This study proposes Fourier Transform Infrared (FTIR) spectroscopy as a more sensitive, rapid, no... more This study proposes Fourier Transform Infrared (FTIR) spectroscopy as a more sensitive, rapid, non-destructive and operator-independent analytical diagnostic method for bladder cancer recurrence from bladder wash than other routinely used urine cytology and cystoscopy methods. A total of 136 patients were recruited. FTIR spectroscopic experiments were carried out as a blind study, the classification results of which were then compared with those of cytology and cystoscopy. Firstly, 71 samples (n = 37; bladder cancer and n = 34; control) were studied with transmittance FTIR spectroscopy. After achieving successful differentiation of the groups, to develop a more rapid diagnostic tool and check the reproducibility of the results, the work was continued with different samples (n = 65 as n = 44; bladder cancer and n = 21; control), using the reflection mode (ATR) of FTIR spectroscopy by a different operator. The results revealed significant alterations in moleculer content in the cancer...
International Medical Journal of Sifa University, 2015
Uretrorenoscopy (URS) has become the gold standard in the treatment of ureteral stones. Ureteral ... more Uretrorenoscopy (URS) has become the gold standard in the treatment of ureteral stones. Ureteral avulsion (0.1-0.3%) and ureteral perforation (1.7-6%) are the worst morbid complications of the URS. Ureteral avulsion has been mostly encountered in URS procedures for ureteral stones in the ureteropelvic junction. Renal autotransplantation is one of the elective treatment options in patients with ureteral avulsion. An urgent renal autotransplantation owing to an iatrogenic ureteral avulsion after a ureteral extraction in a 42-year-old female patient who underwent URS is presented in the light of literature.
We investigated the efficacy of prophylactic radiotherapy for gynecomastia/breast pain induced by... more We investigated the efficacy of prophylactic radiotherapy for gynecomastia/breast pain induced by 150 mg bicalutamide in a prospective, randomized, multi-institutional trial. After definitive treatment for localized prostate cancer 125 patients were randomized to 12 Gy radiotherapy before bicalutamide as prophylactic radiotherapy (53) or bicalutamide only for nonprophylactic radiotherapy (72). The incidence of gynecomastia, breast pain and tenderness, and discomfort perceived by the patients was assessed by physical examination and direct questioning at 3, 6 and 12 months of followup. At the end of 12 months the gynecomastia rate was 15.8% in the prophylactic group and 50.8% in the nonprophylactic group (p <0.001). On patient evaluation the breast enlargement rate was 34.4%. The severity of breast pain and tenderness was not different between the groups. The breast pain rate was 36.4% and 49.2% by 12 months in the prophylactic and nonprophylactic groups, and the rate of patients who felt discomfort from gynecomastia was 11.4% and 29.5%, respectively. In this prospective study the incidence of gynecomastia was not as high as previously believed. Although prophylactic breast irradiation seemed to decrease the gynecomastia rate in patients on 150 mg bicalutamide, our study proves that not all patients need prophylaxis since only 52% were significantly bothered by gynecomastia. Thus, individual assessment is needed to select patients who need prophylactic radiation while on 150 mg bicalutamide.
Leiyomiyoma mesanenin nonepitelyal benign tümörüdür. Mesane leiyomiyomları seyrektir ve tüm mesan... more Leiyomiyoma mesanenin nonepitelyal benign tümörüdür. Mesane leiyomiyomları seyrektir ve tüm mesane tümörlerinin %1'den daha azını oluşturur. Bu tümörlerin etiyolojisi ve patogenezi açıklanamamıştır. Mesane leiyomiyomları tanısı genellikle rastlantısal olarak mesane ...
Objective: Radical prostatectomy (RP) is considered as the gold standard method in the treatment ... more Objective: Radical prostatectomy (RP) is considered as the gold standard method in the treatment of localized prostate cancer in patients with more than 10 years’ life expectancy. Biochemical recurrence (BCR) is seen in patients followed up after surgery and additional treatment is required for these patients. In our study, we aimed to evaluate those who were clinically diagnosed with localized prostate cancer, had an RP operation and then developed biochemical recurrence; we also aimed to determine the efficacy of the neutrophil-lymphocyte ratio (NLR) to predict BCR. Materials and Methods: The data of 996 patients diagnosed with prostate cancer in our clinic were analyzed retrospectively. Age, PSA value before transrectal ultrasonography guided prostate biopsy, digital rectal examination, Gleason score on biopsy, neutrophil and lymphocyte values detected by preoperative routine hemogram analysis, date of RP, pathological examination data of RP specimen, PSA values at follow-up afte...
Objective: We aimed to demonstrate the effects of clinical evaluations as well as biopsy characte... more Objective: We aimed to demonstrate the effects of clinical evaluations as well as biopsy characteristics in terms of lymph node involvement (LNI) despite the small number of patients in our study. Materials and Methods: A total of 221 patients who underwent radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) in our clinic between 2010 and 2015 and who met the inclusion criteria were enrolled in our study group. All of the patients were evaluated in terms of age, prostate-specific antigen (PSA) value before transrectal ultrasound-guided prostate biopsy (TRUSPB), digital rectal examination, Gleason score (GS) on TRUSPB, percentage of positive cores on TRUSPB, total number of positive cores, highest percentage of cancer in positive cores, and number of lymph nodes removed at RP. Pathological examination of the data of RP specimens, PSA values in follow-up after surgery, and follow-up periods was recorded. The TNM 2009 classification was used for staging. Results: In the evaluation of LNI risk, as regards the assessment of predictors and outcomes with respect to the univariate and multivariate analyses, LNI was found in the univariate analysis to be associated with GS, clinical stage, number of lymph nodes removed according to the D'Amico risk classification. In the multivariate analysis, however, the number of lymph nodes removed was found significant. Conclusion: Risk stratification should be considered in patients with prostate cancer while selecting the patients who would undergo pelvic lymphadenectomy. In addition, ePLND should be performed to patients undergoing lymphadenectomy.
The aim of this study was to investigate the effect of carbamazepine (CBZ) and sodium valproate (... more The aim of this study was to investigate the effect of carbamazepine (CBZ) and sodium valproate (VPA) monotherapy on sexual functions, sex hormones, and semen analysis and quality in male patients with epilepsy. Methods: A total of 59 male patients with epilepsy, of which 30 were on VPA monotherapy and 29 were on CBZ monotherapy, were included in the study between January 2015 and March 2016. A control group was established with 30 healthy males. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), free testosterone (fT), estradiol (E2), sex hormone-binding globulin (SHBG) levels and bioactive testosterone (BAT)/bioactive estradiol (BAE), and BAT/LH ratio were studied in groups. All groups received semen analysis and International Index of Erectile Function Scale (IIEF-5) test for erectile dysfunction. Results: E2 and DHEAS levels were higher in VPA and CBZ groups compared to control group (P < .001, P = .014). The decrease in fT levels in the VPA group was statistically significant (P = .038). No significant difference was detected in levels of SHBG, LH, and FSH (P > .05). BAT/BAE ratios were low both in VPA and CBZ groups (P < .001; P < .001), while BAT/LH ratios were low only in CBZ group (P = .033). In semen analysis, semen volume and number of normal sperms were found to be significantly lower in patients receiving antiepileptic drugs compared to control group (P < .05). There were no differences between the groups in rates of abnormal sperm morphology. IIEF-5 scores were found to be significantly lower in VPA and CBZ groups (P < .001). Conclusion: VPA or CBZ therapy may lead to dysregulation of sex hormones, sexual dysfunction, and alterations in semen analysis in male patients with epilepsy. This must be considered for the selection of antiepileptic drugs in young male patients.
Radical cystectomy (RC) is the standard treatment model in invasive bladder cancer patients. Risk... more Radical cystectomy (RC) is the standard treatment model in invasive bladder cancer patients. Risk definitions before RC is mainly based on pathological results. Neutrophil/lymphocyte (N/L) rate is one of the inflammation markers. Some other studies reported negative prognostic results with increased N/L rates. In our study, we reviewed the relationship between preoperative N/L rate and clinicopathological results following RC. Data gathered from 296 bladder cancer patients that received RC between 2002 and 2012 were retrospectively reviewed. All patients received preoperative routine hematological and biochemical tests and metastasis screening. All patients were treated with radical cystoprostatectomy and standard pelvic lymph node dissection. The cutoff value for N/L rate was calculated using a web-based "cutoff finder" software. Patient mean age was calculated as 65.7 years. Mean follow-up period was 24.5 (2-84) months. Cancer-related death was seen in 132 (44.6%) patien...
Introduction: Radical cystectomy (RC) is the main treatment option for patients with muscle-invas... more Introduction: Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. Methods: The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. Results: Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metasta...
Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia, 2011
Fibrous pseudotumors of the tunica vaginalis, epididymis, and spermatic cord are uncommon benign ... more Fibrous pseudotumors of the tunica vaginalis, epididymis, and spermatic cord are uncommon benign paratesticular masses. We report the case of a 27-year-old man who presented with grossly abnormal testicular examination. Scrotal Doppler ultrasound scan showed normal testicles bilaterally and solid, round, multiple 15-40 mm hypoechoic lesions adjacent to the right testis. Tumoral markers were within normal limits. Uncomplicated right radical orchiectomy was performed. After a follow-up of 12 months, no relapse occurred. We discuss about rare benign paratesticular masses identified as fibrous pseudotumors.
The etiology of premature ejaculation (PE) is unknown. Over the past two decades several studies ... more The etiology of premature ejaculation (PE) is unknown. Over the past two decades several studies have suggested that lifelong and acquired PE may be caused by somatic disorders and/or neurobiological disturbances. One controversial factor is the effect of circumcision on ejaculation. This prospective study investigated the relationship between postcircumcision penile mucosal cuff length, circumcision scar thickness and the PE syndromes. Features of PE patients were compared with those of a normal healthy control (NHC) group. In total, 160 circumcised men were studied: 80 men with PE and 80 men in the NHC group. The following data and measurements were evaluated: age, type of PE syndrome, intravaginal ejaculation latency time (IELT), circumcision scar thickness and postcircumcision mucosal cuff length. In terms of the mean IELT, a statistically significant difference was detected between the PE syndromes (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), and between the PE patients and the control group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Among the four PE syndromes, there was no significant difference related to the mean mucosal cuff length and mean circumcision scar thickness (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). No significant difference was observed between the two groups for mean mucosal cuff length (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) or mean circumcision scar thickness (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). In this study, no relationship was observed between PE and postcircumcision penile mucosal cuff length and circumcision scar thickness. Further studies are required to evaluate the positive and negative effects of circumcision on PE syndromes.
We determined the frequency of hydronephrosis at initial diagnosis, and its effect on recurrence ... more We determined the frequency of hydronephrosis at initial diagnosis, and its effect on recurrence and progression in patients with superficial bladder cancer. Between January 1993 and April 2006 we retrospectively reviewed the records of 931 patients with superficial transitional cell carcinoma of the bladder at our institute. Hydronephrosis status was determined by excretory urogram, ultrasound or computerized tomography of the abdomen and pelvis at initial evaluation. The number of tumors, tumor size, tumor location, T category (pTa vs pT1) and histological grade were assessed at study entry. The absence or presence of unilateral or bilateral upper tract obstruction/hydronephrosis was recorded for all cohorts. We examined the frequency of hydronephrosis in patients with superficial bladder carcinoma according to T status and investigated the relationship between hydronephrosis, and recurrence-free and progression-free survival for pTa and pT1 stage. The end points assessed were recurrence and progression. Histopathological results showed that 63.8% of all superficial bladder cancer cases were pT1 stage. Preoperative radiological evaluation revealed unilateral and bilateral hydronephrosis in 70 (7.5%) and 19 (2.1%) patients in all cohorts, respectively. Of patients with pTa tumors 304 (90.2%) had low grade lesions and 207 (61.4%) had a single tumor. Unilateral and bilateral hydronephrosis was detected in 16 (4.7%) and 4 (1.2%) patients with pTa, respectively. Of patients with pT1 tumors 196 (33.0%) had low grade lesions and 283 (47.6%) had a single tumor. Unilateral and bilateral hydronephrosis was detected in 54 (9.1%) and 15 (2.5%) patients with pT1 disease, respectively. The increased probability of hydronephrosis was detected in higher stage, higher grade multiple tumors and in tumors larger than 3 cm. Of 931 patients 37.9% had at least 1 recurrence with an incidence of 27.3% for Ta and 43.9% for T1 disease. The recurrence rate was 52.8% for patients with hydronephrosis, that is 35.0% for Ta and 58.0% for T1 disease. Median time to first recurrence was 22 months. Multivariate Cox analysis confirmed that T category, grade, tumor size and hydronephrosis were significant prognostic variables of recurrence. Of the cases 11% progressed to muscle invasive bladder cancer. Multivariate analysis revealed that progression was statistically significant for T category, disease grade, multiplicity, tumor size and the presence or absence of hydronephrosis. Unilateral/bilateral hydronephrosis detected at the first evaluation at diagnosis of superficial bladder tumors is an independent prognostic factor for recurrence and progression.
We evaluated the potential risk factors for disease relapse in patients with clinical stage I non... more We evaluated the potential risk factors for disease relapse in patients with clinical stage I nonseminomatous germ cell tumors treated with surveillance and reevaluated our treatment of these patients. A total of 211 consecutive patients with clinical stage I nonseminomatous germ cell tumors treated with surveillance after orchiectomy between 1993 and 2005 were included in this retrospective study. Risk factors evaluated were presence of vascular invasion, proportion of embryonal carcinoma, age, tumor size, preoperatively increased serum alpha-fetoprotein and the absence of yolk sac component. Of the 211 patients 66 (31.3%) had disease relapse. Recurrence ranged from 2 to 32 months after orchiectomy (median 6). A total of 52 (78.8%) cases of relapse were diagnosed in year 1 of followup, 11 (16.7%) during year 2 and only 3 cases were diagnosed thereafter. The first evidence of relapse was most commonly the increase in serum tumor markers alone (28.8%) or in combination with other modalities (66.7%, overall 95.5%). While 40.9% of patients with more than 50% embryonal carcinoma had disease relapse, the relapse rate was 20.8% in patients with less than 50% embryonal carcinoma (p = 0.002). Relapse rates in patients with and without vascular invasion were 75.5% and 17.9%, respectively (p = 0.000). The relapse rates were 6.1% and 75.7% in patients with no risk factors (no vascular invasion and less than 50% embryonal carcinoma) and 2 risk factors (vascular invasion and more than 50% embryonal carcinoma), respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Multivariate analysis revealed that vascular invasion was the most powerful predictor of relapse (OR 16.350, 95% CI 5.582-47.893). Disease-free and disease specific survival rates were 97.6% at a median followup of 75 months. In light of our results we suggest that all patients with vascular invasion should receive chemotherapy. However, patients with no risk factors and those with more than 50% embryonal carcinoma but without vascular invasion should be on surveillance after orchiectomy since the relapse rate is less than 30%. Although strict followup in the first year is justified, followup schemas may be reassessed for the frequency of radiological investigations.
This study proposes Fourier Transform Infrared (FTIR) spectroscopy as a more sensitive, rapid, no... more This study proposes Fourier Transform Infrared (FTIR) spectroscopy as a more sensitive, rapid, non-destructive and operator-independent analytical diagnostic method for bladder cancer recurrence from bladder wash than other routinely used urine cytology and cystoscopy methods. A total of 136 patients were recruited. FTIR spectroscopic experiments were carried out as a blind study, the classification results of which were then compared with those of cytology and cystoscopy. Firstly, 71 samples (n = 37; bladder cancer and n = 34; control) were studied with transmittance FTIR spectroscopy. After achieving successful differentiation of the groups, to develop a more rapid diagnostic tool and check the reproducibility of the results, the work was continued with different samples (n = 65 as n = 44; bladder cancer and n = 21; control), using the reflection mode (ATR) of FTIR spectroscopy by a different operator. The results revealed significant alterations in moleculer content in the cancer...
International Medical Journal of Sifa University, 2015
Uretrorenoscopy (URS) has become the gold standard in the treatment of ureteral stones. Ureteral ... more Uretrorenoscopy (URS) has become the gold standard in the treatment of ureteral stones. Ureteral avulsion (0.1-0.3%) and ureteral perforation (1.7-6%) are the worst morbid complications of the URS. Ureteral avulsion has been mostly encountered in URS procedures for ureteral stones in the ureteropelvic junction. Renal autotransplantation is one of the elective treatment options in patients with ureteral avulsion. An urgent renal autotransplantation owing to an iatrogenic ureteral avulsion after a ureteral extraction in a 42-year-old female patient who underwent URS is presented in the light of literature.
We investigated the efficacy of prophylactic radiotherapy for gynecomastia/breast pain induced by... more We investigated the efficacy of prophylactic radiotherapy for gynecomastia/breast pain induced by 150 mg bicalutamide in a prospective, randomized, multi-institutional trial. After definitive treatment for localized prostate cancer 125 patients were randomized to 12 Gy radiotherapy before bicalutamide as prophylactic radiotherapy (53) or bicalutamide only for nonprophylactic radiotherapy (72). The incidence of gynecomastia, breast pain and tenderness, and discomfort perceived by the patients was assessed by physical examination and direct questioning at 3, 6 and 12 months of followup. At the end of 12 months the gynecomastia rate was 15.8% in the prophylactic group and 50.8% in the nonprophylactic group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). On patient evaluation the breast enlargement rate was 34.4%. The severity of breast pain and tenderness was not different between the groups. The breast pain rate was 36.4% and 49.2% by 12 months in the prophylactic and nonprophylactic groups, and the rate of patients who felt discomfort from gynecomastia was 11.4% and 29.5%, respectively. In this prospective study the incidence of gynecomastia was not as high as previously believed. Although prophylactic breast irradiation seemed to decrease the gynecomastia rate in patients on 150 mg bicalutamide, our study proves that not all patients need prophylaxis since only 52% were significantly bothered by gynecomastia. Thus, individual assessment is needed to select patients who need prophylactic radiation while on 150 mg bicalutamide.
Leiyomiyoma mesanenin nonepitelyal benign tümörüdür. Mesane leiyomiyomları seyrektir ve tüm mesan... more Leiyomiyoma mesanenin nonepitelyal benign tümörüdür. Mesane leiyomiyomları seyrektir ve tüm mesane tümörlerinin %1'den daha azını oluşturur. Bu tümörlerin etiyolojisi ve patogenezi açıklanamamıştır. Mesane leiyomiyomları tanısı genellikle rastlantısal olarak mesane ...
Objective: Radical prostatectomy (RP) is considered as the gold standard method in the treatment ... more Objective: Radical prostatectomy (RP) is considered as the gold standard method in the treatment of localized prostate cancer in patients with more than 10 years’ life expectancy. Biochemical recurrence (BCR) is seen in patients followed up after surgery and additional treatment is required for these patients. In our study, we aimed to evaluate those who were clinically diagnosed with localized prostate cancer, had an RP operation and then developed biochemical recurrence; we also aimed to determine the efficacy of the neutrophil-lymphocyte ratio (NLR) to predict BCR. Materials and Methods: The data of 996 patients diagnosed with prostate cancer in our clinic were analyzed retrospectively. Age, PSA value before transrectal ultrasonography guided prostate biopsy, digital rectal examination, Gleason score on biopsy, neutrophil and lymphocyte values detected by preoperative routine hemogram analysis, date of RP, pathological examination data of RP specimen, PSA values at follow-up afte...
Objective: We aimed to demonstrate the effects of clinical evaluations as well as biopsy characte... more Objective: We aimed to demonstrate the effects of clinical evaluations as well as biopsy characteristics in terms of lymph node involvement (LNI) despite the small number of patients in our study. Materials and Methods: A total of 221 patients who underwent radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) in our clinic between 2010 and 2015 and who met the inclusion criteria were enrolled in our study group. All of the patients were evaluated in terms of age, prostate-specific antigen (PSA) value before transrectal ultrasound-guided prostate biopsy (TRUSPB), digital rectal examination, Gleason score (GS) on TRUSPB, percentage of positive cores on TRUSPB, total number of positive cores, highest percentage of cancer in positive cores, and number of lymph nodes removed at RP. Pathological examination of the data of RP specimens, PSA values in follow-up after surgery, and follow-up periods was recorded. The TNM 2009 classification was used for staging. Results: In the evaluation of LNI risk, as regards the assessment of predictors and outcomes with respect to the univariate and multivariate analyses, LNI was found in the univariate analysis to be associated with GS, clinical stage, number of lymph nodes removed according to the D'Amico risk classification. In the multivariate analysis, however, the number of lymph nodes removed was found significant. Conclusion: Risk stratification should be considered in patients with prostate cancer while selecting the patients who would undergo pelvic lymphadenectomy. In addition, ePLND should be performed to patients undergoing lymphadenectomy.
The aim of this study was to investigate the effect of carbamazepine (CBZ) and sodium valproate (... more The aim of this study was to investigate the effect of carbamazepine (CBZ) and sodium valproate (VPA) monotherapy on sexual functions, sex hormones, and semen analysis and quality in male patients with epilepsy. Methods: A total of 59 male patients with epilepsy, of which 30 were on VPA monotherapy and 29 were on CBZ monotherapy, were included in the study between January 2015 and March 2016. A control group was established with 30 healthy males. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), free testosterone (fT), estradiol (E2), sex hormone-binding globulin (SHBG) levels and bioactive testosterone (BAT)/bioactive estradiol (BAE), and BAT/LH ratio were studied in groups. All groups received semen analysis and International Index of Erectile Function Scale (IIEF-5) test for erectile dysfunction. Results: E2 and DHEAS levels were higher in VPA and CBZ groups compared to control group (P < .001, P = .014). The decrease in fT levels in the VPA group was statistically significant (P = .038). No significant difference was detected in levels of SHBG, LH, and FSH (P > .05). BAT/BAE ratios were low both in VPA and CBZ groups (P < .001; P < .001), while BAT/LH ratios were low only in CBZ group (P = .033). In semen analysis, semen volume and number of normal sperms were found to be significantly lower in patients receiving antiepileptic drugs compared to control group (P < .05). There were no differences between the groups in rates of abnormal sperm morphology. IIEF-5 scores were found to be significantly lower in VPA and CBZ groups (P < .001). Conclusion: VPA or CBZ therapy may lead to dysregulation of sex hormones, sexual dysfunction, and alterations in semen analysis in male patients with epilepsy. This must be considered for the selection of antiepileptic drugs in young male patients.
Radical cystectomy (RC) is the standard treatment model in invasive bladder cancer patients. Risk... more Radical cystectomy (RC) is the standard treatment model in invasive bladder cancer patients. Risk definitions before RC is mainly based on pathological results. Neutrophil/lymphocyte (N/L) rate is one of the inflammation markers. Some other studies reported negative prognostic results with increased N/L rates. In our study, we reviewed the relationship between preoperative N/L rate and clinicopathological results following RC. Data gathered from 296 bladder cancer patients that received RC between 2002 and 2012 were retrospectively reviewed. All patients received preoperative routine hematological and biochemical tests and metastasis screening. All patients were treated with radical cystoprostatectomy and standard pelvic lymph node dissection. The cutoff value for N/L rate was calculated using a web-based "cutoff finder" software. Patient mean age was calculated as 65.7 years. Mean follow-up period was 24.5 (2-84) months. Cancer-related death was seen in 132 (44.6%) patien...
Introduction: Radical cystectomy (RC) is the main treatment option for patients with muscle-invas... more Introduction: Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. Methods: The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. Results: Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metasta...
Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia, 2011
Fibrous pseudotumors of the tunica vaginalis, epididymis, and spermatic cord are uncommon benign ... more Fibrous pseudotumors of the tunica vaginalis, epididymis, and spermatic cord are uncommon benign paratesticular masses. We report the case of a 27-year-old man who presented with grossly abnormal testicular examination. Scrotal Doppler ultrasound scan showed normal testicles bilaterally and solid, round, multiple 15-40 mm hypoechoic lesions adjacent to the right testis. Tumoral markers were within normal limits. Uncomplicated right radical orchiectomy was performed. After a follow-up of 12 months, no relapse occurred. We discuss about rare benign paratesticular masses identified as fibrous pseudotumors.
The etiology of premature ejaculation (PE) is unknown. Over the past two decades several studies ... more The etiology of premature ejaculation (PE) is unknown. Over the past two decades several studies have suggested that lifelong and acquired PE may be caused by somatic disorders and/or neurobiological disturbances. One controversial factor is the effect of circumcision on ejaculation. This prospective study investigated the relationship between postcircumcision penile mucosal cuff length, circumcision scar thickness and the PE syndromes. Features of PE patients were compared with those of a normal healthy control (NHC) group. In total, 160 circumcised men were studied: 80 men with PE and 80 men in the NHC group. The following data and measurements were evaluated: age, type of PE syndrome, intravaginal ejaculation latency time (IELT), circumcision scar thickness and postcircumcision mucosal cuff length. In terms of the mean IELT, a statistically significant difference was detected between the PE syndromes (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), and between the PE patients and the control group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Among the four PE syndromes, there was no significant difference related to the mean mucosal cuff length and mean circumcision scar thickness (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). No significant difference was observed between the two groups for mean mucosal cuff length (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) or mean circumcision scar thickness (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). In this study, no relationship was observed between PE and postcircumcision penile mucosal cuff length and circumcision scar thickness. Further studies are required to evaluate the positive and negative effects of circumcision on PE syndromes.
We determined the frequency of hydronephrosis at initial diagnosis, and its effect on recurrence ... more We determined the frequency of hydronephrosis at initial diagnosis, and its effect on recurrence and progression in patients with superficial bladder cancer. Between January 1993 and April 2006 we retrospectively reviewed the records of 931 patients with superficial transitional cell carcinoma of the bladder at our institute. Hydronephrosis status was determined by excretory urogram, ultrasound or computerized tomography of the abdomen and pelvis at initial evaluation. The number of tumors, tumor size, tumor location, T category (pTa vs pT1) and histological grade were assessed at study entry. The absence or presence of unilateral or bilateral upper tract obstruction/hydronephrosis was recorded for all cohorts. We examined the frequency of hydronephrosis in patients with superficial bladder carcinoma according to T status and investigated the relationship between hydronephrosis, and recurrence-free and progression-free survival for pTa and pT1 stage. The end points assessed were recurrence and progression. Histopathological results showed that 63.8% of all superficial bladder cancer cases were pT1 stage. Preoperative radiological evaluation revealed unilateral and bilateral hydronephrosis in 70 (7.5%) and 19 (2.1%) patients in all cohorts, respectively. Of patients with pTa tumors 304 (90.2%) had low grade lesions and 207 (61.4%) had a single tumor. Unilateral and bilateral hydronephrosis was detected in 16 (4.7%) and 4 (1.2%) patients with pTa, respectively. Of patients with pT1 tumors 196 (33.0%) had low grade lesions and 283 (47.6%) had a single tumor. Unilateral and bilateral hydronephrosis was detected in 54 (9.1%) and 15 (2.5%) patients with pT1 disease, respectively. The increased probability of hydronephrosis was detected in higher stage, higher grade multiple tumors and in tumors larger than 3 cm. Of 931 patients 37.9% had at least 1 recurrence with an incidence of 27.3% for Ta and 43.9% for T1 disease. The recurrence rate was 52.8% for patients with hydronephrosis, that is 35.0% for Ta and 58.0% for T1 disease. Median time to first recurrence was 22 months. Multivariate Cox analysis confirmed that T category, grade, tumor size and hydronephrosis were significant prognostic variables of recurrence. Of the cases 11% progressed to muscle invasive bladder cancer. Multivariate analysis revealed that progression was statistically significant for T category, disease grade, multiplicity, tumor size and the presence or absence of hydronephrosis. Unilateral/bilateral hydronephrosis detected at the first evaluation at diagnosis of superficial bladder tumors is an independent prognostic factor for recurrence and progression.
We evaluated the potential risk factors for disease relapse in patients with clinical stage I non... more We evaluated the potential risk factors for disease relapse in patients with clinical stage I nonseminomatous germ cell tumors treated with surveillance and reevaluated our treatment of these patients. A total of 211 consecutive patients with clinical stage I nonseminomatous germ cell tumors treated with surveillance after orchiectomy between 1993 and 2005 were included in this retrospective study. Risk factors evaluated were presence of vascular invasion, proportion of embryonal carcinoma, age, tumor size, preoperatively increased serum alpha-fetoprotein and the absence of yolk sac component. Of the 211 patients 66 (31.3%) had disease relapse. Recurrence ranged from 2 to 32 months after orchiectomy (median 6). A total of 52 (78.8%) cases of relapse were diagnosed in year 1 of followup, 11 (16.7%) during year 2 and only 3 cases were diagnosed thereafter. The first evidence of relapse was most commonly the increase in serum tumor markers alone (28.8%) or in combination with other modalities (66.7%, overall 95.5%). While 40.9% of patients with more than 50% embryonal carcinoma had disease relapse, the relapse rate was 20.8% in patients with less than 50% embryonal carcinoma (p = 0.002). Relapse rates in patients with and without vascular invasion were 75.5% and 17.9%, respectively (p = 0.000). The relapse rates were 6.1% and 75.7% in patients with no risk factors (no vascular invasion and less than 50% embryonal carcinoma) and 2 risk factors (vascular invasion and more than 50% embryonal carcinoma), respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Multivariate analysis revealed that vascular invasion was the most powerful predictor of relapse (OR 16.350, 95% CI 5.582-47.893). Disease-free and disease specific survival rates were 97.6% at a median followup of 75 months. In light of our results we suggest that all patients with vascular invasion should receive chemotherapy. However, patients with no risk factors and those with more than 50% embryonal carcinoma but without vascular invasion should be on surveillance after orchiectomy since the relapse rate is less than 30%. Although strict followup in the first year is justified, followup schemas may be reassessed for the frequency of radiological investigations.
Uploads
Papers by ferruh zorlu