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Öğe The association of serum PSA levels and histopathological criteria with positive surgical margin in radical retropubic prostatectomy(2008) Kandirali, Engin; Arma?an, Abdullah; Özcan, Faruk; Esen, Tarik; Aras, Necdet; Tunç, MuratIntroduction: Radical prostatectomy is a common therapeutic procedure applied when clinically organ confined prostate cancer is diagnosed. Unfortunately, approximately one third of patients who undergo radical prostatectomy have positive surgical margins, and these patients have increased risk of local and systemic cancer progression. The aim of this study is to determine the association between preoperative serum prostate specific antigen levels (PSA) and biopsy Gleason sum with surgical margin status in patients with prostate cancer treated by radical retropubic prostatectomy and bilateral pelvic lymphadenectomy. Materials and Methods: In this study, 259 patients who underwent radical retropubic prostetectomy and bilateral pelvic lymphadenectomy in our clinic with the diagnosis of organ confined prostate cancer were included. All patients were evaluated by detailed medical examination, digital rectal examination, serum PSA levels, and transrectal ultrasound-guided prostate biopsy. Pelvic computerized tomography, magnetic resonance imaging and bone scan were performed as clinically indicated. The correlation of data including preoperative serum PSA levels, biopsy Gleason sum, postoperative Gleason sum, and pathologic stage with postoperative surgical margin status was examined. Fisher's exact test was used for statistical analysis and p values < 0.05 were considered statistically significant. Results: The mean age of patients was 64.4±6.1 years (range 46-78 years), and the mean preoperative serum PSA level was 11.3±14.1 ng/ml (range 0.6-150 ng/ml). The overall positive surgical margin rate was 21.2% (55/259). Histopathological evaluation of radical retropubic prostatectomy specimens revealed that 2.6% (n=3) of patients with pT2, 26.7% (n=27) with pT3a, 50% (n=16) with pT3b, and 69.2% (n=9) with pN1 had positive surgical margin. A positive surgical margin occurred in 16.7% of patients with a preoperative serum PSA level of 10 ng/ml or less compared to 27.6% of patients with serum PSA level greater than 10 ng/ml, and this difference was statistically significant (p<0.05). Of patients with biopsy Gleason sum 7 or greater, 33.9% had a positive surgical margin compared to 17.5% with biopsy Gleason sum less than 7; this difference was also statistically significant (p<0.05). Of patients with final Gleason sum 7 or greater, 34.6% had a positive surgical margin compared to 13.6% with Gleason sum less than 7 (p<0.05). Conclusion: When biopsy Gleason sum and/or serum PSA levels increase, positive surgical margin status increases. Biopsy Gleason sum and serum PSA levels provide an estimation of the risk for positive surgical margin; thus, this information may be useful for the stratification of patients who undergo radical retropubic prostatectomy.Öğe THE ASSOCIATION OF SERUM PSA LEVELS AND HISTOPATHOLOGICAL CRITERIA WITH POSITIVE SURGICAL MARGIN IN RADICAL RETROPUBIC PROSTATECTOMY(Aves, 2008) Kandirali, Engin; Armagan, Abdullah; Ozcan, Faruk; Esen, Tarik; Aras, Necdet; Tunc, MuratIntroduction: Radical prostatectomy is a common therapeutic procedure applied when clinically organ confined prostate cancer is diagnosed. Unfortunately, approximately one third of patients who undergo radical prostatectomy have positive surgical margins, and these patients have increased risk of local and systemic cancer progression. The aim of this study is to determine the association between preoperative serum prostate specific antigen levels (PSA) and biopsy Gleason sum with surgical margin status in patients with prostate cancer treated by radical retropubic prostatectomy and bilateral pelvic lymphadenectomy. Materials and Methods: In this study, 259 patients who underwent radical retropubic prostetectomy and bilateral pelvic lymphadenectomy in our clinic with the diagnosis of organ confined prostate cancer were included. All patients were evaluated by detailed medical examination, digital rectal examination, serum PSA levels, and transrectal ultrasound-guided prostate biopsy. Pelvic computerized tomography, magnetic resonance imaging and bone scan were performed as clinically indicated. The correlation of data including preoperative serum PSA levels, biopsy Gleason sum, postoperative Gleason sum, and pathologic stage with postoperative surgical margin status was examined. Fisher's exact test was used for statistical analysis and p values <0.05 were considered statistically significant. Results: The mean age of patients was 64.4 +/- 6.1 years (range 46-78 years), and the mean preoperative serum PSA level was 11.3 +/- 14.1 ng/ml (range 0.6-150 ng/ml). The overall positive surgical margin rate was 21.2% (55/259). Histopathological evaluation of radical retropubic prostatectomy specimens revealed that 2.6% (n=3) of patients with pT2, 26.7% (n=27) with pT3a, 50% (n=16) with pT3b, and 69.2% (n=9) with pN1 had positive surgical margin. A positive surgical margin occurred in 16.7% of patients with a preoperative serum PSA level of 10 ng/ml or less compared to 27.6% of patients with serum PSA level greater than 10 ng/ml, and this difference was statistically significant (p<0.05). Of patients with biopsy Gleason sum 7 or greater, 33.9% had a positive surgical margin compared to 17.5% with biopsy Gleason sum less than 7; this difference was also statistically significant (p<0.05). Of patients with final Gleason sum 7 or greater, 34.6% had a positive surgical margin compared to 13.6% with Gleason sum less than 7 (p<0.05). Conclusion: When biopsy Gleason sum and/or serum PSA levels increase, positive surgical margin status increases. Biopsy Gleason sum and serum PSA levels provide an estimation of the risk for positive surgical margin; thus, this information may be useful for the stratification of patients who undergo radical retropubic prostatectomy.Öğe Does serum prostate specific antigen levels correlate with the prostatic inflammation in elderly patients without clinically proven prostate cancer?(2022) Çolakerol, Aykut; Temiz, Mustafa Zafer; Boran, Çetin; Baştuğ, Yavuz; Kandirali, EnginObjectives: To determine the whether histological prostatic inflammation correlates with serum prostate specific antigen (PSA), free PSA (fPSA) and percent of fPSA (%fPSA) levels in elderly patients without clinically proven prostate cancer. Methods: A total of 115 patients without clinically proven prostate cancer with transrectal prostate biopsy were included in this retrospective study. Patients were divided two main groups as patients with and without histologic prostatic inflammation. A grading of the histological prostatic inflammation was performed and patients with prostatic inflammation were divided into three subgroups. The age, prostate volume, serum PSA, fPSA and %fPSA levels were compared between patients with and without prostatic inflammation. Correlation between the parameters and grade of prostatic inflammation was also investigated. Results: Serum PSA and %fPSA levels were significantly higher in men with histologically proven prostatic inflammation (15.47 ± 15.28 ng/mL vs. 11.67 ± 8.12 ng/mL; p = 0.002 and 19.8 ± 0.7 vs. 15.79 ± 0.9; p = 0.01, respectively). The mean serum PSA levels were significantly different among the subgroups (p = 0.02) and prostatic inflammation correlated positively with the PSA levels (r = 0.320, p < 0.001).Conclusions: Our findings suggested that reporting the grade of prostatic inflammation in elderly patients may help avoiding unnecessary repeat biopsies if elevated serum PSA level is the only indication for initial prostate biopsy.Öğe DOUBLE INTRAUTERINE DEVICE: PRESENTED WITH PROTRUDING URETHRAL STONE(Marmara Univ, Fac Medicine, 2008) Kandirali, Engin; Topcuoglu, Mehmet Ata; Semercioz, Atilla; Metin, AhmetIntrauterine devices (IUDs) are widely used for reversible contraception. Perforation of the uterus and migration of the device into the retroperitoneal or abdominal cavity is a major but an infrequent complication. We present this report to highlight two interesting aspects of this case: One is that two IUDs were present simultaneously and second is that the patient presented with urethral stone after an asymptomatic period of 10 years.Öğe Enterovesical fistula secondary to Crohn's disease mimicking bladder tumor(2006) Kandirali, Engin; Şengül, Neriman; Akkoç, Ali; Türkeli, Vildan; Semerciöz, Atilla; Metin, AhmetIntroduction: Although most fistulas in Crohn's disease are perianal or enterocutaneous, a small portion involves the bladder and urinary system. We describe enterovesical fistulas in a patient with Crohn's disease that presented exclusively as urinary symptoms mimicking bladder tumor. A 55 years-old man presented with lower urinary tract symptoms to our clinic. Ulrasonographic examination showed a normal upper urinary tract and 4 cm papillary bladder tumor. TUR-T was performed and an enterovesical fistula was noticed during operation. Patient underwent abdominal exploration and partial resection of the ileum, ileostomy, and primary bladder repair was performed. Urologic manifestations must be recognized of fistulizing Crohn's disease and urologist should be aware that Crohn's disease may involve the bladder as inflammatory tumor.Öğe ENTEROVESICAL FISTULA SECONDARY TO CROHN'S DISEASE MIMICKING BLADDER TUMOR(Aves, 2006) Kandirali, Engin; Sengul, Neriman; Akkoc, Ali; Turkeli, Vildan; Semercioz, Atilla; Metin, AhmetIntroduction: Although most fistulas in Crohn's disease are perianal or enterocutaneous, a small portion involves the bladder and urinary system. We describe enterovesical fistulas in a patient with Crohn's disease that presented exclusively as urinary symptoms mimicking bladder tumor. A 55 years-old man presented with lower urinary tract symptoms to our clinic. Ulrasonographic examination showed a normal upper urinary tract and 4 cm papillary bladder tumor. TUR-T was performed and an enterovesical fistula was noticed during operation. Patient underwent abdominal exploration and partial resection of the ileum, ileostomy, and primary bladder repair was performed. Urologic manifestations must be recognized of fistulizing Crohn's disease and urologist should be aware that Crohn's disease may involve the bladder as inflammatory tumor.Öğe NON-FUNCTIONING KIDNEY RESULTED FROM PRIMARY HYDATID CYST OF THE PSOAS MUSCLE(Marmara Univ, Fac Medicine, 2006) Kandirali, Engin; Semercioz, Atilla; Metin, Ahmet; Eroglu, Muzaffer; Uysal, BulentHydatid cyst is rarely located in the psoas muscle. Herein, we report a case with non-functioning kidney resulted from a primary hydatid cyst located at the psoas muscle obstructing upper segment of the ureter.Öğe Penile lymphangioma circumscriptum in advanced age: a rare case(Aves, 2011) Akkoc, Ali; Metin, Ahmet; Yanik, Serdar; Yildiz, Mevlut; Kandirali, Engin; Eroglu, MuzafferLymphangioma circumscriptum is a lymphatic malformation that is observed at early ages. It affects mostly the skin and subcutaneous tissues, but may affect all of the body organs and extend to the muscles. A 67-year-old male was referred to our department complaining of vesicular and erythematous lesions on the glans penis and an edematous skin lesion on the penile shaft that had recurred over the last 6 months. The patient had no history of allergy, trauma, drug use, or insect bites. An excisional biopsy taken from the penile skin was diagnosed as lymphangioma circumscriptum. The patient refused surgical excision or other treatment options for the penile lesion. Lymphangioma circumscriptum is predominantly observed at early ages, but it may arise at advanced ages and be confused with other penile lesions. Here, we report a case of penile lymphangioma circumscriptum that was observed at an advanced age to alert physicians to this rare condition and to prevent unnecessary therapy.Öğe Retrospective analysis of sarcomas of the urogenital system(2005) Kandirali, Engin; Şanli, Öner; Erdemir, Fikret; Özcan, Faruk; Esen, Tarik; Tunç, MuratIntroduction: Sarcomas account for only about 1% of all malignant tumors. Less than 5% or soft tissue sarcomas arise from the genitourinary tract, accounting for only 1 to 2% of all malignant genitourinary tumors. Because of the rarity of these tumors, the basic problem in the management of these tumors is the lack of a uniform approach for staging and treatment. Although sarcomas arise from different organs in the genitourinary tract and compromise different histopathological features, the main treatment modality is surgical resection of the tumor. The aim of this study is to evaluate the clinical and pathological features and prognosis of genitourinary tumors treated in our clinic. Materials and methods: Between 1997 and 2003, after excluding the gynecological sarcomas, a total of 15 genitourinary sarcomas were treated in our clinic. All patients were evaluated with a detailed medical history, physical examination, multiple serum analyses and imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging if needed. Thus, tru-cut biopsy was performed if indicated. For all patients, the primary treatment modality was open surgical resection. In addition to surgery, some of these patients also received adjuvant radiation therapy and/or chemotherapy. For staging, Memorial Sloan-Kettering Cancer Center soft tissue sarcoma staging system was used. Post-operative follow-up was done in regular intervals. Results: The mean age of patients was 50.4 ±14.7 (16-69) years and the mean tumor size was 8±3.5 cm. The chief complaints (one or more) of these patients were hematuria in 9, flank pain in 7, weight loss in 6, abdominal pain in 5, abdominal mass in 4, lower urinary tract symptoms in 3. Five bladder, six kidney, three retroperitoneal and one prostate sarcoma were detected in three women and 12 men. Histopathology of these tumors were leiomyosarcomas in nine, liposarcomas in three, rhabdomyosarcomas in two, malignant fibrous histiocytoma in one of the patients. Of these tumors, three were low grade and 12 were high grade. All patients except one underwent open surgical resection of the tumors. For five patients surgical resection was the only treatment modality, while eleven patients received adjuvant chemotherapy and/or radiotherapy after surgery. After a follow-up of 10.2±4.7 (3-20) months, overall survival rate was found to be 20% (3/15). Conclusion: Genitourinary sarcomas are a rare group of tumors with a generally poor prognosis. Complete surgical resection is still the mainstay of treatment. Further large scale studies, are needed to better understand the major prognostic determinants of these tumors and to identify specific treatments.Öğe RETROSPECTIVE ANALYSIS OF SARCOMAS OF THE UROGENITAL SYSTEM(Aves, 2005) Kandirali, Engin; Sanli, Oner; Erdemir, Fikret; Ozcan, Faruk; Esen, Tarik; Tunc, MuratIntroduction: Sarcomas account for only about 1% of all malignant tumors. Less than 5% of soft tissue sarcomas arise from the genitourinary tract, accounting for only 1 to 2% of all malignant genitourinary tumors. Because of the rarity of these tumors, the basic problem in the management of these tumors is the lack of a uniform approach for staging and treatment. Although sarcomas arise from different organs in the genitourinary tract and compromise different histopathological features, the main treatment modality is surgical resection of the tumor. The aim of this study is to evaluate the clinical and pathological features and prognosis of genitourinary tumors treated in our clinic. Materials and Methods: Between 1997 and 2003, after excluding the gynecological sarcomas, a total of 15 genitourinary sarcomas were treated in our clinic. All patients were evaluated with a detailed medical history, physical examination, multiple serum analyses and imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging if needed. Thus, tru-cut biopsy was performed if indicated. For all patients, the primary treatment modality was open surgical resection. In addition to surgery, some of these patients also received adjuvant radiation therapy and/or chemotherapy. For staging, Memorial Sloan-Kettering Cancer Center soft tissue sarcoma staging system was used. Post-operative follow-up was done in regular intervals. Results: The mean age of patients was 50.4 +/- 14.7 (16-69) years and the mean tumor size was 8 +/- 3.5 cm. The chief complaints (one or more) of these patients were hematuria in 9, flank pain in 7, weight loss in 6, abdominal pain in 5, abdominal mass in 4, lower urinary tract symptoms in 3. Five bladder, six kidney, three retroperitoneal and one prostate sarcoma were detected in three women and 12 men. Histopathology of these tumors were leiomyosarcomas in nine, liposarcomas in three, rhabdomyosarcomas in two, malignant fibrous histiocytoma in one of the patients. Of these tumors, three were low grade and 12 were high grade. All patients except one underwent open surgical resection of the tumors. For five patients surgical resection was the only treatment modality, while eleven patients received adjuvant chemotherapy and/or radiotherapy after surgery. After a follow-up of 10.2 +/- 4.7 (3-20) months, overall survival rate was found to be 20% (3/15). Conclusion: Genitourinary sarcomas are a rare group of tumors with a generally poor prognosis. Complete surgical resection is still the mainstay of treatment. Further large scale studies, are needed to better understand the major prognostic determinants of these tumors and to identify specific treatments.Öğe A surgery underestimated by urology: Adrenalectomy; Clinical experience of Istanbul medical faculty(2004) Kandirali, Engin; Erdemir, Fikret; Korgali, Esat; Atilgan, Do?an; Esen, Tarik; Tunç, MuratIntroduction: The most common adrenal disorder encountered by clinicians today is the incidentally discovered adrenal mass as a result of the more widespread use of enhanced quality of high-resolution radiological techniques. Autopsy series have identified adrenal masses in 1.4% to 9% of patients who had no evidence of adrenal dysfunction prior to death. The incidence of adrenal masses detected by computed tomography scanning has ranged from 0.4% to 4.4%. The etiology of adrenal masses includes benign or malignant adrenal cortical tumors, adrenal medullary tumors, and other benign lesions. An adrenal mass is characterized according to functional status, with a medical history, physical examination, and hormonal assessment, and malignant potential, with an assessment of the imaging phenotype and mass size. Adrenal masses are commonly small (80% smaller than two cm), benign (94%), and non-functioning (%90). Malignant adrenal masses are rare (%2.7), and the most of them are larger than five cm. All adrenal masses require biochemical workup to evaluate adrenal function. Hormonally inactive tumors smaller than five cm. are followed regularly. Surgery is indicated for masses that are larger than five cm. in diameter, hormonally active adrenal masses or malignancy suspicione. The aim of this study is to investigate the features and the preoperative evaluation of patients who have had adrenalectomy in our clinic, to point out how to perform the biochemical evaluation, and to emphasize the importance of adrenal surgery. Materials and Methods: In our department, between January 1997 and December 2003, we performed a total of 13 open adrenalectomies via the retroperitoneal or transperitoneal approach, including eight on the right and five on the left side, in nine men add four women. Ten patients who completed post-operative follow up examination were included in our study. All patients were evaluated with a medical history, physical examination, ultrasonography, computed tomography, magnetic resonance imaging, serum multipl analyses and hormonal activity. Pre-operative and post-operative medical treatments of the patients were done by an endocrinologist. Results: Mean age of our patients was 51.4±7.8 (36-65) years and mean follow up period was 43.1±22.7 (4-78) months. Eight adrenal masses are detected on the right side and five adrenal masses are on the left side, in nine men and four women. One case had hormonally active adrenal mass and 12 cases had hormonally inactive adrenal mass. The average adrenal mass size was 7.9 cm (3-16). Mean operation time was 120 (60-180) minutes and no complication was seen during the operation. Mean duration of hospital stay was six (4-10) days. The most common lesions were benign cortical adenoma (%30.5), metastasis of renal cell carcinoma (%23), primer adrenal carcinoma (%15.2) and son. Ten of 13 operated patients' follow-up visits were done regularly. Two patients who had metastasis of renal cell carcinoma died due to primary illness approximately 9.7 months after the operation. We did not detect recurrence in the other eight patients. Median survival rate was 80%. Conclusion: After a careful clinical, biochemical and radiological evaluation, patients are selected for surgery. Although laparoscopic adrenalectomy has become a standard procedure for the treatment of adrenal tumors, the open surgery can be perform safety with low morbidity rates especially if the tumor size is large and there is malignancy suspicione. Pre-operative, intra-operative and post-operative preparation of the patients is very important. All adrenal masses should be evaluated hormonally. Appearance and clinical history should indicate how to perform the biochemical evaluation keeping in mind that the presence of pheochrocytomas must be ruled out. We believe that the subject of adrenal gland surgery should be considered as a part of urology practice although many other departments such as general surgery, plastic surgery, obstetrics and gynecology and pediatric surgery have a tendency to be involved in many of the subjects included in urology.
