Yunus Emre Göger

In this prospective controlled cohort study, we aimed to compare the safety and efficacy of Retrograde intrarenal surgery (RIRS) combined with high-power holmium:YAG laser and vacuum-assisted, flexible, navigable access sheaths (FANS) vs. mini-percutaneous nephrolithotomy (miniPCNL) in 2-3 cm kidney stones. Between June 2022 and June 2024, 60 patients with 2-3 cm in diameter kidney stones, aged 18 years or older, were prospectively included. Patients were classified into two groups based on their decision: RIRS (Group 1) and miniPCNL (Group 2). Patient demographic data, preoperative creatinine, and hemoglobin levels were recorded. Stone-related factors were evaluated using preoperative tomography. Creatinine and hemoglobin values were measured on the first postoperative day. Stone-free status (SFRs) was evaluated on the first postoperative day and at the first month. Hospital stays and complications were assessed. This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026. Patient demographic data, preoperative creatinine levels, hemoglobin levels, and stone-related factors were comparable between the groups. The prestenting rate was higher in Group 1 (16.6%, 95% CI: 3.3-30) than in Group 2 (0%, 95% CI: 0-0, p = 0.02). The operative time and complication rates were comparable between the groups. The fluoroscopy time was lower in Group 1 (p < 0.001). The mean hemoglobin decrease was greater in Group 2 (p < 0.001). Stone-free status was comparable on the first day and first month. Hospital stay was shorter in Group 1 (p < 0.001). Retrograde intrarenal surgery combined with a high-power holmium:YAG laser and FANS shows comparable outcomes to miniPCNL for 2-3 cm kidney stones, yielding a similar SFRs with lower hemoglobin decrease, shorter hospitalization time, and reduced fluoroscopy exposure. However, increased prestenting rates should be considered. This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026.

Objective: Accurate prediction of disease progression and metastatic potential remains a major challenge in prostate cancer management. This study aimed to evaluate the expression profiles of selected microRNAs (miRNAs) and cell cycle–related genes as centromere protein genes (CENPs) in prostate cancer and to explore their potential clinical relevance in distinguishing metastatic disease. Methods: Formalin-fixed paraffin-embedded prostate tissue samples from patients with benign prostatic hyperplasia, localized prostate cancer, and metastatic prostate cancer were analyzed. Quantitative real-time polymerase chain reaction (PCR) (qRTPCR) was used to assess the expression of miRNAs targeted CENPs as well as CENPA, CENPC, HJURP, and AURKB. Expression patterns were further validated in the metastatic prostate cancer cell line PC3. Relative expression levels were calculated using the 2−ΔΔCt (cycle threshold) method. Results: Expression analysis of selected miRNAs revealed a significant upregulation of hsa-miR-4755-5p in the metastatic PCa (P = .027), despite no significant differences in fold change. Additionally, hsa-miR-5680 showed a significantly higher fold change in the metastatic group compared to controls (P = .034). Although not statistically significant (P > .05), hsa-miR-5688, hsa-miR-20a-5p, and hsa-miR-4500 demonstrated a consistent trend toward downregulation, as indicated by lower ΔΔCt values in both PCa and metastatic groups relative to controls. In PCa cell line CENPA, CENPC,and HJURP expression levels increased over time, whereas AURKB was downregulated. Conclusion: The findings indicate that combined dysregulation of specific microRNAs and centromere-associated genes characterizes metastatic prostate cancer. This molecular signature may provide clinically relevant information for risk stratification and warrants further investigation as a potential adjunct to conventional prognostic markers in prostate cancer. Cite this article as: Somuncu MN, Karalezli I, Göger YE, et al. Dysregulation of microRNAs and centromere protein genes in prostate cancer and metastatic progression. Urol Res Pract., 52, 0143, doi:10.5152/tud.2026.26143.

Background: Erectile dysfunction (ED) is a significant complication following penile fracture repair, and early prediction is critical for clinical management. Aim: To evaluate the effectiveness of machine learning (ML) algorithms in predicting the development of severe ED after penile fracture repair and to identify complex risk factors beyond the scope of traditional statistical methods. Methods: A retrospective analysis was conducted using data from 547 patients who underwent surgical repair for penile fracture between January 2020 and June 2024 at 23 urology centers affiliated with the Reconstructive Urology and Trauma Study Group of the Urological Surgery Society. Patients were categorized into two groups based on their International Index of Erectile Function-5 scores at six months postoperatively: severe ED (+) (≤7) and ED (−) (>7). Eleven different ML classifiers were evaluated to determine the most predictive models. Four distinct resampling techniques were employed to address class imbalance in the dataset. Feature importance analysis was also performed to identify the most influential variables contributing to ED risk. Outcomes: This study was conducted to enable the early identification of patients at high risk of developing severe ED following penile fracture surgery. Results: Logistic Regression, Gaussian Naive Bayes, and Linear Support Vector Machine emerged as the best-performing algorithms on the original dataset, with Area Under the Curve (AUC) scores of 0.81, 0.78, and 0.76, respectively. On the Synthetic Minority Over-sampling Technique (SMOTE)-resampled dataset, Quadratic Discriminant Analysis (QDA) achieved an AUC of 0.85, while the Artificial Neural Network (ANN) reached an AUC of 0.84. On the SMOTE-resampled dataset, QDA achieved a ROC-AUC of 0.85 (95% CI: 0.75-0.93), whereas on the SMOTE–Tomek Link–resampled dataset, the ANN attained a ROC-AUC of 0.84 (95% CI: 0.71-0.94). The most critical predictors of severe ED were age, comorbidities, tunical tear length, and time to surgery. Urethral injuries were not significant contributors, as all were minor and managed conservatively without urethroplasty. Clinical Implications: Integration of ML-based prediction models into clinical workflows could support early risk stratification and individualized patient care, ultimately improving postoperative functional outcomes. Strengths and Limitations: This study benefits from a large, multicenter dataset and a comparative analysis of multiple ML algorithms. However, its retrospective nature and inter-center variability in data reporting may limit generalizability. Conclusion: ML algorithms are effective and reliable tools for predicting severe ED after penile fracture repair and may enhance personalized postoperative management. Eliminating class imbalance in the data with resampling techniques improves model performance.

The purpose of the study was to determine the urologists' knowledge of ionizing radiation and the frequency of CT scan utilization for pediatric patients with urolithiasis. The second aim is to examine the factors that affect the choice of the CT imaging method in these patients. We sent a quantitative online questionnaire to urologists and pediatric urologists in various regions and practice settings of Turkey via a web survey database in June 2022. The survey consisted of 22 items in a multiple-choice or yes/no format and was divided into three sections: participant characteristics, knowledge, and current practice. One hundred and fifty-four participants fully completed this questionnaire. Forty-two participants (27.3%) correctly stated the radiation dose of an abdominal CT scan. Thirty of the participants (19.5%) thought that there was no relationship between exposure to radiation and cancer development. In addition, 76 participants (49.4%) were aware of any scientific literature about this relationship. Ninety-eight participants (63.6%) think that they did not receive adequate training on imaging methods for pediatric patients during their residency program. The choice of CT scans as the first imaging method was increased with age. Even if the choice of imaging method is mostly decided according to the guidelines, various factors such as medicolegal causes, long ultrasound appointment dates, poor quality of assessment, and clinical experiences are inevitable facts that guide the choice of computed tomography. Urologists are responsible for knowing the effects of ionizing radiation and the ALARA principle. Our findings emphasize the lack of knowledge about ionizing radiation. Encouragement of the literature, provision of the mandatory curriculum, and supervision of the use of ionizing radiation will contribute to the elimination of the deficiency in this area.

Objective: To evaluate our testis-sparing surgery ( TSS) experiences in our clinic and outline its oncological and functional outcomes. Materials and Methods: Patients who underwent TSS due to testicular mass in our clinic between 2008 and 2023 were included in the study. Patients with a mass in solitary testis, bilateral testicular mass as well as patients with a normal contralateral testis and a mass of less than 2 cm or less than 30% of the testicular volume were included in the study. Patient demographics, tumor characteristics, and follow-up data were collected and analyzed statistically. Results: A total of 26 patients who underwent TSS were evaluated. Germ Cell Tumor (GCT ) was detected in 9 patients, and benign testicular mass was detected in 17 patients. The mean patient age was 25±6.1 (18-69) years. The mean tumor size was 12.9±4.4 (range 7-24) mm in all patients. Patients with GCTs were followed up for a mean of 21.8±7.8 (10-36) months. Local recurrence was observed in one patient during follow-up, and radical orchiectomy was performed. No recurrence or metastasis was observed in other patients during the follow-up period. Benign lesions were followed up for 21.5±9.3 (10-38) months. Recurrence was not observed. There was no significant decrease in testosterone levels after surgery (p=0.3). Conclusions: Excellent outcomes for benign tumors using TSS were obtained in the present study. TSS could be suggested as a safe and effective treatment option in patients with germ cell tumors, as in the present study. However, more data regarding the potential risks and benefits of TSS with a larger patient series is needed. Keywords: Bilateral testicular tumor, germ cell tumor, solitary testis, testis sparing surgery

Laser lithotripsy mechanisms can cause the chemical decomposition of stone components and the emergence of different end products. However, the potentially toxic end products formed during thulium fiber laser (TFL) lithotripsy of cystine stones have not been sufficiently investigated. The aim of our in vitro study is to analyze the chemical content of the gas products formed during the fragmentation of cystine stone with TFL. Human renal calculi consisting of 100% pure cystine, calcium oxalate monohydrate, or uric acid were fragmented separately with TFL in experimental setups and observed for gas release. After the lithotripsy, only the cystine stones showed gas formation. Gas chromatography-mass spectrometry was used to analyze the gas qualitatively, and scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX) and X-ray diffraction was used to examine the dried cystine stone fragments. Fragmentation of the cystine stones released free cystine, sulfur, hydrogen sulfide, and carbon disulfide gas. The SEM-EDX and X-ray diffraction analyses revealed that the free cystine in the dried fragments contained 43.1% oxygen, 28.7% sulfur, 16.1% nitrogen, and 12.1% carbon atoms according to atomic weight. The detection of potentially toxic gases after lithotripsy of cystine stones with TFL indicates a risk of in vivo production. Awareness needs to be increased among healthcare professionals to prevent potential inhalation and systemic toxicity for patients and operating room personnel during TFL lithotripsy of cystine stones.

Purpose: We aimed to evaluate the diagnostic sensitivity and specificity of the miRNA-371a-3p for the primary diagnosis of germ cell tumors (GCT) and to investigate its relationship with pathological factors and clinical stage in the Turkish population. Materials and Methods: In this prospective study, a total of 60 patients with GCTs, and 40 healthy male controls were examined for serum levels of miRNA-371a-3p before orchiectomy and again two weeks after surgery. The miRNA-371a-3p, alpha-fetoprotein (AFP), and beta -human chorionic gonadotropin (bHCG) levels in the preoperative and postoperative periods were compared at different clinical stages. Receiver operating characteristics curve analyses were performed to determine the sensitivity and specificity of miRNA-371a-3p. Clinical and pathological factors such as clinical stage (CS), tumor size, histology, rete testis invasion, and lymphovascular invasion, potentially impacting miRNA-371a-3p expression levels (relative quantity, RQ), were evaluated statistically. Results: The sensitivity of miR-371a-3p in GCT patients was 98.3%, and the specificity was 95% (AUC = 0.997 [95%Cl:0.99-1], p < .001). miR-371a-3p expression was not detected in two patients with teratoma. The median miR-371a-3p RQ was 489 times in GCT and 2.2 times in the Control group ( p < .001). In the postoperative period, there was a significant decrease in AFP and bHCG levels in all CS -1 ( p = .01) and 30% of the other CS ( p = .3). Throughout this time there was a decrease of 19 times at the miR-371a-3p RQ in CS -1( p < .001) and 1.6 times in the other CS ( p < .001). The miR-371a-3p RQs were correlated with tumor size and CS. Conclusion: The miR-371a-3p seems to have higher diagnostic accuracy than classical serum tumor markers in GCT.

The primary aim of the present in vitro study is to analyze the chemical content of the bubbles occurring during the fragmentation of cystine stones with both the high-power and low-power holmium:YAG (Ho:YAG) lasers. The secondary aim is to discuss their clinical importance. Three types of human renal calculi calcium oxalate monohydrate (COM), cystine, and uric acid were fragmented with both low-power and high-power Ho:YAG lasers in separate experimental setups at room temperature, during which time it was observed whether gas was produced. After laser lithotripsy, a cloudy white gas was obtained, after the fragmentation of cystine stones only. A qualitative gas content analysis was performed with a gas chromatography–mass spectrometry (GC–MS) device. The fragments in the aqueous cystine calculi setup were dried and taken to the laboratory to be examined by scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM–EDX) and X-ray diffraction analysis. No gas production was observed after fragmentation in the COM and uric acid stones. Free cystine, sulfur, thiophene, and hydrogen sulfide gas were produced by both low-power and high-power Ho:YAG laser lithotripsy of the cystine stones. In the SEM–EDX mapping analysis, a free cystine molecule containing 42.8% sulfur (S), 21% oxygen (O), 14.9% carbon (C), and 21% nitrogen (N) atoms was detected in the cystine stone experimental setup. The evidence obtained, which shows that hydrogen sulfide emerges in the gaseous environment during Ho:YAG laser fragmentation of cystine stones, indicates that caution is required to prevent the risk of in vivo production and toxicity.

Purpose To investigate the influencing factors of acute kidney injury (AKI) following retrograde intrarenal surgery (RIRS). Methods The data of patients who underwent RIRS for kidney stones between January 2018 and June 2022 at two tertiary centers were retrospectively analyzed. Demographic data of patients were obtained. According to kidney disease: Improving Global Outcomes (KDIGO) criteria, those with and without AKI were divided into two groups. Preoperative, intraoperative, and postoperative predictive factors of patients were investigated between the groups. In addition, the influencing factors of AKI were examined by multivariate analysis. Results This study included 295 (35.7%) women and 532 (64.3%) men. The mean age was 50.03 ± 15.4 years (range 18–89), and mean stone size was 15.5 ± 6.1 mm (range 6–47). Overall, 672 of patients (81.3%) were stone-free after the initial treatment. According to KDIGO, 110 of patients (13.3%) had AKI during the postoperative period. Univariate analysis showed that stone size (P = .003), previous stone surgery (P = .010), renal malformations (P = .017), high operative time (P = < .001), high preoperative creatinine value (P = .036), intraoperative complications (P = .018), and postoperative urinary tract infection (P = .003) had significant influence on the AKI after RIRS. Multivariate analysis excluded previous stone surgery, high preoperative creatinine value, renal malformations, and intraoperative complications from the logistic regression model, whereas other factors maintained their statistically significant effect on AKI, indicating that they were independent predictors. Conclusions Stone size, operative time, postoperative urinary tract infection, and diabetes mellitus are significant predictors of AKI. During RIRS, urologists should consider the factors that increase the risk of AKI and evaluate the treatment outcomes based on these factors.