Aydin Sencan

Effect of alarm Treatment on bladder storage capacities in monosymptomatic nocturnal enuresis

Objective: Despite a great number of studies, very little is known about the mechanism of action of enuresis alarm systems. Nevertheless, as a result of this treatment many children are able firstly to wake up before urination occurs and then, in time, to sleep through the night without voiding. The aim of this study was to investigate the effect of enuresis alarms on bladder storage capacities. Material and Methods: A total of 28 children aged >7 years who were not polyuric but who voided once every night, slept alone in their own bedroom and who were willing, along with their family members, to cooperate were recruited. Patients were asked to record their urine output using a frequency/volume chart for two consecutive days. After these records and the results of physical and laboratory examinations were taken into consideration, treatment was instituted with the bell‐and‐pad (alarm) system for a period of 12 weeks. At the end of this period, patients were asked to complete another frequency/volume chart. Results: The pre‐ and post‐treatment maximum functional bladder capacity was 178.35 ± 87.86 ml and 243.03 ± 102.84 ml, respectively and the pre‐ and post‐treatment mean day‐time bladder capacity was 111.11 ± 45.87 and 148.445 ± 7.68 ml. Both of these differences were statistically significant (p < 0.0001 and <0.0001, respectively). The maximum nocturnal bladder capacity was found to be increased from 177.85 ± 84.95 to 255.25 ± 124.52 ml after treatment (p < 0.0001). Conclusion: Treatment with the alarm system for a period of 12 weeks was seen to be associated with a significant increase in bladder storage capacities (maximum nocturnal bladder capacity, maximum functional bladder capacity and mean day‐time bladder capacity).

The role of CAPE in PI3K/AKT/mTOR activation and oxidative stress on testis torsion

Ischemia reperfusion injury arises from testicular torsion resulting in a loss of spermatogenesis and significant germ cell apoptosis. This study evaluates the prooxidant/antioxidant effects of caffeic acid phenethyl ester (CAPE) through PI3K/AKT/mTOR signal pathways on testis torsion. A total of (28) male Wistar rats were divided randomly into 4 groups (n=7 for each group):group A (sham) group,group B torsion/detorsion group, group C (saturation group, during four days of CAPE, one dose (10 μmol/kg, i.p)) and group D (a single dose of CAPE 2h after torsion and before detorsion). At the end of the study, unilateral orchiectomies were performed for measurements of MDA and 8OHdG levels, histopathologic and immunohistochemical and TUNEL apoptotic cell examination. Testicular torsion-detorsion led to a significant decrease in the mean values of the Johnsens scores and a significant increase in the apoptotic cell values of group B. There were no significant differences between group D and group A. In addition, the MDA and 8OHdG levels increased significantly in group B. The MDA and 8OHdG values were lower in group D. However, the 8OHdG levels were higher in group C than the groups A and D. On the other hand, CAPE suppresses mTOR activation and reduces the apoptosis on ischemia/reperfusion damage in rat testis. These results demonstrate that CAPE suppresses mTOR activation and reduces the apoptosis on ischemia/reperfusion damage in rat testis.

Primary Duhamel-Martin operations in neonates and infants.

Abstract Background : With advances in neonatal anesthetic and surgical care, a safe, one stage, definitive procedure has been possible in Hirschsprung’s disease. Since 1996, we have performed this type of operation in the neonatal and early infancy period. We aimed to review our data to state the feasibility of this operation in these age groups.

Long-term effect of pentoxifylline and NG-nitro-L-arginine methyl ester on testicular function in spermatic artery ligation

Objective. To investigate long-term testicular function in pentoxifylline- and NG-nitro-L-arginine methyl ester (L-NAME)-treated rats prior to spermatic artery ligation by assessing serum inhibin B concentration, a reliable endocrine marker of spermatogenesis. Material and methods. Forty prepubertal rats were randomly divided into four equal groups. Right orchiectomy was performed in all rats. Intraperitoneal pentoxifylline and L-NAME were administered to Groups 1 and 2, respectively. Rats in Group 3 did not receive any medication. The spermatic arteries of the left testes were ligated in all groups with the exception of the sham controls (Group 4). One month postoperatively, a histopathologic evaluation was performed and serum inhibin B concentrations were assessed in all groups. Results. There were no statistically significant differences in testis size or serum inhibin B concentration between Groups 1, 2 and 3. However, the testes were significantly smaller (p1=0.01, p2=0.01, p3=0.01) and serum inhibin B levels were significantly decreased (p1=0.01, p2=0.01, p3=0.01) when Groups 1–3 were compared with Group 4. Histopathological evaluations revealed necrosis and calcification in all specimens with the exception of the sham-operated group. Conclusions. The long-term outcomes of spermatic artery ligation were poor and testicular atrophy developed in rat testes in all study groups. Testicular atrophy could not be reversed by preoperative administration of pentoxifylline and L-NAME.

Comparison of the learning curves and frustration level in performing laparoscopic and robotic training skills by experts and novices

AbstractIntroductionRobotic assistance may provide for distinct technical advantages over conventional laparoscopic technique. The goals of this study were (1) to objectively evaluate the difference in the learning curves by novice and expert surgeons in performing fundamental laparoscopic skills using conventional laparoscopic surgery (CLS) and robotic-assisted laparoscopic surgery (RALS) and (2) to evaluate the surgeons’ frustration level in performing these tasks. MethodsTwelve experienced and 31 novices in laparoscopy were prospectively evaluated in performing three standardized laparoscopic tasks in five consecutive, weekly training sessions. Analysis of the learning curves was based on the magnitude, rate, and quickness in performance improvement. The participant’s frustration and mood were also evaluated during and after every session. ResultsFor the novice participants, RALS allowed for shorter time to task completion and greater accuracy. However, significant and rapid improvement in performance as measured by magnitude, rate, and quickness at each session was also seen with CLS. For the experienced surgeons, RALS only provided a slight improvement in performance. For all participants, the use of RALS was associated with less number of sessions in which they felt frustrated, less number of frustration episodes during a session, lower frustration score during and after the session, and higher good mood score.ConclusionThe advantages of RALS may be of most benefit when doing more complex tasks and by less experienced surgeons. RALS should not be used as a replacement for CLS but rather in specific situations in which it has the greatest advantages.

Modification of meatal advancement and glanuloplasty for correction of distal hypospadias

Objective: The meatal advancement and glanuloplasty (MAGPI) technique is still successfully used for the repair of distal hypospadias. The technique has been modified considerably since it was first described in 1981. The primary drawbacks of the procedure are the complications of meatal regression and meatal stenosis. The aim of this study was to present a modification of MAGPI for correction of distal hypospadias. Material and Methods: Ten cases with distal hypospadias were operated on using our modified MAGPI procedure. The modification involves excision of a pull‐out, tag‐shaped piece of glanular tissue through the vertical incision in the meatoplasty section of the original operation. By means of this excision, burying of the meatus into the glans was eased without inducing extra mobilization of the glans wings. As less glans tissue was left at the dorsal urethra the urethral meatus could be replaced in the center of the glans and better anatomic reconstruction could be attained. Results: After 1–3 years of follow‐up, all the operated cases showed functionally and cosmetically satisfactory results. The cosmetic appearance achieved with our modified technique was better than that obtained with the classical MAGPI procedure. Conclusions: Using our MAGPI modification, the urethra was localized deeper in the glans and an elliptical (slit‐like), wide meatus was obtained, the cosmetic appearance of which was more acceptable than that achieved with classical MAGPI.

Early renal parenchymal histological changes in an experimental model of vesico-ureteral reflux and the role of apoptosis.

Objectives. To observe early renal parenchymal cellular changes in an experimental model of vesico-ureteral reflux (VUR) and to show whether the apoptotic pathway plays a role in these cellular changes. Material and methods. Fourteen New Zealand breed rabbits were used and were divided into two equal groups (control and experimental groups). Urine samples were obtained in a sterile manner and cultured. In the study group, reflux was created in the right kidneys surgically. Renal scintigraphy and voiding cystourethrography (VCUG) were performed in both groups on Day 17. The kidneys were examined in terms of histology, apoptotic activity and caspase activity. Results. No growth was observed in urine cultures in either group. VUR was manifested in only two rabbits in the experimental group on VCUG. On renal scintigraphy, no renal scarring was observed in either of the groups and renal uptake values were in the normal range. There was a greater increase in collagen in the right kidneys in the experimental group than in the control group and apoptotic activity was significantly increased in the study group: 0% in the control group, 10.8%±0.7% in the experimental group (p<0.001). Caspase-6 activity was strongly positive and caspase-8 and -9 activities were moderately positive in the right kidneys of the experimental group. Caspase-6 activity was moderately positive, and caspase-8 and -9 activities were weakly positive in the contralateral kidneys of the experimental group. Caspase activities in the control group were negative (p<0.001). Conclusions. In this experimental model of VUR, apoptotic activity was initiated via the caspase-8 and -9 pathway and collagen tissue increased in the renal parenchyma where reflux occurred. The balance of apoptotic activity may play a key role in the occurrence of reflux nephropathy.

Effect of adhesion barrier (interceed TC7) on two-stage orchidopexy operation

Objective: In two-stage orchidopexy, adhesions formed after the first stage usually cause difficulty during the second operation and may even lead to injury to the testis itself or to the spermatic cord. We investigated whether the use of adhesion-preventing barriers in the abdominal or pelvic region during surgery could lessen adhesions formed during two-stage orchidopexy and thus ease dissection. Material and Methods: The study subjects comprised 21 male, albino, 30-day-old Wistar rats that were divided into three equal groups. In Group 1, the right testes were enveloped in adhesion barriers after dissection and sutured to the inguinal canal. In Group 2, the right testes were sutured to the inguinal canal without the barriers. In Group 3 (sham-operated group), all testes were dissected but no suturing was performed. Rats were sacrificed after 21 days and the ipsilateral testes were harvested. Results: Dissection of barrier-enveloped testes was relatively easy; however, no significant (p < 0.535) difference was seen in adhesion scores between Groups 1 and 2. Total tissue collagen was estimated by means of the hydroxyproline content. Tissue hydroxyproline levels were 16.04 ± 8.58, 13.20 ± 6.34 and 14.71 ± 5.51 μg/mg wet tissue in Groups 1-3, respectively and these differences were not significant. The histopathologic evaluation revealed significant differences only in the thickness of the tunica albuginea in Groups 1 and 2 (110.0 ± 30.0 vs 77.1 ± 21.3 μm, respectively; p < 0.038). Conclusion: The adhesion scores and the biochemical and histopathological examinations showed that an adhesion barrier is not beneficial in two-stage orchidopexy.

A rare cause of glans penis masses in childhood: Fibroepithelial polyp.

Fibroepithelial polyps of glans penis are very rarely seen in childhood. A 6-month-old male admitted to our institution with a slowly enlarging glans penis mass on the ventral side of the glans penis. The mass was totally excised, and hystopathological diagnosis was a fibroepithelial polyp. All of the reported cases published previously, except one, are of adult age and all of them have been associated with the history of long-term condom catheter use. The presence of the case in childhood; however, suggests that the pathology might be congenital. This is the second pediatric case presented in the English literature.

The Effect of Tunica Albuginea Incision on Testicular Tissue After Detorsion in the Experimental Model of Testicular Torsion

PURPOSE Testis torsion is a surgical emergency, and sometimes we cannot sufficiently prevent injury even surgical detorsion of the testis is performed in the appropriate time period due to some reasons such as tissue edema. In this experimental study, we investigated the effect of tunica albuginea incision (TAI) on testicular torsion-detorsion model (TDM). MATERIALS AND METHODS Twenty four male rats were used. The rats were randomly divided into three groups. In Group I, testicular torsion (TT) of 720° was created. After 4 hours of torsion period, the testis was detorsioned. Then three longitudinal incisions were made on tunica albuginea of the testis. In Group II, torsion and detorsion was created by the same way as in Group I, but TAI was not added to the procedure. Group III was Sham group. At the end of the first week, rats in the experimental groups were sacrificed and the testes were harvested for histological, immunohistological examinations and for the assessment of apoptotic activity. RESULTS In Group I, the procedures led to partial improvement in color of the testes. Modified Johnsen Scores in Groups I, II and III were detected as 7.8, 4.3 and 9.6 respectively (P = .001). In Group I, immunoreactivity of anti-APAF-1 was moderate in 7 rats, and strong in 1 rat. Immunoreactivity of anti-cytochrome C and anti-caspase3 were moderate in 6 rats, and strong in 2 rats. Immunoreactivity of anti-caspase 8 and 9 were moderate in 5 rats, and strong in 3 rats. The differences of immunoreactivity between the groups were statistically significant. TUNEL percentages were detected as 40, 62% in Group I, 60% in Group II and 11,75% in Group III respectively (P = .001). CONCLUSION As a result, multiple incisions made on tunica albuginea after detorsion in the TDM in rats, decrease the amount of ischemia- reperfusion injury. This effect might be related with the decrease in testicular edema and free oxygen radicals together with increase in tissue perfusion. Moreover, the decreased apoptotic activity seems to play a role in the decrease in inflammatory response and preservation of tissue parenchyma consequently.