Intradetrusor Injections of Onabotulinum Toxin-A in Children With Urinary Incontinence due to Neurogenic Detrusor Overactivity Refractory to Antimuscarinic Treatment

Tufan Tarcan,Cem Akbal,Çağrı A. Şekerci,Tuncay Top,Ferruh Şimşek 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.4

Purpose: This was a prospective single-arm study to assess the efficacy and safety ofintradetrusor injections of onabotulinum toxin-A in children with urinary incontinenceassociated with neurogenic detrusor overactivity due to myelomeningocele. All patientshad failed the first-line treatment of a combination of oral antimuscarinics andintermittent catheterization. Materials and Methods: The study group consisted of 31 children with myelomeningocelewith a mean age of 7.95 years (range, 5–13 years) who were followed up for a meanof 29 weeks. The amount of onabotulinum toxin A injected was 10 U/kg with a maximaldose of 300 U. There were 20 to 30 injection sites with rigid cystoscopic guidance undergeneral anesthesia. Results: Thirty of 31 patients reported dryness between intermittent catheterizationintervals. The mean reduction in maximum detrusor pressure and the mean increasein maximum cystometric capacity from baseline were 53% and 51.5%, respectively, 6weeks after injection. We found a 324% increase in mean bladder compliance and a 57%increase in mean intermittent catheterization volumes. The mean duration of efficacywas 28 weeks with a single injection and 36 weeks for repeated injections (minimum,16 weeks; maximum, 52 weeks). The mean time interval between repeated onabotulinumtoxin-A injections was 7 months (maximum, 13 months). Intradetrusor injectionsof onabotulinum toxin-A were well tolerated. Conclusions: Onabotulinum toxin-A injections into the bladder wall provide a significantsymptomatic and urodynamic improvement in children with neurogenic detrusoroveractivity due to myelomeningocele who are on intermittent catheterization. The treatment seems to be safe and very well tolerated.

Comparison between Radiological and Invasive Diagnostic Modalities in Diagnosis of Breast Cancer

Onur, Gulcin Ozkan,Tarcan, Ercument,Onur, Asim,Can, Huseyin,Atahan, Murat Kemal,Yigit, Seyran Ceri,Cakalagaoglu, Fulya Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.10

Background: Breast cancer is the most common cause of deaths of cancer in women. Nowadays, following completion of imaging methods, mainly fine needle aspiration biopsy (FNAB) and core biopsy methods have been used for establishing cytopathological diagnosis although discussions regarding superiority continue. Materials and Methods: Those with a complaint of "mass in breast" along with those diagnosed to have a mass as a result of routine physical examination among all patients applying to our clinic between 01.01.2009 and 31.12.2011 were retrospectively assessed. Totals of 146 and 64 patients with complete radiological observation who had undergone FNAB and core biopsies, respectively, were evaluated. Postoperative pathological results of patients of both groups receiving surgery were also taken into consideration. All results were compared in terms of false positivity/negativity, sensitivity/specifity, surgery types and distribution of postoperative results with regard to diagnoses along with those of malignant/benign masses with regard to quadrants determined. Results: Diagnostic malignancy power of mammographic BIRADS classification was 87.3%. However, the value was 75% in the core biopsy group. Sensitivity and specifity following comparison of FNAB and postoperative pathology results of those receiving surgery were 85.4% and 92.9% while they were 93.5% and 100% in the core biopsy group. Diagnostic malignancy power, calculated by determining AUC in ROC analysis, of FNAB was 89.1% while that of core biopsy was 96.7%. Conclusions: It was shown that core biopsy is superior to FNAB in terms of sensitivity, specificity and accurate histopathological classification. However; quick, cheap and basic diagnosis by means of FNAB should not be ignored. Sensitivity of FNAB is rather high in experienced hands and furthermore it would be expected to be lower than with core biopsy.

Management of Complications After Tension-Free Midurethral Slings

Bülent Çetinel,Tufan Tarcan 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.10

Since their introduction in 1996, tension-free midurethral slings (MUS) have been proven to have long-term efficacy and safety. They are considered the gold standard treatment of female stress urinary incontinence, especially in cases that are associated with urethral hypermobility. However, they are not free of complications and, although rare, some of these complications can be challenging for both patients and physicians. Some complications occur intraoperatively, whereas others appear in the early or late postoperative period. There is less controversy in the diagnosis and treatment of complications such as vaginal extrusion or urinary system erosion, whereas de novo voiding problems are at best not completely understood. Voiding dysfunction after MUS placement may vary in a wide range from urinary frequency or urgency to retention and is usually attributed to the obstructive or irritative effect of the sling. However, present urodynamic criteria for the diagnosis of female infravesical obstruction are not satisfactory, and the best management policy for de novo voiding dysfunction remains controversial. In the majority of cases, the diagnosis of obstruction leading to a urethral release surgery depends on a combination of several clinical findings. The timing of urethral release surgery varies depending on the preferences of the surgeon, and the outcome of this surgery is not always predictable. The purpose of this review was to assess the diagnosis and management of the immediate, short-term, and long-term complications of MUS in light of the current literature in an attempt to determine the best management policy.

The Effect of Asymptomatic Urethral Caruncle on Micturition in Women with Urinary Incontinence

Cuneyd Ozkurkcugil,Levend Ozkan,Tufan Tarcan 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.4

Purpose: The aim of this study was to evaluate the effect of asymptomatic urethral caruncle (UC) on micturition in women suffering from urinary incontinence. Materials and Methods: A total of 232 patients participated in the study. UC was diagnosed in 50 of 232 patients with urinary incontinence during a physical examination in our clinic. All cases were divided into 2 groups: UC combined with urinary incontinence (group 1) and urinary incontinence only (group 2). Urodynamic evaluations were performed according to the International Continence Society standards. Results: Both groups were similar in terms of voiding diary, pad test and residual urine volume. Urodynamic studies revealed no significant difference between group 1 and 2 (infravesical obstruction: 6% vs. 4.4%; overactive detrusor: 44% vs. 42.9% respectively). The rates of severe IPSS (37.8% vs. 20.9%) and severe cystocele (20.9% vs. 13.8%) were numerically higher in group 1 with no statistically significant difference. Conclusions: Our results suggest that there is no effect of asymptomatic UC on lower urinary tract symptoms in women with urinary incontinence. Therefore, treating asymptomatic UC is unnecessary in these patients. However, during incontinence surgery, it is the surgeon’s decision whether to treat asymptomatic UC. Purpose: The aim of this study was to evaluate the effect of asymptomatic urethral caruncle (UC) on micturition in women suffering from urinary incontinence. Materials and Methods: A total of 232 patients participated in the study. UC was diagnosed in 50 of 232 patients with urinary incontinence during a physical examination in our clinic. All cases were divided into 2 groups: UC combined with urinary incontinence (group 1) and urinary incontinence only (group 2). Urodynamic evaluations were performed according to the International Continence Society standards. Results: Both groups were similar in terms of voiding diary, pad test and residual urine volume. Urodynamic studies revealed no significant difference between group 1 and 2 (infravesical obstruction: 6% vs. 4.4%; overactive detrusor: 44% vs. 42.9% respectively). The rates of severe IPSS (37.8% vs. 20.9%) and severe cystocele (20.9% vs. 13.8%) were numerically higher in group 1 with no statistically significant difference. Conclusions: Our results suggest that there is no effect of asymptomatic UC on lower urinary tract symptoms in women with urinary incontinence. Therefore, treating asymptomatic UC is unnecessary in these patients. However, during incontinence surgery, it is the surgeon’s decision whether to treat asymptomatic UC.

Risk factors for postoperative ileus

Aybala Agac Ay,Suat Kutun,Haluk Ulucanlar,Oguz Tarcan,Abdullah Demir,Abdullah Cetin 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.4

Purpose: This study aimed to examine extended postoperative ileus and its risk factors in patients who have undergone abdominal surgery, and discuss the techniques of prevention and management thereof the light of related risk factors connected with our study. Methods: This prospective study involved 103 patients who had undergone abdominal surgery. The effects of age, gender, diagnosis, surgical operation conducted, excessive small intestine manipulation, opioid analgesic usage time, and systemic inflammation on the time required for the restoration of intestinal motility were investigated. The parameters were investigated prospectively. Results: Regarding the factors that affected the restoration of gastrointestinal motility, resection operation type, longer operation period, longer opioid analgesics use period, longer nasogastric catheter use period, and the presence of systemic inflammation were shown to retard bowel motility for 3 days or more. Conclusion: Our study confirmed that unnecessary analgesics use in patients with pain tolerance with non-steroid anti-inflammatory drugs, excessive small bowel manipulation, prolonged nasogastric catheter use have a direct negative effect on gastrointestinal motility. Considering that an exact treatment for postoperative ileus has not yet been established, and in light of the risk factors mentioned above, we regard that prevention of postoperative ileus is the most effective way of coping with intestinal dysmotility.