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Öğe Efficacy of semirigid ureterorenoscopy with the use of ureteral acsess sheath in the treatment of impacted ureteral stones: A prospective randomized study(2020) Keskin, Ercument; Erdogan, Abdullah; Karabulut, IbrahimAim: To investigate the advantages of using Ureteral Access Sheat (UAS) with semirigid ureterorenoscopy in patients with impacted ureteral stones. Materials and Methods: One hundred and 22 adult patients that presented to our clinic with the complaint of impacted stones in the middle and upper parts of the ureter and were scheduled for surgical treatment. The procedure was performed without UAS in control group and using UAS in study group. Results: No significant difference was found between the two groups in terms of age, gender, stone disease history, presentation complaint, stone side, size, density and localization, degree of renal hydronephrosis, complications and length of hospital stay. Stone migration, operation time, duration of fluoroscopy, and postoperative additional surgical intervention rates were significantly lower in the UAS group [26.2% (n = 16) vs 11.5% (n = 7), p = 0.037; 35.46 ± 5.3 min vs 25.56 ± 4.2 min, p 0.001, 5.50 ± 0.86 sec vs 3.24 ± 0.69 sec, p 0.001; and 19.7% (n = 12) vs 6.6% (n = 4), p = 0.032, respectively]. The operation was successful in 48 (78.7%) patients in the control group and 57 (93.4%) in the UAS group, with a statistically significant difference (p = 0.019).Conclusion: The use of UAS in the treatment of middle-upper impacted ureteral stones presents as an advantageous method due to the shorter operation time and lower rates of intraoperative stone migration and high success rates of the operation.Öğe Preoperative anxiety in children undergoing elective circumcision: A cross-sectional study in a training and research hospital(2020) Karayagmurlu, Ali; Naldan, Muhammet Emin; Karabulut, IbrahimAim: Limited research has been conducted regarding the symptoms of preoperative anxiety that children exhibit prior to circumcision. The aim of this study is to determine the frequency of preoperative anxiety symptoms in children preparing for circumcision and the associated factors.Materials and Methods: This cross-sectional study included 62 subjects ranging from ages 2-12. A personal information form, which the research team developed, was used to evaluate the socio-demographic and clinical data of the participants. Symptoms of preoperative anxiety were assessed using the modified Yale Preoperative Anxiety Scale.Results: The mean age of the participants was 7.37±2.97 and m-YPAS scores were 56±18.10. Increased preoperative anxiety symptoms were observed in 82.3% (n=51) of circumcised children. Subjects who engaged in certain activities prior to admission exhibited significantly lower m-YPAS scores compared to those who did not (p0.05).Conclusions: The early recognition and management of preoperative anxiety in children expecting circumcision will help clinicians in preventing the potential complications associated with increased preoperative anxiety.Öğe Robot assisted partial nephrectomy: Single center our experiences(2019) Karabulut, Ibrahim; Yilmaz, Ali Haydar; Yilmazel, Fatih Kursat; Ceylan, OnurAim: In this study, we aimed to present the functional and oncologic results of robotic assisted partial nephrectomy (RAPN) in clinical stage T1 tumors.Material and Methods: Fifteen patients who had undergone RAPN for T1a-b kidney tumor between July 2017 and January 2019 were included in the study. The demographic data, mean operation time, estimated blood loss, duration of warm ischemia, length of hospital stay and oncologic results were evaluated retrospectively.Results: Ten male and five female patients with a mean age of 55.4±7.6 (48-71) years were included in the study. A 4-port trans peritoneal approach was applied to all the patients. Nine right and six left renal masses with a mean tm diameter of 2.8±0.4 (2.4-3.6) cm were operated. The mean operation time was 217 (185-250) minutes, the mean blood loss was 225.6 (180-265) cc. Bleeding requiring transfusion was seen in one patient and a spontaneously resolved ileus was seen in another patient. Urethral stents were placed into two patients because the collector system was opened. 8 (53%) of renal masses were reported as renal cell carcinoma. Surgical margin positivity was identified in 2 (13%) of the patients. No local recurrence or distant metastasis was observed in any of the patients. None of the patients experienced incisional hernia and late complications. Conclusion: Robot-assisted partial nephrectomy is presently the gold standard treatment for patients with clinical stage T1 renal tumor. RAPN is an effective, safe and minimally invasive treatment modality in patients eligible for partial nephrectomy.Öğe Robot-assisted laparoscopic radical prostatectomy: A single center initial experience(2019) Karabulut, Ibrahim; Yilmaz, Ali Haydar; Yilmazel, Fatih Kursat; Keskin, ErcumentAim: The aim of this study is to present the surgical, oncologic and functional results of the first 34 robotic radical prostatectomy (RARP) procedures performed in our clinic.Material and Methods: Data of 34 patients who underwent RARP between July 2017 and October 2019 were evaluated.Results: The mean patient age was 58.73±4.94 years, and the mean preoperative serum prostate-specific antigen level was 8.9±2.07 ng/mL. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 7.5, and 22 cases, respectively. The mean prostate weight was 58.73±26.03g. Anterior reconstruction suture was performed in 22 (64.7%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 195.2±14.03min, 120.3±21.2cc, 7.34±1.62 days, and 7.26±1.26 days, respectively. Biochemi¬cal recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up were fully continent (0 pads/day). Of the 16 (47%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 9 (62.5%) had no ED, with or without any additional medica¬tion including phosphodiesterase-5 (PDE5) inhibitors. Conclusion: RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results.Öğe Transitional cell carcinoma of the bladder in young adult patients(2019) Keskin, Ercument; Erdogan, Abdullah; Karabulut, IbrahimAim: Transitional cell carcinoma of the bladder (TCC) mostly affects the middle and old population as in other cancers. We aimed to present the results and clinical behaviors of patients treated with bladder TCC under the age of 40 years.Material and Methods: Fifteen patients who were admitted to our clinic between 2005 and 2019 and diagnosed as TCC were evaluated retrospectively. Demographic characteristics, initial and follow-up transurethral resection pathologies, intravesical treatment and follow-up periods were evaluated. All patients underwent transurethral resection after ultrasonography (USG) and cystoscopy examination. Results: The most common complaint was macroscopic hematuria (n:12.80%).Smoking rate was 66% (n:10). The mean age of the patients was 32.4 (19-39). Male / female ratio was 13/2. The mean follow-up period was 55 weeks. Ten patients (66%) had single focus and five (34%) had multiple focus tumors. In 10 patients, the tumor pathology TaG1, TaG3 in 3, T1G1 in one and T1G3 in one patient were reported.4 patients received intravesical chemotherapy and four patients underwent intravesical immunotherapy (BCG). The recurrence rate was 53% (n:8) and the rate of pro- gression was 13% (n:2) (TaG1-T1G3). None of the patients progressed to T2 disease.Conclusuion: Bladder TCC under 40 years of age usually presents as TaG1. Survival rates are high if follow-up and treatment protocols are followed. It should be kept in mind that there may be bladder tumors in young adult patients regardless of age.Keywords: Bladder tumor; cystoscopy; hematuria.
