Our Multiple Single-step Access Results in Percutaneous Nephrolithotomy

Objective:The aim of this study is to evaluate the success and complication rates of percutaneous nephrolithotomy (PNL) with multiple single step access in patients with staghorn kidney stones.Materials and Methods:A total of 118 patients with staghorn kidney stones, who underwent PNL in our clinic between 2008 and 2015, were included in the study. All patients were examined with non-contrast abdominal computed tomography before the operation. Demographic data of patients, operation details, intra- and postoperative complications and additional interventions were evaluated.Results:The mean age of the patients included in the study was 49.6 years. The mean operative time was 139.4 minutes and the mean fluoroscopy time was 126.9 seconds. Postoperative residual stone was detected in 28% of the patients. Postoperative fever was observed in 19 patients (16.2%), and sepsis developed in 3 (2.5%) of them. Additional postoperative procedures were required in 11 patients (9.3%). No patient was lost due to complications. Operation success and complication rates were compatible with the literature.Conclusion:For staghorn stones, PNL with multiple single step dilatation technique can be used as an effective and safe method in adult patients

Nephrocutaneous Fistula: An Unusual Nephrectomy Indication in Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PNL) is recognized as the gold standard treatment method for stones larger than 2 cm due to its high success and acceptably low complication rates. The complications of PNL are well defined. Prolonged urinary leakage is one of them. In this study, a case of post-PNL urine leakage that was eventually treated with nephrectomy is discussed

Does Ozone Administration Have a Protective Effect Against Cisplatininduced Histological Changes in Rat Testis?

Objective:We investigated the protective and therapeutic effects of ozone therapy (OT) on cisplatin (CP)-induced testicular damage.Materials and Methods:Thirty healthy adult male Wistar rats were divided into five groups consisting of 6 animals each: 1) control, 2) CP, 3) OT, 4) OT + CP and 5) CP + OT groups. Histopathological findings, Johnsen scores, thiobarbituric acid-reactive substances (TBARS), glutathione (GSH), superoxide dismutase (SOD), catalase, and GSH peroxidase (GPx) levels were evaluated.Results:CP caused a significant decrease in testicular weight and Johnsen score compared to the control group. In addition, TBARS level was significantly higher, whereas GSH, SOD, catalase and GPx levels were significantly lower in the CP group when compared to the control group. Pre- and post-CP OT significantly increased GSH, SOD, catalase and GPx levels and decreased TBARS level. Also, testicular weight and Johnsen score were increased with OT.Conclusion:The present study showed that OT is protective against CP-induced testicular damage. OT may be beneficial to patients who underwent CP chemotherapy

Vaginocutaneous fistula and inguinal abcess presented 6 years after tension-free vaginal tape sling

Surgical treatment of female stress urinary incontinence (SUI) has become very pop- ular after respectable success with minimal invasive surgeries. This is the first report of long term vaginocutaneous fistula (VCF) plus inguinal abcess after tension-free vaginal tape (TVT). A 67 year-old woman with vaginal discharge lasting more than 3 years complained with a painful swelling in the left inguinal area for the last three months. She had a medical history of TVT sling procedure for SUI six years ago. She had no history of pelvic surgery, cancer treatment or pelvic irradiation before or after TVT sling. No urethrovaginal or vesicovaginal fistula was found in physical examination and cystocopy. MRI showed a vaginocutenaous fistula and inguinal abcess. This case highlights the need for a high index of suspicion for VCF after TVT

Our Results in Penile Fractures

Introduction Penile fracture is a urological emergency caused by direct trauma to an erected penis, tearing the tunica albuginea in the corpus cavernosum. The preferred treatment method is draining the hematoma and surgical repair of tunica albuginea tear as soon as possible following diagnosis. Materials and Methods Forty-nine patients who were diagnosed with penile fracture between January 2009 and December 2014 were reviewed. Physical examination was performed to see the extent of penile hematoma, the side of the penile curvature and the presence of blood in the external meatus. Two patients who were diagnosed with urethrorrhagia underwent retrograde urethrogram for urethral injury. In all patients, penile skin was peeled using a circular subcoronal degloving incision and tunica tear was repaired using absorbable suture materials. The patients were then followed for painful erections, penile deformities and erection angles. Results The average age of the 49 patients, who were included in the study, was 36.5 years (21-65). In their etiological questioning, most patients reported the fracture occurring during sexual intercourse. Retrograde urethrography was indicated in 2 patients with blood in the external meatus and were diagnosed with urethral injury. The patients were taken to emergency surgery. Tunica defects varied between 1 and 2 cm. Incomplete urethral injuries were primarily repaired around 18 French Foley catheter. None of the patients reported penile deformity or painful erections. Their erection angles were found to be within the normal range. Conclusion Even though it is a relatively rare condition, penile fractures are so important that might cause serious complications when not treated surgically. A thorough anamnesis and physical examination suffice for diagnosis

Biyopsiden Radikal Prostatektomiye Prostat Kanserinin Derece Yükselmesi ve Düşmesini Predikte Eden Faktörler: Bildiklerimiz Değişti mi?

Amaç: Gleason skor (GS), prostat kanserinin agresifliği ve progresyonu ile yüksek oranda ilişkilidir. Literatür verilerine göre biyopsi GS’si ile radikal prostatektomi (RP) GS’si arasındaki korelasyon ilginç bir şekilde, çok düşük olarak bildirilmiştir. Bu çalışmanın amacı, prostat kanserli hastalarda ameliyat öncesi klinik ve patolojik değişkenlerin biyopsi ve RP arasında tümör derecesi değişikliklerinin ve korelasyonunun öngörülmesindeki etkisini değerlendirmek ve eski literatür verileri ile yeni sonuçlarımızı karşılaştırmaktır. Yöntem: Kliniğimizde Ocak 2017 ile Mart 2020 tarihleri arasında prostat biyopsisi yapılıp ardından RP uygulanan 229 hasta çalışmaya dahil edildi. Bu hastaların tıbbi kayıtları retrospektif olarak incelendi. Derece yükselmesi ve düşmesi olan gruptaki hastaların demografik verileri, derece yükselmesi ve düşmesini predikte eden preoperatif ve postoperatif değişkenler; derece yükselmesi olmayan kontrol grubunun verileri ile karşılaştırıldı. Bulgular: Hastalarımızın 123’ünde (%53,7) prostat biyopsisi ile RP spesmen patolojileri arasında GS yönünden korelasyon saptanırken; 72 (%31,4) hastada derece yükselmesi ve 34 (%14,8) hastada ise derece düşmesi olduğu görüldü. Derece yükselmesini predikte edebilecek faktörlerden RP’deki prostat ağırlığı, cerrahi sınır pozitifliği, ekstrakapsüler yayılım ve seminal vezikül invazyonunun; derece düşmesini predikte edebilecek faktörlerden ise preoperatif total PSA değerinin istatistiksel olarak anlamlı derecede etkili olduğu sonuçlarına ulaşılmıştır. Sonuç: Biyopsi GS’sinin gerçek hastalık derecesini tahmin etmedeki genel doğruluğu ciddi şekilde sınırlıdır. Nitekim biyopsi ile RP GS’si arasındaki uyumsuzluk nedeniyle neredeyse prostat kanserinin gerçek evresinin yarısının tahmin edilemediği bir hastalık olduğu sonucuna biz de ulaştık. Sonuçlarımızın literatürle paralel oluşu bildiklerimizin henüz değişmediğini göstermektedir. Mevcut standart klinik ve patolojik değişkenler, klinik kullanım için yeterince öngörücü olmadığından, derece yükselme ve düşmeyi daha iyi tahmin etmek için ek araçlara ihtiyaç vardır