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Publication Metadata only Accuracy of sampling PI-RADS 4-5 index lesions alone by MRI-guided in-bore biopsy in biopsy-naive patients undergoing radical prostatectomy(Elsevier, 2020) Kılıç, Mert; Vural, Metin; Coskun, Bilgen; Saglican, Yesim; Akpek, Sergin; N/A; Acar, Ömer; Esen, Tarık; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 237530; 50536Background: Targeting multİparametric magnetic resonance imaging (MP-MRI)-suspicious regions alone in biopsy-naive patients is not common practice, since it may miss clinically significant prostate cancer (PCa). Objective: To investigate the accuracy of in-bore MRI-guided biopsy of Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 index lesions alone in biopsy-naive patients undergoing radical prostatectomy (RP). Design, setting and participants: A total of 170 patients underwent MRI-guided in-bore biopsy for PI-RADS 4 and 5 index lesions alone between 2013 and 2018, of whom 136 patients were diagnosed with PCa. Fifty-two patients without prior biopsy who underwent RP were included in this study. MP-MRI findings, biopsy results, and whole-mount step-section specimen evaluation were retrospectively analyzed. Outcome measurements and stAtıştical analysis: Continuous variables were reported as mean (standard deviation) or median (range). Differences in parametric variables were calculated by Student t test. Results and limitations: Overall International Society of Urological Pathology grade group (GG) up- and downgrading rates were 23.0% and 7.6% per patient and 24.5% and 6.5% per focus, respectively. Ten of 12 biopsy-detected GG 1 foci were upgraded in the final pathology. In 30 patients, a total of 43 different tumor foci were identified outside the sampled index lesion. Average biopsied and nonbiopsied tumor volumes were found to be 2.02 and 0.45 cm(3), respectively (p < 0.001). The index lesion was the largest focus of tumor in all patients' final histopathological examination; upgrading was identified in only one nonbiopsied focus in a single patient. Limitations include retrospective design and nonstandard indications of in-bore MRI biopsy. Conclusions: In-bore MRI-guided biopsy of PI-RADS 4-5 index lesions alone in biopsy-naive patients is a safe and accurate diagnostic modality allowing appropriate patient selection for individualized treatment. Patient summary: In-bore magnetic resonance imaging-guided prostate biopsy of suspicious lesions alone allows accurate risk stratification of patients and reduces the detection of insignificant prostate cancer. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.Publication Metadata only Can Ga-68 PSMA PET/CT replace conventional imaging modalities for primary lymph node and bone staging of prostate cancer?(Elsevier, 2020) Kılıç, Mert; N/A; Esen, Tarık; Seymen, Hülya; Acar, Ömer; Demirkol, Mehmet Onur; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 50536; 350778; 237530; 196946Imaging is critical for primary staging of prostate cancer. Traditional imaging modalities (computerized tomography scan and nuclear medicine bone scans) are limited by their suboptimal diagnostic performance. Recent meta-analyses have demonstrated that nuclear imaging with Ga-68-labeled prostate-specific membrane antigen ligand (Ga-68-PSMA) using positron emission tomography/computed tomography (PET/CT) has higher sensitivity and specificity in this setting compared to conventional imaging techniques. Ga-68-PSMA PET/CT for whole-body assessment can be used as the sole imaging modality for primary lymph node and bone staging of prostate cancer. Patient summary: There is a rapidly growing body of evidence that nuclear imaging with Ga-68-labeled prostate-specific membrane antigen ligand using positron emission tomography/computed tomography has a higher detection rate for lymph node and bone metastases in prostate cancer patients. This approach has strong potential to replace conventional techniques in the primary setting in the near future. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.Publication Metadata only Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI-RS 2023(Wiley, 2024) Hashim, Hashim; Malde, Sachin; Sinha, Sanjay; Sahai, Arun; Selai, Caroline; Agro, Enrico Finazzi; Abrams, Paul; Wein, Alan; Tarcan, Tufan; Acar, Ömer; ; School of Medicine;Aims Lower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome.MethodsA think tank of ICI-RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS.ResultsOur think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity.ConclusionFuture research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.Publication Metadata only Can we predict whether a man with acute or chronic urinary retention will void after bladder outflow resistance reduction surgery? ICI-RS 2023(Wiley, 2024) Malde, Sachin; Sinha, Sanjay; Sahai, Arun; Perrouin-Verbe, Marie-Aimee; Hashim, Hashim; Agro, Enrico Finazzi; Wein, Alan; Abrams, Paul; Tarcan, Tufan; Acar, Ömer; ; School of Medicine;Aims To address the predictive factors of a successful voiding after bladder outflow resistance reduction surgery (BORRS) in men presenting with acute or chronic urinary retention (UR).MethodsA think tank (TT) of ICI-RS was gathered in 2023, Bristol, UK, to discuss several aspects of the problem, such as the pathophysiology of UR, the clinical and urodynamic evaluation of men with UR and whether it is possible to predict which men will be able to successfully void after treatment with contemporary surgical options.ResultsThe TT agreed that successful voiding after BORRS depends on several factors but that a strong recommendation cannot be made regarding preoperative evaluation and whether there are predictive factors of success because of the heterogeneity of patients and methodology in published trials. The diagnosis of obstruction in men with UR may be challenging when there is apparent reduced detrusor contraction during urodynamic studies. Even in the absence of bladder contractility there is documentation of such cases that have voided adequately after BORRS. Still, detrusor underactivity and inadequate relief of prostatic obstruction are the main causes of an unsuccessful voiding after BORRS. Conventional resection and enucleation methods remain the most successful surgeries in relieving UR in men, whereas the efficacy of minimally invasive surgical treatments needs to be assessed further.ConclusionResearch is needed to understand the pathophysiology of UR and the predictors of successful voiding after different types of BORRS in men with UR.Publication Metadata only Erdheim-chester disease: case report with testes involvement and review of literature(Elsevier Science inc, 2018) N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; Sezer, Havva; Aygün, Murat Serhat; Armutlu, Ayşe; Acar, Ömer; Falay, Fikri Okan; Dereli, Dilek Yazıcı; Deyneli, Oğuzhan; Alagöl, Faruk; Teaching Faculty; Teaching Faculty; Teaching Faculty; Faculty Member; Teaching Faculty; Faculty; Faculty Member; Doctor; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 154807; 291692; 133567; 237530; 246484; 179659; 171914; /N/AN/APublication Metadata only False-positive pancreatic uptake detected on 68GA-PSMA PET/CT: a priority changing incidental finding while assessing the need for a prostate biopsy(Lippincott Williams & Wilkins, 2017) N/A; N/A; N/A; N/A; N/A; Demirkol, Mehmet Onur; Kiremit, Murat Can; Acar, Ömer; Sağ, Alan Alper; Kapran, Yersu; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 196946; 222920; 237530; N/A; 168101A 72-year-old man underwent Ga-PSMA PET/CT because of an elevated prostate-specific antigen level despite prior prostatectomy. Besides low-intensity prostatic PSMA reactivities, a faintly PSMA-positive lesion in the pancreatic corpus drew attention, which seemed suggestive of a primary pancreatic cancer on the subsequent MRI and therefore had to be excised. The final diagnosis was pT3 low-grade neuroendocrine tumor. PSMA-positive incidentalomas, detected on Ga-PSMA PET/CT, can reveal more clinically significant extraprostatic disorders.Publication Metadata only Feasibility, safety and efficacy of argon beam coagulation in robot-assisted partial nephrectomy for solid renal masses <= 7 cm in size(Springernature, 2021) Kılıç, Mert; Tarım, Kayhan; Köseoğlu, Ersin; Canda, Abdullah Erdem; Kordan, Yakup; Balbay, Mevlana Derya; Acar, Ömer; Esen, Tarık; Researcher; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 327605; 350876; 116202; 157552; 153320; 237530; 50536One of the most important steps of the partial nephrectomy (PN) is hemostatic control of tumor bed which also effects the warm ischemia time (WIT). Argon beam coagulation (ABC) for decades is a well-known method for surface controls during major open surgical sites. This study aimed to compare peri- and postoperative relevant parameters in patients with ABC or internal renorrhaphy (IR) during robot-assisted partial nephrectomy (RAPN). One hundred seventy patients with <= 7 cm tumors, who underwent RAPN at our institutions, were included in this retrospective study. Tumor bed was controlled by either IR or by ABC after closing isolated overt collecting system defects. No additional IR was performed in patients with ABC. Estimated blood loss (EBL), WIT, estimated glomerular filtration rate (eGFR) change, on- vs. off-clamp procedure as well as Clavien-Dindo > 2 complications in both groups were compared. Eighty-seven (51.1%) patients had ABC and 83 (48.9%) had IR as their tumor bed control method. Tumor size, side and RENAL nephrometry score in both groups were similar. Mean warm ischemia time (WIT) was 20.8 min in ABC group and 23.8 min in IR group (p = 0.03). In 4-7 cm tumors, WIT was 19.9 min in ABC group while 26.6 min in IR group (p = 0.026). eGFR change from baseline and EBL favored ABC in entire cohort as well as in 4-7 cm tumors with statistical significance. There were more off-clamp procedures with ABC in <= 4 cm tumors. No ABC specific complications were observed. Within 2 years of follow-up, no patient developed recurrences. The control of the tumor base with ABC during RAPN shortens the warm ischemia times significantly compared to IR. Besides, ABC had better EBL and GFR changes outcomes. With close monitoring of intra-abdominal pressure and frequent venting, disturbing complications of ABC could completely be avoided. ABC was found to be feasible, safe and effective during RAPN.Publication Metadata only Histologically benign PI-RADS 4 and 5 lesions contain cancer-associated epigenetic alterations(Wiley, 2022) Sağlıcan, Yeşim; İnce, Ümit; Kılıc, Mert; Vural, Metin; Coşkun, Bilgen; N/A; N/A; N/A; N/A; N/A; Şeref, Ceren; Acar, Ömer; Saraç, Hilal; Esen, Tarık; Lack, Nathan Alan; PhD Student; Faculty Member; PhD Student; Faculty Member; Faculty Member; Graduate School of Health Sciences; School of Medicine; Graduate School of Sciences and Engineering; School of Medicine; School of Medicine; N/A; 237530; N/A; 50536; 120842Background: The detection rate of clinically significant prostate cancer has improved with the use of multiparametric magnetic resonance imaging (mpMRI). Yet, even with MRI-guided biopsy 15%-35% of high-risk lesions (Prostate Imaging-Reporting and Data System [PI-RADS] 4 and 5) are histologically benign. It is unclear if these false positives are due to diagnostic/sampling errors or pathophysiological alterations. To better understand this, we tested histologically benign PI-RAD 4 and 5 lesions for common malignant epigenetic alterations. Materials and Methods: MRI-guided in-bore biopsy samples were collected from 45 patients with PI-RADS 4 (n = 31) or 5 (n = 14) lesions. Patients had a median clinical follow-up of 3.8 years. High-risk mpMRI patients were grouped based on their histology into biopsy positive for tumor (BPT; n = 28) or biopsy negative for tumor (BNT; n = 17). From these biopsy samples, DNA methylation of well-known tumor suppressor genes (APC, GSTP1, and RAR beta 2) was quantified. Results: Similar to previous work we observed high rates of promoter methylation at GSTP1 (92.7%), RAR beta 2 (57.3%), and APC (37.8%) in malignant BPT samples but no methylation in benign TURP chips. Interestingly, similar to the malignant samples the BNT biopsies also had increased methylation at the promoter of GSTP1 (78.8%) and RAR beta 2 (34.6%). However, despite these epigenetic alterations none of these BNT patients developed prostate cancer, and those who underwent repeat mpMRI (n = 8) demonstrated either radiological regression or stability. Conclusions: Histologically benign PI-RADS 4 and 5 lesions harbor prostate cancer-associated epigenetic alterations.Publication Metadata only ICS educational module: the practice of uroflowmetry in adults(Elsevier B.V., 2024) Agarwal, Mayank Mohan; Rubilotta, Emanuele; De Nunzio, Cosimo; Rosier, Peter; Tarcan, Tufan; Acar, Ömer; School of MedicineAim: To present the body of evidence behind the International Continence Society (ICS) educational module on “Practice of uroflowmetry in adults” which consists of a PowerPoint® presentation. Methods: This evidence review has been prepared by a working group instituted by the ICS Urodynamics Committee. The method used included systematic literature review, consensus formation by the members of the Working Group, and review by members of the ICS Urodynamics Committee core panel. Results: A total of 104 articles were included in this systematic review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Evidence analysis was conducted along the following themes: physiology of voiding, pathophysiology of lower urinary tract dysfunction, technique of uroflowmetry, quality check of the uroflowmetry test, interpretation and reporting of uroflowmetry findings. Conclusions: Uroflowmetry is the most commonly utilized diagnostic test in the evaluation of adults presenting with lower urinary tract symptoms. The practice of uroflowmetry exhibits variations which might lead to inconclusive or inaccurate assessments. The ICS educational module on the Practice of Uroflowmetry in Adults provides up-to-date and evidence-based guidance in an effort to establish standards in the technique, interpretation, and reporting of uroflowmetry.Publication Metadata only Intraoperative inspection of the ureteropelvic junction during pyeloplasty is not sufficient to distinguish between extrinsic and intrinsic causes of obstruction: correlation with histological analysis(Elsevier, 2016) Mut, Tuna; Oktar, Tayfun; Kılıçaslan, Işın; Ander, Haluk; Ziylan, Orhan; N/A; Acar, Ömer; Esen, Tarık; Faculty Member; Faculty Member; School of Medicine; School of Medicine; Koç University Hospital; Koç University Hospital; 237530; 50536N/APublication Metadata only Is there a relationship between alcohol/drug abuse and LUTS/ED?(Carbone Editore, 2016) Uluocak, N.; Kulu, M.; Atılgan, D.; Parlaktaş, B. S.; Kılıç, S.; İnanç, L.; Erdemir, F.; Acar, Ömer; Faculty Member; School of Medicine; 237530Introduction: The aim of the study was to assess the presence and severity of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in the drug and alcohol addicted population. Materials and methods: Alcohol and drug abuse groups constituted of male abusers who presented to a local Alcohol and Drug Abuse Research Center. Control groups were composed of age-matched healthy men who denied any drug/alcohol abuse. Each group was composed of 30 men. Beck Depression and Anxiety Scales, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OAB-V8), International Index of Erectile Function (IIEF-5) and sexual satisfaction scale were the tools applied to the subjects and controls. Additionally, maximum (Qmax) and average urinary flow rates (Qave) were recorded for statistical assessment in all groups. Results: The mean age, number of children, number of siblings, were comparable between the subjects and controls (p> 0.05). LUTS and ED were more prevalent in drug and alcohol abusers when compared with their controls. Higher mean depression and anxiety scores of the drug and alcohol abusers highlighted their worse psychological status. The quality of life and sexual satisfaction assessment of the drug abusers yielded significantly lower results when compared with their controls. Regarding the comparison between alcohol addicts and their controls; quality of life scores were significantly higher whereas sexual satisfaction assessment results were comparable. The Qave values were similar between drug abusers and their controls while mean Qave was significantly higher in the alcohol addicts than their controls. Conclusion: ED and LUTS are more prevalent in alcohol and drug abusers when compared to healthy controls. It can be proposed that alcohol and drug addiction should be considered in the etiology of ED and LUTS especially in young adult population.Publication Metadata only Local salvage treatment of post-brachytherapy recurrent prostate cancer via theranostic application of PSMA-labeled lutetium-177(CIG Media Group, Lp, 2018) Uçar, Burcu; N/A; N/A; N/A; N/A; N/A; Demirkol, Mehmet Onur; Kiremit, Murat Can; Acar, Ömer; Falay, Fikri Okan; Esen, Tarık; Faculty Member; Faculty Member; Faculty Member; Teaching Faculty; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 108964; 222920; 237530; 246484; 50536Both radical prostatectomy (RP) and radiotherapy (RT) are effective treatment alternatives of localized prostate cancer (PCa). However, 10% to 50% and 20% to 65% of the patients will experience biochemical recurrence within 15 years following RP and RT, respectively. According to the results of watchful waiting policy, the median time from biochemical recurrence to development of distant metastases is 3 years, more or less, which pushes clinicians to apply further curative local salvage therapy (LST). LST via various surgical (salvage RP) and non-surgical (high-intensity focused ultrasound, re-brachytherapy, cryotherapy, etc.) options can be offered in this setting. We present a case of locally recurrent PCa after brachytherapy. Considering our patients' body habitus, relatively young age, and marital status (just recently married), sexual side effects of androgen deprivation therapy, local adhesions induced by brachytherapy and prior abdominopelvic surgeries, the lack of institutional experience on cryotherapy/high-intensity focused ultrasound, and the risk of metastatic progression associated with watchful waiting, theranostic application of lutetium-177-labeled prostate-specific membrane antigen imaging and therapy was offered. To the best of our knowledge, this case represents the first example of the successful theranostic application of lutetium-177-labeled prostate-specific membrane antigen, as a LST option in the setting of locally recurrent PCa following curative intent brachytherapy for organ-confined PCa. (C) 2017 Elsevier Inc. All rights reserved.Publication Metadata only Minimally invasive management of zinner's syndrome with same-session robot-assisted seminal vesiculectomy and ipsilateral nephroureterectomy using a single geometry of trocars(Mary Ann Liebert, Inc., 2018) Sağ, Alan Alper; Kılıç, Mert; N/A; Kiremit, Murat Can; Acar, Ömer; Köseoğlu, Ersin; Kordan, Yakup; Balbay, Mevlana Derya; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; Koç University Hospital; N/A; N/A; 222920; 237530; 350876; 350876; 153320Background: seminal vesicle cyst is an extremely rare condition, which is frequently congenital and associated with Zinner's syndrome. This syndrome represents a constellation of seminal vesicle cyst, ipsilateral or contralateral renal agenesis or renal dysplasia, ureteral ectopia, and ejaculatory duct obstruction. We report a young symptomatic patient undergoing robot-assisted laparoscopic excision of a huge seminal vesicle cyst during which an atrophic ipsilateral kidney was discovered incidentally and managed by nephroureterectomy in the same session without changing trocar positions. Case Presentation: a 23-year-old male patient presented with a 2-year history of lower urinary tract symptoms, perineal pain, and recurrent urinary tract infections. Ultrasonography revealed the absence of left kidney and a fluid-filled cystic lesion located behind the bladder on the left side, which was consistent with cystic dilatation of the left seminal vesicle. MRI confirmed the diagnosis of a huge cystic structure originating from the left seminal vesicle and identified the presence of a rudimentary left ureter without an associated renal unit. Cystoscopy revealed bulging of the bladder neck at 6 o'clock position and the ureteral orifices at normal positions and configurations. Based on these findings, the clinical diagnosis was established as Zinner's syndrome. The present case was performed by Da Vinci Si robotic platform using the 5-trocar technique. Conclusion: robot-assisted laparoscopic excision is a safe and feasible option to treat large seminal vesicle cysts, which may be a component of Zinner's syndrome. Simultaneous upper urinary tract interventions, such as nephroureterectomy, can be employed by redocking the robot and repositioning the patient, using the same layout of robotic trocars.Publication Metadata only Multiparametric mri guidance in first-time prostate biopsies: what is the real benefit?(Turkish Soc Radiology, 2015) Colakoglu, Bulent; Vural, Metin; Saglican, Yesim; Tuerkbey, Baris; N/A; Acar, Ömer; Esen, Tarık; Onay, Aslıhan; Rozanes, İzzet; Faculty Member; Faculty Member; Doctor; Faculty Member; School of Medicine; School of Medicine; N/A; School of Medicine; N/A; N/A; Koç Universitiy Hospital; N/A; 237530; 50536; N/A; 125890PURPOSE With the increased recognition of the capabilities of prostate multiparametric (mp) magnetic resonance imaging (MRI), attempts are being made to incorporate MRI into routine prostate biopsies. In this study, we aimed to analyze the diagnostic yield via cognitive fusion, transrectal ultrasound (TRUS)-guided, and in-bore MRI-guided biopsies in biopsy-naive patients with positive findings for prostate cancer screening. METHODS Charts of 140 patients, who underwent transrectal prostate biopsy after the adaptation of mp-MRI into our routine clinical practice, were reviewed retrospectively. Patients with previous negative biopsies (n=24) and digital rectal examination findings suspicious for >= cT3 prostate cancer (n=16) were excluded. T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging were included in mp-MRI. Cognitive fusion biopsies were performed after a review of mp-MRI data, whereas TRUS-guided biopsies were performed blinded to MRI information. In-bore biopsies were conducted by means of real-time targeting under MRI guidance. RESULTS Between January 2012 and February 2014, a total of 100 patients fulfilling the inclusion criteria underwent TRUS-guided (n=37), cognitive fusion (n=49), and in-bore (n=14) biopsies. Mean age, serum prostate specific antigen level, and prostate size did not differ significantly among the study groups. In TRUS-guided biopsy group, 51.3% were diagnosed with prostate cancer, while the same ratio was 55.1% and 71.4% in cognitive fusion and in-bore biopsy groups, respectively (P = 0.429). Clinically significant prostate cancer detection rate was 69.1%, 70.3%, and 90% in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively (P = 0.31). According to histopathologic variables in the prostatectomy specimen, significant prostate cancer was detected in 85.7%, 93.3%, and 100% of patients in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively. CONCLUSION In the first set of transrectal prostate biopsies, mp-MRI guidance did not increase the diagnostic yield significantly.Publication Metadata only Nephron-sparing surgery for renal masses measuring larger than 7 cm on preoperative imaging: a single surgeon, single center experience(Hindawi, 2013) Musaoğlu, Ahmet; Vural, Metin; Akpek, Sergin; N/A; Esen, Tarık; Acar, Ömer; Faculty Member; Faculty Member; School of Medicine; School of Medicine; Koç University Hospital; 50536; 237530Objectives: to document the feasibility of nephron-sparing surgery (NSS) for the surgical treatment of renal masses measuring larger than 7 cm (cT2) on preoperative imaging. Methods: a total of 139 patients have undergone NSS between 2001 and 2012 by a single surgeon in our clinic. Of these, we identified 17 patients whose tumors were measuring greater than 7 cm on preoperative imaging studies and were limited to the kidney. Their charts were retrospectively reviewed. Results: mean age of the study population was 49.8 ± 11.3 years. Thirteen patients were managed by open NSS, while 4 patients have undergone robot-assisted NSS. Mean diameter and mean R.E.N.A.L. score of the tumors that were enucleoresected were 8.2 cm and 8.5, respectively. A total of 5 Clavien grade 2 and higher complications were recorded within 30 days of surgery. Histopathologic examination revealed benign histology in almost 1/4 of the cases. After a median followup of 33 months, all of our patients were alive. Only one patient (5.8%) experienced local recurrence. Conclusions: NSS is a feasible and safe option for large (>7 cm) renal masses. It may be considered not only for imperative conditions but also for highly selected cases with a normal contralateral kidney.Publication Metadata only Preoperative prediction of lymph node invasion in prostate cancer: Ga-68 PSMA PET or nomograms?(Elsevier, 2021) Kılıç, M.; Musaoğlu, A.; N/A; Kordan, Yakup; Köseoğlu, Ersin; Sarıkaya, Ahmet Furkan; Tarım, Kayhan; Özkan, Alev; Kiremit, Murat Can; Acar, Ömer; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Esen, Tarık; Faculty Member; Faculty Member; Researcher; Researcher; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 157552; 350876; 327615; 327605; 12695; 222920; 237530; 116202; 153320; 50536N/APublication Metadata only Prostate-specific membrane antigen-based imaging in prostate cancer: impact on clinical decision making process(Wiley, 2015) Uçar, Burcu; Ramazanoğlu, Sultan Rana; Sağlıcan, Yeşim; N/A; N/A; N/A; Demirkol, Mehmet Onur; Acar, Ömer; Esen, Tarık; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 196946; 237530; 50536BACKGROUND:There is an ongoing need for an accurate imaging modality which can be used for staging purposes, metastatic evaluation, predicting biologic aggresiveness and investigating recurrent disease in prostate cancer. Prostate specific membrane antigen, given its favorable molecular characteristics, holds a promise as an ideal target for prostate cancer-specific nuclear imaging. In this study, we evaluated our initial results of PSMA based PET/CT imaging in prostate cancer. METHODSA total of 22 patients with a median age and serum PSA level of 68 years and 4.15ng/ml, respectively underwent Ga-68 PSMA PET/CT in our hospital between Februrary and August 2014. Their charts were retrospectively reviewed in order to document the clinical characteristics, the indications for and the results of PSMA based imaging and the impact of Ga-68 PSMA PET/CT findings on disease management. RESULTSThe most common indications were rising PSA after localadjuvant treatment followed by staging and metastatic evaluation before definitive or salvage treatment. All except 2 patients had prostatic +/- extraprostatic PSMA positive lesions. For those who had a positive result; treatment strategies were tailored accordingly. Above the PSA level of 2ng/ml, none of the PSMA based nuclear imaging studies revealed negative results. CONCLUSIONSPSMA based nuclear imaging has significantly impacted our way of handling patients with prostate cancer. Its preliminary performance in different clinical scenarios and ability to detect lesions even in low PSA values seems fairly promising and deserves to be supplemented with further clinical studies. Prostate 75:748-757, 2015. (c) 2015 Wiley Periodicals, Inc.Publication Metadata only Robotic surgery in prostate cancer(Springer, 2017) Acar, Ömer; Esen, Tarık; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 237530; 50536Prostate cancer is the second most common malignancy in men (excluding skin cancer) behind lung cancer, with more than one million cases estimated to be diagnosed worldwide in 2016. Radical prostatectomy (RP) has been the most widely used approach for the treatment of organ-confined prostate cancer. However, the high incidence of perioperative morbidities and functional derangements related with open radical retropubic prostatectomy (RRP) has led to the search for less invasive treatments to improve oncological outcomes and quality of life issues. Binder and Kramer were the first to report the feasibility of robotassisted laparoscopic radical prostatectomy in 2001, and the Vattikuti Urology Institute at Henry Ford Hospital in Detroit, Michigan, USA, pioneered the establishment of urologic robotic surgery programs worldwide. The application of robotic technology in surgical practice has developed tremendously over the past three decades. Urologists in particular have embraced surgical robots throughout their evolution, and robot-assisted urologic surgeries have matured into everyday clinical practice in many parts of the world. Herein, we will review the available literature data about robotic surgery in prostate cancer concentrating mainly on the evolution and adaptation of robot-assisted radical prostatectomy (RARP), its perioperative/functional/oncological outcomes, results of comparative studies with open/laparoscopic RP, and relevant future directions related with optimization of RARP outcomes.Publication Metadata only Surgical management of local recurrences of renal cell carcinoma(Hindawi Limited, 2016) Şanli, Öner; Acar, Ömer; Faculty Member; School of Medicine; 237530Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy) may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach) and nonsurgical alternatives (cryoablation, radiofrequency ablation) have yet to be described. In selected patients, surgical resection may have to be complemented with (neo)adjuvant radiotherapy or medical treatment.Publication Metadata only The real-life management of overactive bladder: Turkish Continence Society multicenter prospective cohort study with short-term outcome(WILEY, 2019) Zumrutbas, Ali E.; Citgez, Sinharib; Izol, Volkan; Uzun, Hakki; Kabay, Sahin; Sancak, Eyup B.; Yazici, Cenk; Erdogan, Mehmet S.; Demirkesen, Oktay; N/A; Acar, Ömer; Tarcan, Tufan; Faculty Member; Other; N/A; School of Medicine; School of Medicine; 237530; 173289Introduction Turkish Continence Society aimed to analyze how overactive bladder (OAB) is being managed in routine practice by the urologists in Turkey. Material and methods Fourteen urology departments were randomly selected to represent the whole population in this multicenter study. An online data entry and storage software was created for patient recruitment and data assessment. A survey including demographic data, daily habits, lower urinary tract symptoms, and Turkish-validated OAB-V8 and ICIQ-SF questionnaires were completed by all patients. Second part of the survey, including the questions about clinical evaluation and management of the patient, was completed by the treating physician. Results A total of 507 patients (394 female and 113 male) were included. Behavioral therapy was recommended to 73.2% of female and 81.4% of male patients although bladder diary was requested for 59.5% and 52.7% of the female and male patients, respectively. In the first visit, 86.1% of the female and 89.3% of the male patients were given antimuscarinics (P = .431). Antimuscarinic-related side effects occurred in 94.9% and 88.9% of the female and male patients, respectively (P = .937). However, the rate of medical treatment change due to antimuscarinic-related side effects was only 1.7% in female and 4.8% in male patients at the end of 4 months. Conclusions Behavioral therapy and antimuscarinics were the preferred initial treatment modalities of OAB in concordance with the guidelines. Despite guideline recommendations, bladder diaries were not utilized in half of the patients. Insufficient efficacy appeared to be the main reason for treatment modification.