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18 yaşından küçük pediatrik hastalarda uygulanan farklı perkütan nefrolitotomi prosedürlerinin değerlendirilmesi
(Avrasya Üroonkoloji Derneği, 2020) Alan, Cem; Dede, Onur
Amaç: Bu çalışmada kliniğimizde standart perkütan nefrolitotomi (PNL), mini perkütan nefrolitotomi (mini-PNL), ultra-mini perkütan nefrolitotomi (UMP) ve mikro perkütan nefroli-totripsi (mikro-PNL) prosedürleri uygulanan 18 yaş altı pediatrik hastaların sonuçları sunulmuş-tur.Gereç ve Yöntemler: Mart 2011 ile Ekim 2015 tarihleri arasında böbrek taşı tedavisi için farklı PNL prosedürleri uygulanan 18 yaş altı 272 hastanın verileri retrospektif olarak incelendi. Hastalar operasyonda uygulanan dilatasyon ça-pına göre standart PNL (30 Fr-24 Fr) ( Grup 1), mini-PNL (20 Fr-16 Fr) (Grup 2), UMP (14 Fr-12 Fr) (Grup 3) ve mikro-PNL (4,8 Fr) (Grup 4) şek-linde dört gruba ayrıldı.Bulgular: Böbrek taşı nedeniyle 18 yaş altı olup 73 hasta (Grup 1), 75 hasta (Grup 2), 78 hasta (Grup 3), 46 hasta (Grup 4) çalışmaya dâhil edilmiştir. Ortalama operasyon süresi; Grup 1’de 56,3±21,6 dk, Grup 2’de 49,9±15,3 dk, Grup 3’te 57,3±16,2 dk, Grup 4’te 61,7±22,6 dk şeklinde bu-lunmuştur (p=0,006).Skopi süresi Grup 1’de 1,7±1,1 dk, Grup 2’de 1,5±0,9 dk, Grup 3’te 2,3±1,3 dk, Grup 4’te 1,6±1,2 dk olarak hesaplanmıştır (p<0,001). Hemoglobin miktarındaki azalma Grup 1’de 1,4±1,5 gr/dL, Grup 2’de 1,1±1,2 gr/dL, Grup 3’te 0,8±0,9 gr/dL, Grup 4’te 0,5±0,9 gr/dL saptanmıştır (p<0,001).Başarı oranları karşılaştırıldığında ilk mü-dahale sonrası fark olsına rağmen ek müdaha-leler sonrası taşsızlık oranı Grup 1’de 61 hastaya (%83,6), Grup 2’de 70 hastaya (%93,3), Grup 3’te 66 hastaya (%84,6), Grup 4’te 41 hastaya (%89,1) olarak hesaplanmıştır (p=0,093).Sonuç: Çalışmamızda 18 yaş altı pediatrik hasta grubunda farklı PNL prosedürlerinin benzer başarı ve komplikasyon oranları görül-mesine rağmen; kanama miktarının UMP ve mikro-PNL’de düşük bulunmuştur. Bu yaş grubunda akses, dilatasyon ve fragmantasyon esnasında minyatür enstrümanlar kullanılarak daha düşük kanama oranı ile benzer başarı ve etkinlik sağlandığı görülmüştür.
Acquired Urethral Diverticulum Following Hypospadias Repair: A Case Report
(Derman Medical Publ, 2014) Dede, Onur; Daggulli, Mansur; Utangac, Mazhar; Penbegül, Necmettin; Dede, Gulay
Urethral diverbculurn is a rare condition in men. Patients often presented with voiding symptoms and mass with related urethra. In this study, diverticula did not detected after result of ultrasound, MRI and physical examination, Retrograde urethrography was performed and diverticulum and 2.5 cm stone was detected in diverticula. The exision of urethral diverticula and urethroplasty were performed.
Aşırı aktif mesanede konservatif tedaviler
(Avrasya Üroonkoloji Derneği, 2015) Bağbancı, Muhammet Şahin; Emir, Levent; Dede, Onur
Tüm kılavuzlarda, aşırı aktif mesane hastalığının ilk basamak tedavisinde konservatif yöntemler önerilmektedir. Bu makalede aşırı aktif mesane tedavisinde konservatif tedavilerin yeri ve etkinliği literatür bilgileri ışığında değerlendirilmiştir.
Bilateral microperc in a severe kyphoscoliosis
(Aves, 2016) Daggulli, Mansur; Penbegül, Necmettin; Dede, Onur; Utangac, Mehmet Mazhar
Percutaneous nephrolithotomy is the standard modality for large renal calculi in normal and abnormal renal anatomic situations. This case report describes a 57-year-old male patient who presented with bilateral kidney stones and severe kyphoscoliosis. He had successfully been treated with a bilateral microperc technique.
Bitlis Devlet Hastanesi'nde yapılan ilk 70 perkütan nefrolitotomi deneyimimiz; retrospektif bir analiz
(Avrasya Üroonkoloji Derneği, 2015) Bağbancı, Şahin; Dede, Onur; Kayan, Devrim; Sezgin, Tezcan; Aydoğmuş, Yasin
Amaç: Bu çalışmada, Bitlis Devlet Hastanesinde böbrek taşı nedeniyle perkütan nefrolitotomi (PCNL) yapılan ilk 70 vakayla ilgili deneyimimizi paylaşmak amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmaya, Mart 2011 ve Ocak 2013 tarihleri arasında Bitlis Devlet Hastanesinde böbrek taşı nedeniyle PCNL yapılan 70 hasta alındı. Hastaların verileri retrospektif olarak değerlendirildi. Cerrahi süresi ile taş boyutları arasındaki ilişki, taş yükü ile taşsızlık oranları ve başarı oranları arasındaki ilişki analiz edildi. Endotrakeal tüp takılmasından akses iğnesi ponksiyonuna kadar olan sürenin zaman içerisindeki değişimine bakılarak yardımcı sağlık personelinin öğrenim eğrisi değerlendirildi. Bulgular: Hastaların ortalama yaşları 39,6±13,6 idi. Ortalama operasyon süresi 120±16,37 dk idi. Cerrahi sonrası taşsızlık oranı %80, başarı oranı %84,3 idi. Ondört (%20) hastada rezidü taş kaldı, yedi hastaya kan transfüzyonu yapıldı(% 10). Dokuz hastaya cerrahi sonrası taş kırma (ESWL) yapıldı. Ortalama nefrostomili kalma süresi iki gün, postop double J (DJ) kateter takılma oranı ise %11,4tü. Sonuç: Günümüzde 2 cmden büyük böbrek taşlarında PCNL ilk tercih edilen cerrahi seçenektir. Uygun koşullar sağlandığında ikinci basamak hastanelerde seçilmiş vakalarda gü- venle yapılabilecek bir cerrahi tekniktir
A case of micro-percutaneous nephrolithotomy with macro complication
(Aves Yayincilik, Ibrahim Kara, 2015) Dede, Onur; Utangac, Mazhar; Dagguli, Mansur; Hatipoglu, Namik Kemal; Sancaktutar, Ahmet Ali; Bodakci, Mehmet Nuri
Percutaneous nephrolithotomy is accepted as the standard management approach for kidney stones that are either refractory to extracorporeal shock wave lithotripsy or are >2 cm in diameter. The recently developed micro-percutaneous nephrolithotomy (microperc) technique provides intrarenal access under full vision using an optic instrument with a smaller calibration. A lesser amount of bleeding has been reported with the use of this method. Here we present a case of a bleeding complication on postoperative day 15 after a microperc procedure used to treat a left kidney stone. The complication led to retention of bloody urine in the bladder and required transfusion of 5 units of whole blood.
Comparison of Monoplanar and Biplanar Access Techniques for Percutaneous Nephrolithotomy
(Mary Ann Liebert, Inc, 2015) Dede, Onur; Bas, Okan; Sancaktutar, Ahmet Ali; Daggulli, Mansur; Utangac, Mazhar; Penbegül, Necmettin; Hatipoglu, Namik Kemal
Purpose: The aim of this study was to compare the positive aspects and complications of monoplanar and biplanar access techniques used in percutaneous nephrolithotomy (PCNL) based on the modified Clavien complication grading system. Patients and Methods: The data from patients who underwent PCNL using either monoplanar access (group 1) or biplanar access (group 2) techniques were analyzed retrospectively. For the biplanar technique, puncture is adjusted based on different fluoroscopic projections, including vertical and 30 degree positions. For the monoplanar technique, a C-arm fluoroscope was brought into vertical position, the collecting system was visualized with a contrast agent, and the most appropriate calix was selected to extract the targeted stone. Results: The monoplanar technique was performed for renal access in 310 patients (group 1), and the biplanar technique was used for renal access in 351 patients (group 2). There were no statistically significant differences between the two groups with regard to demographic data. The mean puncture time was significantly lower in group 1 (monoplanar) when compared with that of group 2 (biplanar, P=0.04). The overall success rates of the monoplanar and biplanar groups were 88% and 89% (including clinically insignifican residual fragments in 9% and 7%), respectively (P>0.05), and the complication rates of both groups were similar. Conclusion: The monoplanar access technique, which is safe to use, decreases puncture time, minimizes the surgeon's direct exposure time to radiation, and has similar success rates as the biplanar access technique.
Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy in Moderately Sized Pediatric Kidney Stones
(Mary Ann Liebert, Inc, 2016) Bas, Okan; Dede, Onur; Aydogmus, Yasin; Utangac, Mazhar; Yikilmaz, Taha Numan; Damar, Erman; Nalbant, Ismail
Purpose: To compare the effectiveness and reliability of retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (micro-perc) for the management of kidney stones in pediatric patients. Materials and Methods: A retrospective analysis was made of pediatric patients aged < 18 years with kidney stones that ranged from 10 to 20mm in size, who underwent RIRS (n = 36) or micro-perc (n = 45) in referral centers. Results: In the RIRS group, the mean age of patients was 8.39 -4.72 years and in the micro-perc group, it was 5.62 -4.50 years (p = 0.01). The mean stone size was 12.80 -3.03mm in the RIRS group and 13.97 -3.46mm in the micro-perc group (p = 0.189). The success rate was 86.2% (n = 31) in the RIRS group and 80.0% (n = 36) in the micro-perc group (p = 0.47). The mean complication rate was 16.6% and 13.3% in the RIRS and microperc groups, respectively (p = 0.675). Hospital stay and radiation exposure were significantly lower in the RIRS group (all p < 0.001). The mean anesthesia session was 1.94 in the RIRS group and 1.26 in the micro-perc group (p < 0.001). The mean hemoglobin drop was 0.53 -0.87 g/dL in the micro-perc group, and none of the cases required blood transfusion. Conclusion: The results of this study suggested that micro-perc and RIRS were highly effective methods for the treatment of moderately sized renal stones in children, with comparable success and complication rates. Patients and their parents should be informed about the currently available treatment options, and of their efficacy and safety. However, further clinical trials are needed to support these results.
Comparison of Scoring Systems in Pediatric Mini-Percutaneous Nephrolithotomy
(Elsevier Science Inc, 2016) Utangac, Mehmet Mazhar; Tepeler, Abdulkadir; Daggulli, Mansur; Tosun, Muhammed; Dede, Onur; Armagan, Abdullah
OBJECTIVE To apply urolithiasis scoring systems to the pediatric miniperc procedure and to compare their predictive capability for postoperative outcomes. MATERIALS AND METHODS Records from 2 referral centers of patients under 18 years of age who had the miniperc procedure between 2010 and 2015 were retrospectively investigated. All patients included in the study were graded by the same surgeon according to Guy's and Clinical Research Office of the Endourological Society (CROES) scoring systems using preoperative imaging methods. Patient demographics and outcomes were compared according to the complexity of the procedure as graded by each scoring system. RESULTS The mean age of the 97 patients was 7.1 +/- 5.2 (1-17) years. The mean stone burden and number were 388.4 +/- 233.9 mm(2) and 1.5 +/- 1.3, respectively. The mean procedure, fluoroscopy, and hospitalization times were 78.2 +/- 32.8 minutes, 144.8 +/- 84.3 seconds, and 4.1 +/- 2.8 days, respectively. The mean hematocrit drop was calculated as 2.2 +/- 2.2. The mean scores were 1.7 +/- 1.0 and 259.9 +/- 50.6 for Guy's and CROES scoring systems, respectively. In the multivariate analysis, stone-free status was found to be associated with Guy's (r: -0.464, p: .000) and CROES (r: 0.490, : 0.000) scoring systems and stone burden (r: -0.161, p: .041). In the analysis of factors related to complication, Guy's score was identified as an independent predictor of complication (p: .02, odds ratio: 1.9, 95% confidence interval 1.097-3.319). CONCLUSION According to our results, using Guy's and CROES scoring systems, stone-free ratios after percutaneous nephrolithotomy may be predicted preoperatively. In addition, Guy's system is a predictor of postoperative complication rate. (C) 2016 Elsevier Inc.
Comparison of the results of pediatric percutaneous nephrolithotomy with different sized instruments
(Springer, 2017) Celik, Huseyin; Camtosun, Ahmet; Dede, Onur; Dagguli, Mansur; Altintas, Ramazan; Tasdemir, Cemal
We aim to compare the outcomes, including the morbidity and success rates in children undergoing percutaneous nephrolithotomy (PCNL) using different sized devices. According to the size of instruments used during surgery, three different groups (ultra-mini-PCNL, mini-PCNL and adult size PCNL) were composed and the outcomes were compared between the groups. PCNL was applied to 225 renal units of 220 children, including 5 patients with bilateral kidney stones. Percutaneous nephrolithotomy was performed using adult instruments (24 F) in 82 renal units, using pediatric instruments (18 F) in 89 and using minimal-size instruments (9.5 F) in 50. One-hundred and twenty-four girls and 96 boys with a mean age of 8.33 (< 17) years were assessed. Stone-free rates were 78 % in group 1 (n = 39) using 9.5 F nephroscope, 75.8 % in group 2 (n = 69) using 18 F nephroscope and 71.4 % in group 3 (n = 60) using 24 F nephroscope. Time to access the collecting system, operative time, duration of nephrostomy and average postoperative hospital stay did not differ between the groups. However, mean hematocrit drop and stone burden were significantly lesser in ultra-mini-PCNL group. There was no significant difference in the complication rates between the groups, according to the modified Clavien classification system. As the important complication of PCNL, bleeding seems to be associated with diameter of dilatation, calibre of nephroscopes and stone burden. To reduce the certain complications, pediatric type of instruments is suitable but the use of adult instruments and techniques may achieve equal results.
Does morbid obesity influence the success and complication rates of extracorporeal shockwave lithotripsy for upper ureteral stones?
(Aves Yayincilik, Ibrahim Kara, 2015) Dede, Onur; Sener, Nevzat Can; Bas, Okan; Dede, Gulay; Bagbanci, Muhammet Sahin
Objective: The aim of the current study was to investigate whether obesity influences the outcome of extracorporeal shockwave lithotripsy (ESWL) treatment for upper ureteral stones. Material and methods: This is a retrospective study of 134 patients who underwent ESWL between June 2011 and May 2014. Patients were divided into 2 groups. Group 1 comprised 94 patients of normal weight, and group 2 comprised 40 morbidly obese patients. Patients in both groups had upper ureteral stones. Results: The mean age of groups 1 and 2 was 45.6 +/- 12.1 and 45.3 +/- 15.5 years, respectively (p=0.98). There was no significant difference in demographic variables between the groups. The mean stone size in Groups 1 and 2 was 81.7 +/- 25.7 mm(2) and 86.3 +/- 22.4 mm(2), respectively (p=0.51), the mean body mass index (BMI) was 27.4 +/- 2.9 and 42.9 +/- 2.1, respectively (p<0.01), the mean number of ESWL sessions was 2.4 +/- 0.6 and 2.4 +/- 0.7, respectively (p=0.97), and the mean follow-up time was 7.1 +/- 3.4 and 6.6 +/- 2.8 weeks, respectively (p=0.67). The overall stone-free rate was 82% in group 1 and 67% in group 2 (p=0.01). Conclusion: It is well-known that morbidly obese patients have higher rates of anesthesia-related problems due to the comorbidities commonly observed in this population. In the current study, we found that ESWL is a safe and acceptable treatment option for morbidly obese patients with upper ureteral stones.
The Effect of Metabolic Syndrome on the Success and Complications of Percutaneous Nephrolitotomy
(Mary Ann Liebert, Inc, 2015) Nalbant, Ismail; Dede, Onur; Sener, Nevzat Can; Ozturk, Ufuk; Yesil, Suleyman; Karakoyunlu, A. Nihat; Imamoglu, M. Abdurrahim
Background: The aim of this study was to investigate the effect of Metabolic syndrome (MetS) on the success and complications of percutaneous nephrolithotomy (PNL). Methods: Two hundred ten patients who had undergone PNL for kidney stones in our clinic between May 2012 and May 2014 were retrospectively analyzed. The patients were divided into two groups based on whether they had diagnostic criteria for MetS. All patients had lower pole kidney stones between 15 and 20mm. Complication rates between groups were evaluated using a modified Clavien grading system. Results: Group1 was a standard PNL group and group 2 consisted of patients with MetS. Mean stone size was 293.25102.4mm(2) for group 1 and 301.10 +/- 169.5mm(2) for group 2 (p<0.05). Mean hospitalization days, fluoroscopy duration, and mean hematocrit loss were significantly higher in group 2. Mean operative time and need for blood transfusions were higher in group 2 but statistically insignificant. One hundred twenty five patients in group 1 (96.1%) and 72 patients in group 2 (90%) obtained stone-free state. Conclusions: Our study results reveal an increase in complications and morbidity for patients with MetS during PNL.
The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception
(Taylor & Francis Ltd, 2016) Akbas, Alpaslan; Gulpinar, Murat Tolga; Sancak, Eyup Burak; Karakan, Tolga; Demirbas, Arif; Utangac, Mehmet Mazhar; Dede, Onur
Objectives: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction. Patients and methods: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0=never to 4 happily), and patient satisfaction rates (0=poor to 4=excellent) were assessed. Results: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p< 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. Conclusion: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.
Effectiveness of ureteroscopy among the youngest patients: One centre's experience in an endemic region in Turkey
(Elsevier Sci Ltd, 2017) Utangac, Mehmet Mazhar; Daggulli, Mansur; Dede, Onur; Sancaktutar, Ahmet Ali; Bozkurt, Yasar
Background In recent years, the incidence of urinary stone disease reportedly has been increasing. The use of shockwave lithotripsy has seen low success rates, the inefficacy of a single session, and the need for general anaesthesia in children; additionally, children are exposed to radiation. These suboptimal treatment conditions have all led to ureteroscopy (URS) becoming the treatment method of choice for paediatric ureter stones. The aim of this study is to examine the effectiveness of 4.5-Fr URS when used on children younger than 1 year of age. Patients and methods The operation results of 34 patients (12 girls and 22 boys) who had undergone intervention for ureter stones at our clinic were retrospectively evaluated. For URS, a 4.5-Fr semi-rigid ureteroscope was used; a Holmium: YAG laser machine was used as a lithotripter. Result The mean patient age was 9.6 months (range 4-12 months) (Table). The mean stone surface area was 25.39 mm2 (range 11.84-84.78 mm(2)). In six cases, a ureteral catheter was inserted, because of minimal oedema in the ureters; in nine cases, a Double J (DJ) stent was inserted. The mean operation time was 45.3 min (range 22-87 min). In the first week of control with urinary ultrasonography and kidney-ureter and bladder radiograph, a stone-free condition was determined in 28 (82.3%) patients. In two cases-in which sufficient fragmentation could not be achieved, because of minimal bleeding during operation-during the exertion of a DJ stent, another URS was performed. In the first postoperative month, a stone-free condition was established in 32 (94.1%) patients. The mean hospital stay period was 28.6 h (range 12-72 h). There were seven cases (20.5%) with Clavien II-III complications. Conclusion Use of a ureteroscope is safe and effective with paediatric patients: we found that a 4.5-Fr ureteroscope can be safely used on children under 1 year of age. We therefore consider a 4.5-Fr ureteroscopic instrument to be an appropriate tool for treating URS in children within this age range.
An examination on composition of spermatozoa obtained from pre-operative and post-operative varicocele patients
(Inst Animal Reproduction Food Research, 2018) Afsin, Muhamet; Otludil, Birgul; Dede, Onur; Akkus, Murat
Varicocele is one of the main and surgically repairable causes of male infertility, which arises from dilatation and torsion of the testicular veins in the plexus pampiniformis. In this study, we examined semen samples from 40 patients diagnosed with varicocele between the ages of 15 and 30 years, according to WHO criteria (pre-operatively, and at 3, 6, and 12 months post-operatively). The mean spermatozoa concentration was found to be 45.25 +/- 34.83 million/ml pre-operatively, while the mean post-operative concentration was 48.85 +/- 35.73 million/ml at three months, 51.72 +/- 32.82 million/ml at six months, and 49.63 +/- 28.05 million/ml at 12 months (P > 0.05). The mean rate of A + B motile spermatozoa was 35.5 +/- 14.71% pre-operatively, 42.65 +/- 16.80% at three months, 43 +/- 13.52%at six months and 44 +/- 14.76 percent at 12 months post-operatively (P < 0.05). The mean Kruger morphology score was 3.15 +/- 3.0% pre-operatively, and 3.20 +/- 2.83% at three months, 2.97 +/- 2.61%at six months and 3.27 +/- 2.50%at 12 months post-operatively (P > 0.05). The nucleus, acrosomal cap, mitochondrial structure and microtubules of the tail of the spermatozoa were examined under electron microscopy. The mean DNA fragmentation index (DFI%) of the spermatozoa was 20.57 +/- 4.60% pre-operatively, and post-operatively at 17.27 +/- 3.65% at three months, 15.5 +/- 3.23% at six months and 15.3 +/- 3.63% at 12 months (P < 0.001). The findings suggest that despite the increased count and motility, as well as the improved DNA fractures observed post-operatively in the spermatozoa of varicocele patients, the morphology rates remain intact.
Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures-a single-center experience
(Springer, 2017) Bas, Okan; Tuygun, Can; Dede, Onur; Sari, Sercan; Cakici, Mehmet Caglar; Ozturk, Ufuk; Goktug, Goksel
To evaluate the factors affecting complication rates of flexible ureteroscopy and laser lithotripsy (FURSL). Data on a total of 1395 patients, with 1411 renal units underwent 1571 procedures with FURSL for renal and/or proximal ureteral stones between April 2012 and January 2016, were retrospectively analyzed. Complications were assessed using the Satava and modified Clavien systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. The mean patient age in the total procedures was 45.68 +/- 14.00 years (range 2-86 years), and the mean stone size was 15.15 +/- 8.32 mm (range 5-75 mm). The overall success rate was 95.6 %. A total of 209 (13.3 %) cases suffered from complications with intraoperative complications rates of 5.9 % and postoperative complication rates of 7.3 %. Univariate analysis revealed no significant difference in complication rates in respect of age, gender, body mass index, use of ureteral access sheath, operation time, bleeding disorder, solitary kidney, preoperative stenting, American Society of Anesthesiologists score, repeated procedure or location of stones (all p value > 0.05). Complication rates were determined to be significantly affected by stone size (p = 0.026), multiplicity (p = 0.028) and the presence of congenital renal abnormality (p < 0.01). The only significant factor in multivariate analysis was the presence of congenital renal abnormalities (p = 0.02). The results of the current study indicated that stone size, stone number and the presence of congenital renal abnormalities were factors affecting complication rates after FURSL, although congenital renal abnormality was the only independent predictor among these risk factors.
For reliable urine cultures in the detection of complicated urinary tract infection, do we use urine specimens obtained with urethral catheter or a nephrostomy tube?
(Aves Yayıncılık, 2016) Dede, Gülay; Deveci, Özcan; Dede, Onur; Utanğaç, Mazhar; Daggülli, Mansur; Penbegül, Necmettin; Hatipoğlu, Namık Kemal
Objective: The aim of this study was to compare the results of urine cultures obtained either from urethral, and percutaneous nephrostomy (PCN) catheters. Materials and methods: This study included 328 consecutive patients that underwent PCN at our institution with complicated urinary tract infections (UTIs) between July 2010 and April 2015. Results of urine cultures obtained from the urethral and nephrostomy catheters were compared. Results: This study included 152 male and 176 female patients. Mean age of the patients was 46.2±24.3 years. The main indications were obstructive uropathy due to urolithiasis complicated with pyonephrosis 145 (44%), malignant disease (n=87; 26%), pregnancy (n=26; 8%), and anatomical abnormality (n=23; 7%). One hundred and twenty three patients had diabetes mellitus. The most common causative organisms were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Blood cultures showed the same results for the PCN and bladder urine cultures. The bladder urine culture was positive in 304 patients, while the PCN urine culture in 314 patients. Conclusion: PCN is an important treatment for the management of pyonephrosis. Cultures from the PCN yield valuable information that is not available from urethral urine cultures, and is a guiding tool for antibiotic therapy selection.
Holmium: Yttrium-aluminum-garnet (Ho:YAG) laser for resection of bladder tumor in a pediatric patient
(2015) Çakmakçı, Süleyman; Penbegül, Necmettin; Utanğaç, Mehmet Mazhar; Dağgülli, Mansur; Dede, Onur; Bodakçı, Mehmet Nuri; Sancaktutar, Ahmet Ali; Bozkurt, Yaşar
Bladder tumours are rare in children, with only 0.4% of cases occurring in the first 2 decades of life. Herein, a pediatric patient who underwent TUR-B with a holmium: yttrium-aluminum-garnet (Ho:YAG) laser is presented. Its histopathology was reported as urothelial papilloma.
INVESTIGATION OF GLOBOZOOSPERMIA’S MORPHOLOGICAL STRUCTURE AND DNA FRAGMENTATION IN OLIGOZOOSPERMIA CASES IN INFERTILE MALES
(2022) Yıldızhan, Eda; Çankırı, Zuhal; Akıncı, Dilara; Aşır, Fırat; Afşin, Muhamet; Akkuş, Murat; Dede, Onur
Total globozoospermia is diagnosed by the presence of 100% round-headed spermatozoa without acrosomes. It is still unclear whether patients whose ejaculate contains both normal and globozoospermic cells (partial globozoospermia) suffer from a variation of the same syndrome. Affected men may experience decreased fertility and even infertility. In some cases, an increased number of cells with DNA fragmentation has also been observed in patients with globozoospermia..In this study, standard semen analysis methods in accordance with WHO criteria were applied to infertile male patient groups consisting of 20 normozoospermic and 20 oligozoospermic individuals who were admitted to our clinic. Age, sperm parameters (volume, vitality, concentration, total motility and morphology) were determined and statistically analyzed in normozoospermic and oligozoospermic infertile men.Sperms were stained with the Eosin-Nigrosin method and were visualized under an immersion lens light microscope and evaluated for vitality. The slides were stained using sperm staining solutions with the Spermac technique and the sperms were evaluated morphologically. Sperm DNA fragmentation damage was evaluated by acridine orange staining method.Our results revealed that sperm morphological features (Kruger test) and sperm DNA fragmentation, obtained with various staining techniques, are important in the clinical approach to male infertility and ART methods, and should be used together.
Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys
(Springer, 2016) Soylemez, Haluk; Penbegül, Necmettin; Utangac, Mehmet Mazhar; Dede, Onur; Cakmakci, Suleyman; Hatipoglu, Namik Kemal
Pelvic kidney stones remain a unique challenge to the endourologists. Treatment options include open surgery, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery, and laparoscopy assisted PNL (LA-PNL). As a minimal invasive option, LA-PNL can decrease the risk for bowel and major vessel injury. Here, we describe our experience using the LA-PNL procedures with different combinations, to treat kidney stones in multiple patients with a pelvic ectopic kidney (PEK). Eight patients, with PEK, kidney stones, and no other treatment choice, but open surgery, were included in the study. Two different laparoscopic techniques such as mesocolon dissection and transmesocolic, and four different percutaneous procedures such as standard-PNL, mini-PNL, micro-PNL, and a PNL through the renal pelvis were used for stone extraction in these patients. The mean age of patients was 25.6 +/- 12.9 years and mean stone size was 524.1 +/- 430.3 mm(2). Mean operation time was 150.5 +/- 40.0 (77-210) min which was composed of retrograde catheterization (14.8 +/- 2.9 min), laparoscopic procedure (48.7 +/- 20.6 min) and PNL procedure (86.8 +/- 31.1 min). Residual stones were seen in two patients (no additional treatment was need), while a 'stone-free' procedure was achieved in six patients (75.0 %). On the post-operative first month visit, a stone was observed on radiological examinations in only one patient (87.5 % stone-free). Mean hospitalization time was 2.8 +/- 0.9 days. No perioperative or post-operative complication was observed in all patients. LA-PNL surgery is a safe and effective option for treatment of PEK stones, and has several alternative approaches.

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