Bayram Doğan

Introduction: Managing patients on antiplatelet (AP) therapy undergoing transurethral resection of bladder cancer (TURBT) is challenging due to bleeding and thromboembolic risks. Methods: We retrospectively analyzed patients who underwent TURBT between January 2020 and December 2024. Patients were divided into an AP group and a control group without AP therapy. Demographic, perioperative, and postoperative parameters, including low-molecular-weight heparin (LMWH) bridging, were evaluated. The primary endpoint was readmission due to hematuria within 30 days; secondary outcomes included rehospitalization, clot retention, and reoperation. Logistic regression analyses identified predictors of readmission. Results: A total of 103 patients were included, with 40 in the AP group and 63 in the control group. Readmission with hematuria occurred in 10% of AP patients versus 6.3% of controls ( p = 0.707). All readmissions in the AP group involved clopidogrel users, alone or with acetylsalicylic acid (ASA), while none occurred in ASA-only users ( p = 0.004). Rehospitalization was observed only in the AP group (7.5% vs 0%, p = 0.055). LMWH bridging (OR = 18.40, 95%CI = 2.93–115.40, p = 0.002) and clopidogrel use (OR = 10.88, 95% CI = 2.2851.94, p = 0.003) predicted readmission in univariable analysis but not multivariable models. Conclusion: Perioperative ASA monotherapy appears safe, while clopidogrel use may increase the risk of hematuria-related readmission and warrants closer monitoring.

Objective: This study investigates the potential discrepancy between post-void residual urine (PVR) measurements obtained immediately after uroflowmetry and those reflecting patients’ usual voiding patterns, aiming to evaluate the reliability of immediate post-test measurements.Methods: This prospective study included 110 men >45 years with lower urinary tract symptoms. PVR was measured by transabdominal ultrasonography immediately after uroflowmetry (PVR0), on day 1 (PVR1), and day 7 (PVR7). Patients were grouped by pre-void bladder volume: 500 mL. Uroflowmetric parameters, prostate volume, PSA, IPSS, BMI, and detrusor thickness were recorded.Results: The mean age was 60.32±6.93 years; mean prostate volume 44.84±20.44 mL. In the uroflowmetry test, the mean values for Qmax, Qave, and voided volume were detected as 15.83±7.00 mL/sec, 6.21±2.62 mL/sec, and 304.15±157.81 mL, respectively. The mean bladder volume was 408.30±191.53 mL. When stratified into three groups based on bladder volume (500 mL), 26.4% of the patients had a bladder volume 500 mL. The mean PVR0, PVR1, and PVR7 were 104.12±108.51 mL, 33.74±82.54 mL, and 19.59±47.91 mL, respectively. A comparative analysis of PVR0, PVR1, and PVR7 revealed a statistically significant decreasing trend over time: PVR7 < PVR1 < PVR0 (PVR0 vs. PVR1, p < 0.001; PVR0 vs. PVR7, p < 0.001; PVR1 vs. PVR7, p = 0.003).Conclusions: Measuring PVR at a scheduled time after natural bladder filling may yield more accurate and clinically representative data, supporting more reliable treatment planning.

Objective: Varicocele is the most common correctable cause of male infertility, and microsurgical varicocelectomy (MSV) is the gold standard treatment. This study aims to compare the inguinal and subinguinal approaches in microsurgery and to evaluate the effect of external spermatic vein (ESV) ligation on semen parameters. Materials and Methods: A total of 464 patients who underwent MSV between January 2017 and December 2023 were retrospectively reviewed. Patients were divided into two groups based on the surgical approach: subinguinal ( n = 133) and inguinal ( n = 331). Semen analysis was performed preoperatively and at the postoperative sixth month. Demographic data, intraoperative findings, and complications were recorded. Results: Both surgical techniques provided significant improvement in sperm concentration, total motile sperm count (TMSC), progressive motility, and morphology ( p < 0.001). The improvement in morphology was significantly higher in the subinguinal group compared to the inguinal group (0.82 ± 1.56 vs. 0.46 ± 1.45, p = 0.017). In the group where ESV ligation was performed, the increase in progressive motility (5.26 ± 11.92 vs. 2.74 ± 9.00, p = 0.019) and the decrease in immotility (−5.48 ± 12.22 vs. −2.83 ± 14.13, p = 0.035) were more pronounced. Furthermore, an increase in the number of ESVs showed a significant correlation with an increase in progressive motility ( r = 0.144, p = 0.002) and a decrease in immotility ( r = −0.124, p = 0.007). The subinguinal approach significantly increased the probability of accessing the ESV (82.7% vs. 57.7%, p < 0.001). Conclusion: MSV provides effective improvement in semen parameters. The subinguinal approach is more advantageous for morphological improvement and accessing ESVs. Ligation of the ESVs has a positive effect, particularly on sperm motility, and should be considered a critical step for surgical success.

Background/aim: To investigate the effect of antibiotic treatment on PSA when deciding on prostate biopsy. Materials and methods: A total of 206 patients with an elevated PSA level (2.5-30) were included. Mp-MRI could be done on 129 patients. Patients were given ciprofloxacin (500 mg, b.i.d. p.o.) for 4 weeks and PSA measurements were repeated. Systematic prostate biopsy was performed regardless of PSA changes on all patients. Additionally, cognitive biopsies were performed from PI-RADs III, IV, and V lesions. Results: Prostate cancer was detected in 36.4% of patients. 53.3% had Gleason score of 3+3, 46.7% had Gleason score ≥ 3+4. PSA values decreased in 56.3% and in 43.7% and remained the same or increased but cancer detection rates were not different: 34.5% vs. 38.9%, respectively (p = 0.514). PSA change in whole group was significant (6.38 ng/mL vs. 5.95 ng/mL, respectively (p = 0.01). No significant PSA decrease was observed in cancer patients (7.1 ng/mL vs. 7.05 ng/mL, p = 0.09), whereas PSA decrease was significant in patients with benign pathology (6.1 ng/mL vs. 5.5 ng/mL, p = 0.01). In patients with PI-RADs IV-V lesions, adenocarcinoma was present in 33.9% and 30.4% with or without PSA decrease, respectively (p = 0.209). Clinically significant cancer was higher in patients with after antibiotherapy PSA values >4 ng/mL regardless of PI-RADs grouping (p = 0.08). Addition of any PSA value to PI-RADs grouping did not have any significant effect on the detection of cancer. Conclusion: PSA change after antibiotic treatment has no effect in detecting cancer and should not delay performing a biopsy

Objective: This study aims to compare the clinically significant prostate cancer (csPCa) detection rates of cognitive targeted biopsy (CTB) and systematic biopsy (SB) and to reveal the factors affecting csPCa detection rates. Material and Methods: Patients diagnosed with localized prostate cancer between 2016-2019 were evaluated retrospectively. Patients who underwent SB and concomitant CTB were recorded. The number of cores taken from the index lesion in CTB, age, prostate-specific antigen (PSA) level, Gleason score, International Society of Urological Pathology (ISUP) grade, Prostate Imaging and Data Reporting System (PIRADS) score, the diameter of index lesion, and digital rectal examination (DRE) findings was recorded. We also studied whether there was a concordance between the localization of the lesion on MRI (magnetic resonance imaging) and the localization of the nodule detected on DRE. Results: Eighty patients were included in the study. csPCa was detected in 55 (68.7%) patients with SB, whereas CTB alone detected csPCa in 35 (43.7%) patients (p<0,01). SB missed 2 patients with csPCa, but 35% of the men with csPCa would be missed by CTB. Detection rates of csPCa in SB and CTB were significantly higher in patients with a concordance between DRE and mpMRI (p= 0.012 and p<0.01, respectively). In patients who had csPCa in CTB, significant differences were detected in the mean age, prostate volume, PSA, lesion diameter, number of cores, and PIRADS score (p=0.005, p=0.02, p=0.005, p=0.003, p=0.017, and p=0.002, respectively) Conclusion: SB maintains its importance in the diagnosis of csPCa. CTB can be preferred in patients with larger lesions. Keywords: Prostate cancer, prostate biopsy, magnetic resonance imaging, targeted biopsy

Objective: Incidental prostate cancer (PCa) is defined as the clinically inapparent tumor detected after transurethral resection of prostate (TURP) or open prostatectomy with benign preoperative rectal examination, prostate specific antigen (PSA) and imaging. The aim of this study is to determine the incidence and clinical significance of incidental prostate cancer in our clinic. Material and Methods: A retrospective analysis was performed in patients who were treated with TURP or transvesical open prostatectomy (TVP) between January 2014 and December 2019. Age, prostate volume, preoperative PSA value, Gleason score, ISUP score, stage and presence of previous prostate biopsy were noted. Treatment performed for incidental PCA was determined. Results: A total of 1020 patients were surgically treated for benign prostate hyperplasia between January 2014 and December 2019. Incidental PCa was diagnosed in 57 (5.6%) patients. 51 (89%) of the patients had TURP and 6 (11%) had TVP. Mean age was 69.9±7.1 years and mean PSA value was 5.3±4.8 ng/ml. Majority of the patients (82.4%) had a Gleason score of 6 (3+3) and 37 (64.9%) patients were reported as stage 1a. Patients with preoperative prostate biopsy have significantly higher prostate volume and PSA values compared to the patients without biopsy (p<0.01). Active surveillance was performed in 42 patients, 2 patients underwent radical prostatectomy, 6 patients had radiotherapy and 7 patients had androgen blockade. Conclusion: We have an incidental PCa rate similar to the literature. Majority of the patients have stage 1a disease and a Gleason score of 6. Most of the patients were managed conservatively. Keywords: incidental prostate cancer, benign prostate hyperplasia, transurethral resection of prostate

The aim of this study is to present our experience on the use of the holmium:yttrium-aluminum-garnet (Ho:YAG) laser in pediatric patients for pediatric urolithiasis and describe the optimal settings. A total of 116 children who underwent urolithiasis treatment (percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS), retrograde intrarenal surgery (RIRS)) were included. The mean age of the patients was 8.4 ± 5.2 years (1–18). The mean follow-up was 26 ± 8.8 months (9–45). There was no difference between the mean stone sizes of PNL and RIRS patients (p = 0.816). Operations were performed with 200, 272, and 365-μm fibers. In mini-URS, stone fragmentation was achieved with the energy settings set between 0.5 and 1 J and frequency set to > 8 Hz. In RIRS, fragmentation was achieved with the setting of 0.5–0.8 J at 10–20 Hz. Stone fragmentation was performed with energy settings of 0.8 to 2 J between 5 and 15 Hz for PNL. There was no significant difference between the stone-free rates of the PNL and RIRS (p = 0.150). Four postoperative complications occurred (Clavien II), which included febrile urinary infections in two patients who underwent mini-URS, one patient who underwent PNL, and one patient who underwent RIRS. Our results confirmed that Ho-YAG laser can be effectively used in children for stone treatment by using low-energy high-frequency settings for URS and RIRS and a high energy setting for PNL.

The present study assessed the results of varicocelectomy in patients with isolated teratozoospermia. Sixty‐two infertile men with isolated teratozoospermia were evaluated retrospectively. There were significant improvements between preoperative and postoperative mean percentages of spermatozoa with normal morphology (1.15 ± 1.1% versus 2.3 ± 1.8%, p < .001) and spermatozoa with head abnormalities (92.9 ± 4.5% versus 88.6 ± 7.4%, p < .001). Nineteen (31%) patients had children through natural conception, 4 (6%) patients had children with assisted reproductive techniques and 39 (63%) patients had got no children within a mean follow‐up period of 31.3 months. In patients who had children with natural conception, significant improvements were detected in postoperative mean percentages of spermatozoa with normal morphology (p < .001), head abnormalities (p < .001), neck/midpiece abnormalities (p = .003) and tail abnormalities (p = .007). When semen parameters of men who had children via natural conception was compared with the men with no children, we found that the percentage of spermatozoa with normal morphology was significantly higher (p = .008) and percentage of spermaztozoa with head anomalies was significantly lower (p = .019) in men who had children via natural conception. We believe that varicocelectomy is a beneficial surgical method for the treatment of isolated teratozoospermia and better postoperative rates of spermatozoa having normal morphology and head abnormalities are related with natural conception.