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Background: We aimed to compare the results of patients who underwent laparoscopic adrenalectomy (LA) for masses ≥6 cm versus

Introduction: To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. Methods: Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. Results: HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. Conclusion: LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

Objective: The best therapeutic option for renal tumours smaller than 7 cm is partial nephrectomy. The aim of this study was to compare the positive surgical margin (PSM) rates, recurrence rates and oncological outcomes between laparoscopic partial nephrectomies and open partial nephrectomies at a single tertiary referral centre. Materials and Methods: We included patients with renal tumours treated with partial nephrectomies between January 2008 and December 2016 in the study. We retrospectively reviewed the patients' demographic data, surgical reports, clinical charts, laboratory results and histopathological reports. Binary regression analysis was used to assess the impact of the tumour diameter, laterality, polarity and localization for PSM. Results: We included a total of 215 patients in the study. The mean preoperative and postoperative haemoglobin and creatinine levels, blood loss, time of surgery and follow-up periods was similar between the two groups. The mean ischaemic time in the open partial nephrectomy group was significantly lower than that of the laparoscopic partial nephrectomy group (p

Objective: In this study, we aim to compare the perioperative and midterm oncological outcomes in patients with advanced bladder cancer and those who had laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC). Material and methods: We retrospectively reviewed medical records of patients who underwent LRC or ORC in a single center between 2008 and 2014 with a pathological diagnosis of pT3 and pT4 bladder cancer. Thirty-five and 39 patients were included in the study as part of the LRC and ORC groups, respectively. Results: There was no statistically significant difference between the two groups in terms of disease-free survival (LRC, 39.8±4.86 months; ORC, 45.47±8.92 months, P=0.896). Average estimated blood loss and length of hospitalization were significantly less in the LRC group. The overall survival rates of patients at 1, 2, and 3 years were 73%, 46%, and 46% in the ORC group and 78%, 65%, and 40% in the LRC group, respectively, and there was no statistically significant difference between the two groups. One patient in the ORC group experienced rectal injury in the form of a serosal tear, which was repaired primarily without any postoperative sequelae. There were no conversions in the laparoscopic group. Similarly, in 1 patient, rectal serosal tear was repaired preoperatively. Conclusion: Our study showed that LRC provides midterm oncological outcomes similar to ORC in the treatment of locally advanced T3 and T4 bladder cancer. However, long-term oncological and functional outcomes are required. © 2020 by Turkish Association of Urology.

Incidental prostate cancers are frequently encountered in radical cystoprostatectomy materials, which are widely used in the treatment of bladder cancer. We aimed to evaluate incidental prostate cancer’s incidence, stage, histopathological features and their effect on prognosis in patients who underwent radical cystoprostatectomy in our center. 499 patients who underwent radical cystoprostatectomy for bladder cancer between 2006 and 2020 were retrospectively evaluated. Incidental prostate tumor was detected in 141 (28.3%) cases. All tumors were diagnosed as prostate acinar adenocarcinoma. 127 (90.1%) patients had pT2, 10 (7.1%) patients had pT3a and 4 (2.8%) patients had pT3b tumor. Clinically significant prostate cancer was present in 35 (24.8%) patients. Of the 14 patients with an increased PSA level preoperatively, 4 had a clinically significant prostate tumor. Incidence of incidental prostate tumor is high in radical cystoprostatectomy materials, but most of them are clinically insignificant. The benefit of preoperative evaluation of serum PSA for the detection of incidental tumors is controversial. Although an unfavorable clinical course is not observed in patients with incidental prostate tumor, the main determinant of prognosis is the bladder tumor., Mesane kanseri tedavisinde yaygın olarak uygulanan radikal sistoprostatektomi materyallerinde klinik bulgu vermeyen, insidental prostat kanserlerine sıklıkla rastlanmaktadır. Çalışmamızda, merkezimizde radikal sistoprostatektomi uygulanan hastalarda prostat kanseri insidansını, evresini, histopatolojik özellikleri ve bu tümörlerin prognoza etkisini değerlendirmeyi amaçladık. 2006 - 2020 arasında merkezimizde mesane kanseri nedeniyle radikal sistoprostatektomi uygulanan 499 hastaya ait dosyalar retrospektif olarak incelendi. İnsidental prostat tümörü 141 (%28,3) olguda tespit edildi. Tümörlerin tamamı prostat asiner adenokarsinomu olarak tanı aldı. 127 (%90,1) hasta pT2, 10 (%7,1) hasta pT3a ve 4 (%2,8) hasta pT3b tümöre sahipti. 35 (%24,8) hastada klinik olarak önemli prostat kanseri mevcuttu. Ameliyat öncesi artmış PSA değerine sahip 14 hastadan 4’ü klinik olarak anlamlı prostat tümörüne sahipti. Radikal sistoprostatektomi materyallerinde insidental prostat tümörü saptanma oranları yüksektir ancak tümörlerin çoğu klinik olarak önemsiz grupta yer alır. Serum PSA değerinin ameliyat öncesi insidental tümörü tespitinde faydası sınırlıdır. İnsidental prostat tümörüne sahip hastalarda olumsuz klinik seyir izlenmemekle birlikte prognozun asıl belirleyicisi mesane tümörüdür.

Kliniğimizde çeşitli adrenal bez patolojileri nedeniyle laparoskopik adrenalektomi (LA) uygulanan hastaların intra-operatif ve post-operatif sonuçlarını değerlendirmeyi amaçladık. 2008 - 2020 yılları arasında LA uygulanan hastaların verileri retrospektif olarak değerlendirildi. Hastaların yaş, cinsiyet gibi demografik özellikleri, adrenal kitlenin boyutu, operasyon süresi, kanama miktarı, preop ve postop hemoglobin değerleri, hastanede kalış süresi, intraoperatif ve postoperatif komplikasyonlar açısından değerlendirildi. Patoloji raporları incelenerek kaydedildi. Çalışmaya 196’sı (%60.3) kadın ve 129’u erkek olmak üzere toplam 325 hasta dahil edildi. Yüz elliyedi hastaya sağ ve 168 (%51.7) hastaya sol LA uygulandı. Ortalama yaş 51.6 ± 12.1 ve ortalama kitle boyutu 40.3 ± 20.2 mm idi. Ortalama operasyon süresi 97 ± 36.2 dk ve ortalama kanama miktarı 50.8 ± 44.1 ml idi. Ortalama hastanede kalış süresi 3.1 ± 2.2 gün idi. İntraoperatif dönemde bir hastada distal pankreas yaralanması, 2 hastada kanama ile toplam 3 hastada intra-operatif komplikasyon gelişti. Bir hastda açık cerrahiye geçildi. Post-operatif dönemde 7 hastada komplikasyon görüldü. Tüm postoperatif komplikasyonlar ek girişime gerek kalmadan konservatif izlem ile tedavi edildi. LA, adrenal kitlelerin cerrahi tedavisinde tecrübeli merkezlerde güvenle uygulanabilecek efektif ve minimal invazif bir tedavi yöntemdir., We aimed to evaluate intraoperative and postoperative outcomes of the patients who underwent laparoscopic adrenalectomy (LA) for various adrenal gland pathologies in our clinic. The data of patients who underwent LA between 2008 and 2020 were evaluated retrospectively. The demographic characteristics of the patients such as age and gender, size of the adrenal mass, operation time, estimated blood loss, preoperative and postoperative hemoglobin, length of hospital stay, intraoperative and postoperative complications were evaluated. Pathology reports were examined and recorded. A total of 325 patients, 196 (60.3%) female and 129 male, were included to study. Right LA was applied to 157 patients and left LA to 168 (51.7%) patients. The mean age was 51.6 ± 12.1 years and the mean tumor size was 40.3 ± 20.2 mm. The mean operation time was 97 ± 36.2 minutes and the mean estimated blood loss was 50.8 ± 44.1 ml. Mean length of hospital stay was 3.1 ± 2.2 days. In the intraoperative period, distal pancreatic injury in one patient, bleeding due to vascular injury in 2 patients, at totally, intra-operative complications developed in 3 patients. In one patient conversion to open surgery was needed. Complications were seen in 7 patients in the post-operative period. All post-operative complications were treated with conservative follow-up without the need for additional intervention. LA is an effective and minimally invasive treatment method that can be safely applied in experienced centers in the surgical treatment of adrenal tumors.

Background Clear cell type renal cell carcinoma (ccRCC) is the most common renal cell carcinoma (RCC). In this study, we examined the expressions of VHL and miR-223 in ccRCC patients׳ tissues to investigate the possible role in the development of ccRCC. Methods and results This study collected five expression profiles (GSE36139, GSE3, GSE73731, GSE40435, and GSE26032) from Gene Omnibus Data. Expressions of VHL and miR-223 in paraffinized tumor and normal tissues of 100 Turkish patients' ccRCC tissues were determined by bioinformatic data mining and real-time quantitative polymerase chain reaction (qRT-PCR). The VHL gene was subjected to mutational analysis by DNA sequencing, and pVHL was analyzed using western blotting. Our study's t-test and Pearson correlation analysis showed that VHL gene expression in tumoral tissues with a - 0.39-fold decrease was not significantly lower than normal tissues (p = 0.441), and a 0.97-fold increase miR-223 (p = 0.045) was determined by real-time PCR. Also, as a result of DNA sequence analysis performed in the VHL gene, it was found that 26% of the patients have mutations. The mutations for (VHL):c.60C>A (p.Val20=) and (VHL):c.467delA (p.Tyr156Leu) was detected for the first time in Turkish patients. Conclusions The present study demonstrated that the differences in the expression levels of miR-223 have the potential to be biomarkers to determine the poor prognosis in ccRCC.

Aim: Laparoscopy is an important part of surgical training. Laparoscopy courses are organized to increase competence of laparoscopy. This aim of this paper is to evaluate the laparoscopic surgery competence of Turkish urologists and the effectiveness of laparoscopy courses.Methods: In 2014, an online survey consisting of 11 questions was sent to 180 urologists via e-mail, among which 78 responded. The survey questions aimed at gathering information about where the urologists worked, their laparoscopic surgical experience, how long they attended laparoscopy courses, and whether they considered themselves to be competent in laparoscopic surgeries.Results: 41.2% of the respondents who considered themselves to be competent in laparoscopy and 84.1% of those who did not, stated that they wanted to attend laparoscopy courses (P, Amaç: Laparoskopi, cerrahi eğitimin önemli bir parçasıdır. Laparoskopi yeterliliğini arttırmak için laparoskopi kursları düzenlenmektedir. Bu yazıda Türk ürologların, laparoskopik cerrahi yeterliliği ve laparoskopi kurslarının etkinliğinin değerlendirilmesi planlandı.Yöntemler: 2014 yılında Türkiye’de üroloji alanındaki 180 uzmana e-mail anket formu gönderildi. Sorulara yanıt veren 78 üroloji uzmanının, çalıştığı kurum, laparoskopik deneyimi, aldıkları laparoskopi kurs süresi ve laparoskopi cerrahisindeki yeterlilikleri 11 soruluk anket ile sorgulanmıştır.Bulgular: Laparoskopi konusunda kendini yeterli gören uzmanların %41,2’si, yeterli görmeyenlerin %84,1’i kurs almak istediğini belirtti (P

Kistik nefroma böbreğin nadir görülen multikistik benigntümörüdür. Çalışmamızda 2005– 2017 yılları arasında, Kistik Nefroma tanısıalmış 20 olgu, retrospektif olarak incelenerek, klinik ve histopatolojiközellikleri ortaya konuldu. Hastakayıtlarından elde edilen bilgiler, klinik hikâyeleri, klinik tanısı ve cerrahimateryalin histopatolojik özelliklerine göre not edildi. Olguların 15’ ikadındı. Yaş aralığı 1 - 63 arasındaydı. 12 vakada lomber veya yan ağrısışikayeti mevcuttu. 14 hastaya radikal, 6 hastaya parsiyel nefrektomi yapıldı.Olguların takiplerinde rekürrens görülmedi. Kistik nefromalar klinik veradyolojik olarak diğer kistik renal tümörlerle karışabilir, ayırıcı tanıdahistopatolojik inceleme gereklidir., Cystic nephroma is arare multicystic benign tumor of kidney. In our study we evaluatedretrospectively the clinical and histopathologic features of 20 patients withcystic nephroma that were diagnosed between 2005-2017. Demographics ofpatients, clinical history, clinical diagnosis and pathologic characteristicsof the specimen were assessed. 15 patients were female. Ages ranged from 1 to63 years. 12 patients had lomber or flank pain. 14 patients underwent radicaland 6 patients underwent partial nephrectomy. There was no recurrence during follow-up.Cystic nephromas mimic other cystic renal neoplasms clinically andradiologically, necessitating histopathological examination for definitivediagnosis.

Numerous studies have found that the short-term results of laparoscopic sacrocolpopexy for pelvic organ prolapse are safe and effective. This study evaluates the long-term results of the laparoscopic sacrocolpopexy operation between the urology and gynecology branches. A prospective study enrolling 206 patients was conducted to evaluate laparoscopic sacrocolpopexy as a surgical treatment for vaginal vault prolapse from 2011 to 2014. Two different surgical branches (urology and gynecology) applied laparoscopic sacrocolpopexy to their patients with their own techniques. The long-term results were assessed postoperatively after 4 years by pelvic examinations, including the Pelvic Organ Prolapse Quantification system (POP-Q) and quality-of-life assessments using validated questionnaires. A total of 190 patients (94 urology and 96 gynecology patients) received a full clinical follow-up examination between April 2014–June 2018. Postoperative pelvic organ prolapse recurrence rates in each compartment were similar in both groups during the 4 years; 87.2% of the urology and 86.5% of the gynecology patients had no prolapse in any compartment according to the POP-Q system. The reoperation rate was 5.3% for the urology and 6.2% for the gynecology group. Mesh erosion was detected in two patients in both groups. Three patients responded to local estrogen therapy, and we removed the mesh vaginally in one patient. The subjective cure rate was 89.4% in the urology and 88.5% in the gynecology group after 4 years. Although different surgical branches perform laparoscopic sacrocolpopexy with their own techniques, long-term anatomical and functional results are similar between the branches. From a urogynecological point of view, laparoscopic sacrocolpopexy is a gold standard surgical procedure that can be performed by both urologists and gynecologists with similar long-term outcomes.

Background: We aimed to report surgical and oncological outcomes of renal cell carcinoma (RCC) patients with level I and II thrombus treated with laparoscopic transperitoneal radical nephrectomy. Patients and Methods: Medical records of 13 patients were reviewed retrospectively in a single center between 2005 and 2017. Hem-o-lok ® clips were used to secure renal artery and renal vein, excluding 2 patients with an attached thrombus on the right side. Results: Seven male and 6 female patients were treated laparoscopically, and conversion to open surgery was not required in any case. The mean age was 61.6 ± 7.8 years (range 45 to 75 years) and the mean body mass index was 27 ± 4.6 kg/m 2 (range 18.8 to 34.5 kg/m 2 ). Median tumor size was 9.5 × 7.3 cm (range 5 to 14 cm) and 5 patients who had preoperative metastases underwent cytoreductive nephrectomy. The mean operative time was 137.6 ± 45.8 minutes (range 60 to 200 minutes) and blood loss was 105 ± 34.9 mL (range 50 to 150 mL). The mean hospital stay was 4.4 ± 3.9 days (range 1 to 15 days). Splenic capsular injury occurred in 1 patient and the vena cava was injured in another. Three patients needed blood transfusions. The mean follow-up period was 25 months (range 12 to 86 months). Conclusion: Laparoscopic transperitoneal radical nephrectomy can be reliable option for surgical management of RCC with level I and II thrombus in experienced centers. © 2019, Mary Ann Liebert, Inc., publishers 2019.

Müsinöz tübüler ve iğsi hücreli karsinoma; oldukça nadir görülen renal epitelyal bir neoplazmdır. Olgu sunumumuzda müsinöz tübüler ve iğsi hücreli karsinoma saptanan olgu sunulmuş ve hastalığın epidemiyolojisi, radyolojik bulguları ve histopatolojik özellikleri ilgili literatür eşliğinde kısaca tartışılmıştır. 43 yaşındaki erkek hasta, sol yan ağrısı şikayeti ile başvurduğu dış merkezde yapılan radyolojik incelemede, sol böbreğinde kitle saptanması üzerine ileri tanı ve tedavi için hastanemiz üroloji polikliniğine yönlendirildi. Yapılan fizik muayene ve tetkikler doğrultusunda renal hücreli karsinoma düşünülen olguya radikal nefrektomi operasyonu planlandı. Materyalden hazırlanan kesitlerin mikroskobik incelemesinde; miksoid stroma içerisinde, eozinofilik sitoplazmalı, iğsi şekilli, düşük gradeli nükleer özellikler gösteren hücrelerin, uzamış veya birbiri ile anastomozlaşan tubul benzeri yapılanmalarından oluşan tümöral lezyon dikkati çekti. Histopatolojik ve immünohistokimyasal bulgular doğrultusunda olguya müsinöz tübüler ve iğsi hücreli karsinoma tanısı verildi. Tüm renal neoplazilerin %1'den azını oluşturan bu tümörlerin prognozu, diğer epitelyal böbrek tümörlerine kıyasla daha iyidir. Bu nedenle müsinöz tübüler ve iğsi hücreli karsinoma olgularını ayırıcı tanıya girdikleri papiller renal hücreli karsinoma olgularından ayırmak son derece önemlidir.

OBJECTIVES The study aimed to assess the haemodynamic changes of laparoscopic adrenalectomy (LA) in geriatric patients with pheochromocytoma (PHEO). To the best of our knowledge, this is the first study to evaluate the haemodynamic outcomes of LA in this patient population. METHODS Data of 350 patients who underwent single-side transperitoneal LA between 2000 and 2020 were reviewed retrospectively. Patients with a histopathological diagnosis of PHEO were included in the study and classified into two groups according to their ages at the date of surgery. Patients older than 65 years were accepted as elderly according to the World Health Organisation (WHO) recommendations. RESULTS A total of 54 patients underwent LA for PHEO. Fifteen patients were enrolled in the elderly and 39 in the young groups. There were no significant differences in terms of the operation site (0.564), tumour size (0.878), perioperative results such as mean anaesthesia; operation times, blood loss and haemodynamic changes. There were no significant differences in mean hospitalisation and intensive care unit times. One patient in both groups had grade 1 complication according to Clavien Dindo classification (prolonged ileus, managed with medical treatment and transfusion during surgery, respectively). CONCLUSION Young and elderly patients had similar outcomes in terms of haemodynamic changes that occurred with LA. LA in elderly patients with PHEO is as safe and effective as in younger patients.

Objective The aim of this study is to evaluate the effects of laparoscopic urologic surgery on cardiac functions by the parameter pulse wave velocity (PWV), a noninvasive method. Material and methods Between July 2012 and February 2013, a total of 47 patients were included in this prospective controlled study. Patients who have been scheduled for laparoscopic surgery (LS) (n=30) and open surgery (n=17) were enrolled in the study. Preoperative, perioperative, and postoperative cardiovascular parameters were measured by a PWV instrument, and the results were compared between laparoscopic (L) group and open (C) group. Results In the L group, compared to preoperative values, perioperative systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure increased considerably, by 2.6%, 7.9%, and 4.7%, respectively. This was in contrary to reductions in these parameters by 9.5%, 5.7%, and 10%, respectively, in the C group. For the L group, cardiac output (CO) and cardiac index (CI) were increased in the perioperative period and decreased in the postoperative period. For the C group, there were no changes in measurements of perioperative and postoperative CO and CI. However, these changes in CO and CI were not significantly different between the L and C groups. Postoperative large artery elasticity index decreased in both groups. However, these changes did not represent significant difference between groups. Conclusion Compared to open surgery, LS may cause increases in perioperative blood pressures. In addition, increased blood pressures may last even on the first postoperative day. These effects may be more important for patients with high cardiovascular risk.

Objective: In this study, we aim to compare the perioperative and midterm oncological outcomes in patients with advanced bladder cancer and those who had laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC). Material and methods: We retrospectively reviewed medical records of patients who underwent LRC or ORC in a single center between 2008 and 2014 with a pathological diagnosis of pT3 and pT4 bladder cancer. Thirty-five and 39 patients were included in the study as part of the LRC and ORC groups, respectively. Results: There was no statistically significant difference between the two groups in terms of disease-free survival (LRC, 39.8±4.86 months; ORC, 45.47±8.92 months, P=0.896). Average estimated blood loss and length of hospitalization were significantly less in the LRC group. The overall survival rates of patients at 1, 2, and 3 years were 73%, 46%, and 46% in the ORC group and 78%, 65%, and 40% in the LRC group, respectively, and there was no statistically significant difference between the two groups. One patient in the ORC group experienced rectal injury in the form of a serosal tear, which was repaired primarily without any postoperative sequelae. There were no conversions in the laparoscopic group. Similarly, in 1 patient, rectal serosal tear was repaired preoperatively. Conclusion: Our study showed that LRC provides midterm oncological outcomes similar to ORC in the treatment of locally advanced T3 and T4 bladder cancer. However, long-term oncological and functional outcomes are required.

Renal anjiomiyolipoma, preoperatif olarak renal hücreli karsinoma ile karışabilen böbreğin benign tümörüdür. Çalışmamızda 2005 – 2011 yılları arasında, renal anjiomiyolipoma tanısı almış olgular, retrospektif olarak incelenerek, klinik ve histopatolojik özellikleri ortaya konuldu. Hasta kayıtlarından elde edilen bilgiler, klinik hikâyeleri, klinik tanısı ve cerrahi materyalin histopatolojik özellikleri not edildi. Olguların 19’ u kadındı. Yaş aralığı 15 - 68 arasındaydı. 13 vakada lezyonlar rastlantısal olarak saptandı. Bilateral lezyonu olan bir vakanın tuberosklerozis olduğu belirlendi. Renal anjiomiyolipomaların karakteristik görüntüleme bulgularını ve renal hücreli karsinoma ile karışabileceğini bilmek önemlidir. Özellikle preoperatif olarak bu tümörleri tanımak nefron koruyucu tedavi seçeneklerini değerlendirmek açısından gereklidir.

Üretral karünküller, postmenopozal kadınlarda daha sık gözlenen üretral meatusun benign polipoid kitleleridir. Çalışmada 2005 – 2013 yılları arasında, üretral karünkül tanısı almış olgular, geriye dönük incelenerek, klinik ve histopatolojik özellikleri ortaya konuldu. Üretral karünküller benign ve malign tümörleri taklit edebilen lezyonlardır. Özellikle semptomatik veya malignite şüphesi taşıyan üretral karünküllerden biyopsi örneklemesi yapılmalıdır.

Objective: To assess the effects of obesity on the surgical success and perioperative results and continence status in laparoscopic radical prostatectomy (LRP). Materials and Methods: The results of 300 consecutive patients undergoing LRP between April 2004 and January 2014 were analyzed retrospectively. Twenty patients were excluded from the study, thus, 280 patients remained. The patients were separated into 3 groups according to their body mass index. Based on this classification, group 1 (< 25 kg/m(2)) was normal, group 2 (25- 30 kg/m(2)) was overweight, and group 3 (> 30 kg/m(2)) was obese. The demographic data, intraoperative results, pathological results, and states of continence were compared among the groups. Results: There were 81 patients in group 1, 152 patients in group 2, and 47 patients in group 3. There were no significant differences when the groups were compared according to age and prostate specific antigen values. The intraoperative blood loss was high in group 3 only. Moreover, the estimated blood loss, transfusion, operative time, bilateral nerve- sparing rate, hospitalization days, and complication rate were similar between the groups. There were no significant differences when the pathological results were compared according to the positive surgical margins and Gleason scores. Although the continence rates in group 3 were significantly low 6 months after the operation (p< 0.05), the results were similar at 1 year (p= 0.738). Conclusion: LRP can be applied confidently in obese patients as well as normal and overweight patients., NA

OBJECTIVES Lymphocele is a well-known postoperative surgical complication after kidney transplant. In this study, our aim was to analyze incidence, risk factors, and outcomes of posttransplant lymphocele in a large cohort. MATERIALS AND METHODS This observational study included 395 consecutive patients (219 males and 176 females) who underwent kidney transplant procedures from 183 living and 212 deceased donors in our center between January 2007 and 2014. A lymphocele was diagnosed with ultrasonography. RESULTS The incidence of lymphoceles in our cohort was 31.9% (n = 126). There were no significant dif-ferences with regard to body mass indexes, age of donors, deceased donor ratios, acute rejection episodes, and history of abdominal surgery between those with and without lymphoceles. The pre-transplant serum albumin levels (3.29 ± 0.67 vs 3.48 ± 0.69 g/dL; P = .009) in the lymphocele group and diabetes mellitus ratios (15.9% vs 4.5%; P < .001) in the nonlymphocele group were lower than levels shown in the other group. The lymphocele ratio in patients who received cyclosporine was higher than that shown in patients who did not received it (37.5% vs. 27.4%; P = .032). There was no difference in lymphocele incidence between patients who were taking and those who were not taking mammalian target of rapamycin inhibitors, mycophenolate mofetil, or mycophenolate sodium. In regression analysis, presence of diabetes mellitus, transplant from deceased donors, older age of donors, and lower albumin levels were independent risk factors for posttransplant lymphocele occurrence. CONCLUSIONS Posttransplant lymphocele was a relatively common surgical complication in our cohort. We concluded that diabetes mellitus, use of kidneys from deceased donors, older donor age, and hypoalbuminemia were independent risk factors for lymphocele development.

Purpose This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. Materials and Methods A total of 272 patient’s medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. Results 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the first 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. Conclusions During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.

Amiloidoz, sistemik veya lokalize tutulumgösterebilen, amiloid proteinin ekstraselüler matrikste birikimi ile karakterize heterojen bir hastalıkgrubudur. Lokalize amiloidoz, amiloid birikiminin tek bir dokuya sınırlıkalması sonucu gelişen ve lokalize bir kitle oluşturması nedeniyle de klinikolarak maligniteleri taklit edebilen non-neoplastik bir hastalıktır. Bu çalışmada vezikula seminalis ve duktusdeferens yerleşimli lokalize amiloidoz serimizin sunulması ve bu tümörlerinklinikopatolojik özelliklerinin literatür bilgileri eşliğinde sunulmasıamaçlanmıştır. Çalışmamızda Uludağ Üniversitesi Tıp Fakültesi Tıbbi PatolojiAnabilim Dalı arşivi taranarak 2013–2018 yılları arasında tanı almış vezikulaseminalis ve duktus deferens yerleşimli lokalize amiloidoz olguları incelendi. Sistoprostatektomiprosedürü uygulanan 4 olguda sadece vezikula seminalislerde, prostatektomiprosedürü uygulanan 6 olgunun 5'inde hem vezikula seminalis hem de duktusdeferenslerde ve 1 olguda ise sadece duktus deferenslerde lokalize amiloidozsaptandı. Olguların tamamında subepitelyal yerleşimli, eozinofilik, amorf,homojen madde şeklinde gözlenen birikimlere Kongo red boyaması uygulandı. Kongored histokimyasal boyaması ile bu alanlarda kiremit kırmızısı boyanma saptandıve polarize ışık mikroskobi bakısında elma yeşili refle verdiği tespit edildi. Sonuçolarak, lokalize amiloidoz çok farklı lokalizasyonlarda saptanabilmeklebirlikte vezikula seminalis ve duktus deferens lokalizasyonunda nispetennadirdir. İnsidental saptanmaları nedeniyle biyopsi örneklerideğerlendirilirken amiloid birikimi açısından da olguların değerlendirilmesi vegerekli görülen olgularda Kongo red boyamasının yapılması önem arz etmektedir., Amyloidosis is aheterogeneous group of diseases characterized by accumulation of amyloidprotein in the extracellular matrix, which may be systemic or localized.Localized amyloidosis is a non-neoplastic disease that results from limitedamyloid accumulation to a single tissue, and clinically mimics malignanciesforming a localized mass. In this descriptive study, we aim to report ourseries of localized amyloidosis in the vesicula seminalis and the ductusdeferens as well as clinicopathologic characteristics of these tumors in literaturedata. In this study, we examined the localized amyloidosis cases of thevesicula seminalis and the ductus deferens, diagnosed between 2013 and 2018 by searchingthe archives of Uludag University, Faculty of Medicine, Department of Pathology. The sites where localizedamyloidosis was detected include only the vesicula seminalis in four cases whounderwent a cystoprostatectomy procedure, both the vesicula seminalis and theductus deferens in five out of six cases with a prostatectomy procedure, andonly the ductus deferens in one case. The deposits in the form ofsubepithelial, eosinophilic, amorphous and homogeneous substance were treatedwith Congo Red staining in all cases. The histochemical treatment with Congo Redyielded tile reddish staining in these areas, making them appear apple-green onthe polarized light microscopy. In conclusion, localized amyloidoses arerelatively rare in the vesicula seminalis and the ductus deferens, althoughthey can be detected at very different locations. Since they are incidentallydetected, it is important to evaluate a case in terms of amyloid deposits whileexamining biopsy specimens, as well as staining with Congo Red when necessary.

Objectives: To compare the effectiveness and complications of ureteroscopic laser lithotripsy with laparoscopic ureter laparoscopic ureterolithotomy in mid- or proximal portion of large ureteral stones. Material and Methods: We reviewed patients with large (>15 mm) ureteral stone and those who underwent ureteroscopic laser lithotripsy (URS group) or laparoscopic ureterolithotomy (LU group). The first attempt was considered successful in patients who had residual fragments smaller than 2 mm and no conversion of the primary procedure to another. Results: Sixty patients (URS group 29, LU group 31) met inclusion criteria. FURS was used as an adjunctive procedure in one patient for URS group and in two patients for LU group in the same season. LU had a higher success rate and the first-day stone-free rate when compared with URS. Number of procedures was also significantly higher in URS group. There was no difference in stone-free rates at the first and third months, and length of hospitalization and operation were higher in the LU group. Only two patients in the LU group and one patient in the URS group had major complications. Conclusions: Laparoscopy is an effective option of large proximal and mid-ureter stone treatment; however, URS provides similar stone-free rates at three months as a minimal invasive procedure.

Aim. The aim of this study was to evaluate risk factors affecting graft and patient survival after transplantation from deceased donors. Methods. We retrospectively analyzed the outcomes of 186 transplantations from deceased donors performed at our center between 2006 and 2014. The recipients were divided into two groups: Group I (141 recipients without graft loss) and Group II (45 recipients with graft loss). Kaplan-Meier, log-rank test, and Cox proportional hazard regressions were used. Results. The characteristics of both groups were similar except renal resistive index at the last follow-ups. When graft survival and mortality at the first, third, and fifth years were analyzed, tacrolimus (Tac)-based regimens were superior to cyclosporine (CsA)-based regimens (P

Objective: To comparatively evaluate the traditional interrupted knot-tying and running suture renorrhaphy with Monocryl (R) in laparoscopic partial nephrectomy (LPN). Materials and Methods: A retrospective analysis of 62 consecutive patients undergoing LPN using traditional interrupted knot-tying suture renorrhaphy (Group 1; n= 31) or running suture technique renorrhaphy with 2-0 monofilament polyglecaprone (Monocryl (R), Ethicon) (Group 2; n= 31) from December 2011 to October 2015 at the University. All patients underwent LPN performed by an experienced laparoscopic surgeon. The demographic, perioperative and postoperative parameters were compared between the groups, and the effect of both suture techniques on the warm ischemic time (WIT) and trifecta were evaluated. Results: The running suture renorrhaphy with Monocryl (R) reduced WIT, estimated blood lost and length of hospitalization stay significantly without increasing postoperative complication rate during LPN in comparison with interrupted knot-tying suture. Conclusion: The renorrhaphy using the running suture with Monocryl (R) is an effective and safe technique with the advantage of shortening WIT even in more challenging and larger tumors during LPN.

ObjectiveTo evaluate the immunohistochemical staining pattern of caudal type homeobox 2 (CDX2) protein in germ cell tumours (GCTs) of the testis.MethodsThis study reassessed archival tissue samples collected from patients diagnosed with primary and metastatic testicular GCTs for CDX2 immunoreactivity using standard immunohistochemical techniques. Positive nuclear immunostaining was evaluated with regard to both the staining intensity and the extent of the staining.ResultsTissue sections from primary and metastatic testicular GCTs ( n = 104), germ cell neoplasia in situ (GCNis) ( n = 5) and benign testicles ( n = 15) were analysed. The GCNis and benign testicular tissues showed no immunoreactivity for CDX2. Strong and diffuse staining of CDX2 was demonstrated only in the mature colonic epithelium of teratomas in both primary and metastatic GCTs. CDX2 positivity in other tumours (one pure yolk sac tumour, one yolk sac component of a mixed GCT and one pure seminoma) was infrequent, and was only weak and focal.ConclusionsCDX2 immunostaining should be interpreted based on both the staining intensity and the extent of staining so as not to cause misdiagnosis. Teratomas with colonic-type epithelium should be considered in the differential diagnosis if a metastatic tumour with an unknown primary shows prominent CDX2 immunostaining.

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

Introduction: We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP). Patients and Methods: A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically. Results: No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Q(max)), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Q(max) values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. Conclusion: The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount, and Q(max) values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.

Urokinase is synthesized by various cells such as kidney, pneumocytes, and phagocytes. It cleaves plasminogen to plasmin and hence stimulates fibrinolysis. Urokinase breaks down the matrix protein within the stone and thus prevents stone formation and growth. Urokinase concentrations are lower and urokinase gene 3′-UTR T/C polymorphism is higher in patients with recurrent stones. Our aim was to investigate the role of urokinase gene 3′-UTR T/C polymorphism in childhood recurrent stone disease. A control group of 40 healthy children having no history of stone formation (group 1) (mean age 10.5 ± 4.2 years), 40 children (mean age 10.5 ± 4.33 years) who had calcium oxalate stones for the first time (group 2), and 40 patients (mean age 11.2 ± 3.8 years) with recurrent calcium oxalate stone disease (group 3) were included in the study. The groups were compared with respect to age, gender and urokinase gene 3′-UTR T/C polymorphism. Polymerase chain reaction-based restriction analysis was used to identify C/T polymorphism of the urokinase gene. No significant difference was observed between the three groups with respect to age and gender, while urokinase gene 3′-UTR T/C gene polymorphism was observed in four patients (10%) from group 3. In groups 1 and 2 there was no patient with T/C polymorphism. Urokinase 3′-UTR T/C gene polymorphism seems to appear more commonly in children with recurrent calcium oxalate stone disease than in healthy children and in those with stones for the first time. These results suggest that the urokinase gene might play a role in childhood recurrent calcium oxalate stone disease.

The study investigated immunoexpression of amyloid A (AA) in clear cell renal cell carcinoma (CCRCC) and evaluated its clinicopathologic correlation, particularly in disease progression. Expression of AA protein was evaluated in patients with CCRCC by immunohistochemistry. 146 cancerous tissue samples from 86 male and 60 female patients were studied. The relationship between AA protein expression and TNM stage, nuclear grade, renal capsule invasion, perirenal invasion, and survival of the patients were assessed. Thirty four percent of CCRCC cases were AA positive. The positive AA immunoexpression was related to higher Fuhrman nuclear grade, presence of perirenal invasion of the tumor, and poor survival of patients with CCRCC. There was not any statistically significant difference between patients' gender, status of capsule invasion, and stages of the tumor in terms of AA immunoexpression. Tumor stage (Hazard ratio (HR) = 7.76 (95% CI: 2.43-24.8) for stage 3 and HR = 29.9 (95% CI: 6.97-128.32) for stage 4) and AA immunoexpression (HR = 2.16 (95% CI: 1.01-4.64) were found to be associated with survival of the patients with CCRCC in Cox regression analysis. Immunoexpression of AA was increased in high grade CCRCCs. Immunoexpression of AA was associated with poor survival in patients with CCRCC. Thus, AA staining might be used as a useful immunohistological marker for the prediction of poor prognosis in renal cell cancer.

Background: Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique. Objective: To report a large multi-institutional series of minimally invasive SP (MISP). Design, setting, and participants: Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis. Intervention: Laparoscopic or robotic SP. Outcome measurements and statistical analysis: Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score 15 ml/s, and no perioperative complications. Results and limitations: Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6%) and 843 laparoscopic (63.4%) SP cases. Median overall prostate volume was 100 ml (range: 89-128). Median estimated blood loss was 200 ml (range: 150-300). An intraoperative transfusion was required in 3.5% of cases, an intraoperative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 d (range: 3-5). On pathology, prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p = 0.136; odds ratio [OR]: 1.6; 95% confidence interval [CI], 0.8-2.9), whereas operative time (p = 0.01; OR: 0.9; 95% CI, 0.9-1.0) and estimated blood loss ( p = 0.03; OR: 0.9; 95% CI, 0.9-1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis. Conclusions: This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications. Patient summary: Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy.

Although the association and causality between chronic inflammatory states and systemic AA amyloidosis have been well established, the evidence linking solid malignancies to reactive AA amyloidosis is scarce. Here, a case of diagnosed AA amyloidosis associated with synchronous carcinomas of stomach and bladder complicated with nephrotic syndrome and renal failure is reported.

Angiomyofibroblastoma-like tumor is a rare mesenchymal tumor of men. It commonly occurs during the fifth to eighth decades of life and mainly involves the inguinoscrotal region. It is derived from perivascular stem cells and has capacity of lipoid and myofibroblastic differentiation. Histopathologically this tumor in the male genitalia mimics female angiomyofibroblastoma but there are morphological and immunohistochemical differences between these lesions. We report a case of an angiomyofibroblastoma-like tumor that arose in the scrotal region in a 40-year-old man.

Objective Multicystic dysplastic kidney is a relatively common developmental abnormality in infants and children. Additional abnormalities like vesicoureteral reflux, ureteropelvic junction obstruction, and ureterovesical junction obstruction may accompany multicystic dysplastic kidney. In this article, we reviewed the pathogenesis, diagnosis, associated urinary tract anomalies and results of management of multicystic dysplastic kidney in the light of the literature. Material and method We retrospectively assessed 20 children with unilateral multicystic dysplastic kidney between January 2005 and December 2009. Mean duration of follow-up was 35 ± 8.7 months. All children with multicystic dysplastic kidney underwent nephrectomy. Patient characteristics, the pathology findings, associated urinary tract anomalies and results of management were reviewed. Results Abdominal ultrasound, voiding cystourethrography and renal scintigraphy revealed vesicoureteral reflux in 3 (15%) children, ureteropelvic junction obstruction in 3 (15%) children, and a duplex system in the contralateral kidney in 1 (5%) child. Blood pressure values, serum urea, creatinine and urinalysis were within normal range in all children during follow-up. Conclusion A conservative approach to children with multicystic dysplastic kidney has been advocated, but surgical removal is also another management modality on the basis of risk of hypertension, mass effect, potential for malignant change, and cost of repeated ultrasound examination.