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Objective:This study aimed to investigate the influence of different ischaemia techniques on short-term and one year renal function following laparoscopic partial nephrectomy (LPN).Materials and Methods:Data of 359 patients who underwent LPN between November 2009 and April 2018 were reviewed, retrospectively. A total of 287 patients were included in the study. Patients were divided into 4 groups according to type of ischaemia as follows: group A (n=33) was warm ischaemia time (WIT) >20 minute, group B (n=202) was WIT ≤20 minute, group C (n=16) was selective arterial clamping and group D (n=36) was off-clamp. Demographic data, preoperative and postoperative outcomes were compared. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Change in eGFR according to group and time was evaluated using two-way analysis of variance. P values 0.05) between groups. Only 4 patients in group B had positive surgical margin. The percentage of relative eGFR (% of ΔeGFR) decline 1 year after LPN was significantly (p=0.001) higher in the ischaemic groups (A and B: 9.3% and 7.5%) compared to the zero-ischaemia groups (C and D: 5% and 3.7%).Conclusion:This study revealed that after LPN, cumulative renal function decreases to a certain extent regardless of the technique. However, it was found that cumulative renal functions are better preserved when ischaemia time is reduced to ≤20 min or eliminated.

Objective:The aim of this study is to investigate the surgical and functional outcomes of laparoscopic partial nephrectomy (LPN) in patients with renal angiomyolipoma (RAML).Materials and Methods:From April 2014 to February 2018, the data of a total of 346 patients who underwent LPN were retrospectively reviewed. Twenty-one patients with final pathology report indicating RAML were included in the study. Demographic data, operative indications, intraoperative and postoperative outcomes as well as complications were evaluated.Results:Eighteen female (85.7%) and 3 male (14.3%) patients were included in this study. The mean age was 55.14±11.95 years. Of the RAMLs, 52.4% were in the right kidney and 47.6% in the left kidney. The mean tumor size was 31.38±16.72 mm and the mean RENAL Nephrometry score was 5.90±1.51 (4-10). RAML could not be differentiated from RCC in 12 patients (57.1%) by preoperative computer tomography and/or magnetic resonance images. In 4 patients, LPN was implemented by off-clamp technique whereas, in 17 patients it was implemented by global ischemia technique. The mean operation duration was 67.86±20.77 (40-110) minutes (min) and the mean estimated blood loss was 117.14±59.7 (30-220) milliliters. In 17 patients who underwent LPN by global ischemia technique, the mean warm ischemia time was 10.88±5.19 (6-22) min. According to the Modified Clavien-Dindo classification, grade 1 complications were detected in 3 patients, postoperatively. The most considerable renal functional changes were detected between preoperative and postoperative- 1st day levels. However, at the end of the first year, the difference was found to decrease.Conclusion:LPN is a safe and effective treatment option for the treatment of RAMLs that are not able to be distinguished from renal cell carcinoma radiologically. Besides the definitive treatment, the exact pathological diagnosis can be ensured by LPN.

The incidence of renal tumor on the allograft kidney is relatively rare. There is no standard treatment available for the management of such cases. However, if technically feasible nephron-sparing surgical approaches, whether open or minimally invasive, should be preferred for the management of these challenging cases. To our knowledge, there is no pure laparoscopic technique reported in the literature but only 3 cases of robot-assisted partial nephrectomy. In this article, we aimed to present the application of pure transperitoneal laparoscopic partial nephrectomy for the management of a renal mass on the allograft kidney.

Background: Partial nephrectomy (PN) is the standard of treatment in patients with cT1 renal tumors. Current guidelines recommend PN as a standard of treatment in patients with cT1 renal tumors. Ho...

Mercimek, Mehmet Necmettin/0000-0002-0680-4451; Gulsen, Murat/0000-0001-5371-0960; Ozden, Ender/0000-0003-3196-4024 WOS: 000526101600001 PubMed: 32293992 Background: A double-pigtail ureteral stent (DPUS) can cause untoward symptoms, such as urgency, frequency, urinary incontinence, hematuria, and body pain that are bothersome to patient's quality of life (QoL). By reducing the quantity of material in the bladder, it could be reasonable to decrease stent-related symptoms (SRSs). We aimed to evaluate the tolerability of single pigtail suture stent (SPSS) with a validated questionnaire after uncomplicated retrograde semirigid ureteroscopic lithotripsy (URSL). Materials and Methods: A total of 130 patients who underwent ureteral stent placement after URSL for unilateral symptomatic ureteral stones with

Purpose Iatrogenic bladder injury remains a major challenge. We compared the success and reliability of laparoscopic repair of intraperitoneal bladder rupture in patients who had undergone total laparoscopic hysterectomy. Methods This retrospective study included patients who underwent total laparoscopic hysterectomy for benign gynaecological cases at a tertiary academic hospital between January 2018 and June 2019. All patient medical records included in the study were reviewed, and the causes, incidence and management of bladder injuries were assessed. Results There were nine patients. The cause of all the ruptures was iatrogenic, and all were intra-operatively detected. In all patients, bladder injuries occurred in the posterior side of the bladder during vesicouterine dissection. Laparoscopic bladder perforation repair was performed successfully in all patients. No major complications had occurred in any patients after surgery. The foley catheters were removed 6.67 +/- 0.7 (5-7) days after surgery. Conclusions If performed by well-trained laparoscopic surgeons, laparoscopic hysterectomy could be the best option for appropriate patients. Nevertheless, patients should be well aware of the potential complications in endometriosis and caesarean cases before the procedure, and care should be paid during dissection. When a urogenital injury is suspected or detected the condition must be adequately identified and proper treatment must be performed to avoid postoperative complications and long-term morbidity. WOS:000526169600001 2-s2.0-85083427391 PubMed: 32267049

Ozden, Ender/0000-0003-3196-4024; Mercimek, Mehmet Necmettin/0000-0002-0680-4451 WOS: 000525208400001 PubMed: 32208049 Background: Considering the increase in a number of vascular complications, right laparoscopic donor nephrectomy is less preferred due to achieving not only shorter renal vein but also longer renal artery. However, recent studies have indicated that the side of the surgery would not affect the outcomes. Aim: The aim of this study is to evaluate the outcomes and strategies to increase the safety of pure retroperitoneoscopic donor nephrectomy (RDN). Methods: We analyzed the prospectively collected medical records of 158 kidney donors who underwent RDN from January 2010 to August 2018. The patients were divided into two groups based on their side of surgery. Right- and left-sided RDNs were compared in terms of demographics, intraoperative, and postoperative data, including the development of incisional hernia (IH). The outcomes of the recipients were also evaluated. Results: Right RDN was performed in 40 (25.3%) and left RDN was performed in 118 (74.7%) donors. Operation time (P = .593), warm ischemia time (P = .271), blood loss (P = .787), and length of hospital stay (P = .908) were statistically similar in right and left RDN groups. Intraoperative and postoperative complications were statistically showed no difference between right and left RDNs. No IH was observed in any group. One-year and five-year patient survival and graft survival rates were 100% versus 97% (P = .299) and 100% versus 95% (P = .126) on both sides, respectively. Conclusion: Right RDN is an effective and safe method as on the left side. RDN has an additional advantage in the absence of IH. Experience with other retroperitoneoscopic urological interventions may have had a positive effect on the outcomes of pure RDN.

Unilateral synchronous multifocal renal tumors are rare. Due to the limited data in the literature and challenges in the technique, there is still doubt on the application of laparoscopic partial nephrectomy (LPN) for the management of such tumors. Herein, we report a 36-year male patient presenting with right-sided flank pain and microscopic hematuria. Abdominal computed tomography (CT) revealed five solid masses, the largest of which was 27 x 18 mm. The patient underwent LPN and the largest mass was resected with the control of segmental artery of the lower pole of the right kidney. The remaining four masses were resected by zero-ischemia technique. Final pathology revealed renal cell carcinoma in all masses. Postoperative period was uneventful. No recurrence was detected during a 5-year follow-up.

Anterior urethra stones are extremely rare causes of acute urinary retention. The data of 34 adult patients who presented with acute urinary retention between August 2011 and September 2017 and treated with anterior urethra were evaluated retrospectively. Their ages, sizes of stones, locations, etiological factors, physical examination findings, treatment modalities, operation period and complications were analyzed. All the patients were male and the mean age was 46.9 ± 17.88 years. All of the stones evaluated in the study were single and the mean stone size was 12.17 ± 3.23 (6-19) mm. Location of the urethral calculi was fossa navicularis in 12 (35.3%) patients, bulbar urethra in 7 (20.6%) patients and penile urethra in 15 (44.1%) patients. A total of 20 patients had urinary calculi located in the other parts of the urinary system at the time of presentation. Stone of the 7 patients with fossa navicularis localized had been treated by intraurethral instillation of 2% lidocaine gel, the other 5 patients had been treated with ventral meatotomy. Urethral stone of the 7 patients with penile and bulbar urethra located was taken by the help of direct forceps without requiring any fragmentation operation. Other stones were treated with endoscopic holmium laser lithotripsy. As a result of surgery operations, urinary tract infection in 3 patients, urethrorrhagia in 2 patients and hematuria in 5 patients were observed. We consider that it is very important to keep anterior urethral stones in mind among differential diagnosis especially in male patients admitted with acute urinary retention. acute urinary retention. [Med-Science 2019; 8(2.000): 365-9]

Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Mercimek, Mehmet Necmettin/0000-0002-0680-4451; ozkaya, ozan/0000-0002-0198-1221; Ozden, Ender/0000-0003-3196-4024 WOS: 000285141900098 PubMed: 21074805 Purpose: Although percutaneous nephrolithotomy has been accepted as an effective minimally invasive procedure in children, there is still no consensus on how to define and stratify complications by severity. Materials and Methods: We retrospectively reviewed data of children who underwent percutaneous nephrolithotomy at our center between January 2002 and March 2010. A total of 100 procedures were performed in 94 patients with a mean age of 9.5 years. Complications were recorded according to modified Clavien classification. Results: Average stone burden ranged from 100 to 2,850 mm(2) (mean +/- SD 507.5 +/- 475). Stones were located in the renal pelvis in 32 kidneys, calices in 20, renal pelvis and calices in 31, and upper ureter in 3. Stone-free rate after a single session of percutaneous nephrolithotomy was 85%. After auxiliary procedures in 7 cases stone-free rate increased to 89%. Grade I complications were seen in 7 patients postoperatively, grade II in 19 (hematuria requiring blood transfusion in 13 and nonseptic infection requiring antibiotics in 6) and grade III in 4 (hydro-hemothorax in 2 and urine leakage requiring Double-J (R) stent in 2). No grade IV or V complications were observed. Regression analysis showed that stone burden (OR 1.006, 95% CI 1.001-1.011; p = 0.03) and operative time (OR 1.044, 95% CI 1.011-1.077; p = 0.009) were independent risk factors for complications. Conclusions: Percutaneous nephrolithotomy in children is safe, feasible and effective. Stone burden and operative time are independent risk factors for complications. The modified Clavien system provides a straightforward and validated method to classify postoperative complications.

Management of kidney stone disease in pediatric population is a challenging condition in urology practice. While the incidence of kidney stone is increasing in those group, technological innovations have conrtibuted to the development of minimally invasive treatment of urinary stone disease such as mini-percutenous nephrolitotomy (mini-PCNL), micro-PCNL, ultra mini-PCNL. In this review we tried to evaluate the effect of new teratment techniques on pediatric kidney stones.

Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Mercimek, Mehmet Necmettin/0000-0002-0680-4451; Ozden, Ender/0000-0003-3196-4024 WOS: 000303470600012 PubMed: 22309786 OBJECTIVE To present our long-term follow-up data from patients with kidney stones and chronic kidney disease to identify the factors that could help predict the likelihood of long-term deterioration in renal function. METHODS From January 2002 to July 2010, we performed 1117 percutaneous nephrolithotomy (PNL) procedures in 1051 patients. We retrospectively analyzed 69 PNL procedures for 67 patients (47 men and 20 women) in whom the estimated glomerular filtration rate (eGFR) was 5%; and group 3, an eGFR decrease of

tomy tube insertion (p 0.0002, OR 6.4), and post operative fever (p 0.0001). CONCLUSIONS: For patients undergoing PCNL and URS, factors predisposing the development of sepsis include bladder outlet obstruction, positive pre-operative urine culture, and nephrostomy tube insertion. Treatment of a positive preoperative urine culture did not reduce the risk of sepsis, and cannot be considered a reliable preventative measure. A larger sample size is needed to perform multivariate analysis and logistic regression. This would elucidate relationships found on univariate analysis and enable further risk stratification.

Sahin, Ahmet/0000-0003-1354-988X; Mercimek, Mehmet Necmettin/0000-0002-0680-4451; Ozden, Ender/0000-0003-3196-4024 WOS: 000277408800016 PubMed: 19931900 OBJECTIVES To compare the stone-free rate and complications between horseshoe and normal kidneys. METHODS Between December 1997 and June 2008, a total of 2401 patients with 2618 renal units underwent percutaneous nephrolithotomy (PCNL). During this period, we retrospectively reviewed the data of 46 patients with 50 (1.9%) renal units with horseshoe kidneys treated by PCNL. We compared the success and complication rate in horseshoe kidney and normal kidney. RESULTS Fifty PCNL were performed in the above-mentioned 46 patients with a mean age of 41.6 years. The average stone burden ranged from 100 to 4900 mm(2) (mean, 644 +/- 135 mm(2)). The stones were located in the renal pelvis in 13 (26%), calices in 17 (34%), and in both in 11 kidneys (22%). A single tract was used in 42 kidneys (84%), and 2 tracts were created in the remaining 8 (16%). Major complications were seen in 8 PCNL procedures (16%). A detailed comparison between horseshoe and normal kidneys showed that stone burden, operation time, stone-free rates, and auxiliary procedure rates were similar. The only statistically significant difference was detected in the number of access, which is more in normal kidneys. Logistic regression analysis did not reveal that horseshoe kidney did not have any negative effect on success after PCNL. CONCLUSIONS Despite the anatomic abnormalities, PCNL is a safe and effective treatment option for calculi both in the horseshoe kidney and the normal kidney with the similar success and complications rates. UROLOGY 75: 1049-1052, 2010. (C) 2010 Elsevier Inc.

Objective: This study aims to compare renal functional outcomes of access techniques in patients who underwent off-clamp (Off-C) laparoscopic partial nephrectomy (LPN). Materials and Methods: Thirty-four Off-C LPNs in patients with functioning contralateral kidney from March 2011 to June 2018 were included in the study. Twenty-two patients underwent transperitoneal, 12 patients underwent retroperitoneal Off-C LPN. The primary outcome was glomerular filtration rate changes over time, postoperatively. The secondary outcome was the evaluation of trifecta and pentafecta rate. Results: Preoperative demographics, tumor size (26.59 vs. 22.83mm, p=0.790), RENAL score (5.45 vs. 5.33, p=0.990), operation time (79.95 vs. 81.33 min, p=0.157), blood loss (170.23 vs. 150.83mL, p=0.790) were similar in both groups. Although preservation of renal function was better in group 2 in the early period, similar results were found in both groups at the end of the first year, postoperatively. No positive surgical margin and postoperative major complications were detected in any patient. While trifecta goals were achieved in all the patients in the cohort, pentafecta rates were 90.9% and 91.7% in the transperitoneal and retroperitoneal groups, respectively. Conclusions: Transperitoneal and retroperitoneal access were found to have similar outcomes in terms of preservation of renal function at the end of the first year postoperatively. Off-C LPN may be considered as a safe and effective treatment option in patients having non-complex renal tumors.