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Öğe Endoscopic treatment of complete posterior urethral obliteration.(1998) Sahin H.; Bircan M.K.; Akay A.F.; Göçmen M.; Bilici A.The management of posterior urethral obliteration remains a surgical challenge. We report our experience with 5 patients treated endoscopically for posterior urethral obliteration. We performed endoscopic reconstitution of the urethra followed by temporary self-dilation in five patients with complete short posterior urethral obliteration (less than 3 cm). Average follow-up is 31 months (21-53 months). During follow-up 4 of these patients required 1 or 2 internal urethrotomies within the first 4 to 24 months after treatment. But, any urethral stricture has not been established until the average 23.2 months (21 to 27 months). The other fifth patient has no complication at twenty-first month postoperatively. One patient had impotence after the injury. Impotence continued and total incontinence developed after the endoscopic treatment. We believe that endoscopic treatment followed by temporary self-dilation could be a reasonable alternative to open urethroplasty in patients with an impassable short stricture.Öğe Use of stone cone™ device in ureteroscopic management of proximal ureter stones(2005) Atu? F.; Akay A.F.; Alar S.; Yamiş S.; Bircan M.K.Introduction: 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™, Lithovac™ and Parachute™ 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™ is a device that goals to prevent proximal calculus migration and allow safe extraction of small calculi during ureteroscopy. The stone cone™ 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™ device in the treatment of proximal ureter stones. Materials and methods: Between 2003 and 2004, we used the stone cone™ 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 min (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™ was introduced through the cystoscope under fluoroscopic control. Stone cone™ was required placement under direct ureteroscopic control in patients with impacted stones. Results: Stone cone™ 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™, 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™. Conclusion: In this study, stone cone™ 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™ 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™ appears to be a useful addition to the urological armemantarium.Öğe Vesicoureteral reflux incidance in children with urinary stone disease(2005) Akay A.F.; Uzun F.; Akay H.Ö.; Aflay U.; Şahin H.Introduction: 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.
