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Öğe Ateşli silah ile penis ve skrotum yaralanması ve başarılı tamiri(Dicle Üniversitesi Tıp Fakültesi, 2009) Gedik, Abdullah; Tutuş, Ali; Kayan, Devrim; Bircan, Mehmet KamuranKırk yedi yaşında erkek hasta silah ile yaralanmadan 3 saat sonra acil servisimize başvurdu. Hastada geniş skrotal defekt vardı. Her iki testis ve korpus kavernozum yaralanmıştı. Üretra ve korpus spongiosum tamamen kopmuştu. Opere edilerek penisteki yaralanması onarılan hastanın postoperatif 6. haftada yapılan kontrolünde hasta sonuçtan memnun olduğunu ve ereksiyonların devam ettiğini belirtti. Tek yakınması glans penisteki hafif his kaybı idi. Genital yaralanmaların tedavisinde testis ve penisin korunması için tüm olasılıklar değerlendirilmelidir.Öğe 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, YasinAmaç: 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 tekniktirÖğe 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 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 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 KamuranPurpose: 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.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 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 KamuranPurpose: 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.Öğe Yüzeyel mesane tümörlerinde primer ve nüks tümör lokalizasyonları(2015) Kayan, DevrimBu çalışmanın amacı yüzeyel mesane tümörlerinde gelişen rekürrenslerin lokalizasyonuyla primer tümör lokalizasyonu arasındaki ilişkiyi incelemek. Ocak 1996 - Aralık 2009 tarihleri arasında kliniğimizde primer yüzeyel mesane tümörü tanısı ile takip edilen ve tedavisi yapılan 88 hastanın dosyası retrospektif olarak incelendi. Çalışmaya transizyonel hücreli yüzeyel mesane tümörlü 11’i kadın, 77’si erkek toplam 88 hasta alındı. Hastaların yaş ortalaması 62,05 ± 11,26 yıl idi. Hastaların 77’inde (% 87,5) low grade, 11’inde (% 12,5) high grade patoloji saptandı. Patolojisi low grade saptanan 77 hastanın 38’inde (% 49,4) nüks gelişirken; 39’unda (% 50,6) nüks gelişmemişti. Patolojisi high grade saptanan 11 hastanın 9’unda (% 81,8) nüks gözlenirken; 2’sinde (% 18,2) nüks yoktu (p<0,05). Tümör çapı ve sayısı nüks eden ve nüks etmeyen arasında anlamlı bulunmadı (p>0,05). Tüm hastaların primer tümör lokalizasyonuna bakıldığında 34’ü (% 38,63) sağ yan duvarda, 42’si (% 47,77) sol yan duvarda, 8’i (% 9,09) tabanda, 2’si (% 2,27) tavanda, 2’si (% 2,27) karşı duvarda olduğu görüldü. Nüks eden grupta primer tümör lokalizasyonu sağ yan duvar olan 17 hastadan 9’u (% 52,9) yine sağ yan duvarda nüks ederken, Primer tümör lokalizasyonu sol yan duvar olan 23 hastadan 12’si (% 52,2) yine sol yan duvarda nüks etmişti. Tüm hastaların primer tümör lokalizasyonuna bakıldığında daha çok yan duvarlardan kaynaklandığı görüldü. Nüks gelişen hastaların nüks lokalizasyonu olarak yine sıklıkla yan duvarlarda nüks ettiği görüldü. ANAHTAR SÖZCÜKLER: Mesane Kanseri, Yüzeyel, Transüretral Rezeksiyon, Lokalizasyon, Nüks.
