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Öğe Accuracy of transrectal ultrasound guided prostate biopsy: histopathological correlation to matched prostatectomy specimens(Blackwell Publishing Asia, 2002) Çam, Kamil; Yücel, Selçuk; Türkeri, Levent; Akdaş, AtıfBackground: The Gleason grading system is currently the world's most commonly used histological system for prostate cancer. It provides significant information about the prognosis. Therefore, Gleason score is accepted as an important factor in therapeutic decision-making for prostate cancer. This retrospective study assessed the correlation of transrectal ultrasound (TRUS) guided biopsy and radical prostatectomy specimens in terms of Gleason scores. Methods: We reviewed the records of 103 patients who underwent radical prostatectomy due to clinically localized prostate cancer. The Gleason scores of the TRUS biopsies were compared with the respective Gleason scores of surgical specimen. Results: In 28.7% of cases, the TRUS biopsy score was the same as that of the radical prostatectomy specimen. The most significant discordance was the upgrading of well-differentiated tumors after surgery in 71.7% of cases. However, in 81.8% of cases with high Gleason score on TRUS, biopsy was correlated with poorly differentiated tumor after surgery. Conclusions: Well-differentiated tumors on TRUS biopsy did not correlate with the grades of final pathology in the majority of cases; however, a high Gleason score on TRUS biopsy usually indicated a poorly differentiated tumor on prostatectomy specimen. Therefore, the treatment algorithms for particularly well-differentiated tumors should not be deduced from biopsy histology alone.Öğe Alt üriner sistem yakınmaları ile başvuran hastalarda prostat kanseri erken tanısı ve hastaların yıllık takip protokolüne uyumu(2001) Akman, Yavuz; Çam, Kamil; Erol, AliProstat kanseri erken tanısında 50 yaş üzerindeki erkeklerde yıllık prostat spesifik antijen (PSA) ve parmakla rektal muayene (PRM) uygulaması önerilmektedir. Bu çalışmada alt Üriner sistem yakınmaları ile başvuran hastalarda prostat kanseri erken tanısı ve benign prostat hiperplazisi tanısı ile tedavi edilen hastaların prostat kanseri açısından yıllık takip protokolüne uyumu araştırıldı. Bir yıl içerisinde toplam 779 hasta alt Üriner sistem yakınmaları ile üroloji polikiniğimize başvurdu. Tüm hastalarda PRM ve PSA ile prostat kanseri taraması yapıldı. Sonuçları normal olan tüm hastalar benign prostat hiperolazisine yönelik hangi tedavi alırlarsa alsınlar yıllık takip gerekliliği konusunda bilgilendirilerek takip protokolüne alındı. PSA 4 ng/ml üzeri ve/veya PRM sonucu anormal olan toplam 156 hastaya prostat biyopsisi uygulandı ve sonuçta alt Üriner sistem yakınmaları ile başvuran hastalarda %4 (30/779) oranında prostat kanseri saptandı. Klinik evrelendirme sonucunda 20 hastada metastatik, 10 hastada ise lokal prostat kanseri belirlendi. Öte yandan, prostatektomi yapılan 115 hastanın sadece 14'ünün (%12) 1. yılda bu amaçla kontrole geldiği görüldü. Uzun dönem (bir yıldan uzun) medikal tedavi önerilen hastaların (toplam 33) ise daha büyük oranda (14 hasta, %42) prostat kanseri taraması için geldikleri izlendi, îlk biyopsi sonucu benign olan hastaların bile (125 hasta) sadece 39'nun (%31,2) kontrole geldiği saptandı. Sonuç olarak bu çalışmada, alt Üriner sistem yakınmaları ile başvuran hastalarda PSA ve PRM kombinasyonu ile %4 oranında prostat kanseri saptanmıştır. Ancak hastaların çoğunluğunun küratif tedavi sınırlarının dışında olduğu görülmektedir. Öte yandan prostat kanseri takip protokolü (yıllık PSA+PRM) önerilen hastaların büyük çoğunluğu birinci yıldaki kontrollerine dahi gelmemişlerdir. Bu oran özellikle prostatektomi grubunda oldukça yüksektir. Dolayısıyla prostat kanseri taraması gündeme geldiğinde kamuoyuna yönelik bilgilendirme çalışmalarına gereksinim duyulmaktadır.Öğe Contemporary approach in the medical treatment for benign prostatic hyperplasia(2003) Çiçekçi, Bülent; Çam, Kamil; Akman, Yavuz; Erol, AliBenign prostatic hyperplasia (BPH) contemporarily constitutes one of the major public health problems as its incidence increases with aging. Surgical treatment modalities were the main stay in the management of BPH. However, several medical treatment alternatives have been developed and extensively utilised especially during the last decade. Consequently, medical treatment alternatives have decreased the number of surgeries for BPH all over the world. In this review, current medical treatment approaches in the management of BPH were discussed.Öğe Düzce ilinde ilköğretim çağındaki erkek çocuklarda dış genital organ anomali oranları(2005) Kayıkçı, M. Ali; Çam, Kamil; Akman, R. Yavuz; Erol, AliBu çalışmada Düzce ilinde ilköğretim çağındaki erkek çocuklarda dış genital organ anomali oranlarım belirlenmesi hedeflendi. İl merkezindeki 25 adet ilköğretim okulunda öğrenim görmekte olan ve rastgele örnekleme yöntemi ile 7-15 yaş arasındaki toplam 13420 erkek öğrenciden, 1534 erkek öğrenci çalışmaya dahil edildi. Tüm öğrenciler aynı hekim tarafından okullarında muayene edildi ve tespit edilen dış genital organ anomalileri kaydedildi. Yapılan incelemede 1534 erkek öğrencinin 104'ünde (%7,2) 110 patoloji saptandı. En sık rastlanan patolojiler sırasıyla varikosel, fımosiz ve inmemiş testis idi. Bu çalışmada bir çoğu ilköğretim çağından önce tespit ve tedavi edilmesi gereken dış genital organ anomalileri yüksek oranda bulundu. Dolayısıyla bu sonuç, gerek neonatal dönemde gerekse de sonraki izlemde çocukların genital sistem açısından yeterli kontrollerinin yapılmadığını ve ailelerin bu patolojiler hakkında bilgi sahibi olmadığını göstermektedir.Öğe The effect of extracorporeal shock waves on a rat model of injury to tendo achillis - a histological and biomechanical study(British Editorial Soc Bone Joint Surgery, 2004) Orhan, Zafer; Özturan, Kutay; Güven, Aysel; Çam, KamilThe effects of extracorporeal shock waves (ESWT) on tendon healing were assessed by observing histological and biomechanical parameters in a rat model of injury to the tendo Achillis. The injury was created by inserting an 18-G needle through tendo Achillis in 48 adult Wistar albino rats. The animals were divided into three groups. The first group received radiation only after the operation. The second received no shock waves and the third had 500 15 KV shocks on the second post-operative day. All the rats were killed on the 21st day after surgery. Histopathological analysis showed an increase in the number of capillaries and less formation of adhesions in the study group compared with the control group (p = 0.03). A significantly greater force was required to rupture the tendon in the study group (p = 0.028). Our findings suggest a basis for clinical trials using ESWT.Öğe The effects of extracorporeal shock waves on the rat achilles tendon: is there a critical dose for tissue injury?(Springer, 2004) Orhan, Zafer; Çam, Kamil; Alper, Murat; Özturan, KutayIntroduction: Extracorporeal shock waves (ESW) have been extensively studied in the field of orthopedics. Experimental and focused, well-designed clinical studies have suggested the clinical utilisation of ESW in several pathologies including delayed bone union, tennis elbow, and plantar fasciitis. However, the unwanted detrimental effects of ESW on various tissues have been questioned by some authors. In this experimental study, the effects of ESW were investigated at different intensity applications on the Achilles tendons of rat. Materials and methods: A total of 32 adult Wistar albino rats was divided into four groups. The first three groups received 1000 impulses of 0.15 MJ/mm(2) 1500 impulses of 0.15 mJ/mm(2), and 2000 impulses of 0.20 mJ/mm(2), respectively. The last group was kept as the control group. Subsequently, Achilles tendons were harvested for histological studies from all rats at the 3rd week after a single application of ESW. Results: There were no histological abnormalities observed in the Achilles tendons of the first two groups compared with the control group. No alteration in the histological configuration was observed, and consequently the pathologist who had been blinded could not differentiate these rats from the control group by light microscopy. However, in the high intensity group (2000 impulses of 0.20 mJ/mm(2)), grade II and III disorganisation of collagen fibers was noticed in 7 out of 8 rats, which was not detected in any of the rats from the first two groups (p<0.05). Consequently, the pathologist could distinguish the majority of the rats (7 out of 8) of this group from the remaining ones. Meanwhile, grade I lymphocyte infiltration was observed in some sections of the rats receiving the highest ESW dose. Conclusion: This study confirms that ESW application at high intensity is associated with detrimental tissue effects. Additionally, it was suggested that the extent of tissue injury caused by ESW is dose-related.Öğe The efficacy of an abbreviated model of the International prostate symptom score in evaluating benign prostatic hyperplasia(Wiley, 2003) Çam, Kamil; Şenel, Ferda; Akman, Yavuz; Erol, AliOBJECTIVES To investigate the acceptability to patients in Turkey of the International Prostate Symptom Score (IPSS) for evaluating benign prostatic hyperplasia (BPH), and to devise a possible abbreviated model, saving time when administered by a physician. PATIENTS AND MEATHODS The IPSS questionnaire was initially self-administered in 200 consecutive patients aged> 50 years and with lower urinary tract symptoms. Patients were instructed only to mark questions which they clearly understood. The IPSS was then administered to 500 consecutive patients by the same physician. Subsequently, each of the seven questions was separately correlated with the IPSS and quality-of-life (QoL) score. The first five questions with the highest correlation coefficient for both the total IPSS and QoL score were identified, and every possible combination of these questions produced and correlated. RESULTS In the first group, 29% of the patients did not complete the form and 44% could not mark at least one item; the effect of educational level was significant (P < 0.05). In the second group a combination of the first three items had a Pearson's correlation of 0.90 with the total IPSS; similarly, four questions combined (2, 3, 6 and 7) also correlated well (r = 0.92). Both combinations took significantly less time to administer (P < 0.05). CONCLUSION The abbreviated form of the IPSS consisting of three or four items may be used to assess symptoms in patients with BPH, especially in underdeveloped countries.Öğe An eleven year old forgotten ureteral stent: A serious dilemma in the management(2003) Çam, Kamil; Çiçekçi, Bülent; Akman, Yavuz; Erol, AliUreteral stents play a major role in the endourological management of a vide spectrum of urological disorders and have been utilised tremendously almost in all urology clinics. Although, duration of various stents may vary they should usually be removed in six months. Otherwise, the management of forgotten stents may constitute a major dilemma. Here, we report three cases of forgotten stents. One of them had duration of eleven years-the longest time in the literature and required open surgery with multiple incisions.Öğe Extensive cutaneous metastasis of transitional cell carcinoma of the bladder(Blackwell Publishing Asia, 2003) Akman, Yavuz; Çam, Kamil; Kavak, Ayşe; Alper, MuratCutaneous metastasis of bladder carcinoma is extremely rare. Iatrogenic implantations have been the main cause in the majority of cases of transitional cell carcinoma with cutaneous metastasis. Otherwise, primary cutaneous metastasis is accepted as the late manifestation of systemic spread. The present paper describes a case of relatively early and extensive skin metastasis of transitional cell carcinoma in a 78-year-old man. The patient had a histopathological diagnosis of poorly differentiated (grade III) muscle invasive transitional cell carcinoma with a staging of T2NOMO 6 months prior to presenting. He presented to our outpatient clinic with a 3-month history of skin lesions as multiple, rubbery subcutaneous nodules. Radiological reinvestigation revealed no other metastatic site (including bone and lung), except for a metastatic nodule in the liver. The present paper reports an interesting and rare case of extensive skin metastasis of transitional cell carcinoma as the primary complaint.Öğe Isolated congenital urethrocutaneous fistula(2005) Akman, Ramazan Yavuz; Çam, Kamil; Akyüz, Osman; Erol, AliCongenital urethrocutaneous fistula of the male urethra is an extremely rare anomaly that is commonly seen in association with anorectal malformations or chordee. A case of congenital urethrocutaneous fistula not associated with other congenital anomalies is reported, discussing possible etiologies and surgical management.Öğe Mode of administration of international prostate symptom score in patients with lower urinary tract symptoms: physician vs self(Nature Publishing Group, 2004) Çam, Kamil; Akman, Yavuz; Çiçekçi, Bülent; Şenel, Ferda; Erol, AliInternational prostate symptom score (IPSS) was claimed to be complicated for patients. The aim of this study was to measure differences in IPSS when introduced by a physician vs self-administration. Patients with lower urinary tract symptoms completed two IPSS questionnaires: one self-administrated and the other by a physician 1 week apart. Results with 75 patients in each group suggested that there was no statistically significant difference between patient and physician administration, although the mean scores of patients' administration were higher in both groups. In conclusion, when assessing IPSS before treatment, we found no difference between patient administration and physician administration.Öğe The place of estramustine phosphate in the management of prostate cancer(2003) Çam, Kamil; Yıldırım, Asıf; Özveri, Hakan; Akdaş, ArifEstramustine phosphate has been extensively used in the management of prostate cancer with distinct purposes that include primary treatment of metastatic prostate cancer and adjuvant or neoadjuvant applications in the localised cases. However, the most common clinical use is in the management of hormone refractory prostate cancer. Oral administration provides an important preference and also proven synergism with a number of chemotherapetic agents has caused utilisation in different combinations. The PSA response was documented between 30 to %60 in these studies. Gastrointestinal tract and cardiovascular toxicities are the main drawbacks. In conclusion, estramustine phosphate with respect to its easy administration as a hormonal and chemotherapeutic agent is one of the most common drugs used in the management of prostate cancer particularly in the case of hormone refractory disease.Öğe The ratio of external genital anomalies in male children attending primary school in Düzce(2005) Kayikçi, M. Ali; Çam, Kamil; Akman, R. Yavuz; Erol, AliIntroduction: The aim of the study was to identify the rates of external genital anomalies in male children who are attending primary school in Düzce. Materials and methods: A total of 1534 children out of 13420 male students attending to 25 primary schools in Düzce were included into the study. The age range was between 7 and 16. The same physician examined all students, and external genital anomalies were identified and noted. Results: In this study, a total of 110 (7.2%) anomalies were identified in 104 students. The most common anomalies were varicocele (3.22%), phimosis (1.49%) and undescended testis (1.10%). Conclusion: The rate of external genital anomalies was found to be remarkably high. Actually, almost all of these anomalies had had to be diagnosed and managed before the school ages. Consequently, the results of the current study suggest that there is an insufficient examination and follow up during the neonatal period extending up to school ages. In addition to this, parents do not have any information about these pathologies. Such undiagnosed pathologies will cause significant psychological and urological problems in these children. They may also progress to tumor or infertility. Therefore, this observation should be regarded as an important public health issue.Öğe The role of reactive oxygen species and apoptosis in the pathogenesis of varicocele in a rat model and efficiency of vitamin e treatment(Wiley, 2004) Çam, Kamil; Şimşek, Ferruh; Yüksel, Meral; Türker, Levent; Haklar, Goncagül; Yalçın, Süha; Akdaş, AtıfWe investigated role of reactive oxygen species (ROS) and apoptosis in the pathogenesis of infertility in experimental model of varicocele. The protective effect of vitamin E was also examined. Three groups of rats were constructed as the first group had sham operation, experimental varicoceles were established by partial ligation of the left renal vein in later two groups. Third group had received vitamin E. Production of ROS was determined by chemiluminescence assay (CL). The in situ end labelling technique was utilized to investigate apoptosis. Tissue vitamin E levels were measured by high performance liquid chromatography. The differences between luminol enhanced CL levels of groups were not statistically significant. However, the difference between CL levels of lucigenin probe in left testicles of sham and varicocele groups were statistically significant (p = 0.0007). Similarly, the results of the third group receiving vitamin E significantly differed from the varicocele group (p = 0.0025). The difference of apoptotic index was also statistically significant between sham and varicocele groups (p = 0.0038). Although the values of apoptotic index detected in the vitamin E group were lower compared with the varicocele group, the difference was not significant. This study proposes that ROS production and apoptosis in the testicles were induced with experimental varicocele. Vitamin E had a protective role. An increased rate of apoptosis with experimental varicocele suggests a molecular alteration, which may involve ROS overproduction as the triggering mechanism. Consequently, this study indicates an association between varicocele and infertility at molecular level through stimulation of ROS and apoptosis.Öğe Selim prostat büyümesinde yaşam kalitesi(2006) Müezzinoğlu, Talha; Çam, KamilSon yıllarda yaşam kalitesinin (YK) her alanda giderek artan bir ilgi gördüğü dikkate alınarak bu derlemede YK'nin selim prostat büyümesindeki (BPH) özellikle tedaviyi yönlendirmedeki rolünün ortaya konması amaçlanmıştır. Aslında BPH hastalarında genellikle tedavide hedef hastanın semptomları olmaktadır. Dolayısıyla hastanın YK'nin bu semptomlardan ne kadar etkilendiğinin bilinmesi en uygun tedavi seçiminde esas olmalıdır. Mevcut uygulamaların özellikle semptom skorlarının YK'yi ölçmediği de bilindiğinden, sadece bunlara dayanarak bir tedavi önerilmemelidir. Bu derlemede mevcut bilgi birikimi ve gelecekteki perspektifi ile BPH'da YK irdelenmiştir.Öğe Short-term subjective efficacy of doxazosin in predicting probability of prostatectomy in the management of benign prostatic hyperplasia in patients with severe symptoms(Blackwell Publishing Asia, 2003) Çam, Kamil; Akman, Yavuz; Kayıkçı, Ali; Şenel, Ferda; Erol, AliBackground. The severity of symptoms still constitutes the major indication for transurethral prostatectomy, despite the extensive utilization of medical treatments. The aim of the study presented here was to investigate the impact of doxazosin on symptoms in relation to the probability of consequent surgery in severely symptomatic patients. Methods. Patients with an International Prostate Symptom Score (IPSS) between 18 and 35 were included in the study. The patients received 4 mg/day doxazosin, and subjective efficacy was assessed by IPSS at the first and third months. In addition, the patients were classified at the third month according to a single question regarding satisfaction with medical treatment in terms of symptom relief as 'ineffective, no change, and effective'. Results. A total of 178 patients constituted the study group. Mean total symptom scores were 24, 19 and 17 at baseline, first and third months, respectively (P < 0.05). According to results of the questionnaire, 23% of the patients claimed the treatment was ineffective, and subsequently, the majority of this group (93%) underwent prostatectomy in a year. In addition, 33% of the patients reported no change in their symptoms, while 44% reported that the medication was effective. However, after 1 year, 59% and 15% of these cases underwent surgical treatment, respectively. The probability of surgery in the 'ineffective' group was significantly higher compared to the remaining groups (P < 0.05). Conclusion. The majority of patients with severe symptoms who were not satisfied with the medication at the 3rd month underwent surgery. This observation may provide a predictor for subsequent probability of prostatectomy. Therefore, reassessment of patients would be a cost-effective approach for the treatment of BPH in severely symptomatic patients.Öğe Tuberculous orchitis in chronic renal failure.(2004) Alper, M.; Balbay, Öner Abidin; Akman, Yavuz Ramazan; Arbak, Peri Meram; Çam, KamilTuberculosis confined to the testes with no epididymal involvement is uncommon. Chronic renal failure patients requiring hemodialysis have increased risk for developing tuberculosis. We report a 47-year old chronic renal failure man presenting with right testicular tuberculous orchitis. A high index of suspicion is required to recognize the unusual presentation of tuberculosis in this group of patients, and routine screening for tuberculosis may be recommended in patients undergoing hemodialysis.
