Bilal Çetin

Objective: To quantify phase-specific operative efficiency in holmium laser enucleation of the prostate (HoLEP) and assess the association between comorbidity burden and efficiency metrics. Material and Methods: This single-center retrospective cohort included HoLEP cases performed between January 2023 and June 2025. Of 574 screened patients, 349 met eligibility criteria. Efficiency was calculated as enucleation efficiency (g/min; primary outcome), morcellation efficiency (g/min), and overall extraction efficiency (g/min). Associations were evaluated using multivariable linear regression models after natural log transformation of skewed efficiency outcomes, adjusted for age, log-transformed enucleated tissue weight, and prostate-volume (PV) stratum. Results: Median age was 67 years and 67.9% had ≥1 comorbidity. Median enucleated tissue weight was 53.0 g; median enucleation efficiency was 1.12 g/min, morcellation efficiency 7.00 g/min, and overall extraction efficiency 0.96 g/min. Enucleation efficiency increased across PV strata (0.86 to 1.75 g/min; p

A 15-year-old girl was followed up for 2 years in a district hospital for management of vesicoureteral reflux and, subsequently, hydronephrosis of both kidneys and required bilateral ureteroneocystostomy. Despite surgery, there was continuous progression of the left hydronephrosis. Referral to a tertiary hospital because of continued sterile pyuria prompted investigation for tuberculosis (TB): she was diagnosed with bilateral pulmonary TB and urine culture confirmedMycobacterium tuberculosis. Despite tuberculous chemotherapy and dexamethasone, she required a left nephrectomy. Histology demonstrated necrotising granulomatous pyelonephritis. She remains well with normal function of the right kidney. Despite the rarity, chronic urinary tract disorders should always prompt investigation for tuberculosis.