[show abstract][hide abstract] ABSTRACT: Metastatic malignant melanoma of the prostate is extremely rare in clinical practice, and only one case has been reported in the English literature in the past 30 years. We report a case of malignant melanoma that metastasized to the prostate and review the current literature. A 50-year-old man with a history of malignant melanoma metastasis to the left axilla, which was excised 3 years ago, presented with lower urinary tract symptoms and gross hematuria. He underwent cystoscopy and transurethral resection of the prostate. The pathological examination showed metastatic malignant melanoma of the prostate gland. The patient died 6 months after the transurethral resection.
[show abstract][hide abstract] ABSTRACT: Ischemic priapism, a compartment syndrome, requires urgent treatment in order to nourish the corpora cavernosa. As the first step, aspiration of blood and irrigation of the cavernosal bodies is performed to prevent fibrotic activity and secure erectile capability. During aspiration, there are risks of cardiovascular side effects of adrenergic agonists. We aimed to evaluate a transient distal penile corporoglanular shunt technique in place of aspiration and irrigation techniques for treatment of early ischemic priapism.
A transient distal penile shunt was applied to 15 patients with early ischemic priapism between January 2011 and May 2012. Priapism duration, history, causes, pain, and any prior management of priapism were assessed in all patients. A complete blood count and penile Doppler ultrasonography were performed, which showed attenuated blood flow in the cavernosal artery. A sterile closed system blood collection set, which has two needles and tubing, was used for the transient distal penile shunt.
Ten of 15 patients with early ischemic priapism were successfully treated with this transient shunt technique. No additional procedures were needed after the resolution of rigidity in the 10 successfully treated patients.
The transient nature of this technique is an advantage over aspiration and irrigation in the treatment of early ischemic priapism. Our results indicate that the technique can be offered for patients with an ischemic priapism episode of no more than 7 hours.
[show abstract][hide abstract] ABSTRACT: Crystal-cell interaction has been reported as one of the most crucial steps in urinary stone formation. Hyperoxaluria-induced apoptotic changes in renal tubular epithelial cells is the end-stage of this interaction. We aimed to evaluate the possible pathways responsible in the induction of apoptosis within the involved cells by assessing the receptoral expression of three different pathways. 16 male Spraque-Dowley rats were divided into two groups: Group 1 (n:8) received only distilled water; Group 2 (n:8) received 0.75 % ethylene glycol (EG) in their daily water to induce hyperoxaluria for 2 weeks. After 24 h urine collection, all animals were euthenized and right kidneys were removed and fixed for immunohistochemical evaluation. Oxalate and creatinine levels (in 24 h-urine) and FAS, tumor necrosis factor (TNF), TNF-related apoptosis-inducing ligand (TRAIL) and TRAIL receptor-2 expressions (in tissue) have been assessed. In addition to TNF (p = 0.0007) expression; both FAS (p = 0.0129 ) and FASL (p = 0.032) expressions significantly increased in animals treated with EG. The expressions of TRAIL (p = 0.49) and TRAIL-R2 (p = 0.34) receptors did not change statistically after hyperoxaluria induction. Although a positive correlation with cytokine expression density and 24 h-urinary oxalate expression (mg oxalate/mg creatinine) has been assessed with TNF (p = 0.04, r = 0.82), FAS (p = 0.05, r = 0.80), FAS-L (p = 0.04, r = 0.82); no correlation could be demonstrated between TRAIL and TRAIL R2 expressions. Our results indicate that apoptosis induced by oxalate is possibly mediated via TNF and FAS pathways. However, TRAIL and TRAIL-R2 seemed to have no function in the cascade. Correlation with urinary oxalate levels did further strengthen the findings.
[show abstract][hide abstract] ABSTRACT: AIM: Although the management of urinary stones in obese patients is a challenge and the impact of the patient-related parameter has been well studied in adults: No study has evaluated the possible impact of obesity in terms of body mass index related SWL success in pediatric population. In this present study, we aimed to evaluate the safety and efficiency of SWL in obese children in a comparative manner with the cases in normal BMI value limits. PATIENTS AND METHODS: A total of 66 children (45 boys and 21 girls, M/F:2.1) with renal calculi were treated with SWL. Depending on the BMI values, the children were divided into two groups as; Group 1 (n:50) children with normal BMI values (mean: 16.1) and Group 2 (n:16) obese children with higher BMI values (mean: 20.3). The success rates, complications, and need for auxiliary procedures after SWL were evaluated between two groups of patients in a comparative manner. While majority of the cases were treated under general anesthesia (n:61), a limited number of cases were treated under neurolept anesthesia with PiezoLith 3000 (Richard Wolf GmbH) lithotripter. Evaluation of efficiency was based on radiological examinations using abdominal radiography, ultrasonography, or CT scan when needed. RESULTS: Both the mean age and mean stone size values were similar in both groups. While the mean age was 62 months (24-148) in Group 1, this value was 68 months (24-137) in Group 2. Again mean stone size was 10.26 mm(5-25 mm) in Group 1 and 10.12 mm (6-20 mm) in Group 2. The mean number of SWL sessions and the number of SW's applied were similar in both groups (2.06 vs. 2.0 and 1975 vs. 1835, respectively). Evaluation of success rates after 3-months again did not show any statistically significant difference with respect to stone-free rates in both groups (47/50-94 %, 16/16-100 %, respectively). However, 3 children in Group 1 did show residual fragments (≤3 mm) which were followed closely with regular visits without any problem. In another 3 cases, again fragments migrated to involved ureter after lithotripsy and these fragments were successfully treated in situ with further SWL. With respect to auxiliary procedures, there was no specific procedure has been done in Group 2, but 3 cases did undergo further SWL for ureteral stones in Group 1. Stone location did not affect the final outcome of the procedure in a significant manner in both groups. Lastly, no serious complication could be demonstrated in both groups either during or after SWL procedures. CONCLUSIONS: In the light of the successful treatment outcomes with limited need for auxiliary procedures in both groups, we may say that obesity might not be a disadvantage for SWL in children with renal stones.
International Urology and Nephrology 01/2013; · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: PURPOSE: We aimed to propose a practical selection method predicting the easier radical perineal prostatectomy (RPP) cases before the operation. METHODS: Fifty sequential RPP cases were divided into two groups according to the estimated difficulty of the operation (Group I: Easier, Group II: Difficult) which was assessed by using a RPP difficulty scale, constituted by three parameters (operation time, blood loss, and the judgment of the surgeon) each ranging between 1 and 3 points. As the localization parameters, skin-to-prostatic apex (SPAD) and skin-to-prostatic base (SPBD) distances and distance between bilateral ischial tuberosities (ITD) were measured. During suprapubic ultrasonography, a probe-divergence angle (PDA) and prostate volumes (PV) were recorded. These parameters were compared between the groups. RESULTS: In Group I (n = 29) and Group II (n = 21), the difficulty scores were 4.37 (3-5) and 6.80 (6-9), respectively. Data of age, clinical stages, and findings of digital rectal examination were not different between groups. While SPBD, SPAD, and ITD values were found similar (p > 0.05), PDA and PV were significantly different. PDA was > 45 degree in 21 cases in Group I (72.4 %) and in 7 cases in Group II (33.3 %) (p = 0.011). The mean of PV was 37.4 (20-60) cc and 49.9 (30-75) cc in Group I and Group II, respectively (p = 0.001). CONCLUSIONS: While planning RPP operations, by selecting the prostate cancer cases with a prostate of low volume and localized deeper in the pelvis during suprapubic ultrasonography, urologists may have a chance to perform this technique more easily during the learning period.
International Urology and Nephrology 10/2012; · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Hemangiopericytoma, which is derived from pericytes, is rarely seen in the kidney and adical nephrectomy with or without chemotherapy is the treatment of choice in most of the cases. We report a fifty-year-old male patient presenting with gross hematuria that radiologic evaluation confirmed due to a solid mass in the right kidney. Its clinical manifestations and radiologic tests were similar to renal cell carcinoma. Radical nephrectomy was performed and the pathological examination revealed the specimen as hemangiopericytoma. No additional treatment was added and the patient remained disease free at the end of the first year follow up after radical nephrectomy.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 09/2012; 84(3):158-60.
[show abstract][hide abstract] ABSTRACT: To evaluate the possible effects of citrate replacement on the efficacy of shockwave lithotripsy (SWL) in the management of kidney stones in cases with hypocitraturia.
Forty hypocitraturic cases with renal pelvic stones were randomized into two groups; while citrate replacement has been done before and at the time of SWL in Study Group I (n: 20), SWL was performed without any additional specific management for hypocitraturia in Study Group II (n: 20). Twenty normocitraturic cases were also chosen as the control group (Group III). Data of the patients were evaluated comparatively.
Patient, stone, and urinary pH characteristics of the groups were similar. Pre-SWL urinary citrate levels were 0.71 (0.1-1.3), 0.86 (0.1-1.4), and 3.12 (1.8-4.4) mmol/24 h in Group I, II, and III, respectively. Urinary citrate value increased from 0.71 (0.1-1.3) to 1.96 (1.6-4.1) mmol/24 h following replacement therapy (before and at the time of SWL) in Group I. Mean number of SW (p = 0.461), rate of stone-street formation (p = 0.146), and Double-J placement (p = 0.291) were similar in Group I and Group II. While the mean number of SWL sessions (2.27 ± 0.71 in Group I vs. 2.94 ± 0.59 in Group II; p = 0.027), and time to stone-free status [29.1 (16-47) days in Group I vs. 38.4(21-63) days in Group II; p = 0.043], was significantly different between study groups, these parameters were found similar between Group I and Group III.
In our study, the patients with hypocitraturia, who did receive replacement therapy, tended to require lower number of SWL sessions and became stone free in a shorter period than the others who underwent SWL without any specific management of hypocitraturia.
International Urology and Nephrology 05/2012; 44(5):1357-62. · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: We evaluated the data of our patients who experienced rectal injury during radical prostatectomy (RP).
We analyzed the data for the 7 patients (6 perineal, 1 retropubic) with iatrogenic rectal injury who were selected from 451 patients with RP (218 retropubic, 233 perineal) operated in our clinic between 2003 and 2011.
The mean age of the 7 patients was 64.4 years. Rectal injury occurred during prostatic apical dissection in 4 patients, during dissection of Denonvilliers fascia in 1 patient, during transection of the rectourethral muscles in 1 patient, and during dissection of the rectal region proximal to the anal sphincter in 1 patient. The mean size of the lesions was 2 (1-4) cm. All of the rectal injuries were recognized during the operation, and double-layered sutures were used for the primary repair. None of the cases required colostomy procedure. No postoperative complications were encountered in 6 of the patients; however, 1 patient underwent a second operation on the following day due to detachment at the injury site. None of the patients displayed urethrorectal fistula, urinary incontinence or urethral stricture.
Primary repair with double-layered suturing is sufficient for the treatment of rectal injuries that occur during RP if they are recognized intraoperatively.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 05/2012; 18(3):250-4. · 0.34 Impact Factor
[show abstract][hide abstract] ABSTRACT: Introduction and objectivesWe aimed to assess the results of the genitourinary fistula cases intervened in our center in a ten year period.Patients and methodsWe evaluated the clinical data regarding genitourinary fistula from the medical records of 42 female patients who underwent surgery for this condition between May 2001 and June 2010. Age, previous medical history, diagnostic tools used, operative data and clinical outcomes of the patients were evaluated retrospectively.ResultsThe mean age of patients was 51 years. Of 42 patients, 28 had vesicovaginal, 11 had ureterovaginal, and 3 had vesicouterine fistulas. Etiology of vesicovaginal fistula was surgical trauma in 71,5% and obstetric trauma in 28,5% of the patients. O’Connor technique was performed as a single procedure in 12 vesicovaginal fistula cases, and ureteroneocystostomy was added in 3. Transvesical repair was performed in 9, and transvaginal repair in 3 of the patients. All of 11 patients with ureterovaginal fistula were of iatrogenic origin; ureteroneocystostomy was performed in 6, and Boari flap was performed in 5 of these patients. Three vesicouterine fistulas were repaired primarily. Success rates in vesicovaginal, ureterovaginal and vesicouterine fistulas were 96, 100 and 100 percent, respectively.Conclusion
In experienced hands and according with the related basic surgical principles, operative treatment in genitourinary fistula represents an effective modality with high success rate.
[show abstract][hide abstract] ABSTRACT: To evaluate the success rates and complications of extracorporeal shock wave lithotripsy (ESWL) in children with renal stones in an age-dependent manner.
From 2006 to 2010, 164 children (male/female ratio 1:3) with renal calculi have been treated with ESWL (PiezoLith3000 lithotripter). The children were divided into 2 age groups: group 1, 0-6 years old (n = 133); and group 2, 7-15 years (n = 31). The patient- and treatment-related parameters were recorded for comparative evaluation. The success of ESWL in terms of the stone-free rates, additional procedures, and complications were comparatively evaluated. The data were analyzed statistically.
The mean age of groups 1 and 2 was 28 ± 18 months (range 4-71) and 119 ± 28 months (range 73-178), respectively. Although general anesthesia was used for all patients in group 1, 29% of the patients were treated under neuroleptic anesthesia in group 2. During the 3-month follow-up period, the complete stone-free rate was 94.7% (126 of 133), and treatment was unsuccessful in 7 patients (5.3%) in group 1. The corresponding data were 87% (27 of 31; P = .222) and 4 (13%; P = .089) in group 2. The stone-free rate after the first session was 67.6% (90 of 133) and 38.7% (12 of 31) in groups 1 and 2, respectively (P = .004). The mean number of ESWL sessions applied was 1.6 (range 1-5) and 2.9 (range 1-6) in groups 1 and group 2, respectively (P = .0001). No major complications were noted.
Our results have demonstrated that ESWL is highly successful in the management of renal calculi in children. Compared the outcomes by age, the younger children become stone free more quickly than the older children with fewer ESWL sessions.
[show abstract][hide abstract] ABSTRACT: Extracorporeal shockwave lithotripsy (ESWL) has dramatically changed the treatment of urinary lithiasis and has been the first treatment option for the majority of patients for more than two decades. Despite its significant benefits, it induces acute renal injury that extends from the papilla to the outer cortex. We evaluated the severity of the inflammatory response to ESWL by measuring the urinary excretion of the cytokines TNF-α, IL-1α, and IL-6. The study included 21 selected patients and 14 control subjects. All patients underwent the same ESWL procedure (2,500 shockwaves at 100 shockwaves/min and 0.039 J from the lithotripter). Urine TNF-α, IL-1α, and IL-6 levels were measured using standard ELISA kits. In the study population (patients and controls), we did not detect TNF-α in the urine samples. The levels of both IL-1α (2.5 pg/ml) and IL-6 (3.8 pg/ml) measured before ESWL were not significantly different from the control group (2.5 and 5.2 pg/ml, respectively; p > 0.05). Twenty-four hours after ESWL, in contrast to IL-1α (4 pg/ml), urine IL-6 (19.7 pg/ml) increased significantly (p < 0.05). Fourteen days after ESWL, IL-1α increased to 5 pg/ml, while IL-6 (7 pg/ml) decreased to the control level. Urine cytokine levels may be used to evaluate the inflammatory response to ESWL. After ESWL, IL-6 levels increased in the early phase, while IL-1α levels increased later. These two markers may be used to measure the severity of inflammation. In contrast to IL-1α and IL-6, urine TNF-α excretion was not increased by ESWL. We believe that the inflammatory response to ESWL can be detected by the urinary excretion of IL-1α for up to 14 days.
[show abstract][hide abstract] ABSTRACT: To evaluate the outcomes of major urological procedures performed in patients with locally advanced colorectal cancer.
Data of 37 patients with locally advanced colorectal cancer who underwent major urological surgical procedures along with simultaneous cancer surgery between the years of 2005 and 2010 were retrospectively evaluated.
The mean age was 58.3 years. Male/Female ratio was 2.7. 59% of the patients were primary, and 41% were recurrent cases of colorectal cancer. Bladder, ureters, urethra, kidneys and prostate were found as invaded in 19, 9, 5, 2 and 2 cases, respectively. The following single or combined procedures were performed; partial (n=11) or total (n=8; 2 combined with urethrocutaneostomy, 6 with ileal-conduit) cystectomy, urethroplasty (n=5), nephroureterectomy (n=2), radical nephrectomy (n=1), partial nephrectomy (n=1), ureteroneocystostomy (n=7), Boari's flap (n=4), transureteroureterostomy (n=3). Prolonged drainage was the most common surgical complication (27%). Urethrocutaneous fistula and total urinary incontinence were encountered in 1 and 1 patient, respectively. The incidence of hydronephrosis and elevated creatinine were 38% (preoperative 27%; postoperative 11%) and 24% (11% preoperative; 13% postoperative), respectively. Two deaths occurred in the first month of operations. Mean duration of follow up was 18(6-28) months for surviving 13 patients. Overall survival in 24 cases resulting in death was 21(1-42) months.
Since the most important eventual effects of locally advanced colorectal cancer are on the kidneys from the urological point of view; the aim of an urologist, as a member of surgical team, should be preserving renal function in addition to helping complete removal of the tumor.
[show abstract][hide abstract] ABSTRACT: We aimed to evaluate the factors potentially affecting the number of surgical debridements in patients with Fournier's gangrene (FG) who underwent single or multiple operative sessions.
We retrospectively reviewed the data of 36 patients with FG. The patients were assigned to one of two groups according to the number of debridements (Group I: single session; Group II: ?2 sessions). Data of the patients (clinical and surgical data, lesion characteristics, FG severity index, and prognosis) were compared between the groups.
The mean age of the patients was 55.5 years, and all were male. Group I consisted of 21 patients and Group II of 15 patients. The mean number of debridements was 2.2 in Group II. Our overall mortality rate was 11% (Group I: 4.8% vs Group II: 20%; p=0.287). Diabetes was the most common coexistent pathology (44%). Time to admission to the clinic, size of the lesions at admission, and FG Severity Index (FGSI) scores of the groups were similar. In Group II, FGSI scores were found increased before each of the repeated debridement sessions (p<0.05).
There was no difference in the clinical data of the patients who required single or multiple debridement sessions; however, FGSI may be useful in deciding repeated debridements, as it was found increased at each repeated session.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 01/2012; 18(1):43-8. · 0.34 Impact Factor
[show abstract][hide abstract] ABSTRACT: We aimed to evaluate the success rates, auxiliary procedures and complications after ureteroscopic lithotripsy (URS) during which the fragments left in situ for spontaneous passage after complete disintegration into a acceptable (<4 mm) size. 238 patients with ureteral stones were treated with URS between 2005 and 2011, and disintegrated fragments (<4 mm) were left in situ for spontaneous passage. Patients were followed with radiography for 3 months and evaluated with respect to the success rates (stone-free), auxiliary procedures, complication rates and additional analgesic requirement. The median age was 42.2 ± 13.7 years, and overall stone size was 8.79 ± 2.94 mm. Significantly lower rate of stone-free status was achieved in proximal stones (p < 0.05). A second URS was necessary in 5% (n = 12) of the patients. Double-J catheter placement during initial URS did not cause any change in the rate of secondary URS (p = 0.620). Additional oral or intramuscular analgesia was required in 41% (n = 97) and 25% (n = 59) of the patients, respectively, after discharge. The overall stone-free rate was 95% and mean time to complete clearance was 5 days. Severe colic pain within 24 h was noted in 21 (9%), and transient hydro-ureteronephrosis in 31 (13%) patients, as minor complications. Leaving the fragments (<4 mm) in place for spontaneous passage following a successful disintegration in URS could be a reasonable approach with acceptable and comparable stone-free rates, and this approach appears to give chance of shortening the duration of operation and also avoiding from the potential morbidity of repeated manipulations during the both further disintegration and extraction.
Urological Research 10/2011; 40(4):383-7. · 1.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the treatment parameters of shockwave lithotripsy (SWL) in lower calyceal calculi in adults and children in a comparative manner.
Between 2006 and 2011, SWL was performed for lower calyceal calculi in 282 adults (mean age 48.5 years, range 28-64) and 54 children (mean age 48 months, range 5-141). The Wolf Piezolith 3000 lithotriptor has been used for SWL. Success rates, auxiliary procedures, additional interventions, and complications were evaluated in detail in a comparative manner.
Mean stone size was 7.7 mm (range 5-25) and 8.1 mm (range 5-23) in children and in adults, respectively. Mean SWL sessions were 1.5 (range 1-5) in children and 2.4 (range 1-6) in adults. Although 66.6% of children were stone-free after the first session, 28% of adult patients were stone-free after the first SWL session, showing a statistically significant difference (P = .0001). After the treatments, although a complete stone-free status was obtained in 85% of children, 31.5% of adults were stone-free at 3-month follow-up after SWL (P = .0001). Although no auxiliary procedures were needed in children, 8.2% of adults required them. Likewise, the percentage of additional procedures were higher in adults than children (20.2%).
SWL for lower calyceal calculi has been found to be highly successful in pediatric patients. These results demonstrate that, irrespective of stone size, SWL should be the first treatment alternative in the management of lower calyx stones in children.