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    External validation and comparison of current scoring systems in retrograde intrarenal surgery: Multi-institutional study with 949 patients
    (Wiley, 2021) Bozkurt, Ibrahim Halil; Karakoyunlu, Ahmet Nihat; Koras, Omer; Celik, Serdar; Sefik, Ertugrul; Cakici, Mehmet Caglar; Degirmenci, Tansu
    Objectives To externally validate and compare Resorlu-Unsal stone score (RUSS), modified Seoul National University Renal Stone Complexity Score(S-ReSC), Ito's nomogram, and Retrograde Intra-Renal Surgery (R.I.R.S.) scoring systems for predicting capabilities of both the stone-free status and complications in a multi-institutional study. Materials and Methods We performed a retrospective analysis of 949 patients who underwent flexible ureterorenoscopy (f-URS) and laser lithotripsy for renal stones in two institutions between March-2015 and June-2020. The RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S. scores were calculated for each patient by the same surgeon on imaging methods. Results were compared for their predictive capability of stone-free status and complications. Results Of 949 patients 603 were male and 346 were female with a mean age of 47.2 +/- 14.3 (range 2-84 years). Mean stone burden was 102.6 +/- 42.2 (48-270 mm(2)). All nomograms predicted stone-free status (Area Under Curve (AUC) were 0.689, 0.657, 0.303, and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286, and 0.664 for RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito's nomogram was able to predict Clavien >= 2 complications. Conclusion All four scoring systems (RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S.) could predict stone-free status after f-URS, however, the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post-operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.
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    On-demand use of fesoterodine: a new paradigm for extended release antimuscarinics
    (Springer London Ltd, 2022) Bozkurt, Ibrahim Halil; Sefik, Ertugrul; Celik, Serdar; Yesilova, Arda; Koras, Omer; Degirmenci, Tansu
    Introduction and hypothesis We aimed to compare on-demand and continuous use of fesoterodine 4 mg concerning efficacy and adverse effects. Methods A total of 100 patients who were diagnosed with non-neurogenic overactive bladder (OAB) syndrome were included in the study. All patients were evaluated with MMSE, ICIQ-SF, SEAPI quality of health and OAB-V8 questionnaires, at the beginning, 1st month and 4th month. Fesoterodine 4 mg was started for treatment. At the end of the 1st month, patients who obtained benefit from the treatment were 1:1 randomized into two groups. In group 1, fesoterodine 4 mg was given 1 x 1 in a standard manner whereas in group 2 patients took the pills on demand. Both groups were evaluated for efficacy and adverse events at 4 months. Results Final analyses included 69 patients. At 4-month follow-up, OAB-V8 scores were significantly improved compared to 1 month in both groups. Again at h months, no difference was detected between the two groups for MMSE, ICIQ-SF and SEAPI scores. In continuous usage group, 4th month MMSE scores were significantly lower than 1st month scores. At 4 months, dry mouth and constipation were lower in the on-demand group compared to continuous usage group. Conclusions Compared to standard continuous usage, on-demand usage of fesoterodine showed similar efficacy with fewer adverse events.
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    Oncological outcomes of papillary versus clear cell renal cell carcinoma in pT1 and pT2 stage : Results from a contemporary Turkish patient cohort
    (Pagepress Publ, 2023) Cetin, Taha; Celik, Serdar; Sozen, Sinan; Akdogan, Bulent; Izol, Volkan; Aslan, Guven; Suer, Evren
    Objectives: To compare overall survival (OS), recurrence free survival (RFS), and cancer-specific survival (CSS) in the long-term follow-up of T1 and T2 clear-cell-Renal Cell Carcinoma (ccRCC) and papillary Renal Cell Carcinoma (pRCC) patients, as well as to determine the risk factors for recurrence and overall mortality. Material and method: Data of patients with kidney tumors obtained from the Urologic Cancer Database -Kidney (UroCaD-K) of Turkish Urooncology Association (TUOA) were evaluated retrospectively. Out of them, patients who had patho-logical T1-T2 ccRCC and pRCC were included in the study. According to the two histological subtype, recurrence and mor-tality status, RFS, OS and CSS data were analyzed. Results: RFS, OS and CSS of pRCC and ccRCC were found to be similar. Radiological local invasion was shown to be a risk fac-tor for recurrence in pRCC, and age was the only independent factor affecting overall mortality. Conclusions: There were no differences in survivals (RFS, OS and CSS) of patients with localized papillary and clear cell RCC. While age was the only factor affecting overall mortality, radiological local invasion was a risk factor for recurrence in papillary RCC.
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    Oncological Outcomes of Patients with Non-Clear Cell Renal Cell Cancers: Subtypes of Unclassified and Translocation Renal Cell Cancers
    (Urol & Nephrol Res Ctr-Unrc, 2023) Gokalp, Fatih; Celik, Serdar; Sozen, Tevfik Sinan; Ozen, Abdurrahim Haluk; Aslan, Guven; Izol, Volkan; Baltaci, Sumer
    Purpose: We aimed to compare oncological outcomes in the two rare subtypes, unclassified renal cell cancer (un-RCC) and translocation RCC (tRCC), vs clear cell RCC (ccRCC). Materials and Methods: Between 2004 and 2019, from Turkish Urooncology Society Database, we identified 2324 patients for histological subtypes including 80 unRCC (3.4%), 19 tRCC (0.8%) and 2225 ccRCC (95.8%). Results: The overall (15.8%) and cancer-specific mortalities (11.1%) were found to be higher in tRCC group and the recurrence free mortality (13.8%) was found to be higher in unRCC group. Larger pathological tumor size (p = 0.012) and advanced pathological T stage (p = 0.042) were independent predictive factors on overall mortality in patients with unRCC tumors. Conclusion: The oncological outcomes of the unRCC and tRCC are worse than ccRCC and pathological tumor size and pathological stage are predictive factors for mortality in the unRCC.
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    Retrospective Analysis of the Factors Affecting Intraoperative and Immediate Postoperative Complications of Retrograde Intrarenal Surgery Classified by the Clavien and Satava Grading Systems
    (Mary Ann Liebert, Inc, 2021) Koras, Omer; Bozkurt, Ibrahim Halil; Karakoyunlu, Ahmet Nihat; Celik, Serdar; Sefik, Ertugrul; Yarimoglu, Serkan; Polat, Salih
    Background: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and proximal ureteral stones at two institutions between March 2015 and June 2020. Intraoperative complications were assessed using the SCS, and postoperative complications were graded according to the MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The median stone size was determined as 13mm (range 10-20mm). The stone-free rate was 83.6% after the first intervention. Reprocedure was applied to 89 of the patients with residual stones and the final stone-free rate was 94.4% after reprocedure. According to SCS, the number of intraoperative events and complication incidences was 153 (16.1%). MCCS revealed postoperative complications in 121 (12.8%) patients. Major complications were observed in 18 (1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.4%, p=0.001). Stone location, stone size, stone burden, stone number, stone density, and residual fragments were determined to be associated with the development of complications (p<0.001, p<0.001, p<0.001, p<0.001, p=0.002, and p<0.001, respectively). In addition, the multivariate analysis revealed that only the presence of residual fragments was a significant predictor of complication development for the patients with Grade 3 complications according to MCCS (p=0.032). However, significant predictors were stone burden (p<0.001), stone density (p=0.002), and fluoroscopy time (p<0.001) for those with Grade >= 2b complications according to SCS. Conclusion: This study showed that abnormal kidney anatomy, operation time, stone burden, and residual fragments were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.
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    What is the Optimal Time Period for Postponing Nephrectomy in Patients with Renal Cell Carcinoma of Various Stages?
    (Galenos Publ House, 2023) Celik, Serdar; Tinay, Iker; Sozen, Sinan; Ozen, Haluk; Akdogan, Bulent; Aslan, Gueven; Baltaci, Suemer
    Objective: The coronavirus disease-2019 pandemic has shown us that postponing elective surgeries that include nephrectomy due to renal cell carcinomas (RCC) was undertaken by the physicians to use hospital facilities in a balanced way. However, both urologists and patients were concerned about postponements that may increase the risk of progression. To determine the optimal threshold of postponement time-period for surgery (PTP) and according to the clinical T stages in patients who underwent nephrectomy due to RCC, we used the Urologic Cancer Database-Kidney.Materials and Methods: Patients who underwent detailed clinical T stage analysis with admission and surgery dates were included in the study. PTP was calculated using the dates of definitive preoperative diagnosis and surgery date. Recurrence, overall mortality (OM), recurrence-free survival, and overall survival (OS) were evaluated. The effects of PTP on oncological outcome according to tumor diameter and clinical T stages were also evaluated. We also analyzed the optimal cut-offs of PTP based on clinical T stages.Results: Among 3.258 patients, in the evaluation of 2.946 clinically localized patients, PTP and tumor diameter were found to be important predictors of recurrence (p=0.037 and p<0.001). The optimal PTP of 30 days was found to be an important significant threshold time for the T1 stage and 20 days for T2-4 stage tumors. Patients with longer PTP according to the thresholds shown in this study had higher upstaging for clinical T1a, T2a, and T3 stages; higher recurrence rates for T1b and T2b stages; and higher OM for T2a and T3 tumors. The survival have also shown that more than 20 days of PTP affected OSs for clinical-stage T1 (p=0.019), T2 (p=0.021) and T3 (p=0.007) tumors.Conclusions: All patients with tumors, including clinical T1 tumors, had worsening oncological results as the PTP increased (>20-30 days).