Yeni Üroloji Dergisi / The New Journal of Urology

59-65

Authors: Ekrem Akdeniz, Kenan Öztorun

Objective: Forgotten ureteral stents (FUS) may entail major complications such as infection, migration, encrustation, stone formation, and kidney failure. These complications increase with duration of stent indwelling. We discuss our experience of therapeutic approaches to treatment management of patients living with double J (DJ) stents for more than 10 years. Material and Methods: Data for three patients living encrusted DJ stents for more than 10 years were evaluated retrospectively. Results: All three subjects stated that they did not present to physicians due to absence of typical stent symptoms (such as hematuria, flank pain, and urgency). All three patients presented to us with urinary tract symptoms. Advanced renal function loss was present in two patients, and non-functional kidney in one. Laparoscopic nephroureterectomy was performed on the patient with a non-functional kidney, and multimodal nephron-sparing surgery on the other two. Conclusions: Despite all the many advances in technology, long-term encrusted stents lead to sepsis and loss of kidney function. We think that not forgetting is the best means of protection against encrusted stent-related complications.

75-79

Authors: Abdullah GÜL, Murat GÜL , Nazım A KANKILIÇ , Ahsen K AKGUL

Objective: To preserve testicular functions, surgery for undescended testis is recommended between 6 and 18 months of age. However, many patients undergo orchiopexy later than recommended ages. In this paper we aimed to assess influence of socio-economic development level of Van province on age at orchiopexy in our center. Materials and methods: The medical records of the patients who were treated with orchiopexy in Van Education and Research Hospital between January 2014 and July 2018 were reviewed in this cross-sectional study. Patients divided into two groups according to age at operation. The surgery which was performed at 18 months of age and later has been defined as “late” orchiopexy. Mean age at orchiopexy was investigated and results were discussed by comparing with other similar studies. Results: The mean age of 353 patients enrolled in this study was 4.9 ± 3.5 years and of them, 242 (68.5%) had late orchiopexy. According to the ‘’Research of socio-economic development of the provinces and regions’’ report published by Ministry of Development in 2011, Van province was in the group of the most underdeveloped provinces and ranked as 75th of 81. Conclusion: Although most of boys included in the study underwent orchiopexy at a later age than suggested, our results were similar with other national and international studies. Socio-economic level of city is an important reason but there are some other factors causing the late surgery. We think that increasing the parents’ education level and regular home visits by primary care providers will be effective on early orchiopexy.

87-90

Authors: Tuncay TAŞ , Basri ÇAKİROGLU , Ersan ARDA

Introduction: Penile superficial venous thrombosis is a rare and little-known benign genital condition. The largest series of penile superficial venous thrombosis cases in literature include 25 and 30 patients. Material-Methods: A retrospective evaluation was made of the data of 23 patients who were treated and followed up for a diagnosis of PMD in the Urology Outpatient Clinic between January 2009 and January 2018. Anamnesis, superficial vein color Doppler ultrasonography and routine laboratory analysis (i.e. blood count, electrolytes and coagulation tests) were applied to the patients. A conservative approach was provided the use of NSAIDs, anti-coagulant agents and topical Arnica Montana, and avoidance of the sexual activity. Follow-up examinations were made after 1, 3, 5, and 8 weeks and 3 months of treatment. Clinical improvement was evaluated. Results: The age of the patients in the study was mean 42.4 ±11.12 years and median 44 years (range, 22-66 years). The mean BMI of the patients was 28.5±2.48 (range, 22.91-34.31). The mean period between the onset of symptoms and presentation was 9.35±13.42 days, median 4 days, and range, 1-60 days. On presentation, all the patients had painless palpable cord symptoms. In 20 patients, the thrombotic vein could not be determined externally. The diameter of the thrombosis was mean 3.09±1.04mm and median 3mm (range, 1.8–5). The diameter of the obstructed veins ranged from 1.3 to 4.7 mm. No pathological findings were determined in the standard laboratory tests of all 23 patients. The lesions were found to be parallel to the sulcus below the coronal sulcus in 8 patients (video), and 15 patients had a cord-like lesion on the dorsal penis (picture). The venous color Doppler ultrasound results were similar for all the patients. No color filling and flow spectrum was observed in the lumen of the superficial vein on color Doppler US. In the etiology, prolonged sexual activity was determined in 8 patients, prolonged masturbation in 5, the use of a vacuum erection device in 3, and 7 patients were idiopathic. Only 1 patient had a history of PMD development. Conservative treatment was applied to 21 of the 23 cases. Thrombectomy was required in 2 cases. At follow-up examination, two recurrent episodes were observed. Conclusions: Penile Mondor’s disease is rare, but causes noticeable anxiety in patients. The results of this study demonstrate the effect of trauma in the etiology. Patients generally recover with conservative treatment, and occasionally surgical treatment may be necessary.

100-108

Authors: Osman AKYÜZ , Kamil ÇAM , Özge UZUN

Objective: It is clearly know that lower urinary tract symptoms (LUTS) are not solely associated with benign prostatic hyperplasia. Any process that can cause structural or functional changes in the bladder might also be related with the development of LUTS. Nevertheless, the exact mechanisms causing LUTS have not clearly been defined yet. The aim of this experimental study was to investigate the impact of aging on detrusor functions using organ bath. Material and Methods: Rats were divided into two groups as young and old. The first group consited of 10 rats with 6 monts of age, while the second group contained 10 rats with 24 months of age. The isolated detrusor strips were placed in the organ bath containing Krebs -Heinseleit solution. Ach (Acetylcholine) and KCl were utilized to study contraction. The response to same agents were obtained with the addition of L-NAME (Nω-Nitro-L-arginine methyl ester). Relaxation function was compared between these groups by using phenilefrine and SNP (Sodium nitropruccide). Student’s t test was used to assess the statistical significance. Results: The contraction response to Ach with high concentrations was significantly powerful in young rats with compare to old rats. A similar significant response was observed in young rats when L-NAME was added to Ach. However, no significant difference was seen when KCl was applied. On the other hand, the old rats showed a significant relaxation response when low concentrations of phenilefrine and SNP were utilized in muscles that had been concracted by Ach. Moreover, when the muscles had been concracted by KCl, a significantly higher relaxation was noticed by using low concentrations of SNP and high concentrations of phenilefrine in old rats with compare to young rats. Couclusion: In this experimental study of aging bladder, a remarkable difference in bladder functions was observed between young and old rats in terms of responding various agents by using organ bath. This finding suggets a possible alteration in receptor properties of the bladder aging. Therefore, it can be postulated that aging may cause alterations in bladder functions which in turn may be associated with development of LUTS.

115-120

Authors: Musab Ali Kutluhan , Tuncay Toprak

Objective: We aimed to determine the relationship between vitamin D levels and benign prostate hyperplasia BPH) related lower urinary tract symptoms (LUTS) in men over 40 years of age. Material and Methods: The study was conducted prospectively between January and April 2019 and included 48 patients who presented to the outpatient clinic with lower urinary tract symptoms and who had not received medical or surgical treatment due to BPH (BPH group) and 52 healthy men (Control group) who did not have lower urinary tract symptoms and applied to the outpatient clinic for routine urological control. Vitamin D, total PSA, total testosterone values, IPSS scores, prostate volumes and maximum urinary velocity in uroflowmetry (Q max) of both groups were evaluated. Results: The mean age of 48 patients with benign prostatic hyperplasia in BPH group was 65.37 ± 7.24 and in control group without urinary tract symptoms was 64.09 ± 8.22. There was a statistically significant difference between BPH and control groups in terms of the mean values of 25 hydroxy vitamin-D values (p< 0.001). When the patients diagnosed with BPH were examined according to their subgroups; there was no statistically significant difference in terms of 25 hydroxy vitamin D level between moderate LUTS (33 patients) and severe LUTS (15 patients) groups(p> 0.05). Conclusion: Our study has shown that in patients with BPH and LUTS, 25 hydroxy vitamin D levels were lower than those in the similar age group without any complaints. Based on this, it was thought that there might be an improvement in the symptoms of patients with increasing vitamin D levels. To reach a final judgment on this subject, larger number of randomized controlled prospective studies are needed.

127-134

Authors: Serdar YALÇIN, Nejdet KARŞIYAKALI, Engin KAYA , Sercan YILMAZ , Eymen GAZEL, Sanan ASGARLI , Mesut GÜRDAL, Selahattin BEDİR

Objective: In this study we aimed to evaluate the effectiveness of shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRC) in treatment of lower pole kidney stones. Material and Methods: The data of 134 patients who underwent SWL or RIRC treatment for lower pole kidney stone between January 2018 and August 2019 were retrospectively reviewed. The groups were compared statistically in terms of demographic characteristics, stone characteristics and stone-free rates. Results: Ninety-two (68.7%) male and 42 (31.3%) female patients were included in the study. Fifty-nine (44.0%) patients had stone in the right kidney and 75 (56.0%) had stone in the left kidney. The mean age of all patients was 47 ± 16 years, stone burden was 94.7 ± 62.0 mm2 and Hounsfield Unit was calculated as 819.5 ± 256.2. There were 73 (54.5%) patients in the SWL group and 61 (45.5%) patients in the RIRC group. Stone-free rates were calculated as 52.1% and 72.1% for SWL and RIRC groups, respectively. Although stone burden was higher in RIRC group than SWL group, stone-free rate was higher (p=0.004 and p=0.018, respectively). Conclusion: When compared with SWL, higher stone-free rates can be achieved with RIRC with lower number of sessions even in cases with higher stone burden.

1-6

Authors: Osman BARUT , Sefa RESİM

Aim: Nowadays, percutaneous nephrolithotripsy (PNL) is the first choice of minimally invasive treatment for large and complex kidney stones. In this retrospective study, we compared the efficacy and safety of PNL surgeries performed under spinal and general anesthesia. Method: A total of 82 patients who underwent PNL between October 2016 and August 2018 were included in the study. There were 34 patients in the general anesthesia group (group 1) and 48 patients in the spinal anesthesia group (group 2). All patients' stone and urinary system features, operation parameters and postoperative findings were recorded. Independent Samples t Test, Mann Whitney U and Chi-Square tests were used. P <0.05 was considered as statistical significance. Results: There was no statistically significant difference between the two groups in terms of mean age, gender and stone sizes respectively (p = 0.20, p = 0.83, p = 0.24). The mean operative time was 57.91 ± 10.18 minutes (min) in Group 1 and 53.56 ± 9.33 min in group 2, and there was a statistically significant difference (p = 0.04). The mean fluoroscopy time in Group 1 was 4.23 ± 1.54 min and 3.56 ± 1.25 min in group 2 and there was a significant difference (p = 0.008). While the stone-free rate was 84.2% in group 1, this rate was 85.5% in group 2 and no significant difference was found (p = 0.31). The mean length of hospital stay was 51,08 ± 11,27 hours in group 1 and 50,12 ± 11,18 hours in group 2 (p = 0,70). There was no postoperative headache in group 1, but 4 patients had postoperative headache in group 2, but this was not statistically significant (p = 0.13). Conclusion: Spinal anesthesia is a fast and reliable method of anesthesia in patients scheduled for PCNL. It is thought that spinal anesthesia will be used with increasing frequency as it has advantages of short operation and fluoroscopy times.

11-18

Authors: Ali Rıza TÜRKOĞLU, Yasemin ÜSTÜNDAĞ , Soner ÇOBAN, Muhammet GÜZELSOY , Murat ÖZTÜRK, Atilla SATIR, Hakan DEMİRCİ, Kağan HUYSAL

Purpose: To investigate the importance of the Hemoglobin/Red cell distribution width ratio (Hb/RDW) and Neutrophil/Lymphocyte ratio (NLR) in predicting bladder lamina propria invasion before transurethral resection in non-muscular invasive bladder cancer (NMIBC) patients Methods: The data of the patients whose pathology after transurethral resection of the bladder was NMIBC between January 2010 and June 2016 were evaluated retrospectively. Group 1 had Ta (mucosa involvement) and Group 2 had T1 (submucosa involvement) lesions. The age, gender, tumor size and number of tumors of the patients were identified. The preoperative blood leucocyte (WBC), hemoglobin (Hb), neutrophil (N), lymphocyte (L), monocyte (M), platelet (PLT), mean platelet volume (MPV), and red cell distribution width (RDW) values were identified and the NLR, PLR, LMR values calculated. The Hb/RDW ratio was determined. Results: A total of 369 patients were evaluated. The mean age was similar between groups. Group 1 (Ta) consisted of 219 patients (66.3±10.7 years) and Group 2 (T1) 150 patients (66.9±10.4 years) (p=0.638). NLR was higher in Group 2 than Group 1 (2.4 (1.5) and 2.2 (1.5), respectively, p=0.042) and this difference was statistically significant. The Hb/RDW ratio in Group 2 was lower than in Group 1 (0.89±21 and 0.94±19, respectively, p=0.019) and this difference was statistically significant. Conclusion: We believe that a decrease in the Hb/RDW ratio and increase in NLR, which can be easily determined from the peripheral blood in the preoperative period, can be associated with lamina propria invasion (T1). These studies should be supported with prospective large series.

27-32

Authors: Soner ÇOBAN, Ünal KURTOĞLU , Ali Rıza TÜRKOĞLU , Muhamammet GÜZELSOY , Murat ÖZTÜRK , Abdullah GÜL , Efe ÖNEN , Osman AKYÜZ, Metin KILIÇ

Aim: To investigate the utility of corticomedullary strain ratio (SR) in the diagnosis and follow-up of urinary obstruction Material and Methods: Forty volunteer patients (26 males, 14 females) aged between 18-60 years, who were admitted to our outpatient urology clinic with renal colic due to stone and diagnosed as unilateral urinary tract obstruction via CT, were included in the study. Contralateral intact kidneys of the same patients were accepted as control group. The age, gender, duration of renal colic, blood pressure and BMI of the all patients were also recorded. Patients were examined with renal ultrasonography, doppler ultrasonography and Real Time Elastography (RTE) by a single radiologist with 8 years of experience in abdominal radiology. The average of these three measurements was used in statistical analysis. Strain ratio (SR) was measured by marking the region of interest in the medulla and cortex determined in B mode during the decompression phase. Results: No difference was observed in terms of age between the groups. We found a positive correlation between renal pelvic diameter and RI in obstructed kidney (p=0.006 ve r=0.446). There was a statistically significant difference between mean corticomedullary SR values of hydronephrotic kidneys (0.38 ± 0.43) and mean SR values of contralateral intact kidneys (0.61 ± 0.69) (p=0.025). Also, we observed statistically significant difference between the mean arterial doppler values of the hydronephrotic kidneys (0.64 ± 0.06) and the arterial doppler values of intact kidneys (0.60 ± 0.05) (p=0.026). Conclusion: The measurement of renal corticomedullary SR by RTE, which is a noninvasive method, can be used in the diagnosis and follow-up of urinary obstruction. This finding is supported by increased arterial RI data in urinary obstruction described in the literature.

39-44

Authors: Mehmet SOLAKHAN , Ömer BAYRAK

Aims: We aimed to compare the efficiency of cold knife urethrotomy and laser urethrotomy in endoscopic surgery of urethral strictures. Material-Methods: A total of 171 patients were evaluated retrospectively. A 118 patients with complete data were divided into two groups (group 1; n = 53 cold knife urethrotomy, group 2; n = 65 laser urethrotomy) in the study. Length of the stricture, operation time, preoperative and postoperative 3rd, 6th and 12th-month Qmax values, recurrence and the presence of complications (such as bleeding, extravasation, fever etc.) were compared in terms of the two groups. Results: The operation time was found to be shorter in patients who underwent cold knife urethrotomy (14.01 ± 3.86 min vs 25.03 ± 4.43 min, p=0.001). The Q max values at the postoperative 3rd, 6th and 12th months were observed to be higher in patients who underwent laser urethrotomy (p=0.03, p=0.001, p=0.001). At the end of a one-year follow-up, recurrence was determined in 28 (52.83%) patients in group 1 and 12 (18.46%) patients had a recurrence in group 2 (p=0.01). No statistically significant difference was observed between the two groups in terms of postoperative complications. (p=0.209). Conclusions: In this study, it was determined that laser urethrotomy technique was a more successful surgical method than cold knife urethrotomy in the endoscopic surgery of urethral strictures as it has higher Qmax values and lower recurrence rate. The results should be supported by prospective, randomized studies.

51-55

Authors: Mehmet SEVİM , Bekir ARAS , Şahin KABAY

Bladder carcinoma is the most common tumor of the urinary system. More than 90 % of malignant bladder cancers are transitional cell tumors. Non-transitional tumors of the bladder account for 5-7 % of all bladder tumors; 3 % squamous cell carcinoma, 2 % adenocarcinoma, 1 % indifferentiated carcinoma and, more rarely, small cell carcinomas and lymphoma. Primary lymphoma of the bladder is very rare. Although rare these tumors should be kept in mind by urologists and should be considered in unusual bladder masses. In this article, we present a case of primary bladder lymphoma who was operated with a preliminary diagnosis of bladder tumor.