Publications by authors named "Kaya Horasanli"

30 Publications

  • Page 1 of 1

The fate of paratesticular masses: 13 years' experience in a tertiary referral centre.

Aktuelle Urol 2021 Apr 14. Epub 2021 Apr 14.

Şişli Hamidiye Etfal Training and Research Hospital, Urology, Şişli, Turkey.

Objective: Paratesticular neoplasms exhibit different behaviours, depending on the embryological tissue of origin. Treatment modalities can depend on the differential diagnosis. The aim of this study is to present the clinical, morphological and histopathological features of patients with paratesticular masses and their follow-ups and is intended to increase awareness of the issues.

Methodology: We included 31 excisions of paratesticular masses, after radiological diagnosis as paratesticular mass in our hospital between 2007-2020. Information on treatment modalities, tumour recurrence, metastasis, and survival rates were obtained from hospital archives. All patients were evaluated by taking patients' history, physical examination, scrotal ultrasound, chest radiography, and serum tumour markers. Treatment modality was selected according to intraoperative findings. Haematoxylin-eosin sections were examined, and immunohistochemical analyses were performed for smooth muscle actin, desmin, Ki67, CD34, S100, and myogenin. Ten high-power fields were counted to document Ki67 and p53 nuclear positivity rates.

Results: A total of 31 operations were performed with recurrence in three patients. Histomorphological and immunohistochemical examination revealed eleven malignant masses; eight rhabdomyosarcomas, a leiomyosarcoma, a liposarcoma and a large B cell lymphoma. Other excised masses were benign and infective lesions.

Conclusion: Paratesticular masses are heterogeneous tumours that follow different clinical courses. Clinicians must be aware of this histological diversity in order to plan a treatment pathway. This study is one of the largest published series, with a long follow-up period. It shows that the most critical features in determining prognosis are histopathological subtype and tumour grade.
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http://dx.doi.org/10.1055/a-1345-6808DOI Listing
April 2021

Rare Causes of Hydronephrosis in Adults and Diagnosis Algorithm: Analysis of 100 Cases During 15 Years.

Cureus 2020 May 21;12(5):e8226. Epub 2020 May 21.

Urology, Sisli Hamidiye Etfal Research and Training Hopsital, University of Health Sciences, Istanbul, TUR.

Introduction Hydronephrosis (HN) is a common pathology that is with/without obstruction. HN should be promptly addressed; otherwise, it progresses to cause impaired kidney function. This study was conducted to define the diagnosis algorithm and poor prognostic parameters used to evaluate unknown HN. Materials and Methods This study enrolled 100 patients who were over 20 years of age and were admitted to the center between 2001 and 2015 for the diagnosis and treatment of HN. Although initial diagnostic tests were applied, the HN etiology of the patients could not be found in ambulatory conditions; therefore, they were hospitalized to seek the causes for their HN. Patients who had a malignancy or tuberculosis or any previous ureteral injury were excluded. Results Of these cases, 29 were on both sides, whereas 42 were on the left side. Despite further investigations, the etiology was not determined in five patients. The frequency of malignancy in patients with hematuria (5/15) was two times higher than in patients without hematuria (33% vs. 17.6%; p = 0.01). Additionally, the malignancy rate was significantly higher in patients with weight loss (100%) than those without weight loss (OR: 6.25; p < 0.001). Conclusions Further investigation is recommended to define the precise etiology of HN. Hematuria and weight loss should be considered poor predictive factors during diagnosis.
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http://dx.doi.org/10.7759/cureus.8226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306661PMC
May 2020

Prognostic factors for surgical margin status and recurrence in partial nephrectomy.

Int J Clin Pract 2020 Oct 14;74(10):e13587. Epub 2020 Jul 14.

Department of Urology, Sisli Hamidiye Etfal Training & Research Hospital, Medical Sciences University, Istanbul, Turkey.

Purpose: To evaluate the prognostic factors affecting the surgical margin and recurrence in patients who underwent partial nephrectomy (PN) for renal masses.

Materials And Methods: Data of 125 patients who underwent open or laparoscopic PN because of renal mass between January 2006 and January 2019 were analysed retrospectively. Demographic data, habits, additional diseases, clinical and laboratory findings, operational data, the morphology of the tumour in computerised tomography or magnetic-resonance imaging and follow-up data were scanned and acquired via our hospital's system and archive.

Results: Average age was 54.4, male-female ratio was 1.55 and average tumour size was 3.31 cm. One hundred and four patients had malignant pathology and 21 were benign. Positive surgical margin (PSM) rate was 5.6% and recurrence rate was 3.2%. Average follow-up was 47.4 months. Pathological size of the tumour was larger (P = .006), warm-ischemia period was lower (P = .003) and PADUA score was higher (P = .015) in open technique. Tumour size and tumour stage were statistically higher in patients with recurrence (P = .009, P < .001, respectively). There was a significantly higher PSM ratio in mandatory indication group than elective indication group (P = .025). No statistically significant difference was observed between surgical margin positivity and tumour size, Fuhrman grades, PADUA scores, RENAL scores and C-index. (P > .05).

Conclusion: Surgical margin positivity after PN is not significantly associated with tumour characteristics and anatomical scoring systems. Surgical indication for PN has a direct influence on PSM rates. Tumour size and stage after PN are valuable parameters in evaluating the recurrence risk.
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http://dx.doi.org/10.1111/ijcp.13587DOI Listing
October 2020

The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux.

Int Braz J Urol 2018 Nov-Dec;44(6):1200-1206

Department of Pediatric Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received.

Materials And Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O'Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow's three groups contained 18 EI procedures, and each of the second fellow's 17.

Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar.

Conclusions: An acceptable rate of success for EI may be reached after about 20 procedures and a high success rate after about 35-40 procedures.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2017.0465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442187PMC
February 2019

Lower urinary tract dysfunction in pediatric patients after ureteroneocystostomy due to vesicoureteral reflux: Long-term follow-up.

Low Urin Tract Symptoms 2019 Apr 11;11(2):O48-O52. Epub 2018 Jan 11.

Urology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: The aim of the present study was to evaluate long-term lower urinary tract dysfunction (LUTD) in pediatric patients who underwent ureteroneocystostomy due to vesicoureteral reflux.

Methods: The present retrospective study was performed on 61 patients. Patients were divided into 3 groups: Group 1 (n = 26), did not have LUTD; Group 2 (n = 23), had LUTD; and Group 3 (n = 12), was not toilet trained preoperatively. Patients were reassessed regarding de novo LUTD or the persistence of LUTD at least 7 years after the ureteroneocystostomy.

Results: Mean patient age was 7 years (range 1-15) when ureteroneocystostomy was performed and the surgery was associated with a 92% success rate. The mean follow-up period was 10 years (range 7-12 years). Postoperative LUTD was present in 6 (23%), 12 (52%), and 1 (8.3%) patients in Groups 1, 2, and 3, respectively. The presence of LUTD before surgery and bilateral repair in the same setting were predictive risk factors for the presence of LUTD during the long-term follow-up. LUTD occurred at higher rate in Group 2 than in Groups 1 and 3 (52% vs. 23% and 8.3%, respectively; P = .015). The presence of de novo LUTD was significant in Group 1 compared with the presence of preoperative and postoperative LUTD (P = .031, Wilcoxon analysis).

Conclusions: LUTD may not resolve after a ureteroneocystostomy, and additional therapy could be necessary. Due to the probability of damage to the ureterovesical nerve and/or disturbed bladder dynamics, de novo LUTD may occur in patients with bilateral high-grade reflux without LUTD before a ureteroneocystostomy.
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http://dx.doi.org/10.1111/luts.12213DOI Listing
April 2019

Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery.

Arch Ital Urol Androl 2017 Oct 3;89(3):222-225. Epub 2017 Oct 3.

Bakirkoy Sadi Konuk Research and Training Hospital, Department of Urology.

Purpose: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT.

Materials And Methods: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level. At the end of 1st year, two groups were compared patient characteristics, operation time, duration of hospital stay, cure and complication rates.

Results: The cure rate was 84.37% 81/96) versus 83.63% (92/110) in TOT and TOT with cough test groups, respectively. Postoperatively ten patient (10/110, 9.09%) suffered voiding difficulties (> 250 ml residual urine) in TOT with cough stress test group. Five patients were discharged with transurethral catheter, whereas, in traditional TOT group, two patients (2/96, 2.1%) had transient postoperative voiding difficulty and two patients were treated with repeated catheterization for 1 week (p < 0.05). Postoperative groin pain was present in 7/96 (8%) versus 24/110 (22%) in TOT and TOT with cough test groups, respectively (p < 0.05). TOT with cough stress test group had an higher rate of complications like, retention of urine, necessitating to cut the tape, mesh erosion and pain in groin or leg. No patient had resistant voiding difficulty or prolonged urinary retention (> 1 week) in traditional TOT group.

Conclusions: We believe that per-operative cough stress test leads to overtreatment of stress urinary incontinence when the complication rates were considered.
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http://dx.doi.org/10.4081/aiua.2017.3.222DOI Listing
October 2017

The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey.

Turk J Urol 2016 Sep;42(3):140-4

Clinic of Urology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Objective: To evaluate long-term outcomes of active surveillance (AS) applied in low-risk prostate cancer patients, and the impact of re-biopsy results on the prediction of progression.

Material And Methods: In our clinic, patients who had undergone AS for low-risk localized prostate cancer between the years 2005-2013 were included in the study. Our AS criteria are Gleason score ≤6, prostate-specific antigen (PSA) level <10 ng/mL, number of positive cores <3, maximum cancer involvement ratio <50% each core. Immediate re-biopsy (within 3 months) was performed to 65 patients who accepted AS. Finally, 43 patients who met re-biopsy criteria were included in the study. Prostate biopsy specimens were harvested from 12 cores under the guidance of transrectal ultrasound (TRUS). Re-biopsy was performed within 3 months (1-12 weeks). In re-biopsy, a total of 20 core biopsies were performed including the far lateral (6 cores) and transition zone (2 cores) in addition to standard 12 core biopsy. Our follow-up protocol is PSA measurement and digital rectal examination (DRE) every 3 months within the first 2 years, than every 6 months. Control biopsies was performed one year later and once upon every 3 years to patients whose PSA levels and DREs were normal at follow-up visits. More than 2 tumor invaded cores or 50% tumor in one core, and Gleason score exceeding 6 points were accepted as indications for definitive treatment. Patients were divided into two groups by re-biopsy results and compared according to the time to progression. We have done multivariate regression analysis to predict prognosis by using data on age, PSA level, and detection of tumor in re-biopsy specimens.

Results: Patients' median age was 61 years and PSA level was 5 (2.7-9) ng/mL. Tumor was detected in 22 (34%) patients at re-biopsy and they underwent definitive treatment. Additionally tumor was detected in 9 patients, but active surveillance was maintained because their pathologic results met active surveillance criteria. Median follow time was 42 (24-117) months. Definitive treatment was performed in 9 (21%) patients. PSA recurrence was not detected in none of 9 patients during 38 months of follow up. Only the presence of tumor in re-biopsy specimens was found predictor of disease progression in multivariate analysis.

Conclusion: We think that AS is safe method for low-risk localized prostate cancer patients, if it is performed in compliance with certain criteria and regular follow up, and early re-biopsy can be useful either during early period or long term follow-up.
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http://dx.doi.org/10.5152/tud.2016.47786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012439PMC
September 2016

Does maternal exposure during pregnancy to higher ambient temperature increase the risk of hypospadias?

J Pediatr Urol 2016 Dec 13;12(6):407.e1-407.e6. Epub 2016 Aug 13.

Department of Urology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Introduction: The association between ambient temperature that the mother is exposed to during pregnancy and hypospadias has not been investigated by the studies, although the recent studies showed the correlation between some congenital malformations (congenital heart disease, neural tube defect, etc.) and ambient temperature.

Objective: The aim was to investigate the relation between hypospadias and the ambient temperatures that the mother is exposed to during her pregnancy.

Methods: The data of patients with hypospadias that had their gestational periods in Ankara and Istanbul regions, and had other urological treatments (circumcision, urinary tract infection, pyeloplasty, nephrolithotomy, etc.) between January 2000 and November 2015 were analyzed retrospectively. The ambient temperature at 8-14 weeks of gestation was investigated for each patient by reviewing the data of the General Directorate of Meteorology, since this period was risky for development of hypospadias. The data including ambient temperature that the pregnant mother was exposed to, maternal age, parity, economical status, gestational age at birth, and birth weight were compared between two groups. The retrospective nature of the study may be a potential source for selection bias.

Results: The data of 1,709 children that had hypospadias repair and 4,946 children that had other urological treatments between 2000 and 2015 were retrospectively analyzed. There were no differences between the groups for maternal age, parity, economical status, gestational age at birth, and birth weight (Table). Analysis of exposed maximum and average ambient temperatures at 8-14 weeks of gestation revealed that July and August, hot periods in summer time, were more prevalent in the hypospadias group (p = 0.01). The average and maximum monthly ambient temperatures during summer increased the risk for hypospadias (OR, 1.32; 95% CI, 1.08-1.52; and OR, 1.22; 95% CI, 0.99-1.54, respectively.

Conclusions: In this paper, we evaluated the relation between hypospadias and the ambient temperatures that the mother is exposed during her pregnancy. The results of this study indicated that the high ambient temperatures the mother and fetus are exposed to at 8-14 weeks of gestation increased the risk of hypospadias in the offspring.
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http://dx.doi.org/10.1016/j.jpurol.2016.06.015DOI Listing
December 2016

Comparison of laparoscopic and open ureterolithotomy in impacted and very large ureteral stones.

Urol J 2014 May 6;11(2):1423-8. Epub 2014 May 6.

Departments of Urology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Purpose: To compare the efficacy of laparoscopic and open ureterolithotomy in patients with ureteral stones.

Materials And Methods: Patients who had undergone open or laparoscopic ureterolithotomy between 2001 and 2013 in our clinic were enrolled in the study.Ureterolithotomy was performed due to the following reasons: failure to position the patient for ureteroscopy, unreachable stone with ureteroscopy also use of balloon dilatation, high stone volume, and the need for removal of kidney stones at the same session.. The patients' demographic data, the volume of the stones, the duration of the operation and the hospital stay, the amount of analgesics administered after the operation, and the need for another procedure were compared.

Results: Of study subjects 32 patients had undergone open and 20 patients had undergone laparoscopic ureterolithotomy. When the two groups were compared, there was no statistically significant difference with regard to the mean age (44.5-44 years), the body mass index (26-24.7 kg/m²), the stone volume (420-580 mm³), the duration of operation (122-123 min), the need for another procedure and complications. The mean amount of analgesics administered after the operation (3.6 and 1.81 doses, P = .02) and the mean hospital stay (6.1 and 2.9 days, P = .01) were significantly lower in the laparoscopic ureterolithotomy group.

Conclusion: Laparoscopic ureterolithotomy is a good alternative with less need for analgesia and a shorter hospital stay when compared with open ureterolithotomy.
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May 2014

"Snodgraft" technique for the treatment of primary distal hypospadias: pushing the envelope.

J Urol 2012 Sep 20;188(3):938-42. Epub 2012 Jul 20.

Department of Urology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.

Purpose: "Snodgraft" modification has been proposed to reduce the risk of meatal/neourethral stenosis in distal hypospadias. We applied the Snodgraft technique by using inner preputial graft in primary distal hypospadias repair.

Materials And Methods: A total of 102 consecutive patients undergoing the Snodgraft procedure were prospectively studied between 2006 and 2011. Mean patient age was 7.2 years. Localization of the meatus was glanular in 5 patients, coronal in 49, subcoronal in 45 and mid penile in 3. In all patients the posterior urethral plate was incised, and the graft harvested from the inner prepuce was sutured from the old meatus to the tip of the glans. A neourethra was created over a urethral catheter using 6-zero polyglactin suture. An interpositional flap was laid over the urethra as a second barrier. All patients were followed at 3 to 6-month intervals for cosmetic and functional results.

Results: At a mean of 2.4 years of followup no patient had meatal stenosis or diverticulum at the inlay graft site. However, urethrocutaneous fistula was observed in 10 patients (9.8%). A slit-like appearance of neomeatus was achieved in all patients. During followup no obstructive urinary flow pattern was detected, and early and long-term maximum urine flow rates were comparable.

Conclusions: No meatal/neourethral stenosis was observed in any patient undergoing a Snodgraft procedure. A randomized trial will be needed to prove that the incidence of meatal/neourethral stenosis is lower after Snodgraft repair compared to routine tubularized incised plate repair.
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http://dx.doi.org/10.1016/j.juro.2012.04.126DOI Listing
September 2012

Twelve-year experience with Hinman-Allen syndrome at a single center.

Urology 2011 Dec 11;78(6):1397-401. Epub 2011 Oct 11.

2nd Urology Department, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: To report the long-term follow-up results of patients with Hinman-Allen syndrome (HAS) at our institution.

Methods: The data from 22 children with HAS were retrospectively analyzed. The patients were followed up every 3-6 months with serial physical examinations, voiding charts, urine culture, postvoid residual urine volume determination, serum creatinine measurement, and urinary imaging. The follow-up time was calculated from the day of the first visit to the day of the latest dimercaptosuccinic acid scan. Urotherapy, pharmacotherapy, clean intermittent catheterization, biofeedback therapy, and surgery were performed sequentially and/or combined, depending on the disease course. Renal deterioration was defined as any presence of a new scar or cortical thinning compared with the findings from the first dimercaptosuccinic acid scan. Upper urinary tract deterioration was defined as the persistence or progression of hydronephrosis on ultrasonography.

Results: The mean age at referral was 9.18 ± 3.36 years (range 2-14), and the mean follow-up period was 80.90 ± 19.57 months (range 54-144). Conservative therapy resulted in improvement of the bladder function in 14 patients; however, 8 patients required surgery owing to failure of this approach. Asymptomatic bacteriuria developed in one half of the children (n = 11, 50%), and in 6 (22.7%), ≥1 febrile urinary tract infection developed. None of the patients had upper urinary tract deterioration; however, renal deterioration developed in 3 patients (13.6%). The mean creatinine levels had remained stable at the end of the follow-up.

Conclusion: Close follow-up at a single institution and proactive treatment resulted in successful stabilization of HAS in most of our children with HAS.
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http://dx.doi.org/10.1016/j.urology.2011.08.018DOI Listing
December 2011

Factors affecting complication rates of ureteroscopic lithotripsy in children: results of multi-institutional retrospective analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society.

J Urol 2011 Sep 23;186(3):1035-40. Epub 2011 Jul 23.

Department of Urology, Uludag University Faculty of Medicine, Bursa, Turkey.

Purpose: We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi.

Materials And Methods: We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates.

Results: A total of 367 females and 265 males were studied. Mean±SD patient age was 90.2±51.4 months (range 4 to 204). Mean±SD stone size, operative time and postoperative hospital stay were 8.9±4.7 mm, 45.8±23.8 minutes and 1.8±2.8 days, respectively. At a mean±SD followup of 13.3±17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate.

Conclusions: Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.
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http://dx.doi.org/10.1016/j.juro.2011.04.097DOI Listing
September 2011

Bowel preparation and peri-operative management for radical cystectomy in Turkey: Turkish Urooncology Association multicenter survey.

Urol J 2011 ;8(2):113-9

Department of Urology, Dokuz Eylul University, Izmir, Turkey.

Purpose: To investigate the preferences and practice patterns of urooncologic surgeons in Turkey on bowel preparation and peri-operative management for radical cystectomy.

Materials And Methods: This study was conducted by Turkish Urooncology Association as a multicenter survey. Participants were asked to fill in questionnaires dispensed at annual oncologic meeting or using internet access to the website of Urooncology Association. The questionnaire consisted of multiple choice or open-ended questions related to frequency of cystectomy, surgical technique and type of diversion, bowel preparation protocol, nasogastric tube applications, antibiotic prophylaxis, and deep vein thrombosis prophylaxis. Collected data from the survey were presented descriptively.

Results: Forty-four questionnaires from 44 surgeons of different centers were evaluated. All participants answered that they always perform bowel preparation before cystectomy. Four participants reported that they had an experience of cystectomy without bowel preparation. Bowel preparation methods included long conservative methods, short enema protocols, and Golytely, but there were significant differences in application of each method. Of participants, 88.6% perform diversion by themselves whereas others ask help from a general surgeon. Antibiotic prophylaxis is preferred mostly by 2 agents using third-generation cephalosporins and metronidazole for a period of 5 days or more in the majority. Type, duration, and dosage of deep vein thrombosis prophylaxis differed among participants.

Conclusion: There are significant individual differences in peri-operative management of radical cystectomy, which render deficient and sometimes inadequate patient care. There is a need to establish standard protocols for bowel preparation and adequate peri-operative management for radical cystectomy.
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October 2011

Comparison of ureteroscopic procedures with rigid and semirigid ureteroscopes in pediatric population: does the caliber of instrument matter?

Pediatr Surg Int 2010 Jul 3;26(7):733-8. Epub 2010 Jun 3.

2nd Urology Department, Sisli Etfal Training and Research Hospital, 34360, Istanbul, Turkey.

Objectives: To compare the results of two different ureteroscopes in pediatric ureteroscopy (URS) procedures.

Patients And Methods: Sixty-five consecutive URS procedures in pediatric population (39 males, 26 females) were retrospectively evaluated. The subjects were divided in two groups according to the type of ureteroscope used: Group 1 (n = 32, Wolf 8F) and group 2 (n = 33, ACMI 6.9F). All the procedures performed in both groups were statistically compared regarding patient age, gender, lateralization, complication rates, whether the procedure was diagnostic or therapeutic, and whether a guide-wire was used. Additionally, in cases with ureteral stones, stone clearance rate and the necessity of a stone extractor were also compared between the groups. All data were statistically analyzed using chi-square and t tests, where appropriate. A p value less than 0.05 was considered as significant.

Results: Mean age of the groups were comparable (9.44 +/- 4.3 and 8.67 +/- 3.9, p = 0.456). There was no statistically meaningful difference between the groups regarding patients' gender, lateralization rates, whether the procedure was diagnostic or therapeutic, the need for a guide-wire use, and complication rates (p > 0.05). In cases with ureteral stones, both groups exhibited statistically comparable results in stone clearance rates and the use of a stone extractor (p > 0.05).

Conclusions: Data on this comparison demonstrated that both ureteroscopy devices in pediatric population can be used safely in URS procedures. Neither the diameter nor the rigidity is significantly affecting the outcomes and success rates
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http://dx.doi.org/10.1007/s00383-010-2630-5DOI Listing
July 2010

Photoselective vaporization of the prostate in men with a history of chronic oral anti-coagulation.

Int Braz J Urol 2010 Mar-Apr;36(2):190-7

Department of Urology, Memorial Hospital, Istanbul, Turkey.

Purpose: A considerable percentage of patients with benign prostatic hyperplasia (BPH) also have additional cardiac pathologies, which often require anticoagulant therapy. The aim of this study was to evaluate the efficacy and safety of photoselective vaporization of the prostate (PVP) for BPH in cardiac patients receiving anticoagulant therapy.

Materials And Methods: A total of 67 patients suffering from BPH and high risk cardiac pathologies were operated on using laser prostatectomy. All patients had cardiac pathologies with bleeding disorders requiring anticoagulant use, and underwent standard urologic evaluation for BPH. Patients were treated with laser prostatectomy for relief of the obstruction using the KTP/532 laser energy at 80 W.

Results: The mean patient age was 71.4 years (range 55-80). Mean prostate volume on transrectal ultrasonography was 73.2 mL (range 44-120). Operation time ranged from 40 to 90 min, with an average value of 55 min. The average hospital stay was 48 hours (range 12-72) and the Foley catheters were removed within 48 hours, with a mean catheterization time of 34.2 +/- 5.9 hours (0-48). No patient required an additional procedure due to severe bleeding necessitating intervention during the early postoperative phase. Mean International symptoms scoring system (IPSS) values and post voiding residual volume decreased and peak urinary flow rate increased (p < 0.001). Our results showed that the mean prostate volume had decreased by 53% at 6 months.

Conclusions: High-power photo selective laser vaporization prostatectomy is a feasible, safe, and effective alternative for the minimal invasive management of BPH, particularly in cardiac patients receiving anticoagulant therapy.
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http://dx.doi.org/10.1590/s1677-55382010000200009DOI Listing
February 2011

Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial.

Urology 2008 Feb;71(2):247-51

Department of 2nd Urology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Objectives: To compare the short term outcomes of photoselective vaporization (PVP) and transurethral resection of the prostate (TURP) for glands larger than 70 mL in a prospective randomized trial.

Methods: Seventy-six consecutive patients with enlarged prostatic adenomas of 70 to 100 mL were randomly assigned for surgical treatment with TURP (n = 37) or PVP (n = 39). International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) scores, maximum flow rates (Qmax), postvoid urine residues (PVR), and transrectal ultrasound (TRUS) volumes were recorded. Operative data, complications, catheter removal, and hospitalization periods were also recorded. Patients were reassessed at 3 and 6 months.

Results: Baseline characteristics of both groups were similar. Mean preoperative TRUS volume was 88 +/- 9.2 mL in the TURP group and 86.1 +/- 8.8 mL in the PVP group. The procedure was significantly shorter for the TURP group (51 +/- 17.2 minutes versus 87 +/- 18.3 minutes, P <0.05), catheter removal (3.9 +/- 1.2 days and 1.7 +/- 0.8 days, P <0.05), and hospital stay (4.8 +/- 1.2 days versus 2 +/- 0.7 days, P <0.05) were shorter in the PVP group. A significant difference in IPSS, Qmax and PVR values was observed within the follow-up period in favor of the TURP. The percentage volume reduction was significantly higher in TURP group. Reoperation was necessary in 7 patients in PVP but none in TURP group.

Conclusions: Although PVP offers advantageous over TURP with regard to intraoperative and perioperative safety, early functional results of TURP are superior to PVP in patients with enlarged prostates larger than 70 mL.
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http://dx.doi.org/10.1016/j.urology.2007.09.017DOI Listing
February 2008

A case of primary lymphoma of the bladder managed with multimodal therapy.

Nat Clin Pract Urol 2008 Mar 22;5(3):167-70. Epub 2008 Jan 22.

Sisli Etfal Egitim ve Arastirma Hastanesi, 2 Uroloji Klinigi, Sisli 34360, Istanbul, Turkey.

Background: A 65-year-old female patient presented to a urology department with macroscopic hematuria, dysuria, urinary frequency and urgency. One year previously, she had visited a urologist because of a 1-month history of hematuria, dysuria, urinary frequency and urgency. She had subsequently undergone successful, simultaneous surgeries for resection of a basal cell carcinoma of the nasal skin and lymphoma of the bladder.

Investigations: Physical examination, measurement of serum urea, creatinine and electrolyte levels, peripheral blood film evaluation, ultrasonography, intravenous pyelography, abdominal, thoracic and pelvic CT, bone marrow aspiration and biopsy, cystoscopy and pathologic examination.

Diagnosis: Primary lymphoma of the bladder.

Management: Transurethral resection, chemotherapy, radiotherapy and follow-up comprising cystoscopy, biopsy, CT imaging and immunocytologic analyses of urine samples.
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http://dx.doi.org/10.1038/ncpuro1035DOI Listing
March 2008

Do lifestyle changes work for improving erectile dysfunction?

Asian J Androl 2008 Jan;10(1):28-35

Sisli Etfal Egitim ve Arastirma Hastanesi, 2. Uroloji Klinigi, Sisli-34377, Istanbul, Turkey.

The main cause of erectile dysfunction (ED) is organic in nature, with vascular etiologies being the most common risk factors. Although there have been sufficient data on the relationship between ED and several well-recognized risk factors, including aging, coronary artery disease, atherosclerosis, diabetes mellitus, dyslipidemia, high blood pressure, and pelvic surgeries, little attention has been paid by the urologists to the role of lifestyle factors in ED. However, accumulating data from basic science and clinical studies have determined a link between the occurrence of ED and a number of lifestyle factors, such as smoking, obesity, alcohol consumption, and lack of physical activity. The application of findings from animal and human studies to the clinical practice regarding the modification of lifestyle factors could help improving ED as well as reducing the risks of developing cardiovascular diseases. This communication addresses the impact of lifestyle factors on erectile function and the potential benefits of modifying these factors to improve ED in respect to the current evidence.
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http://dx.doi.org/10.1111/j.1745-7262.2008.00363.xDOI Listing
January 2008

Healing of the urethral plate after deep incision: does catheterization change the course of this process?

Urol Int 2007 ;78(3):249-53

2nd Department of Urology, Sisli Etfal Teaching Hospital, Istanbul, Turkey.

Background: We aimed to evaluate the sequence of healing process as well as possible effects of stent placement on the healing process after deep urethral plate incision.

Methods: A deep urethral plate incision was done at the 12 o'clock position. After that, in the first group (n = 14) the anterior urethra was stented with a silicon catheter. Animals in the second group (n = 14) underwent the same incision procedure, however no stent was placed after this operation. All animals in both groups were again divided into three groups with respect to the follow-up period (7-14 and 21 days). Partial penectomy was performed in all subgroups and histopathologic evaluation performed.

Results: In the first group after 7 days, limited neovascularization and granulation tissue formation could be noted far away from the epithelial lumen. Evaluation of these specimens during the long-term follow-up (21 days) demonstrated an almost completely healed tissue with a remarkable neovascularization and well-developed granulation tissue. In the second group during 14-21 days, evaluation progression of tissue healing along with increasing vessel formation and re-epithelialization were demonstrated. Although the incision edges did show evident approximation, no sign of fibrosis could be demonstrated in these specimens.

Conclusion: We may say that tissue healing with a desired and complete re-epithelialization could be achieved without inserting a catheter. Prevention of re-approximation along with the limited urinary extravasations to the subepithelial area might be responsible for tissue protection that will limit the long-term aforementioned adverse effects of the procedure.
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http://dx.doi.org/10.1159/000099347DOI Listing
December 2007

The learning curve in the training of percutaneous nephrolithotomy.

Eur Urol 2007 Jul 10;52(1):206-11. Epub 2007 Jan 10.

2nd Urology Department, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Objectives: To investigate the learning curve in the training of percutaneous nephrolithotomy (PCNL).

Methods: A total of 104 PCNL cases were included in this evaluation to define the learning curve of a surgeon with no previous experience at performing solo PCNL. Two parameters of expertise were reviewed, namely the operation and fluoroscopic screening times. The operation time was calculated as the beginning of access with the needle until the nephrostomy tube was placed and secured. PCNL procedures were analyzed in seven sets of 15 cases regarding the operation and fluoroscopy times, stone size, stone clearance rate, blood transfusion rate, and estimated blood loss.

Results: The mean operation time was 2.4 h for the first 15 patients. It decreased to a mean of 1.5 h for cases 46 through 60. No further decrease in the operation time was observed after case 60. The fluoroscopic screening time was a peak of 17.5 min in the first 15 cases, whereas it dropped to a mean of 8.9 min for cases 46 through 60. The decline in the mean fluoroscopy screening time continued in cases 61 to 104, but the decline was not significant. There was no significant difference in stone size, stone clearance rate, blood transfusion rate, and estimated blood loss among each set of cases.

Conclusions: This study suggests that the surgical competence in PCNL can be reached after 60 cases. PCNL and fluoroscopy times drop to a steady-state level after performing 60 procedures.
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http://dx.doi.org/10.1016/j.eururo.2007.01.001DOI Listing
July 2007

Single stage Fowler-Stephens orchidopexy: a preferred alternative in the treatment of nonpalpable testes.

Pediatr Surg Int 2006 Sep 5;22(9):759-61. Epub 2006 Aug 5.

Department of 2nd Urology, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey.

In this present study we aimed to discuss the surgical efficacy of single stage Fowler-Stephens orchidopexy (FSO) technique, with an emphasis on its practical and logical application that may be kept in mind during a standard orchidopexy procedure. Twenty-two children have undergone a single stage FSO procedure for nonpalpable testes during the last 9 years in our department. Surgical procedure was initiated with a standard inguinal oblique incision keeping in mind that depending on the position and the anatomic features of the testes a FSO method might be needed. While an excellent result was defined as a testis with good scrotal position, size and adequate blood flow on Doppler sonogram, acceptable result was a palpably normal sized testis in a high scrotal position with adequate blood supply and lastly an unacceptable result was the atrophy of the testis with compromised blood supply. During regular follow-up visits although some cases revealed testicular atrophy; long-term examination (12 months) did show that majority of the testes maintained their normal position and tissue consistency (21/24, 87.5%). Due to the necessity of surgical approach either in the evaluation or the treatment of nonpalpable testes in most cases along with the unsatisfactory data of the time consuming and invasive radiological procedures; we believe that a classical orchidopexy approach together with further single stage FSO will be a rational and satisfactory algorithm in the majority of such cases.
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http://dx.doi.org/10.1007/s00383-006-1739-zDOI Listing
September 2006

Operative failure during ureteroscopic pneumatic lithotripsy: factors affecting successful outcome.

Urol Int 2006 ;77(2):148-51

2nd Urology Department, Sisli Etfal Teaching Hospital, Istanbul, Turkey.

Aim: We aimed to evaluate the predictive factors that would in turn indicate stone migration and the effects of these factors on the ultimate success of the intervention.

Method: Patients were divided into two groups with respect to the migration of the stone treated. Group I: patients demonstrating stone migration during manipulation; group II: no migration of the stones noted. In the second phase of the study, the results of ureteroscopic management in 433 patients were evaluated with respect to the success rates obtained. Parameters such as stone size, stone burden, experience of the surgeon, length of the ureter proximal to the stone treated, and lastly transverse diameter of the ureter were noted in all patients as possible risk factors for stone migration.

Results: Statistical analysis of ureteroscopic success in all patients revealed that there was a meaningful correlation with respect to the length of the proximal ureteral portion (p < 0.0001) and surgeon's experience (p = 0.004). p value for the correlation between stone burden and operative success was 0.056. There was no significant correlation between stone size (p = 0.51), ureter diameter (p = 0.78), and operative success.

Conclusion: Stones that are close to the renal pelvis and treated by inexperienced physicians are the ones most likely to migrate to the renal pelvis during manipulation with pneumatic lithotripsy.
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http://dx.doi.org/10.1159/000093910DOI Listing
February 2007

Accessory scrotum with multiple skeletal abnormalities.

Int J Urol 2006 May;13(5):648-50

2nd Urology Department, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Accessory scrotum is very uncommon. Here we report a 5-year old Caucasian boy presenting with an accessory scrotum localized to the left side of the pubic area. The penis and the primary scrotum were completely normal, containing two dependent testicles. On the right side of the body there was type B proximal femoral focal deficiency and there was also diastasis of the symphisis pubis. As observed in this case, abnormalities of two different embryological organ systems (accessory labioscrotal fold and proximal femoral focal deficiency) may occur concurrently at the same intrauterine time point as part of an overall embryologic mesenchymal disorder.
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http://dx.doi.org/10.1111/j.1442-2042.2006.01362.xDOI Listing
May 2006

Testicular blood flow measurements and mean resistive index values after microsurgical and high ligation varicocelectomy.

Urology 2006 Jun;67(6):1262-5

2nd Department of Urology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Objectives: To compare the effects of the two most commonly used surgical methods in the management of varicocele disease, namely, microsurgery and high-ligation varicocelectomy, on testicular blood flow changes and mean residual index values in a prospective randomized study.

Methods: A total of 56 patients clinically diagnosed with varicocele were randomized into two groups: 28 were selected for high-ligation surgery and 28 for microsurgery. The testicular blood flow was evaluated in all patients before and 7 days after surgery, and the maximal flow velocity (Vmax), minimal flow velocity, and resistive index were measured. The data assessment was performed using the paired t test, and independent t test was used in comparison of the two groups.

Results: No significant difference was detected between the preoperative resistive index, Vmax, and minimal flow velocity of the two groups. The values of the same parameters measured 7 days postoperatively were also not significantly different. The preoperative and postoperative comparison of the three parameters within the microsurgery group revealed no difference, although the postoperative Vmax was significantly lower than the preoperative Vmax in the high-ligation group.

Conclusions: Our data have shown that no significant impairment in testicular circulation results after low microsurgical varicocele repair compared with high ligation.
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http://dx.doi.org/10.1016/j.urology.2005.12.033DOI Listing
June 2006

Evaluation of bone mineral density after ileocystoplasty in children with and without myelomeningocele.

Pediatr Surg Int 2006 Apr 4;22(4):375-9. Epub 2006 Mar 4.

Department of Urology, Sisli Etfal Teaching and Research Hospital, 34377, Sisli, Istanbul, Turkey.

We evaluated the bone mineral density (BMD) after ileal augmentation cystoplasty in a group of children with and without myelomeningocele. Between 1996 and 2003, eight patients with neurogenic bladder and seven patients with non-neurogenic bladder underwent augmentation ileocystoplasty. Preoperative and postoperative serum creatinine and electrolytes were measured. All patients underwent clinical evaluation, supine height measurement, blood gas analysis, and BMD measurement using a dual energy X-ray absorptiometry (DEXA) postoperatively. BMD was measured at L1-L4 and femoral neck, and compared to age- and sex-matched population. Follow-up time was calculated from the day of surgery to the day of DEXA performance. A total of eight boys and seven girls with the mean age of 10.2 +/- 4.1 years were evaluated with respect to BMD measurement. Mean age was 9.8 years in neurogenic group and 10.5 in non-neurogenic group. Mean follow-up was 728 and 616 days in neurogenic and non-neurogenic groups, respectively. There were no significant differences between ages, follow-up times, preoperative and postoperative creatinine levels, pH and bicarbonate values, and supine heights. Mean BMD at L1-L4 was 55.7% in neurogenic group and 83.8% in non-neurogenic group. There was a statistically significant difference between the two groups (P = 0.02). Mean BMD at femoral neck was 72% in neurogenic group and 86.2% in non-neurogenic group. The difference was also statistically significant (P = 0.028). After augmentation ileocystoplasty, the BMD in early postoperative period of patients with myelomeningocele is lower than the patients with non-neurogenic neurogenic bladder, which have the same clinical characteristics except the neurologic pathology. In the light of our findings and the reported literature data as well, we may claim that BMD decrease after augmentation ileocystoplasty depends more on the underlying neurologic pathology and its locomotor consequences rather than the enterocystoplasty itself.
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http://dx.doi.org/10.1007/s00383-006-1660-5DOI Listing
April 2006

Association of positive serum anti-p53 antibodies with poor prognosis in bladder cancer patients.

Int J Urol 2004 Dec;11(12):1070-7

2nd Urology Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Aims: To assess the association of serum anti-p53 antibodies and overexpression of tumor p53 protein with survival and prognostic factors in patients with urinary bladder tumors.

Methods: Seventy-six patients with transitional cell carcinoma of the urinary bladder were assessed prospectively (Ta, 18; T(1), 30; > or =T(2), 28). Serum anti-p53 antibodies were detected by enzyme-linked immunosorbent assay. Tumor p53 gene overexpression was assessed by immunohistochemical staining. The mean follow-up time was 34 months.

Results: Serum anti-p53 antibodies were positive in 25 patients (33%). Overexpression of tumor p53 protein was positive in 41 patients (54%). There was an association between the presence of serum anti-p53 antibodies and tumor p53 gene overexpression (P = 0.001). The total survival of the patients with positive serum anti-p53 antibodies was shorter than the patients with positive tumor p53 gene overexpression (P < 0.001, P = 0.344, respectively). In the multivariate survival analysis, both tumor stage and serum-p53 antibodies were found to be independent survival predictors (P = 0.004, P = 0.006, respectively).

Conclusion: Serum anti-p53 antibody positive tumors had a worse prognosis than those with negative serum levels, regardless of the p53 status of the tumor.
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http://dx.doi.org/10.1111/j.1442-2042.2004.00948.xDOI Listing
December 2004

Relation between serum anti-p53 antibodies and microvessel density in bladder cancer patients.

Urol Int 2004 ;73(3):219-25

2nd Urology Clinic, Sisli Etfal Training and Research Hospital, Istanbul University, Istanbul, Turkey.

Introduction: Etiology of serum anti-p53 antibodies in bladder cancer patients is still unknown. In this study we evaluated the relationship between serum anti-p53 antibodies and microvessel density in bladder cancer patients.

Materials And Methods: Seventy-six patients with transitional cell carcinoma of the urinary bladder were assessed prospectively (18 Ta, 30 T1, 28 T2>or =). Serum anti-p53 antibodies were detected by enzyme-linked immunosorbent assay. Tumor p53 overexpression was assessed by immunohistochemical staining. Vessels were stained immunohistochemically using an antibody against platelet endothelial cell-adhesion molecule CD31. Spearman correlation test and t test were used for statistical analysis.

Results: Serum anti-p53 antibodies were positive in 25 (60%) of 41 tumor p53-positive patients. While the mean (SD, range) microvessel density was found to be 43 (7.59, 8-99) in patients who had positive serum anti-p53 antibodies, it was found to be 23 (4.53, 6-98) in patients who had negative serum anti-p53 antibodies. There was a good correlation between serum anti-p53 antibodies and microvessel density (p<0.05). No correlation was found between tumor p53 expression and microvessel density (p>0.05).

Conclusions: We found that there is a significant correlation between the microvessel density and serum anti-p53 antibodies. This result may show the role of angiogenesis in the etiology of serum anti-p53 antibodies in bladder cancer patients.
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http://dx.doi.org/10.1159/000080831DOI Listing
March 2005

Importance of serum p53 antibodies during follow-up after treatment of invasive bladder tumors.

Urol Int 2004 ;72(4):292-8

2nd Urology Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Introduction: To investigate the prognostic importance of the changes in serum p53 antibody titrations during follow-up of patients who had anti-p53 antibody-positive invasive bladder tumors with transitional epithelial cells.

Materials And Methods: The study group consisted of 23 clinically T3
Results: While serum anti-p53 antibody titrations became negative in 8 (35%) of the 23 seropositive patients, it did not change in 15 patients (65%). There was a correlation between the maintenance of seropositivity, local progression/metastasis and death (p < 0.05). Survival was found to be better in cases who were seronegative after treatment compared with cases who remained positive and also those who were seronegative before treatment (p < 0.05).

Conclusion: The normalization of serum anti-p53 antibody positivity after treatment of invasive bladder tumors seems to be a good and reliable prognostic indicator.
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http://dx.doi.org/10.1159/000077680DOI Listing
September 2004

Neurapraxic complications in operations performed in the lithotomy position.

World J Urol 2002 May;20(1):68-71

Barbaros mah, Sirma Perde sok, Altunizade Hilal Konutlari, Uskudar, Istanbul, Turkey.

In this study, we assessed the incidence and risk factors associated with lower extremity neurapraxia in operations performed in the lithotomy position. A total of 1170 patients, who were operated on in the lithotomy position, were evaluated retrospectively. During the post-operative neurological evaluation, those patients who developed neuropraxic complications were reviewed in detail to identify those with lower extremity sensory and motor deficiencies. The electromyographic (EMG) results of the patients with neurological deficiencies were evaluated. The patients were studied with respect to age, length of operation, type of operation and mode of anaesthesia. Fischer's Exact Probability Test was used for the statistical analyses. Post-operative neurapraxia complications developed in 12 of the patients (1.02%). Of these cases, two had irreversible neurological deficiencies. All other patients recovered without any treatment during the first post-operative month. No correlation was discovered between the type of anaesthesia used and neurapraxia (P> 0.05). However, it was found that age, type of operation and operation time contributed to neurapraxia developing (P < 0.05). Old age (older than 70), prolonged operation time (more than 180 min) and an inappropriate lithotomy position were seen as the main risk factors in developing post-operative neurapraxia. Mistakes in the positioning of the operating staff might be an additional contributing factor.
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http://dx.doi.org/10.1007/s00345-001-0241-4DOI Listing
May 2002