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Öğe Association of ring box-1 protein overexpression with clinicopathologic prognostic parameters in prostate carcinoma(ELSEVIER SCIENCE INC, 2016) Celik, Zeliha Esin; Kaynar, Mehmet; Dobur, Fatma; Karabagli, Pinar; Goktas, SerdarAim: To determine the expression of Ring Box-1 (RBX-1) protein in prostate carcinoma (PCa) and the association between RBX-1 expression and clinicopathologic prognostic parameters. Material and methods: Relevant data such as age, preoperative serum PSA values, and tumor stage were obtained from 51 patients' with PCa record who underwent radical prostatectomy between January 2010 and March 2014. Hematoxylin-eosin stained pathology slides were evaluated by 2 pathologists blinded to patients' data in order to determine Gleason grade groups, tumor stage, tumor volume, capsule invasion, lymphovascular invasion, perineural invasion, and seminal vesicle invasion Immunoreactivity scoring system (IRS) was used to determine RBX-1 expressions. Results: A statistically significant difference was determined in terms of RBX-1 expression between non tumoral prostate tissue, high grade prostatic intraepithelial neoplasia (H-PIN) and carcinoma foci (P = 0.001). RBX-1 expression in the Gleason pattern 4 was higher than the Gleason pattern 3 and H-PIN foci as well as non tumoral prostate tissue. Likewise, in cases with PSA levels of > 10.1 ng/ml, RBX-1 expression was higher than those <= 10 ng/ml. Moreover, RBX-1 expression of stage II cases was higher than stage I (P = 0.019), RBX-1 expression of stage III higher than stage I cases (P = 0.044). However, RBX-1 expression was not related with clinicopathologic parameters including patient age, tumor volume, lymphovascular invasion, perineural invasion, seminal vesicle invasion, or capsule invasion. Conclusions: RBX-1 protein is overexpressed in PCa and associated with clinicopathologic prognostic parameters related with biological potential of the aggressive disease. Further studies of basic and molecular science are needed to reveal clinical and therapeutic implications of RBX-1 in PCa. (C) 2016 Elsevier Inc. All rights reserved.Öğe Benign prostatic hyperplasia and prostate cancer differentiation via platelet to lymphocyte ratio(IOS PRESS, 2015) Kaynar, Mehmet; Yildirim, Mehmet Erol; Gul, Murat; Kilic, Ozcan; Ceylan, Kadir; Goktas, SerdarBACKGROUND: The aim of the current study is to evaluate NLR and PLR inflammation markers in PCa and BPH. METHODS: Clinical and pathological data such as age, prostate volume, PSA, NLR, and PLR levels of 201 patients were retrospectively reviewed. Pathological sample results of these patients were categorized either as benign or malign. The benign group consisted of chronic prostatitis and BPH and the malign group of PCa. The PSA levels were divided into three categories as PSA: 0-4 ng/ml, PSA: 4-10 ng/ml, and 10 ng/ml and above. RESULTS: In the benign category, the mean PLR values for PSA: 0-4 ng/ml is 131.8 +/- 31.2, for PSA: 4-10 ng/ml 124.7 +/- 83.9 and 10 ng/ml and above 124 +/- 53 in chronic prostatitis group and in the BPH group for PSA: 4-10 ng/ml 120.3 +/- 45.1, for PSA: 4-10 ng/ml 126 +/- 54,2, and 10 ng/ml and above 191.4 +/- 176.1. In the malign category, the mean PLR values of PCa patients is for PSA: 0-4 ng/ml 122.8 +/- 43.8, for PSA: 4-10 ng/ml 123 +/- 43.8, and above 10 ng/ml 179.1 +/- 94. Related to the variables of age, NLR, and mean prostate volume, there were no statistically significant differences. Statistically significant differences were observed in the mean PLR values only if the PSA level was 10 ng/ml and above (p: 0.044) in the BPH and PCa groups. The correlation of the PCa Gleason score and PSA, NLR and PLR parameters in the malign category revealed no statistically significant differences (P > 0.05). CONCLUSION: Effective malign and benign differentiation of prostate pathologies based on noninvasive inflammation biomarkers such NLR and PLR necessitate clinical studies with larger patient series.Öğe Controversies in Radical Cystectomy: Meta-Analysis and Systemic Comparison of Open Surgery with Laparoscopic and Robotic Surgery(GALENOS YAYINCILIK, 2016) Kaynar, Mehmet; Goktas, SerdarOpen radical cystectomy (ORC) is the standard treatment modality in high-risk non-muscle-invasive and invasive bladder carcinoma. Although it has some advantages, oncologic outcomes of ORC are associated with high morbidity and mortality risks. In line with recent developments in urotechnology, the minimally invasive treatment modalities, such as laparoscopic radical cystectomy (LRC) and robotic-assisted radical cystectomy (RARC) have emerged as an alternative to ORC. Compared to ORC, both treatment modalities have effective surgical and similar oncological outcomes as reported in various studies. However, due to inherent difficulties in the practice of LRC and high costs of RRC have hindered these two treatment modalities to become widespread. Considering the results obtained in experienced centers as well as long-term oncologic outcomes of large patient series forming samples of the whole population, changes in the standard treatment modality of invasive bladder tumors seem to be unavoidable.Öğe DOES SKIN-TO-STONE DISTANCE HAVE ANY IMPACT ON OUTCOMES OF PERCUTANEOUS NEPHROLITHOTRIPSY?(MARY ANN LIEBERT INC, 2012) Gonulalan, Umut; Akand, Murat; Coban, Gokcen; Cicek, Tufan; Kosan, Murat; Goktas, Serdar; Ozkardes, Hakan[Abstract not Available]Öğe DRUG RESISTANCE RESTRICTS THE EFFICACY OF SHORT TERM LOW DOSE MITOMYCIN-C TREATMENT IN UMUC-3 BLADDER CANCER CELLS(INIESTARES, S.A., 2018) Gul, Murat; Goktas, Serdar; Kars, Meltem Demirel; Kaynar, MehmetOBJECTIVE: Mitomycin-c (MMC) is the most used intravesical adjuvant agent in non-muscle invasive bladder cancer to prevent recurrence. However, a consensus on about appropriate dosage and treatment schedule of MMC is lacking. We, therefore, aimed to evaluate the most appropriate MMC dosage using an in vitro model of high-grade human bladder cancer. METHODS: UMUC-3 cells, a model for high-grade bladder cancer, were exposed to MMC in different time courses to assess its toxicological effects. XTT cell proliferation kit was used to evaluate the effect of MMC on the proliferation of UMUC-3 cell line. Gene expression analysis for the MDR1, BCL2 and ANXA5 genes was performed by Real-time PCR and flow cytometry analysis were conducted to evaluate the cell death mechanism and acquired resistance after MMC exposure. An ANXA5 kit was used to detect apoptotic cells, and 7-AAD was used to detect necrotic cells. RESULTS: Cell proliferation was prevented to a large extent (IC50, 0.175-0.081 mg/mL) and cytotoxic effects were observed after 5 mu g/mL and 10 mu g/mL MMC administrations for 1 and 2-h, after the 4th and 2nd dose cycles, respectively. Moreover, cell death was observed at 5 mu g/mL and 10 mu/mL MMC applications for 1-h and 2-h by the sixth and second week, respectively. Flow cytometry exhibits increased subpopulation of drug-extruding UMUC-3 cells after a single dose of MMC for 1-h. MMC did not increase the number of apoptotic or necrotic cells; yet, MDR1 (multiple drug resistance) and ANXA5 (apoptotic) expression levels were increased and BCL2 (anti-apoptotic) expression was decreased. Limitations: In-vitro nature of the study and working with only one cell culture are inherit limitations of this project. CONCLUSION: A single dose of MMC administration for 1 or 2-h results in drug-resistance. If maintenance treatment is administered for one hour, it should be continued throughout a 6-week period.Öğe The effect of bladder sensation on uroflowmetry parameters in healthy young men(WILEY, 2016) Kaynar, Mehmet; Kucur, Mustafa; Kilic, Ozcan; Akand, Murat; Gul, Murat; Goktas, SerdarAimsTo investigate the effect of the bladder sensation grade on uroflowmetry parameters. MethodsFifty healthy volunteering young men were enrolled in the present study. In total, three uroflowmetry evaluations were made. Q(max), Q(ave), VV, and PVR urine was obtained three times in three described bladder sensation grades, nearly at the same time of the day. ResultsThe mean age of the participants in the present study is 29.083.8 years. The mean Q(max) values of the volunteers were 17.4 +/- 4.8ml/s, 24.1 +/- 6.0ml/s, and 29.6 +/- 6.5ml/s in the first, second, and third, voiding desire grades, respectively. The mean Q(ave) values were 9.9 +/- 2.1ml/s, 12.9 +/- 2.9ml/s, and 15.9 +/- 4.0ml/s for each of the voiding desire grades mentioned. A statistically significant difference was obvious for all three bladder sensation grades in terms of Q(max) and Q(ave) values (P=0.000). However, no statistically significant difference was seen regarding the PVR urine volumes. The mean voided volume in the first, second and third uroflowmetry were 140 +/- 42ml, 245 +/- 64ml, and 449 +/- 105ml, respectively. The highest Q(max) and Q(ave) values were obtained when the desire to void was urgent. ConclusionsThe findings of the study show that, uroflowmetry evaluations are to be made if the patients have a strong desire to void. Only thus the highest Q(max) values can be obtained; yet, the degree of perceived bladder sensation does not have a statistically significant impact on PVR quantity. Neurourol. Urodynam. 35:622-624, 2016. (c) 2015 Wiley Periodicals, Inc.Öğe Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children(KOWSAR PUBL, 2016) Kilic, Ozcan; Akand, Murat; Gul, Murat; Karabagli, Pinar; Goktas, SerdarIntroduction: Eosinophilic cystitis (EC) is a rare and poorly understood inflammatory condition, characterized by eosinophilic infiltration of all layers of the bladder wall, which mimics bladder tumors. EC may present with symptoms such as increased urination frequency, dysuria, gross/microscopic hematuria, suprapubic pain and urinary retention. Case Presentation: We present a 17-year-old male patient, who was continent night and day in his childhood, and was admitted to our clinic for complaints of hematuria and nocturnal enuresis for the past six months. His history and physical examination were unremarkable, and routine hematological and biochemical tests were normal. Cystoscopy revealed a 4 x 3 cm erythematous, polypoidal, solid lesion on the bladder dome. Histopathological examination of the lesion revealed transitional epithelium with stromaledema, where diffuse, dense infiltration of lamina propria by eosinophils and lymphocytes was also seen. According to these findings, a histopathological diagnosis of EC was made, and the patient was treated with corticosteroids, antimicrobial agents and antihistamines. His symptoms dramatically improved and nocturnal enuresis also recovered after treatment. Conclusions: Although it is a rare entity, EC should be kept in mind in the differential diagnosis of patients presenting with dysuria, hematuria and any kind of acquired voiding dysfunction, including frequency, pollakiuria and incontinence.Öğe Ileo-Cavernosal Fistula after Radiotherapy: A Case Report and Review of the Literature(UROL & NEPHROL RES CTR-UNRC, 2015) Gul, Murat; Islamoglu, Necat; Kaynar, Mehmet; Koplay, Mustafa; Goktas, Serdar[Abstract not Available]Öğe Necessity of routine histopathological evaluation subsequent to bladder neck contracture resection(POLISH UROLOGICAL ASSOC, 2016) Kaynar, Mehmet; Gul, Murat; Kucur, Mustafa; Celik, Esin; Bugday, M. Serdar; Goktas, SerdarIntroduction Bladder neck contracture is a well-known complication following some urologic surgical procedures. Regardless of the surgical procedure, any specimen resected should be submitted for histopathological evaluation worldwide. However, the charges of histopathological evaluation may bring a heavy burden to the hospital and health care system. Also, waiting the period of the pathological evaluation process can be an anxious time for patients. Hence, we aimed to investigate the necessity of routine histopathological evaluation of bladder neck contracture bladder neck contraction specimens. Material and methods Patients undergoing bladder neck contraction resection, from 2010 to 2015 were identified. Patient demographics, type of surgery and histopathological diagnosis and cost of histopathological analyses of the specimens were recorded and analyzed. Results Findings of the histopathologic evaluations of 340 bladder neck specimens were reviewed. Out of these, 294 had underwent transurethral resection of the prostate, 38 open prostatectomy, and 8 radical prostatectomy. Evidence of malignant disease involving prostate cancer was present in only 2 specimens. Both of the specimens had a known preexisting history of malignant disease. The remaining 338 specimens showed chronic inflammation (n = 176), chronic active inflammation (n = 64), adenomatous hyperplasia (n = 78) or cystitis (n = 20). Conclusions Our results indicate that routine histopathological examination of bladder neck contraction specimens is clinically unnecessary. We recommend that the surgeon should decide the need for histological examination on individual basis, depending on known preoperative risk factors.Öğe Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscle-invasive bladder cancer(ELSEVIER SCIENCE INC, 2015) Kaynar, Mehmet; Goktas, Serdar[Abstract not Available]Öğe A novel cannulation technique for difficult urethral catheterization(PAGEPRESS PUBL, 2016) Kaynar, Mehmet; Akand, Murat; Goktas, SerdarIntroduction: To propose a novel cannulation technique for difficult urethral catheterization procedures. Technique: The sheath tip of an intravenous catheter is cut off, replaced to the needle tip and pushed through the distal drainage side hole to Foley catheter tip, and finally withdrawn for cannulation. In situations making urethral catheterization difficult, a guide wire is placed under direct vision. The modified Foley catheter is slid successfully over the guide wire from its distal end throughout the urethral passage into the bladder. Results: The modified Foley catheter was used successfully in our clinic in cases requiring difficult urethral catheterization. Conclusions: This easy and rapid modification of a Foley catheter may minimize the potential complications of blind catheter placement in standard catheterization.Öğe The relation between Ring Box-1 protein overexpression and tumor grade and stage in bladder urothelial cell carcinoma(IOS PRESS, 2017) Celik, Zeliha Esin; Kaynar, Mehmet; Karabagli, Pinar; Gergerlioglu, Nursadan; Goktas, SerdarBACKGROUND: Ring Box Protein-1 (RBX-1), a component of SCF E3 ubiquitin ligases, has a crucial role in bladder urothelial cell carcinoma (UCC) carcinogenesis and progression. OBJECTIVES: In the present study, it is aimed to determine the expression of RBX-1 protein in bladder UCC and the association between tumor grade, stage and RBX-1 expression. METHODS: Ninety UCC samples and 20 samples containing foci of normal bladder urothelium were recruited and analyzed immunohistochemically in terms of RBX-1 expression. Immuno-reactivity scoring system (IRS) was used to determine RBX-1 expression levels. RESULTS: RBX-1 overexpression was associated with high tumor grade (p = 0.001) and advanced stage (p = 0.001). pT1 tumors showed higher RBX-1 expression than pTa tumors. pT2 tumors showed not only higher expression than pTa tumors but also higher expression than the total of pTa and pT1 groups combined. There was no statistically significant relation between RBX-1 expression and patient gender (p = 0.116) or age (p = 0.191). CONCLUSIONS: In bladder UCC, RBX-1 overexpression is associated with high tumor grade and advanced stage and represents biological potential of invasiveness and aggressive disease. Results of the present study have to be supported with further studies to reveal clinical and therapeutic implications of RBX-1 overexpression in bladder UCC.Öğe Selective Low-Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study(MARY ANN LIEBERT, INC, 2015) Kucur, Mustafa; Goktas, Serdar; Kaynar, Mehmet; Apiliogullari, Seza; Kilic, Ozcan; Akand, Murat; Gul, MuratPurpose: To evaluate the use of spinal anesthesia by reducing anesthetic agent dose to provide better analgesia with minimal side effects without sacrificing the outpatient setting for prostate biopsy. In this study, efficacy and tolerability of selective low-dose spinal anesthesia versus intrarectal local anesthesia (IRLA) plus periprostatic nerve blockade (PPNB) were compared. Methods: Between September 2012 and April 2013, 100 patients, aged 40 to 80 years, prostate-specific antigen (PSA) 4ng/mL, abnormal digital rectal examinations, and enrolled for biopsy were included in the present study. Ensuring double blindness, pain was assessed using the visual analog scale (VAS). Anal sphincter relaxation, patient satisfaction with the anesthesia technique, and motor response were evaluated. Results: Differences between the two groups, considering age, American Society of Anesthesiologist score, total PSA, prostate volume, anesthesia duration, and cancer presence, were not statistically significant. Pain experienced during probe insertion, biopsy, and 30 minutes after biopsy was significantly lower in the low-dose spinal anesthesia group (P<0.0001). Anal sphincter relaxation degree was significantly higher in the spinal group (P<0.001). Patient procedure-related overall satisfaction level was significantly higher in the spinal anesthesia group (P<0.001). In the spinal anesthesia group, no motor blockade was observed. Between the two groups, no statistically significant difference was seen with regard to complications (P>0.05). Conclusion: Selective low-dose spinal anesthesia provides better pain relief than PPNB plus IRLA without sacrificing the day case setting in ambulatory practice. It is also associated with high patient satisfaction and willingness for a repeated biopsy without differences in procedure duration, tolerance, and complications.Öğe Skin-to-Stone Distance Has No Impact on Outcomes of Percutaneous Nephrolithotomy(KARGER, 2014) Gonulalan, Umut; Akand, Murat; Coban, Gokcen; Cicek, Tufan; Kosan, Murat; Goktas, Serdar; Ozkardes, HakanObjective: 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, BaselÖğe Spontaneous Nephrocutaneous Fistula With Tuberculous Autonephrectomy: A Case Report of a Delayed Diagnosis(KOWSAR PUBL, 2016) Akand, Murat; Kilic, Ozcan; Kucur, Mustafa; Kaynar, Mehmet; Goktas, SerdarIntroduction: Spontaneous nephrocutaneous fistula is a rare manifestation of renal disease that can occur due to various etiologies, such as renal calculus, chronic pyelonephritis, stricture of the ureteropelvic junction, and renal tuberculosis (TB). An autonephrectomy with a nephrocutaneous fistula due to renal tuberculosis can be diagnosed quite late if it is not suspected. Case Presentation: We report a case of a spontaneous nephrocutaneous fistula with tuberculous autonephrectomy. A 40-year-old white male with recurrent flank pain and intermittent purulent drainage from his right flank region for the previous 14 years was admitted to our outpatient clinic. Fistulography and computerized tomography demonstrated a 51 x 60 mm area with a soft-tissue appearance that implied autonephrectomy of the right kidney, and a fistula tract with a 9 mm diameter between the skin and the retroperitoneal space. The patient was successfully treated with nephroureterectomy and excision of the fistulous tract, followed by antituberculous treatment. The pathological examination of the surgical specimen revealed chronic atrophic pyelonephritis, calcifications, and necrotizing granulomatous inflammation suggestive of TB. Conclusions: Urogenital TB is difficult to diagnose due to the lack of specific symptoms and signs. In the case of a nonfunctioning kidney without an obvious cause and a chronic spontaneous nephrocutaneous fistula, the possibility of associated renal TB should be kept in mind, especially in immunocompromised patients or in places where TB is a common health problem.Öğe A Study of Uro-oncology Patient Perceptions of Social Support and Hope Levels(KARE PUBL, 2016) Kocak Uyaroglu, Arzu; Gul, Murat; Sari, Emine; Goktas, SerdarOBJECTIVE The present study measured social support perceptions and hope levels of uro-oncology patients diagnosed with cancer and examined how they vary according to sociodemographic variables. METHODS Research was conducted on 143 uro-oncology patients in Konya, Turkey, using a sociodemographic information form, the Multidimensional Scale of Perceived Social Support (MSPSS) and the Hope Scale. RESULTS Patient mean multidimensional perceived social support score was quite high at 62.14 +/- 14.99, and mean hope level score was 20.62 +/- 4.50. Hope level score was significantly higher in male patients. It was also higher for patients with dependents and for patients who believed their cancer was treatable. Perceived social support levels of patients with dependents and patients who believed their cancer was treatable were also significantly higher. CONCLUSION Hope levels of uro-oncology patients are affected positively by high levels of perceived social support. Women, patients with dependents, and patients who develop a positive attitude toward their cancer treatment were more hopeful than others.
