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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 Comparison of Oral Sodium Bicarbonate and Solifenacin Treatment in Female Overactive Bladder Patients With Acidic Urine pH(Lippincott Williams & Wilkins, 2020) Sonmez, Mehmet Giray; Ecer, Gokhan; Atici, Ahmet; Ozkent, Mehmet Serkan; Iyisoy, Mehmet Sinan; Ozturk, AhmetObjective In this study, we planned to compare the effects of oral sodium bicarbonate (NaHCO3) and anticholinergic (solifenacin) treatments in women with overactive bladder (OAB) and acidic urine pH values (<6). Methods According to the referral order of OAB patients, 8 g/d oral NaHCO3(group 1) or 5 mg/d solifenacin succinate (group 2) was given to the patients. Both treatment regimens were applied one at a time for 12 weeks in total. Laboratory values, bladder diary, Patient Perception of Bladder Condition score, Patient Perception of Intensity of Urgency Scale, Overactive Bladder-Validated 8-Question Awareness Tool, and the King's Health Questionnaire (KHQ) scores before and after treatment were compared. Results A total of 59 patients were evaluated. Thirty-one patients were included in group 1, and 28 patients were included in group 2. No difference was detected in pretreatment and posttreatment laboratory values other than urine pH values in both groups. Whereas there was no difference in pretreatment urine pH values among the 2 groups, posttreatment urine pH values were significantly higher in group 1 compared with group 2 (P= 0.08,P< 0.001, respectively). There was a significant amelioration in the bladder diary parameters, symptom scores, and KHQ values measured after treatment in both groups. However, degree of amelioration in posttreatment outcomes was similar among the groups. Conclusions It was demonstrated that urinary alkalization made with oral NaHCO(3)in female OAB patients with acidic urine pH had a significantly positive effect on symptoms and symptom scores, and these results are similar to the results of solifenacin treatment.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 Dynamic thiol/disulfide homeostasis as a novel indicator of oxidative stress in patients with urolithiasis(Korean Urological Assoc, 2019) Sonmez, Mehmet Giray; Kozanhan, Betul; Deniz, Cigdem Damla; Iyisoy, Mehmet Sinan; Kilinc, Muzaffer Tansel; Ecer, Gokhan; Ozturk, AhmetPurpose: A dynamic thiol/disulfide balance is pivotal in organizing anti-oxidant defense, detoxification, apoptosis, and enzyme activities, as well as transcription and cellular signal-transfer mechanisms. The connection between urolithiasis and oxidant/antioxidant status, which can be assessed through thiol-disulfide homeostasis (TDH), has not yet been examined. In this study, we evaluated the effects of TDH on the formation, size, and location of stones by examining the associations between TDH parameters and urolithiasis. Materials and Methods: Patients with urolithiasis and healthy controls were recruited. The patients were divided into subgroups in terms of stone size (>15 mm or <= 15 mm) and stone location (nephrolithiasis or ureterolithiasis). TDH parameters were measured using a novel automatic and spectrophotometric method and compared statistically. Results: TDH parameters were different between the urolithiasis and control groups. TDH tended towards the disulfide side in the urolithiasis group. Stone size increased an average 0.14 mm with a 1 mu mol/L increase in disulfide level and decreased an average 0.058 mm with a 1 mu mol/L increase in native thiol level. Disulfide and native thiol levels were found to be different across patients with stone size >15 mm, <= 15 mm, and controls (p<0.001 and p<0.001, respectively). However, the nephrolithiasis and ureterolithiasis groups were similar in respect of TDH parameters. Conclusions: In this study, it was found that patients with urolithiasis displayed oxidative stress characterized by a TDH tendency towards the disulfide side, and an inadequate antioxidant response identified by a lower level of native thiol as compared with healthy controls.Öğe Effects of urine alkalinization with sodium bicarbonate orally on lower urinary tract symptoms in female patients: a pilot study(Springer London Ltd, 2018) Sonmez, Mehmet Giray; Goger, Yunus Emre; Ecer, Gokhan; Atici, Ahmet; Ozkent, Mehmet Serkan; Ozturk, AhmetIn this study, we planned to explore the effects of sodium bicarbonate orally (NaHCO3) treatment on female patients with lower urinary tract symptoms (LUTS) who have acidic urine pH values (< 6). NaHCO3 was given orally to 33 female patients for 4 weeks at a dose of 2 x 4 g/day. Laboratory values, bladder diary, the Patient Perception of Bladder Condition Score (PPBC), Patient Perception of Intensity of Urgency Scale (PPIUS), Overactive Bladder-Validated 8-question Awareness tool (OAB-V8), Pelvic Pain and Urgency & Frequency Patient Symptom Scale tests (PUFSS), and the King's Health Questionnaire (KHQ) scores before and after treatment were compared. A significant increase was detected in urine pH values measured after treatment (5.31 +/- 0.52 to 7.2 +/- 0.66, p < 0.001), but not in blood pH values (7.369 +/- 0.33 to 7.384 +/- 0.28, p = 0.14). After treatment, a significant decrease was detected in daily frequency, nocturia, urgency, and urge incontinence prevalence (p < 0.001,p = 0.003, p < 0.001, p = 0.002, respectively) and PPBC, PPIUS, PUFSS, and OAB-V8 symptom scores (p = 0.004, p = 0.002, p < 0.001, p < 0.001, respectively). A significant decrease was detected in all KHQ subunit scores. Urine alkalinization with NaHCO3 orally in female patients with LUTS and acidic urine pH has a significant level of positive effects on symptoms and symptom scores. Our results show that this new treatment modality-which is inexpensive, easy to use, and has a low side-effect profile is effective in this chronic patient group.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 New surgical technique applied with urological instruments in bilobar multiple hepatolithiasis: Ultra-mini percutaneous hepatolithotomy(Aves, 2017) Ozturk, Ahmet; Sonmez, Mehmet Giray; Bakdik, Suleyman; Goger, Yunus Emre; Ozkent, Mehmet Serkan; Aksoy, Faruk; Belviranli, MetinIntrahepatic bile duct stones may emerge with manifestations as chronic stomach ache, cholestasis, cholangitis, abscess, post-obstructive atrophy and liver cirrhosis presentation may occur. Thus the treatment of symptomatic hepatolithiasis patients should be provided. Different methods such as biliary decompression, endoscopic, percutaneous or open surgery are recommended for the treatment of patients with intrahepatic gallstones. The aim of the treatment is to extract the stones and regain biliary drainage. But the treatment regimen to be applied should be determined after examining the age, performance condition, general condition of the patient and location of the stone carefully. In this case, we presented a young female patient who had many unsuccessful surgical interventions due to coledochal cyst and congenital malformation in bile ducts, had large stones in right and left intrahepatic bile ducts and in whom we provided complete stone-free condition through Ultra-Mini Percutaneous Hepatolithotomy (UM-PHL) using urological instruments.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 PRELIMINARY EXPERIENCE WITH MICROPERC IN KIDNEY AND BLADDER STONES: AS FINE AS POSSIBLE(Mary Ann Liebert, Inc, 2012) Piskin, Mesut; Guven, Selcuk; Kilinc, Mehmet; Arslan, Mehmet; Goger, Emre; Ozturk, Ahmet[Abstract Not Availabe]Öğe Preliminary, Favorable Experience with Microperc in Kidney and Bladder Stones(Mary Ann Liebert Inc, 2012) Piskin, Mehmet Mesut; Guven, Selcuk; Kilinc, Mehmet; Arslan, Mehmet; Goger, Emre; Ozturk, AhmetPurpose: In this study, we report our initial experience using microperc for treatment of kidney stones and the implications of the microperc system in bladder stone management. Patients and Methods: Microperc was performed with a 4.85F all-seeing needle in 11 patients with stone disease; 9 of the patients had kidney stones and 2 had bladder stones. Access to the renal collecting system was achieved under fluoroscopic control in eight patients, while ultrasonography was used in one. Fluoroscopy was not used in any of the patients with bladder stones for bladder access. Results: The mean stone burden was 12.8mm (range 7-18 mm). The stone locations were pelvis in three, upper calix in one, middle calix in two, and lower calix in three. The mean age for kidney stones was 20.8 years (range 3-47 years). Single access was sufficient in all cases. In two patients, although the procedure was progressing without complication, conversion to miniperc was needed because of operator-related system errors. There were no intraoperative complications. The stone-free rate in the postoperative first month was 85%. Conclusion: The least invasive microperc with an optical puncture system appears to be a safe and effective treatment modality in patients with different kinds of stone disease with respect to various features. Although the initial cases were patients with single stones of less than 20 mm, the combined use of this system with other minimally invasive treatment modalities for the management of larger stones is promising.Öğe Primary results of transurethral prostate ethanol injection(Springer, 2014) Arslan, Mehmet; Ozturk, Ahmet; Goger, Yunus Emre; Aslan, Erkan; Kilinc, MehmetMinimally invasive methods, especially the novel techniques, gain more and more popularity in benign prostate hyperplasia (BPH) treatment. Transurethral ethanol injection is one of these novel methods as it is easy to apply for BPH treatment and quite successful. The present study evaluates the results of a single-year transurethral ethanol injection prostate (TUEP) follow-up employed for the first time in our country. Fifty-two patients with lower urinary tract symptoms underwent TUEP. It was performed in ten patients under local anesthesia and in 42 patients under sedation. Dehydrated ethanol with a concentration of 95-98 % was injected using transurethral approach with a rigid cystoscope. Forty-two patients were followed for 1 year. At the end of the first year, the average patients' IPSS scores decreased from 22.6 to 12.8 and prostate volume from 49.5 to 38.8 cc. Q-average increased from 3.3 to 7.1 ml/s and Qmax from 6.4 to 9.7 ml/s. Residual urine decreased from 160.1 ml to 68 cc. There were not any dire postoperative complications. In 77.8 % of the patients, TUEP succeeded. In 13.8 % of the patients, alternative treatment methods were to be employed. TUEP, an effective minimally invasive treatment option, can be performed with medically high-risk BPH patients under regional anesthesia. The procedure is easy, inexpensive, safe, and rapid to us. Yet, long-term and multi-centered studies with larger patient series are needed to define further benefits.Öğe Ultra-mini Percutaneous Hepatolithotomy in Patients With Large and Multiple Hepatolithiasis(Lippincott Williams & Wilkins, 2021) Ozturk, Ahmet; Sonmez, Mehmet Giray; Bakdik, Suleyman; Ecer, Gokhan; Altinkaya, Nurullah; Ataseven, Huseyin; Aksoy, FarukBackground: In this study, we applied the ultra-mini percutaneous hepatolithotomy (UM-PHL) technique on hepatolithiasis patients with multiple and large stones on which other minimally invasive methods failed, and our aim was to report its results, sharing in series for the first time. Materials and Methods: Preoperative and postoperative data, laboratory parameters, radiologic findings, and preoperative and postoperative details were recorded for a total of 14 patients for whom the UM-PHL technique was applied between April 2017 and December 2019. As all patients had multiple stones and extreme stone load and had bile duct surgery, they did not have a normal anatomy. All patients were radiologically confirmed to have had preprocedural magnetic retrograde cholangiopancreatography. Results: Operation duration of the patients was 137.6 +/- 44.9 minutes, while intraoperative blood loss was 69.2 +/- 24.9 mL, drainage catheter removal time was 2.85 +/- 0.86 days, and the hospitalization time was 4.28 +/- 2.55 days. Intraoperative balloon dilation was applied to enlarge the stricture area in 5 patients (35.7%). On the basis of the Clavien-Dindo classification, grade 2 complication was observed in 2 patients (14.2%) due to postoperative cholangitis. Patients were followed up for an average of 15 months, and nonsymptomatic radiologic stone recurrence was detected in the 12th month control of 1 patient (7.1%). Conclusion: The UM-PHL technique is a successful method that facilitates stone clearance by providing minimal dilatation through percutaneous intervention and by using instruments with small diameter, and it can safely be applied with its low complication level, low recurrence ratio, and short hospitalization time.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.
