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    Evaluation of Risk Groups for the Prediction of Biochemical Progression in Patients Undergoing Radical Prostatectomy
    (Galenos Publ House, 2022) Madendere, Serdar; Turkkan, Gorkem; Arda, Ersan; Caloglu, Vuslat Yurut; Kuyumcuoglu, Ugur
    Objective: The aim of this study was to investigate the potential relationship between biochemical progression and prognostic risk factors in patients with prostate cancer (PCa) patients undergoing radical prostatectomy (RP). Materials and Methods: After inclusion/exclusion criteria were applied, 216 patients who underwent RP were included in this study. Follow-up protocol included prostate specific antigen (PSA) measurements; every 3 months for the first year, every 6 months for the second year, and an annual check after 2 years. Preoperative and postoperative PSA measurements, pathological stage, Gleason score (GS), extraprostatic extension, positive surgical margins and seminal vesicle invasion were evaluated. Uni- and multivariable analyses were used to detect the relationship between biochemical progression, biochemical progression-free survival (BPFS) and prognostic risk factors. Results: Median follow-up was 29 months. Biochemical progression was observed in 39 (18.1%) patients, in 18 (9.7%) of 185 patients with first postoperative PSA level of <0.2 ng/dL, and 21 (67.7%) of 31 patients with first postoperative PSA level of >= 0.2 ng/dL. Patients with first postoperative PSA level of >= 0.2 ng/dL had a statistically significant higher risk of biochemical progression and shorter BPFS (odds ratio: 2.41; 95% confidence interval: 1.84-3.10; p<0.001), in univariate and multivariate analyses. Patients with GS =8 or T3-4 or positive surgical margins had a statistically significant higher risk of biochemical progression (p<0.001, p=0.003, p<0.001). Conclusion: Postoperative PSA level higher than >= 0.2 ng/dL was the most important predictor of biochemical progression and BPFS after RP. GS >= 8, T3-4 stages, and positive surgical margins are also related to biochemical progression.
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    Impact of venous tumour thrombus consistency (solid vs friable) on cancer-specific survival in patients with renal cell carcinoma
    (Galenos Yayincilik, 2012) Akdere, Hakan; Kuyumcuoglu, Ugur
    Background: To our knowledge, the impact of venous tumour thrombus (VTT) consistency in patients affected by renal cell carcinoma (RCC) has never been addressed. To analyse the effect of VTT consistency on cancer-specific survival (CSS). Methods: We retrospectively analysed 174 consecutive patients with RCC and renal vein or vena cava inferior (VCI) VTT who underwent surgical treatment between 1989 and 2007 at our institute. All patients underwent radical nephrectomy and thrombectomy. Pathologic specimens were reviewed by a single uropathologist. In addition to traditional pathologic features, the morphologic aspect of the tumour thrombus was evaluated to distinguish solid from friable patterns. The prognostic role of thrombus consistency (solid vs friable) on CSS was assessed by means of Cox regression models. Results: The VTT was solid in 107 patients (61.5 %) and friable in 67 patients (38.5 %). The presence of a friable VTT increased the risk of having synchronous nodal or distant metastases, higher tumour grade, higher pathologic stage, and simultaneous perinephric fat invasion (all p < 0.05). The median follow-up was 24 mo. The median CSS was 33 mo; the median CSS was 8 mo in patients with a friable VTT and 55 mo in patients with a solid VTT (p<0.001). On multivariable analyses, the presence of a friable VTT was an independent predictor of CSS (p=0.02). The power of our conclusion may be somewhat limited by the relatively small study population and the retrospective nature of the study. Conclusions: In patients with RCC and VTT, the presence of a friable thrombus is an independent predictor of CSS. If our finding is confirmed by further studies, the consistency of the tumour thrombus should be introduced into routine pathologic reports to provide better patient risk stratification.
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    Malignant Mesothelioma of Tunica Vaginalis Testis: Macroscopic and Microscopic Features of a Very Rare Malignancy
    (Springernature, 2017) Arda, Ersan; Arikan, Mehmet Gurkan; Cetin, Gizem; Kuyumcuoglu, Ugur; Usta, Ufuk
    Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is an extremely rare tumour, usually mimicking benign pathologies of the scrotum. Our case is an 84-year-old male patient who appealed with a painless, left-sided scrotal swelling longer than 2 months. Although the level of tumour markers was normal, ultrasonographic examination results forced us to perform an inguinal scrotal exploration. Multiple small papillary tumours, both on tunica vaginalis and tunica albuginea, were detected intraoperatively. Due to these findings, radical orchiectomy was performed. A pathological evaluation showed malignant mesothelioma (MM) of the tunica vaginalis testis. Exposure to asbestos is a well-known risk factor. Furthermore, a history of trauma, herniorrhaphy and chronic hydroceles is blamed as a possible risk factor. Scrotal ultrasonography is the mainstay of primary diagnosis and, therefore, it should not be overlooked when dealing with benign scrotal cysts or hydroceles, which are very common pathologies at these decades, too. Radical inguinal orchiectomy is the primary treatment choice for localised MMTVT disease, whereas in signs of lymph node metastasis, inguinal lymph node dissection is required. Radical resection should be completed with chemotherapy and/or radiotherapy for an advanced or recurrent disease. This case, which is very rarely reported in the literature and detected during inguinal exploration, along with the pathological works that supported the diagnosis, was presented with this report.
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    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, Oztug
    Objective: 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.
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    Radical Cystectomy in Elderly Patients: Predicting Complications and Mortality, Technical Aspects and Postoperative Care
    (Galenos Yayincilik, 2015) Kuyumcuoglu, Ugur; Ozdedeli, Kaan
    Bladder cancer is one of the leading cancers all over the world and is the fifth among the cancer related mortality. Radical cystectomy and urinary diversion surgery; even if it has lost its traditional morbidity and mortality rates, still stands as one of the serious and major operations in urologic armamentarium. Quality of life issues are gaining much more importance in the new millennium with the significantly increased life expectancy. As demonstrated in many studies, the age of the patient is a factor increasing morbidity and mortality rates in radical cystectomy and urinary diversion. In the last decades beside geriatric patients' increased expectancies, new developments in surgical techniques and materials, postoperative care and anesthetic agents and techniques, the morbidity and mortality rates of radical cystectomy has reached to acceptable levels in this population as well as the quality life issues. As demonstrated in contemporary large clinical series, centers with high volume of patients, patient selection which will be made by considering postoperative care and comorbidity are remarkable since they are factors increasing the success.
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    A rare complication of ESWL: Focal metastatic multiple organ abscesses in a horseshoe kidney
    (Pagepress Publ, 2014) Kuyumcuoglu, Ugur; Eryildirim, Bilal; Tuncer, Murat; Faydaci, Gokhan; Aktoz, Tevfik; Akdere, Hakan; Sarica, Kemal
    Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment modality in the minimal invasive management of urinary system stone disease. Although the majority of the complications occuring after ESWL are minor (most common ones are gross haematuria, pain, perinephritic hematoma); bacteriuria may also occur in some cases which sometimes can lead to sepsis and even metastatic abscess formation in a very rare part of the cases treated. In this rare situation infection agent spreads quickly via hematogenous route and causes abscess formation in different parts of the body. Majority of such cases usually have an underlying systemic disease like diabetes mellitus (DM), malignancy, HIV or steroid use which lead to disruption of immune system functions. Abscess formation following ESWL is extremely rare and usually limited with some case reports published in the literature. Herein, we present a diabetic case with formation of multiple abscess foci in kidney, as well as in lungs and liver following ESWL. The patient was first admitted to our emergency department with high fever and respiratory distress and misdiagnosed as metastatic tumor foci based on radiologic findings. To the best of our knowledge, our case is the first one in the literature in whom simultanous abscess formation in multiple organ systems has been documented following an otherwise uneventful ESWL.
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    An update on palliative therapy in advanced prostate cancer
    (Galenos Yayincilik, 2014) Ozdedeli, Kaan; Kuyumcuoglu, Ugur
    Advanced prostat cancer is a progressive and debilitating disease which may lead to complex physical and emotional complications due to disease's progression and treatment morbidities. Physical complications like pain, skeletal complications, hot flushes, fatique, gastrointestinal and lower urinary dysfunction as well as the emotional problems may result in severe alterations in disease progresion and Qol parameters. Current approach favors an early and more meticilous palliative care, along with the primary treatment of the disease. Multidisiplinary treatment must be the choice in this stage of the disease which lacks significant evidence based data due to its complex symptomatology and deficiencies in current health systems. Patient's education, communication, emotional support and periodical monitorisation of quality of life are important issues that have to be included necessarily in advanced prostate cancer.