Serhat Çetin

Purpose: Fluoroscopy is commonly used during Percutaneous Nephrolithotomy (PCNL) for renal access and tract dilatation; however, it is associated with radiation exposure for both patients and surgical staff. Strategies to minimize exposure include reducing fluoroscopy time, which serves as a surrogate marker of radiation dose. This study aims to examine the effect of reducing fluoroscopy time using intermittent fluoroscopy on treatment and perioperative outcomes in supine PCNL. Methods: We retrospectively analyzed data from 446 patients who underwent supine PCNL between April 2021 and August 2025. After applying exclusion criteria, 392 patients were included. Two experienced surgeons performed or supervised the procedures, one utilizing intermittent fluoroscopy and the other live fluoroscopy. Baseline demographics, stone characteristics, operative variables, fluoroscopy time, stone-free rates (SFR), complications, and hospital stay were compared. Propensity score matching (PSM) was conducted to minimize group baseline differences. Results: Before matching, 310 patients underwent intermittent fluoroscopy, and 82 underwent live fluoroscopy. After PSM, 82 patients remained in each group with comparable demographics and stone characteristics. Median fluoroscopy time was significantly lower in the intermittent group (25.5 s [IQR: 18–35.25]) compared with the live group (267 s [IQR: 182.5–314]; p < 0.001). Stone-free rates were similar (79.3% vs. 81.7%; p = 0.694), as were operative time, hospital stay, and complication rates(all p > 0.05). Conclusion: Intermittent fluoroscopy during supine PCNL substantially reduces fluoroscopy time without compromising stone-free rates, operative outcomes, or complication rates. This approach may be considered a safer alternative for minimizing radiation exposure to patients and healthcare providers.

Laser lithotripsy, which is widely applied in treating urinary system stones, presents difficulties such as stone migration due to retropulsion, especially in upper ureteral stones. This study aims to compare the stone migration rates of conventional Holmium:YAG (Ho:YAG), pulse modulated Ho:YAG, and Thulium Fiber Laser (TFL) in patients undergoing laser lithotripsy. A retrospective analysis of 455 patients who underwent laser lithotripsy for upper ureteral stones between 01.01.2021 and 01.06.2025 at a tertiary hospital was conducted. The cohort was divided into three groups based on the laser used: conventional 30 W Ho:YAG (Group A), pulse-modulated 65 W Ho:YAG (Group B), and TFL (Group C). Data on stone migration, operation time, laser-on time, and stone-free rates (SFR) were collected and analyzed. Significant differences in stone migration rates were observed, with Group C showing the lowest migration rate (7.8%) compared to Groups A (28.9%) and B (16.8%) (p < 0.001). TFL also resulted in significantly higher SFRs (97.1%) compared to conventional Ho:YAG laser (86.8%) (p = 0.002). Additionally, TFL reduced the need for auxiliary procedures, with only 2.9% of patients requiring flexible ureteroscopy, compared to 12.2% in Group A and 9.7% in Group B (p = 0.032). TFL significantly reduces stone migration and improves stone-free rates compared to conventional and pulse-modulated Ho:YAG lasers. Its clinical and economic benefits, including reduced need for auxiliary procedures and shorter operation times, suggest TFL as a promising alternative for upper ureteral stone treatment. Further large-scale, prospective studies are needed to validate these findings.

Objective: Combined biopsy (CBx) is a combination of multiparametric magnetic resonance imaging (MpMRI)-targeted prostate biopsy (FBx) and systematic biopsy (SBx). CBx offers highly accurate diagnostic rates, but the increased number of cores taken and the longer procedure time may pose challenges in tolerability compared to traditional biopsies in terms of pain and anxiety. This situation leads to the need to evaluate pain and anxiety. Methods: In a tertiary hospital in Turkey, 149 patients with suspicious lesions (PI-RADS ≥ 3 on MpMRI) who underwent transrectal CBx were included between May 2023 and August 2023. Following FBx, patients underwent a 12-core systematic biopsy. During CBx, 78 patients listened to classical music, while 71 patients used noise-canceling headphones without music. Ten minutes after the procedure, patients completed the Visual Analog Scale (VAS) and the State-Trait Anxiety Inventory (s-STAI, t-STAI) questionnaires to measure pain and anxiety. s-STAI determines how anxious a person feels at a specific moment. t-STAI indicates the general level of anxiety a person experiences independently of their current situation. Results: Median VAS score was 3.6 (3.0 – 4.3) in the music group and 5.4 (4.4 – 6.9) in the control group (p < 0.001). The median s-STAI score was 38 (34 – 44) in the music group and 44 (39 – 48) in the control group (p < 0.001). For t-STAI scores, no significant difference between groups was observed. Conclusion: Incorporating music during CBx, alongside traditional pain management, effectively reduces pain and anxiety levels. Its cost-effectiveness, accessibility, and non-invasive nature make routine use of music during CBx procedures advantageous for pain palliation.

Background: Overactive bladder (OAB) is a common syndrome that can negatively affect patients’ daily activities, sleep patterns, mental health, sexual function, and general health. In addition to reducing the frequency of attacks, treatment of OAB can be expected to improve the psychological and sexual health of patients. Aims: To evaluate the effects of mirabegron used in the treatment of overactive bladder (OAB) on female sexual function (FSF). Methods: This retrospective study includes 48 sexually active women who were diagnosed with overactive bladder and treated with a daily oral dose of 50 mg mirabegron between November 2021 and March 2022. The evaluation of FSF was conducted using female sexual function index (FSFI) along with urinary parameters before the start of the treatment and at the 6th week of the treatment. Results: In the study, out of 48 participants, 40 (83.3%) were identified with the dry type and 8 (16.7%) with the wet type OAB. The median age when diagnosed was 43.5 years. Although the decrease in the Overactive Bladder Questionnaire (OAB-V8) score did not reach statistical significance in the entire patient group after treatment ( p = 0.058), a statistically significant decrease in the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) score was detected in the wet type OAB group ( p < 0.001). During the assessment of sexual function, there was a statistically significant increase in the FSFI score, from 21.4 to 23.05, by the 6th week of treatment ( p = 0.017). Specifically, the scores for desire, lubrication, and satisfaction showed a statistically significant post-treatment improvement ( p < 0.001, p = 0.049, and p = 0.035, respectively). Conclusion: The study indicates that a 6-week regimen of a daily 50 mg mirabegron dose enhanced sexual function in women. This beneficial impact of mirabegron on sexual health should be taken into account when selecting a treatment for OAB.

Background/Aim: This study aims to compare the success rates of rigid registration (RR) and elastic registration (ER)systems in diagnosing all cancers and clinically significant prostate cancer (csPC) in software-based targeted prostate biopsies (TPBs) by performing matching analysis.Materials and Methods: The data of 2,061 patients from six centers where software-based TPB was performed were used. All cancer and csPC detection rates of the RR and ER systems were compared following Mahalanobis distance matching within the propensity score caliper method. Logistic regression analysis was applied to identify factors predicting clinically insignificant prostate cancer (ciPC) and csPC diagnoses. Additionally, the International Society of Urological Pathology Grade Group (ISUP GG) upgrade rates of RR and ER systems were compared between biopsy and radical prostatectomy pathologies.Results: The matched sample included 157 RR and 157 ER patients. No statistically significant difference was found between ER and RR in terms of the csPC detection rate (28.0% vs. 22.3%, p = 0.242, respectively). The detection rate of all cancers by ER compared to RR was found to be significantly higher (54.8% vs. 35.7%, p < 0.001, respectively). No statistically significant difference was found between the ER and RR groups regarding pathological upgrade (39.7% vs. 24.2%, p = 0.130, respectively). In the logistic regression analysis performed to determine the factors predicting ciPC, decreased prostate volume and ER system use were found to be independent predictive factors.Conclusion: While the detection rate of csPC was similar for the RR and ER systems, the detection rate of all cancers and ciPC was significantly higher in ER systems.

Background and Objectives: In the surgical treatment of benign prostatic hyperplasia (BPH), laser enucleation of the prostate is recommended as an alternative to transurethral resection (TURP) and open prostatectomy (OP). The thulium fiber laser, with its superficial penetration depth, can offer a rapid learning process by causing less heat injury and capsule damage. This study compares the first 60 cases of an endourologist performing thulium fiber enucleation of the prostate (ThuFLEP) without a mentor to the results of OP and TURP performed by experienced surgeons. It also identifies the case number at which the operation time for ThuFLEP starts to plateau. Materials and Methods: Between 1 November 2021 and 1 November 2023, the initial 60 ThuFLEP cases of an endourologist with no prior enucleation experience were compared with TURP and OP operations performed by experienced surgeons. Since the first 60 ThuFLEP cases involved 80–120 cc prostates, TURP and OP operations within this size range performed during the same period were included in the study. The groups were assessed for age, preoperative and postoperative prostate volume, PSA levels, the IPSS, the IPSS Quality of Life (QoL), and maximum urinary flow (Q_max). The 60 consecutive ThuFLEP cases were divided into three groups of 20 (Groups 1, 2, and 3) and compared for operation time, IPSS, and Q_max. Results: The operation time for TURP was shorter than for ThuFLEP and OP (p < 0.001). There was no significant difference between ThuFLEP and OP in postoperative Q_max and IPSS, while TURP had lower values than the other two methods. For ThuFLEP, the operation time was longer in the first 20 cases but plateaued in groups 2 and 3 (p < 0.001). Postoperative Q_max and IPSS values showed no significant differences among the three ThuFLEP groups (p > 0.05). Conclusions: For large prostates, ThuFLEP provides better postoperative results than TURP and offers shorter catheterization and hospital stay times than OP. Its short learning curve makes it a preferable method for treating BPH compared to other laser techniques.

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is a current treatment method with high success rates and low complication rates in treating large kidney stones. It can be conducted in different positions, especially supine and prone positions. PCNL in the supine position is becoming increasingly common due to its advantages, such as simultaneous retrograde intervention and better anesthesia management. This study aimed to assess how the choice of position impacts the PCNL learning curve. Materials and Methods: The results of the first 50 consecutive PCNL cases performed by two separate chief residents as primary surgeons in supine and prone positions in a reference center for stone treatment between August 2021 and January 2023 were evaluated. The two groups’ demographic and clinical data, stone-free rates, operation times, and fluoroscopy times were compared. Results: While the mean operation time was 94.6 ± 9.8 min in the supine PCNL group, it was 129.9 ± 20.3 min in the prone PCNL group (p < 0.001). Median fluoroscopy times in the supine PCNL and prone PCNL groups were 31 (10–89) seconds and 48 (23–156) seconds, respectively (p = 0.001). During the operation, the plateau was reached after the 10th case in the supine PCNL group, while it was reached after the 40th case in the prone PCNL group. Conclusions: For surgeons who are novices in performing PCNL, supine PCNL may offer both better results and a faster learning curve. Prospective and randomized studies can provide more robust conclusions on this subject.