Bedir, Fevzi; Özbey, İsa; Karabulut, İbrahim; Keskin, Ercüment; Yılmazel, Fatih Kürşat; Yilmaz, Ali Haydar

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Bedir, Fevzi; Keskin, Ercüment; Karabakan, Mehmet; Karabulut, İbrahim; Yılmazel, Fatih Kürşat; Özbey, Ertuğrul Gazi; Aksoy, Yılmaz; Özbey, İsa

Objective: The incidence of varicocele is approximately 15% in adolecent men. Early treatment with varicocele is aimed to resolve testicular hypotrophy and ensure catch-up growth. The aim of this study was to evaluate ipsilateral catch-up growth rates relative to contralateral testicular growth in adolescents with varicocele undergoing microsurgical subinguinal varicocelectomy. Material and methods: Fifty adolescents with unilateral grade 2-3 varicoceles were included in the study. All patients underwent microsurgical subinguinal left varicocelectomies performed by the same experienced surgeon. All patients were evaluated clinically and using orchidometric measurements to define the grade of varicocele and testicular volume at presentation and follow-up. The number of internal and external spermatic veins, testicular arteries and lymphatic vessels preserved during the subinguinal microsurgical varicocelectomy were recorded. The mean follow-up period was 26 months (range 6-48 months). Results: At presentation, mean patient age was 12.9±2.1 years. Mean testicular preoperative volumes were 7.1±4.3 mL for the right and 5.4±3.4 mL for the left testis. There were significant differences between mean volumes of the right and left testis (p=0.002). At the final postoperative follow-up visit, mean testicular volumes were 10.8±5.1 mL (range 3-25) for the right and 9.9±4.3 mL (range 2-20) for the left, and the difference between the right and left testicular volumes was insignificant (p=0.47). In our series, catch-up growth was observed in 70% (35/50) of our patients. Conclusion: Adolescent varicocelectomy is associated with a higher percentage of patients showing testicular catch-up growth. In our study, similarly to the available literature the catch-up growth rate was found as 70% and observed to have positive effects of adolescent varicocelectomy on testicular growth.

Uçar, Murat; Akin, Yigit; Yücel, Selçuk

Although the prevalence of urolithiasis is nearly 2-3% in childhood, the risk of recurrence may range from 6.5-54%. There has been an increase in urinary stone disease among pediatric age groups, and stone disease has a multifactorial etiology. After the diagnosis, detailed metabolic evaluation is required. High recurrence rates, therapeutic irregularities and deficiency in diagnosis may lead to comorbidities such as loss of kid- ney function. Following diagnosis, the requirement for surgery, such as stone extraction and correction of anatomical anomalies, is determined. Medical and supportive treatments are also needed to prevent recur- rence and urinary tract infections and to preserve renal function. Supportive care includes increased fluid intake and dietary modifications. Medical treatment is dependent on the cause of urinary stone disease. The morbidities associated with pediatric urolithiasis can be prevented by early diagnosis, detailed metabolic analysis, regular follow-up and medical treatment protocols.

Usta, Mustafa Faruk; Şahiner, İlker Fatih; Akin, Yigit

Amaç: Kliniğimizin 12 yıllık tecrübesinde, diabetes mellitus (DM) ve organik kaynaklı erektil disfonk- siyonu (ED) olan, standart cerrahi tedavi olarak; şişirilebilir üç parçalı penil protez uygulanan hastalarda, değişen kavernozal uzunlukların değerlendirilmesi amaçlanmıştır. Gereç ve yöntemler: Nisan 2000 ve Aralık 2012 arasında organik kaynaklı ED tanısı konularak penil protez implantasyonu (PPI) yapılan hastalar geriye dönük olarak değerlendirildi. İki yüz otuz dokuz has- tadan, 235i çalışmaya alındı. Cinsiyet değişimi için opere edilen 4 hasta çalışma dışında tutuldu. Hastalar 2 Gruba ayrıldı; DMli hastalar Grup 1e dahil edildi, Grup 2ye ise diğer hastalar alındı. Hastaların yaşı, vücut kitle indeksleri (kg/m2), geçirilmiş operasyon öyküsü, ek hastalıkları, ereksiyon işlevi uluslararası değerlendirme skorları (IIEF), intrakavernozal stimülasyon test (CIS) sonuçları, operasyon sırasında ölçülen korpus kavernozum boyları, komplikasyonlar, operasyon süresi, hastanede kalış süresi, hasta ve partner memnuniyeti kaydedildi. Kruskal-Wallis ve Mann-Whitney U istatistiki yöntemleri kullanıldı ve istatistik anlamlı p değeri p<0,05 olarak kabul edildi. Bulgular: Hastalarımızın ortalama yaşı 57,9±10,5 olarak saptandı. Diabetes mellitusu olan 65 hasta, radikal pelvik cerrahi geçiren 51 hasta, sadece ek hastalık hipertansiyonu (HT) olan 21 hasta, DM ve HT birlikteliği olan 28 hasta, sadece hiperlipidemisi olan 5 hasta, DM ve radikal pelvik cerrahi geçieren 4 hasta, herhangi bir prepisdoze edici ek hastalığı olmayan 62 hasta mevcuttu. Grup 1de ortalama korpus kavernosum boyu 17,277±0,1509 ve Grup 2de 17,289±0,1598 cm idi (p<0,05). Diğer parametreler; yaş, operasyon süresi, hasta ve hastanın partnerinin memnuniyet oranları iki grup arasında farklı değildi (p>0,05). Sonuç: Korpus kavernosum uzunluğunu ya da destrüksiyonu, sadece DMye bağlı değildir. Multifaktöriyel nedenlere bağlı olabileceğini düşünmekteyiz.

Akin, Yiǧit; Uçar, Murat; Yücel, Selçuk

Although the prevalence of urolithiasis is nearly 2-3% in childhood, the risk of recurrence may range from 6.5-54%. There has been an increase in urinary stone disease among pediatric age groups, and stone disease has a multifactorial etiology. After the diagnosis, detailed metabolic evaluation is required. High recurrence rates, therapeutic irregularities and deficiency in diagnosis may lead to comorbidities such as loss of kidney function. Following diagnosis, the requirement for surgery, such as stone extraction and correction of anatomical anomalies, is determined. Medical and supportive treatments are also needed to prevent recurrence and urinary tract infections and to preserve renal function. Supportive care includes increased fluid intake and dietary modifications. Medical treatment is dependent on the cause of urinary stone disease. The morbidities associated with pediatric urolithiasis can be prevented by early diagnosis, detailed metabolic analysis, regular follow-up and medical treatment protocols.

Akin, Yiǧit; Fatih Şahiner, Ilker; Usta, Mustafa Faruk

Objective: To evaluate the changing cavernosal length of patients with diabetes mellitus (DM) and organic erectile dysfunction (ED) who were treated with inflatable, three-piece penile prostheses, a current surgical treatment option in our clinic, over the course of 12 years. Materials and methods: Between April 2000 and December 2012, we retrospectively investigated data from patients who were diagnosed with organic ED and performed penile prosthesis implantation (PPI). Of the 239 patients, 235 patients were included in the study. Four patients who were operated on for transsexuality were excluded from the study. All patients were divided into two groups; group 1 included patients with DM, and group 2 included patients without DM. Data, including age, body mass index (BMI) in kg/ m2, operation history, comorbidities, International Index of Erectile Function (IIEF) questionnaire results, combined intracavernous injection and stimulation (CIS) test results, the measured length of the corpus cavernosum while implanting the penile prosthesis, complications, operation time, mean hospital stay, and the satisfaction of the patient and partner, were recorded. Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis. A p-value of <0.05 was considered to be statistically significant. Results: The mean age was 57.9±10.5 years. In the study, 65 patients with DM, 51 patients who underwent radical pelvic surgery, 21 with only additional disease hypertension (HT), 28 with combined DM and HT, 5 with hyperlipidemia, 4 with DM and radical pelvic surgery, and 62 without any additional comorbidity were identified. The mean measured length of the corpus cavernosum was 17.277±0.1509 cm in group 1 and 17.289±0.1598 cm in group 2 (p<0.05). Additionally, the other parameters, including age, operation time, and the satisfaction of the patient and partner, were not different between these groups (p>0.05). Conclusion: The length of the corpus cavernosum and the destruction of cavernosal tissues do not depend only on DM. We conclude that these features may have multifactorial causes.

Akin, Yigit; Kol, Arif; Sahiner, Ilker Fatih; Usta, Mustafa Faruk

Objective: The aim of this study is to evaluate surgical results and postoperative results of men diagnosed with organic erectile dysfunction (ED) who underwent penile prosthesis (antibiotic-coated vs. non-coated) implantation in the last 13 years. Additionally, we compared the frequency of complications between the two groups. Materials and methods: In the last 13 years, 202 men diagnosed with organic erectile dysfunction (ED) had previously undergone penile prosthesis implantation. Patient data were evaluated retrospectively. Of the 202 patients, 175 were included to the study. The mean age of patients was 57.5 (34-83) years. Preoperatively, a physical examination, medical and sexual history, International Index of Erectile Function (IIEF) questionnaire, Combined Injection and Stimulation (CIS) test and, if necessary, Nocturnal Penile Tumescence (NPT) / Penile Doppler ultrasonography (US) were performed in all cases. Results: All patients were diagnosed with organic ED. We determined that 43 (21%) patients had diabetes mellitus, 53 (26%) had a history of radical pelvic surgery, 38 (19%) had cardiovascular pathology and 19 (9%) had other reasons for ED. Approximately 98% of patients and their partners were satisfied with the surgical results of the penile prosthesis operation. Conclusion: The infection rate results in the present study were not statistically significant, and the number of patients in our study was not sufficient to make reliable conclusions. Studies with a larger sample sizes are needed.

Akin, Yigit; Saraç, Mehmet; Ates, Erhan; Yücel, Selcuk; Sevük, Metin

Lesions of the pediatric glans penis are uncommon but important for pediatric urological care. Pediatric glans penis lesions have been reported more frequently in the literature in recent years. The lesions are diagnosed at birth or with advancing age. All lesions are benign and diagnosed with a simple physical examination and radiological evaluation. Although, a minority of these lesions have been linked with malignant transformation, the malignant transformation has not been reported for the pediatric glans penis in the literature. After diagnosis and treatment, long-term follow-up is very important. To date, the literature describes 142 pediatric glans penis malformations. We prepared a comprehensive study by using data from 2 different clinics and added 3 new cases from our institutions. The common glans penis anomalies, which are hypospadiac-epispadiac anomalies, were excluded.