A serious circumcision complication: penile shaft amputation and a new reattachment technique with a successful outcome.
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Amputation, Traumatic↗
Biomedical subjects
T Gürpinar
Publications and source records attributed to T Gürpinar.
The prosthetic bladder.
Bladder reconstruction may be required in a variety of pathological conditions, including bladder cancer, irradiation cystitis, interstitial cystitis, tuberculosis, and various congenital anomalies. Currently, bladder reconstruction is done with an autogenous bowel segment. Use of a total prosthetic bladder as an intracorporeal urinary reservoir has been an elusive goal for many decades. Many investigational and a few clinical trials have been performed in an attempt to develop a near-normal bladder prosthesis utilizing alloplastic materials. To date the ideal prosthetic bladder has not been developed. However, cumulative experimental studies suggest that many, perhaps all, of the ideal functional characteristics of a total prosthetic bladder are possible. Basically, two different alloplastic models have been investigated.
Bioprosthesis↗
The role of digital rectal examination, biopsy Gleason sum and prostate-specific antigen in selecting patients who require pelvic lymph node dissections for prostate cancer.
OBJECTIVE: To examine the usefulness of clinical stage, tumour differentiation and prostate-specific antigen (PSA) level, alone and in combination, to predict regional nodal metastases in individual patients with localized prostate cancer. PATIENTS AND METHODS: The usefulness of digital rectal examination (DRE), biopsy Gleason sum and PSA, alone and in combination, to predict nodal metastases in an individual patient was examined. The study included 689 patients who had laparoscopic or open pelvic lymph node dissection for clinical stage T1-3 prostate cancer. The Kruskal-Wallis test, Mantel-Haenszel test, chi-squared test and logistic regression were used for continuous, ordinal, categorical, and multivariate analysis, respectively. RESULTS: Of the 689 patients who underwent radical prostatectomy, 52 (8%) had nodal metastases. Although clinical stage, DRE, pre-operative PSA level and biopsy Gleason sum were significantly related in the univariate analysis, only pre-operative PSA level and biopsy Gleason sum were significant predictors of lymph node status in a multivariate analysis. However, based on a receiver operating characteristic curve, a model with satisfactory sensitivity and specificity could not be obtained. CONCLUSION: Current estimations of primary prostate cancer biology using pre-operative PSA level, clinical stage and biopsy Gleason sum are not sufficiently sensitive to predict nodal metastases, and pelvic lymphadenectomy remains the definitive method of detection.
Adult↗
Electromotive administration of intravesical lidocaine in patients with interstitial cystitis.
Six patients with long-standing interstitial cystitis (IC) were treated with intravesical electromotive drug-assisted (EMDA) therapy using lidocaine (1.5%) and 1:100,000 epinephrine in aqueous solution. A stainless-steel silver-coated anode placed through an 18F Foley catheter was positioned in the urinary bladder, and a 5 x 10-cm dispersion electrode (cathode) was placed on the suprapubic skin, which was well lubricated with conductive jelly. The two electrodes were connected to a pulsed DC generator, and electrical current was slowly ramped from 0 to 15 mA while the lidocaine and epinephrine were in the urinary bladder. After 40 minutes of current application, the bladder was hydraulically dilated to maximum tolerance. Significant bladder dilatation was achieved without systemic symptoms. Post-treatment, voiding symptoms decreased, as did suprapubic and perineal pain, and in four patients, the results have been durable.
Administration, Intravesical↗
Electromotive drug administration to the urinary bladder: an animal model and preliminary results.
PURPOSE: Electromotive drug delivery (EMDA) is the use of an electrical field to enhance penetration of ionized drugs into local tissues. Intraurinary EMDA may be of value in the treatment of various pathological conditions involving the urinary bladder, prostate gland and urethra. We have developed an animal model to study this hypothesis. MATERIALS AND METHODS: Anesthetized adult mongrel dogs were studied. An intravesical anode was inserted through a Foley catheter into the urinary bladder. Two patch electrodes were positioned on the animals' abdominal skin. Both skin and intravesical electrodes were attached to a direct current generator. The bladder was then distended with an anionic blue dye (methylene blue). Fifteen milliamperes (15 mA) pulsed direct current was applied for 40 minutes. After EMDA, the bladder was surgically removed and representative sections of full thickness bladder wall were immediately frozen in liquid nitrogen. Methylene blue was used to visually demonstrate EMDA-enhanced anion penetration into bladder submucosa and muscularis. RESULT: This experimental model demonstrates significant submucosal and muscularis methylene blue penetration in the presence of the electric field. CONCLUSION: Electromotive drug delivery technology may have applications for treating bladder pathology.
Administration, Intravesical↗
Laser-welded ureteral anastomoses: experimental studies with three techniques.
Tissue welding with laser energy is a new technique for reconstructive surgery. The potential advantages of laser welding are (a) lack of foreign body reaction, (b) decreased operative time, (c) less tissue manipulation, and (d) effective union of tissues equivalent to sutured anastomoses. We have performed ureteral anastomoses in adult mongrel dogs using a KTP 532 nm laser at an intensity of 1.4 W. Multiple "spot welds" of 1-s duration were utilized in a single layer anastomosis. Laser-welded anastomoses were performed with and without protein solder (33% and 50% human albumin) and were compared to sutured anastomoses. The laser-welded anastomoses required less operative time and provided bursting pressure levels similar to those of traditional sutured anastomoses. There was no advantage or disadvantage to the addition of human albumin as a solder in these experimental studies.
Anastomosis, Surgical↗
Retroperitoneoscopic bilateral spermatic vein ligation.
An alternative method for bilateral spermatic vein ligation is presented. With a retroperitoneoscopic approach, the vascular structures are clearly identified, and damage to the intraperitoneal organs, spermatic arteries and lymphatics is minimized. We believe that the potential complications of transperitoneal laparoscopic techniques may be decreased with a retroperitoneoscopic approach.
Adult↗
In situ prone ESWL for the treatment of lower ureteral stones: experience with 28 patients.
Twenty-eight patients with lower ureteral stones underwent in situ extracorporeal shock wave lithotripsy (ESWL) in the prone position over the period of 7 months between March 1990 and September 1990. For stone disintegration the spark gap shock wave lithotripter Tripter XI (Direx) was used. Satisfactory disintegration was achieved in 93 per cent of patients. The stone-free rate at 12 weeks was 82 per cent, and 11 per cent had residual fragments less than or equal to 4 mm in diameter. Twenty-one per cent of patients required repeat treatments. For only 2 patients general anaesthesia was required (7 per cent). There were no remarkable complications except for haemospermia which resolved spontaneously 15 days after treatment. It was concluded that in situ prone ESWL is an effective and safe procedure for the treatment of lower ureteral stones.
Adult↗
In situ extracorporeal shock wave lithotripsy for upper ureteral stones: experience with 65 patients.
A total of 65 patients with 67 upper ureteral stones underwent in situ extracorporeal shock wave lithotripsy (ESWL) between March 1990 and September 1990. For stone disintegration the electrohydraulic shock wave lithotripter Tripter XI (Direx) was used. Eighty-seven per cent of stones showed satisfactory disintegration after the first treatment and a further 9 per cent after repeat treatments. The stone-free rate at 12 weeks was 85 per cent. General anaesthesia was needed in only 12 per cent of patients. The retreatment rate was 13 per cent. It was concluded that in situ ESWL is an effective procedure with negligible morbidity for treating upper ureteral stones.
Adult↗