Turgay Turan

Can intervals in extracorporeal shock wave lithotripsy sessions affect success in the treatment of upper ureteral stones

Introduction Managing upper ureteral stones with shock wave lithotripsy (SWL) has been done for many years. However, no conclusive data have been found on the intervals required between repeated SWL sessions. Aim To identify the most optimal intervals between SWL sessions. Material and methods Between September 2015 and December 2016, 80 patients undergoing elective outpatient lithotripsy who required repeated SWL sessions for ureteral stones were evaluated. These patients were categorised into two groups according to different SWL session intervals. The intervals between SWL sessions (n = 40) for the first group lasted one day, whereas those for the second group (n = 40) lasted 1 week. The data recorded during SWL included visual analogue scale (VAS) scores, total number of shocks, total energy used and number of sessions. The stone clearance rates, number of urinary tract infections, complication rates and VAS scores were compared between the two groups. Results All patients’ clinical outcomes after SWL therapy are shown in Table I. The stone clearance rate for group 1 was 70%, whereas that for group 2 was 72.5% (p = 0.805). Additionally, the number of urinary tract infections, complications and VAS scores were similar for both groups. In group 1, 3 patients had steinstrasse, two suffered from severe renal colic, and one had a urinary tract infection. In group 2, 3 patients endured steinstrasse, and 2 patients experienced severe renal colic during the study. Conclusions Short-interval SWL sessions are safe and effective for treating upper ureteral stones, and such sessions do not increase complication rates.

Reconstruction of an Incompletely Amputated Penis with The Radical Penile Crural Dissection and Radial Forearm Free Flap

INTRODUCTION Penile amputation is a rare injury that occurs most frequently because of self-mutilation in patients suffering from psychotic problems, especially schizophrenia. Less frequent reasons for penile amputation are non-self-mutilation, trauma due to an industrial or traffic accident, incidents during circumcision, hypospadias repair or surgery for bladder extrophy, surgical resection for malignancy, strangulation by hair coil, and penetrating injuries during war. Surgical techniques for penile reconstruction continue to evolve. However, because of the complexity of the penis, repairing and reconstructing this organ remains a great challenge for surgeons, anatomically, functionally, and aesthetically. Treatment and care vary depending on the severity of the lesions, the delay in seeking consultation, and the patient’s mental state. The goal of penile reconstruction is to restore urinary and sexual functions with cosmetically acceptable results. Ideally, surgical repair should be immediate, to preserve as much viable tissue as possible. This is because no other tissue in the body has the characteristics, in terms of elasticity, texture, and color, to be considered an ideal candidate for genital reconstruction. For penile amputation, microvascular replantation can be preferred as one of the treatments. When primary repair with genital tissue is not feasible, skin grafts and various pedicle and free flaps can be used for reconstruction. We report a case of criminal penile amputation that was restored by radical penile crural dissection and use of a radial forearm free flap (RFFF) to cover the corpus cavernosum.

Supraclavicular lymph node as the first presentation and late skin metastasis: an unusual clinical course for prostate cancer

Prostate cancer is the most common non-cutaneous malignancy and the second cause of cancer death in men. Despite improvements in diagnostic methods, the primary diagnosis of a number of patients may still be on metastatic stage. Cutaneous and supraclavicular lymph nodes are very rare metastatic sites for prostate cancer. In this report we present an extremely rare prostate cancer case diagnosed with supraclavicular lymph node and then developed cutaneous metastasis. A 64 year-old man was admitted to an internal medicine outpatient clinic with supraclavicular lymph node and biopsy of lymph node showed an adenocarcinoma. After prostate cancer diagnosis, patient was treated with androgen deprivation therapy, docetaxel chemotherapy and abiraterone acetate, respectively. While abiraterone treatment, cutaneous metastasis developed in inguinal area and diagnosis was confirmed by skin biopsy. In some cases, atypical symptoms may guide us to find disease with aggressive clinics. Thats why, physical rectal examination and prostate specific antigen measurements should be kept in mind for prostate cancer in male patients with supraclavicular lymph node or atypical metastasis.

Kidneys with small renal masses: Can they be utilized for kidney transplantation in the era of partial nephrectomy?

OBJECTIVE To retrospectively evaluate our database to determine our partial nephrectomy and radical nephrectomy rates and to see percentage of the discarded kidneys which were suitable for transplantation after radical nephrectomy. MATERIAL AND METHODS Patients who underwent radical or partial nephrectomy between January 2000 and December 2016 were identified. Only stage I tumors according to tumor, node, metastasis classification were included in this review. Tumor size, location, proximity to renal collecting system and hilum were considered while deciding the suitability of a kidney for transplantation. RESULTS A statistically significant gradual increase in the number of patients treated with partial nephrectomy was observed (p=0.00001). Only 17 out of 181 kidneys with a tumor size smaller than 3 cm could be an appropriate candidate for a renal transplantation if they were to be transplanted. CONCLUSION Exact number of the discarded kidneys with small renal masses which can be used for kidney transplantation should be determined by large scale studies. A national or governmental policy may only be developed to utilize these discarded organs after the magnitude of the wasted kidneys can be determined.

Disseminated Bacillus Calmette-Guérin (BCG) Infection Caused By Inadvertent Intravenous Infusion of BCG for the Treatment of Bladder Cancer: Case Report

Nonmuscle invasive bladder cancer is a common malignancy. After transurethral resection, intravesical administration of Bacillus Calmette-Guérin (BCG) is a treatment that is generally used for non-muscle-invasive bladder cancer. Intravesical BCG treatment decrease the number of tumor recurrence and progression. The complications of BCG therapy are important that clinicians are aware of these. Serious complications are uncommon with BCG treatment, but life-threatening side effects such as sepsis, hepatitis and pneumonia may occur. The person who applies the intravesical BCG must be very careful throughout the entire administration procedure. We present a patient whom an intravenous BCG infusion was inadvertently administered and the patient was successfully treated with anti-tuberculin therapy. A review of available literature on the possible complications of this treatment have been performed.

Comparison of intravesical (Cohen) and extravesical (Lich–Gregoir) ureteroneocystostomy in the treatment of unilateral primary vesicoureteric reflux in children

INTRODUCTION Various intravesical and extravesical techniques have been described for the surgical correction of vesicoureteral reflux (VUR). Among those techniques Cohen (intra-vesical) and Lich-Gregoir (extra-vesical) are the most commonly used ones. However, there are limited studies that compare those two surgical techniques in the literature. OBJECTIVE In this study, we aim to compare the outcomes of the open intravesical and extravesical procedures for unilateral primary VUR in children. METHODS We analyzed the records of 118 consecutive children with primary VUR who underwent open ureteral reimplantation surgery by single surgeon from January 2011 to October 2015 at our institution. Among them, intravesical reimplantation was group A, and extravesical reimplantation procedure was group B. We retrospectively analyzed the clinical data of both groups, including age, sex, preoperative reflux grade, presence of lower urinary tract symptoms (LUTS), operative time, postoperative complications and hospitalization period. Success of surgery was defined as the resolution of the VUR as determined by voiding cystourethrography 6 -12 months after surgery. All the parameters were statistically compared. RESULTS A total of 58 patients were found eligible for the study. In 23 cases intravesical (group A) and in 35 cases extravesical (group B) procedure were performed. The operative time in group A was significantly higher than group B (110.3±16.9 and 87±29.8 min, respectively, p = 0.002). The mean hospital stay was also longer in group A (2.8±0.8 and 1.2±0.6 days, respectively, p = 0.007). The ureteral catheterization periods were 14.1±6.1 days for group A and there was no ureteral catheter placement in group B. The success rate of the two groups were comparable (100% vs 94.9%, p = 0.513). No intraoperative complications were detected in either group. The number of febrile urinary tract infections were similar between the groups after a mean follow up of 18.2 months (p = 0.746). DISCUSSION Our results confirmed that both Cohen and Lich-Gregoir procedures had equivalent success and complication rates. Lich-Gregoir technique was found superior to Cohen technique in terms of hospital stay and operative time. Moreover, it avoids the necessity of urethral and ureteral stenting which probably might increase the comfort of the patients postoperatively. The main limitations of our study are unrecorded pain scores and amount of analgesics taken the after surgery and retrospective analysis of the data. CONCLUSION Both the open intravesical and extravesical ureteroneocystostomy procedures are equally effective in the treatment of primary unilateral VUR. Any of the techniques can be opted by the surgeons depending on their surgical experience.

Have the Technological Advancements Changed the Distribution of Treatment Modalities for Urolithiasis

ABS TRACT Ob jec ti ve: The aim of this study was to assess the current practice patterns and the distribution of treatment modalities in treatment of urolithiasis. Material and Methods: A retrospective study was conducted on the patients who underwent procedures for stone removal or fragmentation in 6 centers in İstanbul, between January 1, 2008 and December 31, 2009. Hospital and office charts, operative notes and records, and pertinent radiographic studies of all patients were reviewed. Patient characteristics, treatment modalities, lithotripter use, stone localization and the side were documented for each patient. Results: Of 1756 procedures, the majority was endoscopic surgery (80.7%, n=1417), while 21.6% (n=379) of the patients had percutaneous nephrolithotomy, 47.3% (n=831) had semirigid ureteroscopy, 7.6% (n=134) had cystolithotripsy, 2.2% (n=38) had retrograde intrarenal surgery, 1.4% (n=24) had flexible ureteroscopy, 0.3% (n=6) had laparoscopic ureterolithotomy, and 0.1% (n=2) had laparoscopic pyelolithotomy. Open stone surgery rate was 19.3% (n=339) which included pyelolithotomy (8.5%, n=150), ureterolithotomy (4.7%, n=82), cystolithotomy (2.4%, n=43), nephrolithotomy (2.2%, n=39), pyelonephrolithotomy (0.7%, n=13), anatrophic nephrolithotomy (0.5%, n=8), pyeloplasty (0.3%, n=5) and nephrectomy (0.1%, n=2). There were 1276 (72.7%) males and 480 (27.3%) females between the ages of 3-85 years (mean age 45.5±15.8 years). Conclusion: Although the advent of percutaneous nephrolithotomy and ureteroscopy in combination with lithotripsy technique has dramatically altered the management of renal and ureteral stones, open stone surgery maintains a small but continued role in the treatment of patients with renal and ureteral calculi.