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    Accuracy of Unenhanced Computerized Tomography Interpretation by Urologists in Patients with Acute Flank Pain
    (Karger, 2015) Sancak, Eyup Burak; Resorlu, Mustafa; Celik, Orcun; Resorlu, Berkan; Gulpinar, Murat Tolga; Akbas, Alpaslan; Karakan, Tolga
    Purpose: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. Materials and Methods: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. Results: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [K]: 0.904), categorical stone size (K: 0.81), the location of calculus (K: 0.88), and hydronephrosis (K: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (K: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. Conclusion: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system. (C) 2015 S. Karger AG, Basel
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    Categorization of ureteroscopy complications and investigation of associated factors by using the modified Clavien classification system
    (Tubitak Scientific & Technological Research Council Turkey, 2016) Ogreden, Ercan; Oguz, Ural; Demirelli, Erhan; Benli, Erdal; Sancak, Eyup Burak; Gulpinar, Murat Tolga; Akbas, Alpaslan
    Background/aim: The purpose of the present study was to review the complications of ureteroscopy (URS) by using the modified Clavien classification system (MCCS) and to investigate the factors associated with complications. Materials and methods: Data regarding 811 patients who underwent URS for ureteral calculus were analyzed. Peroperative and postoperative complications were recorded. The patients were divided into seven groups depending on the severity of the complications. The association of sex, stone size, number, and localization with each MCCS grade was also evaluated. Results: The average age was 45 years. The success of the procedure after one session was 93.5%. Complications were recorded in 57.9% of the patients. According to the MCCS, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were documented in 29.8%, 7.1%, 8.6%, 11%, 0%, 1.2%, and 0% of the patients, respectively. The factors associated with the complications graded by MCCS were sex, stone size, number of stones, and localization. In addition, in multivariate analysis, history of previous surgeries for urolithiasis, orifice dilatation, and instrument size were associated with complications. Conclusion: According to MCCS, sex, history of previous surgeries for urolithiasis, orifice dilatation, size of the instrument, stone size, number of stones, and localization are associated with different grades of complications in URS.
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    Comparison of individuals consuming natural spring water and tap water in terms of urinary tract stone disease
    (Pagepress Publ, 2014) Resorlu, Mustafa; Arslan, Muhammet; Resorlu, Eylem Burcu; Gulpinar, Murat Tolga; Adam, Gurhan; Sancak, Eyup Burak; Akbas, Alpaslan
    Objectives: To compare individuals consuming natural spring water and tap water in terms of presence of urinary tract stone disease. Patients and methods: Patients were divided into two groups on the basis of the type of water: tap water (Group I) vs natural spring water consumers (Group II). The two groups were compared in terms of presence of urolithiasis. In addition to the type of water consumed, participants were investigated in terms of age, sex, occupation, body mass index (BMI) and presence of hypertension (HT) and diabetes mellitus in order to evaluate if they constituted a risk factor for urolithiasis. Results: Two hundred fifty-nine patients consuming tap water and 254 consuming natural spring water were included in this study. Presence of urinary stone disease was determined in 27% of patients in Group I and 26% of Group II (p = 0.794). At multivariate analysis involving all variables that might be correlated with the presence of urolithiasis; male gender, high BMI and presence of HT emerged as being significantly associated with urolithiasis. Conclusions: Although we showed that male gender, presence of HT and high BMI affect stone formation, no difference was demonstated in terms of presence of stone among patients consuming tap or natural spring water
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    Comparison of transperitoneal laparoscopic nephrectomy outcomes in atrophic and hydronephrotic kidneys
    (Aves, 2015) Gulpinar, Murat Tolga; Akcay, Muzaffer; Sancak, Eyup Burak; Akbas, Alpaslan; Tepeler, Abdulkadir; Resorlu, Berkan; Armagan, Abdullah
    Objective: To compare the results of transperitoneal laparoscopic nephrectomy in patients with atrophic and hydronephrotic kidneys. Material and methods: Clinical data were collected from 35 patients who had undergone laparoscopic nephrectomies for atrophic or hydronephrotic non-functioning kidneys between January 2010 and March 2014. Comparative analysis was carried out between the two groups examining demographic characteristics, imaging modalities, etiology, operative times, port numbers, conversion to open surgery, complications, pre- and post-operative hemoglobin and creatinine values, transfussion rates and length of hospital stays. Results: Laparoscopic nephrectomy was performed for atrophic kidneys in 20 (57%) patients and for hydronephrotic kidneys in 15 (42%) patients. In the atrophic group, 3 patients (15%) required transfusion because of bleeding but none of the patients required conversion to open surgery. In the hydronephrotic group one patient (6.6%) required transfusion and conversion to open surgery because of bleeding. Both of the groups were similar in terms of postoperative hospital stay but compared to the atrophic kidneys, hydronephrotic ones were associated with a longer total operative times (90.1 min vs. 73.6 min, p=0.03). Any serious complication (except for bleeding) and mortality were not encountered in both groups. Conclusion: Laparoscopic nephrectomy is a safe and effective minimally invasive technique that can be used in atrophic and hydronephrotic non-functioning kidneys.
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    Do Hypertension, diabetes mellitus and obesity increase the risk of severity of nephrolithiasis?
    (Professional Medical Publications, 2015) Sancak, Eyup Burak; Resorlu, Mustafa; Akbas, Alpaslan; Gulpinar, Murat Tolga; Arslan, Muhammet; Resorlu, Berkan
    Objective: In this study we planned to investigate the relationship between presence of kidney stones and stone burden with hypertension (HT), diabetes mellitus (DM) and body mass index (BMI). Methods: A total of 574 patients were included in the study. None of the patients had a history of stones. The 121 patients with kidney stone identified on ultrasound evaluation and the 453 patients with no stones were compared in terms of HT, BMI and DM. The stone burden of 121 patients with diagnosed stones was compared in terms of the same variables. Results: Of the 121 patients with kidney stones 30 (24.7%) had HT, while 66 (14.5%) of the 453 patients without stones had HT (p=0.007). BMI values of those with and without stones were 27.2 +/- 4.93 kg/m(2) and 25.29 +/- 4.12 kg/m(2), respectively (p<0.001). Twenty-five (20.6%) of the patients with stones diagnosed by ultrasound had DM, while 49 (10.8%) of those without stones had DM (p=0.004). When comparing patients with and without kidney stones, logistic regression analysis revealed that DM (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.17 to 3.63, p=0.013) and BMI (OR 1.08, CI 1.03 to 1.13, p=0.003) were independently associated with presence of stones. No significant relationship was found between the same variables and cumulative stone diameter (CSD) and stone surface area (SA) evaluated for stone burden. Conclusions: While diabetes mellitus, Hypertension and increased Body Mass Index may add to the possibility of stone formation, they did not affect stone burden.
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    Does Preoperative Use of Dutasteride Decrease Bleeding During Open Prostatectomy?
    (Urol & Nephrol Res Ctr-Unrc, 2018) Demirbas, Arif; Resorlu, Berkan; Gulpinar, Murat Tolga; Kardas, Sina; Doluoglu, Omer Gokhan; Tepeler, Abdulkadir; Kilinc, Muhammet Fatih
    Purpose: To investigate whether use of dutasteride, a 5-alpha reductase inhibitor, for at least four weeks preoperatively affected the blood loss during open prostatectomy (OP). Materials and methods: Retrospective analysis was made of the data of 110 patients who had undergone OP. Group I comprised 50 patients that used dutasteride for 4 weeks preoperatively, and Group II comprised 60 patients that did not use the drug. The groups were compared in respect of age, total prostate specific antigen (TPSA) levels, prostate volumes, preoperative hemoglobin (Hgb) and hematocrit (Hct) levels, postoperative reduction of Hgb and Hct, percentage reduction in Hgb and Hct, and the administration of postoperative blood products. Results: No differences were determined between the two groups in respect of prostate volumes, TPSA, preoperative Hgb and Hct levels (P = .813, P = .978, P = .422, P = .183, respectively). Postoperative Hgb reduction was 2.19 +/- 1.36 g/dL in Group I, and 2.5 +/- 1.47 g/dL in Group 11 (P = .260). Hgb reduction was calculated as 16.4 +/- 9.7% in Group I and 17.6 +/- 9.7% in Group II (P = .505). Reductions in Hct were 5.8 +/- 3.7% in Group I, and 7.3 +/- 4.4% in Group II, and percent reductions were 14.8 +/- 9.4% in Group I and 17.3 +/- 10.2% in Group II (P = .068, P = .182, respectively). Conclusion: The use of dutasteride before OP did not affect blood loss during surgery, therefore surgery should not be delayed for the administration of dutasteride to patients.
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    Instrascrotal Non-Testicular Ancient Schwannoma: A Rare Case Report
    (Derman Medical Publ, 2013) Uysal, Fatma; Gulpinar, Murat Tolga; Adam, Gurhan; Resorlu, Mustafa; Aylanc, Nilufer
    Schwannomas, which may occur in any region of the body, is very rare in the scrotum. Schwannomas are tumors that originate from Schwann cells and, theoretically, could affect any nerve. In spite of the rich innervation of the genital area, these kinds of tumors are not common in the scrotum. A 66 year old man presented with a 1-year history of painless scrotal swelling. Scrotal ultrasonography and magnetic resonance imaging revealed intrascrotal and extratesticular mass in the mid- scrotal region. Surgical excision was undertaken and histology was an ancient schwannoma of the scrotum. We report one case of ancient schwannomas of the scrotum with a review of the literature.
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    Is PSA Still the Best Marker in Diagnosis and Monitoring of Prostate Cancer?
    (Modestum Ltd, 2015) Akbas, Alpaslan; Abdulmajed, Mohamed Ismat; Gulpinar, Murat Tolga; Sancak, Eyup Burak
    Prostate cancer is the second most common cancer in males. At an early stage, prostate cancer barely causes any symptoms. The presence of symptoms upon presentation usually implies the presence of locally-advanced or metastatic disease. Therefore, early detection of prostate cancer is a necessity. Serum Prostate-Specific Antigen (PSA) test and Digital Rectal Examination (DRE) are used for early detection by the urologist. However serum PSA level is not only affected by the tumours but also other factors. The limitations of serum PSA test led to the introduction and application of various PSA derivatives to improve test sensitivity and specificity. In this review article, we provide a literature review and analysis of the currently available PSA test and its derivatives compared to new and developing potential tumour markers for detection and monitoring of prostate cancer.
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    Major Ozonated Autohemotherapy Preconditioning Ameliorates Kidney Ischemia-Reperfusion Injury
    (Springer/Plenum Publishers, 2016) Sancak, Eyup Burak; Turkon, Hakan; Cukur, Selma; Erimsah, Sevilay; Akbas, Alpaslan; Gulpinar, Murat Tolga; Toman, Huseyin
    Medical ozone has therapeutic properties as an antimicrobial, anti-inflammatory, modulator of antioxidant defense system. Major ozonated autohemotherapy (MOA) is a new therapeutic approach that is widely used in the treatment of many diseases. The objective of the present study was to determine whether preischemic application of MOA would attenuate renal ischemia-reperfusion injury (IRI) in rabbits. Twenty-four male New Zealand white rabbits were divided into four groups, each including six animals: (1) Sham-operated group, (2) Ozone group (the MOA group without IRI), (3) IR group (60 min ischemia followed by 24 h reperfusion), and (4) IR + MOA group (MOA group). The effects of MOA were examined by use of hematologic and biochemical parameters consisting of neutrophil to lymphocyte ratio (NLR), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). In addition, the histopathological changes including the tubular brush border loss (TBBL), tubular cast (TC), tubular necrosis (TN), intertubular hemorrhage and congestion (IHC), dilatation of bowman space (DBS), and interstitial inflammatory cells infiltration (IECI) were evaluated. In the IR group, compared to the Sham group, biochemical parameters indicating oxidative stress, NLR, IL-6, TNF-alpha, IMA, TOS, and OSI have increased. MOA reduced inflammation and oxidative stress parameters. Although TAS values have decreased in the IR group and increased in the MOA-pretreated group, no significant changes in TAS values were detected between the IR and MOA groups. The total score was obtained by summing all the scores from morphological kidney damage markers. The total score has increased with IR damage when compared with the Sham group (13.83 +/- 4.30 vs 1.51 +/- 1.71; p = 0.002). But, the total score has decreased significantly after application of MOA (5.01 +/- 1.49; p = 0.002; compared with the IR group). MOA preconditioning is effective in reducing tissue damage induced in kidney ischemia-reperfusion injury. The protective effect of MOA is mediated via reducing inflammatory response and regulating of reactive oxygen species (ROS). Renal histology also showed convincing evidence regarding MOA's protective nature against kidney injury induced renal ischemia-reperfusion. Consequently, MOA might be helpful in protecting the kidneys from IR-induced damage in humans, probably through the anti-inflammatory effect and reducing the total oxidant status.
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    Mean platelet volume and platelet distribution as a diagnostic marker for penile vascular disease in patients with erectile dysfunction
    (Elsevier Doyma Sl, 2016) Resorlu, Mustafa; Adam, Gurhan; Doluoglu, Omer Gokhan; Bozkurt, Selen; Sancak, Eyup Burak; Akbas, Alpaslan; Gulpinar, Murat Tolga
    Objective: To investigate the relationship between platelet activation parameters that are involved in the vascular response, the atherothrombotic process, and erectile function, in which epithelial dysfunction plays a significant role. Materials and methods: A study was performed on patients who had a color Doppler ultrasound (CDUS) of the penis due to erectile dysfunction. The patients were divided into two groups: those with normal CDUS findings, and those with vascular dysfunction on CDUS. Patients were also divided into two groups according to their scores using the International Index of Erectile Function (IIEF). The relationships between platelet activation factors, vascular parameters, and severity of the disorder were analyzed. Results: A total of 91 patients who fulfilled the inclusion criteria were included in the study. CDUS showed vascular dysfunction in 55 patients (Group I), while the findings were normal in 36 patients (Group II). Age., cholesterol level, disease duration, mean platelet volume (MPV), and platelet distribution width (PDW) were compared between Groups I and II, with Group I showing significantly higher values. The parameters that could affect Doppler ultrasound results were analyzed using multivariate regression analysis. This showed that PDW and disease duration were independent prognostic factors (p=.021 and p=.005, respectively). When the patients were divided into two groups according to their IIEF scores, in those with mild (Group A) and severe disease (Group B), it was found that there were significant differences between the groups with age, disease duration, and PDW, while two groups were found similar in terms of MPV, cholesterol levels, and hormone parameters. Conclusion: It is supposed that increased platelet activation parameters, and PDW in particular, give important information for disease progression and follow-up of vascular dysfunction in erectile dysfunction. (C) 2015 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.
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    Re: El-Tabey et al.: Long-term Functional Outcome of Percutaneous Nephrolithotomy in Solitary Kidney (Urology 2014;83:1011-1015)
    (Elsevier Science Inc, 2014) Resorlu, Mustafa; Adam, Gurhan; Sancak, Eyup Burak; Akbas, Alpaslan; Gulpinar, Murat Tolga
    [Anstract Not Available]
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    Renoprotective Effect of Humic Acid on Renal Ischemia-Reperfusion Injury: An Experimental Study in Rats
    (Springer/Plenum Publishers, 2015) Akbas, Alpaslan; Sılan, Coşkun; Gulpinar, Murat Tolga; Sancak, Eyup Burak; Ozkanli, Sidika Seyma; Cakir, Dilek Ulker
    Humic acid is an antioxidant molecule used in agriculture and livestock breeding, as well as in medicine. Our aim was to investigate the potential renoprotective effects of humic acid in a renal ischemia reperfusion model. Twenty-one rats were randomly divided into three equal groups. Intraperitoneal serum or humic acid was injected at 1, 12, and 24 h. Non-ischemic group I was evaluated as sham. The left renal artery was clamped in serum (group II) and intraperitoneal humic acid (group III) to subject to left renal ischemic reperfusion procedure. Ischemia and reperfusion time was 60 min for each. Total antioxidant status, total oxidative status, oxidative stress index, and ischemia-modified albumin levels were analyzed biochemically from the serum samples. Kidneys were evaluated histopatologically and immunohistochemically. Biochemical results showed that total oxidative status, ischemia-modified albumin, and oxidative stress index levels were significantly decreased, but total antioxidant status was increased in the humic acid group (III) compared with the ischemia group (II) On histopathological examination, renal tubular dilatation, tubular cell damage and necrosis, dilatation of Bowman's capsule, hyaline casts, and tubular cell spillage were decreased in the humic acid group (III) compared with the ischemia group (II). Immunohistochemical results showed that apoptosis was deteriorated in group III. Renal ischemia reperfusion injury was attenuated by humic acid administration. These observations indicate that humic acid may have a potential therapeutic effect on renal ischemia reperfusion injury by preventing oxidative stress.
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    The Approaches Taken by Family Physicians in Turkey Regarding Prostate Patients and Prostate Specific Antigen
    (Derman Medical Publ, 2016) Akbas, Alpaslan; Tekin, Murat; Verim, Levent; Gulpinar, Murat Tolga; Sancak, Eyup Burak; Ertekin, Yusuf Haydar; Uludag, Aysegul
    Aim: This survey study questioned family physicians about their approaches to lower urinary tract symptoms (LUTS) and about the clinical application of total and free prostate-specific antigens (tPSA and fPSA). Material and Method: The survey link was prepared online and sent to an email group for family physicians. The survey had 14 questions, none of which identified the respondents, concerning approaches to male patients with LUTS. Some questions were multiple choice and others allowed multiple answers to be chosen. The results were graphed and interpreted. Results: A total of 350 family physicians responded online. While 250 (72%) were family physician assistants or experts, 214 (61%) worked in family health centers. Of the 300 (85%) family physicians who had seen male patients with LUTS, only 64 (20%) stated that they performed a prostate examination. While 298 (99%) of the physicians prescribed alpha blockers, 234 (78%) physicians stated they requested a tPSA, and 134 (44%) answered that they requested an fPSA. Of the 134 physicians, 104 requested an fPSA without regard to the tPSA value. Discussion: The study identified differences in the approaches of family physicians to male patients with LUTS. DRE was not performed for the majority of patients and, as a result, unnecessary requests for fPSA were made. Increased awareness of approaches to LUTS patients can be provided for family physicians at events such as in-service training and scientific congresses.
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    The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception
    (Taylor & Francis Ltd, 2016) Akbas, Alpaslan; Gulpinar, Murat Tolga; Sancak, Eyup Burak; Karakan, Tolga; Demirbas, Arif; Utangac, Mehmet Mazhar; Dede, Onur
    Objectives: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction. Patients and methods: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0=never to 4 happily), and patient satisfaction rates (0=poor to 4=excellent) were assessed. Results: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p< 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. Conclusion: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.
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    The relationship between platelet-lymphocyte ratio and severity of erectile dysfunction
    (Elsevier Taiwan, 2016) Akbas, Alpaslan; Gulpinar, Murat Tolga; Sancak, Eyup Burak; Gunes, Mustafa; Ucar, Murat; Altok, Muammer; Umul, Mehmet
    The prognostic importance of platelet-lymphocyte ratio (PLR) is already known for various artery diseases. In this study, the relationship between PLR and severity of erectile dysfunction (ED) is examined in patients with impotence. The data from patients suffering from erection problems was screened retrospectively. Detailed medical history, age, International Index of Erectile Function-5 (IIEF-5) scores, fasting blood glucose, lipid, whole blood count, and hormone profile values were examined. Patients with no ED were selected as the control group. All men answered the IIEF-5 questions and were then classified according to their scores. Patients were determined to have severe ED (scores 5-7), moderate ED (scores 8-16), or mild ED (scores 17-21). An IIEF-5 score greater than 21 was accepted for the control group. The PLR values from both patient and control groups were evaluated. Demographic data were similar in both groups. Mean PLR value was 104 in control and 118 in the patient group (p < 0.001). PLR value increased depending on the severity of ED. Mean PLR values were 108 in mild, 116 in moderate, and 130 in severe ED groups. Compared with the control group, this value was statistically significant for patients with moderate and severe ED (p = 0.04 and p < 0.001). PLR showed weak negative but significant correlation with IIEF-5 scores (r = -0.27 and p < 0.001). The PLR value was found to be higher in patients with ED. PLR value may be related to ED and its severity in patients with impotence. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.
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    Time to say good bye to shockwave lithotripsy?
    (Springer, 2014) Resorlu, Berkan; Sancak, Eyup Burak; Akbas, Alpaslan; Gulpinar, Murat Tolga
    [Anstract Not Available]