Ozan HORSANALI

Pure renal leiomyosarcoma is a rare and agg-
ressive tumor. It is very difficult to distinguish
from other renal tumors clinically and radiolo-
gically. It resistants to radiotherapy and chemot-
herapy and treatment is only surgery. Here we
presented a case with left renal mass which diag-
nosed kidney leiomyosarcoma.

Üretral yabancı cisim nadir görülen bir du-
rumdur. Yabancı cisimler genellikle cinsel amaçlı
olarak kişinin kendisi tarafından üretraya sokul-
maktadır ve sıklıkla psikiyatrik bozukluğu olan
hastalarda görülmektedir. Ürogenital diafram
distaline lokalize yabancı cisimler genellikle en-
doskopik metodlar ile başarıyla çıkarılabilir. Bazen
eksternal üretratomi (pendüler üretrada yabancı
cisimler), suprapubik sistotomi (posterior üret-
radaki yabancı cisimler) veya meatotomi operas-
yonu gerekir. Burada 42 yaşında üretrasına kalem
şekilli silikon çubuk sokan ve eksternal üretratomi
operasyonu ile tedavi edilen olguyu sunduk.

Kadın hastalarda pelvik organ prolapsusu sıklığı yaşla birlikte artmaktadır. Pelvik organ prolapsusu üriner sisteme yakınlığı nedeniyle hidronefroz ve üremiye neden olabilir. Pesser uygulaması cerrahi istemeyen kadın hastalarda pelvik organ prolapsusu için alternatif bir tedavi yöntemidir. Burada uterin prolapsusa bağlı hidronefroz ve üremi gelişen, pesser ile tedavi edilen olguyu sunduk. Abstract The incidence of pelvic organ prolapse has increased with age in female patients. Pelvic organ prolapse can cause hydronephrosis and uremia because of close to urinary system. The application of pessary is an alternative treatment method for pelvic organ prolapsus in female patient who do not want surgery. In this report, we present a female patient who has hydronephrosis and uremia due to uterine prolapse uterine prolapse treated with pessary. Giriş Pelvik organ prolapsus sıklığı yaşla birlikte artmakla beraber kesin tedavisi cerrahidir. Cerrahi istemeyen veya komorbitide nedeniyle cerrahiye uygun olmayan hastalarda pesser uygulaması alternatif bir tedavi yöntemidir [1]. Uterus prolapsusu toplumda görülme sıklığı yaklaşık % 14 olup önemli bir halk sağlığı sorunu oluşturmaktadır [2]. Uterus prolapsusu özellikle alt üriner sistem ile anatomik komşuluğu nedeniyle zaman zaman üst üriner sistemde hidronefroza ve böbrek yetmezliğine kadar gidebilen sorunlara neden olmaktadır [3]. Burada uterin prolapsusa bağlı hidronefroz ve üremi gelişen pesser ile tedavi edilen olguyu sunduk.

A large variety of foreign bodies have been detected in the urethra and urinary bladder. Usually, these foreign bodies are self-inserted for masturbation, frequently in patients with psychiatric disorders. In this manuscript we report the case of a 72-year-old male patient who inserted a rosary into the urethra for sexual gratification and was treated with open surgical technique.

Üreteroskopi eşliğinde taş fragmantasyonu üroloji prati-ğinde en sık uygulanan ameliyatlardan bir tanesidir.  Üre-terin narin yapısına ek olarak taşın proksimal üreterde
olması, tecrübesizlik, taşın boyutunun artması, taşın im-pakte olması ve geniş çaplı üreteroskop kullanımı kompli-kasyonları artıran sebeplerdir. Submukozal üreter taşı lite-ratürde nadir bildirilen vakalardandır. Litotripsi sonrasında
rezidü taş kalması ve üreterdeki hasarın üzerine oturması
neticesinde oluştuğu düşünülmektedir.  Major bir komp-likasyon olan üreter perforasyonundan kaçınmak için bu
tür vakalarda dikkatli ve sabırlı olunması gereklidir.  Bizde
geçirilmiş başarısız üreterorenoskopi sonrasında oluşan
submukozal taş olgusunu sunduk

Poliorşidizm, skrotumda birden fazla testisin olması
şekinde tanımlanmaktadır. Nadir görülen bir durum-dur. En sık görülen şekli triorşidizm olup genellikle sol
tarafta görülmektedir. Bizde kliniğimize skrotal şişlik
ve ağrı şikayeti ile başvuran sol skrotumda triorşidizm
olgusunu sunduk

Inguinal herniation of urinary bladder is usually asyptomatic and a rare condition Inguinal hernia-tion of bladder can cause filling and emptying disorders symptoms of bladder, bladder necrosis and obstructive uropathy. Treatment is surgery. In here, we presented a case with inguinal herniation of the bladder cause ingu-nal swelling and emptying disorders symptoms.

Incidence of carcinoma bladder is increasing in industrialized and developed countries. Most of tumors are superficial and well differentiated transitional cell carcinomas. Transurethral resection of bladder tumor is a routinely performed procedure for bladder tumors. This procedure is more likely to stimulate the adjacent obturator nerve, which is in close proximity to the lateral bladder wall. This stimulation causes obturator nerve reflex, leading to inadvertent bleeding and bladder perforation.

Mesanede çok farklı yabancı cisimler bulunmuştur. Bu yabancı cisimler genellikle cinsel amaçlı olarak kişinin kendisi tarafından mesaneye sokulmaktadır ve sıklıkla psikiyatrik bozuklukluğu olan hastalarda görülmektedir. Burada cinsel ilişki esnasında üretradan mesanesine tığ sokan ve açık cerrahi ile tedavi edilen 34 yaşındaki kadın hastayı sunduk. Anah tar söz cük ler: Kadın; mesane; yabancı cisimler. Abstract Many different foreign bodies have been found in the urinary bladder. Usually, these foreign bodies were self-inserted for autoeroticism, frequently in patients with psychiatric disorders. Here we report the case of a 34-year-old female patient who inserted a beading awl through the urethra into the bladder during sexual intercourse and was treated with open surgery.

Hidatik kist hastalığı, oral yolla alınarak ince bağırsak
mukozasına invaze olan Echinococcus granulosus lar-valarının kan ve lenf dolaşımı aracılığıyla organlara
yerleşmesiyle oluşan parazitik bir enfeksiyondur. Re-nal hidatik kist oldukça nadirdir ve olguların yalnızca
%2 sinde renal tutulum görülür. Biz de yazımızda, 30
yaşında sol yan ağrısı ile başvuran, köpek ve koyun -larla temas öyküsü olan erkek hastada yapılan tetkik-ler sonucunda tespit ettiğimiz karaciğer kist hidatiği
ile birlikte dev renal kist hidatik olgusunu sunduk

Amaç:  Hematüri ürologların, aile hekimlerinin ve di -
ğer branşlardaki hekimlerin sıkça karşılaştığı bir du -
rumdur. Çalışmamızda hastanemizde, son bir yılda
acil servise ve üroloji polikliniğine ayaktan başvuran
ve hematüri tesbit edilen hastaları retrospektif olarak
inceledik.
Gereç ve yöntemler: Hastanemize 2014 yılında acil
servise ve üroloji polikliniğine ayaktan başvuran ve
hematüri tanısı alan hastalar, hastane kayıt sistemin -
den alınan bilgiler doğrultusunda retrospektif olarak
incelenerek analiz edildi. Hastalar hematüri türüne
göre makroskopik ve mikroskopik olarak iki gruba ay-
rılarak incelendi.
Bulgular:  Hastanemize başvuran 452 hastanın veri -
leri retrospektif olarak analiz edildi. Hastaların yaş
ortalaması 57,3±20,4 yıl idi. Makroskopik hematü -
rili hastaların 23(%34)’sinde sistit , 18(%27) hastada
mesane  malign  neoplazmı,  12(%18)’sinde  benign
prostatik hiperplazi ve 13(%11)’ünde diğer nedenle-
re bağlı hematüri izlendi. Mikroskopik hematüri ile
başvuran hastalarda ise, 203(%52) hastada üriner
enfeksiyona bağlı akut sistit, 40(%1) hastada mesane
malign neoplazmı, 33(%0,8) hastada benign prostat
hiperplazisi ve 109(%28) hastada diğer nedenlere
bağlı hematüri izlendi.
Sonuç:  Çalışmada hem mikroskopik hem de mak-
roskopik hematüriyle başvuran hastalarda en çok
üriner enfeksiyona bağlı akut sistit, görülmesine rağ -
men %13 oranında ürolojik maligniteye bağlı hema-
türi olduğunu tesbit ettik. %10 hastada ise başvuru
esnasında yapılan idrar tetkikinde normal değerler
bulunduğunu gördük. Makroskopik hematüri ile baş -
vuran hastalarda daha fazla ürolojik malignite tesbit
ettik. Makroskopik hematüri tesbit edilen hastaların
ileri incelemeye alınması, mikroskopik hematüriyle
başvuran hastalarda  ise tekrarlayan mikroskopik he -
matüri durumunda ileri tetkik ve değerlendirme ya -
pılmasını önermekteyiz.

Amaç: Radikal nefrektomi yapılan hasta-larda yaş ve cinsiyetin sağ kalıma etkisini araş -tırmak.
Gereç ve Yöntemler:  1990 – 2012 tarihleri
arasında kliniğimizde böbrek tümörü nedeniy -le radikal nefrektomi operasyonu uygulanan
177 hasta retrospektif olarak değerlendirildi.
Hastalar yaş gruplarına göre 5 gruba (<49, 50-59, 60-69, 70-79, ≥80) ayrılarak yaş ve cinsiye -tin sağkalıma etkisi araştırıldı.
Bulgular: Hastaların 73’ü (%41,2) kadın,
104’ü (%58,8) erkekti. Tüm hastaların yaş or -talaması 69,11±12.42 yıl olarak hesaplandı.
Hastaların ortalama takip süresi 36,7 ±38.92
ay idi. Yaş gruplarına göre sağkalım değerlen -dirildiğinde ≤49 yaş grubunda median sağka-lım 29 ±28,65 ay, 50-59 yaş grubunda 46±11,34
ay, 60-69 yaş grubunda 48 ±8,11 ay, 70-79 yaş
grubunda 41±5,28 ay, ≥80 yaş grubunda 32±3,8
ay olarak hesaplandı ve gruplar arasında istatis -tiksel olarak anlamlı fark saptanmadı (p=0,684)
(Şekil 1). Kadınlarda median sağkalım 41
±12,55 ay, erkeklerde 44±6,78 ay olarak bulun-du (p=0,59)(Şekil 2).
  5 yıllık sağkalım analizlerinde erkek
cinsiyette median 31,2 ay, kadınlarda ise 29,3
ay  olarak hesaplandı. Yaş gruplarına göre 5 yıl -lık sağkalım analizlerine baktığımızda ≤49 yaş
grubunda median 48 ay, 50-59 yaş grubunda
29,2 ay, 60-69 yaş grubunda 36,6 ay, 70-79 yaş
grubunda 36,9 ay,  ≥80 yaş grubunda 35,5  ay
olarak hesaplandı.
Sonuç:  Çalışmamızda yaş ve cinsiyetin
sağ kalım üzerine etkisi olmadığı gözlendi. Bu
nedenle böbrek hücreli kanser nedeniyle ileri
yaşlarda da radikal nefrektomi operasyonunun
yapılabileceğini düşünmekteyiz.

Giriş Varikosel pampiniform pleksus venlerinin dilatasyonudur. Erişkin yaşta prevalansı %15-22 iken infertilite ile başvuran hastalarda bu oran %25-40, sekonder infertilite ile başvuran hastalarda ise %69-81 oranlarındadır. Ancak bu bulguların tersine varikoselli hastaların %80'inde infertilite görülmez. Varikosel %75-95 oranında sol tarafta görülür. Bilateral görülme olasılığı ise %10'dur. Ancak güncel literatürde Doppler Ultrasonografinin (USG) daha yaygın kullanılması ile birlikte subklinik varikoseller dahil bu oranın %30-80 düzeylerinde olduğu bildirilmektedir [1,2]. Etiyolojik olarak birçok faktör suçlanmakla birlikte günümüzde en bilinen ve kabul gören anatomik faktörlerdir. Sol sprematik venin sağa göre yaklaşık 8-10 cmdaha uzun olması, sol spermatik venin sol renal vene dik bir açı ile açılması, sol spermatik vendeki valvlerin disfonksiyonu ve " nutcracker " (fındıkkıran) fenomenidir. Bu fenomende proksimal tipte; sol renal ven aort ile süperior mezenterik arter arasında sıkışarak internal spermatik vende basınç artışı ve dilatasyon gelişmesi, distal tipte ise ilak arterin iliak vene bası yapması ile eksternal spermatik vende basınç artışı ve dilatasyon gelişmesi şelinde tanımlanmaktadır [2]. Amerika üroloji kılavuzlarında; Palpable varikosel varlığı, anormal semen parametre varlığı, dökümente edilmiş infertilite varlığı, kadın partnerin normal olması veya düzeltilebilir infertilitesinin olması durumlarının tümünün varlığında varikoselektomi önerilmektedir [3]. Avrupa üroloji kılavuzlarında ise; progresif testiküler gelişim bozukluğu varlığı olan adelosanlar, klinik varikoseli olan ve 2 yıldır süren açıklanamayan infertilite varlığında varikoselektomi önerilir iken, normal semen analizi olan ve subklinik varikoselli infertil hastalarda varikoselektomi önerilmemektedir [4]. Erkek infertilitesi ve varikosel ilişkisi net olarak bilinmemektedir, fakat son zamanlarda yapılan bir meta-analizde cerrahi tedavi sonrası semen paramatrelerinde iyileşme gözlenmiştir [5]. Varikoselektomi operasyonu sonrası sperm DNA hasarının da düzelebileceği gösterilmiştir [6]. Bu çalışmada varikoselektomi operasyonu sonrası sperm sayı ve hareketindeki değişikliğin yaş ile ilişkisini değerlendirmeyi amaçladık.

GİRİŞ Üretra darlığı, üretra lümenini daraltan, korpus spongiosumda-ki subüretral dokunun skarlaşması sonucunda oluşmaktadır (1). Üretra darlığı, idrar akışına engel olarak hastanın yaşam kalitesini bozabilir ve ayrıca kronik idrar retansiyona bağlı böbrek yetmezli-ği gibi ciddi komplikasyonlara neden olabilir (2). Üretra darlıkları-nın nedeni sıklıkla idiyopatik olmakla birlikte, travma ve iatrojenik nedenlerle de üretrada darlık ortaya çıkabilmektedir (3). ÖZ Amaç: Üretra darlığı, üretra lümenini daraltan, korpus spongiosumdaki subüretral dokunun skarlaşması sonucunda oluşmaktadır. Üretra darlıklarının ne-deni sıklıkla idiyopatik olmakla birlikte, travma ve iatrojenik nedenlerle de üretrada darlık ortaya çıkabilmektedir. Çalışmamızda kliniğimizde üretra darlığı nedeniyle internal üretrotomi uygulanan hastalarda üriner kateterizasyon süresiyle ile rekürren darlık arasındaki ilişkiyi inceledik. Yöntemler: Kliniğimizde2014 yılında üretra darlığı nedeniyle endoskopik görüntüleme eşliğinde soğuk bıçakla internal üretrotomi uygulanan 157 hasta dahil edildi. Operasyon sonrası üriner kateterizasyon sürelerine göre 3 gün, 5 gün ve 7 gün olmak üzere 3 gruba randomize edildi. Gruplar arasında nüks ve post operatif Qmax değerleri Ki-kare testi ve Varyans analizi (ANOVA) ile değerlendirildi. Bulgular: 157 hastanın yaş ortalaması 63,51±13,86 yıl idi. Tüm hastaların ortalama preoperatif Qmax değerleri 6,07±2,70 mL/sn, darlık uzunlukları 2,61±2,19 cm ve post operatif Qmax değerleri 10,9±4,1mL/sn idi. Hastaların 49'unda (%31,2) nüks izlenirken, 108 (%68,8) hastada nüks darlık izlenmedi. Post operatif üriner kateter 3 gün bırakılan hastaların 17 (%36)'sinde, 5 gün bırakılan hastaların 12 (%22)'sinde, 7 gün bırakılan hastaların 20 (%35)'sinde nüks üretra darlığı izlendi. İstatistiksel analizde gruplar arasında tekrarlayan üretra darlığı ve post operatif Qmax değerleri açısından anlamlı fark bulunmadı. Sonuç: Günümüzde üretra darlıkları için tavsiye edilen altın standart tedavi yöntemi endoskopik internal üretrotomi yöntemidir. Literatürde birçok çalışma-da internal üretrotomi cerrahi tekniği ve sonuçları birbiriyle karşılaştırılmıştır. Yaptığımız çalışmada üretra darlığı sebebiyle soğuk bıçak yöntemiyle internal üretrotomi yaptığımız hastalarda post operatif üriner kateterizasyonun 3, 5 ve 7 gün bırakılması arasında istatistiksel olarak anlamlı bir fark saptamadık. Hastalarda post operatif üriner kateterizasyon süresinin uzatılmamasını, mümkün olan en kısa zamanda çıkarılmasını önermekteyiz. Operasyon sonrası sonda süresi makul olan en kısa sürede tutularak, hem hasta konforunun arttırılabileceğini, hem de üriner kateterizasyonun uzun süre kalmasına bağlı gelişebilecek rekürren darlıkların önlenebileceğini düşünmekteyiz. (JAREM 2015; 5: 121-4) Anahtar Kelimeler: Üretra, üretra darlığı, üriner kateterizasyon ABSTRACT Objective: Narrowing of the urethral lumen due to fibrosis, which occurs in the urethral mucosa and the surrounding tissue, is defined as urethral stricture. Even though the most common reason for urethral stricture is idiopathic, trauma and iatrogenic applications can also cause urethral stricture. In this study, we analyzed the association between recurrent stricture and urinary catheterization duration in patients who underwent direct vision internal urethrotomy for urethral stricture. Methods: In our clinic, in 2014, we analyzed 157 patients who underwent direct vision internal urethrotomy with a cold knife for urethral stricture. All patients were divided into the following three groups as 3 days, 5 days, and 7 days after the operation in terms of urinary catheterization duration. To analyze the association between recurrent and postoperative Qmax values, Chi-square test and one-way analysis of variance (ANOVA) were performed. Results: The mean age of 157 patients was 63.51±13.86 years. The mean preoperative Qmax, stricture length, and postoperative Qmax values of all patients were 6.07±2.70 mL/s, 2.61±2.19 cm, and 10.9±4.1 mL/s, respectively. Additionally, 49 (31.2%) patients had recurrent stricture and 108 (68.8%) patient had no recurrence. In total, 17 (36%) patients in the 3-day postoperative urinary catheterization group, 12 (22%) in the 5-day group, and 20 (35%) in the 7-day group had recurrent stricture. Statistical analyses revealed no statistical significance between groups in terms of recurrent stricture and postopera-tive Qmax values. Conclusion: Currently, the recommended gold standard treatment for urethral stricture is direct vision internal urethrotomy. In the literature, many studies have compared surgical techniques and results. In our study, we found no statistical significance between urinary catheterization duration (3, 5, or 7 days postoperatively) in patients who underwent direct vision cold knife internal urethrotomy. The duration of postoperative urinary catheterization should not be extended; we recommend that remove it as soon as possible. After the operation, we believe that urinary catheterization must remove reasonable period of time, so patient comfort can be increased and urinary catheterization for recurrent strictures that develop due to remaining for a long time, could have been avoided. (JAREM 2015; 5: 121-4)

Amaç:Üretra darlığı nedeniyle internel üretratomi
operasyonu yapılan hastalarda spinal anestezi ihtiyacını
değerlendirmek.
Gereç ve Yöntem:Üretra darlığı nedeniyle internal
üretrotomi operasyonu yapılan 104 erkek hasta ve
sistoskopi yapılan 50 erkek hasta çalışmaya dahil edildi.
Tüm olgular preoperatif retrograd üretrografi ile
değerlendirildi. Dar segment uzunluğu 1 cm’den kısa ve
tek darlığı olan olgular çalışmaya dahil edildi. 46
hastaya lokal anestezi altında (Grup 1), 58 hastaya spinal
anestezi altında (Grup 2) internal üretrotomi operasyonu
uygulandı. Lokal anestezi ile opere edilen olguların ağrı
skoru sistoskopi yapılan hastalar ile karşılaştırıldı (Grup
3). Ağrı skoru VAS (visuel analog scale) ile
değerlendirildi. Üretrotomi operasyonu sonrası tüm
hastalara 20 Fr üretral kateter takıldı. Lokal anestezi için
lidokainli jel kullanıldı.
Bulgular :Grup 1’in yaş ortalaması 66±17.15, grup
2’nin 68±15.44, grup 3’ün 68±19.25 idi. (p=0.49).
Ortalama operasyon süresi; Grup 1’de 6.9 ± 3.1 dk iken
Grup 2’de 7.1± 4.2 dk idi (p=0.16). Grup 2’de ortalama
VAS skoru 3.2 ± 1.4 iken Grup 3’te 3.0 ± 1.5 idi
(p=0.52).
Sonuç : Lokal veya spinal anestezi altında internal
üretrotomi operasyonu yapılan hastalarda operasyon
süresi açısından anlamlı fark saptanmamıştır. Lokal
anestezi ile internal üretrotomi yapılan olguların ağrı
skoru sistoskopi ile benzerdi. Seçilmiş vakalarda (1
cm’den kısa ve tek darlık) spinal anesteziye gerek
kalmadan lokal anestezi ile internal üretrotomi
operasyonu güvenle yapılabilir.

Objective: In this study, our main objective is to show the connection between metabolic syndrome (MetS) and bladder functions by using urodynamic evaluation in female MetS patients. Materials and Methods: 131 female patients referred to our clinic for urodynamic evaluation from April 2014 to December 2014 were included in our study. 85 of these patients were diagnosed with MetS (study group) meanwhile 46 patients did not meet MetS criteria (control group). MetS definitions were taken from National Cholesterol Education Program's Third Adult Treatment Panel criteria. SPSS 17.0 was used for statistical analysis of data and p<0.05 values were deemed as statistically significant. Results: Urodynamic results of 131 patients were analyzed and patients were divided into study and control groups in accordance with their MetS profile. 85 patients were included in the study group and rest 46 were used as the controls. A statistically significant difference was detected when IPSS results were separated into low, intermediate and severe between study and controls (p=0.007). Moreover, urge-type incontinence was more frequent in MetS patients when compared with control group (p<0.001). However, there was no significant difference between groups in terms of SEAPI scores and IPSS. Patients with MetS had significantly higher detrusor, vesical and abdominal pressure in comparison with control group (p<0.001). No significant difference was found in uninhibited contractions, first urinary sense, strong desire to urinate, Valsalva leak-point pressure (VLPP) and abdominal leak-point pressure (ALPP) parameters between the groups Conclusion: Our results showed that MetS and its components can be associated with neurogenic bladder symptoms due to peripheral neuropathy and urge incontinence. Female patients with MetS have significantly higher post-voiding residue and intravesical pressure in comparison with control group. Further clinical studies with longer and controlled series are necessary for clarification of the metabolic syndrome's effect on bladder dysfunction on a molecular level.

Objectives: To investigate relationship between the lymphovascular invasion(LVI) and tumor characteristics and to evaluate effect on survival of LVI in patients who underwent radical cystectomy because of bladder cancer. Materials and Methods: Five hundred and six patients were enrolled the study between 1990 and 2013. Patients were divided into two groups in terms of lymphovascular invasion at final pathology after radical cystectomy. There were 108 patients with LVI(group1) and 244 patients without LVI(group2). Both groups were compared in terms of clinicopathologic features and survival. Results: There was no statically different for gender in both group(p=0,222).Lymh node involvement, grade, and p T stage were higher significantly in group 1(p<0,05). Positive lymph node number was 2.3±3.1 in group 1 and 0.6 ± 2.1 in group 2(p<0.001). Lymph node density was 24.3±30.1 in group 1 and 5.6±9.2 in group 2 (p<0.001).Estimated mean survival time was 27.2±3.4 months in group 1 and 80.2 ± 8.1 months in group 2 (p<0.001). Conclusions: Lymphovascular invasion is an independent prognostic factor for disease specific survival and effects survival negatively in patients who underwent radical cystectomy for bladder cancer. Patients with lymphovascular invasion should be considered for close monitoring after cystectomy.

Objective: To evaluate the effect of anterior suspension stitch during radical cystectomy and ileal neobladder urinary
diversion on continence.

Methods: 176male patients who underwent radical cystectomy and neobladder urinary diversion because of bladder
cancer  in  our  clinic.  We  analyzed  75  patientsretrospectively,  36  with  the  placement  of  anterior  suspension  stitch
Group 1 and 39 without anterior suspension stitch Group 2.  Both groups were compared in terms of age, maximum
urinary  flow  rate,  post  voiding  residual  urine  volume,  total,  nighttime  and  daytime  continence  status.  Incontinence
status was evaluated by International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) 

Results: The two groups had no significant differences in their age, post voiding residual urine volume and maximum
urinary  flow  rate.  Total,  nighttime  and  daytime  continence  rates  were  better  in  group  1.  The  mean  International
Consultation on Incontinence Questionnaire-Short Form score was significantly lower in group 1 (p<0.05). 

Conclusions: We  found  that  the  continence  rates  was  significantly  higher  in  patients  with  the  anterior  suspension
stitch. This technique improves the quality of life of patients in the way of incontinence. The anterior suspension stitch
during radical cystectomy and neobladder urinary diversion is a reliable and applicable procedure.

Objective: To evaluate the difference between testosterone and total prostate specific antigen (TPSA) serum levels between Arabic and Turkish people in the Middle East. Material and methods: The study included 3 groups of healthy men; Group I included 119 patients with a mean age of 52.73±7.53 years from east of Turkey. Group II consisted of 196 patients with a mean age of 50.32±7.84 years from west of Turkey. Group III consisted of 388, with mean age of 51±6 years from west bank in Palestine. The mean values of PSA and testosterone were calculated for each groups and a comparison were carried out. The relationships among testosterone and TPSA levels and patients' age were investigated.

Introduction:  Diabetes  Mellitus  (DM)  is  increasing  worldwide  health  problems.  Several  studies  have
proposed  an  epidemiological  association  between  DM  and  bladder  cancer.  CIS  is  a  high-grade  carcinoma
with the potential for invasion and metastases. We aimed to reveal association between DM, CIS and tumour
characteristics of patients with bladder cancer.
Material  and  Method: We  retrospectively  analyzed  615  patients  between  January  2007  and  December
2014  who  diagnosed  bladder  cancer  and  performed  TUR-BT  or  radical  cystectomy. All  patients  with  bladder
cancer separated two groups as Non-Muscle Invasive Bladder Cancer (NMIBC) and Muscle Invasive Bladder
Cancer (MIBC). Each groups separated two groups inside them as diabetic or non diabetic.
Results: We analyzed 615 patients with bladder cancer. There was statistically significance for relapse
frequency was higher in diabetic patients than non-diabetic patients. T, N and M stages were more advance in
diabetic patients. Although concurrent CIS is higher in diabetic patients, squamous metaplasias between diabetic
and non-diabetic patients were not significant.
Discussion:  Diabetes is the critical worldwide health problem that has serious complications that can cause
much  kind  of  cancers.  We  revealed  that  there  is  negative  effect  of  diabetes  on  patients  with  bladder  cancer
especially patients with CIS.
Conclusion: Patients with diabetes had advanced stage, grade and concurrent CIS than patients without
diabetes. And also, diabetic patients have more recurrent disease than non-diabetic patients.

Background: Epidemiological evidence indicates that individuals with diabetes mellitus (DM) may have a
modestly increased risk of bladder cancer. In the present study, we aimed to show any association between DM
and risk of metastasis in patients with non-muscle-invasive bladder cancer (NMIBC). Materials and Methods:
We retrospectively analyzed 698 patients between January 2007 and December 2014 who were diagnosed with
and underwent transurethral resection of bladder tumors (TUR-BT). Comparisons of means was conducted by
independent samples t test, and relations between categorical variables were investigated by non-parametric chi-square test. A p value of 0.05 was accepted as statistically significant in comparisons.  Results: We analyzed 418
patients with non muscle invasive bladder cancer. 123 of whom were diabetic and 295 non-diabetic. In diabetic
patients, 13 were N1 stage and 11 M1 stage. When compared with non diabetic patients that was statistically
significant (p<0.001). TNM stages were more advanced in diabetic patients (p<0.001), but concurrent CIS (p=0.1)
and squamous metaplasia did not significantly differ between diabetic and non-diabetic cases (p=1). Conclusions:
Diabetic patients with non-muscle-invasive bladder cancer may suffer metastases earlier than expected although
they are non invasive. Therefore such patients must be followed-up carefully and early cystectomy decision may
be necessary. Further prospective studies with more patients are needed to confirm these findings

Introduction Transurethral resection (TUR) is the most common surgical technique for the diagnosis and initial treatment of bladder cancer. In this study, we evaluated two surgical techniques in terms of bladder injury due to obturator reflex in patients that underwent TUR for non-muscle invasive bladder cancer (NMIBC). Material and methods 93 patients who underwent TUR for bladder cancer were analyzed. Fifty patients underwent monopolar resection and 43 patients underwent plasmakinetic resection. Standard TUR were performed with conventional Storz monopolar resection using a U-shaped cutting loop, 120V cutting/80 V coagulation settings, 5% mannitol fluid was used for irrigation. For bipolar resection, an Olympus ESG-400 plasmakinetic loop bipolar device using a U-shaped cutting loop, 160V cutting/80V coagulation settings and normal saline for irrigation was used. Results In the monopolar resection group; obturator reflex was seen in 4 (8%) patients. Bladder perforation caused by the obturator reflex was seen in 4 (8%) patients, but hemorrhage and other major complications were not seen in this group. In the bipolar resection group; obturator reflex was seen in 15 (34%) patients. Bladder perforation caused by the obturator reflex was seen in 10 (23%) patients. Conclusions Bipolar transurethral resection of bladder tumor was not superior to monopolar resection with respect to obturator reflex and bladder perforation. We conclude that we do not yet have enough experience concerning the long-term complications and major complications associated with bipolar resection of bladder cancer. Key Words: bladder injury ‹› obturator reflex ‹› plasmakinetic ‹› transurethral resection ‹› monopolar

Purpose: The aim of this study was to evaluate the relationship between tumor size and grade with visceral adipose index (VAI) levels in patients with renal cell carcinoma. Materials and methods: We retrospectively reviewed the records of 310 consecutive patients with RCC who underwent radical nephrectomy at our institution between Janu-ary 2007 and May 2014. VAI was calculates for males and females seperately as this formula like previous study. The relationship between tumor size and nuclear grade with VAI levels were evaluated statisticaly. Analyses were completed using Chi-square tests and Logistic regression analysis. Results: Among the 310 total patients analyzed in our study, there were 176 males (56.8%) and 134 females (43.2%). VAI levels were statistically higher in men and women with high tumor size (p<0.001). VAI levels were statistically higher in men and women with high fuhrman grade (p<0.001). Conclusions: The components of VAI may have effect on tumor carcinogenesis in similar pathways. In our study patients with high VAI levels were found to have statistically significant higher nuclear grade and tumor size. VAI can be a useful index for the evaluation and calculation of renal cell cancer aggressiviness. Further studies with more patients are needed to confirm our study.

Introduction: We investigated the prognostic significance of the neutrophil-to-lym-phocyte ratio on tumor stage and Fuhrman nuclear grade in renal cell carcinoma. Methods: The records of 432 patients with RCC who underwent radical or partial ne-phrectomy between 2005 and 2014 were retrospectively reviewed. Patients were classified as group lower tumor stage(T1 + T2) and higher(T3 + T4). As like tumor stage, Fuhrman nuclear grade were classified lower (G1+G2) and higher(G3+G4) too. The best NLR cut off value was 3.01.Two sample t-test or Mann–Whitney U-test used for the continuous variables and a chi-square test or Fisher's exact test used for the categorical variables. Results: Among the 432 total patients analyzed in our study, there were 275 males (63.7%) and 157 females (36.3%). Mean laboratory values were CRP 2.73 ± 1.93 mg/ dL (normal less than 0.3), neutrophil count 4,23 ± 1.46/μL, lymphocyte count 1,61 ± 0,61/μL and NLR 2.64 ± 1.24. According to our data, statistically pretreatment NLR significantly correlated with CRP (p<0.0001). And tumor patologic stage (p=0.08), tumor histologic grade (p<0.001) was significantly associated with NLR. Discussion: We compared the relationship of preoperative NLR and NC parameters with RCC tumor stage and grade. And NLR were found to have statistically significant higher T stage and grade at RCC. Further studies with more patients are needed to confirm our study.

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significance. Results: There was statistical significance between NLR and patients with severe IPSS score (>20) and over age 60 years (p = 0.02). Patients younger than 60 years had statistical significance between NLR and PSA <2.5 ng/dl (p = 0.004). When body mass index was selected, there was statistical significance between prostate volume <35 ml (p = 0.009) and age >60 years (p = 0.028). If 60 years of age was selected as cutoff value, there is statistical significance between age and severe IPSS, and in terms of mild erectile dys-function, PSA >2.5 ng/dl, and prostate volume >35 ml. Conclusion: We found positive correlation between NLR and severe symptoms and progression of BPH. In this manner, anti-inflammatory therapy could contribute to the medical treatment of BPH. Higher NLR may be a candidate marker for severity of symptoms in BPH patients.

Background: We investigated the correlation between standardized uptake value (SUVmax), tumor size and
Fuhrman grade in patients with renal cell carcinoma (RC).  Materials and Methods: We retrospectively analyzed
the data of 54 patients with clear cell renal cell carcinoma histopathologically diagnosed who underwent fuorine-18
fuoro-2 deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) between
January 2005 and March 2014.  Results: Avarage tumor sizes were 5.64±1.85, 6.85±2.24 and 7.98±2.45 in low,
medium and high SUVmax groups, respectively. The Spearman’s correlation coeffcient between the tumor size
and SUVmax was 0.385 (p=0.004) and between the Fuhrman grade and SUVmax was 0.578 (p<0.001). Conclusions:
SUVmax appears highly correlated with tumor size and Fuhrman grade in patients with histopathologically
confrmed clear cell RC. Multicenter studies are needed to provide larger series for more accurate results

Epidemiological investigations of burn patients help health services to identify the need for burn care and to plan burn care facilities. Various epidemiological studies on burn injury have been conducted, but they have usually covered major burn victims who required hospitalization or minor burn victims who were treated at health care centers. Few studies have included burn victims who were not admitted to any health care center. Through a population-based questionnaire, we studied the epidemiology of the entire population of burn victims, including those who did not seek medical attention. Thus, we identified the actual frequency of hospital admission and the frequency of se-quelae. In total, 1068 persons from the city of Denizli, Turkey were questioned about burns in the last 10 years and the burn prevalence was found to be 12.6%. Only 33.3% of the burn victims were treated at a health care center; thus, 66.7% of the victims were treated at home with traditional burn wound care methods. Etiologic factors such as the age and sex of each victim, the cause and anatomic location of the burn, and location of the victim when burned were all investigated. The overall percentage of sequelae was 31.3%; of these, 89.5% were cosmetic problems, 7.9% were functional impairments, and 2.9% were physiological problems. The low percentage of health care center admissions and high incidence of sequelae suggest the need for professional burn care centers that can be easily reached by burn victims. (J Burn Care Res 2008;29:446 – 450)

Bladder cancer is the second most common genitourinary malignancy with urothelial cancer comprising nearly 90% of primary bladder tumors. Urothelial carcinoma of the urinary bladder is the fifth most common malignancy in the United States, with an estimated 76,960 new cases and 163,900 deaths in 2016. Radical cystectomy with lymph node dissection remains the standard treatment for patients with muscle-invasive urothelial carcinoma of the bladder, and also for nonmuscle-invasive disease, refractory to intravesical therapy. The current approaches to pelvic lymph node dissections are based on the removal of lymph nodes most commonly harboring metastatic disease, notably the external iliac, obturator, and hypogastric lymph nodes. The boundaries for a standard pelvic lymph node dissection generally include the bifurcation of the common iliac vessels superiorly and the genitofemoral nerve laterally. Extended pelvic lymph node includes the removal of lymph nodes between the bifurcation of the common iliac vessels and the level of the aortic bifurcation, sometimes including distal aortic and caval nodes up to the level of the inferior mesenteric artery, as well as presacral nodes. Extended and superextended dissection has been reported to be associated with superior survival outcome.

Urethroplasty means plastic surgery of the  urethra. Herein we are going to describe
urethroplasty in terms of; diagnosis, indications, surgical techniques and definition of
failure or success. A lot of issues related to urethroplasty remain to be defined, therefore we
will clarify the debatable issues and highlight the last advances on urethroplasty. 
There are two main causes which mandate ur ethroplasty; the first is the congenital
anomalies with hypospadias being the most  common, and the acquired anomalies with
urethral stricture being the most common of them. Hypospadias is found commonly in
newborn boys and it seen in approximately 8.2 per 1000 births. The goal of hypospadias
reconstruction are to bring the meatus close to  glans to allow the child to void standing,
removing the chordee to allow for normal sexual intercourse and giving the phallus
appearance of a normally circumcised penis wh en observed from distance. There are more
than 200 named surgical procedure to correct  hypospadias. Now a days tubularized incised
plate (TIP) urethroplasty described by Snodgrass in 1994 is the most common procedure
used for repair of hypospadias. The advantages of this technique include its simplicity, high
success rate, low rate of complication and excellent cosmetic results. A lot of modifications
were introduced on the TIP urethroplasty aiming to improve the success rate and to
decrease fistula formation. We were from the firsts who published such modification
regarding the use of double- layer dartos flap  covering for urethra instead of the classic way
of utilizing dorsal dartos flap (button hole maneuver).
The second cause of urethroplasty is the acquired  anomalies. Strictures of urethra is of much
clinical important than hypospadias, because it  bothers the patients more, unfortunately the
results of surgery is not promising as that of hypospadias. The term “urethral stricture”
refer to anterior urethral disease or scaring pr ocess involving the spongy erectile tissue of
the corpus spongiosum (spongiofibrosis).  According to World Health Organization
posterior urethral stricture are not included in the common definition of urethral stricture and the term stricture is limited to the anterior urethra. Urethral disruption injuries typically
occur in conjunction with multisystem trauma from vehicular accident, falls, or industrial
accident. Because the posterior urethra is fixe d at both the urogenital diaphragm and the
puboprostatic ligaments, the bulbomembranous junction is more vulnerable to injury
during pelvic fractures. When the fracture occur the two separa ted ends fill with scar tissue,
resulting in a complete lack of urethral continuity. The location of urethral strictures was
classified as penile(including navicularis fossa) , bulbar or posterior (excluding bladder neck
contractures).While posterior urethral strictures were commonly caused by traumatic
disruption distinctly different from etiology compared to that of anterior strictures disease,
recurrence was monitored with the same procedure used for surveillance of anterior
urethral reconstruction. 
The Urethral disruption is heralded by the tria d of blood at the meatus, inability to urinate,
and palpably full bladder. When blood at the  urethral meatus is discovered, an immediate
retrograde urethrogram should be performed  to rule out urethral injury.When urethral
stricture is diagnosed immediate suprapubic tube placement remains the standard of care. 
While the diagnosis of hypospadias needs no radiologic tests, diagnosis of urethral stricture
is a matter of discussion. The most common primary diagnostic tests are uroflowmetry
(56%), urethrography (51%) and cystourethro scopy (21%). Definition of recurrence of
stricture or failure of surgery is also a questionable issue. In 75% of papers regarding
urethroplasty, recurrence was defined as the n eed for additional surgical procedure and in
52% as the need for additional urethral dilation.
The treatment of urethral strictures is divide d in two groups; endoscopic and open surgery.
The endoscopic treatment such as direct-visio n internal urethrotomy are the best reserved
for selected short urethral stricture. However wh en the defects are 1 cm or longer or when a
significant corpus spongiofibrosis is present , endoscopic procedure such as cutting through
the pelvic scare”cut-to-light” are ineffective.  Despite the popularity of this procedure the
failure rate after initial urethrotomy is reported to be at least 50%. The failure rate after the
second urethrotomy is considered much higher and can be as high as 100%. Therefore there
has been continuing discussion about the most  appropriate use of urethrotomy, dilation,
stenting, and intermittent self dilation. Question have also su rfaced about the best technique
for urethrotomy. There is no compelling evidence  in the literature that any particular form
of urethrotomy is more effective than anothe r, whether using a cold knife or laser. 
The second treatment option is open surgical reconstruction. There are two kinds of open
surgical techniques used for urethroplasty; anastomotic urethroplasty and substitution
urethroplasty. Anastomotic urethroplasty involves excision of the strictures and primary
anastomosis of urethral ends. Open posterior  urethroplasty through a perineal anastomotic
approach is the treatment of choice for the most urethral distraction injuries because it
definitely cure the patient without the need for multiple procedure. Care must be taken to
carefully and meticulously excise all fibrotic tissue from the proximal urethra margin until
at least a 28 french bougie passes without resistance. Free tension end to end anastomosis is
the procedure of choice when the scar is 1.5-2 cm long and this is highly successful
procedure in more than 95% of cases. Urethroplasty remains the gold standard for the
management of urethral stricture offering the lowest rate of stricture recurrence and in some
circumstance the most cost-effective compared to  repeat dilation or endoscopic incision. The
limiting factors with anastomotic urethroplasty is the strictures length, in particular the
length of component distal to bulbopenile ju nction. Anastomatic procedure in the bulbar urethra resulted in a significant impairment of erectile function initially which improved in
the majority of cases with a low of  long term erectile dysfunction. 
The second kind of urethroplasty is substitution urethroplasty. Recent advances in tissue
graft sources and the introduction of tissue sealants improve surgical outcomes and
minimize patients morbidity by decreasing the number of surgical procedures and the
potential disfigurement related to graft site morbidity. Substitution urethroplasty can be
performed as a one-stage procedure via an  augmented anastomotic procedure, patch
substitution (onlay procedure) or a circumfe rential patch, or two-stage procedure which
involves the formation of a roof strip followed be second stage tubularization. It has been
shown that the efficacy of both grafts and fl aps was identical , but there was a much higher
morbidity with penile skin flaps which were also more complex with higher morbidity. The
graft which has been used included scrotal skin, oral mucosa, extrag enital skin, bladder
mucosa, and colonic mucosa. The success rate at average follow-up of 53 months was
reported to be 60% for augmented anastomo tic repair and 80% for onlay procedure. 
In conclusion urethroplasty especially in patients with urethral stricture required the
urologist to be aware of the techniques which offer the patient the best success. Therefore
different considerations have to be taken in to account like length , location, anatomy and
etiology of stricture. In comparison to reconstruction of urethral stricture, urethroplasty
done due to hypospadias seems to be less complicated with high success rate at long term
follow-up.

Because of the variable techniques and patients' positions used in urological surgery, anesthesia for urologic surgery requires advanced knowledge and special transactions. In this matter, it is important to follow current approaches for anesthesiologists. Different surgical procedures and complications due to different positions or anesthesia were eval‐ uated separately to be more concise. We have researched recent literature and created this chapter about new technologies in urological surgery and development in anesthesia for urological surgery.