For decades, the male genitourinary tract was considered sterile in healthy individuals. However, advances in culture-independent molecular techniques, particularly next-generation sequencing, have revealed that semen contains a diverse microbial ecosystem known as the seminal microbiome. This paradigm shift has led to growing interest in the relationship between microbial composition and male reproductive health. Current evidence suggests that male infertility is associated not merely with the presence of bacteria in semen, but with alterations in microbial balance, termed seminal dysbiosis. Beneficial genera such as Lactobacillus are often associated with normal sperm parameters and genomic stability, whereas increased abundance of opportunistic and pathogenic bacteria—including Escherichia coli, Enterococcus faecalis, Ureaplasma urealyticum, and Prevotella—is associated with reduced sperm motility, abnormal morphology, and decreased sperm concentration. The pathological mechanisms underlying this relationship involve both host-mediated and pathogen-mediated pathways. Dysbiosis has been suggested to promote chronic inflammation and leukocytospermia, leading to excessive production of reactive oxygen species and consequent oxidative stress. This environment promotes lipid peroxidation and sperm deoxyribonucleic acid (DNA) fragmentation, key contributors to impaired fertilization and poor reproductive outcomes. Despite increasing recognition of the seminal microbiome’s role in infertility, current diagnostic approaches remain limited. Culture-based methods frequently fail to detect viable but non-culturable microorganisms, while molecular assays cannot reliably distinguish viable pathogens from residual DNA. Improved diagnostic strategies targeting microbial viability and virulence may therefore play an important role in addressing unexplained male infertility.
Objective: Retrograde intrarenal surgery (RIRS) is an established treatment modality for renal calculi ≤2 cm. Preoperative ureteral stenting is often employed to facilitate access, but its influence on residual fragment rates remains controversial. This prospective study aimed to evaluate the impact of ureteral pre-stenting on residual stone fragments following RIRS. Materials and Methods: A prospective observational study was conducted at a tertiary care center from July 2023 to December 2024, involving 180 patients with renal calculi. Participants were randomized into two groups: pre-stented (n=90) and non-stented (n=90). All patients underwent RIRS according to standardized protocols and had a non-contrast computed tomography kidney, ureter, and bladder on postoperative day 90. Residual fragments ≥3 mm were considered significant. Baseline demographics, stone parameters, intraoperative data, and postoperative outcomes were analyzed. Statistical significance was set at p<0.05. Results: Baseline characteristics, including age, body mass index, stone size, volume, and density, were comparable between groups. Ureteric access sheath (UAS) insertion was significantly more successful in the pre-stented group (100%) than in the non-stented group (86.66%, p=0.037). The mean operative time was shorter in the pre-stented group (79.70±18.83 min vs. 89.33±16.02 min, p=0.036). However, the residual fragment rate was identical in both groups (2 patients per group, 6.6%, p=1.000). Postoperative complications, including fever and urinary tract infection, did not differ significantly. Conclusion: Preoperative ureteral stenting improved the success of UAS insertion and reduced operative time during RIRS but did not influence the rate of residual stone fragments. Pre-stenting may be beneficial in optimizing surgical access, but does not appear to directly enhance stone clearance outcomes.
Objective: To evaluate the long-term outcomes of the transobturator mid-urethral sling (TO-MUS) procedure for the treatment of female stress urinary incontinence (SUI) when performed by a single surgeon using a standardized surgical technique and the same material. Materials and Methods: Patients (n=42) who underwent TO-MUS between 2006 and 2023 were retrospectively analyzed. Inclusion criteria were a diagnosis of urodynamic SUI confirmed by the International Continence Society Uniform Cough Stress Test and a minimum follow-up duration of 12 months. Treatment success was defined as no pad use and a negative response to item 6 of the International Consultation on Incontinence Questionnaire-Short Form. Patient satisfaction was assessed via structured telephone interviews. The treatment success and patient satisfaction rates were compared between patients with follow-up periods above and below ten years. Group 1 comprises patients with follow-up durations ranging from 12 to 120 months, while Group 2 consists of patients with follow-up durations of 121 months or more. Results: With a median follow-up of 125 months (range: 12-204). Group 1 (n=24) had a median follow-up duration of 69.5 months, while Group 2 (n=18) had a median follow-up duration of 154 months. TO-MUS was the primary intervention in 92.9% of patients. Across all patients, treatment success and patient satisfaction rates were 83.3% (35/42) and 92.8% (39/42), respectively. No statistically significant differences were observed between the two groups. De novo urgency was reported in 16.6% of patients; one patient experienced persistent voiding difficulty. Three patients (7.1%) required reoperation. No mesh-related complications were observed. Conclusion: This study presents one of the longest follow-up periods (more than 10 years) among single-surgeon, single-center TO-MUS case series. High long-term treatment success and satisfaction rates, together with low complication and reoperation rates support the durability and safety of the TO-MUS procedure in carefully selected patients when it is performed by experienced surgeons using standardized techniques and surgical materials.
Objective: This study aimed to assess the responses of three artificial intelligence (AI) chatbots (ChatGPT-4, Gemini Pro, Llama 3.1 Large) on prostatitis using quality, reliability, readability scales and examine their role in disease management. Materials and Methods: Keywords related to prostatitis were identified using Google Trends and Semrush platforms. The search volume and regional distribution of these terms over the past five years were analyzed, leading to the selection of 25 questions. The core question set was categorized into six subgroups: general information, symptoms, diagnostic methods, treatment methods, complications, and myths. The responses generated by the AI chatbots were assessed for readability using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRES) scores. Quality and reliability were evaluated using the Educational Quality of Information for Patients (EQIP) score and the Modified DISCERN score. Results: No significant difference was observed among AI chatbots in mean FKGL scores (p=0.354). However, ChatGPT-4 had a significantly higher mean FRES score than Gemini Pro and Llama 3.1 Large (p=0.016 and p=0.003, respectively). Gemini Pro had the highest mean EQIP score, significantly surpassing Llama 3.1 Large and ChatGPT-4 (p<0.001); Llama 3.1 Large had the highest median Modified DISCERN score (p<0.001). Across all subgroup analyses, Gemini Pro yielded the highest mean EQIP score, while Llama 3.1 Large had the highest median Modified DISCERN score. Conclusion: The findings of this study suggest that Llama 3.1 Large provides more reliable responses to questions about prostatitis, whereas Gemini Pro delivers higher-quality responses. However, the readability levels of all AI chatbots exceeded the recommended 6th-grade level, indicating that their responses may be challenging for general audiences.
Objective: Urothelial carcinoma is an aggressive malignancy with limited therapeutic options in the metastatic setting. Neurotrophic receptor tyrosine kinase (NTRK) gene fusions are actionable alterations in several solid tumors; however, their prevalence and clinical relevance in bladder cancer remain unclear. Materials and Methods: A retrospective analysis was performed on cystectomy specimens from 60 patients with metastatic urothelial carcinoma who were treated between 2009 and 2021 at a single tertiary center. Tropomyosin receptor kinase (TRK) protein expression was evaluated by immunohistochemistry using a pan-TRK antibody. Positive cases were further analyzed for NTRK1/2/3 fusions using a real-time polymerase chain reaction assay detecting 109 known variants. Clinicopathological parameters and survival outcomes were reviewed. Results: The cohort included 55 males (91.7%) and 5 females (8.3%), with a median age of 62 years. At cystectomy, all tumors were high-grade, with pathological stages ranging from pT1 to pT4a. Median overall survival was 49.5 months, and median survival after progression to metastatic disease was 19.5 months. Pan-TRK positivity was observed in 2 of 60 cases (3.3%). Molecular analyses of these samples revealed no NTRK fusions, indicating isolated TRK protein overexpression without gene rearrangements. Conclusion: TRK expression was rare, and NTRK fusions were absent in this cohort with metastatic urothelial carcinoma. These results suggest that TRK-targeted therapies are unlikely to benefit unselected bladder cancer populations. Nonetheless, systematic molecular profiling remains essential for identifying patients with rare targetable alterations, while TRK signaling does not appear to represent a major oncogenic driver in urothelial carcinoma.
Objective: Genitourinary tuberculosis (GUTB), a prevalent form of extrapulmonary tuberculosis, is challenging to diagnose because of non-specific symptoms, and the low sensitivity of conventional diagnostic tests. The GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay offers rapid detection, however, its performance in urine for GUTB diagnosis has not been well characterized. The objective is to evaluate the clinical spectrum, diagnostic approaches, and management of GUTB and assess the sensitivity of urine GeneXpert compared to acid-fast bacilli (AFB) culture. Materials and Methods: We conducted a retrospective analysis of 42 GUTB cases diagnosed using South Indian Consensus criteria at a tertiary care hospital in India (March 2013-March 2019). Diagnostics included urine AFB staining, GeneXpert MTB/RIF, and culture (Löwenstein-Jensen and mycobacterial growth indicator tube). The clinical features, radiological findings (computed tomography, intravenous pyelogram, retrograde pyelography, GUTB, magnetic resonance imaging), histopathology, and treatment outcomes were evaluated for each patient. The sensitivities of GeneXpert and culture were calculated with 95% confidence intervals (CIs) for all cases. Results: Among 42 patients (male: female ratio 1.1), 38% were in their fourth decade of life. Flank pain was predominant (52%; 22/42), and 27% had a history of tuberculosis. Urine AFB was positive in 12% (5/42) of samples, GeneXpert was positive in 57% (24/42; 95% CI: 41-72%), and culture was positive in 52% (22/42; 95% CI: 37-68%). In histopathologically confirmed cases (n=19), GeneXpert sensitivity was 52.6% (10/19; 95% CI: 29-76%) and culture sensitivity was 47.4% (9/19; 95% CI: 24-71%). Radiology suggested GUTB in 82.5% (35/42) of the cases, with renal involvement being the most common finding. Nephrectomy was performed in 59% (25/42) of the patients, and no rifampicin resistance was detected. Conclusion: The sensitivity of GeneXpert in urine samples (52-57%) is comparable to that of AFB culture, offering a rapid diagnosis of GUTB. The integration of clinical and radiological data enhances diagnostic accuracy. Multicenter studies are needed to optimize urine-based protocols.
Objective: Benign prostatic enlargement (BPE) causes lower urinary tract symptoms (LUTS) in ageing men. While conventional diagnostic tools like the international prostate symptom score (IPSS) and uroflowmetry are routinely used, they often yield equivocal findings. Urodynamic studies, though definitive, are invasive and less accessible. This study aimed to evaluate the clinical utility of a novel, non-invasive uroflowmetry-derived parameter—flow-derived bladder outlet efficiency (FDBOE)—in assessing symptom severity and predicting treatment outcomes in BPE. Materials and Methods: A prospective observational study was conducted over four months involving 51 male patients aged >45 years presenting with LUTS due to BPE. After exclusion of confounding urological conditions, baseline IPSS and uroflowmetry assessments were performed. FDBOE was calculated using the formula: Voiding efficiency × Qavg × (flow time/total voiding time). All patients were started on silodosin (8 mg daily) and reassessed after four weeks. Results: FDBOE values ranged from 0.51 to 7.76 mL/sec, with a mean of 3.49±1.70 mL/sec. A strong inverse correlation between FDBOE and IPSS (r=-0.832, p<0.001) was observed. Sensitivity analysis using an FDBOE threshold of ≤3.3 mL/sec yielded a sensitivity of 92.6% for detecting severe LUTS. Post-treatment analysis revealed that 95% of grade I patients, 35% of grade II patients, and none of the grade III patients required surgical intervention. Conclusion: FDBOE is a simple, reproducible, non-invasive parameter that correlates strongly with LUTS severity, and predicts treatment outcomes in BPE. It offers practical utility in clinical decision-making, especially in resource-limited settings.
Laparoscopic nephrectomy is a widely performed urologic surgical procedure in which non-absorbable polymer ligation (NPL) clips are frequently used for vascular control. We present a case involving a 64-year-old male scheduled for laparoscopic radical nephrectomy due to renal cell carcinoma, during which two Hem-o-lok clips applied to the renal artery unexpectedly reopened intraoperatively. Even when applied by experienced surgeons in accordance with standard protocols, the risk of malfunction remains and must be considered during laparoscopic renal surgery. NPL clips are frequently used to achieve secure vascular control. Although generally considered reliable, these clips may occasionally malfunction leading to potentially life-threatening complications.
Renal cell carcinoma (RCC) is a common urologic malignancy with poor outcomes in metastatic disease, despite advances in targeted therapies and immune checkpoint inhibitors. Chimeric antigen receptor (CAR)-engineered cell therapies, particularly CAR-T and CAR-natural killer (CAR-NK) cells, have revolutionized the treatment of hematologic malignancies, but face unique barriers in solid tumors such as RCC, including tumor heterogeneity and an immunosuppressive microenvironment. Using the Trialtrove database with the keywords “CAR” and “oncology: kidney,” we identified 44 eligible interventional trials as of June 10, 2025. Most are early-phase and industry-sponsored, and are conducted primarily in China and the United States. CAR-T studies outnumber CAR-NK trials, with cluster of differentiation 70 as the most common target, followed by estimated glomerular filtration rate and programmed cell death protein 1. Combination regimens frequently incorporate lymphodepletion with cyclophosphamide and fludarabine. Preliminary clinical data indicate that CAR therapies for RCC are generally safe and feasible but show limited durable efficacy. Key obstacles include antigen escape and poor persistence of infused cells within the tumor microenvironment. To overcome these challenges, next-generation strategies—such as dual-target CAR constructs, cytokine co-expression (e.g., interleukin-15), and biomarker-guided patient selection—are actively being explored. Regulatory frameworks in the United States and China increasingly support innovation in cellular therapies. Overall, the evolving clinical landscape highlights both the promise and the ongoing challenges of CAR-engineered therapies for RCC, underscoring the need for optimized designs and rational combination approaches to improve patient outcomes.
Objective: Traffic accidents are the most frequent cause of genitourinary injuries. There exists a paucity of data on lower genitourinary injuries (LGUI) after traffic accidents. The main objective of our study was to analyze the incidence and clinical patterns of LGUI in traffic accidents. The secondary objective was to determine the LGUI predictive factors, and the associations with lesions. Materials and Methods: Patient cases were extracted from the trauma registry of the French department of Rhone from 1995 to 2015. We assessed the LGUI presented by each road user category. Injuries were coded with the abbreviated injury scale and the injury severity score. Multivariate prediction models and the DataShared-SepLogit method were used for data analysis. Results: Of 178,625 victims, 591 (0.33%) presented with LGUI, 53% were motorcyclists, and 26.4% were cyclists. The most commonly injured organ was testicles (41%) followed by scrota (20%) and penises (15%). Among the 312 motorcyclists, testicular (60%) and scrotal (24%) injuries were the most frequent lesions. Among the 156 cyclists, penile injuries were the most frequent (27%). Among the 54 motorists, bladder (46%) and testicle (20%) injuries were the most frequent. For motorcyclists, motorists, and pedestrians, compared to women, a four, three, and two-fold risk of LGUI was observed for men, respectively. For cyclists, being a man was a protective factor. Testicular lesions were strongly associated with penile lesions for motorists and cyclists. Bladder injuries were strongly associated with pelvic fractures for pedestrians and motorists. Within the 78 testicular traumatisms with clinically available records, 69% (54) had an ultrasound examination and 12.5% (16) had an albuginea rupture. The salvage rates for patients who had surgery after blunt testicular trauma were 64% (7 albuginea repairs for 11 albuginea ruptures) and 33% after open wound trauma. Conclusion: LGUI is an infrequent trauma after traffic accidents, with testicular injuries being the most commonly injured. Physicians must maintain a high awareness of external genitalia injuries in motorcyclists and cyclists.
Objective: Kidney stone disease is among the most common urological disorders worldwide. Patients frequently search online for information regarding etiology, management, and prevention; however, the quality and readability of available resources are variable. This study aimed to evaluate and compare the quality and readability of responses generated by three large language model (LLM)-based chatbots—OpenAI GPT-4, Google Gemini 2.5 Pro, and DeepSeek R1—for common patient-oriented kidney stone queries. Materials and Methods: A set of 15 frequently asked questions was curated from online search trends and categorized into three domains: definitions and epidemiology, medical and surgical management, and lifestyle or behavioral aspects. Readability was assessed using Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). Response quality was evaluated with the Ensuring Quality Information for Patients (EQIP) tool and the modified DISCERN instrument. Statistical analyses were performed using the Kruskal-Wallis test with Dunn’s post-hoc comparisons. Results: Mean DISCERN and EQIP scores did not significantly differ among platforms, with overall ratings falling in the “limited to acceptable” range. FRES scores were comparable across groups, whereas FKGL revealed significant differences: Gemini responses required a lower educational level than those of ChatGPT (p<0.016) and DeepSeek (adjusted p<0.02). No differences were observed in word count, sentence count, or total text length. Conclusion: Although all three LLMs generated structured, patient-centered outputs, quality remained modest and readability varied. Some ChatGPT responses demand higher health literacy, potentially limiting accessibility. These findings underscore the need for expert oversight and domain-specific refinement before widespread clinical adoption.
Objective: To identify a better predictor of renal stone burden among stone volume and stone size, and their predictive efficacy on residual fragments post-retrograde intrarenal surgery (RIRS). Materials and Methods: This single-center prospective observational study was conducted from July 2023 to December 2024, involving patients undergoing RIRS for renal calculi. Pre-operative renal stone parameters were analyzed on non-contrast computed tomography (NCCT) kidney, ureter, and bladder (KUB) scan. The residual fragments were determined by NCCT-KUB, on the 90th postoperative day. The relationships between possible predictors and the residual fragments were analyzed using a logistic regression model. Results: According to multivariate analysis, the stone volume (p=0.038) was found to be the only significant independent predictor of residual fragments, while other factors such as stone size (p=0.627), age (p=0.251), location (p=0.506), and body mass index (p=0.69) did not have an impact on stone-free rates post RIRS. The area under curve generated cut-off was 889 mm3 for stone volume. Conclusion: Among the parameters of renal stone burden, the stone volume determined by NCCT-KUB was a statistically significant predictor of residual fragments, post-RIRS, compared to stone size.
Objective: Prognostic nutritional index (PNI) is a parameter that reflects nutritional status and inflammation. It is calculated from serum albumin and lymphocyte count. Our study investigated whether PNI has a predictive value in urolithiasis. Materials and Methods: Data of patients who applied to A & gbreve;r & imath; Training and Research Hospital with renal colic between January 2017 and December 2024 were retrospectively examined. Three hundred forty-eight patients were included in the stone group and 627 patients were included in the control group. Patients' age, gender, smoking, hypertension, and diabetes history, body mass index, hemoglobin level, glomerular filtration rate (GFR), blood urea nitrogen, uric acid levels, sodium, potassium, calcium, white blood cell count (WBC), neutrophil count, lymphocyte count, albumin, neutrophil/lymphocyte ratio (NLR), and PNI levels were compared. Results: No statistically significant difference existed between the demographic data and the patients' comorbidities. In the stone patients group and the control group, mean GFR was 88.04 [standard deviation (SD): 13.21], 93.90 (SD: 13.17); mean WBC was 8910 (SD: 1629), 8268 (SD: 1562); mean neutrophil count was 6040 (SD: 1416), 4933 (SD: 1283); mean lymphocyte count was 2070 (SD: 879), 2535 (SD: 944); mean NLR was 3.62 (SD: 2.1), 2.34 (SD: 1.41); PNI was 30.73 (SD: 6.85), 53.66 (SD: 6.94) (p<0.001, all). Conclusion: PNI value was lower in stone patients than in the control group. PNI may be a parameter predicting stone formation. Additionally, the predictive value can be strengthened with the NLR value.
Ketamine-induced ulcerative cystitis (KIC) is an emerging urological disorder associated with recreational ketamine use, characterized by inflammation, bladder wall hypertrophy, and involvement of the upper urinary tract. We report two female patients with ketamine-related ulcerative cystitis. The first case represented advanced-stage KIC, with findings including hydronephrosis, bladder fibrosis, and impaired renal function. In contrast, the second case presented at an early stage with clinical and radiological findings that were reversible after complete cessation of ketamine use. Histopathological examination in both cases revealed ulceration, chronic inflammation, and fibrosis. Radiological and cystoscopic findings closely correlated with disease severity. Early recognition of KIC and strict cessation of ketamine use are crucial to prevent irreversible bladder damage and progressive renal deterioration.
Objective: This study aimed to compare the clinical and radiographic success rates of endoscopic treatment for vesicoureteral reflux (VUR) using two different formulations of dextranomer microspheres. Materials and Methods: This retrospective study included 119 children treated endoscopically for VUR between 2015 and 2020 at a single tertiary center. Subureteric injections were performed using either Dexell (n=61) or Deflux (n=58) by a single surgeon applying the hydrodistention implantation technique. Clinical data, including demographics, VUR grade, voiding status, injection volume, and complications, were collected from medical records. Treatment success was defined as the resolution of reflux on voiding cystourethrogram at 3 months, and the absence of febrile urinary tract infections during the 2- and 5-year follow-ups. Statistical analyses included chi-square and Mann-Whitney U tests, and logistic regression was used to identify predictors of treatment failure. Results: The mean follow-up durations were 75.9 months in the Dexell group and 78.2 months in the Deflux group, with comparable baseline demographic and clinical characteristics between groups. The short-term success rates at 3 months were 83.6% for Dexell and 84.5% for Deflux (p=0.896). Long-term success rates remained similar at both 2 years (80.3% vs. 81.0%, p=0.922) and 5 years (72.1% vs. 74.1%, p=0.805). Postoperative obstruction occurred in 3 patients in the Dexell group and 2 patients in the Deflux group, all of which resolved conservatively. Multivariable analysis revealed no independent predictors of treatment failure. Conclusion: Our analysis showed that the diameter of dextranomer microspheres, frequently utilized for the endoscopic treatment of pediatric VUR, did not affect the short-term or long-term success rates of the procedure. Therefore, Dexell may be considered a cost-effective alternative to Deflux in clinical practice. However, multicentric, randomized, prospective trials with long follow-up durations are necessary.
Objective: To evaluate the effect of bipolar radiofrequency (RF) ablation therapy on prostate volume, urinary flow rates, post-void residual urine volume (PVR), and symptom scores in benign prostatic hyperplasia (BPH) patients. Materials and Methods: A retrospective analysis was conducted on 40 BPH patients who underwent bipolar RF ablation between November 2017 and June 2018 after failed medical treatment. Prostate volume, International Prostate Symptom Score (IPSS), Q(max), Q(ave), and PVR were assessed before treatment, and at 1, 3 months and 1 year post-treatment. Results: The mean age was 72.8 years. Prostate volume decreased by 12.6% from 53.06 +/- 19.53 mL to 46.34 +/- 21.15 mL at 1 year, although this change was not statistically significant (p=0.105). PVR showed a significant reduction from 148.83 +/- 103.18 mL to 106.37 +/- 100.26 mL (p=0.0018). Maximum urinary flow rate (Q(max)) increased by 48.3% from 11.03 +/- 6.62 to 16.36 +/- 6.70 mL/s at 3 months, and remained stable at 16.10 +/- 6.12 mL/s at 1 year. The IPSS improved significantly from 21.86 +/- 7.61 to 13.30 +/- 7.14 at 3 months, and further to 10.40 +/- 3.64 at 1 year (p<0.001). No major complications were observed throughout the follow-up period. Conclusion: Bipolar RF ablation is a safe and effective minimally invasive treatment for BPH, especially in patients with high surgical risk. It significantly improves urinary parameters and symptom scores.
This case report presents the surgical management of a patient with complex Peyronie’s disease involving a densely ossified plaque. The report highlights technical tips and tricks used to overcome intraoperative challenges, including dissection strategies and grafting techniques. Our experience emphasizes the importance of surgical expertise in achieving successful outcomes in such demanding cases.
Objective: Percutaneous nephrolithotomy (PCNL) is considered the gold standard for the treatment of kidney stones >2 cm in size and those who fail other treatment modalities. Standard PCNL is associated with a significant number of complications mostly attributed to the larger tract circumference. Mini-PCNL, which utilizes a small tract size of less than 22 Fr, is associated with significantly fewer complications while maintaining a clearance rate comparable to that of standard PCNL. Prone position leads to upward migration of the kidney under the rib cage, making supracostal puncture necessary in a significant number of cases. Mini-PCNL, when performed under spinal anesthesia, is safe and reduces operative time without compromising stone clearance rate. This study was carried out to establish the safety and efficacy of supracostal tubeless mini-PCNL done under spinal anesthesia. Materials and Methods: This is a retrospective study carried over a period of 5 years. It includes all the patients who underwent supracostal mini-PCNL under spinal anesthesia. The procedure was carried out in the prone position, employing 18 Fr Amplatz sheath with 12 Fr nephroscope. The outcome and perioperative complications were recorded and stored via Microsoft Excel and analyzed using SPSS Software, version 20.0. Results: This study included 1135 patients with an average age of 40.6 +/- 13.8 years. The average stone size was 2.87 +/- 0.98 cm, and stones had predominantly calyceal distribution in 42.37% of cases. The 11th and 10th intercostal spaces were entered in 89.16%and 10.83% of cases, respectively, to gain access to superior (35.85%) and middle (64.14%) calyces. A single tract was usually required (78.32%) and the average operative time was 52.72 +/- 11.42 minutes. The rate of blood transfusion was 0.61%, and angioembolization was required to seal pseudoaneurysm/AVF in 0.52% of patients. The rate of hydrothorax/pneumothorax associated with 11th and 10th intercostal space entry was 0.49% and 7.3%, respectively. Only 1.23% of patients required intracostal tube drainage for pneumothorax/hydrothorax. The average rates of stone clearance and hospital stay were 97.53% and 1.8 +/- 0.45 days, respectively. Conclusion: Supracostal tubeless mini-PCNL done under spinal anesthesia is safe and has high stone clearance rate. The associated thoracic and non-thoracic complications are minimal and the procedure can be safely performed when indicated, provided proper technique is employed.
Objective: This study aims to evaluate the etiological distribution among patients presenting with chronic scrotal pain, to demonstrate the contribution of a multidisciplinary approach to diagnosis, and to help determine possible causes, especially in cases classified as idiopathic. Materials and Methods: In this retrospective study, 127 patients (mean age 35 years, range 18-66 years) who presented to our urology clinic with chronic scrotal pain (CSP) between January 2023 and June 2025 were evaluated. All patients underwent a diagnostic evaluation, including a detailed medical history, a comprehensive physical examination, scrotal Doppler ultrasonography, and laboratory investigations. To identify possible sources of pain beyond urological causes, patients were evaluated in multidisciplinary consultations. Results: Pain was unilateral in 40 patients (31.5%) and bilateral in 87 patients (68.5%). Chronic epididymitis and prostatitis were present in 25 patients (19.68%); varicocele was present in 27 patients (21.26%); and pain after varicocelectomy-inguinal hernia repair was present in 18 patients (14.17%). Of the 57 patients (44.90%) with undetermined urological etiology, 20 (15.75%) were diagnosed with perianal pathologies during consultation in the general surgery clinic, and 7 (5.51%) were diagnosed with lumbar disc herniation during consultation in the neurosurgery clinic. Conclusion: CSP is a multifactorial clinical condition. We believe that rates of idiopathic cases, reported in the literature as 35-45%, can be reduced to 23.62%, as observed in our study, through a multidisciplinary approach that includes systematic evaluation and clinical consultations.
