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Analysis of Factors Affecting Functional Outcomes in Robotic-assisted Laparoscopic Radical ProstatectomyAnalysis of Factors Affecting Functional Outcomes in Robotic-assisted Laparoscopic Radical Prostatectomy
(Galenos Yayincilik, 2018) Kizilay, Fuat; Ismaylov, Fuad; Simsir, Adnan; Turna, Burak; Semerci, Bulent; Apaydin, Erdal
Objective: In addition to ensuring cancer control, prevention of incontinence and erectile dysfunction, which significantly impact patients' quality of life, is also an important issue in robot-assisted laparoscopic radical prostatectomy (RALRP) operations. In this study, we aimed to evaluate the factors affecting postoperative urinary continence and erectile function in patients who underwent RALRP due to localized prostate cancer in our clinic. Materials and Methods: Our study included 439 patients who were diagnosed with stage 1 prostate cancer and underwent RALRP. Patients' age, preoperative prostate-specific antigen (PSA) value, prostate volume, radical prostatectomy material Gleason score, operative time, transperitoneal surgical approach (posterior or anterior), and surgical margin and extraprostatic extension statuses were recorded. Postoperative continence and erectile function status of the patients were questioned and recorded via telephone interviews and in outpatient clinic follow-up. Patients were divided into groups according to postoperative incontinence and erectile dysfunction status and the variables were compared between the groups. Results: There was no statistically significant difference between the continent and incontinent groups in terms of age, preoperative PSA, prostate volume, operative time, postoperative Gleason score, surgical margin status, extraprostatic extension status, or anterior or posterior approach (p>0.05). There was no statistically significant difference between the groups with and without erectile dysfunction in terms of prostate volume, operative time, postoperative Gleason score, surgical margin status, or extraprostatic extension status (p>0.05), while there were statistically significant differences between the 2 groups in terms of age (p<0.001), preoperative PSA value (p=0.042), and surgical technique (p<0.001). Conclusion: We concluded that patient-and disease-related factors did not significantly affect postoperative urinary continence in patients undergoing RALRP due to prostate cancer, while patient age, preoperative PSA value, and operative technique had a significant effect on erectile function.
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.
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.
Analysis of recurrent urethral strictures due to iatrogenic urethral trauma
(Tubitak Scientific & Technical Research Council Turkey, 2017) Kizilay, Fuat; Simsir, Adnan; Ozyurt, Ceyhun
Background/aim: We aimed to analyze the effects of stricture location, etiology, age, and catheterization time on recurrence rate and recurrence time in patients who underwent direct vision internal urethrotomy (DVIU) for urethral strictures. Materials and methods: Patients were divided into three groups according to the location of the stricture: penile urethra, membranous urethra, and prostatic urethra strictures. Patients were also divided into three groups according to etiologic factors: strictures secondary to endoscopic procedures, urethral catheterization, and open or radical prostatectomy (anastomotic strictures were included in this group). Patients were also divided into three groups according to catheterization time: < 2, 2-5, and > 5-7 days. Recurrence rate and time data were analyzed according to stricture location, etiology, age, and catheterization time. Results: The recurrence rate was significantly higher in endoscopic procedures. Recurrence rate was significantly lower and recurrence time was significantly earlier in penile urethral strictures. Recurrence rate was significantly lower and recurrence time was significantly longer in short catheterized group than in the other two groups. However, first recurrence time was not different between the groups, while second and multiple recurrence times were significantly earlier in patients < 60 years old. Conclusion: Patients are exposed to multiple operations as a result of frequently recurring urethral strictures. Although DVIU is an important first-line treatment method for strictures, alternative methods should be considered for frequently recurring cases.
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.
Are the Recommended Criteria for Clinically Insignificant Prostate Cancer Applicable to 12-core Prostate Biopsy Scheme? A Multicentre Study of Urooncology Association, Turkey
(Galenos Yayincilik, 2021) Celik, Serdar; Kizilay, Fuat; Yorukoglu, Kutsal; Ozen, Haluk; Akdogan, Bulent; Izol, Volkan; Muezzinoglu, Talha
Objective: The aim of this study is to investigate the relevance of the Epstein criteria for the 12-core transrectal prostate biopsy (TRUS-Bx) scheme with the evaluation of clinicopathologic data recorded in the Urologic Cancer Database - Prostate (UroCaD-P), Urooncology Association, Turkey (UOAT). Materials and Methods: Patients with detailed pathological 12-core TRUS-Bx data for each biopsy core and who underwent RP due to PCa were included in this study. A total of 1167 patients from seven different centres were analysed. TRUS-Bx pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian-lateral) scheme and in all 12-core biopsy areas (12-core biopsy scheme). Overall detection rates of PCa and ratios of clinically significant (sPCa) and insignificant PCa (insPCa) after RP were defined and compared between the biopsy schemes. Biopsy findings, according to the Epstein criteria, were also compared between the two schemes. A model for each biopsy scheme was created, including the Epstein criteria and additional biopsy findings using logistic regression analysis to predict clinically sPCa after RP. Results: There was a high correlation for the prediction of clinically insPCa between the two biopsy schemes in the same population. However, 7.3% of PCa could not be diagnosed in the 6-core TRUS-Bx scheme. Also, 69.4% of these had clinically sPCa according to the Epstein criteria in 12-core TRUS-Bx scheme and 51.8% of these were clinically sPCa after RP. The presence of perineural invasion (PNI) in 12-core biopsy was also significant regarding predicting sPCa (p<0.001). Conclusion: The Epstein criteria in 12-core prostate biopsy provide a better prediction of clinically sPCa than the 6-core biopsy scheme. Biopsy PNI findings appeared to improve the effectiveness of 12-core prostate biopsy, in addition to the Epstein criteria.
Can High Preoperative Neutrophil-lymphocyte Ratio Predict the Recurrence and Progression Risk of Non-muscle-invasive Bladder Tumors?
(Galenos Yayincilik, 2019) Kizilay, Fuat; Simsir, Adnan
Objective: Neutrophil-lymphocyte ratio (NLR) is a well-known, cost-effective biomarker of inflammatory conditions, and its protumor effect has been shown in different types of cancers. In this study, we aimed to evaluate the relationship between blood parameters, especially NLR, with the risk of progression and recurrence in non-muscle-invasive bladder tumors (NMIBT). Materials and Methods: Seventy-six patients were included in the study. Patients were divided into low, moderate and high-risk groups according to the risk of progression and recurrence. The preoperative blood parameters of the patients were recorded from the patient files and the NLR of each patient was calculated. These parameters were compared in terms of progression and recurrence risk groups. P values less than 0.05 were accepted statistically significant. Results: Neutrophil-lymphocyte ratio was significantly higher in the high-risk group in both the progression and recurrence risk groups than in the low and moderate risk groups (p<0.001). In addition, according to the post hoc results, the NLR values in the high-moderate and moderate-low risk groups showed significant differences (high-moderate and moderate-low values in terms of risk of recurrence were 4.66 vs 3.67 and 3.67 vs 2.88, respectively, p<0.001; high-moderate and moderate-low values in terms of risk of progression were 4.72 vs 3.68 and 3.68 vs 2.92, respectively, p<0.001). Conclusion: In our study, we found that groups with high risk of recurrence and progression had higher NLR values in patients with NMIBT. NLR, which is cheap, rapid and routinely applied in preoperative evaluation, is a promising biomarker in the prognostic classification of bladder tumors. Well-designed, large-scale prospective studies with long-term follow-up are needed to determine the role of NLR in this issue.
Comparing the efficacy of extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy in the treatment of proximal ureteral stones in children: A retrospective study
(Wiley, 2023) Bagci, Uygar; Dinckal, Mustafa; Tekin, Ali; Kizilay, Fuat; Nazli, Oktay; Ulman, Ibrahim
Objectives: Ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy methods are commonly used in the treatment of proximal ureteral stones. There are no adequate studies showing which method is more effective in children. In our study, we aimed to evaluate and compare the efficacy of two treatment methods, commonly used for proximal ureteral stones in children.Methods: A total of 78 patients who underwent ureteroscopic lithotripsy (n = 38) and extracorporeal shock wave lithotripsy (n = 40) due to stones located in the proximal ureter between 2010 and 2021 were included in the study. Demographic data, clinical characteristics, and treatment outcomes were retrospectively analyzed. Kolmogorov-Smirnov, Chi-square, and Mann-Whitney U tests were used for statistical analysis.Results: There was no statistical difference between the demographic characteristics of the groups, except for the mean age values (p = 0.008). A statistically significant difference was found in favor of the extracorporeal shock wave lithotripsy group in terms of stone-free rates after the first intervention, complication rates requiring intervention, re-intervention rates, and the average number of anesthesia sessions per patient until stone-free status (p = 0.043, p = 0.009, p = 0.017, and p < 0.001, respectively).Conclusions: The results of this retrospective study suggest that extracorporeal shock wave lithotripsy is the primary treatment option for single, non-complicated proximal ureteral stones.
Comparison of Efficacy and Complications of Holmium Laser and Pneumatic Lithotripters Used in the Ureterorenoscopic Treatment of Proximal Ureter Stones, a Multi-Center Study of Society of Urological Surgery Aegean Study Group
(Galenos Yayincilik, 2018) Irer, Bora; Sen, Volkan; Erbatu, Oguzcan; Yildiz, Alperen; Ongun, Sakir; Cinar, Onder; Cihan, Ahmet; Sahin, Mehmet; Sahin, Mehmet Oguz; Ucer, Oktay; Kizilay, Fuat; Bozkurt, Ozan
Objective:The aim of this study is to compare the efficacy and complications of holmium laser and pneumatic lithotripsy used in the ureterorenoscopic treatment of proximal ureteral stones. Materials and Methods: Data of 638 patients, who underwent ureterorenoscopy (URS) due to proximal ureteral stones in different centers, were obtained from patient files. The patients were divided into two groups according to the type of lithotripter used: group 1; laser lithotripter (n=324; 50.8%) and group 2; pneumatic lithotripter (n=314; 49.2%). URS was considered successful upon determination stone-free status with the imaging methods after treatment. The effectiveness and the complications of holmium:yttrium-aluminum-garnet laser and pneumatic lithotripsy were compared. Results: The total success rate of URS was 82.6% and the complication rate was 8.1%. The mean age of patients was similar between the groups; however, the body mass index values, stone surface area and stone Hounsfield unit were significantly higher in group 1. Although the mean operative time, complication rate and the mean length of hospital stay were similar between the groups; the URS success and postoperative ureteral J stent use rates were significantly higher in group 1 and the push-back rate was significantly higher in group 2. Conclusion: If laser lithotripsy is available in a clinic, we believe that it is better to use it as the first option in the treatment of proximal ureter stones. However, considering that it is not easy to access laser lithotripters due to their high cost in Turkey, pneumatic lithotripters may be an effective and inexpensive alternative that can also be safely used in these cases.
Comparison of long-term outcomes of laparoscopic and robot-assisted laparoscopic partial nephrectomy
(Wiley, 2019) Kizilay, Fuat; Turna, Burak; Apaydin, Erdal; Semerci, Bulent
In this study, we compared the long-term oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) and robot-assisted laparoscopic partial nephrectomy (RAPN) performed in the treatment of renal tumors. The data of 142 patients (RAPN = 71, LPN = 71) were evaluated. Demographic data, perioperative and postoperative outcomes, long-term (5-year) overall survival (OS) and cancer-specific survival (CSS) rates of the patients were compared between the two groups. A P value of less than 0.05 was considered statistically significant The mean follow-up time was 61.38 months. There were more complex tumors in the RAPN group (P = 0.014). The duration of warm ischemia time (WIT) was shorter in the RAPN group (P = 0.019). Perioperative and postoperative outcomes were similar. There were no differences between the groups in terms of 5-year metastasis-free survival, OS, and CSS rates. Hypertension, diabetes, and preoperative estimated glomerular filtration rate (eGFR) were the predictive factors for renal insufficiency; and preoperative eGFR, WIT, and positive surgical margin were the predictive factors for 5-year CSS. We concluded that RAPN is an important minimally invasive treatment method for partial nephrectomy with long-term favorable results, especially in complex tumors. Comparisons of two methods should be made with comparative, prospective, randomized, high case number studies, and the place of RAPN in the treatment of these tumors should be clarified.
Comparison of percutaneous nephrostomy and double J stent in symptomatic pregnancy hydronephrosis treatment
(Tubitak Scientific & Technical Research Council Turkey, 2018) Simsir, Adnan; Kizilay, Fuat; Semerci, Bulent
Background/aim: We aimed to compare the success rate of percutaneous nephrostomy (PCN) and double J stenting (DJS) in the treatment of symptomatic pregnancy hydronephrosis. Materials and methods: Diagnosis and grading of hydronephrosis were performed by urinary ultrasound (USG) and Doppler mode was used for evaluation of renal arterial resistivity index (RI). Patients were divided into two groups according to the method used for the treatment of hydronephrosis: group A (PCN, n = 38) and group B (DJS, n = 46). A P value < 0.05 was considered significant. Results: The number of patients requiring second intervention was higher in group B (P = 0.0018) and time to secondary intervention was significantly earlier in group B also (P = 0.0025). The number of tertiary intervention was again higher in group B (5/16 vs. 1/6) and the need for tertiary intervention was higher in patients who underwent DJS implantation as a secondary intervention than those who underwent PCN (5/11 vs. 1/11, P = 0.0012). The time to tertiary intervention was longer in patients with PCN than in those with DJS (P = 0.0048). Conclusion: PCN may be preferred to DJS in symptomatic pregnancy hydronephrosis because it requires fewer re-interventions after longer times.
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.
Comparison of Shockwave Lithotripsy and Laser Ureterolithotripsy for Ureteral Stones
(Galenos Yayincilik, 2021) Bahceci, Tuncer; Kizilay, Fuat; Cal, Ahmet Cag; Simsir, Adnan
Objective: This study aimed to compare shockwave lithotripsy (SWL) with ureteroscopic lithotripsy (URS) for ureteral stones in terms of stone-free rates, complication rates, and overall treatment costs. Materials and Methods: Data of 886 adult patients who underwent URS or SWL were retrospectively evaluated, of which 184 patients underwent SWL and 702 underwent URS. The groups were compared in terms of patient characteristics, stone-free rates, complications, and costs. Results: No significant differences were found between the groups in terms of age, gender, and relevant sides (p>0.05). A significant difference was observed in favor of SWL for upper ureteral stones <10 mm regarding treatment success (p=0.018), and no significant difference was observed between the two groups in terms of mid- and distal ureteral stones (p=1 and p=0.655, respectively). Complications were classified according to the modified Clavien-Dindo grading system. No major complications were observed in the two groups, except for one patient with Clavien-Dindo grade IVa complication. SWL was significantly more economical than URS (p<0.001). Conclusion: The results of this study suggest that SWL can be recommended as the primary treatment option for upper ureteral stones <10 mm because of its high stone-free rates and low overall costs.
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.
Correlation of Prostate-Imaging Reporting and Data Scoring System scoring on multiparametric prostate magnetic resonance imaging with histopathological factors in radical prostatectomy material in Turkish prostate cancer patients: a multicenter study of the Urooncology Association
(Elsevier Inc, 2020) Kizilay, Fuat; Celik, Serdar; Sozen, Sinan; Ozveren, Bora; Eskicorapci, Saadettin; Ozgen, Mahir; Cal, Cag
Background: Histopathological features after radical prostatectomy (RP) provide important information for the prognosis of prostate cancer (PCa). The possible correlations between Prostate-Imaging Reporting and Data Scoring System (PIRADS) scores in multiparametric magnetic resonance imaging (mpMRI) may also be predictive for prognosis. in this study, we aimed to evaluate the correlation of PIRADS scores with histopathological data. Methods: A total of 177 patients who underwent preoperative mpMRI and RP for PCa from eight institutions were included in the study. Correlation of PIRADS score in preoperative mpMRI with adverse histopathological factors in RP specimen was investigated using univariate and multivariate analyses. Results: The relationship between PIRADS score and postoperative extracapsular extension, lymphovascular invasion, and seminal vesicle involvement was significant (P < 0.001, P = 0.032, and P = 0.007, respectively). Although the PIRADS score was significantly correlated with the number of dissected lymph nodes (p = 0.026), it had no significant correlation with the number of positive nodes (P = 0.611). Total Gleason score, extracapsular extension, seminal vesicle invasion, and number of lymph nodes were found to be independent factors, which correlated with high PIRADS scores in ordinal logistic regression analysis. Conclusion: PIRADS scoring system in mpMRI showed a statistically significant correlation with adverse histopathological factors in RP specimen. A higher PIRADS score may help to predict a higher Gleason score, indicating clinically important PCa as well as poor prognotic factors such as extracapsular extension, lymphovascular invasion, and seminal vesicle invasion that may indicate a higher risk of recurrence and the need for additional treatment. (C) 2020 Asian Pacific Prostate Society. Publishing services by Elsevier B.V.
Current Status of Oligometastatic Prostate Cancer: Risk Factors and Treatment Approaches
(Galenos Yayincilik, 2018) Kizilay, Fuat
Prostate cancer (PCa) is a common disease that causes significant mortality rates. The widespread use of more sophisticated imaging methods has led to the identification of oligometastatic PCa, which has a limited number of metastases. Local therapy (radical prostatectomy and/or radiotherapy) for the primary tumor and metastasis-directed therapies have been proposed. A number of retrospective analyses have been conducted in this patient group to determine the place of systemic treatment, which is still the recommended standard treatment for metastatic disease. These studies were based on the aims of improving survival, protecting the patient from the potential side effects of systemic therapy, and eliminating local prostate-related symptoms. Although the studies were retrospective in nature, a survival advantage has been demonstrated in patients receiving local treatment or metastasis-directed treatments. It has been also shown in these studies that local treatment has no effect, at least no detrimental effect, on non-oncologic outcomes. However, these studies have significant limitations, primarily their retrospective design, differences in definitions and end-points used, and patient selection biases. Nevertheless, these results are clinically valuable and can be utilized in practice in some special cases. This patient group needs comprehensive standardization and risk stratification. Determining the definition, staging, treatment, and which patients will benefit from local treatment is essential. With ongoing prospective studies, it is expected that these uncertainties will be resolved and there will be revolutionary changes in the treatment of oligometastatic PCa in the near future.
Determination of the PSA Cut-off Value to Predict the Clinically Significant Prostate Cancer in Patients with Positive Multiparametric MRI: A Population-based Study
(Galenos Publ House, 2023) Kizilay, Fuat; Celik, Serdar; Narter, Fehmi; Sozen, Sinan; Ozen, Haluk; Akdogan, Bulent; Aslan, Guven
Objective: In this study, we investigated the correlation between prostate imaging reporting and data scoring system (PIRADS) grades of patients' prostate lesions detected by multiparametric prostate magnetic resonance imaging (MpMRI) and prostate specific antigen (PSA) values obtained before prostate biopsy and its role in predicting clinically significant cancer in prostatectomy specimens. Materials and Methods: Patients who underwent biopsy and were diagnosed with prostate cancer (PCa) because of positive or negative MpMRI were evaluated. Histopathological factors were recorded, and the relationship between the PIRADS grading system and PSA values was analyzed in patients who underwent radical prostatectomy and preoperative MpMRI. PSA cut-off values predicting clinically significant PCa (CSPCa) in MpMRI were calculated. Results: A total of 1,319 patients were included in the study. MR-fusion biopsy was performed in 58% of the patients, and malignant histopathology was detected in 49% of the patients. While 87% of the patients had CSPCa, 13% had clinically insignificant PCa. The sensitivity and specificity of the PSA 4 ng/mL cut-off value were 88.6% and 15.1% in all patient groups, respectively. In predicting CSPCa, sensitivity was 88.9% and specificity was 18.8% for PSA 4 ng/mL cut-off value in MpMRI-negative patients. If PSA >4 ng/mL in MpMRI-negative patients, there is a >45% PCa detection rate in biopsy, but biopsy is more appropriate for PSA >10 ng/mL for CSPCa. In MpMRI-positive patients, if PSA is >2.5 ng/mL, biopsy provides a >50% PCa and >30% CSPCa diagnosis. If there are PIRADS 5 lesions and PSA is >2.5 ng/mL, biopsy has a >70% PCa and >60% CSPCa detection rate. Conclusions: It may be appropriate to consider higher PSA cut-off values (PSA >10 ng/mL) to make a biopsy decision in patients with negative MpMRI, whereas it may be possible to detect CSPCa at lower PSA values in patients with positive MpMRI findings and high PIRADS grade.
Do body mass index, hormone profile and testicular volume effect sperm retrieval rates of microsurgical sperm extraction in the patients with nonobstructive azoospermia?
(Aves, 2018) Karamazak, Serkan; Kizilay, Fuat; Bahceci, Tuncer; Semerci, Bulent
Objective: We aimed to evaluate the effect of body mass index (BMI), follicle stimulating hormone (FSH), and luteinizing hormone (LH) levels and the mean testicular volume on sperm retrieval rates in microsurgical sperm extraction (microTESE) in the patients with nonobstructive azoospermia (NOA). Material and methods: The data of 282 infertile patients with NOA were analysed retrospectively. The patients with normal karyotype and no Y microdeletions were included in the study. The patients were classified according to their BMI scores and the medical history, physical examination and hormonal parameters were evaluated. The overall data were processed statistically with chi-square and logistic regression analysis and the relation between preoperative findings and sperm retrieval rates was investigated. Results: The sperm retrieval rate of 282 patients after microTESE was found as 41.1%. There was no statistically significant difference in sperm retrieval rates among the subgroups classified according to BMI. FSH and LH levels and the mean testicular volume and pathologic findings were significantly correlated with sperm retrieval rates. Conclusion: Finally significant correlation was determined between sperm retrieval rates and FSH, and LH levels and testicular volumes but no statistically significant difference was found in sperm retrieval rates among BMI groups.
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.
Do sperm parameters and infertility affect sexuality of couples?
(Wiley, 2018) Kizilay, Fuat; Sahin, Mehmet; Altay, Baris
We aimed to analyse the relationship between sperm parameters and International Index of Erectile Function (IIEF) score, the Female Sexual Function Index (FSFI) score, the testosterone (T) level in infertile men and between FSFI score and partners' fertility. Patients were divided into three groups; (group 1: azoospermia [n=57], group 2: sperm count <15million [n=41], group 3: sperm count >15million [n=81]). Patients and their partners filled the IIEF and FSFI forms. The normality of the tests was analysed with Kolmogorov-Smirnov and Shapiro-Wilk tests. Spearman's rho test, a nonparametric test, was used to correlate the data. A value of p<.05 was considered statistically significant. There was a positive correlation between the sperm count, other sperm parameters, morphology and motility and IIEF score, FSFI score and T (p=.037, .028 and .041 respectively). We found a positive correlation between IIEF score and FSFI score (p=.182). Infertile partners' FSFI score was lower than fertile partners' scores (p=.023). Male infertility causes severe sexual dysfunction in couples, and female sexual dysfunction increases in parallel to that of men. Male sexual function also tends to decrease with low sperm count. While the clinician evaluates infertile couples, psychological and sexual functions should also be evaluated and patients should not be deprived of appropriate treatment.

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