Grand Journal of Urology
E-ISSN : 2757-7163

Articles See All

Ekrem GUNER
Dear colleagues, I am honored to share with you the third 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 EBSCOhost, J-Gate, Index Copernicus International (World of Journals List), 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, Female Urology, 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 September 2022 Assoc. Prof. Ekrem GUNER, MD Editor-in-Chief
Yusuf Kasap, Muhammed Emin Polat, Kazim Ceviz, et al.
COVID-19 is a widespread and life-threatening viral infection that frequently appears with respiratory symptoms and fever []. It can also affect other systems, such as cardiovascular, hepatobiliary, or hematologic systems [,]. Retroperitoneal bleeding (RPB) is another life-threatening condition that can manifest due to trauma, vascular lesions, tumors, surgical procedures, anticoagulant treatment, or idiopathic risk factors [,]. The hypercoagulable state occurs secondary to the effect of the virus or increased cytokine secretion []. Therefore, anticoagulant treatments are recommended widely in COVID-19 patients, and the risk of bleeding concomitantly increases [,]. Due to the thromboembolic complications and the bleeding risk of the viral infection, the predictability of bleeding is becoming an important issue requiring safe use of anticoagulants []. To predict and prevent this complication, we analyzed the clinical and laboratory results of 54 RPB cases among anticoagulated COVID-19 inpatients. We aimed both to describe incidence, morbidity, and mortality rates related to RPB, also search for factors that affect bleeding to improve clinicians" knowledge.
Ferhat Yakup Suceken
Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms (LUTS) in men. Transurethral resection of the prostate (TUR-P) is the standard surgical technique to be applied in patients with a prostate volume of 30-80 cc []. According to the current guidelines, open simple prostatectomy (OSP), holmium laser enucleation of the prostate (HoLEP), and bipolar enucleation are recommended techniques in the presence of enlarged adenoma tissue (>80 cc), and short-term and long-term functional outcomes of these methods are reported to be comparable []. The main limitations of OSP are its relatively higher morbidity and blood transfusion rates (7-14%) [,], while those of the HoLEP technique is its longer learning curve, unavailability in some centers []. The bipolar enucleation technique shows a similar safety profile to HoLEP [,]. In addition to these techniques, Mariano et al. described the laparoscopic simple prostatectomy (LSP) in 2002 and Sotelo et al. described robot-assisted simple prostatectomy (RASP) in 2008 [,]. LSP and RASP, which are classified as minimally invasive simple prostatectomy (MISP) techniques, have been found to provide similar functional outcomes, as well as having common advantages compared to the open surgery in terms of blood loss and hospital stay. LSP is one of the main alternatives to OSP, but it has some disadvantages such as its higher cost, requirement of special equipment, and their inapplicability in every clinic []. This study aims to compare the perioperative and postoperative results and long-term functional outcomes of the OSP and LSP operations performed by a single surgeon in our clinic.
Emre Salabas, Huseyin Cihan Demirel, Ozlem Ton Eryilmaz
Prostate cancer is the most common malignancy of men except skin cancers and causes significant mortality and morbidity []. There is a wide variety of therapy options for prostate cancer ranging from conservative managements like watchful waiting and active surveillance to definitive treatments such as radical prostatectomy, radiotherapy and brachytherapy []. Gleason score (GS) classification of prostate biopsy specimens is a vital part of management algorithm [,]. GS is especially important for choosing between active surveillance and definitive treatment options like surgery or radiotherapy []. However, upgrade of Gleason scores has been reported in subjects who underwent radical prostatectomy following an active surveillance protocol period. The discrepancies between pathologic upgrade rates ranged between 14-55% in different series [-]. Furthermore, this pathologic upgrade rate has been increasing in recent years []. This phenomenon may lead to either overtreatment (surgery or radiotherapy) of subjects as a result of overgrading of needle biopsy specimens or under treatment (active surveillance) of them following an understaged biopsy []. Gleason grading system was modified by the grading group classification in order to improve identification of low-grade cancers [,]. The 2014 International Society of Urological Pathology (ISUP) grading system classifies Gleason grades into 5 tiers with corresponding Gleason scores as follows: Grade group 1 (ISUP GG 1): GS< 6; GG 2: GS 3+4=7 ; GG 3: GS 4+3=7; GG 4: GS 4 and GG 5: GS 9 and 10. The stratification of GS 7 into two separate parts with different survival outcomes and treatment requirements as well as comforting patients by naming GS< 6 cancers as GG 1 are important aspects of this classification system []. The primary aim of this study is the determination of ISUP GG upgrading prevalence and its risk factors in a group of cases who underwent prostate needle biopsy or radical prostatectomy. Investigation of prostate cancer grade group upgrading using a relatively recent system (ISUP 14 GG) encompassing all risk groups is the essence of this article.
Fidan Aslanova, Ece Bahceci, Keziban Dogan, et al.
Pelvic organ prolapse (POP) is defined as the descent of the pelvic organs into or out of the vagina. It can be seen in about half of women giving birth. It causes urogenital symptoms and sexual dysfunction. The main reason is the loss of pelvic support []. In gynecology, hydronephrosis is present in many diseases, including severe genital mechanical defects, endometriosis, and postoperative iatrogenic lesions. The prevalence of hydronephrosis is shown to be significantly related to the severity of prolapse [,]. In this study, we aimed to investigate the frequency of pelvic hydronephrosis and the effect of hydronephrosis diagnosed by ultrasonography on urodynamic parameters in patients with symptomatic POP.
Hatice Zoroglu, Fikret Erdemir, Nejmiye Akkus
The incidence of infertility, which is the inability to achieve conception at the end of one year despite regular attempts at unprotected sexual intercourse, ranges from 7% to 15% []. Infertility is an important problem that causes loss of selfconfidence, mental disorders, sexual dysfunction and social withdrawal in couples. Male factor infertility is present in approximately half of all infertile couples []. In the etiology of male infertility, several congenital or acquired factors such as urogenital abnormalities, varicocele, undescended testis, infections of the genital tract, metabolic and endocrine disorders, testicular failure, immunologic problems, cancer, drugs, radiotherapy, altered lifestyle, and genetic factors have been reported []. Apparently, genetic factors, especially in oligozoospermic and azoospermic patients, have been increasingly investigated in recent years. Genetic examination in infertility is important in terms of revealing the etiological factor and predicting the pregnancy potential, and the need for future counseling. Klinefelter syndrome (KS), known as 47XXY, can be seen in up to 10% of the cases with nonobstructive azoospermia and in one in 500-1000 live births []. Various variants of Klinefelter syndrome have been reported. Here, a case with a genetic diagnosis of 48XXYY, which is a very rare variant of Klinefelter syndrome, will be presented.
Erhan Ates, Hakan Gorkem Kazici, Gokhan Sahin, et al.
Liposarcomas, soft tissue malignancies originating from mesodermal tissues, account for around 20% of all sarcomas. They are generally seen in the retroperitoneal area and extremities []. Approximately 12% of liposarcomas originate from the spermatic cord, testicular tunica and epididymis and are called paratesticular liposarcomas (PLSs) []. When the tumor diameter exceeds 10 cm, the PLS is classified as "giant" []. According to a recent meta-analysis, there are 265 PLS cases in the literature, and only a few cases of giant PLS []. Due to its rarity, there is no standard guideline regarding the incidence, diagnosis, recurrence and treatment of PLS []. In this case report, we aimed to present our treatment approach for two cases of giant LPS.
Murat Yavuz Koparal, Ugur Aydin, Burak Elmas, et al.
Zinner syndrome is a rarely seen congenital anomaly characterized by developmental defects of mesonephric (Wolffian) duct. The classic triad includes ejaculatory duct obstruction, an ipsilateral seminal vesicle cyst, and an ipsilateral renal agenesis. It was first described by A. Zinner in 1914 []. Bladder neck, half of the trigone, urethra, vas deferens, seminal vesicles, and epididymis in men develop from the distal mesonephric duct under the influence of testosterone and anti- Müllerian hormone. During embryogenesis, developmental disorders of the distal mesonephric duct affect the formation of the ipsilateral kidney, ureter, vas deferens, and seminal vesicles. The ejaculatory duct obstruction results in cystic dilatation of seminal vesicles because of the accumulation, and retention of seminal fluid. Patients may present with genitourinary system complaints, or they may be completely asymptomatic and detected incidentally. In this paper, we report a case of a 32-yearold male patient who presented with acute urinary retention, and diagnosed as Zinner syndrome based on radiological examinations.
Binhan Kagan Aktas, Ozdem Levent Ozdal
Dear editor, We have read with great interest, the case series and literature review of false penile fracture by Ozlu et al. in which the authors share clinical experience with more than 100 patients over a 13-year period []. By examination of operative reports, they retrospectively evaluated the patients with a pre-diagnosis of penile fracture and frankly reported a misdiagnosis rate of approximately 8%. This ratio is comparable and consistent with the literature [-]. Examining the patient clinical and operative characteristics, shown as a table on a separate page, we see that only two of total eight false penile fracture cases underwent radiological examination. Magnetic resonance imaging (MRI) was preferred in these patients, and it was stated that one of them was MRI positive (patient 4) and the other was MRI false positive (patient 2). Patients with a tunical tear in preoperative MRI, but no tear in surgical exploration were considered to have false penile fracture. Since only ligation procedures were performed on both MRI positive and MRI false positive patients, we think that such a distinction is confusing and not necessary. Perhaps ultrasonography could be preferred for the remaining six patients for whom radiological examination was not performed, due to its easy accessibility and provide medical recording. However, an ideal radiographic imaging modality is still lacking so far []. Although there are some clinical differences between false and true penile fractures, the two conditions cannot be clearly distinguished from each other either clinically or radiologically []. Consequently, we would like to encourage Ozlu et al., on a very diligently written and quite informative article that briefly summarizes the studies that have already been published and the approach to the patient with penile fracture. Urologists somehow have to base the definitive diagnosis of penile fracture on surgical exploration in order to eliminate serious long-term potential problems of an overlooked tunical tear. Sincerely yours. Ethics Committee Approval: This article does not contain any studies with human participants performed by the author. Authorship Contributions: Any contribution was not made by any individual not listed as an author. Concept - B.K.A., O.L.O.; Design - B.K.A., O.L.O.; Supervision - B.K.A., O.L.O.; Resources - B.K.A., O.L.O.; Materials - B.K.A., O.L.O.; Data Collection and/or Processing - B.K.A., O.L.O.; Analysis and/ or Interpretation - B.K.A., O.L.O.; Literature Search - B.K.A., O.L.O.; Writing - B.K.A., O.L.O.; Critical Review - B.K.A., O.L.O. Conflict of Interest: The author declares that he has no conflict of interest. Financial Disclosure: No grants or funding was provided for this study.

Image Column

Well-differentiated and Dedifferentiated Giant Paratesticular Liposarcoma: A Report of Two Cases and a Review of the Literature

Liposarcomas, soft tissue malignancies originating from mesodermal tissues, account for around 20% of all sarcomas. They are generally seen in the retroperitoneal area and extremities. Approximately 12% of liposarcomas originate from the spermatic cord, testicular tunica and epididymis and are called paratesticular liposarcomas (PLSs). When the tumor diameter exceeds 10 cm, the PLS is classified as “giant”.

The Retrospective Analysis of 54 COVID-19 Patients with Retroperitoneal Bleeding in One Center

The hypercoagulable state occurs secondary to the effect of the virus or increased cytokine secretion. Therefore, anticoagulant treatments are recommended widely in COVID-19 patients, and the risk of bleeding concomitantly increases. Due to the thromboembolic complications and the bleeding risk of the viral infection, the predictability of bleeding is becoming an important issue requiring safe use of anticoagulants.

A Rare Cause of Infertility: 48XXYY Syndrome

Apparently, genetic factors, especially in oligoospermic and azoospermic patients, have been increasingly investigated in recent years. Klinefelter syndrome (KS), known as 47XXY, can be seen in up to 10% of the cases with nonobstructive azoospermia and in one in 500-1000 live births [4]. Various variants of Klinefelter syndrome have been reported. Here, a case with a genetic diagnosis of 48XXYY, which is a very rare variant of Klinefelter syndrome, will be presented.

A Rare Cause of Acute Urinary Retention in a Young Man: Zinner Syndrome

Zinner syndrome is a rarely seen congenital anomaly characterized by developmental defects of mesonephric (Wolffian) duct. The classic triad includes ejaculatory duct obstruction, an ipsilateral seminal vesicle cyst, and an ipsilateral renal agenesis. It was first described by A. Zinner in 1914 []. Bladder neck, half of the trigone, urethra, vas deferens, seminal vesicles, and epididymis in men develop from the distal mesonephric duct under the influence of testosterone and anti-Müllerian hormone.

Diphallus: A Rare Urological Anomaly- What to Do Next? Case Report and Literature Review

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.

Is Computed Tomography an Alternative to Scintigraphy for Preoperative Evaluation of Living Kidney Donor Split Renal Function?

Systematic evaluation is of importance in the selection of an eligible donor prior to transplantation. Not only kidney functions but also other concomitant organ pathologies which affect the decision-making process are assessed. During the preparation estimated glomerular filtration rate (eGFR), 24-hour urine creatinine clearance (CrCl), 24-hour urine proteinuria, and microalbuminuria are used to determine kidney functions and/ or damage.

Two Cystic Masses in the Same Kidney: Renal Cell Carcinoma and Cystic Nephroma

Cystic nephroma, first described by Edmunds, is a non-hereditary, multicystic usually unilateral benign lesion of the kidney that does not contain solid components. Histologically, it contains cysts with flat or cuboidal epithelium and fibrous or stromal septa. It is generally seen in the first 2 years of life and after the third decade. Histopathological examination is the only way to confirm the diagnosis of multilocular cystic lesion detected by imaging studies.

Latest Issue

Volume 2 Issue 3
Cover Page

News from GJU See All

J-Gate contains abstracts, citations, full-text access for all Open Access journals and other key details from academic journals by covering 71 Million+ Indexed Articles, 58,000+ Journals from over 16,000 Publishers.

EBSCO,  a research database presenting academic journals electronically, provides a range of library database services around the world. EBSCO Information Services, Ipswich, Massachusetts, USA.

EuroPub is a comprehensive, multipurpose database covering scholarly literature, with indexed records from active, authoritative journals, and indexes articles from journals all over the world.

ICI Journal Master List is an international indexing database of scientific journals that has been evaluating the submitted periodicals since almost 20 years. The condition for indexation in our database is passing a positive multidimensional evaluation which is based on over 100 criteria.

SCILIT is a comprehensive, free database for scientists using a new method to collate data and indexing scientific material. Our crawlers extract the latest data from CrossRef and PubMed on a daily basis. 

News See All

Acute urinary retention is one of the most common situations encountered in urological emergencies. It is more frequently seen in older men. Acute urinary retention in pregnant women is a rare condition but it may cause abortus, preterm labor and rarely uterine ischemia. It is very difficult to reveal the causes of acute urinary retention in pregnant women. One of them is acute urinary retention due to retroverted uterus which is observed in 11% of pregnant women.  In this case, we discussed a young pregnant patient who presented to our outpatient clinic.
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.
Varicocele is dilatation and tortuosity of the vessels in the pampiniform plexus of spermatic cord and occurs in 11.7% of adult men. Varicocelectomy may lead to various complications such as hydrocele, testicular atrophy, haematoma, infection, damage of nerves and recurrence. A 22-year-old man presented after varicocelectomy with a rare postoperative complication of a fistula. The fistula tract was removed en bloc. The patient had a history of varicocelectomy, suggesting suture reaction. The fact that it is a rare complication of varicocelectomy makes our case interesting.
COVID-19 pandemic is the newest and most serious health threat worldwide. Medical and surgical priorities have been dramatically changed during this outbreak. Cancellation or postponement was fulfilled or considered for whole outpatient and some severe conditions to protect the facilities and resources for urgent healthcare. Most hospitals accepted individuals who have COVID-19 in affected countries. The COVID-19 pandemic has changed the patient admission process and healthcare strategies at numerous emergency departments across Turkey, and the possible effects of this alteration on people are still unclear. In upcoming periods, the healthcare workers, including urologists, possibly would be facing increasingly complex challenges, which could, in turn, make them develop various protection modalities to provide sufficient defense against this insult when dealing with the COVID-19 patients. 
 
Besides some modifications seen in the general medical approach, the treatment options applied in urinary stone cases have also significantly changed during the pandemic. Hence, the optimal anesthesia methods are still unknown. Under the current outbreak and COVID-19 pandemic scenario, hospitals should prioritized patients affected by lithiasis into low, intermediate, high risk, and emergency categories (according to the priority classification of the European Urology Guidelines Office Rapid Reaction Group Urolithiasis Guidelines Panel) to decide their delay and save resources, healthcare personnel, beds, and ventilators. However, patients with potentially serious septic complications need emergency interventions. The possibility of performing or restarting elective activity depends on local conditions, the availability of beds and ventilators, and the implementation of screening protocols in the context of the COVID-19 pandemic. Emergency intervention is inevitable if any alarming indication exists. Emergency cases tend to have a higher incidence of complications with the initiation of the COVID-19 outbreak when compared with before.
 
In a non-urgent urolithiasis condition, endo-urologists should make a rational treatment decision to prioritize the urolithiasis treatment. They should also compare the benefits and risks before the intervention. Because of the fear of being infected with COVID-19, patients with nephrolithiasis who stay at home instead of admitting to a medical center may suffer serious complications such as obstructive uropathy, deterioration of renal functions, sepsis, and even mortality. Although the number of emergency admissions related to stone disease cases has gradually decreased, some severe findings such as leukocytosis, higher creatinine levels, increased grade 3 and 4 hydronephroses, and complications tend to be seen more frequently when compared to the periods before the pandemics. Some endo-urologists prefer definitive stone treatment over temporary drainage to reduce the number of emergency room visits and hospital admissions, except if the infection is present or staged treatment is planned. Several clinical scenarios of non-emergency and non-urgent urinary stones are current; thus, endo-urologists should appropriately weigh patients' risk and surgery benefits to decide the proper intervention time. If the risks are more than the benefits to the patient, it would be better to postpone the surgery. A significant reduction in the global number of patients admitted to Emergency Department (ED) for urolithiasis was noted. Moreover, regarding the choice of treatment of hospitalized patients, a significant increase of stone removal procedures versus urinary drainage was reported in 2020. Renal colic should be managed with expulsive medical therapy and proper pain control with a close follow-up just in case it becomes an emergency. Indwelling JJ stent removal or exchange is a matter of debate: Some endo-urologists recommend removing, while the others recommend postponing it. 
 
In most COVID-19 infected patients with urolithiasis, extracorporeal shock wave lithotripsy (ESWL) should be kept in mind as a treatment option for the patient who doesn't require active stone removal. While patient and health care worker interaction kept minimum, it also represents the least morbid treatment and can generally be performed without a ureteric stent. Physicians can also prefer medical expulsive therapy (MET) as a treatment option for patients with distal ureteral stone, which shows highly effectiveness against distal 5-10 mm urinary stones. If a patient requires an active surgical approach, persistent obstruction, renal failure, and refractory pain can be safely and effectively treated by endoscopic ureteral stone treatment.
 
During the COVID-19 pandemic, there has been a significant reduction of emergency admissions for urolithiasis. Patients admitted to ED had more complications, more frequently need hospitalization, and early stone removal was preferred over urinary drainage only in clinical management. All urologists should be aware that they could face an increased number of admissions for urolithiasis and manage more complicated cases in the following months. Delaying urolithiasis surgery and increasing waiting lists will have consequences and will require considerable additional effort. Teleconsultation may help guide these patients, reduce visits and unnecessary exposure.
 
Coronavirus disease-2019 (COVID-19) is a global epidemic that has affected the whole world. COVID-19 has caused the postponement of elective operations, especially urological cancer surgeries, by affecting hospitals, patients, urologists, auxiliary health personnel, and resources at different rates in many countries and still continues with the current fluctuation. Delayed can-cer diagnosis and management during the pandemic will cause an increase in the incidence of untreated cancer patients in the coming months and we will face greater problems than the effects of COVID-19. If we list the urinary system cancers, they are adrenal, kidney, upper urinary system urothelial cancer, bladder, prostate, penis, and testicular cancer.
 
Adrenal gland cancers, especially adrenocortical cancer, have an aggressive course and require early surgery. Surgery for T1 kidney cancers may be delayed until sufficient resources are available. Early surgery should be planned if patients with T2 kidney cancer have unfavorable pre-operative prognostic factors, otherwise, it may be delayed. Higher stage kidney cancers should be considered for early surgery. An early multidisciplinary approach is recommended for metastatic kidney cancers. Early surgery should be performed especially in patients with the high-risk class of upper urinary tract urothelial carcinoma. Muscle-invasive bladder cancer is susceptible to high progression. Radical cystectomy, including neoadjuvant chemotherapy, should not exceed 12 weeks. If radical cystectomy cannot be performed, radiotherapy in combi-nation with chemotherapy should be considered for eligible patients. Patients with non-muscle invasive bladder cancer should be appropriately counseled based on their risk stratification. Intravesical treatments can be continued in accordance with urology guidelines. Short-term delays in this patient group do not carry a high risk of poor prognosis. Prostate cancer screening, imag-ing, and biopsies may generally be suspended. Active monitoring in low-risk prostate cancer should be done as in normal practice. Treatment can be safely delayed in low and intermediate-risk patients. Although surgery may be delayed in high-risk prostate cancer, neoadjuvant hormonal therapy and radiotherapy may need to be considered with little evidence. Initiation of long-term androgen deprivation therapy (ADT) together with external beam radiotherapy (EBRT) in high-risk and very high-risk prostate cancer may be preferred as a suitable alternative. Testicular cancer should be treated in a timely manner with surgery or chemotherapy as indicated. Penile cancer can have worse sexual, functional, and oncological consequences with prolonged surgical delay. In penile cancer, negative results were observed in 3-month delays before inguinal lymphadenectomy.
 
COVID-19 has dramatically changed the management of urological cancers and raises concern in urological cancer management with its ongoing high case numbers. Telemedicine-online interviews and meetings that increase the patient's awareness about the disease and discuss complicated patients should be encouraged. In order to minimize the risk in all urological cancer groups, correct planning and, if possible, early surgical treatment should be carried out by considering previous guidelines and data on the management of urology cancer patients in the cur-rent COVID-19 pandemic period.