Objective To evaluate retrograde intrarenal surgery (RIRS) outcomes and to determine the effect of operative time on complications of RIRS. Methods Patients undergoing RIRS for renal stones were evaluated. These patients were divided into two groups according to the operation time (Group 1<60 minutes and Group 2>60 minutes). Peroperative outcomes such as fluoroscopy time, stone-free rates, complications and duration of hospitalization were compared. Results Group 1 consisted of 264 patients and Group 2 consisted of 297 patients. SFR rates, duration of hospitalization, and postoperative urinary tract infection rates were similar in both groups. Fluoroscopy time was 7.8±7.3 (0-49) sec in group 1 and 13.1±9.8 (0-81) sec in group 2. Complications according to modified Clavien–Dindo classification system (MCDCS) were 13 and 32 patients (Grade 1), 31 and 63 patients (Grade 2), 1 and 1 patient (Grade 3) in group 1 and 2, respectively. There was statistical difference between the two groups in terms of duration of fluoroscopy time and the MCDCS. Although duration of hospitalization and UTI rates were higher in group 2, no statistical significance was observed among groups. Conclusion Limiting the operation time to 60 minutes in RIRS seems to be important in reducing postoperative complications.
Erectile dysfunction (ED) refers to difficulty in starting and maintaining an adequate erection for satisfactory sexual performance and the stability of this condition (Burnett et al., 2018). The estimated prevalence of ED in men > 40 years of age is almost 50% (Bella, Lee, Carrier, Benard, & Brock, 2015). Different therapeutic agents have been developed for ED treatment, and their effect mechanism depends on the understanding of erection physiology. In ED treatment-resistant patients, lifestyle changes as a first-line treatment option and phosphodiesterase type 5 inhibitors (PDE5 inhibitors) as a second-line treatment option are used. PDE-5 inhibitors are noninvasive, generally well tolerated and efficient in most males. Intracavernosal injections (ICUs), such as alprostadil and papaverine, can be used in 25%-50% of patients who are irresponsive to the treatment and who contraindicate PDE5 inhibitors (Bella et al., 2015; Hatzimouratidis et al., 2019).
Background: In this study, we applied the ultra-mini percutaneous hepatolithotomy (UM-PHL) technique on hepatolithiasis patients with multiple and large stones on which other minimally invasive methods failed, and our aim was to report its results, sharing in series for the first time.Materials and Methods: Preoperative and postoperative data, laboratory parameters, radiologic findings, and preoperative and postoperative details were recorded for a total of 14 patients for whom the UM-PHL technique was applied between April 2017 and December 2019. As all patients had multiple stones and extreme stone load and had bile duct surgery, they did not have a normal anatomy. All patients were radiologically confirmed to have had preprocedural magnetic retrograde cholangiopancreatography.Results: Operation duration of the patients was 137.6 ± 44.9 minutes, while intraoperative blood loss was 69.2 ± 24.9 mL, drainage catheter removal time was 2.85 ± 0.86 days, and the hospitalization time was 4.28 ± 2.55 days. Intraoperative balloon dilation was applied to enlarge the stricture area in 5 patients (35.7%). On the basis of the Clavien-Dindo classification, grade 2 complication was observed in 2 patients (14.2%) due to postoperative cholangitis. Patients were followed up for an average of 15 months, and nonsymptomatic radiologic stone recurrence was detected in the 12th month control of 1 patient (7.1%). Conclusion:The UM-PHL technique is a successful method that facilitates stone clearance by providing minimal dilatation through percutaneous intervention and by using instruments with small diameter, and it can safely be applied with its low complication level, low recurrence ratio, and short hospitalization time.
Objective: In patients treated through the application of intracavernosal alprostadil in second-line treatment due to erectile dysfunction, the effect of the treatment on sexual functions measured with a 15-question International Index of Erectile Function (IIEF-15) questionnaire was investigated in this study. Material and Methods: Twenty-one patients treated due to erectile dysfunction between June 2018-October 2019, taking inadequate response from first-line treatment modalities, were applied intracavernosal alprostadil in second-line treatment and continued it for more than 12 weeks were included in the study, retrospectively. Ages, comorbid diseases, drug usage duration, drug-related side effects, penile Doppler ultrasonography (USG) parameters before application and the erection functions before and 12 weeks after drug use were evaluated with IIEF-15 form for the patients. Intracavernosal alprostadil was started with a dose of 5 μg and was continued with a dose of 10 μg as the result of dose titration. Results: The mean peak systolic blood flow velocity (PS) value of the patients was 24.4 ±15.1 cm/sec, and the mean end-diastolic flow velocity (ED) value was measured as 4.3±4.5 cm/sec based on the pre-treatment penile Doppler USG.Although the IIEF scores were measured in the 12th week, mean drug usage durations were measured as 21.9±16.6 weeks. Erectile Function Score was 9.2±5.3 before application; it was detected as 20.33±6.2 after the application. Orgasmic Function Score was 3.2±2.5 before application; it was detected as 7.5±2.4 after the application. Sexual Desire Score was 3.72±1.48 before application; it was detected as 8.9±1.4 after the application. Intercourse Satisfaction Score was 3.7±2.8 before application; it was detected as 9.1±2.7 after the application. Overall Satisfaction Score was 4±1.7 before application; it was detected as 8.1±1.7 after the application (All parameters p<0.001). Conclusion: Intracavernosal alprostadil treatment used in erectile dysfunction second-line treatment is a cost-effective and efficient treatment method with a tolerable side effect profile and provides recovery in sexual parameters that can be measured with IIEF-15 parameters. Keywords: Alprostadil, erectile dysfunction, intracavernosal treatment.
Amaç: Bu çalışmanın amacı, Trans-Obturator Tape(TOT) cerrahi uygulamasının kadın üriner inkontinans ve kadın cinsel fonksiyonları üzerindeki etkisinin araştırılmasını amaçlamaktır. Yöntemler: Ocak 2018-Temmuz 2021 tarihleri arasında transobturator tape(TOT) cerrahisi uygulanan hastalar çalışmaya dahil edildi. Preoperatif dönemde ve postoperatif 3. ayda Uluslararası Standartlaştırılmış Kadın Cinsel İşlev İndeksi(FSFI), Uluslararası İnkontinans Sorgulama Formu(ICIQ-SF), Aşırı Aktif Mesane Değerlendirme Formu(OAB-V8) ve Ürogenital Distres Envanteri(UDI-6) anketleri uygulandı. Preoperatif ve postoperatif veriler karşılaştırıldı. Bulgular: Çalışmaya TOT cerrahisi uygulanan toplam 37 hasta dahil edildi. Hastaların ortalama yaşı 58.6±7.1 yıl idi. Ortalama takip süresi 15, 2±4.8 ay olarak saptandı. 22(%59,5) hastanın en az bir adet ek hastalığı mevcuttu. FSFI, ICIQ-SF, OAB-V8, UDI-6 skorlarının preoperatif dönemdeki değerlerinin postoperatif dönemde düzelme yönünde anlamlı değişiklik gösterdiği saptandı. (sırasıyla p<0.001, p<0.001, p<0.001, p<0.001) Sonuç: Trans-Obturator Tape(TOT) cerrahi uygulaması kadın stres üriner inkontinansını azaltmakta olup kadın cinsel işlevi üzerinde de olumlu etkilerde bulunmuştur. Ayrıca TOT cerrahisi sonrası başlanan β3- adrenoseptör agonisti olan Mirabegron tedavisinin cerrahi sonrası gelişen aşırı aktif mesane semptomlarını azalttığı görülmüştür. Anahtar Kelimeler: Üriner inkontinans, stres inkontinans, transobturator tape, kadın cinsel fonksiyon bozukluğu
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