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Öğe Additional preoperative parameters to enable the decision of partial orchiectomy in small testicular masses(2020) Selvı, İsmail; Basar, HalilObjective: We aimed to determine the predictive value of additional parameters for differentiating benign-malign tumors and to identify optimal patients for partial orchiectomy in unilateral, small (?2 cm) testicular masses.Methods: The data of 31 patients who underwent radical orchiectomy between January 2010 and December 2017 due to unilateral and small testicular masses were retrospectively analyzed. Demographic data, histopathological tumor types, serum tumor markers, neutrophil/lymphocyte ratio (NLR), monocyte/ lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW), the presence of testicular dysgenesis syndrome (TDS) and its components, postoperative follow-up outcomes were recorded. Patients were divided into two groups as benign and malignant.Results: There was no significant difference between groups in terms of AFP (p=0.116), ?-hCG (p=0.205), LDH (p=0.606), MPV (p=0.087) and RDW (p=0.266); while MLR (p=0.001), NLR (p=0.036) and PLR (p=0.001) were significantly higher in malignant group. The presences of testicular microlithiasis (p=0.719), undescended testis (p=0.254), hypospadias (p=0.645), atrophic testis (p=0.409) were not different between groups; while the rate of disorders of semen parameters (p=0.043) and presence of TDS (p=0.043) were significantly higher in malignant cases. In multivariate analysis, MLR and PLR were found as predictive factors for benign-malign distinction of small testicular masses.Conclusion: In the patients in whom preoperative malignancy suspicion could not be excluded, we think that PLR, MLR, NLR, disorders of semen parameters and presence of TDS may have high predictive value for benign-malign distinction. Partial orchiectomy may be recommended in patients with suspicion of benign lesions according to these parameters.Öğe Can we Avoid the Unnecessary Loss of nephrons in the Management of Small Solid Renal Masses? Additional Clinical Parameters to Predict Benign-malign Distinction(Kare Publ, 2021) Selvi, Ismail; Basar, HalilObjectives: We aimed to investigate the predictive value of additional parameters for distinguishing benign-malign tumors and to prevent the loss of nephrons in small (<= 4 cm) solid renal masses. Methods: The data of 56 patients underwent partial or radical nephrectomy between September 2009 and December 2017 due to diagnosis of localized renal cell carcinoma were retrospectively analyzed. Demographic datas, histopathological tumor types, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV), the Framingham risk score and its components, postoperative follow-up results were recorded. Patients were divided into two groups as benign and malign. Results: Among 56 patients with a median age of 60 (min: 35-max: 74) years, 13 patients had benign and 43 patients had malign pathologies. MLR (p=0.011), NLR (p=0.032), PLR (p=0.006), MPV (p=0.025), eGFR (p=0.019) and the Framingham score (p=0.008) were significantly higher in malign group. Among the components constituting the Framingham score, only presence of smoking (p=0.032), presence of hypertension (p=0.041) and total cholesterol values (p=0.021) were significantly higher. In multivariate analysis, NLR>2.02 (OR:7.184, p=0.037), PLR>109.65 (OR:12.692, p=0.002), MPV>3.44 (OR:10.543, p=0.046) and Framingham score >10.5 (OR:12.287, p=0.007) were found as predictive factors for distinguishing small solid renal masses concerning malignancy. Conclusion: We think that NLR, PLR, MPV and the Framingham scores may be used in the clinical evaluation of small solid renal masses. In this way, we may prevent the unnecessary loss of nephrons in benign masses with suspicion of malignancy.Öğe Clinical-histopathological features of paratesticular masses and factors affecting survival: single center experience(2020) Selvı, İsmail; Basar, HalilObjective: As paratesticular masses constitute 2-3% of all scrotal and inguinal masses, published cases in the literature are limited. We aimed to present our experiences of nine cases which we have treated and followed up in our department.Methods: Between January 2013 and February 2017, weretrospectively analyzed the data of nine patients with paratesticular mass in our department.Results: Seven (77.8%) patients presented with scrotal mass or swelling, while two (22.2%) patients had swelling in the inguinal region. Histological types of malign tumors were rhabdomyosarcoma [(RMS), 2 cases, 22.3%)], liposarcoma [(LPS), 1 case, 11.1%)], leiomyosarcoma [(LMS), 1 case, 11.1%)] and malignant fibrous histiocytoma [(MFH), 1 case,11.1%)]. Bening tumors were fibroma(1 case, 11.1%), adenomatoid tumor (1 case, 11.1%), cystadenoma (1 case, 11.1%) and inflammatory myofibroblastic tumor (1 case, 11.1%). During median 23.5 (4-62) months of follow-up of paratesticular sarcomas, the rates of recurrence-free and progressionfree survival were 60%, overall survival rate was 60%. LMS and MFH had poor prognosis. No recurrence or progression wasobserved in the follow-up of LPS and RMS. Among them, LPS had the best prognosis.The disease-free survival was 100% at the median 49 (36-64) months follow-up of four benign masses without any need for adjuvant treatment. According to FNCLCC Classification, times of local recurrence-free survival and overall survival in grade II sarcomas were significantly higher than those with grade III (p=0.039).Conclusion: It is difficult to differentiate clinically benign paratesticular masses from sarcomas. LPS has better prognosis and high-grade sarcomas have poor prognosis. If adjuvant treatments are not added, local recurrence or progression may be observed in a short time.Öğe The Effect of Cardiovascular Morbidity on Clinical Responsiveness to Anticholinergics in Postmenopausal Women With Urge Urinary Incontinence(Elsevier Science Inc, 2021) Selvi, Ismail; Baydilli, Numan; Arik, Ali Ihsan; Basar, HalilOBJECTIVE To evaluate whether there is an association between severity of cardiovascular morbidity and urge urinary incontinence (UUI), and to assess the clinical responses of postmenopausal female patients in different cardiovascular risk groups to anticholinergics. METHODS A total of 220 postmenopausal female patients aged 43-70 years old with overactive bladder with UUI between December 2019 and July 2020 were included. They were divided into 3 groups according to the Framingham risk score that calculates the 10-year risk of cardiovascular disease development: low-risk (n: 90, 40.9%), intermediate-risk (n: 47, 21.3%), and high-risk (n: 83, 37.8%).Their demographic and clinical data were recorded. The intensity of UUI and its effect on quality of life (QoL) were evaluated at admission, 8th week and 16th week of anticholinergic therapy. RESULTS At admission attendance, BMI, smoking rate, presence of hypertension and diabetes mellitus, total cholesterol level and severity of UUI were higher in the high-risk group, whereas HDL level was lower and the effect of UUI on QoL was worse (P<.001). At the 16-week follow-up the improvement of UUI severity and QoL was significantly more pronounced in the low-risk and intermediate-risk groups (P<.001).The highest daily-dryness rates were observed in the low-risk group (65.6%), while the highest rates for refractory overactive bladder (OAB) were seen in the high-risk group (19.3%). CONCLUSION Our findings show that more severe UUI and more impaired QoL is observed in high-risk patients for cardiovascular morbidity. Individualized treatment may be important in the high-risk group since they may benefit less from anticholinergics and refractory OAB can be more common. (C) 2020 Elsevier Inc.Öğe The Effect of Framingham Score on the Oncological Outcomes in Localized (T1-T2 Stage) Renal Cell Carcinoma Patients(Galenos Yayincilik, 2019) Selvi, Ismail; Basar, HalilObjective: To evaluate the effect of cardiovascular disease risk on local recurrence, distant metastasis development and cancer-specific survival in patients with localized (stage 1 and 2) renal cell carcinoma (RCC). Materials and Methods: Data of patients who underwent partial or radical nephrectomy due to pathological stage 1 and 2 RCC between September 2009 and July 2016 were retrospectively evaluated. Ninety-six patients with fully accessible data were included in the study. Demographic data, histological tumor type, Fuhrman grading, local recurrence, metastasis and survival after nephrectomy were recorded. Framingham risk score, which predicts cardiovascular disease within 10 years, was calculated in all patients. The patients were divided into three groups as low (group 1), moderate (group 2) and high risk (group 3). Results: Mean age of patients was 58.66 +/- 10.55 years at the time of nephrectomy. Nine (9.4%) patients had local recurrence, 12 (12.5%) had distant metastasis and 11 (11.5%) died due to cancer during a median follow-up period of 57 (6-102) months. Regarding intergroup comparison, local recurrence rate (21.9%, p=0.012) and distant metastasis rate (25%, p=0.025) were significantly higher in group 3, and predicted recurrence-free survival (66.4 months, p=0.005), metastasis-free survival (77 months, p=0.017) and cancer-specific survival (79.9 months, p=0.024) were found to be significantly lower. In univariate analysis, body mass index, total cholesterol level, estimated glomerular filtration rate and Framingham risk score were independent predictive factors for local recurrence, distant metastasis development and cancer-specific survival. In multivariate analysis, body mass index, estimated glomerular filtration rate and Framingham risk score were more significant. Conclusion: Patients who are at high risk of developing cardiovascular disease have more local recurrence, distant metastasis and cancer-specific mortality rates, even though nephrectomy is performed due to localized RCC. Therefore, we suggest that these patients should be followed more carefully in the post-nephrectomy period.Öğe The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study(Associacao Paulista Medicina, 2021) Selvi, Ismail; Arik, Ali Ihsan; Basay, Mehmet Sinan; Basar, HalilBACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.Öğe The importance of plasma arginine level and its downstream metabolites in diagnosing prostate cancer(Springer, 2019) Selvi, Ismail; Basar, Halil; Baydilli, Numan; Murat, Koza; Kaymaz, OzlemPurpose There is still no certain threshold value of prostate-specific antigen (PSA) for prostate cancer diagnosis. We aimed to investigate the predictive value of arginine and its metabolites for diagnosing prostate cancer in patients with PSA 4-10 ng/ml and evaluate their usefulness as prognostic tumor markers. Methods Seventy-eight patients with a mean age of 64.505.49 years were included in our prospective observational study between November 2016 and March 2017. They were divided into two equal groups according to the pathologic results of prostate biopsy (benign vs. malignant). Plasma arginine and ornithine levels were analyzed before biopsy by liquid chromatography-tandem mass spectrometry. ELISA was used for analyzing urinary diacetylspermine. Results In PSA-adjusted analysis, the malignant group had lower plasma arginine levels (p=0.021) and arginine to ornithine ratio (AOR) (p=0.010), but higher plasma ornithine levels (p=0.012) and urinary diacetylspermine levels (p<0.001) as compared with the benign group. While arginine (r=-0.628, p<0.001) and AOR (r=-0.714, p<0.001) were negatively correlated with D'Amico clinical classification (p<0.001), ornithine (r=0.659, p<0.001) and diacetylspermine (r=0.710, p<0.001) were found to be positively correlated (p<0.001). In multivariate analysis, ornithine [OR 3.264, 95% CI (1.045-10.196), p=0.042] and diacetylspermine [OR 6.982, 95% CI (2.403-20.290), p<0.001] were found to be more significant in detection of prostate cancer. Conclusion Plasma arginine, ornithine, AOR and urinary diacetylspermine levels may be used as molecular markers to predict prostate biopsy outcomes in patients with PSA 4-10 ng/ml. But according to our results, the use of ornithine and diacethylspermine prior to biopsy seems to be the most cost-effective diagnostic strategy.Öğe IS TESTICULAR MICROLITHIASIS A REALLY INNOCENT CONDITION? ITS EFFECTS ON ONCOLOGICAL OUTCOMES OF GERM CELL TESTICULAR CANCER: AN OBSERVATIONAL STUDY(Iniestares, S.A., 2020) Selvi, Ismail; Sarikaya, Selcuk; Basar, HalilOBJECTIVES: Although it is a well known condition that presence of testicular microlithiasis (TM) with the co-occurrence of specific risk factors such as history of previous germ cell testicular cancer (GCTC), infertility, undescended testes or atrophic testes have high risks for GCTC development,TM is still a controversial topic. Its effects on oncological outcomes have still not been investigated in detail. In this study, we aimed to evaluate whether the presence of TM has an effect on GCTC prognosis and oncological outcomes. METHODS: Seventy five patients among 93 patients who underwent radical orchidectomy between January 2010 and February 2016 were selected and divided into two groups. Group I consisted of 51 patients without TM. Group II consisted of 24 patients with TM. Each groups were compared in terms of demographic datas, prognostic risk factors, complete blood count parameters and oncological outcomes. RESULTS: During the median follow-up of 58 (1-106) months, a significantly higher local recurrence rate (54.2% vs. 3.9%, p<0.001), distant metastasis rate (58.3% vs. 5.9%, p<0.001) and lower cancer-spesific survival rate (45.8% vs. 94.1%, p<0.001) were observed in patients with TM. In this group, the duration of recurrence-free survival (47.65 +/- 9.45 vs.101.96 +/- 2 .80 months, p<0.001), metastasis-free survival (49.50 +/- 8.88 vs. 100.00 +/- 3.36 months, p<0.001) and cancer-specific survival (54.37 +/- 8.76 vs. 100.19 +/- 3.25 months, p<0.001) were also statistically lower. In multivariate analysis, beta-hCG, LDH, neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio and the presence of undescended testis were found as independent predictive factors for local recurrence, distant metastasis and cancer-specific survival. Red blood cell distribution width and the presence of testicular microlithiasis were found to be independent predictive factors for local recurrence. CONCLUSION: According to our results, bilateral TM was associated with higher rates of local recurrence, distant metastasis and cancer spesific mortality in presence of risk factors, regardless of classic or limited microlithiasis.Öğe Predictive factors for postoperative decline in renal functions following partial nephrectomy: preliminary results(2020) Selvı, İsmail; Basar, HalilObjective: We aimed to determine the risk factors related to patient, tumor characteristics and surgery that may be associated with decline in renalfunction during follow-up after partial nephrectomy (PN).Materials and Methods: Sixty-one patients who underwent PN due to localized stage Ia renal cell carcinoma between January 2010 and October2018 were retrospectively analyzed. Demographic characteristics of the patients, clinical and pathological data, information about surgicaltechniques, preoperative score to predict postoperative mortality (POSPOM), Age-adjusted Charlson Comorbidity index (ACCI), Eastern CooperativeOncology Group score, American Society of Anesthesiologists’ score, preoperative estimated glomerular filtration rate (eGFR) and eGFR levels duringpostoperative follow-up were recorded.Results: Twelve (19.7%) patients experienced a decline in eGFR (<60 mL/min/1.73 m2) at the postoperative follow-up of median 30 months. Olderage, higher Body Mass index, presence of hypertension, Diabetes Mellitus, tumor in the hilar region, higher scores of POSPOM, ACCI, RENAL andPADUA, lower preoperative eGFR, cold ischemia technique, total arterial clamping technique, longer warm ischemia time, longer cold ischemiatime and lower preserved renal parenchymal volume (RPV) were found to be associated with both short- and long-term decline in eGFR (<60 mL/min/1.73 m2).Conclusion: Although lower percentage of preserved RPV is a significant predictor of the postoperative deterioration of renal function, our resultshave shown that preoperative POSPOM score, ACCI and eGFR levels are just as important as surgical factors.Öğe Predictive value of different parameters for estimating the first 90-days and long-term survival following radical cystectomy(2020) Selvı, İsmail; Basar, HalilObjective: We aimed to define the prognostic risk factors which may have an impact on the survival by assessing the effects of the different clinicalparameters and several comorbidity classifications on the oncologic outcomes within the first 90 days and long-term follow-up after radical cystectomy.Materials and Methods: Fifty-two patients who underwent radical cystectomy between June 2013-and June 2017 due to bladder tumors and whosedata were fully accessible, have been assessed retrospectively. The demographical, clinical and pathologic data of the patients were recorded alongwith the progression and mortality rates within the first 90 days follow up period and the subsequent long-term follow-up. Age-adjusted CharlsonComorbidity index (ACCI), Eastern Cooperative Oncology Group (ECOG) score, American Society of Anesthesiologists (ASA) score, Framinghamrisk score, Preoperative Score to Predict Postoperative Mortality, Rockwood frailty index, preoperative serum hemogram parameters and estimatedglomerular filtration rate (eGFR) were all calculated and recorded.Results: Out of the 52 patients the average age was 68.21±6.47, distant metastasis was observed in 17 (32.7%) patients during monthly follow upsat an average of 37.52±26.15 [minimum (min)=1, maximum (max)= 96], while morbidity was observed in 23 patients (44.2%). According to receiveroperativing characteristic analysis, the two parameters as the most reliable tool in the prediction of the mortality during long term follow up were eGFR[area under the curve (AUC)=0.754, p<0.001] and Framingham score (AUC=0.782, p=0.001). It has also been observed in multivariate analysis thatFramingham score and Clavien-Dindo classification was the most meaningful predictive factor in the estimation of the mortality in the first 90 daysperiod, progression free survival (PFS) and overall survival (OS); eGFR for PFS and OS; ECOG score for PFS; ASA score for OS; monazite/lymphocyterate for the estimation of the mortality in the first 90 days period. In addition, pT3-4 stage has been observed to be much more meaningful in theprediction of PFS, non-transitional cell carcinoma pathology for PFS and OS, and, lymph node positivity for OS.Conclusion: Radical cystectomy is a surgical procedure with high morbidity and mortality due to perioperative complications both in the first 90-daysof the postoperative period and long-term follow-up.We found that Framingham score and eGFR were superior and easily applicable parameters inprediction of PFS and OS, whereas Framingham score and MLR were better in prediction of the first 90-days mortality. In this way, we think that wecan identify patients who are more suitable for cystectomy, so we can provide more successful postoperative follow-up and treatment management.Öğe The prognostic effect of immunoscore in patients with clear cell renal cell carcinoma: preliminary results(Springer, 2020) Selvi, Ismail; Demirci, Umut; Bozdogan, Nazan; Basar, HalilPurpose This study aimed to evaluate the density of CD8(+) and CD3(+) tumor-infiltrating lymphocytes (TILs) and determine whether the immunoscore has any prognostic effect on the oncological outcomes in patients with clear cell renal cell carcinoma (RCC). Materials and methods A total of 129 patients diagnosed with clear cell RCC following radical or partial nephrectomy between 2009 and 2014 were retrospectively analyzed. Both tumor core (CT) and the invasive margin of nephrectomy specimens were assessed. The specimens were immunostained for anti-CD8(+) and anti-CD3(+) TILs. The patients were divided into three groups (favorable, intermediate, and poor risk) according to immunoscore levels. Results In the multivariate analysis, a favorable immunoscore (I3-4) was associated with prolonged disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS) (HR 2.652, 2.848, and 2.933, respectively; all p < 0.001). The lower Fuhrman grade and pathological tumor-node-metastasis (TNM) stage had better DFS, PFS, and OS, whereas prolonged PFS was associated with a higher density of CD8(+) CT (HR 1.602, 95% CI 0.934-3.470; p = 0.014). The shorter DFS, PFS, and OS were observed in the group with poor immunoscore (I0-1) at the early TNM stage of RCC (p < 0.001). In the metastatic subgroup analysis, the immunoscore showed better estimation than the International Metastatic RCC Database Consortium model and the Memorial Sloan-Kettering Cancer Center risk model for progression and OS (p < 0.001). Conclusion The additional contributions of immunoscore to TNM stage, Fuhrman grade, and the WHO/ISUP 2016 grade for estimating oncological outcomes were found in ROC analysis. According to our preliminary results, immunoscore can be a promising prediction tool in clear cell RCC for postoperative oncological outcomes following nephrectomy.Öğe Reappraisal of the Definition Criteria for Genitourinary Syndrome of Menopause, and its Effect on Quality of Life in Turkish Postmenopausal Women(Elsevier Science Inc, 2020) Selvi, Ismail; Baydilli, Numan; Yuksel, Dilek; Akinsal, Emre Can; Basar, HalilOBJECTIVE To reappraise the definition of Genitourinary syndrome of menopause (GSM) and to evaluate the prevalence and effect of GSM on quality of life in Turkish postmenopausal women. METHODS A multicenter, cross-sectional, and observational study was designed. Four hundred three postmenopausal women between the ages of 43-75 who attended Urology and Gynecology clinics between November 2019 and April 2020 were included.They were divided into 2 groups: Group I (GSM, n:288, 71.5%) and Group II (non-GSM, n:115, 28.5%). Demographic data, presence and intensity of genitourinary symptoms were recorded. The impact of menopause and urinary incontinence on quality of life was evaluated with the Menopause-Specific Quality of Life Questionnaire and the King's Health Questionnaire. RESULTS The most common symptoms were vaginal dryness (66.2%), reduced lubrication (55.3%), and urgency (54.8%). Urinary incontinence was present in 39.2% of women. Worse quality of life in terms of psychosocial and sexual domains of the Menopause-Specific Quality of Life Questionnaire was significant in Group 1 (P < .001). Group 1 had significantly worse scores for all domains of the King's Health Questionnaire. Only the rate of patients with stress incontinence was higher in Group 1. However, the percentage of moderate and severe symptoms for all types of incontinence was higher in Group 1. Although the prevalence of GSM was 71.5% according to our definition, the percentage of patients previously visiting healthcare professionals for their symptoms was low (52.8%). CONCLUSION Our findings show that urologists and gynecologists should question both symptom groups of postmenopausal women, even if patients do not bring up genitourinary symptoms. UROLOGY 144: 83-91, 2020. (c) 2020 Elsevier Inc.Öğe Subcapsular orchiectomy versus total orchiectomy and LHRH analogue in the treatment of hormone-sensitive metastatic prostate cancer: a different perspective in evaluation of the psychosocial effects(Springer, 2020) Selvi, Ismail; Basar, HalilPurpose We aimed to compare total orchiectomy, subcapsular orchiectomy, and luteinizing hormone-releasing hormone (LHRH) analogue treatment in patients with hormone-sensitive metastatic prostate cancer in terms of efficacy of androgen deprivation treatment (ADT), patient satisfaction, health-related quality of life (HRQoL), development of phantom testis syndrome (PTS), and post-traumatic stress disorder (PTSD). Method Among 272 patients treated between July 2015 and January 2019, 189 patients were enrolled in this prospective, cohort study and the patients were divided into three groups: group I, bilateral total orchiectomy (n66); group II, bilateral subcapsular orchiectomy (n63); and group III, LHRH analogue treatment (n60). The adequacy of ADT was routinely monitored every 3 months and clinical parameters were evaluated. After 6 to 36 months following ADT, questionnaires were used to evaluate PTS, PTSD, and HRQoL during outpatient visits. The patient satisfaction was questioned as yes/no. Results Adequate castration was provided with all three treatments, while the presence and frequency of PTS and severity of PTSD were lower, and patient satisfaction related to ADT and all components of HRQoL were better in patients undergoing subcapsular orchiectomy than those undergoing total orchiectomy. All findings except for PTS were similar in patients undergoing subcapsular orchiectomy and LHRH analogue treatment. In analysis of all patients, total incidence of PTS was 43.4% and PTSD was reported to be 48.7%. A strong relationship was found between PTSD and phantom testis pain (r0.621,p < 0.001). Conclusions Subcapsular orchiectomy has less psychosocial side effects than total orchiectomy and is similar to LHRH analogue treatment. It can be a reliable, cheaper, and fast-acting alternative to LHRH analogue treatment.Öğe Transüretral rezeksiyon sonrası kas invaze mesane tümörlerinin klinik evrelemesinde, tanısal doğruluğu artırabilecek ek parametreler(2020) Selvi, İsmail; Basar, HalilAmaç: Transüretral mesane tümör rezeksi-yonu (TUR-MT) sonucu kas invaze transizyonel hücreli karsinom gelen hastalarda, klinik evre-lemede ekstravezikal tümör yayılımını tahmin etmede tanısal doğruluğu artırabilecek ek kli-nik parametrelerin öngörü değerini araştırmayı amaçladık.Gereç ve Yöntemler: Ocak 2009-Aralık 2016 tarihleri arasında, TUR-MT patolojisi transizyo-nal hücreli kas invaze mesane tümörü gelen ve kli-nik evrelemesi T2 veya T3 olarak değerlendirilip radikal sistektomi yapılan 52 hastadan, verilerine tam olarak ulaşılabilen 43’ü retrospektif olarak değerlendirildi. Hastaların demografik, patolojik ve klinik verileri kaydedilerek, radikal sistektomi sonrası histopatolojik evrelemede ekstravezikal tümör yayılımı olmayan (pT2) 26 hasta Grup I, ekstravezikal tümör yayılımı olan (pT3) 17 hasta ise Grup II olarak isimlendirilerek iki gruba ay-rıldı.Bulgular: Ortanca yaşı 65 olan hastaların 40 (%93)’ı erkek, 3 (%7)’ü kadındı. Grup II’de ECOG skoru, ASA skoru, Charlson komorbidite indeksi (CCI), nötrofil/lenfosit oranı (NLO), platelet/len-fosit oranı (PLO), monosit/lenfosit oranı (MLO), ortalama platelet hacmi (MPV) anlamlı olarak daha yüksek; preoperatif hidronefroz varlığı, eşlik eden karsinoma in situ (CIS), lenfovasküler invaz-yon (LVİ) varlığı, muskularis propria tabakasında invazyon derinliğinin >%50 olması, önceki tümörrekürrensi öyküsü daha fazla oranda saptandı. Tahmini glome-rüler filtrasyon hızı (eGFR) ise anlamlı olarak daha düşüktü. Çok değişkenli analizde, hidronefroz, önceki rekürrens öyküsü, LVİ varlığı, muskularis propria invazyon derinliğinin >%50 ol-ması, eGFR, NLO, PLO ve MLO değerlerinin ekstravezikal yayı-lım varlığını öngörmede daha önemli faktörler olduğunu belir-ledik. ROC analizine göre, eGFR, MLO, PLO, NLO için kestirim değerleri sırasıyla 77.73 (AUC:0.805, p=0.001), 0.24(AUC:0.771, p=0.003), 116 (AUC:0.766, p=0.004), 2.07 (AUC:0.710, p=0.021) olarak hesaplandı.Sonuç: Radikal sistektomi öncesi klinik evrelemede BT veya MRG dışında kullanılabilecek çeşitli ek parametrelerin kullanı-mı ile tanısal doğruluğun artabileceğini düşünmekteyiz
