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Güler Y. Effects of body mass index on urinary lithogenic factors in urinary system stone patients. Folia Med (Plovdiv) 2024; 66:80-87. [PMID: 38426469 DOI: 10.3897/folmed.66.e114369] [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: 10/18/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024] Open
Abstract
AIM Obesity and metabolic syndrome are becoming more prevalent these days. In addition, we know that urinary stone disease is also on the rise. In this study, we wanted to examine if body mass index (BMI) had a negative effect on the stone disease by evaluating 24-hour urinalysis in stone patients and recurrence rates in our region.
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Ozmerdiven G, Güler Y, Cicek C, Gunseren KO, Kilicarslan H. The role of retrograde intrarenal surgery in kidney stones of upper urinary system anomalies. Folia Med (Plovdiv) 2023; 65:226-234. [PMID: 37144307 DOI: 10.3897/folmed.65.e77728] [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: 11/07/2021] [Accepted: 03/30/2022] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Fusion, pelvic, and duplicated urinary tract anomalies of the kidney are rarely seen. There might be some difficulties in the stone treatment, in the administration of extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and laparoscopic pyelolithotomy procedures in these patients due to the anatomical variations in kidneys with anomalies. AIM To evaluate RIRS results on patients with upper urinary tract anomalies. MATERIALS AND METHODS Data of 35 patients with horseshoe kidney, pelvic ectopic kidney, and double urinary system in two referral centers were reviewed retrospectively. Demographic data, stone characteristics, and postoperative characteristics of the patients were evaluated. RESULTS The mean age of patients (n=35, 6 women and 29 men) was 50 years. Thirty-nine stones were detected. The total mean stone surface area in all anomaly groups was found to be 140 mm2, and the mean operative time was 54.7±24.7 minutes. The rate of using ureteral access sheath (UAS) was very low (5/35). Eight patients needed auxiliary treatment after the operation. The residual rate, which was 33.3% in the first 15 days, decreased to 22.6% in the third month follow-ups. Four patients had minor complications. In patients with horseshoe kidney and duplicated ureteral systems, it was observed that the risk factor increasing the presence of residual stones was the total stone volume. CONCLUSIONS RIRS for kidneys with low and medium stone volume anomalies is an effective treatment method with high stone-free and low complication rates.
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Affiliation(s)
- Gokhun Ozmerdiven
- Department of Urology, School of Medicine, Istanbul Aydin University, Istanbul, Turkiye
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Güler Y. Uretroplastia con injerto de mucosa oral para la estenosis de uretra bulbar: resultados y factores predictivos asociados al éxito. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2022.04.010] [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: 03/06/2023]
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Güler Y. Comparison of closure versus non-closure of the intraoral buccal mucosa graft site in urethroplasties. A systematic review and meta-analysis. Arab J Urol 2023; 21:18-30. [PMID: 36818369 PMCID: PMC9930765 DOI: 10.1080/2090598x.2022.2097613] [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: 11/02/2022] Open
Abstract
Aim To assess postoperative oral morbidity through meta-analysis of comparative studies for closure or non-closure of the buccal mucosa graft harvest area in patients undergoing urethroplasty. Methods A systematic literature review was conducted in January 2022. Randomized controlled studies were assessed according to the Cochrane collaboration guidelines. Postoperative pain, difficult mouth opening, alteration of oral salivation, perioral numbness, and tolerance of solid and liquid intake results were assessed. Standard mean differences and risk ratios with 95% confidence intervals were estimated for relative risk. Assessment was performed with subgroup analyses according to time points. Results This meta-analysis included 373 patients in 7 randomized studies. The oral pain overall pooled effect estimates were investigated for the time points of day 0-1, day 3-7 and months 1-6. According to corrected effect estimates after sensitivity analysis, at the day 0-1 time point, the non-closure group was significantly superior compared to the closure group. But there was no difference at the other time points and in total. The overall pooled effect estimates for difficult mouth opening were investigated at 4 time points (day 1, days 5-7, months 1-3 and months 6). After sensitivity analysis, the overall pooled effect estimates at 6 months were significantly superior for the non-closure group. There were no significant differences between the non-closed and closed groups based on the overall pooled-effect estimates for oral numbness, salivary secretion alteration, and tolerance of liquid and solid food variants. Conclusion The non-closure group was more advantageous in terms of oral pain in the early postoperative period. There were no differences between the groups in terms of alteration of salivation, oral numbness and toleration of liquid/solid food. Although the non-closed group seems more advantageous in terms of ease in mouth movements, more studies are needed to prove this.
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Affiliation(s)
- Yavuz Güler
- İstanbul Rumeli University, Private Safa Hospital, Urology Department, İstanbul, Turkey,CONTACT Yavuz Güler İstanbul Rumeli University, Private Safa Hospital, Urology Department, İstanbul
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Güler Y. Outcomes and predictive factors for re-stricture with urethroplasty methods for anterior urethra stricture. Urologia 2023:3915603221148532. [PMID: 36636940 DOI: 10.1177/03915603221148532] [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: 01/14/2023]
Abstract
OBJECTIVES We wished to compare the treatment success of urethroplasty methods (EPA and BMG) used for anterior urethra stricture after unsuccessful internal urethrotomy. METHODS A total of 85 and 51 patients, respectively, who underwent excision and primary anastomosis (EPA) and buccal mucosal graft (BMG) urethroplasty due to recurrent strictures after direct vision internal urethrotomy (DVIU) were evaluated retrospectively. On the uroflowmetry test, >15 ml/s urine flow and residual urine (PVR) below 50 ml were determined as success criteria. Cox regression analysis investigated the probable predictive factors for surgery success. Kaplan-Meier analysis assessed stricture free survival after redo-urethroplasty. RESULTS After surgery, EPA and BMG patients were followed for 31.9 ± 9.8 (4-40) and 30.7 ± 10.3 (4-40) months. At the end of this follow-up duration, success was obtained for 71 (83.5%) and 44 (86.3%) patients. Mean re-stricture times were 13.9 ± 6.0 (4-19) and 10.2 ± 5.1 (4-26) months. Most re-strictures had penile location (10 (71.5%) and 7 (100%)). After one session of DVIU, there was 100% success in both groups, but after >3 sessions of DVIU, success fell to 70.3% and 78.3% in the groups respectively. Patients with high numbers of DVIU sessions had longer durations for urethroplasty surgery. Apart from complications related to the donor field in the oral region with BMG and four patients who developed fistula (7.8%), complications were similar in both groups. CONCLUSIONS In this series of cases, it was not possible to identify which of the techniques employed provides the best result or predictive factors for stenosis recurrence after correction procedures for anterior urethral stenosis.
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Affiliation(s)
- Yavuz Güler
- Rumeli University, İstanbul, Turkey.,Private Safa Hospital, İstanbul, Turkey
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Erdogan O, Çeli K A, Yildirim ANT, Tekçe E, Altun G, Demi Röz S, Güler Y, Ozkan K, Gurkan V. Popliteal Fossa Sarcomas. Acta Chir Orthop Traumatol Cech 2023; 90:181-187. [PMID: 37395425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
PURPOSE OF THE STUDY Soft tissue sarcomas of the popliteal fossa are extremely rare tumors of mesenchymal origin accounting for 3%-5% of all extremity sarcomas. However, data regarding the tumor type, neurovascular involvement, and administration of radiation therapy before or after resection are limited. This study aimed to report on popliteal fossa sarcomas analyzing data from two institutions based on a relatively large patient sample. MATERIAL AND METHODS Twenty-four patients (80%; 9 men and 15 women) with a popliteal fossa soft tissue sarcoma were included in this study. The reviewed patient data included sex, age, duration of complaints, interval to diagnosis, radiology, pre- and postoperative biopsy, tumor histology, surgery type, complications, and pre- and postoperative oncologic and functional outcomes. The minimum follow-up was 24 months. RESULTS The mean age of the patients was 48 ± 21.23 (range 3-72) years at the time of diagnosis. The mean follow-up was 41.79 ± 16.97 (range 24-120) months. The most common histological diagnoses were synovial sarcoma (6 patients), hemangiopericytoma (2 patients), soft tissue osteosarcoma (2 patients), unidentified fusiform cell sarcoma (2 patients), and myxofibrosarcoma (2 patients). Local recurrence after limb salvage was observed in six patients (26%). At the latest followup, 2 patients died of the disease, 2 patients were still alive with progressive lung disease and soft tissue metastasis, and the remaining 20 patients were free from the disease. CONCLUSIONS Microscopically positive margins may not be an absolute indication for amputation. Also, negative margins do not provide a guarantee that local recurrence will not occur. Lymph node or distant metastasis may be predictive factors for local recurrence rather than positive margins. Key words: fossa poplitea, sarcoma.
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Affiliation(s)
- O Erdogan
- Haydarpasa Numune Training and Research Hospital, Orthopaedics and Traumatology Clinic, Istanbul, Turkey
| | - A Çeli K
- Istanbul Medeniyet University, Faculty of Medicine, Orthopaedics and Traumatology Clinic, Istanbul, Turkey
| | - A N T Yildirim
- Istanbul Medeniyet University, Faculty of Medicine, Pathology Clinic, Istanbul, Turkey
| | - E Tekçe
- Bezmialem University, Faculty of Medicine, Radiation Oncology Clinic, Istanbul, Turkey
| | - G Altun
- Ümraniye Training and Research Hospital, Orthopaedics and Traumatology Clinic, Istanbul, Turkey
| | - S Demi Röz
- Kocaeli University, Orthopaedics and Traumatology Clinic, Kocaeli, Turkey
| | - Y Güler
- Baltalimanı Training and Research Hospital, Orthopaedics and Traumatology Clinic, Istanbul, Turkey
| | - K Ozkan
- Istanbul Medeniyet University, Faculty of Medicine, Orthopaedics and Traumatology Clinic, Istanbul, Turkey
| | - V Gurkan
- Bezmialem University, Faculty of Medicine, Orthopaedics and Traumatology Clinic, Istanbul, Turkey
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Güler Y. Buccal mucosal graft urethroplasty outcomes for bulbar urethra stricture and predictive factors affecting success. Actas Urológicas Españolas (English Edition) 2022; 47:78-86. [PMID: 37078848 DOI: 10.1016/j.acuroe.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/10/2022] [Accepted: 04/28/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND OBJECTIVE The bulbar urethra is the location where urethral stricture is most commonly observed. The most successful method for long and recurrent urethral stenosis is graft urethroplasty. The most successful graft source is buccal mucosa, with advantages like easy adaptation to the corporeal bed, thick epithelium, thin lamina propria with rich vascular structure and easy ability to obtain the graft. In this study we aimed to retrospectively assess the outcomes and predictive factors affecting surgical success of our buccal mucosal graft urethroplasty surgery performed for bulbar urethra stenosis with moderate length. MATERIAL AND METHOD In this study, we monitored 51 patients with mean 4.4 cm bulbar urethral stricture length for mean 17 months follow-up. From operative and postoperative data, stenosis length, operation duration, Qmax, International Prostate Symptom Score, International Index of Erectile Function-Erectile Function and OF, success rates in total and in subgroups (age, according to DVIU, etiology, BMI and DM), follow-up duration, complications, re-stricture time and number were assessed. RESULTS The total success of the operations was 86.3%. In 17 months, the re-stricture rate was 13.7%. Oral and urethral complications were all minor. The complications with longest duration (6 months) were ejaculation, erection problems and urethral fistula. Mean time to re-stricture was 11 months. All re-stricture patients were relieved by one DVIU session each. CONCLUSION For bulbar urethral stricture longer than 2 cm and with recurrence, the dorsal buccal mucosa graft replacement is a very successful method with low complication rates.
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Güler Y. Medium-long-term outcomes of saphenous vein graft in Peyronie surgery: Is there a need for new graft material? Rev Int Androl 2022; 20:145-151. [DOI: 10.1016/j.androl.2020.12.009] [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] [Received: 05/07/2020] [Revised: 10/05/2020] [Accepted: 12/06/2020] [Indexed: 10/18/2022]
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Güler Y, Erbin A, Gozdas T. An outbreak of postoperative rapidly developing and multidrug-resistant Klebsiella pneumoniae urosepsis due to a contaminated ureteroscope. Folia Med (Plovdiv) 2022; 64:401-407. [PMID: 35856100 DOI: 10.3897/folmed.64.e62365] [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: 12/22/2020] [Accepted: 04/15/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Outbreaks caused by microorganisms contaminating the inside of rigid ureteroscopes are extremely rare. Some of these outbreaks, especially those caused by multidrug-resistant (MDR) infections, can cause serious problems, even death. Among these serious infections, we have no data about Klebsiellapneumoniae outbreaks caused by rigid ureteroscopes and their management and consequences.
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Affiliation(s)
| | - Akif Erbin
- Haseki Traning and Research Hospital, Istanbul, Turkey
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Güler Y. Retrograde intrarenal surgery for impacted upper ureteral stone in a patient with advanced lumbar scoliosis and lower-extremity development defect: a case report. J Med Case Rep 2022; 16:204. [PMID: 35614450 PMCID: PMC9134654 DOI: 10.1186/s13256-022-03411-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today, retrograde intrarenal surgery is the most preferred and very successful treatment method for upper ureteral stones that do not spontaneously pass and/or do not benefit from extracorporeal wave lithotripsy. However, perioperative complications are more common in retrograde intrarenal surgery if the stone in the ureter is impacted. Moreover, urosepsis and renal dysfunction are detected more frequently in patients with impacted stones. Impacted stones, which are a risky stone group even in patients with normal vertebral anatomy, are a more challenging situation in patients with advanced vertebral scoliosis. It is difficult to achieve an operating position in these patients. In addition, the ureteral tracing is altered, curved, and tortuous, making it more difficult for the endoscope to advance through the ureter. CASE PRESENTATION In this case report, we present a 23-year-old Caucasian male patient with right concavity and severe scoliosis, lower-extremity developmental disorder, and urosepsis. To treat the urosepsis picture, first percutaneous nephrostomy drainage was provided and the urine was sterilized with appropriate antibiotics according to the culture/antibiogram. Then, we performed ureterolithotripsy with a flexureterorenoscope. Finally, we see that flexible ureterorenoscopic lithotripsy to the upper ureteral stone with impacted stones, which is a very challenging operation even in patients with normal vertebrae, could be successfully performed in our patient with advanced scoliosis deformity. CONCLUSION High stone-free and low complication rates can be obtained with flexible ureterorenoscopic retrograde intrarenal surgery in medium-sized impacted upper ureteral stones in patients with advanced scoliosis.
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Affiliation(s)
- Yavuz Güler
- Private Safa Hospital, Rumeli Universty, İstanbul, Turkey.
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Güler Y, Özmerdiven GÇ, Erbin A. Comparison of ring instruments and classic circumcision methods: a systematic review and meta-analysis. Arab J Urol 2022; 20:144-158. [PMID: 35935913 PMCID: PMC9354637 DOI: 10.1080/2090598x.2022.2071545] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim To determine the advantages and disadvantages of both methods by comparing classic circumcision methods with circumcision methods assisted by ring instruments. Material-Methods Only studies that compared open procedures and ring devices for male circumcision were included. A total of
6226 patients were examined in 14 studies. The methodological quality of RCT was evaluated using Cochrane collaboration’s tools. The Review Manager software statistical package was used to analyze the ORs for dichotomous variables and
the mean differences for continuous variables. The proportion of heterogeneity across the studies was tested using the I 2 index. Potential publication bias was assessed by identifying the presence of visual asymmetry/symmetry with funnel plot studies. Results There were 1812 patients in the open circumcision group and 4414 patients in the ring groups. In total, there was no difference identified between the groups. The open procedure had an advantage compared to the Plastibell subgroup for hemorrhage, while in the other two subgroups, the ring instrument groups had the advantage. Statistically significant in favor of ring devices was found in operating time.There was no difference between the groups for early (postoperative) pain scores. For late-period pain scores, differences with statistical significance were identified in favor of ring devices both in subgroups and in total. For satisfaction, apart from one study in the PrePex group, statistical significance was obtained in favor
of ring devices for the other subgroups and in total. Conclusion The main factors in favor of the use of ring instruments for circumcision are the short total surgical duration, not requiring advanced surgical experience, ease of learning and application, and patient relative satisfaction rates. However, it is a condition to know open circumcision methods and to have experience of this surgery for use in situations with hemorrhage complications, mainly, and without ring instruments of appropriate size.
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Affiliation(s)
- Yavuz Güler
- Urology Department, İstanbul Rumeli University, Private Safa Hospital, İstanbul, Turkey
| | | | - Akif Erbin
- Urology Department, Haseki Training and Research Hospital, İstanbul, Turkey
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Güler Y. Urethral Injury Treatment Challenge. Comparison of Surgical Treatments for Acquired or Iatrogenic Urethral Stenosis and Predictive Values for Failure of Each Surgical Method. Folia Med (Plovdiv) 2021; 63:42-50. [PMID: 33650395 DOI: 10.3897/folmed.63.e53739] [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: 04/28/2020] [Accepted: 07/30/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Minimal invasive endo-urologic interventions and prostate surgeries performed through the urethral route are the most commonly used surgeries in the urology field at present. One of the unwanted complications weeks after some of these surgeries is urethral stenosis. AIM In this study, we aimed to review our treatment methods for patients with urethral stricture occurring after urologic interventions retrospectively to evaluate our success rates and data predicting recurrence and to determine the most feasible method. MATERIALS AND METHODS From 2008 to 2017, we evaluated retrospectively 234, 85, and 51 patients with urethral stenosis due to iatrogenic causes treated with direct visual internal urethrotomy (DVIU), anastomotic excision urethroplasty, and buccal graft urethro-plasty, respectively. Postoperative Qmax above 15 mL/s and >17 CH cystoscope easily passing the urethra was accepted as success for patients. Group variables were compared using ANOVA. Multivariate logistic regression analysis was performed to determine variables with predictive values. Predictive values significant in regression analysis (p<0.005) were evaluated with ROC analysis. RESULTS Patients were followed up for mean 48 (16-56) months, 48 (23-60) months, and 50 (32-65) months after DVIU, anastomotic and graft urethroplasty, respectively, and success was obtained for 75 (32.1%), 71 (83.5%) and 42 patients (82.4%). Multivariate logistic regression analysis found age, DM, BMI and stenosis length were independent predictive factors for DVIU success, while stenosis length was the independent predictive factor for excision anastomosis and buccal graft urethroplasty success. Cut-off values were determined as 56.5 years of age, 30.2 kg/m2 BMI and 1.85 mm stenosis length for DVIU patients, while 2.15 mm and 5.9 mm stenosis lengths, respectively, were determined for excision anastomosis and buccal graft urethroplasty with ROC analysis. CONCLUSIONS DVIU is a failed method for urethral stenosis in the long term. In contrast, resection / anastomosis and graft urethro-plasty are very successful methods.
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Güler Y, Erbin A. Comparative evaluation of retrograde intrarenal surgery, antegrade ureterorenoscopy and laparoscopic ureterolithotomy in the treatment of impacted proximal ureteral stones larger than 1.5 cm. Cent European J Urol 2021; 74:57-63. [PMID: 33976917 PMCID: PMC8097644 DOI: 10.5173/ceju.2021.0174.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 10/10/2020] [Accepted: 01/03/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The aim of this article was to compare retrograde intrarenal surgery (RIRS), antegrade ureterorenoscopy (URS), and laparoscopic ureterolithotomy (LU) for impacted proximal ureter stones larger than 1.5 cm in terms of operative data, success, complications, auxiliary treatment rates, and visual analog scale (VAS) scores. MATERIAL AND METHODS Medical records of patients undergoing RIRS, antegrade URS, or LU were retrospectively reviewed. After exclusion criteria, 122 patients were included in advanced analyses. Patients were divided into 3 groups as RIRS (n = 43), antegrade URS (n = 38) and LU (n = 41). RESULTS Operation time was shortest in the antegrade URS and hospitalization time was shortest in the RIRS group (p <0.001 and p <0.001, respectively). VAS scores were lowest in the RIRS group and highest in the LU group (p <0.001). Success (complete stone clearance) rates were 83.7%, 97.4%, and 97.5% in the RIRS, antegrade URS, and LU groups, respectively (p <0.001). Auxiliary treatment rates in the RIRS, antegrade URS, and LU groups were 19.1%, 2.6%, and 4.7%, respectively (p <0.001). Although there was no significant difference in terms of general complication rates, grade II complication rate (blood transfusion) was significantly higher in the antegrade URS group and grade IVb complication rate (urosepsis) was higher in the RIRS group according to the modified Clavien-Dindo classification system (p = 0.007 and p = 0.02, respectively). CONCLUSIONS Antegrade URS or LU are more logical options than RIRS for the treatment of large impacted proximal ureter stones. Between antegrade URS or LU, antegrade URS seems to be a more reasonable option due to its less invasive nature.
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Affiliation(s)
- Yavuz Güler
- Department of Urology, Private Safa Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Haseki, Turkey
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Güler Y, Erbin A, Ozmerdiven G, Yazici O. Comparison of Retrograde Intrarenal Surgery and Laparoscopic Surgery in the Treatment of Proximal Ureteral and Renal Pelvic Stones Greater than 15 mm. Folia Med (Plovdiv) 2020; 62:490-496. [PMID: 33009767 DOI: 10.3897/folmed.62.e48934] [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: 11/29/2019] [Accepted: 04/09/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION There is insufficient data on which modality should be the first choice in the treatment of proximal ureteral and renal pelvic stones greater than 15 mm.Aim: To compare retrograde intrarenal surgery (RIRS) and laparoscopic stone surgery for big upper ureteral and renal pelvic stones. MATERIALS AND METHODS We reviewed medical records of 163 adult patients who underwent RIRS or laparoscopic surgery for upper ureteral or renal pelvic stones ≥15 mm between January 2013 and February 2018. A total of 121 patients were included in the study. The patients were divided into two groups as RIRS (n=58) and laparoscopic surgery (n=63) and the groups were compared with regard to their demographic, stone, and operative characteristics and postoperative outcomes and complications. RESULTS Both operation time and hospitalization time were significantly shorter in the RIRS group compared to the laparoscopic surgery group (p<0.001). Complete stone clearance was achieved in 44 (76%) patients in the RIRS group and in 57 (90%) patients in the laparoscopic surgery group (p=0.031). Both the VAS scores and postoperative analgesic requirement were lower in the RIRS group. Based on the modified Clavien-Dindo classification, the two groups were similar with regard to peri- and post-operative complication rates. However, the incidence of Grade 3b complications (e.g. ureteral rupture, conversion to open surgery) was significantly higher in the laparoscopic surgery group and the incidence of Grade 4b complication (urosepsis) was significantly higher in the RIRS group. CONCLUSIONS Laparoscopic surgery can provide higher stone clearance and lower auxiliary treatment rates compared to RIRSalthough it can be more disadvantageous in terms of operative time, hospitalization time, postoperative VAS scores, and analgesic usage (narcotic and non-narcotic).
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Affiliation(s)
- Yavuz Güler
- Department of Urology, Private Safa Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Gokhun Ozmerdiven
- Department of Urology, Medical Faculty, Istanbul Aydin University, Istanbul , Turkey
| | - Ozgur Yazici
- Department of Urology, Medical Faculty, Istanbul Aydin University, Istanbul, Turkey
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Güler Y. TIPU outcomes for hypospadias treatment and predictive factors causing urethrocutaneous fistula and external urethral meatus stenosis in TIPU: Clinical study. Andrologia 2020; 52:e13668. [PMID: 32501558 DOI: 10.1111/and.13668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022] Open
Abstract
Our aim is to present patient outcomes for the TIPU method, currently mostly used for distal and sometimes proximal hypospadias treatment, and to identify predictive factors for the most commonly encountered complications of this surgery of urethrocutaneous fistula and urethral meatus stenosis. TIPU is a versatile, reliable, cosmetic and functionally successful surgical method mainly used for distal hypospadias patients but also in recent times for some proximal hypospadias patients. The main complications are urethrocutaneous fistula, urethral meatus stenosis, glans dehiscence and urethral meatus dehiscence. The pre-operative anatomic features of patients were assessed with the glans-meatus-shaft (GMS) scoring. Post-operative assessment of surgical outcomes was performed with the hypospadias objective scoring evaluation (HOSE). The mean total urethrocutaneous fistula and meatal stenosis development rates were 20 (12.3%) and 25 (15.4%). Both complications were found to be significantly high among hypospadias patients with narrow urethral plate, flat glandular groove and small glans (p < .001). Multivariate binary logistic regression analysis found urethral plate, glandular groove and glans shape were predictive factors for fistula and stenosis development.
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Affiliation(s)
- Yavuz Güler
- Urology Clinics, Private Safa Hospital, İstanbul, Turkey
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Güler Y, Erbin A. Independent Predictive Factors for Occurrence of Ischemic Priapism after Papaverine Injection. Urol J 2020; 17:512-516. [PMID: 32478401 DOI: 10.22037/uj.v0i0.5890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze the predictive factors causing ischemic priapism following penile doppler ultrasonography (PDU) with intracavernosal papaverine injection Materials and methods: Medical records of 467 patients who underwent PDU examination following intracavernosal papaverine injection for erectile dysfunction (ED) between 2009 and 2017 were retrospectively reviewed. Patients with hematological disease anamnesis, patients taking phosphodiesterase-5 inhibitor, patients with intracavernosal injection therapy anamnesis and patients who underwent PDU with other intracavernosal vasodilator drugs other than papaverine were excluded from the study. The remaining 268 patients were divided into two groups as priapism (38 patients) and non-priapism (230 patients). The groups were compared in terms of demographic data, American Society of Anesthesiologists (ASA) score, comorbidities, international index of erectile dysfunction (IIEF) score and PDU results. The significant parameters were analyzed with binary logistic regression analysis. The receiver operating analysis was used to obtain cut-off, sensitivity and specificity values for the independent predictive factors. Results: The age, ASA score, diabetes mellitus, IIEF score, duration of ED, peak arterial and peak end diastolic venous flow values in the 20th minute were significantly different in the two groups (p<0.001). Binary logistic regression analysis found age, duration of erectile dysfunction, IIEF score, peak arterial flow and venous flow rate in the 20th minute were predictive variables for the occurrence of priapism. Conclusions: Young patients, patients with good IIEF score, patients with ED for a short time, and patients with normal peak arterial and venous flows are more prone to developing post-papaverine ischemic priapism.
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Affiliation(s)
- Yavuz Güler
- Department of Urology, Private Safa Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
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17
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Güler Y. Renal pelvis stone in reverse kidney: A case report and literature review. Urol Case Rep 2020; 29:101104. [PMID: 31908962 PMCID: PMC6938845 DOI: 10.1016/j.eucr.2019.101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/01/2022] Open
Abstract
In neonates, kidney and urinary tract anomalies, like rotation anomalies, may be observed at rates of 3–11%. During rise to the lumbar region, the kidney completes rotation from left to right around the long axis from top to bottom and the renal hilum turns toward the medial direction. However, generally due to vascular causes, this rotation around the long axis of the kidney (renal axis, pole to pole) may be incomplete or may not occur. In this case report, we present a 45-year old male patient with stone in a kidney with renal hilum facing fully lateral.
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18
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Güler Y. Colon perforation after PCNL in reverse rotation anomalous kidney: A very rare case report and literature review. Urol Case Rep 2020; 29:101081. [PMID: 31867217 PMCID: PMC6906650 DOI: 10.1016/j.eucr.2019.101081] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 11/29/2022] Open
Abstract
PCNL is the gold standard method for large kidney stones currently. It offers high success and low complication rates. In recent times, miniaturized PCNL methods are used to further reduce the complication rates. Still major hemorrhage, mediastinum, spleen, liver and colon injuries are encountered at rates of 1–3%. Colon injuries occur in 0.3–0.8%. Thin patients, horseshoe kidney, retrorenal colon, previous intestinal surgeries, and access from posterior axillary line increase the risk of colon perforations. Treatment is mostly conservative approaches while sometimes major surgeries like colostomy and/or colon resection are required. The patient in our case report benefitted from conservative treatment.
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Affiliation(s)
- Yavuz Güler
- The Private Safa Hospital, Urology Clinics, İstanbul, Turkey
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19
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Kuyucu E, Çabuk H, Güler Y, Çabuk F, Kiliç E, Bülbül M. Can Intra-articular 1α, 25-Dihydroxyvitamin D3 Administration Be Therapeutical in Joint Cartilage Damage? Acta Chir Orthop Traumatol Cech 2020; 87:90-94. [PMID: 32396508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Vitamin D-deficiency is known to cause nerve conduction impairments, cancer and chronic diseases, as well as the pathogenesis of osteoarthritis. Our goal with this study is to evaluate the cartilage healing by applying intraarticular 1α, 25 (OH) 2D3 at different doses in rats with normal vitamin D levels and metabolism, which we made focal chondral damage model in the knee joint. MATERIAL AND METHODS 35 male Sprague-Dawley rats aged 20-24 weeks were used in our study. Both knees of rats were cartilage defected surgically on day 0. Joint injections performed at 06:00 am on 0th and 2nd days and after second injection others performed on days 9-16 and 23 following a weekly period. RESULTS In the fourth week, hematoxylin eosin staining measurements showed statistically significant difference according to the groups (p < 0.01) Metalloproteinase-13 (MMP-13) in histological staining for evaluating cartilage healing and healing levels showed statistically significant differences between the groups at first week and fourth week (p < 0.05). DISCUSSION Vitamin D, which affects many tissues through its receptors, is believed to be chondroprotective and neuroprotective by decreasing the expression of MMP in cartilage fibroblast, macrophage, lymphocyte through its intracellular receptors. To the best of our knowledge, this is the first study known to be intraarticular use of 1α, 25-dihydroxyvitamin D3. Our study has been found to be safe and successful in terms of weight, systemic PTH and 1α, 25-dihydroxyvitamin D3 levels in rats during treatment as well as better healing of cartilage damage. Key words: vitamin D3 receptor, articular cartilage, orthopedics, nerve conduction.
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Affiliation(s)
- E Kuyucu
- Istanbul Medipol University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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20
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Güler Y, Arslanoğlu F, Korkmaz O, Hakyemez ÖS, Ateş G, Çaçan MA. Missed Sleeve Fracture of the Superior Pole of Patella. Acta Chir Orthop Traumatol Cech 2020; 87:127-128. [PMID: 32396514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patellar sleeve fracture is a form of injury in which small osseous fragments avulsed with periosteum and cartilage. 15-year-old male patient, playing in school football team, apllied to our clinic with a history of previously missed patellar superior pole sleeve avulsion fracture. Care must be taken in order not to miss the patellar superior pole sleeve fractures, which are very rare in children. Extra care must be taken in patients, whose X-ray imaging is clean but there is a problem in the extensor mechanism of the knee. INTRODUCTION Since the patella has high mobility and large cartilage surfaces, it's fracture is very rare in children (9). Growing patella is more prone to osteochondral or avulsion fractures (8). Patellar sleeve fracture is a form of injury in which small osseous fragments fractured with periosteum and cartilage (5). Avulsion or sleeve fractures of patella can be seen in inferior and superior patellar poles. Fractures in superior pole is very rare and only a few cases have been described in the literature (2).
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Affiliation(s)
- Y Güler
- Istanbul Medipol University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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21
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Güler Y, Üçpınar B, Erbin A. Renal pyelocalyceal squamous cell carcinoma in a patient with an ectopic kidney presenting with chronic pyelonephritis: a case report. J Med Case Rep 2019; 13:154. [PMID: 31118085 PMCID: PMC6532225 DOI: 10.1186/s13256-019-2090-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022] Open
Abstract
Background Until now, few cases of pelvis squamous cell carcinoma in various renal anomalies have been reported. To our knowledge, primary squamous cell carcinoma arising from a pelvic ectopic kidney has never been described. In this report, we describe a case of renal pyelocalyceal squamous cell carcinoma in a patient with an ectopic kidney presenting with chronic pyelonephritis. Case summary A 73-year-old Caucasian woman presented to our hospital with pyelonephritis symptoms. Abdominopelvic computed tomography revealed heterogeneous and irregular minimal contrast enhancement in the pelvic ectopic kidney parenchyma. Radiologists reported that the images were consistent with chronic pyelonephritis. A Tc-99m dimercaptosuccinic acid renal scan demonstrated a nonfunctioning right pelvic ectopic kidney. The patient underwent open simple nephrectomy via modified Gibson incision. The whole mass was a distended, saclike structure without any grossly visible renal tissue. Pathological examination showed renal pelvis squamous cell carcinoma 8 cm in diameter infiltrating into the renal capsule and perinephritic fatty tissue. The patient was staged as T4N0M1 renal pelvis squamous cell carcinoma. The patient was being treated in the intensive care unit for respiratory distress on the seventh day after the operation. By the first-month follow-up visit, the patient had died of acute respiratory distress syndrome. Conclusions Although rare, renal pelvis squamous cell carcinoma should be considered in the differential diagnosis of a renal mass in patients who have renal anomalies and chronic pyelonephritis.
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Affiliation(s)
- Yavuz Güler
- Department of Urology, Private Safa Hospital, Istanbul, Turkey.
| | - Burak Üçpınar
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
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Güler Y, Erbin A, Üçpınar B. Transobturator tape material detected in the bladder neck: a case report. J Med Case Rep 2019; 13:119. [PMID: 31036070 PMCID: PMC6489214 DOI: 10.1186/s13256-019-2059-y] [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: 01/21/2019] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Stress urinary incontinence surgeries (transobturator tape and tension-free vaginal tape) are safely performed with success rates over 90%. The transobturator tape procedure attracted more attention due to the lack of major complications, such as intraabdominal organ and vascular injuries, related to the tension-free vaginal tape procedure. Although there are no major or mortality-related complications, more lower urinary complaints, especially vaginal erosion, are reported in transobturator tape surgery. Here we present a rare complication of transobturator tape surgery: the accidental placement of mesh material in the bladder neck. With this case report, we aimed to discuss the diagnosis and management of misplaced transobturator tape material. CASE PRESENTATION A 38-year-old Caucasian woman who had stress urinary incontinence that had persisted for 6 years underwent transobturator tape surgery in a different clinic 2 years ago. Subsequently, she presented to our clinic with lower urinary tract complaints such as incontinence and dysuria. A physical examination was unremarkable besides total incontinence. A diagnostic cystoscopy was performed and sling material that crossed her bladder neck from 3 o'clock to 10 o'clock was identified. The misplaced transobturator tape material was cut endoscopically with an internal urethrotomy knife. Afterwards, a midurethral incision was made and mesh parts were removed bilaterally. After successful removal of the mesh material, a new transobturator tape was placed. CONCLUSIONS Even though transobturator tape surgery is a safe and effective procedure for stress urinary incontinence, certain complications can be encountered. Misplacement of the mesh material through the bladder neck is a rare complication and can be managed by successfully removing the mesh material and appropriately placing new transobturator tape material.
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Affiliation(s)
- Yavuz Güler
- Department of Urology, Safa Hospital, Istanbul, TR, Turkey.
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Burak Üçpınar
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
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Güler Y, Erbin A, Üçpınar B, Vural Ö, Tatar Z. Congenital prepubic sinus presenting with purulent discharge after circumcision: a case report. J Med Case Rep 2019; 13:46. [PMID: 30813946 PMCID: PMC6393969 DOI: 10.1186/s13256-019-2019-6] [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: 12/19/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital prepubic sinus is a rare anomaly found in the midline of the lower abdomen. Congenital prepubic sinus is usually asymptomatic in neonates, and a diagnosis is often achieved later in life after spontaneous extrusion of purulent material from the pre-existing hole in the pubic region. We present a case of congenital prepubic sinus presenting with purulent discharge after circumcision. A 4-year-old Caucasian boy presented to our urology out-patient clinic with purulent discharge from the distal part of the dorsum of his penis. He had a history of circumcision performed at a different center, 6 months ago. His parents stated that although various antibiotics were used, the purulent discharge continued for 6 months and the child had no complaints before circumcision. His condition was reported as superficial dorsal venous thrombosis, known as penile Mondor disease, in magnetic resonance imaging that was performed in the previous hospital. A physical examination revealed a small pinhole lesion at the distal part of his penis and a rigid cylindrical tube extending to the proximal side of his penis. We performed fistulography by injecting contrast material through a small angiocatheter and confirmed the diagnosis of prepubic sinus. Surgical exploration was performed and a long sinus, apparently ending as a fibrous tract at the anterior surface of his pubic symphysis, was found and resected. CONCLUSIONS Before congenital prepubic sinus surgery, it is critically important to rule out penile Mondor disease and the possibility of a circumcision complication (especially infective complications) mimicking congenital prepubic sinus.
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Affiliation(s)
- Yavuz Güler
- Department of Urology, Safa Hospital, Istanbul, TR, Turkey.
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, TR, Turkey
| | - Burak Üçpınar
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, TR, Turkey
| | - Ömer Vural
- Department of Pediatric Surgery, Safa Hospital, Istanbul, TR, Turkey
| | - Zeynep Tatar
- Department of Pathology, Patomer Pathological Cytological Research Center, Istanbul, TR, Turkey
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Gülenç B, Günaydin B, Çamur S, Talmaç MA, Güler Y, Kara A. An Effective Technique in Treatment of Femoral Neck Fractures - Ostheosynthesis under Double Fluoroscopic Guidance. Acta Chir Orthop Traumatol Cech 2019; 86:271-275. [PMID: 31524588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF THE STUDY The most commonly used technique for fixation of the femoral neck fractures is percutaneous osteosynthesis with cannulated screw under fluoroscopy guidance. Osteosynthesis performed under single-fluoroscopic guidance requires continuous repositioning the fluoroscope to obtain biplane imaging. This study aimed to evaluate whether there is a statistically significant difference between the osteosynthesis procedures performed under guidance of single-fluoroscopy and double fluoroscopy with respect to radiation emission safety and treatment parameters for fixation of femoral neck fractures. MATERIAL AND METHODS This retrospective study included 35 patients operated for femoral neck fracture between December 2013 and October 2017. Osteosynthesis was performed in 21 of these patients using cannulated screw under guidance of single-fluoroscopy whereas other 14 patients underwent same type of osteosynthesis assisted by double-fluoroscopy. The parameters of these two groups such as duration of surgery preparation, duration of the surgery, duration of radiation exposure, collo-diaphyseal angle and Harris hip score values were recorded. RESULTS No significant difference was found between the groups regarding time for surgery preparation (p > 0.05). On the other hand, duration of surgery and overall duration of radiation exposure were found 14 (p < 0.05) and 15 (p < 0.05) minutes shorter in the double-fluoroscopy group, respectively. No significant difference was found between the groups in terms of collo-diaphyseal angle and Harris hip score values (p > 0.05). CONCLUSIONS Use of double-fluoroscopy significantly reduces time of surgical duration and also level of radiation exposure in surgery of femoral neck fractures. Key words:double fluoroscopy, femoral neck fractures, radiation, osteosynthesis, cannulated screw.
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Affiliation(s)
- B Gülenç
- Istanbul Medipol University, Orthopaedics and Traumatology Department, Istanbul, Turkey
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25
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Kuyucu E, Çabuk H, Güler Y, Çabuk F, Kiliç E, Bülbül M. Is Intraarticular Antibiotic Administration Effective in the Treatment of Methicillin-Resistant Staphylococcus aureus? Acta Chir Orthop Traumatol Cech 2019; 86:276-280. [PMID: 31524589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF THE STUDY Septic arthritis is an infection of joints caused by a pathogenic microorganism. Septic arthritis has a mortality rate of 11-40% when it's not treated properly. The mortality rate with methicillin-sensitive Staphylococcus aureus (MSSA)is 5-7%, while the rate with methicillin-resistant Staphylococcus aureus (MRSA)is 13-20%. The aim of this study is to evaluate the effects of intraarticular vancomycin and teicoplanin on joint cartilage in in vivo settings and its utility in routine MRSA treatment. MATERIALS AND METHODS In our study, 35 male Sprague-Dawley rats aged 28 days were used. Rats were obtained from the Regenerative and Restorative Medicine Research Center (REMER) of Istanbul Medipol University. Rats were randomly divided into 5 groups each containing 7 rats. Joint injections were administered with isoflurane analgesia every day at 6 am. Three rats (15 rats) from each group were sacrified in seventh day and evaluated immunohistologically to evaluate acute healing in articular cartilage. All remaining rats were sacrificed on day 28 and their knees were evaluated by immunohistochemical examination. RESULTS In our study, there were no complications in any rat during injection and the study period. Hematoxylin eosin (H & E) histological staining for evaluating cartilage healing and healing levels did not show statistically significant differences between the groups at first week (p > 0.05). Matrix metalloproteinase-13 (MMP-13) staining did not show any statistically significant difference between the groups. (p > 0.05). DISCUSSION MRSAseptic arthritis, diagnosed for the first time in 1960, has recently been responsible for 6-22% of all septic arthritis and is increasing day by day. The use of systemic vancomycin or teicoplanin is the first-line treatment method in MRSA septic arthritis. Serum levels reach the desired level, especially with intravenous infusion dose. On the other hand, it has been shown that intraarticular concentration does not reach a sufficient level in studies conducted. The use of intraarticular antibiotics during treatment can lead to more effective and early disease control by turning this negative situation into favor of the patient. As a result, intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSAseptic arthritis. CONCLUSIONS Intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSA septic arthritis. Key words:arthritis, infectious; methicillin-resistant Staphylococcus aureus; mortality.
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Affiliation(s)
- E Kuyucu
- Istanbul Medipol University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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26
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Aung SM, Güler A, Güler Y, Huraibat A, Karabay CY, Akdemir I. Left atrial strain in heart failure with preserved ejection fraction. Herz 2016; 42:194-199. [DOI: 10.1007/s00059-016-4456-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/06/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
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Kalkan M, Şahin M, Kalkan A, Güler A, Taş M, Bulut M, Demir S, Acar R, Arslantaş U, Öztürkeri B, Güler Y, Akçakoyun M. OP-013 The Relation of Neutrophil-Lymphocyte Ratio and Coronary Collateral Circulation in Patients with Chronic Total Occlusion. Am J Cardiol 2014. [DOI: 10.1016/j.amjcard.2014.01.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kalkan M, Sahin M, Kalkan A, Güler A, Taş M, Bulut M, Demir S, Acar R, Arslantaş U, Oztürkeri B, Güler Y, Akçakoyun M. The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion. Perfusion 2014; 29:360-366. [PMID: 24534889 DOI: 10.1177/0267659114521102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Previous studies showed the association between the major adverse cardiovascular outcomes and both higher neutrophil and lower lymphocyte counts. We aimed to investigate whether there is an association between the neutrophil-lymphocyte ratio (NLR) value and the development of coronary collateral circulation (CCC) in patients with coronary chronic total occlusion (CTO). METHODS A total of 274 patients with CTO were included in this study. Patients were then classified according to their Rentrop collateral grades as either poor (Rentrop grades 0-1) or good (Rentrop grades 2-3). Clinical information and analyses of blood samples were obtained from a review of the patients' charts. RESULTS Although there was no difference between the two groups with regard to cardiovascular risk profiles, the NLR values were significantly higher in the patients who had poorly developed CCC (2.6 ± 0.5 vs 2.2 ± 0.4, p<0.001). NLR, high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), age, diabetes, fasting glucose levels and body mass index were found to have univariate association with poorly developed CCC (p<0.1). In a multivariate logistic regression model, NLR (odds ratio 1.88, 95% confidence interval (CI) 1.37-2.74; p<0.001), high-sensitivity C-reactive protein and WBC were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, the optimal cut-off value of NLR to predict poor CCC was found as 2.17, with 77% sensitivity and 65% specificity. CONCLUSION NLR, as a novel cardiovascular risk marker, is an important, simple and inexpensive method which can be used by the cardiologist as a screening inflammation tool to estimate the development of CCC in patients with CTO.
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Affiliation(s)
- Me Kalkan
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - M Sahin
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Ak Kalkan
- Mehmet Akif Ersoy, Department of Cardiology, Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - A Güler
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Mh Taş
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - M Bulut
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - S Demir
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Rd Acar
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - U Arslantaş
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - B Oztürkeri
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Y Güler
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - M Akçakoyun
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
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Khachatryan V, Sirunyan AM, Tumasyan A, Adam W, Bergauer T, Dragicevic M, Erö J, Fabjan C, Friedl M, Frühwirth R, Ghete VM, Hammer J, Hänsel S, Hartl C, Hoch M, Hörmann N, Hrubec J, Jeitler M, Kasieczka G, Kiesenhofer W, Krammer M, Liko D, Mikulec I, Pernicka M, Rohringer H, Schöfbeck R, Strauss J, Taurok A, Teischinger F, Waltenberger W, Walzel G, Widl E, Wulz CE, Mossolov V, Shumeiko N, Gonzalez JS, Benucci L, Ceard L, De Wolf EA, Janssen X, Maes T, Mucibello L, Ochesanu S, Roland B, Rougny R, Selvaggi M, Van Haevermaet H, Van Mechelen P, Van Remortel N, Adler V, Beauceron S, Blyweert S, D'Hondt J, Devroede O, Kalogeropoulos A, Maes J, Maes M, Tavernier S, Van Doninck W, Van Mulders P, Van Onsem GP, Villella I, Charaf O, Clerbaux B, De Lentdecker G, Dero V, Gay APR, Hammad GH, Hreus T, Marage PE, Thomas L, Vander Velde C, Vanlaer P, Wickens J, Costantini S, Grunewald M, Klein B, Marinov A, Ryckbosch D, Thyssen F, Tytgat M, Vanelderen L, Verwilligen P, Walsh S, Zaganidis N, Basegmez S, Bruno G, Caudron J, De Favereau De Jeneret J, Delaere C, Demin P, Favart D, Giammanco A, Grégoire G, Hollar J, Lemaitre V, Militaru O, Ovyn S, Pagano D, Pin A, Piotrzkowski K, Quertenmont L, Schul N, Beliy N, Caebergs T, Daubie E, Alves GA, De JesusDamiao D, Pol ME, Souza MHG, Carvalho W, Da Costa EM, Martins CDO, De Souza SF, Mundim L, Nogima H, Oguri V, Goicochea JMO, Da Silva WLP, Santoro A, Do Amaral SMS, Sznajder A, De Araujo FTDS, Dias FA, Dias MAF, Tomei TRFP, Gregores EM, Marinho F, Novaes SF, Padula SS, Darmenov N, Dimitrov L, Genchev V, Iaydjiev P, Piperov S, Rodozov M, Stoykova S, Sultanov G, Tcholakov V, Trayanov R, Vankov I, Dyulendarova M, Hadjiiska R, Kozhuharov V, Litov L, Marinova E, Mateev M, Pavlov B, Petkov P, Bian JG, Chen GM, Chen HS, Jiang CH, Liang D, Liang S, Wang J, Wang J, Wang X, Wang Z, Yang M, Zang J, Zhang Z, Ban Y, Guo S, Hu Z, Li W, Mao Y, Qian SJ, Teng H, Zhu B, Cabrera A, Moreno BG, Rios AAO, Oliveros AFO, Sanabria JC, Godinovic N, Lelas D, Lelas 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Search for quark compositeness with the dijet centrality ratio in pp collisions at √s=7 TeV. Phys Rev Lett 2010; 105:262001. [PMID: 21231646 DOI: 10.1103/physrevlett.105.262001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Indexed: 05/30/2023]
Abstract
A search for quark compositeness in the form of quark contact interactions, based on hadronic jet pairs (dijets) produced in proton-proton collisions at √s=7 TeV, is described. The data sample of the study corresponds to an integrated luminosity of 2.9 pb(-1) collected with the CMS detector at the LHC. The dijet centrality ratio, which quantifies the angular distribution of the dijets, is measured as a function of the invariant mass of the dijet system and is found to agree with the predictions of the standard model. A statistical analysis of the data provides a lower limit on the energy scale of quark contact interactions. The sensitivity of the analysis is such that the expected limit is 2.9 TeV; because the observed value of the centrality ratio at high invariant mass is below the expectation, the observed limit is 4.0 TeV at the 95% confidence level.
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Zielinski M, Bhatti A, Demortier L, Goulianos K, Lungu G, Mesropian C, Yan M, Atramentov O, Barker A, Duggan D, Gershtein Y, Gray R, Halkiadakis E, Hidas D, Hits D, Lath A, Panwalkar S, Patel R, Richards A, Rose K, Schnetzer S, Somalwar S, Stone R, Thomas S, Cerizza G, Hollingsworth M, Spanier S, Yang ZC, York A, Asaadi J, Eusebi R, Gilmore J, Gurrola A, Kamon T, Khotilovich V, Montalvo R, Nguyen CN, Pivarski J, Safonov A, Sengupta S, Tatarinov A, Toback D, Weinberger M, Akchurin N, Bardak C, Damgov J, Jeong C, Kovitanggoon K, Lee SW, Mane P, Roh Y, Sill A, Volobouev I, Wigmans R, Yazgan E, Appelt E, Brownson E, Engh D, Florez C, Gabella W, Johns W, Kurt P, Maguire C, Melo A, Sheldon P, Velkovska J, Arenton MW, Balazs M, Boutle S, Buehler M, Conetti S, Cox B, Francis B, Hirosky R, Ledovskoy A, Lin C, Neu C, Patel T, Yohay R, Gollapinni S, Harr R, Karchin PE, Loggins V, Mattson M, Milstène C, Sakharov A, Anderson M, Bachtis M, Bellinger JN, Carlsmith D, Dasu S, Efron J, Gray L, Grogg KS, Grothe M, Hall-Wilton R, Herndon M, Klabbers P, Klukas J, Lanaro A, Lazaridis C, Leonard J, Liu J, Lomidze D, Loveless R, Mohapatra A, Parker W, Reeder D, Ross I, Savin A, Smith WH, Swanson J, Weinberg M. Search for dijet resonances in 7 TeV pp collisions at CMS. Phys Rev Lett 2010; 105:211801. [PMID: 21231289 DOI: 10.1103/physrevlett.105.211801] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Indexed: 05/30/2023]
Abstract
A search for narrow resonances in the dijet mass spectrum is performed using data corresponding to an integrated luminosity of 2.9 pb⁻¹ collected by the CMS experiment at the Large Hadron Collider. Upper limits at the 95% confidence level are presented on the product of the resonance cross section, branching fraction into dijets, and acceptance, separately for decays into quark-quark, quark-gluon, or gluon-gluon pairs. The data exclude new particles predicted in the following models at the 95% confidence level: string resonances, with mass less than 2.50 TeV, excited quarks, with mass less than 1.58 TeV, and axigluons, colorons, and E6 diquarks, in specific mass intervals. This extends previously published limits on these models.
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Petrillo G, Vishnevskiy D, Zielinski M, Bhatti A, Demortier L, Goulianos K, Hatakeyama K, Lungu G, Mesropian C, Yan M, Atramentov O, Gershtein Y, Gray R, Halkiadakis E, Hidas D, Hits D, Lath A, Rose K, Schnetzer S, Somalwar S, Stone R, Thomas S, Cerizza G, Hollingsworth M, Spanier S, Yang ZC, York A, Asaadi J, Eusebi R, Gilmore J, Gurrola A, Kamon T, Khotilovich V, Montalvo R, Nguyen CN, Pivarski J, Safonov A, Sengupta S, Toback D, Weinberger M, Akchurin N, Bardak C, Damgov J, Jeong C, Kovitanggoon K, Lee SW, Mane P, Roh Y, Sill A, Volobouev I, Wigmans R, Yazgan E, Appelt E, Brownson E, Engh D, Florez C, Gabella W, Johns W, Kurt P, Maguire C, Melo A, Sheldon P, Velkovska J, Arenton MW, Balazs M, Buehler M, Conetti S, Cox B, Hirosky R, Ledovskoy A, Neu C, Yohay R, Gollapinni S, Gunthoti K, Harr R, Karchin PE, Mattson M, Milstène C, Sakharov A, Anderson M, Bachtis M, Bellinger JN, Carlsmith D, Dasu S, Dutta S, Efron J, Gray L, Grogg KS, Grothe M, Herndon M, Klabbers P, Klukas J, Lanaro A, Lazaridis C, Leonard J, Lomidze D, Loveless R, Mohapatra A, Polese G, Reeder D, Savin A, Smith WH, Swanson J, Weinberg M. First measurement of Bose-Einstein correlations in proton-proton collisions at √s=0.9 and 2.36 TeV at the LHC. Phys Rev Lett 2010; 105:032001. [PMID: 20867758 DOI: 10.1103/physrevlett.105.032001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Indexed: 05/29/2023]
Abstract
Bose-Einstein correlations have been measured using samples of proton-proton collisions at 0.9 and 2.36 TeV center-of-mass energies, recorded by the CMS experiment at the CERN Large Hadron Collider. The signal is observed in the form of an enhancement of pairs of same-sign charged particles with small relative four-momentum. The size of the correlated particle emission region is seen to increase significantly with the particle multiplicity of the event.
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Transverse-momentum and pseudorapidity distributions of charged hadrons in pp collisions at square root of s = 7 TeV. Phys Rev Lett 2010; 105:022002. [PMID: 20867699 DOI: 10.1103/physrevlett.105.022002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Indexed: 05/29/2023]
Abstract
Charged-hadron transverse-momentum and pseudorapidity distributions in proton-proton collisions at square root of s = 7 TeV are measured with the inner tracking system of the CMS detector at the LHC. The charged-hadron yield is obtained by counting the number of reconstructed hits, hit pairs, and fully reconstructed charged-particle tracks. The combination of the three methods gives a charged-particle multiplicity per unit of pseudorapidity dN(ch)/dη|(|η|<0.5) = 5.78 ± 0.01(stat) ± 0.23(syst) for non-single-diffractive events, higher than predicted by commonly used models. The relative increase in charged-particle multiplicity from square root of s = 0.9 to 7 TeV is [66.1 ± 1.0(stat) ± 4.2(syst)]%. The mean transverse momentum is measured to be 0.545 ± 0.005(stat) ± 0.015(syst) GeV/c. The results are compared with similar measurements at lower energies.
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Kansu E, Ozer FL, Akalin E, Güler Y, Zileli T, Tanman E, Kaplaman E, Müftüoğlu E. Behçet's syndrome with obstruction of the venae cavae. A report of seven cases. Q J Med 1972; 41:151-68. [PMID: 5074056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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