Grand Journal of Urology
E-ISSN : 2757-7163

Current Issue
Dear colleagues, I am honored to share with you the second 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 abstracted/indexed in J-Gate, Index Copernicus International ICI World of Journals, 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. 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. In this issue of our journal, there are many valuable articles under the subheadings of Andrology, General Urology, Laparoscopic and Robotic Surgery, Pediatric Urology, Renal Transplantation 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 2022 Assoc. Prof. Ekrem GUNER, MD Editor-in-Chief
Original Article
Urological Oncology, Online First: 10 March 2022
Grand J Urol 2022;2(2):047-052, DOI: 10.5505/GJU.2022.02986
Objective: To evaluate the impact of radical prostatectomy (RP) and extended pelvic lymph node dissection (EPLND) on the disease process in terms of oncological outcomes and quality of life in the treatment of clinical stage C T3N0M0 prostate cancer (PCa). Materials and Methods: The data of patients with cT3N0M0 who had undergone open radical prostatectomy and extended pelvic lymph node dissection in our clinic between January 2015 and March 2021 were analyzed retrospectively. Preoperative and postoperative data were compared in terms of oncological and functional outcomes. Biochemical recurrence was accepted as detection of PSA >0.2 ng/ml on consecutive measurements and biochemical disease-free survival time was calculated. Results: The mean age of 23 operated patients who met the study criteria, was 66.8±7.4 years. In the pathological staging, the organ-confined disease was detected in 10 (43.4%) patients. Surgical margin positivity was observed in 6 (26.2%), while lymph node positivity in 3 (13.1%) patients. Biochemical recurrence was detected in 7 (30.2%) patients during a mean follow-up period of 33.6±22.9 months. The mean biochemical disease-free survival time was 48.4±6.3 months. In the evaluations of the patients at the postoperative 6th months, a 3.2±2.2-point decrease was found in the International Prostate Symptom Score (IPSS) (p=0.001) and a 13.1±5.0 point decrease in the International Index of Erectile Function (IIEF) score (p=
Renal Transplantation, Online First: 23 March 2022
Grand J Urol 2022;2(2):053-057, DOI: 10.5505/GJU.2022.70288
Objective: This study aimed to evaluate whether computed tomography (CT) can replace scintigraphy for the preoperative evaluation of split renal function (SRF) and to determine the agreement between different CT volumetric measurement methods used so as to demonstrate this function. Materials and Methods: The split renal function (SRF) percentage of living kidney donor candidates was determined by diethylenetriamine pentaacetic acid (DTPA) perfusion scintigraphy. The modified ellipsoid volume (MELV), semi-automatic total kidney volume (STKV) and semi-automatic renal cortex volume (SRCV) of the candidates who underwent contrast-enhanced CT were measured and the percentages of both kidney volumes were calculated. The inter-method agreement was evaluated using Pearson's correlation test and the Bland-Altman plot test. Results: There was no correlation between the right and left kidney SRF and MELV (r=-0.033 and r=-0.092), MELV% (r=0.076 and r=0.076), STKV (r=-0.005 and r=-0.120), STKV% (r=0.175 and r=0.172), SRCV (r=-0.001 and r=0.130) and SRCV% (r=0.205 and r=0.183). There were significant correlations between the right MELV and STKV (r=0.855) and SRCV (r=0.813), and between the left MELV and STKV (r=0.787) and SRCV (r=0.770). Conclusion: Although CT provided detailed preoperative anatomical information, volumetric measurements did not show agreement with SRF. The agreement of each 3 volumetric examinations within themselves made us think that disagreement with SRF was independent of the volumetric method chosen.
Pediatric Urology, Online First: 25 April 2022
Grand J Urol 2022;2(2):058-063, DOI: 10.5505/GJU.2022.87596
Objective: In the present study, we aimed to investigate the relationship between primary monosymptomatic enuresis nocturna (MEN) and chronotypes in children. Materials and Methods: Fifty children diagnosed with primary MEN and 50 healthy children were included in the study. All participants underwent the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)-based psychiatric, and a semi-structured interview, the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version, K-SADS-PL. The information obtained from the socio-demographic data form and Children's Chronotype Questionnaire (CCTQ) for the patient and the control groups were recorded and statistical analyses were carried out. Results: Evening chronotype was significantly more often observed in the patient group (X2=6,225, SD=2, p=0.044). No difference was found between the groups with regard to morning and intermediate chronotypes. In the patient group, the time of going to bed, turning off the lights, the time to start sleeping and mid-sleep time were significantly delayed in free days (p=0.001, p=0.005, p=0.004, and p=0.004, respectively). The sleep duration and the time spent in bed were also significantly shorter in the patient group (p=0.029, p=0.004, respectively). Conclusion: Primary MEN is associated with circadian rhythm disorders and evening chronotype. As the mechanisms that lead to this condition is not clear yet, further studies with randomized controlled design and larger sample size are required to determine etiopathogenesis and treatment options, and also to reveal the association between MEN and chronotypes.
Laparoscopic and Robotic Surgery, Online First: 06 May 2022
Grand J Urol 2022;2(2):064-071, DOI: 10.5505/GJU.2022.68077
Objective: Evaluation of surgical, oncological and functional results in patients with prostate cancer and enlarged median lobe who underwent robot- assisted radical prostatectomy (RARP). Materials and Methods: Medical records of 489 patients who underwent RARP between August 2009 and December 2013 were retrospectively evaluated. Among them, 40 patients who had enlarged median lobe were included in Group 1. Forty patients without median lobe hyperplasia were included with matched analysis (Group 2). Patients who were followed up for 12 months were assessed. Results: No significant differences were found between the two groups in terms of demographic values, erectile function, preoperative PSA levels, prostate dimensions, distribution of clinical stages, Gleason scores and D"Amico risk classification (p˃0,05). Perioperative data revealed that mean operative times were 219.9 ± 64.5 (130-360) min and 185.6 ± 57.1 (120-355) min in Groups 1 and 2, respectively which was significantly prolonged in Group 1 (p˂0.05). Bladder neck reconstruction was performed in Groups 1 (n=14: 5%) and 2 (n=1: 3%). Rates of full continence after removal of urethral catheter on day 7 and at the end of months 1, 3, 6 and 12 were similar in Groups 1 and 2 (p˃0.05). Rates of potency and biochemical recurrence were similar at the end of the postoperative 6 months and one year in Groups 1 and 2 (p˃0.05). Conclusion: RARP in patients with prostate cancer with an enlarged median lobe is a challenging operation with significantly longer operative times. With its inherent procedural difficulties, RARP is a good treatment option in patients with prostate cancer and an enlarged median lobe with its successful surgical dissection and anastomosis possibilities.
Case Report
Urological Oncology, Online First: 25 February 2022
Grand J Urol 2022;2(2):072-075, DOI: 10.5505/GJU.2022.18209
Cystic nephroma is a rare, multicystic, non-hereditary benign lesion that does not contain solid components. The fact that this entity can not be easily distinguished from other cystic tumors of kidney creates difficulties in diagnosis and treatment. We present a 37-year-old male case with incidentally detected two cystic masses in his left kidney. After nephron-sparing nephrectomy, the histopathology of one of the cystic mass of the patient was reported as renal cell cancer and the other as cystic nephroma. Cystic nephroma is a rare tumor of the kidney. Definitive diagnosis can be made histopathologically rather than using physical examination and imaging methods. We reviewed the literature by presenting our case that had 2 cystic lesions in the same kidney, one of which was renal cell cancer and the other was cystic nephroma.
Urological Oncology, Online First: 09 May 2022
Grand J Urol 2022;2(2):076-079, DOI: 10.5505/GJU.2022.14622
Splenogonadal fusion (SGF) is a very rarely seen congenital anomaly localized usually in the left testis and mimics a testicular tumor. There are two subtypes of SGF, as continuous and discontinuous SGF. Continuous SGF can usually be detected in childhood. The less common discontinious SGF may not be detected until adulthood, and may be mistaken for testicular tumor and cause unnecessary orchiectomies. In this case report, we aimed to present a patient who underwent orchiectomy due to a left testicular mass associated with hydrocele and was found to have discontinuous SGF in his histopathological evaluation.
General Urology, Online First: 13 May 2022
Grand J Urol 2022;2(2):080-084, DOI: 10.5505/GJU.2022.57441
Concurrence of emphysematous pyelonephritis related to renal tuberculosis and iliopsoas abscess is exceedingly rare, and its coexistence with COVID-19 pneumonia presented as "diabetic ketoacidosis" may have fatal consequences. A 46-year-old diabetic female patient was manifesting signs of septic shock; unconsciousness, febrile episodes, tachycardia and tachypneia when she was first admitted to our emergency department. She had positive real-time PCR test results for COVID-19 four days before her admission with symptoms of abdominal pain, fever, nausea, weakness, chest tightness, and shortness of breath persisting for a week. Blood test results were consistent with diabetic keto acidosis. Computed tomography (CT) showed left-sided emphysematous pyelonephritis and iliopsoas abscess. The patient was managed using percutaneous drainage and empirical antibiotics. Besides, renal tuberculosis was identified in the patient who did not respond to the treatment offered. A poor glycemic control may cause various fatal clinical complications. Concurrence of emphysematous pyelonephritis and iliopsoas abscess may be devastating for the patient that must be promptly managed to avoid any occurrence of septic shock. As the response to the treatment offered was inadequate, the coexistence of other disease states as renal tuberculosis was contemplated.
Letter to the Editor
Andrology (Male Sexual Disfunction, Infertility), Online First: 25 March 2022
Grand J Urol 2022;2(2):085-086, DOI: 10.5505/GJU.2022.36854
Dear Editor, We have read with great interest the study entitled "Factors Affecting TESE Success in Infertility Treatment: Preliminary Results of Single-Center Experience" published in the first issue of your journal []. Both techniques are very common in daily urology practice. Epigenetic changes already create many problems that we will insidiously pass to the next generations. One of the most obvious consequences of epigenetic disorders affecting the male gender is the deterioration in sperm parameters. Decrease in sperm parameters and fertility rates have necessitated acceptance of lower sperm parameters as criteria of fertility compared to those defined by WHO []. The decreased sperm parameters and even the absence of sperm in the ejaculate (nonobstructive [NOA] or obstructive azoospermia) have led to the birth of new sperm retrieval methods. Microdissection testicular sperm extraction (micro-TESE, mTESE) which is a surgical sperm retrieval method under local anesthesia with the aid of a magnifying glass was first defined by Schlegel in 1999 []. The success rate of mTESE even in experienced hands is around 50%. The selection criteria of study population in published reports also directly affect the success rates. In particular, success rate increases in studies in which patients with chromosomal abnormalities are excluded []. Nevertheless, such a high success rate of 100% in this study may not be explained by only excluding patients with Klinefelter and/or Sertoli cellonly syndrome from the study. As stated, the creation of a large population in the planning phase of the study will result in rates compatible with the literature. Also in order to expound the study design more clearly, the indications that were taken into consideration when TESE or mTESE was preferred between the two groups, and previously applied assisted reproductive technologies should be displayed in detail. One of the arguments used to predict success of mTESE was the FSH level in the blood. In large series, although increased FSH levels in infertile men have been shown to be associated with impaired spermatogenesis, a low-to-moderate relationship between sperm recovery rates and FSH elevation could be shown []. The value of genetic examination is strongly proven in predicting sperm recovery rates other than FSH in patients scheduled for TESE. Although not specified in this study, it is important to search for Y chromosome deletion in the patient population with nonobstructive azoospermia before TESE. In the etiology of infertility, the most common genetic defect after Klinefelter syndrome is Yq microdeletion and the defects in the AZF gene region are very useful in predicting sperm retrieval. Thanks to a pre-procedural genetic examination, medical conditions where it is impossible to obtain sperm can be detected and unnecessary morbidity can be avoided. In NOA cases, especially in patients with genetic disorders, mTESE can effectively find spermatozoa and minimize the risk of complications. Nevertheless, more research is required to better understand the complex pathophysiology underlying NOA and to find more accurate predictors of sperm recovery rates. Sincerely yours,