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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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2
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Sonmez MG, Guven S, Tuncel A, Karabulut I, Kilic O, Seckiner I, Tefik T, Atis G, Ergin G, Tugcu V, Erkurt B, Muslumanoglu A, Sarica K. A multicenter-based critical analysis of laser settings during intrarenal laser lithotripsy by the Turkish academy of urology prospective study group (ACUP study). Turkish Journal of Urology 2022; 48:64-73. [PMID: 35118991 PMCID: PMC9612732 DOI: 10.5152/tud.2022.21214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: In this multicenter prospective study, we aimed to evaluate the use of holmium:yttrium–aluminum–garnet laser during retrograde intrarenal surgery for kidney stones and the relationship between laser-related parameters and procedure-related perioperative parameters. Material and methods: The 769 patients whose laser setting parameters (fiber thickness, number of shots, frequency (max.), laser power (max.), and total energy) were completely registered were included in this study program. The intraoperative ureteral lesions were evaluated using postureteroscopic lesion scale (PULS) scores and the postoperative complications with the modified Clavien-Dindo classification system. Results: The maximum levels of laser power and the frequency were used in the middle calyceal stones; the value of total energy consumed was found to be higher gain in cases with multiple stones (all parameters P < .05). There was a significant positive correlation among (mean number of shots [P < .001, r = 0.46], frequency [P = .009, r = 0.1], maximum power [P < .001, r = 0.11], total energy [P < .001, r = 0.25]), anesthesia time (P < .001, r = 0.42), surgery time (P < .001, r = 0.47), and stone size. The mean number of shots increased (P < .001, r = 0.25), and the frequency level decreased (P < .001, r = –0.17) significantly with increasing Hounsfield unit (HU) values. Again, the mean number of shots and maximum laser power increased in correlation with the increasing hospitalization time (P = .004, r = 0.09 and P = .02, r = 0.07, respectively). In addition, it was observed that higher laser subparameter values and thicker fibers were used in PULS grade 2. Conclusion:
As the stone size and HU values increased, laser-setting parameters were found to show significant variability. The increase in different parameters of the laser setting was found to be associated with longer anesthesia time, surgery time, and hospitalization period and increased risk of local trauma with PULS grade.
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Affiliation(s)
- Mehmet Giray Sonmez
- Department of Urology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Selcuk Guven
- Department of Urology, Istanbul Medipol University, Mega Hospitals Complex, Istanbul, Turkey
| | - Altug Tuncel
- Department of Urology, University of Health Sciences, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Ibrahim Karabulut
- Department of Urology, University of Health Sciences, Erzurum Research and Training Hospital, Erzurum, Turkey
| | - Ozcan Kilic
- Department of Urology, Selçuk University Selçuklu Medical School, Konya, Turkey
| | - Ilker Seckiner
- Department of Urology, Gaziantep University, Gaziantep, Turkey
| | - Tzevat Tefik
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Gökhan Atis
- Department of Urology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Giray Ergin
- Department of Urology, Koru Hospital, Ankara, Turkey
| | - Volkan Tugcu
- Department of Urology, University of Health Sciences, Bakırköy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Bulent Erkurt
- Department of Urology, Istanbul Medipol University, Kosuyolu Hospital, Istanbul, Turkey
| | - Ahmet Muslumanoglu
- Department of Urology, University of Health Sciences, Bağcılar Research and Training Hospital, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Medicana Bahçelievler Hospital, Istanbul, Turkey
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Culpan M, Atis G, Sanli O, Bozkurt Y, Atmaca AF, Semerci B, Kutsal C, Canda AE, Akbulut F, Tugcu V, Boylu U, Erturhan S, Koca O, Ateş F, Halis F, Soyupek S, Turna B, Cakmak S, Sahin S, Erdem S, Yildirim A. Comparison of Tumor Enucleation and Standard Partial Nephrectomy According to Trifecta Outcomes: A Multicenter Study by the Turkish Academy of Urology, Uro-Oncology Working Group. J INVEST SURG 2021; 35:1112-1118. [PMID: 34913804 DOI: 10.1080/08941939.2021.2015490] [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: 10/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN). MATERIALS AND METHODS We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins. RESULTS A total of 1070 patients with a mean age 56.11 ± 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001). CONCLUSION TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.
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Affiliation(s)
- Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gokhan Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Oner Sanli
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Bozkurt
- Department of Urology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Ali Fuat Atmaca
- Faculty of Medicine, Department of Urology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bülent Semerci
- Faculty of Medicine, Department of Urology, Ege University, Izmir, Turkey
| | - Cemil Kutsal
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Fatih Akbulut
- Department of Urology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Department of Urology, University of Health Sciences, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ugur Boylu
- Department of Urology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Sakip Erturhan
- School of Medicine, Department of Urology, Gaziantep University, Gaziantep, Turkey
| | - Orhan Koca
- Department of Urology, University of Health Sciences, Haydarpasa Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Ateş
- Department of Urology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Fikret Halis
- Department of Urology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Sedat Soyupek
- School of Medicine, Department of Urology, Suleyman Demirel University, Isparta, Turkey
| | - Burak Turna
- Faculty of Medicine, Department of Urology, Ege University, Izmir, Turkey
| | - Sedat Cakmak
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Erdem
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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4
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Tural D, Akar E, Baytekin HF, Canoglu D, Yilmaz M, Tugcu V. Relationship between survival outcomes and microsatellite instability, tumor infiltrating lymphocytes and programmed cell death ligand-1 expression in patients with bladder cancer and radical cystectomy. J BUON 2021; 26:2117-2125. [PMID: 34761625] [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] [Indexed: 06/13/2023]
Abstract
PURPOSE Platin-based chemotherapies are first-line treatment methods after surgery in bladder cancer. Recently, novel immunotherapies emerged after platin-based regimens. The purpose of this study was to evaluate the prognostic significance of microsatellite instability (MSI), tumor infiltrating lymphocytes (TILs) and programmed cell death ligand-1 (PD-L1) expression which are used as predictive biomarkers in immunotherapy. METHODS Clinical and pathological features of bladder cancer patients who underwent radical cystectomy were retrospectively analyzed from their records in this single-center study. PD-L1, PD-L1 on TIL, PMS2, MSH2, MSH6 and MLH1 immunohistochemistry staining were carried out to archieve resected tumor specimens of the eligible patients. MSI was evaluated according to existing of PMS2, MSH2, MSH6 and MLH1. RESULTS MSI was high in 24.6% of 61 patients. PD-L1 expression on tumor cells and PD-L1 expression on TIL were positive in 14.8% and 16.4% of the patients, respectively. Intratumoral TIL rate was >10% in 12 patients (19.7%). There was no statistically significant relationship between PD-L1, PD-L1 on TIL, MSI and TIL rate and patients' characteristics including sex, stage, pathologic grade and lymph node status. There was a positive trend between MSI-high patients and overall survival (OS) (p=0.089). Univariate analysis did not reveal any significant difference at 3-years OS with PD-L1 tumor expression and PD-L1 expression on TIL and TIL rate >10% (p=0.822, p=0.638, p=0.318, respectively) Conclusion: This study revealed that there is a positive trend between OS and MSI but no prognostic significance of PD-L1 and TIL which are proven predictive biomarkers of immunotherapy in patients with bladder cancer.
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Affiliation(s)
- Deniz Tural
- Medical Oncology, Bakirkoy Sadi Konuk 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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6
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Musquera M, Peri L, Ajami T, Campi R, Tugcu V, Decaestecker K, Stockle M, Fornara P, Doumerc N, Vigues F, Barod R, Desender L, Territo A, Serni S, Vignolini G, Sahin S, Zeuschner P, Banga N, Breda A, Alcaraz A. Robot-assisted kidney transplantation: update from the European Robotic Urology Section (ERUS) series. BJU Int 2020; 127:222-228. [PMID: 32770633 DOI: 10.1111/bju.15199] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 12/14/2022]
Abstract
OBJECTIVE To report the results of the robot-assisted kidney transplantation (RAKT) experience performed in 10 European centres by members of the European Robotic Urology Section (ERUS)-RAKT group. PATIENTS AND METHODS This is a multicentre prospective observational study of RAKT. Descriptive analysis of recipients and donor characteristics, surgical data, intraoperative outcomes, complications rate and functional results were collected and analysed. RESULTS Between July 2015 and September 2019, 291 living-donor RAKTs were performed. Recipients were mostly male (189 [65%]), the mean Standard deviation (sd) age was 45.2 (13.35) years, the mean (sd) body mass index was 27.13 (19.28) kg/m2 , and RAKT was pre-emptive in 155 (53.8%) cases. Right and multiple arteries kidneys were used in 15.4%. The mean (sd) total surgical and re-warming time was 244 (70.5) min and 53.16 (15.27) min, respectively. In all, 17 patients presented with postoperative bleeding (5.7%). Five kidneys had delayed graft function; five (2%) were lost due to thrombosis and one due to acute rejection. Two patients had arterial stenosis, three had incisional hernias, six had ureteric stenosis, and nine had lymphoceles. Neither surgical nor re-warming times were correlated with postoperative serum creatinine levels (P > 0.05). Comparison of surgical data between the first 120 cases and the following 171 cases showed a significantly shorter total surgical time in the second group (265 vs 230 min, P = 0.005). CONCLUSIONS This is the largest European multicentre study of RAKT with good surgical and functional results competitive with open kidney transplant series, with a relatively short learning curve when performed in centres with a wide experience in open kidney transplantation and robotic surgery.
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Affiliation(s)
- Mireia Musquera
- Department of Urology, Hospital Clinic de Barcelona Instituto Clínic de Nefrología y Urología, Barcelona, Spain
| | - Lluis Peri
- Department of Urology, Hospital Clinic de Barcelona Instituto Clínic de Nefrología y Urología, Barcelona, Spain
| | - Tarek Ajami
- Department of Urology, Hospital Clinic de Barcelona Instituto Clínic de Nefrología y Urología, Barcelona, Spain
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Michael Stockle
- Department of Urology, University Saarland, Homburg/Saar, Germany
| | - Paolo Fornara
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Frances Vigues
- Department of Urology, Hospital Universitari de Bellvitge, Hospitalet del Llobregat, Spain
| | - Ravi Barod
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Selçuk Sahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Neal Banga
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic de Barcelona Instituto Clínic de Nefrología y Urología, Barcelona, Spain
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Gallioli A, Boissier R, Territo A, Campi R, Vignolini G, Musquera M, Alcaraz A, Decaestecker K, Tugcu V, Vanacore D, Serni S, Breda A. Innovations and technical variations in robot-assisted kidney transplantation: Results from the ERUS working group. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34238-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Gallioli A, Territo A, Boissier R, Campi R, Vignolini G, Musquera M, Alcaraz A, Decaestecker K, Tugcu V, Vanacore D, Serni S, Breda A. The European experience in robot-assisted kidney transplantation: Learning curve. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33556-4] [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: 11/29/2022] Open
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9
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Prudhomme T, Beauval J, Lesourd M, Roumiguié M, Decaestecker K, Vignolini G, Campi R, Serni S, Territo A, Gausa L, Tugcu V, Sahin S, Alcaraz A, Musquera M, Stockle M, Janssen M, Fornara P, Mohammed N, Kamar N, Sallusto F, Breda A, Doumerc N. Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients: The European experience. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33559-x] [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: 10/23/2022] Open
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10
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Guven S, Yigit P, Tuncel A, Karabulut İ, Sahin S, Kilic O, Balasar M, Seckiner I, Canda E, Sonmez MG, Tefik T, Boz MY, Atis G, Ergin G, Soytas M, Senel Ç, Kirac M, Kiremit MC, Akand M, Tugcu V, Erkurt B, Muslumanoglu A, Sarica K. Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study). World J Urol 2020; 39:549-554. [PMID: 32347334 DOI: 10.1007/s00345-020-03210-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/27/2019] [Accepted: 04/09/2020] [Indexed: 11/26/2022] Open
Abstract
AIMS To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study). METHODS Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program ( https://acup.uroturk.org.tr/ ) created by Turkish Urology Academy for Residual Stone Study. RESULTS A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%). CONCLUSIONS Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.
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Affiliation(s)
- Selcuk Guven
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey.
| | - Pakize Yigit
- Department of Medical Statistics and Medical Informatics, Istanbul Medipol University, Istanbul, Turkey
| | - Altug Tuncel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - İbrahim Karabulut
- Department of Urology, Erzurum Research and Training Hospital, University of Health Sciences, Erzurum, Turkey
| | - Selcuk Sahin
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozcan Kilic
- Department of Urology, Selcuklu Medical School, Selcuk University, Konya, Turkey
| | - Mehmet Balasar
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Ilker Seckiner
- Department of Urology, Gaziantep University, Gaziantep, Turkey
| | - Erdem Canda
- Department of Urology, Yıldırım Beyazit University, Ankara, Turkey
| | - Mehmet Giray Sonmez
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Mustafa Yucel Boz
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey
| | - Gokhan Atis
- Department of Urology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Giray Ergin
- Department of Urology, Koru Hospital, Ankara, Turkey
| | - Mustafa Soytas
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Çagdas Senel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Mustafa Kirac
- Department of Urology, Koru Hospital, Ankara, Turkey
| | | | - Murat Akand
- Department of Urology, Selcuklu Medical School, Selcuk University, Konya, Turkey
| | - Volkan Tugcu
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bulent Erkurt
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey
| | - Ahmet Muslumanoglu
- Department of Urology, Bagcilar Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University, Istanbul, Turkey
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11
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Tasci AI, Simsek A, Sam E, Seker KG, Atar FA, Sahin S, Tugcu V. Gasless robotic perineal radical prostatectomy: Experience of the first 12 cases. ARCH ESP UROL 2020; 73:236-241. [PMID: 32240115] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To present our results of first 12 patients on whom we performed gasless robotic perineal radical prostatectomy (r-PRP). METHODS We performed gasless r-PRP on 12 patients between August 2018 and October 2018. Multiparametric magnetic resonance imaging was performed forall patients to exclude local advanced disease. Demographic characteristics, technical details, and intra and postoperative data were analyzed. RESULTS The mean age of the patients was 62.6 ± 6years. The mean body mass index of the patients was 27 ± 4 kg/m2. Four patients had a history of major abdominal surgery. The mean preoperative prostate-specific antigen (PSA) was 7.4 ± 2.5 ng/mL. The mean prostate volume was 40 ± 10.2 cc. The mean perineal dissection time was 45.6 ± 5.8 minutes. The mean console time and total operative time were 117.8 ± 28.1 and 163.3 ± 30.7 minutes, respectively. The mean urethral catheter removal time was 9.2 ± 1.9 days. The immediate continence rate was 25% after the urethral catheter removal and the continence rate was 75% and 91.67% at the 3rd and 6th month follow-up, respectively. CONCLUSIONS Gasless r-PRP is an efficient and safe method in prostate cancer surgery. However, prospective randomized and comparative studies are required with large patient series.
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Affiliation(s)
- Ali Ihsan Tasci
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Abdulmuttalip Simsek
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Emre Sam
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Kamil Gokhan Seker
- Department of Urology. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
| | - Feyzi Arda Atar
- 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. University of Health Sciences. Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Istanbul. Turkey
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Yenice MG, Yigitbasi I, Turkay R, Sahin S, Tugcu V. Effect of pelvimetric diameters on success of surgery in patients submitted to robot-assisted perineal radical prostatectomy. Int Braz J Urol 2020; 46:425-433. [PMID: 32167708 PMCID: PMC7088495 DOI: 10.1590/s1677-5538.ibju.2019.0413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/13/2019] [Indexed: 11/21/2022] Open
Abstract
Objective: Minimally invasive techniques are used increasingly by virtue of advancements in technology. Surgery for prostate cancer, which has high morbidity, is performed with an increasing momentum based on the successful oncological and functional outcomes as well as cosmetic aspects. Materials and methods: Sixty two patients underwent robot-assisted perineal radical prostatectomy (R-PRP) surgery at our clinic between November 2016 and August 2017. Six pelvimetric dimensions were defined and measured by performing multiparametric magnetic resonance imaging (mpMRI) prior to operation in all patients. In light of these data, we aimed to investigate the effect of pelvimetric measurements on surgery duration and surgical margin positivity. Results: By using this technique in pelvic area, we observed that measurements only representing surgical site and excluding other pelvic organs had a significant effect on surgery duration, and pelvic dimensions had no significant effect on surgical margin positivity. Conclusion: In R-PRP technique, peroperative findings and oncological outcomes can vary depending on several variable factors, but although usually not taken into account, pelvimetric measurements can also affect these outcomes. However, there is a need for randomised controlled trials to be conducted with more patients.
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Affiliation(s)
- Mustafa Gurkan Yenice
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Yigitbasi
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Rustu Turkay
- Department of Radiology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Yenice MG, Yigitbasi I, Sam E, Simsek A, Tugcu V. Robotic perineal radical prostatectomy in a patient with a pre-existing three piece inflatable penile prosthesis. Aktuelle Urol 2020; 53:351-353. [PMID: 31994151 DOI: 10.1055/a-0945-2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Radical prostatectomy (RP) is the primary and standard treatment for localized prostate cancer. As in many surgical procedures, RP can now be accomplished through minimally invasive methods. RP in a patient with a pre-existing 3-piece inflatable penile prosthesis (IPP) is an exceptional condition and involves coping with many difficulties. In this case report, we aimed to present a patient with pre-existing 3-piece IPP for whom we successfully performed robotic perineal RP (r-PRP).
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Affiliation(s)
- Mustafa Gurkan Yenice
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul
| | - Ismail Yigitbasi
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul
| | - Emre Sam
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul
| | - Abdulmuttalip Simsek
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul
| | - Volkan Tugcu
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul
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Prudhomme T, Beauval J, Lesourd M, Roumiguié M, Decaestecker K, Siena G, Serni S, Territo A, Gausa L, Tugcu V, Alcaraz A, Musquera M, Stockle M, Janssen M, Fornara P, Mohammed N, Kamar N, Sallusto F, Breda A, Doumerc N. Comparaison de la transplantation rénale cœlioscopique robot-assistée de donneur vivant entre receveurs obèses et non-obèses : une série internationale de 169 transplantations. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.097] [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: 11/16/2022]
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Evren I, Hacıislamoğlu A, Ekşi M, Yavuzsan AH, Baytekin F, Çolakoğlu Y, Canoğlu D, Tugcu V. The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy. Int Braz J Urol 2019; 45:45-53. [PMID: 30325603 PMCID: PMC6442133 DOI: 10.1590/s1677-5538.ibju.2017.0702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/11/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular extension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic. MATERIALS AND METHODS We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the patients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were included in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated. RESULTS The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recurrence (p = 0.03). CONCLUSION Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.
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Affiliation(s)
- Ismail Evren
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Hacıislamoğlu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mithat Ekşi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Hizir Yavuzsan
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Firat Baytekin
- Department of Pathology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yunus Çolakoğlu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Didem Canoğlu
- Department of Pathology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Yilmaz B, Turkay R, Colakoglu Y, Baytekin HF, Ergul N, Sahin S, Tugcu V, Inci E, Tasci AI, Cermik TF. Comparison of preoperative locoregional Ga-68 PSMA-11 PET-CT and mp-MRI results with postoperative histopathology of prostate cancer. Prostate 2019; 79:1007-1017. [PMID: 31012125 DOI: 10.1002/pros.23812] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/12/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. MATERIALS AND METHODS Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities. RESULTS Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/CT had strong results for appropriate tumor localization in the gland. CONCLUSION Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning.
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Affiliation(s)
- Burcak Yilmaz
- Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Rustu Turkay
- Clinic of Radiology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Yunus Colakoglu
- Clinic of Urology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Halil F Baytekin
- Clinic of Pathology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Nurhan Ergul
- Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Selcuk Sahin
- Clinic of Urology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Volkan Tugcu
- Clinic of Urology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ercan Inci
- Clinic of Radiology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ali I Tasci
- Clinic of Urology, Bakırkoy Dr. Sadi Konuk Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Tevfik F Cermik
- Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Health Sciences University, Istanbul, Turkey
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Yenice MG, Arikan Y, Seker KG, Simsek A, Tugcu V. Resistant Priapism in Hemodialysis Patient: A Rare Case. J Emerg Med Case Rep 2018. [DOI: 10.5152/jemcr.2018.2127] [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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Ahlawat RK, Tugcu V, Arora S, Wong P, Sood A, Jeong W, Bhandari M, Menon M. Learning Curves and Timing of Surgical Trials: Robotic Kidney Transplantation with Regional Hypothermia. J Endourol 2018; 32:1160-1165. [PMID: 29587531 DOI: 10.1089/end.2017.0697] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 01/13/2023] Open
Abstract
PURPOSE Outcomes of surgical procedures can be affected by multiple factors including surgical skill and learning curve (LC). These factors need to be considered for optimal timing of surgical trials. We used the LC cumulative summation (CUSUM) method to describe the number of cases associated with competency of a single surgeon learning the technique of robotic kidney transplantation (RKT). METHODS Thirty-three patients underwent Vattikuti Urology Institute technique of RKT at a center that recently adopted this procedure (study group). Anastomoses times and short-term functional outcomes were compared with an established RKT program (reference group). LCs were evaluated using CUSUM analysis using target values from the reference group. RESULTS Mean ± standard deviation for console time, rewarming time (RWT), arterial anastomosis, venous anastomosis, and ureterovesical anastomosis times for the study group was 187 ± 34.6 minutes, 58.03 ± 17.81 minutes, 19.36 ± 5.91 minutes, 21.97 ± 6.78 minutes, and 22.55 ± 4.24 minutes, respectively, significantly longer than reference group (p < 0.001 for all). Mean ± standard deviation for serum creatinine at discharge and 1 month in the study group was 1.43 ± 0.57 mg/dL and 1.23 ± 0.35 mg/dL, respectively, similar to the reference group (p = 0.074 at discharge and p = 0.163 at 1 month). The LC was short, with competence achieved for RWT within 9, proficiency within 16, and mastery within 21 cases. Longer anastomosis times during the LC did not affect graft function. CONCLUSIONS The LC of RKT is short, with improving skill up to 20-25 cases. The procedure is reproducible by surgeons experienced with open transplant and robotic surgery for other procedures, with comparable outcomes and low complication rates at a new center during adoption.
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Affiliation(s)
- Rajesh K Ahlawat
- 1 Fortis Escorts Kidney and Urology Institute , Okhla Road, New Delhi, India
| | - Volkan Tugcu
- 2 Sadi Konuk Bakırköy Education and Training Hospital , Istanbul, Turkey
| | - Sohrab Arora
- 3 Vattikuti Urology Institute , Henry Ford Hospital, Detroit, Michigan
| | - Philip Wong
- 3 Vattikuti Urology Institute , Henry Ford Hospital, Detroit, Michigan
| | - Akshay Sood
- 3 Vattikuti Urology Institute , Henry Ford Hospital, Detroit, Michigan
| | - Wooju Jeong
- 3 Vattikuti Urology Institute , Henry Ford Hospital, Detroit, Michigan
| | - Mahendra Bhandari
- 3 Vattikuti Urology Institute , Henry Ford Hospital, Detroit, Michigan
| | - Mani Menon
- 3 Vattikuti Urology Institute , Henry Ford Hospital, Detroit, Michigan
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Tugcu V, akca O, Simsek A, yigitbasi I, sahin S, yenice M, tasci A. V08-08 ROBOTIC PERINEAL RADICAL PROSTATECTOMY AND BILATERAL LYMPH NODE DISSECTION WITH PERINEAL APPROACH. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tugcu V, Simsek A, Yigitbasi I, Yenice MG, Sahin S, Tasci AI. Robotic perineal radical prostatectomy with high prostate volume. ACTA ACUST UNITED AC 2018; 90:65-67. [PMID: 29633801 DOI: 10.4081/aiua.2018.1.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Minimally invasive techniques are ever improving and are preferred more. Many techniques were developed in radical prostatectomy operations. Robotic radical prostatectomy with the perineal approach is a new technique. CASE PRESENTATION A 66-year-old male patient presented because of lower urinary tract symptoms, a PSA value of 5.5 ng/ml was detected, prostate biopsy was performed under transrectal ultrasound guide, a Gleason 3+3 adenocarcinoma on 3/12 foci was reported at pathology. Robotic perineal radical prostatectomy (r-PRP) operation was performed in the patient who had a prostate volume of 130 cc with middle lobe and a body mass index of 32 without additional disease. The duration of operation was 140 minutes in total and the duration at the console was 95 minutes, the amount of bleeding was 85 cc and no intraoperative complication was detected. CONCLUSION r-PRP is a technique that can be applied safely without prolonging the operation period and without additional morbidity to the patient, preserving the oncologic and functional outcomes in patients with surgical history and large prostate volume.
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Affiliation(s)
- Volkan Tugcu
- Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Department of Urology, Istanbul.
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Tugcu V, Simsek A, Yigitbasi I, Yenice MG, Sahin S, Tasci AI. Robot-Assisted Perineal Radical Prostatectomy in a Post-Kidney Transplant Recipient. J Endourol Case Rep 2018; 4:21-24. [PMID: 29468200 PMCID: PMC5820682 DOI: 10.1089/cren.2017.0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: After almost two decades, transabdominal robotic radical prostatectomy techniques have been fully developed and are widely practiced by many robotic urologists. Recently, a transperineal robotic radical prostatectomy, a technique not yet popular to many, was introduced as an alternative approach in patients with previous abdominal surgery. Here, we present our unique experience with robotic perineal radical prostatectomy (r-PRP) on a kidney transplant recipient. Case Presentation: A 71-year-old man who had a kidney transplant 4 months previously was diagnosed with prostate cancer (PCa) and underwent r-PRP using the da Vinci Xi robotic system. The operative time was 110 minutes and blood loss was minimal. After the perineal drain was removed on postoperative day 3, the patient was discharged. The urethral catheter was subsequently removed on postoperative day 8. Pathologic analysis revealed localized PCa with negative surgical margins. Conclusion: The r-PRP offers all the advantages of minimally invasive surgery. Moreover, in a kidney transplant recipient, it provides additional benefits, such as avoidance of allograft vascular and ureteral injuries, while maintaining an equivalent oncologic efficacy and surgical safety compared with its transabdominal counterpart.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Abdulmuttalip Simsek
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Ismail Yigitbasi
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Mustafa Gurkan Yenice
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Ali Ihsan Tasci
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
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Seker KG, Sam E, Sahin S, Yenice MG, Aktas AG, Simsek A, Tugcu V. Partial nephrectomy in horseshoe kidney: Primary carcinoid tumor. Arch Ital Urol Androl 2017; 89:316-318. [DOI: 10.4081/aiua.2017.4.316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/23/2022] Open
Abstract
Primary neuroendocrine carcinoma of the kidney is a rarely observed clinical condition because neuroendocrine cells are not found in kidney parenchyma. It’s not clinically and radiologically possible to distinguish from other kidney tumors. Incidence with horseshoe kidney anomaly, it should be considered as a definitive diagnosis for the patients with this condition. In this case report, we reported about a carcinoid tumor in horseshoe kidney in a 37-year-old woman.
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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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Yenice MG, Seker KG, Sam E, Colakoglu Y, Atar FA, Sahin S, Simsek A, Tugcu V. Comparison of cold-knife optical internal urethrotomy and holmium:YAG laser internal urethrotomy in bulbar urethral strictures. Cent European J Urol 2017; 71:114-120. [PMID: 29732217 PMCID: PMC5926630 DOI: 10.5173/ceju.2017.1391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/12/2017] [Accepted: 11/13/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction To compare the results of cold-knife optical internal urethrotomy (OIU) and Holmium:YAG laser internal urethrotomy (HIU) in primary bulbar urethral strictures. Material and methods A total of 63 patients diagnosed with primary bulbar urethral stricture between August 2014 and September 2015 were assigned to the OIU (n = 29) and HIU (n = 34) groups. The demographic variables, biochemistry panels, and preoperative and postoperative uroflowmetry results including the maximum flow rate (Qmax) and mean flow rate (Qmean) values, retrograde urethrography, and diagnostic flexible urethroscopy findings were recorded prospectively. Demographic features and preoperative values were not statistically different between groups (p >0.05). Mean surgical times were 18.4 ±2.3 min for OIU and 21.9 ±3.8 min for HIU groups, which was statistically significant (p <0.05). There was no significant difference in complication rates in both groups (p = 0.618). Results Postoperative Qmax values were increased in both groups even though postoperative Qmax values were not significantly different between the two groups in the short- and long-term results at 3, 6, and 12 months (p >0.05). There was no recurrence in the first 3 months in either group. The urethral stricture recurrence rate up to month 12 was not statistically significant for the OIU group (n = 6, 20.7%) as compared to the HIU group (n = 11, 32.4%; p = 0.299). At follow-up, the SFR and IFR was 96% and 88% at 3-months, and 82% and 71% at 12-months, respectively (p <0.001). While almost three-quarters of patients were stone and infection free at 12-months, the majority of those with stones recurrence also had recurrence of their UTI. Conclusions HIU is an alternative method to OIU, and it has similar success rates in the treatment of short segment bulbar urethral strictures.
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Affiliation(s)
- Mustafa Gurkan Yenice
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Kamil Gokhan Seker
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Emre Sam
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Yunus Colakoglu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Feyzi Arda Atar
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Selcuk Sahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Abdulmuttalip Simsek
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
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Tugcu V, Simsek A, Evren I, Seker KG, Kocakaya R, Torer BD, Atar A, Tasci AI. Single plus one port robotic radical prostatectomy (SPORP); Initial experience. Arch Ital Urol Androl 2017; 89:178-181. [DOI: 10.4081/aiua.2017.3.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/02/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: This article reports on patients with early stage prostate cancer treated with single plus one port robotic radical prostatectomy (SPORP). Materials and methods: Since January 2014, we performed SPORP in 8 patients with localized prostate cancer. Age of patients, clinical stage, operation time, intraoperative and postoperative complications, blood loss, histopathological evaluation, postoperative continence, serum level of PSA were evaluated. Results: Mean age of the 8 patients was 59.85 years. All operations were completed without conversion to standard robotic procedure or open surgery. No intra operative complications occurred. Mean operating time was 143 minutes; prostate excision 123 minutes and urethrovesical anastomosis 20 minutes. Mean blood loss was 45 ml. Preoperative Gleason scores were (3 + 4) in one patient and (3 + 3) in 7 patients. Postoperative Gleason scores were (3 + 4) in 2 patients, and (3 + 3) in 6 patients. All these 8 cases were in T1c clinical stage. Early postoperative complications were drain leakage (n = 1), atelectasis (n = 1), wound infection (n = 1) and fever (n = 1). There was no positive surgical margin. The serum level of PSA was less than 0.2 ng/ml and no other complications happened during the 4 to 12 months follow-up period. Postoperative continence and cosmetic results were excellent. Conclusions: It is relatively easy for urologists who are skilled in traditional laparoscopic and robotic surgeries to master SPORP. However long-term outcomes of this surgery need further investigations.
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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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Simsek A, Yavuzsan AH, Colakoglu Y, Atar A, Sahin S, Tugcu V. Comparison of robotic and laparoscopic partial nephrectomy for small renal tumours. Arch Ital Urol Androl 2017; 89:93-96. [DOI: 10.4081/aiua.2017.2.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/23/2017] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal tumours. Materials and methods: Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20) or RPN (n = 22) by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes. Results: There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001). Warm ischemia time was similar in both groups (p = 0.58). Estimated blood loss (EBL) was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin. Conclusions: RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.
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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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Inci E, Turkay R, Nalbant MO, Yenice MG, Tugcu V. The value of shear wave elastography in the quantification of corpus cavernosum penis rigidity and its alteration with age. Eur J Radiol 2017; 89:106-110. [DOI: 10.1016/j.ejrad.2017.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/03/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
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Arora S, Tugcu V, Sood A, Bhandari M, Ahlawat R, Menon M. MP06-05 LEARNING CURVE OF A NEW SURGICAL PROCEDURE: EXPERIENCE FROM A NEW CENTER ADOPTING ROBOTIC KIDNEY TRANSPLANT. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Keske M, Canda AE, Yalcin S, Kilicarslan A, Kibar Y, Tuygun C, Onder E, Atmaca AF, Yildirim A, Ozkanli SS, Kandemir O, Kargi T, Sar M, Tugcu V, Resorlu B, Aslan Y, Sarikaya S, Boylu U, Cicek AF, Basar H, Tuncel A, Balbay MD. Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study. Can Urol Assoc J 2017; 11:E100-E104. [PMID: 28360955 DOI: 10.5489/cuaj.4016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal-appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm. METHODS In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0-1 cm; n=35), Group 2 (1.1-2cm; n=99), and Group 3 (2.1-3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups. RESULTS Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p<0.05 between groups). TIN was detected in 20%, 42.4%, and 41.5% of Groups 1, 2, and 3, respectively (p<0.05 for Group 1 vs. Groups 2 and 3; p>0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p<0.05 for both Group 1 vs. Group 3 and for Group 2 vs. Group 3; p>0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs. >1.5 cm (p>0.05). CONCLUSIONS Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.
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Affiliation(s)
- Murat Keske
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey; Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | | | | | - Yusuf Kibar
- Gulhane Military Medical Academy, Ankara, Turkey
| | - Can Tuygun
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Evrim Onder
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey; Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Asif Yildirim
- Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | | | - Olcay Kandemir
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Taner Kargi
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Sar
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Berkan Resorlu
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Yilmaz Aslan
- Numune Training and Research Hospital, Ankara, Turkey
| | | | - Ugur Boylu
- Umraniye Training and Research Hospital, Istanbul, Turkey
| | | | - Halil Basar
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Altug Tuncel
- Numune Training and Research Hospital, Ankara, Turkey
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Turkay R, Inci E, Yenice MG, Tugcu V. Shear wave elastography: Can it be a new radiologic approach for the diagnosis of erectile dysfunction? Ultrasound 2017; 25:150-155. [PMID: 29410690 DOI: 10.1177/1742271x17697512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/02/2017] [Indexed: 01/12/2023]
Abstract
Introduction Erectile dysfunction (ED) is a common health problem among males, and radiology has limited use in its diagnosis and treatment. Shear wave elastography (SWE) is a new sonographic technique. In this study, we examined the significance of SWE in the diagnosis of ED. Methods The study included a total number of 70 participants. The mean age of the participants was 54.14 ± 8.03 years (range: 39 and 71 years old). We composed two groups. Group 1 had 35 patients who presented to the urology clinic in our hospital complaining of ED, and had a score of 17 or lower from the International Index of Erectile Function (IIEF) questionnaire. Group 2 consisted of 35 healthy volunteers who did not have ED. SWE measurements were performed from corpus cavernosum penis in both groups, and the results were noted. Differences between the groups were evaluated statistically. Results The difference between the mean SWE measurements of two groups (Group 1: 20.94 ± 6.23 kPa and group 2: 24.63 ± 7.58 kPa) was found to be statistically significant (p = 0.027; p < 0.05). For a cut-off value of 17.1 kPa, the SWE method has specificity, sensitivity, positive predictive value, and negative predictive value regarding diagnosis of ED as 94.29%, 34.29%, 85.71%, and 58.93%, respectively. The mean age of the groups did not show a statistically significant difference (p = 0.287; p > 0.05). Conclusions Due to its high specificity and positive predictive value, SWE can offer useful data in the radiologic evaluation of ED cases.
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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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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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Tugcu V, Sahin S, Resorlu B, Yigitbasi I, Yavuzsan AH, Tasci AI. Comparison of antegrade and retrograde laparoscopic radical prostatectomy techniques. Kaohsiung J Med Sci 2016; 32:403-6. [PMID: 27523453 DOI: 10.1016/j.kjms.2016.07.003] [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: 03/04/2016] [Revised: 05/09/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022] Open
Abstract
We evaluated the effect of antegrade and retrograde approaches on functional recovery and surgical outcomes of extraperitoneal laparoscopic radical prostatectomy (LRP). We analyzed 135 patients who underwent extraperitoneal LRP, with the retrograde technique performed on 42 (31%; Group 1) and the antegrade technique on 93 (69%; Group 2). Both groups were statistically similar with respect to age, clinical stage, preoperative prostate-specific antigen (PSA) and American Society of Anesthesiologists (ASA) scores, prostate volume, and previous surgical history. Mean operative time was significantly longer in Group 1 (244±18.3 vs. 203.3±18.4 min, p<0.001), whereas mean anastomosis times for both groups were similar (35.8±7.2 vs. 34.7±5.8 min, p=0.155). Estimated blood loss and transfusion rates were significantly lower in Group 2. A significant difference was observed for both hospitalization (6.79±3.3 vs. 5.46±3.08 days, respectively; p=0.026) and catheterization times (12.24±2.1 vs. 11±1.08 days, respectively; p=0.001) for Group 2. The total complication rate was 47.6% in Group 1, and 11.8% in Group 2 (p<0.01). Rates of positive surgical margins were 14.2% and 15% for Groups 1 and 2, respectively. At the 12-month interval from operation, similar recoveries in urinary continence were obtained for both groups (81% in Group 1; 91% in Group 2). Upon comparison of the two LRP techniques, we found that both were effective; however, the latter resulted in lower minor complication rate, lower blood loss, shorter operation time, and shorter length of hospital stay.
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Affiliation(s)
- Volkan Tugcu
- 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.
| | - Berkan Resorlu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Yigitbasi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Abdullah H Yavuzsan
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali I Tasci
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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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, Atar A, Sahin S, Kargi T, Gokhan Seker K, IlkerComez Y, IhsanTasci A. Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery. JSLS 2016; 19:JSLS.2015.00080. [PMID: 26648678 PMCID: PMC4653581 DOI: 10.4293/jsls.2015.00080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: Our objective is to clarify the effect of previous transurethral resection of the prostate (TURP) or open prostatectomy (OP) on surgical, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP). Methods: Between August 1, 2009, and March 31, 2013, 380 patients underwent RARP. Of these, 25 patients had undergone surgery for primary bladder outlet obstruction (TURP, 20 patients; OP, 5 patents) (group 1). A match-paired analysis was performed to identify 36 patients without a history of prostate surgery with equivalent clinicopathologic characteristics to serve as a control group (group 2). Patients followed up for 12 months were assessed. Results: Both groups were similar with respect to preoperative characteristics, as mean age, body mass index, median prostate-specific antigen, prostate volume, clinical stage, the biopsy Gleason score, D'Amico risk, the American Society of Anesthesiologists (ASA) classification score, the International Prostate Symptom Score, continence, and potency status. RARP resulted in longer console and anastomotic time, as well as higher blood loss compared with surgery-naive patients. We noted a greater rate of urinary leakage (pelvic drainage, >4 d) in group 1 (12% vs 2,8%). The anastomotic stricture rate was significantly higher in group 1 (16% vs 2.8%). No difference was found in the pathologic stage, positive surgical margin, and nerve-sparing procedure between the groups. Biochemical recurrence was observed in 12% (group 1) and 11.1% (group 2) of patients, respectively. No significant difference was found in the continence and potency rates. Conclusions: RARP after TURP or OP is a challenging but oncologically promising procedure with a longer console and anastomosis time, as well as higher blood loss and higher anastomotic stricture rate.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Arda Atar
- 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
| | - Taner Kargi
- 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
| | - Yusuf IlkerComez
- Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali IhsanTasci
- Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Sahin S, Bicer M, Yenice MG, Seker KG, Yavuzsan AH, Tugcu V. A Prospective Randomized Controlled Study to Compare Acupuncture and Dapoxetine for the Treatment of Premature Ejaculation. Urol Int 2016; 97:104-11. [PMID: 27049323 DOI: 10.1159/000445253] [Citation(s) in RCA: 16] [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] [Received: 01/19/2016] [Accepted: 03/03/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the safety and efficacy of dapoxetine and acupuncture for the treatment of premature ejaculation (PE) with other treatment methods. METHODS One hundred twenty patients with PE in an outpatient urology clinic were randomized to receive dapoxetine 30 mg and 60 mg, acupuncture or sham acupuncture. The intravaginal ejaculatory latency time (IELT), the PE diagnostic tool (PEDT) score, and adverse events were compared. RESULTS There were no differences between the groups in terms of age, body mass index, baseline IELT and PEDT scores (p > 0.05). After 4 weeks, IELT was significantly longer compared to baseline values in all groups (p < 0.001 for all comparisons). Comparisons between the groups showed that changes in IELT and PEDT observed after 4 weeks with dapoxetine 60 mg was significantly higher than those achieved in all other groups (p < 0.001 for all comparisons), changes observed with dapoxetine 30 mg was significantly higher than those achieved with acupuncture and sham acupuncture groups (p < 0.001 for both comparisons) and changes observed with acupuncture was significantly higher than those observed with sham acupuncture (p < 0.001). CONCLUSION Our results confirm previous reports on the efficacy and safety of dapoxetine. Although less effective than dapoxetine, acupuncture had a significant ejaculation-delaying effect.
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Affiliation(s)
- Selcuk Sahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Rassweiler J, Sarica K, Geavlete P, Tokatli NZ, Klein J, Traxer O, Al Zarooni A, Farahat Y, Hoenig DM, Giusti G, Tugcu V, Imamoglu MA, Muslumanoglu AY, Savas M, Saglam R, Patel A. V6-11 THE NEW DEVELOPMENTS OF THE ROBOTIC ASSISTED RETROGRADE INTRA-RENAL SURGERY (RA-RIRS) WITH AVICENNA ROBOFLEX. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Atar A, Gedikbasi A, Sonmezay E, Kiraz ZK, Abbasoglu S, Tasci AI, Tugcu V. Serum paraoxonase-1 gene polymorphism and enzyme activity in patients with urolithiasis. Ren Fail 2016; 38:378-82. [DOI: 10.3109/0886022x.2015.1136872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tugcu V, Atar A, Sahin S, Seker G, Kargi T, Tasci AI. Upper Tract Urological Laparoendoscopic Single-Site Surgery (LESS). JSLS 2015; 19:JSLS.2015.00081. [PMID: 26648679 PMCID: PMC4653582 DOI: 10.4293/jsls.2015.00081] [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 Our objective is to report intermediate-term outcomes for patients who have undergone upper tract urologic laparoendoscopic single-site surgery (LESS) at a single institution. METHODS From January 1, 2008, through November 30, 2012, 107 cases treated with LESS were identified, including pyeloplasty (n = 30), ureterolithotomy (n = 32), nephrectomy (n = 35; simple = 31, partial = 4), and cyst decortication (n = 10). Perioperative data were reviewed, and conversion and complication rates were noted. RESULTS The median follow-up was 21.5 months for pyeloplasty, 20.5 for ureterolithotomy, 28.0 for simple nephrectomy, 14.0 for partial nephrectomy, and 19.0 for cyst decortication. Major complications were encountered in 8 patients, including 3 intraoperative complications (2 bowel injury with serosal tearing and 1 intraoperative bleeding), which were recognized and repaired with LESS or conversion to conventional laparoscopy (CL). During the intermediate postoperative period (30-90 days) major complications occurred in 5 patients: 4 ureteral strictures (Clavien-Dindo grade [CG] IIIb) and 1 urinoma formation (CG IIIa). During the early postoperative period (<30 days), the most common minor complications were flank pain (CG I) in 16 patients and urinary tract infection (CG II) in 11, followed by urinary leakage (CG I) in 8. CONCLUSIONS Intermediate-term functional outcomes of this single-center study confirm that upper tract LESS is a challenging procedure that can be safe and effective when performed by an experienced team. Prospective studies with longer follow-up periods are needed to investigate the safety of LESS in the treatment of various upper urinary tract conditions.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Arda Atar
- 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
| | - Gokhan Seker
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Taner Kargi
- 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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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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Sahin S, Bicer M, Eren GA, Tas S, Tugcu V, Tasci AI, Cek M. Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial. Prostate Cancer Prostatic Dis 2015; 18:249-54. [PMID: 25939517 DOI: 10.1038/pcan.2015.13] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are multiple approaches to the management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS); and lately the data suggesting the ability of acupuncture treatment to decrease pain, positively impact quality of life and potentially modulate inflammation has suggested it as a potential therapeutic option for men with CP/CPPS. We conducted this study to determine whether acupuncture is really an effective therapeutic modality for CP/CPPS in terms of >50% decrease in total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score from baseline compared with sham. METHODS One hundred patients with CP/CPPS (category III B) in an outpatient urology clinic were randomized to receive acupuncture at either seven acupoints bilaterally or sham points adjacent to these points. NIH-CPSI was completed by each patient before and 6, 8, 16, 24 weeks after the treatment. Mean values of total CPSI score and subscores after the treatment and on follow-up following the treatment were compared. RESULTS Of the acupuncture participants, 92% were NIH-CPSI responders (>50% decrease in total NIH-CPSI score from baseline) compared with 48% of sham participants, 8 weeks after the end of the therapy. Both groups experienced significant decrease in CPSI subscores throughout the whole follow-up period; however, the decline remained significantly greater in the active acupuncture group as compared with the sham group. CONCLUSIONS Our results show that the use of acupuncture in treatment of men with CP/CPPS symptoms resulted in a significant decrease in total NIH-CPSI scores.
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Affiliation(s)
- S Sahin
- Department of Urology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - M Bicer
- Department of Physical Treatment and Rehabilitation, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - G A Eren
- Department of Anesthesiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - S Tas
- Department of Urology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - V Tugcu
- Department of Urology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - A I Tasci
- Department of Urology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - M Cek
- Department of Urology, Trakya University, Edirne, Turkey
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Gedikbasi A, Atar A, Sonmezay E, Kusku Kiraz Z, Abbasoglu S, Tasci AI, Tugcu V. MP34-12 SERUM PARAOXANASE-1 GENE POLYMORPHISM AND ENZYME ACTIVITY IN PATIENTS WITH UROLITHIASIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ihsan-Tasci A, Simsek A, Dogukan-Torer M, Sokmen D, Sahin S, Bitkin A, Tugcu V. Oncologic results, functional outcomes, and complication rates of transperitoneal robotic assisted radical prostatectomy: single centre's experience. Actas Urol Esp 2015; 39:70-7. [PMID: 24856651 DOI: 10.1016/j.acuro.2014.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/31/2013] [Accepted: 02/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND We report the operative details and short term oncologic and functional outcome of the first 334 Robotic-assisted radical prostatectomy experiences for organ confined prostate cancer METHODS From August 2009 to December 2012, details of 334 consecutive patients were retrospectively analyzed. The analyzed parameters included: preoperative, per-operative characteristics, postoperative minor and major complications, positive surgical margin continence, potency, and biochemical progression at the follow-up period. RESULTS The classical extrafascial, interfascial, intrafascial and fascia sparing radical prostatectomy were performed in 31, 41, 200, and 62 cases, respectively. The mean operation time was 213.8±90.1minutes, and the mean estimated blood loss was 116.1±58.9cc during operation. A nerve-sparing procedure was performed bilaterally in 198 (59.3%) cases and unilaterally in 126 (37.7%) cases. The catheter was removed on postoperative day 9, 1±1.9. Surgical margin was positive in 36 (10.7%) patients. The overall, pT2, pT3a and pT3b PSM rates were 8 (2.4%), 12 (3.6%), 16 (4.8%) respectively and PSM and BCR rates were not statistically different among four approach (P>.05). At the follow-up period, the continence rates were 74.4%, 80.4%, 80.5%, and 96.7% (P<.001), and previously potent patients' potency rates were 64.3%, 66.6%, 68.1%, and 74.5% (P>.05), in classic extrafascial, interfascial, intrafascial, and fascia sparing intrafascial prostatectomy, respectively. CONCLUSION RARP is a safe and feasible technique in treatment of localized prostate cancer. Fascia sparing approach has better continence rate. This results need to be supported by new prospective, randomized studies.
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Tasci AI, Simsek A, Torer BD, Sokmen D, Sahin S, Tugcu V. Fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis: point of technique. ARCH ESP UROL 2014; 67:731-739. [PMID: 25568908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Nerve-sparing radical prostatectomies provide excellent control of cancer, but the recovery of continence and sexual function are uncertain. We report the operative details and surgical techniques of a robot-assisted radical prostatectomy (RARP) experiences for organ confined prostate cancer. METHODS Between the years of 2009 and 2012, 68 patients with clinically localized prostate cancer underwent fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis. None of the patients were incontinent. 48 of them had an IIEF-5 potency score equal or greater than 22, without receiving phosphodiesterase-5 inhibitors. Our techniques included preservation of the bladder neck, preservation of the endopelvic fascia and puboprostatic ligaments, a nerve-sparing intrafascial approach, selective suturing of the dorsal venous complex, and anterior and posterior reconstruction. We evaluated the patients at the 1st, 3rd, 6th, and 12th postoperative months to determine if these techniques are correlated with early recovery of urinary continence and potency. RESULTS The mean operation time was 258.2±78.5 minutes, and the mean estimated blood loss was 111.2±22.9 cc during the operation. A nerve-sparing procedure was performed bilaterally in 62 (91.2 %) cases and unilaterally in 6 (8.8%) cases. The mean drain extraction time was 2.3±0.9 days, and the mean hospital stay was 3.4±1.1 days. The catheter was removed on postoperative day 9.9±0.9. The surgical margin was positive in 10 (14.7%) patients. The continence rates at 1, 3, 6, and 12 months were 74.2%, 76.9%, 80.6%, and 95.6%, respectively. During the same period, among the patients without ED, the potency rates were 29.4%, 38.2%, 54.1%, and 75%, respectively All operations were completed successfully, and there were no major complications. CONCLUSIONS A more comprehensive approach for reporting prostate cancer surgery outcomes is needed. Our study findings suggest that fascia-sparing techniques positively influence the early recovery of urinary continence. However, randomized controlled trials with large samples are needed.
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Simsek A, Tugcu V, Erturkuner P, Alkan F, Ozbek E, Tasci AI. Effects of the recreational use of PDE5 inhibitors on the corpus cavernosum of young, healthy rats. Int Urol Nephrol 2014; 46:1889-93. [DOI: 10.1007/s11255-014-0746-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/11/2014] [Indexed: 01/22/2023]
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Tasci A, Simsek A, Tugcu V, Bitkin A, Sonmezay E, Torer B. Abdominal wall haemorrhage after robotic-assisted radical prostatectomy: is it a complication of robotic surgery? Actas Urol Esp 2013; 37:634-9. [PMID: 23768503 DOI: 10.1016/j.acuro.2013.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/23/2012] [Accepted: 01/07/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Robotic-assisted radical prostatectomy (RARP) is the minimally invasive surgical treatment for patients with localized prostate cancer. Perioperative or postoperative complications following RARP have been reported in some studies and severe postoperative bleeding after RARP is rare, but hemodynamic instability may necessitate open surgical exploration and be associated with considerable morbidity. We reported postoperative bleeding cases, which is a kind of complication associated with robotic surgery and requiring massive transfusion after RARP. PATIENTS AND METHODS From August 2009 to May 2012, 317 consecutive patients who underwent RARP performed at our institution were analyzed. Patients with serious postoperative bleeding that caused hemodynamic instability after surgery were enrolled. RESULTS A total of 5 among 317 (1.6%) patients had bleeding requiring postoperative transfusion. In these cases, mean operative time was 114 min. The mean estimated blood loss was 110 ml during operation. In these patients, hematocrit (Hct) levels gradually fell after surgery and ecchymosis was detected on the side and posterior walls of the abdomen on the second day. The mean preoperative Hct was 44.3% and mean lowest Hct was 23.1%. All patients were successfully treatment without surgical exploration. CONCLUSIONS Robotic radical prostatectomy has proven to be a safe surgical treatment with low morbidity. However, postoperative bleeding can reach serious problems. This is the first study to explain haemorrhage, associated with possible risk of robotic surgery.
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Rais-Bahrami S, Rizkala ER, Cadeddu JA, Tugcu V, Derweesh IH, Abdel-Karim AM, Kawauchi A, George AK, Autorino R, Bagrodia A, Sonmezay E, Elsalmy S, Liss MA, Harrow BM, Kaouk JH, Richstone L, Stein RJ. Laparoendoscopic single-site pyeloplasty: outcomes of an international multi-institutional study of 140 patients. Urology 2013; 82:366-72. [PMID: 23810729 DOI: 10.1016/j.urology.2013.04.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/25/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report an international, multi-institutional series of laparoendoscopic single-site pyeloplasty (LESS-P) with analysis of functional outcomes. MATERIALS AND METHODS LESS-P cases performed between October 2007 and June 2012 at 7 institutions worldwide per individual institutional protocols, entry criteria, and techniques were included. Patient characteristics, operative indications, perioperative outcomes, and postoperative follow-up were retrospectively collected and analyzed. RESULTS The study included 140 adult patients (age 39.9 ± 15.7 years; body mass index 24.8 ± 4.2 kg/m(2); 15% with previous abdominal surgery) who underwent unilateral LESS-P, most of whom (94.3%) had dismembered reconstructions. Mean operative time was 202.1 ± 47 minutes with an estimated blood loss of 61.2 ± 44.6 mL. Robotic laparoendoscopic single-site surgery was applied in 31 patients (22.1%). A single 2-3 mm accessory port was used in 44 patients (31.4%) and a single 5-12 mm accessory port was added in 9 patients (6.4%), whereas 10 patients (7.1%) were converted to conventional multiport laparoscopy. No patients required conversion to open surgery, nor were any intraoperative complications reported. Length of hospitalization was 2.4 ± 1.6 days. The overall 90-day postoperative complication rate was 18.6%, mostly low-grade complications (Clavien I-II). With a mean follow-up of 14.0 ± 10.8 months, 93.4% had resolution of symptoms and 94.4% had radiographic evidence demonstrating resolution of ureteropelvic junction obstruction. Assessment of drainage with diuretic nuclear renal scan provided evidence of improvement in 86.5% of patients on their first postoperative renal scan. CONCLUSION This study highlights the most comprehensive experience with LESS-P reported to date. Outcome measures parallel those of large published series of conventional laparoscopic pyeloplasty. Despite these encouraging findings, longer follow-up is needed to determine the efficacy and durability of this approach for the treatment of ureteropelvic junction obstruction.
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Affiliation(s)
- Soroush Rais-Bahrami
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA.
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