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Öğe A Rare Case in Urology: Inflammatory Myofibroblastic Tumour(Coll Physicians & Surgeons Pakistan, 2022) Akgül, Murat; Şahin, Mehmet Fatih; Arslan, Ayşegül; Öznur, Meltem; Yazıcı, CenkInflammatory myofibroblastic tumour (IMT) is a soft tissue malignancy with a mixture of myofibroblastic spindle cells with hyalinised stroma and inflammatory infiltrates. We report a case of a 35-year male patient with a 100x90 mm mass located at the posterior wall of the urinary bladder just adjacent to the prostate and rectum. The mass caused grade 3 hydronephrosis in the left kidney and grade 1 hydronephrosis in the right kidney. The patient was operated and the mass lesion was excised completely. Because the left ureter was adherent to the mass, it was excised at the most distal part and uretero-neo-cystostomy was performed as the bladder and the prostate were preserved. Morphology and immunohistochemistry were consistent with IMT. With surgical excision of the tumour, no recurrence or metastases were seen up to 3 years postoperatively.Öğe Erectile dysfunction iceberg in an urology outpatient clinic: How can we encourage our patients to be more forthcoming?(Wiley, 2021) Akgül, Murat; Yazıcı, Cenk Murat; Doğan, Çağrı; Özcan, Rıdvan; Şahin, Mehmet FatihThe study's aim was to document the rates of declared and hidden erectile dysfunction (ED) at urology outpatient clinic while attempting to develop a method to encourage patients to talk about ED. A total of 506 patients, all of whom underwent the same procedure by the same clinician with a standard algorithm, were prospectively evaluated. The patients who declared ED as their primary or secondary symptom were grouped as 'very early treatment seekers' (VETS) and 'early treatment seekers' (ETS) respectively. The patients who hid their ED until directly questioned and the patients whose ED was diagnosed with an IIEF-5 questionnaire were grouped as 'late treatment seekers' (LTS) and 'very late treatment seekers' (VLTS) respectively. The total number of ED was 291 (57.5%), comprised of 54 (18.6%) patients in the VETS, 48 (16.5%) in the ETS, 143 (49.1%) in the LTS and 46 (15.8%) in the VLTS groups. The rate of severe ED was significantly higher in the VETS group, whereas the rate of mild ED was significantly higher in the VLTS group (p < .001). Most of the patients would not seek help for their ED until the clinician directly or indirectly questioned them. Simple manipulations uncovered the hidden ED patients.Öğe For which non-muscle invasive bladder cancer is Re-Transurethral Resection more valuable? Which bladder cancer deserves Re-TUR?(Bayrakol Medical Publisher, 2021) Akgül, Murat; Doğan, Çağrı; Yazıcı, Cenk Murat; Şahin, Mehmet Fatih; İşal Arslan, Ayşegül; Öznur, MeltemAim: In this study, we aimed to evaluate the re-transurethral resection (re-TUR) pathologies and to compare the pathology results between transurethral resection of the bladder (TUR-B) and re-TUR for non-muscle invasive bladder cancer (NMIBC). Additionally, we aimed to assess the factors affecting the re-TUR pathology and try to define more valuable re-TUR patient groups. We also aimed to evaluate the effect of re-TUR on recurrence and progression. Material and Method: We performed re-TUR in intermediate/high-risk NMIBC patients, 4-6 weeks after the index TUR-B. Both TUR-B and re-TUR pathology characteristics, including tumor stage, grade, size, number, lymphovascular invasion (LVI), carcinoma in situ (CIS), variant pathology, and intermediate/high-risk status were analyzed retrospectively. The recurrence and progression rates were also evaluated according to re-TUR. Results: A total of 78 patients with NMIBC were included in the study. The index TUR-B pathologies were Ta-Low: 6 (7,7%), Ta-High: 5 (6,4%), T1-Low: 14 (17,9%), T1-High: 53 (67,9%). Re-TUR positivity was n: 40 (51 %), and upstaging/upgrading at re-TUR was n: 11 (14 %) in all groups. Re-TUR positivity was significantly higher in high-risk compared to intermediate-risk NMIBC (p:0,026). Re-TUR positivity was higher in patients with hydronephrosis, C15. LVI, differentiation, size (>3 cm), and multiple tumor presence (p<0,05). There was no significant relationship between recurrence/progression and re-TUR (p>0,05). Discussion: Residual tumor was common after the index TUR-B, and upstaging after re-TUR was very important Re-TUR is critically important in high-risk NMIBC, presence of hydronephrosis, CIS, LVI, variant pathology, size (>3 cm). and multiple number of tumors.Öğe Prognostic Role of Tumor Percentage in Multiparametric MRI for Upgrade Prediction Before Radical Prostatectomy(2024) Arıkan, Mehmet Gürkan; Ecer, Gökhan; Şahin, Mehmet Fatih; Hereklioğlu, Savaş; Gökalp, Fatih; Arda, Ersan; Akgül, BurakObjective: To determine the parameters that can predict upgrade with multiparametric magnetic resonance imaging (mpMRI) findings before radical prostatectomy (RP) in prostate cancer. The development of mpMRI increases the prediction rate of upgrades. Materials and Methods: The study included 69 patients who were diagnosed with prostate cancer (PCa) between January 2017-December 2020 and subsequently underwent RP. Patients were divided into two groups by comparing prostate biopsies and RP specimens as patients with upgrade (group 1) and patients without upgrade (group 2). Of the 69 patients, 26 were in group 1 and 43 in group 2. The images were evaluated by a single radiologist experienced in mpMRI using the Prostate Imaging Reporting and Data System v2.1 scoring system. Biopsy and RP pathology specimens were evaluated by an experienced neuropathologist. Results: The median prostate-specific antigen (PSA) levels were higher in patients with upgraded pathology [8.60 (5.90-14.00) ng/dL vs. 7.70 (5.20-10.00) ng/dL, respectively; p=0.040]. The prostate volume [31.88 (23.40-51.48) vs. 48.06 (23.40-87.35); p=0.009] and PSA density [3.72 (2.17-5.62) vs. 5.75 (3.35-9.6), respectively; p=0.007] were lower in patients with upgraded pathology. The tumor percentage on mpMRI was not different between the groups [3.70 (1.80-16.20 vs. 2.50 (1.10-6.60); p=0.076]. The histopathological tumor percentage was significantly higher in patients with upgraded histology (p=0.006). Conclusions: Although the percentage of tumors on multiparametric mpMRI is an inadequate pattern to predict upgrade in PCa patients, prospective studies designed to evaluate its potential will be of great interest.Öğe PROSTAT KANSERİNDE AKTİF İZLEM KARARI; BİYOPSİ GLEASON SKORU NE KADAR GÜVENLİ?(Namık Kemal Üniversitesi, 2017) Yazıcı, Cenk Murat; Türker, Polat; Şahin, Mehmet Fatih; Özcan, RıdvanAmaç: Prostat spesifik antijenin tanımlanmasından sonra insidental prostat kanseri oranı yükselmiş ve hastalar gereksiz tedavilere maruz kalabilmişlerdir. İnsidental prostat kanseri olan hastalarda herhangi bir tedavi uygulanmadan yakın izlem kılavuzlara girmiş ve hastalara uygulanmaya başlamıştır. Ancak transrektal ultrasonografi eşliğinde biyopsi patolojilerindeki veriler ile radikal prostatektomi spesimen patolojilerindeki verilerin uyumsuzluğu, küratif tedavi ihtiyacı olabilecek hastaları riske atmaktadır. Bu çalışmada; radikal prostatektomi spesimenlerindeki Gleason skorları ile TRUS-bx Gleason skorlarının karşılaştırılması amaçlanmıştır. Materyal – Metot: Mart 2011 ile Haziran 2016 tarihleri arasında, kliniğimizde radikal prostatektomi cerrahisi geçirmiş hastaların verileri retrospektif olarak değerlendirildi. Hastaların transrektal ultrasonografi eşliğinde biyopsi öncesi PSA değerleri, biyopsi kor sayıları, kanser pozitif biyopsi kor sayıları, biyopsideki kanser yüzdeleri ve Gleason skorları tespit edilerek, radikal prostatektomi sonrası Gleason skorları, doku kanser oranları, cerrahi sınırlar ve patolojik evre ile karşılaştırıldı. Bulgular: Toplam 44 hastanın verileri değerlendirildi. Transrektal ultrasonografi eşliğinde biyopsi patolojisinde Gleason skoru <7 olan hastaların 11’inde(%44), prostat spesimen patolojisi Gleason skoru da <7 olarak tespit edildi. Transrektal ultrasonografi eşliğinde biyopsi patolojisinde Gleason skoru 7 olan hastaların 8’inde (%61,5) prostat spesimen patoloji Gleason skoru 7 olarak tespit edildi. Trus-bx patolojisinde Gleason skoru >7 olan hastaların 1’inde (%16,6) prostat spesimen Gleason skoru >7 olarak tespit edildi Sonuç: Transrektal ultrasonografi eşliğinde biyopsi patolojilerinde bildirilen Gleason skorları ile radikal prostatektomi Gleason skorları arasında fark olabilmekte, bu fark özellikle biyopsi Gleason skoru <7 olan hastalarda daha belirginleşebilmektedir. Aktif izlemin hedefi olan bu hasta grubunda, patologların bildirdiği Gleason skorlarının güvenilirliği tartışmalı olup, diğer değişkenler (kor-tümör oranı, tümör kor sayısı, PSA) dikkate alınarak karar verilmesi gerekmektedir.Öğe Reliability and accuracy of varicocoele videos in YouTube(Pakistan Medical Association, 2022) Doğan, Çağrı; Akgül, Hacı Murat; Yazıcı, Cenk Murat; Şahin, Mehmet Fatih; Keleş, A.Objectives: To evaluate the scientific impact of videos about varicocoele on YouTube. Method: A cross-sectional study was conducted at Turkey in September 2020, and comprised YouTube videos related to varicocoele. The videos were divided into 2 groups according to their reliability and accuracy using the European Association of Urology Sexual and Reproductive Guidelines 2020. A 5-point modified reliability (DISCERN) tool, Global Quality Score, and Journal of the American Medical Association scores of each video were calculated. The user's engagements by total views, video-related comments, and "likes" and "dislikes" to the videos were compared. Data was analysed using SPSS 23. Results: Of the 151 videos assessed, 73(48.34%) were included; 36(49.3%) reliable and 37(50.7%) unreliable. All scores were significantly higher for reliable videos (p<0.05). The mean number of views was 108448±90567 for reliable and 392626±895897 for unreliable videos (p=0.044). The rates of "likes" and "dislikes" were similar between the groups, whereas the comment rate was significantly higher for reliable videos (p<0.05). Most of the videos 40(54.8%) were uploaded by medical advertisements or for-profit companies, while those uploaded by universities or professional organisations were 19(26%). Conclusion: Nearly half of the varicocoele-related videos on YouTube were unreliable, and the reliability of videos was not directly related to their popularity. © 2022 Pakistan Medical Association. All rights reserved.Öğe Smoking cessation rates of patients with bladder cancer and its effect on oncological outcomes(E-Century Publishing Corp, 2021) Akgül, Murat; Doğan, Çağrı; Yazıcı, Cenk Murat; Şahin, Mehmet Fatih; Özcan, RıdvanObjective: Smoking is a major risk factor for the development of bladder cancer (BC). We evaluated the rate and the time of cessation of smoking in patients with BC and analyzed the effect of ongoing smoking on BC recurrence and progression. Methods: All patients were informed at the time of BC diagnosis about the correlation between smoking and BC and were strictly warned to quit smoking. The demographic properties, pathologic characteristics, and smoking status of the patients were evaluated retrospectively. Both the patients and the family members were questioned to evaluate the smoking status of the patient during the follow-up period. The disease recurrence and progression were correlated with the habitual attitude of patients in terms of smoking status. Results: A total of 245 patients were included in the study. The mean follow-up period was 37.3 +/- 27.8 months (7-143 months). There were 102 (41.6%) patients who were smokers and 143 (58.4%) patients who were non-smokers at the time of diagnosis. Among the smoker patients, 34 (33.3%) stopped smoking after the diagnosis of BC. The median smoking cessation time was 1.5 months and 64.7% of these patients stopped smoking in the first six months after the diagnosis. The Cox regression model did not show any relationship between smoking status and recurrence/progression. Conclusion: The rate of cessation of smoking in BC patients was low. The first months of the diagnosis were the most suitable period for the patients to stop smoking. The smoking status after the diagnosis was not related to the tumor recurrence and progression.Öğe Tekirdağ ilindeki taş analizi ve metabolik değerlendirme sonuçları ve metaflaksiye etkisinin retrospektif incelenmesi(Tekirdağ Namık Kemal Üniversitesi, 2021) Şahin, Mehmet Fatih; Yazıcı, Cenk Murat; Akgül, Hacı MuratÖZET Çalışmamızda; taş açısından endemik bir bölgede yer alan Tekirdağ ilindeki taş analizi ve metabolik değerlendirme sonuçlarını sunarak bunlar ile hastaların demografik ve kişisel özelliklerini ve ilişkilerini saptamayı ve bunların metaflaksiye olan etkisini ortaya koymayı hedefledik. Bu amaçla, Ağustos 2018 ile Ocak 2021 tarihleri arasında kliniğimize başvuran, üriner sistem taş hastalığı olan 312 hastanın verileri incelendi. Bu hastalara taş analizi yöntemi olarak spektroskopik yöntem tercih edilerek taş analizi yapıldı. Taş analizi mevcut olan hastalardan 156 tanesine de 24 saatlik idrarda ve eş zamanlı olarak serumda metabolik değerlendirme yapıldı. Hastaların yaş, cinsiyet ve hastaların ikamet ettikleri merkezler; taşların taraf dağılımı, lokalizasyonu, dansiteleri, hacimleri ve 24 saatlik idrar ve serum parametreleri değerlendirmeye alındı. Üriner sistemde farklı lokalizasyonda mevcut olan taşlar da ayrı ayrı analiz edildi. Taş hastalığı erkek baskın, solda, üriner sistemde multipl lokasyonlarında, sıklıkla tek, steril idrar kültüründe ve çoğunlukla kent merkezinde ikamet eden hastalarda görülmekteydi. En sık tespit edilen taş çeşidi kalsiyum oksalat; en az görülen taş çeşidi ise ksantin taşıydı. En yüksek ortalama HU kalsiyum oksalat taşlarında, en düşük de ürik asit+amonyum ürat taşlarındadır. Kalsiyum içeriği arttıkça, taşın sertliği de artmaktadır. Ortalama taş hacmi en yüksek taş çeşidi sistin, en düşük olan ise ksantin'dir. En sık taş 50-59; en nadir 18 yaş altında görülmektedir. İdrarda en sık hiperkalsiüri, en az hipersistinüri; plazmada en sık hiperürisemi, en az hiperkalsemi görülmüştür. Metaflakside en sık potasyum sitrat kullanılmıştır. Sonuçta; ilimizdeki taş çeşitliliği ve predispozan metabolik bozukluklar incelendi ve kliniğe yansımaları değerlendirildi. Metabolik değerlendirmeye daha fazla önem göstermeli ve zaman ayrılmalıdır.Öğe The efficacy and safety of three different single-use ureteroscopes in retrograde intrarenal surgery: a comparative analysis of a single surgeon’s experience in a single center(Springer Science and Business Media Deutschland GmbH, 2024) Şahin, Mehmet Fatih; Topkaç, Erdem Can; Şeramet, Serkan; Doğan, Çağrı; Yazıcı, Cenk MuratPurpose: To evaluate and compare the clinical results of different single-use flexible ureteroscopes (su-fURS) used in retrograde intrarenal surgery (RIRS). Materials and methods: RIRS cases performed identically by an experienced surgeon between 2022 and 2023 in a single center were retrospectively analyzed. These surgeries were performed with three su-fURS (Redpine RP-U-C12, Hugemed HU30, and Pusen Uscope 3022 A). In the study, the age, gender, body mass index, and Charlson comorbidity index of the patients were compared, along with their clinical details, such as the stone size, volume, density, location, and history of hydronephrosis or a double J stent or SWL. Operation time, stone-free rates (SFR), perioperative and postoperative complications, and hospitalization times were also compared. Results: The study included 208 patients. Pusen had 63 cases, Hugemed had 62, and Redpine had 83. The comparison of the patient’s demographic and clinical properties with stone-related variables was similar between the groups. The SFR was similar between the groups (p = 0.056). Perioperative, postoperative, and total complication rates and the need for a second intervention showed no significant differences among the three groups (p = 0.324, 0.088, 0.061, and 0.052, respectively). Conclusion: In the first study comparing the clinical results of cases in which different su-fURS were used, no difference was observed in surgical outcomes and complications, even though the technical features of these devices were different. Urologists should select su-fURS based on clinical requirements, financial constraints, and personal experiences. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
