Abdullah Ilktac

Background: Transurethral resection of the prostate (TURP) is s the gold standard surgical treatment method for benign prostatic hyperplasia. With the aging population and the increasing prevalence of cardiovascular diseases, the number of patients requiring anticoagulant (AC) or antiplatelet (AP) therapy continues to rise. The perioperative management of these medications remains challenging because continuation may increase bleeding complications, whereas discontinuation may increase thromboembolic risk. In this study, we evaluated bleeding-related outcomes after TURP in patients receiving chronic AP or AC therapy undergoing perioperative medication interruption. Methods: This retrospective study included patients who underwent TURP between January 2020 and December 2024 at our tertiary referral center. Patients were divided into three groups according to their perioperative use of AP and AC medications. Control group: Patients who did not receive any AC or AP therapy. AP group: Patients receiving antiplatelet therapy. AC group: Patients treated with anticoagulants. None of the patients underwent TURP under continued AP or AC therapy. Perioperative and postoperative outcomes, including duration of irrigation, duration of catheterization, length of hospital stay, development of clot retention during hospitalization, need for postoperative blood transfusion, readmission due to hematuria within 30 days, and need for recatheterization or reoperation due to bleeding, were evaluated. A composite bleeding outcome was created to increase statistical power including postoperative blood transfusion, clot retention, and hematuria-related readmission. Results: A total of 325 patients were included: 198 in the control group, 97 in the AP group, and 30 in the AC group. Overall comparisons showed significant differences in postoperative transfusion ( p = 0.001) and hematuria-related readmission rates ( p = 0.032) between three groups but post-hoc pairwise Fisher’s exact tests with Bonferroni correction did not confirm statistical significance between specific pairs. There were no significant differences between the groups in other parameters. Multivariable logistic regression identified antiplatelet therapy as an independent predictor of hematuria-related readmission (OR:4.17, p = 0.010). Conclusion: AP therapy is independently associated with an increased risk of hematuria-related readmission even after perioperative interruption of therapy. Patients receiving antithrombotic therapy should be carefully monitored during the perioperative period, and clinicians should remain vigilant for potential bleeding-related complications.

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: This study assesses ChatGPT-4o′s responses to common patient inquiries regarding urinary incontinence (UI), a condition that significantly impacts quality of life but often goes untreated due to low healthcare-seeking behavior. The evaluation focuses on four key metrics: understandability, actionability, reliability, and readability. Material and Methods: In this non-human subject qualitative study, 13 patient-focused questions—derived from AUA/SUFU and EAU guidelines—were posed to ChatGPT-4o in Turkish. The questions were categorized into four themes: Definition, Diagnosis, Management, and Surgical Considerations. Three blinded experts (an urogynecologist, a urologist, and a pelvic floor physiotherapist) independently evaluated the responses using the Patient Education Materials Assessment Tool (PEMAT) for understandability and actionability and the modified DISCERN (mDISCERN) tool for reliability. Readability was measured using the Çetinkaya–Uzun formula , specifically designed for Turkish text. Statistical analysis included descriptive statistics and the Intraclass Correlation Coefficient (ICC) to determine inter-rater reliability. Results: In evaluating ChatGPT-4o’s performance in urinary incontinence education, experts found strong agreement in their assessments, with inter-rater reliability scores were 0.80 (95% CI: 0.70-0.91) for PEMAT and 0.82 (95% CI: 0.70-0.91) for mDISCERN. The AI’s responses were consistently highly understandable, particularly when explaining diagnoses (achieving a peak score of 94.4 %), yet they were significantly less actionable, meaning they often failed to provide clear, practical steps for patients to follow. This gap was most evident in surgical considerations, which were deemed the least actionable at 68.2 %. The overall reliability of the content was rated as “fair” across all categories—with surgical information being the most reliable. Most responses were classified as “difficult,” requiring a university-level education to comprehend, with surgery-related topics being the most linguistically complex. Conclusion: While ChatGPT-4o yields comprehensible health information, its limited actionability and high linguistic complexity pose barriers to patients with lower health literacy.

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.

Background: The use of anticoagulant (AC) and antiaggregant (AG) medications is increasingly common in elderly patients undergoing urologic surgeries. This prospective observational study aimed to evaluate the influence of AC/AG therapy on bleeding-related complications following transurethral resection of the prostate (TURP), transurethral resection of bladder tumour (TURBT) and open prostatectomy (OP). Methods: Patients who underwent TURP, TURBT or OP between March 2022 and January 2023 were included in this study. Patients were stratified according to AC/AG usage. Perioperative management details, including low-molecular-weight heparin (LMWH) bridging, were recorded. We evaluated parameters including duration of irrigation, length of stay, episodes of clot retention, transfusion rate and re-admission rate due to haematuria. Results: Among TURP patients, those using AC/AG therapy had significantly higher rates of transfusion (2.27% vs 0%, p = 0.038), postoperative clot retention (7.57% vs 0.53%, p = 0.008), re-catheterisation (9.09% vs 3.72%, p = 0.046) and re-admission due to haematuria (11.36% vs 3.72%, p = 0.008) compared with those not receiving AC/AG therapy. In the TURBT group, AC/AG use was associated with an elevated rate of rehospitalisation (p = 0.026). OP patients on AC/AG therapy experienced increased transfusion rates (p = 0.030), early postoperative clot retention (p = 0.034) and re-operations (p = 0.016). LMWH bridging was associated with further increases in irrigation volume, early clot retention and rehospitalisation, particularly in TURBT and OP patients. Conclusions: AC/AG therapy significantly influences bleeding outcomes after TURP, TURBT and OP. LMWH bridging may further exacerbate these risks. This study emphasises the need for caution regarding bleeding-related complications in patients receiving AC/AG therapy.

Objective: Metastatic tumors of the kidney are quite rare. In this study, we aimed to increase awareness by discussing the clinicopathological data of our cases in the context of the literature. Materials and Methods: A total of 760 cases, subjected to trucut biopsy or resection, were examined. The primary diagnoses, clinical, and histopathological features of the cases were investigated. Results: The study included 60 trucut and 700 partial/radical nephrectomy cases, with metastasis to the kidney detected in 24 cases. The most common primary organ was the lung, with less frequent cases from lymph nodes, skin, breast, nasal sinus, gall bladder, pleura, prostate, colon, esophagus, stomach, and ovary. Most tumors were of epithelial origin. The majority of the cases were solitary and endophytic in appearance. Kidney metastasis occurred at a median of 36 (2-123) months after the primary diagnosis. The median survival time after kidney metastasis was 8 (1-90) months. Conclusion: In this study, detailed demographic and pathological data of cases metastasizing to the kidney were documented. Although the rate of metastatic tumors in the kidney is low, even in solitary and endophytic appearances, the possibility of metastasis should be considered, especially in elderly patients, and confirmed with histopathological findings.

AIM: Parkinson's disease is a neurodegenerative disease characterized by both motor and non-motor symptoms. Pelvic floor dysfunction due to autonomic disorders are common in this population. The purpose of this case report is to assess the early and long-term effects of comprehensive pelvic physiotherapy on autonomic dysfunction in a woman with Parkinson's disease. MATERIAL AND METHOD: Bladder diary, Pelvic Floor Distress Inventory-20, Overactive Bladder Questionnaire, Incontinence Severity Index, Incontinence Impact Questionnaire- short form, and PERFECT scheme were evaluated at baseline, immediately after the 12-week comprehensive pelvic physiotherapy program, and after 1-year follow-up. RESULTS: Improvements were detected in all parameters in the short term and maintained in the long term. CONCLUSION: We think that a comprehensive pelvic physiotherapy program is an effective method that can non-invasively improve the symptoms of pelvic floor dysfunction and quality of life seen in Parkinson's disease.

The incidence of renal cell cancer (RCC) is low in individuals aged less than 40 years; however several studies have shown this increasing trend over the years. Hereditary syndromes are associated with RCC and are more frequently observed in early-onset cases. In this study, we investigated the characteristics of the patients, aged less than 40 years, who were operated for a renal mass with the suspicion of RCC. We analyzed patients aged <40 years who underwent partial or radical nephrectomy between January 2012 and December 2022. A total of 618 patients underwent partial or radical nephrectomy and 60 (9.7%) patients were aged <40 years. A total of 62 renal masses were resected. The median age of the patients was 34 (31.75–38) years. RCC was detected in 50 (80.6%) lesions, while 12 (19.4%) lesions were benign. The most commonly observed benign tumors were oncocytoma and multicystic nephroma. Low-stage RCC (stage 1) was detected in 78% of patients. Recurrence was observed in two patients and both had von Hippel–Landau gene mutation. During follow-up, two patients were found to have lung metastasis, while another patient had bone metastasis. Three patients died during the follow-up period. Disease free survival rate was 89.58% and cancer specific survival rate was 93.88%. The incidences of kidney cancer in young adults are increasing; therefore, early discovery and the diagnosis are important. Further research is required to gain a better understanding.