Mustafa Hoscan

Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: experience and results.

To evaluate the clinical, urodynamic, functional, radiological and metabolic results of the ileal (modified Hautmann) orthotopic neobladder over 10 years of experience.

Risk Factors for the Formation of a Steinstrasse after Shock Wave Lithotripsy

Introduction: We studied the various stone, renal, and therapy factors that could affect steinstrasse formation after shock wave lithotripsy (SWL) to define their predictive value. Patients and Methods: Between May 1999 and September 2002, 563 patients were treated with a Stonelight V3 lithotriptor. A steinstrasse was recorded in 46 patients. All patient data, stone and renal characteristics, and data of SWL were reviewed. Statistical analyses of patients, stones, and therapy characteristics in correlation with the incidence of steinstrasse formation were performed to assign factors that had a significant impact on the formation of this complication. Results: The overall incidence of a steinstrasse was 8.17%. The steinstrasse was in the pelvic ureter in 84.3% of the cases, in the iliac ureter in 7.84% of them, and in pelvic and iliac ureter in 7.84% of the patients. The incidence of a steinstrasse significantly correlated with stone size and site. The incidence rates of a steinstrasse in renal stones <1 cm, 1–2 cm, and >2 cm were 4.46, 15.87, and 24.3% respectively. The incidence rates of this complication in ureteral stones <1 cm and 1–2 cm were 3.37 and 9.52%, respectively. The incidence rates of a steinstrasse in stones located in upper calices, middle calices, lower calices, and renal pelvis were 6.12, 10.52, 6.36, and 19.32%, respectively. Conclusions: Stone size and site are the significant factors predicting the formation of a steinstrasse. If a patient has a high probability of steinstrasse formation, close follow-up with early intervention or prophylactic pre-SWL ureteral stenting is indicated.

Intravesical migration of intrauterine device resulting in pregnancy

Abstract  Spontaneous migration of an intrauterine device into the bladder is very rare. A 29‐year‐old woman in whom an intrauterine device had been placed 6 years previously, presented complaining of chronic pelvic pain and recurrent irritative urinary tract symptoms. One year after insertion she had became pregnant and given birth without complications. Intravesical migration of the intrauterine device was confirmed by sonography and cystoscopy. The intrauterine device was removed by suprapubic cystostomy.

Extracorporeal Magnetic Innervation for the Treatment of Stress Urinary Incontinence: Results of Two-Year Follow-Up

Introduction: Extracorporeal magnetic innervation (ExMI) is a relatively new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We aimed to evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress urinary incontinence. Materials and Methods: A total of 30 patients with demonstrable stress urinary incontinence were enrolled in this study. All were neurologically normal with normal urinalysis and none was pregnant. Evaluation before treatment included 3-day bladder diaries, a dynamic pad weight test, urodynamics, and a validated quality of life survey. Treatment sessions lasted 20 min, twice a week, for 6 weeks. After ExMI, all measures were repeated at follow-up including 3-day bladder diary, dynamic pad weight test, urodynamics and quality of life survey. The follow-up was done at 3, 12 and 24 months after ExMI therapy but urodynamics were performed only at first follow-up. Results: After ExMI therapy, 8 out of the 27 patients were cured (29.7%) and 13 patients were improved (48.1%) at 3 months. The cumulative success rate was 77.8%. Six patients did not show any improvement after treatment. Pad weight was reduced from 14.4 ± 10.7 to 6.5 ± 5.1 g. The mean score of quality of life survey at baseline was 61.6 and this increased to 75.4 at 12 weeks. The effect of ExMI approximately continued until the 1st year after therapy but gradually decreased and came close to baseline at the 2nd year after therapy. Conclusion: As a result, ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI also offers a noninvasive, effective and painless treatment for women with stress urinary incontinence. Further studies are needed to address how long the therapy will continue and benefits will last and whether retreatment or continuation therapy sessions will be necessary.

The selection of the regional anaesthesia in the transurethral resection of the prostate (TURP) operation

Background and objectives: The aim of ourstudy was to compare the three differentregional anaesthesia methods in patients whounderwent transurethral resection of theprostate (TURP) and to determine the idealanaesthesia method for TURP operation.Methods: Totally 77 ASA II–III patientswere preloaded with 500 ml 0.9% NaCl solutionbefore regional anaesthesia. In group E (n:27)epidural anaesthesia were achieved by applying75 mg bupivacaine heavy + 50 µg fentanyl inthe L3–L4 intervertebral space. In group SP(n:28) 15 mg bupivacaine heavy + 50 µgfentanyl were used for spinal anaesthesia(L3–L4 intervertebral space) while in group SA(n:30) 10 mg bupivacaine heavy + 50 µgfentanyl were used with saddle blockade.Systolic arterial pressure (SAP), heart rate(HR), peripheral oxygen saturation (SpO2),serum sodium measurement was recorded beforeand after hydration and during operation. Themotor block and sensory level have beenmeasured.Results: Intraoperative SAP values were morestable than the other groups in group SA. Thedecrease in HR values were significant 15minutes after prehydration in three groups(p < 0.05). SpO2 values of the groups werestable during the operation. The time to reachthe maximum block was very short in patients inGroup SA (p < 0.0001). There was astatistically significant difference betweenthe groups in terms of motor block values(p < 0.0001). No fully paralysed sample wasseen in Group SA even though there was asufficient surgical anaesthesia.Conclusions: Saddle block has someadvantages compared to spinal and epiduralanaesthesia methods such as achieving adequateanaesthesia, stable haemodynami, the lowerdegree of motor blockage and no full blockagein patients. Saddle block is an the mostoptimal anaesthesia method for TURP operation.

Management of forgotten ureteral stents.

Dear Editor, We read with great interest the study reported by Rabani (1). The author reported their experiences in endoscopic management of forgotten ureteral stents with large burden stone encrustation. As the author stated, ureteral stents are widely used in urology practices. However, complications including migration, fragmentation, and encrustation can be related to stents and sometimes the stents may possibly be forgotten. We would like to add some additional comments and suggestions on the issue of forgotten ureteral stents. Although ureteral stents have various advantages, forgotten stents are a challenging situation even for the experienced endourologists. Forgotten stents can result in serious morbidity, mortality, and an increased financial burden for health services (2). Forgotten ureteral stents usually arise from poor compliance of the patient or failure of the physician to adequately counsel the patient. One important medicolegal issue also needs to be emphasized. The attending urologist is ultimately responsible for the removal of stent and also responsible for the complications if the patient with stent is lost to follow-up. Gravas et al. (3) underscored some important points in the management of forgotten ureteral stents. They reported that a thorough, preoperative, imaging evaluation is necessary to decide the treatment strategy, which should aim to keep the number of necessary interventions as low as possible. They also stated that the most controversial and difficult part in the management of forgotten ureteral stents is the encrusted upper curl, and the critical question is which method out of percutaneous nephrolithotomy, ureteroscopy and extracorporeal shockwave lithotripsy is the most appropriate. As Rabani (1) mentioned, while endourological manage¬ment of these stents achieves success in majority of cases with minimal complications, the best treatment would be prevention of this complication. For achieving this important goal, some investigators have offered different strategies. Lynch et al. have suggested an electronic stent extraction reminder facility recall base to prevent forgot¬ten stents (4). Sancaktutar et al. Described and presented the initial results of a computer-based system that tracks ureteral stents and automatically sends a reminder through a short message service to both the patient’s and the urologist’s mobile phones (2). Recently, Chew et al. even described a novel biodegradable ureteral stent in a porcine model (5). Although endourologic management of forgotten ureteral stents possible in most of the cases with success, further efforts and studies must be made for prevention strategies and possibilities for new kind or type of ureteral stents.

The Effect of Prostate Weight on the Radical Prostatectomy Outcomes

DOI: 10.4328/JCAM.552 Received: 20.12.2010 Accepted: 02.01.2011 Printed: 01.01.2012 J Clin Anal Med 2012;3(1):56-8 Corresponding Author: Taylan Oksay, Süleyman Demirel Üniversitesi Tıp Fak.Üroloji AD, 32400 Isparta, Türkiye. T.: +90246 2119259 F.: +90 246 2371762 E-Mail: drtaylanoksay@yahoo.com Özet Amaç: Prostat kanserli hastalarda büyük prostat hacminin radikal prostatektomi sonuçları (kanser kontrolü, üriner kontinans, erektil fonksiyon) üzerine olan etkileri değerlendirildi. Gereç ve Yöntem: Radikal retropubik prostatektomi operasyonu yapılan 92 hastanın dosyaları retrospektif olarak değerlendirildi. Hastaların demografik verileri, tümör karakteristikleri, onkolojik, üriner ve erektil fonksiyon sonuçları toplandı. Sonuçlar prostat ağırlıklarına (Grup 1: ≤60 g, Grup 2: >60 g) göre karşılaştırıldı. Bulgular: Hastaların %35,9’unun prostat ağırlığı >60 g idi. Büyük prostat hacmine sahip hastaların preoperatif Prostat Spesifik Antijen (PSA) seviyeleri (9.9 – 14.1 ng/ml, p<0.05) daha yüksek idi ve bu grupta biyopsi Gleason skoru ≤6 olan hasta sayısı (%76.3 %87.9, p<0.05) daha fazla idi. Grup 2’de patolojik olarak T2a-b evresinde olan hasta sayısı (%20.4 %45.4, p<0.05) daha fazla idi. Gruplar arasında cerrahi sınır pozitifliği, biyokimyasal rekürrens, kontinans durumu ve erektil fonksiyon açısından fark yoktu. Sonuç: Büyük prostat hacmine sahip prostat kanserli hastalarda radikal prostatektomi operasyonu yüksek PSA seviyelerine rağmen iyi ve yeterli onkolojik sonuçlar sağlamaktadır ve küçük prostat ile karşılaştırıldığında üriner ve erektil fonksiyonlar açısından bir fark oluşturmamaktadır.

A Surprising Attempt for Urinary Incontinence

DOI: 10.4328/JCAM.414 Received: 20.09.2010 Accepted: 02.2010 Printed: 01.01.2012 J Clin Anal Med 2012;3(1):104-5 Corresponding Author: M.Burak Hoşcan, Baskent University Alanya Research and Practice Center, Alanya, Antalya, Turkey. F.: +902425112350 E-Mail: drburakhoscan@yahoo.com Özet İdrar kaçırma şikayeti olan kadınların çoğunluğu, çok sayıda tedavi seçeneği olmasına rağmen, tedavi için başvurmamaktadır. İdrar kaçırmanın tedavisi için kendi kendine ceviz kullanan bir kadın hasta olgusunu sunmaktayız.

Where Do Patients Go for Treatment of Urethritis

Background: Urethritis is characterized by urethral inflammation, and it can result from both infectious and noninfectious conditions. Physicians and other health care providers play a critical role in preventing and treating urethritis. Objectives: The aim of this study was to describe and identify predictors of health care seeking behavior among men with urethritis. Patients and Methods: In total, 98 male patients aged between 16 to 52 years-of-age (mean 30.9 ± 8.0 years), who attended our clinic with symptoms of urethritis, were included in the study. We conducted face-to-face interviews with the patients using a 9-item survey questionnaire. Patients were divided into three groups according to their level of education as follows: group I (n = 44), elementary school; group II (n = 38), high school; and group III (n = 16), university. Results: Among the 98 patients evaluated, the source of treatment was physicians in 44 patients (44.9%), drugstores in 38 cases (38.77%), and friends in 16 patients (16.32%). There was a statistically significant difference found between the groups according to the source of treatment (P < 0.001). The most common factors associated with seeking care from other sources, rather than physicians, were economic reasons in 19 patients (35.18%), confidentiality concerns in 24 (44.4%), and ease of access in 11 patients (20.37%). Conclusions: A substantial proportion of patients with urethritis sought help from other sources, rather than physicians. The results of our study show that the patients with higher levels of education were more likely to seek help from health care services. It is important to promote the public’s knowledge through informative studies and educational materials in order to encourage patients to seek rapid and effective treatment from proper sources.

What is the ratio of urethral recurrence risk after radical cystoprostatectomy for bladder cancer

Objective: There is always a risk of urethral recurrence after radical cystoprostatectomy in patients with bladder transitional cell cancer. Taking these risk factors of urethral recurrence into account, orthotopic neobladders or urinary diversions without using the urethra are performed. But urethral tumour recurrence occurs much less than the expected. We assessed the etiological factors that affect the urethral recurrence in orthotopic and nonorthotopic urinary diversion cases. Methods: Sixty-four patients with bladder cancer who underwent radical cystoprostatectomy and urinary diversion between 1994 and 2002 were included this study. Conventional risk factors effecting the selection of operation type and urethral recurrence were evaluated in these patients. Cystoscopy and biopsy were done and pathologic specimen was obtained preoperatively, and cystoscopy and urethral washout cytology were done postoperatively. Routine bladder biopsies were done in uncertain cases at follow-up. Risk factors increasing the urethral recurrence are as follows: papillary and multiple tumours, tumour invading bladder neck and trigone, extensive CIS, prostatic stromal and urethral invasion, positive surgical margin and history of upper urinary tract tumour. In 31 patients having one or more of these criteria, continent nonorthotopic urinary diversion was performed, but 33 patients without these risk factors underwent orthotopic urinary diversion. Simultaneous urethrectomy was not done in any of these patients. Results: Among the patients who underwent radical cystoprostatectomy, none was with positive surgical margin in the distal end of the prostatic urethra. In preoperative cystoscopy, tumoural mass was seen near to collum in eight patients and in the prostatic urethra in three patients. Histopathological examination of cystoprostatectomy specimen displayed transient epithelial cell carcinoma of prostatic urethra in three patients, transient epithelial cell metaplasia inside the prostate in five patients and invasion to the urothelium of bladder neck in three patients. There were not any transient epithelial cell cancer metastases in prostatic stroma in any of these patients. One patient underwent urethrectomy, since atypical cells were observed in postradical prostatectomy urethral washout cytology but there was no tumour found in pathological examination of the specimen. Therefore, urethral tumour recurrence did not occur after 25 months follow up. Conclusion: These findings suggest that some of the conventional risk factors of urethral recurrence were exaggerated. We may also conclude that there is no need for prophylactic urethrectomy unless there is urethral cancer or cancer in the surgical margin. But if utilization of urethra is planned, evaluation of prostatic stroma by TUR biopsies and urethral anastomose margin by frozen section during the operation is necessary.