Browsing by Author "Cihan, A"

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    Impact of previous SWL on ureterorenoscopy outcomes and optimal timing for ureterorenoscopy after SWL failure in proximal ureteral stones
    Irer, B; Sahin, MO; Erbatu, O; Yildiz, A; Ongun, S; Cinar, O; Cihan, A; Sahin, M; Sen, V; Ucer, O; Kizilay, F; Bozkurt, O
    Purpose We aimed to evaluate the impact of previous unsuccessful shock wave lithotripsy (SWL) therapy on ureterorenoscopy (URS) outcomes in proximal ureteral stones and to define whether there is any optimal timing for safe URS after SWL. Methods The patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were included. Patients were divided into two groups according to previous SWL history; group 1 consisted of patients without SWL before URS for the stone [SWL (-)] and group 2 consisted of patients with a previous SWL for the stone [SWL (+)]. Demographics, operation outcomes and stone characteristics were compared between these two groups. Regarding the complication and success rates, optimal timing for URS after SWL for the stone was calculated with receiver operator characteristics curve analysis. Results Totally 638 patients were included (group 1: 466 patients and group 2: 172 patients). The operation and hospitalization times, rate of ureteral stenting and complications were significantly higher in group 2. Stone free status was similar between the groups. Optimal timing for URS after SWL was calculated as 16.5 days (AUC = 0.657, p = 0.012) with a sensitivity of 68% and specificity of 72%, regarding the complication rates. Complication rates were significantly higher in patients who were operated before 16.5 days (27.7% vs 6.5%, p < 0.001). Conclusions The optimal timing; 2-3 weeks delay of the URS procedure after unsuccessful SWL may decrease complication rates according to our results.
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    Predictive Factors of Ureterorenoscopy Outcomes in Proximal Ureteral Stones: A Multicenter Study of Aegean Study Group of the Society of Urological Surgery
    Sen, V; Irer, B; Erbatu, O; Yildiz, A; Ongun, S; Cinar, O; Cihan, A; Sahin, M; Sahin, MO; Ucer, O; Kizilay, F; Bozkurt, O
    Introduction: We aimed to evaluate the predictive factors in a holistic manner for ureterorenoscopy (URS) outcomes in proximal ureteral stones by a multicenter study. Materials and Methods: The data of patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were recorded retrospectively. Patients were divided into two groups according to URS success: Group 1 consisted of patients with successful URS, and Group 2 consisted of patients with unsuccessful URS. The two groups were compared in terms of risk factors, stone, and clinical characteristics of patients. Results: A total of 638 patients were included in the study. Group 1 consisted of 527 (82.6%) patients, and Group 2 consisted of 111 (17.4%) patients. In multivariate logistic analysis, the key risk factors for URS success was found to be age (OR = 0.980, 95% [CI] = 0.963-0.996, p = 0.018), stone area (OR = 0.993, 95% [CI] = 0.989-0.997, p = 0.002), and operation time (OR = 0.981, 95% [CI] = 0.968-0.994, p = 0.005). Conclusions: To make the treatment decision of proximal ureteral stones, it is necessary to examine several parameters including available equipment, stone, and patient characteristics. Physicians should keep these risk factors in mind in the decision of treatment options.
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    Mechanisms and grading of nocturia: Results from a multicentre prospective study
    Bozkurt, O; Irer, B; Kizilay, F; Erbatu, O; Sen, V; Cinar, O; Ongun, S; Cihan, A; Ozdemir, T; Tasdemir, D; Ucer, O
    Objective To identify the pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. Methodology After approval by the local ethics committee, all patients with nocturia (>= 1 nocturnal void/night) were included and filled the Overactive Bladder questionnaire, Nocturia Quality of Life, Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (male), International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (female) and 3-day frequency-volume chart. Patients were divided into three groups according to the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis was performed between groups, andP About 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria (NP), reduced bladder capacity and global polyuria, respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the aforementioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia, 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher NP, global polyuria and reduced bladder capacity rates. Conclusions Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardisation of the diagnostic and treatment approaches as well as for the design of future clinical trials.
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    Comparison of Efficacy and Complications of Holmium Laser and Pneumatic Lithotripters Used in the Ureterorenoscopic Treatment of Proximal Ureter Stones, a Multi-Center Study of Society of Urological Surgery Aegean Study Group
    Irer, B; Sen, V; Erbatu, O; Yildiz, A; Ongün, S; Çinar, Ö; Cihan, A; Sahin, M; Sahin, MO; Üçer, O; Kizilay, F; Bozkurt, O
    Objective:The aim of this study is to compare the efficacy and complications of holmium laser and pneumatic lithotripsy used in the ureterorenoscopic treatment of proximal ureteral stones. Materials and Methods: Data of 638 patients, who underwent ureterorenoscopy (URS) due to proximal ureteral stones in different centers, were obtained from patient files. The patients were divided into two groups according to the type of lithotripter used: group 1; laser lithotripter (n=324; 50.8%) and group 2; pneumatic lithotripter (n=314; 49.2%). URS was considered successful upon determination stone-free status with the imaging methods after treatment. The effectiveness and the complications of holmium:yttrium-aluminum-garnet laser and pneumatic lithotripsy were compared. Results: The total success rate of URS was 82.6% and the complication rate was 8.1%. The mean age of patients was similar between the groups; however, the body mass index values, stone surface area and stone Hounsfield unit were significantly higher in group 1. Although the mean operative time, complication rate and the mean length of hospital stay were similar between the groups; the URS success and postoperative ureteral J stent use rates were significantly higher in group 1 and the push-back rate was significantly higher in group 2. Conclusion: If laser lithotripsy is available in a clinic, we believe that it is better to use it as the first option in the treatment of proximal ureter stones. However, considering that it is not easy to access laser lithotripters due to their high cost in Turkey, pneumatic lithotripters may be an effective and inexpensive alternative that can also be safely used in these cases.
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    Clinical Characteristics of the Premature Ejaculation Sufferers in Aegean Region of the Turkey: A Multicentre, Observational Study
    Cihan, A; Demir, Ö; Sahin, A; Zeren, F; Bolat, D; Özçift, B; Pektas, A; Can, E; Gümüs, B; Turan, T; Bölükbasi, A; Erol, H; Esen, AA
    Objective Demonstration of the intra-vaginal ejaculation latency time (IELT) distribution in male subjects and its clinical expressions among couples in the Aegean region of the Turkey. Materials and Methods Subjects were recruited to the study from six different urologic centers in the Aegean region. During the enrollment period subjects were recruited in to two group according to presence of premature ejaculation (PE). PE diagnosis was made according to DSM-4 definition. Subjects and their partners were evaluated with patient reported outcome measures (PRO) related to the ejaculation-based questionnaire (Premature ejaculation patient profile questionnaire -PEPQ). Stopwatch measurements were also asked from each couple to record intravaginal ejaculation latency time (IELT). Couples who completed two clinical visits with 4 wk interval were recruited to the data analysis. Results Among 141 eligible subjects, mean age was 36.5 +/- 9.7 years and mean partner age was 32.9 +/- 9.8 years. Following the initial evaluation 80 subjects recruited to group 1(PE) and 41 subjects recruited to the group 2 (non-PE). Geometric mean IELT of the subjects was significantly differed between PE and non-PE group (64.7 +/- 66.8 vs. 521.5 +/- 414.7 seconds, p<0.001). All of the PEPQ domain scores were also differed between groups. Subjects in the PE group gave poor ratings than non-PE subjects. Partner responses were similar pattern. Correlation analyses of the PEPQ scores demonstrated significant positive correlations between perceived control over ejaculation and satisfaction with sexual intercourse domains of the PEPQ and with IELT. Conclusion Geographic distribution of IELT and its impacts among couples by the several subjective aspects of PRO measures should be assessed during PE investigations.