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    The Current Approach for Small Adrenal Masses
    (Galenos Publ House, 2022) Şenoğlu, Yusuf; Balık, Ahmet Yıldırım; Ediz, Emre; Yüksel, Alpaslan; Baba, Dursun
    Adrenal tumors originate from the medulla or cortex of the adrenal gland and may be benign or malignant, functional or non-functional. Adrenal tumors discovered during imaging for non-adrenal indications are called incidentalomas and are more common than non-incidental masses. Most incidentalomas are hormonally inactive and benign. Adrenal masses are approximately 30-35 mm in diameter at the time of diagnosis. While masses less than 4 cm are generally considered to be small masses, they are at lower risk for malignancy than adrenal masses larger than 4 cm. An incidentally detected adrenal mass should be investigated for malignancy and functional activity. Hormonal activity or malignancy of the adrenal mass are indications for surgery. Laparoscopic surgery for adrenal adenomas is the gold standard. Evaluation is important to determine the treatment and follow-up process. Although the frequency of benign small adrenal masses increase with age, even if the mass size is <4 cm in young patients, because of their rarity at this age, a closer follow-up is required. The ideal follow-up schedule for these small masses <4 cm in diameter has not been precisely defined. However, clinical guidelines recommend clinical and hormonal follow-up for at least 4 years, and follow-up imaging [computed tomography (CT), magnetic resonance imaging] 6-12-24 months after the first CT. If the size increase in a followed mass is >0.8 cm/ year, surgery is recommended, but the malignancy rate is low in these masses.
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    Is Laparoscopic Approach Adequate for Zinner's Syndrome? One Patient, Two Cases
    (Galenos Publ House, 2024) Dilek, Ismail Eyuep; Ediz, Emre; Senoglu, Yusuf
    Zinner syndrome (ZS) was first described by Zinner in 1914. This condition includes unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. ZS treatments ranging from medical drug therapy to laparoscopic interventions have been investigated in the literature. A 21-year-old patient presented with scrotal pain after ejaculation. The diagnosis was Zinner's syndrome, and the patient underwent transperitoneal laparoscopic excision of the left seminal vesicle cyst. After 2 years, transurethral ejaculatory duct resection (TUR-ED) was performed at a single center because of symptomatic dilatation in the seminal vesicles. The patient's 1-year urological follow-up after TUR-ED remained normal. This presentation is a case report of a single patient and two cases that are rare in the literature. Cyst aspiration and seminal cyst excision may be considered as first-line treatment options, but the possibility of recurrence should not be forgotten. Even if seminal cyst excision is performed, it should be kept in mind that TUR-ED may be required in the future.
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    Supine and Prone Positions in Percutaneous Nephrolithotomy: Exploring Their Roles in Operative Efficiency and Patient Comfort
    (2025) Baba, Dursun; Dilek, İsmail Eyüp; Ediz, Emre; Ayvacık, Burak; Senoglu, Yusuf; Taşkıran, Arda Taşkın; Balık, Ahmet Yıldırım
    Aim: This study aimed to compare the effects of supine and prone positions during percutaneous nephrolithotomy (PCNL) on operative characteristics, patient out-comes and postoperative quality of recovery. Material and Methods: A retrospective analysis was conducted on 78 patients who underwent PCNL for renal stones ≥2 cm at a single center between December 2022 and August 2024. Patients were divided into two groups: 41 treated in the mini-PCNL (mPCNL) supine position and 37 in the standart PCNL (sPCNL) prone position. Demographic data, operative time, hospital stay duration, complication rates, postoperative pain and analgesic requirements and quality of recovery scores (QoR) were compared. Treatment efficacy was assessed based on residual stone presence at 2 months postoperatively, with <2 mm considered stone-free. Results: Operative and access times were significantly shorter in the supine group and these patients had a reduced hospital stay. Quality of recovery improvement was more pronounced in the supine group with lower postoperative pain and analgesic requirements. Additionally, supine-positioned patients had a lower rate of residual stones compared to the prone group, suggesting enhanced treatment efficacy. Conclusion: The supine position in mPCNL offers advantages over the prone position in terms of operative efficiency, patient comfort and postoperative quality of recovery. Given these benefits the supine position may be a preferable choice for PCNL procedures. Further multicenter studies are recommended to validate these findings across broader patient populations.