Yildirim Bayazit

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.

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

OBJECTIVEnTo investigate the effect of Rolipram, a phosphodiesterase-4-inhibitor, on renal ischemia-reperfusion injury (IRI) in rats.nnnMETHODSnThirty 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.nnnRESULTSnThe 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).nnnCONCLUSIONnWe 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.

Effects of Vas Deferens Obstruction on Cajal-Like Cells in Rats

Objective: Cajal cells have been defined as pacemakers in the gastrointestinal tract, and have recently been reported in the urogenital tract. In this study, the effects of experimental obstruction of the vas deferens on Cajal-like cells in rats were investigated. Material and Methods: Ninety rats were divided into study (S), sham-operated (SH) and control (C) groups. The vasa deferentia were removed at the beginning of the study in the C group and in the 1st, 2nd and 3rd months after distal vas deferens ligation in the SH and S groups (S1, S2 and S3 consecutively). The sections stained with c-kit antibody were studied under a light microscope to determine the number and morphology of Cajal-like cells in the submucosal and muscular layers. Results: There were no statistically significant differences between the C, S1 and S2 groups despite a higher mean in S1. The decrease in the mean values for the submucosal and muscular layers in S3 was statistically significant compared to the C group. No morphologically significant difference was detected under a light microscope after obstruction. Conclusions: The increase in Cajal-like cells in the early phase, although insignificant, might be associated with increased motility to overcome the obstruction, whereas the significant decrease in the late phase might be a sign of disordered motility.

Laparoscopic pyeloplasty in adults: stented versus stentless.

INTRODUCTIONnIn this study, we aimed to investigate the efficacy and feasibility of stentless laparoscopic pyeloplasty (LP), compared with the stented counterpart.nnnMATERIALS AND METHODSnWe compared the results of stented and stentless LP procedures performed at two centers. The indications included symptoms such as loin pain or urinary tract infection with documented obstruction on renal scintigraphy. Transperitoneal approach was standard for both techniques. The stented and stentless patient groups were compared with regard to surgical duration, length of hospital stay, postoperative symptomatology, complications, and radiologic and scintigraphic findings.nnnRESULTSnTwenty-seven patients with stentless pyeloplasty with at least 6 months of follow-up were included in the study and compared with a matched group of 21 stented LP patients. All had Anderson-Hynes dismembered pyeloplasty. Mean operative time was 151.9 minutes and 144.6 minutes in the stented and stentless groups, respectively (pu2009>u20090.05). Mean drain removal time and hospital stay were 1.9 days (range: 1-9 days) and 3.4 days (range: 2-9 days) in the stented group, respectively, and 2 days (range: 1-10 days) and 3.1 days (range: 1-10 days) in the stentless group, respectively (pu2009>u20090.05). Renal scintigraphy studies improved in 14 patients in the stented group and in 22 patients in the stentless group during the 6-month follow-up. Symptoms completely resolved in 19 of the stented and in 24 of the stentless cases.nnnCONCLUSIONnStentless LP is a feasible technique as its stented counterpart. Although it has a relatively high prolonged leakage risk, it could be performed without compromising the success rate by experienced surgeons.

Retroperitoneoscopic nephroureterectomy via three trocars in pediatric patients with end-stage reflux nephropathy.

BACKGROUND AND PURPOSEnIn children with end-stage reflux nephropathy, nephroureterectomy can be performed either open or laparoscopically. It is not common to use a three-trocar retroperitoneal approach for nephroureterectomy with complete ureteral excision in the pediatric age group. We report the results of pediatric retroperitoneoscopic nephroureterectomies by using three trocars only.nnnPATIENTS AND METHODSnBetween August 2003 and November 2009, 13 children-seven boys and six girls-with end-stage reflux nephropathy underwent retroperitoneoscopic nephroureterectomy. The operations were performed by using three trocars with the patient in a flank position under general anesthesia. Renal blood vessels were individually dissected and divided followed by the transection of the ureter at the level of the ureterovesical junction.nnnRESULTSnThe mean age of the patients was 6.5 ± 4.4 years (15 months-14 years). Eight of the operations were performed on the left and five on the right side. Mean operative time was 137 ± 47 minutes (75-230 min). Estimated blood losses were minimal. Mean hospitalization time was 2.2 ± 0.9 days (2-5 d). No major intraoperative complication was seen. Overall postoperative analgesic requirement was minimal. Cosmetic results were excellent at the initial postoperative visit.nnnCONCLUSIONnRetroperitoneoscopic nephroureterectomy by using three trocars is feasible and safe with excellent outcomes in pediatric patients with end-stage reflux nephropathy.

Beneficial effects of rolipram, a phosphodiesterase 4 specific inhibitor, on testicular torsion-detorsion injury in rats

INTRODUCTIONnThe aim of the study is to investigate the effect of Rolipram, a selective phosphodiesterase 4 inhibitor, on testicular torsion - detorsion injury.nnnMETHODSnSixty young male rats were divided into five groups. In each group, the right testes of six rats were removed four hours after detorsion for biochemical analysis, and the right testes of the remaining six rats were removed 24u202fh after detorsion for pathological analysis. In group 1 (sham-operated) right orchiectomy was performed without torsion, and right testes were sent to the laboratory for biochemical and pathologic analyses. In group 2 (control) torsion was applied to the right testes for 60u202fmin, and detorsion was performed without the administration of Rolipram. In group 3 torsion was applied to the right testes for 60u202fmin. 1u202fmg/kg Rolipram was administered 30u202fmin before detorsion. In group 4 torsion was applied to the right testes for 60u202fmin, and 1u202fmg/kg Rolipram was administered during detorsion. In group 5 torsion was applied to the right testes for 60u202fmin. 1u202fmg/kg Rolipram was administered 30u202fmin after detorsion. The malondialdehyde and nitric oxide levels were determined. The rates of necrosis and apoptosis were evaluated by histopathological examination.nnnRESULTSnThe level of malondialdehyde was higher in the torsioned groups (Group 2, 3, 4, 5) than that in group 1 (pu202f=u202f0.004). There was no statistically significant difference between the groups regarding the level of nitric oxide (pu202f=u202f0.182). Apoptosis was higher in groups 2, 3 and 4 than in group 1; however, apoptosis was similar in group 1 and group 5 (pu202f=u202f0.122). The level of necrosis in group 1 was similar to that in groups 4 and 5 (pu202f=u202f0.194 and pu202f=u202f0.847, respectively).nnnCONCLUSIONnWe suggest that the administration of Rolipram can decrease the rate of necrosis and apoptosis in testicular ischaemia-reperfusion injury.

Evaluation of Concordance between Gleason Scores of Tansrectal Ultrasound Guided Biopsy and Radical Prostatectomy Samples in Prostate Cancer

Objective : In this study, we investigated the concordance between Gleason scores of transrectal ultrasound guided biopsy and radical prostatectomy specimens in patients diagnosed with prostate cancer via transrectal ultrasound guided biopsy and treated with radical prostatectomy in our clinic. Material and Method : 115 patients were included in our study treated with radical prostatectomy for organ-confined prostate cancer between the dates of November 2011 and December 2014. Data of these patients are reviewed retrospectively. Results : The average age of the patients was 61.8 ± 6.8 (43-76) years. The average body mass index of these patients were (BMI) 26.7 ± 3.34 (19.3 – 35.3) kg/m². Average PSA value was 6.6 ± 10.1 (1.4 – 80) ng/ml. Gleason scores of transrectal ultrasound guided biopsy and radical prostatectomy were observed concordant in 74 (64.3%) of 115 patients, while 41 (35.6%) were not concordant. Gleason score was decreased by 1 grade for 8.6% (10 patients) of patients, it was increased by 1 for 26.0% (30 patients) of patients and for 0.8% (1 patient) it was increased by 3. Discussion : These findings indicate indicate that Gleason scores of transrectal ultrasound guided biopsy and prostatectomy specimens may be discordant.

Effects of Laparoscopic Ureterolithotomy and Simultaneous Trans-Trocar Semi-Rigid Ureteroscopy on Stone-Free Rate in the Treatment of Proximal Ureteral Stones

Between November 2011 and July 2013, laparoscopic ureterolithotomy was performed in 19 patients with proximal ureteral stones. A history of failed shock wave lithotripsy (SWL) or semi-rigid ureteroscopy (sr-URS), presence of ureter stones ≥15 mm and/or impacted stones, or a socioeconomic status not allowing the patient to reach an advanced center for flexible ureteroscopy (f-URS) were identified as the surgical indications.

İntraabdominal Kriptorşidizmle Bağlantılı Splenogonadal Füzyonun Laparoskopik Tanı ve Tedavisi

Splenogonadal fusion is a rare congenital anomaly in which there is a fusion between spleen and gonad. According to the literature, 37% of them had unnecessary orchiectomy. We present a patient with splenogonadal fusion in undescended testis, who was preserved from unnecessary orchiectomy.