Serdar Celik

Objective: This study aimed to investigate the association between the preoperative albumin-to-globulin ratio (AGR) and pathological stage and tumor grade in patients who underwent transurethral resection of bladder tumor (TURBT) for primary bladder tumors.Materials and Methods: A total of 153 patients who underwent transurethral resection of bladder tumor (TURBT) for primary urothelial carcinoma between March 2017 and February 2020 were included in the study. AGR was calculated using preoperative serum albumin and total protein levels. Among the exclusion criteria were active infection, autoimmune disease, hepatic disease, and concomitant malignancy. The optimal AGR cut-off value was determined using receiver operating characteristic (ROC) curve analysis and the Youden index. Independent predictors of pathological stage (NMIBC/MIBC) and tumor grade (low/high Grade) were evaluated using logistic regression analysis.Results: The median age of the patients was 68 years (IQR: 59–75), and 88.9% were male. The pathological stage distribution was Ta in 39.9%, T1 in 39.9%, and T2 in 20.3% of patients, while tumor grade distribution was low Grade in 54.2% and high Grade in 43.1%. The median AGR value of the cohort was 1.32 (IQR: 1.17–1.50). AGR was significantly lower in both the MIBC group (p = 0.003) and the high-grade group (p < 0.001) compared to their respective counterparts. ROC analysis identified an optimal cut-off value of 1.35 for both clinical outcomes (AUC=0.649, 95% CI: 0.542–0.755 for MIBC and AUC=0.656, 95% CI: 0.568–0.744 for high-grade disease). In multivariate logistic regression analysis, AGR was independently associated with both MIBC (OR=0.16, 95% CI: 0.03–0.97; p = 0.046) and high-grade disease (OR=0.18, 95% CI: 0.04–0.74; p = 0.018).Conclusion: Preoperative AGR is independently associated with pathological stage and tumor grade in primary bladder tumors. The ability to calculate this parameter from routine biochemical tests without additional cost makes it clinically valuable for preoperative risk stratification. Further validation of these findings in larger patient cohorts is warranted.

Aim: This study aimed to look into how well ureteral jet flow can predict whether ureteral stones will pass naturally and to observe any changes in jet flow after treatment, with a focus on where the stones are located. Materials and Methods: We conducted this study with 50 adults who had acute renal colic and were found to have a single ureteral stone less than 10 mm through non-contrast CT scans. We used Doppler ultrasound before treatment and again between days 15 and 20 to measure jet frequency (JETfreq) and mean jet velocity (JETmean). We checked to see if the stones passed after 28 days. For analysis, we used paired tests, the Mann Whitney U test, and Pearson correlation. Results: After treatment, we saw significant increases in JETfreq and JETmean only in the obstructed ureter, which suggests some recovery. For stones located farther down the ureter, the jet measurements improved more than in those closer to the kidney. In total, 54% of patients passed their stones naturally. Those who did not had stones that were larger, covered a bigger area, and had higher Hounsfield Birimi HU values (p

Background: With the increasing integration of multiparametric MRI (mpMRI) and 68Ga‐PSMA PET/CT into the diagnostic and staging algorithms of prostate cancer (PCa), digital rectal examination (DRE)—a once foundational and cost‐effective physical examination—has gradually become marginalized in daily clinical practice. However, the continued relevance of DRE in the modern imaging era remains uncertain. This study aimed to reassess the diagnostic value of DRE in the context of contemporary imaging tools, particularly mpMRI and PSMA PET/CT. Methods: This retrospective analysis included 164 patients diagnosed with prostate adenocarcinoma via transrectal ultrasound‐guided biopsy. All patients underwent DRE before biopsy, and 151 received mpMRI while 62 underwent PSMA PET/CT. mpMRI findings were reported using PI‐RADS v2.1, and SUVmax values were recorded from PET/CT reports. Radical prostatectomy was performed in 156 patients. The relationship between DRE findings and imaging parameters, biopsy results, and pathological staging was analyzed using multivariate statistics and ROC curve analyses. Results: DRE findings were benign in 100 patients and suspicious for malignancy in 64. Suspicious DRE was significantly associated with higher PI‐RADS scores, greater lesion size, elevated SUVmax, and clinically significant PCa ( p < 0.001 for all). Each one‐point increase in PI‐RADS was associated with a twofold rise in the likelihood of a positive DRE. ROC analyses identified a 13.5 mm lesion size and an SUVmax of 15.1 as predictive thresholds for DRE positivity. Suspicious DRE also correlated with advanced pathological stage (≥ pT3) ( p < 0.001). Conclusion: Despite the rise of advanced imaging techniques, DRE remains a valuable adjunctive tool in identifying high‐risk and advanced PCa. When interpreted alongside mpMRI and PSMA PET/CT findings, DRE provides additional clinical insight, supporting its continued role in risk stratification rather than screening in the modern diagnostic workflow.

Objectives: To evaluate the role of neoadjuvant chemotherapy in the final treatment plan and its impact on survival in bladder cancer patients who were diagnosed with variant histology in the radical cystectomy specimen and whose diagnostic accuracy was achieved with the previous transurethral resection of the bladder specimen.Methods: In this retrospective multicenter study, data from 221 patients across 9 centers were analyzed between January 2012 and January 2022. The primary endpoint was overall, cancer‐specific, recurrence‐free, and metastasis‐free survival rates among patients with and without neoadjuvant chemotherapy, and the secondary endpoint was to identify independent predictors of survival. The Kaplan–Meier method was used to estimate overall survival, cancer‐specific survival, recurrence‐free survival, and metastasis‐free survival, and multivariate analyses were performed using the Cox‐regression model.Results: Kaplan–Meier estimates of overall, cancer‐specific, recurrence‐free, and metastasis‐free survival demonstrated no significant difference between two groups. Cox multifactorial analysis revealed that the age (HR 1.030, 95% CI 1.003–1.057, p = 0.027), presence of pT4 tumor stage (HR 3.861, 95% CI 1.303–11.494, p = 0.015), and pN+ (HR 2.288, 95% CI 1.475–3.550, p < 0.001) at radical cystectomy histopathology were independent predictors of overall survival; presence of pT4 tumor stage and pN+ at radical cystectomy histopathology were independent predictors of cancer‐specific survival (HR 8.245, 95% CI 1.873–36.292, p = 0.005 and HR 1.792, 95% CI 1.049–3.061, p = 0.033) and metastasis‐free survival (HR 9.957, 95% CI 1.286–77.073, p = 0.028 and HR 2.949, 95% CI 1.674–5.197, p < 0.001); and the age (HR 1.047, 95% CI 1.006–1.090, p = 0.025) and pN+ at radical cystectomy histopathology (HR 4.150, 95% CI 1.917–8.981, p < 0.001) were independent predictors of recurrence‐free survival.Conclusion: Neoadjuvant chemotherapy does not provide any survival advantage in variant histology; therefore, considering the disadvantages, such as delaying radical cystectomy, which can lead to inadvertent disease progression and chemotherapy‐related toxicities, cautious should be exercised when administering neoadjuvant chemotherapy.

Background/Aim: This study aims to compare the success rates of rigid registration (RR) and elastic registration (ER)systems in diagnosing all cancers and clinically significant prostate cancer (csPC) in software-based targeted prostate biopsies (TPBs) by performing matching analysis.Materials and Methods: The data of 2,061 patients from six centers where software-based TPB was performed were used. All cancer and csPC detection rates of the RR and ER systems were compared following Mahalanobis distance matching within the propensity score caliper method. Logistic regression analysis was applied to identify factors predicting clinically insignificant prostate cancer (ciPC) and csPC diagnoses. Additionally, the International Society of Urological Pathology Grade Group (ISUP GG) upgrade rates of RR and ER systems were compared between biopsy and radical prostatectomy pathologies.Results: The matched sample included 157 RR and 157 ER patients. No statistically significant difference was found between ER and RR in terms of the csPC detection rate (28.0% vs. 22.3%, p = 0.242, respectively). The detection rate of all cancers by ER compared to RR was found to be significantly higher (54.8% vs. 35.7%, p < 0.001, respectively). No statistically significant difference was found between the ER and RR groups regarding pathological upgrade (39.7% vs. 24.2%, p = 0.130, respectively). In the logistic regression analysis performed to determine the factors predicting ciPC, decreased prostate volume and ER system use were found to be independent predictive factors.Conclusion: While the detection rate of csPC was similar for the RR and ER systems, the detection rate of all cancers and ciPC was significantly higher in ER systems.

Purpose: To compare the oncological outcomes of clear cell RCC (ccRCC), which is common in renal cell carcinomas (RCC), and chromophobic RCC (chRCC), which is less common, and to define the factors affecting survival in the Turkish patient population for both RCC subclassifications. Materials and Methods: Patients with a pathologically confirmed RCC diagnosis after radical or partial nephrectomy in the Turkish Urooncology Association (TUOA), Urological Cancers Database-Kidney (UroCaD-K), were retrospectively reviewed. Patients with ccRCC and chRCC were included in the study. The primary outcomes of this study are recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) for each histological subtype. Results: Data from 5300 patients in the TUOA UroCaD-K are reviewed and a total of 2560 patients (2225 in the ccRCC group and 335 in the chRCC group) are included in the final analysis. In the comparison of the groups, tumor size was greater both radiologically and pathologically in chRCC (p p = 0.019 vs 0.002 respectively). Recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) rates are worse in ccRCC subgroup. In the evaluation of risk factors; pathological stage, local invasion and Fuhrmann grade were found to be significant for recurrence in ccRCC. Age, body mass index and pathological stage were the risk factors affecting overall mortality (OM). Pathological tumor size was an independent risk factor for recurrence in chRCC, while age was analyzed as the only parameter affecting OM. Conclusion: chRCC oncological data and OS, CSS and RFS rates were found to be better than ccRCC in the Turkish patient population.

The aim of the study was to demonstrate the most common genetic alterations and evaluate possible targets involving phosphatidylinositol-3-OH kinase (PIK3)/AKT/mammalian target of rapamycin (mTOR) signaling and DNA damage repair (DDR) pathways for personalized treatment in patients with non-muscle invasive bladder cancer (NMIBC). Alterations of these pathways were observed in 89.5% and 100% of patients, respectively. Among them, BARD1 was more frequently altered in low/intermediate-risk cases, but PARP4 was more frequently affected in intermediate/high-risk patients. The possible target feasibility of BARD1 and PARP4 alterations should be evaluated for personalized treatment using PARP-inhibitors in NMIBC. It is important to detect high tumor mutation burden (TMB) in patients in terms of immunotherapy.