Hakan Hakkı Taşkapu

Objectives: We aimed to compare the observed rates of postoperative urethral stricture between patients undergoing thulium fibre laser enucleation of the prostate (ThuFLEP) using a 22 Fr miniaturised instrument strategy and those treated using a standard 26 Fr strategy. Methods: This prospective, two-centre comparative cohort study included 208 patients with benign prostatic hyperplasia and a prostate volume of less than 150 mL who underwent thulium fibre laser enucleation of the prostate (ThuFLEP) between 2024 and 2026. Patients were grouped according to the resectoscope sheath used at each centre: Group 1 comprised 99 patients treated with a 22 Fr miniaturised sheath and Group 2 comprised 109 patients treated with a standard 26 Fr sheath. The primary endpoint was the development of postoperative urethral stricture. Patient demographics and preoperative and postoperative clinical outcomes were also recorded. Results: Demographic and operative parameters were comparable between the groups. No significant difference was observed in mean prostate volumes (68.8 ± 34.1 vs. 70.8 ± 25.7 mL). Although the enucleation efficiency (g/min) was numerically higher in Group 1, the difference did not reach statistical significance (2.2 ± 1.1 vs. 1.8 ± 0.6; p = 0.082). Postoperative urethral stricture was observed in 2 patients (2.0%) in Group 1 and in 10 patients (9.2%) in Group 2. The incidence of stricture was significantly higher in Group 2 (p = 0.036). Conclusions: The 22 Fr ThuFLEP strategy was associated with a lower observed urethral stricture rate. However, the independent effect of sheath diameter could not be separated from centre- and surgeon-related factors. Further randomised studies are required to confirm these findings.

In this prospective controlled cohort study, we aimed to compare the safety and efficacy of Retrograde intrarenal surgery (RIRS) combined with high-power holmium:YAG laser and vacuum-assisted, flexible, navigable access sheaths (FANS) vs. mini-percutaneous nephrolithotomy (miniPCNL) in 2-3 cm kidney stones. Between June 2022 and June 2024, 60 patients with 2-3 cm in diameter kidney stones, aged 18 years or older, were prospectively included. Patients were classified into two groups based on their decision: RIRS (Group 1) and miniPCNL (Group 2). Patient demographic data, preoperative creatinine, and hemoglobin levels were recorded. Stone-related factors were evaluated using preoperative tomography. Creatinine and hemoglobin values were measured on the first postoperative day. Stone-free status (SFRs) was evaluated on the first postoperative day and at the first month. Hospital stays and complications were assessed. This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026. Patient demographic data, preoperative creatinine levels, hemoglobin levels, and stone-related factors were comparable between the groups. The prestenting rate was higher in Group 1 (16.6%, 95% CI: 3.3-30) than in Group 2 (0%, 95% CI: 0-0, p = 0.02). The operative time and complication rates were comparable between the groups. The fluoroscopy time was lower in Group 1 (p < 0.001). The mean hemoglobin decrease was greater in Group 2 (p < 0.001). Stone-free status was comparable on the first day and first month. Hospital stay was shorter in Group 1 (p < 0.001). Retrograde intrarenal surgery combined with a high-power holmium:YAG laser and FANS shows comparable outcomes to miniPCNL for 2-3 cm kidney stones, yielding a similar SFRs with lower hemoglobin decrease, shorter hospitalization time, and reduced fluoroscopy exposure. However, increased prestenting rates should be considered. This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026.

OBJECTIVE: In this review, we aimed to highlight the current status and clinical challenges in fertility preservation practices in testicular cancer patients. MATERIAL and METHODS: The review was prepared based on a structured literature search in the MEDLINE (PubMed) database using predetermined inclusion and exclusion criteria. RESULTS: Testicular cancer (TC) is the most common solid malignancy in men aged 15–44 years. Radical inguinal orchiectomy (RIO) is the standard first step in diagnosis and treatment before further chemotherapy and radiotherapy. However, all these treatment modalities and TC cause fertility problems of varying degrees, up to permanent infertility. Since it is not known which patients will be affected by clinical consequences that may lead to permanent infertility, cryopreservation is the only and most important way for fertility preservation today. However, sperm banking is applied in approximately 30–40% of TC patients. Considering the irreversible physical and psychological effects of cancer and treatment-related infertility, it is necessary to investigate the underlying causes. In this review, we aimed to highlight the current status and clinical challenges in fertility preservation practices in testicular cancer patients. These challenges can be evaluated under the headings of physician, patient, economic, and sociocultural reasons. These factors cannot be evaluated independently and should be considered when tailoring management for each patient. CONCLUSION: Awareness of the clinical challenges for fertility preservation will help preserve fertility in TC, which has excellent long-term survival outcomes. Keywords: chemotherapy, cryopreservation, fertility, orchiectomy

This study aimed to determine the effect of the perceived social support level on coping methods for urinary incontinence among men aged 65 years and over with urinary incontinence. A total of 92 male patients over the age of 65 years with urinary incontinence and adequate cognitive levels were included in the study. The coping methods, the environmental support, and the Multidimensional Scale of Perceived Social Support were used to collect data. The most common method of coping was changing clothes (64 [69.6%]). The Multidimensional Scale of Perceived Social Support total mean score was 55.83±14.8, which was considered above the medium-level support. The perception level of social support caused significant differences in coping methods in individuals with urinary incontinence. The view that urinary incontinence is a problem related to aging is regarded as an obstacle to seeking healthcare. Society should be made aware that urinary incontinence is not a normal condition related to aging and that it is not an insoluble problem that the elderly must endure.

Purpose To investigate the influencing factors of acute kidney injury (AKI) following retrograde intrarenal surgery (RIRS). Methods The data of patients who underwent RIRS for kidney stones between January 2018 and June 2022 at two tertiary centers were retrospectively analyzed. Demographic data of patients were obtained. According to kidney disease: Improving Global Outcomes (KDIGO) criteria, those with and without AKI were divided into two groups. Preoperative, intraoperative, and postoperative predictive factors of patients were investigated between the groups. In addition, the influencing factors of AKI were examined by multivariate analysis. Results This study included 295 (35.7%) women and 532 (64.3%) men. The mean age was 50.03 ± 15.4 years (range 18–89), and mean stone size was 15.5 ± 6.1 mm (range 6–47). Overall, 672 of patients (81.3%) were stone-free after the initial treatment. According to KDIGO, 110 of patients (13.3%) had AKI during the postoperative period. Univariate analysis showed that stone size (P = .003), previous stone surgery (P = .010), renal malformations (P = .017), high operative time (P = < .001), high preoperative creatinine value (P = .036), intraoperative complications (P = .018), and postoperative urinary tract infection (P = .003) had significant influence on the AKI after RIRS. Multivariate analysis excluded previous stone surgery, high preoperative creatinine value, renal malformations, and intraoperative complications from the logistic regression model, whereas other factors maintained their statistically significant effect on AKI, indicating that they were independent predictors. Conclusions Stone size, operative time, postoperative urinary tract infection, and diabetes mellitus are significant predictors of AKI. During RIRS, urologists should consider the factors that increase the risk of AKI and evaluate the treatment outcomes based on these factors.

Objective: In patients treated through the application of intracavernosal alprostadil in second-line treatment due to erectile dysfunction, the effect of the treatment on sexual functions measured with a 15-question International Index of Erectile Function (IIEF-15) questionnaire was investigated in this study. Material and Methods: Twenty-one patients treated due to erectile dysfunction between June 2018-October 2019, taking inadequate response from first-line treatment modalities, were applied intracavernosal alprostadil in second-line treatment and continued it for more than 12 weeks were included in the study, retrospectively. Ages, comorbid diseases, drug usage duration, drug-related side effects, penile Doppler ultrasonography (USG) parameters before application and the erection functions before and 12 weeks after drug use were evaluated with IIEF-15 form for the patients. Intracavernosal alprostadil was started with a dose of 5 μg and was continued with a dose of 10 μg as the result of dose titration. Results: The mean peak systolic blood flow velocity (PS) value of the patients was 24.4 ±15.1 cm/sec, and the mean end-diastolic flow velocity (ED) value was measured as 4.3±4.5 cm/sec based on the pre-treatment penile Doppler USG.Although the IIEF scores were measured in the 12th week, mean drug usage durations were measured as 21.9±16.6 weeks. Erectile Function Score was 9.2±5.3 before application; it was detected as 20.33±6.2 after the application. Orgasmic Function Score was 3.2±2.5 before application; it was detected as 7.5±2.4 after the application. Sexual Desire Score was 3.72±1.48 before application; it was detected as 8.9±1.4 after the application. Intercourse Satisfaction Score was 3.7±2.8 before application; it was detected as 9.1±2.7 after the application. Overall Satisfaction Score was 4±1.7 before application; it was detected as 8.1±1.7 after the application (All parameters p<0.001). Conclusion: Intracavernosal alprostadil treatment used in erectile dysfunction second-line treatment is a cost-effective and efficient treatment method with a tolerable side effect profile and provides recovery in sexual parameters that can be measured with IIEF-15 parameters. Keywords: Alprostadil, erectile dysfunction, intracavernosal treatment.

After nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as "postsurgical fatty tumor." This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.

Purpose The primary aim of this study to comparison of reusable and disposable flexible ureterorenoscope (fURS) efficiency in lower pole renal stone disease management. In addition, the secondary goal of this study was to evaluate the factors affecting stone-free rates (SFR) in lower pole stones. Materials and methods A prospective case–control study utilizing data from 122 consecutive ureteroscopic cases. The patients were divided into two groups according to the ureterorenoscope employed in the surgical intervention as disposable fURS (Group1, n:52) and reusable fURS (Group 2, n:70). Demographic characteristics, stone size, infundibulopelvic angle (IPA), SFR, hospitalization time, intraoperative complication rate (CR), operative time, preoperative or postoperative JJ stenting, and postoperative CR were analyzed. Results There was no statistical difference between the demographic and renal stone-related data between the groups. Likewise, no difference is observed in term of intraoperative and postoperative outcomes such as fluoroscopy time, CR, and hospitalization time between the groups. Although SFR was higher in the disposable fURS group, there was no difference statistically. However, the operative time was longer in reusable fURS Group (47.02 ± 9.91 min in Group 1, and it was 57.97 ± 14.28 in Group 2) (p: 0.001). The multivariate regression analysis result to evaluate the factors of effect to operative time; the use of disposable fURS was associated with a 10.95-min decrease in procedure duration (p < 0.001). Conclusions Disposable fURS and reusable fURS have similar clinical efficiency and complication rates in the treatment of lower calyceal stones with RIRS. Nevertheless, disposable fURS is a useful treatment option for increased stone volume due to the advantages such as shorter operative time.