Person: TANIDIR, YILÖREN
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TANIDIR
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YILÖREN
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Publication Metadata only Supi̇n perkütan nefroli̇totomi sonrası akut faz reaktanlarının postoperati̇f kompli̇kasyonları öngörmedeki̇ başarısı(2022-03-10) SARAÇOĞLU, SERTAÇ; ŞENER, TARIK EMRE; TOPBAŞ, FEVZİ BATUHAN; ÖZKAN, ONUR CAN; TANIDIR, YILÖREN; Saraçoğlu S., Şener T. E., Topbaş F. B., Özkan O. C., Tanıdır Y.Giriş Perkütan nefrolitotomi (PNL), her boyutta üst üriner sistem taşlarının tedavi algoritması içerisinde önerilebilen, yüksek başarı ve düşük komplikasyon oranları ile uygulanan bir ameliyattır. PNL sonrası gelişen idrar yolu enfeksiyonları (İYE), PNL’ye bağlı komorbiditelerin en önemli sebeplerindendir. Postoperatif erken dönemde yükselen akut faz reaktanları, enfektif komplikasyonların erken tanınmasını sağlayabilir. Materyal & Metod Haziran 2018 – Mart 2021 tarihleri arasında PNL ameliyatı endikasyonu konularak opere edilen, CRP ve prokalsitonin değerlerine ulaşılabilen hastalar çalışmaya dahil edildi. Hastalar, güncel kılavuzların önerdiği preoperatif değerlendirmeler ile ameliyata alındı. Ameliyat edilen taşların boyutu ve hacmi, uygulanan PNL işlemine ait veriler ve post-operatif veriler prospektif olarak toplandı. Her hastanın preoperatif, erken postoperatif dönemlerde ve postoperatif 1. günde bakılan hemogram, CRP ve prokalsitonin değerlerinin, postoperatif enfektif komplikasyonlarla ilişkisi araştırıldı. Bulgular Çalışmaya 113 hasta dahil edildi. Hastaların demografik verileri ile ameliyat öncesi özellikleri ve ameliyat edilecek taşa ait bulgular tablo 1’de verildi. 77 hastada multiple (61 multiple simple, 7 staghorn + simple, 9 semi staghorn + simple), 36 hastada tek (7 semistaghorn ,29 single simple) taş saptandı. Taşların lokalizasyonu 40 hastada renal pelvis taşı + diğer kalikslerde taş, 15 hastada birden fazla kaliks içerisinde taş, 26 hastada ise renal pelviste tek taş şeklindeydi. Ortanca taş sayısı 2 (min 1, maks 15), ortanca total taş hacmi 2723,25 mm3 (min 295,07, maks 35797), ortanca taş yüzey alanı 1448,89 mm2 (min 235,16, maks 12400,51) saptandı. Tüm ameliyatlar supin pozisyonda yapıldı. 34 hastada (%30,1) endoskopik kombine girişim (“ECIRS”), 79 hastada (%69,9) supin PNL uygulandı. 77 hastada (%68,1) mini-PNL (16-22 Fr), 27 hastada (%23,9) standart-PNL (24-30 Fr), 9 hastada (%8) ise ultra mini-PNL (10-14 Fr) uygulandı. Ameliyat sonunda 33 hastaya (%29,2) nefrostomi, 62 hastaya (%54,9) DJ stent (“Tubeless”), 18 hastaya (%15,9) hem nefrostomi hem DJ stent takıldı. Clavien Dindo sınıflamasına göre 18 hastada (%15,9) 2. derece, 1 hastada (%0,9) 3. derece, 1 hastada (%0,9) 4. derece komplikasyon gelişti. Gelişen 4. derece komplikasyon 1 hastada kardiyak komplikasyona bağlı yoğun bakım ihtiyacının gelişmesiydi, gelişen 3. derece komplikasyon ise yine 1 hastada kanamaya bağlı anjiyoembolizasyon ihtiyacı olmasıydı. Clavien Dindo 2. Derece komplikasyonlar ise 12 hastada postoperatif ateş, 2 hastada idrar yolu enfeksiyonu ve 5 hastada ES transfüzyonu gerektiren kanamaydı. Postoperatif döneme ait bulgular tablo 2’de verildi. Ameliyat öncesi ve sonrasındaki bakılan akut faz reaktanları değerlendirildiğinde CRP, prokalsitonin ve lökosit değerlerinin postoperatif enfektif komplikasyonlarla korelasyon gösterdiği görüldü. Sonuç Supin PNL ameliyatları yüksek taşsızlık oranları ve düşük komplikasyon yüzdesi ile uygulanmaktadır. Ameliyat öncesinde ve postoperatif dönemde hastaların takibinde bakılacak akut faz reaktanlarının postoperatif enfektif komplikasyonları öngörmede başarılı olduğu görülmüştür. Anahtar Kelimeler : Nefrolitotomi, Perkütan, Akut Faz ReaktanlarıPublication Open Access Re: Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study(2022-07-01) ŞENER, TARIK EMRE; TANIDIR, YILÖREN; Vicentini F. C., Mazzucchi E., Gokce M., Sofer M., Tanidir Y., Sener T. E., Melo P. A. d. S., Eisner B., Batter T. H., Chi T., et al.This retrospective, multicenter study of patients with horseshoe kidneyssubjected to percutaneous nephrolithotomy (PCNL) demonstrated some expected findings: those withhigher stone burden less apt to be cleared of stone (stone-freeþresidual fragments<4 mm).Increasing body mass index was shown to negatively impact this parameter which has not beenreported for the generic patient subjected to PCNL. These results also demonstrate that supine PCNLcan be undertaken safely and effectively in this cohort.Publication Metadata only Atnalı böbrekte supi̇n perkütan nefroli̇totomi̇(2022-03-10) SARAÇOĞLU, SERTAÇ; TOPBAŞ, FEVZİ BATUHAN; ŞENER, TARIK EMRE; TANIDIR, YILÖREN; Şener T. E., Saraçoğlu S., Topbaş F. B., Tanıdır Y.Atnalı böbrek sık karşılaşılan bir füzyon anomalisidir. Üreter girişlerinin süperolateral yerleşimli olması sebebiyle toplayıcı sistem drenajı normal böbreklere kıyasla daha zordur ve bu durum kliniğe üriner staz, tekrarlayan idrar yolu enfeksiyonları ve tekrarlara böbrek taşı oluşumu ile yansır. Avrupa Üroloji Kılavuzlarına uygun olarak atnalı böbreklerde karşılaşılan >2cm taşlar için Perkütan Nefrolitotomi (PNL) taşsızlık oranları yüksek ve komplikasyon oranları düşük olan uygun bir seçenektir. Bu video-bildiride atnalı böbreğinde 25 mm’ye ulaşan taşı olan bir hastaya uygulanan supin mini-PNL ameliyatının tekniğini paylaşmayı amaçladık. Hasta: Hasta, B.K., ek hastalığı olmayan bir erkek hastadır. Hastanın 2017 tarihinden itibaren tekrarlayan idrar yolu enfeksiyonu ve taş düşürme öyküsü mevcuttur. Şiddetli sol yan ağrısı olması üzerine çekilen kontrastsız tüm batın tomografisinde atnalı böbrek anomalisi, sol böbrekte 25 x 14 x 16 mm renal pelvis taşı (Hounsfield maks 1275, ort 899) ve sağ böbrekte 4 x 4 mm & 3 x 2 mm alt kaliks taşları saptanmıştır. Hastanın sol böbrek taşına yönelik sol supin mini-PNL planlanarak hasta operasyon sonunda taşsız olacak şekilde operasyon komplikasyonsuz olarak tamamlanmıştır. Sonuç: Atnalı böbrekte supin perkütan nefrolitotomi güvenli ve etkili bir tedavi yöntemidir. Anahtar Kelimeler : Kidney, Horseshoe Kidney, Nephrolithotomy, PercutaneousPublication Metadata only Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review(2023-01-01) TANIDIR, YILÖREN; Giulioni C., Castellani D., Traxer O., Gadzhiev N., Pirola G., TANIDIR Y., Da Silva R., Glover X., Giusti G., Proietti S., et al.Objective: To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. Basic procedures: A systematic literature search was performed on 4 th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. Main findings: Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. Conclusion: Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.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 Metadata only Predictive factors of full response to desmopressin treatment in children with primary monosymptomatic enuresis nocturna(2023-02-01) ÖZGÜR, GÜNAL; TANIDIR, YILÖREN; TARCAN, TUFAN; YÜCEL, SELÇUK; Ozgur G., Sekerci C. A., TANIDIR Y., Tarcan T., YÜCEL S.Publication Open Access Worldwide survey on the current practice of asymptomatic urinary stone management: a survey from eau, young academic urologists (yau), endourology and urolithiasis working party(2022-05-01) ŞENER, TARIK EMRE; TANIDIR, YILÖREN; Sener T. E. , Tailly T., Pietropaolo A., Keller E. X. , Tanidir Y., Gomez Rivas J., Hameed Z., De Coninck V., Tefik T., Sarica K., et al.Publication Metadata only Outcomes from practice of Retrograde Intrarenal Surgery (RIRS) in a paediatric setting of various age groups: A global study across 8 centres(2022-02-01) TANIDIR, YILÖREN; Lim E. J., Traxer O., Madarriaga Y. Q., Castellani D., Fong K., Chan V. W., Tur A. B., Pietropaolo A., Ragoori D., Shrestha A., et al.Publication Open Access The efficacy of retrograde intra-renal surgery (RIRS) for lower pole stones: results from 2946 patients(2023-01-01) TANIDIR, YILÖREN; Giulioni C., Castellani D., Somani B. K., Chew B. H., Tailly T., Keat W. O. L., Teoh J. Y., Emiliani E., Chai C. A., Galosi A. B., et al.Purpose: To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR). Methods: Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value < 0.05. Results: 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF. Conclusions: RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.