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Retrograt intrarenal cerrahi geriatrik erkek hastalarda böbrek taşı tedavisinde etkin ve güvenilir bir seçenek midir?
(Selçuk Üniversitesi, 2021) Batur, Ali Furkan; Gülmen, Mustafa; Böcü, Kadir; Böcü, Kadir; Altınaş, Emre; Gül, Murat; Kaynar, Mehmet; Kılıç, Özcan; Göktaş, Serdar
Amaç: Bu çalışmada böbrek taşı tedavisi için kliniğimizde retrograt intrarenal cerrahi(RİRC) uygulanılan geriatrik yaş grubu erkek hastaların etkinlik ve güvenlik sonuçlarının, daha genç yaş hasta grubu ile karşılaştırılarak sunulması amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde böbrek taşı nedeniyle RİRC uygulanmış olan, 40 yaş üzeri erkek hastaların verileri retrospektif olarak değerlendirildi. Hastalar yaşlarına göre iki gruba ayrıldı: 40-64 yaş (Grup 1) ve 65 yaş ve üzeri (Grup 2). Komorbidite değerlendirilmesi için anestezi risk skoru (ASA) ve modifiye Charlson komorbidite indeksi (MCKİ) kullanıldı. Hastanenin kayıt sisteminden ve hastaların dosyalarından genel bilgiler, komplikasyon bilgileri, renal anormallik varlığı, taşın bulunduğu böbrek ve lokalizasyonu, taşın dansitesi, taşın boyutu, taş sayısı verileri ve postoperatif taş temizlenme verileri elde edildi. Bulgular: Çalışmaya 233 tanesi Grup 1 (40-64 yaş) ve 61 tanesi Grup 2 (65 yaş ve üstü) olmak üzere toplam 294 hasta alınmıştır. ASA ve MCKİ skorları bakımından Grup 2’de yer alan hastaların skorları Grup 1’e göre istatistiksel olarak anlamlı olarak daha yüksek olarak bulunmuştur (sırasıyla p<0.001, p<0.001). Gruplar arasında taş dansitesi, taş boyutu, taş hacmi, operasyon süresi, hastanede yatış süreleri ve postoperatif taşsızlık oranları bakımından fark bulunmamıştır. Grup 1’de toplam 25 (%10.7) hastada ve Grup 2’de toplam 10 (%16.4) hastada komplikasyon geliştiği tespit edilmiştir ve gruplar arasında genel komplikasyon oranları açısından istatistiki fark bulunmamıştır (p=.265). Sonuç: Dünya nüfusunun giderek yaşlanması ile beraber bu hasta grubunun hastalıklarının da en uygun tedavi metodlarıyla tedavi edilmesinin önemi artmıştır. Çalışmamızda RİRC yöntemi ile böbrek taşı tedavisi yaşlı hasta grubunda da güvenli ve etkili olarak çıkmıştır.
Prognostic score predicts overall survival following complete urinary tract extirpation
(TAYLOR & FRANCIS LTD, 2020) Akand, Murat; Muilwijk, Tim; Van Der Aa, Frank; Gevaert, Thomas; Milenkovic, Uros; Moris, Lisa; Blyweert, Wim; Poppel, Hendrik Van; Albersen, Maarten; Joniau, Steven
Purpose: To evaluate the oncological outcome and complications of patients treated with complete urinary tract extirpation (CUTE) in our department, and to identify prognostic factors for survival. Methods: Clinico-pathological data of patients treated with one-step or stepwise CUTE between 1999 and 2017 were collected retrospectively. Complications were classified according to the modified Clavien-Dindo classification (CDC) in the early (<= 30 days) and late (>30 days) follow-up. Log-rank test was used to assess independent predictors of overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS). Results: Twenty-five patients (20 male) underwent CUTE (16 one-step) for BC + unilateral/bilateral UTUC. Minor (CDC 1-2) and major (CDC3-5) complications were observed in 72% and 40% of patients, respectively, in the early postoperative period (<= 30 days). Five (20%) patients died in the perioperative period (CDC 5) with a median OS of 52 days (range: 25-77). Median time to last follow-up or death was 30 months (range: 0-161). Median OS was 50 months (95% Confidence Interval [CI]: 22-118 months), while median CCS and RFS were not reached. The 5-year OS, CSS and RFS were 42.7%, 69.6% and 66.7%, respectively. A score for determining which patients would benefit from CUTE was arbitrarily developed, and showed that the patients with a score of 0-2 points (good prognosis) had a better OS than the patients with a poor prognosis (3-4 points) in the log-rank test. Conclusions: Because of lower OS rates, patients with ESRD or with a CUTE score of 3-4 points are probably not ideal candidates for CUTE.
Expression of Ring Box-1 protein and its relationship with Fuhrman grade and other clinical-pathological parameters in renal cell cancer
(ELSEVIER SCIENCE INC, 2020) Altıntaş, Emre; Kaynar, Mehmet; Çelik, Zehra Esin; Çelik, Murat; Kılıç, Özcan; Akand, Murat; Göktaş, Serdar
Objective: To determine the relationship between RING-box protein 1 (RBX-1) expression and renal cell carcinoma (RCC) with prognostic factors. Methods: A total of 88 patients who underwent radical/partial nephrectomy between January 2009 and January 2016 have been included in our study. The age, gender, tumor location, tumor size, and tumor-node-metastasis stage of each patient was evaluated. From the best sections in hematoxylin-eosin stained pathology preparations, tumor histological subtype, Fuhrman nuclear grade, lymphovascular invasion, renal artery/vein invasion, capsule invasion, perirenal fatty tissue invasion, and tumor grade were evaluated. Participants were divided into 2 groups according to Fuhrman grade. Fuhrman grades 1 to 2 comprised Group 1, and Fuhrman grades 3 to 4 comprised Group 2. An immunoreactivity scoring system was used to evaluate RBX-1 expression. Results: Upon examining all histological subtypes together, it was observed that RBX-1 expression was statistically higher in Group 2 compared to Group 1 (P < 0.008). Upon examining clear RCC cases, it was observed again that Group 2 had a higher RBX-1 expression than Group 1 (P < 0.009). RBX-1 expression was not associated with clinical-pathological parameters including tumor grade, lymphovascular invasion, capsule invasion, or perirenal invasion. Conclusion: RBX-1 expression is closely associated with a highly important prognostic factor in RCC-Fuhrman grade-and it shows promise as a prognostic marker. Further studies are required to reveal the importance of RBX-1 in RCC prognosis and treatment. (C) 2019 Elsevier Inc. All rights reserved.
Development of a prospective data registry system for retrograde intrarenal surgery in renal stones: Turkish Academy of Urology Prospective Study Group (ACUP study)
(AVES, 2020) Akand, Murat.; Sarıca, Kemal.; Kiremit, Murat Can.; Soytaş, Mustafa.; Güven, Selçuk.
Objective: We aimed to report the development of a prospective data registry by generating a retrograde intrarenal surgery (RIRS)-specific electronic case report form (eCRF), which can be used by multiple centers in Turkey. Material and methods: The Stone Disease Study Group of Turkish Urology Academy developed a template for the necessary data to be collected, which was then implemented within a dedicated server. Urologists from different universities, research and training centers, and private hospitals were invited to participate in this data registry. Each urologist was provided with a unique username and password after they agreed to participate in the study. Results: In March 2015, the development of the eCRF was completed, and the server was opened for data input in April 2015. We started a prospective clinical data registry for all patients undergoing RIRS for renal stone(s) in 15 participating hospitals. Until the end of June 2016, 1112 RIRSs on 1264 patients have been included in the dataset. Conclusion: The easy-to-use eCRF specifically developed for RIRS was first of its kind in Turkey. This prospective data registry harvests important data that will be used to identify real-world demographic, clinical and operative data of patients with renal stone who undergo RIRS in various urology departments throughout Turkey. The results of this dataset will be presented in various papers.
Transcriptomic expression levels of the VHL, TIMP-3, and RASSF1A genes in renal tumors
(VERDUCI PUBLISHER, 2019) Üre, I.; Konaç, Ece; Alp, E.; Önen, Hacer İlke; Batur, A. F.; Gönül, I. I.; Menevşe, S.; Sözen, S.
OBJECTIVE: In this study, we aimed to investigate the relation between the mRNA expression levels of VHL, TIMP-3 and RASSF1A genes, and the histopathological and clinical characteristics of patients with renal tumors. PATIENTS AND METHODS: Radical nephrectomy specimens of cases presented without neoadjuvant treatment were confirmed to be cancerous, non-cancerous, benign, and healthy after removal from separate localizations. A total of 69 patients with kidney tumors (138 tissue samples) were included in the study group. RNA isolation, reverse transcriptase PCR (RT-PCR), and quantitative real time PCR (qPCR) were performed, and the GAPDH gene was used to normalize mRNA levels. RESULTS: In the RCC cancerous tissue. TIMP-3 levels increased 1.3 times and RASSF1A levels increased 1.4 times compared to the corresponding levels in non-cancerous tissues, and there was no statistically significant difference in these values. On the other hand, VHL gene expression levels in cancerous tissue were 2.8 times higher than in matched adjacent non-cancerous tissues (p < 0.05). In the case of oncocytomas, TIMP-3 levels were found to be 3.2 times higher, RASSF1A levels 3.8 times higher, and VHL levels 2.2 times lower than the corresponding levels in healthy tissues (p < 0.05). CONCLUSIONS: The roles of VHL, TIMP-3, and RASSF1A mRNA expression in contributing to the development of renal tumors could not be clearly established. Further studies are therefore required to elucidate the mechanisms underlying renal tumors.
Quality control ındicators for transurethral resection of none-muscle-ınvasive bladder cancer
(CIG MEDIA GROUP, LP, 2019) Akand, Murat; Muilwijk, Tim; Raskin, Yannic; De Vrieze, Maxime; Joniau, Steven; Van der Aa, Frank
Complete transurethral resection of bladder tumor (TURBT) is the initial procedure of choice for nonemuscle-invasive bladder cancer, but its quality is far from optimal in clinical practice. We evaluated the existing body of evidence substantiating current quality control indicators (QCIs) for TURBT. A literature search was performed using PubMed and Embase, and selected articles were reviewed according to their level of evidence. Disease recurrence and progression were used as the primary end points. No hard evidence supports complete resection as a QCI, but rationally, it is the most important indicator for TURBT. A repeat resection is an important QCI in high-risk disease patients, but evidence suggests that it may not be necessary when detrusor muscle is present in the initial resection specimen. The presence of detrusor muscle in the resection specimen is a validated QCI for TURBT. Adjuvant intravesical instillation is a scientifically proven QCI. Bladder perforation is a controversial QCI in the existing literature. No evidence indicates the ideal time frame for the initial TURBT; thus, initial therapy in the first 6 weeks after diagnosis is not a good QCI. Three of the 6 proposed QCIs for TURBT are supported by evidence. Our literature analysis indicated the use of complete resection, repeat resection, the presence of detrusor muscle, and intravesical instillation are QCIs to minimize recurrence and progression, and increase beneficial outcomes.
Paratesticular solitary fibrous pseudotumor and a brief literature review
(GALENOS YAYINCILIK, 2019) Batur, Ali Furkan.; Kaynar, Mehmet.; Çelik, Zeliha Esin.; Göktaş, Serdar.
A 19-year-old male patient was admitted to our clinic with a left-sided scrotal painless mass. Ultrasonography of the scrotum revealed a paratesticular mass arising from the left testicular sac. Surgical excision of the mass was performed. lntraoperative frozen section evaluation revealed a benign fibrous tumor. Microscopically, the specimen was composed of eosinophilic cytoplasmic tumor cells with spindle nucleus on a fibrous connective tissue ground. It is important to diagnose correctly this rare condition preoperatively or intraoperatively to avoid unnecessary orchiectomies. We present this case report to increase awareness and knowledge with the support of a brief literature review.
No survival difference between super extended and standard lymph node dissection at radical cystectomy: what can we learn from the first prospective randomized phase III trial?
(AME PUBL CO, 2019) Muilwijk, Tim; Akand, Murat; Gevaert, Thomas; Joniau, Steven
[Abstract not Available]
Impact of neoadjuvant chemotherapy on short-term complications and survival following radical cystectomy
(SPRINGER, 2019) Milenkovic, Uros; Akand, Murat; Moris, Lisa; Demaegd, Liesbeth; Muilwijk, Tim; Bekhuis, Youri; Laenen, Annouschka; Cleynenbreugel, Ben Van; Everaerts, Wouter; Poppel, Hein Van; Dumez, Herlinde; Albersen, Maarten; Joniau, Steven
Objectives To compare perioperative and short-term postoperative complication rates between patients receiving radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) and patients undergoing RC alone. Secondary objectives were to compare overall survival (OS) and cancer-specific survival (CSS). Materials and methods Clinico-pathological data of all patients who received RC between 1996 and 2015 were retrospectively collected. Only patients with RC for muscle-invasive bladder cancer were included in the final analysis. Short-term (30-day) postoperative complications were assessed by registering the Clavien-Dindo classification (CDC) and dividing into sub-groups: low-grade (LGC) CDC 1-2 and high-grade (HGC) CDC 3-5. To compare populations with similar age, comorbidities and preoperative creatinine, we used a propensity score-adjusted statistical model. Pre- and perioperative predictors of short-term complications were identified using uni- and multivariable models. Survival was assessed using Kaplan-Meier analysis. Results A total of 491 patients undergoing RC were included, of whom 102 (20.8%) received NAC. After propensity score covariate adjustment, there was no significant difference in postoperative complications between patients undergoing NAC plus RC and RC alone with an overall complication rate of 69% and 66%, respectively. No significant differences in the 30-day HGC rates (11.76% and 11.83%, respectively) were observed. NAC plus RC patients had worse prognostic factors at baseline; nevertheless, after correction for group differences OS and CSS did not differ from RC only group (5-year OS 61.3% vs. 50.2%, and 5-year CSS 61.8% vs. 57.9% respectively, p > 0.05 for all). Conclusion In appropriately selected patients, exposure to NAC is not associated with increased short-term complications.
First experience with a new form of orthotopic ileal neobladder (Leuven N-Pouch) following radical cystectomy
(AVES, 2019) Akand, Murat; Kilic, Ozcan; Bocu, Kadir; Harmankaya, Ismail; Aydogan, Muhammed Furkan
Bladder cancer is the most common malignancy of the urinary tract. Radical cystectomy with pelvic lymph node dissection and a urinary diversion (UD) is the gold standard treatment of non-metastatic muscle-invasive bladder cancer (MIBC). Although ileal conduit is the standard and most commonly performed type of UD, more number of centers have recently started to perform orthotopic ileal neobladder (OIN). A novel OIN has been described in 2005 as the so-called "Leuven N-pouch", which combines the features of the commonly used Hautmann and Studer neobladders. Herein, we report our first experience with a case of Leuven N-pouch in our department, which was performed for a male patient with MIBC.
Feasibility of a novel technique using 3-dimensional modeling and augmented reality for access during percutaneous nephrolithotomy in two different ex-vivo models
(SPRINGER, 2019) Akand, Murat; Civcik, Levent; Büyükaslan, Ahmet; Altıntaş, Emre; Koçer, Erdinç; Koplay, Mustafa; Erdoğru, Tibet
PurposeWe describe a novel technique that uses mathematical calculation software, 3-dimensional (3D) modeling and augmented reality (AR) technology for access during percutaneous nephrolithotomy (PCNL) and report our first preliminary results in two different ex-vivo models.MethodsNovel software was created in order to calculate access point and angle by using pre-operative computed tomography (CT) obtained in 50 patients. Two scans, 27s and 10min after injection of contrast agent, were taken in prone PCNL position. By using DICOM objects, mathematical and software functions were developed to measure distance of stone from reference electrodes. Vectoral 3D modeling was performed to calculate the access point, direction angle and access angle. With specific programs and AR, 3D modeling was placed virtually onto real object, and the calculated access point and an access needle according to the calculated direction angle and access angle were displayed virtually on the object on the screen of tablet.ResultsThe system was tested on two different modelsa stone placed in a gel cushion, and a stone inserted in a bovine kidney that was placed in a chickenfor twice, and correct access point and angle were achieved at every time. Accuracy of insertion of needle was checked by feeling crepitation on stone surface and observing tip of needle touching stone in a control CT scan.ConclusionsThis novel device, which uses software-based mathematical calculation, 3D modeling and AR, seems to ensure a correct access point and angle for PCNL. Further research is required to test its accuracy and safety in humans.
Development of a prospective data registry system for non-muscle-invasive bladder cancer patients incorporated in the electronic patient file system
(FRONTIERS MEDIA SA, 2019) Akand, Murat.; Muilwijk, Tim.; Cornelissen, Jan.; Van Bruwaene, Siska.; Vander Eeckt, Kathy.; Baekelandt, Frederic.; Mattelaer, Pieter.; Van Reusel, Raf.; Van Cleynenbreugel, Ben.; Joniau, Steven.; Van Der Aa, Frank.
Purpose: To develop a prospective non-muscle-invasive bladder cancer (NMIBC) data registry by generating NMIBC-specific electronic case report forms (eCRFs) in our institution's electronic patient file system, and to report on the development and implementation of a prospective multicentric registry. Methods: Templates for data collection, including clinical outcome parameters and quality indicators, were developed in InfoPath (TM) as an eCRF and were incorporated in our hospital's electronic patient file system. Quality parameters for managing NMIBC patients that were identified by comprehensive literature review were included in the eCRFs. Three separate eCRFs were developed for the management of NMIBC patients: surgery report, bladder instillation form, and multidisciplinary team form. Results: In August 2013, we started a Flemish prospective clinical and pathological data registry for all patients undergoing transurethral resection of bladder tumor (TURBT) for NMIBC in four participating hospitals, three of which continued using this to date. Three more hospitals started enrolling in 2017, 2018, and 2019, respectively. Written reports of the registered clinical actions are automatically generated within the electronic medical file. When urologists complete these eCRFs, an automated ready-to-send letter to the general practitioner is generated. Up till May 2019, 2,756 TURBTs in 2,419 patients are included in the dataset. Currently, we are recruiting over 600 TURBTs every year. Conclusions: Easy-to-use eCRFs were developed and included in the electronic patient file system. This registration tool was implemented in 7 hospitals, 6 of which are still using it today. The register harvests important clinical data, while performing routine clinical practice. The data will be used to analyze real-life data of NMIBC patients, to challenge the existing guidelines, to create novel risk stratification tools, and to develop, monitor and validate quality parameters for NMIBC management.
Aggressive treatment for urothelial cancer-complete urinary tract extirpation: operative feasibility in two cases
(AVES, 2019) Akand, Murat.; Kılıç, Özcan.; Harmankaya, İsmail.; Karabağlı, Pınar.; Yavaş, Çağdaş.; Ata, Özlem.
Bladder cancer (BC), the most common malignancy of the urinary tract, accounts for 90-95% of all urothelial carcinomas (UCs), while upper urinary tract UC (UUTUC) accounts for only 5-10%. Radical nephroureterectomy with excision of bladder cuff, and radical cystectomy with pelvic lymph node dissection and a urinary diversion (UD) are the gold standard treatments for UUTUC and muscle-invasive bladder cancer (MIBC), respectively. These two treatments can be performed simultaneously when a bilateral or unilateral UUTUC is present with a MIBC, and are called complete urinary tract extirpation (CUTE) and hemi-CUTE, respectively. This complex surgery can help the patient by avoiding multi-staged surgeries, repeated anesthesia, and delay in completion of treatment. Herein, we report the first cases of a hemi-CUTE and CUTE in our department and share our experience with this aggressive and complex surgical treatment.
Çocuk böbrek taşlarında perkutan nefrolitotomi deneyimlerimiz
(2015) Kaba, Mehmet; Pirinççi, Necip; Taken, Kerem; Kaba, Sultan; Geçit, İlhan; Eren, Hüseyin; Demir, Murat; Ceylan, Kadir
Amaç: Kliniğimizde son 3 yılda pediatrik yaş grubunda yapılan perkutan nefrolitotomi deneyimlerimizi sunmaktır. Yöntem: Yaş ortalaması 12,76 yıl (5-16yıl) olan 14ü erkek, 11ü kız olmak üzere 25 hastada 25 renal üniteye PNL ameliyatı yapıldı. Taşlar 16 hastada (%64) sağ, 9 hastada(%36) sol taraf yerleşimiydi. Taşların 12si pelvis renalis, 6sı alt pol, 1i orta pol ve 6sında hem pelvis hem de alt pol yerleşimliydi. Böbreğe giriş sağlamak için tüm hastalarda18F balon dilatasyon yapıldı. PNL işlemi için 15 F rijid nefroskop kullanıldı. Bulgular: Ortalama taş boyutu 321.68 mm2 (142.377) idi. Ortalama PNL ameliyatı süresi 58.48 dk (11.8 dk) idi. Ortalama skopi kullanma süresi 3.48 dk (1.75 dk) idi. Akses için balon dilatasyon yapıldı. Postoperatif 1. günde 21 hastada tam taşsızlık (%84) sağlandı. 4 hastada (%16) operasyon sonrası rezidüel taş saptandı. 1 hastada (%4) forsepsle taş alınması sırasında kopan üreteral stentin akciğere migrade olduğu görüldü. İki hastada(%8) postoperatif dönemde kan replasmanına gerek duyuldu. Ortalama hastanede yatış süresi 2.76 gün (1.6) idi. Sonuç: Çocuklarda taş hastalığının tedavisinde PNL güvenli ve başarılı sonuçları olan bir tedavi yöntemidir.
Comparison of the Therapeutic Effects of Diclofenac Sodium, Prednisolone and an Alpha Blocker for the Treatment of Renal Colic
(2012) Sümer, Alpay; Kaynar, Mehmet; Topbaş, Emrah; Hassan, Mustafa Aziz; Gürbüz, Recai
Objective: In this study, we compare the efficacy of diclofenac sodium, methylprednisolone and alphablockers for the treatment of renal colic treatment. Material and methods: A total of 30 patients between the ages of 18-70 were included in this study. Patients were referred to the Meram Medical Faculty Urology Department or Department of Emergency Medicine at Selcuk University between October 2008 and January 2009. This prospective study was approved by the Selcuk University Meram Medical Faculty Ethics Committee. Patients were randomly divided into 3 cohorts of 10 patients each. The first group consisted of patients receiving diclofenac sodium and an alpha blocker, the second group of patients received diclofenac sodium and prednisolone, and the third group of patients received diclofenac sodium alone. Each patient was diagnosed and evaluated by the same clinician. Evaluation was based on the Numerical Classification Score (NCS) and the Renal Colic Symptom Score (RCSS). Pain intensity was evaluated prior to medication administration and 5, 10, 15, 20, and 30 hours thereafter. Statistical analysis was performed using chi-squared analysis and the Kruskal-Wallis test. Pvalue of ?0.05 were considered statistically significant. Results: Symptoms immediatiely prior to medication administration and after 5, 10, 15, 20 and 30 hours are evaluated. There are no significant differences between the groups (p>0.05). In group 1, stone expulsion occured in 4 patients (40%), a finding that is statistically significant (p=0.01). No adverse events occurred in any group during this study. Conclusion: Comparison of the therapeutic response among the 3 groups revealed no statistically significant difference. The most important aspects to consider in regard to a treatment modality include diminishing pain, dissolving blockage, a preservation of renal function and minimizing the side effects.
Percutaneous Nephrolithotomy in Children in Different Age Groups
(ELSEVIER SCIENCE BV, 2012) Güven, Selçuk; Frattini, Antonio; Onal, Bülent; Desai, Mahesh; Montanari, Emanuele; Kums, Jan; Garofalo, Marco; Rosette, Jean De La
Objectives: To present the overall results of paediatric percutaneous nephrolithotomy (PCNL) compared with adults. To present the indications, complications and outcomes of patients treated in the participating centres in the PCNL Global Study, as categorised in different age groups. Patients and Methods. The Clinical Research Office of the Endourological Society (CROES) Study was conducted from November 2007 to December 2009, and included 96 centres and >5800 patients. All children aged 14 years in the PCNL Global Study database were the focus of the study. Results: In all, 107 children aged 14 years were included in the analysis. he PCNL procedure was conducted in 13 patients (12.1%) in the supine position; tubeless PCNL was performed in 15 patients (14%); and balloon dilatation was preferred in 22 patients (20.5%). The overall mean operative duration was 97.02 min; blood transfusion rate, fever and stone-free rates were 9%, 14% and 70.1%, respectively. A comparison of the paediatric PCNL cases according to age groups showed no statistically significant differences between the subgroups for patient characteristics, co-morbidities, renal anomalies, or previous surgical history. In the evaluation of the operative details, the mean sheath size and nephrostomy tube size were larger in school-age children than the preschool children (P = 0.01 and 0.002, respectively). There was a difference in the preferred methods for confirming stone-free status, with ultrasonography preferred more in preschool children (P < 0.001). The PCNL procedure position, puncture site, dilatation method, postoperative tube application, and surgical outcomes were comparable in school- and preschool-age children. While operative details showed some differences between children and adults, the surgical outcomes were comparable. Conclusions: A considerable number (45.7%) of the paediatric patients had a previous history of stone intervention. Based on the findings of the present study, we can suggest that PCNL can be applied safely and effectively in children in different age groups. Outcomes appear comparable with those in adults for the success and complication rates, in the presence of substantial indications, appropriate equipment and adequate experience.
On-Demand Tramadol Hydrochloride Use in Premature Ejaculation Treatment
(ELSEVIER SCIENCE INC, 2012) Kaynar, Mehmet; Kılıç, Özcan; Yurdakul, Talat
OBJECTIVES To determine the efficacy of tramadol in premature ejaculation (PE) treatment compared with placebo. METHODS A single-blind, placebo-controlled, crossover study was conducted with 60 lifelong (primary) patients with PE. The patients were randomized into 2 groups, each consisting of 30 patients, who took tramadol or placebo on demand. PE was defined as an intravaginal ejaculation latency time of <= 60 seconds in 90% of intercourse episodes. The efficacy of the drugs was assessed using the intravaginal ejaculation latency time, ability of ejaculation control, and sexual satisfaction scores after an 8-week treatment period. RESULTS All participants completed the study voluntarily. Two groups were similar in terms of the patient demographics. Increases in the intravaginal ejaculation latency time, ability of ejaculation control, and sexual satisfaction score between the placebo and tramadol groups were compared with the baseline values in both groups. At the end of study period, the tramadol group had significantly (P<.001) greater values for all 3 parameters compared with those in the placebo group. CONCLUSIONS On-demand use of low-dose tramadol is effective for lifelong PE. Currently, selective seratonin reuptake inhibitors such as dapoxetine, are a more popular treatment option for PE. However, tramadol might be considered an alternative agent for primary PE treatment.
Modified Raz Operation Backed With Periurethral Roll Mesh in Female Stress Urinary Incontinence
(Verduci Publisher, 2012) Pirinçci, N.; Kamberoğlu, H.; Kaya, C.; Kaba, M.; Geçit, I.; Güneş, M.; Ceylan, K.; Karaman, M.I.
OBJECTIVES: With the modifications that we made, the aim is to increase the effectiveness and the success rate of the Raz operation in the treatment of stress urinary incontinence (SUI) and to present a new approach in the treatment by reducing the complication rates. PATIENTS AND METHODS: Between November 2002 and December 2010, the Raz operation that we modified with the changes such as the placement of cystostomy catheter with the Lowsley clamp, vaginal incision of the bilateral oblique, the placement of periurethral roll mesh, the use of a single 0-degree stamey needle instead of a double needle applicator, binding the sutures mutually and on the support of the polypropylene mesh in suprapubic region was performed to 81 female patients with SUI in lithotomy position under the regional anesthesia. RESULTS: We performed the modified Raz operation to 81 female patients with SUI, who had the complaint of urinary incontinence with the effort lasting for about 4.5 years (between 1-16 years) and whose ages were 28-83 years (mean 55.2 years), childbirth numbers were 0-11 (mean 4.8), weights were 60-85 kg (mean 69.3 kg), and 32 of whom (39.5%) were of grade 1, 49 of whom (60.5%) were of grade 2 with the anamnesia of SUI, and whose stres test was (+) in the physical examination. While the duration of the operation was 39.8 minutes (20-85 minutes) and the duration of the hospitalization was 2.9 days (2-4 days), the duration of the stay of the patients with the cystostomy catheter was determined to be 4.8 days (3-11 days). We found the rate of our success as 93.8% according to the objective criteria. CONCLUSIONS: With the modifications that we made, we increased the success rate of the Raz operation and reduced the rates of the complication. We believe that the place of our modification method in incontinence surgery becomes more clearly with the comparison of the other anti-incontinence surgery techniques in patient groups with the same characteristics.
Management of Multiple Stones in a Single Session Using Minimally Invasive Methods in Infants with Renal Failure: Renal Salvage
(SPRINGER, 2012) Öztürk, Ahmet; Güven, Selçuk; Pişkin, Mesut; Kılınç, Mehmet; Çelik, Jale; Arslan, Mehmet
The goal in the treatment of stone disease causing infantile obstructive uropathy is to obtain a quick resolution of the obstruction using the least invasive treatment modality available and rendering the patient stone-free, if possible. Two infants with bilateral kidney stones, the first of whom also had ureteral stone, were referred to our clinic with acute renal failure and were treated successfully in a single session using minimally invasive methods. In this report, we discuss the management of these two cases, aged 9 and 26 months, which resulted in favorable outcomes.
Glutathione S-Transferase M1 and T1 Polymorphisms in Turkish Patients With Varicocele
(WILEY-BLACKWELL, 2012) Acar, H.; Kılınç, M.; Güven, S.; İnan, Z.
Several studies have shown that high oxidative stress levels are associated with varicocele. The GST (glutathione S-transferase) family of genes is critical in the protection of cells from oxidative stress because they utilise as substrates a wide variety of products of oxidative stress. The objective of this study was to assess the relationship between genetic polymorphism in GST-M1 and GST-T1 and varicocele using 109 varicocele patients and 123 controls. Varicoceles were clinically graded as Grade 1, Grade 2 and Grade 3. GST-M1 and GST-T1 genes were determined by polymerase chain reaction. Although the GST-M1 null genotype was higher in Grade 3 than in Grade 1, 2 and controls, there were no statistical differences between control group and varicocele groups according to GST-M1 and GST-T1 null genotype. Men with varicocele do not have more GST-M1 and GST-T1 null polymorphisms than men without varicocele. Additional studies are needed to assess the exact mechanism by which the varicocele corresponds to elevated ROS levels.

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