Parviz Hajiyev*, Berk Burgu, Evren Suer, Yusuf Kibar, Ankara, Turkey; Mesrur Selcuk Silay, Istanb... more Parviz Hajiyev*, Berk Burgu, Evren Suer, Yusuf Kibar, Ankara, Turkey; Mesrur Selcuk Silay, Istanbul, Turkey; Serhat Gurocak, Hasan Serkan Dogan, Hasan Cem Irkilata Irkilata, Ankara, Turkey; Tayfun Oktar, Bulent Onal, Istanbul, Turkey; Erim Erdem, Mersin, Turkey; Yuksel Cem Aygul, Ankara, Turkey; Cem Balcý, Ahmet Ruknettin Aslan, Istanbul, Turkey; Tarkan Soygur, Ankara, Turkey; Þaban Sarýkaya, Samsun, Turkey; Serdar Tekgul, Ankara, Turkey
Gunshot injuries of the bladder are uncommon. Penetrating injuries of the bladder are usually man... more Gunshot injuries of the bladder are uncommon. Penetrating injuries of the bladder are usually managed by the removal of the bullet and closure of the perforation. A 35-year-old man visited our clinic with acute urinary retention. The patient reported a gunshot injury previously with a small caliber bullet which could not be found and therefore be removed. A bullet was detected in the bladder radiologically and removed endoscopically. Various foreign bodies can exhibit bladder erosion in a similar manner. Although the data is scanty, retained bullets adjacent to the bladder have a risk of late migration and urinary retention. Adjacent foreign bodies to the bladder may migrate and cause lower urinary tract symptoms and retained bullets can be a rare cause of acute urinary retention.
ABSTRACT Purpose We evaluated the pre and postoperative videourodynamic(VUD) results of children ... more ABSTRACT Purpose We evaluated the pre and postoperative videourodynamic(VUD) results of children with high pressure low compliant bladders and vesicoureteral reflux (VUR) who underwent augmentation cystoplasty without antireflux surgery. We hypothesized that not always bad preoperative bladder dynamics are to blame for the associated VUR. VUR persists despite successful augmentation in some. We tried to find objective urodynamic criteria where antireflux surgery might potentially be necessary to avoid persisting VUR. Material and methods 19 meningomyelocele patients with hypocompliant overactive bladder and associated high gradeVUR with a mean age of 11.4 years(5-21) underwent ileocystoplasty alone. Bladder outlet procedures, previous operation and persitent night-time drainage were excluded. Bladders were assessed preoperatively and sixth months postoperatively by multicycleVUDs Results VUR persisted in 9 patients despite a low pressure, compliant bladder being achieved. In these, VUR started at lower volumes with a mean of 29.6ml;(19-52ml) and lower pressures with a mean of 14.6cm-H20(9.6-25). Whereas in patients with no persistent VUR, it started at higher pressures (mean 49 cm-H20)(33-68). When preoperative VUD findings were retrospectively analysed, VUR started at lower volumes (mean14.8ml; 8-33) and intravesical pressures (mean7.8 cm-H20; 4 -17) in these 9 patients when compared to cases with resolved VUR Conclusions Preoperative VUD findings might be a predictor for resolution of VUR after augmentation. If VUR starts at low pressures, it is very likely to persist after augmentation. In these patients VUR should be corrected during augmentation. Further urodynamic cut off values for reimplantation would be useful to predict the outcome and thus the approach to VUR during augmentation.
Purpose: To investigate the prognostic role of time to castration resistance(TTCR) in patients wh... more Purpose: To investigate the prognostic role of time to castration resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for castration resistant prostate cancer(CRPC). Methods: Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC were gath-ered. Patients were divided into three groups according to TTCR: Group 1(? 12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded. Result: The mean age of the 162 patients was 74.4 ± 8.5 years. Data on mean age, type of castration, adding estra-mustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. PSA values were higher in group 1 than other groups. PSA response to docetaxel was 59.2% in all patient and it was worse in group 1 than other groups (P = .009). Two years overall survival rates were 7.6%, 25% and 32.3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=.016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment. Conclusion: TTCR appears to be an independent prognostic factor for patients who are candidates for DCR.
To determine preoperative predictive factors of postoperative complications of ureteric re-implan... more To determine preoperative predictive factors of postoperative complications of ureteric re-implantation in children by using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical procedures. In all, 383 children who underwent ureteric re-implantation for vesico-ureteric reflux (VUR) and obstructing megaureters between 2002 and 2011 were included in the study. Intravesical and extravesical ureteric re-implantations were performed in 338 and 45 children, respectively. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. In all, 247 girls and 136 boys were studied. The mean (sd) age was 46 (25) months and the mean (sd) follow-up was 49.4 (27.8) months. The mean (sd) hospitalisation time was 4.7 (1.6) days. Complications occurred in 76 (19.8%) children; 34 (8.9%) were MCCS grade I, 22 (5.7%) were grade II and 20 (5.2%) were grade III. Society of Fetal Urology (SFU) grade 3-4 hydronephrosis, obstructing megaureters, a tailoring-tapering and folding procedure, refractory voiding dysfunction and a duplex system were statistically significant predictors of complications on univariate analysis. Prior injection history, paraureteric diverticula, stenting, gender, age, operation technique (intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and a duplex system were statistically significant predictors of complications. Ureteric re-implantation remains a valid option for the treatment of certain patients with VUR. Refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and associated duplex systems were the main predictive factors for postoperative complications. Use of a standardised complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.
Although the role of second transurethral resection of bladder tumor (TURB) is well established i... more Although the role of second transurethral resection of bladder tumor (TURB) is well established in high-risk non-muscle-invasive bladder cancer, to the best of our knowledge, there is no study regarding the role of a second transurethral resection (TUR) after a complete first TURB in multimodal therapy (MMT). The aim of this study was to evaluate the role of a second TUR on disease-specific survival (DSS) and overall survival (OS) rates in muscle-invasive bladder cancer (MIBC) patients who were treated with MMT. We assessed the data of 90 patients (stage T2-4, N0-1, M0 urothelial cancer) who were treated with MMT at our clinic between January 2000 and June 2014. Patients with incomplete initial TURB were excluded. A total of 43 patients had a second TUR before starting radiochemotherapy of MMT (group 1), and 47 patients (group 2) were treated with MMT without having a second TUR. The impact of second TUR on DSS and OS rates was the primary outcome measure of the study. Mean (SD, range) age and mean follow-up of the patients were 65.1 (7.1, 52-81) years and 60.3 (38.3, 6-159) months, respectively. The two groups were similar with regard to sex, age, presence of hydronephrosis, lymph node involvement and stage. The 5-year DSS rate was better in group 1 compared to group 2 (68 vs. 41 %) (p = 0.046). The 5-year OS rates of the patients were 63.7 and 40.1 % in groups 1 and 2, respectively (p = 0.054). Multivariate analysis revealed that second TUR, lymph node involvement, presence of hydronephrosis and tumor stage were independent prognostic factors for DSS. Second TUR should be performed in patients with MIBC who are going to be treated with bladder-preserving MMT protocols.
Parviz Hajiyev*, Berk Burgu, Evren Suer, Yusuf Kibar, Ankara, Turkey; Mesrur Selcuk Silay, Istanb... more Parviz Hajiyev*, Berk Burgu, Evren Suer, Yusuf Kibar, Ankara, Turkey; Mesrur Selcuk Silay, Istanbul, Turkey; Serhat Gurocak, Hasan Serkan Dogan, Hasan Cem Irkilata Irkilata, Ankara, Turkey; Tayfun Oktar, Bulent Onal, Istanbul, Turkey; Erim Erdem, Mersin, Turkey; Yuksel Cem Aygul, Ankara, Turkey; Cem Balcý, Ahmet Ruknettin Aslan, Istanbul, Turkey; Tarkan Soygur, Ankara, Turkey; Þaban Sarýkaya, Samsun, Turkey; Serdar Tekgul, Ankara, Turkey
Gunshot injuries of the bladder are uncommon. Penetrating injuries of the bladder are usually man... more Gunshot injuries of the bladder are uncommon. Penetrating injuries of the bladder are usually managed by the removal of the bullet and closure of the perforation. A 35-year-old man visited our clinic with acute urinary retention. The patient reported a gunshot injury previously with a small caliber bullet which could not be found and therefore be removed. A bullet was detected in the bladder radiologically and removed endoscopically. Various foreign bodies can exhibit bladder erosion in a similar manner. Although the data is scanty, retained bullets adjacent to the bladder have a risk of late migration and urinary retention. Adjacent foreign bodies to the bladder may migrate and cause lower urinary tract symptoms and retained bullets can be a rare cause of acute urinary retention.
ABSTRACT Purpose We evaluated the pre and postoperative videourodynamic(VUD) results of children ... more ABSTRACT Purpose We evaluated the pre and postoperative videourodynamic(VUD) results of children with high pressure low compliant bladders and vesicoureteral reflux (VUR) who underwent augmentation cystoplasty without antireflux surgery. We hypothesized that not always bad preoperative bladder dynamics are to blame for the associated VUR. VUR persists despite successful augmentation in some. We tried to find objective urodynamic criteria where antireflux surgery might potentially be necessary to avoid persisting VUR. Material and methods 19 meningomyelocele patients with hypocompliant overactive bladder and associated high gradeVUR with a mean age of 11.4 years(5-21) underwent ileocystoplasty alone. Bladder outlet procedures, previous operation and persitent night-time drainage were excluded. Bladders were assessed preoperatively and sixth months postoperatively by multicycleVUDs Results VUR persisted in 9 patients despite a low pressure, compliant bladder being achieved. In these, VUR started at lower volumes with a mean of 29.6ml;(19-52ml) and lower pressures with a mean of 14.6cm-H20(9.6-25). Whereas in patients with no persistent VUR, it started at higher pressures (mean 49 cm-H20)(33-68). When preoperative VUD findings were retrospectively analysed, VUR started at lower volumes (mean14.8ml; 8-33) and intravesical pressures (mean7.8 cm-H20; 4 -17) in these 9 patients when compared to cases with resolved VUR Conclusions Preoperative VUD findings might be a predictor for resolution of VUR after augmentation. If VUR starts at low pressures, it is very likely to persist after augmentation. In these patients VUR should be corrected during augmentation. Further urodynamic cut off values for reimplantation would be useful to predict the outcome and thus the approach to VUR during augmentation.
Purpose: To investigate the prognostic role of time to castration resistance(TTCR) in patients wh... more Purpose: To investigate the prognostic role of time to castration resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for castration resistant prostate cancer(CRPC). Methods: Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC were gath-ered. Patients were divided into three groups according to TTCR: Group 1(? 12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded. Result: The mean age of the 162 patients was 74.4 ± 8.5 years. Data on mean age, type of castration, adding estra-mustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. PSA values were higher in group 1 than other groups. PSA response to docetaxel was 59.2% in all patient and it was worse in group 1 than other groups (P = .009). Two years overall survival rates were 7.6%, 25% and 32.3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=.016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment. Conclusion: TTCR appears to be an independent prognostic factor for patients who are candidates for DCR.
To determine preoperative predictive factors of postoperative complications of ureteric re-implan... more To determine preoperative predictive factors of postoperative complications of ureteric re-implantation in children by using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical procedures. In all, 383 children who underwent ureteric re-implantation for vesico-ureteric reflux (VUR) and obstructing megaureters between 2002 and 2011 were included in the study. Intravesical and extravesical ureteric re-implantations were performed in 338 and 45 children, respectively. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. In all, 247 girls and 136 boys were studied. The mean (sd) age was 46 (25) months and the mean (sd) follow-up was 49.4 (27.8) months. The mean (sd) hospitalisation time was 4.7 (1.6) days. Complications occurred in 76 (19.8%) children; 34 (8.9%) were MCCS grade I, 22 (5.7%) were grade II and 20 (5.2%) were grade III. Society of Fetal Urology (SFU) grade 3-4 hydronephrosis, obstructing megaureters, a tailoring-tapering and folding procedure, refractory voiding dysfunction and a duplex system were statistically significant predictors of complications on univariate analysis. Prior injection history, paraureteric diverticula, stenting, gender, age, operation technique (intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and a duplex system were statistically significant predictors of complications. Ureteric re-implantation remains a valid option for the treatment of certain patients with VUR. Refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and associated duplex systems were the main predictive factors for postoperative complications. Use of a standardised complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.
Although the role of second transurethral resection of bladder tumor (TURB) is well established i... more Although the role of second transurethral resection of bladder tumor (TURB) is well established in high-risk non-muscle-invasive bladder cancer, to the best of our knowledge, there is no study regarding the role of a second transurethral resection (TUR) after a complete first TURB in multimodal therapy (MMT). The aim of this study was to evaluate the role of a second TUR on disease-specific survival (DSS) and overall survival (OS) rates in muscle-invasive bladder cancer (MIBC) patients who were treated with MMT. We assessed the data of 90 patients (stage T2-4, N0-1, M0 urothelial cancer) who were treated with MMT at our clinic between January 2000 and June 2014. Patients with incomplete initial TURB were excluded. A total of 43 patients had a second TUR before starting radiochemotherapy of MMT (group 1), and 47 patients (group 2) were treated with MMT without having a second TUR. The impact of second TUR on DSS and OS rates was the primary outcome measure of the study. Mean (SD, range) age and mean follow-up of the patients were 65.1 (7.1, 52-81) years and 60.3 (38.3, 6-159) months, respectively. The two groups were similar with regard to sex, age, presence of hydronephrosis, lymph node involvement and stage. The 5-year DSS rate was better in group 1 compared to group 2 (68 vs. 41 %) (p = 0.046). The 5-year OS rates of the patients were 63.7 and 40.1 % in groups 1 and 2, respectively (p = 0.054). Multivariate analysis revealed that second TUR, lymph node involvement, presence of hydronephrosis and tumor stage were independent prognostic factors for DSS. Second TUR should be performed in patients with MIBC who are going to be treated with bladder-preserving MMT protocols.
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