JPMA. The Journal of the Pakistan Medical Association, 2015
To assess the success rates of endoscopic management of upper ureteral stones using semirigid ure... more To assess the success rates of endoscopic management of upper ureteral stones using semirigid ureterorenoscopy and holmium: YAG laser lithotripters. A total of 74 patients with an established diagnosis of upper ureteric stone and scheduled for endoscopic ureteral stone treatment were retrospectively evaluated. Failure was defined as the inability to contact or fragment the stone, migration of the stone into the renal pelvis and difficulty in visualizing the stone for the second time. Success rates and influencing factors as for stone-free state were investigated. Mean age of our patients was 45.99±15.00 (range: 24-82) years. In 14 of 74 patients procedural failure was observed. Double J stents were implanted in 65 % of the patients and ureteral catheterization was performed on 20% of them. The total success rate was 81.1 %. Major complication rate was 1.1 percent. Factors effecting the success rate as gender, age, body mass index, grade of hydronephrosis and stone size were evaluate...
International braz j urol : official journal of the Brazilian Society of Urology
The place of oncological cases of upper urinary system in the laparoscopic learning curve was inv... more The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated. A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study. Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were o...
Functional adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Over half... more Functional adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Over half (60%) of ACCs bigger than 6 cm synthesize hormones; hormone-secreting ACCs generally include virilization, feminization or Cushing syndrome. Besides, 82% of ACCs are metastatic at the time of diagnosis. While a 48-year-old female patient was examined for abdominal pain and flushing, we detected a non-metastasizing mass (23 × 18 × 16 cm) in the adrenal lodge. The mass was extracted en bloc during open exploration and its histopathology was reported as ACC. We review the literature and report the largest androgen-producing, clinically silent ACC mass cited in the literature so far.
Objective: Main treatment modalities for renal stones are extracorporeal shock wave lithotripsy (... more Objective: Main treatment modalities for renal stones are extracorporeal shock wave lithotripsy (SWL), percutane- ous nephrolithotomy (PNL), open surgery, or combination of PNL and SWL. In this retrospective study, we evaluat- ed the success and complication rates of PNL in patients with renal calculi. Özet
Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We ... more Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We discuss clinical details and treatment strategies of 8 patients with EPN followed at our clinic. We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 8 patients with EPN followed at our urology clinic between 2012 and 2015. The mean patient age (female: 5; male: 3) was 62 (range: 51-82) years. Based on computed tomographic findings, EPN was classified as class 1 (n = 3), class 2 (n = 3) and class 3a (n = 2). All patients had fever, flank pain, nausea, and vomiting. Five patients had type 2 diabetes mellitus and 3 diabetic patients also had renal stones. Escherichia coli (n = 6), Klebsiella species (n = 1), and Proteus species (n = 1) were grown in urine cultures. All patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 2 patients underwent a nephrostomy catheter placement and another 2 patients underwent nephrectomy upon deterioration of her general health state. After achieving clinical stabilization with medical treatment, 1 patient underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotherapy. All patients were discharged with clinical cure. Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotherapy, and drainage.
Cystitis glandularis is a proliferative disease of the urinary bladder epithelium. It is rare in ... more Cystitis glandularis is a proliferative disease of the urinary bladder epithelium. It is rare in children. We report a case of a 23-year-old female with intractable macroscopic hematuria and severe irritative bladder symptoms persisting for 13 years. The patient, who had undergone open and endoscopic bladder surgery at various medical centres, is currently being followed up at our clinic. Cystoscopy revealed multiple edematous papillary tumours on the bladder neck, trigone, and lateral wall on both sides and she underwent transurethral resection of the bladder tumour. The pathological diagnosis was cystitis glandularis in accordance with the histopathological reports obtained from the other medical centres. Her condition was resistant to transurethral resection, partial cystectomy, intravesical mitomycin, and bacillus Calmette-Guerin (BCG) treatment; it eventually could have affected the upper urinary tract. Oral steroid treatment was given for 6 months; after treatment, her symptoms improved and the cystoscopy revealed a dramatic improvement in her condition.
Epispadias surgery has mainly two components: bladder and genitourethral reconstruction. Herein, ... more Epispadias surgery has mainly two components: bladder and genitourethral reconstruction. Herein, a novel vulvoplasty method, an alternative for the latter component, carried out in a rare case of female epispadias was presented. In a 6-year-old girl admitted with complaint of total incontinence, epispadias without evident extrophy associated with adequate bladder capacity was determined. Firstly the vulvoplasty in which a circumferencial skin flap around the urethral meatus was rolled backwards, and secondly bladder neck reconstruction was performed. The vulvoplasty resulted in sufficient cosmetic outcome and continence up to half an hour, and after cervicoplasty total day and night continence at rest or on exertion were obtained. It was concluded that this vulvoplasty with sufficient cosmetic outcome could be considered as a first stage operation in female epispadias, because it could facilitate bladder neck reconstruction by increasing urethral resistance, and contribute to contin...
To investigate the oxidative and antioxidative status of urine and serum of patients with urinary... more To investigate the oxidative and antioxidative status of urine and serum of patients with urinary tract infection (UTI) and to compare them with those of controls. The antioxidative status of urine and serum were evaluated by measuring total antioxidant capacity (TAC) and plasma vitamin C concentration. The oxidative status of the samples was assessed by measuring the total peroxide and the oxidative stress index (OSI) levels. The means of the parameters were compared and the relationships among them were determined. Total peroxide and OSI levels were found to be lower and TAC was found to be higher in the urine of patients with UTI. On the contrary, while the plasma vitamin C concentration and TAC of serum was lower, the total peroxide and OSI levels were higher in patients than controls. There was a negative correlation between serum TAC and urine TAC values. There was also a positive correlation between plasma vitamin C concentration and serum TAC levels. The urine of the patients with UTI have higher TAC and lower total peroxide and OSI levels. However, lower TAC and plasma vitamin C concentration and higher total peroxide and OSI levels were observed in UTI. This condition may be a factor which facilitates the development of the infection or is secondary to UTI.
To examine whether a beneficial effect of N-acetylcysteine (NAC) on semen parameters and oxidativ... more To examine whether a beneficial effect of N-acetylcysteine (NAC) on semen parameters and oxidative/antioxidant status in idiopathic male infertility exists. The production of reactive oxygen species is a normal physiologic event in various organs. However, overproduction of reactive oxygen species can be detrimental to sperm and has been associated with male infertility. Our study included 120 patients who had attended our clinic and were diagnosed with idiopathic infertility according to medical history and physical and seminal examination findings, as initial evaluations. The patients were divided randomly into 2 groups. Those in the study group (60 men) were given NAC (600 mg/d orally) for 3 months; the control group (60 men) received a placebo. The oxidative status was determined by measuring the total antioxidant capacity, total peroxide and oxidative stress index in plasma samples. The sperm parameters were evaluated after NAC treatment and were compared with those in the control group. NAC had significant improving effects on the volume, motility, and viscosity of semen. After NAC treatment, the serum total antioxidant capacity was greater and the total peroxide and oxidative stress index were lower in the NAC-treated group compared with the control group. These beneficial effects resulted from reduced reactive oxygen species in the serum and reduced viscosity of the semen. No significant differences were found in the number or morphology of the sperm between the 2 groups. We believe that NAC could improve some semen parameters and the oxidative/antioxidant status in patients with male infertility.
Millions of male children are circumcised throughout the world. We investigated the opinions and ... more Millions of male children are circumcised throughout the world. We investigated the opinions and thoughts about the past and future aspects of circumcision by interviewing 100 male family members of the health care staff. 100 male volunteers answered a questionnaire comprising questions about their personal observations, feelings, festivities and opinions about their own circumcisions as well as their views about the circumcision phenomenon as a parent, and the legality of circumcision. 81% of the volunteers in our study had been circumcised by traditional circumcisers. The rest had been circumcised by doctors (10%), barbers (7%) and sheikhs (2%). In 90% the circumcision took place at home, 7% in hospitals and in 3% in village squares. While 66% of the subjects do not remember anything, the remaining 33% reported some bad sensations like fear, pain and shame about their circumcisions, and 1 (1%) subject reported happiness. As a parent, they answered the questions on their preferences on the place and performer of the circumcision. 44% preferred to have circumcision performed in the hospital by a physician, 26% at home by a physician, and 30% at home by a circumciser. There are significant changes in the attitudes of people in Turkey on circumcision as a traditional culture, though its perception has remained unchanged.
Purpose Sildenafil is a new and effective oral medication for the treatment of erectile dysfunct... more Purpose Sildenafil is a new and effective oral medication for the treatment of erectile dysfunction. The purpose of this study was to assess the long-term effects of sildenafil on visual acuity, color vision, intraocular pressure (IOP), electroretinography (ERG), blue-on-yellow and white-on-white Humphrey visual field (HVF), and tear functions. Methods Ten impotent patients ingested 50 mg of sildenafil one or more times a
To investigate the efficiency and safety of Foley catheter intraballoon illumination in determini... more To investigate the efficiency and safety of Foley catheter intraballoon illumination in determining the urethrovesical junction (UVJ) in retropubic colposuspension. Our accessory set for UVJ determination is composed of a 24-french Foley catheter and a 5-mm 0 degrees telescope. The telescope is inserted into the catheter from the urinary luminal side until the tip has reached the level of the catheter balloon. After dissection of the bladder, urethra, and paraurethral tissues to reveal the submucosal endopelvic fascia, the accessory set is inserted into the bladder and the balloon is inflated with 5 ml air and illuminated by a switch on the cold light source. To determine the right side of UVJ, the catheter is pulled slightly downward and to the right of the patient. The contralateral side of the UVJ is determined by pulling the catheter slightly downward and to the left of the patient. Intraballoon illumination of the Foley catheter helps to ensure accurate placement of paraurethral sutures at UVJ. Intraballoon illumination for determination of UVJ is simple, safe, effective and precludes an invasive approach such as cystoscopy and cystotomy.
To investigate the effectiveness of a new tension-adjustment technique for postoperative voiding ... more To investigate the effectiveness of a new tension-adjustment technique for postoperative voiding difficulties encountered after sling operations. To test our new method, urethral obstruction was developed in 5 female dogs by modifying the sling operation by exerting more tension on a specially prepared polypropylene strip in which a gap had been developed. After filling the bladder with isotonic solution, detrusor contractions were induced by pelvic nerve stimulations, and urodynamic studies were performed to document the urethral obstruction. In each case Foley catheters were inserted into the bladder and left in place until the time of tension adjustment. Tension adjustment was performed in the 1st, 2nd, 3rd, 4th and 5th weeks postoperatively for dogs 1, 2, 3, 4, and 5, respectively. On the day of tension adjustment, after filling the bladder with isotonic solution and removing the Foley catheter, none of the dogs, except dog 3, was able to produce a free flow of urine either spontaneously or provoked by detrusor contractions. The release of the prolene sutures was readily achieved in all cases except dog 5. In this case, sling takedown was achieved after surgical exploration in which the sling location was confirmed by following the prolene sutures and Hegar's dilator. After identifying the sling, the gap was opened by cutting the prolene sutures, instead of a sling incision. Release of the prolene sutures resulted in a distinct drop in the urethra with decreased resistance of Hegar's dilator. The improvement in voiding was confirmed by postoperative urodynamic studies and was immediate in all cases. Our new technique for postoperative voiding difficulties encountered after sling operation is simple, effective and avoids re-operation in the early postoperative period.
To investigate whether ordinary tests used in urolithiasis can increase the diagnostic value of u... more To investigate whether ordinary tests used in urolithiasis can increase the diagnostic value of unenhanced helical computed tomography (HCT). Of all patients admitted with acute flank pain, 137 without radiocontrast allergy, pregnancy and renal insufficiency were included in the study. After urinalysis (Ur) and ultrasonography (USG), HCT without a contrast agent was taken by 5-mm collimation, thereafter excretory urography (EU) was obtained. Confirmation of a stone was done by various tests and/or treatment methods. Statistically, the predictive values of HCT, USG, EU and Ur and their combinations were evaluated using the area under the receiver operating characteristic curve (AROC). The patients' mean age was 38 (range 4-72) years. Sensitivity values of HCT, USG, EU and Ur were 97, 69, 71 and 81%, respectively. Their specificity values were 96, 87, 91 and 65%, respectively. The widest AROC was found for HCT (97%). The best test combination was [HCT or USG] according to the AROC value (93%), but none of the AROC values of the test combinations was higher than that of HCT. However, 95% confidence intervals of the AROC values of these tests and their combinations overlapped. Because the HCT combinations with other tests improved the diagnostic value of HCT, they should be preferred in some individuals suspected of having urolithiasis. However, the most feasible single test meeting the all usage purposes was HCT in terms of the AROC value, and the combination was [HCT or USG] in which either HCT or USG was positive.
To evaluate the effectiveness and complications of the combination of minimal transurethral resec... more To evaluate the effectiveness and complications of the combination of minimal transurethral resection of the prostate and bladder neck incision in comparison with those of the standard transurethral resection of the prostate (TURP). Forty patients with prostates of <or=25 ml were randomized to two equal groups (20 cases in each). In group I minimal transurethral resection of the prostate followed by bladder neck incision at the 6 o'clock position and in group II standard TURP were performed. Patients were evaluated in terms of the change in symptom severity, maximal flow rate and sexual function in addition to operating time, length of hospital stay, problems of catheter positioning at the end of the operation and the rate of bladder neck contracture using chi(2) and independent t tests. Age, prostate volume postoperative follow-up time, improvement in international prostate symptom score and maximal flow rate, length of hospital stay and erectile dysfunction rates were not statistically different between the 2 groups. Operation time was shorter in group I (p = 0.001). Although the urethral catheter was easily positioned at the end of the operation in group I, it was not possible in group II for 4 patients (p = 0.053). Postoperative retrograde ejaculation for groups I and II were determined in 7 and 16 patients, respectively (p = 0.005). Bladder neck contracture was not found in group I, while it was seen in 2 patients in group II (p = 0.487). The combination of minimal transurethral resection and bladder neck incision in patients with small prostates appears to provide a satisfactory clinical outcome, comparable with standard TURP, while preventing the difficulty of urethral catheter positioning at the end of the operation, decreasing bladder neck contracture and lowering the incidence of retrograde ejaculation.
JPMA. The Journal of the Pakistan Medical Association, 2015
To assess the success rates of endoscopic management of upper ureteral stones using semirigid ure... more To assess the success rates of endoscopic management of upper ureteral stones using semirigid ureterorenoscopy and holmium: YAG laser lithotripters. A total of 74 patients with an established diagnosis of upper ureteric stone and scheduled for endoscopic ureteral stone treatment were retrospectively evaluated. Failure was defined as the inability to contact or fragment the stone, migration of the stone into the renal pelvis and difficulty in visualizing the stone for the second time. Success rates and influencing factors as for stone-free state were investigated. Mean age of our patients was 45.99±15.00 (range: 24-82) years. In 14 of 74 patients procedural failure was observed. Double J stents were implanted in 65 % of the patients and ureteral catheterization was performed on 20% of them. The total success rate was 81.1 %. Major complication rate was 1.1 percent. Factors effecting the success rate as gender, age, body mass index, grade of hydronephrosis and stone size were evaluate...
International braz j urol : official journal of the Brazilian Society of Urology
The place of oncological cases of upper urinary system in the laparoscopic learning curve was inv... more The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated. A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study. Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were o...
Functional adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Over half... more Functional adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Over half (60%) of ACCs bigger than 6 cm synthesize hormones; hormone-secreting ACCs generally include virilization, feminization or Cushing syndrome. Besides, 82% of ACCs are metastatic at the time of diagnosis. While a 48-year-old female patient was examined for abdominal pain and flushing, we detected a non-metastasizing mass (23 × 18 × 16 cm) in the adrenal lodge. The mass was extracted en bloc during open exploration and its histopathology was reported as ACC. We review the literature and report the largest androgen-producing, clinically silent ACC mass cited in the literature so far.
Objective: Main treatment modalities for renal stones are extracorporeal shock wave lithotripsy (... more Objective: Main treatment modalities for renal stones are extracorporeal shock wave lithotripsy (SWL), percutane- ous nephrolithotomy (PNL), open surgery, or combination of PNL and SWL. In this retrospective study, we evaluat- ed the success and complication rates of PNL in patients with renal calculi. Özet
Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We ... more Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We discuss clinical details and treatment strategies of 8 patients with EPN followed at our clinic. We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 8 patients with EPN followed at our urology clinic between 2012 and 2015. The mean patient age (female: 5; male: 3) was 62 (range: 51-82) years. Based on computed tomographic findings, EPN was classified as class 1 (n = 3), class 2 (n = 3) and class 3a (n = 2). All patients had fever, flank pain, nausea, and vomiting. Five patients had type 2 diabetes mellitus and 3 diabetic patients also had renal stones. Escherichia coli (n = 6), Klebsiella species (n = 1), and Proteus species (n = 1) were grown in urine cultures. All patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 2 patients underwent a nephrostomy catheter placement and another 2 patients underwent nephrectomy upon deterioration of her general health state. After achieving clinical stabilization with medical treatment, 1 patient underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotherapy. All patients were discharged with clinical cure. Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotherapy, and drainage.
Cystitis glandularis is a proliferative disease of the urinary bladder epithelium. It is rare in ... more Cystitis glandularis is a proliferative disease of the urinary bladder epithelium. It is rare in children. We report a case of a 23-year-old female with intractable macroscopic hematuria and severe irritative bladder symptoms persisting for 13 years. The patient, who had undergone open and endoscopic bladder surgery at various medical centres, is currently being followed up at our clinic. Cystoscopy revealed multiple edematous papillary tumours on the bladder neck, trigone, and lateral wall on both sides and she underwent transurethral resection of the bladder tumour. The pathological diagnosis was cystitis glandularis in accordance with the histopathological reports obtained from the other medical centres. Her condition was resistant to transurethral resection, partial cystectomy, intravesical mitomycin, and bacillus Calmette-Guerin (BCG) treatment; it eventually could have affected the upper urinary tract. Oral steroid treatment was given for 6 months; after treatment, her symptoms improved and the cystoscopy revealed a dramatic improvement in her condition.
Epispadias surgery has mainly two components: bladder and genitourethral reconstruction. Herein, ... more Epispadias surgery has mainly two components: bladder and genitourethral reconstruction. Herein, a novel vulvoplasty method, an alternative for the latter component, carried out in a rare case of female epispadias was presented. In a 6-year-old girl admitted with complaint of total incontinence, epispadias without evident extrophy associated with adequate bladder capacity was determined. Firstly the vulvoplasty in which a circumferencial skin flap around the urethral meatus was rolled backwards, and secondly bladder neck reconstruction was performed. The vulvoplasty resulted in sufficient cosmetic outcome and continence up to half an hour, and after cervicoplasty total day and night continence at rest or on exertion were obtained. It was concluded that this vulvoplasty with sufficient cosmetic outcome could be considered as a first stage operation in female epispadias, because it could facilitate bladder neck reconstruction by increasing urethral resistance, and contribute to contin...
To investigate the oxidative and antioxidative status of urine and serum of patients with urinary... more To investigate the oxidative and antioxidative status of urine and serum of patients with urinary tract infection (UTI) and to compare them with those of controls. The antioxidative status of urine and serum were evaluated by measuring total antioxidant capacity (TAC) and plasma vitamin C concentration. The oxidative status of the samples was assessed by measuring the total peroxide and the oxidative stress index (OSI) levels. The means of the parameters were compared and the relationships among them were determined. Total peroxide and OSI levels were found to be lower and TAC was found to be higher in the urine of patients with UTI. On the contrary, while the plasma vitamin C concentration and TAC of serum was lower, the total peroxide and OSI levels were higher in patients than controls. There was a negative correlation between serum TAC and urine TAC values. There was also a positive correlation between plasma vitamin C concentration and serum TAC levels. The urine of the patients with UTI have higher TAC and lower total peroxide and OSI levels. However, lower TAC and plasma vitamin C concentration and higher total peroxide and OSI levels were observed in UTI. This condition may be a factor which facilitates the development of the infection or is secondary to UTI.
To examine whether a beneficial effect of N-acetylcysteine (NAC) on semen parameters and oxidativ... more To examine whether a beneficial effect of N-acetylcysteine (NAC) on semen parameters and oxidative/antioxidant status in idiopathic male infertility exists. The production of reactive oxygen species is a normal physiologic event in various organs. However, overproduction of reactive oxygen species can be detrimental to sperm and has been associated with male infertility. Our study included 120 patients who had attended our clinic and were diagnosed with idiopathic infertility according to medical history and physical and seminal examination findings, as initial evaluations. The patients were divided randomly into 2 groups. Those in the study group (60 men) were given NAC (600 mg/d orally) for 3 months; the control group (60 men) received a placebo. The oxidative status was determined by measuring the total antioxidant capacity, total peroxide and oxidative stress index in plasma samples. The sperm parameters were evaluated after NAC treatment and were compared with those in the control group. NAC had significant improving effects on the volume, motility, and viscosity of semen. After NAC treatment, the serum total antioxidant capacity was greater and the total peroxide and oxidative stress index were lower in the NAC-treated group compared with the control group. These beneficial effects resulted from reduced reactive oxygen species in the serum and reduced viscosity of the semen. No significant differences were found in the number or morphology of the sperm between the 2 groups. We believe that NAC could improve some semen parameters and the oxidative/antioxidant status in patients with male infertility.
Millions of male children are circumcised throughout the world. We investigated the opinions and ... more Millions of male children are circumcised throughout the world. We investigated the opinions and thoughts about the past and future aspects of circumcision by interviewing 100 male family members of the health care staff. 100 male volunteers answered a questionnaire comprising questions about their personal observations, feelings, festivities and opinions about their own circumcisions as well as their views about the circumcision phenomenon as a parent, and the legality of circumcision. 81% of the volunteers in our study had been circumcised by traditional circumcisers. The rest had been circumcised by doctors (10%), barbers (7%) and sheikhs (2%). In 90% the circumcision took place at home, 7% in hospitals and in 3% in village squares. While 66% of the subjects do not remember anything, the remaining 33% reported some bad sensations like fear, pain and shame about their circumcisions, and 1 (1%) subject reported happiness. As a parent, they answered the questions on their preferences on the place and performer of the circumcision. 44% preferred to have circumcision performed in the hospital by a physician, 26% at home by a physician, and 30% at home by a circumciser. There are significant changes in the attitudes of people in Turkey on circumcision as a traditional culture, though its perception has remained unchanged.
Purpose Sildenafil is a new and effective oral medication for the treatment of erectile dysfunct... more Purpose Sildenafil is a new and effective oral medication for the treatment of erectile dysfunction. The purpose of this study was to assess the long-term effects of sildenafil on visual acuity, color vision, intraocular pressure (IOP), electroretinography (ERG), blue-on-yellow and white-on-white Humphrey visual field (HVF), and tear functions. Methods Ten impotent patients ingested 50 mg of sildenafil one or more times a
To investigate the efficiency and safety of Foley catheter intraballoon illumination in determini... more To investigate the efficiency and safety of Foley catheter intraballoon illumination in determining the urethrovesical junction (UVJ) in retropubic colposuspension. Our accessory set for UVJ determination is composed of a 24-french Foley catheter and a 5-mm 0 degrees telescope. The telescope is inserted into the catheter from the urinary luminal side until the tip has reached the level of the catheter balloon. After dissection of the bladder, urethra, and paraurethral tissues to reveal the submucosal endopelvic fascia, the accessory set is inserted into the bladder and the balloon is inflated with 5 ml air and illuminated by a switch on the cold light source. To determine the right side of UVJ, the catheter is pulled slightly downward and to the right of the patient. The contralateral side of the UVJ is determined by pulling the catheter slightly downward and to the left of the patient. Intraballoon illumination of the Foley catheter helps to ensure accurate placement of paraurethral sutures at UVJ. Intraballoon illumination for determination of UVJ is simple, safe, effective and precludes an invasive approach such as cystoscopy and cystotomy.
To investigate the effectiveness of a new tension-adjustment technique for postoperative voiding ... more To investigate the effectiveness of a new tension-adjustment technique for postoperative voiding difficulties encountered after sling operations. To test our new method, urethral obstruction was developed in 5 female dogs by modifying the sling operation by exerting more tension on a specially prepared polypropylene strip in which a gap had been developed. After filling the bladder with isotonic solution, detrusor contractions were induced by pelvic nerve stimulations, and urodynamic studies were performed to document the urethral obstruction. In each case Foley catheters were inserted into the bladder and left in place until the time of tension adjustment. Tension adjustment was performed in the 1st, 2nd, 3rd, 4th and 5th weeks postoperatively for dogs 1, 2, 3, 4, and 5, respectively. On the day of tension adjustment, after filling the bladder with isotonic solution and removing the Foley catheter, none of the dogs, except dog 3, was able to produce a free flow of urine either spontaneously or provoked by detrusor contractions. The release of the prolene sutures was readily achieved in all cases except dog 5. In this case, sling takedown was achieved after surgical exploration in which the sling location was confirmed by following the prolene sutures and Hegar's dilator. After identifying the sling, the gap was opened by cutting the prolene sutures, instead of a sling incision. Release of the prolene sutures resulted in a distinct drop in the urethra with decreased resistance of Hegar's dilator. The improvement in voiding was confirmed by postoperative urodynamic studies and was immediate in all cases. Our new technique for postoperative voiding difficulties encountered after sling operation is simple, effective and avoids re-operation in the early postoperative period.
To investigate whether ordinary tests used in urolithiasis can increase the diagnostic value of u... more To investigate whether ordinary tests used in urolithiasis can increase the diagnostic value of unenhanced helical computed tomography (HCT). Of all patients admitted with acute flank pain, 137 without radiocontrast allergy, pregnancy and renal insufficiency were included in the study. After urinalysis (Ur) and ultrasonography (USG), HCT without a contrast agent was taken by 5-mm collimation, thereafter excretory urography (EU) was obtained. Confirmation of a stone was done by various tests and/or treatment methods. Statistically, the predictive values of HCT, USG, EU and Ur and their combinations were evaluated using the area under the receiver operating characteristic curve (AROC). The patients' mean age was 38 (range 4-72) years. Sensitivity values of HCT, USG, EU and Ur were 97, 69, 71 and 81%, respectively. Their specificity values were 96, 87, 91 and 65%, respectively. The widest AROC was found for HCT (97%). The best test combination was [HCT or USG] according to the AROC value (93%), but none of the AROC values of the test combinations was higher than that of HCT. However, 95% confidence intervals of the AROC values of these tests and their combinations overlapped. Because the HCT combinations with other tests improved the diagnostic value of HCT, they should be preferred in some individuals suspected of having urolithiasis. However, the most feasible single test meeting the all usage purposes was HCT in terms of the AROC value, and the combination was [HCT or USG] in which either HCT or USG was positive.
To evaluate the effectiveness and complications of the combination of minimal transurethral resec... more To evaluate the effectiveness and complications of the combination of minimal transurethral resection of the prostate and bladder neck incision in comparison with those of the standard transurethral resection of the prostate (TURP). Forty patients with prostates of <or=25 ml were randomized to two equal groups (20 cases in each). In group I minimal transurethral resection of the prostate followed by bladder neck incision at the 6 o'clock position and in group II standard TURP were performed. Patients were evaluated in terms of the change in symptom severity, maximal flow rate and sexual function in addition to operating time, length of hospital stay, problems of catheter positioning at the end of the operation and the rate of bladder neck contracture using chi(2) and independent t tests. Age, prostate volume postoperative follow-up time, improvement in international prostate symptom score and maximal flow rate, length of hospital stay and erectile dysfunction rates were not statistically different between the 2 groups. Operation time was shorter in group I (p = 0.001). Although the urethral catheter was easily positioned at the end of the operation in group I, it was not possible in group II for 4 patients (p = 0.053). Postoperative retrograde ejaculation for groups I and II were determined in 7 and 16 patients, respectively (p = 0.005). Bladder neck contracture was not found in group I, while it was seen in 2 patients in group II (p = 0.487). The combination of minimal transurethral resection and bladder neck incision in patients with small prostates appears to provide a satisfactory clinical outcome, comparable with standard TURP, while preventing the difficulty of urethral catheter positioning at the end of the operation, decreasing bladder neck contracture and lowering the incidence of retrograde ejaculation.
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