Aykut Akinci

Background: Preservation of sexual function has become a central goal in the surgical management of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS), yet the impact of treatment on the patient’s partner has rarely been examined. Transperineal laser ablation (TPLA) is an emerging, explicitly ejaculation-sparing technique with a favorable reported sexual function profile. Objective: In this retrospective, single-center, single-arm cohort study, we aimed to longitudinally evaluate erectile function, ejaculatory function and bother, and partner sexual function from the first postoperative week to 12 months after TPLA. Materials and Methods: This retrospective study was based on prospectively collected outcome data from 36 consecutive sexually active men who underwent ultrasound-guided TPLA (SoracteLite™/EchoLaser™) for moderate-to-severe LUTS/BPH, with assessments at postoperative weeks 1 and 2 and months 1, 3, 6, 9, and 12. Erectile function (IIEF-5), ejaculatory function and bother (MSHQ-EjD), and partner sexual function (Female Sexual Function Index, FSFI) were assessed longitudinally alongside IPSS, Qmax, post-void residual volume, and prostate volume. Results: Median baseline IPSS was 31 and prostate volume was 70 mL. IIEF-5 declined transiently at weeks 1 and 2 (both p < 0.001), returned to baseline by month 1, and did not differ significantly from baseline thereafter, consistent with preservation of erectile function. MSHQ-EjD function scores likewise declined transiently in the early postoperative period before rising modestly above baseline from month 3 onward (all p < 0.001, months 3–12), with a parallel change in the bother domain over the same period. Partner FSFI scores followed a similar temporal pattern, declining transiently during the first postoperative month, normalizing by month 3, and was slightly higher than baseline at month 12 (p < 0.05). IPSS improved from 31 to 8 and prostate volume decreased by a median of 52.5% at 12 months (both p < 0.001). No Clavien–Dindo grade ≥II complication occurred. Conclusions: In this retrospective single-arm cohort, TPLA was followed by substantial relief of severe LUTS. The findings are compatible with preservation of erectile function and a small increase in ejaculatory function scores, with partner sexual function following a parallel, non-causal trajectory. In the absence of a comparator group, these later changes cannot be attributed to TPLA itself and may partly reflect urinary symptom relief, medication changes, regression to the mean, or expectation effects. Controlled studies incorporating partner-reported outcomes are needed to determine whether TPLA confers couple-level sexual benefit.

Background. Clean intermittent catheterization (CIC) is an established treatment for lower urinary tract dysfunction and has been used across age groups with voiding problems due to various etiologies. Although medically safe and straightforward, CIC may create social and emotional challenges for adolescents and their caregivers. During adolescence, when autonomy and peer acceptance become central, the need for continuous catheterization in daily life and, at times, dependence on another person can be difficult to cope with and may affect psychological well-being and peer relations. This study aimed to examine factors associated with potential psychopathology, self-perception, peer relationship characteristics, and quality of life in adolescents performing CIC. Methods. This prospective cross-sectional study included 50 adolescents aged 12–18 years: 25 performing CIC and 25 age and sex-matched healthy controls. Participants with intellectual disability, low mental capacity preventing comprehension of study procedures, or uncorrected vision/hearing deficits were excluded. Psychiatric diagnoses were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children—Present and Lifetime Version DSM-5 (K-SADS-PL). Self-perception, quality of life, behavioral difficulties, and peer relationships were evaluated using the Piers-Harris Children’s Self-Concept Scale, Pediatric Quality of Life Inventory, Strengths and Difficulties Questionnaire, and Peer Relationship Scale. Parental attitudes and caregivers’ psychological symptoms were assessed using the Parental Attitude Research Instrument and the General Health Questionnaire-28. Statistical analyses were performed using SPSS version 23.0. Group comparisons were conducted using the independent samples t-test or Mann–Whitney U test as appropriate; categorical variables were analyzed with the Chi-square or Fisher’s exact test. Multiple linear regression analysis was performed to identify independent predictors. A two-tailed p value <0.05 was considered statistically significant. Results. The groups were similar in age, sex and sociodemographic characteristics. Adolescents performing CIC showed higher social avoidance and poorer peer relationships. Eight adolescents (32%) in the CIC group met criteria for at least one psychiatric disorder according to DSM-5. Negative parental attitudes, maternal mental disorders, primary etiology requiring CIC, age at self-catheterization initiation, and catheterization performed by another individual were identified as significant predictors of lower self-esteem, reduced quality of life, and poorer peer relationships. Conclusion. CIC may have meaningful psychological and psychosocial effects on adolescents, influenced by clinical variables and parental factors. Early identification of risk indicators and strengthening of protective factors are essential. A multidisciplinary approach incorporating psychiatric, familial, and psychosocial components should be included in the management and follow-up of adolescents performing CIC.

Purpose: To evaluate the efficacy, safety, and tolerability of combined low-intensity extracorporeal shock wave therapy and platelet-rich plasma in patients with acute-phase Peyronie’s disease.Materials and methods: This retrospective single-center study included 42 men with acute-phase Peyronie’s disease treated between January 2025 and January 2026. The acute phase was defined as a symptom duration of less than 6 months. All patients received daily tadalafil, six sessions of low-intensity extracorporeal shock wave therapy, and three intralesional platelet-rich plasma injections. Penile curvature, plaque size, penile pain, and erectile function were assessed before treatment and 3 months after treatment. Penile pain was evaluated with a visual analog scale, and erectile function was assessed using the International Index of Erectile Function. Paired comparisons were performed according to data distribution.Results: The median pain score decreased significantly from 7.00 to 3.50 (p<0.001). Erectile function also improved significantly, with the mean score increasing from 16.59±4.51 to 20.88±5.51 (p<0.001). Mean penile curvature decreased from 33.89±10.49 degrees to 31.53±13.26 degrees, but this change was not significant (p=0.058). Mean plaque size changed from 1.58±0.45 cm to 1.56±0.46 cm without statistical significance (p=0.594). No major adverse events were observed. Minor local complications included mild ecchymosis in 11.9% and transient edema in 4.8% of patients.Conclusion: Combined low-intensity extracorporeal shock wave therapy and platelet-rich plasma appears to be a safe and effective conservative treatment option in acute-phase Peyronie’s disease. The protocol provided significant pain relief and improved erectile function, while stabilizing penile curvature and plaque size

Background: Artificial intelligence (AI) and large language models (LLMs) are increasingly integrated into healthcare, yet their adoption in pediatric urology remains insufficiently explored. Pediatric urology, with its complex and rare conditions, may particularly benefit from AI-based innovations. Objectives: This study aimed to assess pediatric urologists’ awareness, usage patterns, and perceptions regarding AI and LLMs, while also identifying potential applications, barriers, and educational needs. Design: A cross-sectional, descriptive survey was conducted among pediatric urologists. Methods: Between May and July 2025, a 21-item questionnaire was distributed via professional networks and mailing lists. Items addressed demographics, knowledge of AI, frequency and purpose of AI and LLM use, perceived clinical and surgical applications, ethical concerns, and interest in AI training. Descriptive statistics were used for analysis. Results: Of 368 invited pediatric urologists, 103 (28%) responded. Most reported moderate (35.0%) or low (29.1%) knowledge of AI, yet more than half (51.5%) used AI tools daily. LLMs had been used by 96.1% of participants, mainly for scientific writing (78.8%), language editing (54.5%), and text summarization (46.5%). Surgical simulation (46.6%), imaging-based strategy planning (40.8%), and preoperative planning (36.9%) were identified as promising clinical applications. Barriers included lack of trust (52.4%), ethical concerns (43.7%), and insufficient knowledge (35.0%). A strong interest in structured AI training was expressed by 81% of participants. Although responses were obtained from multiple countries, the majority of participants were based in Turkey, and the findings should be interpreted accordingly. Conclusion: Pediatric urologists demonstrate substantial engagement with AI in academic work, while clinical integration is still limited. The findings highlight a strong demand for AI education and emphasize the need for regulatory clarity, ethical frameworks, and validated tools to enable safe and effective use of AI in pediatric urology.

Objectives: Transperineal (TP) prostate biopsy is increasingly used because of its lower complication rates compared with the transrectal approach. However, prospective data regarding its effects on erectile and ejaculatory function remain limited. This study prospectively evaluated short-term sexual function outcomes after TP prostate biopsy in sexually active men. Methods: This single-center prospective observational cohort study included men undergoing TP prostate biopsy between 15 April 2025 and 1 September 2025. Indications for biopsy were prostate-specific antigen levels >4 ng/mL, abnormal digital rectal examination findings, or suspicious lesions (PI-RADS ≥ 3) on multiparametric prostate MRI. Sexual function was assessed at baseline and at 1 and 3 months after biopsy using the International Index of Erectile Function (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). Results: Overall, 249 sexually active men were analyzed. No significant changes in erectile or ejaculatory function were observed in the overall cohort at either follow-up point. In contrast, among 132 men diagnosed with prostate cancer, significant declines were observed in IIEF-5, PEDT, and MSHQ-EjD-SF scores at both 1 and 3 months compared to baseline (all p < 0.001). Conclusions: Transperineal prostate biopsy minimally affects sexual function in the general population. However, prostate cancer patients experience notable deterioration in erectile and ejaculatory outcomes, which may be a transient decline, and long-term follow-up is necessary for this subgroup.

Background: Monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition that affects a child’s self-esteem and daily family life. Both enuresis alarm and desmopressin are recommended as first-line treatment options, but their comparative effectiveness and relapse rates remain subjects of discussion. Aim: This study aimed to compare the short-term treatment outcomes and relapse rates of desmopressin, alarm therapy, and combination therapy in children with primary MNE. Materials and Methods: This retrospective two-center study included 202 children diagnosed with MNE between September 2022 and January 2025. Patients were grouped into desmopressin monotherapy (n=124), alarm therapy (n=45), and combination therapy (n=33). Demographic data, treatment responses, and relapse rates were evaluated. Results: Complete response rates were 39.5% for desmopressin, 42.2% for alarm therapy, and 63.6% for the combination group. Relapse occurred in 48.4% of the desmopressin group, 33.3% of the alarm group, and 30.3% of the combination group. Although the combination group showed higher response rates and lower relapse rates, these differences were not statistically significant (p>0.05). Conclusion: Desmopressin, alarm therapy, and their combination are effective options for the treatment of primary MNE. Combination therapy may provide added benefit in selected patients, but no clear superiority was demonstrated in this study. Treatment plans should consider individual factors such as nocturnal urine output and family compliance.

Background/Objectives: To characterize functional brain activation during smiling and to assess cognitive profiles in patients with Ochoa (Urofacial) syndrome (UFS). Materials and Methods: In a block-design fMRI paradigm, participants alternated between imitating a smiling emoji and viewing a fixation cross. Images were preprocessed and analyzed in SPM12; Smile > Rest contrasts were tested with a voxelwise threshold of p < 0.001 (uncorrected). Cognitive levels were assessed using age-appropriate Wechsler scales administered by certified psychologists. Results: Six patients (mean age 20 years; 50% female) with genetically/clinically confirmed UFS were included. Smile > Rest elicited robust activation in the supplementary motor area (highest Z = 4.70), insula (largest cluster), dorsal anterior cingulate, primary motor cortex, and frontal eye fields, among others. Five patients completed cognitive testing; Full-Scale IQ ranged 50–74, consistent with mild intellectual disability to borderline intellectual functioning. Conclusions: During voluntary smiling, UFS patients exhibit activation patterns that overlap extensively with those reported in healthy cohorts. Nevertheless, cognitive performance was limited in this sample. Given the rarity of UFS and the small cohort, findings should be interpreted cautiously and validated in multicenter studies.

Sperm DNA fragmentation is associated with poor sperm quality and reproductive outcomes. Free radicals are a significant cause of DNA fragmentation, with mitochondria being the primary intrinsic source. To investigate the relationship between midpiece measurements containing mitochondria and sperm DNA fragmentation, and to determine the ideal midpiece area. Demographic data, semen analysis results, and DNA fragmentation values were prospectively collected from 239 men with infertility complaints. Detailed analyses and morphometric measurements were performed on 50 spermatozoa from each patient, totaling 11,950 spermatozoa. The ideal DNA fragmentation index (DFI) cutoff value was calculated. Patients were classified into three subgroups based on midpiece length, midpiece width, and midpiece area measurements. The correlation between mid-piece measurements and DFI was investigated. The cutoff value for DFI was determined as 19.50. The odds ratio evaluating the relationship between morphology status and high DFI was 0.159 (95% CI: 0.089—0.282). It was observed that midpiece length and width have statistically significant but low correlations with DFI, whereas midpiece area shows a higher correlation. Finally, based on DFI values, the ideal midpiece area was between 2.31 and 3.13 µm ² . There is a significant correlation between sperm midpiece area and DFI value, surpassing that of length and width. Future studies may yield important insights by exploring the impact of midpiece area measurements on reproductive outcomes.