Atilla Semercioz

Background: Bladder cancer is the sixth most common cancer in males. Bacillus Calmette-Guerin (BCG) immunotherapy, the standard for non-muscle-invasive bladder cancer (NMIBC), effectively reduces recurrence and progression. This study examines the impact of intravesical BCG therapy on semen parameters, focusing on hormonal profiles and sperm quality. Results: This prospective study included 23 sexually active males diagnosed with NMIBC receiving intravesical BCG therapy. Semen analyses were performed prior to treatment and three months following the induction course. Hormonal profiles, comprising total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL), were evaluated. Patients underwent six weekly instillations of 80 mg/ml SII-ONCO-BCG®, commencing four weeks post-TUR-B surgery. Data from clinical, radiological, and laboratory sources were gathered for analysis. Post-treatment evaluation indicated a significant reduction in sperm concentration, total sperm count, progressive motility, and normal morphology (p < 0.05), alongside a notable increase in the percentage of immotile sperm. LH and PRL levels remained stable despite these changes, while FSH levels exhibited a significant increase (p < 0.05). Conclusion: BCG therapy adversely affects sperm quality, leading to a marked decrease in sperm concentration, total sperm count, progressive motility, and normal morphology. The findings underscore the potential gonadotoxic effects of BCG, necessitating fertility counseling prior to treatment initiation, especially in younger patients. Semen cryopreservation should be regarded as a preventive strategy. While BCG is considered the gold standard for NMIBC treatment, additional long-term studies are necessary to evaluate the reversibility of its effects and to investigate alternative intravesical therapies that present lower reproductive risks.

Introduction The safety of simultaneous transurethral resection of the prostate (TUR-P) and bladder tumor removal in patients with benign prostatic hyperplasia (BPH) and bladder cancer remains unclear. The purpose of this study is to find out how TUR-P affects the recurrence, progression, and prostatic urethral invasion in patients with NMIBC (non-muscle invasive bladder cancer) and BPH. Materials and methods We performed a retrospective analysis of bladder cancer patients treated between 2010 and 2023. Among them, 49 patients received either TUR-P alone or in conjunction with transurethral bladder tumor resection (TUR-B), while an additional 49 patients comprised the control group. We examined recurrence, progression, and invasion of the prostatic urethra. Statistical analyses included independent t-tests, Kaplan–Meier analysis, and Chi-square testing, with significance set at p < 0.001. Results No significant difference in recurrence was observed between the control (73.5%) and TUR-P (65.3%) groups (p = 0.769). Progression was observed in 6.1% of the control group and 4.2% of the TUR-P group (p = 0.663). In the TUR-P group, one patient (2%) had prostatic urethral invasion; however, none in the control group did (p > 0.05). The recurrence rates increased more rapidly in the control and TUR-P-only cohorts than in the TUR-P + TUR-B cohort. Conclusion Transurethral resection of the prostate in NMIBC patients with BPH is safe and does not result in increased recurrence, progression, or invasion of the prostatic urethra. This technique reduces bladder outlet obstruction without significantly impacting oncologic outcomes. Large-scale, multicenter, prospective studies are required to validate these findings and further evaluate the long-term oncologic and functional outcomes of this combined surgical approach.

Ulus I, et al. Investig Clin Urol. 2025 Jun;66:e41. https://doi.org/10.4111/icu.20250124

Purpose The aim of this study is to investigate the results and safety of retrograde intrarenal surgery (RIRS) in patients who have previously undergone percutaneous nephrolithotomy (PCNL). Methods A retrospective analysis included patients who underwent RIRS for kidney stones between August 2018 and April 2023. Group 1 comprised 396 patients who underwent primary RIRS, while Group 2 included 231 individuals who had RIRS after previous PCNL. Evaluation parameters included preoperative characteristics, stone attributes, operative details, treatment outcomes, stone-free status, and complications. Statistical analysis utilized Student’s t test, Mann–Whitney U test, and Pearson Chi-square test (p < 0.05). Results The mean age, body mass index, stone number, mean stone burden, and SFS were not statistically different between the groups. Lower pole stones were identified in 144 patients in Group 1 and 88 patients in Group 2 (p = 0.315). In Group 1 and Group 2, the mean operation time and fluoroscopy time were 65.23 ± 18.1 min, 81.32 ± 14.3 min, 26.34 ± 8.31 s, 46.61 ± 7.6 s, respectively, showing statistically significant differences between the groups (p = 0.013, p < 0.001, respectively). Infundibulum stenosis was identified and treated with a laser in 12% of Group 2 cases. Complications occurred in 12 patients in Group 1 and 14 patients in Group 2 (p = 0.136). Conclusion A history of PCNL may contribute to extended operation times and increased fluoroscopy exposure in subsequent RIRS without significantly affecting postoperative SFS or complication rates.

(1) Background: Standard semen analysis methods may exhibit variability between observers and/or human error; therefore, additional methods are needed to overcome these handicaps. We aimed to present a new smartphone-applied semen analyzer, Sperm Cell™, investigate its diagnostic efficacy by comparing it with the standard analysis method, and determine its user-friendly nature. (2) Methods: A cross-sectional study was conducted on a large sample cohort, including 102 men. Three semen analyses were performed for each semen sample. The first employed the standard manual method, whereas the others were smartphone-based analyses performed by technicians and patients. We compared major semen parameters between the three semen analyses. The user-friendly nature of the analyzer was also evaluated with a mini-questionnaire completed by the participants. (3) Results: The determined median sperm count, motile sperm count, and percentage of motile sperms, on standard manual semen analysis, were 50.00 × 10⁶/mL (0–160 × 10⁶/mL), 23.94 × 10⁶/mL (0–108 × 10⁶/mL) and 50.00% (0–73.00%), respectively. Median sperm count and motile sperm count were 50.52 × 10⁶/mL (6/mL) vs. 55.77 × 10⁶/mL ( 0.05 for each). The SpermCell™ analysis results were correlated with the standard manual method with up to 0.85 correlation coefficients. Moreover, substantial diagnostic accuracy, sensitivity and specificity were obtained in determining the oligospermia and asthenozoospermia via the device-based analyses performed by technician and patients. The mini-questionnaire results revealed that the analyzer is useful. (4) Conclusions: The novel smartphone-applied semen analyzer is a helpful tool with acceptable diagnostic accuracy in determining the major semen parameters. It can be used as an efficient at-home point-of-care testing method in the initial assessment of couples with infertility concerns.

Objectives: Glucagon like peptide-1 (GLP-1) is a hormone released from intestinal L-cells following nutrient consumption. It potentiates secretion of insulin from pancreatic beta-cells thus GLP-1 analogues are used for the treatment of type-2 diabetes mellitus( T2DM). This study aims to evaluate impact of GLP-1 receptor agonist liraglutide on erectile function of diabetic rats. Methods: Male Sprague-Dawley rats (n = 30, 13-weeks old, 240-335 gr) were fed with fatty diet for 2-weeks and divided into 3 groups (n = 10 each). The rats in the first group served as controls (Group C) whereas the rats in the remaining two groups were injected with streptozocin and became T2DM for forming diabetic group (Group D) and treatment group (Group DT). Rats in group D received citrate buffer injections whereas rats in the group DT received liraglutide injections (0.3 mg/kg/12h) subcutaneously. Erectile functions of all rats were evaluated with intracavernosal pressure (ICP)/mean arterial pressure (MAP) measurements. Moreover, plasma sex hormone levels (Testosterone, FSH, LH) were measured and histological assessment of midpenile tissue were performed (Collagen-Type-IV, rat epithelial antigen-1, nNOS). Results: Maximum ICP/MAP ratios were 0.790 ± 0.164, 0.263 ± 0.139 and 0.652 ± 0.131 in Group C, Group D and Group DT. Although mean ICP/MAP ratios were similar in Group C and Group DT (p = 0.076), mean ICP/MAP ratio was significantly lower in Group D (p < 0.001). Testosterone and FSH results were significantly lower in the Group D as well (p = 0.001). Histological analyses revealed that nNOS (p < 0.001), rat epithelial antigen-1 (p = 0.016) and muscle/collagen ratio (p = 0.015) were also lower in Group D, compared with the other groups. Conclusions: GLP-1 receptor agonist liraglutide demonstrated protective effects on the erectile tissues of the diabetic rats. Clinical trials are required to confirm if liraglutide treatment has similar beneficial effects on men who have T2DM.

Objective: Not only the frequency of surgery for small renal masses has increased secondary to the improvements and frequent use of imaging techniques but also the frequency of detection of benign lesions in nephrectomy specimens has increased as well. We aimed to assess the predictive value of computed tomography density of perirenal adipose tissue and peritumoral adipose tissue in distinguishing between benign and malignant renal masses. Materials and Methods: The current study included 116 patients who underwent nephrectomy for renal masses between January 2015 and December 2020. Clinicodemographic and preoperative computed tomography features and final pathological findings of the patients were recorded. According to the final pathological results, the patients were divided into 2 groups benign (n = 32) and malignant (n = 84). Groups were compared statistically in terms of perirenal adipose tissue and peritumoral adipose tissue density. Results: The median tumor size was 5.00 cm. The rate of benign tumors was higher in female patients (P = .005). The median peritumoral adipose tissue density among cT1 and cT1a tumors was higher in the malignant group (P < .001, for each). At a cutoff value of 97.50 Hounsfield Units, the peritumoral adipose tissue density had a sensitivity of 83.0% and a specificity of 79.2% for predicting the presence of malignant tumors in ≤7 cm renal masses. Using a cutoff value of −97.50 Hounsfield Units, the peritumoral adipose tissue density had a sensitivity of 88.9% and a specificity of 83.3% for predicting the presence of malignant tumors in ≤4 cm renal masses. Conclusion: The peritumoral adipose tissue density in the preoperative computed tomography images predicts the malignancy in cT1 renal masses. Cite this article as: Sahin Y, Aygan S, Hacibey I, et al. Peritumoral adipose tissue density predicts the malignancy in cT1 renal masses. Urol Res Pract. 2023;49(3):191-197.

Background/Aim: Several blood and serum-based parameters have been described as prognostic markers of clear cell renal cell carcinoma (ccRCC). But most of these markers have inconsistent results and are not used in routine clinical practice. Therefore, novel potential predictor biomarkers are needed for the management of ccRCC patients in clinical practice. Here, we investigate the predictive value of a novel marker, serum C-NLR score, for pathological characteristics and oncological outcomes of ccRCC. Methods: A total of 162 RCC patients who underwent radical or partial nephrectomy between January 2015 and January 2021 were evaluated in a retrospective cohort study setting. The serum C-NLR score was compared according to the tumor histopathology-associated parameters. The predictive role of those parameters and C-NLR score on the oncological outcomes of ccRCC was also investigated. Results: The median serum C-NLR scores exhibited statistically significant increases in ccRCC patients with pathological necrosis, lymphovascular invasion, and variant differentiation. Among histopathological characteristics, only tumor necrosis and variant differentiation were associated with overall survival (OS) and tumor grade with metastasis-free survival (MFS) (no metastasis detected in grade 1–2 tumors) in Kaplan Meier analyses. Serum C-NLR score was also associated with OS but not MFS. In the univariate analyses, tumor necrosis, variant differentiation, and C-NLR score were associated with OS of localized RCC patients who underwent nephrectomy (HR: 0.29; 95% CI: 0.08–1.01; P=0.04, HR: 6.01; 95% CI: 1.66–21.82; P=0.006 and, HR: 1.21; 95% CI: 0.20–5.16; P=0.04). However, in the multivariate analysis, only variant differentiation and C-NLR score were associated with OS (HR: 1.43; 95% CI: 0.82–2.98; P=0.03 and HR: 1.21; 95% CI: 0.20–5.16; P=0.04). Tumor grade was directly associated with MFS because grade 1–2 tumors did not exhibit any metastasis. Conclusion: Serum C-NLR score was higher in worse histopathological entities. Moreover, it predicts the OS for patients with ccRCC as an independent factor.

Although the efficacy of extracorporeal shock wave lithotripsy (ESWL) has been well established within the literature, debate continues on the safety of the procedure while focusing on cellular injury and its long-term consequences. Here, we describe the role of neutrophil elastase (NE) in ESWL-related rat kidney damage and investigate the protective effects of sivelestat, an inhibitor of NE, during the early and late phases. Four groups including control, ESWL alone, ESWL with sivelestat 50 mg/kg and ESWL with treatment of 100 mg/kg, each consisting of ten rats were created. Biochemical parameters of kidney function and damage and immunohistopathological findings were compared in the early (72 h after ESWL) and late (1 week after ESWL) periods between the groups. During the early period, serum and urine creatinine levels and urine kidney injury molecule-1 (KIM-1) levels and the KIM-1/creatinine ratio increased in rats treated with ESWL compared to the control group. Furthermore, increased tissue inflammation, ductal dilatation and hemorrhage, and glomerular, tubular, and interstitial damage with increased NE staining were also detected in the ESWL treatment group. During the late phase, although urine KIM-1 levels remained stable at high levels, other parameters showed significant improvements. On the other hand, the administration of sivelestat 50 mg/kg decreased serum creatinine and urine KIM-1 and KIM-1/creatinine levels significantly in rats treated with ESWL, during the early and late periods. Significant decreases in tissue inflammation, tubular, and interstitial tissue damage were also observed during the early period. In conclusion, ESWL-related kidney tissue damage occurs primarily during the early period, and NE is involved in this process. On the other hand, the NE inhibitor sivelestat attenuated this ESWL-induced kidney damage.