Publications by authors named "Mazhar Ortac"

20 Publications

  • Page 1 of 1

The Effect of a Sharp Increase in Estrogen Levels on Overactive Bladder Symptoms in Women Undergoing Ovulation Induction.

Urology 2021 Jan 13. Epub 2021 Jan 13.

Istanbul University Istanbul School of Medicine, Department of Urology, Istanbul Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2020.12.030DOI Listing
January 2021

Indication for Y Chromosome Microdeletion Analysis in Infertile Men: Is a New Sperm Concentration Threshold Needed?

Urology 2020 Dec 6;146:113-117. Epub 2020 Oct 6.

Istanbul University, Istanbul Faculty of Medicine, Urology Department, Istanbul, Turkey.

Objective: To describe the prevalence of Y-chromosome deletions in patients with a sperm concentration of less than 5 million/mL. To also determine a new sperm threshold for Y-chromosome analysis in men with infertility.

Methods: A total of 3023 patients who had a semen concentration of less than 5 million/mL included in this retrospective study. All of these patients had a genetic evaluation, hormonal evaluation, and 2 abnormal semen analyses.

Results: Y-chromosome deletions were present in 116 (3.8 %) patients with sperm concentration <5 million/mL. The frequency of a Y-chromosome deletions was 6.8%, 1.0%, 0.15% in azoospermic men, in men with sperm concentrations of 0-1 million /mL, in men with sperm concentrations of 1-5 million/mL. Patients were divided into 2 groups regarding the determined new sperm threshold. The sensitivity and specificity of the Y-chromosome deletions test were 92.2.7% and 49.3 %, 99.1%, and 22.1% in patients with azoospermia and sperm concentrations <1 million/mL, respectively. If the sperm concentration thresholds of azoospermia or <1 million/mL, are applied, the number of tests decreased to 50.5% (1442 tests) and 23.1% (643 tests), respectively. Approximately $108,150 and $48,225 would be saved if the sperm thresholds were azoospermia and <1 million/mL, respectively CONCLUSION: The current threshold of sperm concentration for Y-chromosome deletions is controversial. The new proposed sperm threshold for genetic testing of 1 million/mL would increase sensitivity and more cost-effective compared to the current threshold.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2020.09.032DOI Listing
December 2020

Effects of Ankylosing Spondylitis on Erectile Function.

Sisli Etfal Hastan Tip Bul 2020 10;54(2):188-192. Epub 2020 Jun 10.

Department of Urology, Biruni University Faculty of Medicine, Istanbul, Turkey.

Objectives: Ankylosing spondylitis (AS), which is a chronic rheumatologic disorder, may be associated with erectile dysfunction (ED). This study aims to investigate the incidence of erectile dysfunction in patients with AS with a control group and to investigate the risk factors for ED.

Methods: All demographic data were recorded. Participants in both groups filled in the IIEF-5 (International Index of Erectile Function), Beck Depression Index (BDI) and Beck Anxiety Index (BAI) questionnaires, whereas patients with AS additionally filled in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrological Index (BASMI) and Ankylosing Spondylitis Quality of Life (ASQoL) questionnaires. Patients were compared concerning erectile function and predictive factors. Fifty patients with the AS diagnosis and fifty healthy males were included in this study.

Results: ED of all degrees was present in 38% and 30% of males in the AS group and control group, respectively, with no statistical difference. However, the mean IIEF-EF domain score of the AS group (22.3±7.0) was significantly lower than the control group (25.7±4.3) (p=0.004). In addition, BDI and BAI scores were significantly higher in the AS group. When we have divided patients in the AS group into two, according to the presence or absence of the ED, the mean IIEF-EF domain score of patients with ED was lower than AS patients without ED. No difference was detected in both groups concerning age and the duration of the disease. Patients who had ED in the AS group had significantly higher scores in BASDAI, BASFI, depression and anxiety; however, no significant difference was detected among groups regarding BASMI scores.Mean IIEF score was lower in patients with AS, and this had a negative correlation with BASDAI, BASFI, ASQoL, BDI and BAI scores.

Conclusion: Erectile function scores were slightly lower in the AS group than the control group in our study. ED risk factors were shown as disease activity and psychological status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14744/SEMB.2018.49358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326678PMC
June 2020

Undescended Testis Does Not Affect the Outcome of Microdissection Testicular Sperm Extraction.

Urology 2020 Jul 15;141:77-81. Epub 2020 Apr 15.

Urology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Objective: To determine the sperm retrieval rates (SRRs) and predictive factors of patients with a history of undescended testis after testicular sperm extraction (TESE).

Methods: A total of 311 patients were diagnosed with nonobstructive azoospermia (NOA) and underwent TESE were included in this study. These patients were divided into 2 groups: an undescended group consisting of 62 patients who had a history of undescended testes and an idiopathic group consisting of 249 patients. Of the 62 patients with a history of undescended testes, 26 had a history of bilateral orchidopexy, 15 had a history of unilateral orchidopexy, and 21 had no history of surgery.

Results: The testicular spermatozoa were found in 134 (53.8%) and 31 (50%) patients in the idiopathic NOA and undescended testes groups, respectively. Similar to patients with idiopathic NOA, the overall SRRs were strongly associated with histopathology for patients with a history of undescended testes. These SRRs were 34.2%, 33.3%, 71.4%, 100%, and 100% for Sertoli Cell Only, late maturation arrest, early maturation arrest, hypospermatogenesis, and normal spermatogenesis, respectively (P <.001). In the undescended group, the SRRs of patients who underwent orchidopexy were not different than patients without a history of orchidopexy. However, patients who underwent unilateral orchidopexy had a higher SRR than those who underwent bilateral orchidopexy (P = .031).

Conclusion: TESE is a successful treatment modality for men with NOA associated with or without a history of undescended testis. The testicular histopathology and unilateral undescended testis were identified as independent predictors of SRRs for men with a history of undescended testis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2020.03.046DOI Listing
July 2020

Efficacy of follitropin-alpha versus human menopausal gonadotropin for male patients with congenital hypogonadotropic hypogonadism.

Turk J Urol 2020 01 29;46(1):13-17. Epub 2019 Nov 29.

Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.

Objective: To compare human menopausal gonadotropin (hMG) and recombinant follicle-stimulating hormone (rFSH) with respect to successful spermatogenesis and pregnancy outcomes in patients with congenital hypogonadotropic hypogonadism (CHH).

Material And Methods: This retrospective study included a total of 112 male patients with CHH. Of these, 70 were to receive treatment with hMG and 42 with rFSH following the hCG administration.

Results: The average age at diagnosis was 27.9 (range, 15-51) years. The baseline luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone levels were 0.53±0.77 IU/L, 0.63±0.61 IU/L, and 1.10±1.90 ng/dL, respectively. Following the combined hormonal treatment, 85.7% (96/112) of patients had sperm detected in ejaculate samples. In the hMG group, the mean baseline of a testicular size was slightly lower than in the rFSH group (5.0±3.5 mL and 5.3±3.9 mL), whereas these differences were not statistically significant (p=0.364). The mean baseline age, level of FSH, LH, and testosterone also showed no significant difference between the two treatment options. The rate of successful spermatogenesis was similar (85.7%) in both groups, while the pregnancy rates of patients who underwent hMG and rFSH treatments were 38.6% (n=27) and 51.2% (n=21); however, these differences were not statistically significant (p=0.314). No patients developed severe effects during the treatment period.

Conclusion: Successful spermatogenesis and pregnancy rates with hMG and rFSH are similar.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/tud.2019.19177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944427PMC
January 2020

The Effectiveness of 3-D Computed Tomography in the Evaluation of Penile Deformities in Patients With Peyronie's Disease: A Pilot Study.

Sex Med 2019 Sep 16;7(3):311-317. Epub 2019 Jul 16.

Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. Electronic address:

Background: Anatomic and functional evaluation of the penis before treatment is very important in the choice of treatment in patients with Peyronie's disease (PD).

Aim: To compare 3 different methods for the evaluation of the penile deformity, including auto-photography, combined intracavernous injection stimulation test (CIS), and 3-dimensional computed tomography (3D CT) during artificial penile erection in patients with PD.

Methods: Pretreatment penile deformities of patients with PD were compared with those detected with auto-photography, using goniometer after intracavernosal vasoactive agent, and 3D CT correlations among these 3 methods were investigated.

Main Outcome Measures: Assessments of penile curvature with auto-photography, CIS, and 3D CT.

Results: The mean age of 36 patients who were included in the study was 58 ± 8.25 (36-72) years, and the mean time since the onset of the disease was 25 ± 24 months (2-144). Degrees of penile curvatures measured using auto-photography, CIS, and CT were determined as 24° (0°-80°), 40° (0°-90°), and 34° (0°-80°), respectively. When general correlation analysis was performed to evaluate the penile curvatures of all patients using 3 methods, a moderate correlation between auto-photography and both CIS (r = 0.72, P < .001) and 3D CT (r = 0.56, P < .001) was detected, whereas a strong correlation was noticed between CIS and 3D CT (r = 0.78, P < .001). When the correlation analysis between patients with and without ED was examined, a statistically significant decrease in the strength of correlation between CIS and auto-photography in patients with ED (0.629 vs 0.925, P < .05), however, was detected without any statistically significant difference in patients without ED (0.694 vs 0.813, P > .05).

Conclusion: The superiority of 3D CT over auto-photography and its strong correlation with CIS in most parameters have been demonstrated. However, it was found that CT did not give more information than the evaluation with CIS. Current limitations and cost increases limit the use of 3D CT in the assessment of PD. Özmez A, Ortac M, Cevik G, et al. The Effectiveness of 3-D Computed Tomography in the Evaluation of Penile Deformities in Patients With Peyronie's Disease: A Pilot Study. Sex Med 2019;7:311-317.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.esxm.2019.06.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728762PMC
September 2019

Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment İschemic Priapism: A Single-Center Experience.

J Sex Med 2019 08 21;16(8):1290-1296. Epub 2019 Jun 21.

Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. Electronic address:

Background: Ischemic priapism (IP) is a urologic emergency that requires early intervention. The main aim of IP treatment is to relieve the cavernosal pressure and provide erectile function.

Aim: The aim of this study was to determine the correlation between preoperative risk factors (patient's age, duration of priapism, preoperative erectile function) and postoperative erectile dysfunction (ED).

Methods: This retrospective study consisted of 25 patients diagnosed with refractory IP between 2009-2017. The diagnosis of IP was confirmed by medical history, physical examination, and cavernosal blood gas analysis. All of the patients underwent the T-shunt procedure ± tunneling after a failed initial intervention.

Results: The mean age at the time of the IP diagnosis was 46.84 years (range 23-77). The average follow-up time of the study population was 40.4 months (range 3-114), and the median time from the occurrence of IP to surgery was 58 hours (range 24-240). In all cases, rapid resolution of the erection was achieved with the T-shunt ± tunneling procedure. In 1 patient, priapism recurred after 12 hours. Postoperative ED was reported by 16 (84.21%) patients, with degrees of mild, mild to moderate, and severe in 6, 1, and 9 of these cases, respectively. During the follow-up, the mean International Index of Erectile Function-5 (IIEF-5) score was 12.68 (range 5-23). Only 3 (15.78%) patients achieved successful sexual intercourse without any treatment. 6 (31.5%) patients required the aid of phosphodiesterase type 5 inhibitors, and 1 (5.26%) patient required the aid of a vacuum erection device. The 9 (47.36%) patients with severe ED failed to respond to medical treatment and were considered candidates for a penile implant. According to Kendall's tau-b correlation coefficient analysis, there was a positive correlation between the preoperative and postoperative IIEF-5 scores (P = .005), whereas the patient's age and duration of priapism were negatively correlated with the postoperative IIEF-5 score (P = .016 and P = .046, respectively).

Clinical Implications: Treatment options of IP should be discussed with patients in terms of both preoperative erectile function and the duration of priapism.

Strengths & Limitations: The small sample size and retrospective nature of this study were the main limitations.

Conclusions: Despite high success and low complication rates of T-shunt surgery, the rate of undisturbed erectile function is only 14.6%. The patient's age, the existence of preoperative ED, and the duration of priapism are associated with postoperative IIEF-5 scores. Ortaç M, Çevik G, Akdere H, et al. Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment İschemic Priapism: A Single-Center Experience. J Sex Med 2019;16:1290-1296.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsxm.2019.05.011DOI Listing
August 2019

Older age and a large tunical tear may be predictors of increased erectile dysfunction rates following penile fracture surgery.

Int J Impot Res 2020 Mar 5;32(2):226-231. Epub 2019 Jun 5.

Haseki Training and Research Hospital, Department of Urology, Istanbul, Turkey.

Penile fracture is a rare urological occurrence resulting from a tear in the tunica albuginea of the penis. In this study, 26 patients diagnosed with a penile fracture were treated with early surgical correction. The mean age at the time of the injury was 41.7 years. The average follow-up time of the study population was 28.8 months. The mean time from fracture to surgery was 15.6 ± 19.9 h. In total, 23% of the patients had a penile nodule and 11.5% of these patients reported penile deviation. Post surgery, erectile dysfunction (ED) was present in nine (34.6%) patients. During the follow-up, the mean International Index of Erectile Function (IIEF-5) score was 20.9 ± 4.3 (10-25). There was no significant difference in the time from fracture to surgery among the patients with or without ED. However, the tunical tear size was significantly larger in the patients with ED as compared with those without ED. Furthermore, the patients with ED were older than those without ED. Older age and the size of the tunical tear appeared to be correlated with the development of ED. However, prospective large series are needed to confirm these results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41443-019-0159-2DOI Listing
March 2020

Evaluation of gonadotropin-replacement therapy in male patients with hypogonadotropic hypogonadism.

Asian J Androl 2019 Nov-Dec;21(6):623-627

Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34104, Turkey.

Hypogonadotropic hypogonadism (HH) is a rare disease in which medical treatment has a high success rate to achieve fertility. This study aimed to analyze the efficacy of hormone replacement therapy and determine predictive factors for successful spermatogenesis and spontaneous pregnancy in patients with idiopathic HH. A total of 112 patients with low testosterone (T), luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and normal prolactin levels were diagnosed with HH and administered LH and FSH analogs as hormone replacement therapy. During treatment, 96 (85.7%) patients had sperm present in ejaculate samples. Among these patients, 72 were married and wanted a child. Of these 72 patients, 48 (66.7%) of couples had pregnancies from natural conception. After initiation of treatment, the mean time for the appearance of sperm in semen was 9.48 months. There were no significant differences between baseline FSH, T, and LH levels; however, older age, larger testicular size, and low rate of undescended testes were favorable factors for successful spermatogenesis. Larger testicular size and older age were also the main predictive factors for natural conception. We found that patients with undescended testes had a younger age, smaller testes, and lower T levels compared with patients exhibiting descended testes. The rate of sperm found in the ejaculate was not significantly decreased in patients with undescended compared with descended testis (73.7% vs 87.6%, P = 0.261). The medical approach for males with HH and azoospermia provides a successful treatment modality in regard to successful spermatogenesis and achievement of pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/aja.aja_6_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859661PMC
August 2020

Factors affecting infectious complications following flexible ureterorenoscopy.

Urolithiasis 2019 Oct 17;47(5):481-486. Epub 2018 Nov 17.

Urology Department, Haseki Training and Research Hospital, Millet Street, Fatih, Istanbul, Turkey.

In the present study, we aimed to clarify predictive factors that may cause postoperative infectious complications after flexible ureterorenoscopy (f-URS). In a 4-year prospective study, charts of patients who underwent f-URS between January 2014 and January 2018 for renal stone(s) in a tertiary academic center were reviewed. A standardized f-URS procedure was performed for all patients. Post-operative infectious complications including fever, sepsis and septic shock were categorized into same group. Patients with and without infectious complications were compared in the terms of preoperative, operative and post operative characteristics. In total, 463 patients who did not face infectious complications and 31 patients who faced infectious complications were enrolled into the study. The mean age was significantly lower in patients who did face infectious complications (34.8 vs 44.7 years old, p < 0.001). On the other hand, presence of renal abnormality was significantly more common in patients with infectious complications (12.3% vs 35.5%, p < 0.001). The mean operation time was 65.3 min in patients with infectious complications and significantly longer when compared with patients who did not face infectious complication (47.8 min, p < 0.001). Stone-free rate was significantly higher in patients without infectious complications (85.3% vs 77.5, p = 0.009). Multivariate regression analysis revealed that longer operation time ≥ 60 min, presence of renal abnormality and age ≤ 40 years were predictive factors for infectious complications following f-URS. The present study has demonstrated that operation time ≥ 60 min, presence of renal abnormality and patients with ≤ 40 years were significantly associated with infectious complications following f-URS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00240-018-1098-yDOI Listing
October 2019

Sexual function in women with Cushing's Syndrome: A controlled study.

Turk J Urol 2018 Jul;44(4):287-293

Department of Internal Medicine, Division of Endocrinology-Metabolism and Diabetes, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.

Objective: The aim of this study is to determine the severity of female sexual dysfunction (FSD), quality of life, and depression status in female patients with Cushing's syndrome (CS).

Material And Methods: This study included 29 sexually active women with CS and 30 healthy age and body mass index matched women. The Female Sexual Function Index (FSFI) questionnaire, Beck Depression Inventory (BDI) and Short Form Health Survey (SF-36) were filled by each participant. Plasma levels of FSH, LH, PRL, cortisol, DHEA-S, 17-hydroxyprogesterone, androstenedione, free testosterone, total testosterone and estradiol were measured.

Results: Female sexual dysfunction was present in 88.9% of the women with CS and 24.1% of the control group. The CS group showed a lower total FSFI score [16.6 (IQR: 5-23)] compared to the healthy women [26.8 (IQR: 25.5-30.4) (p<0.001)]. The FSFI scores in the arousal, lubrication, orgasm, pain and satisfaction domains were all lower in the women with CS (p<0.001). Both summary scores of the SF-36 were reduced in women with Cushing's syndrome compared to the control group (p=0.001). The BDI scores of patients were significantly higher than those of the control subjects (p=0.007). In patients with CS, levels of LH, estradiol, and DHEA-S04 were significantly lower while cortisol (p<0.05), and 17 hydroxyprogestrone levels were higher than control subjects (p<0.05).

Conclusion: This study showed that majority of the women with CS had FSD. This may be related to the inhibitory effect of cortisol on sex hormones.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/tud.2018.74240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016657PMC
July 2018

Peyronie's disease surgery: Surgical outcomes of 268 cases.

Turk J Urol 2018 Jan 1;44(1):10-15. Epub 2017 Jan 1.

Department of Urology, İstinye State Hospital, İstanbul, Turkey.

Objective: To assess the outcomes of the surgical techniques used in Peyronie's disease (PD) surgery.

Material And Methods: Two hundred and sixty-eight patients received surgical treatment for PD. Fifty four and 144 patients underwent simple corporoplasties (shortening procedure, SP, group 1) or plaque incision and grafting surgery (lengthening surgery, LP, group 2), respectively, whereas 70 patients with erectile dysfunction underwent penile prosthesis implantation.

Results: Penile plication and Nesbit surgeries were performed in 5 (9%) and 42 (78%) patients out of total 54 patients. In the remaining 7 (13%) patients, Nesbit and plication suture combination was required for complete penile straightening. Mean curvature degree was 52.2±12.3 degrees. Follow up time was 36.1±29.4 months. No significant difference was demonstrated between the two groups in the baseline features and co-morbidities except age. In 144 patients who underwent plaque incision and grafting, mean age and PD onset duration were 54.1±9.2 years and 28.2±17.3 months respectively. Mean curvature degree was 58.4±18.9 degrees. Post-operative follow up time of the second group was 51.1±39.6 months. Additional plication suture was used in 48 patients (33%) patients. Degree of curvature improvement was 37.9±19.1 and 52.1±23.5 in SP and LP respectively (p=0.01). The initial anatomic success rates were 90.4% and 87.5% at their early post-operative follow-ups for group 1 and 2 respectively. These rates dropped to 82.7% and 83.6% at the long term follow-up (36 and 51 months) respectively (p=0.9). Although the average follow-up time of LP group was longer than SP group (52.1 mo vs. 37.0 mo), recurrence rates of these two groups were comparable. The combined functional and anatomical success of patients were demonstrated to be 79% and 75% in shortening and grafting surgery. Shortening surgery was not statistically superior to grafting surgery for patients in terms of having erection with or without the aid of PDE-5 inhibitors (94.4% vs. 88.2%, p=0.28). Shortening surgery makes a difference in the long term follow-up for patients who had erections without the aid of PDE-5 inhibitors (90.7% vs. 67.3%, p=0.02).

Conclusion: Both SP and LP are successful in terms of penile straightening in the short and long-term follow-up. Curvature degree improvement is greater in LP. Patients who undergo LP surgery may suffer from ED in the long-term follow-ups. Greater percentage of patients who underwent LP require PDE-5 inhibitors usage for sexual intercourse. Despite stated shortcomings, combined success (anatomic and functional) is achieved in three out of four patients for both groups. Penile prosthesis implantation should be preferred for patients with ED and penile deformity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/tud.2018.87405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821276PMC
January 2018

The role of sperm DNA testing on male infertility.

Transl Androl Urol 2017 Sep;6(Suppl 4):S600-S603

Urology Department, Bahçelievler State Hospital, Istanbul, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/tau.2017.03.82DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643647PMC
September 2017

Effect of low-energy shockwave therapy on angiogenic factors in the penile tissue of diabetic rats.

Turk J Urol 2017 Jun 3;43(2):130-134. Epub 2017 May 3.

Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.

Objective: The aim of this study is to investigate the effect of low-energy shock wave therapy (LESWT) on angiogenesis factors at penile tissue in a diabetic rat model.

Material And Methods: A total of 30 male Sprague-Dawley rats which were allocated into three equal groups were included study. Group 1 (control group) included 10 male rats which did not receive any treatment were randomly chosen to serve as normal control. The remaining rats were injected intraperitoneally with 60 mg/kg of streptozotocin (STZ) to induce diabetes. Diabetic rats were divided into two equal group which constituted diabetic control, and LESWT treatment (DM+LESWT) group. Each rat in the DM+LESWT group received L-ESWT therapy. Endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) mRNA expression levels of penile tissue were evaluated.

Results: Following STZ dosing eNOS level dropped in the diabetic control group relative to the control group. Statistically significant increase in eNOS levels were seen in the LESWT+DM group. Similarly, in the diabetic control group STZ treatment decreased VEGF levels, while in the LESWT+DM group VEGF nearly approached to baseline levels. However variations in VEGF levels were not statistically significant.

Conclusion: Mechanism action of ESWT in the penile tissue seems to involve angiogenic factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/tud.2017.35002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503429PMC
June 2017

Comparison of Two Different Methods Used for Semen Evaluation: Analysis of Semen Samples from 1,055 Men.

Urol Int 2017 22;98(2):215-221. Epub 2016 Jun 22.

Section of Andrology, Department of Urology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.

The aim of this study was to evaluate whether there is a difference between gravimetrically and volumetrically measured semen samples and to assess the impact of semen volume, density, and sperm count on the discrepancy between gravimetric and volumetric methods. This study was designed in an andrology laboratory setting and performed on semen samples of 1,055 men receiving infertility treatment. Semen volume was calculated by gravimetric and volumetric methods. The total sperm count, semen density and sperm viability were also examined according to recent version of World Health Organization manual. The median values for gravimetric and volumetric measurements were 3.44 g and 2.96 ml respectively. The numeric difference in semen volume between 2 methods was 0.48. The mean density of samples was 1.01 ± 0.46 g/ml (range 0.90-2.0 g/ml). The numeric difference between 2 methods gets higher as semen volume increases (p < 0.001). Gravimetric and volumetric semen volume measurements were strongly correlated for all samples and for each subgroup of semen volume, semen density and sperm count, with minimum correlation coefficient of 0.895 (p < 0.001). In conclusion, the gravimetric measurement provides higher results than volumetric one and numeric differences between 2 methods increase as semen volume increases. However, further studies are needed to offer the use of gravimetrical method, which was thought to minimize laboratory errors, particularly for a high amount of semen samples.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000446445DOI Listing
October 2017

Prospective evaluation of complications in laparoscopic urology at a mid-volume institution using standardized criteria: Experience of 1023 cases including learning curve in 9 years.

J Minim Access Surg 2016 Jan-Mar;12(1):33-40

Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Aim: To evaluate the laparoscopic operations performed in our department according to the modified Clavien classification system of complications.

Materials And Methods: Between September, 2005 and February, 2014, a total of 1023 laparoscopic cases were performed. This period was divided into three terms (Terms 1, 2 and 3 consisting of 38, 32 and 32 months, respectively). According to the European Scoring System (ESS), easy (E), slightly difficult (SD), fairly difficult (FD), difficult (D), very difficult (VD) and extremely difficult (ED) cases were 35, 88, 170, 390, 203 and 137, respectively. The perioperative complications were evaluated based on the 3 time periods, with a specific emphasis on determining the learning curve according to the modified Clavien classification system of complications.

Results: A total of 236 (23.1%) complications were observed according to the modified Clavien classification. The minor (Clavien I-II) and major (Clavien III, IV and V) complication rates were 20.5% (n = 210) and 2.4% (n = 26), respectively. Clavien I was the most frequently encountered type of complication (n = 120, %11.7). No significant difference was observed among all 3 time periods regarding total complication rates. The D cases had the highest complication rate compared to E, SD, FD, VD and ED cases among all three terms. The total number of complications increased significantly with increasing grade of technical difficulty according to the ESS.

Conclusion: Complications encountered in our laparoscopic surgery experience were predominantly minor, and the rate of complications was not significantly increased during the learning curve. The present data can provide guidance and manage expectations for surgeons introducing laparoscopy into their practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0972-9941.158154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746972PMC
February 2016

Pharmacologic and surgical therapies for sexual dysfunction in male cancer survivors.

Transl Androl Urol 2015 Apr;4(2):148-59

1 Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey ; 2 University of Western Ontario, London, Ontario, Canada.

The recent recognition that many men experience sexual dysfunction following their diagnosis and treatment of genitourinary cancers, has led to the development multiple varied strategies that attempt to restore or preserve that function. In this manuscript we review the understanding of why it happens, highlight novel management strategies and discuss the concept of penile rehabilitation (PR) following prostate cancer (PCa) treatment, glans preserving strategies among men diagnosed with penile cancer and address the controversial issue of testosterone therapy in men with PCa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3978/j.issn.2223-4683.2014.12.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708121PMC
April 2015

Tadalafil therapy for erectile dysfunction following prostatectomy.

Ther Adv Urol 2015 Jun;7(3):146-51

University of Western Ontario, 268 Grosvenor St, London, Ontario, Canada N6A4V2.

Erectile dysfunction is a major complication affecting the quality of life of patients and partners after radical prostatectomy. Evolving evidence suggests that early penile rehabilitation may provide better erectile function after surgery. Phosphodiesterase type 5 (PDE-5) inhibitors are routinely considered a first-line treatment option in most algorithms for penile rehabilitation owing to their efficacy, ease of use, wide availability and minimal morbidity. Tadalafil is a long-acting, potent PDE-5 inhibitor for erectile dysfunction, with demonstrated effect in animal studies at preserving penile smooth muscle content and prevention of fibrosis of cavernosal tissue. This article evaluates the existing literature on tadalafil and critically analyzes its impact on erectile function following radical prostatectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1756287215576626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485415PMC
June 2015

Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients: medial or lateral?

Asian J Androl 2014 May-Jun;16(3):442-5

Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey.

The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle (NVB) to correct ventral congenital penile curvatures (CPCs). The bundle was mobilized using the medial and lateral dissection technique in 21 (Group 1) and 13 (Group 2) patients, respectively. In the medial technique, Buck's fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea (TA) is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck's fascia above the urethra at the 5 and 7 o'clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients' photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 (P = 0.01). In Group 1, nine patients (42.8%) required one diamond excision, 10 (47.6%) required two diamond excisions and two (9.5%) required more than two excisions; in Group 2, six patients (46.2%) required two diamond excisions and seven patients (53.8%) required more than two diamond excisions (P = 0.019). The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/1008-682X.123667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023375PMC
December 2014

Laparoscopic nephrectomy in patients undergoing hemodialysis treatment.

JSLS 2010 Oct-Dec;14(4):534-40

Department of Urology and Anesthesiology, Istanbul University, Turkey.

Background And Objectives: To report our experience with laparoscopic nephrectomy (LN) in patients undergoing hemodialysis compared with normal counterparts.

Methods: Seventeen patients (20 renal units, Group 1) undergoing hemodialysis underwent LN, which was indicated due to nonfunctioning kidney in 17 and suspected malignancy in 3 renal units. Radical nephrectomy (RN), simple nephrectomy (SN), and simple nephroureterectomy (SNU) were performed in 3, 9, and 8 cases, respectively. For comparison, 101 patients (Group 2) without CRF (chronic renal failure) who had undergone LN were evaluated. In this group, RN, SN, SNU and radical nephroureterectomy (RNU) were performed in 48, 41, 8, and 4 patients, respectively.

Results: The mean age (36.9 ±13.1 vs. 48.7±19.4yr, P=0.002) and BMI (22.1±4.8 vs. 26.2±5.1kg/m(2), P=0.001) were lower in Group 1, whereas ASA (physical status score of American Society of Anesthesiologists) score (2.8±0.4 vs. 1.5±0.7, P<0.001) was lower in Group 2. The estimated blood loss (111±114 vs. 184±335mL, P=0.34) was higher in Group 2. Both groups were comparable in regard to mean operative time (133±79 vs. 119±45, P±0.70), hematocrit drop (4.69±3.9 vs. 3.86±3.0, P=0.29) and hospital stay (3.6±3.3 vs. 3.3±2.4 days, P=0.34). Meanwhile, when only patients undergoing SN and SNU in the study cohort (n=17 in Group 1 and n=49 in Group 2) are taken into consideration, no significant difference was observed between the 2 groups in terms of any kind of above-mentioned perioperative parameters. No case in Group 1 was converted to open surgery due to metabolic problems.

Conclusions: LN in patients undergoing hemodialysis may be performed safely by an experienced laparoscopy team.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4293/108680810X12924466008123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083045PMC
July 2011