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    The antioxidant effect of dexmedetomidine on testicular ischemia-reperfusion injury
    (Acta Cirurgica Brasileira, 2015) Tuglu, Devrim; Yuvanc, Ercan; Yilmaz, Erdal; Gencay, Isin Yazici; Atasoy, Pinar; Kisa, Ucler; Batislam, Ertan
    PURPOSE: To investigate the protective effect of dexmedetomidine (Dex) on testicular damage induced by ischemia-reperfusion injury in rats. METHODS: Sham group underwent left scrotal exploration only (group 1). The ischemia-reperfusion only group underwent left testicular torsion and detorsion (group 2). The ischemia-reperfusion plus Dex group underwent left testicular torsion, received 50 mu g/kg Dex (group 3) and 100 mu g/kg Dex (group 4) intraperitoneally at minute 180 of ischemia and then underwent detorsion. We determined histopathological findings and performed specific biochemical analyses. RESULTS: Increasing doses of Dex significantly increased TAS, and significantly decreased OSI. Analyzing the antioxidant effects of increasing doses of Dex in torsion and contrlateral testicles: Dex 100 mu g/kg statistically significant increased the tissue total antioxidant status (TAS) and oxidative stress index (OSI) when compared with Dex 50 mu g/kg but not found significantly change on the tissue total oxidant status (TOS). However, Dex did not significantly improve these histological alterations. CONCLUSION: The antioxidant effects of dexmedetomidine on testicular ischemia-reperfusion injury in ipsilateral and contrlateral testis, but in the histopathological level, there was no difference statistically according to Johnsen's scoring system between groups at both sides.
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    Can prilocaine infiltration alone be the most minimally invasive approach in terms of anesthesia during extracorporeal shock wave lithotripsy?
    (Elsevier Science Inc, 2006) Yilmaz, Erdal; Batislam, Ertan; Başar, Murad; Tuğlu, Devrim; Yuvanc, Ercan
    Objectives. To evaluate the analgesic effect and utility of prilocaine infiltration alone for minimal morbidity during extracorporeal shock wave lithotripsy. Methods. A total of 114 patients with kidney stones, aged 18 to 69 years, were randomly separated into two groups. The 58 patients in group 1 received intramuscular diclophenac 30 minutes before extracorporeal shock wave lithotripsy, and the 56 patients in group 2 received prilocaine infiltration into the 30 cm(2) area below the 12th rib right before the session. A visual analog scale (0 to 100 mm) was used to evaluate pain. Results. The visual analog scale scores for group 2 were statistically lower at 1, 10, and 20 minutes compared with the scores for group 1 (P = 0.006, P = 0.005, and P = 0.006, respectively). However, no difference was detected at the end of the procedure. The requirement for additional analgesic was less in group 2 (P = 0.007). Conclusions. Prilocaine infiltration alone can be used for analgesic purposes efficiently and safely during extracorporeal shock wave lithotripsy with minimal morbidity.
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    Changes in blood gas in supine and prone positions in percutaneous stone surgery: does position have any advantage for hemodynamics? (vol 52, 121, 2024)
    (Springer, 2024) Yilmaz, Erdal; Senocak, Ibrahim; Ataman, Mirac; Yuvanc, Ercan
    [Abstract No tAvailable]
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    Citrate levels in fresh tomato juice: A possible dietary alternative to traditional citrate supplementation in stone-forming patients
    (Elsevier Science Inc, 2008) Yilmaz, Erdal; Batislam, Ertan; Basar, Murad; Tuglu, Devrim; Erguder, Imge
    OBJECTIVES To detect citrate levels in fresh tomato juice, to reveal whether it can be studied for prevention of recurrent hypocitraturic nephrolithiasis. METHODS Juices of tomato, orange, lemon, and mandarin were extracted and blended with a hand blender, and 10 samples of 100 mL were taken from each. Citrate, oxalate, calcium, phosphorus, magnesium, sodium, potassium, chloride, and pH levels were examined in these. The same variables were re-evaluated after the samples were stored at +4 degrees C for 1 week. RESULTS In fresh tomato juice, higher citrate and magnesium levels as well as lower sodium and oxalate levels were detected as compared with the other juices. No differences were observed with regard to all variables among fresh orange, lemon, and mandarin juices. The level of citrate in the fresh tomato juice was higher at a statistically significant level than that in tomato juice that was stored for 1 week. The amount of oxalate increased in stored tomato juice. CONCLUSIONS Fresh tomato juice is considered a rich source of citrate. Furthermore, a high level of magnesium and a low level of sodium and oxalate content were detected in fresh tomato juice, the usability of which in recurrent hypocitraturic nephrolithiasis can be investigated in clinical studies.
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    Column of bertin: Normal sonographic findings
    (2005) Ünal, Birsen; Aktaş, Aykut; Bilgili, Yasemin; Yilmaz, Erdal
    Introduction: We aimed to describe the normal and pathologic sonographic (US) findings of column of Bertin (CB). Materials and methods: The study was performed on sixty-six patients who had CB on CT. CB was found to be suspicious in 22 cases; with either hypoechoic, heterogeneous, bulging contour, increased vascularity or cystic areas on US. Patient underwent US and CT imaging following their initial CT and US examinations, respectively. On CT images, isodens and homogeneous texture, enhancement equal to renal cortex were accepted as normal findings. The thickness of CB on axial (AT) and longitudinal (LT) sonography images and the thickness of renal parenchyme (PT) on longitudinal images were measured. The ratio of AT to PT and LT to PT were calculated. Echogenity, vascularity, and contours of CB were evaluated on sonography. The data evaluated with Pearson and t tests. Results: CB was bilateral in 39, and double in 9 cases. Totally 136 CB were evaluated. In two sonographically suspicious CB, renal cell carcinoma (pathologically confirmed) and Bosniak type 2 cysts were detected. In LT, AT, LT/PT and AT/PT were 14.0+3.1 mm (maximum: 23.4mm), 13.2±2.9 mm (maximum: 21.8 mm), 1.1±0.19 (maximum: 1.56) and 1.0±0.17 (maximum: 1.67) in normal cases, 28 mm, 26 mm, 2.15 and 2 mm, in case with renal cell carcinoma. The correlation between thickness of CB and parenchyme was significant (AT-PT r=0.555, p<0.001, and LT-PT r=0.614, p<0.001). Peripheral vascularities were observed in all, central minute vascular focuses in 24 (18%), hypoechogenity in 12 (9.0%), bulging exterior contour in 9 (6%) CB. Conclusion: Increased vascularity, hypoechogenity, increased thickness of CB and thickness to parenchyme ratio are suspicious sonographic findings which may necessitate CT examination.
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    COLUMN OF BERTIN: NORMAL SONOGRAPHIC FINDINGS
    (Aves, 2005) Unal, Birsen; Aktas, Aykut; Bilgili, Yasemin; Yilmaz, Erdal
    Introduction: We aimed to describe the normal and pathologic sonographic (US) findings of column of Bertin (CB). Materials and Methods: The study was performed on sixty-six patients who had CB on CT. CB was found to be suspicious in 22 cases; with either hypoechoic, heterogeneous, bulging contour, increased vascularity or cystic areas on US. Patient underwent US and CT imaging following their initial CT and US examinations, respectively. On CT images, isodens and homogeneous texture, enhancement equal to renal cortex were accepted as normal findings. The thickness of CB on axial (AT) and longitudinal (LT) sonography images and the thickness of renal parenchyme (PT) on longitudinal images were measured. The ratio of AT to PT and LT to PT were calculated. Echogenity, vascularity, and contours of CB were evaluated on sonography. The data evaluated with Pearson and t tests. Results: CB was bilateral in 39, and double in 9 cases. Totally 136 CB were evaluated. In two sonographically suspicious CB, renal cell carcinoma (pathologically confirmed) and Bosniak type 2 cysts were detected. In LT, AT, LT/PT and AT/PT were 14.0 +/- 3.1 mm (maximum: 23.4mm), 13.2 +/- 2.9 mm (maximum: 21.8 mm), 1.1 +/- 0.19 (maximum: 1.56) and 1.0 +/- 0.17 (maximum: 1.67) in normal cases, 28 mm, 26 mm, 2.15 and 2 mm, in case with renal cell carcinoma. The correlation between thickness of CB and parenchyme was significant (AT-PT r=0.555, p<0.001, and LT-PT r=0.614, p<0.001). Peripheral vascularities were observed in all, central minute vascular focuses in 24 (18%), hypoechogenity in 12 (9.0%), bulging exterior contour in 9 (6%) CB. Conclusion: Increased vascularity, hypoechogenity, increased thickness of CB and thickness to parenchyme ratio are suspicious sonographic findings which may necessitate CT examination.
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    The effect of coenzyme Q and selenium on kidney in rats with partial unilateral ureteral obstruction
    (Aves, 2019) Kirdag, Mustafa Koray; Tuglu, Devrim; Yuvanc, Ercan; Kisa, Ucler; Balci, Mahi; Batislam, Ertan; Yilmaz, Erdal
    Objective: In this study, we aimed to investigate the antioxidant effects of selenium and coenzyme Q on renal damage in a partial unilateral ureteral obstruction (PUUO) in a rat model. Material and methods: A total of 24 Sprague-Dawley rats were divided into four groups as Group 1 Control Group, Group 2, PUUO Group, Group 3 PUUO + coenzyme Q group, Group 4 PUUO + selenium group. Paraoxonase (PON), total antioxidant capacity (TAC), and total oxidant levels (TOS) were analyzed biochemically from tissue and blood samples. Tissue samples were examined histopathologically. Results: The TAC in the tissues was found to be statistically significantly increased in Groups 3 and 4, compared to Group 2. Tissue TOS was found to be significantly reduced in Groups 3 and 4, compared to Group 2. Serum PON levels were significantly increased in Group 3 and 4, compared to Group 1 and 2. Histopathological examination showed that interstitial inflammation and congestion were lesser in the coenzyme Q and selenium groups than in the PUUO group. A more significant decrease was found in the selenium group than in the coenzyme Q group. Conclusion: Our study results showed that coenzyme Q and selenium reduced the oxidation and the damage in tissue in PUUO in rats.
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    Effect of SWL on renal hemodynamics: could a change in renal artery contraction-relaxation responses be the cause?
    (Springer, 2012) Yilmaz, Erdal; Mert, Cagatay; Keskil, Zuhal; Tuglu, Devrim; Batislam, Ertan
    The aim of this study was to reveal the effect of shock wave lithotripsy (SWL) on renal artery contraction-relaxation responses and the relation of this effect with renal hemodynamics. Twenty-four rabbits are divided into six different groups. The first two groups evaluated as the control groups. After isolating the kidneys, we applied phenylephrine (Ph) and acetylcholine (Ach) in the first group and sodium nitroprusside (SNP) and histamine (H) in the second group. In the third, fourth, fifth and sixth groups, 14.5 kV shock wave (SW) was focused on the left kidneys. We adjusted the number of shocks to a total of 500, 1,500, and 3,000 SW, in the third, fourth and fifth groups, respectively. After isolating the kidneys, Ph, Ach was given in groups 3, 4 and 5. In the sixth group, to get the SNP and the H responses, 3,000 shocks modality was utilized. Marked contractile responses were obtained by phenylephrine in the control group. In kidneys that were exposed to 500 shocks SWL procedures, a decrease in contractile responses and hence, in perfusion pressures in different concentrations of phenylephrine was noted. However, a notable change in relaxation responses occurred after 3,000-shock applications. No difference in relaxation responses to nitroprusside, a direct vasodilating agent, was observed in any group, compared to the control group. Another cause of deterioration of renal hemodynamics after SWL can be attributed to the reduction in renal artery contraction-relaxation responses that result in the vascular smooth muscle and endothelial damage.
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    Effectiveness of eutectic mixture of local anesthetic cream and occlusive dressing with low dosage of fentanyl for pain control during shockwave lithotripsy
    (Mary Ann Liebert, Inc, 2005) Yilmaz, Erdal; Batislam, Ertan; Basar, M. Murad; Tuglu, Devrim; Özcan, Şaziye; Basar, Halil
    Background and Purpose: To investigate the effect and usefulness of Eutectic Mixture of Local Anesthetic (EMLA) applied with an occlusive dressing and used simultaneously with a low dose of fentanyl during shockwave lithotripsy (SWL). Patients and Methods: One hundred sixty patients with kidney stones, aged between 19 and 68 years, were randomly, divided into seven groups that were treated as follows: group 1: fentanyl 1 mu g/kg by intravenous infusion (IV); group 2: IV fentanyl 0.25 mu g/kg; group 3: occlusive dressing and IV fentanyl 0.25 mu g/kg; group 4: placebo cream and IV fentanyl 0.25 mu g/kg; group 5: EMLA cream and IV fentanyl 0.25 mu g/kg; group 6: placebo cream and IV fentanyl 0.25 mu g/kg with an occlusive dressing; and group 7: EMLA cream and IV fentanyl 0.25 mu g/kg with an occlusive dressing. The mean arterial pressure (MAP), heart rate, ventilatory rate, and oxygen saturation (SpO(2)) were recorded on all patients. A visual analog scale 0-100 mm (VAS) was used for the evaluation of pain. The skin integrity was inspected to detect any lesions after SWL. Results: The SPO2 in group I was lower statistically than in the other groups. The VAS score in group 7 was clearly lower than in the others in the first, tenth, and twentieth minutes and at the end of SWL. In groups 6 and 7, additional fentanyl doses were lower than in the other groups, but only in group 7 was the total fentanyl dosage low. Skin lesions were not seen only in groups 3, 6, and 7. Conclusion: Use of EMLA and an occlusive dressing with low doses of fentanyl during SWL provides appropriate analgesia with minimal morbidity.
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    Evaluation of pheniramine maleate and zofenopril in reducing renal damage induced by unilateral ureter obstruction. An experimental study
    (Termedia Publishing House Ltd, 2021) Yuvanc, Ercan; Tuglu, Devrim; Ozan, Tunc; Kisa, Ucler; Balci, Mahi; Batislam, Ertan; Yilmaz, Erdal
    Introduction: Obstruction of the ureter may occur due to congenital, iatro-genic or other reasons. This can cause hydronephrosis in the early stage and can lead to cellular inflammation, necrosis and atrophy in the kidney tissue. The aim of this paper is to evaluate the protective effect of pheniramine maleate (PM) and zofenopril on renal damage caused by hydronephrosis due to unilateral partial ureter obstruction. Material and methods: Twenty-four female Sprague Dawley rats were divided into 4 groups. Group 1: sham group, group 2: partial unilateral ureteral obstruction (PUUO) group, group 3: PUUO + PM group, group 4: PUUO + zofenopril group. Paraoxonase (PON), total antioxidant status (TAS) and total oxidant status (TOS) of tissue and blood samples were measured and calculated. Tissue samples were evaluated histopathologically. Results: An increase in tissue TAS and a decrease in tissue TOS and OSI levels were detected in groups 3 and 4 compared to group 2 (both: p < 0.01). Tissue PON levels showed an increase in groups 3 and 4 compared to groups 1 and 2 (both: p < 0.01). Histopathological evaluation showed a decrease in interstitial inflammation and congestion in groups 3 and 4 compared to the control group (p < 0.001). The decrease was observed to be more significant in group 4 compared to group 3 (p < 0.01). Conclusions: In our experimental study, we observed that PM and zofenopril reduce the oxidation and tissue damage caused by unilateral partial obstruction.
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    Investigation of the antioxidant effects of pheniramine maleate and nebivolol on testicular damage in rats with experimentally induced testis torsion
    (Acta Cirurgica Brasileira, 2018) Yuvanc, Ercan; Tuglu, Devrim; Ozan, Tunc; Kisa, Ucler; Balci, Mahi; Batislam, Ertan; Yilmaz, Erdal
    Purpose: To investigate the biochemical, histopathologic, and spermatogenetic changes in the detorsionated testicle after experimental torsion and to study the antioxidant effects of pheniramine maleate and nebivolol. Methods: Twenty-four Sprague-Dawley male rats were divided into 4 groups: Group 1: Sham; Group 2: Torsion/Detorsion (T/D); Group 3: T/D + Pheniramine maleate (PM); Group 4: T/D + Nebivolol (NB) group. Paroxanase (PON), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stres index (OSI) were measured, and spermatogenetic and histopathologic evaluation was performed in tissue and blood samples. Results: The evaluation of tissue TAS indicated no statistically significant difference in Group 3 compared to Group 2. A statistically significant increase was detected in Group 4 compared to Group 2. Serum PON levels revealed a statistically significant increase in Groups 3 and 4 compared to Groups 1 and 2. The Johnsen testicular biopsy score decreased in Groups 3 and 4, but the decrease was not statistically significant. Conclusions: Pheniramine maleate and nebivolol have antioxidant effects against ischemia-reperfusion damage. They also support tissue recovery, which is more significantly observed by nebivolol.
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    Local Anesthesia with 20 mL prilocaine infiltration: The ultimate point for analgesia during shockwave lithotripsy?
    (Mary Ann Liebert, Inc, 2008) Yilmaz, Erdal; Batislam, Ertan; Tuglu, Devrim; Yuvanc, Ercan
    Purpose: The effectiveness of 10 mL and 20 mL local prilocaine infiltration for analgesic purposes during shockwave lithotripsy (SWL) was compared, and the differences in pain intensity and need for additional analgesics were defined. Patients and Methods: One hundred and twenty-one patients between the ages of 16 and 69 with kidney stones were randomly separated into two groups. The 60 patients in group 1 received 10 mL prilocaine subcutaneously and deep lumbar infiltration into the area 1 cm below the twelfth rib 2 minutes before SWL. The 61 patients in group 2 received 20 mL subcutaneously and deep lumbar infiltration of prilocaine to the same locale, again 2 minutes before the process. All the patients received one session of SWL. For measurement of pain intensity, the 0 to 100 mm visual analog scale ( VAS) was used at 1 minute and every 10 minutes during the process. Intravenous fentanyl was administered to patients who had steady or increasing intensity of pain during the process. Results: VAS values were statistically significantly higher in patients in group 1 compared with patients in group 2 during the process. While 40 patients received additional analgesia in group 1, only three patients in group 2 needed additional analgesia. Conclusion: Use of 20 mL subcutaneous and deep lumbar prilocaine infiltration during SWL for analgesic purposes is recommended as an efficient, cost-effective, anesthetist-independent, and reliable method.
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    Multiple urethral anomalies: Parameatal urethral cyst, penile curvature, incomplete hypospadiac anterior duplication of the urethra and distal hipospadias
    (Canadian Urological Association, 2015) Tuglu, Devrim; Yuvanc, Ercan; Yilmaz, Erdal; Gur, Serhan; Batislam, Ertan
    The male genitourinary system is quite complex. There are numerous known anomalies of the male urethra either as isolated cases or in combination with other disorders. An improved understanding of the embryology and anatomy of the normal male urethral development might help explain the causes of the various urethral abnormalities. We contribute to the etiology of congenital anomalies with this multiple urethral anomalies case.
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    Percutaneous nephrolithotomy in patients with incidental encountered purulent urine at initial puncture
    (Springer, 2023) Sipal, Timucin; Senocak, Ibrahim; Ataman, Mirac; Yuvanc, Ercan; Yilmaz, Erdal
    We are reporting the 39 patients' outcomes who underwent percutaneous nephrolithotomy and purulent urine encountered at the initial steps of surgery. Of 873 patients who underwent PCNL, 48 had purulent fluid during the initial puncture. After excluding those at risk for infection, we studied 39 patients' preoperative and postoperative variables-including postoperative day (POD) 1, 3, 5 fevers. In group 1, 21 patients had a nephrostomy tube placed, and PCNL was postponed. In group 2, 18 patients had successful stone removal in the first session. All surgeries were successful, with no septic events during follow-up. No significant differences in preoperative variables were found. 14% and 22% of patients in groups 1 and 2 had infected fluid (p = 0.470). Four patients in group 1 (19%) and seven patients in group 2 (38.9%) had a high fever (& GE; 38 C) on POD1 (p = 0.171), and 1 (5%) in group 1 and 3 (17%) in group 2 had high fever on POD 3 (p = 0.22). No patients remained with high fever on POD5. Mild sepsis was diagnosed in 9.5% of group 1 and 16% of group 2 (p = 0.820), and hospitalization time differed significantly (p < 0.001). Stone size and operation time were correlated with postoperative fever, and prolonged hospital stays were associated with positive blood cultures and postponed procedures. PCNL with proper technique and antibiotics can lead to quicker recovery and reduced hospitalization time in selected patients with pus in their pelvicalyceal system.
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    Quantitative analysis of colonization with real-time PCR to identify the role of Oxalobacter formigenes in calcium oxalate urolithiasis
    (Springer, 2012) Batislam, Ertan; Yilmaz, Erdal; Yuvanc, Ercan; Kisa, Ozgul; Kisa, Ucler
    The objective of the study was to quantitatively measure the number of Oxalobacter formigenes (O. formigenes) colonizations in the gastrointestinal tract in calcium oxalate-forming patients with real-time polymerase chain reaction (PCR). Calcium oxalate-forming patients (n: 27) were included in the study. Serum calcium, sodium, potassium, urea and creatinine levels, as well as 24 h urine levels of calcium and oxalate were measured. The numbers of O. formigenes colonies in stool samples were detected by real-time PCR. One or two metabolic abnormalities were detected in 15 of 27 patients. The O. formigenes levels in patients with metabolic disturbance were significantly decreased when compared to the patients with no metabolic abnormalities (p: 0.038). The undetectable levels of O. formigenes were encountered in one of five patients with hypercalciuria, in three of four patients with hyperoxaluria and in four of six patients with both hypercalciuria and hyperoxaluria. In nine patients with a history of stone recurrence, O. formigenes colonization was significantly lower than the patients with the first stone attack (p: 0.001). O. formigenes formation ceased or significantly diminished in patients with calcium oxalate stones with a coexistence of both hyperoxaluria and hypercalciuria. The measurement of O. formigenes colonies by real-time PCR seemed to be an inconvenient and expensive method. For this reason, the real-time PCR measurements can be spared for the patients with stone recurrences and with metabolic abnormalities like hypercalciuria and hyperoxaluria. The exact measurement of O. formigenes may also help more accurate programming of O. formigenes-based treatments.
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    Unknown complication of preputial calculi: preputial skin fistula
    (Springer, 2013) Tuglu, Devrim; Yuvanc, Ercan; Yilmaz, Erdal; Batislam, Ertan; Gurer, Yahya Kemal Yavuz
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    Use of the NMDA antagonist magnesium sulfate during monitored anesthesia care for shockwave lithotripsy
    (Mary Ann Liebert, Inc, 2007) Kaymak, Çetin; Yilmaz, Erdal; Başar, Hülya; Özçakir, Sibel; Apan, Alpaslan; Batislam, Ertan
    Purpose: To assess whether intravenous magnesium sulfate infusion affects analgesic requirements during monitored anesthesia care (MAC) for shockwave lithotripsy (SWL). Patients and Methods: Fifty patients in ASA class I or II undergoing SWL with MAC were randomized into two groups. Induction of MAC was produced by bolus doses of midazolam 0.03 mg/kg(-1) and fentanyl 0.5 mu g/kg(-1) followed by intravenous infusion of midazolam 0.015 to 0.06 mg/kg(-1)/hr(-1) with fentanyl supplementation 0.2 mu g/kg(-1). In addition, group I patients received magnesium sulfate 30 mg/kg(-1) intravenously as a bolus dose followed by a continuous infusion of 10 mg/kg(-1) /hr(-1) beginning 15 minutes before induction of sedation. The midazolam infusion rate and additional fentanyl doses were adjusted by verbal analog scale (VAS) measurements, observer assessment sedation score (OAA/S), and achieving a target bispectral index (BIS) in a range of 70 to 90. At the end of SWL, the total midazolam and total fentanyl consumptions were recorded, and the serum magnesium concentration was measured. Results: Magnesium caused significant decreases in the total consumption of midazolam (P = 0.001) and fentanyl (P = 0.001). The VAS values at the 15th, 20th, and 25th minute in group I were significantly lower than in group II. In group I, hemodynamic and arterial oxygen parameters were better than in group II. Conclusion: A magnesium bolus and infusion can be utilized to reduce analgesic requirements under MAC during SWL.