Ali Yıldız

Background: Erectile dysfunction (ED) is a prevalent condition, with vasculogenic ED being the most common subtype, primarily related to endothelial dysfunction and cardiovascular risk factors. Low-intensity extracorporeal shock wave therapy (Li-ESWT) has emerged as a promising non-invasive treatment option. However, predictors of treatment response remain poorly defined. Aim: To identify clinical and vascular predictors of treatment success following Li-ESWT in patients with vasculogenic ED and to develop a novel, practical, and non-invasive scoring system to predict therapeutic response. Methods: This prospective study included 219 men aged 18-80 years with vasculogenic ED between January 2024 and January 2025. All patients underwent Li-ESWT (18 000 pulses over 3 weeks). Clinical and vascular parameters, including age, ED duration, body mass index, presence of cardiovascular risk factors, diabetes mellitus (DM), carotid intima-media thickness (cIMT), flow-mediated dilation rate (FMD), and prior phosphodiesterase type 5 inhibitor (PDE5i) response, were recorded. Treatment success at 6 months was defined as an increase of ≥1 point in the erection hardness score or ≥5 points in the International Index of Erectile Function-5 EF. Outcomes: The primary outcome was treatment success at 6 months after Li-ESWT. Secondary outcomes included the development and validation of a predictive scoring system. Results: Treatment success rate was 66.2% (145/219). Independent predictors of treatment success were absence of DM (odds ratio [OR] = 2.67, P = .012), ED duration <36 months (OR = 2.23, P = .026), cIMT <0.8 mm (OR = 2.04, P = .042), prior PDE5i benefit (OR = 2.47, P = .016), FMD ≥5% (OR = 2.57, P = .012), age <65 years (OR = 2.28, P = .032), and presence of cardiovascular risk factors (OR = 2.23, P = .036). A scoring system incorporating these 7 variables achieved an area under the curve of 0.819 (95% confidence interval [CI] 0.762-0.877). Using a cut-off of 4.5 points, the sensitivity was 73% and the specificity was 77% (P < .001). Clinical Implications: This scoring system may help clinicians identify patients most likely to benefit from Li-ESWT, optimize patient selection, and improve individualized treatment strategies in vasculogenic ED. Strengths & Limitations: The study is strengthened by its prospective design, relatively large sample size, and inclusion of vascular function parameters (FMD, cIMT). Limitations include the lack of external validation and the absence of penile Doppler ultrasound confirmation in all patients. Conclusion: This study identified key demographic and vascular predictors of Li-ESWT response and introduces a novel, non-invasive clinical scoring system with strong predictive accuracy. This tool may enhance treatment personalization and support clinical decision-making in the management of ED.

Purpose: The medical expulsive therapy stone score (METSS) was developed to assess the success of MET in distal ureteral stones. In this study, we aimed to perform an external validation of the METSS to estimate spontaneous passage in patients with proximal and mid-ureteral stones. Materials and methods: We retrospectively analyzed 62 adult patients with 4-10 mm proximal or mid-ureteral stones treated with medical expulsive therapy (MET) between September 2022 and June 2024. MET consisted of silodosin (4 mg) once daily. Patients were followed weekly for up to four weeks to assess stone passage. METSS scores were calculated, and treatment outcomes were compared. Results: Spontaneous stone passage occurred in 53.7% of the 54 patients who completed the study. Stone size, stone burden, and the METSS score were significantly associated with treatment outcomes. Patients with lower METSSs had higher stone passage rates. The area under the ROC curve (AUROC) for the METSS was 0.674 (p=0.029). The METSS score demonstrated a sensitivity of 76% and specificity of 56%, indicating moderate predictive performance. Conclusion: The METSS scoring system has a moderate ability to predict the spontaneous passage of proximal and mid-ureteral stones. Nevertheless, it may assist clinicians in making informed decisions between conservative and interventional treatment strategies.

Anıl H, et al. Investig Clin Urol. 2023 May;64:e32. https://doi.org/10.4111/icu.20220361

Amaç Üroloji kılavuzlarında 10-20 mm arası alt pol taşlarında özellikle ekstrakorporal şok dalga litotripsi (SWL)'nin başarısız olduğu veya SWL'nin uygun olmadığı durumlarda endoürolojik tedaviler olan perkütan nefrolitotomi (PCNL) ve retrograd intrarenal cerrahi (RİRC) önerilmektedir. Bu çalışmada 10-20 mm arası alt pol taşlarında RİRC ile mini perkütan nefrolitotomi (m-PCNL) uygulanan hastaların sonuçlarını karşılaştırdık. Gereç ve Yöntem 2020 ile 2022 yılları arasında 10-20 mm arası alt pol böbrek taşı nedeniyle endoürolojik tedavi (RİRC veya m-PCNL) uygulanan 116’sı RİRC, 71’i m-PCNL olan toplam 187 hastanın dosyaları retrospektif olarak incelendi. Preoperatif yanlılıkları önlemek için 1:1 oranı temel alınarak eğilim skoru eşleştirmesi (propensity score-match) uygulandı. Analiz sonucuna göre RİRC uygulanan 65 hasta ve m-PCNL uygulanan 65 hasta çalışmaya dahil edildi. İki grup arasında intraoperatif (operasyon süresi, floroskopi süresi) ve postoperatif bulgular (hastane yatış süresi, hematokrit düşüşü, taşsızlık oranları ve komplikasyonlar) karşılaştırıldı. Operasyon sonrası 4 mm veya daha büyük taş saptanması klinik anlamlı rezidü olarak tanımlandı. Komplikasyonlar Clavien skorlama sistemine göre ve intraoperatif-postoperatif olarak sınıflandırıldı. Bulgular Her iki grup, demografik özellikler (yaş, cinsiyet, vücut kitle indeksi), radyografik taş karakteristikleri (taş boyutu, taş lateralitesi, taş opasitesi, ve taş dansitesi) açısından karşılaştırıldığında istatistiksel olarak anlamlı fark gözlenmedi. Operasyon süresi, floroskopi süresi, hastane yatış süresi açısından gruplar karşı- laştırıldığında, RİRC grubunda bu süreler istatistiksel olarak anlamlı derecede daha kısaydı (p

Background: We aim to directly compare the feasibility and safety of extended pelvic lymph node dissection (PLND) during transperitoneal robotic-assisted radical prostatectomy (Tp-RARP) and extraperitoneal laparoscopic radical prostatectomy (Ep-LRP). Materials and Methods: We retrospectively identified the prospectively maintained database records of 162 patients diagnosed with prostate cancer (PC) who underwent Ep-LRP or Tp-RARP with extended PLND. Patients with risk of nodal metastases over 5% according to Briganti nomogram received extended PLND. All data analyzed in this study were based on the documentation in our PC database including age, body mass index, Charlson comorbidity index score, preoperative prostate-specific antigen, history of abdominal surgery, biopsy Gleason score, total operation time, postoperative pelvic drainage time, pathological results, lymph node yield (LNY), percentage lymph node involvement (%LNI), and perioperative complications. Patients were followed up for biochemical recurrence in the postoperative period. Results: Eighty-two of the 162 enrolled patients were in group 1 (Ep-LRP+PLND) and 80 were in group 2 (Tp-RARP+PLND). There were no statistically significant differences between the groups regarding preoperative demographics and clinical characteristics. The median LNY was 17 (range 8–27) and 17.5 (range 10–29) in groups 1 and 2, respectively, and no statistically significant difference was found. There was no significant difference between the groups in terms of biochemical recurrence-free survival with mean follow-up of 44.8 months after radical surgery. Conclusion: Our results support the view that extended PLND through the Ep-LRP approach is a feasible and safe procedure without compromising oncological efficacy compared with a similar template attempted during Tp-RARP. Clinical Trial Registration number is 01/21-2.

Sağlık Sektöründe Yerli Üretimi Artırma Çalışmaları Mehmet ATASEVER Tıbbi Cihaz Teknolojileri ve Ülkemizdeki Yeri Savaş NEHRİ Salih YALÇIN Yerli ve Milli İlk Sağlık Dronu Hızır Sağlık Dronu Can ÖZLÜ Hilmi Sefa YANGAL Sami Engin MUZ Hasan ALPAY Uğur SİVRİKAYA Deniz FEYYAZ Sağlıkta Yapay Zeka Merve Ayyüce KIZRAK Sağlıkta AR ve VR Teknolojileri Yusuf YEŞİL Oftalmoloji’de Yapay Zekâ Teknolojisi Türkay KART Nilüfer KÖYLÜOĞLU İnme Rehabilitasyonunda Sanal Gerçeklik Uygulamaları Aynur METİN TERZİBAŞIOĞLU Ürolojide Sanal Gerçeklik Uygulamaları ve 3 Boyutlu Medikal Teknolojilerin Kullanımı Mehmet EZER Emre HURİ Teletıp Muhammed İkbal ŞAŞMAZ Geleceğin Hastaneleri -Dijital Hastaneler Anıl UÇAN 5G Remote Surgery (5G Uzaktan Cerrahi) Oktay ÖZMAN Kök Hücre Tedavileri Dünü, bugünü ve yarını İbrahim EKER Kornea Doku Mühendisliği Ali Rıza Cenk ÇELEBİ Hipek (Hipertermik İntraperitoneal Kemoterapi) Selçuk GÜLMEZ Göğüs Hastalıklarında Endobronşiyal Ultrasonografinin Kullanımı Ruşen UZUN Robotik Rehabilitasyon Kübra USTAÖMER Radyoloji’nin Dünü, Bugünü, Yarını: Radyoloji Nereye Gidiyor ? Radyoloji’de Yapay Zekanın Yeri Hüseyin Alper KIZILOĞLU Renkli MR Nevit Dilmen Tıbbi Görüntülemede Üç Boyutlu Yazıcı Kullanımı Ali Ege TERZİBAŞIOĞLU Nörolojik Hastalıklarda Derin Beyin Stimulasyonu Tedavisi Nazan ŞİMŞEK ERDEM Beyin ve Sinir Cerrahisi’nde İntraoperatif Gerçek Zamanlı Nöroklavuzlama Yöntemleri Türker KARANCI Perkütan Nefrolitotomide Perkütan Girişe Yardımcı Yeni Teknolojiler Abdullah ERDOĞAN Salih POLAT Tek-Port Robot-Yardımlı Radikal Prostatektomi Ali YILDIZ Mahmut Taha ÖLÇÜCÜ Jinekolojik Genital Estetik Uygulamalarında Cerrahisiz Teknolojiler Deniz BALSAK Jinekolojik Cerrahide Laparoskopinin Rolü Ahmet YILDIZBAKAN Kanser Metilasyon Analizlerinde MS-HRM Yönteminin Kullanımı Ebubekir DİRİCAN Kodlamayan RNA’lar Dünyası: Tıptaki Yeri, Önemi ve Geleceği Levent ELMAS Mücahit SEÇME Yapay Zeka ve Diş Hekimliği Gözde SERİNDERE Ceren AKTUNA BELGİN İn Vitro Yeni Nesil Hücre Kültürü: Üç Boyutlu Kültür, Sferoidler ve Organoidler Emine TURAL Doku Yapıştırıcıları: Mevcut Durum ve Yeni Trendler Ayça BAL ÖZTÜRK Emine ALARÇİN

Objective: To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. Materials and methods: The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. Results: Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). Conclusions: Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.

Treatment recommendations for kidney or ureteral stones are based on stone size; however, this is uncertain for bladder stones. This study aims to determine the best approach to bladder stones based on their size. We retrospectively analyzed 401 patients with bladder stones. Patients were divided into three different groups according to stone size (11–20 mm, 21–30 mm, 31–40 mm as groups 1, 2, and 3 respectively). Patients had transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), and open cystolithotomy (OCL) performed. Stone fragments were removed completely in all patients. When catheter time, postoperative stay, and hematocrit decrease values were compared, the results were significantly higher for OCL in all three groups (p: 0.001). When the relationship between stone sizes and operation time is evaluated, TUCL had shorter operation times (34.1 ± 10.6 min) in group 1. However, TUCL had longer operation times in group 2 and group 3 compared to OCL and PCCL. TUCL may be preferable due to better postoperative outcomes and shorter operative time for ⩽2 cm stones. As the stone size increases, PCCL is more favorable in terms of operation time.