Mehmet Uğur Yilmaz

Background: The SIOP-RTSG and NWTSG/COG approaches differ primarily in the timing of nephrectomy and the clinical information used for risk stratification. Direct comparisons are complicated because protocol selection is closely linked to treatment center, institutional practice, and healthcare-system context. We compared real-world survival outcomes between two protocol–care ecosystems after adjustment for harmonizable baseline risk factors. Methods: This retrospective, two-country, multicenter cohort study included 183 consecutive children treated for Wilms tumor between 1997 and 2025 at centers in Azerbaijan and Türkiye. Of these, 78 received SIOP-RTSG-based treatment and 105 received NWTSG/COG-based treatment. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Cox proportional hazards models were used to evaluate the association of protocol–care ecosystem with OS and EFS after adjustment for age category and harmonized disease stage. Preoperative response and histological risk were evaluated exploratively within the SIOP-RTSG cohort. Results: Five-year OS was 84.8% in the SIOP-RTSG group and 87.0% in the NWTSG/COG group, with no difference between the survival curves (log-rank p=0.978). Five-year EFS was 76.3% and 80.7%, respectively (log-rank p=0.661). In the multivariable OS model, the protocol–care ecosystem was not independently associated with mortality (adjusted hazard ratio [aHR] 1.046, 95% confidence interval [CI] 0.453–2.413; p=0.916). Older age category (aHR 2.858, 95% CI 1.513–5.400; p=0.0012) and stage III–V disease (aHR 3.364, 95% CI 1.117–10.132; p=0.031) were independently associated with poorer OS. Similarly, the protocol–care ecosystem was not associated with EFS (aHR 0.963, 95% CI 0.501–1.853; p=0.911), whereas older age category (aHR 1.869, 95% CI 1.173–2.978; p=0.0085) and stage III–V disease (aHR 2.556, 95% CI 1.186–5.510; p=0.0166) were associated with a higher event risk. Within the SIOP-RTSG cohort, poor preoperative response was associated with inferior OS (HR 5.957, 95% CI 1.542–23.016; p=0.0097) and EFS (HR 3.640, 95% CI 1.341–9.883; p=0.0112). High-risk histology was associated with inferior EFS (HR 3.748, 95% CI 1.010–13.903; p=0.0482), but not significantly with OS.Conclusions: After adjustment for age and stage, the protocol–care ecosystem was not independently associated with OS or EFS. Older age and advanced-stage disease were the principal unfavorable prognostic factors, while poor preoperative response and high-risk histology provided additional prognostic information within the SIOP-RTSG cohort. These findings do not establish equivalence between the SIOP-RTSG and NWTSG/COG strategies but indicate that both may achieve satisfactory survival outcomes when implemented within structured multidisciplinary care systems. Due to the retrospective, observational nature of the study and the use of anonymized patient data, the requirement for written informed consent was waived by the institutional review boards.

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.

Çocuklarda genital bölge kitlelerinin ayırıcı tanısında abseler, hemanjiomlar ve yumuşak doku kaynaklı kitleler yer alır. Labial anjiomiksomalı adolesan hastayı sunmayı amaçladık. On dört yaşında kız hasta 9 ay içinde progresif büyüyen sağ labiumda sert, immobil, ağrısız bir kitle ile başvurdu. Yapılan manyetik rezonans incelemede sağ labium majus düzeyinde 42x33x38 mm boyutlu, multilokule, lobule konturlu kitlesel lezyon saptandı. Eksize edildi ve patolojisi anjiyomiksoma ile uyumlu saptandı. Hastanın lokal nüks açısından takipleri devam etmekte olup ameliyat sırasında ve sonrasında herhangi bir sorun yaşanmadı. Genitoüriner anjiomiksomalar adolesanlarda nadiren görülür. Cerrahi eksizyonu ve lokal nüks açısından postoperatif yakın takibi önemlidir.