Eyup Burak Sancak

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception.

Abstract Objectives: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient’s pain control, anxiety levels, and satisfaction. Patients and methods: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed. Results: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. Conclusion: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

Retrograde intrarenal surgery in pediatric patients.

Urinary tract stone disease is seen at a level of 1%-2% in childhood (< 18 years). In recent years, however, there has been a marked increased in pediatric stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to todays advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques.

Prevalence of Daytime Urinary Incontinence and Related Risk Factors in Primary School Children in Turkey

Purpose Urinary incontinence is one of the major urinary symptoms in children and adolescents and can lead to major distress for the affected children and their parents. In accordance with the definitions of the Standardization Committee of the International Childrens Continence Society, daytime urinary incontinence (DUI) is uncontrollable leakage of urine during the day. The aim of this cross-sectional study was to investigate the prevalence and associated risk factors of DUI in Turkish primary school children. Materials and Methods The questionnaire, which covered sociodemographic variables and the voiding habits of the children, was completed by the parents of 2,353 children who were attending primary school in Denizli, a developing city of Turkey. The childrens voiding habits were evaluated by use of the Dysfunctional Voiding and Incontinence Symptoms Score, which is a validated questionnaire. Children with a history of neurological or urological diseases were excluded. Results The participation rate was 91.9% (2,164 people). The overall prevalence of DUI was 8.0%. The incidence of DUI tended to decrease with increasing age and was not significantly different between genders (boys, 8.8%; girls, 7.3%; p=0.062). Age, maternal education level, family history of daytime wetting, settlement (urban/rural), history of constipation, urinary tract infection, and urgency were independent risk factors of DUI. Conclusions Our findings showed that DUI is a common health problem in primary school children. In an effort to increase awareness of childrens voiding problems and the risk factors for urinary dysfunction in the population, educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status.

Protective effect of syringic acid on kidney ischemia-reperfusion injury

Abstract The objective of the present study was to determine whether preischemic administration of syringic acid (SA) would attenuate renal ischemia-reperfusion injury (IRI). Rats were divided into three groups: Sham group; IR group; and IR + SA group. The effects of SA were examined using biochemical parameters including serum ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), tissue superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and malondialdehyde (MDA). The apoptosis status and histopathological changes were evaluated. After calculating the score for each histopathological change, the total score was obtained by summing all the scores. In the SA group, MDA, IMA, TOS, and OSI decreased significantly compared to the IR group. After SA administration, the increase in GPx activity was found to be significant. Apoptosis decreased significantly in the SA group compared with the IR group. The total score significantly decreased after administration of SA. Taken together, our findings suggest that SA preconditioning is effective in reducing tissue damage induced in kidney IRI. Renal histology also showed convincing evidence regarding the protective nature of SA.

Re: Imaging the urologic patient: the utility of intravenous pyelogram in the CT scan era

We read with great interest the recent article by Hale et al. [1] on the comparative study of intravenous urography (IVU) and computerized tomography (CT). They concluded that IVU has a limited clinical role on the evaluation of the urologic patient, and thus, its use should be strictly limited to highly select cases. We congratulate the authors for their work and thank them for bringing this important topic to our attention; however, we feel that some issues described in their paper need further discussion. We know that noncontrast CT is the most accurate imaging method for identifying urinary stones, and it has become the standard test for diagnosis of acute flank pain [2]. It offers the advantages over IVU of avoiding contrast allergy or nephrotoxicity and has ability to determine the other causes for abdominal pain. However, most of the patients with a history of flank pain return with similar symptoms and need to undergo repetitive CT examinations. Furthermore, current EAU guidelines recommend a contrast study (enhanced CT or IVU) if stone removal is planned, because the anatomy of the renal collecting system needs to be assessed prior to stone surgery or shock wave lithotripsy [2]. But use of repeated CT or IVU would increase the risk of cancer development. Epidemiological trials have reported an association between doses of radiation administered in CT and an increased risk of malignancy [3]. Recently, published studies also reported a theoretic increased risk of fatal cancer in pediatric and adult population as a result of single CT scan, based on data from similar levels of exposure to radiation during the atomic bombings of Nagasaki and Hiroshima [4, 5]. It was underlined that a single abdomen CT in infants would cause in one CT-related death per 550 scans [6]. Therefore, we believe that combination of ultrasonography and abdominal radiography may be considered in the evaluation of acute flank pain especially in children and patients with known urinary stone disease. Noncontrast CT may be reserved for those patients with suspected urolithiasis but negative findings on plain radiography and ultrasonography.

Do Hypertension, diabetes mellitus and obesity increase the risk of severity of nephrolithiasis?

Objective: In this study we planned to investigate the relationship between presence of kidney stones and stone burden with hypertension (HT), diabetes mellitus (DM) and body mass index (BMI). Methods: A total of 574 patients were included in the study. None of the patients had a history of stones. The 121 patients with kidney stone identified on ultrasound evaluation and the 453 patients with no stones were compared in terms of HT, BMI and DM. The stone burden of 121 patients with diagnosed stones was compared in terms of the same variables. Results: Of the 121 patients with kidney stones 30 (24.7%) had HT, while 66 (14.5%) of the 453 patients without stones had HT (p=0.007). BMI values of those with and without stones were 27.2 ± 4.93 kg/m2 and 25.29 ± 4.12 kg/m2, respectively (p<0.001). Twenty-five (20.6%) of the patients with stones diagnosed by ultrasound had DM, while 49 (10.8%) of those without stones had DM (p=0.004). When comparing patients with and without kidney stones, logistic regression analysis revealed that DM (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.17 to 3.63, p=0.013) and BMI (OR 1.08, CI 1.03 to 1.13, p=0.003) were independently associated with presence of stones. No significant relationship was found between the same variables and cumulative stone diameter (CSD) and stone surface area (SA) evaluated for stone burden. Conclusions: While diabetes mellitus, Hypertension and increased Body Mass Index may add to the possibility of stone formation, they did not affect stone burden.

Pudendal neuralgia after pelvic surgery using mesh: Case reports and laparoscopic pudendal nerve decompression

Persistent pain after vaginal mesh surgery is a rare and agonizing entity that has devastating consequences for the patients quality of life. Many etiologies have been blamed including nerve injuries and entrapments. Pudendal neuralgia is a rare chronic neuropathic pain syndrome in the anatomical territory of the pudendal nerve. Various treatment options, such as medication management, physiotherapy, nerve blocks, decompression surgery and neuromodulation, have been used, but the most appropriate treatment for pudendal neuralgia has not yet been determined. In this article, we present two cases of postoperative pelvic pain thought to be secondary to injury or mechanical distortion of the pudendal nerve after rectocele repair using mesh and tension‐free vaginal tape sling. In cases of failed conservative treatment and of mesh removal surgery, laparoscopic pudendal nerve decompression and omental flap wrapping operation can be a treatment option for pudendal neuralgia.

Accuracy of Unenhanced Computerized Tomography Interpretation by Urologists in Patients with Acute Flank Pain

Purpose: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. Materials and Methods: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. Results: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [κ]: 0.904), categorical stone size (κ: 0.81), the location of calculus (κ: 0.88), and hydronephrosis (κ: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (κ: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. Conclusion: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.

Is it only a sleeping disorder or more? Restless legs syndrome and erectile function.

Abstract Objective: Sexual dysfunction and restless legs syndrome (RLS) have similar pathophysiological properties. This study evaluated the presence of erectile dysfunction (ED) and premature ejaculation (PE) in patients with RLS. Materials and methods: Fifty patients in the RLS group and 50 in the control group were included in the study. The International Restless Legs Syndrome Study Group rating scale, the five-item International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool were used to define the RLS and erectile function of both the study and control groups. A stopwatch technique was used to evaluate the intravaginal ejaculatory latency time of patients in the study. Results: The mean age of patients in the RLS and control groups was 53.5 ± 9.9 and 53.2 ± 8.8 years, respectively (p = 0.527). None of the patients in either group had diabetes mellitus. There was no difference between the groups in terms of history of hypertension, body mass index and total testosterone level. There were 27 patients (54%) in the RLS group and 17 patients (34%) in the control group with PE (p = 0.008). There were 26 patients (52%) with ED in the RLS group and 17 (34%) in the control group (p = 0.069). The prevalence of moderate and severe ED was significantly higher in the RLS group (p = 0.045). Conclusions: PE was more prevalent in RLS than in control patients. On the other hand, the rate of ED did not differ between the groups. In addition to receiving a neurological evaluation, RLS patients must be evaluated for sexual function.

The association of urolithiasis and androgenetic alopecia

Abstract Objectives: The objective of this study is to investigate whether patients with androgenetic alopecia were at risk in terms of urinary system stone disease. Patients and methods: Patients with no baldness (Hamilton–Norwood Scala [HNS] stage I) were categorized as Group I, those with hair loss in the frontal region (HNS stages II, III, IIIa, and IVa) as Group II, those with hair loss in the vertex region (HNS stage III-vertex, V) as Group III and those with hair loss in both vertex and frontal regions (HNS stages IV, Va, VI, and VII) as Group IV. Patients in all groups were compared in terms of presence of stone, and the presence of any association between alopecia and urolithiasis, with common etiological risk factors, was investigated. Results: Three hundred and two male patients were included in the study. The presence of urolithiasis was detected in 28.9% of patients in Group I; 26.5% of Group II; 36.9% of Group III; and 44.4% of Group IV (p = 0.085). Among patients aged under 60, urinary stone disease was detected in 30.8% of patients in Group I; 26.4% of Group II; 41.2% of Group III; and 53.8% of Group IV (p = 0.001). In patients aged over 60, urolithiasis was detected in 12.5% of patients in Group I; 26.9% of Group II; 32.2% of Group III; and 37.8% of Group IV (p = 0.371). Conclusions: We determined a significant correlation between vertex pattern and total alopecia with urolithiasis in patients younger than 60 years old.