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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 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 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 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.
