Grand Journal of Urology
E-ISSN : 2757-7163

Articles See All

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, Index Copernicus International, 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 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. Respectfully yours May 2024 Assoc. Prof. Ekrem GUNER, MD Editor-in-Chief
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.

Image Column

First Successful Endoscopic Removal of a Pen from the Male Urinary Bladder

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.

Isolated Renal Involvement Requiring Surgical Treatment in Systemic Cat Scratch

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 [].

Is Periprostatic Nerve Block Innocent on Erectile Functions in Prostate Biopsy? Randomized, Controlled, Prospective Observational Study

Periprostatic nerve block (PPNB) has currently been recommended as the standard anesthesia technique for TRUSG prostate biopsy by AUA and the 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. Various studies have demonstrated that the effect on erectile function is short-lived and transient.

Prostate Cancer with Osteolytic Sternal Metastasis: A Rare Clinical Presentation

Chest wall malignancies are considered rare, constituting approximately 1% of all malignancies. These malignancies may originate primarily from bone or soft tissue, result from the infiltration of adjacent organ malignancies, or occur secondary to distant metastasis, with the latter being the predominant cause. Prostate cancer typically exhibits metastasis to various sites, including bone, lymph nodes, lung, bladder, liver, and adrenal glands.

Comparison of Fixed and Ramping Voltage Extracorporeal Shockwave Lithotripsy with Acute Kidney Injury Biomarkers: Prospective Randomized Clinical Study

ESWL has been used successfully for many years in the minimally invasive treatment of upper urinary tract stone disease. Although ESWL is considered a minimally invasive treatment, it has been shown to cause various short- and long-term structural and functional changes in the kidney. Short-term renal damage may be due to vascular or tubular mechanical trauma or oxidative stress due to free radical formation causing ischemia-reperfusion injury in the renal capillary system.

The Effect of Curcumin on Penile Fibrotic Plaque in Rats with Experimental Peyronie’s Disease

Peyronie’s disease (PD) is a condition that progresses with fibrosis in the tunica albuginea (TA) layer of the penis and therefore causes penile pain, curvature, and sexual dysfunction. Despite being frequently seen, its aetiology and pathophysiology are not yet fully understood []. Factors such as trauma, frequency of sexual intercourse, diabetes mellitus, Dupuytren’s contracture, family history, gout, plantar facial contracture, radical prostatectomy, tympanosclerosis, Paget’s disease, beta-blocker use, advancing age, genetic predisposition, smoking, hypertension, and tissue ischemia may play a role in the aetiology.

Effect of Preoperative Kegel Exercises on Continence Rates After Open Radical Prostatectomy

Kegel exercises are defined to strengthen the muscles of pelvic floor, involving rapid and sustained voluntary contractions of the pelvic floor muscles to improve sexual function and urinary incontinence. Studies examining the effect of Kegel exercises on urinary incontinence after radical prostatectomy have obtained conflicting results.

Latest Issue

Volume 4 Issue 2
Cover Page

News from GJU See All

TR Index is a national citation index that can be searched on the web page, which includes bibliographic/full text information of articles in national, peer-reviewed, scientific journals.

DOAJ is a unique and extensive index of diverse open access journals from around the world, committed to ensuring quality content is freely available online for everyone.

EuroPub is a comprehensive, multipurpose database covering scholarly literature, with indexed records from active, authoritative journals, and indexes articles from journals all over the world.

EBSCO,  a research database presenting academic journals electronically, provides a range of library database services around the world. EBSCO Information Services, Ipswich, Massachusetts, USA.

J-Gate contains abstracts, citations, full-text access for all Open Access journals and other key details from academic journals by covering 71 Million+ Indexed Articles, 58,000+ Journals from over 16,000 Publishers.

ICI Journal Master List is an international indexing database of scientific journals that has been evaluating the submitted periodicals since almost 20 years. The condition for indexation in our database is passing a positive multidimensional evaluation which is based on over 100 criteria.

SCILIT is a comprehensive, free database for scientists using a new method to collate data and indexing scientific material. Our crawlers extract the latest data from CrossRef and PubMed on a daily basis. 

News See All

Diphallus, which is also known as diphallia, is a very rare congenital anomaly encountered nearly one in 5.5 million population. Since the first case was presented by Wecker in 1609, only 120 cases have been reported in the literature so far. Vast majority of cases with diphallus were accompanied by various congenital anomalies mainly genitourinary and anorectal malformations. Diphallus can be classified as glandular diphallus, bifid diphallus, and complete diphallia according to the anatomical structure involved.  
In the evaluation of a 32-year-old male patient who was referred to our clinic with the complaint of gynecomastia and primary infertility, ennuchoid structure, hypergonadotropic hypogonadism, and azoospermia were detected. Based on these findings, the genetic evaluation revealed the presence of 48XXYY syndrome. In this case report, we aimed to report the diagnostic algorithm and management of 48 XXYY syndrome. It should be noted that fertility should not be expected in patients with 48XXYY syndrome.
Immunosuppressive therapy is related to the increasing frequency of malignancies after transplantation. A small percentage (4.6%) of malignancies seen in kidney transplant patients are renal cell carcinomas (RCC) which occur almost exclusively in native kidneys. The prognosis of RCC largely depends on the presence of metastasis. Metastatic disease is very rare in small renal masses. In this case report, we aimed to present our case of approximately 4 cm-mass of metastatic RCC in our kidney transplant patient.
Primary or secondary lymphoma of the prostate is a rare condition. Mantle cell lymphoma (MCL) represent 4-9% of all lymphomas. Prostate involvement with MCL is very rare, with only 11 reported cases up to now. Here we present a case with lower urinary tract symptoms and prostate-specific antigen (PSA) elevation diagnosed with MCL of the prostate. Prostate biopsy was performed in a 70-year-old patient due to increased PSA. After the pathology result was reported as prostatic MCL, imaging studies and sampling of additional pathological specimens were performed for staging. 488 576
Apparently, genetic factors, especially in oligoospermic and azoospermic patients, have been increasingly investigated in recent years. Klinefelter syndrome (KS), known as 47XXY, can be seen in up to 10% of the cases with nonobstructive azoospermia and in one in 500-1000 live births [4]. Various variants of Klinefelter syndrome have been reported. Here, a case with a genetic diagnosis of 48XXYY, which is a very rare variant of Klinefelter syndrome, will be presented.