Browsing by Author "Ozveren, Bora"

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A Case of Unclassified Renal Cell Carcinoma Initially Considered as Translocation RCC and Review of Literature
(GALENOS YAYINCILIK, 2021-01-01) Karsiyakali, Nejdet; Ozgen, Mahir Bulent; Ozveren, Bora; Ekici, Isin Dogan; Turkeri, Levent
This case report aimed to review the literature on translocation renal cell carcinoma (tRCC), which is a rare form of kidney cancer and was the initial diagnosis of a recently treated patient. We report our findings in a 30-year-old female who underwent robot-assisted radical nephrectomy for an incidental right renal mass, which was reported as unclassified RCC at final pathologic evaluation after eliminating tRCC as differential diagnosis, and discuss the main aspects of tRCC based on current literature.
An unusual cause of Grade IIIb Clavien complication of percutaneous nephrolithotomy: Broken and retained Malecot nephrostomy catheter
(CANADIAN UROLOGICAL ASSOCIATION, 2016-01-01) Ozveren, Bora; Sahin, Ahmet
Percutaneous nephrolithotomy (PCNL) is a relatively safe operation with low rates of major complications. Clavien-Dindo classification is a validated system to record complications, although still needing standardization in reporting and scoring of complex and rare events. We report an unusual adverse incident that required interventional management and impacted the postoperative course. The case of a broken re-entry Malecot nephrostomy catheter as it was being removed on the third postoperative day of an otherwise uneventful PCNL is described. The retained part was removed by open-surgery under general anesthesia. This incident has upgraded the minimally invasive surgery to a Grade IIIb complicated procedure according to the modified Clavien classification. Patient data, procedure conditions, and surgical retrieval of the catheter are detailed. Although far from being life-threatening, this rare complication due to a broken and retained drainage catheter is regarded as a high-grade complication according to the Clavien system.
Bilateral same-session ureterorenoscopy: A feasible approach to treat pan-urinary stone disease
(ARAB ASSOC UROLOGY, 2017-01-01) Ozveren, Bora; Eren, Murat Tugrul; Ozveri, Hakan; Altug, Ugur; Sahin, Ahmet
Objectives: To assess treatment effectiveness and safety of bilateral same-session ureterorenoscopy (BSSU) for the management of stone disease involving the entire urinary system. Patients and methods: We reviewed the records of 64 patients who underwent BSSU for the treatment of bilateral ureteric and/or kidney stones. Size, number, location per side, and the total burden of stones were recorded. Data on stenting, lithotripsy, and stone retrieval, and details of hospital stay and operation times were investigated. Treatment results were assessed using intraoperative findings and postoperative imaging. The outcome was considered successful in patients who were completely stone-free or who had only residual fragments of <= 2 mm. Results: The outcome was successful in 82.8\% of the patients who received BSSU (54.7\% stone-free and 28.1\% insignificant residual fragments). The success rate per renal unit was 89.8\%. There were no adverse events in 73.4\% of the patients. The most common intraoperative complication was mucosal injury (36\%). The complications were Clavien-Dindo Grade I in 9.4\% and Grade II in 7.8\%. Grade IIIa and IIIb (9.4\%) complications required re-treatments. Statistical evaluation showed no association between complication grades and stone, patient, or operation features. Stone burden had no negative impact on BSSU results. The presence of impacted proximal ureteric stones was significantly related to unsuccessful outcomes. Conclusion: BSSU is safe and effective for the management of bilateral urolithiasis. BSSU can prevent recurrent surgeries, reduce overall hospital stay, and achieve a stone-free status and complication rates that are comparable to those of unilateral or staged bilateral procedures. (C) 2017 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.
Increased Prostate Imaging-Reporting and Data System Scores in Multiparametric Magnetic Resonance Imaging May Predict More Extensive Disease in Radical Prostatectomy Specimens
(GALENOS YAYINCILIK, 2021-01-01) Karsiyakali, Nejdet; Ozgen, Mahir Bulent; Ozveren, Bora; Akbal, Cem; Dincer, Alp; Durak, Haydar; Turkeri, Levent
Objective: This study aimed to investigate the correlation between index lesion prostate imaging-reporting and data system (PI-RADS) version-2 score and histopathological outcomes of prostatectomy specimens. Materials and Methods: A total of 78 male patients with prostate cancer (PCa) treated with robot-assisted radical prostatectomy between August 2015 and June 2020 were included in this study. In this cohort, suspicious lesions on multiparametric magnetic resonance imaging (mpMRI) were scored according to PI-RADS version-2 criteria. MpMRI-targeted prostate biopsy was performed for all suspicious lesions with a PI-RADS score of >= 3 followed by systematic prostate biopsy. The relationship between index lesion PI-RADS score and histopathological outcomes of prostatectomy specimens were evaluated statistically. Results: The mean age of the patients was 65.0 +/- 7.0 years. The distribution of PI-RADS scores of 3, 4, and 5 of the index lesions were 6 (7.7\%), 29 (37.2\%), and 43 (55.1\%), respectively. Lower tumor volume and tumor volume ratio were observed in patients with a PI-RADS score of 3 when they were compared with patients with PI-RADS scores of 4 and PI-RADS-5 (p<0.001, for each). No significant correlation was found between index lesion PI-RADS score in mpMRI and clinically significant PCa in prostatectomy specimens (r<0.200, p>0.05). However, a significant correlation was observed between index lesion PI-RADS score and extracapsular extension (ECE), as well as seminal vesicle invasion (SVI) and pT stage (r=0.327, p=0.004
Initial Outcomes and Assessment of the Transperineal Multiparametric-Magnetic Resonance Imaging/Ultrasonography Fusion Biopsy Method in Diagnosing Clinically-significant Prostate Cancer
(GALENOS YAYINCILIK, 2017-01-01) Ozgen, Mahir B.; Ozveren, Bora; Uzel, Sertac; Altug, Ugur; Turkeri, Levent
Objective: In this study, it was aimed to investigate the success of transperineal multiparametric magnetic resonance imaging (mp-MRI)/transrectal ultrasonography (USG) fusion prostate biopsy method in prostate cancer diagnosis and detection of clinically significant cancer. Materials and Methods: All patients signed written informed consent then patients with an indication for prostate cancer, therefore biopsy was planned for the last year underwent 3 Tesla mp-MRI retrospectively. All the lesions of patients with Prostate Imaging, Reporting and Data System (PIRADS) 3, 4 and 5 lesions were marked using MIM (TM) Symphony software by a single radiologist. All patients underwent transperineal MRI/USG fusion biopsy under general anesthesia. In the prostate MRI evaluation of the targeted lesions with a PIRADS score of 3-4-5 were sampled with 2 to 5 cores followed by random biopsies of both of the prostate lobes. Results: Prostate adenocarcinoma was diagnosed in 20 of 59 patients (33.8\%) having fusion biopsy. No difference was observed in prostate-specific antigen levels of patients whose biopsy results were benign and malignant. In 63\% of patients, only PIRADS 3 lesions were found, whereas PIRADS 4 and/or 5 lesions were reported in 22 (37\%) patients. The fusion biopsy of PIRADS 3 lesions revealed cancer in 7 patients (19\%), of which 6 had clinically-insignificant prostate cancer criteria. Adenocarcinoma was diagnosed in 59\% who had PIRADS 4 and/or 5 lesions. All these tumors had clinically-significant cancer characteristics. Lesion-targeted fusion biopsies missed 1 clinically-insignificant adenocarcinoma (1/7
Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?
(BRAZILIAN SOC UROL, 2016-01-01) Ozgen, Serpil Ustalar; Ozveren, Bora; Kilercik, Meltem; Aksu, Ugur; Ay, Binnaz; Tufek, Ilter; Kural, Ali Riza; Turkeri, Levent N.; Toraman, Fevzi
Background: The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies. Patients and Methods: Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation. Exclusion criteria: The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery. Results: (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05)
Massive rectal bleeding after prostate biopsy controlled by endoclipping in a patient using acetylsalicylic acid
(CANADIAN UROLOGICAL ASSOCIATION, 2013-01-01) Ozveren, Bora; Turkeri, Levent
A case of severe rectal bleeding following transurethral ultrasound (TRUS)-guided prostate biopsy is reported. Rectal bleeding is considered a minor, transient complication of this standard diagnostic procedure that can usually be controlled successfully by conservative measures. In this case where the patient had been taking acetylsalicylic acid (ASA), massive bleeding required hospitalization and blood transfusions. Conservative treatment attempts were not succesful, and profuse rectal bleeding was eventually treated by colonoscopy and endoclipping of the bleeding vessel. Although generally regarded as a less significant complication, rectal bleeding may rarely be encountered as a life-threatening situation. Furthermore, conservative therapeutic approach to this minor complication may be ineffective in patients taking ASA. Early endoscopic intervention may be necessary to prevent blood transfusion and prolonged hospitalization in severe rectal bleeding after TRUS biopsy.
Metastasis Targeted Therapies in Renal Cell Cancer
(GALENOS YAYINCILIK, 2018-01-01) Narter, K. Fehmi; Ozveren, Bora
Metastatic renal cell cancer is a malignant disease and its treatment has been not been described clearly yet. These patients are generally symptomatic and resistant to current treatment modalities. Radiotherapy, chemotherapy, and hormonal therapy are not curative in many of these patients. A multimodal approach consisting of cytoreductive nephrectomy, systemic therapy (immunotherapy or targeted molecules), and metastasectomy has been shown to be hopeful in prolonging the survival and improving the quality of life in some of these patients. Patients with oligometastatic disease and good performance status have better results following this multimodal approach. Cytoreductive nephrectomy and adjuvant/neoadjuvant systemic therapies (immunotherapy, targeted therapy) have been investigated for treatment options of metastatic renal cancer patients. After better understanding of the genetic basis and the molecular biology of the renal cell carcinoma, targeted molecular therapies and immunotherapies have emerged as more efficient alternative therapy options with moderate adverse effects. Metastasectomy in some of these patients improves survival and quality of life, especially in those with lung and bone metastases. In this review we will summarize treatment options for metastatic renal cancer patients.
Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients
(MEDKNOW PUBLICATIONS \& MEDIA PVT LTD, 2016-01-01) Ozveren, Bora; Keskin, Selcuk
Objectives: Acute urinary retention (AUR) in females is a poorly defined condition with undetermined epidemiology. This study aimed to evaluate female AUR in an outpatient population. Patients and Methods: One hundred and thirty-eight adult female outpatients who presented to the emergency room with symptoms of urinary retention were retrospectively analyzed. The women who were ultimately diagnosed with true, complete AUR were systematically reviewed for clinical characteristics and management. Results: In this outpatient cohort with urinary retention complaints, only 23\% of the patients were diagnosed with objective AUR. Detailed medical and urological history in addition to urogenital, neurological, and pelvic examinations was essential
The Comparison of Conventional and Retzius-Sparing Robot-Assisted Radical Prostatectomy for Clinical, Pathological, and Oncological Outcomes
(GALENOS YAYINCILIK, 2022-01-01) Karsiyakali, Nejdet; Ozgen, Mahir Bulent; Ozveren, Bora; Durak, Haydar; Saglican, Yesim; Turkeri, Levent
Objective: This study aimed to assess and compare the conventional and Retzius-sparing robot-assisted radical prostatectomy (cRARP and RsRARP) in term of perioperative clinical, pathological, and oncological outcomes. Materials and Methods: This study included 238 consecutive male patients who underwent RARP between May 2008 and November 2020. RARP operations were performed by a single-surgeon. Patients were divided into groups according to the surgical approach and were statistically compared in terms of perioperative clinical, final pathological, and oncological outcomes. Results: The mean age of patients was 64 +/- 7 years. cRARP was performed in 134 (56.3\%) patients, whereas RsRARP in 104 (43.7\%). The frequency of patients with the American Society of Anesthesiologists Class-2 score was higher in the RsRARP group (p<0.001). The median surgery duration was 300 (270-360) min. The median surgery duration was shorter in RsRARP group (290 vs. 330 minute) (p<0.001). No difference was found between the groups in terms of estimated blood loss and postoperative complication rates (p=0.112 and p=0.182, respectively). No difference was found between the groups when they were compared for surgical margin positivity (p=0.453). Although not statistically significant, the frequency of surgical margin positivity with pT3a/pT3b disease was higher in patients who underwent cRARP (p=0.412 and p=0.261, respectively). At a median follow-up of 13 (6-36) months, no difference was found between the groups in terms of biochemical recurrence at months-3,-6,-9,-12,-18,-24, and-30, respectively (p>0.05, for each). Conclusion: RsRARP allows a safe operation with a shorter surgical time and similar surgical margin positivity, oncological outcomes, and complication rates compared to cRARP.
The Key Steps in Robotic Radical Prostatectomy
(GALENOS YAYINCILIK, 2020-01-01) Ozveren, Bora; Turkeri, Levent
Trends and Risk Factors for Ciprofloxacin Resistance and Extended- spectrum Beta-lactamase Production in Uropathogens from Urology and Non-urology Outpatients
(GALENOS YAYINCILIK, 2021-01-01) Ozveren, Bora; Narter, Kamil Fehmi; Turkeri, Levent; Sahin, Ahmet
Objective: This study aimed to identify the patterns and temporal changes of ciprofloxacin resistance and extended-spectrum beta-lactamase (ESBL) production in uropathogenic isolates obtained from urology and non-urology outpatients. Materials and Methods: In this cross-sectional study, electronic data of urine culture and antimicrobial susceptibility test results of samples collected in urology and non-urology outpatient departments from 2008 to 2016 were retrospectively analysed to identify correlations between basic demographic features and clinical settings. Results: Escherichia coli (E. coli) was the most prevalent (70\%) uropathogenic isolate in a cohort of 7.973 patients consisting of 82.8\% women, 70.7\% adults and 15.7 \% urology outpatients. Overall, resistance to ciprofloxacin was found in 16.3\% of the patients. Ciprofloxacin resistance was associated with being male and old, observed more frequently in urology outpatients, detected in 19.2\% of E. coli isolates and increased to 54.5\% among ESBL-producing bacterial strains (p<0.05). ESBL production was observed in 12\% of all isolates. Increased ESBL production was associated with old age and isolates of E. coli and Klebsiellaspp. (p<0.05). Statistical analysis using multivariate generalised linear mixed models (mGLMMs) to assess the relationship between the outcomes predicted a significantly higher ESBL production in E. coli and Klebsiella spp. isolates and in geriatric patients. Furthermore, mGLMM analysis predicted a significantly increased likelihood of ciprofloxacin resistance in older adult male patients, especially in E. coil and Enterococcusspp. isolates. Moreover, a high rate of ESBL production was observed, reaching over 15\% in 2015 (p<0.05). The rates of ciprofloxacin resistance remained >10\% and peaked in 2015 (20.2\%, p<0.001). However, in 2016, the rate of ESBL production and ciprofloxacin resistance started to decline, displaying significance only regarding the latter (p<0.05). Conclusion: Empirical ciprofloxacin treatment of community-acquired urinary tract infections carries a higher risk of an unsuccessful outcome in male, geriatric and urology outpatients. Empirical antibacterial therapy for urological infections in the outpatient setting should be conducted based on patient risk profiles and contemporary local resistance data.
Vascular Endothelial Growth Factor and Thrombospondin-1 mRNA Expression in Bladder Tumors: Correlation with Histopathology and Prognosis
(GALENOS YAYINCILIK, 2019-01-01) Ozveren, Bora; Turkeri, Levent
Objective: The purpose of this study was to determine genetic expression levels of vascular endothelial growth factor (VEGF) and thrombospondin-1 (TSP-1) in fresh bladder tumor specimens and evaluate their relationship with tumor histopathological features and their prognostic value in recurrence and progression in patients with bladder cancer. Materials and Methods: Patients who were treated for urothelial cancer of the bladder and followed for at least 6 months were included in this retrospective study. Following RNA isolation from fresh tumor tissue samples recovered from transurethral resection or radical cystectomy specimens, VEGF and TSP-1 mRNA expression was analysed by reverse transcription polymerase chain reaction (RT-PCR). The findings were examined in relation to the histopathological parameters and recurrence and progression rates of the respective tumors. Results: Sixty-eight patients were included in the study. Mean follow-up time was 22.6 months. In patients with non-muscle-invasive urothelial bladder cancer (NMIBC), rates of recurrence and progression were 64\% and 35\%, respectively. RT-PCR analyses revealed VEGF mRNA expression in 29 patients (43\%) and TSP-1 mRNA expression in 22 patients (32\%). Recurrence and progression were observed during follow-up in 64\% and 24\% of the 25 NIMBC patients with positive VEGF expression, while these rates were 63\% and 30\% among the 30 NIMBC patients with no VEGF expression, respectively. Rates of recurrence and progression during follow-up were 70\% and 30\% among NIMBC patients with positive TSP-1 expression and 60\% and 26\% among patients with no TSP-1 mRNA expression, respectively. Conclusion: In this study, VEGF and TSP-1 mRNA expression was not associated with histological grade or stage of bladder cancer. There was no difference in VEGF expression in tumor tissues from NIMBC patients with or without disease recurrence. Though lacking statistical significance, a positive correlation between TSP-1 expression and tumor recurrence and progression was seen among the NIMBC patients in our study. Although stimulatory and inhibitory factors are known to regulate angiogenesis, no definitive conclusions have been reached regarding their mechanism of action or the prognostic significance of their up-or down-regulation.