Çetin Harmankaya

Is There Significance of the Choice of Prone versus Supine Position in the Treatment of Proximal Ureter Stones with Extracorporeal Shock Wave Lithotripsy

Objective: To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL).Methods: Ninety–six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone–free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups.Results: The mean session number per patients was 1.64±0.75 in group 1 and 1.33±0.59 in group 2 (p = 0.224). The stone–free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p<0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54±2,114.85 in group 1 and 3,704.16±1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae.Conclusion: These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost–effective.

External vacuum device therapy for spinal cord injured males with erectile dysfunction

Neurogenic factors contributing to erectile dysfunction may be found in up to 20 per cent of organically impotent men. Although many options have been suggested for the treatment of some of these problems in male patients, most are invasive and have substantial morbidity.Our study group comprised 32 patients with spinal cord injury. These 32 patients with neurogenic impotence, who had been injued at least one year previously and had a regular sexual partner were evaluated. We selected external vacuum therapy as the treatment modality.During the initial phase of the study, six patients refused treatment due to negative cultural perception and they were excluded from the study group. Four patients discontinued treatment because of minor complications such as ecchymoses, petechiae and lack of motivation.Our data suggest that external vacuum therapy is a feasible, safe, noninvasive alternative and possibly a better initial treatment for the management of impotence secondary to spinal cord injury.

Surgical treatment of urethral diverticula in men

Two 21-year-old men were treated for congenital diverticulum at the bulbous portion of the anterior urethra. One of the diverticula contained a stone. Acquired anterior urethral diverticulum with ventral displacement of the penile shaft following repair of hypospadias was treated in a 21-year-old man. Correction of the defect involved ventral paramedian vertical incision, excision of the diverticulum with closure at the urethra, and traction sutures for the ventral penile displacement.

Giant Seminal Vesicle Stones

Seminal vesicle stones are rare conditions and only a few cases have been reported in the literature. Here we present 2 cases with single and multiple seminal vesicle calculi.

Ureterocystoplasty in Bilaterally Functional Kidneys

Objective: Traditional augmentation cystoplasty using gastrointestinal segments is known to be associated with metabolic abnormalities and alterations in the bladder causing potential carcinogenesis. In this respect alternative techniques have been searched preferably lined by urothelium. We performed ureterocystoplasty in 7 patients with a diagnosis of neurogenic bladder and investigated the clinical and functional aspects.Patients and Methods: Between 1995 and 1999, ureterocystoplasty was performed using both ureters in 4 male and 3 female children with bilaterally functional kidneys. Patients’ ages varied between 1 and 7 (mean 4.7) years. Before the operation all the children were incontinent, had a small–capacity noncompliant bladder, and high–grade (IV–V, International Classification System) reflux on voiding cystouretrography (VCU). Technetium–99m DTPA renal scintigraphy was also performed in all children to evaluate renal function before and after the operation. Results: Before the operation the mean end–filling intravesical pressure was 45.6 (35–60) cm H2O which decreased to 18.9 cm H2O 3 months postoperatively. The mean bladder capacity 3 months after ureterocystoplasty was found to be 279.3 (250–330) ml. All the children were continent and VCU showed the absence of reflux. There was mild to moderate improvement in renal function after surgery in both kidneys on technetium–99m DTPA renal scintigraphy. Three (43%) patients could void spontaneously with abdominal straining, whereas 4 (57%) children could empty their bladders by clean intermittent catheterization. A double–J stent was inserted in 1 (14%) patient because of a rise in serum creatinine after the removal of the ureteral catheter. Patients were followed for a mean period of 30 (8–50) months and all the children remained continent. The bladder capacity and end–filling pressure measurements were also stable.Conclusion: Ureterocystoplasty was found to be an effective method for bladder augmentation in bilaterally functional kidneys with an acceptable complication rate

Transverse Fibrous Bar in Prostatic Urethra After Transurethral Prostatectomy

Transurethral prostatic resection is now considered the gold standard for surgical treatment of obstructing benign prostatic hyperplasia. However, transurethral prostatic resection is associated with several perioperative and postoperative complications. We describe the development of a transverse fibrous bar within the prostatic urethra, resulting from transurethral prostatic resection, with interesting endoscopic images. To our knowledge this condition has not been reported previously.

Reimplanted Ureter as an Alternative to the Catheterizable Mitrofanoff Tube

Objective: We performed this study in dogs to investigate whether a ureter can be used as an alternative to the appendix without disrupting the uniformity of the gastrointestinal system. Materials and Methods: This study comprised 10 adult healthy female mongrel dogs. The procedure was done in 2 stages: in the first stage, we performed a left-end cutaneous ureterostomy at the lower left quadrant just above the inguinal ligament. A second operation was performed 6 weeks later. The left ureter was divided and using Paquin’s technique, the proximal end of the distal third of the left ureter was reimplanted in the anterolateral surface near the dome of the bladder. A high transureteroureterostomy with the remaining left proximal ureter to the opposite ureter completed the reconstruction. The bladder neck was ligated in order to create an experimental bladder outlet obstruction. At the time of creating the distal ureteral stoma, a feeding tube was left in the bladder, passing through the ureterostomy stoma and sutured to the skin. This catheter remained in place for 20 days, preventing the bladder form distending. Then in the following 6 months, intermittent catheterization was applied through the stoma at 3- to 4-hour intervals. Exploration was performed at the end of the 6th month. Results: No animal died. The dogs were still continent. Intravenous urography, urea and creatinin values were normal. The ureteral stoma was viable in all 10 cases. Stenosis of the ureteral stoma developed in 1 dog and required surgical revision. Possible traumatic effects were investigated by histological sections, but no harmful effects were found at the ureteral endothelium. Conclusions: This method may be an alternative to the Mitrofanoff method, which uses the appendix.

A rare cause of urethral obstruction: verumontanum attachment.

A 52-year-old man presented with obstructive urinary symptoms, including weakness of urinary stream, hesitancy, intermittency and the sensation of incomplete bladder emptying many years in duration. Medical history revealed no urogenital trauma or urethral instrumentation. However, a urogenital infection, probably urethritis, due to prostatitis 5 years ago had not been treated with any drugs. Urinalysis and serum prostate specific antigen were normal. International Prostate Symptom Score was 23. The patient had severe symptoms. Maximum flow rate was 9 ml. per second. On cystoscopy a verumontanum attachment causing urethral obstruction was observed at 12 o’clock (see figure). A resectoscope was inserted into the urethra and the attachment was separated using loop without resection. Benign prostatic obstruction was evident but the urethral lumen was not fully obstructed. Transurethral resection was performed and a urethral catheter was placed.

A Pseudotumour of the Bladder

A case of pseudotumour involving the bladder is presented. The differential diagnostic importance of the lesion is stressed.