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Öğe Auditory event-related potentials in patients with premature ejaculation(Elsevier Science Inc, 2001) Ozcan, C; Ozbek, E; Soylu, A; Yilmaz, U; Guzelipek, M; Balbay, MDObjectives. To investigate in a descriptive manner the P300 component of the event-related potential (ERP), which is related to aspects of cognitive processing, in patients with premature ejaculation (PE) to determine whether there is a cognitive alteration in this condition. Recent studies with short latency evoked potentials such as cortical somatosensory evoked potentials have indicated that afferent sensory inputs from the genital area to the nervous system are increased in PE, However, the cortical neural process of ejaculation has remained poorly understood. Methods. We performed ERPs in 20 patients with PE and in 20 age-matched healthy subjects. ERPs were evoked by an auditory oddball paradigm consisting of 150 tone bursts (80% 1 kHz; 20% 2 kHz). The latencies of the N200 and the P300 waves and the amplitude of the P300 wave were measured. Results. The mean latencies of the N200 and P300 waves were significantly longer in the patients with PE than in the controls (P<0.04 and <0.03, respectively). No significant difference was found in the P300 amplitude between the controls and patients (P>0.05). Conclusions. These data indicate that the greater cortical representation of sensory stimuli from the genital areas that has been shown with somatosensory evoked potential studies might be related to a cognitive/neurobehavioral dysfunction. The dysfunction involves an increased time to evaluate and categorize the stimuli in the central nervous system, with no change in the quality of cognition and neural disinhibition by the prefrontal cortex to early sensory processing in subcortical or primary cortical regions, which are cognitive neural processes underlying ERP generation. UROLOGY 58: 1025-1029, 2001 (C) 2001, Elsevier Science Inc.Öğe Bilateral disruption of corpus cavernosum with complete urethral rupture(Blackwell Publishing Asia, 2004) Soylu, A; Yilmaz, U; Davarci, M; Baydinc, CPenile fracture is a relatively rare condition. We report an unusual case of the bilateral disruption of the corpus cavernosum with complete urethral rupture resulting from blunt trauma during sexual intercourse. The subject underwent emergency surgery with preservation of erectile and voiding functions in the follow-up.Öğe Bilateral kidney stones with ureteropelvic junction obstruction(Nature Publishing Group, 2005) Soylu, A; Ugras, YM; Günes, A; Baydinç, CBackground A 56-year-old male with bilateral flank pain was admitted following diagnosis of bilateral kidney stone disease. He had previously undergone four separate pyelolithotomy sessions (two per kidney), the latest being 14 years prior. At presentation the patient had two stones in the right kidney and seven in the left kidney. The right renal pelvis was dilated, indicating obstruction of the ureteropelvic junction. Investigations Plain radiography, ultrasonography, intravenous pyelography, retrograde ureteropyelography and spiral tomography. Diagnosis Bilateral kidney stones and obstruction of the right ureteropelvic junction. Management Bilateral percutaneous nephrolithotomy and simultaneous right endopyelotomy; intraoperative antegrade nephrogram; preoperative and postoperative measurement of hemoglobin, blood urea nitrogen and creatinine; postoperative nephrostograms, plain X-ray, diuretic renogram and intravenous pyelography.Öğe Clitoral electromyography(Lippincott Williams & Wilkins, 2002) Yilmaz, U; Soylu, A; Ozcan, C; Caliskan, OPurpose: The clitoris has several histomorphological and functional similarities to the penis, In this study we evaluated spontaneous and evoked electromyography activity in the clitoris. Materials and Methods: We evaluated 11 healthy female volunteers with clitoral electromyography using a concentric needle electrode placed intracorporeally. The hand, foot and genital sympathetic skin responses, and spontaneous electrodermal activity were simultaneously recorded with silver surface electrodes. Another concentric needle electrode was placed subdermally on the mons pubis to differentiate clitoral activity from possible artifact. After recording spontaneous electromyography and electrodermal activity the left median nerve was stimulated to record evoked clitoral activity, and the sympathetic skin response in the hand, foot and genital regions. Results: There was spontaneous electromyography activity in the corpus clitoris. All dermal sites, including the hand, foot and genital regions, showed spontaneous electrodermal activity. No spontaneous activity was recorded from the subdermal needle electrode, Distraction of attention and coughing increased the amplitude and frequency of spontaneous clitoral electromyography and electrodermal activity at all sites. After stimulating the left median nerve all sites except that of the subdermal needle electrode showed evoked activity. Conclusions: The demonstrated evoked and spontaneous clitoral electromyography activity seems to indicate a sympathetic tonus of the corpus clitoris, as recorded from the corpus cavernosum of the penis in human males. Clitoral electromyography may be a useful objective assessment tool for evaluating female sexual dysfunction as well as genital autonomic innervation.Öğe Evoked cavernous activity(Lippincott Williams & Wilkins, 2002) Yilmaz, U; Soylu, A; Ozcan, C; Kutlu, R; Gunes, APurpose: Corpus cavernosum electromyography has been widely done to evaluate autonomic dysfunction in patients with erectile dysfunction. We assessed the value of corpus cavernosum electromyography, evoked cavernous activity and penile sympathetic skin responses for their accuracy in determining autonomic involvement in cases of erectile dysfunction. Materials and Method: We evaluated 75 men with erectile dysfunction by corpus cavernosum electromyography, evoked cavernous activity and penile sympathetic skin response tests at our neurourology laboratory. The etiology of dysfunction was vascular, neurogenic, psychogenic or mixed based on a detailed medical and sexual history, physical examination, electrophysiological and laboratory studies, penile color Doppler ultrasonography, and cavernosography and/or cavernosometry. Autonomic involvement was clinically assessed by systemic findings, such as orthostatic hypotension, impaired gastrointestinal motility, sinus dysrhythmia and secretomotor changes. A concentric electromyography needle placed in the right cavernous body was used to record corpus cavernosum electromyography and evoked cavernous activity. The right median nerve was stimulated electrically with 13 to 16 mA. to determine evoked cavernous activity and the penile sympathetic skin response. The latter response was recorded with silver disc electrodes placed on the left cavernous body. All tests were performed using an electromyography/ evoked potential machine. We determined the relationships among corpus cavernosum electromyography, evoked cavernous activity and penile sympathetic skin response tests in respect to etiological factors. Results: The 56 patients with normal corpus cavernosum electromyography activity had also evoked cavernous activity and a penile sympathetic skin response except for 1 with no penile sympathetic skin response but evoked cavernous activity. None of these patients had autonomic neuropathy. Of the 19 patients without corpus cavernosum electromyography activity 11 had evoked cavernous activity, including 10 with no autonomic neuropathy. The remaining 8 patients had no evoked cavernous activity, of whom 7 had autonomic neuropathy. A penile sympathetic skin response was recorded in 18 men with absent corpus cavernosum electromyography. Conclusions: Due to false-negative results on corpus cavernosum electromyography and penile sympathetic skin response testing evoked cavernous activity seems more reliable for determining autonomic involvement in the pathophysiology of erectile dysfunction.Öğe Intratesticular arteriovenous malformation - Color Doppler sonographic findings(Amer Inst Ultrasound Medicine, 2003) Kutlu, R; Alkan, A; Soylu, A; Sigirci, A; Dusak, AArteriovenous malformations (AVMs) of male genitalia are rare. In the literature there are reports of AVMs involving the scrotum,(1,2) penis,(3) spermatic cord,(4) testis, and epididymis(5) and interventional. treatment of scrotal AVMs.(6) In our literature search, we found no report about intratesticular AVMs. In this report we present the sonographic features of a small intratesticular AVM, which was incidentally found in a patient during scrotal examination for infertility evaluation. This rare entity should be considered in the differential diagnosis of intratesticular masses.Öğe Percutaneous nephrolithotomy for pediatric stone disease - Our experience with adult-sized equipment(Informa Healthcare, 2003) Gunes, A; Ugras, MY; Yilmaz, U; Baydinc, C; Soylu, AObjective: We evaluated the outcomes and complications of percutaneous nephrolithotomy (PNL) operations performed in pediatric patients using adult-sized surgical equipment at our center. Material and Methods: The medical and surgical records of 23 children who underwent a total of 25 PNL operations using 24 or 26 F rigid nephroscopes were evaluated retrospectively. The following aspects were considered: stone burden; duration of surgery and complications; details concerning recovery, success, residual fragments and auxiliary procedures; and follow-up details. Results: The success rate of a single PNL session was 70.8%; with the use of auxiliary procedures this was increased to 91.6%. Perioperative and early postoperative complications were excessive bleeding and transfusion in two patients, hydro-pneumothorax in one, perforation of the collecting system in three and urinoma in one. Complications were more common in children aged <7 years or with staghorn stones. The mean time to catheter removal was 3.4 days and the mean hospitalization time was 4.8 days. Idiopathic hypercalciuria, hypocitraturia, cystinuria and hyperoxaluria were diagnosed in two, two, one and three patients, respectively. Conclusion: Performing PNL with adult-sized equipment is associated with significant complications in children aged <7 years or with staghorn stones. This treatment should not be considered in routine clinical practice. As all stone-removal methods are associated with complications, PNL should be used only if other methods fail or are unavailable.Öğe Re: Transcutaneous electrocavernosography: A tool for recording the electromyographic activity of the corpora cavernosa(Lippincott Williams & Wilkins, 2006) Yilmaz, U; Soylu, A[Abstract Not Available]Öğe The role of adrenomedullin in varicocele and impotence(Blackwell Science Ltd, 2000) Ozbek, E; Yurekli, M; Soylu, A; Davarci, M; Balbay, MDObjective To assess the levels of adrenomedullin (a vasodilatory peptide) in penile blood before and after injection with papaverine in impotent men, and in the internal spermatic vein in infertile patients with varicocele, comparing the results with levels in the brachial vein in the same patients. Patients and methods Intracavernosal levels of adrenomedullin were determined in 14 impotent men (with no vascular pathology, as assessed by colour Doppler ultrasonography) before and after papaverine-induced penile erection. The effect of needle puncture alone was assessed in eight control patients. The level of adrenomedullin was also measured in the internal spermatic vein and brachial vein in 14 infertile men with varicocele. Results The mean (SD) intracavernosal adrenomedullin levels in the 14 impotent men were significantly different between the flaccid and papaverine-induced erectile state, at 93.5 (33.0) and 135.8 (34.9) pmol/mL, respectively, (P < 0.05). Needle puncture alone had no effect on adrenomedullin levels. In men with varicocele, the adrenomedullin level of 139.0 (34.3) pmol/mL within the internal spermatic vein was significantly higher than that in the brachial vein, at 103.9 (37.6) pmol/mL (P < 0.05). Conclusion Injection with papaverine increases adrenomedullin release into penile blood; this release may be responsible for the increase in penile blood flow and penile erection. Higher levels of adrenomedullin within the internal spermatic vein of patients with varicocele may result from the retrograde flow of venous blood from the left adrenal gland and kidney. Further studies are needed to determine the role of adrenomedullin in male infertility and impotence.Öğe Role of penile electrodermal activity in the evaluation of autonomic innervation of corpus cavernosum(Nature Publishing Group, 2004) Soylu, A; Yilmaz, U; Ozcan, C; Sarier, M; Baydinc, CElectrodiagnostic tests measuring the activities of cavernous smooth muscle and sudomotor structures of penile skin are used in order to evaluate autonomic innervation of the penis. Owing to closeness of these tissues, the interference of sympathetic activity during recording is a possibility. In this study, we investigated this possibility in 10 patients whose cavernosal tissues were destroyed during penile prosthesis implantation by comparing the pre- and postoperative penile skin electrodermal activities. Penile electrodermal activities were recorded with surface electrodes before and after the operation. All of the patients had spontaneous and evoked penile electrodermal activity (EDA). The mean amplitude of evoked EDA decreased from 2159 +/- 700 to 1413 +/- 515 muV following penile prosthesis surgery ( P = 0.017). The decrease in the amplitude of penile-evoked EDA following penile prosthesis implantation suggests the contribution of cavernous smooth muscle activity to the sudomotor responses prior to operation. Although corpus cavernosum sympathetic activity contributes to the penile skin recordings, these recordings are mostly the result of penile skin sudomotor sympathetic activity. Therefore, surface potentials recorded from penile skin should not be used for the evaluation of autonomic innervation of corpus cavernosum.Öğe Sympathetic skin responses in type-1 diabetic children: Relationship to urodynamic findings(Wiley, 2006) Soylu, A; Akinci, A; Yilmaz, U; Sarier, M; Aslan, M; Oman, CAims: Cystopathy is an important problem in diabetes mellitus (DM) when diabetes is not well-controlled. In most cases of diabetic csytopathy, autonomic involvement is responsible, which develops insidiously over a long time. We investigated the hand and genital sympathetic skin responses (SSRs) and its relation to urodynamic abnormalities in this group of patients. Methods: We performed hand and genital SSRs in 24 children with Type-1 DM,whose hemoglobin A1C values were above normal limits. We also recruited 19 healthy children for SSRs measurements. Cystometry was performed in 24 children with Type-1 DM. Based on cystometry findings, these children were classified into two groups as normal (n:6) and abnormal (n:18). The amplitude and latency of hand and genital SSRs of 24 children with Type-1 DM and 19 healthy children were compared. Results: Hand and genital SSRs were obtained from all of the diabetic and healthy children. The mean genital SSRs amplitude in diabetic children was significantly lower than the controls. There was no difference in the mean values of all investigated parameters between the normal group and controls. When compared to the controls, there was prolonged latency and decreased amplitude of genital SSRs and decreased hand SSRs amplitude in abnormal group. Conclusions: SSR is a non-invasive test for the evaluation of autonomic sympathetic involvement. Our study revealed differences in genital SSR before the manifestations of cystopathy. Children with abnormal urodynamic findings had changes in both hand and genital SSRs. These findings suggest that SSR tests may have a place in the evaluation of diabetic cystopathy in the early asymptomatic period.Öğe Topographic abnormalities in event-related potentials in children with monosyptomatic nocturnal enuresis(Wiley, 2004) Karlidag, R; Ozisik, HI; Soylu, A; Kizkin, S; Sipahi, B; Unal, S; Ozcan, CAims: A functional maturational delay in the central nervous system is dwelled upon in the pathogenesis of monosymptomatic nocturnal enuresis (NINE). In this study we studied whether according to controls N200 and P300, components of the event-related potential (ERP), which is related to aspects of cognitive processing, showed any difference in its topographic distribution in children within the age group 10-13 with monosymptomatic nocturnal enuresis and discussed its relation to the pathogenesis of MNE. Methods: We performed P300 in 18 patients with MNE and in 16 age-matched healthy subjects. P300 were evoked by an auditory oddball paradigm consisting of 150 tone bursts (80% 1 kHz; 20% 2 kHz). The latencies of the N200 and the P300 waves and the amplitude of the P300 wave were measured. Results: There was no statistical difference between the enuretic group and the controls in N200 and P300 latency and amplitude in the midline frontal (Fz), central (Cz), and parietal (Pz) recording site of the 10-20 International System. In the enuretic group while P300 amplitude in the Fz site was significantly less than the P300 amplitude in the Cz site, there was no statistical difference between the Fz and Pz P300 amplitude values. Conclusions: When different levels of maturational delay are considered in NINE, it may be claimed that maturational delay in children whose enuresis lasts until older ages will be different from those whose enuresis ends at an early age. The determination of P300 amplitude in parietal records being less in enuretics when compared to the controls may show that there are regional differences in stimuli processing rate/quality. (C) 2004 Wiley-Liss, Inc.Öğe Urothelial carcinoma featuring lipid cell and plasmacytoid morphology with poor prognostic outcome(Elsevier Science Inc, 2005) Soylu, A; Aydin, NE; Yilmaz, U; Kutlu, R; Günes, AAn aggressive urothelial carcinoma classified as lipid cell variant with plasmacytoid features was diagnosed in a 67-year-old man. His overall survival was 18 months after limited surgery followed by chemotherapy. The histopathologic features were the same in the recurrences. (c) 2005 Elsevier Inc.
