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.
It is still unknown whether switching the bacillus Calmette-Guérin (BCG) strain at the second ind... more It is still unknown whether switching the bacillus Calmette-Guérin (BCG) strain at the second induction course of BCG therapy has a therapeutic benefit in patients with tumor recurrence after the initial BCG therapy (BCG-relapsing tumor). Materials and methods: We retrospectively reviewed the clinicopathological features of 97 patients treated with a second induction course of BCG therapy between 1986 and 2014. Among the patients initially treated with BCG Tokyo-172, the second course was either BCG Tokyo-172 in 56 (57.8%) or BCG Connaught in 15 (15.5%). Among those who were initially treated with BCG Connaught, the corresponding numbers were 13 (13.4%) or 13 (13.4%), respectively. Twenty-eight (28.9%) patients were given a different BCG strain at the 2 BCG therapies (switching group), and 69 (71.1%) patients were given the same BCG strain (non-switching group). Result: The 5-year recurrence-free survival rate of the switching group was 64.7 ± 9.6%, which was not significantly different from that of the non-switching group (54.8 ± 6.9%, P ¼ 0.427). Switching or not switching the BCG strain was not significantly associated with tumor recurrence after the second BCG therapy. The 5-year progression-free survival rate of the switching group was 95.4 ± 2.6%, which was also not significantly different from that of the non-switching group (96.0 ± 3.9%, P ¼ 0.674). Patients treated with BCG Tokyo-172 to Tokyo-172 had significantly higher incidences of side effects during the second BCG therapy. Conclusions: The results of this study indicate that in patients with a BCG-relapsing tumor after the initial BCG therapy, the same BCG strain as that administered at the initial BCG therapy could be utilized effectively for the second BCG therapy. Patients treated with BCG Tokyo-172 for an initial tumor had a higher incidence of side effects during the second BCG therapy using the same strain.
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.
Objectives: To evaluate the relationship between preoperative high sensitive C-reactive protein (... more Objectives: To evaluate the relationship between preoperative high sensitive C-reactive protein (hs-CRP) and procalcitonin (PCT) levels with the two important prognostic factors, tumor stage and tumor grade, in patients with clear cell renal cell carcinoma (RCC). Methods: We evaluated 116 clear cell RCC patients who had undergone either radical or partial nephrectomy at Ankara University, Department of Urology between November 2011 and June 2014. Comparison of hs-CRP and PCT levels between the subgroups of pathological stage and nuclear grade were evaluated. The cut off value for hs-CRP and PCT was determined by receiver-operating characteristic (ROC) analysis. Results: Median levels of hs-CRP and PCT levels of the patients were 0.818 mg/L and 0.0825 ng/mL, respectively. Hs-CRP levels of pT 1 stage patients was found to be lower compared to the pT 3-4 group (p = 0.016). Median hs-CRP levels of the grade 1-2 group was found to be significantly lower compared to the grade 3-4 group (p = 0.0001). The difference of median PCT levels between stage pT 1 vs. pT 2 (p = 0.003) and stage pT 1 vs. pT 3-4 (p = 0.0001) were statistically significant. Regarding Fuhrman grade, median PCT levels of Fuhrman grade 1-2 patients were significantly lower compared to grade 3-4 patients (p = 0.001). To predict higher Fuhrman grade of the tumor (grade 3-4), ROC analysis was performed and cut off values of 0.645 mg/L and 0.087 ng/mL were detected for hs-CRP and PCT, respectively. Conclusion: High preoperative serum hs-CRP and PCT values may play a role in the prognostic stratification of localized clear cell RCC patients. Further prospective validation is required prior to recommendation regarding suitability as biomarkers for RCC clinical prediction.
Introduction: Triple D score was recently developed for prediction of extracorporeal shockwave li... more Introduction: Triple D score was recently developed for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes. However, it has not been validated. SWL in elderly patients results in lower success and higher complication rates. We aimed at externally validating Triple D score in a population ‡65 years of age. Patients and Methods: We retrospectively analyzed the data of 182 patients ‡65 years of age who underwent SWL for renal or ureteral stones and were evaluated with non-contrast computed tomography before SWL. Stone volume (SV), skin-to-stone distance (SSD), and stone density were measured, and cutoff values were determined with receiver operator characteristic analysis. Triple D scores were calculated, and success rates were determined for each score. Results: Mean SV, SSD, and stone density values were significantly higher in patients with failed outcomes compared with those with successful outcomes in both renal and ureteral cases. Cutoff values of 187.5 mm 3 , 10.5 cm, and 675 HU for renal stones and of 185 mm 3 , 11.5 cm, and 785 HU for ureteral stones were detected. Success rates of 95.5% and 95% were detected for patients with a Triple D score of 3 in the renal and ureteral stone groups, respectively. Success rates of patients with a Triple D score of 0 were 20% and 25% in the renal and ureteral stone groups, respectively. Conclusions: Triple D score correlated well with SWL outcomes in patients ‡65 years of age, and it is externally validated. Various factors may deal with cutoff levels of involved parameters. Therefore, we suggest that each institution determines its unique cutoff levels for SV, SSD, and stone density parameters and calculates the Triple D score for its patients with respect to these cutoff levels to predict the success after SWL and aid in decision making.
Purpose: We evaluated whether stress levels in children and parents during radiological evaluatio... more Purpose: We evaluated whether stress levels in children and parents during radiological evaluation after febrile urinary tract infection are really lower using the top-down approach, where 99m technetium dimercaptosuccinic acid renal scintigraphy is used initially, than the bottom-up approach, where voiding cystourethrography is initially performed and repeated examinations are easier for all. Materials and Methods: We prospectively evaluated 120 children 3 to 8 years old. Pain ratings were obtained using the Faces Pain Scale-Revised, and conversation during the procedure was evaluated using the Child-Adult Medical Procedure Interaction Scale-Revised by 2 independent observers. To evaluate parental anxiety, the State-Trait Anxiety Inventory form was also completed. Following a documented febrile urinary tract infection children were randomized to the top-down or bottom-up group. A third group of 44 children undergoing repeat voiding cystourethrography and their parents were also evaluated. Results: Child ratings of pain using the Faces Pain Scale-Revised were not significantly different between the top-down group following 99m technetium dimercaptosuccinic acid renal scintigraphy (2.99 on a scale of 10) and the bottom-up group following voiding cystourethrography (3.21). Also the Faces Pain Scale-Revised was not significantly different in the repeat voiding cystourethrography group (3.35). On the Child-Adult Medical Procedure Interaction Scale-Revised there was negative correlation between child coping and child distress, as well as rate of child distress and adult coping promoting behavior. Parental state anxiety scores were significantly less in the top-down and repeat voiding cystourethrography groups than in the bottom-up group. Conclusions: Although the top-down approach and repeat voiding cystourethrography cause less anxiety for caregivers, these values do not correlate to pain scale in children. This finding might be due to lack of appropriate evaluation tools of pediatric pain and anxiety. However, the theory that the top-down approach is less invasive, and thus less stressful, requires further research. The Child-Adult Medical Procedure Interaction Scale-Revised data indicate that influences in adult-child interaction are bidirectional.
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.
Extracorporeal shock wave lithotripsy has proved to be an effective method of treating upper urin... more Extracorporeal shock wave lithotripsy has proved to be an effective method of treating upper urinary tract calculi. We report on 14 patients 17 years old or younger who were treated with the Dornier lithotriptor. Special adjustments of the gantry and water level, as well as shielding of the lungs, were necessary in those children less than 135 cm. in height or 30 kg. in weight. Hospital stay averaged 2.5 days and ranged from 1 to 6 days. There were no major intraoperative complications. Postoperative pulmonary edema developed in 1 patient and only 3 required parenteral analgesics for postoperative pain control. Of the 12 patients for whom a 3-month followup is available 10 are free of stone. One patient required ureterolithotomy for removal of impacted stone fragments. We conclude that extracorporeal shock wave lithotripsy is a safe and effective method of treating renal calculi in children.
OBJECTIVES To evaluate, in a retrospective, single-center trial, our open prostatectomy outcomes ... more OBJECTIVES To evaluate, in a retrospective, single-center trial, our open prostatectomy outcomes and complications in the past 12 years to emphasize the feasibility of open prostatectomy for large prostates. METHODS A total of 1193 patients underwent open prostatectomy from 1995 to 2007. We retrospectively analyzed the data from 664 patients who had preoperative, operative, and postoperative data available. RESULTS The mean patient age was 67.5 years (range 52-86). The mean preoperative prostate-specific antigen value was 9.6 ng/mL (range 1.65-45.6). The mean prostatic weight was 88.7 g (range 45-324) and was significantly different for the 1995-2001 and 2002-2007 groups (73.6 vs 98.2 g, respectively). Of the 664 patients, 208 (31%) had had an indwelling catheter before surgery. The average International Prostate Symptom Score was 21.7 (range 13-32) preoperatively and 10.6 (range 8-18) postoperatively (P Ͻ.005). The average hospitalization was 6.74 days (range 4-14). Blood transfusion was required in 12.7% of the patients either intraoperatively or postoperatively. Postoperatively, 82 patients (12.3%) had urinary tract infections, 22 (3.2%) had bladder neck obstruction, 5 (0.7%) had urinary incontinence, and 15 (2.3%) had a ureteral meatus stricture. CONCLUSIONS Open prostatectomy is a feasible treatment option for patients with a large prostate and also for patients with additional bladder pathologic findings such as bladder calculi or diverticula for whom endoscopic treatment modalities are not appropriate. Consequently, open prostatectomy is still the primary option for patients with a prostate greater than 100 cm 3 and preserves its importance in urology practice, even in the presence of endoscopic innovations. UROLOGY 72:
Sleep Slow Oscillations (SSOs), paradigmatic EEG markers of cortical bistability (alternation bet... more Sleep Slow Oscillations (SSOs), paradigmatic EEG markers of cortical bistability (alternation between cellular downstates and upstates), and sleep spindles, paradigmatic EEG markers of thalamic rhythm, are two hallmarks of sleeping brain. Selective thalamic lesions are reportedly associated to reductions of spindle activity and its spectrum~14 Hz (sigma), and to alterations of SSO features. This apparent, parallel behavior suggests that thalamo-cortical entrainment favors cortical bistability. Here we investigate temporally-causal associations between thalamic sigma activity and shape, topology, and dynamics of SSOs. We recorded sleep EEG and studied whether spatio-temporal variability of SSO amplitude, negative slope (synchronization in downstate falling) and detection rate are driven by cortical-sigma-activity expression (12-18 Hz), in 3 consecutive 1 s-EEG-epochs preceding each SSO event (Baselines). We analyzed: (i) spatial variability, comparing maps of baseline sigma power and of SSO features, averaged over the first sleep cycle; (ii) event-by-event shape variability, computing for each electrode correlations between baseline sigma power and amplitude/slope of related SSOs; (iii) eventby-event spreading variability, comparing baseline sigma power in electrodes showing an SSO event with the homologous ones, spared by the event. The scalp distribution of baseline sigma power mirrored those of SSO amplitude and slope; event-by-event variability in baseline sigma power was associated with that in SSO amplitude in fronto-central areas; within each SSO event, electrodes involved in cortical bistability presented higher baseline sigma activity than those free of SSO. In conclusion, spatio-temporal variability of thalamocortical entrainment, measured by background sigma activity, is a reliable estimate of the cortical proneness to bistability.
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.
It is still unknown whether switching the bacillus Calmette-Guérin (BCG) strain at the second ind... more It is still unknown whether switching the bacillus Calmette-Guérin (BCG) strain at the second induction course of BCG therapy has a therapeutic benefit in patients with tumor recurrence after the initial BCG therapy (BCG-relapsing tumor). Materials and methods: We retrospectively reviewed the clinicopathological features of 97 patients treated with a second induction course of BCG therapy between 1986 and 2014. Among the patients initially treated with BCG Tokyo-172, the second course was either BCG Tokyo-172 in 56 (57.8%) or BCG Connaught in 15 (15.5%). Among those who were initially treated with BCG Connaught, the corresponding numbers were 13 (13.4%) or 13 (13.4%), respectively. Twenty-eight (28.9%) patients were given a different BCG strain at the 2 BCG therapies (switching group), and 69 (71.1%) patients were given the same BCG strain (non-switching group). Result: The 5-year recurrence-free survival rate of the switching group was 64.7 ± 9.6%, which was not significantly different from that of the non-switching group (54.8 ± 6.9%, P ¼ 0.427). Switching or not switching the BCG strain was not significantly associated with tumor recurrence after the second BCG therapy. The 5-year progression-free survival rate of the switching group was 95.4 ± 2.6%, which was also not significantly different from that of the non-switching group (96.0 ± 3.9%, P ¼ 0.674). Patients treated with BCG Tokyo-172 to Tokyo-172 had significantly higher incidences of side effects during the second BCG therapy. Conclusions: The results of this study indicate that in patients with a BCG-relapsing tumor after the initial BCG therapy, the same BCG strain as that administered at the initial BCG therapy could be utilized effectively for the second BCG therapy. Patients treated with BCG Tokyo-172 for an initial tumor had a higher incidence of side effects during the second BCG therapy using the same strain.
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.
Objectives: To evaluate the relationship between preoperative high sensitive C-reactive protein (... more Objectives: To evaluate the relationship between preoperative high sensitive C-reactive protein (hs-CRP) and procalcitonin (PCT) levels with the two important prognostic factors, tumor stage and tumor grade, in patients with clear cell renal cell carcinoma (RCC). Methods: We evaluated 116 clear cell RCC patients who had undergone either radical or partial nephrectomy at Ankara University, Department of Urology between November 2011 and June 2014. Comparison of hs-CRP and PCT levels between the subgroups of pathological stage and nuclear grade were evaluated. The cut off value for hs-CRP and PCT was determined by receiver-operating characteristic (ROC) analysis. Results: Median levels of hs-CRP and PCT levels of the patients were 0.818 mg/L and 0.0825 ng/mL, respectively. Hs-CRP levels of pT 1 stage patients was found to be lower compared to the pT 3-4 group (p = 0.016). Median hs-CRP levels of the grade 1-2 group was found to be significantly lower compared to the grade 3-4 group (p = 0.0001). The difference of median PCT levels between stage pT 1 vs. pT 2 (p = 0.003) and stage pT 1 vs. pT 3-4 (p = 0.0001) were statistically significant. Regarding Fuhrman grade, median PCT levels of Fuhrman grade 1-2 patients were significantly lower compared to grade 3-4 patients (p = 0.001). To predict higher Fuhrman grade of the tumor (grade 3-4), ROC analysis was performed and cut off values of 0.645 mg/L and 0.087 ng/mL were detected for hs-CRP and PCT, respectively. Conclusion: High preoperative serum hs-CRP and PCT values may play a role in the prognostic stratification of localized clear cell RCC patients. Further prospective validation is required prior to recommendation regarding suitability as biomarkers for RCC clinical prediction.
Introduction: Triple D score was recently developed for prediction of extracorporeal shockwave li... more Introduction: Triple D score was recently developed for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes. However, it has not been validated. SWL in elderly patients results in lower success and higher complication rates. We aimed at externally validating Triple D score in a population ‡65 years of age. Patients and Methods: We retrospectively analyzed the data of 182 patients ‡65 years of age who underwent SWL for renal or ureteral stones and were evaluated with non-contrast computed tomography before SWL. Stone volume (SV), skin-to-stone distance (SSD), and stone density were measured, and cutoff values were determined with receiver operator characteristic analysis. Triple D scores were calculated, and success rates were determined for each score. Results: Mean SV, SSD, and stone density values were significantly higher in patients with failed outcomes compared with those with successful outcomes in both renal and ureteral cases. Cutoff values of 187.5 mm 3 , 10.5 cm, and 675 HU for renal stones and of 185 mm 3 , 11.5 cm, and 785 HU for ureteral stones were detected. Success rates of 95.5% and 95% were detected for patients with a Triple D score of 3 in the renal and ureteral stone groups, respectively. Success rates of patients with a Triple D score of 0 were 20% and 25% in the renal and ureteral stone groups, respectively. Conclusions: Triple D score correlated well with SWL outcomes in patients ‡65 years of age, and it is externally validated. Various factors may deal with cutoff levels of involved parameters. Therefore, we suggest that each institution determines its unique cutoff levels for SV, SSD, and stone density parameters and calculates the Triple D score for its patients with respect to these cutoff levels to predict the success after SWL and aid in decision making.
Purpose: We evaluated whether stress levels in children and parents during radiological evaluatio... more Purpose: We evaluated whether stress levels in children and parents during radiological evaluation after febrile urinary tract infection are really lower using the top-down approach, where 99m technetium dimercaptosuccinic acid renal scintigraphy is used initially, than the bottom-up approach, where voiding cystourethrography is initially performed and repeated examinations are easier for all. Materials and Methods: We prospectively evaluated 120 children 3 to 8 years old. Pain ratings were obtained using the Faces Pain Scale-Revised, and conversation during the procedure was evaluated using the Child-Adult Medical Procedure Interaction Scale-Revised by 2 independent observers. To evaluate parental anxiety, the State-Trait Anxiety Inventory form was also completed. Following a documented febrile urinary tract infection children were randomized to the top-down or bottom-up group. A third group of 44 children undergoing repeat voiding cystourethrography and their parents were also evaluated. Results: Child ratings of pain using the Faces Pain Scale-Revised were not significantly different between the top-down group following 99m technetium dimercaptosuccinic acid renal scintigraphy (2.99 on a scale of 10) and the bottom-up group following voiding cystourethrography (3.21). Also the Faces Pain Scale-Revised was not significantly different in the repeat voiding cystourethrography group (3.35). On the Child-Adult Medical Procedure Interaction Scale-Revised there was negative correlation between child coping and child distress, as well as rate of child distress and adult coping promoting behavior. Parental state anxiety scores were significantly less in the top-down and repeat voiding cystourethrography groups than in the bottom-up group. Conclusions: Although the top-down approach and repeat voiding cystourethrography cause less anxiety for caregivers, these values do not correlate to pain scale in children. This finding might be due to lack of appropriate evaluation tools of pediatric pain and anxiety. However, the theory that the top-down approach is less invasive, and thus less stressful, requires further research. The Child-Adult Medical Procedure Interaction Scale-Revised data indicate that influences in adult-child interaction are bidirectional.
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.
Extracorporeal shock wave lithotripsy has proved to be an effective method of treating upper urin... more Extracorporeal shock wave lithotripsy has proved to be an effective method of treating upper urinary tract calculi. We report on 14 patients 17 years old or younger who were treated with the Dornier lithotriptor. Special adjustments of the gantry and water level, as well as shielding of the lungs, were necessary in those children less than 135 cm. in height or 30 kg. in weight. Hospital stay averaged 2.5 days and ranged from 1 to 6 days. There were no major intraoperative complications. Postoperative pulmonary edema developed in 1 patient and only 3 required parenteral analgesics for postoperative pain control. Of the 12 patients for whom a 3-month followup is available 10 are free of stone. One patient required ureterolithotomy for removal of impacted stone fragments. We conclude that extracorporeal shock wave lithotripsy is a safe and effective method of treating renal calculi in children.
OBJECTIVES To evaluate, in a retrospective, single-center trial, our open prostatectomy outcomes ... more OBJECTIVES To evaluate, in a retrospective, single-center trial, our open prostatectomy outcomes and complications in the past 12 years to emphasize the feasibility of open prostatectomy for large prostates. METHODS A total of 1193 patients underwent open prostatectomy from 1995 to 2007. We retrospectively analyzed the data from 664 patients who had preoperative, operative, and postoperative data available. RESULTS The mean patient age was 67.5 years (range 52-86). The mean preoperative prostate-specific antigen value was 9.6 ng/mL (range 1.65-45.6). The mean prostatic weight was 88.7 g (range 45-324) and was significantly different for the 1995-2001 and 2002-2007 groups (73.6 vs 98.2 g, respectively). Of the 664 patients, 208 (31%) had had an indwelling catheter before surgery. The average International Prostate Symptom Score was 21.7 (range 13-32) preoperatively and 10.6 (range 8-18) postoperatively (P Ͻ.005). The average hospitalization was 6.74 days (range 4-14). Blood transfusion was required in 12.7% of the patients either intraoperatively or postoperatively. Postoperatively, 82 patients (12.3%) had urinary tract infections, 22 (3.2%) had bladder neck obstruction, 5 (0.7%) had urinary incontinence, and 15 (2.3%) had a ureteral meatus stricture. CONCLUSIONS Open prostatectomy is a feasible treatment option for patients with a large prostate and also for patients with additional bladder pathologic findings such as bladder calculi or diverticula for whom endoscopic treatment modalities are not appropriate. Consequently, open prostatectomy is still the primary option for patients with a prostate greater than 100 cm 3 and preserves its importance in urology practice, even in the presence of endoscopic innovations. UROLOGY 72:
Sleep Slow Oscillations (SSOs), paradigmatic EEG markers of cortical bistability (alternation bet... more Sleep Slow Oscillations (SSOs), paradigmatic EEG markers of cortical bistability (alternation between cellular downstates and upstates), and sleep spindles, paradigmatic EEG markers of thalamic rhythm, are two hallmarks of sleeping brain. Selective thalamic lesions are reportedly associated to reductions of spindle activity and its spectrum~14 Hz (sigma), and to alterations of SSO features. This apparent, parallel behavior suggests that thalamo-cortical entrainment favors cortical bistability. Here we investigate temporally-causal associations between thalamic sigma activity and shape, topology, and dynamics of SSOs. We recorded sleep EEG and studied whether spatio-temporal variability of SSO amplitude, negative slope (synchronization in downstate falling) and detection rate are driven by cortical-sigma-activity expression (12-18 Hz), in 3 consecutive 1 s-EEG-epochs preceding each SSO event (Baselines). We analyzed: (i) spatial variability, comparing maps of baseline sigma power and of SSO features, averaged over the first sleep cycle; (ii) event-by-event shape variability, computing for each electrode correlations between baseline sigma power and amplitude/slope of related SSOs; (iii) eventby-event spreading variability, comparing baseline sigma power in electrodes showing an SSO event with the homologous ones, spared by the event. The scalp distribution of baseline sigma power mirrored those of SSO amplitude and slope; event-by-event variability in baseline sigma power was associated with that in SSO amplitude in fronto-central areas; within each SSO event, electrodes involved in cortical bistability presented higher baseline sigma activity than those free of SSO. In conclusion, spatio-temporal variability of thalamocortical entrainment, measured by background sigma activity, is a reliable estimate of the cortical proneness to bistability.
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