Background: Disorders of sex development (DSD), which has the possibility of the risk of lifethre... more Background: Disorders of sex development (DSD), which has the possibility of the risk of lifethreatening endocrinologic emergencies of the newborn, require a careful multidisciplinary approach. Objectives: The aim of our study is to consolidate the proposed classification, evaluation and management of DSD. Materials and methods: The literatures related with DSD were reviewed to find the best approach for this disease. Results: The detailed history, systemic physical examination of the patient, particular laboratory and imagine evaluations are needed for the urgent treatment of life-threatening abnormalities and the gender assignment. Conclusion: The gender should be assigned depending on the definitive diagnosis, fertility potential, genital appearance, surgical options, and the parents' opinion.
Objective: The purpose of the present study is to determine the neurophysiological components ass... more Objective: The purpose of the present study is to determine the neurophysiological components associated with levodopa responsiveness in patients with Parkinson's disease (PD). Methods: The short-latency somatosensory evoked potentials (SSEPs), brainstem auditory evoked potentials (BAEPs), visual evoked potentials (VEPs) and auditory event-related potentials (ERPs) were recorded in 55 patients with PD diagnosed on the basis of the UK Parkinson's disease society bank criteria. The patients with PD were divided into two groups: good response (improvement 1 by Yahr stage) (n = 36) and mild response (improvement < 1 by Yahr stage) (n = 19) according to response to levodopa. Results: Significant differences were found in P300 latency between the two groups (P < 0.001), whereas there were no differences in N100, P250 and N200 latencies of ERPs, N13 and N20 latencies of SSEPs, I, III and V latencies of BAEPs and P100 latency of VEPs. No differences were shown in MMSE score, duration of illness, and Yahr stage between the two groups although the mean age in the good response group was significantly younger than that in the mild response group (P < 0.01). Conclusions: Present results suggest that levodopa response may be decreased in PD patients with cognitive impairment shown by prolonged P300 latency.
ObjectiveOne of the most important complications of radical prostatectomy operation is erectile d... more ObjectiveOne of the most important complications of radical prostatectomy operation is erectile disfunction (ED). Oxidative stress patterns and apoptotic changes may happen in smooth muscles and endothelial cells of corpus cavernosum after neuropraxia or neurectomy. Alpha lipoic acid (ALA) shows its antioxidant properties by eliminating free radicals. In this experimental study we investigated the effects of ALA on rehabilitation of
The purpose of this study was to examine the effectiveness and safety of percutaneous nephrolitho... more The purpose of this study was to examine the effectiveness and safety of percutaneous nephrolithotomy with ultrasonography-guided renal access in the flank position without the use of fluoroscopy in any stage of the procedure. Percutaneous nephrolithotomy was performed in flank position under the guidance of ultrasound (USG) without the use of fluoroscopy between December 2008 and January 2010 on 43 patients who had kidney stones bigger than 20 mm. Access to the kidney's proper calyx was achieved by dilatation through the guide wire placed after insertion of the needle through the needle director under the guidance of transrectal ultrasound probe placed on the patient's flank area. A convex USG probe was used for imaging during dilatation and lithotripsy instead of fluoroscopy. Access to the targeted calyx was achieved successfully in all patients (100%). The percentage stone free rate was 86.1% (37 patients). Residual stones were detected in six patients. Their dimensions ranged from 5 to 12 mm. The mean stone diameter was 29 (20-41) mm, duration of surgery was 87.1 ± 43.2 (55-210) min and duration of hospital stay was 3.1 (2-8) days. Blood transfusions were given to two patients; none of the patients had major intraoperative or postoperative complications. In comparison with standard percutaneous nephrolithotomy, percutaneous nephrolithotomy in flank position under ultrasonographic imaging instead of using fluoroscopy seems to be safe and effective. This procedure has to be limited to selected cases with one or maximum two big stones in the pelvis or in a single calyx in absence of complex intrarenal anatomy. Both surgical team and the patients were protected from the harmful effects of radiation. Regarding anesthesia, flank position is more comfortable for the patient than prone position.
Scandinavian Journal of Urology and Nephrology, 2004
Management of male sphincteric incontinence is still challenging. We present our experience with ... more Management of male sphincteric incontinence is still challenging. We present our experience with a new male sling technique using polypropylene mesh tape (PMT). A total of 12 patients (age range 17-75 years; median age 61 years) underwent the procedure. Sphincteric incontinence was due to radical prostatectomy in three patients, transurethral prostatectomy in four, open prostatectomy in two and neurologic etiologies in three. All patients had urodynamic stress incontinence with a mean Valsalva leak point pressure of 48.8 cmH2O (range 40-68 cmH2O). Through a midline incision the PMT sling was passed through the perineal membrane on each side and the limbs of the tape were withdrawn to a suprapubic incision with the help of trocars. The tension of the tape was adjusted during a retrograde sphincterometry until a retrograde leak point pressure of 30-50 cmH2O was achieved. The average operative time was 65 min (45-110 min). Follow-up was 12.1-46.4 months (median 31.6 months). Urinary incontinence was cured or improved in nine patients (75%) and there was no improvement in three (25%). Intermittent catheterization was initiated in three patients with impaired detrusor contractions due to neurologic etiology. One patient had intraoperative bladder perforation and one had perineal numbness lasting for 2 months. None of the patients had urethral erosion, wound infection or any other major complications. This procedure seems to be an effective and safe treatment for patients with sphincteric incontinence. Regarding the etiology of urinary incontinence, this technique seems to be more effective in transurethral prostatectomy-related sphincteric incontinence than in sphincteric incontinence of other etiologies. Further experience with more patients and a longer follow-up period is mandatory to determine the long-term effectiveness of the technique.
Prostate cancer is a common malignancy that develops by structural mutation(s) and/or other genet... more Prostate cancer is a common malignancy that develops by structural mutation(s) and/or other genetic alterations in specific genes.The G to T transversions in codon 12 and C to T transitions in codon 13 of KRAS protooncogene are predominant point mutations that occur in about 20% of different cancers in human. In the current study it was aimed to investigate the prevalence and predictive significance of KRAS mutations in patients with prostate carcinomas. In a total of 30 fresh tumoural tissue specimens were investigated in patients with prostate carcinoma. All tumoural specimens were histo-pathologically diagnosed and genotyped for codon 12, 13 KRAS point mutations by reverse hybridisation and direct sequencing methods. KRAS mutations were found in 12 (40%) samples with 29 samples deriving from adenocarcinomas and 1 sample was small cell prostate carcinoma. In 1 (3.44%) sample codon 12 was found to be mutated and in 2 (6.8%) samples codon 13 and in 9 (31%) samples combined codon 12 and 13 were found to be mutated particularly in higher grade of tumoural tissues. Our study, based on representative collection of human prostate tumours, indicates that combined mutations in codons 12 and 13 KRAS are relatively infrequent and most commonly occur in prostate carcinomas.
Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated... more Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated by percutaneous aspiration with injection of sclerosant agents. Our aim was to compare the efficacy and side effects of ethanol and sodium tetradecyl sulfate (STDS) as sclerosants for symptomatic simple renal cyst. Sixty-five patients with 68 symptomatic simple renal cysts were included in this study. An 8F pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of the cyst fluid. Either 95% ethanol (N = 34) or 3% STDS (N = 34), assigned randomly, was then instilled into the empty sac. Patients recorded any flank pain on a visual analog scale and were followed up by ultrasonography for 6 to 18 months. There was complete ablation of 28 (82%) and 26 (76%) cysts, partial regression of 3 (9%) and 6 (18%) cysts, and failure of treatment in 3 (9%) and 2 (6%) cysts in the ethanol and STDS groups, respectively. There was no major complication in either group. The pain caused by the injection was significantly less for the group receiving STDS (pain score 2.1 +/- 1.1 v 3.8 +/- 1.2 for ethanol; P = 0.019). Ethanol and STDS are simple, noninvasive, cost-effective, and well-tolerated sclerosants for the treatment of simple renal cysts. We prefer STDS as a first choice because it causes less pain.
An 18-year-old patient with repaired bladder exstrophy developed a 550-g stone burden in his augm... more An 18-year-old patient with repaired bladder exstrophy developed a 550-g stone burden in his augmented bladder. The stones were removed percutaneously with the aid of a pneumatic lithotripter. This should be considered the method of choice in these difficult cases.
Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. With the revie... more Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. With the review of the literature, we reported two cases of XPN with psoas muscle abscesses caused by Staphylococci aereus in one of the patient and Serratia mascerentes in the other. Both of the patients had renal calculus. We performed nephrectomy with psoas abscess drainage and started appropriate antibiotics, but one of the patients died of septic shock. Other patient is free of symptoms at the end of 5 years follow-up.
International Urogynecology Journal and Pelvic Floor Dysfunction, 2004
Ó International Urogynecological Association 2004 dictive factor affecting the cure rate while no... more Ó International Urogynecological Association 2004 dictive factor affecting the cure rate while no significant factor predicting the complications was detected. Cure rate was significantly lower in patients over 55 years of age.
After pelvic surgeries such as radical prostatectomy, two major complications urinary incontine... more After pelvic surgeries such as radical prostatectomy, two major complications urinary incontinence and erectile dysfunction (ED) may occur. Etiologies for ED are multiple pathologic mediators/systems. Oxidative stress, which is known to be induced after surgical trauma, ...
Transforming growth factor-β1 (TGF-β1) has a crucial role in collagen synthesis and fibrosis. TGF... more Transforming growth factor-β1 (TGF-β1) has a crucial role in collagen synthesis and fibrosis. TGF-β1 can be antagonized and/or reduced by the action of certain agents. We propose to identify the role of decorin in treatment of tubular and interstitial fibrosis and in the inhibition of TGF-β1 in an acute ischaemic kidney. We grouped 34 female Sprague Dawley type rats into 3 groups as 9 sham, 9 ischaemia-reperfusion (I/R) and 16 I/R + decorin respectively. The rats in the I/R + decorin group had decorin administered intraperitoneally at the dose of 0.1 mg/kg for 9 days after reperfusion. After 9 days, all the rats in the 3 groups were unilaterally nephrectomized. The TGF-β1 level was measured immunohistochemically in the nephrectomized material. The TGF-β1 level was lower in the I/R + decorin group. Evaluation of apoptotic activity level by caspase staining showed a statistically significant difference between the 3 groups. The number of caspase stained cells was lower in the I/R + decorin group. The amount of collagen in interstitial tissue was higher in the I/R group than in the I/R + decorin group, but this difference was not statistically significant. We found that the TGF-β1 level - the so-called initiator of fibrotic activity - and apoptotic activity were low in the I/R + decorin group. Additional studies must be performed to understand the role of decorin in inhibition of TGF-β1 and to assess decorin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s routine use in acute renal ischaemia.
IntroductionStone characterization is becoming important before decision of treatment such as per... more IntroductionStone characterization is becoming important before decision of treatment such as percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL). Some studies have reported that the twinkling artifact (color-flow ultrasonography artifact) may be useful to detect urinary stones. This study aims to determine whether the presence or absence of the twinkling artifact is correlated with the chemical composition of the
Primary pure small cell neuroendocrine carcinoma of the bladder is a rare condition. It is an agg... more Primary pure small cell neuroendocrine carcinoma of the bladder is a rare condition. It is an aggressive tumor with an average five-year survival rate of less than 10% as cited by multiple case reports. We report a 48 year-old male patient with primary small cell neuroendocrine carcinoma of the bladder who was treated with TUR-T, adjuvant carboplatin-based chemotherapy and radiotherapy. The patient is free of disease at the end of 30 months with a normally functioning bladder.
Background: Disorders of sex development (DSD), which has the possibility of the risk of lifethre... more Background: Disorders of sex development (DSD), which has the possibility of the risk of lifethreatening endocrinologic emergencies of the newborn, require a careful multidisciplinary approach. Objectives: The aim of our study is to consolidate the proposed classification, evaluation and management of DSD. Materials and methods: The literatures related with DSD were reviewed to find the best approach for this disease. Results: The detailed history, systemic physical examination of the patient, particular laboratory and imagine evaluations are needed for the urgent treatment of life-threatening abnormalities and the gender assignment. Conclusion: The gender should be assigned depending on the definitive diagnosis, fertility potential, genital appearance, surgical options, and the parents' opinion.
Objective: The purpose of the present study is to determine the neurophysiological components ass... more Objective: The purpose of the present study is to determine the neurophysiological components associated with levodopa responsiveness in patients with Parkinson's disease (PD). Methods: The short-latency somatosensory evoked potentials (SSEPs), brainstem auditory evoked potentials (BAEPs), visual evoked potentials (VEPs) and auditory event-related potentials (ERPs) were recorded in 55 patients with PD diagnosed on the basis of the UK Parkinson's disease society bank criteria. The patients with PD were divided into two groups: good response (improvement 1 by Yahr stage) (n = 36) and mild response (improvement < 1 by Yahr stage) (n = 19) according to response to levodopa. Results: Significant differences were found in P300 latency between the two groups (P < 0.001), whereas there were no differences in N100, P250 and N200 latencies of ERPs, N13 and N20 latencies of SSEPs, I, III and V latencies of BAEPs and P100 latency of VEPs. No differences were shown in MMSE score, duration of illness, and Yahr stage between the two groups although the mean age in the good response group was significantly younger than that in the mild response group (P < 0.01). Conclusions: Present results suggest that levodopa response may be decreased in PD patients with cognitive impairment shown by prolonged P300 latency.
ObjectiveOne of the most important complications of radical prostatectomy operation is erectile d... more ObjectiveOne of the most important complications of radical prostatectomy operation is erectile disfunction (ED). Oxidative stress patterns and apoptotic changes may happen in smooth muscles and endothelial cells of corpus cavernosum after neuropraxia or neurectomy. Alpha lipoic acid (ALA) shows its antioxidant properties by eliminating free radicals. In this experimental study we investigated the effects of ALA on rehabilitation of
The purpose of this study was to examine the effectiveness and safety of percutaneous nephrolitho... more The purpose of this study was to examine the effectiveness and safety of percutaneous nephrolithotomy with ultrasonography-guided renal access in the flank position without the use of fluoroscopy in any stage of the procedure. Percutaneous nephrolithotomy was performed in flank position under the guidance of ultrasound (USG) without the use of fluoroscopy between December 2008 and January 2010 on 43 patients who had kidney stones bigger than 20 mm. Access to the kidney's proper calyx was achieved by dilatation through the guide wire placed after insertion of the needle through the needle director under the guidance of transrectal ultrasound probe placed on the patient's flank area. A convex USG probe was used for imaging during dilatation and lithotripsy instead of fluoroscopy. Access to the targeted calyx was achieved successfully in all patients (100%). The percentage stone free rate was 86.1% (37 patients). Residual stones were detected in six patients. Their dimensions ranged from 5 to 12 mm. The mean stone diameter was 29 (20-41) mm, duration of surgery was 87.1 ± 43.2 (55-210) min and duration of hospital stay was 3.1 (2-8) days. Blood transfusions were given to two patients; none of the patients had major intraoperative or postoperative complications. In comparison with standard percutaneous nephrolithotomy, percutaneous nephrolithotomy in flank position under ultrasonographic imaging instead of using fluoroscopy seems to be safe and effective. This procedure has to be limited to selected cases with one or maximum two big stones in the pelvis or in a single calyx in absence of complex intrarenal anatomy. Both surgical team and the patients were protected from the harmful effects of radiation. Regarding anesthesia, flank position is more comfortable for the patient than prone position.
Scandinavian Journal of Urology and Nephrology, 2004
Management of male sphincteric incontinence is still challenging. We present our experience with ... more Management of male sphincteric incontinence is still challenging. We present our experience with a new male sling technique using polypropylene mesh tape (PMT). A total of 12 patients (age range 17-75 years; median age 61 years) underwent the procedure. Sphincteric incontinence was due to radical prostatectomy in three patients, transurethral prostatectomy in four, open prostatectomy in two and neurologic etiologies in three. All patients had urodynamic stress incontinence with a mean Valsalva leak point pressure of 48.8 cmH2O (range 40-68 cmH2O). Through a midline incision the PMT sling was passed through the perineal membrane on each side and the limbs of the tape were withdrawn to a suprapubic incision with the help of trocars. The tension of the tape was adjusted during a retrograde sphincterometry until a retrograde leak point pressure of 30-50 cmH2O was achieved. The average operative time was 65 min (45-110 min). Follow-up was 12.1-46.4 months (median 31.6 months). Urinary incontinence was cured or improved in nine patients (75%) and there was no improvement in three (25%). Intermittent catheterization was initiated in three patients with impaired detrusor contractions due to neurologic etiology. One patient had intraoperative bladder perforation and one had perineal numbness lasting for 2 months. None of the patients had urethral erosion, wound infection or any other major complications. This procedure seems to be an effective and safe treatment for patients with sphincteric incontinence. Regarding the etiology of urinary incontinence, this technique seems to be more effective in transurethral prostatectomy-related sphincteric incontinence than in sphincteric incontinence of other etiologies. Further experience with more patients and a longer follow-up period is mandatory to determine the long-term effectiveness of the technique.
Prostate cancer is a common malignancy that develops by structural mutation(s) and/or other genet... more Prostate cancer is a common malignancy that develops by structural mutation(s) and/or other genetic alterations in specific genes.The G to T transversions in codon 12 and C to T transitions in codon 13 of KRAS protooncogene are predominant point mutations that occur in about 20% of different cancers in human. In the current study it was aimed to investigate the prevalence and predictive significance of KRAS mutations in patients with prostate carcinomas. In a total of 30 fresh tumoural tissue specimens were investigated in patients with prostate carcinoma. All tumoural specimens were histo-pathologically diagnosed and genotyped for codon 12, 13 KRAS point mutations by reverse hybridisation and direct sequencing methods. KRAS mutations were found in 12 (40%) samples with 29 samples deriving from adenocarcinomas and 1 sample was small cell prostate carcinoma. In 1 (3.44%) sample codon 12 was found to be mutated and in 2 (6.8%) samples codon 13 and in 9 (31%) samples combined codon 12 and 13 were found to be mutated particularly in higher grade of tumoural tissues. Our study, based on representative collection of human prostate tumours, indicates that combined mutations in codons 12 and 13 KRAS are relatively infrequent and most commonly occur in prostate carcinomas.
Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated... more Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated by percutaneous aspiration with injection of sclerosant agents. Our aim was to compare the efficacy and side effects of ethanol and sodium tetradecyl sulfate (STDS) as sclerosants for symptomatic simple renal cyst. Sixty-five patients with 68 symptomatic simple renal cysts were included in this study. An 8F pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of the cyst fluid. Either 95% ethanol (N = 34) or 3% STDS (N = 34), assigned randomly, was then instilled into the empty sac. Patients recorded any flank pain on a visual analog scale and were followed up by ultrasonography for 6 to 18 months. There was complete ablation of 28 (82%) and 26 (76%) cysts, partial regression of 3 (9%) and 6 (18%) cysts, and failure of treatment in 3 (9%) and 2 (6%) cysts in the ethanol and STDS groups, respectively. There was no major complication in either group. The pain caused by the injection was significantly less for the group receiving STDS (pain score 2.1 +/- 1.1 v 3.8 +/- 1.2 for ethanol; P = 0.019). Ethanol and STDS are simple, noninvasive, cost-effective, and well-tolerated sclerosants for the treatment of simple renal cysts. We prefer STDS as a first choice because it causes less pain.
An 18-year-old patient with repaired bladder exstrophy developed a 550-g stone burden in his augm... more An 18-year-old patient with repaired bladder exstrophy developed a 550-g stone burden in his augmented bladder. The stones were removed percutaneously with the aid of a pneumatic lithotripter. This should be considered the method of choice in these difficult cases.
Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. With the revie... more Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. With the review of the literature, we reported two cases of XPN with psoas muscle abscesses caused by Staphylococci aereus in one of the patient and Serratia mascerentes in the other. Both of the patients had renal calculus. We performed nephrectomy with psoas abscess drainage and started appropriate antibiotics, but one of the patients died of septic shock. Other patient is free of symptoms at the end of 5 years follow-up.
International Urogynecology Journal and Pelvic Floor Dysfunction, 2004
Ó International Urogynecological Association 2004 dictive factor affecting the cure rate while no... more Ó International Urogynecological Association 2004 dictive factor affecting the cure rate while no significant factor predicting the complications was detected. Cure rate was significantly lower in patients over 55 years of age.
After pelvic surgeries such as radical prostatectomy, two major complications urinary incontine... more After pelvic surgeries such as radical prostatectomy, two major complications urinary incontinence and erectile dysfunction (ED) may occur. Etiologies for ED are multiple pathologic mediators/systems. Oxidative stress, which is known to be induced after surgical trauma, ...
Transforming growth factor-β1 (TGF-β1) has a crucial role in collagen synthesis and fibrosis. TGF... more Transforming growth factor-β1 (TGF-β1) has a crucial role in collagen synthesis and fibrosis. TGF-β1 can be antagonized and/or reduced by the action of certain agents. We propose to identify the role of decorin in treatment of tubular and interstitial fibrosis and in the inhibition of TGF-β1 in an acute ischaemic kidney. We grouped 34 female Sprague Dawley type rats into 3 groups as 9 sham, 9 ischaemia-reperfusion (I/R) and 16 I/R + decorin respectively. The rats in the I/R + decorin group had decorin administered intraperitoneally at the dose of 0.1 mg/kg for 9 days after reperfusion. After 9 days, all the rats in the 3 groups were unilaterally nephrectomized. The TGF-β1 level was measured immunohistochemically in the nephrectomized material. The TGF-β1 level was lower in the I/R + decorin group. Evaluation of apoptotic activity level by caspase staining showed a statistically significant difference between the 3 groups. The number of caspase stained cells was lower in the I/R + decorin group. The amount of collagen in interstitial tissue was higher in the I/R group than in the I/R + decorin group, but this difference was not statistically significant. We found that the TGF-β1 level - the so-called initiator of fibrotic activity - and apoptotic activity were low in the I/R + decorin group. Additional studies must be performed to understand the role of decorin in inhibition of TGF-β1 and to assess decorin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s routine use in acute renal ischaemia.
IntroductionStone characterization is becoming important before decision of treatment such as per... more IntroductionStone characterization is becoming important before decision of treatment such as percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL). Some studies have reported that the twinkling artifact (color-flow ultrasonography artifact) may be useful to detect urinary stones. This study aims to determine whether the presence or absence of the twinkling artifact is correlated with the chemical composition of the
Primary pure small cell neuroendocrine carcinoma of the bladder is a rare condition. It is an agg... more Primary pure small cell neuroendocrine carcinoma of the bladder is a rare condition. It is an aggressive tumor with an average five-year survival rate of less than 10% as cited by multiple case reports. We report a 48 year-old male patient with primary small cell neuroendocrine carcinoma of the bladder who was treated with TUR-T, adjuvant carboplatin-based chemotherapy and radiotherapy. The patient is free of disease at the end of 30 months with a normally functioning bladder.
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