Browsing by Author "Taken, Kerem"

Now showing 1 - 20 of 40

Application of Ureteroscopic Pneumatic Lithortripsy in Patients With Ureter Calculi: Our Five Years Experience
(Professional Medical Publications, 2012) Gecit, Ilhan; Pirincci, Necip; Taken, Kerem; Benli, Erdal; Ceylan, Kadir
Objectives: To evaluate the efficacy and reliability of ureteroscopic pneumatic lithoripsy (URS-PL) in patients with ureter calculi. Methodology: A total of 612 patients who were treated with URS-PL in Medical school of Yuzuncu Yil University, Van State Hospital and Bingol State Hospital in the period between April 2005-May 2010 were studied. Diagnoses of ureter stones were made with intravenous pyelography (IVP) or computerize tomography (CT). Ureteral balloon dilation was not performed on any patient. On the post-operative 1st, 7th and 21st days, control direct urinary system graphic (DUSG) was taken. The rates of stone free and complication were analyzed with the ki-kare test. P < 0.05 was accepted as significant. Results: The mean age of the patients was 39 +/- 10 (18-75). There were 417 males (68.13%) and 195 females (31.86%). The mean volume of calculi in patients was 10.1 +/- 2.3 mm. Of these patients, 121 had proximal ureter stone, 169 medial ureter stones and 322 had distal ureter stones. In the first session of URS-PL, the calculi of 96 patients in proximal ureter (80%), those of 143 patients in medial ureter (85%) and those of 305 patients (95%) in distal ureter were cracked successfully. The mean stone free rate was 92.4% (79.4% in upper ureter, 94.1% in middle ureter and 93.7% in distal ureter (P < 0.05). Overall complication rate was 7.6% (7.7% in distal ureter, 3.9% in middle ureter and 11.8% in proximal ureter) (P>0.05). Most common peroperative complications of the procedure were ureteral perforation 4,2% (n=26), infection 2.2% (n=14), and mucosal laceration 1.9% (n=12). The most common late complication was ureteral stricture in 1.3% (n=8) of patients. Conclusion: Although URS-PL is a commonly used application for the treatment of patients with proximal and middle ureter stones, its common usage could also be extended to patients with distal ureter stones in the first stage of treatment, and it could be considered as an efficient and reliable procedure.
Benign ve Malign Böbrek Kitlelerinin Enflamasyon Markerlarıyla Ayrımı
(2021) Taken, Kerem; Ertaş, Kasım; Aslan, Rahmi; Eryılmaz, Recep; Demir, Murat
Amaç: Görüntüleme yöntemlerindeki son gelişmelere rağmen, böbrek kitlelerinin patolojisini tahmin etmede hala %10-20 oranı yetersizdir. Bu nedenle, hematolojik enflamatuvar belirteçlerin patoloji sonucunu tahmin etmede yararlı olup olmadığını incelemeyi amaçladık. Yöntem: Ocak 2010 ile Ekim 2020 tarihleri arasında böbrek kitlesi nedeniyle opere edilen 116 hasta çalışmaya dahil edildi. Retrospektif olarak preoperatif trombosit, nötrofiller, lenfosit sayıları ve oranları patoloji sonuçları ile karşılaştırıldı. Bulgular: Çalışmaya alınan 116 hastanın yaş ortalaması 55,36±13,93 yıl idi. Yirmi altı (%22,4) hastanın patoloji sonuçları benign iken 90’ı (%77,6) malign idi. Nötrofil sayısı ve nötrofil lenfosit oranı benign grupta anlamlı olarak daha düşüktü. Renal hücreli karsinomlu hastalarda yüksek Fuhrman derecelerinde trombosit sayısı ve trombosit lenfosit oranı daha yüksek iken lenfosit sayısı ise daha düşüktü. Sonuç: Hematolojik enflamatuvar belirteçler, ameliyattan öncesi böbrek kitlelerinin patoloji sonucunu tahmin etmede yararlıdır
Comparative Evaluation of Bilateral Pudendal Nerve Blockade and Periprostatic Nerve Block in Transrectal Ultrasound Guided Prostate Biopsy: a Prospective Randomised Trial
(Polish Urological Assoc, 2020) Aslan, Rahmi; Erbin, Akif; Eryilmaz, Recep; Taken, Kerem
Introduction Although the periprostatic nerve block (PNB) is accepted as the standard method for local anesthesia prior to transrectal ultrasound (TRUS)-guided prostate biopsy, it is not the most ideal method. We aimed to analyze the effectiveness and safety of bilateral pudendal nerve blockage (PuNB) by comparing with PNB. Material and methods Between June 2019 and October 2019, a total of 108 patients with elevated serum prostate specific antigen values (PSA >= 4 ng/ml) and/or abnormal digital rectal examination findings were included in the study. After exclusion criteria, the remaining 91 patients were randomly divided into two groups as PuNB (n = 46) and PNB (n = 45). Pain during local anesthesia application was recorded as a visual analog scale (VAS) 1, pain during placement of the rectal probe and manipulation was recorded as VAS 2 and pain during needle penetration into prostate tissue and sampling was recorded as VAS 3. Results No significant difference was found between the two groups with regard to age, body mass index, serum PSA, prostate volume and prostate cancer rates. Mean VAS-2 score was significantly lower in the PuNB group when compared with the PNB group. There was no significant difference in terms of VAS-1 and VAS-3 scores. There was no significant difference between the groups in terms of mild and severe complications. Conclusions Both techniques are safe for TRUS-guided prostate biopsy; however, PuNB provided more effective pain control compared to PNB especially during placement of rectal probe and manipulation.
Comparison of Ceftriaxone and Cefazolin Sodium Antibiotic Prophylaxis in Terms of Sirs/Urosepsis Rates in Patients Undergoing Percutaneous Nephrolithotomy
(Galenos Yayincilik, 2019) Taken, Kerem; Asik, Alper; Eryilmaz, Recep; Aslan, Rahmi; Donmez, Muhammet Irfan; Gunes, Mustafa
Objective: The aim of this study is to compare ceftriaxone and cefazoline sodium antibiotic prophylaxis in terms of development of Systemic Inflammatory Response syndrome (SIRS)/urosepsis in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods: Patients who underwent PCNL between June 2015 and October 2015 in our hospital were prospectively randomized to ceftriaxone (n=30) and cefazoline sodium (n=32) antibiotic prophylaxis groups. Patients with predisposing conditions to SIRS were excluded. Intraoperative urine cultures from renal pelvis and stone cultures were obtained from all patients. Clinical and laboratory findings of the patients who developed postoperative fever were evaluated. SIRS and urosepsis rates were compared between two groups. Results: There were 7 patients in ceftriaxone group (23.3%) and 4 patients in cefazoline sodium group (12.5%) who developed SIRS (p=0.264). Sepsis was observed in 2 patients in both groups (p=0.826). Prolonged duration of surgery in ceftriaxone group and renal pelvis urine culture positivity in cefazoline group were found to be statistically significant in patients who developed SIRS (p=0.02, p=0.015, respectively). Conclusion: There was no significant difference between two groups in terms of SIRS and sepsis following PCNL. Therefore, cefazoline, which has a narrower antimicrobial spectrum, may be preferred for prophylaxis.
Comparison of Complications Following Laparoscopic Radical and Simple Nephreoctomy Using the Clavien-Dindo Clasification
(Galenos Yayincilik, 2019) Eryilmaz, Recep; Aslan, Rahmi; Taken, Kerem; Gunes, Mustafa
Aim: In this article, we aimed to compare the complications occurring after laparoscopic radical (LRN) and simple nephrectomy (LSN). Methods: After obtaining local ethics committee approval, we analyzed the records of a total of 98 patients, who underwent transperitoneal laparoscopic nephrectomy. LSN and LRN were performed in 64 and 34 patients, respectively. The Clavien-Dindo classification was used for evaluating complications. Pneumoperitoneum was created using a Veress needle. Intraabdominal carbon dioxide pressure was 18 mmHg while three 10 mm trocars were inserted and then one 5 mm trocar was inserted if needed. Results: The mean age of the LSN and LRN patients was 38.8 +/- 18.43 and 55.7 +/- 14.75 years, respectively. Five patients who underwent LSN developed postoperative minor complications (fever in one patient, nausea and vomiting in four patient). In addition, one patient who underwent LSN died postoperatively (vascular injury). Minor complications (fever in two patients, nausea and vomiting two, and ileus in one patient) developed postoperatively in five of 34 patients in LRN group. Conclusion: The rate of complication after LRN was found to be statistically significantly higher than that after LSN.
Comparison of Cystoscopy and Diffusion Weighted Magnetic Resonance Imaging(DWMRI)for Diagnosis and Follow Up of Urinary Bladder Carcinoma
(2009) Taken, Kerem; Ceylan, Kadir
Giriş ve Amaç: Amacımız mesane tümörlü hastaların tanı ve takibinde DAMRG'yi sistoskopi ile karşılaştırıp histopatolojik korelasyonunu araştırmaktır. DAMRG'nin tanı testleri (sensitivite, spesifite, yanlış pozitif oran, yanlış negatif oran ve doğruluk) ve mesane kitlelerinde DAMRG ile ADC değerleri ölçülerek malign-benign ayırımına katkısı tesbit edildi.Gereç ve Yöntem: Çalışmaya yaşları 31-85 arasında olan primer veya seconder hematüri ile üroloji polikliniğine başvuran toplam 59 kişi (yaş ortalaması 60±13.03) alındı.Üst üriner sistem patolojisi USG ile ekarte edildikten sonra hastalara önce DAMRG çekildi (ort. 7 gün ), daha sonra KS yapıldı.İncelemeler Siemens Magnetom Symphony (Siemens, Erlangen, Germany) cihazında faz dizilimli Body koil ile alt batın MR incelemesi yapıldı.. Eko-planar difüzyon MRG için kullanılan ` trace?0?500?1000-ADC' protokoldür.Elde olunan görüntüler üzerinden, görünür difüzyon katsayısı (apparent diffusion coefficient, ADC) normal mesane mukozasına ait dokudan ve mesane kitlelerinden hesaplanmıstır. Total tarama zamanı 151 sn sürmüştür.ADC değerleri bakımından Hasta-Kontrol grupları arasında fark olup olmadığını belirlemek amacıyla; tek yönlü varyans analizi (One-way ANOVA) yapılmıştır.Ayrıca test tanı ölçüt değerleri (duyarlılık, özgüllük, yanlış pozitif oran,yanlış negatif oran, doğruluk) kullanılmıştır. Hesaplamalarda anlamlılık düzeyi olarak %5 alınmış ve hesaplamalar SPSS istatistik paket programında yürütülmüştür.Bulgular: Çalışmamıza 59 hasta alınmıştır (47/12,E/K). Sistoskopi ile 43 hastada mesanede kitle saptanırken (n:34 malign,n:9 benign) 16 hastada kitle saptanmamıştır. DAMRG ile 40 hastada kitle saptanırken 19 hastada kitle saptanmadı.Sistoskopi ile 3 hastada izlenen kitle( (n:2) benign,(n:1) malign) DAMRG'de izlenmedi. DAMRG'de malign olarak yorumlanan 1 hastanın patolojisi benign idi. Histopatolojiye göre DAMRG'nin sırasıyla sensitivite, spesifite, doğruluk değerleri %97.6, %96, %96.6 olarak saptandı.Sistoskopi'ye göre ise DAMRG'nin sırasıyla sensitivite, spesifite, doğruluk değerleri % 90, %93, %91 olarak saptandı.ADC değerleri bakımından mesane tümörü saptanan 34 olgunun ortalama ADC değerleri (1,05±0.22 x10?³mm²/s), normal mesane duvarından alınan ortalama ADC değerlerinden (1,830±0.18x10?³mm²/s ) belirgin düşük olup, aralarında istatiksel olarak anlamlı fark bulundu (p<0.001). Benign lezyon saptanan 9 hastanın 6 `sı DAMRG' de benign, 1'i ise malign idi. Bunların ortalama ADC değerleri (1,73±0.12 x10?³mm²/s), normal mesane duvarından alınan ortalama ADC değerlerinden (1.78±0.2x10?³mm²/s ) istatistiksel olarak anlamlı fark bulunmadı (p>0.05). Bu benign lezyonların ADC değerleri malign lezyonların ADC değerleriyle karşılaştırıldığında aralarında anlamlı fark bulundu (p<0.001).Sonuç:.DAMRG'nin sensitivite, spesifite, doğruluk değerleri yüksek saptandı. DAMRG'nin non invazif ve hızlı bir çekim tekniği olması, iyonizan radyasyon içermemesi, tümör selüleritesinin önemli bir belirteci olması nedeniyle gelecekte mesane tümörlerinin tanısında ve takibinde gittikçe artarak kullanılacaktır.
Comparison of Cystoscopy With Diffusion-Weighted Magnetic Resonance Images Used in the Diagnosis and Follow-Up of Patients With Bladder Tumors
(Asian Pacific Organization Cancer Prevention, 2010) Ceylan, Kadir; Taken, Kerem; Gecit, Ilhan; Pirincci, Necip; Gunes, Mustafa; Tanik, Serhat; Karaman, Ihsan
Purpose: To compare diffusion-weighted magnetic resonance imaging (DW-MRI) with cystoscopy in the diagnosis and follow-up of patients with bladder tumor and to investigate any histopathological correlation. Materials and Methods: Totally 59 patients, between 31-85 years (mean age 60 +/- 13) referred to our clinic due to a hematuria complaint were enrolled and evaluated by upper urinary system pathology and then DW-MRI (average 7 days) and cystoscopy. Apparent diffusion coefficients (ADCs) of images were calculated. Results: While a mass in bladder was determined with cystoscopy in 43 out of 59 patients, the mass was not deternined in 16 of the patients(n=34 malign, n=9 benign). While a mass was determined in 40 out of 59 patients with DW-MRI, the mass was not determined in 19 of the patients(n=40 malign, n=19 benign). Regarding ADC values, mean ADC values of 34 patients who were diagnosed with a bladder tumor (1.05 +/- 0.22 x 10(-3)mm(2)/s), were significantly lower than the mean ADC values obtained from the normal bladder wall (1.830 +/- 0.18 x 10(-3)mm(2)/s) whereas a statistically significant difference was found (p<0.001). ADC values in 9 patients with a benign lesion (1,73 +/- 0.12 x 10(-3)mm(2)/s), were not found statistically different from the mean ADC values obtained from the normal bladder wall (1.78 +/- 0.2x10(-3)mm(2)/s) (p>0.05). A significant difference was determined between ADC values of benign lesions and the ADC values of malign lesions (p<0.001). Conclusions: According to cystoscopy, values of DW-MRI's related with sensitivity, specificity and accuracy were found, respectively 90%, 93% and 91%. As the DW-MRI is a non-invasive and a rapid technique, and does not contain ionized radiation and because it is accepted as an important marker of tumor cellularity, it may be used as an alternative in future diagnosis and follow-up of bladder tumors.
Comparison of Retrograde Intrarenal Surgery, Mini Percutaneous and Super Mini Percutaneous in the Treatment of <2cm Renal Lower Pole Stones
(2020) Taken, Kerem; Duran, Mehmet Arif; Md, Kasim Ertas; Eryilmaz, Recep; Aslan, Rahmi
Renal lower pole stones are a common disorder in the community. In this study, we aimed to compare Retrograde intrarenal surgery (RIRS), Mini PCNL(percutaneous nephrolithotomy) and Super Mini PCNL treatments in the treatment of lower pole stones. Patients who had lower pol renal stones with <20 mm stone sizes were en-rolled in the study. Preoperatively, renal stone and kidney characteristics were evaluated renal ultrasonography, intravenous pyelography and/or non-contrast abdominal computed tomography (CT). RIRS, Mini PCNL and Super Mini PCNL surgery methods were performed. Holmium laser and pneumatic lithotriptor were used for stone lithotripsy. The mean age of the patients in the RIRS group was 35 ± 5.23 years, the mean age in the Mini PCNL group was 38.3 ± 6.47 years and the mean age in the Super Mini PCNL group was 34.12 ± 3.56 years. RIRS were performed in 43 patients, Mini PCNL 37 patients and Supper Mini PCNL 35 patients.Stone free in RIRS was 74.3% Mini PCNL was 93.3% Super Mini PCNL was 94.6 %. According to clavien dindo classification postop grade2-3 complication , in RIRS was 4,6%Mini PCNL was 8,1% .But no grade2-3 complication was seen in Super Mini PCNL group. Hospital stay of RIRS was 1.59± 2.03 mini pnl was 3.73±1.76 and Super Mini PCNL was 2.3±1.55.Cost analysis respectively ,RIRS group, $801.52 ± 25.32; Mini PCNL group, $698.33 ± 22.37; Super Mini PCNL group,$703.13±62. In lower pole stones, RIRS is minimally invasive and have less hospital stay.Stone free rates were higher in Mini PCNL and Super Mini PCNL than RIRS. Super Mini PCNL has short hospital stay and less postoperative complication rate than Mini PCNL. RIRS is more expensive than Mini PCNL and SMP.
Comparison of Supine-Prone Percutaneous Nephrolithotomy Methods in the Treatment of Kidney Stones in Pediatric Patients: Prospective Randomized Study
(Springer, 2024) Eryilmaz, Recep; Ertas, Kasim; Aslan, Rahmi; Sevim, Mehmet; Keles, Muhammed Fatih; Taken, Kerem
Mini-PCNL is one of the most effective surgical methods in the treatment of kidney stones in pediatric patients. In this study, we aimed to compare PCNL in the supine-prone position in pediatric patients (especially operation time, postop complications, hospital stay and stone-free rates).We conducted our study in a randomized and prospective manner. Patients with lower pole stones larger than 1 cm, stones larger than 1.5 cm in the pelvis, upper pole, midpole or multiple locations, and patients who did not respond to ESWL or whose family that preferred mini-PCNL to be the primary treatment were included in the study. Patients with any previous kidney stone surgery, patients with coagulation disorders and patients with retrorenal colon were excluded from the study. Between 2021 and 2023, a total of 144 patients underwent PCNL. 68 of these patients had supine PCNL and 76 prone PCNL. Postoperative Clavien grade1 complication occurred in a total of 7 patients in the prone position; Clavien grade1 complication occurred in 1 patient in the supine position. The mean operation time for prone PCNL was 119.88 +/- 28.32 min, and the mean operative time for supine PCNL was 98.12 +/- 14.97 the mean hospitalization time in prone PCNL was 3.56 +/- 1.12 days, and 3.00 +/- 0.85 days in supine PCNL. In conclusion, supine PCNL is a safe and effective method in the treatment of pediatric kidney stones and postoperative complications were observed to be less; the operation time and hospital stay were shorter in supine PCNL.
Comparison of the Techniques of the Microscopic Varicocelectomy and Inguinal Varicocelectomy
(derman Medical Publ, 2012) Pirincci, Necip; Gecit, Man; Curies, Mustafa; Taken, Kerem; Canbeyt, Ozcan; Ceylanl, Kadir
Aim: The aim is to compare the results of two different varicocelectomy techniques. Material and Method: Between July 2005 and February 2011; 68 patients who are of 84 varicocele whose ages were ranged from 15 to 39 (26.4 +/- 6) and whom inguinal varicocelectomy or subinguinal microscopic varicocelectomy were performed due to the clinical varicocele were retrospectively evaluated. The complication rates; preoperative and postoperative sperm parameters and pregnancy rates of both groups were evaluated and compared. Results: The duration of the operation in the subinguinal microscopic group was significantly long compared to the inguinal group. Hydrocelectomy and the recurrence of varicocele were not observed in the subinguinal microscopic group; hydrocele in 3 cases and the recurrence of varicocele in 5 cases were detected in the inguinal group. The difference in between was significant. There was a recovery of 75% in the number of sperm and / or movement in the subinguinal microscopic group and a recovery of 64% in the inguinal group; these values were statistically significant comparable level in both group. The rates of the pregnancy in the first year was 29% in the subinguinal microscopic group and was 26% in the inguinal group; there was no significant difference among the pregnancy rates between both groups. Discussion: Subinguinal microscopic varicocelectomy has yielded better results with low complication and higher success rates compared to the inguinal varicocelectomy.
The Diagnostic Value of Ischemia-Modified Albumin in Prostate Cancer
(Galenos Yayincilik, 2020) Aslan, Rahmi; Eryilmaz, Recep; Sevim, Mehmet; Demir, Murat; Taken, Kerem
Aim: The aim of this study was to investigate whether serum ischemia-modified albumin (IMA) levels have a diagnostic value in prostate cancer (Pca). Methods: Thirty primary Pca patients and 30 age-matched healthy male subjects were included in this prospective case-control study. The patients were selected from the urology clinic of a tertiary university hospital. Healthy men included in the control group were selected from hospital staff and patient relatives. Patients with severe chronic diseases and other malignancies were excluded. Serum IMA level was measured using the colorimetric method. The results were reported in absorbance unit (ABSU). Results: Serum IMA levels were significantly higher in the study group when compared to the control group (0.843 +/- 0.76 and 0.443 +/- 0.49 ABSU, respectively; p=0.002). The mean IMA value in patients with a Gleason score >= 7 (1.08 +/- 0.053 ABSU) was significantly higher than in patients with Gleason score <= 6 (IMA 0.418 +/- 0.64 ABSU). According to the receiving operating characteristic (ROC) analysis, when the cut-off value was ABSU=0.57, the sensitivity and specificity were 80% and 56.7%, respectively. Conclusion: Serum concentrations of IMA are significantly elevated especially in clinically significant Pca patients. Its high sensitivity (80%) in ROC analysis suggests that IMA can be used an ancillary biomarker in diagnosis.
Does Tamsulosin Use Before Ureteroscopy Increase the Success of the Operation
(Coll Physicians & Surgeons Pakistan, 2022) Demir, Murat; Ertas, Kasim; Aslan, Rahmi; Eryilmaz, Recep; Sevim, Mehmet; Taken, Kerem
Objective: To investigate the effect of preoperative tamsulosin use on the success and complications rates of ureteroscopy for ureteral stone removal. Study Design: A randomised clinical trial. Place and Duration of Study: Department of Urology, Dursun Odabas Medical Center, Van Yuzuncu Yil University, Turkey, from December 2020 to June 2021. Methodology: Patients were scheduled for ureteroscopy due to ureteral stones, and were randomly divided into two groups; 67 patients preoperatively were given 0.4 mg tamsulosin for 7 days and 70 patients were not given tamsulosin. Each patient's intraoperative surgical complications, preoperative and postoperative pain, postoperative fever, need for analgesia, stone-free rate, and double J ureteral stent (DJ) insertion rates were recorded and evaluated. Results: A total of 137 patients, 103 (75.1%) males, and 34 (24.8%) females, were included. In 70 (51.1%) of these patients, the stone was on the right side, while in 67 (48.9%) the stone was on the left side. The stone was in the distal ureter in 47 (34.3%) patients, in the middle in 38 (27.7%) patients, and the proximal in 52 (37.9%) patients. The patients who were given tamsulosin had lower preoperative visual analog scale (p=0.02), operation time (p=0.003), post-ureteroscopic lesion scale (p=0.01), postoperative 24th-hour visual analog scale (p=0.03), fever (p=0.02), and analgesic need (p=0.04), while their rate of accessing the stone (p=0.02); and their stone-free rates (p=0.02) was higher. Conclusion: Preoperative tamsulosin use increases the success of the operation and reduces complications.
Effect of Combined Use of Tolterodine and Continuous Positive Airway Pressure Vs Continuous Positive Airway Pressure Only Treatment on Overactive Bladder Symptoms in Women With Moderate-To Obstructive Sleep Apnea Syndrome: a Randomized Clinical Trial
(Springer London Ltd, 2022) Ertas, Kasim; Yildiz, Hanifi; Demir, Murat; Aslan, Rahmi; Eryilmaz, Recep; Kirmizitoprak, Sevder; Taken, Kerem
Introduction and hypothesis Obstructive sleep apnea syndrome is associated with urological symptoms, including overactive bladder (OAB). This study aims to determine whether combined tolterodine and CPAP therapies are more effective for patients with OSAS than CPAP treatment only. Methods Women who underwent polysomnography test and were diagnosed with moderate-to-severe OSAS with apnea-hypopnea index (AHI) were included in the study. Data were collected on AHI, OAB awareness-8-item tool (OAB-V8), incontinence questionnaire-urinary incontinence short form (ICIQ-UI-SF), total daily urine volume (DUV), and the Benefit, satisfaction with treatment and willingness (BSW) tool. Eligible patients were randomized to receive either CPAP treatment only or combined CPAP and tolterodine treatment for 3 months. Results Among 103 participants, a total of 60 were included. Patients in both treatment arms showed significant improvements in OAB-V8, ICIQ-UI-SF, and total DUV compared to their baseline. The mean OAB-V8 was 15.7 at baseline and 5.6 at 3 months for the combined treatment arm and 16.6 and 7.6 at 3 months for the CPAP group only (mean baseline-adjusted between-group difference -1.1 [95% CI, -12.3 to -7.4]; p < 0.001). The improvement in the mean ICIQ-UI-SF was also statistically more significant in the combined therapy group than in the CPAP only arm (mean baseline-adjusted between-group difference -3.27 [95% CI, -4.6 to -1.59]; p < 0.001). No statistical significance was found in the improvement of total DUV between the groups. Conclusions In this study, combined use of tolterodine with CPAP provides beneficial effects to CPAP treatment only regarding OAB symptoms. Further research is required to confirm these findings in a large cohort.
The Effect of Plasma Rich Platelet Graft on Post-Operative Complications in Mid-Penile Hypospadias
(Wiley, 2020) Eryilmaz, Recep; Simsek, Metin; Aslan, Rahmi; Beger, Burhan; Ertas, Kasim; Taken, Kerem
Hypospadias is one of the most common penile congenital anomalies, which often requires a surgical approach. After the hypospadias is repaired, urethral fistula can occur in around 20% of patients. In this study, we used platelet-rich plasma (PRP) to reduce the urethral fistula and other post-operative complications after hypospadias repair. Only patients with primary mid-penile hypospadias were included study. Patients with forms other than mid-penile hypospadias and cases with previous hypospadias surgery were excluded from the study. A total of 40 hypospadias patients were included in this study. These patients were divided into groups A and B with 20 patients in each group. Hypospadias repair was performed with the Snodgrass TIPU technique on both groups. PRP was used with group A, and PRP was not use with group B. These two groups were compared in terms of early and long-term post-operative complications. Both early and long-term post-operative UCF, urethral stenosis and post-operative infection rates were lower in the group using PRP, group A. PRP has the potential to prevent post-operative complications occurring after hypospadias repair, particularly post-operative infection.
Erectile Dysfunction Is a Marker for Obstructive Sleep Apnea
(Taylor & Francis Ltd, 2016) Taken, Kerem; Ekin, Selami; Arisoy, Ahmet; Gunes, Mustafa; Donmez, Muhammet Irfan
Purpose: To investigate the prevalence of erectile dysfunction (ED) in patients with obstructive sleep apnea (OSA) with and without any other comorbidities. Methods: The patient group was newly diagnosed as having OSA (apnea-hypopnea index [AHI]>5/h) using a polysomnographic examination. A group of subjects with simple snoring were included into the control group. Clinically relevant comorbidities were systematically assessed in face-to-face interviews. All patients were asked to complete the 15-item International Index of Erectile Function (IIEF-15) questionnaire for the evaluation of ED. The patients with OSA and ED were evaluated according to these comorbidities. Results: Of the 94 patients, 39 patients were excluded because of severe diseases. OSA was observed in 38 (69.1%) of the 55 patients. ED was seen in 24 (63.2%) patients with OSA, and in 8 (47.1%) patients without OSA (p>0.05). There were no statistical differences between the groups' ages, IIEF scores, and body mass index (BMI) scores. There were statistically significant differences between the groups' AHI scores (p<0.05). There was a significant correlation between the groups' AHI scores, BMI, and age (p<0.05). There was no statistically significant difference in patients with OSA, with and without comorbidity in terms of ED. Conclusion: The rate of ED was higher in patients with OSA who had no other comorbidities. Therefore, ED can be a sensitive marker of OSA.
Evaluation of Hemorrhoidal Disease and Lower Extremity Venous Insufficiency in Primary Adult Varicocele: a Prospective Controlled Study
(Sage Publications inc, 2019) Aslan, Rahmi; Erbin, Akif; Celik, Sebahattin; Ucpinar, Burak; Sahinalp, Sahin; Yildizhan, Murat; Taken, Kerem
Background The study investigated the association between varicocele, lower extremity venous insufficiency and hemorrhoidal disease. Methods The study included 62 patients with varicocele and 60 voluntary subjects with no varicocele. Patients who were diagnosed as having varicocele on physical examination and Doppler ultrasonography were included in the study group. Examination of lower extremity venous insufficiency was performed by physical examination and Doppler ultrasonography. Examination of hemorrhoidal disease was performed by a general surgery specialist. Results The patients with varicocele had a statistically significant (p < 0.05) higher rates of venous insufficiency of the lower extremities and had a borderline significant difference of higher hemorrhoidal disease rates (p = 0.05). Therewithal incidences of hemorrhoidal disease and lower extremity venous insufficiency were significantly higher in body mass index > 25 and age > 30 years of varicocele patients. Conclusion There is a statistically significant relation between varicocele, lower extremity venous insufficiency, and hemorrhoidal disease. In particular, varicocele patients who are aged over 30 years and overweight are at higher risk.
Fournier's Gangrene: Causes, Presentation and Survival of Sixty-Five Patients
(Professional Medical Publications, 2016) Taken, Kerem; Oncu, Mehmet Resit; Ergun, Muslum; Eryilmaz, Recep; Demir, Canser Yilmaz; Demir, Murat; Gunes, Mustafa
Objective: To report our experience with Fournier's Gangrene (FG) over the past eight years and evaluate the predisposing factors which affect the mortality. Methods: Sixty-five patients who were admitted to emergency surgical unit of our institution presenting with FG between January 2006 and August 2014 were included. The anatomical site of infective gangrene, predisposing factors, etiological factors, and outcomes were retrospectively reviewed. Results: Our cases included 8 women and 57 men. The average age of men was 51 +/- 13.9 (range 19-75) and the average age of women was 63 +/- 10.5 (range 52-76). Average hospitalization time was 9.2 +/- 6.6 days (range 5-25) days. The most frequent comorbid disease was diabetes mellitus and the most frequent etiology was perianal abscess. Colostomy was performed in 11 patients, orchidectomy in two patients, cystostomy in two patients. Notably, all of the 8 (12.3%) patients who died from FG had diabetes and low socioeconomic status. A total of six patients who died required more than one surgical debridement. Conclusions: Fournier's gangrene is a severe surgical emergency, with a high mortality rate. Low socioeconomic status, diabetes and more than one debridement play a major role in mortality and morbidity.
Hospital Readmissions Due To Subcapsular Renal Hematoma After Flexible and Rigid Ureterorenoscopy
(Galenos Yayincilik, 2018) Taken, Kerem; Gunes, Mustafa; Ergun, Muslum; Donmez, Muhammet Irfan
Objective: The aim of this study is to compare the rates of hospitalization due to subcapsular renal hematoma (SRH) following flexible ureterorenoscopy (FURS) and semirigid ureterorenoscopy (RURS) for the treatment of ureteral and renal stones. Materials and Methods: Patients who have been treated with FURS and RURS at two different institutions between March 2009 and February 2014 were enrolled in the study. Patient files and hospital records were reviewed. Pneumatic lithotriptor was used in RURS while holmium:yttrium aluminium garnet laser was used for FURS. Subcapsular hematoma diagnosis was based on clinical and radiological findings. Comparative analysis of patients with SRH in terms of age, sex, stone size/position, degree of preoperative hydronephrosis, duration of surgery and size of hematoma was done. Results: A total of 1187 patients were found to have undergone ureteroscopic intervention due to ureteal or renal stones. RURS was performed in 992 (83.6%) patients and FURS was performed in 195 patients (16.4%). Of the 992 patients who underwent RURS, postoperative SRH occurred in 6 patients (0.6%). Postoperative SRH occurred in 3 patients (1.5%) who underwent FURS. Of the 9 patients who developed SRH, blood transfusions were needed in three patients and one patient was treated with percutaneous drainage catheter insertion. No patient underwent open surgery. There was no statistically significant difference between the two types of surgeries with regard to age, stone size/localization, degree of preoperative hydronephrosis, duration of surgery and size of SRH (p>0.05). Conclusion: SRH is a rare complication following RURS and FURS. There is no statistically significant difference in the risk for this specific complication between FURS and RURS.
Isolated Renal Pelvis Rupture Secondary To Blunt Trauma: Case Report
(Elsevier Sci Ltd, 2015) Taken, Kerem; Oncu, Mehmet Resit; Ergun, Muslum; Eryilmaz, Recep; Gunes, Mustafa
Introduction: Isolated rupture of the renal pelvis is a very rare condition and thus causes delays in the diagnosis of the rupture. It is most commonly seen in the setting of obstructive ureteric calculus. Other rare causes include neoplasms, trauma, and iatrogenic procedures. Diagnosis is usually established on computed tomography (CT) which demonstrates the extravasation of the contrast in the peripelvic, perinephric, or retroperitoneal collections. PRESENTATION OF CASE: A 27-year-old male patient was admitted to our hospital due to multiple traumas associated with motor vehicle accidents. The patient had clear urine output. A large pelvic rupture was detected by abdominal contrast-enhanced CT and after consulting with other departments, emergency repair of the renal pelvis was performed and a ureteral stent was implanted. DISCUSSION: Only a few isolated cases of pelvis rupture with resultant extravasation have been reported in the literature. The treatment of pelvic rupture should be preceded by the removal of underlying causes, followed by conservative management. However, surgical intervention should be warranted in the emergency cases presenting with the symptoms that may impede the decision-making process and in the cases whose diagnosis cannot be clarified by radiological techniques. CONCLUSION: Renal pelvic injury must be considered in the differential diagnosis of blunt trauma. Surgical intervention may be necessary in some cases. We present a case who underwent surgery due to isolated renal pelvis rupture caused by blunt abdominal trauma. (C) 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd.
Levels of Serum Trace Elements in Patients With Peyronie
(Taylor & Francis Ltd, 2020) Gunes, Mustafa; Aslan, Rahmi; Eryilmaz, Recep; Demir, Halit; Taken, Kerem
Aim: The etiology of the disease of Peyronie is not certainly known. However, penile micro traumas are thought to be important in the pathogenesis of Peyronie's disease (PD) in genetically predisposed individuals. In this study, we aimed to determine the relationship of some trace element and heavy metals with PD. Material and methods: Thirty Peyronie patients and 26 healthy volunteers were included in the study. In individuals in both groups, levels of serum trace elements (Manganese [Mn], Cu, Cobalt (Co), zinc [Zn], Cd, and iron [Fe]) were determined separately by Atomic Absorption Spectrophotometer method in Yuzuncu Yil University Central Research Laboratory. Results: Mn, Cu, Zn, and Fe levels in Peyronie patients were statistically significantly lower when compared to the healthy control group (p < .05). Cd and Co levels were similar for both groups but not statistically significant (p > .05). Conclusions: The changes in trace element levels are related to the etiopathogenesis of PD. We think that our study is the first from this aspect.