Introduction: Clot retention in the urinary bladder is a very common health problem in surgical and nonsurgical cases and clot retention treatment is quite costly. Objectives: The aim of this retrospective study was to describe an alternative technique for removing tenacious and chronic clots by using a thoracic catheter technique. Materials and methods: Between January 2011 and June 2018, a total of 27 patients of clot retention were treated under local anesthesia with the thoracic catheter technique. Results: Twenty-seven patients with a mean age of 58 years (range 45-70) were included. The etiologies of bladder clots included surgical causes and nonsurgical causes. Of the surgical causes, the most common cause was post-transurethral resection of the prostate (TURP). The nonsurgical causes were upper tract bleeding, drug-induced bleeding, post-traumatic bleeding, and haematochyluria. It was found that the thoracic catheter technique was simple and easily adoptable, with no training required. Conclusions: Clot retention in the urinary bladder is a very common problem in surgical and nonsurgical cases. Our technique is a simple, safe, fast, and effective option of clot removal from the urinary bladder and it doesn’t require any added cost.

Kliniğimizde gerçekleştirilen ürolojik laparoskopik cerrahi olguların sonuçları ve komplikasyonlarını geriye dönük olarak değerlendirmek. Yöntemler: Ocak 2012 -Ocak 2015 tarihleri arasında laparoskopik operasyon geçiren toplam 115 hasta geriye dönük incelendi. Hastaların demografik özellikleri, preoperatif tanıları, laparoskopik yaklaşım şekli, ameliyat ve yatış süreleri, cerrahi işlem esnasında ve sonrasında gelişen komplikasyonlar ve açık cerrahiye geçilen hastalar açısından incelendi. Bulgular: Hastaların 61'i kadın, 54'ü erkek ve ortalama yaşları 52,4±11,7 yıl idi. Altmış sekiz olguda transperitoneal, 47 olguda ise retroperitoneal girişim uygulandı. Toplam 29 hastaya basit böbrek kisti eksizyonu, 25 hastaya basit nefrektomi, 22 hastaya üreterolitotomi, 19 hastaya radikal nefrektomi, 15 hastaya piyelolitotomi ve 5 hastaya da piyeloplasti yapıldı. Toplam 115 vakanın 4'ünde (%3,4) açık operasyona geçildi. Bu hastalar dışında majör komplikasyon ve mortalite görülmedi. En sık yapılan ameliyatların ortalama süreleri ise; böbrek kist eksizyonu 62 (50-110) dk, basit nefrektomi 125 (95-140) dk, üreterolitotomi 108 (90-130) dk, radikal nefrektomi 141 (105-175) dk, piyelolitotomi 116 (95-140) dk ve pyeloplasti 166 (150-190) dk idi. Ortalama yatış süresi 3,7±2,8 gün (2-11) idi.Sonuç: Uyguladığımız laparoskopik cerrahilerin sonuçları, başarı ve komplikasyon oranları literatürle uyumlu bulundu. Laparoskopik cerrahi, teknolojinin gelişmesi, deneyimlerin artmasıyla ayrıca hastalar tarafından daha iyi tolere edilmesi nedeniyle açık cerrahiye alternatif, güvenli ve minimal invaziv bir tedavi yöntemi olduğunu düşünmekteyiz.

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SUMMARY OBJECTIVE Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Various intravesical and extravesical techniques have been described for the surgical correction of VUR. The aim of our study was to compare the results of open intravesical and extravesical procedures for unilateral primary VUR in children. METHODS Between January 2012 and August 2018, 38 children with primary VUR who underwent open ureteral reimplantation surgery were retrospectively reviewed. The Cohen (intravesical) and the Lich-Gregoir (extravesical) approach were grouped as groups A and B, respectively. The groups were compared for age, gender, preoperative reflux grade, presence of lower urinary tract symptoms, operation time, discomfort and pain, analgesic requirements, duration of hematuria, postoperative complications, and hospital stay. All the parameters were statistically compared. RESULTS There were 38 patients in this study. Group A had 18 patients, and group B had 20 patients. The mean operative time was significantly shorter in group B than in group A. The mean hospital stay was also shorter in group B. The urethral foley stay period was 4.7±0.9 days 2±0 days (p = 0.000*), respectively, for group A and B. Macroscopic hematuria was seen in group A. The objective pain scale was worse after intravesical surgery. Analgesic requirements were higher in group A (p =0.131). CONCLUSION Intravesical and extravesical ureteroneocystostomy methods are equally successful and feasible in the treatment of primary unilateral VUR. The Cohen technique is associated with a longer and more painful hospital stay, gross hematuria, and longer operative time, compared to the Lich-Gregoir technique.

Purpose: Our aim was to determine the diagnostic performance of the combined usage of diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS) and perfusion MR (MRP) imaging for the differential diagnosis of benign and malignant intracranial lesions. Materials and methods: A total of 30 patients with intracranial lesions who were prospectively evaluated with contrast-enhanced magnetic resonance imaging (MRI), DWI, MRS, and MRP were included in this study. The lesions were classified as benign and malignant according to the radiologic findings. All imaging data were compared with the histopathologic results and follow-up of the patients. We used the Pearson chi-square test and Fischer's exact t-test for statistical analysis. Results: For the differentiation of benign and malignant brain lesions, CBV and choline/creatine (Cho/Cr) ratio at short echo time (TE) had the highest sensitivity (87%-88%), Cho/N-acetyl aspartate (NAA) at short TE had the highest specificity (86%). DWI predicted 77% sensitivity, 75% specificity; MRP presented 91% sensitivity, 88% specificity; MRS yielded 77% sensitivity, 63% specificity. The combination of either DWI and MRS, MRP and MRS or DWI+MRS+MRP revealed 100% sensitivity, 100% specificity. Conclusion: For the differentiation of benign and malignant brain lesions, the combination of DWI, MRS, and MRP predicted 100% sensitivity. Invasive procedures like transcranial biopsy were not required via the usage of these advanced MRI techniques.

Introduction We investigated the clinical, operational, and pain parameters of patients who underwent semirigid ureterorenoscopy (sURS) under spinal anesthesia (SA) and general anesthesia (GA) for proximal ureter stones. Material and methods Patients treated with sURS after diagnosis of proximal ureter stones between January 2014 and May 2017 were reviewed retrospectively. The patients were divided into two groups (the SA group and the GA group) based on the type of anesthesia used. Perioperative variables and operation results were evaluated and compared. Success was defined as the patient being stone-free as observed on low-dose non-contrast computed tomography performed in the first month postoperatively. Results The SA and GA groups had 40 and 32 patients, respectively. There were no statistically significant differences between the groups in terms of age (p = 0.593), gender (p = 0.910), average stone size (p = 0.056), side (p = 0.958), or density (p = 0.337). Based on the Clavien classification system, complication rates between the two groups were similar. The postoperative visual pain scale in the SA group was statistically significantly lower (p <0.05) than in the GA group. Success rates in the SA and GA groups were found to be 90% (36/40) and 93.7% (30/32), respectively, with no significant difference between the groups (p = 0.819). Conclusions Ureterorenoscopy, which is performed for proximal ureter stone treatment in adult patients, is a reliable surgical method that can be performed under both SA and GA. SA offers the advantage of reduced postoperative pain as compared to GA.

IntroductionThe aim of this study was to present our results regarding the feasibility and possible complications of 4.5 Fr semi-rigid ureterorenoscopy (URS) treatments in pediatric patients.MethodsThe files and computer records of a total of 33 pediatric patients (20 males and 13 females), who underwent URS procedures for ureteral stones > 5 mm between January 2013 and June 2017, were retrospectively reviewed. A 4.5 Fr semi-rigid ureteroscope (Ultrathin 4.5/6.5 Fr Ureterorenoscope; Richard Wolf GmbH, Knittlingen, Germany) was used for the URS procedures. For the stone-free rate evaluations, abdominopelvic ultrasound or direct radiography scans were performed one week after the surgery, and low-dose non-contrast computed tomography (CT) was performed during the first month.ResultsThe mean age of the patients was 9.8 ± 2.8 (range 4-16) years old, and the mean ureteral stone size was 8.9 ± 1.4 (range 6-13) mm. The mean surgical duration was 45 ± 21.2 (range 30-75) minutes, and the mean hospital stay length was 1.2 (range 1-4) days. Minor complications occurred in five (15.1%) of the patients. The success rates for the first week and first month were 90.9% and 96.9%, respectively.ConclusionThe endoscopic management of pediatric ureteral stones using a 4.5 Fr ureteroscope seems to be a safe and feasible treatment option with high success and low complication rates.

We present the 68 Ga-PSMA and 18 F-FDG PET/CT findings comparatively of a 67-year-old prostate cancer and malignant melanoma patient who had COVID-19 pneumonia 3 months ago. In 68 Ga-PSMA PET/CT, ground-glass opacities showing markedly increased PSMA uptake were observed in the patient’s lungs. It was learned that the patient had COVID-19 pneumonia 3 months ago and was treated in the intensive care unit for 13 days. In 18 F-FDG PET/CT, FDG uptake was minimal in the same areas. In the midterm period after COVID-19 pneumonia, lung PSMA uptake is more intense than FDG, which may help better understand the disease’s healing phase.