Publications by authors named "Göksel Bayar"

17 Publications

  • Page 1 of 1

Rare Causes of Hydronephrosis in Adults and Diagnosis Algorithm: Analysis of 100 Cases During 15 Years.

Cureus 2020 May 21;12(5):e8226. Epub 2020 May 21.

Urology, Sisli Hamidiye Etfal Research and Training Hopsital, University of Health Sciences, Istanbul, TUR.

Introduction Hydronephrosis (HN) is a common pathology that is with/without obstruction. HN should be promptly addressed; otherwise, it progresses to cause impaired kidney function. This study was conducted to define the diagnosis algorithm and poor prognostic parameters used to evaluate unknown HN. Materials and Methods This study enrolled 100 patients who were over 20 years of age and were admitted to the center between 2001 and 2015 for the diagnosis and treatment of HN. Although initial diagnostic tests were applied, the HN etiology of the patients could not be found in ambulatory conditions; therefore, they were hospitalized to seek the causes for their HN. Patients who had a malignancy or tuberculosis or any previous ureteral injury were excluded. Results Of these cases, 29 were on both sides, whereas 42 were on the left side. Despite further investigations, the etiology was not determined in five patients. The frequency of malignancy in patients with hematuria (5/15) was two times higher than in patients without hematuria (33% vs. 17.6%; p = 0.01). Additionally, the malignancy rate was significantly higher in patients with weight loss (100%) than those without weight loss (OR: 6.25; p < 0.001). Conclusions Further investigation is recommended to define the precise etiology of HN. Hematuria and weight loss should be considered poor predictive factors during diagnosis.
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http://dx.doi.org/10.7759/cureus.8226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306661PMC
May 2020

Does tamsulosin or mirabegron improve ureteral stent-related symptoms? A prospective placebo-controlled study.

Low Urin Tract Symptoms 2021 Jan 14;13(1):17-21. Epub 2020 May 14.

Urology Department, Sancaktepe Martyr Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey.

Objective: The main objective of this study was to evaluate the efficacy of tamsulosin or mirabegron on ureteral stent-related symptoms.

Patients And Methods: This was a prospective, randomized, controlled, and single-blinded study. In total, 180 patients who had undergone ureterolithotripsy and ureteral stent insertion were included. Patients were randomly divided into three groups as follows: Group 1 was the control group taking placebo; group 2 was administered tamsulosin (0.4 mg) once a day; and group 3 received mirabegron (50 mg) once a day. The Turkish version of the ureteral stent symptom questionnaire was filled out after 4 weeks.

Results: After excluding patients who were lost to follow-up, 161 patients were included in the final analysis. Analgesic usage doses were lower in the tamsulosin (5.1 ± 1.8) and mirabegron (4.5 ± 1.4) groups than in the control group (5.9 ± 2.1; P < .001). The urinary symptoms score was lower in tamsulosin group than it was in the control group (22.1 vs 27.8; P = .001); however, the other scores (body pain, general health, work performance, sexual matters, and other problems) were similar between the groups.

Conclusions: Tamsulosin improves only urinary symptoms due to the ureteral stent and decreases the need for analgesics. Mirabegron has no effect on ureteral stent-related symptoms, but it decreases analgesic need.
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http://dx.doi.org/10.1111/luts.12320DOI Listing
January 2021

Outcomes of different minimally invasive techniques in lower calyceal stones of 1 to 2 centimeters: A prospective, randomized study.

Arch Esp Urol 2020 May;73(4):307-315

Urology Department. Martyr Prof Dr Ilhan Varank Sancaktepe Training and Research Hospital. Istanbul. Turkey.

Objective: To compare efficiency, safety and full cost of lower retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) types for the treatment of lower calyceal stones between 1 and 2 cm in size.

Methods: This was a prospective, randomized study. In all, 175 patients were randomly divided into five groups of 35 patients each: Group A was managed by RIRS, Group B by micro PNL, Group C by ultra-mini PNL, Group D by mini PNL, and Group E by standard PNL. Operating and fluoroscopy time, length of hospital stay, stone-free rates (SFR), complications, secondar y ureterolithotripsy and cost were compared between groups. RESULTS: A total of 168 patients were included in the final analysis. The SFR was 76%, 77%, 90.1%, 94.1% and 94%; median length of hospital stay 1, 1.5, 2, 2, and 3 days was for RIRS, micro, ultra-mini, mini, and standard PNL, respectively (p<0.001). The mean costs of the procedures per case were $1,250, $962,$695, $632, and $619, and the mean return to daily activities time was 3.9, 4.5, 6.5, 9.3, and 13.5 days for RIRS, micro, ultra-mini, mini,and standard PNL, respectively (p<0.001).

Conclusions: SFR of treatment of lower calyceal stone was higher in ultra-mini, mini and standard PNL than micro PNL and RIRS. Moreover, patients should be informed about the results of all different procedures ; with increasing of the invasiveness of treatment, cost of the procedure decrease; but the hospital stay and return to daily activity interval increase.
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May 2020

Efficacy of silodosin or mirabegron in medical expulsive therapy for ureteral stones: a prospective, randomized-controlled study.

Int Urol Nephrol 2020 May 23;52(5):835-840. Epub 2019 Dec 23.

Urology Department, Samsun Training and Research Hospital, Samsun, Turkey.

Objective: To evaluate the efficacy of silodosin or mirabegron as a medical expulsive therapy for ureteric stones in adults.

Patients-method: This is a prospective, randomized multicentric study. Patients who had ureter stones in size between 4 and 10 mm were assessed prospectively. Patients were divided into three groups with equal randomization. Group 1 was the control group; group 2 took silodosin 8 mg, and group 3 took mirabegron 50 mg once daily.

Results: All 169 patients were included in the final analysis. The spontaneous expulsion rate was similar between groups. In patients with distal localization, the stone expulsion interval was shorter in the silodosin group (7.1 ± 4.5 days) than the control (12 ± 8.7) (p = 0.034). In patients with stone size smaller than 6 mm, the stone expulsion interval was shorter in the silodosin group (5.8 ± 4) than the control (12.2 ± 2.8) (p = 0.004); the analgesic requirement was less in the silodosin group (1.4 ± 1.3) than in the control (3.6 ± 2.8) (p = 0.028). Mirabegron had no effect on stone expulsion interval in any analysis. In patients with distal localization or stone size bigger or equal to 6 mm, the need for an analgesic was less in the mirabegron group (1.8 ± 1.9) (1.9 ± 1.8) than in the control (3.6 ± 2.3) (3.2 ± 1.8), respectively (p = 0.004) (p = 0.017).

Conclusions: Silodosin or mirabegron does not improve the stone expulsion rate. Silodosin improves the stone expulsion interval and decreases the need for an analgesic or < 6 mm stones. Mirabegron has no effect on the stone expulsion interval, but decreases the need for an analgesic in patients with distal or sized ≥ 6 mm stones.
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http://dx.doi.org/10.1007/s11255-019-02368-yDOI Listing
May 2020

Adjunction of tamsulosin or mirabegron before semi-rigid ureterolithotripsy improves outcomes: prospective, randomized single-blind study.

Int Urol Nephrol 2019 Jun 15;51(6):931-936. Epub 2019 Apr 15.

Urology Department, Samsun Training and Research Hospital, Samsun, Turkey.

Objective: To evaluate efficiency and safety of adjunct tamsulosin and mirabegron therapy before semi-rigid ureteroscopy for ureteral stones.

Materials And Methods: In this prospective, randomized, single-blind and multicentric study, participants were randomized into three groups. Group 1 was the control, participants in Group 2 used tamsulosin, and those in Group 3 used mirabegron. Operations were performed 7 days after drug administration. In all clinics, a 6/7.5-Fr ureteroscope with a laser power source for lithotripsy was used.

Results: After excluding participants whose stones spontaneously passed, who discontinued medication due to adverse events and who were lost to follow-up, 186 participants were included in the final analysis. Mean age, gender, laterality, stone distribution and mean stone surface area were similar between groups. The number of participants requiring balloon dilatation was higher in the control group (23.8%) than in the tamsulosin (8.2%) and mirabegron (6.5%) groups (p = 0.006). Successful access rate was lower in the control group (81%) than in the tamsulosin (96.7%) and mirabegron (95.2%) groups (p = 0.003). Stone-free rate was lower in the control group (77.8%) than in the tamsulosin (90.2%) and mirabegron (95.2%) groups (p = 0.01). Complication rates were similar among groups.

Conclusions: Tamsulosin or mirabegron use for 1 week before semi-rigid ureteroscope increases stone access and the stone-free rate. Tamsulosin or mirabegron can be used with safety and efficacy before ureteroscopy for ureteral stones.
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http://dx.doi.org/10.1007/s11255-019-02142-0DOI Listing
June 2019

The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux.

Int Braz J Urol 2018 Nov-Dec;44(6):1200-1206

Department of Pediatric Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received.

Materials And Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O'Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow's three groups contained 18 EI procedures, and each of the second fellow's 17.

Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar.

Conclusions: An acceptable rate of success for EI may be reached after about 20 procedures and a high success rate after about 35-40 procedures.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2017.0465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442187PMC
February 2019

A Comparison of EORTC And CUETO Risk Tables in Terms of the Prediction of Recurrence and Progression in All Non-Muscle-Invasive Bladder Cancer Patients.

Urol J 2019 02 21;16(1):37-43. Epub 2019 Feb 21.

Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey.

Purpose: To compare the prediction accuracy of the European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Urology Association for Oncological Treatment (CUETO) risk tables in all non-muscle invasive bladder cancer patients.

Material And Methods: Recurrence and progression-free survival of all patients were assessed according to the EORTC and the CUETO risk tables for each patient and the concordance index was used to indicate discriminative ability. Statistical analyses were performed, at 1 and 5 years, to the whole group and separately to those treated or not treated with bacillus Calmette-Guerin (BCG) .

Results: The study included 400 patients. One-year BCG maintenance therapy was applied to 181 patients (45.3%). The recurrence rate was higher than in CUETO, and similar to EORTC. The EORTC was determined to provide better discrimination than CUETO in the whole patient group and in those treated or not treated with BCG. The concordance indices for these groups were 0.777, 0.705; 0.773, 0.669; and 0.823, 0.758, respectively . The progression rate was similar in this study to the rate defined in both risk tables. The discrimination power was similarin EORTC and CUETO for all the groups. The concordance indices were 0.801, 0.881; 0.915, 0.930; and 0.832, 0.806, respectively.

Conclusion: The EORTC has more power than CUETO to discriminate each recurrence risk group and both risk tables can successfully discriminate progression risk groups in all patients.
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http://dx.doi.org/10.22037/uj.v0i0.4091DOI Listing
February 2019

The Relationship Between Nocturnal Enuresis and Spina Bifida Occulta: A Prospective Controlled Trial.

Urology 2018 Oct 9;120:216-221. Epub 2018 Aug 9.

Department of Urology, Sultan Abdulhamid Training and Research Hospital, Istanbul, Turkey.

Objective: To compare the frequency of spina bifida occulta (SBO) detected in patients with nocturnal enuresis (NE) and to investigate its clinical significance.

Methods: Patients aged 6 to 15 years who were admitted to the urology clinic with NE were included in this prospective study. The control group consisted of patients who were admitted with a complaint of abdominal or lateral pain. The patients who had lower urinary tract symptoms (LUTS) were classified as nonmonosymptomatic NE (NMNE). Those with monosymptomatic NE were treated with desmopressine. In patients with NMNE, treatment with oxybutynin was added if an overactive bladder or uninhibited contraction was detected by urodynamics.

Results: A total of 184 NE and 180 control patients were included in the study. SBO was detected in 71 (19.5%) patients and LUTS in 100 (27.4%). When the groups with and without NE were compared, the number of patients with SBO (26% vs 17%, P = .044) and those with LUTS (36% vs 17.5%, P < .001) were significantly higher in the NE group. The overall rate of dryness (67.4% vs 83.6%, P = .024) and response to LUTS treatment (65% vs 97%, P < .01) were significantly lower in those with SBO than in those without SBO.

Conclusion: SBO is more common in NE patients than in non-NE patients. Response to NE treatment is lower in SBO patients with severe LUTS; for this population, advanced treatment options may be considered earlier.
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http://dx.doi.org/10.1016/j.urology.2018.07.038DOI Listing
October 2018

Lower urinary tract dysfunction in pediatric patients after ureteroneocystostomy due to vesicoureteral reflux: Long-term follow-up.

Low Urin Tract Symptoms 2019 Apr 11;11(2):O48-O52. Epub 2018 Jan 11.

Urology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: The aim of the present study was to evaluate long-term lower urinary tract dysfunction (LUTD) in pediatric patients who underwent ureteroneocystostomy due to vesicoureteral reflux.

Methods: The present retrospective study was performed on 61 patients. Patients were divided into 3 groups: Group 1 (n = 26), did not have LUTD; Group 2 (n = 23), had LUTD; and Group 3 (n = 12), was not toilet trained preoperatively. Patients were reassessed regarding de novo LUTD or the persistence of LUTD at least 7 years after the ureteroneocystostomy.

Results: Mean patient age was 7 years (range 1-15) when ureteroneocystostomy was performed and the surgery was associated with a 92% success rate. The mean follow-up period was 10 years (range 7-12 years). Postoperative LUTD was present in 6 (23%), 12 (52%), and 1 (8.3%) patients in Groups 1, 2, and 3, respectively. The presence of LUTD before surgery and bilateral repair in the same setting were predictive risk factors for the presence of LUTD during the long-term follow-up. LUTD occurred at higher rate in Group 2 than in Groups 1 and 3 (52% vs. 23% and 8.3%, respectively; P = .015). The presence of de novo LUTD was significant in Group 1 compared with the presence of preoperative and postoperative LUTD (P = .031, Wilcoxon analysis).

Conclusions: LUTD may not resolve after a ureteroneocystostomy, and additional therapy could be necessary. Due to the probability of damage to the ureterovesical nerve and/or disturbed bladder dynamics, de novo LUTD may occur in patients with bilateral high-grade reflux without LUTD before a ureteroneocystostomy.
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http://dx.doi.org/10.1111/luts.12213DOI Listing
April 2019

Do alpha-1 antagonist medications affect the success of semi-rigid ureteroscopy? A prospective, randomised, single-blind, multicentric study.

Urolithiasis 2018 Nov 18;46(6):567-572. Epub 2017 Nov 18.

Department of Urology, İdil State Hospital, Şırnak, Turkey.

The objective of this study is to assess the efficacy of adjunctive silodosin therapy in improving the success rate of semi-rigid ureteroscopy for removing ureteral stones. Prospective randomised controlled clinical trial performed between July 2016 and September 2016. All the patients underwent ureteroscopic holmium lithotripsy with a YAG laser. The patients were randomised into one of three groups: those who did not use an alpha-1 blocker (AB) (Group 1, n = 50), those who used an AB for one day (Group 2, n = 50), and those who used an AB for three days (Group 3, n = 47). The following information was recorded for each patient: the side, location, and surface area of the stone; successful access; operative success; complications; and operative time. There were no significant differences between the three groups in terms of demographics, stone location or size, and number of doses of an analgesic drug used. Access to the stone and the stone-free rate were significantly higher in group 3 (95.7, 93.6%) than in group 1 (76, 74%) and group 2 (78, 74%) (p = 0.018, p = 0.021), respectively. Balloon dilatation and complication rates were significantly lower in group 3 (12.8, 0%) than in group 1 (34, 12%) and group 2 (22, 4%) (p = 0.045, p = 0.029), respectively. The use of silodosin for 3 days before ureteroscopy for ureteral stones increased the rate of access to all ureter stones and decreased the complication rate.
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http://dx.doi.org/10.1007/s00240-017-1026-6DOI Listing
November 2018

Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery.

Arch Ital Urol Androl 2017 Oct 3;89(3):222-225. Epub 2017 Oct 3.

Bakirkoy Sadi Konuk Research and Training Hospital, Department of Urology.

Purpose: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT.

Materials And Methods: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level. At the end of 1st year, two groups were compared patient characteristics, operation time, duration of hospital stay, cure and complication rates.

Results: The cure rate was 84.37% 81/96) versus 83.63% (92/110) in TOT and TOT with cough test groups, respectively. Postoperatively ten patient (10/110, 9.09%) suffered voiding difficulties (> 250 ml residual urine) in TOT with cough stress test group. Five patients were discharged with transurethral catheter, whereas, in traditional TOT group, two patients (2/96, 2.1%) had transient postoperative voiding difficulty and two patients were treated with repeated catheterization for 1 week (p < 0.05). Postoperative groin pain was present in 7/96 (8%) versus 24/110 (22%) in TOT and TOT with cough test groups, respectively (p < 0.05). TOT with cough stress test group had an higher rate of complications like, retention of urine, necessitating to cut the tape, mesh erosion and pain in groin or leg. No patient had resistant voiding difficulty or prolonged urinary retention (> 1 week) in traditional TOT group.

Conclusions: We believe that per-operative cough stress test leads to overtreatment of stress urinary incontinence when the complication rates were considered.
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http://dx.doi.org/10.4081/aiua.2017.3.222DOI Listing
October 2017

Low free and bioavailable testosterone levels may predict pathologically-proven high-risk prostate cancer: a prospective, clinical trial.

Turk J Urol 2017 Sep 1;43(3):289-296. Epub 2017 Aug 1.

Department of Urology, İstinye University School of Medicine, Liv Hospital Ulus, İstanbul, Turkey.

Objective: To determine the predictive value of free and bioavailable testosterone levels on the detection of high-grade prostate cancer proven by histopathological examination of transrectal prostate biopsy specimens.

Material And Methods: A total of 405 patients who underwent transrectal prostate biopsy due to high prostatic specific antigen (PSA) (>2.5 ng/mL) and/or abnormal findings at digital rectal examination were included in this study. Blood free and bioavailable testosterone levels were calculated by the formula recommended by International Society for the Study of the Aging Male (ISSAM). The patients were stratified according to the D'Amico classification based on PSA levels and histological outcomes of prostate biopsies as benign, low, intermediate and high-risk prostate cancer. Patients were also divided into five groups according to the percentage of cancerous cores.

Results: Prostate cancer was detected in 160 of 405 (39.5%) patients. Total, free and bioavailable testosterone levels did not differ significantly between the patients with benign or malign histology. However, mean free (6.2 vs. 5.2 ng/dL, p=0.02) and bioavailable (151 vs. 125 ng/dL, p=0.001) testosterone levels were found to be significantly different in men with low-intermediate and high-risk prostate cancer. Moreover, a significant correlation was found between free, and bioavailable testosterone levels and percentage of cores with cancer (p=0.002 for free and p=0.016 for bioavailable testosterone, respectively).

Conclusion: This prospective clinical study demonstrates that reduced levels of calculated blood free and bioavailable testosterone levels are associated with an increased risk of high-grade prostate cancer. Based on these findings blood free and bioavailable testosterone levels may be be thought to be an adjunctive factor in the prediction of high-risk prostate cancer.
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http://dx.doi.org/10.5152/tud.2017.35467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562247PMC
September 2017

Applicability of the EORTC risk tables to predict outcomes in non-muscle-invasive bladder cancer in Turkish patients.

Turk J Urol 2017 Mar 6;43(1):48-54. Epub 2017 Jan 6.

Clinic of Urology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Objective: To evaluate the consistency of the results of patients who were treated for non-muscle-invasive bladder cancer (NMIBC) in our clinic with the European Organization for Research and Treatment of Cancer (EORTC) risk table.

Material And Methods: Data were retrospectively analyzed from 452 patients who had undergone transurethral resection of bladder tumor (TUR-BT) between the years 2002, and 2010 for primary or recurrent NMIBC. Our study had a retrospective design but based on prospective cohort study. Patients were staged according to the 2002 Tumor Node Metastasis (TNM) classification and the 1973 World Health Organization grading system. Recurrence was defined as non-muscle-invasive or muscle-invasive and progression as muscle-invasive tumor determined based on following cystoscopy and TUR-BT results, and confirmed by histopathologic analysis. Patients in the current study were classified into four groups according to the EORTC risk tables. Time to first recurrence and progression was determined for each risk group.

Results: Of the 452 patients, 348 were enrolled in this study. The overall mean follow-up period was 55.25 months of all patients. Of 348 patients, 130 (37.4%) and 258 patients (74.1%) had recurrence after treatment at the 1 and 5 year follow-up period, respectively. While 35 (10.1%) and 99 patients (28.4%) progressed to muscle-invasive cancer at the 1 and 5 year follow-up period, respectively. In the multivariate analysis, grade, number, size of the tumor size, and concomitant carcinoma in situ were found to be statistically significant for disease progression and recurrence.

Conclusion: When EORTC risk tables were comparatively evaluated in our patient population, we can say that EORTC tables predict nearly accurately the clinical course of patients with NMIBC.
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http://dx.doi.org/10.5152/tud.2016.77603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330268PMC
March 2017

The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey.

Turk J Urol 2016 Sep;42(3):140-4

Clinic of Urology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Objective: To evaluate long-term outcomes of active surveillance (AS) applied in low-risk prostate cancer patients, and the impact of re-biopsy results on the prediction of progression.

Material And Methods: In our clinic, patients who had undergone AS for low-risk localized prostate cancer between the years 2005-2013 were included in the study. Our AS criteria are Gleason score ≤6, prostate-specific antigen (PSA) level <10 ng/mL, number of positive cores <3, maximum cancer involvement ratio <50% each core. Immediate re-biopsy (within 3 months) was performed to 65 patients who accepted AS. Finally, 43 patients who met re-biopsy criteria were included in the study. Prostate biopsy specimens were harvested from 12 cores under the guidance of transrectal ultrasound (TRUS). Re-biopsy was performed within 3 months (1-12 weeks). In re-biopsy, a total of 20 core biopsies were performed including the far lateral (6 cores) and transition zone (2 cores) in addition to standard 12 core biopsy. Our follow-up protocol is PSA measurement and digital rectal examination (DRE) every 3 months within the first 2 years, than every 6 months. Control biopsies was performed one year later and once upon every 3 years to patients whose PSA levels and DREs were normal at follow-up visits. More than 2 tumor invaded cores or 50% tumor in one core, and Gleason score exceeding 6 points were accepted as indications for definitive treatment. Patients were divided into two groups by re-biopsy results and compared according to the time to progression. We have done multivariate regression analysis to predict prognosis by using data on age, PSA level, and detection of tumor in re-biopsy specimens.

Results: Patients' median age was 61 years and PSA level was 5 (2.7-9) ng/mL. Tumor was detected in 22 (34%) patients at re-biopsy and they underwent definitive treatment. Additionally tumor was detected in 9 patients, but active surveillance was maintained because their pathologic results met active surveillance criteria. Median follow time was 42 (24-117) months. Definitive treatment was performed in 9 (21%) patients. PSA recurrence was not detected in none of 9 patients during 38 months of follow up. Only the presence of tumor in re-biopsy specimens was found predictor of disease progression in multivariate analysis.

Conclusion: We think that AS is safe method for low-risk localized prostate cancer patients, if it is performed in compliance with certain criteria and regular follow up, and early re-biopsy can be useful either during early period or long term follow-up.
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http://dx.doi.org/10.5152/tud.2016.47786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012439PMC
September 2016

Which treatment method should be used in pregnant patients with ureteral calculi? Two center comparative study.

Arch Esp Urol 2015 May;68(4):435-40

Department of Urology. Sisli Hamidiye Etfal Training and Research Hospital. Istanbul. Turkey.

Objectives: We aimed to compare ureterolithotripsy and inserting only ureteral-j stent in terms of efficiency, safety and patient comfort in treatment of ureteral calculi in pregnant patients.

Methods: Seventy patients who developed hydronephrosis due to ureteral calculi during pregnancy, and on whom endoscopic intervention was performed were included in the study. In a center, the stones were broken up by ureteroscopy, and then ureteral stents (JJ) were placed if needed. In the other center, nothing was performed on the stones, and only ureteral stents (JJ) was placed. For the statistical analysis, Pearson's chi squared test and the Mann-Whitney U tests were used and the significance level was determined as p < 0.05.

Results: The average age of the patients was 26.2 years (18-39) and the average gestational week was 23.4 weeks (8-36). While no significant difference was found between the two groups in terms of the frequency of complications (p=0.381) and post-operative pyelonephritis (p=0.2), the need for additional intervention in the group on whom ureteroscopy was performed was found to be less (9.7% vs. 31%; p=0.032). Moderate or severe LUTS or flank pain during the period between the procedure and the birth was found to be significantly less in the group in which ureterolithotripsy was performed (14% vs. 55%; p=0.036).

Conclusions: Ureterolithotripsy is a safe and more comfortable procedure than only ureteral double-j insertion on pregnant patients with ureterolithiasis.
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May 2015

The effect of stone localization on the success and complication rates of percutaneous nephrolithotomy.

Urol J 2014 Nov 30;11(6):1938-42. Epub 2014 Nov 30.

Department of Urology, Bahcesehir University, Faculty of Medicine, Liv Hospital, Besiktas, Istanbul, Turkey.

Purpose: To evaluate the effect of stone localization on the success and complication rates of the percutaneous nephrolithotomy (PNL) procedure.

Materials And Methods: Five hundred seventy-eight PNL procedures that were performed in our clinic were retrospectively evaluated. The patients were divided into seven groups according to the localization of the renal stones as: group 1, patients having stones only in the upper calyx; group 2, patients having stones only in the pelvis; group 3, patients having stones only in the lower calyx; group 4, patients having partial staghorn stones; group 5, patients having multiple calyx stones; group 6, patients having stones in both the pelvis and lower calyx and group 7, patients having complete staghorn stones. The first three groups were defined as simple stones, and the other four groups were defined as complex stones.

Results: The mean stone clearance rate was 77% in simple stones and 53% in complex stones (P = .005). The complication rate was significantly higher only in the group with complex staghorn stones at a rate of 19.5% (P = .006). The difference between preoperative and postoperative hematocrit concentrations was the least in the group that had stones in the pelvis and this value was statistically significantly lower than the patients with complex staghorn stones (P = .027). The mean duration of the operation and the number of ports was higher in patients with complex stones.

Conclusion: The localization of stone affects the success and complication rates of the operation. 
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November 2014

Comparison of laparoscopic and open ureterolithotomy in impacted and very large ureteral stones.

Urol J 2014 May 6;11(2):1423-8. Epub 2014 May 6.

Departments of Urology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Purpose: To compare the efficacy of laparoscopic and open ureterolithotomy in patients with ureteral stones.

Materials And Methods: Patients who had undergone open or laparoscopic ureterolithotomy between 2001 and 2013 in our clinic were enrolled in the study.Ureterolithotomy was performed due to the following reasons: failure to position the patient for ureteroscopy, unreachable stone with ureteroscopy also use of balloon dilatation, high stone volume, and the need for removal of kidney stones at the same session.. The patients' demographic data, the volume of the stones, the duration of the operation and the hospital stay, the amount of analgesics administered after the operation, and the need for another procedure were compared.

Results: Of study subjects 32 patients had undergone open and 20 patients had undergone laparoscopic ureterolithotomy. When the two groups were compared, there was no statistically significant difference with regard to the mean age (44.5-44 years), the body mass index (26-24.7 kg/m²), the stone volume (420-580 mm³), the duration of operation (122-123 min), the need for another procedure and complications. The mean amount of analgesics administered after the operation (3.6 and 1.81 doses, P = .02) and the mean hospital stay (6.1 and 2.9 days, P = .01) were significantly lower in the laparoscopic ureterolithotomy group.

Conclusion: Laparoscopic ureterolithotomy is a good alternative with less need for analgesia and a shorter hospital stay when compared with open ureterolithotomy.
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May 2014