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Öğe An unresolved discussion: presence of premature ejaculation and erectile dysfunction in lumbar disc hernia(Springer, 2013) Yazıcı, Cenk Murat; Sarıfakıo?lu, Ayşe Banu; Yıldırım Güzelant, Aliye; Türker, Polat; Ateş, ÖzkanPremature ejaculation (PE) and erectile dysfunction (ED) are both frequent diseases with several questions about the aetiological factors for these disorders. Lumbar disc herniation (LDH), which can cause both neurological and physiological impairments, may be a causative reason. We prospectively tried to evaluate the presence of PE and ED in patients with LDH and identify the effect of both surgical and physical therapy treatments for LDH on PE and ED. A total of 50 patients with LDH and a corresponding control group without LDH at an age of 18-50 years were included in the study. Both PE and ED were evaluated with premature ejaculation diagnostic tool (PEDT) and International Index of Erectile Function. Mean intravaginal ejaculatory latency time (IELT) was calculated at their 5 consecutive intercourse. Physical therapy or microdiscectomy was performed according to indication. After 6 months of follow-up, patients in treatment group were re-evaluated for PE and ED. Mean age of study and control group was 34.1 +/- A 3.3 and 34.2 +/- A 4.0 years, respectively (p = 0.979). In LDH group, IELT was < 1 min in 12 (24 %), 1-2 (16 %) min in 8, 2-3 min in 7 (14 %), 3-4 min in 7 (14 %) and 4 or more minutes in 16 (32 %) patients. These numbers were 11 (22 %), 8 (16 %), 5 (10 %), 9 (18 %) and 17 (34 %) in control group, respectively. Mean PEDT score of patients who had IELT < 1 min was 11.9 +/- A 2.1 and 10.7 +/- A 2.1 in study and control group, whereas it decreased to 1.0 +/- A 2.8 and 0.5 +/- A 1.8 as IELT increased over 4 min, respectively. There were 11 (22 %) patients with ED in LDH group, whereas there were only 2 (4 %) in control group (p = 0.017). Twenty patients with LDH underwent surgery while 30 had been taken into physical therapy. After 6 months, patients with PE significantly decreased in both surgery and physical therapy group (p = 0.025 and p = 0.046). Patients with ED also decreased after treatment, but the numbers were so limited for statistical evaluation. Although ED was more frequent in patients with LDH, PE was similar in both study and control groups, but the treatment of LDH had positive effects on PE and ED.Öğe Anxiety and Depression are Two Important Causes of Erectile Dysfunction after Saturation Biopsy: A Pilot Study(Galenos Yayincilik, 2014) Akbal, Cem; Türker, Polat; Şekerci, Çağrı Akın; Özgen, Mahir Bülent; Şimşek, Ferruh; Türkeri, LeventObjective To evaluate the role of the patient's mood as a possible cause of erectile dysfunction (ED) following transrectal ultrasound-guided saturation biopsy. Materials and Methods One hundred and thirty five patients who underwent a saturation biopsy due to persistently elevated levels of prostate specific antigen (PSA) were included in the study. Group 1 included 78 patients for whom the biopsy indicated that they were cancer-free, and group 2 included 57 patients for whom the biopsy indicated that they had prostate cancer and were thus on a waiting list for a radical treatment. Patients were evaluated using the International Index of Erectile Function-5 (IIEF-5) and the Hospital Anxiety-Depression Scale (HADS). Results Among the cancer-free group, 17% of patients exhibited a decline in erectile function after the biopsy according to their IIEF-5 scores. The anxiety or depression rate according to the HADS was 69% in the patients exhibiting a decrease in erectile function, which was greater than that of the rest of the cancer-free patients who had no erectile function deterioration. Patients who learned that they had cancer exhibited a statistically significant average decrease in IIEF-5 scores (p=0.04). Their scores on the HADS were significantly higher. Conclusion Although a saturation biopsy of the prostate is a safe procedure in terms of erectile function, the risk of ED after a biopsy should be discussed with patients who have had previous normal erectile function and have been diagnosed with cancer.Öğe Clinical evaluation of pediatric testicular masses(Aves, 2010) Yazıcı, Cenk Murat; Türker, Polat; Yücel, SelçukScrotal pathologies are frequently seen in pediatric population. There are plenty of diseases that can be seen with similar clinical findings. These are generally benign lesions that can be diagnosed by simple physical examination and radiological techniques. Most of the clinicians are familiar with these diseases and are able to manage them. The problematic diseases of scrotum are testicular masses. They are seen rarely, but when they are diagnosed, they cause anxiety in both family and clinician. This may cause overtreatment of these diseases, as it is proposed to be in adult patients. However, these tumors have different characteristics in pediatric population. They also differ between prepubertal and postpubertal pediatric patients. Like histopathological properties, malignancy potentials of testis tumors are different in prepubertal ages. Benign tumors are much more frequent in pediatric group. This gives the clinician an opportunity for conservative treatment. Testis sparing surgery which is performed rarely for adult testis tumors, can be very efficient for prepubertal patients. According to oncologic principles, conservative surgery must be performed only for absolutely indicated patients. For this reason, clinicians must have the idea how to differentiate benign and malign testicular masses. In this review, we summarized the most common testicular pathologies in children, and tried to point out the principles of evaluating, differentiating and treating benign and malignant testicular masses of pediatric age group.Öğe Comparison of the Clinical and Pathologic Staging in Patients Undergoing Radical Cystectomy, the Factors Associated with Upstaging and its Effect on Outcome(Galenos Yayincilik, 2014) Türker, PolatBladder cancer is clinically understaged in about half of the cases and no improvements in solving this problem has been observed during the past 25 years. Patients who are clinically upstaged after radical cystectomy have higher recurrence and bladder cancer mortality rates when compared to those who are correctly staged. Currently, reliable predictors of extravesical upstaging at the time of radical cystectomy do not exist. In various studies of T2 staging, hydronephrosis, carcinoma in situ, high- grade disease, lymphovascular invasion, female gender and neutrophil- lymphocyte ratio are found to be associated with upstaging.Öğe Does patient age affect survival after radical cystectomy?(Wiley, 2012) Horovitz, David; Türker, Polat; Bostrom, Peter J.; Mirtti, Tuomas; Nurmi, Martti; Kuk, Cynthia; Zlotta, Alexandre R.OBJECTIVE To analyse the impact of patient age on survival after radical cystectomy (RC). PATIENTS AND METHODS After ethics review board approval, two databases of patients with bladder cancer (BC) undergoing RC at the University Heath Network, Toronto, Canada (1992-2008) and the University of Turku, Turku, Finland (1986-2005) were retrospectively analysed. A total of 605 patients who underwent this procedure between June 1985 and March 2010 were included. Patients were divided into four age groups: <= 59, 60-69, 70-79 and >= 80 years. Demographic, clinical and pathological data were compared, as well as recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OAS) rates. RESULTS Compared with younger patients (age <= 79 years), elderly patients (age >= 80 years) had higher American Society of Anesthesiologists scores (P < 0.001), a greater number of lymph nodes removed during surgical dissection (P < 0.001), and underwent less adjuvant treatment (P < 0.001). Choice of urinary diversion differed among the groups, with ileal conduit being used for all patients >= 80 years (P < 0.001). No differences were noted between age groups with respect to RFS (P = 0.3), DSS (P = 0.4) or OAS (P = 0.4). CONCLUSION Although RC is an operation with significant morbidity, it is a viable treatment option for carefully selected elderly patients. Senior patients (>= 80 years) should not be denied RC if they are deemed fit to undergo surgery. Senior adults do not suffer from adverse histopathological features as compared with younger patients.Öğe Öğe Effect of Voiding Position on Uroflowmetric Parameters in Healthy and Obstructed Male Patients(Urol & Nephrol Res Ctr-Unrc, 2013) Yazıcı, Cenk Murat; Türker, Polat; Doğan, ÇağrıPurpose: Uroflowmetry is frequently used and simple urodynamic test, but it may be affected by various factors. Voiding position is one of the factors that can change the results. We tried to compare the uroflowmetric parameters in sitting and standing positions during urination. Material and Methods: A total of 198 patients were enrolled to the study. All patients underwent an uroflowmetry in standing and sitting position at late afternoon (2-4 PM) of two corresponding days with a gravimetric uroflowmeter (Uroscan, Aymed, Turkey). A transabdominal ultrasonography was used to evaluate post voiding residue (PVR). All uroflowmetric parameters and PVR. were compared with paired t test or Wilcoxon signed rank test. Results: The median age of study population was 58.0 (36-69) years. There was no statistically significant difference at voided volume of patients in standing and sitting position as it was 271.5 +/- 81.8 mL and 274.8 +/- 82.4 mL, respectively (P = .505). Mean maximum flow rate (Qmax) during urination at standing position was 15.3 +/- 6.7 mL/s while it was 15.0 +/- 7.0 mL/s at sitting position (P = .29). Mean average flow rate in standing position was 8.60 +/- 4.0 mL/s and 8.25 +/- 3.8 mL/s in sitting position (P = .054). There was a statistically significant difference between the median post-voiding residues in standing and sitting urination which was 29.5 (0-257) mL in standing and 47.5 (2-209) mL in sitting position (P < .0001). Other uroflowmetric parameters (time to maximum flow and voiding time) was not statistically different between groups. Conclusion: There are no clinically important uroflowmetric differences between voiding in sitting and standing positions so voiding position may be left to personal preferences during uroflowmetric evaluation.Öğe Is intravesical BCG treatment necessary and/or sufficient?(Galenos Yayincilik, 2013) Ekici, Sinan; Türker, PolatIntravesical BCG treatment has been used over 3 decades in the treatment of non-muscle invasive bladder cancer. Although the exact mechanism of its action is not clear, its clinical efficiency has been proven. Numerous clinical trials are still trying to answer; which tumoral lesions this drug should be used for, which dosage is enough, which maintanence should be chosen and how long it should be continued. In this article the answers of these questions, with the current evidence, are summarised.Öğe Is it possible to predict BCG effectivity in the treatment of superficial bladder cancer? Are there any markers?(Galenos Yayincilik, 2012) Türker, Polat; Ekici, SinanAim: Bacillus Calmette-Guerin (BCG) is a standard treatment for reducing tumour recurrence and delaying progression of highrisk, non-muscle-invasive bladder tumours. However, it is not clear yet which patients are more likely to be responders to BCG. New Findings: The host factors and the tumor characteristics failed to be an independent factor in the prediction of BCG affectivity in the treatment of non-muscle invasive bladder cancer. The local immune response after intravesical BCG installation was studied meticulously and the predictive value of the elements in this pathway was determined. Among these urine levels of IL-2 has most encouraging results and also the determination of nucleotide polymorphisms of different cytokines in the inflammatory pathway seem promising. Results: Research continues to determine which patients would benefit from BCG treatment and also to establish a better outcome. New approaches are needed in the light of developments in biomedical technology. A very critical part of this therapy is to find out the correlation of different cytokines with BCG therapy, which will give a better insight not only the mechanism but also a better therapeutic options.Öğe Is Standard Urine Bag or Urofix? Which is More Usefull in Surgical Nursing Care? Accuracy of Urine Output Monitoring(2020) Yıldız, Tülin; Yazıcı, Cenk Murat; Türker, Polat; Önler, Ebru; Malak, Arzu; Eren, ElifObjective: The aim of this study is to evaluate and compare the accuracy of urine output measurement performed by standard urine bags and urofix. Methods: This is a prospective study conducted at a 22-bed urology unit. Urine volume was measured either by a standard urine bag or urofix, verified by scaled container measurements in patients dressed with urinary catheter and expected to stay with it for 24 hours or more. In total, 1048 measurements were obtained for 131 patients. Results: The difference between median, maximum and minimum values of urine volumes from the scaled container and nurse’s forecast was evaluated for each of 4 measurements. When the urine volume was measured with the standard urine bag, the average volume was 550 cc in the first measurement while it was 300 cc with urofix. Mean values for the second, third and fourth measurements with standard urine bag and urofix were as follows respectively; 590 cc and 335 cc, 500 cc and 300 cc, 600 cc and 300 cc. The difference was statistically significant in all measurements (p<0.001). Conclusion: In this study, urofix was the most reliable method for measuring urine output and fluid management. Furthermore, if the patient has a standard urine bag, it is recommended to confirm the urine output with a scaled container.Öğe Metabolic syndrome in the etiology of benign prostatic hyperplasia/lower urinary tract symptoms(Galenos Yayincilik, 2013) Türker, Polat; Yazıcı, Cenk MuratMetabolic syndrome is a growing health burden in the world and Turkish population, affecting the length and the quality of life. Although it involves some interrelated metabolic abnormalities like central obesity, dyslipidemia, hypertension, insulin resistance and following hyperinsulinemia and glucose intolerance; insulin resistance and hyperinsulinemia are the basic components of its patho-physiology. Recently the relationship between the metabolic syndrome, benign prostatic hyperplasia and lower urinary tract symptoms has been announced with research and clinical studies. The main factors in this relationship can be summarized as; insulin like growth factor activity, sympathic nervous system activity and increase in smooth muscle tone, nitric oxide and nitric oxide synthase activity and Rho kinase activity. The aim of this paper is to summarise the important articles about this topic explaining the patho-physiology.Öğe Non-Muscle Invasive Bladder Cancer Resistant to Bcg(Iniestares, S.A., 2013) Türker, Polat; Türkeri, LeventTreatment options for patients with non-muscle invasive bladder cancer (NM/BC) refractory to intravesical bacillus Calmette-Guerin (BCG) therapy is reviewed in this article based on the recent published literature. Although intravesical BCG is the best bladder sparing treatment option for NM/BC to prevent recurrence and progression, about 1/3 of cases are refractory to this treatment. At this point radical cystectomy is the standard treatment of choice. If this option is not feasible, intravesical chemotherapy with docetaxel or gemcitabine, the combination of BCG and interferon (INF)-alpha or device-assisted intravesical strategies, such as mitomycin-EMDA or chemohyperthermia are some of the candidates for further treatment.Öğe Open surgery is still gold standard for radical prostatectomy(Galenos Yayincilik, 2014) Türker, Polat; Türkeri, LeventOpen radical prostatectomy is considered as the standart of care for localised prostate cancer. It has longterm followup results and has a proven efficacy over cancer control and preservation of functional outcomes. Robot asisted laparoscopic radical prostatectomy is a minimally invasive surgical technique that brought some advantages to the field and has been adapted by urologic surgeons and patients in a very short time. Advantages of robotic surgery include decreased blood loss and transfusion rates comparable to open technique, wheras major disadvantages are high cost and absence of longterm results. In this article the main reasons for open surgery stil remaining the standart of care procedure are discussed.Öğe Presence of high grade tertiary Gleason pattern upgrades the Gleason sum score and is inversely associated with biochemical recurrence-free survival(Elsevier Science Inc, 2013) Türker, Polat; Baş, Emine; Bozkurt, Süheyla; Günlüsoy, Bülent; Sezgin, Arsenal; Postacı, Hakan; Türkeri, LeventObjectives: Tumor heterogeneity is a common finding and led to realization of a tertiary Gleason component (TGC) in prostate cancer. In an attempt to further investigate its prognostic value, we analyzed the association of tertiary Gleason pattern in Gleason score <= 7 tumors with pathologic stage and biochemical disease-free survival. Material and methods: A total of 331 radical prostatectomy specimens were analyzed retrospectively. The primary, secondary, and the tertiary patterns were evaluated by reviewing all of the pathologic slides. TGC was defined as Gleason grade pattern 4 or 5 for Gleason score <7 tumors and Gleason grade pattern 5 for Gleason score 7 tumors. The pathologic prognostic factors, (extraprostatic extension, seminal vesicle and lymph node invasion, surgical margin status) of Gleason score <7, 3+4, and 4+3 tumors with or without TGC were compared. Biochemical recurrence-free survival (BRFS) was calculated using Kaplan-Meier method with log rank test, and the influence of TGC was assessed in a Cox regression model. Results: TGC observed more frequently with higher Gleason scores (21% of the GS <7 cases, 23% of the GS 3+4 cases, and 58% of the GS 4+3 cases). In terms of adverse pathologic prognostic factors and BRFS, GS <7 tumors with TGC behaved significantly worse than GS <7 tumors without TGC (P = 0.01 and P = 0.001, respectively) with properties similar to GS 3+4 tumors without TGC. Gleason score 3+4 and 4+3 tumors without TGC were statistically similar and had better features than corresponding tumors of same Gleason score with TGC. Furthermore, Gleason score 7 tumors with TGC had similar features with GS 8-10 tumors. During follow-up, 73 (22%) subjects had PSA recurrence. In the Cox regression model TGC was an independent variable for BRFS (BR = 2.63, 95% CI = 1.39-4.98, P = 0.003). Conclusion: According to the present study, 3 different prognostic groups were observed; good prognostic group: GS <7, intermediate prognostic group: GS <7+TGC, GS 3+4, and GS 4+3, and finally bad prognostic group: GS (3+4)+TGC, GS (4+3)+TGC, GS >7. Presence of a TGC appears to upgrade the total score and adjuvant treatment decisions may further be refined by considering the tertiary pattern. (C) 2013 Elsevier Inc. All rights reserved.Öğe Primary carcinoid tumor of the kidney(2015) Gelincik, İbrahim; Türker, Polat; Özçağlayan, Ömer; Uygur, RamazanBöbreğin primer karsinoid tümörü, ilk olarak 1966 yılında Rensick ve arkadaşları tarafından bildirilen çok nadir bir neoplazmdır. Literatürü kapsamlı şekilde 2006 yılına kadar gözden geçiren Murali ve arkadaşları 51 vakanın, Romero ve arkadaşları ise 56 vakanın bildirildiğini bulmuşlardır. Nöroendokrin hücreler normal erişkinlerin böbrek parankiminde bulunmadığından dolayı bu tümörün patojenezi tam olarak açıklanamamıştır. Klinik açıdan diğer böbrek tümörlerine benzediğinden dolayı teşhis güçlüğü vardır. Biz 55 yaşındaki erkek hastanın sağ böbreğindeki primer karsinoid tümörü rapor ettik.Öğe PROSTAT KANSERİNDE AKTİF İZLEM KARARI; BİYOPSİ GLEASON SKORU NE KADAR GÜVENLİ?(Namık Kemal Üniversitesi, 2017) Yazıcı, Cenk Murat; Türker, Polat; Şahin, Mehmet Fatih; Özcan, RıdvanAmaç: Prostat spesifik antijenin tanımlanmasından sonra insidental prostat kanseri oranı yükselmiş ve hastalar gereksiz tedavilere maruz kalabilmişlerdir. İnsidental prostat kanseri olan hastalarda herhangi bir tedavi uygulanmadan yakın izlem kılavuzlara girmiş ve hastalara uygulanmaya başlamıştır. Ancak transrektal ultrasonografi eşliğinde biyopsi patolojilerindeki veriler ile radikal prostatektomi spesimen patolojilerindeki verilerin uyumsuzluğu, küratif tedavi ihtiyacı olabilecek hastaları riske atmaktadır. Bu çalışmada; radikal prostatektomi spesimenlerindeki Gleason skorları ile TRUS-bx Gleason skorlarının karşılaştırılması amaçlanmıştır. Materyal – Metot: Mart 2011 ile Haziran 2016 tarihleri arasında, kliniğimizde radikal prostatektomi cerrahisi geçirmiş hastaların verileri retrospektif olarak değerlendirildi. Hastaların transrektal ultrasonografi eşliğinde biyopsi öncesi PSA değerleri, biyopsi kor sayıları, kanser pozitif biyopsi kor sayıları, biyopsideki kanser yüzdeleri ve Gleason skorları tespit edilerek, radikal prostatektomi sonrası Gleason skorları, doku kanser oranları, cerrahi sınırlar ve patolojik evre ile karşılaştırıldı. Bulgular: Toplam 44 hastanın verileri değerlendirildi. Transrektal ultrasonografi eşliğinde biyopsi patolojisinde Gleason skoru <7 olan hastaların 11’inde(%44), prostat spesimen patolojisi Gleason skoru da <7 olarak tespit edildi. Transrektal ultrasonografi eşliğinde biyopsi patolojisinde Gleason skoru 7 olan hastaların 8’inde (%61,5) prostat spesimen patoloji Gleason skoru 7 olarak tespit edildi. Trus-bx patolojisinde Gleason skoru >7 olan hastaların 1’inde (%16,6) prostat spesimen Gleason skoru >7 olarak tespit edildi Sonuç: Transrektal ultrasonografi eşliğinde biyopsi patolojilerinde bildirilen Gleason skorları ile radikal prostatektomi Gleason skorları arasında fark olabilmekte, bu fark özellikle biyopsi Gleason skoru <7 olan hastalarda daha belirginleşebilmektedir. Aktif izlemin hedefi olan bu hasta grubunda, patologların bildirdiği Gleason skorlarının güvenilirliği tartışmalı olup, diğer değişkenler (kor-tümör oranı, tümör kor sayısı, PSA) dikkate alınarak karar verilmesi gerekmektedir.Öğe The Approach to High Risk Bladder Cancers in the Absence of Bacillus Calmette Guerin: What should Be the Treatment and Follow Up?(Galenos Yayincilik, 2014) Türker, Polat; Türkeri, LeventBacillus Calmette Guerin (BCG), is the optimal bladder-sparing treatment option for patients with high-risk, non-muscle invasive bladder cancer. Recently, the application of BCG has been hindered due to the problem of its availability in Turkey. Alternative treatment options are needed until this problem is solved. In this article, the recommendations about the preferred treatment options and the follow-up, are summarized in the light of the current literature.Öğe The Comparison of the Effects of Nebivolol and Metoprolol on Erectile Dysfunction in the Cases with Coronary Artery Bypass Surgery(Medical Tribune Inc, 2017) Gür, Özcan; Gürkan, Selami; Yümün, Gündüz; Türker, PolatPurpose: Beta-blocker use is common in the cases with coronary artery bypass surgery. According to the literature, beta-blockers have positive effects but may cause erectile dysfunction (ED). The most commonly used beta-blockers in ischemic cardiac disease are nebivolol and metoprolol. In our clinic, we aimed to compare the effects of nebivolol and metoprolol succinate on ED in the sexually active cases with coronary artery bypass surgery. Methods: In our clinic, a total of 119 patients with coronary artery bypass surgery were included in the study. International Index of Erectile Function (IIEF-5) Test was used to evaluate whether the patients had ED and to grade the cases. Results: No significant difference was found in terms of anti-ischemic efficacy between metoprolol succinate and nebivolol in the postoperative period; however, the incidence of any grade ED was % 85.96 in Group 1, % 83.87 in Group 2. This difference was considered as statistically significant (p = 0.036). Conclusion: Beta-blocker use increases the risk of ED in cases with ischemic cardiac disease. We suggest that the complaints of ED could be less frequent with nebivolol use in sexually active cases with ischemic cardiac disease.Öğe The Evaluation of the Relationship between Bladder Cancer and Oxidative Stress Using NRF-2/KEAP-1 Pathway, Zinc and Copper Levels(Urology and Nephrology Research Centre, 2021) Doğan, Cağrı; Yazıcı, Cenk Murat; Akgül, Murat; Türker, PolatPurpose: It has been shown that Copper and Zinc contribute to the structure of the antioxidant enzymes. In addition, NRF-2 and KEAP-1 complex have a powerful effect on the intracellular organization of the antioxidants. We evaluated the relation of Copper, Zinc, NRF-2, and KEAP-1 complex regarding the oxidative stress with tumor stage - grade in patients with bladder cancer. Materials and Methods: A total of 52 patients (32 bladder cancer and 20 control group) were included in the study. The demographic properties of groups were identical. Serum NRF-2, KEAP-1, Cu, and Zn levels were compared by ELISA method between the groups, and tissue NRF-2, KEAP-1, Cu and Zn levels were evaluated also by ELISA method in cancer patients. Results: Serum levels of NRF-2 and KEAP-1 of the bladder cancer patients were found to be higher than the control group (p = 0.004 and p = 0.001, respectively). On the other hand serum levels of Copper and Zinc were found to be lower than the control group (p = 0.008 and p = 0.001, respectively). However, the subgroup analysis according to the stages and grades of the tumour showed no difference. The Copper level obtained from the tissue analysis was detected to be considerably decreased with tumour stage and grade. Conclusion: Bladder cancer patients had higher serum NRF-2 and KEAP-1 levels and lower serum Copper and Zinc levels. In addition, the Copper levels decreased with the tumour stage and grade. Studies with larger number of patients are needed to demonstrate the efficacy of these markers. © 2021. Urology Journal. All Rights Reserved.Öğe The histomorphological findings of kidneys after application of high dose and high-energy shock wave lithotripsy(Polish Urological Assoc, 2015) Demir, Aslan; Türker, Polat; Bozkurt, Süheyla Uyar; İlker, Yalçın NazmiIntroduction In this animal study, we reviewed the histomorphological findings in rabbit kidneys after a high number of high-energy shock wave applications and observed if there were any cumulative effects after repeated sessions. Material and methods We formed 2 groups, each consisting of 8 rabbits. Group 1 received 1 session and group 2 received 3 sessions of ESWL with a 7 day interval between sessions, consisting of 3500 beats to the left kidney and 5500 beats to the right kidney per session. The specimens of kidneys were examined histomorphologically after bilateral nephrectomy was performed. For statistical analysis, 4 groups of specimens were formed. The first and second groups received 1 session, 3500 and 5500 beats, respectively. The third and fourth groups received 3 sessions, at 3500 and 5500 beats per each session, respectively. The sections were evaluated under a light microscope to determine subcapsular thickening; subcapsular, intratubular and parenchymal hemorrhage; subcapsular, intersitital, perivascular and proximal ureteral fibrosis; paranchymal necrosis; tubular epithelial vacuolization; tubular atrophy; glomerular destruction and calcification. Results In histopathological examinations capsular thickening, subcapsular hematoma, tubuloepithelial vacuolisation, glomerular destruction, parenchymal hemorrhage, interstitial fibrosis, and perivascular fibrosis were observed in all groups. In statistical analysis, on the basis of perivascular fibrosis and tubular atrophy, there was a beats per session dependent increase of both. Conclusions The detrimental effects from ESWL are dose dependent but not cumulative for up to 3 sessions. Histopathological experimental animal studies will aid in understanding local and maybe, by means of these local effects, systemic effects.
