Arif Demirbas

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception.

Abstract Objectives: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient’s pain control, anxiety levels, and satisfaction. Patients and methods: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed. Results: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. Conclusion: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study

OBJECTIVE To investigate the effect of sexual intercourse on spontaneous passage of distal ureteral stones. MATERIAL AND METHODS The patients were randomly divided into 3 groups with random number table envelope method. Patients in group 1 were asked to have sexual intercourse at least 3-4 times a week. Patients in group 2 were administered tamsulosin 0.4 mg/d. Patients in group 3 received standard medical therapy alone and acted as the controls. The expulsion rate was controlled after 2 and 4 weeks. Differences in the expulsion rate between groups were compared with the chi-square test for 3 × 2 tables. P <.05 was considered as statistically significant. RESULTS The mean stone size was 4.7 ± 0.8 mm in group 1, 5 ± 1 mm group 2, and 4.9 ± 0.8 mm group 3 (P = .4). Two weeks later, 26 of 31 patients (83.9%) in the sexual intercourse group, and 10 of 21 patients (47.6%) in tamsulosin group passed their stones, whereas 8 of 23 patients (34.8%) in the control group passed their stones (P = .001). The mean stone expulsion time was 10 ± 5.8 days in group 1, 16.6 ± 8.5 days in group 2, and 18 ± 5.5 days in group 3 (P = .0001). CONCLUSION Our results have indicated that patients who have distal ureteral stones ≤6 mm and a sexual partner may be advised to have sexual intercourse 3-4 times a week to increase the probability of spontaneous passage of the stones.

Evaluating Ureteral Wall Injuries with Endoscopic Grading System and Analysis of the Predisposing Factors

OBJECTIVE To analyze the predictive factors for intraoperative ureteral wall injury due to semirigid ureteroscopy (URS) used in the treatment of ureteral calculi. METHODS The data of 437 patients who had URS due to ureteral stones were prospectively analyzed. The ureteral wall injuries that occurred during URS were reviewed endoscopically at the end of surgery and divided into two groups as low grade (grades 0 and 1) and high grade (grades 2, 3, and 4) according to classification of ureteral wall injuries. Those two groups were compared for patient and stone characteristics and perioperative findings. RESULTS Ureteral wall injury was seen in 133 (30.4%) patients after surgery. According to the endoscopic classification of the lesions after URS, grades 0, 1, 2, and 3 injury were seen in 69.5%, 16.4%, 11.2%, and 2.7% of the patients, respectively. There were no grade 4 injuries in our series. Two groups showed statistically significant differences for the location (prox- vs distal and mid-ureter) and size of the stone (9.9 mm vs 14.03 mm), presence of preoperatively urinary tract infection (UTI) (12% vs 50.8%), needed balloon dilatation (9.8% vs 36.1%), duration of surgery (33.6 min vs 43.3 min), and surgical success rate (90% vs 76%) (p = 0.01, for all). Stone size, location, duration of surgery, and presence of preoperative infection were determined as independent prognostic factors for mucosal injury. CONCLUSION The ureteral wall injury grading system may be used for standardized reporting of ureteral lesions after ureteroscopy. Big, proximal ureteral stone, longer operation time, and presence of UTI are the risk factors for ureteral wall injury during URS.

The Relationship between Acidic Urinary pH and Overactive Bladder; Alkalization of Urine Improves the Symptoms of Overactive Bladder

Background: To determine association between urine pH and OAB symptoms and to determine if urinary alkalization improves overactive bladder (OAB) symptoms. Methods: 659 patients with OAB were enrolled in this study between June 2012 and May 2014. 329 patients (group 1) were included in the final analysis. 201 adults were used as a control group (group 2). 24-hour urinary pH and the validated Turkish version of the OAB-V8 questionnaire were performed in patients. A 24-hour urine pH <6.2 was considered acidic urine. In the second part, a diet program was performed for 4 weeks in 30 participants. Urine pH values and OAB-V8 scoring results were recorded before the diet program and 2 and 4 weeks after the diet program. Results: Acidic urinary pH was determined in 61.4% of patients with OAB. There was a significant association between the presence of acidic urine and OAB. Also, the OAB-V8 scores of patients were significantly higher in patients with acidic urine than nonacidic urine. OAB-V8 scores of patients showed statistically significant improvement after diet therapy (17.87 ± 6.52 vs. 10.43 ± 7.17; p < 0.001). Conclusions: We found that acidic urinary pH was closely associated with OAB, and alkalization of urine improved lower urinary tract symptoms. We suggest that urinary pH should be considered as a parameter in treatment planning of patients with OAB.

Which Should be Preferred for Moderate-Size Kidney Stones? Ultramini Percutaneous Nephrolithotomy or Retrograde Intrarenal Surgery?

PURPOSE Comparison of effectiveness and safety of ultramini percutaneous nephrolithotomy (UMPNL) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized renal stones. MATERIAL AND METHODS The patients scheduled for surgery attributable to renal stones with the greatest diameter of 10 to 25 mm were prospectively analyzed. Patients were randomized into groups with tossing a coin method. The patients who had UMPNL and RIRS were defined as Group I and Group II, respectively. The groups were compared for demograhic data, stone characteristics, operative and postoperative data, stone-free status, and the complications. Students t-test and Pearsons Chi square tests were used for statistical analysis. p < 0.05 was considered as statistically significant. RESULTS There were 30 patients in Group I, and 43 patients in Group II. The groups were similar for age, gender, side of the stone, and surface area characteristics of the stone (p = 0.194, p = 0.470, p = 0.990, and p = 0.487, respectively). Stone-free rate was 80% (n = 24) in UMPNL, and 74.4% (n = 32) in RIRS (p = 0.579). Modified Clavien Classification Grade 1 to 2 and 3A to 3B complications were similar in two groups (p = 0.959 and p = 0.192, respectively). Comparison of stone-free rates was 93.3% in UMPNL, and 42.9% in RIRS groups for lower pole stones (p = 0.009). Groups I and II were significantly different for visual analog scale scores for postoperative pain (4.73 ± 1.25 vs 2.30 ± 1.12), hospital stay (2.46 ± 3.02 vs 1.37 ± 1.48 days), and time to return to normal daily life (11.26 ± 5.55 vs 6.65 ± 4.30 days) (p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION Both UMPNL and RIRS procedures are effective and safe methods in treatment of middle-sized renal stones. However, UMPNL is more effective than RIRS in treatment of lower pole stones. RIRS is more advantageous when loss from work is taken into consideration.

UREAPLASMA UREALYTICUM: THEPRESENCE AMONG SEXUALLY TRANSMITTED DISEASES.

The aim of this study was to detect the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Trichomonas vaginalis, and Ureaplasma urealyticum in genital specimens of symptomatic patients. This study also examined the role of U. urealyticum in infections of the lower genital tract. Cervical and urethral samples from 96 patients (46 males, 50 females) were tested using the Seeplex(®) STD6 ACE kit. Consent forms were received and a questionnaire was applied. All statistical analyses were performed using the SPSS statistical software program (version 17.0). Among the samples tested, at least 1 pathogen was detected in 49% of the samples; specifically, the rate of detection of U. urealyticum, M. hominis, C. trachomatis, N. gonorrhoeae, M. genitalium, and T. vaginalis was 29.1%, 10.4%, 8.3%, 7.3%, 6.3%, and 4.2%, respectively. U. urealyticum was detected as the sole pathogen in samples from 10% of female patients and 28.3% of male patients (p = 0.035). U. urealyticum was present in 54.5% (18/33) of samples in which a single pathogen was detected and 71.4% (10/14) of samples in which multiple pathogens were detected. Among men, significant differences in discharge, dysuria, and pruritus were not noted among those with negative results (84.6%, 69.2%, and 38.5%, respectively), among those positive for only U. urealyticum (100%, 66.7%, and 26.7%, respectively), and those positive for N. gonorrhoeae, C. trachomatis, M. genitalium, and T. vaginalis (100%, 93.3%, and 26.7%, respectively). Detection of U. urealyticum, either alone or together with other pathogens, in a symptomatic group of patients is an important finding, particularly in men.

Does Preoperative Use of Dutasteride Decrease Bleeding During Open Prostatectomy

PURPOSE To investigate whether use of dutasteride, a 5-alpha reductase inhibitor, for at least four weeks preoperatively affected the blood loss during open prostatectomy (OP). MATERIALS AND METHODS Retrospective analysis was made of the data of 110 patients who had undergone OP. Group I comprised 50 patients that used dutasteride for 4 weeks preoperatively, and Group II comprised 60 patients that did not use the drug. The groups were compared in respect of age, total prostate specific antigen (TPSA) levels, prostate volumes, preoperative hemoglobin (Hgb) and hematocrit (Hct) levels, postoperative reduction of Hgb and Hct, percentage reduction in Hgb and Hct, and the administration of postoperative blood products. RESULTS No differences were determined between the two groups in respect of prostate volumes, TPSA, preoperative Hgb and Hct levels (P = .813, P = .978, P = .422, P =.183, respectively). Postoperative Hgb reduction was 2.19 ± 1.36 g/dL in Group I, and 2.5 ± 1.47 g/dL in Group II (P = .260). Hgb reduction was calculated as 16.4 ± 9.7% in Group I and 17.6 ± 9.7% in Group II (P = .505). Reductions in Hct were 5.8 ± 3.7% in Group I, and 7.3 ± 4.4% in Group II, and percent reductions were 14.8 ± 9.4% in Group I and 17.3 ± 10.2% in Group II (P = .068, P = .182, respectively). CONCLUSION The use of dutasteride before OP did not affect blood loss during surgery, therefore surgery should not be delayed for the administration of dutasteride to patients.

The Respiratory Induced Kidney Motion: Does It Really Effect the Shock Wave Lithotripsy?

PURPOSE To investigate the effect of respiratory induced kidney mobility on success of shock wave lithotripsy (SWL) with an electrohydraulic lithotripter. MATERIALS AND METHODS Between May 2013 and April 2015, 158 patients underwent SWL treatment for kidney stones with an electrohydraulic lithotripter. The exclusion criteria were presence of a known metabolic disease (such as cystinuria), non-opaque stones, need for focusing with ultrasonography, abnormal habitus, urinary tract abnormalities, and inability to tolerate SWL until the end of the procedure. Stones greater than 20 mm, and lower pole stones were also excluded. The movement of the kidneys were measured with fluoroscopy guidance. RESULTS The procedure was successful in 66.7% of the males, and 56.9% of the females. The mean stone size was 11 ± 3 mm in the successful group, and it was 14 ± 4 mm in the unsuccessful group. The mean stone mobility rate was 32 ± 10 in the successful group and 40 ± 11 in the unsuccessful group. Multivariate analysis showed that stone size and kidney mobility affected the success rate significantly, however Hounsfield Unit (HU) did not. CONCLUSION The current study shows the significant effect of kidney motion on the success of SWL. Further studies with different lithotripters are needed to determine the significance of kidney mobility.

Response to ‘Re. Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children’

We thank colleagues for the commentary on our manuscript on the prevalence of nocturnal enuresis and its influence on quality of life in school-aged children [1]. As correctly pointed out, prevalence of daytime incontinence in our study was 18% (34/189) of children with enuresis that can be related with study population. However, the study reported that 1.7% of children had both daytime incontinence and nocturnal enuresis, similar to results from previous studies performed in Finland, England, and Turkey which indicated 1.6%, 3.3%, and 1.9% of children had combined NE and daytime incontinence [2e4]. In the study by Watanabe, it was determined that children diagnosed with MNE who have no diurnal symptoms may have OAB [5]. It has been reported that one-third of enuretic children have nocturnal detrusor overactivity [6]. Daytime symptoms suggestive of an overactive bladder may help to find pathogenetic clues and prognostic indicators as guides for choice of therapy by the clinician. Daily voiding frequencies in table 2 were misspelled (One Z 1e3: Two Z 4e5; Three Z 6 or more). Additionally, as we specified in the limitation section, data were collected and evaluated in accordance with the description of parents that could potentially bias the responses. The study was performed in a less developed region and the study did not differentiate the socioeconomic background. The parents did not participate in the social life of the children, and considered the condition to be developmental and only temporary.

Efficacy of using Zaontz urethral stent in hypospadias repair by the Face, Legs, Activity, Cry, Consolability (FLACC) scale: A prospective study

INTRODUCTION The developments in hypospadias surgical techniques and materials are intended to improve surgery outcomes and patient comfort. The aim of this study is to determine the effect of the Zaontz urethral stent (ZUS) (Cook Medical) on patient comfort and surgical success rates in children undergoing hypospadias surgery. METHODS A feeding tube was used to repair 46 cases of primary distal hypospadias, and ZUS (6F, 8F, and 10F in diameter) was used to repair to 31 cases of primary distal hypospadias between December 2009 and June 2011 in our clinic. ZUS was compared with the feeding tube in terms of surgical success rates and patient comfort in assessments made during postoperative periods. RESULTS The patients with ZUS were followed with a stent for seven days postoperatively, as were the patients with the feeding tube. There was no statistical difference between the two groups in terms of fistula formation (p>0.05). Patient comfort was evaluated by the Face, Legs, Activity, Cry, Consolability (FLACC) scale on the first and third postoperative days, and a statistically significant difference was observed in favour of ZUS on the third postoperative day (p<0.05). CONCLUSIONS Compared with a feeding tube in hypospadias repair, ZUS does not make any contribution to the urinary fistula rates. However, ZUS may have an advantage in terms of patient comfort in the postoperative followup. On the other hand, the small number of patients and the high price of the ZUS were the most important limitations. Prospective, randomized trials are needed to assess efficacy and cost.