Quantifying subjective assessment of sleep quality, quality of life and depressed mood in children with enuresis

AIM: The aim of this study was to compare a group of children who has monosymptomatic nocturnal enuresis (MNE) with a healthy control group by assessing their depression scales, quality of life and sleep quality. METHODS: Hundred and one children with MNE and 38 healthy controls are included in the study, aged between 8 and 16 years old. All participants were performed the Pediatric Quality of Life Inventory (PedsQL 4.0), Depression Scale for Children (CES-DC) and The Pittsburgh Sleep Quality Index (PSQI) tests. The two groups were compared for their demographic factors and for the results of the tests above. RESULTS: There were no significant differences between the two groups according to age, gender and other demographic factors. Quality of life, depression and sleep quality scores implied worse health in the patient group. The PedsQL scores were assessed as 1,659.90 ± 296.01 in the patient group and 1,818.42 ± 227.92 in the control group (p = 0.001). The CES-DC scores were 11.74 ± 6.11 in the patient group and 7.00 ± 3.97 in the control group (p < 0.001). And the PSQI scores were 2.58 ± 2.48 in the patient group, 1.15 ± 1.10 in the control group (p < 0.001). Also in the patient group, there was a positive correlation between participants’ ages and the PedsQL (p = 0.010; r = 0.256), the CES-DC (p = 0.000; r = 0.382), the PSQI (p = 0.000; r = 0.403) scores. The success parameters at school were significantly worse in the patient group (p = 0.05). CONCLUSION: All our findings show us that the children with nocturnal enuresis were affected negatively because of their disease; especially when they grow up the scores get worse health, so we suggest that treatment must be started at suitable age according to guidelines

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

The treatment of late-onset hypogonadism

Late-onset hypogonadism (LOH) in aging men is a clinical and biochemical syndrome caused by an age-re - lated decline in testosterone. Despite published in guidelines and recommendations, uncertainty surrounds the profle of clinical symptoms as well as the biochemical threshold of diagnosis. The only evidence-based treatment of late-onset hypogonadism is testosterone replacement therapy. The actual available evidence of the long-term risks and outcomes of testosterone-replacement therapy remains very limited, and care - fully designed placebo-controlled trials of testosterone administration to assess the risks and benefts of such a therapy are required. Until such evidence is available, testosterone treatment should be restricted to elderly men with very low testosterone levels in the presence of clinical symptoms, and the advantages and disadvantages need to be accurately assessed. Careful monitoring of potential side effects is necessary. The purpose of this review is to discuss what is known and what remains unclear with respect to the benefts and risks of testosterone replacement treatment

Sponge migration into the urinary bladder following inguinal hernia repair

Mesane içinde yabancı cisim varlığı alt üriner sistem semptomlarına (AÜSS) neden olmaktadır ve tanı koymak genellikle kolaydır. Ancak bazen tahmin edilemeyen durumlarla da karşılaşılmaktadır. 7 yıl önce iki taraflı ingüinal herni onarımı uygulanan olguda endoskopik yolla transüretral olarak spanç çıkartılmasını sunuyoruz.Introduction: Foreign bodies in the bladder might cause lower urinary tract symptoms which is usually easy to diagnose. However, we might sometimes meet unexpected findings. We present endoscopical removal of a bladder sponge from a patient who underwent bilateral inguinal hernia repair 7 years ago

Retroperitoneal İnflamatuvar Miyofibroblastik Tümör: Olgu Sunumu ve Literatür Taraması

Primer retroperitoneal inflamatuvar miyofibroblastik tümörler (İMT) klinikte oldukça nadir görülür. Burada retroperitoneal alandaki İMT olgusu sunuldu. Elli iki yaşında kadın hasta batında kitle ve halsizlik şikayetleriyle başvurdu. Fizik muayenesinde patolojik bir bulgu saptanmadı. Kontrastlı bilgisayarlı tomografisinde retroperitonda sağ adrenal bezin altında ve böbreğin arkasında 10,5 cm çaplı heterojen kitle görüldü. Kitle cerrahi olarak eksize edildi ve patolojisi İMT geldi. İMT kötü huylu lezyonlardan daha agresif özellikler taşıyana kadar değişik şekillerde görülebilmektedir. Kesin tanı histopatolojik olarak konulmaktadır. Küratif tedavideki amaç kitlenin tam cerrahi eksizyonudur.Primary retroperitoneal inflammatory myofibroblastic tumors (IMT) are a very rare clinical condition. Herein, we present a case of IMT in the retroperitoneal area. A 52-year-old woman presented with abdominal lump and exhaustion. On physical examination, there was no pathological finding. The diagnostic workup included contrast computer tomography that revealed a 10,5-cm heterogeneous retroperitoneal mass under the right adrenal gland, localized behind the right kidney. At laparotomy, the mass arising from the retroperitoneum was excised. Histopathology showed an IMT. IMTs has a variable biologic behavior that ranges from the frequently benign lesions to more aggressive variants. Final diagnosis is based on histomorphological features. Complete surgical excision should be the aim of the curative treatment

Sol varikoselli hastalarda varikoselin sağ testiküler kan akımı üzerine etkisi

Amaç: Varikosel hastalarında görülen sperm parametre bozukluğu hakkında çok sayıda teori ileri sürülmüştür. Bu teorilerden biri de, testisin arteriyel kan akımındaki deği- şikliklerdir. Biz çalışmamızda; sol varikoseli ve normal sağ testisi olan hastaların sağ ve sol testislerindeki arteriyel kan akım değerlerini karşılaştırmayı amaçladık. Yöntemler: Üroloji polikliniğine başvuran ve fizik muayenesinde sol varikosel saptanan 41 erkek çalışmaya alındı. Sağ ve sol testislerindeki kan akımını değerlendirmek için tüm hastalara renkli doopler ultrason yapıldı.Her iki testisteki testiküler, kapsüler ve intratestiküler arterlerdeki pik sistolik hız, end diyastolik hız, resisitive ve pulsatilite indeksleri ölçüldü. Semen parametreleri de ayrıca değerlendirildi. Her iki testisin kan akım değerleri karşılaştırıldı. Bulgular: Çalışmaya katılan hastaların yaş ortalaması 25,95±5,27(16-37) idi. Tüm hastaların sperm parametre ortalamaları; ml deki sayı(milyon) 31,56±19,05, hareket(%) 51,21±22,27, morfoloji(%) 12,75±2,97 ve total motil sperm sayısı 54,92±47,46 olarak belirlendi. Testiküler arter ile bu arterin testis içindeki dalları olan kapsüler ve parankimal arterlerin pik sistolik hızları, diastol sonu hızları, direnç ve pulsatilite indeksleri arasında her iki testis karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı(p>0,05). Sonuç: Sağ ve sol testiküler akım değerlerinde anlamlı bir farklılık saptanmaması, çalışmanın sperm parametreleri normal sınırlarda olan bir grupla yapılmasına bağlanabilir. Sperm parametreleri etkilenmiş başka bir sol varikoselli hasta grubuyla karşılaştırmalı olarak yapılacak yeni çalışmalara gereksinim duyulmaktadır.Objective: There are many theories about the mechanism how varicocele causes infertility. One of these theories is about the negative effect of varicocele on testicular blood flow. We aimed to compare the measurements of testicular blood flow in right and left testes in patients with left varicocele and normal right testes. Methods: Forty-one patients with left varicocele were enrolled in the study. All participants were performed color Doppler sonography to assess testicular blood flow of the both testes. Blood flow parameters such as peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), pulsatility index (PI) were measured in testicular, capsular and intratesticular arteries. Semen parameters were also assessed in the participants. Testicular blood flow parameters were compared between the two testes. Results: Mean age of the patients was 25,95&plusmn;5,27(16- 37). The mean semen parameters of the patients; sperm count (million/ml) was 31.56&plusmn;19.05, motility (%) was 51.21&plusmn;22.27, normal morphology (%) was 12.75&plusmn;2.97 and total motile sperm count (million/ml) was 54.92&plusmn;47.46. There were no statistically significant differences between the testicular blood flow parameters of both testes which are PSV, EDV, RI and PI values in the testicular artery and its branches (capsular and intratesticular arteries) (p&gt;0.05). Conclusion: The fact that there were no differences between the blood flows in both testes may depend on the study group who had normal sperm parameters. We suggest that testicular blood flow may be evaluated in patients with left varicocele and impaired sperm parameters

Dev prostat hiperplazisi: Olgu sunumu ve literatürün gözden geçirilmesi

Dev benign prostat hiperpilazisi prostatın oldukça nadir görülen bir patolojisidir. Literatürde sunulan Türkiye’de en büyük, dünyada ise 3. büyük 500 gram üzerindeki prostatın komplikasyonsuz çıkartılmasını sunduk.The giant hyperplasia of the prostate is an extremely rare pathology of prostate gland. We report the uncomplicated removal of the largest ever prostate from Turkey and the 3rd case exceeding 500 grams in the world literature

Partial Urethrectomy for Female Urethral Transitional Epithelial Cell Carcinoma

Kadın hastada distal üretradan kaynaklanan değişici epitel hücreli karsinom için uyguladığımız parsiyel üretrektomiyi ve sonrasında planlanan adjuvan tedaviyi literatür eşliğinde tartışmayı amaçladık. Altmış dört yaşında kadın hasta bir aydır olan dizüri, intermitant hematüri ve üretrada ele gelen kitle şikayetleriyle başvurdu. Yapılan vajinal muayenesinde üretra ağzında papiller tümöral yapılar görüldü. Sistoskopisinde üretra orta kısımdan başlayan ve distale kadar uzanan tümöral lezyondan punch biyopsi alındı. Patoloji sonucunun değişici epitel karsinomu gelmesi üzerine hastaya parsiyel üretrektomi ve üretroplasti uygulandı. Patoloji sonucu yüksek dereceli değişici epitel karsinomu ve squamoz diferensiasyon geldi. Hastaya 3 kür gemsitabin ve sisplatin kemoterapisi uygulandı. Dördüncü ay kontrolünde nüks kitle saptanması üzerine radyoterapi sonrasında gerekirse cerrahi rezeksiyon yapılması planlandı. Distal üretra tümörlü kadın hastalarda intraoperatif cerrahi sınır negatif ise üretra koruyucu cerrahiler primer üretrektomiye alternatiftir. Agresif seyreden bu hastalar için sıklıkla cerrahi sonrası adjuvan kemoradyoterapi ihtiyacı olmaktadır.To present a female case of partial urethrectomy and the following adjuvant chemo-radio-therapy for urethral transitional epithelial cell carcinoma originating from distal urethra in the light of literature. The patient was a 64-year-old female presented with dysuria, intermittent hematuria and a palpable urethral mass that she first experienced a few months ago. On physical examination of the vagina, papillary tumor was observed at the urethral meatus. During cystoscopy procedure, punch biopsy was performed from the tumoral lesion which lines from the middle urethra to distal. After the pathologic examination result of transitional epithelial cell carcinoma of urethra partial urethrectomy with urethroplasty was performed. On pathologic examination, high grade transitional epithelial cell carcinoma of urethra with squamous differentiation was detected. Three cures of gemcitabine and cisplatin were adminisered. After detecting a local recurrent mass four months after the surgery we planed radiotherapy and then surgical resection of the mass if needed. In women with distal urethral tumors, urethrasparing surgery is alternative to primary urethrectomy if negative surgical margins can be achieved intra-operatively. Patients with tumor progression usually need to receive chemo-radio-therapy after the surgery

Success of rigid ureteroscopy according to the stone localization in the ureter

Amaç: Bu çalışmada rijid üreteroskop (URS) kullanarak yaptığımız üreter taşlarında endoürolojik tedavilerimiz retrospektif olarak incelendi ve taşın yerine göre URS’nin etkinliği değerlendirildi. Gereç ve yöntem: Ocak 2007- Haziran 2009 tarihleri arasında rijid URS (Wolf 8.0-9.8 Fr, Germany) ile tedavi edilen alt üreter (n=69), orta üreter (n=23) ve üst üreter (n=9) taşları olan toplam 101 hasta değerlendirildi. Taşlar forseps veya basket kateteri yardımı ile tek parça olarak ya da pnömotik litotriptör (EMS Swiss-lithoclast Master) ile parçalanarak çıkartıldı. Bulgular: Hastaların yaş ortalaması 45.1 (19-78) yıl idi. Taşlar 52 hastada sağ, 49 hastada sol taraftaydı. Taş büyüklüğü ortalama 7.4 (5-15) mm idi. Üst üreter taşı olan 9 hastanın 7’sinde (%77.8) taşsızlık sağlandı. İki hastada taş renal pelvise migrate oldu ve izlemde tekrar üretere düşen bu taşlar URS yapılarak alındı. Orta üreter taşı olan 23 hastanın 22’sinde (%95.7) taşsızlık sağlanırken, bir hastada distal üreter perforasyonu gelişti, üreterolitotomi ve üreteroneosistostomi yapıldı. Alt üreter taşı olan 69 hastanın 68’inde taşsızlık sağlanırken (%98.6), bir hastada üreter perforasyonu gelişti ve üreter kateteriyle iyileşme sağlandıktan sonra tekrar URS yapılarak taş alındı. Çalışmaya katılan 101 hastanın sadece 2’sinde (%1.9) üreter perforasyonu oluştu. Bir hastada (%0.9) P.aeroginosa’ya bağlı dirençli üriner sistem enfeksiyonu gelişti. Sonuç: Rijid URS ve pnömotik litotripsi ile özellikle alt üreter taşlarınıendoskopik tedavisinde yüksek başarı sağlanmakla birlikte, taşın yerleşimi proksimale doğru gittikçe bu oran azalmaktadır. URS üreter taşlarının tedavisinde düşük komplikasyon oranıyla güvenle yapılabilmesine karşın, üreterdeki travmaya bağlı üreter perforasyonu gibi ciddi komplikasyonlar oluşabilmektedir.Objectives: We retrospectively evaluated our rigid ureteroscopy (URS) treatment results in ureteric stones and assessed its effectiveness concerning ureteric stone localisation. Materials and methods: Overall, 101 patients were retrospectively evaluated including lower (n=69), mid (n=23) and upper ureteric (n=9) stones which were treated with rigid URS (Wolf 8.0-9.8Fr, Germany) in our hospital between January 2007- June 2009. Stones were removed by stone forceps/basket catheter either as single piece or fragmented by pneumatic lithotripsy (EMS-Swisslithoclast-Master). Results: Mean patient age was 45.1 (19-78) years. Stones were located in the right (n=52) and left (n=49) ureters, respectively. Mean stone size was 7,4 mm (5-15). Of the 9 patients with upper ureteric stones, 7 were (77.8%) stone-free. However, stone migrated into renal pelvis in two patients but passed into ureter again in the follow-up and removed by URS. Of the 23 patients with mid-ureteric stones, 22 were (95.7%) stone-free. Ureter perforation occurred in one patient and ureteroneocystostomy was performed. Of the 69 patients with lower ureteric stones, 68 were (98.6%) stone-free. Ureter perforation occurred in one patient and healed spontaneously by ureter catheter replacement. Stone was removed afterwards by URS. Overall (n=101), ureter perforation occurred in 1.9% (n=2) in our series. Resistant urinary tract infection developed in one patient (0.9%) (P.aeroginosa). Conclusion: Due to results of this preliminary study, rigid URS and pneumatic lithotripsy can be performed successfully particularly in lower ureteric stones. However, as stone location shifts to upper ureter, success rate decreases. Although URS can be performed safely with low complication rates in the treatment of ureteric stones, severe complications like ureter perforation might occur