Assoc. Prof. Ekrem GUNER

Dear colleagues,
I am honored to share with you the first issue of 2023 (volume 3, issue 1) of the Grand Journal of Urology (Grand J
Urol) with the contributions of many respected researchers and authors.
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.
Our journal has been abstracted/indexed in 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 international databases.
In this issue of our journal, there are many valuable articles under the subheadings of Urological Oncology,
Neurourology, Urolithiasis and General Urology. 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
January 2023
Assoc. Prof. Ekrem GUNER, MD
Editor-in-Chief
Ali Unsal, Serhat Cetin, Fazil Polat, et al.

Prostate cancer is the second most common cancer in men,
and approximately 1.1 million new cases are diagnosed annually
[]. Prostate cancer in more than 90% of the patients is organconfined
at the time of diagnosis []. Radical prostatectomy
(RP) is the only definitive treatment alternative in localized
disease, while it is performed as a part of multimodal therapy in
locally advanced disease. In the 2020 EAU guidelines, there is
a weak recommendation that none of the RP techniques (open,
laparoscopic, robotic) is superior to each other in terms of
functional and oncological results [].
Over the years, thanks to the better definition of deep dorsal
venous complex, puboprostatic ligaments, prostate shape and
sphincter anatomy, RP techniques developed and contributed
favorably to oncological and functional results [-]. In spite
of the improvement in surgical techniques, urinary incontinence
after RP remains an important complication that adversely
affects patients" quality of life. In a meta-analysis including 51
articles, incontinence rates of patients who underwent RALP
were evaluated. According to this meta-analysis, in the studies
in which no pad use was accepted as full continence, the mean
rate of incontinence at postoperative 12th months was shown
as 16% (4-31%). In other studies which defined full continence
as either no urine leakage or usage of security pads, this rate
dropped to 9% (8-11%) [].
Consequently, the preservation of urinary continence is an
important target in patients undergoing RP. Anatomical and
functional studies have shown that the length of the functional
urethra is between 1.5-2.4 cm, and a significant part of it is
located intraprostatically between the prostate apex and the
colliculus seminalis [-]. In 2011, it was shown that the
continence rate in patients who underwent open RP with the
full functional-length urethral (FFLU) sphincter preservation
technique defined by Schlomm et al. was significantly higher
in the first week after catheter removal compared to patients
who did not undergo this surgical technique. However, no
significant difference was found between these two techniques
in terms of continence rates at 12 months after catheter removal.
Even if long-term continence results are comparable, earlyterm
continence is an important desirable outcome for patients
with incontinence anxiety. FFLU technique aims to preserve
the functional urethral length in the patient by maintaining the
integrity of the intraprostatic part of the urethra, including the
colliculus seminalis []. The "collar technique" (CT) described
by the Bianchi L et al. is the adaptation of the FFLU technique
to RALP. Before the collar technique was described in the
literature, we were performing the RALP procedure in our clinic
by applying almost the same technique and planning to describe
this technique. However, after this demonstrative new technical
article published by Bianchi L et al., we have just aimed to
compare our results with those of the standard technique [].
Dogukan Sokmen, Bedriye Koyuncu Sokmen

In developed countries, prostate cancer (PCa) is the most
commonly diagnosed cancer in men and is the second-most
common cancer overall. Recent epidemiologic studies have
found a correlation between obesity and a rise in the incidence
of various cancers. Obesity is linked to aggressiveness of PCa,
a poor response to treatment, and a high risk of cancer- specific
mortality [,].
Increased periprostatic fat tissue contributes to the
development and progression of PCa which may be due to the
disruption of adipokines (such as adiponectin, leptin, CCL7, etc.)
secreted from enlarged periprostatic fat tissue [,]. Furthermore,
increased periprostatic fat thickness (PPFT) is related to a higher
stage or grade of PCa [,]. Magnetic resonance imaging (MRI)
measures PPFT and visceral fat at multiple levels of the body.
As a result, we believe that the measurement of PPFT with MRI
could be a useful diagnostic tool for PCa. However, few studies
have been conducted on the utility of PPFT in detecting PCa or
clinically significant PCa (Gleason score 3+4 or higher).
In this study, we aim to investigate the relationship between
PPFT on MRI and GS.
Ismail Evren, Yusuf Arikan, Deniz Noyan Ozlu, et al.

Testicular malignancy (TM) is the most common solid organ
cancer in men aged 15-35 years and constitutes 1-1.5% of all
male cancer cases []. Patient outcomes are very favorable with
early diagnosis which increases the importance of diagnosis
and treatment of testicular malignancies in their early-stages.
The methods used in diagnosing TM are as follows: physical
examination, imaging techniques, analysis of laboratory
parameters, and tumor markers. In the literature, besides the
studies showing the relationship between some hematological
parameters with inflammation and tumorigenesis, the
close relationship between the inflammatory response with
tumorigenesis and invasion has also been demonstrated [].
Inflammation plays a role in every step of carcinogenesis by
various mechanisms []. Changes in the systemic inflammatory
response can be evaluated using hematological parameters.
Indeed, changes in C-reactive protein (CRP) levels, and
the neutrophil-lymphocyte ratios (NLRs) are indicators of
systemic inflammatory response in many malignancies []. The
association of high NLR value with poor prognosis in some
urological cancers has been shown in previous studies []. NLR
is not only a marker of systemic inflammatory manifestations,
but also a valuable predictor in many malignancies []. There
is an increasing interest in easy-to-obtain hematological
parameters, such as NLR to predict cancer prognosis and
inflammatory conditions. NLR, LMR, PLR, and MPV can be
used as prognostic predictive factors in many clinical conditions
[]. In the current study, we retrospectively examined these
parameters that can be easily evaluated in clinical practice in
patients diagnosed with TM in comparison with a control group
of similar age that underwent varicocelectomy. Thus, we aimed
to investigate the effects of these hematological parameters on
the prognosis of TM.
Mehmet Sevim, Sibel Canbaz Kabay, Bekir Aras, et al.

Multiple sclerosis (MS) is a chronic young adult disease
that shows its effect in the central nervous system (CNS)
and manifests itself with attacks. It is an autoimmune and
demyelinating disease. The disease mainly affects the brain
and spinal cord, and is characterized by the accumulation of
demyelinating plaques in the white and gray matter. In addition,
atrophy and irreversible axonal degeneration can also be observed
[]. Demyelinated lesions and plaques eventually cause lower
urinary tract dysfunction (LUTD) during the progressive course
of the disease, depending on their localization in the CNS. LUTD
may present in 5-10% of MS patients as the first symptom, but
neuro-urological symptoms occur in 80% of patients 10 years
later during the course of the disease. Depending on the location
of the lesion, detrusor overactivity (DO), detrusor sphincter
dyssynergia (DSD), or hypocontractility may occur during the
course of the disease [].
There are many medical and surgical treatment options for
DO, but their therapeutic success is controversial. The firstline
treatment of DO includes bladder training, pelvic floor
muscle training, and anticholinergics. Since side effects of
anticholinergic drugs which are among effective treatment
options for DO such as dry mouth and constipation are common,
only 20% of patients continue to take these drugs after 6 months
[,]. Treatment options such as neuromodulation, intravesical
botulinum toxin injection, bladder augmentation, detrusor
myomectomy and urinary diversion are available for patients
who discontinue the treatment due to its side effects, do not want
to use drugs, or do not benefit from medical treatment.
Percutaneous tibial nerve stimulation (PTNS) can be
preferred as a safe and effective treatment option for the patients
with DO symptoms who have not benefited from conservative
and medical therapy or did not respond to treatment with at least
two oral anticholinergic drugs [,-]. It has been reported that
neuromodulation of the sacral nerve plexus (S2-4 roots) can be
achieved by stimulating the posterior tibial nerve (PTN). The
PTN contains mixed motorsensory fibers that originate from L5
through S3 in the spinal cord. It modulates the innervation to
the bladder, urinary sphincter, and pelvic floor. The mechanism
of PTNS in attenuating lower urinary tract symptoms (LUTS),
however, is not yet fully understood [,,].
The effectiveness of PTNS for LUTS in overactive bladder
(OAB) has been demonstrated in several studies []. It has been
also reported that interruption of PTNS treatment may result
in the reappearance of OAB symptoms []. Therefore, the
introduction of maintenance therapy for PTNS is important for
the treatment plan. Our study aims to reveal the changes in LUTS
after 24 months of maintenance PTNS therapy in MS patients.
Mammadbaghir Aghasiyev, Cemil Kutsal

Bladder cancer is the second most common cancer of the
genitourinary system. It ranks 7th in the male population
worldwide and 11th in both genders. The average age at
diagnosis is 65 years. By this age, 75% of bladder cancers are
localized, while 25% of them metastasize to lymph nodes or
distant organs [].
Non-muscle invasive bladder cancer (NMIBC) consists
of the majority of urothelial carcinomas, and it is the most
expensive group receiving cancer treatment []. Cystoscopy is
the gold standard diagnostic procedure used during diagnostic
process and follow-up of these patients []. Urine cytology was
expected to replace cystoscopy due to its low false-positive rates
and high specificity, but it could not give the desired result due
to its low sensitivity and its inability to recognize low-grade
tumors [-]. Furthermore, NMIBCs are tumors with a high
potential for progression and recurrence. Therefore, control
and follow-up of the patients are essential. Various studies have
been conducted on the factors affecting the recurrence and
progression of bladder cancers []. However, any biomarker has
not been used routinely in daily practice.
An ideal tumor marker should be specific for the tumor being
screened, should not yield positive results in other diseases or
conditions, should demonstrate diagnostic sensitivity in the early
stage of the disease and screening of small tumors, and should
be able to identify all tumors in question. Since cystoscopy
is the gold standard method for detecting bladder tumors the
cystoscopic findings reported up to date in all studies have been
evaluated and some sensitivity and specificity rates have been
retrieved [,]. Considering that cystoscopy is practitionerdependent,
using an additional diagnostic method and urologist"s
prior knowledge about the NIMBC before application of the
cystoscopy procedure may increase the detection rate of the
tumor during cystoscopy [].
As an actively used up-to-date parameter in the treatment
and follow-up of many diseases, NLR suggestively predicts
disease recurrence and progression in oncological patients [].
Therefore, in this study, we aimed to investigate the predictive
value of NLR in determining disease progression and recurrence
in patients with NMIBC.
Kaan Karamik, Mehmet Kisaarslan
Bladder calculi occur most commonly as a result of either
migration from the upper urinary tract or in the presence of
predisposing conditions such as bladder outlet obstruction,
neurogenic bladder dysfunction, intravesical foreign body,
bladder augmentation, and urinary diversion []. Although stone
formation around a foreign body in the bladder is common,
the presence of a bladder stone around a foreign body with a
bladder tumor is a very rare condition. We report the case of a
patient who was admitted to our clinic with lower urinary tract
symptoms (LUTS), recurrent urinary tract infection (UTI), and
a hanging bladder stone formed around a nonabsorbable suture
material and concurrent bladder tumor.
Seref Coser, Melih Balci, Serra Kayacetin, et al.
Although spontaneous retroperitoneal hematomas have a low
incidence, the morbidity and mortality of the condition is high.
Acute abdominal pain is a common presenting complaint in
patients visiting the Emergency Department (ED). Spontaneous
retroperitoneal hematoma is mostly of renal origin (rupture of
parenchymal lesions such as angiomyolipomas, cysts and kidney
carcinomas) []. Acute adrenal hemorrhage is rare but may have
devastating outcomes. Main causes of acute adrenal bleedings
are trauma and ruptured neoplasms. Adrenal myelolipoma is a
benign tumor that contains mature fat cells and relatively young
hematopoietic elements. Rarely, spontaneous rupture leading to
retroperitoneal hemorrhage develops in some large lesions.
Herein, we report a patient with a giant adrenal myelolipoma
that presented with retroperitoneal hemorrhage and underwent
emergency surgery.