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Kazan O, Cakici MC, Kokurcan A, Ozenc G, Karakoyunlu N, Atis G, Imamoglu MA, Yildirim A. Factors influencing the decision-making in laparoscopic partial nephrectomy for small renal masses. Urologia 2023; 90:693-701. [PMID: 37470329 DOI: 10.1177/03915603231189025] [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] [Indexed: 07/21/2023]
Abstract
BACKGROUND AND OBJECTIVES We analyzed the factors affecting the decision on surgical approach such as hilum dissection, vessel clamping, and the warm ischemia time (WIT) in laparoscopic partial nephrectomy (LPN) for small renal masses (SRMs). METHODS Patients who underwent LPN for SRMs between 2011 and 2021 in two centers were retrospectively screened. Standardized R.E.N.A.L. nephrometry score (RNS) and each of the components were scored on a Likert scale and the effect on the surgical approach was examined by using them separately. RESULTS A total of 133 patients, 85 of whom were on-clamp and 48 were off-clamp, were included in the study. Greater tumor size, low BMI, higher RNS, upper pole tumor, low exophytic rate, and nearness to the collecting system were statistically significant for both on/off-clamp and hilar dissection decisions. In multivariate analysis, greater tumor size, upper pole tumor, lower rate of exophytic part (E2), nearness to the collecting system (N3) were independent risk factors for vessel clamping. Greater tumor size and lower exophytic tumor rate (E2) were independent risk factors for hilum dissection. We could not identify any factor affecting WIT. CONCLUSION Individual components of RNS may serve as a better tool for decision-making on vessel clamping and hilum dissection during LPN for SRMs.
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Affiliation(s)
- Ozgur Kazan
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
- Department of Urology, School of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Alihan Kokurcan
- Department of Urology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gorkem Ozenc
- Department of Urology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, 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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Cetin T, Celik S, Sozen S, Akdogan B, Izol V, Aslan G, Suer E, Bayazit Y, Karakoyunlu N, Ozen H, Baltaci S, Gokalp F, Tinay I. Oncological outcomes of papillary versus clear cell renal cell carcinoma in pT1 and pT2 stage: Results from a contemporary Turkish patient cohort. Arch Ital Urol Androl 2023:11218. [PMID: 37254924 DOI: 10.4081/aiua.2023.11218] [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: 01/26/2023] [Accepted: 02/17/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES To compare overall survival (OS), recurrence free survival (RFS), and cancer-specific survival (CSS) in the long-term follow-up of T1 and T2 clear-cell-Renal Cell Carcinoma (ccRCC) and papillary Renal Cell Carcinoma (pRCC) patients, as well as to determine the risk factors for recurrence and overall mortality. MATERIAL AND METHOD Data of patients with kidney tumors obtained from the Urologic Cancer Database - Kidney (UroCaD-K) of Turkish Urooncology Association (TUOA) were evaluated retrospectively. Out of them, patients who had pathological T1-T2 ccRCC and pRCC were included in the study. According to the two histological subtype, recurrence and mortality status, RFS, OS and CSS data were analyzed. RESULTS RFS, OS and CSS of pRCC and ccRCC were found to be similar. Radiological local invasion was shown to be a risk factor for recurrence in pRCC, and age was the only independent factor affecting overall mortality. CONCLUSIONS There were no differences in survivals (RFS, OS and CSS) of patients with localized papillary and clear cell RCC. While age was the only factor affecting overall mortality, radiological local invasion was a risk factor for recurrence in papillary RCC.
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Affiliation(s)
- Taha Cetin
- Izmir Bozyaka Research and Training Hospital Urology Department, Izmir; Member of Turkish Urooncology Association.
| | - Serdar Celik
- Izmir Bozyaka Research and Training Hospital Urology Department, Izmir; Member of Turkish Urooncology Association.
| | - Sinan Sozen
- Gazi University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Bulent Akdogan
- Hacettepe University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Volkan Izol
- Cukurova University Faculty of Medicine Urology Department, Adana; Member of Turkish Urooncology Association.
| | - Guven Aslan
- Dokuz Eylul University Faculty of Medicine Urology Department, Izmir; Member of Turkish Urooncology Association.
| | - Evren Suer
- Ankara University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Yildirim Bayazit
- Cukurova University Faculty of Medicine Urology Department, Adana; Member of Turkish Urooncology Association.
| | - Nihat Karakoyunlu
- University of Health Sciences Dıskapi Yildirim Beyazit Research and Training Hospital Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Haluk Ozen
- Hacettepe University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Sumer Baltaci
- Ankara University Faculty of Medicine Urology Department, Ankara; Member of Turkish Urooncology Association.
| | - Fatih Gokalp
- Mustafa Kemal University Tayfur Ata Sokmen Medicine Faculty Urology Department, Hatay; Member of Turkish Urooncology Association.
| | - Ilker Tinay
- Marmara University Faculty of Medicine Urology Department, Istanbul; Member of Turkish Urooncology Association.
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Campi R, Grosso AA, Lane BR, DE Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Noyes S, DI Maida F, Mari A, Rodriguez-Faba O, Keeley FX, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend JE, Smaldone MC, Uzzo RG, Kutikov A, Minervini A. Impact of Trifecta definition on rates and predictors of "successful" robotic partial nephrectomy for localized renal masses: results from the Surface-Intermediate-Base Margin Score International Consortium. Minerva Urol Nephrol 2022; 74:186-193. [PMID: 35345387 DOI: 10.23736/s2724-6051.21.04601-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Over the years, five different Trifecta score definitions have been proposed to optimize the framing of "success" in partial nephrectomy (PN) field. However, such classifications rely on different metrics. The aim of the present study was to explore how the success rate of robotic PN, as well as its drivers, vary according to the currently available definitions of Trifecta. METHODS Data from consecutive patients with cT1-2N0M0 renal masses treated with robotic PN at 16 referral centers from September 2014 to March 2015 were prospectively collected. Trifecta rate was defined for each of the currently available definitions. Multivariable logistic regression analysis was used to evaluate possible predictors of "Trifecta failure" according to the different adopted formulation. RESULTS Overall, 289 patients met the inclusion criteria. Among the definitions, Trifecta rates ranged between 66.4% and 85.9%. Multivariable analysis showed that predictors for "Trifecta failure" were mainly tumor-related (i.e. tumor's nephrometry) for those Trifecta scores relying on WIT as a surrogate metric for postoperative renal function deterioration (definitions 1,2), while mainly surgery-related (i.e. ischemia time and excision strategy) for those including the percentage change in postoperative eGFR as the functional cornerstone of Trifecta (definitions 3-5). CONCLUSIONS There was large variability in rates and predictors of "unsuccessful PN" when using different Trifecta scores. Further research is needed to improve the value of the Trifecta metrics, integrating them into routine patient counseling and standardized assessment of surgical quality across institutions.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonio A Grosso
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Brian R Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Ottavio DE Cobelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Sanguedolce
- Bristol Urological Institute, Southmead Hospital, Bristol, UK.,Unit of Uro-Oncology, Puigvert Foundation, Barcelona, Spain
| | - Georgios Hatzichristodoulou
- Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany.,Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | | | - Sabrina Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Fabrizio DI Maida
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Frank X Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Johan Langenhuijsen
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bulent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Maria Furlan
- Department of Urology, University of Brescia, Brescia, Italy
| | - Nihat Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Martin Marszalek
- Department of Urology and Andrology, Donauspital, Austria.,Department of Urology, Graz Medical University, Graz, Austria
| | - Umberto Capitanio
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Sabine Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU) Munich, Germany.,Janssen Pharma Research and Development, Los Angeles, CA, USA
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andrea Minervini
- Department of Urology, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Di Maida F, Campi R, Lane BR, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Grosso AA, Noyes S, Rodriguez-Faba O, Keeley FX, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Simeone C, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend JE, Smaldone MC, Uzzo RG, Kutikov A, Minervini A. Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium). J Clin Med 2022; 11:jcm11071765. [PMID: 35407375 PMCID: PMC8999836 DOI: 10.3390/jcm11071765] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/12/2022] [Accepted: 03/19/2022] [Indexed: 12/30/2022] Open
Abstract
Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3−4.2) cm and median (IQR) PADUA score was 8 (7−9). SIB scores of 0−2 (enucleation), 3−4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3−4) versus enucleation (SIB score 0−2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25−7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN.
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Affiliation(s)
- Fabrizio Di Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, 50134 Florence, Italy;
| | - Brian R. Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA; (B.R.L.); (S.N.)
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy; (O.D.C.); (G.M.)
| | - Francesco Sanguedolce
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (F.S.); (F.X.K.)
- Uro-Oncology Unit, Fundacio Puigvert, 08025 Barcelona, Spain;
| | - Georgios Hatzichristodoulou
- Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany; (G.H.); (J.E.G.)
- Department of Urology, Martha-Maria Hospital Nuremberg, 90491 Nurnberg, Germany
| | - Alessandro Antonelli
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Antonio Andrea Grosso
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
| | - Sabrina Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA; (B.R.L.); (S.N.)
| | | | - Frank X. Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (F.S.); (F.X.K.)
| | - Johan Langenhuijsen
- Department of Urology, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy; (O.D.C.); (G.M.)
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK;
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Bulent Akdogan
- Department of Urology, School of Medicine, Hacettepe University, Ankara 06800, Turkey;
| | - Maria Furlan
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
| | - Claudio Simeone
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 06145, Turkey;
| | - Martin Marszalek
- Department of Urology and Andrology, Sozialmedizinishes Zentrum Ost-Donauspital, 1220 Vienna, Austria;
- Department of Urology, Graz Medical University, 8036 Graz, Austria
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Sabine Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU), 80539 Munich, Germany;
- Janssen Pharma Research and Development, San Diego, CA 92121, USA
| | - Jürgen E. Gschwend
- Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany; (G.H.); (J.E.G.)
| | - Marc C. Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Robert G. Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
- Correspondence:
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Karakoyunlu N, Çakıcı MÇ, Sarı S, Hepşen E, Bikirov M, Kısa E, Özbal S, Özok HU, Ersoy H. Efficacy of various laser devices on lithotripsy in retrograde intrarenal surgery used to treat 1-2 cm kidney stones: A prospective randomized study. Int J Clin Pract 2021; 75:e14216. [PMID: 33864337 DOI: 10.1111/ijcp.14216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/28/2020] [Accepted: 04/05/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS To compare the efficacy of different laser devices and power ranges on lithotripsy in retrograde intrarenal surgery (RIRS) for 1-2 cm kidney stones. METHODS A total of 223 participants undergoing RIRS for 1-2 cm kidney stones at our clinic between January 2015 and January 2017 were recruited for this prospective study (NCT02451319). Two hundred and four participants included in our study were randomly allocated into either ≤20 W with 20 W laser device (group 1) or ≤20 W with 30 W laser device (group 2) or >20 W with 30 W laser device (group 3). RESULTS There was no significant difference between the groups in terms of demographic and stone characteristics. Operation and fluoroscopy times were significantly longer (P = .003 and P < .001, respectively) and stone-free rate (SFR) was significantly lower in group 1 (P = .002). Complications were similar in all three groups (P = .512). However, post-operative pain scores were significantly higher in group 1 (P < .001). The multivariate analysis revealed that stone size (95% CI: 0.654-0.878, OR = 0.758, P < .001), ureteral access sheath use (95% CI: 1.003-20.725, OR = 4.560, P = .049), and lithotripsy with 30 W laser device (95% CI: 1.304-11.632, OR = 3.895, P = .015; 95% CI: 1.738-17.281, OR = 5.480, P = .004, groups 2 and 3, respectively) were independent factors predicting SFR for RIRS used in 1-2 cm kidney stones. CONCLUSION The 30 W laser device used in RIRS for 1-2 cm kidney stones had shorter operation times, higher SFRs, and lower post-operative pain scores compared with the 20 W device. The 30 W laser device is safe and more efficient in RIRS for treatment of 1-2 cm kidney stones.
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Affiliation(s)
- Nihat Karakoyunlu
- Department of Urology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Çağlar Çakıcı
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Sercan Sarı
- Department of Urology, Faculty of Medicine Hospital, Bozok University, Yozgat, Turkey
| | - Emre Hepşen
- Department of Urology, Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Muslim Bikirov
- Department of Urology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Erdem Kısa
- Department of Urology, Health Sciences University, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Serra Özbal
- Department of Radiology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hakkı Uğur Özok
- Department of Urology, Faculty of Medicine Hospital, Karabuk University, Karabük, Turkey
| | - Hamit Ersoy
- Department of Urology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Koras O, Bozkurt IH, Karakoyunlu N, Celik S, Sefik E, Yarimoglu S, Polat S, Sahan M, Degirmenci T. Retrospective analysis of the factors affecting intraoperative and immediate postoperative complications of RIRS classified by the Clavien and Satava grading systems. J Endourol 2021; 35:1764-1772. [PMID: 34235967 DOI: 10.1089/end.2021.0238] [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: 11/13/2022] Open
Abstract
BACKGROUND To classify intraoperative and postoperative complications using the modified Clavien classification system(MCCS) and modified Satava classification system(SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery(RIRS) for renal and proximal ureteral stones. MATERIALS AND METHODS We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and proximal ureteral stones at two institutions between March 2015 and June 2020. Intraoperative complications were assessed using SCS and postoperative complications were graded according to MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. RESULTS The median stone size was determined as 13 mm (range 10-20 mm). The stone-free rate was 83.6% after the first intervention. Reprocedure was applied to 89 of the patients with residual stones and the final stone-free rate was 94.4% after reprocedure. According to SCS, the number of intraoperative events and complication incidences was 153(16.1%). MCCS revealed postoperative complications in 121(12.8%) patients. Major complications were observed in 18(1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.4%, p=0.001). Stone location, stone size, stone burden, stone number, stone density and residual fragments were determined to be associated with the development of complications (p<0.001,p<0.001,p<0.001, p<0.001,p=0.002 and p<0.001 respectively). In addition, the multivariate analysis revealed that only presence of residual fragments was a significant predictor of complication development for the patients with Grade≥3 complications according to MCCS (p=0.032). However, significant predictors were stone burden (p<0.001), stone density (p=0.002) and fluoroscopy time (p<0.001) for those with Grade≥2b complications according to SCS. CONCLUSION This study showed that abnormal kidney anatomy, operation time, stone burden and residual fragments were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.
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Affiliation(s)
- Omer Koras
- Mustafa Kemal University Faculty of Medicine, 111335, Urology, Mustafa Kemal University, Faculty of Medicine, Department of Urology, 31100, Antakya/HATAY, TURKEY, Hatay, Turkey, 31040;
| | - Ibrahim Halil Bozkurt
- Bozyaka Training and Research Hospital, Urology, Saim Cikrikci Str No:59, Karabaglar, Izmir, Turkey, 35170;
| | - Nihat Karakoyunlu
- Min.of Health Yildirim Beyazit Training Hosp., Urology Clinic, İrfan Baştuğ Cad. Dışkapı / ANKARA, Ankara, Turkey, 06110.,Eryaman mah 2.cd 15/20Etimesgutankaraankara, Turkey;
| | - Serdar Celik
- University of Health Sciences Izmir Bozyaka Education and Research Hospital, 169317, Urology, Izmir, Izmir, Turkey;
| | - Ertugrul Sefik
- Izmir Bozyaka Egitim ve Arastirma Hastanesi, 169317, Urology, Bozyaka Training And Research Hospital, Department Of Urology, Izmir, Turkey, Turkey, 35000.,Bozyaka Training And Research Hospital;
| | - Serkan Yarimoglu
- Izmir Bozyaka Training and Research Hospital, 169317, Urology, Izmir, Izmir, Turkey, 35000;
| | - Salih Polat
- Amasya University, 111366, Urology, Amasya, Turkey;
| | - Murat Sahan
- University of Health Sciences Izmir Bozyaka Education and Research Hospital, 169317, Urology, Izmir, Izmir, Turkey;
| | - Tansu Degirmenci
- Bozyaka Education and Research Hospital, Department of Urology, Izmir, Turkey;
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Çakıcı MÇ, Karakoyunlu N, Kokurcan A, Sarı S, Sandıkçı F, Karabacak OR, Sağnak L, Topaloğlu H, Ersoy H. Effect of Positive Surgical Margin on Survival After Partial Nephrectomy for Renal Cell Cancer: Long-term Results of a Single Center. jus 2020. [DOI: 10.4274/jus.galenos.2020.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Çakıcı MÇ, Karakoyunlu N, Sari S, Ozok HU, Selmi V, Kartal IG, Nalbant I, Sagnak L, Ersoy H. Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Used in the Treatment of 2–4 cm Kidney Stones in Terms of Pain and Need for Additional Analgesics: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A 2020; 30:1301-1307. [DOI: 10.1089/lap.2020.0179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mehmet Çağlar Çakıcı
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Sercan Sari
- Department of Urology, Bozok University School of Medicine, Yozgat, Turkey
| | - Hakki Ugur Ozok
- Department of Urology, Karabük University School of Medicine, Karabük, Turkey
| | - Volkan Selmi
- Department of Urology, Bozok University School of Medicine, Yozgat, Turkey
| | - Ibrahim Guven Kartal
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ismail Nalbant
- Department of Urology, Lokman Hekim Etlik Hospital, Ankara, Turkey
| | - Levent Sagnak
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Hamit Ersoy
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
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Cakici MC, Karakoyunlu N, Sagnak L. Approach to Treatment of a Non-functional Retrovesical Bladder Paraganglioma. J Coll Physicians Surg Pak 2020; 30:1113-1114. [PMID: 33143843 DOI: 10.29271/jcpsp.2020.10.1113] [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] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Mehmet Caglar Cakici
- Department of Urology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Health Sciences University, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Levent Sagnak
- Department of Urology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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Di Maida F, Campi R, Tellini R, Lane B, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Mari A, Brookman-May S, Klatte T, Roscigno M, Akdogan B, Karakoyunlu N, Langenhuijsen H, Keeley F, Marszalek M, Capitanio U, Carini M, Kutikov A, Minervini A. Predictors of trifecta after open and robot partial nephrectomy for highly complex localized renal tumor: results from a large multicenter international prospective observational project (the surface-intermediate-base margin score consortium). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35482-3] [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: 11/25/2022] Open
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Kartal I, Karakoyunlu N, Çakici MÇ, Karabacak O, Sağnak L, Ersoy H. Oncological and functional outcomes of open versus laparoscopic partial nephrectomy in T1b tumors: A single-center analysis. Int Braz J Urol 2020; 46:341-350. [PMID: 32167695 PMCID: PMC7088474 DOI: 10.1590/s1677-5538.ibju.2018.0865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/13/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE This study aims to evaluate the oncological and functional results of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) at the T1b clinical stage, which constitutes 25% of renal cell carcinomas (RCC) at diagnosis. MATERIALS AND METHODS The characteristics of 63 patients with stage T1b solitary tumor who underwent OPN (41) or LPN (22) were compared. The survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting disease-free survival. Potential predictive factors, which might affect the postoperative glomerular filtration rate (GFR), were evaluated using multivariate linear regression analysis. RESULTS No differences were observed between OPN and LPN groups regarding patient and tumor characteristics. Although the warm ischemia time, intraoperative estimated blood loss, and operation duration were higher in the LPN group, no differences were noted between the two techniques regarding complication rates (p<0.001, p=0.023, p≤0.001, and p=0.190, respectively). The median hospitalization time was shorter in the LPN group than that in the OPN group (4 and 5 days, respectively), with less severe complications. No intergroup differences were observed regarding cancer-specific survival (CSS), disease-free survival (DFS), and overall survival (OS). The evaluation of the factors affecting DFS showed that age was an effective parameter (RR = 1.112, 95% CI: 1.010-8.254), but the surgical technique was not. CONCLUSION No differences were observed between OPN and LPN techniques between oncological and functional outcomes in patients with clinical stage T1b RCC.
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Affiliation(s)
- Ibrahim Kartal
- Department of Urology, University of Health Sciences, Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, University of Health Sciences, Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Çağlar Çakici
- Department of Urology, University of Health Sciences, Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Osman Karabacak
- Department of Urology, University of Health Sciences, Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Levent Sağnak
- Department of Urology, University of Health Sciences, Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hamit Ersoy
- Department of Urology, University of Health Sciences, Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Kartal I, Çimen S, Karakoyunlu N, Sandıkçı F, Eraslan A, Yalçınkaya F. Factors affecting the effectiveness and success of retrograde holmium laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults. Urologia 2020; 88:34-40. [PMID: 32048558 DOI: 10.1177/0391560320904259] [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: 11/17/2022]
Abstract
PURPOSE To evaluate the factors affecting the effectiveness, safety, and success of retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults. METHODS Adult patients who underwent retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction between January 2012 and June 2016 at our clinic were retrospectively analyzed. Success was defined as the relief of symptoms and the resolution of obstruction, as assessed via radiography. Factors affecting success were analyzed, such as the clinical characteristics, procedural outcomes, complications, and the type of ureteroscopy used in the procedure. RESULTS Procedural success was achieved in 29 (74.4%) out of 39 patients, with a mean age of 38.3 ± 12.3 years during a median follow-up duration of 44 (33-65) months. Failure occurred at a median of 4.5 (3-22) months. It was detected that the presence of primary obstruction, ipsilateral kidney function being >30% of normal, and the length of obstruction being <1 cm positively affected procedural success (p = 0.009, p = 0.011, and p = 0.019, respectively). In the postoperative period, two Grade I and four Grade II complications were observed according to the Clavien-Dindo classification. There was a difference only in the operation time between semirigid (24) and flexible ureteroscopes (15), with the operation time being shorter with the use of a semirigid ureteroscope than with the use of a flexible uteroscope (p < 0.001). CONCLUSION Retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy is a minimally invasive method that can be used effectively and safely as the primary treatment of patients with ureteropelvic obstruction, when long-term results are also taken into consideration. The decision of performing laser endopyelotomy should be made after a detailed evaluation of the characteristics of the patient as well as of the obstruction.
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Affiliation(s)
- Ibrahim Kartal
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Sertaç Çimen
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Fatih Sandıkçı
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Aşır Eraslan
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Fatih Yalçınkaya
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Çakici MÇ, Özok HU, Erol D, Çatalca S, Sari S, Özdemir H, Selmi V, Kartal İG, Karakoyunlu N. Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery. MINERVA UROL NEFROL 2019; 71:636-643. [DOI: 10.23736/s0393-2249.19.03481-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cakici MC, Sari S, Selmi V, Sandikci F, Karakoyunlu N, Ozok U. Is the Efficacy and Safety of Retrograde Flexible Ureteroscopy in the Elderly Population Different from Non-elderly Adults? Cureus 2019; 11:e4852. [PMID: 31410335 PMCID: PMC6684111 DOI: 10.7759/cureus.4852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives The population of elderly adults is increasing globally, and due to metabolic changes related to advanced age, many elderly adults experience kidney stones. Flexible ureteroscopy (f-URS) is a minimally invasive procedure to treat kidney stones, but it is not free of complications. The goals of this study were to analyze the efficacy and safety of f-URS in the management of kidney stones in patients aged ≥60 years and compare the outcomes of this surgery with the outcomes of the same surgery in a younger population. Materials and methods We retrospectively reviewed patient data from 1750 patients who met our inclusion criteria and received f-URS at the urology clinic of our hospital from 2012 to 2017. Patients were assigned into two groups: those aged ≥60 years (Group 1, n=291) and those aged 19-59 years (Group 2, n=1459). The perioperative results were evaluated comparatively. We performed multivariable analyses for factors predicting complications. Results When we compared the groups on demographic attributes, we noted statistically significant differences in gender, body mass index (BMI), and American Society of Anesthesiologists scores. Stone size and operation time were higher in the ≥60-year age group (Group 1). Other stone characteristics and operative features were similar. Stone-free rates (SFR) after the first procedure were 88.0% in Group 1 and 89.2% in Group 2. SFR and success rates at three months were similar for both groups. The complication rates were similar, and multivariable regression analysis revealed the most important factor affecting the complications was the presence of residual stones in both groups. The second most important factor affecting the complication was the operation time in Group 1 and the number of stones in Group 2. Conclusion In our study, there were no significant differences in terms of results and complications among elderly and young patients after f-URS except for the duration of the operation. The prolongation of operation time results in worse outcomes in terms of perioperative complications in patients aged ≥60 years. f-URS is a relatively safe and efficient procedure, with a small risk of minor complications even in the elderly population, with increased comorbidity.
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Affiliation(s)
- Mehmet Caglar Cakici
- Urology, Medeniyet University, Göztepe Training and Research Hospital, Istanbul, TUR
| | - Sercan Sari
- Urology, Bozok University Faculty of Medicine, Yozgat, TUR
| | - Volkan Selmi
- Urology, Bozok University Faculty of Medicine, Yozgat, TUR
| | - Fatih Sandikci
- Urology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Nihat Karakoyunlu
- Urology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Ugur Ozok
- Urology, Karabuk University School of Medicine, Karabük, TUR
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Çakıcı MÇ, Sarı S, Özok HU, Karakoyunlu N, Hepşen E, Sağnak L, Topaloğlu H, Ersoy H. Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy in the Treatment of 2-3 cm Multicalyceal Kidney Stones. jus 2018. [DOI: 10.4274/jus.1993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kartal IG, Baylan B, Gok A, Sagnak AL, Karakoyunlu N, Cakici MC, Kaymak S, Karabacak OR, Topaloglu H, Ersoy H. The Association of Encrustation and Ureteral Stent Indwelling Time in Urolithiasis and KUB Grading System. Urol J 2018; 15:323-328. [PMID: 30043389 DOI: 10.22037/uj.v0i0.4592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the management of prolonged indwelling ureteral stents and the newly developed KUB (kidney, ureter, and bladder) grading system for the classification of encrusted stents in urolithiasis. METHOD This study involved 69 patients that had indwelling and forgotten ureteral stents for more than 6 months after urolithiasis treatment. They were categorized into 4 groups based on indwelling time and were reviewed retrospectively. Patients whose ureteral stent could not be removed with simple cystoscopy were graded according to stone surface area and the KUB system. RESULTS The mean stent indwelling time was 23.1 months. Stone burden in KUB and, in proportion to that, total KUB (T) score showed increased association that was directly proportional to indwelling time (p < 0.001, p = 0.008). Surgical intervention was required in 73.9% of patients. Among patients requiring surgery, 78.4% were treated in a single session and multi-modal interventions were performed in 70.5%. K score ? 3 was found to be associated with multiple surgery requirements (odds ratio [OR];11.25, %95 confidence interval [CI]:2.132-59.375),multi-modal procedure requirements (OR;16.50, %95 CI:3.434-79.826 ), and lower stone-free rates (p = 0.04). Bscore ? 3 was associated with multi-modal procedure requirements (OR;8.90, %95 CI:1.052-75.462). U score ? 3and T score ? 9 were associated with an operating time >180 minutes (p < 0.001, p = 0.008). CONCLUSION Prolonged indwelling time of the ureteral stent in urolithiasis is associated with increased encrustation and stone burden. Since the KUB system specifies stone burden and its particular localization, it can be used as a simple, convenient method for the planning treatment of encrusted ureteral stents.
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Affiliation(s)
- Ibrahim Guven Kartal
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey.
| | - Burhan Baylan
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Alper Gok
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Azmi Levent Sagnak
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Serafettin Kaymak
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Osman Raif Karabacak
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Hikmet Topaloglu
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Hamit Ersoy
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
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Cavıldak İK, Çakıcı MÇ, Karakoyunlu N, Ersoy H. Cystic nephroma: A case report in adult patients. Turk J Urol 2018; 44:373-376. [PMID: 29799412 DOI: 10.5152/tud.2017.56957] [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: 07/28/2016] [Accepted: 01/25/2017] [Indexed: 11/22/2022]
Abstract
Cystic nephroma is an unusual, cystic neoplasm of the kidney and is usually benign. There are two peaks in the incidence of the tumor, with a bimodal distribution presenting in children younger than two years old and in adults. These benign lesions are usually seen in childhood, whose clinical presentation is nonspecific with symptoms such as flank pain, hematuria and urinary tract infection. We aim to report treatment, and follow-up of a 48-year-old female patient with cystic nephroma for whom we performed open partial nephrectomy. As a surgical treatment radical or partial nephrectomy is applied according to the size and position of the masses. Long-term follow-up is recommended to rule out local recurrence or metastasis.
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Affiliation(s)
- İdris Kıvanç Cavıldak
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Çağlar Çakıcı
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Hamit Ersoy
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Kutikov A, Campi R, Lane B, De Cobelli O, Sanguedolce F, Villeda Sandoval C, Hatzichristodoulou G, Mari A, Antonelli A, Rodriguez Faba O, Langenhuijsen H, Klatte T, Roscigno M, Akdogan B, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Uzzo R, Carini M, Minervini A. MP48-07 PATTERNS AND PREDICTORS OF RESECTION TECHNIQUES DURING PARTIAL NEPHRECTOMY FOR T1 RENAL MASSES: RESULTS OF A MULTICENTRE PROSPECTIVE COHORT STUDY FROM THE SURFACE-INTERMEDIATE-BASE (SIB) MARGIN SCORE INTERNATIONAL CONSORTIUM (IDEAL PHASE 2B). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ozkan TA, Karakoyunlu N, Polat R, Sarıbaş GS, Şener NC, Özdemir S, Peker K, Ünal D, Tuygun C. An evaluation of the protective effect of esomeprazole in an experimental model of renal ischemia–reperfusion. Int Urol Nephrol 2017; 50:217-223. [DOI: 10.1007/s11255-017-1775-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
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Sari S, Ozok HU, Cakici MC, Ozdemir H, Bas O, Karakoyunlu N, Sagnak L, Senturk AB, Ersoy H. A Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy for Management of Renal Stones ?2 CM. Urol J 2017; 14:2949-2954. [PMID: 28116738] [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: 08/21/2016] [Revised: 12/22/2016] [Accepted: 12/24/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE In this retrospective study, we aimed to compare the outcomes in patients who have been treated withpercutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) on renal stones ≥ 2 cm size. MATERIALS AND METHODS We evaluated patients who underwent PNL or RIRS for renal stones ≥ 2 cm size betweenNovember 2011 and November 2014. Stone size, operation, fluoroscopy and hospitalization time, success rates,stone-free rates and complication rates were compared in both groups. Patients were followed for three months. RESULTS 254 patients were in the PNL Group. 185 patients were in the RIRS Group. The mean age was 46.88 and48.04 years in PNL and RIRS groups, respectively.The patient and stone characteristics (age, gender, Body Mass Index, kidney anomaly, SWL history and stoneradioopacity) were similar between two groups.The mean stone size preoperatively was significantly larger in patients who were treated with PNL (26.33mm.vs24.04mm.; P = .006). In the RIRS group, the mean stone number was significantly higher than PNL group (P <.001).The mean operative, fluoroscopy and hospitalization time were significantly higher in PNL group (P < .001). Thestone-free rate was 93.3% for the PNL group and 73.5% for the RIRS group after first procedure (P < .001). Nomajor complication (Clavien III-V) occurred in the RIRS group. CONCLUSION Although the primary treatment method for renal stones ≥ 2cm size is PNL, serious complicationscan be seen. Therefore, RIRS can be an alternative treatment option in the management of renal stones ≥2 cm size.
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Affiliation(s)
- Sercan Sari
- Department of Urology,Sarikamis State Hospital, Kars, Turkey.
| | - Hakki Ugur Ozok
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Harun Ozdemir
- Department of Urology, Haseki Training and Research Hospital, Istanbul,Turkey
| | - Okan Bas
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Levent Sagnak
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | | | - Hamit Ersoy
- Department of Urology, Hitit University, Faculty of Medicine, Corum, Turkey
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Guzel O, Tuncel A, Balci M, Karakoyunlu N, Aslan Y, Erkan A, Senel C. Retrograde Intrarenal Surgery is equally efficient and safe in patients with different American Society of Anesthesia physical status. Ren Fail 2016; 38:503-7. [PMID: 26895083 DOI: 10.3109/0886022x.2016.1144248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of Retrograde Intrarenal Surgery to treat renal stones in patients with different American Society of Anesthesia (ASA) physical status. MATERIAL AND METHODS We performed a retrospective analysis of 150 patients who underwent Retrograde Intrarenal Surgery for renal stone between October 2013 and December 2014. Patients were categorized into three groups according to their ASA physical status: ASA Class 1 (Group 1, n = 23), ASA Class 2 (Group 2, n = 113) and ASA Class 3 (Group 3, n = 14). We documented and stratified the per-operative and postoperative complications according to modified Satava Classification System and Clavien-Dindo Classification. RESULTS The mean age of the patients was 44 years. The total stone-free rate was 81.2%. According to the groups, the stone-free rate was 75% in Group 1, 82.5% in Group 2, and 83.3% in Group 3 (p = 0.340). Per-operative and postoperative complications were recorded in 12% (n = 18) and 5.3% (n = 8) of the patients. We did not find significant difference in terms of per-operative and postoperative complication rates among patients with different ASA physical status (p(per-operative) = 0.392 and p(postoperative) = 0.136). CONCLUSIONS Retrograde Intrarenal Surgery is an effective and safe surgery with high stone-free rates and low morbidity in patients with different ASA physical status.
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Affiliation(s)
- Ozer Guzel
- a Third Department of Urology, Ministry of Health , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Altug Tuncel
- a Third Department of Urology, Ministry of Health , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Melih Balci
- a Third Department of Urology, Ministry of Health , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Nihat Karakoyunlu
- b Department of Urology, Ministry of Health , Diskapi Yildirim Beyazit Research and Training Hospital , Ankara , Turkey
| | - Yilmaz Aslan
- a Third Department of Urology, Ministry of Health , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Anil Erkan
- a Third Department of Urology, Ministry of Health , Ankara Numune Research and Training Hospital , Ankara , Turkey
| | - Cagdas Senel
- a Third Department of Urology, Ministry of Health , Ankara Numune Research and Training Hospital , Ankara , Turkey
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Karakoyunlu N, Sarı S, Ozdemir H, Topaloglu H, Ozok U, Sagnak L, Ersoy H. Malfunctioned and Fractured Penile Prosthesis Caused by Cross Placement: Case Report. Urol Case Rep 2016; 3:80-1. [PMID: 26793509 PMCID: PMC4714312 DOI: 10.1016/j.eucr.2015.03.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 10/31/2022] Open
Abstract
Penile prosthesis is a functional option for patients who have erectile dysfunction after failed medical and intracavernosal treatments. Malleable penile prosthesis is a good alternative. Penile prosthesis implantation is a surgical process. Seldomly complications occur. In this study we presented a 61 y old man who has malfunctioned and broken penile prosthesis due to cross implantation.
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Affiliation(s)
- Nihat Karakoyunlu
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sercan Sarı
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Harun Ozdemir
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hikmet Topaloglu
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ugur Ozok
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Levent Sagnak
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hamit Ersoy
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; Hitit University, Department of Urology, Corum, Turkey
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Karakoyunlu N, Yildirim M, Topaloglu H, Ozok U, Sagnak L, Ersoy H. Endovascular Treatment of a Blunt Trauma which Caused Massive Perineoscrotal Haematoma in a Child. Erciyes Med J 2015. [DOI: 10.5152/etd.2015.7973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Goktug G, Karakoyunlu N, Sener NC, Zengin K, Nalbant I, Karabacak O, Ozturk U, Imamoglu A. Standard percutaneous nephrolithotomy alone versus in combination with intraoperative anterograde flexible nephroscopy for staghorn stones: A retrospective study. Kaohsiung J Med Sci 2015; 31:568-71. [PMID: 26678936 DOI: 10.1016/j.kjms.2015.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 11/16/2022] Open
Abstract
This study aimed to compare the outcomes of standard percutaneous nephrolithotomy (PCNL) to PCNL with intraoperative antegrade flexible nephroscopy (IAFN) for treating stones of staghorn nature. We retrospectively analyzed patients treated using PCNL between January 2007 and July 2013. A total of 1250 patients were treated using PCNL, and 166 patients had staghorn stones. All patients had been subjected to a complete blood count, routine biochemical analyses, coagulation tests, a complete urine analysis, and urine cultures. Patients with a positive urine culture had been treated with appropriate antibiotics until the urine culture became negative. After purchasing a flexible renoscope in March 2012, we routinely used this tool to improve the stone-free (SF) rate. The 105 patients who underwent standard PCNL prior to March 2012 were classified as Group 1, and the 61 patients who underwent PCNL + IAFN after that date were classified as Group 2. The two groups had similar and homogeneous demographic data. The fluoroscopy and total operative times were significantly higher in Group 2 than in Group 1 (p < 0.01). Additionally, the hospitalization time (p < 0.01) and the mean hematocrit decrease (p < 0.01) were significantly lower in Group 1. In both groups, the SF rates were higher than 85%, similar to those reported in the literature. Although Group 2 had a slightly better SF rates, this difference was not statistically significant. For staghorn calculi, PCNL combined with IAFN yields excellent outcomes. However, similar prospective studies on larger cohorts should be performed to support our findings.
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Affiliation(s)
- Goksel Goktug
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Nevzat Can Sener
- Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Kursad Zengin
- Department of Urology, Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Ismail Nalbant
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Osman Karabacak
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ufuk Ozturk
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Abdurrahim Imamoglu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Karakoyunlu N, Polat R, Aydin GB, Ergil J, Akkaya T, Ersoy H. Effect of two surgical circumcision procedures on postoperative pain: A prospective, randomized, double-blind study. J Pediatr Urol 2015; 11:124.e1-5. [PMID: 25842991 DOI: 10.1016/j.jpurol.2015.01.002] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/08/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Male circumcision (MC) is one of the most commonly used surgical procedures worldwide for medical and traditional reasons. No studies have compared the postoperative pain advantages of conventional techniques (i.e., sleeve and dorsal slit). OBJECTIVE In this prospective randomized double-blind study, we investigated the effect of two surgical techniques (i.e., sleeve and dorsal slit) on postoperative pain and emergence agitation. STUDY DESIGN This prospective study was conducted between January and July 2013. Approval was obtained from the local Ethical Committee on 17 December 2012, 06/23 (CLINICAL TRIALS IDENTIFIER: NCT 01909765). We compared two surgical techniques (i.e., the dorsal slit incision technique (Group A) and the double incision (i.e., sleeve) technique (Group B) in 60 children who were subjected to MC surgery under general anesthesia. All children received dorsal nerve blocks with bupivacaine. The modified objective pain scale (MOPS) was used for pain assessment, and the Ramsey Sedation Scale was used for the assessment of agitation during anesthesia emergence. RESULTS The MOPS scores were lower in Group B than in Group A in the post-anesthesia care unit and during the 4th hour post-surgery (p = 0.01 and p = 0.037, respectively). Twelve children (40%) in Group A and 23 children (76.6%) in Group B required no additional analgesia on postoperative day one (p = 0.004). The Ramsey sedation scores were lower in Group A (p = 0.018). DISCUSSION Dorsal slit is often the primary method in cases with paraphimosis; during this procedure, the frenulum frequently cannot be preserved at the 6-o'clock position of the mucosa, because of traction applied to skin and mucosa. As a result, the frenular artery is injured. In contrast, the sleeve technique protects the frenulum and the anatomic structures of the glans. In the sleeve technique, providing hemostasis and preventing partial ischemia by protecting the frenular artery reduces postoperative pain and complications. This present study demonstrated that the sleeve technique, which preserved the frenular artery, caused less bleeding, reduced electrocautery use and less ischemia than the dorsal slit technique. The sleeve technique effectively reduces early postoperative pain and agitation after circumcision, provided that adequate postoperative analgesia has been achieved. While all variables except the employed surgical techniques were similar, Group B had advantages with respect to analgesic requirement and pain control during the first 8 h after the operation. CONCLUSION The sleeve technique provides lower pain scores and a reduced incidence of agitation after elective MC.
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Affiliation(s)
- N Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, İrfan Baştuğ Cad. Dışkapı, Ankara 06110, Turkey.
| | - R Polat
- Department of Anaesthesiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, İrfan Baştuğ Cad. Dışkapı, Ankara 06110, Turkey
| | - G B Aydin
- Department of Anaesthesiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, İrfan Baştuğ Cad. Dışkapı, Ankara 06110, Turkey
| | - J Ergil
- Department of Anaesthesiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, İrfan Baştuğ Cad. Dışkapı, Ankara 06110, Turkey
| | - T Akkaya
- Department of Anaesthesiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, İrfan Baştuğ Cad. Dışkapı, Ankara 06110, Turkey
| | - H Ersoy
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, İrfan Baştuğ Cad. Dışkapı, Ankara 06110, Turkey
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Karakoyunlu N, Goktug G, Şener NC, Zengin K, Nalbant I, Ozturk U, Ozok U, Imamoglu A. A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: a prospective randomized study. Urolithiasis 2015; 43:283-7. [DOI: 10.1007/s00240-015-0768-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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Karakoyunlu N, Ekici M, Yesil S, Zengin K, Goktug G, Ozok U. Comparison of complications associated with standard and totally tubeless percutaneous nephrolithotomy according to modified Clavien grading: a multicenter retrospective study. Kaohsiung J Med Sci 2014; 30:613-8. [PMID: 25476099 DOI: 10.1016/j.kjms.2014.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/06/2014] [Revised: 08/06/2014] [Accepted: 04/29/2014] [Indexed: 10/24/2022] Open
Abstract
The aim of this study was to compare the complications of standard and totally tubeless percutaneous nephrolithotomy (PCNL) based on the modified Clavien complication grading system. We retrospectively evaluated the complications of 290 consecutive patients who had undergone standard or totally tubeless PCNL at four institutes between January 2010 and August 2012 based on the modified Clavien scale. The totally tubeless cases were classified as Group 1 and the cases to which a Malecot re-entry catheter was applied were classified as Group 2. The postoperative complications were recorded according to the modified Clavien complication grading system. Statistically significant differences were observed only in the first-degree injury class between the two groups based on the modified Clavien classification. The requirement for blood transfusion and prolonged percutaneous access site leakage were more frequent in Group 2, but these differences were not statistically significant. We also performed a pain evaluation by monitoring postoperative analgesia demands. In Group 1, the analgesic demand rates in the 1(st) and 6(th) postoperative hours were 64.6% and 31.5%, respectively. In Group 2, the analgesic demand rates were 87.5% and 58.75% in the 1(st) and 6(th) postoperative hours, respectively. The mean ± standard deviation of analgesic doses in the first 6 hours was 0.96 ± 0.7 and 1.46 ± 0.6 in Groups 1 and 2, respectively. These differences were statistically significant. Based on our results, we can conclude that the tubeless technique has fewer complications, improved postoperative patient comfort, shorter hospitalization times, and a reduced need for analgesics, suggesting that tubeless PCNL should be the standard approach. For suitable cases, this technique may be used safely as the standard PCNL approach.
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Affiliation(s)
- Nihat Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Musa Ekici
- Department of Urology, Hitit University, School of Medicine, Çorum, Turkey
| | - Suleyman Yesil
- Department of Urology, Gazi University, School of Medicine, Ankara, Turkey
| | - Kursad Zengin
- Department of Urology, Bozok University, School of Medicine, Yozgat, Turkey
| | - Goksel Goktug
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ugur Ozok
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Ozkan D, Akkaya T, Karakoyunlu N, Arık E, Ergil J, Koc Z, Gumus H, Ersoy H. Effect of ultrasound-guided intercostal nerve block on postoperative pain after percutaneous nephrolithotomy : prospective randomized controlled study. Anaesthesist 2013; 62:988-94. [PMID: 24173546 DOI: 10.1007/s00101-013-2253-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/13/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of the study was to investigate the effect of preoperative ultrasound-guided (US) intercostal nerve block (ICNB) in the 11th and 12th intercostal spaces on postoperative pain control and tramadol consumption in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS After obtaining ethical committee approval and written informed patient consent, 40 patients were randomly allocated to the ICNB group or the control group. For the ICNB group US-guided ICNB was performed with 0.5 % bupivacaine and 1/200,000 epinephrine at the 11th and 12th intercostal spaces after premedication. A sham block was performed for the control group and postoperative pain and tramadol consumption were recorded by anesthesiologists blinded to the treatment. RESULTS Postoperative visual analog scale scores at all follow-up times were found to be significantly lower in the ICNB group than in the control group (p < 0.05). The mean 24 h intravenous tramadol consumption was 97.5 ± 39.5 mg for the ICNB group which was significantly lower than the 199.7 ± 77.6 mg recorded for the control group (p < 0.05). CONCLUSION In PCNL with nephrostomy tube placement US-guided ICNB performed at the 11th and 12th intercostal spaces provided effective analgesia.
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Affiliation(s)
- D Ozkan
- Department of Anaesthesia, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Koru M Kavakli S No:4/44, 06810, Ankara, Turkey,
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Sagnak L, Ersoy H, Karakoyunlu N, Murat S, Ozok U, Topaloglu H, Ozturk U, Akdemir R. Evaluation of erectile dysfunction in permanent pacemaker implanted patients with cardiac rhythm disorder prediagnosis. Scott Med J 2013; 58:7-11. [DOI: 10.1177/0036933012474580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background and aims To evaluate the anxiety, depression and related psychogenic erectile dysfunction that might be developed before and after pacemaker implantation in patients with cardiac arrhythmias. Material and methods Thirty permanent pacemaker implanted male patients, were enrolled to study between September 2006 and September 2008. Erectile function domain questions of International Index of Erectile Function (IIEF‐6) and Hospital Anxiety and Depression Scale (HAD) questionnaires were applied to patients, 6 months before pacemaker implantation (BP6) and on month 1 (AP1) and 6 after application (AP6). Patients were included in a multidisciplinary cardiac rehabilitation-adaptation program with a duration of 1–2 months. Patients were evaluated in subgroups. Results Mean age was 51.5 ± 10.3. Most frequent diagnosis was observed as AV block in etiology. The mean IIEF values were changed 22.8→20.2→24.6 in BP6, AP1 and AP6 time frames consecutively. However, the mean HAD-Anxiety scores were evaluated as 8.1→17.0→7.3 and the mean HAD-Depression as 3.9→7.9→8.9 consecutively in the same time frames. Conclusion Cardiac arrhythmia plus permanent pacemaker implantation, increased anxiety and depression of patients and decreased erectile function at AP1; however, the improvement in cardiac symptoms at AP6 with the possible positive effects of rehabilitation program, helps to reduce anxiety and increased IIEF scores, although there was still a slight increase in depression levels.
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Affiliation(s)
- L Sagnak
- Associate Professor, Urology Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - H Ersoy
- Associate Professor, Urology Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - N Karakoyunlu
- Expert Urologist, Urology Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - S Murat
- Associate Professor, Cardiology Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - U Ozok
- Expert Urologist, Urology Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - H Topaloglu
- Expert Urologist, Urology Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
| | - U Ozturk
- Expert Urologist, Urology Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey
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Topaloglu H, Karakoyunlu N, Ozok U, Dilli A, Onder E, Sagnak L, Ersoy H. Lymphangioma of pyeloureteral junction: an extremely rare case. Urol Int 2012; 90:243-5. [PMID: 23147238 DOI: 10.1159/000343498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/05/2012] [Indexed: 11/19/2022]
Abstract
Benign tumors of the proximal ureter are very rare. Many of them could be confused with urothelial carcinoma and unnecessarily treated by nephrectomy. In this case, we present the treatment of a lymphangioma localized in the upper ureter, which is an example of benign tumor. During treatment percutaneous tumor resection, an organ-sparing approach, was employed.
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Affiliation(s)
- H Topaloglu
- Department of Urology, Diskapı Yildirim Beyazit Training and Research Hospital, Ministry of Health, Ankara, Turkey
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Akdemir R, Karakurt O, Orcan S, Karakoyunlu N, Balci MM, Sağnak L, Ersoy H, Vatan MB, Kilic H, Yeter E. Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction. Asian J Androl 2012; 14:784-7. [PMID: 22796737 DOI: 10.1038/aja.2012.41] [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: 11/09/2022] Open
Abstract
Acute ST elevation myocardial infarction has high mortality and morbidity rates. The majority of patients with this condition face erectile dysfunction in addition to other health problems. In this study, we aimed to investigate the effects of two different reperfusion strategies, primary angioplasty and thrombolytic therapy, on the prevalence of erectile dysfunction after acute myocardial infarction. Of the 71 patients matching the selection criteria, 45 were treated with primary coronary angioplasty with stenting, and 26 were treated with thrombolytic agents. Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patient's sexual function before the acute myocardial infarction and 6 months after the event. The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction. The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group (P=0.008). In conclusion, this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence, and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.
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Affiliation(s)
- Ramazan Akdemir
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya 54054, Turkey.
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Ozok HU, Sagnak L, Senturk AB, Karakoyunlu N, Topaloglu H, Ersoy H. A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy. J Endourol 2011; 26:630-4. [PMID: 21999400 DOI: 10.1089/end.2011.0291] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Nephrostomy tract dilation is one of the important steps in percutaneous renal surgery. We present our experiences with using Amplatz and metal telescopic dilators (Alken) to create a percutaneous tract and compare the advantages and risk factors of both procedures. PATIENTS AND METHODS We retrospectively reviewed the medical records of 173 patients who had undergone 188 percutaneous nephrolithotomy procedures between April 2007 and December 2010. The nephrostomy tracts had been created by using Amplatz (67 cases) or Alken dilators (121 cases). Total operative time, scope time, tract formation time, decrease in hemoglobin concentrations, blood transfusion rates, tract dilation failures, and the cost of both systems were compared between the groups. RESULTS There were no statistically significant differences in total operative time (103.3 ± 46.5 vs 99.1 ± 44.4 min, P=0.583), scope time (5.23 ± 3.06 vs 5.28 ± 2.52 min, P=0.732), decrease in hemoglobin concentration (-1.5 ± 1.2 vs-1.3 ± 1.1 mg/dL, P=0.230), blood transfusion rates (13.4% vs 11.6%, P=0.709), and tract dilation failure rates (6.0% vs 1.7%, P=0.107) for Amplatz and Alken dilation groups, respectively. A shorter tract formation time (6.56 ± 3.04 vs 5.42 ± 3.07 min, P<0.001) was observed in the Alken dilation group. The approximate costs per each case were $220 and $7.25 for Amplatz and Alken dilation groups, respectively. CONCLUSIONS The Alken dilation technique produces similar results to the Amplatz dilators in terms of efficiency, safety, and total operative time. Notwithstanding, it is more cost-effective in comparison.
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Affiliation(s)
- Hakki Ugur Ozok
- Diskapı Yildirim Beyazit Training and Research Hospital, 3rd Urology Clinic, Ministry of Health, Ankara, Turkey.
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Koca O, Ozok HU, Oktay M, Sagnak L, Karakoyunlu N, Ersoy H, Alper M. The effect of modified Gleason grading on the score concordance between the Gleason scores of needle biopsy and radical prostatectomy specimens in prostatic carcinoma. ACTA ACUST UNITED AC 2010. [DOI: 10.5152/tud.2010.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ozok HU, Sagnak L, Ates MA, Karakoyunlu N, Topaloglu H, Ersoy H. The efficiency of a sedative or analgesic supplement to periprostatic nerve blockage for pain control during transrectal ultrasound-guided prostate biopsy - a prospective, randomized, controlled, double blind study. Arch Med Sci 2010; 6:787-92. [PMID: 22419940 PMCID: PMC3298350 DOI: 10.5114/aoms.2010.17096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/05/2010] [Accepted: 05/19/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim was to examine the effect of a sedative or analgesic supplement to periprostatic nerve blockage (PNB) on pain reduction during probe insertion and needle penetration in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. We also investigated the effects of this procedure on the positive response rate in re-biopsy. MATERIAL AND METHODS One hundred TRUS-guided prostate biopsy patients due to prostate-specific antigen (PSA) levels higher than 2.5 ng/ml and/or abnormal rectal examination findings were evaluated. Group 1 (PNB) was given periprostatic lidocaine injection before the procedure. Group 2 (analgesic) was given tramadol and PNB. Group 3 (sedative) was given midazolam and PNB. Group 4 (control) was not given any anaesthesia or analgesics. Pain scores were assessed during probe insertion and needle penetration by a visual analogue scale. RESULTS During probe insertion, the mean pain score of the sedative group was lower than that of the control, analgesic and PNB groups (p < 0.001, p = 0.009, and p < 0.001, respectively). During needle penetration, the mean pain score of the control group was higher than that of the other groups (p < 0.001). The rate of positive response to re-biopsy was found to be 56% in the control group and between 92% and 100% in the other three groups (p < 0.001). CONCLUSION According to our results, it can be concluded that midazolam, given supplementary to PNB, contributes as an effective and safe alternative for pain control during both probe insertion and penetration of the biopsy needle into the prostate capsule; however, tramadol supplement does not provide any additional contributions.
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Affiliation(s)
- Hakki U Ozok
- 3 Urology Clinic, Ankara Dis¸kapi Yildirim Beyazit Training and Research Hospital, Ministry of Health, Ankara, Turkey
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Ozok HU, Sagnak L, Tuygun C, Oktay M, Karakoyunlu N, Ersoy H, Alper M. Will the modification of the Gleason grading system affect the urology practice? Int J Surg Pathol 2009; 18:248-54. [PMID: 19793829 DOI: 10.1177/1066896909346272] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to determine how the modified Gleason grading (mGG) system affects the score discrepancy between needle biopsy (NB) and radical prostatectomy (RP) and to investigate the effect of the modified scores on nomogram predictions. When the conventional Gleason grading (cGG) and mGG systems were compared, a new Gleason score was obtained in the NBs for 40 out of 97 patients (41.2%; P < .001) and in the RP specimens for 15 out of 97 patients (15.5%; P = .005). The agreement between the NBs and RP specimens rose from 31.9% to 44.3% with the mGG system (P = .017). However, when the predictions calculated with the location of modified Gleason scores in the Memorial Sloan Kettering Cancer Center nomogram were compared with those of the conventional Gleason scores, higher pathological stage and lower life expectancy predictions were obtained. Therefore, when a clinician is making a choice from therapeutic options, this change should be taken into account.
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Affiliation(s)
- Hakki Ugur Ozok
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of 3rd Urology, Ministry of Health, Ankara, Turkey.
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Ersoy H, Sagnak L, Ozok U, Karakoyunlu N. Case report: a novel and easy technique to remove stitched urethral foley catheter after radical retropubic prostatectomy. J Endourol 2008; 22:1721-3. [PMID: 18657039 DOI: 10.1089/end.2008.0157] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The inability to remove a urethral catheter because of inadvertent stitching or entrapped sutures after radical retropubic prostatectomy is rarely reported in the literature. Various methods are recommended to solve this problem. Here, we discuss a method developed by using a pediatric optical urethrotome to remove endoscopically a Foley urethral catheter that was encircled by a vesicouretheral anastomotic suture.
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Affiliation(s)
- Hamit Ersoy
- Ministry of Health, Yildirim Beyazit Training Hospital, Third Urology Clinic, Ankara, Turkey
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