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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 Anatomical studies of the urethral plate: Why preservation of the urethral plate is important in hypospadias repair(2000) Erol, Ali; Baskin, Laurence S.; Li, Yingwu; Liu, WenhuiObjective. To describe the detailed anatomy of the urethral plate in relation to its controversial role in hypospadias surgery. Materials and methods. A newborn penis with proximal penile hypospadias and two fetal penises with distal shaft hypospadias were included in the study; 30 normal fetal penises served as the control. Specimens were embedded in paraffin and serially sectioned (6 ?m) after formalin fixation. Every 10 th section was stained with haematoxylin and eosin. Immunohistochemical staining for nerves (S100), smooth muscles (?-actin), blood vessels (factor VIII) and epithelium (cytokeratins 7, 14 and 18) were used on selected sections, with particular attention to the urethral plate. Masson's trichrome and Sirius Red stains were used to localize collagen. Results. There were extensive blood vessels, glands and smooth muscle under the urethral plate in the hypospadias specimens. These relatively well organized tissues corresponded to an abnormally formed corpus spongiosum. The glands underneath the urethral plate and adjacent to the normal urethra showed positive staining for cytokeratins 7 and 18, respectively (markers of endodermal origin) but were negative for cytokeratin 14 (a marker of ectodermal origin). Penile skin and urethral plate epithelium stained positively for cytokeratin 14 but not for cytokeratin 7 and 18. The urethral plate has a rich nerve supply, as determined by S100 staining. Collagen intensity under the urethral plate was no different from that in normal areas. Tunica albuginea stained intensely for type I and III collagen. Conclusion. These results show that the urethral plate is well vascularized, has a rich nerve supply and an extensive muscular and connective tissue backing. These features may explain the lower complication rate with onlay flaps than with tube flaps. Therefore, from these anatomical findings, we continue to advocate preservation of the urethral plate and the onlay island flap for hypospadias reconstruction.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 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 Is midazolam effective as an antioxidant in preventing reperfusion injury in rat kidney?(2002) Erol, Uğur; Gürdal, Mesut; Erol, Ali; Aslan, Ruknettin; Konukoğlu, Dildar; Onmuş, HaleThis experimental study was designed to investigate whether midazolam has antioxidant effects in reperfused rat kidneys following ischemia. Twenty Wistar Albino rats were incuded in the study. Rats were anesthesized with the mixture of ketamine 90 mg/kg and xylazine 10 mg/kg administered intraperitoneally. Following anesthesia, the rats were divided into two groups. The first group was considered as the control group, whereas the second group received additional midazolam 3.5 mg/kg intraperitoneally. The left kidney was approached via a transabdominal incision and the left renal artery was dissected. Left renal ischemia was created by clamping the left renal artery for 45 minutes. Following the ischemia period, the kidney was reperfused for one hour. Both kidneys were then removed. Half of the left kidneys were immediately immersed in liquid nitrogen for transportation and then frozen at -70 C until measurements of tissue malondialdehyde (MDA) and glutathione (GSH) levels. The remaining halves of the left kidneys and right kidneys were fixed in 10% formalin. The changes which developed during the ischemia-reperfusion period in the left kidney were investigated by histopathological examination and compared with those of the normal contralateral kidney. When compared with the control group, tissue MDA and GSH levels were similar in the midazolam group (p > 0.05). Tubular damage with tubulitis and focal interstitial inflammatory infiltration were observed in histopathological examinations of reperfused left kidneys of the control group. There was PMNL infiltration only in perirenal fat tissue of the midazolam group. Right kidneys were histopathologically normal in both groups. We concluded that within this dosage midazolam does not have any antioxidant effect in reperfused rat kidneys following ischemia.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 Komplike bir ikontinans olgusu: Vezikovajinal fistüle sekonder gelişen mesane pseudotümörü ve kompanse böbrek yetmezliği(2004) Karateke, Ateş; Gürbüz, Ayşe; Gaziyiz, Öztürk Göknur; Erol, AliBiz bu olgu sunumunda renal fonksiyonların olumsuz etkilendiği bir üriner inkontinans olgusu nedeniyle, üriner inkontinansın ayırıcı tanısının önemini ve gelişebilecek komplikasyonları tartıştık. Bu olgumuzda vajinal histerektomi sonrası gelişen ve tanısı koyulamayan veziko-vajinal fistül, sekonder olarak enflamatuvar mesane pseudotümörüne ve mesane duvarı infiltrasyonu sonucu azalmış mesane kapasitesine yolaçmıştır. Üriner inkontinansın nedeni stres üriner inkontinans olarak değerlendirilip, 2 yıl önce uygulanan pubovajinal sling operasyonu, outlet obstrüksüyona neden olmuştur. Bu nedenlerle oluşan grade 5 vezikoüreteral reflü böbrek fonksiyonlarında bozulmaya neden olmuştur. Bu olguda renal fonksiyonların korunmasına yönelik ileal konduit operasyonu uygulandı. Sonuç olarak; üriner inkontinansın nedeni özellikle cerrahi operasyon geçirmiş, daha önceki cerrahi tedaviye cevap vermeyen olgularda dikkatle incelenmeli, ayrıntılı anamnez alınmalı, dikkatli fizik muayene ve ürodinamik inceleme uygulanmalıdır.Öğe Malignant mesothelioma of tunica vaginalis testis associated with long-lasting hydrocele: Could hydrocele be an etiological factor?(2001) Gürdal, Mesut; Erol, AliA case of malign mesothelioma of tunica vaginalis testis in a 67 year old man with a 30 year history of hydrocele was reported. The diagnosis was made with an excisional biopsy performed in scrotal exploration and revealed epithelial type mesothelioma. High orchiectomy with hemiscrotectomy was performed. The patient had a local recurrence at the end of two years. As there were no distant metastasis only local excision was performed. In his sixth month after the second surgery he is still tumor free. Related literature reviewed.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 Pediyatrik üroloji operasyonlarında epidural tramadol ve morfinin analjezik etkinliğinin karşılaştırılması(2003) Demiaran, Yavuz; Akman, Yavuz R; Kocaman, Buket; Erol, AliÇalışmamızda majör ürolojik (epispadiyas, hipospadiyas) ameliyat geçiren çocuklarda tek doz olarak epidural aralıktan yapılan morfin ile tramadolün peroperatif hemodinamik etkisi, postoperatif analjezik etkinliği ve yan etkileri karşılaştırıldı. Majör ürolojik ameliyat geçiren yaşları 3 ile 14 yıl arasında değişen toplam 40 çocuk çalışma kapsamına alındı. Entübasyonu takiben, lateral dekübitüs pozisyonu verildi. Bu pozisyonda epidural iğneyle epidural bölgeye Morfin (M) grubuna 0.1 mg/kg morfin 0.2 mL/kg serum fizyolojik içinde, Tramadol (T) grubuna ise 2 mg/kg tramadol 0.2 mL/kg serum fizyolojik içinde tek doz olarak verildi. Postoperatif dönemde 24 saat süresince kalp atım hızı (KAH), sistolik arter basıncı (SAB), solunum sayısı, ağrı skorları ve sedasyon düzeyi izlendi. Yüz skoru >= 3 yetersiz analjezi olarak kabul edilerek, 20 mg/kg parasetamol suppozituar ile tedavi edildi. İlk analjezik gereksinim zamanı kaydedildi. Sedasyon düzeyi; four-point sedasyon skorlaması ile 0-3 arasında puan verilerek değerlendirildi. Postoperatif dönemde, ağrı skorları, analjezik ihtiyaçları açısından gruplar arasında anlamlı bir fark gözlenmedi. Morfin grubunda bulantı, kusma, allerjik döküntü, sedasyon skorları ve solunum depresyonu, tramadol grubuna nazaran anlamlı fazla idi. Pediyatrik girişimlerde daha sıklıkla genel anestezi uygulanmasına rağmen, rejyonel anestezi, hem intraoperatif hem de postoperatif dönemde uygulanabilmekte, postoperatif dönemde solunum merkezlerinde depresyon yapmaksızın etkin analjezi ve erken mobilizasyon sağlanmaktadır. Epidural verilen morfin, tramadol'e nazaran daha fazla yan etkileri gözlendiğinden ağrı skorları arasında anlamlı fark olmadığı için tramadol'ün güvenle kullanılabileceğini düşünüyoruz.Öğe THE RATIO OF EXTERNAL GENITAL ANOMALIES IN MALE CHILDREN ATTENDING PRIMARY SCHOOL IN DUZCE(Aves, 2005) Kayikci, M. Ali; Cam, 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 Duzce. Materials and Methods: A total of 1534 children out of 13420 male students attending to 25 primary schools in Duzce 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 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 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 Surgical treatment alternatives in the management of benign prostatic hyperplasia(2003) Kayıtçı, M. A.; Çam, Haydar Kamil; Akman, Yavuz; Erol, AliBenign prostatic hyperplasia (BPH) contemporarily constitutes a major public health problem especially in developed countries as its incidence increases with aging. Although several medical treatment alternatives have been developed, surgical management still provides the most successful clinical outcome. Trans-urethral prostate resection (TUR-P) is accepted as the gold standard in the management of BPH. However, in considering the relatively high rate of morbidity of TUR-P, several minimally invasive surgical treatment alternatives have been developed. In this review, we discussed the surgical treatment alternatives in the management of BPH.Öğe
