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Öğe Analyzing the quality and validity of holmium laser enucleation of prostate (HoLEP) videos on social media(Termedia Publishing House Ltd, 2022) Söğütdelen, Emrullah; Tonyalı, ŞenolIntroduction: The number of social media users is gradually increasing, and they are spending their time gathering a lot of useful information for themselves. Here, we analysed the quality of Holmium Laser Enucleation of Prostate (HoLEP) surgery videos on YouTube. Aim: To assess the quality of the most viewed HoLEP videos on YouTube using validated questionnaires and scoring systems developed to evaluate the significant features. Material and methods: The most viewed 98 videos were included in this study by the search for 'Holep' keyword on YouTube. The Journal of American Medical Association Benchmark Score (JAMAS) and Global Quality Score (GQS) were used to analyse the videos after the validated HoLEP Scoring System Score (HSSS) was performed by 3 HoLEP trained surgeons to evaluate the technical quality of videos. Results: The videos including surgical technique (76.5%) and uploaded by urologists (63.3%) constituted the majority of videos. The median of JAMAS, GQS, and HSSS were 1 (0-3), 2 (0-4), and 1.5 (0-11), respectively. The mean GQS and JAMAS of videos uploaded by academic centres was higher than those uploaded by commercial centres and urologists (p = 0.01; p = 0.01, respectively). The mean HSSS was lower in the videos uploaded in the last 5 years, while JAMAS was higher (p = 0.03, p = 0.005, respectively). The mean GQS and HSSS of videos with higher likes were found statistically significantly higher (p = 0.01; p = 0.02, respectively). Conclusions: HoLEP videos on YouTube are not adequate to obtain proper information about the surgery. Videos uploaded by academic centres and in recent years provide more valid information for patients and urologists. To increase the value of information, online materials need to be checked, for patients to access accurate, reliable, and appropriate healthcare information.Öğe Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations(Korean Society for Sexual Medicine and Andrology, 2023) Shah, Rupin; Agarwal, Ashok; Kavoussi, Parviz; Rambhatla, Amarnath; Saleh, Ramadan; Söğütdelen, EmrullahPurpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological As-sociation [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/ uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the re-sponses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identi-fied where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male in-fertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical prac-tice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.Öğe Controversy and consensus on indications for sperm DNA fragmentation testing in male infertility: A global survey, current guidelines, and expert recommendations(Korean Society for Sexual Medicine and Andrology, 2023) Agarwal, Ashok; Farkouh, Ala'a; Saleh, Ramadan; Hamoda, Taha Abo-Almagd Abdel-Meguid; Harraz, Ahmed M.; Söğütdelen, EmrullahPurpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associ-ated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant pro-fessional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clini-cal practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indi-cations for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recur-rent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demon-strates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.Öğe Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations(Korean Society for Sexual Medicine and Andrology, 2023) Farkouh, Ala'a; Agarwal, Ashok; Hamoda, Taha Abo-Almagd Abdel-Meguid; Kavoussi, Parviz; Saleh, Ramadan; Söğütdelen, EmrullahPurpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproduc-tive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clini-cians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formu-lated and adapted using the Delphi method.Results: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unex-plained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respon-dents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical vari-cocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated.Conclusions: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.Öğe Effect of varicocele repair on conventional sperm parameters in infertile patients with clinical varicocele: A systematic review and metaanalysis(Elseiver Science Inc, 2022) Agarwal, Ashok; Cannarella, Rossella; Saleh, Ramadan; Boitrelle, Florence; Hamoda, Taha Abdel-Meguid; Söğütdelen, EmrullahEffect of varicocele repair on conventional sperm parameters in infertile patients with clinical varicocele: A systematic review and metaanalysisÖğe Efficacy of intravesical cocktail therapy with or without dimethyl sulphoxide in interstitial cystitis(Polish Urological Assoc, 2022) Söğütdelen, Emrullah; Çıtamak, BurakIntroduction Interstitial cystitis (IC) is a chronic bladder inflammation with unknown etiologies that impairs the quality of life of patients. We aimed to investigate the efficacy of dimethyl sulphoxide (DMSO) use in the cocktail therapy in IC patients. Material and methods Patients treated with intravesical cocktail therapy which contained a mixture of 10 mL of bupivacaine, 1 mL of heparin, and 9 mL of sodium bicarbonate, was introduced to Group 1, and, 25 mL of DMSO was added to this cocktail and introduced to Group 2. Statistical analyses between groups were assessed by Turkish validated O'Leary Sant score composed of IC Symptom Index (ICSI) and IC Problem Index (ICPI), visual analog scale (VAS) score, and short form-36 (SF-36) questionnaire in the baseline versus post-instillation week 6, month 6, and month 12, comparatively.Results A total of 62 patients (58 women and 4 men) with a median age of 52 (28-76) years were included. Baseline versus post-instillation 6th week of ICSI and ICPI scores were 15 +/- 3.4 vs 7.4 +/- 2.9 and 12.6 +/- 2.8 vs 6.1 +/- 2.7, respectively (p <0.001 and <0.001, respectively). VAS scores of Group 2 were statistically significantly lower than that of Group 1 in the post-instillation month 6 (p = 0.03) whereas, the baseline of VAS scores were similar.Conclusions Intravesical cocktail therapy is an effective and reliable treatment method and can be safely applied with or without DMSO. Adding DMSO to cocktail therapy provides a further decrease in VAS score in the post-instillation month 6.Öğe Evaluating the effects of subnormothermic perfusion with AP39 in a novel blood-free model of ex vivo kidney preservation and reperfusio(MDPI, 2021) Juriasingani, Smriti; Jackson, Ashley; Zhang, Max Yulin; Ruthirakanthan, Aushanth; Dugbartey, George J.; Söğütdelen, EmrullahThe use of blood for normothermic and subnormothermic kidney preservation hinders the translation of these approaches and promising therapeutics. This study evaluates whether adding hydrogen sulfide donor AP39 to Hemopure, a blood substitute, during subnormothermic perfusion improves kidney outcomes. After 30 min of renal pedicle clamping, porcine kidneys were treated to 4 h of static cold storage (SCS-4 degrees C) or subnormothermic perfusion at 21 degrees C with Hemopure (H-21 degrees C), Hemopure + 200 nM AP39 (H200nM-21 degrees C) or Hemopure + 1 mu M AP39 (H1 mu M-21 degrees C). Then, kidneys were reperfused with Hemopure at 37 degrees C for 4 h with metabolic support. Perfusate composition, tissue oxygenation, urinalysis and histopathology were analyzed. During preservation, the H200nM-21 degrees C group exhibited significantly higher urine output than the other groups and significantly higher tissue oxygenation than the H1 mu M-21 degrees C group at 1 h and 2h. During reperfusion, the H200nM-21 degrees C group exhibited significantly higher urine output and lower urine protein than the other groups. Additionally, the H200nM-21 degrees C group exhibited higher perfusate pO(2) levels than the other groups and significantly lower apoptotic injury than the H-21 degrees C and the H1 mu M-21 degrees C groups. Thus, subnormothermic perfusion at 21 degrees C with Hemopure + 200 nM AP39 improves renal outcomes. Additionally, our novel blood-free model of ex vivo kidney preservation and reperfusion could be useful for studying other therapeutics.Öğe Impact of varicocele repair on semen parameters in infertile men: A systematic review and meta-analysis(Korean Society for Sexual Medicine and Andrology, 2022) Agarwal, Ashok; Cannarella, Rossella; Saleh, Ramadan; Boitrelle, Florence; Gül, Murat; Söğütdelen, EmrullahPurpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls.Materials and Methods: A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies).Results: A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I2=97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I2=97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I2=98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I2=97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I2=98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI-0.242 to 0.868; I2=89.7%).Conclusions: This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies' practice recommendations favoring VR to improve conventional semen parameters in infertile men.Öğe The impact of varicocele repairon conventional semen paramaeters in infertile men: A meta-analysis using pre- and post-operative data(Elsevier Science Inc, 2022) Agarwal, Ashok; Cannarella, Rossella; Shah, Rupin; Boitrelle, Florence; Gül, Murat; Söğütdelen, EmrullahThe impact of varicocele repairon conventional semen paramaeters in infertile men: A meta-analysis using pre- and post-operative dataÖğe Is an academic title an aim or a device? Publication productivity of urologists in Turkiye(Galenos Publ House, 2022) Söğütdelen, Emrullah; Akın, GüvenAs it is known, producing a scientific publication requires a long effort and endeavor. Scientific researches play a key role not only in the contribution of individuals at the academic level but also contribute to the development of countries. This study is a unique study to evaluate publication productivity of urologists by comparative analysis of parameters affecting the quality of publications in Turkiye for the first time. This bibliometric study showed that the number and quality of publications of urologists in Turkiye are very low. Relatively younger and at the beginning of their academic level and also tertiary care physicians publish more and receive more citations for their publications.Öğe Is extraperitoneal approach in radical cystectomy really effective on bowel recovery? A comperative analysis of extraperitoneal versus transperitoneal approach(Galenos Publ House, 2022) Güner, Ekrem; Söğütdelen, Emrullah; Şeker, Kamil Gökhan; Özdemir, OsmanObjective: Radical cystectomy with extended pelvic lymph node (LN) dissection is a gold standard surgical treatment for muscle-invasive bladder cancer which is a common urological malignancy in elderly people. Despite common surgical technique is a transperitoneal approach, we aimed to analyze the benefit of extraperitoneal approach radical cystectomy in the gastrointestinal system.Materials and Methods: We retrospectively analyzed a total number of 110 (52 intraperitoneal and 58 extraperitoneal) radical cystectomy patients operated extraperitoneal or transperitoneal by 2 expert urologists between January 2016 to December 2019 in this study. All operated patients had indications for radical cystectomy and extended LN dissection and Wallace type ileal loop were performed adding to the operations. Patients have available data were included in this study and complications were assessed by Clavien-Dindo classification system.Results: The median age of a total number of 110 patients was 66 (minimum: 43 -maximum: 82) years. There were no differences between groups in terms of surgical region infection, urinary leakage, ileus treated surgically, and emergency admission after discharge of patients. Twenty-four (46.1%) patients in the transperitoneal group needed for erythrocyte transfusion whereas, 16 (27.5%) patients in the extraperitoneal approach group (p=0.04). Additionally, 13 (19.2%) patients in the transperitoneal group had ileus treated conservatively, whereas, 8 (13.7%) patients in the extraperitoneal approach group (p=0.02).Conclusion: Extraperitoneal approach and retroperitonealization of an ileal loop in radical cystectomy are safe and effective on oncological surgical principles. It may also provide better gastrointestinal motility after surgery.Öğe Is low-risk prostate cancer really low-risk? Consider factors affecting biochemical recurrence and tumour upgrade(Coll Physicians & Surgeons Pakistan, 2023) Söğütdelen, Emrullah; Çıtamak, BurakObjective: To evaluate the demographics, preoperative or pathological factors, and findings of magnetic resonance imaging (MRI) to predict the factors affecting biochemical recurrence and tumour upgrade in low-risk prostate cancer. Study Design: A descriptive study. Methodology: The data of 135 patients, who underwent radical prostatectomy for low-risk prostate cancer according to prostate-specific antigen (PSA) level, biopsy result and clinical stage, were analysed. Preoperative clinicopathological factors, MRI findings, and the final pathological results were analysed. Prognostic factors affecting the biochemical recurrence in the follow-up and tumour upgrade in the final pathology according to the International Society of Urological Pathology (ISUP) were evaluated. Results: Mean age and preoperative PSA level were 61.37 +/- 5.53 (46-74) years and 6.74 +/- 1.97 (range 1.88-9.9) ng/dL, respectively. Multivariate analysis showed that the prostate volume and diameter of lesions were statistically significant in the patients with ISUP upgrade (p=0.006, p=0.025, respectively), and surgical margin positivity in the final pathology specimen was statistically significant for biochemical recurrence (p=0.016). Logistic regression analysis revealed that prostate volume and diameter of the lesion in MRI were independent predictors of ISUP score upgrade. Receiver operating characteristic (ROC) curve analysis showed that tumour size on the MRI had 49.4% sensitivity and 77.8% specificity at 10 mm (AUC:0.634, p=0.009 for predicting). Conclusion: Lower prostate volume, higher diameter of lesions in multiparametric MRI and surgical margin positivity were associated factors affecting the ISUP score upgrade and biochemical recurrence. Therefore, patients should be evaluated preoperatively and patient-based factors should be considered in the choice of a treatment plan.Öğe KEEP IN MIND OTHER CAUSES THAN INTRINSIC SPHINCTER DYSFUNCTION IN POST-PROSTATECTOMY INCONTINENCE(2023) Yildiz, Hüseyin Alperen; Söğütdelen, EmrullahObjective: This study aims to determine the causes of urinary incontinence and accompanying bladder pathologies in patients with persistent incontinence 12 months after radical prostatectomy. Methods: Thirty-four patients who underwent open radical retropubic prostatectomy (RRP) due to localized prostate cancer and incontinent after surgery between January 2015 and December 2020 and underwent urodynamic study (UDS) were retrospectively reviewed. All UDSs were performed according to the ICS protocol of good urodynamic practice and assessed by the same doctor. Patients were assessed by demographic and clinical parameters including age, body mass index (BMI), comorbidity, preoperative PSA level, prostate volume (PV), transrectal prostate biopsy Gleason score, clinical stage, pathological ISUP grade, pathological stage, lymph node positivity, international consultation on incontinence questionnaire-short form and subjective questionnaire for daily pad use. Results: Urodynamic studies showed that 29 patients (85.2%) had intrinsic sphincter deficiency (ISD). Nine (26.4%) of 29 patients with ISD had a secondary diagnosis of overactive bladder (OAB), impaired detrusor contractility (IDC) and OAB+IDC 9 (11.6%), 4 (11.6%), 1 (2.9%), respectively. Nineteen patients (55.8%) had a sole diagnosis of ISD, whereas 15 patients (44.1%) had another primary diagnosis or a secondary diagnosis other than ISD. Conclusion: Although ISD is the most common cause of persistent urinary incontinence in patients after radical prostatectomy, it should be taken into account that overactive bladder and impaired detrusor contractility are also accompanied by a significant proportion of patients.Öğe Patterns of expression of h2s-producing enzyme in human renal cell carcinoma specimens: Potential avenue for future therapeutics(Int Inst Anticancer Research, 2020) Söğütdelen, Emrullah; Pacoli, Katharine; Juriasingani, Smriti; Akbari, Masoud; Gabril, Manal; Şener, AlpBackground: Renal cell carcinoma (RCC) is the most common cancer of the kidney. The most common histotype is clear-cell (cc) RCC. Hydrogen sulfide (H2S) is an angiogenic and anti-apoptotic gasotransmitter that is elevated under pseudohypoxic conditions. H2S is endogenously produced by three enzymes: Cystathionine gamma-lyase (CSE), cystathionine beta-synthase (CBS), and 3-mercaptopyruvate sulfurtransferase (MPST). Seeing as increased expression of these enzymes has been observed in other human cancer types, this study aimed to quantify H2S-producing enzyme expression in human RCC samples and evaluate whether it correlated with clinical outcomes. Patients and Methods: Eighty-eight human kidney tissue specimens, with healthy and cancerous tissue components, were immunohistochemically stained for CSE, CBS, and MPST. The mean pixel intensity of positively stained areas was quantified. A retrospective analysis was conducted to obtain patient demographics, rates of metastasis/recurrence, and prognostic characteristics. Statistical correlations between enzyme expressions and subsequent patient outcomes were evaluated. Results: There was significantly greater expression of CSE, CBS, and MPST in cc-RCC compared to paired healthy tissue (p<0.0001). The difference in expression of CSE in cancerous versus normal tissue was significantly greater than that for CBS and MPST (p<0.000I and p<0.01, respectively). Enzyme expression patterns in cancerous versus normal tissue did not correlate with nuclear grade, stage, histological type or cancer recurrence/metastasis. Conclusion: To our knowledge, this is the first report of the differential increase in expression of CSE, CBS, and MPST in human RCC. Although these patterns do not appear to correlate with cancer recurrence, metastasis, size or nuclear grade, their differential increase suggests a potential therapeutic target.Öğe Portal hypertension secondary to benign prostatic hyperplasia(Galenos Yayıncılık, 2022) Küçükyangöz, Mustafa; Söğütdelen, Emrullah; Gücük, Sebahat; Gücük, AdnanBenign prostatic hyperplasia (BPH) obstructs the bladder outlet. Patients with BPH frequently present with lower urinary tract symptoms. However, patients with BPH can present with serious fatal complications unless diagnosed and treated sufficiently. In this case report, we present the case of a 63-year-old male patient with renal insufficiency, generalized edema, and portal hypertension due to chronic obstructive uropathy secondary to BPH. To the best of our knowledge, this is the first report to present portal hypertension secondary to BPH as a rare complication.Öğe Publication Status of Urology Theses in Turkey(2022) Söğütdelen, Emrullah; Küçükyangöz, MustafaObjective: Production of a thesis during residency requires a great deal of dedication and effort. It is an honor to share the results of this effort with everyone when the thesis is published. In this study, we aimed to investigate the factors affecting the publication of a thesis in the field of urology. Methods: Theses completed between 2014 and 2018 were searched in the Institution of Higher Education Thesis Center. Keywords, title, and authors on the thesis were searched in the PubMed and Google Scholar databases. Journal tags were categorized according to whether they are indexed in Medline or not. Publication status was analyzed with the subject of the thesis, the year of thesis was completed, hospital where urology residents graduated, and the current workplace of the urologists. Results: Three hundred and fifty-three theses were analyzed in this study. The number of theses that were published in index journals and non-index journals was 65 (18.4) and 15 (4.2%), respectively. The median citation for published theses was 2 (0-21). The subject of the thesis, time passed after the thesis, and the current workplace of urologist was found to be statistically significant in the publication status of the theses (p<0.001, p= 0.02, p<0.001, respectively). Conclusion: Most of the theses produced by urologists were not published. Published theses received few citations. Theses produced from animal studies and a long period passed over the thesis increase the rate of publication. Urologists whose theses have been published mostly work in tertiary care hospitals.Öğe Re: Huseynov et al.: The Effects of Previous Renal Stone Surgery on Percutaneous Nephrolithotomy Outcomes (Grand J Urol 2021;1:18-21)(2022) Söğütdelen, Emrullah; Küçükyangöz, Mustafa-Öğe Technical aspects and clinical limitations of sperm DNA fragmentation testing in male infertility a global survey, current guidelines, and expert recommendations(Korean Soc Sexual Medicine & Andrology, 2024) Söğütdelen, Emrullah; Agarwal, Ashok; Farkouh, Ala'a; Saleh, Ramadan; Hamoda, Taha Abo-Almagd Abdel-Meguid; Salvio, GianmariaPurpose: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the exami-nation and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. Materials and Methods: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current profes-sional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. Results: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuri-dine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely in-fluenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respon-dents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). Conclusions: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers en-countered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory inter-pretation of SDF testing are crucial.
