Altuğ Tuncel

Case report: Incidental primary transitional cell carcinoma of the prostate treated with transurethral prostatectomy only

A 65-year-old man presented with a history of painless gross hematuria and severe obstructive symptoms. Abdominal ultrasonography and intravenous urogram revealed the absence of any disease in the urinary tract except benign prostatic hyperplasia. He underwent a transurethral resection of the prostate and was found to have incidental primary transitional cell carcinoma of the prostatic ducts localized to the gland. Radical cystoprostatectomy was offered but the patient was hypertensive, had a history of cerebrovascular accident and refused another major operation. Since also his general condition was not good enough for further therapy, he was treated with transurethral prostatectomy only. After 16 months he is still alive and free of disease.

Evaluation of the complications in transperitoneal laparoscopic renal and adrenal surgery with Clavien-Dindo classification.

OBJECTIVE To evaluate our complications in renal and adrenal transperitoneal laparoscopic surgeries with Clavien-Dindo classification. MATERIAL AND METHODS Two hundred and eight patients to whom renal and adrenal laparoscopic surgeries were performed between January 2008 and June 2015 were included the study. One hundred and twenty one (58.2%) patients were female and 87 (41.8%) of them were male. Laparoscopic procedures were performed as radical nephrectomy (n=49; 23.6%), simple nephrectomy (n=56; 26.9%), and partial nephrectomy (n=7; 3.4%), renal cyst decortication (n=27; 13%), pyelopasty (n=14; 6.7%) and adrenalectomy (n=55; 26.4%). Complications were classified according to Clavien-Dindo classification. RESULTS The mean age of the patients was 48.01±14.9 years. The mean duration of hospital stay was 3.5±1.9 days. According to European Scoring System for Laparoscopic Operations the procedures were graded based on procedural difficulty as simple (n=27; 12.9%), difficult (n=172; 82.8%), and highly difficult (n=9; 4.3%). Complications were observed in 13 (6.3%) interventions. One of these occurred during very hard and 14 during difficult procedures. According to Clavien-Dindo Classification; Grades 1, 2, and 3 A complications developed in 3 (1.4%), 9 (4.3%), and 1(0.5%) patient, respectively. CONCLUSION Laparoscopic surgery is an efficient procedure in well-chosen patients for renal and adrenal diseases with low complication rates.

Seperation of dorsal vein complex from the urethra by blunt finger dissection during radical retropubic prostatectomy.

We present our initial experience on the isolation of dorsal vein complex by blunt finger dissection in 26 patients with localised prostate cancer who underwent open retropubic radical prostatectomy. Loss of blood was between 300 and 500 mL (mean 350 mL). Two of 26 patients (7.6%) required blood transfusion. There was no positive surgical margin at prostatic apex in the patients. Twenty four of our patients (92.4%) were continent on the 3(rd) month. Control of dorsal vein complex is very important to decrease blood loss and to improve intraoperative exposure of retropubic area in order to get negative margin of prostatic apex and to provide the urethra long enough for a nice urethrovesical anastomosis. According to our initial experience, this technique seems to provide these aims.

Transperitoneal laparoscopic adrenalectomy: five years' experience with 35 patients.

OBJECTIVE To present our laparoscopic surgery experience in the treatment of adrenal masses. MATERIAL AND METHODS Between January 2008 and February 2013, a total of 35 patients (24 females, 11 males) underwent transperitoneal laparoscopic adrenalectomy to treat an adrenal mass. The patients underwent hormonal evaluation, chemical shift magnetic resonance imaging, or abdominal computed tomography. Twenty-seven patients (77.1%) had a hormone-active adrenal mass. RESULTS Eighteen right, 16 left, and one bilateral transperitoneal laparoscopic adrenalectomies were performed. The mean age and body mass index of the patients were 47.4 years and 26.6 kg/m(2), respectively. The mean adrenal mass size, operation time, estimated blood loss, and hospitalization duration were 41.9 mm, 94.7 min, 30 cc, and 2.4 days, respectively. No minor or major complications were observed perioperatively or postoperatively. In one patient (2.8%), the laparoscopic approach was converted to open surgery due to severe bradycardia resulting from chronic obstructive pulmonary disease. Histopathological examinations revealed adrenocortical hyperplasia in 23 (66%) patients, benign pheochromocytoma in 8 (22.8%) patients, and periadrenal paraganglioma, adrenocortical carcinoma, myeloid metaplasia, and myelolipoma in one (2.8%) patient for each entity. CONCLUSION Transperitoneal laparoscopic adrenalectomy is a safe and efficient minimally invasive treatment option with a low morbidity rate in the surgical treatment of adrenal masses.

How to clearly articulate results and construct tables and figures in a scientific paper

The writing of the results section of a scientific paper is very important for the readers for clearly understanding of the study. This review summarizes the rules for writing the results section of a scientific paper and describes the use of tables and figures.

Benign Prostat Hiperplazisi Tedavisinde Alfa Adrenerjik Reseptör Blokeri ve 5-Alfa Redüktaz Enzim İnhibitörü Dışındaki Tedaviler: Endikasyonlar ve Sonuçlar

Benign prostat hiperplazisi (BPH), erkeklerde alt üriner sistem semptomları (AÜSS)’na neden olan, prostatın transizyonel alanında düz kas ve epitelyal hücre proliferasyonu ile karakterize, prostat’ın kötü huylu olmayan büyümesidir (1). Yaş ve fonksiyonel testis varlığı, BPH’nin ortaya çıkmasında bilinen en önemli etiyolojik faktörler olarak karşımıza çıkmaktadır. BPH gelişimi; 30-40 yaşları arasında %10, 40-50 yaşları arasında %20, 60-70 yaşları arasında %50-60, 70-80 yaşlarından sonra tüm erkeklerde gözlenmektedir (2). BPH’ne bağlı idrar yapma ve depolama yakınmalarının temel nedeni büyümüş adenom kitlesine, prostat stromasındaki artmış düz kas aktivitesine ve mesane aşırı aktivitesine bağlıdır (3). BPH ile ilişkili AÜSS’nın tedavisinde izlem-gözlem, medikal (alfa adrenerjik reseptör blokeri, 5-alfa redüktaz inhibitörleri, muskarinik reseptör antagonistleri, desmopressin, kombinasyon tedavileri) ve cerrahi tedavi seçenekleri mevcuttur. Medikal tedavi uygulanacak hastalarda büyümüş olan adenom kitlesine yönelik 5-alfa redüktaz inhibitörleri, prostat stromasındaki artmış düz kas aktivitesine yönelik alfa adrenerjik reseptör blokerleri ve mesane bileşenine yönelik muskarinik reseptör antagonistleri medikal tedavi seçeneklerinin temelini oluşturur. Medikal tedaviden fayda görmeyen ve/veya BPH’ne bağlı bir takım komplikasyonlar gelişen hastalarda cerrahi tedavi seçenekleri önerilmektedir (4). Ancak hangi hastaya hangi tedavi verileceği konusunda net değildir. Uygulanacak tedavide etkinlik, yan etki, maliyet gibi faktörlerin göz önünde bulundurulması, hekim ve hastanın ortak kararı vermesi doğru olacaktır. Bu derlemede, BPH ile ilişkili AÜSS’nın tedavisinde yaygın olarak kullanılan alfa adrenerjik reseptör blokerleri ve 5-alfa redüktaz enzim inhibitörleri dışındaki medikal tedavi seçenekleri, bu tedavi seçeneklerinin endikasyonları ve sonuçları özetlenmektedir.

Our results of tubularized incised plate urethroplasty in cases with primer and recurrent hipospadias

Objective: To compare the efficacy of tubularized incised plate urethroplasty (TIPU) technique on cases with primer and recurrent hypospadias. Materials and methods: Records of 141 (120 primary, 21 recurrent) hypospadias patients who underwent TIPU and completed 3rd month control were retrospectively reviewed. Urethral stent with percutaneous cystostomy and Foley catheter were used in 110 (72%) and 31 (22%) patients, respectively. Catheter or stent was removed on postoperative 7th day, and patients were asked for control visit on 2nd week and third month. The success rate of TIPU was assessed on primary and recurrent cases. Additionally, the effect of patient’s age, placement of urethral meatus, and type of urinary divertion on TIPU success were investigated. Results: The mean age of the patients was 8.4±4.6 years (range 2-25 years). Urethral fistula developed in 23 (19.2%) of 120 primary patients and 5 (23.8%) of 21 recurrent patients (p=0.623). There was no difference in term of mean age in patients with and without urethral fistula (9.2 years vs. 8.2 years, p=0.377). The placement of urethral meatus were coronal in 27 (19.1%), subcoronal in 101 (71.6%), and mid-penil in 13 patients (9.2%). There was no difference in terms of placement of urethral meatus and urethral fistula in primary and recurrent cases (p=0.147). There was no difference between urethral Foley catheter and urethral stent with percutaneous cystostomy usage in terms of urethral fistula development (20.9% vs. 16.1%, p=0.738). Conclusion: TIPU is an easy-to-apply technique with low complications rates, good functional and cosmetic outcomes in both primary and recurrent hypospadias cases.