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Öğe Antegrade stent placement in laparoscopic upper urinary tract surgery. Is there an easy way?(TERMEDIA PUBLISHING HOUSE LTD, 2019) Gokcen, Kaan; Gokce, Gokhan; Kordan, Yakup; Kirac, Emre; Dundar, Gokce; Gultekin, Emin YenerIntroduction: Antegrade placement of double J stents in laparoscopy is considered a challenging and time-consuming process due to limitations regarding stent flexibility. Aim: To describe the method we used to facilitate the antegrade placement of intracorporeal stents in laparoscopic upper urinary tract (LUUT) surgery and report its results. Material and methods: Data obtained from 42 consecutive patients who had stents placed antegradely in laparoscopic pyeloplasty or in laparoscopic ureterolithotomy for middle-upper ureteral stones were retrospectively evaluated. The mean age of the patients was 30.1 +/- 18.6 (10 months-68 years) and 13 patients were in the paediatric age group. All patients in the paediatric age group underwent laparoscopic pyeloplasty. Results: The mean operative time for the 42 total cases, of which 32 underwent laparoscopic dismembered pyeloplasty and 10 laparoscopic ureterolithotomy, was 126.9 +/- 33.5 (70-200) min and the intraoperative stent placement time was calculated as 2.61 +/- 0.8 (1.5-5) min. The patients, who had a mean hospitalization time of 2.8 +/- 0.9 (2-5) months, required no additional interventions and no complications were encountered intraoperatively. In the patient series that had a mean follow-up time of 17.4 +/- 11.3 (1-35), it was determined only in 1 patient that the distal tip of the stent had not been in the bladder. Conclusions: The described modified antegrade stent placement technique is a practical method that is safe for all LUUT cases in both paediatric and adult age groups and it has been shown to produce successful outcomes and to be time-saving.Öğe Bellini Duct Carcinoma: Case Report and Review of the Literature(GALENOS YAYINCILIK, 2016) Dundar, Gokce; Korgali, EsatBellini duct carcinoma is highly aggressive tumor with poor prognosis. Metastases develop in most patients. Early diagnosis is very important and might increase the patient's life span. Various treatment protocols including radiotherapy, chemotherapy and immunotherapy have been adopted. However, these treatments do not create satisfactory results. We aimed to present an 80-year-old female patient who underwent left radical nephrectomy due to the presence of a cystic mass with the dimensions of 96x91x118 mm that was located in the upper pole of the left kidney. Pathology resulted as "collecting duct carcinoma" with lymph node metastasis. Metastatic lesions were observed in bilateral cerebellar hemispheres, cerebral hemispheres and brain stem of the patient on the magnetic resonance images that were obtained when the patient was admitted to the emergency service at the postoperative 10th day with hemifacial paralysis. Bellini duct carcinoma is a rare and aggressive type of kidney tumor with a low survival rate. A curative treatment option is still not available in the contemporary literature for this tumor which is mostly locally advanced or metastatic at the time of diagnosis.Öğe Can routine peripheral blood counts like neutrophil-to-lymphocyte ratio be beneficial in prediagnosis of testicular cancer and its stages?(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2018) Gokcen, Kaan; Dundar, Gokce; Gulbahar, Halil; Gokce, Gokhan; Gultekin, Emin YenerBackground: The purpose of this study was to assess the diagnostic role of preoperative hematological parameters, especially neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) in germ cell testicular malignancies and their prediagnostic role in staging of testicular cancer. Materials and Methods: In this cross-sectional retrospective study, we analyzed 39 patients who underwent radical orchiectomy due to a testicular cancer (Group 1) and 82 patients on whom varicocelectomy procedure was performed as control group (Group 2) between January 2006 and January 2016 in our clinic. Evaluation of the preoperative hematological parameters in both groups and also the subgroups in malignancy group according to histopathological stages was conducted in this study. Results: When the hematological parameters were compared, a statistically significant difference was found between the two groups in terms of neutrophil counts, NLR, PLR, and MPV. NLR and PLR were significantly higher and MPV was significantly lower in testicular cancer group compared to the control group. NLR was 3.1 +/- 1.4 and 2.0 +/- 1.5, PLR was 141.3 +/- 53.2 and 115.7 +/- 44.8, and MPV was 8.9 +/- 1.0 and 9.3 +/- 1.1 for testicular cancer and control groups, respectively (P < 0.05). Furthermore, differences were observed between only mean corpuscular volume, mean corpuscular hemoglobin, and MPV (P < 0.05) in different stages of malignancy. Conclusion: In accordance with these findings, NLR, PLR, and MPV may be helpful for prediagnosis of testicular malignancies. Hematological parameters will become important in the preoperative assessment for those patients.Öğe The Effect of Local Anesthetic Agent Infiltration Around Nephrostomy Tract On Postoperative Pain Control After Percutaneous Nephrolithotomy: A single-centre, randomised, double-blind, placebo-controlled clinical trial(UROL & NEPHROL RES CTR-UNRC, 2018) Dundar, Gokce; Gokcen, Kaan; Gokce, Gokhan; Gultekin, Emin YenerPurpose: Insufficient alleviation of pain after percutaneous nephrolithotomy causes patient dissatisfaction and generates additional morbidity factors by preventing early mobilization. This study investigated the effects of bupivacaine infiltration with two different doses around the nephrostomy tract after percutaneous nephrolithotomy. Materials and Methods: Patients who underwent subcostal single entrance percutaneous nephrolithotomy were randomly divided into 3 groups of 20 patients. While the first and second group were planned to receive bupivacaine at rates of 0.5% and 0.25% respectively, the third group was planned to receive a placebo agent to preserve the doubly blinded nature of the study. Results: A statistically significant difference was found in the number of patients using tramadole. The frequency of analgesic administration was found lower in the two groups that received bupivacaine in comparison to the group that did not, while the time of the first analgesic administration in the group that received high dose bupivacaine was significantly later than the other groups. Although there was no difference between the groups in terms of total amount of analgesic usage, patients who received higher concentrations of bupivacaine were likely to require a lower amount of narcotic agent. The frequency of analgesic administration decreased significantly in patients of both groups that received bupivacaine. Moreover, by administering bupivacaine at a 0.5% rate, fewer patients (50%) required narcotic analgesia and the first time of analgesic administration was found to be significantly later. Conclusion: Administering bupivacaine at a 0.5% rate around the nephrostomy tract after surgery was demonstrated to be more effective.Öğe Gleason Score Correlation Between Prostate Need e Biopsy and Radical Prostatectomy Materials(Federation Turkish Pathology Soc, 2019) Yeldir, Nese; Yildiz, Esin; Dundar, GokceObjective: Prostate cancer is the second most common cancer in men. Digital rectal examination, transrectal ultrasonography and serum prostate specific antigen represents a diagnostic triad for the detection of prostatic carcinoma. About 50 years ago, Dr. Donald Gleason created a grading system for prostate cancer based on its histologic patterns. Currently, this system maintains its validity with various changes. New updates were made in 2005 and 2014 by the International Society of Urological Pathology. The goal of biopsies is to determine the Gleason score and prognosis in prostatectomy material. The aim of this study was to determine the concordance of the Gleason score, tumor volwne and tumor laterality between prostate needle biopsy and prostatectomy materials. Material and Method: The study was performed with 112 patients who had biopsy and prostatectomy materials. The Gleason grades of the tumors have been evaluated with the new grading system. Tumor volumes were calculated by the number of positive blocks while tumor laterality was evaluated as unilateral or bilateral. Statistical analysis was performed on the obtained data. Results: Gleason score, tumor volume and tumor laterality discordance between needle biopsy and prostatectomy materials was found to be statistically significant. However, the concordance increased as the Gleason score and tumor volume increased. Conclusion: Digital examination, serum prostate specific antigen value and needle biopsy together are very sensitive for a prostate adenocarcinoma diagnosis. The Gleason score, localization and volume of the tumors are important for patient follow-up, treatment and prognosis.Öğe Laparoscopic dismembered pyeloplasty combined with port entrance flexible renoscopic lithotripsy(BRAZILIAN SOC UROL, 2018) Gokcen, Kaan; Gokce, Gokhan; Dundar, Gokce; Cicek, Resul; Gulbahar, Halil; Gultekin, Emin YenerIntroduction: Ureteropelvic junction obstruction and concomitant calculus disease may coexist. We demonstrate our use of flexible renoscopy during laparoscopic pyeloplasty for caliceal stone removal. Patient and methods: A 28-year-old female patient presented with recurrent attacks of flank pain of two years duration. When noncontrast-CT and DTPA were performed, the patient was diagnosed with ureteropelvic junction stenosis and 3 stones with a total burden of 14mm in the lower pole of right kidney. After pneumoperitoneum was established in right flank position, three 10mm trocars were placed including one camera port. 5mm trocar was placed for convenience to retraction and dissection. The surgery was uneventful, with no operative complications or evidence of intra-abdominal bleeding. Results: The duration of the surgery was 110 minutes. The amount of bleeding was 30ml. On the postoperative 2nd day, the urethral catheter was removed and the patient was discharged on the fourth day postoperatively. Stent removal was done on the 3rd postoperative week and retrograde pyelogram showed normal ureter. Post-operative follow-up with ultrasound showed that hydronephrosis had regressed. Conclusions: Laparoscopic pyeloplasty and concomitant flexible renoscopy through lowermost trocar with basket extraction is a simple, attractive alternative for the simultaneous treatment of ureteropelvic junction obstruction presenting with coexisting nephrolithiasis. This method is useful and feasible, with minimal invasiveness and an early post-operative recovery.Öğe Laparoscopic transperitoneal repair of retrocaval (circumcaval) ureter(BRAZILIAN SOC UROL, 2018) Gokcen, Kaan; Dundar, Gokce; Gokce, Gokhan; Gultekin, Emin Yener…Öğe Methylation of the e-cadherin (ECAD) gene in clear cell renal cell carcinoma (CCRCC)(Parlar Scientific Publications, 2020) Kitapci, Aytul; Dastan, Taner; Dundar, Gokce; Pektas, Ayse Nur; Dastan, Sevgi Durna; Korgali, Esat; Turkoglu, SifaClear cell renal carcinoma is one of the most common sub-types of renal cell cancer. Methylation is the leading type of epigenetic changes. Many studies in the field emphasized that hypermethylation of some genes is efficient on the formation of many cancer types. In this study, the aim is to analyze DNA methylation, one of the epigenetic changes in the ECAD gene of renal cell carcinoma (RCC) patients, and to determine the relations by comparing the present epigenetic features with clinic-pathologic parameters. Studies were organized in two groups: a control group with 153 individuals and a patient group with 113 individuals. The methylation of blood samples was determined by displaying in the gel after methylation specific PCR (MSP) steps. Some descriptive statistics and Wilcoxon, Correlation and Logistic Regression analyses were performed using SPSS. As a result of this study, it was found out that the probability of the occurrence of this disease was 5 times higher in people who have methylation in their ECAD genes than those who have not. Furthermore, it was observed that women are 4.253 times more likely to have disease compared to men. This research is a very important and fundamental study on the diagnosis and treatment of CCRCC disease in terms of the effect of epigenetic mechanisms such as methylation analysis. © 2020 Parlar Scientific Publications. All rights reserved.Öğe METHYLATION OF THE E-CADHERIN (ECAD) GENE IN CLEAR CELL RENAL CELL CARCINOMA (CCRCC)(Parlar Scientific Publications (P S P), 2020) Kitapci, Aytul; Dastan, Taner; Dundar, Gokce; Pektas, Ayse Nur; Dastan, Sevgi Durna; Korgali, Esat; Turkoglu, SifaClear cell renal carcinoma is one of the most common sub-types of renal cell cancer. Methylation is the leading type of epigenetic changes. Many studies in the field emphasized that hypermethylation of some genes is efficient on the formation of many cancer types. In this study, the aim is to analyze DNA methylation, one of the epigenetic changes in the ECAD gene of renal cell carcinoma (RCC) patients, and to determine the relations by comparing the present epigenetic features with clinic-pathologic parameters. Studies were organized in two groups: a control group with 153 individuals and a patient group with 113 individuals. The methylation of blood samples was determined by displaying in the gel after methylation specific PCR (MSP) steps. Some descriptive statistics and Wilcoxon, Correlation and Logistic Regression analyses were performed using SPSS. As a result of this study, it was found out that the probability of the occurrence of this disease was 5 times higher in people who have methylation in their ECAD genes than those who have not. Furthermore, it was observed that women are 4.253 times more likely to have disease compared to men. This research is a very important and fundamental study on the diagnosis and treatment of CCRCC disease in terms of the effect of epigenetic mechanisms such as methylation analysis.Öğe Microperc Versus Miniperc for Treatment of Renal Stones Smaller Than 2 cm in Pediatric Patients(UROL & NEPHROL RES CTR-UNRC, 2016) Dundar, Gokce; Gokce, Gokhan; Gokcen, Kaan; Korgali, Esat; Asdemir, Aydemir; Kaygusuz, KenanPurpose: Pediatric stone disease is an important clinical problem in pediatric urology practice. We aimed to compare mini-percutaneous nephrolithotomy (miniperc) and micro-percutaneous nephrolithotomy (microperc) in pediatric patients who underwent unsuccesful SWL procedure. Materials and methods: A number of 43 pediatric patients, aged 17 years or younger, were treated with miniperc or microperc procedures due to renal calculi by a single surgeon. In group 1, there were 27 patients who underwent miniperc procedure. In group 2, 16 patients were treated by microperc. Results: Mean age of the patients were 9.5 (3-17) years in group 1 and 7.9 (2-16) years in group 2 (P = .25). Stone burden was similar between the two groups. Mean operation duration was 74.1 (40-110) minutes in miniperc group and 37.2 (20-55) minutes in microperc group (P < .01). Patients who underwent microperc were discharged from clinic earlier. Hyperthermia without bacteraemia was observed in 2 children in the miniperc group and was treated by using a single dose of paracetamol and also 2 children in the same group needed blood transfusion. There was a tendency for low haemoglobin decrease in microperc group compared to miniperc (P > .05). Conclusion: The management of pediatric stone disease has evolved with improvements in techniques and minimalisation of surgical instruments and thus, it can be effectively and safely used in children by experienced surgeons.Öğe Safety and Efficacy of RIRS in Geriatric Patients: A Comparative Evaluation on an Age Based Manner(Urol & Nephrol Res Ctr-Unrc, 2020) Gokcen, Kaan; Dundar, Gokce; Bagcioglu, Murat; Karagoz, Mehmet Ali; Gokce, Gokhan; Sarica, KemalPurpose: In this retrospective study, we aimed to comparatively evaluate the efficacy and safety of RIRS procedure on an age-based manner in patients younger and above 65 years. Materials and Methods: A total of 165 patients undergoing RIRS procedure for renal stones were divided into two groups on an age-based manner namely; Group 1 (n=122) patients aging < 65 years and Group 2 (n=43) patients aging above 65 years. Demographic and clinical data regarding the stone free rates, complication rates and need for secondary procedures were retrospectively evaluated. Results: Of all the patients undergoing RIRS for kidney stones, 122 were below the age of 65 (73.9%) and 43 were above the age of 65 (26.1%). Mean age value for the patients aging more than 65 years was 74.16 +/- 5.03 years and in addition to higher percentage of comorbidities, serum creatinine levels as well as ASA scores were also higher in this group when compared with younger counterparts. Although there was no statistically significant difference with respect to the operative duration, stone-free rates (SFR) and hospitalization period between the two groups, both complication rates and the need for additional interventions were higher in the older patient group (p = 0.038; p = 0.032). All complications noted in the both groups were minor (Grade I) complications according to the Clavien classification system. Conclusion: RIRS procedure can be applied as an effective and safe treatment alternative for the minimal invasive management of renal stones in relatively older patients (> 65 years) with similar hospitalization as well as stone free rates noted in the younger patients. No procedure related severe complication was noted in these cases.
