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Öğe ENDOUROLOGIC MANAGEMENT OF PEDIATRIC FORGOTTEN STENTS: 22 PATIENTS FROM 4 CLINICS(Mary Ann Liebert, Inc, 2012) Sancaktutar, Ahmet Ali; Adanur, Senol; Resorlu, Berkan; Tepeler, Abdulkadir; Ziypak, Tevfik; Atar, Murat; Bozkurt, Yasar[Abstract Not Available]Öğe Flexible Ureterorenoscopy for the Treatment of Kidney Stone Within Pelvic Ectopic Kidney(Elsevier Science Inc, 2014) Bozkurt, Omer Faruk; Tepeler, Abdulkadir; Sninsky, Brian; Ozyuvali, Ekrem; Ziypak, Tevfik; Atis, Gokhan; Daggulli, MansurOBJECTIVE To present the outcomes of flexible ureterorenoscopy (F-URS) and laser lithotripsy for the treatment of calculi within pelvic ectopic kidney (PEK). PATIENTS AND METHODS We retrospectively reviewed the medical records of 26 patients with calculi in PEK treated with F-URS in 5 referral hospitals between 2010 and 2013. Patient demographics and stone characteristics (age, sex, body mass index, stone size, location, history of shock wave lithotripsy or kidney surgery), and perioperative measures (duration of operation, fluoroscopic imaging, and hospitalization and success and complication rates) were reviewed. RESULTS A total of 26 patients with mean age of 41.1 +/- 15.8 years (7-72 years) were included in the study. The mean stone size was 17.0 +/- 5.1 mm (10-28 mm). The mean procedure and fluoroscopy times were calculated as 52.1 +/- 27.7 minutes (30-120 minutes) and 54.8 +/- 48.9 seconds (10-180 seconds), respectively. The mean length of hospital stay was 2.7 +/- 1.8 days (1-9 days). Treatment was deemed successful in 22 patients (84.6%). Ureteroscopy failed in 4 patients (15.4%) due to impaired passage of fragments (n = 3) or inability to reach the stone secondary to the location in an isolated lower calyx (n = 1). Minor postoperative complications were observed in 5 patients (19.2%; persistent hematuria [n = 1], fever [n = 1], renal colic [n = 2], and urinary tract infection [n = 1]). No severe complications or mortality occurred. CONCLUSION Our results suggest that F-URS is a safe and effective minimally invasive treatment modality for small-and medium-sized stones in PEK. (C) 2014 Elsevier Inc.Öğe The Forgotten Ureteral Stent in Children: From Diagnosis to Treatment(Elsevier Science Inc, 2013) Sancaktutar, Ahmet Ali; Adanur, Senol; Resorlu, Berkan; Tepeler, Abdulkadir; Ziypak, Tevfik; Soylemez, Haluk; Atar, MuratPurpose: We conducted a multicenter pediatric study of ureteral stents unintentionally left in situ. Materials and Methods: A total of 22 patients with encrusted Double-J (R) ureteral stents unintentionally left in situ were treated at 4 centers between January 2007 and March 2012. Stone burdens were estimated using plain radiography and computerized tomography. Treatment decision was made based on clinical and radiological findings or stone burden. Results: Nine girls and 13 boys with a mean age of 9.5 years (range 2 to 16) were analyzed. Mean indwelling time of ureteral stent was 21.7 months (range 6 to 60). Stents were inserted for the indication of urolithiasis (17 patients) and reconstructive urological intervention (5). In 2 patients stents had been placed bilaterally. Mean stent stone burden was 184 mm(2) on plain radiography and 247 mm(2) on computerized tomography, a difference that was statistically significant (p = 0.002). Shock wave lithotripsy was done in 6 cases. Endoscopic procedures were performed in all patients, including ureteroscopy in 8, simple stent removal in 7, endoscopic cystolithotripsy in 6, percutaneous nephrolithotomy in 5, retrograde intrarenal surgery in 3 and percutaneous cystolithotripsy in 2. Surgical removal of each stent required a mean of 1.5 interventions and a mean hospital stay of 4.4 days. Conclusions: At experienced centers combined endourological techniques can achieve successful and safe management of forgotten stents even in the pediatric age group. Thus, routine preprocedural tomography is a must in children with forgotten ureteral stents.Öğe Letter to the editor regarding the article Experience on semirigid ureteroscopy and pneumatic lithotripsy in children at a single center(Springer, 2013) Sancaktutar, Ahmet Ali; Bozkurt, Yasar; Soylemez, Haluk; Ziypak, Tevfik[Abstract Not Available]Öğe Micropercutaneous Nephrolithotomy in the Management of Bilateral Renal Stones in a 7-Month-Old Infant: The Youngest Case in the Literature(Karger, 2016) Sancaktutar, Ahmet Ali; Adanur, Senol; Ziypak, Tevfik; Hatipoglu, Namik Kemal; Bodakci, Mehmet Nuri; Soylemez, Haluk; Ozbey, IsaDuring infancy, the renal parenchyma and pelvicalyceal system are relatively fragile. Therefore, percutaneous nephrolithotomy for the management of renal stones in this age group is a challenging procedure for urologists. Herein, we present the uneventful management of bilateral renal stones using micropercutaneous nephrolithotomy (microperc) administered to a 7-month-old infant with recurrent urinary tract infections. In this paper, the advantages and disadvantages of the microperc procedure are discussed. As far as we know, our patient is the youngest case in whom the microperc procedure has been performed. (C) 2014 S. Karger AG, BaselÖğe Minipercutaneous nephrolithotomy in infants: a single-center experience in an endemic region in Turkey(SPRINGER, 233 SPRING ST, NEW YORK, NY 10013 USA, 2014) Bodakçı, Mehmet Nuri; Daggulli, Mansur; Sancaktutar, Ahmet Ali; Söylemez, Haluk; Hatipoğlu, Namık Kemal; Utangaç, Mehmet Mazhar; Penbegül, Necmettin; Ziypak, Tevfik; Bozkurt, YaşarThe objective of the study is to evaluate the effectiveness and safety of miniaturized percutaneous nephrolithotomy (mini-PNL) method in infantile patients < 3 years of age diagnosed with renal stones. We studied 48 renal units in 40 patients of infantile patients < 3 years of age who underwent mini-PCNL at our institute. The mean age of the patients was 24.02 (5-36) months. The mean diameter of the stones was 22.3 mm (11-45 mm). Intrarenal access was achieved under fluoroscopic (n = 43) or ultrasonographic (n = 5) guidance under general anesthesia. A 20 Fr peel-away sheath, a 17 Fr rigid nephroscope and a pneumatic intracorporeal lithotripsy were used. Mean operative time for PNL was 85 (25-135) min. Mean fluoroscopy time was estimated as 3.7 min. The mean hospital stay was 4.3 days (2-10). Mean hemoglobin loss was 0.89 g/L (11.56-10.67) and three of the patients, including one case during the perioperative period, required blood transfusions. Colonic perforation developed in one case. In two patients, urinary drainage persisted for more than 24 h after withdrawal of the nephrostomy tube. Seven patients developed urinary tract infections (UTI). At the end of the postoperative first week, the stone-free rate was estimated to be 81.2 %. In conclusion, for percutaneous management of renal stones in the infantile age group, mini-PNL is an applicable treatment modality that can be applied through small incisions. It has higher stone-free rates, shorter hospital stays, and excellent esthetic outcomes. In this age group especially, surgical exposure to hypothermia and radiation should be avoided.Öğe A NEW PRACTICAL MODEL OF TESTES SHIELD: THE EFFECTIVENESS DURING ABDOMINO-PELVIC COMPUTERIZED TOMOGRAPHY(Mary Ann Liebert, Inc, 2012) Sancaktutar, Ahmet Ali; Bozkurt, Yasar; Onder, Hakan; Soylemez, Haluk; Atar, Murat; Penbegül, Necmettin; Ziypak, Tevfik[Abstract Not Available]Öğe A New Practical Model of Testes Shield: The Effectiveness During Abdominopelvic Computed Tomography(Amer Soc Andrology, Inc, 2012) Sancaktutar, Ahmet Ali; Bozkurt, Yasar; Onder, Hakan; Soylemez, Haluk; Atar, Murat; Penbegül, Necmettin; Ziypak, TevfikThe goal of our prospective study was to measure the effect of a new standard model male gonad shield on the testicular radiation exposure during routine abdominopelvic computed tomography (CT). Two hundred male patients who underwent upper abdominal and pelvic CT examinations were included in our study. To prepare the testes shield (TS), 2 No. 8 fluoroscopy radiation-protection gloves made of bismuth (0.35 mm lead equivalent) were used. These gloves were invaginated into one another and their fingers were turned inside out. Scrotums of all patients were pushed into these lead-containing gloves. Upper abdominal CT (n = 6), pelvic CT (n = 9), and abdominopelvic scanning (n = 185) were performed. Immediately after the CT examinations and at postprocedural day 1, the scrotal examinations were repeated. None of the patients exhibited scrotal laceration, edema, eruption, erythema, tenderness, or pain. During the CT examinations, 22 patients (11%) felt unrest because of their exposed genital regions, without any adverse effect on the procedure. Dosimetric measurements of radioactivity inside the TS (dosimeter I) and outside it (dosimeter II) were 6.8 and 69.00 mSv, respectively. Accordingly, the TS we used in our study reduced the radiation exposure of the testes by 90.2% (10.1 times). We think that the use of this radioprotective TS during radiological diagnostic and therapeutic procedures is an appropriate approach from both a medical and legal perspective. Therefore, we recommend this user-friendly, practical, low-cost, and effective TS for all radiologic procedures.Öğe Percutaneous nephrolithotomy for the treatment of radiolucent renal stones in children: is it different opaque stone treatment?(Springer, 2014) Adanur, Senol; Ziypak, Tevfik; Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir; Resorlu, Berkan; Soylemez, Haluk; Daggulli, MansurWe aimed to evaluate the effectiveness of percutaneous nephrolithotomy (PNL), stone-free rates, and related complications in children with radiolucent renal stones. A total of 56 patients aged < 16 years from four institutions were enrolled in our study. Asymptomatic, clinically insignificant residual fragments measuring < 4 mm or a complete stone-free status was accepted as the criterion for clinical success. Complications were evaluated according to the modified Clavien classification. The mean age of the patients was 7.8 +/- A 4.5 years. The mean stone size was calculated as 24.07 +/- A 10.4 mm. The median operative and fluoroscopy times were 53.2 min (15-170 min) and 172.4 s (5-520 s), respectively. The success rate after PNL monotherapy was 87.4 %; the total success rate with shock wave lithotripsy used as an auxillary treatment method was detected as 94.6 %. The total complication rate was 19.6 % (11 patients). No adjacent organ injury was observed. All of the complications that occurred were minor according to the Clavien classification (Clavien Grades I-II). PNL can be applied to radiolucent pediatric renal stones in children with similar success, and complication rates as noted for radiopaque stones.Öğe A questionnaire study about gonadal shield use of urologists(Dicle Üniversitesi Tıp Fakültesi, 2012) Sancaktutar, Ahmet Ali; Ziypak, Tevfik; Adanur, Şenol; Söylemez, Haluk; Hamidi, Cihat; Bozkurt, Yaşar; Atar, Murat; Bodakçi, Mehmet NuriObjectives: Our aim is to reflect routines, awareness, and consciousness level of urologists about usage of gonadal shield (GS) in Turkey. Materials and methods: Because of this objective a questionnaire which includes 15 questions was prepared. The questionnaire was delivered to urologists in a Turkish Urology congress. Data derived from 271 urologists by face to face interview were evaluated. Results: Participant were urologists (n=271), consisted of professors (n=33), associate professors (n= 36), assistant professors (n= 36), specialists (n=94), and residents (n=81). According to the data obtained from the questionnaires, 22% of the participants acquired their first information about GS as a medical student, 44% during their residency training, and 14% of them had no information about GS at all. Besides 64% of them did not read any medical article about this subject until that time, and 54% them practically hadn’t seen any GS during their urology practice. In 82% of the hospitals where participants were working hadn’t had any GS, and 18% of the urologists had indicated that GS was available in their hospitals, and they used them once in a while. Urologists responded favorably (20%) or unfavorably (80 %) to the question of ‘Do you find yourself or your colleagues adequately sensitive, and mindful about GS use? Conclusions: Sensitivity and awareness about use of gonadal shields among Turkish urologists are not at a desired level and for this reason, it is not used widely. The urologists should be informed in urological academic platforms about gonad protecting devices.Öğe Transrektal prostat biyopsisinde anestezi seçimi: rektal lidokain jel instillasyonu ve lidokainle periprostatik sinir blokajı karşılaştırması(Avrasya Üroonkoloji Derneği, 2014) Turgut, Hasan; Aydın, Hasan Rıza; Adanur, Şenol; Ziypak, Tevfik; Bağcıoğlu, Murat; Dağgülli, MansurAmaç: Prostat patolojilerinin benin ya da malin ayrımının kesin olarak yapılabilmesi için prostat biyopsisi altın standarttır. Ancak işlem sırasında duyulan ağrı ciddi bir sorun teşkil etmektedir. Bu çalışmanın amacı; iki farklı yöntemle transrektal ultrasonografi (TRUS) rehberliğinde, prostat biyopsisi sırasında duyulan ağrının derecesine etkili olabilecek anestezi tekniklerini karşılaştırmaktır Gereç ve Yöntemler: Kliniğimizde prostat spesifik antijen (PSA) yüksekliği ve parmakla rektal muayenede şüpheli bulgusu olan toplam 92 hastaya prostat biyopsisi yapıldı. Hastaların duydukları ağrı vizüel analog ağrı skalası (VAS) (şekil 1) ile değerlendirildi. İşlem, hastalara lateral dekübitis pozisyonunda 7 MHz transrektal ultrason probu eşliğinde, 18 G Tru-cut otomatik biyopsi ataçmanları kullanılarak yapıldı. Bir gruba TRUS probunun yerleştirilmesinden 5 dakika önce rektum içine 10 ml %2’ lik Lidokain HCL jel verildi. Diğer gruba yine işlem öncesi %2’lik lidokain HCL jel ve periprostatik sinir blokajı yapılmak üzere sağ ve sol lop için ayrı ayrı 5 cc lidokain enjeksiyonu yapıldı. Bulgular: Hiçbir hasta şiddetli veya dayanılmaz ağrı tarif etmedi. Gruplar VAS skorları dikkate alınarak karşılaştırıldığında sinir blokajı yapılan hastalar lehine anlamlı fark belirlendi (p<0.05). Sonuç: Rektal lidokain jel anestezisi ile yapılan TRUS rehberliğinde prostat biyopsileri tolere edilebilir bulunmuştur. Lidokain instilasyonunun ardından yapılan periprostatik sinir blokajı işlemin ve hastanın konforunu arttırmaktadır ve sadece lidokain jel instilasyonuna göre daha az ağrılı olduğu tespit edilmiştir. Biz prostat biyopsileri öncesi lidokain jel instilasyonuna ilave olarak periprostatik lidokain enjeksiyonunu öneriyoruz.
