Can Baydinç

Percutaneous nephrolithotomy for pediatric stone disease--our experience with adult-sized equipment.

Objective: We evaluated the outcomes and complications of percutaneous nephrolithotomy (PNL) operations performed in pediatric patients using adult‐sized surgical equipment at our center. Material and Methods: The medical and surgical records of 23 children who underwent a total of 25 PNL operations using 24 or 26 F rigid nephroscopes were evaluated retrospectively. The following aspects were considered: stone burden; duration of surgery and complications; details concerning recovery, success, residual fragments and auxiliary procedures; and follow‐up details. Results: The success rate of a single PNL session was 70.8%; with the use of auxiliary procedures this was increased to 91.6%. Perioperative and early postoperative complications were excessive bleeding and transfusion in two patients, hydro‐pneumothorax in one, perforation of the collecting system in three and urinoma in one. Complications were more common in children aged <7 years or with staghorn stones. The mean time to catheter removal was 3.4 days and the mean hospitalization time was 4.8 days. Idiopathic hypercalciuria, hypocitraturia, cystinuria and hyperoxaluria were diagnosed in two, two, one and three patients, respectively. Conclusion: Performing PNL with adult‐sized equipment is associated with significant complications in children aged <7 years or with staghorn stones. This treatment should not be considered in routine clinical practice. As all stone‐removal methods are associated with complications, PNL should be used only if other methods fail or are unavailable.

Some Criteria to Attempt Second Side Safely in Planned Bilateral Simultaneous Percutaneous Nephrolithotomy

OBJECTIVES To determine the validity of some criteria that could guide in the decision to cancel or proceed with the second side of planned bilateral simultaneous percutaneous nephrolithotomy (bsPCNL). METHODS Patients with an indication for bilateral PCNL were enrolled in this study. The operation was stopped at the end of the initial side if operative time was >180 min, the hemoglobin level was <11 g/dL, the hemoglobin decrease was >3 g/dL, the systolic arterial pressure was <100 mm Hg, the arterial oxygen saturation was <95%, the arterial blood pH was <7.35, or the blood sodium was <128 mg/mL. The success and complication rates were compared in patients who underwent second side PCNL (group 1) and those for whom the procedure was stopped after the initial side (group 2). RESULTS Of 42 planned bsPCNLs, 12 were stopped after the initial side, with the cause being prolonged operative time in 7, hemoglobin decrease in 6, systolic arterial pressure decrease in 2, arterial oxygen saturation decrease in 2, pH decrease in 1, and sodium decrease in 1. Differences in patient characteristics, stone burdens, and overall success and complication rates were insignificant. Transfusion, postoperative urinary infection, and prolonged urine drainage rates were similar, but the total hospitalization time was significantly longer in group 2. One hydrothorax and one renal pelvic perforation occurred in group 2. The need for transfusion correlated positively with the number of nephrostomy tracts in group 2 (r = 0.895, P = .001). No such correlation was found in group 1. CONCLUSIONS Despite the best of intentions, about 30% of anticipated bsPCNL cases might be limited to single-sided PCNL, depending on the intraoperative events. Our criteria seem reasonable, because similar success and complication rates were obtained with bilateral, separate-session PCNL and bsPCNL. These criteria can be considered in the decision making to omit the advantages of a single session for safety.

Bilateral disruption of corpus cavernosum with complete urethral rupture

Abstract Penile fracture is a relatively rare condition. We report an unusual case of the bilateral disruption of the corpus cavernosum with complete urethral rupture resulting from blunt trauma during sexual intercourse. The subject underwent emergency surgery with preservation of erectile and voiding functions in the follow‐up.

Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy

BackgroundPercutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon.Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure.Case reportWe present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation.ConclusionAlthough considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation.

Role of penile electrodermal activity in the evaluation of autonomic innervation of corpus cavernosum

Electrodiagnostic tests measuring the activities of cavernous smooth muscle and sudomotor structures of penile skin are used in order to evaluate autonomic innervation of the penis. Owing to closeness of these tissues, the interference of sympathetic activity during recording is a possibility. In this study, we investigated this possibility in 10 patients whose cavernosal tissues were destroyed during penile prosthesis implantation by comparing the pre- and postoperative penile skin electrodermal activities. Penile electrodermal activities were recorded with surface electrodes before and after the operation. All of the patients had spontaneous and evoked penile electrodermal activity (EDA). The mean amplitude of evoked EDA decreased from 2159±700 to 1413±515 μV following penile prosthesis surgery (P=0.017). The decrease in the amplitude of penile-evoked EDA following penile prosthesis implantation suggests the contribution of cavernous smooth muscle activity to the sudomotor responses prior to operation. Although corpus cavernosum sympathetic activity contributes to the penile skin recordings, these recordings are mostly the result of penile skin sudomotor sympathetic activity. Therefore, surface potentials recorded from penile skin should not be used for the evaluation of autonomic innervation of corpus cavernosum.

Polypoid cystitis unrelated to indwelling catheters

Since polypoid cystitis (PC) is generally caused by indwelling catheter use, in order to evaluate the patients with PC unrelated to a intravesical catheter, a retrospective analysis of the records of the Pathology Department of Turgut Özal Medical Center was performed and this revealed 8 patients. Mean age of the 2 female and 6 male patients was 48 years (28 to 70). None of the patients had bacterial growth in urine cultures. All cases were diagnosed incidentally by radiologic and cystoscopic examinations in the evaluation of different conditions, such as hematuria, ovarian abscess, bladder carcinoma, erectile dysfunction, neurogenic bladder, benign prostate hyperplasia and unexplained dysuria. At the beginning, all patients were diagnosed mistakenly as bladder carcinoma. The definitive diagnosis was made after histopathologic examinations of transurethrally resected specimens. Patients were followed for 6 months to 2 years after first diagnosis. No recurrence was established during follow-up. The final urologic examinations which were done currently, were normal.In conclusion, PC is a benign lesion and should be considered in the differential diagnosis of transitional cell carcinoma of the bladder.

Bilateral kidney stones with ureteropelvic junction obstruction

Background A 56-year-old male with bilateral flank pain was admitted following diagnosis of bilateral kidney stone disease. He had previously undergone four separate pyelolithotomy sessions (two per kidney), the latest being 14 years prior. At presentation the patient had two stones in the right kidney and seven in the left kidney. The right renal pelvis was dilated, indicating obstruction of the ureteropelvic junction.Investigations Plain radiography, ultrasonography, intravenous pyelography, retrograde ureteropyelography and spiral tomography.Diagnosis Bilateral kidney stones and obstruction of the right ureteropelvic junction.Management Bilateral percutaneous nephrolithotomy and simultaneous right endopyelotomy; intraoperative antegrade nephrogram; preoperative and postoperative measurement of hemoglobin, blood urea nitrogen and creatinine; postoperative nephrostograms, plain X-ray, diuretic renogram and intravenous pyelography.

Single session endoscopic management of intrinsic ureteropelvic junction obstruction and concomitant renal stone disease in a child: a case report.

BackgroundPercutaneous nephrolithotomy is a well known therapeutic modality for stone diseases of childhood. Antegrade and retrograde endopyelotomies are also well defined options of treatment for secondary ureteropelvic junction obstruction. Yet there are few reports regarding endoscopic therapy of intrinsic ureteropelvic junction obstruction. To our knowledge, there exist only a few reports of endosurgical treatment of children with stone disease and with concomitant intrinsic ureteropelvic junction obstruction, in the literature.Case presentationWe present the endoscopic management of stone disease and concomitant intrinsic ureteropelvic junction obstruction of a child in one session.ConclusionPercutaneous nephrolithotomy and antegrade endopyelotomy is combined safely with successful outcome in a child.

Deterioration of renal function in patients operated for lower urinary tract symptoms

Özet Amaç: Alt üriner yol semptomu nedeniyle cerrahi tedavi uygulanan hastalarda böbrek fonksiyonlarındaki bozulma oranını ve bunun hasta yaşı, semptom ciddiyeti ve eşlik eden hastalıklarla ilişkisini belirlemeyi amaçladık. Gereç ve yöntem: Polikliniğimize 01/06/2001-31/03/2005 tarihleri arasında alt üriner sistem semptomları ile başvuran ve ameliyat edilen 369 hastanın kayıtları retrospektif olarak incelendi ve muayene bulguları ile laboratuvar sonuçları kaydedildi. Bulgular: Operasyon öncesi serum kreatinin değeri ≤1.4 mg/dL olan hasta sayısı 315 (%85.4), >1.4 mg/dL olanların sayısı ise 54 (%14.6) idi. Kreatinin değeri ≤1.4 mg/ dL olanların yaş ortalamaları 68.64±8.24 iken, kreatinin değeri >1.4 mg/dL olanların yaş ortalamaları 72.56±7.96 olarak bulundu (p<0.05). İlerleyen yaş ile serum kreatinin değerinin arttığı, böbrek fonksiyon bozukluğunun semptom skorundaki artış ile arttığı, hipertansiyon ve diyabet gibi kronik hastalıkların varlığında böbrek yetmezliği oranlarının 2.5 kat arttığı (%25.5’e karşılık %10.9) saptandı. İşeme sonrası rezidü idrar ile böbrek fonksiyon bozukluğu arasında ilişki saptanmadı. Ayrıca renal dilatasyonun serum kreatinin seviyesi yüksekliğine eşlik ettiği kaydedildi. Sonuç: Alt üriner yol semptomu olan hastalarda böbrek yetmezliğinin erken tanısı ve tedavisi için ilk başvuru anında böbrek fonksiyonlarını gösteren serum kreatinin seviyesine mutlaka bakılmalıdır.