Dear colleagues, I am honored to share with you the second issue of 2024 (volume 4, 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 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 Functional Urology, General Urology, Urological Oncology and Urolithiasis. 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 September 2024 Assoc. Prof. Ekrem GUNER, MD Editor-in-Chief

Prostate cancer (PCa) is one of the most common diseases among men []. Over one million transrectal ultrasoundguided prostate biopsies (TRUS-Bx) which are among the gold standard diagnostic procedures for PCa have been performed annually []. Although TRUS-Bx is an invasive procedure, it can be performed safely, even under outpatient conditions. Patients often feel pain during the procedure, and such methods as intrarectal application of local anesthetics and periprostatic nerve blockade are implemented before TRUS-Bx to reduce intraprocedural pain []. Despite the use of various methods of anesthesia, approximately 16% of patients experience moderate to severe pain during the procedure and 18% of them state that they will not accept application of such a procedure again []. The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" and notes that "pain is always a subjective feeling" []. So, pain is a subjective unpleasant experience and therefore has an emotional impact []. Pain can only be assessed self-reportedly because it is the unique cognitive process of previous pain experiences of an individual concerning duration, and intensity of pain, social parameters, emotional stress, and memory. The sensory components of pain are felt when the impulses are trensferred to the lateral thalamus, somatosensory cortex, and finally to posterior insular cortex []. The pain threshold is defined as the minimal level of pain that an individual can recognize. To induce painful stimuli, commonly, four different types namely pressure, electrical, thermal, and laser-induced pain assessment techniques are used. However, pain scores can only be assessed subjectively, and individuals rate the pain according to their own previous experiences []. Local anesthesia whose effectiveness in reducing intraprocedural pain has been shown in placebo-controlled studies is commonly applied to the periprostatic region during prostate biopsy [-]. However, despite perception of pain is reduced after application of anesthesia, patients still feel pain during biopsy []. Predicting patient's discomfort during the procedure with anxiety, pain assessment before TRUS-Bx might be useful in reducing the intraprocedural pain of the patient. Thus, decreasing patient's discomfort can reduce the rate of refusals for a repeat biopsy. In this study, we investigated the relationship between emotional status and pain assessments in patients scheduled for TRUS-Bx and the pain they felt during the biopsy procedure.

According to the American Urological Association / Endourological Society Guidelines, percutaneous nephrolithotomy (PCNL) is recommended for patients with a stone burden greater than 2 cm or staghorn stones in the pelvis []. PCNL which is performed by puncturing the renal parenchyma, is more successful in terms of stone removal compared to other endoscopic procedures, but with an increased risk of complications. With the technological developments on PCNL, it has been associated with lower rates of postoperative complications, lesser pain, shorter hospital stay and decreased hospital readmission (HR) rates [,]. HRs and emergency room (ER) readmissions after hospital discharge are considered as negative indicators of healthcare quality and are associated with significant economic burden. For these reasons, it is necessary to minimise the rate of HR and ER referrals. [,]. In this study, we aimed to determine the patientand procedure-related factors that increase the risk of HRs and ER admissions after PCNL.

Prostate cancer is the most frequently diagnosed cancer among men in 105 countries and is the second leading cause of cancer-related deaths []. In patients with advanced prostate cancer (PCa), androgen deprivation therapy (ADT) is the standard treatment and currently the most frequently used drugs in ADT are gonadotropin-releasing hormone agonists (GnRHs) []. After a median time of 18-24 months of ADT treatment, castration- resistant prostate cancer (CRPC) will develop in most patients [,]. In patients with metastatic CRPC (mCRPC), median survival time is 16 months []. In most studies, various prognostic factors have been identified indicating progression to castration therapy, such as Gleason score (GS), the presence of bone and visceral metastases, and performance status [,]. The prostate-specific antigen (PSA) is a useful tool in diagnosing prostate cancer. Additionally, PSA levels are evaluated periodically after completion of ADT for advanced prostate cancer and used to estimate life expectancy based on its serum levels. However, there is disagreement about the prognostic significance of various PSA indices after hormone therapy. Additionally, there are few studies on whether these PSA indices accurately predict progression towards hormoneresistant prostate cancer. ALP is one of the oldest known tumor markers whose main sources are liver and bone. ALP is a prognostic marker for overall survival (OS). In castrationresistant metastatic prostate cancer patients, and its increased levels correlate with the spread of metastatic bone disease. Although there is not enough correlation between PSA and ALP values in the evaluation of treatment responses, it is stated that the evaluation of the treatment response with ALP is more meaningful []. ALP is often used as a prognostic marker of bone metastases. Although not certain, ALP is associated with increased bone turnover, osteoblastic activity and osteoid formation in the presence of bone metastasis. According to a meta-analysis, high serum ALP levels in patients with hormonesensitive prostate cancer were associated with increased overall mortality and disease progression, but not with cancer-specific mortality rates []. Positron emission tomography/computed tomography (PET/ CT) is a hybrid imaging method that demonstrates molecular processes of tissues as well as morphological imaging, providing superior diagnostic performance. Prostate-specific membrane antigen (PSMA) is a transmembrane protein primarily present in all prostatic tissues and PSMA expression increases in prostate cancer patients []. In recent years 68Ga PSMA PET/ CT has been the standard assessment method for prostate cancer staging, evaluation of biochemical recurrence and treatment response []. In patients receiving ADT for advanced prostate cancer, PSA levels increase 6 to 12 months before emengence of any clinical indicators of disease progression [,]. The time to disease progression is important for planning treatment. Indeed, when the tumor burden is at a minimum level, the general health status of the patients can tolerate alternative treatments. Therefore, it is important to determine a suitable factor that can predict progression to hormone-refractory prostate cancer (HRPC) before the serum PSA value rises again. In this way, alternative treatments can be applied at appropriate times. In this study, we investigated the relationship between PSA levels measured before GnRH treatment in metastatic prostate cancer patients, ALP levels, SUVmax values obtained by Ga-68 PSMA PET/ CT, and nadir PSA levels during follow-up and the time to the development of castration- resistant PCa.

Current hypotheses suggest that overactive bladder (OAB) develops as a result of disabled inhibitory mechanisms due to sensitized afferent nerves leading to contractions similar to primitive voiding reflexes. Another hypothesis suggests that the intercellular connections between detrusor myocytes increase and the spontaneous stimulation of these cells results in OAB []. Despite the fact that none of these hypotheses completely explains the pathophysiology of OAB syndrome, some writers have proposed that sensory hypersensitivity may play a role in OAB [,]. According to a study, up to 40% of the OAB-afflicted women who took part associated the urge brought on by the symptoms with pain, pressure, or discomfort rather than the fear of incontinence, a symptom that significantly reduced patients with OAB syndrome's quality of life and led to admission to medical facilities [-]. Central sensitization has been suggested to be the underlying cause of chronic pain syndromes [,]. Central sensitization is a state of increased neuronal hyperexcitability in response to peripheral stimuli. Primary hyperalgesia, secondary hyperalgesia, reflected pain, and allodynia are observed in cases where the supraspinal and spinal levels are responsible []. Patients with central sensitization experience pain perception changes and decreased pain threshold, which leads to psychosocial effects and deterioration in the quality of life [,]. Although pain is not considered a feature of OAB, the mechanisms underlying pain perception and afferent hypersensitivity are thought to contribute to the clinical manifestations of OAB []. Given that central sensitization is one of the pathophysiological processes driving OAB, it should be kept in mind that these individuals may suffer symptoms similar to those of chronic pain syndromes []. Studies on the issue showed that compared to healthy women, women with OAB experienced much more pain from bladder symptoms [,]. However, there is no study that compared patients with OAB to healthy controls to examine changes in general pain perception and pain threshold. The aim of our study was to examine the differences between pain characteristics and quality of life in women with OAB and healthy controls.

Renal cell carcinoma (RCC) can present with venous thrombus in approximately 6% of cases, and invasion of the renal vein, and extension up to the atrium may be seen in 44%, and 1-4 % of these cases, respectively []. Mayo clinic thrombus classification is the most frequently used staging system to decide on feasibility of surgical treatment. Since various treatment methods have been used for level III tumors, Ciancio et al. divided these tumors into 4 sublevels, so as to assess therapeutic challenges and surgical feasibility in the management of these tumors []. Multidisciplinary management is required from both clinical and surgical perspectives, and the surgical intervention is the first option in these patients []. Systemic treatment should be considered as a first-line alternative if a metastatic or unresectable RCC is present []. We have described 2 cases and reviewed the available literature up to February 2024.

As rarely encountered neoplasms, extra-uterine leiomyomas of urethral origin were first reported in 1894 by Buttner et al. [] They most commonly manifest themselves as perineal masses. Apart from the rarely recognized characteristics of the disease, unique properties such as its characteristic growth pattern and excellent prognosis following surgical excision make it an entity of clinical relevance with good curative possibilities. In addition, the diagnostic difficulties owing to a long list of possible differential diagnoses and specific complications that accompany surgical management make urethral leiomyomas an interesting entity to report with the aim to recognize this pathology, and learn its characteristic features [].

A 22-year-old woman presented to the emergency department with a 2-hour history of abdominal/flank pain. She was involved in a motor vehicle collision where she was the driver. Airbags were deployed, but her seat belt compliance was unknown at the time of injury. Her medical history was mysterious and unattainable due to her altered mental status. On general appearance, the patient appeared intoxicated. Physical examination was only significant for abdominal tenderness to palpation. Vital signs revealed hypotension (97/64 mmHg). All other values, such as pulse, temperature, oxygen saturation, and respiration, were within normal limits. Laboratory values on admission revealed elevated transaminases (AST 117/ ALT 86), and urinalysis showed hematuria (RBCs >182/HPF). All other values were within the normal range. A FAST (focused assessment with sonography in trauma) ultrasound was subsequently done, which revealed free fluid collection within the abdomen. A multidisciplinary team, including urological surgery, was consulted. A subsequent computed tomography (CT) scan of the abdomen and pelvis showed intraperitoneal extravasation of contrast, consistent with dome rupture (Figure 1). Exploratory laparotomy was performed after and revealed a rupture across the bladder dome (Figure 2). The bladder was surgically repaired (3-0 Vicryl), and a Foley catheter was placed for twelve days. On follow-up, a cystogram was performed, which confirmed bladder healing, and the catheter was removed. The postoperative course was uncomplicated, and the patient completely recovered after two months. Figure 1. A computed tomography scan of the pelvis showing extravasation of contrast, which is consistent with an intraperitoneal bladder rupture. A: coronal view; B: sagittal view Figure 2. Laparoscopic view of the abdomen demonstrating free bloodstained fluid in the pelvic cavity and rupture across the dome of the bladder Bladder rupture is a rare condition due to the protection of the bladder by the sturdy pelvic bones []. Today, bladder injuries remain relatively uncommon, accounting for only up to 10% of abdominal trauma [-]. Although motor vehicle collision is the most common cause of injury, intragenic causes, including surgical and endoscopic procedures, have also been identified [,]. Bladder rupture can be divided into intraperitoneal or extraperitoneal rupture []. Extraperitoneal injuries are the most common among the two, accounting for approximately 80% of cases, with a general association of pelvic fracture with damage to the bladder trigone, neck, or wall []. Extraperitoneal injuries are commonly treated conservatively (with catheter drainage via foley or suprapubic tube) []. Most bladder ruptures, regardless of the classification, typically manifest with symptoms of pelvic pain with difficulty voiding and gross hematuria [-]. Intraperitoneal injuries, on the other hand, account for 15% of bladder injuries []. This typically occurs when there is a compressive force against a full bladder, which ruptures the weakest portion (dome) as presented in this patient [,]. A FAST ultrasound may be positive as urine accumulates in the abdominal cavity [,]. Treatment includes surgical repair, which has demonstrated high success rates [-]. Recent practical guidelines regarding intraperitoneal bladder injuries suggest surgical repair due to a more considerable risk for lacerations with poor wound healing, electrolyte derangement, and peritonitis [-]. According to the American Urological Association (AUA) guidelines, extraperitoneal injuries should be managed conservatively [-]. Acknowledgements: I would like to sincerely thank Dr. Matthew Meece (Department of General Surgery, University of Miami Leonard M. Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA) for his assistance in interpretation of the images. Ethics Committee Approval: Not applicable, as this is an anonymous clinical image. Informed Consent: The patient in this study provided written informed consent prior to participation. Publication: The results of the study were not published in full or in part in form of abstracts. Peer-review: Externally peer-reviewed. Authorship Contributions: Any contribution was not made by any individual not listed as an author. Concept – K.E.; Design – K.E.; Supervision – K.E.; Resources – K.E.; Materials – K.E.; Data Collection and/or Processing – K.E.; Analysis and/or Interpretation – K.E.; Literature Search – K.E.; Writing Manuscript – K.E.; Critical Review – K.E. Financial Disclosure: This article received no specific grant or support from any public or private agencies.