Nihat Karakoyunlu

Will the Modification of the Gleason Grading System Affect the Urology Practice

The aim of the present study was to determine how the modified Gleason grading (mGG) system affects the score discrepancy between needle biopsy (NB) and radical prostatectomy (RP) and to investigate the effect of the modified scores on nomogram predictions. When the conventional Gleason grading (cGG) and mGG systems were compared, a new Gleason score was obtained in the NBs for 40 out of 97 patients (41.2%; P < .001) and in the RP specimens for 15 out of 97 patients (15.5%; P = .005). The agreement between the NBs and RP specimens rose from 31.9% to 44.3% with the mGG system (P = .017). However, when the predictions calculated with the location of modified Gleason scores in the Memorial Sloan Kettering Cancer Center nomogram were compared with those of the conventional Gleason scores, higher pathological stage and lower life expectancy predictions were obtained. Therefore, when a clinician is making a choice from therapeutic options, this change should be taken into account.

A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy.

BACKGROUND AND PURPOSE Nephrostomy tract dilation is one of the important steps in percutaneous renal surgery. We present our experiences with using Amplatz and metal telescopic dilators (Alken) to create a percutaneous tract and compare the advantages and risk factors of both procedures. PATIENTS AND METHODS We retrospectively reviewed the medical records of 173 patients who had undergone 188 percutaneous nephrolithotomy procedures between April 2007 and December 2010. The nephrostomy tracts had been created by using Amplatz (67 cases) or Alken dilators (121 cases). Total operative time, scope time, tract formation time, decrease in hemoglobin concentrations, blood transfusion rates, tract dilation failures, and the cost of both systems were compared between the groups. RESULTS There were no statistically significant differences in total operative time (103.3 ± 46.5 vs 99.1 ± 44.4 min, P=0.583), scope time (5.23 ± 3.06 vs 5.28 ± 2.52 min, P=0.732), decrease in hemoglobin concentration (-1.5 ± 1.2 vs-1.3 ± 1.1 mg/dL, P=0.230), blood transfusion rates (13.4% vs 11.6%, P=0.709), and tract dilation failure rates (6.0% vs 1.7%, P=0.107) for Amplatz and Alken dilation groups, respectively. A shorter tract formation time (6.56 ± 3.04 vs 5.42 ± 3.07 min, P<0.001) was observed in the Alken dilation group. The approximate costs per each case were

The efficiency of a sedative or analgesic supplement to periprostatic nerve blockage for pain control during transrectal ultrasound-guided prostate biopsy - a prospective, randomized, controlled, double blind study

220 and

A Comparison of Antegrade Percutaneous and Laparoscopic Approaches in the Treatment of Proximal Ureteral Stones

7.25 for Amplatz and Alken dilation groups, respectively. CONCLUSIONS The Alken dilation technique produces similar results to the Amplatz dilators in terms of efficiency, safety, and total operative time. Notwithstanding, it is more cost-effective in comparison.

Pudendal block in transurethral prostatectomy: A randomised trial.

Introduction The aim was to examine the effect of a sedative or analgesic supplement to periprostatic nerve blockage (PNB) on pain reduction during probe insertion and needle penetration in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. We also investigated the effects of this procedure on the positive response rate in re-biopsy. Material and methods One hundred TRUS-guided prostate biopsy patients due to prostate-specific antigen (PSA) levels higher than 2.5 ng/ml and/or abnormal rectal examination findings were evaluated. Group 1 (PNB) was given periprostatic lidocaine injection before the procedure. Group 2 (analgesic) was given tramadol and PNB. Group 3 (sedative) was given midazolam and PNB. Group 4 (control) was not given any anaesthesia or analgesics. Pain scores were assessed during probe insertion and needle penetration by a visual analogue scale. Results During probe insertion, the mean pain score of the sedative group was lower than that of the control, analgesic and PNB groups (p < 0.001, p = 0.009, and p < 0.001, respectively). During needle penetration, the mean pain score of the control group was higher than that of the other groups (p < 0.001). The rate of positive response to re-biopsy was found to be 56% in the control group and between 92% and 100% in the other three groups (p < 0.001). Conclusion According to our results, it can be concluded that midazolam, given supplementary to PNB, contributes as an effective and safe alternative for pain control during both probe insertion and penetration of the biopsy needle into the prostate capsule; however, tramadol supplement does not provide any additional contributions.

Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction.

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.

Cystic nephroma: A case report in adult patients

The innervation of the prostate gland is primarily due to the pelvic plexus, but neuroanatomical studies have demonstrated that the afferent fibres of the bladder can travel with the pudendal nerve. Ultrasonography-guided pudendal block with a transgluteal approach is recommended in the prone position. However, because the TURP procedure is performed in the lithotomy position, transperineal pudendal block may be a more practical approach.

MP73-16 AN EVALUATION OF THE PROTECTIVE EFFECT OF ESOMEPRAZOLE IN AN EXPERIMENTAL MODEL OF RENAL ISCHEMIA REPERFUSION

Acute ST elevation myocardial infarction has high mortality and morbidity rates. The majority of patients with this condition face erectile dysfunction in addition to other health problems. In this study, we aimed to investigate the effects of two different reperfusion strategies, primary angioplasty and thrombolytic therapy, on the prevalence of erectile dysfunction after acute myocardial infarction. Of the 71 patients matching the selection criteria, 45 were treated with primary coronary angioplasty with stenting, and 26 were treated with thrombolytic agents. Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patients sexual function before the acute myocardial infarction and 6 months after the event. The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction. The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group (P=0.008). In conclusion, this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence, and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.

Necessity of Preoperative Computed Tomography In Percutaneous Renal Surgery

Cystic nephroma is an unusual, cystic neoplasm of the kidney and is usually benign. There are two peaks in the incidence of the tumor, with a bimodal distribution presenting in children younger than two years old and in adults. These benign lesions are usually seen in childhood, whose clinical presentation is nonspecific with symptoms such as flank pain, hematuria and urinary tract infection. We aim to report treatment, and follow-up of a 48-year-old female patient with cystic nephroma for whom we performed open partial nephrectomy. As a surgical treatment radical or partial nephrectomy is applied according to the size and position of the masses. Long-term follow-up is recommended to rule out local recurrence or metastasis.

Malfunctioned and Fractured Penile Prosthesis Caused by Cross Placement: Case Report

RESULTS: The mean magnitude and phase angle of the impedances were proved to have a statistically significant variation (p <0.05) in accordance with the distance from the tumor at the frequency from 10.08 kHz to 1MHz and at 39.89 kHz, respectively. At these frequencies, the mean magnitude and phase angle of section V was significantly different (p <0.05) to that of at least one other section of the specimen. However, the mean impedance differences between each respective sections other than section V did not show any statistical significance. CONCLUSIONS: The present thesis has proved the capability of EoN in detecting the tumor when EoN was inserted from the normal renal parenchyma. The depth of tumor margin beneath the renal surface is assumed to be measurable by estimating the inserted length of EoN which has reached an area showing significant change of impedance values at specific frequencies.