Ekrem GUNER

Dear colleagues,
I am honored to share with you the second issue of 2022 of the Grand Journal of Urology (Grand J Urol) with the
contributions of many respected researchers and authors.
Our journal has been abstracted/indexed in J-Gate, Index Copernicus International ICI World of Journals, EuroPub,
SciLit, ResearchGate, ScienceGate and Google Scholar international databases. As of these achievements, the Grand
Journal of Urology (GJU) has taken its place among the journals indexed by international databases.
Grand Journal of Urology (GJU) aims to carry written and visual scientific urology studies to academic platforms and to
make significant contributions to the science of urology.
In this issue of our journal, there are many valuable articles under the subheadings of Andrology, General Urology,
Laparoscopic and Robotic Surgery, Pediatric Urology, Renal Transplantation and Urological Oncology. I hope that these
carefully prepared articles will make important contributions to valuable readers, researchers and the urology literature.
On this occasion, I would like to express my heartfelt gratitude to our authors who have contributed to our journal with
their articles, to our reviewers who have meticulously evaluate the articles.
Respectfully yours
May 2022
Assoc. Prof. Ekrem GUNER, MD
Editor-in-Chief
Ibrahim Guven Kartal, Okan Alkıs, Mehmet Sevim, et al.

Clinical stage cT3N0M0 prostate cancer is defined within
the high-risk prostate cancer group in the European Association
of Urology (EAU) and American Urological Association (AUA)
guidelines []. External beam radiotherapy (EBRT), radical
prostatectomy (RP), brachytherapy, focal treatment methods,
androgen deprivation therapy (ADT), or combinations of these
schemes constitute high-risk prostate cancer treatment protocols
[,]. However, discussions remain for the treatment methods to
be applied in high-risk prostate cancer. Clinical stage T3N0M0
prostate cancer can be defined as the most localized group
within the definition of high-risk prostate cancer. Therefore, it
can be suggested that this group would benefit most from local
treatments.
RP is increasingly preferred in the treatment of high-risk
prostate cancer. Although there are no consistent results in the
literature, still some studies have reported serious advantages
of RP in cancer-specific survival []. It has been suggested
that surgery can be used as a monotherapy, as well as to avoid
potential side effects of ADT and EBRT []. In our study we
aimed to evaluate the impact of RP and extended pelvic lymph
node dissection on the course of the disease in terms of its
oncological outcomes and quality of life in the treatment of
cT3N0M0 stage cancers with the hypothesis of whether we can
be protected from the side effects of systemic treatments.
Bekir Voyvoda, Nuray Voyvoda, Omur Memik, et al.

Renal transplantation is the best option for the treatment
of end-stage renal disease []. Renal transplantation can be
performed from a deceased or a living donor. Since the number
of organ donations after brain death is insufficient in our country,
the number of renal transplantations from living donors is higher
[].
Predonation evaluation of the living donor is important both
in predicting the recipient"s graft function and the kidney damage
that may develop in the donor over the years after nephrectomy
[].
Systematic evaluation is of importance in the selection
of an eligible donor prior to transplantation. Not only kidney
functions but also other concomitant organ pathologies which
affect the decision-making process are assessed. During the
preparation estimated glomerular filtration rate (eGFR), 24-hour
urine creatinine clearance (CrCl), 24-hour urine proteinuria, and
microalbuminuria are used to determine kidney functions and/
or damage [].
Split renal function (SRF) demonstrates the performance
distribution of each kidney, and usually the less functional
kidney is selected for transplantation. Scintigraphic techniques
performed using Tc-99m diethylenetriamine pentaacetic acid
(DTPA), dimercaptosuccinic acid (DMSA) or mercapto-acetyltriglycine
(MAG-3) is being performed as gold standards for the
scintigraphic evaluation of split renal functions [].
Computed tomography is currently used as a noninvasive
test that has replaced digital subtraction angiography for
preoperative evaluation of the vascular structures of the donor
candidate []. Morphological evaluation can be made, and also
vascular variations can be demonstrated by CT. The fact that
volumetric calculations can also be made by CT suggests that
CT may replace scintigraphy for the evaluation of the SRF [].
The primary aim of this study was to evaluate whether CT
can replace scintigraphy for demonstrating split renal function,
while the secondary aim was to determine the agreement
between different CT volumetric measurement methods so as to
demonstrate SRF.
Esen Yildirim Demirdogen, Saban Oguz Demirdogen, Gulsum Yitik Tonkaz, et al.

Enuresis nocturna (EN) is defined as the recurrent lack
of urinary control during night sleep for at least 2 times a
week during 3 months []. EN is classified in two separate
categories as simple (monosymptomatic) and complicated
(polysymptomatic), and also as primary and secondary. While as
lower urinary tract symptoms only enuresis nocturna is seen in
monosymptomatic enuresis nocturna (MEN), lower urinary tract
symptoms such as urgency, frequency, decreased urinary flow
are also seen in polysymptomatic EN. While the child is never
dry since birth in primary EN, there is at least 6 months of dry
period in secondary EN []. Despite methodological variations,
the prevalence of MEN has been reported as 15-20% around
5, 10% around 7, 5% around 10 and less than 1% around 15
years of age []. The etiology of MEN is multifactorial including
genetic factors, waking disorder, nocturnal polyuria, increased
detrusor activity, low urinary bladder capacity at night and
obstructive sleep apnea [-].
Human body is regulated by an endogenous clock that
controls daily rhythms, sleep/wake cycles, behavior, and
physiological functions (melatonin excretion, cortisol levels,
cell replication, etc.). This biological clock is repeated at every
24 hours and is therefore defined as the "circadian" rhythm that
encompasses approximately one day []. The suprachiasmatic
nucleus in the hypothalamus serves as the master pacemaker
that sets the timing of circadian rhythm by regulating neuronal
activity, body temperature and hormonal signals []. Light is
the strongest stimulus in the regulation of circadian rhythm [].
The vast majority of etiological factors of MEN such as the level
of being stimulated during sleep, urine production and urinary
bladder storage are closely related to the circadian rhythm [].
Chronotype, an external marker of circadian rhythm, is defined
as the time when the best mental and bodily performances are
exhibited []. Morning, evening and intermediate chronotypes
have been defined. Morning chronotypes (larks) wake up early
and feel more active during the first part of the day and exhibit
a higher physical and cognitive performance during these hours.
Evening chronotypes (owls) go to bed late and have difficulty
in waking up in the morning and exhibit a better performance
in the afternoon and evening. The most common intermediate
chronotypes show the features of both types [-].
Evening chronotypes are more prone to medical problems
like diabetes mellitus, hypertension, obesity, and asthma [].
Evening chronotypes experience psychiatric problems such
as anxiety, depression and substance abuse more often, and
severely compared to morning chronotypes [,].
MEN, which is among the most common problems in
childhood, is usually self-limited and spontaneously resolves
without sequelae. However, some individuals may have
significant emotional and social problems like poor sense of
self, poor self-esteem, social restriction, and family conflict.
Therefore, it is of great importance to determine the etiologic
factors of MEN and to apply behavioral, psychotherapeutic, and
pharmacologic treatments based on individual assessment. As
the etiology of MEN is enlightened, more effective treatments
may become available.
In the present study, we aimed to evaluate the relationship
between MEN and chronotypes in children.
Taner Kargi, Kamil Gokhan Seker, Abdullah Hizir Yavuzsan, et al.

Radical prostatectomy (RP) is the gold standard treatment
option in cases with organ limited prostate cancer (PCa) with
a life expectancy of more than 10 years. Primary goal of the
operation is complete removal of the tumor. However, it is very
important that the patient maintains its postoperative erectile
function and urinary continence []. Although the oncological
results are positive, there is an increasing interest in minimally
invasive methods due to the higher perioperative complication
rates of open surgery and the negative consequences of
postoperative functional outcomes such as erectile dysfunction
and incontinence []. However, there are randomized controlled
studies showing that the functional results are similar [].
Laparoscopic radical prostatectomy has not been widely used
due to its technical difficulties and long learning curve []. It was
possible to overcome the challenges of the complex laparoscopic
method when Da Vinci robotic system was introduced in that it
enhanced movement ability of the operator"s wrist, eliminated
hand tremors of the surgeon, enabled more sensitive work in a
three-dimensional medium with greater possibility of successful
surgical dissection and anastomosis [,].
Large prostates cause difficulties in treatment. Large
prostates restrict mobilization in the pelvis and may distort the
visual appearance []. However, the stereoscopic visualization,
magnification, and improved ergonomics of robot-assisted
radical prostatectomy (RARP) can reduce the challenges posed
by enlarged prostates with hyperplasic median lobes. However,
RARP was found to be associated with more bleeding and
longer operative times in some studies performed in patients
with a large prostate and especially a voluminous median
lobe, although functional and oncological results were not
significantly different [-].
The aim of this cross-sectional study is to evaluate the effect
of the enlarged median lobe on the surgical, oncological and
functional outcomes of RARP in patients with enlarged median
lobe and PCa in our patient series.
Ugur Aydin, Ender Cem Bulut, Metin Onaran, et al.

Cystic nephroma, first described by Edmunds in 1892, is a
non-hereditary, multicystic usually unilateral benign lesion of the
kidney that does not contain solid components. Histologically, it
contains cysts with flat or cuboidal epithelium and fibrous or
stromal septa. It is generally seen in the first 2 years of life and after
the third decade. The fact that the kidney has great similarities
with other cystic masses, especially cystic renal cell carcinoma,
causes diagnostic difficulties, and uncertainty in determining
the method of treatment. Histopathological examination is the
only way to confirm the diagnosis of multilocular cystic lesion
detected by imaging studies [].
Two cystic masses located side by side in the lower pole of
the left kidney of our patient were successfully treated with the
"open partial nephrectomy" method. In this study, we presented
our case of two cystic lesions in the same kidney, one of which
was reported as renal cell carcinoma and the other as cystic
nephroma and reviewed the relevant literature.
Huseyin Bicer, Ahmet Gur, Cemil Bayraktar, et al.

Splenogonadal fusion (SGF) is one of the very rarely
seen fusion anomalies []. This anomaly occurs during the
splenogonadal convergence that develops between the 5th-8th
weeks of the embryonic life []. SGF was first described by
Bostroem et al. in 1883 []. Its continuous and discontinuous
types were reported in 1956 []. More than 150 cases of SGF
have been reported to date, and only 4 cases have been associated
with malignancy. For this reason, they are generally considered
as benign lesions [,].
In continuous SGF, the spleen tissue is continuous on
the spermatic cord. Although the discontinuous type is less
common, spleen tissue is not observed on the spermatic cord. In
these cases, a mass of ectopic spleen or accessory spleen tissue
is usually detected on the testis [].
SGF is usually diagnosed in childhood. However, it is rarely
detected until adulthood, and it can be confused with malignant
testicular tumors and cause unnecessary orchiectomies [,].
Indeed, approximately 35-40% of these patients can only be
detected after orchiectomy [].
In this case report, we aimed to present an adult case who
underwent radical orchiectomy due to the suspicion of testicular
cancer which was revealed to be discontinious SGF later on.
Muge Bilge, Isil Kibar Akilli, Furkan Isgoren, et al.

One of the major severe acute consequences of diabetes
mellitus (DM) is diabetic ketoacidosis (DKA). The outbreak
of the newly emergent severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) disease has been a major cause of
death for the last two years.
The COVID-19 pandemic has been disruptive for many
patients worsening their dietary and exercise habits. As is known,
poor glycemic control causes various fatal clinical complications
such as infectious diseases. Emphysematous pyelonephritis
(EPN) is a rare, but potentially fatal necrotic kidney infection
that usually leads to septic shock and its frequency is higher in
patients who are immunocompromised, especially those with
DM (87-97%) []. Mortality rates have been estimated to be
as high as 80% in cases of misdiagnosis or delayed treatment.
Most common causative organisms are Enterobacteriaceae;
especially Escherichia coli and Klebsiella pneumoniae [].
On the other hand, another infectious agent Mycobacterium
tuberculosis that causes the disease called tuberculosis (TB), is
still an important public health issue in developing countries.
Urogenital TB comprises 27% of extrapulmonary cases of TB.
Renal involvement in TB is manifested as part of a disseminated
infection or a localized genitourinary disease []. A very rare
clinical scenario is EPN concurrent with iliopsoas abscess (IPA)
[].
Herein, we present a case of DKA in a patient having
concurrent EPN, IPA and COVID-19 pneumonia along with
a critical review of the previous literature to contextualize our
observations. There are two salient features in this case which
make the problem unique: i) the condition manifested itself in the
context of multiple fatal conditions, ii) the condition highlighted
in this case coexisted with COVID-19 pandemic, DKA, EPN,
IPA and renal TB which are all successfully managed with good
clinical outcomes.
Onur Demirbas, Murat Keske, Mert Ali Karadag

Dear Editor,
We have read with great interest the study entitled "Factors
Affecting TESE Success in Infertility Treatment: Preliminary
Results of Single-Center Experience" published in the first issue
of your journal []. Both techniques are very common in daily
urology practice.
Epigenetic changes already create many problems that we
will insidiously pass to the next generations. One of the most
obvious consequences of epigenetic disorders affecting the male
gender is the deterioration in sperm parameters. Decrease in
sperm parameters and fertility rates have necessitated acceptance
of lower sperm parameters as criteria of fertility compared to
those defined by WHO []. The decreased sperm parameters and
even the absence of sperm in the ejaculate (nonobstructive [NOA]
or obstructive azoospermia) have led to the birth of new sperm
retrieval methods. Microdissection testicular sperm extraction
(micro-TESE, mTESE) which is a surgical sperm retrieval
method under local anesthesia with the aid of a magnifying glass
was first defined by Schlegel in 1999 [].
The success rate of mTESE even in experienced hands is
around 50%. The selection criteria of study population in
published reports also directly affect the success rates. In
particular, success rate increases in studies in which patients with
chromosomal abnormalities are excluded []. Nevertheless, such
a high success rate of 100% in this study may not be explained
by only excluding patients with Klinefelter and/or Sertoli cellonly
syndrome from the study. As stated, the creation of a large
population in the planning phase of the study will result in rates compatible with the literature. Also in order to expound the
study design more clearly, the indications that were taken into
consideration when TESE or mTESE was preferred between
the two groups, and previously applied assisted reproductive
technologies should be displayed in detail.
One of the arguments used to predict success of mTESE was
the FSH level in the blood. In large series, although increased
FSH levels in infertile men have been shown to be associated
with impaired spermatogenesis, a low-to-moderate relationship
between sperm recovery rates and FSH elevation could be
shown []. The value of genetic examination is strongly proven
in predicting sperm recovery rates other than FSH in patients
scheduled for TESE. Although not specified in this study, it is
important to search for Y chromosome deletion in the patient
population with nonobstructive azoospermia before TESE. In
the etiology of infertility, the most common genetic defect after
Klinefelter syndrome is Yq microdeletion and the defects in the
AZF gene region are very useful in predicting sperm retrieval.
Thanks to a pre-procedural genetic examination, medical
conditions where it is impossible to obtain sperm can be detected
and unnecessary morbidity can be avoided.
In NOA cases, especially in patients with genetic disorders,
mTESE can effectively find spermatozoa and minimize the
risk of complications. Nevertheless, more research is required
to better understand the complex pathophysiology underlying
NOA and to find more accurate predictors of sperm recovery
rates.
Sincerely yours,