Browsing by Author "Kosan, Murat"

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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.
Evaluation of the Current Situation Tissue and Serum Biomarkers in Prostate Cancer
(2015) Kervancioglu, Enis; Kosan, Murat
Prostate cancer, is the most commonly diagnosed cancer in the United States and in many parts of the world and ranks 2nd in death from cancer among men. Lifetime risk of developing prostate cancer is 16%. Currently the only accepted screening tool Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE). PSA is a specific biomarker but non-specific for prostate cancer. In diseases such as Benign Prostatic Hyperplasia (BPH) and prostatitis high serum PSA levels can be detected. Therefore, identifying prostate cancer only with serum PSA measurement has lower specificity and may lead to false positive results and unnecessary biopsies. Some encountered problems such as unnecessary diagnoses of clinically insignificant cancer and the non-diagnosis of early stage cancers can take. In recent years there are too many studies to investigate new biomarkers for replacing or helping PSA. The aim of this article was the evaluation of the current situation for PSA and non-PSA tissue and serum biomarkers which are published.
Experimental Bladder Cancer Models for Animals
(2015) Kosan, Murat; Mungan, Aydin
Transitional cell carcinoma (TCC) is the most common malignancy of the genitourinary tract and TCC models are being developed over the past decades. Experimental models are needed so that more effective treatments can be developed in preclinical evaluation. Even if, in vitro models are useful for initial development and evaluation of therapeutic agents and modalities, adequate animal models are still essential in the preclinical development of new effective and safe therapies. A great variety of ex vivo and in vivo models has been described in the literature. Chemical carcinogens are most commonly used to induce bladder cancer. Cell culture techniques are also widely used to study different oncological processes. To test potential new drugs in a preclinical setting, a clinically relevant orthotopic bladder tumor model is highly desirable. The aim of this review article was the assessment of different animal models available for the study of bladder carcinogenesis.
Laparoscopic Transperitoneal Adrenalectomy: Experience with the First 10 Patients
(2014) Cicek, Tufan; Karagulle, Erdal; Turk, Emin; Demir, Canan Cicek; Kosan, Murat; 0000-0003-4766-3373; AAJ-5609-2021; JBF-7113-2023; AAK-4857-2021
Purpose: In this study we aimed to assess the outcomes and complications of laparoscopic transperitoneal adrenalectomy operation performed in our clinic Materials and Methods: Medical records of patients operated with laparoscopic transperitoneal adrenalectomy between February 2007 and November 2013 at Baskent University Konya Application and Research Center Urology Clinic are examined retrospectively. The demographic characteristics, preoperative and postoperative laboratory results, operation times, complications, and duration of hospital stay and follow- up were recorded. Results: A total of 10 patients underwent laparoscopic transperitoneal adrenalectomy. Seven of these were male and 3 were female. The mean age was 48 +/- 17.4 (27-71) years. The operation time was 104.4 +/- 36.5 (40-185) on average and the mean amount of blood loss was 43.5 +/- 121.2 ml. The average mass size was 41.6 +/- 23.8 (15-90) mm. The mean duration of hospital stay was 3.8 +/- 1.3 (2-6) days. The patients were followed for an average of 45.8 +/- 28.7 (4-85) months. The operation was turned to open technique in two patients. Mean preoperative and postoperative hemoglobin levels of the patients were 13.38 +/- 1.91 and 11.6 +/- 1.7 mg/dl, respectively. Postoperative hemoglobin level was on average lower than the preoperative level (p< 0.001). One patient required blood transfusion. Conclusion: We suggest that the complication rate of laparoscopic adrenalectomy would be lowered by selecting appropriate patients, more detailed assessment of adrenal functions, and increased surgical experience. Laparoscopic transperitoneal adrenalectomy is regarded as a safe and efficient treatment method.
Lympadenectomy in Prostate Cancer
(2014) Kosan, Murat
Aim: Radical prostatectomy is the standard treatment in localized prostate cancer. The limited or extended lymph node dissection in pelvic region is additionally applied to this procedure. We aimed to review the publications about the recently popularized extended pelvic lymph node dissection (PLND). New Findings: The extended PLND is not suggested in patients with low risk prostate cancer. On the other hand, extended PLND is suggested to make a good staging and treat the micrometastasis in patients with intermediate and high risk prostate cancer. The complication rates of PLND are acceptable in comparison with the benefits. The benefits of other expansive methods for clinical staging are still lower than PLND. Conclusion: However, prospective and randomized clinical trials are needed to investigate the efficiency of PLND in localized prostate cancer, PLND has important role with good oncological results in patients with intermediate and high risk prostate cancer.
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.
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.
Urethral Duplication: A Rare Cause of Recurrent Urinary Infection
(2015) Cicek, Tufan; Kizilkan, Yalcin; Coban, Gokcen; Kosan, Murat; 0000-0002-4729-0100; 0000-0002-0784-9926; 25831685; P-7533-2014; ADD-5305-2022
Urethral duplication is quite a rare congenital anomaly with ill-defined aetiology. Patients often present with penile deformity, recurrent urinary infections, urinary incontinence, serosal discharge from the accessory urethra, and difficulty in urinating. Urethral duplication is most commonly grouped according to the Efmann classification. It has 3 main types as Type I, II, and III. There is no consensus on its therapy. There are non-surgical solutions, including follow-up without therapy, as well as many surgical options, including urethral reconstruction. Anatomical urethra and the external sphincter should absolutely be delineated when a surgery is contemplated. We herein report the case of a two-year-old male patient referred to our clinic with recurrent urinary infection, bilateral hydronephrosis and difficulty in urinating who was diagnosed with urethral duplication. We discuss our findings with review of the relevant literature.
Vesicouterina fistula: Youssef's syndrome
(2015) Cicek, Tufan; Duman, Enes; Toprak, Erzat; Kosan, Murat
Vesico-uterin fistula is a rare type of fistulas and can be diagnosed frequently after surgery. First described by Youssef in 1957. Clasically findings are; cyclic haematuria without urinary incontinence and secondary amenorrhea. The patient was referred to our clinic for cyclic hematuria and she was diagnosed with vesicouterine fistula by radiological imaging methods and a cystoscopy procedure. Being a rare occurrence, this case was reported with a discussion of the relevant literature.