Publications by authors named "Serhat Cetin"

10 Publications

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[Comparison of magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy with standard systematic biopsy: A single center experience.]

Arch Esp Urol 2021 Oct;74(8):790-795

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

Objective: To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms of cancer detection rates.

Patients And Methods: The data of the patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI and underwent MRI-TRUS fusion biopsy with simultaneous 12-core standard systematic biopsy from June 2016 to June 2019 in our tertiary center were retrospectively reviewed. Clinical, radiological and pathological data were recorded. Statistical difference among the groups was determined by using McNemar tests.

Results: A total of 344 patients were included in the study. As a result of transrectal targeted and systematic combined biopsy, 117 patients were diagnosed with prostate cancer. Benign pathology rates in patients with PI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were 93.8%, 68.5%, and 46.4%, respectively. Patients were divided into two groups as ISUP grade 1 and ISUP grade ≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy compared with the systematic biopsy (12.5% vs. %6.4, p=0.007 and 17.4% vs. 8.7%, p<0.001, respectively). Targeted biopsy CDRs were found significantly higher in the high PSA density group (24.5% vs. 41.4%, p=0.001) unlike the systematic biopsy.

Conclusion: Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making a biopsy decision for patients with PI-RADS 3 lesions. PSA density can be used as a criterion for patient selection for targeted biopsy.
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October 2021

The role of histopathological and biochemical parameters for predicting metastatic disease on Ga-PSMA-11 PET in prostate cancer.

Prostate 2021 Dec 13;81(16):1337-1348. Epub 2021 Sep 13.

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

Background: The aim of this study was to evaluate the role of histopathological and biochemical parameters in the prediction of the presence and number of PSMA positive lesions consistent with the metastatic spread of prostate cancer on Ga-PSMA PET images.

Methods: Biochemical, histopathological and imaging data of 302 prostate cancer patients who underwent Ga-PSMA-11 PET/CT or PET/MR imaging for primary staging were retrospectively analyzed. Patients were divided into two groups as "PET positive" and "PET negative" according to the presence of pathologic extraprostatic PSMA involvement. "PET positive" patients were additionally divided into two groups: oligometastatic (1-3 metastatic lesion) and multimetastatic (>3 metastatic lesions).

Results: The mean age of patients was 66.8 ± 7.6 years. Imaging modality was PET/MR in 223 (73.8%) and PET/CT in 79 (26.2%) of patients. Total PSA, PSA density (PSAD), ALP, and tumor ratio in biopsy specimens were found to be significantly higher in "PET positive" group compared to "PET negative" group and in multimetastatic group compared to oligometastatic group. PET positivity was observed in 3.8% of the low-intermediate risk groups (ISUP 1-3 and total PSA ≤ 20 ng/ml and PSAD < 0.15 ng/ml/cc). This ratio was 46% in the high-risk group (ISUP 4-5 or total PSA > 20 ng/ml or PSAD ≥ 0.15 ng/ml/cc) with a relative risk of 12 (p < .001). The prediction models to predict the PET positivity and the presence of distant metastasis had AUCs of 0.901 and 0.925, respectively; with ALP, total PSA, and tumor ratio in needle biopsy specimen as significant independent predictors (p < .05).

Conclusions: In this study, Ga-PSMA-11 PET positivity was significantly higher in the high-risk patient group than in the low-intermediate risk groups. The prediction models used for predicting the PET positivity and the presence of distant metastasis on PET imaging were successful with high discriminatory powers. In addition to total PSA and ISUP GG, ALP and tumor ratio in biopsy specimens can be used to identify high-risk patients.
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http://dx.doi.org/10.1002/pros.24231DOI Listing
December 2021

Predicting factors of acute kidney injury after partial nephrectomy and its impact on long-term renal function: A multicentre study of the Turkish Urooncology Association.

Int J Clin Pract 2021 Nov 30;75(11):e14751. Epub 2021 Aug 30.

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

Objectives: To investigate the predictors of acute kidney injury (AKI) after partial nephrectomy and the impact of AKI stage on long-term kidney function.

Methods: Data of 1055 patients who underwent partial nephrectomy between January 2008 and January 2018 at seven separate tertiary centres were analysed. AKI was defined according to AKI Network criteria. The association between pre-operative and perioperative factors and AKI was evaluated using logistic regression analysis. Recovery of at least 90% of baseline glomerular filtration rate 1 year after partial nephrectomy, change of 1 year glomerular filtration rate compared with baseline glomerular filtration rate and stage ≥3 chronic kidney disease (CKD) progression were assessed according to the stage of AKI.

Results: AKI was recorded in 281 (26.7%) of 1055 patients after partial nephrectomy, and of these patients, 197 (70.1%) had stage 1, 77 (27.4%) had stage 2 and 7 (2.5%) had stage 3. Higher tumour complexity and baseline glomerular filtration rate were independent predictors for AKI. The proportion of recovering 90% of baseline glomerular filtration rate at 1 year for any patient who had stage ≤1 vs stage 2-3 of AKI was 78.2% (95% CI: 73.2%-83.7%) and 23.8% (95% CI: 14.7%-38.7%), respectively (P < .001). The risk of stage ≥3 CKD progression for any patient who had stage ≤1 vs stage 2-3 of AKI was 6.2% (95% CI: 4.1%-9.2%) and 63.1% (95% CI: 52.5%-75.6%), respectively (P < .001).

Conclusions: AKI adversely affects renal function in the long-term after partial nephrectomy and stage 2-3 significantly increases the risk of CKD in the long term.
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http://dx.doi.org/10.1111/ijcp.14751DOI Listing
November 2021

External validation of a prostate cancer nomogram on magnetic resonance/transrectal ultrasound fusion biopsy in men with prior negative systematic biopsy.

Int J Clin Pract 2021 Oct 9;75(10):e14654. Epub 2021 Aug 9.

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

Objective: To observe how the nomogram, which was created by Truong et al, works in an independent patient group by performing external validation.

Patients And Methods: One hundred and eighty-one patients who had at least one prior negative 12-core standard systematic biopsy and lesions with PI-RADS scores of 3 or higher that were detected as a result of mpMRI were included in the study. Targeted biopsy with 12-core standard systematic biopsy was performed on all patients. Clinical and pathological features of the patients were recorded. The discrimination, calibration and decision curve analysis were performed to externally validate the nomogram.

Results: A total of 181 patients with previous negative 12-core systematic biopsies were analysed. One hundred and thirty-four patients (74%) had benign pathology. Radiological volume and PI-RADS scores of 4 and 5 were found as independent predictors of benign pathology. The area under the curve (CI 95%) was found to be 0.80 (0.73-0.87), indicating good discrimination. The median residual was calculated as -0.0873, the intercept as -0.0690, the slope as 0.8927 and r as 0.2586, indicating good calibration. The standardised net benefit of follow-up decisions was found to be 0.54 and 0.36 at the probability threshold of 0.7 and 0.8, respectively.

Conclusion: The original model showed good discrimination and calibration with our data. Defining a high probability threshold for clinical use would be appropriate for centres with high benign biopsy rates similar to our centre.
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http://dx.doi.org/10.1111/ijcp.14654DOI Listing
October 2021

How accurate is radiological imaging for perirenal fat and renal vein invasion in renal cell carcinoma?

Int J Clin Pract 2021 Sep 24;75(9):e14359. Epub 2021 May 24.

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

Objective: To evaluate the accuracy of radiological staging, especially renal venous and perirenal fat invasion, in renal cell carcinoma (RCC).

Material And Methods: Data of 4823 renal tumour patients from Renal Tumor Database of Association of Uro-oncology in Turkey were evaluated. Of 4823 patients, 3309 RCC patients had complete radiological, and histopathological data were included to this study. The Pearson chi-squared test (χ ) was used to compare radiological and histopathological stages.

Results: The mean (SD) age of 3309 patients was 58 (12.3). Preoperative radiological imaging was performed using computed tomography (CT) (n = 2510, 75.8%) or magnetic resonance imaging (MRI) (n = 799, 24.2%). There was a substantial concordance between radiological and pathological staging (к = 0.52, P < .001). Sensitivities of radiological staging in stages I, II, III and IV were 90.7%, 67.3%, 27.7% and 64.2%, respectively. The sensitivity in stage III was lower than the other stages. Subanalysis of stage IIIa cases revealed that, for perirenal fat invasion and renal vein invasion, sensitivity values were 15.4% and 11.3%, respectively.

Conclusions: There was a substantial concordance between radiological (CT and/or MRI) and pathological T staging in RCC. However, this is not true for T3 cases. Sensitivity of preoperative radiological imaging in patients with pT3a tumours is insufficient and lower than the other stages. Consequently, preoperative imaging in patients with T3 RCC has to be improved, in order to better inform the patients regarding prognosis of their disease.
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http://dx.doi.org/10.1111/ijcp.14359DOI Listing
September 2021

The effect of COVID-19 epidemic on the sexual function of healthcare professionals.

Andrologia 2021 Apr 13;53(3):e13971. Epub 2021 Jan 13.

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

Studies have shown that healthcare professionals struggling with epidemics develop symptoms of post-traumatic stress disorder. The aim of this study is to show how often and severely erectile dysfunction, one of the components of post-traumatic stress disorder, is seen among healthcare professionals during COVID-19 outbreak. The Impact of Event Scale-Revised (IES-R) and the Index of Erectile Function-5 (IIEF-5) were applied to 159 male healthcare professionals working in COVID-19 units and a control group of 200 people. Healthcare professional group was divided into subgroups according to occupation (physician, nurse), age-group (18-25, 26-30, >30), marital status and unit of work (Suspected Patient Area, Diagnosed Patient Area). Both stress disorder and erectile dysfunction were seen at higher rates in healthcare professionals group (p < .001). The median IIEF-5 scores of nurses, married subjects and those working in the Diagnosed Patient Area, were found to be higher (p < .001, p = .014, p = .011 respectively). During the COVID-19 outbreak, healthcare professionals are exposed to psychological trauma and their sexual function may be negatively affected. The measures to be taken are important to estimate which groups are more affected.
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http://dx.doi.org/10.1111/and.13971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995045PMC
April 2021

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

Factors affecting long-term renal functions after partial vs radical nephrectomy for clinical T1 renal masses: A Multicentre Study of the Urooncology Association, Turkey.

Int J Clin Pract 2021 May 22;75(5):e13960. Epub 2021 Jan 22.

Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey.

Purpose: To compare the functional outcomes of patients who underwent partial (PN) or radical nephrectomy (RN) for clinical T1 (cT1) renal tumours using the Kidney Cancer Database of the Urooncology Association, Turkey.

Methods: We retrospectively reviewed 1004 patients who underwent PN and RN for cT1 renal tumours at multiple academic tertiary centres between 2000 and 2018. Patients with preoperative end-stage chronic kidney disease and/or metastatic disease were excluded.

Results: There were 452 patients in the PN group and 552 patients in the RN group. The median follow-ups were 74.9 and 83.7 months in RN and PN cohort. The eGFR was significantly reduced in both groups on postoperative day 1 (PN = 13.7 vs RN = 19.1 mL/min/1.73 m : P < .001). In the PN group, eGFR showed a tendency to recover according to a quadratic pattern and reached preoperative levels in the first and third years (95.6 ± 28.8 mL/min/1.73 m and 96.9 ± 28.9 mL/min/1.73 m , respectively), with no significant difference between the eGFRs in the 1st and 3rd years (P = .710). To define groups at risk, different cut-off values for the GFR were considered. Among patients with a baseline GFR < 90, the RN cohort had significantly lower eGFRs in the first and third years than the PN cohort (P = .02). Logistic regression showed that comorbidities, coronary artery disease, diabetes and hypertension had no adverse impacts on the changes in the eGFR (P = .60, P = .13, and P = .13, respectively).

Conclusion: For the treatment of stage T1 kidney tumours, open or laparoscopic partial nephrectomy has the benefit to preserve renal function.
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http://dx.doi.org/10.1111/ijcp.13960DOI Listing
May 2021

Efficiency of radiation-free retrograde intrarenal surgery (RIRS) in children and evaluation of factors affecting surgical success.

Arch Esp Urol 2020 Nov;73(9):843-851

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

Objective: To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and under went one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed.

Results: Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by stone size (p<0.01). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p<0.05).

Conclusion: RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy.
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November 2020

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma.

Int Braz J Urol 2018 Sep-Oct;44(5):933-946

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

Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients.

Patients And Methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS.

Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively).

Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2018.0012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237545PMC
December 2018
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