Mesut Cetinkaya

Ankara Numune Training and Research Hospital, Engüri, Ankara, Turkey

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Publications (65)117.33 Total impact

  • The Journal of Urology 04/2014; 191(4):e862. DOI:10.1016/j.juro.2014.02.2348 · 3.75 Impact Factor
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    ABSTRACT: We aimed to evaluate the effect of acetylsalicylic acid (ASA) treatment on diabetes-induced erectile dysfunction. Adult male Sprague-Dawley rats were divided into four groups as follows: (i) control (C), (ii) diabetic (D), (iii) ASA-treated control (C+ASA) and (iv) ASA-treated diabetic (D+ASA) groups. In groups 2 and 4, diabetes was induced by injection of 35 mg kg(-1) streptozotocin. ASA (100 mg kg(-1) day(-1), orally) was administrated to rats in groups 3 and 4 for 8 weeks. Both intracavernosal pressure (ICP) and mean arterial blood pressure (MAP) were measured in in vivo studies. In organ bath, the relaxation responses to acetylcholine (ACh), electrical field stimulation (EFS) and sodium nitroprusside were tested in corpus cavernosum (CC) strips. The mRNA expression for neuronal nitric oxide synthase (nNOS) was calculated using reverse transcription polymerase chain reaction technique. In in vivo experiments, diabetic rats displayed reduced ICP/MAP values, which were normalised with ASA treatment. The relaxant response to high-dose ACh and EFS at low frequencies (1-8 Hz) in CC strips from the D+ASA group were significantly higher when compared to the D group. Treatment with ASA normalised the raised mRNA expressions of nNOS in diabetic penile tissues. ASA may be involved in mRNA of protein synthesis of NO released from nonadrenergic and noncholinergic cavernosal nerve in diabetes.
    Andrologia 11/2013; 46(9). DOI:10.1111/and.12187 · 1.17 Impact Factor
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    ABSTRACT: Erectile dysfunction (ED)develops owing to pshycogenic, organic or/and both of these two factors. The aim of this study was to investigate the relationship between penile cavernosal arterial flow and peripheral athersosclerosis in men with ED. This study was conducted on 102 patients who had presented to Radiology Clinic with a prediagnosis of ED. Diabetes, hypertension (HT) and smoking were recorded. Blood were taken from all patients for analysis of fasting blood glucose, total cholesterol and high-density lipoprotein level. All the patients underwent high-resolution penile colour Doppler ultrasound (CDUS). The peak-systolic velocity and the end-diastolic velocity values in the bilateral cavernosal arteries were recorded. At the same session, all the patients underwent evaluation for bilateral common carotid artery and femoral artery intima media thickness and for the presence of atherosclerotic plaque. Patients were classified as ED of arterial origin and non-arterial origin according to penile CDUS findings. Of the total 102 patients, 43 (42.2%) had arterial ED and the remaining 59 (57.8%) were contained in non-arterial ED. There was a significant difference between groups for diabetes mellitus (DM), HT, atherosclerotic cardiovascular diseases (ACVD) and total cholesterol level (P<0.05). There was also a significant difference between groups for the presence of plaque in the carotid and the femoral artery (P<0.05). The relationship between smoking and arterial ED was not found to be statistically significant (P>0.05). Non-diagnosed or silent DM, HT and ACVD can have roles in the etiology of arterial ED. Patients who are diagnosed as having arterial ED with Doppler Ultrasound should also be evaluated with B-mode ultrasonography for other peripheral vascular atheroschlerotic processes. In this way, subclinical cases can be detected and further possible complications can be avoided.International Journal of Impotence Research advance online publication, 17 October 2013; doi:10.1038/ijir.2013.35.
    International journal of impotence research 10/2013; DOI:10.1038/ijir.2013.35 · 1.37 Impact Factor
  • Turk Uroloji Dergisi 08/2013; 39(2):74-77. DOI:10.5152/tud.2013.019
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    ABSTRACT: This study evaluated the action of pomegranate juice (PJ) and its five principal phenolic constituents on rat corpus cavernosum smooth muscle (CCSM). Isometric tension studies were performed after precontraction with phenylephrine in CCSM from rats. Relaxant responses to PJ and its constituents ellagic acid (EA), chlorogenic acid, caffeic acid, cumaric acid and rutin were investigated. PJ and EA caused CCSM relaxations (94.1±3.7 and 51.3±9.9%), while others induced limited relaxant responses. EA response was not inhibited by L-N(G)-nitroarginine methyl ester (100 μM) and 1H-[1,2,4]-oxadiazolo[4,3-a]quinoxalin-1-one (1 μM). Tetraethylammonium (100 μM) and apamin (10 μM) and nifedipine (10 μM) inhibited EA-induced relaxations at 10(-3) M by 84%, 82% and 78%, respectively. Glibenclamide (10 μM) inhibited EA response (97%, 100 μM). PJ-induced relaxation was not altered by several inhibitors. EA was estimated to be responsible for 13.3% of relaxation caused by PJ. Our study demonstrated that PJ and EA-induced marked relaxations in CCSM. The opening of Ca(2+)-activated K+ channels and the inhibition of Ca(2+)-channels regulate the relaxation by EA, but not PJ. EA has a minor contribution to the marked relaxation obtained by PJ, suggesting the presence of other PJ constituents, which induce nitric oxide-independent corporal relaxation. Further studies are needed to examine the potential of PJ in combination with a PDE5 inhibitor in ED.International Journal of Impotence Research advance online publication, 1 August 2013; doi:10.1038/ijir.2013.33.
    International journal of impotence research 08/2013; DOI:10.1038/ijir.2013.33 · 1.37 Impact Factor
  • Turk Uroloji Dergisi 09/2012; 38(3):154-158. DOI:10.5152/tud.2012.033
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    ABSTRACT: To detect the possible alterations on density or sensitivity of α1-adrenergic subtypes in diabetic bladder by reverse transcriptase-polymerase chain reaction technology and in vitro studies. Experimental diabetes was induced by administration of streptozotocin with a single injection through the tail vein. Rats were divided into control and diabetic groups. Contractile responses of bladder strips from each group were obtained for postassium chloride, adenosine triphosphate, and electrical field stimulation (0.5-32 Hz) in organ bath. Electrical field stimulation responses of strips were evaluated in the presence of PPADS (nonselective P2 antagonist), atropine (cholinergic antagonist), 5 MU (α-1a-adrenergic antagonist), BMY-7378 (α-1d-adrenergic antagonist), and finally CED (α-1b-adrenergic antagonist). mRNA expression of α1-adrenergic subtypes was determined for each group. The difference between contractile responses related to electrical field stimulation with incubation with PPADS, atropine, 5 MU, BMY-7378, and CED, respectively, was not significant in the control and diabetic groups (P > .05). The electrical field stimulation responses of strips at 0.5-2 Hz without incubation were significantly different between the control and diabetic groups (P < .05). The contractile responses of strips with PPADS + atropine + 5 MU and BMY-7378 incubations in the diabetic group were significantly lower than in the control group in all doses (P < .05), The mRNA expression of α-1a-adrenergic in the diabetic group was significantly lower than in the control group (P < .05). No change was found in the expression of mRNA of α-1b-adrenergic. These results support the probability of changes in presynaptic and autonomic receptor sensitivity. We believe that α-1a-adrenergic and α-1d-adrenergic subtypes should be kept in mind in the treatment of diabetic cystopathy.
    Urology 08/2012; 80(4):951.e9-951.e16. DOI:10.1016/j.urology.2012.06.019 · 2.13 Impact Factor
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    ABSTRACT: Purpose. The aim of this study is to investigate the reliability of diffusion MRI for detection of cancer foci by comparing diffusion-weighted imaging (DWI) results and pathology results of prostate biopsy sites. Methods. Of the patients who applied with lower urinary tract symptoms, 36 patients who had suspected DRE and/or PSA ≥2.5 ng/mL were included in the study. Patients underwent DWI prior to 10 cores-prostate biopsy. 356 biopsy cores were obtained from the patients. Foci from the patients with prostate cancer were labeled as malignant or benign foci, likewise foci from the patients with benign pathology were grouped as BPH and inflammation foci. Apparent diffusion coefficients (ADCs) of biopsy groups were compared with each other in order to measure the reliability of DWI in detection of PCa foci. Results. When ADC values of adenocarcinoma foci and BPH foci were compared, a statistically significant difference was found (P < 0.001). When ADC values obtained from adenocarcinoma foci and chronic inflammation foci are compared, the difference between two groups is statistically significant, too (P < 0.001). Conclusions. Biopsies focused on suspected regions after formation of ADC maps by means of DWI would provide to start definitive treatment immediately as well as being beneficial to prevent morbidity related to repeated prostate biopsies.
    06/2012; 2012:252846. DOI:10.5402/2012/252846
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    ABSTRACT: The association of 5-alpha reductase inhibitor (5ARI) therapy and sexual dysfunction has been reported. Some patients claim persistent erectile dysfunction despite long-term discontinuation of 5ARI treatment. The aim of this study was to assess erectile function after cessation of 5ARI therapy using a rat model. Twenty-six adult male Sprague-Dawley rats were randomized into three groups: (i) control (N = 10); (ii) 8-week dutasteride treatment (0.5 mg/rat/day, in drinking water, N = 8); and (iii) 6-week dutasteride treatment followed by a 2-week washout period (N = 8). The experiments were performed after 8 weeks from the initiation of treatment in all groups. In vivo erectile activity and in vitro contractile and relaxant responses of cavernosal smooth muscle were investigated. In vivo erectile activity (intracavernosal pressure [ICP]/mean arterial pressure [MAP] and total ICP) in treatment groups were significantly decreased compared with controls (ICP/MAP: P < 0.001 for 2.5 v, 5 v, and 7.5 v; total ICP: P < 0.001 for 5 v and P < 0.01 for 7.5 v). Acetylcholine-induced relaxations were diminished in treatment groups (P < 0.05). Relaxant responses to electrical field stimulation (EFS) were decreased in the 8-week treatment group (P < 0.05) but were similar to controls in the washout group. Sodium nitroprusside (SNP)-induced endothelium-independent relaxations were reduced in the 8-week dutasteride treatment group (P < 0.01), while these responses were restored in the washout group. The contractile responses to the alpha1-adrenergic agonist phenylephrine were decreased in treatment groups compared with controls (P < 0.01). Direct neurogenic contractile responses in the dutasteride groups were significantly lower than controls between 1 and 15 Hz frequencies (but not at 20 Hz) and washout partially restored the responses at 10 and 15 Hz. Discontinuation of dutasteride improved the relaxant responses to EFS and SNP, while cholinergic and adrenergic responses remained depressed. Our findings suggest a time-dependent detriment of dutasteride on erectile function. The withdrawal/washout effect of 5ARIs on parameters of human sexual function warrants further investigation.
    Journal of Sexual Medicine 05/2012; 9(7):1773-81. DOI:10.1111/j.1743-6109.2012.02759.x · 3.15 Impact Factor
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    ABSTRACT: Objectives: To compare the prevalence of preoperative co-morbid factors and complications of transurethral resection of prostate (TUR-P) in patients with normal and non-dialysis requiring elevated serum creatinine levels.Methods: The records of 357 consecutive patients with IPSS≥20, serum creatinine level ≤ 3 mg/dl, residual urine volume ≤ 300 ml and with no upper urinary tract dilatation or evidence of prostate cancer that underwent TUR-P were retrospectively evaluated. 60 patients who did not fulfill the inclusion criteria were excluded. The preoperative Na, K, creatinine levels and the early changes observed in these parameters after TUR-P of the patients with normal (Group1, n = 272) and elevated (Group2, n = 25) serum creatinine levels, as well as the preoperative baseline data and postoperative complications were compared.Results: Preoperative PSA, serum urea, creatinine and K levels were significantly higher in group2. No significant differences were observed between early and late postoperative complications of the two groups. Co-morbid diseases were significantly more common in group2. No progression in renal failure or de novo need for hemodialysis was observed in group2.Conclusions: TUR-P can be safely performed in BPH patients with mild serum creatinine elevations (1.6-3 mg/dl) and moderately increased prostate volumes without additional morbidity and mortality.
    Therapeutic Advances in Urology 04/2012; 4(2):51-6. DOI:10.1177/1756287211435088
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    ABSTRACT: To evaluate the relationship between pathologically proven prostatic inflammation (PI) and re-operation rates due to urethral stricture (US) or bladder neck contracture (BNC) after transurethral resection of prostate (TUR-P). We have retrospectively reviewed the data of 917 consecutive TUR-P cases. Eligible patients (n = 276) were grouped with respect to presence of PI on TUR-P pathology; Group1: PI (+) (n = 67, 24.3%), and Group2: PI (-) (n = 209, 75.7%). The "re-operation" was defined as internal urethrotomy or bladder neck resection performed for BNC or US. Groups were compared with respect to descriptive data and need for re-operation. Logistic regression analysis was performed to estimate the independent risk factors for the development of BNC and US. P values under 0.05 were considered significant. Of the patients, 38 (13.8%) needed re-operation while 238 (86.2%) did not. The re-operation rate in Group1 was significantly higher than Group2 (29.8 vs. 8.6%, P < 0.001). In logistic regression analysis, duration of initial TUR-P and PI were found to be independent risk factors for development of BNC or US after TUR-P. Prostatic inflammation on TUR-P pathology is an independent variable affecting the development of US or BNC. Our results should be supported by prospective studies including higher number of patients.
    International Urology and Nephrology 01/2012; 44(4):1085-90. DOI:10.1007/s11255-012-0127-y · 1.29 Impact Factor
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    ABSTRACT: To evaluate the mechanism of action of imatinib mesylate (Gleevec), a protein tyrosine kinase inhibitor on the human prostate with benign prostatic hyperplasia. Prostate samples were obtained from 16 patients with benign prostatic hyperplasia (mean age 68.3 ± 1.9 years), who had undergone transurethral prostatectomy. In tissue bath studies, cumulative concentration-response curves were constructed for imatinib after precontraction with 120 mM KCl. Imatinib-induced relaxation was quantitated in tissues treated with l-N(G)-Nitroarginine Methyl Ester (l-NAME) (an inhibitor of nitric oxide synthase) or 1H-[1,2,4]-oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) (a soluble guanylyl cyclase inhibitor). Two K+ channel blockers (adenosine triphosphate [K(ATP)] and Large-conductance Ca(2+)-activated K(+) channels [BK(Ca2+)] channels) were also evaluated as antagonists of imatinib-induced relaxation and repeated in the presence of the α-adrenergic receptor blocker alfuzosin. An electrical field stimulation (1-20 Hz, 5 ms, 5 seconds, 60 V)-induced contractile response was performed on strips incubated with imatinib (10(-3) M). KCl-induced contractions in human prostatic tissue were significantly inhibited by imatinib (maximal response 84.9 ± 4.5%) and were attenuated by l-NAME (42%, P < .001) and ODQ (43%, P < .001). This relaxant effect was also suppressed by glibenclamide (adenosine triphosphate-sensitive K+ channel blocker, 41%, P < .001) and tetraethylammonium (BK(Ca2+) channel blocker, 24%, P < .05). Imatinib induced prostatic smooth muscle relaxation in vitro. This effect was suppressed by l-NAME and ODQ, showing a dependence on the nitric oxide-cyclic guanosine monophosphate pathway and modulated by the K(ATP) and BK(Ca2+) K+ channels. Our findings suggest that imatinib can augment relaxation of human prostatic tissues by way of a novel ligand-protein tyrosine kinase signaling pathway.
    Urology 08/2011; 78(4):968.e1-6. DOI:10.1016/j.urology.2011.06.033 · 2.13 Impact Factor
  • European Urology Supplements 03/2011; 10(2):62-63. DOI:10.1016/S1569-9056(11)60122-X · 3.37 Impact Factor
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    ABSTRACT: To evaluate the effects of pathological stage and surgical margin status on biochemical failure rates after radical prostatectomy (RP). The records of 205 patients who underwent RP for clinically localized prostate cancer (CaP) were evaluated. Known risk factors for biochemical failure (BF) were analyzed using univariate and multivariate logistic regression analysis. The effects of surgical margin status together with pathological stage on BF were evaluated. p values lower than 0.05 were accepted to be statistically significant. Pathological stage, positive surgical margin (PSM), seminal vesicle invasion, lymph node involvement, biopsy Gleason score and postoperative Gleason score were the factors associated with BF in univariate analysis. Logistic regression analysis revealed that pT3a patients with PSM had a significant BF rate when compared to pT2 patients with a negative surgical margin (NSM) (OR 7.46, p = 0.002). pT3a patients with a NSM had a similar BF rate to that of pT2 patients with PSM. pT2 patients with PSM had a similar biochemical prognosis to that of pT3a patients without PSM, implicating that a PSM may have a negative effect on prognosis similar to that of extracapsular invasion.
    Urologia Internationalis 02/2011; 86(2):156-60. DOI:10.1159/000322840 · 1.15 Impact Factor
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    ABSTRACT: The aim of this study was to determine if antibiotic or anti-inflammatory medications lower serum prostate-specific antigen (PSA) in the presence or absence of inflammation in the prostatic secretions of patients with PSA levels between 2.5 and 10 ng/ml and normal digital rectal examinations (DRE). Patients with PSA levels between 2.5 and 10 ng/ml and normal DRE were candidates for the study. One hundred and eight patients with positive expressed prostate secretion (EPS) were randomized into antibiotics, anti-inflammatory and control groups (groups 1, 2 and 3, respectively), and 108 patients with negative EPS were randomized into similar groups (groups 4, 5 and 6, respectively). Repeat PSA levels of all patients were obtained 6 weeks after randomization and 10 core prostate biopsies were performed. Median PSA levels in group 1 before and after treatment were 5.2 (4.3-6.4) and 4.0 ng/ml (3.1-4.9), respectively (p < 0.001). The only significant decrease in PSA was observed in group 1. The percent change in PSA levels in group 1 was significantly greater than both in its control group (group 3; p < 0.001) and the EPS- antibiotics group (group 4; p < 0.001). Antibiotherapy significantly reduces serum PSA only in EPS+ patients, which justifies limiting the use of prebiopsy antibiotics to EPS+ patients with a normal DRE and PSA level between 2.5 and 10 ng/ml, minimizing the major drawbacks of empirical antibiotics usage.
    Urologia Internationalis 01/2010; 84(2):185-90. DOI:10.1159/000277596 · 1.15 Impact Factor
  • European Urology Supplements 03/2009; 8(4):235-235. DOI:10.1016/S1569-9056(09)60457-7 · 3.37 Impact Factor
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    ABSTRACT: Performance of 16 (16 g) (n=103) and 18 gauge (18 g) (n=101) biopsy needles in transrectal ultrasound (TRUS)-guided 10-core prostate biopsies were compared in terms of cancer detection and pre-defined specimen quality criteria in this prospective randomized study. Cancer detection rates of the two groups were similar, although the mean core volume of 16 g needles was almost twice that of 18 g needles. On the other hand, using 16 g needles significantly improved specimen quality by acquiring less empty cores, small cores and fragmented cores. There were no significant differences among the complication rates and VAS pain scores of the two groups. Sixteen gauge needles can safely be used in TRUS-guided prostate biopsies, as they improve specimen quality without increasing morbidity and patient discomfort.
    Prostate cancer and prostatic diseases 06/2008; 11(3):270-3. DOI:10.1038/pcan.2008.34 · 2.83 Impact Factor
  • The Journal of Urology 04/2008; 7(3):139-139. DOI:10.1016/S1569-9056(08)60273-0 · 3.75 Impact Factor
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    ABSTRACT: In this study, we aimed to evaluate changes in contractile responses under in vitro conditions in detrusor overactivity (DO) in patients with bladder outflow obstruction (BOO). Detrusor strips obtained during open prostatectomy procedure from 16 patients with BOO related to benign prostate hyperplasia were evaluated under in vitro conditions. Patients were assigned to two groups as patients with (DO) and without (no DO) DO. Four detrusor strips were prepared from each bladder in dimensions of 2 x 10 mm, and were suspended in organ bath. Responses to carbachol (10(-8) to 10(-3)M), electrical field stimulation (EFS) (0.5-32 Hz), single-dose adenosine 5'-triphosphate (ATP) (10(-3)M) and KCl (120 mM) were recorded to evaluate the contractile responses. EFS responses were repeated in the presence of NG-nitro-L-arginine methyl ester (L-NAME; 10 muM) and L-NAME + indomethacin. All responses were expressed as mg tension developed per mg of bladder tissue. Data obtained were compared using independent t test and one-way ANOVA test. Values of p < 0.05 were accepted as statistically significant. Of the 16 patients on whom open prostatectomy was performed because of BOO, 8 of the patients were determined as no DO and 8 as DO. There were no differences between groups regarding age and residual urine. We found statistically significant differences between groups regarding dimensions of prostate, maximum bladder capacity and maximum bladder pressure. In the comparison of cumulative dose of carbachol, it was seen that responses were higher in the DO group, but the differences were not statistically significant. In EFS application, contractile responses were found to increase significantly in the DO group. No changes were observed between groups for ATP and KCl. EFS responses were found to be significantly higher in presence of L-NAME + indomethacin in the no DO group; however, no difference was seen in the DO group. Detrusor contractile responses to EFS increased in patients with BOO in presence of overactivity. These changes in contractile responses are observed possibly as a result of deterioration in neuromodulation, rather than as a result of changes in purinergic or cholinergic receptor sensation or level. We suggest that a noncholinergic-nonpurinergic mechanism can have some effect on these changes.
    Urologia Internationalis 02/2008; 80(2):193-200. DOI:10.1159/000112613 · 1.15 Impact Factor
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    ABSTRACT: Suture materials are widely used in urological surgery especially in regions that are in contact with urine. In this study, we aimed to compare polyglactine 910, chromed catgut and polydioxanone sutures according to stone formation and inflammation, congestion and foreign body reaction that occur on bladder mucosa. Cystotomy procedure was performed, in three groups of Wistar female rats, with 4/0 polyglactine 910, 4/0 chromed catgut and 4/0 polydioxanone sutures. All groups were divided into two sub-groups with 4 and 8-week follow up periods. Rats were treated with 20 mg kg(-1) day(-1) Ofloxacin (i.p.) daily until the seventh post-operative day. Urinary pH, leucocyte esterase and nitrite levels were determined. All rats were killed at the end of the follow-up period and stone formation on sutures and degrees of tissue reactions (inflammation, congestion and foreign body reaction) on bladder mucosa were compared. Tissue reactions were evaluated by the same pathologist (S. K.). Chi-square and Student's t test were used in statistical analysis (p<0.05). There was no significant difference between the mean weights of the groups. Leucocyte esterase and nitrite were negative in urine analyses. There was no significant difference between urinary pH levels of the groups with 4 and 8 weeks follow-up (p>0.05). Although the difference between the degrees of congestion in groups was not statistically significant (p>0.05), there were statistically significant differences between the degrees of inflammation and foreign body reaction in groups. Although the duration of urinary contact of suture is the main factor in stone formation on suture material, tissue reaction on mucosa and the physical structure of suture also affect this formation. We observed lower degrees of inflammation and foreign body reaction with 4/0 polydioxanone and no stone formation. We believe that polydioxanone may be useful and reliable in urological surgery due to these properties.
    Urological Research 02/2008; 36(1):43-9. DOI:10.1007/s00240-007-0124-2 · 1.31 Impact Factor