Wos Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10754
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Item Can We Predict the Surgical Margin Positivity in Patients Treated with Radical Prostatectomy? A Multicenter Cohort of Turkish Association of Uro-Oncology(2015) Dirim, AyhanObjective To analyze the parameters that predict the surgical margin positivity after radical prostatectomy for localized prostate cancer. Materials and Methods In this multicenter study, the data of 1607 consecutive patients undergoing radical prostatectomy for localized prostate cancer in 12 different clinics in Turkey between 1993-2011 were assessed. Patients who had neoadjuvant treatment were excluded. We assessed the relationship between potential predictive factors and surgical margin status after radical prostatectomy such as age, cancer characteristics, history of transurethral prostate resection, surgical experience and nerve-sparing technique by using univariate and multivariate Cox regression analyses and t test. Results The overall surgical margin positivity rate was 22.6% (359 patients). In univariate analyses, preoperative prostate specific antigen level, clinical stage, biopsy Gleason score, percentage of tumor involvement per biopsy specimen, transurethral prostate resection history, surgical experience and nerve-sparing technique were significantly associated with positive surgical margin rate. In multivariate analyses, preoperative prostate specific antigen level (OR: 1.03, p=0.06), percentage of tumor involvement per biopsy specimen (OR: 7,14, p<0,001), surgical experience (OR: 2.35, p=0.011) and unilateral nerve-sparing technique (OR: 1.81, p=0.018) were independent predictive factors for surgical margin positivity. Conclusion Preoperative prostate specific antigen level, percentage of tumor involvement per biopsy specimen, surgical experience and nerve-sparing technique are the most important predictive factors of surgical margin positivity in patients undergoing radical prostatectomy for localized prostate cancer.Item Surgical Treatment Options for High Risk Patients with Benign Prostatic Hyperplasia(2015) Hasirci, Eray; Dirim, Ayhan; Ozkardes, HakanLower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are a complex symptoms that almost every man will somehow experience in some part of his life. Today, treatment of BPH can be successfully achieved in most of the cases. However, surgical therapies may become inevitable in a group of non-complient patients or in those who have failed medical therapy. The increasing incidence of systemic diseases with age may cause difficulty in decision making for surgey in high-risk patients. In this review, different treatment options such as bipolar resection, laser prostatectomy, microwave thermotherapy, ethanol ablation and radiofrequency ablation in addition to conventional transurethral resection of prostate are compared in high risk patients with BPH. Although treatment options appear to achieve comparable outcome, differences between methods are hidden in side the effects. Choosing the most appropriate method for a particular high-risk case should be based on surgeon's experience, possible side effects of the procedure and severity of comorbidities.Item Synchronous and Metachronous Secondary Tumors of Bladder Cancer Patients(2016) Dirim, Ayhan; Ozkardes, Hakan; Hasirci, ErayThe improvements in cancer treatment prolonged survival in patients. Despite this survival benefit, chemotherapies, radiotherapies or combination therapies, and continuing exposure to the same carcinogenic agents may lead to secondary cancers. Multiple primary neoplasm is described as multiple tumors in a single patient posing distinct individual malignant characteristics with definite exclusion of one tumor is the metastasis of the other. According to the time of onset, these are considered to be synchronous or metachronous tumors. While synchronous tumors often occur due to carcinogen exposure, metachronous tumors often develop after treatments such as radiotherapy. Although the cause and developmental mechanisms of multiple primary tumors are not clear, several factors including immune deficiency, genetic instability, increased use of systemic chemotherapy and radiotherapy, increased survival, elderliness, and smoking have been implicated. The two developmental hypotheses in development of multiple primary tumors appear as field cancerization and common clonal origin. Multiple primary tumors often involve respiratory, gastrointestinal, and genitourinary systems. Transitional cell carcinoma of the urinary bladder may also rise as part of synchronous or metachronous multiple tumors. We still lack large scale studies relevant to the treatment of multiple primary cancers. Close follow-up in primary malignant tumor patients is of extreme importance for the risk of secondary cancers.Item Distribution and number of Cajal-like cells in testis tissue with azoospermia(2017) Hasirci, Eray; Turunc, Tahsin; Bal, Nebil; Goren, Mehmet Resit; Celik, Huseyin; Kervancioglu, Enis; Dirim, Ayhan; Tekindal, Mustafa Agah; Ozkardes, Hakan; 0000-0002-7936-2172; 0000-0003-2898-485X; 0000-0002-2001-1386; 0000-0002-7277-449X; 0000-0002-4060-7048; 0000-0002-4147-2966; 0000-0003-3465-9092; 28359405; ABD-4332-2020; AAJ-5689-2021; Y-6143-2019; AAH-1052-2020; U-9270-2018; AAI-7997-2021; AAA-3033-2021; AAM-4475-2021We investigated the number and distribution of Cajal-like cells in patients with azoospermia. A total of 99 patients with non-obstructive azoospermia were divided into subgroups [19 patientsin hypospermatogenesis group (S1), 40 patients in maturation arrest group (S2), 20 patients in a Sertoli cell-only syndrome (S3), and 20 patients in a testicular atrophy and fibrosis group (S4)], and 20 patients with obstructive azoospermia group (SO). Sections stained with a c-kit antibody were studied by light microscopy to determine the number and distribution of Cajal-like cells in peritubular and perivascular areas of testis. The number of Cajal-like cells were higher in all the non-obstructive groups than in the obstructive group (S0: 2.43 cells/mm(2), S1: 3.14 cells/mm(2), S2: 4.00 cells/mm(2), S3: 4.57 cells/mm(2), S4: 3.86 cells/mm(2)) but statistically significantly different (p < 0.05) in the S2 and S3 subgroups only. Distribution of Cajal-like cells were similar in all groups. The number and distribution of Cajal-like cells in non obstructive groups suggest that these cells may affect spermatogenesis. This cellular type can be responsible for the regulation of cellular motility or spermatogenesis. Electrophysiological and electron microscopic studies are needed to better define morphology and function of Cajal-like cells in the testis, especially totally the normal testis tissue. Copyright (C) 2017, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.Item An Independent Validation of 2010 Tumor-Node-Metastasis Classification for Renal Cell Carcinoma: A Multi-center Study by the Urooncology Association of Turkey Renal Cancer-Study Group(2017) Dirim, Ayhan; Ozkan, Tayyar Alp; Eskicorapci, Sadettin; Yaycioglu, Ozgur; Akdogan, Bulent; Gogus, Cagatay; Can, Cavit; Yildirim, Asif; Ozen, Haluk; Tukeri, LeventObjective: The American Joint Committee on Cancer tumor-node-metastasis (TNM) classification has been updated by the 7th edition in 2010. The objective of the study was to evaluate cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC) and assess the concordance of 2002 and novel 2010 TNM primary tumor classifications. Materials and Methods: A retrospective analysis of RCC registries from 25 institutions of the Urooncology Association of Turkey Renal CancerStudy Group was performed. Patients with RCC had a radical or partial nephrectomy. The database consisted of 1889 patients. Results: Median follow-up time was 25 months (interquartile range: 11.2-47.8). The 5-year CSS rate for pT1a, pT1b, pT2a, pT2b, pT3a and pT4 tumors were 97% [95% confidence interval (CI): 0.93-0.99], 94% (95% CI: 0.91-0.97), 88% (95% CI: 0.81-0.93), 77% (95% CI: 0.64-0.86) 74% (95% CI: 0.65-0.81) and 66% (95% CI: 0.51-0.77), respectively according to the 2010 TNM classification (p<0.001). CSS comparisons between pT1a-pT1b (p=0.022), pT1b-pT2a (p=0.030), pT3a-pT3b (p<0.001) and pT3b-pT4 (p=0.020) were statistically significant. Conversely, pT2a-pT2b (p=0.070) and pT2b-pT3a (p=0.314) were not statistically significant. Multivariable analyses revealed the pT stage in the 2010 TNM classification as an independent prognostic factor for CSS (p for trend=0.002). C-indexes for 2002 and 2010 TNM classifications were 0.8683 and 0.8706, respectively. Conclusion: Subdividing pT2 does not have a CSS advantage. Moving adrenal involvement to pT4 yielded a more accurate prognosis prediction. T stage and LNI are independent prognostic factors for CSS in RCC. Overall, the novel 2010 TNM classification is slightly improved over the former one. However, shown by C-index values, this improvement is not sufficient to state that 2010 TNM outperforms the 2002 TNM.Item Endovascular Management of Surgically Uncontrolled Hemorrhage Following Post-Radical Nephrectomy: A Case Report(2018) Dirim, Ayhan; Ozyer, Umut; 0000-0002-4300-009X; AAK-9071-2021We present an isolated right lumbar arterial hemorrhage following right radical nephrectomy. Surgical re-exploration was unsuccessful therefore active bleeding was diagnosed and treated with endovascular approach.Item Adrenal Myelolipoma: A Case Presentation(2018) Kervancioglu, Enis; Hasirci, Eray; Dirim, Ayhan; Aygun, Yuksel Cem; 0000-0002-6232-4313; 0000-0002-4147-2966; 0000-0003-3465-9092; AAM-3015-2021; AAI-7997-2021; AAM-4475-2021Adrenal myelolipomas are non-functional benign tumors of hematopoietic and mature adipose tissue. Adrenal myelolipomas, which are generally detected in post-mortem examinations, have become more detectable thanks to evolution and frequent use of imaging techniques. This presentation elaborates on a case of 35-year old male patient presenting with no complaint but diagnosed with adrenal myelolipoma in histopathological examination following surrenalectomy operation for an adrenal mass incidentally detected on ultrasonography and computed tomography work-up.Item Complete resection in old age bladder cancers filling bladder cavity(2018) Dirim, AyhanRadical cystectomy is often the treatment of choice in widespread bladder tumors that may not be possible to be resected. However, it is extremely important to perform a complete resection prior to surgery, to perform healthy staging, to remove complaints related to the tumor, and to offer alternative treatment options for patients who do not accept surgery or who are at risk for surgery. In this study, the results of complete resection of two old age patients with bladder cancer tumors filling all the bladder cavity were reported.Item A Rare Case of the Urinary Bladder: Small Cell Carcinoma(2018) Kervancioglu, Enis; Dirim, Ayhan; Akcay, Eda YilmazSmall cell carcinoma generally originates from the lungs. However, rarely, it could be observed in organs other than the lungs. Primary small cell carcinoma of the bladder is a rare and aggressive disease and it generally presents itself with metastasis. Although there has not been a consensus on the method of treatment for this rare disease, multimodal treatment is recommended. In this study, we present long-term results of transurethral resection in a patient with non-muscle-invasive primary small cell carcinoma who refused additional treatments.