Grand Journal of Urology
E-ISSN : 2757-7163

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Dear colleagues, I am honored to share with you the third issue of 2023 (volume 3, issue 3) 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 General Urology, Neurourology, Urolithiasis 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 January 2024 Assoc. Prof. Ekrem GUNER, MD Editor-in-Chief
Erdem Akbay, Erim Erdem, Selahittin Cayan, et al.
Advances in telecommunication technology such as mobile internet devices have changed medical educational practices in academic centers. Today, the biggest benefit of the use of mobile phones and laptops for education is that they provide a great deal of freedom regarding the time and place at which information is obtained []. In recent years, the transfer of educational programs to virtual platforms has begun to take its place in medical education. Applications used in other fields of education have become important tools when used for medical education []. The development of instant messaging applications, especially on mobile phones, has gained popularity among healthcare professionals and medical students. Traditional medicine education continues to be the cornerstone of many educational institutions in the world. In addition to traditional education, the use of mobile devices will be essential for the education and exams of medical students, interns, and medical residents [-]. There is limited information in the literature about the place of hybrid models in urology. In this study, we have compared training success rates between traditional and hybrid model of education among 4th-year medical students rotating in urology clinics of a university hospital.
Sinan Eliacık, Aykut Baser, Funda Uysal Tan
Chronic migraine (CM) is a disease that negatively affects the quality of life of individuals, and it is more common in women, it affects approximately 12% of the general population. Similarly, overactive bladder (OAB), the most common subtype of urinary incontinence, has also an adverse effect on life quality. Unfortunately, most women hardly reveal their complaints, living with the course despite worsening of OAB symptoms. Altman et. al. have documented the association between OAB and various somatic disorders []. The comorbidity between CM and OAB was also supported by other studies, however, both disorders have complex multifactorial etiopathogenesis affected by both environmental and genetic factors []. Thus, the physiopathological basis of the possible association between CM and OAB remains obscure. Based on the study in which we found an association between CM and OAB; suspecting a common etiopathogenesis behind the comorbidity, we aimed to determine whether migraine prophylaxis would affect the symptom severity of OAB []. Thus, we evaluated the changes in OAB symptoms in patients given migraine prophylaxis treatment.
Kenan Yalcin, Erim Ersoy
With the higher prevalence of surgical interventions that reduce renal blood flow such as transplantation, trauma, anatrophic nephrolithotomy, nephron-sparing surgery, and renal artery surgery ischemia-reperfusion injury has been more frequently cited in the literature. In ischemia, oxygen required to maintain aerobic metabolism is not supplied to the living tissue. Recovery of normal blood flow after a period of ischemia is called reperfusion. Since the self-control of the metabolism of the oxygen entering the atmosphere with reperfusion of the organ that remains ischemic for a while deteriorates, free oxygen radicals (FORs) with their toxic effects become manifest and cause ischemia-reperfusion injury in the tissue. Along with emerging FORs, activation of various proteases and phospholipase A2 by calcium entering the cell during ischemia is also a response to ischemia-reperfusion injury [-]. The response that organs give to experimental ischemiareperfusion injury was very well specified in the rats and rats were preferred as experimental animals in most of the literature studies [-]. During ischemia, the tissue is damaged by asphyxiation and when the normal blood flow is retrieved, tissue damage aggravates greatly as a result of a series of events caused by the oxygen entering the atmosphere [,]. Mitochondrial electron transport chain reactions, inhibition of arachidonic acid metabolites, increase in intracellular calcium levels, xanthine oxidase system, iron ion, etc. involve in the production of FORs which induce ischemia-reperfusion injury in the kidney tissue. These factors affect each other sequentially and disrupt cell functions, increase membrane destruction, and result in the production of endogenous toxins [-]. The only way of treatment in ischemic kidneys is to increase the renal blood flow through reperfusion. Yet in that case reperfusion damage inevitably occurs. In such a case, since the increase of blood supply is inevitable, it is necessary to look for solutions to prevent reperfusion damage. Many agents such as vitamin E, melatonin, phospholipase type 3 enzyme inhibitors (amrinone, olprinone), adenosine, n-acetyl cysteine, nitric oxide (NO), calcium channel blockers, mycophenolate mofetil have been used in order to prevent or alleviate renal ischemia-reperfusion injury associated with various etiologic factors [,]. Diosmin-hesperidin is produced by the purification of flavonoid extracts of a plant found in the nature. Daflon is a phlebotonic and vasculoprotector agent that is comprised of 90% diosmin and 10% hesperidin. Hesperidin reinforces the activity of diosmin, improves wound recovery by acting against inflammatory mediators and protects microcirculation via decreasing blood viscosity []. Diosmin-hesperidin has also shown anti-inflammatory effects through many mechanisms of action in our study. Many studies have been conducted on significant ischemia-reperfusion injury preventing effects of diosmin-hesperidin in multiple organs such as heart, brain muscle tissue, and peritoneum [,]. Diosmin-hesperidin is an important antioxidant drug combination. Leukocyte aggregation is important in ischemiareperfusion injury and damage can be prevented with diosminhesperidin at daily oral doses of 500 mg. Also, this drug combination reduces the amount of H2O2 released from leukocytes by suppressing activity of myeloperoxidase (MPO). A decrease in the MPO activity can explain the decrease in H2O2 in the group that received diosmin-hesperidin at doses protecting against oxidative stress associated with glutathione (GSH). Diosmin-hesperidin given at doses protecting against oxidative stress associated with GSH guards the escape of macromolecules from the microvascular structures. According to histopathological data, diosmin-hesperidin prevents infiltration of leukocytes into the perivascular area. Although it does not totally prevent leukocyte infiltration, a significant reduction in leukocyte accumulation in the perivascular area in the kidney was observed []. We have aimed to experimentally investigate the activity of diosmin-hesperidin, which acts against inflammatory mediators in ischemia-reperfusion injury and protects microcirculation by decreasing blood viscosity in cases with renal ischemiareperfusion injury.
Muhittin Atar, Abdullah Turan, Ali Haydar Yilmaz, et al.
Urinary system stone disease is one of the oldest diseases affecting human health. The prevalence rate of stone disease varies between 1 and 20%, depending on climate, ethnic characteristics, genetics, and dietary habits. Among individuals with stone disease experiencing at least one episode in their lifetime, the recurrence rate has been reported to be approximately 50% []. The prevalence of stone disease is 3-11% in Europe; however, in regions with hot climates, such as Africa and the Middle East, it can reach 20% [,]. In Türkiye, this rate was found to be 14.8% according to a study conducted by Akınci et al. []. Non-contrast computed tomography (CT) has now replaced urography as the gold standard due to its high sensitivity and accuracy in diagnosing urolithiasis and the incorporation of new techniques to reduce radiation doses [,]. In addition to the diagnosis of urolithiasis, CT also provides important information concerning stone location, stone density, stone size, stone volume, stone-to-skin distance, hydronephrosis, and perinephric stranding. Stone density is determined by measuring the Hounsfield unit (HU) of the stone on CT. Through these measurements, the hardness, composition, heterogeneity, or homogeneity of the stone can be calculated. This information is important for clinicians to determine the fragility of the stone [-]. Evaluation of stone density has been integrated into daily medical practice to decide on the best treatment option for urinary tract stone disease. It has been suggested that HU affects the success of lithotripsy in treatment methods such as extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotomy (PCNL) [-]. We hypothesized that stone density would affect the duration of lithotripsy performed with a Holmium laser as well as the postoperative stone-free outcome. Thus, large-volume kidney and ureteral stones with low stone density can be treated with URS and RIRS, and stone density can be an important determinant in case selection. In this study, we aimed to investigate the effect of stone density on the success of URS and RIRS in the treatment of kidney and ureteral stones.
Kenan Yalcin
Wilms tumor (WT) is the most common renal tumor in childhood period, affecting one in 10,000 children [–]. It is mostly seen between the ages of 2-4. WT is an embriological tumor that classicaly shows a triphasic histological complex structure originating from blastem, epithelial and stroma components. Besides that it may also includes cartilage, osteoid and neuronal elements []. The WT treatment is implemented with two distinctive methods: The Europe"s International Society of Pediatric Oncology (SIOP) method which adopts the principle of initiating chemotherapy (CT) without tissue diagnosis and then surgical application and North America"s National Wilms Tumor Study (NWTS), now known as the Children"s Oncology Group method (COG) which carries out a treatment plan with tissue diagnosis. Primarly providing CT contributes to preventation of phase escalation due to tumor cells being shed during surgery and surgical complications that may occur in the presence of large-sized or thrombus but besides that has a disadvantage of providing unnecessary CT to the cases diagnosed histopathologically other than WT. In NWTS/COG method, although tissue diagnosis is the main criterion, the principle of providing CT first is adopted in very large tumors, bilateral cases and the presence of thrombus extending into the IVC or atrium. However, the most important factor determining the prognosis in both methods is the phase of tumor, whether it contains anaplasia and the positivity of biological indicators such as 1p, 16q LOH veya 11p15q LOH [,,]. Surgery is one of the key factors in WT treatment. Transperitoneal radical nephrectomy is standard operation for unilateral WTs. Nephron sparing surgery is suggested to be implemented in selected patient cases with single kidneys or bilateral WT. In this case report, a patient who diagnosed with Wilms tumor in right kidney at the age of 4 and underwent partial nephrectomy which is rarely implemented or suggested to be implemented in selected cases is represented.
Somanatha Sharma, Kiritha Ranjani Ac, Sethu Ram Sharma
Chest wall malignancies are considered rare, constituting approximately 1% of all malignancies. These malignancies may originate primarily from bone or soft tissue, result from the infiltration of adjacent organ malignancies, or occur secondary to distant metastasis, with the latter being the predominant cause []. Prostate cancer, ranking as the second most diagnosed cancer in men and the fourth most common overall, typically exhibits metastasis to various sites, including bone, lymph nodes, lung, bladder, liver, and adrenal glands []. While the literature reports prostatic metastases to almost every organ in the body, involvement of the sternum is notably infrequent in prostate cancer cases []. Within sternum involvement, osteosclerotic metastasis have been documented, yet osteolytic metastasis in the sternum due to prostate cancer remains an exceedingly rare occurrence, lacking documented cases in medical literature []. This article presents a noteworthy case of metastatic prostate cancer, wherein the clinical presentation manifested as a sizable sternal mass. Further evaluation revealed an expansile osteolytic sternal body metastasis in a 75-year-old gentleman. The peculiarity of this manifestation, along with its diagnostic and therapeutic challenges, underscores the need for a detailed examination of such atypical cases.
Saurabh Kumar Negi, Sandip Desai, Gaurav Faujdar, et al.
Amyloidosis is a rare disease characterized by deposition of extracellular, hyaline and proteinaceous material in various organs. Amyloidosis can be primary, secondary, and hereditary. Localized amyloidosis of the urinary bladder is rare easily confused with an infiltrating tumor on imaging and cystoscopy []. Accurate diagnosis depends on biopsy showing negative malignant cells and presence of amyloid fibrils on cong red staining.

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Prostate Cancer with Osteolytic Sternal Metastasis: A Rare Clinical Presentation

Chest wall malignancies are considered rare, constituting approximately 1% of all malignancies. These malignancies may originate primarily from bone or soft tissue, result from the infiltration of adjacent organ malignancies, or occur secondary to distant metastasis, with the latter being the predominant cause. Prostate cancer typically exhibits metastasis to various sites, including bone, lymph nodes, lung, bladder, liver, and adrenal glands.

Comparison of Fixed and Ramping Voltage Extracorporeal Shockwave Lithotripsy with Acute Kidney Injury Biomarkers: Prospective Randomized Clinical Study

ESWL has been used successfully for many years in the minimally invasive treatment of upper urinary tract stone disease. Although ESWL is considered a minimally invasive treatment, it has been shown to cause various short- and long-term structural and functional changes in the kidney. Short-term renal damage may be due to vascular or tubular mechanical trauma or oxidative stress due to free radical formation causing ischemia-reperfusion injury in the renal capillary system.

Effect of Preoperative Kegel Exercises on Continence Rates After Open Radical Prostatectomy

Kegel exercises are defined to strengthen the muscles of pelvic floor, involving rapid and sustained voluntary contractions of the pelvic floor muscles to improve sexual function and urinary incontinence. Studies examining the effect of Kegel exercises on urinary incontinence after radical prostatectomy have obtained conflicting results.

The Effect of Curcumin on Penile Fibrotic Plaque in Rats with Experimental Peyronie’s Disease

Peyronie’s disease (PD) is a condition that progresses with fibrosis in the tunica albuginea (TA) layer of the penis and therefore causes penile pain, curvature, and sexual dysfunction. Despite being frequently seen, its aetiology and pathophysiology are not yet fully understood []. Factors such as trauma, frequency of sexual intercourse, diabetes mellitus, Dupuytren’s contracture, family history, gout, plantar facial contracture, radical prostatectomy, tympanosclerosis, Paget’s disease, beta-blocker use, advancing age, genetic predisposition, smoking, hypertension, and tissue ischemia may play a role in the aetiology.

A Rare Clinical Condition That Can Mimic Bladder Malignancy: Primary Bladder Amyloidosis

Amyloidosis is a rare disease characterized by deposition of extracellular, hyaline and proteinaceous material in various organs. Amyloidosis can be primary, secondary, and hereditary. Localized amyloidosis of the urinary bladder is rare easily confused with an infiltrating tumor on imaging and cystoscopy. Accurate diagnosis depends on biopsy showing negative malignant cells and presence of amyloid fibrils on cong red staining.

Anuria in a Child Secondary to Rupture due to Ureteropelvic Junction Obstruction in a Solitary Functioning Kidney Following Trivial Trauma: An Incidental Finding

Pediatric kidneys are more susceptible to trauma due to poor protective mechanisms due to immature and more pliable thoracic cage, weak abdominal wall musculature and inadequate perirenal fat. Ureteropelvic junction obstruction (UPJO) is one of the most frequently found renal anomaly, and pelvicalyceal (PCS) rupture is a rare presentation whose diagnosis may be delayed due to lack of hematuria and unnoticed trauma. We present a case of child with PCS rupture in solitary functioning right kidney following trivial trauma.


Focal Ablation Therapies in Prostate Cancer

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.

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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.  
In the evaluation of a 32-year-old male patient who was referred to our clinic with the complaint of gynecomastia and primary infertility, ennuchoid structure, hypergonadotropic hypogonadism, and azoospermia were detected. Based on these findings, the genetic evaluation revealed the presence of 48XXYY syndrome. In this case report, we aimed to report the diagnostic algorithm and management of 48 XXYY syndrome. It should be noted that fertility should not be expected in patients with 48XXYY syndrome.
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.
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.