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Öğe Bilgisayarlı tomografi eşliğinde perkütan nefrostomi(Türk Üroloji Dergisi/Turkish Journal of Urology, 2003) Baysal, T.; Soylu, A.; Saraç, K.; Alkan, A.; Dusak, A.; Sarıer, M.Öz: Bu çalışmada ultrasonografi veya floroskopi yardımı olmadan bilgisayarlı tomografi (BT) eşliğinde yapılan perkutan nefrostomilerin (PN), özellikle pelvikalisiyel dilatasyonu minimal olan veya hiç olmayan hastalarla, böbrek anatomisi ve yerleşimi normalden farklı hastalardaki yeri araştırıldı. Çalışmaya toplam 40 hastaya BT eşliğinde uygulanan 48 PN'nin (8 hastada bilateral) verileri dahil edildi. Uygulama Seldinger yöntemine uygun olarak yapıldı ve BT hem pelvikalisiyel sisteme iğne girişinde hem de kateter yerleştirmede kullanıldı. Perkutan nefrostomi hastaların tümünde başarıyla gerçekleştirildi. İşlemler sırasında herhangi bir majör komplikasyon gözlenmedi. Perkutan nefrostomi uygulanan 48 böbreğin 28'inde (%58.3) minimal pelvikalisiyel genişleme mevcuttu. Hastaların 4'ünde obezite, 4'ünde ise böbrek rotasyon anomalisi mevcuttu. Bir hastanın böbreği hem ektopik yerleşimli hem rotasyon anomalisine sahipti. Bir hastada önceki PN girişimine bağlı olarak subkapsüler hematom ve bir başka hastada böbrek posterolateraline doğru uzanan kolon segmenti mevcuttu. Perkutan nefrostomi işlemlerinin 18'i interkostal aralıktan yapıldı. Perkutan nefrostomi 35 (%73) işlemde tek iğne girişi ile gerçekleştirilirken. 13 (%27) işlemde ikinci kez tekrarlanan iğne girişi ile pelvikalisiyel sisteme ulaşıldı. İşlem süresi ortalama 28 dk (17-36 dk) idi. Bilgisayarlı tomografi eşliğinde PN obez hastalarda, pelvikalisiyel dilatasyonu olmayan veya minimal olan, böbrek anatomisi ve yerleşimi normalden farklı veya retrorenal yerleşimli kolon varyasyonuna sahip hastalarda güvenle kullanılabilecek komplikasyon oranı düşük, güvenli bir yöntemdir. Başlık (İngilizce): Computed tomography guided percutaneous nephrostomy Öz (İngilizce): Objectives: We investigated the value of computed tomography guided nephrostomies in patients with absent or minimal pelvicaliceal dilatation and with different kidney anatomy and localization without using ultrasound and fluoroscopy. Material and Methods: We attempted 48 computed tomography guided nephrostomy placements in 40 patients. Both puncture of collecting system and placement of the catheters were made under computed tomography guidance. The Seldinger method was used in all procedures. Results: Percutaneous nephrostomies were successfully achieved in all patients without major complications. There were minimal dilatation of the pelvicaliceal systems in 28 (58.3%) of 48 nephrostomies. Four patients had obesity, and another 4 had rotation anomaly. One patient had both ectopic located and malrotated kidney. One patient had subcapsular haematoma and another one had retrorenal colon variation. Eighteen of the percutaneous nephrostomies were made intercostally. Single puncture was used in 35 (73%) and twice puncture were used in 13 (27%) procedures. The time necessary for the procedure ranged from 17-36 min (mean 28 min). Conclusion: Computed tomography guided percutaneous nephrostomy is a safe method with low rate of complications especially in patients with obesity, without pelvicaliceal dilatation or with minimal dilatation and patients with ectopic, malrotated kidneys and retrorenal colon variations.Öğe Diagnostic value of penile color doppler ultrasonography in patients with veno-occlusive erectile dysfunction(Wolters Kluwer Medknow Publications, 2021) Soylu, A.; Sarier, M.; Kutlu, R.Background: The method used in the first assessment of patients with veno-occlusive erectile dysfunction (ED) is penile color doppler ultrasonography (PCDU). However, cavernosography performed following intracavernosal pharmacostimulation is accepted as a more precise method for showing venous leakage. Aims: The objectives of this study were to compare results obtained from patients undergoing PCDU, and those undergoing cavernosography, and to investigate the diagnostic value of PCDU in the diagnosis. Methods: A total of 133 patients who presented at the urology clinic due to ED have veno-occlusive dysfunction (VOD) detected as a result of PCDU and underwent cavernosography for further assessment when scheduled for penile embolization. The results obtained were retrospectively evaluated. Results: The mean age of 133 patients with VOD identified as a result of PCDU was 48.7 +/- 11.2 years. In cavernosography performed after PCDU, venous leakage was detected in 127 patients (95.49%), while no leakage was found in six patients (4.51%). Bilateral venous leakage was found in 91.34% (n:116), right venous leakage in 5.51% (n:7), and left venous leakage in 3.15% (n:4) of the patients with venous leakage. Conclusion: Evaluating the cavernosography results, PCDU alone is often sufficient to diagnose veno-occlusive ED. Cavernosography is a more invasive diagnostic method compared to PCDU that is adequate in cases where venous surgery or embolization is not considered, and cavernosography is not recommended in these patients.Öğe EFFECTS OF EXERCISE ON VARICOCELE(Elsevier Science Bv, 2010) Soylemez, H.; Beytur, A.; Oguz, F.; Kahraman, B.; Soylu, A.[Abstract Not Available]Öğe İki taraflı böbrek taşlarına eş zamanlı perkütan nefrolitotomi: İlk deneyimlerimiz(Türk Üroloji Dergisi/Turkish Journal of Urology, 2003) Uğraş, M. Y.; Güneş, A.; Yılmaz, U.; Soylu, A.; Baydinç, C.Öz: Aynı ameliyat seansında iki taraflı böbrek taşlarına perkutan nefrolitotomi yaptığımız hastalardaki cerrahi sonuçlarımızı değerlendirdik. Aynı zamanda hastalardaki erken dönem renal fonksiyon değişikliklerini inceledik. Bu ameliyatı yaptığımız altı hastanın başarı, komplikasyon, ek tedavi, kateterizasyon ve hospitalizasyon sürelerini değerlendirdik. Aynı zamanda, hastaların cerrahi öncesi ile cerrahi sonrası 6. ve 48. saatler arasında BUN ve kreatinin değişikliklerim saptadık. Dört hasta taşlanndan temizlendi veya klinik önemi olmayan parçalar kaldı. Bir hasta ek tedavi olarak ESWL ve sonra üreterorenoskopi ile taştan kurtuldu. Bir hastada rezidü taş kaldı. Cerrahi ortalama 225 dakika sürdü, hemoglobin ortalama 2,75 gr/dl azaldı. Bir hastada kan transfüzyonu gereği oldu. Ameliyattan sonra 6. saatte yapılan ölçümlerde üç hastanın BUN ve kreatinin değerlerinde ılımlı yükselme görüldü. Bu değişiklikler 48. saatte eski değerlerine döndü. Hastalar ortalama 5,5 gün hastanede kaldı. Aynı seansta iki taraflı perkutan nefrolitotomi, uygun endikasyonlu hastalarda etkin ve güvenli bir ameliyat tekniği olabilir. Başlık (İngilizce): Bilateral simultaneous percutaneous nephrolithotomy: Our initial experience Öz (İngilizce): 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 à 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 11 and 12 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 48' 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 THE MIDDLE AND EARLY TERM RESULTS OF TRANSOBTURATORY TAPE METHOD(Elsevier Science Bv, 2010) Soylu, A.; Karaca, S.; Beytur, A.; Baydinc, C.[Abstract Not Available]Öğe OUR EXPERIENCES OF HEMOSTASIS WITH PERCUTANEOUS CAUTERIZATION IN PERCUTANEOUS NEPHROLITHOTOMY CASES(Elsevier Science Bv, 2010) Oguz, F.; Soylemez, H.; Beytur, A.; Soylu, A.; Gunes, A.[Abstract Not Available]Öğe OUTCOME OF TIPU TECNIQUE IN CHILDREN AND ADULTS WITH PRIMARY DISTAL AND MIDPENIL HYPOSPADIAS(Elsevier Science Bv, 2010) Soylemez, H.; Oguz, F.; Beytur, A.; Burgu, B.; Soylu, A.[Abstract Not Available]Öğe Penil fraktür: 11 yıllık deneyim(Türk Üroloji Dergisi/Turkish Journal of Urology, 2003) Soylu, A.; Güneş, A.; Uğraş, M. Y.; İpek, D.; Baydinç, C.Öz: Penil fraktür, ereksiyon halindeki penisin direkt travmaya maruz kalması sonucu tek veya iki taraflı korpus kavernozumda tunika albugineanın yırtılmasıdır. Penil fraktüre parsiyel veya komplet üretra rüptüru veya derin dorsal ven yaralanmaları da eşlik edebilir. Bu çalışmada kliniğimize 1992-2003 yılları arasında penil fraktür nedeniyle başvuran 15 olgudaki 11 yıllık klinik deneyimimiz sunulmaktadır. Olgularımızın 14'ü ilk 24 saatte başvurdu ve hepsine acil cerrahi girişim uygulandı. Bir olgu penil fraktürden 6 ay sonra başvurdu. Hastaların 9'unda sağ, 4'ünde sol, birinde her iki korpus kavernozumlarda tunika albuginealarda 1-2,5 cm arasında değişen uzunluklarda yırtılmalar vardı. Bilateral yırtılma olan hastada aynı zamanda komplet üretra rüptüru vardı. Bir olguda da sadece derin dorsal ven rüptüru meydana gelmişti. Postoperatif komplikasyon olarak 2 olguda ereksiyon kalitesinde azalma, 3 olguda ağrılı ereksiyon ve 2 olguda prematür ejakülasyon gelişti. Geç başvuran ve cerrahi onarım yapılmayan hastada ise penil bükülme ve ağrılı ereksiyon vardı. Penil fraktür olguları dünya geneline göre ülkemizde oldukça sık görülmekte olup sayı gittikçe artmaktadır. Tanı ve tedavisinin iyi bilinmesi önemlidir. Bizim 11 yıllık tecrübemize göre acil cerrahi girişim postoperatif komplikasyonları önlemede etkin tedavi yöntemidir.Öğe Some Criteria to Attempt Second Side Safely in Planned Bilateral Simultaneous Percutaneous Nephrolithotomy Editorial Comment(Elsevier Science Inc, 2009) Ugras, M. Y.; Gedik, E.; Gunes, A.; Yanik, M.; Soylu, A.; Baydinc, C.Objectives: 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 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.
