Abdullah Armagan

Bezmiâlem Vakif Üniversitesi, İstanbul, Istanbul, Turkey

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Publications (109)208.04 Total impact

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    ABSTRACT: Objective: There are 2 critical steps of stent placement during laparoscopic pyeloplasty (LP) in children. Introduction to the ureteropelvic junction and passing through the ureterovesical junction. We aimed at overcoming those 2 steps by creating a modified technique. Methods: Consecutive 27 children undergoing transperitoneal laparoscopic dismembered pyeloplasty by a single surgeon were prospectively enrolled into this study. The modifications of our technique are using an Amplatz dilator and a closed tip stent. Results: The mean age of the children was 6.7 (range 4 months-17 years). The mean time of stent insertion was 2.7 ± 2.0 (2-6) min and the operative time was 128.3 ± 17.6 (90-180) min. The mean number of days of hospital stay was 2.0 ± 0.4 (1-3). After a mean follow-up period of 20.3 ± 4.2 (14-30) months, no operative failure was detected. Conclusion: Our modified technique is a completion of the current armamentarium for stent placement during LP in infants and children.
    No preview · Article · Jan 2016 · Urologia Internationalis
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    ABSTRACT: Purpose: To evaluate and compare effectivity and safety of flexible ureteroscopy (F-URS) and mini-percutaneous nephrolithotomy (mPNL) for 10-20 mm renal stones in obese patients. Methods: Between 2012 and 2015, charts of patients who were treated with F-URS or mPNL for 10-20 mm kidney stone(s) were analyzed. Patients with BMI > 30 kg/m(2) were enrolled into the study. Total of 315 patients were treated with mPNL, and 56 patients were matched our inclusion criteria. In the same period, F-URS was performed in 669 patients, and 157 of them had 10-20 mm kidney stones, and their BMI values were >30 kg/m(2). The patients were retrospectively matched at a 1:1 ratio to index F-URS-mPNL cases with respect to the patient age, gender, ASA score, BMI and size, number, and location of stone. Results: Gender, age, BMI, stone size, stone number, location of stone(s), and ASA scores were similar between groups. The mean operation time was significantly longer in mPNL group (p: 0.021). However, the mean fluoroscopy time was similar (p: 0.270). Hemoglobin drop requiring blood transfusion and angioembolization was performed in two and one patients after mPNL, respectively. Overall complication rate was significantly higher in mPNL group than F-URS group (30.3 vs. 5.3 %, p: 0.001). Conclusion: Our results demonstrated that both F-URS and mPNL achieve acceptable stone-free rates in obese patients with 10-20 mm renal stones. However, complication rates were significantly lower in F-URS group.
    No preview · Article · Dec 2015 · World Journal of Urology
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    ABSTRACT: Objective: To compare the results of transperitoneal laparoscopic nephrectomy in patients with atrophic and hydronephrotic kidneys. Material and methods: Clinical data were collected from 35 patients who had undergone laparoscopic nephrectomies for atrophic or hydronephrotic non-functioning kidneys between January 2010 and March 2014. Comparative analysis was carried out between the two groups examining demographic characteristics, imaging modalities, etiology, operative times, port numbers, conversion to open surgery, complications, pre-and post-operative hemoglobin and creatinine values, transfusion rates and length of hospital stays. Results: Laparoscopic nephrectomy was performed for atrophic kidneys in 20 (57%) patients and for hydronephrotic kidneys in 15 (42%) patients. In the atrophic group, 3 patients (15%) required transfusion because of bleeding but none of the patients required conversion to open surgery. In the hydronephrotic group one patient (6.6%) required transfusion and conversion to open surgery because of bleeding. Both of the groups were similar in terms of postoperative hospital stay but compared to the atrophic kidneys, hydronephrotic ones were associated with a longer total operative times (90.1 min vs. 73.6 min, p=0.03). Any serious complication (except for bleeding) and mortality were not encountered in both groups. Conclusion: Laparoscopic nephrectomy is a safe and effective minimally invasive technique that can be used in atrophic and hydronephrotic non-functioning kidneys.
    Full-text · Article · Oct 2015
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    ABSTRACT: Objective: In this study, the outcomes of 279 cases in whom we performed retrograde intrarenal surgery (RIRS) were evaluated retrospectively. Material and methods: RIRS was performed on 279 cases with the aid of access sheath of guidewire between March 2011 and February 2015. All patients were operated in the standard lithotomy position. A hydrophilic guidewire was inserted with the aid of rigid ureterorenoscopy and we checked whether there were any residual ureteral stones and other pathologies. Fluoroscopy was used routinely in all cases. Stone fragments smaller than 3 mm were left off but those bigger than 3 mm were removed by grasper after stone fragmentation. Controls of the patients were assessed by plain films (KUB), urinary tract ultrasonography (US) and/or computed tomography (CT) 1 month after the operation. Success rate of the procedure was defined as the stone-free status or presence of residual fragments less than 3 mm. Results: 152 of the patients were male and 127 were female. The median ages of the male and female patients were 47.7 (1-86) ve 45.9 (3-79) years respectively. The median stone size was 13.5 mm (8-25). Preoperatively 34 (12.1%) patients had double-J ureteral stent. 19 (6.8%) patients were operated while they were still receiving antithrombotic and antiplatelet therapy Solitary kidney was present in 24 patients while the remaining patients had kyphoscoliosis (n=3), rotation anomaly (n=6), pelvic kidney (n=2), double collecting system (n=3), and horseshoe kidney (n=6). In 264 patients access sheath was used, in 15 patients operation was performed with the help of the guidewire. Double-J stents were inserted to 14 patients because of ureteral stricture and they underwent operation after 2 weeks later. Renal stones of 219 patients among all cases were fragmented completely and the patients were discharged as stone free (SF). Our success rate (SF or presence of clinically insignificant residual [CIRF]) was 78.4%. Stone size (p=0.029), stone number (p=0.01), stone location (p=0.023) had significant influence on the stone-free rate after RIRS The mean operation and floroscopy time was 62.5 min. (40-180) and 29.8 sec (4-96), respectively. The mean hospitalization time was 26.4 hours (12-72). Double J stents were placed to 253 patients for more stone burden and ureteral edema. Any complication was not observed for all cases except perioperative developed infection for two patients. Conclusion: With advances in laser technology and flexible ureterorenoscopy, kidney stones can be treated with lower morbidity and high success rates.
    No preview · Article · Sep 2015 · Turk Uroloji Dergisi
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    Preview · Article · Sep 2015
  • A. Tok · A. Tepeler · T. Akman · M.F. Kilinc · M. Tosun · B. Resorlu · A. Armagan

    No preview · Article · Sep 2015 · European Urology Supplements
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    ABSTRACT: Ischaemic priapism is characterised by hypoxia, hypercapnia and acidosis with resultant corporal fibrosis. Studies reported decreased erectile recovery after treatment of priapism longer than 36 h. However, a recent study revealed that half of patients with 3 days of priapism achieved recovery after T-shunt, although mechanism remains unclear. We aimed to investigate the effect of priapism duration on oxidative stress and antioxidant enzymes. Twenty-four male rats were divided into four groups. Group 1 served as control. Groups 2, 3 and 4 represented 1, 2 and 4 h, respectively, of priapism induced by vacuum device and rubber band placed at base of erect penis. After 30 min of reperfusion, penectomy and blood withdrawal were performed to investigate levels of malondialdehyde (MDA), protein carbonyl (PC), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx). Corporal MDA progressively increased with priapism duration (P = 0.01). Corporal SOD significantly differed between groups 1, 2 and 4. Also, there were significant differences in corporal GPx in groups 1 and 4 (P = 0.004) and groups 2 and 4 (P = 0.01). Corporal CAT was higher in group 4, but multivariable analysis revealed insignificant differences. Plasma MDA of the experimental groups was significantly higher than that of controls. There were no differences among groups in terms of other parameters. Increased antioxidant enzymes according to duration of priapism suggest that immediate treatment to relieve oxidative stress should be initiated in prolonged cases. However, further studies should be conducted to determine resistance mechanisms of the corpora to prolonged ischaemia. © 2015 Blackwell Verlag GmbH.
    Full-text · Article · Jul 2015 · Andrologia
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    ABSTRACT: The objective of this study was to present the outcomes of comparative clinical study of microperc versus mini-percutaneous nephrolithotomy (mini-PNL) in the treatment of lower calyx stones of 10-20 mm. Patients with lower calyx stones treated with microperc (Group-1) or mini-PNL (Group-2) between 2011 and 2014 were retrospectively analyzed. Demographics of the patients were compared, including age, gender, BMI, stone size, laterality and procedural parameters (operation and fluoroscopy time), and outcomes (success and complication rates). A total of 98 patients were evaluated, assigned to Group-1 (n = 58) and to Group-2 (n = 40). Groups were statistically similar in terms of age, stone size, and BMI (p = 0.3, 0.07, 0.6, respectively). The mean procedure and fluoroscopy duration for Group-1 were 43.02 ± 27.98 min and 112.05 ± 72.5 s, and 52.25 ± 23.09 min and 138.53 ± 56.39 s in Group-2 (p = 0.006 and 0.006). The mean hematocrit drop was significantly higher in Group-2 compared to Group-1 (3.98 vs. 1.96 %; p < 0.001); however, none of the cases required blood transfusion. Overall complication rates exhibited no statistically significant difference (p = 0.57). Stone-free status was similar (86.2 vs. 82.5 %, p = 0.66). The tubeless procedure rate was significantly higher in Group-1 (p < 0.001). In Group-2, duration of hospitalization was significantly longer than in Group-1 (2.63 vs. 1.55 days; p < 0.01). Outcomes of the present retrospective study show that microperc is a treatment option for medium-sized lower calyx stone, being associated with lower blood loss, procedure, reduced fluoroscopy and hospitalization time, and a higher tubeless rate.
    Full-text · Article · Jul 2015 · Urolithiasis
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    Preview · Article · Jun 2015
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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.
    No preview · Article · May 2015 · Urology
  • Osman Ergün · Ahmet Güzel · Abdullah Armağan · Alim Koşar · Ayşe Gül Ergün
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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.
    No preview · Article · Apr 2015 · International Urology and Nephrology

  • No preview · Article · Apr 2015 · The Journal of Urology
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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.
    No preview · Article · Mar 2015 · Turkish Journal of Medical Sciences
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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.
    No preview · Article · Feb 2015 · World Journal of Urology
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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.
    No preview · Article · Jan 2015 · Urolithiasis
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    Full-text · Article · Nov 2014 · European Urology Supplements
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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.
    No preview · Article · Nov 2014 · Urolithiasis
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    ABSTRACT: Objective: To analyze the patient- and procedure-related factors affecting the outcomes of percutaneous nephrolithotomy (PNL) in horseshoe kidneys (HSKs). Methods: A retrospective analysis was done of patients with stones in HSKs treated with PNL in 3 referral centers between 1998 and 2013. Demographics, along with perioperative characteristics, were evaluated in detail as to whether or not they had an effect on the success and complication rates. Results: A total of 54 HSKs with calculi in 53 patients were treated with PNL. Mean stone size was 28.4 ± 19.6 mm (range, 10-120 mm). Fifty-three patients were treated through a single tract, and 1 patient required additional access. Access was directed to the upper calyx (n = 27), middle calyx (n = 17), and lower calyx (n = 10) through the intercostal (n = 23) and subcostal (n = 31) areas. Flexible nephroscopy was used in 18.5% of the procedures. Postoperative complications were observed in 9 (16.7%) of the procedures. Success rate was 66.7% after a single session of PNL and increased to 90.7% with additional treatments. Although patient demographics, preoperative imaging, and other operative measures did not have significant effect on the complication rate, stone complexity and multiplicity, in combination with flexible nephroscopy, were found to significantly affect the success rate (P = .026, P = .043, and P = .021, respectively). However, in multivariate analysis stone multiplicity was the only factor that affected success rate (P = .004). Conclusion: Stone parameters play an important role in achieving stone-free status in HSKs. Use of flexible nephroscopy positively affects the success rate by allowing reaching the peripherally located calices.
    No preview · Article · Oct 2014 · Urology
  • Abdulkadir Tepeler · Muzaffer Akçay · Abdullah Armağan

    No preview · Article · Sep 2014

  • No preview · Article · Sep 2014 · European Urology Supplements

Publication Stats

776 Citations
208.04 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