Cemal Göktaş

SWL in Lower Calyceal Calculi: Evaluation of the Treatment Results in Children and Adults

OBJECTIVE To evaluate the treatment parameters of shockwave lithotripsy (SWL) in lower calyceal calculi in adults and children in a comparative manner. MATERIAL AND METHODS Between 2006 and 2011, SWL was performed for lower calyceal calculi in 282 adults (mean age 48.5 years, range 28-64) and 54 children (mean age 48 months, range 5-141). The Wolf Piezolith 3000 lithotriptor has been used for SWL. Success rates, auxiliary procedures, additional interventions, and complications were evaluated in detail in a comparative manner. RESULTS Mean stone size was 7.7 mm (range 5-25) and 8.1 mm (range 5-23) in children and in adults, respectively. Mean SWL sessions were 1.5 (range 1-5) in children and 2.4 (range 1-6) in adults. Although 66.6% of children were stone-free after the first session, 28% of adult patients were stone-free after the first SWL session, showing a statistically significant difference (P = .0001). After the treatments, although a complete stone-free status was obtained in 85% of children, 31.5% of adults were stone-free at 3-month follow-up after SWL (P = .0001). Although no auxiliary procedures were needed in children, 8.2% of adults required them. Likewise, the percentage of additional procedures were higher in adults than children (20.2%). CONCLUSION SWL for lower calyceal calculi has been found to be highly successful in pediatric patients. These results demonstrate that, irrespective of stone size, SWL should be the first treatment alternative in the management of lower calyx stones in children.

Role of Papaverine Hydrochloride Administration in Patients With Intractable Renal Colic: Randomized Prospective Trial

OBJECTIVES To evaluate the therapeutic effect of papaverine hydrochloride in the treatment of patients with renal colic pain unresponsive to conventional treatment. METHODS From March 2007 to January 2008, a total of 561 patients with severe renal colic pain due to a ureteral stone were treated with conventional agents (hyoscine-N-butylbromide and diclofenac sodium) in the emergency and urology departments. Of these 561 patients, 110, with no response to the treatment and persistent severe pain, were randomized into 3 groups for additional treatment. The patients in group 1 (n = 37) received intravenous hyoscine-N-butylbromide, those in group 2 (n = 37) received papaverine hydrochloride, and those in group 3 (n = 36) received pethidine. Before and after treatment, all patients completed a visual analog scale (VAS) questionnaire, with a scale of 0 (no pain) to 10 (maximal complaint), to measure their subjective pain. The mean VAS score of each group was compared with that of the other groups. RESULTS The pretreatment mean VAS scores of all 3 groups were not significantly different statistically from each other (4.02 +/- 1.20, 4.36 +/- 1.97, and 4.27 +/- 1.50; P > .05). However, after treatment, the mean VAS scores of the patients treated with papaverine (0.93 +/- 0.29) and pethidine (0.81 +/- 0.38) were significantly different from those of the hycosine group (3.67 +/- 2.21; P < .001). However, the mean VAS scores of groups 2 and 3 were comparable (P = .67). Unlike opioids, no papaverine-related severe side effects were observed. CONCLUSIONS Our results indicate that papaverine hydrochloride can used in an effective manner in the management of renal colic pain in patients unresponsive to commonly used conventional agents.

Role of MMP-1 1G/2G Promoter Gene Polymorphism on the Development of Prostate Cancer in the Turkish Population

Introduction: To investigate the association of 1G/2G polymorphism in matrix metalloproteinase-1 (MMP-1) promoter with susceptibility to prostate carcinoma in the Turkish population. Materials and Methods: MMP-1 promoter polymorphism was genotyped by PCR-RFLP analysis in 55 prostate cancer patients and 43 healthy controls. Results: The frequency of 1G/2G genotypes in prostate cancer patients was similar to that of the controls (all p values were >0.05). Compared with the 1G/1G genotype, neither the 2G/2G nor a combination with the 1G/2G genotype significantly modified the risk of developing prostate cancer and metastasis status. In addition, the frequencies of genotypes were not significantly different among patients stratified by smoking status and family history of prostate cancer. Conclusions: The 2G allele of the MMP-1 promoter polymorphism might not modify the risk of prostate cancer development and might not be used as a putative marker to predict the potential of metastasis in this cancer type, at least in the Turkish population.

Does Child's Age Affect Interval to Stone-free Status After SWL? A Critical Analysis

OBJECTIVE To evaluate the success rates and complications of extracorporeal shock wave lithotripsy (ESWL) in children with renal stones in an age-dependent manner. METHODS From 2006 to 2010, 164 children (male/female ratio 1:3) with renal calculi have been treated with ESWL (PiezoLith3000 lithotripter). The children were divided into 2 age groups: group 1, 0-6 years old (n = 133); and group 2, 7-15 years (n = 31). The patient- and treatment-related parameters were recorded for comparative evaluation. The success of ESWL in terms of the stone-free rates, additional procedures, and complications were comparatively evaluated. The data were analyzed statistically. RESULTS The mean age of groups 1 and 2 was 28 ± 18 months (range 4-71) and 119 ± 28 months (range 73-178), respectively. Although general anesthesia was used for all patients in group 1, 29% of the patients were treated under neuroleptic anesthesia in group 2. During the 3-month follow-up period, the complete stone-free rate was 94.7% (126 of 133), and treatment was unsuccessful in 7 patients (5.3%) in group 1. The corresponding data were 87% (27 of 31; P = .222) and 4 (13%; P = .089) in group 2. The stone-free rate after the first session was 67.6% (90 of 133) and 38.7% (12 of 31) in groups 1 and 2, respectively (P = .004). The mean number of ESWL sessions applied was 1.6 (range 1-5) and 2.9 (range 1-6) in groups 1 and group 2, respectively (P = .0001). No major complications were noted. CONCLUSION Our results have demonstrated that ESWL is highly successful in the management of renal calculi in children. Compared the outcomes by age, the younger children become stone free more quickly than the older children with fewer ESWL sessions.

Endoscope-Assisted Radical Perineal Prostatectomy

Dissection of the bladder neck is particularly important in patients who have previously had prostate surgery due to hyperplasia. We describe an endoscope-assisted radical perineal prostatectomy (RPP) technique that facilitates the dissection of the prostate-vesical junction. The technique was employed in four patients with a history of transurethral prostate resection. Before dissecting the prostate from the bladder neck during RPP, we circumscribed the bladder neck perurethrally with a Collins knife. The remaining of the RPP procedure was performed via the traditional approach. The incision of the prostate-vesical junction with the Collins knife protected the bladder-neck integrity and made the dissection of this junction easier. The final pathologic diagnosis was organ-confined prostate cancer with negative surgical margins. All the patients had continence during a 6-month follow-up. The major advantage of this technique is to precisely locate the prostate-vesical junction under direct vision. Our modified technique may prove to be a simple, less invasive, and oncologically safe method to manage the bladder neck perurethrally.

A new technique for simple renal cyst: cystoretroperitoneal shunt.

Purpose. To evaluate the results of patient symptoms and radiologic outcomes of cystoretroperitoneal shunt (CRS) technique in the treatment of symptomatic simple renal cysts. Patients and Methods. In a prospective study, 37 patients with a simple renal cyst were treated with ultrasound-guided percutaneous CRS-catheter. Radiological success was indicated as no recurrence of the cyst or a reduction in cyst volume by at least half. Results. CRS technique was performed successfully in 36 patients with a simple renal cyst. The mean size of all cysts decreased from 8.8 cm (range 7 to 14) to 1.7 cm (range 0 to 9; P < .001). Symptomatic success (pain relief) was achieved in 29/36 (80.5%) of patients, and radiographic success was achieved in 23/36 (63.8%) of patients, with a median follow-up of 16 months (range 6 to 24). Conclusion. Ultrasound-guided percutaneous CRS technique for simple renal cysts is fast, safe, effective, and inexpensive.

Transient Distal Penile Corporoglanular Shunt as an Adjunct to Aspiration and Irrigation Procedures in the Treatment of Early Ischemic Priapism

Purpose Ischemic priapism, a compartment syndrome, requires urgent treatment in order to nourish the corpora cavernosa. As the first step, aspiration of blood and irrigation of the cavernosal bodies is performed to prevent fibrotic activity and secure erectile capability. During aspiration, there are risks of cardiovascular side effects of adrenergic agonists. We aimed to evaluate a transient distal penile corporoglanular shunt technique in place of aspiration and irrigation techniques for treatment of early ischemic priapism. Materials and Methods A transient distal penile shunt was applied to 15 patients with early ischemic priapism between January 2011 and May 2012. Priapism duration, history, causes, pain, and any prior management of priapism were assessed in all patients. A complete blood count and penile Doppler ultrasonography were performed, which showed attenuated blood flow in the cavernosal artery. A sterile closed system blood collection set, which has two needles and tubing, was used for the transient distal penile shunt. Results Ten of 15 patients with early ischemic priapism were successfully treated with this transient shunt technique. No additional procedures were needed after the resolution of rigidity in the 10 successfully treated patients. Conclusions The transient nature of this technique is an advantage over aspiration and irrigation in the treatment of early ischemic priapism. Our results indicate that the technique can be offered for patients with an ischemic priapism episode of no more than 7 hours.

Use of atresic vagina as a urethra to repair iatrogenic incontinence, secondary to a complete longitudinal urethral incision

Abstract  Vaginal atresia is a rare congenital anomaly. Patients with this pathology commonly present with amenorrhea, or an inability to have sexual intercourse. A dorsal urethral wall incision was performed in a woman who complained of difficulty with coitus. Her gynecologist intended to expand the vagina, thinking the diagnosis was a vaginal septum. We report a repair technique for total urinary incontinence following a longitudinal complete urethral incision, which also involved the bladder neck. The vaginal reconstruction consisted of an ileal segment, whereas the urinary incontinence was corrected using a rectus fascial sling. To our knowledge, this is the first case of this kind reported in the literature.

Rectal injury during radical prostatectomy.

BACKGROUND We evaluated the data of our patients who experienced rectal injury during radical prostatectomy (RP). METHODS We analyzed the data for the 7 patients (6 perineal, 1 retropubic) with iatrogenic rectal injury who were selected from 451 patients with RP (218 retropubic, 233 perineal) operated in our clinic between 2003 and 2011. RESULTS The mean age of the 7 patients was 64.4 years. Rectal injury occurred during prostatic apical dissection in 4 patients, during dissection of Denonvilliers fascia in 1 patient, during transection of the rectourethral muscles in 1 patient, and during dissection of the rectal region proximal to the anal sphincter in 1 patient. The mean size of the lesions was 2 (1-4) cm. All of the rectal injuries were recognized during the operation, and double-layered sutures were used for the primary repair. None of the cases required colostomy procedure. No postoperative complications were encountered in 6 of the patients; however, 1 patient underwent a second operation on the following day due to detachment at the injury site. None of the patients displayed urethrorectal fistula, urinary incontinence or urethral stricture. CONCLUSION Primary repair with double-layered suturing is sufficient for the treatment of rectal injuries that occur during RP if they are recognized intraoperatively.

Enigmatic Traces Determined on Radical Perineal Prostatectomy Specimens: An Anatomohistological Study

Aim: An anatomohistological evaluation of tissue found on specimens of radical perineal prostatectomy which could influence oncological and functional outcome. Material and Method: A certain surgeon’s batch of 41 RPP (Radical perineal prostatectomy) specimens were evaluated. The RPP specimens were dissected from apex to basis. The following slices were dissected: 1 from the Apex, 2 from the center of the prostate, and 1 from the basis. Totaling 4 selected slices. Tissue surrounding these slices were anatomohistologically evaluated working from the following 7 parameters determined in light of latest anatomical and pathological insight on the prostate:“Dorsal venous complex(DVC)”, “Striated muscle(Rhabdosphincter)”, “Periprostatic fascial tissue (PPFT)”, “Neurovascular bundle(NVB)”, “Bladder neck smooth muscle”, “Surgical margins” and “Capsular incision”. Results: Whilst no DVC was found in the dissected Apex slices, muscle striation was found with 39 (95,1%) of the patients. PPFT within central prostate sections was found with 36 (87,8%) of the patients, predominantly within posterior quadrants. Again within central prostate sections NVB was found with 23 (56%) of the patients. All basis slices were found to have bladder neck smooth muscle. Surgical margin positivity was found with only 5 (12,1%) of the patients. Capsular incision was found with 15 (36,5%) of the patients. Discussion: Our study provides a quantitative report of the extent to which other anatomical structures are extracted when removing the prostate from the perineum employing the RPP technique. That the specimen show no trace of DVC is significant in terms of pubovesical complex sparing.