Alkan Cubuk

Background and Objectives: In this study, we aimed to compare the effects of 4.8 F and 6 F JJ stents on irritative symptoms and success rate in patients with a preoperative JJ stent prior to RIRS. Materials and Methods: A total of 316 patients who underwent JJ stent implantation prior to retrograde intrarenal surgery were retrospectively analyzed. Patients were classified into Group 1 (4.8 F stent) and Group 2 (6 F stent) based on stent diameter. Urinary symptoms prior to the insertion of the JJ stent and the day before RIRS were evaluated using the Quality of Life (QoL) score (VAS), International Prostate Symptom Score (IPSS), and Visual Analog Scale. The groups were compared in terms of demographic data, stone characteristics, perioperative data, length of stay, complications, stone-free rates (SFRs) and change in total VAS score, IPSS and QoL. Results: The patients’ demographic data and the stone characteristics of the two groups were similar. There was no statistical difference between groups in the SFR, length of stay, or total complication rates (p = 0.5, p = 0.159, and p = 0.13, respectively). Operation time was similar between the groups (p = 0.13). Although the change in total VAS scores was similar between the two groups (p = 0.1), QoL was higher in Group 1 compared with Group 2 (p < 0.001). Group 2 demonstrated worse outcomes in total IPSS, as well as in the storage subscores (Q2, Q4, and Q7) and voiding symptom subscores (Q1, Q3, Q5, and Q6), with all comparisons showing statistical significance (p < 0.001 for each). Conclusions: Varying calibers of JJ stents have comparable success rates and complication outcomes. However, when the stent caliber is reduced, patients experience better QoL and fewer lower urinary tract symptoms. Smaller-diameter stents were associated with significantly better symptom-related outcomes without compromising surgical success.

Introduction and Hypothesis The objective was to compare the outcomes of dorsal and ventral onlay urethroplasties using buccal mucosal grafts for the treatment of urethral strictures in women, focusing on patency, complications, de novo incontinence, and impact on sexual function. Methods A retrospective analysis was conducted on 65 patients who underwent dorsal (n = 38) and ventral (n = 27) onlay female urethroplasty using a buccal mucosal graft between July 2017 and January 2024 across three centers. Patency was determined by the successful passage of a 16-French cystoscope or by a maximum flow rate exceeding 15 ml/s. Results Median age, etiology, and stenosis characteristics of the two groups were comparable. At the final follow-up, the patency rates for dorsal and ventral onlay female urethroplasty were 92.1% and 92.6% respectively (p = 1.0). There was no significant difference in postoperative maximum flow rates, postvoid residual urine, Female Sexual Function Index scores, Patient Global Impressions of Change scores, and de novo incontinence rates between the groups. The median blood loss was significantly lower in the ventral onlay group than in the dorsal onlay group (10 vs 20 ml, p = 0.001). Conclusions Dorsal and ventral onlay urethroplasties with buccal mucosal graft are safe and effective techniques for managing female urethral stricture, with similar patency, complications, de novo incontinence rates, and improvements in sexual function. Ventral onlay female urethroplasty has been associated with reduced intraoperative bleeding. To the best of our knowledge, this study represents the largest individual comparative cohort in the literature that directly evaluates dorsal and ventral onlay female urethroplasty.

Purpose: Our aim was to assess the efficacy and safety of Rezum therapy in patients with symptomatic benign prostatic hyperplasia (BPH) in comparison to Holmium laser enucleation of the prostate (HoLEP). Methods: The retrospective study included 338 patients (204 HoLEP and 134 Rezum) operated on for BPH between January 2020 and November 2024. A 1:1 matching of treated patients (Rezum) to HoLEP patients based on the closest propensity score value was conducted for 131 successful matching pairs. The groups were compared regarding; Age, Prostate volume, PSA, Catheter-dependence, Qmax, PVR, IIEF, IPSS, PGI-I, operation time (OT) and hospital time (HS). Results: Concerning perioperative data, there was a statistically significant difference between the Rezum and HoLEP groups regarding OT (8.29 ± 1.21 vs. 68.01 ± 31.01 min; P < 0.001) and HS (1 vs. 2.61 ± 1.53 days; P < 0.001) with higher values for HoLEP. At the same time, the catheter duration was longer in the Rezum group (7.6 ± 2.19 vs. 3.49 ± 1.16 days; P < 0.001). In terms of clinical outcomes, there was a statistically significant improvement in Qmax, IPSS and a decrease in PVR at 12 months for the HoLEP group compared to the Rezum group (16.82 ± 2.27 ml/sn vs. 22.14 ± 7.17 ml/sn, P < 0.001; 12.1 ± 2.1 vs. 7.1 ± 1.9, P < 0.001; 43.05 ± 32.62 ml vs. 29.73 ± 43.73 ml, P = 0.006; respectively). PGI-I scores ( p = 0.620) and antegrade ejaculation ( p < 0.001) were in favour of Rezum therapy. Conclusion: The HoLEP technique demonstrates superior functional outcomes compared to Rezum, particularly in cases with larger prostates. However, Rezum is an ejaculation-sparing technique demonstrating high tolerability, and patient satisfaction even in larger prostates.

Backgrounds This study aims to describe and evaluate outcomes of transurethral surgery-natural orifice transluminal endoscopic surgery (TUS-Notes) technique in patients treated with transurethral excision of vesico-urachal diverticula (VD). Methods Patients who underwent TUS-Notes following transurethral VD excision due to recurrent urinary tract infection (rUTI) since 2013 were included in this prospective non-randomized cohort study. Under cystoscopic guidance VD and surrounding bladder wall was resected until the fatty tissue using monopolar resectoscope. The specimen was removed with a grasper through the cystoscope. TUS-Notes technique was performed with Minimal Suturing Device (MSD-Ney®). The needle of the suture was shaped according to suturing position and loaded into MSD-Ney. They were inserted into the bladder under cystoscopic guidance transurethrally. Once the defect was sutured properly, an extracorporeal knot was prepared and tied. The length of the operation (LOO), and perioperative complications according to the Clavien–Dindo grading system were noted. The integrity of the bladder was checked with cystography to assess objective cure. Subjective cure was evaluated with Patient Global Impression of Improvement (PGI-I) scale. Results The follow-up period of 65 participants varied from three months to eight years. The median LOO was 37 min. A Clavien grade-3 complication was observed in one patient. Peroperative failure was not noted. The median duration of hospital stays, and catheterization time was three days. Objective cure rate and subjective cure rates were 100%. UTI was not noted after surgery. Conclusions Transurethral complete excision of VD is an acceptable technique to prevent rUTI. The TUS-Notes technique provides a successful minimal invasive treatment option for the treatment of bladder defects. Concise Transurethral suturing of urinary bladder.