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Yayın Are Hounsfield densities of ureteral stones a predictive factor for effectiveness of extracorporeal shock wave lithotripsy?(E-CENTURY PUBLISHING CORP, 2014) Cakiroglu, Basri; Eyyupoglu, S. Erkan; Tas, Tuncay; Balci, M. B. Can; Hazar, Ismet; Aksoy, S. Hilmi; Sinanoglu, OrhunExtracorporeal Shock Wave Lithotripsy (SWL) has long been used successfully to dissolve ureteral stones. We researched whether Hounsfield values of ureteral stones is a factor that affects the success of SWL. Methods: Data from 144 patients who had diagnoses of ureteral stones and underwent SWL, were retrospectively reviewed between January 2011 and December 2012. Urinary tomography of patients was processed and classified into 3 groups by Hounsfield units (Group 1, < 500 HU; Group 2, 500-1000 HU; and Group 3, > 1000 HU) and 2 groups by stone size (Group A; < 1 cm, Group B; > 1 cm). SWL success was analyzed for both of these group types. Failure was defined as any fragments of the stone that remained within the ureter. Results were analyzed by evaluating the predictive factors in both groups. Results: The study included 144 patients (100 men, 44 women) who fit the inclusion criteria. In Hounsfield unit Group 1 (12 women and 44 men), the mean age was 37.2 +/- 13.2, stone size was 8.5 +/- 2.5 mm, number of shocks was 3240 +/- 1414 (1200-7500) and number of treatments was 1.4 +/- 0.6. In Group 2 (26 women and 32 men), the mean age was 33.6 +/- 7.6, stone size was 9.6 +/- 3.1 mm, process number was 3375 +/- 2103 (1200-8750) and shock amount was 1.6 +/- 0.8. In Group 3 (6 women and 24 men), the mean age was 42.2 +/- 13.6, stone size was 11.7 +/- 3.0 mm, number of shocks was 4513 +/- 2458 (1300-8700) and number of treatments was 2.1 +/- 1.2. In size Group 1 (28 women and 74 men), the mean age was 35.8 +/- 10.6, stone size was 8.1 +/- 1.4 mm, process number was 3105 +/- 1604, shock amount was 1.4 +/- 0.5 and HU value was 580 +/- 297. In Group 2 (16 women and 26 men), the mean age was 39.9 +/- 14.2, stone size was 13.9 +/- 2.4 mm, number of shocks was 4722 +/- 2467, number of treatments was 2.3 +/- 1.1 and HU value was 912 +/- 270. Conclusion: Although stone density predicted the failure of SWL, size of the stone is more important criterion for successful lithotripsy of ureteral stones.Yayın Bladder Neck Collagen Injection in the Treatment of Congenital Retrograde Ejaculation: A Case Report(CUREUS INC, 2017) Cakiroglu, Basri; Sinanoglu, Orhun; Arda, ErsanThe present study describes the first successful treatment of a congenital retrograde ejaculation case with a submucosal collagen injection to the bladder neck. A 28-year-old male (height 170 cm, weight 80 kg) attended to the urology outpatient clinic with complaints of scattered urine stream and absence of ejaculation. The laboratory tests, including hormone profile (follicle stimulating hormone, luteinizing hormone, and testosterone) and the routine blood count were within normal ranges, whereas semen analysis demonstrated a total absence of ejaculation. The analysis of post-ejaculate urine specimens revealed an elevated sperm concentration indicative of retrograde ejaculation. The cystoscopy was performed; the prostatic urethra was normal, the verumontanum was in the orthotopic position, and the bladder neck was wide opened. Dextranomer/hyaluronic acid copolymer (Deflux, 8 ml) was injected into the bladder neck at clock positions of one, five, seven, and 11 o'clock. During the same procedure, the large opening in the vesical collum was obliterated. During the first followup (four weeks after surgery), the patient was able to produce a normal (2.8 ml) ejaculation volume. The sperm analysis revealed normozoospermia, with 25 million spermatozoa/ml, 26% (a) and 57% (a + b) motility, and 14% normal morphology. The submucosal bladder neck collagen injection is a minimally invasive technique that quickly restores anterograde ejaculation and should be considered in the patients with congenital or acquired retrograde ejaculation and for those who did not respond to the medical treatment.Yayın The comparative evaluation of apoptosis produced by leuprolide or orchiectomy on rat prostate tissue(PAGEPRESS PUBL, 2015) Cakiroglu, Basri; Hazar, Aydin Ismet; Eyyupoglu, Seyit Erkan; Balci, Mustafa Bahadir Can; Sinanoglu, Orhun; Tuzlali, PinarIntroduction: Organisms are constantly in a balance meaning that while new cells are produced, some of the older ones die which takes place in 2 ways: necrosis or apoptosis. Apoptosis is the programmed cellular death triggered by intrinsic or extrinsic stimuli. In this study we have evaluated the apoptosis of prostate tissue generated by surgical or medical orchiectomy. Material and Method: In this experimental study, we used 36 adult male rats that were evaluated in 3 groups. The first group (Group 1) consisted of 12 rats that had bilateral orchiectomy; the second group (Group 2) included 12 rats that were given leuprolide acetate and the third group (Group 3) consisted of 12 control rats. Immunohistochemical staining of the prostate of all rats was performed and the presence of glandular atrophy and apoptosis were evaluated in the three groups. The statistical differences between the two groups were evaluated by the Fisher exact test. Results: Glandular atrophy was not determined in any rat of the control group, and the apoptotic staining was in the normal limits in all the control rats. In Leuprolide group, glandular atrophy was mild in 7 cases, and moderate in 3 rats. In 2 rats of the Leuprolide group, atrophy was not demonstrated. In surgical orchiectomy group, glandular atrophy was present in all cases. Atrophy was observed as cystic atrophy. Statistical analysis with the Fisher exact test revealed that glandular atrophy was statistically significantly more common in surgical orchiectomy group compared with Leuprolide group (p = 0,012). Conclusion: If the aim of treatment in androgen dependent prostatic adenocarcinoma or benign prostate hypertrophy is the construction of a robust apoptosis, bilateral orchiectomy generates a more powerful apoptosis compared with Leuprolide.Yayın COMPARISON OF HOUNSFIELD UNITS OF THE RENAL PAPILLAE IN KIDNEY STONE FORMERS AND NON STONE FORMERS(NOBEL ILAC, 2014) Sinanoglu, Orhun; Ekici, Sinan; Cakiroglu, Basri; Cubuk, Rahmi; Aksoy, Suleyman HilmiObjective: To investigate whether renal papillae of patients with nephrolithiasis are more radiodense than that of control patients and to evaluate the predictibility of urolithiasis events using papillary density differences between stone and non stone formers. Material and Method: Hounsfield unit (HU) values of the papillae of 212 patients with unilateral nephrolithiasis and 108 patients in the control group at the level of the upper pole, middle region and lower pole of both kidneys were evaluated. Results: Mean HU density of all papillae of kidneys with stones was higher than that of stone free kidneys in nephrolithiasis patients (27.21 +/- 2.83 vs 25.66 +/- 2, p=0.000). Mean HU density of renal papillae of stone patients in calyces with stones was significantly higher than that of all papillae in control patients (25,82 +/- 1.97 vs 30,25 +/- 4,03, p<0,001). Mean HU density of all papillae in stone-free kidneys of nephrolithiasis patients was not significantly different from that of control patients (25.82 +/- 1.97 vs 25.66 +/- 2.57, p=0.642). When the values for control and patient groups according to stone laterality was evaluated, the difference was significant only between right upper and right lower calyces for the right nephrolithiasis and the left middle region for the left nephrolithiasis. (26.32 +/- 3.30 vs. 27.90 +/- 3.92 and 25.10 +/- 3.34 vs. 26.95 +/- 4.73, p=0.003 and p=0.009 and 25.70 +/- 3.67 vs 27.15 +/- 3.77 p=0.001, respectively). Conclusion: Only the kidneys with stones and especially the patients with papillae facing the stones in nephrolithiasis have higher renal papillary HU. This fact implies the impossibility of HU per se in predicting future urolithiasis events and/or patients; opposing to the findings of a few previous studies.Yayın Comparison of transurethral incision of the prostate and silodosin in patients having benign prostatic obstruction in terms of retrograde ejaculation(PAGEPRESS PUBL, 2017) Cakiroglu, Basri; Hazar, Aydin Ismet; Sinanoglu, Orhun; Arda, Ersan; Ekici, SinanBackground: To compare the functional outcomes and retrograde ejaculation (RE) after transurethral incision of the prostate (TUIP) or silodosin in bladder outlet obstruction (BOO) secondary to a small prostate. Methods: Prospectively collected data from December 2011 through December 2014 of 192 LUTS patients having fertility concerns with prostate volume smaller than 40 ml receiving either TUIP or silodosin treatment were prospectively reviewed. The treatment outcomes were evaluated and compared. Results: TUIP was performed in 96 cases and silodosin 8 mg was prescribed in 96 cases. At 12th months after TUIP or continuous silodosin treatment, the decrease in mean International Prostate Symptom Score (IPSS) and postvoiding residual urine (PVR) and the improvement of mean maximal flow rate (Q(max)) were significant (p = 0.000). The improvement in IPPS and Qmax was significantly higher in TUIP group compared to silodosin group (p = 0.005, p = 0.000) with a lower rate of retrograde ejaculation (RE) in TUIP group. (11/96 vs 33/96) (p = 0.000) Conclusions: Both TUIP and silodosin ensures comparable improvement in PVR, IPSS and Q(max) with a lower rate of RE on the TUIP group in prostates weighing less than 40 grams suggesting that TUIP is a better choice in younger patiens seeking preservation of ejaculation with fertility concerns.Yayın Does Mild Hydronephrosis Induced by Full-Bladder Improve Outcomes in Patients Undergoing Shock Wave Lithotripsy for Lower Calyceal Stones?: A Prospective Randomized Study(UROL & NEPHROL RES CTR-UNRC, 2018) Hazar, Ismet Aydin; Cakiroglu, Basri; Sinanoglu, Orhun; Akgun, Feride Sinem; Arda, Ersan; Yuksel, Ilkan; Akdere, HakanPurpose: To compare the outcomes, sessions and shock wave numbers in patients undergoing standard procedure shock wave lithotripsy (SWL) and patients undergoing SWL with mild hydronephrosis induced by full-bladder following oral hydration before SWL procedure for lower calyceal stones. Materials and Methods: Between January 2014-January 2016 a total of 371 patients who underwent SWL, for lower pole calyceal stones 2 cm, were included into the study. 127 patients were treated in the supine position (Group A), 123 in the prone position (Group B) and 121 in the prone position with full bladder and mild hydronephrosis checked by ultrasound before procedure (Group C). There were 286 men and 85 women with a mean SD age of 36 11 years Results: The mean (SD) stone sizes within the group A, group B and group C were 11 mm (+/- 3 mm), 12 mm (+/- 4.1 mm) and 11 mm ( +/- 3.8 mm) respectively. No significant difference was found in age (P =.18) and stone size between 3 groups (P =.07). The median interquartile range (IQR) number of shocks within the group A, group B and group C were 7600 (3855), 6500 (4300) and 6700 (4915) respectively. Significant difference was found in number of shock waves among 3 groups (P <.01). The difference between groups according to stone expulsion rate was found significant in all sessions (P =.01). Conclusion: The present study suggests that mild hydronephrotic status induced by full-bladder before SWL can lower cost and patient discomfort by decrease in number of sessions and increase in stone clearance.Yayın The effect of inclined position on stone free rates in patients with lower caliceal stones during SWL session(PAGEPRESS PUBL, 2015) Cakiroglu, Basri; Sinanoglu, Orhun; Tas, Tuncay; Hazar, Ismet Aydin; Balci, Mustafa Bahadir CanObjective: To compare the outcomes of shock wave lithotripsy (SWL) combined with inclined position and SWL alone in patients with lower pole calyx stones. Methods: Seven hundred forty patients who underwent SWL treatment for lower pole renal stones with a total diameter of 2 cm or less were prospectively randomized into two groups. They were comparable in terms of age, sex, and stone diameters. Patients with lower calyceal stones (4-20 mm) were randomized to SWL (368 patients) or SWL with simultaneous inclination (372 patients) with 30o head down Trendelenburg position). Shock wave and session numbers were standardized according to stone size. Additional standardized shock waves were given to patients with stone fragments determined by kidney urinary bladder film and ultrasound at weeks 1, 4, 10. Results: The overall stone free rate (SFR) was 73% (268/368) in patients with SWL alone and 81% (300/372) in SWL with inclination at the end of 12th week (p = 0.015). No significant adverse events were noted in both treatment groups. Conclusion: Simultaneous inclination of patients during SWL session increase SFR in lower caliceal stones significantly compared to SWL treatment alone.Yayın The histology and the proapoptotic control in the ipsilateral and the contralateral testes following unilateral vasectomy(PAGEPRESS PUBL, 2015) Hazar, Aydin Ismet; Cakiroglu, Basri; Sakalli, Ertan; Balci, Mustafa Bahadir Can; Eyyupoglu, Erkan; Tas, Tuncay; Sinanoglu, Orhun; Tuzlali, Pinar; Cilesiz, Nusret CanObjective: The aim of this study was to enlighten both the testicular histology and the genetic aspects of the apoptotic process. Thus an experimental study was designed with a model of unilateral vasectomy. Methods: Twenty-two adult male rats were used and 4 main groups were formed. The first (A), the second (B), the third (C), and the fourth group (D) consisted of 4, 4, 4 and 10 rats respectively. Rats in group A had sham operation while rats in other groups (B, C, D) underwent left vasectomy operation including binding of ductus deferens with a 3/0 silk and cutting a minimum of 1 cm part while preserving the vascular structure under 9x magnification. Rats undergoing unilateral vasectomy were sacrificed at the 1st, 2nd and 8th weeks and their testicular structure and proapoptotic gene proteins were compared with that of the control group undergoing sham operation. Results: We found that vasectomy gradually caused destruction and both ipsilateral and contralateral testicles were affected showing initial apoptosis. Conclusion: The procedure causes destruction in the testicular structure by causing bilateral intratubular germ cell necrosis, unilateral obstruction, increase in the tubular pressure and processes that are aggravated by some probable autoimmune reactions.Yayın MODIFIED KDIGO FOR PREDICTING MORTALITY IN ICU PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY FOR ACUTE RENAL FAILURE: KDIGO-URINARY OUTPUT VS. KDIGO-SERUM CREATININE LEVEL(CARBONE EDITORE, 2016) Tulgar, Serkan; Cakiroglu, Basri; Cevik, Banu Eler; Karakilic, Evvah; Ates, Nagihan Gozde; Gergerli, Ruken; Ozdemir, ErmanIntroduction: Acute Renal Injury (ARI) is a constant problem for patients in intensive care and Continuous Renal Replacement Therapy (CRRT) is an ever-more important part of acute renal injury (ARI) treatment. Various criteria have been used for the diagnosis and classification of acute renal failure, including RIFLE (Risk-Injury-Failure-Loss-End stage), AKIN (Acute Kidney Injury Network) and most recently KDIGO (Kidney Disease: Improving Global Outcomes). Many studies have only evaluated urinary output or serum creatinine when categorizing ARI. Our aim was to determine the predictors of mortality in intensive care patients treated with CRRT and to compare mortality with ARI level as determined by KDIGO-Serum Creatinine (KDIGO-SCr) and KDIGO-urinary output (KDIGO-UO) Materials and methods: This retrospective study was performed on intensive care patients receiving CRRT at our institute between January 2010-December 2011. Patient files were reviewed and demographic data, hospitalization time, laboratory findings, CRRT commencement and ARI levels were noted. Results: Seventy patients were included in the study. Mortality was found to be associated with patients' age, Glascow Coma Scale (GCS) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score and adjusted predicted death rate. (p<0,01). Receiver Operating Curve (ROC) area under the curve was statistically significant for determination of mortality using KDIGO-SCR (p<0.01) although the same was not true for KDIGO-UO (p>0.05). Conclusions: We believe that RIFLE, AKIN, KDIGO criteria are each good predictors of mortality. In the case of KDIGO criteria, based solely on serum creatinine or urinary output, KDIGO-SCr was found to be a better predictor of mortality when compared to KDIGO-UO.Yayın Monosymptomatic nocturnal enuresis caused by seasonal temperature changes(E-CENTURY PUBLISHING CORP, 2014) Tas, Tuncay; Cakiroglu, Basri; Hazar, Aydin Ismet; Balci, Mustafa Bahadir Can; Sinanoglu, Orhun; Nas, Yunus; Yilmazer, FazliBackground: Primary nocturnal enuresis is the most frequent urologic complaint among pediatric patients. Enuresis is believed to have a complex etiology involving genetic, somatic, and behavioral factors. We study the relationship between seasonal temperature changes effect and monosymptomatic nocturnal enuresis (MNE). Methods: Between 2011 and 2012, a total of 75 children with primary MNE selected from urology and pediatry clinics were included in this study. All of the children underwent physical examinations, urine analyses, urinary ultrasounds, and direct urinary graphs. We evaluated the enuresis ratio for the summer (the hot season from June to September) and winter (the cold season from December to March) months in nightly, weekly, and monthly intervals via prepared questionnaires. Results: Of the 75 study participants, 45 were boys (60%) and 30 were girls (40%). The age range was 6-16 years (mean 10.3 +/- 2.0 years). We observed a difference in the ratio of enuresis data between the summer and winter months in 29 males and 19 females, which totals 48 of the 75 MNE patients evaluated in this study. There was a statistically significant difference noted in monthly enuresis ratio in the summer and winter (p<0.0001). We observed a significant difference in quality of life, and this difference caused considerable emotional discomfort for the patients. Conclusion: In the winter months, the nightly, weekly, and monthly ratios are higher in children with MNE. This increase causes a decrease in the quality of life of these children.Yayın Outcome of buccal mucosa urethroplasty in the management of urethral strictures(PAGEPRESS PUBL, 2017) Cakiroglu, Basri; Sinanoglu, Orhun; Arda, ErsanObjective: The objective of the study is to report the outcome of buccal mucosal urethroplasty. Materials and methods: The follow up data of 15 patients undergoing single stage urethroplasty from September 2010 to September 2015 were retropectively reviewed. They received buccal mucosa graft for urethroplasty. The patients were followed for complications and outcome. Results: Mean age was 53.7 +/- 13.6 The stricture length ranged from 3 to 6 cm (mean 4.4 +/- 0.8). The success rate for buccal mucosa urethroplasty (BMU) was 67.7% at 12th month. Three patients presenting with voiding difficulty in the 3rd month and one in the next 12 months, had urethral restenosis. One patient had fistula formation at 6th month postoperatively. Five patients underwent retreatment procedures such as internal urethrotomy, urethroplasty and/or internal urethrotomy. Conclusions: The buccal mucosa is easy to obtain and handle, therefore BMU can be safely and effectively managed outside high volume institutions.Yayın Safety of greenlight photoselective vaporisation of prostate in lower urinary tract symptoms due to benign prostatic hyperplasia in patients using anticoagulants due to cardiovascular comorbidities(PAGEPRESS PUBL, 2015) Cakiroglu, Basri; Sinanoglu, Orhun; Dogan, Akif NuriLasers have been used in the management of benign prostatic hyperplasia for the last two decades. To be comparable, they should reduce or avoid the immediate and long-term complications of transurethral resection of the prostate (TURP) or open prostatectomy (OP), especially bleeding and need for blood transfusion. Although Holmium laser treatment of the prostate was compared frequently in terms of cardiovascular safety with TURP or OP, photoselective vaporisation of the prostate (PVP) was not largely evaluated. In this article we analyzed the current literature to see if there is convincing data to support the observation of some authors that use of PVP is associated with increased safety in patients on anticoagulants with cardiovascular comorbidities. With this purpose a Medline search between January 2004 to March 2013 was performed using evidence obtained from randomised trials, well-designed controlled studies without randomisation, individual cohort studies, individual case control studies and case reports Results: In the last 10 years, several case-control and cohort studies have demonstrated the efficacy of PVP as well as its safety in patients with cardiovascular comorbidities using anticoagulants. The results confirmed the overall lower peri-operative and postoperative morbidity of PVP, whereas the efficacy was comparable to TURP in the short term, despite a higher reoperation rate. Conclusion: Although it is still developing, PVP with KTP or LBO seems to be a promising alternative to both TURP and OP in terms of cardiovascular safety and in patients using anticoagulants.Yayın Short-lasting pediatric laparoscopic surgery: Are muscle relaxants necessary? Endotracheal intubation vs. laryngeal mask airway(W B SAUNDERS CO-ELSEVIER INC, 2017) Tulgar, Serkan; Boga, Ibrahim; Cakiroglu, Basri; Thomas, David TerencePurpose: Technical advances have led to lower insufflation pressures and shorter anesthesia times for children undergoing laparoscopic procedures. In this study we compared the use of endotracheal tube (ETT) and laryngeal mask airway (LMA) with or without muscle relaxant (MR) in children undergoing laparoscopic repair for inguinal hernia. Methods: Children undergoing laparoscopic inguinal hernia repair were randomized into four groups which underwent procedure with either ETT + MR (group 1), ETT without MR (group 2), LMA with subparalytic dose of MR (group 3) or LMA without MR (group 4). Surgical, anesthesia and recovery times, intragastric pressures and peak airway pressures during insufflation were compared. Results: After exclusion criteria and discontinued interventions, groups 1 and 3 contained 20, groups 2 and 4 contained 19 patients each. Surgical times were similar between groups. Anesthesia times were statistically significantly different between groups with shortest time in group 4 and longest time in group 1. Recovery time was statistically significantly longer in group 1 when compared to other groups. There was no difference between basal intragastric pressure, average intragastric pressure during insufflation, peak airway pressure, and average peak airway pressure during insufflation of groups. Conclusion: Use of muscle relaxants in short-lasting laparoscopic procedures in children is not absolutely necessary and LMA with subparalytic dose of muscle relaxant or with no muscle relaxant is a safe alternative. (C) 2017 Elsevier Inc. All rights reserved.
