Kaan Gokcen

Comparison of patient satisfaction rates for the malleable and two piece-inflatable penile prostheses

OBJECTIVE To compare patient/partner satisfaction with AMS 600-650 and AMS Ambicore penile implants (American Medical Systems, Minneapolis, USA) in patients with erectile dysfunction. MATERIAL AND METHODS The modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at six months after implantation of 46 patients who underwent AMS 600-650 (n=23) or Ambicore placement (n=23) between 1/1/2008 and 1/1/2013 were analyzed. RESULTS The percentages of patients with AMS 600-650 who reported to be satisfied, very satisfied and neither satisfied nor dissatisfied with their prostheses were 34.78% (n=8), 30.43% (n=7) and 34.78% (n=8), respectively. For patients with AMS Ambicore, these percentages were 73.91% (n=17), 13.04% (n=3) and 13.04% (n=3), respectively. These overall satisfaction rates were significantly different between patients with AMS 600-650 and Ambicore (p=0.013). For patients with AMS 600-650, the percentages of patients who reported to be very likely, neither likely nor unlikely, or very unlikely to continue using their prosthesis were 30.43% (n=7), 34.78% (n=8), and 34.78% (n=8) while for patients with AMS Ambicore, these percentages were 65.21%, 21.33%, and 13.04%, respectively. These percentages were different between patients with AMS 600-650 and Ambicore (p=0.018). CONCLUSION The two-piece inflatable penile prosthesis was found to be more successful in overall satisfaction and more likely for continued use when compared to the malleable penile prosthesis.

The Effect of Local Anesthetic Agent Infiltration Around Nephrostomy Tract On Postoperative Pain Control After Percutaneous Nephrolithotomy: A single-centre, randomised, double-blind, placebocontrolled clinical trial

PURPOSE Insufficient alleviation of pain after percutaneous nephrolithotomy causes patient dissatisfaction and generates additional morbidity factors by preventing early mobilization. This study investigated the effects of bupivacaine infiltration with two different doses around the nephrostomy tract after percutaneous nephrolithotomy. MATERIALS AND METHODS Patients who underwent subcostal single entrance percutaneous nephrolithotomy were randomly divided into 3 groups of 20 patients. While the first and second group were planned to receive bupivacaine at rates of 0.5% and 0.25% respectively, the third group was planned to receive a placebo agent to preserve the doubly blinded nature of the study. RESULTS A statistically significant difference was found in the number of patients using tramadole. The frequency of analgesic administration was found lower in the two groups that received bupivacaine in comparison to the group that did not, while the time of the first analgesic administration in the group that received high dose bupivacaine was significantly later than the other groups. Although there was no difference between the groups in terms of total amount of analgesic usage, patients who received higher concentrations of bupivacaine were likely to requirea lower amount of narcotic agent. The frequency of analgesic administration decreased significantly in patients of both groups that received bupivacaine. Moreover, by administering bupivacaine at a 0.5% rate, fewer patients (50%) required narcotic analgesia and the first time of analgesic administration was found to be significantly later. CONCLUSION Administering bupivacaine at a 0.5% rate around the nephrostomy tract after surgery was demonstrated to be more effective.

Paraneoplastic hyperbilirubinemia in metastatic prostate cancer and review of the current literature

Paraneoplastic syndromes are functional clinical disorders caused by the direct effect of the primary tumor or metastasis. The initial presenting symptom of the patients may be associated with paraneoplastic manifestations. Paraneoplastic cholestasis is most frequently defined in association with renal cell carcinoma (Stauffers syndrome), but it is an extremely rare clinical entity seen in association with prostate cancer. Etiology of cholestasis was investigated in the case diagnosed as metastatic prostate cancer who applied to the gastroenterology outpatient clinic due to complaints of ascites and jaundice that established the diagnosis of paraneoplastic hyperbilirubinemia. We observed improvement of his cholestasis with hormonotherapy used for prostate cancer.

Preoperative AST/ALT (De Ritis) Ratio as a Prognostic Factor in a Cohort of Patients who underwent radical cystectomy

Aim: This study aims to evaluate the prognostic significance of the preoperative aspartate aminotransferase (AST) / alanine aminotransferase (ALT) (De Ritis) ratio in bladder cancer (BC) patients who underwent radical cystectomy (RC). Materials-Method: We evaluated the clinical and histopathological data of 58 patients who had undergone RC between January 2008-August 2018 at our tertiary hospital. The potential prognostic value of the De Ritis ratio with regard to BC was evaluated using ROC curve analysis. The effect of the De Ritis ratio on disease specific survival (DSS) and overall survival (OS) was analyzed using the Kaplan-Meier method and multivariate Cox regression models. Results: A total of fifty-eight patients underwent RC and 95.6% were male (M/F:56/2). Mean age of the patients was 68.6 ± 11,56. The cut-off value of the De Ritis ratio for DSS was calculated as 1.417 in the ROC analysis. In Kaplan-Meier analyses, the group with a higher De Ritis ratio presented a more unfavorable progression in terms of DSS and OS (p=0.004). Based on the Cox regression models adjusted for clinical and pathological parameters, for DSS, the De Ritis ratio (HR 2.70, 95% CI 2.34-3.05 p=0.005) , pathological T stage (HR 3.36, 95% CI 2.91-3.82, p =0.007), and age (HR 1,038 95% CI 1,02-1,05; p=0.015) were determined as independent prognostic factors; and for OS, the De Ritis ratio (HR 2.71, 95% CI 2.33 -3.09; p =0.005), pathological T stage (HR 4.36, 95% CI 3.87 – 4.85; p=0.007) and age (HR 1.04, 95% CI 1.03-1.06; p = 0.015) were determined as independent prognostic factors. Turkce ozet Amac: Radikal sistektomi (RC) uygulanan mesane kanseri (BC) hastalarinda preoperatif olarak degerlendirilen aspartat aminotransaminaz (AST) / alanin aminotransferaz (ALT) (De Ritis) oraninin prognostik onemini degerlendirmeyi amacladik. Materyal-Metod: Ocak 2008 ile Agustos 2018 tarihleri ​​arasinda ucuncu basamak hastanemizde RS uygulanan 58 hastanin klinik ve histopatolojik verilerini inceledik. De Ritis oraninin BC uzerindeki potansiyel prognostik degeri ROC egrisi analizi kullanilarak degerlendirildi. Hastaliga bagli sag kalim (DSS) ve genel sag kalim (OAS) da De Ritis oraninin etkisi, Kaplan-Meier yontemi ve multivariate Cox regresyon modelleri ile analiz edildi. Bulgular: RC uygulanan toplamda ellisekiz hastanin 95.6% erkek (E/K:56/2) idi. Hastalarin yas ortalamasi 68.6± 11,56 idi. ROC analizine gore DSS icin De Ritis oraninin cut-off degeri 1.417 olarak saptandi. Kaplan-Meier analizlerinde yuksek De Ritis orani gorulen grupta DSS ve OAS icin daha kotu progresyon gosterdi (p =0.004). Klinik ve patolojik parametrelerin Cox regresyon modellerinde DSS icin De Ritis orani (HR 2.70, 95% CI 2.34-3.05 p=0.005), patolojik T evresi (HR 3.36, 95% CI 2.91-3.82, p =0.007) ve yas (HR 1,038 95% CI 1,02-1,05; p=0.015) iken OAS icin De Ritis orani (HR 2.71, 95% CI 2.33 -3.09; p =0.005), patolojik T evresi (HR 4.36, 95% CI 3.87–4.85; p=0.007) ve yas (HR 1.04, 95% CI 1.03-1.06; p = 0.015) bagimsiz prognostik faktorler olarak belirlendi. Sonuc : Preoperatif artmis De Ritis orani; RC uygulanan BC hastalarinda bagimsiz bir prognostik faktor olarak degerlendirilebilir. Sonuclarimizin genis ve uygun sekilde tasarlanmis prospektif, randomize calismalarla dogrulanmasi ve desteklenmesi gerekmektedir

In vitro evaluation of nebivolol effects on nonadrenergic noncholinergic responses in rabbit corpus cavernosum

The purpose of this study was to compare the effects of nebivolol on nonadrenergic noncholinergic (NANC) relaxation functions that are mediated by electric field stimulation (EFS) in rabbit corpus cavernosum smooth muscle by comparison with other beta‐adrenergic receptor blockers and show the level on which its effects through nitric oxide take place. After the effects of nebivolol on the isolated corpus cavernosum tissues that were contracted through the alpha‐adrenergic pathway and application of L‐NAME’ (NG‐nitro‐L‐arginine methyl ester) which is a competitive inhibitor of nitric oxide synthase (NOS), the changes that occurred were recorded. Following the effect on the tissue that was contracted with phenylephrine in the presence of atropine and guanethidine that was created by EFS, nebivolol and other beta‐blockers were added and the changes were recorded. After receiving relaxation responses with EFS‐mediated NANC, no difference was observed between the relaxation responses due to addition of nebivolol and other beta‐adrenergic blockers (p > 0.05). The finding that nebivolol which has a NO‐mediated relaxation effect did not have an effect on EFS‐mediated NANC relaxation but created relaxation on the tissue that was contracted by phenylephrine and the effect was reversed by L‐NAME, shows that its effects are on a postsynaptic level.

Effect of ADMA levels on severity of erectile dysfunction in chronic kidney disease and other risk factors

INTRODUCTION Hormonal, neurogenic, vasculogenic, and psychogenic impairments, as well as endothelial dysfunction may play a role in erectile dysfunction (ED) in patients with chronic kidney disease (CKD). Asymmetrical dimethylarginine (ADMA) is an inhibitor of nitric oxide, which is the key element of ED. ADMA levels are increased in CKD. We aimed to evaluate the effect of serum ADMA, prolactin, testosterone, and hemoglobin levels on erectile function of patients with CKD and control subjects. METHODS A total of 42 men with CKD and 25 age-matched controls were enrolled. The patients with CKD were categorized into group 1 and group 2 based on whether they had ED according to their response to International Index of Erectile Function questionnaire (IIEF-EFD). Group 3 was a control group. Serum ADMA, total testosterone prolactin, and hemoglobin levels of the patients were evaluated. RESULTS Serum ADMA, testosterone, and hemoglobin levels were similar between group 1 and 2, serum prolactin level was significantly high in group 1 than in group 2 or 3 (control group). There was no correlation between ADMA levels and IIEF-EFD scores of patients with CKD. CONCLUSIONS The results of this study suggest serum ADMA level is not related with ED in patients with CKD. Also, low testosterone and hemoglobin levels were not significant factors. High levels of serum prolactin are related with ED in patients with CKD.