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.