Publications by authors named "Hasan Biri"

36 Publications

Comparison of corporal plication for the correction of congenital penile curvature in pre-pubertal and post-pubertal patients: Does age matter?

Andrologia 2021 Apr 10;53(3):e13965. Epub 2021 Jan 10.

Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey.

We retrospectively reviewed and compared the results of corporal plication procedures for the correction of congenital penile curvature (CPC) between pre-pubertal and post-pubertal boys and find whether age matters in the success rates. We reviewed the records of 32 patients with CPC without hypospadias treated by simple plication near the 12 o'clock position between 1998 and 2018 in our clinic. Patients under 13 years of age and not had puberty yet were accepted as pre-pubertal. Residual curvature less than 10° during follow-up was accepted as a surgical success. The mean age of the pre-pubertal group was 8.3 (2-12) years, while 16.2 (14-21) for the post-pubertal patients. The mean follow-up was 38.7 (24-154) months in the pre-pubertal group and 45.1 (23-150) months in the post-pubertal group. The success rates of corporal plication in pre-pubertal and post-pubertal groups were 78% and 83% respectively (p = .753). The success rates of corporal plication were similar between pre-pubertal and post-pubertal boys. However, as the series was small further studies should be favoured to determine the effect of age on success rates.
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http://dx.doi.org/10.1111/and.13965DOI Listing
April 2021

Is fluoroscopy necessary during flexible ureteroscopy for the treatment of renal stones?

Arab J Urol 2019 Dec 18;18(2):112-117. Epub 2019 Dec 18.

Department of Urology, Koru Ankara Hospital, Yuksek Ihtisas University, Ankara, Turkey.

Objective: To investigate the feasibility and effectiveness of flexible ureteroscopy (fURS) without fluoroscopy during the treatment of renal stones.

Patients And Methods: Between April 2013 and August 2018, 744 patients' data were evaluated retrospectively. Of these, 576 patients were included in the study. All fURS were performed by experienced surgeons. All procedures were planned with zero-dose fluoroscopy. But, if fluoroscopy was necessary for any reasons, these patients were excluded from the study. Demographic data, perioperative parameters, stone-free rate (SFR), and complication rates were recorded.

Results: Of the patients planned for fluoroless fURS (ffURS), the procedure was successfully achieved in 96.7% (557/576 patients), as 19 patients required fluoroscopy during the procedure for various reasons. In the patients included in the study, the mean (SD) stone size was 11.6 (5.2) mm and the mean (SD) operating time was 39.4 (8.2) min. After the first session of ffURS, the SFR was 83.3% (achieved in 464 patients). Second and third sessions of ffURS were performed in 32 (5.7%) and seven (1.2%) patients, respectively. Overall, the complication rate was 11.8% and all complications were minor (Clavien-Dindo Grade I or II).

Conclusions: The ffURS technique seems to be a safe and effective treatment compared to conventional fURS in patients with renal stones. This procedure should be performed in experienced centers, where fluoroscopy can be considered not to be mandatory during fURS.

Abbreviations Cirf: clinically insignificant residual fragment; CT: computed tomography; EAU: European Association of Urology; (f)fURS: (fluoroless) flexible ureteroscopy; FT: fluoroscopy time; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; mSv: millisievert; PCNL: percutaneous nephrolithotomy; pps: pulse-per-second; rem: roentgen equivalent man; PUJ: pelvi-ureteric junction; SFR: stone-free rate.
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http://dx.doi.org/10.1080/2090598X.2019.1702242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473199PMC
December 2019

Unusual intrascrotal lesions in adults in urological practice.

Arch Esp Urol 2019 Nov;72(9):955-964

Departamento de Urología. Hospital de la Universidad de Yüksek Ihtisas Koru Ankara. Ankara. Turquía.

Objective: Unusual intrascrotal lesions in adults generally have been described as case reports in the medical literature. We present two lesions observed in two clinics over more than 28 years, with their radiological, pathological and clinical characteristics.

Methods: Retrospective study preformed between 1989 and 2017 in 446 patients undergoing inguinal orchiectomy. Clinical data were obtained reviewing patient` s tables. All patients were evaluated with physical examination, medical history, serum tumor markers (alpha fetoprotein, beta human chorionic gonadotropin, LDH), and scrotal ultrasound in the perioperative period.

Results: In 396 cases (88,78%) the diagnosis was germ cell or non-germ cell tumor and the remainder 50 patients (11.2%) presented 15 different intrascrotal lesions. These lesions were rhabdomyosarcoma (1 patient), intrascrotal cavernous hemangioma (1 patient), dermoid cyst (2 cases), epidermoid cyst (4 patients), paratesticular mesothelioma (1 case), parietal testicular tunica vaginalis cyst (2 patients), spermatic granuloma (3 cases). The number of patients with tuberculosis orchitis was 6 and granulomatous orchitis 8. There were 8 patients with fibrous pseudotumor. 1 patient presented testicular plasmocytoma. Metastatic involvement secondary to lymphoma and leukemia appeared in 4 cases. Brucella epididymitis-orchitis 7 cases. 2 cases of adult pure yolk sac testicular tumors. Additional evaluations and treatments were performed depending on histologic diagnosis.

Conclusions: The exact diagnosis of these lesions is difficult due to their rarity and they must always be considered for differential diagnosis.
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November 2019

Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones.

Urol J 2018 11 17;15(6):313-317. Epub 2018 Nov 17.

Koru Ankara Hospital, Department of Urology, Ankara, Turkey.

Purpose: To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneousnephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones.

Materials And Methods: This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative andpostoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient.

Results: Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P < .05). The stone-free status and complication rates were similar between the two groups (P > .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P < .05).

Conclusion: F-URS is less painful than mini-PNL for the treatment of 1- to 2-cm renal stones. However, the stone free rate is similar between the two procedures while mini-PNL is superior in terms of fluoroscopy, operation, hospitalization and return to work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones.
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http://dx.doi.org/10.22037/uj.v0i0.4208DOI Listing
November 2018

Shock wave lithotripsy or retrograde intrarenal surgery: which one is more effective for 10-20-mm renal stones in children.

Ir J Med Sci 2018 Nov 3;187(4):1121-1126. Epub 2018 Mar 3.

Department of Urology, Koru Ankara Hospital, Ankara, Turkey.

Objectives: To compare shock wave lithotripsy and flexible ureteroscopy in children with renal stone's diameter of 10 to 20 mm.

Materials And Methods: This is a retrospective study including 79 children, who had renal stone and underwent either shock wave lithotripsy or flexible ureteroscopy between January 2007 and June 2017. Of those, 38 patients underwent shock wave lithotripsy assigned as group 1 and 41 patients underwent flexible ureteroscopy assigned as group 2. Stone-free rate, fluoroscopy time, procedure time, complication rates, hospitalization time, and cost-effectiveness were monitored and included in the analyses.

Results: The mean patient age was 4.4 ± 3.5 in group 1 and 4.9 ± 4.1 in group 2. Stone-free rate was not different in both groups in the first and third months of follow-up. The mean fluoroscopy time was statistically significantly longer in group 1 compared to group 2. Procedure and hospitalization times were longer in group 2 compared to group 1. No complications were seen in either groups. The expenditure was calculated as 135.23 and 869.41 Euro per patient for groups 1 and 2, respectively, which shows significant higher cost in group 2.

Conclusions: In this present study, we have shown that shock wave lithotripsy is cheaper, has short hospitalization time and long fluoroscopy time and similar stone-free rate, and has the same efficiency compared to flexible ureteroscopy regarding pediatric renal stones with the diameter between 10 and 20 mm.
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http://dx.doi.org/10.1007/s11845-018-1776-3DOI Listing
November 2018

The Efficacy of Ureteroscopy Without Fluoroscopy for Ureteral and Renal Stones in Pediatric Patients.

J Endourol 2018 02 15;32(2):100-105. Epub 2018 Jan 15.

Department of Urology, Koru Ankara Hospital , Ankara, Turkey .

Objectives: In the pediatric population, there have been significant improvements in the treatment of stones in recent years. Conventionally, ureteroscopy (URS) and/or retrograde intrarenal surgery are techniques performed with fluoroscopy. When using fluoroscopy, problems, including malignancy, may arise because of radiation exposure in the patient, physician, and operation room staff. The aim of this study is to evaluate the possibility of ureteroscopic treatment without fluoroscopy in children with ureteral and renal stones.

Materials And Methods: Between December 2010 and April 2017, pediatric patients were enrolled in this study. Data were retrospectively evaluated. URS was performed by the experienced surgeons in our center. Fluoroscopy was not routinely used during the operations. Demographic data, perioperative parameters, and success and complication rates were evaluated.

Results: Sixty-seven renal units from 61 patients were operated on. URS without fluoroscopy was achieved in 95.0% of 61 patients (95.5% of 67 renal units). Three patients needed fluoroscopy during the operation. The mean stone size was 12.4 ± 5.3 mm, and the mean operation time was 41.9 ± 15.1 minutes. The success rates in the postoperative first and third mounts were 82.1% (55 renal units) and 88.0% (59 renal units), respectively. For 10 patients, second-session URS without fluoroscopy was needed. Clinically insignificant residual fragments were detected in three patients. There were no major complications.

Conclusion: URS without fluoroscopy for ureteral and renal stones in pediatric patients can be safely and effectively performed in experienced centers.
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http://dx.doi.org/10.1089/end.2017.0593DOI Listing
February 2018

Surgical management of urinary stones with abnormal kidney anatomy.

Kaohsiung J Med Sci 2017 Apr 1;33(4):207-211. Epub 2017 Mar 1.

Department of Urology, Koru Ankara Hospital, Ankara, Turkey.

In spite of the fact that urologic surgical techniques used by urologists are becoming more and more minimally invasive and easier because of developing technologies, surgical approaches for the urinary stones in kidneys with abnormal anatomy are still confusing. The objective of this article is to determine the treatment options in these kidneys. For this purpose, between 2005 and 2015, we retrospectively evaluated patients operated for urolithiasis with various congenital renal anomalies in five referral urology clinics in our country. Of the 178 patients (110 male, 60 female), 96 had horseshoe kidneys, 42 had pelvic ectopic kidneys (PEKs), and 40 had isolated rotation anomalies (IRAs) of the kidney. We evaluated the patients for stone-free rate (SFR), mean operation time, mean hospitalization time, and complication rate. In horseshoe kidney, SFRs for retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups were 72.2% and 90%, respectively. In PEKs, these rates were 83.6% and 100% for RIRS and laparoscopic pyelolithotomy, respectively. SFRs in kidneys with IRA were 75% for RIRS and 83.3% for PNL. The mean operation time for RIRS and PNL groups in horseshoe kidney was 40.5±11.2 minutes and 74.5±19.3 minutes, respectively. In PEKs, these times were 52.1±19.3 minutes and 53.1±24.3 minutes for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 48.7±14.4 minutes for RIRS and 53.2±11.3 minutes for PNL. Mean hospitalization times for RIRS and PNL groups in horseshoe kidneys were 1.4±0.7 days and 2.2±1.4 days, respectively. In PEKs, these times were 2.7±1.8 days and 1.9±0.4 days for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 1.5±0.9 days for RIRS and 1.8±0.6 days for PNL. The results of our study showed that RIRS could be used in all of types of abnormal kidneys with small- and medium-sized renal calculi safely and satisfactorily.
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http://dx.doi.org/10.1016/j.kjms.2017.01.003DOI Listing
April 2017

Surgical treatment of an acquired posterior urethral diverticulum with cystoscopy assisted robotic technique.

J Robot Surg 2017 Mar 20;11(1):83-86. Epub 2016 Jul 20.

Department of Urology, Private Koru Hospital, Ankara, Turkey.

A 42-year-old man with a history of recurrent urethral stenosis, recurrent urinary tract infection and macroscopic hematuria has referred to our clinic. He underwent several internal urethrotomies and currently using clean intermittent self-catheterization. During the internal urethrotomy, we noted a large posterior urethral diverticulum (UD) between verumontanum and bladder neck. His obstructive symptoms were resolved after the catheter removal. But perineal discomfort, urgency and dysuria were prolonged about 3-4 weeks. Urinalysis and urine culture confirmed recurrent urinary tract infections. Due to this conditions and symptoms, we planned a surgical approach which was planned as transperitoneal robotic-assisted laparoscopic approach. This technique is still applied for the diverticulectomy of the bladder. In addition to this we utilized the cystoscopy equipments for assistance. During this process, cystoscope was placed in the UD to help the identification of UD from adjacent tissues like seminal vesicles by its movement and translumination. Operating time was 185 min. On the post-operative third day he was discharged. Foley catheter was removed after 2 weeks. Urination was quite satisfactory. His perineal discomfort was resolved. The pathology report confirmed epidermoid (tailgut) cyst of the prostate. Urethrogram showed no radiologic signs of UD after 4 weeks. Irritative and obstructive symptoms were completely resolved after 3 months. No urinary incontinence, erectile dysfunction or retrograde ejaculation was noted. While posterior UD is an extremely rare situation, surgical treatment of posterior UD remains uncertain. To our knowledge, no above-mentioned cystoscopy assisted robotic technique for the treatment was described in the literature.
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http://dx.doi.org/10.1007/s11701-016-0623-7DOI Listing
March 2017

Does the Intensity of Cutting Power Affect Postoperative Symptoms During Transurethral Resection with a Monopolar System?

Indian J Surg 2015 Dec 19;77(Suppl 2):589-93. Epub 2013 Jun 19.

Department of Urology, University of Gazi, Ankara, Turkey.

The aim of this study was to investigate the effect of intensity of cutting power on postoperative symptoms after transurethral resection (TURP) with a monopolar system for benign prostatic hyperplasia. One hundred thirty-six men with benign prostatic obstructions undergoing elective transurethral prostatectomy were enrolled in the study. Patients were divided into three groups according to the intensity of cutting power. The cutting power intensities were 80-119 W for group 1, 120-159 W for group 2, and 160-200 W for group 3, respectively. In the postoperative period, patients were evaluated with International Prostate Symptom Score (IPSS) and quality-of-life (QoL) questionnaires. In the postoperative period, maximal flow rate (Q max), and post-voiding residue (PVR) were significantly improved in patients who had monopolar TURP performed. When compared to the other groups, the IPSS score was found to be significantly higher in group 3 at 3, 4, and 8 weeks. In addition, the QoL assessment scores for group 3 were superior at 3 weeks. The improvements of Q max and PVR were similar among the three groups (p < 0.0001). At the end of 3 months, IPSS and QoL were significantly improved in all groups. The intensity of cutting power during prostate resection with a monopolar system may affect the postoperative improvements and symptoms.
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http://dx.doi.org/10.1007/s12262-013-0933-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692864PMC
December 2015

Reduced radiation fluoroscopy protocol during retrograde intrarenal surgery for the treatment of kidney stones.

Urol J 2014 Jul 8;11(3):1589-94. Epub 2014 Jul 8.

Department of Urology, Gazi University, Ankara, Turkey.

Purpose: To discuss whether fluoroscopic imaging is essential during the ureteroscopic treatment of kidney stones in an effort to diminish radiation exposure.

Materials And Methods: Seventy-six patients with kidney stones were treated with retrograde intrarenal surgery (RIRS). In the operation room, a mobile C-arm fluoroscopy system was ready to use in case fluoroscopic imaging was needed. The manipulations were performed with tactile and visual cues. The perioperative and postoperative parameters were retrospectively evaluated.

Results: The mean age of the patients was 39.9 ± 13.8 years. The mean stone size was 14.1 ± 4.1 mm. The insertion of the access sheath was performed over the guidewire under single shoot fluoroscopic imaging in all patients. Additional fluoroscopic imaging was required to localize the stone (n = 2) and to determine the collecting system anatomy (n = 2) for 4 (5.2%) patients with previous renal surgery and severe hydronephrosis. Stone-free status was accomplished in 63 (82.9%) patients.

Conclusion: The RIRS with low-dose fluoroscopy protocol for kidney stones can be safely and effectively performed in patients with no special circumstances such as anatomical abnormalities or calyceal diverticular stones.
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July 2014

Laparoscopic nephropexy with polymer clips.

JSLS 2014 Jan-Mar;18(1):116-9

Department of Urology, Gazi University, Ankara, Turkey.

Background And Objectives: We present our initial experience and long-term results with transperitoneal laparoscopic nephropexy with nonabsorbable polymer clips.

Methods: Seven patients aged 34 to 47 years previously diagnosed with mobile kidney presented with chronic pain refractory to analgesics and underwent a transperitoneal laparoscopic nephropexy procedure with nonabsorbable polymer clips by fixing the perirenal tissue to the transversus abdominis fascia and triangular ligament.

Results: Mean operation time was 20 minutes. All patients were discharged after 24 hours. Follow-up intravenous pyelogram (IVP) at 60 and 150 days showed the right kidneys in a more cephalad position, and showed pelvicaliceal dilatations and that the ureteral kinks seemed to be resolved. On days 15, 60, 90, and 150 of the first- and second-year follow-ups, severity of pain was 1 of 10 on the visual analog scale.

Conclusion: We believe that the technique of transperitoneal laparascopic nephropexy with nonabsorbable polymer clips on patients with symptomatic mobile kidney is safe and easy to perform and shows successful long-term results.
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http://dx.doi.org/10.4293/108680813X13693422519235DOI Listing
December 2014

Ureteroscopy: the first-line treatment for distally located ureteral stones smaller than 10 mm.

Urol J 2014 01 4;10(4):1028-34. Epub 2014 Jan 4.

Department of Urology, Koru Hospital.

Purpose: To compare the efficacy of different treatment strategies for distal ureteral stones smaller than 10 mm.

Material And Methods: A total 127 patient were included in the study. Based on the treatment modality , patients were divided into three groups.Patients in group 1 only received conventional treatment including daily hydration of 2500 mL, ciprofloxacin, diclofenac sodium and a spasmolytic agent; group 2 patients received conventional treatment (daily hydration of 2500 mL, ciprofloxacin, diclofenac sodium and a spasmolytic agent) and tamsulosin 0.4 mg orally daily for 4 weeks; and group 3 patients underwent ureteroscopy. Patients were further subdivided into 2 categories based on maximum stone diameter: category A (less than 5 mm) and category B (5.0-9.9 mm). Following treatment, all groups were compared in terms of stone-free rate and time to expulsion.

Results: Following treatment, the stone-free rates for groups 1, 2 and 3 were 48.7%, 59.5% and 95.6%, respectively (P < .0001).The mean expulsion times for groups 1, 2 and 3 were 15.3 ± 5.33, 15.1 ± 5.5 and 1.95 ± 2.2 days, respectively (P < .001). Compared to the other treatments, the stone-free rate and mean expulsion time in the ureteroscopy group were significantly increased and decreased, respectively.

Conclusion: There are several treatment options for distal ureteral stones. Based on our data,we conclude that ureterorenoscopy should be the standard of care for distal ureteral stones smaller than 10 mm.
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January 2014

The efficacy of bupivacaine infiltration on the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy: a prospective, randomized, multicenter study.

Urology 2013 Sep 4;82(3):526-31. Epub 2013 Jul 4.

Department of Urology, Koru Hospital, Ankara, Turkey.

Objective: To assess the analgesic efficacy of bupivacaine infiltrations into the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy (PCNL).

Methods: This prospective, randomized controlled study enrolled 121 patients. Patients were randomized to receive a 20-mL infiltration of 0.25% bupivacaine into the nephrostomy tract after PCNL. Patients were divided into 2 groups. The group 1 patients received bupivacaine infiltrations, whereas group 2 did not. Patients' visual analog scale (VAS) pain scores were evaluated at 6, 12, and 24 hours postoperatively. Pain in the postoperative period was managed with intramuscular diclofenac sodium (75 mg) or meperidine (pethidine) hydrochloride (50 mg), as requested by the patients.

Results: The patients were a mean age of 43.2 ± 12.7 years (range, 18-74 years). The VAS pain scores at 6, 12, and 24 hours postoperatively and the amount of diclofenac sodium needed were significantly less in the group with bupivacaine infiltration than in those that did not receive the infiltration (P <.05). The VAS pain scores in patients with tubeless PCNL were significantly lower than those in patients with standard PCNL (P <.05).

Conclusion: The pain after tubeless and standard PCNL may be decreased by bupivacaine infiltration into the nephrostomy tract. The findings of the present study reveal that a tubeless procedure and local analgesic infiltration into the nephrostomy tract after the PCNL is the more comfortable procedure for the patients.
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http://dx.doi.org/10.1016/j.urology.2013.02.083DOI Listing
September 2013

Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in management of lower-pole renal stones with a diameter of smaller than 15 mm.

Urolithiasis 2013 Jun 13;41(3):241-6. Epub 2013 Mar 13.

Department of Urology, Koru Hospital, Ankara, Turkey.

The aim of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PNL) in management of lower-pole renal stones with a diameter smaller than 15 mm. Between December 2009 and July 2012, the patients with the diagnosis of lower-pole stones were evaluated by ultrasonography, intravenous pyelography and computed tomography. The records of 73 evaluable patients who underwent mini-PNL (n = 37) or RIRS (n = 36) for lower-pole (LP) stones with diameter smaller than 15 mm were reviewed retrospectively. Of the 73 patients, 37 underwent mini-PNL and 36 underwent RIRS. The stone-free rates were 89.1 and 88.8 % for mini-PNL and RIRS groups, respectively. The mean operation time was 53.7 ± 14.5 in the mini-PNL group but 66.4 ± 15.8 in the RIRS group (P = 0.01). The mean fluoroscopy times and hospitalization times were significantly higher in the mini-PNL group. There was no major complication in any patient. RIRS and mini-PNL are safe and effective methods for treatment of LP calculi with a diameter smaller than 15 mm. RIRS is a non-invasive and feasible treatment option, and has also short hospitalization time, low morbidity and complication rate. It may be an alternative of mini-PNL in the treatment LP calculi with smaller than 15 mm.
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http://dx.doi.org/10.1007/s00240-013-0552-0DOI Listing
June 2013

The use of titanium ligation clips in microsurgical subinguinal varicocelectomy.

Turk J Urol 2013 Mar;39(1):29-34

Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey.

Objective: The aim of this study is to evaluate the use of titanium ligation clips for dilated spermatic veins in microsurgical subinguinal varicocelectomy.

Material And Methods: In this retrospective study, eighty-four men with clinical varicocele underwent microsurgical varicocele repair. The patients were divided into two groups according to the ligation materials used for the varicocelectomy (silk sutures vs. titanium clips). Group 1 included 43 patients; these patients underwent microsurgical subinguinal varicocelectomy with the titanium clips. The 41 patients included in Group 2 underwent microsurgical subinguinal varicocelectomy with silk sutures. Microsurgical subinguinal varicocelectomy was performed in all patients. The two study groups were compared in terms of intra-operative and postoperative parameters.

Results: The mean age of the patients was 28.6±4.6 years, and the mean follow-up was 12.3±2.7 months. The two groups exhibited comparable improvements in sperm motility and/or concentration: 79.1% and 82.9% in Group 1 and Group 2, respectively (p>0.05). The operation time in Group 1 (titanium clip) was significantly shorter than in Group 2 (silk sutures). None of the patients experienced any intra-operative complications. There were no significant differences between Group 1 and Group 2 with regard to postoperative recurrences, ligated veins, postoperative complications and hydrocele formation, hospitalization time, the requirement for postoperative analgesia or the time until the patient could return to work.

Conclusion: Titanium ligation clips can be used for the ligation of dilated vessels during microsurgical subinguinal varicocelectomy, and the operation time is significantly reduced with the use of titanium ligation clips.
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http://dx.doi.org/10.5152/tud.2013.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548580PMC
March 2013

The effect of microsurgical varicocelectomy on semen parameters in men with non-obstructive azoospermia.

Curr Urol 2013 Jan 21;6(3):136-40. Epub 2012 Dec 21.

Department of Urology, Gazi University, Ankara, Turkey.

Introduction: The aim of this study was to evaluate the effect of microsurgical subinguinal varicocelectomy on semen parameters in azoospermic men with clinical varicocele and to determine the predictive parameters of postoperative improvement.

Methods: Twenty-three men with non-obstructive complete azoospermia and varicocele underwent subinguinal open microsurgical varicocele repair. The outcome was assessed in terms of improvement in semen parameters after surgical repair for varicocelectomy.

Results: Bilateral varicocelectomy was performed on 15 patients and unilateral (left) varicocelectomy was performed on 8 patients. In the post-operative period, of the 23 patients, 7 (30.4%) had motile sperm in the ejaculate. The mean sperm concentration of these patients was 1.34 ± 2.6 × 10(6)/ml and the mean total sperm motility was 37.5 ± 15.5%.

Conclusion: Infertile men with non-obstructive azospermia can have improvement in semen analysis after subinguinal microsurgical repair of varicoceles. Motile sperm in ejaculate were detected after microsurgical varicocele repair.
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http://dx.doi.org/10.1159/000343527DOI Listing
January 2013

Safety of ESWL in elderly: evaluation of independent predictors and comorbidity on stone-free rate and complications.

Geriatr Gerontol Int 2012 Jul 23;12(3):413-7. Epub 2011 Dec 23.

Urology Department, Gazi University School of Medicine, Cukurambar, Ankara, Turkey.

Aim: Urinary stone disease affects people of all ages. With its satisfactory efficacy ranges in all age groups and lack of side-effects, extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for uncomplicated renal and proximal calculi ≤ 20 mm. In the present study, we aimed to assess the safety and efficacy of the ESWL treatment in elderly patients.

Methods: A retrospective study was carried out on patients aged over 65 years who underwent shock wave lithotripsy at our Department from 2009 to 2011, with a Siemens Lithostar electromagnetic shockwave lithotripter. A total of 231 patients (157 males, 74 females) out of 1694 (13.6%) were studied. The patients were divided into two groups (group 1 = 65-70; group 2 >70). The effect of age and other possible predicting factors (sex, stone localization and stone size) were investigated. Concomitant diseases and related complications were also evaluated.

Results: An overall stone-free rate (SFR) of 82.2% was found. The influence of sex on SFR was non-significant. There was no significant difference when comparing SFR between the age groups. When patients were divided into those with renal and ureteral stones, the SFR were 94.4% and 67.6% (P < 0.01), respectively. The SFR of the stone size groups, ≤ 10 mm and > 10 mm were 80% and 84.4%, respectively. Comorbidity was present in 148 patients. Complications were noted in 56 of 231 patients. Of 56 patients, 43 had minor complications and 13 major complications.

Conclusion: ESWL seems to be an effective first-line treatment choice for urinary stones in elderly patients with careful patient selection and personalized preparation.
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http://dx.doi.org/10.1111/j.1447-0594.2011.00781.xDOI Listing
July 2012

Direct upper kidney pole access and early ligation of renal pedicle significantly facilitates transperitoneal laparoscopic nephrectomy procedures: Tunc technique.

Surg Laparosc Endosc Percutan Tech 2011 Dec;21(6):453-7

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

We modified our technique in transperitoneal laparoscopic nephrectomies and compared its results with the classical technique. Classical technique was performed in 85 cases (group 1). Modified technique (n=98) included direct kidney upper pole access and early ligation of renal pedicle (group 2). No significant differences were detected regarding mean patient age, intraoperative blood loss, and duration of hospital stay between the 2 groups (P>0.05). Mean operation time was 64.9 ± 19.3 and 28.2 ± 7.7 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including right nephrectomies was 68.7 ± 23.4 and 24.2 ± 6.3 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including left nephrectomies was 63.8 ± 17.1 and 33.6 ± 5.1 minutes, respectively in groups 1 and 2 (P=0.001). Similarly, mean operation time was significantly shorter in group 2 when analysis was performed among right and left radical and simple nephrectomies between the 2 groups (P=0.001). Direct upper kidney pole access and early ligation of renal pedicle seems to be significantly facilitating transperitoneal laparoscopic nephrectomy procedures.
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http://dx.doi.org/10.1097/SLE.0b013e31823badc1DOI Listing
December 2011

Treatment outcomes of semirigid ureterorenoscopy and intracorporeal lithotripsy in pregnant women with obstructive ureteral calculi.

Urol Res 2011 Dec 30;39(6):487-90. Epub 2011 Mar 30.

Urology Department, Gazi University School of Medicine, Cukurambar mah. No: 2/8, 06520, Cukurambar/Ankara, Turkey.

The purpose of the study is to evaluate the outcomes of semirigid ureterorenoscopy and intracorporeal lithotripsy as a definitive treatment in pregnant women with obstructive ureteral calculi. A retrospective analysis was performed of 16 pregnant patients referred to gynecology department with ureteral obstruction from 2007 to 2009. The mean age was 25 years, and mean gestation period was 30 weeks. Of the 16 patients; 50% had fever, 100% flank pain, 56% dysuria, 25% gross hematuria, 50% positive urine culture, and 75% pyuria and microscopic hematuria. Abdominal ultrasonography was the principle diagnostic test used. The mean stone size was 9.45 mm. Eleven of the 16 patients, 54% had stones located in the distal ureter and 46% proximal ureter. The stones were fragmented using a swiss pneumatic lithoclast through 9.5 F semirigid ureteroscope by 0.035 mm safety guidewire with the patient under general anesthesia. Eleven patients had obstruction due to the ureteral calculi. Eight of 11 patients had complete fragmentation of the calculi by ureteroscopy as a primary treatment. Push-back was performed in the other three patients. By applying Dj catheter, and performing eswl after giving birth, the patient became stone-free. Dj catheter was applied peroperative to all 16 patients. No complications were recorded, and all patients completed the full term of pregnancy. The results of our study have shown that semirigid ureteroscopy to diagnose ureteral calculi and treat them with intracorporeal pneumatic lithotripsy and ureteral stent insertion, as indicated, is the most efficient and definitive treatment modality in pregnant women.
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http://dx.doi.org/10.1007/s00240-011-0376-8DOI Listing
December 2011

Association of genetic polymorphisms in vitamin D receptor gene and susceptibility to sporadic prostate cancer.

Exp Biol Med (Maywood) 2008 Dec 10;233(12):1608-14. Epub 2008 Oct 10.

Department of Medical Biology and Genetics, Faculty of Medicine, Gazi University, Besevler, 06500, Ankara, Turkey.

Genetic and environmental factors are involved in prostate cancer (PCa) etiology. Single nucleotide polymorphisms (SNPs) may contribute to the PCa pathogenesis. The goal of this study is to determine the role of vitamin D receptor (VDR) gene polymorphisms and haplotypes in the development and progression of sporadic PCa. One hundred and thirty-three PCa patients and 157 age-matched healthy controls were genotyped for the Apa I (rs7975232), Bsm I (rs1544410) and Taq I (rs731236) polymorphisms in VDR gene by using polymerase chain reaction-restriction fragment length polymorphism. An association was observed between the Apa I polymorphism and PCa predisposition (P = 0.03). When compared with AA genotype, there was a highly notable difference in the frequencies of the Aa (P = 0.02), aa (P = 0.026) and Apa I ''a'' allele carriers (Aa + aa) (P = 0.009) genotypes. Furthermore, we found a statistical difference in the allele frequencies of the Apa I polymorphism between the sporadic PCa patients and control subjects (P = 0.013). The genotype distribution for the Bsm I and Taq I polymorphisms were similar between cases and controls (P > 0.05). No clinically significant relationship was found between the three-locus haplotypes and development of sporadic PCa. The genotype frequencies for the three polymorphisms of the VDR gene within subgroups of PCa (defined by tumor stage, Gleason score, PSA levels) were also analyzed, but no statistically noteworthy difference was observed (P > 0.05). As far as we know, this is the first study which investigates the relationship between VDR genotypes and sporadic PCa in the Turkish population. Our findings suggest that the VDR ApaI (rs7975232) polymorphism may play a role in the development of sporadic PCa.
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http://dx.doi.org/10.3181/0803-RM-110DOI Listing
December 2008

The use of polymer clips in transperitoneal laparoscopic nephropexy.

Surg Laparosc Endosc Percutan Tech 2008 Feb;18(1):124-6

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

Here we report a patient with symptomatic mobile kidney (nephroptosis) who was treated successfully with transperitoneal laparoscopic nephropexy with the use of nonabsorbable polymer clips. In this procedure, clips were used on Gerota's fascia to fix the kidney to the transversus abdominis fascia and the triangular ligament. This method is easier and requires less time than previously reported techniques.
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http://dx.doi.org/10.1097/SLE.0b013e31815678d7DOI Listing
February 2008

Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis in the absence of kidney stones or clinical urinary infection.

Surg Laparosc Endosc Percutan Tech 2007 Dec;17(6):570-2

Urology Department, Gazi University School of Medicine, Ankara, Turkey.

Here, we present a patient who underwent transperitoneal laparoscopic nephrectomy for a nonfunctional kidney on the left side, and who was found to have xanthogranulomatous pyelonephritis (XGP) on the subsequent histopathology examination. XGP is a severe, chronic infection of the renal parenchyma. Nephrectomy is the treatment of choice. Preoperative diagnosis of XGP can be challenging because the clinical presentation may vary. Our patient's loss of kidney function was due to a simple cortical kidney cyst that compressed the urinary collecting system. He presented only with mild flank pain and a poorly functioning kidney, and therefore XGP was not suspected before surgery. Because of the renal and perirenal inflammatory changes that commonly accompany XGP, the laparoscopic approach is difficult and is therefore rarely used. However, laparoscopic nephrectomy for XGP offers an easier recovery for the patient and therefore deserves further consideration as a method of treatment.
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http://dx.doi.org/10.1097/SLE.0b013e31812e5360DOI Listing
December 2007

The association of 5alpha-reductase II (SRD5A2) and 17 hydroxylase (CYP17) gene polymorphisms with prostate cancer patients in the Turkish population.

DNA Cell Biol 2007 Feb;26(2):100-7

Department of Medical Biology and Genetics, Faculty of Medicine, Gazi University, Besevler, Ankara, Turkey.

To date, research has led to the invention of multiple genes and their single nucleotide polymorphisms (SNPs) and environmental factors that influence the prostate cancer (PCa) pathogenesis. Therefore, the genes involved in these pathways are candidates for PCa predisposition. It is thought that polymorphisms of 5alpha-reductase II (SRD5A2) and 17 hydroxylase (CYP17) genes are likely to increase susceptibility. The aim of this study was to investigate the risk association of SRD5A2 and CYP17 gene polymorphisms in the development and progression of PCa in the Turkish population. In this study, 100 PCa patients and 105 healthy controls were studied. SRD5A2 and CYP17 gene polymorphisms were determined by real-time PCR and polymerase chain reaction-restriction length polymorphisms (PCR-RFLP) techniques. First, the AT and TT genotypes of SRD5A2 gene at codon 49 were not observed. Second, there was no significant association between the polymorphisms at codon 89 and the risk of PCa. Third, in the CYP17 gene, the A1A1 genotype is more common (46%) in cases than controls (32.4%). The odds ratios (ORs) of the A1A1 genotype was found at 1.69 (95% confidence interval [CI], 0.77-3.74) compare with the A2A2 genotype. Genotyping results of the SRD5A2 and CYP17 genes were also analyzed in relation to prostate-specific antigen (PSA) levels, Gleason score (GS), and tumor stage, but no statistically significant difference was observed (P > 0.05). Finally, we conclude that there was no evidence of an association between CYP17 (P = 0.134) and SRD5A2 (P = 0.784) polymorphism and PCa risk in the Turkish population.
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http://dx.doi.org/10.1089/dna.2006.0534DOI Listing
February 2007

Assessment of urinary symptoms in children with dysfunctional elimination syndrome.

Int Urol Nephrol 2007 17;39(2):425-36. Epub 2007 Feb 17.

Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey.

Objective: This study was organized to form a symptom scale for diagnosis and assessment of urinary and bowel symptoms in children with dysfunctional elimination syndrome (DES).

Methods: The study group included 81 children presented to our clinic with symptoms of DES like enuresis, abnormal voiding, urinary tract infection and urgency, between January 2003 and February 2004. Age matched 102 children with no history of urological complaints were randomly recruited from a public school as control group. Children with isolated, mono-symptomatic nocturnal enuresis were not taken to the study. All children and parents were requested to fill a 35-item questionnaire related to symptoms of DES. After statistical analysis, questions from the initial form that had a P-value <0.05 and an area under curve (AUC) value >0.6 were selected to form a final scale.

Results: The mean ages for study and control groups were 8.7 +/- 2.5 and 8.3 +/- 2.2 years, respectively (P = 0.236). The final scale was composed of 15 questions. The cut-off score for the presence of DES was determined as 7.5 (sensitivity 85.2%, specificity 93.1%, AUC value = 0.943) for the total population. When only the male population were concerned the cut-off score was 4.5 (sensitivity 93.8%, specificity 78%, AUC value = 0.913) while the cut-off score for the female population was 7.5 (sensitivity 87.7%, specificity 94.2%, AUC value = 0.953).

Conclusion: Providing objective assessment of symptom severity, formation of a validated scoring system for children with DES might be a good tool for diagnosis, confirmation of treatment results and follow up. It might also be useful for screening purposes.
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http://dx.doi.org/10.1007/s11255-006-9062-0DOI Listing
September 2007

No association between polymorphism in the vascular endothelial growth factor gene at position -460 and sporadic prostate cancer in the Turkish population.

Mol Biol Rep 2008 Mar 11;35(1):17-22. Epub 2007 Jan 11.

Department of Medical Biology and Genetics, Faculty of Medicine, Gazi University, Besevler, Ankara, 06510, Turkey.

The development and progression of prostate cancer (PCa) has biologically and genetically remained a mystery. A man's risk of developing PCa is influenced by both genetic and environmental factors. Angiogenic cytokines like vascular endothelial growth factor (VEGF) play a pivotal role in tumor angiogenesis. Single nucleotide polymorphisms in angiogenesis-dependent genes affect the sensibility of cancer development and progression. Therefore, we hypothesized a potential association between DNA sequence variations in VEGF -460 gene region and sporadic PCa patients in the Turkish population. 133 sporadic PCa patients and 157 healthy controls were studied. Genotypes were determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis. The distribution of genotype and allele frequencies of the polymorphism did not yield a statistically significant difference between patients and controls (P>0.05). Furthermore, classification of patients by tumor-lymph nodes-metastasis (TNM), Gleason Scores (GS) and serum prostate-specific antigen (PSA) levels did not show significant differences among the VEGF -460 C>T genotypes (P>0.05). This is the first demonstration showing that the VEGF -460 C>T polymorphism in men is not associated with sporadic PCa in the Turkish population.
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http://dx.doi.org/10.1007/s11033-006-9046-2DOI Listing
March 2008

Minimally invasive treatment of ureteral calculi in children.

Urol Res 2006 Dec;34(6):381-7

Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey.

A retrospective analysis was done to determine the efficacy of shock wave lithotripsy (SWL) and ureteroscopy in the treatment of paediatric ureteral calculi. We reviewed the records of 67 (35 boys, 32 girls) children (71 ureters) admitted to our clinic for treatment of ureteral calculi during 1990-2005. The initial treatment method was SWL in 80.3% (57 ureters), ureteroscopy in 11.3% (eight ureters) and open surgery in 8.5% (six ureters) of the renal units. The mean age of the patients was 10.67 +/- 4.4(1-16) years. The stone-free rates after SWL for upper, middle and lower ureteral calculi were 74.1, 100 and 75.9%, respectively. Increased stone diameter (P = 0.014) and/or burden (P = 0.002) were found to be significant factors that had an adverse affect on the stone-free rate after SWL while the success rates of SWL were independent of location. Including six patients (seven ureters) with failed SWL, a total of 14 patients (15 renal units) subjected to ureteroscopy for lower ureteral calculi yielded a stone-free rate of 93.3%. Thus, the overall stone-free rates after SWL, ureteroscopy and open surgery were found to be 75.4, 93.3 and 100%, respectively. Depending on the stone burden, SWL might be a good option for initial treatment of most ureteral calculi in children. Ureteroscopy offers a high success rate for lower ureteral calculi, including SWL failures.
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http://dx.doi.org/10.1007/s00240-006-0072-2DOI Listing
December 2006

Prolapse of a simple ureterocele presenting as a vulval mass in a woman.

Int J Urol 2006 Apr;13(4):447-8

Department of Urology, School of Medicine, Gazi University, Ankara, Turkey.

A 48-year-old woman presented with a large vulval mass after prolapse of a ureterocele. Her past excretory urogram showed a filling defect (cobra head appearance) in the bladder related to a single-system ureterocele on the left. The mass was manually reduced back through to the urethra under sedation and a urethral catheter was inserted. The anterior wall of the ureterocele was resected transurethrally for definitive treatment.
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http://dx.doi.org/10.1111/j.1442-2042.2006.01336.xDOI Listing
April 2006

Incidence of stress urinary incontinence among women in Turkey.

Int Urogynecol J Pelvic Floor Dysfunct 2006 Nov 21;17(6):604-10. Epub 2006 Apr 21.

Obstetrics and Gynecology Department, Faculty of Medicine, Gazi University, Ankara, Turkey.

The aim of this study was to determine the incidence of stress urinary incontinence among women at the age of 15 and above who applied to the primary health care centers in Ankara, Turkey. We applied the urinary stress incontinence questionnaire to 2,601 women at the age of 15 or above who consulted to the "mother-child health care and family planning centers" in January 2002. To evaluate the urinary incontinence status with respect to age groups and other risk factors, chi-square test was used. Stress incontinence prevalence was 16.1% in our population. Age was a statistically significant risk factor affecting the incidence of stress incontinence. As the number of gravida increases, the frequency of stress incontinence increases (p<0.05). Presence of a systemic disease was also an important risk factor (p<0.05). Alcohol use and smoking were not found to affect the incidence of urinary stress incontinence (p>0.05). As urinary incontinence greatly influences life quality and social and psychological status of the person, and also creates economic burden, predisposing factors of stress incontinence should be well defined and measures should be taken to encourage women experiencing this problem to visit a doctor and to get an efficient treatment.
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http://dx.doi.org/10.1007/s00192-006-0074-1DOI Listing
November 2006

Renal brucelloma: a rare infection of the kidney.

Int J Urol 2005 Dec;12(12):1058-60

Gazi University, School of Medicine, Urology Department, Ankara, Turkey.

We report a case of renal abscess caused by brucellosis (renal brucelloma) which was treated by surgery. Renal parenchymal involvement of systemic brucellosis is a very rare condition and relapses after medical treatment, such as solid organ abscess including kidney, should be especially considered. In chronic cases, laboratory findings including polymerase chain-reaction examination is needed for definitive diagnosis.
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http://dx.doi.org/10.1111/j.1442-2042.2004.01207.xDOI Listing
December 2005

Extracorporeal shock wave lithotripsy in L-shaped kidneys: report of two cases.

Int Urol Nephrol 2005 ;37(4):685-9

Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey.

The L-shaped or tandem kidney is a type of crossed ectopia with fusion in which the crossed kidney assumes a transverse position during its attachment to the inferior pole of the other kidney. Calculus formation is a well-known sequel of congenital abnormalities of the urinary tract and we like to present two patients harbouring calculi in L-shaped kidneys treated by extracorporeal shock wave lithotripsy (ESWL). The first patient had a calculus in renal pelvis of the transverse kidney. The second case had multiple calculi in renal pelvis and calices of the vertically positioned kidney. After three sessions, first patient was stone free, whereas no fragmentation in the second case. As a conclusion, ESWL might be an option for L-shaped kidneys.
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http://dx.doi.org/10.1007/s11255-005-8436-zDOI Listing
June 2006
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