Uğur Aydın

Purpose Penile surgeries, such as circumcision and hypospadias repair, somewhat raise concerns about long-term effects on genital sensation and sexual function. This study was conducted to support a hypothesis that preserving the dorsal preputial subcutaneous tissue and adding it as a tissue onlay to the ventral hypospadias penis could provide a potential benefit in the future on penile sensation and sexual function. Methods The study groups consisted of 22 children who underwent tubularized incised plate urethroplasty (TIPU) distal hypospadias repair, and 24 standard circumcision cases for religious purpose between June 2022-November 2023. Dorsal subcutaneous preputial flap was used to cover the neourethra to reduce the risk of fistula formation in all TIPU repairs as described. Dorsal hood preputium specimens as full layer (after circumcision) and after dissecting its subcutaneous layer (after TIPU) were compared histopathologically for vascular and neural components, focusing on peripheral nerve endings, Meissner and Pacinian corpuscles. Results There was no statistically significant difference between full dorsal skin and dissected TIPU skin in terms of the number of arteries, the number of peripheral nerves, and the number of Meissner and Pacini corpuscles. Conclusion The structure of skin devoid of subcutaneous layer still contained the same number of neural structures as the normal skin, so the subcutaneous tissue laid ventrally probably will add no benefit for future penile sensation.

Objective: Ureteral double-J (DJ) stents are frequently used in urology. Overdue or forgotten DJ stents are associated with many complications. This study will examine the factors affecting the stent forgetting period of patients with forgotten DJ stents. Materials and Methods: It was reviewed by Ağrı İbrahim Çeçen University Scientific Research Ethics Committee and approved with the decision numbered 108 dated 27.03.2025. Data from 12 patients with DJ stent indwelling longer than 6 months between January 2017 and December 2024 at Ağrı Training and Research Hospital, a rural tertiary center in Türkiye, were examined. Two groups were formed according to the median stent indwelling time: short-term (group 1) and long-term (group 2). The patient’s age, gender, DJ stent placement indication, additional endourological procedure need and duration, restenting rates, and distances to the hospital were compared. Results: There was no difference between the two groups regarding gender, indication for stent placement, additional endourological procedures, and restenting rate after additional endourological procedures. The mean age was 43.5 years (SD: 11) in group 1 and 61.3 years (SD : 9.5) in group 2 (p: 0.012). Median additional endourological procedures’ duration was 37.5 minutes (IQR:27.5-40) in group 1 and 67.5 minutes (IQR: 52.5-87.5) in group 2 (p = 0.005). Median distance to the hospital was 38.5 kilometers (IQR: 19.25-77.75) in group 1 and 85.5 kilometers (IQR: 75.75-91.5) in group 2 (p = 0.037). Conclusion: Our study concluded that patients whose DJ stents were forgotten for longer were older and resided in a center farther from the hospital. It would be beneficial to be careful, especially in this patient group.

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 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.

Purpose Investigation of how position affects postoperative pain levels and hospitalization in patients undergoing percutaneous nephrolithotomy (PNL) surgery. Methods Between August 2019 and December 2022, a total of 156 patients who underwent prone (pPNL) and supine percutaneous nephrolithotomy (sPNL) due to kidney stones were included in the study. Demographic data, preoperative CT scans, laboratory results, transfusion rates, operation durations, complication rates, stone-free rates, analgesic use, nephrostomy removal time, hospitalization duration, fluoroscopy time, hemoglobin decrease and postoperative Visual Analog Scale (VAS) scores were evaluated for all patients. By comparing these data between the sPNL and pPNL groups, the effect of position selection in PNL on pain control, analgesic requirement, and hospitalization duration was examined. Results In the comparison of the pPNL and sPNL groups, there was a significant difference between the two groups in body mass index, hounsfield unit, complication rate, analgesic rate, nephrostomy remove time, hospitalization time, operation time, fluoroscopy time and VAS score (p = 0.025, p < 0.001, p = 0.012, p = 0.012, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). Conclusion The shorter operation and hospitalization time in the sPNL group could be attributed to performing surgeries in a physiological position. Additionally, sPNL seems advantageous in terms of patients' pain levels, hospitalization time and VAS scores. One reason for this could be the different areas of access in sPNL and pPNL, which may correspond to different dermatome regions. Considering the low level of pain and reduced analgesic usage, sPNL appears to be advantageous.

Objective: To analyze the parameters that can facilitate the differential diagnosis of brucella epididymorchitis (BEO) and non-brucella epididymorchitis (NBEO) and to facilitate early diagnosis. Material And Methods: The data of 23 BEO patients and 80 NBEO patients, who applied in a tertiary center in eastern Turkey, where brucellosis is common, were retrospectively analyzed. Age, hemogram parameters (white blood cell (WBC)), neutrophil, lymphocyte, monocyte, eosinophil, basophil, platelet, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), red blood cell distribution width (RDW), biochemical parameters (aspartate transaminase and alanine aminotransferase), inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and procalcitonin), urine culture, and scrotal doppler ultrasound findings were analyzed retrospectively and were compared between BEO and NBEO groups. Results: In the comparison of the BEO and NBEO groups, there was a significant difference between the two groups in WBC count, neutrophil count, monocytes count, NLR, MLR, MPV, and procalcitonin levels (p = 0.035, p = 0.007, p = 0.003, p = 0.005, p = 0.01, p < 0.001, p < 0.001, respectively). Conclusions: The NLR may be promising for use in the early diagnosis of BEO. The MPV also drew attention as parameters that can be evaluated