Person: ŞİMŞEK, FERRUH
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ŞİMŞEK
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FERRUH
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Publication Metadata only The effect of intradetrusor botulinum neurotoxin type A on urinary NGF, TGF BETA-1, TIMP-2 levels in children with neurogenic detrusor overactivity due to myelodysplasia(WILEY, 2017) ŞEKERCİ, ÇAĞRI AKIN; Top, Tuncay; Sekerci, Cagri Akin; Isbilen-Basok, Banu; Tanidir, Yiloren; Tinay, Ilker; Isman, Ferruh Kemal; Akbal, Cem; Simsek, Ferruh; Tarcan, TufanAimsThe aim of this study was to determine the value of urine nerve growth factor (NGF), transforming growth factor beta 1 (TGF-Beta-1), tissue inhibitor of matrix metalloproteinase 2 (TIMP-2) levels to predict the urodynamic profile before and after botulinum neurotoxin type A (BoNT-A) treatment in children with myelodysplasia. MethodsThis prospective study included 15 children with myelodysplasia who underwent intradetrusor BoNT-A injections due to neurogenic detrusor overactivity (NDOA). Urine samples of each child were collected before and after BoNT-A injections, specifically at the first and third postoperative months. Urine samples were analyzed with ELISA method and NGF, TGF-Beta-1, and TIMP-2 levels were measured. Urine marker levels and clinical findings were assessed for statistical significance with Wilcoxon Signed Ranks Test and Friedman Test. ResultsA total of 15 children (5 boys and 10 girls) were assigned as the study group. Mean age of the patients was 7.12.5 years (range 2.5-11). A statistically significantly decline was observed in urinary TGF-Beta-1 and NGF levels following BoNT-A injections, compared to the preoperative levels (P<0.05). TIMP-2 levels also tend to decrease following BoNT-A injections but this was not statistically significant compared to the preoperative levels. ConclusionThis preliminary study, suggests urinary TGF-Beta-1 and NGF as a potent marker in children with NDOA, as they decline following BoNT-A injection. Further studies are needed in identifying their special role in assessing treatment success after invasive interventions.Publication Metadata only Erectile dysfunction following radiotherapy and brachytherapy for prostate cancer: pathophysiology, prevention and treatment(SPRINGER, 2008) ŞİMŞEK, FERRUH; Akbal, Cem; Tinay, Ilker; Simsek, Ferruh; Turkeri, Levent N.Objectives Although detrimental impact on sexual function following radiotherapy (RT) and brachytherapy decreases the quality of life of prostate cancer survivors, the etiology, pathophysiology, prophylaxis and treatment of this condition has not yet been fully clarified. We reviewed the published literature in terms of etiology, treatment and possible prevention of erectile dysfunction (ED) following RT and/or brachytherapy. Method We have reviewed the literature through a MEDLINE search. Prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, treatment and quality of life were used as keywords. Conclusion Both RT and brachytherapy result in high rates of ED. Although arterial damage seems to be the main cause of ED after RT, exposure of neurovascular bundle to high levels of radiation dose has been also implicated in some studies with brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of ED. The most important predictive factor of ED following RT is the treatment modality. Intensity-modulated radiotherapy and vessel-sparing prostate radiotherapy are new techniques but those treatments may not guarantee complete preservation of the erectile function. Patients need to be correctly informed on the possible sequela of radiation-based treatments on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for ED, which may develop in due course.Publication Metadata only Aşırı akti̇f mesanesi̇ olan çocuklarda pedi̇atri̇k alt üri̇ner si̇stem semptom skorunun tanısal değeri̇(2013-11-24) ŞENER, TARIK EMRE; ŞAHİN, BAHADIR; TİNAY, İLKER; TARCAN, TUFAN; ŞİMŞEK, FERRUH; AKBAL C., Sahan A., ŞENER T. E., ŞAHİN B., TİNAY İ., TARCAN T., ŞİMŞEK F.Publication Metadata only Diagnostic value of the pediatric lower urinary tract symptom score in children with overactive bladder(SPRINGER, 2014) ŞİMŞEK, FERRUH; Akbal, Cem; Sahan, Ahmet; Sener, T. Emre; Sahin, Bahadir; Tinay, Ilker; Tarcan, Tufan; Simsek, FerruhThe aims were (1) to assess the pediatric lower urinary tract symptom score (SS) prior to treatment as a means of determining severity of overactive bladder (OAB) and (2) to investigate relationships between SS results and those of standard diagnostic modalities. Symptom scores were recorded pre- and 6 months SS for 294 children with OAB unrelated to neurological disorder. Uroflowmetry-electromyography data, total bladder capacity, and a 2-day bladder diary were also recorded, and upper urinary tract deterioration was investigated as indicated. Overactive bladder was treated with standard approaches. No response to treatment was defined as 0-49 % reduction in OAB-related symptoms based on SS results. Non-responders underwent additional evaluations as indicated. Two hundred forty-one patients (97 %; mean age 9.8 +/- A 2.8 years; mean follow-up 11 months; range 6-18 months) completed the study. One hundred thirteen (47 %) required ultrasonography (USG), and those with abnormal USG had a significantly higher pre- and 6 months SS (p = 0.016). All non-responders (n = 38; 16 %) underwent urodynamics evaluation, 34 underwent spinal magnetic resonance imaging (MRI), 34 underwent voiding cystourethrography (VCUG), and 34 underwent dimercaptosuccinic acid scanning (DMSA). Non-responders with terminal detrusor hyperactivity had significantly lower SS after therapy (p = 0.09). Non-responders with abnormal MRI had higher pre- and 6 months SS than those with normal MRI. Thirteen (38 %) of the non-responders who required VCUG had vesicoureteral reflux (VUR), and this subgroup had higher pre-treatment SS (p = 0.030). Seven (21 %) of the non-responders who required DMSA had scarring, and all 7 had VUR. The subgroup with scarring had higher pre-treatment SS (p = 0.030). Pediatric OAB patients with high 6 months SS have a higher incidence of additional upper urinary tract pathology. Those with low pre-treatment SS require fewer laboratory tests and other assessments. The SS tool can reduce the number of urodynamics evaluations, and other tests required to diagnose renal damage in children with OAB.Publication Metadata only Differentiation of ureteral stones and phleboliths using Hounsfield units on computerized tomography: a new method without observer bias(SPRINGER, 2017) ŞEKERCİ, ÇAĞRI AKIN; Tanidir, Yiloren; Sahan, Ahmet; Asutay, Mehmet Kazim; Sener, Tarik Emre; Talibzade, Farhad; Garayev, Asgar; Tinay, Ilker; Sekerci, Cagri Akin; Simsek, FerruhTo differentiate ureteral stones and phleboliths by measuring density [as Hounsfield unit (HU)] and volume (as mm(3)) of the opacities in the bony pelvis on unenhanced computerized tomography (U-CT). A total of 52 patients, who underwent semirigid ureteroscopy and laser lithotripsy for distal ureteral stone and had isochoronous phleboliths in U-CT, were included. Images were reviewed for density and volume of the opacities. Data were compared, and a cut-off value was defined with receiver operating characteristics curve analysis to differentiate the nature of the opacity. Using the cut-off values of 171 mmA(3) for volume (sensitivity 75 %, specificity 100 %) and 643 HU for density (sensitivity 75 %, specificity 93 %), differentiation between stone and phlebolith was achieved. Differentiation of pelvic opacities needs meticulous observation with certain signs on U-CT. On the other hand, our study offers a new method, with certain cut-off values, such as 643 HU and 171 mm(3), which can be used to precisely predict the actual nature of opacities of interest.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 Metadata only Güvenli̇k kılavuz teli̇ üreteroskopi̇k taş cerrahi̇si̇nde ruti̇n kullanilmali mi?: Prospekti̇f randomi̇ze çalışma ön sonuçları(2016-11-06) TANIDIR, YILÖREN; ŞAHİN, BAHADIR; ŞENER, TARIK EMRE; TİNAY, İLKER; ŞİMŞEK, FERRUH; TANIDIR Y., ŞAHİN B., ŞENER T. E., Sulukaya M., Sekerci C. A., TİNAY İ., ŞİMŞEK F.Publication Metadata only The value of sacral skin lesions in predicting occult spinal dysraphism in children with voiding dysfunction and normal neurological examination(ELSEVIER SCI LTD, 2012) ŞİMŞEK, FERRUH; Tarcan, Tufan; Tinay, Ilker; Temiz, Yusuf; Alpay, Harika; Ozek, Memet; Simsek, FerruhObjective: The role of magnetic resonance imaging (MRI) in detecting occult spinal dysraphism (OSD) in children with voiding dysfunction and a normal neurological examination is still under debate. The aim of this study was to assess the correlation of sacral skin lesions with OSD detected on MRI, in a population of children with resistant lower urinary tract symptoms (LUTS). Patients and methods: A total of 114 children over 5 years of age with urinary tract infection (UTI) and/or LUTS and normal neurological examination were enrolled. All children underwent sacral neurological examination, urine analysis and cultures, renal/bladder ultrasound, voiding cystourethrogram and urodynamic examination. After a treatment period of 6 months, the patients were re-evaluated and spinal MRI was performed in 61 with ongoing LUTS or UTI. Results: Nineteen of 61 children (31%) had cutaneous stigmas. MRI detected spinal abnormality in 2/42 children with a normal sacral examination in comparison to 7/19 children with an abnormal sacral finding (Chi-squared test, P < 0.005). The sensitivity and specificity of an abnormal sacral finding in predicting MRI abnormality were 0.76 and 0.77, respectively. Urodynamic parameters did not predict an abnormal spinal MRI. Conclusions: Abnormal sacral findings, but not urodynamic studies, are strong predictors of OSD. A normal sacral examination does not rule out OSD. (C) 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.Publication Metadata only Is 40cmH(2)O detrusor leak point pressure cut-off reliable for upper urinary tract protection in children with myelodysplasia?(WILEY, 2017) ŞEKERCİ, ÇAĞRI AKIN; Tarcan, Tufan; Sekerci, Cagri Akin; Akbal, Cem; Tinay, Ilker; Tanidir, Yiloren; Sahan, Ahmet; Sahin, Bahadir; Top, Tuncay; Simsek, FerruhPurposeThe purpose of this study, is to find out the most accurate cut-off level for the detrusor leak point pressure (DLPP) in terms of upper urinary tract (UUT) protection in a cohort of children with myelodysplasia. Materials and MethodsOne hundred and ninety-three children with myelodysplasia were included in the study based on the availability of urological evaluation at age of 3 years. Children were assigned to one of two groupsthose who had UUT damage at age 3 (group 1, n: 70) and those without UUT changes (group 2, n: 123), and compared. ResultsUrological follow-up data revealed higher incidences of febrile urinary tract infections and secondary tethering of the spinal cord in group 1. No statistically significant difference was determined between group 1 and group 2 in terms of DLPP values (median 42.5 vs. 39.5cmH(2)O, respectively, P=0.087). Analysis of different cut-off values showed that DLPP above 20cmH(2)O had a higher sensitivity for UUT damage (91.4%). A normal UUT was found in 56.5% and 62.2% of children with DLPP between 20 and 40cmH(2)O, and with DLPP over 40cmH(2)O, respectively. ConclusionsPresent study showed that more than half of the children with myelodysplasia had normal UUT function even with a DLPP of 40cmH(2)O and over. Thus, DLPP, is not the sole decision making parameter to rely for more invasive therapies in children with myelodysplasia. On the other hand, a DLPP cut-off value of 20cmH(2)O showed a higher sensitivity to predict UUT damage instead of 40cmH(2)O. Neurourol. Urodynam. 36:759-763, 2017. (c) 2016 Wiley Periodicals, Inc.Publication Metadata only Outcome of preemptive penile rehabilitation before bilateral cavernosal nerve injury in rats(SPRINGER, 2010) ŞİMŞEK, FERRUH; Tavukcu, Hasan Huseyin; Akbal, Cem; Tinay, Ilker; Simsek, Ferruh; Turkeri, LeventIn this study, prophylactic penile rehabilitation (PR) with sildenafil before and after a cavernosal nerve (CN) injury was analyzed in an animal model. Thirty-six animals were divided into six groups as follows: (1) those with no CN injury (i.e., sham), (2) those with a bilateral CN injury (i.e., control), (3, 4) those with a bilateral CN injury treated with 10-20 mg/kg of sildenafil subcutaneously (SC) on a daily basis commencing 1 month prior to and after nerve injuries, respectively, (5, 6) those with a bilateral CN injury treated daily with 10-20 mg/kg of sildenafil SC after the nerve injuries, respectively. Mean arterial pressure (MAP) and intracavernosal pressure (ICP) were measured in response to CN stimulation to assess erectile function (EF). Neuronal nitric oxide synthase (nNOS) immunohistochemical analysis and real-time polymerase chain reaction (RT-PCR) were performed. The maximal ICP/MAP ratio was 60 +/- A 18% in the sham, 22 +/- A 5% in the control, 28 +/- A 9% in Group III, 45 +/- A 16% in Group IV, 45 +/- A 17% in Group V, and 49 +/- A 21% in Group VI. Although EF was improved with sildenafil treatment in a dose-dependent fashion, no statistically significant difference was observed between the preemptive and standard rehabilitation groups. Again, nNOS immunoreactivity and RT-PCR results showed the beneficial effect of sildenafil, but the study did not support the efficacy of preemptive rehabilitation when compared to the standard rehabilitation group. Although, a dose-response relationship was observed for PR treatment with sildenafil; i.e., outcomes improved at higher doses of sildenafil for PR, preemptive PR should not be pursued as an alternative rehabilitation modality.