Browsing by Author "Büyüksu, C"

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    Which one is responsible for pain during transrectal guided prostate biopsy
    Lekili, M; Lu, TM; Ceylan, Y; Temelta, G; Büyüksu, C
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    INFLUENCE OF THE ERECTILE DYSFUNCTION ON QUALITY OF LIFE ACCOMPANYING DIABETES MELLITUS: A LONGITUDINAL, CONTROLLED STUDY
    Okur, M; Gümüs, B; Üçer, O; Karatas, TC; Özmen, E; Büyüksu, C
    Introduction: Erectile dysfunction (ED) is one of the most common complications of Diabetes Mellitus (DM) in males and has a negative impact on the quality of life (QoL). The number of studies related with this subject is limited in the literature. QoL was evaluated and compared in diabetic patients with and without ED. Materials and Methods: Patients with ED who applied to our outpatient clinics (Celal Bayar University, Medical Faculty, Department of Urology) were included in the study. We interviewed 82 patients with DM+ED, 85 patients with ED and 65 normal (control) male subjects. All men (study and control groups) were asked to fill the IIEF (International Index of Erectile Function), CES-D (Center of Epidemiological StudiesDepression), BAI (Beck Anxiety Inventory), PIED (Pyschological Impact of Erectile Dysfunction) forms. Sildenafil citrate was administered as a medical treatment. Same forms were asked to be filled again in the 3th, 6th, 9th months of the therapy. Results: We observed that QoL of the patients with DM+ED and ED were affected negatively. ED was worse in the DM group compared to others. Significant improvements were detected in both QoL and ED in 3th and 6th months of the therapy. Conclusion: Our data show that treatment of ED significantly improves QoL in the patients with DM therefore, presence of ED has to be assessed in the patients with DM.
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    Histopathological effects of sildenafil citrate on rat corpus cavernosum
    Gümüs, B; Vatansever, HS; Müezzinoglu, T; Müftüoglu, S; Kaymaz, F; Büyüksu, C
    Sildenafil citrate (Viagra) is widely used for the treatment of erectile dysfunction with various etiologies. The aim of the present study was the investigation of histopathotogical effects of sildenafil citrate on, rat corpus cavernosum using light and electron microscopical techniques. Twenty mate rats were divided into two groups. The first group (n = 10) was used as a Control and the second group (n = 10) was treated with sildenafil citrate. Penile tissue was collected, fixed with formalin and embedded in paraffin for light microscopy, or fixed with gluteraldehyde and osmium tetroxide and embedded in Epon for electron microscopy. Light microscopical analysis showed that the corpus cavernosum was elongated and the number of blood vessels was increased. The amount of connective tissue in the penis was increased and dense collagen and smooth muscle fibers were observed in treated rats. electron microscopical analysis showed that stromal. structures of the corpus cavernosum (collagen fibers and number of cellular elements) were increased in treated rats. Fibroblasts showed signs of activation and the number of other stromal cells was increased. Immature newly synthesized collagen fibers were observed and penetrated endothelial basement membranes. In addition, endothelial cells also showed signs of activation such as cytoplasmic granules in treated rats, whereas the surface area of blood vessels was increased and basement membranes were thickened. These histopathological changes due to treatment with sildenafil citrate indicate that prolonged use of sildenafil citrate may increase the risk of fibrosis in the penis. (C) 2003 Elsevier GmbH. All rights reserved.
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    The diagnostic value of the phosphate levels in serum and 24-hour urine samples in patients with recurrent renal stone disease
    Muezzinoglu, T; Gümüs, B; Sener, E; Ari, Z; Büyüksu, C
    Objective: The aim of this study is to investigate the value of phosphate levels in serum and urine in patients with recurrent renal stone disease. Materials and methods: The patients (n: 60) were divided into two groups as first-time stone disease (group 1) and recurrent renal stone disease ( group 2). The demographical datas and their historical information were recorded and physical examination was done. The sera and urine for 24 hr were obtained from patients to measure electrolyte levels especially phosphorus. In addition, based on presenting serum phosphate levels, patients were divided into the hypophosphatemia group, less than 2.5 mg/dl; normophosphatemia group, between 2.5-5.2 mg/dl; and hyperphosphatemia group greater than 5.2 mg/dl. Results: The mean age of study group was 45 (21-70) years. Thirty-six patients (60%) were in group 1 and 24 patients (40%) were in group 2. No statistically correlation was found between stone recurrence and phosphate levels both in serum and urine. There was only a statistical association of K levels in 24-hour urine samples between group 1 and 2. Conclusion: There was no significant association between stone recurrence and initial phosphate levels in the serum or in urine. We do not propose to determine phosphate levels routinely in management of patients with stone disease.
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    Comparison of the nuclear matrix protein 22 with voided urine cytology in the diagnosis of transitional cell carcinoma of the bladder
    Lekili, M; Sener, E; Demir, MA; Temeltas, G; Müezzinoglu, T; Büyüksu, C
    Several urinary markers for transitional cell carcinoma have been investigated, including urine cytology, bladder tumor antigen, autocrine motility factor receptor and fibrin degradation products. Unfortunately, they have poor overall sensitivity. The United States Food and Drug Administration have recently approved nuclear matrix protein (NMP 22) for the detection of occult or rapidly recurring disease after transurethral resection of bladder tumor. The objective of the current study was to assess the sensitivity of NMP 22 for the detection of bladder carcinoma, as well as to correlate the NMP 22 values with multiplicity of tumor, tumor size, configuration, stage and grade respectively. A total of 78 patients (38 with bladder cancer) provided a urine sample which was divided into appropriate aliquots for each of urine cytology and NMP 22. Comparative results demonstrate a clear superiority of NMP 22 in bladder cancer detection (52.6% vs 31.6% sensitivity), while specificity was in favor of urine cytology (100% vs 82.5%). For superficial tumors, sensitivity was 78.5% for NMP 22 and 41.6% for cytology and for invasive cancers, sensitivity was 90% for NMP 22 and 60% for cytology. Urinary NMP 22 levels were significantly correlated with tumor grade and were significantly higher in large tumors than small tumors. NMP 22 test results showed sufficient sensitivity in comparison with urine cytology for the detection of transitional cell carcinoma. However, we do not think that it is a useful tool as a substitute for endoscopic examination for the detection and surveillance in bladder cancer.
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    Does Late-Onset Hypogonadism Occur by Aging? The Evaluation of IIEF, Ams-Q and Biochemical Parameters
    Üçer, O; Gümüs, B; Okur, M; Karatas, TC; Büyüksu, C
    Objective: The aim of this study is to investigate whether biochemical (hormonal) hypogonadism occurs by aging and whether ANIS-Q(Aging Male Symptoms-Questionnaire) and IIEF (International Index of Erectile Function) forms are adequate in order to evaluate its presence in case it occurs. Material and Methods: A total of 182 males who applied to the outpatient clinics of Urology Department and whose ages were between 45-90 years were included in the study. Those who had diabetes mellitus, hypertension, coronary artery disease, dyslipidemia, any psychiatric disorder and any malignancy were excluded. The patients were classified into three groups (Group 1; 45-54, Group 2; 55-64 and Group 3; over 65 years). All participants were asked to complete IIEF and AMS-Q forms and serum levels of total testosterone, free testosterone, LH, DHEA-S, SHBG and prolactin were measured. Results: Total testosterone and prolactin levels did not change with aging. Although free testosterone, bio-available testosterone and DHEA-S levels decreased with age, it was detected that LH and SHBG levels were increased. While IIEF scores decreased with age, however AMS-Q scores did not change. When subgroups of AMS-Q were taken into consideration, sexual scores increased, and a decrease in somatic and psychological scores was detected. There was a strong relationship between IIEF-EF (erectile function) and AMS-Sexual forms, Conclusion: All of the data indicate that secondary hypogonadism occurs by aging and consequent symptoms (especially sexual ones) can be evaluated with IIEF and AMS-Sexual forms.
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    Is it necessary to use Sexual Health Inventory for Men (SHIM) routinely?
    Temeltas, G; Gündüz, MI; Ceylan, Y; Gümüs, BH; Büyüksu, C
    This study was conducted to evaluate the prevalence of erectile dysfunction (ED) according to the Sexual Health Inventory for Men (SHIM) and its relationship with age and education. Six hundred and thirty-nine male patients aged >= 20 years attending a urology clinic were studied. After a detailed history and physical examination, all Patients were evaluated with SHIM. Scores were categorized into 5 groups: severe (1-7), moderate (8-11), mild-moderate (12-16), mild (17-21) and normal (22-25). The patients were classified into three groups according to their application to the urology clinic: A - patients attending specifically for ED; B - patients not ED based on SHIM and attending not for ED; C - patients ED based on SHIM, but attending not for ED. In addition, patients were partitioned into 3 age groups according to their age: 20-35, 35-55 and >55 years. Educational levels were of 2 groups: lower education and higher education. Erectile dysfunction was determined in 3.7% in the 20-35 years group, 55% in 3555 years and 41% in >55 years (P < 0.01). In men having ED through SHIM and attending not for ED, the ratio of ED was higher in the lower education than in the higher education groups (P = 0.01). SHIM is a diagnostic tool used for ED, and routine application of SHIM for patients attending the urology clinic is advisable.
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    Serum lipid levels in benign prostatic hyperplasia
    Lekili, M; Müezzinoglu, T; Uyanik, BS; Büyüksu, C
    The relationship between serum lipid levels and measures of benign prostatic hyperplasia was investigated. The study was community based. All the participants had undergone a urological investigation which included International Prostate Symptom Score (I-PSS) and Quality of Life Score (QoL), serum lipid concentrations and determination of prostate volume with transrectal ultrasonography. Body mass index was calculated with the formula of weight (kg)/surface area (m(2)) respectively. Men were considered obese if their body mass index was over 25 kg/m(2). BPH was defined by prostate volume greater than 20 ml and I-PSS greater than seven. Comparisons of serum lipid levels between men with BPH and without BPH were done. There was no correlation for serum lipid levels with either mean I-PSS and QoL scores. However, triglyceride and cholesterol levels were the lowest in severe symptomatic men than men with low symptoms. Using clinical definition of BPH that prostate volume was greater than 20 ml and I-PSS was greater than seven, men with BPH had not significantly different serum lipid levels from men without BPH. Our population-based data reflect that there was no relationship between serum lipid levels and certain physiological measures of lower urinary tract symptoms and clinical benign prostatic hyperplasia.
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    A relationship of sex hormone levels and erectile dysfunction
    Müezzinoglu, T; Gümüs, B; Temeltas, G; An, Z; Büyüksu, C
    Purpose: In this study, the relationship between sex hormone levels and erectile dysfunction (ED), as well as the necessity of routinely measuring sex hormone levels were evaluated. Materials and Methods: This study included one hundred patients admitted to a urology clinic for sexual dysfunction. To determine the hormone levels, following the history (included IIEF-5 score) and physical examination, triple blood samples were collected at intervals of 15 minutes between 08:00 and 10:00 am. Total and free testosterone, prolactin, follicle stimulating hormone and luteinizing hormone levels were studied. Results: Mean age was 43 (23 - 80) years. IIEF-5 score was less than 21 [9.8 - 4.3 (3 - 19)] in all study groups. There was a statistically significant correlation between tT and FSH, as well as between LH and FSH in Pearson (r = - 0.513, p < 0.001, respectively) and also in Spearman tests (r = - 0.224, p = 0.042 and r = - 0.459, p < 0.001, respectively). However, there was no correlation between age and serum hormone levels (p > 0.05). Of the 100 patients, 18 (18%) had low tT, 77 (77%) had normal and 5 (5%) had high tT levels. No statistically significant correlation was found between decreased libido and tT levels (p > 0.05). Twelve (66.6%) of the 18 patients with low tT had normal libido. Conclusion: Analyzing the medical history in detail and performing a thorough physical examination can reduce the need for excessive studies and consultations, and enables patients to save time and costs.
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    THE RELATIONSHIP BETWEEN SMOKING AND LOWER URINARY TRACT SYMPTOMS: COMMUNITY BASED STUDY
    Temeltas, G; Müezzinoglu, T; Üçer, O; Lekili, M; Büyüksu, C
    Introduction: The studies, investigated the relationship between smoking and benign prostatic hyperplasia (BPH), are commonly clinically based. We aimed that whether smoking has any effect on BPH and/or lower urinary tract symptoms in a community based fashion. Materials and Methods: The forms of international prostate symptom score (I-PSS), quality of life (QoL) and asking smoking addiction were fulfilled by 255 men over 40 years old living in a small town of Manisa. Meanwhile prostatic volume and post-voiding residual urine volume calculations with ultrasound were evaluated. Results: While the degree of smoking (package/year) increased, I-PSS, QoL and residual urine volume slightly increased, but no correlation found with Pearson co-efficient. Although no statistically significant relation was observed, prevalence of BPH in this population was higher in smoking men than non smoking men. Conclusion: In this study, although no statistically correlation was found between smoking and BPH, it is observed that smoking is slightly effect the prevalence of BPH. It may be speculated that smoking has variable effects on sex steroids.
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    PRE/POST MEAL PSA VALUES: SHOULD IT BE MEASURED IN PRE-MEAL BLOOD SERUM?
    Müezzinoglu, T; Lekili, M; Ceylan, Y; Var, A; Büyüksu, C
    Introduction: Prostate specific antigen (PSA) is the commonly used tumor marker in the early diagnosis of prostate cancer. Although it is highly specific for prostate, its specifity is low for prostate cancer. Since it is affected by many factors other than cancer such as diurnal variations of the secretion, existing of infections or inflammations in the prostatic tissue, volume of prostate, digital rectal examination, ejaculation or rectal manipulations and surgery of the prostate, the value of serum PSA level is limited. Serum insulin level increases and reaches maximum level at first hour due to increased glucose level after meal. Thereafter the level of serum insulin values return to its normal level at approximately two hours after meal. On the other hand, insulin suppresses the production of sex hormone binding protein in liver cells. Therefore, it is logic to investigate PSA levels due to metabolic and hormonal changes after meal. We investigated changes of PSA level after meal in this prospective study. Materials and Methods: Thirty-three healthy cases were included in this study to determine changes of serum PSA levels pre and post-meal manner. All patients were given same regular diet comprised of 700 calories (50-55% carbohydrates, 25-30% lipids and 20% proteins). Blood samples were taken an hour before meal (PSA-0), and one (PSA-1) and two (PSA-2) hours after meal. Serum PSA levels were determined by chemiluminescence method. Paired sample t test and Pearson correlation coefficient were used for statistical analysis. Results: The mean age of the patients was 42 +/- 17.5 (Range 20-80) years. The mean PSA level at one hour before meal, one and two hours after meal were 0.70 +/- 0.69 ngr/ml (PSA-0), 0.74 +/- 0.75 ngr/ml (PSA-1) and 0.65 +/- 0.57 ngr/ml, (PSA-2) respectively. There was no statistically significant difference between serum PSA-0 levels with PSA-1 (p=0.106) and PSA-2 (p=0.109) levels. However, there was a statistically significant difference between first hour and second hour after meal mean PSA levels (p=0.029). Conclusion: Serum PSA values may be affected not only from prostatic disturbances, but also the changes of its metabolism and levels of PSA binding proteins. Insulin, proinsulin, C-peptid and Zn secretion increase after meal. In contrast, glukagon, cortisol, epinephrin, norepinephrin secretion decrease. These differences could also change the levels of detectable fractions of PSA temprorarily and may affect serum total PSA levels. The differences of serum PSA levels represent paralelism with the changes in serum insulin levels after meal. In this study, mean PSA levels increased at first hour after meal and decreased at second hour after meal. These differences in PSA levels could affect the decision making for indication of prostate biopsy in patients with borderline PSA levels and it should be considered when the serum samples are taken whether patients are hungry or not. The determination of ideal serum PSA sampling time would be important in order to prevent false negative or positive serum PSA results. In this way, clinicians would decide not to do invasive procedures especially in patients with borderline serum PSA levels.
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    Evaluation of pain caused by urethrocystoscopy in patients with superficial bladder cancer
    Müezzinoglu, T; Ceylan, Y; Temeltas, G; Lekili, M; Büyüksu, C
    Aim: The aim of this study is to evaluate patients' tolerance to pain caused by urethrocystoscopy ( UCS) in both diagnosis and the period of follow- up in patients with superficial bladder cancer, and to evaluate these results with respect to quality of life. Patients and Methods: Between March 2003 and October 2004, 66 patients with bladder cancer or hematuria underwent UCS and recorded their overall pain level. Results: The mean age was 60.4 ( range 26 - 83) years. UCS was done only one time in 22 patients for the diagnosis of etiology of hematuria and was done 4 times in 44 patients every 3 months for bladder cancer follow- up. The mean pain scores on first, second, third, and fourth UCS were 4.3 +/- 2.2, 4.7 +/- 2.5, 4.68 +/- 2.45, and 5.1 +/- 2.5, respectively. Statistically significant differences were found among mean pain scores of patients on first, third, and forth cystoscopic examinations ( p < 0.05). No correlation was found between age and pain scores in this study group ( p > 0.05). Conclusion: UCS is a painful surgical procedure and pain tolerance was not observed on repeated UCS. Therefore urologists need to use more effective anesthetic methods to provide better patients' tolerance to pain and quality of life during the endoscopic procedure.
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    Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey
    Gümüs, B; Vurgun, N; Lekili, M; Iscan, A; Müezzinoglu, T; Büyüksu, C
    There has been limited epidemiological research about nocturnal enuresis in Turkey. The objectives of this study were to ascertain the prevalence of nocturnal enuresis and the epidemiological factors associated with this in Turkish children aged 7-11y, living in Manisa. Included in the study were 2000 children from various primary schools in Manisa. Parents were asked to fill out our specially designed questionnaire. In all, questionnaires for 1703 children were completed and returned to the department (871F, 51.1%; 832M, 48.9%). The prevalence of nocturnal enuresis for females was 10.6%, for males it was 16.9% and the overall prevalence was 13.7%. The prevalence of nocturnal enuresis decreased with age. Enuresis nocturna was found to be more common in children with a family history of bedwetting (76.5%). Deep sleeping, poor toilet habits and low educational level of the family were associated with enuresis. Consanguineous marriage did not influence the incidence of enuresis nocturna. There was no difference between enuretics and non-enuretics with reference to breastfeeding, being firstborn or being right- or left-handed. In our opinion, enuresis is an important problem for both families and children in Turkey for which specific guidelines should be developed. Various methods have been tried in the treatment of enuresis because of its multi-factorial aetiology. Child, family and physician co-operating together achieve the best help to both child and family.
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    THE RELATIONSHIP BETWEEN SERUM STEROID HORMON LEVELS AND I-PSS, PROSTATIC VOLUME, RESIDUAL URINE: A COMMUNITY BASED STUDY
    Temeltas, G; Muezzinoglu, T; Akar, Z; Lekili, M; Büyüksu, C
    Introduction: It is evaluated that endocrinolgical effect is the most reliable factor for development of histological and clinical BPH which is the common disease in older males. Materials and Methods: In our study, we investigated the relationship between BPH incidence and steroid hormone levels by using the criteria of I-PSS, residual urine and prostatic volume in the men over 40 in a rural town. Total and free testosterone, estradiol, dihidroepiandosteron sulfate, sex hormone binding globulin, FSH and LH levels were analyzed. I-PSS and quality of life scores were evaluated. Results: Mean FSH, LH, DHEAS, SHBG, E2, tT and fT levels were 11.03 +/- 11.06 mIU/ml (0.9-83.7), 9.26 +/- 18.7 mIU/ml (0.7-200), 114, 86 +/- 68.3 pg/dl (30-417), 55.28 +/- 31.4 nmol/L (2-180), 23.03 +/- 9.05 pg/mL (2046.1), 3.9 +/- 1.82 ng/dl (0.2-16) and 13.7 +/- 4.7 pg/mL (0.6-31.6). Mean I-PSS, QoL, residual urine and prostatic volume were 4.7 +/- 5.9 (0-30), 0.7 +/- 1.3 (0-6), 21.5 +/- 30.7 (0-295) ml and 24.4 +/- 11.4 (9-82) gr. respectively. With Pearson correlation system; age, I-PSS, QoL, residual urine and prostatic volume were well correlated with each other (p<0.05). While age increased, FSH and SHBG increased significantly (r=0.2979 and r=0.3642). On the other hand, DHEAS ( r=-0.4792) and fT (r=-0.3306) decreased, while age increased. There was no correlation between E2, LH, tT, SHBG and age. When it is accepted as all the men with their I-PSS over 7 has BPH; fT levels were statistically lower (14/12.3, p=0.009) and their SHBG levels were higher than those without BPH (52.5/64.8, p=0.029). Conclusion: If the diagnosis of BPH is determined with the different combination of I-PSS, residual urine and prostatic volume, no significant data was revealed between serum steroid hormone levels and BPH. fT levels were significantly lower in men with high I-PSS than those with low I-PSS.