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Öğe Author reply(Elsevier Inc., 2016) Akça, Oktay; Zargar, Homayoun; Albayrak, Selami; Kaouk, Jihad H.Robotic retropubic prostate surgery has improved our knowl-edge of anatomy with respect to the prostatic and pelvic fasciaeas well as the neurovascular bundles.1This knowledge not onlyhas served us in the laparoscopic-based operations but is also trans-ferable to the open retropubic technique. However, oncological2and functional results of laparoscopic or open retropubic tech-niques are not significantly superior to the “open” technique ofradical perineal prostatectomy, a procedure that has changed littlesince it was first described by Young in 1905.3Although sur-geons are able to visualize and spare the neurovascular bundlesbilaterally in the retropubic approach, the overall erectile satis-faction rate was not more than 27% in a recent contemporaryseries.4With respect to the immediate return of continence aftercatheter removal, perineal prostatectomy achieves this withoutthe need for additional reconstructive maneuvers. This is achieved,owing to the minimum disturbance of the supportive anatomi-cal structures during perineal prostatectomy.Öğe Descriptive technique and initial results for robotic radical perineal prostatectomy(Elsevier Science Inc, 2016) Kaouk, Jihad H.; Akça, Oktay; Zargar, Homayoun; Caputo, Peter; Ramirez, Daniel; Andrade, Hiury; Albayrak, Selami; Laydner, Humberto; Angermeier, KennethOBJECTIVE To minimize technical challenges of radical perineal prostatectomy (RPP), we conceived and applied the robotic approach to this technique in an aim to improve surgical applicability of RPP. Radical prostatectomy via the perineal route, avoiding the intra-abdominal cavity, has been shown to be oncologically safe, with excellent functional outcomes and a short hospital stay. We report our initial results with this novel approach. MATERIALS AND METHODS We performed the procedure in 4 patients. With the patient in the exaggerated lithotomy position, following a 3 cm perineal incision, the initial perineal dissection using Belt's approach is performed, followed by single port placement and docking of the robot. RESULTS The median age for patients was 64 years (60-69). Two patients had no rectum because of the abdominoperineal resection due to inflammatory bowel diseases. One of the other 2 patients had a surgical history of aborted robotic-assisted laparoscopic radical prostatectomy and 1 patient had no surgical history. There were no perioperative complications and the patients were discharged within 16-48 hours. Urethral catheter was removed within 10 days in 3 patients, and 3 weeks in 1 patient. Two patients were immediately continent when Foley was removed. The final pathology revealed focally positive margin in those 3 patients who had surgical histories and it was margin negative in the patient with native anatomy. All patients had undetectable prostate-specific antigen postoperatively. CONCLUSION RPP was successfully completed in 4 cases, applying a single port robotic perineal approach. Initial results are encouraging, with short hospital stay and minimal postoperative pain.Öğe Descriptive technique and initial results for robotic radical perineal prostatectomy reply(Elsevier Science Inc, 2016) Akça, Oktay; Zargar, Homayoun; Albayrak, Selami; Kaouk, Jihad H.[Abstract Not Available]Öğe Medical expulsive therapy for pediatric ureteral stones: A meta-analysis of randomized clinical trials(MDPI, 2023) Ziaeefar, Pardis; Basiri, Abbas; Zangiabadian, Moein; de la Rosette, Jean J. M. C. H.; Zargar, Homayoun; Taheri, Maryam; Kashi, Amir H.To evaluate the efficacy and safety of medical expulsive therapy (MET) for ureteral stones in pediatric patients, Cochrane, PubMed, Web of Science, Scopus, and the reference list of retrieved studies were searched up to September 2022 to identify RCTs on the efficacy of MET. The protocol was prospectively registered at PROSPERO (CRD42022339093). Articles were reviewed, data were extracted by two reviewers, and the differences were resolved by the third reviewer. The risk of bias was assessed using the RoB2. The outcomes, including the stone expulsion rate (SER), stone expulsion time (SET), episode of pain, analgesic consumption, and adverse effects, were evaluated. Six RCTs enrolling 415 patients were included in the meta-analysis. The duration of MET ranged from 19 to 28 days. The investigated medications included tamsulosin, silodosin, and doxazosin. The stone-free rate after 4 weeks in the MET group was 1.42 times that of the control group (RR: 1.42; 95% CI: 1.26–1.61, p < 0.001). The stone expulsion time also decreased by an average of 5.18 days (95% CI: ?8.46/?1.89, p = 0.002). Adverse effects were more commonly observed in the MET group (RR: 2.18; 95% CI: 1.28–3.69, p = 0.004). The subgroup analysis evaluating the influence of the type of medication, the stone size, and the age of patients failed to reveal any impact of the aforementioned factors on the stone expulsion rate or stone expulsion time. Alpha-blockers as medical expulsive therapy among pediatric patients are efficient and safe. They increase the stone expulsion rate and decrease the stone expulsion time; however, this included a higher rate of adverse effects, which include headache, dizziness, or nasal congestion.Öğe The transrectal single port laparoscopic radical prostatectomy in a cadaver model(Turkish Association of Urology, 2015) Akça, Oktay; Zargar, Homayoun; Autorino, Riccardo; Brandão, Luis Felipe; Gürler, Ahmet Selçuk; Avşar, Abdullah; Horuz, Rahim; Albayrak, SelamiObjective: To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. Material and methods: After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT (R) Path) was inserted trans-anally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT (R) Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0 degrees degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. Results: Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. Conclusion: Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.
