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    Iatrogenic rectal injury during radical prostatectomy: Is colostomy inevitable end?
    (Derman Medical Publishing, 2016) Topaktaş, Ramazan; Erdem, Mehmet Remzi; Polat, Emre Can; Ersöz, Cevper; Önol, Şinasi Yavuz
    Aim: Radical prostatectomy (RP) is the gold standard treatment method for localized prostate cancer, because of its high oncological success. Iatrogenic rectal injury (IRI) during RP is rarely seen, but it may causes serious complications because of the close anatomic relationship between the prostate and rectum. Aim is to present our series about management of IRI without colostomy. Material and Method: Between June 1999 and June 2013, radical retropubic prostatectomy (RRP) was performed to 372 patients by a single surgeon. 10 cases (% 2,6) were complicated by a rectal injury during RRP. Instant rectal closure was performed in 3 layers without a diverting colostomy, at the time of surgery. Omental vascular flap was placed between rectum and vesicourethral anastomosis. Results: The clinical stages of IRI cases were T1c, T2a and T2c in 2, 3 and 5 patients, respectively. Their preoperative Gleason scores were 6, 7 and 8 in 3, 5 and 2 patient, respectively. None of the 10 had undergone previous prostatic or rectal surgery, or received preoperative radiotherapy or hormonal therapy. Discussion: Instant diagnosis and rectal wall closures by three layers are essential for successful repair. Our technique seems as a safe, minimal invasive and highly effective option for the management of IRI.
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    Our experience in chordee without hypospadias: Results of 102 cases
    (Urology and Nephrology Research Centre, 2014) Polat, Emre Can; Erdem, Mehmet Remzi; Topaktaş, Ramazan; Ersöz, Cevper; Önol, Şinasi Yavuz
    Purpose: We present long-term surgical experience of 102 chordee without hypospadias cases. Materials and Methods: This retrospective study included 102 chordee without hypospadias cases who were surgically treated between 1999 and 2012. Range of patients' age was from 1 month to 31 years. Seventy-two patients were adult, and 30 were children. Mean duration of follow up was 49.3 months. The patients were categorized into 4 groups including skin tethering (group 1), fibrotic dartos and Buck's fasciae (group 2), corporeal disproportion (group 3) and urethral tethering (group 4) with the aid of intraoperative artificial erection, according to the structural defect. Results: Forty patients (group 1) were successfully treated with penile degloving. Except 3 (10%) of 31 (group 2) cases, extensive resection of the fibrotic dartos and Buck's fascia was needed to straighten the penis. Corporeal disproportion was identified in 27 patients of whom 2 cases (7%) had complications. One of them developed urethrocutaneous fistula, and he was treated with buccal mucosal graft urethroplasty successfully. In other one, chordee persisted after two years, and we had to do Nesbit wedge resection after tunica albuginea plication to achieve penile straightening at the same session; otherwise we avoid tunica albuginea excision or incision. Overall 96 (94%) of 102 patients were successfully treated at first operation. Conclusion: We concluded that tunica albuginea plication is very effective for both prepubertal and postpubertal period and also in management of recurrence. We believe that, in experienced hands, early surgical correction can be done successfully in this condition.
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    The all-seeing needle instead of the veress needle in pediatric urologic laparoscopy
    (Mary Ann Liebert, Inc, 2013) Mesrur, Silay Selçuk; Tepeler, Abdulkadir; Sancaktutar, Ahmet Ali; Kılınçaslan, Hüseyin; Altay, Bülent; Erdem, Mehmet Remzi; Hatipoğlu, Namık Kemal; Akçay, Muzaffer; Akman, Tolga; Armağan, Abdullah
    Purpose: To investigate the feasibility of the all-seeing needle for safe entry and creation of pneumoperitoneum in pediatric urologic laparoscopy. Patients and Methods: A total of 14 children underwent various transperitoneal urologic laparoscopic procedures. The all-seeing needle, which is 4.85F in diameter, was used for safe entry into the abdominal cavity at the site of the umblicus in all cases. The microoptic was integrated with the light system and connected via a zoom ocular enabling direct visualization of the layers between the skin and the peritoneal cavity. Once the intraperitoneal access was obtained, CO2 pneumoperitoneum was created from one port of the three-way connector attached to the proximal part of the needle. Then the laparoscopic trocars were placed under vision of the microoptical system. Results: Mean age of the children was 4.52.9 years. In all children, the all-seeing needle was safely introduced into the abdominal cavity under direct vision. Then, CO2 pneumoperitoneum was succesfully performed. The mean time for optical puncture was calculated as 1.1 +/- 0.8 minutes. No complication was encountered during the introduction of the needle, creation of the pneumoperitoneum, and placement of the trocars. Conclusions: The all-seeing needle appears to be beneficial in safe entry and for creating pneumoperitoneum in laparoscopic pediatric urology cases. It eliminates the disadvantages of the Veress needle, which is blunt insertion, and may possibly prevent complications.