Factors affecting length of stay in Fournier's gangrene: a retrospective analysis of 10 years' data.

BACKGROUND: We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene. MATERIAL AND METHODS: A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated. RESULTS: Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ±â€Š2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality. CONCLUSION: Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.

Percutaneous versus transurethral cystolithotripsy.

PURPOSE: To compare transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL) modalities performed during simultaneous transurethral resection of the prostate (TURP) in patients with prostate hyperplasia and large bladder stones. PATIENTS AND METHODS: Sixty-three patients with prostate volume >40 cc and aggregate stone size >2.5 cm were enrolled in the study between August 2003 and February 2007. TUCL (n = 38) or PCCL (n = 25) procedures were performed during simultaneous TURP. In the TUCL group, the stones were removed after fragmentation through a 23F cystolithotripter with pneumatic lithotripsy. This was followed by TURP, performed with a 26F continuous-flow resectoscope. In the PCCL group, the stones were removed through a suprapubic 30F Amplatz sheath after fragmentation. TURP was then performed with the suprapubic sheath providing continuous drainage. RESULTS: Mean age and prostate volumes of the groups were similar. Mean aggregate stone sizes were significantly larger in the PCCL group. The operative time for stone removal was significantly less in the PCCL group while time needed for TURP was statistically similar in the two groups. In the TUCL group, three patients had residual stones necessitating repeated TUCL and urethral stricture developed in three patients. CONCLUSION: The smaller caliber of the working channel during TUCL, compared with PCCL, necessitates disintegration of the stones into smaller fragments. This elongates the duration of the intervention and results in increased urethral and bladder trauma. Combined TURP and PCCL is a safer, more effective, and much faster alternative to combined TURP and TUCL in patients with large bladder stones and prostate hyperplasia.

Do microdeletions in the AZF region of the Y chromosome accompany cryptorchidism in Turkish children?

OBJECTIVE: To investigate the presence of Y chromosome microdeletions in children with cryptorchidism. MATERIALS AND METHODS: Male patients aged between 1 and 17 years, who had been diagnosed by physical examination to have cryptorchid testes, were included in the study. Microdeletions of 24 gene loci belonging to the AZF-a, AZF-b and AZF-c regions of the Y chromosome were examined by multiplex polymerase chain reaction (PCR) multiplication of the DNA sample extracted from peripheral leukocytes. RESULTS: Sixty-four patients with a mean age of 7.82+/-3.21 (range: 1-17) years were included in the study. There was unilateral cryptorchidism in 53.1% (34/64) of the patients and bilateral cryptorchidism in 46.8% (30/48) of the patients. No microdeletion of gene loci on the AZF-a, AZF-b and AZF-c regions of the Y chromosome was determined in any patient. CONCLUSION: Studies on Y chromosome microdeletions are important due to a potential for the transmission of genetic abnormalities to offspring. Assisted reproduction techniques may cause the transmission of genetic abnormalities to offspring because the physiological fertilisation mechanism is bypassed. It was found that there was probably no aetiologic correlation between microdeletions in gene loci on the AZF-a, AZF-b and AZF-c regions of the Y chromosome and cryptorchidism.