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Öğe Blunt and penetrating bladder injuries(Aves, 2010) Gedik, Abdullah; Gedik, Ercan; Tutus, Ali; Kayan, Devrim; Bircan, KamuranObjectives: We aimed to review our diagnostic and treatment protocols for patients with injured bladders by blunt and penetrating traumas. Materials and methods: Fifty-two patients with injured bladders hospitalized in the Urology and General Surgery clinics between January 1996 and January 2009 were retrospectively evaluated. Results: Of the patients 43 (81%) were males and 9 (19%) were females, and their ages were between 17 and 70 (mean 31.9 +/- 12.11). Twenty eight (54%) of the patients were injured by penetrating and 24 (46%) by blunt traumas. The mean transportation time to hospital was 155 +/- 34.12 (range 30-1440) min. Retrograde cystographies could only be done in 28 patients. In the remaining hemodynamically unstable 24 patients, bladder injuries were diagnosed during laparatomy. Totally 41 (79%) patients including all 28 penetrating injuries and 13 of 24 blunt injuries had intraperitoneal bladder rupture. The rupture was retroperitoneal in the remaining 11 (21%) patients injured by blunt traumas. Intraabdominal adjacent organ injuries were more frequent in intraperitoneally ruptured cases. In extraperitoneally ruptured patients bone fractures were the main adjacent pathologies. Intraperitoneal rupture of all 41 patients was sutured primarily and we replaced a cystostomy tube in 14 of these patients. In 7 of 11 cystographically diagnosed retroperitoneal ruptures we only replaced a urethral Foley catheter for treatment. In the remainining 4 patients the bladder was sutured primarily because wide rupture and diffuse extravasation. One patient was lost because of acute respiratory distress syndrome developed following surgery. Wound infections, pneumonia, intraabdominal abcess, enterocutaneous fistula, and evisceration were seen as postoperative complications in 4, 2, 1, 1, and 1 patients, respectively. Conclusions: When diagnosed early the success rate of treatment in bladder injuries was quiet high. The adjacent organ injuries were the main pathologies increasing the postoperative morbidity and mortality.Öğe Blunt and penetrating renal injuries: 18-year experience(Aves, 2009) Gedik, Abdullah; Gedik, Ercan; Deliktas, Hasan; Sahin, Hayrettin; Bircan, KamuranObjective: We evaluated patients who were treated for renal injuries. Materials and methods: A total of 203 patients (168 males, 35 females; mean age 31 +/- 9 years) who underwent treatment for renal injuries between January 1990 and August 2008 were evaluated with respect to etiology, diagnostic methods, the severity of injury, accompanying organ injuries, treatment, and complications. Renal injuries were graded according to the severity scale of the American Association for the Surgery of Trauma. Results: Penetrating injuries accounted for 60.1% (n= 122), and blunt trauma accounted for 39.4% (n= 80), while one patient had both. The majority of penetrating injuries were gunshot wounds (69.7%). Six patients (3%) had bilateral renal injury. Time to presentation ranged from 20 minutes to 10 days (mean 113 min). Emergency laparotomy was performed in 117 patients ((57.6%). Radiological investigation was made in 86 patients (42.4%), of whom 22 patients underwent laparotomy due to hemodynamic deterioration, and 64 patients (31.5%) were treated conservatively for grade I to III injuries (46, 15, and 3 patients, respectively). Isolated renal injury was seen in 74 patients (55 blunt, 19 penetrating), while 129 patients (63.6%) had accompanying intra-abdominal and 72 patients had extra-abdominal injuries. A total of 140 renal procedures were performed in 139 patients, including nephrorrhaphy (n= 54), partial nephrectomy (n= 5), nephrectomy (n= 74), and renal artery repair (n= 1). No renal pathology was detected in four patients (2.9%) and only a double J stent was placed in two patients. Perioperative mortality occurred in five patients (2.5%). The overall mortality rate was 16.8% (n= 34). The mean transfusion requirements were 3.4 +/- 0.8 units and 2.3 +/- 0.6 units, and the mean hospitalization times were 9.2 +/- 3.5 days and 13 +/- 2 days in patients treated surgically and conservatively, respectively. Conclusion: Nonoperative management of renal trauma in hemodynamically stable patients preserves renal function and reduces nephrectomy rates.Öğe The diagnosis and treatment of penile fracture: our 19-year experience(Turkish Assoc Trauma Emergency Surgery, 2011) Gedik, Abdullah; Kayan, Devrim; Yamis, Sait; Yilmaz, Yakup; Bircan, KamuranBACKGROUND The aim of this study was to retrospectively evaluate our approach to the diagnosis and treatment of penile fracture. METHODS We retrospectively evaluated the results of 107 patients with penile fracture treated in our clinic between January 1990 and January 2009. Patient age, etiology of each fracture, history, physical examination results, radiologic findings, type of treatment, and postoperative complications were recorded. In 5 cases cavernosography was performed and in 8 cases retrograde urethrography. RESULTS The most common etiologies of penile fracture were coitus and manually bending the penis for detumescence. Diagnoses were made based on history and physical examination in 102 patients and cavernosography in 5 patients. In order to evaluate urethral injury in 8 cases, retrograde urethrography was performed. Rupture was repaired surgically in 101 patients, but 6 patients were treated conservatively. Among the 6 conservatively treated patients, 3 developed penile curvature 6 months post-treatment; no complications occurred in the surgically treated patients. CONCLUSION Cavernosography should be performed only when history and physical examination are insufficient for diagnosis, and retrograde urethrography should be performed when urethral injury is suspected. In order to prevent the development of penile curvature and to ensure rapid recovery, early surgical repair is advised.Öğe Glomerüler filtrasyon hızı hesaplanmasında kullanılan üç ayrı yöntemin karşılaştırılması(1997) Şahin, Hayrettin; Kaplan, Abdurrahman; Muhtar, A. Cengiz; Bircan, Kamuran; Gedik, AbdullahBu çalışmada, glomerüler filtrasyon hızının (GFR) hesaplanmasında kullanılan üç değişik yöntem yatmakta olan 16 hastada karşılaştırıldı. Üç yöntem arasında anlamlı fark saptanmadı (p>0.05). İki böbreğin karşılaştırmalı GFR değerinin bilinmesi gerekmiyorsa ya da böbrekler üzerine toksik ilaçları başlamadan önce Crockcroft ve Gault'un tanımladığı yöntemle GFR ölçülebilir. İki böbrek için ayrı ayrı GFR bilinmesi gerekiyorsa renal sintigrafi ya da ayrı toplanan idrarlarda hesaplanan kreatinin klirensi kullanılabilir.Öğe Is procalcitonin valuable in the differential diagnosis of testicular torsion and epididymo-orchitis(Saudi Med J, 2010) Yamis, Sait; Gedik, Abdullah; Sahin, Hayrettin; Batun, Sabri; Nergiz, Yusuf; Bircan, KamuranObjectives: To evaluate the efficacy of procalcitonin (PCT) in the differential diagnosis of testicular torsion and epididymo-orchitis. Methods: This experimental study was performed in the research laboratory of Dicle University, School of Medicine, Diyarbakir, Turkey between March and June 2008. The study included 24 male rats randomized equally in 3 groups: sham, epididymo-orchids, and torsion groups. Blood samples were obtained from all rats at the beginning of the study. After torsion and infection occurred in the testes, new blood samples were obtained for PCT measurement. Then, all the right testes of the rats were excised for histopathological evaluation. The Wilcoxon signed test was used for statistical evaluation. Results: Pre- and post PCT levels were statically compared, and PCT levels were significantly higher in the epididymo-orchitis group. Conclusion: Procalcitonin could be an easy, fast, and safe marker for use in the differential diagnosis of testicular torsion and epididymo-orchitis.Öğe Künt ve kesici-delici böbrek yaralanmaları: 18 yıllık deneyimimiz(2009) Gedik, Ercan; Bircan, Kamuran; Deliktaş, Hasan; Gedik, Abdullah; Şahin, HayrettinAmaç: Böbrek yaralanmaları (BY) nedeniyle tedavi edi- len hastalar değerlendirildi. Gereç ve yöntem: Ocak 1990 ile Ağustos 2008 tarihleriarasında, karın travmasına bağlı BY nedeniyle tedaviedilen 203 hasta (168 erkek, 35 kadın; ort. yaş 31±9)travma nedeni, tanı yöntemleri, yaralanma derecesi, eşlikeden organ yaralanmaları, tedavi ve komplikasyonlaraçısından değerlendirildi. Böbrek yaralanmalarının ciddi- yeti, Amerika Travma Cerrahisi Birliği’nin sistemine görederecelendirildi. Bul gu lar: Travmaların 122’si (%60.1) delici, 80’i (%39.4)künt yaralanma şeklindeydi; bir hastada hem delici hemkünt yaralanma vardı. Delici yaralanmaların çoğu (%69.7)ateşli silah yaralanmasıydı. Altı hastada (%3) iki taraflıBY görüldü. Hastaneye başvuru süreleri 20 dakika ile 10gün (ort. 113 dakika) arasında değişmekteydi. Hastaların117’sinde (%57.6) acil laparotomi yapıldı. Radyolojik ince- leme yapılan 86 hastanın (%42.4) 22’sinde hemodinamikbozukluk nedeniyle laparotomi uygulandı, 64 hasta (%31.5)konservatif tedaviyle izlendi. Konservatif tedavi grubunda 46hastada derece I, 15 hastada derece II, üç hastada dereceIII yaralanma vardı. İzole böbrek yaralanması 74 hastada(55 künt, 19 delici yaralanma) görülürken, 129 hastada(%63.6) karın içi ek organ yaralanması, 72 hastada karındışı ek organ yaralanması görüldü. Ameliyat edilen 139hastada 140 renal işlem uygulandı: 54 nefrorafi, 5 parsiyelnefrektomi, 74 nefrektomi, 1 renal arter onarımı. Dört hasta- da (%2.9) renal patoloji saptanmadı. İki hastaya ise sadeceçift J stent kondu. Beş hasta (%2.5) ameliyat sırasındakaybedildi. Mortalite toplam 34 hastada (%16.8) görüldü.Ameliyat edilen grupta ortalama 3.4±0.8 ünite, konservatiftedavi grubunda ise 2.3±0.6 ünite kan transfüzyonu yapıl- dı. Bu iki grupta ortalama hastanede kalış süresi sırasıyla9.2±3.5 gün ve 13±2 gün idi. So nuç: Hemodinamisi stabil olan böbrek yaralanmalı has- talarda konservatif tedavi böbrek fonksiyonlarının korun- masını sağlamakta ve nefrektomi oranlarını azaltmaktadır.Öğe Künt ve penetran mesane yaralanmaları(2010) Gedik, Ercan; Gedik, Abdullah; Bircan, Kamuran; Tutuş, Ali; Kauan, DervrimAmaç: Künt ve penetran travma ile mesane yaralanması gelişen hastalara uyguladığımız tanı ve tedavi protokollerimizi gözden geçirmeyi amaçladık. Gereç ve yöntem: Ocak 1996-Ocak 2009 tarihleri arasında mesane travması nedeniyle Üroloji ve Genel Cerrahi kliniklerinde yatırılan 52 hasta geriye dönük olarak değerlendirildi. Bulgular: Hastaların 43’ü (%81) erkek, 9’u (%19) kadındı ve yaşları 17 ila 70 arasında (ortalama 31.9±12.11) idi. Hastaların 28’inde penetran (%54), 24’ünde künt (%46) travmaya bağlı mesane yaralanması mevcuttu. Hastaneye nakil süresi ortalama 155±34.12 (dağılım 30-1440) dk olarak tespit edildi. Retrograd sistografi 28 hastaya yapılabildi. Hemodinamik olarak stabil olmayan kalan 24 hastaya mesane rüptürü tanısı laparatomi esnasında konuldu. Penetran travma nedeniyle yaralanan 28 hastanın tümünde ve künt travma nedeniyle yaralanan 24 hastanın 13’ünde olmak üzere toplam 41 hastada (%79) intraperitoneal mesane rüptürü vardı. Künt travma nedeniyle yaralanan 24 hastanın 11’inde (%21) ekstraperitoneal rüptür mevcuttu. İntraperitoneal mesane yaralanması olan hastalarda olaya batın içi organ yaralanmaları daha çok eşlik ederken, ekstraperitoneal mesane yaralanması olan hastalarda olaya daha çok kemik fraktürleri eşlik etmekteydi. İntraperitoneal mesane rüptürü olan 41 hastada primer sütür ile mesane onarımı yapıldı. Bu hastaların 14’üne sistostomi konuldu. Sistografilerde ekstraperitoneal rüptür saptanan 11 hastanın 7’si üretral foley kateter konarak tedavi edildi. Ekstraperitoneal yaralanması olan 4 hasta ise rüptür büyük ve ekstravazasyon yaygın olduğundan primer mesane onarımı yapıldı. Akut respiratuar distress sendromu tablosu gelişen bir hasta ameliyat sonrasında kaybedildi. Postoperatif morbidite açısından değerlendirildiğinde 4 hastada yara enfeksiyonu, 2 hastada pnömoni, 1 hastada intraabdominal abse, 1 hastada enterokutanöz fistül, 1 hastada evisserasyon görüldü. Sonuç: Mesane travmaları erken tanı ve uygun tedaviye çok iyi yanıt verirler. Eşlik eden organ yaralanmaları morbidite ve mortaliteyi arttırabilmektedir.Öğe Percutaneous drainage of prostatic abscess(Kluwer Academic Publishers, 1992) Bircan, Kamuran; Öztürk, O.; Haksöz, Çaǧrı; Bilici, AslanThe treatment results of 2 patients with prostatic abscess who underwent perineal percutaneous drainage under transrectal ultrasonographic guidance are described. Both patients were treated definitely and without complications. It is concluded that the use of transrectal ultrasound during the procedure increases the effectivity and safety of treatment.Öğe Percutaneous nephrolithotomy in pediatric patients: is computerized tomography a must?(Springer, 2011) Gedik, Abdullah; Tutus, Ali; Kayan, Devrim; Yilmaz, Yakup; Bircan, KamuranThe aim of this study was to retrospectively evaluate the results of pediatric percutaneous nephrolithotomy (PNL) cases, and discuss the results and necessity of non-contrast computerized tomography (CT) in these cases. In all, 48 pediatric patients who underwent PNL were retrospectively evaluated. Before PNL, either intravenous urography or CT was performed. In all patients, we evaluated the PNL time, scopy time with stone burden, and complications. During the PNL procedure, we switched to open surgery in two cases: in one because of renal pelvis perforation and in the other because of transcolonic access. In one patient who was scheduled to undergo PNL, we performed open surgery, primarily because we detected a retrorenal colon with CT. The stone burden in 45 patients who underwent PNL was 445 +/- A 225 mm(2), the PNL time was 51 +/- A 23 min, and the scopy time was 6.1 +/- A 2.7 min. We removed nephrostomy tubes 1-4 days after the procedure. In two patients, 24 h after removal of nephrostomy tubes, we inserted double J stents because of prolonged urine extravasation from the tract. In all, 34 of the 45 patients were stone-free, 5 patients had clinically insignificant stone fragments, and 6 patients had residual stones. PNL is a safe and effective method in the treatment of pediatric patients with kidney stones. Clinical experience is the most important factor in obtaining stone-free results. CT should be performed in all pediatric patients in order to prevent colon perforation.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 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 USE OF MIDAZOLAM DURING TRANSRECTAL ULTRASONOGRAPHY GUIDED PROSTATE BIOPSY: EFFECTS OF SEDATION AND RETROGRADE AMNESIA(Aves, 2005) Atug, Fatih; Akay, Ferruh; Akay, Hatice Ozturkmen; Eksioglu, Ali; Bircan, KamuranIntroduction: Urologists perform approximately 500.000 prostate biopsies per year in United States of America. Currently there is no universally agreed standard of analgesia. Several studies evaluating the tolerance of transrectal ultrasound (TRUS) guided biopsies showed that moderate to severe pain was associated with the procedure. Patients may not return for repeat biopsies due to unpleasant experience with prior biopsies. Large number of patients perceives the procedure painful with major psychological trauma. Midazolam is used for gastrointestinal endoscopies because of its sedative and amnestic effects. To this end, we evaluated the feasibility of midazolam and retrograde amnesia effect in patients undergoing transrectal prostate biopsy. Materials and Methods: A total of 52 patients undergoing TRUS-guided prostate biopsy were enrolled into the study. Indications for biopsy were increased prostate specific antigen (PSA) or abnormal digital rectal examination of the prostate. Patients were given midazolam as a bolus injection (70 mcg/kg, maximum total dosage: 5 mg) before the biopsy procedure. All patients were examined in left lateral decubitus position and TRUS biopsies were performed with a 7 MHz probe. Four core biopsies were obtained from the each lobe of the prostate. After completion of biopsy, flumazenil (0.5 mg IV) was used to reverse the effects of midazolam. All patients were placed on oxygen saturation monitorization during the procedure. The degree of sedation, degree of pain, side effects and retrograde amnesia were evaluated with a validated questionnaire by the surgeon and patient. A visual analog scale (VAS) was used to asses the pain score and Ramsey sedation score was used to asses the sedation score. The Ramsey sedation scale scores between 2 and 4 were accepted as satisfactory degree of sedation. Results: After injection of midazolam, sedation was achieved in all patients in a short period of time. Ninety-six percent of patients exhibited procedural amnesia, characterized by an inability to recall neither the initial probe insertion nor the biopsy procedure. Only two patients remembered some parts of the procedure. Forty four patients (%85) were willing to undergo re-biopsy if needed. These patients stated that they will undergo a second biopsy only under the same conditions. Eight patients (%15) refused to undergo any further diagnostic test or examination. The mean pain score of patients was 1.96 +/- 0.69. The Ramsey sedation scale scores ranged between 2 and 4 in all patients. Nausea and vomiting due to midazolam were not observed in our study, and we did not see any complication related to midazolam usage. Conclusion: In this study we found high satisfaction rates, lower pain scores and lower anxiety in patients undergoing TRUS guided biopsies due to sedative and amnestic effects of midazolam. This resulted in higher acceptability of a repeat biopsy procedure, if indicated. Besides its sedative properties, midazolam can be used as an effective agent during TRUS-guided prostate biopsies due to its procedural amnesia effect, which results in minimal psychological trauma to patients.
