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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 Body mass index, body fat percentage, and the effect of body fat mass on SWL success(Springer, 2007) Akay, Ali Ferruh; Gedik, Abdullah; Tutus, Ali; Sahin, Hayrettin; Bircan, Mehmet KamuranObjectives In the present study, we investigated the effects of the Body Mass Index (BMI), the Body Fat Percentage (BFP), and the Body Fat Mass (BFM) on success of SWL, prospectively. Patients and methods The BMI, BFP, BFM values of patients, who were treated by SWL due to upper urinary system stone disease (pelvis renalis, upper ureter, kidney lower and upper calices) between January and December 2005 in our hospital's urolithiasis center, were measured. Patients with stones smaller than 5 mm or larger than 20 mm and patients who had a stone localized somewhere other than in the upper urinary system, were not included in the study. Patients evaluated to be clinically successful according to the SWL were put in group 1, and the other patients who were not successful were included in group 2. Results About 158 (97 male, 61 female) patients aged between 16 and 92 (mean 36.69 (+/- 13.22) years), put on SWL therapy due to presence of upper urinary system stone disease, were included in the study. While the mean BMI was 23.97 +/- 0.4 in group 1 and 25.98 +/- 0.5 (P = 0.02) in group 2, BFP was 23.85 +/- 0.8 in group 1 and 29.19 +/- 1.1 (P = 0.001) in group 2, and BFM was determined to be 16.74 +/- 0.7 and 21.19 +/- 1.01 (P = 0.001) in group 2. Regarding all the parameters (BMI, BFP, BFM), the statistical analyses carried out between the groups showed significant differences. Conclusion BFP and BFM parameters are also important factors along with the BMI in providing a successful SWL treatment. All the parameters should be considered regarding the success of the treatment and the patients should be informed.Öğe 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, HayrettinObjective 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.Öğe Comparison of lornoxicam versus tramadol analgesia for transrectal prostate biopsy: a randomized prospective study(Springer, 2008) Olmez, Gonul; Kaya, Sedat; Aflay, Ugur; Sahin, HayrettinIntroduction We compared the efficacy of lornoxicam and tramadol to provide analgesia and comfort during transrectal ultrasound-guided biopsy of the prostate (TRUSP) as a noninvasive method. Materials and methods A total of 62 men undergoing TRUSP were enrolled in this study. Patients were randomized to three groups. Group 1 (n = 21) received 8 mg of lornoxicam, group 2 (n = 21) received 100 mg of tramadol, and group 3 (n = 20) received saline as a control. The drugs were given intramuscularly half an hour prior to the procedure. All patients were asked to indicate the level of pain experienced after the procedure by visual analog score (VAS), and the patient's comfort level was scored by a comfort score. Additionally, the patients were asked if they were willing to undergo a. future TRUSP. Results The data obtained revealed that both experimental groups receiving lornoxicam and tramadol had lower VAS scores compared to the control group (3.4 and 2.4 vs. 6.4, respectively; P < 0.0001). There were also significant differences in VAS scores between group 1 and group 2 (P = 0.027). There was a significant difference in the comfort score between the drug groups and control (P > 0.0001) and between the lornoxicam and tramadol group (P < 0.05). Pain and discomfort were least in the tramadol group. The percentage of patients who would not consent to future TRUSP was lower in the drug groups compared to control (P < 0.0001). But there were not any differences between the drug groups. Conclusions The use of lornoxicam or tramadol for pain relief in TRUSP is a practical, effective and comfortable method compared to the results of the control group. In addition, tramadol was found to be more effective than lornoxicam.Öğe Comparison of the Efficacy of Single or Double Intravesical Epirubicin Instillation in the Early Postoperative Period to Prevent Recurrences in Non-Muscle-Invasive Urothelial Carcinoma of the Bladder: Prospective, Randomized Multicenter Study(Karger, 2010) Turkeri, Levent; Tanidir, Yiloren; Cal, Cag; Ozen, Haluk; Sahin, HayrettinObjectives: To investigate the efficacy of single or double epirubicin instillation during the early postoperative period (EPP) in intermediate-risk non-muscle-invasive urothelial cancer. Methods: Patients with primary and solitary or multiple (3 or less) Ta (grade 2-3) or T1 (grade 1-2) tumors were enrolled. Patients were randomized to receive either a single dose of 100 mg epirubicin instillation within 6 h or a second 100 mg epirubicin instillation during the 12th-18th hours after a complete TUR-BT. At the end of the 60-month follow-up period, the available data were statistically analyzed. The end-points of the study were determined as disease-free survival, progression and recurrence rates, time to recurrence, and time to progression. Results: A total of 299 patients from 24 institutions were randomized between January 2002 and June 2004. There were 143 patients from 18 institutions who met the eligibility criteria. The follow-up and disease-free survival periods were 16.9 months and 16 months, respectively. There was no statistical difference in the demographic properties and the end-points between the groups. Conclusions: A single dose of intravesical 100 mg epirubicin chemotherapy during the early postoperative period for primary intermediate-risk non-muscle-invasive urothelial cancer achieved 16 months of mean disease-free survival. A second intravesical epirubicin instillation did not provide any significant benefit. Copyright (C) 2010 S. Karger AG, BaselÖğe 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, HayrettinPurpose: 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.Öğe 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, HayrettinObjectives: 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.Öğe Erectile dysfunction rates and requests for treatment in patients attending outpatient urology clinics and those accompanying them(Springer, 2004) Kuru, Ahmet Fevzi; Sahin, Hayrettin; Akay, Ali Ferruh; Bircan, Mehmet KamuranBackground: Erectile dysfunction is a common sexual function disorder in men. The aim of the present study was to determine the rates of erectile dysfunction and requests for treatment in male patients refered to our outpatient urology clinics and those accompanying them who were older than 20 years. Methods: The study comprised 2 groups: group 1 included male patients older than 20 years whom attend to the outpatient urology clinics, and group 2 included their companies whom were older than 20 years. Subjects were asked whether they had erectile dysfunction or not, if so whether they had been treated or not, if not then why, and whether they desired treatment or not at present. Results: Erectile dysfunction was determined in 224 subjects (13.9%) in group 1, and 57 (8.5%) in group 2. It was found that approximately one half (49.1%) of patients with erectile dysfunction did not complaint about this. The main reasons for this were failure to perceive sexual dysfunction as a problem, and shame. Of 281 men who determined to have erectile dysfunction, 71 indicated that they desired treatment. In those who did not desire treatment, the main reasons were failure to perceive it as a problem, and shame. Conclusions: These findings show that the doctor has a great responsibility in determining erectile dysfunction. Therefore discussions of sexual health should be made a routine part of doctor-patient discussions, and patients, especially those over 50, should be asked whether they have a complaint of erectile dysfunction.Öğe 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, YusufObjectives: 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.Öğe The increasing use of intravesical therapies for stage T1 bladder cancer coincides with decreasing survival after cystectomy(Galenos Yayincilik, 2007) Sahin, HayrettinObjective: In this retrospective study, it is examined the patterns of use of intravesical therapy (IVT) in high-grade T1 bladder cancer and the subsequent impact on survival for patients ultimately proceeding to radical cystectomy ( RC). Patients and Methods: The study evaluates a total of 104 patients with T1 high-grade transitional cell carcinoma (TCC) and who underwent RC between 1990 and 2005. Patients were divided into two groups; those having RC before 1998 and those after 1998. Trends in time from diagnosis to RC, courses of IVT, recurrence and pathological stage were analysed using two-sample t-tests with 95% confidence intervals. Results: Before 1998, 28 of 38 patients (74%) proceeded directly to RC with no IVT, vs 20 of 47 (43%) after 1998 (P=0.004). The mean number of IVT courses per patient was 0.53 before 1998 and 1.2 afterward (P=0.016). Patients who had RC before 1998 had a 69.7% disease-free survival at 5 years, vs 39.6% for those after 1998 (P=0.05). Conclusion: This retrospective study indicates that patients having RC for T1 high-grade TCC after 1998 were more likely to receive IVT. These same patients had a worsening diseasefreesurvival. The decreasing in survival might be related to an increased use of IVT. The possibility that IVT might be delaying curative surgery.Öğe Injury or body fluid splash incidence rate during three months period in elective surgery procedures, at Dicle University Hospital, Diyarbakir, Turkey(Turkish Assoc Trauma Emergency Surgery, 2008) Ertem, Meliksah; Dalar, Yasemin; Cevik, Ugur; Sahin, HayrettinBACKGROUND In this study we aimed to determine the prevalence of sharp injuries (SI) and blood and body fluid (BBF) splashes in health care workers during elective surgery procedures (ESP). This study would help to plan the preventive measures for injuries and BBF splashes. METHODS All ESP were recorded during three months period and SI and BBF splashes were analyzed in Hospital of Dicle University. Hospital employees who reported SI or BBF splashes were interviewed about the types of devices causing injury and the circumstances of the injury. RESULTS During three months period, 1988 ESPs were recorded. SIs were reported in 111 procedures (5.6%) and BBF splashes were in 145 (7.3%). Incidence rate of SI was 2.8 per person year in teaching staff, 5.6 in residents, 6.3 in nurses and 1.5 for other health care workers. Incidence rate of BBF splashes was 14.5 per person year in trainers, 6.9 in residents, 8.4 in nurses, respectively. Duration of ESP, start time of ESP and number of employed personnel in the ESP were the factors that significantly influenced SI incidence. Duration of ESP and total person worked in ESP was effective on BBF splashes. SI was occurred in 14.4 of mandibulofacial, 12.2% of general surgery, 10.5% of chest surgery and 8.4% of brain surgery ESP. BBF splashes occurred in 14.4% of general surgery's, 13.5% of urology's, 14% of chest surgery's, 14.7% of cardiovascular surgery's ESP. The most frequently injured tissue was index finger (33.9%) and the pollex finger (31.4%). CONCLUSION SIs and BBFs are important health risks for health professionals who are involved in surgery, as it is in all other medical practices. SI and BBF splashes should be monitored and preventive measures should be planned urgently.Öğe IS IT NECESSARY TO PLACE URETERAL STENTING AFTER UNCOMPLICATED URETEROSCOPIC LITHOTRIPSY?(Aves, 2006) Atug, Fatih; Akay, Ferruh; Akkus, Zeki; Orgen, Sait; Alar, Salih; Sahin, HayrettinIntroduction: The routine placement of ureteral stents after ureteroscopic lithotripsy procedure is controversial. The main aim of placing a ureteral stent is to prevent ureteral obstruction and renal colic which may develop as a result of uretral edema. Additionally, stents are thought to assist the passage of residual fragments after lithotripsy through passive ureteral dilatation. However, the placement of a ureteral stent is associated with complications including stent migration, breakage, encrustation, stone formation, urinary tract infections and patient discomfort. Therefore numerous studies have been questioned the routine use of ureteral stents after uncomplicated uretroscopic lithotripsy. In this study we compared the results and stone free rates of patients with and without ureteral stenting after uncomplicated ureteroscopic lithotripsy. Materials and Methods: In this study, 367 patients who underwent ureteroscopic lithotripsy between 1996 and 2004 were evaluated retrospectively. Patients were divided into two groups. The first group consisted of 236 stented patients and the second group consisted of 132 non-stented patients. In both groups, patients were evaluated for results and stone free rates. Only uncomplicated ureteroscopy patients were included to the study. Patients with solitary kidney, history of renal failure, transplant kidney and a significant perforation or injury to ureter, high grade hydronephrosis, urinary tract infections and patients with impacted stones were excluded from the study. Additionally, patients with retrogarde stone migration were excluded from the study. The operation was performed under general anesthesia with 8.5 F rigid ureteroscope and stones were fragmented with pneumatic lithotriptor. In stented patients a double-J stent was placed in the treated ureter under fluoroscopic monitoring. In the non-stented group the safety wire was removed from the ureter and then the procedure was terminated. In stented patients, stents were removed cystoscopically under local or general anesthesia. Results: The mean age of patients was 40.1 years (range 22 to 76) in the stented group and 37.8 (range 19 to 65) in the non-stented group. The mean stone size was 9.1 mm (range 4 to 21) and 7.8 mm (range 3 to 17) in the in the stented and nonstented patients, respectively. There was no statistical difference between stone free rates in both groups. The stone free rate was %92.4 in stented group and %90.8 in the non-stented group (p>0.05). However, there was statistically significant difference for operative times between the two groups. The mean operative time was 51.4 min (range 30 to 110) in the stented group and 40.2 min. in the non-stented group (range 25 to 70) (p<0.05). The mean operative times increased 28% in the stented group. The symptoms of urinary frequency, flank pain, urgency and dysuria were more common and severe in the stented group. Additionally, hematuria was more severe and prolonged in stented patients when compared to non-stented patients. Conclusion: Our results demonstrate that it is not necessary to place uretral stent after uncomplicated ureteroscopic pneumatic lithotripsy. There was no difference between nonstented and stented patients with respect to stone free status. Ureteral stent placement following uncomplicated lithotripsy augments the operation time, surgical cost and increases patient morbidity.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 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 Risk factors for lower urinary tract infection and bacterial stent colonization in patients with a double J ureteral stent(Springer, 2007) Akay, Ali Ferruh; Aflay, Ugur; Gedik, Abdullah; Sahin, Hayrettin; Bircan, Mehmet KamuranObjectives We investigated the potential risk factors for lower urinary tract infection and bacterial stent colonization in patients with double-J stents. Patients and Methods A total of 195 double-J stents from 190 patients (95 men and 95 women, mean age 40.22 years) were examined. In all patients, prophylactic antimicrobial therapy was administered at the time of stenting. The stents and urine samples were removed aseptically and the proximal and distal tip segments of the stents were obtained. Three culture specimens were obtained from each stent segment and urine sample. Chi-square tests, odds ratio, and relative risk were used for the statistical analysis. Results Bacterial colonies were found in 24% (47 of 190) of the urine samples, 31% (61 of 195) of the proximal stent segments, and 34% (67 of 195) of the distal stent segments. Of the pathogens identified, Escherichia coli (34 of 47) was the most common. Diabetes mellitus (P < 0.01), chronic renal failure (P < 0.001), and pregnancy (P < 0.01) were found to be risk factors for lower urinary tract infection in patients with stents. An increased stent colonization rate was associated with implantation time, age, and female sex, but these were not statistically significant for lower urinary tract infection Conclusions Diabetes mellitus, chronic renal failure, and pregnancy are associated with a higher risk of lower urinary tract infection. Therefore, patients in these categories should be monitored carefully for infectious complications.Öğe Semi-rigid ureterorenoscopy in children without ureteral dilatation(Springer, 2008) Gedik, Abdullah; Orgen, Seyfettin; Akay, Ali Ferruh; Sahin, Hayrettin; Bircan, Mehmet KamuranObjectives We aimed to retrospectively review the efficiency of ureterorenoscopy (URS) applied without ureteral dilatation for evaluating pediatric ureteral pathologies. Methods The files of pediatric patients hospitalized in our clinic between January 2000 and June 2006 due to ureteral stone disease were reviewed and evaluated retrospectively. The ages, medical histories, physical examination results, preoperative routine blood and urinary tests, and culture results were recorded. Ureteral orifice dilatation was not needed in any of the patients. Due to the risk of mucosal trauma and edema development in the ureteral orifice and intramural ureter, 3F and 4F catheters were applied in all patients following the ureterenoscopy. These catheters were removed 24 h after the procedure. Results The files of 54 pediatric patients with a mean age of 8.5 years (range 1-16 years) were evaluated retrospectively. While diagnostic URS was applied in 12 (22.2%) of the patients, ureteral calculi were determined in 42 (77.8%) patients and the stones were fragmented by pneumatic lithotripter. Twenty-five of the stones were localized in the lower ureter, 16 in the mid-ureter, and 3 in upper ureter. The mean stone size was found to be 7.1 mm (range 4-12). None of the stones migrated to the proximal region. In 2 patients open ureterolithotomy was applied; stones were localized in the upper ureter in both of these patients. Conclusions Ureterorenoscopy can be successfully and safely applied without the need for ureteral dilatation in ureteral pathologies of children.Öğe VESICOURETERAL REFLUX INCIDANCE IN CHILDREN WITH URINARY STONE DISEASE(Aves, 2005) Akay, Ali Ferruh; Uzun, Fatih; Akay, Hatice Ozturkmen; Aflay, Ugur; Sahin, HayrettinIntroduction: 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.
