Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Mesane Kanserli Hastalarda Double J Stent Yerleştirme ve Perkütan Nefrostomi Drenaj Yöntemlerinin Metakron Üst Üriner Sistem Ürotelyal Hücreli Karsinom Gelişimi Açısından Karşılaştırılması: Retrospektif Klinik Çalışma
Comparison of Double J Stent Insertion and Percutaneous Nephrostomy Drainage Methods in Patients with Bladder Cancer in Terms of Metachronous Upper Urinary Tract Urothelial Cell Carcinoma Development: Retrospective Clinical Study
Özgür EKİCİa, Abdullah GÜLb, Salim ZENGİNb, Gökçe DÜNDARb, Sinan AVCIc, Metin KILIÇb
aNusaybin Devlet Hastanesi, Üroloji Kliniği, Mardin, Türkiye
bSağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Bursa, Türkiye
cBursa Şehir Hastanesi, Üroloji Kliniği, Bursa, Türkiye
J Reconstr Urol. 2022;12(2):48-55
doi: 10.5336/urology.2022-88011
Article Language: TR
Full Text
ÖZET
 Amaç: Hidronefroz, yüzeyel ve kas invaziv mesane kanseri (MK) hastalarında sırasıyla %7,5 ve %54'e varan oranlarda görülebilmektedir. MK hastalarında tıkalı bir böbreğin double J stentleme (DJS) yöntemiyle drenajının sağlanması, olası metakron üst üriner sistem tümörü (ÜÜST) gelişimi korkusu nedeniyle tartışmalıdır. MK hastalarında, transüretral rezeksiyon sırasında perkütan nefrostomi ya da DJS takma yöntemlerini, metakron ÜÜST gelişimi açısından karşılaştırmayı amaçladık. Gereç ve Yöntemler: Ocak 2016-Aralık 2021 tarihleri arasında eş zamanlı olarak mesane kanserinin transüretral rezeksiyonu ve retrograd/antegrad DJS veya perkütan nefrostomi yerleştirilmesi ile opere edilen MK hastalarının verileri geriye dönük olarak analiz edildi. Hastaların takiplerinde, metakron ÜÜST oluşumu açısından, tümör gelişen ve gelişmeyen olarak 2 gruba ayrıldı. Hastaların yaş, cinsiyet gibi demografik özellikleri ile tedavi öncesi hematolojik parametreleri ve serum biyokimyasal parametre seviyeleri, ameliyat öncesi görüntülemede hidronefroz derecesi, drenaj yöntemi ile ameliyat sonrası patoloji sonuçları kaydedildi ve gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya dâhil edilen 133 hastanın 8'inde (%6) metakron ÜÜST gelişti [perkütan nefrostomi (n=2), DJS (n=6)]. Nefrostomi takılan hastalar ile DJS takılan hastalar arasında metakron ÜÜST gelişim oranı istatistiksel olarak farklı saptanmadı (p=0,27). MK'nin yerleşimi, patolojisi, sayısı ve hidronefroz dereceleri her iki grup arasında benzerdi (p>0,05). Ameliyat öncesi nötrofil/lenfosit oranı, platelet/lenfosit oranı ve De Ritis oranında her iki grup arasında fark saptanmadı (p>0,05). Sonuç: Çalışmamızda, MK hastalarında perkütan nefrostomi ve DJS yerleştirilmesi yöntemleri, metakron ÜÜST gelişim riski açısından benzerdi.

Anahtar Kelimeler: Mesane neoplazileri; karsinom, değişici hücreli; nefrostomi, perkütan; stentler
ABSTRACT
 Objective: Hydronephrosis can be seen in up to 7.5% and 54% of non-muscle invasive and muscle invasive bladder cancer (BC) patients, respectively. Drainage of an obstructed kidney with double J stenting (DJS) method in BC patients is controversial due to the fear of possible metachronous upper urinary tract urothelial cancer (UUTUC) development. We aimed to compare the methods of percutaneous nephrostomy or DJS insertion during transurethral resection in BC patients in terms of metachronous UUTUC development. Material and Methods: Data of BC patients operated by concomitant transurethral resection of bladder tumor and retrograde/antegrade DJS or percutaneous nephrostomy placement between January 2016 and December 2021 were analyzed retrospectively. The patients were divided into 2 groups as UUTUC and non-UUTUC. Demographic features of the patients such as age, gender as well as pretreatment hematological and serum biochemical parameters, degree of hydronephrosis in preoperative imaging, drainage method, postoperative pathological findings were recorded and compared between groups. Results: Of the 133 eligible patients, 8 (6%) had metachronous UUTUC after the drainage of hydronephrosis by nephrostomy (n=2) or DJS (n=6). The rate of metachronous UUTUC development was not statistically different between patients treated with nephrostomy or with DJS (p=0.27). Location, pathological features and number of tumors along with hydronephrosis grades were similar between the two groups (p>0.05). There was no difference between the two groups in terms of the preoperative ratios of neutrophil/lymphocyte, platelet/lymphocyte and De Ritis (p>0.05). Conclusion: In our study, percutaneous nephrostomy or DJS insertion methods in BC patients were similar in terms of metachronous UUTUC development.

Keywords: Urinary bladder neoplasms; carcinoma, transitional cell; nephrostomy, percutaneous; stents
REFERENCES:
  1. IARC, Cancer Today. Estimated number of new cases in 2020, worldwide, both sexes, all ages. 2021. [Link] 
  2. Compérat E, Larré S, Roupret M, Neuzillet Y, Pignot G, Quintens H, et al. Clinicopathological characteristics of urothelial bladder cancer in patients less than 40 years old. Virchows Arch. 2015;466(5):589-94. [Crossref]  [PubMed] 
  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34. [Crossref]  [PubMed] 
  4. Shariat SF, Favaretto RL, Gupta A, Fritsche HM, Matsumoto K, Kassouf W, et al. Gender differences in radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol. 2011;29(4):481-6. [Crossref]  [PubMed] 
  5. Green DA, Rink M, Xylinas E, Matin SF, Stenzl A, Roupret M, et al. Urothelial carcinoma of the bladder and the upper tract: disparate twins. J Urol. 2013;189(4):1214-21. [Crossref]  [PubMed] 
  6. Soria F, Shariat SF, Lerner SP, Fritsche HM, Rink M, Kassouf W, et al. Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol. 2017;35(3):379-87. [Crossref]  [PubMed] 
  7. Cosentino M, Palou J, Gaya JM, Breda A, Rodriguez-Faba O, Villavicencio-Mavrich H. Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma. World J Urol. 2013;31(1):141-5. [Crossref]  [PubMed] 
  8. Xylinas E, Rink M, Margulis V, Karakiewicz P, Novara G, Shariat SF; Upper Tract Urothelial Carcinoma Collaboration (UTUCC). Multifocal carcinoma in situ of the upper tract is associated with high risk of bladder cancer recurrence. Eur Urol. 2012;61(5):1069-70. [Crossref]  [PubMed] 
  9. Li WM, Shen JT, Li CC, Ke HL, Wei YC, Wu WJ, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010;57(6):963-9. [Crossref]  [PubMed] 
  10. Herr HW. Extravesical tumor relapse in patients with superficial bladder tumors. J Clin Oncol. 1998;16(3):1099-102. [Crossref]  [PubMed] 
  11. Nishiyama N, Hotta H, Takahashi A, Yanase M, Itoh N, Tachiki H, et al. Upper tract urothelial carcinoma following intravesical bacillus Calmette-Guérin therapy for nonmuscle-invasive bladder cancer: results from a multi-institutional retrospective study. Urol Oncol. 2018;36(6):306.e9-306.e15. [Crossref]  [PubMed] 
  12. Millán-Rodríguez F, Chéchile-Toniolo G, Salvador-Bayarri J, Huguet-Pérez J, Vicente-Rodríguez J. Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol. 2000;164(4):1183-7. [Crossref]  [PubMed] 
  13. Sanderson KM, Rouprêt M. Upper urinary tract tumour after radical cystectomy for transitional cell carcinoma of the bladder: an update on the risk factors, surveillance regimens and treatments. BJU Int. 2007;100(1):11-6. [Crossref]  [PubMed] 
  14. Ayyathurai R, Soloway MS. Monitoring of the upper urinary tract in patients with bladder cancer. Indian J Urol. 2011;27(2):238-44. [Crossref]  [PubMed]  [PMC] 
  15. Furukawa J, Miyake H, Hara I, Takenaka A, Fujisawa M. Upper urinary tract recurrence following radical cystectomy for bladder cancer. Int J Urol. 2007;14(6):496-9. [Crossref]  [PubMed] 
  16. Miest TS, Sharma V, Boeri L, Tollefson MK, Thompson RH, Boorjian SA, et al. Does ureteral stent drainage prior to cystectomy increase the risk of subsequent upper tract urothelial carcinoma and ureteral complications? Urology. 2021;153:215-20. [Crossref]  [PubMed] 
  17. Sountoulides P, Pyrgidis N, Brookman-May S, Mykoniatis I, Karasavvidis T, Hatzichristou D. Does ureteral stenting increase the risk of metachronous upper tract urothelial carcinoma in patients with bladder tumors? A systematic review and meta-analysis. J Urol. 2021;205(4):956-66. [Crossref]  [PubMed] 
  18. Volkmer BG, Schnoeller T, Kuefer R, Gust K, Finter F, Hautmann RE. Upper urinary tract recurrence after radical cystectomy for bladder cancer--who is at risk? J Urol. 2009;182(6):2632-7. [Crossref]  [PubMed] 
  19. Kiss B, Furrer MA, Wuethrich PY, Burkhard FC, Thalmann GN, Roth B. Stenting prior to cystectomy is an independent risk factor for upper urinary tract recurrence. The Journal of Urology, 2017;198(6):1263-8. [Crossref]  [PubMed] 
  20. Hupe MC, Dormayer L, Ozimek T, Struck JP, Hennig MJP, Klee M, et al. Impact of double J stenting or nephrostomy placement during transurethral resection of bladder tumour on the incidence of metachronous upper urinary tract urothelial cancer. BMC Cancer. 2020;20(1):140. [Crossref]  [PubMed]  [PMC] 
  21. Picozzi S, Ricci C, Gaeta M, Ratti D, Macchi A, Casellato S, et al. Upper urinary tract recurrence following radical cystectomy for bladder cancer: a meta-analysis on 13,185 patients. J Urol. 2012;188(6):2046-54. [Crossref]  [PubMed] 
  22. Alma E, Ercil H, Vuruskan E, Altunkol A, Unal U, Gurlen G, et al. Long-term follow-up results and complications in cancer patients with persistent nephrostomy due to malignant ureteral obstruction. Support Care Cancer. 2020;28(11):5581-8. [Crossref]  [PubMed] 
  23. Song Y, Fei X, Song Y. Percutaneous nephrostomy versus indwelling ureteral stent in the management of gynecological malignancies. Int J Gynecol Cancer. 2012;22(4):697-702. [Crossref]  [PubMed] 
  24. Rouprêt M, Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol. 2021;79(1):62-79. [Crossref]  [PubMed] 
  25. Marchioni M, Cindolo L, Autorino R, Primiceri G, Arcaniolo D, De Sio M, et al. High neutrophil-to-lymphocyte ratio as prognostic factor in patients affected by upper tract urothelial cancer: a systematic review and meta-analysis. Clin Genitourin Cancer. 2017;15(3):343-9.e1. [Crossref]  [PubMed] 
  26. Vartolomei MD, Porav-Hodade D, Ferro M, Mathieu R, Abufaraj M, Foerster B, et al. Prognostic role of pretreatment neutrophil-to-lymphocyte ratio (NLR) in patients with non-muscle-invasive bladder cancer (NMIBC): a systematic review and meta-analysis. Urol Oncol. 2018;36(9):389-99. [Crossref]  [PubMed] 
  27. Dalpiaz O, Ehrlich GC, Mannweiler S, Hernández JM, Gerger A, Stojakovic T, et al. Validation of pretreatment neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma. BJU Int. 2014;114(3):334-9. [Crossref]  [PubMed] 
  28. Dalpiaz O, Krieger D, Ehrlich GC, Pohlmann K, Stojakovic T, Pummer K, et al. Validation of the preoperative platelet-to-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma. Urol Int. 2017;98(3):320-7. [Crossref]  [PubMed] 
  29. Bao Y, Wang Y, Li X, Pan M, Zhang H, Cheng Z, et al. Prognostic significance of platelet-to-lymphocyte ratio in urothelial carcinoma patients: a meta-analysis. Cancer Cell Int. 2019;19:315. [Crossref]  [PubMed]  [PMC] 
  30. De Ritis F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chim Acta. 1957;2(1):70-4. [Crossref]  [PubMed] 
  31. Gül A, Kankılıç NA. Association of preoperative De Ritis ratio (aspartate amino transferase/alanine amino transferase) and tumour histology in patients with primary bladder cancer. Bull Urooncology. 2020;19(3):136-40. [Crossref] 
  32. Lee H, Choi YH, Sung HH, Han DH, Jeon HG, Chang Jeong B, et al. De Ritis Ratio (AST/ALT) as a significant prognostic factor in patients with upper tract urothelial cancer treated with surgery. Clin Genitourin Cancer. 2017;15(3):e379-e85. [Crossref]  [PubMed] 
  33. Cho YH, Hwang JE, Chung HS, Kim MS, Hwang EC, Jung SI, et al. The De Ritis (aspartate transaminase/alanine transaminase) ratio as a predictor of oncological outcomes in patients after surgery for upper urinary tract urothelial carcinoma. Int Urol Nephrol. 2017;49(8):1383-90. [Crossref]  [PubMed] 
  34. Su S, Liu L, Li C, Zhang J, Li S. Prognostic role of pretreatment de ritis ratio (aspartate transaminase/alanine transaminase ratio) in urological cancers: a systematic review and meta-analysis. Front Oncol. 2020;10:1650. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com