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Prof.Dr. R. Gökhan ATIŞ
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Original Article
Frequency of Anxiety and Depression in Urolithiasis Patients Undergoing Ureteral Stent Removal
Abuzer Öztürk, Hüseyin Sosa, İbrahim Karaca, İsmail Emre Ergin, Aydemir Asdemir
Abstract
Objective: Cystoscopy-guided ureteral stent removal is a standard procedure and can cause significant psychological distress in patients. In this study, we evaluated the prevalence and severity of anxiety and depression in patients with urolithiasis undergoing ureteral stent removal.
Material and Methods: This prospective observational study included 50 consecutive patients undergoing cystoscopic ureteral stent removal after endoscopic stone treatment. Anxiety and depression were assessed using Visual Analog Scale for Anxiety (VAS-A), Amsterdam Preoperative Anxiety and Information Scale (APAIS), Beck Depression Scale (BDS), and Beck Anxiety Scale (BAS).
Results: The cohort comprised 47 males and 3 females (mean age 53.2 ± 15.25 years). All patients experienced pre-procedure anxiety (VAS-A > 0, mean 3.52 ± 1.94). Mean APAIS anxiety and knowledge scores were 6.94 ± 2.44 and 4.28± 1.75, respectively. Patients with APAIS knowledge scores >4 demonstrated significantly higher information-seeking behavior (p < 0.05). Despite universal anxiety presence, BAS scores remained in the low range for all patients.
Conclusions: Universal pre-procedure anxiety occurs in patients undergoing ureteral stent removal, though severity remains generally low. Enhanced patient education and information provision may reduce psychological distress.
Keywords: anxiety, stent, ureteroscopy, quality of life
Original Article
Urological Evaluation Processes of Patients with Microscopic Hematuria Identified in Primary Healthcare Services: A Retrospective Analysis
Mehmet Uçar, Halil İbrahim İvelik, Duygu İvelik
Abstract
Objective: This study aimed to investigate the diagnostic evaluation pathways, referral rates for advanced testing, final diagnoses, and follow-up outcomes of patients with microscopic hematuria (MH) identified through routine urinalysis in primary care settings.
Materials and Methods: In this retrospective cross-sectional study, clinical data were reviewed for 73 patients who presented to primary healthcare centers between 2022 and 2023 and had ≥3 red blood cells per high-power field (RBC/HPF) on urinalysis. Data included demographic characteristics, medical history, laboratory findings, imaging studies, specialist consultations, and treatment outcomes.
Results: The mean age of participants was 39.6 ± 14.3 years, with 63% being female. MH was classified as benign in 80.8% of cases. Urolithiasis accounted for 13.7%, while glomerular pathology and malignancy were each identified in 2.7% of patients. A follow-up-only approach was adopted in 60.3% of cases. During follow-up, hematuria resolved spontaneously in 84.9% of patients. The presence of malignancy was more common among high-risk individuals, particularly older adults and smokers.
Conclusion: Microscopic hematuria is most often benign but may signal serious underlying conditions in high-risk patients. Nurses in primary care play a vital role in the early identification and triage of such patients by interpreting urinalysis findings using a risk-based approach and ensuring timely specialist referrals.
Keywords: hematuria, nursing, oncology, primary healthcare, urology
Original Article
Can the De Nunzio Nomogram Reliably Predict Stone-Free Rates After Semirigid Ureteroscopy? A Retrospective External Validation Study
Mehmet Şahin, Ertuğrul Arıkız, Yusra Nur Aksakal, Yiğit Can Filtekin, Turan Özdemir, Metin Savun, Halil Lütfi Canat
Abstract
Objective: To externally validate the De Nunzio nomogram for predicting stone-free outcomes after semirigid ureteroscopic lithotripsy (ULT) in patients with ureteral stones.
Materials and Methods: This retrospective study included 385 patients who underwent semirigid ULT for ureteral stones between December 2021 and October 2024. Demographic, clinical, and radiological data were collected. The De Nunzio nomogram score was calculated for each patient. Stone-free status was defined as the complete absence of residual fragments on imaging within 4–6 weeks postoperatively. Predictive performance of the nomogram was assessed using ROC curve analysis and decision curve analysis (DCA).
Results: The overall stone-free rate was 85.7%. There were no significant differences between the stone-free and non-stone-free groups regarding age, gender, or stone density. However, patients in the stone-free group more frequently had single stones, lower median stone length, and lower De Nunzio scores. Stones were more commonly located in the middle and distal ureter, while pyuria and hydronephrosis were less frequently observed in this group. The nomogram demonstrated high discriminative performance with an AUC of 0.866. DCA showed a net clinical benefit across a wide range of threshold probabilities.
Conclusions: The De Nunzio nomogram is a valid and clinically useful tool for predicting stone-free outcomes following semirigid ULT. Its implementation may enhance preoperative risk stratification and support individualized treatment planning in patients with ureteral stones.
Keywords: de Nunzio score, nomogram validation, semirigid ureteroscopy, stone-free rate, , ureteral stones, urolithiasis
Original Article
A Comparison Study of AI Response Quality in Kidney Stone-Related Questions: Google vs. ChatGPT
Burak Elmaağaç, Abdullah Gölbaşı, Ali Yasin Özercan, Hüseyin Biçer
Abstract
Objective:This study intends to evaluate, in Türkiye during the previous 12 months, the readability, reliability, and general quality of responses given by Google and ChatGPT on often-requested inquiries about kidney stones.
Material And Methods: The 10 most often searched queries and 4 trending topics on kidney stones were found by means of Google Trends data. Fourteen queries in all were asked on Google and ChatGPT. Gunning Fog Index (readability), a modified 5-question DISCERN Score (reliability), the Global Quality Score, and expert urologists’ assessments guided responses’ analysis. Independent t-tests let one evaluate Google’s and ChatGPT’s performance differences.
Results: ChatGPT showed notably better performance than Google in terms of the DISCERN Score (mean: 21.4 vs. 18.0; p = 0.002), Global Quality Score (mean: 4.8 vs. 4.0; p = 0.001), and expert urologists’ ratings (mean: 4.6 vs. 3.8; p= 0.001). Though ChatGPT had a lower Gunning Fog Index (mean: 15.84 vs. 18.23), indicating more legible text, this difference was not statistically significant (p = 0.165).
Conclusion: ChatGPT exceeded Google in offering consistent, high-quality, expert-endorsed knowledge about kidney stones. These results show the possibilities of artificial intelligence language models in access to correct healthcare information and patient education. Additionally, improving transparency of information sources and implementing further verification mechanisms for clinical accuracy are recommended to ensure the reliability of AI-generated medical information.
Keywords:artificial intelligence, health literacy, internet, kidney stone, patient education, urolithiasis
Original Article
Comparison of A Novel Open Fingertip Technique for Laparoscopic Entry with the Veress Needle
Erdinç Dinçer, Orkunt Özkaptan, Alkan Çubuk, Cengiz Çanakçı, Utku Can, Ahmet Şahan
Abstract
Objective: To compare our novel abdominal entry technique (i.e., the fingertip technique) with the Veress needle technique in laparoscopic urological surgery, in terms of feasibility and complications.
Material And Methods: A total of 90 patients who underwent laparoscopic transperitoneal surgery were assigned to either the Fingertip technique group (n = 45) or the Veress needle technique group (n = 45). The duration of time for initial entry, the occurrence of gas leakage, the number of attempts for successful entry into the abdomen, and the complications were evaluated.
Results:The two groups had comparable demographic characteristics. The laparoscopic entry time was shorter in the fingertip group than it was in the Veress needle group (175.7 ± 64.9 versus 103.8 ± 26.7 s; p < 0.001). Pneumoperitoneum was established at the first attempt in 35 (77.7%) of the Veress needle patients and in 45 (100%) patients in the fingertip method group. The overall complication rates were 4 (8.8%) in the Veress needle group and 3 (6.6%) in the fingertip group (p = 0.693). In the Veress needle group, minor complications included liver injury in one patient, intestinal injury in one patient, subcutaneous emphysema in one patient and omental injury or insufflation in one patient. In contrast, in the fingertip group, subcutaneous bleeding occurred in three patients.
Conclusion: The fingertip technique may be considered as a feasible option for laparoscopic entry with its lower complications rates and shorter applying time compared to the Veress needle technique.
Keywords:complication, fingertip technique, gas leakage, laparoscopic abdominal entry, veress needle technique
Original Article
Lesion-Based Comparison of Storz Professional Image Enhancement System and White-Light Cystoscopy for Detecting Bladder Carcinoma In Situ
İsmail Ulus, Yunus Emre Düşünüş, Ahmet Yaser Müslümanoğlu
Abstract
Objective: This study aimed to evaluate whether the Storz Professional Image Enhancement System (SPIES) offers superior diagnostic accuracy compared with white-light cystoscopy (WLC) in the detection of bladder carcinoma in situ (CIS), given the limited evidence available for CIS-suspicious lesions.
Material and Methods: This retrospective study included 46 patients who underwent cystoscopy under local anesthesia for microscopic or macroscopic hematuria between July 2022 and July 2025. Patients with prior cystoscopy, pelvic radiotherapy, or active urinary tract infection were excluded. CIS-suspicious lesions identified during WLC prompted scheduling for TUR-BT under general anesthesia. During TUR-BT, all lesions were evaluated sequentially with WLC followed by three SPIES modes (Clara+Chroma, Spectra A, and Spectra B) by a single experienced urologist. A total of 95 CIS-suspicious lesions were recorded, individually resected, and submitted for separate pathological analysis.
Results: A total of 95 CIS-suspicious lesions were identified in 46 patients, of which 28 were CIS-positive. Lesion-based diagnostic accuracy was 30.5% for WLC and 33.7% for SPIES. SPIES detected 23 additional lesions not visualized with WLC, corresponding to an incremental lesion detection contribution of 24.2% overall and 31.9% relative to WLC-positive findings. Among CIS-positive lesions, SPIES provided an incremental diagnostic gain of 35.7% and a 55.6% relative improvement over WLC. McNemar’s test demonstrated a statistically significant difference in paired detection outcomes between the modalities (χ² = 8.1, p = 0.004), confirming the superior detection performance of SPIES.
Conclusions:SPIES outperformed WLC in detecting bladder CIS, indicating a meaningful diagnostic benefit that warrants validation in prospective comparative studies.
Keywords: bladder, carcinoma in situ, cystoscopy
Case Report
Knotting of Percutaneous Nephrostomy Catheter within the Renal Calyx and Endoscopic Removal: An Extremely Rare Complication
Mert Başaranoğlu, Ali Halhallı, Ali Nebioğlu
Abstract
Percutaneous nephrostomy catheter placement is a widely used decompression method for upper urinary tract obstructions. This case report presents the successful endoscopic management of an extremely rare complication: spontaneous knotting of a nephrostomy catheter within the renal calyx.
A 31-year-old female patient presented to the urology clinic with right flank pain of colicky nature. Non-contrast computed tomography imaging revealed a 17 mm stone in the right proximal ureter and grade 3 hydronephrosis in the right kidney, while laboratory tests indicated urinary tract infection. An emergency percutaneous nephrostomy catheter was placed, and endoscopic stone treatment was planned following infection treatment and hospitalization. During the operation, it was discovered that the nephrostomy catheter could not be removed and the catheter tip was knotted. Under flexible renoscopy guidance, stone formations around the catheter were fragmented with holmium laser, and the catheter was successfully removed. The patient was discharged on the first postoperative day without complications.
Nephrostomy catheter knotting is an extremely rare but serious complication reported in the literature. Endoscopic approaches represent a safe and effective treatment option in such cases. Proper technical use during catheter placement and regular follow-up are crucial in preventing this complication. For clinicians encountering similar situations, endoscopic solution methods should be the preferred choice.
Keywords: catheter knotting, complication management, flexible renoscopy, percutaneous nephrostomy
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