Urology Journal

Purpose: To evaluate the effectiveness of the Complete Primary Repair of Exstrophy (CPRE) technique for bladder exstrophy-epispadias complex (BEEC) reconstruction and its comparison with the Modern Staged Repair of Exstrophy (MSRE) technique.
Materials and Methods: A comprehensive literature review of CPRE and MSRE was conducted, focusing on factors such as continence rates, postoperative outcomes, and complications. Various studies on pelvic biometry, surgical approaches, and long-term evaluations of renal function and continence were analyzed.
Results: CPRE demonstrates promising outcomes, particularly in resource-limited settings, by reducing the number of surgeries and associated risks compared to MSRE. Success rates for continence post-CPRE were higher when performed correctly in the first attempt, with fewer complications such as vesicoureteral reflux and hydronephrosis. Pelvic biometry assessments, including bladder neck placement and levator ani angle, were significant predictors of successful continence outcomes.
Conclusion: CPRE offers a viable alternative to MSRE, particularly in low-resource environments, with favorable continence and renal outcomes. Proper surgical execution in the first attempt is critical for long-term success, emphasizing the importance of surgeon expertise and postoperative care. Further long-term studies are necessary to solidify CPRE's role as the primary surgical approach for BEEC.

Purpose: Positive surgical margins (PSM) following partial nephrectomy (PN) for renal cell carcinoma (RCC)
are a concern due to potential implications for recurrence and survival. This systematic review and meta-analysis assess the impact of PSM on recurrence rates and progression-free survival in RCC patients.
Methods: We conducted a systematic search of PubMed, Embase, Scopus, Cochrane, and Web of Science databases from inception through July 2024. Studies examining recurrence and survival outcomes in RCC patients with and without PSM post-PN were included. A random-effects model was applied to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) for recurrence and survival.
Results: Thirty studies met the inclusion criteria. Our analysis showed that PSM was significantly associated with a higher risk of local recurrence (HR = 2.13, 95% CI: 1.67–2.72) and a lower recurrence/progression-free survival (HR = 1.70, 95% CI: 1.40–2.07) compared to negative surgical margins. Subgroup analyses indicated consistent results across study designs and RCC histologic subtypes.
Conclusion: The presence of PSM following PN for RCC is associated with a 2.13-fold increase in local recurrence and a 1.7-fold reduction in progression-free survival, emphasizing the need for precise margin management during surgery. These findings highlight the importance of optimizing surgical techniques and considering adjuvant treatment strategies for patients with PSM to improve oncologic outcomes.

Purpose: Retrograde intrarenal surgery has become increasingly popular for renal stone disease but has very different stone-free rates in children. There is insufficient data in the literature regarding how long it takes to reach a stone-free status in children after retrograde intrarenal surgery. We aimed to evaluate the time to reach stone-free status and stone-free rates (SFR) in children who underwent retrograde intrarenal surgery.

Materials and Methods: This retrospective study included children who had undergone retrograde intrarenal surgery. Ultrasonography was performed three months after the procedures for 18 months to evaluate stone clearance. We analyzed the stone-free rate and time to reach stone-free status.

Results: One hundred and five patients (mean age 6.66 + 5.27 years) were evaluated. Fifteen patients had staghorn stones, 31 had multiple stones, and 44 had single stones. The median follow-up period was 29 months (9-44 months) Of the 90 patients who underwent RIRS as the first treatment option, 38 (42.2%) achieved stone-free status with a single procedure, while 30 (33.3%) required repeat RIRS and other procedures.The stone-free rate was achieved in 75.5% of the patients in a mean of 12.25+40.19 months, In the group with staghorn stones, stone-free status was achieved in 4-36 months with a mean of 16.85+12.03 months, in patients with multiple stones in 2-41 months with a mean of 12.72+10.03 months, and in patients with single stones in 1-36 months with a mean of 10.23+9.10 months. Although the staghorn group achieved stone-free time for longer than the other two groups, there was no significant relationship between the three groups (P = .131) and achieved stone-free time.

Conclusion: A stone-free status can be achieved in children 12 months after retrograde intrarenal surgery. Since stone-free status is achieved over a long period, patient follow-ups should be planned accordingly, and there should be no rush to perform additional interventions in asymptomatic cases with residual stones.

Purpose: To investigate the effect of using three-dimensional (3D) modeling before the surgery on positive surgical margins (PSM) in patients who underwent radical retropubic prostatectomy (RRP).
Materials and Methods: A prospective data analysis of 81 patients who underwent RRP between April 2021 and December 2023 was performed. Patients were randomized into 2 groups. In “3D group” (n:41), patients were evaluated by the surgeon and radiologist by using a 3D modeling of the mpMRI images which were done by two experienced radiologists just before the surgery. In “non-3D group” (n:40), the surgeon evaluated the mpMRI scans and reports by himself without a 3D modeling of the mpMRI before the operation. Finally, positive surgical margins of two groups were compared.
Results: The mean age of the patients was 66.7 ± 5.2 and 65.3±4.9 years in 3D group and non-3D group, respectively. (p = .65) Preoperative PSA value, prostate volume, preoperative PIRADS 4 and PIRADS 5 scores, postoperative ISUP grades and T stages were statistically similar in both groups. (p > .05) The PSM rate was 24 (29.6%) in the overall patient population. PSM was detected in 6 (14.6%) and 18 (45%) of the patients in 3D group and non-3D group, respectively. (p = .005)
Conclusion: Using a 3D modeling of the mpMRI images before the surgery decreased the PSM rates after radical retropubic prostatectomy. The present study also reveals the importance of collaboration between radiologists and urologists in the accurate preoperative evaluation of prostate cancer.

Purpose: This study aimed to compare the effects of transperineal prostate combined biopsy (TP-CB) and transrectal prostate systematic biopsy (TR-SB) on the detection rate and safety of prostate cancer in patients with prostate-specific antigen (PSA) gray zone, PSA levels of 10~20 ng/mL, and 20~40 ng/mL, and explore the comparative value of their applications.
Materials and Methods: We collected 243 samples from patients with PSA ≤ 40 ng/mL who underwent prostate biopsy. All patients were divided into two groups according to different patterns of prostate biopsy. The detection rates of prostate cancer and clinically significant prostate cancer (CsPCa) in patients with PSA levels of 4~10,10~20, and 20~40 ng/mL were compared between two different biopsy methods, surgical conditions, and the incidence of complications.
Results: The rate of a positive prostate cancer biopsy was significantly higher in TP-CB than in TR-SB (P < 0.05). Further subgroup analyses revealed no statistical significance in the rate of positive prostate cancer biopsy in patients with PSA levels of 4~10 and 20~40 ng/mL between the two groups (P > 0.05). However, patients with PSA levels of 10~20 ng/mL in the TP-CB group exhibited a higher detection rate (P < 0.05), with CsPCa accounting for a higher proportion. The TP-CB and TR-SB groups did not exhibit a significant difference in surgical conditions or overall complication rates (P > 0.05). However, the TR-SB group exhibited a higher risk of postoperative febrile infection than the TP-CB group (P < 0.05).
Conclusion: For patients with PSA in the 'sub-gray zone' (10~20 ng/mL), TP-CB has a better diagnostic and application value and is more suitable for clinical promotion.

Purpose: To examine the sexual and psychological conditions of men with Bilateral Congenital Bilateral Absence of the Vas Deferens (CBAVD), a rare condition that contributes to male infertility, and compare it with healthy fertile men.
Material and Methods: A total of 52 patients with CBAVD and 66 healthy, fertile men who attended our infertility and andrology clinic were included in the study. Patients with cognitive impairments, language barriers, significant comorbidities, or a history of urogenital surgery were excluded. Reproductive hormone levels and semen volumes were evaluated. In addition, sexual status was investigated with validated questionnaires such as the International Index of Erectile Function, Male Sexual Health Questionnaire, Arabic Index of Premature Ejaculation, Premature Ejaculation Diagnostic Tool, and Premature Ejaculation Profile.
Results: In the CBAVD group, median total testosterone, FSH, LH levels, and semen volume were 401 ng/dL, 3.9 mIU/ml, 3.9 mIU/ml, and 0.9 ml, respectively. These parameters were 376 (ng/dL), 4.8 mIU/ml, 5 mIU/ml, and 3 ml in the control group. Semen volume was significantly lower in CBAVD men (p < 0.001). Questionnaires assessing erectile and ejaculatory function have shown that there was no significant difference between the CBAVD and control groups in terms of erectile function, orgasmic function, and sexual relationship satisfaction. However, sexual desire (p = 0.006) and overall satisfaction (p = 0.028) were found to be higher in the CBAVD group.
Conclusion: The study suggests that CBAVD may not be a direct etiological factor for erectile dysfunction or
premature ejaculation.

Purpose: To compare postoperative ejaculation disorders (EjDs) between transurethral resection of the prostate (TURP) with 0.5-cm tissue preservation proximal to the verumontanum and the standard TURP procedure.

Materials and Methods: Between February 2016 and August 2020, 226 patients who underwent TURP for symptomatic benign prostatic hyperplasia were retrospectively screened. The patients were analyzed in two groups: In Group A (n = 106), TURP was performed by preserving 0.5-cm tissue proximal to the verumontanum, while in Group B (n = 120), standard TURP was performed. The postoperative voiding functions and EjD rates were compared.

Results: Similar findings were observed in the international prostate symptom score, health-related quality of life score, maximum urine flow rate, and post-void residual volume in both groups. In Group A, ejaculation was preserved in 55 (51.9%) patients, the ejaculation volume was decreased in 13 (12.3%), and EjD developed in 38 (35.8%). In Group B, ejaculation was preserved in 16 (13.8%) patients, the ejaculation volume decreased in 15 (12.5%), and EjD developed in 89 (74.2%).

Conclusion: The ejaculatory function of patients can be maintained in the TURP procedure through the preservation of 0.5-cm tissue from the proximal verumontanum. The modification of TURP can further reduce the risks and undesirable effects of the procedure. The implementation of novel surgical technique modifications and technological developments can potentially decrease complication rates. This approach will also eliminate the assumption that the development of EjD is inevitable after prostate surgery.