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    Bowel preparation and peri-operative management for radical cystectomy in Turkey: Turkish Urooncology Association multicenter survey
    (2011) Aslan G.; Baltaci S.; Cal C.; Turkeri L.; Gunlusoy B.; Adsan O.; Sanli O.; Tansug Z.; Horasanli K.; Uygur C.; Ozen H.
    Purpose: To investigate the preferences and practice patterns of urooncologic surgeons in Turkey on bowel preparation and peri-operative management for radical cystectomy. Materials and Methods: This study was conducted by Turkish Urooncology Association as a multicenter survey. Participants were asked to fill in questionnaires dispensed at annual oncologic meeting or using internet access to the website of Urooncology Association. The questionnaire consisted of multiple choice or open-ended questions related to frequency of cystectomy, surgical technique and type of diversion, bowel preparation protocol, nasogastric tube applications, antibiotic prophylaxis, and deep vein thrombosis prophylaxis. Collected data from the survey were presented descriptively. Results: Forty-four questionnaires from 44 surgeons of different centers were evaluated. All participants answered that they always perform bowel preparation before cystectomy. Four participants reported that they had an experience of cystectomy without bowel preparation. Bowel preparation methods included long conservative methods, short enema protocols, and Golytely, but there were significant differences in application of each method. Of participants, 88.6% perform diversion by themselves whereas others ask help from a general surgeon. Antibiotic prophylaxis is preferred mostly by 2 agents using third-generation cephalosporins and metronidazole for a period of 5 days or more in the majority. Type, duration, and dosage of deep vein thrombosis prophylaxis differed among participants.Conclusion: There are significant individual differences in peri-operative management of radical cystectomy, which render deficient and sometimes inadequate patient care. There is a need to establish standard protocols for bowel preparation and adequate peri-operative management for radical cystectomy.
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    Factors affecting complication rates of ureteroscopic lithotripsy in children: Results of multi-institutional retrospective analysis by pediatric stone disease study group of Turkish pediatric urology society
    (2011) Dogan H.S.; Onal B.; Satar N.; Aygun C.; Piskin M.; Tanriverdi O.; Gurocak S.; Gunay L.M.; Burgu B.; Ozden E.; Nazli O.; Erdem E.; Yucel S.; Kefi A.; Demirci D.; Uluocak N.; Aridogan I.A.; Turunc T.; Yalcin V.; Kilinc M.; Horasanli K.; Tan M.O.; Soygur T.; Sarikaya S.; Kilicarslan H.; Turna B.; Doruk H.E.; Tekgul S.
    Purpose: We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. Materials and Methods: We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. Results: A total of 367 females and 265 males were studied. Mean ± SD patient age was 90.2 ± 51.4 months (range 4 to 204). Mean ± SD stone size, operative time and postoperative hospital stay were 8.9 ± 4.7 mm, 45.8 ± 23.8 minutes and 1.8 ± 2.8 days, respectively. At a mean ± SD followup of 13.3 ± 17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. Conclusions: Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality. © 2011 American Urological Association Education and Research, Inc.