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Keles A, Iplikci A, Arikan O, Culpan M, Baydili KN, Keser F, Yildirim A. Evolving horizons in renal angiomyolipoma: two decades of management strategies and clinical perspectives in a single institutional study. Aging Male 2024; 27:2346308. [PMID: 38709235 DOI: 10.1080/13685538.2024.2346308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE To assess various management options for renal angiomyolipoma (AML) to guide clinical practice. METHODS A single center retrospectively reviewed an AML series from 2002 to 2022. The image reports and chart reviews of patients who received two abdominal scans at least 6 months between the first and last scans were assessed. RESULTS A total of 203 patients with 209 tumors were identified and followed up for a median of 42.6 months. Active surveillance (AS) was the most frequently selected option (70.9% of cases). Interventions were required for 59 AMLs, of which 20 were treated with embolization, 29 with partial nephrectomy, 9 with radical nephrectomy, and 1 with radiofrequency (RF) ablation. The median size of the lesions at intervention was 5 cm. The average growth rate of the lesions was 0.12 cm/year, and there was a significant difference in the average growth rate of lesions ≤4 cm and those >4 cm (0.11 vs. 0.24 cm/year; p = 0.0046). CONCLUSION This series on AMLs confirms that lesions >4 cm do not require early intervention based on size alone. Appropriately selected cases of renal AML can be managed by AS.KEYWORDS: Angiomyolipoma; active surveillance; embolization; nephrectomy; nephron-sparing surgery.
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Affiliation(s)
- Ahmet Keles
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ayberk Iplikci
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ozgur Arikan
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Kursad Nuri Baydili
- Department of Biostatistics, University of Health Sciences, School of Medicine, Istanbul, Turkey
| | - Ferhat Keser
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
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Akan S, Tavukcu HH, Culpan M, Cella D. Reliability and validity analysis of Turkish version of the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10) questionnaire. Arch Ital Urol Androl 2024:12415. [PMID: 38758013 DOI: 10.4081/aiua.2024.12415] [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] [Received: 02/22/2024] [Accepted: 03/28/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION To evaluate the validity and reliability of the Turkish version of the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10). MATERIALS AND METHODS In this, single-centre study, patients between 18 and 65 years old, who were suffering from lower urinary tract symptoms (LUTS) without any known urinary tract disease and on no medication, were enrolled. The control group consisted of participants, who were admitted to our clinic suffering from any complaint except LUTS and met all of the other inclusion and exclusion criteria. Participants' demographics such as age, sex, and level of education were recorded. The Turkish version of the LURN SI-10, International Prostate Symptom Score (IPSS) and Overactive Bladder Questionnaire (OAB-V8) were administered to all participants. Construct validity was evaluated by confirmatory factor analysis and concurrent validity was evaluated with correlations to similar measures. Internal consistency (Cronbach's alpha) was used to establish the scale's internal consistency reliability. RESULTS A total of 164 participants were included in the final analysis. Of those, 57% were male. The individuals were identified as being in the "patient group" (n = 86) and a "control group" (n = 78). The mean age was 48.24 ± 14.30 years. The median total LURN SI-10 scores of patient group and control group were 12.0 (9-18.25) and 4.0 (2.75-6), respectively. The LURN SI-10 questionnaire showed a high correlation with the IPSS and the OAB-V8 questionnaires (r: 0.761; p: 0.001; r: 0.737; p: 0.001, respectively) in concurrent validity analysis. Cronbach's alpha coefficient of the LURN SI-10 was 0.850. CONCLUSIONS This promising measurement tool can be used to evaluate LUTS in Turkish women and men. Further studies should be conducted to assess the clinical usefulness of this questionnaire.
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Affiliation(s)
- Serkan Akan
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul.
| | | | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul.
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Keles A, Kose M, Somun UF, Culpan M, Yaksi N, Yıldırım A. Impact of health and digital health literacy on quality of life following radical prostatectomy for prostate cancer: prospective single-center cohort study. World J Urol 2024; 42:241. [PMID: 38632212 PMCID: PMC11024042 DOI: 10.1007/s00345-024-04960-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The importance of health literacy (HL) and digital health literacy (e-HL) in promoting healthy behavior and informed decision making is becoming increasingly apparent. This study aimed to assess the effects of HL and e-HL on the quality of life (QoL) of men who underwent radical prostatectomy (RP) for localized prostate cancer. MATERIALS AND METHODS This prospective observational study included 104 patients who underwent RP for localized prostate cancer. HL and e-HL were evaluated using the validated eHealth Literacy Scale and European Health Literacy Survey Questionnaire Short Form before RP. We evaluated patients' physical, psychological, social, and global QoL using the validated EORTC QLQ-C30 8 weeks after RP. The exclusion criterion was any difficulties in language and comprehension. We employed one-way ANOVA to compare continuous variables across groups in univariate analysis and used MANOVA for exploring relationships among multiple continuous variables and groups in the multivariate analysis. RESULTS Multivariate analyses showed that poorer e-HL and HL were associated with being older (p = 0.019), having less education (p < 0.001), and not having access to the internet (p < 0.001). Logistic regression analysis revealed significant associations between improved e-HL (p = 0.043) and HL (p = 0.023), better global health status, and higher emotional functioning (p = 0.011). However, the symptom scales did not differ significantly between the e-HL and HL groups. CONCLUSION Our study showed a positive association between self-reported HL/e-HL and QoL, marking the first report on the impact of HL/e-HL on the QoL in men who underwent RP for clinically localized prostate cancer.
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Affiliation(s)
- Ahmet Keles
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Muhammed Kose
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Umit Furkan Somun
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nese Yaksi
- Department of Public Health, School of Medicine, University of Amasya, Amasya, Turkey
| | - Asıf Yıldırım
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Culpan M, Yildirim A, Ozkanli SS, Sobay R, Gursoy F, Topaktas R, Gumrukcu G, Gorgel SN, Cakalagaoglu F, Cil G, Ozsoy Ş, Gunel H, Kucuk EV, Ozturk MI, Akin Y, Muslumanoglu AY, Aydin A, Pes MDPL. The Status of Spermatogenesis in Germ Cell Tumor Bearing Testis and Its Association with Metastatic Disease. Clin Genitourin Cancer 2024; 22:102089. [PMID: 38728792 DOI: 10.1016/j.clgc.2024.102089] [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: 12/15/2023] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION We aimed to evaluate the status of spermatogenesis detected by histological examination of non-tumoral testicular tissues in tumor bearing testis and its association with advanced stage disease. PATIENTS AND METHODS We retrospectively reviewed patients with testicular germ cell tumors (TGCTs) that undergone radical orchiectomy. All non-tumoral areas of the orchiectomy specimens were examined for the status of spermatogenesis. Patients were divided into two groups as localized (stage I) and metastatic (stage II-III) disease and analyzed separately for seminomatous (SGCT) and nonseminomatous germ cell tumors (NSGCT). RESULTS Four hundred fifty-four patients were included in our final analysis. Of those, 195 patients had SGCT, and 259 patients had NSGCT. Three hundred and six patients had localized disease at the time of diagnosis. Median (Q1-Q3) age was 31 (26 - 38) years and 102 (22.5%) patients had normal spermatogenesis, 177 (39.0%) patients had hypospermatogenesis and 175 (38.5%) patients had no mature spermatozoa. On multivariate logistic regression analysis, embryonal carcinoma >50% (1.944, 95 %CI 1.054-3.585, P = .033) and spermatogenesis status (2.796 95% CI 1.251-6.250, P = .012 for hypospermatogenesis, and 3.907, 95% CI 1.692-9.021, P = .001 for absence of mature spermatozoa) were independently associated with metastatic NSGCT. However, there was not any variables significantly associated with metastatic SGCT on multivariate logistic regression analysis. CONCLUSION Our study demonstrated that only 22.5% of patients with TGCTs had normal spermatogenesis in tumor bearing testis. Impaired spermatogenesis (hypospermatogenesis or no mature spermatozoa) and predominant embryonal carcinoma are associated with advanced stage NSGCT.
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Affiliation(s)
- Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Asif Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sidika Seyma Ozkanli
- Department of Pathology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Resul Sobay
- Department of Urology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatıma Gursoy
- Department of Pathology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Topaktas
- Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Gulistan Gumrukcu
- Department of Pathology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Sacit Nuri Gorgel
- Department of Urology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Fulya Cakalagaoglu
- Department of Pathology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Gokhan Cil
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Şule Ozsoy
- Department of Pathology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Humeyra Gunel
- Department of Pathology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Eyup Veli Kucuk
- Department of Urology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Metin Ishak Ozturk
- Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yigit Akin
- Department of Urology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Ahmet Yaser Muslumanoglu
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Aydin
- Department of Pathology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Kazan O, Gunduz N, Bakir B, Iplikci A, Culpan M, Ersoy B, Yildirim A. Diagnostic validity of the vesical imaging-reporting and data system (VI-RADS): a real-world study. Actas Urol Esp 2023; 47:638-644. [PMID: 37209783 DOI: 10.1016/j.acuroe.2023.05.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Preoperative Vesical Imaging-Reporting and Data System (VI-RADS) becomes widespread. We aimed to validate the diagnostic performance of VI-RADS in differentiating muscle-invasive (MIBC) from non-muscle-invasive bladder cancer (NMIBC) in a real-world setting. METHODS Between December 2019 and February 2022 suspected primary bladder cancer patients were reviewed. Those with proper multiparametric MRI (mpMRI) protocol for VI-RADS before any invasive treatment were included. Patients were locally staged according to transurethral resection, second resection, or radical cystectomy as the reference standard. Two experienced genitourinary radiologists who were blinded to clinical and histopathological data evaluated the mpMRI images independently and retrospectively. The diagnostic performance of both radiologists and the interreader agreement were analyzed. RESULTS Among 96 patients, 20 (20.8%) had MIBC, and 76 (79.2%) had NMIBC. Both radiologists had great diagnostic performance in diagnosing MIBC. The first radiologist had an area under curve (AUC) of 0.83 and 0.84, the sensitivity of 85% and 80%, and the specificity of 80.3% and 88.2% for VI-RADS ≥3 and ≥4, respectively. The second radiologist had an area under curve (AUC) of 0.79 and 0.77, the sensitivity of 85% and 65%, and the specificity of 73.7% and 89.5% for VI-RADS ≥3 and ≥4, respectively. The overall VI-RADS score agreement between the two radiologists was moderate (κ = 0.45). CONCLUSION VI-RADS is diagnostically powerful in differentiating MIBC from NMBIC prior to transurethral resection. The agreement between radiologists is moderate.
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Affiliation(s)
- O Kazan
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey.
| | - N Gunduz
- Servicio de Radiología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - B Bakir
- Servicio de Radiología, Universidad de Estambul, Escuela de Medicina de Estambul, Estambul, Turkey
| | - A Iplikci
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - M Culpan
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - B Ersoy
- Servicio de Radiología, Universidad de Estambul, Escuela de Medicina de Estambul, Estambul, Turkey
| | - A Yildirim
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
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Kir G, Cecikoglu GE, Topal CS, Sorkun MH, Culpan M, Suceken FY, Karaca H, Yildirim A. Clinicopathologic features and prognostic significance of mixed (Low and high-grade) papillary urothelial carcinoma comparison with low and high-grade papillary urothelial carcinoma. Virchows Arch 2023; 483:621-634. [PMID: 37632533 DOI: 10.1007/s00428-023-03625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/18/2023] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
The World Health Organization/International Society of Urological Pathology (2022 WHO/ISUP) classification categorizes noninvasive carcinomas based on the highest grade observed in a pathology sample. According to this classification, a lesion is classified as mixed-grade (MG) if the highest-grade component comprises less than 5% high-grade (HG) carcinoma [14]. This study included 160 cases of low-grade papillary urothelial carcinoma (LGUC) and 160 cases of HG papillary urothelial carcinoma (HGUC), selected randomly. In addition, 160 consecutive and unselected cases of MG papillary urothelial carcinoma (MGUC) were obtained from all bladder transurethral resection specimens diagnosed with papillary urothelial carcinoma between January 2007 and January 2021. The results of the multivariate analysis showed that histologic grade, invasion of the lamina propria, and the presence of carcinoma in situ at presentation were independent prognostic parameters regarding recurrence-free survival (p = 0.002; hazard ratio (HR) = 1.44, 95% confidence interval (CI) = 1.059-1.956, p = 0.02; and HR = 1.76, 95% CI = 1.159-2.684, p = 0.008, respectively). Histologic grade was the only independent prognostic parameter of disease-specific survival (DSS) (p < 0.001). Comparisons between non-muscle invasive (NMI) MGUC and NMI LGUC, as well as between NMI MGUC and NMI HGUC, revealed statistically significant differences in terms of DSS (HR = 0.07, 95% CI = 0.024-0.252, p < 0.001 and HR = 1.59, 95% CI = 1.023-2.460, p = 0.039, respectively). Our study findings demonstrate statistically significant differences regarding DSS between NMI MGUC and NMI HGUC, as well as between NMI MGUC and NMI LGUC. Therefore, we suggested that considering the presence of less than 5% MGUC as a separate category may be appropriate. However, it is important to validate our results in larger cohorts with longer follow-up periods to establish the clinical significance of MGUC and provide guidance for patient management.
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Affiliation(s)
- Gozde Kir
- Pathology Department, Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Dr.Erkin Caddesi, Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Patoloji Laboratuarı, 34720, Kadıköy, Istanbul, Turkey.
| | - Gozde Ecem Cecikoglu
- Pathology Department, Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Fahrettin Kerim Gökay Caddesi, 34722, Kadıköy, Istanbul, Turkey
| | - Cumhur Selcuk Topal
- Pathology Department, Umraniye Training and Research Hospital, Elmalıkent Mahallesi, Adem Yavuz Cad. No:1, 34764, Ümraniye, Istanbul, Turkey
| | | | - Meftun Culpan
- Urology Department, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Fahrettin Kerim Gökay Caddesi, Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi Patoloji Laboratuvarı, 34722, Kadıköy, Istanbul, Turkey
| | - Ferhat Yakup Suceken
- Urology Department, Umraniye Training and Research Hospital, Elmalıkent Mahallesi, Adem Yavuz Cad. No:1, 34764, Ümraniye, Istanbul, Turkey
| | - Hakan Karaca
- Urology Department, Umraniye Training and Research Hospital, Elmalıkent Mahallesi, Adem Yavuz Cad. No:1, 34764, Ümraniye, Istanbul, Turkey
| | - Asif Yildirim
- Urology Department, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Fahrettin Kerim Gökay Caddesi, Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi Patoloji Laboratuvarı, 34722, Kadıköy, Istanbul, Turkey
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Keser F, Culpan M, Cakici MC, Atis RG, Yildirim A. The effect of bioelectric impedance analysis on the success of extracorporeal shock wave lithotripsy. Urolithiasis 2023; 51:93. [PMID: 37400587 DOI: 10.1007/s00240-023-01465-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
Bioelectric impedance analysis (BIA) is a non-invasive method that can show the distribution of fatty and lean mass of the body. In this study, we aimed to determine the effect of BIA on extracorporeal shock wave lithotripsy (SWL) success. Our secondary aim was to determine the factors predicting transition from a single SWL session to multiple sessions. Patients who underwent SWL due to kidney stones were prospectively included. Demographics, pre-procedural BIA parameters (fat percentage, obesity degree, muscle mass, total water and metabolic rate), stone parameters, and number of SWL sessions were recorded. Univariate and multivariate regression analyzes were made to determine independent risk factors for success. Then, the successful group was divided into two subgroups according to their SWL session number as one session or multiple sessions and multivariate regression analysis was made to determine independent risk factors. Stone-free status was achieved in 114 (61.2%) of 186 patients. Stone Hounsfield Unit (HU) (OR: 0.998, p = 0.004), stone volume (OR: 0.999, p = 0.023) and fat percentage (OR: 0.933, p = 0.001) were independent risk factors for stone-free status in multivariate analysis. HU value of the stone (OR: 1.003, p = 0.005) and age (OR: 1.032, p = 0.031) were determined as independent risk factors for transition to multiple sessions in the subgroup analysis of the successful group. Fat percentage, stone volume, and stone density were determined as factors affecting success in SWL. Routine use of BIA may be considered to predict success before SWL. The probability of SWL success in a single session decreases as the age and stone's HU value increase.
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Affiliation(s)
- Ferhat Keser
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | | | - Asif Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Kazan O, Akalin MK, Culpan M, Atis G, Yildirim A. The Clinical Impact of Physical Activity on the Diagnosis of Prostate Cancer and Postprostatectomy Functional Outcomes in the Elderly. Sisli Etfal Hastan Tip Bul 2023; 57:210-215. [PMID: 37899799 PMCID: PMC10600627 DOI: 10.14744/semb.2023.32549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/05/2023] [Accepted: 02/17/2023] [Indexed: 02/19/2023]
Abstract
Objectives The effect of physical activity on prostate cancer is controversial. We aimed to investigate the effect of physical activity on prostate cancer detection and functional outcomes after radical prostatectomy. Methods Between 2019 and 2020, 166 patients who underwent prostate biopsy were included. The physical activity scores of patients were evaluated by the Physical Activity Scale for the Elderly (PASE) questionnaire before the procedure. PASE scores were compared between the patients with and without prostate cancer and local and metastatic aggressiveness of cancer. Patients who underwent radical prostatectomy were followed up for 12 months to analyze the effect of physical activity on erectile dysfunction (ED) and urinary incontinence (UI). Results There was no significant difference between patients with and without prostate cancer in terms of PASE scores (187.7 vs. 195.5, p=0.665). PASE scores were also similar when separated according to D'Amico risk classification and metastatic events. Twenty-seven patients who underwent radical prostatectomy were evaluated in terms of functional outcomes at the first year of surgery. PASE scores of the patients with severe ED were lower than mild-moderate ED, but no statistically significant difference was observed (197.0 vs. 268.5, p=0.267). Patients with persistent UI had a significantly lower PASE score overall than continent patients (128.3 vs. 271.1, p=0.001), and PASE score was the only independent predictor of UI following radical prostatectomy. Conclusion The effect of physical activity on prostate cancer development or aggressiveness could not be determined. Physical activity was associated with a reduced risk of UI following radical prostatectomy.
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Affiliation(s)
- Ozgur Kazan
- Department of Urology, Kutahya Health Sciences University, Faculty of Medicine, Kutahya, Türkiye
| | - Mustafa Kaan Akalin
- Department of Urology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Türkiye
| | - Meftun Culpan
- Department of Urology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Türkiye
| | - Gokhan Atis
- Department of Urology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Türkiye
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Türkiye
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Kazan O, Gunduz N, Kir G, Iplikci A, Dogan MB, Cecikoglu GE, Culpan M, Yildirim A. The cribriform morphology impairs Gleason 7 prostate cancer lesion detection on multiparametric magnetic resonance imaging. Prostate 2023; 83:331-339. [PMID: 36477738 DOI: 10.1002/pros.24465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/21/2022] [Revised: 09/08/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prostate multiparametric magnetic resonance imaging (mpMRI) is a useful tool for the detection of tumor lesions however, some clinically significant lesions are still missed. We determined whether the cribriform pattern has an effect on lesion detection in mpMRI. METHODS We reviewed the single-institution database of the patients who underwent mpMRI before radical prostatectomy. We included the patients only with the Gleason 7 final pathology of open radical prostatectomy with curative intent between 2016 and 2021. Prostatectomy mappings according to the 16-sector map and cribriform patterns were re-evaluated by two genitourinary pathologists. Prostate mpMRIs were read by two genitourinary radiologists. If the index and nonindex lesions in pathology mapping were matched with mpMRI as Prostate Imaging Reporting and Data System-3 or higher, it was defined as detectable. We compared the detection rates of lesions with and without cribriform morphology. In regression analysis, we also assessed the factors affecting the detectability of prostate cancer lesions. RESULTS A total of 120 patients and 157 lesions were included in our study. While 52 of 83 cribriform pattern positive lesions could be detected in mpMRI, 59 of 74 cribriform pattern negative lesions could be detected (62.7% vs. 79.7%, respectively, p = 0.019). The lesions were also distributed homogeneously according to diameters and analyzed separately. All lesions between 21 and 30 mm with the negative cribriform pattern were detected on mpMRI. However, only 77.8% of cribriform pattern positive lesions between 21 and 30 mm could be detected (p = 0.034). The Higher D'Amico risk group and the absence of cribriform morphology were independent predictors for the lesion detection on mpMRI. CONCLUSION The presence of cribriform pattern in Gleason 7 prostate cancer lesions decreases the lesion detection rate of mpMRI.
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Affiliation(s)
- Ozgur Kazan
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
- Department of Urology, Kutahya University of Health Sciences, Kutahya, Turkey
| | - Nesrin Gunduz
- Department of Radiology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gozde Kir
- Department of Pathology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayberk Iplikci
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut B Dogan
- Department of Radiology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gozde E Cecikoglu
- Department of Pathology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
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Ucar T, Gunduz N, Demirci E, Culpan M, Gunel H, Kir G, Atis RG, Yildirim A. Comparison of 68Ga-PSMA PET/CT and mp-MRI in regard to local staging for prostate cancer with histopathological results: A retrospective study. Prostate 2022; 82:1462-1468. [PMID: 35915579 DOI: 10.1002/pros.24420] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/10/2022] [Revised: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Imaging modalities are used to diagnose and clinical grading of clinically significant prostate cancer. In this study, 68Ga-PSMA PET/CT (PSMA) and multiparametric prostate MRI (mp-MRI) were compared in regard to locating intraprostatic tumor and locoregional staging. METHODS After ethics committee approval, a total of 49 patients with prostate cancer who had mp-MRI and PSMA before radical prostatectomy were included. Preoperative and postoperative PSA, transrectal ultrasound-guided prostate biopsy (TRUS-Bx) ISUP grade, radical prostatectomy ISUP grade, body mass index (BMI), TRUS prostate volume, mp-MRI tumor mapping, PSMAtumor mapping, pathologic tumor mapping, extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node invasion (LNI), and bladder neck invasion (BNI)were retrospectively evaluated. Index tumor was located by uroradiologist, nuclear medicine specialist, and uropathologist on a 12-sector prostate pathology map and compared with each other in terms of accuracy and locoregional clinical staging. RESULTS Mean age of the patients was 66.18 ± 6.67 years and the mean of preoperative PSA results was 21.11 ± 32.56 ng/ml. Nearly half of the patients' (44.9%) pathology was reported as ISUP grade 4 and 5% and 18.4% of patients were surgical margin positive. According to the pathological findings, 362 out of 588 sectors were tumor-positive, 174 out of 362 sectors were tumor-positive in mp-MRI, and 175 out of 362 sectors were tumor-positive in PSMA. Both PSMA and mp-MRI were comparable (p = 0.823) and accurate to detect the location of the intraprostatic index tumor (AUC = 0.66 vs. 0.69 respectively, p = 0.82). The sensitivity and the specificity of the PSMA and mp-MRI for localizing intraprostatic index tumors were 42.5% versus 49.5% and 90.7% versus 88.6% respectively. mp-MRI was more accurate than PSMA in terms of EPE (AUC = 0.8 vs. AUC = 0.57 respectively, p = 0.027) and both methods were comparable in terms of SVI (AUC = 0.75 vs. AUC = 0.75, p = 0.886) and BNI (AUC = 0.51 vs. AUC = 0.59, p = 0.597). PSMA and mp-MRI were comparable in terms of LNI (AUC = 0.76 vs. AUC = 0.64, p = 0.39). CONCLUSION mp-MRI should be considered for its high accuracy in the diagnosis of EPE, especially before decision-making for nerve-sparing surgery in high-risk patients. Both imaging modalities were accurate for localizing intraprostatic index tumor. PSMA is accurate for detecting LNI.
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Affiliation(s)
- Taha Ucar
- Department of Urology, Nigde Omer Halis Demir University Research and Training Hospital, Nigde, Turkey
| | - Nesrin Gunduz
- Department of Radiology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Emre Demirci
- Department of Nuclear Medicine, Yeditepe University, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Humeyra Gunel
- Department of Pathology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Gozde Kir
- Department of Pathology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Ramazan Gokhan Atis
- Department of Urology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin Research and Training Hospital, Istanbul, Turkey
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Culpan M, Iplikci A, Kir G, Cecikoglu GE, Atis G, Yildirim A. The prognostic impact of tumor necrosis in non-muscle invasive bladder cancer. Rev Assoc Med Bras (1992) 2022; 68:1587-1592. [DOI: 10.1590/1806-9282.20220812] [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] [Received: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Gozde Kir
- Istanbul Medeniyet University, Turkey
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Culpan M, Cakici MC, Keser F, Yigit Yalcin M, Kargi T, Kayar R, Abay E, Ozenc G, Kumcu A, Pehlivanoglu M, Turk S, Kisa E, Sahin S, Ishak Ozturk M, Otunctemur A, Sobay R, Cihan Demirel H, Yilmaz O, Atis G, Imamoglu MA, Yildirim A, Yildirim A. Biopsy with Ureterorenoscopy Before Radical Nephroureterectomy is Associated with Increased Intravesical Recurrence in Urothelial Cancer Located in the Kidney. Turk J Urol 2022; 48:431-439. [PMID: 36416333 PMCID: PMC9797743 DOI: 10.5152/tud.2022.22143] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Diagnostic ureterorenoscopy is used to identify upper tract urothelial cancer before radical nephro ureterectomy, especially for uncertain lesions in imaging modalities or urine cytology. However, diagnostic ureterorenoscopy can potentially cause intravesical tumor spillage and can increase intravesical recurrence rates. We aimed to investigate the impact of diagnostic ureterorenoscopy before radical nephroureterectomy, with and without biopsy, on intravesical recurrence rates of patients with upper tract urothelial cancer. MATERIAL AND METHODS Patients with localized upper tract urothelial cancer from 8 different tertiary referral centers, who underwent radical nephroureterectomy between 2001 and 2020, were included. Three groups were made: no URS (group 1); diagnostic ureterorenoscopy without biopsy (group 2); and diagnostic ure terorenoscopy with biopsy (group 3). Intravesical recurrence rates and survival outcomes were compared. Univariate and multivariate Cox regression analyses were performed to determine the factors that were asso ciated with intravesical recurrence-free survival. RESULTS Twenty-two (20.8%), 10 (24.4%), and 23 (39%) patients experienced intravesical recurrence in groups 1, 2, and 3, respectively (P=.037) among 206 patients. The 2-year intravesical recurrence-free sur vival rate was 83.1%, 82.4%, and 69.2%, for groups 1, 2, and 3, respectively (P=.004). Cancer-specific survival and overall survival were comparable (P=.560 and P=.803, respectively). Diagnostic ureterore noscopy+biopsy (hazard ratio: 6.88, 95% CI: 2.41-19.65, P < .001) was the only independent predictor of intravesical recurrence in patients with upper tract urothelial cancer located in the kidney, according to tumor location. CONCLUSION Diagnostic ureterorenoscopy+biopsy before radical nephroureterectomy significantly increased the rates of intravesical recurrence in tumors located in kidney. This result suggests tumor spillage with this type of biopsy, so further studies with different biopsy options or without biopsy can be designed.
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Affiliation(s)
- Meftun Culpan
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, İstanbul Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey
| | - Ferhat Keser
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey,Corresponding author:Ferhat KeserE-mail:
| | - Mehmet Yigit Yalcin
- Department of Urology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Taner Kargi
- Department of Urology, University of Health Sciences, Bakirkoy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Rıdvan Kayar
- Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Erdal Abay
- Department of Urology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğulu City Hospital, İstanbul, Turkey
| | - Gorkem Ozenc
- Department of Urology, University of Health Sciences, Diskapi Yıldırım Beyazıt Training and Research Hospital, İstanbul, Turkey
| | - Ali Kumcu
- Department of Urology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Pehlivanoglu
- Department of Urology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Semih Turk
- Department of Urology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Erdem Kisa
- Department of Urology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences, Bakirkoy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Metin Ishak Ozturk
- Department of Urology, University of Health Sciences, Haydarpaşa Training and Research Hospital, İstanbul, Turkey
| | - Alper Otunctemur
- Department of Urology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğulu City Hospital, İstanbul, Turkey
| | - Resul Sobay
- Department of Urology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Huseyin Cihan Demirel
- Department of Urology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Omer Yilmaz
- Department of Urology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Gokhan Atis
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Muhammet Abdurrahim Imamoglu
- Department of Urology, University of Health Sciences, Diskapi Yıldırım Beyazıt Training and Research Hospital, İstanbul, Turkey
| | - Asif Yildirim
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
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Culpan M, Acar HC, Akalin K, Cakici MC, Tufekci B, Gunduz N, Dogan MB, Yildirim A, Atis G. Are the current nomograms sufficient to predict shockwave lithotripsy outcomes? Actas Urol Esp 2022; 46:473-480. [PMID: 35803872 DOI: 10.1016/j.acuroe.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. PATIENTS AND METHODS Medical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). RESULTS A total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350-6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472-6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182-3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140-2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098-1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001-1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. CONCLUSIONS Stone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, "Kim JK nomogram", "Triple D score" and "S3HoCKwave score" can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.
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Affiliation(s)
- M Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - H C Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - K Akalin
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - M C Cakici
- Department of Urology, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - B Tufekci
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - N Gunduz
- Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - M B Dogan
- Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - A Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - G Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Culpan M, Kazan O, Acar HC, Iplikci A, Atis G, Yildirim A. The probability of residual tumor detection in the second transurethral resection of pT1 urothelial bladder cancer according to the risk factors. Actas Urol Esp 2022; 46:423-430. [PMID: 35725972 DOI: 10.1016/j.acuroe.2022.05.001] [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: 05/07/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyze the predictive factors for residual tumors in the second resection after the initial transurethral resection of bladder tumor (TUR-BT) in patients with pT1 tumors and to develop a simple method to predict the probability of residual tumor detection. MATERIAL AND METHODS Patients with pT1 bladder cancer who underwent a second resection within two to six weeks after the initial TUR-BT were included in our retrospective study. The patients' demographics and the tumor characteristics of the initial and second resections were recorded. RESULTS A total of 144 patients were included in our analysis with a 53-month follow-up. In the univariate logistic regression analysis, tumor grade, concomitant carcinoma in situ (CIS), macroscopic appearance of the tumor (solid vs papillary), and presence of a variant histology, were significant risk factors for residual tumor. In the multivariate analysis, tumor grade was the only independent predictor of residual tumor at second TUR (OR: 5.62, 95% CI: 1.228-25.708, p = 0.026). According to our findings, the patients with the highest risk have a 90.9% residual tumor detection probability at the second resection, and the patients with the lowest risk have 25.4%. CONCLUSIONS Tumor grade, macroscopic appearance of the tumor (solid vs papillary), and concomitant CIS, were important predictors of residual tumors at second resection of primary pT1 NMIBC patients. We were able to calculate the probability of residual tumor which helped us determine risk adapted strategies according to these probabilities.
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Affiliation(s)
- M Culpan
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - O Kazan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - H Cansu Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - A Iplikci
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - G Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - A Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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15
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Kazan O, Kir G, Culpan M, Cecikoglu GE, Atis G, Yildirim A. The association between PI3K, JAK/STAT pathways with the PDL-1 expression in prostate cancer. Andrologia 2022; 54:e14541. [PMID: 35880672 DOI: 10.1111/and.14541] [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: 03/09/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Programmed cell death protein-1/programmed death-ligand-1 (PD-1/PDL-1) signalling pathway has gained attention in prostate cancer. The relationship between pSTAT-1, pSTAT-3 expressions and PTEN loss with PDL-1 expression was assessed and the effects of the pathways on prostate cancer prognosis were evaluated. Patients who underwent radical prostatectomy between 2011 and 2017 were included in our study. Prostatectomy materials were evaluated using immunohistochemical staining of pSTAT-1, pSTAT-3, PTEN, and PDL-1. The relationship between PDL-1 and pSTAT-1, pSTAT-3 expressions and PTEN loss was evaluated. Additionally, factors affecting biochemical recurrence-free survival and clinical progression-free survival were analysed. Within100 patients, 9 of 11 patients with PDL-1 expression also had intermediate-high pSTAT-1 staining intensity, and those with PDL-1 expression had higher pSTAT-1 staining intensity than those without (81.9% vs. 56.2%, p = 0.014). In univariate analysis, pSTAT-1, pSTAT-3 and PDL-1 expressions had significant impact on biochemical recurrence-free and clinical progression-free survival. In multivariate analysis, pSTAT-1 staining intensity with radical prostatectomy ISUP grade in terms of biochemical recurrence-free survival and the pSTAT-1 H-score with radical prostatectomy ISUP grade in terms of clinical progression-free survival were independent risk factors. Moderate-high expression of pSTAT-1 was closely associated with PDL-1 expression, and pSTAT-1 was also a predictor of biochemical recurrence and clinical progression.
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Affiliation(s)
- Ozgur Kazan
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gozde Kir
- Department of Pathology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gozde Ecem Cecikoglu
- Department of Pathology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gokhan Atis
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Culpan M, Acar HC, Akalin K, Cakici MC, Tufekci B, Gunduz N, Dogan MB, Yildirim A, Atis G. ¿Son suficientes los nomogramas actuales para predecir los resultados de la litotricia por ondas de choque? Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.010] [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: 11/30/2022]
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17
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Kazan O, Caglar Cakici M, Keser F, Culpan M, Efiloglu O, Yildirim A, Atis G. The Role of Preoperative Urinalysis in Predicting Postoperative Infection After Retrograde Intrarenal Surgery in Patients with Sterile Urine Culture. Turk J Urol 2022; 48:136-141. [PMID: 35420056 PMCID: PMC9612787 DOI: 10.5152/tud.2022.21331] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Postoperative urinary tract infection is the most common complication of retrograde intrarenal surgery, and no consensus has been obtained that would reveal exact reasons yet. It was aimed to determine the possible factors, especially preoperative urinalysis, of postoperative urinary tract infection after retrograde intrarenal surgery. MATERIAL AND METHODS Patients who underwent retrograde intrarenal surgery in our clinic between 2013 and 2019 were retrospectively screened. Stone size 2 cm and pediatric patients were excluded from the study. The patients were divided into 2 groups as those with and without urinary infections in the early postoperative period. Urine analysis parameters and sterile urine cultures that were taken before the procedure were also analyzed separately. RESULTS A total of 289 patients meeting the defined criteria were included in the study. There was no statistical difference between the 2 groups in terms of demographics. The number of patients with previous urinary tract infection history (55% vs. 20.5%) and operation time (62.5 ± 16.6 minutes vs. 60 ± 19.4 minutes) were significantly higher in those who had postoperative early urinary tract infection. Among urinalysis, the presence of pyuria, leukocyte count, leukocyte esterase positivity, and nitrite positivity were significantly higher in those who had postoperative early urinary tract infection. In multivariate analysis, urinary tract infection history, operation time, and nitrite positivity were found as independent factors in predicting postoperative early urinary tract infection. CONCLUSION Previous urinary tract infection history, prolonged operation time, and nitrite positivity in urinalysis were determined as independent risk factors for postoperative urinary tract infection in kidney stones between 1 and 2 cm.
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Affiliation(s)
- Ozgur Kazan
- Department of Urology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Ferhat Keser
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Meftun Culpan
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Ozgur Efiloglu
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Asif Yildirim
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Gokhan Atis
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
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Culpan M, Keser F, İplikci A, Kır G, Atış G, Yıldırım A. The Clinical Impact of Tumor Grade Heterogeneity in Nonmuscle- invasive Urothelial Carcinoma of the Bladder. Medeni Med J 2021; 36:310-317. [PMID: 34937341 PMCID: PMC8694165 DOI: 10.4274/mmj.galenos.2021.48447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: This study aimed to determine the oncological outcomes of mixed-grade tumors by comparing them with pure low-grade and high-grade tumors. Methods: We retrospectively reviewed the medical records of patients with primary non-muscle-invasive bladder cancer. Patients were categorized into three groups according to the histological grade of their tumors: low-grade, mixed-grade, and high-grade. Clinicopathological characteristics and oncological outcomes, such as recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS), were compared between the three groups. Results: A total of 369 patients (190 low, 40 mixed, and 139 high-grade) were included in our study, with a mean follow-up of 55.94±41.73 months. Patients with mixed-grade tumors had lower rates of pT1 stage diseases than those with high-grade tumors (42.5% vs. 64.0%, respectively) and higher rates than those with low-grade tumors (14.7% vs. 42.5%, respectively) (p=0.001). There was no significant difference in RFS between low-, mixed-, and high-grade tumor patients (p=0.887). Patients with mixed-grade tumors had worse PFS and CSS outcomes than those with low-grade tumors (199.84±23.22 vs. 214.94±15.92 for PFS and 202.07±19.86 vs. 233.61±9.84 for CSS, respectively) and better PFS and CSS outcomes than those with high-grade tumors (199.84±23.22 vs. 163.28±16.18 for PFS and 202.07±19.86 vs. 180.81±15.89 for CSS, respectively), although these comparisons were not statistically significant. Conclusions: Patients with mixed-grade tumors had worse PFS and CSS outcomes than patients with low-grade tumors and better PFS and CSS outcomes than patients with high-grade tumors, although these comparisons were not statistically significant. Our results should be verified by future studies.
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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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Danacioglu YO, Keser F, Efiloğlu Ö, Culpan M, Polat S, Atis RG, Yildirim A. The efficiency of prostate-specific antigen density measurement using three different methods on the prediction of biochemical recurrence. Aging Male 2021; 24:15-23. [PMID: 34006169 DOI: 10.1080/13685538.2021.1924667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficiency of prostate-specific antigen (PSA) density (PSAD) calculated through prostate volume (PV) obtained via transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) and actual prostate weight (PW) methods obtained via pathological evaluation on the prediction of biochemical recurrence (BCR) in the follow-ups of patients who had undergone radical prostatectomy (RP). METHODS A total of 335 clinically localized prostate cancer (PCa) patients who had received open RP between January 2015 and December 2018 were enrolled in the study. Pre and postoperative demographic data, clinical and pathological findings and BCR conditions were recorded. The PSAD was calculated using information obtained through preoperative TRUS examinations, MRI, and collected pathological specimens after RP by dividing the maximum preoperative PSA value and PV/PW. RESULTS In a mean follow-up duration of 20.2 ± 8.5 months, recurrence was observed in 52 patients (24.4%) and progression was observed in 8 (3.8%) patients. The TRUS-PSAD, MRI-PSAD, and PW-PSAD values were statistically significantly higher in BCR patients compared to non-BCR patients. The International Society of Urologic Pathologists (ISUP) grade 5 and pT3b as a pathological stage were detected as independent variables in the prediction of BCR formation. Actual PW had a high prediction value compared to other PSAD measurements at <40 g prostate weights, but it had a low prediction value in prostates with an actual PW >60 g. CONCLUSIONS In this study, it was stated that PSAD acquired through different imaging methods does not affect the usability of PSAD in BCR prediction in clinical practice. The ISUP grade 5 and pT3b stage PCa were detected as independent markers in BCR prediction after RP.
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Affiliation(s)
- Yavuz Onur Danacioglu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Keser
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Özgür Efiloğlu
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Salih Polat
- Department of Urology, Amasya University, Amasya, Turkey
| | - Ramazan Gokhan Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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21
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Culpan M, Acar HC, Cella D, Tahra A, Cakici MC, Efiloğlu Ö, Atis G, Yildirim A. Turkish validation and reliability of the symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29) questionnaire in patients with lower urinary tract symptoms. Neurourol Urodyn 2021; 40:2034-2040. [PMID: 34499765 DOI: 10.1002/nau.24791] [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: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 11/07/2022]
Abstract
AIMS To evaluate the validity and reliability of the Turkish version of the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29). METHODS Patients with lower urinary tract symptoms (LUTS) were included in a single-center study between January and April 2021. Patients' demographics, such as age, sex, and level of education, were recorded. The Turkish version of the LURN SI-29 and the International Prostate Symptom Score (IPSS) were administered to all patients, and the Urogenital Distress Inventory (UDI-6) was additionally administered to female patients. Construct validity was evaluated by confirmatory factor analysis. Concurrent validity was evaluated with correlations to similar measures. Internal consistency (Cronbach's alpha) and split-half reliability analyses were used to establish the scale's reliability. RESULTS A total of 295 participants, 35.3% females and 64.7% males, were included in the final analysis. The mean age was 56.4 ± 11.7 years. The median total LURN SI-29 scores were 38.0 (26-50) and 26.0 (18-43) for female and male patients, respectively. The LURN SI-29 scale showed a high correlation with IPSS and UDI-6 scales (r = .758, p < .001; r = .774, p < .001, respectively) in concurrent validity analysis. Cronbach's alpha coefficient of the scale and all subscales were greater than 0.70 for both female and male patients. CONCLUSIONS This measurement tool can potentially be used to evaluate LUTS in Turkish women and men. Further studies should be performed to reveal the clinical usefulness of this scale.
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Affiliation(s)
- Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hazal C Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ahmet Tahra
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet C Cakici
- Department of Urology, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Özgür Efiloğlu
- Department of Urology, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Gokhan Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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22
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Culpan M, Keser F, Acar HC, Otunctemur A, Kucuk EV, Erdem S, Ozer M, Sen UT, Degirmenci E, Ergul R, Atis RG, Yildirim A. Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic. Int J Clin Pract 2021; 75:e14490. [PMID: 34117682 PMCID: PMC8420249 DOI: 10.1111/ijcp.14490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.
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Affiliation(s)
- Meftun Culpan
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Ferhat Keser
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Hazal Cansu Acar
- Department of Public HealthCerrahpasa Faculty of MedicineIstanbul University‐CerrahpasaIstanbulTurkey
| | - Alper Otunctemur
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Eyup Veli Kucuk
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Selcuk Erdem
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Murat Ozer
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Ugur Tolga Sen
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Enes Degirmenci
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Rifat Ergul
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ramazan Gokhan Atis
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Asif Yildirim
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
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Kazan HO, Culpan M, Gunduz N, Keser F, Iplikci A, Atis RG, Yildirim A. Accuracy of Inchworm Sign on Diffusion-Weighted MRI in Differentiating Muscle-Invasive Bladder Cancer. Bladder Cancer 2021. [DOI: 10.3233/blc-211535] [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: 11/15/2022]
Abstract
BACKGROUND: Inchworm sign is a finding on diffusion-weighted magnetic resonance imaging (DWI-MRI) and is used to better stratify T-staging in muscle invasive (MIBC) and non-muscle-invasive bladder cancer (NMIBC). An uninterrupted low submucosal signal on DWI, defined as inchworm sign (IS), indicates NMIBC. OBJECTIVE: We aimed to define the diagnostic accuracy of IS in primary bladder cancer, as well as find agreement between the urologists and the radiologist. METHODS: Between December 2018 and December 2020, we retrospectively analyzed 95 primary bladder cancer patients who had undergone multiparametric-MRI before transurethral resection. Patients with former bladder cancer history, tumors smaller than 10 mm, and MRI without proper protocol, as well as patients who did not attend follow-up, were excluded. In total, 71 patients’ images were evaluated by a genitourinary specialist radiologist and two urologists. Sensitivity, specificity, positive and negative predictive values of IS and VI-RADS in differentiating MIBC and NMIBC, and interreader agreement between the radiologist and urologists were analyzed. RESULTS: During follow-up, 38 patients (53.5%) were IS-positive, while 33 patients (46.5%) were negative. Among the 33 patients with negative IS, 14 patients (42.4%) had MIBC. Meanwhile, two out of the 38 IS-positive patients (5.3%) had MIBC (p = 0.00). Sensitivity, specificity, and positive and negative predictive values of IS in predicting MIBC were 87.5%, 63.6%, 41.2%and 94.6%, respectively. The interobserver agreement between the urologists and radiologist was almost perfect ( K = 0.802 and K = 0.745) CONCLUSION: The absence of IS on DWI is useful in differentiating MIBC from NMIBC. It is a simple finding that can be interpreted by urologists.
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Affiliation(s)
- Huseyin Ozgur Kazan
- Istanbul Medeniyet University, School of Medicine, Department of Urology, Istanbul, Turkey
| | - Meftun Culpan
- Istanbul Medeniyet University, School of Medicine, Department of Urology, Istanbul, Turkey
| | - Nesrin Gunduz
- Istanbul Medeniyet University, School of Medicine, Department of Radiology, Istanbul, Turkey
| | - Ferhat Keser
- Istanbul Medeniyet University, School of Medicine, Department of Urology, Istanbul, Turkey
| | - Ayberk Iplikci
- Istanbul Medeniyet University, School of Medicine, Department of Urology, Istanbul, Turkey
| | - Ramazan Gokhan Atis
- Istanbul Medeniyet University, School of Medicine, Department of Urology, Istanbul, Turkey
| | - Asif Yildirim
- Istanbul Medeniyet University, School of Medicine, Department of Urology, Istanbul, Turkey
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Culpan M, Turan T, Ozkanli SS, Zenginkinet T, Kazan O, Ucar T, Atis G, Caskurlu T, Yildirim A. Prognostic and clinicopathologic value of ki-67 and profilin 1 immunohistochemical expression in primary pT1 urothelial bladder cancer. J Cancer Res Ther 2021; 17:434-442. [PMID: 34121689 DOI: 10.4103/jcrt.jcrt_408_19] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose To investigate the prognostic and clinicopathologic value of Ki-67 and profilin 1 immunohistochemical expression in primary pT1 papillary urothelial bladder cancer. Materials and Methods This study included 88 male and 13 female pT1 primary bladder cancer patients. Demographic characteristics, tumor histological grade, tumor number, presence of concomitant carcinoma in situ, tumor size, and status of recurrence or progression were recorded for each patient. Expression of Ki-67 and profilin 1 was evaluated by immunohistochemical analysis of paraffin-embedded tumor tissues. The Pearson's Chi-square test was used for the analysis of qualitative data, and the Kaplan-Meier method and the log-rank test were used for the survival analysis. Results In the mean follow-up period of 52 months, 52 (51.5%) patients experienced recurrence, 24 (23.8%) patients experienced progression, and 17 (16.8%) patients died from bladder cancer-related causes. Ki-67 expression was significantly associated with tumor histological grade (P = 0.001). In multivariate analysis, Ki-67 positivity had significantly worse outcome for recurrence (P = 0.006) and mortality (P = 0.022). Ki-67-positive (Ki-67 index ≥15%) patients had shorter recurrence-free (P = 0.003), progression-free (P = 0.002), and cancer-specific (P = 0.003) survival. However, no statistically significant relationship was found between profilin 1 expression and clinicopathologic features and prognosis. Conclusions Ki-67 is a highly predictive biomarker for recurrence-free, progression-free, and cancer-specific survival in pT1 bladder cancer patients, in whom prediction of recurrence and progression are difficult. Ki-67 expression can be safely combined with other prognostic factors. However, in pT1 bladder cancer patients, no significant relationship was found between profilin 1 expression and tumor characteristics or prognostic parameters.
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Affiliation(s)
- Meftun Culpan
- Department of Urology, Okan University Hospital, Istanbul, Turkey
| | - Turgay Turan
- Department of Urology, Turgutlu State Hospital, Manisa, Turkey
| | - Sidika Seyma Ozkanli
- Department of Pathology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tulay Zenginkinet
- Department of Pathology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ozgur Kazan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Taha Ucar
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gokhan Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Turhan Caskurlu
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Culpan M, Kazan H, Akalin M, Atis G, Yildirim A. Time to cystectomy affects survival in initial pT1 non-muscle invasive bladder cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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26
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Atis G, Culpan M, Ucar T, Sendogan F, Kazan HO, Yildirim A. The effect of shock wave lithotripsy and retrograde intrarenal surgery on health-related quality of life in 10-20 mm renal stones: a prospective randomized pilot study. Urolithiasis 2020; 49:247-253. [PMID: 33074423 DOI: 10.1007/s00240-020-01219-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
The effects of treatment modalities such as retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) on health-related quality of life (HRQoL) were determined in patients with renal stones between 10 and 20 mm. A total of 120 patients were included in the study and prospectively randomized to RIRS or SWL group. A total of 39 patients experienced treatment failure and finally 81 patients (45 patients in the RIRS group, 36 patients in the SWL group) were analyzed for HRQoL. SF-36 survey was used to determine HRQoL pre-operatively, post-operative day 1 and 1 month. The patient and stone characteristics such as age, gender, stone size, grade of hydronephrosis and body mass index were similar between the two groups. At post-operative day 1, the RIRS group was associated with lower scores of role functioning/physical (p = 0.008), role functioning/emotional (p = 0.047) energy/fatigue (p = 0.011), social functioning (p = 0.003) and pain (p = 0.003) when compared to the SWL group. At post-operative 1 month, only pain and emotional well-being scores (p = 0.012 and p = 0.011, respectively) in the RIRS group were statistically lower according to the SWL group. In our study, patients in the SWL group showed more favorable HRQoL scores when compared to the patients in the RIRS group in short-term follow-up.
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Affiliation(s)
- Gokhan Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Eğitim Mah. Dr. Erkin Cad. Kadıköy, 34722, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Eğitim Mah. Dr. Erkin Cad. Kadıköy, 34722, Istanbul, Turkey.
| | - Taha Ucar
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Eğitim Mah. Dr. Erkin Cad. Kadıköy, 34722, Istanbul, Turkey
| | - Furkan Sendogan
- Department of Urology, Ardahan State Hospital, Ardahan, Turkey
| | - Huseyin Ozgur Kazan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Eğitim Mah. Dr. Erkin Cad. Kadıköy, 34722, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Eğitim Mah. Dr. Erkin Cad. Kadıköy, 34722, Istanbul, Turkey
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Caskurlu H, Culpan M, Erol B, Turan T, Vahaboglu H, Caskurlu T. Changes in Antimicrobial Resistance of Urinary Tract Infections in Adult Patients over a 5-Year Period. Urol Int 2020; 104:287-292. [PMID: 31940639 DOI: 10.1159/000504415] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to determine the most common bacteria that cause urinary tract infections (UTIs), the rate of antibiotic resistance of these uropathogens, and the changes in resistance rates over the years for adult patients diagnosed with UTIs. METHODS We retrospectively reviewed urine cultures and antibiotic susceptibility results of patients >17 years of age from our outpatient clinic between 2014 and 2018. The most common uropathogens and their antibiotic resistance rates were identified in different age groups (18-39, 40-59, and ≥60 years) and with respect to gender and date of admission. In addition, the change in antibiotic resistance of Escherichia coli between 2014 and 2018 was also examined. RESULTS A total of 9,556 positive urine cultures were included. The most common uropathogen was E. coli, and its prevalence was higher in females than males (70.6 vs. 53.4%, respectively). The majority of isolates were from patients ≥60 years of age. E. coli resistance was most pronounced for ampicillin (61.56%), followed by trimeth-oprim-sulfamethoxazole (49.80%), amoxicillin-clavulanic acid (34.69%), and cefazolin (30.72%). E. coli resistance to ampicillin, nitrofurantoin, cefepime, ciprofloxacin, fosfomycin, and amoxicillin-clavulanic acid increased significantly with time (all p = 0.001). For E. coli, resistance to ciprofloxacin, one of the most commonly used antibiotics for UTI, increased from 17 to 43% from 2014 to 2018. CONCLUSION Most of the uropathogens displayed high resistance to ampicillin, tri-methoprim-sulfamethoxazole, and amoxicillin-clavulanic acid, and were susceptible to meropenem, ertapenem, and imipenem. Fosfomycin and cefepime were useful in the empirical treatment of community-acquired UTIs. A surprisingly high increase was observed in the resistance of E. coli to antimicrobial agents from 2014 to 2018.
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Affiliation(s)
- Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Bulent Erol
- Department of Urology, Goztepe Training and Research Hospital, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey,
| | - Turgay Turan
- Department of Urology, Turgutlu State Hospital, Manisa, Turkey
| | - Haluk Vahaboglu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Turhan Caskurlu
- Department of Urology, Goztepe Training and Research Hospital, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Atis G, Pelit ES, Culpan M, Gunaydin B, Turan T, Danacioglu YO, Yildirim A, Caskurlu T. The Fate of Residual Fragments After Retrograde Intrarenal Surgery in Long-Term Follow-up. Urol J 2019; 16:1-5. [PMID: 30033513 DOI: 10.22037/uj.v0i0.4124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 12/15/2017] [Accepted: 01/21/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE We aimed to describe the natural history of stone fragments ? 7 mm that remained after retrograde intrarenalsurgery (RIRS) in long-term follow-up. MATERIALS AND METHODS We retrospectively reviewed 142 medical records of patients who had residual fragments (RFs) ? 7 mm after RIRS. Patients were divided into 2 groups according to the size of RFs as ? 4 mm (group 1) and 5 - 7 mm (group 2). Patients' demographic data, stone characteristics, perioperative data and complications were recorded. Re-growth of RFs, spontaneous passage, renal colic, infection and re-operation rates were our main variables. RESULT A total of 142 patients (86 in group 1 / 56 in group 2) were followed for mean 54.45 ± 14.24 and 56.22 ± 10.28 months. Mean size of RFs was 2.85 ± 1.22 mm in group 1 and 6.81 ? 2.21 mm in group 2. Mean number of RFs were 1.1 ± 0.2 in group 1 and 2.4 ± 1.6 in group 2 (P = .035). Spontaneous passage rate of RFs were 30.23% and 17.85% in group 1 and 2, respectively (P = .032). No difference was observed in the re-growth rate of RFs between the two groups (P = .094). Although no difference was observed in re-growth of RFs between the groups, patients in group 2 were more likely to experience stone-related events such as renal colic and re-intervention rate (P = .034, P = .029; respectively). CONCLUSION Our results demonstrate that RFs > 4 mm take higher risk in terms of stone-related events and shouldbe followed up more closely.
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Affiliation(s)
- Gokhan Atis
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Urology, Istanbul, Turkey.
| | | | - Meftun Culpan
- Sirnak Silopi State Hospital, Department of Urology, Silopi Sirnak, Turkey
| | - Bilal Gunaydin
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Turgay Turan
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Yavuz Onur Danacioglu
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Asif Yildirim
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Turhan Caskurlu
- Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Urology, Istanbul, Turkey
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29
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Erol B, Culpan M, Caskurlu H, Sari U, Cag Y, Vahaboglu H, Özumut SH, Karaman MI, Caskurlu T. Changes in antimicrobial resistance and demographics of UTIs in pediatric patients in a single institution over a 6-year period. J Pediatr Urol 2018; 14:176.e1-176.e5. [PMID: 29428362 DOI: 10.1016/j.jpurol.2017.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine changes in antimicrobial resistance and demographics of UTIs in pediatric patients in a single institution over a 6-year period. MATERIALS AND METHODS The current study examined outpatient urinary isolates from patients aged <18 years. A retrospective cross-sectional analysis of bacteria isolated from children with UTI was performed between 2009 and 2014. The most common bacterial pathogens were determined in the following four age groups: <2 years; 2-5 years; 6-12 years; and 13-17 years. The study analyzed the prevalence and antibiotic resistance patterns for the six most common uropathogens: Escherichia coli, Proteus, Klebsiella, Enterobacter, Pseudomonas and Enterococcus (Summary table). The antibiotic resistance pattern for UTI during 2009-2014 was also examined. RESULTS A total of 6515 urinary cultures was examined. The majority of these isolates were from female patients (66.8%). E. coli was the most common uropathogen overall, but the prevalence of E. coli was higher among females (79.5%) than males (54.9%). The biggest percentage of isolates in males was from children aged <2 years (46.1%). Conversely, the majority of isolates in females were from children aged >6 years (46.8%). Results of antimicrobial resistance for E. coli were the highest for ampicillin (70%) and lowest for meropenem (0.19%). Comparing the hospital network data from 2009 to 2014, E. coli resistance increased for ampicillin (from 47.1% to 89%), trimethoprim-sulfamethoxazole (TMP-SMX) (from 44.8% to 56%) and nitrofurantoin (from 5.3% to 15.1%). In contrast, cephalosporins have maintained low antibiotic resistance. CONCLUSION UTI in females was nearly twice as common than in males. E. coli remained the most common pediatric uropathogen. Although widely used in other tract infections, ampicillin was a poor empiric choice for pediatric UTIs. Cephalosporins were appropriate alternatives given their low resistance rates. A successful empirical treatment protocol should be based on local epidemiology and susceptibility rates.
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Affiliation(s)
- B Erol
- Istanbul Medeniyet University Faculty of Medicine, Department of Urology, Istanbul, Turkey.
| | - M Culpan
- Istanbul Medeniyet University Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - H Caskurlu
- Istanbul Medeniyet University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - U Sari
- Istanbul Medeniyet University Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - Y Cag
- Istanbul Medeniyet University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Vahaboglu
- Istanbul Medeniyet University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - S H Özumut
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey
| | - M I Karaman
- Istanbul Medeniyet University Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - T Caskurlu
- Istanbul Medeniyet University Faculty of Medicine, Department of Urology, Istanbul, Turkey
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Atis G, Culpan M, Pelit ES, Canakci C, Ulus I, Gunaydin B, Yildirim A, Caskurlu T. Comparison of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Treating 20-40 mm Renal Stones. Urol J 2017; 14:2995-2999. [PMID: 28299761] [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: 08/03/2016] [Revised: 01/16/2017] [Accepted: 01/28/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE To compare the outcomes of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating renal stones between 20 and 40 mm in diameter. MATERIALS AND METHODS 146 patients, who were treated with RIRS and 146 patients, who were treated with PCNL for renal stones between 20 and 40 mm in diameter were compared retrospectively using a matched-pair analysis. The operative and post-operative outcomes of both groups were analyzed retrospectively. RESULTS The mean age, gender, body mass index and stone laterality were similar between the groups. The mean stone size was 28.39 ± 4.67 mm for the PCNL group and 25.08 ± 6.07 mm for the RIRS group (P =.21). The mean operative times were statistically longer in the RIRS group, whereas the fluoroscopy times, hospitalization times and post-operative visual analogue scores were statistically higher in the PCNL group. The stone- free rates (SFR) after a single procedure were 91.7% in the PCNL group and 74% in the RIRS group (P = .04). After auxiliary procedures, the overall SFRs reached 94.4% for the PCNL group and 92.3% for the RIRS group (P = .52). No major complications were observed for both groups. Minor complication (Clavien 1-3) rates were 6.8% and 3.4% for the PCNL and RIRS group, respectively (P =.18). CONCLUSION RIRS has some advantages over PCNL such as shorter hospitalization times, shorter fluoroscopy times and less post-operative pain in treating renal stones between 20 and 40 mm in diameter. However, PCNL has a higher SFR with only a single session.
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Affiliation(s)
- Gokhan Atis
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Urology, Istanbul, TR.
| | - Meftun Culpan
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Urology, Istanbul, TR
| | | | - Cengiz Canakci
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Urology, Istanbul, TR
| | - Ismail Ulus
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Urology, Istanbul, TR
| | - Bilal Gunaydin
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Urology, Istanbul, TR
| | - Asif Yildirim
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Urology, Istanbul, TR
| | - Turhan Caskurlu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Urology, Istanbul, TR
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Pelit ES, Atis G, Kati B, Akin Y, Çiftçi H, Culpan M, Yeni E, Caskurlu T. Comparison of Mini-percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Preschool-aged Children. Urology 2016; 101:21-25. [PMID: 27818164 DOI: 10.1016/j.urology.2016.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To compare the outcomes of mini-percutaneous nephrolithotomy (m-PCNL) and retrograde intrarenal surgery (RIRS) in treating renal stones in preschool-aged children. MATERIALS AND METHODS Forty-five patients treated with m-PCNL and 32 patients treated with RIRS for renal stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed retrospectively. RESULTS The mean age and gender were similar between the groups. The mean stone size was 19.30 ± 4.21 mm for the RIRS group and 21.06 ± 5.61 mm for the PCNL group (P = .720). The mean operative times, fluoroscopy times, and hospitalization times were statistically higher in the PCNL group. The stone-free rates (SFRs) after a single procedure were 84.4% in the PCNL group and 75% in the RIRS group (P = .036). After auxiliary procedures, the overall SFRs reached 91.1% for the PCNL group and 90.6% for the RIRS group (P = .081). No major complications were observed for both groups. Minor complication (Clavien 1-3) rates were 15.5% and 12.5% for the PCNL and RIRC group, respectively (P = .385). CONCLUSION RIRS has some advantages over PCNL such as shorter hospitalization times, shorter fluoroscopy times, and shorter operative time in treating renal stones. However, PCNL achieves higher SFR after a single session.
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Affiliation(s)
- Eyyup Sabri Pelit
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
| | - Gökhan Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bülent Kati
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Yiğit Akin
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Halil Çiftçi
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ercan Yeni
- Department of Urology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Turhan Caskurlu
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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