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Öğe Benign Prostat Hiperplazisi ve Antimuskarinik Tedavi(2016) Kaynar, Mehmet; Altıntaş, Emre; Göktaş, SerdarAlt üriner sistem semptomları (AÜSS) terimi; üriner sistem semptomlarına sahip erkek hastaları değerlendirmede kullanılan prostatizm, semptomatik benign prostat hiperplazisi (BPH) ve klinik BPH terimlerinin yerini almaktadır. BPH, aşırı aktif mesane (AAM), nokturnal poliüri, üriner sistem enfeksiyonları, distal üreter taşları ve mesane tümörleri gibi birçok sağlık sorunu AÜSS'ye neden olabilir. Yaygın kullanılan bir terim olan AÜSS kapsamına giren semptomlar; depolama (acil idrar yapma hissi, sık idrara çıkma, gece idrar yapmak için uyanma ve urge inkontinans), işeme (işeme gücünde azalma, idrarı başlatmakta gecikme, kesik kesik idrar yapma) ve işeme sonrası (işeme sonrası damlama, yetersiz boşaltım hissi) ile ilgili semptomlar olarak üç alt grupta toplanmıştır. Günümüzde BPH için uygulanan en yaygın ve standart tıbbi tedavide ?1-adrenerjik reseptör antagonistleri kullanılmaktadır. Bu tedavinin yetersiz kaldığı düşünülen durumlar için alternatif tedavi arayışları halen sürmektedir. Bu çalışmalar sonucunda, BPH'nin tedavisinde ?1blokerler ile birlikte kullanılan antimuskarinik ilaçlar, bir kombine tedavi olarak literatürdeki yerini almıştır. Bu derlemede; BPH'den muzdarip hastalarda antimuskarinik tedavilerinin etkinliği ve güvenilirliği değerlendirilmiştirÖğe Comparison of Post Biopsy Pathology and Post Radical Prostatectomy Pathology in Patients with Prostate Cancer Detected After Fusion Biopsy(Selçuk Üniversitesi, 2023 Ekim) Altıntaş, Emre; Kaynar, Mehmet; Kılıç, Özcan; Batur, Ali Furkan; Gül, Murat; Özer, Halil; Çelik, Murat; Göktaş, SerdarAims: To compare the post-radical prostatectomy (RP) final pathologies and post-biopsy pathologies of the patients diagnosed with prostate cancer (PCa) after fusion biopsy according to the International Society of Urological Pathology (ISUP) grading system. Material and Methods: In this retrospective study, data of 182 patients who underwent fusion biopsy and concomitant systematic biopsy between January 2020 and August 2022 was reviewed. All these patients were biopsy naive with PIRADS-3 lesions according to the multiparametric MRI (mpMRI) imaging. A total of 89 patients with PCa detected by biopsy were included in the study. Age, PSA, PSA density, and lesion grades according to PI-RADS were analyzed. The post-biopsy (fusion and systematic biopsy) pathology results of 60 patients who underwent RP were compared with the final pathology results after RP. Results: Pathological results after fusion biopsy and RP were compared. The individual agreement between RP and fusion biopsy for each ISUP grade was moderate to almost excellent (0.558 to 0.848). When the overall agreement between RP and fusion biopsy was evaluated, the weighted kappa was calculated as 0.721 (95% CI: 0.577 to 0.865), which was determined as substantial significant agreement. On the other hand, the overall agreement between systematic biopsy and pathology results after RP was calculated as weighted kappa 0.544 (95% CI: 0.405 to 0.683) and this agreement was determined as moderate agreement. Conclusion: Our study showed that the concordance between the pathology result after fusion biopsy and the final pathology after RP was higher than the standard TRUS prostate biopsy. We think this compliance is crucial in the regulation and follow-up of the treatment of the patients.Öğe Does hypericin boost the efficacy of high-power laser? A preliminary experimental study on rats [A hipericina aumenta a eficácia do laser de alta potência? um estudo preliminar e experimental em ratos](Associacao Paulista de Medicina, 2014) Zor, Murat; Göktaş, Serdar; Yıldırım, İbrahim; Zorba, Ünal Orhan; Başal, Şeref; Alp, Bilal Fırat; Kaya, EnginDESIGN AND SETTING: Experimental animal study conducted in the Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey, in 2012.METHODS: Sixteen rats were randomized into four groups: 120 W KTP laser + hypericin; 120 W KTP laser alone; 80 W KTP laser + hypericin; and 80 W KTP laser alone. Hypericin was given intraperitoneally two hours prior to laser applications. The laser incisions were made through the quadriceps muscle of the rats. The depth and the width of the laser incisions were evaluated histologically and recorded.RESULTS: To standardize the effects of the laser, we used the ratio of depth to width. These new values showed us the depth of the laser application per unit width. The new values acquired were evaluated statistically. Mean depth/width values were 231.6, 173.6, 214.1 and 178.9 in groups 1, 2, 3 and 4, respectively. The most notable result was that higher degrees of tissue penetration were achieved in the groups with hypericin (P < 0.05).CONCLUSIONS: The encouraging results from our preliminary study demonstrated that hypericin may improve the effects of KTP laser applications.CONTEXT AND OBJECTIVE: Lasers are widely used in treating symptomatic benign prostatic hyperplasia. In current practice, potassium titanyl phosphate (KTP) lasers are the most common type of laser systems used. The aim here was to evaluate the rapid effect of high-power laser systems after application of hypericin. © 2014 Associacao Paulista de Medicina. All right reserved.Öğe Expression of Ring Box-1 protein and its relationship with Fuhrman grade and other clinical-pathological parameters in renal cell cancer(ELSEVIER SCIENCE INC, 2020) Altıntaş, Emre; Kaynar, Mehmet; Çelik, Zehra Esin; Çelik, Murat; Kılıç, Özcan; Akand, Murat; Göktaş, SerdarObjective: To determine the relationship between RING-box protein 1 (RBX-1) expression and renal cell carcinoma (RCC) with prognostic factors. Methods: A total of 88 patients who underwent radical/partial nephrectomy between January 2009 and January 2016 have been included in our study. The age, gender, tumor location, tumor size, and tumor-node-metastasis stage of each patient was evaluated. From the best sections in hematoxylin-eosin stained pathology preparations, tumor histological subtype, Fuhrman nuclear grade, lymphovascular invasion, renal artery/vein invasion, capsule invasion, perirenal fatty tissue invasion, and tumor grade were evaluated. Participants were divided into 2 groups according to Fuhrman grade. Fuhrman grades 1 to 2 comprised Group 1, and Fuhrman grades 3 to 4 comprised Group 2. An immunoreactivity scoring system was used to evaluate RBX-1 expression. Results: Upon examining all histological subtypes together, it was observed that RBX-1 expression was statistically higher in Group 2 compared to Group 1 (P < 0.008). Upon examining clear RCC cases, it was observed again that Group 2 had a higher RBX-1 expression than Group 1 (P < 0.009). RBX-1 expression was not associated with clinical-pathological parameters including tumor grade, lymphovascular invasion, capsule invasion, or perirenal invasion. Conclusion: RBX-1 expression is closely associated with a highly important prognostic factor in RCC-Fuhrman grade-and it shows promise as a prognostic marker. Further studies are required to reveal the importance of RBX-1 in RCC prognosis and treatment. (C) 2019 Elsevier Inc. All rights reserved.Öğe Fibrous pseudotumors of the testis: The balance between sparing the testis and preoperative diagnostic difculty(2014) Başal, Şeref; Malkoç, Ercan; Aydur, Emin; Yıldırım, İbrahim; Kibar, Yusuf; Kurt, Bülent; Göktaş, SerdarObjective: To determine a paradigm that will be helpful for urologists to manage fbrous pseudotumors, which are a very rare condition of the testis. Material and methods: We retrospectively evaluated the patients with fbrous pseudotumors in our uropathological database from 1995 to 2013. Patients who had tumor markers and ultrosonography (USG) screening before surgery and a fnal pathology report of a fbrous pseudotumor were included in the study. Results: In total, 838 patients with a testis mass were evaluated. Only 6 of these patients met the inclusion criteria. The mean age was 34 years (min: 20, max: 72). Serum tumor markers were in the normal range for all patients. The scrotal tumors were not clearly related to the testis parenchyma, and the radiologists could not defnitively determine the nature of the masses (benign or malignant). A concomitant hydrocele was detected in 2 patients. After inguinal exploration, radical orchiectomy was performed in one patient with an ipsilateral atrophic testis, and biopsies were taken from the lesions for frozen section analysis in the other 5 patients. Pathologists reported benign tumors for all of these patients based on the frozen sections, and testicular sparing surgery was then performed in these 5 patients. Conclusion: If scrotal tumors are detected by ultrasonography in patients with normal tumor markers, and the tumor cannot be clear distinguished from the testis, these patients might have a fbrous pseudotumor, and organ-sparing surgery can be performed on these patients.Öğe The predictive value of platelet to lymphocyte and neutrophil to lymphocyte ratio in determining urethral stricture after transurethral resection of prostate(AVES, 2017) Gül, Murat; Altıntaş, Emre; Kaynar, Mehmet; Buğday, Muhammet Serdar; Göktaş, SerdarObjective: The pathology of urethral stricture disease is still unclear however progressive inflammation may contribute to the development of urethral stricture. The platelet-to-lymphocyte ratio (PLR) is a new and simple marker that indicates inflammation. In this study we aimed to investigate the predictive value of neutrophil to lymphocyte ratio (NLR) and PLR in patients with urethral stricture who underwent transurethral resection of prostate (TURP). Material and methods: A total of 208 patients who underwent bipolar-TURP were included in this study. Patients who had previously undergone surgery due to any urethral pathology, posterior urethral strictures, previous or ongoing treatment for any cancer, hematologic disorders, presence of an active infection at the time of surgical intervention, and prior blood transfusion were excluded. PLR, NLR and red cell distribution width (RDW) levels were measured. In order to investigate the predictive values of NLR and PLR variables, binary logistic regression analysis was performed. Results: No statistically significant differences were observed between the groups in terms of age, NLR, RDW, prostate size and operative times. Statistically significant differences were presented only in the median PLR-values. For predicting urethral stricture, the optimal cut-off value was 112.5, (sensitivity: 0.84, specificity: 0.64; AUC=0.762, 95% CI 0.684-0.84). Conclusion: In this study we showed that PLR can be used to determine urethral stricture as a cost-effective, common, and simple biomarker in patients after TURP.Öğe Prostate myths: What is the prostate awareness in the general male population in Turkey?(2014) Kulaksızoğlu, Haluk; Akand, Murat; Kılıç, Özcan; Gül, Murat; Kucur, Mustafa; Göktaş, SerdarObjective: The aim of the study was to evaluate prostate awareness in the general male population and discover the common misinformation about prostate diseases (PDs). Material and methods: A cross-sectional population sampling was performed in the general population for men between the ages of 18-70 with a survey conducted by medical students. The survey consisted of 15 questions addressing different aspects of PDs and common misinformation in the general population. All participants were stratifed according to age, degree of education, occupation and whether the person himself or a close relative had visited a urologist for PDs. All questionnaires were anonymous, and patients were informed about the confdentiality of the results. Results: A total of 1004 men between the ages of 18-70 were included in the study (mean age 38.0±12.9 years). Of those included, 20.2% were primary school graduates, 8.6% were secondary school graduates, 25.5% were high school graduates, 39.8% were university graduates, and 5.8% had a doctorate or higher education. Of all 1004 men, 31.5% had seen a urologist or attended an interview with a close relative for a PDs-related visit in a urologists offce; 56.2% reported prostate as a disease and only 16.5% as an organ. In terms of beliefs, 50.2% believed that all men had a prostate, 5.4% said that sexual activity would cause PDs, 13% thought that sexual activity would prevent PD, 24.9% reported that a rectal exam would affect sexual activity, and 63.5% believed that urinating when squatting would prevent prostate hyperplasia. Prostate cancer transmission to sexual partners was marked as true by 5% of the men. As many as 41.3% of the participants believed that early prostate surgery for BPH would prevent prostate cancer, and 13% reported that sexual activity ceases with prostate surgery and that retrograde ejaculation or anejaculation is the end of sexual activity in men. Conclusion: The survey clearly showed that prostate awareness is still very unsatisfactory in the Turkish male population and that urologists need to better inform the general population. PD knowledge is still lacking throughout all education levels. This is a unique study showing a cross-sectional analysis of the Turkish community; however, the applicability of these results to other communities should be evaluated.Öğe Radikal Sistektomide Karşıtlıklar: Laparoskopik ve Robotik Cerrahi ile Açık Cerrahinin Meta-Analiz veSistemik Analizler Eşliğinde Karşılaştırılması(2016) Kaynar, Mehmet; Göktaş, SerdarKas invaziv ve yüksek riskli invaziv olmayan mesane kanserlerinin tedavisinde açık radikal sistektomi (ARS) standart tedavi yöntemidir. ARS avantajlı onkolojik sonuçlarına rağmen yüksek morbidite ve mortalite oranlarına sahiptir. Son yıllarda üroteknolojideki gelişmeler ile birlikte minimal invaziv tedavi seçeneklerinden laparoskopik radikal sistektomi (LRS) ve robot yardımlı radikal sistektomi (RYRS) mesane tümörlerinin tedavisinde ARS'ye alternatif olarak ortaya çıkmıştır. Her iki yöntemin etkin cerrahi ve benzer onkolojik sonuçlarının olduğu çeşitli çalışmalarda gösterilmiştir. Fakat LRS'deki uygulama zorluğu ve RYRS'deki yüksek maliyetler nedeni ile yaygınlaşması kısıtlanmaktadır. Deneyimli merkezlerin uygulamalarının yanında genel popülasyona dayalı geniş hasta serilerini içeren uzun süreli onkolojik sonuçların karşılaştırmalı olarak ortaya konması ile birlikte invaziv mesane tümörlerinin standart tedavisindeki manzaranın değişmesi kaçınılmaz görünmektedir.Öğe Retrograt intrarenal cerrahi geriatrik erkek hastalarda böbrek taşı tedavisinde etkin ve güvenilir bir seçenek midir?(Selçuk Üniversitesi, 2021) Batur, Ali Furkan; Gülmen, Mustafa; Böcü, Kadir; Böcü, Kadir; Altınaş, Emre; Gül, Murat; Kaynar, Mehmet; Kılıç, Özcan; Göktaş, SerdarAmaç: Bu çalışmada böbrek taşı tedavisi için kliniğimizde retrograt intrarenal cerrahi(RİRC) uygulanılan geriatrik yaş grubu erkek hastaların etkinlik ve güvenlik sonuçlarının, daha genç yaş hasta grubu ile karşılaştırılarak sunulması amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde böbrek taşı nedeniyle RİRC uygulanmış olan, 40 yaş üzeri erkek hastaların verileri retrospektif olarak değerlendirildi. Hastalar yaşlarına göre iki gruba ayrıldı: 40-64 yaş (Grup 1) ve 65 yaş ve üzeri (Grup 2). Komorbidite değerlendirilmesi için anestezi risk skoru (ASA) ve modifiye Charlson komorbidite indeksi (MCKİ) kullanıldı. Hastanenin kayıt sisteminden ve hastaların dosyalarından genel bilgiler, komplikasyon bilgileri, renal anormallik varlığı, taşın bulunduğu böbrek ve lokalizasyonu, taşın dansitesi, taşın boyutu, taş sayısı verileri ve postoperatif taş temizlenme verileri elde edildi. Bulgular: Çalışmaya 233 tanesi Grup 1 (40-64 yaş) ve 61 tanesi Grup 2 (65 yaş ve üstü) olmak üzere toplam 294 hasta alınmıştır. ASA ve MCKİ skorları bakımından Grup 2’de yer alan hastaların skorları Grup 1’e göre istatistiksel olarak anlamlı olarak daha yüksek olarak bulunmuştur (sırasıyla p<0.001, p<0.001). Gruplar arasında taş dansitesi, taş boyutu, taş hacmi, operasyon süresi, hastanede yatış süreleri ve postoperatif taşsızlık oranları bakımından fark bulunmamıştır. Grup 1’de toplam 25 (%10.7) hastada ve Grup 2’de toplam 10 (%16.4) hastada komplikasyon geliştiği tespit edilmiştir ve gruplar arasında genel komplikasyon oranları açısından istatistiki fark bulunmamıştır (p=.265). Sonuç: Dünya nüfusunun giderek yaşlanması ile beraber bu hasta grubunun hastalıklarının da en uygun tedavi metodlarıyla tedavi edilmesinin önemi artmıştır. Çalışmamızda RİRC yöntemi ile böbrek taşı tedavisi yaşlı hasta grubunda da güvenli ve etkili olarak çıkmıştır.Öğe Testiküler kitlenin nadir sebebi: Fıtık eşliğinde paratestiküler liposarkom(2015) Kaynar, Mehmet; Akand, Murat; Gül, Murat; Göktaş, SerdarYumuşak dokunun sık gözlenen tümörü olan liposarkomun paratestiküler yerleşimi oldukça nadir görülmektedir. Sıklıkla ekstrape- ritoneal yağ dokusundan köken alan bu tümörler distale doğru korda ait yağ dokusuyla devam etmektedir. Tanı; genellikle operasyon sırasında şüphe üzerine histopatolojik değerlendirme ile konur. Bu yazıda testiküler kitle nedeni ile opere edilen paratestiküler lipo- sarkom ve beraberinde inguinal hernisi olan olgu sunulmuştur