Assoc. Prof. Ekrem GUNER, MD
Dear colleagues,
I am honored to share with you the second issue of 2024 (volume 4, issue 2) of the Grand Journal of Urology (Grand J Urol) with the
contributions of many respected researchers and authors.
Grand Journal of Urology (GJU) aimsto carry written and visualscientific urology studies to academic platforms and to make significant
contributions to the science of urology. Our journal has been abstracted/indexed in Tubitak Ulakbim TR Index, DOAJ, EBSCOhost,
J-Gate, SciLit, ResearchGate and Google Scholar international databases. As of these achievements, the Grand Journal of Urology
(GJU) has taken its place among the journals indexed by national and international databases.
In this issue of our journal, there are many valuable articles under the subheadings of Andrology, Endourology, General Urology,
Laparoscopic and Robotic Surgery, Pediatric Urology 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.
Burhan Baylan, Berkay Eren
Radical cystoprostatectomy is the most important treatment
option in local control and standard surgical treatment of
muscle-invasive bladder cancer []. In addition, radical
cystoprostatectomy and urinary diversion have serious
complications that occur during the postoperative period [-].
Intestinal complications including bowel obstruction is associated
with serious mortality rates, and requires reoperation. Intestinal
obstruction that may require reoperation can be seen during the
early or late postoperative period [,].
Ten percent of the patients with urinary diversion performed
using the ileal loop or gastric segment suffer from postoperative
bowel obstruction that requires reoperation []. Mechanical ileus
requiring reexploration has been reported at an incidence rate of
10.5 percent []. Studies have been conducted to improve early
return of bowel functions with resultant decrease in bowel-related
complications []. In a Cochrane review, the effect of prokinetic
agents on intestinal complications was investigated. According
to the results of the study, some drugs shortened bowel passage
time by accelerating intestinal motility and also reduced the
length of hospital stay []. Reyblat et al. investigated patients who
developed neurogenic bladder after spinal cord injury and therefore
underwent extraperitoneal augmentation enterocystoplasty.
Compared to intraperitoneal surgery, bowel-related complications
had been less frequently seen in the patient group in which
extraperitoneal technique was applied [].
Herein, we aimed to comparatively evaluate bowel
complications after radical cystectomy performed using
traditional cystectomy vs peritoneal closure-assisted ileal
conduit extraperitonealization technique.
Mehmet Aktaş, Mansur Dağgülli
Fournier"s gangrene (FG) was described in 1883 by the
French venerologist Jean Alfred Fournier. In his series with 5
patients, he defined this disease as idiopathic fulminant gangrene
involving the scrotum and penis []. FG usually begins with
perianal or perineal pain. Scrotal swelling, local erythema of
the skin and pain are the common symptoms. Also, hyperemia,
pruritus, fever, nonspecific abdominal pain are other common
symptoms. Cellulitis-like lesions in the early period complexify
the diagnosis of the disease and cause it to be missed.
FG mostly develops in patients with comorbidities; however,
it can also occur in patients without comorbidities. Hypertension,
obesity (BMI>30 kg/m2), congestive heart failure, tobacco
use, immunosuppressive conditions (such as acquired immun
deficiency syndrome [AIDS]), peripheral vascular diseases and
alcoholism have been found to be associated with an increased
risk in FG []. Diseases and risk factors in the etiology for FG help
inoculation of microorganisms by damaging the immune system.
Polymicrobial agents, as in many necrotizing soft tissue infections,
cause FG. Microorganisms normally found in the perineum and
genital area cause infection after a suitable environment is created.
The cornerstones of FG treatment are immediate debridement of
all necrotic tissues, initiation of broad-spectrum antibiotics, and
patient stabilization with hemodynamic resuscitation []. FG is
accepted as one of the urological emergencies because the rate of
spread of facial necrosis can be 2-3 cm/hour. In addition, the fact
that up to 21% of patients present with hypotension and septic
shock increase the importance of patient stabilization before
emergency surgery [].
Broad-spectrum antibiotherapy should be started empirically
as soon as FG is diagnosed, and then revised according to culture
results []. Initial antibiotherapy should target common bacteria
such as staphylococcus and streptococcal species, gram-negative
bacteria, clostridium, bacteroides and pseudomonas []. In
patients with a history of fungal infection or in immunosuppressed
patients, antifungals such as amphotericin B or fluoroquinolones
should be added to the treatment, considering fungal infection
as the causative agent []. However, due to poor vascularization
in fascial tissues, surgical intervention is key for an effective
antibiotic therapy.
Early debridement of necrotic and dead tissue is a critical
step in controlling the infection. Debridement of all dead tissues
in the first operation is considered the most important factor in
the patient"s survival []. Extensive debridement and ventilation
of living tissues by opening windows are recommended.
Close monitoring of the wound and repeated debridements are
necessary to control infection [].
While FG can also be treated with classical dressing, vacuumassisted
closure (VAC) therapy has become popular in recent
years [0]. VAC method accelerates wound healing by reducing
edema and increasing blood flow. VAC system increases
angiogenesis and improves tissue nutrition and formation. The
main mechanism of the device is that VAC system drains dirty
liquid and stagnant debris [].
In this study, the effect of VAC therapy for the treatment of
FG and the factors affecting this disease tried to be shown.
Muharrem Baturu, Mehmet Öztürk, Haluk Şen, et al.
Ureteropelvic junction obstruction (UPJO) is a common
condition resulting in hydronephrosis in adult and pediatric
patients []. UPJO may cause urinary tract infections and pain
and to lead to a decline in renal functions. In the presence of
critically reduced renal function, use of particularly the
Anderson-Hynes pyeloplasty technique, is recommended as the
optimal treatment approach [-].
The progression of hydronephrosis in cases with delayed
diagnosis can lead to degeneration of the renal parenchyma.
While the optimal treatment approach for patients with
reduced renal function (10%-25%) is still a matter of debate,
nephrectomy may be recommended if adequate improvement
in renal functions with alternative treatmen methods can not be
achieved [,].
The magnitude of postoperative improvement in differential
renal function (DRF) is strictly correlated with the baseline
DRF, renal cortical thickness, anteroposterior diameter (APD)
of the renal pelvis, pelvis-to-cortex ratio, and calyx-toparenchyma
ratio []. The present study evaluates the outcomes
of pyeloplasty and the factors [renal pelvis APD, parenchymal
thickness (PT), APD/PT, DRF] affecting surgical outcomes in
patients with a preoperative GFR of ≤15 ml/min.
Ali Yasin Özercan, Özer Güzel, Şeref Coşer, et al.
Transrectal ultrasonography-guided (TRUSG) prostate
biopsy is frequently performed in outpatient settings due to its
ease, lack of need for hospitalization, and low rate of severe
complications. However, recent studies and clinical experience
have shown that patients experience discomfort and pain during
the procedure, contrary to earlier beliefs that the procedure was
painless without local anesthesia []. Periprostatic nerve block
(PPNB) was first described by Soloway and Obek in 2000 [],
and since then has become a widely agreed method for pain
relief during TRUSG prostate biopsy.
PPNB has currently been recommended as the standard
anesthesia technique for TRUSG prostate biopsy by American
Urological Association (AUA) and the European Association
of Urology (EAU) [,]. However, other techniques including
intrarectal local anesthesia (IRLA) with lidocaine gel,
intravenous sedation and general anesthesia may also be
employed, depending on patient preference, medical history,
and the clinical decision of the physician.
Although TRUSG prostate biopsy is generally considered
safe, it may lead to complications such as bleeding, infection,
urinary retention, pain and lower urinary tract symptoms.
Moreover, it has been claimed that it may impair erectile function
[-]. Various studies have demonstrated that the effect on
erectile function is short-lived and transient. In fact, our previous
study indicated impairment of erectile function up to six months
after biopsy []. Another study with a follow up period of three
months suggested that the effect on erectile function might be
related to inflammation caused by the biopsy procedure itself
[]. However, it is not clear whether the impairment of erectile
function is due to the anesthesia technique used during the
biopsy or the inflammation caused by the biopsy procedure.
Herein, we aimed to compare the IRLA and PPNB, two
anesthetic methods administered for prostate biopsy, on erectile
function following the procedure.
Somanatha Sharma, Javangula Venkata Surya Prakash, Vetrivel Natarajan
The presence of self-inflicted foreign bodies in the urinary
bladder is an uncommon phenomenon, with objects typically
small in size and associated with factors like sexual gratification,
psychiatric disorders, or advanced age []. In literature, there
have been reports of long foreign bodies such as pens, pencils,
telephone cable, beading awl and thermometer that have been
found in the bladder [-]. This case presents the unique instance
of a self-inserted ball-point pen in a male patient"s bladder,
successfully removed through endoscopic methods using a
nephroscope cystoscopy.
Bakytbek Kozubaev, Şaban Oğuz Demirdöğen, Tugay Aksakallı, et al.
Cat scratch disease (CSD) is a self-limiting infectious disease
that develops after a cat bite or scratch, caused by the Gramnegative
bacillus Bartonella henselae []. It is seen in children,
young adults, patients with compromised immune systems, and
rarely in the elderly []. The disease is generally characterized
by fever and regional granulomatous lymphadenopathy, but
it can occur as a systemic disease in 5-10% of cases and lead
to various diseases []. In systemic CSD, all systemic organs,
especially the liver and spleen, can be affected along with longterm
fever [].
There is no gold standard method for the diagnosis of the
disease. However, diagnostic criteria have been proposed by
Margileth as follows: history of contact with cats; negative
Mantoux, interferon gamma releasing assay tests, or serologies
for other agents that may cause abscesses; B. henselae observed
by positive polymerase chain reaction (PCR) test and imaging
in spleen and liver lesions; enzyme immunoassay (EIA) or
immunofluorescence (IFA) positive with a 4-fold increase in
titer between the acute phase and convalescence or a single titer
≥1:64; Histopathological examination showing granulomatous
inflammation suggestive of systemic CSD. The presence of at
least 3 of these 5 criteria confirms systemic CSD [].
Because cat scratch disease is often a self-limiting disease,
initiation of antibiotic therapy is controversial. However, in
prolonged cases of the disease and systemic cat scratch disease,
single or combination antibiotic agents such as gentamicin,
trimethoprim/sulfamethoxazole, rifampicin, ciprofloxacin,
azithromycin tetracycline are used []. It has also been reported that
surgical treatment is required for abscesses of internal organs [].
In this case report, we aimed to emphasize the importance of
detailed patient history and a multidisciplinary approach in the
diagnosis and treatment of patients despite advanced imaging
methods in patients with suspected renal cancer.
Kenan Yalçın, Engin Kölükçü, Fatih Fırat
Stomach ache does not usually require surgical intervention,
and it may be felt secondary to disorders associated with extraabdominal
organs [,]. Testicular torsion is an emergency
situation that causes severe scrotal pain []. Torsion of the
spermatic cord is a rare disease often seen in adolescent males.
It is seen in 1/4000 of the male population under the age of 25,
but this rate is estimated to be below the actual frequency of
testicular torsion. While sudden scrotal pain concludes classical
clinical manifestations of the spermatic cord torsion, pain may
be less severe and the set up may be slower in some of the
children. In addition to scrotal pain, increase in scrotal volume,
scrotal rash, pain in the lower quadrant of the abdomen, nausea
and vomiting may accompany the clinical picture [].
In this study we present a 2-year-old case with abdominal
pain that was treated as an inpatient at an external center but
after his discharge his parents noticed swelling and rash of the
left scrotum. Then he was operated with preliminary diagnosis
of testicular torsion and his severely impaired testis was removed.
Presentation of this case conveys importance in that it emphasizes
the significance of a full physical examination including the
genital area in patients manifesting with stomach ache.
