Publications by authors named "Ibrahim Bozkirli"

47 Publications

Comparison of corporal plication for the correction of congenital penile curvature in pre-pubertal and post-pubertal patients: Does age matter?

Andrologia 2021 Apr 10;53(3):e13965. Epub 2021 Jan 10.

Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey.

We retrospectively reviewed and compared the results of corporal plication procedures for the correction of congenital penile curvature (CPC) between pre-pubertal and post-pubertal boys and find whether age matters in the success rates. We reviewed the records of 32 patients with CPC without hypospadias treated by simple plication near the 12 o'clock position between 1998 and 2018 in our clinic. Patients under 13 years of age and not had puberty yet were accepted as pre-pubertal. Residual curvature less than 10° during follow-up was accepted as a surgical success. The mean age of the pre-pubertal group was 8.3 (2-12) years, while 16.2 (14-21) for the post-pubertal patients. The mean follow-up was 38.7 (24-154) months in the pre-pubertal group and 45.1 (23-150) months in the post-pubertal group. The success rates of corporal plication in pre-pubertal and post-pubertal groups were 78% and 83% respectively (p = .753). The success rates of corporal plication were similar between pre-pubertal and post-pubertal boys. However, as the series was small further studies should be favoured to determine the effect of age on success rates.
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http://dx.doi.org/10.1111/and.13965DOI Listing
April 2021

A novel surgical technique for preserving the bladder neck during robot-assisted laparoscopic radical prostatectomy: preliminary results.

J Endourol 2015 Feb 5;29(2):186-91. Epub 2014 Sep 5.

1 Department of Urology, Gazi University School of Medicine , Ankara, Turkey .

Purpose: To describe our new surgical technique for preserving the bladder neck during robot-assisted laparoscopic prostatectomy (RALP) and to present the anatomy between the bladder neck and prostate.

Methods: Between December 2012 and May 2014, 52 RALPs were performed at our institute. Demographic, perioperative, and postoperative data were recorded. Quality of life (QoL) scores were assessed before RALP, after urethral catheter removal, and at the first month after RALP. Fatty connective tissue between bladder neck and prostate was introduced, and circular muscle fibers of the internal sphincter were seen in all patients. Complications were classified according to the Clavien-Dindo classification. Statistical analyses were performed.

Results: Mean follow-up was 9.6±5.2 months; mean age was 61.1±6.5 years. Our novel surgical technique for preserving the bladder neck was performed in 52 patients, and they were continent after catheter removal; mean duration of the catheter was 9.4±1.4 days. There was a significant difference in QoL before RALP and after catheter removal, however, but there was no statistical difference between before and 1 month after RALP (respectively; P<0.001, P=0.5). Furthermore, there was no complication related to the bladder neck such as bladder neck stricture, acute/chronic urinary retention, as well as no Clavien III, IV, and V complications. In addition, conventional laparoscopy and/or open surgery was not needed in any of the RALP cases.

Conclusion: Our novel technique provided very early continence at the time of catheter removal after RALP within short-term follow-up. This can help early recovery and develop QoL scores after RALP.
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http://dx.doi.org/10.1089/end.2014.0459DOI Listing
February 2015

Laparoscopic nephropexy with polymer clips.

JSLS 2014 Jan-Mar;18(1):116-9

Department of Urology, Gazi University, Ankara, Turkey.

Background And Objectives: We present our initial experience and long-term results with transperitoneal laparoscopic nephropexy with nonabsorbable polymer clips.

Methods: Seven patients aged 34 to 47 years previously diagnosed with mobile kidney presented with chronic pain refractory to analgesics and underwent a transperitoneal laparoscopic nephropexy procedure with nonabsorbable polymer clips by fixing the perirenal tissue to the transversus abdominis fascia and triangular ligament.

Results: Mean operation time was 20 minutes. All patients were discharged after 24 hours. Follow-up intravenous pyelogram (IVP) at 60 and 150 days showed the right kidneys in a more cephalad position, and showed pelvicaliceal dilatations and that the ureteral kinks seemed to be resolved. On days 15, 60, 90, and 150 of the first- and second-year follow-ups, severity of pain was 1 of 10 on the visual analog scale.

Conclusion: We believe that the technique of transperitoneal laparascopic nephropexy with nonabsorbable polymer clips on patients with symptomatic mobile kidney is safe and easy to perform and shows successful long-term results.
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http://dx.doi.org/10.4293/108680813X13693422519235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939325PMC
December 2014

The risk of arteriovenous fistula formation after en bloc stapling of the renal hilum during transperitoneal laparoscopic nephrectomies.

Surg Laparosc Endosc Percutan Tech 2014 Feb;24(1):80-4

*Department of Urology, Çubuk Halil Şivgin State Hospital †Department of Urology, Gazi University §Department of Urology, Koru Hospital, Ankara ‡Department of Urology, Görele State Hospital, Giresun, Turkey.

Our aim was to evaluate the risk of arteriovenous fistula (AVF) formation after en bloc stapling of the renal hilum during transperitoneal laparoscopic nephrectomies (LNs). A retrospective review of 35 laparoscopic simple or radical nephrectomies or LNs was carried out. Patients were clinically followed up for renal hilar AVF formation, which could lead to new onset diastolic hypertension, abdominal murmur, and congestive heart failure. In addition, abdominal computed tomography and arteriography were carried out to diagnose renal hilar AVF formation during 6 to 20 months' follow-up. No statistically significant differences were measured between the systolic and the diastolic blood pressures between the preoperative and the postoperative periods (P>0.005). Abdominal murmur and new-onset congestive heart failure were not detected in any of the patients on physical examination. Our results suggest that en bloc stapling of the renal hilum during LN procedures is safe and effective.
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http://dx.doi.org/10.1097/SLE.0b013e31828f6721DOI Listing
February 2014

Effects of dietary interventions on 24-hour urine parameters in patients with idiopathic recurrent calcium oxalate stones.

Kaohsiung J Med Sci 2013 Feb 12;29(2):88-92. Epub 2012 Oct 12.

Department of Urology, Koru Hospital, Ankara, Turkey.

The aim of this study is to investigate the effects of dietary factors on 24-hour urine parameters in patients with idiopathic recurrent calcium oxalate stones. A total of 108 of idiopathic recurrent calcium oxalate stones were included in the study. A 24-hour urinalysis was performed and metabolic abnormalities were measured for all of the patients. All of the patients were given specialized diets for their 24-hour urine abnormalities. At the end of first month, the same parameters were examined in another 24-hour urinalysis. Hyperoxaluria, hypernatruria, and hypercalciuria were found in 84 (77%), 43 (39.8%), and 38 (35.5%) of the patients, respectively. The differences between the oxalate, sodium, volume, uric acid, and citrate parameters before and after the dietary intervention were significant (p < 0.05). The calcium parameters were not significantly different before and after the intervention. We found that oxalate, sodium, volume, uric acid, and citrate-but not calcium-abnormalities in patients with recurrent calcium oxalate stones can be corrected by diet. The metabolic profiles of idiopathic calcium oxalate stone patients should be evaluated and the appropriate dietary interventions should be implemented to decrease stone recurrence.
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http://dx.doi.org/10.1016/j.kjms.2012.08.015DOI Listing
February 2013

Safety of ESWL in elderly: evaluation of independent predictors and comorbidity on stone-free rate and complications.

Geriatr Gerontol Int 2012 Jul 23;12(3):413-7. Epub 2011 Dec 23.

Urology Department, Gazi University School of Medicine, Cukurambar, Ankara, Turkey.

Aim: Urinary stone disease affects people of all ages. With its satisfactory efficacy ranges in all age groups and lack of side-effects, extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for uncomplicated renal and proximal calculi ≤ 20 mm. In the present study, we aimed to assess the safety and efficacy of the ESWL treatment in elderly patients.

Methods: A retrospective study was carried out on patients aged over 65 years who underwent shock wave lithotripsy at our Department from 2009 to 2011, with a Siemens Lithostar electromagnetic shockwave lithotripter. A total of 231 patients (157 males, 74 females) out of 1694 (13.6%) were studied. The patients were divided into two groups (group 1 = 65-70; group 2 >70). The effect of age and other possible predicting factors (sex, stone localization and stone size) were investigated. Concomitant diseases and related complications were also evaluated.

Results: An overall stone-free rate (SFR) of 82.2% was found. The influence of sex on SFR was non-significant. There was no significant difference when comparing SFR between the age groups. When patients were divided into those with renal and ureteral stones, the SFR were 94.4% and 67.6% (P < 0.01), respectively. The SFR of the stone size groups, ≤ 10 mm and > 10 mm were 80% and 84.4%, respectively. Comorbidity was present in 148 patients. Complications were noted in 56 of 231 patients. Of 56 patients, 43 had minor complications and 13 major complications.

Conclusion: ESWL seems to be an effective first-line treatment choice for urinary stones in elderly patients with careful patient selection and personalized preparation.
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http://dx.doi.org/10.1111/j.1447-0594.2011.00781.xDOI Listing
July 2012

Direct upper kidney pole access and early ligation of renal pedicle significantly facilitates transperitoneal laparoscopic nephrectomy procedures: Tunc technique.

Surg Laparosc Endosc Percutan Tech 2011 Dec;21(6):453-7

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

We modified our technique in transperitoneal laparoscopic nephrectomies and compared its results with the classical technique. Classical technique was performed in 85 cases (group 1). Modified technique (n=98) included direct kidney upper pole access and early ligation of renal pedicle (group 2). No significant differences were detected regarding mean patient age, intraoperative blood loss, and duration of hospital stay between the 2 groups (P>0.05). Mean operation time was 64.9 ± 19.3 and 28.2 ± 7.7 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including right nephrectomies was 68.7 ± 23.4 and 24.2 ± 6.3 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including left nephrectomies was 63.8 ± 17.1 and 33.6 ± 5.1 minutes, respectively in groups 1 and 2 (P=0.001). Similarly, mean operation time was significantly shorter in group 2 when analysis was performed among right and left radical and simple nephrectomies between the 2 groups (P=0.001). Direct upper kidney pole access and early ligation of renal pedicle seems to be significantly facilitating transperitoneal laparoscopic nephrectomy procedures.
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http://dx.doi.org/10.1097/SLE.0b013e31823badc1DOI Listing
December 2011

Inflammation and oxidative stress in testicular torsion: do they deserve intensive treatment to save both guilty and innocent testes?

Urology 2011 Jul 21;78(1):164-9. Epub 2011 Mar 21.

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Objectives: To investigate at the molecular level, whether the combined use of an antioxidant (L-carnitine) and a selective cyclooxygenase-2 (COX-2) inhibitor (meloxicam) is effective in the treatment of cellular damage caused by testicular torsion.

Methods: A total of 30 male Wistar rats were randomly divided into 5 groups. The control group underwent a sham operation, and the second group underwent torsion/detorsion for 90 minutes. Groups 3 and 4 received L-carnitine (500 mg/kg/d) and meloxicam (3 mg/kg/d), respectively. Group 5 also received these 2 agents, in addition to the same torsion/detorsion procedure. Bilateral orchiectomy was performed 96 hours after the operation in all groups. cDNA was synthesized after isolation of total RNA from the tissues. The relative expression of interleukin (IL)-1a, COX-2, and β-actin genes was measured by real-time polymerase chain reaction.

Results: The COX-2 and IL-1a mRNA levels had significantly decreased in groups 3, 4, and 5 compared with group 2 (P<.05). COX-2 and IL-1a mRNA levels were significantly great in the torsion/detorsion group (P=.007). The COX-2 and IL-1a mRNA levels significantly decreased in the torsion/detorsion testis after maximal treatment (P<.001).

Conclusions: Meloxicam seems to exert its inhibitory effect on the expression of specific genes of inflammation, as well as the combination therapy. Because the effects of these inflammatory genes are still evident 4 days after detorsion, combination therapy using these agents could be administered until late postoperative period to prevent the initiation of autoimmune activity against sperm cells and protect the innocent contralateral testis from the insult of antisperm antibodies.
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http://dx.doi.org/10.1016/j.urology.2010.12.069DOI Listing
July 2011

E-cadherin gene 3'-UTR C/T polymorphism in Turkish patients with nephrolithiasis.

Mol Biol Rep 2011 Nov 14;38(8):4931-4. Epub 2010 Dec 14.

Department of Medical Biology and Genetics, Faculty of Medicine, Gazi University, Besevler, Ankara 06500, Turkey.

Nephrolithiasis is a complex disease and many gene polymorphisms have been associated with stone formation. In this study we aimed to investigate another possible relationship between E-cadherin gene (CHD1) 3'-UTR C/T polymorphism and calcium oxalate nephrolithiasis in the Turkish population. Study population was composed of 143 patients with nephrolithiasis and 158 control subjects. CHD1 3'-UTR C/T polymorphism was analysed using polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) technique. Genotype distribution of the investigated polymorphism was not deviated from Hardy-Weinberg equilibrium (HWE) in patients and control subjects (P > 0.05). C allele frequency was 85.7 and 85.1% in patients and controls, respectively (P = 0.836). Genotype distributions of the CHD1 3'-UTR C/T polymorphism among patients were also not significantly different from those among control subjects (P = 0.636). Our results showed that there is no association between the CHD1 gene 3'-UTR C/T polymorphism and nephrolithiasis in our population.
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http://dx.doi.org/10.1007/s11033-010-0635-8DOI Listing
November 2011

Renal tissue damage after experimental pyelonephritis: role of antioxidants and selective cyclooxygenase-2 inhibitors.

Urology 2010 Aug 26;76(2):508.e1-5. Epub 2010 May 26.

Department of Urology, Gazi University, Faculty of Medicine, Ankara, Turkey.

Objectives: To investigate the involvement of oxidative stress in the pathogenesis of acute pyelonephritis, and to evaluate the impact of meloxicam and/or L-carnitine in addition to conventional antibiotic treatment.

Methods: A total of 48 Wistar rats were divided into 4 groups according to their treatment, which was started 1 day after inoculation of all rats with Escherichia coli (ATCC 25 922, 10(10) cfu/mL). Group 1 received only antibiotic treatment with ceftriaxone (50 mg/kg, IM). Groups 2 and 3 received L-carnitine (500 mg/kg, IM) and meloxicam (3 mg/kg, IM) in addition to conventional treatment, respectively. Group 4 received combination therapy (L-carnitine and meloxicam) in addition to the first group. Rats were killed 3 and 7 days after E. coli inoculation and underwent nephrectomy. Histologic determination of tubular atrophy, acute and chronic inflammation, interstitial fibrosis and biochemical determination of superoxide dismutase and catalase activity, total thiol content, total antioxidant capacity, and malondialdehyde and protein hydroperoxide levels were measured.

Results: Interstitial fibrosis (P = .06), chronic inflammation (P = .536), and tubular atrophy (P = 0.094) decreased in group 4 compared with the other groups, but there was a statistically significant decrease only in acute inflammation (P = .015). In addition, if the day of nephrectomy is considered, there was again a significant decrease in acute inflammation on day 7 compared with day 3 in groups 2, 3, and 4 (P = .002). Catalase significantly increased in group 2 (P = .029), group 3 (P = .02), and group 4 (P = .014), and decreased in group 1 (P = .012) in day 7.

Conclusions: L-carnitine and meloxicam alleviated oxidative stress, probably by decreasing lipid peroxidation and enforcing antioxidant defense system. Acute renal inflammatory injury can be prevented much more effectively by combination therapy rather than by conventional therapy alone.
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http://dx.doi.org/10.1016/j.urology.2010.03.040DOI Listing
August 2010

A HindIII polymorphism of fibronectin gene is associated with nephrolithiasis.

Urology 2009 Nov 17;74(5):1004-7. Epub 2009 Jul 17.

Department of Urology, School of Medicine, Gazi University, Ankara, Turkey.

Objectives: To evaluate the association between fibronectin gene (FN1) polymorphisms and calcium oxalate nephrolithiasis as a genetic risk factor.

Methods: Genomic DNA of 143 patients with calcium oxalate nephrolithiasis and 154 healthy controls were screened for polymorphisms (HaeIII b, MspI, and HindIII) of the FN1 gene, using polymerase chain reaction-restriction fragments length polymorphism method. Allele and genotype frequencies were compared between the groups.

Results: Although the observed differences between distribution of genotypes of AA, AB, and BB (for HaeIII b), as well as CC, CD, and DD (MspI) were not significant, FF genotype for HindIII showed significant difference when compared with both EF and EE + EF genotype (P = .00202 and P = .00203, respectively).

Conclusions: The results of our study revealed that HindIII polymorphism of the FN1 gene is highly associated with calcium oxalate stone disease. This association makes FN a good candidate for further studies about the etiology of stone disease, and in the future it could be a candidate marker for evaluating the genetic risks in patients with nephrolithiasis.
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http://dx.doi.org/10.1016/j.urology.2009.05.010DOI Listing
November 2009

Heparan sulfate gene polymorphism in calcium oxalate nephrolithiasis.

Urol Res 2009 Feb 9;37(1):47-50. Epub 2008 Dec 9.

Department of Urology, School of Medicine, Gazi University, Ankara, Turkey.

Calcium oxalate (CaOx) nephrolithiasis has a complex pathogenic mechanism. Besides environmental factors, genetic factors also have influence on stone formation. This study represents the effects of heparan sulfate (HSPG2) gene polymorphism for determining the risk of urolithiasis. We investigated 143 CaOx stone formers with 158 healthy individuals for the BamHI restriction site polymorphism located in intron 6 of the HSPG gene using the polymerase chain reaction, restriction fragments length polymorphism method. After digestion with BamHI, the polymorphism was assumed to cause three genotypes according to the banding types as GG (242 bp), GT (242, 144, and 98 bp) and TT (144 and 98 bp). According to the genotype frequencies between the groups, TT genotype showed significantly increased risk for urolithiasis than TG and GG genotypes. We concluded that HSPG2 gene polymorphism might be one of the genetic factors affecting the CaOx stone formation.
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http://dx.doi.org/10.1007/s00240-008-0167-zDOI Listing
February 2009

Significance of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy in nonobstructive isolated renal pelvic stones.

J Endourol 2008 May;22(5):877-81

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Purpose: To investigate the probable effect of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy (SWL) in patients with nonobstructive renal pelvic stones.

Patients And Methods: The clinical records of patients with isolated renal pelvic stones who underwent SWL between 1996 and 2005 were reviewed. After excluding patients with obstruction leading to dilatation, major anatomic abnormalities, noncalcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones, and previous renal surgery, 153 patients were enrolled in the study. Lower pole infundibulopelvic angle (IPA) and infundibular length and width were measured from intravenous urography. Patients were classified into three groups according to stone burden (group 1, <100 mm(2); group 2, 101-200 mm(2); group 3, 201-400 mm(2)).

Results: The mean stone size was 142.08+/-86.3 mm(2). Overall stone-free rate was 53.6%. Localization of clinically significant or insignificant residual fragments was in the lower calix, renal pelvis, and both in 50 (32.6%), 29 (18.9%), and 8 (5.2%) patients, respectively. There was no statistically significant difference in pelvicaliceal anatomic features except narrower IPA (P=0.02) in group 1 patients with residual stones.

Conclusion: The falling of stone fragments to the lower calix in spite of the ureter whether clinically significant or not after SWL of pelvic stones initially seems to be related to stone burden rather than lower caliceal anatomy. However, existence of a more narrow IPA in group 1 patients with residual fragments led us to believe that lower-pole IPA can play a role in stone clearance, especially for smaller stones, probably because of smaller residual fragment size or the more mobile nature of the primary stone.
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http://dx.doi.org/10.1089/end.2007.0277DOI Listing
May 2008

The use of polymer clips in transperitoneal laparoscopic nephropexy.

Surg Laparosc Endosc Percutan Tech 2008 Feb;18(1):124-6

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Here we report a patient with symptomatic mobile kidney (nephroptosis) who was treated successfully with transperitoneal laparoscopic nephropexy with the use of nonabsorbable polymer clips. In this procedure, clips were used on Gerota's fascia to fix the kidney to the transversus abdominis fascia and the triangular ligament. This method is easier and requires less time than previously reported techniques.
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http://dx.doi.org/10.1097/SLE.0b013e31815678d7DOI Listing
February 2008

Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis in the absence of kidney stones or clinical urinary infection.

Surg Laparosc Endosc Percutan Tech 2007 Dec;17(6):570-2

Urology Department, Gazi University School of Medicine, Ankara, Turkey.

Here, we present a patient who underwent transperitoneal laparoscopic nephrectomy for a nonfunctional kidney on the left side, and who was found to have xanthogranulomatous pyelonephritis (XGP) on the subsequent histopathology examination. XGP is a severe, chronic infection of the renal parenchyma. Nephrectomy is the treatment of choice. Preoperative diagnosis of XGP can be challenging because the clinical presentation may vary. Our patient's loss of kidney function was due to a simple cortical kidney cyst that compressed the urinary collecting system. He presented only with mild flank pain and a poorly functioning kidney, and therefore XGP was not suspected before surgery. Because of the renal and perirenal inflammatory changes that commonly accompany XGP, the laparoscopic approach is difficult and is therefore rarely used. However, laparoscopic nephrectomy for XGP offers an easier recovery for the patient and therefore deserves further consideration as a method of treatment.
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http://dx.doi.org/10.1097/SLE.0b013e31812e5360DOI Listing
December 2007

The impact of pelvicaliceal features on problematic lower pole stone clearance in different age groups.

Int Urol Nephrol 2008 6;40(1):31-7. Epub 2007 Jul 6.

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Aim: Our aim was to evaluate the impact of pelvicaliceal variables in pediatric and adult age groups who underwent SWL for lower caliceal calculi.

Methods: 25 pediatric and 78 adult patients treated with extracorporeal shock wave lithotripsy (SWL) between 1996 and 2004 were enrolled into the study after exclusion of patients with hydronephrosis, major renal anatomic anomalies, non-calcium stones, history of recurrent stone disease and previous renal surgery. Lower pole infundibulopelvic angle (IPA), infundibular length (IL), infundibular width (IW) and pelvicaliceal volume were measured from pre-SWL intravenous urography. The pelvicaliceal stone load (PSL) index implicating the stone burden of each patient described as the relationship between stone volume and total estimated pelvicaliceal volume for stone-bearing kidney was also calculated.

Results: Sixty-eight percent of adult and 80% of pediatric patients became stone-free after SWL. The statistical insignificance between PSL index (p=0.097) of two groups shows that both groups shared a similar stone burden. According to SWL outcome, mean IPA values of stone-free and residual patients were 46.85 degrees and 30 degrees in pediatric group, respectively (p=0.01), whereas these values were 48.08 degrees and 43.06 degrees in the adult group, respectively (p=0.352). In the pediatric age group, stone-free and cumulative success rates increased with increasing IPA but this correlation was statistically insignificant (p: 0.263).

Conclusions: Lower caliceal anatomy has a higher impact on stone clearance after SWL in pediatric patients and urologists can expect better SWL outcomes from pediatric population with solitary lower caliceal stone than adults under the same conditions.
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http://dx.doi.org/10.1007/s11255-007-9220-zDOI Listing
September 2008

The impact of radiological anatomy in clearance of lower caliceal stones after shock wave lithotripsy.

Urol Res 2007 Jun 20;35(3):143-7. Epub 2007 Apr 20.

Faculty of Medicine, Department of Urology, Gazi University, Elçi Sokak 19/18, Ankara, Turkey.

The goal of this study was to determine the factors affecting stone clearance after extracorporeal shock wave lithotripsy (ESWL) for lower caliceal stones. Lower pole stone clearance was investigated in 128 (80 males, 48 females) patients treated with ESWL during 1998-2003 in our clinic. Renal anatomy was determined on standard intravenous urogram. The lower infundibulopelvic angle (LIPA) was measured as the angle between the vertical pelvis axis and the vertical axis of lower infundibulum (Sampaio's method). The mean age of the patients was 42.8 +/- 12.4 (19-77) years. The mean stone diameter and burden were found to be 1.28 +/- 0.58 (0.5-3.5) cm and 1.2 +/- 1 (0-7) cm(2) respectively. The stone-free rate was 62.5% and ESWL was unsuccessful in 16 (12.5%) patients. Thirty-two (25%) patients had residual fragments < or =4 mm retained in lower calices after lithotripsy. The stone clearance was found to be unrelated to stone burden and diameter (P = 0.17 and P = 0.14, respectively). However, there was a significant difference between mean lower pole infundibulum length (P = 0.001), infundibulum width (P = 0.001) and LIPA (P = 0.0001) between stone-free patients and patients with residual fragments. Multivariate logistic regression analysis accepting stone-free as the favourable result also confirmed that LIPA, lower pole infundibulum length and width were factors that significantly affected the outcome. Lower pole anatomy has a significant influence on clearance of fragments after ESWL.
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http://dx.doi.org/10.1007/s00240-007-0093-5DOI Listing
June 2007

Pneumatic lithotripsy for large ureteral stones: is it the first line treatment?

Int Urol Nephrol 2007 22;39(3):759-64. Epub 2007 Feb 22.

Urology, gazi university, cukurambar mah. 38. cad. 3/21, Balgat, Ankara, 06520, Turkey.

Objective: To evaluate the effectiveness of pneumatic lithotripsy (PL) with ureteroscopy in the treatment of large ureteral stones.

Methods: We reviewed, retrospectively, the records of 156 patients (122 male, 34 female) who had ureteral calculi larger than 10 mm that were treated with PL. Of these patients, 41 (26.3%) were treated primarily with PL and 115 (73.7%) were treated secondarily after unsuccessful extracorporeal shock wave lithotripsy (SWL). The mean stone diameter was 12.87 mm (range 10-20.5 mm). Results were evaluated 3 months after treatment by excretory urography and/or ultrasonography.

Results: The overall stone-free and fragmentation rates (FRs) were 85.2 and 92.3%, respectively. Corresponding values were 60 and 84% for upper ureteral stones, 79.5 and 89.7% for middle ureter stones and 94.5 and 95.6% for lower ureteral stones, respectively. The main complications were migration of a complete stone or of fragments (7.1%), urosepsis (4.5%) and ureteral perforation (1.3%).

Conclusions: Although SWL is generally accepted as the first treatment option for ureteral stones because of its non-invasive nature, PL with ureteroscopy seems to be a good alternative with the advantage of higher success rates and quick stone clearance. Especially when we take the importance of quick stone removal into account for larger ureteral stones, which are more likely to have obstruction, impaction, or infection, we believe that PL may be chosen as the first line treatment rather than SWL for stones larger than 10 mm.
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http://dx.doi.org/10.1007/s11255-006-9084-7DOI Listing
January 2008

Assessment of urinary symptoms in children with dysfunctional elimination syndrome.

Int Urol Nephrol 2007 17;39(2):425-36. Epub 2007 Feb 17.

Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey.

Objective: This study was organized to form a symptom scale for diagnosis and assessment of urinary and bowel symptoms in children with dysfunctional elimination syndrome (DES).

Methods: The study group included 81 children presented to our clinic with symptoms of DES like enuresis, abnormal voiding, urinary tract infection and urgency, between January 2003 and February 2004. Age matched 102 children with no history of urological complaints were randomly recruited from a public school as control group. Children with isolated, mono-symptomatic nocturnal enuresis were not taken to the study. All children and parents were requested to fill a 35-item questionnaire related to symptoms of DES. After statistical analysis, questions from the initial form that had a P-value <0.05 and an area under curve (AUC) value >0.6 were selected to form a final scale.

Results: The mean ages for study and control groups were 8.7 +/- 2.5 and 8.3 +/- 2.2 years, respectively (P = 0.236). The final scale was composed of 15 questions. The cut-off score for the presence of DES was determined as 7.5 (sensitivity 85.2%, specificity 93.1%, AUC value = 0.943) for the total population. When only the male population were concerned the cut-off score was 4.5 (sensitivity 93.8%, specificity 78%, AUC value = 0.913) while the cut-off score for the female population was 7.5 (sensitivity 87.7%, specificity 94.2%, AUC value = 0.953).

Conclusion: Providing objective assessment of symptom severity, formation of a validated scoring system for children with DES might be a good tool for diagnosis, confirmation of treatment results and follow up. It might also be useful for screening purposes.
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http://dx.doi.org/10.1007/s11255-006-9062-0DOI Listing
September 2007

Evaluation of sexual function in women with overactive bladder syndrome.

Urol Int 2007 ;78(2):112-5

Gazi University, School of Medicine, Department of Urology, Ankara, Turkey.

Introduction: Of late, little data is available concerning factors affecting female sexual function. In the present study, we evaluated the effects of overactive bladder (OAB) syndrome symptoms on female sexual function.

Materials And Methods: 40 patients with OAB symptoms and 40 age-matched women as a control group were evaluated using the Female Sexual Function Index (FSFI) for sexual function. According to the presence of urge incontinence, women with OAB were also divided into wet and dry groups. After completion of the forms, groups were compared.

Results: Although scores of all domains of FSFI (desire, arousal, lubrication, orgasm, satisfaction, pain and total) in the OAB group were found to be lower than in the control group, only 'desire' was found to be significantly different (p = 0.035). The FSFI scores of the OAB-dry and OAB-wet group were similar to each other.

Conclusion: The results indicate that there is a trend toward lower sexual function scores in women with OAB compared to controls.
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http://dx.doi.org/10.1159/000098066DOI Listing
April 2007

The impact of urinary incontinence on female sexual function.

Adv Ther 2006 Nov-Dec;23(6):999-1008

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Although urinary incontinence is not a life-threatening disorder, it has been shown to have detrimental effects on quality of life in terms of psychological, social, and sexual problems. In this study, investigators explored the effects of different types of urinary incontinence on female sexual function with a reliable and validated questionnaire, the Female Sexual Function Index (FSFI). One hundred fifty-three women with complaints of incontinence were enrolled in the study. An age-matched group of 89 women who had no incontinence or lower urinary tract disorders were enrolled as a control group; all completed the FSFI. Incontinence was classified as urge, stress, and mixed type. Pelvic organ prolapse (POP), if present, was also recorded. FSFI scores were compared between the incontinent and control groups. A multivariate linear regression analysis model was used to explore the effects of patient characteristics on total FSFI domain score. All domain scores of FSFI except lubrication and pain were statistically significant in the incontinence group (for total domain score, P=.005). For FSFI, in terms of types of incontinence, the difference was significant when the group with mixed urinary incontinence was compared with the control group. In multivariate linear regression analysis, age, presence of POP, and mode of delivery were predictors of female sexual function. Mixed urinary incontinence, when compared with other types, had a significant impact on sexual function. When POP was also present, no negative effects were noted in incontinent women.
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http://dx.doi.org/10.1007/BF02850220DOI Listing
March 2007

Is stone clearance after shockwave lithotripsy in patients with solitary upper-caliceal stone influenced by anatomic differences in the pelvicaliceal system?

J Endourol 2007 Jan;21(1):18-22

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Purpose: We investigated the effect of pelvicaliceal differences on stone clearance after extracorporeal shockwave lithotripsy (SWL) in patients with solitary upper-caliceal stones.

Patients And Methods: The clinical records of patients with solitary upper-caliceal stones who underwent SWL between 1996 and 2004 were reviewed. After excluding patients with hydronephrosis, significant anatomic abnormalities, non-calcium stones, metabolic abnormalities, recurrent stone disease, multiple stones, and previous renal surgery, 42 patients with a mean stone size of 153.47 mm2 (range 20-896 mm2) were enrolled in this study. They were divided into three groups according to stone burden (group 1 < or =100 mm2, group 2,101 mm2-200 mm2, and group 3 >200 mm2). Upper-pole infundibulopelvic angle (IPA), infundibular length (IL), and infundibular width (IW) were measured from intravenous urograms.

Results: Of the total, 29 patients (69%) were stone free after SWL treatment. The differences in the upperpole IPA, IL, and IW of stone-free patients and patients with residual stones were not statistically significant (P = 0.85, P = 0.89, and P = 0.37, respectively). Again, there were no statistically significant differences in terms of upper IPA, IW, and IL in comparing the three groups divided by initial stone size.

Conclusion: Upper-caliceal anatomy does not exert a significant impact on stone clearance after SWL for isolated upper-caliceal stones. To best of our knowledge, this is the first study to investigate the effects of pelvicaliceal anatomy on SWL treatment for upper-caliceal stones, so there is a need for further investigations to confirm our findings.
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http://dx.doi.org/10.1089/end.2006.0156DOI Listing
January 2007

Can serum Inhibin B and FSH levels, testicular histology and volume predict the outcome of testicular sperm extraction in patients with non-obstructive azoospermia?

Int Urol Nephrol 2006 3;38(3-4):629-35. Epub 2006 Nov 3.

Urology, Gazi university, Cukurambar mah. 38. cad. 3/21 Balgat, Ankara, 06520, Turkey.

Introduction: In our study, we evaluated the diagnostic accuracy of serum follicle stimulating hormone (FSH), Inhibin B, testicular volumes and distribution of testicular sperm extraction (TESE) outcome according to the histological diagnosis in men with non-obstructive azoospermia.

Materials And Methods: Between February 2001 and April 2002, 66 men presenting with infertility of at least 1 year were found to have non-obstructive azoospermia. Serum FSH and Inhibin B levels, testicular volumes and pathological analysis were reviewed retrospectively using medical records of these patients.

Results: Of 66 patients, 52 were enrolled into the study and sperm extraction was successful in 31 of 52 patients (59.6%). There was no statistically significant difference between the patients who had successful and unsuccessful TESE in terms of mean serum Inhibin B, FSH levels and testicular volumes (P>0.05). The area under ROC analysis for serum Inhibin, serum FSH and testicular volume was 0.557, 0.523 and 0.479, respectively. For Inhibin B, the best cut-off value for discriminating between successful and failed TESE at 90% sensitivity was 6.25 with a very low level of specificity (14%) and diagnostic accuracy that was 53.8.

Conclusion: Besides the controversies about the direct marker role of serum Inhibin B in determination of spermatogenesis, it does not seem to give a clue about the prediction of sperm presence before TESE. Because of the conflicting results in the literature, the potential role of serum Inhibin B as a marker for prediction of sperm presence in testis is yet to be determined.
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http://dx.doi.org/10.1007/s11255-006-0095-1DOI Listing
September 2007

Minimally invasive treatment of ureteral calculi in children.

Urol Res 2006 Dec;34(6):381-7

Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey.

A retrospective analysis was done to determine the efficacy of shock wave lithotripsy (SWL) and ureteroscopy in the treatment of paediatric ureteral calculi. We reviewed the records of 67 (35 boys, 32 girls) children (71 ureters) admitted to our clinic for treatment of ureteral calculi during 1990-2005. The initial treatment method was SWL in 80.3% (57 ureters), ureteroscopy in 11.3% (eight ureters) and open surgery in 8.5% (six ureters) of the renal units. The mean age of the patients was 10.67 +/- 4.4(1-16) years. The stone-free rates after SWL for upper, middle and lower ureteral calculi were 74.1, 100 and 75.9%, respectively. Increased stone diameter (P = 0.014) and/or burden (P = 0.002) were found to be significant factors that had an adverse affect on the stone-free rate after SWL while the success rates of SWL were independent of location. Including six patients (seven ureters) with failed SWL, a total of 14 patients (15 renal units) subjected to ureteroscopy for lower ureteral calculi yielded a stone-free rate of 93.3%. Thus, the overall stone-free rates after SWL, ureteroscopy and open surgery were found to be 75.4, 93.3 and 100%, respectively. Depending on the stone burden, SWL might be a good option for initial treatment of most ureteral calculi in children. Ureteroscopy offers a high success rate for lower ureteral calculi, including SWL failures.
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http://dx.doi.org/10.1007/s00240-006-0072-2DOI Listing
December 2006

Parameatal cyst of urethra: a rare congenital anomaly.

Int Urol Nephrol 2006 ;38(2):273-4

School of Medicine, Urology Department, Gazi University, 12. kat, 06510, Besevler, Ankara, Turkey.

We report a case of parameatal urethral cyst in a 15-year-old boy which is a very rare congenital anomaly. The cyst recognized at infancy but the boy presented to our clinic at the age of 15 when the mass was grown enough to cause spraying of urine and poor cosmesis. Complete excision of the cyst with total removal of the epithelium is the required for treatment and prevention of recurrence.
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http://dx.doi.org/10.1007/s11255-006-0034-1DOI Listing
March 2007

The impact of pelvicaliceal anatomical variation between the stone-bearing and normal contralateral kidney on stone formation in adult patients with lower caliceal stones.

Int Braz J Urol 2006 May-Jun;32(3):287-92; discussion 292-4

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Objective: We aimed to investigate the effect of pelvicaliceal anatomical differences on the etiology of lower caliceal stones.

Materials And Methods: Records of adult patients between January 1996 and December 2005 with solitary lower caliceal stone were reviewed. After exclusion of patients with hydronephrosis, major renal anatomic anomalies, non-calcium stones, history of recurrent stone disease and previous renal surgery, 78 patients were enrolled into the study. Lower pole infundibulopelvic angle (IPA), infundibulovertebral angle (IVA), infundibular length (IL), width (IW), number of minor calices and cortical thickness of the lower pole together with other caliceal variables obtained from the whole pelvicaliceal anatomy of both stone-bearing and contralateral normal kidneys were measured from intravenous pyelogram of the patients. Total pelvicaliceal volume was also calculated by a previously described formula for both kidneys.

Results: There were statistically significant difference between two kidneys in terms of IW (p < 0.001) and IL (p = 0.002) of the upper calyx, IW (p = 0.001) and IVA (p < 0.001) of the lower calyx), pelvicaliceal volume (p < 0.001), IPA of middle calyx (p = 0.006) and cortical thickness over the lower pole (p < 0.001). However there was no difference between stone-bearing and contralateral normal kidneys in terms of lower pole IPA (p = 0.864) and IL (p = 0.568).

Conclusion: Pelvicaliceal volume but not lower caliceal properties seem to be a risk factor for stone formation in lower calyx.
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http://dx.doi.org/10.1590/s1677-55382006000300005DOI Listing
February 2007

Is pelvicaliceal anatomy a risk factor for stone formation in patients with solitary upper caliceal stone?

Urology 2006 Jun;67(6):1159-63

Department of Urology, School of Medicine, Gazi University, Ankara, Turkey.

Objectives: To investigate the effect of pelvicaliceal anatomy on stone formation in patients with solitary upper caliceal stones.

Methods: The records of patients with solitary upper caliceal stones between 1996 and 2004 were reviewed. After the exclusion of patients with hydronephrosis, major anatomic abnormalities, noncalcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones, and previous renal surgery, 42 patients (24 male, 18 female) and 42 healthy subjects (22 male, 20 female) with normal results on intravenous pyelography (IVP) were enrolled into the study. With a previously described formula, upper pole infundibulopelvic angle (IPA), infundibular length (IL) and width (IW), and pelvicaliceal volume of the stone-bearing and contralateral normal kidney of patients and bilateral normal kidneys of healthy subjects were measured from IVP.

Results: Forty-two stone-bearing and 126 normal kidneys (42 contralateral, 84 healthy) were assessed. The mean stone size was 153.47 mm2 (range, 20 to 896 mm2). There were no statistically significant differences in terms of upper caliceal specifications between stone-bearing and normal kidneys. The mean (+/- standard deviation) pelvicaliceal volume of 42 stone-bearing and 126 normal kidneys was 2455.2 +/- 1380.2 mm3 and 1845.7 +/- 1454.8 mm3, respectively (P = 0.019). These values were 2114 +/- 2081.5 mm3 (P = 0.34) and 1709.5 +/- 989.1 mm3 (P = 0.001) for contralateral normal kidneys (n = 42) and normal kidneys of healthy subjects (n = 84), respectively.

Conclusions: Explanation of the etiology of the upper caliceal stone by the anatomic features is very difficult, and these caliceal anatomic variables (IPA, IL, IW) seem not to be a significant risk factor for stone formation in the upper calyx.
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http://dx.doi.org/10.1016/j.urology.2005.12.025DOI Listing
June 2006

Prolapse of a simple ureterocele presenting as a vulval mass in a woman.

Int J Urol 2006 Apr;13(4):447-8

Department of Urology, School of Medicine, Gazi University, Ankara, Turkey.

A 48-year-old woman presented with a large vulval mass after prolapse of a ureterocele. Her past excretory urogram showed a filling defect (cobra head appearance) in the bladder related to a single-system ureterocele on the left. The mass was manually reduced back through to the urethra under sedation and a urethral catheter was inserted. The anterior wall of the ureterocele was resected transurethrally for definitive treatment.
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http://dx.doi.org/10.1111/j.1442-2042.2006.01336.xDOI Listing
April 2006

Factors affecting the success rate of extracorporeal shock wave lithotripsy for renal calculi in children.

Urol Res 2006 Jun 4;34(3):215-21. Epub 2006 Mar 4.

Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey.

The aim of the study was to analyse factors affecting the success rate of extracorporeal shock wave lithotripsy (ESWL) in children with renal calculi. We performed a retrospective analysis reviewing records of 85 (40 female, 45 male) children (89 renal units) subjected to ESWL for treatment of renal calculi during 1990-2005 in our department. As 4 patients had bilateral calculi and 19 children (21 renal units) had renal stones at more than one different site, each location was analysed separately for convenience. The mean age of the patients was 10.3+/-4.6 (2-16) years. The stone-free rates for renal pelvis, lower, middle and upper caliceal calculi were 70, 62, 50 and 73%, respectively. A higher rate (33%) of insignificant fragments (< or = 4 mm) was noted for lower pole calculi. Increased stone diameter (P=0.0001) and burden (P=0.04) were found as the most significant factors that adversely affect the stone-free rate for pelvis renalis calculi, whereas an acutely oriented infundibulum and/or a long lower infundibulum (P=0.005) were unfavourable factors for clearance of lower caliceal stones. The stone-free rate in children with multiple calculi was 48%, while 29% of the renal units had retained fragments. ESWL is a good initial option for treatment of most of the renal calculi < 2 cm except in the presence of unfavourable lower caliceal anatomy. Increased stone burden, multiple stones, staghorn calculi, narrow lower infundibulopelvic angle and long lower infundibulum are factors that adversely affect the clearance rate.
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http://dx.doi.org/10.1007/s00240-006-0047-3DOI Listing
June 2006

Pelvicaliceal anatomical variation between stone bearing and normal contralateral kidneys--does it have an impact on stone formation in pediatric patients with a solitary lower caliceal stone?

J Urol 2006 Jan;175(1):270-5; discussion 275

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Purpose: We aimed to investigate the probable effect of pelvicaliceal anatomical differences between stone bearing and normal contralateral kidneys on the etiology of stone formation in children with a solitary lower pole caliceal stone.

Materials And Methods: We reviewed the clinical records of 25 pediatric patients who underwent SWL for a solitary lower caliceal stone and 15 healthy pediatric patients who served as controls. Lower pole IPA, IL and IW, together with other caliceal variables obtained from the pelvicaliceal anatomy of the stone bearing and contralateral normal kidneys of patients with urolithiasis, and both kidneys of the control group were measured based on excretory urography. Also, total pelvicaliceal volume for both kidneys was calculated.

Results: Mean LIPAs of stone bearing kidneys compared to the normal contralateral kidneys was more acute, equal and wider in 52%, 16% and 32% of the patients, respectively. Mean pelvicaliceal volumes of the stone forming and normal kidneys were 1,553.8 mm(3) (range 242 to 7,107) and 581.0 mm(3) (90 to 2,662), respectively, and there was statistical significance only in pelvicaliceal volumes between the stone bearing and contralateral normal kidneys (p <0.001).

Conclusions: Our results reveal that IPA, IL and IW of calices do not have an effect on stone formation in pediatric patients. However, large pelvicaliceal volume seems to be a significant risk factor for stone formation in the lower calix, probably because it creates abnormal urodynamic and morphological features, especially when accompanied by other metabolic abnormalities.
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http://dx.doi.org/10.1016/S0022-5347(05)00010-8DOI Listing
January 2006
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