Tarkan Soygür

Ankara University, Engüri, Ankara, Turkey

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Publications (61)140.16 Total impact

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    ABSTRACT: Background: relapse after cessation of desmopressin is an important problem in enuresis treatment. Structured withdrawal of desmopressin tablets was shown to decrease relapse rates. However, scientific data is lacking on structured withdrawal of melt formulation. Objective: To compare relapse rates of structured withdrawal with placebo and direct cessation in a population of desmopressin responding enuretics. Design, setting, and participants: Patients diagnosed with enuresis and responding to desmopressin from 13 different centers were involved in the study. Patients were randomized to 4 groups. Two different structured withdrawal strategies are compared with placebo and direct withdrawal. Outcome measurements and statistical analysis: Sample size was estimated as 240 (60 patients in each group) with power of 0.80 and an effect size of 30%. Randomization is performed by NCSS software from a single centre. The relapse rates of the groups were compared with Chi-Square test. To define the independent factors having effect on relapse rates, logistic regression analysis was performed. Results and limitations: desmopressin treatment was initiated to 421 patients and 259 patients were eligible for randomization. Relapse rates were 39, 1% and 42, 4% for the structured withdrawal groups which were significantly lower than direct withdrawal (55, 3%) and placebo (53, 1%). Logistic regression analysis revealed that initial efficient dose of 240 µcg, higher number of wet nights before treatment and non-structured withdrawal were associated with higher relapse rates. Conclusions: Our study has shown that structured withdrawal with MELT formulation of desmopressin mediates decreased relapse rates. Application of a structured withdrawal programme was also an independent factor associated with decreased relapse rates together with lower initial effective dose and number of wet nights / week. Patient summary: relapse after cessation of desmopressin is an important problem and in this study, structured withdrawal is found to be associated with decreased relapse
    The Journal of urology 01/2014; · 4.02 Impact Factor
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    ABSTRACT: The urofacial syndrome is a rare condition that occurs in both genders and characterized by uropathy and facial abnormalities. Early diagnosis is crucial for the management and prognosis of urinary problems. Paradoxical inversion of facial musculature when smiling, giving an appearance of crying associated with severe urinary tract dysfunction is typical in these patients. Although facial signs and symptoms are generally ignored and shadowed by the dominant bladder symptoms, we have recently realized a unique but constant finding in majority of these patients, nocturnal lagophthalmos which is described as inability to close the eyelids during sleep. We report 15 patients with urofacial syndrome (Ochoa) whom mostly had admitted with major urological symptoms and 12 of the cases had nocturnal lagophthalmos. Lagophthalmos may lead to keratitis, corneal abrasion, infection, vascularization, and in extreme cases, ocular perforation, endophthalmitis and loss of the eye. Basic modalities like lubricant drops during the day and ointments at night are usually enough to protect the cornea from exposure keratopathy. In moderate to severe cases, overnight taping of the lid or the use of a moisture chamber might be necessary. Majority of our patients responded to basic therapy. Conclusion Nocturnal lagophthalmos is a novel symptom described in patients with urofacial syndrome. The pediatricians and urologists should be careful about this symptom to prevent eye damage and quality of life problems.
    European Journal of Pediatrics 11/2013; · 1.91 Impact Factor
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    ABSTRACT: BACKGROUND: To evaluate the effect of circumcision and/or antibiotic prophylaxis on periurethral flora and associated bacteriuria in male children with and without vesicoureteral reflux (VUR). PATIENTS AND METHODS: The study included 91 boys with low-grade VUR and 106 healthy boys (control) without VUR. The boys with VUR were randomized as antibiotic prophylaxis only and antibiotic prophylaxis plus circumcision. The boys without VUR were randomized as circumcision group and followed-up group without circumcision. Periurethral swab and urine cultures were obtained from the participants at the beginning of the study, and at 1st, 3rd, 6th, 9th, and 12th month. The groups were compared in terms of positive periurethral and urine cultures. RESULTS: The positive periurethral culture rate was significantly lower in the circumcised boys at all measurement times. The positive urine culture rate in the circumcised boys was lower than in the uncircumcised boys. Subgroup analysis based on age groups showed that age did not affect these statistical differences. CONCLUSION: Circumcision decreases colonization of periurethral bacterial pathogenic flora. In boys with low-grade VUR, circumcision plus antibiotic prophylaxis prevented recurrent and febrile urinary tract infections.
    Journal of pediatric urology 05/2013; · 1.38 Impact Factor
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    ABSTRACT: Urofacial syndrome (UFS) (or Ochoa syndrome) is an autosomal-recessive disease characterized by congenital urinary bladder dysfunction, associated with a significant risk of kidney failure, and an abnormal facial expression upon smiling, laughing, and crying. We report that a subset of UFS-affected individuals have biallelic mutations in LRIG2, encoding leucine-rich repeats and immunoglobulin-like domains 2, a protein implicated in neural cell signaling and tumorigenesis. Importantly, we have demonstrated that rare variants in LRIG2 might be relevant to nonsyndromic bladder disease. We have previously shown that UFS is also caused by mutations in HPSE2, encoding heparanase-2. LRIG2 and heparanase-2 were immunodetected in nerve fascicles growing between muscle bundles within the human fetal bladder, directly implicating both molecules in neural development in the lower urinary tract.
    The American Journal of Human Genetics 01/2013; · 11.20 Impact Factor
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    ABSTRACT: Mayer-Rokitansky-Küster-Hauser anomaly originates from agenesis of the Müllerian duct including agenesis of the uterus and the vagina because of abnormal development of the uterine ducts. This syndrome may be accompanied by the upper urinary tract anomalies such as unilateral renal agenesis, ectopia of 1 or both kidneys, renal hypoplasia, horseshoe kidney, and hydronephrosis. We report a 16-year-old girl, with unilateral renal agenesis, herniating ovary, and renal cell carcinoma in her solitary kidney, associated with Mayer-Rokitansky-Küster-Hauser syndrome-the first case in the literature to our knowledge.
    Journal of Pediatric Hematology/Oncology 10/2012; · 0.97 Impact Factor
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    ABSTRACT: Inflammatory myofibroblastic tumors (IMTs) of the bladder are rarely encountered bladder tumors during the pediatric age. The unknown malignant potential of these tumors causes controversy for their treatment and follow-up. We report a 10-year-old girl who was referred to our clinic with dysuria and enuresis. The clinicopathological evaluation was compatible with IMT and a bladder preserving approach was used. There was no recurrence in the first year of follow-up examinations.
    Urology 09/2012; · 2.42 Impact Factor
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    ABSTRACT: Bladder augmentation has revolutionized the care of children with neurogenic bladder but it is associated with certain short- and long-term complications. Using the combination of gastric and ileal segments to balance effects of these segments might be a solution for complications. A total of 39 female Spraque-Dawley rats randomly divided into four groups: ileocystoplasty (11), gastrocystoplasty (9), ileogastrocystoplasty (11) and control (8). Serum/urine electrolytes and pH values, and serum creatinine levels and urine mucus concentration were measured. Kruskal-Wallis non-parametric variance analysis was performed to compare the groups and p < 0.05 was accepted as significant. Metabolic alkalosis with significantly lower urine pH was observed in gastrocystoplasty group. Gastroileal group showed similar results with the ileal group in all parameters. No stone formation was detected in the sham and gastric cystoplasty groups. Metaplastic and hyperplastic changes were observed in all segments surrounding urothelium. In conclusion, combination of gastric and ileal segments does not significantly reduce the rate of metabolic impairments, stone and mucus formation. Besides it is not associated with significant improvement in histological outcome since urine is still in contact with the gastrointestinal mucosa.
    Urological Research 02/2011; 39(1):39-44. · 1.59 Impact Factor
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    ABSTRACT: Nutcracker syndrome (NS) refers to compression of the left renal vein between the aorta and the superior mesenteric artery which results in left renal venous hypertension. The typical clinical presenting feature is hematuria. In this report we describe the case of patient with a single kidney who developed severe proteinuria due to NS. She was successfully treated with left renal vein transposition. This case clearly shows the relation between NS and severe proteinuria based on normal biopsy findings and the complete disappearance of proteinuria following surgery.
    Pediatric Nephrology 02/2011; 26(6):987-90. · 2.94 Impact Factor
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    ABSTRACT: A multidisciplinary approach is mandatory in defining the cause and directing the treatment of childhood urinary incontinence. Both pediatricians and pediatric urologists should carefully evaluate a child with incontinence for possible overlapping etiologies, before labeling him or her as a refractory case. We report an epileptic boy with dysfunctional elimination syndrome (DES) with associated rare complications of giggle incontinence and idiopathic urethritis, proving the need for a good voiding diary, patient history and structured symptom scores.
    The Turkish journal of pediatrics 01/2011; 53(1):100-3. · 0.56 Impact Factor
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    ABSTRACT: In this case report we describe a case of persistant Müllerian duct syndrome together with transverse testicular ectopia. These 2 entities are discussed to assess the relationship between them and the lack of necessity for magnetic resonance imaging in cases of undescended testes, and relevant literature is reviewed.
    Urology 12/2010; 76(6):1475-7. · 2.42 Impact Factor
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    ABSTRACT: The nutcracker syndrome, caused by compression of the left renal vein between the superior mesenteric artery and the aorta, usually manifests with hematuria, flank pain and proteinuria. We report on a 9-year-old boy who was previously diagnosed with urolithiasis but had significant proteinuria, not explained by this diagnosis. On further investigation by renal Doppler ultrasonography it was found that he had nutcracker syndrome. We would like to emphasize that this syndrome should be considered where there is no obvious cause of proteinuria and hematuria.
    Journal of pediatric urology 10/2010; 6(5):519-21. · 1.38 Impact Factor
  • Pediatric Nephrology 02/2010; 25(12):2443-7. · 2.94 Impact Factor
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    ABSTRACT: levels of 44.8 ng/ml/h (normal range: 0.5–1.9 ng/ml/h) and 140 ng/dl (normal range: 0.8–17.2 ng/dl), respectively, when the patient was in the supine position. These results allowed us to rule out true mineralocorticoid excess, such as primary aldosteronism or glucocorticoid-remediable aldosteronism. We also ruled out non-aldosterone mineralocorticoid excess, which is observed in patients with congenital adrenal hyperplasia or in apparent mineralocorticoid excess, because the suppression of both PRA and serum aldosterone concentration is expected in these diseases [1]. The results steered us towards a diagnosis of secondary aldosteronism with excess renin secretion, a condition that can occur in renal parenchymal disease associated with inflammation or scarring, renovascular diseases, or aortic coarctation [2]. However, our previous clinical, laboratory, and radiological findings did not indicate any of these diseases. Our plan, therefore, was to repeat the renal ultrasound and renal arterial Doppler ultrasound and, if the results were normal, to perform a conventional angiography. Renal ultrasound revealed a 3-cm, solid, exophytic mass in the upper pole of the left kidney. The mass was isoechoic to the renal parenchyma, and it could not be demarcated from the parenchyma other than by the bulging of the renal contour. Magnetic resonance imaging (MRI) of the abdomen showed a 3.5-cm well-circumscribed mass in the posterolateral upper pole of the left kidney. The lesion was slightly heterogenous and isointense to the renal medulla on both T1- and T2weighted images (Fig. 1). Dynamic contrast-enhanced imaging revealed rapid enhancement in the early arterial phase, which subsequently became isointense with the surrounding normal parenchyma in the delayed phase. While these evaluations were being carried out, the hypertension of the patient once again became apparent, and antihypertensive therapy was restarted. The patient was transferred to the
    Pediatric Nephrology 02/2010; · 2.94 Impact Factor
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    ABSTRACT: Purpose We have previously shown that VEGF and its receptors were expressed in embryonic bladder development in mice. Both exogenous and hypoxia triggered endogenous VEGF enhanced organ growth, cell proliferation and decreased apoptosis. Strikingly not only endothelial, but also detrusor cell proportions are increased by higher levels of VEGF. We hypothesized that embryonic ureter smooth muscle should express VEGF and receptors and react similarly to exogenous VEGF like detrusor in organ culture. Material and Methods Expression of VEGF and related molecules were explored by immunohistochemistry in embryonic day (E) 16, 18 and postnatal day 1(D1) ureters. Whole (E) 16 bladders and ureters from mice were grown in organ culture for 6 days and some cultures were supplemented with different doses of VEGF. Results VEGF and VEGF receptor (R1) were immunodetected in E16, E18 and D1 ureters. VEGFR2 was not immunodetected prenatally. Although exogenous VEGF had aforementioned effects on embryonic bladder detrusor and endothelia, simultaneously explanted ureters did not reveal increase in total cell numbers, DNA and protein content. Apoptosis and proliferation was not affected. VEGF increased proportions of cells expressing endothelial (CD31) marker however smooth muscle (smooth muscle actin) marker was not affected. Conclusions In organ culture, exogenous VEGF stimulates proliferation of bladder endothelial and detrusor cells. However effects on embryonic ureter are diverse and only limited to endothelial proliferation. VEGF is present in both embryonic organs however affects smooth muscle cell populations divergently. This raises the possibility that undesirable remodeling of detrusor related to hypoxia and VEGF associated conditions (obstruction etc.) can be illuminated by further investigations.
    Journal of Pediatric Urology. 01/2010; 6.
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    ABSTRACT: Purpose Comparing ultrasound (US) scan and nuclear renography findings in patients who underwent pyeloplasty with and without pelvic reduction in a randomized prospective study. Material and Methods 42 patients, all prenatally diagnosed with unilateral hydronephrosis, were included. Hydronephrosis was confirmed postnatally. 20 were randomly selected to undergo pyeloplasty with pelvic reduction and 22 underwent pelvis sparing pyeloplasty. Patients were evaluated with MAG-3 scans on 6th and US scans on 1st, 3rd and 6th months postoperatively. Mean follow up was 37±5, 6 weeks. Statistical analyses were performed using chi-square test and significance was set as p<0.05. Power analyzes were performed by ncss pass programme. Power value of 0.84 was calculated for sample size of 42. Results The AP pelvic diameter decreased significantly in the pelvic reduction group compared to pelvis sparing group in the first and third month US scans. However the difference was not significant on the 6th month. The improvements on the US findings for the pelvis sparing group catch up the pelvic reduction group later in postoperative period. Pelvic reduction significantly improved the renal wash out time (T ½) in MAG 3 renography when compared to pyeloplasty group without reduction at postoperative 6th month. Differential renal function (DRF) was found to be not affected from pelvic reduction. Conclusions Resolution of AP diameter in US scan is more prominent in the pelvic reduction group at earlier stages of the postoperative period. Although T ½ decreases more prominently at the pelvic reduction group, the employability of this is still indecisive. This feature can reveal possible surgical failures earlier and strengthen the values of US and renography postoperatively.
    Journal of Pediatric Urology. 01/2010; 6.
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    ABSTRACT: KeywordsChild-Neurogenic bladder-Ochoa syndrome
    Pediatric Nephrology 01/2010; 25(6):1059-1061. · 2.94 Impact Factor
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    Pediatric Nephrology 08/2009; 25(6):1057; answer 1059-61. · 2.94 Impact Factor
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    ABSTRACT: To investigate the factors affecting desmopressin response and relapse rates in an adult male population with monosymptomatic nocturnal enuresis (MNE). Nocturnal enuresis is a frequent heterogeneous condition, which is genetically complex in nature. Between September 2007 and January 2009, a total of 143 male soldiers with nocturnal enuresis admitted to a military referral center. Eighty-six male soldiers with MNE were investigated. Family history, smoking habits, previous treatment history, coexisting urinary symptoms, bowel habits, maximal functional bladder capacity, and body mass index were examined to determine their effects on desmopressin response. All patients initially received 0.2 mg of desmopressin. Patients were evaluated after 2 weeks and non-full responders were switched to 0.4-mg desmopressin, with total treatment duration of 3 months. The mean follow-up after starting the initial dose was 9.4 months (4.5-15 months). Of the 86 patients with MNE, 37 patients (43%) showed full response. None of the investigated parameters were shown to affect response rates. With regard to the relapse rates, 36.1% of the patients were taking 0.2-mg tablets and 63.9% were taking 0.4-mg tablets. This difference was statistically significant (P <.05). Other parameters did not have any significant effect on relapse rates. Adult male MNE is a heterogeneous condition and desmopressin appears to be an effective and well-tolerated treatment. Higher response rate can be predicted if the nocturnal urine output exceeds functional bladder capacity for each individual. Our study also contributed that relapse rates depend on initial tailored dose; however, this needs to be confirmed with further studies.
    Urology 07/2009; 74(4):915-9. · 2.42 Impact Factor
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    ABSTRACT: Posterior urethral valves are a common obstructive uropathy causing severe hydroureteronephrosis. Ureteral herniation is very rare and often misdiagnosed. We report a male infant with posterior urethral valves who had increased persistent hydronephrosis despite prior successful ablation. Further examination revealed a paraperitoneal inguinal ureter herniation to be responsible for the clinical status.
    Journal of pediatric urology 07/2009; 6(1):87-8. · 1.38 Impact Factor
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    ABSTRACT: HC is a common complication following HSCT. Risk factors include viral infections, cyclophosphamide and busulfan usage, pelvic irradiation, older age at transplantation, allogeneic HSCT and GvHD. The severity of HC ranges from mild hematuria to life-threatening bleeding. Here, we present a seven-and-a-half-yr-old boy with Wiskott-Aldrich syndrome who experienced a late onset Grade III hemorrhagic cystitis following HSCT from his fully matched sibling. A Grade I GvHD localized to skin developed on day +11 and prednisolone therapy was given between the 11th and 22nd d. Myeloid and platelet engraftments were achieved +13 and +16 d, respectively. A gross hematuria began on the 21st post-transplant day. The urine cultures for bacterial or fungal organisms were negative. Urine analysis by PCR revealed a CMV viruria. Following systemic ganciclovir treatment, urinary CMV became negative but hemorrhagic cystitis did not improve. Due to the probability of existing BK virus or adenovirus, two doses of cidofovir were administered intravesically. As he continued to have painful hematuria with large clot formations, two doses of intravesical hyaluronic acid were applied. Macroscopic hematuria resolved within four d after the second dose. Complete remission was achieved on day +77. Finally, intravesical administration of hyaluronic acid seems to be effective and safe and can be a promising treatment in patients suffering from severe and late onset HC.
    Pediatric Transplantation 05/2009; 14(6):E79-82. · 1.50 Impact Factor

Publication Stats

439 Citations
140.16 Total Impact Points

Institutions

  • 1996–2014
    • Ankara University
      • • Department of Pediatric Neurology
      • • Department of Urology
      • • Department of Pediatric Nephrology
      Engüri, Ankara, Turkey
  • 2013
    • Abant İzzet Baysal Üniversitesi
      • Faculty of Medicine
      Bolu, Bolu, Turkey
  • 1997
    • Ibn Sina Hospital Dhanmondi
      Baghdād, Mayorality of Baghdad, Iraq