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TANIDIR, YILÖREN

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    Real-world Global Outcomes of Retrograde Intrarenal Surgery in Anomalous Kidneys: A High Volume International Multicenter Study
    (Elsevier Inc., 2021) TANIDIR, YILÖREN; García Rojo E., Teoh J.Y.-C., Castellani D., Brime Menéndez R., Tanidir Y., Benedetto Galosi A., Bhatia T.P., Soebhali B., Sridharan V., Corrales M., Vaddi C.M., Shrestha A., Singh A., Lakmichi M.A., Ragoori D., Sepulveda F., Hamri S.B., Ganpule A.P., Emiliani E., Somani B., Traxer O., Gauhar V.
    Objective: To analyze the trends and outcomes of retrograde intrarenal surgery for treatment of urolithiasis in anomalous kidneys in a large international multicenter series. Materials and Methods: We designed a multicentric retrospective study. Nineteen high-volume centers worldwide were included. Pre-, peri- and postoperative data were collected, and a subgroup analysis was performed according to renal anomaly. Results: We analyzed 414 procedures: 119 (28.7%) were horseshoe kidneys, 102 (24.6%) pelvic ectopic kidneys, 69 (16.7%) malrotated kidneys and 50 (12.1%) diverticular calculus. The average size (SD) of the stone was 13.9 (±6) millimeters and 193 (46.6%) patients had a pre-operative stent. In 249 cases (60.1%) a disposable scope was used. A UAS (ureteral access sheath) was used in 373 (90%) patients. A Holmium laser was used in 391 (94.4%) patients. The average (SD) operating time was 65.3 (±24.2) minutes. Hematuria, caliceal perforation and difficulty in stone localisation were mostly seen in diverticular stones and difficulty in UAS placement and lithotripsy in the cases of renal malrotation. The overall complication rate was 12%. Global stone-free rate was 79.2%. Residual fragments (RF) were significantly lesser in the pre-stented group (P <.05). Diverticular calculi was the group with more RF and needed ancillary procedures (P <.05). Conclusion: Retrograde intrarenal surgery in patients with anomalous kidneys is safe and effective with a high single-stage stone-free rate and low complication rate. There is a trend toward using smaller and disposable scopes and smaller UAS. Diverticular stones can still be challenging with higher rates of intraoperative hematuria, caliceal perforation and RF. © 2021 Elsevier Inc.
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    PublicationOpen Access
    Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey
    (WILEY, 2021-04) TANIDIR, YILÖREN; Bozkurt, Ozan; Sen, Volkan; Irer, Bora; Sagnak, Levent; Onal, Bulent; Tanidir, Yiloren; Karabay, Emre; Kaya, Coskun; Ceyhan, Erman; Baser, Aykut; Duran, Mesut Berkan; Suer, Evren; Celen, Ilker; Selvi, Ismail; Ucer, Oktay; Karakoc, Sedat; Sarikaya, Ege; Ozden, Ender; Deger, Dogan; Egriboyun, Sedat; Ongun, Sakir; Gurboga, Ozgur; Asutay, Mehmet Kazim; Kazaz, Ilke Onur; Yilmaz, Ismail Onder; Kisa, Erdem; Demirkiran, Engin Denizhan; Horsanali, Ozan; Akarken, Ilker; Kizer, Onur; Eren, Huseyin; Ucar, Murat; Cebeci, Oguz Ozden; Kizilay, Fuat; Comez, Kaan; Mercimek, Mehmet Necmettin; Ozkent, Mehmet Serkan; Izol, Volkan; Gudeloglu, Ahmet; Ozturk, Bilgin; Akbaba, Kaan Turker; Polat, Salih; Gucuk, Adnan; Ziyan, Avni; Selcuk, Berin; Akdeniz, Firat; Turgut, Hasan; Sabuncu, Kubilay; Kaygisiz, Onur; Ersahin, Veli; Kahraman, Halil Ibrahim; Guzelsoy, Muhammet; Demir, Omer
    Objective 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.
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    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 Reaktanları
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    PublicationOpen 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.
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    PublicationOpen Access
    Clinical presentation, microbiological characteristics, and their implications for perioperative outcomes in xanthogranulomatous pyelonephritis: perspectives from a real-world multicenter practice
    (2023-05-10) TANIDIR, YILÖREN; Gauhar V., Robles-Torres J. I., Wroclawski M. L., Trujillo-Santamaría H., Teoh J. Y. C., Tanidir Y., Mahajan A., Gadzhiev N., Ragoori D., Kumar S., et al.
    Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic granulomatous infection of renal parenchyma. XGP is often associated with long-term urinary tract obstruction due to stones and infection. We aimed to analyze the clinical, laboratory, and microbial culture profiles from bladder and kidney urine of patients who were diagnosed with XGP. Databases of patients with histopathological diagnosis of XGP from 10 centers across 5 countries were retrospectively reviewed between 2018 and 2022. Patients with incomplete medical records were excluded. A total of 365 patients were included. There were 228 (62.5%) women. The mean age was 45 ± 14.4 years. The most common comorbidity was chronic kidney disease (71%). Multiple stones were present in 34.5% of cases. Bladder urine culture results were positive in 53.2% of cases. Kidney urine culture was positive in 81.9% of patients. Sepsis and septic shock were present in 13.4% and 6.6% of patients, respectively. Three deaths were reported. Escherichia coli was the most common isolated pathogen in both urine (28.4%) and kidney cultures (42.4%), followed by Proteus mirabilis in bladder urine cultures (6.3%) and Klebsiella pneumoniae (7.6%) in kidney cultures. Extended-spectrum beta-lactamases producing bacteria were reported in 6% of the bladder urine cultures. On multivariable analysis, urosepsis, recurrent urinary tract infections, increased creatinine, and disease extension to perirenal and pararenal space were independent factors associated with positive bladder urine cultures. On multivariable analysis, only the presence of anemia was significantly more frequent in patients with positive kidney cultures. Our results can help urologists counsel XGP patients undergoing nephrectomy.
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    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, Percutaneous
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    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.
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    Bilateral simultane endoskopik taş cerrahisinin (sbes) etkinlik ve güvenlik profilinin değerlendirilmesi
    (2022-03-13) ŞENER, TARIK EMRE; KÜTÜKOĞLU, MEHMET UMUT; TANIDIR, YILÖREN; ÖZGÜR G., ŞENER T. E., KÜTÜKOĞLU M. U., TANIDIR Y.
    Giriş Her iki böbreğinde taş bulunan hastalarda multiple operasyonlardan kaçınmak ve operasyon sürelerini kısaltmak için Bilateral Simultane Endoskopik Taş cerrahisi (SBES) yapılabilmektedir. Bu çalışmamızda bilateral böbrek taşı olan hastalarda SBES'in etkinlik ve güvenlik profilini değerlendirmeyi amaçladık. Method Her iki böbrek taşı için tedavi endikasyonu bulunan ve aynı seansta bir böbreğine supin perkütan nefrolitotomi (PNL), diğer böbreğine fleksible üreterorenoskopi (FURS) yapılan hastalar prospektif olarak çalışmaya dahil edildi. Hastalar ameliyat öncesi ve sonrası kan ve idrar testleri ile ameliyat öncesi kontrastsız BT taramasını içeren standart bir ürolitiazis tanı yaklaşımı ile değerlendirildi. Çalışmamızda elde etmek istediğimiz birincil sonuç taşsızlık durumunu (fragmanlar <3mm) ve komplikasyonları belirleyerek SBES'in güvenlik ve etkinlik profilini değerlendirmektir. İkincil sonuç ise hastanede kalış süresi, floroskopi dozu ve ameliyat sonrası çıkış stratejisini değerlendirmektir. Bulgular Çalışmaya 45 hasta (Erkek/kadın : 31/14) dahil edildi. Hastaların ortanca yaşı 51 idi (min 27 , Mak 90) Hastaların PCNL ile tedavi edilen böbrekteki ortanca taş hacmi 2880,4 mm3 (min 644,4 mak 62724,2) ve FURS ile tedavi edilen böbrekteki ortanca taş hacmi 543,64 mm3 (min 43,3 mak 11291,2) idi. Ortanca operasyon süresi 150 dakika ve ortanca floroskopi dozu 41.08 mGy idi. (Tablo 1.) PCNL uygulanan böbrek tarafından 35 (77,8%) hastada, FURS uygulanan böbrek tarafında 36 (80%) hastada taşsızlık sağlandı. PCNL uygulanan böbrekte saptanan ortanca rezidüel taş fragmanı 7.5 mm (min 2 max 12) ve FURS uygulanan böbrekte saptanan ortanca rezidüel taş fragmanı 7 mm (min 1 max 15) olarak saptandı. PCNL uygulamasında 6 (%13,3) hastada 12-16 Fr, 1 (%2,2) hastada 14-18 Fr , 22 (%48,9) hastada 16 - 20 Fr, 1 (%2,2) hastada 20-24 Fr ve kalan 15 (%33,4) hastada 26-30 Fr amplatz kılıf kullanılmıştır. Taşların kırılması için 28 (%62,2) hastada lazer litotripsi, 14 (%13,3) hastada balistik litotripsi, 2 (%4,2) hastada her iki yöntem ve 1 (%2,2) hastada taşın mekanik olarak ekstraksiyonu uygulandı. FURS uygulamasında 2 (%4,4) hastada üreteral akses kılıfı (ÜAK) kullanılmamış olup 19 (%42,2) hastada 9,5/11,5 Fr; 4 (%8,9) hastada 10/12 Fr; 20 (%44,4) hastada 12/14 Fr ÜAK kullanıldı. Tüm hastalarda taş tedavisi için lazer litotripsi kullanıldı. Sonuç Bilateral Simultane Endoskopik Taş cerrahisi (SBES) , seçilmiş hastalarda güvenli ve uygulanabilir bir yöntem olarak görünmektedir ancak en az 2 deneyimli cerrah ve iyi donanımlı bir hastaneye ihtiyaç vardır.
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    Melatonin prevents deterioration of erectile function in streptozotocin-induced diabetic rats via sirtuin-1 expression
    (WILEY, 2020) ŞEKERCİ, ÇAĞRI AKIN; Sahan, Ahmet; Akbal, Cem; Tavukcu, Hasan Huseyin; Cevik, Ozge; Cetinel, Sule; Sekerci, Cagri Akin; Sener, Tarik Emre; Sener, Goksel; Tanidir, Yiloren
    A review of the literature indicated that sirtuin-1 expression, a regulator of nitric oxide bioavailability in erectile dysfunction (ED) after melatonin therapy, has not yet been investigated. The objective of this study was to evaluate the protective effects of melatonin for erectile function with sirtuin-1 protein expression in type 1 diabetic rat models. Fifty male Sprague Dawley rats were placed into five groups. Except for those in the control group (C), each animal received a single dose (60 mg/kg) of streptozotocin to induce diabetes. The animals were placed into the diabetes (D) group, insulin (I) group (6 U/kg/day), melatonin (Mel) group (10 mg kg(-1) day(-1)) and combined treatment (I + Mel) group. Ten weeks later, the serum testosterone levels, intracavernosal pressure (ICP), mean arterial pressure (MAP), malondialdehyde (MDA), cyclic guanosine monophosphate (c-GMP), 8-hydroxydeoxyguanosine (8-OHdG), nitric oxide synthase (NOS), caspase-3 activity, sirtuin-1 and endothelial nitric oxide synthase (eNOS) protein expression and histological findings were assessed. The mean ICP/MAP ratio for the D group was lower than the mean ratios for the other groups. The treatment groups, particularly the I + Mel group, exhibited lower 8-OHdG and MDA levels and caspase-3 activity than the D group. The sirtuin-1 and eNOS expression and cavernosal tissue (CT) histology seemed to have been preserved by the melatonin and/or insulin therapy. These results were indicative of a profound protective effect of melatonin by the activation of sirtuin-1 protein expression against hyperglycemia-induced oxidative CT injury.
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    PublicationOpen 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.