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Öğe THE AFFECTS OF INCREASING EXPERIENCE ON THE PERCUTANEOUS NEPHROLITHOTOMY OPERATIONS(Aves, 2007) Ugras, Yahya Murat; Gunes, Ali; Soylu, Ahmet; Baydinc, Yasar CanIntroduction: Importance and priority of minimally invasive methods in treatment of kidney stones are known and accepted by concerned medical doctors. Percutaneous nephrolithotomy is a minimally invasive surgical technique that is being applied for 30 years, and is also continuing its evolution meanwhile. From the first years of establishment to date, indications and surgical technique of this operation is developed as well as surgical results. Application in our country for this operation began at 1990's. Knowing how surgical results are affected by passing time and increasing experience is important for both getting information on how budding young surgeons should be trained on this issue and for developing anticipation on the future of percutaneous nephrolithotomy. In this review, in the light of national and international publications, we tried to summarize the evolution process, investigate the affects of increasing clinical and academical experience on results and give an idea on the surgical training methods of percutaneous nephrolithotomy.Öğe ASSESSMENT OF FEMALE PATIENTS PRESENTING WITH URINARY INCONTINENCE(Mary Ann Liebert, Inc, 2012) Altintas, Ramazan; Oguz, Fatih; Beytur, Ali; Kati, Bulent; Gunes, Ali[Abstract Not Available]Öğe Comparison of Venous Blood Gas Levels Between Pampiniform Plexus and Brachial Vein in Patients With Varicocele(Aves Yayincilik, Ibrahim Kara, 2010) Beytur, Ali; Soylu, Ahmet; Ugras, Yahya Murat; Gunes, Ali; Baydinc, Yasar CanObjectives: In this study, we aimed to determine whether there were some changes in the oxygenation and metabolism of testis tissue in patients with varicocele by comparing blood gas levels in dilated pampiniform plexus and brachial vein. Patients and Methods: Venous blood samples of 52 patients (mean age 24.4 +/- 7 years; range 17 to 49 years) who underwent varicocelectomy were taken from most dilated vein of the pampiniform plexus and simultaneously from brachial vein during varicocelectomy. In these samples, pH, lactate, SO(2), pO(2), pCO(2), HCO(3) values were measured and their means were compared. Results: While there were no significant differences between the pH, pO(2) and SO(2) levels of venous samples from brachial vein and pampiniform plexus, lactate level was significantly higher, pCO(2) and HCO(3) levels were significantly lower. Despite these significant differences, mean values measured were within normal laboratory ranges. Conclusion: Although the results of this study showed that varicocele caused statistically significant decreases in the rate of oxygen consumption and metabolism level in the testis tissue compared with the peripheral tissues, values obtained from the venous sample of pampiniform plexus were normal. Therefore, diminished oxygen consumption and decreased metabolism can not explain the negative effects of varicocele on testis tissue. This topic remains to be elucidated in later studies.Öğe The epidemiology and factors associated with nocturnal enuresis among boarding and daytime school children in southeast of Turkey: a cross sectional study(Bmc, 2009) Gunes, Ali; Gunes, Gulsen; Acik, Yasemin; Akilli, AdemBackground: Nocturnal enuresis is an important problem among young children living in Turkey. The purpose of this study was to determine the possible differences in the prevalence of enuresis between children in boarding school and daytime school and the association of enuresis with sociodemographic factors. Methods: This was a cross-sectional survey. A total of 562 self-administered questionnaires were distrubuted to parents from two different types of schools. One of them was a day-time school and the other was a boarding school. To describe enuresis the ICD-10 definition of at least one wet night per month for three consecutive months was used. Chi-square test and a logistic regression model was used to identify significant predictive factors for enuresis. Results: The overall prevalence of nocturnal enuresis was 14.9%. The prevalence of nocturnal enuresis declined with age. Of the 6 year old children 33.3% still wetted their beds, while the ratio was 2.6% for 15 years-olds. There was no significant difference in prevalence of nocturnal enuresis between boys and girls (14.3% versus 16.8%). Enuresis was reported as 18.5% among children attending day time school and among those 11.5% attending boarding school (p < 0.05). Prevalence of enuresis was increased in children living in villages, with low income and with positive family history (p < 0.05). After multivariate analysis, history of urinary tract infection (OR = 2.02), age (OR = 1.28), low monthly income (OR = 2.86) and family history of enuresis (OR = 3.64) were factors associated with enuresis. 46.4% of parents and 57.1% of enuretic children were significantly concerned about the impact of enuresis. Conclusion: Enuresis was more frequent among children attending daytime school when compared to boarding school. Our findings suggest that nocturnal enuresis is a common problem among school children, especially with low income, smaller age, family history of enuresis and history of urinary tract infection. Enuresis is a pediatric public health problem and efforts at all levels should be made such as preventive, etiological and curative.Öğe Factors Affecting Complication Rates of Percutaneous Nephrolithotomy in Children: Results of a Multi-Institutional Retrospective Analysis by the Turkish Pediatric Urology Society(Elsevier Science Inc, 2014) Onal, Bulent; Dogan, Hasan Serkan; Satar, Nihat; Bilen, Cenk Y.; Gunes, Ali; Ozden, Ender; Ozturk, AhmetPurpose: We assessed factors affecting complication rates of percutaneous nephrolithotomy in children. Materials and Methods: We retrospectively evaluated data on 1,205 renal units in 1,157 children treated with percutaneous nephrolithotomy at 16 Turkish centers between 1991 and 2012. Of the patients 28.3% had a history of urolithiasis. Complications were evaluated according to the Satava classification system and modified Clavien grading system. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. Results: A total of 515 females and 642 males were studied. Mean +/- SD patient age was 8.8 +/- 4.7 years (range 4 months to 17 years). Mean +/- SD stone size, operative time and postoperative hospital stay were 4.09 +/- 4.06 cm 2, 93.5 +/- 48.6 minutes and 5.1 +/- 3.3 days, respectively. Postoperative stone-free rate was 81.6%. A total of 359 complications occurred in 334 renal units (27.7%). Complications were intraoperative in 118 cases and postoperative in 241. While univariate analysis revealed that stone history, positive urine culture, operative time, length of hospitalization, treatment success, punctured calyx and location of the stone significantly affected the complication rates (p <0.05), operative time, sheath size, mid calyceal puncture and partial staghorn formation were the statistically significant parameters affecting complication rates on multivariate logistic regression analysis. Conclusions: Percutaneous nephrolithotomy is the treatment of choice for most renal calculi in children. The technique is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.Öğe FACTORS AFFECTING COMPLICATION RATES OF PERCUTANEOUS NEPHROLITHOTOMY IN CHILDREN: RESULTS OF MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS BY PEDIATRIC STONE DISEASE STUDY GROUP OF TURKISH PEDIATRIC UROLOGY SOCIETY(Mary Ann Liebert, Inc, 2012) Onal, Bulent; Dogan, Hasan Serkan; Satar, Nihat; Bilen, Cenk Y.; Gunes, Ali; Ozden, Ender; Ozturk, Ahmet[Abstract Not Available]Öğe FACTORS AFFECTING SUCCESS IN SURGERY FOR MID-AND DISTAL PENILE HYPOSPADIAS: A COMPARATIVE STUDY OF MATHIEU AND TIPU TECHNIQUES(Aves, 2006) Ugras, Murat Yahya; Ergin, Hseyin; Kilic, Sleyman; Gunes, Ali; Baydinc, CanIntroduction: Surgical repair of hypospadias is influenced by many factors, the most important being the experience of surgeon. In this study, we aimed to determine factors affecting success in Mathieu and TIPU procedures conducted for mid-and distal penile hypospadias. Since we have some differences in patient profile regarding age, previous circumcision and hospital stay, we think that we need our own data to evaluate factors affecting surgical success. Materials and Methods: We retrospectively evaluated our surgical records and retrieved data on primary surgery for mid-and distal penile hypospadias, using either Mathieu or TIPU techniques. We reached patients and refreshed data when necessary. We gathered data on age, family history, previous surgery (circumcision or chordee), native meatal place, existence of chordee, anesthesia technique, type and time of urinary diversion, medications, hospital stay and complications. We analyzed data with software (SPSS 10.0, SPSS inc. ILL, USA) using parametric tests (ANNOVA, Student's T Test, Pearson) and nonparametric (Kruskal Wallis Test, Mann Whitney-U Test) accepted p< 0,05 as statistically significant. Results: Among a total of 149 hypospadias patients presented between 1999 and 2004, 54 meeting our criteria were enrolled. Mathieu and TIPU operations were conducted in 34 (63%) and 20 (37%) patients, respectively. Mean age was 9.6 +/- 6.2 years. Regarding age groups, 15 patients (27.8%) were at 0-5, 25 (46.3%) at 6-12 and 14 (25.9%) at 12< years of age. Native meatus was placed at coronal, subcoronal, distal and mid penis in 16 (29,. 5%), 8 (14.8%), 19 (35.2%) and 11 (20.5%) patients, respectively. Initial operation was successful in 28/ 34 (82.4%) of Mathieu and 15/ 20 (75.0%) of TIPU procedures. The difference was not statistically significant (p> 0.05). Considering age groups or place of native meatus, success rates of both procedure were not significantly different (p> 0.05). Hospital stay ranged between 5 and 33 (mean 8.4 +/- 4.7) days. Postoperative complications were as follows: After Mathieu procedure, 5 (14.7%) urethrocutaneous fistulas were seen and 3 were treated surgically. One patient had wound infection and skin disruption with an intact tube. He had debridement, antibiotic therapy and late closure of skin. After treatment of complications, success rate was 32/ 34 (94.1%). After TIPU procedure, 3 (15.0%) urethrocutaneous fistulas were seen, 2 that applicated were treated surgically. One patient had meatal stenosis and another had skin disruption with intact tube, both treated surgically. After treatment of complications, success rate was 19/ 20 (95.0%). Complication rates of both procedures were similar (p> 0.05). Foley and Nelaton catheters were used as urethral stents in 17 (31.5%) and 37 (68.5%) patients, respectively. Complication rate was significantly higher with Foley Catheter (r: 0.45; p= 0.001). General and spinal-caudal anesthesia were performed in 30 (55.6%) and 24 (44.4%) patients, respectively. Complication rate was significantly higher with regional anesthesia (r: 0.38; p= 0,005). Conclusion: In this series, we encountered factors that affect surgical success, which was in concordance with literature. Due to significantly higher complication rate, Foley catheter is not recommended as drain after both procedures. Regardless of age, we prefer to use general anesthesia in all patients.Öğe Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children(Elsevier Sci Ltd, 2018) Kaygisiz, Onur; Satar, Nihat; Gunes, Ali; Dogan, Hasan Serkan; Erozenci, Ahmet; Ozden, Ender; Piskin, Mehmet MesutBackground Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. Objectives To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. Study design Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups. Results Mean age was 6.46 +/- 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI Table Predictive factors for FUTI. occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI. Discussion The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL. Conclusions Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.Öğe Factors predicting postoperative febrile urinary tract infection following percutaneousnephrolithotomy in prepubertal children(Elsevıer scı ltd, the boulevard, langford lane, kıdlıngton, oxford ox5 1gb, oxon, england, 2018) Kaygisiz, Onur; Satar, Nihat; Gunes, Ali; Dogan, Hasan SerkanBackground Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. Objectives To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. Study design Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groupsÖğe Germ cell testicular tumor showing spontaneous regression(2018) Cimen, Serhan; Gunes, Ali; Beytur, Ali; Gokce, HasanÖğe Giant Hydronephrosis and Nonfunction Kidney Dependent to Ureter Tumor: A Case Report(Galenos Yayincilik, 2015) Cimen, Serhan; Altintas, Ramazan; Gunes, AliTransitional epithelial cancers in upper urinary tract are quite rare. It is less often being synchronous with the bladder cancer and this situation needs closer follow-up of the patient. In this case report, we evaluated a 56 years-old male having a giant hydronephrosis and nonfunctional kidney, urethra tumor in the light of current literature. The patient presented with right flank pain, palpable abdominal mass and intermittent hematuria in last one years.Öğe The importance of instrument type in paediatric percutaneous nephrolithotomy(Springer, 2014) Altintas, Ramazan; Oguz, Fatih; Tasdemir, Cemal; Beytur, Ali; Cimen, Serhan; Gunes, Ali; Colak, CemilWe reported our experience with percutaneous nephrolithotomy in children and compared the outcomes, including the morbidity and success rates, regarding the instruments of different sizes. One hundred and seventy-three paediatric patients, who underwent percutaneous nephrolithotomy in our clinic between 1999 and 2013, were assessed. According to the size of instruments used during surgery, three different groups were formed and the pre- and postopeartive outcomes were compared between the groups. 76 girls and 97 boys with a mean age of 9.24 (a parts per thousand currency sign17) years were assessed. Stone-free rates were 75.6 % in group 1 (n = 82) using 17 F nephroscope, 79.4 % in group 2 (n = 73) using 24 F nephroscope and 72.2 % in group 3 (n = 18) using 26 F nephroscope. Postoperative fever was seen in four, five and one patient in group 1, 2 and 3, respectively. Urinary infection was seen in one patient in group 1 and four patients in group 2. Mean haematocrit drop and stone burden were significantly lesser in group 1. No significant difference was seen in the duration of nephrostomy and hospitalization between the groups. The success rates obtained in the groups using different instrument types (paediatric or adult) were similar. However, age, weight, height, stone burden and bleeding were significantly lesser in group 1 that used paediatric type of instrument. As the most frequent complication of PNL, bleeding seems to be associated with stone burden, the diameter of dilatation and the calibre of instrument. To decrease the particular complications, paediatric type of instruments are convenient and do not affect the success.Öğe Is There a Relationship Between Chronic Periodontitis and Erectile Dysfunction?(Elsevier Sci Ltd, 2013) Oguz, Fatih; Eltas, Abubekir; Beytur, Ali; Akdemir, Ender; Uslu, Mustafa Ozay; Gunes, AliIntroduction. Chronic periodontitis (CP) is characterized with inflammation of the gingival tissues, which causes endothelial dysfunction in different organs. Aim. In this study, we investigated the association of CP with the erectile dysfunction (ED). Methods. The study group included 80 male patients with ED and 82 male patients without ED (control), aged between 30 and 40 years. The International Index of Erectile Function (IIEF) questionnaire was used to assess male sexual function, particularly the presence or absence of ED. Main Outcome Measures. The patients in the study and control groups were statistically compared according to their plaque index (PI), bleeding on probing (BoP), probing depth (PD), and clinical attachment level (CAL). Results. In the non-ED and the ED groups, the mean age was 35.7 +/- 4.8 and 34.9 +/- 4.9 years, respectively. Patients' characteristics including body mass index, household income, and education status were similar in both groups (0.05). Nineteen patients (23%) had severe CP in the non-ED group; 42 patients (53%) had severe CP in the ED group. Logistic regression analysis showed a significantly high association between ED and the severity of CP (odds ratio: 3.29, 95% confidence interval: 1.369.55, P<0.01). The mean values of PI, BoP, and the percentages of sites with PD >4mm and sites with CAL >4mm were significantly higher in the ED group than in the control group (P<0.05). The mean values of PD and CAL were not significantly different in the two groups (0.05). The decayed, missing, filled teeth scores were also significantly higher in the ED group than in the non-ED group (P<0.05). Conclusion. Our results have suggested that CP had a high association with ED in young adults at 3040 years. We think that it will be of benefit to consider periodontal disease as a causative clinical condition of ED in such patients. Ouz F, Eltas A, Beytur A, and Akdemir E. Is there a relationship between chronic periodontitis and erectile dysfunction? J Sex Med 2013;10:838843.Öğe Is there any relationship between ureteral DJ stent colonization and lower urinary tract symptom severity?(2018) Kati, Bulent; Yakupogullari, Yusuf; Polat, Emre Can; Pelit, Eyyup Sabri; Gunes, AliAim: The purpose of this study is to evaluate risk factors for, and the relationship between, lower urinary tract symptoms (LUTS) and double J stent (DJS) colonization. Material and Methods: One hundred and thirty five patients aged 18 to 77 were included in this prospective study conducted at Urology Clinic in our university hospital between July 2012 and December 2013. Patients were followed clinically; we recorded any bothersome symptoms after treatment. Stents were removed under aseptic conditions. Their distal ends were removed and placed in a culture medium for evaluation. The relationship between colonization and LUTS was evaluated. Results: Bacteriuria and stent colonization were found in 10 (7.4%) and 35 (26%) patients, respectively. In the colonized stents, Candida spp. was the most commonly observed pathogen (40%). Mean indwelling times were different for the colonized (68.6 days) and non-colonized (46.2 days) groups. Similarly, the encrustation rate was significantly higher in colonized patients (42.8%) than in non-colonized cases (27%). In the colonized group, rates were significantly higher for irritative voiding symptoms such as polyuria (57.1% vs. 31%), nocturia (71.4% vs. 57%), and urgency (54.2% vs. 33%). Conclusions: LUTS, especially irritative voiding symptoms including polyuria and nocturia, are more frequent in patients with stent colonization. Patients at risk of stent colonization should be followed up for the development of infections, and prophylactic treatment should be administered. In addition, indwelling time may be shortened to prevent colonization.Öğe Minimally invasive approaches and their efficacy in pediatric urolithiasis(Aves, 2013) Altintas, Ramazan; Beytur, Ali; Oguz, Fatih; Cimen, Serhan; Akdemir, Ender; Gunes, AliObjective: We compared the frequency of usage and success of minimally invasive approaches in the management of pediatric urolithiasis in our clinic. Material and methods: Data from pediatric patients (<= 16 years of age) who had undergone percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS), and extracorporeal shock wave lithotripsy (ESWL) between January 2001 and December 2011 were retrospectively investigated. Results: In this study, 415 pediatric patients, who were treated for 291 renal, and 124 ureteral stones, were evaluated. The patients were treated with PNL (n=148; 82 boys, 66 girls), URS (n=99; 58 boys, and 41 girls) or ESWL (n=168; 91 boys, and 77 girls). The mean patient ages were 7.3 (1-16), 9.1 (1-16), and 8.8 (1-16) years in the PNL, URS, and ESWL groups, respectively. The stone-free rates after treatment with PNL, URS, and ESWL were 77, 83.8 and 88.7%, respectively. Conclusion: It is important that selected therapies are properly planned, and the use of minimally invasive approaches is important in pediatric patients due to potentially high recurrence rates. Currently, ESWL, PNL and URS are performed with high success rates for the treatment of stones, and open surgery is rarely used due to the success obtained with minimally invasive approaches.Öğe OUR PERCUTANEOUS NEPHROLITHOTOMY EXPERIENCES OF PEDIATRICS CASES (UNDER THREE YEARS OLD)(Mary Ann Liebert, Inc, 2012) Beytur, Ali; Oguz, Fatih; Altintas, Ramazan; Gunes, Ali[Abstract Not Available]Öğe Radiological findings of the primary female urethral malignant melanoma: a rare case report(European journal of therapeutıcs, 2018) Oner, Serkan; Erdem, Gulnur; Özdemir, Zeynep Maraş; Gunes, Ali; Unlu, SerkanPrimary malignant melanomas of the female urethra are rare tumors with poor prognosis. Biopsy of the detected urethral mass was performed in a 71-year-old woman who presented with hematuria and voiding dysfunction. No other localized lesions were detected. The patient was diagnosed with primary malignant melanoma of the urethra according to the histopathologic and immunohistochemical findings. Immunohistochemical staining revealed that the tumor cells were immunoreactive for vimentin, HMB-45, S-100, and Melan-A. The present study aimed to present radiological findings of very rare primary urethral malign melanoma with histopathologic correlation and to review the relevant literature.Öğe Radiological Findings of the Primary Female Urethral Malignant Melanoma: A Rare Case Report(Aves, 2019) Oner, Serkan; Erdem, Gulnur; Ozdemir, Zeynep Maras; Gunes, Ali; Unlu, SerkanPrimary malignant melanomas of the female urethra are rare tumors with poor prognosis. Biopsy of the detected urethral mass was performed in a 71-year-old woman who presented with hematuria and voiding dysfunction. No other localized lesions were detected. The patient was diagnosed with primary malignant melanoma of the urethra according to the histopathologic and immunohistochemical findings. Immunohistochemical staining revealed that the tumor cells were immunoreactive for vimentin, HMB-45, S-100, and Melan-A. The present study aimed to present radiological findings of very rare primary urethral malign melanoma with histopathologic correlation and to review the relevant literature.Öğe A rare reason of PSA elevation seen during intravesical BCG therapy: Granulomatous prostatitis(2019) Cimen, Serhan; Gunes, Ali; Oguz, Fatih; Topcu, Ibrahim; Akatli, Ayşe Nur; Ozcan, MehmetÖğe Renal cell carcinoma diagnosed during pregnancy: a case report and literature review(Sage Publications Ltd, 2018) Yilmaz, Ercan; Oguz, Fatih; Tuncay, Gorkem; Melekoglu, Rauf; Beytur, Ali; Coskun, Ebru Inci; Gunes, AliDiagnosing cancer during pregnancy is uncommon. Although pregnancies with concomitant malignancies have been reported, urological tumours are possibly the most rarely identified tumours during pregnancy. Renal cell carcinoma appears to be the most common urological malignancy during pregnancy. In this case report, we discuss successful management of a patient who was diagnosed with renal cell carcinoma during the antenatal period.
