Person: ŞİMŞEK, FERRUH
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ŞİMŞEK
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FERRUH
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Publication Open Access Resistant pediatric priapism: A real challenge for the urologist(CANADIAN UROLOGICAL ASSOCIATION, 2015-08-10) ŞEKERCİ, ÇAĞRI AKIN; Sekerci, Cagri Akin; Akbal, Cem; Sener, Tarik Emre; Sahan, Ahmet; Sahin, Bahadir; Baltacioglu, Feyyaz; Simsek, FerruhPriapism in pediatric patients is a rare entity. We present an 8-year-old boy with known cerebral palsy. He came to the emergency department with sustained painful erection for 12 hours. Physical examination showed rigid penis. Blood count and biochemical analysis were normal. Although penile Doppler ultrasound revealed normal arterial and venous flow, cavernosal blood gas was hypoxic. A total of 50 mL of dark blood was aspirated, and 2 mL of 0.001% adrenalin solution was applied to both corpus cavernosum, twice within 20 minutes, which eventually did not achieve detumescence. A distal Winter shunt was performed at the end of which the penis was semi-flaccid. By the 18th hour of surgery, the penis re-gained painful erection status, so an Al-Ghorab shunt was performed. After the Al-Ghorab shunt, the penis was still in the semi-flaccid state. The next day, an angiography was performed and an arteriovenous fistula was discovered and treated by embolization. The flaccid state was achieved and the patient was discharged the day after the embolization.Publication Open Access Are There Any Differences in the Neural and Extracellular Matrix Proteins Density Between Children and Adults with Intrinsic Ureteropelvic Junction Obstruction?(GALENOS YAYINCILIK, 2017-12-27) KAYA, CEVDET; Sahin, Bahadir; Kaya, Cevdet; Talibzade, Farhad; Tanidir, Yiloren; Ercan, Feriha; Demirci, Elif Kervancioglu; Sekerci, Cagri Akin; Akbal, Cem; Simsek, FerruhObjective: To compare changes in connective, neural and muscle tissues, and extracellular matrix in child and adult patients so that we can create a more objective view on the timing of surgery. Materials and Methods: Twenty-six patients, who were operated for ureteropelvic junction (UPJ) obstruction in our clinic between September 2014 and May 2016, were included in the study. For the evaluation of connective tissue, Masson's trichrome staining was used. Muscle, extracellular matrix elements and neural tissue were evaluated with immunohistochemistry using alpha-smooth muscle actin (a-SMA), Tenascin C and S100, respectively. Microscopically, the tissues were scored according to their staining density (0: No staining; 1: Minor; 2: Moderate, 3: Dense). Results: There were 12 children and 14 adults in the study groups. The initial evaluation showed no statistically significant difference between studied tissue types with respect to staining density for all parameters (Masson: p=0.414, a-SMA: p=0.204, Tenascin-C: p=0.264, S100: p=0.534). There was no statistically significant correlation between staining density and renal function percentage of the affected kidney (Masson: r=0.454, p=0.051, alpha-SMA: r=-0.323, p=0.177 -Tenascin-C: r=0.290, p=0.229 -S100: r=-0.080, p=0.744). Conclusion: Our preliminary study showed some structural changes between adult and child patients but there is no statistically significant difference between the groups with respect to staining density scores. These results state that although UPJ obstruction is an ongoing process, there is no correlation between the histological deterioration degree of the UPJ segment and the loss on renal function for both children and adults.Publication Open Access Can Surgical Technique Affect the Success of Endoscopic Treatment in Children with Vesicoureteral Reflux and Overactive Bladder Syndrome?(GALENOS YAYINCILIK, 2015-09-05) ŞEKERCİ, ÇAĞRI AKIN; Sahan, Ahmet; Akbal, Cem; Garayev, Asgar; Sekerci, Cagri Akin; Sulukaya, Muhammed; Tanidir, Yiloren; Tinay, Ilker; Tarcan, Tufan; Simsek, FerruhObjective Traditional subureteral transurethral injection (STING) and Double hydrodistention-implantation (Double-HIT) injection techniques for vesicoureteral reflux (VUR) treatment are a less invasive, yet very effective options. The influence of injection techniques in treatment success is not adequately searched in children with overactive bladder syndrome (OAB). The objective of this study to compare the short-term success rates of STING and Double-HIT techniques in children with OAB-VUR complex. Materials and Methods Children who underwent endoscopic injection for VUR between 2010 and 2013 were retrospectively evaluated. Patients were grouped into two groups according to the surgical techniques (STING or Double-HIT). Success of the treatment was defined with a negative voiding cystourethrogram at the 6th postoperative week. Patients were evaluated according to sex, age, pre- and postoperative reflux grades, laterality, type and volume of bulking agent and presence of OAB. Results Both groups were similar in terms of sex, age, lower urinary tract dysfunction, reflux grade and success rates. Surgical technique, score of pediatric lower urinary tract symptom questionnaire, age, sex, laterality of reflux and type of the bulking agent found to have no effect on the overall success rates (p>0.05). Presence of OAB and/or a high grade reflux were identified as statistically significant predictive factors that could affect the treatment results. Conclusion The short-term surgical success of the double-HIT and STING techniques showed no difference in children with OAB. The presence of a high grade reflux and/or OAB seemed to be the main factors for overall success in endoscopic VUR surgery.Publication Open Access Utility of Voiding Dysfunction Symptom Score in Diagnosis and Treatment of Enuresis Nocturna(GALENOS YAYINCILIK, 2017-03-13) ŞEKERCİ, ÇAĞRI AKIN; Tanidir, Yiloren; Sekerci, Cagri Akin; Top, Tuncay; Talibzade, Farhad; Sahan, Ahmet; Sener, Tarik Emre; Tarcan, Tufan; Simsek, Ferruh; Akbal, CemObjective: The aim of this study was to determine the effectiveness of the voiding dysfunction symptom score (VDSS) in evaluation of children with nocturnal enuresis. Materials and Methods: Four hundred children with nocturnal enuresis were included in the study. They were evaluated with VDSS, physical examination, urinalysis and 2-day voiding diary. All children with nocturnal enuresis symptoms were treated with desmopressin and/or urotherapy. However, children with overactive bladder symptoms were also treated with anticholinergics. Treatment success and change in VDSS were compared and assessed between different treatment methods. Results: Two hundred forty-five children (61.25%) were male and 155 (38.75%) were female. The mean age was 7.6 +/- 3.0 years (range: 5-18). The mean VDSS was 9.2 +/- 6.3. 35% of children with nocturnal enuresis had concomitant daytime symptoms. 126 children (31.5%) had a VDSS of nine or above and majority of these children were treated with anticholinergic therapy. VDSS questionnaire could not help determine treatment success in children with non-monosymptomatic nocturnal enuresis. However, children treated with urotherapy and desmopressine showed significant difference in VDSSs according to their treatment response. Conclusion: VDSS has shown to decrease after treatment in children with mono-symptomatic nocturnal enuresis. The treatment strategies should be checked and modified if VDSS does not decrease after proper therapy as this would increase the success of treatment.Publication Open Access Assessment of Differential Renal Function in Children with Hydronephrosis: Comparison of DMSA and MAG-3(GALENOS YAYINCILIK, 2015-09-05) ŞEKERCİ, ÇAĞRI AKIN; Akbal, Cem; Sahan, Ahmet; Garayev, Asgar; Sekerci, Cagri Akin; Sulukaya, Muhammed; Alpay, Harika; Tarcan, Tufan; Simsek, FerruhObjective Nuclear imaging techniques such as 99mTc-dimercaptosuccinic acid (DMSA) and (99)mTc-mercaptoacetyltriglycine (MAG-3) are widely used for the diagnosis and follow-up of urinary tract obstructions. Both imaging techniques provide the differential renal function (DRF) in slightly different ways. The aim of this study was to assess the MAG-3 scan as an adjunct or alternative to DMSA for evaluating DRF in children with hydronephrosis. Materials and Methods Eighty-one patients with hydronephrosis were enrolled in this study. Patient age, sex, anteroposterior renal pelvis diameter (RPD) at the time of diagnosis, parenchymal thickness and the DRF percentage found by both DMSA and MAG-3 were recorded. DMSA scintigraphy was used for detecting renal scars and estimating DRF. MAG-3 scintigraphy was used for evaluation of renal clearance, the collecting system's outflow pattern and estimating DRF. Results A total of 102 renal units (38 left, 22 right and 21 bilateral) were evaluated. High correlation rates were found when we compared both tests' DRF values according to antero-posterior renal pelvic diameter and patient age (p>0.05). In all groups compared in the present study, both tests demonstrated very similar results and DRF values. Statistical analysis of cut-offs (45%, 40%, 10%) were also similar in both methods (p>0.05, kappa > 0.7, r=0.926 Pearson). Conclusion DMSA and MAG-3 are tests that are of assistance in the evaluation of hydronephrosis. Compared to DMSA, MAG-3 also provides valuable information to evaluate DRF values in hydronephrotic renal unit (RU). Avoiding unnecessary DMSA imaging will save time and cost and prevent over-radiation of the pediatric population.Publication Open Access Management of Neonatal Priapism: Report of Two Cases and Review of the Literature(GALENOS YAYINCILIK, 2016-03-30) ŞEKERCİ, ÇAĞRI AKIN; Talibzade, Farhad; Akbal, Cem; Sekerci, Cagri Akin; Ozgur, Mehmet Ozay; Cam, Haydar Kamil; Simsek, FerruhPriapism in a newborn is a rare entity with only 15 cases reported in the literature since 1879. The most commonly detected etiologic factor is polycythemia, but most of the cases are idiopathic. Conservative treatment seems to be sufficient and surgical approach is usually unnecessary. Here, we present a prolonged erection in two newborns which occurred at the first day of life and detumescence was achieved with conservative approach at the 6th and 7th day of life, respectively. We also reviewed the literature to investigate the most adequate evaluation and management criteria.Publication Open Access The Significance of the Contralateral Testis Size Measurement with Ultrasonography in Predicting Monorchism in Boys with Nonpalpable Testicles(GALENOS YAYINCILIK, 2017-06-16) ŞEKERCİ, ÇAĞRI AKIN; Sekerci, Cagri Akin; Tanidir, Yiloren; Sener, Tarik Emre; Asadov, Ruslan; Sahan, Ahmet; Tarcan, Tufan; Simsek, Ferruh; Akbal, CemObjective: The aim of this study was to determine the significance of contralateral testis size in predicting monorchism in pediatric patients with unilateral undescended testis. Materials and Methods: The data of patients who underwent surgical operation by a single pediatric urologist for undescended testis between 2013 and 2016 was evaluated retrospectively. The patients were grouped as having monorchism (M), nonpalpable intra-abdominal testis (NPIAT), and palpable undescended testis (PUDT). The dimensions of the testes were measured ultrasonographically and recorded before operation. Patients with nonpalpable testis underwent diagnostic laparoscopy and patients with PUDT underwent inguinal orchiopexy. Results: A total of 57 children with a mean age of 31 (11-60) months were evaluated. Of the children, 12 had M, 9 had NPIAT and 36 had PUDT with a similar mean age (p>0.05). The size of the descended testis was found to be significantly small in NPIAT* and PUDT** groups compared to the M group (*p<0.05, **p<0.001). However, the size of the undescended and descended testes was found to be similar between NPIAT and PUDT groups (p>0.05). Conclusion: The size of the testis in the scrotum might help to localize the position of the undescended testis.