Biomedical subjects
Publications and source records attributed to Erdal Erturk.
Secondary polycythemia is a condition that causes an increase in red blood cell count either because of the physiologic response to stress or inappropriate secretion of erythropoietin. We report a case of a secondary polycythemia caused by ureteropelvic junction obstruction that was successfully treated by laparoscopic nephrectomy.
PURPOSE: To evaluate the efficacy of povidone-iodine sclerotherapy after percutaneous drainage of simple renal cysts in the treatment of symptomatic patients. PATIENTS AND METHODS: Sixteen patients with symptomatic renal cysts were treated by percutaneous drainage and injection of povidone-iodine solution. The cysts were drained by a nephrostomy tube catheter, and povidone- iodine injections were repeated every 24 hours for 3 days. All patients were followed up by ultrasound examination during a period ranging from 1 to 4 years (mean 1.8 years). RESULTS: Thirteen patients experienced recurrence of cysts, while complete resolution was observed in only three patients. Of the cysts that recurred, only partial resolution in cyst diameter was observed (from 3-10.5 cm to 2.4-8.6 cm). During the follow-up period, 12 of the 16 patients (75%) continued to have pain that necessitated additional treatments. CONCLUSION: Povidone-iodine sclerotherapy is followed by a high rate of recurrence and is therefore not indicated for the treatment of symptomatic simple renal cysts.
We present a rare case of paraffinoma of the urinary bladder. Paraffinomas involving the urinary tract are rare and not well described. They are usually associated with insertion of materials into the lower urinary tract by patients with psychiatric disorders. Not only can the diagnosis be delayed, but they are also easily misdiagnosed. They are usually discovered during work up for recurrent urinary tract infections. Therefore, a high index of suspicion is needed in patients with recurrent urinary tract infections, psychiatric histories, and past history of foreign object insertion. Treatment options for paraffinoma includes open surgical excision, possibly transurethral excision or dissolution, and is usually dictated by the size of the mass.
OBJECTIVES: Few centers perform extraperitoneal robot assisted radical prostatectomy. The average patient weight is increasing to the mildly obese. Little is known as to the difficulty-impact, obesity may have on robot-assisted extraperitoneal prostatectomy (RAP). We assess our own experience with obese patients undergoing RAP. MATERIALS AND METHODS: Information on 375 consecutive patients undergoing robot-assisted extraperitoneal prostatectomy by a single surgeon was gathered. Obesity is defined as having a body mass index (BMI) greater than 30 kg/m2. Patients with BMI >/= 30 were compared to those with BMI < 30. Specific comparators between the groups were: age, total operating time, estimated blood loss, total prostate specific antigen (PSA), specimen weight, pathological stage, grade and margin, complications, and functional outcomes. RESULTS: Sixty-seven men were identified as obese. When comparing the two groups, no statistically significant difference (p > .05) was noted in operative time (229 versus 217 min), blood loss (205 versus 175 ml), PSA, clinical and pathologic stages, specimen weight, and complications. 15% of non-obese patients had a positive margin compared to 12% of obese patients (p > .05). The 6-month continence rate in patients with a BMI >/= 30 was 92% versus 97% in patients with a BMI < 30. CONCLUSIONS: The extraperitoneal approach to performing a robot-assisted prostatectomy is not associated with increased morbidity in the obese patient. There were no statistically significant differences noted in oncological or functional outcomes between the two groups.
The incidence of tuberculosis (TB) is increasing worldwide, with more than 20% of cases exhibiting extrapulmonary manifestations. The genitourinary tract is the most common site of extrapulmonary TB. Epididymal TB, although rare, may be the initial location of infection and may cause infertility. The diagnosis depends on culture of the organism but has been facilitated by the development of urine polymerase chain reaction analysis. Treatment for TB remains the combination of three or four anti-TB drugs for 6 to 9 months. Genitourinary TB remains relatively rare in the United States and requires a high index of suspicion to make the diagnosis.
OBJECTIVE: To compare our experience of pure laparoscopic radical prostatectomy (LRP) with robot-assisted radical prostatectomy (RAP). PATIENTS AND METHODS: The two techniques were compared retrospectively in 100 patients with localized prostate cancer who had LRP or RAP (50 each). Both groups were similar in age, serum prostate-specific antigen level, Gleason score and clinical stage. Their charts were reviewed, collating intraoperative data and early functional outcome. RESULTS: The mean surgical time for LRP and RAP was 235 and 202 min (P > 0.05) and mean (95% confidence interval) blood loss 299 (40) and 206 (63) mL (P = 0.014), with no transfusions in either group. The positive margin rate did not differ significantly (14% LRP and 12% RAP) and there was no biochemical recurrence in either group. Early functional outcomes were similar. CONCLUSIONS: Both LRP and RAP are technically demanding, but feasible, with the patient clearly benefiting. There were no major surgical differences between the techniques, but RAP is more costly.
BACKGROUND AND PURPOSE: New devices such as the Ti-knot and Hem-o-lok clips have been developed for laparoscopic surgical applications. We compared the effectiveness of Ti-knot TK5 (LSI Solutions), Hem-o-lok MLK clips (Weck Closure), Ligaclip 5-mm titanium clips (Ethicon), and Endopath vascular staples (35 mm long, 12.3 mm wide) (Ethicon). MATERIALS AND METHODS: Renal artery segments from 5 to 6 mm in diameter were harvested from fresh porcine kidneys. One end of the vessel was intubated with a 25-gauge ball-tipped needle and fastened with two silk ties. The other end was occluded with one of the test devices. Saline was infused into each arterial segment at 3 mL/min with the maximum pump pressure at 800 mm Hg. The maximum pressure with leakage was recorded. Each of the five test devices was tested eight times on a rotating basis. Saline infusion was stopped when the maximum pump pressure was reached or when leakage was observed. RESULTS: All Ti-knot devices, Hem-o-lok clips, titanium metal clips, and standard hand ties tolerated pressures >800 mm Hg with no leakage, but 4 of the 8 vascular staple lines (50%) leaked before this maximum pump pressure was reached. For those that leaked, the mean leak pressure was 273 mm Hg (range 237-322 mm Hg). CONCLUSIONS: All devices tested are capable of occluding renal arteries under physiologic conditions. Ti-knot devices and Hem-o-lok clips occluded renal arteries to pressures that exceeded 800 mm Hg. They are equivalent to hand ties under supraphysiologic conditions.
Laparoscopic techniques performed in the urologic setting have received great attention in the past decade. With the development of improved laparoscopic instrumentation, approaches to gonadal, renal, prostate, and bladder diseases have been successfully performed. A discussion of urologic laparoscopy (UL) with particular attention to potential complications and limitations is presented. Awareness of these evolving technologies remains critical to all surgeons with an interest in laparoscopy.
BACKGROUND AND PURPOSE: Indwelling double-pigtail ureteral stents are frequently associated with debilitating symptoms. A randomized study was performed to evaluate the effect of stent diameter (4.7F v. 6F) on symptoms and tolerability. PATIENTS AND METHODS: Between February and October 2000, 46 consecutive patients undergoing ureteroscopy for stone disease were randomly assigned to receive either a 4.7F (group I) or a 6F (group II) ureteral stent following the procedure. The patients were asked to leave their stents in place for minimum of 7 days. Pain and irritative urinary symptoms in the two groups were compared according to a scale ranging from 0 (none) to 5 (severe). The two groups were also compared for stone size and location, rigid v. flexible ureteroscopy, anesthesia, stent migration, and ureteral dilation. RESULTS: There were no differences between the groups in terms of pain (P = 0.28) or irritative symptoms (P = 0.37). There was a tendency for stents in group I to migrate distally and dislodge more often than those in group II (32% v 10%). CONCLUSIONS: When stent insertion following ureteroscopy is deemed necessary, a minimum diameter of 6F is recommended.
Urological laparoscopic techniques have received great attention in the past decade. With the development of improved laparoscopic instrumentation, approaches to kidney and prostatic diseases have been successfully performed. Laparoscopic nephrectomy and prostatectomy are discussed. Awareness of these evolving technologies is critical for all surgeons with an interest in laparoscopy.
OBJECTIVES: To determine the clinical association between urinary glycosaminoglycan (GAG) concentration and kidney stone disease. METHODS: Thirty-five patients (14 women and 21 men) with a history of stone disease and 37 controls (13 women and 24 men) were evaluated for urinary GAG concentration. By using a new dye-binding assay, the total GAG concentration in the urine was measured and corrected to urinary creatinine levels (micrograms of GAG per milligram creatinine). RESULTS: The mean urinary GAG concentration in those with stones was significantly lower (31.5 +/- 2.6 microg GAG/mg creatinine) than in the controls (43.8 +/- 3.8 microg GAG/mg creatinine, P = 0.01). Male patients with stones also had a significantly lower mean GAG concentration (26.1 +/- 1.8) than did the female patients (39.6 +/- 5.3, P = 0.009). The mean GAG concentration between ureteral (n = 13) versus renal (n = 22), single (n = 19) versus multiple (n = 16), family history (n = 11) versus no family history (n = 24), large (n = 13) versus small (n = 20), and the presence (n = 22) versus absence (n = 13) of residual stones did not show any significant differences. However, patients with recurrent stone formation (n = 21) had significantly lower mean GAG levels (26.4 +/- 1.6) compared with those with single stone formation (n = 14; 39.2 +/- 5.5, P = 0.01). CONCLUSIONS: Lower urinary GAG levels are more common in patients with stone formation. This may play a more determinant role in male patients and those with recurrent stone formation.
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PURPOSE: We examined the status of laparoscopy in urology and the impact of residency and fellowship training on the performance of laparoscopy as primary surgeon. We also examined whether performing nonsurgical tasks requiring two-handed dexterity had any link to the adoption of laparoscopic techniques by urologists. MATERIALS AND METHODS: A total of 8760 laparoscopy questionnaires containing 135 queries were mailed to urologists listed on the American Urological Association practicing urologists mailing list. The questions sought information on area of practice, time in practice, fellowship training, ambidexterity, laparoscopic experience, and experience with robotics. The response rate was 1.8% (155 of 8760). RESULTS: There appeared to be no significant correlation between the performance of laparoscopic surgery and participation in activities requiring bimanual dexterity. However, a correlation of strong statistical significance did exist between laparoscopic residency training and performance of laparoscopy after residency (p=0.003. There also was a correlation between fellowship training in laparoscopy/endourology and doing laparoscopy as primary surgeon. CONCLUSIONS: Participation in laparoscopic surgery during residency training is a major determining factor in performance of laparoscopy as a primary surgeon in practice. Younger surgeons trained in laparoscopy during residency are performing more laparoscopy post residency than those without laparoscopic training during residency. At present, there is a need to train more urologists in laparoscopy at the postgraduate level.
Laparoscopic mesh hernia repair is an effective form of management of inguinal hernias. Polypropylene mesh is generally placed at the internal rings extending across the midline resulting in an intense fibrotic reaction that can make subsequent radical retropubic prostatectomy and lymphadenectomy difficult. We report the first case of laparoscopic radical prostatectomy following laparoscopic bilateral mesh hernia repair.