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Öğe Current laparoscopic practice patterns among urologists in Turkey(Aves, 2012) Altunoluk, Bulent; Soylemez, Haluk; Ozer, Ali; Efe, Erkan; Sancaktutar, Ahmet Ali; Resim, SefaObjective: Laparoscopic surgery has become increasingly popular in urology over the last decade. This survey was performed to evaluate the current practice patterns in laparoscopy among urologists in Turkey. Material and methods: A detailed questionnaire about urologic laparoscopic practice patterns was distributed to 1242 urologists who were working in Turkey. The questions pertained to age, practice demographics, and the amount and variety of laparoscopy performed. Results: Nearly half of the respondents (48.3%) already performed laparoscopy. Of the urologists in academic settings, including university hospitals and education and research hospitals, 69.6% and 59.4% performed laparoscopy, respectively. In state hospitals, the percentage of those who performed laparoscopy was lower (26.9%). The most important reasons mentioned for performing laparoscopy were shorter hospital stay, patient requests and greater flexibility of possible surgical techniques. The main laparoscopic procedures performed were nephrectomy (benign indication), 91%; renal cyst decortications, 90%; nephrectomy (malign indication), 65%; laparoscopic stone surgery, 47% and pyeloplasty, 38%. A large percentage (77.2%) of respondents intended to attend continuing education and to perform laparoscopy in the future. Conclusions: Our results show that laparoscopic practice steadily increases in frequency and that urologists are willing to substitute open surgery for laparoscopic surgery. The performance of laparoscopic surgery has become a goal for most urologists in Turkey to achieve in the near future.Öğe Deterioration of renal function in patients operated for lower urinary tract symptoms(Aves, 2011) Altunoluk, Bulent; Soylu, Ahmet; Beytur, Ali; Soylemez, Haluk; Baydinc, CanObjective: We aimed to investigate the rate of deterioration of the renal function in patients operated for lower urinary tract symptoms, the relation between this rate and patient age, symptom severity, and accompanying diseases. Materials and methods: The data of 369 patients who admitted to our clinic with lower urinary tract symptoms and operated between 01/06/2001 and 31/03/2005 were retrospectively evaluated, and the examination findings and laboratory results have recorded. Results: The preoperative serum creatinin level was <= 1.4 mg/dL in 315 (85.4%) patients and >1.4 mg/dL in 54 (14.6%) patients. The mean age of the patients with serum creatinin level <= 1.4 mg/dL was 68.64 +/- 8.24 years, and that of patients with serum creatinin level >1.4 mg/dL was 72.56 +/- 7.96 years (p<0.05). The level of serum creatinin increased with increasing age, and the renal function was worsened with the increase of symptom score. Also, in the presence of the chronic diseases such as hypertension and diabetes, the rate of renal dysfunction increased by 2.5 times (25.5% vs. 10.9%). There was no correlation between postvoiding residue urine and renal dysfunction. Additionally, the renal dilatation accompanied the increase in the serum creatinin level. Conclusion: In the patients with with lower urinary tract symptoms, the serum creatinin level must be evaluated at the first admission for early diagnosis and treatment of renal dysfunction.Öğe Effects of acute exercise on the diameter of the spermatic vein, and duration of reflux in patients with varicocele(Informa Healthcare, 2013) Atar, Murat; Soylemez, Haluk; Oguz, Fatih; Beytur, Alt; Altunoluk, Bulent; Kahraman, Bayram; Islamoglu, YahyaObjective. The aim of this study was to investigate the effects of acute exercise on the diameter of the spermatic vein, and on the duration of reflux in patients with varicocele. Material and methods. The study included 38 patients with complaints of infertility and scrotal pain between 2009 and 2010. The diagnoses were made by physical examination and colour Doppler ultrasound, with both performed before and after exercise tests. Results. The mean age of the participants was 25.7 +/- 4.9 years. During the first examination, the grades of the varicoceles detected were as follows: grade I, n = 7; II, n = 10; and III, n = 21. The diameters of veins in patients with grades I, II and III varicocele were 2.1 mm, 2.9 mm and 4.2 mm, respectively, before exercise, whereas they were 2.6 mm, 3.2 mm and 4.3 nun, respectively, after exercise. In patients with grade I varicoceles, compared with pre-exercise values, the diameter of the left spermatic vein and duration of reflux measured during Valsalva manoeuvres were increased significantly after exercise (p = 0.042 and p = 0.034, respectively); similar results were obtained for the patients with grade II varicoceles (p = 0.007 and p = 0.008, respectively). However, the minimal relative increase in cases with grade III varicoceles was not statistically significant (p > 0.05). Conclusions. This study demonstrates that acute exercise increases the spermatic vein diameter and reflux time in patients with varicoceles. These outcomes demonstrate that acute exercise may be an aggravating factor for varicocele, as seen in chronic exercise.Öğe EVALUATION OF SYMPTOMS DUE TO URETERAL STENTS(Aves, 2007) Soylu, Ahmet; Altunoluk, Bulent; Soylemez, Haluk; Yologlu, Saim; Baydinc, Yasar CanIntroduction: Double J ureteral stents are being used in urological practice for more than 25 years and in the recent years indications have continued to expand. Thus the complications and side effects of ureteral stents are also more frequent than previously reported. In addition to the severe complications resulting from forgotten or intentionally left stents for longer durations in ureters, they might also cause physical and emotional side effects due to bothering symptoms. The majority of the uncomfortable symptoms are related to urinary tract and these symptoms have severe negative impact on patients' general health status and quality of life. In this study, we evaluated the symptoms bothering the patient and impairing the quality of life due to stents. Materials and Methods: One hundred and twenty eight men and 79 women who were treated with ureteral double J stents were recruited. The patients were followed with a questionnaire consisting of 14 questions concerning urgency, incontinence, painful voiding, incomplete emptying, urethral pain, hematuria, sleep disturbance, need for analgesics, overall weakness, social life enjoyment, sexual dysfunction, getting permission from work/school, urinary tract infection and the need for extra antibiotics at 1 and 4 weeks after stent insertion and 1 week after stent removal. In addition to the presence or absence of a symptom, the frequency of the symptom, when it is present, was also asked based on a subjective classification [occasionally (25%), sometimes (50%), most of the time (75%), all of the time (100%)]. The symptoms of each period are compared by statistical analysis. Results: The mean age was 40.1 (range: 8-80) years. The indications for double J insertion were nephro-ureterolithiasis (n: 184), pregnancy related hydronephrosis (n: 8), malignancy (n: 7), ureteropelvic junction obstruction (n: 5), ureterovesical junction obstruction (n: 2), perforation (n: 1). There was no history of previous double J stent insertion in any patient. Double J stents were inserted to the right, left and both ureters in 92, 100 and 15 patients respectively. All double J stents used in the study were made up of polyethylene and except for 4 patients' stents with 6F diameter and 26 cm length were inserted. In the 4 pediatric patients 4.8 F diameter and 16 cm length double J stents were used. There was no change in the social life enjoyment with stent placement or removal. All other symptoms increased with the increased duration of the stent and decreased with the removal. The most significant two symptoms at the post insertion one week were painful voiding (43%) and urgency (41%) resulting from irritation of the stent. Also these two symptoms were significantly high (73%) at the fourth week. Conclusion: The results of our study indicates that ureteral stents have negative impact on general health status, sexual functions, school/work performance and quality of life in addition to the increased urinary tract related symptoms, and these negative effects increase with the duration of the stent. Therefore, the indications and durations of the ureteral stents must be revisited in the light of the quality of life, and unnecessary insertions and longer durations should be avoided.Öğe RESULTS OF 78 INTRAUTERINE INSEMINATION (IUI) CYCLES WITH HUSBAND SPERM IN INFERTILITY AND FACTORS AFFECTING IUI SUCCESS: A RETROSPECTIVE STUDY(Aves, 2005) Kilic, Suleyman; Beytur, Ali; Altunoluk, Bulent; Beytur, Leyla; Oguz, Fatih; Atmaca, RusenIntroduction: Intrauterine insemination (IUI) with or without controlled ovarian hyperstimulation is a widely used therapeutic option for a variety of causes of infertility. Compared to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), IUI is efficient and more cost-effective than the others for the treatment of unexplained and nonsevere male factor infertility. In this retrospective study, we aimed to determine our IUI outcomes and the variables influencing IUI success. Materials and Methods: To determine the influence of several parameters (age, duration and type of infertility, semen parameters, presence of varicocele, varicocelectomy and smoking histories) on the outcome of IUI in 35 women undergoing ovarian stimulation with clomiphen citrat, a retrospective review of 78 IUI cycles, which were done for the treatment of infertility using fresh husband sperm, was performed for approximately 1 year on data from the IUI program. Results of Pre-IUI evaluations were normal in all women and all men had normal semen analyses results. Discontinuous gradient centrifugation (DGC) with Sil-Select Plus was used for sperm preparation. Maximum number of IUI cycles per couple was three. In statistical analysis, chi(2), Fisher's exact and Mann-Whitney U tests for in-and between-group comparisons and Pearson and Spearman tests for correlation analyses were used. Results: Primary and secondary infertility were determined in 25 and 10 couples, respectively. Fourteen men had varicocelectomy history. Ten men were smoking cigarette. Seven men had left varicocele at physical examination. Means of man and woman age and infertility duration were 29.94+/-4.72 (23-46) years, 27.46+/-4.55 (20-38) years and 63.23+/-30.88 (15-123) months, respectively. The pregnancy rate was 8.97% (7/78) per treatment cycle, 20% (7/35) per patient, 5.71% (2/35) for first cycle, 10.34% (3/29) for second cycle and 14.3% (2/14) for third cycle. All pregnancies were normal. No miscarriage, tubal pregnancy, birth defect and prematurity were observed. Difference between the pregnancy rates of each cycle was statistically insignificant (p=0.697). There were statistically significant negative correlations between the pregnancy rate and mean ages of the men and especially women (p=0.041, p=0.009, respectively). However, no correlation was found between pregnancy rate and infertility duration (p=0.108). DGC procedure increased percents of the sperms moving with a slow, meandering forward progression (grade 2) and in a straight line with high speed (grade 4) and decreased percent of sperms with no movement (grade 0) very significantly, without changing the percent of those with sluggish or nonprogressive movement (grade 1). However no-one of the pre and post-DGC semen analysis parameter was found to have influence on pregnancy rate. Pregnancy rates in the primary and secondary infertile couples were statistically indifferent. Pregnancy rates achieved in patients without varicocele or with a history of successful varicocelectomy were higher than those with untreated varicocele and with a history of unsuccessful varicocelectomy. There was not any statistically significant difference between the pregnancy rates in the patients with and without smoking history. Conclusion: The most significant predictors of success of IUI with fresh husband sperm in infertile couples were age of the woman and man. Absence of varicocele and treatment of it seemed to have affirmative effect on pregnancy rate.
