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Öğe Clinical and pathological predictors of prolonged lymphorrhoea after pelvic lymph dissection in radical cystectomy(Yuzuncu Yil Universitesi Tip Fakultesi, 2020) Özkaptan, Orkunt; Balaban, Muhsin; Çubuk A.; Sahan A.; Ertaş K.; Sevinç, Cüneyd; Karadeniz, TahirThe aim of the study was to determine different variables that may be predictive for prolonged lymporrhoea and duration of lymphatic drainage. Two hundred and three patients who underwent radical cystectomy (RC) and pelvic lymph node dissection (PLND) were enrolled in this study. Lymphorrhoea was defined as the total amount of lymph drained by the drains until their removal. Duration of drainage was defined as the days until the removal of the last drains. Parameters that might be related to lymphorrhoea and duration of drainage including age, body mass index (BMI), removed lymph nodes, hemoglobin level (gr/dl), estimated blood loss (ml) (EBL), platelet count (PLN), hospital stay (HS) and lymph node status were reviewed retrospectively. Statistical analyses were performed to determine the association between lymphorrhoea with probable predictors for these variables. The mean number of removed lymph nodes was 28.52 (16-58). The mean amount of lymphorrhoea and the duration of drainage were 1504 ml (300-5850) and 10.10 days (2-27), respectively. Multivariate analyses revealed that the mean amount of lymphorrhoea rises gradually as EBL, patients age, negative lymph nodes and lymphadenectomy extension increases (P<0.05). Related to the duration of drainage, multivariate analyses showed that BMI and the number of removed lymph nodes were statistically significant predictors of prolonged drainage (p=0.016, p=0.046; respectively). Predictors for lymphorrhoea may help us mainly to foresee the duration of the hospital stay and the eventual complications that may be induced by lymphorrhoea. In patients with a higher risk for lymphorrhoea, preoperative maneuvers could be applied to decrease lymphorrhoea. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Öğe A different obturator nerve block approach using nerve stimulation device under fluoroscopy guidance in the transurethral resection of lateral bladder wall tumors(Galenos, 2021) Sevinç, Cüneyd; Karadeniz, TahirAim: This study aims to define the efficacy and safety of a different obturator nerve block technique using fluoroscopy and nerve stimulation device during transurethral resection of bladder tumor (TUR-BT). Methods: Sixty patients with lateral bladder wall tumors who had TURBT were retrospectively analyzed for the formation of obturator reflex. Thirty patients received spinal anesthesia (SA) and 30 patients received SA combined with an obturator nerve block (ONB). ONB was performed in the lithotomy position. A percutaneous needle was advanced to the superolateral portion of the obturator foramen under fluoroscopic guidance. The nerve was localized with a nerve stimulation device and 5 mL of 2% prilocaine was injected to perineural area. Additionally, the tumor base was marked intravesically by resectoscope with fluoroscopy and 5 mL of %2 prilocaine was administered to nearby tissue. Obturator reflex formation reflex-related related complications were compared between the two groups. Results: The results of our study yielded a statistically significant difference in the favor of ONB compared to SA alone for the occurrence of obturator reflex (13% vs 43%, p=0.020), bladder perforation (0% vs 23.3%, p=0.002), and absence muscle tissue in the pathological specimen (10% vs 40%, p=0.01). Conclusion: ONB with the help of a nerve stimulation device, directed by fluoroscopy is effective to prevent obturator reflex and related complications.Öğe Minimally invasive approach to ureteral stricture in transplant kidney by periodic retrograde ureteral stent placement and exchange(Elsevier Science Inc, 2018) Balaban, Muhsin; Özkaptan, Orkunt; Sevinç, Cüneyd; Karadeniz, TahirPurpose. The aim of the study was to evaluate the effectiveness of minimally invasive treatment of ureteral strictures and describe the technique that we used for retrograde placement of ureteral stent in transplant kidneys. Material and methods. We reviewed the medical cards of all transplant kidney patients with persistent ureteral strictures who were managed with periodical ureteral stent placement and balloon dilatation between 2008 and 2016. Different maneuvers that were used to overcome the difficulties for retrograde ureteral stent placement and exchange were discussed. Clinical characteristics and treatment outcomes of the study cohort were analyzed. Results. Between 2008 and 2016, a total of 1026 transplantations were performed in our clinic, and ureteral stricture was found in 13 patients (1.26%). Of the 13 patients, 8 were treated with periodic ureteral stent insertion and balloon dilatation. Ureteral stent insertion or stent exchange was performed in 52 transplant renal units. The overall success rate of retrograde ureteral stent insertion at the first attempt was 75% and stent exchange success rate was 100%. Renal function remained stable in all patients during a median follow-up of 41 months (range, 13-60 months). No other local or systemic complication was encountered and no stent encrustation was noted. Conclusions. Endoscopic management of ureteral stricture by periodical retrograde ureteral stent replacement and balloon dilatation is safe, effective, and highly successful in transplant patients who are not eligible for open reconstructive surgery.Öğe An open radical prostatectomy approach that mimics the technique of robot-assisted prostatectomy: a comparison of perioperative outcomes(Urol & Nephrol Res Ctr-Unrc, 2019) Özkaptan, Orkunt; Balaban, Muhsin; Sevinç, Cüneyd; Karadeniz, TahirPurpose: To report on an ascending radical retropubic prostatectomy (RRP) technique and determine whether this technique has better perioperative, oncological and functional outcomes than the standard RRP technique applied in our clinic. Materials and Methods: The perioperative and functional outcomes of the 246 patients that underwent standard RRP (N = 150) or modified RRP (N = 96) were evaluated, retrospectively. In the modified RRP technique the dorsal vascular complex (DVC) was controlled at first. Thereafter, the bladder neck was incised at the prostate-vesical junction. After seminal vesicles and vasa were exposed, posterior dissection was continued until to the apex. Finally, the urethra was divided. Results: The mean volume of estimated blood loss (EBL) was significantly longer in the standard RRP group than in the modified RRP group (610 vs. 210 ml, respectively; P = .001). The mean operative time (OT) was significantly less in the modified RRP group (177 vs. 134 min, respectively; P = .003), as were the transfusion rate TR (P = .041). With regard to the rate of postoperative complications, a statistically significant difference was observed between the two groups (P = .014). Continence rates after 3 and 12 months postoperatively were 98.95% and 98.95 % in the modified RRP group, and 97.33% and 98.66% in the standard RRP group, respectively (P = .83). Conclusion: We observed that the EBL, TR and OT were significantly lower when we applied the modified RRP technique to patients. This modified technique might be applicable for institutions as an alternative procedure for the standard RRP technique.Öğe Pelvic dimensions do not impact on complications and operative difficulty in radical cystoprostatectomy and orthotopic neobladder(Edizioni Minerva Medica, 2019) Özkaptan, Orkunt; Balaban, Muhsin; Sevinç, Cüneyd; Topsakal, Medih; Karadeniz, TahirBACKROUND: To evaluate the factors including pelvic dimensions, which might influence operative difficulty and complications after open radical cystoprostatectomy and orthotopic neobladder reconstruction in men. METHODS: A total of 198 RC patients operated in our institution with preoperative magnetic resonance (MRI) were analyzed were included in the study. Pelvic dimensions, including interspinous distance (ISD), bony femoral - (BFW) and soft tissue width (SW), apical prostate depth (AD), upper conjugate (UC), lower conjugate (LC) were measured by preoperative MRI. BFW, ISD, and SW indexes were defined as BFW/AD, ISD/AD, and SW/AD, respectively. Complicatons were classified according to the Clavien-Dindo classification system. As indicators of surgical difficulty; transfusion rate (TR), estimated blood loss (EBL), operative time (OT) and hospital stay (HS) were assessed. SPSS version 17.0 was used for statistical analyses. RESULTS: A total of 239 complications developed in 143 of the 198 patients (72.2%). Correlation analysis revealed a significant indirect relationship between TR and SW/AD (P=0.023). For EBL, there were significant indirect correlations between the SW/AD, BFW/AD and ISD/AD indexes (P=0.026, P=0.05, P=0.009; respectively). Additionally, OT was directly correlated body mass index (BMI) (P=0.001); and indirectly correlated with UC, SW/AD, and BFW/AD (P=0.047, P=0.038, P=0.016, respectively). On multivariate logistic regression analyses higher American Society of Anesthesiologist (ASA) score was associated with major complications. Multivariate analyses revealed that pathological stage was a significant predictor of EBL. CONCLUSIONS: Patients with smaller pelvises might undergo more difficult surgeries. However, it seems that small sized pelvis does not impact on operative difficulty and complication rate in radical cystoprostatectomy and orthotopic neobladder.
