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    Açık ve robot yardımlı laparoskopik radikal prostatektominin erken dönem onkolojik ve fonksiyonel sonuçları açısından karşılaştırılması
    (2022) Kalemci, Serdar; Ergün, Kasım Emre; Bahçeci, Tuncer; Kızılay, Fuat; Turna, Burak
    Amaç: Radikal prostatektomi (RP), son yirmi yılda açık cerrahiden minimal invaziv cerrahiye kayda değer bir dönüşüm geçirdi. Çalışmamızda lokalize prostat kanseri nedeniyle açık ve robot yardımlı RP yapılan hastaları erken dönem onkolojik ve fonksiyonel sonuçları açısından karşılaştırılmayı amaçladık. Gereç ve Yöntem: Çalışmamıza Ocak 2009 ile Ocak 2014 tarihleri arasında prostat kanseri tanısı alıp RP yapılan 537 hasta dâhil edildi. (Açık retropubik radikal prostatektomi (ARRP)=387, robot yardımlı laparoskopik radikal prostatektomi (RYRP)=150). Hastaların demografik verileri, perioperatif ve postoperatif sonuçları iki grup arasında karşılaştırıldı. Bulgular: Hastaların ortalama yaşı ARRP grubunda 62,9 (46-76), RYRP grubunda ise 61,1 (42-76) yıl idi. Ortalama hastanede kalış süresi, üretral kateterizasyon süresi ve kan transfüzyonu ihtiyacının RYRP grubunda anlamlı olarak daha kısa olduğu görüldü. Cerrahi sınır pozitifliği oranlarının pT2 evreye sahip olanlarda ARRP ve RYRP grubu için sırasıyla %16,3 ve %20 (p=0,412), pT3 evreye sahip olanlarda ise ARRP ve RYRP grubunda sırasıyla %40,9 ve %68,8 (p=0,05) olduğu görüldü. Ortalama takip süresi, ARRP grubunda 30,6 (3-64) ay, RYRP grubunda ise 11,3 (1-24) ay olarak hesaplandı. Takipte RYRP grubunda anastomoz darlığı ve biyokimyasal rekürrens gelişiminin daha az olduğu görüldü (%3,9 vs %29,9 p<0,05, %6,3 vs %20,1 p=0,01). RP sonrası bir yıllık süre içerisinde takipte kontinans oranları açısından her iki grup arasında anlamlı fark saptanmazken (p=0,184), takip süresi 12 ay ve üzerinde olan hastalarda; RYRP grubunda kontinan hasta oranın daha fazla olduğu görüldü (p<0.05). Sonuç: Her iki yaklaşım benzer onkolojik sonuçlar göstermekle birlikte daha iyi fonksiyonel sonuçları ile RYRP lokalize prostat kanseri cerrahisi için standart tedavi olma yolunda hızla ilerlemektedir.
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    Analysis of factors affecting repeat microdissection testicular sperm extraction outcomes in infertile men
    (Aves, 2019) Kizilay, Fuat; Semerci, Bulent; Simsir, Adnan; Kalemci, Serdar; Altay, Baris
    Objective: There is no clear consensus on which patients and how many of microscopic testicular sperm extraction (mTESE) procedures will be successful. in this study, we aimed to evaluate the sperm retrieval rates and factors affecting these rates in men who underwent repeat mTESEs. Material and methods: A total of 346 patients who underwent mTESE for sperm retrieval were included in the study. Patients were divided into groups according to the number of mTESE operations. Patients' karyotype, follicle-stimulating hormone (FSH) and testosterone levels, varicocele presence, and testis volumes were recorded from patient files. the sperm retrieval rates were compared between groups, and predicting factors for successful sperm retrieval were evaluated. Results: Microscopic TESE was applied for the first time in 244 patients, 1-2 times in 73 patients, and 3-4 times in 29 patients. There was a significant difference between groups in preoperative FSH values and postoperative testicular histopathology (p=0.004 and p<0.001). the sperm retrieval rate in the group of patients who had not undergone previous TESE was higher than the group of patients that had undergone TESE for 1-2 times and 3-4 times (p=0.028). in addition, testicular volume, histology, karyotype, and Y-chromosome microdeletion were predicting factors for successful sperm retrieval (p=0.011, p=0.039, p=0.002, and p<0.001, respectively). Conclusion: Our results confirm the necessity for repeat mTESE operations to be performed by experienced surgeons in reference centers to optimize the chance of reduced sperm retrieval rates with recurrent biopsies.
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    Analysis of Prognostic Factors Affecting Cancer-specific Survival in Renal Tumors Larger than Ten Centimeters
    (2019) Kızılay, Fuat; Şimşir, Adnan; Akıncıoğlu, Emir; Kalemci, Serdar; Çal, Çağla; Cüreklibatır, İbrahim; Kumbaracı, Banu Sarsık
    Objective: the aim of this study was to evaluate the relationship between prognostic factors and cancer-specific survival (CSS) in renal tumors larger than ten centimeters. Materials and Methods: We evaluated the data of 126 patients who underwent open radical nephrectomy due to a renal mass larger than 10 cm between January 2010 and June 2016. Kaplan-Meier analysis or Cox regression was used to analyze the relationship between CSS and variables. Pairwise group comparisons were also evaluated with the Log-Rank test. A p-value <0.05 was considered statistically significant. Results: Mean follow-up was 68.5 months and mean survival was 39.2 months. the relationships between tumor histopathology, stage and CSS were significant. Tumor size negatively affected CSS, but the relationship was not significant. Tumor stage (T2b, T3b), tumor thrombus, lymph node metastasis and adjuvant therapy were the most effective independent factors affecting CSS according to Cox regression analysis results. Conclusion: Although tumor size is an important prognostic factor for T2b and lower stage kidney tumors, this effect is less in larger tumors and other clinicopathological features should be considered further to predict prognosis.
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    Analysis of Prognostic Factors Affecting Cancer-specific Survival in Renal Tumors Larger than Ten Centimeters
    (2019) Kızılay, Fuat; Şimşir, Adnan; Akıncıoğlu, Emir; Kalemci, Serdar; Çal, Çağla; Cüreklibatır, İbrahim; Kumbaracı, Banu Sarsık
    Objective: The aim of this study was to evaluate the relationship between prognostic factors and cancer-specific survival (CSS) in renal tumors larger than ten centimeters. Materials and Methods: We evaluated the data of 126 patients who underwent open radical nephrectomy due to a renal mass larger than 10 cm between January 2010 and June 2016. Kaplan-Meier analysis or Cox regression was used to analyze the relationship between CSS and variables. Pairwise group comparisons were also evaluated with the Log-Rank test. A p-value <0.05 was considered statistically significant. Results: Mean follow-up was 68.5 months and mean survival was 39.2 months. The relationships between tumor histopathology, stage and CSS were significant. Tumor size negatively affected CSS, but the relationship was not significant. Tumor stage (T2b, T3b), tumor thrombus, lymph node metastasis and adjuvant therapy were the most effective independent factors affecting CSS according to Cox regression analysis results. Conclusion: Although tumor size is an important prognostic factor for T2b and lower stage kidney tumors, this effect is less in larger tumors and other clinicopathological features should be considered further to predict prognosis.
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    Analysis of Prognostic Factors Affecting Cancer-specific Survival in Renal Tumors Larger than Ten Centimeters
    (Galenos Yayincilik, 2019) Kizilay, Fuat; Simsir, Adnan; Akincioglu, Emir; Kalemci, Serdar; Sen, Sait; Sarsik, Banu; Cal, Cag; Cureklibatir, Ibrahim
    Objective: The aim of this study was to evaluate the relationship between prognostic factors and cancer-specific survival (CSS) in renal tumors larger than ten centimeters. Materials and Methods: We evaluated the data of 126 patients who underwent open radical nephrectomy due to a renal mass larger than 10 cm between January 2010 and June 2016. Kaplan-Meier analysis or Cox regression was used to analyze the relationship between CSS and variables. Pairwise group comparisons were also evaluated with the Log-Rank test. A p-value <0.05 was considered statistically significant. Results: Mean follow-up was 68.5 months and mean survival was 39.2 months. The relationships between tumor histopathology, stage and CSS were significant. Tumor size negatively affected CSS, but the relationship was not significant. Tumor stage (T2b, T3b), tumor thrombus, lymph node metastasis and adjuvant therapy were the most effective independent factors affecting CSS according to Cox regression analysis results. Conclusion: Although tumor size is an important prognostic factor for T2b and lower stage kidney tumors, this effect is less in larger tumors and other clinicopathological features should be considered further to predict prognosis.
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    Analysis of risk factors of abdominal wound dehiscence after radical cystectomy
    (Assoc Medica Brasileira, 2022) Kalemci, Serdar; Ergun, Kasim Emre; Kizilay, Fuat; Yildiz, Bugra; Simsir, Adnan
    OBJECTIVE: Wound dehiscence is associated with high morbidity and mortality. This study aimed to analyze the risk factors and comorbidities in the patients undergoing radical cystectomy with early postoperative wound dehiscence.METHODS: In all, 539 patients with bladder cancer who underwent radical cystectomy and urinary diversion at a single center between January 2008 and January 2022 were included in the study. The data related to the demographics, medical history, and perioperative clinical features were reviewed. Univariate and multivariate regression analysis was performed to identify risk factors for wound dehiscence.RESULTS: The mean age of the patients was 64.2 years (22-91). The mean body mass index was 26.4 kg/m2 (18.7-35.4). Wound dehiscence was observed in 43 (7.9%) of 539 patients. The patients with wound dehiscence had significantly higher mean BMI (27.8 vs. 26.3, p=0.006), ASA scores (p=0.002), history of chronic obstructive pulmonary disease (30.2 vs. 14.3%, p=0.006), diabetes mellitus (44.2 vs. 17.9%, p=0.003), previous abdominal surgery (18.6 vs. 7.7%, p=0.014), and postoperative ileus (58.1 vs. 16.9%, p=0.006). In the multivariable regression model, diabetes mellitus (odds ratio [OR] 4.9, 95%CI 2.3-10.1; p<0.001), postoperative ileus (OR 8.1, 95%CI 4.1-16.5; p<0.001), and chronic obstructive pulmonary disease (OR 2.6, 95%CI 1.2-5.7; p=0.013) were independent predictors of abdominal wound dehiscence following radical cystectomy. CONCLUSION: Diabetes mellitus, chronic obstructive pulmonary disease, and postoperative ileus were strongly associated with abdominal wound dehiscence following radical cystectomy. Both potential preventive and therapeutic interventions may decrease the risk of wound dehiscence.
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    Benign prostat hiperplazisi nedeniyle transüretral prostat rezeksiyonu uygulanan hastalarda tedavi etkinliği ile ilişkili parametrelerin araştırılması
    (2022) Ergün, Kasım Emre; Kalemci, Serdar; Bahçeci, Tuncer; Kızılay, Fuat; Özyurt, Ceyhun
    Amaç: Benign prostat büyümesi nedeniyle transüretral prostat rezeksiyonu yapılan hastalarda postoperatif yarar oranlarını ve postoperatif yararla ilişkili olabilecek çeşitli parametreleri değerlendirerek, transüretral prostat rezeksiyonunun tedavi etkinliğini değerlendirmeyi ve bunu öngörebilecek parametrelere ulaşılıp ulaşılamayacağını araştırmayı amaçladık. Gereç ve Yöntem: 2015-2016 Temmuz tarihleri arasında kliniğimizde transüretral prostat rezeksiyonu yapılan 100 hasta retrospektif olarak değerlendirildi. Preoperatif tahmini prostat ağırlığı (TPA), uluslararası prostat semptom skoru (IPSS), maksimum akım hızı (Qmax) ve işeme sonrası rezidü idrar hacmi (PVR) değerleri ve rezeke edilen prostat dokusu ağırlıkları (RDA) kaydedildi. Postoperatif altı hafta ile altı ay arası dönemde hastaların verileri tekrar kaydedilip istatistiksel analizler yapıldı. Bulgular: Uluslararası prostat semptom skorundaki azalmanın 11,40 (%53,4), Qmax’taki artışın 11,10 ml/sn (%110) ve PVR’deki azalmanın 59,60 ml (%59) olduğu tespit edildi. IPSS’deki düşüş, preoperatif IPSS ? 20 olanlarda, preoperatif Qmax ? 10 ml/sn olanlarda ve PVR >100 ml olanlarda istatistiksel anlamlı olarak daha fazla saptandı (sırasıyla p<0,001, p=0,038, p=0,012). Preoperatif PVR > 100 ml olan hastalarda Qmax’daki artış ve PVR’deki azalma istatistiksel anlamlı olarak daha fazla bulundu (sırasıyla p=0,012, p<0,001). TPA > 50 gr olan hastalarda ve RDA / TPA ? 0,3 olan hastalarda PVR azalması istatistiksel anlamlı olarak daha fazla bulundu (sırasıyla p=0,027 ve p=0,008) Sonuç: Transüretral prostat rezeksiyonu tedavi etkinliği ile ilişkili olabilecek daha net verilere ulaşılmasının hasta takibi ve tedavi seçimi konusunda klinisyenleri yönlendirebileceğini ve bu konuda daha fazla çalışma yapılması gerektiğini düşünmekteyiz.
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    Bir Üroloji Kliniğindeki Adli Vakaların epidemiyolojisi
    (2011) Şimşir, Adnan; Şenol, Ender; Kalemci, Serdar; Turna, Burak; Çıkılı, Necmettin
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    Carbapenem-resistant Klebsiella pneumonia infection outbreak in a tertiary urology clinic: analysis of influencing factors with a controlled trial
    (2020) Kızılay, Fuat; Aliyev, Bayram; Şimşir, Adnan; Kalemci, Serdar; Köse, Timur; Taşbakan, Meltem; Pullukçu, Hüsnü
    Background/aim: Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections encountered in urology patients differentiate from infections caused by other factors, both in respect to prophylaxis and treatment stage, and require a special approach. We aimed to analyse the predisposing factors and the antibiotherapies for CR-KP infection outbreak in a tertiary urology clinic. Materials and methods: There were 75 patients in the CR-KP positive group (Group I) and 146 patients in the CR-KP negative group (Group II). Analysis of the predisposing factors for CR-KP infection and comparison of the reinfection rate and the antibiotherapies in the 2 groups were the endpoints. Results: in the first group, age, comorbidity, previous antibiotic use, and nephrostomy tube rates were higher (P = 0.015, P = 0.001, P = 0.004, and P < 0.001, respectively). in the second group, open urological surgery rate, and the proportion of patients presenting with flank pain, lower urinary tract symptoms, and haematuria were higher (P = 0.029, P < 0.001, P < 0.001, and P = 0.007). in the first group, the proportion of patients treated with transurethral bladder tumour resection was higher, whereas, percutaneous nephrolithotomy was higher in the second group (P = 0.045 for both). While hospitalization and Foley catheterization duration were longer in the first group (P < 0.001 for both), double J stent and nephrostomy duration were longer in the second group (P < 0.001 and P = 0.005). Mean leukocyte count at admission was higher in the first group (P < 0.001). Conclusion: Advanced age, comorbidities, previous antibiotic use, and prolonged Foley catheterization duration are predisposing factors for this infection in the urology department. Two-week administration of combination antibiotic regimens containing carbapenem were effective for the treatment of this infection.
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    Carbapenem-resistant Klebsiella pneumonia infection outbreak in a tertiary urology clinic: analysis of influencing factors with a controlled trial
    (2020) Kalemci, Serdar; Köse, Timur; Taşbakan, Meltem; Pullukçu, Hüsnü; Aliyev, Bayram; Kızılay, Fuat; Şimşir, Adnan
    Background/aim: Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections encountered in urology patients differentiate frominfections caused by other factors, both in respect to prophylaxis and treatment stage, and require a special approach. We aimed toanalyse the predisposing factors and the antibiotherapies for CR-KP infection outbreak in a tertiary urology clinic.Materials and methods: There were 75 patients in the CR-KP positive group (Group I) and 146 patients in the CR-KP negative group(Group II). Analysis of the predisposing factors for CR-KP infection and comparison of the reinfection rate and the antibiotherapies inthe 2 groups were the endpoints.Results: In the first group, age, comorbidity, previous antibiotic use, and nephrostomy tube rates were higher (P = 0.015, P = 0.001, P= 0.004, and P < 0.001, respectively). In the second group, open urological surgery rate, and the proportion of patients presenting withflank pain, lower urinary tract symptoms, and haematuria were higher (P = 0.029, P < 0.001, P < 0.001, and P = 0.007). In the first group,the proportion of patients treated with transurethral bladder tumour resection was higher, whereas, percutaneous nephrolithotomywas higher in the second group (P = 0.045 for both). While hospitalization and Foley catheterization duration were longer in the firstgroup (P < 0.001 for both), double J stent and nephrostomy duration were longer in the second group (P < 0.001 and P = 0.005). Meanleukocyte count at admission was higher in the first group (P < 0.001).Conclusion: Advanced age, comorbidities, previous antibiotic use, and prolonged Foley catheterization duration are predisposing factorsfor this infection in the urology department. Two-week administration of combination antibiotic regimens containing carbapenem wereeffective for the treatment of this infection.
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    Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon
    (Professional Medical Publications, 2021) Simsir, Adnan; Kizilay, Fuat; Aliyev, Bayram; Kalemci, Serdar
    Objective: in this study, we aimed to make a comprehensive comparison of the first hundred robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) cases of a single surgeon in a high-volume center. Methods: Preoperative, perioperative and postoperative data were collected retrospectively. Perioperative, oncological data and functional results in the first year were compared between the two groups. There were 204 RARPs between January 1, 2014 and December 31, 2019, and 755 RRPs between April 1, 2007 and December 31, 2019. Results: While the operation time was in favor of the open group (117 vs 188 min, p<0.001), the estimated blood loss (328 vs 150 ml, p<0.001), blood transfusion rate (12 vs 2, p=0.021), and re-operation rate (6 vs 0, p=0.001) were in favor of the robotic group. Mean length of hospital stay (5.4 vs 3.1, p<0.001), urine leak rate (11 vs 2, p=0.033), complication rate (37 vs 16, p=0.018), and the 12th month continence rate (67 vs 85, p=0.002) were better in the robotic group. Conclusions: RARP may provide better perioperative outcomes and lower complication rates after the surgeon factor is eliminated in the early period. Since our case group includes the initial 100 patients, studies with larger patient groups with longer follow-up are needed to adapt these early results to general outcomes.
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    Comparison of the Abdominal and Transvaginal Techniques in the Surgical Treatment of Vesicovaginal Fistula and Analyzing the Factors Affecting Its Recurrence
    (2020) Kızılay, Fuat; Özdemir, Turan Senem; Aliyev, Bayram; Şimşir, Adnan; Kalemci, Serdar; Özyurt, Ceyhun
    Objective: To compare the abdominal and transvaginal techniques in the surgical treatment of vesicovaginal fistula (VVF) and analyze the factors affecting its recurrence rate. Materials and Methods: Patients were divided into two groups according to the operation technique used (abdominal-transvaginal) and the recurrence status (recurrent and non-recurrent). The primary endpoint of the study was the comparison of the factors related to fistula and surgical techniques. Results: The number of cases with radiotherapy history was found to be higher in the recurrent group (68.2% vs 11.5%, p<0.001). Although fistulas were more subtrigonally located in the transvaginal repair group, the supratrigonal localization was more frequent in those operated with abdominal technique (p=0.019). While the rates of first and second recurrences were more in the cases managed by the transvaginal technique (p=0.041), the length of hospitalization and the mean operation time were longer in women managed by abdominal technique (p=0.025 and p=0.019, respectively). Conclusion: The abdominal technique provides more favorable outcomes by allowing extensive tissue exposure and omental tissue flep in the surgical treatment of VVF. Patients with a history of radiotherapy are more likely to have a recurrence after the surgery and repetitive treatment may be needed.
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    Comparison of the Abdominal and Transvaginal Techniques in the Surgical Treatment of Vesicovaginal Fistula and Analyzing the Factors Affecting Its Recurrence
    (Galenos Yayincilik, 2020) Kizilay, Fuat; Ozdemir, Turan; Aliyev, Bayram; Simsir, Adnan; Kalemci, Serdar; Ozyurt, Ceyhun
    Objective: To compare the abdominal and transvaginal techniques in the surgical treatment of vesicovaginal fistula (VVF) and analyze the factors affecting its recurrence rate. Materials and Methods: Patients were divided into two groups according to the operation technique used (abdominal-transvaginal) and the recurrence status (recurrent and non-recurrent). the primary endpoint of the study was the comparison of the factors related to fistula and surgical techniques. Results: the number of cases with radiotherapy history was found to be higher in the recurrent group (68.2% vs 11.5%, p<0.001). Although fistulas were more subtrigonally located in the transvaginal repair group, the supratrigonal localization was more frequent in those operated with abdominal technique (p=0.019). While the rates of first and second recurrences were more in the cases managed by the transvaginal technique (p=0.041), the length of hospitalization and the mean operation time were longer in women managed by abdominal technique (p=0.025 and p=0.019, respectively). Conclusion: the abdominal technique provides more favorable outcomes by allowing extensive tissue exposure and omental tissue flep in the surgical treatment of WF. Patients with a history of radiotherapy are more likely to have a recurrence after the surgery and repetitive treatment may be needed.
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    Could spot urine analysis of calcium and uric acid help predict density of urinary stone in computerized tomography? A preliminary study
    (Edizioni Minerva Medica, 2016) Demiray, Ozay; Cuce, Ferhat; Cevik, Erdem; Cataloglu, Berkay; Kalemci, Serdar
    BACKGROUD: This research studies if Hounsfield density of urinary stone can be predicted without computerized tomography (CT) caused by because increased radiation exposure in follow-up of patients. METHODS: The records of patients with renal or ureteral stone were analyzed retrospectively for the time period between November 2013 and April 2014. The inclusion criteria defined were: no multiple stones; stone size >= 3 mm; presence of renal and ureteral stones; absence of staghom stone. All CT images were assessed in abdominal windows by a single radiologist. Hounsfield Unit (HU) value of CT was used to interpret the density of the stone. The density of the stone was measured in the longest axis of the stone center (core) and the edges (periphery) of each stone. Biochemical analysis of spot urine calcium (Ca) and uric acid (UA) was done at the time of diagnosis. Correlation and linear regression analysis was performed. RESULTS: Forty patients were included the study and median age of patients is 22 (IQR 21-28). Since the unit was a military hospital, most patients admitted to hospital were young male conscripts with low median age. It has been found that spot urine uric acid and uric acid/Ca ratio is associated with stone density as HU (P=0.004, P<0.001). Although predictive value appeared low, linear regression model statistically predicted stone density as HU (P<0.001 R-2=0.32). Stone size has proved to be positively correlated with stone density (P<0.001). CONCLUSIONS: Despite the predictive value of urine analysis model is low, it may be considered to predict HU attenuation of stone. Spot urine analysis of calcium and uric acid may be helpful for both diagnosis and follow-up. We believe that controlled studies with larger patient populations will provide further insights into this issue.
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    Do bony pelvis parameters affect perioperative outcomes in open radical prostatectomy?
    (Elsevier Inc, 2022) Kalemci, Serdar; Ergun, Kasim E.; Kizilay, Fuat; Akyol, Alp; Simsir, Adnan
    Objective: The present study aimed to evaluate the predictive value of bony pelvic parameters measured by computerized tomography (CT) for use in the estimation of the likely technical difficulties that may be encountered when performing open radical prostatectomy (RP) for localized prostate cancer. Material and methods: One hundred patients, undergoing open RP for localized prostate cancer, were evaluated between October 2016 to November 2018. All operations were performed by the same experienced surgeon. Pelvic parameters were measured using spiral CT images. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. Positive surgical margin (PSM), presence of vesicourethral anastomosis stricture (VUAS) and urine leakage, operative time, urethral catheterization time, and estimated blood loss were used as indicators of operative difficulty. Univariate and multivariate analyses were performed to determine the significance of these variables. Results: There was no significant correlation between the pelvic parameters of the patients and the presence of PSM, VUAS, and urine leakage. Only PSA levels and pathological tumor stage were higher in patients with PSM (p = 0.002 and p = 0.001). On univariate and multivariate analyses, none of the individual pelvic parameters assessed showed a significant relationship with the operation time, estimated blood loss, and urethral catheterization time. In univariate analysis, there was a significant relationship between PSA levels and pathological tumor stage and operation time (p = 0.048 and p = 0.001, respectively). Conclusion: Bony pelvic parameters may not be a significant factor in influencing the perioperative outcomes of open RP. Higher PSA levels and pathological tumor stage may lead to surgical margin positivity and longer operative time. (C) 2022 Asian Pacific Prostate Society. Published by Elsevier B.V.
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    Do tumor size and location affect survival in upper urinary tract urothelial carcinoma?
    (2023) Kalemci, Serdar; Ergün, Kasım Emre; Kızılay, Fuat; Şimşir, Adnan; Köse, Timur
    Aim: This study aimed to evaluate the effect of tumor location based on clinicopathologic features on cancer-specific survival (CSS) of patients who were treated surgically for locally/locally advanced upper tract urothelial carcinoma (UTUC). Materials and Methods: A single-center series of 145 patients with UTUC who underwent radical nephroureterectomy between May 2010 and August 2019 were included in the study. Patients were stratified based on the location of the tumor as renal pelvis and ureter located tumor. Clinicopathologic characteristics and oncological outcomes were compared according to tumor location and CSS rates after surgery were graphically explored using Kaplan–Meier curves. Results: At a mean follow-up time of 41.8 (4-124) months after surgery, 65 patients (44.8%) died from UTUC. Kaplan-Meier curves showed that tumor location was not associated with CSS in the analysis performed according to tumor stage, grade, and size. In the analysis that was conducted without regard to tumor location, worse CSS was found for patients with pT3 disease versus those with ?pT2 and with high-grade tumors versus those with low-grade (p=0.025 and p=0.011, respectively). Conclusion: Tumor location was not associated with CSS in any of the analyses. Regardless of tumor location, patients with pT3 disease and high-grade tumors, have a worse prognosis. Further studies on prognostic factors are needed to evaluate the advantages of these factors in the management of patients with UTUC.
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    Effect of vesicourethral anastomosis technique on functional results in retropubic radical prostatectomy
    (Wiley-Hindawi, 2021) Kizilay, Fuat; Kalemci, Serdar; Simsir, Adnan
    Aim We aimed to compare the functional results of two different vesicourethral anastomosis (VUA) techniques used in open retropubic radical prostatectomy. Methods A total of 476 patients including the first group with four-focus VUA at 12-, 3-, 6-, and 9-o'clock positions (n = 288) and the second group with six-focus VUA at 12-, 2-, 4-, 6-, 8-, and 10-o'clock (n = 188) were included in the study. Perioperative data, erectile function, and continence status over a 12-month period were compared. Results Demographic and perioperative data were similar between two groups. The number of patients with VUA stricture in the first group was significantly higher those in the second group (5.1% vs 3.2%, P = .017). The mean time to stricture development was also shorter in the first group (48.9 vs 74.3 days, P = .002). The number of continent patients at the 6th and 12th months were higher in the second group (79.3% vs 62.8%, P < .001; 92.4% vs 81.3%, P = .032, respectively). There was no significant difference between two groups in terms of the number of potent patients (P = .194 for 6 months and P = .351 for 12 months). Conclusions Better continence results can be provided with the six-focus VUA technique compared with the four-focus technique. The number of anastomotic sutures in VUA may affect functional results and can be a determinative factor for surgeons who focus on functional results as well as oncological results.
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    Ege Üniversitesi hastanesinde prostat kanserlerinin epidemiyolojisi ve genel sağkalım özellikleri
    (2020) Haydaroğlu, Ayfer; Kumbaracı, Banu Sarsık; Yalman, Deniz; Özkök, Serdar; Cüreklibatır, İbrahim; Nazlı, Okay; Kalemci, Serdar
    Amaç: Ege Üniversitesi (EÜ) Hastanesinde 1992-2017 arası kanser tanı ve tedavisi yapılan prostat kanseri (PK) tanılı 4792 hastanın epidemiyolojik özellikleri, tedavi modaliteleri ve sağkalım özelliklerinin tanımlanması amaçlanmıştır. Gereç ve Yöntem: EÜ Kanserle Savaş Araştırma ve Uygulama Merkezi tarafından toplanan PK verileri CANREG özel bilgisayar programına kaydedilmiş, DSÖ (Dünya Sağlık Örgütü) ve SEER (Surveillance, Epidemiolgy, and End Results) sistemleri temelinde gruplanarak analizler yapılmıştır. İstatistiksel analizlerde Kikare, General Linear Model, Kaplan Meier sağkalım analizleri uygulanmıştır. Kaplan-Meier Sağkalım analizinde Log Rank(Mantel-Cox), Breslow(Generalized Wilcoxon) ve TaroneWare istatistikleri kullanılmıştır. İstatistiksel analizlerde p<0,05 değeri anlamlı kabul edilmiştir. Bulgular: PK tanılı 4792 hasta verisi analiz edilmiştir. Olgularımızda PK’ne en çok 60-69 yaş grubunda rastlanmaktadır. Histopatolojik olarak en sık “asiner adenokarsinom” görülmektedir. Evrelendirme çalışması yapılabilen PK’lerinde lokalize dönemin %61,2 oran ile en fazla olduğu saptanmıştır. PK’lerinin görülüşünde yıllara göre doğrusal bir artış dikkat çekmektedir. Mortalitede ise 2008’e kadar doğrusal artış daha sonra azalış vardır. PK olgularımızda ortanca genel sağkalım(GSK) 120 aydır, tüm olgular için 5 ve 10 yıllık GSK’lar %74,2 ve %55,2 bulunmuştur.5 yıllık GSK oranları lokalize, lokal ileri ve metastatik evrelerde sırasıyla %86,3, %78,1 ve %21,7 saptanırken 10 yıllık GSK için sırasıyla %70, %62,7 ve %14’dür. Lokal ve lokal ileri evrelerde tedavi alanlarda sağkalımlarda anlamlı bir fark elde edilirken metastatik evrede anlamlı sonuç kaybolmaktadır. Sonuç: EÜ Hastanesi Kanser veri tabanında bulunan 4792 PK’li bu seri tek merkez olarak Türkiye’deki en geniş PK serisidir. PK olgularımızda 5 ve 10 yıllık GSK oranları sırasıyla %74,2 ve %55,2 bulunmuştur. Evrelere göre tedavilerin GSK’lar üzerine katkıları lokal ve lokal ileri evrede anlamlı bulunurken metastatik evrede bu anlamlılık kalmamaktadır.
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    Endovascular Treatment of a Giant Renal Vein Aneurysm Arising from a High-Flow Arteriovenous Fistula
    (Sage Publications Inc, 2022) Kalemci, Serdar; Kizilay, Fuat; Ergun, Kasim E.; Yurtseven, Emre; Cinar, Celal
    Background: Renal vein aneurysms (RVAs) are considered rare clinical entities. RVAs can be secondary to thrombosis, venous hypertension, or renal arteriovenous fistula (RAVF). RVAs secondary to RAVF are rare. Patients with RVA may present with hypertension, abdominal pain, hematuria, or may even be asymptomatic. However, there may be life-threatening emergencies including aneurysm rupture, thrombosis, and pulmonary embolism. The treatment of RVAs includes reconstruction of the renal vein, nephrectomy, and endovascular treatment. Purpose: In this technical note, we report the endovascular treatment of a giant RVA that developed secondary to an acquired RAVF by the placement of multiple vascular plugs. Conclusion: Endovascular occlusion of the RAVF with vascular plugs is effective to prevent a life-threatening rupture of RVA. Clinical follow-up is crucial to detect leakage or migration of the vascular plugs.
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    Evaluation of lower urinary tract symptoms in children with Down syndrome: A prospective, case-controlled cohort study
    (Wiley, 2020) Kizilay, Fuat; Irer, Bora; Kizilay, Deniz Ozalp; Simsir, Adnan; Kalemci, Serdar; Sen, Volkan; Cogulu, Ozgur
    Aims in children with Down syndrome (DS) which causes cognitive impairment and intellectual disability (ID), dysfunctional voiding is proposed to be more common than in the normal population. in this study, we aimed to compare the voiding symptoms of DS children with a control group by validated questionnaires. Methods Thirty-seven DS children without any previous urological complaints and 59 non-DS healthy children as control group was included in the study. Overactive bladder symptoms and dysfunctional voiding were evaluated with validated Overactive Bladder Questionnaire (OAB-V8) and Dysfunctional Voiding Symptom Score (DVSS) questionnaire, respectively. Data were arranged, descriptive and comparative statistical analysis were performed. Results Demographic data of the two groups were similar except age of completing toilet training being higher in DS group. Total OAB-V8 and DVSS scores were significantly higher in the DS group. the mean scores of questions regarding voiding frequency, urgency and urgency incontinence in OAB-V8 were significantly higher in the DS group. the mean daytime incontinence, urgency, urgency incontinence, and quality of life scores in the DVSS were also significantly higher in the DS group. Conclusions DS children have more frequent dysfunctional voiding than the normal population. ID of these children may prevent the expression of these symptoms. Awareness and early detection of these symptoms are crucial to prevent devastating complications such as renal failure. Therefore, validated questionnaires are simple, useful, and noninvasive methods.