Yusuf Ozlem Ilbey

Objective : This narrative review evaluates current evidence regarding the impact of paternal selective serotonin reuptake inhibitor (SSRI) use on male fertility parameters and neonatal outcomes. Material and Methods: A comprehensive search of PubMed/MEDLINE and Web of Science databases was conducted for studies published up to December 2025. Out of 132 screened records, 13 studies investigating common SSRIs (e.g., sertraline, citalopram, escitalopram, fluoxetine, paroxetine, fluvoxamine) and newer agents (vortioxetine, vilazodone) were included in the narrative synthesis. Results: Evidence indicates that SSRIs may cause transient impairments in sperm motility, morphology, and DNA integrity, which are generally reversible following treatment discontinuation. Large-scale cohort studies demonstrate no significant association between paternal SSRI use and major congenital malformations, low Apgar scores, or small-for-gestational-age (SGA) births. While a modest increase in preterm birth risk was noted, this is likely attributable to confounding by the underlying paternal psychiatric condition rather than direct pharmacological exposure. Similarly, associations with neurodevelopmental outcomes, such as Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD), are more likely explained by paternal psychiatric conditions rather than direct drug exposure. Conclusion: Paternal SSRI use does not appear to pose a significant risk to clinical fertility or offspring health. Given the transient nature of semen abnormalities, treatment should be tailored individually to balance psychiatric stability and reproductive goals.

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.

Aim: Incidentally diagnosed renal cancers have increased with the increase in imaging modalities. Incidentally diagnosed masses are smaller in size and there are conflicts in the management of these 3,259 masses. Active surveillance (AS) and surgery are the treatment options. In our study, we aimed to compare the data of patients who underwent these two methods. Methods: The data of 34 patients who underwent AS and 89 patients who underwent surgery were retrospectively analyzed. AS patients were defined as Group 1 and surgical patients as Group 2. Treatment options were determined according to tumor characteristics, patient age, comorbidities, and surgical risks. The Eastern Cooperative Oncology Group (ECOG) performance score and the Charlson Comorbidity Index (CCI) were used to assess comorbidity in each patient. AS patients were offered surgical treatment when their tumors reached > 4 cm in maximal diameter or had rapid tumor growth rates. Results: The mean patient age was 74.06 ± 6.78 in Group 1 and 58.82 ± 7.60 in Group 2 (P < 0.001). The ECOG performance score was > 1 in all patients in Group 1, while the rate of ECOG > 1 was 59.6% in Group 2 (P < 0.001). CCI was 8.09 ± 0.75 in Group 1 and 3.94 ± 1.14 in Group 2 (P < 0.001). Mortality rates developed in 10 (29.4%) patients in Group 1 and 3 (3.4%) patients in Group 2. Regarding 5- and 10-year cancer-specific survival (CSS), the 5-year survival rate was 81.1% in Group 1 and 97.7% in Group 2, and the 10-year CSS was 63.2% in Group 1 and 89.5% in Group 2, which was statistically higher in Group 2 (P : 0.0022). Conclusion: Although AS has worse outcomes than surgery in terms of CSS, it is a recommended option for patients with older age and poor performance scores.

Purpose: To assess the impact of the The Controlling Nutritional Status (CONUT) score, an indicator of nutritional status, on the survival and prognosis after radical cystectomy. Materials and Methods: The medical records of patients who underwent consecutive radical cystectomy operations with the diagnosis of muscle-invasive bladder cancer at our clinic were retrospectively examined. The patients were separated into two groups based on the cut-off CONUT score which was derived using the receiver operating characteristic (ROC) curve. The group with a CONUT score >= 3 was categorized as high CONUT, whereas the group with a CONUT score < 3 was categorized as low CONUT. The groups were compaired according to oncological outcomes and survival risk factors. Results: Cancer-specific survival (CSS) and overall survival (OS) were statistically significantly lower in the High CONUT group compared to the Low CONUT group (p < 0.001, p = 0.024, respectively). Age (HR: 1.02, 95% CI: 1.006-1.04, p = 0.011) and CONUT score (HR: 3.92, 95% CI: 2.66-5.77, p < 0.001) were revealed to be independent prognostic variables in the multivariate analysis for OS. Conclusion: The CONUT score was found to be an independent predictor of survival in patients with muscle-invasive bladder cancer in this study.

To compare 5 published scoring systems (Fournier gangrene severity index [FGSI], Uludag FGSI [UFGSI], age-adjusted Charlson Comorbidity Index [ACCI] and the Quick Sequential Organ Failure Assessment (qSOFA) and the Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) scores and to evaluate risk factors for outcome prediction in patients with Fournier gangrene (FG). Between 2010 and 2024, 311 patients were included in the study. The data of 276 survivors and 55 non-survivors were compared. Univariate and multivariate analyses were performed to determine which of the 5 scoring systems calculated according to demographic, laboratory and clinical data predicted mortality better. In addition, a cut-off value for these scoring systems was determined by ROC analysis. The mortality rate was 17.6% in FG patients. In all 5 scoring systems, univariate analyses showed higher values in non-survivor patients, while UFGSI and FGSI scoring systems were superior to other scoring systems in multivariate analyses (p < 0.001). ROC analysis using mortality-based sensitivity and specificity revealed that the optimal cut-off values for FGSI, UFGSI, ACCI, SOFA and LRINEC should be equal to or higher than 10, 12, 4, 2 and 8, respectively. UFGSI and FGSI scores had the highest AUC values among all scores. This was followed by ACCI, qSOFAand LRINEC. For a UFGSI score ≥ 12, the sensitivity was 84%, specificity 97%, PPV 85% and NPV 97%. Among the scoring systems used to predict mortality, UFGSI was the most accurate, while LRINEC was the least accurate.

Objective: In patients who underwent percutaneous nephrolithotomy (PNL),it was aimed to determine the accuracy of the surgeon’s intraoperative stone-free status (SFS) prediction, the factors affecting it, the predictors that cause incorrect estimation, and finally to evaluate the reliability of the “surgeon’s eye”. Material and Methods: The data of 1025 patients who underwent PNL and met the inclusion criteria were evaluated retrospectively. Since the basis of our study was based on the evaluation of the surgeon’s stone-free prediction, patients identified as “absence of residual stone fragment (RF)” by the surgeon were grouped and compared with postoperative computed tomography imaging according to the presence of RF. Results: Sensitivity, specificity, positive predictive value and negative predictive value were calculated as 67.87%, 96.23%, 91.67% and 83.04%, respectively. In our study, it was found that the “surgeon’s eye” predicted SFS incorrectly at a rate of 16.9%. There was no statistically significant relationship between gender,- stone side,stone density and hemoglobin decrease between the two groups. Stone size,operation time, fluoroscopy time, location of the stone,number of stones in the calyces and GUY’s stone score (GSS) were found to be statistically significant in relation to the “surgeon’s eye”. As a result of multivariate logistic regression analysis stone size, number of stones in the calyces and GSS were significant predictors of the parameters that had a statistically significant relationship with the surgeon’s eye. Conclusion: The most important determinants of “surgeon’s eye” in PNL were stone size,number of stones in the calyces and GSS. These predictors can be used as an effective criterion in the use of methods to reduce radiation exposure in postoperative imaging of patients who are predicted to be stone-free.

Purpose To compare the efficacy and safety of gradual dilation (GD) and one-shot dilation (OSD) techniques in patients who underwent supine percutaneous nephrolithotomy (PCNL). Methods The data of 176 patients who underwent supine PCNL were reviewed. Eighty-seven patients who underwent OSD were defined as group 1, and 89 patients who underwent GD were defined as group 2. Both surgical techniques were compared with each other in terms of various parameters. Then, regression analysis of factors predicting stone-free status and complications in patients who underwent supine PNL were performed. Then, regression analysis of factors predicting success rate and complications in patients who underwent supine PNL were performed. Results No statistical difference was found in terms of stone-free rate, Clavien–Dindo complication grade and operation time. No statistical difference was found in terms of success rate, Clavien–Dindo complication grade and operation time. However, the fluoroscopy time was found to be significantly shorter in group 1 (p < 0.001). In the analysis of factors predicting stone-free status, the presence of calyceal stones, increased stone size and number were associated with a decrease in stone-free rate. In the analysis of factors predicting success, the presence of calyceal stones, increased stone size and number were associated with a decrease in success rate. Increased fluoroscopy and operation time, increased complication rates were found to be significantly associated with residual stone. Analysis of factors predicting complications found a higher complication rate in patients with low BMI and severe hydronephrosis. Increased complication was associated with increased time to nephrostomy removal and hospital stay, decrease in stone-free rate, decrease in Hb and increase in Cre value at the postoperative 24th hour. Conclusion When comparing OSD and GD in patients undergoing supine PCNL, both techniques have similar stone-free and complication rates. When comparing OSD and GD in patients undergoing supine PCNL, both techniques have similar success and complication rates. Compared to GD, the OSD technique can be preferred primarily due to its shorter fluoroscopy time.