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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 Fracture with Urethral Injury: Evaluation by Retrograde Urethrogram(2017) Balasar, Mehmet; Poyraz, Necdet; Pişkin, Mehmet Mesut; Kandemir, AbdulkadirPenile fracture is a rare condition. It primarily involves the rupture of the corpus cavernosum during erection, which may also affect the corpus spongiosum and urethra. We describe the case of a 35-year-old man who presented with acute penile pain, penile swelling, and a hematuria after a blunt trauma during sexual intercourse. The emergency retrograde urethrogram revealed a rare condition, extravasation of the opaque material from the penile urethra into the cavernous structure. The partial rupture of the corpus cavernosum with urethral disruption was repaired surgically. At the 3-month postoperative follow-up control, no complications were reported by the patient who has had both normal erectile and voiding functions. In cases of penile fracture with suspected urethral injury, retrograde urethrogram can be used for definitive diagnosis.Öğe Incidence of retrorenal colon during percutaneous nephrolithotomy(Brazilian Soc Urol, 2015) Balasar, Mehmet; Kandemir, Abdulkadir; Poyraz, Necdet; Unal, Yunus; Ozturk, AhmetObjective: The aim of this study was to investigate retrorenal colon incidence in percutaneous nephrolithotomy (PNL) interventions made in our clinic. Materials and Methods: Clinical data of 804 PNL patients, accumulated over a 7 year period (2006-2012), was surveyed. The patient files were reviewed retrospectively, and only those who had abdominal computed tomography (CT) images before PNL intervention were included in the study. In the CT images, the position of both the ascending and descending colon in relation to the right and left kidneys were evaluated. Results: According to our hospital reports, 394 patients with CT images were included in the present study 27 patients (6.9%) had retrorenal colon, of which 18 (4.6%) were on the left side, 4 (1.0%) on the right side and 5 (1.3%) had bilateral retrorenal colons. Colonic perforation complication was seen only in two patients and the colonic perforation rate was 0.3%. These two cases had no CT images. Conclusions: PNL, in the process of becoming the standard treatment modality, is a safe and reliable technique for renal stone treatment. Colonic injury should be taken into consideration during PNL interventions of the lower pole of the kidney (especially on the left side) due to the location of retrorenal colon.Öğe Incidence of retrorenal colon during percutaneous nephrolithotomy(Brazilian Soc Urol, 2015) Balasar, Mehmet; Kandemir, Abdulkadir; Poyraz, Necdet; Unal, Yunus; Ozturk, AhmetObjective: The aim of this study was to investigate retrorenal colon incidence in percutaneous nephrolithotomy (PNL) interventions made in our clinic. Materials and Methods: Clinical data of 804 PNL patients, accumulated over a 7 year period (2006-2012), was surveyed. The patient files were reviewed retrospectively, and only those who had abdominal computed tomography (CT) images before PNL intervention were included in the study. In the CT images, the position of both the ascending and descending colon in relation to the right and left kidneys were evaluated. Results: According to our hospital reports, 394 patients with CT images were included in the present study 27 patients (6.9%) had retrorenal colon, of which 18 (4.6%) were on the left side, 4 (1.0%) on the right side and 5 (1.3%) had bilateral retrorenal colons. Colonic perforation complication was seen only in two patients and the colonic perforation rate was 0.3%. These two cases had no CT images. Conclusions: PNL, in the process of becoming the standard treatment modality, is a safe and reliable technique for renal stone treatment. Colonic injury should be taken into consideration during PNL interventions of the lower pole of the kidney (especially on the left side) due to the location of retrorenal colon.Öğe Investigation of granulomatous prostatitis incidence following intravesical BCG therapy(E-Century Publishing Corp, 2014) Balasar, Mehmet; Dogan, Metin; Kandemir, Abdulkadir; Taskapu, Hakan Hakki; Cicekci, Faruk; Toy, Hatice; Gurbuz, RecaiIn the present manuscript, we studied the incidence of granulomatous prostatitis in the prostatectomy specimen of the patients who underwent transurethral resection of the prostate (TURP) after superficial bladder cancer treatment with intravesical Bacillus Calmette-Guerin (BCG) and were diagnosed with benign prostate hyperplasia (BPH). The clinical data and histopathological specimen records of 472 patients who underwent TUR-P due to BPH diagnosis, obtained over a period of 6 years in the urology department of Private Konya Hospital, Konya, Turkey, were studied retrospectively. The cases were divided into two groups as (Group I) who did not undergo any treatment and as (Group II) who underwent BCG treatment. The frequency and the clinical course of the cases with granulomatous prostatitis were studied histopathologically. There were in total 472 patients who underwent TUR-P. Out of the 459 patients who did not undergo BCG treatment (Group I), the histopathological specimen records of 262 (57%) was BPH, of 197 (43%) BPH + chronic prostatitis. Of the second group, 13 cases underwent intravesical BCG treatment before surgical intervention due to superficial bladder CA diagnosis. In this group 4 of the cases were diagnosed as (30%) BPH, 9 as (70%) chronic prostatitis + BPH. 6 out of the 9 chronic prostatitis cases were chronic prostatitis, 2 caseous granulomatous prostatitis, 1 non-caseous granulomatous prostatitis. Granulomatous prostatitis cases should require no specific therapy. Conclusion: In patients with obstruction complaints following intravesical BCG treatment, granulomatous prostatitis should also be considered and treatment plans should be made accordingly.Öğe Outcomes of mini-percutaneous nephrolithotomies in children: a single centre experience(Polish Urological Assoc, 2019) Kandemir, Abdulkadir; Balasar, Mehmet; Piskin, Mehmet Mesut; Ozturk, AhmetIntroduction The aim of this study was to present to present our experiences with pediatric mini-percutaneous nephrolithotomies (MPNL) in our center. Material and methods A total of 85 MPNLs performed on 79 pediatric patients being treated for upper urinary tract stones from 2007 to 2017 were analyzed retrospectively in order to determine their safety, efficacy, and relevant outcomes. Results 85 MPNLs performed on 79 patients with a mean age of 6.58 (1-14) years were included in this study. The mean size of the stones was 1.99 (1-6.4) mm. A 17 Fr rigid pediatric nephroscope with a pneumatic intracorporeal lithotripsy was used through a 20 Fr access sheath. The stone-free rate was 87.1% at 1 month postoperatively. Mean operative time was 56.4 (20-120) min. Mean fluoroscopy screening time was 183.2 (40-510) sec. Average hospitalization duration was 4.78 (2-13) days. Auxiliary procedures were performed on 7 (8.2%) patients (5 extracorporeal shock wave lithotripsy, 2 re-percutaneous nephrolitho-tomy). The complication rate of these cases was 6.3% according to the modified Clavien Classification System. However, no major complications classified as Clavien IV-V were observed in the study group. Conclusions The outcomes of the contemporary analysis confirm that MNPL is a safe and efficient method of intervention resulting in a stone-free state in pediatric cases.Öğe A prospective randomized comparison of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) for the management of lower pole kidney stones(Springer, 2017) Kandemir, Abdulkadir; Guven, Selcuk; Balasar, Mehmet; Sonmez, Mehmet Giray; Taskapu, Hakan; Gurbuz, RecaiTo make a comparison between the safety and efficacy of micropercutaneous nephrolithotomy (microperc) and retrograde intrarenal surgery (RIRS) for the management of lower pole kidney stones up to 15 mm. 60 patients presenting with solitary lower pole kidney stones up to 15 mm were included in the study between March 2013 and December 2015. Patients were randomized into Microperc or RIRS groups with computer-generated numbers. The mean stone size was 10.6 (5-15) and 11.5 (7-15) mm for Microperc and RIRS groups, respectively (P = 0.213). In the Microperc group, the scopy time was 158.5 s, while in the RIRS group, the scopy time was 26.6 s (P = 0.001). The hospitalization period in the Microperc group was 542 h, while it was 19 h in the RIRS group (P = 0.001). No statistical differences were observed during the operating time, pre-operative-post-operative hemoglobin (Hb), serum creatinine, and estimated glomerular filtration speed (e-GFR) values and stone-free rates. No intraoperative complications were observed in either of the groups, while post-operative complications were observed in six patients in Microperc Group and five patients belonging to the RIRS Group (P = 0.922). Both Microperc and RIRS are safe and effective alternatives, and have similar stone clearance and complication rates for the management of lower pole kidney stones up to 15 mm in diameter. However, prolonged hospital stay and scopy times are the main disadvantages of Microperc and further research is needed to evaluate the renal tubular damages caused by both of these methods.Öğe Treatment of fragmented and severely encrusted ureteral double-J stent forgotten for 11 years through multimodal endourological methods(Wolters Kluwer Medknow Publications, 2019) Kandemir, Abdulkadir; Sonmez, Mehmet GirayUreteral catheters are frequently used in urology clinics for intrinsic or extrinsic pathologies which cause ureteral obstruction to provide urinary drainage from the kidney to the bladder. With the increase in stent use, an increase is observed in complications occurring due to ureteral stents in direct proportion with this increase, and ureteral double-J (DJ) stents forgotten in the urinary system are observed commonly in urological cases when the patients do not refer to a health institution in this condition and may cause severe problems, such as infection, stent fragmentation, migration, kidney failure, encrustation, and hydronephrosis conditions. A 30-year-old male patient referred to our clinic with right-side pain, dysuria, and incontinence complaints. It was learned that the patient had endoscopic stone surgery due to right ureteral stone and kidney stone 11 years before the presentation. In the imaging methods of the patient, it was observed that the DJ stent forgotten had separated into three parts, and stones were observed in the right ureter. Cystoscopy was made under general anesthesia. The torn distal end of DJ stent was observed in distal urethra. The foreign object was removed with forceps. Then with ureterorenoscope, the stones integrated with the stent at the end of the piece of DJ stent in the ureter were fragmented with pneumolithotriptor. Stone pieces and the second removed part of the stent were extracted with foreign object forceps. Then using nephroscope through percutaneous intervention, the stones at the end of the third torn piece of DJ stent were fragmented with pneumolithotriptor. They were extracted with forceps. After DJ stent installation, each patient should be checked by giving required information and told that the stent must be removed. In cases with forgotten stents and complications, the stents should be removed with suitable medical, endourological, or minimally invasive surgical methods taking care to protect kidney functions.Öğe Urinary kidney injury molecule-1 levels in renal stone patients(Springer, 2016) Balasar, Mehmet; Piskin, Mehmet Mesut; Topcu, Cemile; Demir, Lutfi Saltuk; Gurbilek, Mehmet; Kandemir, Abdulkadir; Ozturk, AhmetTo study kidney injury molecule-1 (KIM-1) biomarker levels, indicating renal tubular damage, in patients with kidney stones and in those who underwent minimally invasive method stone treatment. Sixty patients with renal stones between 10 and 20 mm were included into the present study. Patients who were divided into three cohorts underwent micropercutaneous nephrolithotomy (microperc), retrograde intrarenal stone surgery (RIRS), and percutaneous nephrolithotomy (PNL). Urine samples were obtained from all participants before, 4 h and 14 days after the procedure. In all the samples obtained, urinary KIM-1 and creatinine (Cr) levels were measured and KIM-1/Cr ratios (ng/mg creatinine) were calculated. Preoperative urine KIM-1/Cr ratio was higher than postoperative 14th day. The bigger the renal stone size, the higher was the ratio (correlation coefficient 0.353, p = 0.006). According to preferred treatment procedure, there was a statistically significant decrease in preoperative and postoperative 4th hour and 14th day urine KIM-1/Cr rates in the RIRS and PNL, yet none in the microperc group (p = 0.010, p = 0.001, p = 0.212, respectively). In renal stone patients, the elevated urine KIM-1/Cr ratio levels increase further according to stone size. KIM-1/Cr ratio is a promising marker might be helpful in monitoring the damage created by stone disease.
