Alpaslan Akbaş

Reconstruction of Strictures of the Fossa Navicularis and Meatus With Transverse Island Fasciocutaneous Penile Flap

PURPOSE Reconstruction of post-prostatectomy strictures involving the fossa navicularis and external urethral meatus following benign prostatic hyperplasia treatment is challenging in terms of creating a functional and cosmetically appealing penis. We reviewed our results with the use of ventral transverse island fasciocutaneous penile flap in the reconstruction of these strictures. MATERIALS AND METHODS Between 1997 and 2007 a total of 26 men (mean age 59 years, range 49 to 76) with post-prostatectomy distal urethral strictures underwent urethral reconstruction with a ventral transverse island fasciocutaneous penile flap. All patients had undergone multiple urethral dilatations. Stricture length was less than 1.5 cm in all cases. Urethral catheter was removed within 3 weeks. Followup included an initial uroflowmetry obtained 1 month after removal of the catheter followed by re-assessment at third month. The patients were followed for urinary pattern changes and/or irritative symptoms with a mean followup of 30.2 months (range 4 to 96). RESULTS Mean maximum urine flow rate at first month assessment was 17 ml per second. Flap necrosis and fistula developed in 1 patient 3 months after surgery. In the remaining patients stricture was not evident. A mild urinary splaying was observed in all patients which improved significantly within 6 weeks. A functional and cosmetic outcome was achieved in 96% of the patients. CONCLUSIONS Reconstruction of post-prostatectomy strictures involving the fossa navicularis and external meatus with ventral transverse island fasciocutaneous penile flap is an efficient method for the restoration of a functional and cosmetic penis with preserved glandular integrity.

A Novel Pull-Through Technique for the Surgical Management of Idiopathic Hydrocele

PURPOSE Standard surgical procedures for hydrocele may cause postoperative discomfort, temporary limitation of normal activities and complications, such as hematoma, infection, persistent swelling, chronic pain and decreased fertility. We describe a new technique in an effort to decrease these complications. MATERIALS AND METHODS Between April 2004 and December 2006, 21 patients underwent hydrocelectomy, which was bilateral in 1. Through a 15 mm transverse scrotal incision the tunica vaginalis parietalis was identified and grasped. Under gentle traction the sac was dissected bluntly and delivered out of the incision. The fully mobilized tunica was excised by electrocautery at its base, followed by wound closure. Patients were discharged home within 24 hours after surgery and were followed at 6-month intervals for a minimum of 18 months. RESULTS Mean operative time was 27.3 minutes. Postoperatively hematoma or wound infection was not evident in any case. Mild scrotal edema usually subsided within a few days after the procedure. Two patients with persistent edema and hardening of the scrotum required additional bed rest and anti-inflammatory agents. Patients were able to resume normal daily activity an average of 6 days after surgery (range 3 to 21). Cure was achieved in 21 of the 22 hydrocele cases (95%). CONCLUSIONS Our pull-through technique enables the surgeon to remove large hydrocele sacs through a small incision and with minimal dissection under direct vision of the testicular structures, resulting in early recovery and minimal complications. This procedure may be a viable option for the surgical management of idiopathic hydrocele.

Female Urethral Malignant Melanoma With Vesical Invasion: A Case Report

We report a 75‐year‐old female with a primary urethral malignant melanoma. A mass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4 × 2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+) malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery.

Short Stay Pyeloplasty With Transverse Dorsal Lumbotomy Incision: Our 10-Year Experience

OBJECTIVES To review our long-term results with a modified dorsal lumbotomy (DL) approach and evaluate its role as a minimally-invasive alternative for the surgical management of ureteropelvic junction obstruction (UPJO). METHODS Fifty-nine consecutive children (42 males, 17 females, median age: 5.7 years) underwent pyeloplasty with transverse DL (TDL) between 1999 and 2008. Kidney stones, solitary kidney, and bilateral UPJ obstruction was present in 6, 3, and 5 children, respectively. Forty-nine and 10 children received stented dismembered pyeloplasty and Y-V plasty, respectively. Information on the duration of surgery, length of hospital stay, length of time to return to unrestricted activity, and per/postoperative complications was recorded. Children were followed up postoperatively with urinalysis and ultrasonography (US) at first month, diuretic renogram or intravenous urography (IVU) or both at sixth month, and yearly thereafter with US and renal scintigraphy for the emergence of recurrent clinical symptoms, deterioration of differential renal function, or increase in hydronephrosis. RESULTS Median operative time was 78 minutes and median incision length ranged between 3 and 5 cm for all age groups. All children tolerated liquid diet within the evening of surgery and returned to unrestricted activity within 48 hours. Eight-eight percent of all patients were discharged within 2 days, and 88% of children operated after 2004 were discharged in less than 30 hours. Recurrent UPJO was not evident in any case with a median follow-up of 56 months. CONCLUSIONS TDL provides excellent exposure for UPJO repair with a cosmetically appealing scar while maintaining a minimal convalescence advantage. It is particularly beneficial in bilateral pyeloplasty as synchronous bilateral repair can be performed without repositioning the patient.

Accuracy of Unenhanced Computerized Tomography Interpretation by Urologists in Patients with Acute Flank Pain

Purpose: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. Materials and Methods: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. Results: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [κ]: 0.904), categorical stone size (κ: 0.81), the location of calculus (κ: 0.88), and hydronephrosis (κ: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (κ: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. Conclusion: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.

Female sexual dysfunction in androgenetic alopecia: Case-control study.

INTRODUCTION We sought to evaluate the association of female sexual dysfunction (FSD) with androgenetic alopecia (AGA) and metabolic syndrome (MetS) in premenopausal women. METHODS From December 2013 to June 2015, we performed a case-control, prospective study of 115 patients with AGA and 97 age-matched control patients without AGA from among premenopausal women who visited dermatology clinics of the two reference hospitals. Comprehensive history, anthropometric measurements, and questionnaire administration were performed for each of the total of 212 women. The Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function. AGA was assessed and graded by an experienced dermatologist according to Ludwigs classification. The MetS assessment was made according to the NCEP-ATP III criteria. RESULTS In univariate analysis, age, weight, waist circumference, hip circumference, waist-to-hip ratio, body mass index (BMI), AGA, MetS, cardiovascular event, marital status, hypertension, high fasting plasma glucose, high triglyceride, large waist, total testosterone, and free testosterone were associated with presence of FSD. In logistic regression analysis, age (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.13-1.30; p<0.001), AGA (OR 3.42, 95% CI 1.31-8.94; p=0.017), MetS (OR 5.39, 95% CI 1.34-21.62; p=0.012), and free testosterone (OR 0.18, 95% CI 0.09-0.37; p<0.001) were independently associated with FSD. CONCLUSIONS Our study suggests that age, AGA, MetS, and free testosterone may have strong impact on sexual function in premenopausal women. Further studies with population-based and longitudinal design should be conducted to confirm this finding.

Malignant Melanoma in Genito-Urinary Tract

It manifests itself with flank pain and usually renal involvement is detected at the time of diagnosis. Additionally, distant lymph node metastasis could also be detected. Absence of previous unilateral adrenal gland involvement, presence of pigmented lesions without any signs of endocrine disorder, and negative immunohistochemical endocrine markers are typical characteristics of primary malignant melanoma of the adrenal gland. Presence of an occult primary lesion should also be excluded by autopsy. Pluripotent neural crest cells are localized within adrenal gland medulla. They are precursors of melanocytes, neurons, glial cells of the peripheral nervous system, and adrenal chromaffin cells. Under the influence of microenvironment, and various growth factors, these multipotent cells might transform into different cell types.

Angiomyolipoma Accompanied by Renal Aberrant Artery

Renal angiomyolipoma (AML) is the most common mesenchymal tumor of the kidney composed of fat, smooth muscle and blood vessels. Although AML is usually asymptomatic, it may sometimes be symptomatic because of retroperitoneal haematoma. The treatment modalities are the stabilization of the patient pursued by either selective transarterial embolization as a first line treatment or the second option of surgery. Dilated and tortuous renal artery anomalies can be observed in AML and may complicate selective embolization. In our study we present a case with large AML developing spontaneous rupture. Selective angioembolization for pseudoaneurysms was unsuccessful due to aberrant artery and torsioned vessel structures, finally the patient underwent surgical treatment.

Comparison of transperitoneal laparoscopic nephrectomy outcomes in atrophic and hydronephrotic kidneys.

OBJECTIVE To compare the results of transperitoneal laparoscopic nephrectomy in patients with atrophic and hydronephrotic kidneys. MATERIAL AND METHODS Clinical data were collected from 35 patients who had undergone laparoscopic nephrectomies for atrophic or hydronephrotic non-functioning kidneys between January 2010 and March 2014. Comparative analysis was carried out between the two groups examining demographic characteristics, imaging modalities, etiology, operative times, port numbers, conversion to open surgery, complications, pre-and post-operative hemoglobin and creatinine values, transfusion rates and length of hospital stays. RESULTS Laparoscopic nephrectomy was performed for atrophic kidneys in 20 (57%) patients and for hydronephrotic kidneys in 15 (42%) patients. In the atrophic group, 3 patients (15%) required transfusion because of bleeding but none of the patients required conversion to open surgery. In the hydronephrotic group one patient (6.6%) required transfusion and conversion to open surgery because of bleeding. Both of the groups were similar in terms of postoperative hospital stay but compared to the atrophic kidneys, hydronephrotic ones were associated with a longer total operative times (90.1 min vs. 73.6 min, p=0.03). Any serious complication (except for bleeding) and mortality were not encountered in both groups. CONCLUSION Laparoscopic nephrectomy is a safe and effective minimally invasive technique that can be used in atrophic and hydronephrotic non-functioning kidneys.

Intravesical Migration and Calcification of Intrauterin Device: A Case Report and Review of the Literature

ÖZ Intrauterine device (IUD) is widely used for the long duration of protection, cost-effectiveness and for being a reversible contraceptive method as well as having low complication rates. Despite low complication rates, various IUD-related complications, such as spontaneous aborts, bleeding, infection, and uterine perforation may occur. Although perforation of the uterus by an IUD is not uncommon, bladder perforation is a rare complication. A regular follow-up of patients with IUDs for the complications and training of clinicians for insertion and removal are mandatory to provide better and safe family planning services. Here, we report a case of a patient with uterine perforation with a calcified IUD migration into the the bladder.