Volkan Izol

Factors Affecting Complication Rates of Percutaneous Nephrolithotomy in Children: Results of a Multi-Institutional Retrospective Analysis by the Turkish Pediatric Urology Society

PURPOSE We assessed factors affecting complication rates of percutaneous nephrolithotomy in children. MATERIALS AND METHODS We retrospectively evaluated data on 1,205 renal units in 1,157 children treated with percutaneous nephrolithotomy at 16 Turkish centers between 1991 and 2012. Of the patients 28.3% had a history of urolithiasis. Complications were evaluated according to the Satava classification system and modified Clavien grading system. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS A total of 515 females and 642 males were studied. Mean ± SD patient age was 8.8 ± 4.7 years (range 4 months to 17 years). Mean ± SD stone size, operative time and postoperative hospital stay were 4.09 ± 4.06 cm(2), 93.5 ± 48.6 minutes and 5.1 ± 3.3 days, respectively. Postoperative stone-free rate was 81.6%. A total of 359 complications occurred in 334 renal units (27.7%). Complications were intraoperative in 118 cases and postoperative in 241. While univariate analysis revealed that stone history, positive urine culture, operative time, length of hospitalization, treatment success, punctured calyx and location of the stone significantly affected the complication rates (p <0.05), operative time, sheath size, mid calyceal puncture and partial staghorn formation were the statistically significant parameters affecting complication rates on multivariate logistic regression analysis. CONCLUSIONS Percutaneous nephrolithotomy is the treatment of choice for most renal calculi in children. The technique is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.

An Evaluation of the Effects of Long-term Cell Phone Use on the Testes Via Light and Electron Microscope Analysis

OBJECTIVE To investigate whether the low-intensity electromagnetic waves transmitted by cell phones cause histopathological or ultrastructural changes in the testes of rats. MATERIALS AND METHODS Wistar-Kyoto male rats were placed into either a control group or a group that was exposed to an electromagnetic field (EMF). Two cell phones with Specific Absorbation Rate values of 1.58 were placed and left off in cages that housed 15 rats included in the control group, and four cell phones were placed and left on in cages that housed 30 rats included in the experimental group. After 3 months, weights, seminiferous tubule diameters, and spermatogenic cell conditions of all testes of the rats were evaluated. One half of each testis was examined also under an electron microscope. RESULTS No significant differences were observed between the testis weights, seminiferous tubule diameters, and histopathological evaluations between rats that had and had not been exposed to EMF. Electron microscope analysis revealed that the membrana propria thickness and the collagen fiber contents were increased and the capillary veins extended in the experimental group. Common vacuolization in the cytoplasm of the Sertoli cells, growth of electron-dense structures, and existence of large lipid droplets were noted as the remarkable findings of this study. CONCLUSION Although the cells that had been exposed to long-term, low-dose EMF did not present any findings that were contrary to the control conditions, the changes observed during ultrastructural examination gave the impression that significant changes may occur if the study period were to be extended. Longer studies are needed to better understand the effects of EMFs on testis tissue.

Malassezia and Candida colonisation on glans penis of circumcised men

The Malassezia yeast are members of the normal human cutaneous flora in adults. They also are reported as part of the microflora of the male genital region in mostly uncircumcised males. It has been reported that Malassezia sympodialis and Malassezia globosa are the most frequent yeast belonging to the resident microflora of the penis as in other human skin areas. The aim was to evaluate the prevalence of Malassezia and Candida yeast colonisation on the glans penis of circumcised males. Impression preparations were made on modified Dixon agar. The isolates were identified by morphological and physiological characteristics. A total of 245 circumcised males were included in the study. Of the 245 patients examined, 55 (22.4%) were found to have a mycologically proven yeast fungi on their glans penis. In 17 (30.9%) Malassezia, in 36 (65.5%) Candida, in one (1.8%) Malassezia and Candida, and in one (1.8%) Saccharomyces strains were detected. Malassezia furfur (66.7%) was the most common species among the lipophilic yeast, followed by Malassezia globosa (11.1%), Malassezia obtusa (11.1%) and Malassezia slooffiae (11.1%). Candida albicans was the most common non‐lipophilic yeast (46.0%), that was isolated among the other yeast, followed by unidentified Candida strains (18.9%), Candida tropicalis (8.1%), Candida glabrata (8.1%), Candida parapsilosis (8.1%), Candida zeylanoides (5.4%), Candida guilliermondii (2.7%) and Saccharomyces cerevisiae (2.7%). The results of this study showed that Malassezia species were also colonised like Candida on the glans penis of circumcised males.

Superficial fungal infections of the male genitalia: a review.

Fungal infections of the genitals are probably more common than realized; however, relatively few reports concerning fungal genital infections exist in the literature. In this review, the fungal microbiota of the penis are highlighted, and the epidemiological characteristics of Candida balanitis, penile pityriasis versicolor, and tinea genitalis are addressed. In addition, the benefits of circumcision on male genital infections are included. However, systemic mycoses affecting the penis and/or scrotum will not be addressed in this review. To obtain a reliable diagnosis of genital fungal infections, medical history, clinical examination, and mycological and histological investigations of the lesions are critical.

Glans penis and prepuce colonisation of yeast fungi in a paediatric population: pre- and postcircumcision results.

The members of the genera Candida and Malassezia comprise opportunistic yeast with a natural habitat on the skin of humans and warm‐blooded animals. This study aimed to compare the prevalence of these yeast fungi in samples from the glans penis and prepuce 3–5 min prior to circumcision and after 1‐month follow‐up by mycological examination. A total of 77 children aged between 0.01 and 13.0 years (mean age 5.8 ± 3.4) were included in the study. Impression preparations were made on modified Dixon and Leeming‐Notman agars without cycloheximide. The isolates were identified by morphological, biochemical and physiological characteristics. The frequency of yeast colonisation was found to be significantly decreased from 11.7% to 1.3% following circumcision (P = 0.008). The glans penis and prepuce were colonised with especially Candida albicans (50%) followed by Malassezia furfur (40%) and Malassezia sympodialis (10%). This study highlighted the potential medical benefits of circumcision as a significant factor decreasing the colonisation rate of yeast fungi. We suggest that circumcision, rather than age, plays an important part in the reduction of yeast fungi in genitalia.

Epidemiological Characteristics of Fournier's Gangrene: A Report of 71 Patients

Introduction: To identify the predisposing factors, etiological and clinical characteristics as well as the Fournier’s gangrene (FG) severity index (FGSI) in the outcomes of patients with FG. Materials and Methods: The data from 71 patients diagnosed with FG in a period of 17 years were retrospectively reviewed for the age of the patient, their history, predisposing factors, etiology, prodromal symptoms, FGSI, culture results, hospitalization period, surgical interventions, responses to the therapy and complications. Results: All of the patients were Caucasian males, and the mean age was 61.3 (range 36–92) years. The mean duration from the onset of symptoms to surgery was 7.5 days. The mean hospitalization time was 27.4 days and the most common etiological factor for FG was a perineal abscess. The overall mortality rate was 29.6%. The relationship between the number of predisposing factors and mortality rates in patients with FG was the most statistically significant parameter (p = 0.001). Conclusions: Multiple predisposing factors predict a poor prognosis and correlate significantly with mortality. Extension of the disease and the FGSI score were not predictive of outcome. The most essential intervention for stopping the rapidly progressing infectious process of FG consists of early recognition of the disease, proper management of the predisposing factors and aggressive surgical debridement. Such an intervention can improve clinical outcomes.

Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis: A Case Study and Review of the Literature

Well-differentiated papillary mesothelioma is an uncommon tumor of the testes that usually presents as a hydrocele. Here, we present the case of one patient who did not have a history of asbestos exposure. The tumor was localized in the tunica vaginalis and was composed of three pedunculated masses macroscopically. Microscopically, branching papillary structures with focal coagulative necrosis were present. In addition to immunohistochemistry, simian virus 40 DNA was also tested by polymerase chain reaction. This report presents one case of this rare entity, its clinical and macroscopic features, and follow-up results.

Tinea cruris in Routine Urology Practice

Introduction: Tinea cruris is almost exclusively a male dermatophytosis. This infection is also sexually transmitted, and may cause epidemics in public areas such as common bathing facilities, dormitories and among military recruits. It has been aimed to investigate the prevalence and the causative agents of tinea cruris and tinea pedis in patients who were admitted to the Department of Urology with various pathologies. Materials and Methods: Direct microscopy and cultures of the epithelial scrapings were performed to identify the causative agent in patients who were admitted to the Department of Urology. Results: Out of a total of 155 cases examined, 39 (25.1%) were mycologically proven cases of dermatomycosis. In 11 (28.2%) of the patients tinea pedis, in 3 (7.7%) tinea cruris and in 10 (25.6%) Candida intertrigo were detected. In the remaining 15 (38.5%) cases, only direct microscopic examinations were found positive. The most common causative agent was Candida albicans (33.4%) followed by Trichophyton rubrum (29.1%), Trichophyton mentagrophytes var. interdigitale (29.1%), Candida glabrata (4.2%) and Candida tropicalis (4.2%).Conclusion: The investigation of genital dermatomycosis should be a part of routine urological examination and the clinical diagnosis should be confirmed by mycological methods.

Protective Effects of Phosphodiesterase-4-specific Inhibitor Rolipram on Acute Ischemia-reperfusion Injury in Rat Kidney

OBJECTIVE To investigate the effect of Rolipram, a phosphodiesterase-4-inhibitor, on renal ischemia-reperfusion injury (IRI) in rats. METHODS Thirty rats were divided into 5 different groups of 6 rats. Nothing was done to the control group. In the second group, the renal pedicle was clamped for 30 minutes. In the third group, 1 mg/kg of Rolipram was given by intraperitoneal injection 30 minutes before clamping. The fourth group received the same injection when the clamp was placed, as did the fifth group 30 minutes after the clamp was opened. Clamping time was set at 30 minutes. Twenty-four hours later, nephrectomy was performed in all the groups. Half of each kidney was examined histopathologically. Levels of biochemical agents, such as malondialdehyde, superoxide dismutase, and catalase, were measured in the other half. RESULTS The malondialdehyde (MDA) levels significantly decreased and reached control levels in the group in which Rolipram was administered 30 minutes after reperfusion (P = .07). The catalase and superoxide dismutase activities obtained from renal homogentisates of the ischemia groups were evaluated; there were striking increases in tissue levels of these 2 enzymes in the groups in which Rolipram was administered during ischemia and 30 minutes after ischemia (P < .001). Histopathologically, there was no significant difference in inflammation between the Rolipram-administrated groups compared with group 1 (control) and group 2 (IRI). Tubular necrosis and apoptosis was significantly lower in group 5 than the other groups, except group 1 (P < .001). CONCLUSION We suggest that in surgical procedures that can lead to renal IRI, the administration of Rolipram can decrease oxidative renal tissue damage and the severe deterioration of renal function.

An unusual cause of hematospermia: Primary adenocarcinoma of the seminal vesicle.

Adenocarcinoma of the seminal vesicles is one of the rare causes of hematospermia. Primary seminal vesicle adenocarcinoma is extremely rare and difficult to diagnose due to frequent invasion of adenocarcinomas of the surrounding organs, especially the prostate. In the present study, a case of a primary seminal vesicle adenocarcinoma will be discussed in the light of the current literature.