Ahmet Tunç Özdemir

The incidence of postoperative ileus in patients who underwent robotic assisted radical prostatectomy.

Introduction Our aim was to examine the incidence and risk factors of postoperative ileus among patients who underwent robot–assisted radical prostatectomy (RARP). Material and methods We retrospectively reviewed 239 patients who underwent RARP transperitoneally between February 2009 and December 2011. Patients switched to open surgery were excluded. We defined postoperative ileus as intolerance of a solid diet continued until the third postoperative day and beyond. By Clavien classification, we evaluated the perioperative complications that cause or contribute to postoperative ileus. Similarly, we analyzed the impact of anesthesia risk score on the incidence of postoperative ileus. Results The study included 228 patients. The mean period to tolerate solid food was 1.24 days. Only 6 patients experienced postoperative ileus, all of whom were treated with a conservative approach. The two groups differed significantly in the duration of abdominal drainage, hospital stay, modified Clavien classification, and the presence of comorbidity diabetes mellitus (P <0.5 for all factors). Multiple logistic regression analysis revealed that diabetes mellitus was an independent risk factor for postoperative ileus. Conclusions We suggest that diabetes mellitus is an independent risk factor for postoperative ileus in patients undergoing robot–assisted radical prostatectomy.

Intrarenal Surgery vs Percutaneous Nephrolithotomy in the Management of Lower Pole Stones Greater than 2 cm.

Purpose To compare the efficacy of RIRS and PNL in lower pole stones ≥2 cm. Materials and and Methods: A total of 109 patients who underwent PNL or RIRS for solitary lower pole stone between April 2009 and December 2012, were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both PNL and RIRS before the selection of the procedure. Patients decided the surgery type by themselves without being under any influences and written informed consent was obtained from all patients prior to the surgery. Patients were divided into two groups according to the patients’ preference of surgery type. Group 1 consisted of 77 patients who underwent PNL and Group 2 consisted of 32 patients treated with RIRS. Stone free statuses, postoperative complications, operative time and hospitalization time were compared in both groups. Results There was no statistical significance between the two groups in mean age, stone size, stone laterality, mean follow-up periods and mean operative times. In PNL group, stone-free rate was 96.1% at first session and 100% after the additional procedure. In Group 2, stone-free rate was 90.6% at the first procedure and 100% after the additional procedure. The final stone-free rates and operative times were similar in both groups. Conclusions RIRS should be an effective treatment alternative to PNL in lower pole stones larger than 2 cm, especially in selected patients.

Is there a correlation between intravaginal ejaculatory latency time and enuresis? An exploratory study

Introduction Premature ejaculation (PE) is the most common male sexual dysfunction. Monosymptomatic enuresis (ME) is nocturnal bed wetting, without any daytime symptoms. Recent clinical studies report an association between lifelong PE and ME. The purpose of this study was to compare the intravaginal ejaculatory time (IELT) between lifelong PE in men with and without ME. The goal was to determine if there is an association between the severity of ME and of IELT. Material and methods A total of 137 men with lifelong PE were included in this study. Subjects were asked if they had childhood ME. The characteristics and mean IELTs of patients with and without ME were compared using the students t–test, and the correlation between severity of ME and IELT was assessed with trend test. Results Of the 137 lifelong PE patients, 57 reported ME. There was a strong negative correlation in patients with ME between the severity of enuresis and IELT, with IELT being shorter in patients with severe ME. Conclusions A strong correlation between IELT and the severity of ME suggests a common underlying mechanism. Further studies are required to confirm these findings and elucidate the exact pathophysiology.

Factors Predictive of Pain During Cystoscopy: A Prospective Study

1 Ahmet Tunc Ozdemir1, Serkan Altınova1, Hakan Koyuncu2, Ege Can Serefoglu1, Mevlana Derya Balbay1, 1Ataturk Training and Research Hospital, Department of Urology, Ankara, 2Yeditepe University School of Medicine, Department of Urology, Istanbul, Turkey Sistoskopi Esnasında Ağrı / Pain During Outpatient Cystoscopy Factors Predictive of Pain During Cystoscopy: A Prospective Study Sistoskopi Esnasında Ağrıyı Etkileyen Faktörler: Prospektif Bir Çalışma

Triple Peripheral Nerve Injury Accompanying to Traumatic Brain Injury: A Case Report

Secondary injuries especially extremity fractures may be seen concurrently with traumatic brain injury (TBI). Peripheral nerve damages may accompany to these fractures and may be missed out, especially in acute stage. In this case report; damage of radial, ulnar and median nerves which was developed secondarily to distal humerus fracture that could not be detected in acute stage, in a patient who had motor vehicle accident (MVA). 29-year-old male patient was admitted with weakness in the right upper extremity. 9 months ago, he had traumatic brain injury because of MVA, and fracture of distal humerus was detected in follow-ups. Upon the suspect of the peripheral nerve injury, the diagnosis was confirmed with ENMG. The patient responded well to the rehabilitation program treatment. In a TBI patient, it must be kept in mind that there might be a secondary trauma and therefore peripheral nerve lesions may accompany to TBI.

Re: The 20-Core Prostate Biopsy Protocol—A New Gold Standard?: V. Ravery, S. Dominique, X. Panhard, M. Toublanc, L. Boccon-Gibod and L. Boccon-Gibod J Urol 2008; 179: 504–507

Association of Urology (EAU) recommendations. Due to conflicting data, the EAU guidelines are not precise on the duration and schedule of instillations, but they clearly state that early instillation is recommended in all papillary tumors. In addition, the authors claim that there is no additional value of early instillation in patients treated with a standard series of instillations. However, in the aforementioned metaanalysis of multiple tumors the percentage of recurrence decreased from 80.5% to 65.2%. While several trials suggest that additional intravesical treatment after immediate instillation might further reduce the recurrence rate, they do not suggest that early instillation is useless. Finally, the authors advise readers to “avoid single instillation in patients with multiple tumors” since further instillations are necessary. We fully support the suggestion for a less aggressive cystoscopy followup schedule and office fulguration in selected cases. Many urologists like the arguments of the article, which confirm their attitude with regard to skipping early instillation despite overwhelming evidence of its efficacy. The comments that follow the article also support this opinion. Our conclusions from the same data are that 1 early instillation reduces the odds of recurrence by 40% in all types of papillary tumors. It has not been sufficiently studied to determine whether this approach is also beneficial from an economical and quality of life standpoint. The fact that many recurrences are small and can be treated with office fulguration suggests the use of a less intensive followup schedule in low grade tumors. These are the recommendations given in the EAU guidelines.

Diagnostic significance of biopsies in renal masses.

Introduction We investigated the reliability and mapping of percutaneous needle core biopsies in the kidney in histopathological diagnosis of renal masses particularly for those with suspicious radiologic appearance in an attempt to prevent unnecessary nephrectomies. Material and methods Overall, 96 cases were included in our study that underwent radical nephrectomy or partial nephrectomy due to renal mass between November 2007 – March 2010. Ex–vivo biopsies 1 cm apart were obtained from the peripheral region of the mass. Additionally, half of these peripheral biopsies were obtained from the central region of the mass. Diagnostic yield of the biopsy cores were correlated. Sensitivity and specificity of peripheral and central biopsies in differentiating benign and malignant tissues were calculated. Results Sensitivity and specificity in differentiating malignant lesions were 93% and 87%, and 90% and 93% for peripheral and central biopsies, respectively. Positive and negative predictive values were 97% and 68%, and 98% and 64% for peripheral biopsies and central biopsies, respectively. Hazard ratio for cigarette smoking and presence of necrosis on CT scans were 4.76 (CI 1, 6–14.3; p = 0.04) and 3.32 (CI 1,2–9.2; p = 0.017) and 3.71 (CI 1.3–10.7; p = 0.013) and 3,51 (CI 1.3–9.6; p = 0.012) for peripheral and central biopsies, respectively. Conclusions Kidney biopsies can be performed in suspicious renal masses of central and peripheral biopsies with similar efficacy.

IFN Alfa-2B and BCG Therapy Is An Effective Method In Superficial Bladder Carcinoma

DOI: 10.4328/JCAM.605 Received: 07.02.2011 Accepted: 04.03.2011 Printed: 01.04.2012 J Clin Anal Med 2012;3(2): 155-8 Corresponding Author: Serkan Altıova, Ahmet Taner Kışlalı Mah. Park Cad. Rönesans Evleri A Blok D:5 Çayyolu, Ankara, Turkey. T.: +905326455226 F.: +903122912705 E-Mail: saltinova@yahoo.com Özet Amaç: Yüzeyel mesane tümörlerinin başlangıç tedavisi tümörün transüretral rezeksiyonudur. Başarılı rezeksiyonlara rağmen, %60-79 rekürrens ve %15 progrsyon oranları vardır. Yüzeyel mesane kanserlerinde ek tedailer önerilmiştir. Biz çalışmamızda yüzeyel mesane kanserli hastalarda tek başına interferon alfa-2b tedavisini interferon alfa-2b ve Bacillus Calmette Guerin (BCG) kombinasyon tedavisi ile birlikte idrar interlökin (IL) 2,6 ve 10 seviyelerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Prospektif çalışmamıza hastanemizde 2004-2007 yılları arasında TUR-MT operasyonu uygulanan hastalar (patolojik evre Ta-T1) dahil edildi. Hastalara TUR-MT operasyonundan 15 gün sonra başlamak üzere, 6 hafta süreyle haftada bir kez ve sonrası 6 ay boyunca aylık intravezikal immünoterapi uygulandı. IL seviyeleri ölçüldü. Bulgular: İntravezikal tedavinin 2. ve 4. saatlerinde idrar IL 2, IL 6 ve IL 10 seviyeleri ölçüldü. 2. ve 4. saatlerde tek başına IFNα-2b ve IFNα-2b+BCG kombinasyon tedavisi alan gruplarda IL 2 seviyelerinde istatistiksel olarak anlamlı farklılık saptandı. (p=0.05) IFNα-2b+BCG kombinasyon grubunda evreler göz önüne alınınca IL 2 ve IL 6 seviyelerinde istatistiksel olarak anlamlı farklılık saptandı. (p=0.05) G3 tümörü olan hastalarda 2. ve 4. saatte IL 2 seviyeleri daha yüksekti (p=0.05), fakat intravezikal tedavi şeklinden bağımsız olarak bu grup hastalarda IL 6 ve IL 10 seviyelerinde anlamlı farklılık yoktu. (p=0.05) Sonuç: Yüzeyel mesane tümörlerinin tedavisinde IFNα-2b ve BCG kombinasyon tedavisi güvenilir ve etkili bir tedavi yöntemidir.

Semptomatik Periüretral Kistte Tanı ve Tedavi

Ozet Periuretral kist nadir bir antitedir. Periuretral kitlelerin cogunun benzer semptomlara sahip olmasindan dolayi periuretral kistlerin degerlendirilmesi ve tedavisi zordur. Periuretral kistlerin cogu fizik muayene ile teshis edilebilir.Cerrahi eksizyon etkili bir tedavi yontemidir ve takiplerde minimal rekurrens riski vardir. Biz calismamizda perineal agri sikayeti olan 54 yasinda kadin hastada periuretralkist vakasini sunduk.