ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and...
Transcript of ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and...
![Page 1: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/1.jpg)
International Hospital
21 Ekim 2013
ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ
FONKSİYONEL VE REKONSTRÜKTİF ÜROLOJİ
Prof. Dr. Selçuk Yücel, FEAPU
![Page 2: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/2.jpg)
International Hospital
21 Ekim 2013
Prof. Dr. Selçuk Yücel • Akdeniz Üniversitesi Tıp Fakültesi Üroloji ABD (2001-
2013)
• Çocuk Ürolojisi Bilim Dalı Başkanı (2011-2013)
• Acıbadem Üniversitesi Atakent Hastanesi Üroloji Bölümü Sorumlusu
– Çocuk Ürolojisi Bilim Dalı – Nöroüroloji (İdrar kaçırma veya yapamama ve Ağrılı Pelvis Sendromları) – Fonksiyonel ve Rekonstrüktif Üroloji (Penis ve Üretra Onarımları, Protez Cerrahileri, Pelvik Taban,
Mesane ve Üreter Onarımları)
![Page 3: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/3.jpg)
International Hospital
21 Ekim 2013
Prof. Dr. Selçuk Yücel
• Marmara Üniversitesi Tıp Fakültesi, 1995
• Marmara Üniversitesi Tıp Fakültesi Üroloji ABD, 2000
• ECFMG, 2000
• University of California San Francisco
Çocuk Ürolojisi ve Rekonstrüktif Üroloji, 2001-2004
• University of Texas Southwestern at Dallas
Çocuk Ürolojisi, 2005-2006
• ABU sertifikalı Çocuk Ürolojisi Uzmanlığı Ek yeterlilik Belgesi, 2006
• FEAPU, 2006
![Page 4: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/4.jpg)
International Hospital
21 Ekim 2013
Prof. Dr. Selçuk Yücel • Epithelial-Mesenchymal Interactions, National Institutes of Health ,
R01-DK57246-04, Key Personnel, UCSF 2001-2003.
• Hypospadias and Gene Expression, The California Urology Foundation. Co- PI, UCSF 2002-2003
• Serum and Urine Neuropeptides in overactive bladder, Pfizer Detrusitol Research Award, Co-PI, Akdeniz Univ 2005-2009
• Serum and Urine Neuropeptides in overactive bladder in children, Akdeniz University Project , Co-PI , Akdeniz Univ 2005-2009
• Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ, 2008-2010
• Diagnosis of Testicular Torsion with Minimally Invasive Laser Techniques through Tissue Oxygen Measurement, Co-PI, Akdeniz University Project, 2009-2011
• Development of an Optical System to Diagnose Testicular Torsion and Testing in Clinic, Co-PI, TÜBİTAK, 1003 Priority Areas Projects , 113S071 # Project
![Page 5: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/5.jpg)
International Hospital
21 Ekim 2013
Prof. Dr. Selçuk Yücel • SIU Ödülü, 2001
• California Urology Foundation Ödülü, 2002 • Jack Lapides Nöroüroloji Ödülü, 2003 ve 2004
• European Assoc of Urology, Best Paper Ödülü, 2004
• Pfizer Detrol XL Ödülü, 2006
• International Continence Society, Çocuk ve Ergen Masası Board Üyesi
• Society of Pediatric Urology
• Reconstructive Urological Surgery
• European Society of Pediatric Urology
• Türk Üroloji Yeterlilik Kurulu
![Page 6: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/6.jpg)
International Hospital
21 Ekim 2013
Çocuklarda Neler ile İlgileniyorum ?
BÖBREK
Prenatal hidronefroz, VUR, Posterior Uretral valv
Taş
MESANE
Spina Bifida
Gündüz idrar kaçırma
Yatak ıslatma
PENİS
Fimoz ve Sünnet Hipospadias, Eğri Penis, Gömük Penis
VAJEN
Labial adhezyon
Feminizan genitoplasti
SKROTUM
Şiş skrotum
Boş skrotum
![Page 7: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/7.jpg)
International Hospital
21 Ekim 2013
Prenatal Hidronefroz
• ABD de yıllık 4 milyon gebelik ultrasonu yapılmakta
• Yakalanan konjenital anomali oranı: %1-2
• Yakalanan anomalilerin %50-75’ i Hidronefroz
• Bunların %70 i fizyolojik hidronefroz
![Page 8: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/8.jpg)
International Hospital
21 Ekim 2013
Prenatal Hidronefrozda Ayırıcı Tanı
Fizyolojik (70%)
UPJ obstrüksiyonu (39-64%)
Vezikoüreteral reflü (33%)
UVJ obstrüksiyonu (9-14%)
PUV (2-9%)
Üreterosel/ ektopik ureter
MKDB(4-25%)
Duplex sistem
Prenatal Dönemde Hidronefroz
![Page 9: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/9.jpg)
International Hospital
21 Ekim 2013
Obstrüksiyon
UP
J
PUV
UVJ
Korkutucu Dörtlü
Ureterocele
![Page 10: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/10.jpg)
International Hospital
21 Ekim 2013
Vezikoüreteral reflü
![Page 11: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/11.jpg)
International Hospital
21 Ekim 2013
Prenatal Hidronefrozlu Bebeğin Postnatal Değerlendirilmesi
Obstrüksiyon
Reflü Fizyolojik
Tedavi gerekli
Böbreği koru
Bebeği büyüt
Tedaviye gerek yok
Gereksiz girişimden kaçın
Prenatal US
![Page 12: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/12.jpg)
International Hospital
21 Ekim 2013
Prenatal Tanınmış UPJ Obstr
Pelvis
Pelvis
Böbrek
![Page 13: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/13.jpg)
International Hospital
21 Ekim 2013
Prenatal Tanınmış UPJ Obstr
Böbrek
Pelvis
U
US
R
L
![Page 14: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/14.jpg)
International Hospital
21 Ekim 2013
• Yucel S, Gungor F, Aydın F, Kabaalioglu A, Alimoglu E. “Postnatal follow-up of patients with prenatal hydronephrosis (143 cases). Annual Scientific Meeting of the European Society for Paediatric Nephrology, Birmingham, 2009
• Yucel S, Samuelson M, Nguyen M, Baker L. “Utility of short term retriviable double-J ureteral stenting in pediatric laparoscopic pyeloplasty?” J Urol;177: 720-725, (2007)
• Yucel S, Brown B, Bush NC, Ahmad N, Baker LA. : What to anticipate with experience in laparoscopic ablative renal surgery in children. J Urol. Feb;179(2):697-702, (2008)
• Yucel S, Erdogru T, Baykara M. “Transmesenterıc laparoscopic pyeloplasty ın children”. ESPU, Brugge, Belgium, 2007
• Baykara M, Erdogru T, Yucel S. “ Laparsocopic removal of rudimentary pelvic kidney with ectopic ureter to cytstic ejaculatory duct.” World Endourology Meeting, Cancun, 2007
Chertin B et al, 2006
![Page 15: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/15.jpg)
International Hospital
21 Ekim 2013
Prenatal Tanınmış UVJ Obstr
![Page 16: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/16.jpg)
International Hospital
21 Ekim 2013
Prenatal Tanınmış Üreterosel
![Page 17: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/17.jpg)
International Hospital
21 Ekim 2013
Prenatal Tanınmış PUV
Ablasyon öncesi
Ablasyon sonrası
![Page 18: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/18.jpg)
International Hospital
21 Ekim 2013
VUR
Endoskopik STING
>%85 Başarı
![Page 19: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/19.jpg)
International Hospital
21 Ekim 2013
VUR
• Simsek F, Yucel S, Aktas M, Turkeri L. “Ordinary Glass Sphere As An Alternative Injectable Material For Endoscopic Correction of Vesicoureteral
Reflux”. J Urol March: 171(3): 1282-6. (2004)
• Yucel S, Ucar M, Guntekin E, Kukul E, Melikoglu M, Baykara M. “The impact of ureteral orifice location on the efficacy of endoscopic injection to correct
vesicoureteral reflux.” BJU Int; 95: 1314-18 (2005)
• Yucel S, Snodgrass WT. “Predictive factors for successful endoscopic correction of vesicoureteral reflux” J Urol; 177: 1505-1509, (2007)
• Yucel S, Tarcan T, Sımsek F “Durability of a single successful endoscopic polytetrafluoroethylene injection for primary vesicoureteral reflux: 14-year
followup results.” J Urol;; 177: 720-725, (2007)
• : Yucel S, Akin Y, Celik O, Erdogru T, Baykara M. Endoscopic vesicoureteral
reflux correction in transplanted kidneys: does injection technique matter? J
Endourol. Oct;24(10):1661-4, (2010)
![Page 20: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/20.jpg)
International Hospital
21 Ekim 2013
Üriner Sistem Taşları
•İnsidans 1/ 1000 hastane başvurusu
•Başvuru yaşı: 1-15 yaş maksimum frekans 4 yaş
•Nüks oranı 7-54% ortalama interval 3-6 yıl
•Etyoloji
Anatomik 33%
Metabolik 33-50%
Idyopatik 30%
![Page 21: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/21.jpg)
International Hospital
21 Ekim 2013
Üriner Sistem Taşları
Kalsiyum (oksalat veya fosfat) 55 - 60%
Struvite ve Kalsiyum apatit 25 - 30%
Urik Asid 6 - 8%
Sistin 4 - 6%
4-6 mm arası taşlar > 90% spontan düşer Üreter alt uç taşlarında alfa blokör tedavi
pasajı hızlandırır
![Page 22: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/22.jpg)
International Hospital
21 Ekim 2013
Üriner Sistem Taşları
![Page 23: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/23.jpg)
International Hospital
21 Ekim 2013
Üriner Sistem Taşları Şok Dalgaları ile Taş Kırma (ESWL)
Çocuklarda anestezi veya sedo-analjezi
Çocuklarda yüksek başarı (>85%) Sistin taşlarında düşük başarı
![Page 24: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/24.jpg)
International Hospital
21 Ekim 2013
Üriner Sistem Taşları
Perkütan Nefrolitotomi
![Page 25: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/25.jpg)
International Hospital
21 Ekim 2013
Üriner Sistem Taşları
11.5 & 12.5 Fr Ureteroskop
6.9 Fr Ureteroskop
Kıvrılabilir Ureteroskop
Üreteroskopik litotripsi
![Page 26: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/26.jpg)
International Hospital
21 Ekim 2013
Üriner Sistem Taşları
![Page 27: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/27.jpg)
International Hospital
21 Ekim 2013
Üriner Sistem Taşları
Yucel S, Kefi A, Tan MO, Soygur T, Sarikaya S, Tekgul S. Factors
affecting complication rates of ureteroscopic lithotripsy in children:
results of multi-institutional retrospective analysis by pediatric stone
disease study group of Turkish pediatric urology society. J Urol.
Sep;186(3):1035-40. (2011)
Yucel S, Akin Y, Danisman, Guntekin E: Complications and
associated factors of pediatric extracorporeal shock wave
lithotripsy. J Urol; May(187), 1812-1816 (2012)
Yucel S, Akin Y, Kol A, Danisman A, Guntekin E Experience on
semirigid ureteroscopy and pneumatic lithotripsy in children at a
single center.. World J Urol. Oct 7. [Epub ahead of print] (2010)
![Page 28: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/28.jpg)
International Hospital
21 Ekim 2013
Çocuğun farkında ya da farkında olmadan idrar kaçırması ya da
çok sık tuvalete gitme isteğinin olması Çocuk Büyüdükçe Değişen Parametreler:
İşeme Sıklığı 30 kez(3. tm) 24 kez(1 ay) 12 kez (1 yaş) 9 kez (2-3 yaş)
Mesane ve İşenen Miktar Kapasitesi MK (ml)= 38 + 2.5 x yaş(ay) MK (ml)= [yaş (yıl) +2] x 30
Gündüz İdrar Kaçırma
![Page 29: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/29.jpg)
International Hospital
21 Ekim 2013
İşeme
Kasılı sfinktere bağlı olarak bakiye idrar
Yüksek basınçlı işeme
ve
kasılı sfinkter Dolum
Mesane kasılması ve
engelleyici olarak
sfinkter kasılması
![Page 30: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/30.jpg)
International Hospital
21 Ekim 2013
Gündüz İdrar kaçırma
Sınıflandırma:
Dolum Sırasındaki Disfonksiyon AşırıAktif Mesane/Urge (Aciliyet) Sendromu/Aciliyet İnkontinansı Fonksiyonel İdrar İnkontinansı Kıkırdama İnkontinansı
Boşaltım Sırasındaki Disfonksiyon Disfonksiyonel İşeme
Kesintili/İnişli Çıkışlı(Staccato) İşeme
İşeme Ertelemesi (Tembel Mesane) Hinman-Allen Sendromu
İşeme Sonrası Damlama
Disfonksiyonel Boşaltım Sendromu
![Page 31: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/31.jpg)
International Hospital
21 Ekim 2013
Kapalı sfinkter
Üroflowmetri ve Rezidiv İdrar Tayini
![Page 32: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/32.jpg)
International Hospital
21 Ekim 2013
Altı Islak Çocuğa Pratik Yaklaşım 5 yaş öncesi 5 yaş sonrası
fizik inceleme, İYE, USG
Normal Anormal Anormal
Normal
Takip İleri değerlendirme
Nadir işeme Sık ve az hacimli işeme
İşeme günlüğü
PVR
Yüksek Normal
Üroterapi
Antimuskaranik
Yanıt yok Yanıt var
Takip
![Page 33: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/33.jpg)
International Hospital
21 Ekim 2013
Tedavi:
Standart Uroterapi
Farmakoterapi
Temiz Aralıklı Kateterizasyon
Cerrahi Tedavi
•Çocuk-Ebeveyn Görüşmesi •Diyet-Sıvı Alımı •Barsak Tedavisi
•İşeme Eğitimi •Biyogeribesleme (Biofeedback)
•Nöromodülasyon/Akapunktur/Hipnoz/….
•Antimuskaranik tedavi
•Alfa Blokörler •İmipramin
•Psödoefedrin
•İşemenin kateterizasyon ile sağlanması •Bakiye idrarın atılması
•MK nin artırılması
![Page 34: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/34.jpg)
International Hospital
21 Ekim 2013
Ürodinami
![Page 35: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/35.jpg)
International Hospital
21 Ekim 2013
![Page 36: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/36.jpg)
International Hospital
21 Ekim 2013
• Yucel S, Ates M, Erdoğru T, Baykara M. “Dysfunctional elimination syndrome in three generations of one family: might it be hereditary ?” Urology ;64:1231. (2004)
• A21: Yucel S, Akkaya E, Guntekin E, Kukul E, Danışman A, Akman S, Baykara M. “Should we switch over to tolterodine in every child with non-neurogenic daytime urinary incontinence in whom oxybutynin failed.” Urology ;65:369-73. (2005)
• Yucel S, Akkaya E, Guntekin E, Kukul E, Akman S, Melikoğlu M, Baykara M. “Can alpha-blocker therapy be an alternative therapy to biofeedback in dysfunctional voiding and urinary retention: a prospective study.” J Urol ;174:1612-15. (2005)
• Yucel S, Erin N, Guntekin E. “The Role BDNF in Overactive Bladder in Children: Can It Predict the Response to Conservative Treatment ? American Academy of Pediatrics, San Francisco, 2007
![Page 37: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/37.jpg)
International Hospital
21 Ekim 2013
Yatağı Islak Çocuğa Pratik Yaklaşım
6 yaş öncesi 6 yaş sonrası
FM, İYE, AKŞ, Düşük dansite
Anormal
Normal
Takip İleri değerlendirme
Yüksek sıvı alımı ve idrar miktarı
Şiddetli gündüz yakınmaları
İşeme günlüğü
Konzervatif
Alarm
Yanıt yok
Desmopressin
Takip
Sıvı kısıtlaması ile idrar miktarı takibi
Normal
![Page 38: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/38.jpg)
International Hospital
21 Ekim 2013
Tedavi:
Konzervatif
Alarm tedavisi
Desmopressin
•Çocuk-Ebeveyn Görüşmesi •Diyet-Sıvı Alımı •Barsak Tedavisi
•İşeme Eğitimi •Ödüllendirme (Feedback yaklaşımları)
•Ebeveyn motivasyonu
•En az 12 hafta
•Ağızda eriyen pastil •Yatmadan 1 saat önce başlangıç 60 mcgr •Düşük dozda yanıtsızlık ileri tetkik
![Page 39: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/39.jpg)
International Hospital
21 Ekim 2013
• Yucel S, Celik O, Guntekin E. “Improvement in functional bladder capacity
may not be the sole factor to achieve night-time dryness ”. American
Urological Association Meeting, Anaheim,2007
• Yucel S, Kol A, Guntekin E, Baykara M. Anticholinergics do not improve cure
rate of alarm treatment of monosymptomatic nocturnal enuresis.Urology.
Mar;77(3):721-4, (2011)
• Yucel S, Kutlu O, Kukul E, Baykara M. “Impact of urodynamics in treatment of
primary nocturnal enuresis persisting into adulthood.” Urology ;64:1020-5.
(2004)
![Page 40: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/40.jpg)
International Hospital
21 Ekim 2013
Fimoz ve Sünnet
Sünnet derisi glansa yapışıktır
Smegma
sünnet derisini glanstan ayırır
![Page 41: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/41.jpg)
International Hospital
21 Ekim 2013
Çocuklarda Fimoz İnsidansı Yaş (Yıl) Fimoz (%)
> 1 100
2-3 75
3-5 10
6-7 8
8-11 6
12-13 3
14-17 1
(Oster, 1968; Walker, 1992)
![Page 42: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/42.jpg)
International Hospital
21 Ekim 2013
Fimoz ve Sünnet
![Page 43: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/43.jpg)
International Hospital
21 Ekim 2013
Fimoz ve Sünnet Sünnet Endikasyonları
• İki kezden fazla balanopostit enfeksiyonu • Proteus enfeksiyonu
• Balonlaşma – işeme güçlüğü
• Betametazon 0.05% günde üç kez 2 hafta boyunca yanıtsızlığı
• Parafimoz
![Page 44: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/44.jpg)
International Hospital
21 Ekim 2013
Fimoz ve Sünnet İYE: İyi 90% azalma
CTH:
GUD Orta Frengi, şankroid ve herpesde azalma
Üretrit Orta GU, klamidyada
azalma
Mantar Belirsiz
HPV Belirsiz
HIV İyi Belirgin azalma
Kanser İyi 3 kat azalma
Hastalık Öneri Bulgu
![Page 45: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/45.jpg)
International Hospital
21 Ekim 2013
Fimoz ve Sünnet Sünnet ne zaman ve nasıl ?
• Yenidoğan
• Yenidoğan sonrası – Genel anestezi – Sedoanaljezi (Amnezi)
– Klasik cerrahi yöntem
– İşlem sonrası penil blok
– Pansumansız takip
– 5 yaş sonrası önerisi sadece lokal anestezi planlanlarda
![Page 46: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/46.jpg)
International Hospital
21 Ekim 2013
Fimoz ve Sünnet
Komplikasyonlar
Adhezyonlar Geride sünnet derisi
Yeniden fimoz
Kist
Gömülü penis Cilt nekrozu Ampute penis
Üretral fistül
![Page 47: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/47.jpg)
International Hospital
21 Ekim 2013
Hipospadias
![Page 48: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/48.jpg)
International Hospital
21 Ekim 2013
Normal görünümlü bir glans ve meatus elde etmek olduğu kadar elastikiyeti ve patensi ile fonksiyonel bir tüp de elde etmek
Hipospadias onarımında amaç
![Page 49: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/49.jpg)
International Hospital
21 Ekim 2013
Eşlik Eden Hastalıklar
Kriptorşidizm veya İnguinal Herni en sık eşlik eden hastalıklardır. Radyolojik görüntüleme gereksizdir.
Çift taraflı palpe edilemeyen testislerle eşlik eden hipospadias %50 olasılıkla DSD dir
Tek taraflı ve palpe edilebilir kriptorşidizm ile beraberse %15 olasılıkla DSD dir.
Eşlik eden tek/çift taraflı palpe edilemeyen kriptorşidizmde KARYOTİPLEME YAPINIZ
![Page 50: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/50.jpg)
International Hospital
21 Ekim 2013
Zamanlama:
6-12 ay arası ideal Hormon manipülasyonu: Operasyon öncesi 3 ay boyunca i.m. veya pomad T (2 mg/kg) Hemostaz:
Turnike veya epinefrin. HİÇ KOTER KULLANMA!!! Optik Büyütme: MUTLAKA!!!
Sütür Teknikleri Dokuya az hasar ve su sızdırmaz teknik
Üretral kateter ve Pansuman: Tamamen tecrübeye göre değişir
Cerrahi Onarım Önerileri
![Page 51: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/51.jpg)
International Hospital
21 Ekim 2013
PRİMER HİPOSPADİAS ONARIMI
![Page 52: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/52.jpg)
International Hospital
21 Ekim 2013
KOMPLİKASYONLAR
Distal %5
Orta %25
Proksimal %50-75
•Meatal stenoz
•Fistül •Divertikül •BXO
•Glans/Tüp açılması •Darlık
•Üretrada kıl •Tekrarlayan penil eğrilik
•Enfeksiyon
•Kanama
6 AY BEKLE!!!!
![Page 53: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/53.jpg)
International Hospital
21 Ekim 2013
Eğri Penis
![Page 54: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/54.jpg)
International Hospital
21 Ekim 2013
Eğri Penis
Prepubertal onarım önemlidir
![Page 55: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/55.jpg)
International Hospital
21 Ekim 2013
Gömük Penis
Sünnet sonrası gelişir
Kilolu çocuklarda
Ventral penis derisi kısa olanlarda
![Page 56: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/56.jpg)
International Hospital
21 Ekim 2013
Gömük Penis
Post-op
Post-op
![Page 57: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/57.jpg)
International Hospital
21 Ekim 2013
• Yucel S, Guntekin E, Kukul E, Karagüzel G, Çitçioğlu A, Melikoğlu M, Baykara M. “Comparison of hypospadiac and normal preputial vascular anatomy.” J Urol .;172:1973-6. (2004)
• Yucel S, Sanli A, E, Kukul E, Melikoğlu M, Guntekin E “Midline dorsal plication to repair chordee in reoperation for hypospadias surgery complications.” J Urol ; 175: 699- 703 (2006)
• Snodgrass WT , Yucel S, “Tubularized urethral plate for midshaft and proximal hypospadias repair?” J Urol; 177: 698-702, (2007)
• Snodgrass W, Ziada A, Yucel S, Gupta A.: Comparison of outcomes of tubularized incised plate hypospadias repair and circumcision: a questionnaire-based survey of parents and surgeon. J Pediatr Urol. Aug;4(4):250-4, (2008)
• Bagrodia A, Yucel S, Baker LA. Staged Male Urethroplasty Transferring Megalourethra Tissue as Free Graft Dorsal Inlay to Proximal Urethral Atresia in VACTERL Association.Urology. 2011 May 19 [Epub ahead of print] (2011)
Penis Gelişimi ve Hastalıkları
![Page 58: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/58.jpg)
International Hospital
21 Ekim 2013
Labial Adhezyon
![Page 59: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/59.jpg)
International Hospital
21 Ekim 2013
Labial Adhezyon
• Sadece İYE varlığında ya da vajinal işeme varlığında patolojik
• 1 yıl içinde sponran düzelme %80
• Estradiol krem 0.01% günde üç kez 3 hafta
• Sonrasında betametazon 0.05% veya vazelin krem masaj
• Direçli olgularda manuel ayırma (işlem öncesi EMLA )
![Page 60: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/60.jpg)
International Hospital
21 Ekim 2013
Feminizan genitoplasti
![Page 61: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/61.jpg)
International Hospital
21 Ekim 2013
Feminizan genitoplasti
• Yucel S, Cavalcanti AG, Wang Z, Baskin LS. “The impact of prenatal androgens on vaginal and urogenital sinus development in the female Mouse”. J Urol. Oct;170(4 Pt 1):1432-6. (2003)
• Yucel S, Baskin LS. “An anatomical description of the male and female urethral sphincter complex”. J Urol May: 171(5): 1890-7. (2004)
• Yucel S, De Souza A Jr, Baskin LS. “Neuroanatomy of the human female lower urogenital tract.” J Urol .;172:191-5. (2004)
• Baskin LS, Yucel S, Cunha GR, Glickman S, Place NJ “A neuroanatomical comparison of humans ans Spotted Hyena, a natural animal model for common urogenital sinus: clinical reflections on feminizing genitoplasty.” J Urol ; 175: 276-83 (2006)
• Erman-Akar M, Ozkan O, Ozkan O, Yucel S, Dolay K, Ertugrul F, Bektas G Uterine preservation and vaginal reconstruction in a patient with congenital vaginal agenesis presenting with cyclic menouria. J Minim Invasive Gynecol. Sep-Oct;18(5):682-5. (2011)
![Page 62: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/62.jpg)
International Hospital
21 Ekim 2013
Şiş Skrotum
Epididimo-orşit Torsiyon
Tümör
Herni Hidrosel
Varikosel
![Page 63: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/63.jpg)
International Hospital
21 Ekim 2013
Şiş Skrotum
Hidrosel
Ağrısız doğumdan beri olan şişlik
Gece gündüz arasında şişlik farkı var
2 yaşa kadar düzelme olmazsa cerrahi
![Page 64: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/64.jpg)
International Hospital
21 Ekim 2013
Şiş Skrotum
Herni
Ağrısız doğumdan beri olan şişlik
Yatarken şişlik inguinal kanaldadır
Elektif onarım
![Page 65: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/65.jpg)
International Hospital
21 Ekim 2013
Şiş Skrotum
Varikosel
Testis hipotrofisi
Şiddetli varikosel Bilateral varikosel
Prepubertal onarım
Testis boyutu diğerini 1 yıl içinde yakalar
![Page 66: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/66.jpg)
International Hospital
21 Ekim 2013
Şiş Skrotum
Torsiyon
Ağrılı şişlik
Genellikle fizik aktivite sonrası İlk bir ay içinde ağrısız olabilir
Cinsel aktif olmayan her çocukta acil skrotal girişim gerektirir İlk 8-12 saat içinde testis kurtarılabilir Diğer testis mutlaka skrotuma sabitlenir
![Page 67: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/67.jpg)
International Hospital
21 Ekim 2013
Şiş Skrotum
Ağrılı şişlik
Genel enfeksiyon bulguları Virütik – bakteriyel
Cinsel aktivite ?
En sık karıştığı testis appendiks torsiyonu
Antibiyotik ve buz tedavisi
Akut epididimo-orşit
![Page 68: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/68.jpg)
International Hospital
21 Ekim 2013
Boş Skrotum
![Page 69: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/69.jpg)
International Hospital
21 Ekim 2013
Boş Skrotum
Palpe edilebilir testis ise 6 aylığa kadar inmesini bekle
İdeal tedavi 1 yaş (maksimum fertilite potansiyeli)
3 yaş altı testis muayenede elle iniyor ama hemen yukarı çıkıyor ise onarım (HCG nin kalıcı başarısı zayıf)
5-10 yaş arası elle rahat iniyor ama hemen ardından çıkıyor ise takip (HCG tedavisi denenebilir)
![Page 70: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/70.jpg)
International Hospital
21 Ekim 2013
Boş Skrotum
Palpe edilemeyen testis çift taraflı ise intersex ???
Palpe edilemeyen testis tek taraflı ise laparoskopi
Eğer testis atrofik şekilde skrotumda ya da abdomende ise mutlaka çıkartılmalı
![Page 71: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/71.jpg)
International Hospital
21 Ekim 2013
Boş Skrotum
•Yucel S, Ziada A, Harrison C, Wilcox D, Baker L, Snodgrass W:
Decision making during laparoscopic orchiopexy for intra-
abdominal testes near the internal ring. J Urol, 178; 1447-1450,
(2007)
•Snodgrass W, Yucel S, Ziada A: Scrotal exploration for
unilateral nonpalpable testis. J Urol, 178: 1718-1721, (2007)
•Yucel S, Celik O, Kol A, Baykara M, Guntekin E Initial pre-
scrotal approach for palpable cryptorchid testis: results during a
3-year period.. J Urol. Feb;185(2):669-72. (2011)
•Canpolat M, Yucel S, Sircan-Kucuksayan A, Kol A, Kazanci HO,
Denkceken T. Diagnosis of testicular torsion by measuring
attenuation of dual wavelengths in transmission geometry across
the testis: an experimental study in a rat model. Urology.
Apr;79(4):966.e9-966.e12. (2012)
![Page 72: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/72.jpg)
International Hospital
21 Ekim 2013
NÖROÜROLOJİ •Urge inkontinans
•Stress inkontinans
•İşeyememe
Spinal Kord Travmaları, Nöral Tüp Defektleri •Ağrılı işeme
•Tekrarlayan inatçı sistitler •Ağrılı pelvis sendromu
•Interstisyel sistitler
•Kronik prostatit
![Page 73: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/73.jpg)
International Hospital
21 Ekim 2013
NÖROÜROLOJİ
Urge İnkontinans
•Nörolojik nedenler (Parkinson, Alzheimer, SVO, pelvik cerrahi, spinal
cerrahi vs.)
•Vasküler nedenler (Atheroskleroz, Pelvik cerrahi, geçirilmiş kardiak cerrahi vs.)
•Hormonal nedenler (Menapoz,
Yaşlanan Erkek Sendromu vs.) •İatrojenik Nedenler ( Geçirilmiş pelvik Cerrahi, İnkontinans Cerrahisi, ürolojik cerrahi vs)
![Page 74: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/74.jpg)
International Hospital
21 Ekim 2013
NÖROÜROLOJİ
Stress / Total İnkontinans
•Kadın Tipi Stress İnkontinans
•Geçirilmiş Prostat Cerrahisi
•Extrofia vesika, female
epi/hipospadias veya Nöral tüp defektlerine bağlı
![Page 75: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/75.jpg)
International Hospital
21 Ekim 2013
NÖROÜROLOJİ
Stress / Total İnkontinans
![Page 76: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/76.jpg)
International Hospital
21 Ekim 2013
FONKSİYONEL VE REKONSTRUKTİF ÜROLOJİ
•Pelvik Taban ve Kadın Uretra Cerrahisi •Erkek Üretra Cerrahisi •Penil ve Genital Cerrahi
•Alt Üriner Sistem ve Kontinans Cerrahisi
![Page 77: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/77.jpg)
International Hospital
21 Ekim 2013
FONKSİYONEL VE REKONSTRUKTİF ÜROLOJİ
PELVİK TABAN ve URETRA CERRAHİSİ
![Page 78: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/78.jpg)
International Hospital
21 Ekim 2013
FONKSİYONEL VE REKONSTRUKTİF ÜROLOJİ
ERKEK URETRA CERRAHİSİ
![Page 79: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/79.jpg)
International Hospital
21 Ekim 2013
![Page 80: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/80.jpg)
International Hospital
21 Ekim 2013
![Page 81: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/81.jpg)
International Hospital
21 Ekim 2013
![Page 82: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/82.jpg)
International Hospital
21 Ekim 2013
FONKSİYONEL VE REKONSTRUKTİF ÜROLOJİ
PENİS VE GENİTALYA CERRAHİSİ
![Page 83: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/83.jpg)
International Hospital
21 Ekim 2013
FONKSİYONEL VE REKONSTRUKTİF ÜROLOJİ
PENİS VE GENİTALYA CERRAHİSİ
![Page 84: ÇOCUK ÜROLOJİSİ NÖROÜROLOJİ FONKSİYONEL VE …€¦ · • Immunologic Studies in Serum and Tissue in Prostate Cancer and BPH, Akdeniz University Project, Co-PI, Akdeniz Univ,](https://reader036.fdocuments.net/reader036/viewer/2022081407/604d667a1c2bac182d47e28c/html5/thumbnails/84.jpg)
International Hospital
21 Ekim 2013
FONKSİYONEL VE REKONSTRUKTİF ÜROLOJİ
KONTİNANS CERRAHİSİ