Wos Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10754
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Item Non-Tumoral Factors Affecting The Preference of Nephron-Sparing Surgery in The Treatment of Stage 1 Renal Cell Carcinoma Patients in Turkey(2021) Kuzgunbay, Baris; Yaycioglu, OzgurObjective: Nephron-sparing surgery (NSS) is the first-line treatment for T1N0M0 renal tumors (RT). The aim of this multicentric retrospective study is to investigate the national trends and the effect of non-tumoral factors in the preference of NSS as treatment of T1 RT in Turkey. Materials and Methods: Relevant data for patients operated between 1997 and 2017 was collected from the Urologic Cancer Database-Kidney Urooncology Association, Turkey (UroCaD-K). Results: We included 3195 T1N0M0 RT patients in this study. There was a significant increase in the number of NSS performed with time, 9.26% between 1997-2002 to 54.78% between 2013-2017 (p<0.001). NSS proportion decreased with increasing age (p<0.001); but increased with better hospital facility (p<0.001). From multivariate analysis; younger age, later operation date, larger hospital size with higher nephrectomy centers like university hospitals were independently associated non-tumoral factors favoring NSS over radical nephrectomy (RN). Conclusion: We observed significant disparity in the use of NSS for T1 RT among the elderly (>61 years), small hospital size (<= 500 beds), lower nephrectomy volume (<100 nephrectomies/year), and Non-University Hospitals. This disparity can be resolved by persistent education of the residents and urologists with periodic courses and practical training, increasing the funds and strengthening the technical equipment of centers, thereby favoring the performance of NSS even in smaller centers. This will ensure that suitable patients are treated with NSS rather than RN, regardless of the hospital type.Item Does Robot-assisted Surgery in Urology Has Benefits? The Current Status(2019) Sah, Cem; Kuzgunbay, Baris; 0000-0001-5598-4666Minimally invasive surgery has gradually replaced the conventional surgery with the introduction of laparoscopy. Subsequently, with intensive advertisement and marketing strategies, robot-assisted surgery became popular and robot-assisted surgery has been used in almost every surgical procedure. Despite its high cost, the robotic platform, which has proven its general advantages such as less hospital stay and less blood loss, has become controversial in the literature in terms of cost effectiveness. In this study, the advantages and disadvantages of the robot-assisted surgery in urology have been reviewed in the light of current literature.Item The Risk Stratifications in Non-Muscle Invasive Bladder Cancer: How Much Accurate are the Methods That We Use? A Multi-Directional View(2015) Kuzgunbay, Baris; Beyazit, YildirimNon-muscle invasive bladder cancer (NMIBC) have heterogeneous pattern inside, rapid recurrence might be seen in some of the patients while earlier progression might be seen in other patients. Recently, European Organization for Research and Treatment of Cancer (EORTC) risk tables are the most commonly used as scoring systems in stratifying the risk group in NMIBC. The scoring system was developed based on tumor number and size, prior recurrence rate, T stage, concurrent CIS and tumor grade, thus the total score should be calculated individually for recurrence and progression. EAU guidelines also advices stratifying the patients into 3 risk groups according to the prognostic factors and data from the EORTC tables. In addition, the maintenance BCG therapy, secondary TUR operation, substaging in T1 tumors, pathological variants of uroepithelial carcinoma, lymphovascular invasion and some molecular markers have been reported to significantly affect the prognosis of NMIBC in consecutive studies. Today, EORTC and other stratification remains valid, however, needs to be improved and validated under the guidance of the previous studies.Item The Treatment Modalities in Stage 1 Seminoma; Alterations in Last Five Years(2015) Kuzgunbay, BarisSeminomas are diagnosed generally in early period. Eighty-five percent of the patients were in clinical stage (CS) 1 at the time of diagnosis and occult metastasis rate was 10-15% and systemic relapse rate after retroperitoneal treatment was 1-4%. However, there have been significant alterations in treatment of stage 1 seminomas for 20 years; thus, dog-leg radiotherapy had been recommended as the only choice of adjuvant therapy in 1990s, totally 20 Gy adjuvant radiotherapy to para-aortic (PA) field or hockey stick field and single dose carboplatinium based chemotherapy have been recommended since 2010. Active surveillance has become popular after the relation between radiotherapy and platinum based chemotherapy with cardiovascular toxicity and seconder malignancy was proven and long term results of surveillance were reported. Achieving the cure rates of % 100 in CS 1 seminoma patients with all kind of therapy modalities, adjuvant radiotherapy, chemotherapy or active surveillance, indicate that all kinds of therapies are appropriate. However, the relapse rate of 15-20% of the disease in the patients under surveillance without any treatment indicates the over-treatment risk of 80-85%. In conclusion, the identified side effects of the radiotherapy and chemotherapy, the report of successfully treatment of the disease even in the relapse under active surveillance caries the surveillance as the first choice in guidelines however it is seem that the best approach is to give the decision with the patient after detailed information by taking into consideration of the patients expectations.Item The Role of Radical Prostatectomy in the Treatment of Patients with High-Risk Prostate Cancer(2015) Kuzgunbay, Baris; Yaycioglu, OzgurHigh-risk prostate cancer (PCa), which is defined as PSA > 20 ng/mL or Gleason Score (GS) > 7 or >= cT3a, accounts for up to 40% of newly diagnosed cases and carries a significant risk of progression and death. However, the best management approach for patients with high-risk PCa is still under debate. Recently, radical prostatectomy (RP) with extended lymphadenectomy (LND) has become popular for the treatment of high-risk PCa with good prognosis in selected patients in the context of multimodal approach. However, decision should be made after all treatments have been discussed by a multidisciplinary team and the patient should be informed about the likelihood of a multimodal approach. On the other hand, necessity of sufficient surgical expertise for RP to keep the level of morbidity acceptable in high-risk PCa patients should be kept in mind.Item Is Learning Curve Short for MicroTESE Operation in Nonobstructive Azoospermic Patients?(2016) Turunc, Tahsin; Kuzgunbay, BarisAim: To evaluate learning curve in microdissection testicular sperm extraction (microTESE) surgery performed in non-obstructive azoospermia patients. Material and Method: The study included 300 non-obstructive azoospermic (NOA) patients, who underwent microTESE surgery performed by a single urologist. The patients were divided into three groups (the first 100 patients, the second 100 patients, and the third 100 patients) and these groups were compared in terms of sperm retrieval rate (SRR) and other clinical parameters. It was planned to compare the patients in first 99 patients between themselves in case there is no difference between the groups in terms of SRR. Results: The overall SRR was 47% in 300 NOA patients. No significant difference was determined between the three groups in terms of SRR (49%, 46%, and 46%, respectively). Accordingly, the first 99 patients were re-compared in terms of SRR (the first 33 patients, the second 33 patients, and the third 33 patients). It was observed that there is also no significant difference between these groups in terms of SRR (54.5%, 42.4%, and 51.5%, respectively). Moreover, no significant difference was determined between all of the groups in terms of patient age, testis volume, and serum follicle-stimulating hormone and testosterone levels. It was observed that duration of surgery has been significantly shortened in all groups as the number of surgical procedures increased. Discussion: Learning curve in microTESE surgery is shorter according to learning curves in other urological surgeries.Item Percutaneous Nephrolithotomy for Kidney Stones in Patients with Hematological Malignancy(2016) Kuzgunbay, Baris; Turunc, TahsinTo define the alterations in the outcomes of percutaneous nephrolithotomy (PNL) operations for kidney stones in patients with history of hematological malignancy (HM). Material and Method: Between 2000 and 2013, 1700 adult patients underwent PNL for the treatment of kidney stones in our institution. Four of these patients had a history of HM and considered to be HM group (n=4). Ten elderly (>65 years) patients who had no history of operation, HM or any other co-morbide diseases were chosen as the control group (n=10). Surgical parameters, success rates, additional treatments and complications were evaluated. Results: Statistical analyses showed no significant differences between HM and control group according to stone area, operation time, fluoroscopy time, hospitalization time,Delta Hb, blood transfusion rates and INR values (p>0.05). Statistical analyses revealed no significant differences between HM and control groups according to the success rates (p=0.470). Statistical analyses revealed no significant difference between groups for additional treatment requirements (p=0.882). No major perioperative complication was seen in both of the groups. Discussion: The treatment of kidney stone disease by PNL in patients with hematological malignancy is feasible, safe and effective. However, close cooperation with the Hematology Department before the operation is mandatory.Item Risk Factors for Urothelial Cancers(2016) Kuzgunbay, Baris; Gul, Umit; 0000-0003-3249-0895; AAK-8394-2021Urothelial cancers affect renal pelvis and ureters in the upper urinary tract, however they affect bladder and urethra in the lower urinary tract. The rate of the urothelial carcinoma makes up 3% pf cancers in the world. Although urothelial cancer locations and frequencies show difference, their etiology are similar. Environmental factors are responsible for most urothelial cancer cases. Major risk factors are smoking and chemical carcinogens. Other important factors include radiotherapy, alcohol, coffee consumption, artificial sweeteners, arsenic exposure, schistomiasis, cronical cystitis, urolithiasis, analgesics, cyclophosphamide and genetic predisposition. Identification of these factors and avoiding them are important for the prevention of the disease. The evaluation and follow up of the whole urothelium is critical since the urothelial cancers are a kind of panurethelial diseases.