Deniz Bolat

Objective: This study aimed to investigate the association between the preoperative albumin-to-globulin ratio (AGR) and pathological stage and tumor grade in patients who underwent transurethral resection of bladder tumor (TURBT) for primary bladder tumors.Materials and Methods: A total of 153 patients who underwent transurethral resection of bladder tumor (TURBT) for primary urothelial carcinoma between March 2017 and February 2020 were included in the study. AGR was calculated using preoperative serum albumin and total protein levels. Among the exclusion criteria were active infection, autoimmune disease, hepatic disease, and concomitant malignancy. The optimal AGR cut-off value was determined using receiver operating characteristic (ROC) curve analysis and the Youden index. Independent predictors of pathological stage (NMIBC/MIBC) and tumor grade (low/high Grade) were evaluated using logistic regression analysis.Results: The median age of the patients was 68 years (IQR: 59–75), and 88.9% were male. The pathological stage distribution was Ta in 39.9%, T1 in 39.9%, and T2 in 20.3% of patients, while tumor grade distribution was low Grade in 54.2% and high Grade in 43.1%. The median AGR value of the cohort was 1.32 (IQR: 1.17–1.50). AGR was significantly lower in both the MIBC group (p = 0.003) and the high-grade group (p < 0.001) compared to their respective counterparts. ROC analysis identified an optimal cut-off value of 1.35 for both clinical outcomes (AUC=0.649, 95% CI: 0.542–0.755 for MIBC and AUC=0.656, 95% CI: 0.568–0.744 for high-grade disease). In multivariate logistic regression analysis, AGR was independently associated with both MIBC (OR=0.16, 95% CI: 0.03–0.97; p = 0.046) and high-grade disease (OR=0.18, 95% CI: 0.04–0.74; p = 0.018).Conclusion: Preoperative AGR is independently associated with pathological stage and tumor grade in primary bladder tumors. The ability to calculate this parameter from routine biochemical tests without additional cost makes it clinically valuable for preoperative risk stratification. Further validation of these findings in larger patient cohorts is warranted.

Background and Objectives: Radical cystectomy (RC) is standard treatment for muscle-invasive bladder cancer, but the role of gynecologic organ preservation in women remains uncertain. We primarily evaluated the prevalence and predictors of pathological gynecologic organ involvement and secondarily assessed survival and developed a prediction model. Materials and Methods: This multicenter retrospective study included 232 women undergoing RC at 13 tertiary centers. Of the 232 women, 182 had clinical T2 disease and 50 had BCG-unresponsive or very-high-risk Ta/T1 non-muscle-invasive bladder cancer. Overall survival (OS) was the primary endpoint; CSS and RFS were secondary outcomes. Multivariable logistic regression was used to identify predictors and develop preoperative prediction models. Results: Pathological gynecologic organ involvement was identified in 26 patients (11.2%): uterine in 15 (6.5%), vaginal in 11 (4.7%), ovarian in five (2.2%), and adnexal in 21 (9.1%). The median OS was shorter in patients with involvement than in those without (19.0 vs. 48.0 months; p = 0.048). Vaginal and ovarian involvement were associated with shorter OS (both p < 0.001), whereas uterine and adnexal involvement were not. Pathological T stage was associated with organ involvement (p = 0.001), with the highest frequency in pT4 disease. Model 2 showed an AUC of 0.898 and an optimism-corrected AUC of 0.872. A risk score of 0 classified 31.0% as low risk, with an NPV of 97.2% and a sensitivity of 92.3%. Conclusions: Pathological gynecologic organ involvement was uncommon but associated with poorer survival. These findings may support preoperative risk stratification, although the oncologic safety of organ-preserving surgery cannot be established from pathological involvement data alone.

Background: With the increasing integration of multiparametric MRI (mpMRI) and 68Ga‐PSMA PET/CT into the diagnostic and staging algorithms of prostate cancer (PCa), digital rectal examination (DRE)—a once foundational and cost‐effective physical examination—has gradually become marginalized in daily clinical practice. However, the continued relevance of DRE in the modern imaging era remains uncertain. This study aimed to reassess the diagnostic value of DRE in the context of contemporary imaging tools, particularly mpMRI and PSMA PET/CT. Methods: This retrospective analysis included 164 patients diagnosed with prostate adenocarcinoma via transrectal ultrasound‐guided biopsy. All patients underwent DRE before biopsy, and 151 received mpMRI while 62 underwent PSMA PET/CT. mpMRI findings were reported using PI‐RADS v2.1, and SUVmax values were recorded from PET/CT reports. Radical prostatectomy was performed in 156 patients. The relationship between DRE findings and imaging parameters, biopsy results, and pathological staging was analyzed using multivariate statistics and ROC curve analyses. Results: DRE findings were benign in 100 patients and suspicious for malignancy in 64. Suspicious DRE was significantly associated with higher PI‐RADS scores, greater lesion size, elevated SUVmax, and clinically significant PCa ( p < 0.001 for all). Each one‐point increase in PI‐RADS was associated with a twofold rise in the likelihood of a positive DRE. ROC analyses identified a 13.5 mm lesion size and an SUVmax of 15.1 as predictive thresholds for DRE positivity. Suspicious DRE also correlated with advanced pathological stage (≥ pT3) ( p < 0.001). Conclusion: Despite the rise of advanced imaging techniques, DRE remains a valuable adjunctive tool in identifying high‐risk and advanced PCa. When interpreted alongside mpMRI and PSMA PET/CT findings, DRE provides additional clinical insight, supporting its continued role in risk stratification rather than screening in the modern diagnostic workflow.

Background: Cholelithiasis can lead to significant complications if not diagnosed and treated promptly. Recent advances in deep learning and the improved ability of computer systems to detect clinically significant textural and morphological patterns in magnetic resonance imaging (MRI) can help reduce the time and resources required for the radiological evaluation of the gallbladder and cholelithiasis. Objective: To detect cholelithiasis, a support system with a graphical user interface for magnetic resonance (MR) images of the gallbladder was implemented to reduce the manual effort and time required to identify gallstones. Method: A commonly used deep learning model for pixel-level mask generation and instance segmentation, Mask Region Based Convolutional Neural Network (Mask R-CNN), was modified, trained, and evaluated to provide a robust pipeline for automated analysis. The primary aim was to automatically locate and label the gallbladder in T2-weighted axial MR images to detect gallstones and highlight the visual characteristics of the target region, thereby supporting radiologists. All automation was designed to operate on a single optimal slice instead of the entire volume. While this approach limits generalisability, it offers a practical starting point for method development. This setup reflects a feasibility-oriented design, rather than a comprehensive diagnostic capability. The dataset included 788 axial MR images from different patients. Each image was labeled and segmented by an experienced radiologist to train and test the models at the image level. Results: The proposed model with squeeze and excitation (SE) modification improved classification accuracy, and at the image level, stone detection improved in terms of accuracy, precision, and specificity, although recall and F1 scores slightly decreased. Conclusions: The results show that the modified Mask R-CNN model can detect gallstones with up to 0.89 accuracy, supporting the clinical applicability of the proposed method.

Artificial intelligence (AI) is quickly transforming healthcare by improving patient and clinician access to and understanding of medical information. Generative AI models answer healthcare queries and provide tailored and quick responses. This research evaluates the readability and quality of bladder cancer (BC) patient information in 10 popular AI-enabled chatbots. We used the latest versions of ten popular chatbots: OpenAI's GPT-4o, Microsoft's Copilot Pro, Claude-3.5 Haiku, Sonar Large, Grok 2, Gemini Advanced 1.5 Pro, Mistral Large, Google Palm 2 (Google Bard), Meta's Llama 3.3, and Meta AI v2. Prompts were developed to provide texts about BC, non-muscle-invasive BC, muscle-invasive BC, and metastatic BC. The modified Ensuring Quality Information for Patients (mEQIP), the Quality Evaluating Scoring Tool (QUEST), and DISCERN were used to assess quality. The Average Reading Level Consensus (ARLC), Flesch Reading Ease (FKRE), and Flesch-Kincaid Grade Level (FKGL) were used to evaluate readability. Ten chatbots exhibited statistically significant differences in mean mEQIP, DISCERN, and QUEST scores (p = 0.048, p = 0.025, and p = 0.021, respectively). Meta scored lowest on the average mEQIP, DISCERN, and QUEST, while Llama attained the highest. Statistically significant differences were also seen in the chatbots' average ARLC, FKGL, and FKRE scores (p = 0.002, p = 0.001, and p = 0.002, respectively), in which Google Palm produced texts that are easiest to read, and Llama is the most difficult chatbot to understand. AI chatbots can produce information on BC that is of moderate quality and readability, while there is significant variability among platforms. Results should be evaluated with caution due to the single-query approach and the continuously advancing AI models. Clinicians can support safety in implementation by delivering structured feedback and incorporating content review stages into patient education processes. Continuous collaboration between healthcare practitioners and AI developers is crucial to maintain the accuracy, currency, and clarity of AI-generated content.

Objectives The study aimed to assess the haemodynamic changes of laparoscopic adrenalectomy (LA) in geriatric patients with pheochromocytoma (PHEO). To the best of our knowledge, this is the first study to evaluate the haemodynamic outcomes of LA in this patient population. Methods Data of 350 patients who underwent single-side transperitoneal LA between 2000-2020 were reviewed retrospectively. Patients with a histopathological diagnosis of PHEO were included in the study and classified into two groups according to their ages at the date of surgery. Patients older than 65 years were accepted as elderly according to the World Health Organisation (WHO) recommendations. Results A total of 54 patients underwent LA for PHEO. Fifteen patients were enrolled in the elderly and 39 in the young groups. There were no significant differences in terms of the operation site (0.564), tumour size (0.878), perioperative results such as mean anaesthesia; operation times, blood loss and hemodynamic changes. There were no significant differences in mean hospitalization and intensive care unit times. One patient in both groups had Grade 1 complication according to Clavien Dindo classification (prolonged ileus, managed with medical treatment and transfusion during surgery, respectively). Conclusion Young and elderly patients had similar outcomes in terms of hemodynamic changes that occurred with laparoscopic adrenalectomy. Laparoscopic adrenalectomy in elderly patients with PHEO is as safe and effective as in younger patients.

Introduction: The aim of the present prospective-randomized study was to compare perioperative outcomes and complications of bipolar and monopolar TURBT for lateral wall-located non-muscle invasive bladder cancers (NMIBC) under obturator nerve block (ONB). Patients and Methods: 80 patients who underwent TURBT for lateral wall-located primary bladder tumors under ONB from March, 2016 to November, 2019 were included in the present study. The patients were randomized equally into two groups; monopolar TUR (M-TURBT) and bipolar TUR (B-TURBT). The primary and secondary outcomes were safety (obturator jerk and bladder perforation) and efficacy (complete tumor resection and sampling of the deep muscle tissue). Results: Obturator jerk was detected in 2 patients (5%) in M-TURBT while obturator jerk was not observed during B-TURBT (p=0.494). Bladder perforation was not observed in both groups. All of the patients underwent complete tumor resection. There was no significant difference in muscle tissue sampling (67.5% vs. 72.5%, p=0.626) and thermal tissue damage rates (12.5% vs. 25%, p=0.201). The majority of complications were low-grade and the differences in Clavien grade 1-3 complications between groups were not statistically significant. Conclusion: In the treatment of lateral-wall located NMIBCs, either M-TURBT or B-TURBT can be safely and effectively performed by combining spinal anesthesia with ONB. Even so, it should be taken into consideration that low-grade postoperative hemorrhagic complications may occur in patients who undergo M-TURBT.

İnguinal mesane herniasyonu nadir olmakla birlikte tüm inguinal hernili olguların %1-4’ünde görülmektedir. Üreterin inguinal herniasyonu ise daha nadir bir durumdur ve literatürde 2009 yılına kadar yaklaşık 140 olgu bildirilmiştir. Bu yazıda solda daha belirgin olmak üzere her iki skrotal bölgesinde şişlik nedenli kliniğimize başvuran hastaya konan mesane ve üreter herniasyonu olgusu sunulmuş olup literatür eşliğinde tartışılmaktadır.