Hayrettin Sahin

Effects of extracorporeal shock‐wave lithotripsy on intrarenal resistive index

Objective: This prospective study was performed to determine whether extracorporeal shock‐wave lithotripsy (ESWL), widely used for treating renal and ureteral stones, affects the kidney interlobar artery resistive index (RI). Material and Methods: A total of 43 patients (30 with renal and 13 with ureteral stones) underwent color Doppler examination before and 30 min and 3 h after ESWL. Seventeen patients with renal and nine with ureteral stones underwent Doppler examination 2 weeks later. Measurements were made near the stones (nearby region), at least 2 cm from the stones (remote region) and in the contralateral kidney for renal stones, and in the ipsilateral and contralateral kidneys for ureteral stones. Results: In patients with renal stones, the RI was increased 30 min and 3 h after ESWL in the nearby and remote regions, and more markedly in the former. In the contralateral kidney, there was an increase in RI only at 3 h, which was less than that in the ipsilateral kidney. The RI at 2 weeks post‐ESWL in the nearby region and contralateral kidney did not differ from the pre‐ESWL values. ESWL performed for ureteral stones caused no increase in RI in the ipsilateral kidney. Conclusion: Patients with renal stones had a temporary increase in RI in the hours following ESWL in both the ipsilateral and contralateral kidneys, which was highest in the region near the stones and lowest in the contralateral kidney. Two weeks later, the RI in both areas had returned to pre‐ESWL levels.

Retrospective analysis of 135 renal trauma cases

Background: We review our trauma cases over the last 11 years and discuss our diagnosis and treatment modalities.

A new treatment for clot retention : Intravesical streptokinase instillation

A 12-year-old boy with acute renal failure and hypertension caused by tubulointerstitial nephritis underwent ultrasound guided renal needle biopsy in February 1995. The day after biopsy the patient was referred to our urology department because of massive hematuria. After evaluation we placed a 12F multiple hole urethral Robinson catheter and irrigated the bladder with saline. However, clot retention developed 4 days later. Pelvic ultrasonography revealed a 55 mm. hematoma in the bladder (fig. 1). A total of 100,000 IU streptokinase was diluted with 100 ml. saline, 30 ml. of this solution were injected into the bladder via the catheter and the catheter was clamped for 30 minutes. Later the bladder was irrigated with saline, which easily evacuated the clots. This procedure was repeated 3 times at 4-hour intervals. After 3 applications the urine was clear and no bladder hematoma was seen on followup ultrasonography (fig. 2). Hematocrit was stable during the procedure. Serum coagulation studies were not altered. Voiding cystourethrography before renal biopsy demonstrated no vesicoureteral reflux.

Gunshot Injuries of the Ureter: One Centre’s 15-Year Experience

Abstract Purpose: Ureteral injury is a rare condition. It is difficult to identify the best diagnostic methods and treatment. We report our experience with penetrating ureteral injuries secondary to gunshot wounds. The methods of diagnosis and treatment options of these cases are described and discussed. Materials and Methods: A retrospective review of ureteral injuries due to penetrating trauma between January 1990 and December 2005, in the Urology and General Surgery departments of our hospital. Ureteral injures were graded according to the AAST-OIS. We evaluated mechanism of injury, initial urinalysis, radiologic and operative procedure, associated injuries, and postoperative complications. Results: A total of twenty-one (sixteen male, five female) cases of gunshot ureteral injuries were evaluated retrospectively. The median patient age was 27.85 years (16–48 years). All patients had signs and symptoms of an acute abdomen and only nine patients were evaluated radiologically. Haematuria was absent in 71.4% of patients (15 of 21). All patients had associated injuries and were evaluated from grade I to V. Grade I had none, grade II had 1 (4.76%), grade III had 3 (14.29%), grade IV had 14 (66.6%), grade V had 3 (14.29%). Ureteral stent or nephrostomy tubes were used in all primarily repaired patients. Two patients developed urinary leakage, which resolved spontaneously. Conclusions: Ureteral injury should always be borne in mind and, when suspected, the surgeon should dissect and visualize the ureter during exploration. Adequate debridment, and ureteral stenting or nephrostomy drainage are good techniques for successful treatment.

Cerebrospinal fluid prostate specific antigen (CSF PSA) in prostate cancer patients with lower spine metastasis.

Aim: In this prospective study, our aim was to investigate the CSF PSA levels and CSF/Serum PSA ratios in patients with prostate cancer with lower spine metastasis. Methods: The study involved patients with prostate cancer (n = 15), benign prostatic hyperplasia (n = 17) and non-prostatic disease (n = 9). Serum and CSF were obtained prior to spinal anesthesia for urological surgery. Total PSA levels in the serum and CSF were measured by electrochemiluminescence immunoassay. The results were tested statistically using the Mann–Whitney U test. Results: The mean serum PSA levels were 20.36 ng/ml in the prostate cancer patients, 5.37 ng/ml in the BPH patients and 0.76 ng/ml non-prostatic disease. The mean CSF PSA levels in groups were 0.127, 0.051 and 0.027 ng/ml, respectively. The mean CSF PSA/serum PSA ratios in groups were 0.007, 0.018 and 0.042, respectively. This result is statistically significant (P < 0.001).Conclusions: Although mean serum PSA and CSF PSA levels in the patients with cancer of the prostate and lower spine metastasis are higher than those in the others, the mean CSF PSA/serum PSA ratio is lower. However, clinical usefulness of CSF PSA value and CSF PSA/ Serum PSA ratio can be limited because CSF PSA values are usually very low, and CSF PSA/Serum PSA ratio of 4 prostate cancer patients are as high as 1 BPH patient.

Erectile dysfunction rates and requests for treatment in patients attending outpatient urology clinics and those accompanying them.

Background: Erectile dysfunction is a common sexual function disorder in men. The aim of the present study was to determine the rates of erectile dysfunction and requests for treatment in male patients refered to our outpatient urology clinics and those accompanying them who were older than 20 years. Methods: The study comprised 2 groups: group 1 included male patients older than 20 years whom attend to the outpatient urology clinics, and group 2 included their companies whom were older than 20 years. Subjects were asked whether they had erectile dysfunction or not, if so whether they had been treated or not, if not then why, and whether they desired treatment or not at present. Results: Erectile dysfunction was determined in 224 subjects (13.9%) in group 1, and 57 (8.5%) in group 2. It was found that approximately one half (49.1%) of patients with erectile dysfunction did not complaint about this. The main reasons for this were failure to perceive sexual dysfunction as a problem, and shame. Of 281 men who determined to have erectile dysfunction, 71 indicated that they desired treatment. In those who did not desire treatment, the main reasons were failure to perceive it as a problem, and shame. Conclusions: These findings show that the doctor has a great responsibility in determining erectile dysfunction. Therefore discussions of sexual health should be made a routine part of doctor-patient discussions, and patients, especially those over 50, should be asked whether they have a complaint of erectile dysfunction.

Premature ejaculation rates and treatment needs in males aged 20 years and over attending urology outpatient clinic

Aim: The purpose of this study was the assessment of the rates of premature ejaculation and desires for treatment in male patients 20 years and over attending urology outpatient clinic. Methods: All subjects included in the study were asked whether they had a complaint of premature ejaculation; if so, whether they had sought a doctor’s assistance; if not, why they had not; why they did not mention their complaint during the first visit; whether they desired treatment; and if not, why they did not. Results: A total of 1608 subjects were questioned. Premature ejaculation was present in 333 (20.7%). Premature ejaculation was the primary complaint of 33 of those attending the urology outpatient clinic. The most common reasons for not seeking a doctor’s assistance were failure to see the condition as a problem, and embarrassment. Fifty four (16.2%) of these patients did not desire treatment. The most common reason for not desiring treatment was regarding it as unnecessary at present, and old age. Conclusion: The questioning of all men aged 20 and over attending urology outpatient clinic concerning premature ejaculation will greatly increase diagnoses and treatments.

622 EFFICACY OF LORNOXICAM AND TRAMADOL FOR PAIN CONTROL DURING TRANSRECTAL PROSTATE BIOPSY

pediatric cleft lip and palate surgery for determining the efficacy of different doses of Fentanyl. Methods: 40 children aged 3mo-3 yrs were divided in 2 groups randomly (n = 20) after induction of general anesthesia with Thiopental 5mg/kg, Lidocaine 1mg/kg, Midazolam 0.2mg, Patients received 3m/kgfentanyl in group A, and Fentanyl 1m/kg + Acetaminophen rectal 20mg/kg in group B, repeated doses of rectal Acetaminophen was 10mg/kg/2 h. Intra operative pain was measured with change of vital signs from base and need to increase of halothane percentage. Results: Vital signs were more stable in group B than group A (P> 0.05). There was a need to increase halothane percentage during surgery in group A, rather than group B (P< 0.05). Conclusion: We conclude that low dose Fentanyl + repeated rectal Acetaminophen provides more effective analgesia and less side effects in children.

The first micturition times of the newborns whose mothers were treated with magnesium sulfate

Background: The aim of this study was to determine whether magnesium sulfate used for the treatment of severe pre-eclampsia or eclampsia had an effect on the first micturition time of the newborn. Methods: The first group included 20 newborns all of whose mothers had severe pre-eclampsia or eclampsia, and all mothers had been treated with magnesium sulfate according to the Parkland Memorial Hospital eclampsia regimen. The second group included 20 newborns all of whose mothers were normal pregnants, and did not receive any drug that had an effect on the contractility of smooth muscles. The first micturition times of all newborns in two groups were determined following delivery and were compared statistically. Results: All newborns urinated in the first 24 hours. There were no statistically significant differences in the micturition times between the two groups (p > 0.05). There was no residual urine after the first micturition, and none of them had any urinary tract abnormality and neurological pathology. Conclusions: From the results, it was concluded that magnesium sulfate had no effect on the first micturition time of the newborns, when applied according to the Parkland Memorial Hospital eclampsia regimen in severe pre-eclamptic or eclamptic pregnants.