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    Comparison of Safety and Efficiency of General, Spinal and Epidural Anesthesia Methods Used for the Endoscopic Surgical Treatment of Ureteral Stones: Which One is Better To Access The Ureter and Reach The Stone?
    (UROL & NEPHROL RES CTR-UNRC, 2020) Oztekin, Unal; Caniklioglu, Mehmet; Atac, Fatih; Kantekin, Cigdem Unal; Gurel, Abdullah; Isikay, Levent
    Purpose: The aim of this study is to evaluate the effects of anesthesia methods on the success of urethral access and stone access achievement in endoscopic treatment of urolithiasis. Materials and Methods: In this prospective randomized study, 105 patients who underwent primary ureterorenoscopy (URS) procedure for ureteral stones were evaluated. The patients were randomized into three groups by permuted block randomization according to the applied anesthesia method: General anesthesia (GA): 33 patients, Spinal anesthesia (SA): 31 patients, and Epidural anesthesia (EA): 31 patients. Ten patients, whose ureteral access was not successful, were dropped out. The success of the three anesthesia methods on the success of the ureter access and its effects on surgical outcomes were compared. Results: There was no statistically significant difference among the three groups in terms of the demographic values and preoperative features except the American Society of Anesthesiologists (ASA) status. Dilatation and the access time to stone were statistically significantly longer in SA and EA group compared to the GA group. There was no statistically significant difference among the groups in terms of operation, lithotripsy time, stone-free rate (SFR), and complication rates. The Visual Analog Scale (VAS) scores in the 8th and 24th hours were statistically significantly higher in the GA group. Conclusion: In patients who decided to undergo primary ureterorenoscopy procedure, it can be suggested to treat with GA to provide a better relaxation of the ureter if there are no contraindications.
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    The concomitant use of USP28 and p53 to predict the progression of urothelial carcinoma of the bladder
    (ELSEVIER GMBH, 2020) Devrim, Tuba; Atac, Fatih; Devrim, Alparslan Kadir; Balci, Mahi
    The Ubiquitin Specific Peptidase 28 (USP28) is a deubiquitinase involved in the DNA damage pathway. Recently, USP28 protein is reported to play roles in the mechanism of p53 action and could be a possible prognostic marker for bladder cancer (BCa). This study aims to explore the relation of USP28 with tumor growth and invasion, and also to investigate the interplay between USP28 and p53 in BCa. Expression levels of USP28 and p53 in human BCa (invasive and non-invasive, n = 43) and control tissues (n = 8) were evaluated by immunohistochemistry and quantitative real-time polymerase chain reaction (qPCR) profiling. The relationship between protein and gene expression levels, clinicopathologic features and prognosis were evaluated. Significant positive correlations were found between BCa tumor progression and the USP28 expression, and also between the USP28 and p53 scores (p all < 0.05). Immunohistochemistry staining percentages were strongly correlated between USP28 and p53, and also positive correlations between tumor progression and p53 expressions were determined (p all < 0.001). Interestingly, USP28 and p53 were highly expressed and correlated in BCa. Consequently, the immunohistochemistry and qPCR results reported in our study suggested the idea that USP28 in coordination with p53 could serve as a marker in BCa progression.
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    The effect of ureterorenoscopy and retrograde intrarenal surgery procedures on renovascular hemodynamics
    (BAYRAKOL MEDICAL PUBLISHER, 2020) Oztekin, Unal; Erkoc, Fatih; Sari, Sercan; Selmi, Volkan; Gurel, Abdullah; Atac, Fatih
    Aim: The aim of this prospective clinical study was to evaluate the preoperative and postoperative intrarenal vascular parameters of the kidneys undergoing URS and RIRS operations and compare the outcomes with the results of the normal contralateral kidneys. Materials and Methods: A total of 89 patients were included in the study. There were 42 and 47 patients in RIRS and URS groups respectively. The ureteral tract with stone formation was named as operated side, and the contralateral side was named as non-operated side. Preoperative gray-scale and CDUS measurements were obtained 24 h before and 8 h after the operations. The RI measurements were calculated from the upper pole, middle area, and the lower pole of the kidney and averaged. Results: There was no statistically significant difference in the demographic and peroperative features between the two groups except for irrigation fluid volume. Preoperative mean RI values were higher than the contralateral non-operated side kidney but not statistically significant (p=0,346). The.RI values were higher on the operated side in RIRS group compared with URS according to the selected surgery method (p=0,041). Discussion: Endoscopic stone surgery procedures increase renal vascular resistance by increasing intrarenal pressure. Therefore, we recommend reducing the use of irrigation fluids as much as possible during surgical applications.
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    Rare Plasmacytoid Urothelial Carcinoma of the Bladder: Two Case Reports
    (Urol & Nephrol Res Ctr-Unrc, 2019) Devrim, Tuba; Atac, Fatih; Altunkaya, Canan; Ozbek, Aye; Ozdemir, Gulhan; Eryol, Merve
    Plasmacytoid urothelial carcinoma is a rare and aggressive form of urothelial carcinoma characterized with delayed presentation and poor prognosis. Very few cases of this carcinoma have been reported in the literature. Here, we report and discuss two cases of bladder plasmacytoid urothelial carcinoma of a 57-year-old male presented with renal colic, and a 33-year-old female presented with macroscopic hematuria. Pathologic examinations of the transurethral biopsies revealed urothelial carcinoma with plasmacytoid appearance. Subsequently, immunohistochemical evaluation showed positive expression of epithelial markers and CD138. Additionally, losing of the membranous expression of E-cadherin verified the diagnosis of plasmacytoid urothelial carcinoma.