Ahmet Tunçkıran

Management of symptomatic ureteral calculi complicating pregnancy.

OBJECTIVE To review our experiences with management of symptomatic ureteral calculi complicating pregnancy. METHODS Between January 2001 and December 2011, 57 pregnant women were treated for symptomatic ureteral stones. The medical records of these patients were reviewed retrospectively. RESULTS The mean patient age was 24 (range 17-37) years and gestational age at presentation was 26 weeks (range 12-38). Most of the cases (60%) occurred in the third trimester. Flank pain was the most common presenting symptom (90%). Ultrasonography was the initial test confirming diagnosis. With conservative management, spontaneous passing of stones was noted in 13 cases (22.8%). In 10 patients (17.5%), symptomatic relief occurred without spontaneous passing of stones until the end of pregnancy. Invasive management was required in 34 patients (59.6%) because of persistent pain and/or ureteral obstruction. In 29 patients, ureteral calculi were treated successfully by ureteroscopy. Stones were extracted by pneumatic lithotripsy or forceps. In 5 patients, only double-J stent was inserted during ureteroscopy as a result of unreached or migrated stone. The majority of patients (58.8%) had lower ureteric calculi. The mean size of the stones retrieved was 7 mm (range 4-13 mm). Minor complications like ureteric edema, mild ureteric laceration, or bleeding were seen in 5 patients. Three patients had a urinary tract infection and 3 complained of stent-induced bladder irritation; uterine contraction was observed after the procedure in 1 patient, but no serious obstetric or urologic complications were observed in any case. CONCLUSION When conservative treatment fails, ureteroscopy is an effective and safe therapeutic option in symptomatic ureteral calculi complicating pregnancy.

Intraoperative floppy iris syndrome associated with silodosin.

Editor, W e read the article by StorrPaulsen et al. (2014) with great interests. They contributed literature with a large numbers of patients. It is well known that tamsulosin is associated with intraoperative floppy iris syndrome (IFIS), which includes a triad of a flaccid iris, propensity for the iris and progressive pupil construction, during cataract surgery (Chang & Campbell 2005). Thus, surgical adjustment is needed by ophthalmologists. They also described IFIS with another alpha blocker drug as doxazosin. Additionally, Settas and Fitt described IFIS with alfuzosin (Settas & Fitt 2006). To overcome these issues, we would like to affix a case of IFIS with silodosin. To our best knowledge, this is the first IFIS by silodosin, in the literature. A 60-year-old man, with lower urinary tract symptoms (LUTS) admitted urology outpatient clinic. Detailed clinical and laboratory examinations including uroflowmetry which an obstructive pattern was presented in terms of maximum urinary flow (Qmax) rate was 14 ml/second were performed. Therefore, he was diagnosed as benign prostate hyperplasia, and silodosin 8 mg was prescribed. In the 1st month of drug, he was benefitted from silodosin as Qmax was 19 ml/second and he had few LUTS. After 2 months from start to use silodosin, he went to ophthalmology outpatient clinic and he was diagnosed as cataract in his left eye. The ophthalmology clinic made plan for cataract surgery, and they consulted him with us for possible IFIS. However, there has not been any IFIS by silodosin in the literature; we preferred to stop silodosin. After 45 days, he stopped silodosin; he underwent cataract surgery. During the surgery, ophthalmologist reported the triad of IFIS and the patient needed surgical interventions, during cataract surgery in which surgeons also were allowed to use intraoperative prophylactic measures (Klysik & Korzycka 2014). To our best knowledge, this was the first case of IFIS by silodosin. The rate of IFIS with tamsulosin was 60% in literature (Michel et al. 2006; Settas & Fitt 2006). Michel et al. (2006) reported IFIS with other alpha blockers in rabbits. The main cause seems like it is associated with selective alpha-1 blockage; thereby, silodosin has a selective and strong capacity in alpha-1 blockage (Akin et al. 2013). The ophthalmologist should be aware of IFIS before cataract surgery in men who use alpha blocker drugs specifically selective ones such as tamsulosin and silodosin. Nevertheless, each patients who use alpha blocker would not experience IFIS.

Top cited articles in urology from Turkey

OBJECTIVE Citation is the name given for a scientific publication in order to be used as a reference by another publication. In this study, we reviewed the most frequently cited publications in urology from Turkey. Although the number of citations is not completely definitive on its own, it shows the importance and effect of the publication. Besides the number of citations directly determines the impact factor of the journals and this factor is generally used in the evaluation of the quality and importance of the journal. MATERIAL AND METHODS On March 7-14, 2016, 51 studies with highest number of citations from Turkey are determined from Science Citation Index Expanded database index and the journals in which studies are published, the authors of the publications, their cities and departments, study types, publication date of the studies and the number of citations are recorded. RESULTS The most frequently encountered subjects in the publications that are mostly cited from Turkey are urolithiasis (23.5%), infertility (15.6%), benign prostatic hyperplasia (11.7%), sexual dysfunction (11.7%) and bladder carcinoma/urothelial carcinoma (9.8%). Distribution of 51 publications is as follows: 18 case series, 11 randomized study, 7 non-randomized study, 6 study, 3 review, 3 cross-sectional studies and 3 survey studies. Of all the studies, 68.6% are from Ankara, İstanbul and İzmir and 72.5% of them have originated from the university hospitals. CONCLUSION It is important to show the most cited Turkish publications in order to show the contribution in the world literature regarding to urology. The most cited publications in Turkey belong to urolithiasis and andrology areas. When the citation analysis publications in urology and different areas both in Turkey and in the world, it is observed that the number of our qualified publications is at acceptable levels.

Tips and Tricks in Laparoscopic Surgery in Light of 172 Patients, From A Gynecological Point of View in Turkey

DOI: 10.4328/JCAM.2754 Received: 25.08.2014 Accepted: 13.09.2014 Printed: 01.05.2016 J Clin Anal Med 2016;7(3): 321-6 Corresponding Author: Kadir Bakay, Baskent Universitesi Kadın Hastalıkları ve Doğum Kliniği, Alanya Uygulama Merkezi, Alanya, Antalya, Türkiye. GSM: +905308265868 E-Mail: drkadirbakay@gmail.com Özet Giriş: Bu çalışmada laparoskopik cerrahide edindiğimiz tecrübeleri paylaşmayı amaçladık. Gereç ve Yöntem: Prospektif vaka kontrollü çalışmada Başkent Universitesi Alanya Uygulama Merkezi Kadın Hastalıkları ve Doğum kliniğindeki Nisan 2012 ve Mart 2014 tarihleri arasında opere edilen 172 hastadan elde edilen veriler kullanıldı. Bulgular: Batın duvarı elle tutulduğunda veya çamaşır klempi ile tutulduğunda trokar girişi sırasında uygulanan güce bağlı değişiklik; elle tutulduğunda 1cm’den 3cm’ye (ortalama: 2.13±1cm), çamaşır klempi ile tutulduğunda 0.5cm’den 3cm’ye (ortalama: 0.89±0.8cm) kadar ölçülmüş ve aradaki fark istatistiksel olarak anlamlı bulunmuştur (p<0.05). Tartışma: Laparoskopik cerrahi veya genel anlamda minimal invaziv cerrahi, gelecekte tıbbın neredeyse tüm alanlarına hakim olacaktır. Bu nedenle tüm cerrahi branşların hem mezuniyet öncesi hem de mezuniyet sonrası cerraha yeterli eğitimi sunması elzemdir.

Do Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia Affect Sexual Functions

Aim: To evaluate the possible effect of lower urinary tract symptoms on sexual functions. Material and Method: 219 patients were included in this study. Of the 177 patients completed the study. All the patients filled Turkish validated form of IPSS and ICS-sex questionnaire. The patients were grouped due to the symptom scores, quality of life scores, age, etc. Results: The rate of erectile dysfunction significantly raised as the age raised (p=0.00). Erectile dysfunction rate was significantly higher in the group those have severe uri nary symptoms (p=0.03). Patients were grouped as life quality score and the rates of erectile and ejaculatory functions significantly raised as life quality score became higher (p=0.008, p=0.01, respectively). Pain during ejaculation rates significantly raised as the irritative symptoms scores and nocturia raised (p=0.002 and p=0.029, respectively). Discussion: Study demonstrated that the severity of LUTS (lower urinary tract symptoms) has a significant impact on sexual functions in patients with BPH.

Management of forgotten ureteral stents.

Dear Editor, We read with great interest the study reported by Rabani (1). The author reported their experiences in endoscopic management of forgotten ureteral stents with large burden stone encrustation. As the author stated, ureteral stents are widely used in urology practices. However, complications including migration, fragmentation, and encrustation can be related to stents and sometimes the stents may possibly be forgotten. We would like to add some additional comments and suggestions on the issue of forgotten ureteral stents. Although ureteral stents have various advantages, forgotten stents are a challenging situation even for the experienced endourologists. Forgotten stents can result in serious morbidity, mortality, and an increased financial burden for health services (2). Forgotten ureteral stents usually arise from poor compliance of the patient or failure of the physician to adequately counsel the patient. One important medicolegal issue also needs to be emphasized. The attending urologist is ultimately responsible for the removal of stent and also responsible for the complications if the patient with stent is lost to follow-up. Gravas et al. (3) underscored some important points in the management of forgotten ureteral stents. They reported that a thorough, preoperative, imaging evaluation is necessary to decide the treatment strategy, which should aim to keep the number of necessary interventions as low as possible. They also stated that the most controversial and difficult part in the management of forgotten ureteral stents is the encrusted upper curl, and the critical question is which method out of percutaneous nephrolithotomy, ureteroscopy and extracorporeal shockwave lithotripsy is the most appropriate. As Rabani (1) mentioned, while endourological manage¬ment of these stents achieves success in majority of cases with minimal complications, the best treatment would be prevention of this complication. For achieving this important goal, some investigators have offered different strategies. Lynch et al. have suggested an electronic stent extraction reminder facility recall base to prevent forgot¬ten stents (4). Sancaktutar et al. Described and presented the initial results of a computer-based system that tracks ureteral stents and automatically sends a reminder through a short message service to both the patient’s and the urologist’s mobile phones (2). Recently, Chew et al. even described a novel biodegradable ureteral stent in a porcine model (5). Although endourologic management of forgotten ureteral stents possible in most of the cases with success, further efforts and studies must be made for prevention strategies and possibilities for new kind or type of ureteral stents.

Massive Idiopathic Scrotal Calcinosis

Idiopathic scrotal calcinosis is a rare, benign condition with the presence of multiple slow-growing yellowish-white calcified asymptomatic nodules that appear within the scrotal skin. The disease affects patients in childhood or early adulthood. The etiology of idiopathic scrotal calcinosis is still controversial. It can extensively affect the scrotal skin, but primary closure is usually achievable with good esthetic outcomes.

A Surprising Attempt for Urinary Incontinence

DOI: 10.4328/JCAM.414 Received: 20.09.2010 Accepted: 02.2010 Printed: 01.01.2012 J Clin Anal Med 2012;3(1):104-5 Corresponding Author: M.Burak Hoşcan, Baskent University Alanya Research and Practice Center, Alanya, Antalya, Turkey. F.: +902425112350 E-Mail: drburakhoscan@yahoo.com Özet İdrar kaçırma şikayeti olan kadınların çoğunluğu, çok sayıda tedavi seçeneği olmasına rağmen, tedavi için başvurmamaktadır. İdrar kaçırmanın tedavisi için kendi kendine ceviz kullanan bir kadın hasta olgusunu sunmaktayız.

Publication rates of dissertations written in medical faculties of Turkey in the field of urology between the years 2008, and 2011, and citation analysis: A cross-sectional study

OBJECTIVE In our country, preparing dissertation is essential for the research assistants in order to complete their expertise in medicine. It is aimed to produce hypothesis for researchers via writing their dissertations, to collect data for the hypothesis established, to make the analysis and interpretation of these data, and to gain the ability for the comparison of the findings obtained with the literature. In this study, we want to investigate the publication rates and citations of urology dissertations that are written at the university hospitals in our country between 2008 and 2011. MATERIAL AND METHODS Urology dissertations that are written at the university hospitals between 2008 and 2011 were reviewed by entering the website of Board of Higher Education Dissertation between 23-27 March 2017 and 229 dissertations were reported. The publication rates of these dissertations were analysed. RESULTS Hundred and fourteen of 229 dissertations (49.7%) analysed were published. Of these publications, 75 (32.7%) in Science Citation Index Expanded, 24 (10.4%) in international, 15 (6.5%) are published in national indexed peer-reviewed journals. While the publication rate of 81 dissertations written in universities located in 3 metropolitan cities (Istanbul, Ankara, and Izmir) of Turkey was 50.6%, the publication rate of 148 dissertations written in remaining universities was 49.3%; and no statistically significant difference was found between the two groups (p=0.96). CONCLUSION Preparing dissertation is a challenging process that requires considerable effort and time. At the end of this process, it is necessary to publish the dissertation in order to have it reach more people and to contribute to the literature. Even though publication rate of dissertations written in urology at university hospitals in Turkey was at acceptable level, there have still been problems required to solve.

Where Do Patients Go for Treatment of Urethritis

Background: Urethritis is characterized by urethral inflammation, and it can result from both infectious and noninfectious conditions. Physicians and other health care providers play a critical role in preventing and treating urethritis. Objectives: The aim of this study was to describe and identify predictors of health care seeking behavior among men with urethritis. Patients and Methods: In total, 98 male patients aged between 16 to 52 years-of-age (mean 30.9 ± 8.0 years), who attended our clinic with symptoms of urethritis, were included in the study. We conducted face-to-face interviews with the patients using a 9-item survey questionnaire. Patients were divided into three groups according to their level of education as follows: group I (n = 44), elementary school; group II (n = 38), high school; and group III (n = 16), university. Results: Among the 98 patients evaluated, the source of treatment was physicians in 44 patients (44.9%), drugstores in 38 cases (38.77%), and friends in 16 patients (16.32%). There was a statistically significant difference found between the groups according to the source of treatment (P < 0.001). The most common factors associated with seeking care from other sources, rather than physicians, were economic reasons in 19 patients (35.18%), confidentiality concerns in 24 (44.4%), and ease of access in 11 patients (20.37%). Conclusions: A substantial proportion of patients with urethritis sought help from other sources, rather than physicians. The results of our study show that the patients with higher levels of education were more likely to seek help from health care services. It is important to promote the public’s knowledge through informative studies and educational materials in order to encourage patients to seek rapid and effective treatment from proper sources.