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Öğe A Cheap Minimally Painful and Widely Usable Alternative for Retrieving Ureteral Stents(Karger, 2011) Soylemez, Haluk; Sancaktutar, Ahmet Ali; Bozkurt, Yasar; Atar, Murat; Penbegül, Necmettin; Yildirim, KadirObjective: To describe a cheap, minimally painful and widely usable method for retrieving ureteral stents by using an ureteroscope. Subjects and Methods: Sixty-seven patients with ureteral stents were enrolled in this study. The patients were randomized into a cystoscopic (35 patients) and a ureteroscopic (32 patients) group. All stents were retrieved by a flexible cystoscope in the first group and by a ureteroscope in the second group under local anesthesia. Patients in each group were assessed for stented time, stent side, cause of stent placement, operative time, peroperative pain, postoperative pain, irritative voiding symptoms and hematuria. Also costs of instruments were calculated. Results: Stents were successfully retrieved in 67 patients. There were no statistical differences in the two groups regarding patient gender and age or stent side, operative time, stented time, mean operative pain score, irritative voiding symptom scores and hematuria. Total selling price was USD 20.399 for flexible instruments and USD 10.516 for rigid ones. Total maintenance price was higher in flexible instruments than in the rigid ones (USD 197.8 and 51.7 per use, respectively). Conclusion: Ureteroscopic stent retrieval is a minimally painful, safe and highly tolerable method under local anesthesia as well as flexible cystoscopic retrieval. Also, it is a cheap and widely usable method. Copyright (C) 2011 S. Karger AG, BaselÖğe Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis(Wiley-Blackwell, 2010) Nas, Kemal; Yildirim, Kadir; Cevik, Remzi; Karatay, Saliha; Erdal, Akin; Baysal, Ozlem; Altay, ZuhalObjectives: To investigate discrimination ability of the Assessment of Spondyloarthritis International Society (ASAS) endorsed disease activity score (ASDAS) versions evaluating low and high disease activity in an unselected group of patients with ankylosing spondylitis (AS). Methods: Patients consecutively included into the joint database of five university hospitals were analyzed for low or high disease activity according to different criteria. Standardized mean differences (SMD) for two ASDAS versions were evaluated. Results: The ASDAS versions (back pain, morning stiffness, patient global pain, pain/swelling of peripheral joints, plus either erythrocyte sedimentation rate or C-reactive protein) discriminated high and low disease activity in subgroups according to Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and ASAS remission/partial remission criteria. ASDAS versions were also not influenced by peripheral arthritis and correlated well with other outcome measurements and acute-phase reactants. The ASDAS versions performed better than patient-reported measures or acute-phase reactants discriminating high and low disease activity status. Conclusion: Both ASDAS versions, consisting of both patient-reported data and acute-phase reactants, performed well in discriminating low and high disease activity. Further longitudinal data may better estimate the usefulness of ASDAS to assess disease activity subgroups and treatment response.Öğe THE EDUCATION OF PEDIATRIC ENDOUROLOGY: THE STATUS OF TURKISH UROLOGY RESIDENTS(Mary Ann Liebert, Inc, 2012) Sancaktutar, Ahmet Ali; Yildirim, Kadir; Bodakci, Mehmet Nuri; Yavuz, Sevgi; Hatipoglu, Namik Kemal; Soylemez, Haluk; Penbegül, Necmettin[Abstract Not Available]Öğe The efficacy and safety of ureteroscopy for ureteral calculi in pregnancy: our experience in 32 patients(Springer, 2012) Bozkurt, Yasar; Penbegül, Necmettin; Soylemez, Haluk; Atar, Murat; Sancaktutar, Ahmet Ali; Yildirim, Kadir; Sak, Muhammet ErdalThe aim of this study was to investigate the efficacy and safety of ureteroscopy (URS) in pregnant women. A retrospective analysis was performed on 32 pregnant patients referred to our center between April 2005 and November 2010 with hydronephrosis requiring surgical intervention. A semirigid URS of 9.5 F was used in all patients. The mean age of patients was 27.8 years (range 20-39), and the mean gestation duration was 24 weeks (15-34). The ultrasound findings were diagnostic of obstructive ureteral calculi in 16 (50%) patients and the mean stone diameter was 8 mm. Spinal anaesthesia was performed in 22 (68.8%) patients, while general anaesthesia was performed in 7 (21.8%) patients. Ureteric stones were found in 27 (84.3%) patients during endoscopy, 10 being distal, 9 middle and 8 proximal. There were no stones in five patients. The stones were fragmented with pneumatic lithotripsy in 8 patients and with holmium laser in 17 patients and the fragments were retracted with forceps. Of the 32 patients, 19 (59.4%) required JJ stent insertion peroperatively. There was no serious complication intraoperatively, while urinary tract infection developed in four and renal colic in two patients postoperatively. In one patient, sepsis developed postoperatively, and improved with appropriate treatment. All babies were born normally. Semirigid ureteroscopy for diagnosing and treating ureteral calculi by intracorporeal pneumatic or holmium laser lithotripsy is a safe and reasonable treatment option for pregnant patients.Öğe How can the operation time be shortened by reducing the tract size?(Springer, 2018) Yildirim, Kadir; Hatipoglu, Namik Kemal[Abstract Not Available]Öğe Microsheath for Microperc: 14-Gauge Angiocath(Mary Ann Liebert, Inc, 2013) Penbegül, Necmettin; Bodakci, Mehmet Nuri; Hatipoglu, Namik Kemal; Sancaktutar, Ahmet Ali; Atar, Murat; Cakmakci, Suleyman; Yildirim, KadirMicropercutaneous nephrolithotomy (microperc) is the end point percutaneous nephrolithotomy (PCNL) technology for the present. In routine PCNL surgery, use of an Amplatz sheath is an important step, but in this technique, there is no Amplatz sheath. Some problems during surgery may occur because of the lack of an Amplatz sheath, which provides a tract between the skin and the collecting system. Therefore, we describe the smallest Amplatz sheath (6.6F) that is compatible with the microperc instrument and can be used during percutaneous surgery, especially in preschool pediatric patients.Öğe Multiple Surgeries Due To Pneumaturia, Cystolithiasis and Neurogenic Bladder in a Case with Munchausen Syndrome(Urol & Nephrol Res Ctr-Unrc, 2014) Penbegül, Necmettin; Bozkurt, Yasar; Yildirim, Kadir; Sancaktutar, Ahmet Ali; Soylemez, Haluk; Atar, Murat; Bez, Yasin[Abstract Not Available]Öğe A New Alternative for Difficult Ureter in Adult Patients: No Need to Dilate Ureter via a Balloon or a Stent with the Aid of 4.5F Semirigid Ureteroscope(Mary Ann Liebert, Inc, 2016) Soylemez, Haluk; Yildirim, Kadir; Utangac, Mehmet Mazhar; Aydogan, Tahsin Batuhan; Ezer, Mehmet; Atar, MuratObjective: To investigate the effectivity of 4.5F ultrathin ureteroscope (UT-URS) without any need for active or passive dilation in the treatment of adult patient population in whom ureteral orifices cannot be engaged using conventional URS. Materials and Methods: Among a total of 512 adult patients who had undergone URS between April 2012 and November 2015 in our department for diagnostic or therapeutic purposes, 43 (8.4%) patients required ureteral dilation because we could not engage ureteral orifice. In adult patients in whom we could not engage ureteral orifice with 7.5F and 8F semirigid URS, we tried to complete the operation using 4.5F UT-URS without resorting to dilation. Age and gender of the patients, indication for operation, stone size, location, operative times, laterality of stone(s), stone-free rates, length of hospital stay, and complications were recorded. Results: Mean age of the patients was 34.5 +/- 11.2 (21-66) years. The patients had undergone operations for ureteral stone (n = 39), unexplained hydronephrosis (n = 2), and ureteral stenosis (n = 2). Mean stone size was 8.2 +/- 2.3 (4-18) mm. Mean operative time was 64.2 +/- 13.5 minutes. In 37 of 39 patients, a complete stone-free rate (94.8%) was achieved. Mean length of hospital stay was 8.9 +/- 5.8 hours. Conclusion: It has been demonstrated that in an adult patient population in whom ureteral orifices cannot be engaged using conventional URS, ureteral access could be achieved with 4.5F UT-URS without any need for dilation. At the same time, use of 4.5F UT-URS resulted in an acceptable treatment success and lower complication rates in most of these patients without the need for a second session.Öğe Pattern of Disease Onset, Diagnostic Delay, and Clinical Features in Juvenile Onset and Adult Onset Ankylosing Spondylitis(J Rheumatol Publ Co, 2009) Ozgocmen, Salih; Ardicoglu, Ozge; Kamanli, Ayhan; Kaya, Arzu; Durmus, Bekir; Yildirim, Kadir; Baysal, OzlemObjective. To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design. Methods. A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey. Results. Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% Cl 1.25-6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51-6.98, adjusted for current age; and OR 2.26, 95% CI 1.07-4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life. Conclusion. JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient Populations. (First Release Nov 1 2009; J Rheumatol 2009;36:2830-3; doi: 10.3899/jrheum.090435)Öğe Prevalence of atopic disorders in rheumatic diseases(Springer, 2013) Karatay, Saliha; Yildirim, Kadir; Ugur, Mahir; Senel, Kazim; Erdal, Akin; Durmus, Bekir; Baysal, OzlemThe aim of this study was to assess the point prevalences of hay fever, asthma, and atopic dermatitis in OA, RA, and AS, and to compare with healthy controls. A total of 935 patients and healthy controls were included. Demographic and clinical features were recorded, and a questionnaire assessing the existence of atopic disorders like asthma, hay fever, and atopic dermatitis in all groups was applied. Either atopy implied that an individual was either diagnosed with or had symptoms of one or more of these disorders, such as asthma, hay fever, or atopic dermatitis. When compared to the controls, only patients with AS had an increased risk for hay fever (OR 1.52, 95 % CI 1.00-2.41). Patients with RA had increased risks for hay fever, atopic dermatitis, and either atopy compared to the patients with OA (2.14, 95 % CI 1.18-3.89; 1.77, 95 % CI 1.00-3.18; and 3.45, 95 % CI 1.10-10.87, respectively). Steroid use had no effect on the prevalence of atopic disorders in patients with RA. Patients with OA, RA, and AS seem to have similar risks for asthma, atopic dermatitis, and either atopy to healthy controls. However, the prevalence of hay fever may increase in AS. Patients with RA have a higher risk of atopy than patients with OA.Öğe Prevalence of enuresis nocturna among a group of primary school children living in Diyarbakir(Aves, 2013) Penbegül, Necmettin; Celik, Hilmi; Palanci, Yilmaz; Yildirim, Kadir; Atar, Murat; Hatipoglu, Namik Kemal; Bodakci, Mehmet NuriObjective: In this study, the prevalence of enuresis nocturna (EN) was investigated among primary school children living in Diyarbakir. Material and methods: Five primary schools in the center of Diyarbakir and a village primary school were selected randomly. Four thousand and five hundred self-administered questionnaires were distributed to parents; 4300 were returned, and 4203 of these questionnaires were included in this study. Results: Of the children participating in the study, 52.2% of them were boys and 47.8% of them were girls. The mean age of the children was 8.66 +/- 1.61 (6-15) years, and the mean number of siblings was 4.03 +/- 2.06 (0-13). The prevalence of nocturnal enuresis was determined to be 25.9% (1087) among 4203 children, and it was more common in boys than in girls (27.8 and 23.7%, respectively). The rate of a positive family history in the nocturnal enuresis, and nonenuretic groups were 64.8, and 35.2%, respectively. The average number of siblings in the enuretic, and nonenuretic groups were 4.49 +/- 2.65, and 3.87 +/- 2.57, respectively Socioeconomic level of the families of enuretic children was worse than that of nonenuretic children. Enuretic children had episodes of bedwetting (92.3%) during night hours or both day and night (8.7 %). The number of bed wetting incidents per week was 4.1 +/- 2.2. A minority (5.7%) of the families believed that the condition resolved without any treatment. Conclusion: Family history, a low socioeconomic level and an increased number of children were factors that increased the frequency of enuresis nocturna in our region.Öğe Safety and Efficacy of Ultrasound-guided Percutaneous Nephrolithotomy for Treatment of Urinary Stone Disease in Children(Elsevier Science Inc, 2012) Penbegül, Necmettin; Tepeler, Abdulkadir; Sancaktutar, Ahmet Ali; Bozkurt, Yasar; Atar, Murat; Yildirim, Kadir; Soylemez, HalukOBJECTIVE To present the feasibility and efficacy of ultrasound-guided percutaneous nephrolithotomy for the treatment of urinary stone disease in children. METHODS The medical records and files of 17 patients with renal stones (17 renal units) who were aged <= 16 years who had undergone ultrasound-guided percutaneous nephrolithotomy from 2008 to 2010 were retrospectively reviewed and analyzed. Ultrasonography was used for guidance in all patients in every step of the procedure. Fluoroscopy was used to aid in tract dilation in the initial cases of the series and to evaluate for stone clearance in all cases. The operative and postoperative findings were assessed. RESULTS The average age of the patients was 8.8 +/- 2.86 years (range 5-15). The mean stone size was calculated as 337.4 +/- 52.9 mm(2) (range 260-446). The mean operative time was 67.9 +/- 14.58 minutes (range 45-95). Fever, urine leakage, and bleeding requiring blood transfusion were observed in 3, 1, and 1 patient, respectively. The fluoroscopic screening time was limited to 17.76 +/- 15.5 seconds (range 1-54). Neighboring organ injuries were not observed. The overall success rate improved from 82.35% to 100% with additional treatment modalities (shock wave lithotripsy in 2 and ureteroscopy in 1). CONCLUSION Percutaneous nephrolithotomy can be safely performed with ultrasound guidance in children, providing the advantages of less radiation exposure, no adjacent organ injury, and similar success and complication rates compared with fluoroscopic guidance. UROLOGY 79: 1015-1019, 2012. (C) 2012 Elsevier Inc.Öğe A solution for medical and legal problems arising from forgotten ureteral stents: initial results from a reminder short message service (SMS)(Springer, 2012) Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir; Soylemez, Haluk; Penbegül, Necmettin; Atar, Murat; Bozkurt, Yasar; Yildirim, KadirThe objective of this study was to describe and present the initial results of a computer-based system that tracks ureteral stents and automatically sends a reminder through a short message service (SMS) to both the patient's and the urologist's mobile phones Using an integrated stent register program (SRP) and a stent extraction reminder program (SERP) with an electronic patient record program (EPRP) located within our hospital's computer network. In this system, the demographic data of all of the patients are recorded into the password-protected EPRP. After a stent is inserted, the surgeon enters the details of the operation into the EPRP. The SRP automatically asks the user to define the optimal stent life (OSL). The SERP checks the recorded patients daily and sends an SMS reminder to staff and patient when the OSL is reached. The SERP continues to send reminders via the SMS until stent is removed. We analyzed the success of the SMS recall system. A total of 186 patients received stents over an 11-month period. The patients in group-2 ( = 108) were recalled by the SERP, and the remainder of the patients ( = 78, group-1) were not included in the project. The mean delay from the designated OSL to the time of stent removal was 307 +/- A 118.6 (72-1,344) and 14.6 +/- A 2.06 (5-36) h in groups 1 and 2, respectively ( < 0.0001). Our initial results showed that the SRP and SERP prevent stent removal from being forgotten, thus preventing related medical and legal problems.Öğe Ultrasound-guided Percutaneous Nephrolithotripsy in the Supine Position in a Patient with Severe Kyphoscoliosis(Marmara Univ, Fac Medicine, 2011) Penbegül, Necmettin; Soylemez, Haluk; Sancaktutar, Ahmet Ali; Atar, Murat; Bozkurt, Yasar; Yildirim, Kadir; Kilic, FahrettinPercutaneous nephrolithotomy (PNL) is the gold standard for the treatment of kidney stones larger than 2 cm. In patients with anatomical anomalies or musculoskeletal deformities PNL can be challenging due to abnormal anatomy. Kyphoscoliosis is a musculoskeletal disorder in which there is abnormal relationship of kidney to surrounding organs. We present a case of ultrasound-guided percutaneous nephrolithotripsy in supine position in a 38-year-old male patient with severe kyphoscoliosis.
