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Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations. Materials and Methods:Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 coun-tries were analyzed descriptively, with a Delphi process used for expert recommendations. Results:Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoosper-mia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differ-entiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate. Conclusions:Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.

Purpose: 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 examination 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 professional 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 deoxyuridine 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 influenced 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 respondents 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 encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial.

Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive 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 clinicians, 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 formulated 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 unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, 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.

Purpose: 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 associated 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 professional 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 clinical 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 indications 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. Recurrent 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 demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.

Purpose: 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 Association [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 responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

Purpose The aim of this study was to investigate the clinical manifestations of overactive bladder (OAB) with migraine as a comorbidity and to shed light on possible new treatment strategies. Methods This study included patients aged 18 years and older who were admitted to urology and neurology outpatient clinics between March 1, 2019 and March 1, 2020 for OAB and migraine. The study questionnaire contained 3 sections: (1) questions on demographic characteristics, (2) a migraine ID test, and (3) the Overactive Bladder Inquiry Form - V8 (OAB-V8) form. Results A total of 265 patients participated in the study. The average age of the participants was 39.75±11.93 years. The patients were divided into 3 groups according to the coexistence of OAB with migraine: group 1, OAB(+)/migraine(+); group 2, OAB(+)/migraine(-); and group 3, OAB(-)/migraine(+). The mean OAB-V8 score was 22.82 ±8.15 in group 1 and 25.64±7.49 in group 2. The mean OAB-V8 score of OAB patients with migraine as a comorbidity was statistically significantly lower than that of OAB patients without migraine (P=0.015). The median visual analogue scale (VAS) score was 7.11 (range, 2–10) in group 1 and 5.95 (range, 2–10) in group 3. This finding indicates that in patients with migraine, having OAB was associated with significantly higher VAS scores (P

Purpose In this study, we aimed to determine the prevalence of lower urinary tract symptoms (LUTS) in patients with Behçet disease (BD) and to investigate the relationship between the severity of BD and LUTS. Methods Fifty-five patients with BD were included in this study from January to December 2018. All patients received a detailed urological evaluation. Additionally, BD activity was investigated using the Behçet Disease Current Activation Form. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Short Form, 8-item overactive bladder questionnaire forms, uroflowmetry, and postvoid residual urine volume were evaluated. Results The mean age of the patients was 42.6 years. The mean activity score of BD was 4.6±3.2 and the mean IPSS score was 7.3±7.3. Sex had no significant effect on the BD activity score. The BD activity score was significantly correlated with the IPSS score, frequency of daytime urination, nocturia, and urgency. It was also correlated with the presence and the severity of urinary incontinence and the effect of urinary incontinence on daily life. Peak flow rate, voided volume, and the postvoid residual urine volume were not correlated with the BD activity score. Conclusions LUTS were highly prevalent in patients with BD, and the severity and current activity of BD were correlated with frequency, nocturia, urgency, and urinary incontinence. Therefore, a urological evaluation of patients with BD in whom the activity and severity of the disease is elevated should be carried out comprehensively and patients should be managed accordingly.

OBJECTIVES: This study aims to determine the factors that would lead the doctors in EDs to a more the accurate diagnosis of urinary tract infection (UTI) and the correct initiation of empirical antibiotherapy in the emergency room and reduce the use of unnecessary antibiotherapy. METHODS: This study is a prospective observational study from a single-center, investigating patients with an age of 18 years and older who presented to the emergency department (ED) with the symptoms of UTI between January and May 2018. The guiding parameters to establish a UTI diagnosis and start an empirical antibiotherapy were investigated between the negative (Group 1) and positive (>103 colonies) (Group 2) groups, as a result of urine culture in terms of urine culture. RESULTS: Our study included a total of 108 patients (59 women and 49 men). The average age was 47.11 ± 14.97. Age and gender were similar among the groups and not a discriminating factor in the diagnosis of UTI. High Charlson Comorbidity Index score, history of chronic kidney failure and cerebrovascular disease, leukocyte esterase, nitrite positivity, and leukocyte cluster presence were higher in Group 2. We suggest that these parameters might be predictive values to detect bacterial growth in urine culture. Empirical antibiotherapy was started in 48.4% of the patients in Group 1 and 95.7% of the patients in Group 2. CONCLUSIONS: In EDs, admission complaints of the patients and physical examination findings do not always result in the diagnosis of UTI. Our study showed that UTI diagnosis could be made more accurately using leukocyte esterase, nitrite positivity, the presence of leukocyte clusters, and the Charlson Comorbidity Index score. We also suggest that regional antibiotic resistance should be considered before starting empirical antibiotherapy.

Penetrating injuries are caused by the injury of perineal area with gun or stab wounds, which may cause complex injuries or multiple organ injuries. Infections, bleeding, necrotizing fasciitis, ureterocutaneous fistulas, diverticulum, abscesses, narrowing, and incontinence may arise after urethral injuries. Although there are several case reports of urogenital system traumas in the literature, this case reports a schizophrenic patient who had a multisystem genitourinary and rectal trauma after self-detonation of an explosive in the rectum and managed with reconstructive surgery without any postoperative complications. Lower urinary tract anatomy was preserved and full continence was achieved after the surgical procedure.

Objective: Many complications after prostate biopsy (PB) have been reported. One of the possible complication after PB is erectile dysfunction (ED). In this study, we showed the early (1 month after PB) effect of PB on erectile function. Materials and Methods: A total of 207 men who underwent PB between April 2021 and October 2021 were evaluated. Before and 1 month after PB, all patients were evaluated with the IIEF-5 (5-item version of the International Index of Erectile Function) prospectively. Patient data such as age, body mass index, prostate-specific antigen levels, prostate volume, periprostatic local anesthesia, pathological results, and post-biopsy complications were noted. Results: The mean IIEF-5 score was 13.3 (5-25) before PB. One month after the biopsy it was 13.5 (5-25). There were no differences between the before and after PB IIEF scores. The only significant change was observed in the prostate cancer (PCa) group. Conclusion: In past studies, it has been shown that ED after prostate biopsy is mostly seen at the first month and improves after that. In our study, PB did not affect erectile function. Only the PCa-diagnosed group showed a significant decrease in erectile function, and this effect was not attributed to prostate biopsy.

Objective: To compare fluoroscopy-free retrograde intrarenal surgery (RIRS) with routine RIRS with fluoroscopy for urolithiasis treatment in terms of efficacy and safety. Prospective quasi-experimental study. Hitit University Çorum Erol Olçok Training and Research Hospital, Department of Urology, Çorum, Turkiye August 2019-2020. Materials and Methods: Pre-operative and postoperative data for 98 patients who underwent RIRS using fluoroscopy and 100 patients who underwent RIRS without fluoroscopy were prospectively assessed. Patients who did not provide preoperative consent, were pregnant, or had a clotting disorder, active urinary system infection, or anatomic abnormalities such as ectopic kidney were excluded from the study. In the technique without fluoroscopy, the fluoroscopic device was ready for use in surgery; however, all manipulations were performed by all-seeing access without fluoroscopy. Patients beginning without fluoroscopy who required fluoroscopy were not included in the study. Results: The mean stone size was 18.5±2.31 (5-30) mm (in the fluoroscopy group 17.2±25.3 mm, in the non-fluoroscopy group 19.8±20.9). Stone-free rates were similar between the groups (91% in the fluoroscopy group and 90% in the non-fluoroscopy group) (p=0.683). The mean duration of fluoroscopy use in the fluoroscopy group was 8.76±9.50 s. A Clavien 3b complication (perirenal hematoma) was observed in one patient (in the fluoroscopy group), which regressed with observation. Minor complications were observed in both groups: fever in 7 patients (3.6%), hematuria in 7 patients (3.6%), and steinstrasse in 1 patient (0.5%). Conclusion: Fluoroscopy-free RIRS may be applied effectively and safely by endourologists for patients with urolithiasis, similar to the routine method with fluoroscopy.

Objective:Recent findings implicate a higher prevalence of erectile dysfunction (ED) among men with sleep disorders. We investigated sleep quality among men with ED.Materials and Methods:A prospective study was conducted at 12 different andrology outpatient clinics among men with complaints of insufficient erections. The subjective quality of sleep was measured using the Pittsburgh Sleep Quality Inventory. Erectile function and its dimensions were measured using the International Index of Erectile Function (IIEF) questionnaire. The age-adjusted Charlson comorbidity index and Beck Depression Inventory were used to evaluate interrelations with comorbid disease severity and depression of the subjects consecutively in the study.Results:Among 431 eligible men, the median age of the participants and their erectile function scores in the IIEF were 51 [interquartile range (IQR)=43-59] and 16 (IQR=11-19), respectively. Poor sleep was observed in 192 of 431 (44.5%) subjects. Multivariable analysis revealed that younger age [odds ratio (OR)=0.95, p=0.01], lower body mass (OR=0.86, p=0.01), lower serum high-density lipoprotein cholesterol (OR=0.95, p=0.02), and higher severity of depression (OR=2.1, p=0.0001) were predictors of poor sleep quality among men with ED.Conclusion:Nearly half of the men with ED also suffer from poor sleep. Younger age, lean body mass, and severe depression were the main predictors of poor sleep quality among ED sufferers.

Abstract Background To assess the learning curve in laparoscopic radical prostatectomy (LRP) performed by a single surgeon who had a healthcare career as a surgical first assistant for 2 years in high-volume centers treating > 150 cases per year. Methods The records of 80 LRP cases performed between October 2017 and August 2018 by a single surgeon were consecutively divided into four groups (groups A = first 20 cases, B = second 20 cases, C = third 20 cases, and D = last 20 cases). The groups were compared in terms of surgical and functional outcomes with a minimum follow-up of 6 months. Results Clinical and surgical stages of the four groups were similar between groups. The operative time (126.8 ± 5.48 min; P = 0.001) and time of removal of the drain (1.65 ± 0.93 days; P = 0.029) were significantly lower in group D; however, hospitalization, catheterization time, and blood loss were similar between groups. The complication rate was low. No patient had a visceral injury, and there were no procedures needed to open conversion. The positive surgical margin (PSM) rates were similar between groups. In terms of continence and potency, all groups were similar at the 6th-month follow-up after surgery. Conclusions Our results showed that prior experience in laparoscopic surgery as a surgical first assistant in a high-volume center improves the learning curve and oncological and functional outcomes, and helps to minimize the complication rate

Objective:Non-muscle invasive bladder cancer (NMIBC) accounts for 75% of all bladder cancer cases. Several models to predict relapses and progression have been developed. We aimed to determine the predictive value of the neutrophil-lymphocyte ratio (NLR) for recurrence and/or progression of the disease.Materials and Methods:Seventy patients with high-risk NMIBC according to the European Organization for Research and Treatment of Cancer (EORTC) risk classification who were receiving Bacillus Calmette-Guerin (BCG) treatment and were followed up at our clinic were included in the study.Results:The average score level and NLR values differed significantly on patient classification according to the EORTC Progression and Recurrence Risk score. The positive correlations among EORTC Recurrence score, EORTC Progression score, Club Urológico Espanol de Tratamiento Oncológico (CUETO) Recurrence score, and CUETO Progression score and NLR values were not statistically significant. The NLR values decreased significantly on follow-ups on BCG treatment.Conclusion:Patients with bladder cancer have a high NLR, which has predictive utility with regard to prognosis. A decrease in NLR with BCG treatment is indicative of the decreased likelihood of recurrence and progression.

Purpose: The main objective of this study was to reveal the relationship between lower urinary tract symptoms (LUTS) and post-void residual (PVR) urine volume. Materials and Methods: Between October 2014 and February 2015, older than 40 years patients were included in this study. Volunteers filled out a questionnaire consisted of demographic characteristics, comorbidities, medications, history of surgery and LUTS. Volunteers were undergone PVR measurement with transabdominal ultrasonography. The relationship between symptoms, demographic characteristics and PVR were analyzed. Results: A total of 939 patients (756 men and 183 women) were enrolled in this study. There was a positive correlation between the sensation of incomplete bladder emptying and PVR volume in all age groups of women (p=0.0001). However such a relationship was found only over the age of 60 in the subgroup analysis of men (p=0.001). PVR volume increased in men by age (0.65 mL per year of age, p=0.011). In men, voiding symptoms and urgency were associated with a high PVR volume. In women, storage and voiding symptoms (except slow stream and terminal dribble) did not correlate with PVR volume. Conclusions: Our study showed that all men over the age of 60 years and all women with the complaint of feeling of incomplete emptying should undergone PVR measurement. Women with the complaint of poor stream and men mainly with voiding symptoms are other candidates in whom PVR measurement would be considered as an important tool in the clinical management and follow-up.

Vesicouterine fistulae (VUFs) are the least common type of urogenital fistulae and they are usually associated with lower segment caesarean section. The classic triad of VUF has been defined as urinary incontinence, amenorrhea, and cyclic hematuria. In the literature, spontaneous VUF without a history of previous surgery or radiotherapy has not been reported before. In this report, we present a female patient who presented with continuous urinary incontinence and was diagnosed with VUF. The patient was managed with cystectomy and hysterectomy and ileal conduit diversion. To our knowledge, this is the only reported case of spontaneous VUF.