Browsing by Author "Karamik, Kaan"

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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.