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    Before the Needle: The Impact of Ejaculation on Prostate Biopsy Outcomes in a Prospective Comparative Study
    (Springernature, 2025) Baba, Dursun; Dilek, Ismail Eyup; Ekici, Necati; Ozel, Mehmet Ali; Balik, Ahmet Yildirim; Basaran, Ekrem; Taskiran, Arda Taskin
    BackgroundAlthough transrectal ultrasound (TRUS)-guided prostate biopsy is widely used for prostate cancer diagnosis, the role of pre-biopsy ejaculation in influencing procedural outcomes and complication risk remains largely unexplored. This study aimed to evaluate whether recent ejaculation affects seminal vesicle volume, biopsy-related complications, and patient-reported outcomes.MethodsIn this prospective comparative study, 32 patients undergoing TRUS-guided 12-core prostate biopsy were divided into two groups based on their sexual activity: the ejaculation group (n = 14), who ejaculated within 24 h prior to the procedure, and the abstinence group (n = 18), who reported abstinence for at least 3 days. Data collected included seminal vesicle volume, pain scores, urinary symptoms, erectile function, quality of life, and post-procedural complications. Histopathological results were also recorded and summarized. ROC analyses were used to determine cutoff values for key complications. Although transperineal biopsy is now recommended by current EAU guidelines, our study was conducted using the transrectal approach, which remains widely practiced and relevant in clinical settings.ResultsWhile seminal vesicle volume tended to be higher in the abstinence group, the difference was not statistically significant (p = 0.184). No meaningful differences were found in pain perception, urinary symptoms, erectile function, or quality of life. However, hematospermia (p = 0.017) and hematochezia (p = 0.011) were significantly more frequent in the ejaculation group. ROC analysis showed that abstinence <= 7.5 days predicted hematospermia (AUC = 0.731), and abstinence <= 2 days predicted hematochezia (AUC = 0.760). A pain score >= 1.5 was predictive of hematuria (AUC = 0.810). Histological analysis revealed benign findings in the majority of patients, with no significant difference in cancer grade between groups.ConclusionEjaculation prior to TRUS-guided prostate biopsy may increase the risk of certain complications without negatively affecting patient comfort. Abstinence duration could serve as a simple and modifiable factor in optimizing biopsy preparation. Despite the limited sample size, this prospective study provides preliminary evidence supporting patient counseling on sexual activity prior to biopsy.
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    Can Laparoscopic Adrenalectomy Be A Reliable Method for Adrenal Masses Larger than 4 Cm?: Our Clinical Outcomes
    (Galenos Publ House, 2025) Senoglu, Yusuf; Balik, Ahmet Yildirim; Baba, Dursun; Taskiran, Arda Taskin; Basaran, Ekrem; Tekin, Ali
    Objective: The laparoscopic approach to large adrenal masses is becoming increasingly common. Our study aims to investigate the reliability and effectiveness of adrenalectomy performed with laparoscopic surgery in adrenal masses larger than 4 cm. Materials and Methods: Fifty-two patients who underwent transperitoneal laparoscopic adrenalectomy in our clinic between January 2014 and July 2022 were evaluated retrospectively. Each patient's age, gender, hormonal activity status, tumor size and side, hospital stay, amount of bleeding, operation time, complication rates (Clavian classification), pathology results, and surgical margin positivity were evaluated. Thirty patients with tumor size over 4 cm and 22 patients under 4 cm were compared separately. Results: There was no statistically significant difference between the two groups regarding hospital stay (p=0.11). When the operation time and bleeding amount were compared, no statistically significant difference was found between these two groups (p=0.392, p=0.761; respectively). Although slightly more complications were seen in patients with tumors smaller than 4 cm, no statistical difference was observed (p>0.05). Surgical margin positivity was detected only in one of the patients with a tumor size of less than 4 cm, and this patient was reported to have adenoma. All operations were completed laparoscopically. No complications occurred in Clavien class 3 or above in any of the patients. Conclusion: Our study and experience unequivocally demonstrate that transperitoneal laparoscopic adrenalectomy is not only effective but also remarkably safe for large (>4 cm) adrenal masses.
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    Complete urethral rupture accompanying penile fracture: a case report
    (Bmc, 2025) Baba, Dursun; Ekici, Necati; Taskiran, Arda Taskin; Senoglu, Yusuf; Basaran, Ekrem; Balik, Ahmet Yildirim
    Introduction and importancePenile fracture is a rare urological emergency. It occurs due to the penis being subjected to force during intercourse or other causes. Treatment is usually surgical. Urethral injury accompanies 10-20% of cases. In this case, a complete urethral rupture accompanying a penile fracture is aimed to be presented.Presentation of caseA 45-year-old male patient presented to the emergency department with complaints of a snapping sound, pain, and sudden loss of erection during sexual intercourse. After a while, bleeding from the external meatus and inability to urinate were added to his complaints. Physical examination showed typical signs of penile fracture along with urethrorrhagia. The penile doppler ultrasound result was reported to be consistent with a penile fracture and uretral injury. Approximately one hour after presenting to the emergency department, the patient underwent surgery. Considering the possibility of urethral rupture, a urethroscopy was performed before fracture repair, revealing a urethral defect approximately 8 cm proximal to the external meatus. Surgical repair found a near-complete bilateral rupture of the corpus cavernosum and a complete urethral rupture. The urethral rupture and fracture area were repaired according to surgical procedure standards. No additional complaints or new pathologies were observed in the early postoperative follow-up. The patient was discharged with a catheter on postoperative day 3. On the 14th postoperative day, the patient's catheter was removed. At the 3-month follow-up, the patient had no urinary complaints, and the uroflowmetry test showed a Qmax of 35. No pathology was detected in the urethrography performed. At the one-year follow-up, the patient's International Index of Erectile Function (IIEF) score was 26, indicating no additional complaints.Clinical discussionComplete urethral rupture and bilateral corpus cavernosum rupture are rare urological emergencies, typically resulting from trauma applied to an erect penis. A physical examination, ultrasonography, and, when necessary, imaging techniques such as cystoscopy are the diagnostic modalities employed in such cases. Early surgical treatment has been shown to improve functional outcomes and reduce long-term complications.ConclusionEarly surgical intervention in the treatment of penile fractures not only preserves sexual function but also significantly reduces long-term complications. Urethral rupture should always be considered in fractures accompanied by urethrorrhagia and hematuria.
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    Investigation of rs11568476 Polymorphism in the SLC13A2 Gene in Turkish Patients with Hypocitraturia and Calcium-Containing Kidney Stones
    (Mdpi, 2025) Basaran, Ekrem; Baba, Dursun; Senoglu, Yusuf; Yuksel, Alpaslan; Kayikci, Muhammet Ali; Duzenli, Selma; Tekin, Ali
    Background and Objectives: Hypocitraturia is a major risk factor for calcium-containing kidney stone disease. Citrate inhibits stone formation by binding calcium in the urine. The SLC13A2 gene encodes the sodium-dependent dicarboxylate cotransporter 1 (NaDC1), a membrane transport protein that facilitates citrate reabsorption in the proximal renal tubules. Variants in this gene, such as rs11568476 (V477M), have been shown to significantly impair transporter activity. This study aimed to investigate the presence of the rs11568476 polymorphism in SLC13A2 and its association with hypocitraturia in Turkish patients with calcium-containing kidney stones. To our knowledge, this is the first genetic study evaluating this polymorphism in a Turkish cohort. Materials and Methods: This prospective cross-sectional study included 90 patients diagnosed with calcium-containing kidney stones at D & uuml;zce University Faculty of Medicine, Department of Urology. Based on 24 h urinary citrate levels, patients were divided into two groups: normocitraturic (n = 38) and hypocitraturic (n = 52). Blood and 24 h urine samples were analyzed for biochemical parameters. The rs11568476 polymorphism in SLC13A2 was analyzed using Real-Time PCR. Results: There were no significant differences between the two groups in terms of age, gender, and most biochemical parameters. Serum uric acid levels were significantly higher in the hypocitraturic group (p = 0.002), whereas family history of stone disease was more prevalent in the normocitraturic group (p = 0.024). Genetic analysis revealed no polymorphism in the rs11568476 region; all patients exhibited the homozygous wild-type genotype (GG). Conclusions: No association was observed between the rs11568476 polymorphism and hypocitraturia in this cohort. The absence of the polymorphism suggests that this variant may be rare or absent in the Turkish population. These findings highlight the importance of investigating additional genetic and environmental contributors to hypocitraturia and nephrolithiasis through larger, multicenter studies.
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    Treatment Strategies for Kidney Stones Following ESWL Failure: A Prospective Comparative Study of Three Surgical Approaches
    (Galenos Publ House, 2025) Baba, Dursun; Dilek, Ismail Eyup; Basaran, Ekrem; Senoglu, Yusuf; Balik, Ahmet Yildirim; Taskiran, Arda Taskin; Yuksel, Alpaslan
    Objective: This study aims to evaluate the efficacy and safety of retrograde intrarenal stone surgery (RIRS), mini-percutaneous nephrolithotomy (miniPCNL), and PCNL in patients with 1-2 cm kidney stones who failed extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: This prospective study analyzed the medical records of 90 patients who underwent RIRS (n=29), miniPCNL (n=31), or PCNL (n=30) after unsuccessful ESWL treatment. The groups were compared based on operative time, hospital stay, complication rates, narcotic analgesic use, catheterization requirements, perioperative hemoglobin changes, transfusion needs, and treatment efficacy. Statistical analyses were performed using appropriate methods based on variable distribution. Results: RIRS resulted in significantly shorter hospital stays than miniPCNL and PCNL groups (p<0.001). MiniPCNL patients also had a shorter hospital stay than those in the PCNL group (p=0.047). The shortest operative time was observed in the PCNL group (59.9 min) compared to both the RIRS and miniPCNL groups (p<0.05). However, PCNL was associated with significantly higher narcotic analgesic use, greater hemoglobin reduction, and longer hospitalization. No significant differences were found among the three groups regarding transfusion requirements, residual stone rates, or overall complications. Conclusion: All three surgical methods were effective and safe for treating kidney stones measuring 1-2 cm in patients who previously failed ESWL. However, considering the shorter hospital stay and lower complication rates, RIRS and miniPCNL may be preferable options, while PCNL should be considered in selected cases.
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    Which localization method is optimal in ESWL: fluoroscopy or ultrasonography?
    (Bmc, 2025) Baba, Dursun; Ekici, Necati; Taskiran, Arda Taskin; Senoglu, Yusuf; Yuksel, Alpaslan; Basaran, Ekrem; Ozel, Mehmet Ali
    BackgroundUrinary stone disease is a common urological disorder, particularly among middle-aged individuals. Extracorporeal Shock Wave Lithotripsy (ESWL) is often the first-line treatment for kidney and ureteral stones. Traditionally, fluoroscopy is used for stone targeting in ESWL, but it exposes patients and clinicians to radiation and cannot visualize non-opaque stones. Ultrasonographic targeting eliminates these issues. This study compares the advantages and disadvantages of fluoroscopy and ultrasound-targeted ESWL. MethodsAt D & uuml;zce University Hospital, 100 patients with radio-opaque stones indicated for ESWL between February 2023 and February 2024 were divided into two groups. Group A underwent ESWL with fluoroscopic targeting, while Group B used ultrasonographic targeting. Patient demographics, stone size (measured by CT), and stone locations were recorded. The number of shocks per session, energy intensity (kV), and fluoroscopy time were noted for Group A. One week after each ESWL session, patients were evaluated by ultrasound or direct radiography. Success was defined as being stone-free or having <= 4 mm asymptomatic residual stones after up to four sessions. Failure was defined as no results after two sessions or the need for additional treatment. ResultsThe procedure success rate was 66% for men and 78% for women, with no statistically significant gender difference (p > 0.05). Stone locations were similar in both groups. Success rates were 66% in Group A and 74% in Group B, with no significant difference (p > 0.05). Successful procedures were associated with an average patient weight of 76.6 kg, stone size of 8.9 mm, and total energy of 12.2 kV, with significant differences compared to unsuccessful procedures (p < 0.04, p < 0.04, p < 0.001, respectively). No significant differences were found between Group A and Group B in terms of age, height, BMI, stone density (HU), and number of sessions (p > 0.05). ConclusionUltrasonography is as effective as fluoroscopy for imaging and focusing during ESWL treatment. It enhances the success of ESWL for non-opaque stones and reduces radiation exposure disadvantages.