Şeref Coşer

Introduction: This study aimed to assess the predictive power of the “Briganti,” “Partin,” and “Memorial Sloan Kettering Cancer Center” (MSKCC) nomograms in the Turkish population. Methods: Between 2010 and 2021, 575 patients retrospectively evaluated in our center who underwent radical prostatectomy and bilateral pelvic lymph node dissection. The patients’ lymph node invasion (LNI) risk was calculated from every 3 nomograms and compared with the LNI rates. The general accuracy of the nomograms in predicting metastatic lymph node disease was measured by creating the characteristic receiver operating characteristic curve. Results: The average age of patients was 63.9 ± 6.7 (40–79) and lymph node involvement was present in 8.6% of all patients. Considering the 5% cut-off value according to the European Association of Urology guideline and 2% cut-off value based on National Comprehensive Cancer Network’s guideline, the accuracies of the nomograms were 76.8% (95% CI: 0.700–0.836, p < 0.001) and 68.2% (95% CI: 0.623–0.742, p < 0.001) for the Briganti nomogram; and 74.2% (95% CI: 0.684–0.818, p < 0.001) and 77.6% (95% CI: 0.710–0.841, p < 0.001) for the Partin nomogram, respectively. For the MSKCC nomogram, it was determined to be 75.1% (95% CI: 0.684–0.816, p < 0.001) and 69.6% (95% CI: 0.638–0.754, p < 0.001). Conclusion: All 3 nomograms demonstrated clinically relevant predictive accuracy in predicting lymph node metastasis. In particular, the Partin nomogram revealed the highest predictive power according to the NCCN criteria. These findings provide evidence for external validity of these nomograms for clinical use in the Turkish population.

Background/Objectives: The aim of this study was to develop a modified version of the T.O.HO. score for predicting percutaneous nephrolithotomy (PCNL) success. Materials and Methods: Patient demographics, stone-related parameters, perioperative findings, and postoperative outcomes were recorded. We reviewed the data of 155 patients who underwent percutaneous nephrolithotomy (PCNL) between October 2020 and December 2024. Patients were divided into two groups: success and failure. While preserving the validated components of the existing T.O.HO. score, the stone location parameter was restructured to more accurately reflect the anatomic challenges inherent to PCNL and was scored to include locations in the renal pelvis, upper, middle, lower and multiple calyces. The performance of the T.O.HO.-PCNL score in predicting surgical success was evaluated using ROC curve analysis. Results: The overall success rate was 65.8%. Patients in the successful group had smaller stone sizes and shorter operative times and hospital stays (p < 0.01). Preoperative hydronephrosis was more commonly observed among unsuccessful group (p < 0.05). The T.O.HO.-PCNL score was significantly lower in the successful group compared with the unsuccessful group. (p < 0.05). In the multivariate logistic regression analysis, stone size emerged as an independent predictor of PCNL success (OR: 1.076; 95% CI: 1.032–1.122; p < 0.001). ROC curve analysis demonstrated that the T.O.HO.-PCNL score had predictive value for PCNL success, with an optimal cut-off of 8.5 (AUC: 0.598; 95% CI: 0.506–0.690; p = 0.046). Conclusions: The T.O.HO.-PCNL scoring system is a promising nomogram for predicting stone-free status after PCNL in preoperative evaluation.

Aim Erectile dysfunction (ED) represents one of the most clinically significant and detrimental quality-of-life complications in prostate cancer (PCa) patients following treatment. Different modalities are applied to improve and rehabilitate functional results, especially erectile function after radical prostatectomy (RP). We aimed to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative erectile function in patients who underwent bilateral nerve sparing robot-assisted radical prostatectomy (RARP). Methods The data of patients who underwent RARP for PCa were retrospectively examined. Patients were divided into two groups: those who underwent TENS to improve ED status after RARP (TENS(+)) and those who did not (TENS(-)). The patients’ demographic data, surgical data, pre-op/post-op 3rd month International Prostate Symptom Score (IPSS), and pre-op/post-op 6th and 12th month International Index of Erectile Function (IIEF-5) data were evaluated. Results Of the 80 patients included in the study, 40 were allocated to the TENS(+) group and 40 to the TENS(-) group. The demographic and operative characteristics of the groups were similar. Preoperative and postoperative IPSS were statistically similar in both groups (p = 0.07 and p = 0.12, respectively). While, the mean preoperative IIEF-5 scores were similar for two groups, they were found to be statistically higher in the TENS(+) group in post-operative 6th months (p < 0.001). However, the improvement in IIEF score in the TENS(-) group was more pronounced during the second six months post-operatively, and no statistically significant difference was observed between the two groups at the 12th postoperative month (p = 0.12). Conclusion TENS therapy administered following RARP may be efficacious in penile rehabilitation 6 months post-surgery. TENS may be an alternative therapy for patients seeking early erectile recovery after RARP.

Objective: Bladder stones represent a significant part of urinary stone diseases, predominantly affecting men over 60, especially those with benign prostatic hyperplasia and neurological disorders with urinary dysfunction. Technological advancements have led to various treatment modalities for bladder stones, including transurethral cystolithotripsy, extracorporeal shock wave lithotripsy (ESWL), percutaneous cystolithotripsy, and open cystolithotomy. Mechanical lithotriptors, despite their long history and efficacy, have become less prominent in favor of newer technologies like laser lithotripsy. This study evaluates the effectiveness and safety of mechanical lithotriptors in the treatment of bladder stones. Material and Methods: This retrospective study included 194 patients who underwent surgery for bladder stones at Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital between January 2020 and January 2023. Inclusion criteria were male patients over 18 years undergoing endoscopic intervention with available preoperative and postoperative data. Patients who underwent open surgery or had incomplete data were excluded. Surgical methods included lithotripsy using a 30 Watt Holmium Laser and litholapaxy using Mauermayer’s Stone punch lithotriptor. Data on demographics, surgery duration, surgical equipment used, stone size, postoperative complications, and additional treatments were recorded and analyzed using SPSS 24.0. Results: The mechanical lithotripsy group (n=140) had an average age of 65.44±14.74 years, while the laser lithotripsy group (n=54) had an average age of 67.91±14.58 years (p=0.297). In the mechanical group, 117 patients had spinal anesthesia and 23 had general anesthesia, compared to 44 spinal and 10 general anesthesia in the laser group (p=0.728). Additional surgical interventions were required in both groups with no significant difference (p=0.360). The average lithotripsy time was significantly shorter in the mechanical group (52.29±28.86 minutes) compared to the laser group (62.69±22.83 minutes) (p=0.01). No significant differences were found in stone size between groups. Complication rates were comparable, with 133 complication-free cases in the mechanical group and 52 in the laser group (p=0.809). Conclusions: Mechanical lithotripsy offers a shorter surgery duration with comparable complication rates to laser lithotripsy. Despite being underutilized, mechanical lithotriptors continue to be a viable and effective option for treating bladder stones, particularly in centers with surgical expertise. The findings of this study support the safety and efficacy of mechanical lithotriptors in clinical practice, contributing to the existing literature on bladder stone treatment options.

Varicocele is a common vascular condition characterized by abnormal dilation of the pampiniform plexus due to venous valve insufficiency. Anatomical factors contribute to its higher prevalence on the left side. While the overall prevalence in the general male population is 15%, it rises to 35–80%among infertile men. The incidence increases during adolescence due to hormonal changes and testicular growth. The pathophysiology of varicocele involves testicular hyperthermia, oxidative stress, and venous stasis. Testicular hyperthermia negatively affects sperm production, while oxidative stress causes sperm DNA damage, threatening fertility. Venous reflux leads to the accumulation of adrenal and renal metabolites in the testes, resulting in cellular damage. Although adolescent varicocele is often asymptomatic, it can lead to testicular volume loss and infertility over time. Physical examination is the primary diagnostic method, but Doppler ultrasonography is necessary for detecting subclinical cases. Treatment decisions depend on the severity of the varicocele and differences in testicular volume. Various surgical and interventional treatment options exist, but there is no consensus on the best technique. Microsurgical approaches reduce recurrence rates and lower the risk of hydrocele formation. In adolescents, treatment is indicated in cases with a testicular volume difference >2 mL or 20%, pathological semen analysis, or symptomatic varicocele. Conservative follow-up involves regular ultrasonographic monitoring to assess testicular growth. The long-term impact of adolescent varicocele on fertility remains controversial. Some studies suggest that early treatment improves future fertility, while others report no significant benefit. However, early diagnosis and individualized treatment strategies are recommended to preserve testicular function and prevent future complications. Keywords: varicocele, adolescent, testicular function, infertility, microsurgery

Introduction: This study aims to show the bacteriologic picture of acute prostatitis and bacteremia caused by infective agent after transrectal ultrasound-guided prostate biopsy (TRUSBx) and to determine the resistance rates of the infections in patients undergoing transrectal biopsy and to guide prophylaxis approach before biopsy. Methodology: The retrospective data of 935 patients who underwent TRUSBx between January 2010 to January 2019 were reviewed. Pre-biopsy urine cultures and antimicrobial susceptibility were obtained. Subsequently, patients admitted to the hospital with any complaint after biopsy were examined for severe infection complications. Results: Of the 430 (61.7%) patients who underwent urine culture before the procedure, 45 (10.5%) had growth; 30 (66.7%) of the growing microorganisms were Escherichia coli. Twenty (44.4%) of all Gram-negative agents in pre-biopsy urine culture were susceptible to quinolone. Post TRUSBx bacteremia was present in 18.2%, urinary system infection in 83.6%, and hospitalization in 61.8% of 55 patients who were admitted to the hospital. In the isolated gram-negative microorganisms, fluoroquinolones resistance in urinary system infections was seen in 40% and bacteremia was seen in 70% of the cases. ESBL-producing Gram-negative bacteria were determined in 40% of infections in blood and 38.5% of urinary system infections in the post biopsy period in the current study. Conclusions: These high antibiotic resistance rates suggest that we better review our pre-procedure prophylaxis approaches.

Primer Adrenal Malignitelere Yaklaşım Feyzi Sinan ERDAL Benign Böbrek Tümörleri Selim TAŞ Renal Kitlelerde Tanısal Yaklaşım Ali Erhan EREN Küçük Renal Kitlelere Yaklaşım Çağatay ÖZSOY Kayhan YILMAZ Böbrek Tümörlerinde Biyokimyasal Belirteçler Osman CAN Böbrek Tümörlerinde Biyopsinin Yeri Kenan ÖZTORUN Lokalize Böbrek Kanserinde Cerrahi Tedaviler Mehmet Vehbi KAYRA Metastatik Böbrek Kanserine Yaklaşım Mehmet Vehbi KAYRA Lokalize Hastalığın Tedavisinden Sonra Lokal Olarak Tekrarlayan RCC Mustafa Serdar ÇAĞLAYAN Böbrek Kanserlerinde Fokal Tedaviler Arif KOL Böbrek Tümörlerinde Laparoskopik ve Robotik Cerrahi Tedavi Yöntemleri Abdulkadir ÖZMEZ Retroperitoneal Kitlelere Yaklaşım Ali SEZER Böbrek Kanserinde İmmunoloji ve İmmunoterapiler Fahri Yavuz İLKİ Emre BÜLBÜL Üst Üriner Sistem Tümörlerine Yaklaşım Yaşar PAZIR Mesanenin Prekanseröz Lezyonlarına Yaklaşım Çağrı DOĞAN Kasa İnvaze Olmayan Mesane Kanserine Yaklaşım Ahmet Ender CAYLAN Yüzeyel Mesane Kanserinde İntravezikal Tedaviler Şeref COŞER Kasa İnvaze Mesane Kanserine Yaklaşım Uğur AFERİN Kasa İnvaze Mesane Kanserinde Açık, Laparoskopik ve Robotik Cerrahi Yöntemleri Mehmet Yiğit YALÇIN Üriner Diversiyon Yöntemleri Eyyüp DANIŞ Metastatik Mesane Kanserine Yaklaşım Mithat KIVRAK Çağlar YILDIRIM Ürotelyal Karsinom Dışı Varyant Tip Mesane Kanserlerine Yaklaşım Tuncer BAHÇECİ Mesane Kanserinde İmmunoloji ve İmmunoterapiler Burhan BAYLAN Üretral Tümörlere Yaklaşım Osman Murat İPEK Prostat Kanseri Gelişimi, Patofizyolojisi ve Moleküler Biyolojisi Mustafa KARABIÇAK Prostat Kanseri: Epidemiyoloji, Etiyoloji ve Korunma Yöntemleri Eyyüp DANIŞ Prostat Kanserinde Tümör Belirteçleri Oğuzhan KAHRAMAN Prostat Biyopsilerinde Histopatolojik Değerlendirme Özlem ÜÇER Prostat Kanserinde Tanı ve Evreleme Yaşar PAZIR Lokalize Prostat Kanserine Yaklaşım Enis Mert YORULMAZ Prostat Kanserinde Aktif İzlem Utku CAN Açık, Laparoskopik ve Robotik Radikal Prostatektomi Yöntemleri Alper COŞKUN Prostat Kanserinde Cerrahi Sonrası Görülen Komplikasyonlara Yaklaşım Mehmet İkbal İPEK Prostat Kanserinde Radyoterapi Kemal GÜMÜŞ Prostat Kanserinde Fokal Tedaviler Engin Denizhan DEMİRKIRAN Lokal İleri Prostat Kanserine Yaklaşım Adem UTLU Tugay AKSAKALLI Prostat Kanseri Definitif Tedavisi Sonrası Biyokimyasal Nükse Yaklaşım Yasin AKTAŞ Mahmut Taha ÖLÇÜCÜ Prostat Kanserinde Hormonal Tedavi Ömer ERDOĞAN Metastatik Prostat Kanserine Yaklaşım Feyzi Sinan ERDAL Nazım Furkan GÜNAY Testis Tümörlerinde Patofizyoloji, Risk Faktörleri ve Biyolojik Gelişim Haydar GÜLER Testiküler Mikrolitiyazis Eray KEMAHLI Emrullah SÖĞÜTDELEN Testis Tümörü Tanı ve Evrelemesi Sinan AVCI Rıdvan ÖZCAN Testis Tümörlerinde Cerrahi Tedavi Yöntemleri Emre KANDEMİR Testis Tümöründe Cerrahi Sonrası Takip-Tedavi Cihan TOKTAŞ Penil Kanserlere Yaklaşım Muzaffer Tansel KILINÇ Pediatrik Olgularda Mesane, Adrenal ve Renal Tümörlere Yaklaşım Mesut DEMİR Pediatrik Olgularda Testis Tümörlerine Yaklaşım Mehmet Nuri CEVİZCİ Üroonkolojide Robot Yardımlı Cerrahinin Yeri Mehmet Fatih ŞAHİN