Cenk Gurbuz

Retrograde Intrarenal Surgery for the Treatment of Renal Stones in Patients With a Solitary Kidney

OBJECTIVE To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of renal stones in patients with a solitary kidney. MATERIALS AND METHODS From December 2008 to March 2012, 24 patients with a solitary kidney who were treated with RIRS for renal stones were included in the study. All patients were preoperatively evaluated with urine culture, serum biochemistry, urinary ultrasonography, noncontrast computed tomography or intravenous urography, or both. The procedure was considered as successful in patients with complete stone disappearance or fragments <4 mm on computed tomography. Preoperative, operative, and postoperative data of the patients were retrospectively analyzed. The mean serum creatinine levels before and after the procedures were compared using a paired sample t-test. RESULTS The study included 24 patients with a mean age of 44.41 ± 12.15 years (range, 24-70). The mean stone size was 19.83 ± 5.90 mm (range, 10-35). The mean operative time was 55.83 ± 10.90 minutes (range, 40-75). The success rates were 83.3% and 95.8% after the first and second procedures, respectively. A pigtail stent was placed in all patients. The mean serum creatinine levels before the procedures and at 2 weeks after removal of the pigtail stents were 1.54 ± 0.55 mg/dL (range, 0.7-2.8) and 1.56 ± 0.50 mg/dL (range, 0.9-2.6), respectively (P = .92). Minor complications, classified as Clavien I or II, occurred in 4 patients (16.6%). No major complications (Clavien III-V) occurred in the study group. CONCLUSION RIRS is an effective and safe procedure that can be used to manage renal stones in patients with a solitary kidney.

The cost analysis of flexible ureteroscopic lithotripsy in 302 cases

The objective of this study was to audit the cost of flexible ureterorenoscopic lithotripsy. The data for 302 consecutive flexible ureteroscopic lithotripsy (FURSL) procedure undertaken in our department for renal stone treatment were collected retrospectively. The costs associated with performing FURSL, including the cost of ancillary equipment were analyzed. This includes the cost of the initial purchase of the ureterorenoscopes and the holmium laser equipment. The cost of flexible ureterorenoscopy for each lithotripsy procedure (for a total of 302 FURSL) was

Hyperthyroidism: A Risk Factor for Female Sexual Dysfunction

118. Additional cost of ancillary equipment including laser device, ureteral acces sheath and stone retrival catheter were

Comparison of Different Ureteroscope Sizes in Treating Ureteral Calculi in Adult Patients

156,

Is there a relationship between severity of coronary artery disease and severity of erectile dysfunction

231 and

Effects of three-times-per-week versus on-demand tadalafil treatment on erectile function and continence recovery following bilateral nerve sparing radical prostatectomy: results of a prospective, randomized, and single-center study.

611, respectively. In this series, the costs of the ancillary equipment including laser exceeded the purchase and maintenance of the flexible ureteroscope. The cost of disposables rather than flexible ureteroscope itself should be considered in planning the budget.

Reducing Infectious Complications after Transrectal Prostate Needle Biopsy Using a Disposable Needle Guide: Is It Possible?

INTRODUCTION Hyperthyroidism is a common hormonal disorder in women that may cause female sexual dysfunction (FSD). AIM To assess sexual function in women with hyperthyroidism. METHODS A total of 40 women with clinical hyperthyroidism and 40 age-matched voluntary healthy women controls were included in the study. All the subjects were evaluated with a detailed medical and sexual history, including a Female Sexual Function Index (FSFI) questionnaire for sexual status and the Beck Depression Inventory (BDI) for psychiatric assessment. MAIN OUTCOMES MEASURES The levels of serum thyroid-stimulating hormone (TSH), thyroid hormones, sex hormone binding globulin (SHBG), total testosterone (tT), free testosterone (fT), prolactin, estradiol, follicle-stimulating hormone, and luteinizing hormone were measured. RESULTS The mean total FSFI scores were 24.2 ± 9.96 in the hyperthyroidic group and 29 ± 10.4 in the control group (P < 0.0001). Desire (P < 0.040), arousal (P < 0.0001), lubrication (P < 0.0001), orgasm (P < 0.0001), satisfaction (P < 0.0001), and pain (P < 0.007) domain scores were also significantly lower in women with hyperthyroidism. The mean BDI score for hyperthyroidic patients was significantly greater than the score for the control group (P < 0.0001). The mean SHBG level in the hyperthyroidic group was found to be significantly higher than the level in the controls (P < 0.0001), whereas the mean fT level in the hyperthyroidic group was lower than in the control group (P < 0.0001). The FSFI score showed a significant negative correlation with the serum SHBG (r = -0.309, P = 0.005), free triiodothyronine (r = -0.353, P = 0.006) and free tetraiodothyronine (r = -0.305, P = 0.018) levels, BDI scores (r = -0.802, P = 0.0001) and positive correlation with tT (r = 0.284, P = 0.011), fT (r = 0.407, P = 0.001), and TSH (r = 0.615, P = 0.0001) levels. CONCLUSIONS A significant percentage of women with clinical hyperthyroidism had sexual dysfunction. Increased depressive symptoms, increased SHBG level, and decreased fT levels were all found to be associated with FSD in clinical hyperthyroidism.

Visual pain score during transrectal ultrasound-guided prostate biopsy using no anaesthesia or three different types of local anaesthetic application

OBJECTIVE To compare the success and complication rates of a 4.5-6.5F semirigid ureteroscope (S-URS) with an 8.5-11.5F S-URS in treating ureteral stones in adult patients. MATERIALS AND METHODS Fifty-two patients with ureteral stones, who were treated with 4.5-6.5F S-URS (group 1) and 52 patients who were treated with 8.5-11.5F S-URS (group 2) were compared retrospectively using a matched-pair analysis. The size, lateralization, location, and impaction of the stones and also the patient age, gender, body mass index, and the presence of hydronephrosis were used as the matching parameters. The stones were fragmented with Holmium-YAG laser. RESULTS The matching parameters were comparable between the 2 groups. The stone-free rates were 88.5% in group 1 and 84.6% in group 2 (P = .566) after a single procedure. The mean operative times for groups 1 and 2 were 32.7 ± 5.8 and 30.2 ± 5.4 minutes, respectively (P = .06). Postoperative hematuria was detected in 1.9% and 13.5% of patients in groups 1 and 2 (P = .027). Ureteral balloon dilation was needed in 1.9% and 15.4% of patients in groups 1 and 2, respectively (P = .015). Mucosal injury was observed in 1.9% and 13.5% of the patients in groups 1 and 2, respectively (P = .027). No major complications were noted in either group. CONCLUSION Although the stone-free rates and operative times were similar between the 2 groups, a 4.5-6.5F ureteroscope can reduce the need for ureteral balloon dilation and some minor complications, such as mucosal injury and postoperative hematuria, in adult patients.

Is Activating Transcription Factor 3 Up-Regulated in Patients with Hypospadias?

INTRODUCTION The correlation between erectile dysfunction (ED) and coronary artery disease has been emphasized and ED has been recognized as a potential independent risk factor and/or predictor of coronary artery disease (CAD). We evaluated the association between the number of occluded coronary arteries in myocardial infarction (MI) patients with the severity of ED, and investigated the influence of related risk factors in our study group. MATERIALS AND METHODS 183 male patients who underwent coronary angiography because of acute MI from November 2009 to May 2011 were included. Following the stabilization of patients after the treatment, each patient was evaluated for erectile functionality. Risk factors such as age, diabetes, smoking, waist circumference, hypertension, and hematologic parameters were recorded. RESULTS Among 183 patients with a mean age of 55.2 years who underwent coronary angiography due to acute MI, 100 (54.64 %) had ED, while the ED rate was 45.36 % (44/97) in cases of single-vessel disease, 64.5 % (31/48) in cases of two-vessel disease, and 65.7 % (25/38) in cases of three-vessel disease. The mean IIEF score was 24.2 ± 4.3, 20.4 ± 4.9 and 20.5 ± 4.2 for single or two or three-vessel disease, respectively. The presence of hypertension aggravated ED only in patients with three-vessel disease and increased total and LDL cholesterol levels in patients with single-vessel or two-vessel disease were accompanied by significantly decreasing IIEF scores. CONCLUSION The severity of ED correlated with the number of occluded vessels documented by coronary angiography, in male patients with acute myocardial infarction. In addition, the presence of hypertension had a significant influence over erectile function only in patients with three-vessel occlusion.

Pseudosarcomatous fibromyxoid tumor of the prostate.

Erectile dysfunction (ED) and urinary incontinence after bilateral nerve‐sparing radical prostatectomy (BNSRP) still remain major causes of morbidity. Phosphodiesterase type 5 inhibitors (PDE5‐Is) have a role in the treatment of ED after BNSRP. Several studies in patients with ED and lower urinary tract symptoms demonstrated that PDE5‐Is could improve both erectile function and urinary symptoms. The aim of this study was to compare the efficacies of two dosing regimens of 20 mg tadalafil (on‐demand and 3 times per week) and to assess the role of tadalafil in recovery of erectile function and continence after BNSRP. We conducted a single‐center, prospective, randomized controlled trial of three times per week versus on‐demand tadalafil 20 mg and a control group after BNSRP. A total of 129 preoperatively potent and continent patients were included in the study. The patients were evaluated at 6 weeks and 12 months postoperatively for erectile function and continence status. There was no significant difference between all three groups with respect to erectile function at 6 weeks after the surgery. Twelve months after the surgery, the International Index of Erectile Function score was significantly higher in the group using tadalafil 20 mg three times per week. However, there was no significant difference between the treated groups and the control group with respect to the continence status at 12 months after the surgery. There was no correlation between incontinence and ED after the surgery in all groups. Tadalafil 20 mg three times per week is an efficacious and well‐tolerated treatment option for ED after BNSRP. Treatment with 20 mg tadalafil either three times per week or on demand cannot improve continence recovery after BNSRP compared with the control group.