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Öğe 980-Nm Diode Laser Vaporization versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: Randomized Controlled Study(Urol & Nephrol Res Ctr-Unrc, 2015) Cetinkaya, Mehmet; Onem, Kadir; Rifaioglu, Mehmet Murat; Yalcin, VeliPurpose: We compared the effectiveness and complications of 980-nm diode laser vaporization and transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH). Materials and Methods: In total, 72 consecutive patients with BPH entered the study. All patients underwent general and urological evaluations. The primary outcome was improvement in the International Prostate Symptom Score (IPSS). The secondary outcomes were IPSS quality of life (QoL), maximum urinary flow rate (Qmax), residual volume, and complications. Patients were allocated randomly to the TURP and laser groups. The Ceralas HPD120, a diode laser system emitting at a wavelength of 980 nm, was used for photoselective vaporization of the prostate (PVP). TURP was performed with a monopolar 26 French resectoscope. Preoperative and operative parameters and surgical outcomes were compared. Results: In total, 36 patients in each group underwent PVP and TURP. The mean age standard deviation was 63.1 +/- 9.1 years and 64.7 +/- 10.2 years in the PVP and TURP groups, respectively. There were no statistically significant differences in age, prostate size, prostate-specific antigen concentration, Qmax, preoperative IPSS, or preoperative Qmax between the two groups. The operation duration was also similar between the groups (P =.36). The catheterization time was 1.45 +/- 0.75 and 2.63 +/- 0.49 days in the PVP and TURP groups, respectively (P <.01). The PVP group had a shorter hospital stay than the TURP group. The 3-month postoperative Qmax increased to 9.90 +/- 3.61 and 6.59 +/- 6.06 mL/s from baseline in the TURP and PVP groups, respectively; there was no difference in the increases between the groups (P =.08). The IPSS and IPSS-QoL were significantly improved with the operation (P <.01), and this improvement was similar in both groups P=.3 and P=.8, respectively. The complication rate was also similar between the two groups. Conclusions: PVP with a diode laser is as safe and effective as TURP in the treatment of BPH, and the techniques have similar complication rates and functional results. PVP has the advantage of shorter hospitalization and catheter indwelling times and no need for discontinuation of anticoagulant therapy.Öğe Association Between Prostate Volume and Red Cell Distribution Width(Wiley, 2014) Zorba, Orhan U.; Uzun, Hakki; Onem, Kadir; Cetinkaya, Mehmet; Rifaioglu, Murat; Akca, NezihObjectivesTo evaluate relation between red cell distribution width (RDW) and benign prostatic hyperplasia (BPH). MethodsThe overall study population consisted of 942 men with lower urinary tract symptoms (LUTS), ranging in age from 60 to 85years old. Patients with disorder or medication that can influence lower urinary tract or erythrocytes were excluded from the study. The relationship between RDW, white blood cell (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and prostate volume, International Prostate Symptom Score (IPSS) were assessed with multivariate linear regression model. Patients were analyzed in four groups stratified according to the quartiles of prostate volume. The one-way analysis of variance (anova) was used to compare RDW, WBC CRP, and ESR between different quartiles of prostate volume. ResultsA graded and independent association of RDW with the prostate volume was identified (P=0.001). RDW was significantly associated with prostate volume in multivariate linear regression model that was adjusted for age and hemoglobin. IPSS was significantly correlated with RDW, CRP and ESR. However significance was lost after adjustment for age and prostate volume. The RDW was significantly associated with the surgical treatment in the multivariate linear regression model that was adjusted for age and prostate volume. ConclusionsA correlation between an increased RDW and prostate volume was suggested by the new data from this study. This relation may be a consequence of inflammatory stress arising from BPH. The significant association between the easy, inexpensive RDW may provide a rational basis to include the RDW in algorithms for surgery risk prediction.Öğe Autonomic Nervous System Dysfunction in Lifelong Premature Ejaculation: Analysis of Heart Rate Variability(Elsevier Science Inc, 2012) Zorba, Orhan Unal; Cicek, Yuksel; Uzun, Hakki; Cetinkaya, Mehmet; Onem, Kadir; Rifaioglu, Mehmet MuratOBJECTIVE To identify autonomic nervous dysfunction in patients with lifelong premature ejaculation. METHODS The study participants were 25 men with lifelong premature ejaculation and 25 healthy controls. The parameters of 24-hour heart rate variability that are influenced by the autonomic nervous system were compared between the men with lifelong premature ejaculation and the healthy controls. RESULTS The laboratory results of all patients were within normal limits, and no significant differences were found between the patients and the controls in age, body weight, and body mass index. A low-frequency signal that is influenced by the sympathetic system was increased in the patients (P = .026). Furthermore, a high-frequency signal that is influenced by the parasympathetic system was decreased in the patients (P = .011). Finally, the low frequency-to-high frequency ratio, an indicator of the balance between the two components of the autonomic nervous system, was increased in the patients (P = .002). CONCLUSION To our knowledge, no study has investigated the influence of the autonomic nervous system on 24-hour heart rate variability in premature ejaculation. In the present study, sympathetic activity was increased in men with lifelong premature ejaculation; this overactivity might lead to lifelong premature ejaculation. Additional studies are required to reveal the possible alteration of the autonomic nervous system in premature ejaculation. UROLOGY 80: 1283-1286, 2012. (c) 2012 Elsevier Inc.Öğe Does renal parenchymal thickness affect bleeding in percutaneous nephrolithotomy?(Tubitak Scientific & Technological Research Council Turkey, 2013) Rifaioglu, Mehmet Murat; Onem, Kadir; Celik, Huseyin; Davarci, Mursel; Cetinkaya, Mehmet; Inci, Mehmet; Gunesli Yetisken, AylinAim: Blood loss is a major concern during percutaneous nephrolithotomy. The aim of this study was to evaluate the effect of access point parenchymal thickness on bleeding in percutaneous nephrolithotomy procedures. Materials and methods: In this study 85 patients who had undergone a percutaneous nephrolithotomy operation between February 2009 and July 2011 were reviewed retrospectively. All characteristics of the patients were investigated. The details of the operative procedure and the renal parenchymal thickness at the puncture site were also recorded. Blood loss was calculated during the peroperative and postoperative periods. Correlation and multivariate regression analysis were done to detect predictive factors on bleeding. Results: Of the 85 percutaneous nephrolithotomy procedures done, 12 (14.1%) patients had no diminution of hemoglobin value postoperatively and were excluded. This left 73 percutaneous nephrolithotomy procedures that were evaluated. The mean peroperative hemoglobin drop was 1.79 +/- 1.17 mg/dL. Stone size, operation time, and grade of hydronephrosis were correlated with hemoglobin drop significantly (P = 0.047, P = 0.016, and P = 0.034, respectively). There was no correlation between parenchymal thickness and bleeding (P = 0.545). In multivariate regression analysis, only the operation time was found to be a statistically significant independent predictive factor for peroperative bleeding in percutaneous nephrolithotomy (P = 0.005). Conclusion: Renal parenchymal thickness and the grade of hydronephrosis do not predict peroperative hemorrhage in percutaneous nephrolithotomy procedures.Öğe Histopathologic Evaluation of Neurovascular Bundles and Periprostatic Tissue in Interfascial and Intrafascial Nerve-sparing Radical Prostatectomy Technique: A Cadaveric Anatomic Study(Elsevier Science Inc, 2013) Rifaioglu, Murat M.; Davarci, Mursel; Ozgur, Tumay; Ozkanli, Seyma; Ozdes, Taskin; Inci, Mehmet; Onem, KadirOBJECTIVE To compare interfascial (IEF) or intrafascial (IAF) periprostatic nerve dissection technique in prostate tissue using immunohistochemical methods in fresh cadavers. MATERIALS AND METHODS Prostate tissues of 25 fresh cadavers were removed from rectum and other surrounding structures. IEF nerve dissection (n - 25) was performed on the right and IAF nerve (n - 25) dissection on the left side of each prostate under direct visualization. The base, center, and apex of each prostate lobes and fascia dissected were sampled for blind histopathologic evaluation. Total counts of nerve, artery, and vein were performed on hematoxylin and eosin stained sections, whereas sympathetic and parasympathetic nerve counts were performed on immunohistochemical stained sections. Iatrogenic surgical margin injury at base, center, and apex detected were compared between groups. RESULTS Thickness of neurovascular bundle dissected in IAF was found significantly higher than IEF technique. The number of residual sympathetic fibers after dissection of neurovascular bundle was found significantly higher in IAF group. There were significant decreases in total nerve, parasympathetic, and sympathetic nerve counts only at the central region of prostate in IAF group. A significant decrease was found in the number of residual vein left in the fascia only at the apex by IAF dissection. Of surgical margin injury results, no significant difference was detected between IAF and IEF groups at any location. CONCLUSION IAF provides better preservation of sympathetic but not parasympathetic fibers without increasing surgical injury of prostate capsule. (C) 2013 Elsevier Inc.Öğe Is There a Relation between Reticular Formation and Storage Symptoms in Men(Wiley, 2014) Zorba, Orhan U.; Kirbas, Serkan; Uzun, Hakki; Onem, Kadir; Cetinkaya, Mehmet; Rifaioglu, Mehmet M.ObjectiveTo reveal brainstem originated pathology in men with different types of lower urinary tract symptoms blink reflex latency times were assessed. MethodsA total of 32 men, 16 with storage and 16 with voiding symptoms, were enrolled in the study. Blink reflex latency times were analyzed through electrical stimulation of the supraorbital nerve. Two responses in the orbicularis oculi muscle were recorded: the latency times for the early ipsilateral response, R1, and the late bilateral responses, R2. ResultsThe mean ages of the patients with storage and voiding symptoms were 57.316.87 and 58.06 +/- 6.29years, respectively. The R2 latency times were significantly longer in men with storage symptoms. However, the R1 latency times were similar for the two groups. ConclusionLate blink latency times were long only in patients who had storage symptoms. An oligosynaptic path through the trigeminal nuclei, which includes one or two interneurons, is responsible for early response; however, late response is relayed through a polysynaptic path, including neurons in the reticular formation. It has also been shown that stimulation of the pontine reticular formation inhibits the micturition contraction. In some patients, storage symptoms may result from pathology that originates with the reticular formation and this pathology may lead to increases in late blink latency times. Additional studies are needed on other reflexes that are mediated through reticular formation, in order to show the possible dysfunction of the reticular formation in men with storage symptoms.Öğe Overactive Bladder and Pontine Reticular Formation(Karger, 2013) Zorba, Orhan Unal; Kirbas, Serkan; Uzun, Hakki; Cetinkaya, Mehmet; Onem, Kadir; Rifaioglu, Mehmet MuratBackground: The etiology of overactive bladder (OAB) remains unclear. Observed neurogenic factors in the literature are limited to suprapontine or spinal pathologies. The blink reflex is a useful tool in the evaluation of brainstem functions. Blink reflex latency times were evaluated in order to reveal pathology in the brainstem. Methods: A total of 60 women, 30 patients with idiopathic OAB and 30 healthy controls, were enrolled in the study. Blink reflex latency times were analyzed by electrical stimulation of the supraorbital nerve. Two responses in the orbicularis oculi muscle, early ipsilateral response (R1) and late bilateral response (R2) latency times, were recorded. Results: Mean ages of the patients and controls were 51.9 +/- 5.3 and 49.2 +/- 6.2 years, respectively. R2 latency times were significantly higher in patients than in controls. However, R1 latency times were similar between the two groups. Conclusions:The results of the study suggest a significant relation between late blink latencytimes and OAB. An oligosynaptic path via the trigeminal nuclei is responsible for R1; however, R2 response is relayed through the reticular formation. Stimulation of pontine reticular formation inhibits micturition contraction. In some patients, idiopathic OAB may result from reticular formation-originated pathology. Additional studies on other reticular formation-mediated reflexes are needed to reveal possible dysfunction of reticular formation. Copyright (C) 2013 S. Karger AG, BaselÖğe Tubeless percutaneous nephrolithotomy: yes but when? A multicentre retrospective cohort study(Springer, 2014) Rifaioglu, Murat M.; Onem, Kadir; Buldu, Ibrahim; Karatag, Tuna; Istanbulluoglu, Mustafa OkanThe aim of our study is to determine the predictive factors for placement of percutaneous nephrostomy tube (PNT) in percutaneous nephrolithotomy (PCNL) procedure and to evaluate the optimal cutoff points of the predictive factors. 229 patients, who had undergone percutaneous nephrolithotomy operation between February 2009 and February 2013 were reviewed retrospectively. Five patients were excluded from the study because of solitary kidney. All characteristics of 224 patients, stones and operative data were investigated. Patient and stone-related factors, such as age, BMI, history of previous surgery or SWL, characteristics of the stone, renal parenchymal thickness (RPT), as well as procedural factors, such as percutaneous access number and location were analyzed by univariate and multivariate tests. The continuous variables were analyzed using Receiver operating characteristic curve analysis. There were no differences in sex, age, BMI and hemoglobin decrease between the groups. Previous operation status, RPT, stone size, multiplicity of the stone, stone localization, blood transfusion presence, access points, access number and operation time were found statistically different according to univariate analysis. Multivariate analysis showed that RPT, operation time and stone size were the independent factors that affected the PNT insertion. For RPT, operation time and stone size, the optimal cutoff points for insertion PNT were 13.75 mm, 75.5 min and 890 mm(2), respectively. Tubeless PCNL should be chosen in patients with stone area less than 890 mm(2), and parenchymal thickness thicker than 13.75 mm and procedure with operation period < 75.5 min.
