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Tokuc E, Eksi M, Kayar R, Demir S, Topaktas R, Bastug Y, Akyuz M, Ozturk M. Inflammation indexes and machine-learning algorithm in predicting urethroplasty success. Investig Clin Urol 2024; 65:240-247. [PMID: 38714514 PMCID: PMC11076797 DOI: 10.4111/icu.20230302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/06/2023] [Accepted: 12/29/2023] [Indexed: 05/10/2024] Open
Abstract
PURPOSE To assess the predictive capability of hematological inflammatory markers for urethral stricture recurrence after primary urethroplasty and to compare traditional statistical methods with a machine-learning-based artificial intelligence algorithm. MATERIALS AND METHODS Two hundred eighty-seven patients who underwent primary urethroplasty were scanned. Ages, smoking status, comorbidities, hematological inflammatory parameters (neutrophil-lymphocyte ratios, platelet-lymphocyte ratios [PLR], systemic immune-inflammation indexes [SII], and pan-immune-inflammation values [PIV]), stricture characteristics, history of previous direct-visual internal urethrotomy, urethroplasty techniques, and grafts/flaps placements were collected. Patients were followed up for one year for recurrence and grouped accordingly. Univariate and multivariate logistic regression analyses were conducted to create a predictive model. Additionally, a machine-learning-based logistic regression analysis was implemented to compare predictive performances. p<0.05 was considered statistically significant. RESULTS Comparative analysis between the groups revealed statistically significant differences in stricture length (p=0.003), localization (p=0.027), lymphocyte counts (p=0.008), PLR (p=0.003), SII (p=0.003), and PIV (p=0.001). In multivariate analysis, stricture length (odds ratio [OR] 1.230, 95% confidence interval [CI] 1.142-1.539, p<0.0001) and PIV (OR 1.002, 95% CI 1.000-1.003, p=0.039) were identified as significant predictors of recurrence. Classical logistic regression model exhibited a sensitivity of 0.76, specificity of 0.43 with an area under curve (AUC) of 0.65. However, the machine-learning algorithm outperformed traditional methods achieving a sensitivity of 0.80, specificity of 0.76 with a higher AUC of 0.82. CONCLUSIONS PIV and machine-learning algorithms shows promise on predicting urethroplasty outcomes, potentially leading to develop possible nomograms. Evolving machine-learning algorithms will contribute to more personalized and accurate approaches in managing urethral stricture.
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Affiliation(s)
- Emre Tokuc
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye.
| | - Mithat Eksi
- Urology Clinic, Bakırkoy Dr. Sadi Konuk SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Ridvan Kayar
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Samet Demir
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Ramazan Topaktas
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Yavuz Bastug
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Mehmet Akyuz
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
| | - Metin Ozturk
- Urology Clinic, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Türkiye
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Arikan Y, Eksi M, Sungur U, Yoldas M, Keskin MZ, Tevfik ZM, No SC. Variation coefficient of stone density and renal cortical thickness: the parameters evaluating non-contrast computed tomography imaging for predict extracorporeal shock wave lithotripsy success. Urolithiasis 2024; 52:53. [PMID: 38564004 DOI: 10.1007/s00240-024-01561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates.
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Affiliation(s)
- Yusuf Arikan
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Mithat Eksi
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ubeyd Sungur
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yoldas
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Zeynel Keskin
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | | | - Saglam Cd No
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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Kalkanli A, Sönmez SZ, Guvel M, Aglamis E, Araz S, Asfuroglu A, Avci HK, Aydin M, Aydos M, Balci U, Baran C, Bastug Y, Baydilli N, Bayrak O, Benlioglu C, Halil Bozkurt I, Bursali K, Can U, Coser S, Caglar Cakici M, Calik G, Cift A, Cilesiz NC, Demir DO, Demir M, Cihan Demirel H, Dursun M, Demirelli E, Ekenci BY, Eksi M, Ergin G, Ergin IE, Erkan A, Fikri O, Tugrul Gezmis C, Gül A, Guzelsoy M, Ibis MA, Inkaya A, Ipekci T, Karakeci A, Karkin K, Kaya C, Kazan O, Koray Kirdag M, Cagri Kizilcay Y, Koseoglu B, Kucuk E, Gonultas S, Ogras MS, Olgun A, Ordek E, Ozbey I, Sarier M, Senel S, Tahra A, Toprak T, Yigit Yalcin M, Hizir Yavuzsan A, Yazar S, Hacıbey İ, Yildirim K, Yilmaz K, Yilmaz S, Yoldas M, Yuce A, Ozgur Yucel M, Nedim Yuceturk C, de la Rosette J, Kadioglu A. Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines. Urol Res Pract 2023; 49:225-232. [PMID: 37877823 PMCID: PMC10544432 DOI: 10.5152/tud.2023.22209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 04/06/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. METHODS Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. RESULTS Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. CONCLUSION It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.
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Affiliation(s)
- Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Salih Zeki Sönmez
- Department of Urology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Mine Guvel
- Istanbul Provincial Health Directorate, Istanbul, Turkey
| | | | - Seyhmuz Araz
- Department of Urology, Esenyurt Necmi Kadıoğlu State Hospital, Istanbul, Turkey
| | | | - Huseyin Kursad Avci
- Department of Urology, Ankara Gülhane Training and Research Hospital, Ankara, Turkey
| | - Memduh Aydin
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Murat Aydos
- Department of Urology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ugur Balci
- Department of Urology, Katip Çelebi University, School of Medicine, Izmir, Turkey
| | - Caner Baran
- Department of Urology, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Yavuz Bastug
- Department of Urology, Haydarpaşa Education and Research Hospital, Istanbul, Turkey
| | - Numan Baydilli
- Department of Urology, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Omer Bayrak
- Department of Urology, Gaziantep University, School of Medicine, Gaziantep, Turkey
| | - Can Benlioglu
- Department of Urology, Adıyaman University, School of Medicine, Adiyaman, Turkey
| | | | - Kerem Bursali
- Department of Urology, Şişli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Utku Can
- Department of Urology, Kartal Dr Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Seref Coser
- Department of Urology, Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, Göztepe Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Gokhan Calik
- Department of Urology, Medipol University, School of Medicine, Istanbul, Turkey
| | - Ali Cift
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Nusret Can Cilesiz
- Department of Urology, Biruni University, School of Medicine, Istanbul, Turkey
| | | | - Murat Demir
- Department of Urology, Van YY University, School of Medicine, Van, Turkey
| | | | - Murat Dursun
- Department of Urology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey
| | - Erhan Demirelli
- Department of Urology, Giresun University, School of Medicine, Giresun, Turkey
| | - Berk Yasin Ekenci
- Department of Urology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Mithat Eksi
- Department of Urology, Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Giray Ergin
- Department of Urology, Koru Hospital, Ankara, Turkey
| | - Ismail Emre Ergin
- Department of Urology, Cumhuriyet University, School of Medicine, Sivas, Turkey
| | - Anil Erkan
- Department of Urology, Katip Çelebi University, School of Medicine, Izmir, Turkey
| | - Onur Fikri
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Cem Tugrul Gezmis
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Abdullah Gül
- Department of Urology, Bursa Education and Research hospital, Bursa, Turkey
| | - Muhammet Guzelsoy
- Department of Urology, Katip Çelebi University, School of Medicine, Izmir, Turkey
| | - Muhammed Arif Ibis
- Department of Urology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Abdurrahman Inkaya
- Department of Urology, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Tumay Ipekci
- Department of Urology, Bahceşehir University, School of Medicine, Istanbul, Turkey
| | - Ahmet Karakeci
- Department of Urology, Fırat University, School of Medicine, Elazığ, Turkey
| | - Kadir Karkin
- Department of Urology, Adana City Hospital, Adana, Turkey
| | - Coskun Kaya
- Department of Urology, Eskişehir City Hospital, Eskişehir, Turkey
| | - Ozgur Kazan
- Department of Urology, Göztepe Medeniyet University, School of Medicine, Istanbul, Turkey
| | | | - Yigit Cagri Kizilcay
- Department of Urology, Balıkesir University, School of Medicine, Balıkesir, Turkey
| | - Burak Koseoglu
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | - Emrah Kucuk
- Department of Urology, Akçakale State Hospital, Şanlıurfa, Turkey
| | - Serkan Gonultas
- Department of Urology, aziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | | | - Ahmet Olgun
- Department of Urology, Elazığ City Hospital, Elazığ, Turkey
| | - Eser Ordek
- Department of Urology, Gazi University, School of Medicine, Ankara, Turkey
| | - Isa Ozbey
- Department of Urology, Kahta State Hospital, Adıyaman, Turkey
| | - Mehmet Sarier
- Department of Urology, Atatürk University, School of Medicine, Erzurum, Turkey
| | - Samet Senel
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Tahra
- Department of Urology, Medipol University, School of Medicine, Istanbul, Turkey
| | - Tuncay Toprak
- Department of Urology, Istinye University, School of Medicine, Istanbul, Turkey
| | | | - Abdullah Hizir Yavuzsan
- Department of Urology, Kartal Dr Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Selim Yazar
- Department of Urology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - İbrahim Hacıbey
- Department of Urology, Rize Training and Research Hospital, Rize, Turkey
| | - Kadir Yildirim
- Department of Urology, Medical Park Hospital, Elazığ, Turkey
| | - Kemal Yilmaz
- Department of Urology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Sercan Yilmaz
- Department of Urology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet Yoldas
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ahmet Yuce
- Department of Urology, Darende State Hospital, Malatya, Turkey
| | - Mehmet Ozgur Yucel
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Cem Nedim Yuceturk
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Jean de la Rosette
- Department of Urology, Medipol University, School of Medicine, Istanbul, Turkey
| | - Ates Kadioglu
- Department of Urology, Section of Andrology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey On Behalf of Turkish Urology Academy
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Arikan Y, Eksi M, Tasci AI. Comparison of oncological and functional outcomes of perineoscopic radical prostatectomy and robot-assisted radical prostatectomy. Updates Surg 2023:10.1007/s13304-023-01453-3. [PMID: 36788157 DOI: 10.1007/s13304-023-01453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
The aim of this study is to compare the functional, oncological, and complication outcomes of perineoscopic radical prostatectomy (PeRP) and robot-assisted radical prostatectomy (RARP) operations. Patients who underwent radical prostatectomy (RP) between October 2018 and June 2020 for localized prostate cancer (N0, < T3) were retrospectively screened. After the exclusion criteria, 56 patients who underwent PeRP and 67 patients who underwent RARP remained in the study. Demographic, perioperative, and postoperative data were collected. In functional outcomes, continence and potency status were compared at 1, 3, 6, and 12 months. The mean age of the patients was 61.3 ± 5.9 years in the PeRP group and 62.2 ± 5.7 years in the RARP group. No statistically significant differences were present between preoperative and postoperative values. Among the perioperative findings, the mean operation time was 90.4 ± 11.2 min for the PeRP group and 114.6 ± 14.7 min for the RARP group. The operation time was shorter in the PeRP group. The average hospital stay was 2 ± 0.6 days in the PeRP group and 2.3 ± 0.5 days in the RARP group. It was significantly shorter in the PeRP group. There is no statistically significant difference between the two groups in the oncological and functional results. PeRP is a surgical procedure safe in low-risk patients with medium-risk prostate cancer (PCa) who do not require lymph-node dissection. Moreover, PeRP minimizes the difficulties of perineal surgery.
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Affiliation(s)
- Yusuf Arikan
- Urology, Mus State Hospital, Saray Mah., Yeni Hastane Cad., No:1/A, Muş Merkez, Turkey.
| | - Mithat Eksi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh. Tevfik Saglam Cd. No:11 Bakirkoy, Istanbul, Turkey
| | - Ali Ihsan Tasci
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh. Tevfik Saglam Cd. No:11 Bakirkoy, Istanbul, Turkey
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Eksi M, Arikan Y, Simsek A, Ozdemir O, Karadag S, Gurbuz N, Sahin S, Tasci AI. Factors affecting length of stay in Fournier's gangrene: a retrospective analysis of 10 years' data. Aktuelle Urol 2022; 53:262-268. [PMID: 33086391 DOI: 10.1055/a-1260-2576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene. MATERIAL AND METHODS A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated. RESULTS Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ± 2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality. CONCLUSION Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.
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Affiliation(s)
- Mithat Eksi
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Urology, Istanbul
| | - Yusuf Arikan
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Urology, Istanbul
| | | | - Osman Ozdemir
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Urology, Istanbul
| | - Serdar Karadag
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Urology, Istanbul
| | - Necati Gurbuz
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Urology, Istanbul
| | - Selcuk Sahin
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Urology, Istanbul
| | - Ali Ihsan Tasci
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Urology, Istanbul
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Karadag S, Eksi M, Ozdemir O, Kargi T, Haciislamoglu A, Evren I, Polat H, Sokmen D, Ozlu DN, Sahin S, Tugcu V. Comparison of Open and Robot-Assisted Kidney Transplantation in terms of Perioperative and Postoperative Outcomes. Int J Clin Pract 2022; 2022:2663108. [PMID: 35685484 PMCID: PMC9159158 DOI: 10.1155/2022/2663108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT). Methods Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded. Results 98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group. Conclusion Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.
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Affiliation(s)
- Serdar Karadag
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mithat Eksi
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Osman Ozdemir
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Taner Kargi
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Haciislamoglu
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Evren
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hakan Polat
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Dogukan Sokmen
- Department of Urology, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Deniz Noyan Ozlu
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Department of Urology, Bahçelievler Memorial Hospital, Istanbul, Turkey
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Sokmen BK, Sokmen D, Comez Yİ, Eksi M. Prediction of Prostate Cancer Aggressiveness Using a Novel Multiparametric Magnetic Resonance Imaging Parameter: Tumor Heterogeneity Index. Urol Int 2022; 106:946-953. [DOI: 10.1159/000521606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Background and Aims:</i></b> The aim of this study was to evaluate if the tumor heterogeneity index can predict the aggressiveness of prostate cancer (PCa) in patients diagnosed by magnetic resonance imaging (MRI) fusion biopsy. <b><i>Material and Methods:</i></b> Patients who underwent MRI fusion prostatic biopsy between July 2019 and December 2020 were retrospectively reviewed. Tumor heterogeneity index (coefficient of variation [CV]) and PI-RADS v2.1 scoring were analyzed by using multiparametric MRI. The patients were divided into 3 groups according to the risk classification, and the correlation between tumor heterogeneity index and PCa aggressiveness was studied by using apparent diffusion coefficient (ADC<sub>mean</sub> and ADC<sub>cv</sub>), Gleason score (GS), and risk classifications. <b><i>Results:</i></b> One hundred two patients were included in this study. Patients were evaluated as low-risk (group 1) (<i>n</i> = 35), moderate-risk (group 2) (<i>n</i> = 37), and high-risk (group 3) (<i>n</i> = 30). ADC<sub>mean</sub> values for all groups were significantly different (<i>p</i> < 0.0001). ADC<sub>cv</sub> tumor heterogeneity index values were higher in group 2 and group 3 by the score increases in subgroups according to GS, while being higher than group 1 (<i>p</i> < 0.001). The multivariate analysis revealed that prostate-specific antigen, PI-RADS, ADC<sub>mean</sub>, and ADC<sub>cv</sub> values were predictive for tumor aggressiveness. <b><i>Conclusion:</i></b> ADC<sub>cv</sub> value as a tissue texture parameter can be used as a new biomarker to evaluate tumor aggressiveness in patients with PCa.
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Yavuzsan AH, Albayrak AT, Yesildal C, Ilgi M, Baloglu IH, Eksi M, Horasanli K, Kirecci SL, Ozkurt H. The role of preoperative ultrasound in the diagnosis of penile fractures and the effect of tunica defect length on postoperative functional outcomes. Int J Clin Pract 2021; 75:e14568. [PMID: 34165862 DOI: 10.1111/ijcp.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aimed to investigate the rate of tunica defect detection by postoperative penile ultrasound (US) and the effect of tunica defect length (TDL) on functional outcomes. METHODS Forty-six patients who underwent early penile fracture surgery in our hospital between July 2010 and December 2018 were included in the study. Each diagnosis was made via history, physical examination and US. Functional outcomes were assessed at 3, 6 and 12 months postoperatively. The International Index of Erectile Function-5 (IIEF-5) score was used to assess erectile function. US detection rates for tunica defects, as well as whether the rates changed according to TDL, were also analysed. The TDL cut-off value for US detection was determined to be 11 mm using the receiver operating characteristic curve. The impact of TDL on functional outcomes was also evaluated using this cut-off value. RESULTS The main cause of fractures in 34 patients (74%) was sexual intercourse. One patient (2.2%) had penile curvature, and 16 (34.8%) had penile nodules in the follow-ups. US had a higher detection rate in the group with TDL >11mm (94% vs 25%). IIEF-5 scores at the postoperative third month were statistically lower in patients with TDL >11mm (n = 34) compared with those with ≤11 mm (n = 12). The rate of penile nodules was found to be statistically higher in the group with TDL >11mm at the end of the 1-year follow-up period (44.1% vs 8.3%). CONCLUSIONS US is a valuable tool for the detection of tunica defects especially with >11mm length. In addition, TDL >11 mm in penile fractures is associated with lower IIEF-5 scores in the early postoperative period and higher rates of penile nodules.
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Affiliation(s)
- Abdullah Hizir Yavuzsan
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Tevfik Albayrak
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cumhur Yesildal
- Department of Urology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Musab Ilgi
- Department of Urology, KMG Klinikum Luckenwalde, Luckenwalde, Germany
| | - Ibrahim Halil Baloglu
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mithat Eksi
- Department of Urology, Arnavutkoy State Hospital, Istanbul, Turkey
| | - Kaya Horasanli
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sinan Levent Kirecci
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Ozkurt
- Department of Radiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Eksi M, Evren İ, Akkas F, Arikan Y, Ozdemir O, Ozlu D, Ayten A, Sahin S, Tugcu V, Tasci A. Machine learning algorithms can more efficiently predict biochemical recurrence after robot assisted radical prostatectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Eksi M, Arikan Y, Simsek A, Ozdemir O, Karadag S, Gurbuz N, Sahin S, Tasci A. Factors affecting length of stay and mortality in Fournier gangrene: A retrospective analysis of 10 years data. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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11
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Arıkan Y, Ozdemir O, Seker KG, Eksi M, Guner E, Kalfazade N, Sahin S, Tasci AI. Gossypiboma: A Dramatic Result of Human Error, Case Report and Literature Review. Prague Med Rep 2020; 120:144-149. [PMID: 31935350 DOI: 10.14712/23362936.2019.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Gossypiboma refers to a retained foreign object that was forgotten in the body cavity during an operation. It is a rare surgical complication that most commonly occurs after intraperitoneal abdominal emergency surgical procedures, but may also occur after virtually any type of operation. Gossypiboma can be confused with neoplastic lesions and abscess. Clinical examination and radiological findings may sometimes mislead the physician. We intend to present our cases, which is thought to be a kidney tumour and bladder cancer but resulted gossypiboma which is a condition that is caused by a forgotten sponge during the operation and it can mimic the cancer. During the operation, the team must work in coordination and be careful. Unnecessary operations in such situation can significantly increase the patient's morbidity.
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Affiliation(s)
- Yusuf Arıkan
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Osman Ozdemir
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Kamil Gokhan Seker
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mithat Eksi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ekrem Guner
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nadir Kalfazade
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Ihsan Tasci
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Seker KG, Eksi M, Colakoglu Y, Yenice MG, Akbay FG, Tugcu V, Simsek A. A rare cause of acute post renal failure: Retroperitoneal fibrosis. ACTA ACUST UNITED AC 2017; 89:301-304. [PMID: 29473379 DOI: 10.4081/aiua.2017.4.301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/23/2017] [Indexed: 11/23/2022]
Abstract
Retroperitoneal fibrosis is an inflammatory process which may cause acute renal failure. In patients who admitted to emergency services with obstructive uropathy, retroperitoneal fibrosis should be considered in the differential diagnosis. We present our ten cases who admitted to emergency department with obstructive acute renal failure related to retroperitoneal fibrosis.
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Affiliation(s)
- Kamil Gokhan Seker
- Bakirkoy Sadi Konuk Research and Training Hospital, Department of Urology, Istanbul.
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13
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Atar A, Eksi M, Güler AF, Tuncer M, Akkas F, Tugcu V. Long Term Outcomes of Laparoscopic and Open Modified Lich-Gregoir Reimplantation in Adults: A multicentric comparative study. Pak J Med Sci 2017; 33:788-792. [PMID: 29067040 PMCID: PMC5648939 DOI: 10.12669/pjms.334.12661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & Objective: Obstructive ureteral pathologies in adult patients are most commonly due to ureteral strictures and secondary to surgical interventions. In this study, we aimed to compare open and laparoscopic modified Lich-Gregoir ureteral reimplantation with regards to outcomes in benign ureteral pathologies in adult patients. Methods: Between December 2008 and December 2014, 32 open cases and 29 laparoscopic cases were performed as per the data retrieved from surgical databases. All laparoscopic procedures were performed in Bakirkoy Dr. Sadi Konuk Training and Research Hospital(BEAH) and all open ureteral reimplantation procedures in Kartal Dr Lutfi Kirdar Training and Research Hospital(KEAH) and Okmeydani Training and Research Hospital(OEAH). Results: The mean operation time was significantly lower in the group of patients operated with open group (142.5 minutes versus 188.9 minutes; P< 0.0001). The mean duration of follow-up was longer in the laparoscopy group (31 versus 28 months; p< 0.0001). The mean amount of operation associated blood loss was significantly lower in patients operated laparoscopically (93.7 mL versus 214 mL; P< 0.0001). The mean VAS score obtained six hours after surgery was 6.6 ± 0.8 in open group, and 5.8 ± 0.7 in laparoscopic group (p=0.0004). The mean VAS scores measured at post-operative day 1 was 4.5 ± 0.7 in open group and 3.7 ± 0.9 in laparoscopy group. Time required to achieve the pre-operative capability of daily activities was significantly longer in open group (15 ± 1.4 days vs 11 ± 1.4 days; p< 0.0001). Conclusion: Despite open techniques provide shorter operation time and laparoscopic techniques require long learning curve, we think that laparoscopic techniques are superior to open ones since that they provide a better post-operative comfort and are better tolerated in terms of complications.
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Affiliation(s)
- Arda Atar
- Arda Atar, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Mithat Eksi
- Mithat Eksi, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Ahmet Faysal Güler
- Ahmet Faysal Güler, Okmeydani Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Murat Tuncer
- Murat Tuncer, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Deparment of Urology, Istanbul, Turkey
| | - Fatih Akkas
- Fatih Akkas, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Volkan Tugcu
- Volkan Tugcu, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
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14
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Eksi M, Evren I, Atar FA, Tugcu V. Unexpected Etiology of Pure Macroscopic Hematuria: Emphysematous Cystitis. J Emerg Med Case Rep 2017. [DOI: 10.5152/jemcr.2016.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Tugcu V, Sener NC, Sahin S, Sevinc C, Eksi M, Yavuzsan AH, Tasci AI. Immediate Continence Rates in RALRP: A Comparison of Three Techniques. JSLS 2016; 20:JSLS.2016.00058. [PMID: 27777500 PMCID: PMC5067246 DOI: 10.4293/jsls.2016.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Robot-assisted laparoscopic radical prostatectomy (RALRP) is said to provide excellent long-term continence. In this study, we compared the early incontinence outcomes of our patients, who had undergone no reconstruction, posterior reconstruction only, or total anatomic restoration and posterior reconstruction. Methods: We retrospectively analyzed the patients who underwent RALRP for localized prostate cancer by a single surgeon in our clinic from January 1, 2009–February 1, 2016. Continence was defined as no leakage or use of a safety pad for minimal leakage. The main outcome measure was continence at postoperative week 1 and months 1, 6, and 12. Results: Between 2009 and 2016, 239 patients underwent RALRP for localized prostate disease. Seventy-four patients underwent a standard approach (group 1), 88 had posterior reconstruction (group 2), and 77 had posterior reconstruction with total anatomic restoration (group 3). After 1 week, 24.3% of the patients in group 1 (18/74), 31.8% in group 2 (28/88), and 45.8% in group 3 (33/72) were continent (P = .02). One month after the surgery, continence rates for groups 1, 2, and 3 were 56.7, 67, and 75%, respectively (0.065). After 6 and 12 months, continence rates for groups 1, 2, and 3 were 72.9 and 87.8%, 81.8 and 89.7%, and 84.7 and 91.6%, respectively (P = .178 and .7484). Conclusion: Anatomic restoration improves continence rates in the early period after RALRP. Even though other parameters were higher in the total restoration group, immediate continence (at 1 week) was significantly better.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Nevzat Can Sener
- Department of Urology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Cuneyd Sevinc
- Department of Urology, Medicana Beylikduzu International Hospital, Istanbul, Turkey
| | - Mithat Eksi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Abdullah Hizir Yavuzsan
- Department of Urology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Ali Ihsan Tasci
- Department of Urology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
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16
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Sahin S, Resorlu B, Atar FA, Eksi M, Sener NC, Tugcu V. Laparoscopic Ureterolithotomy with Concomitant Pyelolithotomy Using Flexible Cystoscope. Urol J 2016; 13:2833-2836. [PMID: 27734424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To report and discuss the treatment of ipsilateral upper ureteral and renal stones by laparoscopic ureterolithotomy with concomitant pyelolithotomy using flexible cystoscope. MATERIALS AND METHODS A total of 19 patients (14 men and 5 women) underwent laparoscopic retroperitoneal ureterolithotomy with concomitant pyelolithotomy using flexible cystoscope through the ureterotomy site. The mean age of the patients was 37.9 (22-61) years. Stones were on the right side in 12, on the left side in 7, and multiple in 6 patients. All ureteral stones were located in the upper ureter. Most renal stones were in the pelvis or in the calices. RESULTS All procedures were completed laparoscopically without conversion to open surgery. Mean operation duration was 86.5 (range: 80-93) minutes, thus operation duration was prolonged by a mean of 24.4 minutes in patients with concomitant stone extraction. Fifteen cases were treated using flexible cystoscope and a nitinol basket; in the remaining four cases holmium laser lithotripsy was performed. Complete stone clearance was confirmed by postoperative imaging in all patients. CONCLUSIONS Laparoscopic ureterolithotomy with concomitant pyelolithotomy is a feasible and effective technique for patients with large ureteral stone and low renal stone burden. .
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Affiliation(s)
- Selcuk Sahin
- Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey.
| | - Berkan Resorlu
- Department of Urology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Feyzi Arda Atar
- Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Mithat Eksi
- Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Nevzat Can Sener
- Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Volkan Tugcu
- Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
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17
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Sahin S, Resorlu B, Eksi M, Aras B, Atar A, Tugcu V. Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis. Pak J Med Sci 2016; 32:570-4. [PMID: 27375691 PMCID: PMC4928400 DOI: 10.12669/pjms.323.9938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones. Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group. Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001). Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities.
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Affiliation(s)
- Selcuk Sahin
- Selcuk Sahin, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Berkan Resorlu
- Berkan Resorlu, Department of Urology, Ondokuz Mayis Univercity, Faculty of Medicine, Samsun, Turkey
| | - Mithat Eksi
- Mithat Eksi, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Bekir Aras
- Bekir Aras, Department of Urology, Dumlupinar Univercity, Faculty of Medicine, Kutahya, Turkey
| | - Arda Atar
- Arda Atar, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Volkan Tugcu
- Volkan Tugcu, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
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Tugcu V, Resorlu B, Sahin S, Atar A, Kocakaya R, Eksi M, Tasci AI. Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience. Urol Int 2015; 96:77-82. [PMID: 25999091 DOI: 10.1159/000430452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/10/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare safety and effectiveness of flexible ureteroscopy (F-URS) and laparoscopic retroperitoneal ureterolithotomy (L-RU) in treatment of proximal ureteral stones larger than 15 mm. MATERIALS AND METHODS This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients' characteristics and procedure-related parameters including success rate, operation time, hospital stay, postoperative visual analogue scale (VAS) scores, auxiliary procedures, and complications were compared between Groups I and II. RESULTS It was seen that both methods were effective in the treatment of large ureteral stones; however, R-LU provided a higher stone-free rate (100 vs. 87.5%), a lower complication rate (10.6 vs. 23.7%), and a shorter operation time (65.4 vs. 75.1 min). On the other hand, patients treated with F-URS had less postoperative pain, a shorter hospital stay, a faster return to daily activities. CONCLUSIONS For treatment of large proximal ureteral stones, L-RU provides significantly higher success and lower retreatment rate compared with F-URS. Our results also indicate that R-LU, which has been regarded as an invasive procedure is not as invasive as it is thought to be, and it must be kept in mind that F-URS may cause complications despite its noninvasive nature.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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