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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:This study aimed to investigate the influence of different ischaemia techniques on short-term and one year renal function following laparoscopic partial nephrectomy (LPN).Materials and Methods:Data of 359 patients who underwent LPN between November 2009 and April 2018 were reviewed, retrospectively. A total of 287 patients were included in the study. Patients were divided into 4 groups according to type of ischaemia as follows: group A (n=33) was warm ischaemia time (WIT) >20 minute, group B (n=202) was WIT ≤20 minute, group C (n=16) was selective arterial clamping and group D (n=36) was off-clamp. Demographic data, preoperative and postoperative outcomes were compared. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Change in eGFR according to group and time was evaluated using two-way analysis of variance. P values 0.05) between groups. Only 4 patients in group B had positive surgical margin. The percentage of relative eGFR (% of ΔeGFR) decline 1 year after LPN was significantly (p=0.001) higher in the ischaemic groups (A and B: 9.3% and 7.5%) compared to the zero-ischaemia groups (C and D: 5% and 3.7%).Conclusion:This study revealed that after LPN, cumulative renal function decreases to a certain extent regardless of the technique. However, it was found that cumulative renal functions are better preserved when ischaemia time is reduced to ≤20 min or eliminated.

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.

Background Pelvic lymph node dissection (PLND) is the gold standard method for lymph node staging in prostate cancer. We aimed to evaluate the effect of PLND combined with radical prostatectomy (RP) on oncological outcomes in D'Amico intermediate-risk prostate cancer (IRPC) patients. Methods Patients with D'Amico IRPC were included in the study. In the overall cohort and subgroups (biopsy International Society of Urological Pathology [ISUP] grade group 2 and 3), patients were divided into two groups as PLND and no-PLND. More extensive PLND, defined as a number of removed nodes (NRN) >= 75th percentile. Results After exclusion, a total of 631 patients were included: 351 (55.6%) had PLND and 280 (44.4%) had no-PLND. The mean age was 63.1 +/- 3.60 years. The median NRN was 8.0 (1.0-40.0). The mean follow-up period was 47.7 +/- 37.5 months. The lymph node involvement (LNI) rate was 5.7% in the overall cohort, 3.9% in ISUP grade 2, and 10.8% in ISUP grade 3. Patients with PLND were associated with more aggressive clinicopathologic characteristics but no significant difference in biochemical recurrence-free survival (BCRFS) was found between patients with PLND and no-PLND (p = 0.642). In the subgroup analysis for ISUP grades 2 and 3, no significant difference in BCRFS outcomes was found in patients with PLND and No-PLND (p = 0.680 and p = 0.922). Also, PLND extent had no effect on BCRFS (p = 0.569). The multivariable Cox regression model adjusted for preoperative tumor characteristics revealed that prostate specific antigen (PSA) (HR: 1.18, 95% CI: 1.01-1.25; p = 0.048) was an independent predictor of biochemical recurrence (BCR). The optimum cut-off value for PSA, which can predict BCRFS, was assigned to be 7.81 ng/ml, with an AUC of 0.63 (95% CI: 0.571-0.688). The highest sensitivity and specificity were 0.667 and 0.549. Conclusion Overall and cancer-specific survival analyzes were not evaluated because not enough events were observed. Neither PLND nor its extent improved BCRFS outcomes in IRPC. The LNI rate is low in patients with biopsy ISUP grade 2 and the BCR rate is low in those with PSA < 7.81 ng/dl so PLND can be omitted in these IRPC patients.

Objective: Nephron-sparing surgery (NSS) is the first-line treatment for T1N0M0 renal tumors (RT). The aim of this multicentric retrospective study is to investigate the national trends and the effect of non-tumoral factors in the preference of NSS as treatment of T1 RT in Turkey.

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.

Objectives To investigate the predictors of acute kidney injury (AKI) after partial nephrectomy and the impact of AKI stage on long-term kidney function. Methods Data of 1055 patients who underwent partial nephrectomy between January 2008 and January 2018 at seven separate tertiary centres were analysed. AKI was defined according to AKI Network criteria. The association between pre-operative and perioperative factors and AKI was evaluated using logistic regression analysis. Recovery of at least 90% of baseline glomerular filtration rate 1 year after partial nephrectomy, change of 1 year glomerular filtration rate compared with baseline glomerular filtration rate and stage >= 3 chronic kidney disease (CKD) progression were assessed according to the stage of AKI. Results AKI was recorded in 281 (26.7%) of 1055 patients after partial nephrectomy, and of these patients, 197 (70.1%) had stage 1, 77 (27.4%) had stage 2 and 7 (2.5%) had stage 3. Higher tumour complexity and baseline glomerular filtration rate were independent predictors for AKI. The proportion of recovering 90% of baseline glomerular filtration rate at 1 year for any patient who had stage = 3 CKD progression for any patient who had stage

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.

Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Mercimek, Mehmet Necmettin/0000-0002-0680-4451 WOS: 000494962600007 Leiomyomas are rare, benign and solid tumors of the kidney. Although the developments in radiological imaging methods provide early detection of kidney tumors, it is difficult to differentiate leiomyomas radiologically from other malignant renal tumors. Moreover, the definitive diagnosis of leiomyomas can only be achieved by histopathological and also immunohistochemical evaluation after surgical intervention. Immunohistochemically, positive staining with smooth muscle actin and vimentin, whereas negative staining with cytokeratin, S100, Mart1 and HMB45 are the methods used in the differential diagnosis of leiomyomas. In this case series, after preoperative radiological evaluation, two female and two male patients between 45 and 89 years of age underwent laparoscopic treatment with the diagnosis of a malignant mass in the kidney. We aimed to illustrate the clinical, radiological and histopathological relationship of four adult patients who were managed by laparoscopic approach and diagnosed with renal leiomyoma. Renal leiomyomas should be kept in mind in patients with a renal mass before definitive treatment.

Objective:In the present study, we aimed to investigate the short- and long-term protective effects of oral sirolimus therapy on extracorporeal shock wave lithotripsy (ESWL)-induced kidney tissue damage in an experimental rat model.Materials and Methods:Twenty-four male Spraque-Dawley rats were used in the study. A total of 1000 shock waves (SWs) were applied to the left kidney of all rats at 15 kV, 60 SW/min. Two main groups, ESWL (group 1) and ESWL sirolimus (group 2), were formed. Each group was divided into two subgroups as early (E) and late (L). Left nephrectomy was performed on the 15th day in E groups and on the 60th day in L groups. Tubular injury, interstitial changes, as well as scar formation, were scored semi-quantitatively for at least 10 cortical fields in each sample. An average score was calculated for each subject. Independent samples t-test was used for statistical analysis. The statistical significance was accepted as p

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...

PubMed: 32445768 [No abstract available]

Mercimek, Mehmet Necmettin/0000-0002-0680-4451; Gulsen, Murat/0000-0001-5371-0960; Ozden, Ender/0000-0003-3196-4024 WOS: 000526101600001 PubMed: 32293992 Background: A double-pigtail ureteral stent (DPUS) can cause untoward symptoms, such as urgency, frequency, urinary incontinence, hematuria, and body pain that are bothersome to patient's quality of life (QoL). By reducing the quantity of material in the bladder, it could be reasonable to decrease stent-related symptoms (SRSs). We aimed to evaluate the tolerability of single pigtail suture stent (SPSS) with a validated questionnaire after uncomplicated retrograde semirigid ureteroscopic lithotripsy (URSL). Materials and Methods: A total of 130 patients who underwent ureteral stent placement after URSL for unilateral symptomatic ureteral stones with

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.

WOS: 000522673900009 Pheochromocytoma are the functional adrenal lesions originating from the chromaffin cells. For the cases of pheochromocytoma observed in multiple endocrine neoplasia Type 2 and Von Hippel syndrome, the bilateral adrenal glands are involved. In classical approach, total adrenalectomy is applicable on such masses while adrenal failure is almost inevitable. Lifelong cortisol and fludrocortisones replacement are necessary for the patients with adrenal failure while the rate of morbidity and mortality has significantly increased. With the introduction of the minimal invasive surgical approach, cortex sparing adrenalectomy has been brought forward for the adrenal tumors. The primary objective of the cortex sparing surgery is to prevent the lifelong replacement and the permanent adrenal failure after adrenalectomy. Therefore, it is particularly preferred in the case of genetic pheochromocytoma with bilateral adrenal involvement. However, in the case of the selected cases, it can also be applicable for adenoma producing aldostrerone and Cushing syndrome. The adrenal tumor will be completely removed and if sufficient tissue is reserved in the manner to preserve the cortex function, no long-term recurrence and adrenal failure is to be developed. Therefore, cortex-sparing surgery may be a good alternative to total adrenalectomy for the patients with small benign functional adrenal tumors or bilateral genetic pheochromocytoma.

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.

Summary Background Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. Objectives To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. Study design Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups. Results Mean age was 6.46 ± 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI. Discussion The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL. Conclusions Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL. Table . Predictive factors for FUTI. Multivariate Analysis p-value OR 95% Cl Age categories School-aged (ref) Young children 0.025 2.760 1.138–6.696 Side Left (ref) Right 0.004 4.374 1609−11,890 Staghorn stone None (ref) Yes 0.006 3.902 1.488–10.231 Tract size >20 Fr (ref) ≤20 Fr 0.011 3.148 1.307–7.580 Operative time 0.043 1.008 1.001–1.016 Blood transfusion None (ref) Yes 0.011 5.898 1.509–23.050

Medical Technologies National Congress (TIPTEKNO) -- NOV 08-10, 2018 -- Magusa, CYPRUS WOS: 000467637600004 In this paper, a post-operative recurrence estimation tool called Sorbellini's nomogram for the kidney cancer patients showing no metastates is introduced and a novel application for mobile devices based on this model is developed for the physician's follow up procedures. The TNM stage, tumor size, nuclear (Fuhrman) grade, the existance of necrosis and vascular invasion are employed as the input parameters for this software to predict the recurrence probability in mentioned patients. Finaly, the performance analyses are carried out to verify the reliability of the application. Biyomedikal Klinik Muhendisligi Dernegi, Izmir Katip Celebi Univ, Biyomedikal Muhendisligi Bolumu

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.

Tonyali, Senol/0000-0003-1657-4044; Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; AKI, FAZIL TUNCAY T/0000-0002-3625-9968; Ozden, Ender/0000-0003-3196-4024 WOS: 000389566900016 PubMed: 27505010 Objective: The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. Materials and Methods: A total of 14 patients (11 male and 3 female) with a mean age of 47 +/- 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. Results: Mean time from injury to RAT was 21.2 +/- 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). Conclusion: RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail. (C) 2016 S. Karger AG, Basel