Tibet Erdogru

The clinical research office of the endourological society percutaneous nephrolithotomy global study: Nephrolithotomy in 189 patients with solitary kidneys

BACKGROUND AND PURPOSE The study compared characteristics and outcomes in patients with solitary and bilateral kidneys who were treated with percutaneous nephrolithotomy (PCNL) in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. PATIENTS AND METHODS Data from consecutively treated patients from 96 centers worldwide were collated after a 1-year period. The following variables in patients undergoing PCNL with solitary or bilateral kidneys were compared: Prevalence, patient characteristics, intraoperative differences and outcomes, including bleeding and transfusion rates, renal function, and stone-free rates. RESULTS Data from 5803 patients were collated; 189 (3.3%) with solitary and 5556 (96.7%) with bilateral kidneys. Patient characteristics were well matched generally with the exception of cardiovascular disease and American Society of Anesthesiologists (ASA) risk scores, which were significantly greater in patients with solitary than with bilateral kidneys (P<0.0001 and P=0.004, respectively). Patients with solitary kidneys had also undergone significantly more procedures to remove calculi before this survey than bilateral patients (P= 00.049 -<0.0001). Levels of renal impairment were significantly greater (P<0.0001) and stone-free rates were significantly lower (P=0.001) post-PCNL in solitary than bilateral kidney patients. Although bleeding rates were the same in both groups, transfusion rates were significantly greater in solitary kidney patients (P=0.014). CONCLUSIONS Patients with a solitary kidney had a higher cardiovascular risk and ASA score. Outcomes related to morbidity and stone-free rate were less favorable for solitary kidneys.

Laparoscopic transvesical repair of recurrent vesicovaginal fistula using with fleece-bound sealing system

BackgroundVesicovaginal fistula (VVF) is an epithelium-lined communication between the urinary bladder and vagina. Most of VVFs are repaired by conventional open surgery. Laparoscopic repair of VVFs is rare and so far no report is available about laparoscopic repair of persistent VVF using fleece-bound sealing system as a tissue barrier in the literature. Here we describe the operative technique and briefly review the literature.CaseWe present the case of a 37-year-old woman with recurring VVF in two times after abdominal and transvaginal repairs caused by a massive bleeding during caesarian-section due to placenta previa and underwent hysterectomy. During the laparoscopic repair of the fistula and excision of the vaginal cuff, fleece-bound sealing system (TachoSil®) was used as tissue barrier. Laparoscopic transperitoneal transvesical repair was successfully performed by suturing the defects and fixing two TachoSil between the bladder and vagina. The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found.ConclusionWe believe that laparoscopic repair of vesicovaginal fistula is a feasible and efficacious minimally invasive approach for the management of this entity. Whilst proper identification of tissue planes and good laparoscopic suturing technique are required, using fleece-bound sealing system might be convenient especially for persistent VVF.

Analysis of three different vesicourethral anastomotic techniques in laparoscopic radical prostatectomy.

ObjectivesThe vesicourethral anastomosis is critical to the outcome of laparoscopic radical prostatectomy (LRP). We retrospectively compared a recently introduced running suture with existing interrupted techniques.Materials and methodsA total of 600 patients undergoing LRP at our institution were reviewed. Each group consisted of 200 patients. Group 1 (intracorporeal-single-knot-running suture) was compared to cohorts in whom the anastomosis was created by interrupted suturing, with (group 2) or without (group 3) a previously placed 6 o’clock suture. Intraoperative data and cystographic evaluation were collected prospectively. Detailed analysis of the location of extravasation was correlated with duration of leak. At a median follow up of 26 months, continence and stricture rates were assessed.ResultsThe groups were statistically similar with respect to age, prostate volumes and pre-operative PSA. Numbers of patients undergoing lymphadenectomy and/or nerve-sparing procedures were also similar between groups. The median time for anastomosis was significantly shorter for group 1 (15.3 min) compared to group 2 (23.5 min) and group 3 (27.7 min) (P < 0.000.1). This was reflected in the overall operative times [group 1; 155.4 min, group 2; 185.6 min and group 3; 202.2 min (P = 0.03)]. Subjective assessment suggested that tension to the anastamosis was present in fewer patients in group 1 (3.5%) compared to group 2 (17%) and group 3 (9.5%) (P = 0.001). There was no significant difference in the continence or stricture rate between the three groups.ConclusionsThe continuous anastomotic suture reduced the operative time and tension to the anastomosis. However, the long term continence and stricture rates were unaffected by anastomotic technique.

Laparoscopic Radical Prostatectomy in Clinical T1a and T1b Prostate Cancer : Oncologic and Functional Outcomes-A Matched-Pair Analysis

OBJECTIVES To evaluate the effect of previous transurethral resection of the prostate (TURP) on surgical, functional, and oncologic outcomes after laparoscopic radical prostatectomy. METHODS From a series of 2100 patients undergoing laparoscopic radical prostatectomy, we compared the intraoperative complications and functional and oncologic outcomes for 55 patients who had been diagnosed with prostate carcinoma on previous TURP (group 1), with those of 55 matched patients who had not undergone previous prostate surgery (group 2). The patients were match-paired for age, operating surgeon, procedure type (eg, nerve-sparing, lymph node dissection), anastamotic technique, pathologic stage, and Gleason score. The minimal duration of follow-up was 24 months. RESULTS Both groups were similar with respect to patient age and pathologic stage. Of those with Stage cT1a and cT1b, 83.6% had a clinically significant tumor, with a mean tumor volume of 1.7 cm(3) for those with Stage cT1a and 2.4 cm(3) for those with Stage cT1b. The positive surgical margin rate was 14.5% and 16.3% for groups 1 and 2, respectively. Biochemical recurrence developed in 12.7% and 11% of patients in groups 1 and 2, respectively. Neither outcome was significantly different between the 2 groups. The long-term continence rates were similar; however, previous TURP was associated with a lower continence rate (49.1%) at 3 months compared with 61.8% for group 2 (P = .01). A nerve-sparing technique was used in 54% of group 1 patients. No significant difference was found in the potency rates between the 2 groups at 12 months. CONCLUSIONS Laparoscopic radical prostatectomy after TURP is a challenging, but oncologically safe, procedure. The interval to total continence was delayed, but the potency rates remain unchanged.

Effect of experimental varicocele in rats on testicular oxidative stress status

Summary.  The present experiments were undertaken to determine the levels of MDA, SOD and catalase in the testis of adolescent rats with experimental left varicoceles. Male Wistar rats, 7 weeks old and weighing 160–170 g, were randomly allocated into three groups. The first group of rats underwent partial ligation of the left renal vein (n=15). The second group of rats underwent a sham operation (n=7) and the third group acted as controls (n=7). Animals were sacrificed 6 weeks after surgery and dilatation of the internal spermatic veins was observed. Levels of MDA, SOD and catalase activity were measured in testis. The experimental left varicocele group showed severe testicular changes compared to other groups. The mean MDA (SEM) levels in right and left testicular tissues of varicocele bearing rats, sham‐operated rats, and control rats were 0.48 ± 0.24 and 0.31 ± 0.11, 0.22 ± 0.02 and 0.35 ± 0.12, 0.62 ± 0.29 and 0.13 ± 0.05, respectively (P > 0.05). The mean SOD (SEM) levels in right and left testicular tissues of varicocele bearing rats, sham‐operated rats, and control rats were 7790 ± 606 and 6974 ± 574, 7475 ± 1517 and 7020 ± 1106, 8727 ± 1188 and 9019 ± 1129, respectively (P > 0.05). The mean catalase (SEM) levels in right andleft testicular tissues of varicocele bearing rats,sham‐operated rats, and control rats were 75.77 ± 11.5 and 53.82 ± 10.1, 91.94 ± 14 and 94.90 ± 32, 65.40 ± 5.7 and 90.93 ± 16.4, respectively (P > 0.05). Our results suggest that oxidative status, which reflects a relative balance between reactive oxygen species (ROS) generated and ROS scavenged, may not be responsible for the testicular dysfunction associated with experimentally induced varicocele during adolescence in rats.

Primary signet ring cell carcinoma of the urinary bladder. Review of the literature and report of two cases.

The signet ring cell carcinoma of the urinary bladder is a rare neoplasm; the 70 cases found in the literature pursued a fulminant and mostly fatal course; the neoplasms diffusely invaded the bladder wall without forming intraluminal growths and could not be controlled by segmental resection, radiotherapy and chemotherapy alone or in combination. We herewith present 2 cases of primary signet ring cell carcinoma of the urinary bladder--one associated with high-grade transitional cell carcinoma and in situ carcinoma--and review the literature.

The potential role of inducible nitric oxide synthase (iNOS) activity in the testicular dysfunction associated with varicocele: an experimental study.

Nitric oxide (NO) has been reported to be increased in the spermatic veins of men affected by varicocele. The aim of the present study was to determine whether iNOS (inducible nitric oxide synthase) has a role in testicular dysfunction associated with varicocele, immunohistochemistry analyze was used to study iNOS activity in testis of adolescent rats with experimental left varicoceles. Rats were randomly divided into three groups. The first group consisted of rats undergoing partial ligation of left renal vein (n:12). The second group consisted of rats undergoing a sham operation (n:6) and, the third group referred to as control rats (n:7). Immunohistochemistry slides were evaluated by counting the number of positive cells and expressed as percents (% iNOS activity). We found that iNOS was predominantly expressed in the cytoplasm of Leydig cells in each group and only a small amount of iNOS was expressed in Sertoli cells. There were significant differences in % iNOS activity between both testes of varicocele group and both of testes control group(p < 0.01), but no significant differences were noted between other groups (p > 0.05). Because of iNOS activity was markedly increased in the Leydig cells of varicocele bearing rats, we suggest that iNOS activity may play a role in the testicular dysfunction associated with varicocele during adolescence.

Relationship between apoptosis regulator proteins (bcl-2 and p53) and Gleason score in prostate cancer.

Cellular proliferation programmed cell death (apoptosis) are associated with tumor growth in general, and prostate cancer growth in particular. The aim of this study was to examine the expression of the apoptosis regulating genes bcl-2 and p53 and Gleason score in core needle biopsy specimens of prostate cancer using immunohistochemistry. We studied bcl-2 and p53 expression in 12 cases of low grade (Gleason score 2–5), 12 cases of intermediate grade (Gleason score 6–7) and 8 cases of high grade (Gleason score 8–10) prostate cancer. Overexpression of bcl-2 was noted in 3 of 32 patients (9.32%). One of them was high grade; others were intermediate grades. Expression of p53 was observed in 3 of low grades; others were high grade. The statistical analysis of present data suggest that there is no significant relation between p53 and bcl-2 expression and Gleason score in prostate cancer.

Transperitoneal versus extraperitoneal robot‐assisted laparoscopic radical prostatectomy: A prospective single surgeon randomized comparative study

To compare operative, pathological, and functional results of transperitoneal and extraperitoneal robot‐assisted laparoscopic radical prostatectomy carried out by a single surgeon.

Endoscopic Vesicoureteral Reflux Correction in Transplanted Kidneys: Does Injection Technique Matter?

AIM AND BACKGROUND Posttransplant vesicoureteral reflux (VUR) is a common urologic complication after renal transplantation, although its management is controversial. The treatment of choice is open surgical revision ureteral reimplantation with significant morbidity. Recently, endoscopic correction by using nonanimal dextranomer/hyaluronic acid copolymer (NA Dx/HA) injection has been reported to be effective in the treatment of VUR of transplanted kidneys. Herein, we present our 3-year endoscopic correction results in transplanted kidneys where we used two different injection techniques, subureteral and intraureteral. MATERIALS AND METHODS We retrospectively reviewed all patients who underwent endoscopic VUR correction of posttransplant VUR by NA Dx/HA injection between July 2005 and March 2009. We excluded patients with underlying urologic abnormalities. RESULTS A total of 26 patients (14 women and 12 men) with a mean age of 32.2 years (range: 15–55) were studied. The VUR was also graded as nondilating reflux in 10 (grade I–II) and dilating reflux in 16 (grade III–IV). Seventeen ureters (5 nondilating and 12 dilating VUR) were injected NA Dx/HA intraureterally, and 9 ureters (5 nondilating and 4 dilating VUR) were injected NA Dx/HA subureterally. Overall success rate was 53.8% (14 out of 26). Intraureteral injection technique was successful in nine cases (52.9%), and subureteral injection technique was successful in five cases (55.5%). In nondilating VUR, injection corrected 90% (9 out of 10) of posttransplant patients, whereas in dilating VUR group injection corrected only 31.25% (5 out of 16). We found no statistical significance of injection technique on the success rate. CONCLUSIONS Endoscopic correction by using NA Dx/HA with any injection technique seems to be a plausible alternative to correction of refluxing posttransplant ureters, particularly in nondilating VUR.