Mehmet Giray Sönmez

A new approach in ureteral access sheath locating in retrograde intrarenal surgery (RIRS) by endovisional technique

OBJECTIVE To compare the results of patients who underwent retrograde intrarenal surgery (RIRS) using endovisional technique for ureteral sheat locating with control group in which endovisional technique was not applied. MATERIAL AND METHODS Of the 41 patients who underwent RIRS treatment for kidney stone, between March 2014- August 2015, 19 patients treated with endovisional technique formed the study group and remaining 22 patients formed the control group. Patients were evaluated for age and gender, baseline and post procedural creatinine level, duration of operation, fluoroscopy and hospitalization time, size and localization of the stone, presence of multiple stones, previous shock wave lithotripsy (SWL) procedure, double J catheter requirement, complication rate, residual stone rate and absence of stone ratio. RESULTS There was no statistically significant difference between age, gender, location of the stone, previous SWL procedure, presence of multiple stones, baseline and postprocedural creatinine level, absence of stone ratio, double J catheter requirement and hospitalization duration between the groups. The duration of operation and fluoroscopy of the patients were significantly shorter than the control group (p = 0.036 and p < 0.001, respectively). The complication rates of the endovisional technique group was significantly lower than that of the control group (p = 0.032). CONCLUSION Endovisional technique is considered to be an appropriate and useful technique in order to locate the sheath safely in patients who has difficulty in ureteral access sheath locating and to decrease the duration of operation and fluoroscopy.

Can Eosinophil Count, Platelet Count, and Mean Platelet Volume Be a Positive Predictive Factor in Penile Arteriogenic Erectile Dysfunction Etiopathogenesis?

Blood count parameters of patients referring with erectile dysfunction (ED) were examined in this study and it was investigated whether eosinophil count (EC), platelet count (PC), and mean platelet volume values among the suspected predictive parameters which may play a role in especially penile arteriogenic ED etiopathogenesis had a contribution on pathogenesis. Patients referring with ED complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function. Penile Doppler ultrasonography was taken in patients suspected to have vasculogenic ED. According to penile Doppler ultrasonography result, patients with arterial deficiency were included in the penile arteriogenic ED group and the patients with normal results were included in the nonvasculogenic ED group. A total of 36 patients participated in the study from the penile arteriogenic ED group and 32 patients from the nonvasculogenic ED group. Compared with the nonvasculogenic ED group, the penile arteriogenic ED group’s low International Index of Erectile Function score, high EC, mean platelet volume and PC values were detected to be statistically significant (p < .001, p = .021, p = .018, p = .034, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells, and hemoglobin values were considered. Pansystolic volume velocities were detected as statistically significantly low compared with the nonvasculogenic ED group in the measurements made in 5th, 10th, 15th, and 20th minutes on the right and left sides in the penile arteriogenic ED group. High MPV value and PC is a significant predictive factor for penile arteriogenic ED and vasculogenic ED and high EC is specifically predictive of arteriogenic ED.

Evaluation of the Readability of Informed Consent Forms Used for Emergency Procedures

INTRODUCTION: The aim of the study was to evaluate the readability levels of informed consent forms used for patient consent before emergency procedures applied in emergency service in Necmettin Erbakan University Meram Medical Faculty Emergency Service Clinic through readability formula. METHOD: Fifteen informed patient consent forms used for emergency medical applications in Necmettin Erbakan University Meram Medical Faculty Emergency Medicine Department were evaluated. Information text available on the forms was transferred into Microsoft Word program. Average word number, syllable number and words with syllable number of four and above were calculated. Atesman and Bezirci-Yilmaz formulas defined for determining the readability level of Turkish texts and Gunning fog, Flesch kincaid formulas measuring the general readability level were used for calculating the readability level of consent forms. RESULTS: Readability levels of all consent forms were detected at average difficulty level according to Atesman formula, very difficult according to Flesch-Kincaid formula, difficult according to Gunning fog formula and at high school level according to Bezirci-Yilmaz. CONCLUSIONS: In this study, the readability level of emergency intervention consent forms used in the clinic was detected as hard and required high school or higher education level. The conclusion is that attention should be paid to this subject which is both medically and legally binding for the doctors and verbal and visual support should be provided for informing the patients in addition to consent forms.

Is oxidative stress measured by thiol/disulphide homeostasis status associated with prostate adenocarcinoma?

Aim of the study We aim to examine the relation between thiol/disulphide homeostasis and transrectal ultrasound guided prostate biopsy (TRUS-Bx) results and evaluate whether it was effective on the distinction of benign and malign prostate disease. Material and methods The study included 29 men histopathologically diagnosed as prostate adenocancer (Pca) (group 1), 30 men having benign prostate hyperplasia (BPH) (group 2) and age match 30 healthy individuals in the control group (group 3). Thiol/disulphide homeostasis was measured using a novel automatic and spectrophotometric method. Results Among the three groups, a statistically significant difference was detected among native thiol, total thiol levels and disulphide/total thiol, disulphide/native thiol and native thiol/total thiol ratios which are thiol/disulphide homeostasis parameters apart from disulphide (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 respectively). Additionally, no significant difference was detected in albumin and total protein levels among the groups (p = 0.223, p = 0.316 respectively). Serum native and total thiol levels were high and disulphide level was low in group 1 when compared to the group 2 (p = 0.003, p = 0.007, p = 0.265 respectively). In addition, serum native thiol, total thiol and disulphide levels were low in group 1 when compared to the group 3, but while low native and total thiol levels were significant, low disulphide levels were not found significant (p < 0.001, p < 0.001, p = 0.331, respectively). Conclusions Thiol/disulphide homeostasis was found to be disturbed in Pca patients detected with TRUS-Bx. This is suggesting serum native thiol, total thiol level and ratios provides a novel biomarker for the role for oxidative stress in disease etiopathogenesis.

Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy

Introduction Percutaneous nephrolithotomy (PNL) is the preferred procedure for safe and effective surgical treatment of kidney stones. Hemorrhage is the most serious complication of PNL, resulting from pseudoaneurysm (PA) or arteriovenous fistula (AVF), and can usually be controlled with conservative treatment. Aim To evaluate endovascular treatments and outcomes of vascular complications observed after PNL. Material and methods We retrospectively reviewed data on 19 patients who underwent renal embolization due to post-PNL renal artery bleeding between March 2005 and September 2016. Embolization materials included embolization coils and glue. The incidence of post-PNL vascular complications and their endovascular treatments, outcomes, and the follow-up data were analyzed. Results Nineteen (1.1%) of 1,609 patients (mean age: 44.9 years, range: 19–75 years) underwent angiography and subsequent transcatheter embolization to control bleeding. The mean time to onset of hemorrhage was 7.2 days after PNL (range: 3–18 days). The PNL entry site was the lower calyx in 15 patients, the middle calyx in 3, and the upper calyx in 1. PA, AVF, and PA plus AVF occurred in 14, 5, and 3 of the 19 renal angiography patients, respectively. Embolization of the affected vessels was successful in all 19 patients. The embolization materials of coil, glue, and coil plus glue were used in 16, 3, and 2 patients, respectively. Conclusions Severe hematuria is a rare complication of PNL and can be successfully treated with transcatheter embolization.

The effect of zero-ischaemia laparoscopic minimally invasive partial nephrectomy using the modified sequential preplaced suture renorrhaphy technique on long-term renal functions

Introduction Laparoscopic minimally invasive partial nephrectomy (MIPN) is the preferred technique in renal surgery, especially T1 phase kidney tumours, and it is recommended for the protection of renal functions in methods that do not involve ischaemia. Aim To evaluate long-term renal functions of zero-ischaemia laparoscopic MIPN patients who underwent a modified sequential preplaced suture renorrhaphy technique. Material and methods In a total of 17 renal units in 16 patients with kidney tumours that were determined incidentally and did not cause any complaints, the masses were extracted via laparoscopic partial nephrectomy (LPN) using the modified sequential preplaced suture renorrhaphy technique. Creatinine and estimated glomerular filtration rate (eGFR) values of the patients were measured preoperatively and on the first day and after 12 months postoperatively, and the results were compared. Results The differences between the pre- and postoperative values were statistically significant (p = 0.033, p = 0.045), but the changes in postoperative creatinine and eGFR values were clinically insignificant. While the differences between preoperative and first-day postoperative creatinine and eGFR values were found to be statistically significant (p = 0.039, p = 0.042, respectively), a statistically significant difference was not detected between preoperative and 12-month postoperative creatinine and eGFR values (p = 0.09, p = 0.065, respectively). The global percentage of functional recovery was measured as 92.5% on the first day and 95.9% at the 12th month. Conclusions The modified sequential preplaced suture renorrhaphy technique is an effective, reliable method for avoiding complications and preserving renal functions and nephrons in appropriate patients.

Polyorchidism; unilateral, one atrophic undescended double testicles

Polyorchidism is a very rare genitourinary anomaly defined with the presence of more than two testicles. Polyorchidism is associated up to 40% with undescended testicles. The present report is about an incidentally detected triorchidism case with unilateral, one atrophic undescended double testicles. A 4-year-old child, diagnosed with undescended left testicle revealed during orchiopexy polyorchidism with distinct epididymis and vas deferens. Whereas one of the testicles was in regular size; the other two were atrophic. Orchiectomy was conducted on the atrophic testicle and orchiopexy to the regular size testicle. The atrophic testicle excised was referred histopathological analysis and was diagnosed as atrophic testis. The patient discharged on the first postoperative day, was considered as normal during postoperative evaluation made on the third postoperative day. Polyorchidism is a rare genitourinary abnormality, and its management is still controversial. Yet, we believe that orchiectomy is to be conducted in atrophic testicle cases.

Is there a relation between priapism occurring after penile doppler ultrasonography and international erectile function index score and erection hardness score levels

Objective The relation between Erection Hardness Score (EHS) and The International Erectile Function Index (IIEF) Questionnaire- Erectile Function Domain Score (IIEF-EF score) used in erectile dysfunction (ED) evaluation and the prevalence of priapism after penile Doppler ultrasonography (PDU) was examined in this study. Material and methods A total of 62 patients who had PDU were included in the study. Patients were divided into two groups; there were 33 patients in IIEF-EF score ≤10, EHS <2 group (Group 1) and 29 patients in IIEF-EF score >10, EHS ≥2 group (Group 2). The two groups separated according to their scores were compared for age, body mass index (BMI), prevalence of priapism, vascular comorbidities and duration of erection. Results When compared to Group 2, median age, rate of vascular comorbidities rate and BMI were detected to be higher in Group 1 with IIEF-EF score ≤10 and EHS <2. But contrary to age and rate of vascular comorbidities (p=0.035, p=0.049 respectively), higher BMI was detected to be statistically insignificant (p=0.093). Duration of erection, IIEF-EF score and number of cases with priapism were significantly higher in Group 2 with IIEF-EF score >10 and EHS ≥2 (p<0.001, p=0.027, p=0.049 respectively). Conclusion High IIEF-EF and EHS scores, younger ages and lower rates of vascular comorbidities in patients from whom PDU was demanded increase the prevalence of priapism.

New surgical technique applied with urological instruments in bilobar multiple hepatolithiasis: Ultra-mini percutaneous hepatolithotomy

Intrahepatic bile duct stones may emerge with manifestations as chronic stomach ache, cholestasis, cholangitis, abscess, post-obstructive atrophy and liver cirrhosis presentation may occur. Thus the treatment of symptomatic hepatolithiasis patients should be provided. Different methods such as biliary decompression, endoscopic, percutaneous or open surgery are recommended for the treatment of patients with intrahepatic gallstones. The aim of the treatment is to extract the stones and regain biliary drainage. But the treatment regimen to be applied should be determined after examining the age, performance condition, general condition of the patient and location of the stone carefully. In this case, we presented a young female patient who had many unsuccessful surgical interventions due to coledochal cyst and congenital malformation in bile ducts, had large stones in right and left intrahepatic bile ducts and in whom we provided complete stone-free condition through Ultra-Mini Percutaneous Hepatolithotomy (UM-PHL) using urological instruments.

The evaluation of the readability of informed consent forms used for urology: Is there a difference between open, endoscopic and laparoscopic surgery?

OBJECTIVE The aim of this study is to evaluate the readability levels of informed consent forms used in Turkey before urological surgery and to compare the readability levels of open, endoscopic, and laparoscopic surgical informed consent forms. MATERIAL AND METHODS A total of 529 informed consent forms used for urological open, endoscopic, and laparoscopic surgical procedures were collected from different hospitals in Turkey. Evaluating informed consent forms that have exactly the same text only once, a total of 69 consent forms were evaluated. The Gunning Fog Index and Flesch-Kincaid test measuring the general readability level were used to calculate the readability level of informed consent forms in addition to the Ateşman and Bezirci-Yılmaz formulas defined to determine the readability level of Turkish texts. Informed consent forms were evaluated and divided into three groups as open, endoscopic, and laparoscopic surgery forms, depending on their content. RESULTS Among 69 informed consent forms evaluated, 35 were open, 19 were endoscopic, and 15 were laparoscopic surgery consent forms. The readability level of all informed consent forms was detected as average according to the Ateşman formula, very difficult according to the Flesch-Kincaid test, difficult according to the Gunning Fog Index, and at the high school education level according to the Bezirci-Yılmaz formula. A statistical evaluation of the three groups did not show a significant difference in the readability level. CONCLUSION In this study, it was detected that the informed consent form readability levels used for urological surgical procedures in our country were rather low. We think that the cooperation of the concerned institutions is required for the revision of the consent information texts available and the improvement of the texts according to the strategies recommended.