Murat Sambel

Objective: The aim of this study was to evaluate and compare the perioperative, oncological and long-term renal functional outcomes of the zero ischemia (off-clamp) and standard warm ischemia (on-clamp) approaches in patients undergoing robotic partial nephrectomy (RPN).Materials and Methods: This retrospective cohort study examined 56 consecutive patients who underwent RPN for renal masses. The patients were divided into two groups: a zero ischemia group (n = 26) and a warm ischemia group (n = 30). Preoperative demographics, tumour characteristics (RENAL, PADUA and C-index) and perioperative data were recorded. Renal function was assessed using serum creatinine levels and estimated glomerular filtration rates (eGFR) before surgery, on the first day after surgery, and after one year.Results: There were no differences in demographic variables or tumour complexity scores (RENAL, PADUA) between the groups. The C-index score was significantly higher in the zero ischemia group (median 3.1 vs. 1.86, p = 0.001), indicating a more peripheral tumour location. Although postoperative complication (p = 0.494) and positive surgical margin (PSM) (p = 0.140) rates were comparable, estimated blood loss (300 ml vs. 100 ml, p < 0.001) and hospital stay (4 days vs. 3 days, p = 0.001) were higher in the zero ischemia cohort. Both groups experienced an initial deterioration in renal function, but the zero ischemia group’s eGFR and creatinine levels recovered to baseline within one year (p = 0.970). In contrast, the warm ischemia group experienced a significant decline in eGFR that persisted at one year (p = 0.001).Conclusion: The zero ischemia approach in RPN may offer functional advantages, particularly in selected patients, in terms of complete long-term preservation of renal function compared to standard warm ischemia. Despite slightly increased intraoperative bleeding, this approach demonstrates comparable PSM rates, particularly for anatomically suitable, peripherally located tumours.

Objective: We aimed to investigate the effect of tube-shaped bladder neck, which we define as our modified urethral anastomosis technique, on early continence in patients undergoing robot-assisted radical prostatectomy. Methods: This retrospective study (2017-2020) compared standard anastomosis (group 1, n = 75) with a modified technique (group 2, n = 74) in patients undergoing radical prostatectomy. Preoperative, perioperative, postoperative, and histopathological characteristics of the patients were recorded. Continence was assessed using the Turkish version of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and daily pad usage was recorded. Patients who never used a pad and had an ICIQ-SF score of ≤6 were considered continent. Erectile function was evaluated using the International Index of Erectile Function-5 form. Results: When evaluating postoperative continence status, the number of pads used and the ICIQ-SF score were significantly lower in the group that received the new technique at the first, third, and sixth months. In our study, the postoperative continence rates were 18.7%-36.5% at 1 month, 38.7%-63.5% at 3 months, and 56%-77% at 6 months for groups 1 and 2. Our new technique provided statistically superior results during the first 6 months (P = .015, P = .002, and P = .007, respectively). Conclusion: The modified urethral anastomosis technique accelerates the recovery of early continence (within 1-6 months), while achieving comparable long-term outcomes to those of the standard method. Our new technique is oncologically reliable and does not compromise cancer control. Cite this article as: Aktaş Y, Yılmaz K, Kılıç Ş, et al. The impact of tube-shaped bladder neck modification on early-term continence in robotic radical prostatectomy. Urol Res Pract. 2026;52, doi: 10.5152/tud.2026.26053.

Objective: To investigate the association between serum testosterone levels and the severity of penile curvature and plaque size in men with Peyronie’s disease (PD). Materials and Methods: This retrospective cross-sectional study included 108 men diagnosed with Peyronie’s disease who presented to our urology outpatient clinic between January 2022 and July 2025. Patients with prior testosterone replacement therapy, pelvic surgery, intralesional treatment, or systemic conditions affecting testosterone metabolism were excluded. Demographic and clinical data—including disease duration, penile pain, erectile dysfunction (assessed by IIEF-5), and disease phase—were recorded. Penile curvature was assessed via self-photographs during natural or pharmacologically induced erections, and plaque size was measured ultrasonographically. Fasting morning serum samples were analyzed for total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and metabolic parameters. Results: Mean age was 59.6 ± 7.5 years, and mean disease duration was 22.7 ± 29.4 months. Mean horizontal and vertical curvatures were 12.1 ± 19° and 28.5 ± 19.8°, respectively. Mean plaque size was 8.9 ± 7 mm. No significant differences were observed between hypogonadal and eugonadal groups in curvature severity (p>0.05), plaque size (p=0.54), or disease phase. Hypogonadal men had significantly lower SHBG and estradiol levels and higher HbA1c and triglyceride values (all p<0.05). No correlations were found between testosterone levels and curvature degree or plaque dimensions. Conclusion: Serum testosterone levels are not associated with PD severity. Hypogonadism appears to be a comorbidity rather than a determinant of disease severity, suggesting routine testosterone evaluation may not be necessary in PD management. Keywords: Peyronie’s disease, penile curvature, penile plaque, testosterone levels

Introduction: In low-risk prostate cancer (PCa), the aim of active surveillance (AS) is to reduce overtreatment and avoid potential adverse effects. The rebiopsy approach in AS remains debated, spanning routine scheduled biopsies to clinically- or imaging-driven rebiopsies based on PSA kinetics or multiparametric MRI (mpMRI). In this retrospective, single-center comparative cohort study, we examined outcomes of periodic vs patient-based rebiopsy during AS and evaluated oncological outcomes in patients with PCa. Methods: Seventy-four patients who underwent at least one year of AS for PCa between January 2019 and July 2024 were retrospectively analyzed. Two distinct AS protocol patients were included in the study from 4 different physicians in our clinic. Demographic data, PSA levels, PSA kinetics, mpMRI findings, and rebiopsy pathology results were documented. Radical prostatectomy (RP) pathology results and factors influencing definitive treatment (DT) decisions were compared between the 2 groups: periodic rebiopsy (n = 41), and patient-based rebiopsy (n = 33). Results: The median rebiopsy time was shorter in the periodic group (12.5 months, IQR: 1) than in the patient-based group (14 months, IQR: 9; P < 0.001). First-year rebiopsies were more frequent in the periodic group (68.3%) than in the patient-based group (45.5%; P = 0.048). No significant difference in DT switching rates or final pathology outcomes was observed, though patients in the periodic group switched to DTs earlier ( P = 0.045). A positive Spearman’s correlation was identified between the maximum PSA density and the International Society of Urological Pathology (ISUP) score of RP specimens [rho = 0.62, P = 0.001]. A PSA density cut-off value of ≥0.17 ng/mL ² was found to predict an ISUP grade ≥2 in the final pathological assessment with high accuracy (AUC = 0.891, 95% CI: 0.753-1.00, P = 0.003). Conclusions: Patient-based rebiopsy protocols driven by PSA kinetics and mpMRI results can minimize unnecessary procedures, prevent overtreatment, and optimize monitoring in AS of PCa.

The association between prolonged general anaesthesia duration in radical cystectomy (RC) and increased complication rates is well established. This study compared clinical outcomes of open RC performed under combined spinal-epidural anaesthesia (CSEA) versus general anaesthesia in elderly and frail patients. A retrospective evaluation was conducted on data from patients who underwent open RC at our institution between February 2023 and October 2024. Patients with missing data or previous open abdominal surgery, who underwent additional surgical intervention during RC, or who underwent different urinary diversions from ileal loop diversion were excluded. The study comprised two cohorts, designated as CSEA and general anaesthesia groups. Various demographics, including age, body mass index (BMI), comorbidities, pre-and postoperative blood values, operative times, estimated blood loss, and recovery parameters, were retrospectively analyzed. The CSEA group had a higher mean age than the general anaesthesia group (72.40 ± 9.79 vs. 64.40 ± 10.70 years, p = 0.098), though this difference was not statistically significant. BMI values were similar for both groups (25.50 ± 2.80 and 25.34 ± 4.20 kg/m², p = 0.922). The prevalence of comorbidities was significantly higher in the CSEA group (100% vs. 40%, p = 0.011). The mean preoperative albumin level was lower in the CSEA group (3.23 ± 0.68 vs. 3.97 ± 0.51 mg/dL, p = 0.013). Duration of surgery, estimated blood loss and need for blood transfusion were similar between both groups (p > 0.05). Postoperative oral feeding initiation time was significantly earlier in the CSEA group (1 day and 3 days, p < 0.001). Visual Analog Scale (VAS) scores were significantly lower in the CSEA group (3.0 vs. 4.6, p = 0.004). The number of lymph node removals was significantly higher in the CSEA group (28.80 ± 7.77 vs. 12.90 ± 7.13, p < 0.001). Locally advanced disease rate was more common in the CSEA group (80% vs. 20%, p < 0.010). However, Clavien-Dindo Grade ≥ III complication rates and length of hospitalization were similar between the groups (p > 0.05). Open RC under CSEA is a preferable option for elderly patients and those with comorbidities who are not suitable for general anaesthesia. It offers advantages in postoperative bowel function recovery and pain management compared with general anaesthesia. retrospectively registered.

Background: Penile fracture (PF) is a urological emergency that can lead to significant complications if not treated promptly and understanding the factors influencing complications and outcomes in PFs is crucial for improving patient management. Aim: This study aims to evaluate the impact of various factors on postoperative complications and outcomes in patients with PFs based on 10 years of experience at a single center. Methods: In this retrospective study, we analyzed data from 106 patients who underwent surgical treatment for PFs between 2013 and 2023 at our institution. Patient demographics, fracture characteristics, and postoperative outcomes were analyzed. Factors affecting complications including the timing of surgery, defect size were evaluated. Outcomes: The study revealed that early surgical intervention significantly reduced the risk of complications. Factors such as larger defect size and delayed surgery were associated with higher rates of postoperative complications. Results: The mean age of the participants was 46.3 ± 13.9 years. The primary causes of PFs were sexual intercourse (62.3%), masturbation (19.8%), forced penile bending (11.3%), rolling over in bed (4.7%), and falling from bed (1.8%). The mean time from trauma to surgery was 10.5 ± 8 hours, with a mean defect size of 12.7 ± 5.5 mm. Postoperative complications included penile curvature, palpable plaques, and painful erections, with rates of 10.4%, 39.6%, and 23.6%, respectively. International Index of Erectile Function (IIEF-5) scores significantly decreased from preoperative (21.36 ± 2.9) to postoperative values at 6 months (19.48 ± 3.7) (P < 0.001). The time from trauma to surgery significantly correlated with the change in IIEF-5 scores between preoperative and postoperative values (P = 0.007, R2 = 0.067). The group experiencing complications exhibited a mean defect size of 14.54 ± 6 mm, whereas the non-complication group had a mean defect size of 11.07 ± 4.5 mm (P < 0.001). Clinical Implications: The findings suggest that timely surgical intervention and careful assessment of defect size are critical in managing PFs and these insights can guide urologists in optimizing treatment strategies and improving patient outcomes. Strengths and Limitations: This study benefits from a substantial sample size and a decade of surgical experience at a single center. However, the study's retrospective design and unknown patient history with erectogenic drugs are limitations. Conclusion: The timing of surgery significantly impacts IIEF-5 scores, while the size of the defect was associated with other postoperative complications; understanding the factors influencing complications in PFs can improve surgical outcomes.

Objective: This study aims to evaluate the clinical outcomes of patients receiving antithrombotic (antiaggregant and anticoagulant) therapy who underwent emergency percutaneous nephrostomy (PN) for the treatment of receiving complicated upper urinary tract infection. Material and Methods: Data of consecutive patients who underwent emergency PN from January 2014 to October 2024 were retrospectively reviewed. A total of 34 patients on antithrombotic treatment (Group 1) and 35 control group patients (Group 2) without bleeding disorders or any antithrombotic treatment were included. Demographics, indications for PN, pre- and postprocedural hematological, biochemical, and microbiological parameters and complications were analyzed. Results: The mean age was 68.65±1.49 in group 1 and 62.09±1.77 in group 2 (p = 0.006). Sex distribution and indications for PN were comparable between groups. There was no significant difference in emergency PN indications, grade of hydronephrosis, and PN placement sides. The most common antithrombotic agent in group 1 was warfarin (44.1 %). Escherichia coli was the most common bacteria isolated in both groups (55.9% vs. 48.6 % for groups 1 and 2, respectively). No major complications were observed in either group. Blood replacement was performed in 4 and 3 patients in groups 1 and 2, respectively. Mean post-procedure Hg levels were similar in both groups (9.53 ±1.39 vs. 9.98 ±1.18 for groups 1 and 2, respectively). No difference in median hospital stay was observed between the groups. Conclusion: Antithrombotic drugs pose a potential bleeding risk during PN placement. This is the first study in the literature on PN placement in patients on antithrombotic therapy, and it shows that the procedure can be performed with low complication rates in patients on antithrombotic therapy.

The aim of this study is to evaluate the effect of obesity on robotic-assisted radical prostatectomy (RARP) outcomes. This study included 120 obese patients [body mass index (BMI) ≥ 30 kg/m²] and 124 normal weight (BMI ≤ 25 kg/m²)] patients from a total of 750 patients who underwent RARP between January 2017 and March 2023. The perioperative and long-term oncological and functional outcomes were also analyzed. No significant differences were observed between the groups regarding age, prostate-specific antigen (PSA) levels, or International Society of Urological Pathology (ISUP) grade distribution (p > 0.05). The obese group had significantly longer median surgical times, vesicourethral anastomosis times, hospital stays and drain removal times compared to the control group (p < 0.05). The control group demonstrated significantly better continence recovery rate at the 1st month and erectile dysfunction (ED) recovery rate at the 12th month (p < 0.05). Bilateral nerve sparing (OR: 16.59; p < 0.001) and the preoperative IIEF score (OR: 1.29; p < 0.001) were identified as independent predictors of ED recovery in the multivariable logistic regression model. Bilateral nerve sparing (OR: 3.00; p < 0.001) and the absence of metabolic syndrome (OR: 2.03; p < 0.05) were found to be independent predictors of early continence recovery. There were no differences in systemic progression or overall survival at a median follow-up of 24 months (p > 0.05). While obesity adversely impacts perioperative outcomes, short-term continence recovery rates, and mid-term ED recovery rates, it does not affect mid-term oncological outcomes after RARP.

As it is known, sexual health is very important for the quality of life of the individual and his/her partner. In the literature, it has been shown that many diseases can negatively affect sexual health. The most common sexual health problem in men is erectile dysfunction and its etiology is multifactorial. Epilepsy and the treatment process of this disease may also impair erectile functions through various mechanisms. Moreover, it is essential to consider that psychosocial factors may also play a role in erectile dysfunction in patients with epilepsy. Due to the chronic nature of neurological disorders, treatment typically focuses on the primary disease, while sexual dysfunction often remains neglected. Erectile dysfunction, which is a common sexual problem in epilepsy, should be evaluated with a multidisciplinary approach. A thorough understanding of the pathophysiology of erectile dysfunction in these patients is critical for implementing therapeutic interventions and providing solutions to patient problems. This review aims to examine the neurophysiological basis and etiological mechanisms of erectile dysfunction in patients with epilepsy in the light of the literature. Keywords: Erection neurophysiology, erectile dysfunction, epilepsy, sexual health, antiepileptic drugs