Biomedical subjects

Ahmet R Aslan

Publications and source records attributed to Ahmet R Aslan.

6 recordsLinked to original sources

PubMed2006

Short-term catheterization after TIP repair in distal hypospadias: who are the best candidates?

Over the last decade, tubularized incised plate (TIP) urethroplasty has become the first choice of surgical technique in patients with distal hypospadias. Despite the excellent cosmetic and functional results, prolonged catheterization (7-14 days) remains the main disadvantage of the TIP repair. In this study, we investigated the outcomes of the short-term catheterization in children with distal hypospadias in order to elucidate any relationship between the length of catheterization and the patients' age, meatal localization and postoperative complication rates. The charts of 183 patients who underwent TIP repair for distal hypospadias in two different centers were reviewed retrospectively. Patients were grouped based on their catheter removal time (before 24 h vs. after 24 h) and the toilet status of children (toilet-trained vs. in-diaper). Children who had at least 6 months of follow-up and regular office visits were included in the study group, and the results were compared to the literature as well as the subgroups were also evaluated in terms of complications and catheterization period. A total of 128 patients with 40.4 months of the mean age (6-180 months) and 22.7 months of the follow-up (6-49 months) were included in the study. For the group 1 patients (n = 99) in whom the urethral catheter was removed before 24 h, the mean age and follow-up were 33.4 months (6-150 months) and 22.3 months (6-48 months), respectively. The catheters of group 2 patients (n = 29) were removed after 24 h, and their mean age and follow-up were 64.4 months (6-180 months) and 24.2 months (6-49 months), respectively. The group 2 patients were significantly older than those of group 1 (P < 0.05). The complications, such as fistula, meatal stenosis, tube dehiscence and buried penis, were seen in 11.1% of the group 1 and 13.8% of the group 2 (11.7% in overall), showing no statistically significant difference. On the other hand, 44% of the patients (n = 56) were toilet-trained at time of surgery. Although the mean age (79 months vs. 10.4 months) and the catheter removal time (64.3% vs. 87.5% before 24 h) of this group were significantly longer than the patients in diaper (P < 0.05), no significant difference was determined in terms of complication (14.2% vs. 9.7%). TIP repair with short-term catheterization has similar outcomes to the patients who conventionally carry their stent 7-14 days. The meatal position and the toileting status of the patients are not important in the use and length of catheterization.

Child↗

PubMed2006

Resolution of diurnal incontinence and nocturnal enuresis after adenotonsillectomy in children.

PURPOSE: Adenotonsillar hyperplasia causes upper airway obstruction, leading to obstructive sleep apnea. We reviewed the incidence of nocturnal enuresis in a population of children with adenotonsillar hyperplasia. In addition, we investigated the rate of resolution or improvement in enuresis following surgery for relief of adenotonsillar hyperplasia. MATERIALS AND METHODS: We studied 86 consecutive prepubertal children, 46 boys and 40 girls, who underwent adenotonsillectomy. Severity of adenotonsillar obstruction was graded on a scale of 1 to 4. A questionnaire regarding voiding problems, including nocturnal enuresis, voids per day and daytime enuresis episodes, was filled out preoperatively and postoperatively by the patients and their parents. RESULTS: Among the 86 patients who underwent adenotonsillectomy 36 (42%) had nocturnal enuresis. In patients with nocturnal enuresis the number of episodes was significantly less after adenotonsillectomy. Overall, 12 patients (33%) had complete resolution, 11 (31%) had significant improvement and 13 (36%) showed no change. In addition, we noted a significant decrease in daytime enuresis episodes and voids per day. CONCLUSIONS: Children with upper airway obstruction have a high rate of nocturnal enuresis that improves at twice the anticipated rate after treatment of the airway obstruction. In addition, we observed that daytime voiding dysfunction improves in these patients.

Adenoidectomy↗

PubMed2005

Apoptosis and proliferation in human undescended testes.

OBJECTIVE: To study apoptosis and proliferation in the testes of children with undescended testes; the degree to which undescended testes contributes to a patient's ultimate fertility is debatable, but undescended testes have fewer germ cells, and some have proposed that apoptosis is an important cause. PATIENTS AND METHODS: Testis biopsies were taken at the time of orchidopexy in a consecutive series of children undergoing surgical repair for undescended testes. Immunohistological techniques were used to detect apoptosis and proliferation, and the numbers of cells undergoing apoptosis or proliferation per 50 seminiferous tubules were recorded. RESULTS: Inguinal testes had less apoptosis than abdominal testes, with a mean (sd) of 0.71 (1.31) vs 1.63 (1.95) apoptotic cells per 50 seminiferous tubules (P < 0.02). Similarly, there was less apoptosis in children aged > 1 years than in children aged < 1 years (0.68 (1.40) vs 1.35 (1.56); P < 0.03). Proliferation was very limited in all cryptorchid testes. In contrast to cryptorchid testes, five autopsy controls had many more apoptotic cells, (10.60 (1.34) per 50 seminiferous tubules), and many more proliferating cells, (8.40 (6.43) per 50 seminiferous tubules). CONCLUSION: In contrast to animal studies, neither apoptosis nor proliferation was common in undescended testes from 6 months of age onward. However, apoptosis was more common in abdominal testes and in children aged < 1 year. It is likely that, if substantial apoptosis occurs in human undescended testes, it occurs before 6 months of age.

Apoptosis↗

PubMed2004

Recurrence risk in infants with urinary tract infections and a negative radiographic evaluation.

PURPOSE: Infants with urinary tract infections (UTI) and no abnormality on radiological evaluation are usually discharged from urological followup but the natural history of these children is unknown. We evaluate the rate of and potential risk factors for UTI recurrence in this specific population. MATERIALS AND METHODS: We reviewed retrospectively charts of children evaluated for first UTI before age 6 months between January 1996 and February 2001. Only patients with a normal ultrasound and voiding cystourethrogram were included in this study. A telephone questionnaire was administered to the parents, which inquired about the UTI, duration of breast-feeding, type of formula, family history of UTI, neurological problems, history of constipation or recurrent fevers, as well as social status. Chi-square test was performed for statistical analysis. RESULTS: We identified 264 children with UTIs, of whom 119 (45%) had a negative ultrasound and voiding cystourethrogram. Followup was available on 68 girls (81%) and 16 boys (19%) of the 119 children (71%). Of the 84 children 16 (19%) had recurrent UTI. Mean followup was 4.4 years (range 1.9 to 7.0). No factors had a statistically significant correlation for UTI recurrence. The p value for gender and history of undiagnosed fevers was 0.077 and 0.082, respectively. CONCLUSIONS: About 20% of children will have recurrent UTIs despite negative radiological evaluation. Although not statistically significant, there was a trend for an increased risk in girls and those with recurrent febrile illnesses. History of daytime dryness and/or constipation was not predictive of recurrent UTIs in our series.

Child↗

PubMed2003

Reperfusion injury of the rat bladder is worse than ischemia.

PURPOSE: Previous studies have demonstrated that in vivo and in vitro ischemia of the bladder results in decreased contractile responses. However, to our knowledge the effect of reperfusion following ischemia of the bladder is not known. MATERIALS AND METHODS: Adult male rats were subjected to bilateral bladder ischemia and varying periods of reperfusion. In vivo ischemia was created for 4 hours by reversibly clamping the 2 vesical arteries for 4 hours. Reperfusion was produced by removing the clamps and allowing the animals to recover for 1 day, 1 week or 1 month after surgery. Following recovery bladders strips were studied using field stimulation (FS), carbachol and KCl. The maximal contractile response and rate of response generated were recorded digitally and analyzed. RESULTS: The maximal responses to FS, carbachol and adenosine triphosphate (ATP) were not decreased by 4-hour ischemia alone, whereas the response to KCl was decreased significantly. The contractile responses to FS and KCl were significantly decreased after 1 day and 1 week of reperfusion. Responses after 1 month of reperfusion were increased significantly compared with responses after 1 week of reperfusion. The responses to ATP were not affected by ischemia or reperfusion. The contractile response to KCl was significantly more sensitive to ischemia than the responses to carbachol, ATP or FS, whereas the contractile response to FS was significantly more sensitive to reperfusion than the other forms of stimulation. CONCLUSIONS: This study demonstrates clearly that injury by reperfusion following ischemia is more detrimental than the effects of ischemia alone and FS contraction is the most sensitive form of stimulation to reperfusion damage. This study also demonstrates the ability of the bladder to recover from ischemic and reperfusion injuries.

Adaptation, Physiological↗

PubMed2002

Conservative management in neurogenic bladder dysfunction.

PURPOSE OF REVIEW: A few decades ago, urinary diversion, usually with an ileal conduit, was the ultimate outcome for most children with spina bifida. The revolutionary institution of clean intermittent catheterization has changed the algorithm totally. Furthermore many new drugs have been developed during the past decade and have decreased the need for surgery dramatically. In this article, we will focus on the most recent data on new modalities of therapy to help avoid urinary diversion or bladder augmentation. RECENT FINDINGS: In addition to clean intermittent catheterization and oxybutynin treatment, a new generation of anticholinergic medications, such as tolterodine, has been developed. For patients who drop out because of the side-effects of oral administration, new methods of administration are now available, including extended release and intravesical instillation. For those unresponsive, botulinum-A toxin and resiniferatoxin are two relatively new drugs in the field, administered as intravesical injection and instillation, respectively. Intravesical or transdermal electrical stimulation, sacral nerve stimulation and biofeedback therapy are under development, but as currently administered, are not yet completely successful. SUMMARY: Although life-saving in many respects, bladder augmentation introduces life-long risks of its own. Our goal in describing 'conservative' management is to prevent this step. Many alternatives to surgery are available now and more effective strategies are under development.

Anti-Dyskinesia Agents↗