Grand Journal of Urology
E-ISSN : 2757-7163

Current Issue
Editorial
Dear colleagues, I am honored to share with you the third issue of the Grand Journal of Urology (Grand J Urol) with the contributions of many respected researchers and authors. Our journal has been indexed in Index Copernicus International (ICI), EuroPub and SciLit international databases since the second issue. Our applications to Ebsco Host and J Gate databases were also accepted and license agreements were signed mutually. The journal and its content will soon be included in the relevant databases. As of these achievements, the Grand Journal of Urology (GJU) has taken its place among the journals indexed by international databases. With this result, GJU was entitled to be included in the journals in category 1b defined in the application criteria for associate professorship. In this third issue of our journal, there are many valuable articles under the subheadings of Female Urology, General Urology, Urolithiasis, Urological Oncology, Renal Transplantation, Andrology, Functional Urology, Neurourology and Genitourinary Radiology. 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, to our designers and to our publisher. Respectfully yours September 2021 Assoc. Prof. Ekrem GUNER, MD Editor-in-Chief
Original Article
Female Urology, Online First: 07 June 2021
Grand J Urol 2021;1(3):083-088, DOI: 10.5222/GJU.2021.03511
Objective: We aimed to evaluate the results of our minimally invasive (laparoscopic and robotic) sacrocolpopexy operations in patients with pelvic organ prolapse (POP). Materials and Methods: Demographic characteristics, intraoperative and postoperative data of 15 patients for whom we applied laparoscopic or robotic sacrocolpopexy due to symptomatic Grade 2 or higher apical POP based on POP-Q classification between September 2014 and September 2018. Treatment success was defined as Grade 0 or 1 POP in POP examination in the final surveillance. Results: Mean age of the patients was 60.4 ± 8.3 (49-82) years. Four patients (26.7%) were operated using robotic and eleven patients (73.3%) using laparoscopic methods. Uterus conservative surgery was applied in all patients excluding one. Mean operative time was 183.3 ± 21.4 (145-220) minutes and mean hospital stay of the patients was 2.8 ± 0.7 (2-4) days. Intraoperative and postoperative complications developed in a total of two patients (13.3%). Mean duration of follow-up was calculated as 12.1 ± 4.8 (8-24) months. De novo urgency urinary incontinence developed in two patients and stress incontinence in one patient. Based on the physical examination in the follow-ups, 14 patients (93.3%) had Grade 0 and one patient had (6.7%) asymptomatic Grade 2 anterior POP. Conclusion: Minimally invasive sacrocolpopexy is an efficient and safe surgical option for prolapse repair in symptomatic advanced stage POP cases.
General Urology, Online First: 05 August 2021
Grand J Urol 2021;1(3):089-095, DOI: 10.5222/GJU.2021.14633
Objective: Applications are made to health boards for age assessment, gender determination, employment in some occupational groups and detection of disability. The aim of our study is to determine the defined urological pathologies and their incidence rates in the patients who applied to the health board of our hospital. Materials and Methods: Our study included patients who applied to the urology outpatient clinic of the health board between January 2015 and December 2020 for the purpose of employment in some occupational groups, determination of age, gender, disabilities and obtaining a general health report. Patients were investigated in two different groups, according to their indications for their applications as detection of disabilities and other indications, and the diagnoses were classified under the subheadings of stone diseases, malignancies, neurourology-incontinence, andrology and benign prostatic hyperplasia (BPH). Results: A total of 1453 cases were included in the study. Hundred and fifty-one (10.4%) patients applied for the detection of disability. A total of 206 (17%) patients, including 70 (46.3%) cases in the disability detection group and 136 (10.4%) in the other group had a urological diagnosis. The most common pathology was malignancies with 65 (4.4%) cases, in order of frequency; testicular cancer (n=25: 38.4%), bladder cancer (n=15: 23%), prostate cancer (n=13: 20%), kidney cancer (n=11: 16.9%) and penile cancer (n=1: 1,5%). The second most frequently seen diagnostic group was the stone disease group (n=55: 3.7%), and 17 (30.9%) of them required further investigation after diagnosis. Consequently ESWL (n=6: 10.9%), and surgical intervention (n=4: 7.3%) were planned for the indicated number of patients. Conclusion: Urogenital system malignancies and urinary tract stones have been identified as the most common pathologies in patients who applied to the health board. The fact that some diseases, especially urolithiasis were followed by further examination and treatment, shows the contribution of the health board examinations to the treatment as well as the health status determination feature.
Objective: To investigate the effect of ureterorenoscopic stone removal timing on kidney function in unilateral ureteral stones. Materials and Methods: Hundred and eighty-seven patients included in the study were divided into two groups: 98 patients who underwent surgery ≤14 days after the stone diagnosis constituted the Early Surgery Group and 39 patients who were operated >14 days after the stone diagnosis comprised the Late Surgery Group. Preoperative serum levels of creatinine, blood urea nitrogen (BUN), and glomerular filtration rates (GFR) were recorded for the patients in both groups. In the postoperative first month, serum creatinine, BUN, and GFR were again recorded and compared with the preoperative values. Results: The mean preoperative serum creatinine, GFR, and BUN levels in the Early Surgery Group were 1.25 ± 0.65μmol/L, 80.04 ± 33.6ml/min/1.73m2, and 50 ± 16.6mmol/L, respectively. A decrease was observed in serum creatinine (0.82 ± 0.22μmol/L, p< 0.001) and BUN (14.08 ± 7.25mmol/L, p< 0.001) levels one month after surgery, whereas GFR increased (105.33 ± 21.6ml/min/1.73m2, p< 0.001). In the Late Surgery Group, postoperative levels of serum creatinine (0.94 ± 0.33 vs. 0.95 ± 0.30μmol/L, p= 0.102), and BUN (17.38 ± 9 vs. 17.92 ± 8.8mmol/L, p= 0.283), increased minimally, also a minimal decrease was observed in GFR (95.15 ± 27.3 vs. 93.77 ± 24.3ml/min/1.73m2, p= 0.338) without any statistically significant difference. Conclusion: We believe that surgical treatment should be planned within two weeks at the latest, as prolonged obstruction may result in kidney damage.
Urological Oncology, Online First: 26 August 2021
Grand J Urol 2021;1(3):101-108, DOI: 10.5222/GJU.2021.40085
Objective: To specify the prognostic factors predicting complication rates and postoperative renal function in patients operated with partial nephrectomy. Materials and Methods: Our health center"s archive system was scanned retrospectively for the time interval between January 2006- January 2021 for patients operated with partial nephrectomy for renal mass. History, comorbidities and laboratory results, operational information, tumor morphologies in radiographic images and its specified scores (R.E.N.A.L. score, PADUA score, C-index), peroperative and postoperative complications and pathology results of 148 regularly followed-up patients were analyzed. Results: Mean age of the patients was 55.04±10.91 years, ratio of male to female was 1.27 and mean tumor size was 3.56 cm. Mean follow-up period was 55.53±42.26 months. Postoperative creatinine value in the 6th month showed an increase of 0.18 mg/dl compared to preoperative value. Estimated glomerular filtration rate (eGFR) also decreased by an average of 18.3%. Operation of grade 4 tumors significantly affected the postoperative renal function. PADUA score (p=0.023) had a significant effect on postoperative GFRs and duration of ischemia. Also, difference in pre-and postoperative GFRs and its percentage change were significantly affected by C-index (p=0.035, p=0.042). Pathological size (p=0.038), R.E.N.A.L. score (p=0.001), PADUA score (p
Renal Transplantation, Online First: 03 September 2021
Grand J Urol 2021;1(3):109-115, DOI: 10.5222/GJU.2021.75047
Objective: To investigate whether tacrolimus (Tac), mycophenolate mofetil (MMF), mycophenolic acid (MPA), prednisolone (Pred) and methylprednisolone (MP) are affect the COVID-19 pathogenesis and on its progression in kidney transplantation recipients diagnosed with COVID-19 patients. Materials and Methods: Among patients hospitalized due to COVID-19, patients who had kidney transplantation were retrospectively detected on the online database of our center. Referral complaints, laboratory and radiological data at referral, applied treatment protocols, and ultimate conditions of the patients were documented. Results: Among the total of 11 patients, 73% (8) were male and 27% (3) were female. The mean age was 49.63 (27-71). Hypertension and diabetes mellitus were the most common comorbid diseases. The most common symptoms were coughing, fever and exhaustion-fatigue. High serum reactive protein and lymphopenia were detected in almost all patients. Acute renal failure was observed in seven patients (73%). While all patients were using Tac and Pred, nine patients (82%) were using MMF and two patients (18%) were using MPA. Hydroxychloroquine, favipiravir, and azithromycin were treatments for COVID-19. RT-PCR results of 11 patients were positive in 7 and negative in 4 patients. The mean hospital stay of the discharged patients was 8.8 days. Eight patients recovered and were discharged, treatment of two intubated patients continues in intensive care unit and one patient died. Conclusion: Clinical characteristics of COVID-19 in kidney transplanted patients are similar to the general population and it should be kept in mind that the disease occurs with moderate-severe pneumonia in this patient group. Disease progress can be stopped through early treatment.
Andrology (Male Sexual Disfunction, Infertility), Online First: 09 September 2021
Grand J Urol 2021;1(3):116-121, DOI: 10.5222/GJU.2021.00719
Objective: Elevated uric acid (UA) and low levels of high-density lipoprotein (HDL) cholesterol are associated with cardiovascular events and mortality. Erectile dysfunction (ED) has been considered an early marker of cardiovascular disease (CVD). Therefore, this study aimed to investigate the uric acid/ HDL ratio (UHR) as a nowel marker in patients with ED. Materials and Methods: The study included 147 patients with a mean age of 50 years (range 32-76 years). Retrospective analyses were performed on the patients who were admitted to urology outpatient clinics. The laboratory parameter results were retrieved from the hospital medical records, and the UHR value was calculated. Patients were categorized into three groups according to the International Index of Erectile Function (IIEF) score. UHR was compared between groups, and its predictive value was evaluated using regression analysis and ROC curve analysis. Results: Age was found to be significantly different in all three groups (Groups 1-2, p=0.001; Groups 1-3, p=0.000; Groups 2-3, p=0.001). It was observed that the degree of ED increased with age. The values of UA and HDL were similar in all groups (p>0.05). In contrast, the UHR value was statistically significantly higher 0.15 (0.083-0.288, p =0.047) in the moderate-severe ED (Group 3). ROC curve analyses revealed that UHR predicted severe ED (IIEF 5-11) with 42.9% sensitivity and 87.3% specificity (AUC:0.66, CI 95% 0.538-0.781, p=0.019). Conclusion: UHR may serve as a severe ED indicator in patients admitted to the cardiology outpatient clinic since it has a significant association with a low IIEF score.
Functional Urology, Online First: 17 September 2021
Grand J Urol 2021;1(3):122-127, DOI: 10.5222/GJU.2021.10820
Objective: We aimed to investigate the efficacy of silodosin in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) refractory to previous α-adrenergic receptor (AR) blocker therapy. Materials and Methods: Patients who did not benefit from alpha-blocker therapy but avoided surgical treatment constitute the population of our study. Seventy-five patients were studied in each group; Group 1 was given 8 mg of silodosin, while Group 2 continued the previous alpha-blocker treatment. Results: The initial mean international prostate symptom score (IPSS) was calculated as 20.81±0.97 in Group 1, in the third month there was a decrease of 17.12±1.25 (p
Review Article
Urological Oncology, Online First: 19 April 2021
Grand J Urol 2021;1(3):128-132, DOI: 10.5222/GJU.2021.87598
Focal ablation therapies in prostate cancer have been actively evaluated in the light of recent literature. According to published data,focal ablation therapies appear to be well tolerated and have an acceptable side effect profile. Moreover, while clinical outcomes were not homogenous, short-term oncological results of some focal ablation therapies such as laser and irreversible electroporation (IRE) have been found as good as curative ones. While waiting long-term oncological results, focal ablation therapies in prostate cancer are beinmg used increasingly.
Neurourology, Online First: 12 July 2021
Grand J Urol 2021;1(3):133-137, DOI: 10.5222/GJU.2021.43153
The possible effect or activity of the autonomic nervous system (ANS) in urogenital disorders is still controversial. Day by day, further studies that have proved the association between chronic urological situations like chronic pelvic pain, premature ejaculation, etc., and autonomic dysfunction have been published. Understanding the actual role of the autonomic nervous system on chronic pelvic disorders will be of interest soon.
Case Report
Functional Urology, Online First: 09 April 2021
Grand J Urol 2021;1(3):138-141, DOI: 10.5222/GJU.2021.36844
Inguinal bladder herniation is seen in 1% -4% of all inguinal hernia cases; most of them are asymptomatic and come up with swelling in the groin. In symptomatic cases, nonspecific findings such as lower urinary tract symptoms or pain due to strangulation of the hernia sac are seen. Two-stage micturition (manual pressure to the scrotum to empty residual urine) is a pathognomonic sign for the advanced case. Vesicoureteral reflux (VUR), bilateral hydronephrosis, urinary tract infection, acute kidney failure and bladder wall necrosis are complications that may be seen if the problem is not appropriately managed. Preoperative diagnosis rates are low (
Urological Oncology, Online First: 09 June 2021
Grand J Urol 2021;1(3):142-145, DOI: 10.5222/GJU.2021.22931
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. An improvement was observed in the urinary system complaints of the patient who started chemotherapy regimen. While prostatectomy was performed in some of the prostatic MCL cases reported previously, in some, no additional treatment was required after chemotherapy. Our case is the only prostatic MCL case with elevated PSA levels, but did not receive the diagnosis of prostate cancer. Physicians should keep in mind that, prostatic MCL can present with nonspecific symptoms. Staging should be performed in patients whose histopathologic diagnosis is lymphoma of the prostate so as to determine appropriate treatment options.
General Urology, Online First: 14 June 2021
Grand J Urol 2021;1(3):146-149, DOI: 10.5222/GJU.2021.79188
One of the reasons for the high mortality in COVID-19 patients is the increased risk of disseminated intravascular coagulation (DIC) and venous thromboembolism. For this reason, the use of anticoagulant treatments has become widespread. One of the rare complications of anticoagulant therapy is retroperitoneal hemorrhage. These hemorrhagies require immediate intervention. Retroperitoneal hemorrhage should be kept in mind among the many complications that develop in the patient who was followed up during the pandemic period. For this purpose, we present 2 cases who developed spontaneous retroperitoneal bleeding while clinically recovering under COVID-19 treatment.
Clinical Image
Genitourinary Radiology, Online First: 31 March 2021
Grand J Urol 2021;1(3):150-151, DOI: 10.5222/GJU.2021.09797
A 55-year-old female patient admitted to the emergency department with one week long abdominal pain. In the physical examination of the patient, no clinical finding other than sensitivity was observed. The laboratory tests were normal. Because there was discordance between the patients clinical findings and laboratory tests, ultrasound exam was performed to exclude acute abdomen and a mass was detected in the anterior of left kidney's upper pole. There upon, the patient was discharged with recommendations and directed to the urology department. The patient had no history of malignancy or surgical history. Contrast enhanced abdominal magnetic resonance (MR) was performed for the lesion characterization. In the abdominal MRI, a lesion was detected in the anterior region of the left kidney's upper pole which is 36x20 mm in size. The lesion was hypointense on T2 weighted images (WI), slightly hyperintense on T1WI and had central cystic area. Since the mass was closely adjacent to the tail of the pancreas and had similar signal intensity with the pancreas on T2WI and postcontrast images, the origin of the lesion could not be made clearly between left kidney and pancreatic tail (Figure 1-5). Therefore, histopathologic verification was recommended for preoperative management. It was reported as angiomyolipoma, wihch is rich in smooth muscle and poor in fat, after staining with actin and HMB-45 along with immunohistochemical staining obtained as a result of the biopsy procedure. Figure 1: Axial T2 weighted (Contrast-enhanced abdominal magnetic resonance images of the patient) Figure 2: In phase (Contrast-enhanced abdominal magnetic resonance images of the patient) Figure 3: Out of phase (Contrast-enhanced abdominal magnetic resonance images of the patient) Figure 4: T1 Weighted, fat saturated T1 weighted (Contrast-enhanced abdominal magnetic resonance images of the patient) Figure 5: Post contrast images revealed a solid mass with central cystic area (Contrast-enhanced abdominal magnetic resonance images of the patient) Renal angiomyolipomas are the most common benign kidney tumors. Non invasive diagnostic capacity between benign and malignant lesions is not yet at the desired standard. Approximately 10-17% of the resected kidney tumors are benign, and 2-6% of them are reported as angiomyolipomas []. Angiomyolipomas contain smooth muscle tissue, blood vessels and macroscopic fat areas in varying proportions []. In most cases, it is diagnosed radiologically without any further examination due to the macroscopic fat content. In the radiological diagnosis of angiomyolipoma, we use findings such as containing densities below -10 HU in computerized tomography (CT) examination or showing suppression in fat saturated sequences in MRI []. In addition, chemical shift suppression techniques are useful in MRI in cases when there is a small amount of fatty tissue []. On the other hand, in 4.5% of angiomyolipomas, fatty tissue may not be seen radiologically []. Since the imaging findings of these fat-poor lesions, containing less than 25% fat, cannot be distinguished from RCC and they pose a serious problem []. RCCs, especially clear cell carcinomas, may also contain fat, but unlike angiomyolipomas, this adipose tissue is located at intracellular space and we use signal loss in out of phase MR sequence to differentiate RCC from angiomyolipoma []. Angiomyolipomas carry the risk of bleeding, especially in sizes over 4 cm and sometimes, fat densities can be overlooked due to intralesional bleeding and they can be confused with RCC []. Although new methods such as CT histogram [] and specific MR sequences [,] have been used in the separation of fatpoor angiomyolipoma and RCC with new developments in radiology and technology, the application and reliability of these methods in daily practice are not sufficient. Ethics Committee Approval: N/A. Informed Consent: An informed consent was obtained from the patient. Publication: The results of the study were not published in ful lor in part in form of abstracts. Peer-review: Externally peer-reviewed. Conflict of Interest: The authors declare that they have no conflict of interests. Financial Disclosure: The authors declare that this study received no financial support.