Ali Ersin Zumrutbas

Prevalence of lower urinary tract symptoms, overactive bladder and urinary incontinence in western Turkey: results of a population-based survey.

To estimate the prevalence of lower urinary tract symptoms, urinary incontinence and overactive bladder in western Turkey.

The use of biomarkers in the diagnosis and treatment of overactive bladder: Can we predict the patients who will be resistant to treatment?

The main objective of this study was to define urinary biomarkers that can predict the severity of overactive bladder and detect patients who would benefit most from treatment.

Prevalence of Daytime Urinary Incontinence and Related Risk Factors in Primary School Children in Turkey

Purpose Urinary incontinence is one of the major urinary symptoms in children and adolescents and can lead to major distress for the affected children and their parents. In accordance with the definitions of the Standardization Committee of the International Childrens Continence Society, daytime urinary incontinence (DUI) is uncontrollable leakage of urine during the day. The aim of this cross-sectional study was to investigate the prevalence and associated risk factors of DUI in Turkish primary school children. Materials and Methods The questionnaire, which covered sociodemographic variables and the voiding habits of the children, was completed by the parents of 2,353 children who were attending primary school in Denizli, a developing city of Turkey. The childrens voiding habits were evaluated by use of the Dysfunctional Voiding and Incontinence Symptoms Score, which is a validated questionnaire. Children with a history of neurological or urological diseases were excluded. Results The participation rate was 91.9% (2,164 people). The overall prevalence of DUI was 8.0%. The incidence of DUI tended to decrease with increasing age and was not significantly different between genders (boys, 8.8%; girls, 7.3%; p=0.062). Age, maternal education level, family history of daytime wetting, settlement (urban/rural), history of constipation, urinary tract infection, and urgency were independent risk factors of DUI. Conclusions Our findings showed that DUI is a common health problem in primary school children. In an effort to increase awareness of childrens voiding problems and the risk factors for urinary dysfunction in the population, educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status.

The Prevalence of Nocturia and Nocturnal Polyuria: Can New Cutoff Values Be Suggested According to Age and Sex?

Purpose The aims of this study were to assess the prevalence of nocturia and nocturnal polyuria (NP) and to define new cutoff values according to age and sex for both conditions. Methods Data from a population-based prevalence survey conducted among a random sample of 2,128 adults were analyzed in this study. Participants were requested to fill out a questionnaire including the International Continence Society (ICS) definitions of lower urinary tract symptoms and the International Consultation on Incontinence Questionnaire - Short Form. Additionally, a 1-day bladder diary was given to each individual. The participants were divided into 5 age groups. The prevalence of nocturia was calculated based on definitions of nocturia as ≥1 voiding episodes, ≥2 episodes, and ≥3 episodes. NP was evaluated according to the ICS definition. The mean±standard errors and 95th percentile values were calculated in each group as new cutoff values for NP. Results The prevalence of nocturia was estimated as 28.4%, 17.6%, and 8.9% for ≥1, ≥2, and ≥3 voiding episodes each night, respectively. When nocturia was defined as 2 or more voiding episodes at night, the prevalence decreased significantly. The mean NP index was 29.4%±15.0% in men and 23.1%±11.8% in women. For the age groups of <50 years, 50–59 years, and ≥60 years, the new cutoff values for the diagnosis of NP were calculated as 48%, 69%, and 59% for men and 41%, 50%, and 42% for women, respectively. Conclusions We found that the definition of nocturia was still controversial and that waking up once for voiding might be within the normal spectrum of behavior. The definition of NP should be modified, and new cutoff values should be defined using the data presented in our study and in other forthcoming studies.

Primary malignant melanoma of the penis: a case report.

We present the case of a patient with malignant melanoma of the glans penis and urethral meatus, which was found in a 60-year-old man with non-healing ulcerative penile lesion and bilateral clinically palpable inguinal lymphadenopathies at diagnosis. A diagnostic biopsy showed the characteristics of a malignant melanoma. Incisional biopsies from the cutaneous lesions on his glans penis and urethra were performed. Histopathological examination of both specimens showed generally ulceronecrotic surface and numerous atypical melanocytic cells. The diagnosis of giant cell melanoma was made. Two months later, bilateral inguinal lymph nodes dissection was performed. Histopathological examination of both specimens demonstrated malignant melanoma metastasis. Three months after the diagnosis, the patient underwent partial penectomy. High-dose interferon-alpha-2b treatment was started. Early diagnosis is of paramount importance, as the prognosis becomes very poor with an advanced tumor stage.

Optic-Guided Vaginal Repair of Vesicovaginal Fistula

BACKGROUND AND PURPOSE The transvaginal approach for the repair of vesicovaginal fistula (VVF) can sometimes be challenging, especially in fistulas located near the vaginal cuff. We describe a simple technique for the vaginal repair of VVF with the use of endoscopic optics. PATIENTS AND METHODS Three women were admitted to our department with urinary incontinence after total hysterectomy. Assessment with a clinical examination, imaging, and cystoscopy confirmed the diagnosis of VVF. All patients were operated on between December 2012 and January 2013. The operations were conducted under spinal anesthesia with the patients in the lithotomy position. Cystoscopy was performed and retrograde pyelography ruled out any ureteral damage or fistula. A 10F to 12F Foley catheter was inserted into the fistula. From this point, the operation proceeded with optic vision, mimicking laparoscopic dissection and suturing techniques using a standard 5 mm, 30-degree optic lens, a surgical monitor, and open surgical instruments. The fistula was circumferentially incised and widely mobilized from the surrounding tissues and closed without tension in two layers. A urethral Foley catheter was inserted and maintained for 14 days. RESULTS The mean operative time was 70 (range 60-80) minutes. Estimated blood loss was minimal. All patients were discharged at postoperative day 1. No complications were observed. At the postoperative first and third month follow-up visits, all patients were voiding without any urinary leakage or complaints. CONCLUSIONS The use of optics in the vaginal repair of VVF is a useful technique. Optic guidance facilitates surgical vision, dissection, and hemostasis. It is also excellent for surgeon comfort, ergonomics, and resident training.

Assessment of Proportion of Hidden Patients Having Symptoms of Overactive Bladder and Why Has It Been Hidden in Female Outpatients Admitted to Hospital

Purpose: To determine the proportion of patients with undetected symptoms of overactive bladder by using the overactive bladder-validated 8 (OAB-V8) screening questionnaire and investigate these symptoms were undetected in female patients who were hospitalized. Methods: We invited 2,250 female patients hospitalized in the Aegean region of Turkey to answer a self-administered questionnaire. The questionnaire included questions on evidence of lower urinary tract symptoms (OAB-V8), relevant medical history, and demographic data. Patients with a total OAB-V8 score≥8 were defined as having OAB symptoms. Results: The proportion of patients with OAB symptoms in this study was 40.6%. Nearly 57% of the patients with OAB symptoms had not been previously admitted to any hospital for lower urinary tract symptoms (LUTS). The two most common reasons why women with OAB symptoms did not admit themselves to a hospital because of LUTS were as follows: “I did not think I had a disease” and “The symptoms did not bother me,” with a response rate of 74.7%. The mean OAB-V8 scores of the patients with these two responses were significantly lower than those of the other patients (P<0.001). Conclusions: This is the first study to demonstrate a significant proportion of women with undetected OAB symptoms. The main reasons the women did not admit themselves to a hospital were their unawareness of the disease and because the LUTS were not bothersome. Public awareness programs on this disease may resolve this problem.

A rare cause of ureteral injuries; simultaneous common iliac artery and ureter injury during posterior lumbar disc surgery.

Major vascular injuries during lumbar disc surgery are rare but well-recognized complications. However, vascular injuries of the branches of the aorta and ureteral injuries are very rare. Although its incidence is not known definitely, it is estimated to be 1/1000. Ureteral injuries comprise less than 1% of all genitourinary traumas. In this article, we report clinical progress of a patient who had simultaneous internal iliac artery and ureteral injury during lumbar discectomy. The patient was managed with primary ureteroureterostomy. To our knowledge, this is the first case reported with simultaneous ureter and iliac artery trauma during lumbar disc surgery.

The effect of SWL and URS on health-related quality of life in proximal ureteral stones

Abstract Objectives: We aimed to compare the effect of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URS) on health-related quality of life (HRQoL) for the treatment of proximal ureteral stones. Material and methods: Between April 2014 and July 2015, patients with proximal ureteral stones who were successfully treated with URS or SWL in seven different centers were included. Patients were divided into two groups according to stone size: stones ≤10 mm and >10 mm. HRQoL subscales which were evaluated by the Medical Outcome Study Short-Form 36-item survey (SF-36) Turkish version were compared for URS and SWL in these two groups one month after the performed procedure. Results: A total of 273 patients were included in the study. While 116 (52.5%) patients were treated with ureteroscopic lithotripsy, SWL was used for 105 (47.5%) patients. Fifty-two patients were excluded from the study. In proximal ureteral stones ≤10 mm, there were no statistically significant differences for any of the eight subscales of the SF-36 questionnaire. Regarding stones >10 mm, it was found that the three subscales of the SF-36 questionnaire – role limitations because of physical health problems (RP), bodily pain (BP), and general health perception (GH) – were significantly lower in the SWL group compared with the URS group. Conclusions: Patients with proximal ureteral stones >10 mm who were treated with URS generally may have a more favorable HRQoL than those treated with SWL in short-term follow-up.

Evaluation of overactive bladder and nocturia as a risk factor for hip fracture in climacteric women: a matched pair case control study

Abstract The aim of this study was to investigate whether overactive bladder (OAB) influences hip fractures in climacteric women by comparing the frequency of OAB and nocturia symptoms in patients with hip fractures and their age-matched controls in pre-fracture period. A total of 30 climacteric patients with a history of hip fracture were compared to a control group of 51 women in terms of OAB, nocturia and nocturia-QoL. A questionnaire composed of structured questions and Turkish validated versions of the specific questionnaires for OAB, OAB-Quality of Life (OAB-q) and nocturia-QoL was directed to the two groups. We did not detect statistically relevant differences between the groups for the presence or severity of OAB and OAB-q (p > .05). However, Nocturia-QoL was worse in the group with hip fracture (p = .022). Overactive bladder has no contribution to the overall risk of hip fracture, whereas, the severity of nocturia seems to play a role as a risk factor in the formation of hip fracture. Impact statement What is already known on this subject: Hip fracture is associated with high morbidity, mortality and the cost. Prevention of hip fracture is a high priority for the patients, physicians and the public health. Several studies and consensus opinions have investigated the risk factors for the hip fractures. What the results of this study add: Although urinary symptoms were not evaluated in previous studies as a risk factor, desire of urination makes people stand up and move to their toilet, and may put them in a hurry if it is sudden and uncontrollable one. Therefore, we hypothesised that overactive bladder (OAB) and nocturia may be a risk factor in the formation of hip fractures. Our study showed that Nocturia Quality of Life is worse in patients with the hip fracture. Therefore, overactive bladder may not have a role on the overall risk of hip fracture, but the severity of nocturia seems as a risk factor in the fracture process. What the implications are of these findings for clinical practice and/or further research: The getting up from the bed would probably be harder than getting up from a chair in elderly, and life style modifications such as illumination bedroom and organisation of living place may be helpful to minimise the risks.