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Öğe Body mass index, body fat percentage, and the effect of body fat mass on SWL success(Springer, 2007) Akay, Ali Ferruh; Gedik, Abdullah; Tutus, Ali; Sahin, Hayrettin; Bircan, Mehmet KamuranObjectives In the present study, we investigated the effects of the Body Mass Index (BMI), the Body Fat Percentage (BFP), and the Body Fat Mass (BFM) on success of SWL, prospectively. Patients and methods The BMI, BFP, BFM values of patients, who were treated by SWL due to upper urinary system stone disease (pelvis renalis, upper ureter, kidney lower and upper calices) between January and December 2005 in our hospital's urolithiasis center, were measured. Patients with stones smaller than 5 mm or larger than 20 mm and patients who had a stone localized somewhere other than in the upper urinary system, were not included in the study. Patients evaluated to be clinically successful according to the SWL were put in group 1, and the other patients who were not successful were included in group 2. Results About 158 (97 male, 61 female) patients aged between 16 and 92 (mean 36.69 (+/- 13.22) years), put on SWL therapy due to presence of upper urinary system stone disease, were included in the study. While the mean BMI was 23.97 +/- 0.4 in group 1 and 25.98 +/- 0.5 (P = 0.02) in group 2, BFP was 23.85 +/- 0.8 in group 1 and 29.19 +/- 1.1 (P = 0.001) in group 2, and BFM was determined to be 16.74 +/- 0.7 and 21.19 +/- 1.01 (P = 0.001) in group 2. Regarding all the parameters (BMI, BFP, BFM), the statistical analyses carried out between the groups showed significant differences. Conclusion BFP and BFM parameters are also important factors along with the BMI in providing a successful SWL treatment. All the parameters should be considered regarding the success of the treatment and the patients should be informed.Öğe The effects of cellular telephone use on serum PSA levels in men(2003) Şimşek, Veli; Şahin, Hayrettin; Akay, Ali Ferruh; Kaya, Halil; Bircan, Mehmet Kamuran; 0000-0002-0854-0904; 0000-0003-2005-6100Background: The increasing use of cellular telephones is known to have harmful effects on human health. The aim of this prospective study was to determine whether cellular telephone use affected serum PSA levels in men. Methods: Participants included 20 men with ages ranging from 22 to 65 years who had never previously used cellular telephones. Blood samples were taken prior to and 30 days after the beginning of cellular telephone use. Serum was separated from the blood samples and stored in a deep freezer until the end of the study, at which time serum free and total PSA levels were determined by tandem radioimmunoassay. The results were statistically analyzed by the Wilcoxon Paired Signed Rank Test. Results: Average free and total PSA values were 2.070 ng/ml and 0.500 ng/ml before the study, and 2.0 ng/ml and 0.505 ng/ml at the end of the study, respectively. No significant difference was determined between the initial and final values (p > 0.05). Conclusions: The results indicate that cellular telephone use does not significantly affect PSA values in the short term. Nevertheless, we think that there is a need for longer-term studies on this subject.Öğe The effects of GnRH analogues and antiandrogenes in preventing the gonadotoxic effects of COPP chemotherapy(2001) Göçmen, Mustafa; Akay, Ali Ferruh; Şahin, Hayrettin; Deniz, Mustafa; Nergiz, Yusuf; Bircan, Mehmet Kamuran; 0000-0002-0854-0904Background: In this study we aimed to discuss whether the gonadal suppression is effective or not in preventing the gonadal toxic effects of some chemotherapeutics. Methods: Forty Sprague-Dawley adult male rats were randomised into 4 groups, each consisting of 10. No drugs were given to the first group. The second group received GnRH agonist and antiandrogen, the third group received COPP chemotherapy protocol and the last group received COPP together with GnRH agonist and antiandrogen. Ninety days after drug application we sacrificed all rats. Total body weight, testicular weight and testicular size measurements were all recorded. All testicular tissues were examined histologically for the ratio of active seminiferous tubules. Results: There was no difference in total body weight. The weight and measurements of testicular tissues were decreased in-group 3 and 4 when compared with 1 and 2. The amount of active seminiferous tubules was significantly less in the third group. Conclusions: As a conclusion we think that gonadal suppression applied during chemotherapy regimen could decrease the testicular toxic effects of chemotherapeutic but more clinical investigations needed for routine application.Öğe Erectile dysfunction rates and requests for treatment in patients attending outpatient urology clinics and those accompanying them(Springer, 2004) Kuru, Ahmet Fevzi; Sahin, Hayrettin; Akay, Ali Ferruh; Bircan, Mehmet KamuranBackground: Erectile dysfunction is a common sexual function disorder in men. The aim of the present study was to determine the rates of erectile dysfunction and requests for treatment in male patients refered to our outpatient urology clinics and those accompanying them who were older than 20 years. Methods: The study comprised 2 groups: group 1 included male patients older than 20 years whom attend to the outpatient urology clinics, and group 2 included their companies whom were older than 20 years. Subjects were asked whether they had erectile dysfunction or not, if so whether they had been treated or not, if not then why, and whether they desired treatment or not at present. Results: Erectile dysfunction was determined in 224 subjects (13.9%) in group 1, and 57 (8.5%) in group 2. It was found that approximately one half (49.1%) of patients with erectile dysfunction did not complaint about this. The main reasons for this were failure to perceive sexual dysfunction as a problem, and shame. Of 281 men who determined to have erectile dysfunction, 71 indicated that they desired treatment. In those who did not desire treatment, the main reasons were failure to perceive it as a problem, and shame. Conclusions: These findings show that the doctor has a great responsibility in determining erectile dysfunction. Therefore discussions of sexual health should be made a routine part of doctor-patient discussions, and patients, especially those over 50, should be asked whether they have a complaint of erectile dysfunction.Öğe The first micturition times of the newborns whose mothers were treated with magnesium sulfate(2001) Şahin, Hayrettin; Akay, Ali Ferruh; Bircan, Mehmet Kamuran; Göçmen, Ahmet; Bircan, Zelal; 0000-0002-0854-0904Background: The aim of this study was to determine whether magnesium sulfate used for the treatment of severe pre-eclampsia or eclampsia had an effect on the first micturition time of the newborn. Methods: The first group included 20 newborns all of whose mothers had severe pre-eclampsia or eclampsia, and all mothers had been treated with magnesium sulfate according to the Parkland Memorial Hospital eclampsia regimen. The second group included 20 newborns all of whose mothers were normal pregnants, and did not receive any drug that had an effect on the contractility of smooth muscles. The first micturition times of all newborns in two groups were determined following delivery and were compared statistically. Results: All newborns urinated in the first 24 hours. There were no statistically significant differences in the micturition times between the two groups (p > 0.05). There was no residual urine after the first micturition, and none of them had any urinary tract abnormality and neurological pathology. Conclusions: From the results, it was concluded that magnesium sulfate had no effect on the first micturition time of the newborns, when applied according to the Parkland Memorial Hospital eclampsia regimen in severe pre-eclamptic or eclamptic pregnants.Öğe İlkokul çağı erkek çocuklarında penis ve testis boyutlarıyla, dış genital organ anomali insidansı(Dicle Üniversitesi, Tıp Fakültesi, 1999) Akay, Ali Ferruh; Şahin, HayrettinBu çalışma Diyarbakır il merkezinde ükokullardaki 7-8 yaş grubundaki erkek çocukların penis boyu, testis hacmi, sünnet olma ve dış genital organ anomali ir sidansını bulmak için planlandı. Çalışmad j. 2000 erkek öğrenci sosyo ekonomik seviyelerine göre iki gruba ayrıldı. Sosyo ekonomik seviyesi düşük (SESD) grupta 1(302, sosyo ekonomik seviyesi yüksek (SESYi grupta 998 öğrenci yer alıyordu. Çocukların penis boyları, testis boyutları ölçüldü. Dış genital organ muayeneleri yapıldı. Sonuçta; penis boyu ortalaması 38.48mm bulundu. Penis boyu SESD kosimde 38.74 mm, SESY kesimden gelen c 'fencilerde 38.24mm olarak ölçüldü. Aj-alarındaki fark istatistiksel olarak anlamsızdı Çocukların testis hacim ortalamaları 9. 11 mi bulundu. Testis hacimleri SESD öğrene;ıerde 9.38ml iken; SESY öğrencilerde 8.71 mi idi. Aralarındaki fark istatistiksel olarak anlamlıydı. Yapılan muayenede %83.55 öğrenci sünnetliydi, SESD kesimdeki öğrencilerde bu oran %87.23, SESY kosimde bu oran %79.86 bulundu. Aralarındaki fark istatistiksel olarak anlamlıydı, öğrencilerin %5.35'inde dış genital orgdn pnomalisi- saptandı. Bu oran SESD k?>simde %5.89, SESY kesimde %4.80'di. Aralarındaki fark istatistiksel olarak artılamsızdı. En sık izlenen anomali inmemiş sstisti (%1.85). Bu oran literatürdeki l oranlardan yüksekti. Bununda nedeni bölgemizde sosyo ekonomik seviyenin düşük olinasıdır. ı [ Tedavi için çocukların yönlendirilmesind temel sağlık görevlilerine büyük iş düşmektedir. Bu nedenle temel sağlık görevlilerinin çocukların dış genital organ muayenelerini tam olarak yapmaları ve bir patoloji gördüklerinde uzmana sevk etjneleri gerekmektedir. 45Elde edilen bu sonuçlarla bölgemizde penis ve testis boyutlarına ait nmogramlar çıkartılmış oldu. Bu tür çalışmaların başka bölgelerde yapılması i ^ Türkiye'ye ait nomogramların oluşturulmasını sağlayacaktır.Öğe Mozaik 47,XXY/48,XXXY kromozom kuruluşunda Klinefelter sendromlu bir olgu sunumu(Dicle Üniversitesi Tıp Fakültesi, 2007) İsi, Hilmi; Oral, Diclehan; Akay, Ali FerruhHastanemiz Üroloji kliniğine başvuran, iki evlilik yapan ancak, infertilite problemi bulunan hastaya Klinefelter ön tanısı ile genetik araştırma yapılmıştır. Yirmi yedi yaşındaki bu bireyde Barr cisimciği pozitif bulunmuş ve GTG bantlama tekniği ile yapılan karyotip analizinde 47,XXY/48,XXXY mozaik yapıda kromozom kuruluşu saptanmıştır.Öğe Obstrüktif üropatide ultrasonografi kılavuzluğunda perkütan nefrostomi(Dicle Üniversitesi Tıp Fakültesi, 2008) Gedik, Abdullah; Kılınç, İlhan; Bayrak, Aylin Hasanefendioğlu; Akın, Davut; Akay, Ali FerruhUltrasonografi (USG) kılavuzluğunda perkütan nefrostomi (PN) uyguladığımız hastaları endikasyon ve komplikasyonlar yönünden retrospektif olarak değerlendirdik. Ocak 2002 ile Aralık 2005 arasında USG kılavuzluğunda PN uygulanan 371 hasta retrospektif olarak değerlendirildi. Hastaların demografik verileri, obstrüksiyon nedenleri, PN’ye bağlı minör ve majör komplikasyonları tartışıldı. Bu periyotta 371 hastaya toplam olarak 455 PN kondu (84 bilateral, 287 unilateral). Hastaların 113’ü (%30.45) bayan, 258’i (%69.55) erkek olup, yaşları 5 ay ile 85 yıl (ortalama 32.17 yıl) arasında değişmekteydi. Perkütan nefrostomi yerleştirilen hastalardan 17’sinde (%3.73) yapılan antegrad pyelografide kateterlerinin yerinde olmadığı saptandı. Genel başarı oranı %96.37 olarak bulundu. Obstrüksiyon sebebi 76 hastada malign hastalıklarken, 295 hastada benign hastalıklardı. Hastalardan 24’ünde (%6.46) majör komplikasyonlar gözlendi. Bunlar 7 hastada transfüzyon gerektiren makroskopik hematüri, 14 hastada sepsis ve 3 hastada iğneyle retroperitoneal kolona giriş meydana geldi. Hastalardan 51’inde (%13.74) minör komplikasyonlar olarak, kendiliğinden düzelen 24 saatten uzun sürmeyen makroskopik hematüri gözlendi. Sonuç olarak; obstrüktif üropatide ultrasonografi kılavuzluğunda perkütan nefrostominin emniyetli bir şekilde uygulanabileceğini ve üst üriner sistemi drene etmek için oldukça yararlı bir yöntem olduğunu düşünmekteyiz.Öğe Premature ejaculation rates and treatment needs in males aged 20 years and over attending urology outpatient clinic(2004) Kuru, Ahmet Fevzi; Şahin, Hayrettin; Akay, Ali Ferruh; Bircan, Mehmet Kamuran; 0000-0002-0854-0904; 0000-0003-3311-3530Aim: The purpose of this study was the assessment of the rates of premature ejaculation and desires for treatment in male patients 20 years and over attending urology outpatient clinic. Methods: All subjects included in the study were asked whether they had a complaint of premature ejaculation; if so, whether they had sought a doctor's assistance; if not, why they had not; why they did not mention their complaint during the first visit; whether they desired treatment; and if not, why they did not. Results: A total of 1608 subjects were questioned. Premature ejaculation was present in 333 (20.7%). Premature ejaculation was the primary complaint of 33 of those attending the urology outpatient clinic. The most common reasons for not seeking a doctor's assistance were failure to see the condition as a problem, and embarrassment. Fifty four (16.2%) of these patients did not desire treatment. The most common reason for not desiring treatment was regarding it as unnecessary at present, and old age. Conclusion: The questioning of all men aged 20 and over attending urology outpatient clinic concerning premature ejaculation will greatly increase diagnoses and treatments.Öğe Prevention of pain and infective complications after transrectal prostate biopsy: A prospective study(Springer, 2006) Akay, Ali Ferruh; Akay, Hatice; Aflay, Ugur; Sahin, Hayrettin; Bircan, KamuranAim: To investigate the effects of lidocaine gel and parenteral antibiotics and povidine lavage in the treatment of pain occurring during prostate biopsy in terms of infective complications. Patients and methods: Eighty patients with indications for prostate biopsy were randomized into two groups. One group underwent lavage with povidine iodine solution and lidocaine gel, and the other received cephtriaxon and lavage. Pain experienced by the patients was measured by visual analog scale (VAS). Blood samples were taken 15 and 60 min after the procedure, and urine culture antibiograms were taken 60 min after the procedure. Results: The average pain score was 3.70 in Group 1 and 4.25 in Group 2; the difference between the groups was not statistically significant (P > 0.05). Likewise, no statistically significant difference between groups was found by the chi square test in either urine or blood cultures (P > 0.05). Conclusions Lavage with betadine prior to transrectal prostate biopsy is adequate in the prevention of infective complications; however, because lidocaine gel is not effective against pain, alternative methods for pain management need to be developed.Öğe Risk factors for lower urinary tract infection and bacterial stent colonization in patients with a double J ureteral stent(Springer, 2007) Akay, Ali Ferruh; Aflay, Ugur; Gedik, Abdullah; Sahin, Hayrettin; Bircan, Mehmet KamuranObjectives We investigated the potential risk factors for lower urinary tract infection and bacterial stent colonization in patients with double-J stents. Patients and Methods A total of 195 double-J stents from 190 patients (95 men and 95 women, mean age 40.22 years) were examined. In all patients, prophylactic antimicrobial therapy was administered at the time of stenting. The stents and urine samples were removed aseptically and the proximal and distal tip segments of the stents were obtained. Three culture specimens were obtained from each stent segment and urine sample. Chi-square tests, odds ratio, and relative risk were used for the statistical analysis. Results Bacterial colonies were found in 24% (47 of 190) of the urine samples, 31% (61 of 195) of the proximal stent segments, and 34% (67 of 195) of the distal stent segments. Of the pathogens identified, Escherichia coli (34 of 47) was the most common. Diabetes mellitus (P < 0.01), chronic renal failure (P < 0.001), and pregnancy (P < 0.01) were found to be risk factors for lower urinary tract infection in patients with stents. An increased stent colonization rate was associated with implantation time, age, and female sex, but these were not statistically significant for lower urinary tract infection Conclusions Diabetes mellitus, chronic renal failure, and pregnancy are associated with a higher risk of lower urinary tract infection. Therefore, patients in these categories should be monitored carefully for infectious complications.Öğe Semi-rigid ureterorenoscopy in children without ureteral dilatation(Springer, 2008) Gedik, Abdullah; Orgen, Seyfettin; Akay, Ali Ferruh; Sahin, Hayrettin; Bircan, Mehmet KamuranObjectives We aimed to retrospectively review the efficiency of ureterorenoscopy (URS) applied without ureteral dilatation for evaluating pediatric ureteral pathologies. Methods The files of pediatric patients hospitalized in our clinic between January 2000 and June 2006 due to ureteral stone disease were reviewed and evaluated retrospectively. The ages, medical histories, physical examination results, preoperative routine blood and urinary tests, and culture results were recorded. Ureteral orifice dilatation was not needed in any of the patients. Due to the risk of mucosal trauma and edema development in the ureteral orifice and intramural ureter, 3F and 4F catheters were applied in all patients following the ureterenoscopy. These catheters were removed 24 h after the procedure. Results The files of 54 pediatric patients with a mean age of 8.5 years (range 1-16 years) were evaluated retrospectively. While diagnostic URS was applied in 12 (22.2%) of the patients, ureteral calculi were determined in 42 (77.8%) patients and the stones were fragmented by pneumatic lithotripter. Twenty-five of the stones were localized in the lower ureter, 16 in the mid-ureter, and 3 in upper ureter. The mean stone size was found to be 7.1 mm (range 4-12). None of the stones migrated to the proximal region. In 2 patients open ureterolithotomy was applied; stones were localized in the upper ureter in both of these patients. Conclusions Ureterorenoscopy can be successfully and safely applied without the need for ureteral dilatation in ureteral pathologies of children.Öğe Transvaginal electrical stimulation in female genuine stress incontinence(Society of Physical Therapy Science (Rigaku Ryoho Kagakugakkai), 2000) Turhanoǧlu, Ayşe Dicle; Akay, Ali Ferruh; Bayhan, Gökhan; Karabulut, Zülfü; Şahin, Hayrettin; Erdoǧan, Ferda; Bircan, KamuranObjective: In this study the efficacy of transvaginal electrical stimulation in female genuine stress incontinence was assessed. Methods: Female patients with urinary incontinence were examined physically following history in a multiclinically based study involving Urology, Gynaecology, Physical Therapy and Rehabilitation. Urodynamics were performed for all patients, and 27 patients with genuine stress incontinence were included in this study. Transvaginal electrical stimulation were applied to the patients 30 mins once a day, 5 days a week, for a total of 4 weeks. The daily number of pads, incontinence and micturition times (day-night) were obtained and all patients completed the incontinence-specific quality of life questionnaire (1-QoL) before, at the end of and at the 3rd month after therapy, and 25 patients who completed this study were evaluated. Results: In patients treated with transvaginal electrical stimulation, the times of incontinence, micturition times, and number of pads were significantly decreased (p<0.001) and the scores of 1-QoL were significantly increased (p<0.001) after treatment and at the 3rd month post-treatment when compared with pretreatment levels. According to subjective assessment eighteen (72%) of patients were cured. The number of patients improved moderately and minimally were 4 (16%) and 3 (12%) respectively. No patient reported side effects during treatment. Conclusion: Transvaginal electrical stimulation could be an effective and safe treatment for women with genuine stress incontinence.Öğe Üreter üst uç taşlarının üreteroskopik tedavisinde stone cone kullanımı(2005) Bircan, M. Kamuran; Atuğ, Fatih; Akay, Ali Ferruh; Alar, Salih; Yamış, SaitRetrograde taş migrasyonu üreteroskopik litotripsi esnasında proksimal ureter taşlarının %40-50'sinde görülebilmektedir. Taşın tamamı böbreğe geri kaçabildiği gibi litotripsi esnasında kırılan taş parçaları da migrasyona uğrayabilmektedir. Taşın migrasyonunu ve geriye kaçmasını engellemek amacıyla geliştirilmiş olan stone cone tm kateter bu amaçla kullanılabilmektedir. Bu çalışmada stone cone'un proksimal ureter taşlarının üreteroskopik tedavisindeki etkinliğini araştırdık. Bu çalışmada 2003-2004 yılları arasında proksimal üreter taşı olan 22 hastaya üreteroskopik litotripsi işleminden önce stone cone uygulandı. Hastaların ortalama yaşı 33.6 ±0.6 (19-59) yıl, ortalama taş boyutu 9.6±1.4 (8-21) mm olarak saptandı. Stone cone 22 hastada başarıyla yerleştirildi', bu hastaların 14'ünde skopi eşliğinde sistoskopik olarak, 8'inde ise üreteroskopik olarak yerleştirildi. Ortalama operasyon süresi 55±16 dakika (35-80) olarak saptandı. Üreteroskopi işleminde 8.5 F semirigid üreteroskop kullanıldı. Hastaların tamamında pnomotik litotriptör ile litotripsi uygulandı.Stone Cone™ tarafından ureter içerisinde tutulan taş parçaları tripot ve basket kateter kullanılarak güvenle alındı. Hastaların hiçbirinde taşın tamamının böbreğe geri kaçışı görülmedi, sadece 1 hastada (%4.5) 3 mm'lik bir taş parçasının böbreğe geri kaçmış olduğu görüldü. Stone Cone 'nun proksimal ureter taşlarının böbreğe geri kaçmasını engellemede ve litotripsi ile kırılmış olan taş parçalarının üreter içerisinde tutulup alınmasında etkili ve faydalı olduğunu düşünmekteyiz.Öğe Üriner sistem taş hastalığı olan çocuklarda veziko üreteral reflü oranı(2005) Şahin, Hayrettin; Akay, Ali Ferruh; Aflay, Uğur; Uzun, Fatih; Akay, Öztürkmen HaticeBu çalışmada prospektif olarak kliniğimizde üriner sistem taş hastalığı tanısıyla yatan çocuk hastalarda voiding sistoüretrografı ile vezikoüreteral reflü (VUR) sıklığını araştırdık. Eylül 2000 ile Mart 2004 tarihleri arasında hastanemiz üroloji kliniğine taş hastalığı tanısıyla yatırılan hastalarda prospektif olarak VUR sıklığı araştırıldı. Çalışmaya alınan tüm hastaların taş hastalığı tedavisi öncesi, anamnez, fizik muayene, biyokimyasal, mikrobiyolojik analizleri yapıldı. İdrar kültür antibiyogramlarında üreme saptanan hastalara duyarlı antibiyotik tedavisi yapıldı. Tüm hastalara voiding sistoüretrografı uygulandı. Hastalar gerekli taş tedavisini aldıktan sonra, VUR saptananlara supresyon tedavisi uygulanarak kontrol önerildi. Kontrollerde VUR durumuna göre medikal tedaviye devam edildi veya gerekli cerrahi tedavi hastalara önerildi. Çalışmaya yaşları 1.5 ile 13 yıl (Ortalama 6.75 yıl) arasında değişen 50 çocuk taş hastası alındı. Hastaların 41'i (%82) erkek, 9'u (%18) kız idi. Hastaların 37'sinde böbrek, 8'inde üreter, 2'sinde hem böbrek hem mesane, 2'sinde hem böbrek hem üreter ve l'inde de sadece mesane taşı saptandı. Otuz iki hastaya operasyon uygulanırken 17 hastaya ESWL yapıldı; bir hasta ise tedaviyi kabul etmeyerek taburcu edildi. Voiding sistoüretrografı sonrası hastalardan 6'smda (3 erkek, 3 kız) VUR saptandı. Tüm çocuk taş hastalarında VUR görülme oranı %12 olarak bulundu. Sonuç olarak çocuklarda VUR ve üriner sistem taş hastalığı birlikteliğini unutmadan, laboratuar ve radyolojik bulguları iyice değerlendirdikten sonra gerekli hastalara VSUG çekilmelidir.Öğe USE OF STONE CONE™ DEVICE IN URETEROSCOPIC MANAGEMENT OF PROXIMAL URETER STONES(Aves, 2005) Atug, Fatih; Akay, Ali Ferruh; Alar, Salih; Yamis, Sait; Bircan, M. KamuranIntroduction: Ureteroscopy is a very common modality used to treat ureteral calculi. Retrograde stone migration during ureteroscopic lithotripsy might be seen in 40-50% of proximal ureteral stones. Stones are pushed often completely back to the kidney or stone fragments might migrate. This migration increases morbidity and the need for additional procedures. Various different equipments and techniques have been developed for preventing stone migration. Lithocatch T, Lithovac T and Parachute T are some of these devices. Nevertheless these devices are only 12 Fr in largest diameter which may be too small for dilated ureters and they fill up the most of the space of the ureteroscope working channel. The stone cone T is a device that goals to prevent proximal calculus migration and allow safe extraction of small calculi during ureteroscopy. The stone cone T catheter may be used to for these aims during ureteroscopic lithotripsy. In this study, we assessed the clinical use and efficacy of the stone cone T device in the treatment of proximal ureter stones. Materials and Methods: Between 2003 and 2004, we used the stone cone T in 22 patients with proximal ureteral calculi undergoing ureteroscopic lithotipsy. The mean age of patients was 33.6 +/- 0.6 years (19 to 59) and mean stone diameter was 9.6 +/- 1.4 mm (8-21 mm). Stones were on right side in 13 patients and on left side in 9 patients. Preoperative examinations included plain x-ray film of the kidneys, ureters and bladder, excretory urography and urine culture. All procedures were performed under general anesthesia and all patients were operated on standard lithotomy position. Ureteroscopy was performed with 8.5 Fr semirigid ureteroscope. Pneumatic lithoriptor was used for lithotripsy in all cases. Stone cone T was introduced through the cystoscope under fluoroscopic control. Stone cone T was required placement under direct ureteroscopic control in patients with impacted stones. Results: Stone cone T was placed successfully in 22 patients. In 14 patients, it was placed via cystoscopy under fluoroscopic guidance, while 8 patients with impacted stones required ureteroscopic placement. Mean operation time was 55 +/- 16 minutes (35-80 min). Intracoporeal pneumatic lithotripsy was used in all patients. All stones were fragmented successfully with pneumatic lithotriptor. Ureteral stent was placed to all patients with impacted ureteral stones. Stone fragments, which were entrapped in the ureter by the stone cone T, were extracted safely with common stone baskets. Stone migration was seen in only 1 (4.5%) patient, in which a 3 mm stone fragment migrated to the kidney. No major complication was associated with the use of stone cone T. Conclusion: In this study, stone cone T catheter was used in 22 patients with proximal ureteral stone and the efficacy plus the safety of this catheter was evaluated. In our experience, stone cone T is an effective and useful device that prevents proximal ureteral stone migration and allows safe extraction of fragments during ureteroscopic lithotripsy. We think that failure in trapping fragments smaller than 3 mm, is the main disadvantage of this device. The stone cone T appears to be a useful addition to the urological armemantarium.Öğe VESICOURETERAL REFLUX INCIDANCE IN CHILDREN WITH URINARY STONE DISEASE(Aves, 2005) Akay, Ali Ferruh; Uzun, Fatih; Akay, Hatice Ozturkmen; Aflay, Ugur; Sahin, HayrettinIntroduction: In spite of the frequent association of urinary infection with vesicoureteric reflux and urinary calculi, the coexistence of vesicoureteric reflux and calculi is rare. Four factors (urinary calculi, urinary tract infection, structural changes at the uretero vesical junction and reflux) may interact in these cases. In this prospective study we studied the prevalence of vesicoureteral reflux (VUR) in children with urinary stone disease. Materials and Methods: Between September 2000 and March 2004 we evaluated the prevalence of VUR in children with urinary stone disease. In all patients history, physical examination, biochemical and microbiologic analyses were done before the treatment of stone disease. We did voiding cystouretrography in all patients. Patients were divided based on surgical method, including extracorporeal shock wave lithotripsy (ESWL), endoscopy and open surgery. Some patients required combined treatment. After the treatment of stone disease, all patients with VUR received suppressive antibiotic treatment. During follow up period surgical treatment was applied when necessary. Results: Fifty children between 1.5 and 13 years old (median 6.75 years) were included in this study. 41 of patients (82%) were male, 9 (18%) were female. In 37 of patients stone was located only in kidney, 8 were located in urethra, 2 had kidney and bladder stones, 2 had kidney and urethra stones simultaneously. Only 1 patient had bladder stone. In 6 patients (3 male, 3 female) VUR was diagnosed with voiding cystouretrography. Of the patients 2 had bilateral reflux (1 patient with bilateral calculi and the other with left kidney and bladder calculi), 2 had right side reflux (1 had urethra calculi and 1 has contralateral kidney calculi), 2 had left side reflux (1 on ipsilateral kidney calculi and 1 on ipsilateral ureteral calculi). The prevalence of VUR was 12%. Conclusion: In children with urinary stone disease one must always remember that VUR can be seen simultaneously. So if necessary VSUG should always be applied. All patients with urinary stones, particularly staghorn calculi, and urinary tract infection have to be examined for vesicouretral reflux, after the stone or stones have been removed and appropriate antimicrobial therapy has been given.
