Hüseyin Biçer

Background/Objectives: Micro-percutaneous nephrolithotomy (micro-PCNL) offers direct access to lower pole stones but has limited fragment evacuation. Vacuum-assisted micro-endoscopic combined intrarenal surgery (micro-ECIRS) adds flexible ureteroscopy and suction. We evaluated outcomes after institutional adoption of this technique for symptomatic 1–2 cm lower pole stones. Methods: This retrospective non-concurrent cohort included 81 consecutive adults treated between January 2016 and July 2025 (micro-ECIRS, n = 42; micro-PCNL, n = 39). Only micro-PCNL procedures (n = 33) preceded January 2021. One-month low-dose noncontrast computed tomography (earlier, pre-intervention, in four patients) classified outcomes as Grade A (no residual fragment), Grade B (none >2 mm), or Grade C (none >4 mm; main outcome). Comparisons were unadjusted. Results: Grade C was attained in 90.5% (micro-ECIRS) versus 64.1% (micro-PCNL) (absolute difference 26.4 percentage points, 95% confidence interval [CI] 8.2–43.1; risk ratio [RR] 1.41, 95% CI 1.09–1.82; p = 0.007) and Grade B in 71.4% versus 46.2% (p = 0.025). Grade A did not differ significantly (42.9% vs. 28.2%; p = 0.246). Secondary puncture (4.8% vs. 28.2%) and auxiliary procedures (4.8% vs. 25.6%) were less frequent after micro-ECIRS (both p < 0.05). Complications did not differ significantly (11.9% vs. 30.8%; p = 0.055). Conclusions: In this retrospective, predominantly non-concurrent cohort, institutional adoption of vacuum-assisted micro-ECIRS was associated with higher rates of no residual fragment larger than 2 mm or 4 mm and fewer additional punctures and subsequent procedures. A difference in complete stone clearance was not demonstrated. Treatment–era confounding, baseline imbalance, and complete-case selection prevent causal attribution to the technique.

Background: Prostate biopsy is commonly performed under local anesthesia in an office setting, making pain and tolerability important concerns. However, few studies have compared patients' expected pain with the pain they actually experience. This study prospectively compared expected and experienced pain in patients undergoing transrectal (TR) or transperineal (TP) biopsy. Methods: This prospective observational study consecutively enrolled patients aged ≥18 years undergoing their first TR or TP prostate biopsy under local anesthesia in an office setting. Expected (pre-procedure) and experienced (immediately post-procedure) pain were recorded using a 0–10 Numerical Rating Scale (NRS). Willingness to repeat the procedure was recorded. Outcomes were compared between biopsy approaches and age groups (<65 vs. ≥65 years). Results: Of 220 patients, 111 underwent TP and 109 underwent TR biopsy, with comparable baseline characteristics. Procedure duration was significantly longer in the TP group (13 vs. 8 min, p<0.001). Median experienced pain was lower than expected pain in both the TP and TR groups (3 vs. 7 in each; both p<0.001). Neither expected (p=0.789) nor experienced pain (p=0.715) differed between approaches, and the expectation–experience gap was similar (median 4 NRS points; p=0.814). Willingness to repeat (74.8% vs. 80.7%, p=0.293) did not differ between approaches, nor did pain outcomes by age. Conclusions: Patients undergoing office-based prostate biopsy under local anesthesia experienced substantially less pain than they anticipated, regardless of age or biopsy approach. Whether incorporating these findings into pre-procedural counseling can reduce anxiety or improve patient comfort warrants prospective evaluation.

Objective: Symptomatic hydronephrosis occurs in a small subset of pregnancies and may require temporary drainage when conservative management fails. Ureteral Double-J stenting (DJS) is an effective intervention, yet data on maternal and fetal outcomes remain limited. To evaluate maternal and fetal outcomes following DJS placement for symptomatic hydronephrosis during pregnancy and to identify clinical factors associated with stent revision.Material and Methods: This retrospective, single-center cohort was conducted at Kayseri City Hospital, Departments of Urology and Obstetrics & Gynecology (Turkey) between January 2020 and October 2025. Thirty-one pregnant patients who underwent DJS placement for symptomatic hydronephrosis (without obstructive ureteral calculi) were included. Demographic, clinical, and perinatal data were collected from electronic medical records. The primary outcome was a composite adverse perinatal outcome (preterm delivery <37 weeks and/or neonatal intensive care unit [NICU] admission and/or 5-minute Apgar score <7). Secondary outcomes included stent revision and hospital stay. Descriptive statistics and exploratory comparisons were performed.Results: Mean maternal age was 26.2±6.3 years. The mean maximum anteroposterior (AP) diameter was 21.6±8.4 mm, with AP ≥20 mm in 14 patients (45.2%). Stent revision was required in 4 patients (12.9%). Preterm birth occurred in 5 patients (16.2%), NICU admission in 3 patients (9.7%), and mean birth weight was 2884±324 g. Earlier gestational age at stent insertion was significantly associated with stent revision (p=0.017).Conclusion: DJS placement for symptomatic hydronephrosis during pregnancy is generally safe and effective, with favorable maternal and neonatal outcomes. Early gestational stenting may increase revision risk, emphasizing close follow-up, infection surveillance, and timely reassessment of stent function.

Purpose: To evaluate whether use of a vacuum-assisted access sheath (VAAS) improves operative efficiency, perioperative safety, early renal function, and stone-free status compared with a conventional access sheath (CAS) during 16F mini-percutaneous nephrolithotomy (mini-PCNL). Patients and Methods: In this prospective comparative study, 80 adults with 2–4 cm renal calculi were assigned to undergo VAAS mini-PCNL ( n = 40) or CAS mini-PCNL ( n = 40). Coprimary endpoints were operative efficiency (operative, lithotripsy, and stone clearance times) and perioperative safety (postoperative fever, infection, hospital stay, Clavien–Dindo complications). Secondary endpoints were early renal function (estimated glomerular filtration rate [eGFR] by Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and CT-based stone-free status at 1 month. All procedures were performed by a single experienced surgeon using a standardized 16F tract and holmium:yttrium-aluminum-garnet laser lithotripsy. Stone-free status was assessed at 1 month using 1.5-mm thin-slice noncontrast CT and classified as Grade A (no residual fragments), Grade B (A + ≤2 mm fragment), Grade C (A + B + 2.1–4 mm fragment), or nonstone free (>4 mm). Results: VAAS was associated with significantly shorter operative, lithotripsy, and stone clearance times and reduced need for auxiliary instruments (all p s < 0.05). Hospital stay and postoperative pain scores were lower in the VAAS group ( p < 0.001). A significant postoperative eGFR decline was observed in the CAS group but not in the VAAS group, with a significant between-group difference ( p < 0.05). Zero-fragment rates were higher with VAAS (80% vs 67.5%), and clearance ≤4 mm was achieved 90% vs 75%; however, differences were not statistically significant. Stone complexity was significantly associated with zero-fragment outcomes ( p = 0.002). No major (Clavien–Dindo ≥III) complications occurred. Conclusions: VAAS significantly improved operative efficiency and perioperative recovery compared with CAS. Among secondary outcomes, VAAS was associated with better preservation of early renal function, a finding that should be interpreted with caution given its secondary nature. Although stone-free rates were similar, suction-assisted systems may provide functional and procedural advantages in mini-PCNL.

Background/Objectives: Serum prostate-specific antigen (PSA) lacks sufficient specificity for prostate cancer (PCa) detection. We evaluated the diagnostic value of AI-assisted MRI-derived zone-specific PSA density parameters, including transition zone PSA density (TZ-PSAD) and peripheral zone PSA density (PZ-PSAD), in men undergoing prostate biopsy. Methods: This retrospective cohort study included 354 patients who underwent prostate biopsy due to elevated PSA (2024–2026), stratified into PSA 4–10 ng/mL (n = 272) and PSA 10–20 ng/mL (n = 82) groups. Zonal volumes were measured using AI-assisted mp-MRI segmentation per PI-RADS v2.1, and PSAD, TZ-PSAD, and PZ-PSAD were calculated accordingly. MRI readings were performed blinded to pathology. Results: TZ-PSAD was significantly higher in PCa patients in both PSA groups (p < 0.001), demonstrating superior AUC compared to PSAD in both the PSA 4–10 ng/mL (0.711 vs. 0.660) and PSA 10–20 ng/mL (0.841 vs. 0.676) groups. At an optimal cut-off of ≥0.34 ng/mL², TZ-PSAD yielded 44.8% sensitivity and 90.8% specificity in the PSA 4–10 group, improving to 73.8% sensitivity and 94.7% specificity at ≥0.48 ng/mL² in the PSA 10–20 group. On multivariate analysis, TZ-PSAD and PI-RADS ≥ 3 emerged as independent predictors of PCa in both groups. Serum PSA, PZ-PSAD, and PZ volume failed to differentiate BPH from PCa in either group. Conclusions: TZ-PSAD and conventional PSAD were both significantly associated with prostate cancer, whereas PZ-PSAD was not, and TZ-PSAD, combined with PI-RAD ≥3, emerged as an independent predictor in the PSA gray zone.

Aims: This study aimed to evaluate the effect of dorsal penile block on postoperative Face, Legs, Activity, Cry and Consolability (FLACC) score in children undergoing circumcision under ketamine–propofol sedation. Methods: The data of 115 children aged 7-9 years who underwent circumcision under ketamine-propofol sedation were retrospectively analyzed. Patients were categorized into two groups: those who received a dorsal penile block (group 2) and those who did not (group 1). Demographic characteristics, FLACC score, analgesic requirements, operation duration, recovery unit time, intraoperative mean heart rate, oxygen saturation measurements, and time to first micturition were analyzed in both groups. Results: The mean age of the children was 7.77±0.78 years, and no significant difference in age distribution was observed between the groups (p>0.05). Similarly, operation duration, intraoperative heart rate, oxygen saturation measurements, and recovery unit time were comparable between the groups (p>0.05). In group 1, 17 patients (28.3%) had analgesic requirements, and the mean FLACC score was 4.02±1.90. Analgesic requirements and FLACC scores were significantly higher in group 1 compared with group 2 (p=0.017 and p

This study aimed to evaluate the effect of vacuum-assisted access sheath use during mini-percutaneous nephrolithotomy (mini-PCNL) on early postoperative pain intensity and analgesic requirements in the treatment of renal pelvic stones. A total of 150 patients who underwent mini-PCNL for a single renal pelvic stone ≥ 20 mm were retrospectively included. Patients who underwent standard mini-PCNL were classified as Group 1, while those treated with a vacuum-assisted access sheath were assigned to Group 2. Demographic characteristics, perioperative parameters, pain assessed by visual analog scale (VAS), and analgesic requirements were compared between the groups. The two groups were comparable in terms of mean age, body mass index, comorbidity status, ASA scores, degree of hydronephrosis, distance between skin puncture, fluoroscopy time, stone size, and stone density (p > 0.05). Operative time and length of hospital stay were significantly longer in Group 1 (77.97 ± 15.72 min and 3.28 ± 1.56 days, respectively) compared with Group 2 (p < 0.001). The incidence of high-grade fever and urinary tract infections requiring additional antibiotic therapy was significantly higher in Group 1 (p = 0.044 and p = 0.032, respectively). Hemoglobin decrease was also more pronounced in Group 1 (p < 0.001). Postoperative VAS scores were significantly lower in Group 2 than in Group 1 (p < 0.001). The absolute between-group differences in VAS at rest were 1.37 points at 1 h, 1.68 points at 6 h, and 1.81 points at 24 h. For dynamic VAS, the corresponding absolute differences were 2.38, 2.09, and 2.05 points, respectively. Furthermore, the number of patients requiring rescue analgesia was markedly higher in Group 1 (p < 0.001). In addition, Group 1 demonstrated a shorter mean time to rescue analgesia and higher analgesic dosage compared with Group 2 (p = 0.002 and p = 0.019, respectively). In multivariate analysis, vacuum-assisted access sheath use remained an independent predictor of both lower postoperative pain scores and reduced analgesic requirement, with an approximately 90% reduction in the odds of rescue analgesia use after adjustment for operative time and intraoperative remifentanil consumption. Vacuum-assisted access sheath use was associated with lower early postoperative pain scores and reduced analgesic requirements; however, prospective controlled studies are needed to confirm these findings.

Introduction: This study aimed to investigate the impact of peritoneal patency during extraperitoneal laparoscopic radical prostatectomy (eLRP) on perioperative and postoperative outcomes. Methods: Between May 2018 and March 2025, 255 patients who underwent eLRP were retrospectively evaluated. Patients without peritoneal opening were classified as group 1 (n=223), while those with peritoneal opening were classified as group 2 (n=32). Demographic data, operative time, complication rates, and complication grades based on the Clavien-Dindo classification were analyzed. Logistic regression analysis was performed to identify associated risk factors. Results: A history of abdominal surgery was significantly more common in group 2 (p150 ml were significantly associated with postoperative complications; however, peritoneal opening was not identified as an independent risk factor (p=0.113). Conclusions: Although peritoneal opening may introduce technical challenges that compromise the advantages of the extraperitoneal approach, it does not significantly affect postoperative complication rates. With sufficient surgical experience, it appears to be a manageable intraoperative event.

Perkütan nefrolitotomi (PNL), böbrek taşlarının çıkarılması için önemli bir yaklaşımdır. Perkütan nefrostomi drenaj tüpü yerleştirilmesi, PNL ameliyatı sonrası ekstravazasyonu önlemek ve hemostazı sağlama amacıyla yapılır. Bu vakada da tek taraflı PNL ameliyatı sonrasında hemostaz sağlama amacıyla takılan inferior vena kavaya uzanan nefrostomi tüpünün başarılı şekilde konservatif olarak çekilmesini bildireceğiz. Bizim vakamızda olduğu gibi bazen, kateter böbrek parankimini perfore edebilir ve renal vene hatta vena kavaya kadar uzanabilir. Vakamızda nefrostomi tüpü inferior vena cava (İVC) içerisinde yer almaktaydı. Kontrol altına alamadığımız olası masif kanama durumunda Kalp Damar Cerrahisi-Girişimsel Radyoloji ekibinin de bulunduğu vakada floroskopi altında katater çekilmesi uygulandı. Hastanın takiplerinde bir sıkıntı izlenmedi ve başarıyla taburcu edildi.

Study demonstrated that antibiotic resistance in the treatment of uncomplicated urinary tract infections varies by geographical region. We believe this comprehensive, national prospective study will provide valuable insights for clinicians planning empirical treatment for uncomplicated urinary tract infections.