Senol Adanur

ORIGINAL RESEARCH—SURGERY: Seventeen Years' Experience of Penile Fracture: Conservative vs. Surgical Treatment

INTRODUCTION Penile fracture is the rupture of the tunica of one or both corpora cavernosa due to direct blunt trauma to the erected penis. Partial or complete rupture of the urethra or injury to the deep dorsal vein may accompany penile fracture. AIM To compare conservative and surgical treatment modalities in terms of duration of hospitalization, early and late complications such as penile nodule and curvature, erectile dysfunction, and painful erection. MAIN OUTCOME MEASURES Treatment results and complications in two groups were evaluated with history and physical examination, and International Index of Erectile Function-5 Questionnaire was used for erectile function assessment. Methods. The charts of 42 men diagnosed with penile fracture were retrospectively reviewed, and two treatment modalities were compared: conservative (Group I) and surgical (Group II). Results. Between 1991 and 2008, a total of 42 patients with penile fracture were followed in our clinic for a mean of 18 months (range: 6-30 months). Five men who refused surgical treatment were treated conservatively, and the other 37 patients underwent surgical treatment. In Group II, the most common complication was painful erection (in 4 of 37 patients, 10.8 %), whereas in Group I, 80 % (4/5 patients) suffered complications such as wound infection, painful erection, penile nodule and curvature, and erectile dysfunction. Conclusion. Diagnosis of penile fracture can be based on history and physical examination; diagnostic tests such as ultrasonography and magnetic resonance imaging are generally not required. Fractures must be repaired either immediately or delayed. Because management with emergency surgical repair is the most effective approach, with the lowest complication rate, surgical treatment should be preferred compared to a conservative approach.

ORIGINAL RESEARCHORIGINAL RESEARCH—SURGERY: Seventeen Years' Experience of Penile Fracture: Conservative vs. Surgical Treatment

INTRODUCTION Penile fracture is the rupture of the tunica of one or both corpora cavernosa due to direct blunt trauma to the erected penis. Partial or complete rupture of the urethra or injury to the deep dorsal vein may accompany penile fracture. AIM To compare conservative and surgical treatment modalities in terms of duration of hospitalization, early and late complications such as penile nodule and curvature, erectile dysfunction, and painful erection. MAIN OUTCOME MEASURES Treatment results and complications in two groups were evaluated with history and physical examination, and International Index of Erectile Function-5 Questionnaire was used for erectile function assessment. Methods. The charts of 42 men diagnosed with penile fracture were retrospectively reviewed, and two treatment modalities were compared: conservative (Group I) and surgical (Group II). Results. Between 1991 and 2008, a total of 42 patients with penile fracture were followed in our clinic for a mean of 18 months (range: 6-30 months). Five men who refused surgical treatment were treated conservatively, and the other 37 patients underwent surgical treatment. In Group II, the most common complication was painful erection (in 4 of 37 patients, 10.8 %), whereas in Group I, 80 % (4/5 patients) suffered complications such as wound infection, painful erection, penile nodule and curvature, and erectile dysfunction. Conclusion. Diagnosis of penile fracture can be based on history and physical examination; diagnostic tests such as ultrasonography and magnetic resonance imaging are generally not required. Fractures must be repaired either immediately or delayed. Because management with emergency surgical repair is the most effective approach, with the lowest complication rate, surgical treatment should be preferred compared to a conservative approach.

Renoprotective effect of aliskiren on renal ischemia/reperfusion injury in rats: electron microscopy and molecular study

Abstract Purpose: To determine the protective effect of aliskiren on ischemia–reperfusion (I/R) injury in a rat renal (I/R) model. Methods: Rats were randomly divided into five groups: sham control group; sham control with aliskiren pretreatment; I/R group and I/R with two doses of aliskiren pretreatment. Rats were unilaterally nephrectomized and subjected to 45 min of renal pedicle occlusion followed by 24 h reperfusion. Aliskiren (50 and 100 mg/kg) was administered orally by gavage 24 and 1 h prior to ischemia. After 24 h reperfusion, kidney samples were taken for the determination of malondialdehyde (MDA) level, superoxide dismutase (SOD), glutathione (GSH) activity and histological evaluation. The level of serum creatinine (SCR) and blood urea nitrogen (BUN), renin and angiotensin II (AT-2) was measured in serum samples. Results: Kidneys from I/R groups showed significant increase in MDA level and significant decrease in GSH, and SOD activity. IL-1β, iNOS and NFkB gene expression significantly increased in the I/R groups in the rat kidney tissue. Aliskiren treatment showed a significant down-regulatory effect on IL-1β, iNOS and NFkB mRNA expression. Compared with the sham group, SCR and BUN, renin and AT-2 were significantly increased in the I/R rats, accompanied by histopathological damage to the kidney. Conclusion: Pretreatment with aliskiren ameliorated I/R-induced renal injury through decreasing nitric oxide and AT-2 levels and by the reduction of injury induced by I/R injury and ameliorated renal histopathological molecular and biochemical changes.

Ureteroscopy and holmium laser lithotripsy: Is this procedure safe in pregnant women with ureteral stones at different locations?

OBJECTIVES The aim of this study was to assess the safety and effectiveness of ureteroscopy and Holmium: Yttrium-Aluminum-Garnet lithotripsy for the treatment of ureteral stones with different localizations in symptomatic pregnant women. METHODS A retrospective analysis was performed on 19 pregnant patients referred to our center between January 2005 and December 2012 with symptomatic hydronephrosis requiring surgical intervention. 7.5 F and 9.5 F semirigid ureterorenoscopy with Holmium laser lithotripsy was used for treatment in all patients. Complications were stratified according to modified Clavien criteria. RESULTS The mean age of patients was 25.4 (18-41) years, and the mean gestation duration was 24.8 (7-33) weeks. Six cases (31.5%) had a history of stone. Solitary kidney secondary to previous nephrectomy was observed in 2 patients and 1 patient had a hypoplastic kidney. Abdominal ultrasonography was used as the main diagnostic tool. Mean stone size was 9.2 mm (6-13). The location of the stones was the lower, middle, and upper ureter in 8 (42.1%), 5 (26.3%) and 6 (31.5%) cases, respectively. All stones were fragmented with Holmium laser lithotripsy. Of the 19 patients, 11 (57.8%) required double J stent insertion peroperatively. Intraoperative urological and obstetric complications were not observed. Postoperatively two complications were noted. According to Clavien criteria a complication was level 1, and the other was level 2. CONCLUSIONS For treatment of pregnant women with symptomatic ureteral stones in every location, Holmium laser lithotripsy with a semirigid ureteroscopy can be used as judicious treatment. This approach is effective and safe with an acceptable complication rate.

Incidence of bacterial colonisation after indwelling of double-J ureteral stent

OBJECTIVE To determine the bacterial colonisation after double-J stent use and the risk factors for bacteriuria linked to the stent. MATERIALS AND METHODS A total of 102 patients (61 men and 41 women, mean age 47.5 ± 14.16) were examined. The stents were removed under aseptic conditions, and a urine culture was obtained before the removal of the stents. After the stents were removed, the upper, central and lower sections were separated, and washing water was sent through the stent. RESULTS Bacterial colonisation was found in 29.4% (30 of 102) of the stents. The most frequently observed microorganisms were determined as staphylococcus, coagulase negative (8 of 30) and E. coli (5 of 30). The washing fluid used to clean the interior of the catheter produced pathogens in 8 patients (7.8%), and these pathogens were observed to be the same microorganisms that colonised the outside of the stent. There was no statistical difference between the patients with colonisation and those without in terms of age, gender, duration of stenting and reason for stent insertion. CONCLUSIONS Though stent colonisation does not always entail symptomatic urinary tract infections, as shown in our study, the pathogens in the urine culture are the same as those colonising the stent, confirming the reality that colonisation is the main factor in these events. Additionally, according to our study, significant colonisation may be found in the first 3 weeks, contrary to the literature, causing us to consider that urinary tract infections may develop even in the early period.

Holmium Laser Lithotripsy with Semi-Rigid Ureteroscopy: A First-Choice Treatment for Impacted Ureteral Stones in Children?

Background We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children. Material/Methods We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification. Result The mean patient age was 9.5±5.1 years (range 1–18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5–20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3–55). Conclusions For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach.

Feasibility study of CT perfusion imaging for prostate carcinoma

AbstractObjectiveThe aim of this feasibility study was to obtain initial data with which to assess the efficiency of perfusion CT imaging (CTpI) and to compare this with magnetic resonance imaging (MRI) in the diagnosis of prostate carcinoma.Materials and methodsThis prospective study involved 25 patients with prostate carcinoma undergoing MRI and CTpI. All analyses were performed on T2-weighted images (T2WI), apparent diffusion coefficient (ADC) maps, diffusion-weighted images (DWI) and CTp images. We compared the performance of T2WI combined with DWI and CTp alone. The study was approved by the local ethics committee, and written informed consent was obtained from all patients.ResultsTumours were present in 87 areas according to the histopathological results. The diagnostic performance of the T2WI+DWI+CTpI combination was significantly better than that of T2WI alone for prostate carcinoma (P < 0.001). The diagnostic value of CTpI was similar to that of T2WI+DWI in combination. There were statistically significant differences in the blood flow and permeability surface values between prostate carcinoma and background prostate on CTp images.ConclusionCTp may be a valuable tool for detecting prostate carcinoma and may be preferred in cases where MRI is contraindicated. If this technique is combined with T2WI and DWI, its diagnostic value is enhanced.Key Points• Perfusion CT is a helpful technique for prostate carcinoma diagnosis. • Colour maps allow easy and rapid visual assessment of the functional changes. • Colour maps of prostate carcinoma provide information about in vivo tumoral vascularity. • CTp images may be added into routine radiological examinations. • CTp provides guidance for histopathological correlation if biopsy is scheduled.

A Cause of Renal Dysfunction: A Giant Bladder Stone

Bladder stones are frequently seen in elderly men and account for 5% of all urinary stones. They develop secondary to infravesical obstructions, such as prostatic hyperplasia and neurogenic bladder. A 56-year-old patient with frequent and painful urination, dysuria, and minor complaints of suprapubic pain was referred to our clinic. He was diagnosed with bladder stones by non-contrast abdominopelvic computerized tomography, kidney-ureter-bladder radiography, and urinary system ultrasonography. Cystolithotomy was applied on a giant stone measuring 11×6.5×10 cm that filled the intravesical cavity nearly completely. Here, we present this case of a giant bladder stone causing renal dysfunction within the context of findings in the literature.

Micropercutaneous Nephrolithotomy in the Management of Bilateral Renal Stones in a 7-Month-Old Infant: The Youngest Case in the Literature

During infancy, the renal parenchyma and pelvicalyceal system are relatively fragile. Therefore, percutaneous nephrolithotomy for the management of renal stones in this age group is a challenging procedure for urologists. Herein, we present the uneventful management of bilateral renal stones using micropercutaneous nephrolithotomy (microperc) administered to a 7-month-old infant with recurrent urinary tract infections. In this paper, the advantages and disadvantages of the microperc procedure are discussed. As far as we know, our patient is the youngest case in whom the microperc procedure has been performed.

Comparison of the Effect of Lidocaine versus a Lidocaine-Bupivacaine Combination in a Periprostatic Nerve Block Undergoing Transrectal Ultrasound-Guided Prostate Biopsy: A Double-Blind Randomized Controlled Trial.

Introduction: To determine whether a combination of the long acting local anesthetic, bupivacaine, and lidocaine is better than lidocaine alone in the long-term pain control, which is a short-acting anesthetic. Materials and Methods: In group 1, periprostatic nerve block was applied to both neurovascular areas with 2% lidocaine (5 ml) in an isotonic solution (5 ml). In group 2, the combination of 2% lidocaine (5 ml) and 5mg/ml bupivacaine (5 ml) was used for the PPNB. Results: In the first 30 minutes the mean VAS scores of groups 1 and 2 were 2.1 ± 0.2 and 1.2 ± 0.1, respectively (p = 0.002). VAS scores of group II determined at 1, 2, 4, 6, and 8 hours after the biopsy were significantly lower since it was (p < 0.05). Conclusion: While periprostatic nerve block for late phase pain control, applying a combination of a long-acting local anesthetic, such as bupivacaine, is effective in terms of pain control and patient comfort.