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    Blunt and penetrating renal injuries: 18-year experience
    (Aves, 2009) Gedik, Abdullah; Gedik, Ercan; Deliktas, Hasan; Sahin, Hayrettin; Bircan, Kamuran
    Objective: 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.
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    Changes in Collagen Type 3, Elastin, Fibrosis and Cajal Cell in Congenital Ureteropelvic Junction Obstruction
    (Galenos Yayincilik, 2014) Deliktas, Hasan; Issi, Oktay; Gedik, Abdullah; Sahin, Hayrettin
    Objective To compare changes in collagen type 3, elastin, fibrosis and cajal cells through histopathological examination of the ureteropelvic junction (UPJ) segments of pediatric and adult patients who had undergone AndersonHynes pyeloplasty for ureteropelvic junction obstruction (UPJO). Materials and Methods Histopathological evaluation was made of the UPJ segments of 52 patients who underwent Anderson-Hynes pyeloplasty for UPJO between January 2005 and January 2008. Patients were separated into 2 groups as pediatric, aged <= 15 years (group 1, n=10) and adult, aged > 15 years (group 2, n=42). UPJ segments of both groups were compared histopathologically (collagen type 3, elastin, fibrosis and cajal cells). Radiographic evaluations were made with diuretic renogram and/or intravenous pyelography. Results Mean age of group 1 patients was 8.12 +/- 2.6 years (1-12 years) and of group 2 patients, 38.16 +/- 5.91 years (16-62 years). Mean follow-up period was 18 months (9-24 months). No statistically significant difference was determined between the groups in respect of collagen type 3, elastin, fibrosis or cajal cells (p>0.05). Conclusion As the pathology in the UPJ obstruction is a congenital defect, the histopathology does not change with age.
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    Does the Histopathologic Pattern of the Ureteropelvic Junction Affect the Outcome of Pyeloplasty?
    (Urol & Nephrol Res Ctr-Unrc, 2015) Issi, Oktay; Deliktas, Hasan; Gedik, Abdullah; Ozekinci, Selver; Bircan, Mehmet Kamuran; Sahin, Hayrettin
    Purpose: To investigate the effects of the histopathologic pattern of obstructed ureteropelvic junction (UPJ) specimens, including collagen type 3, elastin, fibrosis and Cajal cells, on the outcome of pyeloplasty. Materials and Methods: Histopathological specimens obtained following Anderson-Hynes pycloplasty from 52 patients with intrinsic ureteropelvic junction obstruction (UPJO) between January 2005 and January 2008 were evaluated histopathologically. Patients with extrinsic or secondary UPJO were excluded. Preoperative and postoperative radiographic evaluations were performed either via diuretic renography or intravenous pyelography, or both. Six months post-surgery the patients were divided into 2 groups, as successful surgery (group 1) and unsuccessful surgery (group 2). Histopathological findings (collagen type 3, elastin, fibrosis and Cajal cells) in each group were statistically compared. Results: The study included 52 patients (21 female and 31 male). Mean age of the entire study population was 39.42 +/- 14.5 years, versus 39.63 +/- 14.9 years in group 1 (n = 47) and 37.4 +/- 10.0 years in group 2 (n = 5). Median follow-up was 18 months. There weren't any significant differences in collagen type 3, elastin, fibrosis, or Cajal cells between the 2 groups (P > .05). Conclusion: The histopathologic pattern of UPJ was not a factor associated with the success of pyeloplasty. Based on the present findings, we conclude that surgical technique is more important than the histopathologic pattern of UPJ for the successful treatment of UPJO.
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    The Effect of L-Carnitine on Testicular Ischemia-Reperfusion Injury due to Testicular Torsion in Rats
    (Modestum Ltd, 2012) Deliktas, Hasan; Gedik, Abdullah; Nergiz, Yusuf; Bircan, Mehmet Kamuran
    This experimental was study designed to examine the efficacy of L-carnitine in preventing reperfusion injury following testicular torsion. We aimed to evaluate the effects of L-carnitine, administered during the reperfusion period, on the torsed and contralateral non- torsed testes in cases of unilateral testicular torsion in rats. This experimental study was performed in the research laboratory Dicle University, School of Medicine, between March 1, 2007 and May 31 2007. The study included 20 adult male rats those 6 months old that were divided into 3 groups: a sham group (group 1), ischemia/reperfusion group (group 2), and ischemia/reperfusion + L-carnitine group (group 3). In group 2 one ml of serum physiologic was injected intraperitoneally versus 500 mg/kg of L-carnitine in group 3 immediately after detorsion following a 4-h torsion period; the doses were repeated after 8 h later. Histologically, Sections of the left testes in group 2 showed irregularities in germinal epithelial cell configuration and degeneration in several cells, and all the samples of the right testes in group 2 had arrested sperm maturation and primary spermatocytes had a dusky appearance in some tubules, while all remaining groups were normal. L-carnitine had a positive effect on ipsilateral and contralateral testes. The positive effect of L-carnitine in reducing reperfusion damage in ipsilateral and also in contralateral testis was histopathologically observed. We think L-carnitine should always be apllied immediately after repurfusion period and should be repeated after 8 hours in testicular torsion cases.
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    THE EFFECT OF THE SELECTIVE CYCLOOXYGENASE II INHIBITOR PARECOXIB ON RENAL MORPHOLOGY AND FUNCTION IN ACUTE UNILATERAL URETERAL OBSTRUCTION
    (Carbone Editore, 2014) Tutus, Ali; Deliktas, Hasan; Gedik, Abdullah; Gezici, Ayten; Ozekinci, Selver; Sahin, Hayrettin
    Objectives: This experimental study aimed to examine the efficacy of parecoxib in the treatment of kidney obstruction. The histopathological and seintigraphic effects of the selective cyclooxygenase 11 (cox-in inhibitor parecoxib on renal morphology and function were determined following surgically induced unilateral ureteral obstruction. Materials and methods: The study included 20 male Spragne-Dawley rats that were assigned to 2 groups of 10 each The rats underwent diethylenetriamine pentaacetic acid (DTPA) renal scintigraphy to calculate basal glomerular filtration rate (GFR) values at the beginning of the study. The left ureters in groups 1 and 2 were ligated distally. The rats in group 2 received parecoxib 5 mg-kg(-1)d(-1), for 21 d post surgery, whereas those in group.] received nothing. At the end of postoperative d 21 DTPA renal scintigraphy was repeated in all the rats before undergoing bilateral nephrectomy. All kidneys were evaluated histologically. Results: Histologically, there were no differences between the right kidneys in groups 1 and 2, whereas the occurrence of cortical congestion, glomerular congestion, interstitial inflamation + congestion, and interstitial fibrosis was significantly lower in the left kidneys in group 2 than in those in group I (cortical congestion: P = 0.005; glomerular congestion: P = 0.03; interstitial infomation + congestion: P = 0.01; interstitial fibrosis:,P = 0.005). Scintigraphically; left kidney and right kidney CFR values in group 2 were higher than those in group I; the difference was significant (left kidneys: P = 0.001; right kidneys: P = 0.009). Conclusion: Histopathologically and scintigraphically, kidney function was preserved at the highest level in group 2. Parecoxib treatment was effective in preserving renal function in the obstructed and non obstructed (contralateral) kidneys, and can be administered during the obstruction period until the time radical treatment of obstruction can be performed.
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    Histopathologic and Urodynamic Effects of the Anticholinergic Drugs Oxybutynin, Tolterodine, and Trospium on the Bladder
    (Wiley, 2017) Orgen, Seyfettin; Deliktas, Hasan; Sahin, Hayrettin; Gedik, Abdullah; Nergis, Yusuf
    Objectives: This study aimed to evaluate the effects of intravesical instillation of the anticholinergic drugs oxybutynin, tolterodine, and trospium on bladder capacity and histopathological changes in the bladder mucosa. Methods: The study included 20 male New Zealand white rabbits that were randomly allocated to four groups of five. In the oxybutynin, tolterodine, and trospium groups, the drugs used were 1 mg/kg of crushed tablet mixed with 5 mL of saline, instilled intravesically once per day for 4 weeks. The control group was administered only 5 mL of saline once per day for 4 weeks. Urodynamic measurement of the bladder was made before and after treatment. At the end of the treatment the animals were killed and the bladders were evaluated histopathologically. Results: There were no significant differences between pre- and post-treatment bladder capacity in any of the groups (P>0.05). Histopathological evaluation showed that the mucosal epithelium was intact and there was minor inflammation in the control group and oxybutynin group (P>0.05), whereas there was destruction of the mucosal epithelium and findings of diffuse inflammation in the tolterodine (P=0.014) and trospium (P=0.014) groups. Conclusion: Intravesical oxybutynin treatment was observed to be safe; however, a single daily dose of oxybutynin may not be sufficient to increase bladder capacity. Intravesical use of trospium and tolterodine at high doses caused epithelial destruction and diffuse inflammation in the bladder mucosa. The irritation associated with epithelial destruction and inflammation prevented an increase in bladder capacity.
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    Is percutaneous cystostomy always necessary in transvaginal repair of benign vesicovaginal fistulae?
    (E-Century Publishing Corp, 2016) Gedik, Abdullah; Deliktas, Hasan; Celik, Nurettin; Kayan, Devrim; Bircan, Mehmet Kamuran
    Purpose: To retrospectively evaluate benign, primary vesicovaginal fistulas (VVF), to determine the outcomes of using only a urethral catheter without cystostomy as a urinary diversion. Methods: Twenty-five women with VVF were treated between April 2008 and October 2014 and evaluated retrospectively. Only primary, benign fistulas were included in this study. Patients with a malignant etiology and/or prior irradiation were excluded, as they required a more complex repair. All included VVFs were treated without replacing a percutaneous cystostomy. All patients were called back on postoperative day 10 for urethral catheter removal. Cystography was not performed before catheter removal. Patients were followed in our clinic postoperatively for one year. Results: Twenty-five patients with VVF were treated using a transvaginal technique without percutaneous cystostomy. All patients, except for two, were discharged the day after surgery. There were no major complications, Clavien Class 2 or greater and no recurrent fistulas were detected. Conclusion: We used only a urethral catheter for 10 days postoperatively in transvaginal VVF repairs. The results show that transvaginal repair of benign VVFs only with urethral catheter is successful and cost effective. Cystography was not necessary before catheter removal.
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    Which Surgical Technique Should be Preferred to Repair Benign, Primary Vesicovaginal Fistulas?
    (Urol & Nephrol Res Ctr-Unrc, 2015) Gedik, Abdullah; Deliktas, Hasan; Celik, Nurettin; Kayan, Devrim; Bircan, Mehmet Kamuran
    Purpose: To evaluate and compare the outcomes of benign, primary vesicovaginal fistulas (VVFs) treated using the transabdominal transvesical technique and the transvaginal technique without tissue interposition. Materials and Methods: A total of 53 consecutive women with VVF who were treated between September 1999 and October 2014 were evaluated retrospectively. Patients with a malignant etiology and/or prior irradiation were excluded because they required a more complex repair. In the first group, the repair was performed using the transabdominal transvesical technique (n = 28). After one of our fellows had completed his urogynecology training, he began to perform the repairs using the transvaginal technique (n = 25). All included VVF patients were treated without a tissue interposition. Results: Vesicovaginal fistula repair was performed in 53 patients, with a mean age of 41.4 +/- 15.2 years. There was no significant difference in terms of the patients' age, fistula size, and the number of deliveries between the groups. All cases failed in terms of conservative management. The size of the fistulas ranged from 15 to 20 mm. The admission time was between 3 days and 21 years, and it was longer in less educated patients. The success rate was 96.4% (27/28) in the transabdominal transvesical group and 100% (25/25) in the transvaginal group (P = 1.00). The hospitalization period and complications were significantly reduced in the transvaginal group (P = .00 and P = .004, respectively). No patients converted from a transvaginal to a transabdominal repair. There was only one recurrence in the transabdominal transvesical group. The patients were followed up for 1 year. Conclusion: Transvaginal repair of benign, primary VVFs is more advantageous than transabdominal transvesical repair. There was a significant decrease in the hospitalization period and complications rates using the transvaginal technique without tissue interposition.