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Objectives: The aim of this study is to evaluate prediction of postoperative ureteral obstruction needing ureteral stent insertion by evaluating the resistive index (RI) values and the grade of hydronephrosis. Material and Methods: A total of 66 adult patients undergoing stentless endoscopic ureteral stone treatment (URS) between January 2018 and January 2019 were included in this prospective study. Preoperative patient and stone characteristics were noted. All patients were evaluated with renal Doppler ultrasonography study to assess degree of hydronephrosis and RI values. A renal Doppler ultrasonography was repeated at postoperative 1st, 3rd and 7th days. Changes in both RI and hydronephrosis levels before and after the procedures were noted. On the postoperative 7th day, patients were divided into two groups including obstructive and non-obstructive cases according to RI values assessed where a RI value of 0.7 was accepted as the cut-off for obstruction. The preoperative and perioperative characteristics of both groups were evaluated in a comparative manner. Results: The mean patient age was 43.6 ± 1.72 years. Significant improvements were noted in RI and grade of hydronephrosis after the operation. The grade of hydronephrosis and RI values were found to improve more significantly on postoperative 3rd day when compared to the postoperative 7th day (p < 0.01 and p < 0.01). A significant correlation was detected between the grade of hydronephrosis (>grade 2) and obstructive RI values (> 0.7) in each postoperative visits (p: 0.001). RI values (> 0.7) at postoperative seventh days were correlated with larger mean stone size, increased ureteral wall thickness, increased diameter of the ureter proximal to the stone, and longer duration of the operation. Preoperative high-grade hydronephrosis indicated obstructive RI values at postoperative seventh day (p = 0.001) Conclusion: Changes in RI values on Doppler sonography and the grade of hydronephrosis may be a guiding parameter in assessing postoperative ureteral obstruction.

INTRODUCTION[|]To evaluate the efficacy of JJ stent placement in pregnants with intractable flank pain [¤]METHODS[|]Pregnants with flank pain who referred to our clinic between January 2011 and March 2016 were retrospectively reviewed. Patients who did not respond to first conservative treatments and hospitalized were enrolled into the study. Demographic datas, clinical and laboratory findings, surgical interventions such as JJ stenting or percutaneus nephrostomy as well as the complications were all recorded and evaluated.[¤]RESULTS[|]Fourty-one pregnant women were included in the study. No surgical intervention was required in 7(17%) after second conservative management. 34 patients with intractable flank pain were required JJ stenting/nephrostomy. The mean duration of hospitalization was 2.9 ∓ 2.7 days. Complications such as migration (n = 3), lower urinary tract symptoms (n = 1) and hematuria (n = 2) were observed in stent applied cases. According to the postpartum imaging (abdominal CT scan) 5 of 32 patients required any additional stone surgery.[¤]DISCUSSION AND CONCLUSION[|]JJ stent placement in an emergency based manner was found to be effective and safe with low complication rates in the management of pregnants with intractable flank pain. [¤]

Aim: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). Patients and methods: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. Results: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. Conclusion: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK.

Purpose: To evaluate the true necessity of open end ureteral catheter insertion in patients with moderate to severe pelvicalyceal system dilation treated with percutaneous nephrolithotomy (PNL) under sonographic guidance. Patients and methods: 50 cases treated with PNL under sonographic guidance in prone position for solitary obstructing renal stones were evaluated. Patients were randomly divided into two groups; Group 1: Patients in whom a open end ureteral catheter was inserted prior to the procedure; Group 2: Patients receiving no catheter before PNL. In addition to the duration of the procedure as a whole and also all relevant stages as well, radiation exposure time, hospitalization period, mean nephrostomy tube duration, mean drop in Hb levels and all intra and postoperative complications have been evaluated. Results: Mean size of the stones was 308.5 ± 133.2 mm2. Mean total duration of the PNL procedure in cases with open end ureteral catheter was significantly longer than the other cases (p < 0.001). Evaluation of the outcomes of the PNL procedures revealed no statistically significant difference between two groups regarding the stone-free rates (86% vs 84%). Additionally, there was no significant difference with respect to the duration of nephrostomy tube, hospitalization period and secondary procedures needed, complication rates as well as the post-operative Hb drop levels in both groups (p = 0.6830). Conclusions: Our results indicate that the placement of an open end ureteral catheter prior to a PNL procedure performed under sonographic access may not be indicated in selected cases presenting with solitary obstructing renal pelvic and/or calyceal stones.

Objectives: To evaluate the emergency management of obstructing ureteral calculi with two different techniques (SWL and URS) with an emphasis on patients life quality. Methods: A total of 80 patients presenting with acute colic pain due to a single obstructing ureteral stone were treated within 24 hours following the onset of pain with two different approaches in a randomized manner. Patients requiring DJ stent placement and/or auxiliary measures after both procedures were excluded and the remaining 65 patients were evaluated [Group1: ESWL (n = 34); Group 2: URS (n = 31)]. Patients were followed during 4-weeks period with respect to the analgesic requirement, number of renal colic attacks and emergency department visits along with the HRQOL scores. Results: While 26 patients treated with URS (83.9%) were stone-free, 24 cases in SWL were stone-free (70.6%) after 4 weeks. Evaluation of the cases during this follow-up period demonstrated that cases undergoing SWL required significantly higher amount of analgesics when compared with URS group (p < 0.001). In addition to the lower mean number of renal colic attacks and emergency department visits in URS group; both the mean HRQOL in terms of EQ-5D index and mean EQ-5D VAS values were also significantly higher in these cases when compared with the cases tretaed with SWL. Conclusions: Due to the negative impact of stone related events after emergency SWL on patients HRQOL, emergency URS may be applied more effectively with the advantages of prompt fragmentation of the calculi along with the immediate relief of obstruction and pain.

Objective: To evaluate Transobturator tape (TOT) and Burch colposuspension procedure’s effects on sexual functions and life quality. Materials and Methods: A total of 81 patients who underwent TOT (n = 49) or Burch (n = 32) with stress incontinence were included in this prospective study. Preoperatively and at postoperative 6 month follow up pad and stress tests, physical examinations, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) questionnaires were performed. Patient Global Impression of Improvement (PGI-I) questionnare was added postoperatively. Results: According to stress test, success rate was found to be 69% and 45%, in the TOT and Burch groups respectively. Pad test decreased in both groups (p < 0.05). PGI-I scores was higher in the TOT group when compared to Burch group (p = 0.031). ICIQ-SF scores were improved in both TOT (p < 0.0001) and Burch groups (p < 0.012). IUDI-6 and IIQ-7 scores improved only in TOT group. Total FSFI scores did not change in both groups but only in TOT group sexual desire improved. Total FSFI scores did not change in patients that were successful and unsuccessful according to the stress test in both TOT and Burch groups (p < 0.05). Conclusions: TOT and Burch procedures have no effect on the sexual functions. However TOT improved life quality of patients.

Objective We present two treatment modalities, selective renal angioembolization and renorraphy, in massive renal hemorrage after percutaneous nephrolithotomy (PCNL) that could not be controlled by conservative methods. Materials and Methods One thousand two-hundred patients, who had undergone PCNL between January 2003 and February 2014, were retrospectively reviewed. From these cases, we selected patients with massive post procedural bleeding that could not be taken under control by conservative methods and we reviewed their clinical course and treatment results. Results Bleeding could not controlled by conservative methods in 6 patients and, angioembolization was done succesfully. In 3 patients, angioembolization was not available. Renorraphy was performed in 2 patients and nephrectomy in 1 patient at first attempt. Renorraphy could not solve the problem of massive hemorrage and these 2 patients eventually underwent nephrectomy. Conclusion Renal angiography and embolization is an effective and safe method and renorraphy should not be the first option in massive bleeding after PCNL that can not be taken under control by conservative methods.

Objectives: To evaluate the quality of life (QoL) of the patients after extracorporeal shockwave lithotripsy (ESWL) on a treated stone size related basis. Methods: 90 patients undergoing ESWL for kidney stones were divided into three groups; Group 1 (n: 30, ≤ 10mm), Group 2 (n: 28, 11 mm- ≤ 20 mm) and Group 3 (n: 32, 20- 25 mm). During 3- months follow-up, outcome of the procedure, number of cases with emergency department visits, analgesic required, re-tretatment rates, additional procedures and the changes in the QoL were evaluated. Results: the number of emergency department visits and mean analgesic need; re-treatment rates and additional procedures were significantly higher in Group 3. Evaluation of the QoL scores in three groups showed that cases with larger stone still had lower scores during 3-month evaluation. Conclusions: Stone size could help us to predict the possible impact of ESWL on the QoL and depending on the size of the stone treated, a well planned indication and effective management possibly by an experienced urologist could limit the changes in the QoL of the patients.

ABSTRACTPurpose:To evaluate the patient and stone related factors which may influence the final outcome of SWL in the management of ureteral stones.Materials and Methods:Between October 2011 and October 2013, a total of 204 adult patients undergoing SWL for single ureteral stone sizing 5 to 15 mm were included into the study program. The impact of both patient (age, sex, BMI,) and stone related factors (laterality, location, longest diameter and density as CT HU) along with BUN and lastly SSD (skin to stone distance) on fragmentation were analysed by univariate and multivariate analyses. Results: Stone free rates for proximal and distal ureteral stones were 68.8% and 72.7%, respectively with no statistically significant difference between two groups (p=0.7). According to univariate and multivariate analyses, while higher BMI (mean: 26.8 and 28.1, p=0.048) and stone density values (mean: 702 HU and 930 HU, p

ABSTRACTObjective:We aimed to evaluate the possible effects of ureteroscopic procedures on the sexual function of both genders.Materials and Methods:A total of 102 sexually active cases (60 male, 42 female) undergoing ureteroscopic procedures were included in this study. Sexual function has been evaluated in detail by using International Index of Erectile Function (IIEF) in male and Female Sexual Function Index (FSFI) forms in female cases both before and 1-month after the procedures. Pre-and postoperative data were evaluated in a comparative manner.Results:The pre-and postoperative mean IIEF scores were 57.86±2.26 and 54.57±2.48 (p=0.19) in males and the mean FSFI scores were 13.58±1.46 and 14.46±1.52 (p=0.41), respectively in females. Evaluation of these values showed that regarding the effects of this procedure on male cases although the total scores for sexual function were not influenced it was observed a significant reduction in the intercourse satisfaction sub-domain (IIEF-IS) in males (p

Objectives: To evaluate Internet usage frequency, rate of searched diseases and impact of Internet derived data on future patientphysician relationship in patients applying to an Urology Department. Methods: A well prepared questionnaire has been given to 1000 referring cases, out of which 589 accepted to participate on a volunteer basis to a face to face interview. Patients were divided into subgroups with respect to age, gender and as well as their educational and economical status. Regarding Internet, questions inquired the use of Internet, the point of view about it, opinions about healthcare system and most commonly urological diseases searched in Internet. Results: Of 589 patients participating, 38.2% reported access to the Internet; in relation to subgroup analysis of data, there was a statistically significant relationship between the use of Internet and age (p < 0.001), gender (p = 0.048), educational status (p < 0.001) and economical status of (p = 0.002) the cases evaluated. Diseasespecific information was most frequently sought: 18.2% searched for urolithiasis, 14.2% for non-cancer related kidney diseases, and 14.2% for urologic cancers. Conclusions: Younger patients with higher educational status tended to use Internet and the majority of these cases share all these information with their physicians during their visit. These findings indicate that all physicians should consider this fact seriously and make their future plans in the light of internet based activities which provides numerous advantages.

Purpose:To investigate the effects of information acquired by KETEM’s staff on the diagnosis and treatment of breast cancer.Patients and Methods:Between 2007-2010, BSE was first taught and performed in all women. USG was performed for those ≤40, and MG for those ≥40; also, USG and MRI were ordered, if necessary. For patients with BIRADS 4-5 lesions via USG, MG and MRI and those whose lesions were diagnosed with USG, tru-cut biopsy and USG were performed. While different treatments were administered for those diagnosed with cancer within first 2-year period, their treatments were planned and performed in second 2-year period under decisions by breast council. Information for patients was obtained from the data in hospital, and that concerning staff’s training from personal files.Results:Between 2007-2010, 17768 women applied to Konya KETEM [mean age rate 51 (18-19)]. Of these, 10595(60%), 10492(59%) and 119(0.6%) were administered with MG, USG, respectively. Performing biopsy from suspected malignant 378(2%) breast lesions, 104(0.6%) were diagnosed with cancer. Meetings of Breast Council started on 3rd February, 2009. A surgeon was sent to Breast Unit of Istanbul Medical School, Istanbul University for 3 months. All staff in Konya KETEM were trained. While excisional biopsy was performed for 52% of patients with suspected cancers, and modified radical mastectomy was done before 2007-2008, diagnoses were conducted via tru-cut biopsy between(2009-2010), and rate of breast conserving surgery was 24%.Conclusion:In-service training for all staff in KETEMs contributes to modern and accurate procedures in diagnostic and therapeutic stages of breast cancer.

Background: Breast cancer is the most commonly seen and cause of cancer deaths in women in most of the developed and developing countries. Breast cancer awareness and organized population based screening programmes have resulted in early diagnosis, reduction in mortality, and breastconserving surgery. Therefore, body image of women suff ered from breast cancer has been protected, and overall survival rate has increased. Eighty-four KETEM’s (Cancer Early Detection and Screening Center) in 81 provinces in Turkey has been founded by Cancer Control Department of The Ministry of Health of Turkey. Opportunistic screening has been performed in these centers; however there are no available data regarding the eff ect of opportunistic screening on breast cancer mortality. Population based organized screening programmes should be implemented to reach this aim.Aim: The aim is to organize national early diagnosis and screening programs consistent with the conditions of country, that are necessary for early diagnosis and treatment of breast cancer which is the most frequently seen female cancer with gradually increasing incidence in our country.Methods: National Cancer Advisory Board, Breast Cancer Early Detection and Screening Sub-Committee organized three meetings in Ankara in 2008. In addition to those three-day workshops, a fourth one was performed in January 22-24, 2009 to provide reports from those studies. In these meetings, expert panelists selected by The Ministry of Health, National Cancer Advisory Board, and National Federation of Breast Societies shared their experiences and knowledge on early detection and screening of breast cancer in Turkey. Two representatives from the World Health Organization also attended to the third meeting. During those meetings, targets and strategies for early detection and screening for breast cancer had been evaluated. Possible barriers to screening, their eliminations, methods of follow up the prepared programme step by step had also been discussed.Results: To reach the success with early detection and screening programs is not possible without community awareness about the importance of early detection and especially high-level awareness of the target population. For this reason, education of women and increasing breast cancer awareness should be the fi rst step. Health care providers (physicians, nurses, midwives etc.) and their administrators (health administrators, chief of staff in hospital etc.) should also be trained and included in those programs. A realistic budget for screening projects should be prepared and carried out. There should be a high-level coordination and a comprehensive organization among study groups, screening centers, and institutions. Social, cultural, and other possible regional barriers against the implementation of projects should be explored and eliminated. Activities, performance status and available data should be controlled, evaluated and published periodically. Targets, strategies, activities, criteria relationships with other related organizations should be re-evaluated, and performance should be monitored regularly.Conclusions: Organizing and implementing breast cancer early detection and screening programmes could be possible only with comprehensive, planned in details, and well determined studies. Resources should be used carefully and timely whenever necessary. As a result of this, downstaging of breast cancer and reduction in mortality rate in community could be possible.

Objectives:To determine the effect of tonsillectomy in the gastric H. pylori eradication treatment.Methods:This study was conducted on 46 patients, 32 (69.6%) male and 14(30.4%) female, undergoing tonsillectomy with the indication of chronic tonsillitis. Gastroscopy was performed preoperatively. After pathologic sampling of gastric endoscopic biopsy materials and CLO test patients were divided into two groups. H. pylori positive patients were included in group A, negative patients were included in group B. Demographic properties like age and sex were compared between two patient groups.Results:Patients ages were varied 14-58 years old, the mean age was 28.85 ± 9.65. Group A had 14(30.4%) patients, group B had 32(69.6%) patients. No statistical difference was found between the groups according to ages and sex.Conclusion:Gastric H. pylori positivity of patients who underwent tonsillectomy with the indication of chronic tonsillitis was found similar to the asymptomatic control group with the same social, economic and traditional life style.

Herein we report a sixteen-year-old female that developed deep vein thrombosis (DVT) while undergoing treatment for H1N1 pneumonia. To the best of our knowledge this is the first report of H1N1/09 infection complicated by DVT in an adolescent patient with no detected risk factors other than immobilization. Healthcare providers should be aware of the possibility of thrombosis in patients with swine-origin influenza, especially in those with additional risk factors.

Mumps infection during the course of childhood acute lymphoblastic leukemia (ALL) treatment has been reported to have a mild course and this was related to the intrinsic low cytopathological effect of the virus, contrasting with the severe course of measles and Varicella zoster virus infections in immunocompromised patients. Herein, we present a three-year-old girl, who was previously vaccinated against mumps infection, admitted with bilateral parotid swelling, dactylitis and serum immunoglobulin M positivity for mumps infection and diagnosed to have ALL with bilateral persistent parotid involvement, inconsistent with mumps infection. Acute leukemia should be suspected during the atypical course of any disease during childhood. Besides, mumps infection at presentation of ALL, as similar to infection emerging during the period of the leukemia treatment, has a mild course.

Mumps infection during the course of childhood acute lymphoblastic leukemia (ALL) treatment has been reported to have a mild course and this was related to the intrinsic low cytopathological effect of the virus, contrasting with the severe course of measles and Varicella zoster virus infections in immunocompromised patients. Herein, we present a three-year-old girl, who was previously vaccinated against mumps infection, admitted with bilateral parotid swelling, dactylitis and serum immunoglobulin M positivity for mumps infection and diagnosed to have ALL with bilateral persistent parotid involvement, inconsistent with mumps infection. Acute leukemia should be suspected during the atypical course of any disease during childhood. Besides, mumps infection at presentation of ALL, as similar to infection emerging during the period of the leukemia treatment, has a mild course.

Chilaiditi syndrome, first described in 1910 by the radiologist Chilaiditi from Vienna, is the interposition of right colon between liver and right hemi diaphragm. It occurs most often in males and its incidence increases with age. It is often detected incidentally during radiological examination. It’s rarely symptomatic; symptoms can differ from mild abdominal pain to severe acute intestinal obstruction. Our case applied to emergency service with right flank pain. There was no calculus or dilatation in the urinary system at non-contrast abdominopelvic computerized tomography. Ascending colon was interposed between liver and diaphragm so that the patient was diagnosed as Chiliaditi syndrome. The patient was treated conservatively and discharged with dietary suggestions by the gastroenterology consultant. The conclusion of this report is that the Chilaiditi syndrome must be considered in differential diagnosis for patients presenting with urinary colic pain symptoms with no urinary pathology on radiologic imaging.

Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment modality in the minimal invasive management of urinary system stone disease. Although the majority of the complications occuring after ESWL are minor (most common ones are gross haematuria, pain, perinephritic hematoma); bacteriuria may also occur in some cases which sometimes can lead to sepsis and even metastatic abscess formation in a very rare part of the cases treated. In this rare situation infection agent spreads quickly via hematogenous route and causes abscess formation in different parts of the body. Majority of such cases usually have an underlying systemic disease like diabetes mellitus (DM), malignancy, HIV or steroid use which lead to disruption of immune system functions. Abscess formation following ESWL is extremely rare and usually limited with some case reports published in the literature. Herein, we present a diabetic case with formation of multiple abscess foci in kidney, as well as in lungs and liver following ESWL. The patient was first admitted to our emergency department with high fever and respiratory distress and misdiagnosed as metastatic tumor foci based on radiologic findings. To the best of our knowledge, our case is the first one in the literature in whom simultanous abscess formation in multiple organ systems has been documented following an otherwise uneventful ESWL.