Person: TANIDIR, YILÖREN
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TANIDIR
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YILÖREN
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Publication Open Access Consistency of uroflowmetry analysis in children among observers(2023-01-01) ŞEKERCİ, ÇAĞRI AKIN; TANIDIR, YILÖREN; TARCAN, TUFAN; YÜCEL, SELÇUK; ŞEKERCİ Ç. A., TANIDIR Y., TARCAN T., YÜCEL S.© 2023 Wiley Periodicals LLC.Aim: The aim of the study is to compare the intra- and inter-observer interpretations of the same uroflowmetry study at two different times. Materials and Methods: Two-hundred children with a voided volume of 50% above the expected bladder capacity were included. All traces were asked to be evaluated by 11 observers two times in a time span of 1 month. These observers consist of pediatric urologists (n = 2), pediatric urology fellows (n = 2), urology residents (n = 5), and certified urodynamics nurses (n = 2). Each uroflowmetry was asked to be assessed for three domains: voided volume (VV), detrusor sphincter dyssynergia (DSD), and flow curve pattern (FCP). Results: Of the 200 patients with a median age of 10 (4–18) years, 128 (64%) were girls and 72 (36%) boys. The maximum flow rate and the median voided volume were found to be 20 (4–61) mL/s and 232 (116–781) mL. The Fleiss\" kappa coefficient of VV, DSD, and FCP in the first assessment was 0.510, 0.501, and 0.346. In the second assessment, κ values were 0.530, 0.422, and 0.373. The best-agreed findings were similar at both times. These were found to be low VV (0.602 and 0.626) and intermittent pattern (0.500 and 0.553). Interpreters were found to have a statistically significant difference in agreement with their own interpretation at different times. Conclusion: Both inter- and intra-observer reliability of the agreement point out the problem in the standardization of uroflowmetry. Inter- and intra-observer reliability of uroflowmetry interpretation can be increased by defining precise numbers and numerical algorithms.Publication Metadata only The comparison of anxiety levels in children who underwent invasive or non-invasive urodynamic studies(2022-05-13) ŞEKERCİ, ÇAĞRI AKIN; TARCAN, TUFAN; YÜCEL, SELÇUK; TANIDIR, YILÖREN; Sekerci C. A., Can Ozkan O., Tanidir Y., Tarcan T., Yucel S.INTRODUCTION AND OBJECTIVE: Urodynamic studies play an important role in the evaluation of children with lower urinary tract dysfunction. In this study, we aimed to examine the effects of invasive and non-invasive urodynamic studies on the anxiety levels of children with the help of an anxiety scale. METHODS: Children aged 8-17 years who were scheduled for uroflowmetry (UF) or filling cystometry (FC) and who agreed to fill out an anxiety scale were included in the study. It was the first UF or FC of all children. “The Screen for Child Anxiety Related Disorders (SCARED)” form consisting of 41 questions was used in the evaluation. All children included in the study filled the form themselves. The SCARED results of children who underwent UF and FC were compared. RESULTS: A total of 56 children with a mean age of 10.85þ/- 2.98 years were included in the study. 31 (55.4%) of the children were females and 25 (44.6%) were males. The number of children who had UF was 26 (46.4%; 8.5 (8-14) years), and 30 (53.6%; 11.5 (8-17) years) had FC. The total SCARED scores of the children who underwent UF and FC were 26.5 (5-75) and 27 (2-57), respectively, and there was no statistical difference (p[0.980) (Table 1). A significant difference was found only in "Separation Anxiety Disorder" among sub-score evaluations (p[0.049) (Table 1). In children who underwent filling cystometry, there was no statistical difference in the total SCARED score between those who did and did not do clean intermittent catheterization (28 (3-41); 27 (2-57), respectively) (p[0.860). CONCLUSIONS: The SCARED scores above 25 indicate an anxiety disorder, and interestingly, in this study, both the invasive and noninvasive urodynamic study groups scored over 25. We consider that non-invasive urodynamic tests may cause stress on children as much as invasive ones.Publication Open Access Outcomes and lessons learnt from practice of retrograde intrarenal surgery (RIRS) in a paediatric setting of various age groups: a global study across 8 centres(2022-05-01) ŞEKERCİ, ÇAĞRI AKIN; TANIDIR, YILÖREN; Lim E. J., Traxer O., Quiroz Madarriaga Y., Castellani D., Fong K. Y., Chan V. W., Bujons Tur A., Pietropaolo A., Ragoori D., Shrestha A., et al.Purpose To analyse and report the practice, outcomes and lessons learnt from a global series of retrograde intrarenal surgery (RIRS) in a paediatric multicentre series. Methods A retrospective review of anonymized pooled data gathered globally from 8 centres in paediatric patients ( 10 years (Group C). Overall, post-operative complication rate was 13.7%. Chi-square comparisons were used for categorical variables; analysis of variance (ANOVA) or Kruskal-Wallis tests were used for continuous variables. Results 314 patients were analysed. The mean age was 9.54 +/- 4.76 years. Groups A, B and C had 67 (21.3%), 83 (26.4%) and 164 (52.2%) patients, respectively. Mean stone size was 10.7 +/- 4.62 mm. Pre-stenting was performed in 155 (49.4%) of patients, ureteral access sheaths (UAS) was used in 54.5% of patients with majority (71%) utilizing holmium laser for stone fragmentation. All complications were minor (Clavien-Dindo grade 1 and 2). SFR was 75.5%. Conclusions RIRS is acceptable as a first-line intervention in the paediatric population with reasonable efficacy and low morbidity. Complications are slightly higher in patients < 5 years of age, which should be taken into account while counselling patients.Publication Metadata only Mesane çıkım tıkanıklığı olan erkeklerde idrar glikozaminoglikan düzeyleri tedavi başarısı ve aşırı aktif mesaneyi öngörebilir mi(2022-11-09) ŞEKERCİ, ÇAĞRI AKIN; TANIDIR, YILÖREN; Aydın H. R. , Şekerci Ç. A. , Koçakgöl H., İşbilen Başak B., Güçtaş A. Ö. , Akdeniz F., Aksoy H. Z. , Ramazanoğlu M. A. , Tanıdır Y.Publication Open Access Normal glanular and meatal measurements in boys and men(2023-01-01) ŞEKERCİ, ÇAĞRI AKIN; ÖZKAN, ONUR CAN; GENÇ, YUNUS EMRE; TANIDIR, YILÖREN; TARCAN, TUFAN; YÜCEL, SELÇUK; ŞEKERCİ Ç. A., ÖZKAN O. C., Sahak M. Y., GENÇ Y. E., TANIDIR Y., TARCAN T., YÜCEL S.Objective: To determine the normal vertical urethral meatus length (ML), maximum glanular width (MGW), the glanular seam length (between the lowest edge of urethral meatus and the glans closure line corona) (GSL) and GSL/ML ratio in all age groups. Materials and Methods: Consecutive patients presented to urology and pediatric urology outpatient clinics were included in the study. Penile abnormalities, known endocrinological disorders, history of penile/urethral surgery were excluded. MGW, ML, and GSL were measured with a caliper. Glanular and meatal measurements were compared according to ages. Results: A total of 1398 boys and men (380 (27.18%) prepubertal (1-12), 203 (14.52%) adolescent (13-19), and 815 (58.30%) postpubertal (19-93)) with a median age of 31 years (range: 1-93) were included in the study. In consecutive age groups, ML and GSL gradually increased and became steady between 16-19 & 20-30 age groups and 10-12 & 13-15 age groups, respectively. On the other hand, MGW gradually increased until 20 years of age and became steady at median of 35 mm over 20 years of age. Another interesting finding was a rather stable GSL/ML ratio in all age groups. Pairwise comparison of different age groups seemed to be similar and suggests a fixed ratio of 1.33 (IQR: 0.6). Conclusion: The normal glanular and meatal measurements may guide the surgeons for better cosmetic results during hypospadias repair. The GSL/ML ratio appears to be a stable measure for all ages to achieve better cosmetic results.Publication Metadata only Nadir bir olgu: Grynfelt-lesshaft hernisi.(2022-11-09) GENÇ, YUNUS EMRE; ŞEKERCİ, ÇAĞRI AKIN; TANIDIR, YILÖREN; ÇAM, HAYDAR KAMİL; Genç Y. E. , Güçtaş A. Ö. , Şekerci Ç. A. , Tanıdır Y., Çam H. K.Publication Open Access Outcomes and lessons learnt from practice ofretrograde intrarenal surgery (rirs) in a paediatricsetting of various age groups: a global study across 8 centres(2022-05-13) ŞEKERCİ, ÇAĞRI AKIN; TANIDIR, YILÖREN; Lim E. J., Traxer O., Madarriaga Y. Q., Castellani D., Fong K. Y., Shun Chan V. W., Tur A. B., Pietropaolo A., Ragoori D., Shrestha A., et al.INTRODUCTION AND OBJECTIVE: We aim to analyse and report the practice, outcomes and lessons learnt from a global series of retrograde intrarenal surgery (RIRS) in a paediatric multicentre series. METHODS: Retrospective review of anonymised pooled data gathered globally from 8 centres in paediatric patients ( 18 years of age) who had renal stones and underwent RIRS from 2015 to 2020 was performed. Patient demographics, perioperative parameters, stone characteristics, complications and stone-free rate (SFR) were analysed. Residual fragments(RFs) were defined as a single fragment >2mm or multiple fragments. Our cohort was stratified by age into 3 groups : 5 years (Group A), 5-10 years (Group B) and 10 years (Group C). T-test and ManneWhitney were used for continuous variables. Categorical data between groups were analysed using the c2 test. RESULTS: 314 patients were included for analysis. Mean age was 9.54 þ/- 4.76 years. The number of patients in groups A, B and C were 67 (21.3%), 83 (26.4%) and 164 (52.2%) respectively. The mean stone size was 10.7 þ/- 4.62 mm. While pre-stenting was performed in 155 (49.4%) of patients, ureteral access sheaths (UAS) was used in 54.5% of patients, and majority (71%) utilizing holmium laser for stone fragmentation. The SFR was 75.5% with 77(24.5%) having residual fragments. All post-surgical complications were minor Clavein Dindo (CD) classification and included ureteric injury (n[5), pelvicalyceal injury (n[5, all in group A), fever (n[20), hematuria (n [11) and sepsis (n[2). CONCLUSIONS: RIRS is acceptable as a firstline intervention in the paediatric population with reasonable efficacy and low morbidity; Complications are slightly higher in Group A and this should be taken into account while counselling patients.Publication Open Access Majör yanıklı hastalarda erektil disfonksiyon: Takibin önemi Erectile dysfunction in patients with major burn injury: The significance of follow-up(2022-11-01) ŞEKERCİ, ÇAĞRI AKIN; TANIDIR, YILÖREN; ÇAM, HAYDAR KAMİL; Akdeniz F., ŞEKERCİ Ç. A. , TANIDIR Y., Yılmaz Y., ÇAM H. K.BACKGROUND: There were few prospective studies investigating the relationship between the burn injury and erectile dysfunction (ED). The aim of this study was to prospectively explore the alteration in erectile functions regarding major burn. METHODS: This study was conducted as a prospective survey in patients with major burn injury. The study group consisted of burn cases with at least 20% of body surface area affected according to the Wallace Rule of Nines. Initially International Index of ED-5 (IIEF-5) was administered to the patients in the burn unit, and it was repeated in the 2rd and 6th months. Burn types, the severity of burns, age of patients, and alteration in IIEF-5 scores were compared. RESULTS: The study included 63 male patients. The median age of the patients was 35 (20-73) years, and the median burn percent-age was 22 (20-60). The rate of ED was markedly increased during follow-up as 8%, 39.7%, and 25.4% at baseline, 3rd, and 6th month evaluation, respectively. The median initial IIEF-5 score of the patients was 23 (5-25). Subgroup analysis revealed that IIEF-5 score of patients with electrical and flame burn significantly decreased at 3rd month compared with the baseline values. The median IIEF-5 score of patients with electrical burn increased at 6th month compared with 3rd month (p=0.042). Binary logistic regression analysis showed that age and service period, and IIEF-5 Score at 3rd month and burn grade were all statistically significantly associated with the normal erectile function (IIEF-5>=18), at 3rd month and 6th month, respectively. CONCLUSION: The current trial demonstrated that IIEF-5 scores of patients with major burn can show significant impairment in long term, and it seems a time-dependent process. This is the first prospective trial showing that IIEF can be utilized to monitor erectile function of burn patients in a longer follow-up program.Publication Metadata only Pedi̇atri̇k laparoskopi̇k pi̇yeloplasti̇de perkütan üreteral stent yerleşti̇ri̇lmesi̇(2022-03-10) ŞEKERCİ, ÇAĞRI AKIN; TARCAN, TUFAN; YÜCEL, SELÇUK; TANIDIR, YILÖREN; Tanıdır Y., Şekerci Ç. A., Bülent E., Tarcan T., Yücel S.Amaç: Son yıllarda üreteropelvik bileşke (UP) darlığı olan çocuklarda laparoskopik yaklaşım ile piyeloplasti birçok merkezde uygulanmaya başlamıştır. Öğrenim eğrisi uzun olduğu bilinen bu minimal invaziv yaklaşımın her aşaması için çeşitli yöntemler tarif edilmiştir. Bu video bildiride çocuklarda laparoskopik piyeloplasti sırasında üreteral stent yerleştirilmesini kolaylaştıran bir yöntemin sunulması amaçlanmıştır. Materyal ve Metot: Sağ UP darlık nedeniyle laparoskopik piyeloplasti uygulanan bir hastanın cerrahisini paylaştık. Genel anestezi altında umblikus hizasında orta hattan Hasson tekniği ile 5 mm’lik trokar yerleştirildi. 5 mm’lik ve 30 derecelik laparoskopi lensi görüntüsü altında karaciğer ekartörü ve iki el aleti için biri orta hatta, diğeri krista iliaka anteriorsuperiorun 2 cm mediosüperiorunda olacak şekilde toplam üç adet daha 5 mm’lik trokar yerleştirildi. Ardından 10 mmHg karın içi basınç altında transperitoneal yaklaşım ile çıkan kolon medialize edildi ve UP diseke edildi. Bir adet çaprazlayan aksesuar damar olduğu izlendi. Renal pelvis iki adet askı sütürü ile batın ön duvarına çadır şeklini alacak şekilde asıldı. Bu asma işlemi içinden sütür mataryeli geçirilen bir anjiokat yardımıyla vücut dışına alınıp, cilt üzerinden bir klemp yardımıyla sabitlenerek gerçekleştirildi. Pelvis asıldıktan sonra UP insizyonu ve üreter spatülasyonu yapıldı. Ardından cilt üzerinden üretere ulaşılacak en uygun nokta belirlenerek no 18 anjiokatla batına giriş yapıldı. İğne dışarı alınarak 4 Fr üreter stentin kılavuz teli anjiokat üzerinden üreter içerisinde yeterince ilerletildikten sonra anjiokat çekilerek vücut dışına alındı. Ardından stentin batın katlarından girişini kolaylaştırmak için kılavuz telinin cilde giriş yerine No 11 bistüri ile milimetrik bir insizyon yapıldı. Daha sonra stentin ittiricisi kılavuz teli üzerine yüklenerek cilt girişi ile batın duvarında uygun yol oluşturuldu. Ardından ittirici çıkartılarak kılavuz üzerinden 4 Fr 16 cm üreteral stent yerleştirildi ve kılavuz vücut dışına alındı. Stentin proksimal ucu renal pelvise yerleştirildi. Ardından aksesuar damarlar posteriora yerleştirilerek UP anastomozu yapılarak operasyona son verildi. Bulgular: 2019 – 2021 yılları arasında ortanca yaşı 8,5 yıl (3–14) olan 18 çocuğa bu yöntemle ile laparoskopik piyeloplasti sırasında üreteral stent yerleştirilmiştir. Tüm olgularda postoperatif yapılan direkt üriner sistem grafisinde stentler yerinde olması gereken pozisyonda izlenmiştir. Hiçbir olguda stent pozisyonu ile ilgili bir komplikasyon izlenmemiştir. Sonuç: Perkütan yolla üreteral stent yerleştirilmesinin laparoskopik piyeloplastinin bu aşamasında alternatif bir yöntem olabileceğini düşünmekteyiz. Anahtar Kelimeler : PİYELOPLASTİ,LAPAROSKOPİK,PERKÜTAN,UPBDPublication Open Access The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children(2024-01-01) TANIDIR, YILÖREN; ŞEKERCİ, ÇAĞRI AKIN; TANIDIR Y., ŞEKERCİ Ç. A., Bujons A., Castellani D., Ferretti S., Gatti C., Campobasso D., Quiroz Y., Teoh J. Y., Pietropaolo A., et al.OBJECTIVE: To compare retrograde intrarenal surgery (RIRS) with and without ureteral access sheath (UAS) in different pediatric age groups. METHODS: The data of RIRS for kidney stone in children were obtained from 9 institutions. Demographic characteristics of patients and stones, intraoperative and postoperative results were recorded. While analyzing the data, patients who underwent RIRS without UAS (group 1) (n = 195) and RIRS with UAS (group 2) (n = 194) were compared. RESULTS: Group 1 was found to be young, thin, and short (P <.001, P = .021, P <.001), but there was no gender difference and similar symptoms were present except hematuria, which was predominant in group 2 (10.6% vs 17.3%, P <.001). Group 1 had smaller stone diameter (9.91 ± 4.46 vs 11.59 ± 4.85 mm, P = .001), shorter operation time (P = .040), less stenting (35.7% vs 72.7%, P = .003). Re-intervention rates and stone-free rates (SFR) were similar between groups (P = .5 and P = .374). However, group 1 had significantly high re-RIRS (P = .009). SFR had a positive correlation with smaller stone size and thulium fiber laser usage compared to holmium fiber laser (HFL) (P <.001 and P = .020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments (P = .001). CONCLUSION: RIRS can be performed safely in children with and without UAS. In children of smaller size or younger age (<5 years), limited use of UAS was observed. UAS may be of greater utility in stones larger than 1 cm, regardless of the age, and using smaller diameter UAS and ureteroscopes can decrease the complications.