Biomedical subjects

Bülent Cetinel

Publications and source records attributed to Bülent Cetinel.

3 recordsLinked to original sources

PubMed2005

Which factors predict upper urinary tract deterioration in overactive neurogenic bladder dysfunction?

OBJECTIVES: To determine whether bladder histopathologic changes, detrusor leak point pressure (DLPP), disease duration, and preoperative catheterization time can predict for upper urinary tract (UUT) deterioration in patients with overactive neurogenic bladder dysfunction (ONBD). METHODS: A total of 39 patients (7 women and 32 men) with ONBD who were treated with augmentation cystoplasty were included in the study. The patients had undergone perioperative full-thickness bladder biopsies during augmentation cystoplasty. Routine evaluation using light microscopy to investigate for inflammation, fibrosis, and mast cell count was done. Statistical analysis was done using the chi-square and Mann-Whitney U tests. RESULTS: The mean duration of the disease was 8.7 years. Of the 39 patients, 18 (46%) had had indwelling catheters preoperatively. UUT deterioration was found in 16 (41%) of 39 patients. The mean DLPP was 105 cm H2O. The severity of detrusor fibrosis was a significant risk factor for UUT deterioration (P = 0.036). However, the degree of inflammation and the severity of fibrosis did not affect UUT deterioration. A DLPP of more than 75 cm H2O was a statistically significant risk factor (P = 0.04), but the disease duration and preoperative catheterization time were not. CONCLUSIONS: The results of our study have shown that moderate to severe fibrosis in the detrusor and a DLPP of more than 75 cm H2O are the risk factors for UUT deterioration in patients with ONBD. However, additional studies, including ones with more patients, are needed to determine the relationship between the histopathologic changes and UUT deterioration in ONBD.

Adolescent↗

PubMed2004

Are there any factors predicting the cure and complication rates of tension-free vaginal tape?

Predictive factors that could possibly affect the cure and complication rates of tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) were investigated. Seventy-five consecutive patients with urodynamically proven SUI and who had undergone a TVT operation were evaluated according to a follow-up protocol. Median age was 51.2 (33-69). Thirteen (17%) of the patients had had previous anti-incontinence surgery. Sixteen (21%) patients had complained of pure stress and 59 (79%) of mixed incontinence. Valsalva leak point pressure (VLPP) values had been found to be below 60 cmH(2)O in 36 (48%) and over 60 cmH(2)O in 39 (52%) patients, while detrusor overactivity (DO) had been detected in six (8%) patients during urodynamic evaluation. Local, general, and epidural anesthesia had been performed in 43 (57%), 29 (39%), and three (4%) patients, respectively. Univariate analyses were done using Fisher's exact and Chi-square tests. Multivariate analyses were done using logistic regression test to determine predictive factors affecting cure and complication rates. Mean surgical and hospitalization times were 34.7 min (20-70) and 1.2 days (1-5), respectively. Mean follow-up was 21.6 months (6-38). Cure and improvement rates were 89 and 8%, respectively. Thirty-one complications were observed in 27 (36%) patients. Intraoperative bladder perforation and bleeding occurred in three (4%) and two (3%) patients, respectively. Sixty-six (88%) patients voided spontaneously after TVT while nine (12%) performed clean intermittent catheterization (CIC) for a period of time. Seven of nine patients regained the spontaneous voiding ability within 1 month. The tape was cut in two of these retentive patients and one with severe storage lower urinary tract symptoms (LUTS) either unilaterally or bilaterally. On univariate (Fisher's exact test, p =0.018), and multivariate (Logistic regression, p =0.013) analyses, patient age was the only statistically significant parameter affecting the cure rate, which was significantly lower particularly over 55 years of age. No significant factor predicting the complications was detected. TVT is an effective and safe surgical procedure in the treatment of SUI. In this study age was the only significant predictive 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.

Adult↗

PubMed2003

The use of transversely tubularized bowel segment for segmental ureteral replacement.

The aim of the present study was to evaluate the results of the use of a new technique, i.e. transversely tubularized bowel segment (TTBS) for segmental ureteral replacement in pigs. Eight pigs had segmental left ureteral replacement with the TTBS technique, via midline incision in 5 and flank incision in 3. The right ureters were left untouched and used as controls. The pigs were evaluated by excretory urography approximately 3 months after surgery and then sacrificed thereafter, harvesting the kidneys, ureters, and the bladders en bloc for macroscopic and histologic examination. Three pigs died in the early postoperative period. The remaining 5 pigs were followed for 82-112 days. Postoperative intravenous urograms revealed moderate ureterohydronephrosis in 2, mild ureteral dilation in 1, and normal upper tracts in 2. The 2 pigs with moderate ureterohydronephrosis had had midline incisions, and examination after having sacrificed these pigs revealed many intestinal adhesions to the anastomotic region. Easy catheterization of each left ureter through ileal ureteral segment and histologic examination thereafter demonstrated that all ileal ureteral segments including anastomotic sites were patent. Adjacent to the junctional area, metaplastic transitional epithelium covered atrophic villi and in some regions crypts as well. Ureteral replacement by the TTBS technique seems to be a safe and effective surgical treatment option in segmental ureteral defects in short term. However, long-term follow-up studies are needed.

Animals↗