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Öğe Acute Histopathological Response of Renal Tissues After Varied Fractionated Abdominal 12 Gy Irradiation In Rats(2017) Akdere, HakanObjective: The aim of the present study was to evaluate the effect of fraction dose irradiation on kidney damage due to scattered radiation.Methods: Rats were randomized into 6 groups. Group 1: Control group, a sham irradiation (n=5); Group 2: Hypofractionated total abdominal irradiation (TAI), total of 12 Gy (2 fractions in 2 days) (n=4); Group 3: Hypofractionated TAI, total of 12 Gy (3 fractions in 3 days; n=6); Group 4: Hypofractionated TAI, total of 12 Gy (4 fractions in 4 days; n=6); Group 5: TAI with conventional fractionation, total of 12 Gy (6 fractions in 6 days; n=6); and Group 6: TAI with conventional fractionation, total of 12 Gy (7 fractions in 7 days; n=6).Results: There was no statistically significant difference (p>0.05) between the hypofractionated group sets of Groups 3-4 (2.66±0.51) and 5-6 (1.83±0.40). However, a statistically significant difference was found in the comparison between Group 2 (3.75±0.51) and the group sets of Groups 3–4 and 5–6 (p<0.05).Conclusion: The present study demonstrated that hypofractionated TAI leads to more prominent acute tissue damage in the kidneys than does conventional irradiationÖğe Acute histopathological responses of testicular tissues after different fractionated abdominal irradiation in rats(Informa Healthcare, 2015) Akdere, Hakan; Caloglu, Vuslat Yurut; Tastekin, Ebru; Caloglu, Murat; Turkkan, Gorkem; Mericliler, Meric; Burgazli, Kamil MehmetPurpose: To compare the effects of different fractionated doses of abdominal radiation therapy on acute histopathological responses of testicular tissues in rats. Methods: Thirty-three 3-week-old Wistar albino rats were randomized into 6 groups: group 1 (n = 5), control; group 2 (n = 4), hypofractionated total abdominal irradiation (TAI) of 6 Gy/1 fraction/day for 2 days; group 3 (n = 6), hypofractionated TAI of 4 Gy/1 fraction/day for 3 days; group 4 (n = 6), hypofractionated TAI of 3 Gy/1 fraction/day for 4 days; group 5 (n = 6), conventionally fractionated TAI of 2 Gy/1 fraction/day for 6 days; group 6 (n = 6), conventionally fractionated TAI of 1.7 Gy/1 fraction/day for 7 days. Mean epithelial length and diameter of seminiferous tubules of testicular tissues were determined after euthanasia. Results: Initially, a highly significant decrease in both the mean tubular diameter and epithelial height of the seminiferous tubules was demonstrated in all irradiated rats compared with the control group. No significant differences regarding both damage parameters were found between different hypofractionated radiation therapies. Both conventional radiation therapies reduced the epithelial height and mean diameter of the seminiferous tubules to a lesser extent when compared with 6 Gy/1 fraction/day hypofractionated therapy. It was further shown that parameter values were comparable between rats that received 3 Gy/day hypofractionated therapy and rats that received either of the two conventional therapies. Furthermore, although 4 Gy/day hypofractionation decreased tubular diameter and epithelial length to a greater degree compared with the conventional therapy of 1.7 Gy/1 fraction/day, no statistically significant difference was found when compared with conventional therapy of 2 Gy/1 fraction/day. Additionally, no statistically significant difference was demonstrated between the two types of conventional radiotherapy application. Conclusion: The present study demonstrated that hypofractionated abdominal irradiation leads to more prominent tissue damage in the testes than conventional irradiation.Öğe Ağırlık Kontrolü ve Beslenme Eğitiminin Erektil Disfonksiyon Tedavisindeki Yeri ve Öneminin Değerlendirilmesi(2019) Arda, Ersan; Cakiroglu, Basri; Karacan, Elif; Akdere, Hakan; Şentürk, Aykut BuğraAmaç: Erektil disfonksiyonun (ED) etyolo- jisinde ve tedavisinde beslenme ve vücut ağırlık kontrolünün yeri ve önemini araştırmak. Gereç ve Yöntemler: Kasım 2013 - Aralık 2015 tarihleri arasında üroloji polikliniğinde ED tanısı konulan 152 hasta beslenme eğitimi ve ağırlık tedavisi için diyet polikliniğine yönlendi- rilerek beslenme ve vücut ağırlık kontrolü sağlan- maya çalışıldı. Bu hastalara üroloji polikliniğinde Uluslararası Erektil Fonksiyon İndeksi Formu (IIEF) doldurularak diyet polikliniğinde 2 aylık takip sonrası IIEF skoru yeniden değerlendirildi. Bu iki IIEF skoru arasındaki farkın istatistiksel olarak anlamlılığına bakıldı. Temel beslenme alışkanlıkları ve antropometrik ölçümlere ilişkin bilgileri (boy uzunluğu (cm), vücut ağırlığı (kg), vücut kitle indeksi (VKİ) (kg/m2), bel-kalça çev- resi (cm), bel-kalça oranı, boyun çevresi ve vücut yağ oranı sorgulayan anket formu, günlük besin alımı, beslenme durumunun belirlenmesi için besin tüketim sıklığı formu ve biyokimyasal kan parametreleri formu uygulandı. Bulgular: Çalışmaya toplam 152 hasta katıl- mıştır. Çalışmaya katılanların yaşları ortalaması 41.69 ±11.22 dir. Tedavi öncesi IIEF, VKİ, Homa İndexi sırasıyla 19.5, 30.1kg/m2, 5.05 mg/dl iken tedavi sonrası IIEF, VKİ ve Homa İndex sırasıy- la 21, 29kg/m2, 4.46 mg/dl olarak bulunmuştur (p<0,001). Ayrıca tedavi öncesi ile sonrası sisto- lik kan basınçları arasında istatistiksel olarak an- lamlı düşüş görülmüştür (p=0.008). Buna karşın tedavi öncesi diastolik kan başınçları ile tedavi sonrasındaki değerler arasında anlamlı bir fark tespit edilmedi. Sonuç: Beslenme ve ağırlık kontrolü ile erektil disfonksiyonun tedavisine katkı sağlamak mümkündür.Öğe Analgesic Effects of Oligonol, Acupuncture and Quantum Light Therapy on Chronic Nonbacterial Prostatitis(Zamensalamati Publ Co, 2015) Akdere, Hakan; Oztekin, Ilhan; Arda, Ersan; Aktoz, Tevfik; Turan, Fatma Nesrin; Burgazli, Kamil MehmetBackground: Chronic Nonbacterial Prostatitis (CNBP) is a condition that frequently causes long-term pain and a significant decrease in the quality of life. Objectives: The present study aimed to examine the analgesic effects of oligonol, acupuncture, quantum light therapy and their combinations on estrogen-induced CNBP in rats. Materials and Methods: This experimental study was conducted in Edirne, Turkey, using a simple randomized allocation. A total of 90 adult male Wistar rats were randomized into 9 groups of 10 rats each: Group I, control; Group II, CNBP, Group III, oligonol only, Group IV, acupuncture only; Group V, quantum only; Group VI, oligonol + quantum; Group VII, acupuncture + oligonol; Group VIII, quantum + acupuncture; Group IX, acupuncture + quantum + oligonol. Oligonol treatment was given at a dose of 60 mg/ day for 6 weeks. Conceptual vessels (CV) 3 and 4, and bilaterally urinary bladder (Bl) 32 and 34 points were targeted with 1-hour acupuncture stimulation. The quantum light therapy was applied in 5-minute sessions for 6 weeks (3-times/a week). For pain measurements, mechanical pressure was applied to a point 2 cm distal to the root of the tail to elicit pain and consequent parameters (peak force, latency time of response and total length of measurement) were assessed. Results: Analgesic effects were observed with all treatment regimens; however, the most prominent median analgesic effect was shown in the quantum light therapy in combination with acupuncture for estrogen-induced CNBP (PF1 = 663.9, PF2 = 403.4) (P = 0.012). Furthermore, we observed that monotherapy with quantum light showed a better analgesic efficacy as compared to oligonol and acupuncture monotherapies (PF1 = 1044.6, PF2 = 661.2) (P = 0.018, P = 0.008, P = 0.018; respectively). Conclusions: All treatment modalities showed a significant analgesic effect on CNBP in rats, being most prominent with the quantum light therapy.Öğe Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment Ischemic Priapism: A Single-Center Experience(Elsevier Sci Ltd, 2019) Ortac, Mazhar; Cevik, Gokhan; Akdere, Hakan; Ermec, Bahadir; Kadioglu, AtesBackground: 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. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.Öğe The association of Intron 4 VNTR and Glu298Asp polymorphisms of the nitric oxide synthetase 3 gene and vasculogenic erectile dysfunction in Turkish men(Taylor & Francis Inc, 2019) Arda, Ersan; Ay, Arzu; Akdere, Hakan; Akdeniz, EsraSeveral studies have focused on the impaired role of endothelial nitric oxide synthase (NOS3) gene polymorphism and its association to erectile dysfunction (ED). However, currently controversial results have been reported due to their significant heterogeneity. The present study aimed to assess the genotypic distribution and the allelic frequency of Intron 4 VNTR and Glu298Asp gene polymorphisms in vasculogenic ED patients compared to healthy controls of a specific region of Turkey. A total of 75 patients with ED (median age: 56, IQR:10.5) and 75 healthy controls (median age: 56, IQR:10.5) were prospectively analyzed. All subjects were equally evaluated by the same physician with detailed history-taking, physical examination, International Index of Erectile Function (IIEF) questionnaire, and blood tests (incl. glucose, testosterone, triglyceride and total cholesterol level). Those with an IIEF score under 26 were considered to have ED, by classifying them according to their scores as mild (22-25), moderate (11-21) and severe (1-10) ED. Color doppler ultrasonography was carried out in patients with an IIEF score <22. Hypertension, diabetes mellitus, coronary artery disease, and smoking status were significantly associated with the ED group compared to control subjects with p values of <0.001, <0.001, 0.002 and <0.001, respectively. Overall genotype frequencies was 47 (31%) a/a, 22 (15%) a/b, 82 (55%) b/b for Intron 4 VNTR and 56 (37%) GG, 78 (52%) GT, 16 (11%) TT for the Glu298Asp polymorphism. The frequencies of Intron 4 VNTR a/a allele and Glu298Asp GT allele were associated with severe ED, while a/b and TT were associated with moderate or mild, and b/b and GG were associated with no ED. In contrast to Glu298Asp, statistically significant differences in genotypic frequencies of Intron 4 VNTR gene polymorphism between ED and control subjects was established.Öğe Asymptomatic Giant Right Renal Oncocytoma: A Case Report(Springernature, 2023) Cevik, Gokhan; Tozsin, Atinc; Erdogan, Ezgi G.; Cakici, Hakan; Akdere, HakanRenal oncocytoma is usually detected incidentally. It can be considered as a renal cell carcinoma (RCC) on preoperative imaging. They usually present as small masses and usually look like benign tumors. Giant oncocytomas are rare. A 72-year-old male patient was seen in the outpatient department for left scrotal swelling. Ultrasound (US) showed a giant mass compatible with RCC in the right kidney which was incidentally detected. Abdominal computed tomography (CT) revealed a mass with an axial diameter of 167x146 mm, compatible with RCC, a heterogeneous mass of soft tissue density with central necrosis. There was no evidence of tumor thrombus in the right renal vein or inferior vena cava. Open radical nephrectomy was performed through an anterior subcostal incision. Pathological examination revealed a 17x15 cm renal oncocytoma. The patient was discharged on the sixth day postoperatively. Clinically or radiologically, renal oncocytoma and renal cell carcinoma usually cannot be distinguished, although oncocytoma may be suspected if a central scar with fibrous extensions is seen, the so-called spoke-wheel appearance. The treatment decision should be made according to the clinical aspects. Radical/partial nephrectomy or thermal ablation can be considered as treatment options. In this article, we review the literature on the radiological and pathological features of renal oncocytoma.Öğe Biochemical Recurrence of Prostate Cancer Presenting as Solitary Testicular Metastasis on 68Ga-Labeled Prostate-Specific Membrane Antigen Ligand Positron Emission Tomography/Computed Tomography(Lippincott Williams & Wilkins, 2018) Aktas, Gul Ege; Caloglu, Vuslat Yurut; Akdere, Hakan; Tutug, Busem Binboga; Altun, Guelay DurmusProstate adenocarcinoma (PCa) is the most frequently diagnosed malignancy in the male population, with the most common sites for secondary lesions being the lymph nodes, bones, and lungs. Testicular metastases from PCa are very rare and mostly identified incidentally after therapeutic orchiectomy for advanced PCa or during autopsy. Here we present a case involving a 64-year-old man with biochemical recurrence of castrated oligometastatic PCa that presented as solitary testicular metastasis on Ga-68-PSMA ligand positron emission tomography/computed tomography.Öğe A Case Report: Fournier’S Gangrene in a Patient With Type-1 Diabetes Mellitus(Trakya Üniversitesi, 2015) Emin, Ahmet; Dokuz, Oktay; Köksal, Cemal; Yıldız, Ali; Akdere, HakanAims: Fournier’s gangrene is a necrotizing fasciitis of the perinea and genital areas. Scrotal Fournier’s gangrene,while being rare, is an urological emergency and requires urgent surgery. In this case report, we aimed to investigate a patient with Fournier’s Gangrene (FG), caused by a cut to scrotumÖğe Contrary effects of coenzyme Q10 and vitamin E after testicular ischemia/reperfusion in a rat model validated with glucose metabolism imaging(Sage Publications Ltd, 2021) Arda, Ersan; Yuksel, Ilkan; Akdere, Hakan; Akdeniz, Esra; Yalta, Tulin D.; Aktoz, Tevfik; Altun, Gulay D.Objective: To evaluate the efficacy of antioxidants in cellular-level post-ischemia/reperfusion injury of the testis and to validate these effects with F-18-fluorodeoxyglucose positron emission tomography. Methods: Fifty-six adult male rats were randomly divided into seven groups-Group 1: sham; Group 2: ischemia/reperfusion only group; Group 3: ischemia was induced and vitamin E (100 mg/kg) was administered intraperitoneally 30 min before reperfusion; Group 4: vitamin E was given intraperitoneally without ischemia/reperfusion; Group 5: ischemia was induced and coenzyme Q10 (10 mg/body weight) was administered intraperitoneally 30 min before reperfusion; Group 6: coenzyme Q10 was administered intraperitoneally without ischemia/reperfusion; Group 7: ischemia was induced and coenzyme Q10 + vitamin E was administered intraperitoneally 30 min before reperfusion. After detorsion, fluorodeoxyglucose was applied to all groups according to the animals' weight and fluorodeoxyglucose positron emission tomography was performed after 1 h. In pursuit of imaging, orchiectomy was performed for histopathological and biochemical evaluations. Results: A significant effect of group on catalase, maximum standardized uptake value, and seminiferous tubule diameters (p < 0.005) was observed. According to this, combining ischemia/reperfusion with vitamin E increased the maximum standardized uptake value significantly higher than in all other groups; in addition, catalase was significantly higher than in Groups 4-6. Histopathological outcomes revealed that sham had significantly larger seminiferous tubule diameter than Groups 2-4. Also, ischemia/reperfusion was the only group which had significantly smaller seminiferous tubule diameters than Groups 6 and 7. Conclusion: In contrast to vitamin E, coenzyme Q10 provided remarkable regression of oxidative stress-induced enzymes and revealed consistent effects on histopathological outcomes, which were validated with fluorodeoxyglucose positron emission tomography imaging.Öğe Correlation of Ultrasonically Determined Bladder Wall Thickness and Prostatic Calcification With the Urinary, Psychosocial Dysfunction, Organ Specific, Infection and Neurological/Systemic Symptoms, and Tenderness Scoring System(Elsevier Science Inc, 2019) Arda, Ersan; Cakiroglu, Basri; Akdeniz, Esra; Akdere, Hakan; Yuksel, Ilkan; Senturk, Aykut B.OBJECTIVE To evaluate ultrasonically determined bladder wall thickness (BWT) and prostatic calcification presence, in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and to correlate the findings with patient characteristics and the urinary, psychosocial dysfunction, organ specific, infection and neurological/systemic symptoms, and tenderness (UPOINT) classification system. MATERIAL AND METHODS Between January 2008 and December 2017, data of 1294 patients diagnosed with chronic prostatitis, in a single urology clinic, meeting a number of selective inclusion/exclusion criteria, were retrospectively analyzed. Patients, compliant to fill out all requested questionnaires, between the ages of 21-65 years were included to the study. Exclusion criteria were noncompliance of filling out required questionnaires, acute and/or chronic bacterial prostatitis, history of genitourinary cancer, history of recent prostate surgery, and diagnosis of neurological diseases affecting the bladder. RESULTS The median patient age and UPOINT subdomain was determined as 37 (IQR = 13, range 21-65) and 2 (IQR = 1, range 0-5), respectively. Median values for BWT, National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function were 3 (IQR = 1, range 2-6, 7), 4 (IQR = 6, range 1-23), and 25 (IQR = 10, range 1-30), respectively. The presence of calcification demonstrated a significant association with total NIH-CPSI score and BWT, whereas its relation with age and total UPOINT score was insignificant. However in contrast to calcification status, BWT >= 3.3 showed a strong and statistically significant relation to all the described measurements. CONCLUSION Measurement of BWT can be used as an accessible and objective method for the diagnose of CP/CPPS according to UPOINT scoring system. (C) 2018 Elsevier Inc.Öğe Does Mild Hydronephrosis Induced by Full-Bladder Improve Outcomes in Patients Undergoing Shock Wave Lithotripsy for Lower Calyceal Stones?: A Prospective Randomized Study(Urol & Nephrol Res Ctr-Unrc, 2018) Hazar, Ismet Aydin; Cakiroglu, Basri; Sinanoglu, Orhun; Akgun, Feride Sinem; Arda, Ersan; Yuksel, Ilkan; Akdere, HakanPurpose: To compare the outcomes, sessions and shock wave numbers in patients undergoing standard procedure shock wave lithotripsy (SWL) and patients undergoing SWL with mild hydronephrosis induced by full-bladder following oral hydration before SWL procedure for lower calyceal stones. Materials and Methods: Between January 2014-January 2016 a total of 371 patients who underwent SWL, for lower pole calyceal stones 2 cm, were included into the study. 127 patients were treated in the supine position (Group A), 123 in the prone position (Group B) and 121 in the prone position with full bladder and mild hydronephrosis checked by ultrasound before procedure (Group C). There were 286 men and 85 women with a mean SD age of 36 11 years Results: The mean (SD) stone sizes within the group A, group B and group C were 11 mm (+/- 3 mm), 12 mm (+/- 4.1 mm) and 11 mm ( +/- 3.8 mm) respectively. No significant difference was found in age (P =.18) and stone size between 3 groups (P =.07). The median interquartile range (IQR) number of shocks within the group A, group B and group C were 7600 (3855), 6500 (4300) and 6700 (4915) respectively. Significant difference was found in number of shock waves among 3 groups (P <.01). The difference between groups according to stone expulsion rate was found significant in all sessions (P =.01). Conclusion: The present study suggests that mild hydronephrotic status induced by full-bladder before SWL can lower cost and patient discomfort by decrease in number of sessions and increase in stone clearance.Öğe The Effectiveness of 3-D Computed Tomography in the Evaluation of Penile Deformities in Patients With Peyronie's Disease: A Pilot Study(Elsevier Sci Ltd, 2019) Ozmez, Abdulkadir; Ortac, Mazhar; Cevik, Gokhan; Akdere, Hakan; Bakir, Baris; Kadioglu, AtesBackground: 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 autophotography, 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 degrees (0 degrees-80 degrees), 40 degrees (0 degrees-90 degrees), and 34 degrees (0 degrees-80 degrees), 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. Copyright (C) 2019, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.Öğe Embarking with laparoscopic radical prostatectomy and dealing with the complications and collateral problems: A single-center experience(Aves, 2020) Akdere, Hakan; Aktoz, Tevfik; Arikan, Mehmet Gurkan; Atakan, Irfan Huseyin; Veneziano, Domenico; Gozen, Ali SerdarObjective: The aim of the present study was to report our single-center initial experience in laparoscopic radical prostatectomy (LRP) with special emphasis on the complications and collateral problems and their management. Material and methods: A total of 48 patients (mean age 64 years) underwent LRP in our institution between August 2014 and July 2018. Two surgeons completed a fellowship training program for LRP before. Mentored operations started after the first 10 cases. The patients were divided in two groups of 30 (group I) and 18 (group II) patients. Demographic, preoperative, peroperative, and postoperative data were collected prospectively. Anesthesiology and nurses' team performances, as well as problems and their management, were reviewed. Results: The demographic data for both groups (group I vs. group II) were similar. Estimated blood loss (695.5 +/- 139.23 vs. 398 +/- 339.39 mL) and intraoperative complication rates (36.66% vs. 5.55%) were significantly (p<0.05) higher in group I. Conversion to open surgery occurred in 7 (20%) patients in group I and in 1 (5.55%) patient in group II. Continence rates at 12 (83%) months were similar in both groups. Positive surgical margins were 8.33% for pT2 and 27.1% for pT3 stages. Conclusion: A validated fellowship program before starting LRP and performing the first cases under mentorship are helpful. The complication and conversion rates decrease after 30 cases in addition to the improved experience also with improved cooperation with the anesthesiologist and scrub nurse.Öğe Emergency management of ureteral stones: Evaluation of two different approaches with an emphasis on patients' life quality(Pagepress Publ, 2016) Sarica, Kemal; Eryildirim, Bilal; Sahin, Cahit; Turkoglu, Ozlem Kolcak; Tuncer, Murat; Coskun, Alper; Akdere, HakanObjectives: To evaluate the emergency management of obstructing ureteral calculi with two different techniques (SWL and URS) with an emphasis on patients life quality. Methods: A total of 80 patients presenting with acute colic pain due to a single obstructing ureteral stone were treated within 24 hours following the onset of pain with two different approaches in a randomized manner. Patients requiring DJ stent placement and/or auxiliary measures after both procedures were excluded and the remaining 65 patients were evaluated [Group1: ESWL (n = 34); Group 2: URS (n = 31)]. Patients were followed during 4-weeks period with respect to the analgesic requirement, number of renal colic attacks and emergency department visits along with the HRQOL scores. Results: While 26 patients treated with URS (83.9%) were stone-free, 24 cases in SWL were stone-free (70.6%) after 4 weeks. Evaluation of the cases during this follow-up period demonstrated that cases undergoing SWL required significantly higher amount of analgesics when compared with URS group (p < 0.001). In addition to the lower mean number of renal colic attacks and emergency department visits in URS group; both the mean HRQOL in terms of EQ-5D index and mean EQ-5D VAS values were also significantly higher in these cases when compared with the cases tretaed with SWL. Conclusions: Due to the negative impact of stone related events after emergency SWL on patients HRQOL, emergency URS may be applied more effectively with the advantages of prompt fragmentation of the calculi along with the immediate relief of obstruction and pain.Öğe Hypergonadotropic Hypogonadism: Management of Infertility(Bentham Science Publ Ltd, 2021) Kalkanli, Arif; Akdere, Hakan; Cevik, Gokhan; Salabas, Emre; Cilesiz, Nusret Can; Kadioglu, AtesBackground: Medical treatments are used either alone or in combination with assisted reproductive techniques for the treatment of infertile patients with hypergonadotropic hypogonadism. A wide range of treatment options such as gonadotropins, aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs) and their combination are available as options. Objective: The aim of this review was to evaluate treatment options for infertile men with hypergonadotropic hypogonadism. Methods: A literature search of MEDLINE (1980-2019) was conducted using the terms 'hypogonadism', 'male infertility', 'gonadotropins', 'SERMs' and 'AIs'. Pathologies leading to hypergonadotropic hypogonadism and treatment modalities such as gonadotropins, SERMs, AIs and surgical treatment were discussed. Results: FSH increases spontaneous pregnancy rates but the level of evidence was proven to be low for live birth rates. AIs are valid treatment options for patients with low T/E2 ratio as they significantly increase sperm concentrations. SERMs are recommended for infertile males with a sperm concentration between 10-20 million. Varicocele was reported to increase testosterone levels of hypogonadic infertile males. Conclusion: Medical treatment modalities such as gonadotropins, SERMs, AIs and a combination of these therapies has been showed to have some effect in improvement of fertility but is not mainstream of the treatment.Öğe Impact of venous tumour thrombus consistency (solid vs friable) on cancer-specific survival in patients with renal cell carcinoma(Galenos Yayincilik, 2012) Akdere, Hakan; Kuyumcuoglu, UgurBackground: To our knowledge, the impact of venous tumour thrombus (VTT) consistency in patients affected by renal cell carcinoma (RCC) has never been addressed. To analyse the effect of VTT consistency on cancer-specific survival (CSS). Methods: We retrospectively analysed 174 consecutive patients with RCC and renal vein or vena cava inferior (VCI) VTT who underwent surgical treatment between 1989 and 2007 at our institute. All patients underwent radical nephrectomy and thrombectomy. Pathologic specimens were reviewed by a single uropathologist. In addition to traditional pathologic features, the morphologic aspect of the tumour thrombus was evaluated to distinguish solid from friable patterns. The prognostic role of thrombus consistency (solid vs friable) on CSS was assessed by means of Cox regression models. Results: The VTT was solid in 107 patients (61.5 %) and friable in 67 patients (38.5 %). The presence of a friable VTT increased the risk of having synchronous nodal or distant metastases, higher tumour grade, higher pathologic stage, and simultaneous perinephric fat invasion (all p < 0.05). The median follow-up was 24 mo. The median CSS was 33 mo; the median CSS was 8 mo in patients with a friable VTT and 55 mo in patients with a solid VTT (p<0.001). On multivariable analyses, the presence of a friable VTT was an independent predictor of CSS (p=0.02). The power of our conclusion may be somewhat limited by the relatively small study population and the retrospective nature of the study. Conclusions: In patients with RCC and VTT, the presence of a friable thrombus is an independent predictor of CSS. If our finding is confirmed by further studies, the consistency of the tumour thrombus should be introduced into routine pathologic reports to provide better patient risk stratification.Öğe İnsan Papilloma Virüsü ve Mesane Kanseri İlişkisi(2017) Akdere, Hakan; Taştekin, Ebru; İnci, Osmanİnsan papilloma virüsü (HPV), 170'ten fazla tipi bulunan bir DNA virüsüdür. HPV cinsel bulaşan enfeksiyonlar arasında en yaygın olanıdır ve dünya kanser yükünün %10 kadarının HPV enfeksiyonuna bağlı olduğu sanılmaktadır. Virüsün bazı subgruplarının yaptığı prekanseröz lezyonların invaziv karsinomlara dönüştüğü, serviks, vulva, orofarenks, anüs ve penis kanser etiyolojisindeki yeri bilinmektedir. Anogenital bölgede gözlenen kondilomların üretra, mesane ve üreterde de görüldüğü olgular yayınlanmıştır. Mesane kanseri patogenezindeki yeri ise tartışmalıdır. Yapılan son çalışmalar HPV ile mesane kanseri arasında ilişki olduğunu göstermektedir. Mesanenin skuamöz hücreli karsinomlarının zemininde kondilomların varlığı gösterilmiştir. Bu derlemede literatür eşliğinde HPV-ürotelyal karsinom ve mesanenin skuamöz hücreli karsinomu ilişkisi değerlendirilmeye çalışıldı.Öğe Investigation of the Correlation Between Pelvic Anthropometric Measurements and Penile Length of 250 Turkish Boys Aged 0-5 Years(2016) Akdere, Hakan; Yılmaz, Ali; Arabacı, Özcan; Özdemir, Yavuz; Arda, ErsanAmaç: Çalışmamızda 0-60 ay arası çocukların gerilmiş penis uzunluğu (GPU) ölçüldü ve yaş-boy-kilo-interspinöz mesafe ve pubis yüksekliği gibi antropometrik parametrelerle ilişkisi değerlendirildi. Elde ettiğimiz veriler, benzer diğer literatür çalışmaları ile karşılaştırıldı.Gereç ve Yöntem: Çalışmamız, 0-60 ay yaş arası 250 erkek çocukta yapıldı. Bütün çocukların gerilmiş penis uzunluğu, kilosu, boyu, interspinöz mesafesi ve pubis yüksekliği tek bir ürolog tarafından değerlendirildi. Bu değerlendirmeler optimal poliklinik şartlarında gerçekleştirildi.Bulgular: Çocukların ortalama boyu 55.82±3.22 cm, ortalama vücut ağırlığı 4729.08±54.23 gr, ortalama interspinöz mesafesi 12.757±1.21 cm, ortalama pubis yüksekliği 2.56±0.46 cm, GPU 2.69±0.57 cm olarak ölçüldü. Gerilmiş penis uzunluğu ile çocukların yaşı, ağırlığı, boyu ve interspinöz mesafesi arasında belirgin bir ilişki bulundu (sırasıyla: r=0.240, p=0.001; r=0.242, p=0.001; r=0.204, p=0.006; r=0.224, p=0.002). GPU ve pubis yüksekliği arasında anlamlı bir ilişki bulunmadı (r=0.97, p=0.191).Sonuç: Penis uzunluğundaki anomalileri doğru değerlendirebilmek için yaşa ve ırka özgü ortalama GPU değerleri bilinip, bu veriler göz önünde tutularak muayene yapılmalıdır. Çalışmamız 0-60 ay yaş aralığındaki beyaz ırk çocuklar için güncel referans değerler sağlamıştır. Antropometrik ölçümlerle birlikte değerlendirildiğinde bu veriler klinisyenlere tanı ve tedavi süreci aşamalarında yararlı olabilirÖğe Kalça, diz ve ayak bileği eklemlerinin hareket genişliklerinin ölçümü(Trakya Üniversitesi, 1998) Akdere, Hakan; Mesut, RecepÖZET Araştırmamıza 40 erkek ve 40 bayan toplam kişi dahil edildi. Yaş ortalaması erkeklerde 20.6, bayanlarda 20.4 idi. Sağ ve sol her iki alt ekstremitede kalça, diz ve ayak bileği eklemleri ROM 'u (Eklem hareket genişliği) ölçüldü. Olguların tamamında Elektronik Dijital inklinometre aleti ile ölçüm yapıldı. İki cinste sağ ve sol taraf hareket genişlikleri ortalamaları alındı ve sağ - sol taraf arasında istatistiksel anlamlı fark olup olmadığı araştırıldı. Her iki cinstede tüm hareketlerde anlamlı bir fark olmadığı görüldü. Cinslerin kendi aralarında karşılaştırılmasında diz rotasyon ve ayak bileği dorsal fleksiyon hareketinde genişlikleri ortalamalarında erkekler lehine fark saptadık. Elde edilen verileri literatürdeki diğer örnekleriyle, A.A.O.S'nin verileri ve klasik anatomi kaynaklarındaki değerler ile karşılaştırdık. Genel olarak sonuçlarımızın A.A.O.S ve klasik kaynakların verileriyle uyumlu olduğu görüldü. Diğer ülkelerde yapılan benzer çalışmalar ile bizim sonuçlarımız arasında ciddi farklar mevcuttu. Bu farkların kullanılan alet, eklem pozisyonları, yaş gurupları gibi metodolojik farklar yanında, ölçümlerin yapıldığı populasyonlardaki biyolojik farkları ve bu populasyonladaki günlük aktivite değişikliklerine bağlı olduğu kanısındayız. 73