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Öğe Assistant port is unnecessary for robotic-assisted laparoscopic pyeloplasty in children: a comparative cohort study(Springer, 2022) Danacioglu, Yavuz Onur; Keser, Ferhat; Polat, Salih; Gunaydin, Bilal; Comez, Yusuf Ilker; Silay, Mesrur SelcukObjective To compare the postoperative outcomes including the cosmetic results of robotic-assisted laparoscopic pyeloplasty (RALP) performed with and without assistant port in pediatric population. Methods 47 patients with ureteropelvic junction obstruction consecutively underwent RALP were stratified as: three-port (Group 1, n = 26) and four-port (Group 2, n = 21). In Group 1, no assistant port was placed and double-J stent was introduced with the aid of an angiocatheter via the percutaneous route. In group 2, an assistant port was placed. The Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale(VSS), Satava, Clavien classification systems, and success rates were compared. Results We found similar success rates for both groups (group 1:96.2%, group 2:100%). Two groups were similar in terms of improvement in the postoperative anteroposterior diameter of the renal pelvis and parenchymal thickness. There was no difference in terms of perioperative and postoperative complication rates (group 1:19.2%, group 2:9.5%). The total PSAS was significantly lower in Group 1 (p < 0.008). No difference was observed for VSS and OSAS. Conclusions Using an assistant port does not improve the success or complications of RALP, while the cosmetic outcomes are inferior to three-port RALP in children. We suggest avoiding the use of assistant port during RALP in children.Öğe Comparison of Retrograde Intrarenal Surgery and Micro-percutaneous Nephrolithotomy for Kidney Stones 5-10 mm in Diameter(Galenos Yayincilik, 2020) Guner, Bayram; Gunaydin, BilalAim: To compare the results of micro-percutaneous nephrolithotomy (micro-PNL) and retrograde intrarenal surgery (RIRS) for symptomatic renal stones 5-10 mm in diameter. Methods: A total of 86 patients, who underwent RIRS (n=53) and micro-PNL (n=23), were evaluated retrospectively. Urine analysis, serum creatinine level, urine culture and non-contrast computed tomography scan were performed in all patients preoperatively. Kidney stones were opaque in all cases. Unresolved coagulopathy, active urinary infection, morbid obesity, missing data and pregnancy were considered the criteria for exclusion. The groups were compared in terms of operative time, Visual analogue scale score, analgesic requirement, retreatment, transition to other treatment, complication and stone-free rates and length of hospital stay. Results: Both surgical techniques were similar for all parameters except need for analgesics, which was higher in the micro-PNL group (p=0.026). The stone-free rate was 85.7% in the RIRS group and 78.2% in the micro-PNL group (p=0.43). Conclusion: Both methods can be administered as alternative modalities with high success and low complication rates. However, analgesics requirement was higher in micro-PNL group.Öğe Does previous endoscopic subureteric injection (STING) effect the outcomes of robot-assisted laparoscopic ureteral reimplantation surgery (RALUR) in children?(Elsevier Sci Ltd, 2023) Comez, Ilker; Ucar, Taha; Telli, Onur; Gunaydin, Bilal; Silay, M. SelcukBackground There is lack of evidence on the success of robot-assisted laparoscopic ureteral reimplantation (RALUR) for the treatment of vesicoureteral reflux (VUR) who had prior intervention. Objective This study aimed to evaluate the effect of previous unsuccessful STING on the outcomes of RALUR in children. Study design A total of 67 children treated with RALUR by a single surgeon for the treatment of VUR were scanned between February 2018 and April 2022. Two patients were excluded from the final data analysis due to the presence of a megaureter. Patients were divided into two groups: those with a history of STING (Group A -n:14) and those without STING (Group B -n:51). Patient characteristics, previous numbers of injections, console time, total operative time, perioperative and postoperative complications and clinical success data were collected. Clavien Dindo and Satava complication scales were used as the standard record of peri and postoperative complications. Radiographic success was defined as absence of reflux detected on postoperative voiding cystourethrography, whereas clinical success was defined as the absence of a febrile urinary tract infection during the follow-up. Mann-Whitney U and Chi-square tests and Fisher exact test were used where appropriate. Results A total of 36 (55.3%) female versus 29 (44.6%) male patients were operated for 96 refluxive ureters. Nearly half of the patients were with bilateral VUR (n = 31). The mean follow-up was 20.2 +/- 15.4 months. The median age of patients was 59 +/- 31 (range: 28-132 months) versus 46 +/- 33.1 (range: 7-206 months) for groups A and B respectively (p = 0.22). Gender, age, peri-and postoperative complication rates, and clinical success were comparable between the two groups. The median operative time and the console time was signifi-cantly higher in children with history of STING (op time: 142.5 +/- 27.4 versus 120 +/- 24.9 min (p = 0.008), console time: 117.5 +/- 28.2 versus 100 +/- 24.5 min (p = 0.011) for groups A and B, respectively. A total of six complications (9.2% ) occurred with none of them were greater than Clavien grade 3b. The overall clinical success rate was 97%, with 2 cases of clinical failure. In both cases, VCUG demonstrated absence of VUR. Discussion The outcomes of our study provided that RALUR is effective with more than 95% success rates despite failed endoscopic injection procedures. Conclusion The previous history of STING neither changes the success nor the complication rates of RALUR. How-ever, this can lead to more challenging surgery by increasing the total operative times.Öğe Evaluation of effectiveness of antiandrogen treatments on cavernosal tissues in rats(Wiley, 2020) Firat, Fatih; Erdemir, Fikret; Gunaydin, Bilal; Parlaktas, Bekir Suha; Markoc, Fatma; Yasar, AdemIn this study, we aimed to compare changes in cavernosal tissues in rats with antiandrogen treatment and orchiectomy. A total of 42 Wistar albino rats were divided into four groups. Group I, control group, Group II, LH-RH was given for 1 month, Group III-LH-RH + Bicalutamide was given for 1 month, and Group IV was defined as orchiectomy and followed up for 1 month. Measurements of intracavernosal pressure with different electrical stimuli and pathological findings of smooth muscle collagen in cavernosal tissues were examined. While the cavernosal pressure response in all the different electrical stimuli given in the control group and in all other groups was significantly lower than that in the other groups, it was statistically significant at 7.5 and 10 V (p = .005, p < 0001). According to the pathologic evaluation, the density of tissue collagen increased significantly in the other groups according to the control group. In groups 3 and 4, the density of 4+ collagen was found to be increased according to Groups 1 and 2. In the LH-RH alone group, it appears that there are no 4+ colloid density and less damage. According to these findings, the negative effect of LH-RH treatment on cavernosal tissues appears to be less.Öğe Hand-assisted laparoscopic donor nephrectomy in kidneys with multiple renal arteries versus a single renal artery: An analysis of vascular complications from 1,350 cases(Aves, 2020) Arpali, Emre; Karatas, Cihan; Akyollu, Basak; Yaprak, Dogukan; Gunaydin, Bilal; Kocak, BurakObjective: Laparoscopic donor nephrectomy (LDN) has been shown to be a safe approach with better morbidity results. Impact of multiple renal arteries (MRAs) and anatomical variations has been reviewed by many authors. In our study, the relationship between the donors with MRAs and risk of perioperative vascular complications related to donor nephrectomy was investigated. Material and methods: Patients who underwent hand-assisted LDNs between January 2007 and February 2018 were reviewed retrospectively. Patient age, sex, body mass index (BMI), waist circumference, side of donor nephrectomies, donors with MRAs, intraoperative vascular complications, conversion rates, hospitalization durations, and operative times were extracted. Risk factors for perioperative vascular complications were defined. Results: There were MRAs in 288 kidney donors (21.3%). The number of patients who underwent a right donor nephrectomy was 113 (8.4%). BMI, waist circumference, and postoperative hospital stay were not significantly different between donors with one artery and those with MRAs (p>0.05). The renovascular complication rate and overall conversion rate to open surgery were significantly higher in donors with MRAs (p<0.05). Conclusion: Perioperative safety of the kidney donors is of crucial importance. Surgeons performing LDNs must be aware of the potential risks. Our analysis suggests that procurement of kidneys from donors with MRAs is a risk factor for renovascular complications.Öğe Hand-assisted laparoscopic donor nephrectomy: 1864 cases in 15 years of experience(Tubitak Scientific & Technological Research Council Turkey, 2022) Gunaydin, Bilal; Ucar, Taha; Arpali, Emre; Akyollu, Basak; Akinci, Serkan; Karatas, Cihan; Oztorun, KenanBackground/aim: To evaluate hand-assisted laparoscopic donor nephrectomy (HALDN) in terms of intraoperative and postoperative results. Materials and methods: After institutional review board approval was obtained, a total of 1864 HALDN operations performed between March 2007 and January 2022 were retrospectively analyzed. Age, sex, body mass index (BMI), status of smoking and presence of previous abdominal surgery, laterality, operative time, transfusion requirement, port counts, length of extraction incision, time until mobilization, time until oral intake, donor serum creatinine levels before and one week after the surgery, length of postoperative hospital stay, intraoperative complications, and postoperative recovery and complications were recorded and statistically analyzed. Multiple renal arteries, BMI, right nephrectomy and male sex were also separately evaluated as risk factors for complications and operative time. Results: A total of 825 (44.26%) male and 1039 (55.74%) female patients were enrolled in the study. The mean age of the patients was 45.79 +/- 12.88 years. There were a total of 143 complications (7.67% of the total 1864 cases) consisting of 68 (3.65%) intraoperative and 75 (4.02%) postoperative complications. Open conversion was necessary for 10 patients (0.53%) to manage intraoperative complications. Reoperation was needed for 1 patient due to bleeding 6 h after the operation. Multiple renal arteries were a risk factor for intraoperative complications and prolonged operative time. Right nephrectomy and male sex were also related with longer operative times. Conclusions: HALDN is a safe procedure associated with low complication rates.Öğe Risk factors for febrile urinary tract infections in the first year after pediatric renal transplantation(Wiley, 2020) Arpali, Emre; Karatas, Cihan; Akyollu, Basak; Akinci, Serkan; Gunaydin, Bilal; Sal, Oguzhan; Nayir, AhmetUrinary tract infection is the most common infectious complication following kidney transplant. Anatomic abnormalities, bladder dysfunction, a positive history of febrile urinary tract infection, and recipient age are reported risk factors. The aim of this study was to determine the risk factors for fUTI, which necessitated hospitalization in the first year after renal transplantation in our pediatric transplant population. A retrospective review of 195 pediatric patients who underwent kidney transplant between 2008 and 2017 from a single institution was performed. All patients admitted to the hospital with fUTI were marked for further analyses. The risk factors including age, gender, dialysis type, history of urologic disorders, and preoperative proteinuria for fUTI in the first year after kidney transplantation and graft survivals were investigated. Independent-sample t test and chi-square tests were used for univariate analysis. Exhaustive CHAID algorithm was used for multivariate analysis. The data of 115 male and 80 female patients were retracted. The mean ages of our cohort for males and females were 9.5 +/- 5.1 and 10 +/- 4.8 years, respectively. The age of the patients at transplant and their gender were found to be a statistically significant risk factors for developing fUTIs. Multivariate analysis showed that fUTI was common in female patients and a subgroup of male patients who had preoperative proteinuria, but no neurogenic bladder had higher risk compared with male patients without proteinuria. Patient surveillance and antibiotic prophylaxis algorithms can be developed to prevent febrile urinary tract infections seen after pediatric kidney transplantation in risky population.Öğe Using Polidocanol in Treatment of Simple Renal Cyst(Springer India, 2020) Guner, Bayram; Gunaydin, BilalThe aim of this study was to assess the efficacy of polidocanol in patients with simple renal cysts who were not eligible for surgery due to comorbidities. Twenty-nine patients with Bosniak type 1 or 2 were assessed retrospectively. All of the cysts were exophytic. All of the patients were injected a maximum 20 mL 3% polidocanol as a sclerosing agent following cyst aspiration. Vanishing of symptoms and decrease in size to 10% of the initial size were accepted as complete remission, decrease in size to 10-50% of the initial size was accepted as partial remission, and a return to the initial size of the cyst in a short time or decrease in size > 50% of the initial size was accepted as failure. The results of an average of 14 months' follow-up are reported. Complete remission was seen in 18 (62%) patients, partial remission was seen in 5 (17.2%) patients, and failure was observed in 6 (20.68%) patients during an average of 14 months' follow-up. Percutaneous sclerotherapy using polidocanol can be used safely and with low complication rates in the elderly population with comorbidities.
