Browsing by Author "Gonulalan, Umut"

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The Diagnostic Value of Magnetic Resonance Urography Using A Balanced Turbo Field Echo Sequence
(2016) Cifci, Egemen; Coban, Gokcen; Cicek, Tufan; Gonulalan, Umut; 26984432
The aim of the study was to compare the inter-observer variability and the accuracy of magnetic resonance urography (MRU) using a thin sectional balanced-turbo field echo (B-TFE) sequence for detecting ureteral calculi and to determine the effect of additional factors (size, density and location of the calculus) on the sensitivity and specificity of the MRU. MRU and CT images were evaluated independently by two radiologists according to presence, density and localization of calculi. The degrees of inter-rater agreement for categorical items were evaluated by the Kappa coefficient. According to the 1st and 2nd observers, the sensitivity of MRU was 65.9 %, 71.8 % and the specificity of MRU was 95.9 %, 100 %, respectively. Inter-observer agreement was 84.6 % for stone detection. The larger size had a better effect on detectability (p < 0.05). Also, the higher density had a better impact on detectability (p < 0.05). Our study has shown that B-TFE MRU was useful to detect ureteral calculi. However, B-TFE MRU has low sensitivity and high specificity in comparison with CT images. MRU is a reasonable alternative imaging technique for follow-up periods of selective groups like patients with large urinary stones, children or pregnant patients when ionizing radiation is undesirable. aEuro cent According to 1st and 2nd observers, sensitivity of MRU was 65.9 %, 71.8 %, respectively. aEuro cent According to 1st and 2nd observers, MRU specificity was 95.9 %, 100 %, respectively. aEuro cent Interobserver agreement was found to be over 84 % for stone detection. aEuro cent B-TFE sequence provides calculus follow-up without radiation. aEuro cent Larger calculi and more dense calculi individually have the better effect on detectability.
Early and Late Complications of Urinary Diversions after Radical Cystectomy
(2016) Kosan, Murat; Gonulalan, Umut
One of the strongest predictive factors for the early and late postoperative complications and morbidity of radical cystectomy is the type of urinary diversion following cystectomy. In this paper, we reviewed English-language literature on urinary diversions after cystectomy and their early and late complications. All types of urinary diversions have potential risks of diversion-related metabolic complications, infection, intestinal obstruction and renal deficiency. Although there is no agreement on the ideal urinary diversion, orthotopic neobladder without an external stoma is the most popular type of diversion in appropriate patients due to the protection of body image. Ileal conduit is another frequently selected urinary diversion for elderly patients with comorbidity. Both orthotopic neobladder and ileal conduits are well tolerated options with low morbidity. Nevertheless, postoperative early and late complications, such as urinary tract infections, pyelonephritis, urinary leakage, stomal stenosis, urolithiasis and morphological changes in the upper urinary tract should be kept in mind.
Intravesical BCG Immunotherapy: Sepsis and Multiorgan Failure Developed After Traumatic Catheterization
(2014) Cicek, Tufan; Togan, Turhan; Erinanc, Hilal; Ugur, Murat; Gonulalan, Umut; Cifci, Egemen; 0000-0003-1401-6356; AAL-1268-2021
Intravesical Bacillus Calmette-Guerin (BCG) instillation is a prophylactic therapy using for treating bladder cancer to prevent tumour progression and recurrence. Both local and systemic complications can arise after the installation. Although local complications are common, this therapy is generally well tolerated. Systemic complications are rarely than local complications but can be fatal. We report a case who died from severe complications such as sepsis, pneumonia, renal failure and granulomatous hepatitis after receiving the first maintanence installation of intravesical BCG immunotherapy for bladder transitional cell carcinoma.
The Optimum Dosage of Prilocaine in Periprostatic Nerve Block During Transrectal Ultrasound Guided Prostate Biopsy: A New Approach in Dose Calculation
(2016) Gonulalan, Umut; Kosan, Murat; Kervancioglu, Enis; Cicek, Tufan; Ozturk, Bulent; Ozkardes, Hakan
Objective: We aimed to calculate the optimum dose of prilocaine per one mL prostate volume in periprostatic nerve block (PPNB) during transrectal ultrasound (TRUS) guided prostate biopsy (PBx). Materials and Methods: We retrospectively evaluated the medical records of 83 patients from whom 12 cores TRUS guided PBx were obtained between years 2011 and 2013. Prostatic sizes were evaluated separately as Size 1 (anterior-posterior on the axial plane), Size 2 (transversal), and Size 3 (cranial-caudal on the sagittal plane) for all patients. The visual analog scores (VAS) of the patients during PBx, prostatic volumes, and prilocaine doses per one mL prostate were evaluated. The correlation between VAS of patients during PBx and prostatic volume, the prostatic sizes and prilocaine dosage per one mL prostate was analyzed using Cubic regression test. Results: It was found that VAS scores of patients were significantly positive correlated with prostatic volume, Size 1, 2 and 3 (p<0.05). However, there was a negative significant correlation between VAS and prilocaine dose per one mL prostate volume (r=-0.402, p<0.01). The dose of 0.1 mL prilocaine infiltration per one mL prostatic tissue in PPNB was the maximum dose that caused a mild and under annoying pain (VAS<2) in patients according to cubic regression formula. Conclusion: Prilocaine dosage, prostatic volume and prostatic sizes (especially anterior-posterior and cranial-caudal) significantly affect VAS scores during TRUS guided PBx. The pain in TRUS guided PBx should be controlled with an optimum dose of prilocaine as 0.1 mL per one mL of prostatic tissue.
Predictive values of vascular endothelial growth factor and microvessel-density levels in initial biopsy for prostate cancer
(2016) Kervancioglu, Enis; Kosan, Murat; Erinanc, Hilal; Gonulalan, Umut; Oguzulgen, Ahmet Ibrahim; Coskun, Esra Zeynep; Ozkardes, Hakan; 26944325
Angiogenesis is an important factor in the development and progression of prostate cancer (PCA). We aimed to investigate the values of vascular-endothelial-growth-factor (VEGF) expression level and microvessel density (MVD) in the prediction of PCA diagnosis at repeated prostate biopsy (re-PBx). We retrospectively evaluated 167 patients with re-PBx according to elevated prostate-specific antigen levels, suspicious digital rectal examination, and the presence of premalignant lesions. Patients with PCA on re-PBx were included in the cancer group (n = 17). Patients with benign prostatic hyperplasia or normal tissues on re-PBx were included in the control group (n = 21). The groups were compared according to the expression level of VEGF and MVD in initial prostate biopsy. There was no statistically significant difference between groups according to age and serum prostate-specific-antigen values. The mean VEGF scores of the cancer and control groups were 232.64 +/- 11.14 and 183.09 +/- 14.56, respectively (p < 0.05). The mean MVD of the biopsy samples in the cancer and control groups were 246.47 +/- 17.59 n/mm(2) and 197.33 +/- 16.26 n/mm(2), respectively (p < 0.05). The cutoff values of VEGF scores and MVD were set as 200 and 215, respectively, for PCA detection in our study. Our results showed that the expression level of VEGF and MVD significantly increased in the initial prostate-biopsy samples of patients with PCA diagnosed with re-PBx. The evaluation of VEGF expression level and MVD might have an important value in the prediction of PCA at re-PBx. The expression level of VEGF and MVD should be kept in mind as PCA-related histopathological changes that indicate the increased angiogenesis in prostatic tissue. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.
Prostatic Melanosis: A Case Report
(2014) Cicek, Tufan; Erinanc, Hilal; Gonulalan, Umut; Sen, Erhan; Ozturk, Bulent; 0000-0003-1944-1722; 0000-0003-1401-6356; AAJ-8576-2021; AAL-1268-2021
Prostatic melanosis is characterized by melanocytic proliferation in prostatic stroma and the epithelium. The pathogenesis of the lesion is uncertain. In literature it has been reported as a case associated with prostatic adenocarcinoma before. Primary and metastatic malignant melanoma should be considered in differantial diagnosis of the lesion.
Re: Cicek et al.: Spinal Anesthesia Is an Efficient and Safe Anesthetic Method for Percutaneous Nephrolithotomy (Urology 2013;83:50-55) Reply
(2014) Gonulalan, Umut; Cicek, Tufan; Kosan, Murat; https://orcid.org/0000-0002-0784-9926; 24581537
Skin-to-Stone Distance Has No Impact on Outcomes of Percutaneous Nephrolithotomy
(2014) Gonulalan, Umut; Akand, Murat; Coban, Gokcen; Cicek, Tufan; Kosan, Murat; Goktas, Serdar; Ozkardes, Hakan; https://orcid.org/0000-0002-4010-2883; https://orcid.org/0000-0002-0784-9926; https://orcid.org/0000-0002-7277-449X; 24481206; P-7533-2014; AAH-1052-2020
Objective: Skin-to-stone distance (SSD) is a stronger factor than body mass index in predicting the success of shock wave lithotripsy. We aimed to evaluate the impact of SSD on outcomes of percutaneous nephrolithotomy (PCNL). Materials and Methods: The medical records of 1,280 patients who had undergone PCNL between April 2007 and February 2012 were evaluated retrospectively. 192 patients who had had preoperative non-contrasted computed tomography and single renal access were included the study. According to this median SSD value, patients were divided into two groups: group 1 (SSD <= 94 mm) (n = 92) and group 2 (SSD >94 mm) (n = 90). The groups were compared according to operative and postoperative parameters. Results: We found no significant differences between the two groups with regard to stone-free rate, operation time, fluoroscopy time, hospitalization time, visual analog score of pain, stone burden, transfusion rates and complication rates. On the other hand, the mean body mass index of group 1 was significantly lower than that of group 2 (p < 0.05). Conclusions: In this retrospective review of patients undergoing PCNL, we found that SSD has no impact on operative and postoperative outcomes. These results were in accordance with the safety of PCNL in obese patients. (c) 2014 S. Karger AG, Basel
Transpaeritoneal Laparoscopic Simple Nephrectomy: A Single Center Experience
(2014) Cicek, Tufan; Sen, Erhan; Gonen, Murat; Gonulalan, Umut; Kosan, Murat; Ozturk, Bulent; 0000-0003-1944-1722; AAJ-8576-2021; AAA-7140-2021
Purpose: In this study, we planned to evaluate the efficacy and perioperative outcomes of transperitoneal laparoscopic simple nephrectomy at Baskent University Konya Application and Research Center. Material and Methods: The demographic and perioperative data of patients who underwent transperitoneal laparoscopic simple nephrectomy at Baskent University Konya Application and Research Center Urology clinic between February 2005 and November 2013 were analyzed retrospectively. Operative time, perioperative laboratory results, the durations of hozpitalization and follow-up, perioperative complications and demographic characteristics of each patient were recorded. Results: Overall, 58 patients were included. 27 patients were male (46%) and 31 patients were female (54%). The mean age was 45.3 +/- 17.12 (6-79). The mean operative time was 104.4 +/- 36.5 (40-185) minutes. The mean hospitalization duration was 2.7 +/- 0.7 (2-5) days. The mean preoperative and postoperative hemoglobin levels were 13.7 +/- 1.74 and 12.4 +/- 1.73 mg/dl, respectively. Postoperative hemoglobin levels were statistically significatly lower than preoperative hemoglobin levels (p<0.001). 4 patients (%6.9) needed blood transfusion. 5 patients had grade I, 4 patients had grade II and 2 patients had grade III complications according to modified Clavien classification system. Conclusion: Transperitoneal laparoscopic simple nephrectomy seems to be a safe and efficacious treatment option as having low complication rates.