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Öğe The affects of increasing experience on the percutaneous nephrolithotomy operations(2007) U?raş Y.M.; Güneş A.; Soylu A.; Baydinç Y.C.Introduction: Importance and priority of minimally invasive methods in treatment of kidney stones are known and accepted by concerned medical doctors. Percutaneous nephrolithotomy is a minimally invasive surgical technique that is being applied for 30 years, and is also continuing its evolution meanwhile. From the first years of establishment to date, indications and surgical technique of this operation is developed as well as surgical results. Application in our country for this operation began at 1990's. Knowing how surgical results are affected by passing time and increasing experience is important for both getting information on how budding young surgeons should be trained on this issue and for developing anticipation on the future of percutaneous nephrolithotomy. In this review, in the light of national and international publications, we tried to summarize the evolution process, investigate the affects of increasing clinical and academical experience on results and give an idea on the surgical training methods of percutaneous nephrolithotomy.Öğe Bilateral simultaneous percutaneous nephrolithotomy: Our initial experience(2003) U?raş M.Y.; Güneş A.; Yilmaz U.; Soylu A.; Baydinç C.Introduction: Percutaneous nephrolithotomy is a minimally invasive method of stone disease surgery, defined in 1976 and is being applied for a variety of indications since than. This surgery is a routine in our clinic for treatment of one kidney in a single session for adults and children since 1998. In May 2001, we have performed our first bilateral simultaneous percutaneous nephrolithotomy operation. In this manuscript, we have evaluated our surgical results in patients who underwent this operation, regarding surgical outcomes, success and complication rates and secondary methods of treatment for residual fragments. We have also investigated renal functional changes in early postoperative period by means of renal functional tests. Material and Methods: We have evaluated success, complication, auxiliary and secondary procedure rates, catheterization and hospitalization times in six patients who underwent this operation. At the same time, we noted BUN and creatinine changes between preoperative period and 6th and 48th postoperative hours. A fragment that is 4mm in largest diameter was rendered as "clinically insignificant". We have also summarized our experience in patients who underwent surgery for one kidney at a single session, with special emphasis on success and complications in a table. Since the data is not suitable, we did not perform any statistical tests for comparison. Results: Four of the 12 renal units had staghorn and another four had multiple stones initially. Mean stone surface area was 542 mm2 and 568 mm2 in right and left kidneys, respectively. Nine kidneys were operated via single nephrostomy tract while two and three tracts were created for two and one kidney units, respectively. In four renal units, at least one nephrostomy tract needed to be created between 11th and 12th ribs. Of the six patients operated, four rendered stone free or with clinically insignificant stone fragments in both kidneys. Of the patients with residual stone fragments, one was cleared by ESWL followed by ureterorenoscopy. So, our initial success rate was 66,6% and success after secondary procedures was 83,3%. A residual stone fragment persisted in one patient. Mean time of surgery was 225 minutes and mean hemoglobin decrease was 2,75 mg/ml. The second side was operated at a mean of 80 minutes. Mean body temperature decrease was 1,7°C during the operation. One patient needed blood transfusion. Measurements at 6th postoperative hour revealed a mild increase in BUN and creatinine in three patients, but no clinical sign of renal insufficiency was ever realized in any patients. These changes returned to preoperative values at 48th hour. Mean time of urethral catheterization was 1 day and mean time to nephrostomy removal was 3,6 days. Patients were hospitalized for a mean of 5,5 days. Conclusion: Although we have experience in unilateral operations, bilateral simultaneous operation is a new and limited experience for us; larger series may be more suitable to derive strict knowledge on efficacy and safety. Our data reveals that bilateral simultaneous percutaneous nephrolithotomy may be a safe and efficient operation in patients with suitable indications and with experienced surgeons.Öğe Case report: Percutaneous nephrolithotomy for an ectopic kidney with stone disease(Akademiai Kiado Rt., 2002) Güneş A.; U?raş M.; Yilmaz U.; Bozkurt A.; Gürpinar T.[No abstract available]Öğe Comparison of efficiency and safety of two rigid ureterorenoscopes with different sizes(2003) U?raş M.; Güneş A.; Kiliç S.; Yilmaz U.; Baydinç Y.C.Introduction: Ureterorenoscopes with different features are being produced by various companies for the treatment of ureteric stone disease. Independent and objective evaluations of efficiency and safety are needed for these equipments while purchasing. Material and Methods: Retrospective evaluation of 142 and 115 operations for ureteric stones using 11.5F and 10F rigid ureterorenoscopes respectively was done, noting stone free rates, application of intracorporeal lithotripsy, need for auxilary procedures or open surgery and complications. Efficiency coefficient (EC) was calculated for each equipment, and inter-group statistical analysis was performed. Results: The ureterorenoscope with a smaller diameter had a higher EC, lower need for auxilary procedures and open surgery. Complications showed different dispersion for each equipment and only some of them revealed statistical significance. Conclusion: We think that ureterorenoscopes with smaller diameter are more efficient and safe, but may have some unexpected complications. Although not mentioned in this article, it should be considered that knowledge, experience and habits of the surgeon are as much effective as these objective criteria on the results.Öğe Comparison of screening of vesicoureteral reflux with renal ultrasound and voiding cystourethrography(Akademiai Kiado Rt., 1998) Balbay M.D.; Özsan Ö.; Özbek E.; Özkan S.; Güneş A.Purpose: To suggest a different method for diagnosing vesicoureteral reflux (VUR) in lieu of voiding cystourethrography (VCU), in order to prevent radiation exposure. Materials and methods: Fifty-two ureterorenal units of 26 patients were evaluated ultrasonographically for visualizing the renal collecting systems, both before and after filling up the bladder with saline infusion. Every patient also underwent evaluation with VCU. Results: All patients with Grade 2 or higher degrees of VUR on VCU can be identified by ultrasound (USG). Overall sensitivity and specificity of this technique were 66.7% and 93.48%, respectively, in our patient group. Conclusion: After being diagnosed with VCU initially a VUR patient can be effectively followed up by USG in order to prevent radiation exposure. Considering the clinical management of a patient with Grade 1 VUR which could not be detected with USG, it is concluded that failure to detect Grade 1 VUR will not be a handicap.Öğe Kidney loss due to forgotten ureteral stent(2004) Soylu A.; Altunoluk B.; Güneş A.; Baydinç Y.C.Introduction: Double J ureteral stents are being used in urological practice for more than 25 years. The indications for stent insertion have increased during the recent years. Thus the complications of stents are also more frequent than before. In addition to irritative symptoms, indwelling stent usage could lead to serious complications especially due to prolonged implantation periods. Materials and Methods: In this report, we present two cases in which forgotten double J stents necessitated nephrectomy due to loss of renal function caused by the development of pyonephrosis and retroperitoneal abscess. Conclusion: Kidney loss due to forgotten ureteral stent is the most dramatic and unwanted complication. The indications for stent insertion should be considered carefully in every patient. Preventive measures and regular follow up are very important before indwelling a double J stent, especially for the early diagnosis of complications.Öğe Penile fracture: 11 years' experience(2003) Soylu A.; Güneş A.; U?raş M.Y.; Ipek D.; Baydinç C.Objectives: Penile fracture is the rupture of the tunica albuginea of one or both corpora cavernosa due to direct trauma to the erected penis. Partial or complete rupture of the urethra or injury to the deep dorsal vein may accompany to penile fracture. In this study, we present our clinical experience in 15 patients presented with penile fracture between 1992 and 2003. Material and Methods: Fourteen of the cases applied in the first 24 hours and all has undergone emergency surgery. One case applied six months after the fracture of his penis. Of the patients 9 had right, 4 had left and one had both cavernosal tunical ruptures, with defects of 1 to 2.5 cm in length. Patient with bilateral injury had accompanying complete urethral rupture. One patient had deep dorsal vein rupture. Defects of corpora cavernosa was repaired by interrupted 2/0 vicryl sutures. Tension-free end-to-end anostomosis with 4/0 vicryl sutures was performed for complete urethral rupture, after releasing both ends. Ruptured deep dorsal vein was ligated at both ends with 2/0 vicryl. Results: The patients were aged between 19 and 72 (mean: 36.2 years). Of the cases, 14 have applied within 2 to 13 hours from the rupture and one after 6 months. Seven (46.7%) of the fractures was due to penile straightening or bending by hand, 4 (26.7%) due to sexual intercourse, 2 (13.3%) due to turning on or failing from the bed, 1 (6.7%) due to a child fallen on to the penis while joking, and 1 (6.7%) due to slamming by door. The patient who applied 6 months after the fracture got the diagnosis of impulse control disorder with psychiatry consultation. As postoperative complications, two patients had decreased quality of erections; three had painful erections and two had premature ejaculation. Patient who has not undergone emergency surgical correction due to late application had painful erection with penile deviation. Conclusion: Urethral rupture is usually partial and only seldomly complete among the patients. Among the penile fracture cases from our country, 2.5% had accompanying incomplete urethral rupture. At first, conservative methods like cold applications, antiinflammatory drugs and suppression of erection have been preferred for penile fracture treatment. Recently, early surgical repair of corpora cavernosa that decreases complication rates are being applied. Cases of penile fracture are more common and are increasing in number in our country when compared to cases worldwide. It is important to have knowledge on diagnosis and treatment. According to our experience of 11 years, emergency surgery is the efficient method of treatment to prevent postoperative complications.
