2022, Vol 2, Issue 1 - Grand Journal of Urology

Current Issue

Editorial (1) Original Article (5) Case Report (3) Letter to the Editor (1) Authors Index

Editorial

Editorial, Online First: 20 January 2022

Ekrem GUNER

Dear colleagues, I am honored to share with you the first issue of 2022 of the Grand Journal of Urology (Grand J Urol) with the contributions of many respected researchers and authors. Our journal has been indexed in EBSCOhost, J-Gate, Index Copernicus International ICI World of Journals, EuroPub and SciLit international 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 issue of our journal, there are many valuable articles under the subheadings of Andrology, Endourology, General Urology, Genitourinary Radiology, and Urological Oncology. There are three original articles related to COVID-19 and Urology, which reflect the ongoing pandemic process under the sub-title of 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 2022 Assoc. Prof. Ekrem GUNER, MD Editor-in-Chief

Original Article

Urological Oncology, Online First: 10 October 2021

Grand J Urol 2022;2(1):1-7, DOI: 10.5505/GJU.2022.41636

The Relation Between Multifocality and Clinical, Pathological and Histological Results in Renal Tumors

Bahadir Ermec, Metin Ishak Ozturk, Bilal Eryildirim, Erbil Ergenekon

Objective: In this study, histological, pathological and clinical characteristics that may affect multifocality rate and multifocality in renal tumors were investigated. Materials and Methods: A total of 162 patients who underwent radical nephrectomy with the diagnosis of renal tumor from our urology clinic and urology clinics in two other hospitals between May 2002 and April 2006 and whose results were available were included in the study. Kidney samples were evaluated regarding multifocality through sections made macroscopically at an interval of 3 mm. Results: Of the patients included in the study, 92 (56.8%) were male and 70 (43.2%) were female. The mean age of the patients was 59.98 years (22-87). In 11 (6.7%) of 162 patients, a multifocality focus was pathologically observed. Satellite lesions were radiologically identified in two (18.2%) of the patients with multifocality. On the other hand, satellite lesions could not be identified radiologically in nine patients (5.5%). Univariate and multivariate analyzes were performed to determine the relation between pathological, histological, and clinical characteristics and multifocality. There was no significant relation between age, gender, smoking, the location of the tumor, pathological stage, lymph node involvement, the presence of metastasis, the size of the tumor, and histology of the tumor. Univariate analysis results showed a statistically significant relation between renal capsule involvement and renal vein involvement and multifocality (p=0.015 and p=0.004, respectively); however, only renal capsule involvement was found to be associated with multifocality in multiple logistic regression analysis (p=0.008). Conclusion: In our multicentric study including 162 patients, the multifocality rate in renal tumors was 6.7% (11 patients). There was a significant relationship between capsule involvement and multifocality (p=0.015 – p=0.008). Meta analysis is required to determine the rate of multifocality in renal tumors and identify with which clinical, pathological, and histological characteristics it is associated.

General Urology, Online First: 22 November 2021

Grand J Urol 2022;2(1):8-14, DOI: 10.5505/GJU.2022.58067

Evaluation of the Frequency of Acute Kidney Injury in Hospitalized Patients with Benign Prostatic Hyperplasia Due to COVID-19 Pneumonia

Muge Bilge, Isil Kibar Akilli, Sengul Aydin Yoldemir, Ramazan Korkusuz, Esra Canbolat Unlu, Ekrem Guner, Kadriye Kart Yasar

Objective: Benign prostatic hyperplasia (BPH)-related acute kidney injury (AKI) occurs in male patients as a natural result of aging and androgen exposure. In our study, we investigated the frequency of BPH-related AKI and its relationship with disease severity in patients hospitalized for COVID-19 pneumonia. Materials and Methods: This is a retrospective and observational study on 869 male patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. None of the patients was admitted to the intensive care unit (ICU). 55 patients out of 869 had BPH. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. BPH and non-BPH groups were statistically compared with respect to the existence, frequency, hospitalization duration and in-hospital death. Results: Median age was 70 years for BPH group and BPH patients were significantly older than the non-BPH. Hypertension, coronary artery disease and heart failure were significantly more frequent in the BPH group. On admission, compared with normal serum creatinine, serum urea was significantly higher in the BPH patients. All AKI patients with BPH had three or more comorbidities. During hospitalization, AKI occurred in 7,3% of the BPH patients compared with the non-BPH (0,98%). The incidence of AKI was significantly higher in the patients with BPH (OR:7,94, 95% CI:2,31-27,25). In-hospital death occurred in 16,4% of the patients with BPH. The mortality was significantly lower in non-BPH group (8,6%) compared with the BPH. Our final analysis showed that age, arterial hypertension, prior coronary artery disease and heart failure were independent risk factors for occurred BPH-related AKI. Conclusions: Older male patients with common comorbidities showed a higher risk for mortality from COVID-19 pneumonia. Also, AKI patients with BPH had a poorer prognosis and higher mortality than the non-BPH patients.

Genitourinary Radiology, Online First: 06 December 2021

Grand J Urol 2022;2(1):15-20, DOI: 10.5505/GJU.2022.87599

Relationship Between SUVmax and ADC Values of Metastatic Lymph Nodes Detected by Ga-68 PSMA PET/MR in Prostate Cancer Patients

Fuad Aghazada, Ali Kibar, Rabia Lebriz Uslu Besli, Muhammet Sait Sager, Haluk Burcak Sayman, Kerim Sonmezoglu

Objective: Our aim is to assess if there is a relationship between maximum standardized uptake (SUVmax) and apparent diffusion coefficient (ADC) values of reactive and metastatic lymph nodes, also to compare ADC values of reactive and metastatic lymph nodes in prostate cancer patients. Materials and Methods: We have retrospectively investigated 20 patients diagnosed with prostate cancer who underwent Ga-68 PSMA PET/MR imaging. Three metastatic and three reactive lymph nodes classified according to the level of PSMA Ga-68 uptake in PET/MR were chosen for each patient. SUVmax and ADCmean values were calculated for each lymph node separately. SPSS version 22 was used for statistical analysis. Results: A total of 120 lymph nodes in 20 prostate cancer patients were assessed. There was a moderate negative correlation between SUVmax values and ADCmean values of metastatic lymph nodes (p=0.009, r=-0.333). However, there was no significant correlation between SUVmax values and ADCmean values of reactive lymph nodes. ADCmean values of metastatic lymph nodes were significantly lower than those of reactive lymph nodes (p=0.0001). Conclusion: PET/MR, which combines both advantages of PET and MRI, is an important tool for the diagnosis and management of prostate cancer. We have found that SUVmax values of metastatic lymph nodes were inversely correlated with ADCmean values and combination of both parameters may increase the diagnostic accuracy of Ga-68 PSMA PET/MR in the detection of lymph node metastasis.

General Urology, Online First: 21 December 2021

Grand J Urol 2022;2(1):24-25, DOI: 10.5505/GJU.2022.36035

How Did The COVID-19 Pandemic Affect Urology Publications?

Tumay Ipekci, Ahmet Asfuroglu, Ali Yildiz, Muhammet Murat Dincer, Emrah Yuruk, Murat Bozlu, Ates Kadioglu

Objective: To evaluate the effect of the pandemic on the publications related to urology. Methods: All publications about urology in the PubMed database between 2016 and 2020 were reviewed. The number and the rate of change in the number of these publications issued between the years 2016- 2019, and in 2020 were recorded. The publications about urology and COVID-19 in the pandemic period were identified, their publication rates among them were examined. Results: There was a reduction of 24.33% in the rates of publications on urology during the pandemic period compared to the time interval between the years 2016, and 2019, but without any statistically significant difference (p=0.122). A statistically significant difference was found only in the number of publications related to urological surgery between 2016- 2019 and 2020 (p=0.045), but without any statistically significant difference in the number of publications on other subdiciplines of urology (p>0.05). The ratio of publications on COVID- 19 and urology to all publications on COVID-19 was 1.33 percent. The ratio of publications on COVID-19 and urology to all publications on urology in 2020 was found to be 1.98 percent. Conclusion: The COVID-19 pandemic did not make a significant difference in the number of publications on urology. Although disasters such as pandemics may not affect the number of publications, they can change the types of publications to which scientists are directed to.

General Urology, Online First: 12 January 2022

Grand J Urol 2022;2(1):26-32, DOI: 10.5505/GJU.2022.02886

How Did The COVID-19 Pandemic Affect Urology Outpatient Clinic Applications?

Ahmet Emre Cinislioglu, Nazan Cinislioglu, Saban Oguz Demirdogen, Fatih Kursat Yilmazel, Sibel Guclu Utlu, Ibrahim Karabulut, Senol Adanur, Ozkan Polat

Objective: The Coronavirus Disease-2019 (COVID-19) is particularly more common and deadly among older men who also constitute a significant portion of urology patients. In this study, we aimed to evaluate the change in the diagnostic spectrum in urology outpatient applications after the declaration of pandemic compared to the pre- pandemic period. Materials and Methods: All patients were enrolled between February 12 and May 6, 2020. Demographic, and clinical data of the patients were analyzed pertaining to the period of 4 weeks before, and the first, and second 4 weeks after declaration of the pandemic. Data obtained from the database such as age, gender, diagnoses were anonymized. Recurrent applications with the same diagnosis within ten days after the first presentation were excluded from the analysis. Results: Compared to the pre-pandemic period a significant decrease in the number of patients applied to the urology outpatient clinics after declaration of the pandemic, and in the frequency of diagnoses of prostate diseases, and urine transport, storage and emptying disorders and a significant increase in the frequency of diagnoses of urinary system stone disease, benign or malignant bladder diseases, upper urinary system tumors, and sexual dysfunction were observed after declaration of the pandemic. Conclusion: The risk perception of COVID-19 disease may cause changes in the diagnostic distribution of patients applied to the urology outpatient clinics. During periods of outbreak, the health system must be redesigned by focusing on outpatients.

Urological Oncology, Online First: 19 September 2021

Grand J Urol 2022;2(1):33-37, DOI: 10.5505/GJU.2022.69775

Sertoli Cell Nodule with Histomorphological and Immunohistochemical Features and its Differential Diagnosis: A Case Report

Oyku Dila Gemci, Halil Firat Baytekin, Ismail Evren, Omer Yildiz

Non-germ cell testicular tumors are rarely seen. Sex-cord stromal tumors, which make up the majority of testicular tumors other than germ cell tumors, share common immunohistochemical and histomorphological features. Our aim in presenting this case is to define the Sertoli cell nodule (SCN), which is one of the relatively rare primary testicular pathologies that can be detected in half of adult undescended testes, with its histomorphological and immunohistochemical features, and to make its differential diagnosis.

Urological Oncology, Online First: 27 September 2021

Grand J Urol 2022;2(1):38-41, DOI: 10.5505/GJU.2022.70299

Distant Metastases from a Small Renal Cell Carcinoma in a Renal Allograft Recipient with Prostate Carcinoma: A Case Report

Yunus Colakoglu, Deniz Noyan Ozlu, Serdar Karadag, Zehra Sibel Kahraman, Oznur Dilek Ciftci, Mehmet Dikec, Suheyla Apaydin, Ali Ihsan Tasci

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. During the examination due to exhaustion and weight loss, multiple suspicious metastatic lesions were observed in non-contrast computed tomography. In the patient who had multiple bone metastases on the whole-body bone scintigraphy, prostate cancer metastasis was considered in the first plan due to a history of prostate cancer before transplantation. This diagnosis could not be supported with prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT) scan. Whole body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed. A hypermetabolic mass lesion in the left kidney, multiple hypermetabolic lesions in the liver, in the left aortorenal junction, and in the skeletal system were observed. A biopsy was performed from the metastatic mass in the right lobe of the liver and the result was reported as renal cell carcinoma metastasis. Immunohistochemistry evaluation demonstrated positive staining for PAX-8, CK19, CD10 and negative staining for CK7, CK20, GATA-3, NAPSIN A, TTF-1, PSAP, glutamine synthetase and arginase. With all these findings, it was thought that the primary of metastases was the 4-cm mass in the left native kidney.

Andrology (Male Sexual Disfunction, Infertility), Online First: 20 October 2021

Grand J Urol 2022;2(1):42-44, DOI: 10.5505/GJU.2022.44153

Inguinal Fistula by Suture Granuloma Post Microsurgical Varicocelectomy: A Rare Entity

Ayhan Karakose, Yasin Yitgin

Varicocele is dilatation and tortuosity of the vessels in the pampiniform plexus of spermatic cord and occurs in 11.7% of adult men. Varicocelectomy may lead to various complications such as hydrocele, testicular atrophy, haematoma, infection, damage of nerves and recurrence. A 22-year-old man presented after varicocelectomy with a rare postoperative complication of a fistula. The fistula tract was removed en bloc. The patient had a history of varicocelectomy, suggesting suture reaction. The fact that it is a rare complication of varicocelectomy makes our case interesting.

Endourology, Online First: 30 April 2021

Grand J Urol 2022;2(1):45-46, DOI: 10.5505/GJU.2022.08208

Re: Huseynov et al.: The Effects of Previous Renal Stone Surgery on Percutaneous Nephrolithotomy Outcomes (Grand J Urol 2021;1:18-21)

Emrullah Sogutdelen, Mustafa Kucukyangoz

Dear Editor, I read the article by Huseynov et al., [] in which they examined the effects of previous renal stone surgery on percutaneous nephrolithotomy outcomes with great interest. They concluded that previous renal stone surgery increases the risk of residual stone with a similar complication rate. However, I would like to highlight some issues regarding the methodology and the results of this study. Using the method of percutaneous nephrolithotomy (PNL) in the treatment of renal stones 2 cm and greater is a gold standard according to European Association of Urology guidelines []. By increasing surgeon experience and technological development of tools using in PNL surgery increase the success of the surgery and decrease the complication rate. However, it is known that the success of PNL is also affected by some other influencers such as hydronephrosis, stone location, and as well as Hounsfield unit (HU) []. Gucuk et al. [] showed that the higher HU values increase the stone-free rate and HU is an independent predictive factor affecting the success of PNL. In the study by Huseynov et al., the higher HU may influence the stone-free rate of patients in primary PNL. Therefore, we thought that it must be mentioned in the discussion. Another issue that we have to be clear about is estimated blood loss and stone size. In addition to the decrease in hemoglobin level, the estimated blood loss during the surgery was analyzed but not mentioned how was calculated in the relevant section. Furthermore, calculation of stone size was also mentioned as it was multiplying two dimensions but in the result section, it was expressed the volume of stone in mm³ which means multiplying the three dimensions. For this reason, we are curious about your method of calculating the estimated blood loss during the operation and the technique of preoperative stone size calculation. As a result, we think that other factors including stone location in the kidney affects the success PNL. Hence, it should be examined in the study, otherwise, mentioned in the limitations of this study. Ethics Committee Approval: This article does not contain any studies with human participants performed by the author. Authorship Contributions: Any contribution was not made by any individual not listed as an author. Concept – E.S., M.K.; Design – E.S., M.K.; Supervision – E.S., M.K.; Resources – E.S., M.K.; Materials – E.S., M.K.; Data Collection and/or Processing – E.S., M.K.; Analysis and/or Interpretation – E.S., M.K.; Literature Search – E.S., M.K.; Writing – E.S., M.K.; Critical Review – E.S., M.K. Conflict of Interest: The author declares that he has no conflict of interest. Financial Disclosure: No grants or funding was provided for this study.

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