Ş. Sarikaya

Fournier's gangrene : risk assessment and enzymatic debridement with lyophilized collagenase application

Objectives: Fournier’s gangrene (FG) is an abrupt, rapidly progressive, gangrenous infection of the external genitalia, perineum or abdominal wall and is a real urologic emergency. In this study, the risk factors of FG and the effects of enzymatic debridements on wound healing were investigated. Patients and Methods: We reviewed the records of 34 patients with FG to investigate the possible correlation between clinical outcome and infection focus, patient age, number of types of bacteria cultured, delay until presentation, predisposing diseases or accompanying conditions such as diabetes, neurologic deficit, chronic alcoholism and renal failure. Broad-spectrum triple antimicrobial therapy, aggressive and frequent surgical debridement, and if necessary urinary and colonic diversions were performed to control the infection. The effects of enzymatic debridements with topical lyophilized collagenase applications on the wound healing after the control of active infection were evaluated. Results: The average age of the patients was 55 years. The sources of infections were urogenital in 12 (35.3%), anorectal in 10 (29.4%), dermal in 10 (29.4%) and undetermined in 2 (5.8%) of the patients. The average presentation time was 4.4 days and the number of isolated bacteria was 3.05 per case. The number of isolated bacteria and surgical debridements, the duration of hospital stay and the rate of mortality in patients with anorectal foci were higher than those of the patients with urogenital or dermal foci (p < 0.05). Diabetes, uremia and advanced age did not significantly affect the number of surgical debridements, the duration of hospital stay and control of active infection. Mortality was increased in chronic alcoholism, a finding of undetermined significance. Enzymatic debridements decreased the duration of hospital stay (p < 0.05). Five patients (14.7%) died despite prompt medical and surgical preventive measures. Conclusion: Chronic alcoholism, anorectal infection foci, neurological deficit and delayed presentation were found as risk factors in FG. Diabetes and advanced age did not affect the progression of disease in our cases. Enzymatic debridements decrease the number of surgical debridements and the duration of hospital stay.

Prevalence of epididymal, seminal vesicle, prostate, and testicular cysts in autosomal dominant polycystic kidney disease

OBJECTIVES To assess the prevalence of cysts in the epididymis, seminal vesicles, prostate, and testes of patients with autosomal dominant polycystic kidney disease (ADPKD) and determine their clinical significance. Extrarenal cystic involvement is a well-known manifestation of ADPKD. Although a few reports exist about cysts in the epididymis, seminal vesicles, prostate, and testes, the true prevalence of cysts in these organs is not well known. METHODS A prospective study, consisting of 104 male patients and 62 male controls, was designed at three medical centers to evaluate the prevalence of epididymal, seminal vesicle, prostatic, and testicular cysts in patients with ADPKD by abdominal, transrectal, and scrotal ultrasound examinations. RESULTS Among the 104 patients, epididymal cysts were present in 19 (18%), seminal vesicle cysts were present in 41 (39%), and prostatic cysts were present in 7 patients (7%); the proportion in the control group was 24% (P >0.05), 2% (P <0.01), and 5% (P >0.05), respectively. Testicular cysts were detected in only 3 control patients. Of the 104 patients, 96 were married, and primary infertility was present in 5 patients (5%). CONCLUSIONS We suggest that seminal vesicle cysts are frequent in ADPKD; epididymal cysts are not uncommon in ADPKD, but the frequency is not higher than in the control group; ADPKD should be looked for in patients with seminal vesicle cysts; and additional studies are necessary to evaluate the association between epididymal and seminal vesicle cysts and infertility in patients with ADPKD.

Modified Clavien classification in percutaneous nephrolithotomy: assessment of complications in children.

PURPOSE Although percutaneous nephrolithotomy has been accepted as an effective minimally invasive procedure in children, there is still no consensus on how to define and stratify complications by severity. MATERIALS AND METHODS We retrospectively reviewed data of children who underwent percutaneous nephrolithotomy at our center between January 2002 and March 2010. A total of 100 procedures were performed in 94 patients with a mean age of 9.5 years. Complications were recorded according to modified Clavien classification. RESULTS Average stone burden ranged from 100 to 2,850 mm(2) (mean ± SD 507.5 ± 475). Stones were located in the renal pelvis in 32 kidneys, calices in 20, renal pelvis and calices in 31, and upper ureter in 3. Stone-free rate after a single session of percutaneous nephrolithotomy was 85%. After auxiliary procedures in 7 cases stone-free rate increased to 89%. Grade I complications were seen in 7 patients postoperatively, grade II in 19 (hematuria requiring blood transfusion in 13 and nonseptic infection requiring antibiotics in 6) and grade III in 4 (hydrohemothorax in 2 and urine leakage requiring Double-J® stent in 2). No grade IV or V complications were observed. Regression analysis showed that stone burden (OR 1.006, 95% CI 1.001-1.011; p = 0.03) and operative time (OR 1.044, 95% CI 1.011-1.077; p = 0.009) were independent risk factors for complications. CONCLUSIONS Percutaneous nephrolithotomy in children is safe, feasible and effective. Stone burden and operative time are independent risk factors for complications. The modified Clavien system provides a straightforward and validated method to classify postoperative complications.

Effect of Vitamin E and Pentoxifylline on Glycerol-Induced Acute Renal Failure

The pathogenesis of acute renal failure may involve, among other causes, ischemia, vascular congestion, arachidonic acid pathways, and reactive oxygen metabolites. The aim of this study is to evaluate the effects of pentoxifylline and vitamin E on the prevention of experimental acute renal failure induced by glycerol. Eighty-five Sprague-Dawley rats weighing 170–230 g were included in the study. The rats were randomly divided into four groups: group 1 was given 1 ml saline; group 2, glycerol; group 3, glycerol plus vitamin E, and group 4, glycerol plus pentoxifylline. Extent of histological renal tubular necrosis and regeneration in each animal were graded. Blood urea nitrogen, serum creatinine, and creatine kinase concentrations were measured. Mean blood urea nitrogen and serum creatinine concentrations and tubular injury scores were significantly lower in group 1 than in groups 2–4 (p < 0.001), but there were no significant differences among groups 2–4. We conclude that postinsult administration of vitamin E and pentoxifylline does not have a beneficial effect on prevention and severity of acute renal failure and that controlled, multicenter studies involving a large number of patients are needed to clarify this subject.

Laparoscopic excision of renal hydatid cyst in a preadolescent.

The traditional method of treating hydatid disease by open surgery has, in recent years, been challenged and minimally invasive approaches, including percutaneous and laparoscopic management, have been gaining wide acceptance. We present a 13-year-old boy with the diagnosis of isolated right renal hydatid disease, and a total pericystectomy was performed laparoscopically. Total operative time was 4.5 h and estimated blood loss was 150 ml. The only complication was an early urinary leak which was successfully treated with internal stenting. We believe further experience will reduce the operative time and complications.

Effects of intracavernous calcium channel blockers in dogs

Intracavernous injection of smooth muscle relaxing agents can induce penile erection. In this experimental study, we compared the effects of intracavernously injected calcium channel blockers (CCBs) and papaverine in dogs, and investigated their clinical applicabilities.We administered 30 mg papaverine, 10 mg nifedipine, 10 mg nitrendipine and 2.5 mg verapamil to 10 adult male dogs intracavernously, each at different times. Intracavernous pressure values, systemic arterial pressure values and heart rate values were recorded for 45 minutes after the intracavernous injections. We used the paired Studentt-test for statistical analysis.Papaverine induced full erection in all of the 10 dogs. Nifedipine induced full erection in 4, nitrendipine in 5, and verapamil in 6 of the 10 dogs. Nifedipine and nitrendipine caused significant decreases in blood pressure and increases in heart rate.In conclusion, the effects of intracavernous CCBs are not superior to those of papaverine. We cannot recommend nifedipine and nitrendipine for intracavernous injection, but verapamil may be included in intracavernous pharmacotherapeutic combinations.

Case Series: Pseudotumor Formation in Bladder as a Late Complication of Pelvic and Inguinal Surgeries

Inguinal and pelvic surgeries are rarely complicated by urologic complications. Eleven cases having such history admitted to our department with urologic symptoms were shown to have microscopic hematuria and bladder lesions as well. All of them were explored some due to retained gauze compress some due to suspected malignant formations on computerized tomography. Furthermore all were shown to be benign in nature. The cases were discussed under scope of current literature.

Renal stone composition does not affect the outcome of percutaneous nephrolithotomy in children

PurposeWe sought to investigate the association between renal stone composition and percutaneous nephrolithotomy outcomes in pediatric patients and define the characterization of the stone composition.MethodsThe data of 1157 children who underwent percutaneous nephrolithotomy between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. The study population comprised 359 children (160 girls, 199 boys) with stone analyses. Patients were divided into five groups according to the stone composition [group 1: calcium oxalate; group 2: calcium phosphate; group 3: infection stones (magnesium ammonium phosphate, ammonium urate); group 4: cystine; group 5: uric acid, xanthine stones].ResultsPatient characteristics, perioperative, postoperative, and stone characteristics were compared considering the stone composition. There were no significant differences between the groups concerning age, sex, side involved, preoperative hematocrit levels, and solitary renal unit. Patients with cystine stones were more likely to have a history of stone treatment. Groups 2 and 5 had mostly solitary stones. However, group 3 had staghorn stone more often, and group 4 frequently had multiple stones. Overall stone-free rate (79.4%) was similar among the groups. Although stone composition was related to blood transfusion and prolonged operative and fluoroscopy screening times on univariate analysis, it was not a significant predictor of them on multivariate analysis.ConclusionsStone composition was not a predictor of outcomes of pediatric percutaneous nephrolithotomy. However, cystine and infection stones, which are larger and filled multiple calyxes due to the nature of stone forming, were more challenging cases that need multiple tracts.

Erişkin Enürezis Nokturnada İmipramin Ve Dezmopresin (Ddavp) İle Uzun Süreli Tedavi Sonuçlarının Karşılaştırılması

The Comparison of Imipramine and Desmopressin (DDAVP) Long-Term Therapy Results in Adult Enuresis Nocturna The long-term therapy results of Imipramine and Desmopressin were compared in 35 adult patients with monosymptomatic enuresis nocturna. Randomly selected 17 patients were treated with 1 mg/kg oral Imipramine and 18 with 20 pg intranasal Desmopressin nightly for three months. Dose titration was done for Desmopressin monthly. Complete improvoment rates in the Desmopressin group were 55%, 61% and 72% after the first, the second and the third months respectively, whereas in the Imipramine group these were found 23%, 40% and 47 %, respectively. The difference between the improvement rates of two groups were not statistically significant (p>0.05). Three months after the end of therapy, complete improvement rates were 30% and 28% for Desmopressin and Imipramine respectively. Relaps rates were 61% in the Desmopressin group and 30% in the Imipramine group (p 0.05). Tedavi kesildikten 3 ay sonra tam iyilesme oranlan dezmopressin icin %30 ve imipramin icin %28 bulundu. Rolaps oranlan ise dezmopressin icin %61 ve imipramin icin %30 idi (p<0.05). Ilaclara bagli ciddi yan etki saptanmadi. Rolaps orani dezmopressin grubunda yuksek olmasina ragmen eriskin enurezis nokturnanin uzun sureli tedavisinde iki ilac arasinda fark bulunamadi.

Üreteroneosistostomi: 26 Olgunun Gözden Geçirilmesi

SUMMARY URETERONEOCYSTOSTOMY: REVIEW OF 26 CASES The results of 39 ureteroneocystostomy operations were performed in 26 cases between April 1979 and April 1989 at the Department of Urology, Ondokuz Mayis University, Faculty of Medicine determined retrospective i y . Indications for ureteroneocystostomy were vesicoureteral reflux in 17 patients, stenosis at ureterovesical junction in 8 patients, and distal ureteral traumatisation in 1 patient. Operations were performed bilaterally in 11 of the patients with reflux and 2 of the patients with obstruction. The operative techniques were Politano-Leadfoetter in 22 units, Cohen in 12 units and Lich-Gregoir in 5 units. The success rate of the operations were 92.8 %. OZET Ondokuz Mayis universitesi Tip Fakultesi Hastanesi uroloji Klini¬ginde Nisan 1979- ile Mart 1989- tarihleri arasinda vezikoureteral reflu, obstruksiyon ve distal ureter yaralanmasi nedeniyle 26 olgu icin yapilan 39 ureteroneosistostomi girisimlerine ait so¬nuclar degerlendirildi. Ureteroneosistostomi indikasyonu 17 olgu icin vezikoureteral reflu, 8 olgu icin ureterovezikal birlesim yeri obstruksiyon ve bir olgu icin, ise distal ureter yaralanmasiydi. Reflulu olgularin 11* inde, obstruksiyonlu olgularin 2sinde iki tarafli girisim yapildi. Politano - Leadbetter yontemi 22, Cohen yontemi 12 ve Lich-Gregoir yontemi 5 birimde uygulandi. Girisimlerin basarisi % 92.8 olarak belirlendi.