Burcin Tunc

Outcome of Nephron-Sparing Surgery: Elective versus Imperative Indications

Introduction: The increase in the detection of renal tumors incidentally in earlier stages has enhanced the enthusiasm for nephron-sparing surgery (NSS). Patients and Methods: We performed NSS in 76 patients (53 male, 23 female) with a mean age 52.3 between December 1988 and September 2001. Patients were sub-classified into 2 groups as elective or imperative indication group. They were compared regarding surgical technique, time of surgery, pathological analysis, complications, and disease free status. Results: Elective indication group (group I) with a normal contralateral kidney consisted of 50 patients, whereas there were 26 patients in the imperative indication group (group II). Tumors were incidentally detected in 63%; 74% in group I and 42% in group II. Although the mean diameter of the tumor was slightly higher in group II (39.1 vs. 36.3 mm), this difference did not reach statistical significance (p > 0.05). The partial nephrectomy was performed more frequently compared to enucleation in group I (90 vs. 69%, p = 0.050). However, the mean operation time as well as the mean clamping time did not differ significantly between the two groups (p > 0.05). In the histological evaluation tumors were benign in 16 (21%) and malignant in 60 patients. All of the patients but one with renal cell carcinoma had stage T1-T2 disease. Major complications were observed in 14 (18%) and 12 were from group II. Complication rate was significantly higher in group II (p = 0.000). Of 60 patients with renal cell carcinoma, 2 died of unrelated causes. One patient died with multiple visceral metastases. One patient was lost to follow-up. In the remaining 56 patients with a mean follow-up of 37.1 months (1–152), local recurrence or distant metastases were not detected. Serum creatinine levels have remained almost the same compared to preoperative levels (1.2 ± 0.6 vs. 1.5 ± 0.9). Overall and cancer-specific survivals were 100 and 100% in group I, 85 and 95% in group II, and 94 and 98% for the entire patient population, respectively. Conclusion: NSS is an effective and reliable treatment in low stage renal tumors. It prevents unnecessary nephrectomy in benign lesions that could not be diagnosed preoperatively. However, the patients who underwent NSS with elective indication outcome with better results, compared to those with imperative indication.

Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature.

Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. With the review of the literature, we reported two cases of XPN with psoas muscle abscesses caused by Staphylococciaereus in one of the patient and Serratia mascerentes in the other. Both of the patients had renal calculus. We performed nephrectomy with psoas abscess drainage and started appropriate antibiotics, but one of the patients died of septic shock. Other patient is free of symptoms at the end of 5 years follow-up.

A rare complication of lumbar disk surgery: Ureteral avulsion

A 49-year-old woman was admitted to our clinic with high fever, left lumbar pain and a mass at the flank following spinal surgery for disk disease. Complete left ureteral avulsion with urinoma formation was detected and she was treated with ureteroureterostomy. As in this case shows that the possibility of ureteral injury to the ureter during surgery for a disk hernia should be familiar to all neurosurgeons, orthopedic surgeons and urologists. When the diagnosis is made during early postoperative period, good results with preservation of the kidney can be achieved.

Does vaginal anti-incontinence surgery affect sexual satisfaction? A comparison of TVT and Burch-colposuspension

OBJECTIVE To evaluate the sexual satisfaction rates of women who underwent tension-free vaginal tape (TVT) procedure for stress urinary incontinence and compare it with the results of Burch-colposuspension. MATERIALS AND METHODS A self-administered questionnaire was given to 81 patients who had undergone TVT or Burch-colposuspension at our institution to determine sexual satisfaction rates and reasons for dissatisfaction. Forty-seven patients in TVT group and 22 patients in Burch-colposuspension group were considered eligible for the study. The mean follow-up period and age of patients in TVT and Burch-colposuspension groups were 34 months, 51.5 years and 89 months, 52.9 years, respectively. The difference between the ages in the two groups was not statistically significant, while the difference between mean follow-up periods was significant (p = 0.000). RESULTS When evaluating sexual satisfaction, 73% in the TVT group and 86% in the Burch-colposuspension group did not report any difference in sexual satisfaction following surgery, while in the TVT group, 23% expressed negative and 4% positive changes, and in the Burch-colposuspension group 9% expressed negative and 5% positive post surgical changes. The differences in sexual satisfaction rates between the two groups were not considered significant. The majority (54%) of those who expressed a negative change suffered from dyspareunia. CONCLUSIONS Although sexual satisfaction seems to be more adversely affected by TVT compared to Burch-colposuspension, the difference was not statistically significant. Further studies are required concerning different anti-incontinence techniques in order to arrive at more precise conclusions.

Hypoechoic Space Formation with Periprostatic Nerve Block: Myth or Reality?

Introduction: The most efficacious and commonly applied anesthetic technique for prostate biopsy is periprostatic block. In a previous publication, the creation of a ‘hypoechoic space’ at the injection site was described. This was reported to be a routine and essential part of the technique in various subsequent series. We were interested in assessing the incidence of the formation of such a hypoechoic area, and more importantly, whether it had any impact on pain management. Materials and Methods: One hundred and eleven consecutive patients were prospectively evaluated. Local anesthetic consisted of 2.5 ml of 2% lidocaine for each side of the prostate. Infiltration was done within the neurovascular space at the base of the prostate just lateral to the junction between the prostate and the seminal vesicle. The creation of a hypoechoic nodule was recorded in three categories: no formation, unilateral or bilateral formation. Three groups were compared regarding the intensity of pain using a numeric analog scale. Results: No hypoechoic area was formed in 30 (27%) patients. A unilateral nodule was created in 40 (36%), and a bilateral nodule was seen in 41 (37%) patients. The median pain scores were 3.3, 2.5 and 1.3 for the no hypoechoic wheal, unilateral and bilateral wheal groups, respectively (p < 0.0001). Conclusion: Our results suggest that the creation of a hypoechoic space with anesthetic infiltration for prostate biopsy is indeed an important aspect of the technique with regard to pain control; however, it may not be accomplished in every case.

Bilateral Percutaneous Nephrolithotomy in a Patient with Hemophilia A Disorder

A 50-year-old man with hemophilia A presented with recurrent hematuria due to renal stone disease. He was receiving approximately 50,000 units of recombinant factor (rF) VIII concentrate every year due to hematuria. Between 1996 and 2002, his serum creatinine level increased from 0.7 to 1.2 ng/ml. In an effort to resolve the problems of excessive blood loss with transfusions, recurrent rF VIII replacements and deteriorating renal function, he was offered treatment with percutaneous nephrolithotomy (PNL) in conjunction with rF VIII administration. He underwent left PNL for left staghorn calculi in November 2002 with administration of 52,000 units rF VIII, and another PNL for the right kidney in April 2004 with the administration of 90,500 units rF VIII. A pneumatic lithotriptor was used in both operations. The serum creatinine level was 0.8 ng/ml upon completion of treatment and the patient was symptom and stone free at 10-month follow-up. He has not suffered from hematuria since that time. We conclude that bleeding disorders may not be a contraindication for PNL if corrected and monitored appropriately.

The Clinical Effect of Bipolar and Monopolar Transurethral Resection of the Prostate More Than 60 Milliliters

OBJECTIVE To compare the effect, safety, and complication rates of monopolar vs bipolar transurethral prostate resection (TURP) in patients with prostate gland larger than 60 mL. PATIENTS AND METHODS Patients with prostate gland larger than 60 mL who were scheduled for surgery because of benign prostatic hyperplasia were randomized into bipolar or monopolar TURP arms via software program with a 1:1 ratio. Preoperatively and postoperative sixth hour and first day, hemoglobin and serum sodium levels were measured. International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QoL), and International Index of Erectile Function scores were determined, and maximal flow rate and residual urine volume were calculated in the preoperative period and postoperative sixth month. Postoperative clot formation, blood transfusion rates, and other complications were recorded on a database. RESULTS Of 81 patients included in the study, 45 (55.5%) underwent monopolar and 36 (44.5%) underwent bipolar TURP (M-TURP and B-TURP groups, respectively). The only statistically significant change between the preoperative and the postoperative variables was detected in sodium levels, which were -5.0 mmol/L and -1.2 mmol/L in the M-TURP and B-TURP groups, respectively (P = .001). Although 2 of the patients in the M-TURP group experienced transurethral resection syndrome, none of the patients in the B-TURP group experienced this complication (P = .584). CONCLUSION Bipolar and monopolar TURP showed similar effect and safety in patients with prostate glands larger than 60 mL. The only significant difference between the 2 groups was the greater decrease in serum sodium levels in the M-TURP group.