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Öğe Effect of Age on Outcome of High-Risk Non-Muscle-Invasive Bladder Cancer Patients Treated with Second Transurethral Resection and Maintenance Bacillus Calmette-Guerin Therapy(Galenos Yayincilik, 2016) Baltaci, Sumer; Bozlu, Murat; Yildirim, Asif; Gokce, Mehmet Ilker; Tinay, Ilker; Aslan, Guven; Can, CavitObjective To determine the effect of age on recurrence and progression rates in a population of high-risk non-muscle invasive bladder cancer (NMIBC) patients treated with a second transurethral resection (TUR) and at least 1 year of maintenance Bacillus Calmette-Guerin (BCG) therapy. Materials and Methods In this multicenter study, we reviewed the data of patients treated for high-risk NMIBC between 2005 and 2012. Patients without a muscle-invasive cancer on second TUR and received induction BCG and at least one year of maintenance BCG therapy and at least 12 months of follow-up after completion of maintenance BCG were included. Effect of age was analyzed both dichotomously (< 70 or >= 70 years) as well as by 10-year increments. Chi-square test, Student's T-test and analysis of variance (ANOVA) were used for comparison of the groups. Univariate and multivariate logistic regression analyses were performed to identify predictors of recurrence and progression. Results Overall, 242 eligible patients were included. Baseline parameters were similar. With a mean follow-up of 29.4 +/- 22.2 months, neither 3-year recurrence-free survival nor 3-year progression-free survival differed between the age groups when examined either dichotomously or by 10-year increments. Conclusion In high-risk NMIBC patients treated with a second TUR and received maintenance BCG therapy, age was not associated with increased rates of neither recurrence nor progression. Until a randomized prospective clinical trial assess the appropriate adjuvant intravesical therapy in the elderly, elderly patients should probably be treated in the same manner as younger patients.Öğe Identification of Patients with Microscopic Hematuria who are at Greater Risk for the Presence of Bladder Tumors Using a Dedicated Questionnaire and Point of Care Urine Test - A Study by the Members of Association of Urooncology, Turkey(Asian Pacific Organization Cancer Prevention, 2014) Turkeri, Levent; Mangir, Naside; Gunlusoy, Bulent; Yildirim, Asif; Baltaci, Sumer; Kaplan, Mustafa; Bozlu, MuratIn patients with microscopic hematuria there is a need for better identification of those who are at greater risk of harbouring bladder tumors. The RisikoCheck (c) questionnaire has a strong correlation with the presence of urothelial carcinoma (UC) of the bladder and in combination with other available tests may help identify patients who require detailed clinical investigations due to increased risk of presence of bladder tumors. This study aimed to evaluate the efficacy of RisikoCheck (c) questionnaire together with NMP-22 (R) (BladderChek (R)) as a point-of-care urine test in predicting the presence of bladder tumors in patients presenting with microscopic hematuria as the sole finding. In this multi-institutional prospective evaluation of 303 consecutive patients without a history of urothelial carcinoma (UC), RisikoCheck (c) risk group assessment, urinary tract imaging and cystourethroscopy as well as urine cytology and Nuclear Matrix Protein-22 (NMP-22 BladderChek) testing were performed where available. The sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) for the risk adapted approach were calculated. All patients underwent cystoscopy, and tumors were detected in 18 (5.9%). Urine cytology and NMP-22 was positive for malignancy in 9 (3.2%) and 12 (7.5%) of patients, respectively. A total of 43 (14%) patients were in the high risk group according to the RisikoCheck (c) questionnaire. The sensitivity and specificity of the questionnaire in detecting a bladder tumor was 61.5 % and 84.0 % in the high risk group. In patients with either a positive NMP-22 test or high risk category RisikoCheck (c), 23.6% had bladder tumors with a corresponding sensitivity of 54.2% and specificity of 88.6%. If both tests were negative only 3.3% of the patients had bladder tumors. The results of our study suggest that the efficacy of diagnostic evaluation of patients with microscopic hematuria may be further enhanced by combining RisikoCheck (c) questionnaire with NMP-22.Öğe A prospective randomized multicenter study of Turkish Society of Urooncology comparing two different mechanical bowel preparation methods for radical cystectomy(Elsevier Science Inc, 2013) Aslan, Guven; Baltaci, Sumer; Akdogan, Bulent; Kuyumcuoglu, Ugur; Kaplan, Mustafa; Cal, Cag; Adsan, OztugObjective: To investigate the outcomes and complication rates of urinary diversion using mechanical bowel preparation (BP) with 3 day conventional and limited BP method through a standard perioperative care plan. Materials and methods: This study was designed as a prospective randomized multicenter trial. All patients were randomized to 2 groups. Patients in standard 3-day BP protocol received diet restriction, oral antibiotics to bowel flora, oral laxatives, and saline enemas over a 3-day period, whereas limited the BP arm received liberal use of liquid diet, sodium phosphate laxative, and self administered enema the day before surgery. All patients received same perioperative treatment protocol. The endpoints for the assessment of outcome were anastomotic leakage, wound infection, wound dehiscence, intraperitoneal abscess, peritonitis, sepsis, ileus, reoperation, and mortality. Bowel function recovery, including time to first bowel movement, time to first oral intake, time to regular oral intake, and length of hospital stay were also assessed. Results: Fifty-six patients in 3-day BP and 56 in limited BP arm were evaluable for the study end points. Postoperatively, 1 patient in limited BP and 2 patients in 3-day BP arm died. There was no statistical difference in any of the variables assessed throughout the study, however, a favorable return of bowel function and time to discharge as well as lower complication rate were observed in limited BP group. Conclusions: Regarding all endpoints, including septic and nonseptic complications, current clinical research offers no evidence to show any advantage of 3-day BP over limited BP. (C) 2013 Elsevier Inc. All rights reserved.Öğe Significance of the interval between first and second transurethral resection on recurrence and progression rates in patients with high-risk non-muscle-invasive bladder cancer treated with maintenance intravesical Bacillus Calmette-Guerin(Wiley-Blackwell, 2015) Baltaci, Sumer; Bozlu, Murat; Yildirim, Asif; Gokce, Mehmet Ilker; Tinay, Ilker; Aslan, Guven; Can, CavitObjectives To evaluate the effect of the interval between the initial and second transurethral resection (TUR) on the outcome of patients with high-risk non-muscle-invasive bladder cancer (NMIBC) treated with maintenance intravesical Bacillus Calmette-Guerin (BCG) therapy. Patients and Methods We reviewed the data of patients from 10 centres treated for high-risk NMIBC between 2005 and 2012. Patients without a diagnosis of muscle-invasive cancer on second TUR performed <= 90 days after a complete first TUR, and received at least 1 year of maintenance BCG were included in this study. The interval between first and second TUR in addition to other parameters were recorded. Multivariate logistic regression analysis was used to identify predictors of recurrence and progression. Results In all, 242 patients were included. The mean (SD, range) follow-up was 29.4 (22.2, 12-96) months. The 3-year recurrence-and progression-free survival rates of patients who underwent second TUR between 14 and 42 days and 43-90 days were 73.6% vs 46.2% (P < 0.001) and 89.1% vs 79.1% (P = 0.006), respectively. On multivariate analysis, the interval to second TUR was found to be a predictor of both recurrence [odds ratio (OR) 3.598, 95% confidence interval (CI) 1.885-8.137; P = 0.001] and progression (OR 2.144, 95% CI 1.447-5.137; P = 0.003). Conclusions The interval between first and second TUR should be <= 42 days in order to attain lower recurrence and progression rates. To our knowledge, this is the first study demonstrating the effect of the interval between first and second TUR on patient outcomes.
