Assoc. Prof. Ekrem GUNER, MD
Dear colleagues,
I am honored to share with you the second issue of 2025 (volume 5, issue 2) 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 visualscientific 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, EBSCOhost, J-Gate, SciLit, ResearchGate 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, Pediatric Urology,
Reconstructive Urology and Urologic 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 2025
Assoc. Prof. Ekrem GUNER, MD
Editor-in-Chief
Halil İbrahim İvelik, Okan Alkış, İbrahim Güven Kartal, et al.
Artificial Intelligence (AI) and machine learning (ML) are
rapidly advancing fields with the potential to revolutionize
medical practice. AI refers to the ability of computer programs
to learn and solve problems autonomously. Within AI, ML
involves building mathematical models from input data to make
decisions without human intervention. A subset of ML, known
as deep learning (DL), uses multi-layered neural networks
that mimic brain neurons" structure and activity, significantly
enhances image recognition through neural networks [].
One specific class of DL algorithms, the Convolutional
Neural Network (CNN), is particularly well-suited for image
recognition and analysis due to its architecture, which resembles
the visual cortex. CNNs have driven substantial breakthroughs
in medical image recognition, enabling AI to classify medical
images with high accuracy. In the past, ML models relied on
hand-crafted features such as color, intensity, and texture, but
DL has surpassed these by automatically learning these features
from vast amounts of data [].
AI"s progress in medical imaging spans radiology,
ophthalmology, dermatology, pathology, neurology, and
gastroenterology, where systems like computer-aided diagnosis
(CADx) and detection (CADe) have addressed limitations in
clinical practice [,]. Advances in computing power and big
data analytics further facilitate AI integration into medical
practice.
In urology, cystoscopy is a vital diagnostic tool for
detecting urological pathologies. However, the interpretation of
cystoscopy images relies heavily on the expertise and experience
of clinicians, which can introduce variability and subjectivity
into the diagnostic process. AI-supported systems can mitigate
these issues by providing consistent and accurate image analysis,
potentially enhancing diagnostic accuracy and efficiency [].
This study develops and evaluates a CNN-based AI system
for detecting urological pathologies from cystoscopy images.
The system could be used both in clinical settings and at
home, where patients might upload images captured using
camera-equipped catheters for analysis, reducing the burden on
healthcare professionals and offering a convenient monitoring
tool for patients.
Developing such an AI system requires a multidisciplinary
approach, combining expertise in urology, computer science, and
data analytics. The involvement of clinical experts ensures that
the system is clinically relevant and meets the practical needs
of healthcare providers and patients. Additionally, the economic
and societal benefits of such a system could be substantial,
improving early detection rates and reducing healthcare costs
through more efficient patient monitoring and follow-up.
AI-supported cystoscopy image analysis represents a
promising advancement in urological diagnostics. This
paper outlines the development of our AI system, details the
methodology, and presents the results of our evaluations. By
improving diagnostic accuracy and providing a scalable solution
for patient monitoring, our system aims to enhance the overall
quality of urological care.
Metin Kılıç, Mehmet Özer, Deniz Barali, et al.
Bladder cancer ranks as the 10th most common malignancy
worldwide, with an estimated 573,000 new cases and 213,000
deaths reported annually, according to recent global cancer
statistics []. Approximately 90% of bladder cancers are
classified as urothelial carcinoma (UC), yet a subset exhibits
histological variants collectively referred to as "variant
histologies (VH)." These include micropapillary, squamous
differentiation, adenocarcinoma, and neuroendocrine carcinoma,
which comprise approximately 5–25% of all bladder tumors
depending on the studied population and diagnostic criteria [].
These variants are often associated with advanced disease stages,
aggressive clinical behavior, and distinct treatment responses.
Emerging evidence from international studies highlights
significant heterogeneity in survival outcomes among patients
with these VH. For instance, the five-year overall survival rates
for patients with micropapillary and neuroendocrine variants are
reported to be as low as 35% and 25%, respectively, compared
to nearly 60% in those with pure UC [,]. This variation
underscores the need for an in-depth understanding of the
prognostic differences among these subtypes to inform clinical
management strategies.
Despite these findings, much of the existing literature lacks
direct comparative analyses of survival metrics across VH.
Furthermore, factors such as cohort heterogeneity, variability in
diagnostic practices, and limited representation of rare subtypes
often impede the generalizability of results. This study aims
to bridge these gaps and contribute to the literature to guide
treatment approaches by systematically examining survival
outcomes across variant bladder tumor histologies.
Our study aimed to determine the survival of patients with
variant UC (VUC) and to analyze the factors affecting survival.
Understanding these differences could yield critical insights into
disease biology and improve prognostication and therapeutic
decision-making.
Alper Şimşek, Mehmet Kırdar, Aykut Başer, et al.
Circumcision, the surgical removal of the foreskin covering
the penile glans, is one of the oldest and most commonly performed
surgical procedures worldwide []. Its continued global
practice, driven by religious, traditional, and medical reasons,
sustains interest in this procedure. Despite ongoing debates regarding
its psychological and ethical implications, circumcision
remains one of the most frequently performed surgical interventions,
carried out by physicians from various specialties in many
societies today [-].
Nowadays, a number of methods are used for circumcision,
such as the Shang Ring, PlastiBell, Gomco clamp, Mogen
clamp, Smart clamp, Tara clamp, and thermocautery. The search
for more practical, cost-effective, safe, and less complicated can
be more suitable [,]. Healing period and the rate of complications
can be affected by the surgical technique and energy source
selected. Nonetheless, there are still disagreements on the best
circumcision technique. Thermocautery has been more wellliked
recently as an economical and useful technique. Thermocautery
is a device that cuts tissue with a high-temperature metal
tip while simultaneously providing coagulation. Unlike electrocautery,
it uses a directly heated metal tip and does not transmit
electric current directly to the tissue. The main advantages of
this method include effective hemostasis during cutting, minimal
bleeding, shorter procedure time compared to traditional
surgery, and ease of use in field conditions due to its portability
and low cost. However, thermocautery carries risks of thermal
damage such as burns and delayed wound healing in surrounding
tissues due to heat [].
The aim of this study is to compare the modified three-stage
circumcision technique performed with the aid of a thermocautery
device (Electroteknik Medical, İzmir) (Figure 1) in response
to the high demand for circumcision in our region, and to
contribute to the circumcision literature.
Figure 1. Thermocautery device
Tolga Çiftpınar, Gözde Şahin, Süleyman Şahin, et al.
Due to the nature of oncological cases, morbidity and
mortality in gynecological oncological surgeries are higher than
in gynecological surgeries performed for benign reasons. In
gynecological oncology surgeries, the gastrointestinal, urinary,
and vascular systems can also be a part of the surgery. The
close proximity of the genital and urinary systems increases
the possibility of injury in these areas. Iatrogenic injuries
may occur for reasons such as tumor tissue disrupting the
nutrition in that area, changes to the anatomical structure, the
radiotherapy used in adjuvant treatment destroying the tissues,
and larger resections being made to perform maximal surgery.
The incidence of urinary system complications in benign
gynecological surgeries is reported as 0.3%-1.8% []. While
most of the studies published in the literature describe the results
of benign gynecological operations, very few of them belong to
gynecological oncology cases []. Bladder and ureter injury rates
in gynecological oncological cases range from 1.1% in simple
hysterectomies performed for uterine cancers to 5.3% in radical
hysterectomies []. Although it is difficult to determine the exact
incidence because symptomatic cases are generally published,
developing technology and increased surgical experience have
led to a decrease in urological complications. In this study, we identified iatrogenically developing urological complications in
gynecological oncological surgeries in our clinic and evaluated
them in light of the literature.
Çağatay Özsoy, Erhan Ateş, Ahmet Emre Yıldız, et al.
Urethra is a rare location for urinary system stones,
accounting for less than 1% of all cases []. The majority of
urethral stones are found in the posterior urethra []. These
stones can be asymptomatic, but they may also present with
obstructive symptoms, recurrent urinary tract infections, and
even acute renal failure [,]. One of the rare causes of urethral
stones is urethral diverticula, which can occur as long-term
complications after hypospadias repair []. While hypospadias
surgery is the most common cause of acquired diverticulum in
children, it is not the leading cause in adults []. Diverticula that
develop following hypospadias repair, especially when flaps
from the scrotum or penile skin are used, may contain hairbearing
urethra. The stones found in these hair-bearing urethral
diverticula can grow to very large sizes and may be asymptomatic.
In the existing literature, there have been no reports of urethral
stones causing infertility. Additionally, only one documented
case of infertility caused by a urethral diverticulum has been
reported, and that involved a congenital diverticulum. Our case,
involving a secondary diverticulum with a giant urethral stone
leading to infertility, presents a unique scenario that has not
been previously described. To our knowledge, this is the first
case report of urethral stone in a urethral diverticulum causing
infertility. We present the following case in accordance with the
CARE reporting checklist.
Yassir Benameur, Hommadi Mouhcine, Omar Ait Sahel, et al.
Prostate cancer (PC) is among the most common malignancies
in men, underscoring the importance of early detection and
surveillance for effective management. Imaging plays a pivotal
role in diagnosing, staging, and monitoring PC, particularly
in identifying recurrence post-treatment. 18F-Fluorocholine
(18F-FCH) PET/CT has emerged as a key modality in this
context, leveraging the heightened choline metabolism
characteristic of prostate cancer cells. This metabolic shift,
driven by upregulated choline transporters and increased choline
kinase activity, leads to the accumulation of radiolabeled choline
in malignant tissue [].
18F-FCH PET/CT demonstrates high diagnostic accuracy
in detecting local recurrences and distant metastases, especially
in patients with rising prostate-specific antigen (PSA) levels,
thereby guiding therapeutic decisions []. Its superiority over
conventional imaging is evident in cases where other modalities
fail to identify recurrence []. However, false-positive results
remain a challenge, as non-malignant conditions such as benign
adrenal adenomas can mimic malignancy.
Adrenal incidentalomas, asymptomatic adrenal masses
discovered incidentally, are increasingly identified due to
widespread cross-sectional imaging use. These lesions occur
in up to 10% of the general population, with benign adenomas
comprising 50-70% of cases []. In PC patients, distinguishing
adrenal adenomas from rare metastases is critical, as
management differs markedly: benign lesions typically require
no intervention, whereas malignancies may necessitate surgery
or systemic therapy [].
