Abdullah Armagan

Bezmiâlem Vakif Üniversitesi, İstanbul, Istanbul, Turkey

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Publications (93)168.92 Total impact

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    ABSTRACT: To compare outcomes of micro-percutaneous nephrolithotomy (PNL; microperc) with mini-PNL (miniperc) in the treatment of pediatric renal stones of sizes 10-20 mm. Patients aged <18 years who underwent PNL for renal stones of sizes 10-20 mm between August 2011 and March 2014 in 3 referral centers were reviewed retrospectively. Patients were evaluated in the following 2 groups: microperc (group 1) and miniperc (group 2). Demographics and perioperative parameters (fluoroscopy and operation time, hemoglobin drop, and stone-free and complication rates) were retrospectively analyzed. A total of 119 patients were evaluated, including group 1 (n = 56) for microperc and group 2 (n = 63) for miniperc. We found mean stone sizes as 13.4 ± 3.4 and 14.8 ± 3.7 mm in the groups, respectively (P = .046). Mean operation and fluoroscopy times were 57.1 ± 31.2 minutes and 132.4 ± 92.5 seconds in the microperc group and 68.9 ± 36.7 minutes and 226.2 ± 166.2 seconds in the miniperc group, respectively (P = .110 and P <.001). Stone-free rates were similar in both groups (82.1% vs 87.3%; P = .433 and 92.8% vs 93.6%; P = 0673) on postoperative day 1 and at first-month follow-up. The mean hemoglobin drop in group 2 differed from that in group 1 significantly (P <.001). The difference of average hospitalization times was statistically significant (43.0 ± 15.4 vs 68.5 ± 31.7 hours; P <.001). Our outcomes show that microperc may be preferred as an alternative to mini-PNL for the treatment of pediatric kidney stones of sizes 10-20 mm with comparable success and complication rates, as well as shorter hospitalization and fluoroscopy times. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 05/2015; 85(5). DOI:10.1016/j.urology.2015.02.010 · 2.13 Impact Factor
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    ABSTRACT: Our aim was to evaluate clean intermittent catheterization (CIC) results in combination with triamcinolone ointment and contractubex ointment for lubrication of the catheter after optical internal urethrotomy (OIU). Ninety patients who underwent OIU were randomized into three groups. Two weeks after operation, patients were treated with CIC (group A), triamcinolone ointment CIC (group B), and contractubex ointment CIC (group C). Follow-up continued for 24 months after the OIU. Postoperative results were compared between the three groups. There were no significant differences in the baseline characteristics of the patients or the etiology of the urethral stricture between the three groups. The mean preoperative Q max was 4.31 ml/s. The average score of preoperative international prostate symptom score (IPSS) was 23.1 points. In both groups, after treatment, significant improvements in Q max and IPSS were noted at all follow-up period (p < 0.05). But for Q max and IPSS, there were not any significant differences between groups at all follow-up period (p > 0.05). Overall recurrence rate was 28.9 % (26 out of 90 patients) at the end of the study. Recurrence rates were, however, not found to be statistically significant between these three groups (p > 0.05). Our results indicate that the urethral dilation protocol with CIC after first OIU is a safe, simple, well-tolerated, office-based procedure. Triamcinolone or contractubex ointments of the CIC do not provide an additional benefit. Currently, urethral dilation with CIC after first OIU seems to be the only proven procedure that decreased the recurrence rate.
    International Urology and Nephrology 04/2015; 47(6). DOI:10.1007/s11255-015-0990-4 · 1.29 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e265. DOI:10.1016/j.juro.2015.02.1073 · 3.75 Impact Factor
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    ABSTRACT: To present a retrospective comparative clinical study of micropercutaneous nephrolithotomy (microperc) versus flexible ureterorenoscopy (F-URS) in treatment of moderate-size lower-pole stones (LPSs). We retrospectively reviewed data on patients with isolated LPSs ≤2 cm in diameter treated with F-URS and/or microperc in two referral centers. Patients were divided into two groups by treatment modality: F-URS (Group 1) and microperc (Group 2). Demographics and perioperative parameters were analyzed. A total of 127 patients with isolated LPSs were treated via F-URS (Group 1, n = 59) and microperc (Group 2, n = 68). Mean patient age in microperc group was slightly lower than in F-URS group (p = 0.112). We found no statistically significant difference in terms of either the size or number of stones in two groups (p = 0.113 and p = 0.209, respectively). Operative time was shorter in microperc, whereas fluoroscopy time was shorter in F-URS (60.1 ± 26.2 vs. 46.2 ± 24.3 min, p < 0.001; and 28.3 ± 19.1 vs. 108.9 ± 65.2 s, p < 0.001). Mean fall in hemoglobin level was statistically significantly lower in F-URS and hospitalization time was also significantly shorter in F-URS (0.68 ± 0.51 vs. 1.29 ± 0.88 mg/dL, p < 0.001; and 23.0 ± 58.1 vs. 33.8 ± 17.2 h, p < 0.001, respectively). Stone-free rates (SFRs) were 74.5 % (44/59) in Group 1 and 88.2 % (60/68) in Group 2 (p < 0.001). We found that microperc was safe and efficacious when used to treat moderate-size LPSs and may be considered as an alternative to F-URS, affording a higher SFR. Our study supports the notion that microperc should play an increasing role in treatment of LPSs.
    World Journal of Urology 02/2015; DOI:10.1007/s00345-015-1503-x · 3.42 Impact Factor
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    ABSTRACT: The objective of the study was to present the clinical and operative effects of two types of anesthesia on micro-percutaneous nephrolithotomy (“microperc”). We retrospectively reviewed 116 patients who underwent microperc between August 2011 and September 2013. Patients were sorted into one of the two groups according to the type of anesthesia received: general (Group 1, n:53) or spinal (Group 2, n:63). Perioperative variables (age, stone size, location) and outcomes (operation time, success, complication rate) were evaluated and compared. Although there was a statistically significant difference in the mean age of patients (30.3 ± 22.1 vs. 45.8 ± 14.6, respectively, p p = 0.689). There was no substantial difference in terms of sizes and localizations of stones in the two groups (p = 0.970 and p = 0.795). While a significant difference was found in comparison of operative times (59.62 ± 32.56 vs. 40.98 ± 26.45 min, p p = 0.441). Stone-free rates were similar (90.5 % vs. 93.6 %, p = 0.297). We found no statistical differences between the two groups with respect to mean hemoglobin drop and hospitalization time (p = 0.015 and p = 0.917, respectively). The complication rates and analog pain scores were also similar (p = 0.543 and p = 0.365). Our results show that microperc is a feasible surgical modality in the treatment of kidney stone disease under both spinal and general anesthesia. Spinal anesthesia may be considered for patients at a high risk for general anesthesia, and also may be an alternative for patients who are concerned about and/or fearful of general anesthesia.
    01/2015; 43(3). DOI:10.1007/s00240-015-0752-x
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    ABSTRACT: To compare the protective efficacy of erdosteine and vitamins C and E against renal injury caused by hind limb ischemia-reperfusion (I/R). Rats were split into 4 groups: group I as the control, group II as I/R, group III as I/R + erdosteine, and group IV as I/R + vitamins C and E. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities and malondialdehyde (MDA) tissue levels were determined. MDA levels were found comparable with the control group in groups II and III. However, they were considerably decreased in group IV when compared to group II (P < 0.01). Additionally, SOD, CAT, and GSH-Px activities were considerably (P < 0.05) decreased in group II. While CAT and GSH-Px activities were restored (P <0.01) by vitamin E and C treatment, SOD activity was not significantly affected. While GSH-Px activities were higher (P < 0.05) with erdosteine administration, SOD and CAT activities were unchanged. The protective effect of vitamins C and E is higher than that of erdosteine treatment in reducing the oxidative stress after renal ischemia in this animal model.
    Turkish Journal of Medical Sciences 01/2015; 45(1):33-37. DOI:10.3906/sag-1310-38 · 0.84 Impact Factor
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    European Urology Supplements 11/2014; 13(7). DOI:10.1016/S1569-9056(14)61654-7 · 3.37 Impact Factor
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    ABSTRACT: To investigate whether aging affects surgical outcomes by comparing the results of two patient groups undergoing PNL: those over 60 and those under 60. A retrospective screen was made for patients undergoing conventional PNL surgery for renal stones performed in two separate centers between 2010 and 2013. 520 patients included were classified into age groups: patients aged 18-59 comprised Group-1 and those aged over 60 comprised Group-2. Those between 60-69 years (sexagenarian) were assigned to Group-2a; 70-79 years (septuagenarian) to Group-2b; and 80-89 years (octogenarian) to Group-2c. Patients' demographic characteristics (accompanying comorbidities, ASA scores, body mass indices and stone size) and perioperative values (duration of surgery and hospital stay, success and complication rates) were compared between the groups. Mean stone size was similar in groups (30.1 ± 15.5 vs. 31.5 ± 15.4 mm, p = 0.379). The mean ASA value for the patients in Group-1 was 1.61; significantly lower than that in the other groups (p = 0.000). The level of accompanying comorbidities in Group-1 was significantly lower than that of the other groups (p = 0.000). The mean duration of surgery, postoperative hematocrit drop, complication and success rate were statistically similar in Groups 1 and 2 (p = 0.860, p = 0.430, p = 0.7, and p = 0.66, respectively). The duration of hospital stay was significantly shorter in the patients in Group-1 compared to those in Group-2 (p = 0.008). In experienced hands, PNL can be safely and reliably performed in the treatment of renal stones in elderly patients.
    11/2014; 43(2). DOI:10.1007/s00240-014-0742-4
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    ABSTRACT: To analyze the patient- and procedure-related factors affecting the outcomes of percutaneous nephrolithotomy (PNL) in horseshoe kidneys (HSKs).
    Urology 10/2014; DOI:10.1016/j.urology.2014.08.008 · 2.13 Impact Factor
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    ABSTRACT: Purpose: Flexible nephroscopy is an important technique in the treatment of staghorn renal calculi to reach peripheral calices. In this study, we present our experience with flexible nephroscopy and fluoroscopy-guided additional access creation for staghorn renal calculi. Patients and Methods: We conducted a retrospective analysis of patients with staghorn renal calculi treated with multiple percutaneous renal tracts created with the guidance of flexible nephroscopy and fluoroscopy. Additional tracts were performed with combined flexible nephroscopy and fluoroscopy guidance. Flexible nephroscopy was used to help target the calix and ensure the safety of access. Results: Additional percutaneous renal access was achieved using combined flexible nephroscopy and fluoroscopy guidance in 26 patients with complete staghorn (n21) and partial staghorn (n = 5) kidney stones. The cumulative stone size was measured to be 59.3 mm. The mean procedure times, fluoroscopy times, and hospitalization times were 91.5 minutes, 3.4 minutes, and 2.7 days, respectively. The postoperative hematocrit drop was measured to be 4.96 ± 3.8. Upper and lower calix was most common primary access tracts in 11 and 15 patients, respectively. Stone-free status was achieved in 22 patients (84.6%) with mean 2.1 ± 0.3 tract number. Postoperative complications were observed in 6 patients (23.1%). Conclusions: In the requirement of additional access for staghorn renal calculi, usage of flexible nephroscopy adjacent to fluoroscopy increases the safety of the procedure by confirmation of precise renal access.
    Journal of endourology / Endourological Society 07/2014; 13(7). DOI:10.1089/end.2014.0189 · 2.10 Impact Factor
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    ABSTRACT: Abstract We aimed to evaluate the cancer detection rates of 6-, 10-, 12-core biopsy regimens and the optimal biopsy protocol for prostate cancer diagnosis in patients with renal failure. A total of 122 consecutive patients with renal failure underwent biopsy with age-specific prostate-specific antigen (PSA) levels up to 20 ng/mL. The 12-core biopsy technique (sextant biopsy + lateral base, lateral mid-zone, lateral apex, bilaterally) performed to all patients. Pathology results were examined separately for each sextant, 10-core that exclude parasagittal mid-zones from 12-cores (10a), 10-core that exclude apex zones from 12-cores (10b) and 12-core biopsy regimens. Of 122 patients, 37 (30.3%) were positive for prostate cancer. The cancer detection rates for sextant, 10a, 10b and 12 cores were 17.2%, 29%, 23.7% and 30.7%, respectively. Biopsy techniques of 10a, 10b and 12 cores increased the cancer detection rates by 40%, 27.5% and 43.2% among the sextant technique, respectively. Biopsy techniques of 10a and 12 cores increased the cancer detection rates by 17.1% and 21.6% among 10b biopsy technique, respectively. There were no statistical differences between 12 core and 10a core about cancer detection rate. Adding lateral cores to sextant biopsy improves the cancer detection rates. In our study, 12-core biopsy technique increases the cancer detection rate by 5.4% among 10a core but that was not statistically different. On the other hand, 12-core biopsy technique includes all biopsy regimens. We therefore suggest 12-core biopsy or minimum 10-core strategy incorporating six peripheral biopsies with elevated age- specific PSA levels up to 20 ng/mL in patients with renal failure.
    Renal Failure 05/2014; 36(6). DOI:10.3109/0886022X.2014.915195 · 0.78 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e207. DOI:10.1016/j.juro.2014.02.771 · 3.75 Impact Factor
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    ABSTRACT: The micro-percutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that is performed through a 4.8Fr all-seeing needle. We aimed to measure the intrarenal pelvic pressure (IPP) during microperc and compare it with the levels of conventional PNL. A total of 20 patients with 1- to 3-cm renal calculi resistant to shock wave lithotripsy were treated either with microperc (Group-1, n: 10) or conventional PNL (Group-2, n: 10) by the same surgical team. The IPP was measured during different stages (entrance into the collecting system, stone fragmentation, and before termination) of the procedures by an urodynamic machine using the 6Fr ureteral catheter. All the variables were statistically compared between the two groups. The demographic values of the patients were similar. The operation time and duration of hospitalization were significantly prolonged in conventional PNL group (p = 0.034, p = 0.01, respectively). The mean drop in hematocrit levels was significantly lower in microperc group (3.5 ± 1.5 vs. 1.8 ± 0.8; p = 0.004). The IPP was significantly higher in microperc group during all steps of the procedure. The highest level of the IPP was measured as 30.3 ± 3.9 and 20.1 ± 3.1 mmHg in Group 1 and Group 2, respectively (p < 0.0001). However, the complication and success rates were found comparable. In conclusion, we demonstrate that the level of IPP is significantly increased during microperc compared to conventional PNL. Microperc should be used cautiously in cases with impaired drainage of the collecting system.
    02/2014; 42(3). DOI:10.1007/s00240-014-0646-3
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    ABSTRACT: In this study, we evaluated the safety and efficacy of using the LigaSure sealing system (Valleylab, Boulder, Colorado) for laparoscopic decortication of symptomatic hilar renal cysts.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2014; 18(2):301-307. DOI:10.4293/108680813X13753907291558 · 0.79 Impact Factor
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    ABSTRACT: Purpose: To discuss whether fluoroscopic imaging is essential during the ureteroscopic treatment of kidney stones in an effort to diminish radiation exposure. Materials and Methods: Seventy-six patients with kidney stones were treated with retrograde intrarenal surgery (RIRS). In the operation room, a mobile C-arm fluoroscopy system was ready to use in case fluoroscopic imaging was needed. The manipulations were performed with tactile and visual cues. The perioperative and postoperative parameters were retrospectively evaluated. Results: The mean age of the patients was 39.9 ± 13.8 years. The mean stone size was 14.1 ± 4.1 mm. The insertion of the access sheath was performed over the guidewire under single shoot fluoroscopic imaging in all patients. Additional fluoroscopic imaging was required to localize the stone (n = 2) and to determine the collecting system anatomy (n = 2) for 4 (5.2%) patients with previous renal surgery and severe hydronephrosis. Stone-free status was accomplished in 63 (82.9%) patients. Conclusion: The RIRS with low-dose fluoroscopy protocol for kidney stones can be safely and effectively performed in patients with no special circumstances such as anatomical abnormalities or calyceal diverticular stones.
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    ABSTRACT: The aim of this study was to investigate the effectiveness and reliability of the micro-percutaneous nephrolithotomy (PNL) method for the management of kidney stones. We performed a retrospective analysis of 136 patients (140 renal units) who underwent micro-PNL for renal stones between September 2011 and February 2013 in four referral hospitals in Turkey. The selection of treatment modality was primarily based on factors such as stone size and location. In this study, we analyzed patient- and procedure-related factors. The mean age of patients in this study was 28.7 ± 20.6 (1-69) years, and the mean stone size was 15.1 ± 5.15 (6-32) mm. Conversion to mini-PNL was required in 12 patients. All interventions were performed with the patient in the prone position, except for the 3-year-old patient with the pelvic kidney who was placed in the supine position. The mean hospital stay was 1.76 ± 0.65 (1-4) days, and the mean drop in the hemoglobin level was 0.87 ± 0.84 (0-4.1) mg/dL. One of our patients required transfusion. Ureteral J stent was implanted in nine (6.43 %) patients because of residual stones. Seven (6.43 %) patients complained of postoperative renal colic which was managed conservatively. Abdominal distension related to extravasation of the irrigation fluid was observed in three patients (2.19 %). There were no other postoperative complications. An overall success rate of 82.14 % was achieved. Micro-PNL can be effectively and safely used for small and moderate kidney stones resistant to shock wave lithotripsy or as an alternative to other minimally invasive treatment methods.
    12/2013; 42(2). DOI:10.1007/s00240-013-0631-2
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    European Urology Supplements 09/2013; 12(3):46. DOI:10.1016/S1569-9056(13)61715-7 · 3.37 Impact Factor
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    ABSTRACT: The objective of the study was to investigate the precise role of computed tomography (CT) in preoperative radiologic evaluation and surgical planning of kidney stone in children prior to percutaneous nephrolithotomy (PNL). A total of 113 pediatric patients (aged ≤18 years) undergoing PNL for renal stone(s) in three referral hospitals between March 2010 and August 2012 were retrospectively evaluated. Depending on the preoperative radiologic evaluation, patients were divided into two groups. Those evaluated with CT were classified as group-1 (n = 50) and the remaining cases undergoing intravenous urography (IVU) examination were classified as group-2 (n = 63). Patient- and procedure-related variables and perioperative measures were compared between the groups. The mean age, stone size and localization were similar in both groups (p = 0.07, p = 0.57, p = 0.6, respectively). Although the postoperative hemoglobin drop was found to be significantly higher in group-2 (1.5 ± 1.3 vs. 0.9 ± 0.6 g/dL, p = 0.005), the mean operation time, fluoroscopic screening time, access number, overall success and complication rates were comparable (p = 0.06, p = 0.94, p = 0.75, p = 041, and p = 0.41, respectively). However, the mean hospitalization time was significantly prolonged in group-2 than in group-1 (p = 0.03). Our findings clearly demonstrate that, despite the key role of preoperative CT in particular patients with anatomically abnormal kidneys, IVU is a valuable alternative imaging modality with comparable radiation doses in children.
    08/2013; DOI:10.1007/s00240-013-0593-4
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    ABSTRACT: The aim of the study to compare outcomes of flexible ureterorenoscopy in patients with different body mass index (BMI) scores and to explore whether the BMI has an effect on outcomes of RIRS. Five hundred and two patients who underwent flexible URS in 3 centers between 2008 and 2012 for the management of single upper urinary tract calculi were retrospectively reviewed. Patients were categorized as normal weight BMI 18.5 to 24.99 kg/m(2), overweight 25 to 29.99 kg/m(2), obese 30 to 39.99 kg/m(2) and morbid obese >40 kg/m(2).The groups were assessed in terms of demographic parameters including age, gender, stone size, intraoperative and postoperative variables. The mean patient age was 41.3 ± 15.51 (18-81) years and with an average BMI 26.68 ± 5.2 kg/m(2) (16.64-55.15 kg/m²). Of the patients, 43.2 % had normal weight (NW), 32.2 % were overweight (OW), 21.9 % were obese (O) and 2.5 % were morbidly obese (MO). Stone-free rates after single procedure in NW, OW, O, MO groups were 60.8, 61.7, 73.6, 61.5 %, respectively (p = 0.079). Overall targeted stone-free rates were also similar in four groups (88.9, 90.1, 93.6, 90.4 %, p = 0.586). There were no statistically significant differences in the frequency of complications and mean hospitalization time among the groups (p > 0.05). In conclusion, this study demonstrated that flexible URS is a valuable option for the treatment of kidney stone in both obese and non-obese patients. BMI did not influence the postoperative outcomes.
    07/2013; DOI:10.1007/s00240-013-0590-7
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    ABSTRACT: To assess the analgesic efficacy of bupivacaine infiltrations into the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy (PCNL). This prospective, randomized controlled study enrolled 121 patients. Patients were randomized to receive a 20-mL infiltration of 0.25% bupivacaine into the nephrostomy tract after PCNL. Patients were divided into 2 groups. The group 1 patients received bupivacaine infiltrations, whereas group 2 did not. Patients' visual analog scale (VAS) pain scores were evaluated at 6, 12, and 24 hours postoperatively. Pain in the postoperative period was managed with intramuscular diclofenac sodium (75 mg) or meperidine (pethidine) hydrochloride (50 mg), as requested by the patients. The patients were a mean age of 43.2 ± 12.7 years (range, 18-74 years). The VAS pain scores at 6, 12, and 24 hours postoperatively and the amount of diclofenac sodium needed were significantly less in the group with bupivacaine infiltration than in those that did not receive the infiltration (P <.05). The VAS pain scores in patients with tubeless PCNL were significantly lower than those in patients with standard PCNL (P <.05). The pain after tubeless and standard PCNL may be decreased by bupivacaine infiltration into the nephrostomy tract. The findings of the present study reveal that a tubeless procedure and local analgesic infiltration into the nephrostomy tract after the PCNL is the more comfortable procedure for the patients.
    Urology 07/2013; 82(3). DOI:10.1016/j.urology.2013.02.083 · 2.13 Impact Factor

Publication Stats

563 Citations
168.92 Total Impact Points

Institutions

  • 2011–2015
    • Bezmiâlem Vakif Üniversitesi
      • Faculty of Medicine
      İstanbul, Istanbul, Turkey
  • 2004–2014
    • T.C. Süleyman Demirel Üniversitesi
      • Department of Urology
      Hamitabat, Isparta, Turkey
  • 2003–2009
    • Istanbul University
      • Department of Family Medicine (Istanbul Medical Faculty)
      İstanbul, Istanbul, Turkey
    • Necmettin Erbakan Üniversitesi
      Conia, Konya, Turkey
  • 2007
    • Mersin University
      Zephyrium, Mersin, Turkey