Person: ONUR, AHMET RAHMİ
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ONUR
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AHMET RAHMİ
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Publication Open Access The attitudes of Urologists and Gynecologists about overactive bladder and treatment of it in Turkey: A questionnaire survey(AVES, 2017-02-21) ONUR, AHMET RAHMİ; Coskun, Burhan; Bayrak, Omer; Dincer, Murat; Onem, Kadir; Gurbuz, Cenk; Onur, RahmiObjective: We aimed to review the approaches of urologist and gynecologist in the management of overactive bladder (OAB). Material and methods: A questionnaire consisting of 12 items were answered by 375 urologist and 46 gynecologist. The differences between frequency of encountering OAB, their viewpoints concerning conservative treatment, and their experience related to anticholinergic drug use and the management of refractory OAB were compared. Results: The majority of the urologists, and gynecologists responded to the question How often do you encounter OAB patients in your daily practice? as 'in 10-25, and 50% of our patients', respectively (<0.001). The most common complaint consulted to urologists, and gynecologists were urge incontinence (51.1% vs. 64.8). The frequency of using questionnaire and voiding diary was similar in both specialties (23.9% vs. 25.1%, p=0.892). It was observed that 38.6% of the urologists, and 50% of the gynecologists had recommended conservative treatment as a first-line treatment of overactive bladder (p=0.049). The low sociocultural level was the most important obstacle confronting application of conservative treatment methods (54.3% vs. 37%, p=0.012). The survey participants indicated that the most important factor which affected their decision to select an anticholinergic agent as the first-line treatment of overactive bladder was higher effectiveness of these drugs (urologists; 55.7%, and gynecologists 64%, p=0.371). The patients who started to receive anticholinergic drugs most frequently complained both to their urologists, and/or gynecologists about dry mouth (76.3 vs. 74.5%). Based on the responses of the urologists, and gynecologists, the most frequent reason of anticholinergic drug withdrawal was patients' inability to tolerate side effects of these drugs (48% vs. 47.8%, p=0.697). The participants indicated that in case of unsatisfactory response to one anticholinergic agent, swithching rate to another anticholinergic drug was 56.9% among urologists vs. 59.6%, among gynecologists. In addition, 36.9% of urologists and 38.5% of gynecologists recommended another pharmaceutical form of the drug with a higher dose to their patients (p=0.279). Similar number of physicians indicated that the prescribed anticholinergic drug should be continued for at least 3 months and in case of unresponsiveness patient could be considered refractory. Majority of urologists (68.8%), and gynecologists (56.5%) chose to perform urodynamic tests in patients who are unresponsive to anticholinergic treatment, (p=0.093). Conclusion: The attitudes of urologist and gynecologist for diagnosis and treatment of OAB are mostly correlating with current guideline practices with few exceptions. Urologists tend to use bladder diaries or questionnaires less frequently whereas, gynecologists refer to urodynamic studies in patients with refractory OAB less than the urologists do. However, irrespective of the clinical speciality, conservative treatment modalities are rarely administered.Publication Open Access Botulinum toxin injections for treating neurogenic detrusor overactivity(AVES, 2015-10-14) ONUR, AHMET RAHMİ; Bayrak, Omer; Sadioglu, Erkan; Onur, RahmiNeurogenic detrusor overactivity (NDO) is a disorder that can cause high intravesical pressure, decreased capacity, decreased bladder compliance, and upper urinary system damage. The current treatment options for NDO are established on the basis of agents that block parasympathetic innervation of the detrusor and inhibit involuntary bladder contractions. Several side effects, such as dryness of mouth, constipation, dyspepsia, changes in visual accommodation, somnolence, and being unable to obtain consistently favorable results, caused by anticholinergic agents, which are frequently used for this purpose, decrease the patient's compliance to treatment. Procedures such as neuromodulation, auto-augmentation, and enterocystoplasty are surgical options, and they could be used as the last alternative. Thus, botulinum toxin (BTX) injections to the detrusor have been commonly performed in recent years and lead to satisfactory results. The mechanism of action of BTX in NDO is based on the principal of smooth muscle relaxation in the bladder by the transient inhibition of neuromuscular nerve signals. The aim is to decrease acetylcholine secretion by blocking presynaptic vesicles in the neuromuscular junction. When studies were evaluated, it was observed that BTX injections to the detrusor muscle are a necessary and effective option in patients with incontinence caused by NDO. This treatment option could be indicated in situations where anticholinergic agents are not effective or could not be tolerated, and it could be a valuable alternative to major surgical treatments. In this review, we evaluated the effectiveness and reliability of BTX in patients with NDO.Publication Open Access Management of the complications of pubovaginal sling surgery(2017-06-01) ONUR, AHMET RAHMİ; ÖMER BAYRAK;BURHAN COŞKUN;MUHAMMET MURAT DİNÇER;KADİR ÖNEM;AHMET RAHMİ ONURTo present complications of pubovaginal sling surgery (PVS) and their managements. Methods. A total of 21 patients who underwent PVS in 4 different tertiary refferal centers between June 2014 and May 2016 were reviewed retrospectively. Demographic characteristics of the patients, previous surgical history, daily pad use, Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ) were recorded. Also, the management of the complications were stated. Results. The mean age of the patients were 54.9±12.32 (range, 36-76) years. Six (28.5%) patients had a history of previous incontinence surgery and 15 (71.4%) patients were naïve. There were no intraoperative complications.The mean daily pad use was decreased from 4.04±0.95 to 0.95±0.86 (p=0.0001). While mean preoperative UDI-6 scores were decreased from 6.66±2.09 to 2.09±1.22 (p=0.0001) at postoperative sixth month; preoperative mean IIQ-7 scores decreased from 16.8±1.16 to 5.09±4.21 (p=0.0001) at postoperative sixth month. One (4.76%) patient had abdominal hernia at postoperative 2nd year, three (14.28%) patients had an increased post-micturational residual (150- 200ml) and two (9.52%) patients had urinary retention. Conclusion. Although the efficiency of PVS is high; one should aware of complications. The successful management of the complications will increase efficiency and patient satisfaction.Publication Open Access Artifisyel Üriner Sfinkter Cerrahisine Ait Klinik_x000D_ Sonuçlar ve Hasta Memnuniyetinin Değerlendirilmesi(2019) ONUR, AHMET RAHMİ; Ahmet KARAKEÇİ;Tunç OZAN;Fatih FIRDOLAŞ;Necip PİRİNÇÇİ;Ahmet Rahmi ONURAmaç: Bu çalışmada özellikle prostat cerrahisi sonrasısfinkterik yetmezliğe bağlı meydana gelen inkontinanstedavisinde kullanılan artifisiyel üriner sfinkter (AÜS)uygulamasının etkinliğini, hasta memnuniyetini ve cerrahisonuçlarını değerlendirmeyi amaçladık.Gereç ve Yöntem: Kliniğimizde 2009 -2018 tarihleri arasındaAÜS uygulaması yapılmış olan hastaların verileri geriye dönükolarak değerlendirildi. Hastaların operasyon öncesi ve sonrasıinkontinans durumlarını, AÜS başarı oranını, AÜS sonrasımemnuniyetlerini değerlendirmek amacıyla operasyon öncesive sonrası idrar kaçırma değerlendirme sorgulama formu olanICIQ-SF (International Consultation on IncontinenceQuestionnaire Short Form) doldurtuldu.Bulgular: Hastaların yaş ortalaması 67.92 ±24.08 yıl veortalama takip süresi 66.38 ±11.17 aydı. Günlük ped kullanımmiktarı ve ICIQ-SF skoru sırasıyla preoperatif dönemde4.23±1.49 ve 16.84±4.64 bulunurken, postoperatif dönemdeise 1.33±1.01 ve 2.91±0.64 olarak belirlendi. Bu sonuçlarkarşılaştırıldığında hem ped tüketimi hem de ICIQ-SF skoruaçısından istatistiksel olarak anlamlı fark bulundu (p<0.05).Sonuç: AÜS uygulaması orta ya da şiddetli idrar kaçırmasıolan hastalarda diğer tedavi seçeneklerinden yarar görmeyenhastalarda güvenilir ve etkin bir tedavi seçeneğidir.Publication Open Access EFFICACY AND SAFETY OF BOTULINUM NEUROTOXIN IN GERIATRIC PATIENTS WITH AN OVERACTIVE BLADDER: A MULTICENTRIC STUDY FROM TURKEY(GUNES KITABEVI LTD STI, 2019-06-15) ONUR, AHMET RAHMİ; Karakeci, Ahmet; Keles, Ahmet; Ozan, Tunc; Firdolas, Fatih; Onur, RahmiIntroduction: To evaluate the clinical efficacy and safety of botulinum neurotoxin A injection in geriatric patients with an overactive bladder. Materials and Method: Data of 34 patients aged >65 years who received botulinum neurotoxin A injections (100 U) for overactive bladder at two different urology clinics from 2012 to 2018were retrospectively evaluated. Number of incontinence episodes, urinary frequency, nocturia occurrence, daily pad usage, maximum flow rate, post-void residual urine volume, treatment benefit scale and quality of life scores were evaluated for all patients at pretreatment and then at 3 and 6 months post treatment. Results: Comparison of the pre-treatment and the 3- and 6-month post-treatment data revealedno significant changes in maximum flow rate values (p=0.504 and 0.458, respectively); however, a statistically significant decrease was recorded in the urinary frequency, nocturia occurrence, daily pad usage and number of incontinence episodes (p=0.0001). The post-void residual urine volume significantly increased at 3 and 6 months post treatment (p=0.0001). Significant improvements were detected in the quality of life score at 3-months post treatment (p=0.0001). Conclusion: Botulinum neurotoxin A injection is an efficacious and safe option for treating geriatric patients and improving their symptoms of overactive bladder and quality of life.Publication Metadata only Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population(WILEY, 2018) ONUR, AHMET RAHMİ; Onem, Kadir; Bayrak, Omer; Demirtas, Abdullah; Coskun, Burhan; Dincer, Murat; Kocak, Izzet; Onur, RahmiAimsTo investigate the efficacy and safety of intradetrusor onabotulinumtoxinA (onaBoNT-A) injection in patients with overactive bladder (OAB) refractory to antimuscarinic treatment. MethodsA total of 80 patients with OAB symptoms were enrolled in this prospective multicenter study and received 100U intradetrusor onaBoNT-A injection.The changes from baseline in the frequency of voiding, urge urinary incontinence (UI) and urge episodes, mean and maximum bladder capacities, uroflowmetry, post-void residual urine volume (PVR), quality of life score, and treatment benefit scale score were assessed. The need for a second injection,and treatment-related adverse events were also examined postoperatively. ResultsOnaBoNT-A injection significantly decreased the UI episodes(P=0.0001), the mean voiding frequency (P=0.0001), and the urgency episodes (P=0.0001) in the third month compared to baseline. Similarly, the mean bladder capacity, and maximal bladder capacity were increased (P<0,05). The quality of life scores improved by 57.1% compared to the pre-treatment rate (P=0,0001). No significant change was observed in the PVR or maximum flow rate. Urinary retention developed in 3 (3.75%) patients and urinary infection and transient hematuria were observed in five patients (6.25%) each. The UI episodes, voiding frequency and urgency episodes were significantly lower at the 9th month than at baseline (all P=0.0001). Overall 67% of the patients continued to experience benefits from the injection. Sixteen patients (20%) required a second injection in the third month. Eight patients were lost to follow-up at the last visit in the 9th month, and 34 of the remaining 56 patients required a second injection at the 9th month. Cumulatively, 50 (63%) patients needed re-injections. ConclusionsOur results demonstrated that the onaBoNT-A injection produced significant improvement in all OAB symptoms with a low incidence of treatment related adverse events.