Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Kadınlarda Primer Vezikoüreteral Reflü Tedavisinde, Karbon Kaplı Boncuklar ve Dekstranomer/Hiyalüronik Asidin Değerlendirilmesi
Carbon Coated Beads and Dextranomer/Hyaluronic Acid Copolymer in the Treatment of Primary Vesicoureteral Reflux of Female Adults
Osman KÖSEa, Bilal GÜNAYDINb, Yiğit AKINa, Sacit Nuri GÖRGELa, Serkan ÖZCANa, Enis Mert YORULMAZa, Kenan ÖZTORUNb, Yüksel YILMAZa
aİzmir Kâtip Çelebi Üniversitesi Tıp Fakültesi, Üroloji ABD, İzmir, TÜRKİYE
b Niğde Ömer Halisdemir Üniversitesi Tıp Fakültesi, Üroloji ABD, Niğde, TÜRKİYE
J Reconstr Urol. 2020;10(2):49-55
doi: 10.5336/urology.2020-75589
Article Language: TR
Full Text
ÖZET
 Amaç: Karbon kaplı boncuklar (Durasphere®) ve dekstranomer/hiyalüronik asit kopolimeri (Deflux®) ile primer grade I-III primer vezikoüreteral reflü (VUR) nedeni ile endoskopik subüreterik enjeksiyon yapılan erişkin kadın hastaları retrospektif olarak değerlendirdik. Gereç ve Yöntemler: İzmir Kâtip Çelebi Üniversitesi Tıp Fakültesi ve Niğde Ömer Halisdemir Üniversitesi Tıp Fakültesinin üroloji bölümlerinde, primer grade I-III VUR nedeni ile endoskopik subüreteral enjeksiyon yapılan kadınların tıbbi kayıtları retrospektif olarak gözden geçirildi. Nörojenik mesaneye sekonder VUR, infravezikal obstrüksiyon, mesane tümörünün rezeksiyonu, üreterosel insizyonu veya üreteral reimplantasyonu olan ve 18 yaşın altındaki hastalar çalışma dışı bırakıldı. Bulgular: Durasphere® grubu; preoperatif grade II ve III VUR sırasıyla 7 ve 8 üreterde tespit edildi. Üç hastada bilateral VUR vardı. Cinsel olarak aktif 10 ve tekrarlayan üriner enfeksiyonu olan 7 hasta mevcuttu. Doğum yapan 7 hastanın 6'sında, gebelik sırasında hastaneye yatırılması gereken piyelonefrit öyküsü vardı. Ortalama 38,00±14,70 aylık takip periyodunda vezikoüreteral obstrüksiyon gözlenmedi, ancak 2 olguda VUR nüksüne bağlı ikinci endoskopik girişim, 1 hastaya Cohen üreteroneosistostomi yapıldı. Deflux® grubu; On dört hastanın 3'ünde bilateral VUR vardı. Grade I, II ve III reflü, sırasıyla 3, 8 ve 6 böbrek ünitesinde izlendi. Hastaların 13'ü cinsel olarak aktif olup, 11'inde doğum öyküsü, 6'sında tekrarlayan idrar yolu enfeksiyonu, 4'ünde gebelik sırasında piyelonefrit nedeni ile hastanede yatış öyküsü vardı. Dört hastaya, başarısızlık nedeni ile ikinci endoskopik subüreterik enjeksiyon uygulandı. Gruplarda postoperatif piyelonefrit izlenmedi. Sonuç: Karbon kaplı boncuklar güvenli, uygulanabilir, etkili subüreterik hacim artırıcı maddedir ve erişkin kadın popülasyonunda ciddi dilatasyon olmayan reflüksif üreterlerinin endoskopik tedavisinde Deflux® ile karşılaştırılabilir sonuçlara sahiptir.

Anahtar Kelimeler: Deflux®; Durasphere®; kadın; vezikoüreteral reflü
ABSTRACT
 Objective: We retrospectively evaluated adult female patients who received endoscopic subureteric injection due to carboncoated beads (Durasphere®) and dextranomer/hyaluronic acid copolymer (Deflux®) with primary grade I-III primary vesicoureteral reflux (VUR). Material and Methods: Medical records of women who underwent endoscopic suburethral injection due to primary grade I-III VUR in the urology departments of İzmir Kâtip Çelebi University Faculty of Medicine and Niğde Ömer Halisdemir University Faculty of Medicine were retrospectively reviewed. Patients with secondary VUR to neurogenic bladder, infravesical obstruction, bladder tumor resection, ureterocele incision or ureteral reimplantation, and being under 18 years of age were excluded from the study. Results: Durasphere® group; preoperative grade-II and III VUR were detected in 7 and 8 ureters, respectively. Three patients had bilateral VUR. There were 10 sexually active and 7 patients with recurrent urinary infections. Six of 7 delivered patients had a history of hospitalization during pregnancy due to pyelonephritis. In 38,00±14,70 months follow-up period, there was no vesicoureteral obstruction, but 2 cases needed second endoscopic intervention for VUR recurrence, 1 underwent Cohen ureteroneocystostomy. Deflux® group; three of 14 patients had bilateral VUR. Grade I, II and III reflux was observed in 3, 8 and 6 units, respectively. Thirteen patients were sexually active, 11 were delivered, 6 had recurrent urinary tract infections, and 4 had history of hospitalization for pyelonephritis during pregnancy. Four patients underwent second endoscopic subureteric injection for failure. Postoperative pyelonephritis was not observed in the groups. Conclusion: Carbon coated beads are safe, feasible, effective subureteric bulking agent and have comparable results with Deflux® in the endoscopic treatment of reflux ureters without serious dilatation in the adult female population.

Keywords: Deflux®; Durasphere®; female; vesicoureteral reflux
REFERENCES:
  1. Arce J, Angerri O, Caffaratti J, Garat JM, Villavicencio H. Efficiency of endoscopic treatment for vesico-ureteric reflux in adults. BJU Int. 2009;103(1):71-4. [Crossref]  [PubMed] 
  2. Tekgül S, Reidmiller H, Hoebeke P, Kočvara R, Nijman RJM, Radmayr C, et al; European Association of Urology. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62(3):534-42. [Crossref]  [PubMed] 
  3. Peters CA, Skoof SJ, Arant Jr. BS, Copp HL, Elder JS, Hudson RG, et al. Summary of the AUA Guideline on management of primary vesicoureteral reflux in children. J Urol. 2010;183(3):1134-44. [Crossref]  [PubMed] 
  4. Köhler J, Thysell H, Tencer J, Forsberg L, Hellström M. Concervative treatment and anti-reflux surgery in adults with vesico-ureteral reflux: effect on urinary tract infections, renal function and loin pain in a long term follow-up study. Nephrol Dial Transplant. 2001;16(1):52-60. [Crossref]  [PubMed] 
  5. Smellie JM, Prescod NP, Shaw PJ, Risdon RA, Bryant TN. Childhood reflux and urinary infection: a follow-up of 10-41 years in 226 adults. Pediatr Nephrol. 1998;12(9):727-36. [Crossref]  [PubMed] 
  6. Barai S, Bandopadhayaya GP, Bhowmik D, Patel CD, Malhotra A, Agarwal P, et al. Prevalence of vesicoureteral reflux in patients with incidentally diagnosed adult hypertension. Urology. 2004;63(6):1045-8. [Crossref]  [PubMed] 
  7. Hollowell JG. Outcome of pregnancy in women with in women with a history of vesico-ureteric reflux. BJU Int. 2008;102(7):780-4. [Crossref]  [PubMed] 
  8. Austin JC. Treatment of vesicoureteral reflux after puberty. Adv Urol. 2008;2008:590185. [Crossref]  [PubMed]  [PMC] 
  9. Läckgren G, Wåahlin N, Sköldenberg E, Stenberg A. Long term follow-up of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol. 2001;166(5):1887-92. [Crossref]  [PubMed] 
  10. Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. Pediatrics. 1981;67(3):392-400. [PubMed] 
  11. O'Donnell B, Puri P. Treatment of vesicoureteral reflux by endoscopic injection of Teflon. Br Med J (Clin Res Ed). 1984;289(6436):7-9. [Crossref]  [PubMed]  [PMC] 
  12. Choo MS, Hong B, Ji YH, Chung H, Choe JH, Park WH, et al. Endoscopic treatment of vesicoureteral reflux with polydimethylsiloxane in adult women. Eur Urol. 2004;45(6):787-9. [Crossref]  [PubMed] 
  13. Pichler R, Heidegger I, Schlenck B, Horninger W, Oswald J. Clinical outcome after endoscopic therapy for occult vesicoureteral reflux in females: preliminary results of a retrospective case series. Scand J Urol. 2014;48(4):387-92. [Crossref]  [PubMed] 
  14. Hill JB, Sheffield JS, McIntire DD, Wendel Jr. GD. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005;105(1):18-23. [Crossref]  [PubMed] 
  15. Glaser AP, Schaeffer AJ. Urinary tract infection and bacteriuria in pregnancy. Urol Clin North Am. 2015;42(4):547-60. [Crossref]  [PubMed] 
  16. Murphy AM, Ritch CR, Reiley EA, Hensle TW. Endoscopic management of vesicoureteral reflux in adult women. BJU Int. 2011;108(2):252-4. [Crossref]  [PubMed] 
  17. Moore K, Bolduc S. Treatment of vesicoureteral reflux in adults by endoscopic injection. Urology. 2011;77(6):1284-7. [Crossref]  [PubMed] 
  18. Natsheh A, Shenfeld OZ, Farkas A, Chertin B. Endoscopic treatment of vesicoureteral reflux in an adult population: can we teach our adult urology collegues? J Pediatr Urol. 2010;6(6):600-4. [Crossref]  [PubMed] 
  19. Okeke Z, Fromer D, Katz MH, Reiley EA, Terry W, Hensle TW. Endoscopic management of vesicoureteral reflux in women presenting with pyelonephritis. J Urol 2006;176(5):2219-21. [Crossref]  [PubMed] 
  20. Zilberman DE, Mor Y. Has the data efflux regarding the promising outcome following injection of deflux changed the management of adult vesicoureteral reflux? Adv Urol. 2008;2008:361324. [Crossref]  [PubMed]  [PMC] 
  21. Valdersteen DR, Routh JC, Kirsch AJ, Scherz HC, Ritchey ML, Shapiro E, et al. Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic acid copolymer. J Urol. 2006;176(4 Pt 1):1593-5. [Crossref]  [PubMed] 
  22. Tsai CC, Lin V, Tang L. Injectable biomaterials for incontinence and vesico-ureteral reflux: current status and future promise. J Biomed Mater Res B Appl Biomater. 2006;77B(1):177-8. [Crossref]  [PubMed] 
  23. Kirsch AJ. Injection therapy for reflux: why it works and why it fails. J Urol. 2012;188(1):16-7. [Crossref]  [PubMed] 
  24. Toia B, Gresty H, Pakzad M, Hamid R, Ockrim J, Greenwell T. Bulking for stress urinary incontinence in men: a systematic review. Neurourol Urodyn. 2019;38(7):1804-11. [Crossref]  [PubMed] 
  25. Pannek J, Brands FH, Senge T. Particle migration after transurethral injection of carbon coated beads for stres urinary incontinence. J Urol. 2001;166(4):1350-3. [Crossref]  [PubMed] 
  26. Altomare DF, La Torre F, Rinaldi M, Binda GA, Pescatori M. Carbon-coated microbeads anal injection in outpatient treatment of minor fecal incontinence. Dis Colon Rectum. 2008;51(4):432-5. [Crossref]  [PubMed] 
  27. Ozkuvanci U, Donmez MI, Ozgor F, Erbin A, Pasin Ö, Muslumanoglu AY. Durasphere® EXP: a non-biodegradable agent for treatment of primary vesico-ureteral reflux in children. Int Braz J Urol. 2018;44(3):585-90. [Crossref]  [PubMed]  [PMC] 
  28. Antonopoulos IM, Piovesan AC, Falci Jr. R, Kanashiro H, Saito FJA, Nahas WC. Transurethral injection therapy with carbon-coated beads (Durasphere®) for treatment of recurrent pyelonephritis in kidney transplant patients with vesico-ureteral reflux to the allograft. Clin Transplant. 2011;25(2):329-33. [Crossref]  [PubMed] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com