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    The role of PSMA PET/CT in predicting downgrading in patients with Gleason score 4+4 prostate cancer in prostate biopsy
    (Springer, 2024) N/A; Aykanat, İbrahim Can; Kordan, Yakup; Seymen, Hülya; Köseoğlu, Ersin; Özkan, Arif; Esen, Barış; Tarım, Kayhan; Kulaç, İbrahim; Falay, Fikri Okan; Gürses, Bengi; Baydar, Dilek Ertoy; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Demirkol, Mehmet Onur; Esen, Tarık; School of Medicine; Koç University Hospital
    Background To investigate the predictable parameters associated with downgrading in patients with a Gleason score (GS) 8 (4+4) in prostate biopsy after radical prostatectomy. Methods We retrospectively analyzed 62 patients with a GS of 4+4 on prostate biopsy who underwent robotic radical prostatectomy between 2017 and 2022. Results 38 of 62 (61.2%) were downgraded. In multivariable logistic regression model, Ga-68 prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) SUV max was independent predictor of downgrading (OR 0.904; p = 0.011) and a Logistic Regression model was constructed using the following formula: Y = 1.465-0.95 (PSMA PET/CT SUV max). The model using this variable correctly predicted the downgrading in 72.6% of patients. The AUC for PSMA PET/CT SUV max was 0.709 the cut off being 8.8. A subgroup analysis was performed in 37 patients who had no other European Association of Urology (EAU) high risk features. 25 out of 37 (67.5%) were downgraded, and 21 of these 25 had organ confined disease. Low PSMA SUV max (<8.1) and percentage of GS 4+4 biopsy cores to cancer bearing cores (45.0%) were independently associated with downgrading to GS 7. Conclusion PSMA PET/CT can be used to predict downgrading in patients with GS 4+4 PCa. Patients with GS 4+4 disease, but no other EAU high risk features, low percentage of GS 4+4 biopsy cores to cancer bearing cores, and a low PSMA PET/CT SUV max are associated with a high likelihood of the cancer reclassification to intermediate risk group.
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    Survival benefit of nephroureterectomy in systemic therapy exposed metastatic upper tract urinary urothelial carcinoma patients
    (Springer, 2024) Morra, Simone; Incesu, Reha-Baris; Scheipner, Lukas; Baudo, Andrea; Jannello, Letizia Maria Ippolita; Siech, Carolin; de Angelis, Mario; Tian, Zhe; Creta, Massimiliano; Califano, Gianluigi; Colla Ruvolo, Claudia; Saad, Fred; Shariat, Shahrokh F.; Chun, Felix K. H.; de Cobelli, Ottavio; Musi, Gennaro; Briganti, Alberto; Ahyai, Sascha; Carmignani, Luca; Longo, Nicola; Karakiewicz, Pierre I.; N/A; Tilki, Derya; School of Medicine
    Background It is unknown whether the stage of the primary may influence the survival (OS) of metastatic upper tract urothelial carcinoma (mUTUC) patients treated with nephroureterectomy (NU) and systemic therapy (ST). We tested this hypothesis within a large-scale North American cohort. Methods Within Surveillance Epidemiology and End Results database 2000-2020, all mUTUC patients treated with ST+NU or with ST alone were identified. Kaplan-Maier plots depicted OS. Multivariable Cox regression (MCR) models tested for differences between ST+NU and ST alone predicting overall mortality (OM). All analyses were performed in localized (T1-T2) and then repeated in locally advanced (T3-T4) patients. Results Of all 728 mUTUC patients, 187 (26%) harbored T1-T2 vs 541 (74%) harbored T3-T4. In T1-T2 patients, the median OS was 20 months in ST+NU vs 10 months in ST alone. Moreover, in MCR analyses that also relied on 3 months' landmark analyses, the combination of ST+NU independently predicted lower OM (HR 0.37, p < 0.001). Conversely, in T3-T4 patients, the median OS was 12 in ST+NU vs 10 months in ST alone. Moreover, in MCR analyses that also relied on 3 months' landmark analyses, the combination of ST+NU was not independently associated with lower OM (HR 0.85, p = 0.1). Conclusions In mUTUC patients, treated with ST, NU drastically improved survival in T1-T2 patients, even after strict methodological adjustments (multivariable and landmark analyses). However, this survival benefit did not apply to patients with locally more advanced disease (T3-T4).
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    Uncovering the penile clock: expression of molecular clock proteins in human penile cavernous tissue
    (Korean Soc Sexual Medicine and Andrology, 2024) Alkan, Ilter; Bozkurt, Muammer; Canat, Halil Lutfi; N/A; Durkut, Begüm; Uçak, Melike; Özenci, Çiler Çelik; Koç University Research Center for Translational Medicine (KUTTAM); Graduate School of Health Sciences; School of Medicine
    Purpose: To evaluate the expression of core molecular clock genes/proteins in penile cavernous tissue from healthy male subjects and to determine whether their expression has circadian variation. Materials and Methods: Corpus cavernosum biopsy samples were obtained from 10 healthy males with penile deviation or fracture who underwent surgical intervention during the day and night. The daytime group (n=5) underwent corpus cavernosum tissue sampling during zeitgeber time (ZT) 8-12, while the nighttime group (n=5) underwent sampling during ZT 20-24. The expression and localization of BMAL1, CLOCK, PER1, PER2, PER3, CRY1, and CRY2 proteins were analyzed using immunohistochemistry and quantified using H-score analysis. RT-qPCR analysis was performed to assess the expression of core molecular clock genes in the corpus cavernosum tissue of 5 additional daytime patients. Results: The expression of core molecular clock proteins was detected in vascular endothelial cells (VECs) and smooth muscle cells (SMCs) in corpus cavernosum during daytime and nighttime. BMAL1 exhibited the most significant nuclear expression during daytime in both cell types, whereas its expression decreased significantly at night. In VECs, a significant decrease in the nuclear expression of CRY1 was observed at night. In SMCs, a significant decrease in the cytoplasmic expression of PER3 was observed at night. The expression patterns of the core molecular clock genes were ascertained through a RT-qPCR analysis. Conclusions: Our research provides compelling evidence that core molecular clock genes are distinctly expressed in penile tissue in humans. Furthermore, we observed the expression of molecular clock proteins within the VECs and SMCs of the corpus cavernosum, with BMAL1 being the most prominently expressed. The discovery of core molecular clock genes in penile tissue, as well as proteins within the SMCs and VECs of the corpus cavernosum, introduces the potential significance of the molecular clock mechanism in the physiology of penile erection.
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    Entrapped surgical needle in the valveless AirSeal trocar: a case report and literature review
    (Elsevier Science Inc., 2024) N/A; Aykanat, İbrahim Can; Balbay, Mevlana Derya; School of Medicine; Koç University Hospital
    Background: Valveless trocars like AirSeal system are maintain a stable pneumoperitoneum and reduce instrument friction. Case presentation: A 65-year-old man's robotic radical cystectomy was complicated by a missing needle while using AirSeal system. The needle was detected via backward inspection using the endo camera inserted through the trocar, tip at its most distal end let the visualization of the needle within the air channels and confirmed with a trocar X-ray. Conclusion: Our findings suggest that retrograde inspection and targeted radiography of the trocar, prior to patient imaging, can be helpful in locating the lost needle and prevent prolongation of surgeries.
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    The role of neoadjuvant chemotherapy for patients with variant histology muscle invasive bladder cancer undergoing robotic cystectomy: data from the International Robotic Cystectomy Consortium
    (Elsevier Inc., 2024) Cooke, Ian; Abou Heidar, Nassib; Mahmood, Abdul Wasay; Ahmad, Ali; Jing, Zhe; Stöckle, Michael; Wagner, Andrew A; Roupret, Morgan; Kim, Eric; Vasdev, Nikhil; Rha, Koon Ho; Aboumohamed, Ahmed; Dasgupta, Prokar; Maatman, Thomas J.; Richstone, Lee; Wiklund, Peter; Gaboardi, Franco; Li, Qiang; Hussein, Ahmed A.; Guru, Khurshid; N/A; Balbay, Mevlana Derya; School of Medicine
    Objective: To assess the role of neoadjuvant chemotherapy (NAC) before robot-assisted radical cystectomy (RARC) for patients with variant histology (VH) muscle-invasive bladder cancer (MIBC). Methods: Retrospective review of 988 patients who underwent RARC (2004–2023) for MIBC. Primary outcomes included the utilization of NAC among this cohort of patients, frequency of downstaging, and discordance between preoperative and final pathology in terms of the presence of VH. Secondary outcomes included disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). Results: A total of 349 (35%) had VH on transurethral resection or at RARC. The 4 most common VH subgroups were squamous (n = 94), adenocarcinoma (n = 64), micropapillary (n = 34), and sarcomatoid (n = 21). There was no difference in OS (log-rank: P = 0.43 for adenocarcinoma, P = 0.12 for micropapillary, P = 0.55 for sarcomatoid, P = 0.29 for squamous), RFS (log-rank: P = 0.25 for adenocarcinoma, P = 0.35 for micropapillary, P = 0.83 for sarcomatoid, P = 0.79 for squamous), or DSS (log-rank P = 0.91 for adenocarcinoma, P = 0.15 for micropapillary, 0.28 for sarcomatoid, P = 0.92 for squamous) among any of the VH based on receipt of NAC. Patients with squamous histology who received NAC were more likely to be downstaged on final pathology compared to those who did not (P < 0.01). Conclusion: Our data showed no significant difference in OS, RFS, or DSS for patients with VH MIBC cancer who received NAC before RARC. Patients with the squamous variant who received NAC had more pathologic downstaging compared to those who did not. The role of NAC among patients with VH is yet to be defined. Results were limited by small number in each individual group and lack of exact proportion of VH. © 2024
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    Multicentric evaluation of high and low power lasers on RIRS success using propensity score analysis
    (Springer, 2024) Erol, Eren; Ecer, Gokhan; Gokce, Mehmet Ilker; Balasar, Mehmet; Babayigit, Muammer; Aksoy, Elif Ipek; Sarica, Kemal; Ahmed, Kamran; Guven, Selcuk; N/A; Kiremit, Murat Can; Sarıkaya, Ahmet Furkan; Karaarslan, Umut Can; School of Medicine
    In this study, we aimed to evaluate the effect of HPL on different parameters by different centers and urologists. While doing this, we evaluated different parameters by comparing HPL(High Power laser) and LPL(Low-power laser). This is an observational, retrospective, comparative, multicentric study of prospectively organised database. A total of 217 patients who underwent RIRS for kidney stones smaller than 2 cm in three different centers were included in the study. The patients were divided into two groups; LPL used (Group1, n:121 patients) and HPL used (Group2, n:96). Propensity score matching was done in the data analysis part. After matching, a total of 192 patients, 96 patients in both groups, were evaluated. There was no difference between the groups regarding age, gender, stone side, and stone location. The stone-free rate on the first day was 80.3% in Group 1, it was 78.1% in Group 2 (p = 0.9). In the third month, it was 90.7% in Group 1 and 87.5% in Group 2 (p:0.7).Hospitalization duration was significantly higher in Group 1. (2.35 +/- 2.27 days vs. 1.42 +/- 1.10 days; p < 0.001).The operation duration was 88.70 +/- 29.72 min in Group1 and 66.17 +/- 41.02 min in Group2 (p < 0.001). The fluoroscopy time (FT) was 90.73 +/- 4.79 s in Group 1 and 50.78 +/- 5.64 s in Group 2 (p < 0.001). Complications according to Clavien Classification, were similar between the groups(p > 0.05). According to our study similar SFR and complication rates were found with HPL and LPL. In addition, patients who used HPL had lower operation time, hospital stay, and fluoroscopy time than the LPL group. Although high-power lasers are expensive in terms of cost, they affect many parameters and strengthen the hand of urologists thanks to the wide energy and frequency range they offer.
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    The effect of endoscopic renal and ureteral stone surgeries on renal blood flow in children: a prospective trial
    (Springer, 2024) Topbas, Fevzi Batuhan; Sekerci, Cagri Akin; Soydemir, Efe; Yapici, Ozge; Akbas, Serkan; Yucel, Selcuk; Tanidir, Yiloren; N/A; Tarcan, Tufan; School of Medicine
    Aim: To assess the impact of endoscopic stone surgeries on renal perfusion and blood flow in children. Materials and methods: Children who underwent percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), endoscopic combined intrarenal surgery (ECIRS) were included to the study. Renal Doppler ultrasonography (RDUS) was performed one day before the operation, and on the postoperative 1st day and 1st month. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) was calculated with the (PSV-EDV)/PSV formula. RDUS parameters were compared before and after surgery and between ipsilateral and contralateral kidneys. Results: A total of 45 children with a median age was 8 (2-17) years were included (15 (33.3%) girls, 30 (66.7%) boys). PCNL was performed in 13 children (28.9%), RIRS 11 (24.4%), URS 12 (26.7%), and ECIRS 9 (20%). There was no significant difference in renal and segmental PSV, EDV and RI values of operated kidney in the preoperative, postoperative periods. There was no significant difference between RDUS parameters of the ipsilateral and contralateral kidneys in preoperative or postoperative periods. PSV and EDV values were significantly higher in the 1st postoperative month in the group without preoperative DJ stent than in the group with DJ stent (p = 0,031, p = 0,041, respectively). However, RI values were similar. The mean RI were below the threshold value of 0.7 in each period. Conclusion: RDUS parameters didn't show a significant difference in children. Endoscopic surgeries can be safely performed in pediatric stone disease.
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    Prognostic significance of lymph node count in surgically treated patients with T2-4 stage nonmetastatic adrenocortical carcinoma
    (Elsevier Inc., 2024) Assad, Anis; Barletta, Francesco; Incesu, Reha-Baris; Scheipner, Lukas; Morra, Simone; Baudo, Andrea; Garcia, Cristina Cano; Tian, Zhe; Ahyai, Sascha; Longo, Nicola; Chun, Felix K.H.; Shariat, Shahrokh F.; Briganti, Alberto; Saad, Fred; Karakiewicz, Pierre I.; N/A; Tilki, Derya; School of Medicine
    Purpose: The role of lymphadenectomy and the optimal lymph node count (LNC) cut-off in nonmetastatic adrenocortical carcinoma (nmACC) are unclear. Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database, surgically treated nmACC patients with T2-4 stages were identified between 2004 and 2020. We tested for cancer-specific mortality (CSM) differences according to pathological N-stage (pN0 vs. pN1) and two previously recommended LNC cut-offs (≥4 vs. ≥5) were tested in pN0 and subsequently in pN1 subgroups in Kaplan-Meier plots and multivariable Cox regression models. Results: Of 710 surgically treated nmACC patients, 185 (26%) underwent lymphadenectomy and were assessable for further analyses based on available LNC data. Of 185 assessable patients, 152 (82%) were pN0 and 33 (18%) were pN1. In Kaplan-Meier analyses, CSM-free survival was 74 vs. 14 months (Δ 60 months, P ≤ 0.001) in pN0 vs. pN1 patients, respectively. In multivariable analyses, pN1 was an independent predictor of higher CSM (HR:3.13, P < 0.001). In sensitivity analyses addressing pN0, LNC cut-off of ≥4 was associated with lower CSM (multivariable hazard ratio [HR]: 0.52; P = 0.002). In sensitivity analyses addressing pN0, no difference was recorded when a LNC cut-off of ≥5 was used (HR:0.60, P = 0.09). In pN1 patients, neither of the cut-offs (≥4 and ≥5) resulted in a statistically significant stratification of CSM rate, and neither reached independent predictor status (all P > 0.05). Conclusions: Lymphadenectomy provides a prognostic benefit in nmACC patients and identifies pN1 patients with dismal prognosis. Conversely, in pN0 patients, a LNC cut-off ≥4 identifies those with particularly favorable prognosis. © 2024 Elsevier Inc.
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    Outcome and risk factors for mortality in peritoneal dialysis patients: 22 years of experience in a Turkish center
    (AVES, 2024) Caliskan, Yasar; Goksoy, Yagmur; Sacli, Fadime Sevgi; Mutlu, Ummu; Turkmen, Aydin; Bozfakioglu, Semra; N/A; Demir, Erol; Koç University Transplant Immunology Research Centre of Excellence (TIREX); Graduate School of Health Sciences
    Background: European peritoneal dialysis populations have identified and reported mortality and morbidity risk factors. However, no reports are pointing out the factors affecting the outcomes of these patients during more than 2 decades of follow-up in T & uuml;rkiye. This single -center study aims to evaluate patient mortality and peritonitis rates and estimate confounding factors affecting patient mortality over 22 years. Methods: Adult patients who underwent peritoneal dialysis at our center between December 1994 and December 2016 were enrolled in this retrospective cohort study. The primary outcome of the present study was mortality, and the secondary outcomes were technical failure and peritonitis. Results: Two hundred fifty patients were included in this study. The patients were followed up for a median of 39.5 months (range 17-71). Forty-eight (19.2%) patients died. Survival rates at 5, 10, and 15 years were 86.8% (217/250), 64.6% (86/133), and 41.1% (30/73), respectively. The prevalence of diabetes mellitus [14 (29.2%) vs. 20 (9.9%); P < .001] and cardiovascular disease [16 (33.3%) vs. 24 (11.9%); P < 0.001] were significantly higher in the deceased group compared to the survival group. Cardiovascular disease was the leading cause of death [26 (54.1%)]. Age (hazard ratio (HR) 1.06; 95% CI, 1.04-1.09; P < .001), male sex (HR 2.07; 95% CI, 1.10-3.90; P = .024), and transfer to peritoneal dialysis due to vascular access problems (HR 3.91; 95% CI, 1.90-8.07; P < .001) were associated with mortality in multivariate analysis. Also, catheter exit -site infection, peritonitis rate, catheter removal, and technical complications were similar between the groups. The peritonitis rate was 0.2 episodes per patient per year. Conclusion: The mortality rate of the patient population in our center was similar to Europe and the United States. Cardiovascular diseases and diabetes are the leading causes of death in Turkish peritoneal dialysis patients, as in other populations.
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    Kidney transplantation in patients recovered from Coronavirus disease 2019
    (AVES, 2023) Artan, Ayse Serra; Sadioglu, Rezzan Eren; Yalcin, Funda; Demir, Erol; Keven, Kenan; Safak, Seda; Alpay, Nadir; Guller, Nurana; Memikoglu, Osman; Sengul, Sule; N/A; Yelken, Berna; Okan, Ayşe; Türkmen, Aydın; N/A; Koç University Hospital
    Objective: There is limited information about kidney transplant recipients who recovered from the Coronavirus disease 2019. This study is conducted to investigate the safety of transplantation in this patient population. Methods: Nineteen patients with prior coronavirus disease 2019 were included. We present demographics, clinical characteristics, laboratory findings, and immunosuppressive regimen. Graft functions and patient and allograft outcomes were compared to 19 kidney transplant recipients who did not have coronavirus disease 2019. Results: The median age of participants was 38 (interquartile range, 26-51) years. Most of the recipients were men (n = 30, 78.9%). The most common presenting symptoms of kidney transplant recipients with prior coronavirus disease 2019 were fever (36.8%), fatigue (21.1%), dyspnea (15.8%), cough (10.5%), and myalgia (5.3%). Eight patients (42.2%) were hospitalized, while none required intensive care unit admission and mechanical ventilation. The median wait time for transplantation after the initial diagnosis of coronavirus disease 2019 was 82 days (interquartile range, 57-172). Most recipients in both groups received antithymocyte globulin as an induction agent. Standard doses of maintenance immunosuppression consisting of tacrolimus, mycophenolate derivatives, and corticosteroids were administered. During a follow-up duration of 85 (interquartile range, 39-154) and 134 (interquartile range, 56-240) days for patients and controls, respectively, the rate of complications and graft functions were not statistically significant between groups. Graft and patient survival was 100%. Conclusion: Our study results support the safety of kidney transplantation in patients with prior coronavirus disease 2019. Transplant candidates and donors should be carefully screened for coronavirus disease 2019. We suggest continuing the standard doses of induction and maintenance immunosuppression, especially in patients who recovered without pulmonary sequelae.