Tarik Emre Sener

HoLEP Outcomes in Patients Receiving α1-blockers Alone versus α1-blockers plus 5α-reductase Inhibitors - Journal of Urological Surgery

Objectives: To evaluate the association between operative time (OT) and postoperative complications after percutaneous nephrolithotomy (PCNL) in elderly patients, and to identify a clinically meaningful OT threshold for risk stratification. Patients and Methods: A retrospective international multicentre study was performed including patients aged ≥70 years who underwent PCNL between January 2014 and February 2025 across 21 centres in 15 countries. Postoperative complications within 30 days were analysed as overall, major, and infectious events. The optimal OT threshold was determined using receiver operating characteristic (ROC) analysis, whereas the association between OT and postoperative outcomes was evaluated using multivariable logistic regression and adjusted restricted cubic spline models. Results: Among 716 patients, 120 (16.8%) developed postoperative complications; 49 (6.8%) had major and 49 (6.8%) infectious complications. ROC analysis identified a common OT threshold around 95 min. An OT ≥95 min was independently associated with overall complications (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.16–5.26), major complications (OR 2.63, 95% CI 1.35–5.10), and infectious complications (OR 3.79, 95% CI 1.90–7.57). The highest discriminative performance was observed for infectious complications (multivariable model area under the curve 0.77). Restricted cubic spline analysis confirmed significant non‐linear associations between OT and all outcomes, with a steeper increase in adjusted complication probability beyond approximately 90–100 min. Non‐papillary puncture was independently associated with all complication types, while positive preoperative urine culture predicted infectious complications. Conclusions: In elderly patients undergoing PCNL, prolonged OT was independently associated with higher odds of overall, major, and infectious postoperative complications. The relationship was non‐linear, with a clinically relevant threshold around 95 min, supporting OT as a practical intraoperative marker for risk stratification and procedural planning.

Background and ObjectiveMinimally invasive surgical therapies (MISTs) have emerged as alternative treatment options for benign prostatic obstruction (BPO), aiming to reduce morbidity while preserving functional outcomes. However, their adoption in routine clinical practice remains heterogeneous. We evaluated urologists’ perspectives on the utilization, perceived efficacy, barriers, and future role of MISTs in BPO management.MethodsA prospective, cross-sectional, web-based survey was conducted among members of the Young Academic Urologists (YAU) and the European Association of Urology (EAU) Endourology Section. The questionnaire was distributed via SurveyMonkey between January 27 and March 26, 2026. Descriptive statistics were used.ResultsA total of 77 complete responses were analyzed (response rate 55.7%). Awareness of MISTs was high; however, 29.6% of respondents did not perform any MIST procedures. Compared with medical therapy, MISTs were generally perceived as more effective for improving lower urinary tract symptoms, particularly Rezūm (73.2%) and UroLift (52.7%). Conversely, MISTs were considered less effective than conventional surgery but superior in preserving sexual function and reducing side effects. The most frequently reported barriers to adoption included limited access to training, lack of mentorship, equipment availability, and cost constraints. Most respondents anticipated increased use of MISTs over the next three years. Limitations include the survey-based design, the predominance of academic respondents, and the limited procedural experience of some participants.ConclusionsDespite recognized functional advantages, the adoption of MISTs remains limited by concerns regarding efficacy and structural barriers. Improved training, access, and long-term evidence may facilitate broader implementation in clinical practice.

Objective: To evaluate the predictive value of volumetric stone measurements including manually calculated stone volume and 3D software–derived volume on stone-free outcomes following mini-percutaneous nephrolithotomy (mini-PCNL), and to assess their relationship with perioperative parameters and commonly used nephrolithometry scoring systems. Materials amd Methods: This retrospective study was conducted with patients who underwent primary mini-PCNL between January 2024 and January 2025. Preoperative non-contrast computed tomography scans were used to determine the longest stone diameter, surface area, manually calculated stone volume, and 3D software–derived stone volume. Patients were categorized into two groups according to postoperative imaging: stone-free (Group 1) and residual stone (Group 2). Demographic characteristics, stone features, operative parameters, stone complexity scores (GUY’s and STONE) and complication rates were compared between groups. Results: Of the 80 patients, 61.3% were stone-free postoperatively. Group 2 demonstrated significantly higher manually calculated stone volumes (p = 0.02) and S.T.O.N.E. scores (p = 0.005). Manually calculated and 3D-derived stone volumes both showed significant positive correlations with stone diameter, surface area, nephrolithometry scores, operative time, and laser usage parameters. ROC analysis identified a manually calculated stone volume threshold of 746.9 mm³ for predicting residual fragments (AUC = 0.656, p = 0.02). In the multivariate model, manual stone volume was significantly associated with stone-free status (OR 18.71, p = 0.042). Conclusion: This study demonstrates a significant association between stone volume and stone-free outcomes after mini-PCNL. While volumetric measurements may provide additional information beyond conventional parameters. Therefore, stone volume should be considered as a complementary parameter rather than a standalone predictor in clinical decision-making.

Introduction: Laser enucleation of the prostate (LEP) has become a standard treatment for benign prostatic obstruction, yet its adoption is limited by a steep learning curve and a lack of validated training models. This study aimed to evaluate the face and content validity of a bench-top simulator specifically developed for LEP training within the framework of the European School of Urology (ESU) Lower Urinary Tract Endoscopy Working Group. Methods: Fourteen expert endourologists assessed the simulator during the European Urology Residents Education Programme (EUREP) 2025. Face and content validity were evaluated using 4-point Likert questionnaires, structured using the ESU validation framework. Descriptive statistics and content validity indices (I-CVI, S-CVI/Ave, S-CVI/UA) were calculated to assess agreement across anatomical, procedural, and educational domains. Results: Face validity scores were high across all items (mean 3.57–3.86; ≥90% agreement). The overall S-CVI/Ave was 0.85 and S-CVI/UA 0.47. Domain-specific analysis showed strong content validity for procedural steps (S-CVI/Ave = 0.89) and educational/global domains (0.95), moderate validity for essential anatomy (0.81), and lower ratings for intraoperative conditions (0.69), primarily due to the absence of bleeding simulation. When restricted to core domains (procedural + educational), S-CVI/Ave improved to 0.91. Conclusion: The simulator demonstrated strong face and content validity. Expert ratings indicated favorable perceptions of its realism, procedural similarity, and educational utility. These findings suggest that the simulator may be a useful component of a structured transurethral procedural training curriculum, although further construct validation is needed.

Purpose: To evaluate the educational validity of two bench-top simulators for Transurethral Resection of the Prostate (TURP) and Transurethral Resection of Bladder Tumor (TURB), focusing on their realism, ergonomics, and relevance for structured endourology training. Materials and methods: Fourteen expert endourologists from multiple European centers assessed both simulators during the European Association of Urology Residents Education Programme (EUREP) 2025. Face validity and content validity were evaluated using 4-point Likert questionnaires. Item-level (I-CVI) and scale-level (S-CVI/Ave) content validity indices were calculated for all items and adjusted for core procedural skills. Results: Experts rated both simulators highly for anatomical realism, tissue handling, and overall utility (mean scores > 3.5/4). The TURP simulator achieved an adjusted S-CVI/Ave of 0.92 and the TURB simulator 0.97, indicating excellent consensus on their educational adequacy for key procedural steps. Non-modeled features such as bleeding, obturator reflex, and energy modulation received low ratings, reflecting inherent limitations of bench-top simulation. Both models were considered effective for practicing instrument handling and resection depth control in a risk-free, standardized environment. Conclusions: The TURP and TURB simulators demonstrated strong face and content validity for core resection training. Their modular, non-biological, and reproducible design supports safe, structured skill acquisition and competency assessment in endourology curricula, offering a practical bridge between theoretical learning and clinical performance.

Bisphenol A (BPA) is an endocrine-disrupting chemical known to cause testicular toxicity through oxidative stress and apoptosis. Panax ginseng (PG) is a natural product with anti-inflammatory effects. This study aimed to evaluate the protective effect of PG against BPA-induced testicular damage in rats. Thirty-two Wistar Albino rats aged 10–12 weeks were divided into four groups: Control, PG, BPA, and BPA + PG. BPA (50 mg/kg/day) and PG (100 mg/kg/day) were orally administered for 6 weeks. BPA significantly increased serum total oxidant status and decreased antioxidant status ( p < 0.001, p < 0.001). Also, the levels of superoxide dismutase (an antioxidant enzyme) ( p = 0.0005) and androgen receptor-mRNA (an androgen signaling marker) decreased ( p = 0.014). However, caspase 3 (an apoptosis marker) ( p = 0.0067), 8-hydroxy-2’-deoxyguanosine (a marker of oxidative DNA damage) ( p < 0.001), and tumor necrosis factor-α (a proinflammatory cytokine) ( p < 0.001) levels increased in testicular tissues. Rats treated with PG showed improvements in all oxidative and inflammatory markers and significantly restored androgen receptor expression. Histopathological examination revealed degeneration in seminiferous tubules and reduced spermatozoa in the BPA group, while the BPA + PG group showed marked improvement. These findings suggest that PG may alleviate oxidative stress-related testicular damage at both molecular and histological levels and may offer insights for future clinical studies.

Introduction: This study aimed to compare the predictive value of preoperative midstream urine culture (PMUC), intraoperative renal pelvic urine culture (RPUC), and stone culture (SC) for postoperative urinary tract infections (UTIs) following percutaneous nephrolithotomy (PCNL). Methods: We retrospectively analyzed 234 patients who underwent supine-PCNL between January 2020 and April 2025. UTI was diagnosed based on systemic inflammatory response syndrome criteria and elevated inflammatory markers. Demographic, peri-, intra- and post-operative data were compared between patients with and without UTI. Multivariate logistic regression identified independent predictors. Results: UTI occurred in 14.1%( n = 33) of patients postoperatively, with 72.7% presenting with fever. Culture positivity rates were significantly higher in postoperative UTI-patients (PMUC = 27.3% vs. 7.5%, SC: 39.4% vs. 8.0% and RPUC: 30.3% vs. 6.0%; p < 0.001). In UTI-patients, only 15.2% of postoperative urine cultures obtained before antibiotic treatment showed bacterial growth, which was lower than intraoperative cultures. UTI was higher in female patients (60.6% vs. 39.4%) and in those with an ASA score of 3 ( p = 0.001 and p = 0.020). Female gender (OR = 3.71, p = 0.004), ASA-3 score (OR = 5.13, p = 0.029), positive SC (OR = 5.83, p = 0.001), and RPUC (OR = 3.67, p = 0.023) were independent predictors of postoperative UTI. PMUC was not associated ( p = 0.65) with postoperative UTI in the multivariate analysis. Conclusions: Intraoperative SC and RPUC showed a stronger association with postoperative UTI compared with PMUC and may be considered for routine use. Female gender and ASA-3 score were identified as independent risk factors. In patients who develop UTI, prior empirical or prophylactic antibiotic use may limit pathogen detection in postoperative urine cultures; therefore, intraoperative cultures play a critical role in early and targeted treatment.