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Transobturator bant (TOB) tekniği, Stres Üriner İnkontinans (SÜİ) tedavisinde en sık uygulanan tekniklerden birisidir. Bu tekniğin uzun dönemde en sık görülen komplikasyonları ağrı ve disparonidir. Mesane perforasyonu, TOB yönteminde sık karşılaşılan bir komplikasyon değildir, ancak olduğu zaman katastrofik bir komplikasyondur. Bu nedenle bu teknikte rutin sistoskopi yapılmalıdır. Bu yazıda, şiddetli kasık ağrısı olan ve mesanesinde taşlaşmış askı materyali saptanan bir kadın hasta sunuldu. Hasta, açık sistolitotomi ve meş eksizyonu ile tedavi edildi., Transobturator tape (TOT) technique is one of the most commonly used techniques in Stress Urinary Incontinence (SUI) treatment. The most common complications of this technique in the long term are pain and dyspareunia. Bladder perforation is not a common complication of the TOT technique but, regardless, it is a catastrophic complication, therefore, routine cystoscopy should be done in this technique. In this report, we present a woman who presented with severe groin pain and was diagnosed with lithified sling material in her bladder. The patient was managed with open cystolithotomy and mesh excision.

WOS: 000419241300002, Objective: Predictive factors that could affect the cure and complication rates of midurethral slings (MUS) in the treatment of stress urinary incontinence (SUI) were investigated. Materials and Methods: A total of 594 women (outside-in transobturator in 285, inside-out transobturator in 91, and retropubic in 218) with SUI and who had undergone MUS were evaluated. The median age was 53.9 (27-82) years. Univariate analyses were done using chi-square test, Student's t-test and the Mann-Whitney U test. Multivariate analyses were done using logistic regression analysis to determine predictive factors affecting cure and complication rates. Results: The mean follow-up time was 48 months. The subjective cure rate was 84% and complication rate was 11.2%. On univariate and multivariate analyses, the cure rate was found to be increased in younger patients [odds ratio (OR): 0.97, 95% confidence interval (CI): 0.95-0.99, p=0.038] and in patients with pure SUI (OR: 2.17, 95% CI: 1.31-3.60, p=0.002). The type of surgery was the only statistically significant parameter affecting the complication rate, which was significantly higher in retropubic MUS procedure (OR: 6.28, 95% CI: 3.51-11.22, p

Objective: To compare the abdominal and transvaginal techniques in the surgical treatment of vesicovaginal fistula (VVF) and analyze the factors affecting its recurrence rate. Materials and Methods: Patients were divided into two groups according to the operation technique used (abdominal-transvaginal) and the recurrence status (recurrent and non-recurrent). The primary endpoint of the study was the comparison of the factors related to fistula and surgical techniques. Results: The number of cases with radiotherapy history was found to be higher in the recurrent group (68.2% vs 11.5%, p, Amaç: Vezikovajinal fistül (VVF) onarımında abdominal ve transvajinal tekniklerin karşılaştırılması ve nükse etki eden faktörlerin analizini yapmaktır. Gereç ve Yöntem: Hastalar operasyon tekniğine göre (abdominal-transvajinal) ve nüks durumuna göre (nüks edenler-nüks etmeyenler) gruplara ayrıldı. Fistül ve cerrahi yöntemlerle ilişkili faktörlerin karşılaştırılması, çalışmanın birincil sonlanım noktasıydı. Bulgular: Radyoterapi öyküsü olan olgu sayısı rekürren grupta daha fazlaydı (%68,2 vs %11,5, p

Objective: In the present study, we investigated the efficacy of bladder hydrodistension combined with pentosan polysulfate (PPS) treatment in interstitial cystitis (IC)/bladder pain syndrome (BPS). Methods: In this study, 339 patients diagnosed with IC/BPS were categorized into two groups. The first group only received 300 mg/day PPS, while the second group received 300 mg/day PPS following bladder hydrodistension. The results were evaluated at the 3rd, 6th, and 12th months after the first dose using the interstitial cystitis symptom index (ICSI), international cystitis problem index (ICPI), visual analog scale (VAS), and female sexual function index (FSFI). Results: PPS treatment started just after hydrodistension was significantly more effective than PPS treatment alone and combined treatment significantly reduced the rate of non-compliance such that, at the end of the 3rd month, 12.1% patients in Group-1 did not continue their treatment whereas only 1.9% of patients in Group-2 did not continue. Conclusions: The study results indicate that PPS treatment started just after hydrodistension yields significantly better results in terms of both symptom improvement and treatment compliance in patients with IC/BPS.

WOS: 000414976900032, PubMed ID: 29151330, Background/aim: We aimed to analyze the effects of stricture location, etiology, age, and catheterization time on recurrence rate and recurrence time in patients who underwent direct vision internal urethrotomy (DVIU) for urethral strictures. Materials and methods: Patients were divided into three groups according to the location of the stricture: penile urethra, membranous urethra, and prostatic urethra strictures. Patients were also divided into three groups according to etiologic factors: strictures secondary to endoscopic procedures, urethral catheterization, and open or radical prostatectomy (anastomotic strictures were included in this group). Patients were also divided into three groups according to catheterization time: < 2, 2-5, and > 5-7 days. Recurrence rate and time data were analyzed according to stricture location, etiology, age, and catheterization time. Results: The recurrence rate was significantly higher in endoscopic procedures. Recurrence rate was significantly lower and recurrence time was significantly earlier in penile urethral strictures. Recurrence rate was significantly lower and recurrence time was significantly longer in short catheterized group than in the other two groups. However, first recurrence time was not different between the groups, while second and multiple recurrence times were significantly earlier in patients < 60 years old. Conclusion: Patients are exposed to multiple operations as a result of frequently recurring urethral strictures. Although DVIU is an important first-line treatment method for strictures, alternative methods should be considered for frequently recurring cases.

Objective: in this study, we aimed to investigate the effect of diabetes-related metabolic changes and chronic complications on lower urinary tract (LUT) functions. Materials and Methods: the study included 286 adult patients with type 1 and type 2 diabetes mellitus (DM). All patients’ demographic data, diabetes-specific history, laboratory and physical examination findings were recorded. All the data were compared with uroflowmetric parameters and the scores of questionnaires used for evaluation of LUT symptoms and functions. Results: in the presence of diabetic peripheral neuropathy (DPN), average urinary flow rate (Qave), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score and the Overactive Bladder-questionnaire Short Form (OAB-q SF) score were significantly affected. in the presence of stage 3 or over diabetic nephropathy (DN), ICIQ-SF score was significantly higher. Also, in elderly group, Qave and OAB-q SF score were significantly affected. the Qave was lower both in patients who underwent any surgery due to diabetic complications and in patients with DM-related diseases. Qave and OAB-q SF score were significantly lower in males. Type 2 DM was associated with postvoid residual (PVR) increase and Qave decrease. Poor glycemic control was associated with lower OAB-q SF score. Finally, vitamin D deficiency was found to be associated with an increase in PVR volume. Conclusion: the present study showed that DPN, stage 3 or over DN, aging, DM-related diseases and surgeries, male gender, type 2 DM, poor glycemic control and vitamin D deficiency cause a tendency to develop any kind of LUT dysfunction., Amaç: Bu çalışmanın amacı diyabete bağlı metabolik değişikliklerin ve kronik komplikasyonların alt üriner sistem (AÜS) fonksiyonları üzerine olan etkisini araştırmaktır. Gereç ve Yöntem: Çalışmaya tip 1 ve tip 2 diabetes mellitus (DM) tanılı 286 erişkin hasta alındı. Tüm hastalara ait veriler retrospektif olarak tarandı. Tüm hastaların demografik bilgileri, diyabete özgü hastalık öyküleri, laboratuvar ve fizik muayene bulguları kaydedildi. Hastalara ait tüm veriler üroflovmetrik ölçüm sonuçları ve AÜS semptomu sorgu formlarından elde edilen skorlarla karşılaştırıldı. Bulgular: Diyabetik periferal nöropati (DPN) varlığında ortalama idrar akım hızının (Qave), International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF) skoru ve Overactive Bladder-questionnaire Short Form (OAB-q SF) skorunun anlamlı olarak etkilendiği saptandı. Evre 3 ve üzeri diyabetik nefropati (DN) varlığında ICIQ-SF skoru anlamlı olarak yüksek saptandı. Ayrıca yaşlı hasta grubunda Qave ve OAB-q SF skorunun anlamlı olarak azaldığı saptandı. Diyabetik komplikasyonlar nedeniyle cerrahi geçirenlerde ve DM ile ilişkili komorbid hastalığı olanlarda Qave anlamlı olarak düşük saptandı. Erkek hastalarda Qave ve OAB-q SF skoru anlamlı olarak düşük saptandı. Tip 2 DM’nin postvoid residual (PVR) volümde artış ve Qave’da azalma ile ilişkili olduğu saptandı. Kötü glisemik kontrolün OAB-q SF skorunda düşüş ile ilişkili olduğu gösterildi. Son olarak D vitamini eksikliğinin PVR volümde artış ile ilişkili olduğu saptandı. Sonuç: Çalışmamızda DPN, evre 3 ve üzeri DN, ileri yaş, diyabetik komplikasyonlar nedeniyle geçirilmiş cerrahiler, DM ile ilişkili komorbid hastalıklar, erkek cinsiyet, tip 2 DM, kötü glisemik kontrol ve D vitamini eksikliği faktörlerinin diyabetik hastalarda AÜS disfonksiyonu gelişimine yatkınlık oluşturduğu saptanmıştır.

WOS: 000419992100006, Introduction: Transrectal prostate biopsy (TPB) is currently a commonly used invasive procedure for the diagnosis of prostatic diseases. Due to increasing infectious complications after TPBs in our institute, it was decided to change antimicrobial prophylaxis regimens and pre-intervention measures. The aim of this study was to evaluate the effects of shorter antimicrobial prophylaxis, intestinal cleansing and single use sterile gels on infections developing after TPBs in our tertiary-care educational hospital. Materials and Methods: Infections developing in the last six months after TPB were evaluated retrospectively by using records of microbiology, radiology and urology departments. Sterilization and disinfection, antimicrobial prophylaxis regimens, intestinal decontamination procedures and routine biopsy procedures were reevaluated in cooperation with the corresponding clinics. Afterwards, it was decided to implement three changes in the TPB practice: 1) Shortening the antimicrobial prophylaxis, 2) Intestinal cleansing one day before the intervention by using enema, and 3) Using sterile gel (single patient use only) during biopsy. Patients were diagnosed as clinical or microbiologically confirmed healthcare-associated infection according to the 'Centers for Disease Control and Prevention' criteria. The preintervention period was 2007 July-December and the intervention period was 2008 January-July. Results: Overall infection/infectious complication rate (10.5% vs. 3.8%; p=0.007), overall clinically defined infection rate (4.8% vs. 1.1%; p=0.028) and overall microbiologically defined infection rate (5.8% vs. 2.7%; p=0.002) decreased significantly in the post intervention period. Conclusions: Our findings suggest that shorter antimicrobial prophylaxis regimens, using sterile gels and intestinal cleansing may be useful in the control of infections developing after TPB.

Purpose: The evaluation of lower urinary tract (LUT) before transplantation is not required, except in patients with a history of LUT disfunction (LUTD). In this study, we adressed the necessity for lower urinary system evaluation in transplantation candidates classified according to their etiology. Materials and Methods: Sixty-two patients were prospectively evaluated. The patients were evaluated at 2 months preoperatively and at 6 months post transplantation using questionnaires, bladder diary and urodynamic studies. The end stage renal disease (ESRD) etiologies of the patients were divided into three groups as follows: patients with a parenchymal disease, patients with LUTD and those with unknown etiology and the obtained results were evaluated accordingly. Results: The evaluation of 50 patients revealed significant differences in ICIQ-SF (p < 0.001), IPSS (p < 0.001), daily urine volumes (p = 0.05), maximum urinary flow rate (p = 0.03), PVR, the number of patients with VUR and all cystometric parameters between the patient groups divided according to the etiology. The comparison of the groups to each other revealed no statistically significant differences in all parameters between the LUTD group and the patient groups with unknown etiology. Considering that the results from questionnaires of patients with a single voided volume of 100 cc or greater on the bladder diary would be scientifically more significant, they were evaluated separately. Thus, even though the results from questionnaires did not differ between the group with unknown etiology and the LUTD group, there were significant differences when compared to patients who developed ESRD due to a parenchymal disease. Similar findings were found between the results of urodynamic study. Conclusions: The evaluation of lower urinary tract in patients with a history of LUTD and in those with unknown etiology should be initially evaluated by noninvasive methods such as questionnaires and uroflowmetry.

Prolonged erection is a rare problem in urology but it must be treated effectively. The most common etiological factor is intracavernosal vasoactive agent injection for diagnosis or treatment of erectile dysfunction. The aim of this study was to evaluate the efficacy of intracavernosal adrenalin injection alone in the treatment of priapism. Nineteen patients with prolonged erection were evaluated. Seventeen out of the 19 prolonged erections were due to intracavernosal vasoactive agent injection and the remaining two were idiopathic. In all cases 2 ml adrenalin (1/100 000) was injected in each cavernosal body. In the patients who did not respond to the first injection, repeated adrenalin injections were performed at 20 min intervals. Blood pressure and heart rate were monitored during the injections. Detumescence was achieved in ten (53%) patients after the first injection. Repeated adrenalin injections (2-5 injections) were required in nine patients and eight (42%) of them achieved detumescence. Only one (5%) patient who had 26-h prolonged erection could not achieve detumescence. There was no significant difference in blood pressure and heart rate during the monitoring of the patients when compared to the initial values. No standard treatment method has yet been described for prolonged erection. Repeated aspirations and irrigations for treatment of prolonged erection are problematical applications both for patients and urologist. Intracavernosal adrenalin injection alone can be used with high efficacy and safety for the treatment of prolonged erection especially in patients with a short duration of erection.

Objective: To investigate the effectiveness of ciprofloxacin in the treatment of chronic bacterial prostatitis due to various microorganisms. Methods: Patients with chronic prostatitis symptoms were evaluated by culture of their expressed prostatic secretion and fractionated urine samples according to the four-glass localization test of Meares and Stamey. Patients with an isolated microbial agent were treated with ciprofloxacin 500 mg twice a day for 4 weeks and re-evaluated 1 week and 6 months after the treatment. Results: Sixteen of the 68 (23.5%) evaluated patients were diagnosed as having chronic prostatitis with an isolated microbial agent. Ureaplasma urealyticum was the most common microorganism related to chronic prostatitis. Eradication of the previously isolated microbial agent was found in 11 of the 16 patients at the first-week evaluation. At the 6-month control evaluation no growth was observed on the cultures of seven of the 16 (43.8%) patients, which was accepted as successful treatment. Conclusions: U. urealyticum can be the responsible agent in some chronic prostatitis patients. Ciprofloxacin may be a treatment option in chronic prostatitis.