Fazlı Polat

The Impact of Transrectal Prostate Needle Biopsy on Sexuality In Men and Their Female Partners

OBJECTIVES To evaluate sexuality in men who have undergone transrectal prostate needle biopsy (TPNB) and their female partners. METHODS Ninety-seven men underwent TPNB because of high prostate-specific antigen level (>or=2.5 ng/mL) and/or abnormal digital rectal examination findings and their female partners were included in this study. Men were evaluated for erectile function before biopsy, and the first and sixth months after the biopsy with the 5-item version of the International Index of Erectile Function (IIEF-5). Female partners completed the Female Sexual Function Index (FSFI) in the same periods together with the men. We assessed IIEF-5 and FSFI score alterations after the biopsies. RESULTS The mean ages of men and their partners were 61.2 (40 to 81) years and 56.8 (34 to 70) years, respectively. The mean IIEF-5 scores were 19.1 +/- 5.8, 17.1 +/- 5.9, and 16.8 +/- 7.5 before the biopsy, and 1 and 6 months after the biopsy, respectively. We found significant differences among prebiopsy IIEF-5 scores and postbiopsy first- and sixth-month IIEF-5 scores (P <0.001). On the contrary, there was no significant difference between the postbiopsy first- and sixth-month IIEF-5 scores (P = 0.335). In the female partners, the mean prebiopsy, postbiopsy first- and sixth-month total FSFI scores were 18.0 +/- 6.8, 16.2 +/- 6.8, and 16.0 +/- 8.4, respectively (P <0.001). In first- and sixth-month postbiopsies, all FSFI subscores were significantly lower than the prebiopsy subscores. CONCLUSIONS TPNB seems to have negative impact on erectile function. Male sexual dysfunction after TPNB also has a negative effect on female sexual function. We believe that couples should be informed about the risk of erectile dysfuncton before TPNB.

Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion

Abstract We evaluated the efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) in patients with distal ureteral stone. In addition, we tried to determine the predictive value of Hounsfield Unit (HU) of the stone in the success of MET. A total of 75 patients with a distal ureteral stone of 5–10 mm diameter were randomly divided into three groups. Group 1 (n = 25) received tamsulosin 0.4 mg/d; group 2 (n = 25) received nifedipine 10 mg/day p.o and group 3 (n = 25) received diclofenac sodium 50 mg p.o. when required. At the beginning of each treatment, the HU of the stone was also measured using a non-contrast computerized tomography in all the patients. The results were evaluated at week four. The mean age of the patients was 36.8 (range, 16–68) years. Stone expulsion was observed in 19 (76%) patients in group 1, 16 (64%) patients in group 2 and 9 (36%) patients in group 3 (pgroup1-3 = 0.004, pgroup2-3 = 0.048 and pgroup1-2 = 0.355). The mean expulsion time was 9, 9.1 and 10.3 d, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.619). The mean diclofenac sodium dose per patient was 544, 602 and 1408 mg in groups 1, 2 and 3, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.977). The mean HU of the stone in patients with and without a successful MET was 363 and 389, respectively (p = 0.462). Our results showed that MET with both nifedipine and tamsulosin provided a similar increase in the expulsion rate for distal ureteral stones. HU does not seem to be a predictive parameter for stone expulsion.

RENAL BRUCELLOMA: A RARE INFECTION OF THE KIDNEY

Abstract  We report a case of renal abscess caused by brucellosis (renal brucelloma) which was treated by surgery. Renal parenchymal involvement of systemic brucellosis is a very rare condition and relapses after medical treatment, such as solid organ abscess including kidney, should be especially considered. In chronic cases, laboratory findings including polymerase chain‐reaction examination is needed for definitive diagnosis.

Comparison of local anesthetic effects of lidocaine versus tramadol and effect of child anxiety on pain level in circumcision procedure

OBJECTIVE To compare the local anesthetic effects of tramadol hydrochloride with those of lidocaine in circumcision procedures. We also investigated the effect of child anxiety on pain level. PATIENTS AND METHODS A total of 70 children were included in this study. The children were randomized into 3 groups. Group 1 (n = 26) received lidocaine hydrochloride + epinephrine and they underwent circumcision using Alis clamp(®). Group 2 (n = 35) received lidocaine hydrochloride + epinephrine and group 3 (n = 12) 5% tramadol. The last two groups underwent conventional circumcision. RESULTS The mean anxiety score was 22.6. We did not find significant differences in terms of anxiety score among the groups (p = 0.761). When the pain scores of the groups during injection were compared, it was found that there were no significant differences. However, the pain score of the third group was significantly high when it was compared with the first and second group 2 and 10 min after injection. In the correlation analysis, we found a positive correlation between childrens anxiety scores and the pain degree during injection (r = 0.373, p = 0.001). CONCLUSION Tramadol may not provide effective local anesthesia in male circumcision. The childs anxiety before the circumcision seems to have a negative effect on pain level.

Histopathological evaluation of the preputium in preschool and primary school boys.

Objective: To evaluate the dermatopathology of the preputium in preschool and primary school children. Material and methods: The study group consisted of 32 boys subjected to circumcision procedure for religious belief consecutively between June 2003 and September 2003 in our clinic. The removed foreskin is examined by the same pathologist in all cases and the presence of any dermatopathology was noted. Results: The mean age of the children was 6 ± 2 (4–12) years. Three (9.3%) boys had complete phimosis while 2 (6.2%) had partial phimosis. Among 27 (84.3%) cases without phimosis, the histopathological examination of the preputium revealed focal lichenoid cellular infiltrate with epidermal atrophy in 1 (3.1%) patient. This pattern was considered as early lichen sclerosus et atrophicus (LSA). Minor changes were reported in 1 (3.1%) boy namely minimal inflammation and oedema while 1 (3.1%) patient had more marked oedema and acute inflammatory cell infiltration (diagnosed as balanoposthitis). Three (9.3%) preputium specimens revealed evidence of chronic inflammation. Finally 2 (6.2%) boys showed increased melanin pigmentation in basal segment of the foreskin. In 5 (15.6%) patients with phimosis 1 (20%) (complete phimosis) had chronic inflammation and oedema while the other (20%) (partial phimosis) had chronic inflammatory infiltrate only. The rest of the boys with phimosis had normal preputial pathology. As a total, 22 (68.8%) of the 32 cases had totally normal preputial foreskin. Conclusion: The presence of foreskin in preschool and primary school children might rarely be associated with important inflammatory dermatoses like LSA even in the absence of phimosis.

Direct upper kidney pole access and early ligation of renal pedicle significantly facilitates transperitoneal laparoscopic nephrectomy procedures: Tunc technique.

We modified our technique in transperitoneal laparoscopic nephrectomies and compared its results with the classical technique. Classical technique was performed in 85 cases (group 1). Modified technique (n=98) included direct kidney upper pole access and early ligation of renal pedicle (group 2). No significant differences were detected regarding mean patient age, intraoperative blood loss, and duration of hospital stay between the 2 groups (P>0.05). Mean operation time was 64.9±19.3 and 28.2±7.7 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including right nephrectomies was 68.7±23.4 and 24.2±6.3 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including left nephrectomies was 63.8±17.1 and 33.6±5.1 minutes, respectively in groups 1 and 2 (P=0.001). Similarly, mean operation time was significantly shorter in group 2 when analysis was performed among right and left radical and simple nephrectomies between the 2 groups (P=0.001). Direct upper kidney pole access and early ligation of renal pedicle seems to be significantly facilitating transperitoneal laparoscopic nephrectomy procedures.

Comparative Analysis of Pedicular Vascular Control Techniques during Laparoscopic Nephrectomy: En Bloc Stapling or Separate Ligation?

Objective: To compare the safety and efficacy of en bloc stapling and separate ligation techniques for renal vascular control during laparoscopic nephrectomy. Patients and Methods: Clinical data were collected from 60 patients who underwent laparoscopic nephrectomies using en bloc stapling (n = 27, group 1) or the separate ligation method (n = 33, group 2). Comparative analysis was carried out between the two groups, examining operative times, blood loss, intra- and postoperative complications and hospital stay. Results: Compared with the separate ligation method, the en bloc hilar control technique was associated with a shorter total operating time (98 vs. 121 min, p = 0.029). However, both groups were similar in terms of estimated blood loss, hemoglobin drop, changes in creatinine level and postoperative hospital stay. The total complication rates in group 1 and 2 were 3.7 and 15.1%, respectively, with a statistically significant difference. There were no complications related to the use of the endo-GIA stapler and no patients required conversion to open surgery in group 1. In group 2, 2 patients required conversion to open surgery, including 1 due to renal vein bleeding secondary to inaccurate vascular control and the other due to bleeding from the vena cava during dissection. In addition, 1 patient had a superficial bowel injury that was repaired laparoscopically and another had a superficial liver tear that was managed without conversion or transfusion. Conclusion: En bloc ligation of the renal hilum is an easy and reliable technique that allows safe and fast control of the renal pedicle.

Safety of ESWL in elderly: evaluation of independent predictors and comorbidity on stone-free rate and complications.

Aim:  Urinary stone disease affects people of all ages. With its satisfactory efficacy ranges in all age groups and lack of side‐effects, extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for uncomplicated renal and proximal calculi ≤20 mm. In the present study, we aimed to assess the safety and efficacy of the ESWL treatment in elderly patients.

Retrograde intrarenal surgery by flexible ureteroscope in patients with spinal deformities

Objective: To present our experience with retrograde intrarenal surgery (RIRS) for managing renal stones in patients with spinal deformities. Design: We retrospectively reviewed the records of patients. Methods: We retrospectively reviewed the records of seven patients with congenital scoliosis (n = 5), spina bifida (n = 2) who had undergone RIRS for renal stones. Stone-free status was determined by CT 30 days after the procedure and was defined as the absence of stones in the kidney or residual fragments ≤1 mm. Results: Mean patient age was 27 years (18–45 years), and mean stone size was 176 mm (143–340 mm). The average operative time was 38 minutes (25–53 minutes), and postoperative hospital stay was 1 day (1–2 days). A stone-free status was obtained in six (85.7 %) patients, and one patient was considered to have treatment failure. This patient was managed by a repeat RIRS. A Double-J stent was placed at the end of the procedure in all (100 %) patients. No severe complications, either from anesthesia or the surgical procedure, were observed, and no blood transfusion was reported. Conclusions: The good clearance rate with a low incidence of complications shown by the present study has demonstrated that RIRS is a safe and effective procedure for renal stones in patients with spinal deformities.

Seperation of dorsal vein complex from the urethra by blunt finger dissection during radical retropubic prostatectomy.

We present our initial experience on the isolation of dorsal vein complex by blunt finger dissection in 26 patients with localised prostate cancer who underwent open retropubic radical prostatectomy. Loss of blood was between 300 and 500 mL (mean 350 mL). Two of 26 patients (7.6%) required blood transfusion. There was no positive surgical margin at prostatic apex in the patients. Twenty four of our patients (92.4%) were continent on the 3(rd) month. Control of dorsal vein complex is very important to decrease blood loss and to improve intraoperative exposure of retropubic area in order to get negative margin of prostatic apex and to provide the urethra long enough for a nice urethrovesical anastomosis. According to our initial experience, this technique seems to provide these aims.