Asif Yildirim

The cost analysis of flexible ureteroscopic lithotripsy in 302 cases

The objective of this study was to audit the cost of flexible ureterorenoscopic lithotripsy. The data for 302 consecutive flexible ureteroscopic lithotripsy (FURSL) procedure undertaken in our department for renal stone treatment were collected retrospectively. The costs associated with performing FURSL, including the cost of ancillary equipment were analyzed. This includes the cost of the initial purchase of the ureterorenoscopes and the holmium laser equipment. The cost of flexible ureterorenoscopy for each lithotripsy procedure (for a total of 302 FURSL) was

Comparison of Different Ureteroscope Sizes in Treating Ureteral Calculi in Adult Patients

118. Additional cost of ancillary equipment including laser device, ureteral acces sheath and stone retrival catheter were

Cadaveric Fascia Lata versus Intravaginal Slingplasty for the Pubovaginal Sling: Surgical Outcome, Overall Success and Patient Satisfaction Rates

156,

The accuracy of 68Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer

231 and

Impact of PSA and DRE on Histologic Findings at Prostate Biopsy in Turkish Men Over 75 Years of Age

611, respectively. In this series, the costs of the ancillary equipment including laser exceeded the purchase and maintenance of the flexible ureteroscope. The cost of disposables rather than flexible ureteroscope itself should be considered in planning the budget.

Significance of the interval between first and second transurethral resection on recurrence and progression rates in patients with high‐risk non‐muscle‐invasive bladder cancer treated with maintenance intravesical Bacillus Calmette‐Guérin

OBJECTIVE To compare the success and complication rates of a 4.5-6.5F semirigid ureteroscope (S-URS) with an 8.5-11.5F S-URS in treating ureteral stones in adult patients. MATERIALS AND METHODS Fifty-two patients with ureteral stones, who were treated with 4.5-6.5F S-URS (group 1) and 52 patients who were treated with 8.5-11.5F S-URS (group 2) were compared retrospectively using a matched-pair analysis. The size, lateralization, location, and impaction of the stones and also the patient age, gender, body mass index, and the presence of hydronephrosis were used as the matching parameters. The stones were fragmented with Holmium-YAG laser. RESULTS The matching parameters were comparable between the 2 groups. The stone-free rates were 88.5% in group 1 and 84.6% in group 2 (P = .566) after a single procedure. The mean operative times for groups 1 and 2 were 32.7 ± 5.8 and 30.2 ± 5.4 minutes, respectively (P = .06). Postoperative hematuria was detected in 1.9% and 13.5% of patients in groups 1 and 2 (P = .027). Ureteral balloon dilation was needed in 1.9% and 15.4% of patients in groups 1 and 2, respectively (P = .015). Mucosal injury was observed in 1.9% and 13.5% of the patients in groups 1 and 2, respectively (P = .027). No major complications were noted in either group. CONCLUSION Although the stone-free rates and operative times were similar between the 2 groups, a 4.5-6.5F ureteroscope can reduce the need for ureteral balloon dilation and some minor complications, such as mucosal injury and postoperative hematuria, in adult patients.

Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adults: Do Location and Appearance of the Ureteric Orifice Have a Role in the Success Rates?

Background: A wide variety of surgical procedures has been used to treat female stress urinary incontinence (SUI). The purpose of this study was to compare cadaveric fascia lata (CFL) sling with intravaginal slingplasty (IVS) in the surgical treatment of SUI. Methods: One hundred and thirty-nine women with SUI were randomly assigned to either CFL sling (n = 67) or IVS (n = 72). Concomitant urinary urge incontinence was present in 49 patients (73%) in the CFL sling and 44 patients (61%) in the IVS group. Daily mean pad usage was 4.1 ± 3.5 in the CFL sling and 2.9 ± 1.7 in the IVS group. The objective cure rate was evaluated by the pad test, and patient satisfaction rate was assessed by a subjective questionnaire. Results: The surgical results of both procedures with a follow-up 12 months were documented. The overall success rate was 79% in the CFL sling and 70.8% in the IVS (p = 0.261). In contrast patient satisfaction rates were 82 and 87.5%, respectively (p = 0.210). Comparison of the CFL sling with IVS showed persistent urinary urge incontinence in 67 and 25% (p = 0.0001) and de novo urinary urge incontinence in 22 and 6.9%, respectively (p = 0.009). The groups did not differ significantly with respect to intraoperative and postoperative complications. Conclusions: There is no statistical difference in the overall success, satisfaction and complication rates in either group. In our series, both procedures were found to be effective, durable and significantly improved quality of life in patients with SUI but long-term results are awaited.

Primary Leiomyosarcoma of the Adrenal Gland: A Case Report with Immunohistochemical Study and Literature Review

PurposeTo assess the diagnostic accuracy of 68Ga-PSMA PET in predicting lymph node (LN) metastases in primary N staging in high-risk and very high-risk nonmetastatic prostate cancer in comparison with morphological imaging.MethodsThis was a multicentre trial of the Society of Urologic Oncology in Turkey in conjunction with the Nuclear Medicine Department of Cerrahpasa School of Medicine, Istanbul University. Patients were accrued from eight centres. Patients with high-risk and very high-risk disease scheduled to undergo surgical treatment with extended LN dissection between July 2014 and October 2015 were included. Either MRI or CT was used for morphological imaging. PSMA PET/CT was performed and evaluated at a single centre. Sensitivity, specificity and accuracy were calculated for the detection of lymphatic metastases by PSMA PET/CT and morphological imaging. Kappa values were calculated to evaluate the correlation between the numbers of LN metastases detected by PSMA PET/CT and by histopathology.ResultsData on 51 eligible patients are presented. The sensitivity, specificity and accuracy of PSMA PET in detecting LN metastases in the primary setting were 53%, 86% and 76%, and increased to 67%, 88% and 81% in the subgroup with of patients with ≥15 LN removed. Kappa values for the correlation between imaging and pathology were 0.41 for PSMA PET and 0.18 for morphological imaging.ConclusionsPSMA PET/CT is superior to morphological imaging for the detection of metastatic LNs in patients with primary prostate cancer. Surgical dissection remains the gold standard for precise lymphatic staging.

Gangrene of the distal penis after implantation of malleable penile prosthesis in a diabetic patient

Prostate specidic antigen (PSA) and digital rectal examination (DRE) are the known predictive factors for positive prostate biopsies differing according to the age, region and race. There have been only very limited studies about the impact of PSA on histological findings at prostate biopsy in Turkey. The aim of this study was to evaluate the impact of PSA and clinical stage on histologic findings of prostate biopsy in men older than 75 years of age as a first study in the Turkish population. A total of 1,645 consecutive prostate biopsies were included, with 194 men aged 75 or older. Cancer was identified in 104 patients (53.6%). Of the 104 positive biopsies, Gleason scores were less than 7 in 53 (49%) patients, 7 or greater in 51 (51%) patients. Positive prostate biopsies were significantly correlated with advanced age (p=0.0001), abnormal DRE (p=0.0001) and raised PSA (p=0.0001). The prostate volume was significantly correlated with advanced age especially in prostate cancer patients over 75 years, compared with those under 75 (p=0.0001). These results are useful for counseling men older than 75 years for prostate cancer detection. However, PCa screening decisions are currently based on urologist judgment and detection of latent asymptomatic disease is an important concern regarding costs, overdiagnosis, overtreatment and quality of life (QOL) for men aged 75 years and older. Healthy old patients with a long life expectancy need to be carefully evaluated for eligibility for PCa screening.

Type I and II Circumcaval Ureter in Children : Experience in Three Cases

To evaluate the effect of the interval between the initial and second transurethral resection (TUR) on the outcome of patients with high‐risk non‐muscle‐invasive bladder cancer (NMIBC) treated with maintenance intravesical Bacillus Calmette‐Guérin (BCG) therapy.