Y. Ilker

Antimicrobial prophylaxis in management of urinary tract stones by extracorporeal shock-wave lithotripsy: Is it necessary?

OBJECTIVES In a prospective randomized study, we evaluated the incidence of urinary tract infections following extracorporeal shock-wave lithotripsy (ESWL) and the necessity of prophylactic antibiotic administration in patients treated with this modality. METHODS A total of 360 consecutive patients with renal and ureteric stones who had sterile urine before ESWL treatment and did not have any increased risk of infection received either a single dose of 400 mg of ofloxacin or no prophylaxis. Patients were followed by simple urine analysis and urine cultures together, with clinical evaluations. RESULTS Only 3 patients (0.8%) had positive urine cultures at 1 week after ESWL. Two of these patients were in the antibiotic prophylaxis group. CONCLUSIONS The incidence of urinary tract infections after ESWL is extremely low, provided that patients have sterile urine before ESWL, and prophylactic antibiotics are not required.

Transarterial glue embolization in iatrogenic renovascular injuries

Iatrogenic injuries of the intrarenal arterial system include pseudoaneurysms and fistulas. They can cause hematuria and life-threatening hemodynamic instability, and therefore should be treated promptly. Endovascular treatment is recommended for these cases due to its effectiveness. Among the different agents used for embolization, n-butyl-2-cyanoacrylate (glue) has rarely been used. We present 15 patients with pseudoaneurysms and/or arteriovenous or caliceal fistulas who were treated by glue embolization. In our patient group, five had a history of percutaneous nephrolithotomy, six had renal biopsies, three had nephron-sparing surgery, and one had percutaneous nephrostomy. Glue embolizations were performed with the microcatheter technique. All patients were successfully treated, and all but one had excellent follow-ups. One patient suffered from disseminated intravascular coagulation secondary to transfusion and died after the procedure. We think glue embolization is a safe and effective treatment for this group of patients and present our experience along with the technical approach.

Short-term effect of digital rectal examination on serum prostate-specific antigen levels. A prospective study.

OBJECTIVE Prostate-specific antigen (PSA) is widely used as a tumor marker in the early detection of prostate cancer. However, its value is limited by several factors such as not being specific for the cancer tissue, diurnal variations of the secretion, and changes in the serum levels observed following rectal manipulations. The effect of digital rectal examination (DRE) on serum PSA levels is still debatable. METHODS A prospective study is conducted by utilizing the IRMA count (monoclonal) PSA assay in order to determine the effect of DRE on PSA serum levels. A total of 50 men (median age 61, range 42-75 years) who presented to our outpatient clinic for the first time with lower urinary tract outflow obstruction symptoms were included in this study. Further evaluation revealed prostate cancer in 5 patients (10%) and benign prostate hyperplasia in the others. Blood samples were drawn for a PSA assay from all patients prior to and 30 min and 24 h following DRE (PSA 1-3). RESULTS The mean PSA values prior to and 30 min and 24 h following DRE were 4.09 +/- 0.67 range 0.2-19.47) ng/ml, 4.50 +/- 0.63 (0.15-17.75), and 4.28 +/- 0.68 (0.23-24.12) ng/ml, respectively. The median PSA levels for PSA 1, PSA 2, and PSA 3 were 2.49 +/- 4.74, 3.22 +/- 4.48, and 2.62 +/- 4.82 ng/ml, respectively. Although, there was a statistically significant increase in serum PSA levels 30 min after DRE, the clinical significance of this increase in PSA values with a mean difference of 0.4 ng/ml remains to be clarified. CONCLUSION Although the effect of DRE on PSA levels does not appear to be clinically significant, in order to prevent any confusion, it may be the best approach to perform DRE after obtaining serum for PSA analysis.

Solitary fibrous tumor of the kidney

Solitary fibrous tumors are rare spindle cell neoplasms usually arising in the pleura. They have, however, also been reported at extrapleural locations. Solitary fibrous tumor (SFT) of the kidney is rare. Despite its rarity, histological diagnosis of solitary fibrous tumor is crucial to avoid misdiagnosis with other more aggressive tumors arising in the kidney. We report a solitary fibrous tumor of the left kidney that presented as a malignant tumor in a 51‐year‐old woman, and include clinical and radiographic findings. The tumor was well circumscribed and composed of spindle cells in a collagenous stroma. Immunohistochemistry showed reactivity for vimentin, CD 34, BCL‐2 protein and CD99. Immunohistochemical stains for cytokeratin, S‐100, desmin, α‐smooth muscle actin and HMB‐45 were negative. A diagnosis of SFT was made based on light microscopy and immunohistochemistry.

Efficacy of Prophylactic Gentamicin Use in Postoperative Urinary Tract Infections after Endoscopic Procedures of the Urinary Tract

In this study, the efficacy of prophylactic antibiotic use was investigated. A total of 110 patients undergoing endoscopic procedures of the urinary tract were enrolled in the study. Fifty-five of the patients were treated with 8-hourly, 80 mg gentamicin sulfate of total three doses. The drug administration began just prior to the operation. Seven postoperative infections (12.7%) were detected, the same number as in the control group of 55 patients. The results confirm that there is no place for gentamicin prophylaxis in endoscopic procedures of the urinary tract.

Spontaneous fracture of indwelling ureteral stents in patients treated with extracorporeal shock wave lithotripsy: Two case reports

Placement of indwelling ureteral stents adjunctive to ESWL treatment has been a widespread practice. We herein present two cases of spontaneous breakage of double pigtail ureteral stents and their management. Prevention of this complication may be possible by careful examination of the stents prior to insertion, by following the instructions of manufacturers on maximum time limits and by using stent logs to keep track of patients.

Correction of primary and secondary vesicoureteral reflux by subureteric Teflon injection.

Polytetrafluoroethylene (Teflon) has been used for various purposes since 1963 and in urologic practice for the treatment of vesicoureteral reflux (VUR) since the 1980s. In this study we report on our experience with Teflon injection for the treatment of 28 children with primary or secondary reflux. An overall success rate of 91.3% was achieved in the treatment of primary and 66.6% in secondary reflux. With these results we conclude that Teflon injection is a good alternative in the treatment of VUR.

Retroperitoneal fibrosis due to malignancy: A case report

Retroperitoneal fibrosis is idiopathic in two thirds of cases and is found most commonly as an isolated fibrotic plaque centered over the lumbar spine and entrapping one or both ureters.It has been postulated that fibrosis in the idiopathic cases results from a hypersensitivity reaction to antigens leaking into the retroperitoneum from atheromatous plaques in the aorta or common iliac arteries. In the remaining one third of cases, causes include ergot-derivative drugs, retroperitoneal haemorrhage or urine extravasation, and a desmoplastic response to a variety of tumours.

Social and medical aspects of undescended testes in Turkey.

In this study, 6,381 primary school boys were examined in Turkey in the years 1990 and 1991 and families and medical personnel were questioned about the information they had on undescended testes and their behavior regarding this matter was noted. Undescended testes were found in 91/6,381 pupils (1.43%) Forty-six families (58.7%) were aware of the abnormality. In 36 of these 46 cases (78%), the mother was the first who noticed the problem. Only 3 cases were first diagnosed by medical staff (nurses or doctors). Eighteen cases were diagnosed under 2 years of age, but apparently they had not been managed correctly because of ignorance regarding possible complications. Of the 46 families, who were aware of the problem, only 29 (63%) had seen a physician. In other words, only 31% (29/91) of the boys with undescended testes received medical help. This study has shown that no genital organ examination of the newborn is performed after most deliveries and there is a considerable unawareness of undescended testes both by the families and by medical personnel.

The impact of prostate-specific antigen, its density and the Gleason score in the prediction of extracapsular disease in prostate carcinoma.

OBJECTIVE To evaluate the effectiveness of serum prostate-specific antigen (PSA). PSA density (PSAD), the preoperative Gleason score of transrectal-ultrasonography (TRUS)-guided needle biopsies and the Gleason score of the final histological examination in predicting extracapsular disease in prostate cancer (PCa). MATERIAL AND METHODS We retrospectively analyzed 32 patients who underwent radical retropubic prostatectomy as the primary treatment for their clinically localized disease. RESULTS Extracapsular extension was found in 21 patients. In a comparison of different cutoff levels, the best positive predictive values were found for PSA of 20 ng/ml, PSAD of 0.2 and 0.3, a Gleason score of TRUS-guided biopsies of 5 and one of the prostatectomy specimens of 7 with 100, 80 (both), 74 and 95%, respectively, A PSA value higher than 20 ng/ml and a preoperative Gleason score of 7 or higher predicted extracapsular disease with specificity rates of 100 and 91%, respectively. It was noteworthy that there was a statistically significant undergrading in the extracapsular group in the Gleason scores of TRUS-guided biopsies compared to the prostatectomy specimens. CONCLUSION PSA levels above 20 ng/ ml and/or Gleason scores of 7 or higher in TRUS-guided biopsies are strong indicators of extracapsular extension of PCa.