Lokman Irkilata

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.

Parameatal cyst of urethra: A rare congenital anomaly

We report a case of parameatal urethral cyst in a 15-year-old boy which is a very rare congenital anomaly. The cyst recognized at infancy but the boy presented to our clinic at the age of 15 when the mass was grown enough to cause spraying of urine and poor cosmesis. Complete excision of the cyst with total removal of the epithelium is the required for treatment and prevention of recurrence.

Repair of Hypospadiac Urethral Duplication with Dismembered Urethroplasty

Urethral duplication is a complex and rarely seen anomaly with three anatomic variants: epispadiac (dorsal), hypospadiac (ventral) and Y-type. Here we report an 11-year-old male patient with hypospadiac urethral duplication who presented with daytime urinary incontinence and dribbling, urethral stricture and possible obstructive uropathy. After endoscopic treatment of the stricture in the ventral (dominant) urethra, urethral reconstruction was done anastomosing the ventral (dominant) and dorsal (non-dominant atretic urethra) in a dismembered fashion.

Pediatric extracorporeal shock wave lithotripsy: multi-institutional results

Aim To evaluate the efficacy, auxiliary procedures and complications of pediatric extracorporeal shock wave lithotripsy (ESWL) performed with electrohydraulic lithotripters. Methods Children with urolithiasis, aged between 0 and 15, were retrospectively evaluated. ESWL was performed by using two different electrohydraulic lithotripters, Elmed Multimed Classic (Elmed Medical Systems, Ankara, Turkey) and E-1000 (EMD Medical Systems, Ankara, Turkey), between January 2008 and December 2012 in four different referral centers in Turkey. Results 85.5% of patients were stone-free at 3 months. Further ESWL treatment was needed in 33.7% of the cases (one session, n = 55; two sessions, n = 15; three sessions, n = 13). Steinstrasse occurred in 10 patients but 8 of them cleared completely during the follow-up period. Urinary tract infection was detected in 3 (3.9%), fever in 3 (3.9%) and a small subcapsular hematoma in one (1.3%) patient, respectively. When the stones were divided into two groups as those with diameters <10 mm and ≥10 mm, it was found that the stone-free rate was associated with stone diameter, and that the smaller diameters had higher but statistically insignificant stone-free rates (P = 0.196). Conclusion ESWL yields favorable results with low rates of complication and auxiliary procedures in selected pediatric patients.

Effects of dietary interventions on 24-hour urine parameters in patients with idiopathic recurrent calcium oxalate stones

The aim of this study is to investigate the effects of dietary factors on 24‐hour urine parameters in patients with idiopathic recurrent calcium oxalate stones. A total of 108 of idiopathic recurrent calcium oxalate stones were included in the study. A 24‐hour urinalysis was performed and metabolic abnormalities were measured for all of the patients. All of the patients were given specialized diets for their 24‐hour urine abnormalities. At the end of first month, the same parameters were examined in another 24‐hour urinalysis. Hyperoxaluria, hypernatruria, and hypercalciuria were found in 84 (77%), 43 (39.8%), and 38 (35.5%) of the patients, respectively. The differences between the oxalate, sodium, volume, uric acid, and citrate parameters before and after the dietary intervention were significant (p < 0.05). The calcium parameters were not significantly different before and after the intervention. We found that oxalate, sodium, volume, uric acid, and citrate—but not calcium—abnormalities in patients with recurrent calcium oxalate stones can be corrected by diet. The metabolic profiles of idiopathic calcium oxalate stone patients should be evaluated and the appropriate dietary interventions should be implemented to decrease stone recurrence.

The effect of migraine and tension-type headaches on female sexual functions: A prospective, cross-sectional, controlled study

OBJECTIVE We aimed to investigate the effects of migraine and tension-type headaches (TTH) on female sexual function. MATERIAL AND METHODS In this prospective study, sexually active females; 45 who were suffering from migraines, 47 who were TTH patients as diagnosed by a neurology clinic, and 50 who were healthy women that served as the control group were included. Sexual functions of the cases were evaluated through the Female Sexual Function Index (FSFI) with Turkish validation and the results were compared among the groups. RESULTS There was no significant difference between the ages and body mass index (BMI) of the migraine, TTH, and control groups. Although there was no significant difference between the FSFI scores of women with migraines and TTH, the FSFI scores of these two groups were found to be statistically significantly lower than that of the control group (16.77±4.27, 17.56±3.47, 26.81±3.19) (p<0.001). When all subgroup scales of FSFI scores were examined, both migraine and TTH groups were found to be significantly lower than the control group (p<0.001). CONCLUSION This study shows that migraines and TTH disrupt the quality of life for patients and cause female sexual dysfunction. Therefore, it is important that patients with neurologic disorders are also evaluated for sexual dysfunction.

Effect Of Intra-abdominal Pressure Rise On Hematological Parameters In Laparoscopic Urologic Surgery

OBJECTIVE To determine the potential utility of hematological parameters in the diagnosis of intra-abdominal hypertension (IAH). STUDY DESIGN Cross-sectional descriptive study. PLACE AND DURATION OF STUDY Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey, from January 2016 to July 2017. METHODOLOGY Forty-two patients who underwent transperitoneal laparoscopic urologic surgery were included. Blood samples were obtained during periods of pre-insufflation, insufflation, and desufflation to determine the effects of increased intraabdominal pressure (IAP) on hematological parameters, respectively. RESULTS Leukocyte and neutrophil median values changed with time (p<0.001). The median pre-insufflation, insufflation, and desufflation values for leukocytes were 6.3 fL (4.2-7.8 fL), 7.2 fL (4.4-9.9 fL), and 8.1 fL (4.9-13.5 fL), respectively. In the pre-insufflation period, the median value for neutrophils was 3.7 x 103 µL (2.0-6.2 x 103 µL), increasing 5.1 x 103 µL (2.1-9.7 x 103 µL) during insufflation and 6.1 × 103 µL (3.1-10.0 x 103 µL) during desufflation. The median values obtained in pre-insufflation period were significantly lower than those recorded in the other periods. There was no difference between the median values obtained during insufflation and those obtained during desufflation. The mean platelet volume (MPV) values during pre-insufflation, insufflation, and desufflation were 8.2 fL (6.3-9.6 fL), 8.8 (6.2-10.3 fL), and 8.1 (6.6-10.6 fL), respectively. There was a statistically significant increase in MPV values during high IAP (p<0.001). CONCLUSION The rise in MPV during IAP rise indicated that this parameter may be used to detect IAH.

A Case of Primary Urethral Condyloma Acuminatum after Urethral Instrumentation

1 yil once Prostat Transurethral Rezeksiyonu (TUR-P) ve 3 ay once uretra darligi nedeniyle internal uretrotomi oykusu olan 72 yasinda erkek hasta obstruktif alt uriner sistem semptomlari ile klinigimize basvurdu. Hastanin endoskopik incelemede tum uretrada yaygin papiller olusumlar gozlendi. Sistoskopide mesanede patolojik olusum saptanmayan hastanin uretral lezyonlarina Trans Uretral Rezeksiyon ve lazer ile vaporizasyon uygulandi. Mikroskobik inceleme sonucu kondiloma akuminata olarak saptandi. Literatur incelendiginde farkli urethral kondiloma akuminata vakalari bildirilmektedir. Ilk defa urethral kondiloma akuminata ile karsilasan hekim tarafindan kolaylikla papiller uretelyal kanser ile karistirilabilir. Bizim olgumuzda ek olarak; hastamizda genital lezyon bulunmamasi, seksuel aktif olmamasi, sadece uretral enstrumantasyon oykusu olmasi ve kisa surede tum uretrayi tutan yaygin lezyonlar ile basvurmasi olgumuzu ilginc kilmaktadir.

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.

Extracorporeal shock wave lithotripsy in the primary treatment of encrusted ureteral stents

Double pigtail (JJ) ureteral stents, are the most commonly used method of urinary diversion in the ureteral obstructions. Encrustations may occur as a result of prolonged exposure due to forgetting these stents in the body. Removing these materials might be an annoyance. Forty-four patients from three tertiary referral centres with forgotten JJ stents left in them between the years 2007 and 2014 were included in the study. Stents could not be removed by attempted cystoscopy. As an alternative approach, extracorporeal shock wave lithotripsy (ESWL) was the first choice since it is minimally invasive. The results of that treatment are presented along with the relevant demographic data. JJ stenting for urolithiasis was performed in 36 patients, after open surgery in five patients, and for oncological reasons in three patients. ESWL was applied to stents or to any suspicious region adjacent to the stent. In 29 of 44 patients, the stents were easily removed under cystoscopic procedures while in one patient the fragmented residual stent was spontaneously excreted. In eight patients, ureteroscopy was required; in five patients, percutaneous nephrolithotripsy was required; and in one patient, open surgery was required in order to remove stents. ESWL can be considered as a first-line treatment when a forgotten JJ stent is detected despite all precautions after any kind of urological intervention involving insertion of ureteral stents.