Mümtaz Dadalı

Single-institution Outcomes of Open Reconstruction Techniques for Management of Pediatric and Adolescent Post-traumatic Urethral Strictures

OBJECTIVES To assess the long-term results and efficiency of open reconstruction techniques for pediatric and adolescent post-traumatic urethral strictures. METHODS A total of 75 patients who had undergone open reconstructive urethroplasty for post-traumatic bulbous or posterior urethral obliterative strictures resulting from pelvic fracture urethral injuries were retrospectively analyzed. The mean patient age was 12.3 years (range 6-17). Of the 75 patients, 38 had a bulbar stricture and 37 had posterior urethral obliteration. Perineal end-to-end anastomotic repair, urethral pull-through, and ureteral tube graft urethroplasty were performed in 54, 20, and 1 patient, respectively. All patients were followed up by medical history and a urinary flow rate evaluation at 6 and 12 months postoperatively. RESULTS The patients were followed up for 12-94 months (mean 43.2). The urethral strictures were successfully treated with end-to-end anastomotic urethroplasty in 37 (68.5%) of 54 patients, urethral pull-through urethroplasty in 14 (70%) of 20 patients, and ureteral tube graft in 1 patient. The total primary success rate was 69.3% (52 of 75 patients). Recurrent stricture developed in 23 patients. Of these 23 patients, 7 and 11 were successfully treated with secondary end-to-end anastomosis and direct vision internal urethrotomy, respectively. The overall success rate was 93.3% (70 of 75 patients). Five patients with treatment failure were still in follow-up, with direct vision urethrotomy performed, as needed. No penile curvature, penile shortening, or urethral diverticula developed. CONCLUSIONS The results of our study have shown that open urethral reconstruction techniques are effective for primary and secondary surgical interventions in pediatric and adolescent patients with post-traumatic urethral strictures in experienced centers. These techniques provide excellent long-term results with minimal morbidity.

Vesicouterine fistula, a rare cause of genitourinary fistula

Uterovesical fistulas are rare genitourinary fistulas developing secondary to iatrogenic etiologies. In this article, we report a a post-cesarean vesicouteri fistula with review of the literature.

Chemical castration with intratesticular injection of 20% hypertonic saline: a minimally invasive method.

OBJECTIVES Our aim was to ablate testicular tissue by hypertonic saline solution in a rat model, thereby to discover a minimally invasive alternative method to medical and surgical castration in patients with metastatic prostate carcinoma. METHODS A total of 40 male Wistar rats were divided into orchiectomy (n = 20) and experimental groups. In the experimental group, 20% (n = 20) hypertonic saline solution was injected into the rat testes. Blood was taken prior to, 1 day, and 30 days after the intervention for testosterone determination. All testicles were surgically removed for pathologic examination. RESULTS Skin infection, necrosis, and testicular abscess were not detected in any rat. Pathologic examination revealed necrosis in almost all areas of the testicle. The comparison of 0, day 1, and day 30 measurements of total testosterone did not reveal a statistically significant difference between the control and hypertonic saline groups at each of the three time points (Mann-Whitney U-test, P > 0.05). CONCLUSIONS Intratesticular hypertonic saline injection seems to be an alternative method in the future to its rivals such as orchiectomy and medical castration. This new approach offers a minimally invasive and less expensive method aside from preserving body image in metastatic prostatic carcinoma. However, our conclusions should be supported with more experimental studies before a clinical study is taken into account.

INTRARENAL EPIDERMAL CYST

Although renal cystic formations are seen frequently and arise with diverse symptoms, epidermal cyst is a very unusual cause of renal masses. A50‐year‐old woman was admitted to our clinic because of lumbar pain, hematuria and dysuria that lasted for 2 months. An atrophic and dysfunctional right kidney was identified. Transperitoneal laparoscopic simple nephrectomy was performed. Microscopic examination revealed typical findings of epidermoid cyst. According to the literature, intrarenal epidermal cysts are usually treated by nephrectomy because they cannot be differentiated from renal masses. To the best of our knowledge, this case report of an epider‐moid cyst located in the renal parenchyma of a female patient is the first in the English‐language literature.

Does the Endoscopic Treatment of Lower Ureter Stones Affect Uroflowmetric Values? A Prospective Clinical Trial

Objectives: The aim of this study was to document if stones at the lower ureter alter the micturition capability of the patients and to investigate whether endoscopic removal of these stones restores normal urinary flow rates or not in the 3 months of follow-up. Methods: Forty patients with lower ureteral stone (group 1) and 20 control subjects with proximal ureteral stone (group 2) were enrolled into the study. All patients underwent uroflowmetry testing before and 3 months after the treatment for endoscopic stone removal. The mean average and peak flow rates with a sufficient voided volume (≥150 ml) were evaluated before and after surgery and compared between the groups. Results: Mean values of the peak flow rates before and after surgery were 20.3 and 27.5 ml/s in group 1 and 22.5 and 23.6 ml/s in group 2, and the mean average flow rate values before and after surgery were 10.5 and 13.6 ml/s in group 1 and 11.4 and 12.1 ml/s in group 2. Statistically significant differences were determined between before and after ureteroscopy values were determined in terms of average (p < 0.05) and peak flow rates (p < 0.01) in group I; however, there no significant difference was seen in the control group. Conclusion: We document for the first time in the literature that patients with lower ureteric stones have a reduction in their urinary stream which resolves with endoscopic removal of the stones.

Effect of thioglycolic acid instillation to stop hair growth on the urethral mucosa after urethroplasty with hairy skin in a rat model.

Objective: The aim of this study was to investigate the impact of thioglycolic acid on normal urethral mucosa. Methods: Twenty-four rats were used. Three control and three study groups were formed each consisting of 4 rats. Controls groups were given 0.9% NaCl and study groups received thioglycolic acid instillation. The groups were allocated according to the time of urethral resection and the number of thioglycolic acid instillations (2, 4 or 8 instillations). The urethras of the rats were resected and examined under a light microscope in control and study groups 1, 2 and 3 on days 15, 30 and 60. Results: There was no difference in the urethral mucosa of rats in the study or control groups, and no differences were found when the study groups were compared to each of the other groups at the microscopic level. Conclusion: The application of thioglycolic acid is an easy and inexpensive way of clearing urethral hair and does not cause pathological changes in the normal urethral mucosa.

Effect of positive surgical margins on biochemical failure, biochemical recurrence-free survival, and overall survival after radical prostatectomy: median long-term results.

The aim of this study was to investigate the median long‐term effects of positive surgical margin (PSM) and other prognostic factors on biochemical recurrence‐free survival, overall survival, and biochemical failure in patients who underwent radical prostatectomy. Our study included 121 patients with pT2‐3N0 disease treated between March 2006 and August 2012. The patients were divided into two groups: those with PSM and those with negative surgical margin (NSM). We analyzed the age, clinical and pathological stages, preoperative and postoperative Gleason scores, duration of the follow‐up, adjuvant chemo‐/radiotherapy, biochemical failure, biochemical recurrence‐free survival, and overall survival in these patients. PSM was found in 25 (20%) patients, whereas 96 patients had NSM. The median follow‐up time was 46.6 months (range 12–72 months) for the PSM group and 48.3 months (range 7–149 months) for the NSM group. The biochemical failure rate was 24% in the PSM group and 8.3% in the NSM group (p = 0.029). The biochemical recurrence‐free survival was found as 76% in the PSM group and 91.7% in the NSM group. The difference between the groups was not statistically significant (p = 0.06). The overall survival was 100% in both groups. The surgical margins of the radical prostatectomy material is an important pathological indicator for biochemical failure at mid long‐term follow‐up. We did not find any effect of PSM on overall survival or biochemical recurrence‐free survival.

Pure yolk sac tumor of testis in an adult patient: case report

Adult pure yolk sac tumors are rarely seen. Until now limited number of the cases has been reported in the literature, and it was stated that they had bad prognosis. While pure yolk sac tumors are the most commonly seen testis tumor in childhood, they are observed as the component of mixed germ cell testis tumors in adults, and exhibit more different behaviour than the childhood tumors. In this report, a 22-year-old patient having the complaint of left testicular swelling for about 1.5 years and whose pathology was reported as pure yolk sac tumor after the inguinal orchiectomy has been presented.