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    Does the metabolic syndrome or its components affect the outcome of percutaneous nephrolithotomy?
    (Mary Ann Liebert Inc., 2008) Tefekli, Ahmet; Kurtoğlu, Hilal; Tepeler, Kadir; Karadağ, Mert Ali; Kandıralı, Engin; Sarı, Erhan; Baykal, Murat
    Purpose: Metabolic syndrome is a cluster of cardiovascular disease risk factors. We assessed the impact of these medical disorders on the outcome of percutaneous nephrolithotomy (PCNL). Patients and Methods: Data from 430 consecutive PCNL procedures were retrospectively reviewed. The presence of serum lipid abnormalities (SLA), hypertension (HT), diabetes (DM), and obesity was investigated. Patients were determined to have the metabolic syndrome according to the definition of the International Diabetes Federation. Success rate, need for auxiliary procedures, and major complication rates of PCNL were analyzed separately for patients with or without DM, SLA, HT, obesity, and the metabolic syndrome, and were compared. Results: SLA, HT, and DM were observed in 123 (28.6%), 108 (25.1%), and 44 (10.2%) patients, respectively. Body mass index was > 30 kg/m(2) in 74 (17.2%) patients. Metabolic syndrome was diagnosed in 41 (9.5%) patients. An overall success rate of 96.3% for PCNL was achieved. Success rates were not significantly (P > 0.05) influenced by the presence of SLA, HT, DM, obesity, or the metabolic syndrome. Major complications were encountered in 49 (11.4%) patients and were 2.5 to 2.7 times more common in patients with DM, HT, and the metabolic syndrome. In patients with DM, auxiliary treatment alternatives were necessary in 20.5%, while they were indicated in 10.9% of patients without DM (P = 0.046). Presence of the metabolic syndrome was also associated with an increased necessity for auxiliary treatments after PCNL (P = 0.048). Conclusions: Our results indicate that the metabolic syndrome and its components (DM and HT) significantly augment auxiliary treatment and complication rates after PCNL.
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    Peyronie's disease: a silent consequence of diabetes mellitus
    (Wolters Kluwer Medknow Publications, 2006) Tefekli, Ahmet; Kandıralı, Engin; Erol, Bülent; Tunç, Murat; Kadıoğlu, Ateş
    Aim: To investigate the clinical characteristics of patients with Peyronie's disease (PD) and diabetes mellitus (DM). Methods: During an 8-year period, a total of 307 men seen at our outpatient clinic were diagnosed with PD. Clinical characteristics, penile deformities and the erectile status of patients with PD and DM together (n = 102) were retrospectively analyzed and compared to patients with PD alone with no risk factors for systemic vascular diseases (n = 97). Results: The prevalence of PD among men with DM and sexual dysfunction was 10.7%. The mean age of diabetic patients with PD was (55.9 +/- 8.9) years; in the no risk factor group it was (48.5 +/- 9.0) years (P < 0.05). The median duration of DM was 5 years. The majority of diabetic patients with PD (56.0%) presented in the chronic phase (P < 0.05), and they were more likely to have a severe penile deformity (> 60 degrees) than the no risk factor group (P < 0.05). In the diabetic group, the most common presenting symptom was penile curvature (81.4%), followed by a palpable nodule on the shaft of the penis (22.5%) and penile pain with erection (14.7%). A total of 19.6% of patients were not aware of their penile deformities in the diabetic group. Erectile function, provided by history and in response to intracavernosal injection and a stimulation test, was significantly diminished in patients with PD and DM (P < 0.05). Conclusion: DM probably exaggerates the fibrotic process in PD. Diabetic patients with PD have a higher risk of severe deformity and erectile dysfunction (ED). PD seems to be a silent consequence of DM and should be actively sought in diabetic men.
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    Vaginal evisceration: A rare complication following radical cystectomy in female
    (2004) Kandıralı, Engin; Tefekli, Ahmet; Özcan, Faruk
    Large series on radical cystectomy in female are being reported with increasing frequency, but vaginal evisceration does not attract attention as a significant long-term complication. We herein present a case with vaginal evisceration and protrusion of intestinal loops per introitus, 8 months following radical cystectomy.