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    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, Veli
    Purpose: 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.
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    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 Murat
    OBJECTIVE 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.
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    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, Aylin
    Aim: 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.
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    Glomerular hyperfiltration in hypogonadotropic hypogonadic patients: Overlooking a cache?
    (Springer, 2015) Gozukara, Kerem Han; Arslan, Abdulmuttalip; Gorur, Sadik; Rifaioglu, Mehmet Murat; Carlioglu, Ayse
    To investigate renal function in idiopathic hypogonadotropic hypogonadic (IHH) patients by measuring glomerular filtration rate (GFR) using modification of diet in renal disease formula, and determine whether there is any relationship between GFR and testosterone levels. Thirty-three patients with IHH and 37 healthy control subjects participated in this study. The IHH group showed statistically significant higher GFR and proteinuria with respect to the control group (163.1 +/- A 46.9 to 117.9 +/- A 30.5 mL/min, p < 0.001; 0.2 +/- A 0.1 to 0.08 +/- A 0.02 mg/dL, p = 0.041, respectively). Uric acid and creatinine levels were statistically lower than in the control group (4.6 +/- A 0.5-3.6 +/- A 0.9 mg/dL, p = 0.02; 0.7 +/- A 0.2 to 0.9 +/- A 0.2 mg/dL, p < 0.001, respectively). Hyperfiltration positively correlated with IHH in multivariate linear regression analyses (beta = 0.591, p < 0.001). In addition, in the IHH group, we found that the GFR increased independently of body mass index and age. Our study confirms that low testosterone in IHH patients is associated with glomerular hyperfiltration. Patients with IHH should be carefully monitored with respect to their GFR.
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    The Investigation of Relationship between Coronary Artery Ectasia, Benign Prostatic Enlargement, and Lower Urinary Tract Symptoms
    (Elsevier Science Inc, 2015) Inci, Mehmet; Baydilli, Numan; Akcay, Adnan Burak; Demirtas, Abdullah; Rifaioglu, Mehmet Murat; Gozukara, Kerem Han; Kaya, Mehmet Gungor
    OBJECTIVE To investigate benign prostatic enlargement (BPE) and lower urinary tract symptoms (LUTS) in patients with coronary artery ectasia (CAE). The relation between CAE, BPE, and LUTS has not been studied so far. METHODS We investigated BPE and LUTS symptoms in 47 men with CAE, 45 men with coronary artery disease (CAD), and 47 male controls with normal coronary arteries. LUTS was evaluated by the International Prostate Symptom Score (IPSS). BPE was evaluated with transabdominal ultrasonography. CAD was defined as myocardial infarction and angiographically diagnosed coronary disease. CAE was defined as being without any stenotic lesions with a visual assessment of the coronary arteries showing a luminal dilatation >= 1.5 fold of the adjacent normal coronary segments. RESULTS Prostate volume was higher in CAE and CAD patients compared with that of the control subjects, respectively (41.0 +/- 10.4 vs 33.5 +/- 9.4 cm(3); 39.1 +/- 10.3 vs 33.5 +/- 9.4 cm3; P = .0001); total IPSS was higher in CAD and CAE patients compared with that of the control subjects (P = .0001). Postmictional residual urine volume was higher in CAE and CAD patients compared with that of the control subjects (P = .002). CONCLUSION We showed that patients with CAE have higher prostate volume, IPSS, and postmictional residual urine volume compared with those of controls with normal coronary angiograms. This study proposes that BPE, LUTS, and CAE maybe different disorders to a common vascular pathology and endothelial dysfunction. This study showed that BPE and LUTS were frequently seen in CAE at least as much as in CAD. Therefore, LUTS and BPE should be kept in mind for CAE patients in follow-ups. (C) 2015 Elsevier Inc.
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    Overactive Bladder and Pontine Reticular Formation
    (Karger, 2013) Zorba, Orhan Unal; Kirbas, Serkan; Uzun, Hakki; Cetinkaya, Mehmet; Onem, Kadir; Rifaioglu, Mehmet Murat
    Background: 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, Basel
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    A practice report of bladder injuries due to gunshot wounds in Syrian refugees
    (2014) İnci, Mehmet; Karakuş, Ali; Rifaioglu, Mehmet Murat; Yengil, Erhan; Atcı, Nesrin; Akın, Ömer; Tuzcu, Kasım; Kiper, Ahmet; Demirbaş, Onur; Şahan, Mustafa
    AMAÇ: Suriyeli mültecilerde mesane rüptürlerindeki tecrübelerimizi paylaşmak, tanı ve tedaviye göre literatürü taramak. GEREÇ VE YÖNTEM: Suriye'deki çatışmalarda abdominal ve ingüinal ateşli silah yaralanması ve mesane rüptürü olan 22 olgu sunuldu. Yaş, mekanizma/hasar bölgesi, ilişkili yaralanmalar; revize travma skoru (RTS) hasar ciddiyet skoru (ISS), travma yaralanması şiddet skoru (TRISS) ve komplikasyonları analiz edildi. Mesane yaralanma ciddiyeti Amerikan travma semptom skoru birliğine (AAST-OIS grade >II veritabanı) göre sınıflandırıldı. Mesane rüptür tipi BT sistografi bulguları temelli mesane yaralanma sistemi sınıflamasına göre tanımlandı. BULGULAR: Ortalama yaş 26 (18-36) ortalama hasar ciddiyet skoru 22 (10-57) idi. Ortalama travma yaralanması şiddet skoru 0.64 (0.004-0.95) ve revize travma skoru 6.97 (3.30-7.84) idi. Mortalite grubunda ortalama ISS, TRUS ve RTS sırasıyla 48 (36-57), 0.016 (0.004-0.090) ve 4.10 (3.30-4.92) idi. Oysa ortalama ISS, TRISS ve RTS sırasıyla yaşayan grupta (p=0.06) sırasıyla 21 (10-26), 0.64 (0.49-0.95) ve 7.24 (5.65-7.84) olarak bulundu. CT sistografide 17 tip 2, 3 tip 4 ve 2 tip 5 mesane yaralanması gösterildi. AAST-OIS'ye göre dokuz adet grade IV, altı adet grade VII, beş adet grade II ve iki adet grade V yaralanma vardı. TARTIŞMA: Savaş ortamında yaralanmalar ciddi ve multipl olduğunda cerrahi explorasyon ve kapama zorunludur. Mortalite riski yüksek ISS düşük TRISS ve düşük RTS değerleri ile ilişkiliydi