Süleyman Barış Kartal

Objective: This study aimed to evaluate the safety of percutaneous nephrolithotomy (PNL) following normalization of procalcitonin (PCT) levels in kidney stone patients with recurrent urinary tract infections (rUTIs) and assess the diagnostic performance of PCT in predicting postoperative infective complications.Materials and Methods: A prospective cohort study was conducted between January 2020 and December 2024, including 29 kidney stone patients with a history of rUTI and persistent infection despite multiple antibiotic regimens. PNL was performed after normalization of serum PCT levels (38.5°C, PCT >2.0 ng/mL with clinical signs of infection, or positive blood culture); secondary endpoints included overall complication rate, stone-free rate, and length of hospital stay. The diagnostic performance of PCT was evaluated using ROC curve analysis.Results: The mean age was 48.1±14.4 years, with 51.7% male patients. The average stone size was 31.1±14.1 mm. extendedspectrum betalactamase (ESBL)-producing E. coli was the most common preoperative pathogen (72.4%). Preoperative PCT median value was 0.06 ng/mL (range 0.01-0.24), with all patients within normal limits. All patients underwent successful PNL (mean operative time: 78.5±15.2 minutes). Postoperatively, infectious complications occurred in 3 patients (10.3%), with no cases of sepsis or septic shock. ROC analysis revealed an AUC of 0.887 (95% CI: 0.743–1.000, p=0.032), with an optimal cut-off value of 1.5 ng/mL (sensitivity: 100%, specificity: 89.3%). The stone-free rate was 55.2%, and the mean hospital stay was 2.7±1.04 days.Conclusion: PNL guided by PCT is a safe and effective treatment in patients with rUTI. PCT is a valuable biomarker for predicting postoperative infections and supporting surgical decision-making in high-risk patients.

Background: Data on factors affecting the success of incisional corporoplasty based on the geometric principles in congenital penile curvature (CPC) are limited. Aim: To compare the pubertal status (prepubertal and postpubertal), degree of curvature (<60° and ≥60°), direction of curvature (ventral, dorsal, lateral, ventrolateral), curvature plane (monoplanar or multiplanar) and to investigate the factors affecting success in patients who underwent incisional corporoplasty based on geometric principles due to CPC. Methods: A total of 79 patients who underwent incisional corporoplasty based on geometric principles between 2016 and 2024 in two tertiary care referral centers were evaluated. The surgical technique we apply to our patients is a modification of incisional corporoplasty. This technique is based on the geometric principles of the Egydio technique. Success was defined as complete satisfaction of the patient and/or patient’s parent and absence of recurrence of curvature. Outcomes: Satisfaction, success, complication rates in patients who underwent incisional corporoplasty based on geometric principles due to CPC and comparison of these patients in terms of the pubertal status (prepubertal and postpubertal), degree of curvature(<60° and ≥60°), direction of curvature (ventral, dorsal, lateral, ventrolateral), curvature plane (monoplanar or multiplanar). Results: The success rate in our study was found to be 82.2% and the total complication rate was determined as 26.5%. The success rate was 90.5% in patients in the prepubertal period, and 79.3% in patients in the postpubertal period (P = 0.331). Success occurred 82% of patients with a curvature <60°, while this rate was 82.8% in patients with a curvature of ≥60° (P = 0.396). Success was found to be 75% for multiplanar curvature and 83.1% for monoplanar curvature (P = 0.626). In regression analysis, it was found that age (P = 0.185), puberty status (P = 0.263), degree of curve (P = 0.770), direction of curve (P = 0.927), presence of multiplanar curve (P = 0.573) and operation time (P = 0.924) did not affect success. According to Kaplan–Meier analysis the P-values ​​for puberty status, degree of curvature, curvature plane and curvature direction were found to be 0.575, 0.720, 0.845, and 0.819, respectively. Clinical implications: Modification of incisional corporoplasty based on the geometric principles of the Egydio technique is an effective method in patients with CPC, regardless of age and curvature characteristics. Strengths and limitations: The lack of a group to compare this technique with other techniques, small sample size, the retrospective design of the study, the results being based on patient-reported results. The results discussed may cause bias because they are based on patient reports and do not include standard questionnaires. Conclusions: The geometrically modified incisional corporoplasty technique has a high success rate in patients with CPC up to 90°, regardless of the patient’s age, pubertal status, degree of curvature, direction, and whether it is multiplanar or not.