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Pain control using pethidine in combination with diazepam compared to diclofenac in combination with hyoscine-n-butyl bromide: in patients undergoing extracorporeal shock wave lithotripsy.

Introduction Extracorporeal Shock Wave Lithotripsy (ESWL) remains the preferred least invasive treatment for urinary tract stones. The main purpose of this study was to compare two treatment modalities for pain control during the ESWL procedure. Material and methods From 2013 to 2014, 220 patients received ESWL for kidney stones. Before the procedure, the weight and height were measured to determine the body mass index (BMI); in addition, oxygen saturation and the pulse of the patients, as well as pain level were determined. The pain control provided included two different methods: diclofenac sodium plus hyoscine-N-butyl bromide in the first group and pethidine plus diazepam in the second group. The pain level of the patients was determined using two different scales: the Wong-Baker and the Visual Analogue scales (VAS). At the end of three sessions, all patients were evaluated for the stone fragmentation rate by plain abdominal X-ray, and the findings were recorded and analyzed. Results A total of 220 patients were enrolled in this study. There were 91 patients in the first group (diclofenac sodium + hyoscine-N-butyl bromide) (male/female: 63/28) and 129 (male/female: 83/46) patients in the second group (pethidine HCL +diazepam). The mean age with SD according to each group was 42.03 (±16.43) and 42.56 (±14.23), respectively (p = 0.8). With regard to pain scores (using the Wong-Baker and VAS scales), the responses were significantly lower in the second group (p <0.001). Conclusions Pethidine in combination with diazepam was superior to diclofenac and Hyoscine-N-butyl bromide for pain in patients undergoing ESWL.

Fluorescein as a diagnostic marker of bladder ruptures: an experimental study on rabbit model

Abstract Introduction: The aim of this study was to investigate fluorescein use in the diagnosis of bladder ruptures in rabbits as an experimental model. Material and Methods: The study was conducted on male New Zealand rabbits divided into a retrograde fluorescein group (n = 8) and an intravenous (IV) fluorescein group (n = 8). Following general anaesthesia, 10 mL of 10% fluorescein dye (sodium fluoresceine powder) was administered via ureterorenoscope to the bladder of the first group, and 0.5 mL of 10% fluorescein was administered intravenously to the second group. Then, the bladder was viewed through the cystoscope by urethral aspect. After experimental bladder perforation, groups were comparatively evaluated by paracentesis and laparotomy. Results: Following IV injection of fluorescein dye, the bladder veins were stained green within 10 s and then fluorescein mixed with urine flowed into bladder lumen. The green fluid flow was observed in the abdominal cavity after the perforation of the bladder in both groups. Conclusion: Fluorescein can be used as a marker in diagnosis of bladder ruptures. If there is no bleeding or intestinal content in the abdominal cavity, although a smoky yellow-green image is observed, bladder rupture can be suspected.

Monopolar versus Plasmakinetic™ Energy Effect on Prostatic Tissue Damage in Terms of PSA Levels: A Prospective Randomized Trial

Introduction: We investigated the monopolar and bipolar energy effects on prostate and correlated the results with the type of pathology, thus determining the relationship between tissue damage and the PSA level. Material and Methods: One hundred and twenty four patients underwent TURP and according to the energy source, 2 groups were designed as monopolar (Group 1) and bipolar energy (Group 2). Hemoglobin and free and total PSA were measured preoperatively and 6 hours postoperatively, and differences were calculated. The weight of resected tissue and operation time were also recorded. Two groups were also formed later according to the pathology as chronic prostatitis (CP) and BPH. The findings were analyzed. Results: There were no statistical differences between the groups in terms of age; prostate volumes; resected tissue; operation times; pre- and postoperative Hb, total-free PSA, IPSS, PVR, and quality of life scores; or postoperative maximum flow rates. Changes in total-free PSA (25.7 and 10.8 ng/dl for PSA; 13.2 and 5.76 ng/dl for free PSA for Groups 1 and 2, respectively) were significantly different between Groups 1 and 2. There was a statistical difference in total PSA between the groups among CP patients (28.18 and 11.73 ng/dl for Groups 1 and 2, respectively). But no statistical difference existed among BPH patients. The change in Hb differed based on pathological results. Conclusion: Bipolar TURP is less invasive than monopolar TURP on the basis of postoperative PSA levels. In addition, bleeding during TURP is affected not by the kind of energy, but by the pathology.

Comparison of ureterorenoscopic lithotripsy and extracorporeal shock wave lithotripsy in the management of distal ureteral stones

AIM: To compare the effi ciency of ureterorenoscopic lithotripsy (URS) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of distal ureteral stones. METHODS: The data of all patients with a single distal ureter stone were investigated, retrospectively. The patients were divided into two groups according to the management options as ESWL and URS. The success and complication rates of the groups were compared. RESULTS: There were 112 and 108 patients in ESWL and URS groups, respectively. Patients’ age, stone size and gender were similar in both groups. The average stone size was 10.8 mm. Postoperative success rate defi ned as the removal of all the stones was higher in URS group (89.8%) than ESWL group (59.8%), and the difference was signifi cant (p<0.05). In URS group, ureteral perforation, urinary tract infection, and postoperative fever were encountered in 3.24%, 6.4% and 9.2% of the patients, respectively. Urinary tract infection and fever were noted in 4.4% and 7.9% of patients in ESWL group. However, the complication rates did not differ signifi cantly between groups. The procedure had to be repeated 2.8 times in ESWL group and none of the patients in ESWL needed a double-J stent. In contrary, 28 patients in the URS group required the insertion of a double-J stent. CONCLUSION: Although ESWL is a non-invasive and reliable outpatient procedure that can be used in the treatment of distal ureteral stones, URS seems more successful. However, the invasiveness of URS is its disadvantage.

Pain Control and Its Relationship with Histopathological Outcome in TRUS-Guided Prostate Needle Biopsy: A Prospective Non-Randomized Trial

ÖZET insertion in group 3 was not different from that in group 1. There was no significant difference in pathological results between group 1 and groups 2 and 3. Pain scores in patients with chronic prostatitis were statistically higher than those in patients with benign prostatic hyperplasia (BPH) and Pca in groups 2 and 3 (p<0.05).

SmartClamp circumcision versus conventional dissection technique in terms of parental anxiety: A prospective clinical study

INTRODUCTION We prospectively analyzed parental anxiety and outcomes of the SmartClamp circumcision and the classic surgical dissection technique. METHODS A total of 250 boys underwent circumcision between 2009 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine in Turkey. The initial 125 children were circumcised by conventional dissection method and the remaining children were operated on with a SmartClamp device. Children in both groups were compared in terms of bleeding, infection, penile edema, operative time, cosmetic result, length of the inner mucosal layer, and parental anxiety. We used a State-Trait Anxiety Inventory (STAI) form to gauge how the circumcision affected parental anxiety. This form was completed by parents on postoperative day 2. RESULTS There were no statistically significant differences among the 2 groups in terms of age, bleeding, infection, and cosmetic displeasure (p > 0.05). The STAI scores of the parents from the SmartClamp group were statistically higher than that of the other group (p < 0.001). Penile edema was more common in the SmartClamp group (p = 0.039). However, the mean operative time was statistically shorter (p < 0.001) and the inner mucosal length was significantly longer in the SmartClamp group (p < 0.001). CONCLUSION Circumcision with the SmartClamp device was faster. Cosmetic results and complication rates were similar. Unfortunately, this technique seemed to entail the disadvantages of longer mucosal length, penile edema, and higher parental anxiety. Urologists should keep these points in mind when choosing a technique.

Air-migration after ureteral intervention: a prospective case series.

Aims: To investigate whether air in the kidney or bladder is only associated with gas - forming infection, or whether it can be observed after endoscopic interventions including ureteral and cystoscopic. If this is the case, what are the parameters that affect the amount of air in the urinary tract? Study Design: A prospective case series study. Place and Duration of Study: Sample: Department of Urology, Kafkas University Faculty of Medicine, between 2013 and 20 14. Methodology: One hundred and forty patients who underwent any kind of ureteral intervention including flexible ureteroscopic lithotripsy (FURS - L), semi - rigid ureteroscopic lithotripsy (URS - L), double J stenting alone (JJS), URS - L + JJS, and FURS - L + JJ S due to urinary system stones were enrolled. Computed tomography without contrast substance was performed 6 hours after ureteral intervention in order to determine whether there was any air in the urinary tract. Two groups were

CO2 Flow Dynamics of Bladder Injury During Laparoscopy and the Effect of the Content of the Abdominal Viscera During Injury--Experimental Study.

BACKGROUND Despite the well-known and easily recognizable signs of bladder injury during laparoscopy, some injuries remain unnoticed. Intra-operative diagnosis of a urinary bladder injury provides the opportunity to repair and prevent later complications involving the formation of fistula, infection, ascites and impairment of renal function. Small and unrecognized bladder injuries increase the chance of morbidity and permanent organ dysfunctions. OBJECTIVES The aim of the study was to evaluate the CO2 flow dynamics of bladder injury occurring during laparoscopy and the effect of the content of the abdominal viscera during injury. MATERIAL AND METHODS The study involved eight male New Zealand rabbits. Following urinary catheterization of the rabbits with an 8-gauge urinary catheter connected securely to a urinary drainage bag, pneumoperitoneum was created at a pressure level of 12 mm Hg. The experiment consisted of three phases. After the observational phase (Phase 1), the anterior wall of the urinary bladder was perforated with the tip of a 21 G needle (Phase 2) and methylene blue was administrated to evaluate the CO2 flow dynamics (Phase 3). RESULTS The amount of CO2 consumption and accumulation in the urinary drainage bags differed significantly among the three phases of the experiment (p<0.05). There was no CO2 consumption or accumulation in the urinary drainage bags during Phase 1. The amount of CO2 consumption and accumulation in the urinary drainage bags during Phase 2 was significantly higher than during Phase 3. CONCLUSIONS Urinary catheterization helps in the diagnosis of small or unnoticed urinary bladder injuries occurring during laparoscopy. CO2 flow and consumption is lower if the viscosity of the content overlying the injury site is higher.

The relation between Turkish Symptom Score, Maximal Urethral Flow Velocity, Residual Volume, Functional Urethral Length, Prostatic Urethral Length and Post Prostatectomy Incontinence

AIM: This study was conducted to determine the effects of same diagnostic parameters for getting continence after prostatectomy. METHODS: This study included 75 patients who were decided to undergo prostatectomy. Residual urine volume, maximum urinary fl ow, prostatic urethra lenght, functional urethra lenght and Turkish symptom score were recorded before the operation. The incontinence score defi ned by us was applied to all patients before the operation, on the 1st, 15th, 30th and 90th days after urethral catheter was removed. RESULTS: Incontinence was found to be present in 36% of patients preoperatively, 93% on the 1st day, 32% on the 15th day, 15% on the 30th day and 12% on the 90th day after urethral catheter was removed. A statistically signifi cant difference was present between the incontinence ratios of 15th day after the catheter was removed an the age. There was not any signifi cant difference between the operation types and incontinence ratios. Turkish symptom score did not show any relation with postprostatectomy incontinence ratios. There was not a statistically signifi cant difference between the maximum urinary fl ow and the fi rst and 15th day incontinence ratios. However, a statistically signifi cant difference was found on the 30th day and 90th day. Residual urine volume, measured in the preoperative period, did not affect incontinence ratios. There was not statistically signifi cant difference between prostatic urethra lenght, and incontinence ratios. There appeared a statistically signifi cant difference between functional urethral length and fi rst, 15th and 30th days’ incontinence ratios. CONCLUSION: In order to predict the postprostatectomy incontinence, age and functional urethral lenght may be the effective parameters during the earlier periods (15th and 30th days). However, in the later periods (90th day), maximum urinary fl ow may be a prognostic factor. On the other hand, residual urine volume, prostatic urethral lenght and Turkish symptom score do not seem to be prognostic factors during any period.