Doğan Erduran

Use of bladder mucosal graft for urethral reconstruction

Background: The ideal tissue for complex urethral reconstruction has yet to be determined, especially in patients with deficient preputium. The use of bladder mucosa as a free graft could be an alternative in these problem cases.

The Effects of Subinguinal Varicocelectomy on Kruger Morphology and Semen Parameters

PURPOSE We studied the effect of varicocele ligation on Kruger strict morphology criteria and semen parameters in patients with infertility. MATERIALS AND METHODS A total of 90 patients diagnosed with varicoceles and a normal morphological sperm ratio of less than 14% were evaluated before and 6 months after varicocelectomy. Preoperatively and postoperatively sperm density, motility and morphology using Kruger strict criteria were analyzed. The Wilcoxon test was used to measure levels of statistical significance in all analyses. RESULTS Significant improvement in sperm concentration and motility was evident after varicocele ligation (p <0.0002 and <0.0001, respectively). Using the Kruger classification sperm morphology evaluation revealed a significant increase in the percent of normal forms, and of forms with head and acrosome defects (p <0.0001, <0.0014 and <0.0028, respectively). There were no concomitant changes in strict morphology in forms with mid piece and tail defects or immature forms (p >0.05). Of the 90 patients 18 (20%) achieved a successful full-term pregnancy, including 14 via natural cycle intercourse and 4 by intrauterine insemination. CONCLUSIONS Surgical correction of varicocele was associated with significant improvement in density, motility and sperm morphology evaluated using the Kruger classification.

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.

Extracorporeal shock wave lithotripsy treatment in paraplegic patients with bladder stones

Background: Spinal cord injury patients are at increased risk of developing urolithiasis and many will require treatment, most commonly with extracorporeal shock wave lithotripsy (ESWL).

Nephrogenic adenoma of the bladder after intravesical bacillus Calmette-Guérin treatment.

A 60-year-old female patient was subjected to transurethral resection of transitional cell carcinoma of the bladder and was given intravesical bacillus Calmette-Guérin treatment for 6 weeks. The control cytoscopy performed after 6 months revealed a polypoid lesion at the trigon and the lesion was resected. The pathological examination of the specimen showed no evidence of cancer but the presence of a metaplastic lesion that was nephrogenic adenoma.

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.

Lithiasis in Varicocele Veins: “Varicolithiasis”

A 20-year-old man presented with chronic left scrotal pain and discomfort, especially in the upright position. On physical examination the testes and epididymes were normal on palpation but were remarkable for a grade III left varicocele. Multiple solid “bead string” lesions were also palpated in the varicocele veins. The lesions were opaque on x-ray (fig. 1). Gray scale and color Doppler sonography using a 5 MHz. linear phased array transducer revealed a 6.5 mm. left spermatic vein with multiple calcifications and acoustic shadowing. Roentgenographic examination and ultrasonography of the kidneys, ureters and bladder were normal. Metabolic evaluation included serum electrolyte, creatinine, calcium, phosphorus and uric acid tests. Hemogram, urinalysis and urine culture were performed, and 24-hour urine samples were collected and analyzed for calcium, uric acid, creatinine, oxalate, sodium and citrate. In addition, urinary pH and volume were measured and were found to be normal. History, clinical examination and colony counts were also obtained to exclude genitourinary infections. Exploration of the left spermatic cord and testis showed a normal vas and testis but mobile solid lesions were palpated in the varicocele veins (fig. 2). The varicocele vein segment was then excised and the solid lesions appeared as stones. Stone analysis demonstrated whitlockite calcium phosphate. However, histolopathological examination of the varicocele veins revealed thrombosed large vessels with perivascular fibrosis and interstitial edema.

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.

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.