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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 Computed tomography guided percutaneous nephrostomy(2003) Baysal T.; Soylu A.; Saraç K.; Alkan A.; Dusak A.; Sarier M.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 Evaluation of symptoms due to ureteral stents(2007) Soylu A.; Altunoluk B.; Söylemez H.; Yolo?lu S.; Baydinç Y.C.Introduction: Double J ureteral stents are being used in urological practice for more than 25 years and in the recent years indications have continued to expand. Thus the complications and side effects of ureteral stents are also more frequent than previously reported. In addition to the severe complications resulting from forgotten or intentionally left stents for longer durations in ureters, they might also cause physical and emotional side effects due to bothering symptoms. The majority of the uncomfortable symptoms are related to urinary tract and these symptoms have severe negative impact on patients' general health status and quality of life. In this study, we evaluated the symptoms bothering the patient and impairing the quality of life due to stents. Materials and Methods: One hundred and twenty eight men and 79 women who were treated with ureteral double J stents were recruited. The patients were followed with a questionnaire consisting of 14 questions concerning urgency, incontinence, painful voiding, incomplete emptying, urethral pain, hematuria, sleep disturbance, need for analgesics, overall weakness, social life enjoyment, sexual dysfunction, getting permission from work/school, urinary tract infection and the need for extra antibiotics at 1 and 4 weeks after stent insertion and 1 week after stent removal. In addition to the presence or absence of a symptom, the frequency of the symptom, when it is present, was also asked based on a subjective classification [occasionally (25%), sometimes (50%), most of the time (75%), all of the time (100%)]. The symptoms of each period are compared by statistical analysis. Results: The mean age was 40.1 (range: 8-80) years. The indications for double J insertion were nephroureterolithiasis (n: 184), pregnancy related hydronephrosis (n: 8), malignancy (n: 7), ureteropelvic junction obstruction (n: 5), ureterovesical junction obstruction (n: 2), perforation (n: 1). There was no history of previous double J stent insertion in any patient. Double J stents were inserted to the right, left and both ureters in 92, 100 and 15 patients respectively. All double J stents used in the study were made up of polyethylene and except for 4 patients' stents with 6F diameter and 26 cm length were inserted. In the 4 pediatric patients 4.8 F diameter and 16 cm length double J stents were used. There was no change in the social life enjoyment with stent placement or removal. All other symptoms increased with the increased duration of the stent and decreased with the removal. The most significant two symptoms at the post insertion one week were painful voiding (43%) and urgency (41%) resulting from irritation of the stent. Also these two symptoms were significantly high (73%) at the fourth week. Conclusion: The results of our study indicates that ureteral stents have negative impact on general health status, sexual functions, school/work performance and quality of life in addition to the increased urinary tract related symptoms, and these negative effects increase with the duration of the stent. Therefore, the indications and durations of the ureteral stents must be revisited in the light of the quality of life, and unnecessary insertions and longer durations should be avoided.Öğe Evrim Bougie: A new instrument in the management of urethral strictures(2001) Yilmaz U.; Gunes A.; Soylu A.; Balbay M.D.Background: In this study a new instrument and technique is described for the endoscopic treatment of complete posterior urethral strictures, which may result in serious complications and sometimes require troublesome treatments. Methods: Three patients with complete posterior urethral obstruction were treated endoscopically with the guidance of a new instrument: Evrim Bougie. Evrim Bougie looks like a Guyon Bougie, has a curved end, which facilitates getting into the bladder through the cystostomy tract and with a built in channel of 1.5 mm in diameter for a sliding needle exiting at its tip. Having confirmed fluoroscopically and endoscopically that the sliding needle had passed across the strictured segment, the strictured segment was incised with internal urethrotomy, distal to the strictured segment, and urethral continuity was accomplished. At the end of the operation a Foley urethral catheter was easily placed into the bladder per urethra. Patients were instructed in self-catheterization after removal of the urethral catheter. All patients achieved normal voiding at postoperative 7th month follow-up evaluation. Conclusion: Internal urethrotomy could be performed under the guidance of the sliding needle of Evrim Bougie advanced from above the posterior urethral strictures, which to our knowledge was described for the first time in the English literature. We also believe that there may be other possible indications of Evrim Bougie for different procedures in urethral surgery.Öğe Isolated inguinal bladder hernia izole inguinal mesane hernisi(2010) Baysal T.; Soylu A.; Erdogan O.Isolated urinary bladder herniation into the inguinal canal is rare. It is often diagnosed intraoperative? during surgery or is identified after intraoperative injury. Early diagnosis with radiologic imaging is important to avoid complications during repair surgery. Computed tomography seems the best imaging choice to outline the details of herniation. We report an incidentally discovered case of inguinal bladder herniation with intravenous pyelography and computed tomography findings. © Medical Journal of Trakya University. Published by Ekin Medical Publishing. All rights reserved.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 Labial fusion causing micturitional disturbance(2004) Soylu A.; Sarier M.; Davarci M.; Baydinç Y.C.Introduction: Labial fusion is the complete or partial adherence of the vulval labia majora or labia minora in the midline. The condition is most frequently seen in girls between the ages of 6 months to 6 years The cause is unknown, but it may be related to the low levels of circulating estrogen and to irritation that erodes vulvar epithelium. The urinary tract is rarely affected in patient with labial fusion. Materials and Methods: We report a case of labial fusion that caused micturitional disturbance. She is treated by surgery. Conclusion: Therapy usually consists of estrogen cream application to the contact surface of the labia minor. If estrogen therapy fails, surgical therapy may be necessary.Öğe 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.Öğe Pulmonary embolism after penile deep dorsal vein embolization with n-butyl-2-cyanoacrylate and lipiodol mixture(Elsevier BV, 2004) Kutlu R.; Soylu A.; Alkan A.; Turker G.Venogenic erectile dysfunction is an important problem. Embolization of draining veins through penile deep dorsal vein is an effective alternative endovascular treatment procedure. We report a 27-year-old male with venogenic erectile dysfunction who developed pulmonary embolism after penile deep dorsal vein embolization with n-butyl-2-cyanoacrylate (NBCA) and lipiodol mixture. Although it is uncommon, due to inherent possible complications of liquid embolic material n-butyl-2-cyanoacrylate and lipid soluble contrast material lipiodol, symptomatic pulmonary embolism could be seen after deep dorsal vein embolization if the amount of lipiodol is increased and repeat injection is performed without performing a control venogram. © 2003 Elsevier Ireland Ltd. All rights reserved.
