Murat Akand

Transperitoneal versus extraperitoneal robot‐assisted laparoscopic radical prostatectomy: A prospective single surgeon randomized comparative study

To compare operative, pathological, and functional results of transperitoneal and extraperitoneal robot‐assisted laparoscopic radical prostatectomy carried out by a single surgeon.

Skin-to-Stone Distance Has No Impact on Outcomes of Percutaneous Nephrolithotomy

Objective: Skin-to-stone distance (SSD) is a stronger factor than body mass index in predicting the success of shock wave lithotripsy. We aimed to evaluate the impact of SSD on outcomes of percutaneous nephrolithotomy (PCNL). Materials and Methods: The medical records of 1,280 patients who had undergone PCNL between April 2007 and February 2012 were evaluated retrospectively. 192 patients who had had preoperative non-contrasted computed tomography and single renal access were included the study. According to this median SSD value, patients were divided into two groups: group 1 (SSD ≤94 mm) (n = 92) and group 2 (SSD >94 mm) (n = 90). The groups were compared according to operative and postoperative parameters. Results: We found no significant differences between the two groups with regard to stone-free rate, operation time, fluoroscopy time, hospitalization time, visual analog score of pain, stone burden, transfusion rates and complication rates. On the other hand, the mean body mass index of group 1 was significantly lower than that of group 2 (p < 0.05). Conclusions: In this retrospective review of patients undergoing PCNL, we found that SSD has no impact on operative and postoperative outcomes. These results were in accordance with the safety of PCNL in obese patients.

Predictive Effect of Preoperative Anemia on Long-Term Survival Outcomes with Non-Muscle Invasive Bladder Cancer.

BACKGROUND Anemia is the most common hematologic abnormality in bladder cancer (BC) patients. We evaluated the impact of preoperative anemia on oncologic outcomes in BC undergoing transurethral resection of a bladder tumor (TURBT) for the first time diagnosis. MATERIALS AND METHODS We retrospectively evaluated the data collected from 639 patients who underwent TURBT between January 2006 and September 2014 in our department. Of these patients, 320 qualified for inclusion in the study. The primary efficacy endpoint was the effect of preoperative anemia status on cancer-specific and overall survival. Independent t-test and chi-square analyses were performed to assess the effects of anemia on oncologic outcomes. Survival was estimated by using the Kaplan-Meier test. RESULTS There were 118 (36.9%) and 202 (63.1%) patients in the anemia (Group-1) and non-anemia groups (Group-2), respectively. The median follow-up duration was 68 months. Anemia was associated with decreased overall survival (<0.001). Comparison between cancer-specific survival of two groups did not show any statistically significant difference (p=0.17). CONCLUSIONS Preoperative anemia status of BC patients according to World Health Organization classification is associated with decreased overall survival, but not with cancer-specific survival. We think that preoperative hemoglobin levels should be considered in patient counseling and decision-making for additional therapy.

Laparoscopic Radical Prostatectomy Alone or With Laparoscopic Herniorrhaphy.

Background and Objectives: Prostate cancer and inguinal hernia are common health issues in men aged more than 50 years. Recently, more data are accumulating that laparoscopic radical prostatectomy (LRP) and laparoscopic inguinal hernia repair (LIHR) can be performed in the same operation. The purpose of this study was to compare patients who underwent simultaneous extraperitoneal LRP (E-LRP) and LIHR with control patients who underwent only E-LRP in a matched-pairs design. Methods: Medical records of 215 patients were evaluated, and 20 patients who underwent E-LRP+LIHR were compared with 40 patients who underwent only E-LRP in a matched-pairs analysis. Preoperative clinical parameters (age, body mass index, prostate-specific antigen, clinical stage, Gleason score of the prostate biopsy, and prostate volume) and operative data (operation time, duration of catheterization, length of hospital stay, estimated blood loss, time to perform the anastomosis and its quality, and the percentage of patients with bilateral lymphadenectomy) were evaluated, as well as postoperative parameters (pathological stage, Gleason score, specimen weight, follow-up duration, biochemical recurrence, complication rates, and duration of postoperative analgesic treatment). Results: No statistically significant differences were found in the preoperative and operative parameters between the 2 study groups. Pathological parameters and the follow-up period and complication rates were similar between the 2 groups. Conclusion: Performing LIHR and E-LRP during the same operation is safe and feasible in the treatment of patients with prostate cancer and inguinal hernia.

Hemostatic Efficacy and Histopathological Effects of Ankaferd Blood Stopper in an Experimental Rat Model of Cyclophosphamide-induced Hemorrhagic Cystitis

OBJECTIVE To evaluate the hemostatic efficacy and histopathological effects of Ankaferd Blood Stopper (ABS) in an experimental rat model of cyclophosphamide-induced (CYP) hemorrhagic cystitis (HC). MATERIALS AND METHODS Forty male Sprague-Dawley rats were included in the study. Firstly, 10 rats were divided equally into 2 groups where the first group was administered only an intraperitoneal (i.p.) injection of normal saline to constitute the negative control group (CON). The remaining 5 rats were administered only a single i.p. injection of CYP (without any further treatment) for induction of HC to constitute the positive control group (HC). Subsequently, the remaining 30 rats, which also received i.p. CYP for induction of HC, were divided into 3 groups to which intravesical saline (SAL group), epinephrine (EPN group), and ABS (ANK group) were administered for 3 consecutive days. Ten days after the third instillation, cystectomy was performed for histopathological examination. Specimens were evaluated for presence of congestion, edema, necrosis, ulceration, and regenerated epithelium, and scores were given for each parameter according to the severity. RESULTS No statistically significant difference was observed for congestion, edema, necrosis, and ulceration between HC-SAL, and also between CON-ANK groups (all P values >.05). There was a significant difference for total scores between EPN and ANK groups (P = .009). There was statistically significant difference for regenerating epithelium between CON-EPN, CON-ANK, HC-ANK, and SAL-ANK groups. CONCLUSION Intravesical administration of ABS is at least as efficacious as EPN in terms of congestion, edema, necrosis, and ulceration. Moreover, ABS can be considered as a better option in inducing regenerating epithelium than EPN.

Adrenal lymphangioma mimicking renal cyst: a case report and review of the literature.

We present a case of a 44-year-old female who was evaluated for left recurrent flank and abdominal pain. Abdominal ultrasonography demonstrated a large cystic mass on the upper pole of the left kidney. Magnetic resonance imaging showed a large, homogenous cystic mass measuring 8.5 × 9.5 cm with well-defined contours, being hypointense on T1-weighted images and hyperintense on T2-weighted images on the upper pole of the left kidney without a distinct plan between adrenal gland. According to clinical and radiological findings, surgical excision was carried out with a subcostal flank incision. Histologic and immunohistochemical examination demonstrates that the definite diagnosis is cystic lymphangioma of the left adrenal gland. Adrenal lymphangioma is a very rare lesion. This is the unique case of an adrenal lymphangioma considered as a renal cyst because of its radiological appearance.

Genito-urinary genomics and emerging biomarkers for immunomodulatory cancer treatment.

Immunotherapy is gradually becoming a key factor in the therapeutic algorithm for patients with genito-urinary (GU) cancers at different stages of disease. Robust and reliable biomarkers are crucial for an appropriate inclusion of patients in clinical trials and for a reliable patient selection for treatments with immunomodulatory drugs. The increasing knowledge on the genomic landscape of GU cancers supports stratification of patients for targeted therapies. This review focusses on emerging biomarkers and the role of genomics in predicting clinical benefit to immunomodulatory agents in GU cancers. Based on cancer incidences and available data we restricted this overview to bladder, prostate and renal cancer.

The effect of bladder sensation on uroflowmetry parameters in healthy young men

To investigate the effect of the bladder sensation grade on uroflowmetry parameters.

Spontaneous Nephrocutaneous Fistula With Tuberculous Autonephrectomy: A Case Report of a Delayed Diagnosis

Introduction: Spontaneous nephrocutaneous fistula is a rare manifestation of renal disease that can occur due to various etiologies, such as renal calculus, chronic pyelonephritis, stricture of the ureteropelvic junction, and renal tuberculosis (TB). An autonephrectomy with a nephrocutaneous fistula due to renal tuberculosis can be diagnosed quite late if it is not suspected. Case Presentation: We report a case of a spontaneous nephrocutaneous fistula with tuberculous autonephrectomy. A 40-year-old white male with recurrent flank pain and intermittent purulent drainage from his right flank region for the previous 14 years was admitted to our outpatient clinic. Fistulography and computerized tomography demonstrated a 51 × 60 mm area with a soft-tissue appearance that implied autonephrectomy of the right kidney, and a fistula tract with a 9 mm diameter between the skin and the retroperitoneal space. The patient was successfully treated with nephroureterectomy and excision of the fistulous tract, followed by antituberculous treatment. The pathological examination of the surgical specimen revealed chronic atrophic pyelonephritis, calcifications, and necrotizing granulomatous inflammation suggestive of TB. Conclusions: Urogenital TB is difficult to diagnose due to the lack of specific symptoms and signs. In the case of a nonfunctioning kidney without an obvious cause and a chronic spontaneous nephrocutaneous fistula, the possibility of associated renal TB should be kept in mind, especially in immunocompromised patients or in places where TB is a common health problem.

A novel cannulation technique for difficult urethral catheterization

INTRODUCTION To propose a novel cannulation technique for difficult urethral catheterization procedures. TECHNIQUE The sheath tip of an intravenous catheter is cut off, replaced to the needle tip and pushed through the distal drainage side hole to Foley catheter tip, and finally withdrawn for cannulation. In situations making urethral catheterization difficult, a guide wire is placed under direct vision. The modified Foley catheter is slid successfully over the guide wire from its distal end throughout the urethral passage into the bladder. RESULTS The modified Foley catheter was used successfully in our clinic in cases requiring difficult urethral catheterization. CONCLUSIONS This easy and rapid modification of a Foley catheter may minimize the potential complications of blind catheter placement in standard catheterization.