Enis Rauf Coskuner

Complications of the Mainz Pouch II (Sigma Rectum Pouch)

Objective: The complications of the sigma rectum pouch were analyzed. Methods: A total of 60 patients who underwent a construction of the Mainz pouch II was analyzed retrospectively. Data on early complications was available for all patients, while long–term follow–up data was available for 50 patients. Results: Perioperative mortality was nil. Early complications were encountered in 2 (3.3%) patients. Oral alkalizing supplementation therapy was required in 30 (60%) of the patients; 3 (6%) patients needed hospitalization for severe acidosis and hypokalemia. Hydronephrosis developed in 5 (5%) of 98 renoureteral units anastomosed. Acute pyelonephritis was observed in 3 (8%) patients. All of the patients were continent except for 1 female patient who had had previous radiotherapy to the pelvis. The mean voiding frequency during the day and night was 5.1±1.1 and 1.9±0.7, respectively. The psychological state and general health of 2 patients became progressively worse until they died of probable malnutrition and metabolic abnormalities. Mechanical bowel obstruction developed in 1 patient 2 years after surgery. Conclusion: The complication rate of the Mainz pouch II appears to be acceptable with a median follow–up of 31 months. Patient selection and cooperation are of paramount importance for a successful outcome.

The Use of a Laparoscopic Bulldog Clamp to Control the Dorsal Vein Complex During Robot-Assisted Radical Prostatectomy: A Novel Technique

PURPOSE To describe a novel technique to control dorsal vein complex (DVC) during robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS We have been using a laparoscopic bulldog clamp to control DVC before apical dissection and urethral division. Data of 50 patients who underwent DVC control with laparoscopic bulldog clamp (group 1) were retrospectively compared with 50 consecutive patients in whom DVC was controlled with suture ligation (group 2). In the bulldog and suture groups, 30 and 31 patients underwent concomitant bilateral extended pelvic lymph node dissection (PLND), respectively. Operative and anastomosis time, estimated blood loss (EBL), apical surgical margin positivity, and early continence rates were evaluated. RESULTS Patients in the bulldog group had significantly shorter operative time compared with patients in the suture group (146.8 vs 178.4 min, P=0.0005). Anastomosis time was significantly shorter in the bulldog group (12.3 vs 15.5 min, P=0.002). There was no difference in EBL between the groups (185 vs 184.2 mL). Immediate, postoperative first and third month continence rates were 62% vs 44%, 74% vs 60%, 90% vs 74% in groups 1 and 2, respectively. Although continence rates were better in favor of the bulldog group at each evaluation period, the difference did not reach statistical difference. None of the patients in both groups had apical surgical margin positivity. CONCLUSIONS The use of a laparoscopic bulldog clamp to control DVC was associated with shorter operation and anastomosis time and a trend toward quicker recovery of continence. This technique provides clear vision during apical dissection and urethral division while potentially minimizing the external sphincteric trauma. Prospective randomized trials are needed for better evaluation of this technique.

Impact of the Quadrivalent HPV Vaccine on Disease Recurrence in Men Exposed to HPV Infection: A Randomized Study

INTRODUCTION Human papillomavirus (HPV) is one of the most common sexually transmitted infections and is the cause of several different diseases in men and women. Although little is known about HPV infection in men, they are also in the risk group of HPV infection and play an important role in transmitting the virus to women. AIM To define the efficacy of the HPV vaccine through cross-immunization and its role in clearance of HPV infection, and to assess infection-associated factors in men. METHODS This prospective randomized clinical study enrolled 171 evaluable men with genital warts between June 2009 and October 2013. After the initial treatment intervention, 91 patients were randomly assigned to receive HPV vaccine in three doses. Eighty patients were in the control (unvaccinated) group. One hundred-eleven men were single and 60 men were married. Patients who had previous treatment for pre-existing warts and medical disorders that needed chronic treatment or immunosuppression were not included in the randomization. Also 29 men with follow-up less than 12 months and incomplete vaccination were not included. MAIN OUTCOME MEASURES The patients were assessed regarding age, condom use, marital status, number of visible genital warts, and smoking status. Post-treatment follow-up was monthly up to 12th month. RESULTS Mean age was 34 ± 7.6. One hundred fifteen patients were smokers. For the recurrence of warts, age, smoking, vaccination status were insignificant and marital status was significant in the univariable analysis; only marital status preserved significance (HR: 2.0 CI:1.29-3.12 P = 0.002) in the multivariable analysis including vaccination status, marital status, and smoking. CONCLUSION Among the investigated factors vaccination status was not but marital status significantly influenced wart recurrence. Married men had more recurrences in our population. Larger multicenter randomized clinical trials are lacking and seriously required to investigate the therapeutic effect of current quadrivalent HPV vaccine in genital warts.

Penile Necrosis due to Priapism Developed After Circumcision in a Patient with Protein S Deficiency

INTRODUCTION Hypercoagulable state is a complex condition with an abnormal propensity for thrombosis. The consequences of it due to thrombosis of veins and arteries are the most common cause of sickness. AIM The present study is a report of a case describing penis necrosis after circumcision and evaluation of hypercoagulable state as a reason of it. METHODS l Nine-year-old boy referred from another hospital with the sequelae of the penile ischemia with discoloration of the penis after traditional circumcision. RESULTS The ischemic event developed 3 weeks after circumcision. Priapism that was treated with needed glandulocavernous shunt initially developed following circumcision. All values of routine blood count and blood biochemical analysis were within normal limits. Further, hematologic studies revealed that there might be a hypercoagulable state as a result of lower protein S level. CONCLUSION Circumcision is a common procedure frequently performed in many communities around the world. Although it is seen as an easy procedure and performed even by unauthorized medical stuff, it is not complication-free. Severe penile necrosis after circumcision should be treated on an individual basis, necessitating different techniques. Hypercoagulable state should be concerned and evaluated in such a complication. In short, circumcision has to be done by specialists who can handle such serious complications.

Penile Mondor disease and its effect on erectile function: results of 30 patients.

OBJECTIVE To investigate the treatment outcomes among patients diagnosed with penile Mondor disease and to evaluate the effect of the disease on erectile function. METHODS A total of 30 patients diagnosed with penile Mondor disease were enrolled in the study. All patients underwent physical examination and penile Doppler ultrasonography and filled in the International Index of Erectile Function (IIEF-5) questionnaire at regular intervals. Pharmacotherapy was started when penile Mondor disease was diagnosed. After the data were confirmed to be normally distributed using Kolmogorov-Smirnov test, the differences between the 3 IIEF-5 scores were evaluated using repeated measures analysis of variance and post hoc Bonferroni tests. RESULTS The mean age of the patients was 34.3 years (range, 25-48 years). Ten patients had prolonged sexual intercourse, 4 had recent intestinal infection history, 2 had recent long-haul flights, 1 had sickle cell anemia, and 2 had penile trauma caused by sexual intercourse. Nine patients were considered idiopathic. Mean IIEF-5 scores at the baseline and at 1- and 2-month follow-ups were 20.87, 20.07, and 20.93, respectively. Although no significant difference was found between the baseline and the 2-month follow-up IIEF-5 scores, significant differences between the baseline and the 1-month (P = .004) and the 1- and 2-month follow-up IIEF-5 scores (P = .0001) were detected. CONCLUSION Penile Mondor disease is a rare complication that can be successfully treated with medical therapy and conservative approach. Our series showed that penile Mondors disease does not lead to permanent deformation of the penis or erectile dysfunction.

The Use of a Bulldog Clamp to Control the Dorsal Vein Complex During Robot-Assisted Radical Prostatectomy

Optimal control of the dorsal venous complex (DVC) is a critical step in robot-assisted radical prostatectomy (RARP). If DVC is not controlled properly, bleeding may occur during the apical dissection. On the other hand, if it is controlled well, a bloodless field is attained and, thus, a precise apical dissection and urethral division is possible. Suture ligation is the most common technique used for dorsal vein control, while some authors recommend using an endovascular stapler. Recently, athermal division and selective suture ligation technique has been reported for DVC control. We describe a new technique: Use of a bulldog clamp to control the DVC during RARP. The control of the DVC with a bulldog clamp allows a bloodless field with precise apical dissection and provides preservation of maximum urethral length while avoiding sphincteral injury.

The Role of Partial Nephrectomy without Arterial Embolization in Giant Renal Angiomyolipoma

Angiomyolipoma is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4–8 cm size. We here report our partial nephrectomy experience in the 24 cm size giant angiomyolipoma. 26-year-old woman referred to our clinic with a 24 cm size angiomyolipoma in her lower pole of right kidney. The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free for surgical margin. Warm ischemia time was 35 min. and intraoperative bleeding volume was 200 cc. Postoperative 2nd day the drain was taken and hospital stay was 4 days. In literature we observed very rare angiomyolipoma cases with such a large dimension treated by partial nephrectomy without arterial embolization. If technically suitable partial nephrectomy is the main chioce in this kind of benign lesions in young patients.

Desire for penile girth enhancement and the effects of the self-injection of hyaluronic acid gel

Penile girth enhancement is a controversial subject but demands for enhancement are increasing steadily. Although various fillers have been widely used for soft tissue augmentation, there is no reliable material for this particular situation. Here we report a case of an acute hypersensitivity reaction in a man after his first self-injection of a filler material, which, he claimed, was hyaluronic acid gel for penile girth enhancement and glans penis augmentation.

Post-SSRI Sexual Dysfunction: Preclinical to Clinical. Is It Fact or Fiction?

INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) are a widely used class of drug for various psychiatric disorders during the lifespan, including pregnancy, lactation, childhood, and adolescence. Deterioration in sexual functioning is a major and serious adverse effect of SSRIs. There is emerging evidence that SSRIs can have long-lasting effects on sexuality. AIM To summarize the long-lasting effects of SSRIs on sexuality, starting with animal models and continuing with the clinical experience of different investigators. METHOD A literature review of relevant publications in PubMed. MAIN OUTCOME MEASURES To assess the long-lasting effects of SSRIs on sexuality. RESULTS Although the persistent effects of SSRIs on sexuality have been little studied in humans, animal studies suggest that SSRIs might cause permanent sexual dysfunction after ending SSRI exposure at a young age but not in adulthood in rats. There are no prospective randomized controlled trials in humans and the present evidence is derived from case reports, incidental research findings, and experiences of some internet communities. CONCLUSION There is some preclinical evidence from animal studies for enduring SSRI-induced sexual dysfunction, but the available clinical information could prevent a clear decision about the existence of post-SSRI sexual dysfunction, its pathophysiology, and its management. We need more research to fill in the gaps in our knowledge. Coskuner ER, Culha MG, Ozkan B, Kaleagasi EO. Post-SSRI Sexual Dysfunction: Preclinical to Clinical. Is It Fact or Fiction? Sex Med Rev 2018;6:217-223.

Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience.

OBJECTIVE To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. MATERIAL AND METHODS Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. RESULTS Patients undergoing RAPN had a mean tumor size of 4.42 cm (2-8) and a mean renal nephrometry score of 5.82 (4-11). The mean estimated blood loss was 250 mL (150-450 ml) and the mean operative time was 195 minutes (150-300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p=0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2-10). In only 1 patient disease recurrence was detected at the 21(st) month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3-36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). CONCLUSION With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors.