Bulent Kati

Objective: To evaluate the efficacy, safety, and impact on renal function of same-session bilateral ureteroscopy and laser lithotripsy in patients diagnosed with simultaneous bilateral ureteral stones. Materials and Methods: The data of 80 primary patients who underwent bilateral ureteroscopy for simultaneous bilateral ureteral stones between December 2015 and December 2025 were retrospectively reviewed. Thin-tipped semirigid ureteroscope and a Holmium:YAG laser (1J/10Hz) were used in all procedures. Surgical success (stone-free) was defined as complete clearance or the presence of fragments <4 mm on imaging performed at the 4th postoperative week. Results: The mean age of the 80 patients included in the study was 43.6 ± 15.4 years, the mean total stone burden was 19.9 ± 5.3 mm, and the median operative time was 60.0 (IQR: 48.75–75.0)minutes. The median hospital stay was 2.0 (IQR: 2.0–4.0) days. The stone-free rate (SFR) after the first session was 88.75%, while the final SFR reached 96.25% after additional interventions. Serum creatinine levels showed a significant decrease from a preoperative median of 1.16 mg/dL to a postoperative level of 0.9 mg/dL (p < 0.001). The overall complication rate was 12.5% (n = 10), all of which were Clavien-Dindo Grade I-II (minor). No major complications such as ureteral perforation or avulsion were observed in our series. Conclusion: Same-session bilateral ureteroscopy is a safe and effective method for the treatment of simultaneous bilateral ureteral stones, offering high success rates, a low morbidity profile, and rapid improvement in renal function. With appropriate patient selection, bilateral ureteroscopy should be considered a standard approach in bilateral stone disease.

Mesane içine yabancı cisimler çok çeşitli yollarla ortaya çıkabilir. En sık olarak direk üretradan yabancı cismin mesaneye girmesi veya diğer komşu organlardan perforasyon yoluyla mesaneye geçmesiyle ortaya çıkabilmektedir. Bu olgu sunumunda nörojen mesane nedeniyle temiz aralıklı kateterizasyon (TAK) sonda kullanan ve sonda işlemi sırasında fark edilmeden sondanın iticisinin mesane içine kaçması ve zamanla taşlaşmasıyla oluşan mesane taşı olgusunu sunmayı planladık. Kırk dokuz yaşında kadın hasta tekrarlayan üriner sistem enfeksiyonu nedeniyle yapılan tetkikler sırasında üriner sistem ultrasonografisinde mesanede 45 x 17 mm’lik taş bulunması üzerine sistolitotripsi planlandı. Yapılan sistoüretroskopide mesanede yaklaşık 4,5 cm’lik taş olduğu görüldü ve sistolitotripsi yapıldı. Taş lazer yardımı ile fragmente edildiği sırada taşın içinde yabancı cisim olduğu görüldü. Yabancı cismin etrafındaki taş tamamen fragmente edildikten sonra forseps yardımı ile mesaneden çıkarıldı. Yabancı cismin TAK sonda itici kılıfı olduğu anlaşıldı. Özellikle kadın hastalarda infravezikal obstrüksiyon az olması nedeniyle mesane taşı olan kadın hastalarda mesanede taş oluşumuna zemin hazırlayan yabancı cisim olabileceği unutulmamalıdır. Vakamız bu teoriyi destekler nitelikte olması nedeniyle önemlidir. TAK sonda kullanan hastalara, ayrıntılı bir eğitim verilmesi ve TAK sondanın itici kılıfı hakkında dikkat etmeleri konusunda uyarılmaları son derece önemlidir. Nörojen mesane olan hastalar mesanedeki yabancı cismi hissetmedikleri için geç dönemde başvurabilirler ve genellikle yabancı cisimler taşlaşmış olur.

Background and Objectives: This study aimed to compare the effects of choriogonadotropin alfa and anastrozole treatments on the success of sperm retrieval in patients with Klinefelter syndrome (KS) undergoing micro-TESE at our clinic. Materials and Methods: We conducted a retrospective review of a cohort including patients with non-mosaic KS who underwent micro-TESE for fertility treatment at the Reproductive Medicine Center of our university hospital. This study included 43 patients who had not received exogenous testosterone therapy prior to or during the procedure. Before surgical sperm retrieval, all patients received either choriogonadotropin alfa or anastrozole treatment based on their preference. Micro-TESE was performed on all patients after three months of treatment. Results: The overall SRR in the cohort post-micro-TESE was found to be 32.6%. There was a significant increase in post-treatment testosterone levels compared to pre-treatment levels. Upon dividing patients into two groups based on whether sperm was successfully retrieved, we observed significant improvements in testosterone levels in both groups following treatment. In the group presenting with successful sperm retrieval, 28.6% of patients had received choriogonadotropin alfa, while 71.4% had received anastrozole. No statistically significant difference was found between treatment groups in terms of micro-TESE success. Both choriogonadotropin alfa and anastrozole treatments resulted in significant improvements in testosterone levels following treatment compared to pre-operative levels. Furthermore, in the choriogonadotropin alfa group, there were significant decreases in follicle-stimulating hormone and luteinizing hormone levels, as well as a significant increase in estradiol levels after treatment. Post-treatment E2 levels were significantly lower in the anastrozole group than in the choriogonadotropin alfa group (p = 0.032), while the mean testicular volume was statistically significantly lower in the choriogonadotropin alfa group. Conclusions: This study suggests that anastrozole treatment before micro-TESE in patients with KS yields more successful results in terms of the SRR compared to choriogonadotropin alfa treatment.

Objective: This study aims to compare two different drainage methods, percutaneous nephrostomy (PCN) and retrograde ureteral double-J (DJ) stent insertion, in patients with obstructive pyelonephritis (OP).Methods: The study included 77 patients who presented to the emergency department due to stones. Type of decompression treatment (PCN or DJ stent), fever, white blood cell count (WBC), C-reactive protein (CRP) levels, urine culture, blood culture, presence of additional diseases, and antibiotic treatment were evaluated for these patients. Emergency decompressive treatment was not randomly assigned. The clinician chose the appropriate treatment method based on the patient’s condition after obtaining an informed consent. Patients under the age of 18 were categorized into three subgroups: infants, children under 10 years, and adolescents. Results: Of the 77 patients, 31 were in the DJ stent group and 46 were in the PCN group. Patients in the PCN group exhibited significantly higher fever levels before the procedure (37.6 ± 1.0°C). Additionally, the positivity rate of urine and blood cultures was higher in the PCN group. The average time to stone treatment after infection and medical treatment, as well as fever control, was shorter in the PCN group (9 ± 2.3 days). Empiric treatment with Ceftriaxone (1 g IV) was confirmed by sensitivity results of urine or blood culture in 45% of cases. None of the patients developed advanced urosepsis after the procedure, but the resolution of infection parameters was faster in the PCN group (7 ± 3.3 days). Conclusions: Both PCN and DJ stent insertion are effective and safe methods for managing obstructive pyelonephritis. It was observed that the PCN method under local anesthesia was useful in quickly controlling fever and allowing early surgical treatment. Finally, third-generation cephalosporin antibiotics are beneficial for empiric initial treatment.

Objective: Klinefelter syndrome (KS) represents a sex chromosome anomaly observed in approximately 1 in 500–600 phenotypic males. It is observed in 3% of infertile males and up to 11.9% of azoospermic males. KS manifests in either non-mosaic (47, XXY) or mosaic (47, XXY/46, XY) forms, with 85% of cases presenting as the non-mosaic 47, XXY karyotype. The average rate of surgical sperm retrieval in patients with KS is around 50%, ranging from 28% to 69%. In this study, we aimed to present the outcomes of microscopic testicular sperm extraction (micro-TESE) in patients with non-mosaic KS. Materials and Methods: The results of 61 patients diagnosed with KS, who presented to the Harran University Urology Clinic with azoospermia between 2017 and 2024, were retrospectively reviewed. Hormonal assessments, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and total testosterone (TT), were conducted for all patients, and their partners underwent gynecological evaluations for infertility. Testicular dimensions were recorded via scrotal ultrasonography. Patients were categorized into TESE-positive and TESE-negative groups, and parameters were compared between these groups. Results: The mean age of the patients was 29.0±5.1 years, and their mean infertility duration was 5.9±4.1 years. The sperm retrieval rate was 29.5% (n=18). Mean levels of FSH, LH, prolactin, estradiol, and TT were 44.9 IU/L, 23.3 IU/L, 10 nmol/L, 31.4 pmol/dL, and 219 ng/dL, respectively. Sperm was retrieved in 18 patients (29.5%), while no sperm was obtained in 43 (70.5%). No significant correlation was observed between patient age, testicular size, serum levels of FSH, LH, prolactin, estradiol, and TT, and sperm retrieval rates when comparing the TESE-positive and TESE-negative groups (P>0.005). Conclusion: In patients with non-mosaic KS, hormonal parameters, age, and infertility duration were not found to be significant predictors of the success of micro-TESE in sperm retrieval.

Fournier gangreni (FG), perianal ve genital bölgeyi etkileyen nekrotizan fasiit ile karakterize mikrobiyal bir enfeksiyöz hastalıktır. Hastaların büyük bir kısmında diyabet, sigara, alkol ve madde bağımlılığı, obezite, periferik damar hastalığı, travma, üretral darlık gibi nekrotizan fasii-te yatkınlık yaratacak immünosupresif durumlar bulunmaktadır. Fournier gangreninin tedavisin-de geniş spektrumlu antibiyoterapi, sepsis açısından resusitasyon ve agresif cerrahi debridman bulunmaktadır. Kırk iki yaşında sigara,alkol kullanımı ve ek hastalığı olmayan sağlıklı erkekte, skrotal kılların temizliği sonrası oluşan 1 cm’lik yüzeyel jilet kesinin ilerleyerek Fournier Gangreni gelişebileceğini vurgulamayı amaçladık.

Cystic neoplasms of the kidney are quite rare. Because they contain various differential diagnoses and their radiological features are not specific, their diagnosis is very difficult except for histopathological data. Usually, they can be confused radiologically with benign cysts of the kidney or angiomyolipoma. Radical or partial nephrectomy is the most commonly preferred curative treatment method when it shows features like rapidly growing or malignancy. Histopathological examination is required for definitive diagnosis. In this article, we aimed to present a rare case of tubulocystic renal cell carcinoma after partial nephrectomy in our clinic, who was followed up in another center for years with the pre-diagnosis of angiomyolipoma, in the light of the literature.

Background/aim: Mechanisms to explain inflammation in male infertility of unknown cause are still being investigated. The inflammasome is a key regulator of innate immunity in the inflammatory response to infections. Our study aims to investigate the effects of varicocele on infertility, its relationship with antioxidant and inflammasome mechanisms, and how it could be guided in azoospermic or nonazoospermic patients. Materials and methods: A cross-sectional cohort study was conducted at the department of urology in our university hospital. Eightyeight randomly selected men aged 20-45 admitted to our hospital because of infertility between September 2019 and July 2020 were included in the study. Patients were divided into four equal groups according to their clinical status, those with/without azoospermia and with/without varicocele. Blood and semen samples were taken from the patients. NOD-like receptor pyrin domain-containing 3 (NLRP3) and interleukin-1 beta (IL1ß) and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were measured in serum and semen, and the groups were compared statistically. Results: Serum and semen NLRP3, IL1ß, TAS, TOS, and OSI values of the patients with varicocele or azoospermia were significantly higher than those without either varicocele or azoospermia (p < 0.05). The oxidative stress markers TAS, TOS, and OSI values were significantly higher in the other groups than those without azoospermia and varicocele (p < 0.05). Conclusion: Inflammasome mechanisms, such as NLRP3 and IL1-ß molecules, may provide additional benefit in evaluating the need and benefit of surgical or medical treatment in infertility with and without vascular pathology and with and without azoospermia.

Intravesical ectopic pregnancy is a very rare condition. Unlike traditional ectopic pregnancies, patients generally present with hematuria. Our case presented with abdominal pain and urinary bleeding. Abdominal tenderness was observed on physical examination. The ß-HCG was measured as 10033 IU / ml. In ultrasonography, an appearance compatible with a vesicouterine fistula tract and an ectopic gestational sac in the bladder were observed. In cystoscopy, a mass compatible with a fistula tract ostium and ectopic gestational sac was observed at the junction of the right side of the bladder and the posterior wall. The observed structure was resected and cauterized to achieve hemostasis. No complications were observed during the follow-up, and the patient was discharged. Ectopic pregnancy should be one of the differential diagnoses of patients with a history of pelvic surgery who present with complaints of menstrual delay and hematuria. Keywords: vesical pregnancy, vesicouterine fistula, hematuria