Mehmet Turgut

Eskisehir Osmangazi University, Dorylaeum, Eskişehir, Turkey

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Publications (12)14.32 Total impact

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    ABSTRACT: Extracorporeal shockwave lithotripsy (SWL) has remained the preferred method of treatment of urinary stones since its introduction in 1980. Although SWL is classified as a potential first-line treatment for renal stones smaller than 2 cm and its overall success rate is higher than 85% for stone clearance, not all renal calculi are successfully fragmented after SWL. Among the urinary stones, calcium oxalate monohydrate (COM) stone is one of the hardest stones to fragment. Several factors interfering with stone fragility are known to exist. In addition to technical properties for SWL to increase the quality and rate of stone disintegration, the composition of stones such as trace element levels may also interfere with the efficacy of SWL. Therefore, in the present study, we aimed to elucidate the correlation, if it exists, between fragmentation of renal stones and their trace element (Cu, Zn, Mg, Fe, Pb, Mn, Cr) concentrations. For this purpose, the patients admitted to our department who were identified with urinary stones (740 patients) and underwent SWL sessions were evaluated prospectively. Patients having 5-20 mm of solitary COM stone in the renal pelvis were included in this study. The trace element concentrations of renal stones that were successfully fragmented with SWL (SWL-S) were compared with those that were unsuccessfully fragmented after three SWL sessions (SWL-US) and removed surgically. Our measurements showed that the concentrations of Cu, Fe, Pb, and Cr were similar in both groups; by contrast, the concentration of Zn, Mg and Mn was significantly lower in SWL-US renal stones. The present results suggest that low concentrations of Zn, Mg and Mn in COM stones appear to make them resistant to SWL fragmentation and may offer a critical distinction for the choice of a treatment program.
    No preview · Article · Mar 2008 · Urological Research
  • Mehmet Turgut · Cavit Can · Aydin Yenilmez · Nevbahar Akcar
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    ABSTRACT: Perforation of the upper ureter is a rare but serious complication of extracorporeal shock wave lithotripsy (SWL). Ureteral perforation can cause a series of problems including the retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal function impairment. We reported here a rare case of SWL-induced upper ureteral rupture resulting in an expanding retroperitoneal urinoma that required percutaneous drainage. Ureteral perforation was treated successfully without major surgical intervention by employing temporary percutaneous drainage and antibiotics. The present case indicates that potential ureter rupture may form in rare cases; especially in patients having infected stones and exposed to a high number of shock waves. This complication further emphasizes the importance of adequate pre-and post-operative evaluation and the precise identification of the cause of the persistent pain after SWL.
    No preview · Article · Sep 2007 · Urological Research
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    ABSTRACT: To assess the analgesic efficacy of lornoxicam and compare it with that of tenoxicam in patients undergoing extracorporeal shock-wave lithotripsy (ESWL) for renal stones. The study was carried out in a randomized, double-blind fashion and involved 60 patients (American Society of Anesthesiologists physical status I-II) undergoing ESWL who were divided into three groups. Patients in the placebo group (n = 20) received saline and those in the lornoxicam group (n = 20) received lornoxicam 8 mg intravenously 60 min before the procedure. In the tenoxicam group, patients (n = 20) received tenoxicam 20 mg intravenously at the same time point. All patients were started on patient-controlled i.v. meperidine analgesia during the procedure. The effectiveness was assessed by using a visual analog scale (VAS) and by calculating the total analgesic consumption of meperidine during the procedure. Arterial blood pressure, oxygen saturation, and respiratory rate were recorded throughout the procedure; nausea and vomiting, agitation, and respiratory depression were assessed. Compared with patients in the placebo group, patients in the lornoxicam and tenoxicam groups received smaller doses of meperidine at all time points (p < 0.05). After 30, 45, and 60 min of ESWL, patients in the lornoxicam group required significantly smaller doses of meperidine than those in the tenoxicam group (p < 0.05). Patients in the placebo group showed higher VAS scores than those in the lornoxicam and tenoxicam groups at 15, 30 and 60 min. The VAS score in the lornoxicam group was lower than that in the tenoxicam group at 15, 30, and 45 min, but the difference between the groups was statistically significant only at 45 min (1 and 3, respectively; p < 0.05). In patients undergoing ESWL the i.v. administration of a single dose of 8 mg lornoxicam provides significantly better pain control compared with tenoxicam 20 mg and placebo, without increasing adverse side-effects.
    No preview · Article · May 2007 · Scandinavian Journal of Urology and Nephrology
  • A Yenilmez · M Ozçifçi · Y Aydin · M Turgut · K Uzuner · A Erkul
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    ABSTRACT: We investigated the effect of thiamine (B1) treatment on bladder dysfunction in streptozotocin (STZ)-induced diabetic rats. A total of 40 rats were randomly divided into four groups: a control group, a group given thiamine only, a diabetic group and a diabetic group given thiamine therapy. Diabetes was induced in the rats by 65 mg/kg STZ via an intraperitoneal injection. Thiamine was given 50 mg/kg/day. Diabetic cystopathy was confirmed on cystometry 8 weeks later in diabetic groups. Rats' body and bladder weights were measured. Contractile response to carbachol and potassium chloride (KCl) of detrusor strips in all groups was studied in vitro. The body weights were significantly decreased (p<0.01), the bladder weights were significantly increased (p<0.01), and the cystometric bladder capacity and the residual urine volumes were significantly increased (p<0.001, p<0.01 respectively) in STZ-induced diabetic groups compared to the control group and the group given thiamine only. Contractile responses increased in the diabetic group in high carbachol and KCl concentrations (p<0.01, p<0.01, respectively). On the other hand, there were no differences in the other groups. These data suggest that high-dose thiamine (B(1)) treatment may be beneficial in delaying the progression of diabetic cystopathy in this experimental animal model.
    No preview · Article · Dec 2006 · Acta Diabetologica
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    ABSTRACT: To assess the effects of smoking on total sperm count, progressive sperm motility and sperm morphology among couples attending an infertility clinic. A total of 223 sperm samples (126 smokers and 97 nonsmokers) from men attending an infertility clinic for routine infertility workup were compared on the basis of standard semen analysis. Cigarette smoking is negatively correlated with progressive motile sperm count (r = -0.1464, p = 0.042), but not with sperm concentration (p = 0.961), total motile sperm count (p = 0.890) and sperm morphology (p = 0.838). Furthermore, packages/ year (cumulative dose of cigarettes) did not correlate with any of the sperm parameters including sperm density (p = 0.976), total (p = 0.559) and progressive (p = 0.406) motile sperm count and sperm morphology (p = 0.449). Although the effect of smoking on male infertility remains inconclusive, smoking had an adverse effect on the progressive sperm motility, irrespective of total amount of cigarettes smoked per day.
    No preview · Article · Feb 2006 · Clinical and experimental obstetrics & gynecology
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    ABSTRACT: To determine the prevalence of Y-chromosome microdeletions among infertile men and to correlate the clinical presentation of the men with specific deletions, microdeletion analysis in 53 infertile men (30 nonobstructive azoospermic, 23 severely oligozoospermic patients), and 100 age-matched, fathered normospermic men who had fathered children was performed by the multiplex PCR with 18 different Y-chromosome-specific STS primer sets, spanning the AZFa, AZFb, AZFd, and AZFc regions. Detection of the same locus deletion of the AZFd region in three cases indicated the possible importance of the genes located in this region in spermatogenesis.
    No preview · Article · Sep 2005 · Fertility and sterility
  • A. Yenilmez · M. Turgut · E. Çolak · A. Erkul
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    ABSTRACT: Introduction: The actual incidence of bladder outlet obstruction in female population is unknown and there are no universally accepted urodynamic criteria for diagnosing female bladder outlet obstruction. This study was designed to define cut-off values of pressure flow study for bladder outlet obstruction in women. Materials and methods: An urodynamic database of 413 consecutive women was identified. Clinical bladder outlet obstruction was suspected by history and physical examination findings in 39 women. In these patients voiding cystourethrography, pressure-flow study and/or endoscopy were performed to verify the diagnosis. An additional 83 patients presenting for evaluation of stress urinary incontinence served as controls. Three groups of women with bladder outlet obstruction were identified: 19 with urethral stricture (10 who had undergone previous anti-incontinence surgery), 13 with dysfunctional voiding and 7 with high-grade pelvic prolapse. The optimal cut-off values combination of the maximum flow rate (Qmax) and detrusor pressure at maximum flow rate (PdetQmax) for determining obstruction was calculated using receiver operating characteristic (ROC) curves. Sensitivity and specifity were calculated for different cut-off values. Results: The incidence of bladder outlet obstruction was determined to be 9.4% (39/413) in women. The mean age of the obstructed and control groups was 54.0±12.9 years and 54.1±9.7 years, respectively. In the controls the mean Qmax was 24.8 ml/s, the mean PdetQmax was 27.1 cmH2O, the mean post voiding residual urine volume (PVR) was 12.8 ml, the mean detrusor overactivity 26.5%. In the obstructed group the mean Qmax was 10.6 ml/s, the mean PdetQmax was 49.9 cmH2O, the mean PVR was 70.3 ml, the mean detrusor overactivity 48.7%. Significant differences were found in the two groups for Qmax (p<0.001), PdetQmax (p<0.001), PVR (p<0.001) and detrusor overactivity (p<0.05). No differences were noted in the two groups for bladder capacity and voided volume. On the basis of receiver operating characteristic curves, using cut-off value the optimal Qmax of 17ml/s or less, sensitivity was 92.3% and specificity was 79.5%. Using cut-off value the optimal PdetQmax of more than 35 cmH2O, sensitivity was 82.1% and specificity was 90.4%. Using a combined cut-off value of Qmax of 15 ml/s or less PdetQmax of more than 20 cmH2O, sensitivity was 84.6% and specificity was 84.3%. Conclusion: Bladder outlet obstruction in women is seen more frequently than expected. Pressure flow studies are insufficient for definitive diagnosis of bladder outlet obstruction in women in spite of its high rate sensitivity and specificity cut-off values. Clinical findings, endoscopic methods and cut-off values in pressure-flow studies should be considered together for the most appropriate diagnostic method.
    No preview · Article · Sep 2005 · Turk Uroloji Dergisi
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    ABSTRACT: A case of fibroepithelial polyp of the penis in a 59-year-old man is presented. The physical examination showed that the lesion affected the ventral surface of the glans, near the urethral meatus. No communication was found with the urethra. The patient had a history of long-term condom catheter use. He was successfully treated by wide local excision. The histopathologic diagnosis was a fibroepithelial polyp. Postoperatively, the follow-up examinations at 3, 6, 12, and 24 months showed normal findings and no recurrence.
    No preview · Article · Apr 2005 · Urology
  • Nevbahar Akcar · Mehmet Turgut · Baki Adapinar · I Ragip Ozkan
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    ABSTRACT: The aim of this study was to evaluate whether intratesticular arterial resistance and testicular volume differed between infertile men with subclinical varicoceles and infertile men without varicoceles. Fifty-eight infertile men were examined by gray-scale and color Doppler sonography for presence of varicocele, testicular volume, and arterial resistance. For men in the study group, mean testicular volume and resistance index (RI) in testes with varicoceles were compared with those in the contralateral testis by the paired t-test; statistical analyses between the study and control groups were performed by independent t-tests. Twenty-seven men had left-sided varicoceles (96% of which were subclinical), and 31 infertile men without varicoceles served as controls. Mean volumes of the right and left testes of study subjects were 14.8 ml and 14.6 ml, respectively, and in controls were 14.2 ml and 13.6 ml, respectively. Mean RI values for the right and left testes of study subjects were 0.61 and 0.58, respectively, and in controls were 0.61 and 0.58, respectively. There were no statistically significant differences in volume or RI, either between the right and left testes within patient groups or between the control and study groups' combined mean values. While the mean intertesticular volume differences for the study and control groups were 2.2 ml and 3.4 ml, respectively, the mean intertesticular RI differences were 0.04 and 0.07, respectively. These values also did not differ significantly between the 2 groups. Subclinical varicocele is not associated with ipsilateral testicular atrophy, and does not affect the intratesticular arterial RI.
    No preview · Article · Nov 2004 · Journal of Clinical Ultrasound
  • M. Turgut · C. Can · A. Yenilmez · M. Kale · Y. Özyürek
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    ABSTRACT: Introduction: Percutaneous nephrolithotomy (PNL) has been performed as a minimally invasive method of kidney stone surgery since 1976. Open surgery was preferred only selected cases in western country. In the last 20 years, 95-98% of urinary stones have been treated as a non-invasively or minimally invasive method when PNL are used the combination of other stone therapy modalities such as ureterorenoscopy and extracorporeal shock wave lithotripsy. In this study, we attempted to review the results of PNL in 119 renal units. Materials and Methods: Between April 1999 and February 2003, a total of 72 male and 43 female patients 9 to 71 years old (mean age 41.7) underwent 111 unilateral and 4 bilateral percutaneous access procedures. Of the 119 renal units accessed 62 were on the right and 57 were left side. A total of 10 patients were treated with percutaneous endopyelotomy due to ureteropelvic junction obstruction with a simultaneous renal calculus. Also, infundibulotomy were performed on 3 patients who had infundibular stenosis. All patients were evaluated by antegrade pyelography on early postoperative period. Auxiliary procedure such as repeat-PNL, ureterorenoscopy and extracorporeal shock wave lithotripsy was performed if residual stones are larger than 4mm on antegrade pyelography. Long-term follow-up was done with excretory urography and/or diuretic renal scan as well as urine analysis and culture. Results: The stone-free rate was 70.58% after one session of PNL. When the residual fragments less than 4mm were defined as insignificant, the success rate raised up to 82.35%. This rate raised up to 88.23% after auxiliary procedures such as repeat-PNL, ureterorenoscopy and extracorporeal shock wave lithotripsy. The overall complication rate was 22.68% (27/119). Complications included blood transfusion in 18 patients, hydrothorax in 5, hydroabdomen in 1. Also, one patient underwent nephrectomy because of severe hemorrhage the day after the operation, and one patient was lost because of myocardial infarction after 4 hours of operation, PNL was converted to pyelolithotomy in 1 patient due to inappropriate disposable materials. During follow-up of 3 to 40 months (average 10.8 months) no late complications were noted. Conclusion: In view of this experience, we suggested that PNL is safe and effective in all locations of kidney stones that required surgery. To maximize the success rate of operation, reserve disposable materials that are used during the operation should be kept in stock. Also the angiography department should be checked to be sure before surgery if angiography apparatus is operational in case of complications.
    No preview · Article · Jan 2004 · Turk Uroloji Dergisi
  • A. Yenilmez · M. Turgut · T. Dönmez · Y. Özyürek
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    ABSTRACT: Introduction: The storage and timely expulsion of urine were made by the lower urinary tract. Urinary incontinence occurs when the lower urinary tract fails to maintain its storage function. Urinary incontinence is a storage symptom. However, this symptom does not always imply pure storage disturbances. Therefore, urinary incontinence in women is often evaluated by cystometry only ignores the pressure flow study. In this study, we aimed to evaluate the importance of pressure flow study in women with incontinence Materials and Methods: Between September 1998 and October 2003, we retrospectively reviewed an urodynamic records of 264 consecutive women referred for the evaluation of incontinence symptom. Patients with a history of neurological disease, stage 4 pelvic prolapse and can not micturate during pressure flow study were excluded from study. There are a total of 85 incontinent women who met the inclusion criteria. Cystometry and pressure flow studies were performed using standard techniques. A diagnosis was made in each case based on cystometry findings, while any additional diagnoses when applicable were based on the pressure flow study. The provocative stress test significantly distinguishes stress incontinence from other types. Results: Mean patient age was 55.4 years (range 32-77). The incontinent women were classified as the patients who had stress (41.2%), urge (31.8%) and mixed incontinence (27%), according to their history, physical examination and urodynamic test results. Commonly seen cystometric findings were detrusor overactivity in 21 cases (24.7%), urgency in 17 (20%) and stress incontinence 15 (17.6%). On the other hand in 18 cases (21.2%) cystometry were found normal. Pressure flow study diagnosis of voiding abnormalities was made in 14 women (16.5% of the incontinent patients), including 4 dysfunctional voiding, 3 post-void residual urine over than 100 ml, 2 bladder outlet obstruction, 2 obstruction due to stage 2 to 3 cystocele, 2 obstruction after incontinence surgery and 1 impaired contractility. Impaired compliance and post-void residual urine volume were significantly higher (p<0.01), detrusor pressure at peak urinary flow was significantly lower in women with voiding abnormalities (p<0.001). No differences in age, detrusor overactivity, bladder capacity and detrusor pressure at maximum urinary flow were identified between women with and without voiding abnormalities. Conclusion: Female patients with urinary incontinence may also have voiding abnormalities. Therefore, women with urinary incontinence, pressure flow study should be undergone with cystometry in order to reveal diagnosis of possible voiding abnormalities.
    No preview · Article · Jan 2004
  • A. Yenilmez · M. Turgut · M. Kale
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    ABSTRACT: Introduction: In this study the obstructive effect of catheter diameter used in the pressure-flow study in patients with benign prostatic hyperplasia (BPH) who suffer from bladder outlet obstruction had been examined. Materials and Methods: The patients with symptomatic BPH were underwent pressure-flow study by using 8F urethral catheter following free flow measurements. The pressure flow study was repeated by using 4.5F urethral catheter for the patients established bladder outlet obstruction. Twenty-eight patients with a mean age at 66.3 years were chosen for the study group. The measurements of voided volume, flow time, postvoid residual volume (PVR), maximal flow rates (Qmax), detrusor pressure at maximal flow (PdetQmax) and urethral resistance factor (URA) were compared. Results: The results of pressure-flow study by using 8F urethral catheter were significantly different than the results of pressure-flow study by using 4.5F urethral catheter and free flow parameters in means of all parameters except voided volume and postvoid residual volume. Especially, maximal flow rates were significantly lower and flow time was significantly longer on pressure versus free flow studies. No significant difference was found in maximal flow rates between the usage of 4.5F catheters and free flow. By using small sized catheter, 6 (21.4%) of the 28 patients were found as unobstructed according to the Griffith's nomogram (under 30 cmH20 URA). Conclusion: The obstructive effect of the catheter used in pressure-flow study on the patients with bladder outlet obstruction increases proportionately to the diameter of the catheter.
    No preview · Article · Jan 2003 · Turk Uroloji Dergisi