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Öğe The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery: Postsurgical Fatty Tumor. Is It Related to the Surgical Technique?(Codon Publications, 2022) Balasar, Mehmet; Ozkent, Mehmet Serkan; Aydin, Arif; Taskapu, Hakan Hakki; Atici, Ahmet; Ecer, Gokhan; Sonmez, Mehmet GirayAfter nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as postsurgical fatty tumor. This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.Öğe The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery: Postsurgical Fatty Tumor. Is It Related to the Surgical Technique?(Codon Publications, 2022) Balasar, Mehmet; Ozkent, Mehmet Serkan; Aydin, Arif; Taskapu, Hakan Hakki; Atici, Ahmet; Ecer, Gokhan; Sonmez, Mehmet GirayAfter nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as postsurgical fatty tumor. This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.Öğe Böbrek alt kaliks taşlarının tedavisinde ve tekrar taş oluşumunda kısmi nefrektominin rolü(2003) Balasar, Mehmet; Kılınç, MehmetBöbrek taş hastalığı, tedavi edildikten sonra sık nükseden bir hastalıktır. Böbreklere lokalize taşların % 25-3 5 'ni alt kaliks taşları oluşturmaktadır. Alt kaliks taşlarının tedavisinde pek çok seçenek olmasına rağmen kısmi nefrektominin nüks oranlarını azalttığı belirtilmiştir. Selçuk Üniversitesi Meram Tıp Fakültesi Üroloji kliniğinde Ocak 1992 ile Haziran 2000 tarihleri arasında böbrek alt kaliks taşı teşhisi konan ve cerrahi tedavisi yapılan 57 hasta değerlendirildi. Böbrek anatomisi Sampaio ve arkadaşlarının tarif ettikleri şekilde standart İVP'lerle değerlendirilerek, infundibulapelvik açı, infundibulumun uzunluğu, infundibulumun derinliği ölçüldü. Alt pol nefrektomisi yapılan 29 hasta ile, pyelolitotomi, nefrolitotomi ve pyelonefrolitotomi yapılan 28 hasta ortalama 79 ay takip edildi. Kısmi nefrektomi yapılan hastaların ameliyat öncesi ölçülen infundibulapelvik açı ortalamaları 57 dereceden ameliyat sonrası 108 dereceye yükselirken pyelolitotomi, nefrolitotomi ve pyelonefrolitotomi yapılan hastalarda ortalama açı değerlerinde farklılık gözlenmedi. Alt pol nefrektomisi yapılan hastalarda 78 aylık takip sonucu taş nüksü oranı % 10, pyelolitotomi, nefrolitotomi ve pyelonefrolitotomi yapılan hastalarda ise 80 aylık takip sonucu % 21 idi. Kısmi nefrektomi ile alt kaliks taşı oluşumuna neden olan anatomik faktörün ortadan kaldırılması ile takiplerdeki taş nüks oranlarının azalması sağlanmaktadır.Öğe Böbrek taşı olan ve olmayan hastaların idrar kültürlerinde üreyen etkenler ve antibiyotik duyarlılıkları(2015) Balasar, Mehmet; Kandemir, Abdülkadir; Doğan, Metin; Ünlü, Mahmud Zahid; Pişkin, Mehmet MesutAmaç: Bu çalışmada, üroloji polikliniğine idrar yolu infeksiyon semptomları ile başvuran, görüntüleme tetkiklerinde böbrek taşı tespit edilen ve edilmeyen hasta gruplarının idrar kültürlerinde üreyen etken ve antibiyogram duyarlılık sonuçlarının karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Kasım 2010 - Haziran 2013 tarihleri arasında üroloji polikliniğine idrar yolu infeksiyon semptomları ile başvuran 15-50 yaş arası hastalardan alınan idrar örnekleri Merkez Mikrobiyoloji Laboratuarında mikrobiyolojik açıdan değerlendirildi. Laboratuar bilgi sistemi veritabanından tarama yapılarak idrar kültürlerinde 105 koloni üzerinde bakteri üremesi olan hastaların idrar örnekleri çalışmaya dâhil edildi. Hastalar böbrek taşı olan (Grup I) ve olmayan (Grup II) olarak 2 gruba ayrıldı. Mikroorganizmaların tanımlanması ve antibiyotik duyarlılıkları tam otomatik cihaz ile yapıldı. Bulgular: Çalışmaya toplam 2882 hastanın idrar kültür sonuçları dâhil edildi. İdrar kültürlerinin 441 (%15.3)inde 105 koloni üzerinde bakteri üremesi tespit edildi. Bunların 119 (%27)u Grup I, 322 (%73)si Grup IIye ait sonuçlar idi. Grup Ideki hastalarda Acinetobacter spp. ve Enterobacter spp., Grup IIdeki hastalarda E. coli. ve Klebsiella spp. mikroorganizmalar daha yüksek oranda izole edilmiş olup istatistiki olarak anlamlı bulunmuştur. Enterokok türü mikroorganizmaların antibiyotik duyarlılık oranlarının karşılaştırılmasında ise Grup I hastalarda, direnç oranlarındaki yükseklik siprofloksasin ve gentamisin için istatistikî olarak anlamlı bulunmuştur. Enterobactericeae türü mikroorganizmaların antibiyotik duyarlılık oranlarındaki farklılık istatistikî olarak anlamlı bulunmamıştır. İzole edilen diğer mikroorganizmaların sayısı yeterli olmadığından antibiyotik duyarlılık oranları karşılaştırılmamıştır. Sonuç: Acinetobacter gibi dirençli infeksiyon etkeni mikroorganizmaların böbrek taşı olan hastalarda daha yüksek oranda izole edildiği gözlenmiş olup, tedavi öncesinde ve tamamlanmasından sonra mikroorganizmaların tespit edilmesi ve duyarlılık testlerinin değerlendirilmesi için idrar kültürleri yapılmalıdır.Öğe Can Eosinophil Count, Platelet Count, and Mean Platelet Volume Be a Positive Predictive Factor in Penile Arteriogenic Erectile Dysfunction Etiopathogenesis?(Sage Publications Inc, 2017) Sonmez, Mehmet Giray; Goger, Yunus Emre; Sonmez, Leyla Ozturk; Aydin, Arif; Balasar, Mehmet; Kara, CengizBlood count parameters of patients referring with erectile dysfunction (ED) were examined in this study and it was investigated whether eosinophil count (EC), platelet count (PC), and mean platelet volume values among the suspected predictive parameters which may play a role in especially penile arteriogenic ED etiopathogenesis had a contribution on pathogenesis. Patients referring with ED complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function. Penile Doppler ultrasonography was taken in patients suspected to have vasculogenic ED. According to penile Doppler ultrasonography result, patients with arterial deficiency were included in the penile arteriogenic ED group and the patients with normal results were included in the nonvasculogenic ED group. A total of 36 patients participated in the study from the penile arteriogenic ED group and 32 patients from the nonvasculogenic ED group. Compared with the nonvasculogenic ED group, the penile arteriogenic ED group's low International Index of Erectile Function score, high EC, mean platelet volume and PC values were detected to be statistically significant (p < .001, p = .021, p = .018, p = .034, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells, and hemoglobin values were considered. Pansystolic volume velocities were detected as statistically significantly low compared with the nonvasculogenic ED group in the measurements made in 5th, 10th, 15th, and 20th minutes on the right and left sides in the penile arteriogenic ED group. High MPV value and PC is a significant predictive factor for penile arteriogenic ED and vasculogenic ED and high EC is specifically predictive of arteriogenic ED.Öğe Can Urinary KIM-1 and NGAL Predict Management Endoscopic Surgery in Acute Unilateral Obstructive Stone Disease? Results from a Prospective Cohort Study(Karger, 2021) Goger, Yunus Emre; Ozkent, Mehmet Serkan; Topcu, Cemile; Atici, Ahmet; Sonmez, Mehmet Giray; Balasar, Mehmet; Gurbilek, MehmetIntroduction: Kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are the leading novel biomarkers used efficiently in acute kidney injury (AKI). The levels of these biomarkers increase especially in the early period of nephrotoxic and ischemic renal damage. In this study, we aimed to investigate the clinical importance of NGAL and KIM-1 biomarkers used in the effective evaluation of kidney functions in patients with acute unilateral obstructive stone disease (AUOSD) in the management of endoscopic surgery. Materials and Methods: We prospectively included patients who underwent endoscopic surgery due to AUOSD between January 2018 and December 2019. Urine KIM-1 and NGAL values of the patients were measured preoperative period, postoperative 4th h, and postoperative 7th day. The patients were evaluated according to the location and size of the stone, the degree of renal hydronephrosis, the duration of the operation, complications, and JJ stent placement. Results: The study enrolled 50 patients. Urinary KIM-1/Cr and urinary NGAL/Cr ratios were higher in postoperative 4th h than in others (p < 0.001). Also, we found that urinary KIM-1/Cr and urinary NGAL/Cr ratios with Grade 2 and higher hydronephrosis were statistically higher than Grade 0-1 hydronephrosis (p < 0.001 and p: 0.042, respectively). Additionally, a preoperative urinary KIM-1 value of 1.24 ng/mL had a sensitivity of 78% and a specificity of 63% to predict the presence of hydronephrosis. When urine KIM-1 and NGAL results were compared with surgery time, stone size and location, serum creatinine (sCr) value, and Post-Ureteroscopic Lesion Scale grade, the difference was not statistically significant. Postoperative 7th day NGAL/Cr and KIM-1/Cr ratios were statistically higher in those with JJ stents placed (p: 0.03 and p: 0.004, respectively). Conclusion: KIM-1 and NGAL can be used in our assessment of renal function in patients with AUOSD, even if sCr is normal. Also, these biomarkers can predict the presence of hydronephrosis. It can be helpful in determining the time of surgical treatment, as well as providing information in the follow-up of patients with JJ stents after treatment.Öğe Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy(Termedia Publishing House Ltd, 2017) Poyraz, Necdet; Balasar, Mehmet; Gokmen, Ibrahim Erdem; Koc, Osman; Sonmez, Mehmet Giray; Aydin, Arif; Goger, Yunus EmreIntroduction: Percutaneous nephrolithotomy (PNL) is the preferred procedure for safe and effective surgical treatment of kidney stones. Hemorrhage is the most serious complication of PNL, resulting from pseudoaneurysm (PA) or arteriovenous fistula (AVF), and can usually be controlled with conservative treatment. Aim: To evaluate endovascular treatments and outcomes of vascular complications observed after PNL. Material and methods: We retrospectively reviewed data on 19 patients who underwent renal embolization due to post-PNL renal artery bleeding between March 2005 and September 2016. Embolization materials included embolization coils and glue. The incidence of post-PNL vascular complications and their endovascular treatments, outcomes, and the follow-up data were analyzed. Results: Nineteen (1.1%) of 1,609 patients (mean age: 44.9 years, range: 19-75 years) underwent angiography and subsequent transcatheter embolization to control bleeding. The mean time to onset of hemorrhage was 7.2 days after PNL (range: 3-18 days). The PNL entry site was the lower calyx in 15 patients, the middle calyx in 3, and the upper calyx in 1. PA, AVF, and PA plus AVF occurred in 14, 5, and 3 of the 19 renal angiography patients, respectively. Embolization of the affected vessels was successful in all 19 patients. The embolization materials of coil, glue, and coil plus glue were used in 16, 3, and 2 patients, respectively. Conclusions: Severe hematuria is a rare complication of PNL and can be successfully treated with transcatheter embolization.Öğe Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm(Springer International Publishing Ag, 2016) Guzelburc, Vahit; Balasar, Mehmet; Colakogullari, Mukaddes; Guven, Selcuk; Kandemir, Abdulkadir; Ozturk, Ahmet; Karaaslan, PelinPurpose: Irrigation-induced increase in intrarenal pressure is of concern because it may cause infection due to increased pyelovenous and pyelolymphatic absorption. This study is the first to compare prospectively the absorbed fluid volumes during percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for stones larger than 2 cm. Materials and methods: General anesthesia was applied to all patients. Isotonic solution containing 1 % ethanol was used as irrigation fluid. Venous blood ethanol concentration was first measured with the start of irrigation and thereafter every 15 min until the patients left the recovery room. Absorbed fluid volumes were measured using the blood ethanol concentrations. Duration of irrigation, irrigated fluid volume, stone size and grade of hydronephrosis were also recorded. Results: A total of 60 patients were included the study. Fluid absorption occurred in all patients. Minimum and maximum ranges of fluid absorption were 20-573 mL for RIRS and 13-364 mL for PCNL. The increase in fluid absorbed volume was observed as a result of the given amount of irrigating fluid used in the PCNL group. Also prolongation of operation led to a significant increase in absorption in the PCNL group. Increase in body mass index, stone size, and hydronephrosis did not affect fluid absorption significantly in either of the two operation techniques in correlation analyzes. Conclusion: Both RIRS and PCNL are conducted under high pressure and can be accompanied potential complications such as SIRS. The fluid absorption confirmed in our study should be taken into consideration during RIRS and PCNL.Öğe Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm(Springer International Publishing Ag, 2016) Guzelburc, Vahit; Balasar, Mehmet; Colakogullari, Mukaddes; Guven, Selcuk; Kandemir, Abdulkadir; Ozturk, Ahmet; Karaaslan, PelinPurpose: Irrigation-induced increase in intrarenal pressure is of concern because it may cause infection due to increased pyelovenous and pyelolymphatic absorption. This study is the first to compare prospectively the absorbed fluid volumes during percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for stones larger than 2 cm. Materials and methods: General anesthesia was applied to all patients. Isotonic solution containing 1 % ethanol was used as irrigation fluid. Venous blood ethanol concentration was first measured with the start of irrigation and thereafter every 15 min until the patients left the recovery room. Absorbed fluid volumes were measured using the blood ethanol concentrations. Duration of irrigation, irrigated fluid volume, stone size and grade of hydronephrosis were also recorded. Results: A total of 60 patients were included the study. Fluid absorption occurred in all patients. Minimum and maximum ranges of fluid absorption were 20-573 mL for RIRS and 13-364 mL for PCNL. The increase in fluid absorbed volume was observed as a result of the given amount of irrigating fluid used in the PCNL group. Also prolongation of operation led to a significant increase in absorption in the PCNL group. Increase in body mass index, stone size, and hydronephrosis did not affect fluid absorption significantly in either of the two operation techniques in correlation analyzes. Conclusion: Both RIRS and PCNL are conducted under high pressure and can be accompanied potential complications such as SIRS. The fluid absorption confirmed in our study should be taken into consideration during RIRS and PCNL.Öğe Comparison of early period sexual function parameters between surgical repair and conservative treatment after penile fracture(Elsevier Espana Slu, 2023) Taskapu, Hakan Hakki; Sonmez, Mehmet Giray; Ecer, Gokhan; Ucmak, Harun; Aydin, Arif; Balasar, MehmetIntroduction and objectives: Comparison of early period sexual function parameters in patients who had surgical repair and conservative follow-up after penile fracture and the evaluation of surgical intervention time on these parameters were planned in this study. Materials and methods: Total of 26 patients who were treated for penile fracture were evaluated. 19 patients had surgical repair and 7 patients had conservative treatment.Sexual function and erectile dysfunction (ED) degree of the patients before penile fracture and in the 12th week after fracture were evaluated with 5-question International Index of Erectile Function (IIEF-5) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Pro-file(SEP) 2 and SEP 3. Parameters showing sexual function before and after the fracture were compared. Results: In both groups, a significant change was detected in IIEF-5 score, EHS, SEP-2 and SEP-3 parameters of the patients measured after penile fracture compared to the values before the fracture (all parameters, p < 0.05). No difference was detected in the parameters measured before and after the fracture among surgical repair and conservative treatment groups (all parameters p > 0.05). Mean time passing until the surgery after fracture was measured as 9.6 & PLUSMN; 6.85 h in 19 patients who had surgery. Conclusion: A difference wasn't detected in sexual parameters in conservative treatment and surgical repair groups in this study. As a significant decrease was observed in sexual function parameters even in conservative treatment cases without sudden detumescence and tunica albuginea rupturing, we think that quick surgical exploration would be useful in cases considered to have penile fracture. (c) 2022 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.Öğe Comparison of Non-Hilar Clamping Simple Enucleation and Enucleo-Resection of Exophytic Renal Tumors(Urol & Nephrol Res Ctr-Unrc, 2015) Balasar, Mehmet; Durmus, Emrullah; Piskin, Mehmet Mesut; Karalezli, Giray; Gurbuz, Recai; Kilinc, MehmetPurpose: To retrospectively evaluate our institutional experience with non-hilar-clamping simple enucleation (SE) and enucleoresection (ER) for the treatment of exophytic renal tumors regarding their oncological outcomes. Materials and Methods: We retrospectively evaluated patients treated between 2006 and 2013 for clinical exophytic T1-T2a renal tumors using open nephron-sparing surgery. Results: A total of 33 patients underwent SE and 39 underwent ER. The mean tumor size was 38.7 mm. None of the patients had positive surgical margins. No local recurrences were observed during the postoperative follow-up period (mean 40.7 +/- 23.4 months); however, ipsilateral adrenal and contralateral kidney metastasis was detected in one of the patients. There was no statistically significant difference in the R.E.N.A.L Nephrometry Score, operative time, or intraoperative blood loss in the non-hilar-clamping SE and ER groups (P > .05). During the third postoperative month, the estimated glomerular filtration rate (eGFR) levels in the SE group were significantly reduced compared with the preoperative eGFR levels (P = .046). Conclusion: SE and ER with non-hilar clamping are safe, acceptable approaches for treating exophytic renal tumors.Öğe Comparison of retrograde intrarenal stone surgery with and without a ureteral access sheath using kidney injury molecule-1 (KIM-1) levels: a prospective randomized study(Springer, 2022) Ecer, Gokhan; Sonmez, Mehmet Giray; Ayd, Arif; Topcu, Cemile; Alalam, Haider Nihad Izaddin; Guven, Selcuk; Balasar, MehmetThe objective is to compare patients who underwent retrograde intrarenal surgery with and without a ureteral access sheath (UAS) using kidney injury molecule-1 (KIM-1) levels. We also examined the difference in kidney damage between standard and dual lumen UAS. Sixty patients diagnosed with kidney stones and scheduled for RIRS were randomized into three groups: RIRS without UAS (Group 1), 11Fr/13Fr Boston scientific Navigator (TM) UAS (Group 2), and 11Fr/13Fr dual lumen ClearPetra (TM) UAS (Group 3). Data were prospectively collected in consecutive patients. Urine KIM-1/Cr levels were measured preoperatively, at postoperative 4 h, and on a postoperative day 14. Stone size, location, number, pre- and postoperative stent use, operation time, stone-free rate (SFR), post-ureteroscopic lesion scale (PULS) grade, hospitalization duration, and complications were recorded. There was no significant difference in demographical parameters and preoperative KIM-1/Cr levels among the groups. Postoperative 4th-hour urine KIM-1/Cr levels were higher in patients without UAS than patients with UAS (1.86, 0.67, 0.63 Groups 1, 2, 3, respectively). In comparing group 1 with groups 2 and 3 separately, Group 1 had a statistically significantly higher value than both groups (p = 0.002, p = 0.001, respectively). According to UAS type, there was no significant difference between groups 2 and 3. The use of UAS during RIRS has been shown to reduce kidney injury in the evaluation with KIM-1. Different UAS types on kidney injury and which one can protect the kidneys more during the procedure; will be elucidated by prospective randomized studies involving larger patient groups and UAS types.Öğe Complete treatment with partial cystectomy in giant xanthogranulomatous cystitis case imitating bladder tumor(Medknow Publications & Media Pvt Ltd, 2017) Balasar, Mehmet; Sonmez, Mehmet Giray; Oltulu, Pembe; Kandemir, Abdlkadir; Kilic, Mehmet; Gurbuz, RecaiXanthogranulomatous cystitis (XC) is a very rare chronic benign inflammatory disease of the bladder. It may cause local invasion although it is not a malign lesion and may occur together with malign lesions. It has a clinical importance as the distinction from malign lesions is difficult clinically and pathologically. Sharing a 37-year-old female case with giant XC imitating bladder tumor referring to the hospital with hematuria and stomach ache, together with current literature, we wanted to present that the disease can be treated with bladder-preserving approaches instead of radical approaches even though the mass is big in these cases. Application of basic excision and partial resection for small masses and radical cystectomy for large masses was reported in literature. We think that our case may provide a contribution to literature in treatment approach since we provided surgical cure with partial resection in a big mass with dimensions of 9 cm x 8 cm which is different from the present literature. Even though XC is a rare disease, it should be considered in prediagnosis for especially big dimensioned masses, and treatment should be planned according to the pathology result after together with cystoscopy in suitable patients.Öğe Contemporary Management of Medium-Sized (10-20mm) Renal Stones: A Retrospective Multicenter Observational Study(Mary Ann Liebert, Inc, 2015) Kiremit, Murat Can; Guven, Selcuk; Sarica, Kemal; Ozturk, Ahmet; Buldu, Ibrahim; Kafkasli, Alper; Balasar, MehmetPurpose: To evaluate contemporary management approaches to medium-sized (10-20mm) renal stones. Patients and Methods: A total of 935 patients treated for medium-sized renal stones (10-20mm) between July 2012 and March 2014 were included in the study program. Contemporary minimally invasive approaches applied in the management of such stones were evaluated and compared. Results: The cohort consisted of 561 male (60%) and 374 female (40%) patients. Of the 935 patients with medium-sized renal calculi, 535 (57.2%) were treated with shockwave lithotripsy (SWL), 201 (21.4%) with retrograde intrarenal surgery (RIRS), 110 (11.7%) with minimally invasive percutaneous nephrolithotomy (miniperc), and the remaining 89 (11.7%) patients with micropercutaneous nephrolithotomy (microperc). In the SWL group, stones were located mostly in the pelvis (51%), while in the miniperc and microperc groups, they were located mainly in the lower pole (46%, 53%, respectively). Stone-free rates after a single session were 77.2%, 86.1%, 88.8%, and 83.6% in the SWL, RIRS, microperc, and miniperc groups, respectively. Although no serious complications (above Clavien level III) were noted in any of the groups evaluated, Clavien I to II complications were common in the miniperc group. Conclusion: Although SWL is the preferred treatment option for patients with medium-sized (10-20mm) renal stones, endourologic methods also have been found to have a significant role. Relatively lower complication rates along with higher stone-free status observed with the RIRS technique compared with percutaneous approaches have made this method a valuable option in the management of such stones in recent years.Öğe Different group of non-obstructive intermittent azoospermias among non-obstructive azoospermia patients: A ten-year retrospective cohort study with control group(Wiley, 2022) Salvarci, Ahmet; Balasar, MehmetWe have identified patients among non-obstructive azoospermia (NOA) cases in whom spermatozoa could not be detected despite treatment, but intermittent ejaculatory spermatozoon was found in their follow-up. NOA was observed in the retrospective screening at a rate of 15.35% among infertile men (n = 1976/12,871), while non-obstructive intermittent azoospermia (NO-IA) was detected at a rate of 6.8% among NO-IA (n = 135/1976) and 1.1% among all infertile men (n = 135/12,871). Spermatozoon was identified in the form of cryptospermia or extreme oligospermia in 58.13 (13.6-92.3) weeks on average in n = 55/135 patients among NO-IA. Pregnancy and live birth were achieved at a rate of 43.6% (n = 24/55) and 29% (n = 16/55), respectively, in intracytoplasmic sperm injection. NO-IA was composed of a group with no genetic pathological diagnosis, with lower follicle-stimulating hormone, lutenizing hormone and clinical varicocele rates compared with those of NOA (<0.05) and higher testicular volumes and pathological scores (<0.05). A major activity was observed in total testosterone, lutenizing hormone, testicular volumes and the logistic regression of pathological scores (<0.05).Öğe Early kidney injury in immunoglobulin A vasculitis: Role of renal biomarkers(Wiley, 2021) Ture, Esra; Yazar, Abdullah; Akin, Fatih; Topcu, Cemile; Aydin, Arif; Balasar, Mehmet; Atas, BulentBackground We aimed to determine whether urine kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) can be used as early noninvasive biomarkers of kidney injury in immunoglobulin A vasculitis. Methods Patients who were diagnosed with immunoglobulin A vasculitis were included in the study. Urine samples were collected for determination of urine KIM-1 and NGAL levels. The control group consisted of age-matched healthy children. Results Sixty-one patients who were diagnosed with immunoglobulin A vasculitis were included in the study; 37.7% of these patients were determined to have renal involvement. Median KIM-1 was found to be significantly higher in the patient group (69.59 pg/mL) than the control group (40.84 pg/mL) (P = 0.001). Median NGAL was determined to be statistically significantly higher in the patient group (59.87 ng/mL) compared with the control group (44.87 ng/mL) (P = 0.013). In 23.6% of the patients without renal involvement at admission renal involvement developed within the following 6 months. When median KIM-1 and NGAL at admission of these patients were compared with the control group, they were determined to be statistically significantly higher (P = 0.001, P = 0.003). Conclusions The fact that our patients with late-term nephropathy had no hematuria and / or proteinuria and that KIM-1 and NGAL levels were determined to be high indicates that these biomarkers might be potentially reliable, noninvasive and early determinants of kidney injury.Öğe Efficiency of intracavernosal alprostadil and oral clomiphene citrate combination treatment in penile vasculogenic erectile dysfunction patients accompanied by late-onset hypogonadism(Wiley, 2020) Taskapu, Hakan Hakki; Sonmez, Mehmet Giray; Kilinc, Muzaffer Tansel; Altinkaya, Nurullah; Aydin, Arif; Balasar, MehmetIn this study, the efficiency of intracavernosal alprostadil + oral clomiphene citrate (CC) treatment in late-onset hypogonadism (LOH) accompanied by penile vasculogenic erectile dysfunction (PVED) in patients irresponsive to phosphodiesterase type 5 inhibitor treatment was evaluated. A total of 31 patients with concurrent PVED and LOH were included in the study. The patients were given intracavernosal alprostadil (10-20 mu g) and oral CC (50 mg) every day for 12 weeks. Before and after treatment, a 15-question International Index of Erectile Function (IIEF-15) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile (SEP)2 and SEP3 levels were analysed, and follicle stimulating hormone (FSH), luteinising hormone (LH), total testosterone and prostate-specific antigen (PSA) levels were measured. In all, 41.9% of patients had pure arterial deficiency, 19.3% had pure venous deficiency, and 38.7% had arterial + venous (mixed) deficiency. A significant increase was detected in total testosterone, FSH, LH and PSA values after treatment when compared to values before treatment (p < .001,p < .001,p p = .034 respectively). A significant recovery was observed in IIEF-15 subscores, EHS and SEP2-SEP3 results. In PVED patients accompanied by LOH, intracavernosal alprostadil and oral CC combination is an efficient, low cost, safely applicable and tolerable treatment.Öğe Erkek infertilitesine genetik yaklaşım(2016) Balasar, Mehmet; Balasar, Özgür; Gürbüz, RecaiÖnceden idiyopatik erkek infertilitesi olarak tanımlanan önemli sayıdaki androlojik fertilite bozukluğu, gerçekte genetik kökenlidir. Bu genetik sebepleri anlamak, hem tedavi yaklaşımları hem de onların doğacak bebeklerinin taşıyabileceği riskler hakkında hastaların bilgilendirilmesi açısından önem taşımaktadır. Bu derlemede, erkek infertilitesine neden olan genetik faktörler değerlendirilmiştir.Öğe Estimation of the capacity of emergency surgery in Konya: Nine-year multicenter study(2016) Küçükkartallar, Tevfik; Çakır, Murat; Tekin, Ahmet; Balasar, Mehmet; Kartal, Adil; Köksal, Hande; Erengül, Bülent; Türk, EminAmaç: Cerrahi acillerin sayısının sürekli artmasına rağmen acil cerrahi yatışları hakkında kısıtlı veri bulunmaktadır. Bu çok merkezli çalışmanın amacı, Konya şehrinde acil genel cerrahi sonuçlarını değerlendirmektir.Gereç ve Yöntemler: Konya'da tüm genel cerrahi acil başvurularının dokuz yıllık sonuçları incelendi (Ocak 2003Ocak 2012). Tüm demografik veriler istatistiksel olarak değerlendirildi.Bulgular: Konya'da yer alan 4 hastaneden 21954 hasta çalışmaya alınmıştır. Konya Numune Hastanesi (7154), Konya Eğitim ve Araştırma Hastanesi (6654), Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi (6400) ve Başkent Üniversitesi Konya Eğitim ve Araştırma Hastanesi (1390) verileri toplandı. Hastaların yaş ortalaması 59,6 ve ortalama hastanede kalış süresi 3,3 gündü. Hastaneye kabul edilen hastaların tanıları; akut apandisit (%59,57), bağırsak tıkanıklığı (%11,12), travma (%7,97), boğulmuş kasık fıtığı (%5,46), akut kolesistit (%4,87), peptik ülser perforasyonu (%4,09), mezenterik iskemi (%2,73), nekrotizan fasiit (%2,73), gastrointestinal sistem kanaması (%1,79) ve diğerleriydi (%1,1).Sonuç: Bu çalışma ile cerrahi kabullerin sürekli arttığı görülmüştür. Non-travmatik akut karın, genel cerrahi acillerinin en sık nedeniydi. Yaşlı hastaların sayısında artış olmasına rağmen, hastanede kalış süresi ve mortalite oranları azalmıştır.Öğe Evaluation from a different perspective of 10-year results of infertile males with Y chromosome AZFc microdeletions compared with a control group(Wiley, 2020) Salvarci, Ahmet; Gurbuz, Ali Sami; Balasar, MehmetAZFc microdeletions will be evaluated upon being divided into partial and complete subgroups. The association of deletions with reactive oxidative stress (ROS) and sperm DNA fragmentation (SDFI) and the impact of their coexistence on fertility starting from the pregnancy process until live birth will be presented. Semen analyses, microbiological results, hormones, ROS and sperm TUNEL tests were checked. Preimplantation genetic testing (PGT) was planned for relevant patients. Intracytoplasmic sperm injection (ICSI) was applied. Their embryo fragmentation was monitored via time lapse. Their results were compared with those with no AZF deletion and no other genetic problems. Azoospermia rate was 71.5%, m-TESE success rate was 25%, pregnancy rate was 26% and live child rate was 2.2%. No difference was detected between the partial and total groups in terms of ROS and SDFI rates and no difference was identified with the control group. Better results were obtained in terms of live child rate in patients with partial AZFc and low ROS/SDFI. Spermatozoon was retrieved in AZFc deletions and pregnancy, and live child was identified. No AZFc impact was observed on ROS and SDFI in the results compared with the control groups in terms of their coexistence.
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