A rare cause of acute abdomen: radiotherapy-induced bladder rupture

Introduction: Spontaneous intraperitoneal rupture of the bladder, which is rare, is a life-threatening condition. In emergency services, when patients present with lower quadrant abdominal pain and acute renal failure in the patient's laboratory findings consistent with curriculum vitae should be suspected if there is a history of radiotherapy. A cystography is the most accurate and precise method to make a diagnosis. The definitive solution is surgery, which depends on the condition of the patient.Case Report: A 52-years-old female patient with diffuse abdominal pain applied to our emergency department with complaints of high fever and hematuria. The fact that operated from cervical cancer medical history and undergone radiotherapy was learned. A physical examination of the abdomen and midline defects detected a urine-like liquid coming from the defect. Cystography was also performed because of being macroscopic hematuria to patient, and bladder rupture was detected.Conclusion: The aim of this phenomenon in our presentation. If patients who present to the emergency department with acute renal failure and peritonitis with a medical history of radiotherapy have a history of pelvic radiotherapy in the curriculum vitae with acute renal failure and peritonitis emergency signs, spontaneous rupture of the bladder is to emphasize that occur years after radiation therapy should be considered

The reliability of national videos related to the kidney stones on YouTube

Objective: Kidney stones are one of the most common disorders of the urinary tract. With increasing awareness, a larger proportion of patients are seeking medical knowledge from the Internet. In present study, the features, reliability and efficacy of videos on YouTube related to the treatment of kidney stones were evaluated. Material and methods: In December 2014, YouTube was searched using keywords “nephrolithiasis”; “renal calculi”; “renal stones”; and “kidney stones” for videos uploaded containing relevant information about the disease. Only videos in Turkish were included in the study. Two physician viewers watched each video and classified them as useful, partially useful and useless according to European Association of Urology (EAU) Guidelines. The source, length, number of views, number of favourable opinions, and days since uploaded date of the all videos were evaluated. Results: A total of 600 videos were analysed The median length of videos was 6.7±10.4 (median: 3, IQR: 0.03-58) minutes . Each video was viewed at an average of 2368 (min: 11, max: 97133) times. Most of the videos (32.8%) were created by academicians and physicians. Nearly half (47.4%) of the videos were uploaded in 2014. The majority of the videos (62.5%) contained information for treatment. Percutaneous nephrolithotomy and ureterorenoscopy were the most common treatment modalities (32.8% and 28.0%, respectively) in these videos. A statistically significant difference was not detected between view numbers and source of videos (p=0.87). However, there was a statistically significant difference between usefulness to the viewers and source of videos. Hospital -based videos were detected to be more useful (p=0.000). Conclusion: As a result, videos that would be prepared in internet environment by professional individuals or organizations in a way which would attract attention and be easily comprehended by the public could contribute to the knowledge and education of our society about the stone disease which is commonly seen in our country. © 2016 by Turkish Association of Urology

Prevalence of Poor Sleep Quality and Its Determinants Among Men Suffering from Erectile Dysfunction

Objective:Recent findings implicate a higher prevalence of erectile dysfunction (ED) among men with sleep disorders. We investigated sleep quality among men with ED.Materials and Methods:A prospective study was conducted at 12 different andrology outpatient clinics among men with complaints of insufficient erections. The subjective quality of sleep was measured using the Pittsburgh Sleep Quality Inventory. Erectile function and its dimensions were measured using the International Index of Erectile Function (IIEF) questionnaire. The age-adjusted Charlson comorbidity index and Beck Depression Inventory were used to evaluate interrelations with comorbid disease severity and depression of the subjects consecutively in the study.Results:Among 431 eligible men, the median age of the participants and their erectile function scores in the IIEF were 51 [interquartile range (IQR)=43-59] and 16 (IQR=11-19), respectively. Poor sleep was observed in 192 of 431 (44.5%) subjects. Multivariable analysis revealed that younger age [odds ratio (OR)=0.95, p=0.01], lower body mass (OR=0.86, p=0.01), lower serum high-density lipoprotein cholesterol (OR=0.95, p=0.02), and higher severity of depression (OR=2.1, p=0.0001) were predictors of poor sleep quality among men with ED.Conclusion:Nearly half of the men with ED also suffer from poor sleep. Younger age, lean body mass, and severe depression were the main predictors of poor sleep quality among ED sufferers

Evaluation of quality of life of patients with urinary diversion and ileal conduit after radical cystectomy

Mesane kanseri üriner sistemi en sık etkileyen ve dünyada yaygın görülen kanserler arasındadır. Mesane kanseri evresine ve hastanın tedavi seçimine göre çeşitli tedavi seçenekleri bulunmaktadır. Mesane kanserlerinde uygulanan tedavi seçenekleri hastaların sağlığını olumlu ya da olumsuz etkilediği kadar, hastanın yaşamının diğer alanlarında, örneğin; fiziksel, işlevsel, sosyal alanlarda da değişikliğe neden olmaktadır. Bizde bu çalışmamızda bu tedavi yöntemlerinden biri olan radikal sistektomi ve ileal loop / kontinan diversiyon operasyonu geçiren ve en az 1 yıllık takibi bulunan 53 hastanın klinik, demografik ve yaşam analizi verileri incelenerek, hastaların yaşam kalitesi üzerine etkilerini araştırmayı amaçladık. Pamukkale Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı’nda 2007-2015 yılları arasında radikal sistektomi ve ileal loop / kontinan diversiyon operasyonu geçiren ve en az 1 yıllık takibi bulunan 53 hastanın klinik, demografik verileri Retrospektif olarak, yaşam analizi verileri ise hastalar polikliniğe çağrılarak yüz yüze doldurulan Türkçe validasyonu onaylanmış genel sağlık ölçütü olan Short Form-36 (SF-36) (EK-1), mesane kanseri spesifik yaşam kalitesi ölçümü olan ve yine Türkçe validasyonu olan EORTC QLQ-C30 (version 3.0) (EK-2) ile Türkçe validasyonu olan Beck Depresyon Ölçeği (EK-3) formları sorgularak incelendi. Ayrıca hastalara kendi düşüncelerini ifade edebilecekleri 3 açık uçlu soru ile genel düşünceleri ve yaşadığı sıkıntılar sorgulandı. Veriler SPSS-17 programı kullanılarak istatistiksel olarak değerlendirildi. Sayısal değişkenlikler normal dağılıma uygunlukları Kolmogorow-Smirnov test ile incelendi. Sayısal değişiklikler için tanımlayıcı istatistikler ortalama ± standart sapma, kategorik veriler için sayı ve yüzde olarak ifade edildi. Normal dağılım gösteren sayısal değişkenler bakımından iki grubun karşılaştırılmasında tek yönlü varyans analizi (ANOVA) ve independent-Samples T test kullanıldı, normal dağılım göstermeyen değişkenler için ise two independent-Samples T test kullanıldı. Kategorik yapıdaki değişkenler arasındaki ilişkiler ise Ki-kare testi ile incelendi. Yaşam analizi alt parametreleri ise regresyonyon analizi ile birbiri ile ilişkisi değerlendirildi. Sonuçlar %95 güven aralığında değerlendirildi ve p<0.005 değeri anlamlı olarak kabul edildi. Çalışmamıza 2007-2015 yılları arasında radikal sistektomi ileal loop / kontinan diversiyon operasyonu geçiren 107 hastadan, en az 1 yıllık takibi bulunan ve çalışamaya katılmayı kabul eden 53 hasta alındı. Hastaların 44’ü (% 83) erkek, 9’u (% 17) kadın idi. Çalışma grubundaki hastaların 32’sine (%60,4) ileal loop üriner diversiyon, 21’ine (% 39,6) kontinan üriner diversiyon uygulandı. İleal loop grubunun yaş ortalaması 63.2±9.3, kontinan diversiyon grubunun yaş ortalaması 58.9±9.6 idi. İleal loop grubunun Vücut Kitle Endeksi ortalama 27.8±5.0, kontinan diversiyon grubunun ise 25.9±3.5 olarak hesaplandı ve istatistiksel olarak sınırda anlamlı saptandı.. Her iki grup Charlson Komorbidite İndeksi hesaplandığında ileal loop grubunda 2.3±1.2 olarak saptanırken, kontinan üriner diversiyon grubunda ise 1.8±1.1 olarak saptandı. Her iki grup komorbiditeler yönünden benzer olduğu görüldü. Hastalatın klinik özellikleri incelendiğinde preoperatif böbrek dilatasyonu olan hastalara daha fazla ileal loop üriner diversiyon uygulandığı ve bu seçimin istatistiksel olarak anlamlı olduğu gözlenmiştir. Her iki grubun benzer hospitalizasyon sürelerine sahip olduğu bulunmuştur. Her iki grup için preoperatif bilgisayarlı tomografi veya magnetik rezonans görüntüleme ile yapılan tümör evre ve lenf nodu tutulumları ile postoperatif patolojik tümör evre ve lenf nodu tutulumu açısından gruplar arasında istatistiksel fark olmadığı saptanmıştır. Yaşam analizi değerlendirmesinde, SF-36 fiziksel fonksiyon sorgulamasında kontinan üriner diversiyon lehine istatistiksel olarak pozitif bir fark olduğu (p=0,02), yapılan regresyon analizinde kontinan üriner diversiyonda 0,28 kat fiziksel fonksiyonu daha anlamlı olduğu saptanmıştır.(p=0,036) Diğer özelliklerde ise her iki grubun benzer olduğu görülmüştür. EORTC QLQ C-30 form değerlendirmesinde, Kontinan üriner diversiyon lehine genel işlevde istatistiksel olarak pozitif yönde bir fark gözlenmiş olup yapılan regresyon analizinde etkisinin olmadığı (p=0,224), bulantı-kusma ve ishalde ise ileal loop üriner diversiyon grubunda istatistiksel olarak daha fazla gözlenmiştir. Bulantı-kusma için yapılan regresyon analizinde her iki grup arasında fark olmadığı (p=0,088), ishalde ise yapılan regresyon analizinde ileal loop grubunda istatistiki olarak anlamlı ilişki bulunmuştur (p=0,022). Diğer özelliklerde her iki grup arasında fark gözlenmemiştir. Beck Depresyon formua göre her iki grup incelendiğinde ileal loop grubunda daha yüksek skorlar olduğu, yapılan regresyon analizinde ise diversiyon tipinin Beck depresyon ölçeğinde anlamlı bir etkisinin olmadığı görülmüştür. (OR= -0,25, p=0,061) SF-36 ve EORTC QLQ-C30 yaşam kalitesi sorgulama formları ile her iki grup arasında fark olmadığını, Beck depresyon ölçeğinde ise ileal loop grubunda depresyon yönünden daha fazla dikkatli edilmesi gerektiği saptansada yapılan regresyon analizinde bir fark olmadığı kanaatine varmış bulunmaktayız. Hastaların bireysel ifadesine dayarak belirtilmek gerekir ise aynı diversiyon türünü seçmede kontinan diversiyon grubunun, postoperatif sıkıntılar ile en az karşılamada ise ileal loop grubunun daha avantajlı olduğu görülmektedir. Hangi diversiyon türü olursa olsun onkolojik prensiplerden taviz verilmemesi gerektiği esestır. Hastaya öncelikle preoperatif dönemde bu konu anlatılmalıdır. Sonrasında hastanın diversiyon türlerine yönelik bilgilendirilmesi ve özellikle ileal loop seçimi ön planda ise depresyona yatkınlığının preoperatif olarak değerlendirilmesi gerektiği kanaatindeyiz.Bladder cancer is a type of cancer that affects the urinary system most and is among the most prevalent cancers in the world. There are different alternatives in treatment based on the stage of the cancer and patient’s own decision. The treatment options applied in bladder cancer, along with its positive and negative effects on patient’s health condition, also has effects on other areas of the patients’ life; causing changes in the physical, functional and social fields. In this study we looked into the clinical, demographic, and lifestyle analysis data of 53 patients who underwent radical cystectomy and ileal loop / continent diversion surgery and had at least 1 year of follow-up period; we aimed to investigate the treatment's effects on quality of life of patients. The clinical and demographic data of 53 patients who underwent radical cystectomy and ileal loop / continent diversion surgery and had at least 1 year of follow-up period, were studied retrospectively. To study the lifestyle analysis data, the patients were called to the polyclinic to fill out the Short Form-36 (SF-36); an approved health status survey that has a Turkish validation, EORTC QLQ-C’’30 (version 3.0); a bladder cancer-specific quality of life survey that has a Turkish validation, and Beck Depression Inventory that also has a Turkish validation. Also, to inquire into the thoughts and problems of the patients, 3 open-ended questions were asked where patients could express their own thoughts freely. The data was statistically evaluated using SPSS-17 software. Quantitative variables’ coherence to normal distribution was analyzed with Kolmogorov-Smirnov test. Descriptive statistics for quantitative variables were expressed as “average ± standard deviation”, categorical data was expressed as number and percentage. Comparison of the two groups in terms of quantitative variables that show normal distribution, one-way analysis of variance (ANOVA) and independent-Samples T test were used. For variables that show non-normal distribution, two independent-Samples T test was used. Relations between categorical variables were analyzed using Chi-squared test. Life analysis sub-parameters’ association with each other was evaluated with regression analysis. The results were evaluated in %95 confidence interval and p<0.005 was accepted as significant value. Out of 107 patients who underwent radical cystectomy and ileal loop / continent diversion surgery between years 2007-2015, 53 patients (who had at least 1 year of follow-up period and agreed to participate) participated the study. 44 of patients (%83) were male, 9 patients (%17) were female. 32 of the patients in the study group (%60.49) underwent ileal loop urinary diversion, 21 of patients (%39.6) underwent continent diversion. The average age for ileal loop group is 63.2±9.3, for continent diversion group its 58.9±9.6. Body Mass Index was calculated 27.8±5.0 for ileal loop group and 25.9±3.5 for continent diversion group. According to calculation of Charlson comorbidity index, the similarity of ileal loop group and continent diversion group were observed. Charlson comorbidity index value of ileal loop group was 2.3±1.2, continent diversion was 1.8±1.1 When the clinical features of patients were analyzed, the patients who had preoperative kidney dilatation has shown more implementation of ileal loop urinary diversion and this implementation was observed to be statistically significant. It was found that both of these groups had the same hospitalization duration. It was determined that there is no difference between both group by examining tumor stages with preoperative computer tomography or MR scanning, postoperative pathologic tumor stages with lymph node involvement and lastly lymph node involvement. It is detected in the assessment of survival analysis that statistically there is a positive difference (p=0.02) in SF-36 physical function examination foot the good of continent urinary diversion while the regression analysis applied showed that in continent urinary diversion its physical function is 0,28 times more significant. (p=0.036).It was observed that both group are similar in the other specialties. In the form assessments of EORTC QLQ C-30, a positive difference for the good of continent urinary diversion in basic functions statistically was observed, while it is not effective in the regression analysis applied (p=0,224), and for nausea, vomiting and diarrhea it was observed further statistically in ileal loop urinary diversion group. It is determined that there is no difference between the groups in the regression analysis which is for nausea-vomiting (p=0.088). However, in case of diarrhea, semantic relation is found in the group of ileal loop statistically (p=0.022). It was observed that there is no difference between the groups in other features. When both groups are examined according to Beck Depression Form it is observed that ileal loop group had higher scores, according to applied regression analysis diversion type had no significant effect on Beck Depression Scale(OR= -0,25, p=0,061). Although we found that there is no difference between two groups with the help of SF-36，EORTC QLQ C-30 life quality forms and we should be more careful about ileal loop group because of depression which is realized in Beck depression scale, we came up with a result that there is no variety in the regression analyze. If it must be put out in accordance with patients individual statements; it’s observed that group of continent diversion is more advantageous to select the same diversion; although, ileal loop group is more useful when it comes to facing with less postoperative problems. It’s essential not to make concessions to oncologic principles whichever diversion type it is. First of all, this subject would be instructed to the patient in preoperative period. Later on, we are at the opinion that patient must be informed about diversion types and, especially if patients choose of ileal loop is in the foreground patient’s tendency of depression must be considered preoperatively

Can neutrophil lymphocyte ratio be a marker in stage 1 testicular tumor occult metastasis parameters?

Objective: Neutrophile-Lymphocyte (NLR) and Platelet-Lymphocyte ratio (PLR)comparison is an easy to use and cost-effective method in diagnosis of some cancersand diseases. In this study, we aimed to investigate if NLR/PLR ratio evaluation couldbe utilized in diagnosis of testicular malignencies especially in early-term with occultmetastasis.Materials and methods: A total of 40 patients at stage-I, who have undergone radicalinguinal orchiectomy intervention for testicular tumor between 2015 and 2019, and 43control individuals without any testicular complaints were included in this retrospectivestudy. The relationship between pathological risk factors for occult metastatic disease inStage-I testicular cancer and NLR/PLR values were investigated.Results: The average age was 30.05 years, and there was no significant differencebetween the groups by means of age (p=0.150). The NLR and PLR values of the tumorgroup were prominently higher in the patient group, when compared with the controlgroup (p=0.001 and p=0.016, respectively). In the correlation analysis between riskfactors for occult metastatic disease in Stage-I testicular cancer and NLR/PLR, we havefound that only a significant correlation was present in terms of tumor size.Conclusion: As a result, we have concluded that NLR increases in all types oftesticular tumors. We suggest that higher NLR ratio values can be used as prognosticmarker in clinical practice.Key words: Testicular tumor, occult metastasis, neutrophil/lymphocyte ratio,platelet/lymphocyte ratio.</p