Bulent Ozturk

Factors Affecting Fever Following Percutaneous Nephrolithotomy: A Prospective Clinical Study

AIM To evaluate the preoperative and intraoperative factors that might affect development of fever following percutaneous nephrolithotomy (PCNL) and to investigate the clinical significance of intraoperative microbiologic evaluation in managing postoperative infectious complications. PATIENTS AND METHODS Sixty-one consecutive patients who had undergone PCNL between October 2006 and June 2007 were prospectively recruited into the study. Preoperative urine cultures and intraoperative stone and pelvic urine cultures were obtained from all patients. Postoperatively, patients were closely monitored for fever and other signs of systemic inflammatory response syndrome. RESULTS Of 61 patients, 10 (16.8%) had at least one body temperature recorded at 38 degrees C (group 1), the remaining patients were afebrile (group 2). Fever was associated with a systemic inflammatory response syndrome in one patient (1.6%); in that patient, the antibiotic regimen was altered. There were statistically significantly more positive stone culture results for patients in group 1 than there were for patients in group 2 (5/10 versus 9/51, P < 0.05). There were statistically significantly more positive pelvic urine culture results for patients in group 1 than there were for patients in group 2 (3/10 versus 2/51, P < 0.05). Patients in group 1 also had longer operative times and larger stone burdens than did patients in group 2. CONCLUSIONS Intraoperative microbiologic evaluation may be important in postoperative antibiotic selection and should be routinely used.

Successful percutaneous nephrolithotomy in children: multicenter study on current status of its use, efficacy and complications using Clavien classification.

PURPOSE In this multicenter study we aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy in children with respect to different features and using the Clavien classification system. MATERIALS AND METHODS Percutaneous nephrolithotomies performed in children at 3 urology departments between March 2006 and May 2010 were included in the study. Results are presented for complex/simple renal stones, tubeless/totally tubeless percutaneous nephrolithotomy, simultaneous bilateral percutaneous nephrolithotomy, instrument size and age groups. Patients were divided into 3 distinct groups, infants and toddlers (3 years or younger, group 1), preschool children (4 to 7 years, group 2) and school children (8 to 16 years, group 3). Perioperative complications are presented according to the modified Clavien classification system. RESULTS A total of 140 percutaneous nephrolithotomies were performed in 130 patients (41.5% female, mean age 10.17 years). There were 23, 25 and 92 renal units in groups 1, 2 and 3, respectively. Pediatric instruments were used in 60 renal units and adult-sized instruments in 80. General assessment of complications showed Clavien grade I complications in 17 patients, II in 4, IIIa in 11 and IIIb in 7. There were no grade IV or V complications. CONCLUSIONS Percutaneous nephrolithotomy can be applied safely in children of varying ages, even infants. Complications, as assessed with Clavien classification, are comparable to those seen in adults provided there is enough experience with the technique.

Percutaneous Nephrolithotomy: Nephrostomy or Tubeless or Totally Tubeless?

OBJECTIVES To compare the feasibility and morbidity of tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) with nephrostomy tube in a single center with selected patient population. METHODS Between July 2006 and February 2008, PNL was performed in 176 patients in this retrospective study. Patients with no serious bleeding or perforation in the collecting system during the operation, stone-free status, or clinically insignificant residual fragments (<4 mm) at the end of the procedure and patients with no more than one access were enrolled in the study. Patients were categorized into 3 groups. In group 1 (n = 43), no nephrostomy or ureter catheters were placed after PNL (totally tubeless group); in group 2 (n = 41), no nephrostomy catheter was placed but antegrade J-stent was used (tubeless group), and in group 3 (n = 92), standard nephrostomy catheters were placed (standard group). Three groups were compared with respect to age, stone volume, postoperative hemoglobin change, transfusion rate, operation time, analgesic requirement, hospitalization time, and complication rates. RESULTS No significant differences were found in mean stone volume, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time and the amount of narcotic analgesic required were significantly higher in group 3 compared with the other groups (P <.05). Complications were observed in 2 (4.6%), 3 (7.3%), and 7 (7.6%) patients in groups 1, 2, and 3, respectively (P = .738). CONCLUSIONS In patients with no major intraoperative bleeding and calyceal perforation, tubeless approach is safe with decreased analgesia requirement and hospital stay.

Effect of periprostatic nerve blockade before transrectal ultrasound‐guided prostate biopsy on patient comfort: A randomized placebo controlled study

Background: In the present study, we assessed the efficacy and morbidity of periprostatic local anesthesia before transrectal ultrasound (TRUS)‐guided biopsy of the prostate.

Altered Relaxant Responses to Adenosine and Adenosine 5′-Triphosphate in the Corpus cavernosum from Men and Rats with Diabetes

The present study was aimed at investigating the effects of diabetes on the cavernosal smooth muscle relaxations mediated by adenosine and adenosine triphosphate (ATP) in tissues obtained from men and rats. Adenosine- and ATP-induced relaxant responses showed an enhanced sensitivity with an unaltered effectiveness in diabetic men. Adenosine-elicited relaxation in diabetic rat corporeal tissues exhibited enhanced effectiveness with unaltered sensitivity, whereas ATP-induced relaxations were decreased in diabetic animals when compared to control animals. Tetraethylammonium pretreatment, but not glibenclamide, L-NAME and 8-phenyltheophylline, normalized enhanced apparent affinity to adenosine in tissue from diabetic men and effectiveness (Emax) to adenosine in diabetic rats. These results suggest that adenosine-elicited relaxation in diabetes is controlled at the receptor level events including K+ channels in men whereas in rats postreceptor-related events including K+ channels control the adenosine-induced relaxation. These relaxations to adenosine and ATP in men and rats with and without diabetes may be nitric oxide-independent mechanisms. Our results also suggest that ATP-induced relaxation did not involve KATP channels and Ca-activated K+ channels.The present study was aimed at investigating the effects of diabetes on the cavernosal smooth muscle relaxations mediated by adenosine and adenosine triphosphate (ATP) in tissues obtained from men and

Bladder perforation related to intrauterine device.

Intrauterine devices (IUDs) are currently one of the most popular reversible contraception methods used world wide. Uterine perforation is a rarely observed complication. The bladder is one of the organs that an IUD can migrate to because of its close proximity to the uterus. There are about 70 cases in the literature of IUDs that have migrated into the bladder. The resulting bladder perforation can be complete or partial. Here, we report 2 cases, 1 of complete migration and the other of partial migration.

Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation.

PURPOSE In this study, we present our experience using balloon and Amplatz dilatation to establish a percutaneous tract. We also discuss advantages and risk factors of both techniques. MATERIALS AND METHODS We retrospectively reviewed medical records of 229 patients who had undergone 235 percutaneous nephrolithotomy procedures. The nephrostomy tract had been dilated using a balloon (42 patients) or Amplatz (187 patients) dilator. Total operating time, preoperative and postoperative hemoglobin concentrations, number of tracts required, stone burden, blood transfusion rates, tract dilatation failures, and the cost of the dilatation system were compared between the groups. RESULTS There were no statistically significant differences in operative time (85.7+/-43.2 v 86.3+/-41.2 minutes; P=0.42), preoperative hemoglobin concentration (14.1+/-1.1 v 13.8+/-1.4 mg/dL; P= .153), postoperative hemoglobin concentration (11.6+/-1.7 v 11.2+/-1.5 mg/dL; P= .601), or blood transfusion rate (18.6% v 21.3%; P= .687) between the two groups. Also, there were no differences in failure rates between the two groups. CONCLUSIONS The Amplatz dilator is comparable with the balloon dilator with regard to efficacy, speed, and safety. The Amplatz dilator is more cost-effective than the balloon dilator. However, kidney hypermobility may be a significant problem during Amplatz dilatation.

Double-J Stenting Compared with One Night Externalized Ureteral Catheter Placement in Tubeless Percutaneous Nephrolithotomy

PURPOSE We prospectively analyzed the outcome of tubeless percutaneous nephrolithotomies (PCNLs) using two different stenting techniques (i.e., externalized ureteral catheter compared with Double-J placement) without strict exclusion or inclusion criteria. PATIENTS AND METHODS Forty-six patients who were undergoing tubeless PCNL were randomized to two groups: Group 1 (tubeless PCNL with externalized ureteral catheter) and group 2 (tubeless PCNL with Double-J placement). The only exclusion criterion was presence of significant residual stones. The two groups were comparable with regard to age, sex, stone laterality, stone burden, and number of previous open renal surgeries. Factors evaluated included operative time, stent-related symptoms, analgesic requirement, postoperative pain, postoperative morbidity, hospital stay, blood loss, and success rates. RESULTS The mean operative times, mean number of accesses, percentage of supracostal accesses, mean visual analog scale scores, analgesic requirements, mean decreases in hemoglobin level, blood transfusion rates, success rates, and mean hospital stays were not statistically significant in both groups. The only statistically significant difference between groups was the postoperative stent-related symptoms. In group 2, 52.1% experienced some sort of stent-related symptoms. In most of the patients, these symptoms were not severe; however, in two of them (16.6 %), oral medication therapy with anticholinergics was needed. None of the patients in group 1 had stent-related symptoms and needed medication (P < 0.01). CONCLUSIONS Tubeless PCNL with externalized ureteral catheter is as feasible as Double-J stenting. Moreover, stent-related discomforts because of the presence of a Double-J stent and the need for postoperative cystoscopy to remove the Double-J stent can be avoided with an externalized ureteral catheter.

Effect of Sildenafil Citrate on Penile Weight and Physiology of Cavernous Smooth Muscle in a Post–radical Prostatectomy Model of Erectile Dysfunction in Rats

OBJECTIVES To evaluate the gross morphometric changes and in vitro responses of the corpus cavernosus of rats treated with sildenafil citrate after cavernous neurotomy. METHODS The animals were divided into 3 groups. Group 1 consisted of sham-operated rats (n = 16); group 2 consisted of rats that underwent bilateral cavernous neurotomy (BCN) (n = 16); and group 3 consisted of rats that underwent unilateral cavernous neurotomy (UCN) (n = 16). Each group of rats was further classified into 2 subgroups according to whether or not they received sildenafil treatment. The rats were killed on postoperative day 14, and penectomy was performed. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL), and organ-bath studies were evaluated by Phenylephrine (Phe), acetylcholine (Ach), sodium nitroprusside (SNP), and electrical field stimulation (EFS) responses. RESULTS Penile weight in the BCN group was significantly lower than that of sham-treated group. UCN allowed much more preservation of penile weight compared with that in the sham-treated group. Sildenafil citrate treatment had positive effects on penile weight of both BCN (P = .003) and UCN (P = .004) groups. BCN increased smooth muscle apoptosis when compared with the sham or UCN group. Sildenafil citrate had a positive effect on the apoptotic index. In the BCN group, responses to Phe, Ach, SNP, and EFS decreased significantly, and sildenafil treatment corrected the responses to Phe, Ach, and SNP. CONCLUSIONS Our experimental study results support that early and daily sildenafil citrate treatment has a protective affect on the adrenergic and cholinergic systems, which play a role in erectile function.

Outcome of Percutaneous Nephrolithotomy in Children Having Complex Stones

Objectives: To review our experiences with percutaneous nephrolithotomy in children with complex renal calculi. Patients and Methods: We retrospectively analyzed the records of 31 children with complex renal calculi who were treated by percutaneous nephrolithotomy at 2 hospitals of our university between June 2003 and June 2008. The mean age of the patients was 10.4 years (range 22 months to 15 years). Three patients were aged ≤5 years. Stone clearance and complications were recorded. Results: The mean operating time (time from insertion of the ureteral catheter to placement of a nephrostomy tube) was 87.4 (range 50–180) min. In 2 patients the procedures were staged because of a large residual stone load. The extent of percutaneous tract dilation was undertaken taking patient age and the presence of hydronephrosis into consideration. Complete stone clearance with percutaneous nephrolithotomy was achieved in 21 (67.7%) of 31 patients. Adding extracorporeal lithotripsy increased total clearance to 24/31 (77.4%). The most common complication was bleeding that necessitated blood transfusion (7/31, 22.5%). Conclusion: Percutaneous nephrolithotomy is as safe and effective in children as it is in adults. The clearance rate can be increased with dual therapy. Tract dilation should be tailored according to patient age and the extent of hydronephrosis.