Artificial intelligence and clinical guidance in male reproductive health: ChatGPT4.0's AUA/ASRM guideline compliance evaluation.

BACKGROUND: Male infertility is defined as the inability of a male to achieve a pregnancy in a fertile female by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM). Artificial intelligence, particularly in language processing models like ChatGPT4.0, offers new possibilities for supporting clinical decision-making. This study aims to assess the effectiveness of ChatGPT4.0 in responding to clinical queries regarding male infertility, which is aligned with AUA/ASRM guidelines. METHODS: This observational study employed a design to evaluate the performance of ChatGPT4.0 across 1073 structured clinical queries categorized into true/false, multiple-choice, and open-ended. Two independent reviewers specializing in reproductive medicine assessed the responses using a six-point Likert scale to evaluate accuracy, relevance, and guideline adherence. RESULTS: In the true/false category, the initial accuracy was 92%, which increased to 94% by the end of the study period. For multiple-choice questions, accuracy improved from 85% to 89%. The most significant gains were seen in open-ended questions, where accuracy rose from 78% to 86%. Initially, some responses did not fully align with the AUA/ASRM guidelines. However, by the end of the 60 days, these responses had become more comprehensive and clinically relevant, indicating an improvement in the model's ability to generate guideline-conformant answers (p < 0.05). The depth and accuracy of responses for higher difficulty questions also showed enhancement (p < 0.01). CONCLUSION: ChatGPT4.0 can serve as a valuable support tool in managing male infertility, providing reliable, guideline-based information that enhances the accuracy of clinical decision-making tools and supports patient education.

Rigicon disposable Furlow insertion tool has the potential to decrease infection rates after inflatable penile prosthesis implantation.

Furlow insertion tool is frequently used during the insertion of the inflatable penile prosthesis cylinders inside the corporal bodies. Although these devices are completely disassembled and separately sterilized after each operation, the residual blood clots and tissues after inadequate cleaning may become the primary sources of penile prosthesis infection. In order to minimize the risk of infection, Rigicon, Inc. (NY, USA) has developed the first disposable Furlow insertion tool. Head-to-head comparison studies with conventional and disposable Furlow insertion tools are necessary to confirm if there is a significant difference in post-implant infection rates.

The Evaluation of the First Bahname Written in Turkish in the Ottoman Era Concerning Current Urology.

OBJECTIVE: Our study investigated the oldest known Turkish bahname, translated by Musa b. Mes'ud, in comparison with the current literature. MATERIAL AND METHODS: First, the original manuscript of the translation was transcribed in Latin. The final version of the text was analyzed in the results. In discussion, findings were examined and interpreted within the framework of current knowledge of sexology, urology, and andrology. RESULTS: Although the work mostly mentions supportive and therapeutic practices in sexual health, it also provides advice on sexuality and sexual life, discussing several topics regarding sexual intercourse types, explaining which ones are good or harmful, and their timing or frequency. The author recommends many foods and compounds or specific drugs and ointments to enhance sexual stamina and avoid erectile dysfunc tion. In addition, he also tries to find solutions to some other sexual health problems related to men and women. These issues are generally evaluated in the context of health; a religious perspective is also provided when needed. CONCLUSION: Interestingly, the author's recommendations on sexual health and herbal or animal drugs are consistent with the current literature. Nevertheless, some information and suggestions in works are entirely irrational and unscientific. Consequently, this study is an original investigation of the first translated bahname into Turkish. There is no other study examining the bahnames with this method. Thus, we believe that our work will be a significant contribution to the research literature.

Protective Effect of Udenafil Against Ischemia Reperfusion Injury Due to Testicular Torsion/Detorsion in Rat Model.

OBJECTIVE: Testicular torsion causes migration of neutrophils to the ischemic region and formation of free oxygen radicals that have a critical effect on ischemic reperfusion (I/R) injury. Udenafil is a selective, strong, and reversible inhibitor of phosphodiesterase type enzyme. In our study, we evaluate the protective effect of udenafil against reperfusion injury due to I/R. MATERIALS AND METHODS: Twenty-one male, adult, Wistar-Albino rats aged 8 months were randomly divided into three groups; sham, I/R, and I/R+udenafil. One hour before the detorsion operation, the sham and I/R groupssaline, and I/R+udenafil groups were administered 2 mg/kg udenafil intraperitoneally. Blood samples were collected to evaluate the inflammatory mediators. Spermatogenic factors were evaluated according to Johnsen criteria. RESULTS: Histopathological and molecular parameters from all groups were compared. Mean values of TNF-α and IL-1ß in venous blood samples were calculated. We observed that TNF-a values were statistically significantly increased in the I/R group than those in sham groups, and these values were decreased with udenafil treatment Furthermore, the glutathione peroxidase (GPx) level was statistically significantly decreased in the I/R group, and treatment with udenafil prevented this decrease. Evaluation of spermatogenesis using the Johnsen scoring system showed no statistically significant difference in mean scores between the groups. CONCLUSION: We concluded that deterioration of biochemical and histopathological parameters are reversed, and injury due to I/R in testicle tissue may be decreased with udenafil treatment. Results of this experimental study show that efficacy of the udenafil treatment in testis torsion should be investigated.

The effect of metabolic syndrome on prostate cancer final pathology.

AIM OF STUDY: Metabolic syndrome (MetS) is an abnormality that increases the risk of cardiovascular disease and diabetes. In the recent years, studies showed that MetS is associated with increased risk of incidence, aggressiveness, and mortality of prostate cancer (PCa). We examined the influence of MetS at final pathology in Turkish patients with PCa. MATERIALS AND METHODS: MetS was defined according to the American Heart Association, National Heart, Lung, Blood Institute, and International Diabetes Federation and requires any three of five components. The patients without and with MetS were in Group 1 and 2, respectively. Data were compared with independent sample t-test and Chi-squared test. RESULTS: There were 117 patients in the study. The patients' age was between 51 and 77 years with a median of 64.87 ± 5.65 and 62.29 ± 5.57, and prostate-specific antigen (PSA) level of the patients was 8.19 ± 5.35 and 8.68 ± 2.22 ng/ml in Group 1 and 2. Of these patients; Group 1 and 2 had 86 and 31 patients. High-grade PCa (Gleason >7) and advanced PCa (T3, T4) at final pathology were reported in 44.18-18.60% and 38.70-32.25% in Group 1 and 2. CONCLUSION: The patients with MetS are diagnosed significantly younger and had higher PSA levels than the other patients. Advanced disease of PCa is seen much more in patients with MetS.

Congenital megalourethra and posterior urethral valve in a patient with Down syndrome.

Megalourethra is a rare congenital anomaly of the urethra that develops as a consequence of dysgenesis of the corpus cavernosum and corpus spongiosum. Herein, we present three congenital abnormalities in one newborn ie; Down syndrome, posterior urethral valve (PUV) and scaphoid megalourethra. The patient was treated successfully by ablation PUV and reduction uretrophlasty. The postoperative period was uneventful and the renal functions could be preserved in the long term.

Effect of sildenafil citrate in testosterone induced benign prostate hyperplasia rat model.

OBJECTIVE: Efficacy of treatments for benign prostate hyperplasia (BPH) is limited because the disease has complex etiopathogenesis. Recent studies have demonstrated the presence of phosphodiesterase-5 (PDE-5) receptors in prostate tissue. We investigated efficacy of sildenafil citrate in testosteron - induced BPH in rats. MATERIAL AND METHODS: The rats were divided into three groups. Each groups had 7 rats. Group 1 was control group. Testosteron propionate 3 mg/kg/day was injected subcutaneously for two weeks in Group 2. The same procedure was done for Group 3 and sildenafil citrate was added to water at daily doses of 2 mg/kg for two weeks. The rats were euthanized with intraperitoneal pentobarbital. The body weights were measured and the prostates were removed. RESULTS: The mean weights of rats were 288±31.93, 345±23.23 and 294±32.86 g in Groups 1, 2 and 3, respectively. The mean prostate weights of rats were 0.74±0.18, 1.3±0.13 and 0.72±0.24 g in Groups 1, 2, and 3, respectively. Group 2 had statistically significantly higher prostate weights than the other groups (p<0.01). Relative prostate weight is calculated with ratio of prostate weight to body weight. BPH group showed an increase in relative prostate weight compared with other groups with significant difference (p=0.036 and p=0.040). There was statistical difference for acinar area between Group 2 and the others, no significant difference of number of acini, interstitial space and epithelial thickness. Group 2 has more papillary projections per acini than the other groups. CONCLUSION: Favourable effect of sildenafil citrate on dimensions of prostate but not all on histological parameters was observed. We expect that PDE-5 inhibitors might be a treatment option for BPH patients if the studies support our findings in the future.

Changing the Stage, Grade and Histological Subtypes of Renal Cell Carcinomas during 10 Years Period.

Renal cell carcinomas (RCCs) account 80-85% of all primary renal neoplasms and originate from the renal cortex. The patients who underwent radical or partial nephrectomy for renal tumour in our unit between January 2005 and 2015 were evaluated retrospectively. The patients were divided into two groups; group 1 includes patients who were treated between January 2005 and December 2009, group 2 those from January 2010 to 2015. There were 103 patients in group 1. The patients were between 21 and 89 years with mean age of 61.46 year. Renal cell carcinomas account 83.4% of the patients, benign renal tumours were 8.7% and transitional cell carcinomas were 7.7% of the patients in group 1. A total of 32.5% RCCs were classified as pT1a, 24.4% as pT1b, 15.1% as pT2a, 11.6% as pT2b, 15.1% as pT3a and 1.1% as pT4. There were 202 patients in group 2 and the patients were between 27 and 81 years with mean age of 58.5 year. Renal cell carcinomas comprised the main bulk of the tumours with 182 nephrectomy specimens. According to the pathological classification of RCCs, 51 specimens were found as pT1a, 54 were pT1b, 13 were pT2a, 14 were pT2b, 48 were pT3a and 2 were pT4. Although, the incidence of small renal masses has been increasing with widespread use of imaging techniques and recent advancements, the proportion of high grade and advanced stage renal tumours increased during the study period.

Evaluation of behavioral problems in patients with monosymptomaticnocturnal enuresis: a prospective controlled trial.

BACKGROUND/AIM: The aim of the present study was to evaluate the behavioral and emotional patterns of patients with nocturnal enuresis (NE) and compare them with those of healthy subjects. MATERIALS AND METHODS: Thirty-eight children and adolescents with monosymptomatic NE who were admitted to our hospital's pediatric and urologic outpatient clinics and 46 age-matched, healthy subjects were enrolled in this study. To compare behavioral patterns in these patients, the Child Behavior Checklist (CBCL) was used. Patients' ages, occupations, educational, and socioeconomic status, and mothers' age at delivery were compared in the two groups. One-way ANOVA was used for statistical analysis. RESULTS: Enuretic children were found to have more behavioral problems than nonenuretic children with regard to social (P = 0.008) and attention (P = 0.018) problems. There were no significant differences in anxiety or attractiveness problems between the groups (P > 0.05); however, patients with enuresis were more likely to exhibit these behavioral problems than healthy subjects. The demographics of the patients were significantly different in the two groups in favor of the control group. CONCLUSION: It was shown that patients with enuresis have more social and attention problems than the control group. Treating these patients effectively will increase the likelihood that they will not develop behavioral problems.

Adult urethral stricture: practice of Turkish urologists.

OBJECTIVES: To evaluate national practice patterns in the treatment of male anterior urethral strictures among Turkish urologists. MATERIALS AND METHODS: A survey form including 12 questions prepared to determine active Turkish urologists' approach to diagnosis and treatment of the adult urethral stricture (US) were filled out. Based on the survey results, the institutions which 218 urologists work and their years of expertise, methods they used for diagnosis and treatment, whether or not they perform open urethroplasty and timing of open urethroplasty were investigated. RESULTS: Optic internal urethrotomy and dilatation are the most commonly used minimal invasive procedures in treatment of US with the ratios of 93.5% and 63.3% respectively. On the other hand it was seen that urethroplasty was a less commonly used procedure, compared to minimal invasive techniques, with the ratio of 36.7%. Survey results showed us that the number of US cases observed and open urethroplasty procedures performed increases with increasing years of professional experience. CONCLUSIONS: As a method demanding special surgical experience and known as a time-consuming and challenging procedure, open urethroplasty will be able to take a greater part in current urological practice with the help of theoretical education and practical courses given by specific centers and experienced authors.

Adult urethral stricture: practice of Turkish urologists

ABSTRACT Objectives: To evaluate national practice patterns in the treatment of male anterior urethral strictures among Turkish urologists. Materials and Methods: A survey form including 12 questions prepared to determine active Turkish urologists' approach to diagnosis and treatment of the adult urethral stricture (US) were filled out. Based on the survey results, the institutions which 218 urologists work and their years of expertise, methods they used for diagnosis and treatment, whether or not they perform open urethroplasty and timing of open urethroplasty were investigated. Results: Optic internal urethrotomy and dilatation are the most commonly used minimal invasive procedures in treatment of US with the ratios of 93.5% and 63.3% respectively. On the other hand it was seen that urethroplasty was a less commonly used procedure, compared to minimal invasive techniques, with the ratio of 36.7%. Survey results showed us that the number of US cases observed and open urethroplasty procedures performed increases with increasing years of professional experience. Conclusions: As a method demanding special surgical experience and known as a time-consuming and challenging procedure, open urethroplasty will be able to take a greater part in current urological practice with the help of theoretical education and practical courses given by specific centers and experienced authors.

Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection?

BACKGROUND AND AIMS: To investigate the possible effect of resectoscope size on urethral stricture rate after monopolar TURP. MATERIALS AND METHODS: A retrospective study of 71 men undergoing TURP was conducted at two centers' from November 2009 to May 2013. The patients were divided into one of two groups according to the resectoscope diameter used for TURP. Resectoscope diameter was 24 F in group 1 (n=35) or 26 F in group 2 (n=36). Urethral catheter type, catheter removal time and energy type were kept constant for all patients. Urethral stricture formation in different localizations after TURP was compared between groups. RESULTS: There was no significant difference between the two groups in terms of age, pre-operative prostate gland volume (PV), prostate-specific antigen (PSA), maximal urinary flow rates (Qmax), International Prostate Symptom Score (IPSS) and post-voiding residual urine volume (PVR). The resection time and weight of resected prostate tissue were similar for both groups (p>0.05). A statistically significant higher incidence of bulbar stricture was detected in group 2 compared to group 1 (p=0.018). CONCLUSIONS: The use of small-diameter resectoscope shafts may cause a reduction in the incidence of uretral strictures in relation to urethral friction and mucosal damage.

Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection?

ABSTRACTBackground and aims:To investigate the possible effect of resectoscope size on urethral stricture rate after monopolar TURP.Materials and Methods:A retrospective study of 71 men undergoing TURP was conducted at two centers’ from November 2009 to May 2013. The patients were divided into one of two groups according to the resectoscope diameter used for TURP. Resectoscope diameter was 24 F in group 1 (n=35) or 26 F in group 2 (n=36). Urethral catheter type, catheter removal time and energy type were kept constant for all patients. Urethral stricture formation in different localizations after TURP was compared between groups.Results:There was no significant difference between the two groups in terms of age, pre-operative prostate gland volume (PV), prostate-specific antigen (PSA), maximal urinary flow rates (Qmax), International Prostate Symptom Score (IPSS) and post-voiding residual urine volume (PVR). The resection time and weight of resected prostate tissue were similar for both groups (p>0.05). A statistically significant higher incidence of bulbar stricture was detected in group 2 compared to group1 (p=0.018).Conclusions:The use of small-diameter resectoscope shafts may cause a reduction in the incidence of uretral strictures in relation to urethral friction and mucosal damage.

Evaluation of depression and self-esteem in children with monosymptomatic nocturnal enuresis: A controlled trial.

OBJECTIVES: Nocturnal enuresis (NE) is very common and is one of the most common causes for patients to be admitted to urology, pediatrics, child psychiatry and child surgery departments. We aimed to investigate the effect on depression and self-esteem of this disorder that can cause problems on person's social development and human relations. MATERIAL AND METHODS: 90 patients who were admitted to our clinic with complaints of nocturnal enuresis were enrolled. Investigations to rule out organic causes were performed in this group of patients. Out of them 38 children and adolescents (age range 8-18 years) with primary monosymptomatic nocturnal enuresis (PMNE) agreed to participate in the study In the same period 46 healthy children and adolescents with a similar age range without bed wetting complaint were included in the study as a control group. The age of the family, educational and socioeconomic level were questioned and Piers-Harris Children's Self-Concept Scale (PHCSCS) and Children's Depression Inventory (CDI) forms were filled out. RESULTS: Mean age of the cases (18 females or 47.4% and 20 males or 52.6%) was 10.76 ± 3.82 years whereas mean age of controls (26 females or 56.5% and 20 males or 43.5%) was 10.89 ± 3.11 years. Depression scale was significantly higher (p = 0.001) in the case group than in the control group (10.42 ± 4.31 vs 7.09 ± 4.35). In both groups there was no statistically significant difference by age and sex in terms of depression scale (p > 0.05). CONCLUSION: NE is widely seen as in the community and is a source of stresses either for children and for their families. When patients were admitted to physicians for treatment, a multidisciplinary approach should be offered and the necessary psychological support should be provided jointly by child psychiatrists and psychologists.

A new problem in inflammatory bladder diseases: use of mobile phones!

PURPOSE: Technological developments provide a lot of conveniences to our lives. This issue is one of the risks that arise along with these conveniences. In our study we tried to understand the impact of electromagnetic waves from mobile phones on bladder tissue. MATERIALS AND METHODS: Twenty-one adult male albino rats were divided into three equal groups. Group 1 was exposed to electromagnetic wave for 8 hours per day for 20 days and then their bladders were taken off immediately. Group 2 was firstly exposed to electromagnetic wave for 8 hours per day for 20 days then secondly another for 20 days without exposition to electromagnetic wave and then their bladders were taken off. Group 3 was the control group and they were not exposed to electromagnetic wave. RESULTS: Under microscopic examination of bladder tissue, in the first group severe inflammatory cell infiltration was seen in lamina propria and muscle layer in contrast to intact urothelium. In the second group mild inflammatory cell infiltration was seen in lamina propria and muscle layer. The mean scores for the three groups were 5.5 ± 2.5, 0.8 ± 1.3 and 1.2 ± 1.5 respectively. Mean score of group 1 was statistically higher than others (p = 0.001). CONCLUSION: Intensive use of mobile phones has negative impact on bladder tissue as well as the other organs. Keeping a minimum level of mobile phone use makes it easy to be kept under control of diseases in which inflammation is an etiologic factor.

A new problem in inflammatory bladder diseases: Use of mobile phones!

Purpose Technological developments provide a lot of conveniences to our lives. This issue is one of the risks that arise along with these conveniences. In our study we tried to understand the impact of electromagnetic waves from mobile phones on bladder tissue. Materials and Methods Twenty-one adult male albino rats were divided into three equal groups. Group 1 was exposed to electromagnetic wave for 8 hours per day for 20 days and then their bladders were taken off immediately. Group 2 was firstly exposed to electromagnetic wave for 8 hours per day for 20 days then secondly another for 20 days without exposition to electromagnetic wave and then their bladders were taken off. Group 3 was the control group and they were not exposed to electromagnetic wave. Results Under microscopic examination of bladder tissue, in the first group severe inflammatory cell infiltration was seen in lamina propria and muscle layer in contrast to intact urothelium. In the second group mild inflammatory cell infiltration was seen in lamina propria and muscle layer. The mean scores for the three groups were 5.5 ± 2.5, 0.8 ± 1.3 and 1.2 ± 1.5 respectively. Mean score of group 1 was statistically higher than others (p = 0.001). Conclusion Intensive use of mobile phones has negative impact on bladder tissue as well as the other organs. Keeping a minimum level of mobile phone use makes it easy to be kept under control of diseases in which inflammation is an etiologic factor. .

Circumcision in bleeding disorders: improvement of our cost effective method with diathermic knife.

PURPOSE: Circumcision is a very common surgical procedure that has been performed for thousands of years. In this paper, we report the long-term results of circumcision performed by using diathermic knife on patients with bleeding diathesis and the amount of blood factors used. MATERIALS AND METHODS: A total of 147 patients with bleeding diathesis circumcised under local anesthesia by using diathermic knife between 1996 and 2010 were recruited into this study. Age of the patients, type of the bleeding diathesis and the treatment protocols were recorded. Postsurgical infection and bleeding rates of 2 different factor replacement protocols were recorded. RESULTS: Mean age of the patients was 11.5 years (range, 1.5-37 years). In the group of protocol 1 applied patients, 3 patients (4%) had bleeding and one patient had infection whereas in group of protocol 2, 4 patients (5.4%) had bleeding. The bleeding cases were taken under control after the factor replacement and elastic bandage. CONCLUSION: Whenever it is necessary for an individual to be circumcised for any reason whatsoever, we think that circumcision can be performed in the patients with bleeding diathesis with lower costs and complication rates by using diathermic knife and the protocol that we used.

The use of primary and secondary doxazosin XL (8 mg) in the treatment of benign prostate hyperplasia: Is there a new approach in the event of alpha-blocker failure?

OBJECTIVE: Lower urinary tract symptoms (LUTS), which are related to benign prostate hyperplasia (BPH), are the most commonly encountered diseases in urological practice. In our study, we compared responses to (doxazosin mesylate extended release tablets) treatment. MATERIAL AND METHODS: In our study, we included one hundred patients with LUTS who did not receive any medical treatment, and one hundred patients with LUTS who did not respond to alpha-blocker drugs other than doxazosin XL (8 mg). The inclusion criteria for the study were as follows: international prostate symptom score (IPSS)>7, prostate volume >20 cc, Q-max <15 mL/sn, lack of any previous pelvic or prostatic surgery, and /or urethral catheterization. RESULTS: The mean age of the patients was 62.2±7.9 years. No statistically significant differences were detected between the groups with respect to age, prostate volume, and total prostate-specific antigen (PSA) levels. The duration of the follow-up period was calculated as 3-26 (mean 11) months. Significant differences were detected in post-voiding residual urine, IPSS, quality of life and Qmax between pre- and post-treatment values. Similar decreases in the IPSS scores, and increases in Qmax values were detected in both groups. CONCLUSION: Doxazosin XL (8 mg) treatment was found to be efficient and reliable in primary patients and in patients with severe LUTS who did not respond to medical treatment. Trial of doxazosin XL (8 mg) therapy, before surgery in patients who respond inadequately to other alpha-blocker drugs is a rational approach.

Predictive values for extracapsular extension in prostate cancer patients with PSA values below 10 ng/mL.

OBJECTIVE: We aimed to determine predictive values of extracapsular extension (ECE) in patients who had undergone radical retropubic prostatectomy (RRP) with prostate-specific antigen (PSA) values below 10 ng/mL. MATERIAL AND METHODS: We retrospectively scanned data of 167 patients with PSA values below 10 ng/mL who had undergone radical retropubic prostatectomy (RRP) between April 2004 and August 2011 in our clinic. Age, PSA, PSA ratio, PSA density, digital rectal examination (DRE) findings, biopsy total Gleason score, perineural invasion (PNI), and lymphovascular invasion (LVI) were analyzed. Parameters of the groups with or without extracapsular extension in RRP pathology specimens were compared. RESULTS: The mean age of patients was 66.4±12.3 years. According to histopathological analysis of the specimens of RRP of 167 patients, 45 (26.9%) had extracapsular extension (pT3-4) (Group 1); 122 (73.1%) were confined to the prostate (pT2) (Group 2). The mean PSA level was high in Group 1 (p= 0.114), PSA ratio was higher in Group 2 (p=0.09). PSA density was 0.17 in Group 1 and 0.24 in Group 2 (p=0.03). DRE positivity was 53.3% and 57.1%, respectively (p=0.71). Biopsy total Gleason score was higher in Group 1 than Group 2 with a statistically significant difference (p=0.04). A statistically significant difference was found between the rates of PNI and LVI (28.9% and 1.63%, respectively) (p=0.002). There was no statistically significant difference between both groups as for surgical margin positivity (p=0.18). CONCLUSION: In PCa patients with PSA values below 10 ng/mL, PSA density, lymphovascular invasion and biopsy Gleason total score were statistically significant in predicting extracapsular invasion. Therefore, these results must be considered in preoperative evaluation.