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Biomedical subjects

I Erkan

Publications and source records attributed to I Erkan.

At least 19 recordsLinked to original sources
PubMed2006

How does the presence of urologic problems change the outcome of kidney transplantation in the pediatric age group.

PURPOSE: We retrospectively reviewed the impact of functional and anatomic urologic disorders on kidney transplantation outcomes in terms of the surgical and long-term results of pediatric renal transplantation. MATERIALS AND METHODS: Of the 55 kidney transplantations in the pediatric age group, end-stage renal disease (ESRD) was secondary to genitourinary disorders in 23 patients (42%). The urologic abnormalities were vesicoureteral reflux in 13 patients (59%), neurogenic bladder in 4 patients (18%), posterior urethral valves in 3 patients (14%), renal stone disease in 4 patients (18%), bilateral ureterovesical junction obstruction in 3 patients (14%), and unilateral renal agenesis with concomitant contralateral ureteropelvic junction obstruction in 1 patient (4%). RESULTS: Of the 23 patients with urologic problems, 19 (83%) had functioning grafts with a mean follow-up of 49 months (range, 7-120 months). In the other 32 patients, 26 (81%) had functioning grafts with a mean follow-up of 43 months (range, 1-144 months). The graft survival, mean serum creatinine, and urinary tract infection rates of the patients did not differ between the two groups. CONCLUSIONS: The presence of functional urologic disorders as the cause of ESRD did not seem to change the outcome of renal transplantation in terms of graft survival when compared with patients without any urologic disorders. Urinary tract infections seem to be a little more common and yet clinically not significant in those patients. Reflux does not always need to be corrected before transplantation, unless it is causing symptoms or infection.

Child↗
PubMed2006

Semen variables and hormone profiles after kidney transplantation during adolescence.

Our aim was to investigate the semen variables and hormone profiles among transplant patients who received kidneys during adolescence. Seven postpubertal transplant patients who underwent successful renal transplantation during adolescence (13-19 years; 3 were preemptive) were enrolled in our clinical follow-up. Serum levels of prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone were checked together with the semen analysis. The ages of the patients ranged from 18 to 25 years (median, 22 years). The median age was 15 years (range, 12-18 years) at initial presentation. The median time between initial diagnosis and transplantation was 12 months (range, 2-60 months). The median follow-up after transplantation was 51 months (range, 23-134 months). Three of the seven patients had unilateral low testicular volume. The renal function tests were within normal limits, as well as serum levels of prolactin, FSH, LH, and testosterone. Sperm counts ranged from 0.2 to 55 million/mL (median, 1.7 million/mL). Only 1 patient (14.2%) had normal sperm parameters. Oligoteratozoospermia (low sperm count and defects in morphology) was observed in 1/7 (14.2%), asthenoteratozoospermia (low levels of motility and defects in morphology) in 1/7 (14.2%), and all parameters were abnormal in 4/7 (57.1%) cases. Our data suggest that in contrast to adult patients, semen variables are severely affected and spermatogenesis does not improve after renal transplantation when the patient was subjected to uremia before or during adolescence, the crucial period for spermatogenesis.

Adolescent↗
PubMed2006

Renal transplantation in children with augmentation enterocystoplasty.

INTRODUCTION: We report our experience with renal transplantation in patients with severe bladder dysfunction who underwent prior augmentation cystoplasty. PATIENTS AND METHODS: Among 58 pediatric patients, three underwent bladder augmentation prior to renal transplantation. The patients' ages at transplantation were 10, 13, and 17. The etiologies of bladder dysfunction were posterior urethral valves in two patients and contracted bladder in one patient. Vesicoureteral reflux was concomitantly present in three patients. Pretransplant ileocystoplasty was created in two patients and gastrocystoplasty in one patient. All patients received kidneys from cadaveric donors and were treated with calcineurin-based immunosuppressive therapy. RESULTS: The patients had normal renal function without hydronephrosis of the transplanted kidney at 13, 22, 49 months follow-up. No patients had morbidity due to technical complications. All the patients were continent. Two of three patients required clean intermittent catheterization from a Mitrofanoff conduit, while one patient spontaneously voids without significant residual urine. Urinary tract infections observed in two patients were successfully treated without any permanent deterioration in graft kidney function. CONCLUSIONS: Our data suggest that augmentation cystoplasty is a safe and effective option to treat patients with end-stage renal disease undergoing kidney transplantation. Experience of the transplantation team with a qualified pediatric urologist is essential due to the potentially high risk of surgical complications during the long term management of these patients.

Adolescent↗
PubMed2003

A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours.

OBJECTIVES: To report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs). PATIENTS AND METHODS: Between 1978 and 2000, 132 patients (median age 28 years, range 16-52) who were regularly followed were included in a new surveillance policy. All pathology specimens were studied retrospectively by the same pathologist for embryonal carcinoma, yolk sac tumour and lymphovascular invasion components. A loose surveillance protocol was designed in which computed tomography (CT) was used only for the first year. RESULTS: The median (range) follow-up was 38 (6-265) months; the relapse rate was 24% and all occurred before 23 months, with 87% diagnosed within the first year. Platinum-based chemotherapy was given to patients with relapse, and surgery used after chemotherapy in seven. Among all the risk factors, an embryonal carcinoma component was the only significant predictor of relapse. The overall survival rate was 99%. CONCLUSION: The presence of embryonal carcinoma in the primary pathology is the only risk factor determining the relapse rate of the present surveillance policy for stage I NSGCTs. The overall survival was no different from those reported for retroperitoneal lymph node dissection and primary chemotherapy. Decreasing the frequency of CT in the first year and totally eliminating it after 1 year reduces the cost of surveillance. The possible compliance problems of patients are also minimized, without changing the overall survival. This surveillance protocol for patients with stage I NSGCT has reduced costs and provided a better quality of life for the patients, without jeopardizing the final outcome.

Adolescent↗
PubMed2000

Ureterocystoplasty: an alternative reconstructive procedure to enterocystoplasty in suitable cases.

PURPOSE: The objective of the report is to present the results of ureterocystoplasty in 6 children with megaureters and low-capacity, high-pressure bladders. METHODS: Of the 6 patients, 2 had valve bladders, 1 had Hinmann's syndrome, 1 had neuropathic bladder, and the remaining 2 with ureterocutaneostomy were mainly diverted because of refluxing megaureters. Nephrectomy was performed in both of the boys with posterior urethral valve because of vesicoureteral reflux dysplasia (VURD) syndrome, and the ipsilateral ureter was used for the augmentation. In 2 patients with ureterocutaneostomy and in 1 with Hinmann's syndrome, a transureteroureterostomy was carried out, and the distal part of the ureter was used to perform augmentation. The patient with neuropathic bladder had a nonfunctioning crossed ectopic left kidney with an associated ipsilateral, refluxing megaureter, and the ureter was used for augmentation after the nephrectomy. RESULTS: All of the patients are continent, and 4 patients who are neurologically normal void spontaneously without requiring clean intermittent catheterization (CIC). The average increase in bladder capacity is 263% (range, 190% to 340%). CONCLUSIONS: Ureterocystoplasty is the bladder augmentation of choice for patients with a nonfunctioning kidney with an associated ipsilateral, refluxing megaureter and for patients with kidneys both in good function and megaureters suitable for a transureteroureterostomy.

Adolescent↗
PubMed2000

Marsupialization for bilateral pararenal lymphatic cysts.

A case of bilateral pararenal lymphatic cysts associated with hypertension is described. The cysts surrounded the renal parenchyma and were located underneath the renal capsule. No vascular pathology explaining the cause of hypertension was diagnosed by radiological techniques. Hypertension improved following bilateral marsupialization.

Adult↗
PubMed1993

Intravesical ureteric plication and reimplantation for megaureters in children.

Historically, megaureters have always been a surgical dilemma for paediatric urologists. However, the evolution of modern diagnostic and surgical methods such as tailoring, folding and plication have made it possible to ensure successful correction in most patients. We report 17 megaureters (11 refluxing and 6 obstructing) in 11 children who were treated with intravesical plication and the trans-trigonal advancement technique between January 1986 and April 1991. Results were excellent in 11 ureters and satisfactory in 4. In one ureter additional surgery was needed because of obstruction at the implantation site and in another ureter reflux persisted. Intravesical plication and reimplantation is a good alternative procedure for grossly dilated ureters owing to its low morbidity and high success rate.

Child↗
PubMed1991

The fate of contralateral ureter after ipsilateral reimplantation in unilateral vesicoureteric reflux.

Four patients out of 23 girls and 7 boys who were treated by successful ureteroneocystostomies for unilateral reflux had postoperative contralateral reflux (13.33%). Three of these 4 refluxing ureters resolved with medical treatment. A second surgery was needed in only 1 case (3.33%) who did not respond to medical treatment. There was no correlation between the preoperative severity of ipsilateral reflux, intravenous urography findings and the onset of contralateral reflux after unilateral reimplantations. Data from this study and previous works indicated that bilateral reimplantations are not warranted for unilateral refluxing renal units unless there are position and shape anomalies at the ureterovesical angle and a very careful preoperative evaluation of the patients is mandatory in this regard.

Child↗
PubMed1990

The effect of post-pubertal varicocele on testicular volume.

Paediatric varicocele is a well known entity but its effect on adult infertility has not been adequately clarified. Since measurement of testicular volume is currently the best method of estimating the male reproductive potential, 945 boys aged between 13 and 18 years were examined with regard to testicular volume and the incidence of varicocele. The average volumes for right and left testes were 15.087 +/- 0.237 and 14.514 +/- 0.347 ml respectively, and the incidence of varicocele was 16.7%. The incidence increased from 14.5 to 21.7% as the ages increased from 14 to 18. The differences in volume of the 2 testes in boys with varicocele were statistically significant when compared with the normal group, but this significance failed to become more pronounced when the slight varicocele group (grade I) was included with the normal group and compared with the severe varicocele group (grades II and III). There may be no significant differences between the volumes of the 2 testes in boys with varicocele when careful measurement and strict statistical analyses are applied. However, some boys in the varicocele group were found to have testicular volumes below the confidence interval (mean - SE) or under 1 SD, and the 2 testicular volumes differed in certain age groups. This group requires further follow-up. The results of this study have added further contradictory findings to the issue of paediatric varicocele in terms of testicular atrophy, estimation of potential fertility and the indications for immediate surgery. There is a need for further prospective controlled trials.

Adolescent↗
PubMed1988

Spontaneous perirenal haematoma secondary to polyarteritis nodosa.

Spontaneous perirenal haematoma (SPH) is an unusual but serious complication of polyarteritis nodosa (PAN). We present 3 patients with PAN-associated SPH. One was diagnosed pre-operatively and underwent emergency nephrectomy in order to stop the persistent bleeding; the second patient had surgical drainage of the haematoma and the third recovered without undergoing surgery. The diagnosis is discussed.

Adult↗
PubMed1988

[Fournier's gangrene: report of 6 cases].

6 patients with Fournier's gangrene a rare but life threatening disease, who were successfully managed are presented. Mortality rates between 17-45 percent have been reported for this disease, but through the use of broad-spectrum antibiotics, aggressive surgical debridement and when possible with multiple drainage incisions to avoid skin defects, the mortality rate has been reduced to 0 percent. We have found an association with diabetes mellitus in 2 cases, which is one of the serious predisposition factors and should not be forgotten.

Adolescent↗
PubMed1986

Fracture of the penis and long-term results of surgical treatment.

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.

Adolescent↗