Objective To develop a high-accuracy prediction model using hybrid machine learning (ML) and explainable artificial intelligence (XAI) techniques for distinguishing between orchiectomy and detorsion in testicular torsion (TT), and to create an interactive web application and nomogram for clinical use. Materials and methods Data from 117 patients who underwent surgical treatment for TT at our clinic between January 2005 and June 2025 were retrospectively analyzed (detorsion: 83, orchiectomy: 34). From twenty initial features, seven optimal features were selected using a hybrid Particle Swarm Optimization-Grey Wolf Optimization (PSO-GWO) algorithm. Class imbalance was addressed using SVMSMOTE. Four ensemble learning algorithms were compared, and CatBoost was selected as the final model. SHAP, LIME, Partial Dependence Plot (PDP), and Individual Conditional Expectation (ICE) analyses were performed for model interpretability. A seven-feature nomogram was developed using logistic regression. A two-module web application was created using Python Dash. Results PSO-GWO identified seven optimal features (Age, Symptom Duration, PDW, PCT, MPV, MLR, SII). CatBoost demonstrated the highest performance (AUC: 0.923, Accuracy: 89.5%). XAI analyses identified symptom duration as the strongest predictor (SHAP: 52.72%), followed by MLR (14.24%) and PDW (12.09%). PDW emerged as a novel biomarker with minimal prior investigation in the literature yet demonstrated strong discriminatory power (inverse relationship, cut-off < 17.9 fL). PDP analysis revealed a distinct inflection point at approximately 7 h, corroborating the ROC cut-off values. ICE analysis revealed substantial individual heterogeneity (score > 0.36). The nomogram demonstrated good discrimination (AUC: 0.818) and excellent calibration (Hosmer-Lemeshow p = 0.556). A simplified three-feature risk scoring system (0-3 points) was developed. The web application (medicalinformaticsttrc.adiyaman.edu.tr) provided real-time risk calculation (< 50 ms). Conclusion The CatBoost model developed with hybrid PSO-GWO algorithm and XAI techniques achieved high accuracy in predicting orchiectomy in TT. PDW was identified as a novel, practical, and cost-effective biomarker. The developed web application and risk scoring system may support preoperative counseling, surgical preparedness, and clinical decision-making in the emergency department. The "detorsion" outcome indicates intraoperative non-removal of the testis and does not confirm long-term testicular viability. This exploratory model requires external validation and multicenter prospective studies before clinical adoption.

Background: This retrospective study aimed to evaluate clinical and radiological parameters associated with unsuccessful outcomes of semi-rigid ureteroscopy using holmium: YAG laser lithotripsy in patients with proximal ureteral stones.Materials and Methods: A total of 212 patients who underwent semi-rigid URS for proximal ureteral stones between 2015 and 2025 were retrospectively analyzed. Patients were classified into three groups according to postoperative outcomes: Group 1 (stone-free, n=158), Group 2 (retropulsion, n=32), and Group 3 (residual fragments >3 mm, n=22). Demographic and stone-related parameters, including hydronephrosis grade, stone density, stone volume, and stone-to-renal pelvis distance, were compared statistically among the groups.Results: The overall stone-free rate was 74.5%. Severe hydronephrosis was significantly more frequent in the retropulsion group compared to the stone-free group (46.9% vs. 12.7%, p<0.001), and was associated with a 6.1-fold increased risk of stone migration (95% CI: 2.6-14.1, p<0.001). Mean stone density was significantly higher in Group 2 compared to Group 1 (916±239 HU vs. 692±234 HU, p<0.001) and in Group 3 compared to Group 1 (868±191 HU vs. 692±234 HU, p=0.003). Median stone volume was also significantly greater in Group 2 than in Group 1 (459 mm³ vs. 168 mm³, p<0.001). Additionally, stone-to-renal pelvis distance was significantly shorter in Group 2 (7.5 mm vs. 27 mm, p<0.001).Conclusions: High-grade hydronephrosis, increased stone density, larger stone volume, and shorter stone-to-renal pelvis distance are significantly associated with unsuccessful outcomes of semi-rigid ureteroscopic holmium: YAG laser lithotripsy in proximal ureteral stones. Preoperative evaluation of these parameters may help optimize surgical planning and patient counseling.

PURPOSE:This preliminary study aims to evaluate the immunogenicity and local immune response triggered by the 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. The 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 the 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.

This study compared various circumcision techniques, specifically the dorsal slit (DS), sleeve resection (SR), and forceps-guided (FG) techniques, which fall under the category of conventional circumcision techniques, with the thermocautery-assisted circumcision (TAC) technique. The aim was to investigate the safety and efficacy of these circumcision methods by focusing on clinical outcomes and early complications, categorizing the associated complications using the Clavien-Dindo classification system (CDCS). A total of 7041 circumcised patients were retrospectively analyzed and grouped according to the applied techniques: DS, SR, FG, and TAC. Factors such as age, duration of the procedure, bleeding, edema, infection, recovery time, and local anesthetic technique parameters were compared. Complications were classified according to the modified CDCS. The duration of the procedure was 4.7 min (range 4.5–5.2), and bleeding (hematoma) was significantly lower in the TAC group with seven cases (0.3%) (p < 0.001). The recovery time of 5 days (range 5–7 days) and the incidence of edema were longer in TAC compared to other techniques (p < 0.001). Additionally, the recovery time in the SR group was shorter than that of the FG and DS groups (p < 0.001). After adjusting for confounding factors such as age, duration of the procedure, and local anesthetic techniques, the likelihood of perioperative bleeding was observed to statistically significantly increase in the FG (odds ratio [OR] = 61.663, 95% confidence interval [CI] 42.764–88.913, p < 0.001), DS (OR = 59.249, 95% CI 39.382–89.141, p < 0.001), and SR (OR = 161.952, 95% CI 96.100–272.930, p < 0.001), in that order, compared to the TAC group. Furthermore, compared to the TAC group, the likelihood of severe edema statistically significantly decreased in the FG (OR = 0.010, 95% CI 0.004–0.027, p < 0.001), DS (OR = 0.040, 95% CI 0.017–0.092, p < 0.001), and SR (OR = 0.043, 95% CI 0.015–0.124, p < 0.001) groups, in that order. There was no significant difference between the surgical techniques according to the CDCS evaluation. TAC demonstrated advantages over the remaining techniques in terms of less bleeding and shorter duration of the procedure. However, it also presented with disadvantages such as postoperative edema and longer recovery time.

BACKGROUND:The age-adjusted rate of Bladder cancer (BC) in Türkiye is quite high, and genetic factors are effective in BC. Long non-coding RNAs (lncRNAs) synthesized from the HOTAIR gene have been shown to promote tumor progression in many cancers. rs874945 and rs4759314 polymorphisms in the HOTAIR gene cause changes in the expression levels of lncRNAs synthesized from this gene. The aim of this study was to explore for the first time the association of these variants with BC in a Caucasian population. METHODS:The present study explored the HOTAIR gene polymorphisms in 98 BC patients and in 150 healthy individuals using real-time polymerase chain reaction (RT-PCR). RESULTS:Carrying rs874945 G allele and GA genotype increased the BC risk in the statistic models. However, even if rs4759314 variant increased of BC risk was not significant. Similarly, although both polymorphisms increased clinicopathological features associated with poor prognosis, they were not statistically significant. Moreover, being older than 60 years and smoking are independent risk factors for BC. DISCUSSION:The current study is the first to show that patients carrying the G allele of the rs874945 polymorphism have a higher risk of BC in the Caucasian population. This work suggests that rs4759314 polymorphism should be studied in the Caucasian population with a larger sample size of BC patients.

To predict postoperative infectious complications by utilizing hemogram parameters and derived inflammation indices and to analyze patient-related risk factors to propose a nomogram. The data of patients who underwent retrograde intrarenal surgery were reviewed. The patients were categorized into two groups: those without infectious complications (Group A) and those with infectious complications (Group B). Infectious complications were defined as fever persisting above 38 °C for 48 h and the presence of two or more systemic inflammatory response syndrome (SIRS) criteria. Hemogram parameters and inflammation indices were examined to predict infectious complications. The study utilized neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), along with the pan-immune-inflammation value (PIV) and systemic immune-inflammation index (SII). The data of 658 cases were evaluated. No infectious complications were observed in 610 cases (92.7

Mesane kanseri dünya çapında her iki cinsiyet dikkate alındığında onuncu, erkeklerde en sık teşhis edilen yedinci kanserdir. Etiyolojide tütün, mesleki maruziyet, genetik, beslenme alışkanlıkları, çevresel maruziyet, şistosomiyazis ve pelvik radyasyon başlıca risk faktörleri olarak bilinmektedir. Mukozaya sınırlı ve lamina propriayı invaze eden ürotelyal tümörler, Tümör, Nod, Metastaz sınıflandırma sistemine göre sırasıyla Ta ve T1 evresi olarak sınıflandırılır. Mukozaya sınırlı intra-epitelyal, yüksek dereceli tümörler karsinoma in situ (CİS) (Tis) olarak sınıflandırılır. Hastalarının yaklaşık %75’inde hastalık mukoza (Ta evresi, CİS veya submukoza (T1 evresi) ile sınırlıdır. T1 alt evreleme yöntemleri, mikrometrik (T1e ve T1m) veya histo-anatomik (T1a ve T1b) ilkelere dayanmaktadır; ancak, optimum sınıflandırma sistemi henüz tanımlanmamıştır. 2004 yılında WHO, düşük malign potansiyelli papiller ürotelyal neoplazm, düşük dereceli non-invaziv papiller karsinom ve yüksek dereceli non-invaziv papiller karsinomu içeren üretelyal karsinomlar için bir histolojik sınıflandırma sistemi yayınladı. Bu sistem güncellenen 2016/2022 WHO sınıflandırmalarına da dahil edildi. Kas invaziv olmayan mesane kanseri(KİOMK) başlığı altında gruplandırılan bu tümörlerin tümü, mesanenin transüretral rezeksiyonu (TURMT) ile tedavi edilebilir ve intravezikal instilasyonlarla ek tedaviler gerekebilir. TURMT örneklerinde lenfovasküler invazyonun varlığı, patolojik evreleme riskinin artması ve daha kötü prognozla ilişkilidir. ‘KİOMK’ terimi bir grup tanımını temsil eder ve tüm tümörler evre, derece ve diğer patolojik özelliklerine göre karakterize edilmelidir.

This study aimed to investigate the predictive ability of Hounsfield unit (HU) measurements for microorganism growth observed microbiologically in stone cultures after stone surgery and to create a model by adding other predictive factors for predicting stone culture positivity. Patients who underwent percutaneous nephrolithotomy, retrograde intrarenal surgery, or ureteroscopy and had stone cultures performed were included in the study. Demographic and clinical data, including age, gender, body mass index, stone size, stone volume, hydronephrosis grade, stone location, energy used, presence of preoperative stent or nephrostomy, operation duration, midstream urine culture, renal pelvic urine culture, stone culture results, and postoperative fever and systemic inflammatory response syndrome criteria, were recorded. Non-contrast computed tomography images were used to measure the HU at the stone's core (HUcore), the proximal surface of the stone periphery in the collecting system (HUproximal), the distal surface of the stone periphery in the collecting system (HUdistal), and the average HU of the stone periphery (HUperiphery mean). Absolute and relative differences between these values were calculated. A total of 383 patients were included, with microorganism growth observed in the stone cultures of 75 patients (19.6%). Radiological cut-off values distinguishing stones with positive cultures included RelativeHUdifference distal & proximal < 81.8, HUproximal < 807.0, and AbsoluteHUdifference core & periphery mean > 179.5. Factors associated with a statistically significant increase in the likelihood of positive stone cultures included longer operation duration (odds ratio [OR] = 1.102, 95% confidence interval [CI]: 1.053-1.154, p < 0.001), higher preoperative hydronephrosis grade (OR = 1.898, 95% CI: 1.289-2.795, p < 0.001), and the presence of preoperative stents or nephrostomy (OR = 4.232, 95% CI: 1.551-11.543, p = 0.005) in addition to the identified radiological HU cut-off values. HU values, as a radiological parameter, can predict microorganism growth in stone cultures, enabling identification of patients at risk for postoperative infectious complications.

Abstract Purpose The aim of this study was to assess the clinical outcomes and early postoperative complications linked to four different circumcision techniques. The objective is to emphasize the distinctive aspects of these circumcision techniques by categorizing the associated complications using the Clavien-Dindo classification system (CDCS). Methods 7041 circumcised patients were scanned and examined in 4 groups according to the technique applied: Dorsal slit (DS), sleeve resection (SV), forceps-guided (FG), and thermocautery-assisted circumcision (TAC). Surgery time, anesthesia technique, number of sutures, recovery time, bleeding, edema and infection parameters were compared. Complications were classified based on the modified CDCS. Results Surgery time was 4.7 minutes (range of 4.5–5.2), bleeding(hematoma) with 7 cases (0.3%) and number of sutures with 5 sutures (range of 4–7) was statistically significantly lower in the TAC (p < 0.001). Recovery time with 5 days (range of 5–7) and incidence of edema was longer in TAC compared to FG, DS and SR (p < 0.001). Additionally, the recovery time of the SV group was statistically significantly shorter than the FG and DS groups (p < 0.001). There was no significant difference between the surgical techniques in CDCS. Conclusion TAC exhibits advantages over other techniques regarding bleeding and a shorter procedure time. However, it also comes with disadvantages, such as postoperative edema and a longer recovery time.

study demonstrated that antibiotic resistance in the treatment of uncomplicated urinary tract infections varies by geographical region. We believe this comprehensive, national prospective study will provide valuable insights for clinicians planning empirical treatment for uncomplicated urinary tract infections.

Objective:We aimed to assess the frequency of Y-chromosome microdeletions (YCMs) in a non-multiethnic urban population in our region, define predictive factors, and determine a new clinical threshold for YCMs in infertile men. Materials and Methods:A total of 281 patients with a sperm concentration ≤5 million/mL were retrospectively evaluated. Oligozoospermic and/or azoospermic patients with a sperm concentration of ≤5 million/mL were screened for the YCM analysis. Results:Y-chromosome microdeletion was detected in 9 (3.2%) of the 281 patients. All patients with YCM were azoospermic. The presence of azoospermia, a high folliclestimulating hormone level, and a high luteinizing hormone level were found to be important determinants for the identification of a microdeletion (P = .002, P = .002, and P=.021, respectively). If the presence of azoospermia and a sperm concentration threshold of <1 million/mL had been applied for the YCM test, the number of tests performed would have been reduced by 54.4% (153 tests) and 42.7% (120 tests), respectively, resulting in cost saving of approximately $11 474 and $9000, respectively. Conclusion:We recommend that the threshold for sperm concentration for YCM analysis be set at <1 million in individuals in developed countries and only in patients with azoospermia in developing countries, in order to reduce costs and save labor by excluding unnecessary tests. These proposed thresholds (azoospermia and sperm counts less than <1 million/mL) provide cost-effectiveness by significantly reducing the number of genetic tests ordered without affecting the diagnosis rate.

OBJECTIVE:The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. METHODS:Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. RESULTS:Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. CONCLUSION:It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.

Minimally invasive methods for treating renal stones are increasingly preferred.Retrograde intrarenal surgery (RIRS) is a minimally invasive procedure used for renal stones smaller than 20 mm, which is currently preferred by some surgeons for patients with a larger stone burden (1).RIRS is favored over percutaneous nephrolithotomy (PNL) due to lower morbidity, less postoperative pain, and shorter hospital stay, and over extracorporeal shock wave therapy (ESWL) due to higher stone-free rates (2).RIRS is usually performed with general anesthesia (GA) to reduce respiratory-induced kidney movements.However, applying GA results in increased morbidity in patients with cardiac and pulmonary comorbidities.Thus, patients and surgeons may have reservations about using even minimally invasive pro-cedures, such as RIRS, due to the requirement of GA.The quality of a minimally invasive surgical procedure can be improved using a minimally invasive anesthesia method.A regional anesthesia approach is more reliable in elderly patients with high comorbidities and is therefore preferred by anesthesiologists and patients.Among these applications, spinal anesthesia (SA) is more frequently used due to its low postoperative pain, short hospital stay, and less anesthetic use (3).Another advantage of SA is that it costs much less than GA.Our experience in ureterorenoscopy using SA has led us to consider that successful operations using flexible instruments can be undertaken efficiently and reliably using RIRS in cases of proximal ureteral stone migration into the kidney.

Objective:The coronavirus disease-2019 (COVID-19) pandemic effect diagnosis and treatment of certain conditions, including bladder cancer (BC). This study aimed to evaluate the effects of the COVID-19 pandemic on BC diagnosis and treatment.Materials and Methods:Following the approval of the ethics committee for the study, data of 869 patients who underwent surgery for BC in the 2-year period between March 1, 2019 and February 28, 2021 were analyzed retrospectively. The number of surgeries performed for BC, the time elapsed between symptoms and diagnosis, the treatments performed, and the operative pathologies were compared before and during the COVID-19 pandemic.Results:During the COVID-19 period, there was a decrease in the total number of BC surgeries compared to the pre-COVID-19 period (p=0.004). It was observed that this decrease was due to a decrease in patients newly diagnosed with BC (p=0.001) as well as the decrease in the number of primary transurethral resection for bladder tumor procedures performed. There was no difference in the tumor stages of the patients at diagnosis (p=0.9). Intracavitary Bacillus Calmette-Guérin therapy use in high-risk non-muscle invasive bladder cancers (NMIBC) patients also decreased (p=0.008) during the pandemic period. It was observed that the time between symptom and diagnosis was longer in MIBC than in NIMBC during both periods (p<0.001).Conclusion:Diagnosis and treatment of BC have been adversely affected by the ongoing COVID-19 pandemic. The decrease in the number of new diagnoses may not reflect a true decrease in BC incidence, meaning that BC cases that arose during the pandemic are likely to be diagnosed at a more advanced stage.

Primary renal synovial sarcomas are very rare and highly aggressive tumors. They are seen at an average age of 35 years. Common symptoms include side pain, abdominal pain, and hematuria. Imaging modalities have no specific findings indicating their presence, and the diagnosis is made based on immunohistochemical methods, which may need to be confirmed by cytogenetic analysis. Radical nephrectomy is the best treatment option currently available, with a combination of anthracyclines and ifosfamidine being administered as adjuvant chemotherapy. In this case report, we present a patient with a primary renal synovial sarcoma presenting with spontaneous massive retroperitoneal bleeding due to tumor rupture. To the best of our knowledge, this is only the second case of such clinical presentation reported in the literature.

Objective: In this study, we aimed to investigate the benefit of hematological results in determining the differential diagnosis between testicular torsion (TT) and epididymo-orchitis (EO) in patients presenting with acute scrotum, and to determine its predictive value for the diagnosis of TT. Material and Methods: We retrospectively analyzed 98 patients who applied to our institute’s urology clinics or emergency service with complaints of acute scrotum. Thirty-two patients who underwent orchiectomy or detorsion due to TT and 48 patients with EO were included in the study. The control group consisted of 80 healthy men. Groups were compared in terms of hematological parameters such as age, white blood cell (WBC), mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR). Results: WBC, MPV and NLR were found to be statistically significant in distinguishing TT group from other groups, respectively; (AUC = 0.732, 95% CI: 0.647-0.816 and p<0.001), (AUC = 0.720, 95% CI: 0.615-0.825 and p<0.001), (AUC = 0.629, 95% CI: 0.519-0.739 and p=0.024). In the comparison between the detorsion and orchiectomy subgroups within the TT group, the first had a statistically lower monocyte count (p=0.005) and MLR level (p=0.038). Conclusion: Hematological parameters; that is, WBC, MPV and NLR, which can be easily determined from complete blood count analysis, had high sensitivity and specificity similar to Doppler ultrasonography to predict TT. In addition, we think that monocyte and MLR levels may be beneficial in patients who have difficulty in the decision of orchiectomy or detorsion in TT surgery. Keywords: Acute scrotum, testicular torsion, epididymo-orchitis, mean platelet volume, neutrophil/lymphocyte ratio

Objective: Surgically treating urinary tract stones in paediatric patient groups, especially in the preschool period, is more difficult than that in adult patient groups.For paediatric patients, non-invasive methods have many advantages and disadvantages.In this study, we compared the success rates of extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS) for the treatment of lower pole renal pelvis and kidney stones.Methods: Patients who had lower pole renal pelvis and kidney stones and were subjected to RIRS and ESWL in our clinic between March 2016 and October 2019 were retrospectively reviewed.The success rates and duration of anaesthesia were compared in terms of the size, localisation and hardness of the stones.Results: Surgical success was achieved in 17 (80.9%) of 21 patients who underwent RIRS in the study and in 14 (73.6%) of 19 patients who had ESWL.No relationship was found amongst the size, location, Hounsfield degree and stone-free (SF) rate in either of the methods.RIRS and ESWL had 50% and 60% SF in the lower pole of the kidney, respectively.Conversely, the SF rate in the renal pelvis was around 80%.The anaesthesia duration for RIRS was longer in the successful cases than in the unsuccessful ones, whereas it was just the opposite in ESWL group so anaesthesia duration was longer in the unsuccessful cases.Conclusion: ESWL and RIRS can be successfully applied to preschool children.They have similar success rates in terms of stone treatment.Therefore, the optimal technique should be used individually in each patient.