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    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, Ibrahim
    Aim: 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.
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    The relationship between serum adropin levels and erectile dysfunction
    (Mre Press, 2024) Keskin, Ercument; Ekici, Ozgur; Erdogan, Abdullah; Bozkurt, Aliseydi; Sambel, Murat; Karabakan, Mehmet; Mertoglu, Cuma
    Erectile dysfunction (ED) is associated with endothelial damage, especially atherosclerosis. The search for biomarkers that can predict ED still continues. Adropin is known to affect nitric oxide (NO) bioavailability and energy homeostasis. In our study, we have aimed to investigate the relationship between serum adropin levels and ED. Male patients with and without ED between 40-60 years of age, who presented to the outpatient clinics of urology between November 2019-February 2020, were prospectively included in the study. Biochemical values measured at the time of admission to the outpatient clinic. According to the International Index of Erectile Function -5 (IIEF-5) scores which range between 5 and 25 points, patients with a score <= 21 were considered to have ED. The patients were divided into two groups: as ED and non -ED control groups. Laboratory values obtained at admission to outpatient clinics of urology were compared between groups. Patients with (n: 40), and without (n: 40) ED were included in the study. The mean age (50.2 +/- 5.7 years), average body mass index (BMI) (29.7 +/- 2.5 kg/m(2)), IIEF score (15.8 +/- 6 pts), serum adropin (584.8 +/- 172 pg/mL), and total testosterone (396.4 +/- 91.7 ng/dL) levels were recorded. Serum adropin and testosterone levels were statistically significantly higher in the non -ED group than in the ED group (712.3 +/- 222 pg/mL vs. 511.1 +/- 145 pg/mL, p < 0.001 and 420.5 +/- 56 ng/dL vs. 374.3 +/- 98 ng/dL, respectively p = 0.032). Whereas fasting blood glucose (FBG) values were found to be statistically significantly higher in the ED group (100.2 +/- 14 mg/dL vs. 143.8 +/- 78 mg/dL, p = 0.001). According to the results of our study, serum levels of adropin which improves endothelial functions were comparatively lower in ED patients, as expected.
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    Robot-assisted laparoscopic radical prostatectomy: A single center initial experience
    (2019) Karabulut, Ibrahim; Yilmaz, Ali Haydar; Yilmazel, Fatih Kursat; Keskin, Ercument
    Aim: 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.
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    Transitional cell carcinoma of the bladder in young adult patients
    (2019) Keskin, Ercument; Erdogan, Abdullah; Karabulut, Ibrahim
    Aim: 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.