Browsing by Author "Izol, V"
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Item Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in TurkeyBozkurt, O; Sen, V; Irer, B; Sagnak, L; Onal, B; Tanidir, Y; Karabay, E; Kaya, C; Ceyhan, E; Baser, A; Duran, MB; Suer, E; Celen, I; Selvi, I; Ucer, O; Karakoc, S; Sarikaya, E; Ozden, E; Deger, D; Egriboyun, S; Ongun, S; Gurboga, O; Asutay, MK; Kazaz, IO; Yilmaz, IO; Kisa, E; Demirkiran, ED; Horsanali, O; Akarken, I; Kizer, O; Eren, H; Ucar, M; Cebeci, OO; Kizilay, F; Comez, K; Mercimek, MN; Ozkent, MS; Izol, V; Gudeloglu, A; Ozturk, B; Akbaba, KT; Polat, S; Gucuk, A; Ziyan, A; Selcuk, B; Akdeniz, F; Turgut, H; Sabuncu, K; Kaygisiz, O; Ersahin, V; Kahraman, HI; Guzelsoy, M; Demir, OObjective To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. Methodology The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. Results A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. Conclusions Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.Item Oncological Outcomes of Patients with Non-Clear Cell Renal Cell Cancers: Subtypes of Unclassified and Translocation Renal Cell CancersGokalp, F; Celik, S; Sozen, TS; Ozen, AH; Aslan, G; Izol, V; Baltaci, S; Muezzinoglu, T; Akdogan, B; Suer, E; Tinay, IPurpose: We aimed to compare oncological outcomes in the two rare subtypes, unclassified renal cell cancer (un-RCC) and translocation RCC (tRCC), vs clear cell RCC (ccRCC). Materials and Methods: Between 2004 and 2019, from Turkish Urooncology Society Database, we identified 2324 patients for histological subtypes including 80 unRCC (3.4%), 19 tRCC (0.8%) and 2225 ccRCC (95.8%). Results: The overall (15.8%) and cancer-specific mortalities (11.1%) were found to be higher in tRCC group and the recurrence free mortality (13.8%) was found to be higher in unRCC group. Larger pathological tumor size (p = 0.012) and advanced pathological T stage (p = 0.042) were independent predictive factors on overall mortality in patients with unRCC tumors. Conclusion: The oncological outcomes of the unRCC and tRCC are worse than ccRCC and pathological tumor size and pathological stage are predictive factors for mortality in the unRCC.Item Oncological Outcomes of Chromophobe Versus Clear Cell Renal Cell Carcinoma: Results from A Contemporary Turkish Patient CohortCetin, T; Celik, S; Sozen, S; Ozen, H; Akdogan, B; Aslan, G; Baltaci, S; Suer, E; Bayazit, Y; Izol, V; Muezzinoglu, T; Gokalp, F; Tinay, IPurpose: To compare the oncological outcomes of clear cell RCC (ccRCC), which is common in renal cell carcinomas (RCC), and chromophobic RCC (chRCC), which is less common, and to define the factors affecting survival in the Turkish patient population for both RCC subclassifications. Materials and Methods: Patients with a pathologically confirmed RCC diagnosis after radical or partial nephrectomy in the Turkish Urooncology Association (TUOA), Urological Cancers Database-Kidney (UroCaD-K), were retrospectively reviewed. Patients with ccRCC and chRCC were included in the study. The primary outcomes of this study are recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) for each histological subtype. Results: Data from 5300 patients in the TUOA UroCaD-K are reviewed and a total of 2560 patients (2225 in the ccRCC group and 335 in the chRCC group) are included in the final analysis. In the comparison of the groups, tumor size was greater both radiologically and pathologically in chRCC (p p = 0.019 vs 0.002 respectively). Recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) rates are worse in ccRCC subgroup. In the evaluation of risk factors; pathological stage, local invasion and Fuhrmann grade were found to be significant for recurrence in ccRCC. Age, body mass index and pathological stage were the risk factors affecting overall mortality (OM). Pathological tumor size was an independent risk factor for recurrence in chRCC, while age was analyzed as the only parameter affecting OM. Conclusion: chRCC oncological data and OS, CSS and RFS rates were found to be better than ccRCC in the Turkish patient population.Item Effect of pelvic lymph node dissection and its extent on oncological outcomes in intermediate-risk prostate cancer patients: A multicenter study of the Turkish Uro-oncology AssociationIzol, V; Ok, F; Aslan, G; Akdogan, B; Sozen, S; Ozden, E; Celik, O; Muezzinoglu, T; Turkeri, L; Akdogan, N; Baltaci, SBackground Pelvic lymph node dissection (PLND) is the gold standard method for lymph node staging in prostate cancer. We aimed to evaluate the effect of PLND combined with radical prostatectomy (RP) on oncological outcomes in D'Amico intermediate-risk prostate cancer (IRPC) patients. Methods Patients with D'Amico IRPC were included in the study. In the overall cohort and subgroups (biopsy International Society of Urological Pathology [ISUP] grade group 2 and 3), patients were divided into two groups as PLND and no-PLND. More extensive PLND, defined as a number of removed nodes (NRN) >= 75th percentile. Results After exclusion, a total of 631 patients were included: 351 (55.6%) had PLND and 280 (44.4%) had no-PLND. The mean age was 63.1 +/- 3.60 years. The median NRN was 8.0 (1.0-40.0). The mean follow-up period was 47.7 +/- 37.5 months. The lymph node involvement (LNI) rate was 5.7% in the overall cohort, 3.9% in ISUP grade 2, and 10.8% in ISUP grade 3. Patients with PLND were associated with more aggressive clinicopathologic characteristics but no significant difference in biochemical recurrence-free survival (BCRFS) was found between patients with PLND and no-PLND (p = 0.642). In the subgroup analysis for ISUP grades 2 and 3, no significant difference in BCRFS outcomes was found in patients with PLND and No-PLND (p = 0.680 and p = 0.922). Also, PLND extent had no effect on BCRFS (p = 0.569). The multivariable Cox regression model adjusted for preoperative tumor characteristics revealed that prostate specific antigen (PSA) (HR: 1.18, 95% CI: 1.01-1.25; p = 0.048) was an independent predictor of biochemical recurrence (BCR). The optimum cut-off value for PSA, which can predict BCRFS, was assigned to be 7.81 ng/ml, with an AUC of 0.63 (95% CI: 0.571-0.688). The highest sensitivity and specificity were 0.667 and 0.549. Conclusion Overall and cancer-specific survival analyzes were not evaluated because not enough events were observed. Neither PLND nor its extent improved BCRFS outcomes in IRPC. The LNI rate is low in patients with biopsy ISUP grade 2 and the BCR rate is low in those with PSA < 7.81 ng/dl so PLND can be omitted in these IRPC patients.Item Radical Prostatectomy Outcomes in Patients with Clinical Lymph Node Involvement from The Turkish Urooncology DatabaseTavukçu, HH; Erbatu, O; Akdogan, B; Izol, V; Yücetas, U; Sözen, S; Aslan, G; Sahin, B; Tinay, I; Müezzinoglu, T; Baltaci, SObjective: This study aimed to investigate pathological lymph node involvement in selected patients and the relationship of prostate-specific antigen (PSA) progression-free survival rates between patients with and without lymph node involvement on preoperative conventional radiologic imaging. Limited data is available about local treatment outcomes in patients with prostate cancer (PCa) having clinical lymph node involvement. Materials and Methods: Using the national PCa database, patients who underwent radical prostatectomy (RP) and pelvic lymph node dissection between 2001 and 2019, with pathologic lymph node involvement, were included in the study. Patients were divided into two groups as those with and without clinical lymph node involvement by preoperative imaging. Results: A total of 213 patients were included in the final analysis, wherein 164 are with and 49 are without lymph node involvement. After the mean follow-up periods of 33.9 months, a significant difference was not found between the two groups in terms of recurrence, adjuvant treatment necessity, and final status. The multivariate analysis for 5-year PSA recurrence-free survival revealed that surgical margin positivity was the only significant factor (p=0.016, hazard ratio: 2.67, confidence interval: 1.19-5.98). Conclusion: Our results revealed that preoperative clinical lymph node status did not affect the 5-year PSA recurrence-free survival in pathologic lymph node involvement of patients treated with RP and pelvic lymph node dissection. Therefore, RP stands as an effective treatment option in selected patients with PCa having clinical lymph node involvement.Item Treatment Options in Low-risk Prostate Cancer Patients: A Retrospective Database ReportErbatu, O; Müzzinoglu, T; Akdogan, B; Aslan, G; Sözen, S; Baltaci, S; Süer, E; Izol, V; Üçer, O; Ataus, S; Türkeri, L; Tinay, IObjective: This report examined the approaches to low-risk patients using the data from the Urologic Cancer Database -Prostate, Urooncology Association.Materials and Methods: In this study, there were 920 patients with low-risk prostate cancer according to the current guidelines of the European Urology Association. Patient data were obtained from the Urological Cancer Database -Prostate, the Turkish Urooncology Association (UroCaD-P) from records of the years 1995-2021. Ethics committee approval was obtained for this study to publish in the form of a database report.Results: Our study was conducted with 920 patients with low-risk prostate cancer. Therefore, at the time of diagnosis, all patients in the study were ISUP 1, had a prostate specific antigen (PSA) level lower than 10 ng/mL, and clinically T1-T2a. Surgical treatment was used in 750 (81.5%) of the patients. At the time patients were retrieved from the database for the study, 140 patients (15.2%) were in the active surveillance (AS) process. Thirty patients (3.2%) in the study received their local treatment as radiotherapy (RT). The mean age value at cancer detection in the study was 61.9. The mean ages of the patients who were under AS and who underwent radical prostatectomy (RP) were 61.3 and 61.7 years, respectively. In the RT group, the mean age was 66.7 years. The mean PSA value of the whole group was 5.81 ng/mL. While it was 5.94 in AS patients, it was calculated as 5.89 in patients who underwent radical surgery. The mean PSA value of the RT group was 5.40. The pathological upgrade was detected in 225 patients (30%) after surgery. Surgical margin positivity was in 160 of the patients (21.3%) who underwent surgery. In addition, 100 patients (13.3%) had extracapsular disease. The seminal vesicle invasion was detected in 25 patients (3.3%) after surgery.Conclusion: We predict that the incidence of low-risk prostate cancer will increase over time due to the aging of the population, the use of PSA, advances in imaging modalities, and increasing biopsy success rates. Therefore, the importance of the existence of multicentric databases containing this patient group is undeniable. More studies are needed with these databases, including both patient demographics and treatment outcomes. Hopefully, this database report will be an important step in this direction.Item Are the Recommended Criteria for Clinically Insignificant Prostate Cancer Applicable to 12-core Prostate Biopsy Scheme? A Multicentre Study of Urooncology Association, TurkeyÇelik, S; Kizilay, F; Yörükoglu, K; Özen, H; Akdogan, B; Izol, V; Bayazit, Y; Aslan, G; Sözen, S; Baltaci, S; Müezzinoglu, T; Narter, F; Türkeri, LObjective: The aim of this study is to investigate the relevance of the Epstein criteria for the 12-core transrectal prostate biopsy (TRUS-Bx) scheme with the evaluation of clinicopathologic data recorded in the Urologic Cancer Database - Prostate (UroCaD-P), Urooncology Association, Turkey (UOAT). Materials and Methods: Patients with detailed pathological 12-core TRUS-Bx data for each biopsy core and who underwent RP due to PCa were included in this study. A total of 1167 patients from seven different centres were analysed. TRUS-Bx pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian-lateral) scheme and in all 12-core biopsy areas (12-core biopsy scheme). Overall detection rates of PCa and ratios of clinically significant (sPCa) and insignificant PCa (insPCa) after RP were defined and compared between the biopsy schemes. Biopsy findings, according to the Epstein criteria, were also compared between the two schemes. A model for each biopsy scheme was created, including the Epstein criteria and additional biopsy findings using logistic regression analysis to predict clinically sPCa after RP. Results: There was a high correlation for the prediction of clinically insPCa between the two biopsy schemes in the same population. However, 7.3% of PCa could not be diagnosed in the 6-core TRUS-Bx scheme. Also, 69.4% of these had clinically sPCa according to the Epstein criteria in 12-core TRUS-Bx scheme and 51.8% of these were clinically sPCa after RP. The presence of perineural invasion (PNI) in 12-core biopsy was also significant regarding predicting sPCa (p<0.001). Conclusion: The Epstein criteria in 12-core prostate biopsy provide a better prediction of clinically sPCa than the 6-core biopsy scheme. Biopsy PNI findings appeared to improve the effectiveness of 12-core prostate biopsy, in addition to the Epstein criteria.Item Sextant Biopsy-Based Criteria for Clinically Insignificant Prostate Cancer Are Also Valid for the 12-Core Prostate Biopsy Scheme: A Multicenter Study of Urooncology Association, TurkeyÇelik, S; Kizilay, F; Yörükoglu, K; Aslan, G; Ozen, H; Akdogan, B; Sozen, S; Baltaci, S; Muezzinoglu, T; Izol, V; Bayazit, Y; Narter, F; Türkeri, LBackground: Epstein criteria based on sextant biopsy are assumed to be valid for 12-core biopsies. However, very scarce information is present in the current literature to support this view. Objectives: To investigate the validity of Epstein criteria for clinically insignificant prostate cancer (PCa) in a cohort of the currently utilized 12-core prostate biopsy (TRUS-Bx) scheme in patients with low-risk and intermediate-risk PCa. Method: Pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian) scheme and in all 12-core schemes. Patients were divided into 2 groups according to the final pathology report of RP as true clinically significant PCa (sPCa) and insignificant PCa (insPCa) groups. Predictive factors (including Epstein criteria) and cutoff values for the presence of insPCa were separately evaluated for 6- and 12-core TRUS-Bx schemes. Then, different predictive models based on Epstein criteria with or without additional biopsy findings were created. Results: A total of 442 patients were evaluated. PSA density, biopsy GS, percentage of tumor and number of positive cores, PNI, and HG-PIN were independent predictive factors for insPCa in both TRUS-Bx schemes. For the 12-core scheme, the best cutoff values of tumor percentage and number of positive cores were found to be <= 50% (OR: 3.662) and 1.5 cores (OR: 2.194), respectively. The best predictive model was found to be that which added 3 additional factors (PNI and HG-PIN absence and number of positive cores) to Epstein criteria (OR: 6.041). Conclusions: Using a cutoff value of 1 for the number of positive biopsy cores and absence of biopsy PNI and HG-PIN findings can be more useful for improving the prediction model of the Epstein criteria in the 12-core biopsy scheme.Item How accurate is radiological imaging for perirenal fat and renal vein invasion in renal cell carcinoma?Ucer, O; Muezzinoglu, T; Ozden, E; Aslan, G; Izol, V; Bayazit, Y; Altan, M; Akdogan, B; Ozen, H; Sozen, S; Cetin, S; Suer, E; Esen, B; Baltaci, SObjective To evaluate the accuracy of radiological staging, especially renal venous and perirenal fat invasion, in renal cell carcinoma (RCC). Material and Methods Data of 4823 renal tumour patients from Renal Tumor Database of Association of Uro-oncology in Turkey were evaluated. Of 4823 patients, 3309 RCC patients had complete radiological, and histopathological data were included to this study. The Pearson chi-squared test (chi(2)) was used to compare radiological and histopathological stages. Results The mean (SD) age of 3309 patients was 58 (12.3). Preoperative radiological imaging was performed using computed tomography (CT) (n = 2510, 75.8%) or magnetic resonance imaging (MRI) (n = 799, 24.2%). There was a substantial concordance between radiological and pathological staging (k = 0.52, P < .001). Sensitivities of radiological staging in stages I, II, III and IV were 90.7%, 67.3%, 27.7% and 64.2%, respectively. The sensitivity in stage III was lower than the other stages. Subanalysis of stage IIIa cases revealed that, for perirenal fat invasion and renal vein invasion, sensitivity values were 15.4% and 11.3%, respectively. Conclusions There was a substantial concordance between radiological (CT and/or MRI) and pathological T staging in RCC. However, this is not true for T3 cases. Sensitivity of preoperative radiological imaging in patients with pT3a tumours is insufficient and lower than the other stages. Consequently, preoperative imaging in patients with T3 RCC has to be improved, in order to better inform the patients regarding prognosis of their disease.Item Predicting factors of acute kidney injury after partial nephrectomy and its impact on long-term renal function: A multicentre study of the Turkish Urooncology AssociationSuer, E; Akpinar, C; Izol, V; Bayazit, Y; Sozen, S; Cetin, S; Ozden, E; Turkeri, L; Bozkurt, O; Ucer, O; Baltaci, SObjectives To investigate the predictors of acute kidney injury (AKI) after partial nephrectomy and the impact of AKI stage on long-term kidney function. Methods Data of 1055 patients who underwent partial nephrectomy between January 2008 and January 2018 at seven separate tertiary centres were analysed. AKI was defined according to AKI Network criteria. The association between pre-operative and perioperative factors and AKI was evaluated using logistic regression analysis. Recovery of at least 90% of baseline glomerular filtration rate 1 year after partial nephrectomy, change of 1 year glomerular filtration rate compared with baseline glomerular filtration rate and stage >= 3 chronic kidney disease (CKD) progression were assessed according to the stage of AKI. Results AKI was recorded in 281 (26.7%) of 1055 patients after partial nephrectomy, and of these patients, 197 (70.1%) had stage 1, 77 (27.4%) had stage 2 and 7 (2.5%) had stage 3. Higher tumour complexity and baseline glomerular filtration rate were independent predictors for AKI. The proportion of recovering 90% of baseline glomerular filtration rate at 1 year for any patient who had stage <= 1 vs stage 2-3 of AKI was 78.2% (95% CI: 73.2%-83.7%) and 23.8% (95% CI: 14.7%-38.7%), respectively (P < .001). The risk of stage >= 3 CKD progression for any patient who had stage <= 1 vs stage 2-3 of AKI was 6.2% (95% CI: 4.1%-9.2%) and 63.1% (95% CI: 52.5%-75.6%), respectively (P < .001). Conclusions AKI adversely affects renal function in the long-term after partial nephrectomy and stage 2-3 significantly increases the risk of CKD in the long term.Item Effect of pelvic lymph node dissection and its extent on oncological outcomes in intermediate-risk prostate cancer patients: A multicenter study of the Turkish Urooncology AssociationIzol, V; Ok, F; Aslan, G; Akdogan, B; Sozen, S; Ozden, E; Celik, O; Muezzinoglu, T; Turkeri, L; Akdogan, N; Baltaci, SItem Can We Predict Recurrence of pT1-2 Renal Cell Carcinoma?Üçer, O; Mueezzinoglu, T; Aslan, G; Sueer, E; Baltaci, S; Izol, V; Özden, E; Akdogan, B; Yazici, S; Bulut, EC; Akdogan, N; Sözen, SObjective: Some prognostic models have been described for localized and metastatic renal cell carcinoma (RCC). The European Association of Urology guidelines on RCC recommend using these models. However, there is no model for T1 and T2. The study evaluated the risk factors for recurrence in T1 and T2 RCC. Materials and Methods: Data of 4823 renal tumor patients from the Renal Tumor Database of the Association of Urooncology in Turkey were evaluated. Of 4823 patients, 1845 RCC patients with pathological T1 or T2 were included in this study. The patients were divided into two groups according to the recurrence status. Anatomical, histological, and clinical prognostic factors were statistically compared between the groups. Afterwards, multivariate analysis was performed for the variables that were found to be statistically significant. Results: The mean follow-up time was 30 (4-180) months. Of 1845 RCC patients, 117 (6.3%) had recurrence. Univariate analysis revealed statistically significant differences between age, preoperative hemoglobin, albumin, neutrophil, alkaline phosphates, platelet and calcium values, histological subtype, Fuhrman grade, surgical technique (radical or partial), and pathological stage in the groups. However, in multivariate analysis, only pathological stage was found to be a risk factor for recurrence (2.17 95%, 1.25-3.77). Conclusions: The results of our study show that it is difficult to design a prognostic model for the recurrence of pT1 and pT2 RCC. We suggest that patients with a higher tumor diameter should be followed up more frequently.Item Factors affecting long-term renal functions after partial vs radical nephrectomy for clinical T1 renal masses: A Multicentre Study of the Urooncology Association, TurkeyIzol, V; Gokalp, F; Sozen, S; Ozden, E; Bayazit, Y; Muezzinoglu, T; Kara, O; Cetin, S; Gulsen, M; Turkeri, L; Tansug, MZPurpose To compare the functional outcomes of patients who underwent partial (PN) or radical nephrectomy (RN) for clinical T1 (cT1) renal tumours using the Kidney Cancer Database of the Urooncology Association, Turkey. Methods We retrospectively reviewed 1004 patients who underwent PN and RN for cT1 renal tumours at multiple academic tertiary centres between 2000 and 2018. Patients with preoperative end-stage chronic kidney disease and/or metastatic disease were excluded. Results There were 452 patients in the PN group and 552 patients in the RN group. The median follow-ups were 74.9 and 83.7 months in RN and PN cohort. The eGFR was significantly reduced in both groups on postoperative day 1 (PN = 13.7 vs RN = 19.1 mL/min/1.73 m(2): P < .001). In the PN group, eGFR showed a tendency to recover according to a quadratic pattern and reached preoperative levels in the first and third years (95.6 +/- 28.8 mL/min/1.73 m(2) and 96.9 +/- 28.9 mL/min/1.73 m(2), respectively), with no significant difference between the eGFRs in the 1st and 3rd years (P = .710). To define groups at risk, different cut-off values for the GFR were considered. Among patients with a baseline GFR < 90, the RN cohort had significantly lower eGFRs in the first and third years than the PN cohort (P = .02). Logistic regression showed that comorbidities, coronary artery disease, diabetes and hypertension had no adverse impacts on the changes in the eGFR (P = .60, P = .13, and P = .13, respectively). Conclusion For the treatment of stage T1 kidney tumours, open or laparoscopic partial nephrectomy has the benefit to preserve renal function.Item Oncological outcomes of patients with non-clear cell renal cell cancers: Subtypes of unclassified and translocation renal cell cancersGökalp, F; Celik, S; Sozen, TS; Ozen, AH; Aslan, G; Izol, V; Baltaci, S; Muezzinoglu, T; Akdogan, B; Suer, E; Tinay, I