Ultrastructural Analysis of Urinary Stones by Microfocus Computed Tomography and Comparison with Chemical Analysis

Objective: To investigate the ultra-structure of urinary system stones using micro-focus computed tomography (MCT), which makes non-destructive analysis and to compare with wet chemical analysis. Methods: This study was carried out at the Ankara Train­ing and Research hospital. Renal stones, removed from 30 patients during percutaneous nephrolithotomy (PNL) surgery, were included in the study. The stones were blindly evaluated by the specialists with MCT and chemi­cal analysis. Results: The comparison of the stone components be­tween chemical analysis and MCT, showed that the rate of consistence was very low (p0.05). It was also seen that there was no significant relation between its 3D structure being heterogeneous or homogenous. Conclusion: The stone analysis with MCT is a time con­suming and costly method. This method is useful to un­derstand the mechanisms of stone formation and an im­portant guide to develop the future treatment modalities

First Clinical Experience of Ankaferd BloodStopper as a Hemostatic Agent in Partial Nephrectomy

Open partial nephrectomy is an effective and safe alternative treatment modality to radical nephrectomy for small renal tumors. Many techniques that use hemostatic agents have been described to provide hemostasis during this procedure. Ankaferd BloodStopper® (ABS) is a unique folkloric medicinal plant extract that has been used historically in Turkish traditional medicine as a hemostatic agent. ABS has therapeutic potential to manage hemorrhage and this agent should be investigated in clinical trials. In the present case, we evaluated the effectiveness of ABS in partial nephrectomy and reviewed the literature

The hypospadias profile in Turkey: A multicentric study

Dokuz değişik merkezde son 6 yılda hipospadiyas nedeniyle ameliyat edilen hastalar retrospektif olarak değerlendirildi. Böylece ülkemizdeki güncel hipospadiyas profili çıkarılmaya çalışıldı. 2001-2006 yılları arasında dokuz farklı üroloji kliniğinde hipospadiyas cerrahisi uygulanan 1483 hasta retrospektif olarak incelendi. Başvuru sırasındaki yaş ortalaması 5.8 yıl (1 ay-41 yıl) olan hastalar, tanının kimin tarafından konulduğu, hipospadiyasın yerleşimi, eşlik eden doğumsal bozukluklar, uygulanan ameliyat tekniği, varsa kateterizasyon türü ve hastanede kalış süresi bakımından değerlendirildi. Hastaların ameliyat sırasındaki ortalama yaşı 5.9 yıl olarak bulundu. %57’sinin hipospadiyası bulunduğu annebaba tarafından fark edilmiş iken, %18’i herhangi bir sebeple başvurduğu doktor tarafından, %13’ü doğum sırasında doktor ya da ebe tarafından ve %10’u ise sünnetçi tarafından fark edilmişti. 165 hasta (%11) başvuru sırasında sünnetli idi ve 360 hastada (%24) eşlik eden kordi mevcuttu. Hipospadiyak meatus yerleşimi %38’inde glanülar/koronal, %50’sinde distal penil, %6’sında proksimal penil ve %6’sında penoskrotal idi. Toplam hastaların %9.7’sinde eşlik eden doğumsal eksternal genital organ bozukluğu vardı (62 olguda kriptorşidi, 39 inguinal herni ve/veya hidrosel, 17 penoskrotal transpozisyon, 6 megameatus, 20 olguda diğerleri). Hastaların %77’sine TIP üretroplasti (1141), %11’ine MAGPI (163), %5’ine Mathieu (74) ve 105 hastaya ise diğer cerrahi teknikler uygulanmıştı. Ameliyatta 1160 hasta (%78) üretral yoldan, 251 hasta (%17) suprapubik olarak kateterize edilirken, 72 hastada herhangi bir diversiyon yöntemi kullanılmamıştı. Olguların hastanede ortalama kalış süresi 3 gün (1-20 gün) olarak bulundu. Bu çok merkezli çalışmamız hipospadiyas olgularının yaklaşık yarısının anne-baba tarafından fark edildiğini ve %11’inin başvuru sırasında sünnetli olduğunu göstermiştir. Ek doğumsal bozukluk (kriptorşidi, inguinal herni) oranı yayın bilgilerine göre düşüktür. TIP üretroplasti, yayınlar ile uyumlu olarak günümüzde hipospadiyas cerrahisinde en sık kullanılan tekniktir. Hastanede kalış süresinin nispeten yüksek olması dikkat çekicidir.Introduction: Patients who underwent hypospadias repair in nine different centers were evaluated retrospectively. Materials and Methods: Between 2001 and 2006, 1483 patients with hypospadias, mean age of 5.8 years, who underwent hypospadias operation in nine different centers of Turkey, were enrolled to this epidemiological study. They were evaluated according to the localization of hypospadiac meatus, associated congenital anomalies, the type of operation technique, chordee status and hospitalization time. Results: It was realized that hypospadias was recognized by parents in 57%, by doctors in physical examination in 18%. 13% was noted during the birth, and 10% was recognized by an unlicensed traditional circumciser. 11% of patients had already been circumcised on admission and chordee was present in 24%. The location of hypospadiac meatus was glandular/coronal in 38%, distal penile in 50%, proximal penile in 6% and penoscrotal in 6%. There were associated congenital external genital anomalies in 9.7%. While 77% of the patients underwent TIP urethroplasty, MAGPI was performed in 11%, Mathieu was performed in 5% and 105 patients underwent other surgical techniques. Urethral route was used in 1160 (78%) patients, while suprapubic route was used in 251 patients (17%) for urinary diversion. In 72 patients, no diversion was performed. The mean hospitalization time of patients was 3 days (1-20 day). Conclusion: Half of the cases with hypospadias were recognized by parents and 11% were found to have been circumcised before admission. While the incidence of associated congenital external genital organ anomalies was found to be lower than that of the literature, TIP urethroplasty was the most common technique in hypospadias repair. The hospitalization time was found to be higher than expected

Tubularized incised plate urethroplasty results in patients with proximal hypospadias

Amaç: Proksimal hipospadyaslı primer vakalarda uygulanan “tubularized incised plate” üretroplasti (TIPU) tekniğinin klinik sonuçlarının değerlendirilmesini amaçladık. Yöntemler: Kliniğimizde 2003–2011 tarihleri arasında, eksternal üretral meatusu proksimal penil veya penoskrotal seviyede olan ve TIPU tekniğiyle onarım yapılan 33 primer hipospadyaslı vaka geriye dönük olarak değerlendirildi. Ameliyat sonrası fistülsüz işeme başarı olarak değerlendirildi. Bulgular: Hastaların ortalama yaşı 6,82±3,07 (1–13) idi. Hastaların 15’inde (%45,4) penoskrotal, 18’inde (%54,6) proksimal penil seviyede izlenen üretral meatus bulunmaktaydı. Hastalar üretral kateter çekildikten hemen sonra, taburcu edildikten 2 hafta ve 6 ay sonra idrar yaparken gözlemlenerek değerlendirildiler. İlk operasyon sonrası penoskrotal seviyede 5/15, proksimal penil seviyede 10/18 oranlarında fistülsüz işeme sağlandı; ilk operasyonlar sonrası genel başarı %45,5‘ti. Fistüllü işeyen hastalara yapılan ikinci operasyon ile bu oranlar penoskrotal seviyede 9/15, proksimal penil seviyede ise 16/18’e yükselmiş; total başarı oranı ise %75,8 bulunmuştur. Sonuç: Günümüzde ileri derecede kordisi olmayan proksimal hipospadyas olgularında üretral plate gelişiminde önemli bir bozukluk yoksa TIPU tekniği, deneyimli merkezlerde güvenle tercih edilebilecek bir yöntemdir.Objective: To evaluate the results of the patients with primary proximal hypospadias repaired by “tubularized incised plate” urethroplasty (TIPU). Methods: Thirty-three patients who were operated with TIPU technique in our clinic between 2003-2011 for primary hypospadias with proximal penile and penoscrotal meatus were retrospectively evaluated. Evaluation of the success in this study was, “voiding without fistula”. Results: Mean age was 6.82±3.07 (1-13). Fifteen patients (45.4%) had penoscrotal and 18 patients (54.6%) had proximal penil meatus. Postoperative success was evaluated with direct vision of voiding at the time of uncatheterization, 2 weeks and 6 months after un-catheterization. Success rates were 5/15 and 10/18 after the first repair in the level penoscrotal and proximal penil, respectively. Overall success rate was 45.5% after the first repair. Patients with urethral fistula after first repair were undergone second repair, success rates were increased to 9/15 and 16/18 in the levels of penoscrotal and proximal penil, respectively. Overall success rate after second repair was 75.8%. Conclusion: TIPU may be confidently applied for the patients with proximal hypopadias in experienced clinics, if there is not an uretral cordi or/and abnormality in the development of urethral plate