Kürşat Küçüker

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.

Objectives: This study aimed to investigate the impact of scrotal pain on venous diameter and reflux duration in varicocele, and to assess the predictive value of ultrasonographic findings for varicocele grading. Methods: Fifty-two symptomatic patients with left-sided varicocele, presenting with infertility or scrotal pain, were prospectively evaluated. Grading was based on physical examination. Visual Analog Scale (VAS) scores, venous diameters, and reflux durations were measured using scrotal color Doppler ultrasonography (CDUS) both during active pain and after pain had markedly subsided or resolved. Results: After pain resolution, venous diameters significantly decreased in both resting and Valsalva states (p < 0.001). In grade-specific analysis, this reduction was significant only in grade II varicocele (rest: p = 0.004; Valsalva: p = 0.026). Reflux durations also significantly decreased after pain relief in all varicocele grades, both at rest and during Valsalva (p < 0.001 for all, except G3 Valsalva: p = 0.001). Ultrasonographic parameters during the pain-present state showed better discrimination for detecting grade I varicocele (AUC: 0.88), while the pain-free state provided better diagnostic accuracy for grade III varicocele (AUC: 0.69). Combining measurements from both conditions further improved predictive accuracy, especially for grade III varicocele (AUC: 0.77). Conclusions: Scrotal pain significantly influences scrotal CDUS findings in patients with varicocele, leading to measurable differences in venous diameter and reflux duration between pain-present and pain-free states. Therefore, consideration of symptom status when interpreting scrotal CDUS results may improve diagnostic accuracy and support more informed clinical decision-making.

Background/Objectives: Conventional imaging modalities are often inadequate for evaluating the proximal extent of anterior obliterative urethral strictures. Magnetic Resonance Imaging (MRI), with its superior soft tissue resolution, provides detailed anatomical insights and significantly contributes to surgical planning in such cases. Methods: Four male patients aged 26–63 years with anterior obliterative urethral strictures were evaluated using MRI in addition to conventional imaging. All MRI scans were performed following a modified Joshi protocol. Clinical data, MRI findings, and surgical outcomes were retrospectively reviewed. Results: MRI successfully delineated stricture length, location, periurethral fibrosis, and proximal urethral status in all cases, correlating well with intraoperative findings. Case 1 showed a 2 cm proximal bulbar obliteration, excised with end-to-end anastomosis. Case 2 had a 2.5 cm distal bulbar stricture, managed similarly. Case 3 revealed multi-segmental strictures, treated with a combination of anastomosis, graft, and Kulkarni urethroplasty. Case 4 demonstrated a rare 9 cm distal penile obliteration with preserved proximal urethra, treated with anastomotic repair. MRI provided critical anatomical detail for surgical decision-making. Conclusions: MRI is a valuable imaging modality for the evaluation of anterior obliterative urethral strictures, particularly when the proximal extent of the stricture cannot be visualized with conventional imaging techniques. In our case series, MRI enabled precise delineation of the stricture length and surrounding anatomical structures, which was critical for selecting the most appropriate surgical approach.

Background/Objectives: Benign prostatic hyperplasia (BPH) is a prevalent condition in aging men and a major cause of lower urinary tract symptoms (LUTSs). While traditional treatments such as transurethral resection of the prostate (TURP) are effective, they are associated with notable morbidity. Ultrasound-guided transperineal laser ablation (TPLA) has emerged as a minimally invasive alternative. This study aimed to assess the 12-month efficacy, safety, and functional outcomes of TPLA in patients with LUTS secondary to BPH. Methods: This was a single-center, retrospective observational cohort study including 53 patients with moderate-to-severe LUTS due to BPH who underwent TPLA between November 2021 and May 2024. Baseline and follow-up assessments were conducted at 1, 3, 6, and 12 months, including IPSS, Qmax, PVR, prostate volume (MRI), QoL, IIEF-5, and MSHQ-ED/Bother scores. The procedure was performed under local anesthesia using the EchoLaser™ system, and ablation was guided via real-time transrectal ultrasonography. Results: Statistically significant improvements were observed in IPSS (median decrease from 30 to 13), Qmax (5.5 to 13.0 mL/s), and PVR (200 to 85 mL). Prostate and adenoma volumes decreased by 41.2% and 58.3%, respectively. Quality of life scores improved, and erectile function remained stable. Ejaculatory function improved significantly based on MSHQ-ED and MSHQ-Bother scores. No major complications or conversions to surgery occurred. Conclusions: TPLA appears to be a safe, effective, and minimally invasive treatment modality for LUTS caused by BPH. It offers sustained symptomatic relief, prostate volume reduction, and preservation of sexual function, making it a promising alternative for patients unfit or unwilling to undergo invasive surgery.

Objectives: Complications related to penile prosthesis implantation surgery (PPI) can be categorized as infectious, non‐infectious organ/tissue damage, device failure, and patient/partner dissatisfaction. However, no scoring system has been established to assess both preoperative physical status and intraoperative risk factors. The Estimation of Physiologic Ability and Surgical Stress (E‐PASS) score was originally developed to estimate postoperative complication risk in gastrointestinal surgeries. It incorporates age, severe cardiac/pulmonary disease, diabetes mellitus, performance status index, American Society of Anesthesiologists (ASA) classification, blood loss, body weight, operative time, and skin incision length. This study aims to evaluate the feasibility of the E‐PASS scoring system in predicting postoperative complications following PPI. Methods: In this single‐center retrospective study, data of 56 patients who underwent PPI between 2015 and 2024 were analyzed. Demographics, preoperative physical condition parameters, and intraoperative risk factors were recorded. E‐PASS score and sub‐scores were calculated. Results: Postoperative complications occurred in 17 patients (30.4%). Patients with complications had higher performance scores, ASA scores, prior pelvic/penile/urethral surgeries, prior PPI history, and higher E‐PASS scores (preoperative risk score, surgical stress score, and comprehensive risk score [CRS]). A CRS cut‐off value of −0.1238 predicted complications (AUC = 0.75; 95% CI 0.62–0.88; p < 0.003). CRS above the cut‐off was associated with a 16.2‐fold increase in complication risk. Conclusions: The E‐PASS scoring system appears to be a reliable tool for predicting postoperative complications in patients undergoing PPI by incorporating both preoperative physical condition and intraoperative risk factors.

Objective: Bladder outlet obstruction is a relatively rare problem in women. Experience in diagnosing and managing female urethral stricture disease is limited. The literature emphasizes that urethral dilatation is usually not successful, but surgical reconstruction is successful. Physicians and patients want to obtain information from social media because surgery cannot be performed in every center. With this study, we aimed to make an integrative review of the quality of the information in YouTube videos in the field of female urethroplasty. Material and Method: Using the keyword female urethroplasty, we searched https://www.youtube.com/ for the last 5 years. Video features, quality, and reliability analysis were performed. The reliability and quality of the medical information in the videos were determined by the JAMA (Journal of American Medical Association) scoring system, the Global Quality Score (GQS), and the DISCERN questionnaire. Results: 39 videos out of a total of 49 were included in the study. India was the country with the most video uploads (43.6%). There was no significant correlation between DISCERN score and the number of views and video comment count (rho;-0.101 p=0.539, rho;0.018 p=0.924, respectively). The DISCERN score, GQS, and JAMA scores of videos from Academic institutions or societies were found to be higher than personal videos (p=0.037, p=0.037, p=0.001, respectively). Conclusion: Although there are limited videos about female urethroplasty on YouTube, the accuracy and reliability of the medical information in the most watched videos are low.

Background and Objectives: This study aimed to determine the relationship between miRNAs and overactive bladder (OAB). We also aimed to reveal the diagnostic properties of miRNAs and their potential to predict responses to therapy. Materials and Methods: The study included 60 patients with OAB as the treatment group and 60 healthy individuals as the control group. The blood levels of 15 miRNAs in both groups were determined using PCR. Also, miRNAs with high diagnostic values were identified with receiver operating characteristic (ROC) curves. Finally, the Turkish-validated OAB questionnaire form was filled out before and after the treatment by the participants in the treatment group. In this way, the relationship between OAB score changes and miRNA levels was examined. Results: The let-7a, let-7c, let-7e, let-7f, and let-7g miRNA molecules in the treatment group were higher, with a high level of significance (p = 0.0001). Additionally, the miR-135b, miR-300, miR-372, miR-373, miR-381, miR-520a, miR-520d, and miR-520e miRNA molecules were found to be statistically higher in the control group (p = 0.0001). In addition, let-7c (area under curve [AUC] = 0.985) and the let-7c + miR-381 combination (area under curve [AUC] = 1) were the highest values in the ROC analysis. Finally, after treatment in the patient group, a significant difference was detected in both miRNAs (let-7f and miR-135b) in patients with clinical improvements of 50% and above in the OAB score. Conclusions: miRNAs may help elucidate the pathophysiology of OAB. They may shed light on diagnosis and evaluation of treatment effectiveness.

Purpose: The aim of this study was to compare the safety and efficiency of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) for complex renal tumors with a RENAL nephrometry score of ≥7. Materials and Methods: We evaluated the data of 63 patients who had undergone LPN (n=32) or OPN (n=31) for renal tumors with a RENAL nephrometry score of ≥7 between 2016 and 2022, retrospectively. We compared the preoperative, functional and oncological outcomes among the groups. The warm ischemia time (WIT) of