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Akman T.,Haseki Teaching and Research Hospital | Binbay M.,Haseki Teaching and Research Hospital | Ugurlu M.,Haseki Teaching and Research Hospital | Kaba M.,Haseki Teaching and Research Hospital | And 4 more authors.
Journal of Endourology | Year: 2012

Purpose: The aim of our study was to evaluate the outcomes of retrograde intrarenal surgery (RIRS) in elderly patients with stones of moderate size. Patients and Methods: Between September 2008 and June 2011, a total of 28 patients over 65 years of age with single renal stones that measured 1.5 to 3 cm were treated with RIRS. The outcomes of these patients were compared with those of the patients who underwent percutaneous nephrolithotomy (PCNL) using matched-pair analysis (1:1 scenario). The matching parameters were the size and location of the stone as well as age, sex, body mass index, degree of hydronephrosis, presence of previous shockwave lithotripsy, and open surgery. SPSS version 16 was used for statistical analysis. Results: Stone-free rates after a single procedure were achieved in 82.1% of patients for the RIRS and 92.8% of patients for the PCNL group. The second flexible ureterorenoscopy procedure was performed for five patients in the RIRS group. Finally, stone-free rates during the third month of the follow-up period were 92.8% in the RIRS group and 96.4% in the PCNL group. The mean operative time per patient was 64.5±20.9 minutes in the RIRS group after a total of 33 procedures, while it was 40.7±10.7 minutes in the PCNL groups (P<0.0001). The overall complication rates for the RIRS and PCNL groups were 7.1% and 10.7%, respectively. Blood transfusions were needed in two patients in the PCNL group. Hospitalization time was significantly shorter in the RIRS group (26.5±10.6 h per patient vs 60.0±28.8 h; P<0.0001). In both groups, stones were most frequently composed of calcium oxalate (68.4% in the RIRS group and 77.7% in the PCNL group). Conclusion: RIRS has a low complication rate and represents a safe and effective treatment alternative in selected geriatric patients with kidney stones of moderate size. © Copyright 2012, Mary Ann Liebert, Inc. 2012.


Altunrende F.,Cleveland Clinic | Tefekli A.,Haseki Teaching and Research Hospital | Stein R.J.,Cleveland Clinic | Autorino R.,Cleveland Clinic | And 4 more authors.
Journal of Endourology | Year: 2011

Background and Purpose: Clinically insignificant residual fragments (CIRFs), defined as asymptomatic, noninfectious, ≤4 mm fragments, are sometimes observed after percutaneous nephrolithotomy (PCNL). Because the natural history of these fragments is unclear, we investigated the medium-term outcome of these fragments. Patients and Methods: During a 3-year period, 430 patients underwent PCNL. Overall stone-free rate was 74.5%, and CIRFs were encountered in 22% of cases 3 months after surgery. A total of 38 patients who had CIRFs immediately after PCNL with at least 24 months of follow-up were included in the study. All patients were subjected to periodic follow-up with detailed history, clinical examination, and radiographic follow-up. Serum biochemistry together with urine metabolic evaluation was also performed. Results: The median follow-up was 28.4±5.3 months (range 24-38 mos). Ten (26.3%) patients had a symptomatic episode that necessitated medical therapy during follow-up while others remained asymptomatic. Radiologic assessment showed an increase in the size of the fragments in 8 (21.1%) patients, while the size of the fragments was stable or decreased in 27 (71.1%) cases. Three (7.9%) patients had spontaneous stone passage. Metabolic evaluation revealed abnormalities in 10 (26.3%) patients. Stone analysis revealed magnesium ammonium phosphate in three of eight patients who had an increase in residual fragment size. Also, only two of these eight patients had a metabolic abnormality (one hypocitraturia and one hypercalciuria). Conclusion: Medium-term follow-up of CIRFs after PCNL revealed that progression within 2 years is relatively common. Increase in fragment size is common in patients with struvite stones, and presence of risk factors on 24-hour urine metabolic analysis does not seem to predict growth of observed fragments. © Copyright 2011, Mary Ann Liebert, Inc.


De La Rosette J.,University of Amsterdam | Assimos D.,Wake forest University | Desai M.,Muljibhai Patel Urological Hospital | Gutierrez J.,Nuevo Hospital Civil | And 3 more authors.
Journal of Endourology | Year: 2011

Purpose: To assess the current indications, perioperative morbidity, and stone-free outcomes for percutaneous nephrolithotomy (PCNL) worldwide. Patients and Methods: The Clinical Research Office of the Endourological Society (CROES) collected prospective data for consecutive patients who were treated with PCNL at centers around the world for 1 year. PCNL was performed according to study protocol and local clinical practice guidelines. Stone load and location were recorded, and postoperative complications were graded according to the modified Clavien grading system. Results: Between November 2007 and December 2009, 5803 patients were treated at 96 centers in Europe, Asia, North America, South America, and Australia. Staghorn calculus was present in 1466 (27.5%) patients, and 940, 956, and 2603 patients had stones in the upper, interpolar, and lower pole calices, respectively. The majority of procedures (85.5%) were uneventful. Major procedure-related complications included significant bleeding (7.8%), renal pelvis perforation (3.4%), and hydrothorax (1.8%). Blood transfusion was administered in 328 (5.7%) patients, and fever > 38.58C occurred in 10.5% of patients. The distribution of scores in modified Clavien grades was: No complication (79.5%), I (11.1%), II (5.3%), IIIa (2.3%), IIIb (1.3%), IVa (0.3%), IVb (0.2%), or V (0.03%). At follow-up. the 30-day stone-free rate was 75.7%, and 84.5% of patients did not need additional treatment. Conclusion: With a high success rate and a low major complication rate, PCNL is an effective and safe technique overall for minimally invasive removal of kidney stones. Copyright © Mary Ann Liebert, Inc.


Ozkul M.H.,Haseki Teaching and Research Hospital | Ozkul T.,American University of Sharjah
Journal of the Franklin Institute | Year: 2011

What makes some human faces more attractive than others is an interesting phenomenon which is difficult to explain based on few facial features. Research indicated that many facial parameters contribute to generation of a harmonious face which is found appealing by most observers. There are different theories developed on which and how these parameters blend in to make a harmonious face. Determination of these parameters and the underlying mechanism is important since achieving a harmonious face is the primary goal in dental and aesthetic surgical procedures. This article presents a model developed for computer-aided assessment of facial harmony, which assesses the facial harmony of male patients and generates a score that reflect the level of harmony. The computer-aided tool presented in this paper uses theory of averages as a mechanism for measurement of facial harmony which is frequently used by aesthetic surgeons and orthodontists for assessment of facial proportions of the patient. The output of the developed model is an index which reflects the degree of harmony of facial features and how well they blend into each other. © 2010 The Franklin Institute. Published by Elsevier Ltd. All rights reserved.


Yuruk E.,Haseki Teaching and Research Hospital | Binbay M.,Haseki Teaching and Research Hospital | Sari E.,Haseki Teaching and Research Hospital | Akman T.,Haseki Teaching and Research Hospital | And 4 more authors.
Journal of Urology | Year: 2010

Purpose: We determined the natural course and compared the deleterious effects in kidneys of shock wave lithotripsy, percutaneous nephrolithotomy and observation for asymptomatic lower caliceal stones. Materials and Methods: Between April 2007 and August 2008 patients with asymptomatic lower caliceal calculi were enrolled in the study. To assess stone status noncontrast abdominal helical computerized tomography was done 3 and 12 months after intervention. All patients were evaluated by dimercapto-succinic acid renal scintigraphy 6 weeks and 12 months after intervention. Results: A total of 94 patients were prospectively randomized to percutaneous nephrolithotomy (31), shock wave lithotripsy (31) and observation (32). Mean ± SD followup was 19.3 ± 5 months (range 12 to 29). In the percutaneous nephrolithotomy group all patients were stone-free at month 12. Scintigraphy revealed a scar in 1 patient (3.2%) on month 3 followup imaging. In the shock wave lithotripsy group the stone-free rate was 54.8%. Scintigraphy revealed scarring in 5 patients (16.1%). In the observation group 7 patients (18.7%) required intervention during followup. Median time to intervention was 22.5 ± 3.7 months (range 18 to 26). One patient (3.1%) had spontaneous stone passage. Scintigraphy did not reveal scarring in any patient. Conclusions: Stone related events were noted in more than 20% of patients with asymptomatic lower caliceal stones observed expectantly. To manage lower caliceal stones percutaneous nephrolithotomy has a significantly higher stone-free rate with less renal scarring than shock wave lithotripsy. Thus, patients with asymptomatic lower caliceal stones must be informed in detail about all management options, especially focusing on percutaneous nephrolithotomy with its outstanding outcome. © 2010 American Urological Association Education and Research, Inc.


Akbayir O.,Kanuni Sultan Suleyman Teaching and Research Hospital | Corbacioglu A.,Kanuni Sultan Suleyman Teaching and Research Hospital | Goksedef B.P.C.,Haseki Teaching and Research Hospital | Numanoglu C.,Kanuni Sultan Suleyman Teaching and Research Hospital | And 4 more authors.
Gynecologic Oncology | Year: 2012

Objective: To identify clinicopathological risk factors for pelvic lymph node metastasis, and to evaluate the clinical validity of these factors in selecting patients who need pelvic lymph node dissection. Methods: The data of 466 patients who had lymphadenectomy for endometrioid adenocarcinoma of the endometrium between January 2002 and December 2010 were reviewed retrospectively. Results: All patients underwent pelvic lymphadenectomy and 192 (41.2%) patients also underwent paraaortic lymphadenectomy. The median number of pelvic lymph node was 16 (range: 2-46) and of paraaortic lymph node was 5 (range: 2-16). 10.1% (47/466) of all patients had pelvic lymph node involvement and 7.8% (15/192) of the patients had paraaortic lymph node involvement (LNI). Pelvic LNI was significantly more common in the presence of higher grades of tumor, LVSI, deep myometrial invasion, positive peritoneal cytology and cervical involvement. The logistic regression analysis revealed that LVSI, cervical glandular invasion and cervical stromal invasion remained to be the independent risk factors for LNI. When the LVSI and/or cervical involvement were considered as high risk for pelvic lymph node metastasis, NPV and specificity were found to be 96.3% and 68.4%, respectively. LNI was correctly estimated in 323 women (69%), overestimated in 132 women (28%) and underestimated in 11 women (2%). Conclusion: LVSI, cervical glandular and stromal involvement were independent risk factors for pelvic LNI. These variables can be assessed pre- or intraoperatively with a high rate of accuracy, the model which uses these variables may be successfully used in the prediction of pelvic lymph node metastasis. © 2012 Elsevier Inc. All rights reserved.


Akman T.,Haseki Teaching and Research Hospital | Sari E.,Haseki Teaching and Research Hospital | Binbay M.,Haseki Teaching and Research Hospital | Yuruk E.,Haseki Teaching and Research Hospital | And 4 more authors.
Journal of Endourology | Year: 2010

Purpose: To analyze the early outcome after single tract vs multiple tracts percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi. Patients and Methods: The records of 413 patients with staghorn calculi (223 [54%] had complete and 190 [46%] had partial) who underwent PCNL were reviewed retrospectively. A total of 244 (59%) patients were managed by single access (group 1); meanwhile, multiple accesses were necessary in 169 (41%) patients (group 2). Both groups were compared in terms of perioperative findings and postoperative outcomes. Patients and stone-related factors affecting the number of accesses performed were analyzed. Results: The mean number of percutaneous accesses was 2.42±0.74 (range 2-6) in group 2. Mean durations of fluoroscopy screening time and operative time were significantly longer in group 2 (P=0.002, P<0.0001, respectively). Supracostal access was necessary in 30.7% in group 2 and in 6.9% in group 1 (P=0.001). Success was achieved in 70.1% in group 1 and in 81.1% for group 2 after one session of PCNL (P=0.012). The most common complication was bleeding for both groups, and it was higher in group 2 (P<0.0001). The mean preoperative and postoperative creatinine concentrations were 1.03mg/dL and 1.08mg/dL in group 1, and 0.9mg/dL and 1.03mg/dL in group 2, respectively. The mean changes in creatinine values were not statistically significant between the groups (P=0.16). Conclusions: The impact of PCNL using either single or multiple access tracts on renal function is similar and of a temporary nature. PCNL with multiple accesses is a highly successful alternative with considerable complication rates in the management of staghorn calculi. © Mary Ann Liebert, Inc. 2010.


Muslumanoglu A.Y.,Haseki Teaching and Research Hospital | Yuruk E.,Haseki Teaching and Research Hospital | Binbay M.,Haseki Teaching and Research Hospital | Akman T.,Haseki Teaching and Research Hospital
BJU International | Year: 2012

Objective To compare long-term results of transurethral resection of prostate with PlasmaKinetic® energy (Plasmakinetic) and standard transurethral resection of prostate (TURP). Patients and Methods During the 2-year period between 2001 and 2002, 101 patients with lower urinary tract symptoms related to benign prostatic hyperplasia were enrolled into the study. Patients were randomly assigned to either Plasmakinetic or standard TURP groups using computer-generated simple random tables in a 1:1 ratio. After the publication of initial results, follow-up continued until December 2010. Patients were called by phone and invited for control at 60th and 100th months. An International Prostate Symptom Score (IPSS) form was completed and uroflowmetry was performed to show the final status of the operation. Results Overall, 67 of 101 patients (34 patients in Plasmakinetic group and 33 patients in TURP group) completed the 100th month control. IPSS increased to 8.5 ± 1.6 and 9.4 ± 0.9 in the Plasmakinetic group and 7.9 ± 1.3 and 8.7 ± 1.2 in the TURP group at 60 and 100 months, respectively. Mean maximal flow rate increased to 17.2 ± 3.9 mL/s in the Plasmakinetic group and to 16.9 ± 4.1 mL/s at 12 months in the TURP group but decreased to 15.9 ± 2.5 and 15.8 ± 3.0, respectively (P= 0.34) at 100 months. Reoperation was performed in six patients in the Plasmakinetic group and four patients in the TURP group at the end of 100th month. Conclusion Our 100 months results suggest that Plasmakinetic technology can be used as a first-line treatment instead of monopolar TURP. © 2011 BJU INTERNATIONAL.


Api O.,Dr Lutfi Kirdar Kartal Teaching and Research Hospital | Ergen B.,Dr Lutfi Kirdar Kartal Teaching and Research Hospital | Api M.,Haseki Teaching and Research Hospital | Ugurel V.,Dr Lutfi Kirdar Kartal Teaching and Research Hospital | And 2 more authors.
American Journal of Obstetrics and Gynecology | Year: 2010

Objective: We sought to investigate the analgesic efficacy of oral dexketoprofen trometamol and intrauterine lidocaine in patients undergoing fractional curettage. Study Design: A randomized, double-blind, placebo-controlled trial was conducted on 111 women. Subjects were randomly assigned into 4 groups to receive either 25 mg of dexketoprofen or similar-appearing placebo tablets and either 5 mL intrauterine 2% lidocaine or saline. The main outcome measure was the intensity of pain measured by a 10-cm visual analog scale. Pain scoring was performed prior to, during, and 30 minutes after the procedure. Results: No statistically significant difference was found among the mean pain scores of women during the procedure in the dexketoprofen and saline, placebo and lidocaine, and dexketoprofen and lidocaine groups. The mean pain scores in all 3 groups revealed significant reduction when compared with placebo and saline combination (P = .001). Conclusion: Administration of intrauterine lidocaine or oral dexketoprofen appears to be effective in relieving fractional curettage associated pain. However, a combination of them does not work better in further reduction of pain. © 2010 Mosby, Inc. All rights reserved.


Goksedef B.P.C.,Haseki Teaching and Research Hospital | Kef S.,Haseki Teaching and Research Hospital | Akca A.,Haseki Teaching and Research Hospital | Bayik R.N.E.,Haseki Teaching and Research Hospital | Cetin A.,Haseki Teaching and Research Hospital
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2011

Objectives: The aim of this study is to determine the risk factors for rupture of an ectopic pregnancy (EP) to help physicians identify those women who are at greatest risk. Study design: The study group comprised the cases of EP treated in our department from January 2003 to September 2009. The following parameters were retrospectively examined: rupture status, past history of pelvic infection or EP, use of an intrauterine device (IUD), parity and gestational age. Women with tubal rupture were compared to those without rupture. Where appropriate, univariate and multivariate analyses were used to identify predictors of the outcome of EP. Results: Two hundred and thirty-two cases of EP were retrieved. Eighty-eight of them (37.9%) were cases with ruptured EP and 144 (62.1%) were cases with unruptured EP. No significant associations existed regarding IUD use, smoking, previous ectopic pregnancy, past history of pelvic inflammatory disease (PID) or history of endometriosis. The mean gestation (in weeks) since the last menstrual period and the mean level of βhCG were significantly higher in patients with ruptured EP compared with patients with unruptured EP (7.8 ± 1.09 versus 6.4 ± 1.2, p < 0.0001; and 8735.3 ± 11317.8 IU/ml versus 4506 ± 5673.7 IU/ml, p < 0.0001, respectively). Logistic regression analysis revealed that 6-8 weeks of amenorrhoea (OR: 3.67; 95% CI: 1.60-8.41) and >8 weeks of amenorrhoea (OR: 46.46; 95% CI: 14.20-152.05) and also 1501-5000 IU/ml of βhCG level (OR: 4.11; 95% CI: 1.53-11.01) and >5000 IU/ml of βhCG levels (OR: 4.40; 95% CI: 1.69-11.46) were the significant risk factors for tubal rupture. Conclusions: Higher βhCG levels and higher gestational age seem to be significant risk factors for rupture of an EP. © 2010 Elsevier Ireland Ltd. All rights reserved.

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