Urology Journal

Purpose: To compare outcomes of super mını percutaneous nephrolıthotomy (smPCNL) with extracorporeal shock wave lithotripsy (ESWL) for stones 1- 2 cm.

Material  and Methods: After receiving the ethics committee approval for this study (Date: 10/09/2021 Decision No: 2021/10-01), the files of patients who underwent smPCNL and ESWL for kidney stones between January 2017 and June 2021 by the Urology Department of Van YYU Dursun Odabaşı Medical Center were retrospectively scanned. A total of 300 patients' data were scanned retrospectively. After exclusion criteria and ESWL patients whose sessions were not completed were excluded, a total of 159 patients, 82 ESWL and 77 smPCNL, were included in our study.

Results: The mean age in the ESWL group was 6.72±3.71, and the mean age in the smPCNL group was 6.63±3.59 (1-18). There was no significant difference in age profile between the groups (p=.87). Regarding the direction of the stone procedure in the smPCNL group, the procedure was performed on the right side in 42 patients (54.54%) and on the left side in 35 patients (45.46%). In the ESWL group, the procedure was performed on the right side in 38 patients (46.35%) and on the left side in 44 patients (53.65%). No statistically significant difference was found between the groups in terms of side direction (p=.38). The mean BMI(Body Mass Index)  in the ESWL group was 20.10±2.01, while it was 20.23±2.05 in the smPCNL group.No statistically significant difference was observed between two groups  in terms of BMI (p=.68). The mean stone size in the ESWL group was calculated as 13.74±1.91 mm (10-20 mm) and 149.75±45.46 mm², which would provide more accurate results. The mean value in the smPCNL group was 14.064±2.6 mm (10-20 mm) and 150.879±50.34 mm². No statistically significant difference was found between the groups in terms of stone size (p=(mm)=.37, p=(mm²)=.88). Among 82 patients treated with ESWL, 21 (25.6%) were stone-free after the first session, increasing to 40 (48.8%) by the end of the second session and to 50 (61.0%) at the end of the third session. In terms of sedo-analgesia, 19 (23.20%) were exposed to 1 session, 16 (19.5%)ere exposed to 2 sessions, and 31 (37.80%) were exposed to 3 sessions. 16 (19.5%) patients did not receive anesthesia. When evaluated in terms of the need for re-intervention, it was observed as 22 patients (26.8%) in the ESWL group and 4 patients (5.2%) in the smPCNL group (p=.0003). In the comparison of stone-free rate of smPCNL and ESWL groups, a statistically significant difference was observed in both early and late periods (p=,001).  When comparing the early and late periods of smPCNL (p=.79) and ESWL(p=.19) within their own groups, no statistical difference was observed. When smPCNL and ESWL were classified according to the Clavien-Dindo classification in terms of complications, no statistically significant difference was observed (p=,51).

Conclusion: ESWL remains the preferred first-line option for many pediatric patients due to its safety and non-invasive nature. However, smPCNL provides higher single-session stone-free rates for 10–20 mm renal stones and may reduce repeated anesthesia exposure. SmPCNL should be considered a viable first-line alternative to achieve higher stone-free rates without increasing complication risk. Prospective, multicenter randomized trials are warranted.

Purpose: This preliminary study aims to evaluate the immunogenicity and local immune response triggered by intravesical administration of Brucella abortus S19 (BAS19) in a tumor-free rat model, as a potential alternative to Bacillus Calmette-Guerin (BCG) in bladder cancer immunotherapy. The primary objective is to investigate immune activation and safety in the bladder, establishing a foundation for future studies assessing its therapeutic efficacy against urothelial carcinoma.

Materials and Methods: Nineteen female Wistar albino rats received intravesical BAS19 instillations and were euthanized after 3 and 6 weeks. Blood samples and cystectomy tissues were collected. Systemic immune response was assessed using the Rose Bengal agglutination test, immunocapture agglutination test, and blood cultures. Bladder tissues were examined histopathologically and stained immunohistochemically to evaluate local immune responses, specifically analyzing the expression of CD4, CD8, TLR4, and TNF- α.

Results: Higher Brucella-specific immunocapture titers and increased epithelial inflammation were observed in rats treated with BAS19 for 6 weeks. Moreover, significantly enhanced staining of CD4⁺, CD8⁺, and TNF- α in inflammatory cells was detected in this group. TLR4 expression was observed in all BAS19-treated rats, regardless of exposure duration.

Conclusion: Intravesical BAS19 administration in rats induced strong local immune responses via CD4⁺, CD8⁺, TNF-α, and TLR4 expression without systemic toxicity. These results suggest that BAS19 may mimic BCG’s immunological pathways, particularly through TLR4 signaling. With its safety, low cost, and immunogenicity, BAS19 emerges as a promising immunotherapeutic candidate for further bladder cancer research.

Purpose: The prognosis and clinical management of bladder tumors nearly occupying the entire bladder cavity remain poorly defined due to limited available data. This study aimed to evaluate the clinical features and treatment outcomes of patients presenting with bladder tumors nearly filling the bladder at initial diagnosis.

Materials and Methods: After obtaining ethical approval, a retrospective analysis was conducted on 51 patients diagnosed between 2017 and 2024 with primary bladder tumors nearly filling the bladder. All underwent transurethral resection of bladder tumor (TURBT). The clinical and pathological were analyzed data using descriptive statistics and multivariable logistic regression.

Results : The mean age was 76.24 ± 11.7 years, with a median follow-up of 9.73 months (range: 3–84 months). Hematuria was the most frequent symptom (74.5%). Muscle-invasive disease was identified in 43.1% of cases at initial diagnosis, exceeding the 25% generally reported in newly diagnosed bladder cancer cohorts (P < .001). Complete resection was achieved in 68.6%, while 31.4% required re-TURBT. Among patients initially diagnosed with non-muscle-invasive tumors, 31.1% were found to have muscle invasion upon second resection. Treatments comprised intravesical immunotherapy (48.6%), radical cystectomy (25.7%), chemoradiation (14.3%), and systemic chemotherapy (11.4%).

Conclusion: Bladder tumors nearly filling the bladder cavity are associated with high rates of muscle invasion and pose significant challenges in treatment and management. Larger, prospective multicenter studies are warranted to validate these findings and optimize management in this high-risk population.

Purpose: Diabetes mellitus is a chronic hyperglycemic condition leading to metabolic problems causing organ damage and resulting in serious complications. Long-term complications of diabetes can cause serious health problems, such as sexual and reproductive dysfunction in men and women. Black pepper (Piper nigrum L) is one of medicinal plants proven to increase testosterone hormone levels, sexual function (libido), and spermatogenesis parameters in male rats. In this study the effect of black pepper fruit extract on sexual function and reproductive function (fertility) in alloxan-induced diabetic male-rats were evaluated.

Materials and Methods: Total of 30 male Sprague Dawley rats, Rattus norvegicus, aged 2.5 - 3 months weighing 100-150 g were divided into five groups of 6 individuals each. Group 1 (I) was rats that were only given standard feed. Group 2 (II) was alloxan-induced hyperglycemic rats and given feed. Groups 3 (III) and group 4 (IV) were alloxan-induced hyperglycemic rats and given black pepper extract 122.5 and 245 mg/kg BW respectively for 8 days. Group 5 (V) is alloxan-induced hyperglycemic rats given Sildenafil therapy or Zinc plus Ascorbic acid. After treatment for 8 days the erectile function and libido of rats were assessed, followed by evaluation of spermatozoa and testicular histology. Data were analyzed using ANOVA with significance at p<0.05

Results: Alloxan-induced diabetic rats showed significant impairment in erectile function, libido, sperm quality, and testicular histology (p<0.001 vs control). Administration of black pepper extract at a dose of 122.5 mg/kgBB increased total penile reflexes (9.33 ± 1.03 vs 6.00 ± 1.26 in the diabetes group, p = 0.002) and improved libido with a decrease in courtship latency (5.50 ± 0.55 s vs 21.00 ± 9.47 s, p = 0.013) and increased mounting frequency (18.05 ± 5.99 vs 7.17 ± 1.83, p = 0.009). The extract dose of 245 mg/kgBB increased sperm concentration (158.16 ± 29.80 vs 12.6 ± 1.3 ×10⁶, p = 0.000), progresif sperm motility (65.0 ± 35% vs 27.0 ± 30%, p = 0.006), and increasing normal sperm morphology (82.9 ± 5.7% vs 35.0 ± 10.8%, p = 0.000). The number of Leydig cells increased significantly in the 122.5 mg/kgBB extract group (59.33 ± 4.08 & 30.50 ± 3.86; P = 0.000) compared to the diabetes group, There was no significant difference in spermatogonia count  (640 ± 86.5 & 491 ± 37.0; p = 0.119).

Conclusion: Piper nigrum fruit extract ameliorates sexual dysfunction and reproductive impairment in alloxan-induced diabetic rats, particularly at 122.5 mg/kg BW, with significant improvements in erectile function, libido (p<0.05), sperm quality (p≤0.04), and testicular histology (p=0.035). These findings suggest its potential as a natural therapeutic agent for DM-related male reproductive dysfunction.

Purpose: Varicocele is the abnormal dilatation of the veins of the pampiniform plexus, which considered one of the most common factors related to infertility in men. The aim of the present study was to investigate whether a relationship exists between sleeping position and the presence of varicocele.

Materials and Methods: In this case-control study, including 231 adult infertile men who referred to Kowsar Infertility Center, Yasuj, Iran, divided into two groups: Control group including 113 infertile patients without varicocele and case group 118 infertile patients with varicocele. After the first visit by the urologist and determining the presence or absence of varicocele and clinical grading of varicocele, patients completed demographic, clinical and sleep position questionnaires.

Results: The findings of the current study indicated a significant relationship between the presence of varicocele and Faller down (lying on the abdomen) sleeping position. There was also a significant positive correlation between this position and the degree of varicocele (p=0.003).

Conclusion: Faller down or prone position during sleep has a meaningful relationship with varicocele, which may be due to increased intra-abdominal pressure. More studies are needed to confirm this hypothesis.