Search

SUMMARY OBJECTIVE: The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones. METHODS: The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups. RESULTS: There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p

Penile fracture with complete urethral rupture OBJECTIVES: Penile fracture is a trauma that develops as a result of the rupture of the corpus cavernosum by forcing the erect penis to bend and twist and requires emergency surgery. Urethral trauma accompanies penile fracture in 1–40% of cases. In this study, we aimed to present a case of penile fracture with complete urethral rupture. CASE REPORT: A 51-year-old male patient presented to the emergency service with the complaints of sudden loss of erection, bruising and pain in the penile shaft after a cracking sound during coitus. Physical examination revealed limited ecchymosis and swelling in the penile shaft and hemorrhage in the external urethral meatus. Urethrography was performed on the patient due to urethrography. On urethrography, it was observed that there was contrast extravasation from the middle urethra. The patient was operated in the early period. In the midpenile region, it was observed that there were ruptures of approximately 1 cm in both corpus cavernosum and complete rupture in the urethra. Cavernosal ruptures and urethral rupture were repaired. At the postoperative 6th month follow-up, the patient had no erectile dysfunction and voiding symptoms. CONCLUSIONS: The “crackling sound” heard during coitus, severe pain and penile detumescence are typical clinical findings of penile fracture. If there are symptoms of bleeding in the meatus, hematuria and difficulty in voiding, urethral trauma should be considered. In these patients, urethral repair is also required during the operation. Keywords: penile fracture, urethral rupture, urethrorrhagia

We think that it is necessary and important to share with the Medical Education Community what we have done, what we have done and what we have not been able to do, our educational studies, consultancy work, assessment-evaluation methods, question analysis and feedback from our students during this period, when the uncertainties brought by the pandemic process and the anxiety it created accordingly were the most intense. . This review is a sharing of experience, and only our experiences with undergraduate medical education are summarized., Pandemi sürecinin getirdiği belirsizliklerin ve buna bağlı olarak yarattığı anksiyetenin en yoğun olduğu geride bıraktığımız bu süreçteki eğitici eğitimi çalışmalarımız, danışmanlık çalışmalarımız, ölçme-değerlendirme yöntemlerimiz, soru analizlerimiz ve öğrencilerimizden aldığımız geri dönüş çalışmalarımızı, yaptıklarımızı ve yapamadıklarımızı Tıp Eğitimi Camiasıyla paylaşmanın gerekli ve önemli olduğunu düşünmekteyiz. Bu derleme bir deneyim paylaşımı olup, sadece mezuniyet öncesi tıp eğitimi ile ilgili deneyimlerimiz özetlenmiştir.

INTRODUCTION: In this study we aimed to present the secondary phimosis cases after circumcision as a complication of circumcision and demographic data of the patients.METHODS: The data of 47 patients revised because of secondary phimosis developing after circumcision were analyzed retrospectively. The demographic data of the patients were evaluated.RESULTS: The mean ages of 47 patients were 2.84 years (5 months-11 years). All of the patients had been circumcised under local anesthesia by a non-physician circumciser in the home environment. 37 patients were consulted in the first six months after circumcision, and the remaining 10 patients were consulted in the later period (6 months-8 years). It was found in all patients that both penile skin and mucous was left longer than usual and fibrotic ring which grew out during the healing tightened the glans penis. All disorders were corrected surgically. None of the patients in the early and late postoperative follow-up showed any complications.DISCUSSION and CONCLUSION: Our study reveals that secondary phimosis is a complication requiring circumcision revision and may develop after circumcision made by non-physicians and out of the hospital or a health organization. Moreover, the study shows that sleeve resection technique circumcision is a safe and successful method for revision in the hospital. The limitations of our study are that it is retrospective and there is no control group., GİRİŞ ve AMAÇ: Bu çalışmada bir sünnet komplikasyonu olarak sünnetsonrası sekonder fimozis olgularını ve hastaların demografik verilerinigöstermeyi amaçladık.YÖNTEM ve GEREÇLER: Sünnet sonrası gelişen sekonder fimozis nedeniylerevizyon yapılan 47 hastanın verileri retrospektif incelendi. Hastalarındemografik verileri değerlendirildi.BULGULAR: Kırk yedi hastanın yaş ortalaması 2.84 yıl (5 ay – 11 yıl) idi.Hastaların tamamı hekim olmayan sünnetçiler tarafından lokal anestezi ile evortamında sünnet edilmişti. 37 hasta sünnet sonrası ilk altı ay içinde, kalan10 hasta ise daha geç dönemde (6 ay-8 yıl) başvurmuşlardı. Tüm hastalardamukozanın daha fazla olmak üzere hem mukoza hem de penil derinin normalden dahauzun bırakıldığı ve iyileşme sırasında oluşan fibrotik halkanın glans penisisıktığı saptanmıştır. Ameliyatta tüm bozukluklar düzeltilmiştir. Postoperatiferken ve geç dönem takiplerinde hastaların hiçbirisinde herhangi birkomplikasyon görülmemiştir.TARTIŞMA ve SONUÇ: Bizim çalışmamız, hastane ya da sağlık kuruluşlarıdışında hekim olmayan kişilerce yapılan sünnetlerde sekonder fimozisin sünnetrevizyonu gerektiren bir komplikasyon olduğuna ve hastanede yapılan sünnetrevizyonlarında sleeve rezeksiyon tekniğinin güvenli ve başarılıylauygulanabileceğine dikkat çekmektedir. Çalışmamızın limitasyoları ise, buçalışmanın retrospectif olması ve bir kontrol grubunun bulunmamasıdır.

TEZ10903 Tez (Yüksek Lisans) -- Çukurova Üniversitesi, Adana, 2018. Kaynakça (s. 125-130) var. xvi, 131 s. : res. (bzs. rnk.), tablo ; 29 cm. Bir maden yatağının işletilmesi için öncelikle yatağın doğru modellenmesi gerekmektedir. Birçok farklı metot ve uygulama kullanılarak modelleme çalışmları yapılabilmektedir. Bu çalışmada Afşin–Elbistan Havzası, C ve D Sektörlerinin optimum üretim kapasitesi şartları incelenmiştir. Bu doğrultuda 52 farklı kuyuya ait karotlu sondaj verisi Netpro/Mine programı kullanılarak bu sahanın bir katı modeli oluşturulmuş ve bu katı model kullanılarak Netpro/mine yazılımının optimizasyon modülü kullanılarak, Net bugünkü değeri maksimum yapan yıllık üretim kapasitesi belirlenmiştir ve duyarlılık analizi yapılmıştır. Elde edilen sonuçlara göre, Açık ocağın yıllık kapasitesi ortalama 18,6 milyon ton seçildiğinde net bugünkü değer en yüksek seviyeye çıkmaktadır. Net bugünkü değer miktarının, yıllık enflasyon oranı ve kömür satış fiyatına bağlı olduğu anlaşılmıştır. For a mining bed to be operated, the bed must first be modeled correctly. Modeling studies can be done using many different methods and applications. In this study, optimum annual production capacity conditions of Afşin–Elbistan Basin, (C) and (D) sectors were examined. In this direction, a solid model of this basin was constructed by using the data obtained from 52 cored drilling holes. Netcad/Netpromine software was used to constract the geological and solid model. Optimization module was used to estimate of net present values. As a result, if we select of 18,6 million tone of annual production capacity we will see the net present value is the maximum. The model, created is sensitive to annual inflation rate and saling price of coal. Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: FLY20166389.

Aim: In this study we aimed to evaluate approachments of non-urologist physicians to urinary incontinence (UI) in female patients.Materials and Methods: A brief quastionnaire including 4 questions was given to 358 physicians apart from urologist. Participants were asked if they inquire UI in female patients. Physicians who evaluated UI were asked to determine their way of investigation; and than those who reported that they do not evaluate UI were asked why they don’t inquire about UI. The mean age of parti-cipants was 31.3 years.Results: 74 (%20.6) of participants reported that they inquire UI in all female patients routinly. 236 (%65.9) of them inquire patients if they have urinary system symtoms and 18 (%5) of parti-cipants inquire if they are old or have any problem. 36 (%10) participants reported that they do not inquire about UI in female patients. Among 358 physicians who not inquire UI, 62 (%17.3) believed that inquiring UI was not their primary job, 60 (%16.6) said that they forgot it, 56 (%15.6) reported that they did not have enough time, 20 (%5.5) said the examination enviroment was not suitable, 12 (%3.3) believed that they did not have enough knowledge and 6 (%1.6) reported that he was disturbed of the patients reaction. 102 (%28.5) of physicians proceeded with urology and 58 (%16.2) gynecology consultation, 49 (%13.6) proceeded with laboratory investigation and urology or gynecology consultation with their results. 8 (%2.23) tried to treate patients.Conclusion: Urinary incontinence is not inquired in the departments out of urology.

Amaç: Bu çalışmada üroloji uzmanı olmayan doktorların kadın hastalarda üriner inkontinansa yaklaşımlarını değerlendirmeyi amaçladık Materyal ve Metod: Üroloji branşı dışındaki 358 tıp doktoruna 4 sorudan oluşan kısa bir anket yapıldı.Katılımcılara kadın hastalarda üriner inkontinansı sorgulayıp sorgulamadıkları soruldu. Üriner inkontinans sorgulaması yapanlara nasıl bir yol izledikleri, sorgulamayanlara da bunun nedenlerine yönelik sorular yöneltildi. Ankete katılanların yaş ortalaması 31.3 yıl olarak bulundu. Sonuçlar: Ankete katılan doktorların 74’ü (%20.6) tüm kadın hastalarda rutin olarak üriner inkontinansı sorguladığını, 230’u (%64,2) üriner sistem semptomları olanlarda 18’i (%3,3) ise yaşlı hastalarda ve eşlik eden başka hastalık varlığında sorguladıklarını belirttiler. 36’sı (%10) ise hastalarda üriner inkontinansı hiç sorgulamadıklarını belirttiler. Üriner inkontinans sorgulaması yapmayan hekimlerin en önemli mazeretleri ise uzmanlık alanı olmaması idi. Doktorların 62`si (%17.3) bunu primer işi olarak görmediğini, 60`ı (%16.6) unuttuğunu, 56`sı (%15.6) yeterli zamanı olmadığını, 20`si (%5.5) muayene ortamının uygunsuzluğunu, 12`si (%3.3) yeterli bilgisi olmadığını, 6`sı (%1.6) ise hasta tepkisinden çekindiğini belirtti. Doktorların 102’si (%28.5) üriner inkontinans saptadıkları bayan hastalarını ürolojiye, 58’i (%16.2) ise jinekolojiye konsülte ederken, 49’u (%13.6) tetkik isteyip sonuçlarıyla üroloji ya da kadın doğuma konsülte ettiğini, 8’i (%2.23) ise tetkik sonuçlarına göre tedavi başladığını ifade etti. Tartışma: Bu çalışmada ki anket sonuçlarına göre kadınlarda üroloji dışındaki klinik bölümlerde üriner inkontinans yeterince sorgulanmamaktadır.

WOS: 000395632600024 PubMed: 28263485 Background/aim: We aimed to compare the results of unilateral and bilateral varicocele surgery. Materials and methods: In two referral hospitals, the data of 180 patients who were treated with unilateral and bilateral microscopic varicocelectomy were retrospectively analyzed. Sperm parameters and spontaneous pregnancy rates were compared in patients who underwent bilateral and unilateral microscopic varicocelectomy. Results: The mean age was 29.6 (17- 46) years. While 82 patients underwent unilateral varicocelectomy (Group I), 98 patients underwent bilaterally varicocelectomy (Group II). Forty (48.8%) spontaneous pregnancies occurred in Group I and 59 (60.2%) in Group II. When we analyzed sperm parameters, the rate of increase in the number of sperm in spermiograms was 17% in Group I and 27.5% in Group II. The rate of increase in sperm mobility was 58.5% and 50% in Group I and II, respectively. The improvement rate in sperm morphology was 46.3% in Group I and 56.1% in Group II. There were no significant differences between all these parameters. Conclusion: In light of our results, although pregnancy rates seemed to be higher in patients who underwent bilateral varicocelectomy, these results were not statistically significant. Improvement rates in sperm parameters were similar between the patients who underwent unilateral and bilateral varicocelectomy.

Akbas, Alpaslan/0000-0003-1470-5952 WOS: 000374327500015 PubMed: 27513242 Background/aim: The purpose of the present study was to review the complications of ureteroscopy (URS) by using the modified Clavien classification system (MCCS) and to investigate the factors associated with complications. Materials and methods: Data regarding 811 patients who underwent URS for ureteral calculus were analyzed. Peroperative and postoperative complications were recorded. The patients were divided into seven groups depending on the severity of the complications. The association of sex, stone size, number, and localization with each MCCS grade was also evaluated. Results: The average age was 45 years. The success of the procedure after one session was 93.5%. Complications were recorded in 57.9% of the patients. According to the MCCS, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were documented in 29.8%, 7.1%, 8.6%, 11%, 0%, 1.2%, and 0% of the patients, respectively. The factors associated with the complications graded by MCCS were sex, stone size, number of stones, and localization. In addition, in multivariate analysis, history of previous surgeries for urolithiasis, orifice dilatation, and instrument size were associated with complications. Conclusion: According to MCCS, sex, history of previous surgeries for urolithiasis, orifice dilatation, size of the instrument, stone size, number of stones, and localization are associated with different grades of complications in URS.

Mesane taslari tum uriner sistem taslarinin %5’ini olusturmaktadir. Siklikla ileri yasli erkeklerde gorulurler ve prostat hiperplazisi, norojenik mesane gibi infravezikal obstruksiyonlara sekonder olusurlar. Enfeksiyonlar, yabanci cisim, kadinlarda anti inkontinans cerrahisi ve nadiren gebelik mesane taslari icin predispozan faktor olabilmaktedir. Endemik mesane taslari ise, cocuklarda ve herhangi bir predispozan faktor olmaksizin saglikli genclerde gorulebilmektedir. Bu olgu sunumunda dev endemik mesane tasi olan ve sistolitotomi yaptigimiz 23 yasindaki bir erkek hastayi sunduk. Tasin agirligi 102 gr, boyutlari ise 53x52x43 mm olarak olculdu. Tas analiz sonucu ise kalsiyum oksalat tasi olarak rapor edildi. Bu dev mesane tasi icin hicbir predispozan faktor yoktu. Bu olgu sunumuyla hicbir predispozan faktor olmaksizin genc ve saglikli erkeklerde de mesane tasi olusabilecegi ve DUS grafi ve/veya uriner sistem USG ile kolaylikla tani konulabilecegini vurgulayi amacladik

Fibroepithelial polyps of the urinary tract are rare benign tumors that usually treated with endoscopically today. Endoscopic treatment have been regarded as the gold standart for small lesions, while the management modality for long lesion is stil controversial. We report a case of simultaneous fibroepithelial polyps of bladder and ureter which is incidentally detected on cystoscopy. We review our experience with ureteroscopic management of long (7 cm) ureteral fibroepithlial polyp by holmium: yttrium- aluminum- garnet (YAG) laser resection.

Bladder calculi account for 5% of all urinary system calculi. They are usually seen in older men and occur because of infravesical obstructions such as prostate hyperplasia , neurogenic voiding dysfunction. Infection, foreign bodies, anti incontinence surgery in woman and rarely pregnancy can also be predisposing factors for bladder calculus. But they can be rarely seen in children and young, healthy patiants without any predisposing factors and are called endemic bladder calculi. İn this case report we present a 23 years old man who has endemic giant bladder calculus and on whom we performed cystolithotomy . The stone weighed 102 gr and measured 53x52x43 mm in size. And it was composed of calcium and oxalate. There were no predisposing factors in this giant bladder calculus. The aim of this case report was to emphasize the fact that bladder calculi can develop in young healthy men without any predisposing factors and that it can be diagnosed readily with DUSG and/or urinary tract USG.

In this study we aimed to evaluate approachments of urologist and gynecologist physicians to urinary incontinence (UI) in female patients. A brief quastionnaire including 7 questions was given to 369 these physicians. Physicians who evaluated UI were asked to determine their way of inves-tigation; and than those who reported that they do not evaluate.

Üroloji ve kadın doğum branşlarında asistan ve uzman hekimlerin katılımıyla oluşturduğumuz bu anket çalışmasında bu hekimlerin üriner inkontinansa yaklaşımlarını ve bunun niteliğini irdelemeyi amaçladık. 369 tıp doktoruna (225 Ürolog, 144 kadın doğum doktoru) 7 sorudan oluşan bir anket verildi. Ankette hekimlerin kadınlarda üriner inkontinansı sorgulayıp sorgulamadıkları, sorguluyorlarsa nasıl bir yol izledikleri, tedavi yaklaşımları; sorgulamıyorlarsa bunun nedenlerini irdelemeye yönelik sorular soruldu.

Devletlerin para ve mali politikalar aracılığıyla ekonominin tüm unsurları ile etkileşim içerisine girişinin günden güne artması, ekonomi içerisindeki mali nitelikteki işlemlerin raporlanmasını temin eden devlet muhasebesi anlayışının kabuk değiştirmesine neden olmuştur. Dolayısıyla tüm dünyada sadece bütçe uygulama sonuçlarını gösteren nakit esaslı devlet muhasebesinden mali içerikli tüm olayların tahakkuk ettiğinde kayıt altına alındığı tahakkuk esaslı devlet muhasebesi sistemine geçiş hızlanmıştır. Küreselleşme olgusu ve Avrupa Birliği, Dünya Bankası ve Uluslararası Para Fonu gibi dünya çapındaki kuruluşların devlet muhasebesinde yeknesaklığı sağlamak amacıyla yaptığı çalışmalar, Türkiye'de de devlet muhasebesi sisteminin dünya ile uyumlaştırılması çabalarını arttırmıştır.Türkiye'nin yaşadığı ekonomik krizler, Avrupa Birliği ve Uluslararası Para Fonu ile sürdürülen müzakereler, Türkiye'nin mali sisteminin vergi harcamaları gibi uygulamaları nizami bir biçimde raporlayamıyor oluşu mali saydamlık ve hesap verilebilirliği sağlayabilecek bir mali reformun yapılmasını zaruri hale getirmiştir. Bu nedenle 1995 yılında Kamu Mali Yönetim Projesi ile başlayan çalışmalar 2003 yılında 5018 Sayılı Kamu Mali Yönetimi ve Kontrol Kanunu'nun çıkarılmasıyla ciddi bir boyut kazanmıştır. Mali reform olarak nitelendirilebilecek bu adım ile Türkiye'de ulusal ekonominin sınıflandırması yapılmış, analitik bütçe oluşturulmuş ve genel yönetim kapsamındaki tüm kuruluşlarda tahakkuk esaslı devlet muhasebesine geçilmiştir.Tez çalışması kapsamında Türkiye'de devlet muhasebesinin gelişim süreci; mali reform gereksinimi, 5018 sayılı yasa ve bu yasa ile beraber ortaya çıkan alt mevzuat çalışmaları analiz edilmiş özellikle de tahakkuk esaslı devlet muhasebe sistemi, çerçeve hesap planı ile birlikte detaylı bir biçimde incelenmiştir. Örnek uygulama kapsamında ise Ege Üniversitesinin muhasebe hizmetlerini gören Strateji Geliştirme Daire Başkanlığı tarafından hazırlanan Stratejik Plan, İdari Faaliyet Raporu çerçevesinde üniversitenin mali ve yönetsel yapısı ortaya konmuştur.Anahtar Kelimeler: Mali Saydamlık, Hesap Verilebilirlik, Kamu Mali Reformu, Nakit Esası, Tahakkuk Esaslı Devlet Muhasebesi. Increase in the integration of governments with the economic structure?s elements via the monetary and fiscal policies caused a change in the philosophy of government accounting which provides reporting of fiscal transactions in the economic system. Therefore, many countries started to pass from cash based government accounting system that shows only budget practice results to the accrual based government accounting which provides the recording and the costing of almost all the public service process when the fiscal events are just accrued. Globalization concept and the activities realized by the European Union, World Bank and International Monetary Fund obtained sole system in the government accounting has expanded the studies in Turkey in order to harmonize government accounting system with government accounting system of the other developed countries.The economic crisis in Turkey, the negotiations with the European Union and International Monetary Fund; the problems in the fiscal system like tax expenses and semi-fiscal operation executions made indispensable, the realization of fiscal reform which may provide fiscal transparency and accountability. In Turkey, fiscal reform activities has began with ?Project of Public Fiscal Administration? in 1995 and then has gained a serious dimension with the publication of Law of Fiscal Control and Administration of Public in 2003. So, national economy was classified. Analytic Budget System was formed and the establishments which take place in the general administration of public have passed to the accrual based government accounting system.In the thesis study, the development process of government accounting in Turkey; the causes of fiscal reform necessity; the law of fiscal control and administration of public and the other related sub-laws were analyzed. Especially accrual based government accounting and the account plan was observed in a detailed manner. In the sample study Strategy Development Department Chairmanship of Ege University was chosen and the administrative and fiscal structure of Ege University was analyzed via Strategic Plan and Administrative Activity Report that were published in 2007.Key Words: Fiscal Transparency, Fiscal Accountability, Public Fiscal Reform, Cash Based, Accrual Based Government Accounting. 291

Summary Background Primary monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition and there are two firstline, evidence-based treatments available; desmopressin and the enuresis alarm. Although there are many studies comparing enuresis alarm and desmopressin treatments in the literature, most were conducted using old formulations of desmopressin. Objective To compare the efficacy of desmopressin MELT formulation and enuresis alarm therapy in patients with MNE. Study design A total of 130 patients who had primary MNE were included in the study. The patients were divided into two groups using simple randomization; desmopressin MELT (Group 1, n = 66) and enuresis alarm (Group 2, n = 64). The patients were invited for a follow-up visit at the fourth, 12th and 24th weeks of treatment. Treatment response and compliance were evaluated using bed-wetting diary and ICSS criteria. Results The mean age of the patients Group 1 and 2 was 11.2 + 3.3 and 10.2 + 3.4 years, respectively (p = 0.104). Complete response rate was similar at 4th week (53% vs. 37.3%, p = 0.162) and at 12th week (68.4% vs. 68.2%, p = 0.257). The relapse rate was significantly higher in the desmopressin MELT group than in the enuresis alarm group (48.9% vs 20.5%, p = 0.007). At the end of the study ten patients were excluded from the study because of loss to follow-up and/or side effects. The overall complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group at the end of the study (41.3% vs 64.9%, p = 0.035). When the intention to treat analysis population was considered, similarly the complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group (40.9% vs 64.1%, p = 0.027). Discussion With regard to the management of children with MNE, our study revealed that desmopressin MELT and enuresis alarm both have high efficacy rates in primary MNE treatment both at 4th and 12th week. However, overall complete response rate was better in enuresis alarm treatment at 24th week. In addition, enuresis alarm treatment also presents as a more favorable relapse rate. Conclusions Enuresis alarm presented a more permanent treatment response and a lower relapse rate than desmopressin MELT formulation. Download : Download high-res image (535KB) Download : Download full-size image Summary Figure