Hasan Riza Aydin

Ureteroscopy and holmium laser lithotripsy: Is this procedure safe in pregnant women with ureteral stones at different locations?

OBJECTIVES The aim of this study was to assess the safety and effectiveness of ureteroscopy and Holmium: Yttrium-Aluminum-Garnet lithotripsy for the treatment of ureteral stones with different localizations in symptomatic pregnant women. METHODS A retrospective analysis was performed on 19 pregnant patients referred to our center between January 2005 and December 2012 with symptomatic hydronephrosis requiring surgical intervention. 7.5 F and 9.5 F semirigid ureterorenoscopy with Holmium laser lithotripsy was used for treatment in all patients. Complications were stratified according to modified Clavien criteria. RESULTS The mean age of patients was 25.4 (18-41) years, and the mean gestation duration was 24.8 (7-33) weeks. Six cases (31.5%) had a history of stone. Solitary kidney secondary to previous nephrectomy was observed in 2 patients and 1 patient had a hypoplastic kidney. Abdominal ultrasonography was used as the main diagnostic tool. Mean stone size was 9.2 mm (6-13). The location of the stones was the lower, middle, and upper ureter in 8 (42.1%), 5 (26.3%) and 6 (31.5%) cases, respectively. All stones were fragmented with Holmium laser lithotripsy. Of the 19 patients, 11 (57.8%) required double J stent insertion peroperatively. Intraoperative urological and obstetric complications were not observed. Postoperatively two complications were noted. According to Clavien criteria a complication was level 1, and the other was level 2. CONCLUSIONS For treatment of pregnant women with symptomatic ureteral stones in every location, Holmium laser lithotripsy with a semirigid ureteroscopy can be used as judicious treatment. This approach is effective and safe with an acceptable complication rate.

Incidence of bacterial colonisation after indwelling of double-J ureteral stent

OBJECTIVE To determine the bacterial colonisation after double-J stent use and the risk factors for bacteriuria linked to the stent. MATERIALS AND METHODS A total of 102 patients (61 men and 41 women, mean age 47.5 ± 14.16) were examined. The stents were removed under aseptic conditions, and a urine culture was obtained before the removal of the stents. After the stents were removed, the upper, central and lower sections were separated, and washing water was sent through the stent. RESULTS Bacterial colonisation was found in 29.4% (30 of 102) of the stents. The most frequently observed microorganisms were determined as staphylococcus, coagulase negative (8 of 30) and E. coli (5 of 30). The washing fluid used to clean the interior of the catheter produced pathogens in 8 patients (7.8%), and these pathogens were observed to be the same microorganisms that colonised the outside of the stent. There was no statistical difference between the patients with colonisation and those without in terms of age, gender, duration of stenting and reason for stent insertion. CONCLUSIONS Though stent colonisation does not always entail symptomatic urinary tract infections, as shown in our study, the pathogens in the urine culture are the same as those colonising the stent, confirming the reality that colonisation is the main factor in these events. Additionally, according to our study, significant colonisation may be found in the first 3 weeks, contrary to the literature, causing us to consider that urinary tract infections may develop even in the early period.

Holmium Laser Lithotripsy with Semi-Rigid Ureteroscopy: A First-Choice Treatment for Impacted Ureteral Stones in Children?

Background We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children. Material/Methods We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification. Result The mean patient age was 9.5±5.1 years (range 1–18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5–20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3–55). Conclusions For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach.

A Cause of Renal Dysfunction: A Giant Bladder Stone

Bladder stones are frequently seen in elderly men and account for 5% of all urinary stones. They develop secondary to infravesical obstructions, such as prostatic hyperplasia and neurogenic bladder. A 56-year-old patient with frequent and painful urination, dysuria, and minor complaints of suprapubic pain was referred to our clinic. He was diagnosed with bladder stones by non-contrast abdominopelvic computerized tomography, kidney-ureter-bladder radiography, and urinary system ultrasonography. Cystolithotomy was applied on a giant stone measuring 11×6.5×10 cm that filled the intravesical cavity nearly completely. Here, we present this case of a giant bladder stone causing renal dysfunction within the context of findings in the literature.

ÇOCUKLARDA EPİDİDİMO-ORŞİTLER: 35 OLGUNUN GÖZDEN GEÇİRİLMESİ

Amac: Epididimo-orsit infant ve cocuklarda son derece nadir gorulen bir patolojidir. Cogu olguda epididimo-orsit gelisimindeki patofizyolojik mekanizma anlasilamamistir. Bu retrospektif calismada bu patolojinin olasi nedenleri, tani ve tedavisiyle uzun donem takip sonuclarini irdelemeyi amacladik. Gerec ve Yontem: Ocak 1993 ile Aralik 2006 tarihleri arasindaki 13 yillik periyotat epididimo-orsit tanisi almis 35 olgu bu calismaya kapsamina alindi. Hastalarin yas ortalamasi 10.5 ± 3.7 yil (1-14 yil) idi. Epididimo-orsit tanisi, oyku, fizik muayene ve skrotal doppler ultrasonografi ile konuldu. Altta yatan patolojiyi ortaya koyabilmek icin uriner sistem ultrasonografisi, idrar tetkiki, idrar kulturu ve supheli olgularda intravenoz urografi yaptirildi. Bulgular: Epididimo-orsit’in nedenleri su sekilde idi: idiopatik Epididimo-orsit (n = 22), kabakulak Epididimo-orsit (n=9), bakteriyel epididimo-orsit (n=1), tuberkuloz epididimo-orsit (n=1) ve Henoch-Schonlein purpurasina bagli olusmus epididimo-orsit (n=2). Tuberkuloz epididimo-orsit’i olan hastanin idrarinda tuberkuloz enfeksiyonunu gosteren bir bulgu yoktu. Bu olgu, uygun antituberkulo z ilac tedavisi ve orsiektomi ile tedavi edildi. Otuz bes olgunun 15’inde uzun donem takip yapilabildi. Ortalama takip suresi 49.0 ± 35.8 ay (13 ay-13 yil) idi. Ortalama testis volumleri karsi saglam testisle karsilastirildiginda epididimo-orsit tarafinda anlamli derecede dusuk bulundu (p <0.01). Sonuc: Akut skrotumun nedenlerinin ayirici tanisinda sadece klinik ozellikler ve laboratuvar verileri kullanildiginda zorlanilmaktadir. Doppler ultrasonografi ayirici tanida, ozellikle de spermatik kord torsiyonunun ayiriminda en kullanisli metottur.

Ivabradine inhibits carbachol-induced contractions of isolated rat urinary bladder

BACKGROUND Overactive bladder (OAB), a symptom syndrome defined as urgency, is a common clinical condition, which sometimes cannot be satisfactorily treated with current medications in every subject; therefore, alternatives are needed. OBJECTIVES The aim of this in vitro study was to investigate the effects of ivabradine, a selective pacemaker If current inhibitor, on agonist-induced isometric contractions of the bladder smooth muscles. MATERIAL AND METHODS Urinary bladder strips were isolated from adult male Wistar rats and suspended in a tissue bath containing physiological solution. The strips were contracted by bath applications of carbachol (CCh, 1 μM). Ivabradine (30 μM, 60 μM or 90 μM) was added to the tissue bath either prior to or after the application of the agonist, and the resulting contractile activity was compared to the preceding contractile activity. The amplitude and area under force-time curves (AUFC) of the isometric contractions were evaluated. RESULTS The addition of CCh caused a marked stimulation of contractile force in isolated urinary bladder strips, which was significantly inhibited by ivabradine, both in terms of peak amplitude (29% ±3%, 20% ±6% and 18% ±6% by 30 μM, 60 μM and 90 μM ivabradine, respectively) and AUFC (47% ±5.5%, 35% ±8% and 35% ±6% by 30 μM, 60 μM and 90 μM ivabradine, respectively; n = 7 for each). Pre-treatment with ivabradine (10 μM) significantly attenuated the contractile response to CCh (1 μM; mean peak amplitude from 1493 ±216 mg to 680 ±95 mg; p < 0.003; n = 7). CONCLUSIONS The results of this in vitro study demonstrated that ivabradine inhibits cholinergic agonistinduced bladder contractions, which means that in the future ivabradine may be used in OAB treatment.

The efficacy of udenafil in end-stage renal disease patients undergoing hemodialysis

Abstract Introduction Erectile dysfunction (ED) is frequently observed in end-stage renal disease (ESRD) patients on hemodialysis (HD) compared to non-uremic patients. This situation causes severe psychogenic problems in patients and disrupts the quality of life. Different phosphodiesterase type 5 (PDE-5) inhibitors have been used, and efficacies revealed, for the treatment of ED in HD patients; however, there are no studies related to udenafil use or results for HD patients. This study retrospectively evaluated the efficacy and reliability of udenafil for HD patients. Materials and methods The laboratory findings, side effects after treatment, and International Index of Erectile Function (IIEF) scores before and after treatment were compared and evaluated for HD patients who applied to our urology clinic with ED complaints and were treated with udenafil. Results The results showed that in the HD patient group with ED, apart from ED, there were severe rates of other sexual dysfunction. In our patient group, there was a statistically significant improvement in all scores for erectile function (p = 0.033), orgasmic function (p < 0.001), sexual desire (p < 0.001), relationship satisfaction (p < 0.001), and general satisfaction (p < 0.001) after treatment. The reported side effects were headache in one patient and dyspepsia in one patient. Conclusion We concluded that udenafil is an effective and reliable treatment approach for HD patients; however, our results require support from prospective randomized crossover studies with sildenafil.

Kontinan diversiyonun nadir komplikasyonu: Neobladder taşı ve endoskopik tedavisi

OZET Uriner sistem taslari kontinan uriner diversiyonlarin gec komplikasyonlarindandir. Gross hematuri, diversiyonda basinc hissi, inkontinans ve rekurren uriner sistem enfek- siyonu gibi semptomlar verebilirler. Diversiyon kalkulleri icin cok cesitli tedavi alternatifleri bulunmaktadir. Bu ya - zida klinigimizde tedavi ettigimiz 46 yasinda olan ve ne- obladder icinde radyolojik muayenede 3x2 cm ebatli tas tespit edilen erkek hastayi rapor ettik. Oykusunde 9 yil once mesane tumoru nedeniyle radikal sistoprostatekto- mi ve neobladder operasyonu vardi. ABSTRACT Urinary tract stones are from rare complications of conti- nent urinary diversions. These symptoms may occur such as gross hematuria, feeling the pressure of diverting, in- continence and recurrent urinary tract infection. There are various treatment alternatives for diversion calculi. We reported a male patient who was 46 years old who had 3x2 cm sized stone which is radiologically detected in neobladder and treated in our clinic. In history, there was a radical cystoprostatectomy and neobladder operation due to bladder tumor before 9 years ago.