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Öğe Association between simple renal cysts and frequency of hypertension in patients with microscopic hematuria(Duzce University Medical School, 2018) Yüksel, Alpaslan; Mutlu, AslıAim: Simple renal cyst is the most common cystic formation in adults. The relationship between simple renal cyst and hypertension incidence is still controversial. In this study it is aimed to determine any association between simple renal cyst and frequency of hypertension in patients with microscopic hematuria. Material and Methods: The study was designed by reviewing results of 200 patients with ages between 51 and 89 retrospectively and creating two groups, among 1075 patients who had undergone abdominal ultrasonography and abdominal computer tomography due to microscopic hematuria. The patients were evaluated into two groups regarding presence of simple renal cyst or not. The relationship between simple renal cyst and hypertension was analyzed. Results: There is no significant difference between two groups according to demographic features such as age and gender. Hypertension rate was not differ significantly between the simple renal cyst group and control group (p=0.471). It was detected that cyst size, presence of multiple cysts, cysts at more than one location and bilateral cysts were increased the hypertension rate in addition to age in patients with simple renal cyst (all p values <0.001). Cut-off level of cyst size for hypertension diagnosis was determined as ?2 cm (AUC=0.949, 95% GA=0.903-0.995, p<0.001). Conclusion: As a result, we found a significant association between frequency of hypertension and presence of 2 cm and greater simple renal cysts, presence of multiple cysts and presence of bilateral cysts. Further prospective researches are required to determine the reason and the necessary management. © 2018, Duzce University Medical School. All rights reserved.Öğe The Comparison of Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsies with Conventional Transrectal Biopsies in Prostate Cancer Detection(Galenos Yayincilik, 2021) Baba, Dursun; Balık, Ahmet Yıldırım; Yüksel, Alpaslan; Şenoğlu, YusufObjective: The conventional technique for histological prostate cancer diagnosis is transrectal ultrasound (TRUS)-guided random sampling of the peripheral prostate zone. However, due to method insufficiency and recent developments in prostate imaging, new biopsy methods were introduced. This study aimed to evaluate prostate cancer detection rates by the standard and magnetic resonance (MR) fusion biopsy methods. The main purpose of our study is to mutually evaluate prostate cancer detection rates and results of standard and cognitive MR fusion biopsy methods and share our experiences in this process. Materials and Methods: Patients, who underwent prostate biopsy due to elevated serum prostate-specific antigen levels (>4ng/mL) and/or suspicious rectal examination, were retrospectively evaluated. A total of 160 patients were included in the study between January 2018 and January 2021. Patients were divided into two groups according to the applied method, as standard biopsy (SB) and MR fusion biopsy. Results: Prostate cancer was reported in 25 (31.3%) of 80 patients who underwent SB, wherein 20 (25%) were determined with clinically significant cancer. Prostate cancer was reported in 30 (37.5%) of 80 patients who underwent MR fusion biopsy, wherein 25 (31%) were reported as clinically significant cancer. A statistically significant difference was found in detecting prostate cancer and clinically significant prostate cancer when the prostate imaging-Reporting and Data System (3,4,5) scores were compared with each other (p<0.05, p=0.00). The additional SB to MR-targeted fusion biopsy was statistically significant in prostate cancer diagnosis (p=0.01, p<0.05). Conclusion: The additional SB to targeted biopsy increased the detection rate of clinically significant prostate cancer. Larger randomized studies are needed to reach a consensus on the ideal biopsy technique.Öğe Comparison of Systematic, Targeted and Combined Prostate Biopsy: Our Clinical Outcomes(Galenos Yayincilik, 2022) Şenoğlu, Yusuf; Taşkıran, Arda Taşkın; Yüksel, Alpaslan; Baba, DursunObjective: Our aim was to compare the diagnostic efficacy of the standard systematic, targeted and combined prostate biopsy methods in prostate cancer. Materials and Methods: Total of 161 patients who underwent prostate biopsy combined with magnetic resonance imaging-ultrasonography fusion method between August 2018 and March 2021 was evaluated retrospectively. Clinically important and insignificant cancer detection rates of biopsy results between standard, targeted and combined biopsy (CB) methods were compared. Changes in the results were also evaluated in terms of Prostate Imaging-Reporting and Data System (PIRADS) scores. Results: Prostate cancer was diagnosed in 46 (28.6%) patients by CB. Fourteen (8.7%) patients were interpreted as a clinically insignificant disease. Prostate cancer and clinically significant disease detection rates were statistically significant in favor of CB compared to targeted biopsy (TB). There was no statistically significant difference between systematic biopsy and TB results. Additionally, it was observed that cancer detection rates were higher in PIRADS o4 lesions compared to PIRADS 3 lesions in all biopsy methods. Conclusions: Our results have shown that combined prostate biopsy led to higher detection of prostate cancer and provides increased detection of clinically significant disease. High rates of clinically significant cancer, especially in patients with PIRADS o4 lesions, suggest that the PIRADS scoring is a high-level guide in detecting malignancy.Öğe Comparison of Systematic, Targeted and Combined Prostate Biopsy: Our Clinical Outcomes(2022) Şenoglu, Yusuf; Taşkıran, Arda Taşkın; Yüksel, Alpaslan; Baba, DursunObjective: Our aim was to compare the diagnostic efficacy of the standard systematic, targeted and combined prostate biopsy methods in prostate cancer. Materials and Methods: Total of 161 patients who underwent prostate biopsy combined with magnetic resonance imaging-ultrasonography fusion method between August 2018 and March 2021 was evaluated retrospectively. Clinically important and insignificant cancer detection rates of biopsy results between standard, targeted and combined biopsy (CB) methods were compared. Changes in the results were also evaluated in terms of Prostate Imaging-Reporting and Data System (PIRADS) scores. Results: Prostate cancer was diagnosed in 46 (28.6%) patients by CB. Fourteen (8.7%) patients were interpreted as a clinically insignificant disease. Prostate cancer and clinically significant disease detection rates were statistically significant in favor of CB compared to targeted biopsy (TB). There was no statistically significant difference between systematic biopsy and TB results. Additionally, it was observed that cancer detection rates were higher in PIRADS ?4 lesions compared to PIRADS 3 lesions in all biopsy methods. Conclusions: Our results have shown that combined prostate biopsy led to higher detection of prostate cancer and provides increased detection of clinically significant disease. High rates of clinically significant cancer, especially in patients with PIRADS ?4 lesions, suggest that the PIRADS scoring is a high-level guide in detecting malignancy.Öğe The Current Approach for Small Adrenal Masses(Galenos Publ House, 2022) Şenoğlu, Yusuf; Balık, Ahmet Yıldırım; Ediz, Emre; Yüksel, Alpaslan; Baba, DursunAdrenal tumors originate from the medulla or cortex of the adrenal gland and may be benign or malignant, functional or non-functional. Adrenal tumors discovered during imaging for non-adrenal indications are called incidentalomas and are more common than non-incidental masses. Most incidentalomas are hormonally inactive and benign. Adrenal masses are approximately 30-35 mm in diameter at the time of diagnosis. While masses less than 4 cm are generally considered to be small masses, they are at lower risk for malignancy than adrenal masses larger than 4 cm. An incidentally detected adrenal mass should be investigated for malignancy and functional activity. Hormonal activity or malignancy of the adrenal mass are indications for surgery. Laparoscopic surgery for adrenal adenomas is the gold standard. Evaluation is important to determine the treatment and follow-up process. Although the frequency of benign small adrenal masses increase with age, even if the mass size is <4 cm in young patients, because of their rarity at this age, a closer follow-up is required. The ideal follow-up schedule for these small masses <4 cm in diameter has not been precisely defined. However, clinical guidelines recommend clinical and hormonal follow-up for at least 4 years, and follow-up imaging [computed tomography (CT), magnetic resonance imaging] 6-12-24 months after the first CT. If the size increase in a followed mass is >0.8 cm/ year, surgery is recommended, but the malignancy rate is low in these masses.Öğe The Current Approach for Small Adrenal Masses(2022) Şenoglu, Yusuf; Balık, Ahmet Yıldırım; Ediz, Emre; Yüksel, Alpaslan; Baba, DursunAdrenal tumors originate from the medulla or cortex of the adrenal gland and may be benign or malignant, functional or non-functional. Adrenal tumors discovered during imaging for non-adrenal indications are called incidentalomas and are more common than non-incidental masses. Most incidentalomas are hormonally inactive and benign. Adrenal masses are approximately 30-35 mm in diameter at the time of diagnosis. While masses less than 4 cm are generally considered to be small masses, they are at lower risk for malignancy than adrenal masses larger than 4 cm. An incidentally detected adrenal mass should be investigated for malignancy and functional activity. Hormonal activity or malignancy of the adrenal mass are indications for surgery. Laparoscopic surgery for adrenal adenomas is the gold standard. Evaluation is important to determine the treatment and follow-up process. Although the frequency of benign small adrenal masses increase with age, even if the mass size is <4 cm in young patients, because of their rarity at this age, a closer follow-up is required. The ideal follow-up schedule for these small masses <4 cm in diameter has not been precisely defined. However, clinical guidelines recommend clinical and hormonal follow-up for at least 4 years, and follow-up imaging [computed tomography (CT), magnetic resonance imaging] 6-12-24 months after the first CT. If the size increase in a followed mass is >0.8 cm/ year, surgery is recommended, but the malignancy rate is low in these masses.Öğe The Efficacy of N-acetylcysteine Against Renal Oxidative Stress After Extracorporeal Shock Wave Treatment: An Experimental Rat Model(2020) Baba, Dursun; Çam, H. Kamil; Şenoğlu, Yusuf; Yüksel, Alpaslan; Erdem, Havva; Başaran, EkremObjective: To evaluate effects of renal extracorporeal shock wave lithotripsy (SWL) on plasma Oxidative Stress index (OSI) and to observehistopathological alterations in an experimental model. Secondly, protective role of N-acetylcysteine (NAC) was investigated.Materials and Methods: A total of 24 rats were randomly divided into 3 groups as control (group 1), SWL + saline (group 2), and SWL + NAC(group 3). Study groups were further divided into two subgroups as short-term and long-term. In groups 2 and 3, 2000 shock waves were applied.Intraperitoneal saline was administered in group 2, and intraperitoneal NAC was given to group 3. No treatment was administered to group 1.Blood samples and nephrectomy specimens were obtained for biochemical and histopathological examinations, respectively. OSI was calculatedby measuring plasma total antioxidant status (TAS) and total oxidant status (TOS). Acute and chronic histopathological damage were evaluated bylight microscopy.Results: SWL caused a remarkable increase in oxidative stress. Strikingly, TOS levels were significantly lower (p=0.027) and TAS levels weresignificantly higher (p=0.006) in rats with SWL + NAC (group 3). As a result, OSI was lower (p=0.013). This effect was particularly significant in theshort-term subgroup. It was also concluded that tubular damage and interstitial inflammation were higher in the SWL group (p=0.022). These acutehistological alterations were slighter in rats with NAC.Conclusion: The current study demonstrated that SWL can cause severe oxidative stress and acute renal damage by increasing free oxygen radicalproduction. NAC was effective in decreasing SWL-induced oxidative stress and preventing certain histological alterations to some extent.Öğe Enflamasyonun Etiyopatogenez ve Tedavi Hedefi Olarak Benign Prostat Hiperplazisindeki Rolü(Galenos Yayincilik, 2015) Tekin, Ali; Yüksel, AlpaslanBenign prostat hiperplazisinin (BPH) etiyopatogenezi henüz tam olarak aydınlatılmamış olmakla birlikte, güncel literatür bilgileri prostatik enflamasyonun etiyolojide önemli olabileceğini ve tedavi hedefi olarak bir potansiyel olabileceğini işaret etmektedir. Sadece prostatik enflamasyonun varlığı değil, aynı zamanda bunun derecesi ve şiddeti, Uluslararası Prostat Semptom Skoru ile yakın ilişkili olup, BPH progresyonunu (semptom artışı, akut üriner retansiyon, cerrahi gerekliliği) belirleyici özelliğe sahiptir. Enflamasyonun hangi mekanizma ile BPH oluşumuna neden olduğu tam olarak aydınlatılmamıştır. Bununla birlikte, yaşlanmaya bağlı immünite zayıflaması ve ortaya çıkan hormonal değişikliklerin rolü olabilir. Oksidatif stres, androjen bağımlı genler ve tümör growth faktör-β1 kaskad genlerinin artışı, prostatik antijenleri görmemeyi sağlayan baskılayıcı hücrelerin azalması, IL-6, IL- 8, IL-15 gibi proenflamatuvar sitokinler ile siklooksigenaz-2 ekspresyonu etkisiyle yıkıcı enflamatuvar hücrelerin infiltrasyonu sonucu gelişen zincirleme olaylar da BPH oluşumuna katkı sağlayabilir. Kanıta dayalı veriler nonsteroid anti-enflamatuvar ilaç kullanımının enflamasyonu baskılayıcı mekanizma üzerinden prostat büyümesini, alt üriner sistem yakınmalarının progresyonunu, idrar akım hızında azalmayı ve prostatspesifik antijen yükselmesini engelleyebileceğini veya geciktirebileceğini göstermektedir. Bunun yanında, D vitamini agonistleri, serenoa repens ve fosfodiesteraz-5 inhibitörlerinin BPH tedavisindeki etkinliklerinin bir kısmından enflamasyonu baskılamaları sorumlu olabilir. Sonuç olarak prostatik enflamasyon BPH patogenezinde ve progresyonunda önemli bir role sahip gibi görünmektedir. Anti-enflamatuvar etkili ilaçların yakın gelecekte BPH’nın medikal tedavisinde daha fazla yer alması beklenmelidir.Öğe Investigation of Factors Affecting the Stone-Free Rate in Elderly Patients with Urinary Stones After Shock Wave Lithotripsy(Duzce University Medical School, 2021) Yüksel, Alpaslan; Baba, Dursun; Şenoğlu, Yusuf; Taşkıran, A.T.Aim: Urinary stone disease is an important disease seen in all age groups, including elderly patients. It can cause kidney failure and urinary infection problems. Shock wave therapy, which is the minimal invasive among the different treatment alternatives, is preferred for kidney and proximal ureteral stones smaller than 2 cm. Studies on the efficacy and safety of this treatment in elderly patients are limited. This study aimed to investigate the factors affecting the stone-free rate (SFR) in elderly patients with urinary stones after shock wave lithotripsy. Material and Methods: The data of 120 patients in the Urology department of Duzce University Faculty of Medicine between 2010 and 2018 over 65 years old who underwent extracorporeal shock wave lithotripsy (ESWL) for urinary system stone disease were evaluated retrospectively. The data obtained from these patients included sex, age, location of the stone (upper, middle, or lower calyx, renal pelvis, ureter), number of shock waves, stone size, and the need for the auxiliary procedure were analyzed. Results: Of the 120 patients, 82 (68.3%) were male and 38 (31.7%) were female. Comorbidity was present in 49 patients. An overall SFR of 65.8% (n=79) was found. The highest SFR was found in middle calyx stones with 79.3% (23 of the 29 patients). Post-ESWL auxiliary procedures were needed in 36 (30%) patients. Two patients developed subcapsular renal hematoma and pyelonephritis. Conclusion: ESWL is an appropriate even the first option for elder male with favorable stone size. Furthermore, ESWL caused acceptable morbidity in older patients. © 2021, Duzce University Medical School. All rights reserved.Öğe Post-Prostatic Massage Examination for Prediction of Asymptomatic Prostatitis in Needle Biopsies: A Prospective Study(Elsevier Science Inc, 2009) Tekin, Ali; Yüksel, Alpaslan; Tekin, Soner; Gümrükçü, Gülistan; Aslan, Ahmet Rüknettin; Şengör, FeridunPurpose: Although asymptomatic prostatitis is the most common noneancer diagnosis as demonstrated histologically by biopsies, screening and identification before biopsy remain unclear. In this study we prospectively evaluate the efficacy of examination of post-prostatic massage urine for prediction of asymptomatic prostatitis in biopsies. Materials and Methods: A total of 161 consecutive men 50 to 80 years old with serum prostate specific antigen 4.1 to 10.0 ng/ml, normal digital rectal examination, no evidence of clinical prostatitis or urinary tract infection, who underwent 8 or 10-core prostate biopsies under transrectal ultrasonography guidance were included in the study. Immediate pre-biopsy leukocyte count in post-prostatic massage urine was determined per high power field (400 X). We selected 5, 7 and 10 leukocytes per high power field as cutoffs, and urine was examined for prediction of histological prostatitis. Results: Histological diagnosis was prostatitis, benign prostatic hyperplasia and prostate cancer in 66 (41.0%), 63 (39.1%) and 32 (19.9%) patients, respectively. The mean number of leukocytes and percentage of positive post-prostatic massage urine microscopy for all cutoffs were significantly higher in subjects with prostatitis than in those without prostatitis (p<0.0001). Histological prostatitis was predicted most accurately by the 5 leukocyte cutoff (sensitivity 68.2%, specificity 82.1% and area under the receiver operating characteristics curve 0.75). Conclusions: In asymptomatic men with mild increases of prostate specific antigen histological evidence of prostatic inflammation is common. The leukocyte count in post-prostatic massage urine appears to be useful for screening of this condition before biopsy. Our data suggest that 10 leukocytes per high power field in post-prostatic massage urine, the usually applied cutoff, may be too high for the definition of prostatic inflammation.Öğe Prostatik Üretral Askı Yöntemi: Benign Prostat Hiperplazisi Tedavisinde Yeni Bir Minimal İnvaziv Tedavi Alternatifi(Galenos Yayincilik, 2016) Yüksel, Alpaslan; Tekin, AliImprovements in the treatment of benign prostatic hyperplasia (BPH), which is the most common cause of lower urinary tract symptoms in aging males, are proceeding progressively. The prostatic urethral lift procedure offers a novel treatment option for men with lower urinary tract obstructive symptoms due to BPH. The prostatic urethral lift can be performed under general, regional and local anesthesia. The procedure shows its effect by retracting the obstructing lobes of the prostate through the capsule to provide a sufficient prostatic urethral opening. It is important to offer an alternative option to the patients who feel anxiety about sexual function loss and complications of the procedure. However, short follow-up period, necessity of suitable conditions, such as lack of median lobe or unremarkable post-voiding residual urine, and lack of cost-effectiveness analysis of the procedure are the limitations of this method. In this review, symptomatic, functional, and sexual outcomes following the prostatic urethral lift procedure were assessedÖğe Prostatik Üretral Askı Yöntemi: Benign Prostat Hiperplazisi Tedavisinde Yeni Bir Minimal İnvaziv Tedavi Alternatifi(2016) Yüksel, Alpaslan; Tekin, AliErkeklerde alt üriner sistem semptomlarının en sık nedeni olan benign prostat hiperplazisinin (BPH) tedavisindeki gelişmeler büyük bir hızla devam etmektedir. Prostatik üretral askı yöntemi BPH'ye bağlı alt üriner semptomları olan erkeklere yeni bir tedavi yöntemi olarak sunulmuştur. Askı yöntemi genel, bölgesel veya lokal anestezi altında uygulanabilmektedir. Yöntem etkisini obstrüksiyon yaratan prostat loblarını implantlarla prostat kapsülüne doğru retrakte edip yeterli prostatik üretra açıklığı sağlayarak gösterir. Tedavi alternatifleri içerisinde özellikle medyan lobu olmayan alt üriner sistem şikayetiyle başvuran cinsel fonksiyon kaybı ve ciddi komplikasyonlar ile ilgili kaygıları olan hastalarda bir seçenek olarak sunulabilmesi açısından önemlidir. Ancak takip sürelerinin kısa olması, uygun hasta seçimi gerekliliği (medyan lobunun olmaması, rezidüel idrar miktarının az olması), maliyet analizlerinin olmaması bu yöntemin kısıtlılıkları olarak göze çarpmaktadır. Bu derlemede, askı yönteminin semptomatik, fonksiyonel ve seksüel sonuçları değerlendirilmiştir.Öğe Revascularization in Erectile Dysfunction due to Pelvic Trauma(2019) Yüksel, Alpaslan; Karaca, Okay Güven; Baba, Dursun; Şenoglu, Yusuf; Tekin, AliErectile dysfunction is defined as the inability to achieve penile erection necessary for sexualintercourse or to sustain erection sufficiently. Although the treatment options for erectiledysfunction are limited, the most common surgical treatment is penile prosthesis implantation.In addition, penile revascularization of the penis is very effective in the treatment of erectiledysfunction due to different vasculogenic reasons, especially pudendal artery occlusion, afterperineal trauma. Modified Furlow Fisher technique including anastomosis of the inferiorepigastric artery to the penile dorsal vein is a successful treatment option among therevascularization techniques. Despite invasive preliminary evaluations such as duplex Dopplerultrasound, dynamic cavernosometry, selective internal pudendal arteriography, and the longand difficult surgical procedure, it is highly effective in particularly selected young patients.Öğe An Unusual Case: The Migration of a Bullet into the Bladder and Covered with Stone(Duzce Univ, 2018) Baba, Dursun; Başaran, Ekrem; Yüksel, Alpaslan; Kayıkçı, Muhammet Ali; Tekin, AliIntravesical foreign objects are rare but significant urological problem as they cause recurrent urinary tract infections, bladder stone formation and chronic irritation leading to malignant transformation. Although self-urethral infliction and iatrogenic etiologies are common, trauma-related etiologies and migration from an adjacent organ are also reported within literature. Here we present a case with a prediagnosis of bladder stone and an unexpected intraoperative diagnosis of intravesical bullet covered by stone identified during cystolithotripsy. Further investigation revealed a story of gunshot injury of her lower abdomen and a bullet left in the iliac bones thirty years before. Thus, the bullet was presumed to migrate from the pelvic bones to the urinary bladder.Öğe Üst Üriner Sistem Tümörlerine Yaklaşım: Radikal Nefroüreterektomi ve Nefron Koruyucu Endoskopik Tedavilerin Karşılaştırmalı Onkolojik Etkinlikleri(Galenos Yayincilik, 2015) Tekin, Ali; Yüksel, AlpaslanÜst üriner sistem tümörleri (ÜÜST) üroepitelyumun seyrek görülmekle birlikte nüks ve progresyon riski yüksek öldürücü kanserleridir. Mesaneden kaf eksizyonu ile birlikte radikal nefroüreterektomi (RNU) uygulaması altın standart tedavi olarak kabul edilmesine rağmen, son 10 yılda endoskopik cerrahide sağlanan gelişmelerin de katkısıyla nefron koruyucu endoskopik uygulamalara ilgi giderek artmıştır. Endoskopik tedavi uygulamaları soliter böbrek, renal yetmezlik ve komorbidite varlığı gibi mutlak endikasyonlara sahip hastalar dışında tecrübenin artmasıyla birlikte elektif endikasyonlara sahip düşük risk grubuna giren diğer hastalarda da uygulanabilmektedir. Ancak, az görülen bu tümörlere endoskopik nefron koruyucu yaklaşımların etkinliğine ilişkin literatür bilgisi randomize olmayan, geriye dönük ve kısıtlı hasta gruplarıyla yapılmış az sayıda çalışmaya dayanmaktadır. Bugün itibariyle, ÜÜST’ye endoskopik yaklaşımların onkolojik başarı bakımından nefroüreterektomi ile karşılaştırabilecek yeterli kanıta dayalı bilgi henüz yeterli değildir. Bu derlemede, ÜÜST tedavisinde nefron koruyucu endoskopik uygulamalar ile RNU uygulamalarının rekürens, genel ve hastalığa özgü sağkalım sonuçları açısından güncel literatür bilgileri gözden geçirilmiştir
