Mustafa Karacagil

Retroperitoneoscopic ureterolithotomy for the treatment of ureteral calculi.

Introduction: Most upper or middle ureteral stones are treated with shock wave lithotripsy or endoscopic techniques. In rare cases the ureteral stones are treated with open surgery after failure of first-line treatments. Retroperitoneoscopy is a minimally invasive alternative to open surgery. Patients and Methods: Between May 1995 and January 2001, twenty-one patients underwent retroperitoneoscopic ureterolithotomy. The stones in upper and middle ureter were large and impacted (5 patients) or not fragmented after shock wave lithotripsy (16 patients). A balloon dissector was placed and infiltrated with 800 ml air in the retroperitoneal space. Three 10-mm trocars were used. The pressure was kept at 15 mm Hg by carbon dioxide insufflation. The stones were extracted from the ureter using a laparoscopic stylet. Results: The stones in 17 patients were successfully removed in a median operating time of 105 (min–max 45–190) min. Urine extravasation in all cases and pnomoscrotum in 2 cases were observed as postoperative complications. The median hospital stay was 6 (min–max 3–22) days with minimal analgesic requirement. Conclusion: Retroperitoneoscopic ureterolithotomy is a useful and effective alternative treatment technique to open surgery when first-line treatments have failed or are unlikely to be effective.

Rigorous Bicycling Does Not Increase Serum Levels of Total and Free Prostate-specific Antigen (PSA), the Free/Total PSA Ratio, Gonadotropin Levels, or Uroflowmetric Parameters

OBJECTIVES To determine whether cycling has an effect on serum PSA, gonadotropins, and uroflowmetric parameters. METHODS A total of 34 healthy male athletes from the National Cycling Team and 24 healthy male student volunteers from University and medical staff were prospectively enrolled in the study. Blood samples for serum total prostate-specific antigen (tPSA), free PSA (fPSA, fPSA/tPSA, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone determinations were obtained before and after cyclists completed 300 km bicycle ride and with each cyclist seated without changing posture and with minimal movement for 10 minutes before blood collection. The cyclists also performed uroflowmetric and postvoid residual urine volume analysis before, and 1 hour after cycling course. Blood samples from the control group were drawn for serum hormones. They also underwent uroflowmetric and postvoid residual analysis. RESULTS The athletes and the control group were well matched by age. There was no significant difference between the 2 groups in terms of serum tPSA, fPSA, f/t PSA values, FSH, LH, and testosterone levels and uroflowmetric parameters (P >.05). The differences between pre- and postcycling values for tPSA, fPSA, f/t PSA, FSH, LH, and uroflowmetric parameters were not statistically significant. The postcycling serum testosterone level was significantly lower than precycling levels (mean, 603.6 ng/dL [range, 300-949] vs 424.8 ng/dL [range, 193-723], P = .001]. There was no correlation between body mass index values, postcycling serum FSH, LH levels, age, and testosterone levels. CONCLUSIONS There is no effect of professional bicycle riding on serum total and fPSA levels and uroflowmetric parameters.

The first case of periureteric hibernoma : Case report

Hibernoma is a rare type of soft tissue neoplasm originating from brown fat tissue. The present case is the first periureteric hibernoma concentrically surrounding the ureter with a concomitant renal pelvis stone.

Do all patients with high‐grade prostatic intraepithelial neoplasia on initial prostatic biopsy eventually progress to clinical prostate cancer?

Obesity is cited as a limiting factor in laparoscopy, and can limit instrument movements by the greater degree of port fixity, but this does not preclude this approach in obese patients. However, performing a radical or partial nephrectomy through an 8cm incision in an obese patient might compromise access and prove extremely difficult; the body mass index of the patients in the authors’ series is not mentioned. These patients often benefit the most from a laparoscopic procedure, having otherwise a greater risk of wound complications after open surgery.

Comparison of extraperitoneoscopic and transperitoneoscopic techniques for the treatment of bilateral varicocele

BACKGROUND AND PURPOSE Laparoscopic varicocelectomy has been performed in patients with bilateral varicocele. This procedure could be performed either transperitoneally or extraperitoneally. The purpose of this study was to compare the effectiveness and morbidity of the two approaches. PATIENTS AND METHODS Twenty-one patients underwent transperitoneal repair. Twelve of them had complaints of infertility, and nine of them had pain. Eighteen patient underwent extraperitoneal repair. Twelve of them had complaints of infertility, and six of them had pain. All the patients with pain had clinical varicoceles. In each group, three patients with infertility had unilateral subclinical varicoceles. RESULTS No significant difference was found in the duration of surgery, artery-vein discrimination, or morbidity between the extraperitoneal and transperitoneal techniques. In both approaches, the previously infertile patients who have been followed more than 6 months had significant improvement in sperm counts and motilities (P < 0.05). There were no significant differences in the improvement in the extraperitoneal and transperitoneal groups. CONCLUSION There was no significant difference between the transperitoneal and extraperitoneal techniques in terms of effectiveness and morbidity. The difficulty in identifying the internal spermatic vein and the additional cost of the balloon dissector for the extraperitoneal technique makes us prefer transperitoneal repair.

The effects of caffeine and theophylline on the triple adenosine triphosphatase enzyme activities of spermatozoa from males with oligoasthenospermia.

The triple ATPase activities of washed spermatozoa of oligoasthenospermic men (but not of normals) were enhanced by the addition of caffeine and theophylline, which are known to have a stimulating effect on sperm motility. The biochemical mechanism of action of caffeine and theophylline on sperm homeostasis is discussed.

Management of undeflatable foley catheter balloons in women

The inability to deflate a self-retaining balloon catheter is a rare problem but may be encountered by physicians. Many techniques have been described to solve the problem, some of which may be dangerous. The technique must not disturb the patient or create any additional morbidity. Those methods commonly used are the instillation of ether, liquid paraffin, chloroform or mineral oil through the inflation channel; the use of a fine wire to burst the balloon or to recanalize the obstructed inflation channel; bursting or deflating the balloon through suprapubic, transvaginal or urethral routes: and the overinflation technique. The techniques which might be most appropriate for women are explained in a stepwise manner. First the catheter is cut in the proximal segment of the valve. If this is not successful, a ureteric catheter stylet is advanced through the inflation channel until it touches the balloon. If this is still unsuccessful, the balloon is deflated through the drainage channel using the technique proposed by Davies and Thomas. As a second choice, an intravenous cannula with its inner needle drawn back is advanced through the urethra next to the catheter, towards the balloon which, is then punctured with the inner needle. If these steps are followed, the patient will have no additional discomfort and no trauma to the surrounding tissues, and there will be no need for cystoscopy or any other expensive intervention.