Araştırma Çıktıları
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Item Prostate volume effect on Gleason score upgrading in active surveillance appropriate patients(PAGEPRESS PUBL, 2019-01-01) Camur, Emre; Coskun, Alper; Kavukoglu, Ovunc; Can, Utku; Kara, Onder; Camur, Arzu Develi; Sarica, Kemal; Narter, Kamil FehmiIntroduction: Gleason Score (GS) upgrading rates in the literature are reported to be around 33-45\%. The relationship between prostate volume and GS upgrading should be defined, aiming to reduce upgrading rates in patients with low risk groups who are eligible for active surveillance (AS) or minimally invasive treatment, by varying biopsy cores, or lengths of cores according to prostate volumes. In this regard, the aim of our study was to establish the relationship between prostate volume and GS upgrading. Materials and methods: We retrospectively analyzed the medical records of 78 patients, who were appropriate for AS between 2011-2016 at our hospital. Inclusion criteria were patient age under 65 years, PSA level under 10 ng/ml, GS (3 + 3) or (3 + 4), and 3 or less positive cores, clinical stages <= T2. GS increase in radical prostatectomy specimen was considered as `upgrading' and in addition, score reported by biopsy as 3 + 4 but in surgical specimen as 4 + 3 were also considered as `upgrading'. The effect of prostate volume on Gleason grade upgrading was examined by calculating upgrading rates separately for patients with prostate volume 30 ml or less, those with 30 to 60 ml, and those over 60 ml. Results: As a result of the analysis of the data, upgrading was seen in 35 (44.8\%) of 78 patients included in the study. In the cohort mean prostate volume was 49.8 (+/- 26.3) ml. Twenty-two patients (28.2\%) had prostate volume 30 ml or less, 34 (43.6\%) 30 to 60 ml, and 22 (28.2\%) 60 ml or more. The patients were divided into two groups as those with and without GS upgrading. Between the groups prostate volume and prostate volume range (0-30/31-60/> 60) were not significantly different (p value > 0.05). Conclusions: Gleason grade upgrading causes patients to be classified in a lower risk group than they actually are, and may lead to inappropriate treatment. This condition has a direct effect on the decision of active surveillance. Therefore, it is important to define the factors that can predict GS upgrading in active surveillance appropriate patients. In this study, we found that prostate volume has no significant effect on upgrading in active surveillance appropriate patients.Item Transgender Surgery: A Review Article(GALENOS YAYINCILIK, 2021-01-01) Yilmaz, Kahraman Berkhan; Narter, Kamil FehmiTransgender surgeries are required to correct some congenital genital defects, reconstruct genital trauma, amputate, treat cancer (e.g., penile cancer), or within a wide perspective to treat gender dysphoria. Literature about gender-affirming surgery is limitedItem The role of anticholinergic therapy based on the upoint system in the treatment of chronic prostatitis(PAGEPRESS PUBL, 2019-01-01) Narter, Kamil Fehmi; Can, Utku; Coskun, Alper; Sabuncu, Kubilay; Tarhan, FatihObjective: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common problem and severely impairs the quality of life (QoL). We aimed to investigate the effects of different treatment options on voiding symptoms and QoL in patients with urinary phenotype according to the UPOINT system. Matherial and methods: Ninety-six patients with NIH category II, III CP/CPPS were included in the study prospectively. After the diagnosis, the questionnaires including NIH Chronic prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), Overactive Bladder Screening Questionnaire (OAB-V8), and Beck depression inventory were filled by the patients. The patients with urinary phenotype were treated by alpha-blocker, antimuscarinic or both therapy modalities (combined) considering the specific therapy recommendations by UPOINT. The questionnaires applied on the first visit were reapplied after one month and treatment success was evaluated. Results: Seventy-three patients were included in `Urinary phenotype' group (76\%) and 23 were included in `other phenotypes' (24\%) group of the patients according to the UPOINT classification. Significant improvements of symptoms were observed with the all treatment modalities when the NIH-CPSI, IPSS and OAB-V8 scores were compared before and after treatment in the `Urinary phenotype' group. Significant differences in the percentage of change in values were obtained in the anticholinergic group for pain subdomain of NIH-CPSI and IPSS scores. Conclusion: U-POINT clasification is useful for deciding on the treatment modality in CP/CPSS patients. We showed anticholinergic therapy might be effective option. Addition to the symptomatic recovery, there is need more further studies about effectivity cholinergic system in the prostate tissue.Item 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, AhmetObjective: 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.