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Öğe Can Eosinophil Count, Platelet Count, and Mean Platelet Volume Be a Positive Predictive Factor in Penile Arteriogenic Erectile Dysfunction Etiopathogenesis?(Sage Publications Inc, 2017) Sonmez, Mehmet Giray; Goger, Yunus Emre; Sonmez, Leyla Ozturk; Aydin, Arif; Balasar, Mehmet; Kara, CengizBlood count parameters of patients referring with erectile dysfunction (ED) were examined in this study and it was investigated whether eosinophil count (EC), platelet count (PC), and mean platelet volume values among the suspected predictive parameters which may play a role in especially penile arteriogenic ED etiopathogenesis had a contribution on pathogenesis. Patients referring with ED complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function. Penile Doppler ultrasonography was taken in patients suspected to have vasculogenic ED. According to penile Doppler ultrasonography result, patients with arterial deficiency were included in the penile arteriogenic ED group and the patients with normal results were included in the nonvasculogenic ED group. A total of 36 patients participated in the study from the penile arteriogenic ED group and 32 patients from the nonvasculogenic ED group. Compared with the nonvasculogenic ED group, the penile arteriogenic ED group's low International Index of Erectile Function score, high EC, mean platelet volume and PC values were detected to be statistically significant (p < .001, p = .021, p = .018, p = .034, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells, and hemoglobin values were considered. Pansystolic volume velocities were detected as statistically significantly low compared with the nonvasculogenic ED group in the measurements made in 5th, 10th, 15th, and 20th minutes on the right and left sides in the penile arteriogenic ED group. High MPV value and PC is a significant predictive factor for penile arteriogenic ED and vasculogenic ED and high EC is specifically predictive of arteriogenic ED.Öğe Does inguinal hernia repair have an effect on sexual functions?(Polish Urological Assoc, 2016) Sonmez, Mehmet Giray; Sonbahar, Bilgehan Cagdas; Bora, Gul; Ozalp, Necdet; Kara, CengizIntroduction The aim of this study is to evaluate sexual functions which are affected by inguinal hernias and may change after hernia repair surgery. Material and methods A total of 47 patients who underwent Lichtenstein tension-free anterior repair and inguinal hernia surgery were evaluated in terms of erectile function, intercourse function, sexual desire, overall satisfaction and orgasm satisfaction using the International Index of Erectile function questionnaire (IIEF) scoring system before surgery and in the first and sixth months after surgery. Parameters evaluated with the IIEF score before the surgery and in the first and sixth months after surgery were compared statistically using the Wilcoxon test. Results The average age of patients was 46.2 +/- 11.2 years (range: 22-67). It was determined that all scores, apart from sexual desire (p = 0.08), significantly increased in the postoperative first and sixth months compared to the preoperative period. It was measured that the preoperative sexual desire score increased significantly in the postoperative sixth month (p < 0.001). A significant score was also detected when all scores in the postoperative sixth month were compared to the postoperative first month. Conclusions Inguinal hernia surgery positively affects sexual functions compared to the preoperative period. The improvement in sexual parameters in addition to the benefits of hernia removal and presence of no significant postoperative complications indicates that this surgery is useful and safe.Öğe The effect of zero-ischaemia laparoscopic minimally invasive partial nephrectomy using the modified sequential preplaced suture renorrhaphy technique on long-term renal functions(Termedia Publishing House Ltd, 2017) Sonmez, Mehmet Giray; Kara, CengizIntroduction: Laparoscopic minimally invasive partial nephrectomy (MIPN) is the preferred technique in renal surgery, especially T1 phase kidney tumours, and it is recommended for the protection of renal functions in methods that do not involve ischaemia. Aim: To evaluate long-term renal functions of zero-ischaemia laparoscopic MIPN patients who underwent a modified sequential preplaced suture renorrhaphy technique. Material and methods: In a total of 17 renal units in 16 patients with kidney tumours that were determined incidentally and did not cause any complaints, the masses were extracted via laparoscopic partial nephrectomy (LPN) using the modified sequential preplaced suture renorrhaphy technique. Creatinine and estimated glomerular filtration rate (eGFR) values of the patients were measured preoperatively and on the first day and after 12 months postoperatively, and the results were compared. Results: The differences between the pre-and postoperative values were statistically significant (p = 0.033, p = 0.045), but the changes in postoperative creatinine and eGFR values were clinically insignificant. While the differences between preoperative and first-day postoperative creatinine and eGFR values were found to be statistically significant (p = 0.039, p = 0.042, respectively), a statistically significant difference was not detected between preoperative and 12-month postoperative creatinine and eGFR values (p = 0.09, p = 0.065, respectively). The global percentage of functional recovery was measured as 92.5% on the first day and 95.9% at the 12th month. Conclusions: The modified sequential preplaced suture renorrhaphy technique is an effective, reliable method for avoiding complications and preserving renal functions and nephrons in appropriate patients.Öğe Efficacy of Low Density Linear Shockwave Treatment in Severe Arteriogenic Erectile Dysfunction Patients(2017) Sönmez, Mehmet Giray; Kara, CengizAmaç: Bu çalışmanın amacı, şiddetli arteriyojenik erektil disfonksiyona (ED) sahip hastalarda, fosfodiesteraz tip 5 (PDESİ) inhibitörünün (Tadalafil 5 mg) günlük kullanımı ile kombine edilen düşük dansiteli lineer şok dalga tedavisini (LI-ESWT), sadece PDESİ'nin günlük kullanımı ile kıyaslayarak LI-ESWT'nin etkinliğini değerlendirmektir.Gereç ve Yöntem: Toplam 23 hasta çalışmaya dahil edildi. Bu hastalar LI-ESWT tadalafil 5 mg tedavisi (n10) uygulanan, sadece tadalafil 5 mg tedavisi uygulanan (n13) hastalar şeklinde iki gruba ayrıldı. LI-ESWT, 4 hafta boyunca haftada bir kez uygulandı. Her iki gruptaki hastalara da günde bir defa tadalafil 5 mg tedavisi oral olarak başlandı ve tedaviye her iki grupta 3 ay devam edildi. Tedavi öncesi ve sonrası 1. ay ve 3. ayda hastalar Uluslararası Erektil Fonksiyon İndeks Formu-Erektil Fonksiyon Alanı Skoru (IIEF-EF) ve Ereksiyon Sertlik Derecesi Skoru (ESDS) seviyeleri ve Seksüel İlişki Profili (SEP) 2 ve 3 ile değerlendirildi. Bulgular: Tedavi öncesi ve tedavi sonrası 1. ve 3. ayda ölçülen IIEF-EF skorları arasında istatiksel anlamlı fark saptanmadı (p0,091; p0,198). Üçüncü ay sonunda LI-ESWT tadalafil 5 mg grubunda IIEF-EF skoru 4 puan, Tadalafil 5 mg grubunda 3,2 puan artış gösterdi. İki grup arasında 1. ve 3. ayda ölçülen ESDS, SEP2 ve SEP3 pozitif hasta oranları arasında istatistiksel olarak anlamlı fark saptanmadı.Sonuç: LI-ESWT, ED tedavisinde kolay uygulanabilir, belirgin yan etkisi olamayan ve sonuçlar üzerinde pozitif etkisi olan bir uygulamadır. Fakat ağır arteriyojenik ED mevcut hastalarda etkin bir tedavi yöntemi değildir.Öğe Etiological factors and management in priapism patients and attitude of emergency physicians(Pagepress Publ, 2017) Sonmez, Mehmet Giray; Sonmez, Leyla Ozturk; Taskapu, Hakki Hakan; Kara, Cengiz; Dundar, Zerrin Defne; Goger, Yunus Emre; Evrin, TogayObjective: To present the underlying etiological factors in patients referring with priapism, sharing how they are managed according to etiology and priapism type together with our experiences, creating awareness so that urologists and emergency physicians may play a more active role together in priapism management. Materials and methods: Patients referring to emergency service with priapism were examined. Penile Doppler ultrasonography (PDU) and/or corporeal aspiration and blood gas analysis were made in order to determine priapism type after anamnesis and physical examination. The most appropriate treatment option was chosen and applied on the patients considering priapism type, underlying etiological factors and priapism time. Presence of a statistical difference between etiological factors causing priapism, priapism type and applied treatment methods was calculated using Chi square (chi 2) test. Results: A total of 51 patients referring to emergency service with priapism attacks for 53 times were included in the evaluation. When compared to other etiological factors, number of priapism cases developing secondary to papaverine after PDU was found statistically significantly high (p < 0.001). Ischemic priapism ratio was detected statistically higher compared to other groups (p < 0.001). Aspiration and/or irrigation treatment were the most common method used for treatment at a statistically significant level (p < 0.001). All patients (100%) were hospitalized in urology service without applying any treatment in emergency service and had treatment and intervention under the control of the urologist. Conclusions: Application of non-invasive treatments in suitable priapism patients would protect patients from invasive painful interventions. We believe that emergency physicians should be more effective in priapism phase management and at least noninvasive treatment phase.Öğe Is there a relationship between penile vasculogenic erectile dysfunction, platelet functions and eosinophil count?(Elsevier Espana Slu, 2017) Sonmez, Mehmet Giray; Sonmez, Leyla Ozturk; Goger, Yunus Emre; Aydin, Arif; Demirelli, Erhan; Boga, Mehmet Salih; Kara, CengizPurpose: Blood count parameters of patients referring with penile vasculogenic erectile dysfunction (ED) were examined in this study. It was investigated whether eosinophil count (EC), platelet count (PC) and mean platelet volume (MPV), values among the suspected predictive parameters which may affect vascular functions, have a contribution on ED pathology or not. Materials and methods: Patients referring erectile dysfunction complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function (IIEF). Values such as hormones, complete blood count and other laboratory markers were examined. Penile doppler ultrasonography (PDU) was performed in patients suspected to have vasculogenic ED. According to PDU result, patients with vascular deficiency were included in the penile vasculogenic ED group and patients with normal results were included in the control group. 49 patients participated in the study from the penile vasculogenic ED group and 30 patients from the control group. Intergroup comparisons were performed using the Mann-Whitney U test and the chi-square (chi(2)) test was used to assess the relationship between categorical variables within the patient groups. Results: Low IIEF score in vasculogenic ED group compared to the control group and high EC, MPV and PC values were detected to be statistically significant (p < 0.001, p = 0.026, p = 0.009, p = 0.029, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells or hemoglobin values are considered (p = 0.332, p = 0.235, p = 0.127, p = 0.696, respectively). Conclusion: High MPV value and platelet count showing the platelet functions and high eosinophil count are important factors which may play a role in penile vasculogenic ED etiopathogenesis. (C) 2016 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.Öğe Ischemic priapism: Can eosinophil count and platelet functions be positive predictive factors in etiopathogenesis(Canadian Urological Association, 2017) Sonmez, Mehmet Giray; Kara, Cengiz; Karaibrahimoglu, Adnan; Sonmez, Leyla Ozturk; Goger, Yunus Emre; Balasar, Mehmet; Taskapu, Hakki HakanIntroduction: We evaluated the relation between ischemic priapism (IP) and blood count parameters in IP patients. We especially wanted to examine the contribution of eosinophil count (EC), platelet count (PC), and mean platelet volume (MPV) values, which are suspected predictive parameters for vascular endothelium damage and venoocclusive pathogenesis and etiopathogenesis, particularly in IP. Methods: A total of 40 IP patients fulfilled the study criteria. Forty healthy volunteers in a similar age group were included as the control group. Complete blood count values were compared between the two groups. Intergroup comparisons were performed using the Mann-Whitney U test, and the chi-square test was used to assess the relationship between categorical variables in the patient groups. The area under the curve was calculated by receiver operating characteristic (ROC) regression analyses. Epidemiological diagnosis percentages were calculated by finding cutoff values. Results: The IP group's high MPV, PC, and EC values compared to those of the control group were detected to be statistically significant (p<0.001, p=0,03, p=0.001, respectively). No statistically significant difference was observed between the two groups for other blood count parameters. Statistically significant values for IP were measured as MPV: positive predictive value: 84%; EC: positive predictive value: 71.4%; and PC: positive predictive value: 61.4%. Conclusions: High MPV, PC, and EC values are significant positive predictive factors in IP etiopathogenesis. No proof was detected for other blood count parameters playing an active role in IP etiopathogenesis.Öğe Micropenis Prevalence and Causes for Urology Polyclinic Referral in Prepubertal Boys(Galenos Yayincilik, 2018) Sonmez, Mehmet Giray; Kara, CengizINTRODUCTION: In this study, it was planned to determine the micropenis prevalence in prepubertal boys referred to the urology polyclinic for any reason in a year and their referral causes. METHODS: Prepubertal boys (<12 years old) referred to the urology polyclinic between December 2014 and December 2015 were included in evaluation. Stretching the penis with a ruler, the length was measured along the penis dorsum between the glans end and root of penis in symphysis pubis. After the penis length was measured correctly, the acquired value was compared with the normal values for chronological age and values below -2.5 SD (Conventional measurement) were accepted as micropenis. RESULTS: A total of 227 boys referred to the urology polyclinic in a year were evaluated. Micropenis was detected in a total of six patients (2,6%) according to the conventional measurement and it was detected that three of these boys were referred to the hospital due to short penis, two with circumcision demand and one with retractile testicle. A pathology which could affect penis length was detected in 78,5% (11/14) of the patients referred with short penis. DISCUSSION and CONCLUSION: Micropenis ferquency in prepubertal boys was found high in this study. This result was quite different from previous studies on neonates. Therefore, studies in large groups including possible causes and post-diagnosis treatment phase would be more useful.Öğe Neonatal Screening for Congenital Adrenal Hyperplasia in Turkey: A Pilot Study with 38,935 Infants(Galenos Yayincilik, 2019) Guran, Tulay; Tezel, Basak; Gurbuz, Fatih; Eklioglu, Beray Selver; Hatipoglu, Nihal; Kara, Cengiz; Simsek, EnverObjective: Congenital adrenal hyperplasia (CAH) is the most common form of primary adrenal insufficiency in children. Neonatal screening for CAH is effective in detecting the salt-wasting (SW) form and in reducing mortality. in this study, our aim was to estimate the incidence of CAH in Turkey and to assess the characteristics and efficacy of the adopted newborn CAH screening strategy. Methods: A pilot newborn CAH screening study was carried out under the authority of the Turkish Directorate of Public Health. Newborn babies of >= 32 gestational weeks and >= 1500 gr birth weight from four cities, born between March 27-September 15, 2017 were included in the study. Screening protocol included one sample two-tier testing. In the first step, 17 alpha-hydroxyprogesterone (17-OHP) was measured by fluoroimmunoassay in dried blood spots (DBS) obtained at 3-5 days of life. The cases with positive initial screening were tested by steroid profiling in DBS using a liquid chromatography-tandem mass spectrometry method to measure 17-OHP, 21-deoxycortisol (21-S), cortisol (F), 11-deoxycortisol and androstenedione as a second-tier test. The babies with a steroid ratio (21-S + 17-OHP)/F of >= 0.5 were referred to pediatric endocrinology clinics for diagnostic assessment. Results: 38,935 infants were tested, 2265 (5.82 %) required second-tier testing and 212 (0.54 %) were referred for clinical assessment, six of whom were diagnosed with CAH (four males, two females). Four cases were identified as SW 21-hydroxylase deficiency (21-OHD) (two males, two females). One male baby had simple virilizing 21-0HD and one male baby had II-OHD CAH. The incidence of classical 21-0HD in the screened population was 1:7,787. Conclusion: The incidence of CAH due to classical 21-OHD is higher in Turkey compared to previous reports. We, therefore, suggest that CAH be added to the newborn screening panel in Turkey. The use of steroid profiling as a second-tier test was found to improve the efficacy of the screening and reduce the number of false-positives.Öğe Turner Syndrome and Associated Problems in Turkish Children: A Multicenter Study(2015) Yeşilkaya, Ediz; Bereket, Abdullah; Darendeliler, Fatma Feyza; Baş, Firdevs; Poyrazoğlu, Şükran; Küçükemre Aydın, Banu; Darcan, Şükran; Dündar, Bumin Nuri; Büyükinan, Muammer; Kara, Cengiz; Sarı, Erkan; Adal, Servet Erdal; Akıncı, Ayşehan; Atabek, Mehmet Emre; Demirel, Fatma; Çelik, Nurullah; Özkan, Behzat; Orbak, Zerrin; Ersoy, Betül; Doğan, Murat; Ataş, Ali; Turan, Serap; Gökşen Şimşek, Ruhsar Damla; Tarım, Ömer Faruk; Yüksel, Bilgin; Ercan, Oya; Hatun, Şükrü; Şimşek, Enver; Ökten, Ayşenur; Abacı, Ayhan; Döneray, Hakan; Özbek, Mehmet Nuri; Keskin, Mehmet; Önal, Hasan; Akyürek, Nesibe; Bulan, Kezban; Tepe, Derya; Emeksiz, Hamdi Cihan; Demir, Korcan; Kızılay, Deniz; Topaloğlu, Ali Kemal; Eren, Erdal; Özen, Samim; Abalı, Saygın; Akın, Leyla; Selver Eklioğlu, Beray; Kaba, Sultan; Anık, Ahmet; Baş, Serpil; Ünüvar, Tolga; Sağlam, Halil; Bolu, Semih; Özgen, İlker Tolga; Doğan, Durmuş; Çakır, Esra Deniz; Şen, Yaşar; Andıran, Nesibe; Çizmecioğlu, Filiz Mine; Evliyaoğlu, Saadet Olcay; Karagüzel, Gülay; Pirgon, Mustafa Özgür; Çatlı, Gönül; Can, Hatice Dilek; Gürbüz, Fatih; Binay, Çiğdem; Baş, Veysel Nijat; Fidancı, Muzaffer Kürşat; Polat, Adem; Gül, Davut; Açıkel, Cengizhan; Demirbilek, Hüseyin; Cinaz, Peyami; Bondy, CarolynObjective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespanÖğe What should be done to minimize pain without any sexual function deterioration in transrectal prostate biopsy?(Polish Urological Assoc, 2017) Sonmez, Mehmet Giray; Kozanhan, Betul; Demirelli, Erhan; Sonmez, Leyla Ozturk; Kara, CengizIntroduction The aim of this study was to find an ideal method for the application of a transrectal ultrasound-guided prostate biopsy (TRUS-Bx) without deteriorating patient comfort. Material and methods TRUS-Bx was applied in a total of 93 patients. Taking the application method into consideration, these patients were divided into three groups, each consisting of 31 patients. Methods applied for pain control in the different groups were compared (groups 1, 2 and 3). Age, prostate specific antigen (PSA), prostate volume, cancer detection rate, re-biopsy consent ratio, complication rates, visual analog scale (VAS), and International Index of Erectile Function (IIEF-5) scores were compared among the groups. Results Age, PSA, prostate volume, cancer detection rate, and fever complication rate were not statistically different between the three groups. However, a statistically significant difference was detected among the groups for the VAS measured during and after TRUS-Bx, re-biopsy consent ratio, and hematuria (p < 0.001, p < 0.001, p < 0.001, and p = 0.027, respectively). There was no detected difference in pre-operation IIEF-5 scores, but the difference in IIEF-5 scores in the first month after the operation was significant (p = 0.116, p = 0.024, respectively). Conclusions Anal dilatation after the application of intrarectal topical anesthetic to provide anesthesia during TRUS-Bx and giving lidocaine hydrochloride with epinephrine for periprostatic nerve blockage (PNB) is a successful and effective method to maintain patient comfort, especially as it relates to pain control and sexual function. Anal dilatation seems to minimize any pain that may occur due to probe transition, and adding epinephrine as a vasopressor to the anesthetic agent chosen during the operation will be rather helpful for hemostasis control and pain that results from the needle.
