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Biomedical subjects

H Kulaksizoglu

Publications and source records attributed to H Kulaksizoglu.

5 recordsLinked to original sources
PubMed2003

Lower extremity above-knee prosthesis-associated erectile dysfunction.

Blunt pelvic and perineal trauma has been previously reported to result in site-specific veno-occlusive dysfunction and/or site-specific cavernosal artery insufficiency. We herein describe a case of erectile dysfunction in a young previously potent amputee. We postulate that the erectile dysfunction is associated with a newly described form of blunt trauma, that is, site-specific compression from a perineal weight-bearing lower extremity above-knee prosthetic device. It is hypothesized that when the force exerted by the above-knee prosthesis is directed medially towards the ischiopubic ramus, the penile crura and common penile arterial blood supply become susceptible to crush-like injury, since they are in fixed anatomic locations in the perineum sandwiched between the compressive force and the bone. Clinical evaluation of the erectile dysfunction in this patient revealed site-specific corporal veno-occlusive dysfunction and site-specific common penile arterial occlusive pathology in the precise region of the contact of the above-knee prosthesis with the perineum. Further research is needed in above-knee prosthesis design to prevent erectile dysfunction.

Adult↗
PubMed1996

Vacuum erection associated impotence and Peyronie's disease.

PURPOSE: Use of a nonmedical, catalogue type vacuum erection device resulted in a case of vacuum induced vasculogenic impotence and Peyronie's disease. MATERIALS AND METHODS: A 66-year-old potent man used a nonmedical vacuum erection device (cylinder plus a hand pump without a pressure-release valve and a doughnut-shaped ring at the base without tension bands) after having achieved a spontaneous rigid erection. The resultant excessive overinflation of the penis was followed by dorsal curvature, diminished rigidity and decreased erectile maintenance. RESULTS: Physical examination revealed a dorsal mid shaft Peyronie's plaque. Nocturnal penile tumescence testing and office injection testing were abnormal and demonstrated partial, short-lived, dorsally curved erections. Dynamic pharmaco-cavernosometry and pharmaco-cavernosography established vasculogenic impotence with site-specific crural (unrelated to the Peyronie's plaque) veno-occlusive dysfunction and dorsal penile curvature. CONCLUSIONS: Vacuum erection devices create pulling forces on the penis. We estimate that the pulling forces in this case were prohibitively high (approximately 29 pounds) due to absence of a pressure-release valve and to the preexistent erection at vacuum application. These intense pulling forces are hypothesized to have damaged the tunica in the mid shaft (Peyronie's disease) and the crus (veno-occlusive dysfunction), the latter being the site of attachment of the corpora to the ischiopubic ramus and a most likely location for high magnitude pulling forces to exert an abnormal injury effect. The patient underwent a Nesbit plication procedure and presently performs self-injection for satisfactory sexual activity.

Aged↗
PubMed1996

Evolving concepts in the diagnosis and treatment of arterial high flow priapism.

PURPOSE: We investigated 2 evolving concepts in the management of arterial priapism: 1) the efficacy of perineal duplex Doppler ultrasound as a diagnostic alternative to arteriography and 2) the therapeutic alternative of expectant management. MATERIALS AND METHODS: We evaluated 10 patients with high flow arterial priapism. RESULTS: Compared to selective internal pudendal arteriography, perineal duplex Doppler ultrasonography was associated with 100% sensitivity and 73% specificity rates. Compared to physical examination, followup duplex ultrasonography had a sensitivity of 75% and specificity of 100%. Followup penile duplex ultrasound demonstrated restoration of antegrade flow in the cavernous artery after embolization. Patients on expectant management remained potent as long as 31 years. CONCLUSIONS: Diagnostic perineal duplex Doppler ultrasonography and expectant management are valuable tools for the treatment of arterial priapism. A new algorithm for patient care is presented.

Adolescent↗
PubMed1996

A guide to safe corporotomy incisions in the presence of underlying inflatable penile cylinders: results of in vitro and in vivo studies.

PURPOSE: Because iatrogenic injury to an underlying inflatable implant may be induced by electrocautery incision of the tunica during tunical release or cylinder reexploration, safe electrocautery guidelines are needed. MATERIALS AND METHODS: For the in vitro model silicone and polyurethane elastomer lined inflatable penile prosthetic cylinders were used, and cutting and coagulation electrocautery was applied directly on the device, on a tissue-implant interface, and at minimal, partial or full inflation with saline. For the in vivo study 10 patients with underlying inflatable prosthetic cylinders underwent tunical releases for treatment of secondary penile curvature (7) and reexploration for a malpositioned device (3) with a minimum 1 year of followup. RESULTS: In the in vitro study electrocautery injuries either did not occur when applied directly to silicone and polyurethane elastomer lined devices, occurred in both devices in the presence of a tissue-implant interface, occurred in polyurethane elastomer lined devices at a far less thermal energy setting than with silicone, occurred in both implants at lower wattages with increasing saline inflation or did not occur in 100% of polyurethane elastomer lined devices when coagulation electrocautery was less than 65 watts. In the in vivo study, by adhering to the aforementioned principles and using novel surgical techniques, no device malfunctions were created intraoperatively or observed within a mean followup of 22 months. CONCLUSIONS: Electrocautery can be used safely to create a tunical incision with any underlying inflatable cylinder. To avoid electrocautery injury, based on the clinical study results in polyurethane elastomer lined devices, one should deflate the cylinder before electrocautery, use coagulation current at 35 watts, apply the electrocautery only to the outer longitudinal tunical layer, bluntly dissect through the inner circular layer, and elevate the tunica, protect the device and incise the tissue under direct vision.

Adult↗