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Öğe Comparative analysis of combined spinal-epidural anesthesia and general anesthesia in percutaneous nephrolithotomy: a prospective study on surgical team and operating room personnel satisfaction(Springer, 2024) Burlukkara, Salih; Kabalak, Afife Ayla; Ates, Alpay; Baran, Ozer; Aykac, Aykut; Ozok, Hakki UgurObjective We aimed to investigate the efficacy and complications of combined spinalepidural anesthesia and general anesthesia in percutaneous stone surgery prospectively. Materials and methods The study prospectively included patients who underwent percutaneous nephrolithotomy with general anesthesia (Group.1) or combined spinal-epidural anesthesia (Group.2) at the Department of Urology, Training and Research Hospital, Karabuk University. between December 2018 and December 2019. The effect of the anesthesia technique on the comfort and satisfaction of the operating room personnel, surgeon and anesthesia team were prospectively evaluated and recorded. Results During the postoperative period, the spinal anesthesia group had a significantly lower visual analog score than the general anesthesia group. No patient in either group required narcotic analgesics during the postoperative period. In terms of overall satisfaction scores, the surgeon performing the surgical procedure had a significantly higher satisfaction score in the general anesthesia group than in the CSEA group. The score was considered good in the general anesthesia group and moderate in the CSEA group. Personnel satisfaction was higher in the patient group that underwent CSEA. In the general anesthesia group, the score was considered to be average. In the CSEA group, the satisfaction score was considered good, with a statistically significant difference (p < 0.05). The anesthesia team's satisfaction score was moderate, with no significant difference between the CSEA and general anesthesia groups (p > 0.05). Conclusion PCNL under CSEA can be performed safely in certain individuals. Different anesthetic techniques may have varied levels of satisfaction among the surgical team.Öğe COMPARISON OF RETROGRADE INTRARENAL SURGERY AND PERCUTANEOUS NEPHROLITHOTOMY IN MULTIPLE CALYCEAL STONES: A MATCH PAIR ANALYSIS OF 190 CASES(Iniestares, S.A., 2021) Baran, Ozer; Aykac, AykutOBJECTIVES: The current nephrolithiasis guidelines have no recommendation about multiple calyceal stones treatment. We aimed to compare the results of two effective methods of RIRS and PNL operations in the treatment of multicalyx stones. METHODS: Data of patients who underwent RIRS or PNL for multicalyx stones between September 2014 and May 2019 in our clinic were evaluated retrospectively In both groups, stone-free and complication rates, hospital stay, scopy times, and operation times were examined. In RIRS group, the number of sessions and total stone-free rates at the end of each session were evaluated separately. RESULTS: A total of 162 patients in the RIRS group, and 103 patients in the PNL group were evaluated. After the match pair 1: 1, data of 95 patients were selected in each group. Stone burden, number, density, ASA scores, BMI were similar in both groups. At the end of the first session RIRS, 59 (62.1%) patients became stonefree, while in the PNL group 73 (76.8%) patients (p: 0.027). The statistical analysis showed that the stone-free rates obtained in the second sessions in the RIRS group were similar to those of the PNL group. After a total of 124 sessions of RIRS, a stone-free rate of 8 7 . 1% was achieved by 1.3 sessions on average. CONCLUSION: At least two session of RIRS is as effective as PNL on multiple calyceal stones. Stage RIRS can be an alternative to PNL at multicalyceal renal stones.Öğe The Effect of Double J Stents on the Sexual Life of Male Patients and Their Partners(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2019) Kaya, Coskun; Aykac, Aykut; Kaya, YelizObjective: In this study, it was aimed to show the changes in the sexual function of the male patients who underwent ureterorenoscopic (URS) and who had JJ stent (DJS) because of ureteral calculi and their spouses before and after the procedure. Methods: The male patients and their spouses who were admitted to the Urology Outpatient Clinic of Eskisehir State Hospital between May and August 2018 due to unilateral ureteral stones were included in the study. In order to determine sexual life, all of the male patients filled the International Index of Erectile Function (IIEF) form while their spouses filled the Female Sexual Function Index (FSFI) form. The patients with DJS and their spouses completed the forms just before the removal of DJS while the patients without DJS and their spouses filled the same forms 4 weeks after the procedure. The patients who were applied DJS after the operation of URS were defined as the study group, the patients who were not applied DJS after the operation of URS were defined as the control group. Results: Thirty one (34.4%) of 90 males who participated in the study were included in the study group. Fifty nine males (65.6%) without DJS included in the control group. There was no statistically significant difference between preoperational and post-operational scores of the male patients and their spouses on the scales of IIEF and FSFI, respectively (p>0.05). There was statistically significant decreases in the post-operational total and subscale scores of the male patients on the IIEF scale and the female patients on the FSFI scale compared to their total and subscale pre-operational scores (p<0.001). Conclusion: The male patients should be informed about their sexual life before endo-urologic procedures while their spouses should be informed about their sexual life after the procedure. DJSs should not be inserted except unavoidable circumstances; if they are inserted, they should be removed as soon as possible for minimizing their effects on the sexual lives of couples.Öğe The effect of fear of covid-19 transmission on male sexual behaviour: A cross-sectional survey study(Wiley-Hindawi, 2021) Baran, Ozer; Aykac, AykutIntroduction In December 2019, cases of pneumonia, a new type of corona virus (SARS-CoV-2), began to be reported in Wuhan, China. We aimed to evaluate changes in sexual behaviour of men in the Covid-19 outbreak in Turkey. Material-Method In our cross-sectional and descriptive study, an online questionnaire evaluating sexual habits during the Covid-19 outbreak was conducted on the men living in the Western Black Sea Region between 8 and 25 June6 2020. In the questionnaire, questions were asked to evaluate the sociodemographic data of the participants, their comprehensive medical history, their sexual preferences, their family and social life during the Covid-19 outbreak, their concerns about Covid-19 and their changes in their sexual behaviour after the Covid-19 outbreak. Results A total of 536 participants with mean age of 38.6 +/- 10.3 years were included in the study. 23.9% (128) respondents stated that they had the fear of transmitting Covid-19 to their partner during sexual intercourse. It was observed that 19.4% (104) of the participants developed a fear of Covid-19 transmission from her sexual partner during the relationship. While the number of weekly sexual intercourse of the participants before the pandemic was 2.34 +/- 1.35, this number was found to be 1.54 +/- 1.45 during the epidemic period (P = .001). Conclusion The fear of infection and transmission of the disease to the partner that occurs during the Covid-19 pandemic manifests itself in the form of a decrease in the frequency and quality of sexual intercourse.Öğe The effect of modifiable lifestyle factors on semen quality(Elsevier Espana Slu, 2020) Kaya, Coskun; Aykac, Aykut; Kaya, Yeliz; Tas, MuratIntroduction and objectives: To examine the association between lifestyle factors (body mass index, smoking, alcohol consumption, coffee intake, physical activity, sauna and cell phone usage, wearing tight-fitting underwear), and conventional semen parameters. Materials and methods: 1311 participants who attended the Andrology Clinic were included in the study. All participants were separated into two groups as men with normozoospermia and dysspermia. All participants answered a questionnaire which contains questions about the modifiable lifestyle factors. The total risk scores were calculated after all the positive lifestyle factors had been counted. Results: Men with normozoospermia and dysspermia consisted of 852 (65.0%) and 459 (35.0%) participants respectively. A negative relationship between the wearing of tight underwear and having normal semen parameters was detected between the two groups (p=0.004). While going to a sauna regularly was negatively related to semen concentration, wearing tight underwear was also related to both lower motility, normal morphology as well as semen concentration (p < 0.05). While the total score of all participants was 5.22 +/- 1.34 point, there were no statistical differences between the two groups (p=0.332). It was found that having 3 more or fewer points was not related to any type of semen parameters and results of a spermiogram. Conclusion: The clinicians should give advice to infertile male patients about changing their risky lifestyle, for infertility, to a healthy lifestyle for fertility. Better designed studies, with larger sample sizes using conventional semen analysis with sperm DNA analysis methods, should be planned to identify the possible effects of lifestyle factors on semen quality. (C) 2019 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.Öğe Evaluation of Dynamic Thiol/Disulfide Homeostasis in Patients with Non-Muscle Invasive Bladder Tumor(Galenos Publ House, 2023) Burlukkara, Salih; Baran, Ozer; Aykac, Aykut; Sunay, M. MehmetObjective: To evaluate the thiol-disulfide homeostasis in patients with a diagnosis of non-muscle invasive bladder tumor (NMIBC), which is a new oxidative stress marker, and to investigate the relationship between the development of NMIBC and native thiol, total thiol, and dynamic disulfide values. Materials and Methods: Fifty-three patients who were operated for bladder tumor in Karabuk University Karabuk Training and Research Hospital, Clinic of Urology between February and November 2020 and diagnosed with NMIBC in the pathological examination and 60 healthy volunteers were included in the study. Plasma native thiol, total thiol and disulfide levels of these two groups were measured and compared. Results: There was a statistically significant difference between the two groups in terms of native thiol, total thiol and disulfide values. In the subgroup analysis in those diagnosed with NMIBC, native thiol values were found to be 255,870 mu mol/L in the low grade patient group and 169,420 mu mol/L in the high grade patient group. This difference was statistically significant. Conclusion: The thiol disulfide homeostasis shifted to the disulfide side in the NMIBC group. It was determined that an increase in serum disulfide level and a decrease in native thiol level may have diagnostic value in predicting NMIBC. In addition, in the group diagnosed with NMIBC, there was a significant decrease in native thiol values as the pathological grade increased. This was interpreted as a shift of the equilibrium towards the oxidant side as the tumor showed an aggressive course.Öğe Fixation of the glans penis and urethral catheter to the abdominal skin to avoid wound dehiscence after a hypospadias surgery: A comparative study(Aves, 2019) Atan, Ali; Aykac, Aykut; Baran, Ozer; Sunay, MelihObjective: To evaluate the effect of glanular and urethral catheter fixation to the abdominal skin on wound dehiscence. Material and methods: After a standard tubularized incised plate urethroplasty (TIPU) for hypospadias repair, 128 patients were divided into two groups based on glanular and urethral catheter fixation to the abdominal skin as follows: no glanular and urethral catheter fixation (Group A) and glanular and urethral catheter fixation (Group B). Groups A and B included 61 and 67 patients, respectively. Results: No significant difference was determined between the groups with respect to age, meatal localization, and length of hospital stay. Wound dehiscence was noted in 13.1% and 2.9% patients in Groups A and B, respectively, after surgery (p=0.029, odds ratio=4.9). Patients in Group B had no excessive analgesic usage and unpleasant scarring due to the glans suture. Conclusion: Glanular and urethral catheter fixation to the lower abdominal skin considerably reduced wound dehiscence after hypospadias repair.Öğe Hydrocele with Paratesticular Liposarcoma(Coll Physicians & Surgeons Pakistan, 2022) Baran, Ozer; Bozkurt, Ufuk; Aykac, AykutParatesticular liposarcoma (PLS) is a rare type of genitourinary malignancy in the spermatic cord presenting as scrotal swelling. In this case study, we report an 82-year male who presented with prolonged left scrotal swelling and pain that did not respond to analgesic treatment for one week. His ultrasound confirmed increased fluid content in the left scrotal compartment in the form of septated hydrocele, and hydrocelectomy was planned. During the operation, infected fluid was drained. The testicle and surrounding tissues were infected; hence, left orchiectomy was performed. The pathological examination revealed a dedifferentiated liposarcoma. To our knowledge, this is the first report of liposarcoma of the spermatic cord with hydrocele in the literature.Öğe Kidney Stone Treatment in the Anomalous Kidney with Retrograde Intrarenal Surgery: A Matched Pair Analysis(Galenos Yayincilik, 2020) Sari, Sercan; Cakici, Mehmet Caglar; Aykac, Aykut; Baran, Ozer; Kartal, Ibrahim Guven; Ozok, Hakki Ugur; Karakoyunlu, Ahmet NihatObjective: To show our retrograde intrarenal surgery (RIRS) experience in anomalous kidney stones and compare its safety and efficiency with normal kidney stones. Materials and Methods: Between 2012 and 2018, patient data was reviewed retrospectively and 1700 procedures were taken into consideration. Forty-seven anomalous kidney stones were included in the study (group A). In these patients, 18 had calyx diverticulum, 12 had horseshoe kidney, 8 had ureteral duplication, 2 had ectopic kidneys, 1 had malrotation, and 1 had bifid pelvis. After making a matched pair analysis, 47 normal kidney stones with similar demographic and stone characteristics were included in our study (group N). Demographic, stone, intraoperative and postoperative data were recorded. We compared these groups regarding efficiency and safety. Results: Average scope time, hospitalization time, and postoperative double J-stent rate were higher in group A. The difference was statistically insignificant (p>0.05). Ureteral access sheath usage was higher in group N, though the difference was statistically insignificant (p=0.63). Stone-free rates and success rates were higher in group N though the difference was not statistically significant (p>0.05). The rate of complications was statistically significantly higher in group A (p=0.02). Conclusion: RIRS can be used in the management of anomalous kidney stones. It is an efficient and safe method. Prospective and larger patient numbered studies are needed.Öğe Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis(K Faisal Spec Hosp Res Centre, 2020) Sari, Sercan; Cakici, Mehmet Caglar; Aykac, Aykut; Baran, Ozer; Selmi, Volkan; Karakoyunlu, Ahmet NihatBACKGROUND: Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVES: Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery. DESIGN: A retrospective patient data review. SETTING: Training and research hospital in Turkey. PATIENTS AND METHODS: We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were <18 years old, and who had ureteral and urethral strictures were excluded from the study. The demographic characteristics, stone type, complications, intraoperative and postoperative data of the patients were reviewed. A successful outcome was defined as being stone free or having clinically insignificant residual fragments (<3 mm). The use of the UAS was compared with other procedures in terms of efficiency and safety. Factors determining UAS usage were assessed by multivariate analysis. MAIN OUTCOME MEASURES: Stone free rate and complication rate in patients who underwent retrograde intrarenal surgery. SAMPLE SIZE: 1808 patients met inclusion criteria. RESULTS: The UAS was used in 1489 procedures, while other methods were used in 319 procedures. Operation time was 46.9 (17.3) minutes and 42.9 (19.0) minutes with other methods. Postoperative double J stent usage rates were 88.2% and 63% in the UAS and other methods, respectively. The rate of successful outcome was 88.2% and 81.2% in the UAS and other methods, respectively (P<.001). The rate of complications was similar in both groups (P=.543). In a multivariate analysis, UAS usage was directly proportional with stone size and inversely proportional with preoperative JJ stent usage CONCLUSION: The UAS can be effectively and successfully used in retrograde intrarenal surgery for treatment of urinary system stones. UAS usage should be considered for the patients who have large stones (2 cm) and do not have a preoperative double J stent. LIMITATIONS: Retrospective design.Öğe The Predictive Role of Abdominal Fat Parameters and Stone Density on SWL Outcomes(Bentham Science Publ Ltd, 2020) Kaya, Coskun; Kaynak, Yurdaer; Karabag, Aral; Aykac, AykutBackground: Our aim was to detect the role of radiological abdominal fat parameters by tomography and stone density by plain X-ray on extracorporeal Shock Wave Lithotripsy (SWL) stone-free rate. Methods: The patients who had undergone SWL for a single opaque renal stone < 2 cm in diameter and proximal ureteric stone < 1 cm in diameter were collected retrospectively. The characteristics of patients and stones were recorded. The stone attitude, HU, abdominal fat parameters, paraperirenal fat area, perirenal infiltration and severity of hydronephrosis with pre-treatment Non-Contrast Computed Tomography (NCCT) and stone density with radiography were evaluated by a radiologist. Four weeks after the last SWL; all patients were evaluated by plain X-ray and categorized as Stone Free (SF) and Residual Fragment (RF) group. Results: 51 patients with renal stones and 88 patients with proximal ureteral stones were included in the study. 24 (47%) and 63 (71%) patients were classified as SF for renal and ureteral stones respectively. Only stone size was an independent predictor for stone-free rates after SWL for renal and proximal ureteral stones on multivariate analysis. The Receiver Operating Characteristic (ROC) curves for renal calculi revealed that creatinine level, stone size, stone attitude, Houns-Field Unit (HU) and Skin-to-Stone Distance (SSD) were the predictive factors for the SWL outcome (p<0.05). The ROC curve for ureteral calculi demonstrated that HU, stone size and attitude were the predictive factors (p<0.05). Conclusion: All abdominal fat parameters and the stone density were not related to SWL failure. A large follow-up with more patients is essential to confirm the role of radiological parameters on the outcome of SWL.Öğe Safety and efficacy of retrograde intrarenal surgery in geriatric patients by age groups(Springer, 2020) Aykac, Aykut; Baran, OzerPurpose To evaluate the effects of aging on the success rate of retrograde intrarenal surgery (RIRS) and the development of medical and surgical complications by dividing geriatric patients into subgroups based on their chronological age. Method Data of the patients who underwent RIRS due to kidney stones at our clinic between June 2014 and January 2020 were retrospectively reviewed. Patients were divided into three groups based on age: 65-74 years (Group 1), 75-84 years (Group 2), and >= 85 years (Group 3). The comorbid diseases of patients were evaluated using the Charlson Comorbidity Index (CCI), total Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score, and CIRS severity index (CIRS-G SI). RIRS success rates and complications were evaluated based on age groups. Results A total of 336 patients were included in the study. The mean age of the patients was 72.7 +/- 6.59 years. Stone-free rate was 81.5% in patients aged > 65 years and did not change with age. The modified Clavien-Dindo grade I/II complication rates for surgical complications were similar in all three groups (p = 0.818). In the evaluation of ROC analysis for medical complications, it was observed that the cut-off values were 76.5 years, CIRS-G score of 4.5, CCI score of 2.5, and CIRS-SI score of 1.18 (p < 0.001). Conclusion RIRS is an effective and safe treatment option for kidney and proximal ureteral stones in geriatric patients. Although there is an increase in medical complications post-RIRS with aging, surgical complications and stone-free rates remain unchanged.Öğe Simultaneous Measurement of Pressure in the Calyces During RIRS in a Human Cadaver Model(Galenos Yayincilik, 2019) Aykac, Aykut; Baran, Ozer; Oner, Zulal; Kaya, Coskun; Ozok, Ugur; Sunay, MelihObjective: The aim of this study was to evaluate calyceal pressure caused by irrigation of the upper, mid and lower calyces in a cadaver kidney model and to examine the interactions. Materials and Methods: The kidney was dissected together with the ureter from a human cadaver from a 75-year-old without a history of renal disease. Catheters were placed in the bases of the calyces to perform pressure measurements. After recording baseline pressures while the flexible ureteroscope working channel was empty during irrigation, pressures were then measured by administering fluid with a hand pump, 5 cc and 50 cc syringe. Then, 272 mu and 350 mu laser probes were placed in the flexible ureteroscope and, after recording the baseline calyceal pressures, the measurements were repeated 3 times during hand pump irrigation. Results: Lowest calyceal pressures were measured when a 300 mu laser probe in the working channel of the flexible ureteroscope was placed in the upper calyx during irrigation at 60 cm H2O. Independent of the location of the flexible ureteroscope, the pressure in all the calyces was observed to be >= 50 mmHg during all types of fluid irrigation. All the calyceal pressures were observed to be affected by each other. The pressure within the calyx where the flexible ureteroscope was located was statistically significantly higher than in the other calyces (p<0.001). Conclusion: Application of additional fluid irrigation during flexible ureteroscopy causes a serious increase in intrarenal pressure. If fluid irrigation is to be applied, it should be done using a very small amount of fluid and for a very short duration.Öğe Stent Encrustation due to Forgotten Double-J Stents: A Series of Five Cases(Galenos Yayincilik, 2020) Burlukkara, Salih; Aykac, Aykut; Baran, OzerAlthough Double-J stents have become very common in the urological practice and are effectively used for various reasons, several complications related to it, such as hematuria, infection, irritative symptoms, pain, perforation, encrustation, and migration, have been observed. The present study reports five case reports of stent encrustation due to forgotten stents.Öğe Ureteral Access Sheath Application Without Fluoroscopy in Retrograde Intrarenal Surgery(Coll Physicians & Surgeons Pakistan, 2020) Aykac, Aykut; Baran, Ozer; Sari, SercanObjective: To compare the results and complications of the two techniques of ureteral access sheath application, with and without using fluoroscopy. Study Design: A comparative study. Place and Duration of Study: Department of Urology, Karabuk University Medical Faculty Training and Research Hospital and Ankara Diskapi Yildirim Beyazid Training and Research Hospital between April 2014 and January 2018. Methodology: Retrospective evaluation was made of patients applied with retrograde intrarenal surgery using ureteral access sheath (UAS). In Group 1, defined method were used for UAS application without using scopy. In Group 2, following semi-rigid ureterorenoscopy, localisation of guidewire was checked with fluoroscopy. UAS was advanced to ureter over guidewire under fluoroscopy imaging. Results: Success rate of UAS placement was similar in both groups (p=0.747). The time of UAS placement was 14.75 secs in Group 1 and 14.99 secs in group 2 (p=0.073). Fluoroscopy was not used at all during UAS placement in Group 1. In Group 2, the mean duration of fluoroscopy use was 9.93 +/- 3.89 secs. Total stone-free rate was 82.09% and 83.28% in Group 1 and 2, respectively. (p=0.653). Conclusion: The method described in this paper provides protection against radiation exposure for both the patient and the operating team; and prevents potential complications by enabling clear evaluation of ureteral orifice.Öğe Wunderlich Syndrome, Tuberous Sclerosis-Related Giant Renal Angiomyolipoma Rupture: Case Report(Galenos Yayincilik, 2018) Baran, Ozer; Aykac, Aykut; Oner, Serkan; Aktumen, Alpay; Burlukkara, Salih; Sunay, Mehmet Melih; Ozok, Hakki UgurAngiomyolipoma (AML) is a mesenchymal tumor of the kidney that is composed of morphologically abnormal smooth muscle cells, blood vessels, and adipose-like foci. Renal AML is usually clinically asymptomatic and detected incidentally during imaging. Rarely, renal AML can cause life-threatening spontaneous massive retroperitoneal hemorrhage, known as Wunderlich syndrome. A 39-year-old man with tuberous sclerosis was admitted to the emergency room with left flank pain, hematuria, and nausea. On physical examination, there was a hard sensitive mass extending from the upper left half of the abdomen to the midline. Left renal AML and extensive retroperitoneal hematoma measuring about 360x220x195 mm were detected on abdominal computed tomography. The patient exhibited signs of hypovolemic shock and emergency total nephrectomy was performed. He was discharged from the intensive care unit on postoperative day 1 and from the hospital on day 5.Öğe YouTube as a source of premature ejaculation(Elsevier Espana Slu, 2020) Kaynak, Yurdaer; Kaya, Coskun; Aykac, AykutIntroduction and objectives: To evaluate the quality of information in You Tube videos pertaining to premature ejaculation. Materials and methods: A search for premature ejaculation (PE) was performed on You Tube in August 2018. Two senior urologist viewers watched and categorized each video for their sources, suggestions and information contents (excellent, fair or poor). Results: Of the three hundred videos viewed on You Tube, 155 videos were included and analyzed. Mean video length (mean +/- standard deviation) was 3.08 +/- 2.02 min. The information content was excellent only in 17 (10.9%) of all videos while for a majority of them it was poor (57.4% n= 89). Fair videos constituted 31.7% (n =49) of the videos. There was no relation between the trustworthiness of the videos' contents and either their viewings or ratings (p= 0.561, p = 0.0966, respectively). Videos uploaded by health professionals were more reliable than those uploaded by laypersons (p < 0.001). Conclusions: The study suggests that although some videos, especially those uploaded by healthcare professionals, are useful; the majority of them have misleading information. Therefore, they are not a reliable source of PE information for patients. It is incumbent on urologists to counsel patients for other available useful internet information sources on PE. (C) 2019 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.
