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    Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis
    (Brazilian Soc Urol, 2016) Oguz, Ural; Takci, Zennure; Oguz, Isil Deniz; Resorlu, Berkan; Balta, Ilknur; Unsal, Ali
    Purpose: to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. Patients and Methods: We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. Results: Men/women ratio and mean age were similar between group I and II (p> 0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (% 5) patients in group I and II, respectively (p< 0.05). Hypocitraturia was the most common anomaly with 35% (n: 14) in group I. The rate of hypocitraturia in group II was 12.5% (n: 5) and the difference was statistically significantly different (p= 0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n: 11) and 25% (n: 10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n: 2) in group II and the differences were significant (p< 0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p= 0.001). Conclusion: According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.
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    Categorizing Intraoperative Complications of Retrograde Intrarenal Surgery
    (Karger, 2014) Oguz, Ural; Resorlu, Berkan; Ozyuvali, Ekrern; Bozkurt, Omer Faruk; Senocak, Cagri; Unsal, Ali
    Purpose: To review our intraoperative complications of retrograde intrarenal surgery (RIRS) for kidney calculi and stratify these complications according to the modified Satava classification system (SCS). Patients and Methods: 230 patients (119 males, 111 females) who underwent RIRS because of kidney calculi were analyzed. We documented and stratified the intraoperative complications according to the modified SCS. There are four grades for this classification: grade 1 complications include events without consequences for patients; grade 2a complications include events that could be treated with endoscopic surgery intraoperatively; grade 2b complications include events which were treated with endoscopic treatment in another session, and grade 3 describes the events requiring laparoscopic or open surgery. Results: Mean age was 39.1 years (range 1-78). The stone-free rate after one session was 81%. Intraoperative complications were recorded in 30.4% of the patients. According to the modified SCS, grade 1 complications were documented in 15.9%, grade 2a complications were documented in 5.6%, and grade 2b complications were documented in 8.9% of the patients. Grade 3 complications were not detected in any of the patients. Conclusion: In our opinion, the modified SCS can facilitate patients to understand the safety of this surgery and can make it easier to compare the results of different institutes and surgeons. (C) 2014 S. Karger AG, Basel
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    Comparative Analysis of Pedicular Vascular Control Techniques during Laparoscopic Nephrectomy: En Bloc Stapling or Separate Ligation?
    (Karger, 2015) Resorlu, Berkan; Oguz, Ural; Polat, Fazli; Yesil, Suleyman; Unsal, Ali
    Objective: To compare the safety and efficacy of en bloc stapling and separate ligation techniques for renal vascular control during laparoscopic nephrectomy. Patients and Methods: Clinical data were collected from 60 patients who underwent laparoscopic nephrectomies using en bloc stapling (n = 27, group 1) or the separate ligation method (n = 33, group 2). Comparative analysis was carried out between the two groups, examining operative times, blood loss, intra- and postoperative complications and hospital stay. Results: Compared with the separate ligation method, the en bloc hilar control technique was associated with a shorter total operating time (98 vs. 121 min, p = 0.029). However, both groups were similar in terms of estimated blood loss, hemoglobin drop, changes in creatinine level and postoperative hospital stay. The total complication rates in group 1 and 2 were 3.7 and 15.1%, respectively, with a statistically significant difference. There were no complications related to the use of the endo-GIA stapler and no patients required conversion to open surgery in group 1. In group 2, 2 patients required conversion to open surgery, including 1 due to renal vein bleeding secondary to inaccurate vascular control and the other due to bleeding from the vena cava during dissection. In addition, 1 patient had a superficial bowel injury that was repaired laparoscopically and another had a superficial liver tear that was managed without conversion or transfusion. Conclusion: En bloc ligation of the renal hilum is an easy and reliable technique that allows safe and fast control of the renal pedicle. (C) 2014 S. Karger AG, Basel
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    Effect of percutaneous nephrolithotomy on renal functions in children: assessment by quantitative SPECT of 99mTc-DMSA uptake by the kidneys
    (Taylor & Francis Ltd, 2015) Cicekbilek, Izzet; Resorlu, Berkan; Oguz, Ural; Kara, Cengiz; Unsal, Ali
    Objective: To determine the impact of percutaneous nephrolithotomy (PNL) on global and regional renal function in children. Methods: In total, 40 children (41 renal units) undergoing PNL were included in this prospective study. All patients were evaluated using quantitative single-photon emission computed tomography (QSPECT) with technetium-99 m-dimercaptosuccinic acid (Tc-99m-DMSA) examinations before and 3 months after surgery. Results: The mean age was 9.5 years (range, 3-16), and the mean stone size was 3.4 cm (range, 2-6.5). Of the cases, 39 (95%) were managed as being stone-free after a single session of PNL. After additional treatment procedures, 40 (97.5%) of the cases were managed as being stone-free. Of the 41 renal units, new focal cortical defects on Tc-99m-DMSA scans were seen in 4 (9.7%) patients. Total relative uptake in the treated kidneys increased from 42.3% to 44.1%. The mean creatinine level before PNL was 1.18 +/- 0.45 (0.8-1.6) mg/dL compared with 1.16 (0.7-1.5) mg/dL by the end of the follow-up period (not statistically significantly different, p>0.05). Conclusions: PNL in children is a safe and feasible method for the maximal clearance of stones. QSPECT of Tc-99m-DMSA confirmed that renal function is preserved or even improved after percutaneous stone removal.
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    Evaluation of the pathologic results of prostate biopsies in terms of age, Gleason score and PSA level: Our experience and review of the literature
    (Pagepress Publ, 2014) Sarikaya, Selcuk; Resorlu, Mustafa; Oguz, Ural; Yordam, Mustafa; Bozkurt, Omer Faruk; Unsal, Ali
    Objective: To evaluate the pathologic and clinic results of our large series of transrectal prostate biopsies in relation to Gleason score, age and PSA level. Materials and Methods: We reviewed the pathologic results of transrectal prostate biopsies performed because of high PSA levels and abnormal digital rectal examination findings between January 2008 and February 2012. Results: The pathologic result of 835 prostate biopsies was benign in 82.2% and malign in 17.8%. Furthermore in 3.7% high grade PIN (Prostatic Intraepitelial Neoplasia) or ASAP (Atypical Small Acinar Proliferation) was shown. In the interval of total PSA values between 4 and 10 ng/dl, that is thw so-called grey zone, cancer detection rate was 12.4%. There was a significant relationship between cancer detection and cancer stage at all high levels of PSA also in the grey zone. The most common Gleason score observed was 3 + 3 wirh a rate of 7.4% whereas the second most commonly observed scare was 3 + 4 with a rate of 2.5%. In the patients with abnormal digital rectal examination findings but normal PSA levels according to age the cancer detection rate was 8.7%, in patients with only high PSA levels the rate was 41.2% and in the patients with both high PSA levels and abnormal digital rectal examination findings. the rate was 49.3%. Conclusion: Our study underlines the relationship between age, PSA level and pathologic stage of prostate cancer and also the importance of digital rectal examination.
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    In vivo Porcine Model for Practicing Retrograde Intrarenal Surgery
    (Karger, 2014) Tunc, Lutfi; Resorlu, Berkan; Unsal, Ali; Oguz, Ural; Diri, Akif; Gozen, Ali Serdar; Bedir, Selahattin
    Objectives: To examine the feasibility of retrograde intrarenal surgery (RIRS) in a porcine model. Materials and Methods: Female pigs (n = 3) were placed in a dorsal lithotonny position under general anesthesia, and stone material was inserted into the renal pelvis of the pigs. The bladder was entered with a cystoscope, and a 0.038-inch hydrophilic guidewire was passed into the renal pelvis. Following successful placement of the guidewire, a ureteral access sheath (9.5/11.5 Fr) was placed to allow for optimal visualization. A 7.5-Fr flexible ureteroscope (Karl Storz Flex-X2) and a 200-mu m laser fiber were used for lithotripsy. When basketing was deemed necessary, zero-tipped nitinol stone baskets were used. Trainees then practiced all these manipulations on the model. Results: Urologists with moderate experience in advanced endourologic surgery were trained using this model. However, there were some surgical difficulties due to the urinary system anatomy of the pig. Intravaginal location of the urethra, bladder neck location of the ureters, tight ureteric orifices, tortuous ureters, longitudinally elongated renal pelvis, narrow infundibulopelvic angle and shallow calices made the passage of the instruments and maneuverability of the flexible ureteroscope more difficult than in a human model. Conclusions: Despite some difficulties, our porcine model was very effective, because all the trainees successfully practiced the RIRS manipulations on this model. Copyright (C) 2013 S. Karger AG, Basel
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    Metabolic evaluation of patients with urinary system stone disease: a research of pediatric and adult patients
    (Springer, 2014) Oguz, Ural; Resorlu, Berkan; Unsal, Ali
    Objectives To determine the metabolic risk factors in children and adults with urinary system stone disease. Between September 2008 and February 2011, 257 patients who underwent 24-h urine analysis because of urinary system stone disease were included in the present study. Group I and II include only adult patients. The first-time stone formers were named as Group I (n = 106), and recurrent stone formers were named as Group II (n = 107). Group III was occurred by pediatric patients (n = 44). Control group includes 105 people was called as Group IV. This group was divided into two subgroups. Group IVa includes 70 adult people, and Group IVb includes 35 children. The metabolic evaluation results of patients and control groups were compared. Hypercalciuria (35.8, 44.9, and 47.7 % for Group I, II, and III, respectively) and hypocitraturia (42.5, 40.2, and 50 % for Group I, II, and III, respectively) were most common risk factors for stone formation. However, unlike the literature, we have seen that hypomagnesiuria is also an important risk factor in adults and children. Hypomagnesiuria was defined at 36.4 % in Group I, 29 % in Group II, and 56.8 % in Group III (p < 0.05 for each group). These three parameters were significantly different between patient and control groups. Hypomagnesiuria, hypocitraturia, and hypercalciuria are the most important risk factors for stone formation in adults and pediatric patients.