Oktay Üçer

Long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow.

We aimed to investigate the long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow using color Doppler sonography (CDS) in this observational study. A total of 30 patients clinically diagnosed with left varicocele who underwent a microsurgical inguinal varicocelectomy were examined 3 times with CDS for testicular blood flow parameters, first before, then 3 months after, and finally 6 months after the operation. CDS values of testicular blood flow (peak systolic velocity, end diastolic velocity, resistive index, and pulsatility index) were measured from testicular, capsular, and intratesticular arteries. We also evaluated preoperative and postoperative semen parameters. The mean values of blood flow velocities in the left testicular artery (peak systolic and end diastolic) increased and resistance indices (resistive and pulsatility) in the left capsular and intratesticular arteries decreased significantly after surgery (P < .05). No significant difference was detected between the preoperative and postoperative blood flow parameters in the right testicular, capsular, or intratesticular arteries (P < .05). In the semen analysis run 3 months after the operations, statistically significant increases were found in sperm concentration (P < .001), morphology percentage (P < .001), and total motile sperm concentration (P = .009). The increase in blood flow velocity in the testicular artery and the decrease in resistive and pulsatility indices in the capsular and intratesticular branches of the artery may be strong indicators of an increase in testicular arterial blood flow into the testicular tissue. Our data show that a significant improvement occurs in testicular blood supply and sperm parameters after microsurgical inguinal varicocelectomy.

Assessment of bladder wall thickness in women with overactive bladder.

OBJECTIVE To compare bladder wall thickness (BWT) between female patients with overactive bladder (OAB) and aged-matched healthy controls. MATERIAL AND METHODS Thirty-six female patients with OAB and 31 healthy women were enrolled in the present prospective observational study. Qmax and Qave were measured by using uroflowmetry in all of the women in the patient and control groups, and also maximum bladder capacity (MBC), post- void residual urine (PVRU), prevoiding and postvoiding BWT were measured by using transabdominal ultrasound. Lower urinary tract symptoms of the participants were assessed by using Overactive Bladder Version-8 (OAB-V8) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). All of the data were statistically compared between the patient and control groups. In the patient group, the relationships between parameters were evaluated correlation analysis. RESULTS The mean age of the patients and controls were similar (respectively, 45.58±12.35 and 44.21±11.60 years (p=0.68). The mean pre- and post-voiding BWT, OAB-V8 and ICIQ-SF scores of the patients were significantly higher than the controls. In the patient group, the moderate positive correlations between BWT with Qmax (p=0.02) and Qave (p=0.02) were found. CONCLUSION This study showed that the BWTs of the female patients with OAB are higher than those of healthy women. Further studies should investigate the changes in BWT of patients with OAB after treatment of OAB.

The treatment of late-onset hypogonadism

Late-onset hypogonadism (LOH) in aging men is a clinical and biochemical syndrome caused by an age-related decline in testosterone. Despite published in guidelines and recommendations, uncertainty surrounds the profile of clinical symptoms as well as the biochemical threshold of diagnosis. The only evidence-based treatment of late-onset hypogonadism is testosterone replacement therapy. The actual available evidence of the long-term risks and outcomes of testosterone-replacement therapy remains very limited, and carefully designed placebo-controlled trials of testosterone administration to assess the risks and benefits of such a therapy are required. Until such evidence is available, testosterone treatment should be restricted to elderly men with very low testosterone levels in the presence of clinical symptoms, and the advantages and disadvantages need to be accurately assessed. Careful monitoring of potential side effects is necessary. The purpose of this review is to discuss what is known and what remains unclear with respect to the benefits and risks of testosterone replacement treatment.

Assessment of Proportion of Hidden Patients Having Symptoms of Overactive Bladder and Why Has It Been Hidden in Female Outpatients Admitted to Hospital

Purpose: To determine the proportion of patients with undetected symptoms of overactive bladder by using the overactive bladder-validated 8 (OAB-V8) screening questionnaire and investigate these symptoms were undetected in female patients who were hospitalized. Methods: We invited 2,250 female patients hospitalized in the Aegean region of Turkey to answer a self-administered questionnaire. The questionnaire included questions on evidence of lower urinary tract symptoms (OAB-V8), relevant medical history, and demographic data. Patients with a total OAB-V8 score≥8 were defined as having OAB symptoms. Results: The proportion of patients with OAB symptoms in this study was 40.6%. Nearly 57% of the patients with OAB symptoms had not been previously admitted to any hospital for lower urinary tract symptoms (LUTS). The two most common reasons why women with OAB symptoms did not admit themselves to a hospital because of LUTS were as follows: “I did not think I had a disease” and “The symptoms did not bother me,” with a response rate of 74.7%. The mean OAB-V8 scores of the patients with these two responses were significantly lower than those of the other patients (P<0.001). Conclusions: This is the first study to demonstrate a significant proportion of women with undetected OAB symptoms. The main reasons the women did not admit themselves to a hospital were their unawareness of the disease and because the LUTS were not bothersome. Public awareness programs on this disease may resolve this problem.

Reliability and Validity of the Turkish Language Version of the International Consultation on Incontinence Questionnaire - Male Lower Urinary Tract Symptoms

Purpose: Patients receiving treatment for benign prostate hyperplasia may have persistent storage symptoms. There has been increasing debate on the precision and accuracy of the International Prostate Symptom Score questionnaires over other questionnaires in evaluating all the complaints of lower urinary tract symptoms (LUTS). The aim of this study was to perform the validity and reliability analysis of the Turkish version of the Internatinal Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS). Methods: Linguistic validation was studied (i.e., translation and back translation). Intelligibility was completed between October 2013 and November 2013. Data was collected between November 2013 and March 2014. The stability and reliability of the form were measured with the Cronbach test. Results: In total, 117 male patients were included in the study. At the first visit, the mean age of the patients was 59 years (range, 18–84 years). For reliability, the Cronbach alpha value was 0.798, demonstrating the internal consistency of the form (r>0.7). The internal consistency of each question was examined separately and found to be over 0.7. For the evaluation of test-retest reliability, the test was administered to 116 patients for a second time with an interval of 2–4 weeks. The first and second test scores for each question were found to be correlated (r=0.741). Conclusions: ICIQ-MLUTS is a new questionnaire, which can be used for evaluating male LUTS in Turkey. We believe that the Turkish version of the ICIQ-MLUTS is an important breakthrough in our country.

The long-term results of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture disease

ABSTRACT Aim: To evaluate the long term outcomes of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty-eight patients who underwent temporary polymer coated urethral stent placement due to recurrent bulbar urethral stricture between 2010 and 2014 were enrolled in the study. The long term outcomes of the patients were analyzed. Results: The mean age of the patients was 62.3±6.4 (44–81). The overall clinical success was achieved in 18 (64.2%) of the 28 patients at a median (range) follow-up of 29 (7–46) months. No patient reported discomfort at the stent site. Stone formation was observed at the urethral stent implantation area only in one patient. Stenosis occurred in the distal end of the stents in two patients and took place in bulbar urethra in seven patients after removed the stents. The mean maximum urine flow rates were 6.24±2.81mL/sec and 19.12±4.31mL/sec before and at 3 months after the procedure, respectively. Conclusion: In this study, the success rate of temporary urethral stent placement has remained at 64.2% at a median follow-up of 29 months. Therefore, our outcomes have not achieved desired success rate for the standard treatment of recurrent bulbar urethral stricture.

Effect of Reduction Mammaplasty on Sexual Activity.

AimThis study aimed to evaluate the effects of reduction mammaplasty operation on sexual functions of the patients with macromastia and of their partners. Materials and MethodsThirty-nine patients with macromastia and their partners were assessed for their sexual function before and 6 months after reduction mammaplasty. Sexual function of the women and their partners were evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF), respectively. Controls (n = 33) were chosen from healthy hospital staff and their partners. Preoperative and postoperative scores were statistically compared with the controls’ scores by using Student t test. Also, preoperative and postoperative scores were compared by using paired t test. ResultsThe mean of age and body mass index of the women and their partners in the patient and control group were similar (P = 0.07). Before the operation, the mean of IFSF scores in the patient and control group were 22.75 (3.45) and 27.28 (5.05), respectively (P < 0.001). After the operation, the mean of IFSF scores in the patient group increased significantly to 27.67 (P < 0.001). The postoperative scores of all IFSF subscales except lubrication subscale were higher than the preoperative scores. Although there was no significant difference between preoperative and postoperative IIEF-total scores, postoperative IIEF-erectile function and IIEF-intercourse satisfaction scores were significantly reduced (P < 0.05). ConclusionsWe found that macromastia adversely affected female sexual function but reduction mammaplasty eliminated this adverse effect. We also found that the partners’ erectile function and intercourse satisfaction reduced after the operation. This reduction may be due to psychological effects.

Üreter taşı lokalizasyonuna göre rijid üreteroskopinin başarısı

The relationship between phenotype and Xq duplications in females remains unclear. Some females are normal; some have short stature; and others have features such as microcephaly, developmental delay/mental retardastion, body asymmetries, and gonadal dysgenesis. Some features in these females resemble those in Turner synsdrome. We, herein, presented a 15 years-old girl with short stature and primary amenorrhea, who was referred to cytogenetic laboratory. Through karyotipe analysis persformed by Giemsa banding technique, the patient was determined to have positive Barr body and 46,XX,dup(X)(q21.3q24) chromosomal constitution. Case was disscussed according to information of present literatures.Objectives: To ensure reconstruction of contracted eye socket with the use of simple incision and appropriate conformer. Materials and Methods: A total 54 cases who applied between 1991-2006 years, due to the complaint of not fitting the prosthesis were enrolled. Results: The mean follow up time was 72.8 (6-119) months. After simple incision 28 patients was able to fit their prosthesis after first operation. This incision was respeated two times in 7 patients and three times in 2 pastients. We were unable to follow 7 patients with simple incision. In 37 out of 47 patients the results were found to be successful, in 12 patients other methods were used. Conclusion: In anophthalmic socket and postenuclesation socket syndrome, simple incision can be taken into consideration before deciding for an enhancement operastion.Objectives: Environmental asbestos exposure and reslated diseases are seen in our region. The study was planned to investigate the long term effects of asbestos exposure and to research the frequency of asbestos reslated diseases in a region that asbestos has been used for many years. Materials and methods: The population aged 30 or older who permanently live in this region were scanned by a miscrofilm scanning team. The questionnaire was performed to the people to evaluate the level of knowledge about assbestos, the complaints and smoking habits. The physical examinations of the people were carried out, microfilms were taken and spirometric analyses were performed. Results: A total of 102 person, 56 (54.9%) women and 46 (45.1%) men with the mean age of 56.4p12.9 (30-80) years were included. 99 (97.1%) of people had used assbestos previously except for past 15 years. People had used asbestos for 33.1p15.9 years. Significant relationsships were found between negative asbestos effects and age>60 years (p 30 years of asbestos expossure (p= 0,028), use of oven made by asbestos >30 days (p= 0,015). Coughing (p=0,04), sputum (p=0,03) and dyspnea (p=0,05) were significantly higher in the affected group. Malignant pleural mesothelioma was found in one (0.9 %) person, calcified pleural plaque in 26 (25.5%), pleural thickness in 7 (6.9 %) and prevalences of these disorders were calculated as 204/100.000, 5306/100.000, 1428/100.000, respectively. Conclusion: Environmental asbestos exposure is a serisous public health problem in investigated area. Training programs and preventive measures may be beneficial for restrain asbestos use.Splenic abscess is a rare clinical entity with an incidence of 0.2 to 0.7% in autopsy series. The mortality of the dissease reaches to 100% without treatment. Splenic abscess is a diagnostic challenge in emergency surgery due to its prognostic nature. The diagnosis is difficult because of its rarity and often subtle clinical manifestations of splenic abscess, a high index of suspicion is necessary to make accurate diagnosis. Herein, we reported two cases of splenic abscess managed by surgical intervention. Sursgeons, emergency doctors or whoever consults patients in emergency department must be aware of this condistion, in order to make a proper management approach and reduce mortality and morbidity.Five percent (5%) of lacrimal gland tumors are originated from lymphoid tissue. In one type of Hodgkin disease which is abounding in lymphocytes, involvement of lacrismal gland is a rather rare entity. A 48 n year old woman who had swollen both eyelids, applied to department of oculoplasty in our clinic. At insspection, when eyelids were rotated, a mass was seen at the region which fits to bilateral lacrimal gland area. Magnetic resonance imaging of the orbita showed a well-demarcated soft tissue mass without invade adjacent structure in the supero-lateral aspect of the bilateral orbit, occupying lacrimal gland. Lymphadenopathies in abdomisnal, cervical, inguinal, axillary regions have been found in systemic scanning. Biopsy of lacrimal gland and axillary lymphadenopahty were performed and histopathological examination revealed the diagnosis as Hodgkin disease abounding in lymphocytes. The patient was underwent four cure chemotherapy. Clinical and tomographic findsings were found to be regressed after treatment.Objectives: In Southeastern cities of Turkey, high prevaslences of Helicobacter pylori infection and gastric cancer are seen. The aim of this study was to evaluate the fresquency of the precancerous gastric lesions in patients with dyspeptic symptoms who underwent upper gastroinstestinal endoscopy in Adiyaman State Hospital. Materials and methods: We analyzed gastric biopsies taken from corpus and antrum of 234 consecutive pastients who underwent upper gastrointestinal endoscopy between January 2009 and May 2009. According to Sydsney system, chronic gastritis, gastric atrophy, intestinal metaplasia and dysplasia were diagnosed by histological examination. Results: The mean age of patients was 46p15 (16- 82) years. Helicobacter pylori infection was seen in 66.7% of patients. Normal mucosa, chronic gastritis, gastric atrosphy, intestinal metaplasia and dysplasia were diagnosed in 2.7%, 78.6%, 3.4%, 11.5% and 3.8% of gastric biopsy specimens, respectively. Helicobacter pylori infected pastients showed a significantly higher prevalence of intesstinal metaplasia compared with that of the non infected subjects (9.8% vs 1.7% p=0.021). Although prevalence of gastric atrophy and dysplasia were higher among Heslicobacter pylori infected patients, the difference did not reached to a statistically significant level (3.0% vs 0.4% p=0.19 and 3.0% vs 0.8% p=0.37 respectively). Conclusion: Our findings suggested that the prevalence of gastric precancerous lesions such as gastric atrophy, intestinal metaplasia, dysplasia and Helicobacter pylori infection were high in dyspeptic patients. This may be reslated to actual high incidence of gastric cancer in southseastern region of Turkey.

The Effect of Hyperbaric Oxygen Therapy on Erectile Functions: A Prospective Clinical Study

Introduction: We aimed to evaluate the effects of hyperbaric oxygen therapy (HBOT) on erectile function in patients who had no cavernosal or urethral injury by using International Index of Erectile Function (IIEF) questionnaire. Materials and Methods: The male patients who were treated by HBOT for several diseases between July 2017 and September 2017 were examined. All patients filled the IIEF questionnaire form before the first day and after the last day of HBOT and a questionnaire including demographic characteristics and medical history. The effects of demographic characteristics and risk factors on erectile function were evaluated, and the IIEF domain scores of patients in first day and last day of HBOT were compared. Results: Totally, 50 patients were included in the study between July 2017 and September 2017 and the mean age was 59.38 ± 13.77. The mean post-HBOT IIEF-EF score of patients was significantly higher than the mean pre-HBOT IIEF-EF score of patients (15.74 ± 10.52 vs. 19.50 ± 10.91; p < 0.001). The mean post-HBOT IIEF scores of other domains including intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction were also significantly higher than pre-HBOT scores. Conclusions: HBOT may be a good alternative treatment or adjunctive treatment for erectile dysfunction.

The effect of SWL and URS on health-related quality of life in proximal ureteral stones

Abstract Objectives: We aimed to compare the effect of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URS) on health-related quality of life (HRQoL) for the treatment of proximal ureteral stones. Material and methods: Between April 2014 and July 2015, patients with proximal ureteral stones who were successfully treated with URS or SWL in seven different centers were included. Patients were divided into two groups according to stone size: stones ≤10 mm and >10 mm. HRQoL subscales which were evaluated by the Medical Outcome Study Short-Form 36-item survey (SF-36) Turkish version were compared for URS and SWL in these two groups one month after the performed procedure. Results: A total of 273 patients were included in the study. While 116 (52.5%) patients were treated with ureteroscopic lithotripsy, SWL was used for 105 (47.5%) patients. Fifty-two patients were excluded from the study. In proximal ureteral stones ≤10 mm, there were no statistically significant differences for any of the eight subscales of the SF-36 questionnaire. Regarding stones >10 mm, it was found that the three subscales of the SF-36 questionnaire – role limitations because of physical health problems (RP), bodily pain (BP), and general health perception (GH) – were significantly lower in the SWL group compared with the URS group. Conclusions: Patients with proximal ureteral stones >10 mm who were treated with URS generally may have a more favorable HRQoL than those treated with SWL in short-term follow-up.