Browsing by Author "Akdemir, Serkan"

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Citation Count: 1
Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study
(Wiley, 2022) Tuncel, Altug; Aykanat, Can; Akdemir, Serkan; Oksay, Taylan; Arslan, Murat; Basboga, Serdar; Guzel, Ozer
To assess the efficacy and morbidity of the holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia. The study included 60 (55%) and 49 (45%) patients who underwent laser and bipolar enucleation of the prostate respectively. According to the perioperative data, except for length of hospital stay and enucleated prostate weight, all the remaining parameters were similar between the groups. There were significant differences between the preoperative and the postoperative third and 12th month voiding parameters in both groups. In the laser group, the maximum urine flow rate value was better than the bipolar group at the postoperative third and 12th months. However, we did not find any statistically significant difference between the groups in terms of the serum prostate-specific antigen level, International Prostate Symptom Score and postvoid residual urine volume at the postoperative third and 12th months. Our results show that both laser and bipolar techniques are effective minimally invasive surgical treatment options for men with benign prostatic hyperplasia. When compared to bipolar technique, laser technique provides shorter hospital stay, more prostatic tissue enucleation and better maximum urine flow rate values.
Citation Count: 12
Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time
(Karger, 2021) Gunseren, Kadir Omur; Akdemir, Serkan; cicek, Mehmet Cagatay; Yildiz, Ali; Arslan, Murat; Yavascaoglu, Ismet; Vuruskan, Hakan
Introduction: To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. Methods: Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. Results: HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. Conclusion: LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.
Citation Count: 2
Predictive factors affecting morcellation efficiency in holmium laser enucleation of the prostate
(Korean Urological Assoc, 2023) Anil, Hakan; Guzel, Ahmet; Yildiz, Ali; Akdemir, Serkan; Karamik, Kaan; Arslan, Murat
Purpose: To determine the factors affecting morcellation efficiency in holmium laser enucleation of the prostate (HoLEP) surgery.Materials and Methods: Patients who underwent HoLEP surgery by a single surgeon between 2018 and 2022 were included in the study. Our primary outcome of interest in this study was morcellation efficiency. The effect of preoperative and perioperative variables on morcellation efficiency was evaluated with linear regression analysis. Results: A total of 410 patients were included in the study. The mean morcellation efficiency was 6.95 & PLUSMN;1.70 g/min. Univariable and multivariable linear regression analysis was performed to identify factors affecting morcellation efficiency. Presence of the "beach ball" effect (small, round prostatic tissue fragments that are fibrotic and difficult to morcellate), the learning curve, resectoscope sheath type, prostate-specific antigen (PSA) density, morcellated tissue weight, and the presence of prostate calcification were found to be independent predictive factors ((3=-1.107, 95% CI:-1.59 to-0.55, p<0.001; (3=-0.514, 95% CI:-0.85 to-0.17, p=0.003; (3=-0.394, 95% CI:-0.65 to-0.13, p=0.003; (3=-0.302, 95% CI:-0.59 to-0.09, p=0.043; (3=0.062, 95% CI: 0.05 to 0.06, p<0.001; (3=-0.329, 95% CI:-0.55 to-0.10, p=0.004; respectively).Conclusions: This study reports that presence of the beach ball effect, the learning curve, small resectoscope sheath, PSA density, and presence of prostate calcification negatively affect morcellation efficiency. On the contrary, morcellated tissue weight has a linear relationship with morcellation efficiency.
Citation Count: 0
UPGRADE score: a new scoring system in predicting pathological upgrading after prostatectomy in patients with Gleason grade group 1 prostate cancer
(Mre Press, 2024) Karamik, Kaan; Anil, Hakan; Yildiz, Ali; Guezel, Ahmet; Akdemir, Serkan; Arslan, Murat
Pathological upgrading poses a significant challenge in treatment decision-making, particularly for patients considered for active surveillance (AS). This study aimed to devise a novel scoring system to predict the risk of upgrading in patients with biopsy Gleason grade group 1 prostate cancer. We conducted a retrospective review of 235 patients who underwent radical prostatectomy between February 2014 and June 2022. Data on patient age, prostate-specific antigen (PSA) level, body mass index, clinical T-stage, prior biopsy history, Prostate Imaging-Reporting and Data System (PIRADS) score, time interval from biopsy to surgery, and pathological outcomes were collected. After a comprehensive review of the literature, multivariate analyses identified seven factors associated with upgrading in prostate cancer patients after radical prostatectomy: uninformative prior biopsy sample, PSA level, greatest percentage of tumor involvement, radiological PIRADS score, age, delay from biopsy to surgery and extension of positive cores. These factors were integrated into our devised U.P.G.R.A.D.E. model to form a scoring system. The U.P.G.R.A.D.E. score was calculated based on the cumulative score of these variables. The predictive performance of the U.P.G.R.A.D.E. scoring system was assessed, revealing a cohort with a mean age of 64.22 +/- 5.88 years and a mean PSA value of 8.92 +/- 5.05 ng/mL. The pathological samples of 95 patients (40.6%) were upgraded, and the upgraded patients exhibited significantly higher U.P.G.R.A.D.E. scores (p <0.001). The area under the receiver operating characteristic (AUROC) curve for the U.P.G.R.A.D.E. scoring system demonstrated robust predictive ability for upgrading (AUROC = 0.952; 95% Confidence interval (CI): 0.926-0.978; p < 0.001). In addition, a higher U.P.G.R.A.D.E. score was strongly associated with an increased risk of upgrading in biopsy Gleason grade group 1 patients, suggesting potential limitations for active surveillance eligibility in these individuals. Further validation studies are warranted to confirm these initial findings.