Urology Journal

Purpose: The advancement of anti-cancer treatment has increased survival rates among patients, yet putting them in an increased risk for developing side effects. In addition to early side effects, anti-cancer treatments, in particular chemotherapeutic medications can cause long-term side effects; fertility and sexual dysfunction included. The aim of this study was to review existing data on the effects of different chemotherapeutic agents on fertility and sexual function of male cancer survivors who received chemotherapy at different stages of life.
Methods: We searched PubMed/MEDLINE, Scopus, and Google Scholar to detect studies focused on the effect of chemotherapy on the gonadal/testicular function and sexual function of male cancer survivors. We restricted our search to English language publications and manuscript published before the year 2000 were excluded.
Results: It has been well understood that chemotherapy impairs gonadal function in a major number of cancer survivors and gonadal dysfunction is not protected if chemotherapeutic agents are administered before puberty in males. Moreover, the effect of chemotherapy on sexual function is controversial.
Conclusion: While several articles reported the worst effect of chemotherapy on the sexual function of cancer survivors, some studies reported that chemotherapy does not impair sexual function. Higher levels of chemotherapy dose seem to be associated with more gonadal and sexual dysfunction.

Purpose: Patients with kidney stones have a lower quality of life (QOL) than healthy patients; however, treatment
guidelines neglect their QOL. Wisconsin stone QOL test (WIS-QOL) is the first specific questionnaire for urolithiasis
patients. This study evaluated the reliability and validity of the translated Persian version of the WIS-QOL
questionnaire in patients with kidney stones.
Material and methods: All patients (> 18 years old) with a history of urolithiasis were included in this cross-sectional. The WIS-QOL questionnaire was translated depending on Hutchinson's guideline. Effects of urolithiasis
on the patient's social activity, emotions, disease, and vitality were evaluated. Pearson Correlation and Cronbach's
alpha test were used to assess the validity and reliability of the questionnaire. All data were analyzed by SPSS
software version 26.0.
Results: Among 154 urolithiasis patients, 94 (61%) were males, and 60 (39%) were females. The mean age was
50.4 years (SD: ± 13.6), and the mean QOL score was 84.7 (SD: ± 21.8). For each question, the numerical value of
the Pearson Correlation Coefficient has been compared with the numerical value, and the validity of the questionnaire was confirmed. The overall Cronbach's alpha was 0.94 for all four areas of the questionnaire, so the reliability of the questionnaire in Persian was confirmed.
Conclusion: The present study showed the reliability and validity of the Persian version of the WIS-QOL questionnaire in symptomatic urolithiasis patients. The present study showed the status and impact of urolithiasis on QOL however, longitudinal and prospective studies should be done to specify changes over time.

Purpose: To investigate the efficacy and safety of 177Lu-PSMA-617 in combination with radical prostatectomy
and bilateral orchiectomy in adult male patients with castrate-sensitive metastatic prostate cancer.
Methods: This pilot study included 12 men with metastatic prostate cancer who underwent radical prostatectomy
and received 177Lu-PSMA-617 in combination with hormonal therapy. The primary endpoint was the proportion
of patients who achieved a PSA response, defined as a ≥ 50% reduction in PSA levels at first follow up from
baseline. Secondary endpoints were the proportion of patients who achieved a PSA response, defined as a ≥ 50%
reduction in PSA levels at the second follow up from the first one and progression in pain severity that was defined
as an increase in score of 30% or greater from baseline without a decrease in analgesic use based on Brief Pain
Inventory-short Form (PBI-SF).
Results: The PSA levels of 9(75.0%) patients were reduced after the first course of 177Lu-PSMA-617, additional
reduction was observed in 7(58.3%) patients after receiving the 2nd course of treatment. Of the 12 patients,
3(25.0%) achieved a PSA response (≥ 50% reduction in PSA levels) at first follow up visit and 3(25.0%) patients
had PSA response at second follow up, 6 patients (50.%) had a pain response. The most common adverse events
were Mouth dryness and fatigue, which were manageable with supportive care.
Conclusion: This pilot study suggests that radical prostatectomy and hormonal therapy in combination with
177Lu-PSMA-617 is a safe and effective treatment option and may have a role in the management of select patients
with castrate-sensitive metastatic prostate cancer. Further studies are needed to confirm these findings and
determine the optimal use in this setting.

Purpose: Prostate-specific antigen (PSA) bounce is a common phenomenon that can be observed in patients of
prostate cancer treated by radiotherapy. However, the clinical, pathological, or dosimetric predictors and clinical
significance of PSA bounce in stereotactic body radiotherapy (SBRT) patients is still unknown.
Methods: Between August 2006 to December 2015, 74 prostate cancer patients were treated by SBRT with Cyberknife at two medical centers. The prescription dose was 35-37.5 Gy in 5 fractions. Follow-up PSA tests were
more frequently performed in one hospital than the other (median 4 vs. 10 times for initial one year). PSA bounce
was defined as a rise of 0.2 ng/mL followed by a decline to or below the previous nadir.
Results: A total of 74 patients, PSA bounce was observed in 41 patients (55.4%). On univariate analysis, the treated
medical center (p = 0.02), PSA follow-up frequency (p = 0.01), patient age (p < 0.01), and total prescription
dose (p = 0.03) were significant clinical factors in predicting the incidence of PSA bounce, while in multivariable
analysis only the PSA follow-up frequency, and patient age remains significant.
Conclusion: PSA bounce was seen in a significant proportion of patients after Cyberknife SBRT. The PSA follow-
up test frequency, and patient age were significant factors that were correlated with the incidence of PSA
bounces in this study.

Purpose: To assess the impact of the The Controlling Nutritional Status (CONUT) score, an indicator of nutritional
status, on the survival and prognosis after radical cystectomy.
Materials and Methods: The medical records of patients who underwent consecutive radical cystectomy operations with the diagnosis of muscle-invasive bladder cancer at our clinic were retrospectively examined. The
patients were separated into two groups based on the cut-off CONUT score which was derived using the receiver
operating characteristic (ROC) curve. The group with a CONUT score ≥ 3 was categorized as high CONUT,
whereas the group with a CONUT score < 3 was categorized as low CONUT. The groups were compaired according
to oncological outcomes and survival risk factors.
Results: Cancer-specific survival (CSS) and overall survival (OS) were statistically significantly lower in the High
CONUT group compared to the Low CONUT group (p < 0.001, p = 0.024, respectively). Age (HR: 1.02, 95% CI:
1.006-1.04, p = 0.011) and CONUT score (HR: 3.92, 95% CI: 2.66-5.77, p < 0.001) were revealed to be independent
prognostic variables in the multivariate analysis for OS.
Conclusion: The CONUT score was found to be an independent predictor of survival in patients with muscle-invasive bladder cancer in this study.

Purpose: To explore the efficacy of active fistulation in the treatment of proximal hypospadias in children by
comparing one-stage and two-stage Duckett procedure.
Materials and Methods: A total of sixty-seven children who were diagnosed with proximal hypospadias and
underwent Duckett operation at our hospital between January 2013 and January 2021 were selected for this study.
These subjects were divided into two groups: the research group (n = 36), using two-stage Duckett procedure with
active fistulation, and the control group (n = 31), using one-stage Duckett procedure. The incidence of postoperative
complications and the score of pediatric penile perception Scale were compared between the two groups.
Results: The research group exhibits a significantly lower incidence rate of urethral fistula (8.3% Vs 16.1%) and
urethral stricture (5.6% Vs 12.9%) in comparison to the control group (P < 0.01). Furthermore, the analysis of
Pediatric Penile Perception Scale scores indicates that the research group achieves significantly higher scores in
terms of urethral shape, penile skin shape, and overall appearance than the control group (P < 0.05).
Conclusion: In the treatment of proximal hypospadias in children, active fistulation within the two-stage Duckett
procedure significantly reduces the rate of stage 1 postoperative complications and improves parental satisfaction.
Active fistulation may offer a more promising option for the treatment of proximal hypospadias in children.

Purpose: The management of complicated and irreparable urethral strictures can be challenging, and continent
urinary diversion has emerged as a viable option. This study aims to investigate the complications associated with
continent urinary diversion using the Mitrofanoff principle in patients with complex urethral strictures that cannot
be corrected through urethroplasty surgery.
Materials and Methods: A total of 22 patients were included in this study, who underwent continent urinary diversion surgery using the Mitrofanoff technique. The patients were monitored for post-surgical complications over an average follow-up period of 28.36±14.26 months. Surgical failure was defined as the inability to completely and regularly empty urine from the new urinary tract.
Results: Half of the patients experienced surgical complications, with only one case resulting in surgery failure.
The most common complication observed was stoma stenosis. Two patients reported slight urinary leakage from
the stoma site. Notably, all patients except one, regained control over their urine after the procedure. Early therapeutic interventions were classified according to the Clavien-Dindo grading system, showed that none of the
patients experienced severe complications (grade 4 or 5).
Conclusion: The study examines the outcomes of continent urinary diversion using the Mitrofanoff technique in
adults with complex urethral strictures, providing realistic expectations of complications. Overall, the study shows
that this approach is a viable option with a high success rate and manageable complication for individuals with
complex urethral strictures that cannot be corrected through urethroplasty surgery.

Purpose: With the recent increase in the use of artificial intelligence in the medical field, this study aimed to evaluate the accuracy and adequacy of ChatGPT's responses to questions related to female urology.
Methods: Intensive internet research was performed to prepare a frequently asked question (FAQs) list. Scientific
questions were created in accordance with the European Urology Association (EAU) Non-neurogenic Female
Lower Urinary Tract Symptoms Guidelines, EAU Chronic Pelvis Pain Guidelines, and EAU Neuro-Urology
Guidelines. All answers by ChatGPT were analysed by two experienced urologists and each answer was scored
between 1 and 4 by the physicians. A score of 1 was the highest and showed that the answer was completely true
and sufficient. The reproducibility of ChatGPT answers was evaluated by asking each question twice using two
different computers.
Results: A total of 96 (97.0%) ChatGPT answers about female urology were accurate and sufficient, and categorized
as grade 1. Additionally, two (2.0%) answers were scored as grade 2, and one answer (1.0%) was scored as
grade 3. None of ChatGPT's responses about female urology were classified as grade 4. In total, 83 questions were
prepared according to EAU guidelines recommendations, and ChatGPT gave complete accurate and satisfactory
answers for 68 (82.9%) questions. The reproducibility rate was highest for ChatGPT answers for questions related
to urinary incontinence, pelvic organ prolapses, and pelvic pain syndromes, and reproducibility rate was 100% for
each subgroup. The reproducibility rate for ChatGPT answers was lowest for CPG questions (84.1%).
Conclusion: For the first time our study revealed that ChatGPT had an excellent accuracy rate in answering questions related to female urology with 97% success rate. In addition, the outcomes of this study showed that ChatGPT accurately and satisfactorily answered 82.9% of questions about female urology based on EAU guidelines.

Purpose: This study aimed to assess postoperative pain, depression, and anxiety levels in infertile men who
underwent microsurgical testicular sperm extraction (micro-TESE) for non-obstructive azoospermia (NOA) and
compare results between patients with successful and unsuccessful sperm retrieval.
Material and Methods: A total of 105 NOA patients participated, completing preoperative Beck Depression
Inventory (BDI) and Situational and Transient Anxiety Inventory (SAI and TAI) questionnaires. Postoperatively,
Visual Analog Scale (VAS) scores were recorded. Patients were categorized into primary and repeated micro-
TESE groups, and scale scores, operation duration, and collected tubule count were compared. The relationship
between micro-TESE outcomes, VAS scores, and additional analgesia needs was also examined.
Results: Successful sperm retrieval was achieved in 55.9% of patients. While BDI, SAI, and TAI scores showed
no significant intergroup differences, micro-TESE (-) patients exhibited significantly higher mean VAS scores (p
< 0.001). VAS scores positively correlated with BDI score, operation duration, and tubule count, while patient age
inversely correlated with micro-TESE results.
Conclusion: Infertility, azoospermia, and unsuccessful sperm retrieval impact psychogenic status and pain levels
in male patients. Additionally, a history of micro-TESE procedures and their outcomes elevate depression levels.

Purpose: Evaluating pseudomotor performance can be a valuable tool for investigating the peripheral autonomic
nervous system in diabetic patients. Sudoscan, a simple and non-invasive method for assessing pseudomotor
performance, has been developed in recent years. This study aimed to investigate autonomic neuropathy using
Sudoscan in diabetic patients with lower urinary tract symptoms (LUTS) of unknown cause.
Materials and Methods: In this cross-sectional study conducted from April 2022 to April 2023, we included 195
patients with type 2 diabetes who were referred to the urology clinic. We extracted demographic, clinical, and
laboratory data from the patient files and evaluated urinary symptoms using the International Prostate Symptom
Score (IPSS) questionnaire. Patients underwent Sudoscan testing to evaluate autonomic neuropathy in the physical
medicine and rehabilitation clinic. To further assess urinary irritative symptoms, patients underwent urodynamic
studies (UDS) and ultrasonography.
Results: The Sudoscan test results showed that autonomic neuropathy was present in 77 patients (40%), with 43
(22.1%) having moderate and 44 (22.6%) having severe neuropathy. Patients with autonomic neuropathy were
found to be older, had longer diabetes durations, higher average blood glucose levels, and higher creatinine levels.
Additionally, we found a significant correlation between autonomic neuropathy and signs of high post-void residue
on ultrasound and detrusor contraction disorders on UDS (p-value < 0.05).
Conclusion: Our study found a higher prevalence of autonomic neuropathy in diabetic patients with LUTS using
Sudoscan (40%). Longer diabetes duration and poor glycemic control were associated with an increased risk of
autonomic neuropathy linked with LUTS, such as urge incontinence.