Buğra Aksay

İnfertilite, çiftlerin yaklaşık %15'ini etkileyen küresel bir sağlık sorunudur ve olguların neredeyse yarısında erkek faktörü rol oynamaktadır. Yardımcı üreme tekniklerindeki (YÜT), özellikle intrasitoplazmik sperm enjeksiyonundaki (ICSI) gelişmeler erkek faktörlü infertilitenin tedavisinde bir dönüm noktası olmuştur. Ancak altta yatan nedenlerin doğru tanımlanması önemini korumaktadır. Bu bölümde intrauterin inseminasyon (IUI), in vitro fertilizasyon (IVF) ve ICSI süreçlerinde üroloğun rolü güncel literatür ışığında ele alınmıştır. YÜT öncesi ürolojik değerlendirme semen analizi, fizik muayene, hormonal profil, genetik testler ve sperm DNA fragmantasyonunun incelenmesini kapsar. Varikosel ve hipogonadotropik hipogonadizm gibi düzeltilebilir etiyolojilerin tedavisi semen parametrelerini iyileştirebilir ve doğal gebelik şansı sağlayabilir. Obstrüktif azoospermide PESA ve TESA gibi minimal invaziv yöntemler, non-obstrüktif azoospermide ise Micro-TESE tercih edilen cerrahi yaklaşımdır. Micro-TESE’nin oosit toplama işlemiyle senkronizasyonu ya da testiküler spermin kriyoprezervasyonu tedavi planlamasında belirleyicidir. Androloji ve embriyoloji laboratuvarıyla eş zamanlı iletişim de bu süreçte kritik önem taşır. Gelecekte in vitro spermatogenez, kök hücre temelli yaklaşımlar ve yapay zekâ destekli sperm seçimi üroloğun rolünü genişletebilir. Sonuç olarak üroloğun YÜT’teki rolü cerrahi sperm elde etmenin ötesine geçmekte ve multidisipliner bir yaklaşım gerektirmektedir.

Background: Accurate prediction of postoperative complications following radical nephrectomy is of great clinical importance for perioperative risk stratification and patient management. Although several scoring systems are used in urological surgery, there is no widely accepted, procedure-specific risk assessment tool. This study aimed to evaluate the performance of the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), Estimation of Physiologic Ability and Surgical Stress (E-PASS), and its modified version (mE-PASS) in predicting postoperative complications after radical nephrectomy. As a secondary objective, the association between modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI), and neutrophil-to-lymphocyte ratio (NLR), which reflect systemic inflammation and nutritional status, and postoperative complications was also investigated. Materials and methods: A total of 148 patients who underwent radical nephrectomy for renal tumors at our institution between January 2022 and March 2025 were retrospectively analyzed. Patients were divided into two groups based on the presence of postoperative complications. Postoperative complications were assessed according to the Clavien–Dindo classification, and complications of grade ≥ 2 were included in the analysis. Demographic characteristics, comorbidities, preoperative laboratory parameters, surgical variables, and postoperative outcomes were recorded. The predictive performance of the scoring systems was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Results: Postoperative complications were observed in 51 patients (34.5%). The POSSUM score demonstrated the highest predictive performance with an AUC of 0.810, showing high sensitivity (82.4%) and specificity (71.1%). The E-PASS score was also statistically significant but exhibited a more limited predictive performance (AUC: 0.682). In contrast, the mE-PASS score showed markedly lower predictive ability (AUC: 0.599). Patients who developed complications had significantly lower PNI values and higher NLR values ( p < 0.05). Additionally, intraoperative blood loss, tumor size, and length of hospital stay were significantly greater in the complication group ( p < 0.05). Conclusion: POSSUM and E-PASS may serve as useful tools for predicting postoperative complications following radical nephrectomy. However, given their moderate predictive performance and the limitations of the present study, these findings should be validated in larger, prospective, multicenter studies.

This study aimed to identify predictive factors for the formation of steinstrasse following extracorporeal shock wave lithotripsy (SWL) in patients with me

Purpose We aimed to determine differences in treatment and management of forgotten ureteral stents between adult and pediatric patients. Methods The records of patients treated for forgotten ureteral stents were retrospectively evaluated. Reasons for stent placement, duration of stenting, stent fragmentation status, types and numbers of surgeries performed for stent removal, length of hospital stay, complications, and treatments were recorded. Results There were 43 (37%) patients in the pediatric group and 72 (63%) patients in the adult group. Mean age in the pediatric group was 7.65 ± 4.01 years, while it was 53.18 ± 18.29 years in the adult group. Hydronephrosis and hematuria rates were significantly higher in the adult group (40.3% vs. 20.9, p = 0.033; 33.3% vs. 16.3%, p = 0.046, respectively), whereas fever and sepsis rates were significantly higher in the pediatric patient group (39.5% vs. 12.5%, p = 0.001; 11.6% vs. 1.4%, p = 0.027, respectively). In terms of removal method, endoscopic cystolithotripsy and percutaneous nephrolithotomy (37.2%) were the methods most frequently applied in the pediatric group, and ureteroscopic lithotripsy (34.7%) was used in adults. Conclusions Forgotten ureteral stents can cause life-threatening complications in both pediatric and adult patients due to encrustation and stone formation. Endourological surgeries can be safely performed for treatment in both groups.

Background: The aim of this study was to evaluate the efficacy of bariatric surgery (BS) by evaluating preoperative and postoperative sexual functions in obese men undergoing BS. Materials and Methods: Male patients who underwent BS due to obesity between January 2013 and September 2021 were included in this observational study. Patients underwent standardized laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. For sexual function, the International Index of Erectile Function (IIEF) inquiry form was filled in before, and one year after BS. In addition, the age, Body Mass Index (BMI) and Female Sexual Function Index (FSFI) scores of the female partners were recorded before and after the operation. Follow-up weight, waist circum-ference, serum biochemistry and hormone values of the patients were re-evaluated in the 6-12 month period after the operation. Results: A total of 1027 patients were included in the study. The mean age of the male patients was 37.33±12.40 years, and the mean preoperative BMI was 38.51±3.98kg/m2 (35.20-49.80). The pos-toperative follow-up period of the patients was 9.72±2.98 months. There was a significant increase in the IIEF (all sub-dimensions) scores of the patients after the operation (p<0.001 for each). An increase in FSFI scores was found in female partners after surgery (21.67±6.78 vs. 27.55±5.48; p<0.001). The change in IIEF-EF scores was moderately inversely correlated with partner BMI, mo-derately correlated with vitamin D levels, and linearly correlated with testosterone levels (p=0.034, r=-0.434; p=0.012, r=0.537 and p=0.027, r=0.476, respectively). Conclusions: BS provides a significant increase in the sexual functions of obese men. This increase shows a significant relationship with partner BMI and vitamin D levels.

Kidney stone disease is relatively uncommon in pediatric populations, although its incidence has been steadily increasing in endemic regions. Mini-percutaneous nephrolithotomy (mini-PCNL), considered the most suitable approach for the treatment of large kidney stones, offers a minimally invasive option with fewer complications. This study evaluates the predictive accuracy of the STONE, Guy’s Stone Score, and stone-kidney size (SKS) scoring systems in determining stone-free rates following pediatric mini-PCNL procedures. In this retrospective analysis, data were reviewed from 79 individuals younger than 18 who received mini-PCNL treatment from January 2021 to June 2024. Patients were evaluated as residual group and stone-free group. The diagnostic performance of the nomograms in detecting residual stones was evaluated using ROC analysis, and predictive factors for stone-free success were identified through logistic regression modeling. Guy’s score (cut-off 1.5) had 79.3% sensitivity, 70% specificity, and AUC 0.817. The STONE score (cut-off 5.5) showed 69% sensitivity, 68% specificity, and AUC 0.741. SKS score (cut-off 3.5) resulted in 62.1% sensitivity, 78% specificity, and AUC 0.768. Logistic regression found stone size (OR: 1.137, p < 0.001) and volume (OR: 1.001, p < 0.001) were linked to stone-free success. Guy’s score (OR: 5.438, p < 0.001), STONE score (OR: 1.741, p < 0.001), and SKS (OR: 3.972, p < 0.001) were strong predictors, but in multivariate analysis, only Guy’s score (OR: 3.701, p = 0.010) remained significant. The results of our study demonstrate that the Guy's stone score is the most reliable prognostic tool for predicting stone-free success in pediatric patients undergoing mini-PCNL. Moreover, variables such as stone size and volume exert a substantial influence on the surgical outcomes.

The most appropriate form of urinary diversion (UD) after radical cystectomy remains controversial. In this study, we aimed to compare the health-related quality of life questionnaire results of patients who underwent orthotopic neobladder (ONB), ureterocutaneostomy (UC) and ileal conduit (IC) diversion. A total of 92 patients, including 42 out of 65 IC patients, 11 out of 15 ONB patients, and 39 out of 59 UC patients, completed the SF-36 and Barthel index quality of life questionnaires. The mean follow-up periods were 11.7 ± 13.5 months for UC patients, 24.2 ± 20.8 months for IC patients, and 34.3 ± 25 months for ONB patients. The drain removal times were 5.7 ± 2.3 days in the UC group, 7 ± 2.8 days in the IC group, and 10.9 ± 9.2 days in the ONB group, with both the follow-up and drain removal periods being shorter in the UC group (P < 0.001; P = 0.002). Significant differences were noted in quality of life scores, particularly for emotional function (P = 0.016) and fatigue (P = 0.001), with the ONB group having higher emotional function scores and the UC group having higher fatigue scores than the other groups did. Although there was no significant difference in terms of quality of life among the three methods, according to our results, we concluded that ONB should be performed in healthy, young, fit patients, especially those with body image expectations, and that UC should be performed in high-risk elderly patients. Although the selection of UD is based on individual considerations and the experience of the physician, quality of life questionnaires and patient counseling have critical importance.

Purpose To investigate the effect of the degree of hydronephrosis on extracorporeal shockwave lithotripsy (SWL) success in patients who underwent SWL due to upper ureteral stones. Methods Medical records of 878 patients who underwent SWL were retrospectively reviewed. Patients with isolated unilateral 6–10 mm radiopaque upper ureteral stones above the upper border of the sacroiliac joint were included in the study. The primary endpoint of the study was the relationship between the degree of hydronephrosis with upper ureteral stones and the stone clearance time, number of SWL sessions, and success, while the secondary endpoint was the effect of the presence of severe hydronephrosis (SFU grade 3) on SWL success. Results The mean age of the patients was 41.3 ± 10.9 years. The mean stone size was 8.2 (6–10) mm. Ureteropelvic junction stones were present in 24 (20%) patients. The mean stone clearance time was 14.6 ± 9.7 days. One-month SWL success was determined as 85%. SWL success rates decreased as the degree of hydronephrosis increased (p = 0.047). Being 45 years of age and older increased the risk of SWL failure by 16.25 times (OR = 16.25, p = 0.017). Increasing the stone clearance time by 1 day increased the risk of SWL failure by 1.17 times (OR = 1.17, p = 0.006), and increasing the number of SWL sessions by 1 session increased the risk of SWL failure by 7.69 times (OR = 7.69, p = 0.016). The presence of severe hydronephrosis (grade 3) did not affect SWL success (OR = 5.56, p = 0.071). Conclusion According to our study results, as the degree of hydronephrosis increases in 6–10 mm upper ureteral stones, the number of SWL sessions increases, stone expulsion times prolong, and 1-month success rates decrease.

Background Studies evaluating lower urinary tract symptoms (LUTS) and sexual functions after holmium laser enucleation of prostate (HoLEP) are very limited. Aims To evaluate both the LUTS voiding and storage functions of patients after HoLEP operation and to examine its effect on postoperative sexual functions. Methods The data of male patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between May 2019 and February 2022 were evaluated. The International Prostate Symptom Index (IPSS) was used for questioning LUTS. The International Erectile Function Index-Erectile Function (IIEF-EF) section was completed to evaluate erectile functions and Male Sexual Health Questionnaire-Ejaculation function (MSHQ-EjD) was completed to evaluate ejaculation functions. Results A total of 427 patients were included in the study. A significant improvement was found in IPSS total, storage, and voiding scores at the 3rd month follow-ups of the patients after HoLEP. While improvement was detected in the erectile functions of the patients (p < 0.001), a significant decrease was found in MSHQ-EjD scores (15.97 ± 2.26 vs. 11.02 ± 3.69; p = 0.002). More than 50% reduction in IPSS scores was found in 85.48% (365/427) of the patients. It was determined that the patients who did not benefit from the treatment had higher preoperative IPSS-storage symptoms (p = 0.001), lower IIEF-EF scores (p < 0.001), and higher PVRs (p = 0.001). Conclusions HoLEP is an effective method that can be used safely and effectively in the treatment of LUTS due to BPH. While both storage and voiding functions of the patients improve, there is no worsening in erectile functions, but deterioration in ejaculation functions can be observed.