Biomedical subjects

Tayfun Oktar

Publications and source records attributed to Tayfun Oktar.

8 recordsLinked to original sources

PubMed2006

The impact of late presentation of posterior urethral valves on bladder and renal function.

PURPOSE: We retrospectively reviewed the records of patients with late presentation of PUVs, and compared bladder and renal function to that in patients with an early diagnosis of PUVs. MATERIALS AND METHODS: We retrospectively reviewed the charts of 36 males (mean age at diagnosis 8.8 years, range 5 to 14) with late presentation of PUVs who were treated at our institution between 1986 and 2004. Of these patients 20 had undergone urodynamic evaluation during followup (mean age 10.65 years, range 5 to 23). We chose as controls 19 age matched children with PUVs who were diagnosed and treated before age 5 years and underwent urodynamic evaluation during followup (mean age at urodynamic evaluation 8.52 years, range 6 to 15). Urodynamic parameters were compared between the 2 patient groups. Renal function in the late presenting cases was also compared to controls. RESULTS: The most common symptoms at presentation were diurnal enuresis (17 patients, 47.2%) poor stream (7, 19.4%) and urinary retention (5, 13.9%). Overall, urodynamic bladder abnormalities were detected in 17 of 20 patients (85%), detrusor overactivity in 3 (15%), significant post-void residual in 9 (45%) and bladder capacity greater than expected for age in 9 (45%). No significant difference in bladder capacity, compliance or post-void residual was demonstrated between the late presenting and control groups. Only detrusor overactivity was significantly lower in the late presenting group (p = 0.013). After a mean followup of 67.03 months age specific creatinine levels were increased in 13 of 27 patients (48.1%), including 7 (25.9%) with ESRD. Renal function was significantly impaired in the late presenting group compared to controls (48.1% vs 13.7%, p = 0.001). CONCLUSIONS: We found a significantly lower rate of detrusor overactivity (15%) in patients with late presenting PUVs. Comparison of urodynamic parameters between the early and late presenting groups did not reveal any significant difference. This similar pattern of bladder dysfunction, independent of age at relief of obstruction, may indicate a common pathophysiological etiology for bladder dysfunction in all patients with PUVs. Also, renal function was significantly impaired in the late presenting group in this series.

Adolescent↗

PubMed2006

Polymorphism of endothelial nitric oxide synthase gene in patients with erectile dysfunction.

INTRODUCTION: Endothelial-derived nitric oxide (NO), which is produced by endothelial nitric oxide synthase (eNOS) in response to increased blood flow, maintains the tumescence phase of erection. The eNOS gene is located on the seventh somatic chromosome and the polymorphism of this gene has been reported to cause changes in the structure of enzyme system, resulting in disturbance of its activity. AIM: The aim of this prospective study is to evaluate the relationship between polymorphism of eNOS gene and erectile dysfunction (ED). METHODS: Thirty patients with ED (mean age: 58.7 +/- 9.97, range: 39-74 years) and 25 voluntary controls (mean age: 56.44 +/- 7.58, range: 47-72 years) were enrolled to the study. Patients with ED were evaluated with International Index of Erectile Function (IIEF) questionnaire, routine blood tests for systemic vascular risk factors, and color Doppler ultrasonography while potency of the control group were only assessed with IIEF questionnaire. The presence of polymorphism of eNOS gene was determined in both groups by polymerase chain reaction in the fourth intron of the seventh somatic chromosome that encodes eNOS gene. RESULTS: The incidences of diabetes mellitus and coronary artery disease were statistically higher in the ED group (P = 0.023 and 0.029, respectively) while mean IIEF score was significantly lower (P = 0.001). Evaluation with color Doppler ultrasonography revealed penile arterial insufficiency in six cases, cavernosal insufficiency in 19 cases, and mixed vascular insufficiency in five cases. The distributions of three eNOS genotypes (eNOS4b/b, eNOS4a/b, and eNOS4a/a) among ED patients and controls were similar (P > 0.05). However, eNOS4a/b genotype was statistically higher in diabetics (P = 0.042). Also, 80% of the patients with severe ED and 54.5% of the diabetic patients with ED had eNOS4a/b genotype. CONCLUSION: In our study, no correlation was detected between the polymorphism of eNOS gene and ED. However, 80% of the patients with severe ED and 54.5% of the diabetic patients with ED had eNOS4a/b genotype. Based on our data, it seems that diabetic patients with ED tend to have more eNOS4a/b genotype.

Adult↗

PubMed2006

Should prostate cancer status be determined in patients undergoing radical cystoprostatectomy?

INTRODUCTION: We estimate the frequency of prostate cancers detected incidentally in radical cystoprostatectomy specimens and discuss whether the prostate cancer status should be determined in patients undergoing radical cystoprostatectomy. MATERIALS AND METHODS: A total of 97 radical cystoprostatectomies without evidence of prostate cancer on digital rectal examination were performed for transitional cell carcinomas of the bladder between January 2001 and May 2004. The mean patient age at the time of surgery was 66.9 +/- 9.52 (range 49-75) years. RESULTS: The overall incidence of prostate cancer detected in radical cystoprostatectomy specimens was 21.6% (21/97 specimens). The mean tumor volume was found to be 0.93 +/- 0.81 ml. The tumor volume was >0.5 ml in 12 cases (57.1%). The surgical margin was negative in all cases, and the disease was organ confined in 20 patients (95.2%). Capsular invasion was evident in 2 patients (9.5%), 1 of whom had lymph-node-positive disease. CONCLUSIONS: Despite the high prevalence of incidental prostate carcinomas among patients with bladder cancer undergoing cystoprostatectomy, the vast majority of the cancers are organ confined. However, the prostate cancer status should be determined on the basis of digital rectal examination and prostate-specific antigen in patients undergoing radical cystoprostatectomy - especially if prostate-sparing cystectomy is planned.

Adenocarcinoma↗

PubMed2005

Lower urinary tract reconstruction in ectopic ureteroceles.

OBJECTIVES: The management of ectopic ureteroceles is a challenging entity in pediatric urology. In our study, we aimed to determine the outcome after lower urinary tract reconstruction in ectopic ureteroceles. MATERIALS AND METHODS: A total of 18 (12 girls, 6 boys) children with ectopic ureteroceles, treated between 1993 and 2003 by complete reconstruction, were enrolled in the study and their records were retrospectively reviewed. RESULTS: Ureterocele was found to be unilateral in 16 and bilateral in 2 children. Four patients had been previously managed by endoscopic interventions and 1 patient underwent partial nephrectomy. Ureterocelectomy was performed on 20 renal units, and of these 20 renal units, 9 underwent heminephroureterectomy, 1 ureterectomy, and 3 (with single system ureteroceles) nephroureterectomy. Seven (35%) renal units with adequate function underwent ureteral reimplantations. After a mean follow-up of 5.4 years (range 4 months to 9.5 years), no patient required a second procedure. Contralateral reflux that developed in 2 children after surgical treatment resolved spontaneously after 1 year of follow-up. CONCLUSION: In the management of ectopic ureterocele, lower urinary tract reconstruction is an effective treatment alternative. According to the functional status of the renal parenchyma involved, the surgical procedure was limited to the lower urinary tract in 35% of the cases.

Adolescent↗

PubMed2005

Should high-grade prostatic intraepithelial neoplasia change our approach to infravesical obstruction?

OBJECTIVES: To investigate whether coexistence of high-grade prostatic intraepithelial neoplasia (HPIN) should change our therapeutic approach to infravesical obstruction. MATERIAL AND METHODS: Of 505 patients who underwent sextant transrectal ultrasonography (TRUS)-guided prostate biopsy, 65 (12.8%) had HPIN and 29 of them underwent prostatectomy (23 transurethral resection of prostate (TURP), 6 open) due to obstructive urinary symptoms. Patients without carcinoma were followed up with semiannual prostate-specific antigen (PSA) and digital rectal examination. After a follow-up of 24.8 +/- 11.0 months, 19 of 29 patients who accepted our call had another sextant biopsy. RESULTS: Mean age and initial mean PSA values of 29 patients were 67.6 +/- 6.7 years and 9.26 +/- 5.91 ng/ml, respectively. The final pathological evaluation of the surgical specimens revealed 2 prostatic adenocarcinomas both in the TURP group. The remaining 27 (93.2%) patients were found to have benign prostatic hyperplasia (BPH) and their serum PSA levels declined from 9.26 +/- 5.91 to 4.59 +/- 2.0 ng/ml 3 months after prostatectomy. Of the 19 patients who had another biopsy with a mean PSA value of 4.06 +/- 4.61 ng/ml, 15 and 4 of them had BPH and HPIN respectively. CONCLUSIONS: Our preliminary data indicate that the presence of HPIN on TRUS-guided biopsies is not a factor to delay an indicated surgical intervention for infravesical obstruction.

Adenocarcinoma↗

PubMed2004

Urological and surgical complications in 362 consecutive living related donor kidney transplantations.

OBJECTIVE: The aim of this study is to review retrospectively the surgical and urological complications encountered in 362 cases of living related donor kidney transplantations (LRDTs). MATERIAL AND METHODS: Between 1983 and 2002, 362 consecutive LRDTs were performed at our institution. The urological and surgical complications were determined in these cases. RESULTS: Overall, urological and surgical complications were encountered in 57 (15.7%) of the renal transplants. Of the 362 patients, urological complications were detected in 29 of them (8.01%), including 5 urinary fistula (with 1 distal ureteral necrosis), 2 ureteric stenosis, 1 renal calculi, 8 symptomatic vesicoureteral reflux and 13 lymphocele requiring intervention. Vascular complications were developed in 5 patients such as renal vein thrombus in 1 and renal arterial stenosis in 4 cases. Wound infection was detected in 6 patients. Fourteen patients underwent surgical explorations due to perinephric hematoma during the early postoperative period. Renal allograft rupture due to accelerated rejection was developed in 2 cases. A lower segmental arterial injury occurred in 1 patient during the operation. CONCLUSION: LRDT is an important treatment alternative for patients with end-stage renal disease. Many complications may occur after renal transplantations. Our rate of complications is within the range of the current literature. After a modification of our surgical technique, as not dissecting the external iliac artery, the number of lymphoceles has decreased dramatically and with using ureteric stents, we detected a significant decrease in urinary complication rates.

Adult↗

PubMed2004

Failed orchiopexy.

INTRODUCTION: Failure after orchiopexy or cryptorchidism after inguinal surgery are not so rarely encountered conditions. Reoperative orchiopexies are technically demanding procedures. In our study, we aimed to examine the causes of failures and outcomes of reorchiopexies. PATIENTS AND METHODS: Between 1993 and 2003, a total of 28 children who underwent reoperative orchiopexy were included into the study. Undescended testes was detected as unilateral in 24 and bilateral in 4 cases. The mean age of patients at the time of second operation was 6.8 years. The mean period of time between the first and the second operations was 3.2 (1-13 years) years. RESULTS: The first operations were orchiopexies in all patients. After the first operations, 15 testes were found to be localized at the high scrotal position, 8 at the level of the external ring and 9 within the inguinal canal. Overall, reorchiopexies were performed on 32 testes in 28 patients. During the second operation, patent processus vaginalis was detected in 11 (34.4%), and unsuccessful hernia repair in 9 (28.1%) cases. After reorchiopexies, two testes with preoperative inguinal location could only be brought to high scrotal position and in another case orchiectomy was performed to an atrophic testis. Overall, after a mean follow-up period of 3.8 (1-7 years) years following the second operations, 29 (93.5%) testes were scrotal without evidence of atrophy. CONCLUSION: In our series, inadequate repair of inguinal hernia or patent processus vaginalis, as noted in 62.5% of the cases, was determined as an important factor leading to failure after surgical treatment of undescended testis. Adequate dissection and correction of inguinal hernia increase the success rate after orchiopexies.

Child↗

PubMed2002

A retrospective review of 307 men with Peyronie's disease.

PURPOSE: We discuss the clinical appearance and natural outcome of Peyronie's disease. MATERIALS AND METHODS: During an 8-year period 307 men with Peyronie's disease were evaluated, and clinical characteristics, risk (factors), penile deformities, erectile status and outcome were analyzed. RESULTS: Mean patient age plus or minus standard deviation was 52.8 +/- 9.3 years (range 23 to 76). Penile deformity, pain on erection and palpable nodule were the most common (85%) presenting symptoms, usually in different combinations. The remaining 15% of men (mean age 59.4 +/- 6.5 years) were not aware of the penile deformity and were diagnosed during standard evaluation for erectile dysfunction. Dorsal (45.6%) and lateral (29.3%) were the most common curvatures. The degree of deformity was less than 30 degrees in 42.7% of patients, 31 to 60 degrees in 38.8% and greater than 60 degrees in 18.6%. At least 1 risk factor for systemic vascular disease was identified in 67.5% of patients, and hypercholesterolemia and diabetes were the most common. Patients with at least 1 risk factor had a significantly higher risk for severe penile deformity. Of the men 54.4% complained of erectile dysfunction and the probability of diminished erectile capacity was 86.7% in patients older than 60 years, with Peyronie's disease for more than 12 months and at least 1 risk factor. Of 63 patients presenting with the acute phase of disease penile deformity deteriorated in 30.2%, did not change in 66.7% and resolved spontaneously in 3.2% without any treatment after a mean followup of 8.4 months. CONCLUSIONS: Our data show that penile deformities are disabling (greater than 30 degrees) in 62.5% of cases. Risk factors, such as serum lipid abnormalities, diabetes and hypertension, seem to have significant impact on the severity of symptoms and outcome. Patients must be informed that Peyronie's disease is progressive in 30.2% without treatment and spontaneous resolution is rare.

Adult↗