İskemik priapizm patofizyolojik zemininde testosteron uygulamalarının tedavideki rolü
The role of testosterone application in treatment on the base of ischemic priapism
Yazar: CİHAT TEKTAŞ
Danışman: YRD. DOÇ. DR. FATİH FIRDOLAŞ
Fırat Üniversitesi / Tıp Fakültesi / Üroloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2013
Konu: Üroloji = Urology
Dizin: Apoptozis = Apoptosis ; Penis ereksiyonu = Penile erection ; Priapizm = Priapism ; Testosteron = Testosterone

Özet:
Priapizm, cinsel uyarı olmaksızın uzamış istenmeyen ereksiyon halidir. Priapizmin penil arter kan akımına bağlı olarak iskemik, non iskemik ve tekrarlayan olmak üzere üç tipi vardır. İskemik priapizm hızlı ve doğru yaklaşım gerektiren gerçek ürolojik bir acildir. Hastaları erektil disfonksiyondan korumak için ürolog böyle bir acil durumda nasıl davranacağını bilmelidir. Bu çalışmada iskemik priapizmin erken tedavisi için uygulanacak tedavi yöntemlerini araştırmayı hedefledik ve iskemik priapizm patofizyolojik zemininde testosteron uygulamalarının tedavideki rolünü, sıçan modellerinde değerlendirdik. 
Çalışmada birincisi kontrol grubu, diğer 7'si çalışma grubu olan ve 6 adet rattan oluşan 8 grup kullanıldı. Çalışmaya dahil edilen 48 adet erişkin Sprague-Dawley sıçan 8 eşit gruba ayrıldı. 1.grup kontrol (shame) grubu olup priapizm oluşturulmadan 4.saatte penis rezeke edildi. 2. Grupta priapizm oluşturulup, 4. saatte penis rezeke edildi. 3.grupta priapizm oluşturulup, fizyolojik dozda testosteron verilerek ve 4. saatte penis rezeke edildi. 4.grupta priapizm oluşturulup, yüksek doz testosteron verilip 4.saatte penis rezeke edildi. 5.grupta priapizm oluşturulup fizyolojik dozda testosteron verilip 4. saatte priapizm giderilerek, 8. saatte penis rezeke edildi. 6.grupta priapizm oluşturulup, yüksek dozda testosteron verilip, 4. saatte priapizm giderilerek, 8. saatte penis rezeke edildi. 7. grupta priapizm oluşturulup, 4. saatte priapizm giderilerek, fizyolojik dozda testosteron verilip, 8. saatte penis rezeke edildi. 8.grupta priapizm oluşturulup, 4. saatte priapizm giderilerek, yüksek dozda testosteron verilip, 8. saatte penis rezeke edildi. Bütün sıçanlarda vakum yöntemi ile ereksiyon oluşturuldu ve ereksiyon devamlılığı sağlanarak priapizm geliştirildi. Tüm gruplardaki kavernozal doku örneklerinde Tunel yöntemi ile apoptozis indeksi değerlendirildi. 
Bu çalışmamızda sonuç olarak priapizmin erken döneminde testosteron uygulamasının, apoptotik indeksi kontrol grubuna göre istatistiksel olarak anlamlı ölçüde azalttığı saptandı. 
Priapizmde gelişen apoptozisin, testosteron ile engellenmesi erektil fonksiyonun korunması konusunda gelecek vaad etmektedir.

Anahtar Kelimeler: Priapizm, apoptozis, testosteron.

Abstract:
Priapism is described as the extended unpreferred erection status without any sexual stimulus. There are three types of priapism which are classified as ischemic, non ischemic and recurrent priapism depending on the blood flow of the penile artery. Ischemic priapism is a real urological emergency which require urgent and appropriate approach. In order to prevent any erectile dysfunction, the urologist should know how to manage such an urgent case. In this study, we aimed to evaluate the early therapeutic alternatives such the role of testosterone application in treatment
on the base of ischemic priapism in the rat models.
The study included 8 groups consisting of 6 rats where the first is the control and the other 7 groups were the study groups. Fourty-eight adult Sprague-Dawley rats were divided into 8 equal groups. Group 1 was the control (shame) group. Penises of the rats in the Group 1 were resected after 4 hours without generating priapism. In Group 2 priapism was generated and penile resection was performed after 4 hours.  In Group 3 priapism was generated and testosterone in physiological dose was administrated and penile resection was performed after 4 hours. In Group 4 priapism was obtained, testosterone in supraphysiologic dose was administered and penises were resected after 4 hours. In Group 5 priapism was obtained, testosterone in physiologic dose was administered, priapism was corrected in the fourth hour and penile resection was performed after 8 hours. In Group 6 priapism was obtained, testosterone in supraphysiologic dose was administered, priapism was corrected in the fourth hour and penile resection was performed after 8 hours. . In Group 7 priapism was obtained, priapism was corrected in the fourth hour testosterone in physiologic dose was administered, and penile resection was performed after 8 hours. In Group 8 priapism was obtained priapism was corrected in the fourth hour, testosterone in supraphysiologic dose was administered and penile resection was performed after 8 hours.
Vacuum constriction method was used in all rats for obtaining erection and priapism was generated by maintaining it. Apopitosis index was evaluated by using the Tunel method in the cavernous tissue samples of all groups.
In this study it is detected that testosterone administration in the early phase of priapism is reducing the apoptotic index statistically significantly when compared to the control group.
Preventing of apopitosis occuring during priapism with testosterone is promising a future in the protection of the erectile function.

Key Words: Priapism, apoptosis, testosterone.