Caglar Yildirim

Emphysematous pyelonephritis: Our experience in managing these cases.

INTRODUCTION Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We discuss clinical details and treatment strategies of 8 patients with EPN followed at our clinic. METHODS We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 8 patients with EPN followed at our urology clinic between 2012 and 2015. RESULTS The mean patient age (female: 5; male: 3) was 62 (range: 51-82) years. Based on computed tomographic findings, EPN was classified as class 1 (n = 3), class 2 (n = 3) and class 3a (n = 2). All patients had fever, flank pain, nausea, and vomiting. Five patients had type 2 diabetes mellitus and 3 diabetic patients also had renal stones. Escherichia coli (n = 6), Klebsiella species (n = 1), and Proteus species (n = 1) were grown in urine cultures. All patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 2 patients underwent a nephrostomy catheter placement and another 2 patients underwent nephrectomy upon deterioration of her general health state. After achieving clinical stabilization with medical treatment, 1 patient underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotherapy. All patients were discharged with clinical cure. CONCLUSION Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotherapy, and drainage.

Late-onset secondary nocturnal enuresis in adolescents associated with post-traumatic stress disorder developed after a traffic accident

Secondary nocturnal enuresis is generally seen between 5 and 7 years of age and it is rarely encountered when compared with the primary incontinence. Patients with suggested diagnosis of secondary nocturnal enuresis should be examined for neurological and spinal anomalies and diabetes mellitus, diabetes insipidus, renal failure and urinary tract infection should be ruled out in differential diagnosis (1-3). Herein, we are presenting case reports of adolescent patients with secondary nocturnal enuresis refractory to medical therapy and developed after in-vehicle and extravehicular accidents.

Contralateral tumor seeding of renal cell carcinoma mimicking late metastasis of liver after laparoscopic nephrectomy: A case report with review of the literature

Laparoscopic surgery has been increasingly used every day in the management of urologic malignancies. Even though it seems as a minimally invasive surgery, during these interventions tumor seeding, as seen in open surgery, confronts us as a rarely seen serious risk. Herein, we have reported a case who demonstrated peritoneal tumor implantation at 12 month postoperative follow up after laparoscopic radical nephrectomy (LRN) performed for Furhman grade 1 (T2N0M0) renal cell cancer.

Contralateral Ovarian Metastasis of Clear-Cell Renal Carcinoma: A Rare Case Report and Review of the Literature

Renal cell carcinoma (RCC) constitutes 2-3% of all types of cancers. RCCs metastasize into lungs (50–60%), lymph nodes (36%), bones (30–40%), liver (30–40%), and brain (5%) in respective percentages. RCC rarely metastasizes into ovary. Only 25 cases of ovarian tumor, which metastasized into kidneys, have been presented. In the literature, a kidney-ovary axis has been defined, and its interrelationship begins with embryological life. With this case report, we aimed both to present a very rarely seen metastasis of RCC into contralateral ovary and also to review the literature.

A case of seminoma presented with clinical manifestations of testicular torsion

Testicular tumors rarely manifest themselves with clinical picture of testicular torsion. In this presentation of ours, we reported a 30-year-old patient whose post-orchiectomy histopathology report revealed the presence of seminoma. The patient consulted us with acute scrotum whose physical examination and Doppler ultrasonographic findings showed testicular torsion. Though rarely seen patients, in cases who consulted with acute scrotum, the possibility of testicular tumor should not be discarded. For the establishment of differential diagnosis detailed anamnesis and physical examination findings should be supported with laboratory tests and imaging modalities.

Effects of obesity surgery (laparoscopic sleeve gastrectomy technique) on lower urinary tract symptoms, depression and quality of life of males: Prospective study.

PURPOSE Technically, obesity weakens the pelvic base muscles by causing an increase in the intraabdominal pressure and intravesical pressure due to increasing fat and it triggers the occurrence of lower urinary tract symptoms. However it is believed that weight loss will cause recovery of these symptoms. Our purpose in this study is to research about the effects of the weight loss achieved by using especially the Laparoscopic Sleeve Gastrectomy (LSG) technique of bariatric surgery which is being more and more widely used today. MATERIALS AND METHODS Out of all patients who had LSG surgery due to obesity earlier in our center during the period between April 2014 and March 2015, 22 applicable male patients were considered after a brief exclusion criteria application. Age, height, weight, and body mass index (BMI) data of these patients were recorded before the operation. International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire - short from) (ICIQ-SF), Beck depression inventory (BECK) and Short form - 36 (SF-36) were filled for the patients and the data were recorded. Also, the weight loss amounts and BMI decreases of the patients after the operation were recorded. RESULTS After the procedure, the decrease in the averages of BECK depression inventory, IPSS, ICIQ-SF and the increase in the Mental and Physical subgroup scores of SF-36 were found statistically coherent. CONCLUSION The adverse effect of obesity, which is observed more and more often in todays world, on lower urinary tract symptoms and on the quality of life is undeniable. In our study, we think that the bariatric surgery made by using the LSG technique, not only causes serious amount of weight loss, but also reduces urinary dysfunction and enhances the quality of life among males.

Lower pole renal cut injury due to the iliac wing fracture: A rare case report

The most frequent causes of blunt genitourinary injuries are falls from heights, motor vehicle accidents and sports injuries. Firearm injuries and penetrating stab wounds are also frequently encountered. Skeletal system traumas in the vicinity of the urogenital system can cause urological organ injuries. Though rarely, renal traumas can be dependent on the kinetic energy of the trauma and the retroperitoneal movement capacity of the kidneys and cannot be explained with the proximity of the kidney to the skeletal system. In cases with high-energy decelerations, renal pedicle and ureteropelvic junction traumas are more frequently observed. Herein, we presented a grade 3 left kidney lower pole injury developed secondary to A2 type pelvic fracture following a high energy deceleration trauma. It should not be forgotten that especially in this type of fractures, injuries of the lower renal pole can occur.

Extraintestinal gastrointestinal stromal tumor of undetermined origin: Is the mass resection a wrong approach? A case report and review of the literature

Gastrointestinal stromal tumor (GIST) was first defined by Mazur et al. in 1983. GIST is evaluated among tumoral lesions that can be acquired or congenital. Those not associated with gastrointestinal system are termed as extragastrointestinal stromal tumor (EGIST). EGISTs can develop on intraperitoneal spaces as omentum, mesenterium and gallbladder and they can occur on retroperitoneum, extraperitoneal (prostate) and intrapelvic organs. Herein, we present a case with EGIST in a 65-year-old male patient located in intrapelvic and retroprostatic area which had no connection with gastrointestinal system as assessed by radiological methods and we discuss its treatment. We reviewed the literature and observed that ours is the first case report on a patient in which the mass was only extirpated rather than performing radical surgery. He is still at the 2. year of his follow-up period without any disease recurrence.