Researcher:
Kiremit, Murat Can

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Murat Can

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Kiremit

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Kiremit, Murat Can

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2016 - 201992020 - 202320

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    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; 153320
    Background: 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.
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    Endopelvic fascia sparing robotic radical cystectomy with intracorporeal studer pouch with Balbay's technique
    (Society of Laparoscopic and Robotic Surgeons, 2022) Kilic, Mert; Musaoglu, Ahmet; N/A; N/A; N/A; N/A; N/A; N/A; N/A; Balbay, Mevlana Derya; Köseoğlu, Ersin; Canda, Abdullah Erdem; Özkan, Arif; Kiremit, Murat Can; Tarım, Kayhan; Sarıkaya, Ahmet Furkan; Faculty Member; Faculty Member; Faculty Member; Doctor; Faculty Member; Researcher; Researcher; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 153320; 350876; 116202; 289255; 222920; 327605; 327615
    Background and Objectives: Robotic radical cystec-tomy (RARC) with intracorporeal urinary diversion is a technically complicated, time-consuming procedure. The aim of this study was to present the operative, pathologi-cal, oncological, and functional outcomes of patients who underwent endopelvic fascia sparing (EPFS) RARC with intracorporeal Studer pouch formation. To the best of our knowledge, this is first series in the literature that includes EPFS RARC.Methods: Between October 1, 2019 and April 30, 2022, 10 bladder cancer patients underwent EPFS RARC, bilat-eral extended pelvic lymph node dissection with intra-corporeal Studer pouch reconstruction with Balbay's technique. Patient demographics, operative, and post-operative parameters were recorded.Results: Among 10 patients, 8 were male and 2 were female. Mean operative time, median estimated blood loss, and median duration of hospital stay was 530 minutes, 316 ml, and 8 days, respectively. One month postoperatively, the mean maximum flow, average flow rate, mean voided, and post-voided urine volume were 20.2 ml/sec, 4.4 ml/sec, 273.6 ml, and 3.5 ml, respectively. All of the patients were fully continent during day-time, three had mild night-time incontinence requiring pad use (both patients 1 pad per night). During a mean 11.5 months of follow up, zero patients died. One patient with a pathological, stage 4 tumor, had nodal recurrence at six months postoperatively. No distant metastasis were detected. Conclusion: Endopelvic fascia sparing RARC has very promising early functional results with safe oncological outcomes and low complication rates.
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    The utility of ga-68-psma pet/ct in poorly differentiated metastatic prostate cancer
    (Lippincott Williams & Wilkins, 2017) Uçar, Burcu; Sağlıcan, Yeşim; N/A; N/A; N/A; Demirkol, Mehmet Onur; Kiremit, Murat Can; Acar, Ömer; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 196946; 222920; 237530
    We aimed to emphasize how useful PSMA PET/CT findings can be while trying to restage prostate cancer after radical prostatectomy in the presence of low prostate-specific antigen values. A 64-year-old man with pT3b N1 M0 Gleason 7 adenocarcinoma of the prostate presented 5 years postoperatively with a palpable axillary mass, whereas his prostate-specific antigen was 0.08 ng/mL. Conventional imaging studies and histopathologic findings of the axillary mass biopsy revealed inconclusive results. Ga-68-PSMA PET/CT demonstrated PSMA-positive metastatic lesions, the largest one being located in the right axilla. This finding confirmed metastatic poorly differentiated prostate cancer, and androgen deprivation therapy was initiated.
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    Fluid intake recommendations in urolithiasis and general advice to patients without metabolic risk factors
    (Springer, 2023) Boyuk, Abubekir; Petkova, Kremena; N/A; Kiremit, Murat Can; Faculty Member; School of Medicine; 222920
    Urolithiasis is a highly prevalent global disease with substantially increasing incidence in the last two decades. Data from the literature suggests that 26%-50% of patients will have a recurrence within 10 years after an initial symptomatic stone episode. Therefore, interest has been raised in preventive strategies, aiming to modify the risk factors of stone recurrence by implementing dietary and lifestyle changes and specific medical treatments for stone formers, depending on their recurrence risk factors. Certain dietary factors are thought to contribute significantly to the increased incidence of urolithiasis, particularly a diet low in fiber and high in animal protein, fat, and sodium. Fluid intake is perhaps the most important and modifiable step in the prevention of urolithiasis, irrespective of stone composition. However, the amount of fluid to be consumed and the implications of various fluid types on stone formation are still controversial. In this article, the relationship between fluid intake, beverage types and stone formation-prevention will be discussed. Moreover, general dietary recommendations for patients without metabolic risk factors will be reviewed based on the current literature.
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    Attitudes of urologists on metabolic evaluation for urolithiasis: outcomes of a global survey from 57 countries
    (SPRINGER, 2022) Karagoz, Mehmet Ali; Guven, Selcuk; Tefik, Tzevat; Gokce, Mehmet Ilker; Atar, Feyzi Arda; Ibis, Muhammed Arif; Yitgin, Yasin; Boyuk, Abubekir; Verep, Samed; Sarica, Kemal; N/A; Kiremit, Murat Can; Faculty Member; School of Medicine; Koç University Hospital; 222920
    Although stone disease is an important health problem with high incidence and recurrence rates, it is a preventable disease. Attitudes and practices of urologists regarding the prevention of recurrence continue to be a subject of debate. In this context, an online survey study was conducted involving 305 urologists from 57 different countries. The first 7 questions collected demographic data about the urologists and the remaining 23 questions were about the recurrence and metabolic evaluation, medical treatment, and follow-up of urinary stone disease. Most urologists (85.2%) thought that metabolic examination was important. Approximately one-third of the participants (34.1%) performed 24-hour urine analysis and stone analysis was ordered by 87.5% of the urologists. Metabolic analysis was performed for all patients by 14.7% of the participants. For pediatric patients this rate was 68.5%, and for adults with recurrence the rate was 81.6%. Reasons cited by the urologists for not performing metabolic analysis included not feeling confident doing so (18.3%), having limited facilities in their hospital (26.5%), having an excessive daily workload (31.8%), patient-related factors (27.5%), and referring patients to other departments for metabolic evaluation (20.9%). Although majority of the responding urologists do consider the metabolic analysis as vital important, they seemed not to be willing to perform these tests with the same degree of enthusiasm in their daily practice. Our results show that urologists need support in performing and interpreting 24-hour urine analysis, improving their knowledge levels, and communicating with patients. Urology residency training should focus more on the prevention of urinary stone recurrence in addition to the surgical training.
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    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; 50536
    Both 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.
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    The impact of visible tumor (PI-RADS >= 3) on upgrading and adverse pathology at radical prostatectomy in low risk prostate cancer patients: a biopsy core based analysis
    (Cig Media Group, Lp, 2022) Kilic, Mert; Saglican, Yesim; Tugcu, Volkan; Bakir, Baris; N/A; Özkan, Arif; Köseoğlu, Ersin; Balbay, Mevlana Derya; Canda, Abdullah Erdem; Kordan, Yakup; Kiremit, Murat Can; Esen, Tarık; Baydar, Dilek Ertoy; Çil, Barbaros Erhan; Doctor; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; 289255; 350876; 153320; 116202; 157552; 222920; 50536; 8025; 169993
    Deciding on the management of prostate cancer (PCa), especially GG1 PCa, is quite difficult. The most important thing that will help us in making active surveillance or definitive treatment decision is whether the tumor is a clinically significant tumor. To understand this, we discussed in this article that multiparametric MR, PI-RADS scoring and targeted biopsy can be used. Background
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    The role of sodium intake in nephrolithiasis: epidemiology, pathogenesis, and future directions
    (Elsevier, 2016) Afsar, Baris; Solak, Yalçın; Covic, Adrian; N/A; Kanbay, Mehmet; Kiremit, Murat Can; Acar, Ömer; Esen, Tarık; Sağ, Alan Alper; Tarım, Kayhan; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Researcher; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 110580; 222920; 237530; 50536; N/A; 327605
    The prevalence of nephrolithiasis has doubled over the last decade and the incidence in females nowapproaches that of males. Since dietary salt is lithogenic, a purported mechanism common to both genders is excess dietary sodium intake vis-a-vis processed and fast foods. Nephrolithiasis has far-reaching societal implications such as impact on gross domestic product due to days lost from work (stone disease commonly affects working adults), population-wide carcinogenic diagnostic and interventional radiation exposure (kidney stone disease is typically imaged with computed tomographic imaging and treated under imaging guidance and follow-up), and rising healthcare costs (surgical treatmentwill be indicated for a number of these patients). Therefore, primary prevention of kidney stone disease via dietary intervention is a low-cost public health initiative with massive societal implications. This primer aims to establish baseline epidemiologic and pathophysiologic principles to guide clinicians in sodium-directed primary prevention of kidney stone disease.
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    Postchemotherapy robotic retroperitoneal lymph node dissection for non-seminomatous germ cell tumors in the lateral decubitus position: oncological and functional outcomes
    (Springer, 2023) Kilic, Mert; N/A; Kordan, Yakup; Köseoğlu, Ersin; Esen, Barış; Özkan, Arif; Kiremit, Murat Can; Esen, Tarık; Faculty Member; Faculty Member; Teaching Faculty; Doctor; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; N/A; N/A; N/A; Koç University Hospital; N/A; N/A; 157552; 350876; 199167; 222920; 50536
    Purpose Retroperitoneal lymph node dissection (RPLND) is recommended for residual masses following chemotherapy for non-seminomatous germ cell tumors (NSGCT). Recently, aberrant recurrence patterns were reported in patients who underwent robotic RPLND. We aimed to evaluate perioperative safety in addition to functional and early oncological outcomes of postchemotherapy robotic RPLND (pcR-RPLND) for NSGCT.Methods A total of 25 patients with NSGCT who underwent a pcR-RPLND between January 2011 and June 2022 were evaluated retrospectively. Descriptive statistics were provided for demographics, clinical characteristics, intraoperative and postoperative parameters. Functional and oncological outcomes were recorded.Results The median patient age was 28.9 years (IQR 21.5-32.4). The median retroperitoneal tumor size was 2.6 cm (IQR 1.5-3.5). Intraoperative complications occurred in only one case and the open conversion rate was 12%. There were seven cases with postoperative complications (Clavien grade II: 5 and IIIa: 2). Patients were followed for a median of 33.2 months (IQR 14.8-43.0). Antegrade ejaculation was preserved in 85.7% of the patients. Two patients (8%) relapsed and both had out-of-field recurrences at unusual sites (perinephric fat and omentum). of those, one patient died (4%) of testicular cancer.Conclusion pcR-RPLND is a feasible and technically reproducible procedure with favorable perioperative morbidity, low rate of complications, and acceptable postoperative ejaculatory function. Although the recurrence rate was low (8%), recurrences were observed at unusual sites. Further studies are required to investigate any association between the robotic approach and aberrant recurrence patterns.
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    Is there a relationship between post-ureteroscopic lesion scale and irrigation fluid absorption in ureteral stone disease patients
    (Avrasya Üroonkoloji Derneği, 2021) Güzelburç, Vahit; Çolakoğulları, Mukaddes; Soytaş, Mustafa; Boz, Mustafa; Altay, Bülent; Erkurt, Bülent; Albayrak, Selami; Akbulut, Ziya; N/A; Kiremit, Murat Can; Faculty Member; School of Medicine; 222920
    Objective: Post-Ureteroscopic Lesion Scale (PULS) is used to classify ureteral wall injury that occurs during ureteroscopy. In this study we presented the preliminary results of absorbed irrigation fluid volumes according to PULS grades. Material and Methods: Forty-four patients to whom 7F semirigid ureteroscopy was performed due to ureteral stone were included in the study. All patients received general anesthesia. Isotonic containing 1% ethanol was used as irrigation fluid. Ethanol concentration in venous blood was commenced to be measured at the start of irrigation use and was carried on at 15-minute intervals including the post-operative period in the recovery room. Absorbed fluid volume was calculated by using blood ethanol concentrations. Irrigation time, stone size and PULS grade were recorded. Results: Mean operation time was found to be 44.2 ± 19.9 minutes. Mean stone size was measured to be 12.7± 6 mm and mean irrigation fluid amount used was 1371±1262 ml. PULS grade of 0 was seen in 26 patients and that of 1 or more was seen in 18 patients. No patient had a PULS grade of 3 or 4. Mean absorbed fluid volume was measured to be 58 ± 50,6 ml. No significant correlation was found between PULS grade and mean absorbed fluid volume. Conclusion: Fluid absorption during URS is not correlated with the lesion severity that is PULS grade 1-2, or low grade submucosal. Semirigid URS is a safe treatment option for ureteral stone disease in terms of the level of irrigation fluid being absorbed. / Amaç: Üreteroskopi (URS) esnasında üreter duvarında oluşan hasarı sınıflandırmak için Post-Üreteroskopik Lezyon Skalası (PULS) kullanılmaktadır. Bu çalışmada PULS derecelerine göre absorbe edilen irrigasyon sıvı hacimlerinin ön sonuçlarını sunduk. Gereç ve Yöntemler: Bu çalışmaya üreter taşı nedeniyle 7 F semirijid üreteroskopi uygulanan 44 hasta dahil edildi. Tüm hastalara genel anestezi uygulandı. %1 etanol içeren izotonik irrigasyon sıvısı olarak kullanıldı. Venöz kan etanol konsantrasyonları irrigasyon kullanılmaya başlaması ile ölçülmeye başlandı, operasyon sonrası derlenme odasını kapsayacak şekilde 15 dakika arayla periyodik ölçüldü. Absorbe edilen sıvı hacmi kan etanol konsantrasyonları kullanılarak hesaplandı. İrrigasyon süresi, taş boyutu, PULS derecesi kaydedildi. Bulgular: Ortalama operasyon süresi 44.2 ± 19.9 dakika olarak saptandı. Ortalama taş hacmi 12.7± 6 mm ve ortalama kullanılan irrigasyon sıvı miktarı 1371±1262 mL olarak ölçüldü. Hastaların 26’sınde PULS derecesi 0 iken 18’inde 1 veya üzerindeydi. Hiçbir hastada PULS derecesi 3 veya 4 olmadı. Ortalama absorbe edilen sıvı hacmi 58 ± 50,6 mL olarak hesaplandı. PULS derecesi ile ortalama absorbe edilen sıvı miktarı arasında istatistiksel anlamlı fark saptanmadı. Sonuç: URS esnasında oluşan PULS derecesi 1-2 olan veya düşük dereceli submukozal üreter lezyonlarıyla sıvı emilimi korele bulunmamıştır. Semirijid URS, üreter taşı hastalığı tedavisinde irrigasyon sıvısının emilimi açısından güvenli bir yöntemdir.