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Öğe Combined periprostatic and intraprostatic local anesthesia for prostate biopsy: A double-blind, placebo controlled, randomized trial(Elsevier Science Inc, 2008) Çam, Kamil; Şener, Murat; Kayıkçı, Ali; Akman, Yavuz; Erol, AliPurpose: Transrectal ultrasonography guided prostate biopsy is the principle procedure in the histological diagnosis of prostate cancer. Recently a trend toward increasing the number of cores has been popularized. This practice further increases the need for a proper anesthetic application. However, there is no consensus on a standard local anesthetic strategy, while groups at most institutions currently prefer periprostatic anesthesia. We prospectively evaluated the contribution of intraprostatic anesthesia for transrectal prostate biopsies even when the sampling number was doubled to 12 cores. Materials and Methods: A total of 200 patients who underwent prostate biopsy with transrectal ultrasound guidance were included. The 2 groups received the usual periprostatic anesthesia. Consequently patients were prospectively randomized into 2 groups. Group 1 received additional intraprostatic lidocaine injection, while group 2 received the same amount of injection of 0.9% NaCl. The efficiency of applied local anesthesia was assessed by a visual analog pain scale. Results: The study groups were comparable regarding patient age, prostate size and cancer rate. Pain scores revealed that the combination of intraprostatic and periprostatic local anesthesia provided significantly better pain control than periprostatic infiltration alone. No difference was observed regarding the morbidity rate in the 2 groups. Conclusions: The current study suggested that adding intraprostatic local anesthesia provides a significantly efficient strategy during transrectal ultrasound prostate biopsy, even in cases of 12-core sampling. Subsequent trials are needed to establish a standard analgesia policy for prostate biopsy.Öğe Contemporary approach in the medical treatment for benign prostatic hyperplasia(2003) Çiçekçi, B.; Çam, Kamil; Akman, Yavuz; Erol, AliBenign prostatic hyperplasia (BPH) contemporarily constitutes one of the major public health problems as its incidence increases with aging. Surgical treatment modalities were the main stay in the management of BPH. However, several medical treatment alternatives have been developed and extensively utilised especially during the last decade. Consequently, medical treatment alternatives have decreased the number of surgeries for BPH all over the world. In this review, current medical treatment approaches in the management of BPH were discussed.Öğe The effect of extracorporeal shock wave lithotripsy on the rat spinal cord(Nature Publishing Group, 2008) Karataş, Anıl; Döşoğlu, Murat; Zeyrek, T.; Kayıkçı, A.; Erol, Ali; Can, BelginStudy design: Experimental study. Objectives: To determine the effects of extracorporeal shock wave lithotripsy (ESWL) on the rat spinal cord. Methods: Animals were randomly divided into three groups. Groups 1 and 2 consisted of five rats each that underwent ESWL (2000 impulses at 15 kV and 2000 impulses at 18 kV, respectively) and group 3 contained five control rats (no shock wave treatment). ESWL-treated and control rats were compared with regard to light and electron microscopic findings of the adjacent spinal cord. Results: Gross neurological outcomes were normal in all groups. Light microscopic examination of group 1 showed extensive extravasation of red blood cells over all the interstitial spaces. Group 2 also had haemorrhagic areas and an irregular organization of axons in the white matter. Transmission electron microscopic examination of group 1 indicated extravasated red blood cells through the endothelium and swollen axoplasm, degenerated mitochondria, destruction of myelin sheaths and a slight increase in the number of lysosomes. Extravasated red blood cells were also seen in group 2. The axoplasmic mitochondria were enlarged, but no sign of mitochondrial degeneration was observed. Lamellar degeneration of myelin sheaths and abundant lysosomes were more predominant in group 2 than in group 1. Conclusion: Extracorporeal shock wave lithotripsy caused not only haemorrhage but also damage to neuronal structures except the nucleus. Our findings showed that higher-energy ESWL caused more myelin degeneration in the spinal cord.Öğe High Power Diode Laser Vaporization of the Prostate: Preliminary Results for Benign Prostatic Hyperplasia(Elsevier Science Inc, 2009) Erol, Ali; Çam, Kamil; Tekin, Ali; Memik, Ömür; Çoban, Soner; Özer, YavuzPurpose: Vaporization techniques using lasers have gained wide acceptance for benign prostatic hyperplasia as an alternative to transurethral prostate resection. The high power, 980 nm wavelength diode laser is a new promising alternative with a more rapid ablation rate and excellent hemostatic properties, as shown in ex vivo and in vivo animal models. We prospectively evaluated vaporization efficiency of the high power, 980 nm diode laser for bladder outlet obstruction due to benign prostatic hyperplasia. Materials and Methods: A total of 47 consecutive patients were included in the study. Inclusion criteria were maximal flow rate 12 ml per second or less with voided volume 150 ml or greater, International Prostate Symptom Score 12 or greater and quality of life score 3 or greater. Patients with a history of neurogenic voiding dysfunction, chronic prostatitis, or prostate or bladder cancer were excluded from analysis. Preoperative maximal flow rate, post-void residual urine, International Prostate Symptom Score, quality of life, International Index of Erectile Function-5, prostate specific antigen and prostate volume were compared with values at 3 and 6 months. Complications were assessed. Results: Month 3 assessment revealed that the mean +/- SD International Prostate Symptom Score decreased significantly from 21.93 +/- 4.88 to 10.31 +/- 3.79 (p = 0.0001). The mean maximal flow rate increased significantly from 8.87 +/- 2.18 to 17.51 +/- 4.09 ml per second (p = 0.0001). Quality of life score changed considerably compared to baseline. All of these values showed slight improvement at month 6. There was no deterioration in erectile function according to the International Index of Erectile Function-5 short form. Post-void residual urine decreased significantly. Prostate volume and prostate specific antigen reductions were also significant. The most common postoperative complications were retrograde ejaculation (13 of 41 patients or 31.7%) and irritative symptoms (11 of 47 or 23.4%), which subsided in the maximal flow rate at 2 weeks. Recatheterization was necessary in 2 patients due to urinary retention after catheter removal. Two patients had temporary combined urge and stress incontinence for 2 weeks. Late bleeding in 1 patient 4 weeks postoperatively necessitated catheterization and irrigation. Conclusions: The high power diode laser provided significant improvements in International Prostate Symptom Score and the maximal flow rate with low morbidity. Thus, these results of prostate vaporization with the high power diode laser, representing what is to our knowledge the first clinical study in the literature, are encouraging.Öğe Prospective assessment of the efficacy of single dose versus traditional 3-day antimicrobial prophylaxis in 12-core transrectal prostate biopsy(Wiley, 2008) Çam, Kamil; Kayıkçı, Ali; Akman, Yavuz; Erol, AliObjectives: To prospectively evaluate the efficacy of single dose antibiotic prophylaxis in 12-core transrectal ultrasonography (TRUS) guided prostate biopsy. Methods: A total of 400 patients who underwent prostate biopsy with TRUS guidance were included. The patients were prospectively randomized in three groups regarding antibiotic prophylaxis. The first group (139 patients) received a single gram of intramuscular ceftriaxone, while the second group (131 patients) had a 3-day course of oral ciprofloxacin. The third group (130 patients) had single oral 500 mg of ciprofloxacin. All patients had urine cultures prior to biopsy and on the second day after biopsy. Results: The study groups were compared in terms of the results of urine cultures and clinical parameters. Overall, only seven patients (1.8% of the cases) had positive urine cultures with no difference between these three groups. Additionally, no significant difference was observed regarding morbidity rates in all groups. Only eight patients (2%) developed major complications requiring hospitalization. There was no increase in the rate of infectious complications when the biopsy core numbers were increased up to 12. Conclusions: The current study suggests that a single oral dose of antimicrobial prophylaxis is reasonable in TRUS prostate biopsy even in the case of 12-core sampling.Öğe Prospective evaluation of the efficacy of antibiotic prophylaxis before cystoscopy(2009) Çam, Kamil; Kayıkçı, Ali; Erol, AliBackground: The aim of this study was to prospectively compare single-dose intravenous antibiotic prophylaxis vs. no prophylaxis before minor cystoscopic procedures, including punch biopsy and transurethral resection (TUR) of small bladder tumors. Materials and Methods: A total of 200 patients with a mean age of 47.3 years old (range: 19-84 years old) with initial negative urine cultures were recruited. All patients underwent a diagnostic cystoscopy. Patients were then randomized into 2 groups: o0 ne group that did not receive antibiotics (100 patients) and the other group that received antibiotic treatment (100 patients with a single intravenous dose of cefoperazone). All patients had urine analysis and urine cultures on the second day after the operation. Additionally, clinical parameters including fever and dysuria were recorded. In 15% of the patients, incidental additional interventions such as punch biopsy or TUR of a small bladder tumor that were similarly distributed in both groups were performed. Results: In 1 patient from the antibiotic group and 2 patients from the no prophylaxis group, the urine cultures after cystoscopy were positive. No statistically significant difference was observed between these groups based on the microbiological and clinical parameters. Conclusion: The current study provides evidence that no antibiotic prophylaxis is required before diagnostic cystoscopy in patients without bacteriuria. But, the absolute risk of infection was small, suggesting that a much larger study is required.Öğe The ratio of external genital anomalies in male children attending primary school in Düzce(2005) Kayıkçı, Muhammet Ali; Çam, Kamil; Akman, Yavuz; Erol, AliIntroduction: The aim of the study was to identify the rates of external genital anomalies in male children who are attending primary school in Düzce. Materials and methods: A total of 1534 children out of 13420 male students attending to 25 primary schools in Düzce were included into the study. The age range was between 7 and 16. The same physician examined all students, and external genital anomalies were identified and noted. Results: In this study, a total of 110 (7.2%) anomalies were identified in 104 students. The most common anomalies were varicocele (3.22%), phimosis (1.49%) and undescended testis (1.10%). Conclusion: The rate of external genital anomalies was found to be remarkably high. Actually, almost all of these anomalies had had to be diagnosed and managed before the school ages. Consequently, the results of the current study suggest that there is an insufficient examination and follow up during the neonatal period extending up to school ages. In addition to this, parents do not have any information about these pathologies. Such undiagnosed pathologies will cause significant psychological and urological problems in these children. They may also progress to tumor or infertility. Therefore, this observation should be regarded as an important public health issue.Öğe Short-term subjective efficacy of doxazosin in predicting probability of prostatectomy in the management of benign prostatic hyperplasia in patients with severe symptoms(Blackwell Publishing Asia, 2003) Çam, Kamil; Akman, Ramazan Yavuz; Kayıkçı, Ali; Şenel, Ferda; Erol, AliBackground. The severity of symptoms still constitutes the major indication for transurethral prostatectomy, despite the extensive utilization of medical treatments. The aim of the study presented here was to investigate the impact of doxazosin on symptoms in relation to the probability of consequent surgery in severely symptomatic patients. Methods. Patients with an International Prostate Symptom Score (IPSS) between 18 and 35 were included in the study. The patients received 4 mg/day doxazosin, and subjective efficacy was assessed by IPSS at the first and third months. In addition, the patients were classified at the third month according to a single question regarding satisfaction with medical treatment in terms of symptom relief as 'ineffective, no change, and effective'. Results. A total of 178 patients constituted the study group. Mean total symptom scores were 24, 19 and 17 at baseline, first and third months, respectively (P < 0.05). According to results of the questionnaire, 23% of the patients claimed the treatment was ineffective, and subsequently, the majority of this group (93%) underwent prostatectomy in a year. In addition, 33% of the patients reported no change in their symptoms, while 44% reported that the medication was effective. However, after 1 year, 59% and 15% of these cases underwent surgical treatment, respectively. The probability of surgery in the 'ineffective' group was significantly higher compared to the remaining groups (P < 0.05). Conclusion. The majority of patients with severe symptoms who were not satisfied with the medication at the 3rd month underwent surgery. This observation may provide a predictor for subsequent probability of prostatectomy. Therefore, reassessment of patients would be a cost-effective approach for the treatment of BPH in severely symptomatic patients.Öğe Single vs. Double Dartos Interposition Flaps in Preventing Urethrocutaneous Fistula after Tubularized Incised Plate Urethroplasty in Primary Distal Hypospadias: A Prospective Randomized Study(Karger, 2009) Erol, Ali; Kayıkçı, Ali; Memik, Ömür; Çam, Kamil; Akman, YavuzIntroduction: This prospective study was designed to compare symmetrical overlapping double flaps with a single dartos flap in regard to fistula formation as an adjunct to tubularized incised plate urethroplasty (TIPU). Patients and Methods: 77 consecutive children with primary coronal or subcoronal hypospadias were randomized into 2 groups. A single layer dartos flap was used to cover the anastomotic site in the first group (37 patients). A wider dorsal dartos flap bisectioned in the midline was utilized in the second group of 40 patients. The complication rates were compared. Results: There was no difference between the 2 groups in terms of age, and meatal location. Postoperative median follow-up was 34 months. Urethrocutaneous fistula occurred in 3 patients (8.1%) of the monolayer group. No fistula developed in the second group with double flaps. Conclusions: The current study proposes that the use of double dorsal flaps, although statistically not significant, better prevents fistula formation compared to monolayer dartos flaps following TIPU operation. Copyright (C) 2009 S. Karger AG, BaselÖğe Surgical treatment alternatives in the management of benign prostatic hyperplasia [Selim prostat hiperplazisinde cerrahi tedavi seçenekleri](2003) Kayıkçı, Muhammet Ali; Çam, Kamil; Akman, Yavuz; Erol, AliBenign prostatic hyperplasia (BPH) contemporarily constitutes a major public health problem especially in developed countries as its incidence increases with aging. Although several medical treatment alternatives have been developed, surgical management still provides the most successful clinical outcome. Trans-urethral prostate resection (TUR-P) is accepted as the gold standard in the management of BPH. However, in considering the relatively high rate of morbidity of TUR-P, several minimally invasive surgical treatment alternatives have been developed. In this review, we discussed the surgical treatment alternatives in the management of BPH.Öğe Tartişmali Olgu(2008) Erol, Ali; Tekin, Ali; Çam, Haydar Kamil; Akman, Ramazan Yavuz[No abstract available]
