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If the pain does not disappear after the application of maximum treatment methods (including surgery and painkillers), a permanent reduction in pain can be achieved with the application of a pain pacemaker. Which patients need a pain pacemaker? 1- In spinal cord injuries due to spinal fractures 2- In untreated or inappropriate post-operative hernias with ongoing pain 3- In neuropathic pain due to diabetes 4- In spinal cord damage and edema due to cancer patients Treatment details Treatment time: test stimulation 1-2 hours, Insertion 30 minutes course of treatment We place a sensitive electrode directly on the spine with a minimally invasive procedure. Under local anesthesia, we keep in constant contact with you and position the electrode on the right area. We also check the position of the electrodes by x-ray. Starting from the spinal cord, nerves transmit impulses (stimulus) to the brain, thus preventing the spread of pain. In general, impulses are generated from these electrodes by means of an impulse generator similar to a pacemaker. As a result, the pain disappears and you feel a slight tingling in the pain area. However, in the method we use, there is no battery or cable under the skin. Thus, the patient does not experience any discomfort under the skin and there is no need for re-operation for the device whose battery is dead.

Vertebroplasty is a special interventional treatment method used for the fracture of the body part in the anterior part of the spine, damage due to cancer or for the treatment of some congenital vascular diseases. During the vertebroplasty procedure, a special chemical substance (bone cement) is injected into the damaged spinal bone, under local anesthesia and with radiological control, and the bone is strengthened. In which cases is vertebroplasty performed? Vertebroplasty is most commonly used for spinal fractures due to osteoporosis. Osteoporosis, popularly known as osteoporosis, reduces bone density, reduces the hardness of the bones and causes them to become more weak and brittle. In elderly patients, simple falls, impacts, and heavy lifting may cause fractures of the spine bones, which we call compression fractures. In the same way, vertebroplasty methods are used in diseases called cancer metastases, hemangioma and myeloma that cause bone loss. How is vertebroplasty done? Both procedures are not procedures that require general anesthesia, they can be performed with the help of local anesthesia and intravenous sedatives. In the prone position, the level of the patient's fracture is cleaned to be sterile, and the broken bone is visualized with a special imaging system called fluoroscopy. Radiologic control is performed continuously during the procedure. The skin does not need to be cut, just a skin incision a few millimeters long enough for the special needle to pass through. Under continuous radiological control, the needle is extended to the fracture site of the bone and then bone cement is injected through the needle. Depending on the type of application to be processed, it takes between 15 minutes and 30 minutes. Within a few minutes, the injected bone cement begins to harden inside the bone and completely sets within an hour. When does the pain go away? Pain disappears immediately after vertebroplasty and kyphoplasty. After the procedure, most patients do not even need to use pain relievers. What are the advantages? These treatment methods have extremely important advantages, especially in elderly patients, as they save the patient from problems such as bed rest for weeks or months, the difficulty of applications such as corsets and other health problems, and the difficulty in controlling long-term pain. Almost all of the patients treated with vertebroplasty methods state that 90% of the pain is cut like a knife.

IN WHICH PATIENTS IS THYROID SURGERY DONE? For patients with thyroid cancer. · Patients with suspected thyroid cancer. Thyroid surgery can be performed without cancer When the thyroid gland is enlarged and pressing on the surrounding structures In cases where the thyroid gland grows excessively and reaches a level that will disturb it externally. Thyroid surgery can be performed in patients with Graves' disease, where the thyroid gland is overworked, if the gland is large. HOW MUCH GLAND IS REMOVED IN THYROID SURGERY? How much of the gland will be removed during the operation, whether all or part of it will be removed, is decided by informing the patient before the operation, depending on the condition of the disease. In thyroid cancers, graves disease, and the presence of multiple nodules in both lobes, the entire thyroid tissue is usually removed. After proving that there is no cancer during surgery in unilaterally located thyroid nodules, unilateral thyroidectomy can be performed and the intact thyroid lobe can be left behind. All these possibilities are discussed in detail with the patient before the operation and decisions are made in this way. What kind of preparation is made before the operation? Many examinations were performed before the operation and the decision was made to operate in line with these examinations. Examinations before thyroid surgery: Thyroid Blood tests Thyroid ultrasonography (USG) Thyroid scintigraphy Removal of a thin needle from the thyroid nodule under USG guidance. After the decision for surgery is made with these tests, the general condition of the patient is checked, his blood pressure and heart rate, and whether he has any other diseases, and if possible, these diseases are tried to be corrected before the surgery. If it can't be corrected, it will be checked to see if it will hinder the surgery. Main examinations to be done after the decision of surgery Blood tests (such as thyroid hormones, sugar, urea and liver tests, blood count, bleeding time, hepatitis markers) heart graph Lung film Before the operation, it can be checked to see if there is a problem in the patient's vocal cords. The anesthesiologist, who will put the patient to sleep during the operation, sees the patient with all these tests and his/her file before the operation. In the meantime, be sure to tell your doctor about all your illnesses, medications you are using and any allergies you have. THINGS TO DO BEFORE THYROID SURGERY 1- All cigarettes, alcohol or addictive drugs should be stopped. 2- Since the operation will be performed under general anesthesia, after 12 o'clock at night, one should be completely fasted and nothing should be taken by mouth, including liquids. 3-We should consult our doctor about the drugs we are using, and if there are blood thinners in them, they should generally be discontinued 5-7 days before and instead, a subcutaneous injection should be used. If you have diabetes, you need to stop your diabetes medication and be treated with short-acting insulin. Only blood pressure medications should be taken with very little water on the morning of the day of surgery. 4-Take a shower in the morning of the day of surgery and do your personal cleaning. 5- After you have been adequately informed about the surgery, you must sign the consent form. If there is a point that you do not understand or you are confused about, you should ask your surgeon again and again. WHAT ARE THE CHARACTERISTICS OF THE SURGERY TO DO THYROID SURGERY? Thyroid surgery is an operation that requires a very fine surgical workmanship. Since the thyroid gland is located very close to many vital organs in the human neck, it requires a very good surgical workmanship in order not to damage these organs during the operation. The doctor who will perform the thyroid surgery should have done a lot of this surgery. It is not enough just to have had many of these surgeries; It is also important how many of his surgeries were unsuccessful. HOW LONG DOES THYROID SURGERY TAKE? The operation is performed in the operating room, usually under general anesthesia and very rarely local anesthesia. Although the duration of the operation varies according to the type of surgery to be performed, it usually takes 1.5-2.5 hours. A part or all of the thyroid gland is removed by making a necklace-shaped incision on the neck. After leaving the operating room, they stay in the recovery room for about an hour. HOW LONG DO I STAY IN THE HOSPITAL FOR THE SURGERY? If only thyroid surgery has been performed, it is usually 1-2 days. When can I start my job after the surgery? If there is no extra problem during or after the surgery, you will recover within 15-20 days and continue your normal life. WHAT COMPLAINTS MAY OCCUR IMMEDIATELY AFTER THE SURGERY? Since surgery is usually performed under general anesthesia, patients usually do not remember much about the operating room and recovery room. They remember what happened after they came to their room. In the meantime, there is a feeling of tiredness and exhaustion caused by general anesthesia. In addition, there may be pain at the surgery site. Apart from this, there may be some pain in your arm and back due to the thyroid surgery position. These pains are relieved with painkillers. General a

Liver Cyst What is liver hydatid cyst? Noting that special attention should be paid to hydatid cyst disease, which is common in Turkey due to the widespread use of animal husbandry and insufficient hygienic conditions, General surgery specialist and Organ Transplantation Center responsible Assoc. Dr. Fahri Yetişir gave information about the hydatid cyst of the liver, which can cause the death of patients. Liver hydatid cyst, popularly known as canine cyst, is caused by a parasite that passes from animal to human. It is a disease that cannot be transmitted from person to person. This disease is actually a completely benign disease caused by parasites. It does not cause cancer and does not become cancerous. Liver hydatid cyst can go away for a long time without any symptoms, or it can bring with it many problems, from jaundice, which gives signs and symptoms depending on the location and size of the liver, to fatal allergic reactions. How does the parasite find a breeding ground? The parasite that causes liver hydatid disease needs predatory animals such as dogs, jackals and wolves, and small cattle and cattle, which we call grass buds, in its life cycle. mature parasite; It lives in the intestines of animals such as wolves, jackals and dogs. The eggs of the parasite are thrown out with the feces of these predators. When small cattle and cattle eat contaminated food (grass, water..), the eggs pass into their intestines and maggots are released in the intestines, mix with the bloodstream and settle in different parts of the body, most often in the liver, and gradually grow into cysts. These cysts contain thousands of worms that will cause parasites. Then, after the diseased organs (containing these cysts) are eaten by animals such as wolves, jackals and dogs, the parasite reaches their intestines again, where it develops and becomes an adult parasite. In other words, the parasite needs such a cycle to reproduce. How does it appear in humans? If the substances contaminated by the parasite's eggs (food, water…) are taken by people orally, the eggs open in the intestines and the parasite that comes out of it also often forms cysts in humans to settle in the liver. Can liver hydatid disease be transmitted from person to person? Liver hydatid disease is not transmitted from person to person. There are no parasites or eggs in human feces. How does the disease develop? Although this disease can be seen all over the human body, 75-80% of it settles in the liver. Regardless of the event, a cyst filled with a pressurized fluid that grows and grows at the site of the parasite is formed. Does the disease cause damage to the liver? Generally, liver cells continue to function as they push the liver tissue to make room for itself, but depending on the location and size of the liver, it may impair liver functions. What kind of complaints does liver hydatid cyst cause? How does it reveal itself? There may be one or more cysts in the liver. Small cysts usually do not cause complaints. The disease is usually revealed on ultrasound and tomography performed for other reasons. Larger cysts present with complaints such as pain and fullness on the right side. Sometimes the cysts may come with jaundice by pressing on the bile ducts, or if these cysts become infected, they may cause complaints such as fever and abdominal pain. What happens if the cyst is left alone? It usually grows larger and can spread to neighboring organs. Obstruction in the liver and other adjacent organs can cause perforation and structural deformations. Their emergence increases the risks that complicate the fight against the disease. Therefore, when we detect this disease, we should make a treatment program immediately. If the hydatid cyst disease is not treated, it can lead to serious problems. "If the cyst is ruptured by any impact, severe allergic reactions may occur, which may lead to respiratory arrest. Again, with the rupture of the cyst, the parasite may spread to the entire peritoneum and sometimes lead to abdominal hydatidosis, which cannot be fully cured. The contents of the cyst are infected. This condition can be fatal, especially in elderly patients. The cyst may open into one of the main bile ducts, which can be fatal even in young and healthy individuals, or cause jaundice by blocking the bile ducts. Finally, the cyst presses on the main vascular structures at the entrance of the liver can cause life-threatening problems Treatment of liver cysthidatic Treatment of liver hydatid cyst is a team effort. These patients should be evaluated very well before starting the treatment. The standard treatment for the disease is surgery. The surgical method, on the other hand, is determined by variables such as the size of the cyst, its location in the liver, its number, and whether there are complications. The stage of the cyst is also very important when choosing these treatment options. In appropriate cases, needle aspiration and laparoscopic (door surgeries) can be successfully applied. if m

Where Is The Parathyroid Gland And What Function Does It Have? The parathyroid glands usually consist of 4 glands, two on each side of the neck, close to the thyroid gland. Their size is usually 3-4 mm, as well as the size of a lentil. They are usually located on the posterior side of the thyroid, near the vein that feeds the thyroid and the nerve that stimulates the vocal cords. Sometimes they can progress to the inside of the rib cage. The parathyroid glands produce a hormone that is essential for the body, called parathyroid hormone. One of the main tasks of this hormone is to ensure a balanced distribution of calcium minaret in the body. The function of the parathyroid homonym: Thanks to the parathyroid hormone secreted from the parathyroid glands, it ensures that the blood calcium level is kept within certain limits and therefore the nerves and muscles, heart, kidneys and bones function normally. In order to achieve this, it activates vitamin D and ensures the absorption of calcium from the intestines, the release of calcium from the bones and the retention of calcium from the kidneys. Diseases of the parathyroid gland Excessive secretion of parathyroid hormone is called hyperparathyroidism. These: primary hyperparathyroidism, secondary hyperparathyroidism It is classified as efferent hyperparathyroidism. Primary Hyperparathyroidism: It is the most common parathyroid disease. The most common cause of primary hyperparathyroidism is parathyroid adenoma, the second most common in 80%, parathyroid hyperplasia, and very rarely, cancer of the parathyroid gland. (Parathyroid Adenoma): It is the enlargement of one of the parathyroid glands or, in rare cases, more than one gland, working more than necessary. While there is disease in one gland in approximately 85% or more cases, adenoma in more than one gland or enlargement in all four glands may be found in 15% of cases. It is 2 times more common in women than men. When the parathyroid gland works overtime and too much parathyroid hormone is secreted, calcium dissolution from the bone increases and the amount of calcium in the blood also increases. As a result of excessive secretion of parathyroid hormone, the calcium in the bones is dissolved and given to the blood, bone resorption occurs, bone pains and bone cavities filled with blood, called "brown tumors" in the bones, and eventually bone fractures occur even in simple movements without a pathological blow. As a result of high blood calcium level, it collapses in the kidneys and causes kidney stones and kidney damage. Again, high blood calcium levels cause ulcers and gastritis in the stomach and duodenum, constipation and nausea, muscle weakness, hypertension and psychiatric disorders (such as depression, mood disorders). Parathyroid gland hyperplasia: It is a condition that is usually seen in kidney patients and where four of the 4 glands are overworked. In the treatment of this, 4 glands are laid out and either three and a half glands are removed, half of a gland is preserved, or 4 glands are removed and half of one gland is transplanted. Parathyroid gland cancer: It is a very rare disease, its treatment is neck dissection in which the parathyroid tissue is removed along with the surrounding porous tissues. Clinical Symptoms: Pain in bones, osteoporosis (bone loss) and fractures, recurrent kidney stones, urinating a lot Nausea, loss of appetite, ulcer, constipation and pancreatitis in the stomach and intestinal tract Weakness in the muscles, premature fatigue Fatigue, difficulty concentrating, memory problems are seen. Cardiac manifestations are hypertension, bradycardia (decreased pulse rate), decreased QT interval, and left ventricular hypertrophy. Some of these symptoms may not have even been noticed by the patient, or they may have been thought to be due to other causes; emerges upon detailed inquiry. Tests required for diagnosis: Blood calcium level: The patient's blood calcium level and albumin level are measured together or the ionized calcium level is measured. Hypercalcemia is diagnosed when the blood calcium is high at least twice (Because the calcium may be high due to technical mistakes made while drawing blood). Although the normal value of blood calcium varies from laboratory to laboratory, it is usually between 8.5-10.5 mg/dl and ionized calcium is between 1.13-1.32 mmol/L. The blood calcium (Ca) level is related to the albumin level. Corrected calcium level = Measured total Ca + [0.8 x (4.0 – albumin level)] When the calcium level is found to be at least twice as high, other tests should be done. The first examination is to measure the level of parathyroid hormone (intact PTH). If serum calcium is high and parathyroid hormone level is high, the diagnosis of primary hyperparathyroidism is made. 24-hour urine excretion in the urine should be checked, because familial benign hypercalcemia should be eliminated in the diagnosis. In these patients, 24-hour urinary calcium excretion is lower than normal. This FHD disease is very, very rare. Hypercalcemia due to lithium (a drug usually given in manic-depressive illness) should also be considered in the differential diagnosis. Vitamin D levels in the blood should also be checked. When vitamin D is low, parathormone may be secreted too much to increase it. in blood

The 2-year-old syndrome is a special period in which some problems are encountered during the transition from infancy to childhood. It usually starts around 18 months, which usually coincides with the period when babies start walking and move independently and continues until the child is around 3-3.5 years old. The 2-year-old syndrome is one of the periods when parents have the most difficulty in child development. The main problems faced during this period are: • "I will do it" attachments, insistence on requests, disobedience, doing the opposite of what is requested, jealousy, meticulousness, obsessions and shyness • Appetite problems • Disorders in sleep patterns, not wanting to go to bed • tantrums; parents- hitting, biting, hurting children; banging one's head, throwing oneself to the ground, crying nonstop • Toilet problems The first thing that parents who observe the symptoms of 2-year-old syndrome in their child should know is that these behaviors are a periodic attitude and that the problems can be solved before long. During this period, it is recommended that parents act carefully and calmly and draw the child's attention in different directions in times of conflict. It should not be forgotten that young children should be allowed to explore, mix and experience, provided that they do not harm themselves and the environment. The self and personality formations of children raised in this way are healthier and they can become more self-confident individuals.

Involuntary bedwetting at night is defined as Enuresis Nocturna in children over the age of 5 who do not have congenital or acquired central nervous system problems. It is one of the most common urinary system problems of childhood. Bedwetting is divided into two groups as Simple and Complicated. In simple bedwetting, there are no symptoms other than incontinence to bed at night. In complicated bedwetting, symptoms such as sudden urgency during the daytime, frequent urination, daytime urinary incontinence and chronic constipation are the threshold, apart from nocturnal urinary incontinence. If no nighttime urine control has been achieved since birth, this Primary Enuresis is defined as Secondary Enuresis if it starts again after a dry period longer than 6 months. Why Do Kids Soot? Genetic factors, waking disorders, hormonal factors and bladder (urinary bladder) related factors are responsible for simple bedwetting, which is more common. While the incidence of this problem is 77% in a child who has bedwetting problems in both parents during childhood, this frequency is 46% in a child whose single parent has bedwetting. -Waking Disorders: Families of children with bedwetting problems often mention that their child has difficulty waking up. However, studies have shown that the sleep depth of these children is not different from other children. Most of these children wake up after urinating. However, the main problem in these children is that they do not perceive that their bladder is full. This is a developmental delay and this condition improves with age. - Low bladder capacity: The urinary bladder capacity, which should normally increase at night, was found to be low in children who wet the bed. In addition, some of these children were found to have involuntary contractions in the urinary bladder muscle. - Increased amount of urine at night: Insufficient production of the hormone called Antidiuretic hormone (ADH), which is responsible for regulating urine production, can cause bedwetting. Urinary tract infections: These children may also have problems such as frequent urination and burning while urinating. -Diabetes: It should definitely be investigated, especially in the secondary type. Diabetes without diabetes: In this disease, called Diabetes Insiputus, there is a deficiency of the hormone that controls urine production. -Anatomical problems of the urinary tract -Hyperthyroidism -Sleep apnea syndrome -Psychological reasons -Genetic causes What are the Treatment Methods: 1. Supportive Treatment: Liquid intake should be restricted two hours before going to bed in the evening. If there is a constipation problem, it should be resolved It should be ensured that he goes to the toilet regularly every 2-3 hours during the day. It should be ensured that he sits in the appropriate position on the toilet and his feet are on the ground. If necessary, steps should be placed under their feet. Must go to the toilet before going to sleep. Wake up to urinate 2 hours after sleeping. · Cloth should never be tied The child should actively participate in changing, cleaning and changing the sheets after urinary incontinence. · Punishment should not be given Wet and dry nights can be noted on the calendar to increase motivation. 2.Alarm Treatment: It is an effective treatment especially in children with waking problems. When the child leaks urine, the alarm will sound and he will get used to waking up at that time. It is a method that requires the harmony of the family and should be applied for at least 6-8 weeks to decide on its success. If a response is obtained, treatment should be continued for 6 months. 3. Drug Treatment: Some drugs can be used to reduce the amount of urine at night. It should definitely be used under the supervision of a doctor and following the rules of use.

Swine flu is a respiratory disease caused by type A influenza viruses, often seen in the winter months, and can show itself with the same symptoms as seasonal flu. Influenza viruses are divided into types A, B, and C according to their antigenic structures. Influenza C virus is a rare agent that mostly causes upper respiratory tract disease. Influenza A and B are virus types responsible for epidemics. Why Is It Called Swine Flu? The reason why H1N1 is called swine flu is that the virus is very similar to the virus that causes flu in pigs and is a mutated form of this virus. As a result of this mutation, the virus gained the ability to pass from pig to human and cause disease. How is it found? The H1N1 virus is transmitted from person to person through droplets, but the role of surfaces in transmission should not be neglected. The virus can survive outside the body for 2 hours. Contamination can occur even if the person touches their eyes, nose and mouth after touching surfaces such as tables, door handles, toys that contain large amounts of virus. Post-infection period of the virus (incubation period) is 1-4 days. 24-48 hours after the onset of the disease is the period when the contagiousness is highest, then it may decrease and last for up to a week. What should be done to be protected? The disease is most common in January-March. For this reason, the American Pediatric Association recommends that children between the ages of 6 months and 5 years be vaccinated in October-November. Patients with risk factors (such as going to a nursery, having a brother or sister going to a nursery, having diseases such as asthma, heart disease, diabetes, chronic lung disease, innate immune system deficiency) should especially be vaccinated. The vaccine is not administered to infants under 6 months of age. If it is to be done for the first time, it is recommended to do it 2 times with 1 month intervals, and to continue as a single dose in the following years. Up to 3 years of age, half dose is applied, and after 3 years of age, full dose is applied. In addition to getting vaccinated, some precautions should also be taken to prevent children from catching the flu. Keeping children away from sick people, Covering your face with the inside of your arm when coughing or sneezing Frequent hand washing Not to be in closed, crowded environments during the months when flu is common, Eating a balanced diet rich in vitamin C Regular sports are other precautions that can be taken. Is there a cure for the H1N1 flu? Antibiotics have no place in the treatment of the flu. Fluid intake is very important during the illness. Therefore, water, juice and decaffeinated beverages are recommended. Drinking enough fluids helps the secretions in the sinuses and chest to accumulate less and be cleared from the body more easily. Painkillers can be used to relieve symptoms such as fever and muscle pain in the treatment of flu, antiviral drugs that your doctor deems appropriate can also be used in cases of serious illness, but cold medications should not be used, especially in children under the age of 6. If the child's condition worsens following the flu symptoms, fever, chills, chest pain, rapid breathing, sweating, green or bloody sputum, bruising on the lips or nails, the nearest health institution should be consulted.

Constipation is not just the inability to poop. Hard poop or inability to empty the poop is also an indication of constipation. In constipation, there is constant poop in the rectum. Accumulated poop adds weight, pelvic floor muscles work harder to carry this load and get tired. The pelvic floor muscles, which are constantly contracted, cannot relax after a while. The pelvic floor muscles that cannot relax also prevent the evacuation of poop. The poop that stays inside hardens, and then it becomes more difficult to remove. If we want to get rid of constipation, we need to break this cycle. In poop incontinence, there can be 3 scenarios that affect the pelvic floor. In the first, the pelvic floor muscles are very weak and cannot hold the poop. Urinary incontinence may not always be seen because poop is much heavier than urine, so it requires more force to hold it. In this case, strengthening the pelvic floor muscles will solve the problem. In the latter, the pelvic floor muscles are overactive. Overactive pelvic floor muscles are very tired because they are constantly active. After a while, it becomes unable to bear the weight of the poop, and poop incontinence develops. In the third, the pelvic floor muscles are dyssynergic. When he needs to push the poop, he can't push it, he contracts. This prevents the poop from being emptied. The poop that accumulates in the rectum, which is the last part of the intestine, becomes hard, the soft poop that comes later leaks through these hard poops and the child poops. With pelvic floor rehabilitation and healthy bladder and bowel training, all these pelvic floor disorders can be corrected, constipation and incontinence can be prevented.

How will you help your child make the most of every single poop visit to the toilet? Have your child: Try pooping every day after breakfast and dinner. Especially in the morning after eating, the urge to poop is stronger. The gastrocolic reflex is one of a series of physiological reflexes that control the motility of the gastrointestinal tract. This reflex causes the urge to defecate after eating. The small intestine exhibits a similar motility response. The gastrocolic reflex's function of sending available intestinal contents through the digestive tract helps lead to digested food. For this reason, efforts to sit down and poop after meals may be more successful. Try sitting on the toilet for a full 5 minutes. Children “I don't have to go to the toilet!” They don't want to sit on the toilet. You can set a timer and have your child stop for 5 minutes. Sitting with a favorite book or toy or watching a video can help keep them motivated. Your child may poop very little at first. But still let it sit for 5 minutes. Over time they will poop more. Have him lean forward while pooping. In addition, the child's feet should be firmly on the ground, and the knees should be positioned higher than the bottom. The child should lean forward slightly, put their elbows on their knees, and have rounded shoulders but a straight spine. Proper poop position is pretty simple and can make a big difference. In this position, you can put the rectum in a vertical position so that gravity helps your child. This stretches the abdominal cavity, causing it to pump into the rectum for emptying of the colon. Blow into your hands as if you are inflating a balloon. The child will relax and will be able to evacuate more easily. Sit on the toilet stool so that your feet touch the floor. The human body was created to squat and poop. Thanks to the toilet positioner stool, the required squatting position is provided. Younger children should sit on the toilet seat. Thus, they can discharge more comfortably and more.

The exstrophy-epispadias complex is a serious congenital abnormality with many variations. It is the condition that can be observed immediately after birth, where the bladder and related structures protrude through an opening in the abdominal wall instead of inside the body. It varies depending on which structures constitute the problem. The most severe is cloacal exstrophy, involving the urethra, bladder, and intestines. In classical bladder exstrophy, the abnormality is related to the abdominal wall, bladder, genitals, and urethra. The mildest is epispadias (external genital organ development disorder), which is an opening in the urinary tract. The true cause of bladder exstrophy has not yet been clarified. A determining risk factor or the presence of agents to cause this condition could not be determined. The incidence of this problem in children of patients with exstrophy-epispadias complex is 1 in 70. Observation of exstrophy in twins is accepted as evidence of genetic effect. However, since the rate of co-occurrence in identical twins is less than 100%, he states that environmental factors are among the risk factors. Classical bladder exstrophy occurs in approximately 4 out of 100,000 live births. 1 in 117,000 cases of male epispadias, The case of female epispadias is seen in 1 in 484,000. Cloacal exstrophy is a disease that occurs in every 200,000-400,000 births. Classic cases of bladder exstrophy or epispadias rarely lead to death. Survival rates after surgical treatment are very high. However, while the urinary retention rate is 75-90% in single-stage treatment, this rate may be lower than 25% in several-stage surgical treatment. More than one procedure may be required to improve the urinary retention function of these patients. Many patients may feel the need to perform clean intermittent catheterization. After successful surgical operations in men, reproductive function can continue into adult life. However, the use of assisted reproductive techniques may be required. Women with exstrophy can also experience a normal pregnancy process. However, female patients should inform their doctors about exstrophy treatment and delivery should be by cesarean section in order to avoid pelvic floor traumas. Bladder exstrophy can also be detected by prenatal ultrasonography. The bladder should be protected by using special materials at birth. Each time the child is changed, the bladder should be carefully rinsed with a special solution. And the protective material must be replaced again. A general examination should be performed to observe other congenital abnormalities. There may be undetected female epispadia. This condition can also manifest itself in the form of urinary incontinence during childhood. Aims in the treatment of classical bladder exstrophy; 1) The bladder must be closed in a way that will protect kidney function and ensure urine retention. 2) To create a functional and cosmetically acceptable sexual organ. The surgical treatment of classical bladder exstrophy can be performed with two different methods. The first method consists of multiple surgical procedures spread over several years. In the first surgery, the bladder is closed to allow it to hold the urine. However, this procedure can be done if the bladder is large enough. The bladder is placed in the pelvis and the abdominal wall is closed. Then a series of surgeries are required to reconstruct the urinary tract and genitals. These surgeries are usually performed before the child is 2 years old. The reconstruction of the bladder neck is performed around the age of 5 years. In this way, the child is provided with the opportunity to control the urine. The second method is the restructuring of the bladder, urinary tract and genitals in the early period after the child is born. all done at once. After these surgeries, kidney functions are usually restored. However, in some cases, kidney stone problems may occur in the long term. Kidney infections and varying degrees of urinary incontinence may also occur. Exstrophy-epispadias syndrome is a complex abnormality. While the treatment is performed with the surgical procedure, a lifelong follow-up process begins. Patients and their relatives should be informed in detail about all stages of the disease, the treatment procedure and possible complications and success rates after treatment. Before the patient is taken into surgery, it is important that the relatives of the patient are aware of the urinary tract to be reconstructed, the risks and the benefits of the surgery. However, it is also necessary for the relatives of the patients to know and accept that they should take responsibility for the daily care of the patient.

In fact, this problem is much more common than anticipated worldwide and affects almost half of men aged 40-70 to varying degrees. Most common sexual dysfunctions in men Sexual dysfunctions in men are often seen as inability to achieve an erection and premature ejaculation. Apart from this, we also encounter sexual dysfunctions caused by some congenital structural problems of the penis. hardening problem The hardening of the penis, which we call an erection, is a complex event in which many vascular, nervous, structural and psychological factors play a role. In order for an erection to occur, all of these main structures must work in a healthy and harmonious way. We can describe the problem of erection in the penis as the inability to achieve an erection at a level that will sustain sexual intercourse. Of course, this situation must also be permanent. In fact, this problem is much more common worldwide than anticipated and affects almost half of men aged 40-70 to varying degrees. What are the conditions that increase the risk of contracting this disease? In fact, obesity, diabetes, disorders in blood fat values, lack of exercise and smoking are the most important causes of cardiovascular diseases. Apart from this, hormonal disorders are also seen as a result of decrease in male hormone with age, drugs, psychological problems, stress and surgical interventions. Men with these diseases should be aware that they may encounter erection problems over time. Treatment The severity of the disease determines the treatment and the mode of treatment after the underlying disease is revealed. As urologists, we generally deal with its treatment in several steps. The person should be informed about his condition together with his partner. Especially in correctable situations such as hormonal disorders, the erection problem usually improves with the correction of the underlying hormonal imbalance. It is necessary to make lifestyle changes such as weight loss, quitting smoking, and regular exercise. Then, medical treatments are tried in the first step according to the patient's condition. Here, drugs that are commonly known in the community and that are oral phosphodiesterase inhibitors are given. Depending on the treatment response, it is decided to continue using these drugs or to use different drugs. In the second step of the treatment, vacuum devices, drug injections into the penis or drugs applied into the urinary canal or the penile skin are tried. In patients who do not benefit from these methods, it is now necessary to switch to penile prosthesis applications with surgical intervention. Penile prostheses Penile prosthesis applications are started in patients who do not respond to drugs and now want a permanent treatment. In general, there are two types of penile prosthesis. One of them is the permanent hard prosthesis, which we call malleable penile prosthesis, and the other group is penile prostheses with inflatable parts (2 or 3 parts). Which should be preferred? There are many factors that determine this. These are economic reasons, patient preference, and the patient's condition. Inflatable penile prostheses are actually more suitable for normal prostheses. However, they are more costly and are not usually covered by insurance due to economic implications in health. In addition, the patient's inability to use his hands, for example, is an obstacle to the application of this prosthesis. In addition, this operation is a more complex operation. Some mechanical problems in the prosthesis and complications related to surgery are more common. Permanently hard prosthesis applications are a much simpler application. However, this prosthesis can cause cosmetic problems in patients. Our hospital is one of the largest and most advanced 3rd step treatment centers in our country with its physician and technological infrastructure. In our hospital, laparoscopic and robotic all kinds of minimally invasive surgical methods are performed. All kinds of urological diagnosis and treatment procedures related to adult and pediatric urology are performed in our clinic. Our hospital is one of the few centers in our country that has the Da Vinci Robotic System.