Erdogan, Abdullah; Keskin, Ercument; Sambel, Murat; Polat, Salih; Kocak, Mehmet; Kilinc, Ozkan

Purpose: To examine the efficacy of ureteral jet flow measured by Doppler ultrasonography (USG) together with radiological parameters obtained by noncontrast enhanced CT in predicting whether a ureteral stone is impacted. Materials and Methods: A total of 178 patients that met the criteria were included in the study. Stone size, location, grade of hydronephrosis, HU values of the stone and the proximal and distal parts of the stone, and ureteral wall thickness (UWT) were obtained from noncontrast enhanced abdominal CT images. Ureteral jet flows (Vmax) were measured and recorded by Doppler USG. Thirty-eight cases in whom the guidewire or opaque contrast material could not pass beyond the stone were included in the impacted ureteral stone (IUS) group, whereas the remaining 140 patients constituted the non-IUS (non-IUS) group. Results: Significant independent predictors of IUS were determined as stone size (odds ratio [OR]: 2.23, p = 0.020), ureteral HU value under the stone (OR: 1.11, p = 0.014), UWT (OR: 5.66, p = 0.009), anteroposterior diameter (OR: 1.23, p = 0.033), and the Vmax value of the stone side (OR: 0.76, p = 0.011). The proposed scoring system predicted IUS with 89% sensitivity and 91% specificity at a cutoff value of 11.5. Conclusion: Determining whether a ureteral stone is impacted is important in deciding on the optimal treatment modality. The nomogram and scoring system that we created based on the data that were obtained with noninvasive methods can predict IUS with high sensitivity and specificity.

Gultekin, Mehmet Hamza; Erdogan, Abdullah; Akyol, Fethi

Purpose: To compare the efficacy of the erector spinae plane block (ESPB) and conventional analgesia (CA) in pain management after percutaneous nephrolithotomy (PCNL). Materials and Methods: After obtaining the approval of the institutional ethics committee and patients' written informed consent, 60 cases ages 18 to 65 years, with the status of American Society of Anesthesia I/II and body mass index of 18.5 to 30, were included in the study. The patients were randomized to receive ESPB or CA by a computer-based list. Results: The demographic parameters were similar in both groups. Regarding the visual analog scale (VAS) score assessment, the patients in the ESPB group described statistically less pain according to the total score and evaluations at hours 0, 1, 6, and 24 (p = 0.001, 0.009, <0.001, and 0.014, respectively). The time to first rescue analgesic was longer in the ESPB group compared with the CA group (172.33 ± 180.5 minutes vs 84.33 ± 71.12 minutes), which was statistically significant (p = 0.016). The use of tramadol and paracetamol was less in the ESPB group (60 ± 72.3 mg vs 120 ± 55 mg and 1.8 ± 0.76 g vs 3.2 ± 0.99 g, respectively). (p = 0.001 and <0.001, respectively). Conclusions: ESPB is a safe technique that provides effective postoperative analgesia in patients undergoing PCNL. ESPB decreases the postoperative VAS score, prolongs the salvage analgesia time, and reduces the need for paracetamol and tramadol use compared with general anesthesia with CA.

Aykan, Serdar; Singhal, Paras; Nguyen, Daniel P.; Yigit, Akin; Tuken, Murat; Yakut, Emrah; Colakerol, Aykut; Sulejman, Suhejb; Semercioz, Atilla

Purpose: To examine perioperative, pathologic, and early continence outcomes of laparoscopic radical prostatectomy (RP) aided by a new-generation three-dimensional (3D) display system and compare them with those from the same operation aided by a conventional, two-dimensional (2D) display system. Patients and Methods: A total of 95 consecutive patients underwent laparoscopic RP for clinically localized prostate cancer (PC) by an experienced single surgeon from October 2009 to December 2012. Baseline characteristics, perioperative and pathologic variables, and continence data at 3 months after surgery were retrospectively reviewed from a prospectively maintained database. Categoric and continuous variables were compared using chi-square, Student t, and Wilcoxon rank-sum tests, as appropriate. Results: A total of 29 patients underwent laparoscopic RP using a 3D display system and 66 patients underwent laparoscopic RP using a 2D display system. The two groups were comparable for all clinical and pathologic variables. Mean total operative time for the 3D group was 131 minutes (standard deviation [SD]±18) compared with 190 (SD±31) for the 2D group (P<0.001). Mean time to perform the urethrovesical anastomosis was 28 minutes (SD±6) for the 3D group compared with 87 minutes (SD±17) for the 2D group (P<0.001). Blood loss was lower in the 3D group, and the difference was statistically significant (P<0.001). A statistically significant higher number of patients in the 3D group had early recovery of continence compared with patients in the 2D group (14/28 (50%) patients in the 3D group vs 16/64 (25%) patients in the 2D group, P=0.02). Conclusions: Laparoscopic RP aided by a new-generation 3D display system is associated with shorter operative times, reduced blood loss, and higher early continence rates in comparison with that aided by a 2D display system. In particular when considering economic issues, 3D laparoscopic RP may represent an acceptable alternative to robot-assisted laparoscopic RP.

Akin, Y; Basara, I; Yucel, S; Gulmez, H; Ates, M; Bozkurt, A; Nuhoglu, B; Erdogru, T

Akin, Yigit; Yucel, Selcuk

Akin, Yigit; Yüksel, Kivanc; Bassorgun, Ibrahim; Çiftçioglu, Mehmet Akif; Yücel, Selcuk; Baykara, Mehmet; Nuhoglu, Baris; Erdogru, Tibet

Baykara, Mehmet; Akin, Yigit; Sahiner, Ilker Fatih; Yücel, Selcuk; Erdogru, Tibet; Tosun, Ozgur

Akin, Yigit; Sahiner, Ilker Fatih; Yücel, Selcuk; Danisman, Ahmet; Erdogru, Tibet; Baykara, Mehmet

Akin, Yigit; Yücel, Selcuk; Sahiner, Ilker Fatih; Güntekin, Erol; Baykara, Mehmet