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Asali M, Hallak O. Dynamic renal scans as a modality for follow-up of flexible ureteroscopy. Arch Ital Urol Androl 2024; 96:12393. [PMID: 38742419 DOI: 10.4081/aiua.2024.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/31/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE To determine whether dynamic renal scans - DTPA or MAG3 - routinely performed after flexible ureteroscopies (f-URS) could detect the development of an obstruction and thus promote prompt early intervention for kidney preservation. PATIENTS AND METHODS In this retrospective study, with all the data recorded prospectively between April 2010 and October 2023, 250 renal units in 242 patients with upper urinary tract stones (UUTS) who underwent ureterorenoscopy by one surgeon in the same medical center were evaluated. Stone-free rate (SFR) was defined as no residual fragments at all using an intraoperative "triple test". The following characteristics were examined: gender, BMI, age, Hounsfield unit, stone diameter, laterality, renal/ureteral stones, stone-free rate, and auxiliary procedures per renal unit. The Clavien-Dindo classification was used to report complications. Renal units with residual stones were scheduled for a 2nd f-URS. Post- flexible ureteroscopy ureteral obstruction and renal function were detected using renal scan DTPA or MAG-3. The primary outcome was renal/ ureteral obstruction. RESULTS The mean patient age was 53 years. The mean stone size was 12.3 mm. Stones in renal pelvis, upper, middle and lower calyces were treated in 9.2% (23), 27.6% (69), and 30.8% (77) of cases, respectively; 44% (110) ureteral stones were also treated. The single- and second-session SFRs were 94.8% and 99.7%, respectively. A third auxiliary procedure was needed in one renal unit (0.4%). The mean number of procedures per renal unit was 1.06 (264/250). Ureteral double-J stents were inserted in 53.6% (134) of the cases. In 37 (14.8%) cases, a stent was placed before surgery. Post-operative complications were minor, with readmission and pain control needed in only two patients (0.8%). No avulsion or perforation of the ureters was observed. In six patients with t1/2 between 10-20 minutes, a second renal scan revealed spontaneous improvement and no obstruction in five patients. One patient with large stones and a history of prior ureteroscopy developed a ureteral stricture (0.4%) and needed treatment with laser endoureterotomy. CONCLUSIONS Post-flexible ureteroscopy obstruction due to ureteral stricture is very rare. A routine renal scan post-operatively may be used in potentially high-risk patients.
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Affiliation(s)
- Murad Asali
- Urology Department, Barzilai Medical Center, Ben Gurion University of the Negev, Beer Sheva; Assuta Medical Center, Ramat Hyal, Ben Gurion University of the Negev, Beer Sheva.
| | - Osman Hallak
- Urology Department, Barzilai Medical Center, Ben Gurion University of the Negev, Beer Sheva.
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Shvero A, Herzberg H, Zilberman D, Mor Y, Winkler H, Kleinmann N. Is it safe to use a ureteral access sheath in an unstented ureter? BMC Urol 2019; 19:80. [PMID: 31464587 PMCID: PMC6716863 DOI: 10.1186/s12894-019-0509-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/05/2019] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to examine ureteral stricture rate after the use of UAS in an unstented ureter and compare complications of smaller vs. larger-caliber UAS. Methods We conducted a retrospective analysis of consecutive RIRS for renal stones, with the use of UAS in unstented ureters. We excluded cases with previous ureteroscopies, who carried ureteral stent or nephrostomy, had impacted stones, underwent radiation treatment, or had urinary tract malignancies. The primary outcome was formation of ureteral strictures diagnosed by hydronephrosis in ultrasound test and late secretion in dynamic renal scan. Secondary outcome was stone-free-rate (SFR) and complications. In addition, we compared safety and efficacy of smaller (9.5/11.5Fr) vs. larger-caliber (12/14Fr) UAS. Results The cohort included 165 patients with a median follow-up time of 115 days. There was no case of ureteral stricture formation after the use us UAS, despite using a larger-caliber UAS in nearly half the cases. Larger-caliber UAS was not associated with more complications compared to the smaller-caliber one (p = 0.780). SFR was non-significantly higher in the larger-caliber UAS group (p = 0.056), despite having a larger stone burden, and only stone number was associated with SFR (p = 0.003). Conclusions These data suggest that the use of UAS during RIRS in an unstented ureter is safe and does not involve ureteral stricture formation after one procedure. Furthermore, the use of wider sheaths was not found to be associated with higher complications rate.
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Affiliation(s)
- Asaf Shvero
- Department of Urology, The "Chaim Sheba" Medical Center, Ramat-Gan, Israel. Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Haim Herzberg
- Department Of Urology, Sourasky Medical Center, Tel-Aviv, Israel. Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit Zilberman
- Department of Urology, The "Chaim Sheba" Medical Center, Ramat-Gan, Israel. Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoram Mor
- Department of Urology, The "Chaim Sheba" Medical Center, Ramat-Gan, Israel. Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Harry Winkler
- Department of Urology, The "Chaim Sheba" Medical Center, Ramat-Gan, Israel. Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, The "Chaim Sheba" Medical Center, Ramat-Gan, Israel. Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Modeling the Incidence of Secondary Malignancy Related to Ionizing Radiation Use in the Management of Nephrolithiasis. Urology 2019; 130:48-53. [PMID: 31026476 DOI: 10.1016/j.urology.2019.01.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To model the risk of secondary malignancy and associated mortality due to ionizing radiation from the evaluation and management of nephrolithiasis. METHODS A PUBMED-based literature search was performed to identify model inputs, specifically annual incidence of nephrolithiasis sub-stratified by age and gender and radiation exposure associated with nephrolithiasis episodes. Estimates of age and gender specific radiation-induced malignancy and mortality rates were obtained from the BEIR VII Phase 2 report with dose extrapolation using the linear no-threshold model. RESULTS Incidence of new diagnoses of nephrolithiasis ranged from 42/100,000 in males 20-30 years old to 248/100,000 in males 60-70 years old. Radiation exposure per nephrolithiasis episode was 37.3 mSv over a 2-year period. Data regarding average stone episodes per patient with nephrolithiasis was limited and conservatively estimated at 1.5. Modeled lifetime attributable risk of secondary malignancy and subsequent mortality in individual stone patients ranged from 0.096% and 0.085%, respectively, in males over the age of 70 to 0.59% and 0.39% in females 20-30 years old. In the USA, overall incidence of secondary malignancy and associated mortality related to nephrolithiasis management was calculated to be 862.7 and 545.3 cases/year, respectively. CONCLUSION This model suggests that ionizing radiation from the management of nephrolithiasis carries a small but significant risk of causing secondary malignancy. This knowledge must be considered when using modalities that involve radiation in the diagnosis and therapeutic management of nephrolithiasis.
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Abstract
Patients with nephrolithiasis are exposed to significant quantities of ionizing radiation with the potential to cause secondary malignancy. This risk is magnified by the high recurrence rate of nephrolithiasis. In this article, we identify the risks of ionizing radiation as they pertain to patients with nephrolithiasis. We then identify evidence-based techniques for mitigating patient radiation exposure in the preoperative, intraoperative, and postoperative settings. Key factors include limiting the use of computed tomographic imaging, appropriate modulation of fluoroscopy settings, and minimizing rates of stone recurrence.
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Affiliation(s)
- Todd Samuel Yecies
- Department of Urology, University of Pittsburgh Medical Center, 200 Lothrop Street, Kaufman Building, 701, Pittsburgh, PA 15213, USA
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Increasing the size of ureteral access sheath during retrograde intrarenal surgery improves surgical efficiency without increasing complications. World J Urol 2018; 36:971-978. [DOI: 10.1007/s00345-018-2204-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022] Open
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Brooks NA, Paul CJ, Ghareeb GM, Tracy CR. Pushing Stones Uphill: Why Patients Are Lost to Follow-Up After Uncomplicated Ureteroscopy. J Endourol 2017; 31:135-140. [DOI: 10.1089/end.2016.0675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Charles J. Paul
- Department of Urology, The University of Iowa, Iowa City, Iowa
| | | | - Chad R. Tracy
- Department of Urology, The University of Iowa, Iowa City, Iowa
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Abbott JE, Han A, McDonald M, Lakin C, Sur RL. Are antibiotics necessary during routine cystoscopic stent removal? Transl Androl Urol 2016; 5:784-788. [PMID: 27785437 PMCID: PMC5071197 DOI: 10.21037/tau.2016.08.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The 2008 American Urological Association (AUA) Best Practice Statement on antimicrobial prophylaxis states that prophylaxis is not warranted for subjects with normal risk profile undergoing cystourethroscopy unless manipulation such as ureteral stent removal is performed. To date no studies have specifically assessed the need for antimicrobial prophylaxis during cystoscopic ureteral stent removal. We sought to determine the risk of infectious complications following cystoscopic stent removal with and without antimicrobial prophylaxis. METHODS A retrospective review identified 70 subjects who underwent cystoscopic ureteral stent removal following kidney stone treatment, under the care of two separate urologists with differing practice patterns. Each cohort consisted of 35 subjects: with and without prophylactic antibiotics. Clinical variables assessed included demographics, type of stone intervention, prior urinary tract infection (UTI) history, immunocompromising comorbidities, antimicrobial class at time of stone intervention, and antimicrobial administration at cystoscopic stent removal. The primary outcome assessed was development of symptomatic UTI within 4 weeks after stent removal. RESULTS Overall, 35 patients (50%) received antimicrobial prophylaxis at the time of stent removal and 35 (50%) did not receive antimicrobial prophylaxis, with no demographic or clinical differences between cohorts. Two patients in the antimicrobial cohort (6%) developed a UTI and none of the patients who did not receive antimicrobial prophylaxis developed a UTI (P=0.15). CONCLUSIONS In our cohort study antimicrobial prophylaxis at the time of cystoscopic stent removal did not appear to provide a significant benefit in UTI prevention. Prospective studies would assist in validating these findings.
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Affiliation(s)
- Joel E Abbott
- Department of Urology, University of California, San Diego, San Diego, CA, USA
| | - Allison Han
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Michelle McDonald
- Department of Urology, University of California, San Diego, San Diego, CA, USA
| | - Charlie Lakin
- Department of Urology, University of California, San Diego, San Diego, CA, USA
| | - Roger L Sur
- Department of Urology, University of California, San Diego, San Diego, CA, USA
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Kim SW, Ahn JH, Yim SU, Cho YH, Shin BS, Chung HS, Hwang EC, Yu HS, Oh KJ, Kim SO, Jung SI, Kang TW, Kwon DD, Park K. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy. Investig Clin Urol 2016; 57:343-50. [PMID: 27617316 PMCID: PMC5017563 DOI: 10.4111/icu.2016.57.5.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/04/2016] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis.
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Affiliation(s)
- Sun Woo Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Hoon Ahn
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Un Yim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Yang Hyun Cho
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Bo Sung Shin
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Editorial Comment. Urology 2016; 93:38. [DOI: 10.1016/j.urology.2016.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dauw CA, Simeon L, Alruwaily AF, Sanguedolce F, Hollingsworth JM, Roberts WW, Faerber GJ, Wolf JS, Ghani KR. Contemporary Practice Patterns of Flexible Ureteroscopy for Treating Renal Stones: Results of a Worldwide Survey. J Endourol 2015; 29:1221-30. [DOI: 10.1089/end.2015.0260] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Casey A. Dauw
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Laika Simeon
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | | | | | | | - William W. Roberts
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary J. Faerber
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - J. Stuart Wolf
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Khurshid R. Ghani
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
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How Much is a Kidney Worth? Cost-Effectiveness of Routine Imaging After Ureteroscopy to Prevent Silent Obstruction. J Urol 2013; 189:2136-41. [DOI: 10.1016/j.juro.2012.12.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 11/16/2022]
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Abstract
Imaging of the genitourinary tract is essential in the workup of the majority of the conditions seen daily by urologists. The use of ultrasound in the office provides a safe, low cost, and efficient way for the clinician to evaluate the patient in real time. Ultrasound can allow for bedside diagnosis in many conditions and assist in treatment planning. This chapter covers the major applications of office ultrasound for the urologist as well as discusses future applications of ultrasound for the office setting.
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Affiliation(s)
- Etai Goldenberg
- Hofstra North Shore-LIJ School of Medicine, The Arthur Smith Institute for Urology, New Hyde Park, NY 11042, USA.
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Viprakasit DP, Sawyer MD, Herrell SD, Miller NL. Limitations of Ultrasonography in the Evaluation of Urolithiasis: A Correlation With Computed Tomography. J Endourol 2012; 26:209-13. [DOI: 10.1089/end.2011.0177] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Davis P. Viprakasit
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark D. Sawyer
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. Duke Herrell
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicole L. Miller
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Urological Aspects of Management. Clin Rev Bone Miner Metab 2012. [DOI: 10.1007/s12018-011-9109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Resorlu B, Kara C, Resorlu EB, Unsal A. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatr Surg Int 2011; 27:1337-41. [PMID: 21953523 DOI: 10.1007/s00383-011-2979-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of ultrasonography and to determine whether ionizing radiation is necessary in the postoperative follow-up of children undergoing ureteroscopy. METHODS We reviewed the charts of 49 children who underwent 51 ureteroscopic procedures for ureteral calculi. Renal ultrasound and intravenous urography were performed in all patients at 3 months after surgery for postoperative evaluation. RESULTS In three cases, stones migrated to the kidney. Retrograde intrarenal surgery was performed in two patients and one patient required shockwave lithotripsy to become stone-free. Fourty-six children were completely stone-free and 3 had residual fragments on plain film in the postoperative 3 month. The sensitivity, specificity, negative and positive predictive values of ultrasonography for detecting hydronephrosis were 85.7, 100, 97.7 and 100%, respectively. Two patients under observation and three patients under medical expulsive therapy had resolution of hydronephrosis on follow-up. One patient required ureteroscopy for residual obstructing fragments. CONCLUSIONS Ultrasonography has limited accuracy for detecting residual ureteral stones, but it is a highly specific and reasonably sensitive test for detecting hydronephrosis. A combination of ultrasonography and plain film is a safe and effective imaging procedure in postoperative follow-up of children undergoing ureteroscopy.
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Affiliation(s)
- Berkan Resorlu
- Ministry of Health, Kecioren Training and Research Hospital, Ankara, Turkey.
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