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JANUARY: THE CERVIX CANCER AWARENESS MONTH
The number of women prevented from dying from cervical cancer in a country is directly proportional to the development of that country in terms of health services and the value given to women. It was proven that deaths rates due to cervix cancer which originates from the cervix may be significantly reduced through early diagnosis by screening methods. Therefore, our Ministry manages to carry out Cervix Cancer screening programs included in comprehensive healthcare programs. January has been designated as Cervical Cancer Awareness Month, and Awareness events are held in many countries of the world in order to draw attention to the disease. In our country, these awareness activities are held in all our provinces, and our people are informed about this issue and our screening programs are introduced.

Why is Cervix Cancer Important?
• Cervix cancer is preventable.
• Cervical cancer is 100% curable if detected earlier.
• Death from cervical cancer is completely preventable.
Risk factors:
If you are a woman with following features, you may have a higher risk for cervix cancer.
• If you are over 30 years of age and have untreated Human papilloma Virus (HPV) and/or any sexually transmitted infection. (HPV is a common sexually transmitted virus that may cause at least six types of cancer including cervical cancer.)
• If you have started active sexual life earlier (before 16 years of age) If you have multiple sex partners.
• If you do not have regular cervix screening.
• If you smoke.
• If you have a dietary habit with less fruits and vegetables.
• If you have a history of using birth control pills for a long time (more than 5 years).
• If you have an impaired immune system (i.e. Human Immune Deficiency Virus/HIV)
• If you are over-weighted or obese.
• If you have a close relative such as a sister or mother with cervix cancer.
• If you have been exposed to diethylstilbestrol (DES) before birth.

Symptoms: Changes that develop in the cervix before cancer are usually asymptomatic; however, they may be detected in the early period with pelvic examination, Pap test and HPV tests. If you have any of the following symptoms, immediately refer to a healthcare professional:
• If you have an increased or unusual type of discharge from the vagina
• If pain is observed in the back, legs or in the area of the female genitals
• If tiredness, weight loss, and loss of appetite develop
• If there is swelling on one leg or both legs
• If pain is observed during urination
• If mild blood discharge in spotting form beyond normal menstruation period
• If you have longer or severe menstrual bleeding
• If bleeding or pain is observed during or after sexual intercourse
• If bleeding is observed after menopause

Early Diagnosis
Cervical cancer which may be treated fully with screening and early diagnosis is among the causes of death from cancer today. Cervical cancer is the most common disease associated with HPV. Almost all cervical cancers develop due to HPV infection. HPV also causes genital and oral cavity cancers both in men and women. Detection of HPV facilitates the diagnosis of cancer by indicating the precancerous changes in the cervix in the early period. Two screening tests which have been developed to help prevent or detect cervical cancer early are commonly used today.
• A Pap test (or Pap smear) is based on looking for precancerous conditions (cell changes in the cervix) that may develop into cervical cancer if not treated properly.
• On the other hand HPV test is a test based on the detection of the virus (human papilloma virus) that may cause these cellular changes in cervical cells.
• Both tests are extremely simple and painless procedures which may be performed at the same time.

Cervical cancer is defined by the World Health Organization (WHO) as a “preventable cause of death”. Therefore, it is recommended that this dangerous but preventable cancer should be screened all over the world and each country should establish its own control policy. In accordance with the national cancer screening program implemented in our country, HPV and Pap Test are implemented to women between 30 and 65 years of age in line with our screening standards every 5 years. When the first test result is evaluated as “no disease”, namely, if the HPV test is negative or the Pap-smear pathology report is normal, the person is informed. According to the HPV test, they are informed that they do not have the virus causing s cervical cancer, and according to the Pap-smear test, there are no cancer precursor cells in the swab sample collected. These results do not guarantee that there is no cervical cancer or that it will never appear in the future. The person is invited to be screened for cervical cancer again after 5 years. Positive cases are sent to our diagnostic centers for further examination.

Where may Screening tests be Performed?
In our country, cervical cancer screenings are carried out FREE of charge at Cancer Early Diagnosis, Screening and Training Centers (KETEM), Family Health Centers (ASM), Community Health Centers (TSM) and Healthy Life Centers (SHM).
Cancer screenings continue by taking the necessary precautions in line with the Infection Control Measures Guidelines in the COVID-19 pandemic prepared by our Ministry and the Scientific Committee.

Treatment
• The cervical cancer is treated by surgery, radiation and chemotherapy. These treatment options may be prescribed individually or in combination with each other, depending on the patient’s condition and needs.
• The treatment is associated with cancer stage, type of tumor cells, and your medical condition.

Protection
Cervical cancer is highly preventable due to the availability of effective screening tests and vaccine to prevent Human Papilloma Virus (HPV) infections as of today. When detected early, cervical cancer is highly treatable and associated with long-term survival and good quality of life. Issues to be considered for protection may be summarized as follows:
• There are vaccines developed against the most cancer-causing types of HPV with higher protection. The World Health Organization recommends girls between 9 and 14 years of age to be vaccinated against cervix cancer.
• To have regular screening tests from 30 years of age.
• Training about safe sexual intercourse.
• Use of condom during sexual intercourse.
• Circumcision of men.
• Avoiding smoking.
• A diet which is rich in vegetables and fruits.


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The Results Are Amusing

The condition that occurs with different clinical pictures in people who have been infected with COVID-19 is called post-COVID-19 syndrome or “prolonged COVID-19”.

Elderly people and people with many serious medical conditions are most likely to experience symptoms of COVID-19, but even young and healthy people can experience symptoms weeks or months after getting an infection. Especially, Tiredness, shortness of breath, cough, joint pain, chest pain, muscle pain or headache, fast or heavy heartbeat, loss of smell or taste, memory, concentration or sleep problems, rash or hair loss, stress syndrome, depression and anxiety.

COVID-19 may damage all organs. This organ damage can increase the risk of long-term health problems. Major organs that may be affected by COVID-19: Imaging tests performed months after recovery from COVID-19 have shown that even people who experience only mild symptoms of COVID-19 can have permanent damage at their heart muscle. This can increase the risk of heart failure or other heart complications in the future. COVID-19 can often cause long-term damage to the small air sacs (alveoli) in the lungs. The resulting scar tissue can cause respiratory problems in the long-term.

COVID-19 can cause diseases such as paralysis, seizures, and temporary paralysis.

COVID-19 may also increase the risk of developing Parkinson’s and Alzheimer’s disease.

COVID-19 can increase the possibility of coagulation. While large clots can lead to heart attacks and strokes, it is stated that most of the heart damage caused by COVID-19 is caused by very small clots that block small blood vessels in the heart muscle.

The lungs, legs, liver, and kidneys are other parts of the body that are affected by clots. On the other hand, COVID-19 can weaken blood vessels. This can cause long-term problems in the liver and kidneys. We started rehabilitation and antioxidant treatment after Covid-19 infection in our hospital’s FTR clinic. The results are amusing.


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Breast Cancer which is seen among the women both in our country and world commonly, and the most common cause of death, arises with the uncontrolled cell proliferation in the breast tissue. Breast cancer is observed in the men more less frequently (less than 1% of all breast cancers) compared to women. The breast cancer is among the first ten most common cancers both in the world and our country. Breast cancer continues to be one of every 4 women’s cancers in our country. While the incidence of breast cancer is 47.8 per hundred thousand worldwide, it is 86.4 for Northern European countries, 43.0 for East Asia, 90.3 for the United States and 47.7 for our country.

Approximately 19.000 women are diagnosed as breast cancer in a year in our country. Breast cancer which was diagnosed at a further stage in the past, it can be diagnosed at an early stage by the effect of the screening programs carried out by our ministry and an increase in our early diagnosis rates can be achieved.

Breast cancers detected in the early stages are more successful in their treatment and their quality of life increases significantly. Because of that reason it is possible to detect cancer development at an early stage and to reduce the death rate due to breast cancer in women before clinical findings appear, in case of a possible cancer development in our women, through community-based screenings.

In our country community-based cancer screening has started by establishing Cancer Early Diagnosis, Screening and Education Centers (KETEM) then Family Health Centers (ASM) and Healthy Life Centers (SHM) are included to these screening program. Our people are being served free of charge by means of screening programs in accordance with European Union Quality Standards and our state-of-the-art digital mammography devices at the centers mentioned above. Public training and Self-Breast Examination are being given and brochure distribution is being done in these centers.

In our National Cancer Control Program; protection and prevention programs as well as the screening strategies, awareness raising activities of the public are carried out effectively.

Our women must be informed about risk factors, symptoms, diagnosis and treatment methods of breast cancer and they should be guided to healthy living conditions that will prevent cancer.

PROTECTION

As in all cancer types; the risk of breast cancer can be reduced by consuming foods rich in vegetables and fruits and prepared under appropriate conditions, establishing healthy eating habits, increasing physical activity, maintaining a healthy weight, avoiding smoking and alcohol use. It can be learned whether you are at a healthy weight by consulting your family doctor. Since there are many studies showing that breastfeeding protects against breast cancer, it is recommended that all mothers breastfeed their babies for at least 2 years.

Lifestyle-related and modifiable risk factors for breast cancer are as follows:

  • Being overweight and obese
  • Not doing physical activity (having a sedentary lifestyle)
  • Have never given birth or have had their first birth after age of 30
  • Using birth control pills and injection
  • Having hormone treatment after menopause
  • Having alcohol: In particular, consumption of more than 1 glass of alcohol (1 beer, 1 glass of wine, 1 double hard alcoholic beverage) per day increases the risk more.

Risk factors that cannot be changed for the breast cancer are as follows:

  • Being a woman: Breast cancer is 100 times more common in women than men.
  • Getting older: As age increases, the risk of breast cancer increases.
  • Having certain inherited genes (especially BRCA1, BRCA2)
  • Having breast cancer history in the family: Having breast cancer in first-degree relatives (mother, sister, daughter) doubles the risk. It is important to note that the majority of women with breast cancer (about 8 out of 10) do not have a family history of breast cancer.
  • Having cancer at one breast of the person: This case increases the risk of cancer at the other breast or at the other parts of the same breast.
  • Having an intense breast tissue.
  • Presence of benign formations (such as fibroadenoma) in the breast
  • Early menstruation (especially before the age of 12)
  • Menopause after age of 55
  • Having radiotherapy to breast.

SYMPTOMS OF BREAST CANCER

Knowing how your breasts normally look and feel is an important part of breast health. Diagnosing the breast cancer early provides a successful chance for the treatment. But knowing what to look for cannot substitute for regular mammograms and other screening tests. Screening tests help to diagnose the breast cancer in its early stages before any symptoms appear. The most common symptom of breast cancer; is the palpation and feeling of a painless, growing lump (mass) in the breast. In addition, the following symptoms can also be seen in breast cancer, whether there is a palpable lump (mass) or not:

  • Swelling of all or part of one breast (even if you can feel a distinct lump)
  • Pain at the breast or tit
  • Inflammatory condition with itching and inflammation on the breast skin (eczema)
  • Inverted nipple
  • Orange peel appearance at the breast
  • Irritation of breast skin
  • Unilateral nipple discharge (especially bloody discharge)
  • Swelling in part or all of the breast, change in breast shape
  • Rubescence, crusting, thickening of the breast or nipple skin
  • A lump (mass) in the armpit, sometimes before a lump in the breast is felt, cancer can cause swelling or a lump in the armpit or around the collarbone.

Although any of these symptoms can be caused by conditions other than breast cancer, it’s advised to be examined to a general surgeon to find the cause, when the listed symptoms are seen.

DIAGNOSIS:

            Breast cancer may not show any symptoms until it reaches advanced stages. Because of that reason, since the above symptoms are not sufficient to make a diagnosis, it is necessary to apply to the nearest health centers. Early diagnosis of breast cancer increases the chances of success in treatment and survival. For this reason, it is recommended that all women between the ages of 40-69 have a mammogram every 2 years. The most important factor in early diagnosis, the awareness of the person on this issue, the easy acceptance of the applied method by women, the success of screening methods with having few side effects, easy application, free and economical. The following methods are taught and applied to women in our screening centers, especially for early diagnosis.

BREAST SELF-EXAMINATION:

BSE is an examination method that women can easily perform at home at any time. In order to use BSE, it is necessary to receive adequate training on this subject and to apply what has been learned continuously, regularly and periodically. It is sufficient to apply to our centers to receive training.

Women should do breast self-examination every month after 20 years old. During the examination it is checked whether the image of both breasts is symmetrical by standing in front of the mirror. Nipple and skin collapse or recession, skin redness and edema are examined. With this examination, tumors close to the skin and nipples can be noticed by the woman herself at an early stage. A woman who examines herself regularly can distinguish a newly developing mass, a recession or discoloration of the breast skin or nipple, and an asymmetrical appearance. The masses that are suspicious of cancer are harder than other breast tissue (walnut-like), with indistinct borders, limited movement and usually painless. A woman who notices a mass in her breast should immediately consult her doctor. In addition, she should go to a doctor for a breast examination every two years.

Clinical Breast Examination:

            Women between the ages of 40-69 should do a breast self-exam once a month and go to the doctor for a breast exam once a year.

Taking a Mammogram:

Between 40-69 years old; It is performed for early diagnosis of breast cancer in women without complaints. It has performed every 2 years. During the scan, a standard film is taken for both breasts in two positions, one mediolateral oblique (MLO) and the other craniocaudal (CC). More comfortable service is offered to our women with the digital mammography devices used today.

Treatment:

The treatment of each patient differs; Multiple factors such as the location of the disease, the stage of the disease, the age of the patient and the presence of other health problems are effective in the decision of the treatment. Different treatment options such as surgery, radiation therapy (radiotherapy) and drug therapy (chemotherapy) are applied in breast cancer. You can access documents for breast cancer and other cancers from the Cancer Department’s Web site and be directed to the nearest screening center by using the “Which Screening is Right for Me?” link.


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Breastfeeding:

It has proved that 99% of the mothers have the breast milk sufficient for two babies. If you are experiencing breastfeeding problem; either the baby may be sick, the mother may be sick, or the breastfeeding technic is wrong. There is not any other reason than that. Contrary to the popular belief breastfeeding problems can be solved easily. The rumor on my milk is low or my milk is of poor quality etc. are not true. Not being able to breastfeed or not to breastfeed is a disease, not a normal situation. When you have a problem about breastfeeding, apply to your physician. There may be conditions such as underlying infection, breast cancer, etc. You must breastfeed at different positions. Compared to breastfed babies, the risk of heart disease, diabetes risk, blood cancer risk, sudden infant death risk, obesity risk, pneumonia risk, middle ear infection risk, asthma/allergy risk, severe diarrhea, and the risk of diarrhea for a long time, the risk of psychiatric disease, the risk of breaking ties with the mother, the risk of chronic intestinal inflammation (crohn’s disease), the risk of celiac disease for the babies grown with formula are higher. As they are frequently sick and have a risk of having chronic diseases, they have a shorter life expectancy. Their IQ scores are lower than the others. It has been identified by the economic research that they will have lower income in busines life. When the breastfeeding and no-breastfeeding mothers have been compared, the risk of getting pregnant, anemia, breast cancer and ovarian cancer is higher than the breastfeeding mother. Since the babies delivered cesarian section do not encounter vaginal environment, their immune systems are not prepared like normal babies, and they start life 1-0. The only way to achieve the equality is breastfeeding. If the breastfeeding is applied, equality is achieved within 2 months.

How long should I breastfeed?

Babies born on time and prematurely are given only breast milk for the first 6 months. Breastfeeding should be continued up to 2-3 years old. The baby who takes only breast milk for the first 6 months should not be given water even in the hottest weather because 80% of the mother’s milk is water. In the newborn period (first 30 days), infants are not given herbal tea, sugary water and pacifiers. Breastfeeding up to the age of two is vital. Breastfeeding can be stopped at the age of 1.5 years with the decision of the doctor.

How often should I breastfeed?

0-1 Month: Daytime; at least 12 times (every 2 hours), should be breastfed as much as the baby wants, Night; setting alarm at 2-3 hours.

1-3 Months: Daytime; at least 8 times (every 3 hours), should be breastfed as much as the baby wants, Night; setting alarm at 2-3 hours.

3-6 Months: Daytime; at least 8 times (every 3 hours), should be breastfed as much as the baby wants, Night; when the baby gets up. There is no need to wake the baby up.

When and Which breast should I breastfeed?

Do not switch to the other breast until one breast is empty. Start the next feed from the last breast at the previous feed. The contents of the beginning, middle and end of breast milk are different from each other, so you should breastfeed until your breast is empty.

How can I understand my breast is empty?

You can feel the difference at the beginning and end of breastfeeding by touching the milk flow stops by itself, the baby stops sucking, the baby’s swallowing sound and movements change, you do not see milk in the baby’s mouth or lips. These are signs that your breast is emptying. If your baby has stopped sucking and if you feel that your breast is not fully emptied, and it has not been more than 1-2 hours, start breastfeeding from the breast from which was in the previous breastfeeding.

How can I understand the breastfeeding is true?

If the lips of the baby are curved inwards, there is a smacking sound, there is no swallowing-swallowing sound, the cheeks collapse, the baby fights with the breast while breastfeeding, if you still feel tickling-pain 1 minute after you start breastfeeding, you are breastfeeding incorrectly. Put your little finger in the baby’s mouth and remove your breast, never pull it out. Then open the mouth of the baby by pulling the chin and push your breast into the mouth of the baby (do not pull the baby to you) and allow the baby to take the brown ring behind the nipple. When the nipple touches the palate, the baby is locked to the breast and start to suck even the baby is not hungry. Stimulate sucking by occasionally waking up, pressing under the chin, touching the corner of the mouth while breastfeeding.

How do I know if I have enough milk?

If your baby urinates 4 or mor times in a day and gains 20 grams (30 grams if the baby was born before 37 weeks) daily, your milk is sufficient.

What should I do to increase my milk?

If you eat this way your breastmilk will increase. Daily: 3 liters of water should be drunk daily by measuring with a bottle. Yoghurt: 2-3 water glass. Cheese: size of 2 matchboxes. Egg: 1 pc. Meat: 2 portions. Meat-fish-chicken, one of the three. Spicy-deli products are not recommended. Legumes; 4 days a week: 1 portion legumes (dry beans, chickpeas, kidney beans, lentils). Fresh vegetables/salad: 3 portions. Fruit: 2 portions. Bread: 4-6 slices. Whole wheat bread is recommended. Rice, bulgur, and pasta: 1 portion. Oil: up to 1 teaspoon per bowl. Olive oil and butter are recommended. Nuts: 2 walnut, 5 hazelnuts, 5 almonds, 10 raisins. Tea: Not to exceed 1 tea glass per day. Coffee: not consumed every day. It will not exceed 2-3 cups per week. 1 small chocolate. Herbal teas: not recommended, it may cause allergy for the baby. Milk-increasing tea/medicine: Not recommended unless prescribed by a physician. it may cause allergy for the baby.

I can’t wake my baby, is this normal?

All babies, especially babies that were born cesarian section, may have difficulty waking up in the first week. If you can breastfeed 20-30 minutes every 2 hours and there are not any additional complaints, this is a normal situation. Babies can sleep up to 16-18 hours a day in the first month. You must stimulate the baby when the baby falls asleep. You should push below the chin or push around the lips. If the baby sleeps so much that you cannot breastfeed for 20 minutes every 2-3 hours, you should bring the baby to the pediatrician control.

How long should I burp after breastfeeding?

The main reason of burping application is providing time for the milk to pass from the stomach ton intestines. Otherwise the baby will vomit and the milk may leak into the lungs. After breastfeeding, keep the baby upright on your shoulder for 10-15 minutes and allow the baby to burp. At this time, stomach of the baby will also be emptied. There may be occasional vomiting while burping, it is normal if there is no additional complaint.

How long can I store the milk?

You can store the milk 3 hours in the ambient temperature, 3 days in the door shelf unit of the refrigerator and 3 weeks in the freezing unit of the refrigerator and 3 months in the deepfreeze. Frozen milk is melted in the warm water. Melted milk is not re-frozen, remaining amount is discharged.

I am pregnant during breastfeeding; do I need to stop breastfeeding?

No, breastfeeding does not cause preterm deliver and hurt the other baby. Do not stop breastfeeding. Your milk may decrease due to the pregnancy, it is normal.

ATTİLA ALP GÖZÜBÜYÜK M.D.

PEDIATRICIAN


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Both the urethra passes through the prostate and during ejaculation, semen empties into the urethra and comes out of the urethra.

Lateral Section of Male Urogenital System

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The prostate is an essential organ like our eyes and ears, being only in men, and is at the exit of the urinary bladder, just below the urinary bladder and in front of the rectum (last part of the large intestine). Its main function is related to reproduction and it is a gland of 18-20 grams about the size of a walnut. Both the urinary canal (urethra) and the semen excretory ducts pass through it. The semen passes through the prostate and is eliminated into the urethra.

The importance of the prostate is due to the fact that it secretes a large part of the liquid called semen and that there are some substances in this liquid that give activity and mobility to the sperm and protect the sperm. Approximately 5-10% of the semen that comes out with ejaculation is composed of sperm cells, the remainder is composed of fluids from other glands (Seminal gland, Prostate and Bulbourethral gland) and which keep the sperm alive in the female reproductive organs. If there is a problem in prostate secretion, sperm movements and vitality will be impaired, so there may be a problem in conceiving a child, it might cause infertility.

The prostate enlarges in most of the men with aging, generally outward growth and inward growth, i.e. condensation of the urethra, the larger the prostate, the more difficult it is to urinate. When the prostate rises above its normal size, it does not follow similar path in every man. In some men, there is an enlargement of the urethra passing through the prostate, however, in some men there is an enlargement into the bladder. In this type of enlargement, while the prostate appears slightly enlarged on ultrasound images, serious complaints might occur in the patient. In cases where the prostate enlarges outward, if the urethra is not condensated, the patient does not complain the same even though the prostate is very large. When evaluating the prostate in male patients, we do not only look at its enlargement in volume, but mainly at the level of condensation of the urinary tract and difficulty in urination. The patient might have an outwardly enlarged prostate, if he has no difficulty in urination, and if the urinary tests and cancer screening tests are normal, the patient is usually monitored at 6-month intervals. Complaints about Prostate Enlargement:

  • A frequent need to pee,
  • Straining to pee,
  • Needing to get up frequently in the night to pee,
  • Needing to pee urgently, leaking urine,
  • Having the weak flow of of urine,
  • Not being able to pee at all
  • Swelling of the bladder

Getting a Diagnose of Prostate Enlargement

The diagnosis of prostate enlargement is get by blood and urine tests, ultrasonography, urine flow test (uroflow) and tests that are not disturb the patient in any way.

If the patient has persistent higher PSA despite antibiotic and anti-inflammatory treatment, if a nodule is identified in the prostate during rectal examination or ultrasound examination, it is certained whether there is a possible prostate cancer by performing a Multi-Parametric Prostate MRI examination and, if necessary, a Prostate Needle Biopsy under the guidance of Transrectal Prostate Ultrasound.

Because the treatment of benign prostate enlargement (BPH: Benign Prostatic Hyperplasia) is different, the treatment of prostate enlargement is different due to prostate cancer.

Both BPH and prostate cancer might be carried on one patient. Treatment might be diffirent according to condensation of urethra or stage of the disease. It is recommended that every man over the age of 40, whether or not they have urinary problems, need to visit a Urologist at least once a year for a prostate examination and PSA test. These check-ups are important, especially in people having prostate cancer in their first-degree relatives (father, brother). Because men having relatives with prostate cancer the risk of developing prostate cancer is 2-6 times higher than other men.

Benign Prostatic Hyperplasia Treatment (BPH)

BPH treatment divided into two groups as medical treatment and surgical treatment

In BPH treatment first aproach of treatment need to be medical treatment. Other treatments need to applied when medical treatment fails.

Purpose of drugs treatment, is to relieve the flow of urine, the drug groups used for this purpose and briefly their mechanisms of strenghts are as follows:

1-    Alpha Blockers:

Drugs in this group increase the urine flow rate by relaxing the smooth muscles in the bladder outlet and prostatic urethra, i.e, they provide more comfortable urination. (Tamsulosin, Terazosin, Alfuzosin, Silodosin, Doxazosin)

Since these drugs also relax smooth abdominal muscles, they cause hypotension.

Most known side effects:

1- Orthostatic Hypotension (Sudden drop in the blood pressure and darkening when sudden standing up, therefore it is recommended to stand up slowly)

2- Retrograde ejaculation (the semen cannot be eliminated, one has an orgasm, but because the bladder outlet is loosened, the semen is empjeculated into the bladder and then excreted from the urine)

3-Drugs that cause a decrease in prostate volume act by inhibiting alpha reductase and preventing the transformation of testosterone to di-hydro testosterone. (Drugs with active ingredients are Finasderid, Dutasteride)

4- A plant extract, sabal extract, is also sometimes used in medical treatment.

5- If urinary infection is identified, appropriate antibiotic treatment is administered according to the results of the culture-antibiogram test.

Surgical treatment are administered when medical treatment is not enough.This methods are followed as briefly:

Open Prostatectomy

Transurethral resection (TUR) is done with bipolar energy, plasmokinetics energy or monopolar energy

Laser Enucleation applied transurethrally is done with HOLEP-Holmium Laser.

Transurethrally applied Laser Vaporization is done with Vaporization-KTP, Diode, Thulium Laser

The most recently administered treatment; Transperineal Prostate Laser Ablation Treatment. In this method, we administer laser directly into the prostate with fine needles, painlessly placing laser fiber tips into the prostate without any surgery. Since it is administered with local anesthesia, it is safely administered to elderly patients with severe disease. This practice has been started in our clinic.

It is also possible to treat prostate cancer with this method. Cancerous cells that are get early and have not metastasis beyond the prostate are treated much more easily by laser burning than other treatment methods.

In other treatment methods of prostate cancer, the entire prostate (neoplasm and cortex) is removed together with the seminal sacs. This procedure is called Radical Prostatectomy. The procedure is applied with one of the Open Surgery, Robotic Surgery, Laparoscopic Surgery methods. Depending on the pathology result, other treatments such as radiotherapy, hormonal therapy and chemotherapy are applied if necessary.

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Endoscopic View Of Enlargement Prostate

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TUR Prostatectomy Schematic View

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Laser Prostatik Vaporizasyon (Buharlaştırma) şematik görünüm

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Lazer Vaporizasyon sonrası prostatik üretranın endoskopik görünümü



The best treatment method is EDSWT in men who have erectil dysfunction.

EDSWT (ERECTIL DISFONCTION SHOCK WAVE THERAPY) : is a treatment that has no surgery, anesthesia, hospitilization, painless, needing aproaximetly 45 minutes, administering with a special device penis and around the penis.

It has two methods that applied:

  1. Electrical shock waves formed by the piezo-electric system
  2. Magnetic shock waves formed by the Electro-Magnetic system

In our hospital EDSWT theraphy is applied with NOVAMEDTEK brand device (Novamed ED60), which creates magnetic shock waves, with a linear applicator

It is administered 6 clinics, totally, twice a week for 3 weeks. (ex: Monday- Friday)

In every clinic a total of 3000 shock waves are given to the penis and its circumference by making 7500 shock wave shots from each focus in 4 foci.

A total of 18,000 shots are made in 6 sessions.

Addition to EDSWT theraphy PRP theraphy is recommended and supported with medical treatment. 3 months later, patient come for checking and if it is necessary 1 more EDSWT and PRP treatments cure are applied.

The main problem in Erectile Dysfunction is the consentating of the veins coming to the penis due to various reasons and therefore the erection problem as a result of the inability of sufficient blood go to the erection bodies of the penis for erection.

Erectile Dysfunction is seen more often in one who is over 40 year-old, has diabet, prostate disease, get Radical Prostatectomy operation because of prostate cancer, undergo radiotherapy to pelvic area, has hypercholesterolemic, hypertension, cardiac trouble and vascular disease, smokes and drinks alchol, is obese, has psychological problems.

EDSWT is a new theraphy method developed for erectile dysfunction, which is seen approximately 50% of over 40 year-old men.

In the scientific researches, has been proven that the magnetic shock waves made by the Novamed ED 60 device treats the insulted vascular internal structure and form new microveins (NEOENDOTELIZATION and ANGIOGENESIS) through stem cells, therefore increasing  the blood flow in the penis and treating the main cause of the erection dysfunction.

Erection Dysfunction is more successfull when it is applied with EDSWT theraphy and PRP  theraphy and medical theraphy

PRP (PLATELET Rich Plasma), is a plasma fluid getting from one’s own blood.

Approximately 5 cc of PRP liquid is get by treating 15cc of blood taken from one with the help of the filters and centrifuge in the disposable PRP kit. There are intensely platelets and growth factors (PDGF, VEGF, TGF-alpha and TGF-beta) in the PRP fluid. PRP fluid is given to the erectile bodies of the penis (Corpus Cavernosum = Cavernous Body) with an insulin injector needle. When PRP liquid is injected into the diseased area, it repairs this area, heals tissue, neoplasm, and rejevunates the stem cells in these tissues. However, PRP treatment is not directly a STEM CELL treatment.

In the reaction problem that occur due to organic reasons, the occlusion of the capillaries in the penis, cell death due to aging, called apoptosis, increasing collage tissue instead of dying cells, development of fibrosis, the erection function and elasticity of the penis are destroyed. The capillaries in the cavernous bodies that provide hardening are decreased. And smooth muscles are replaced by hard, inelastic hard fibrotic tissues. Therefore, the hardening of the penis and its ability to maintain its hardness is destroyed.

Injecting the PRP liquid into the cavernous body providing erection of the penis, providing new veins, providing erection (ANGIOGENESIS), regeneration of tissues, (REGENERATION) and rejuvenation.

In erectile dysfunction, PRP theraphy is applied once in two days, totally 3 clinics. Maintenance therapy as a single dose at 3, 6 and 12 months increases efficacy.

In erectile dysfunction treatment both EDSWT and PRP are effective methods. Scientific researchs show that treatment is more efficent when these two methods is applied together.

First, by applying ESWT treatment, micro-traumatic, stimulating areas are made in the cavernous bodies with shock waves, and the platelets start to repair this area and start the new vein formation process.

PRP fluid, on the other hand, repairs the damaged areas in the cavernous body with higher efficiency, since it is a fluid enriched with platelets (thrombocyte) with the procedures performed.

For this reason, in the treatment of Erectile Dysfunction, we achieve the most effective treatment results with PRP application at the end of EDSWT application.



Urology is the brach of medicine that examines urinary system of women and men and genital system of men.

Urınary system: is a sytem that formed with kidney, urethrea, bladder, ureter

Urethrea is approaximetly 3-5 centimetres. It is between bladder and the end of the vagina. In men it is between tip of penis and bladder, It is approaximetly 20-25 centimetres. It goes through end of the baldder and continues in the penis.

The branch of urology gets a diagnose and treats diseases of urinary system of men and women, also genital system of men (penis and testicles).

The branch of urology, besides open surgeries, also performs closed surgeries based on modern technological methods such as endoscopy and laporoscopy. We can classify these attempts as follows.

  1. ANDROLOGY ( Treatment and Diagnosis of Sexual Dysfunctions of Men)
  • Men Interfility
  • Erectil Dysfunciton, Medical and Interventional Treatment (EDSWT- Shockwave Therapy- PRP Therapy),
  • Premature Ejeculation
  • Maleformation in penis and curvature ( Peyronie’s disease)
  • Varicocele (varicose veins in the testicle) surgical and medical treatments (Treatment of varicocele with MICROSURGERY using intraoperative doppler under microscopic vision)

2.Endoüroloji

  • Kidney, ureter, bladder, disease of prostate, endoscopic (closed) surgeries and treatments.Böbrek, üreter, mesane, prostat hastalıkları (stone, tumor, stenosis)
  • Diagnostic Cystoscopy, ureterorenoscopy procedures
  • Ureteroscopic (closed) removal of kidney, ureter and bladder stones using laser (URS-RIRC)
  • Transrectal Prostate Guided Biopsy procedure with Fusion Biopsy technique in prostate diseases.
  • Endoscopic (closed) Prostatectomy operations with Laser or Bipolar system in prostate diseases
  • Laparoscopic kidney, bladder and prostate surgeries
  • Non-surgical prostate treatment using laser (Trans Perineal Laser Prostate Ablation Treatment TPLA)
  • Treatment of laser burning of the cancer applied without removing the prostate in prostate cancer (focal ablation in prostate cancer-organ preserving micro-invasive surgery)
  1. Woman Urology- Urogynecology
  • Medical and surgical treatments of incontinence
  • Bladder, rectum and uterine prolapse surgeries
  • TOT, TVT surgeries
  1. Urologic Oncology
  • Open and endoscopic (closed) surgeries and medical treatments of kidney, bladder, prostate, testicle tumors
  1. Pediatric Urology
  • Undescended testis
  • Medical and surgical treatments of hypospadias, vesicoureteral reflux, enuresis nocturna, enürezis nokturna, hydrocele, bubonocele, circumcision

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Hiccups and sneezing are very common in newborns.

Hiccups occur as a result of contraction of the diaphragm muscle, which separates the chest cavity from abdominal cavity. Vocal cords are pushed nearer during contraction, which results in the characteristic hiccup sound.

Occurring frequently in the first months of life and less frequently until the age of 1 year, hiccup is a natural reflex, indicating that the infant is full, and everything is normal with her stomach growing and digestive system developing normally. It can usually occur when the stomach is full after feeding, when she cannot pass gas properly, when she swallows air, at times of rapid temperature change and when she is excited. The common conception that “belly is growing” is not completely unfounded. Hiccups start as early as the fourth gestational month in the mother’s womb, as the first respiratory action and hiccups after parturition help the development of heart and lungs. Hiccups are usually not a source of discomfort for infants, but are surely bothersome for parents. When the infant is unable to fall asleep due to hiccups, making her swallow may eliminate the spasm of the diaphragm muscle. If it persists, rub your finger on a lemon and have your infant taste it. Such unfamiliar and sour taste will cause a shock, making her hold her breath for a few seconds which may resolve the diaphragm spasm and cure the hiccups.

Sneezing, especially when it happens after bathing your baby, may cause concern that the baby may have gotten cold. You might be compelled to turn up the heater to make it extra warm in the apartment, putting on layers over layers of extra clothing to keep her warm, putting a hat on her head, which would in turn make the air dryer in the apartment. Dry air dehydrates the mucosa in the airways causing cracks, and microbes may contaminate these cracks causing illness. And the culprit would be falsely identified as “the baby got cold after bathing.” Which in turn compels the mother to bath the bay once a week during winter months to avoid illness. Getting cold is not a cause of illness; but microbes are. And sneezing is an indication that her tiny nose is clogged up and a reflex to help her unclog it. Infants’ tiny nostrils can get blocked very easily, causing difficulty breathing and nursing, as the baby must breathe through the nose when feeding. A few years back, I had received a phone call from a postpartum mother: “Nurse Ayşe, I had attended one of your seminars, and I had not problems beginning breastfeeding. But for the past two days, my baby is not taking my nipple. I have plenty of milk, and he advised I should harvest my breast milk and feed it using a baby bottle. But she won’t take the baby bottle also, so we are feeding her with a spoon.” I asked them to come for a visit, thinking that perhaps they were doing something wrong so I could try assisting her with breastfeeding the baby. When they showed up, I could tell from the way the baby was breathing that her nose was clogged up.

I applied a few drops of saline into her nose and cleaned her nose with a nasal aspirator. After that, the boor thing began breastfeeding and did not stop for nearly an hour! As you can imagine, infants are unable to clean nasal secretions like we can, and so mucus dries and crusts blocking the nose especially in winter months. And they might reach by sneezing even when someone opens the door and comes inside, as their tiny and sensitive noses can be easily blocked with the dirt and dust of this new world. Therefore, I would recommend cleaning her nose frequently with saline and a nasal aspirator to help her breathe and breastfeed easily. Because they are in lying position most of the time and nasal secretions flow back into the nasal passage, she may sometimes breathe noisily. Don’t be alarmed with the wheezing sound. They cannot clear their throat, like we can, by coughing away the secretions, and in this case also, saline can help eliminate the wheezing sound. If she has sniffles, however, it may be important, as the Eustachian tube has a large opening into the nasal passage while the tube itself is short. And because the infant is usually lying on her back, sniffles may increase the secretions which may flow into this canal and cling on the walls, providing an attractive spot for microbes and bacteria to grow, leading to an ear infection. Ear infections require attention in young infants. Because the ear is very close to the brain, inflammation may spread to the meninx, leading to meningitis. By applying nasal lavage with saline around the clock will prevent the secretion to become thicker, turning to a greenish color, and cling on the ear canal. Also, it may be advisable to place a pillow to raise her head a bit to help the secretion flow downward, and not toward the ear canal. You might notice some mucus in her stool during this time, but it is nothing to worry about; nasal secretion is also excreted in feces.


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It is a type of convulsion which is accompanied by fever. It is the most common type of childhood convulsions. It is usually seen in children aged 6 months to 5 years, and most frequently in the 18-22 month old age group. Familial inheritance is suspected.
Convulsion may manifest with loss of consciousness, eyes rolling back, blue lips, stopping breathing, muscle contractions in all or some parts of the body and urinary or fecal incontinence. Body temperature rises to 38.5°C or higher before or after convulsion.
Febrile convulsion usually lasts short, in most cases lasting for less than 3 minutes and ending by the time a doctor is consulted. In a quarter of patients, the first sign of fever may be febrile convulsion.
Convulsions lasting less than 15 minutes and not recurring within 24 hours are classified as simple convulsion.

Recurrence Risk of Seizures
• Experiencing the first febrile convulsion at less than one year of age
• History of epilepsy or febrile convulsion in first-degree relatives
• Having frequent infections
• Convulsion occurring at slightly higher body temperature (less than 40°C)
• Time between rising body temperature and convulsion is less than 2 hours
• Warnings for family members:
• Febrile convulsion may involve familial predisposition
• Febrile convulsion is not an epileptic seizure
• Risk of recurrence is lower after three years of age
• Short-lasting febrile convulsions do not cause brain damage
• Vaccination is not a risk factor

Febrile Convulsion May Recur at a Rate of 1/3, in which case:
• Lay the patient on a flat surface on their side
• Do not attempt to restrain the patient
• Do not attempt to open the jaw, arms and legs during the convulsions
• Do not feed anything orally
• Do not have the patient smell onions or other substances
• Do not pour cold water on the patient; however, a warm shower may be useful.



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Last update date: 19.04.2022, 21:30