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Öğe Deterioration of renal function in patients operated for lower urinary tract symptoms(Aves, 2011) Altunoluk, Bulent; Soylu, Ahmet; Beytur, Ali; Soylemez, Haluk; Baydinc, CanObjective: We aimed to investigate the rate of deterioration of the renal function in patients operated for lower urinary tract symptoms, the relation between this rate and patient age, symptom severity, and accompanying diseases. Materials and methods: The data of 369 patients who admitted to our clinic with lower urinary tract symptoms and operated between 01/06/2001 and 31/03/2005 were retrospectively evaluated, and the examination findings and laboratory results have recorded. Results: The preoperative serum creatinin level was <= 1.4 mg/dL in 315 (85.4%) patients and >1.4 mg/dL in 54 (14.6%) patients. The mean age of the patients with serum creatinin level <= 1.4 mg/dL was 68.64 +/- 8.24 years, and that of patients with serum creatinin level >1.4 mg/dL was 72.56 +/- 7.96 years (p<0.05). The level of serum creatinin increased with increasing age, and the renal function was worsened with the increase of symptom score. Also, in the presence of the chronic diseases such as hypertension and diabetes, the rate of renal dysfunction increased by 2.5 times (25.5% vs. 10.9%). There was no correlation between postvoiding residue urine and renal dysfunction. Additionally, the renal dilatation accompanied the increase in the serum creatinin level. Conclusion: In the patients with with lower urinary tract symptoms, the serum creatinin level must be evaluated at the first admission for early diagnosis and treatment of renal dysfunction.Öğe FACTORS AFFECTING SUCCESS IN SURGERY FOR MID-AND DISTAL PENILE HYPOSPADIAS: A COMPARATIVE STUDY OF MATHIEU AND TIPU TECHNIQUES(Aves, 2006) Ugras, Murat Yahya; Ergin, Hseyin; Kilic, Sleyman; Gunes, Ali; Baydinc, CanIntroduction: Surgical repair of hypospadias is influenced by many factors, the most important being the experience of surgeon. In this study, we aimed to determine factors affecting success in Mathieu and TIPU procedures conducted for mid-and distal penile hypospadias. Since we have some differences in patient profile regarding age, previous circumcision and hospital stay, we think that we need our own data to evaluate factors affecting surgical success. Materials and Methods: We retrospectively evaluated our surgical records and retrieved data on primary surgery for mid-and distal penile hypospadias, using either Mathieu or TIPU techniques. We reached patients and refreshed data when necessary. We gathered data on age, family history, previous surgery (circumcision or chordee), native meatal place, existence of chordee, anesthesia technique, type and time of urinary diversion, medications, hospital stay and complications. We analyzed data with software (SPSS 10.0, SPSS inc. ILL, USA) using parametric tests (ANNOVA, Student's T Test, Pearson) and nonparametric (Kruskal Wallis Test, Mann Whitney-U Test) accepted p< 0,05 as statistically significant. Results: Among a total of 149 hypospadias patients presented between 1999 and 2004, 54 meeting our criteria were enrolled. Mathieu and TIPU operations were conducted in 34 (63%) and 20 (37%) patients, respectively. Mean age was 9.6 +/- 6.2 years. Regarding age groups, 15 patients (27.8%) were at 0-5, 25 (46.3%) at 6-12 and 14 (25.9%) at 12< years of age. Native meatus was placed at coronal, subcoronal, distal and mid penis in 16 (29,. 5%), 8 (14.8%), 19 (35.2%) and 11 (20.5%) patients, respectively. Initial operation was successful in 28/ 34 (82.4%) of Mathieu and 15/ 20 (75.0%) of TIPU procedures. The difference was not statistically significant (p> 0.05). Considering age groups or place of native meatus, success rates of both procedure were not significantly different (p> 0.05). Hospital stay ranged between 5 and 33 (mean 8.4 +/- 4.7) days. Postoperative complications were as follows: After Mathieu procedure, 5 (14.7%) urethrocutaneous fistulas were seen and 3 were treated surgically. One patient had wound infection and skin disruption with an intact tube. He had debridement, antibiotic therapy and late closure of skin. After treatment of complications, success rate was 32/ 34 (94.1%). After TIPU procedure, 3 (15.0%) urethrocutaneous fistulas were seen, 2 that applicated were treated surgically. One patient had meatal stenosis and another had skin disruption with intact tube, both treated surgically. After treatment of complications, success rate was 19/ 20 (95.0%). Complication rates of both procedures were similar (p> 0.05). Foley and Nelaton catheters were used as urethral stents in 17 (31.5%) and 37 (68.5%) patients, respectively. Complication rate was significantly higher with Foley Catheter (r: 0.45; p= 0.001). General and spinal-caudal anesthesia were performed in 30 (55.6%) and 24 (44.4%) patients, respectively. Complication rate was significantly higher with regional anesthesia (r: 0.38; p= 0,005). Conclusion: In this series, we encountered factors that affect surgical success, which was in concordance with literature. Due to significantly higher complication rate, Foley catheter is not recommended as drain after both procedures. Regardless of age, we prefer to use general anesthesia in all patients.Öğe Some criteria to attempt second side safely in planned bilateral simultaneous percutaneous nephrolithotomy(Urology, 2008) Gedik, Ender; Güneş, Gülsen; Güneş, Ali; Uğraş, Murat Y.; Yanık, Metin; Soylu, Ahmet; Baydinc, CanTo determine the validity of some criteria that could guide in the decision to cancel or proceed with the second side of planned bilateral simultaneous percutaneous nephrolithotomy (bsPCNL). METHODS Patients with an indication for bilateral PCNL were enrolled in this study. The operation was stopped at the end of the initial side if operative time was 180 min, the hemoglobin level was 11 g/dL, the hemoglobin decrease was 3 g/dL, the systolic arterial pressure was 100 mm Hg, the arterial oxygen saturation was 95%, the arterial blood pH was 7.35, or the blood sodium was 128 mg/mL. The success and complication rates were compared in patients who underwent second side PCNL (group 1) and those for whom the procedure was stopped after the initial side (group 2). RESULTS Of 42 planned bsPCNLs, 12 were stopped after the initial side, with the cause being prolonged operative time in 7, hemoglobin decrease in 6, systolic arterial pressure decrease in 2, arterial oxygen saturation decrease in 2, pH decrease in 1, and sodium decrease in 1. Differences in patient characteristics, stone burdens, and overall success and complication rates were insignificant. Transfusion, postoperative urinary infection, and prolonged urine drainage rates were similar, but the total hospitalization time was significantly longer in group 2. One hydrothorax and one renal pelvic perforation occurred in group 2. The need for transfusion correlated positively with the number of nephrostomy tracts in group 2 (r 0.895, P .001). No such correlation was found in group 1. CONCLUSIONS Despite the best of intentions, about 30% of anticipated bsPCNL cases might be limited to single-sided PCNL, depending on the intraoperative events. Our criteria seem reasonable, because similar success and complication rates were obtained with bilateral, separate-session PCNL and bsPCNL. These criteria can be considered in the decision making to omit the advantages of a single session for safety.Öğe Some Criteria to Attempt Second Side Safely in Planned Bilateral Simultaneous Percutaneous Nephrolithotomy(Elsevier Science Inc, 2008) Ugras, Murat Y.; Gedik, Ender; Gunes, All; Yanik, Metin; Soylu, Ahmet; Baydinc, CanOBJECTIVES To determine the validity of some criteria that could guide in the decision to cancel or proceed with the second side of planned bilateral simultaneous percutaneous nephrolithotomy (bsPCNL). METHODS Patients with an indication for bilateral PCNL were enrolled in this study. The operation was stopped at the end of the initial side if operative time was > 180 min, the hemoglobin level was < 11 g/dL, the hemoglobin decrease was > 3 g/dL, the systolic arterial pressure was < 100 min Hg, the arterial oxygen saturation was < 95%, the arterial blood pH was < 7.35, or the blood sodium was < 128 mg/mL. The success and complication rates were compared in patients who underwent second side PCNL (group 1) and those for whom the procedure was stopped after the initial side (group 2). RESULTS Of 42 planned bsPCNLs, 12 were stopped after the initial side, with the cause being prolonged operative time in 7, hemoglobin decrease in 6, systolic arterial pressure decrease in 2, arterial oxygen saturation decrease in 2, pH decrease in 1, and sodium decrease in 1. Differences in patient characteristics, stone burdens, and overall success and complication rates were insignificant. Transfusion, postoperative urinary infection, and prolonged urine drainage rates were similar, but the total hospitalization time was significantly longer in group 2. One hydrothorax and one renal pelvic perforation occurred in group 2. The need for transfusion correlated positively with the number of nephrostomy tracts in group 2 (r = 0.895, P =.001). No such correlation was found in group 1. CONCLUSIONS Despite the best of intentions, about 30% of anticipated bsPCNL cases might be limited to single-sided PCNL, depending on the intraoperative events. Our criteria seem reasonable, because similar success and complication rates were obtained with bilateral, separate-session PCNL and bsPCNL. These criteria can be considered in the decision making to omit the advantages of a single session for safety. UROLOGY 72: 996-1000, 2008. (c) 2008 Elsevier Inc.
