Abdullah Cirakoglu

This study aimed to evaluate Turkish parents' perceptions and attitudes regarding the appropriate age for circumcision, practice conditions, and procedural indications across different regions of Turkey. This cross-sectional survey study was conducted between March 2023 and March 2025 across urology and pediatric surgery departments in seven distinct regions of Turkey. A total of 637 literate parents (aged ≥ 18) completed a voluntary 16-question online survey via a URL or QR code. Subgroup analysis was performed for parents whose sons had already undergone circumcision (n = 404). Data regarding demographics, circumcision preferences, and information sources were analyzed using descriptive statistics and Chi-square tests. The majority of parents (95.1%) considered circumcision necessary, primarily citing religious (77.7%) and medical (63.8%) reasons. Overall, 76% of participants stated that circumcision should ideally occur outside the psychologically sensitive period (PSP; ages 2-6). Among the 404 parents with already-circumcised sons, 41.1% (n = 166) reported that the procedure was performed during the PSP (ages 2-6). Awareness of the non-PSP increased significantly with higher parental education levels (p < 0.001). Regarding practice, specialists were preferred (pediatric surgeons 54.4%; pediatric urologists 46.3%), and the operating room was identified as the safest setting by 91.7% of respondents. Local anesthesia was the most preferred method (51.6%). Despite high awareness regarding specialist qualifications and clinical settings, a significant "knowledge-practice gap" exists concerning the timing of circumcision. Clinicians should proactively counsel parents regarding the psychological risks associated with the PSP, and public health strategies must move beyond general awareness to provide targeted guidance that ensures optimal timing in circumcision.

Urinary tract obstruction, resulting from various etiologies, is a significant clinical condition associated with substantial morbidity, including life-threatening sepsis and acute kidney injury. Prompt intervention for decompression via ureteral stenting or percutaneous nephrostomy is paramount. This study aimed to assess the practice patterns of urologists in Türkiye concerning percutaneous nephrostomy and to highlight its integral role within urological clinical practice. A cross-sectional study was conducted between 7th May 2022 and 31st May 2023 following institutional ethics committee approval. A 13-item questionnaire was distributed to 131 urologists of various academic ranks. The data were analyzed using the chi-square test. Of the respondents, 71% (n=92) reported competency in performing percutaneous nephrostomy, while 29% (n=38) indicated they could not. Regarding the ideal provider for percutaneous nephrostomy, 31% (n=41) advocated for urologists, 11% (n=14) for interventional radiologists, and 58% (n=76) supported a collaborative approach between both specialties. When asked about institutional practice patterns, 11% (n=14) reported that percutaneous nephrostomy was not performed, 38% (n=50) noted it was performed by urologists, 24% (n=31) by interventional radiologists, and 28% (n=36) by both specialties. Notably, 55% of urologists who do not perform percutaneous nephrostomy, regardless of academic rank, cited malpractice concerns as the primary reason. Percutaneous nephrostomy remains a fundamental procedure in urological clinical practice. Our findings suggest that its inclusion in urology residency training curricula is vital to ensure urologists retain their competency in percutaneous nephrostomy management. Comprehensive training and proficiency in percutaneous nephrostomy should be a core component of urology residency programs.

Objective: Prostate cancer (PCa) remains a major cause of morbidity and mortality among men worldwide, and histopathologic tissue sampling plays a pivotal role in diagnosis. Although transrectal ultrasound–guided prostate needle biopsy (TRUS biopsy) has been the standard diagnostic technique for decades, its effectiveness has increasingly been questioned with the widespread adoption of cognitive and magnetic resonance imaging (MRI)–targeted biopsy techniques. The aim of this study wa to present the clinical outcomes and costs of TRUS-guided prostate biopsy performed in the clinic and to compare its costs with those of MRI-targeted biopsy. Materials and Methods: Data from 221 patients who underwent prostate biopsy were retrospectively analyzed. Patient comorbidities, prostate-specific antigen levels, digital rectal examination findings, histopathologic results, and biopsy-related costs were recorded. Cost data for MRI-targeted biopsy were obtained from 9 private hospitals located in different regions of the country. Results: Prostate cancer was detected in 40.3% (n = 89) of the 221 patients. Clinically significant PCa was identified in 29.9% (n = 66), whereas malignancy could not be excluded in 1.4% (n = 3). The mean cost of TRUS-guided prostate biopsy performed in the clinic was calculated as US $26.8. In contrast, based on data obtained from 9 hospitals, the reported mean cost of MRI-targeted biopsy was US $1449. Conclusion: Transrectal ultrasound–guided prostate needle biopsy remains an effectivemand highly cost-efficient diagnostic method in patients with suspected PCa. This technique may be particularly valuable in clinical settings where access to MRI-targeted biopsy is limited. Cite this article as: Benli E, Kadim N, Yüce A, Çırakoğlu A, Keleş M, Arslan A. Is standard TRUS-guided prostate biopsy the end of the game? Urol Res Pract. 2025;51(6): 237-241.

The following case study is presented in order to illustrate a rare instance of enema-induced rectal perforation in a patient of advanced age who was also frail. The condition rapidly progressed to Fournier gangrene. The importance of early diagnosis, faecal diversion, and staged surgical debridement is emphasised. A 73-year-old male patient suffering from Alzheimer's disease and intellectual disability developed acute perineal pain following the administration of a cleansing enema. A comprehensive clinical examination was conducted, and laboratory tests were performed. Contrast-enhanced computed tomography was also conducted. The patient underwent an emergency laparotomy, which included the Hartmann procedure, followed by staged perineal–inguinal debridements. The patient's clinical progress was meticulously monitored throughout their hospitalisation. Imaging revealed extensive subcutaneous emphysema of the perineum, hemiscrotum, and inguinal canal with perirectal free air, indicating rectal perforation. Intraoperatively, a 1-cm full-thickness perforation was detected at the 12 o'clock position of the rectum. A Hartmann procedure was performed, followed by three staged debridements due to advancing necrotising fasciitis. The wound was closed primarily on postoperative day 18, and the patient was discharged in stable condition. It is important to note that enema-induced rectal perforation has the potential to result in fulminant Fournier gangrene, a condition that is especially prevalent in elderly patients who are considered to be frail. Early CT evaluation, prompt faecal diversion, and serial debridement are essential for successful outcomes. It is imperative that clinicians maintain heightened awareness when managing vulnerable patients undergoing enema procedures.

Objective: Priapism is a penile erection lasting more than four hours with or without sexual stimulation. Ischemic priapism lasting more than 48 hours is difficult to resolve with corporal aspiration, irrigation, and sympathomimetic injection. In such cases, shunt surgery may be necessary. The need for complicated surgeries such as penile prosthesis arises due to the development of fibrosis and erectile dysfunction. Our aim in this study is to present how we manage cases presenting to our clinic with late-stage priapism, accompanied by literature, and to draw attention to this issue. Method: We reviewed the retrospective analyses of patients with late-stage priapism who presented to our hospital between 2020 and 2024. We recorded the patient's demographic information and the procedures and surgeries performed. Results: We reached the data of five patients presenting with late-stage priapism. Although these patients were treated with intracavernous sympathomimetic irrigation along with aspiration, all of them required shunt surgery. T-shunt procedures were performed in all cases. The snake maneuver was applied in 2 of the 5 patients. A total of three patients developed erectile dysfunction. One of them underwent a penile prosthesis... Conclusion: According to our experience, it is tough to achieve detumescence in delayed priapism cases with only corporal aspiration and sympathomimetic injection, so we think that shunt surgeries and penile prostheses should be applied without delay.

Objective: Circumcision is included in European urology guidelines as a treatment choice only for severe phimosis, while it is a procedure routinely performed for socio-cultural reasons in many different countries. Parents bring their children to urology clinics requesting circumcision. Before circumcision, it is very important to perform full urogenital examination because many urogenital anomalies that require treatment may be identified so. In this study, we aimed to determine the urogenital anomalies identified in children before circumcision. Material and Method: This study retrospectively investigated findings of 190 pediatric cases attending our urology for circumcision between September 2015 and September 2021. Each child had standard examinations of penis, urethra, testis and scrotum. The presence and laterality of undescended testis, presence and laterality of retractile testis, presence and degree of phimosis, presence and localization of hypospadias, presence and degree of buried penis, presence direction, and angle of penis chordee-curvature, presence of penoscrotal web, presence and laterality of hydrocele, presence of urethral stenosis, and presence of urethral duplication were recorded. Complete phimosis was noted when the foreskin could not be retracted or when less than half of the glans penis could be seen when retracted; partial phimosis was noted when more than half of the glans penis could be seen but not the whole penis; and no phimosis was noted when the foreskin could be easily retracted without difficulty and the glans penis could be seen completely. When grading the buried penis, fully and partially buried penis were recorded. Results: In our study assessing the examination findings of 190 pediatric cases attending our urology clinic for circumcision between September 2015 and September 2021, a total of 127 children had urogenital anomalies (66%). Buried penis (46 cases, 24%) was the most frequently encountered urogenital anomaly. Undescended testis was the second most common (19 cases, 10%), while retractile testis (15 cases, 7%) was the third most common anomaly. Accordingly, phimosis was identified in 11 cases, penile curvature in 6 cases, hypospadias in 3 cases, hydrocele in 3 cases, penoscrotal web in 1 cases and urethral meatus duplication in 1 case. Conclusion: Circumcision is performed for both medical reasons and socio-cultural reasons in many countries. However, these patients may have serious urogenital anomalies. Careful physical examination is very important for patients attending for circumcision.

Purpose: The aim of the study was to compare the results of radiofrequency (RF) thermotherapy and transurethral resection of the prostate (TURP) in patients who required benign prostatic obstruction (BPO) surgery and had storage symptoms.Methods: The results of patients who had undergone TURP and RF thermotherapy procedures between December 2019 and 2022 were compared before and after the procedure. Patients’ International Prostate Symptom Scores, maximum flow rate (Qmax), postvoiding residues, and overactive bladder validated 8 scores (OAB-V8) at 3 and 6 months were analyzed.Results: While the preprocedural OAB-V8 in the RF thermotherapy group was 25.85, this score decreased to 18.12 (P<0.001) at the postprocedural 3rd month and 16.42 (P<0.001) at the postprocedural 6th month. While the preprocedural OAB-V8 score in TURP group was 23.26, it decreased to 20.17 (P<0.001) at the postprocedural 3rd month and 19.84 at the postprocedural 6th month, and there was no significant difference between the 3rd-month and 6th-month values (P=0.328). The proportion of de crease in the OAB-V8 scores was 30% at the 3rd month and 36% at the 6th month in the RF thermotherapy group, whereas it was 13% at the 3rd month and 15% at the 6th month in TURP group.Conclusions: It was determined that RF thermotherapy was 2.35 times more effective than TURP on OAB-V8 scores. In addition to its acceptable effect on Qmax, its continued effect on storage symptoms at 6 months may be a significant advantage over the TURP. As a minimally invasive method, RF thermotherapy can be offered as a suitable option for BPO patients with storage symptoms.

Introduction: We assessed whether there were changes in the characteristics of the patient population attending our urology clinic during the COVID-19 pandemic. Material and Method: Patients attending the general urology clinic of SB-ODU Education and Research Hospital were assessed. Dates from 3 February 2020-10 March 2020 were accepted as before the pandemic, with 11 March 2020-29 May 2020 accepted as after the pandemic. Complaints of patients on attendance were grouped as follows: benign prostate hyperplasia, ureteral diseases, kidney diseases, testis and scrotum diseases, incontinence, bladder diseases, sexually transmitted diseases, penile diseases, emergency urologic problems, sexual problems, urethral diseases, kidney and ureter stones, pediatric diseases and urologic tumors. Results: While 638 patients attended the urology clinic in the 1.5-month period before the pandemic, 398 patients attended in the 2.5-month period after the pandemic. Additionally, 30.9% of patients attending the clinic before the pandemic were women, while this rate fell to 23.6% after the pandemic. After the pandemic, there were statistically significant reductions identified for attendance due to BPH, ureteral diseases, kidney diseases, incontinence, bladder diseases and urethra diseases. There was no significant difference in attendance due to urinary system tumors, pediatric urologic patient group, attendance due to kidney and ureter stones, sexual problems and emergency urology problems. There were increases identified for attendance for testis and scrotum diseases and sexually-transmitted diseases. Conclusion: During the pandemic, the numbers of patients attending the urology clinic significantly reduced. During the pandemic, there were increases identified for attendance at our clinic for testis and scrotum diseases and sexually-transmitted diseases. While attendance reduced for many disease groups, rates of attendance for urologic emergencies, urinary tumors, pediatric patient group, stone disease and sexual problems continued as usual.