Articles in Press-Grand Journal of Urology

Articles in Press

Original Article

Andrology (Male Sexual Disfunction, Infertility), Online First: 12 January 2026

Transurethral Ejaculatory Duct Resection in Infertile Patients with Aspermia/Hypovolemic Ejaculate and Midline Prostatic Cysts: Results of a Long-Term Retrospective Study

Mehmet Sefa Altay, Tugay Aksakallı, Adem Utlu, Ahmet Emre Cinislioğlu, Fevzi Bedir, Hüseyin Kocatürk, İbrahim Karabulut, Volkan Kurdal, Şaban Oğuz Demirdöğen, İsa Özbey

Objective: Midline prostatic cysts are extremely rare obstructive causes of male infertility. transurethral ejaculatory duct resection (TUR-ED) is performed as a treatment modality. This study aims to evaluate the long-term outcomes of TUR-ED. Materials and Methods: Following approval from the regional ethics committee and in compliance with the Helsinki Declaration, we retrospectively analyzed male patients who presented with infertility and underwent TUR-ED for midline prostatic cysts between January 2015 and June 2024. The patients' medical histories, semen analyses, and imaging findings were reviewed. The surgery was performed by an experienced surgeon using bipolar electrocautery. Postoperative follow-up included assessments of semen parameters, hormone levels, and complications. Statistical analyses were conducted using IBM SPSS version 2020. Results: A total of 28 patients were included in the study. Postoperatively, a statistically significant improvement was observed in semen volume, sperm concentration, and motility. The most common complications were hemospermia (25%) and epididymitis (10.7%). The mean follow-up period was 12.3 months, and pregnancy was achieved in 42.9% of patients, with 25.0% occurring spontaneously and 17.9% via assisted reproductive techniques. Conclusion: TUR-ED is an effective surgical treatment that improves semen parameters. Our long-term follow-up results demonstrate its positive impact on reproductive outcomes. However, due to potential complications, patients will be careful selection and close postoperative monitoring are essential.

Endourology, Online First: 05 January 2026

Grand J Urol 2025; DOI: 10.5505/GJU.2026.97658

Risk Factors Predicting the Need for Urgent URS in Patients Undergoing SWL for Proximal Ureteral Stones

Tugay Aksakallı, Adem Utlu, Şaban Oğuz Demirdöğen, Ahmet Emre Cinislioğlu, Feyzullah Çelik, İbrahim Karabulut

Objective: To evaluate the clinical, anatomical, and stone-related factors in patients who underwent shock wave lithotripsy (SWL) for proximal ureteral stones and to identify the risk factors associated with the subsequent need for urgent ureteroscopy (URS). Materials and Methods: Patients who underwent SWL for proximal ureteral stones were included in the study. Demographic and clinical characteristics, including age, body mass index (BMI), serum creatinine, white blood cell count, hemoglobin, and platelet count, were recorded. Stone characteristics and anatomic factors were determined using parameters obtained from non-contrast lower upper abdomen computed tomography scans: stone density (HU), stone diameter, renal pelvis urine density (HU), perirenal stranding, stone-skin distance, and ureteral wall thickness. Patients who underwent emergency URS were grouped. Logistic regression analysis was used to identify risk factors predicting the need for urgent URS in patients. Results: Among the study population, 232 patients (83.8%) did not require urgent URS (Group 1), while urgent intervention was necessary in 45 patients (16.2%) (Group 2). Patients in the urgent URS group demonstrated a significantly higher body mass index (26 [24-27] vs. 25 [24-26] kg/m², p = 0.002). Non-contrast CT findings revealed that renal pelvis urine density and stone–skin distance were markedly greater in the URS group (13 [9-36] vs. 8 [6-11] HU, p < 0.001 and 12 [6- 16] vs. 9 [7-13] cm, p < 0.001, respectively). Stone density was also higher among patients requiring URS (862 [784-1014] vs. 786 [665-956] HU, p = 0.002). In multivariable analysis, BMI (OR 1.245, 95% CI 1.025–1.512, p = 0.028), stone density (OR 1.003, 95% CI 1.001–1.004, p = 0.002), renal pelvis urine density (OR 1.032, 95% CI 1.009–1.055, p = 0.006), and stone–skin distance (OR 1.654, 95% CI 0.986–1.846, p = 0.004) remained as independent predictors. Conclusion: BMI, stone density, renal pelvic urine density, and stone–skin distance parameters may serve as useful guidance when considering SWL for patients with proximal ureteral stones. Prospective studies with larger samples are needed to support the findings.

Reconstructive Urology, Online First: 30 December 2025

Grand J Urol 2025; DOI: 10.5505/GJU.2026.83584

Staged Bulbar Urethroplasty Using Bilateral Perineal Skin Flaps as The Urethral Plate

Ali Atan, Murat Yavuz Koparal, Ender Cem Bulut, Burak Elmas, Fazlı Polat, Süleyman Yeşil

Objective: To assess outcomes of staged bulbar urethroplasty using bilateral perineal skin flaps as urethral plate substitutes in patients with obliterative or nearly obliterative bulbar urethral strictures. Materials and Methods: A retrospective analysis was conducted on 19 male patients with severe bulbar urethral strictures who underwent two-stage urethroplasty using scrotal or penile fasciocutaneous flaps. Inclusion criteria included urethral mucosa widths less than 3 mm and stricture length exceeding 3 cm. Initially, perineal skin flaps reconstructed the urethral plate. Six months later, a tubularized neourethra was created using scrotal or penile flaps. Patients were evaluated preoperatively and at 1 month and 6 months postoperatively using uroflowmetry and International Prostate Symptom Score (IPSS). Results: Patient ages ranged from 27 to 76 years, with a median of 60. The median stricture length was 4.6 cm. For those with cystostomy, median IPSS at six months post-surgery was 5 (range: 0-8). Postoperative Qmax values at first (Qmax-1) and sixth months (Qmax-6) were 22 ml/s (range: 14–26 ml/s) and 21 ml/s (range: 14–29 ml/s). In patients with urinary difficulties, the maximum urinary flow rate (Qmax) improved from 4.6 to 20 ml/s post-surgery (p = 0.0001), with IPSS reduction from 23 to 4 (p = 0.005). Complications were minimal, with no infections, fistulas, or penile deformities. Two patients developed circular strictures requiring internal urethrotomy, and three experienced terminal dribbling. Conclusion: Staged urethroplasty using bilateral perineal skin flaps is viable and effective for complex bulbar urethral strictures. This method shows favorable functional and cosmetic outcomes with low complications, particularly where single-stage repair is unfeasible.

General Urology, Online First: 23 December 2025

Grand J Urol 2025; DOI: 10.5505/GJU.2026.86570

Chatbots in Urology: A Bibliometric and Trend Analysis of the Emerging Landscape (2023-2025)

Çağatay Özsoy, Mücahit Gelmiş, Erhan Ateş

Objective: Chatbot applications powered by large language models (LLMs) have garnered growing interest in healthcare, including urology. Although recent studies suggest potential roles in patient education, decision support, and medical training, no bibliometric analysis has yet evaluated the research landscape within urology. This study aims to comprehensively reveal the current research trends and scientific contributions related to chatbots in urology. Materials and Methods: A comprehensive bibliometric analysis was conducted using the Web of Science Core Collection (Urology and Nephrology section) to identify original articles on chatbot use in urology published between January 2023 and May 2025. Data were analyzed using the Bibliometrix R package and the Biblioshiny interface. Key metrics included publication trends, citation data, keyword networks, authorship patterns, and international collaboration rates. Results: A total of 81 original articles met the inclusion criteria. The annual growth rate in publication output was 45.3%, with an average of 10.6 citations per article. Most articles appeared in Science Citation Index Expanded indexed journals. The United States (32.1%) and Türkiye (25.9%) were the most prolific countries. However, international collaboration remained low (23.5%). Urolithiasis, prostate cancer, and urinary incontinence were leading clinical themes. Keyword network analysis identified clusters focused on patient education, decision support, and chatbot performance. Conclusions: This study offers a foundational understanding of chatbot-related research in urology and highlights the need for enhanced international collaboration, clinical validation, and data integration to fully realize their transformative potential.

Pediatric Urology, Online First: 18 December 2025

Grand J Urol 2025; DOI: 10.5505/GJU.2026.59672

Effect and Results of Retrograde Intrarenal Surgery in Pediatric Patients According to Stone Size and Location

Mehmet Özay Özgür, İbrahim Halil Baloğlu, Gökçe Karlı, Kaya Horasanlı

Objective: We aimed to evaluate the effects and results of RIRS according to the location and size of kidney stones in the pediatric population. Materials and Methods: A total of 32 pediatric patients with upper urinary tract stones with 40 renal units were investigated in terms of stone size and location. Stone location, gender, stone size, stone Hounsfield unit, preoperative stenting, access sheath size, complication, length of hospital stay, and stone-free rates were retrospectively analyzed . Patients were divided into two groups. The first group patients who had stones smaller than 2cm, and the second group who had stones larger than 2 cm. Results: The mean age of the patients in Group 1 was determined as 10,8 (4-17) years, and the mean age of Group 2 was determined as 15,1 (10-17) years. The age difference was statistically significant (p: 0,003). There was no statistically significant difference in gender distribution (p: 0,289). The average stone size of Group 1 was measured as 12,6 mm (11-17), and the Group 2 stone size was measured as 25,2 mm (20-43) on average. In terms of operation times, the average operation time in Group 1 was 48 (30-70) minutes, and the average operation time in Group 2 was 65 (40-95) minutes, and a statistically significant difference was observed (p: 0.015). In the first group, the stone-free rate in a single session was 76.3%, and in the second group, the stone-free rate in a single session was 62%. There was no statistically significant difference between the groups in terms of stone-free rates (p: 0,295). Conclusion: RIRS is a method that can be used safely and effectively in pediatric patients with kidney stones smaller than 2 cm, with high stone-free rates. Although; the stone-free rate was lower in stones larger than 2 cm compared to those smaller than 2 cm, this difference was not statistically significant.