Ekrem GUNER
Dear colleagues,
I am honored to share with you the second issue of 2023 (volume 3, 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) 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 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, Urological Oncology,
Endourology, Urolithiasis, Pediatric Urology 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
May 2023
Assoc. Prof. Ekrem GUNER, MD
Editor-in-Chief
Jihad Anad Khalef, Ahmed Hadi Essa
One of the most prevalent issues in older men is benign
prostatic hyperplasia (BPH), which causes lower urinary tract
symptoms (LUTS). With the aim of reducing side effects and
improving quality of life (QoL) of the patients, numerous
treatment methods are being used []. The gold standard for
treating symptomatic BPH associated with prostate volumes
ranging between 30 and 80 cc is monopolar transurethral
resection of the prostate (TURP) []. It is approved as a
treatment for LUTS secondary to BPH, but despite numerous
technical advancements, it has drawbacks. Considering that
it still has a morbidity rate of 11% and a death rate of 0.1%,
we are looking for a new procedure that will produce the best
possible functional outcomes []. The bipolar TURP is now
being compared to the traditional monopolar TURP, with
efficacy similar to the monopolar procedure but with reduced
perioperative problems, insignificant TUR symptoms, lesser
blood loss, and shorter catheter dwell time [-]. As a lengthy
procedure a large prostate can be safely removed under normal
saline irrigation []. We planned a three-arm trial with a focus
on perioperative and postoperative complications as well as
immediate functional outcomes because there was a lack of
prospective randomized studies comparing monopolar and
bipolar TURP. The aim of this study is to compare the outcomes
of bipolar and monopolar TURP. To our knowledge, this twopart
study is the first prospective randomized trial to compare
monopolar TURP versus bipolar TURP [-].
Caglar Yildirim, Mehmet Yilmaz Salman, Abdulmecit Yavuz, et al.
Urinary stone disease affects roughly 15% of the population
[]. Kidney stones are most seen in the lower pole calyces
[]. Retrograde intrarenal surgery (RIRS), percutaneous
nephrolithotomy (PNL), and shock wave lithotripsy (SWL) are all
minimally invasive methods used to treat kidney stones. Patients
with stones in the lower pole calyces are treated differently from
those with stones in the upper and middle pole calyces. Because
lower pole calyceal stones must ascend the infundibulum of the
lower pole, reach the renal pelvis, and then depart the kidney
into the ureter, making their removal extremely difficult [].
Many urologists choose SWL as a low-morbidity outpatient
option, and many patients tolerate it. PNL is recommended as the
primary choice by the European Association of Urology (EAU)
for stones bigger than 2 cm and SWL or RIRS for stones smaller
than 1 cm. However, the optimal treatment choice for mediumsized
lower pole calyceal stones measuring 1 to 2 cm is still up
for debate []. Furthermore, it is known that SWL is linked to
insufficient fragment clearance from the lower pole [].
Because it has a high success rate regardless of stone size,
PNL is currently the standard treatment of choice for large
stones (> 2 cm) and is also preferred by many urologists for the
treatment of multiple renal stones or stones in the dependent parts
of the kidney, such as the lower pole. However, the substantial
risk of morbidity outweighs the advantage of high stone-free
rate []. Miniaturized PNLs with smaller nephroscopes can
reduce surgical morbidity. In the removal of renal stones, its
efficiency is comparable to that of normal PNL. Miniaturized
nephroscopes have calibers ranging from 4.8 to 22 F, with mini-
PNL (14-22 F), ultramini-PNL (13 F), and micro-PNL (4.8 F)
being the most used ones [].
Flexible ureteroscopy, which was originally used to treat
lower pole calyceal stones that were resistant to SWL, may be
a less intrusive option to percutaneous treatments []. RIRS is
becoming more popular as a main treatment for these stones,
with greater stone-free rates than SWL and lower patient
morbidity than PNL.
Medical expenditures for treating stone disease involve direct
and indirect costs. All medical expenses (e.g., prescriptions,
hospitalization charges, all consumables and non-consumables
required during surgery) are considered direct costs, whereas
indirect costs include the patient's lost working days []. Healthcare
systems and individuals nowadays desire shorter hospital
stays, speedier return to work, maximum cost efficiency, and
higher surgical success rates [,].
We compared the safety, efficacy, and cost-effectiveness
of SWL, RIRS, and micro-PNL in this study to determine an
individualized management for 1-2-cm stones in the lower pole
calyces.
Ersan Oflar, Cennet Yildiz, Atilla Koyuncu, et al.
Erectile dysfunction (ED) has a negative influence on the
quality of life of patients. Its prevalence shows an association
with age, surpassing over 80% in men who are older than
80 years []. Although this disorder might have organic or
psychological causes, the most common underlying pathology
is abnormalities of the penile blood vessels. ED shares the
same risk factors for cardiovascular disease (CVD) with similar
underlying pathophysiological mechanisms []. The relationship
between ED and CVD is bidirectional. Studies have shown ED
as a predictor of CVD and the presence of CVD has been found
to be associated with more severe forms of ED []. As such,
current guidelines have recommended a detailed examination of
ED patients in terms of CVD and risk factors []. This approach
gives physicians a chance for risk mitigation, early diagnosis,
and management of CVD.
Insulin resistance (IR) coexists with the proatherogenic
milieu and is a part of the atherogenic process []. By affecting
systemic factors as well as intimal cells that are involved in
atherosclerosis, IR seems to have an important role in plaque
formation and progression of ED []. IR has been related to
decreased nitric oxide production and vasodilatation both of
which play a role in the pathogenesis of ED []. Men with ED
have been shown to have higher levels of homeostatic model
assessment insulin resistance (HOMA-IR) index which is the
most popular method for the assessment of IR []. However, this
test is relatively expensive and requires measurement of both
serum insulin and glucose levels, which has led researchers to
search for alternative methods. Triglyceride-glucose index (TyG
index), the calculation of which is based on the measurements
of serum triglyceride (TG) and glucose levels, is an easily
obtainable and reliable marker for IR. The prognostic utility
of the TyG index has been shown in acute coronary syndrome,
lower extremity peripheral artery disease, heart failure, fatty
liver disease, and stable coronary artery disease [-]. In the
present study, we aimed to evaluate the TyG indexes of the ED
patients and to find whether the TyG index has any predictive
value in diagnosing ED.
Leyla Ozturk Sonmez, Hulya Vatansev, Gokhan Ecer, et al.
Coronaviruses mainly cause respiratory tract infections and
gastrointestinal infections in humans []. World Health Organization
(WHO) named the infectious pneumonia disease caused by SARSCoV-
2 virus as coronavirus disease 2019 (COVID-19) []. Hypoxia,
dyspnea, acute respiratory distress syndrome (ARDS), septic shock,
and multiple organ failure can also be seen in severe and critically
ill COVID-19 cases []. But most of the SARS-CoV-2 cases
remain asymptomatic after vaccination []. Many studies revealed
that urinary system involvement is prevalent in patients infected
with SARS-COV-2. Only limited number of studies showing a
correlation between urinary biochemical parameters and SARSCOV-
2 are available in the literature [,].
Urinalysis covers quick, economical, useful, and noninvasive
tests which provide detailed information on urine. These data
can aid in the diagnosis of many diseases including urinary
tract infections and can also be used in the monitorization of the
outcomes of the treatment used for these diseases [,].
The effects of SARS-CoV-2 on urinary biochemical
parameters were analyzed through comparing patient and control
groups or based on the severity of the disease in previous studies
but no research has yet been made both on the effect and change
in urinary parameters in periods before, during, and 15 days after
recovery from COVID-19 disease and also on the relationship
between the change in these parameters and renal function tests
and inflammatory markers. This study compared the parameters
of urinalysis in periods before, during, and after recovery from
pre-COVID-19 disease, and assessed the relationships between
the changes in these parameters and renal functions.
Halil Ibrahim Ivelik, Ibrahim Guven Kartal, Ahmet Kocak, et al.
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 []. During the
12th week of the fetal development, a circular part originated
from ectoderm is seen at the periphery of the glans penis, which
gives rise to prepuce (foreskin), a skin part which covers the
glans. The corpus cavernosum and corpus spongiosum of the
penis develop from the mesenchyme in the phallus. Bilateral
labioscrotal swellings elongate toward each other and fuse in the
midline to form the scrotum. The fusion site is seen as scrotal
raphe []. Bilateral urethral folds fuse in the midline to form the
corpus spongiosum and cavernous urethra between the 12th and
14th weeks of the fetal development. It is estimated that a fusion
defect in genital tubercle during the fetal development period
results in the condition termed diphallia []. Surgical treatment
involves penile reconstruction and restoration of accompanying
malformations after excision of the hypoplastic structure,
however, the number of patients who have undergone surgical
interventions is relatively low. In our case report, we aimed to
present a patient with glandular diphallus and the follow-up
process.
Ismail Emre Ergin, Aydemir Asdemir, Abuzer Ozturk, et al.
Angiomyolipomas (AMLs) are the most common benign
mesenchymal tumors of the kidney, mainly composed of smooth
muscle, dysmorphic vessels and mature adipose tissue, causing
regional complications. They are responsible for 1-3% of kidney
tumors with an incidence of 0.3-3% in general population and
a female-to-male ratio of 2:1 []. Fifty to seventy percent of the
cases consist of sporadic renal AMLs, characterized by a smaller
size (average 1-4 cm), slower growth rate (0.19 cm/year),
unilateral presentation, and an average age at disease onset
ranging between 43 and 53 years at the time of diagnosis [,].
The remaining 30-50% of the cases are associated with genetic
syndromes such as sporadic lymphangioleiomyomatosis (LAM)
and tuberous sclerosis complex (TSC) []. The latter is due to
an autosomal dominant mutation of the TSC1 (9q34) or TSC2
(16q13.3) genes, with activation of the mammalian target of
rapamycin (mTOR) intracellular signaling pathway, associated
with a multisystemic disease, greater number of lesions, higher
growth rate (1.25 cm/year), lower mean age at diagnosis (18
years), and development of considerable complications during
follow-up [].
Factors determining the necessity and type of treatment
include the presence of symptoms, an aneurysm >5 mm in
the mass, the size of the lesion, its association with a disease
complex (TS and LAM), kidney reserve, pregnancy plan, patient
compliance, occupation, and activity status. Most (82-94%) of
the patients with a mass lesion larger than 4 cm are symptomatic
and 50-60% of them may bleed at any time. Major risk factors
for bleeding are tumor size, grade of angiogenic component, and
synchronous presence of TS [,].
Although selective arterial embolization is effective in
controlling bleeding in emergency situations, research on its
effectiveness in long-term treatment continues []. In addition to
surgical and embolization treatment options, studies are continuing
on drug treatments using mTOR inhibitors, which are thought
to play a role in the pathogenesis, especially in the treatment of
multiple, unresectable or metastatic AMLs accompanying disease
complexes such as TS or LAM. The aim of our study is to evaluate
the treatment with everolimus and selective arterial embolization,
and subsequent follow-up period of a patient who applied to our
clinic, and received the diagnosis of renal AML.
Catarina Laranjo Tinoco, Andreia Cardoso, Mariana Capinha, et al.
Patients with penile lesions often delay seeking medical
consultation, leading to advanced presentation of penile
malignancies and extensive lesions. The main challenge in
diagnosing these lesions is distinguishing between benign and
malignant conditions, which cannot be defined on clinical
evaluation only. The main concern is diagnosing squamous cell
carcinoma and its variants. Benign lesions, such as fibroepithelial
polyps, are rare and a diagnosis of exclusion.
Fibroepithelial polyps arise from the mesoderm. They can
occur anywhere on the skin, more frequently in the groin, axilla,
and eyelids. In the urological setting, they are more commonly
found in the ureter. There are few reported cases of penile
presentation, with the polyps typically appearing on the glans
and associated with poor hygiene or urinary catheter use. The
possibility of recurrence or malignant transformation has been
reported inconsistently in the literature [,].
We present a case with a florid manifestation of fibroepithelial
polyps.
