Kadir Bocu

Scopus Publications

Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
Ala’a Farkouh, Ashok Agarwal, Taha Abo-Almagd Abdel-Meguid Hamoda, Parviz Kavoussi, Ramadan Saleh, Armand Zini, Mohamed Arafa, Ahmed M. Harraz, Murat Gul, Vilvapathy Senguttuvan Karthikeyan,et al.
XMLink
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.

Prognostic role of the endothelial cell-specific molecule-1 histopathologic expression in renal cell cancer
Kadir Bocu, Ali Furkan Batur, Zeliha Esin Celik, Murat Gül, Emre Altıntas, Mehmet Kaynar, Ozcan Kılıç, Murat Akand, Sumeyye Nur Tataroglu, and Serdar Goktas
Elsevier BV

Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
Ashok Agarwal, Ala’a Farkouh, Ramadan Saleh, Taha Abo-Almagd Abdel-Meguid Hamoda, Gianmaria Salvio, Florence Boitrelle, Ahmed M. Harraz, Ramy Abou Ghayda, Parviz Kavoussi, Murat Gül,et al.
XMLink
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.

Current and emerging treatment options for premature ejaculation
Murat Gul, Kadir Bocu, and Ege Can Serefoglu
Springer Science and Business Media LLC

Correlation between Twitter mentions and academic citations in sexual medicine journals
Mehmet Serkan Ozkent, Kadir Böcü, Emre Altintas, and Murat Gul
Springer Science and Business Media LLC

Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations
Rupin Shah, Ashok Agarwal, Parviz Kavoussi, Amarnath Rambhatla, Ramadan Saleh, Rossella Cannarella, Ahmed M. Harraz, Florence Boitrelle, Shinnosuke Kuroda, Taha Abo-Almagd Abdel-Meguid Hamoda,et al.
Korean Society for Sexual Medicine and Andrology
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.

Seasonal fluctuation of erectile dysfunction: A cross-sectional study from a tertiary university hospital across 10 years
Murat Gul, Ali Furkan Batur, Kadir Böcü, Mehmet Kaynar, Ozcan Kilic, and Serdar Göktaş
Hindawi Limited
Erectile dysfunction (ED) shares several risk factors with diabetes mellitus (DM), hypertension (HT) and coronary vascular disease (CVD), which were well‐associated with seasonal fluctuation with the highest peak in winter. In this study, we aimed to determine whether ED demonstrates seasonal fluctuations with the above‐mentioned systemic diseases. Database from a tertiary university hospital between 2010 and 2020 was deciphered to retrieve patients diagnosed with ED. Patients with primary bladder tumour and post‐procedural ED constituted the negative control groups from the same study period. International index of erectile function questionnaire (IIEF‐15) was used to segregate included patients into mild/moderate and severe ED groups. The probability of detecting DM, HT and CVD in patients with severe ED was significantly higher than that of with mild/moderate ED (p < 0.05). More ED symptoms emerged and were diagnosed in the winter seasons even though no statistical significance was observed between patients with mild/moderate and severe ED (p = 0.946, Cramer's V coefficient = 0.19). The seasonal variation of patients with bladder tumour and post‐procedural ED groups showed no significant difference (p > 0.05, both). ED admissions are associated with higher peaks in the winter seasons. This may help in daily clinical practice to warrant better clinical and epidemiological interpretation of ED.

First experience with a new form of orthotopic ileal neobladder (Leuven n-pouch) following radical cystectomy
Murat Akand, , Ozkan Kilic, Kadir Bocu, Ismail Harmankaya, Muhammed Furkan Aydogan, , , , and
AVES YAYINCILIK A.Ş.
Bladder cancer is the most common malignancy of the urinary tract. Radical cystectomy with pelvic lymph node dissection and a urinary diversion (UD) is the gold standard treatment of non-metastatic muscle-invasive bladder cancer (MIBC). Although ileal conduit is the standard and most commonly performed type of UD, more number of centers have recently started to perform orthotopic ileal neobladder (OIN). A novel OIN has been described in 2005 as the so-called "Leuven N-pouch", which combines the features of the commonly used Hautmann and Studer neobladders. Herein, we report our first experience with a case of Leuven N-pouch in our department, which was performed for a male patient with MIBC.

Kadir Bocu

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Scopus Publications