Amyloidosis is related to the extracellular deposition of abnormal protein fibrils in various tissues. It is clinically interesting that such cases" clinical, radiological, and even endoscopic presentation mimic urothelial carcinoma to a great extent. Here, we discuss a case of a 34-year-old gentleman who presented with frank painless hematuria. The patient was diagnosed with a bladder mass suspicious of malignancy depending on the clinical presentation aided by the cystoscopic and radiological evaluation. Histopathologic samples of the transurethral resection of the mass proved to be primary bladder amyloidosis. Further investigations of systemic illness excluded the secondary amyloidosis. The purpose of this case presentation is to create awareness among the urologists to think for the rare entity of urinary amyloidosis especially if the histopathology is negative for the malignant cells.

Chest wall malignancies are rare, constituting only 1% of all cancers. Prostate cancer, the second most common in men, typically metastasizes to bones, lymph nodes, and organs. However, sternum involvement is exceptionally rare, particularly with osteolytic metastasis. We report a 75-year-old man, clinically presenting with large anterior chest wall mass, which on further investigation revealed an expansile osteolytic sternal body metastasis from prostate cancer. This rarity poses diagnostic and therapeutic challenges, as documented cases of osteolytic secondaries to the sternum are scarce in medical literature. Diagnostic efforts involved comprehensive imaging and biopsy, confirming prostate cancer metastasis. Management requires a multidisciplinary approach, balancing effective cancer control with preserving the patient"s quality of life through systemic therapies, radiation, and surgery. The scarcity of osteolytic sternal body metastasis in reported cases highlights the atypical pattern of metastasis in prostate cancer emphasizing the need for a deeper understanding and contributing to the knowledge of this uncommon manifestation.

Nephroblastoma (Wilms Tumor / WT) is the rare but the most common primary kidney tumor in children. The WT is generally diagnosed between 1 and 5 and the most common diagnosis is the age of 3. Up to 95% of WTs are diagnosed correctly with visualization (ultrasound, computed tomography and magnetic resonance). Histopathologicaly tissue examination is implemented and subtypes are determined. Surgery is one of the key factors in WT treatment. Transperitoneal radical nephrectomy is the standard operation for unilateral WTs. Nephron sparing surgery (partial nephrectomy) is suggested only in selected cases with a single kidney or bilateral WT. Other treatment combination for Wilms tumor involves chemotherapy and radiation treatment. A patient who was diagnosed with Wilms tumor in the right kidney and underwent partial nephrectomy which is rarely implemented or recommended in selected cases is represented in this article.

Objective: This study aimed to investigate the effect of stone density on the success of ureterorenoscopy (URS) and retrograde intrarenal surgery (RIRS). Materials and Methods: The data of patients who underwent URS or RIRS due to kidney and ureteral stones between January 2013 and March 2018 were retrospectively screened. For all patients, age, gender, comorbidities, the American Society of Anesthesiologists (ASA) score, the presence of preoperative double-J (DJ) stents, extracorporeal shock wave lithotripsy (ESWL) history, ipsilateral stone surgery history, the presence of renal anomalies, stone laterality, stone opacity, stone density, stone size, stone volume, operative time, stone-free status, and the presence and size of residual stones were recorded. Results: The study included 566 patients who underwent URS or RIRS, including 186 women (32.9%) and 380 (67.1%) men. The mean age of the patients was 47 years. The mean stone size was 10 mm, and the mean stone density was 886 Hounsfield units. The mean stone volume was 426.13 mm3. The mean operative time was 31 minutes. The stone-free rate was 89.4%. Stone density, stone size, and stone volume were positively correlated with operative time (p<0.001) and residual stone size (p<0.001). Additionally, stone density and residual stone size were positively correlated in the group that did not achieve stone-free status (p=0.003). Conclusion: In this study, it was determined that stone density, stone size, and stone volume were positively correlated with residual stone size and operative time. In addition, stone density was positively correlated with residual stone size among patients who were not stonefree after treatment, indicating that high stone density negatively affects the success of treatment even in cases presenting with small stone size and volume preoperatively.

Objective: We aimed to investigate the activity of diosmin-hesperidin (DAFLON®) in ischemia-reperfusion injury in the rat kidney. Materials and Methods: Twenty-four Wistar rats were used for the experimental study. Each group comprised of 8 subjects. Sham group (Group 1) was nephrectomized for histopathologic examination and blood samples were obtained for biochemical analysis. Control group (Group 2) was subjected to ischemia for 1 hour and reperfusion for 24 hours, then they were nephrectomized for histopathologic examination and blood samples were taken for biochemical analysis. Treatment group (Group 3) was given 80 mg/kg diosminhesperidin combination (DAFLON®) for 10 days and subjected to ischemia for 1-hour and reperfusion for 24 hours, then they were nephrectomized for histopathologic examination and blood samples were obtained for biochemical analysis. Results: As a result of biochemical analysis and histopathologic examination, more significant results were acquired in regard to other groups. Serum urea values were statistically significant (p<0.05). Consistent with the results of the studies previously performed, higher creatinine values were detected in the control and treatment groups. Enzymatic activities of superoxide dismutase and glutathione peroxidase were significantly lower in the treatment group when compared with the control group. When groups were compared based on histopathologic examination findings, cell necrosis and ischemic alterations were statistically significant parameters (p<0.05). When all parameters were analysed, values indicating any histopathologic abnormalities were at the lowest level in the treatment group. Histopathologic alterations were most frequently detected in the control group. Conclusion: Anti-inflammatory activity of diosmin-hesperidin which is used experimentally in the treatment of ischemia-reperfusion injury was evaluated both biochemically and histopathologically. Based on the literature data, it is thought that the damage occurring after ischemia-reperfusion injury can be prevented with diosmin-hesperidin treatment.

Objective: In this study, we aimed to investigate whether there would be any improvement in symptoms of overactive bladder (OAB) after migraine prophylaxis in patients with chronic migraine (CM) and OAB. Materials and Methods: The study group consisted of women aged 19 to 64 years diagnosed as CM according to current International Headache Society (IHS) criteria, and OAB using the OAB-V8 (Overactive Bladder Inquiry Form - V8) and ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form) forms as well as clinical evaluation in the neurology and urology clinics. 63 patients informed and agreed to enter the study were started migraine prophylaxis and evaluated after 6 months for comparison of pre-treatment and post-treatment VPS (visual pain scale), OAB-V8, and the ICIQ-SF scores. Flunarizine, topiramate, venlafaxine and propranolol were used in the treatment of patients. Results: The mean age of 63 women included in the study was 39.15 ± 8.74 (19-64) years. The mean Body Mass Index (BMI) of the patients was determined as 25.41 ± 3.64 (16.4-35.6) kg/m2. After migraine prophylaxis, VPS, OAB-V8 and ICIQ-SF scores decreased significantly in the entire patient group (p<0.05). Statistically significant changes were found in the values of VPS, OAB-V8 and ICIQ-SF in the topiramate or propranolol treated groups. In the flunarizine group, there was a significant statistical response in the VPS and OAB-V8 scores, while there were no significant changes in the ICIQ-SF and OAB-V8 scores in the venlafaxinetreated group. Conclusion: The beneficial effect of migraine prophylaxis on OAB symptoms support somewhat shared etiopathogenesis for both disorders. However, the series is small and considering the involvement of multifactorial factors and complex physiopathology for both disorders further studies are necessary to reveal the underlying mechanisms and clinical impacts.

Objective: To compare traditional and hybrid model of education in urology among 4th-year medical students in terms of training success Materials and Methods: In our urology clinic, the training success scores of seven randomly selected training groups, who were trained with the traditional model between 1998-2018, and the 4th year medical students who were trained with the hybrid model between 2018-2020 and constituted five randomly selected training groups were compared. Of the total 582 medical students, included in the study, 278 (47.8%) were enrolled in the traditional model group, and 304 (52.2%) in the hybrid model group. The training was evaluated with hands-on applications and theoretical and oral exams. Differences between both male and female students and differences that may vary depending on different faculty members teaching the students were evaluated using multivariate logistic regression analysis. Results: The training success rates were significantly higher in the hybrid model group (300/304; 98.7%) than in the traditional model group (261/278; 93.9%) [p:0.002]. Multivariate logistic regression analysis found that factors such as the number of training groups, gender of medical students, and evaluations of different faculty members did not affect the educational success rate. Conclusion: The hybrid model could be accepted as a mobile education model in a sense. The exam results of medical students educated with the hybrid model were better than those receiviing training with the traditional model which can be explained by the increased accessibility of medical students to education in the hybrid model without constraints of time and place. Additionally, it is thought that conducting the oral exam as a "structured oral exam" also contributed to these results.

Objective: To compare extracorporeal shock wave lithotripsy (ESWL) induced renal injury in patients undergoing different ESWL treatment protocols by measuring urinary tissue metalloproteinase-2 inhibitor (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) excretion. Materials and Methods: This prospective, randomized study was conducted between April 2016 and June 2016 in group 1 patients undergoing fixed voltage ESWL and group 2 patients undergoing ramping voltage ESWL. Urinary TIMP-2 and IGFBP7 levels were analyzed before ESWL and 2 hours after ESWL, and urinary beta2-microglobulin (β2-MG) and albumin were analyzed before ESWL and 1 week after ESWL to assess renal injury. The primary outcome was to compare the effect of ESWL on early renal injury with biochemical markers in the different treatment protocols, and the secondary outcome was to compare the two treatment protocols in terms of stone free rate and complications. Results: There was no statistically significant difference between groups in terms of demographic and stone characteristics. There were statistically significant differences in serum creatinine and e-GFR at baseline and one week after treatment (p<0.05). There was no significant change in serum urea, urinary β2-MG and albumin levels before and after ESWL. There was a statistically significant increase in urinary TIMP-2, IGFBP7 and TIMP-2 x IGFBP7/1000 levels in both groups compared to baseline (p<0.05). There was no statistically significant difference in the rates of stone free and complications between the groups (p>0.05). Conclusion: In this prospective randomized study, we observed a significant increase in TIMP-2, IGFBP7 and combination levels after ESWL treatment in both groups, suggesting that these two biomarkers could be used to identify acute kidney injury due to ESWL. However, the comprehensive evaluation of clinical parameters and urinary markers did not differ in the rates of renal injury, success, and complications after ESWL in both protocols.

Objective: To examine the relationship between prostate weight and oncological and functional outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Materials and Methods: Data of the patients who underwent RS-RARP in our clinic between December 2018 and December 2020 were evaluated retrospectively. A total of 106 patients with 12-month postoperative follow-up data were included in the study. The patients were separated into 2 groups according to the weights of the pathology specimens as Group 1 (n=53, prostate weight less than 50 g), and Group 2 (n=53, prostate weight more than 50 g). Postoperative oncological and functional data were analyzed. At the end of the 12th month, continence was regarded as requirement of no pad or 1 pad per day. Potency was considered as the ability to have sexual intercourse. Prostate-specific antigen (PSA) above 0.2 ng/ml in the follow-up period was considered as biochemical recurrence. Results: Preoperative PSA levels were comparable between groups (9.78+7.84 ng/ml vs. 11.87+8.38 ng/ml). There was no difference in clinical cancer stages and The International Society of Urological Pathology (ISUP) scores between the groups. Median vesicourethral anastomosis time (30 minvs.33 min) and median operative time (240 min vs. 240 min) were comparable in both groups (p>0.05). There was no difference in localized disease and locally advanced disease rates between the groups (pT2: 58.5% vs. 67.9%, pT3: 41.5% vs. 32.0%). Surgical margin positivity (SMP) ([16.9% (n=9) vs 9.4% (n=5]), and 12th month biochemical recurrence rates (11.32% vs 3.77%) were similar in groups 1 and 2 (p>0.05). Postoperative urinary continence rates at 12 months were 89% and 90% in Groups 1 and 2, respectively (p>0.05). Continence status was not different between the groups. Potency rates at 12 months were comparable between the groups. Conclusion: RS-RARP can be applied in patients with any size of prostates with comparable functional and oncological outcomes.

Objective: No effective medical approach for the treatment of Peyronie’s disease (PD) has to date been described. This study was intended to evaluate the antifibrotic, antioxidant, and anti-inflammatory effects of curcumin on fibrotic tissue in the tunica albuginea (TA) in a rat model of PD. Materials and Methods: Twenty-four male Sprague Dawley rats aged 10 months were randomized into three groups (n = 8 in each). No PD model was induced in the control group. The PD+saline (PD+Ps) group received fibrin injection, followed two weeks later by saline administration by oral gavage for 14 days. The PD+Curcumin (PD+Cur) group received fibrin injection into the TA followed two weeks later by curcumin administration by oral gavage for 14 days. At the end of the experiment, fibrotic activity was evaluated using stereological and histopathological methods. Transforming growth factor-β1 (TGF-β1), one of the most fibrogenic cytokines, was evaluated using immunohistochemistry with an anti-TGF-β1 rabbit monoclonal antibody. Results: Stereological analysis revealed significantly greater Peyronie-like plaque areas in the TA in the PD+Ps group than in the control and PD+Cur groups (p<0.0001). No significant difference was observed between the control and PD+Cur groups (p=0.35). The PD+Ps group exhibited strong TGFβ1 immunoreactivity with increased expression in the collagenous connective tissues and fibroblasts around the TA. Conclusion: Curcumin reduced fibrotic tissue in the TA and may represent a novel therapeutic option in the treatment of PD.

Objective: To reveal the effect of preoperative Kegel exercises on early period continence rates after open radical prostatectomy Materials and Methods: Data of patients with open radical prostatectomy between January 2019 and July 2022, in a tertiary academic health center were retrospectively reviewed. Patient’ characteristics, perioperative parameters and postoperative follow-up results were recorded. Patients were divided into two groups as those who did Kegel exercises in the preoperative period and those who did not, and groups were compared. Results: There were 38 patients in the Kegel exercise group and 40 patients in the other group. Postoperative 1st month and postoperative 3rd month incontinence rates were similar between the groups (p=0.406, and p=0.387). At 6th months postoperatively, the rate of incontinence in the Kegel group was 7.9%, while it was 25.0% in the other group (p=0.043). Similarly, the rate of incontinence at 1st year postoperatively was significantly lower in the Kegel group (5.3% vs 20.0%, p=0.001). At 6 months postoperatively, the QoL score in the Kegel positive group was 86, while it was 65 in the other group (p=0.001). In the postoperative 1st year controls, the quality of life (QoL) score was statistically significantly higher in patients with preoperative Kegel exercise (p=0.001). Conclusion: Our study demonstrated that preoperative Kegel exercises had a significant positive effect on continence rate after radical prostatectomy in the postoperative 6th month and in the first year follow-up, and preoperative Kegel exercises were significantly associated with higher quality of life scores at 6th months and 1st year follow-up.

Objective: Circumcision is one of the most common surgical procedures in the world which is performed for various reasons. The aim is to investigate whether people’s satisfaction with circumcision, their perspectives on circumcision, and whether there is a connection between circumcision and psychological/urological problems. Materials and Methods: Between 21 March 2023- 10 April 2023, 1009 men aged between 18-50 who volunteered to participate in the survey were included in the study. Demographic structures of the people (age, education, income status), age of circumcision, by whom, where and with what type of anesthesia; problems during circumcision, satisfaction with circumcision, any sexual and psychological problems and the relationship of this problem with circumcision were investigated. Results: Mean age of 1009 participants was 32.02±9.15 and mean age of circumcision was 6.18±3.10. 269 (26.7%) men stated that they experienced circumcision complications and 145 (14.4%) stated that they were not satisfied with circumcision. 267 men (26.5%) had sexual or urological problems, and 274 (27.2%) had psychological problems, but the relationship of both problems with circumcision was not significant. Both sexual/urological problems and psychological problems were found to be significantly higher in the group satisfied with circumcision (both p:0.000, p<0.05). The relationships between the characteristics of the circumcision performed (circumcision age, anesthesia method, circumcision site and the person performing it) and urological/sexual problems were found to be significant (all p<0.05). Conclusion: This cross-sectional study supports the hypothesis that circumcision has no relationship with urological/andrological or psychological problems. However, although circumcision is a relatively simple and frequently performed surgical procedure, characteristics such as the age at which the circumcision was performed, the type of anesthesia, the place where it was performed, and the person performing the circumcision are important in order to avoid future urological/sexual problems.

Objective: In this study, we aimed to investigate whether there is a difference in the reliability and efficacy of the method according to age in patients divided into 3 different age groups who underwent retrograde intra renal surgery (RIRS) due to kidney stones. Materials and Methods: Patients who underwent RIRS for kidney or ureteral stone disease at the Urology Clinic of Health Sciences University Umraniye Health Application and Research Hospital between May 2017 and January 2021 were retrospectively screened, and those aged 20-80 years were included in the study. The demographic and clinical data of the patients and stone-related data were recorded. Patients aged 20-40 years were classified as Group 1, those aged 41-60 years as Group 2, and those aged 61-80 years as Group 3. Results: After the inclusion and exclusion criteria were applied, the sample consisted of a total of 320 patients, of whom 121 (37.8%) were in Group 1, 133 (41.5%) were in Group 2, and 66 (20.6%) were in Group 3. The mean operative times and stone-free rates were similar between the groups. However, the mean hospital stay was significantly longer in Groups 3 compared to Groups 1 and 2. The minor complication rates were 2.4% in Group 1, 3% in Group 2, and 13.6% in Group 3, indicating a significantly higher value in Group 3 compared to the remaining two groups (p=0.03). The major complication rates of Groups 1, 2, and 3 were 0.8%, 0.7%, and 7.5%, respectively. Accordingly, Group 3 had a significantly higher rate than Groups 1 and 2 (p=0.04). Conclusion: RIRS can be performed on the elderly with success rates comparable to other age groups. However, the elderly, who represent a higher-risk patient population with more comorbidities, have increased rates of minor and major complications both in the perioperative and postoperative periods.

Objective: This study aims to discuss the techniques for safely, quickly, and successfully removing transurethral (TU) foley catheter balloons in patients who present to the emergency and urology clinics due to the inability to remove the catheter through normal means, and to contribute options and insights to the literature. Materials and Methods: This retrospective study included patients who presented to the emergency department for the inability to remove the TU foley catheter, patients referred to the urology clinic, or patients consulted from other clinics, between January 2017 and September 2022. The treatment methods applied by the urologist in this patient group, hospitalization durations, voiding status, and any developed complications were recorded based on patient files. Results: A total of 22 patients who had a transurethral (TU) catheter inserted for various reasons and were unable to remove it were included in our study. It was found that 7 of the patients had permanent TU catheters due to comorbidities, while the remaining 15 had TU catheters inserted after acute urinary retention. Among them, 2 cases had the catheter removed by cutting the inflation channel, 1 case with the assistance of a guidewire, 2 cases by puncturing the balloon with a needle under transrectal ultrasound guidance, 10 cases by puncturing the catheter balloon with a needle under suprapubic ultrasound guidance, and 7 cases had their catheters removed by laser under anesthesia. Only 1 patient who had the balloon punctured by a needle under transrectal ultrasound guidance developed fever after the procedure and had a total of 5 days of hospitalization, while the others were discharged either immediately after the procedure or 1 day later. Conclusion: Patients with indwelling foley catheters that cannot be removed rarely present to us; however, these patients often come to us in an agitated state after multiple unsuccessful attempts to remove the catheter. Therefore, it is important to know which technique should be applied to this patient group in a faster, appropriate, and reliable manner as soon as possible.

Objective: Our goal was to determine whether or not a double-J (DJ) stent insertion is required in cases of ureteral stones based on the absolute white blood cell (WBC) counts, neutrophil-lymphocyte ratio (NLR), absolute monocyte counts, and other laboratory markers. Materials and Methods: The patients were divided into two groups as those who did (Group 1), and did not (Group 2) need DJ stent insertion. The age, symptoms, diagnosis, hemogram parameters, and treatment results of the patients were evaluated. Results: Forty-nine percent (n=44) of the patients were female and 51% (n=46) were male. The groups did not differ in terms of age and gender (p>0.05). A higher incidence of hematuria was observed in Group 1 (p<0.05). WBC (p<0.05), NLR (p<0.05), and monocyte counts (p<0.05) were found to be higher in Group 1. In the ROC analysis; WBC and NLR were found to be two predictive markers for the need for DJ stent insertion. At a cut-off value of 12.6 x 109/L, WBC had 37% sensitivity, and 81% specificity (AUC: 0.67; 95% CI: 0.54-0.80), and at a cut-off value of 3.8, NLR had 65% sensitivity, and 76% specificity (AUC: 0.70; 95%CI: 0.57-0.82) in predicting the need for a DJ stent insertion. Reoperation was not required in any case. Conclusion: In cases of ureteral stones, the absolute WBC count and NLR may help determine the requirement (if any) for a DJ stent insertion.

Objective: As a urological emergency, testicular torsion is one of the causes of acute scrotum in all age groups. This study aimed to evaluate the effectiveness of manual detorsion performed before surgical intervention. Materials and Methods: Retrospective data analysis of the patients with acute scrotum who applied to the emergency department of a 3rd level hospital between the years January 2010 and January 2023 with the complaint acute unbearable pain within the first 12 hours of its onset was performed. Patients were grouped according to whether or not manual detorsion was performed in the emergency department. Successful manual detorsion was defined as postprocedural normal color Doppler ultrasound findings and complete resolution of pain. All patients had undergone surgical exploration. Age, laterality of the torsional testis, manual testicular detorsion attempt (if any), and surgical conditions resulting in testis preservation or orchiectomy were the patient data analyzed. Results: Sixty patients were included in the study. Manual detorsion was performed in 29 (48.3%) patients in the emergency department (Group 1). Scrotal exploration was performed in 31 (51.7%) patients without applying manual detorsion (Group 2). In Group 1, testicular preservation was achieved in 26 (89.7%) patients. In Group 1, in 3 patients (10.3%) testicular necrosis occurred due to failure to achieve adequate blood supply, while orchiectomy was performed in 11 (35.5%) patients in Group 2. Lower rates of orchiectomy were observed in Group 1 compared to Group 2 (p=0.021). We also observed that manual detorsion decreased the rate of orchiectomy (rho- 0.297, p=0.021), and the probability of undergoing orchiectomy increased with increasing age (rho 0.512, p<0.001). Conclusion: Manual testicular detorsion is a noninvasive method that can be safely applied to all patients diagnosed with testicular torsion. We think that it will shorten the duration of testicular ischemia in the emergency department and contribute to testicular salvage.

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Angiomyolipomas are the most common benign mesenchymal tumors of the kidney. Although they are often seen sporadically, they can also be observed as a part of the tuberous sclerosis complex (TSC). They occur at an earlier age in cases associated with tuberous sclerosis (TS), bilateral mass and epithelioid formation. There are various treatment approaches such as active surveillance, nephron-sparing surgery, nephrectomy, angioembolization, and use of mammalian target of rapamycin (mTor) inhibitors. Our case was a patient with bilateral multiple renal angiomyolipomas associated with TS. We applied mTOR inhibitor and angioembolization therapy to this patient. In our article, we tried to evaluate our success rate in our treatment and the treatment regimens to be applied in these patients.