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    Comparison of Early Versus Late Urethral Catheter Removal After Transurethral Resection of the Prostate in Patients with Benign Prostate Hyperplasia
    (Duzce Univ, Fac Medicine, 2023) Senoglu, Yusuf; Tekin, Ali; Yildirim, Olcay; Baba, Dursun; Yuksel, Alpaslan
    Objective: Transurethral resection of the prostate (TURP) is considered the standard in the surgical therapy of lower urinary tract symptoms related to benign prostate hyperplasia (BPH). However, there is no consensus on the timing of catheter removal. In this study, we aimed to compare the long-term effects of early and delayed removal of urethral catheters who underwent TURP.Methods: We prospectively analyzed a total of 91 patients who underwent TURP. Patients were randomized into two groups; the early (postop 1st-2nd days) and delayed (7th day) removal of the urethral catheter. After the surgery in 1, 3, and 6th months, we evaluated all patients regarding treatment success. In addition, international prostate symptom score (IPSS), quality of life (QoL), maximum flow rate, postvoid residual urine volume, and morbidities (hematuria, infection, urethral stricture, irritative symptoms, need for re-operation) were assessed at all visits.Results: After TURP, there was no statistical difference in urodynamic parameters, complications, IPSS, and QoL in both groups. Only in the 3rd-month, the maximum flow rate was higher in favor of the early group. Despite similar results in both groups, strictures occurred earlier in the early group than delayed group (respectively 1 and 3 months).Conclusions: These results suggest that there are no differences in efficacy and complications in groups of early or delayed urethral catheter removal after TURP. The results of long-term studies with large series should be awaited to reach a more definite conclusion. We have tried to shed light on a topic without consensus on the time of urethral catheterization after TURP.
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    Early versus delayed removal of indwelling catheters in patients after elective cesarean section: a prospective randomized trial
    (Taylor & Francis Ltd, 2020) Basbug, Alper; Yuksel, Alpaslan; Kaya, Aski Ellibes
    Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12?h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time. Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2?h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12?h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time. Results: Urinary frequency (p?=?.04), microscopic hematuria incidence (p?=?.04), postoperative mobilization time (p?=?.01), and length of hospital stay (p?=?.009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time. Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.
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    Effect of constipation on acute urinary retention following transrectal prostate biopsy
    (Korean Urological Assoc, 2023) Sahin, Cahit; Sinanoglu, Orhun; Karaca, Yavuz; Yuksel, Alpaslan; Kucuk, Eyup Veli; Sarica, Kemal; Erdogan, Erhan
    Purpose: To evaluate the possible effect of constipation on the acute urinary retention (AUR) after transrectal ultrasound-guidedMaterials and Methods: A total of 1,167 patients with prostate-specific antigen (PSA) >4 ng/mL and/or abnormal digital rectal examination underwent a standard 12 core transrectal ultrasound-guided prostate needle biopsy in our hospital and the findings were examined prospectively. Chronic constipation (CC) was defined according to the Rome IV criteria. All cases were well evaluated with respect to clinical-histopathological factors; International Prostate Symptom Score (IPSS), prostate volume, post-voidResults: The mean age of patients was 64.63 +/- 8.31 years, the PSA level was 11.60 +/- 16.83 ng/mL, and the prostate volume was 54.66 +/- 25.44 mL. In 265 cases (22.7%), CC anamnesis was present and AUR developed in 28 (2.4%) of the cases. In the multivariate analysis for the risk of developing urinary retention, prostate volume, pre-operative IPSS, and presence of CC requiring manual maneuvers to facilitate defecation were found to be risk factors (p=0.023, 0.010, and 0.001, respectively).Conclusions: Our findings demonstrated that CC may be a critical factor in the prediction of AUR formation following TRUS PB.
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    Investigation of the Relationship of Two-Glass Test with Prostate Biopsy and Presence and Grade of Asymptomatic Prostate Inflammation in Men with Serum Prostate-Specific Antigen Level Between 2.5-10 ng/ml
    (Duzce Univ, Fac Medicine, 2024) Yuksel, Alpaslan; Tekin, Ali; Senoglu, Yusuf; Baba, Dursun; Gamsizkan, Mehmet
    Objective: Prostate-specific antigen (PSA) is utilized as a marker to detect prostate cancer. Elevated PSA levels often lead to prostate biopsy to assess the potential presence of cancer. However, PSA elevation is not specific to cancer and can be caused by various conditions, including benign prostatic hyperplasia (BPH), urinary tract infections, and chronic prostatitis. Notably, approximately 66% of patients undergoing biopsy do not have prostate cancer, leading to unnecessary procedures and associated complications. Chronic prostatitis is detected in around 40% of these biopsies. The two-glass test involves examining urine before and after a rectal examination to diagnose chronic prostatitis. This study aims to investigate the effectiveness of the two-glass test in predicting prostatitis and inflammation in patients with PSA levels between 2.5-10 ng/ml who have undergone prostate needle biopsy. Materials and Methods: The study included fifty-two male patients aged between 50 and 78 years with PSA levels between 2.5 and 10 ng/ml who presented to our clinic. All patients underwent the EPS-two-glass test and prostate biopsy. EPS (expressed prostatic secretion) is obtained by collecting fluid from the urethra after prostate massage, while VB-3 (voided bladder-3) is urine collected after a massage. These samples are used to detect prostate infection. Prostate inflammation was deemed significant if >= 10 leukocytes were observed under the microscope. Patients were categorized into three groups based on pathology results: prostate cancer, BPH, and chronic prostatitis. The chronic prostatitis group was further classified based on histopathological calcification described by Nickel. Results: Chronic prostatitis was detected in 38% of the study participants. VB3 positivity was significantly higher in the chronic prostatitis group compared to the other groups (p = 0.028). Although no significant difference was observed in the prevalence of inflammation and PSA elevation, PSA levels were higher in the multifocal inflammation subgroup compared to the focal inflammation group. Conclusions: The relationship between chronic prostatitis and PSA elevation remains unclear. Although this study did not find a statistical relationship between inflammation and PSA elevation, the significant correlation between chronic prostatitis and VB3 positivity suggests a potential link. These findings can serve as a foundation for further research aimed at reducing unnecessary biopsies.
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    KRAS, BRAF, PIK3CA mutation frequency of radical prostatectomy samples and review of the literature
    (Taylor & Francis Ltd, 2021) Bahcivan, Atike; Gamsizkan, Mehmet; Coskun, Sinem Kantarcioglu; Cangur, Sengul; Yuksel, Alpaslan; Ceyhan, Aysegul; Onal, Binnur
    Objective The molecular basis of prostate cancer is highly heterogeneous. Our study aimed to perform the mutation analysis of KRAS, BRAF, PIK3CA, and immunohistochemical (IHC) evaluation of EGFR, HER2, p16, and PTEN to demonstrate new areas for targeted therapies. Methods A total of 24 prostatectomy samples diagnosed with adenocarcinoma were analyzed by microarray hybridization. Also, these samples were IHC stained for EGFR, HER2, P16, and PTEN. The cases were divided into two groups based on low and high Gleason scores. All findings were compared with the clinicopathological parameters of the patients. Results While KRAS mutation was in 3/24 (12.5%) of our cases, BRAF and PIK3CA mutations were not detected. There was no significant difference between the groups in terms of KRAS mutation frequency. HER2 was immunohistochemically negative in all samples. There was no correlation between EGFR, P16 immunopositivity, and clinicopathological features. Conclusion KRAS mutation frequency is similar to those in Asian populations. BRAF and PIK3CA mutation frequencies have been reported in the literature in the range of 0-15% and 0-10.4%, respectively, consistent with our study findings. HER2 immunoexpression is a controversial issue in the literature. EGFR and p16 expressions may not correlate with the stage.
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    Laparoscopic Extraperitoneal Radical Prostatectomy
    (Galenos Yayincilik, 2020) Tekin, Ali; Yuksel, Alpaslan; Taskiran, Arda Taskin; Senoglu, Yusuf; Kayikci, Muhammet Ali
    Radical prostatectomy (RP) involves removing the entire prostate with its capsule intact and the seminal vesicles (SV). In this video article, we summarized the extraperitoneal laparoscopic RP with pelvic lymph node dissection procedure along with a video presentation of a case. The patient is placed in a Trendelenburg position. Through a small transverse infraumblical incision, the anterior rectus aponeurosis is identified and incised. The extraperitoneal surgical field is developed bluntly by a balloon dilator, and a 10 mm trocar is placed for the camera. CO2 insufflation at a 12-15 mmHg pressure is established, and the remaining trocars are placed. The fatty tissue is swept laterally to create a wide operative field. The endopelvic fascia is incised on both sides. The levator ani muscle fibers are separated from the lateral surface of the prostate. Dorsal vascular complex (DVC) is ligated with 2 consecutive sutures. Identification of the bladder neck (BN) is critical for proper dissection between the prostate and the BN. BN is incised until the catheter is seen. The urethral catheter is removed and a Bougie dilator is inserted through the urethra to elevate the prostate. With posterior oblique dissection, the vasa deferentia are exposed and clip-ligated, and SVs are identified and freed. Then, lateral pedicles are ligated with hemoclips and divided. Lateral dissection proceeds with an anterolateral incision from the base to the prostatic apex. The neurovascular bundles lie posterolateral to the prostate. Apical dissection and division of the DVC and urethra is a critical step to ensure a safe surgical margin and good postoperative erectile function and continence. The urethra is divided with a small rim on the prostate. The gland is totally freed, put into an endobag, and extracted. The vesicourethral anastomosis is done using two 3-0 monocryl sutures in a running fashion, starting from the posterior in both direction and tied together at the 12 o'clock position, anteriorly.
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    The role of N-acetylcysteine in preventing hepatic injury associated with systemic oxidative stress after extracorporeal shock wave treatment
    (Wroclaw Medical Univ, 2020) Cam, Sebahat; Baba, Dursun; Senoglu, Yusuf; Yuksel, Alpaslan; Erdem, Havva
    Background. Systemic oxidative stress may cause detrimental consequences for the liver, leading to hepatic fibrogenesis. Objectives. To investigate histopathological changes in liver tissues due to the increased systemic oxidative stress associated with rat extracorporeal shock wave lithotripsy (SWL) model and to document the consequences of N-acetylcysteine (NAC) administration. Material and methods. In this experimental SWL model, 18 Wistar albino rats were randomly assigned into 3 groups. The control group (group I) had no intervention. Group II underwent SWL treatment with intraperitonea I saline injection. Group III also had SWL with intra peritoneal NAC and was divided into short-term (group III-14 days) and long-term (group III-28 days) subgroup. Hepatectomy was performed for histopathological examinations. Histopathological alterations were evaluated with light microscopy. Immunohistological staining for p53 and myeloperoxidase was also performed. Results. Blood samples revealed a significant increase in plasma oxidative stress index (OSI) after plasma total antioxidant status (TAS) and total oxidant status (TOS) had been measured. It was shown that this increased systemic oxidative stress adversely affected liver tissues. Predominantly, sinusoidal dilatation was remarkably observed in rats with significantly high 051 values (p = 0.043). Similarly, periportal necrosis significantly increased in rats with high OSI values (p = 0.033). p53 positivity was also remarkable in rats with systemic oxidative stress (p = 0.049). N-acetylcysteine administration provided a significant decrease in OSI. N-acetylcysteine also improved all these alterations, including p53 staining. Particularly, sinusoidal dilatation was significantly protected in the long-term NAC group (group III-28 days). Conclusions. We demonstrated that SWL-induced systemic oxidative stress causes histological alterations in liver tissues. Increased p53 and myeloperoxidase staining as markers of oxidative damage were also detected. N-acetylcysteine may protect from these histological and ultra-structural alterations related to oxidative stress.