Mustafa Tan

Factors Affecting Complication Rates of Ureteroscopic Lithotripsy in Children: Results of Multi-Institutional Retrospective Analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society

PURPOSE We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. MATERIALS AND METHODS We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS A total of 367 females and 265 males were studied. Mean±SD patient age was 90.2±51.4 months (range 4 to 204). Mean±SD stone size, operative time and postoperative hospital stay were 8.9±4.7 mm, 45.8±23.8 minutes and 1.8±2.8 days, respectively. At a mean±SD followup of 13.3±17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. CONCLUSIONS Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.

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.

Stones in anomalous kidneys : Results of treatment by shock wave lithotripsy in 150 patients

Objective:  To determine the efficacy of shock wave lithotripsy (SWL) in anomalous kidneys.

Measurement of thermal neutron cross-sections and resonance integrals for and by using –Be isotopic neutron source

Abstract Thermal neutron cross-sections and resonance integrals for the 71 Ga ( n , γ ) 72 Ga and 75 As ( n , γ ) 76 As reactions were measured by the activation method. The experimental samples with and without a cylindrical Cd shield case in 1 mm wall thickness were irradiated in an isotropic neutron field of the 241 Am –Be neutron source. The induced activities in the samples were measured by high-resolution γ-ray spectrometry with a calibrated reverse-electrode germanium detector. Thermal neutron cross-sections for 2200 m/s neutrons and resonance integrals for the 71 Ga ( n , γ ) 72 Ga and 75 As ( n , γ ) 76 As reactions have been obtained relative to the reference values, σ 0 =13.3±0.1 b and I 0 =14.0±0.3 b for the 55 Mn ( n , γ ) 56 Mn reaction as a single comparator. The necessary correction factors for gamma attenuation, thermal neutron and resonance neutron self-shielding effects were taken into account in the determinations. By defining Cd cut-off energy 0.55 eV , the results obtained were: σ 0 =4.41±0.18 b and I 0 =32.3±2.3 b for 71 Ga ( n , γ ) 72 Ga , and σ 0 =4.15±0.24 b and I 0 =63.5±3.8 b for 75 As ( n , γ ) 76 As . These results are discussed and compared with previous measurements and the evaluated data in ENDF/B-VI and JENDL-3.2. Thermal neutron cross-sections for 71 Ga ( n , γ ) 72 Ga and 75 As ( n , γ ) 76 As reactions are in good agreement with the recent measurements. However, the discrepancies between present results and some of old experimental data for resonance integrals for both reactions are within about 8–58%.

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.

Bladder augmentation: Review of the literature and recent advances.

Bladder augmentation is an important tool in the management of children requiring reconstructions for urinary incontinence or preserving of the upper urinary tract in congenital malformations. We reviewed the literature and evaluated the long-term results of enterocystoplasty in the pediatric age group and summarized techniques, experimental options and future perspectives for the treatment of these patients. For this purpose, a directed Medline literature review for the assessment of enterocystoplasty was performed. Information gained from these data was reviewed and new perspectives were summarized. The ideal gastrointestinal (GI) segment for enterocystoplasty remains controversial. The use of GI segments for enterocystoplasty is associated with different short and long-term complications. The results of different centers reported in the literature concerning urological complications after enterocystoplasty are difficult to compare because of the non-comparable aspects and different items included by different authors. On the other hand, there are more and more case reports about cancer arising from bowel segments used for bladder augmentation in recent publications. Although bladder reconstruction with GI segments can be associated with multiple complications, such as metabolic disorders, calculus formation, mucus production, enteric fistulas and potential for malignancy, enterocystoplasty is unfortunately still the gold standard. However, there is an urgent need for the development of alternative tissues for bladder augmentation.

L2,3 subshell X-ray fluorescence yields and Coster-Kronig transition probabilities of Nd and Yb

X-ray spectra emitted in the radioactive decay of 17.7y 145Pm and 1.9y 171Tm were studied using a three-parameter technique for XX · t coincidence measurements. The following L2 and L3 subshell X-ray fluorescence yields, ω2, ω3, Coster-Kronig transition probabilities, f23, and radiative decay branching ratios, s2, s3, were determined for Nd (Z = 60) and Yb (Z = 70); At Z = 60, ω3 = 0.108 ± 0.010, ω2 = 0.128 ± 0.018, f23 = 0.123 ± 0.013, s3 = 0.178 ± 0.006, and s2 = 0.205 ± 0.010. At Z = 70, ω3 = 0.227 ± 0.022, ω2 = 0.217 ± 0.030, f23 = 0.141 ± 0.007, s3 = 0.175 ± 0.003, and s2 = 0.197 ± 0.004. These results are compared with available theoretical calculations.

X-Ray Fluorescence Yields and Coster-Kronig Transition Probabilities of the L1, L2 and L3 Subshells of Pb

A three-parameter technique for XX · t and Xe · t coincidence measurements was employed to acquire coincident energy spectra, singles spectra from two semiconductor detectors, and a TAC spectrum simultaneously. From analysis of the singles spectra in each detectror, the total coincidence spectra in each detector, and gated coincidence spectra in each detector, the L1, L2, and L3 subshell X-ray branching ratios (sj) and fluorescence yields (ωi), together with the Coster-Kronig transition probabilities (fij) were determined at Z = 82 from the radioactive decay of 33.4 y207 Bi. The L3 subshell values are: s3 = 0.241 ± 0.024 and ω3 = 0.302 ± 0.021; for the L2 subshell, s2 = 0.235 ± 0.024, ω2 = 0.366 ± 0.026, and f23 = 0.130 ± 0.002. Using these values of ω2 ω3, and f23 as input, the L1 subshell quantities were then determined by a direct measurement of the number of characteristic L1 subshell X-rays per initial vacancy from L X-ray spectra gated by L conversion electrons. This gives s1 = 0.346 ± 0.084, ω1 = 0.104 ± 0.019, f12 = 0.105 ± 0.026, and f13 = 0.658 ± 0.086. Uncertainties are all to 95% confidence. The experimental L-subshell values are compared with theoretical calculations reported in the literature. The f12 value confirms the predicted decrease above Z = 74 due to the absence of some of the L1-L2N Coster-Kronig transitions. The value of ω3 is smaller than the theoretical estimates, while s3 is in good agreement. The value of ω2 also is lower than theory predicts, but s2 agrees well. The measured value of f23 is somewhat larger than theory predicts, but agrees better with the more recent relativistic calculations than with older non-relativistic ones. The values of f12 and f13 are in better agreement with the relativistic calculations than with the older non-relativistic theory.

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.