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Öğe ANOMALİ BÖBREKLERDE FLEKSİBLE ÜRETEROSKOPİ (f-URS) DENEYİMLERİMİZ(2021) Koraş, Ömer; Polat, Salih; Gökalp, Fatih; Şahan, Murat; Baba, Dursun; Deyirmenci, Özgür; Bozkurt, Ibrahim HalilGiriş: Anomalili böbreklerde böbrek ve proksimal üreter taşı hastaları için uyguladığımız fleksibl-URS ( f-URS)\rbaşarısını, komplikasyonlarını ve postopertif sonuçları sunmayı amaçladık.\rGereç ve Yöntem: Nisan 2010 ile Haziran 2020 y ılları arasında anomali böbreği olan f-URS uygulanan 69\rhastanın dosyaları retrospektif olarak tarandı. Hastalar ın dermografik özellikleri, operasyon süresi,skopi süresi,\rtaşsızlık oranları, komplikasyon oranları kaydedildi. Final taşsızlık (FSFR); postoperastif birinci ayda yapılan\rultrasonografi ve radiografik de ğerlendirilerek ta şın yoklu ğu veya bilgisayarlı tomografide 2mm den büyük ta ş\rfragmanı görülmemesi olarak tanımlandı.\rBulgular: Toplam 69 hastanın; parsiyel nefrektomili üç, bifid pelvisli dört, atnalı böbrekli 14, ektopik böbrekli 15,\rrotasyon anomalilisekiz, duplike üreterli 12 ve kaliksiyel divertikül 13 hastaya f-URS yapıldı. Ortalama taş boyutu\r15.1±7.7 mm 2 ve ortalama taş dansitesi (HU) 983±242 olarak saptandı. Tek seansta hastaların %78.2’sinde\rtaşsızlık sağlanmışken ek gişim ile final taşszılık%85,5 olarak saptandı.\rSonuç: Anormal böbrekli hastalarda f-URS teknik olarak zorlayıcı olabilse de endoürolojik tekniklerdeki\rilerlemeler onu güvenli ve etkili bir prosedür haline getirmiştir. f-URS; daha az invaziv yap ısıve kabul edilebilir\rkomplikasyon oranları nedeniyle anormal böbreklerdeki çoğu taş için çok etkili bir tedavi yöntemidir.Öğe Comparison of the effects of general and regional anesthesia on postoperative quality of life in elderly patients after transurethral prostate resection(2022) Ural, Sedef Gülçin; Gökalp, Fatih; Karazindiyanoglu, Sinan; Tor, İbrahim HakkıObjective: In our study, it was investigated whether the anesthesia method applied to patients with lower urinary tract symptoms due to benign prostatic hypertrophy and who will undergo transurethral resection of the prostate has effects on postoperative quality of life. Method: A total of 60 patients scheduled for TUR-P were included in the study. The patients were divided into two groups as those receiving spinal anesthesia and those receiving general anesthesia. We recorded demographic data and preoperative and perioperative parameters. We evaluated the postoperative quality of life and satisfaction of the patients using the Short Form-36 scale. Results: There was no statistically significant difference between the two groups in terms of demographic data and hemodynamic changes. There was a higher rate of patients who consumed alcohol and smoked in the general anesthesia group (p0.05). The preoperative and postoperative SF-36 subdomain scores were compared within the spinal anesthesia group, there was a statistically significant difference in all parameters (pÖğe Do Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Predict the Hardness of Kidney Stone(2021) Karslı, Onur; Üstüner, Murat; Halat, Ahmed Ömer; Özcan, Levent; Gökalp, Fatih; Koraş, Ömer; Voyvoda, BekirObjective: The Hounsfield unit (HU) is the most common value to assess the stone formation and a predictive factor for the management success. In this study, it was aimed to investigate the prediction of the hardness of the stone using systemic inflammatory response markers.Methods: 192 patients (61 female and 131 male) patients who underwent conventional percutaneous nephrolithotomy (PCNL) between 2015 and 2020 were reviewed retrospectively. Patients with malignancy and history of preoperative urinary tract infection were excluded from this study. Patients’ neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and HU of the kidney Stone, which was obtained from NCCT, were recorded to data.Results: The mean age was 47.2 ± 14.11 (11-82) years. The average HU value of the patients’ stones was 1135.47 ± 362.19 (348-2096). The location of the stones was grouped as pelvis (n:64, 33.3%), single calyx (n:14, 7.2%), two calyces (n:93, 48.4%) and staghorn (n:21, 10.9%). In subgroup analysis, when divided by stone location, a negative correlation was found between the HU and N/L ratio in the single calyceal stone group, and a positive correlation was found between the HU and N/L ratio for pelvis and staghorn stones. Among these correlations, only the positive correlation between the HU and N/L ratio in the pelvic stone group was statistically significant (r=0.318, p=0.03). Assuming an arbitrary cut-off value for HU below 1000, there was no significant correlation between NLR and HU (r=0.266, p=0.171). However, HU above 1000, there was a significant positive correlation between NLR and HU (r=0.145, p=0.045).Conclusion: The findings suggest that NLR could be used as a biomarker to choose appropriate management and be helpful to anticipate the hardness of kidney stones by predicting the HU value.Öğe THE EFFECT OF HISTOPATHOLOGICAL CHARACTERISTICS OF TESTICULAR TUMORS ON OVERALL SURVIVAL IN IMMIGRANTS(2022) Gökalp, Fatih; Koraş, Ömer; Gürsoy, Didar; Görür, SadıkIntroduction: Testicular cancer is a rare condition and incidence peaks in 2-3 decades. The incidence and oncological outcomes vary in patients with different race/ethnicity. In this study, we aimed to provide a description of racial difference in testicular cancer. Material and Method: Between 2016 and 2020, A total 52 patients underwent radical orchiectomy due to testicular cancer. All patients with hi stologically proven testicular germ cell tumors were included the study. Patients with other urological or systemic cancers, and lack of data were excluded from study. Results: The seminoma pathology was found in 27 patients. The median tumor size, and rete testis invasion were similar between groups (p=0.410, and p=0.487, respectively). The tumor stage was significantly higher in Immigrants (stage 2A and 3A, p<0.001) and overall survival was significantly lower in Immigrants (p<0.001). A total of 25 patients had non-seminoma pathology. The lymphovascular invasion, and tumor stage was also similar between groups (p=0.532, and p=0.781, respectively). However, overall survival was significantly lower in Immigrants (p=0.003). Conclusion: Testicular cancer is a rare but significant disease for young patients. Race/ethnicity effects oncological outcomes of testicular cancer.Öğe RENAL PELVİSTEKİ İDRARIN ÜRETER TAŞININ İMPAKTASYONUNU BELİRLEMEDEKİ ROLÜ(2021) Abat, Deniz; Gökalp, Fatih; Çam, Ali; Karslı, OnurGiriş: Üreter taşının olduğu taraftaki renal pelvisin Hounsfield Ünitesi değerinin taşın impaktasyonu hakkında fikir verip veremeyeceğini değerlendirmek amaçlandı. Gereç ve Yöntemler: Üreter taşı nedeniyle opere edilen hastaların, demografik verileri ile operasyon öncesi çekilen kontrastsız tomografi filmine göre hesaplanan, taşın transvers ve en uzun boyutu, üst üreterin çapı, üst üreterin alt üreter çapına oranı, taş dansitesi, renal pelvisin ön arka çapı ile renal pelvisteki idrarın ve mesanedeki idrarın HU değeri, taşın impakte olduğu ve olmadığı iki grup arasında karşılaştırıldı. Bulgular: Hastaların ortanca yaşı 44 (37-53) yıl olup, %86,4’ü erkekti. Yaş, cinsiyet, komorbidite, taraf ve taş lokalizasyonu bakımından gruplar arasında fark yoktu (p=0.067, p=0.073, p=0.093, p=0.0141 ve p=0.074, sırasıyla). Renal pelvisteki idrarın HU değeri ile mesanedeki idrarın HU değeri gruplar arasında karşılaştırıldığında anlamlı farklılık görülmedi (p=0.511, p=0.376, sırasıyla). Mesanedeki idrar dansitesinin renal pelvis dansitesine oranına bakıldığında gruplar arasında anlamlı fark yoktu (p=0.461). Transvers taş uzunluğu, en uzun taş boyutu, üst üreter çapı ve üst üreter çapının alt üreter çapına oranı, taş dansitesi ve renal pelvis AP çapı, taş impaktasyonu olan grupta istatistiksel olarak anlamlı olacak şekilde daha büyüktü (p<0.001, p<0.001, p<0.001, p=0.025, p=0.016 ve p<0.001 sırasıyla) Sonuç: Transvers taş uzunluğunun, taşın en uzun boyutunun, üst üreter çapının, üst üreter çapının alt üreter çapına oranının, renal pelvis ön arka çapının ve taşın HU ünitesindeki artışın impaktasyonla ilişkisi gösterilmiştir. Renal pelvisin idrar HU değerinin impaktasyonla ilişkisi bulunamamıştır.Öğe A SAFE AND EFFECTIVE METHOD FOR REMOVING ORGANIZED BLOOD HEMATOMA FROM THE BLADDER: THE CLOT MORCELLATION TECHNIQUE(2023) Ors, Bumin; Akıncıoğlu, Emir; Yildirim, Umit; Uslu, Mehmet; Eskıdemır, Umıt; Gökalp, FatihIntroduction: Urinary retention caused by bladder clots can be an extremely challenging medical condition when these blood clots are difficult to remove. We established an alternative technique to evacuate blood clots from the bladder by using morcellator devices following endoscopic urologic operations when all other conventional methods failed. Material and Method: The clot morcellation technique (CMT) used to treat 12 male patients who had severe clot retention and failed with conventional techniques following TUR-P, TUR-B, or laser prostatectomy. We describe how to use the morcellator to manage bladder blood clots and discuss this novel technique's outcomes. Results: We successfully used this technique to remove a large quantity of hematoma and empty the bladder in all patients with clot retention. The median time of clot removal was 6.9±4.4 minutes. The median estimated volume of hematomas was 80mL (range 20-400). There were no preoperative or postoperative complications. Conclusion: The evacuation of clotted blood in the bladder can be complicated and operational interventions need to be applied. However, having a clot-free bladder at the end of the procedure can be time-consuming and may not always be guaranteed. When other traditional treatments fail to completely remove the blood clot, the CMT is a rapid, easy, safe, and effective method to remove the blood clot entirelyÖğe Urinary Retention After Hemorrhoidectomy: Can We Reduce Risk?(2022) Gökalp, Fatih; Karslı, Onur; Gülsur, TamerObjective: Hemorrhoidectomy is a common surgery and urinary retention (UR) after anorectal surgeries is an unwelcome complication.\rIn this study we aimed to investigate risk of UR after hemorrhoidectomy and predict the factors associated with UR.\rMethods: Between 2016-2018 years, 180 patients who undergone hemorrhoidectomy by general anesthesia were included study. The\rpatients with urological symptoms and urological surgery before were excluded.\rResults: Median age of patients was 45.5 (IQR: 40.0-55.0) years. There was 116 (64.4%) of male and 64 (35.6%) of woman. Urinary retention\rwas seen significantly higher in men (p=0.03) but, visual pain scale (VPS) and the analgesic requirement were similar between men and\rwomen (p=0.39 and p=0.86, respectively). Regression analysis showed that male gender, operation time and analgesic requirement was\rnot associated UR and the VPS is only predictive factor for UR (OR:0.224, p<0.001).\rConclusion: The UR is an often and worrisome complication. The VPS is the important predictive factor for urinary retention. The\rsufficient analgesia could be the key to prevent this complication.
