Alper Gök

Management of Forgotten Ureteral Stents: Relationship between Indwelling Time and Required Treatment Approaches

Background: Double-J stents are widely used in urology practice, and removal of these stents can sometimes be forgotten. Aims: To investigate whether indwelling time of double-J stent can predict which treatment modality is required for removal of the stent from the body. Study Design: A multicentre, retrospective observational study. Methods: The data of 57 patients who were treated for forgotten ureteral stents between January 2007 and December 2014 were evaluated retrospectively. Patients were classified into four groups according to indwelling time of the stents: 6-12 months, 13-24 months, 25-36 months, and >36 months. Encrustation and associated stone burden of the stents were evaluated with non-contrast stone protocol computerised tomography. Results: Patients were classified according to their duration of the stent indwelling time. Simple cystoscopic stent retrieval was performed in 71.4% of patients in the 6-12 months group, 44% of patients in the 13-24 months group, 6.2% of patients in the 25-36 months group, and 11.1% of patients in the >36 months group. A percutaneous or open surgery was required in no patients with an indwelling time of double-J stent shorter than 30 months. Conclusion: Transurethral and/or percutaneous combined endo-urological approaches are usually sufficient for the removal of forgotten double-J stents. Transurethral procedures are sufficient for the treatment of patients with double-J stent indwelling times less than 30 months.

Factors Influencing the Duration of Fluoroscopy in Percutaneous Nephrolithotomy

DOI: 10.4328/JCAM.1318 Received: 05.10.2012 Accepted: 26.11.2012 Printed: 01.07.2014 J Clin Anal Med 2014;5(4): 300-3 Corresponding Author: Alper Gök, Türkiye Yüksek İhtisas Hastanesi, Üroloji Kliniği, Sıhhıye 06100 Ankara, Türkiye. GSM: +905326031181 E-Mail: alper_gok@hotmail.com Özet Amaç: Perkütan nefrolitotomi (PCNL) ameliyatı üroloji pratiğinde sıklıkla floroskopik görüntüleme eşliğinde yapılmaktadır. Bu çalışmanın amacı perkütan nefrolitotomide floroskopi süresini etkileyen faktörleri araştırmaktır. Gereç ve Yöntem: Ocak 2008 ile Mayıs 2011 tarihleri arasında Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi Üroloji Kliniği’nde 199 perkütan nefrolitotomi vakası floroskopi sürelerini etkileyen faktörler açısından değerlendirildi. Tüm hastalara İntravenöz Pyelografi(İVP) ve Kontrastsız Bilgisayarlı Tomografi(BT) çekilerek taşların boyutu ve Hounsfield Ünitesi(HU) yani sertlik derecesi değerlendirildi. Taş yükü, cetvel yardımıyla taşın en büyük eksen çapının ve bunu dik kesen çapın çarpımıyla elde edilen değer olarak kaydedildi. Çalışmamızda cerrahi deneyim, böbreğe giriş sayısı, olgunun daha önceden aynı böbrekten ameliyat geçirip geçirmediği, taşın Bilgisayarlı Tomografide hesaplanan Hounsfield Ünitesi ve preoperatif dönemde hesaplanan taş yükünün floroskopi sürelerine etkileri incelendi. Bulgular: Deneyimin artmasının floroskopi sürelerini istatistiksel olarak etkilediği gözlendi (p=0,006). Ameliyat öncesi hesaplanan taş yükü kategorileri ile floroskopi süreleri arasında istatistiksel anlamlı bir ilişki gözlenmiştir (p<0,001). Geçirilmiş bir böbrek cerrahisinin floroskopi süreleri üzerine etkisi incelendiğinde istatistiksel olarak anlamlı bir ilişki yoktu (p=0,393). Ameliyat öncesi hesaplanan Hounsfield Ünitesi değerleri ile floroskopi süreleri arasında istatistiksel anlamlı bir ilişki vardı (p<0,001). Tek giriş ve multiple girişin floroskopi süreleri ile ilişkisi değerlendirildiğinde aralarında yine istatistiksel olarak anlamlı bir ilişki vardı (p<0,001). Tartışma: Çalışmamızda taş boyutu, Hounsfield Ünitesi, deneyim ve giriş sayısının floroskopi süreleri ile ilişkili olduğu ancak hastanın daha önceden aynı böbrekten cerrahi işlem geçirmesinin floroskopi süreleri ile ilişkili olmadığı gözlendi. Floroskopi sürelerinin uzun olacağı tahmin edilen vakalarda cerrahi ekip radyasyondan korunma önlemlerini daha dikkatli bir şekilde almalıdır.

Characterization Of Kidney Stones With Imaging Modalities: Twinkling Artifact In Color Doppler Ultrasound And Density In Non-Contrast-Enhanced CT

Objective: Accurate characterization of urinary stones is very important in that it effects choice, and outcome of the treatment using imaging techniques various characteristics of the stones including their size, configuration, and location can be determined. In this study we aimed to determine the correlation between the composition of the kidney stones with the twinkling artifact in Color Doppler Ultrasound, and the mean density in the noncontrast-enhanced computed tomography (NCECT). Methods: A total of 49 patients who had kidney stones with an indication for surgery were included in this prospectively planned study. All patients were examined with the NCECT for the mean density measurement in Hounsfield units, and using Color Doppler ultrasound for the twinkling artifact before the surgery. Results: Forty-one (83.68 %) renal stones were composed purely of a single element,while 8 (16.32%) kidney stones composed of two elements.Renal stones only with calcium and non-calcium stones had different mean densities in NCECT, and the cut-off value was calculated as 644.5 Hounsfield Unit (p<0.001). After analyzing kidney stones according to this cut-off value, there was a statistically significant association between the composition of the stone and the twinkling artifact with the stones which had a lower mean density than the cut-off value (p=0.014). The kidney stones with a mean density below this cut off value with grade 0-1 twinkling artifact were uric acid stones, and those with grade 2 twinkling artifact were cystine stones. The kidney stones with a mean density above the cut off value, any statistically significant association between the twinkling artifact and composition of the stones was not detected (p=0.203), but all kidney stones with grade 1 twinkling artifact were found to be calcium oxalate monohydrate. While 83.3%, and 16.7% of the stones with Grade 2 stones with a density above cut-off value were found to be composed of calcium oxalate monohydrate, and calcium oxalate dihydrate, respectively Conclusion: The twinkling artifact of the kidney stones in Color Doppler Ultrasound and the mean density in NCECT, can be used for the characterization of the kidney stones and it is helpful for the right treatment of choice.

Can Hounsfield Unit Value Predict Type of Urinary Stones

1 Alper Gök1, Ali Çift1, Bahri Gök2, Kemal Ener3, Mehmet Özgür Yücel1, Hacı Polat1, Can Benlioğlu1, Bedreddin Kalyenci1, Zeki Ender Güneş4 1Adıyaman Üniversitesi Tıp Fakültesi, Üroloji, Adıyaman, 225 Aralık Devlet Hastanesi, Üroloji, Gaziantep, 3Ankara Atatürk Eğitim ve Araştırma Hastanesi, Üroloji, Ankara, 4Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Üroloji, Ankara, Türkiye Böbrek Taş Cinsleri / Type of Urinary Stones Can Hounsfield Unit Value Predict Type of Urinary Stones?

Perkütan Nefrolitotomide Başarıyı Etkileyen Faktörler

Community mental health centers are centers where patients with heavy mental disorders are provided with not only treatments in order to develop individual functioning, but also psychosocial support services and follow-up and treatment services as well in their own residence integrated with their primary healthcare in accordance with community-based mental health model. In order to provide an efficient mental health care service in a country, first the citizens of that country should be protected in terms of mental health, then the risky groups should be determined, and early diagnosis and treatment methods should be provided and in order to increase the quality of healthy life mental health and rehabilitation services which are composed of education and consultancy steps, should be offered. This study has been conducted in order to compile the research results for the development of nursing services in community-based mental health services in our country, which are still in development stage. In the study, in order to assess the development of community-based mental health services, the founding and functioning of community health service centers and the efficiency of community mental health nurses in those centers, PsychINFO, PsychARTICLES, MEDLINE, PubMED, The COCHRANE LIBRARY, CINAHL databases have been scanned for articles published between the years 1999 and 2014.