Fatih Gevher

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.

Objective: To assess the effectiveness and safety of laparoscopic partial nephrectomy (LPN) in T1a and T1b renal tumors using “Trifecta” in partial nephrectomy and determine the predictive factors in respect to the criteria that constitute Trifecta. Materials and Methods: We retrospectively analyzed the data harvested from the patients who underwent LPN for T1a or T1b tumors. Preoperative, perioperative, and postoperative outcomes were evaluated and analyzed. Patients who had grade 15% decrease in eGFR after surgery. Complications were observed in 11 (8.6%) patients. A total of 78 (60.9%) patients had strict trifecta outcomes. Tumor size was found to be a predictive factor affecting Trifecta at multivariate analysis. Conclusions: LPN procedure has been shown to demonstrate improved strict Trifecta outcomes in patients with T1a and T1b renal tumors. Only the tumor size was found to be a predictive factor regarding the Trifecta criteria.

Background: Scoring systems (SS) are useful to inform the patients about the success and complication rates of the operation prior the surgery.Aims: We aimed to determine the applicability of the popular SS (Guy’s, S.T.O.N.E and CROES) by means of examining preoperative data of patients treated with percutaneous nephrolithotomy (PNL).Study Design: Cross sectional.Methods: We retrospectively reviewed files of the patients who had undergone PNL in our center between 2011 and 2015. Excluded from the study were patients aged < 18 years, and those who were not assessed preoperatively with computed tomography (CT). Preoperative CT images of all patients were assessed by a single observer (MT), and patients were graded based on three SS. Demographic data were analyzed along with perioperative data (operation, fluoroscopy, length of hospital stay, changes in hematocrit values, location, and number of access sites, stone-free and complication rates).Results: A total of 298 patients who had been treated with 300 procedures were enrolled into the study. Mean age, stone burden, number of stones, and density were 48.1±12.9 years, 663.5±442.8mm2, 1.8±1.1 and 888.3±273 HU respectively. Scores of the cases based on Guy’s, S.T.O.N.E, and CROES SS were calculated as 2, 7.6, and 222,1 points respectively. 81.6% of the patients were stone-free. Complications were detected in 30 (9.9%) patients. Based on ROC curve analysis a positive correlation was detected between success rate and scoring systems, i.e., Guy’s (p:<0.001, r:-0.309), S.T.O.N.E. (p:<0.001, r:-0.295), and CROES (p:<0.001, r:0.426). The CROES scoring system had the highest predictive value. The sensitivity rates rates for Guy’s, Croes and Stone SS were as 78.78%, 80% and 82.34% respectively.Conclusion: Our results show that all of SS predicted correctly the success of the PNL procedures. The CROES scoring system had the highest predictive value.