Browsing by Author "Günsar, C"
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Item CAN URINARY BIOMARKERS SUCCEED DIAGNOSTIC VALUE OF RENAL SCINTIGRAPHY IN PATIENTS WITH URETEROPELVIC JUNCTION DISRUPTION?Gürer, DE; Yilmaz, Ö; Ertan, P; Eser, E; Taneli, F; Aras, F; Oran, A; Genç, A; Günsar, C; Sencan, A; Gürer, E; Taneli, CItem Isolated esophageal atresia with spontaneous recanalizationGünsar, C; Sencan, A; Karaca, I; Mir, EIsolated esophageal atresia is characterized by a long segment between the 2 esophageal pouches. The authors describe a case of pure esophageal atresia that showed spontaneous recanalization in the waiting period for primary esophageal anastomosis. Regurgitation of gastrostomy formula surprisingly was seen in her mouth. The patency of the esophagus was confirmed with thoracic computed tomography (CT) and an esophagogram. A strictured area in the proximal upper third of the esophagus was managed with baloon dilatation. She was discharged in normal condition, feeding by mouth, and with a normal esophagogram. This interesting event led us to speculate about a different type of pure esophageal atresia with the feasibility of the ends recanalizing after some events such as inflammation. This could be the subtype 115 of type 2 in Kluth's atlas of esophageal atresia in which they described 2 blind esophageal ends and a cyst occupying the intervening space. Another speculation about this subject is the presence of double membranes associated with esophageal atresia with a normal outer appearance of the esophagus as was first described by A. F. van Loosbroek, Copyright 2002, Elsevier Science (USA), All rights reserved.Item Pyloric atresia associated with multiple intestinal atresias and pylorocholedochal fistulaSencan, A; Mir, E; Karaca, I; Günsar, C; Sencan, A; Topçu, KAlthough congenital pyloric atresia commonly occurs in isolation, it has rarely been reported in association with other alimentary tract atresias. This is a report of a newborn with congenital pyloric atresia associated with duodenal atresia, jejunal atresia, apple-peel ileal atresia, and pylorocholedochal fistula. Preoperative diagnosis was duodenal atresia because of bilious vomiting, and erect radiogram showed double bubble sign. The presented case is the first report of such an association. Copyright 2002, Elsevier Science (USA). All rights reserved.Item Does ileal reverse segment in rats with short bowel syndrome change intestinal morphology?Sencan, A; Akçora, B; Mir, E; Sencan, A; Günsar, C; Arslan, O; Özer, EBackground: The primary goal of surgical therapy for short bowel syndrome is to increase intestinal absorptive capacity. Many surgical procedures have been described for this purpose. One of these is ileal reverse-segment procedure. This procedure after massive small-bowel resection is an alternative way to treat short bowel syndrome. but how it affects intestinal morphology in short bowel syndrome has not been investigated. The aim of this study is to investigate macroscopic and microscopic effects of reverse-segment procedure on the short bowel. Methods: Twenty rats underwent resection of 80% of the small bowel. The rats were separated into two groups (n = 10). In the first group (reverse group). a reverse segment was formed by twisting a 2-cm ileal segment 180degrees, without damaging its vascularity. In the second group (control group), a 2-cm ileal segment was resected, preserving its mesentery, and end-to-end anastomosis was performed to maintain the intestinal passage. The segment was not twisted 180degrees. The 2-cm proximal (jejunal) and distal (ileal) segments of the resected bowel were reserved for histologic investigation. Two months later, the rats were killed and the jejunal and ileal segments were evaluated morphologically, Results: In the reverse group, body weight and total intestinal length significantly increased (14% more than in the control group). The diameter of both proximal (jejunal) and distal (ileal) segments in the reverse group also increased 53.8% and 22.8%, respectively (P < 0.05). Histologically, crypt depth and villus height of the ileal segment in the reverse group increased 15,2% and 18.2% more than in the control group (P < 0.05). No histologic change was observed at the jejunal level except for intestinal muscle thickness. Conclusions: Ilea] reverse-segment procedure in rats with short bowel syndrome 1) does not cause intestinal obstruction, 2) increases total bowel length and body weight, 3) increases the diameter of both jejunal and ileal segments, and 4) increases villus height and crypt depth only at the ileal level. For this reason, reverse-segment procedure positively affects intestinal adaptation.Item Testis fixation in prepubertal ratsSencan, A; Cenç, A; Günsar, C; Daglar, Z; Yilmaz, Ö; Ulukus, Ç; Özer, E; Taneli, C; Mir, EExperimental studies have shown that different suture materials used in testis fixation cause some degree of inflammation in the testis. This study was planned to compare the histological changes that were caused by fibrin glue which is a tissue sealant and by silk and polypropylene for transparenchymal testis fixation. 28 prepubertal rats were divided into 4 groups. Testis was fixed to the tunica vaginalis by fibrin glue in group 1, by silk in group 2 and by polypropylene in group 3. Group 4 was planned as a control. Testicular inflammation and seminiferous tubular diameter were evaluated for histological changes. The least inflammation was observed in the fibrin glue group, while the most inflammation occurred in the silk group. Seminiferous tubular diameter was 241.55 +/- 45.90 in the fibrin glue group, 151.90 +/- 8.34 in the silk group and 161.36 +/- 9.96 in the polypropylene group. In conclusion, fibrin glue, when used for testis fixation, causes less inflammation and less destruction of seminiferous tubular diameter compared with silk and polypropylene.Item The maturity of intestinal neomucosaGünsar, C; Vatansever, HS; Arslan, OA; Sencan, A; Müftüoglu, S; Özbilgin, K; Kaymaz, F; Mir, EBackground/Purpose: The maturity of neomucosa growing on a serosal surface for the treatment of short bowel syndrome still is questionable. The aim of this study was to evaluate the intestinal neomucosa to assess its histologic maturity. Methods: A 6-cm-long isolated ileal segment (IS) was prepared in 8 Wistar albino-type rats. The IS was divided from the antimesenteric side, and 2 intestinal tubes were established, which shared a common wall and a common pedicle. After ileal biopsy sampling for the control group (CG), the IS was fashioned into a mucous fistula. Eight weeks later, all the rats were killed, and the ISs were investigated for neomucosal growth. Sections were prepared with periodic acid shift (PAS) and H & E staining for light microscopy. They also were evaluated by transmission electron microscopy. The microscopic morphology of the 2 groups was evaluated. Immunohistochemical staining was performed to show the expression of the tissue beta1, alpha3 and alpha2beta1 integrin subunits of both the neomucosa (NS) and control group (CG) segments. Results: Sections of the NS showed a well-arranged columnar epithelial cell layer with goblet cells that were generally located superficially and with a complete basement membrane. Under the electron microscope, the sections from the NS group showed an epithelial cell layer with proper microvilli of the same height, although they were shorter than those of the CG, and tight intercellular junctions between the epithelial cells. Significant differences between the NS and CG groups were found in the measurements of villus width at base, microvillus surface, and microvillus height. The lamina propria consisted of rich collagen fibers and active fibroblasts in the NS group. In the immunohistochemical staining, although beta1 integrine showed a dense distribution (+++) in the lamina propria, particularly localizing at the depth of the tunica mucosa layer, alpha3 integrin was observed to have a less dense immunoreactivity (++) in both groups. The expression of alpha2beta1 integrin showed slight and dispersed (+) staining. Conclusions: The NS showed histologic maturity and ultimate structural similarity with the native small bowel mucosa, which provides strong indirect evidence for the proper functioning of the neomucosa. (C) 2004 Elsevier Inc. All rights reserved.Item Does sucralfate prevent apoptosis occurring in the ischemia/reperfusion-induced intestinal injury?Sencan, A; Yilmaz, Ö; Özer, E; Günsar, C; Genç, K; Ulukus, Ç; Taneli, C; Mir, EBackground/Purpose: We have shown in a previous study that sucralfate is beneficial in the prophylaxis and treatment of hypoxia/reoxygenation-induced intestinal injury. The aim of this study is to investigate whether sucralfate has any effect on the prevention of apoptosis in the ischemia/reperfusion (I/R)-induced intestinal injury. Methods: Rats were randomized into three groups. Group 1 and 2 were subjected to I/R. Group 1 (treatment group) received sucralfate while group 2 (treatment control group) did not. Group 3 served as a normal control group (sham group). The terminal ileum was harvested for histopathologic investigation by light microscopy. The presence of apoptotic enterocytes (DNA fragmentation in cell nuclei) was detected by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end-labeling (TUNEL) reaction. Results: In treatment control group, 3 of 7 rats had severe inflammation. None of the sucralfate-treated rats showed severe inflammation, 6 of them only showed mild inflammatory changes (p < 0.05). The apoptotic percentage was found to be 37.1 +/- 9.4 in the sucralfate-treated group (group 1), whereas it was 45.4 +/- 3.9 in the untreated group (group 2) (p < 0.05). The sham group had a completely normal intestinal architecture. Conclusions: The present study shows that 1) the experimental model of I/R-induced intestinal injury induces enterocyte apoptosis; 2) sucralfate decreases enterocyte apoptosis in the experimental model of I/R-induced intestinal injury which may play a key role in the pathophysiological events leading to failure of the intrinsic gut barrier defense mechanisms.Item Pleural Effusions Complicating Upper Abdominal Surgical Pathologies in ChildrenGünsar, C; Asci, A; Sencan, A; Yilmaz, Ö; Mir, EIntractable pleural effusions can occur during the courses of serious intraabdominal surgical pathologies. Information about the pathogenesis, presentation and management of this pulmonary complication is limited in the literature particularly for the childhood period. In this study we aimed to present our experience on management of three adolescent patients with pleural effusions which developed after upper abdominal surgical pathologies. According to the data collected from our patients, presence of peritoneal fluid, fever higher than 38 degrees C and adolescent age can be risk factors for development of pleural effusions. If intractable fluid collections resist to multiple thoracentesis then tube thoracostomy may be needed for the treatment.Item Effect of alarm treatment on bladder storage capacities in monosymptomatic nocturnal enuresisTaneli, C; Ertan, P; Taneli, F; Genç, A; Günsar, C; Sencan, A; Mir, E; Onag, AObjective: Despite a great number of studies, very little is known about the mechanism of action of enuresis alarm systems. Nevertheless, as a result of this treatment many children are able firstly to wake up before urination occurs and then, in time, to sleep through the night without voiding. The aim of this study was to investigate the effect of enuresis alarms on bladder storage capacities. Material and Methods: A total of 28 children aged >7 years who were not polyuric but who voided once every night, slept alone in their own bedroom and who were willing, along with their family members, to cooperate were recruited. Patients were asked to record their urine output using a frequency/volume chart for two consecutive days. After these records and the results of physical and laboratory examinations were taken into consideration, treatment was instituted with the bell-and-pad ( alarm) system for a period of 12 weeks. At the end of this period, patients were asked to complete another frequency/volume chart. Results: The pre- and post-treatment maximum functional bladder capacity was 178.35 +/- 87.86 ml and 243.03 +/- 102.84 ml, respectively and the pre- and post-treatment mean day-time bladder capacity was 111.11 +/- 45.87 and 148.445 +/- 7.68 ml. Both of these differences were statistically significant (p < 0.0001 and < 0.0001, respectively). The maximum nocturnal bladder capacity was found to be increased from 177.85 +/- 84.95 to 255.25 +/- 124.52 ml after treatment (p < 0.0001). Conclusion: Treatment with the alarm system for a period of 12 weeks was seen to be associated with a significant increase in bladder storage capacities ( maximum nocturnal bladder capacity, maximum functional bladder capacity and mean day-time bladder capacity).Item Early postoperative small bowel obstruction is a different clinical entity than postoperative adynamic ileusSencan, A; Sencan, A; Taneli, C; Günsar, C; Genç, A; Ayhan, S; Mir, EEarly postoperative small bowel obstruction is a rare clinical entity different from postoperative adynamic ileus. The cases were presented to emphasize the differences between early postoperative small bowel obstruction and postoperative adynamic ileus. In this study, a 14-year-old patient who developed early postoperative (post op. 2. Day) small bowel obstruction after appendectomy was presented. Re-laparotomy was performed on the 7th postoperative day. It was observed that early postoperative small bowel obstruction was due to adhesions which caused significant intestinal loss. Ileostomy was performed and the patient was discharged from hospital uneventfully on the 25th postoperative day after stoma closure. Since symptoms, and signs of early postoperative small bowel obstruction can be confused with those of postoperative adynamic ileus, long term conservative follow-up may result in significant intestinal loss. For this reason, it is important not to delay the re-laparotomy decisionItem MURCS association and rectovestibular fistulaGünsar, C; Genc, A; Sencan, A; Daglar, Z; Alparslan, O; Mir, EMURCS association is rare, first described by Duncan in 1979, including nonrandom association of Mullerian duct aplasia or hypoplasia (MU), renal agenesis or ectopy (R), and cervicothoracic somite dysplasia. A 5-year-old girl was admitted to the clinic with a complaint of anteriorly located anus. Physical and radiologic examination of the patient found MURCS association with anorectal malformation (ARM) of rectovestibular-type fistula. She had multiple vertebral anomalies, left renal agenesis, vaginal and uterine agenesia, with a normal female 46,XX karyotype. Posterior sagittal anorectoplasty (PSARP) and sigmoid loop vaginal reconstruction was performed as a one-stage operation for the treatment of vaginal agenesis and ARM. There were no complications in the postoperative period. This combined one-stage operation can be used easily in the treatment of some components of the MURCS association such as vaginal agenesis and ARM as an associated anomaly. Copyright 2003, Elsevier Science (USA). All rights reserved.Item The Association of Choledochal Cyst and Pancreatitis: A Case Report and Review of the LiteratureAppak, YÇ; Günsar, C; Dogan, G; Tarhan, S; Kasirga, ECholedochal cysts are relatively rare congenital anomalies which are characterized by dilatation of the extra-and/or intra-hepatic bile ducts. Pancreatic involvement before choledochal cyst operation might be a risk factor for postoperative pancreatitis. In this case report, we present a patient who had pancreatic enzyme elevation before choledochal cyst operation and who developed acute pancreatitis after surgery.Item Modification of meatal advancement and glanuloplasty for correction of distal hypospadiasTaneli, C; Genç, A; Günsar, C; Sencan, A; Arslan, OA; Daglar, Z; Mir, EObjective: The meatal advancement and glanuloplasty (MAGPI) technique is still successfully used for the repair of distal hypospadias. The technique has been modified considerably since it was first described in 1981. The primary drawbacks of the procedure are the complications of meatal regression and meatal stenosis. The aim of this study was to present a modification of MAGPI for correction of distal hypospadias. Material and Methods: Ten cases with distal hypospadias were operated on using our modified MAGPI procedure. The modification involves excision of a pull-out, tag-shaped piece of glanular tissue through the vertical incision in the meatoplasty section of the original operation. By means of this excision, burying of the meatus into the glans was eased without inducing extra mobilization of the glans wings. As less glans tissue was left at the dorsal urethra the urethral meatus could be replaced in the center of the glans and better anatomic reconstruction could be attained. Results: After 1-3 years of follow-up, all the operated cases showed functionally and cosmetically satisfactory results. The cosmetic appearance achieved with our modified technique was better than that obtained with the classical MAGPI procedure. Conclusions: Using our MAGPI modification, the urethra was localized deeper in the glans and an elliptical (slit-like), wide meatus was obtained. the cosmetic appearance of which was more acceptable than that achieved with classical MAGPI.Item Histopathological evaluation of the urethra after the Snodgrass operationGenç, A; Taneli, C; Günsar, C; Türkdogan, P; Yilmaz, Ö; Arslan, OA; Mir, EObjective To investigate the histopathological outcome of the incised urethral plate after tubularized incised-plate urethroplasty (the Snodgrass procedure to repair hypospadias) in a hypospadiac rabbit model, as it can produce meatal and neourethral strictures, and healing with scarring. Materials and methods The study comprised 10 male New Zealand White rabbits (2.2-2.4 kg); under general anaesthesia the ventral urethra was completely excised I cm from the meatus proximally and a model of hypospadias formed. A full-thickness incision was then made in the distal dorsal urethra and the two sides of the incision marked by Indian ink tattooing. After placing a feeding tube (5 F) as a urethral catheter, both urethral wings were sutured ventrally by a 7/0 polydioxanone running suture, and the penile skin approximated by 5/0 chromic catgut. At 21 days and 3 months after surgery the penises were harvested, assessed histopathologically. and compared with those from control untreated rabbits of the same age and weight. Results In the study group the incised area of the dorsal urethra was re-epithelialized; the regional tissue and vascularity were normal. Conclusion In this rabbit model the dorsal urethral incisions healed with no scar tissue; only the ventral suture lines had minimal fibrosis and inflammatory reaction.Item Antibiotic treatment is superior to ursodeoxycholic acid on total parenteral nutrition associated hepatic dysfunctionGünsar, C; Vatansever, S; Var, A; Aygören, R; Yilmaz, Ö; Türköz, E; Sencen, A; Mir, EThis study aimed to investigate the apoptotic mechanisms, oxidative stress, and mechanisms of effect of antibiotics and ursodeoxycholic acid (UDCA) in total parenteral nutrition (TPN)-associated liver injury. Four groups of young rabbits were used in the study as follows: Group 1 (n: 7): TPN + Metronidazole (30 mg/kg IV) + Gentamicin (6 mg/kg IV); Group 2 (n: 7): TPN + UDCA (15 mg/kg per oral); Group 3 (n: 6): TPN only; and Group 4 (n: 7): Control group. After 10 days, the animals were killed and livers were removed. Hepatic apoptosis, apoptotic proteins, malondialdehyde (MDA) and myeloperoxidase (MPO) levels were studied in liver, and direct bilirubin values were assessed in the blood samples. Direct bilirubin increased with TPN, and antibiotic combination, as the most effective group, significantly lowered its levels (p < 0.01). MDA values also showed significant differences in comparisons between G1 and G3 (p < 0.05) and G1-G4 (p < 0.01). An increased number of apoptotic cells was detected particularly in G2 and G3, whereas the lowest levels, other than in the control group, were found in G1. All TUNEL-positive cell number data were statistically significant except between G2 and G3(p < 0.05). Caspase-3 and Bax immunoreactivities were greatest in G2. Significant differences were shown in caspase-3 immunoreactivity between the groups (p < 0.01), except between G1 and G3 (p > 0.05). All comparisons between the groups were significant for Bax (p < 0.01). In contrast, Bcl-2 immunoreactivity was moderate and highest in G1: comparisons between G1 and the other groups demonstrated statistically significant differences (p < 0.01). Fas-L immunoreactivity was greatest in G2, and all comparisons between the groups were statistically significant (p < 0.01). Metronidazole and gentamicin combination is effective on TPN-induced liver injury by the Bcl-2 anti-apoptotic pathway, total anti-apoptotic effect and by decreasing bilirubin levels. Oxidative injury in the liver increased with therapy. UDCA seems less effective on TPN-associated liver injury.Item The effects of transparenchymal suture material and fibrine-a tissue adhesive-on the contralateral testisDilsen, S; Sencan, A; Nese, N; Kandiloglu, AR; Yilmaz, O; Günsar, C; Genc, A; Taneli, C; Mir, EObjective: Experimental studies showed that fibrin glue (FG) which was used in orchidopexy and testicular torsion caused less tissue damage in the ipsilateral testis when compared with the transparenchymal suture materials. However, whether the usage of the FG in testis fixation causes any histological changes in the contralateral testis is not known. The aim of this study was to compare the effects of FG and other suture materials on the contralateral testis where no surgical procedure is performed. Material and Methods: Fifty prepubertal rats were randomly divided into 5 groups and the tunica vaginalis of all the right testes were longitudinally incised. In group 1, the incision line was closed with FG, whereas silk, catgut and polypropylene were used respectively in the groups 2, 3 and 4. Group 5 was the control group and no surgical procedure was performed on the left testes. The rats were sacrificed 3 weeks later and the diameters of the right and left testes were measured. Testes were evaluated by means of inflammation, seminiferous tubular diameter (STD), spermatogenetic activity and epididymal inflammation. Result: In group 2, 3 and 4, spermatogenetic activity, STD and the testis diameter of the ipsilateral testes decreased, whereas testicular and epidydimal inflammation increased. When the contralateral testis was evaluated, STD of the FG group decreased and FG had no extra benefit on testicular histology when compared to other suture materials. Conclusion: Surgical procedures performed on the ipsilateral testis cause only a decrease in the contralateral STD, which is observed by light microscope, but this decrease seems to have no effect on the spermatogenetic activity. Besides, the usage of FG instead of other materials in testis fixation has no extra benefit. However, it must be kept in mind that these results might vary when ultrastructural and immunological evaluations are performed.Item Giant congenital scrotal sinusDemitürk, HC; Günsar, C; Usta, IB; Özamrak, BGCongenital scrotal sinuses are extremely rare midline raphe anomalies in children. Quite few cases are published in the literature up to date. Their etiology is unclear but similar to the perineal midline cystic defects it is believed that during the early phases of embryogenesis they could arise from trapped epithelial cells as a result of incomplate closure of epithelial folds. Diagnosis depends on the physical examination and some radiological investigations such as ultrasonography and contrast studies. The preferred treatment is total excision of the sinus structure both for cosmetic reasons and the prevention of probable future complications.Item The effect of circumcision status on periurethral and glanular bacterial floraGünsar, C; Kurutepe, S; Alparslan, O; Yulmaz, Ö; Daglar, Z; Sencan, A; Genç, A; Taneli, C; Mir, EIntroduction: Circumcision is a historical operation which is still performed for different purposes. The aim of this study is to investigate the changes in periurethral and glanular sulcus flora due to circumcision to determine the role of circumcision on urinary tract infections (UTIs). Patients and Methods: Fifty patients who were circumcised for social-religious reasons between January 2000 and January 2001 were evaluated in this prospective study. Two swabs were taken from the periurethral and glanular sulcus regions both just before circumcision and 4 weeks after, and the bacteria cultured were recorded. Results: We isolated pathogenic bacteria in the periurethral region of 32 (64%) patients (enterococci in 14 cases; Escherichia coli in 12 cases) before circumcision, and this number decreased to 5 (10%) after circumcision. Similarly, pathogenic bacteria were cultured from the glanular sulcus swabs of 33 (68%) patients (enterococci in 14 cases; E. coli in 10 cases), as well as coagulase-negative staphylococci in another 15 patients before circumcision. Following circumcision, we detected pathogenic bacteria in the glanular cultures of only 4 cases, whereas 40 children had non-pathogenic skin flora. Only 1 of 5 children with history of UTIs (n = 1) and retractable phimosis (n = 4) had periurethral pathogenic bacteria (Proteus spp.) in the post-circumcision period. The differences between pre- and post-circumcision values of the pathogenic bacterial colonizations were statistically significant in both groups sampled (p < 0.05). Conclusion: Non-circumcised patients have similar pathogenic bacterial colonizations in the periurethral and the inner preputial regions, although they have no phimosis. The origin of periurethral flora should be the deeper preputial regions. The flora greatly changed with skin commensals after circumcision. Circumcision might be beneficial from this point of view. Copyright (C) 2004 S. Karger AG, Basel.Item Early renal parenchymal histological changes in an experimental model of vesico-ureteral reflux and the role of apoptosisSencan, A; Vatansever, S; Yilmaz, Ö; Genç, A; Serter, S; Gümüser, G; Kurutepe, S; Pekindil, G; Günsar, C; Mir, EObjectives. To observe early renal parenchymal cellular changes in an experimental model of vesico-ureteral reflux (VUR) and to show whether the apoptotic pathway plays a role in these cellular changes. Material and methods. Fourteen New Zealand breed rabbits were used and were divided into two equal groups (control and experimental groups). Urine samples were obtained in a sterile manner and cultured. In the study group, reflux was created in the right kidneys surgically. Renal scintigraphy and voiding cystourethrography (VCUG) were performed in both groups on Day 17. The kidneys were examined in terms of histology, apoptotic activity and caspase activity. Results. No growth was observed in urine cultures in either group. VUR was manifested in only two rabbits in the experimental group on VCUG. On renal scintigraphy, no renal scarring was observed in either of the groups and renal uptake values were in the normal range. There was a greater increase in collagen in the right kidneys in the experimental group than in the control group and apoptotic activity was significantly increased in the study group: 0% in the control group, 10.8%0.7% in the experimental group (p0.001). Caspase-6 activity was strongly positive and caspase-8 and -9 activities were moderately positive in the right kidneys of the experimental group. Caspase-6 activity was moderately positive, and caspase-8 and -9 activities were weakly positive in the contralateral kidneys of the experimental group. Caspase activities in the control group were negative (p0.001). Conclusions. In this experimental model of VUR, apoptotic activity was initiated via the caspase-8 and -9 pathway and collagen tissue increased in the renal parenchyma where reflux occurred. The balance of apoptotic activity may play a key role in the occurrence of reflux nephropathy.Item Tubularised Incised Plate Urethroplasty is an Applicable Method for the Treatment of the Hypospadiac Type of Urethral DuplicationYilmaz, Ö; Günsar, CUrethral duplication is a rare congenital anomaly usually seen in males. We present a case of urethral duplication treated by a tubularised incised plate urethroplasty (TIPU) technique. A 5-year-old male boy was admitted to the clinic with the complaints of thin calibrated urinating and diurnal enuresis. We diagnosed distal penile hypospadias. During the operation, another urethral opening was found proximal to the previously seen hypospadiac meatus, localised on the coronary sulcus. We performed the TIPU procedure without excising the duplicated urethra. We only excised the common wall between the two urethras, and used the dorsal urethral plate of the duplicated urethra for tubularisation of the neourethra. The postoperative course was uneventful. A cystoscopy was done for suspected urogenital sinus. There was no further complaint at the third postoperative month. The TIPU technique can be successfully applied in such cases. The dorsal plate of the duplicated urethra can be used to form the neourethra.