Metin Onaran

Treatment of Ureteral Stones: Comparison of Extracorporeal Shock Wave Lithotripsy and Endourologic Alternatives

Aim of the Study: The aim of the study is to compare the effectiveness of ESWL and ureteroscopic lithotripsy with pneumatic, ultrasonic and electrohydraulic modalities in patients with ureteral stones. Patients and Method: In this study, 1,970 patients with ureteral stones were evaluated. ESWL and ureteroscopic lithotripsies were performed in 1,580 and 484 patients, respectively. The ESWL group was treated with a Siemens Lithostar plus. Ureteroscopic lithotripsy was performed with pneumatic lithotripsy (PL), ultrasonic lithotripsy (USL) and electrohydraulic lithotripsy (EHL) in 140 (28.9%), 311 (64.3%) and 33 (6.8%) patients, respectively. 94 patients underwent both because of unsuccessful ESWL therapy. Results: In the ESWL group, the stone-free rate was 49.9% and the fragmentation rate 71.0%. These values were: 95.0 and 97.1% for PL; 88.1 and 89.4% for USL; 90.9 and 93.9% for EHL, respectively. Ureteroscopic lithotripsy has been found more effective than ESWL in the treatment of middle and lower ureteral calculi (p < 0.001) and PL has the greatest success rate within these endoscopic groups. Conclusion: ESWL therapy can be the first-line therapy in upper ureteral stones keeping the other modalities for unfragmented stones. However, ureteroscopic lithotripsy is the most effective treatment choice in lower ureteral stones no matter which kind of energy used and PL is the most effective and less complicated among the other types.

The impact of urinary incontinence on female sexual function

Although urinary incontinence is not a life-threatening disorder, it has been shown to have detrimental effects on quality of life in terms of psychological, social, and sexual problems. In this study, investigators explored the effects of different types of urinary incontinence on female sexual function with a reliable and validated questionnaire, the Female Sexual Function Index (FSFI). One hundred fifty-three women with complaints of incontinence were enrolled in the study. An age-matched group of 89 women who had no incontinence or lower urinary tract disorders were enrolled as a control group; all completed the FSFI. Incontinence was classified as urge, stress, and mixed type. Pelvic organ prolapse (POP), if present, was also recorded. FSFI scores were compared between the incontinent and control groups. A multivariate linear regression analysis model was used to explore the effects of patient characteristics on total FSFI domain score. All domain scores of FSFI except lubrication and pain were statistically significant in the incontinence group (for total domain score, P=.005). For FSFI, in terms of types of incontinence, the difference was significant when the group with mixed urinary incontinence was compared with the control group. In multivariate linear regression analysis, age, presence of POP, and mode of delivery were predictors of female sexual function. Mixed urinary incontinence, when compared with other types, had a significant impact on sexual function. When POP was also present, no negative effects were noted in incontinent women.

Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study.

This study investigated the efficacy and the adverse effects of sertraline in the treatment of premature ejaculation (PE). Thirty-seven patients with PE were randomly assigned to receive either sertraline or a placebo. Of them 22 were given 50 mg of sertraline per day and the other 15 patients were given an identical placebo one per day. After 4 weeks, the latency to ejaculation in the sertraline group was found to be significantly longer than that of the placebo group (p<0.01). None of the patients discontinued therapy due to adverse effects. These results indicate that sertraline is an effective therapy for PE.

Evaluation of Sexual Function in Women with Overactive Bladder Syndrome

Introduction: Of late, little data is available concerning factors affecting female sexual function. In the present study, we evaluated the effects of overactive bladder (OAB) syndrome symptoms on female sexual function. Materials and Methods: 40 patients with OAB symptoms and 40 age-matched women as a control group were evaluated using the Female Sexual Function Index (FSFI) for sexual function. According to the presence of urge incontinence, women with OAB were also divided into wet and dry groups. After completion of the forms, groups were compared. Results: Although scores of all domains of FSFI (desire, arousal, lubrication, orgasm, satisfaction, pain and total) in the OAB group were found to be lower than in the control group, only ‘desire’ was found to be significantly different (p = 0.035). The FSFI scores of the OAB-dry and OAB-wet group were similar to each other. Conclusion: The results indicate that there is a trend toward lower sexual function scores in women with OAB compared to controls.

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.

A HindIII polymorphism of fibronectin gene is associated with nephrolithiasis.

OBJECTIVES To evaluate the association between fibronectin gene (FN1) polymorphisms and calcium oxalate nephrolithiasis as a genetic risk factor. METHODS Genomic DNA of 143 patients with calcium oxalate nephrolithiasis and 154 healthy controls were screened for polymorphisms (HaeIII b, MspI, and HindIII) of the FN1 gene, using polymerase chain reaction-restriction fragments length polymorphism method. Allele and genotype frequencies were compared between the groups. RESULTS Although the observed differences between distribution of genotypes of AA, AB, and BB (for HaeIII b), as well as CC, CD, and DD (MspI) were not significant, FF genotype for HindIII showed significant difference when compared with both EF and EE + EF genotype (P = .00202 and P = .00203, respectively). CONCLUSIONS The results of our study revealed that HindIII polymorphism of the FN1 gene is highly associated with calcium oxalate stone disease. This association makes FN a good candidate for further studies about the etiology of stone disease, and in the future it could be a candidate marker for evaluating the genetic risks in patients with nephrolithiasis.

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.

Prolapse of a simple ureterocele presenting as a vulval mass in a woman

Abstract  A 48‐year‐old woman presented with a large vulval mass after prolapse of a ureterocele. Her past excretory urogram showed a filling defect (cobra head appearance) in the bladder related to a single‐system ureterocele on the left. The mass was manually reduced back through to the urethra under sedation and a urethral catheter was inserted. The anterior wall of the ureterocele was resected transurethrally for definitive treatment.

Extracorporeal Shock Wave Lithotripsy in L-shaped Kidneys: Report of Two Cases

The L-shaped or tandem kidney is a type of crossed ectopia with fusion in which the crossed kidney assumes a transverse position during its attachment to the inferior pole of the other kidney. Calculus formation is a well-known sequel of congenital abnormalities of the urinary tract and we like to present two patients harbouring calculi in L-shaped kidneys treated by extracorporeal shock wave lithotripsy (ESWL). The first patient had a calculus in renal pelvis of the transverse kidney. The second case had multiple calculi in renal pelvis and calices of the vertically positioned kidney. After three sessions, first patient was stone free, whereas no fragmentation in the second case. As a conclusion, ESWL might be an option for L-shaped kidneys.

Preventive treatment of calcium oxalate crystal deposition with immortal flowers

ETHNOPHARMACOLOGICAL RELEVANCE A number of medicinal plants are used for their diuretic, urolithiatic and anti-inflammatory effects on urinary system problems in Turkey and the most common traditional remedy for kidney stones is the tea of immortal flowers. The aim of this study is to evaluate the preventive effect of infusions prepared from capitulums of Helichrysum graveolens (M.Bieb.) Sweet (HG) and Helichrysum stoechas ssp. barellieri (Ten.) Nyman (HS) on formation of kidney stones. MATERIALS AND METHOD Sodium oxalate (Ox-70mg/kg intraperitoneally) was used to induce kidney stones on Wistar albino rats. At the same time, two different doses of the plant extracts (HG: 62.5 and 125mg/kg; HS: 78 and 156mg/kg) were dissolved in the drinking water and administered to animals for 5 days. Potassium citrate was used as positive control in the experiments. During the experiment, water intake, urine volume and body weights of the animals were recorded. At the end of the experiments, liver, kidney and body weights of the animals were determined; biochemical analysis were conducted on urine, blood and plasma samples. Histopathological changes in kidney tissues were examined and statistical analysis were evaluated. RESULTS HS extract showed the highest preventive effect at 156mg/kg dose (stone formation score: 1.16), whereas a number of kidney stones were maximum in sodium oxalate group (stone formation score: 2.66). Helichrysum extracts decreased urine oxalate and uric acid levels and increased citrate levels significantly. In addition, Helichrysum extracts regulated the negative changes in biochemical and hematological parameters occurred after Ox injection. CONCLUSIONS We conclude that Helichrysum extracts could reduce the formation and growth of kidney stones in Ox-induced urolithiasis and can be beneficial for patients with recurrent stones. In addition, this is the first study on the preventive effect of immortal flowers.