Taksim Teaching Hospital

İstanbul, Turkey

Taksim Teaching Hospital

İstanbul, Turkey

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Wagenlehner F.M.E.,Justus Liebig University | Tenke P.,Jahn Ferenc South Pest Hospital | Tandogdu Z.,Taksim Teaching Hospital | Cek M.,Trakya University | And 7 more authors.
European Urology | Year: 2013

Background: Infection is a serious adverse effect of prostate biopsy (P-Bx), and recent reports suggest an increasing incidence. Objective: The aim of this multinational multicentre study was to evaluate prospectively the incidence of infective complications after P-Bx and identify risk factors. Design, setting, and participants: The study was performed as an adjunct to the Global Prevalence Study of Infections in Urology (GPIU) during 2010 and 2011. Men undergoing P-Bx in participating centres during the 2-wk period commencing on the GPIU study census day were eligible. Outcome measurements and statistical analysis: Baseline data were collected and men were questioned regarding infective complications at 2 wk following their biopsy. The Fisher exact test, Student t test, Mann-Whitney U test, and multivariate regression analysis were used for data analysis. Results and limitations: A total of 702 men from 84 GPIU participating centres worldwide were included. Antibiotic prophylaxis was administered prior to biopsy in 98.2% of men predominantly using a fluoroquinolone (92.5%). Outcome data were available for 521 men (74%). Symptomatic urinary tract infection (UTI) was seen in 27 men (5.2%), which was febrile in 18 (3.5%) and required hospitalisation in 16 (3.1%). Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection after P-Bx. Causative organisms were isolated in 10 cases (37%) with 6 resistant to fluoroquinolones. The small sample size per participating site and in compared with other studies may have limited the conclusions from our study. Conclusions: Infective complications after transrectal P-Bx are important because of the associated patient morbidity. Despite antibiotic prophylaxis, 5% of men will experience an infective complication, but none of the possible factors we examined appeared to increase this risk. Our study confirms a high incidence of fluoroquinolone resistance in causative bacteria. © 2012 European Association of Urology.


Cek M.,Trakya Medical School | Tandogdu Z.,Taksim Teaching Hospital | Wagenlehner F.,Justus Liebig University | Tenke P.,South Pest Teaching Hospital | And 2 more authors.
World Journal of Urology | Year: 2014

Introduction: European Section for Infections in Urology has been conducting an annual prevalence survey investigating various aspects of healthcare-associated urinary tract infections (HAUTI) since 2003.Material and Methods: The data on various clinical categories of HAUTI, the contamination status of HAUTI patients who underwent any urological intervention with regard to microorganisms isolated, resistance status and antibiotics used to treat HAUTI will be presented.Results: Of a total of 19,756 patients screened, 1,866 patients had HAUTI (9.4 %); 1,313 males (70.4 %) and 553 (29.6 %) females. Mean age was 59.9 ± 18.2. Asymptomatic bacteriuria (ASB) and cystitis were the most frequent clinical diagnoses representing 27.0 and 26 % of all HAUTI, respectively. Echerichia coli was found to be the most frequent uropathogen (544 of 1,371 isolates) (39.7 %). Fluoroquinolones were preferred in 26.6 % of cases followed by cephalosporins (23.3 %), aminoglycosides (14.1 %) and penicillins (13.8 %). High global resistance rates to ciprofloxacin (>50 %), cephalosporins (35–50 %) and penicillins (50 %) were found in the GPIU studies 2003–2010.Discussion: We showed that around 10 % of hospitalized urological patients are at risk to develop HAUTI often caused by multiresistant uropathogens. Increased antibiotic use often with broad-spectrum antimicrobials will inevitably be followed by increasing bacterial resistance. To interrupt such a vicious cycle, our results suggest (1) there is still room for improvement in surgical prophylaxis in terms of limiting exposure to antibiotics and (2) far too many patients with ASB are being treated which shows that the new proposal of classification should be adopted where ABS is regarded as colonization and not as an infection to be treated. © 2014, Springer-Verlag Berlin Heidelberg.


Cek M.,Aarhus University Hospital | Cek M.,Trakya University | Tandogdu Z.,Taksim Teaching Hospital | Naber K.,TU Munich | And 5 more authors.
European Urology | Year: 2013

Background: Antibiotic prophylaxis (AP) is an important measure in preventing health care-associated urinary tract infections (HAUTIs). Despite regional variations in the bacterial spectrum and antibiotic susceptibility patterns, guideline recommendations are usually given on an international level. Objective: To describe the use of AP in urology departments and relate this to relevant parameters such as country, type of hospital, and European Association of Urology guideline recommendations. Design, setting, and participants: Data from the Global Prevalence Study on Infections in Urology for the period 2005-2010 were analysed to evaluate the use of antibiotics in general and AP for urologic procedures. Of the 13 723 patients enrolled, 8178 received antibiotics on the study days. Outcome measurements and statistical analysis: Study data were imported from the Web-based survey into Microsoft Access and exported into SPSS v.17.0. The data were then coded and analysed. The Pearson chi-Square test was used to compare categorical data and a probability level of 5% was considered significant. Multiple logistic regression analysis was used to define significantly different variables in multiple set categories. Results and limitations: Questions on AP were answered on 8370 forms and 6306 (75.3%) investigators reported their routine application of AP. Routine AP was highest in Latin America (n = 337; 84%), followed by Asia (n = 1338; 86%), Africa (n = 234; 85%), and Europe (n = 4116; 67%). The antibiotics most frequently used for AP were second-generation cephalosporins, ciprofloxacin, cefotaxime, and amoxicillin plus beta-lactamase inhibitor. Conclusions: There were significant differences between countries/regions and types of hospitals, both in using AP for clean procedures and in the types of antibiotics used. AP was not always consistent with recommended guidelines. © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.


Tandogdu Z.,Taksim Teaching Hospital | Cek M.,Trakya Medical School | Wagenlehner F.,Justus Liebig University | Naber K.,TU Munich | And 3 more authors.
World Journal of Urology | Year: 2014

Objective: To present the worldwide antibiotic resistance rates of uropathogens reported in nosocomial urinary tract infections (NAUTI) during the period of 2003-2010. Materials and methods: Data from the Global Prevalence Study of Infections in Urology from the period of 2003-2010 were analyzed to evaluate the resistance rates of pathogens causing NAUTI. The web-based application was used to record data of investigators from urology departments participating in the study every year during the days allocated in November. Each center was allowed to enter data on a single day of the study. The point prevalence data was used to find differences among geographic regions and years by utilizing multiple logistic regression analysis. Results: A total of 19,756 patients were hospitalized during the study period, and in 1,866 of them, NAUTI was reported. Proof of infection was reported in 1,395 patients. Resistance rates of all antibiotics tested other than imipenem against the total bacterial spectrum were higher than 10 % in all regions. Resistance to almost all pathogens was lowest in North Europe, and there is no single year where an outbreak of resistance has been detected. Conclusion: The resistance rates of most of the uropathogens against the antibiotics tested did not show significant trends of increase or decrease with Asia exhibiting the highest rates in general. The only antibiotic tested with an overall resistance rate below 10 % was imipenem. Knowledge of regional and local resistance data and prudent use of antibiotics are necessary to optimize antibiotic therapy in urological patients with NAUTI. © 2013 Springer-Verlag Berlin Heidelberg.


Fazlioglu A.,Taksim Teaching Hospital | Salman Y.,Taksim Teaching Hospital | Tandogdu Z.,Taksim Teaching Hospital | Kurtulus F.O.,Taksim Teaching Hospital | And 2 more authors.
BMC Urology | Year: 2014

Background: Animal studies have shown that nicotine affects the peristalsis of the ureter. The aim of the study is to analyze the effect of smoking on spontaneous passage of distal ureteral stones. Methods. 88 patients in whom distal ureteral stone below 10 mm diameter diagnosed with helical computerized tomography enhanced images were reviewed. Patients were grouped as either smokers (n:33) or non smokers (n:50). Follow-up for spontaneous passage of stones was limited with 4 weeks. Patients did not receive any additional medical treatment other than non-steroid anti inflamatory drugs only during painful renal colic episodes.Two groups were compared with the chi-square test in terms of passing the stone or not. Stone passage was confirmed with either the patient collecting the stone during urination or by helical CT. Results: Smoking habits was present in 30(34%) patients and the frequency in both groups were similar (smokers: 23(76%) vs non-smokers: 46(79%)). Spontaneous passage of the stone was observed in 69(78%) patients. The two groups were comparable in terms of patien age, male to female ratio and stone size. Stone passage decreased as stone diameter increased. Total stone passage rates were similar in both groups (smokers: 76% vs. non-smokers: 79%) (p > 0.05). Passage of stones > 4 mm was observed in 46% and 67% of smokers and non-smokers respectively. However passage of stones with a diameter ≤ 4 mm were similar in both groups (smokers: 100% vs non-smokers: 92%) (p > 0.05). Conclusion: Smoking has neither a favorable nor un-favorable effect on spontaneous passage of distal ureteral stones. However, spontaneous passage rates in patients with a stone diameter > 4 mm was lower in smokers. These results should be further confirmed with studies including larger numbers of patients. © 2014 Fazlioglu et al.; licensee BioMed Central Ltd.


Kurtulus F.O.,Taksim Teaching Hospital | Tandogdu Z.,Taksim Teaching Hospital | Fazlioglu A.,Taksim Teaching Hospital
Urological Research | Year: 2012

The study is unique in terms of deWning the safety of totally tubeless percutaneous nephrolithotomy (PNL). Furthermore, the authors state that the tubeless group has an advantage of less pain. However, we interpreted the results of pain-related comparisons diVerent than that the authors had. In our opinion, the results gained show that there is no diVerence in terms of pain in both groups. The authors state that they have inserted a double J catheter to patients that were included in the tubeless group in addition to the nephrostomy as a conventional procedure. However, routine Double-J placement in addition to nephrostomy is not a common procedure. Additionally, the large-bore nephrostomy tube preferred is certain to cause pain, as stated in the previous studies. It has been shown that small-bore tubes cause less pain. It may have been more appropriate to compare the groups in such a manner. Even though we have stated our comments with respect to pain issues, it is evident that the study is unique in terms of deWning the safety of a totally tubeless procedure. © Springer-Verlag 2011.


Kurtulus F.,Taksim Teaching Hospital | Fazlioglu A.,Taksim Teaching Hospital | Tandogdu Z.,Taksim Teaching Hospital | Karaca S.,Taksim Teaching Hospital | And 2 more authors.
Canadian Journal of Urology | Year: 2010

Introduction: The aim of the present study is to determine the preoperative and operative factors associated with bleeding in percutaneous nephrolithotomy (PNL) operations where tract dilatation was formed by balloon dilators. Material and methods: A total of 378 patients underwent PNL in our department between 2003 and 2008. After excluding missing data 310 patients were included in the study in whom nephrostomy tract dilatation was performed using balloon dilators. The amount of blood loss was estimated by calculating the change in hemoglobin (Hgb). Preoperative and operative factors were assessed for association with the change in Hgb levels. The preoperative factors were age, sex, hypertension, diabetes mellitus (DM), smoking, ipsilateral pyelonephritis, body mass index, serum creatinine level, stone localization and burden, previous ipsilateral renal stone surgery and extracorporeal shock wave lithotripsy and degree of hydronephrosis. Operative factors were operation time, calyx of puncture and tract number. The possible effect of surgical experience was also taken into consideration. Univariate and stepwise multiple linear regression analysis were performed. Results: The average Hgb drop was 1.9 g/dL (range: 0.1 g/dL-8.8 g/dL). Ancillary procedures were performed due to the residual calculi in 23% of patients. The stone free rates increased from 77% to 94% after the secondary interventions. Prolonged operation time and presence of diabetes mellitus (DM) had a significant association with the decrease in Hgb levels (p < 0.05). However the remaining factors analyzed did not have any association with the change in Hgb values (p > 0.05). Previous ipsilateral open renal stone surgery was not associated with a change in Hgb levels (p > 0.05). Staghorn stones and operation expertise were the factors related with operation time (p < 0.05). Conclusions: In patients where tract dilatation is gained by balloon dilators prolonged operation time and DM are the major risk factors related with a higher incidence of blood loss. Surgical expertise is highly related with operation time. It would be wise to operate staghorn stones when a high surgical experience is gained.


Aydin M.,Taksim Teaching Hospital | Tandogdu Z.,Taksim Teaching Hospital | Kurtulus F.O.,Taksim Teaching Hospital | Avci E.,Taksim Teaching Hospital | And 2 more authors.
Journal of B.U.ON. | Year: 2010

Purpose: In this prospective study we evaluated the benefit of a second transurethral bladder resection (TURB) for Ta-T1 bladder carcinomas. Methods: One hundred consecutive patients with superficial bladder tumor (Ta-T1) undergoing TURB and routine repeat TURB (Re-TURB) 4-6 weeks after the initial resection were included in the study. Re-TURB was applied to the scar of the first resection and other suspicious lesions in the bladder. Results: From January 2003 to December 2008100 patients were enrolled onto the study (mean age 60 years). At the first TURB, 56 (56%) patients had multiple lesions and 44 (44%) had a solitary tumor. Re-TURB revealed histological residual tumors in 40 (40%) patients. Residual tumor was found in 40% of Ta and 40% of T1 disease and 29% of the tumors were found at initial site of resection. Re-TURB revealed residual tumor in 55% of patients with multiple tumors and only 20% of patients with a solitary bladder tumor. Conclusion: These data suggest that tumor stage is not a good indicator to determine the necessity of Re-TURB in superficial bladder carcinomas. Routine Re-TURB is beneficial in Ta-T1 multiple bladder tumors. © 2010 Zerbinis Medical Publications.


Kurtulus F.O.,Taksim Teaching Hospital
Urological research | Year: 2012

We investigated whether previous intraureteral manipulations had an effect on the stone-free rates (SFR) after semi-rigid ureteroscopy (URS) with pneumatic lithotripsy. A retrospective review of all patients who were treated for ureteral stones at two different institutions from June 2003 through January 2010 was performed. Data of 161 URS procedures were analyzed. Stone size, location (distal, mid and proximal) and number (single and multiple), patient demographics and previous intraureteral manipulations were recorded. Patients were grouped as having undergone a previous ipsilateral intraureteral manipulation (Group 1) or not (Group 2). Stone location and number, stone clearance and ancillary procedures were compared. There were no significant differences between Group 1 versus Group 2 for age (p > 0.05), gender (p > 0.05), stone site (p > 0.05) and stone size (p > 0.05). Stones with multiple locations were more frequent in Group 1 (18.5%); however, the difference did not reach statistical significance between the two groups. Similarly, the frequency of multiple stones was also higher in Group 1 (29.6%). Stone site, diameter and gender were comparable in both groups. Stone-free rate of all patients was 84.6% after the first intervention. This rate increased to 98.1% after secondary procedures. Univariate analysis revealed that SFR after URS were low in patients who underwent previous intraureteral manipulations (Group 1:55.6% vs. Group 2:89.1%). SFR after the first intervention were related with stone size, location and number. Additionally, multiple logistic regression analysis indicated a relationship between previous intraureteral manipulations and initial stone clearance rates. Spontaneous passage of stone fragments after URS was associated with stone burden, location, number and previous intraureteral manipulations. Further multiple logistic regression analysis showed that only previous intraureteral manipulations were associated with the expulsion of the stones left for passage.


PubMed | Taksim Teaching Hospital
Type: Journal Article | Journal: Urological research | Year: 2012

We investigated whether previous intraureteral manipulations had an effect on the stone-free rates (SFR) after semi-rigid ureteroscopy (URS) with pneumatic lithotripsy. A retrospective review of all patients who were treated for ureteral stones at two different institutions from June 2003 through January 2010 was performed. Data of 161 URS procedures were analyzed. Stone size, location (distal, mid and proximal) and number (single and multiple), patient demographics and previous intraureteral manipulations were recorded. Patients were grouped as having undergone a previous ipsilateral intraureteral manipulation (Group 1) or not (Group 2). Stone location and number, stone clearance and ancillary procedures were compared. There were no significant differences between Group 1 versus Group 2 for age (p > 0.05), gender (p > 0.05), stone site (p > 0.05) and stone size (p > 0.05). Stones with multiple locations were more frequent in Group 1 (18.5%); however, the difference did not reach statistical significance between the two groups. Similarly, the frequency of multiple stones was also higher in Group 1 (29.6%). Stone site, diameter and gender were comparable in both groups. Stone-free rate of all patients was 84.6% after the first intervention. This rate increased to 98.1% after secondary procedures. Univariate analysis revealed that SFR after URS were low in patients who underwent previous intraureteral manipulations (Group 1:55.6% vs. Group 2:89.1%). SFR after the first intervention were related with stone size, location and number. Additionally, multiple logistic regression analysis indicated a relationship between previous intraureteral manipulations and initial stone clearance rates. Spontaneous passage of stone fragments after URS was associated with stone burden, location, number and previous intraureteral manipulations. Further multiple logistic regression analysis showed that only previous intraureteral manipulations were associated with the expulsion of the stones left for passage.

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