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Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment Ischemic Priapism: A Single-Center Experience
(Elsevier Sci Ltd, 2019) Ortac, Mazhar; Cevik, Gokhan; Akdere, Hakan; Ermec, Bahadir; Kadioglu, Ates
Background: Ischemic priapism (IP) is a urologic emergency that requires early intervention. The main aim of IP treatment is to relieve the cavernosal pressure and provide erectile function. Aim: The aim of this study was to determine the correlation between preoperative risk factors (patient's age, duration of priapism, preoperative erectile function) and postoperative erectile dysfunction (ED). Methods: This retrospective study consisted of 25 patients diagnosed with refractory IP between 2009-2017. The diagnosis of IP was confirmed by medical history, physical examination, and cavernosal blood gas analysis. All of the patients underwent the T-shunt procedure +/- tunneling after a failed initial intervention. Results: The mean age at the time of the IP diagnosis was 46.84 years (range 23-77). The average follow-up time of the study population was 40.4 months (range 3-114), and the median time from the occurrence of IP to surgery was 58 hours (range 24-240). In all cases, rapid resolution of the erection was achieved with the T-shunt +/- tunneling procedure. In 1 patient, priapism recurred after 12 hours. Postoperative ED was reported by 16 (84.21%) patients, with degrees of mild, mild to moderate, and severe in 6, 1, and 9 of these cases, respectively. During the follow-up, the mean International Index of Erectile Function-5 (IIEF-5) score was 12.68 (range 5-23). Only 3 (15.78%) patients achieved successful sexual intercourse without any treatment. 6 (31.5%) patients required the aid of phosphodiesterase type 5 inhibitors, and 1 (5.26%) patient required the aid of a vacuum erection device. The 9 (47.36%) patients with severe ED failed to respond to medical treatment and were considered candidates for a penile implant. According to Kendall's tau-b correlation coefficient analysis, there was a positive correlation between the preoperative and postoperative IIEF-5 scores (P = .005), whereas the patient's age and duration of priapism were negatively correlated with the postoperative IIEF-5 score (P = .016 and P = .046, respectively). Clinical Implications: Treatment options of IP should be discussed with patients in terms of both preoperative erectile function and the duration of priapism. Strengths & Limitations: The small sample size and retrospective nature of this study were the main limitations. Conclusions: Despite high success and low complication rates of T-shunt surgery, the rate of undisturbed erectile function is only 14.6%. The patient's age, the existence of preoperative ED, and the duration of priapism are associated with postoperative IIEF-5 scores. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Asymptomatic Giant Right Renal Oncocytoma: A Case Report
(Springernature, 2023) Cevik, Gokhan; Tozsin, Atinc; Erdogan, Ezgi G.; Cakici, Hakan; Akdere, Hakan
Renal oncocytoma is usually detected incidentally. It can be considered as a renal cell carcinoma (RCC) on preoperative imaging. They usually present as small masses and usually look like benign tumors. Giant oncocytomas are rare. A 72-year-old male patient was seen in the outpatient department for left scrotal swelling. Ultrasound (US) showed a giant mass compatible with RCC in the right kidney which was incidentally detected. Abdominal computed tomography (CT) revealed a mass with an axial diameter of 167x146 mm, compatible with RCC, a heterogeneous mass of soft tissue density with central necrosis. There was no evidence of tumor thrombus in the right renal vein or inferior vena cava. Open radical nephrectomy was performed through an anterior subcostal incision. Pathological examination revealed a 17x15 cm renal oncocytoma. The patient was discharged on the sixth day postoperatively. Clinically or radiologically, renal oncocytoma and renal cell carcinoma usually cannot be distinguished, although oncocytoma may be suspected if a central scar with fibrous extensions is seen, the so-called spoke-wheel appearance. The treatment decision should be made according to the clinical aspects. Radical/partial nephrectomy or thermal ablation can be considered as treatment options. In this article, we review the literature on the radiological and pathological features of renal oncocytoma.
Determination of the Roles of Endothelial Nitric Oxide Synthase 4VNTR (4a/b), G894T, T786C Gene Variations in the Bladder Cancer Development
(Springer India, 2024) Ay, Arzu; Alkanli, Nevra; Cevik, Gokhan
The aim of this study is to determine the roles of eNOS gene variations in BCA development. Our study included 91 patients diagnosed with BCA and 91 healthy controls. eNOS 4VNTR (4a/b), T786C and G894T gene variations genotype distributions were determined by PCR and RFLP methods. The significant difference was determined between these groups in terms of eNOS T786C and eNOS G894T gene variations genotype distributions (p < 0.05). TT genotype for G894T gene variation and CC genotype for T786C gene variation were detected higher in patients. The CC genotype of T786C gene variation was detected significantly higher in male patients than in male controls (p < 0.05). In addition, aa-TT, ab-TT, bb-TT haplotypes of 4VNTR (4a/b)-G894T gene variations, aa-CC, ab-CC, bb-CC haplotypes of 4VNTR (4a/b)-T786C gene variations and TT-TT, TT-CC, TT-CT, GG-CC, GT-CC haplotypes of G894T-T786C gene variations were observed in patient group more than control group. The significant difference was detected between these groups in terms of eNOS (G894T-T786C) haplotypes (p < 0.05). In our study, eNOS T786C and eNOS G894T gene variations were determined important genetic risk factor in the Thrace population of Turkey.
The Effect of Pirfenidone on Peyronie Plaques and Erectile Function in a Peyronie's Rat Model
(Coll Physicians & Surgeons Pakistan, 2023) Cevik, Gokhan; Tozsin, Atinc; Tastekin, Ebru; Dursun, Murat; Aktoz, Tevfik; Kadioglu, Ates
Objective: To investigate the anti-fibrotic effects of pirfenidone on Peyronie's disease in an experimental rat model with intracavernosal injection of TGF-ss and whether pirfenidone improves erectile function. Study Design: Experimental study. Place and Duration of the Study: Faculty of Medical Experimental Animals and Research Laboratory, Trakya University, from January to March 2021. Methodology: In this study, 27 male Sprague Dawley rats were used, and three groups were randomly identified. The rats in Group 1 served as the control group. Group 2 was not treated, and Group 3 was treated with pirfenidone therapy. The rats in Group 3 were administered pirfenidone 30 mg/kg/day by oral gavage, every day for four weeks, three weeks after the start of the experiment. At the end of seven weeks, a haemodynamic study was performed with cavernosal nerve stimulation to evaluate the erectile function, the rats were sacrificed, and the penile tissues were evaluated immunohistochemically. Results: MeICP/MIBP values were found to be higher in treated rats compared to rats in the untreated group but no statistically significant difference was found in MeICP/MIBP values between the control, Peyronie model, and treatment groups (p=0.25). According to the histopathological examination, the rate of fibrosis with H&E staining was mild (100%) in the control group, severe (100%) in the Peyronie group, and severe (87.5% severe and 12.5% moderate) in the Peyronie + treatment group. Conclusion: In the study, pirfenidone used in the treatment of Peyronie's disease had a positive effect on erectile function, though not considered statistically significant. It has been shown that it has no histopathological effect on Peyronie's plaques.
The Effectiveness of 3-D Computed Tomography in the Evaluation of Penile Deformities in Patients With Peyronie's Disease: A Pilot Study
(Elsevier Sci Ltd, 2019) Ozmez, Abdulkadir; Ortac, Mazhar; Cevik, Gokhan; Akdere, Hakan; Bakir, Baris; Kadioglu, Ates
Background: Anatomic and functional evaluation of the penis before treatment is very important in the choice of treatment in patients with Peyronie's disease (PD). Aim: To compare 3 different methods for the evaluation of the penile deformity, including auto-photography, combined intracavernous injection stimulation test (CIS), and 3-dimensional computed tomography (3D CT) during artificial penile erection in patients with PD. Methods: Pretreatment penile deformities of patients with PD were compared with those detected with autophotography, using goniometer after intracavernosal vasoactive agent, and 3D CT correlations among these 3 methods were investigated. Main Outcome Measures: Assessments of penile curvature with auto-photography, CIS, and 3D CT. Results: The mean age of 36 patients who were included in the study was 58 +/- 8.25 (36-72) years, and the mean time since the onset of the disease was 25 +/- 24 months (2-144). Degrees of penile curvatures measured using auto-photography, CIS, and CT were determined as 24 degrees (0 degrees-80 degrees), 40 degrees (0 degrees-90 degrees), and 34 degrees (0 degrees-80 degrees), respectively. When general correlation analysis was performed to evaluate the penile curvatures of all patients using 3 methods, a moderate correlation between auto-photography and both CIS (r = 0.72, P < .001) and 3D CT (r = 0.56, P < .001) was detected, whereas a strong correlation was noticed between CIS and 3D CT (r = 0.78, P < .001). When the correlation analysis between patients with and without ED was examined, a statistically significant decrease in the strength of correlation between CIS and auto-photography in patients with ED (0.629 vs 0.925, P < .05), however, was detected without any statistically significant difference in patients without ED (0.694 vs 0.813, P > .05). Conclusion: The superiority of 3D CT over auto-photography and its strong correlation with CIS in most parameters have been demonstrated. However, it was found that CT did not give more information than the evaluation with CIS. Current limitations and cost increases limit the use of 3D CT in the assessment of PD. Copyright (C) 2019, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.
Hypergonadotropic Hypogonadism: Management of Infertility
(Bentham Science Publ Ltd, 2021) Kalkanli, Arif; Akdere, Hakan; Cevik, Gokhan; Salabas, Emre; Cilesiz, Nusret Can; Kadioglu, Ates
Background: Medical treatments are used either alone or in combination with assisted reproductive techniques for the treatment of infertile patients with hypergonadotropic hypogonadism. A wide range of treatment options such as gonadotropins, aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs) and their combination are available as options. Objective: The aim of this review was to evaluate treatment options for infertile men with hypergonadotropic hypogonadism. Methods: A literature search of MEDLINE (1980-2019) was conducted using the terms 'hypogonadism', 'male infertility', 'gonadotropins', 'SERMs' and 'AIs'. Pathologies leading to hypergonadotropic hypogonadism and treatment modalities such as gonadotropins, SERMs, AIs and surgical treatment were discussed. Results: FSH increases spontaneous pregnancy rates but the level of evidence was proven to be low for live birth rates. AIs are valid treatment options for patients with low T/E2 ratio as they significantly increase sperm concentrations. SERMs are recommended for infertile males with a sperm concentration between 10-20 million. Varicocele was reported to increase testosterone levels of hypogonadic infertile males. Conclusion: Medical treatment modalities such as gonadotropins, SERMs, AIs and a combination of these therapies has been showed to have some effect in improvement of fertility but is not mainstream of the treatment.
Investigation of roles of IL-8 (+781 C/T) and MMP-2 (-735 C/T) gene variations in early diagnosis of bladder cancer and progression
(Springer, 2023) Alkanli, Nevra; Ay, Arzu; Cevik, Gokhan
Background The aim of our study is to investigate the roles of IL-8 (+ 781 C/T) and MMP-2 (-735 C/T) gene variations in early diagnosis and progression of BCA. Methods Polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) methods were used to determine the genotype distributions of IL-8 (+ 781 C/T) and MMP-2 (-735 C/T) gene variations. Results In our study, the genotype distributions of IL-8 (+ 781 C/T) and MMP-2 (-735 C/T) gene variations were not found to be significantly different between the patient and control groups. In addition, C and T allele frequencies for these gene variations were not different from the Hardy-Weinberg distribution in patient and control groups. However, when the combined genotype analyzes for these gene variations were evaluated, CC-CC and CT-CC combined genotypes for + 781 C/T / -735 C/T gene variations were observed significantly more in the patient group compared to other genotypes. Conclusion Although IL-8 (+ 781 C/T) and MMP-2 (-735 C/T) gene variations were not found to be genetic risk factors in the Thrace population in our study, CC-CC and CT-CC combined genotypes were determined as genetic risk factors for BCA susceptibility. The combined genotypes obtained as a result of the combined genotype analysis of these genetic variations that are effective in tumor progression may be considered to be important biomarkers for the early diagnosis and progression of BCA.
Investigation of the relationship between MMP-1 (-1607 1G/2G), MMP-3 (-1171 5A/6A) gene variations and development of bladder cancer
(Springer, 2021) Ay, Arzu; Alkanli, Nevra; Cevik, Gokhan
Background Chronic inflammation is an important risk factor in the development of bladder cancer. It may stimulate growth and metastasis of cancer cells. The inflammatory process includes MMP activities and expression. MMP activation can be stimulated by various inflammatory cells. Pathological processes such as bladder cancer may occur due to imbalance in MMP activities. In our study, we aimed to determine the relationship between MMP-1, MMP-3 gene variations associated with chronic inflammation and the bladder cancer development. Methods Our study was carried out with 89 bladder cancer patients and 78 healthy controls. PCR-RFLP methods were applied to determine MMP-1 and MMP-3 gene variations genotype distributions. Results 1G/1G homozygous and 1G/2G heterozygous genotypes of MMP-1 gene variation were determined more in patients than controls. The 5A/5A homozygous and 5A/6A heterozygous genotypes of the MMP-3 gene variation were detected more in patients than controls. The significant difference was detected in terms of genotype distributions of MMP-1 and MMP-3 gene variations between these groups (p < 0.05). In addition to, the most common haplotype in the patient group were detected as 1G/2G-5A/6A (20.22%). Conclusion In this study, MMP-1 and MMP-3 gene variations were determined as possible genetic risk factors for bladder cancer development in the Thrace population.
Investigation of the relationship between MTRR A66G, MTR A2756G gene variations and cell anomalies in early diagnosis and progression of bladder cancer
(Springer, 2022) Alkanli, Nevra; Ay, Arzu; Aydin, Pinar Koroglu; Cevik, Gokhan
Background The aim of this study is to investigate the relationship between MTRR A66G, MTRA2756G gene variations and cell anomalies in the early diagnosis and progression of bladder cancer. Methods PCR and RFLP methods were used to determine the genotype distributions of MTRR A66G and MTR A2756G gene variations. Peripheral smear preparations prepared from blood samples were fixed with methanol fixative and stained histochemically. Cellular morphological evaluations were made under the light microscope. Results In our study, AA-GG haplotype was observed significantly more in the patient group than control group (OR: 3.304, 95% CI: 1.023-10.665, p = 0.046). The significant increase was determined in terms of histological damage parameters in the patient group compared to the control group (p < 0.05). For multiple vacuoles damage parameter (mild score), AA genotype of MTR A2756G gene variation was significantly different compared to AA genotype of MTRR A66G gene variation (OR: 0.211, 0.049-0.912, p = 0.037). AA genotype of MTR A2756G gene variation was observed more than AA homozygous genotype of MTR A66G gene variation for giant platelets with different sizes damage parameter (mild score) (OR: 0.062, 0.017-0.228, p < 0.001). Conclusions In conclusion, in Thrace population, AA genotype of the MTR A2756G gene variation was significantly higher than the AA homozygous genotype of the MTR A66G gene variation as a genetic risk factor for the multiple vacuoles damage parameter. In addition, AA genotype of MTR A2756G gene variation was determined as a genetic risk factor for giant platelets with different sizes damage parameter.
Investigation of the roles of IL-18 (-607 C/A) and IL-18 (-137 G/C) gene variations in bladder cancer development: case-control study
(Springer, 2021) Alkanli, Nevra; Ay, Arzu; Cevik, Gokhan
Background The purpose of our study is to investigate the roles of IL-18 gene variations in bladder cancer development in Thrace population of Turkey. Methods This study was carried out with 103 bladder cancer patients and 81 healthy controls. Genotype distributions of IL-18 (-137 G/C) and IL-18 (-607 C/A) gene variations were determined using polymerase chain reaction (PCR) method. Results The CC homozygous genotype for IL-18 (-607 C/A) gene variation was significantly higher in patients with bladder cancer compared to healthy controls (OR 0.345, 95% Cl 0.186-0.639, p = 0.001). Besides this, allele frequencies of IL-18 (-137 G/C) and IL-18 (-607 C/A) gene variations in patient with bladder cancer and healthy control groups were significantly different from the Hardy-Weinberg distribution (p < 0.05). For IL-18 (-137 G/C) and IL-18 (-607 C/A) gene variations, significant difference was determined between the bladder cancer patient and healthy control groups in terms of GC-CA (OR 0.381, 95% Cl 0.203-0.714, p = 0.002), GC-CC (OR 2.147, 95% Cl 1.013-4.550, p = 0.043), GG-AA (OR 0.431, 95% Cl 0.365-0.509, p = 0.049), and GG-CC (OR 2.476, 95% Cl 1.177-5.208, p = 0.015) haplotypes. Conclusion In our study, CC genotype of IL-18 (-607 C/A) gene variation was determined as genetic risk factor for bladder cancer development. In bladder cancer patient and healthy control groups, G and C allele frequencies of IL-18 (-137 G/C) gene variation, and C and A allele frequencies of IL-18 (-607 C/A) gene variation were determined significantly different from the Hardy-Weinberg distribution.
A Modified Left Ileal Conduit in the Presence of a Left Short Ureter Following an Urgent Radical Cystectomy: A Case Report
(Springernature, 2023) Cakici, Hakan; Tozsin, Atinc; Cevik, Gokhan; Akdere, Hakan
The ileal conduit is the most common method performed for urinary diversion following radical cystectomy. The prepared conduit is usually placed on the right abdominal wall. There is not enough experience and literature on left-sided ileal conduits. Here, we report a case of a left-sided ileal conduit with a modified method and describe the surgical technique. A 68-year-old male patient had undergone an urgent radical cystectomy operation one year ago due to bladder cancer and gross hematuria. However, urinary diversion was not performed, and a bilateral nephrostomy was inserted. An ileal conduit was planned for the patient after oncological stabilization. On preoperative evaluations, bilateral ureters were observed to be short, with the left being prominent. The prepared ileal conduit was passed under the sigmoid mesentery due to the short ureters and placed on the left abdominal wall. There were no major complications during follow-ups. We emphasize that the method we performed is a safe option in mandatory situations.
Penile curvature after Peyronie's disease surgery: What are the risk factors?
(Wiley, 2020) Salabas, Emre; Ozmez, Abdulkadir; Ermec, Bahadir; Cevik, Gokhan; Akdere, Hakan; Kadioglu, Ates
Surgery is the golden standard for the treatment of patients with Peyronie's disease in chronic phase (12-18 months). Learning risk factors for post-surgical curvature (>20 degrees) would aid both surgeon and patient in their decision-making process. The aim of this study was to investigate the risk factors for residual/recurrent curvatures. The clinical data of the patients, who underwent reconstructive surgery for PD between 1997 and 2016, were retrospectively reviewed. Follow-ups were performed via physical examination, surveys and phone calls. For shortening surgery (Nesbit/plication), initial bi-planar curvature was proved to be a predictor of post-operative curvature (p = .05). Lateral and ventral curvatures were associated with higher recurrence rates in patients who underwent grafting surgery (p = .01). In terms of baseline comorbidities, only diabetes mellitus had an association with curvature nonrecurrence for both shortening and lengthening surgeries (p < .05). Grafting surgery may be suggested to patients who had bi-planar curvatures instead of Nesbit surgery. Nesbit plication surgery may be preferred for patients with lateral and ventral curvatures instead of grafting surgery. Higher cavernosal blood pressures and more nocturnal erections of nondiabetic young patients might impede plication sutures and grafts and therefore increase penile curvature recurrence.

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