastomosis stricture after 90 days. 2 patients had to be managed by radiotherapy because of recurrent mass and metastasis. One patient died because of cardiopulmonary issues and one patient died from cirrhosis. Conclusion: Even though it is associated with higher risk of complications, salvage cystectomy can be performed with acceptable morbidity and mortality rates

Self and partner satisfaction rates after 3 part inflatable penile prosthesis implantation

Objective: To evaluate and present satisfaction rates of our patients and their partners after 3 part inflatable penile prosthesis implantation. Materials and methods: We searched our hospital electronic data for patients who underwent inflatable penile prosthesis implantation between January 2008 and July 2013. Computer and archived file data were used to get information and reach the patients. We made telephone calls to patients and asked questionnaires about self and partner satisfaction rates. Results: 36 patients underwent prosthesis implantation during the 5 year period. We were able to reach by telephone call 18 of them. The mean age of 18 patients was 55.7 ± 9.4 years and mean body mass index was 24.6 ± 2.1 kg/m2. The etiology was diabetes mellitus on 14 (77.8%) and radical pelvic surgery on 4 (22.2%) patients. 14 of 18 patients had penile Doppler ultrasound test. Doppler ultrasound demonstrated venous insufficiency in 8 and arterial insufficiency in 6 patients. Mean time from implantation to study was 20.8 ± 13.9 months. Out of 18 patients 2 had prosthesis removal operation because of infection in one patient and perforation in the other. Satisfaction rate was 88.9%, and recommendation rate was 94.4%. Causes of dissatisfaction were pain in one patient and insufficient rigidity plus shortening of the penis in the other one. Partner satisfaction rate was 94.4%. Conclusion: Penile Prosthesis Implantation (PPI) is the gold standard treatment of erectile dysfunction (ED) irresponsive to medical treatment. Infection and mechanical failure rates are going to be less according to the improvements in synthetic materials and coverings of the prosthesis, so patient and partner satisfaction rates will be higher

Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy

Objective: This study was conducted to evaluate clinical experience and learning curve associated with laparoscopic ureterolithotomy performed for upper ureteral stones. Materials and methods: The medical data of 50 patients who had undergone retroperitoneal laparoscopic ureterolithotomy between June 2010 and March 2013 were retrospectively analyzed. To assess the learning curve, patients were divided into two groups: Group A (the first 25 cases) and Group B (the last 25 cases). In Group A, double J stents were placed in 17 patients, whereas in Group B 15 patients received double J stents. In Group A, three ports were placed in nine patients and four ports in 16 patients. In Group B, three ports were placed in 20 patients and five patients had four ports. The patients were compared according to demographics, operative time, stone size, complications, hospital stay, and transfusion. Results: The mean age for Group A was 47.8 ± 14.13 (21–72) years and that for Group B was 44.2 ± 14.98 (22–78) years. Mean operative times were 106.4 ± 38 (55–210) minutes and 70.76 ± 30.4 (30–180) minutes for Groups A and B, respectively (p  0.05). Conclusion: In our study, as staff experience (in performing laparoscopic retroperitoneal ureterolithotomy) increased, operative time, length of hospital stay, and complication rates have correspondingly declined

Relationship between plasma melatonin levels and the efficacy of selective serotonin reuptake inhibitors treatment on premature ejaculation

Objectives: To examine the relationship between premature ejaculation and plasma melatonin levels, and assess the efficacy of selective serotonin reuptake inhibitors in treating premature ejaculation

The role of RENAL, PADUA and C-index scoring systems in predicting the results of partial nephrectomy without ischemia

Summary: Objective: To evaluate the feasibility and renoprotective effect of off-clamp partial nephrectomy (PN) by renal scoring systems. Methods: After approval of the local ethics committee, the radiological and clinical data of patients with renal masses who underwent PN between January 2012 and January 2017 were evaluated in two university hospitals. Total 132 patients who underwent open surgery and off-clamp technique were included. All patients underwent contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) preoperatively. Preoperative demographic data, estimated glomerular filtration rate (e-GFR) and hematocrit changes, operation time, tumor volume and hospitalization time from patients were evaluated separately and statistically for each of the three scoring systems. Results: Our study consisted of 132 patients with a mean age of 53.9 ± 13.9 with 69 male and 63 female. Statistically significant difference between the risk groups in RENAL and PADUA scoring were found according to tumor T stage and tumor volüme (p  0.005). Conclusions: In our study, all three scoring sytem successfully predicted the surgical complexity ve surgical outcomes and our results indicate that off-clamp PN has similar success and complications rates when compared to the literature. The off-clamp PN must be kept in mind to maintain postoperative renal functions eligible patients. Keywords: Partial nephrectomy, Off-clamp, RENAL, PADUA, C-inde

Is there a difference between presence of single stone and multiple stones in flexible ureterorenoscopy and laser lithotripsy for renal stone burden <300mm2?

ABSTRACT In this study, we aim to evaluate and compare the effectiveness of flexible ureterorenoscopy (f-URS) for solitary and multiple renal stones with <300 mm2 stone burden. Patients' charts who treated with f-URS for kidney stone between January 2010 and June 2015 were reviewed, retrospectively. Patients with solitary kidney stones (n:111) were enrolled in group 1. We selected 111 patients with multiple kidney stones to serve as the control group and the patients were matched at a 1:1 ratio with respect to the patient's age, gender, body mass index and stone burden. Additionally, patients with multiple stones were divided into two groups according to the presence or abscence of lower pole stones. Stone free status was accepted as complete stone clearence and presence of residual fragments < 2 mm. According to the study design; age, stone burden, body mass index were comparable between groups. The mean operation time was longer in group 2 (p= 0.229). However, the mean fluoroscopy screening time in group 1 and in group 2 was 2.1±1.7 and 2.6±1.5 min, respectively and significantly longer in patients with multiple renal stones (P=0.043). The stone-free status was significantly higher in patients with solitary renal stones after a single session procedure (p=0.02). After third month follow up, overall success rate was 92.7% in Group 1 and 86.4% in Group 2. Our study revealed that F-URS achieved better stone free status in solitary renal stones <300 mm2. However, outcomes of F-URS were acceptable in patients with multiple stones

Results of tension-free vaginal tape for recurrent stress urinary incontinence after unsuccessful transobturator tape surgery

Aim The aim of this study was to evaluate cure rate and mid-term results of tension-free vaginal tape for recurrent stress urinary incontinence after failed transobturator tape surgery. Material and Methods Between January 2006 and December 2011, 42 women were enrolled in this study. Patient characteristics and operating parameters were recorded, and any complications were noted. All patients were followed up for at least 24 months after the second surgery. The Incontinence Impact Questionnaire and the Urinary Distress Inventory were used to identify satisfaction level. Results The mean age of the patients was 49.07 +/- 8.6 years, and median period between transobturator surgery and the tension-free vaginal tape procedure was 12.8 (range 9.2-17.8) months. The cure rate was 83.3% and 76.2% at the first- and second-year follow-up visits, respectively. Intraoperative complications were transient and slight. Bladder injury in five patients and subcutaneous hematoma above the pubis in two patients were the most serious complications, but they were managed conservatively. We found the scores of the Incontinence Impact Questionnaire and Urinary Distress Inventory to be significantly lower at follow-up, compared to the preoperative assessment. De novo urgency was the most common complaint at follow-up and occurred in 11.9% of the women. Conclusions We suggest that tension-free vaginal tape is a feasible surgical option for recurrent stress urinary incontinence. Further studies with larger patient numbers and longer follow-up periods are needed to support this finding