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This study aims to investigate whether the calcification of renal arteries and aorta may be risk factors for developing chronic kidney disease (CKD) after Nephron sparing surgery (NSS).The patients that underwent either open or laparoscopic NSS from 2000 to 2019 in 4 different centers were retrospectively assessed. Of these patients, 328 had a non-contrast-enhanced computer tomography. Calcium scores of the renal arteries and abdominal aorta were measured in the non-contrast-enhanced images with the calcium score plugin (version 2.0) of Horos™. Univariate and multivariate logistic regression analysis was performed to determine significant risk factors for developing CKD at the last check-up. Roc curve analysis was performed to determine the optimal cut-off values of age and abdominal aorta calcium scores.A total of 302 patients, of which 52 (16,6%) with CKD and 252 (83,4%) without CKD at the last check-up, were included in the analysis. The mean warm ischemia duration was significantly higher in patients with CKD (18,79±6,72 vs 16,38±5,57 minutes, p=0,016). The mean size of the tumor diameter and the number of the patients with ≥stage T1b were higher in the group with CKD (p=0,024 and 0,005, respectively). The median calcium scores of the aorta and renal arteries were higher in the group with CKD (p0,001 and p0,001, respectively). In multivariate analysis, age60 years (OR:3,65, p=0,022), calcium score of the aorta (OR:4,07, p=0,029), tumor diameter (OR:1,03, p=0,026) and pre-operative CKD stage (OR:10,13, p0,001) found the be significant factors for predicting last check-up CKD.The calcium score of the aorta may be used as an additional risk factor to predict post-operative CKD risk after NSS with sensitivity over 80%.

Introduction: To compare percutaneous nephrolithotomy (PCNL) outcomes between the elderly and young age groups and examined differences between young-old, old-old, and oldest-old patients. Methods:...

Objective: The objective of this study is to evaluate the effect of diagnostic ureterorenoscopy (URS) prior to radical nephroureterectomy (RNU) on intravesical recurrence (IVR), in patients with primary upper urinary tract urothelial carcinoma (UTUC). Materials and Methods: Retrospective analysis of 354 patients, who underwent RNU for UTUC from 10 urology centers between 2005 and 2019, was performed. The primary endpoint was the occurrence of IVR after RNU. Patients were divided into URS prior to RNU (Group 1) and no URS prior to RNU (Group 2). Rates of IVR after RNU were compared, and a Cox proportional hazards model was used to evaluate potential predictors of IVR. Results: After exclusion, a total of 194 patients were analyzed: Group 1 n = 95 (49.0%) and Group 2 n = 99 (51.0%). In Group 1, a tumor biopsy and histopathological confirmation during URS were performed in 58 (61.1%). The mean follow-up was 39.17 ± 39.3 (range 12–250) months. In 54 (27.8%) patients, IVR was recorded after RNU, and the median recurrence time within the bladder was 10.0 (3–144) months. IVR rate was 38.9% in Group 1 versus 17.2% in Group 2 (p = 0.001). In Group 1, IVR rate was 43.1% in those undergoing intraoperative biopsy versus 32.4% of patients without biopsy during diagnostic URS (p =0.29). Intravesical recurrence-free survival (IRFS) was longer in Group 2 compared to Group 1 (median IRFS was 111 vs. 60 months in Groups 2 and 1, respectively (p< 0.001)). Univariate analysis revealed that IRFS was significantly associated with URS prior to RNU (HR: 2.9, 95% CI 1.65–5.41; p < 0.001). In multivariate analysis, URS prior to RNU (HR: 3.5, 95% CI 1.74–7.16; p < 0.001) was found to be an independent prognostic factor for IRFS. Conclusion: Diagnostic URS was associated with the poor IRFS following RNU for primary UTUC. The decision for a diagnostic URS with or without tumor biopsy should be reserved for cases where this information might influence further treatment decisions.

Objective:Laparoscopic adrenalectomy (LA) is the treatment of choice for benign tumours of less than 6 cm. However, there is still an ongoing debate regarding the exact cut-off value of the tumour size. The aim of this study was to determine the effect of tumour size on intraoperative and postoperative outcomes in patients undergoing LA and also to estimate the learning curve for large adrenal tumours.Materials and Methods:The data of 102 patients who underwent LA from April 2010 to October 2018 was retrospectively analysed. The patients were allocated to 2 groups according to tumour size

Objective:The aim of this study is to investigate the surgical and functional outcomes of laparoscopic partial nephrectomy (LPN) in patients with renal angiomyolipoma (RAML).Materials and Methods:From April 2014 to February 2018, the data of a total of 346 patients who underwent LPN were retrospectively reviewed. Twenty-one patients with final pathology report indicating RAML were included in the study. Demographic data, operative indications, intraoperative and postoperative outcomes as well as complications were evaluated.Results:Eighteen female (85.7%) and 3 male (14.3%) patients were included in this study. The mean age was 55.14±11.95 years. Of the RAMLs, 52.4% were in the right kidney and 47.6% in the left kidney. The mean tumor size was 31.38±16.72 mm and the mean RENAL Nephrometry score was 5.90±1.51 (4-10). RAML could not be differentiated from RCC in 12 patients (57.1%) by preoperative computer tomography and/or magnetic resonance images. In 4 patients, LPN was implemented by off-clamp technique whereas, in 17 patients it was implemented by global ischemia technique. The mean operation duration was 67.86±20.77 (40-110) minutes (min) and the mean estimated blood loss was 117.14±59.7 (30-220) milliliters. In 17 patients who underwent LPN by global ischemia technique, the mean warm ischemia time was 10.88±5.19 (6-22) min. According to the Modified Clavien-Dindo classification, grade 1 complications were detected in 3 patients, postoperatively. The most considerable renal functional changes were detected between preoperative and postoperative- 1st day levels. However, at the end of the first year, the difference was found to decrease.Conclusion:LPN is a safe and effective treatment option for the treatment of RAMLs that are not able to be distinguished from renal cell carcinoma radiologically. Besides the definitive treatment, the exact pathological diagnosis can be ensured by LPN.

To evaluate whether pneumoperitoneum pressure lower than the standard pressure would allow higher cerebral oxygen saturation (rSO2) during laparoscopic nephrectomy (LN).Randomised controlled trial.Ondokuz Mayis University Hospital, Samsun, Turkey, from January to November 2020.Sixty-two patients (aged 18-65 years; ASA I-III) scheduled for LN were equally divided into a low-pressure (LP; 8 mmHg) and standard-pressure (SP; 14 mmHg) group. Mechanical ventilator settings were adjusted to maintain 32-37 mmHg ETCO2 and96% SpO2 throughout the surgery. The rSO2 was evaluated by near-infrared spectroscopy before and one minute after induction and then every five minutes until patient transfer to the recovery unit. Oxygen and carbon dioxide partial pressures, pH, and haemoglobin, recorded at five minutes after induction, five and 30 minutes after insufflation, and 10 minutes after desufflation, were examined for correlations with rSO2.Both groups had similar rSo2, arterial blood gas, and haemoglobin values at all measurement times. The LP group showed no differences between the preoperative values and the values obtained at the different time points. In contrast, the SP group showed significant differences between the preoperative and the measured values (except at 25, 30, and 35 minutes) (p = 0.001). Four patients (12.9%) in both groups showed cerebral desaturation. The rSO2 values were moderately correlated with the CO2 and haemoglobin values.Low insufflation pressure offered no advantages over standard pressure in terms of haemodynamics, arterial blood gases, cerebral oxygen saturation during LN, and CO2 insufflation did not change rSO2 levels. Key Words: Pneumoperitoneum, Spectroscopy, Oximetry, Nephrectomy, Surgery, Laparoscopic nephrectomy.

The incidence of renal tumor on the allograft kidney is relatively rare. There is no standard treatment available for the management of such cases. However, if technically feasible nephron-sparing surgical approaches, whether open or minimally invasive, should be preferred for the management of these challenging cases. To our knowledge, there is no pure laparoscopic technique reported in the literature but only 3 cases of robot-assisted partial nephrectomy. In this article, we aimed to present the application of pure transperitoneal laparoscopic partial nephrectomy for the management of a renal mass on the allograft kidney.

Ozden, Ender/0000-0003-3196-4024 WOS: 000467681200019 PubMed: 30637472 PurposeTo investigate whether iodine content can discriminate between benign or malignant renal tumors, malign tumor subtypes, low-grade and high-grade tumors on rapid kv-switching dual-energy CT (rsDECT).MethodsThis prospective study enrolled 95 patients with renal tumors who underwent rsDECT for tumor characterization between 2016 and 2018. Attenuation on true and virtual unenhanced images, absolute enhancement and enhancement ratio and iodine content of each lesion on nephrographic phase iodine density images were measured. Histopathological diagnosis was obtained following either surgery or core biopsy.ResultsEighty-five tumors were renal cell carcinoma (RCC) (56 clear cell, 20 papillary, 9 chromophobe) and 10 were benign (6 angiomyolipoma,4 oncocytoma). 46 tumors were low-grade and 23 high-grade. There was significant difference between iodine content of clear cell and non-clear cell (papillary+chromophobe) RCC (p

OBJECTIVE We aimed to evaluate the effect of body mass index (BMI) on oncological and surgical outcomes in patients who underwent radical cystectomy (RC) for bladder cancer (BC). MATERIALS AND METHODS We retrospectively assessed data from patients who underwent RC with pelvic lymphadenectomy and urinary diversion for BC recorded in the bladder cancer database of the Urooncology Association, Turkey, between 2007 and 2019. Patients were stratified into three groups according to the BMI cut-off values recommended by the WHO; Group 1 (normal weight

Ongün, Şakir (Balikesir Author), Objective To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. Methodology The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. Results A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. Conclusions Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

Purpose: To compare the functional outcomes of patients who underwent partial (PN) or radical nephrectomy (RN) for clinical T1 (cT1) renal tumors using the Kidney Cancer Database of the Urooncology Association, Turkey. Methods: We retrospectively reviewed 1004 patients who underwent PN and RN for cT1 renal tumors at multiple academic tertiary centers between 2000 and 2018. Patients with preoperative end-stage chronic kidney disease and/or metastatic disease were excluded. Results: There were 452 patients in the PN group and 552 patients in the RN group. The eGFR was significantly reduced in both groups on postoperative day one (PN=13.7 vs. RN=19.1 ml/min/1.73 m2: p

PURPOSE To compare the functional outcomes of patients who underwent partial (PN) or radical nephrectomy (RN) for clinical T1 (cT1) renal tumours using the Kidney Cancer Database of the Urooncology Association, Turkey. METHODS We retrospectively reviewed 1004 patients who underwent PN and RN for cT1 renal tumours at multiple academic tertiary centres between 2000 and 2018. Patients with preoperative end-stage chronic kidney disease and/or metastatic disease were excluded. RESULTS There were 452 patients in the PN group and 552 patients in the RN group. The median follow-ups were 74.9 and 83.7 months in RN and PN cohort. The eGFR was significantly reduced in both groups on postoperative day 1 (PN = 13.7 vs RN = 19.1 mL/min/1.73 m2 : P

Background: Partial nephrectomy (PN) is the standard of treatment in patients with cT1 renal tumors. Current guidelines recommend PN as a standard of treatment in patients with cT1 renal tumors. Ho...

Ozden, Ender/0000-0003-3196-4024; Mercimek, Mehmet Necmettin/0000-0002-0680-4451 WOS: 000525208400001 PubMed: 32208049 Background: Considering the increase in a number of vascular complications, right laparoscopic donor nephrectomy is less preferred due to achieving not only shorter renal vein but also longer renal artery. However, recent studies have indicated that the side of the surgery would not affect the outcomes. Aim: The aim of this study is to evaluate the outcomes and strategies to increase the safety of pure retroperitoneoscopic donor nephrectomy (RDN). Methods: We analyzed the prospectively collected medical records of 158 kidney donors who underwent RDN from January 2010 to August 2018. The patients were divided into two groups based on their side of surgery. Right- and left-sided RDNs were compared in terms of demographics, intraoperative, and postoperative data, including the development of incisional hernia (IH). The outcomes of the recipients were also evaluated. Results: Right RDN was performed in 40 (25.3%) and left RDN was performed in 118 (74.7%) donors. Operation time (P = .593), warm ischemia time (P = .271), blood loss (P = .787), and length of hospital stay (P = .908) were statistically similar in right and left RDN groups. Intraoperative and postoperative complications were statistically showed no difference between right and left RDNs. No IH was observed in any group. One-year and five-year patient survival and graft survival rates were 100% versus 97% (P = .299) and 100% versus 95% (P = .126) on both sides, respectively. Conclusion: Right RDN is an effective and safe method as on the left side. RDN has an additional advantage in the absence of IH. Experience with other retroperitoneoscopic urological interventions may have had a positive effect on the outcomes of pure RDN.

Ozden, Ender/0000-0003-3196-4024 WOS: 000466399600003 PubMed: 30560576 Purpose To evaluate whether two-dimensional (2D) shear wave elastography (SWE) can predict the presence of perirenal sticky fat (PSF) by showing increased perirenal fat stiffness. Methods We prospectively enrolled 28 patients with 31 renal tumors and 10 donor cases. Conventional renal ultrasound (US) and 2D-SWE examination of the perirenal fat were performed. Patient age, gender, body mass index (BMI), largest mass size, PF shear wave velocity (SWV) on both sides were recorded. During surgery, presence of PSF and perirenal fat dissection time (PFDT) were recorded. Results Twenty three renal masses were malignant and eight were benign. There were 13 clear cell carcinomas and 10 nonclear cell carcinomas. Eight patients had PSF. Mean PFDT was 13 minutes. PFDT and BMI were significantly increased in the PSF group (p < .05). No statistically significant differences were found in SWVs in patients with and without PSF. There were no significant differences with regard to SWVs between donor cases and patients, tumor side and nontumor side, benign masses and malignant masses, clear cell and nonclear cell tumors. No significant correlations were detected between SWVs and PFDT, mass size, Fuhrman grade and BMI (p > .05). Conclusion 2D-SWE cannot detect PSF.

Primary bladder melanoma (PBM) is an extremely rare tumor. Herein, we present a 39-year female evaluated for a history of dysuria and hematuria for one month and a solid mass of 23x15 mm detected on the left lateral wall of the bladder. The transurethral resection (TUR) of the tumor revealed muscle-invasive malignant melanoma. Laparoscopic partial cystectomy (LPC) and bilateral pelvic lymph node dissection (BPLND) were performed since other sites of melanoma were excluded. In this article, the effects of tumor characteristics and minimally invasive treatment options on survival are discussed in a patient with muscle-invasive PBM.

Unilateral synchronous multifocal renal tumors are rare. Due to the limited data in the literature and challenges in the technique, there is still doubt on the application of laparoscopic partial nephrectomy (LPN) for the management of such tumors. Herein, we report a 36-year male patient presenting with right-sided flank pain and microscopic hematuria. Abdominal computed tomography (CT) revealed five solid masses, the largest of which was 27 x 18 mm. The patient underwent LPN and the largest mass was resected with the control of segmental artery of the lower pole of the right kidney. The remaining four masses were resected by zero-ischemia technique. Final pathology revealed renal cell carcinoma in all masses. Postoperative period was uneventful. No recurrence was detected during a 5-year follow-up.

After comparing fresh and degraded performances of Polymer Electrolyte Membrane (PEM) based components of a hydrogen cycle with the help of computational fluid dynamics simulations, recently established stand-alone solar energy system producing hydrogen for energy storage is investigated focusing on the effects of degradation of fuel cells on the overall performance of the system. A complete model of the system has been developed using TRNSYS, and a degraded PEM Fuel Cell Subsystem has been incorporated into the model. Then, the effects of the PEM fuel cell degradation on the overall performance of the energy system are estimated. After reviewing the simulation results, the model shows that the PEM Fuel Cell degradation has a substantial impact on the overall system performance causing a system down time of approximately one month in a typical simulation year. Consequently, the stand-alone system is not capable of operating continuously for a complete year when the PEM fuel cells are degraded. Furthermore, an economic analysis is performed for a project lifetime of 25 years and the Levelized Cost of Electricity (LCE) value of the degraded system is found to be 0.08 $/kWh higher than the newly established system. Nevertheless, LCE calculations that are repeated for declining PV panel costs show that the considered hybrid system may be an economically competitive alternative to conventional diesel generators, even when the degradation of PEM based components and their regular maintenance are considered. (C) 2017 Hydrogen Energy Publications LLC. Published by Elsevier Ltd. All rights reserved.

A hybrid (Solar–Hydrogen) stand-alone renewable energy system that consists of photovoltaic panels (PV), Proton Exchange Membrane (PEM) fuel cells, PEM based electrolyzers and hydrogen storage is investigated by developing a complete model of the system using TRNSYS. The PV panels are mounted on a tiltable platform to improve the performance of the system by monthly adjustments of the tilt angle. The total area of the PV panels is 300 m 2 , the PEM fuel cell capacity is 5 kW, and the hydrogen storage is at 55 bars pressure and with 45 m 3 capacity. The main goal of this study is to verify that the system meets the electrical power demand of the emergency room without experiencing a shortage for a complete year in an emergency blackout situation. For this purpose, after modeling the system, energy and exergy analyses for the hydrogen cycle of the system for a complete year are performed, and the energy and exergy efficiencies are found as 4.06% and 4.25%, respectively. Furthermore, an economic analysis is performed for a project lifetime of 25 years based on Levelized Cost of Electricity (LCE), and the LCE is calculated as 0.626 $/kWh.

A hybrid (solar-hydrogen) renewable energy system consisting of photovoltaic (PV) panels, proton exchange membrane (PEM) fuel cells, PEM-based electrolyzers, and hydrogen storage has been investigated for a stand-alone application, which was established for the emergency room of Kecioren Training and Research Hospital in Ankara, Turkey. A complete model of the hybrid renewable energy system has been developed using TRNSYS. The main goal of the study is to meet the electrical power demand of the emergency room without any shortage for a complete year in an emergency blackout condition. The emergency room has a peak electrical load of 5 kW and a yearly load of 37.23 MWh. The PV panels are mounted on a tiltable platform to improve the performance of the system. The total area of the PV panels is 300 m2, and the PEM fuel cell capacity is 5 kW. The hydrogen storage pressure is 55 bars with the capacity of 45 m3. Energy and exergy analysis is performed for the hydrogen cycle of the system for a complete year. Overall energy and exergy efficiencies of the hydrogen cycle of the system are calculated as 4.06% and 4.25%, respectively.

WOS: 000218663800025 Patients with renal tumors < 7 cm and those at risk for a significant loss of renal function should be managed with a partial nephrectomy if it is technically feasible. Partial nephrectomy (PN) results in similar oncologic outcomes with radical nephrectomy. With advent of the technology and increase utilization of laparoscopic surgery, laparoscopic approach is considered as one of the option for partial nephrectomy. However laparoscopic partial nephrectomy is technically very difficult procedure and should be performed only by physicians with extensive experience using this approach. In this section, we aimed to present the technical steps of laparoscopic partial nephrectomy.

Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; WOS: 000218663800006 Objective The aim of this study was to determine the metabolic effects of kidney transplantation and calcineurin inhibitors (CNIs) on stone formation in the post-transplant period. Materials and Methods Forty kidney transplant recipients (KTRs) and 40 patients undergoing percutaneous nephrolithotomy (PNL) operation due to kidney stone disease between January 2002 and January 2010 were evaluated retrospectively. For control group 20 patients who neither had urinary stone disease (USD) nor a kidney transplant were chosen. Results No statistical difference was observed in terms of age, gender, body-mass index (BMI) and urinary pH between the groups. Twenty-four hour urine volume was significantly higher in the KTRs (p=0.001). However 24 hour urinary oxalate, citrate, uric acid, sodium and calcium levels were lower in the KTRs when compared to two other groups (p=0.001, p=0.0001, p=0.004, p=0.046, p=0.017, respectively). Twenty-four hour urinary potassium levels in the control group and the phosphorus levels in the group undergoing percutaneous nephrolithotomy were higher compared to other groups (p=0.022, p=0.008). After follow-up of 23.55 +/- 14 (2-50) months none of the KTRs were diagnosed with a urinary stone. Conclusion Although no stones were detected in the transplant group, low levels of urinary citrate may lead to de novo stone formation in the longer follow-up. Low levels of urinary calcium, oxalate, phosphate, uric acid and increased urine volume may axplain the fact that no stone was detected in this group. CNIs may increase metabolic tendency to stone formation in addition to their nephrotoxic effects. However our data does not support routine citrate replacement therapy for preventing stone formation and minimizing the toxic effects of CNIs due to tubular acidosis.

Early diagnosis and treatment of ureteral obstructions are important in terms of protection of renal function. Ureteral strictures which have benign or malignant etiology, can take place a lot of intrinsic and extrinsic reasons. The primary objective is decompression of existing urinary obstruction. Treatment option should be based on according to general conditon and life expectancy of patient, etiology, length and localisation of stricture and renal function. In benign uretral stricture extensive use of endourologic, laparoscopic and robot-assisted treatment options, aplicability and treatment results were reported in various studies, the preference of minimally invasive methods have increased instead of open surgery. DOI:10.4274/kiud.15

Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Ozden, Ender/0000-0003-3196-4024 WOS: 000324515100005 PubMed: 23712738 The aim of this study was to analyze the pre- and intraoperative risk factors that affect the development of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). Medical records on 317 adult patients with the complete data who underwent single-stage PCNL and followed at our center were retrospectively studied. Patients' data were collected through a database which was collected prospectively. All patients' vital signs were recorded hourly in the postoperative period and were divided into two groups as patients developing SIRS and not developing SIRS. There were 202 men and 115 women with a mean age of 48 +/- A 13.7 (range 19-82) years. There were 53 (16.7 %) in the SIRS and 264 (83.3 %) patients in the non-SIRS group. Preoperative positive urine cultures (UCs), intraoperative positive renal pelvic urine cultures (RPUCs), and stone cultures (SCs) were strongly correlated with the development of SIRS (p = 0.001). In the SIRS developers' group, preoperative UCs, intraoperative RPUCs, and SCs were positive in 33.9, 22.5, and 28.6 % of patients, respectively, but only 9.8, 3.3, and 4.2 % for the corresponding specimens in non-SIRS group. Positive preoperative UCs, intraoperative RPUCs, and SCs are important factors indicating the development of postoperative SIRS. Appropriately treated preoperative urinary infections may not prevent infected urine at PCNL. RPUCs and SCs may be the only way to identify the causative organism and direct antimicrobial therapy, so we recommend collecting RPUCs and SCs routinely to identify the offending organism and guide treatment.

It is aimed to evaluate the clinical and laboratory characteristics of children applied to nephrology outpatient clinic with the complaint of bedwetting. The records of all patients who applied to Pediatric Nephrology outpatient clinic with the complaint of bedwetting between January 2006 and June 2012 were evaluated retrospectively. A total of 364 patients, 207 male (56.9%) and 157 female (43.1%), aged between 5 to 17 years were enrolled in the study. Three hundred twenty-six patients (89.6%) had primary and 38 patients (10.4%) had secondary enuresis. Non-mono symptomatic enuresis was determined in 143 (39.3%) of the cases. The most common finding of 34 patients who underwent urodynamic study was low bladder capacity and overactive bladder. In conclusion, voiding disorders are frequently encountered but generally overlooked problems during childhood. By distinguishing monosymptomatic enuresis from nonmonosymptomatic enuresis, it would be possible to determine bladder disorders earlier and give the appropriate treatment. J. Exp. Clin. Med., 2013; 30:11-14

ozkaya, ozan/0000-0002-0198-1221; Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Ozden, Ender/0000-0003-3196-4024 WOS: 000315284900019 PubMed: 23099233 Bilateral obstructive nephrolithiasis is a rare cause of acute kidney injury (AKI) in early childhood. As soon as the identification of AKI secondary to ureteral stone is made, it will necessitate an emergency treatment. Patients: We report three infants with AKI caused by bilateral obstructive ureteral cystine stones. They were diagnosed with acute post-renal injury due to obstructive bilateral ureteral stones based on ultrasound scan findings. Immediately, bilateral ureteral stents were inserted for urinary drainage. Once renal function recovered to normal, each patient underwent ureteroscopy and percutaneous nephrolithotomy at the same session. Cystinuria was diagnosed by stone analysis and increased urinary excretion of cystine. Patients were advised to maintain a high fluid intake and were treated with potassium citrate in addition to tiopronin. Conclusions: With these three cases we would like to emphasize the importance of urolithiasis in the differential diagnosis of acute renal failure in young children, since urolithiasis may only cause nonspecific symptoms in this population. An early diagnosis with prompt treatment and a close follow-up are the key for achieving the best long-term outcome in cystinuria. (C) 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Objective: We aimed to show the short- and long-term protective effects of inhaled hy - drogen gas on renal ischemia/reperfusion (I/R) injury in a rat model. Material and Methods: Thirty Sprague-Dawley rats were randomly divided into 3 major experimental groups (Group 1, sham; Group 2, I/R; Group 3, hydrogen-I/R). Subsequently, Group 2 and 3 were divided into subgroups as early (E) and late (L) periods. Group 2 and 3 underwent 45 minutes of renal ischemia.Group 3 was administered 182.5 min (175-185 min) 2% hydrogen gas (2 L/min) in total (1 h before ischemia, by ischemia period and 1 h after reperfusion). Left nephrectomy was performed 6 hours after reper - fusion in the early groups and at the 14 th day of reperfusion in the late groups. We performed histopathological examination. Results: Kidneys from control rats (Group 2) exhibit significant in - jury characterized by marked histological changes characteristic of I/R injury in the outer medulla and cortex regions. Histological alterations were markedly reduced and all histological scores for renal injury were significantly lower in specimens from the hydrogen-I/R group compared to the control group (p=0.001). Conclusion: In this study, we demonstrated that hydrogen gas significantly attenuated renal I/R injury in early and late periods, and may have therapeutic potential against var - ious clinical conditions involving I/R injury.

A Polymer Electrolyte Membrane (PEM) fuel cell is numerically investigated both as fresh and as degraded with the help of observed degradation patterns reported in the literature. The fresh fuel cell model is validated and verified with the data from the literature. Modifying the model by varying the parameters affected by degradation, a degraded PEM fuel cell model is created. The degraded fuel cell is parametrically analyzed by using a commercial Computational Fluid Dynamics (CFD) software. The investigated parameters are the membrane equivalent weight, the Catalyst Layer (CL) porosity and viscous resistance, the Gas Diffusion Layer (GDL) porosity and viscous resistance, and the bipolar plate contact resistance. It is shown for the first time that PEM fuel cell overall degradation can be numerically estimated by combining experimental data from degraded individual components. By comparing the simulation results for the fresh and the degraded PEM fuel cells for two years of operation, it is concluded that the effects of overall degradation on cell potential is significant - estimated to be 17% around the operating point of the fuel cell at 0.95 V open circuit voltage and 70 degrees C operating temperature. (C) 2015 Elsevier B.V. All rights reserved.

Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Ozden, Ender/0000-0003-3196-4024 WOS: 000308813800011 PubMed: 22160282 Forgotten ureteral stents represent a difficult problem for urologists; the major complications are infection, migration, encrustation, stone formation, and multifractured stent, and a consensus on the best therapeutic approach is lacking. Here we present our experience with endoscopic management of this challenging problem and discuss the various endourological approaches for treating forgotten encrusted ureteral stents. From January 2005 to December 2010, 19 patients (11 women and 8 men) with encrusted ureteral stents were retrospectively analyzed. Combined endourologic therapies including extracorporeal shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopic lithotripsy (URSL), and cystolithotripsy (CLT) were used to achieve stent removal. A total of 19 patients with encrusted ureteral stents were treated at our center. The mean patient age was 46.2 +/- A 18.5 years (8-81), the average indwelling time of the stent was 24.7 +/- A 19.0 months (8-93), and the mean hospital stay was 3.4 +/- A 4.0 days (range 1-15 days). Using the described combination of techniques, all stents and the associated stones were eventually removed without any complications and patients were rendered stone- and stent-free. A main element of the treatment strategy was to keep the number of interventions as low as possible. The use of various combinations of endourological techniques can achieve effective stent and stone treatment after a single anesthesia session with minimal morbidity and short hospital stay.

Amaç: Bu çal›flmayla Samsun il merkezinde ö¤renim gören ilkö¤retim ça¤› erkek çocuklarda testis ve penis boyutlar›n› ölçerek yafla göre standartlar›n› belirlemek, fizik inceleme ile tan›s› konabilen d›fl genital organ anomalilerinin görülme s›kl›¤›n› bulmak ve anomali saptanan çocuklar›n ailelerine tedavi seçenekleri konusunda gerekli bilgilendirmeleri yapmay› amaçlad›k. Gereç ve Yöntem: Samsun Ondokuz May›s Üniversitesi Etik Kurulu’ndan onay (2009-79) al›nd›ktan sonra, Samsun il merkezinde basit rastgele örneklem yöntemi ile seçilen üç ilkö¤retim okulundan 6-11 yafllar› aras›nda (ortalama 8,67±1,51 y›l) 977 erkek çocuk çal›flmaya al›nd›. Testis ve penis boyutlar› ölçüldü. Fizik incelemede saptanan d›fl genital organ anomalileri kaydedildi. ‹statistiksel analiz SPSS 15.0 program› kullan›larak yap›ld›. Bulgular: Testis boyutlar› ve penis uzunluklar›n›n yafllara göre ortalama de¤erleri hesapland›. Ö¤rencilerden 44’ünde (%4,5) 52 genital anomali saptand›. ‹nmemifl testis (%1,2) ve inguinal herni (%0,8) en s›k görülen anomaliler aras›ndayd›. Çal›flmam›zda %3,9 oran›nda ilkokul ça¤›nda bile tedavi edilmemifl d›fl genital organ anomalili çocuk saptand›. Çıkarımlar: ‹lkö¤retim ça¤› çocuklarda yafla göre penis boylar› ve testis boyutlar›n›n toplumumuzdaki normal de¤erlerinin bilinmesi d›fl genital organlar›n de¤erlendirilmesi ve anomalilerin belirlenmesine katk›da bulunacakt›r. Ayr›ca çal›flmam›zda birço¤u ilkokul ça¤› öncesinde saptan›p tedavi edilmifl olmas› gereken d›fl genital organ anomalilerinin oldukça yüksek oranda oldu¤u saptand›., Aim: The objectives of this study are to evaluate malpractice from forensic medicine nbsp; perspective studying lawsuits filed against healthcare professionals who performed medical interventions on cases aged between 0 18 years Material and Method: Medical malpractice claims nbsp; filed against nbsp; healthcare professionals n= 378 submitted nbsp; to The Council of Forensic Medicine during the years 2002 ndash;2006 by the courts to form expert opinion were evaluated by 3 Specialty Board were examined nbsp;retrospectively The cases were evaluated in regard to being complaint about which health workers being engaged with a lawsuit of which health instutions being complaint about which department of health institutions and the damages arising and fault finding processes which occur in medical malpractice cases Results: Among the healthcare institutions subjected to malpractice claims state hospitals ranked first 52 7 followed by private hospitals 16 4 Pediatricians took the lead among healthcare professionals accused of malpractice followed by practicians 219 cases of malpractice 57 9 ensued in death nbsp; Opinions in favour of or against medical malpractice were expressed in 28 8 n=109 and 51 6 n=195 nbsp; of the cases respectively Conclusions: Because of increasing medical malpractices by age group 0 18 in our country the group of health professionals especially pediatricians and practitioners should be more careful and attentive of the diagnosis treatment and care Moreoever the patient his her relatives and intimates should be provided with detailed information about the complications and adverse effects of the recommended treatment using eligible words Turk Arch Ped 2011; 46: 151 8

Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Mercimek, Mehmet Necmettin/0000-0002-0680-4451; ozkaya, ozan/0000-0002-0198-1221; Ozden, Ender/0000-0003-3196-4024 WOS: 000285141900098 PubMed: 21074805 Purpose: Although percutaneous nephrolithotomy has been accepted as an effective minimally invasive procedure in children, there is still no consensus on how to define and stratify complications by severity. Materials and Methods: We retrospectively reviewed data of children who underwent percutaneous nephrolithotomy at our center between January 2002 and March 2010. A total of 100 procedures were performed in 94 patients with a mean age of 9.5 years. Complications were recorded according to modified Clavien classification. Results: Average stone burden ranged from 100 to 2,850 mm(2) (mean +/- SD 507.5 +/- 475). Stones were located in the renal pelvis in 32 kidneys, calices in 20, renal pelvis and calices in 31, and upper ureter in 3. Stone-free rate after a single session of percutaneous nephrolithotomy was 85%. After auxiliary procedures in 7 cases stone-free rate increased to 89%. Grade I complications were seen in 7 patients postoperatively, grade II in 19 (hematuria requiring blood transfusion in 13 and nonseptic infection requiring antibiotics in 6) and grade III in 4 (hydro-hemothorax in 2 and urine leakage requiring Double-J (R) stent in 2). No grade IV or V complications were observed. Regression analysis showed that stone burden (OR 1.006, 95% CI 1.001-1.011; p = 0.03) and operative time (OR 1.044, 95% CI 1.011-1.077; p = 0.009) were independent risk factors for complications. Conclusions: Percutaneous nephrolithotomy in children is safe, feasible and effective. Stone burden and operative time are independent risk factors for complications. The modified Clavien system provides a straightforward and validated method to classify postoperative complications.

Yakupoglu YK, Ozden E, Dilek M, Demirbas A, Adibelli Z, Sarikaya S, Akpolat T. Transplantation tourism: high risk for the recipients. Clin Transplant 2010: 24: 835–838. © 2009 John Wiley & Sons A/S. Abstract: Background: The shortage of donor organ supply is forcing patients with end-stage renal disease to alternative searches. The aim of this study is to present the clinical and laboratory data of five patients who were transplanted in Egypt from paid living-unrelated donors and followed at our institution. Methods: Five patients (four male, one female, mean age 51 yr) were included in this retrospective study. Results: All allografts still have good function with a mean serum creatinine level of 0.9 mg/dL. Surgical and medical problems were common such as wound infection (n = 3), evisceration (n = 2), deep vein thrombosis (n = 2), unexplained abdominal incision requiring removal of an abdominal surgical compress left in situ during previous surgery, placement of allograft on the side of an unrepaired indirect inguinal hernia and transplant pyelonephritis. Conclusion: Although recent developments increased success in renal transplantation, receiving a kidney from a paid living donor at a commercial transplant center still carries great risks for the recipient.

The shell side design of a shell-and-tube heat exchanger; in particular the baffle spacing, baffle cut and shell diameter dependencies of the heat transfer coefficient and the pressure drop are investigated by numerically modeling a small heat exchanger. The flow and temperature fields inside the shell are resolved using a commercial CFD package. A set of CFD simulations is performed for a single shell and single tube pass heat exchanger with a variable number of baffles and turbulent flow. The results are observed to be sensitive to the turbulence model selection. The best turbulence model among the ones considered is determined by comparing the CFD results of heat transfer coefficient, outlet temperature and pressure drop with the Bell–Delaware method results. For two baffle cut values, the effect of the baffle spacing to shell diameter ratio on the heat exchanger performance is investigated by varying flow rate.

Akdeniz, Ekrem/0000-0002-0666-9579; Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Ozden, Ender/0000-0003-3196-4024 WOS: 000267802100028 PubMed: 19464043 OBJECTIVES To study the clinical and bacteriologic Picture of acute prostatitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli after transrectal ultrasound-guided prostate biopsy. METHODS The retrospective data from 1339 patients who had undergone transrectal ultrasound-guided biopsy from November 2003 to June 2008 were reviewed. An automatic biopsy gun with an 18-gauge needle was used to obtain 10-core biopsies for first biopsies and >= 12-core for repeat biopsies. These patients had received 500 mg ciprofloxacin orally twice daily for 5 days, beginning 24 hours before biopsy. All biopsies were performed as Outpatient procedures. RESULTS Of the 1339 patients, 28 (2.1%) had acute bacterial prostatitis detected after transrectal ultrasound-guided prostate biopsy. Acute prostatitis Occurred after the first biopsy in 15 patients (1.3%) a ad after repeat biopsy in 13 (6.8%). The patients had developed infective symptoms a mean of 3 days after transrectal ultrasound-guided prostate biopsy. Of the 28 patients, 17 (61%) had positive urine and/or blood cultures, including E. coli in 14. Of the 14 patients, 6 had acute prostatitis caused by ESBL-producing E. coli. Bacteria isolated from urine were tested for drug susceptibility to a wide range of antibiotics. All patients with ESBL-producing E. coli were treated with imipenem. The bacteria detected in these urine cultures were resistant to ciprofloxacin, ceftriaxone, sulbactam/ampicillin, and cefazolin. Imipenem and piperacillin-tazobactam were the most active agents against ESBL-producing E. coli. ESBL-producing isolates had a significant reduction in activity for most antimicrobial agents, including fluoroquinolones and amikacin. CONCLUSIONS The prompt initiation of effective antimicrobial treatment is essential in patients with ESBL-producing E. coli, and empirical decisions Must be determined by knowledge of the local distribution of pathogens and their susceptibility. UROLOGY 74: 119-124, 2009. (c) 2009 Elsevier Inc.

Epispadias is one of the rarest congenital urological anomalies. In epispadias, prepuce is usually a redundant tissue located on the ventral part of penis. Diagnosis is easily made on physical examination. The presence of a complete prepuce associated with epispadias is rare, and diagnosis can be difficult. A 2.5-year-old male patient was admitted to our center for circumcision. Preputial skin was intact and patient presented with a concealed penis. In this paper, we report an unusual case with epispadias and a concealed penis. The patient was managed with a one-stage reconstruction. © 2013 by Türkiye Klinikleri.