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Öğe Comparison of 68Ga-PSMA PET/CT and mp-MRI in regard to local staging for prostate cancer with histopathological results: A retrospective study(Wiley, 2022) Ucar, Taha; Gunduz, Nesrin; Demirci, Emre; Culpan, Meftun; Gunel, Humeyra; Kir, Gozde; Atis, Ramazan GokhanBackground Imaging modalities are used to diagnose and clinical grading of clinically significant prostate cancer. In this study, 68Ga-PSMA PET/CT (PSMA) and multiparametric prostate MRI (mp-MRI) were compared in regard to locating intraprostatic tumor and locoregional staging. Methods After ethics committee approval, a total of 49 patients with prostate cancer who had mp-MRI and PSMA before radical prostatectomy were included. Preoperative and postoperative PSA, transrectal ultrasound-guided prostate biopsy (TRUS-Bx) ISUP grade, radical prostatectomy ISUP grade, body mass index (BMI), TRUS prostate volume, mp-MRI tumor mapping, PSMAtumor mapping, pathologic tumor mapping, extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node invasion (LNI), and bladder neck invasion (BNI)were retrospectively evaluated. Index tumor was located by uroradiologist, nuclear medicine specialist, and uropathologist on a 12-sector prostate pathology map and compared with each other in terms of accuracy and locoregional clinical staging. Results Mean age of the patients was 66.18 +/- 6.67 years and the mean of preoperative PSA results was 21.11 +/- 32.56 ng/ml. Nearly half of the patients' (44.9%) pathology was reported as ISUP grade 4 and 5% and 18.4% of patients were surgical margin positive. According to the pathological findings, 362 out of 588 sectors were tumor-positive, 174 out of 362 sectors were tumor-positive in mp-MRI, and 175 out of 362 sectors were tumor-positive in PSMA. Both PSMA and mp-MRI were comparable (p = 0.823) and accurate to detect the location of the intraprostatic index tumor (AUC = 0.66 vs. 0.69 respectively, p = 0.82). The sensitivity and the specificity of the PSMA and mp-MRI for localizing intraprostatic index tumors were 42.5% versus 49.5% and 90.7% versus 88.6% respectively. mp-MRI was more accurate than PSMA in terms of EPE (AUC = 0.8 vs. AUC = 0.57 respectively, p = 0.027) and both methods were comparable in terms of SVI (AUC = 0.75 vs. AUC = 0.75, p = 0.886) and BNI (AUC = 0.51 vs. AUC = 0.59, p = 0.597). PSMA and mp-MRI were comparable in terms of LNI (AUC = 0.76 vs. AUC = 0.64, p = 0.39). Conclusion mp-MRI should be considered for its high accuracy in the diagnosis of EPE, especially before decision-making for nerve-sparing surgery in high-risk patients. Both imaging modalities were accurate for localizing intraprostatic index tumor. PSMA is accurate for detecting LNI.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 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 Struggle, current situation and future perspective for European urology trainees. A vision from The European Society of Residents in Urology(Wiley, 2021) Mantica, Guglielmo; Pang, Karl H.; Nikles, Sven; Ucar, Taha; Mattigk, Angelika; Karsza, David; Rivas, Juan Gomez[Abstract Not Available]
