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Öğe 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, AliObjective: 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.Öğe Comparison of Early Versus Late Urethral Catheter Removal After Transurethral Resection of the Prostate in Patients with Benign Prostate Hyperplasia(Duzce Univ, Fac Medicine, 2023) Senoglu, Yusuf; Tekin, Ali; Yildirim, Olcay; Baba, Dursun; Yuksel, AlpaslanObjective: Transurethral resection of the prostate (TURP) is considered the standard in the surgical therapy of lower urinary tract symptoms related to benign prostate hyperplasia (BPH). However, there is no consensus on the timing of catheter removal. In this study, we aimed to compare the long-term effects of early and delayed removal of urethral catheters who underwent TURP.Methods: We prospectively analyzed a total of 91 patients who underwent TURP. Patients were randomized into two groups; the early (postop 1st-2nd days) and delayed (7th day) removal of the urethral catheter. After the surgery in 1, 3, and 6th months, we evaluated all patients regarding treatment success. In addition, international prostate symptom score (IPSS), quality of life (QoL), maximum flow rate, postvoid residual urine volume, and morbidities (hematuria, infection, urethral stricture, irritative symptoms, need for re-operation) were assessed at all visits.Results: After TURP, there was no statistical difference in urodynamic parameters, complications, IPSS, and QoL in both groups. Only in the 3rd-month, the maximum flow rate was higher in favor of the early group. Despite similar results in both groups, strictures occurred earlier in the early group than delayed group (respectively 1 and 3 months).Conclusions: These results suggest that there are no differences in efficacy and complications in groups of early or delayed urethral catheter removal after TURP. The results of long-term studies with large series should be awaited to reach a more definite conclusion. We have tried to shed light on a topic without consensus on the time of urethral catheterization after TURP.Öğe Complete urethral rupture accompanying penile fracture: a case report(Bmc, 2025) Baba, Dursun; Ekici, Necati; Taskiran, Arda Taskin; Senoglu, Yusuf; Basaran, Ekrem; Balik, Ahmet YildirimIntroduction 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.Öğe 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, AliBackground 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.Öğe Investigation of the Relationship of Two-Glass Test with Prostate Biopsy and Presence and Grade of Asymptomatic Prostate Inflammation in Men with Serum Prostate-Specific Antigen Level Between 2.5-10 ng/ml(Duzce Univ, Fac Medicine, 2024) Yuksel, Alpaslan; Tekin, Ali; Senoglu, Yusuf; Baba, Dursun; Gamsizkan, MehmetObjective: Prostate-specific antigen (PSA) is utilized as a marker to detect prostate cancer. Elevated PSA levels often lead to prostate biopsy to assess the potential presence of cancer. However, PSA elevation is not specific to cancer and can be caused by various conditions, including benign prostatic hyperplasia (BPH), urinary tract infections, and chronic prostatitis. Notably, approximately 66% of patients undergoing biopsy do not have prostate cancer, leading to unnecessary procedures and associated complications. Chronic prostatitis is detected in around 40% of these biopsies. The two-glass test involves examining urine before and after a rectal examination to diagnose chronic prostatitis. This study aims to investigate the effectiveness of the two-glass test in predicting prostatitis and inflammation in patients with PSA levels between 2.5-10 ng/ml who have undergone prostate needle biopsy. Materials and Methods: The study included fifty-two male patients aged between 50 and 78 years with PSA levels between 2.5 and 10 ng/ml who presented to our clinic. All patients underwent the EPS-two-glass test and prostate biopsy. EPS (expressed prostatic secretion) is obtained by collecting fluid from the urethra after prostate massage, while VB-3 (voided bladder-3) is urine collected after a massage. These samples are used to detect prostate infection. Prostate inflammation was deemed significant if >= 10 leukocytes were observed under the microscope. Patients were categorized into three groups based on pathology results: prostate cancer, BPH, and chronic prostatitis. The chronic prostatitis group was further classified based on histopathological calcification described by Nickel. Results: Chronic prostatitis was detected in 38% of the study participants. VB3 positivity was significantly higher in the chronic prostatitis group compared to the other groups (p = 0.028). Although no significant difference was observed in the prevalence of inflammation and PSA elevation, PSA levels were higher in the multifocal inflammation subgroup compared to the focal inflammation group. Conclusions: The relationship between chronic prostatitis and PSA elevation remains unclear. Although this study did not find a statistical relationship between inflammation and PSA elevation, the significant correlation between chronic prostatitis and VB3 positivity suggests a potential link. These findings can serve as a foundation for further research aimed at reducing unnecessary biopsies.Öğe Is Laparoscopic Approach Adequate for Zinner's Syndrome? One Patient, Two Cases(Galenos Publ House, 2024) Dilek, Ismail Eyuep; Ediz, Emre; Senoglu, YusufZinner 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.Öğe Laparoscopic Extraperitoneal Radical Prostatectomy(Galenos Yayincilik, 2020) Tekin, Ali; Yuksel, Alpaslan; Taskiran, Arda Taskin; Senoglu, Yusuf; Kayikci, Muhammet AliRadical prostatectomy (RP) involves removing the entire prostate with its capsule intact and the seminal vesicles (SV). In this video article, we summarized the extraperitoneal laparoscopic RP with pelvic lymph node dissection procedure along with a video presentation of a case. The patient is placed in a Trendelenburg position. Through a small transverse infraumblical incision, the anterior rectus aponeurosis is identified and incised. The extraperitoneal surgical field is developed bluntly by a balloon dilator, and a 10 mm trocar is placed for the camera. CO2 insufflation at a 12-15 mmHg pressure is established, and the remaining trocars are placed. The fatty tissue is swept laterally to create a wide operative field. The endopelvic fascia is incised on both sides. The levator ani muscle fibers are separated from the lateral surface of the prostate. Dorsal vascular complex (DVC) is ligated with 2 consecutive sutures. Identification of the bladder neck (BN) is critical for proper dissection between the prostate and the BN. BN is incised until the catheter is seen. The urethral catheter is removed and a Bougie dilator is inserted through the urethra to elevate the prostate. With posterior oblique dissection, the vasa deferentia are exposed and clip-ligated, and SVs are identified and freed. Then, lateral pedicles are ligated with hemoclips and divided. Lateral dissection proceeds with an anterolateral incision from the base to the prostatic apex. The neurovascular bundles lie posterolateral to the prostate. Apical dissection and division of the DVC and urethra is a critical step to ensure a safe surgical margin and good postoperative erectile function and continence. The urethra is divided with a small rim on the prostate. The gland is totally freed, put into an endobag, and extracted. The vesicourethral anastomosis is done using two 3-0 monocryl sutures in a running fashion, starting from the posterior in both direction and tied together at the 12 o'clock position, anteriorly.Öğe Optimizing Prostate Cancer Diagnosis: A Prospective, Randomized Comparison of 12-core vs. 20-core Biopsy for Detection Accuracy and Upgrading Risk(Galenos Publ House, 2025) Baba, Dursun; Coban, Soner; Caliskan, Ahmet; Senoglu, Yusuf; Kayikci, Muhammet Ali; Tekin, AliObjective: This study compares the diagnostic efficacy of 12-core and 20-core transrectal ultrasound (TRUS)-guided prostate biopsy protocols in detecting prostate cancer (PCa) and evaluates the clinical significance of extended biopsy protocols. Materials and Methods: A prospective, randomized, single-center study was conducted with 511 patients who underwent TRUS-guided prostate biopsy for suspected PCa. Patients were randomly assigned to either a 12-core biopsy group (n=248) or a 20-core biopsy group (n=263). The primary endpoint was the cancer detection rate, while secondary endpoints included clinically significant cancer detection [International Association of Urological Pathology (ISUP) grade >= 2], biopsy-pathology correlation, upgrade rates, and complication assessment. Results: The 20-core biopsy group had a significantly higher cancer detection rate (39.2%) compared to the 12-core group (28.6%). However, clinically significant cancer detection rates were similar between the groups. The 20-core protocol reduced the likelihood of ISUP grade 1 cancer being upgraded after radical prostatectomy, improving diagnostic accuracy. A strong correlation was observed between tumor burden in biopsy and radical prostatectomy specimens. Prostate-specific antigen density analysis identified an optimal cutoff value of 0.1058, providing 66.1% diagnostic accuracy. Complication rates were comparable between the protocols [5.65% (n=14), 6.46% (n=17)]. Conclusion: The 20-core biopsy protocol enhances overall cancer detection and reduces unnecessary upgrading in low-risk PCa cases, improving diagnostic precision. While multiparametric magnetic resonance imaging (MRI)-guided fusion biopsy offers high accuracy, its limited availability makes extended biopsy protocols a viable alternative, particularly in centers without MRI-based targeting methods. Further multicenter studies are needed to refine biopsy strategies for clinical practice.Öğe The role of N-acetylcysteine in preventing hepatic injury associated with systemic oxidative stress after extracorporeal shock wave treatment(Wroclaw Medical Univ, 2020) Cam, Sebahat; Baba, Dursun; Senoglu, Yusuf; Yuksel, Alpaslan; Erdem, HavvaBackground. Systemic oxidative stress may cause detrimental consequences for the liver, leading to hepatic fibrogenesis. Objectives. To investigate histopathological changes in liver tissues due to the increased systemic oxidative stress associated with rat extracorporeal shock wave lithotripsy (SWL) model and to document the consequences of N-acetylcysteine (NAC) administration. Material and methods. In this experimental SWL model, 18 Wistar albino rats were randomly assigned into 3 groups. The control group (group I) had no intervention. Group II underwent SWL treatment with intraperitonea I saline injection. Group III also had SWL with intra peritoneal NAC and was divided into short-term (group III-14 days) and long-term (group III-28 days) subgroup. Hepatectomy was performed for histopathological examinations. Histopathological alterations were evaluated with light microscopy. Immunohistological staining for p53 and myeloperoxidase was also performed. Results. Blood samples revealed a significant increase in plasma oxidative stress index (OSI) after plasma total antioxidant status (TAS) and total oxidant status (TOS) had been measured. It was shown that this increased systemic oxidative stress adversely affected liver tissues. Predominantly, sinusoidal dilatation was remarkably observed in rats with significantly high 051 values (p = 0.043). Similarly, periportal necrosis significantly increased in rats with high OSI values (p = 0.033). p53 positivity was also remarkable in rats with systemic oxidative stress (p = 0.049). N-acetylcysteine administration provided a significant decrease in OSI. N-acetylcysteine also improved all these alterations, including p53 staining. Particularly, sinusoidal dilatation was significantly protected in the long-term NAC group (group III-28 days). Conclusions. We demonstrated that SWL-induced systemic oxidative stress causes histological alterations in liver tissues. Increased p53 and myeloperoxidase staining as markers of oxidative damage were also detected. N-acetylcysteine may protect from these histological and ultra-structural alterations related to oxidative stress.Öğe 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 YıldırımAim: 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.Öğe 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, AlpaslanObjective: 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.Öğe 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 AliBackgroundUrinary 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.
