Mert Hamza Özbilen

Objectives: Large language models (LLMs) are increasingly being used in medical research and as clinical decision-support tools. This study aimed to compare the accuracy and reliability of responses generated by large language models in response to andrology-related questions. Materials and methods: Seventy questions concerning diagnosis, treatment, and general information were developed on the basis of the 2024 Andrology Guidelines of the European Association of Urology (EAU). These questions were submitted to three large language models, namely ChatGPT-4, ChatGPT-4o, and Google Gemini 2.0 Flash. The responses were independently evaluated by three senior urologists using a four-point rating scale. A total score (TS) > 9 indicated a good response, 6 ≤ TS ≤ 9 indicated a moderate response, and TS < 6 indicated a poor response. In addition, the self-correction capabilities of the models were evaluated, and changes in response accuracy after re-evaluation were analyzed. Results: ChatGPT-4o achieved the highest total scores in the diagnosis and treatment categories ( p < 0.001). Google Gemini 2.0 Flash generated the longest responses but demonstrated the lowest accuracy. ChatGPT-4o also showed the greatest improvement following the self-correction process (Cohen’s d = − 1.214, p < 0.01). Fleiss’ kappa coefficient values ranged from 0.61 to 0.80, indicating substantial interrater agreement among the urologists. Conclusion: ChatGPT-4o emerged as the most reliable model for andrology-related questions, providing responses that are were highly consistent with current clinical guidelines. The self-correction capabilities of the models improved response accuracy, suggesting that error-awareness mechanisms in large language models have the potential for further refinement. Nevertheless, expert supervision remains essential for the safe implementation of AI-assisted systems in clinical practice.

Background: Accurate prediction of postoperative complications following radical nephrectomy is of great clinical importance for perioperative risk stratification and patient management. Although several scoring systems are used in urological surgery, there is no widely accepted, procedure-specific risk assessment tool. This study aimed to evaluate the performance of the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), Estimation of Physiologic Ability and Surgical Stress (E-PASS), and its modified version (mE-PASS) in predicting postoperative complications after radical nephrectomy. As a secondary objective, the association between modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI), and neutrophil-to-lymphocyte ratio (NLR), which reflect systemic inflammation and nutritional status, and postoperative complications was also investigated. Materials and methods: A total of 148 patients who underwent radical nephrectomy for renal tumors at our institution between January 2022 and March 2025 were retrospectively analyzed. Patients were divided into two groups based on the presence of postoperative complications. Postoperative complications were assessed according to the Clavien–Dindo classification, and complications of grade ≥ 2 were included in the analysis. Demographic characteristics, comorbidities, preoperative laboratory parameters, surgical variables, and postoperative outcomes were recorded. The predictive performance of the scoring systems was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Results: Postoperative complications were observed in 51 patients (34.5%). The POSSUM score demonstrated the highest predictive performance with an AUC of 0.810, showing high sensitivity (82.4%) and specificity (71.1%). The E-PASS score was also statistically significant but exhibited a more limited predictive performance (AUC: 0.682). In contrast, the mE-PASS score showed markedly lower predictive ability (AUC: 0.599). Patients who developed complications had significantly lower PNI values and higher NLR values ( p < 0.05). Additionally, intraoperative blood loss, tumor size, and length of hospital stay were significantly greater in the complication group ( p < 0.05). Conclusion: POSSUM and E-PASS may serve as useful tools for predicting postoperative complications following radical nephrectomy. However, given their moderate predictive performance and the limitations of the present study, these findings should be validated in larger, prospective, multicenter studies.

Objectives: To evaluate the role of clinical and pathological variables, multiparametric magnetic resonance imaging (mpMRI), and Ga-68-PSMA PET/CT in prediction upgrading in patients who underwent radical prostatectomy (RP) for clinically insignificant prostate cancer (ciPCa). Methods: Patients with The International Society of Urological Pathology (ISUP) grade group(GG) 1 by biopsy (bISUP GG 1) who underwent Ga-68-PSMA PET were reviewed. 38 who did not upgrade after RP were defined as group 1, and 37 who were upgraded after RP were defined as group 2. Results: In patients with bISUP GG 1, the upgrade detection rate of the ISUP GG on RP material was 49.3%. PI-RADS 3, 4, and 5 scores were 71.1%, 18.4%, and 2.6% in group 1, respectively, whereas 51.4%, 18.9%, and 29.7% in group 2, respectively (p = 0.002). Mean index lesion diameter on mpMRI (p = 0.007) were found to be higher in patients who upgraded. The SUVmax detected on Ga-68-PSMA PET/CT was 4.65 in group 1 and 7 in group 2 (p = 0.003). ROC curve analysis provided a cut-off value of 4.6 g/mL for the SUVmax that would predict upgrading. PI-RADS 4-5 lesions on mpMRI (OR: 3.354, 95% CI: 1.124–10.007, p = 0.030) and SUVmax ≥ 4.6 on PSMA PET/CT (OR: 6.113, 95%CI: 1.893–19.875, p = 0.002) were found to be predictors for upgrading in multivariate analysis. Conclusions: Ga-68-PSMA PET/CT was found to be a potentially useful imaging biomarker for predicting pathological upgrading from combined systematic biopsy and mpMRI- targeted biopsy to RP. Advances in knowledge: For patients with ciPCa, there is a high likelihood of risk reclassification if they have PI-RADS 4-5 score and SUVmax higher than 4.6 on Ga-68-PSMA PET/CT.

Background: To question the necessity of simultaneous benign prostatic obstruction (BPO) intervention with cystolitholapaxy in patients with bladder stone (BS) due to BPO and to investigate the factors predicting secondary intervention. Methods: A total of 235 male patients over 40 years of age who underwent cystolitholapaxy, had a follow‐up period longer than 12 months, and were thought to have BS secondary to BPO were included in the study. Results: A total of 190 patients who did not require additional intervention were defined as Group 1, and 45 patients who required secondary intervention were defined as Group 2. Secondary surgical intervention was required at a rate of 19.5% with an average follow‐up of 49 months. Mean peak urine flow rate ( Q _max ) was 11 m/s in Group 1 and 8.6 m/s in Group 2 ( p < 0.001), postvoid residual urine volume (PVR) was 85.5 mL in Group 1 and 115.3 mL in Group 2 ( p < 0.001), International Prostate Symptoms Score (IPSS) was 16.7 in Group 1 and 21.7 in Group 2 ( p < 0.001). Total prostate volume (TPV) ( p = 0.015) and serum prostate‐specific antigen (PSA) ( p = 0.005) were also significantly higher in Group 2. In the multivariable Cox proportional hazards regression analysis of factors predicting secondary intervention in patients undergoing cystolitholapaxy, low Q _max (hazard ratio (HR) = 0.905, 95% confidence interval (CI): 0.821–0.997, p = 0.043), high PVR (HR = 1.014, 95% CI: 1.007–1.022, p < 0.001), high IPSS (HR = 1.178, 95% CI: 1.106–1.255, p < 0.001) and high PSA (HR = 1.086, 95% CI: 1.000–1.178, p = 0.05) were found to be predictors. Conclusions: In patients with BS secondary to BPO, performing cystolitholapaxy offers a high likelihood of avoiding secondary intervention. Low Q _max , high PVR, high IPSS, and high PSA are indicators of a higher risk of secondary intervention in the preoperative period. Therefore, in a patient‐centered approach, these predictors should be taken into account when deciding whether BPO surgery is necessary in addition to cystolitholapaxy.

Objectives The aim of our study was to evaluate the frequency of intervention requirements in inpatient urology consultations and the clinical and demographic factors influencing these decisions. Materials and methods We retrospectively analyzed urology consultations over a one-year period at a large tertiary regional hospital. The timing and location of consultations, indications, procedures performed, and the need for intervention were evaluated. Univariate and multivariate logistic regression analyses were conducted to identify predictors of intervention. Results A total of 1,977 consultations were identified. The most common reasons for consultation were hematuria (18.9%), male lower urinary tract symptoms (18.3%), and obstructive uropathy (14.3%). The majority of consultations originated from the emergency department (59.5%). Urologic interventions were performed in 52.5% of the patients, with the most frequent procedures being urethral catheterization (18.2%), bladder irrigation (7.9%), and suprapubic catheterization (3%). According to the univariate analysis, refugee patients had a significantly higher intervention rate (p = 0.046). In the multivariate analysis, factors independently associated with the need for intervention included consultations initiated from the emergency department, the level of seniority of the evaluating physician, and symptom-based consultation requests (p < 0.001). Conclusion Inpatient urology consultations constitute a significant clinical workload, and a considerable proportion of those requiring intervention involve simple procedures that can be performed by nonurologist healthcare personnel. The high rate of noninterventional consultations reduces service efficiency. Improving triage systems and providing targeted training to healthcare staff may help alleviate this burden.

Background: Data on factors affecting the success of incisional corporoplasty based on the geometric principles in congenital penile curvature (CPC) are limited. Aim: To compare the pubertal status (prepubertal and postpubertal), degree of curvature (<60° and ≥60°), direction of curvature (ventral, dorsal, lateral, ventrolateral), curvature plane (monoplanar or multiplanar) and to investigate the factors affecting success in patients who underwent incisional corporoplasty based on geometric principles due to CPC. Methods: A total of 79 patients who underwent incisional corporoplasty based on geometric principles between 2016 and 2024 in two tertiary care referral centers were evaluated. The surgical technique we apply to our patients is a modification of incisional corporoplasty. This technique is based on the geometric principles of the Egydio technique. Success was defined as complete satisfaction of the patient and/or patient’s parent and absence of recurrence of curvature. Outcomes: Satisfaction, success, complication rates in patients who underwent incisional corporoplasty based on geometric principles due to CPC and comparison of these patients in terms of the pubertal status (prepubertal and postpubertal), degree of curvature(<60° and ≥60°), direction of curvature (ventral, dorsal, lateral, ventrolateral), curvature plane (monoplanar or multiplanar). Results: The success rate in our study was found to be 82.2% and the total complication rate was determined as 26.5%. The success rate was 90.5% in patients in the prepubertal period, and 79.3% in patients in the postpubertal period (P = 0.331). Success occurred 82% of patients with a curvature <60°, while this rate was 82.8% in patients with a curvature of ≥60° (P = 0.396). Success was found to be 75% for multiplanar curvature and 83.1% for monoplanar curvature (P = 0.626). In regression analysis, it was found that age (P = 0.185), puberty status (P = 0.263), degree of curve (P = 0.770), direction of curve (P = 0.927), presence of multiplanar curve (P = 0.573) and operation time (P = 0.924) did not affect success. According to Kaplan–Meier analysis the P-values ​​for puberty status, degree of curvature, curvature plane and curvature direction were found to be 0.575, 0.720, 0.845, and 0.819, respectively. Clinical implications: Modification of incisional corporoplasty based on the geometric principles of the Egydio technique is an effective method in patients with CPC, regardless of age and curvature characteristics. Strengths and limitations: The lack of a group to compare this technique with other techniques, small sample size, the retrospective design of the study, the results being based on patient-reported results. The results discussed may cause bias because they are based on patient reports and do not include standard questionnaires. Conclusions: The geometrically modified incisional corporoplasty technique has a high success rate in patients with CPC up to 90°, regardless of the patient’s age, pubertal status, degree of curvature, direction, and whether it is multiplanar or not.

Purpose: To compare the external validation of four existing scoring systems for encrusted ureteral stents (EUS) and their relationship with stent indwelling time, stone-free rates, multiple surgery sessions, multimodal procedures, and prolonged operation times exceeding 120 minutes in total.

Kidney stone disease is relatively uncommon in pediatric populations, although its incidence has been steadily increasing in endemic regions. Mini-percutaneous nephrolithotomy (mini-PCNL), considered the most suitable approach for the treatment of large kidney stones, offers a minimally invasive option with fewer complications. This study evaluates the predictive accuracy of the STONE, Guy’s Stone Score, and stone-kidney size (SKS) scoring systems in determining stone-free rates following pediatric mini-PCNL procedures. In this retrospective analysis, data were reviewed from 79 individuals younger than 18 who received mini-PCNL treatment from January 2021 to June 2024. Patients were evaluated as residual group and stone-free group. The diagnostic performance of the nomograms in detecting residual stones was evaluated using ROC analysis, and predictive factors for stone-free success were identified through logistic regression modeling. Guy’s score (cut-off 1.5) had 79.3% sensitivity, 70% specificity, and AUC 0.817. The STONE score (cut-off 5.5) showed 69% sensitivity, 68% specificity, and AUC 0.741. SKS score (cut-off 3.5) resulted in 62.1% sensitivity, 78% specificity, and AUC 0.768. Logistic regression found stone size (OR: 1.137, p < 0.001) and volume (OR: 1.001, p < 0.001) were linked to stone-free success. Guy’s score (OR: 5.438, p < 0.001), STONE score (OR: 1.741, p < 0.001), and SKS (OR: 3.972, p < 0.001) were strong predictors, but in multivariate analysis, only Guy’s score (OR: 3.701, p = 0.010) remained significant. The results of our study demonstrate that the Guy's stone score is the most reliable prognostic tool for predicting stone-free success in pediatric patients undergoing mini-PCNL. Moreover, variables such as stone size and volume exert a substantial influence on the surgical outcomes.

Erectile dysfunction (ED) and coronary artery disease (CAD) frequently coexist, sharing common risk factors and pathophysiological mechanisms. The frontal QRS-T angle (fQRSTa), a novel electrocardiographic marker reflecting ventricular depolarization-repolarization heterogeneity, has been linked to adverse cardiac outcomes. However, the combined prognostic value of ED and fQRSTa in predicting CAD severity remains unexplored. The aim was to investigate whether the coexistence of ED and widened fQRSTa is associated with increased CAD severity, and to evaluate their individual and combined utility in identifying patients with advanced CAD. This prospective observational study included 236 male patients undergoing first-time coronary angiography for suspected CAD. Patients were stratified into 4 groups based on ED status (International Index of Erectile Function-5 [IIEF-5] ≤21) and fQRSTa (cutoff: 52.5°). Coronary artery disease severity was assessed using the Gensini and SYNTAX scores. Hierarchical regression and correlation analyses were performed to evaluate associations. Erectile dysfunction prevalence was 62.7%, and patients with both ED and high fQRSTa exhibited significantly reduced ejection fraction and the highest Gensini and SYNTAX scores (all P < .001). Regression analyses demonstrated that ED (β = 11.927, P = .009, 95% CI: 2.014-21.839), high fQRSTa (β = 9.906, P = .012, 95% CI: 2.710-22.523), and their interaction (β = 17.233, P = .028, 95% CI: 1.906-32.560) were independent predictors of higher Gensini scores after full adjustment. Similar results were observed for SYNTAX scores. A moderate inverse correlation was found between IIEF-5 and fQRSTa (r = -0.436, P < .001). Erectile dysfunction and widened fQRSTa are independently and synergistically associated with more severe CAD. Their coexistence identifies a high-risk subgroup with pronounced angiographic abnormalities.