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Öğe Bilateral microperc in a severe kyphoscoliosis(Aves, 2016) Daggulli, Mansur; Penbegül, Necmettin; Dede, Onur; Utangac, Mehmet MazharPercutaneous nephrolithotomy is the standard modality for large renal calculi in normal and abnormal renal anatomic situations. This case report describes a 57-year-old male patient who presented with bilateral kidney stones and severe kyphoscoliosis. He had successfully been treated with a bilateral microperc technique.Öğe Comparison of Scoring Systems in Pediatric Mini-Percutaneous Nephrolithotomy(Elsevier Science Inc, 2016) Utangac, Mehmet Mazhar; Tepeler, Abdulkadir; Daggulli, Mansur; Tosun, Muhammed; Dede, Onur; Armagan, AbdullahOBJECTIVE To apply urolithiasis scoring systems to the pediatric miniperc procedure and to compare their predictive capability for postoperative outcomes. MATERIALS AND METHODS Records from 2 referral centers of patients under 18 years of age who had the miniperc procedure between 2010 and 2015 were retrospectively investigated. All patients included in the study were graded by the same surgeon according to Guy's and Clinical Research Office of the Endourological Society (CROES) scoring systems using preoperative imaging methods. Patient demographics and outcomes were compared according to the complexity of the procedure as graded by each scoring system. RESULTS The mean age of the 97 patients was 7.1 +/- 5.2 (1-17) years. The mean stone burden and number were 388.4 +/- 233.9 mm(2) and 1.5 +/- 1.3, respectively. The mean procedure, fluoroscopy, and hospitalization times were 78.2 +/- 32.8 minutes, 144.8 +/- 84.3 seconds, and 4.1 +/- 2.8 days, respectively. The mean hematocrit drop was calculated as 2.2 +/- 2.2. The mean scores were 1.7 +/- 1.0 and 259.9 +/- 50.6 for Guy's and CROES scoring systems, respectively. In the multivariate analysis, stone-free status was found to be associated with Guy's (r: -0.464, p: .000) and CROES (r: 0.490, : 0.000) scoring systems and stone burden (r: -0.161, p: .041). In the analysis of factors related to complication, Guy's score was identified as an independent predictor of complication (p: .02, odds ratio: 1.9, 95% confidence interval 1.097-3.319). CONCLUSION According to our results, using Guy's and CROES scoring systems, stone-free ratios after percutaneous nephrolithotomy may be predicted preoperatively. In addition, Guy's system is a predictor of postoperative complication rate. (C) 2016 Elsevier Inc.Öğe Do the urolithiasis scoring systems predict the success of percutaneous nephrolithotomy in cases with anatomical abnormalities?(Springer, 2017) Kocaaslan, Ramazan; Tepeler, Abdulkadir; Buldu, Ibrahim; Tosun, Muhammed; Utangac, Mehmet Mazhar; Karakan, Tolga; Ozyuvali, EkremThe objective of this study is to assess the utility of the Guy, S.T.O.N.E., and CROES nephrolithometry scoring systems (SS), and compare the capability of each system to predict percutaneous nephrolithotomy (PNL) outcome in patients with anatomical abnormalities. We retrospectively collected medical records of patients with anatomical abnormalities who underwent PNL for the treatment of renal calculi by experienced surgical teams in four referral centers. All of the patients were graded by a single observer from each department based on preoperative computed tomography images using each SS. Patient demographics and outcomes were compared according to the complexity of the procedure as graded by each scoring system. A total of 137 cases with anatomical abnormalities [horseshoe kidney (n = 46), malrotation (n = 33), kypho and/or scoliosis (n = 31) and ectopic kidney (n = 27)] were assessed retrospectively. The mean stone burden, number, and density were 708.5 mm(2), 1.7, and 791.8 HU, respectively. The mean procedure, fluoroscopy, and hospitalization times were 75.2 +/- 35.3 min, 133.4 +/- 92.3 s, and 3.5 +/- 2.1 days, respectively. Stone-free status was achieved in 106 cases (77.4 %). A total of 17 (13.6 %) complications occurred postoperatively. The mean scores were 2.7, 7.2, and 219.1, for the Guy, S.T.O.N.E., and CROES systems, respectively. CROES score was the independent predictor of PNL success in cases with anatomical abnormalities [p: 0.001, OR 1.01, (95 % CI 1005-1021)]. The CROES scoring system is well correlated with the success of PNL in cases with anatomical abnormalities; the S.T.O.N.E. and Guy scoring systems failed to predict the outcomes of PNL in this specific patient population.Öğe The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception(Taylor & Francis Ltd, 2016) Akbas, Alpaslan; Gulpinar, Murat Tolga; Sancak, Eyup Burak; Karakan, Tolga; Demirbas, Arif; Utangac, Mehmet Mazhar; Dede, OnurObjectives: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction. Patients and methods: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0=never to 4 happily), and patient satisfaction rates (0=poor to 4=excellent) were assessed. Results: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p< 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. Conclusion: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.Öğe Effectiveness of ureteroscopy among the youngest patients: One centre's experience in an endemic region in Turkey(Elsevier Sci Ltd, 2017) Utangac, Mehmet Mazhar; Daggulli, Mansur; Dede, Onur; Sancaktutar, Ahmet Ali; Bozkurt, YasarBackground In recent years, the incidence of urinary stone disease reportedly has been increasing. The use of shockwave lithotripsy has seen low success rates, the inefficacy of a single session, and the need for general anaesthesia in children; additionally, children are exposed to radiation. These suboptimal treatment conditions have all led to ureteroscopy (URS) becoming the treatment method of choice for paediatric ureter stones. The aim of this study is to examine the effectiveness of 4.5-Fr URS when used on children younger than 1 year of age. Patients and methods The operation results of 34 patients (12 girls and 22 boys) who had undergone intervention for ureter stones at our clinic were retrospectively evaluated. For URS, a 4.5-Fr semi-rigid ureteroscope was used; a Holmium: YAG laser machine was used as a lithotripter. Result The mean patient age was 9.6 months (range 4-12 months) (Table). The mean stone surface area was 25.39 mm2 (range 11.84-84.78 mm(2)). In six cases, a ureteral catheter was inserted, because of minimal oedema in the ureters; in nine cases, a Double J (DJ) stent was inserted. The mean operation time was 45.3 min (range 22-87 min). In the first week of control with urinary ultrasonography and kidney-ureter and bladder radiograph, a stone-free condition was determined in 28 (82.3%) patients. In two cases-in which sufficient fragmentation could not be achieved, because of minimal bleeding during operation-during the exertion of a DJ stent, another URS was performed. In the first postoperative month, a stone-free condition was established in 32 (94.1%) patients. The mean hospital stay period was 28.6 h (range 12-72 h). There were seven cases (20.5%) with Clavien II-III complications. Conclusion Use of a ureteroscope is safe and effective with paediatric patients: we found that a 4.5-Fr ureteroscope can be safely used on children under 1 year of age. We therefore consider a 4.5-Fr ureteroscopic instrument to be an appropriate tool for treating URS in children within this age range.Öğe Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys(Springer, 2016) Soylemez, Haluk; Penbegül, Necmettin; Utangac, Mehmet Mazhar; Dede, Onur; Cakmakci, Suleyman; Hatipoglu, Namik KemalPelvic kidney stones remain a unique challenge to the endourologists. Treatment options include open surgery, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery, and laparoscopy assisted PNL (LA-PNL). As a minimal invasive option, LA-PNL can decrease the risk for bowel and major vessel injury. Here, we describe our experience using the LA-PNL procedures with different combinations, to treat kidney stones in multiple patients with a pelvic ectopic kidney (PEK). Eight patients, with PEK, kidney stones, and no other treatment choice, but open surgery, were included in the study. Two different laparoscopic techniques such as mesocolon dissection and transmesocolic, and four different percutaneous procedures such as standard-PNL, mini-PNL, micro-PNL, and a PNL through the renal pelvis were used for stone extraction in these patients. The mean age of patients was 25.6 +/- 12.9 years and mean stone size was 524.1 +/- 430.3 mm(2). Mean operation time was 150.5 +/- 40.0 (77-210) min which was composed of retrograde catheterization (14.8 +/- 2.9 min), laparoscopic procedure (48.7 +/- 20.6 min) and PNL procedure (86.8 +/- 31.1 min). Residual stones were seen in two patients (no additional treatment was need), while a 'stone-free' procedure was achieved in six patients (75.0 %). On the post-operative first month visit, a stone was observed on radiological examinations in only one patient (87.5 % stone-free). Mean hospitalization time was 2.8 +/- 0.9 days. No perioperative or post-operative complication was observed in all patients. LA-PNL surgery is a safe and effective option for treatment of PEK stones, and has several alternative approaches.Öğe Micro-percutaneous nephrolithotomy in the treatment of pediatric nephrolithiasis: A single-center experience(W B Saunders Co-Elsevier Inc, 2016) Daggulli, Mansur; Utangac, Mehmet Mazhar; Dede, Onur; Bodakci, Mehmet Nuri; Penbegül, Necmettin; Hatipoglu, Namik Kemal; Atar, MuratObjective: We aimed to clarify the applicability and safety of micro-PNL (microperc) in the treatment of pediatric kidney stones. Material and methods: A single center prospective trial was initiated, and microperc was performed in 40 children using the same two methods: the classical all-seeing needle and microsheath method. Stone fragmentation was performed using a 200-mu m holmium: YAG laser fiber. Results: The mean age of the patients was 6.3 +/- 4.4 years (range: 7 months-16 years). Fourteen were less than 3 years old. The average calculous size was 16.5 mm (range: 10-36 mm). In 20 patients, access was achieved through the all-seeing needle method. In the other patients, access was achieved by the microsheath method. Conversion to mini-PNL was required in 2 patients due to intraoperative bleeding in one and a high stone burden in the other. The mean hospital stay was 3.8 +/- 1.2 days (range: 1-10 days), and the mean hemoglobin decrease was 0.7 +/- 0.3 mg/dl (range: 0-1.7 mg/dl). The duration of surgery and fluoroscopic screening was 75 min and 3.7 min, respectively. A DJ stent was placed in 11 patients due to a high stone burden. A ureteral stent was left for 1 day in the rest of the cases. Complete clearance was achieved in the other 32 children. None of the patients required transfusion caused by renal hemorrhage. In 1 patient, extravasation of the irrigation fluid caused abdominal distention. As assessed by KUB and/or an ultrasound, the overall stone-free rate at 6 weeks was 80%. There were residual fragments in 6 patients (15%). Conclusions: Our results show that microperc is a safe and effective procedure for the treatment of pediatric kidney stones. Children with small renal calculi and with nonobstructed collecting systems are suitable for microperc. (c) 2016 Elsevier Inc. All rights reserved.Öğe Micro-ureteroscopy for the treatment of distal ureteral calculi in children(W B Saunders Co-Elsevier Inc, 2017) Utangac, Mehmet Mazhar; Sancaktutar, Ahmet Ali; Tepeler, AbdulkadirObjective: The objective of this study was to demonstrate the efficacy and safety of micro-ureteroscopy (microURS) in the management of distal ureteral stones in the pediatric population. Materials and Methods: A total of 11 children, who had undergone micro-URS between September 2015 and April 2016 with the indication of distal ureteral calculi in two referral centers, were retrospectively evaluated. The procedures were performed with the patient in the lithotomy position under general anesthesia using the standard URS technique with amicro-ureteroscope that has a caliber of 4.85 Fr all along its length. Demographics, perioperative data, and outcomes were assessed. Results: Right (n = 6) and left (n= 8) ureteral stones were detected in the respective number of patients. The mean age of the children was calculated as 55.1 months (range, 6-161 months). The median stone size was 10.5 mm (range, 6-24 mm). The median operative time was 36.8 min (range, 23-68 min). A double 3 stent was implanted in 3 of 11 patients because of severe edema. As a postoperative complication mild hematuria (Clavien grade 1) was observed in one case and resolved spontaneously. Intraoperative minor or major complication did not occur in any of the cases. The mean hospitalization time was determined as 21.4 h (range, 10-28 h). Stone-free status was accomplished in all patients in the final assessment. Conclusion: The outcomes of our series show that micro-URS can be used safely and effectively in the treatment of pediatric distal ureteral stones. Further prospective and comparative studies comparing instruments of different size are warranted. (C) 2017 Elsevier Inc. All rights reserved.Öğe MICROPERC: calibration of the needle MicroPNL, Micro. What about its length?(Springer, 2014) Utangac, Mehmet Mazhar; Soylemez, Haluk; Sancaktutar, Ahmet Ali[Abstract Not Available]Öğe Minimally invasive percutaneous nephrolithotomy: an effective treatment for kidney stones in infants under 1 year of age. A single-center experience(Springer, 2015) Daggulli, Mansur; Sancaktutar, Ahmet Ali; Dede, Onur; Utangac, Mehmet Mazhar; Bodakci, Mehmet Nuri; Penbegül, Necmettin; Hatipoglu, Namik KemalWe aimed to present the outcomes of PNL surgery performed in infantile patients with small renal stones who were younger than 1 year of age. A single-center prospective trial was initiated and during the period between Jan 2013 and Jan 2015, PNL was applied to 20 renal units of 16 infants (6 girls and 10 boys), including 4 patients with bilateral kidney stones. PNL was performed in patients with renal stones larger than 2 cm, as well as stones resistant to SWL or renal stones that were undetectable during SWL. The mean age of the patients was 9.55 (5-12) months. Of the 20 renal units, 1 had complete staghorn stones, 3 had partial staghorn stones, 13 had renal pelvic stones, and 3 had lower pole stones. The mean stone size was 18.5 mm (range 12-36 mm). Mean operative time for PNL was 88 (25-135 min). Mean fluoroscopy time was estimated as 3.4 min. Mean hemoglobin loss was 0.72 g/L (0.2-3). The mean hospital stay was 4.1 days (2-8 days). On postoperative day 1, a complete stone-free state was achieved in 70 % of renal units (14 of 20). At the end of the first postoperative week, the remaining two patients had insignificant residual fragments of 3 mm and were followed conservatively without any specific intervention. Thus, the total SFR was 80 % (16 of 20) at discharge. In infants aged less than 1 year, minimal access tract dilation during PNL, the use of smaller caliber pediatric instruments, and the realization of this procedure by surgeons with adequate experience in adults carry utmost importance. In addition, special care should be taken to avoid hypothermia and radiation exposure during PNL.Öğe A New Alternative for Difficult Ureter in Adult Patients: No Need to Dilate Ureter via a Balloon or a Stent with the Aid of 4.5F Semirigid Ureteroscope(Mary Ann Liebert, Inc, 2016) Soylemez, Haluk; Yildirim, Kadir; Utangac, Mehmet Mazhar; Aydogan, Tahsin Batuhan; Ezer, Mehmet; Atar, MuratObjective: To investigate the effectivity of 4.5F ultrathin ureteroscope (UT-URS) without any need for active or passive dilation in the treatment of adult patient population in whom ureteral orifices cannot be engaged using conventional URS. Materials and Methods: Among a total of 512 adult patients who had undergone URS between April 2012 and November 2015 in our department for diagnostic or therapeutic purposes, 43 (8.4%) patients required ureteral dilation because we could not engage ureteral orifice. In adult patients in whom we could not engage ureteral orifice with 7.5F and 8F semirigid URS, we tried to complete the operation using 4.5F UT-URS without resorting to dilation. Age and gender of the patients, indication for operation, stone size, location, operative times, laterality of stone(s), stone-free rates, length of hospital stay, and complications were recorded. Results: Mean age of the patients was 34.5 +/- 11.2 (21-66) years. The patients had undergone operations for ureteral stone (n = 39), unexplained hydronephrosis (n = 2), and ureteral stenosis (n = 2). Mean stone size was 8.2 +/- 2.3 (4-18) mm. Mean operative time was 64.2 +/- 13.5 minutes. In 37 of 39 patients, a complete stone-free rate (94.8%) was achieved. Mean length of hospital stay was 8.9 +/- 5.8 hours. Conclusion: It has been demonstrated that in an adult patient population in whom ureteral orifices cannot be engaged using conventional URS, ureteral access could be achieved with 4.5F UT-URS without any need for dilation. At the same time, use of 4.5F UT-URS resulted in an acceptable treatment success and lower complication rates in most of these patients without the need for a second session.Öğe A novel drainage technique during micropercutaneous nephrolithotomy in pediatric patients: double angiocath(W B Saunders Co-Elsevier Inc, 2016) Penbegül, Necmettin; Utangac, Mehmet Mazhar; Daggulli, Mansur; Dede, Onur; Bozkurt, Yasar; Bodakci, Mehmet Nuri; Atar, MuratMicropercutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that has the smallest tract size. The absence of an amplatz sheath during the microperc technique is a fundamental difference that distinguishes it from all other types of PNL (standard, mini, ultramini). Increasing of the intrarenal pelvic pressure (IPP) was demonstrated by the authors in adult patients but this problem may be even more serious in pediatric patients. Previously, the authors defined the use of a 14 gauge angiocath needle and sheath (microsheath) during microperc surgery for pediatric patient to reduce the IPP. In this novel technique, a second angiocath is used to access the renal collecting system to drain fluid during surgery. This technique is more effective in reducing IPP during microperc, especially in pediatric patients. (C) 2016 Elsevier Inc. All rights reserved.Öğe Paraoxonase and arylesterase activity in bladder cancer(Aves, 2017) Utangac, Mehmet Mazhar; Yeni, Ercan; Savas, Murat; Altunkol, Adem; Ciftci, Halil; Gumus, Kemal; Demir, MehmetObjective: Oxidative stress is the main pathogenetic mechanism in bladder cancer among many other causes. We aimed to investigate whether a potential relationship exists between bladder cancer and the activities of paraoxonase (PON1) and arylesterase (ARE) enzymes. Material and methods: The study included 56 patients with bladder cancer, and 57 healthy individuals. The relationships between enzyme activity and tumour grade, stage, muscular invasion and tumour size were evaluated. For statistical analysis, One-Sample Kolmogorov-Smirnov, Independent-T, ANOVA and Post-Hoc Bonferroni tests were used. Results: Serum levels of PON1 and ARE enzymes, and total cholesterol were significantly lower in bladder cancer group. While other lipid parameters were similar in both the patient and the control groups. Levels of ARE were positively correlated with lipid parameters except for HDL cholesterol. Conclusion: Our results showed that decreased serum PON1 and ARE enzyme activities are related with tumour load and recurrence. Further studies with larger samples are needed to confirm predictive role of enzymatic activities of PON1 and ARE in the diagnosis and prognosis of bladder cancer.Öğe Protective effects of carvacrol against methotrexate-induced testicular toxicity in rats(E-Century Publishing Corp, 2014) Daggulli, Mansur; Dede, Onur; Utangac, Mehmet Mazhar; Bodakci, Mehmet Nuri; Hatipoglu, Namik Kemal; Penbegül, Necmettin; Sancaktutar, Ahmet AliTo investigate the effect of carvacrol (CAR) on methotrexate (MTX)-induced testis damage in rats. Twenty-four male rats were equally divided into three groups: group I control treatment; group II MTX-treated; group III MTX + CAR-treated. A single dose of CAR was administered intraperitoneally to group III on the first day of the experiment and a single dose of MTX was administered intraperitoneally to groups II and III on the second day of the experiment. The total duration of the experiment was 8 days. Blood samples and testis tissue were obtained from each animal for the measurement of malondialdehyde (MDA), Total oxidant status (TOS), Total Antioxidant Status (TAS), and Oxidative stress index (OSI). Light microscopy was used to complete the histopathological examination of testis specimens from each animal. Analysis of serum and testis sampled revealed that MDA, TOS and OSI levels were significantly greater in the group receiving MTX alone relative to the control treated animals while the TAS level was significantly reduced in the MTX group when compared with the control group. The administration of CAR was associated with significantly decreased MDA, TOS, and OSI levels and increased TAS levels relative to the rats treated with MTX alone. All of these quantitative values demonstrate that CAR alleviates deleterious effects of MTX on testicular tissue. Use of antioxidants such as CAR may protect germ cells against oxidative stress and apoptosis when used in combination with MTX.Öğe STPEDISET: A novel innovation for percutaneous nephrolithotomy in children(W B Saunders Co-Elsevier Inc, 2016) Utangac, Mehmet Mazhar; Sancaktutar, Ahmet Ali; Daggulli, Mansur; Dede, Onur; Bodakci, Mehmet Nuri; Hatipoglu, Narvik Kemal; Penbegül, NecmettinPurpose: The aim of this study was to report the outcomes of PCNL in patients in whom the Short and Thin Pediatric Set (ST PEDISET) had been used. Methods: Data from 21 patients (11 boys and 10 girls) who underwent PCNL for renal stones using the ST PEDISET between April 2013 and February 2015 were analyzed retrospectively. The patients were evaluated by plane radiography and USG after surgery. Results: In total 21 children (11 boys and 10 girls) with a median age of 13 months (range 5 months to 4 years) who underwent PCNL were included in the study. The median stone burden was 16mm(range 10-36 mm). The success rate was 85.7%. Sixteen patients (76.2%) were stone free and two patients (9.5%) had clinically insignificant residual fragments (CIRF). The median length of hospital stay was 4 days (range 2-9 days). Conclusions: The data of this study clearly show that the ST PEDISET is safe, effective and ergonomic for percutaneous nephrolithotomy in preschool-age children. This study indicates the need for randomized trials on larger cohorts to confirm these findings, and thus improve the surgical procedure. (C) 2016 Elsevier Inc. All rights reserved.Öğe Ultrasound-guided micropercutaneous nephrolithotomy in pediatric patients with kidney stones(Wiley, 2015) Bodakci, Mehmet Nuri; Penbegül, Necmettin; Daggulli, Mansur; Dede, Onur; Utangac, Mehmet Mazhar; Hatipoglu, Namik Kemal; Sancaktutar, Ahmet AliObjective To present the outcomes of ultrasound-guided micropercutaneous nephrolithotomy for the treatment of renal stones in pediatric patients. Methods Ultrasound-guided micropercutaneous nephrolithotomy was carried out on 25 pediatric patients from June 2012 to October 2014. Micropercutaneous nephrolithotomy surgery was completed without the use of fluoroscopy in 19 patients. Medical records were retrieved from our institutional database and retrospectively reviewed. Percutaneous puncture was carried out by an all-seeing needle in seven patients and by a 14-G intravenous cannula in 18 patients. After entering to the collecting system through an all-seeing needle or by Microsheath, the calculus was fragmented using a 273-micron holmium yttrium aluminium garnet laser. After the stone was fragmented to the smallest pieces possible, the operation was terminated. Results Single access was obtained in all patients using ultrasound guidance. The average age of the patients was 4.12 +/- 5.33 years. The mean stone size was 13.45 +/- 3.11 mm. The mean operative time was 51.45 +/- 30.69 min. The mean duration of hospitalization was 3.18 +/- 1.77 days. Treatment success was 92%. Two patients had residual fragments after the procedure; these patients were followed conservatively. A total of three minor complications were observed and all of them were managed conservatively. Conclusions To our knowledge, this is the first study of ultrasound-guided micropercutaneous nephrolithotomy in the pediatric population. Our findings suggest that micropercutaneous nephrolithotomy can be safely carried out with ultrasound guidance in children by experienced hands, allowing to minimize risks associated with radiation exposure in this patient population.
