Ergun Alma

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.

Background: Erectile dysfunction (ED) is a prevalent condition, with vasculogenic ED being the most common subtype, primarily related to endothelial dysfunction and cardiovascular risk factors. Low-intensity extracorporeal shock wave therapy (Li-ESWT) has emerged as a promising non-invasive treatment option. However, predictors of treatment response remain poorly defined. Aim: To identify clinical and vascular predictors of treatment success following Li-ESWT in patients with vasculogenic ED and to develop a novel, practical, and non-invasive scoring system to predict therapeutic response. Methods: This prospective study included 219 men aged 18-80 years with vasculogenic ED between January 2024 and January 2025. All patients underwent Li-ESWT (18 000 pulses over 3 weeks). Clinical and vascular parameters, including age, ED duration, body mass index, presence of cardiovascular risk factors, diabetes mellitus (DM), carotid intima-media thickness (cIMT), flow-mediated dilation rate (FMD), and prior phosphodiesterase type 5 inhibitor (PDE5i) response, were recorded. Treatment success at 6 months was defined as an increase of ≥1 point in the erection hardness score or ≥5 points in the International Index of Erectile Function-5 EF. Outcomes: The primary outcome was treatment success at 6 months after Li-ESWT. Secondary outcomes included the development and validation of a predictive scoring system. Results: Treatment success rate was 66.2% (145/219). Independent predictors of treatment success were absence of DM (odds ratio [OR] = 2.67, P = .012), ED duration <36 months (OR = 2.23, P = .026), cIMT <0.8 mm (OR = 2.04, P = .042), prior PDE5i benefit (OR = 2.47, P = .016), FMD ≥5% (OR = 2.57, P = .012), age <65 years (OR = 2.28, P = .032), and presence of cardiovascular risk factors (OR = 2.23, P = .036). A scoring system incorporating these 7 variables achieved an area under the curve of 0.819 (95% confidence interval [CI] 0.762-0.877). Using a cut-off of 4.5 points, the sensitivity was 73% and the specificity was 77% (P < .001). Clinical Implications: This scoring system may help clinicians identify patients most likely to benefit from Li-ESWT, optimize patient selection, and improve individualized treatment strategies in vasculogenic ED. Strengths & Limitations: The study is strengthened by its prospective design, relatively large sample size, and inclusion of vascular function parameters (FMD, cIMT). Limitations include the lack of external validation and the absence of penile Doppler ultrasound confirmation in all patients. Conclusion: This study identified key demographic and vascular predictors of Li-ESWT response and introduces a novel, non-invasive clinical scoring system with strong predictive accuracy. This tool may enhance treatment personalization and support clinical decision-making in the management of ED.

This study aimed to identify predictive factors for the formation of steinstrasse following extracorporeal shock wave lithotripsy (SWL) in patients with me

Purpose To evaluate and compare the efficacy and safety of retrograde intrarenal surgery (RIRS) and Mini-percutaneous nephrolithotomy (PCNL) in treating pediatric patients with solitary kidneys harboring medium-sized (1–2 cm) kidney stones. Methods This study was conducted retrospectively. The two groups were compared in terms of surgical and postoperative parameters. Renal function was assessed both preoperatively and at the third month following surgery. Results The mean age of patients in the mini-PCNL group was 13.5 ± 3.6 years, whereas that in the RIRS group was 10.7 ± 3.9 years (p = 0.772). The duration of fluoroscopy was significantly longer in the mini-PCNL group (126 ± 46.8 s) than in the RIRS group (55.3 ± 32.6 s) (p < 0.001). Conversely, the RIRS group had a longer operative time (58.3 ± 28.1 min) than did the mini-PCNL group (40.4 ± 19.2 min) (p = 0.028). At the one-month follow-up, stone-free rates were markedly higher in the mini-PCNL group (97.5%) than in the RIRS group (80.6%) (p < 0.001). There was no significant change in renal function following both surgeries. Conclusions Mini-PCNL demonstrated superior outcomes in terms of stone clearance, reduced operative duration, and a lower need for subsequent procedures. In contrast, RIRS was associated with reduced fluoroscopy exposure and minimal blood loss, although it necessitated more frequent use of supplementary interventions.

Purpose We aimed to determine differences in treatment and management of forgotten ureteral stents between adult and pediatric patients. Methods The records of patients treated for forgotten ureteral stents were retrospectively evaluated. Reasons for stent placement, duration of stenting, stent fragmentation status, types and numbers of surgeries performed for stent removal, length of hospital stay, complications, and treatments were recorded. Results There were 43 (37%) patients in the pediatric group and 72 (63%) patients in the adult group. Mean age in the pediatric group was 7.65 ± 4.01 years, while it was 53.18 ± 18.29 years in the adult group. Hydronephrosis and hematuria rates were significantly higher in the adult group (40.3% vs. 20.9, p = 0.033; 33.3% vs. 16.3%, p = 0.046, respectively), whereas fever and sepsis rates were significantly higher in the pediatric patient group (39.5% vs. 12.5%, p = 0.001; 11.6% vs. 1.4%, p = 0.027, respectively). In terms of removal method, endoscopic cystolithotripsy and percutaneous nephrolithotomy (37.2%) were the methods most frequently applied in the pediatric group, and ureteroscopic lithotripsy (34.7%) was used in adults. Conclusions Forgotten ureteral stents can cause life-threatening complications in both pediatric and adult patients due to encrustation and stone formation. Endourological surgeries can be safely performed for treatment in both groups.

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.