Grand Journal of Urology
E-ISSN : 2757-7163

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Grand J Urol 2021;1(1):30-32, DOI: 10.5222/GJU.2021.65375
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 with complaints of recurrent urinary retention due to retroverted uterus.
Grand J Urol 2022;2(1):26-32, DOI: 10.5505/GJU.2022.02886
Objective: The Coronavirus Disease-2019 (COVID-19) is particularly more common and deadly among older men who also constitute a significant portion of urology patients. In this study, we aimed to evaluate the change in the diagnostic spectrum in urology outpatient applications after the declaration of pandemic compared to the pre- pandemic period. Materials and Methods: All patients were enrolled between February 12 and May 6, 2020. Demographic, and clinical data of the patients were analyzed pertaining to the period of 4 weeks before, and the first, and second 4 weeks after declaration of the pandemic. Data obtained from the database such as age, gender, diagnoses were anonymized. Recurrent applications with the same diagnosis within ten days after the first presentation were excluded from the analysis. Results: Compared to the pre-pandemic period a significant decrease in the number of patients applied to the urology outpatient clinics after declaration of the pandemic, and in the frequency of diagnoses of prostate diseases, and urine transport, storage and emptying disorders and a significant increase in the frequency of diagnoses of urinary system stone disease, benign or malignant bladder diseases, upper urinary system tumors, and sexual dysfunction were observed after declaration of the pandemic. Conclusion: The risk perception of COVID-19 disease may cause changes in the diagnostic distribution of patients applied to the urology outpatient clinics. During periods of outbreak, the health system must be redesigned by focusing on outpatients.
Grand J Urol 2021;1(2):55-61, DOI: 10.5222/GJU.2021.36855
Objective: Complete urinalysis (CUA) is one of the indispensable screening tests of clinical laboratories. The compatibility of this test with urine culture is of indispensable importance in the diagnosis and treatment of urinary tract infections. We aimed to evaluate the suitability of the leukocyte parameter measured in the microscopic units of the fully automated urine analyzers which replace traditional methods, by grouping them according to the results of chemical analysis. Materials and Methods: Leukocyte counts in the reported CUA results of 4685 outpatients and the results of 113 urine cultures studied on the same day were analyzed. Noncentrifugated urine samples were included in the analysis. Cells were digitally imaged by flow microscopy. Chemical analyzes were performed using dual wavelength reflectance method. Urine samples were evaluated after 24 hours of incubation. Results: High power field (HPF) values were recorded by grouping the leukocyte counts as negative, trace, 1+, 2+ and 3+. The arithmetic means of HPF values of the groups were calculated as 1.2, 2.1, 5.0, 11 and 208 white blood cell (WBCs/HPF). Bacterial growth was detected in 19 of 113 patients and no reproduction was observed in the remaining 94 cases. When results of microscopic examinations and chemical analysis were compared with the culture results, the analytical sensitivity, specificity, positive, and negative predictive values for microscopic urinalysis were 25%, 86%, 61.3%, and 58.3%, respectively. While, the analytical sensitivity, specificity, positive, and negative predictive values for chemical analysis of urine were 25.8%, 87.7%, 69.7%, and 51.4%, respectively. Conclusion: The workload of medical laboratories is increasing, and the use of urine autoanalyzers may be preferred for busy laboratories. In the diagnosis and follow-up of urinary tract infections, complete urinalysis by autoanalysers in which the harmony of their microscopy and chemical units are closely monitored, may reduce the need for unnecessary requests for urine culture, but it cannot replace urine culture.
Grand J Urol 2021;1(2):71-74, DOI: 10.5222/GJU.2021.25743
Hemorrhagic cystitis (HS) is a frequently seen complication of bone marrow transplantation. This condition occurs depending on the preparatory regimen of bone marrow transplantation. The BK virus (BKV), a human polyomavirus, is a small double helix DNA virüs belonging to the Papovaviridae family. It is commonly found in societies as an occult infection. Whereas, cidofovir (CDV), an acyclic nucleoside phosphonate, is used as a proven antiviral agent against polyomaviruses. In this case report, acute proximal tubular necrosis due to cidofovir used in hemorrhagic cystitis caused by BK virus, and its treatment in a patient diagnosed with T-lymphoblastic lymphoma in remission, and underwent allogeneic stem cell transplantation, was presented.
Grand J Urol 2021;1(1):9-13, DOI: 10.5222/GJU.2021.97269
Objective: Penile fracture is one of the urological emergencies that require early surgical intervention. False penile fracture, on the other hand, is a condition that presents with similar clinical features and can be treated conservatively. In this study, in the light of the literature, it was aimed to present the clinical and operative results of 8 patients who were operated on with a prediagnosis of penile fracture and then diagnosed with a false penile fracture. Material and Methods: Data of 8 patients who were diagnosed with a false penile fracture between January 2006 and September 2019 were retrospectively analyzed. Patients" demographic characteristics, preoperative, intraoperative and postoperative data were retrospectively analyzed. Results: Mean age of the patients was 39.12 (28-54) years. The most common complaints were penile swelling and ecchymosis. The most common etiological factors were as follows: sexual intercourse in 6, masturbation in 1, and manual bending of the erect penis in 1 patient. All operations were performed by degloving the penis from the circumcision line. Superficial dorsal vein injury was detected in 6, and nonspecific dartos bleeding was detected in 2 patients. There were no intraoperative complications. Wound site infection developed in 1 patient postoperatively. No erectile dysfunction, penile curvature, and sensory disturbances were detected in any patient. Conclusion: It is difficult to distinguish a false penile fracture from true penile fracture clinically or radiologically. False penile fracture can be treated conservatively without the need for surgery. Surgery should still be the first-line treatment option in suspected patients. Studies with larger patient series are needed on this subject.
Grand J Urol 2022;2(1):15-20, DOI: 10.5505/GJU.2022.87599
Objective: Our aim is to assess if there is a relationship between maximum standardized uptake (SUVmax) and apparent diffusion coefficient (ADC) values of reactive and metastatic lymph nodes, also to compare ADC values of reactive and metastatic lymph nodes in prostate cancer patients. Materials and Methods: We have retrospectively investigated 20 patients diagnosed with prostate cancer who underwent Ga-68 PSMA PET/MR imaging. Three metastatic and three reactive lymph nodes classified according to the level of PSMA Ga-68 uptake in PET/MR were chosen for each patient. SUVmax and ADCmean values were calculated for each lymph node separately. SPSS version 22 was used for statistical analysis. Results: A total of 120 lymph nodes in 20 prostate cancer patients were assessed. There was a moderate negative correlation between SUVmax values and ADCmean values of metastatic lymph nodes (p=0.009, r=-0.333). However, there was no significant correlation between SUVmax values and ADCmean values of reactive lymph nodes. ADCmean values of metastatic lymph nodes were significantly lower than those of reactive lymph nodes (p=0.0001). Conclusion: PET/MR, which combines both advantages of PET and MRI, is an important tool for the diagnosis and management of prostate cancer. We have found that SUVmax values of metastatic lymph nodes were inversely correlated with ADCmean values and combination of both parameters may increase the diagnostic accuracy of Ga-68 PSMA PET/MR in the detection of lymph node metastasis.
Grand J Urol 2021;1(3):142-145, DOI: 10.5222/GJU.2021.22931
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. An improvement was observed in the urinary system complaints of the patient who started chemotherapy regimen. While prostatectomy was performed in some of the prostatic MCL cases reported previously, in some, no additional treatment was required after chemotherapy. Our case is the only prostatic MCL case with elevated PSA levels, but did not receive the diagnosis of prostate cancer. Physicians should keep in mind that, prostatic MCL can present with nonspecific symptoms. Staging should be performed in patients whose histopathologic diagnosis is lymphoma of the prostate so as to determine appropriate treatment options.
Grand J Urol 2021;1(1):6-8, DOI: 10.5222/GJU.2021.43531
Objective: Varicocele is the abnormal venous dilatation and the tortuosity of the pampiniform plexus. Varicocele has been shown to be related with systemic varicosity in some studies. Platelet volume indices have also been reported to increase in vascular disorders. In this study, we aimed to determine if complete blood count (CBC) parameters especially platelet counts and volume indices could be a practical tool in the diagnosis and follow-up of varicocele. Materials and Methods: The medical records of all patients who underwent varicocelectomy due to grade 2 or 3 clinical varicocele were reviewed. Examined parameters included patient demographic characteristics and preoperative CBC parameters [hemoglobin, white blood cell, platelet, mean platelet volume (MPV) and platelet distribution width (PDW)]. Patients without varicocele, active infection and vascular disorders constituted the control group. Results: The study population consisted of 61 patients with varicocele and 62 control subjects. The mean age of the patients was 28.6 ± 6.2 years. Mean preoperative hemoglobin, WBC, platelet, MPV and PDW were 15.5 ± 1 g/dL, 7.5±1.6 x103/μL, (236 ± 53.4) x103/μL, 9.3±1.1 (fL) and 15.2± 3.9 (%), respectively. There was no difference between patients with varicocele and control subjects in terms of age, mean preoperative Hb, WBC and MPV. However, mean preoperative platelet count was significantly lower and mean PDW was significantly higher in varicocele patients compared to controls (p
Grand J Urol 2021;1(3):146-149, DOI: 10.5222/GJU.2021.79188
One of the reasons for the high mortality in COVID-19 patients is the increased risk of disseminated intravascular coagulation (DIC) and venous thromboembolism. For this reason, the use of anticoagulant treatments has become widespread. One of the rare complications of anticoagulant therapy is retroperitoneal hemorrhage. These hemorrhagies require immediate intervention. Retroperitoneal hemorrhage should be kept in mind among the many complications that develop in the patient who was followed up during the pandemic period. For this purpose, we present 2 cases who developed spontaneous retroperitoneal bleeding while clinically recovering under COVID-19 treatment.
Grand J Urol 2023;3(2):060-063, DOI: 10.5505/GJU.2022.64936
Diphallus is a very rare congenital anomaly usually accompanied by various congenital anomalies and can be classified according to the anatomical structure in which the anomaly develops. Generally, in cases with diphallus the surgical approach is preferred, in that the hypoplastic structure has been excised for esthetic and functional purposes and penile reconstruction is performed. In addition, urethroplasties have been also performed in the presence of any accompanying urethral abnormality. In the current case, we report a two-year-old boy who was diagnosed as having glandular diphallus.
Grand J Urol 2021;1(3):128-132, DOI: 10.5222/GJU.2021.87598
Focal ablation therapies in prostate cancer have been actively evaluated in the light of recent literature. 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. While waiting long-term oncological results, focal ablation therapies in prostate cancer are beinmg used increasingly.
Grand J Urol 2021;1(2):75-77, DOI: 10.5222/GJU.2021.25745
Testicular torsion is a urological emergency that results in deterioration of the blood supply of the testicle and ischemia as a result of the rotation of the spermatic cord around itself. It may show a wide clinical variety with inflammatory manifestations varying from mild abdominal pain to severe scrotal pain. Orchiectomy may be required in cases which are delayed and cannot be operated urgently. Torsion of the testis and epididymis are other frequently seen causes of acute scrotum in children. Growth of masses and hormonal stimulation in the adolescent age cause an increase in the tendency of the torsion of appendix testis which have a small pedicle and epididymis. In the presence of sudden scrotal pain, testicular torsion should be considered, if there is clinical suspicion, patients should be evaluated with color doppler ultrasound (CDUS) and scrotal exploration should be performed immediately. A 20-year-old male whose clinical picture, and scrotal ultrasonography suggested the presence of testicular torsion is presented in this case report.
Grand J Urol 2022;2(3):087-092, DOI: 10.5505/GJU.2022.32032
Objective: We aimed to analyze and report the outcomes of patients with retroperitoneal bleeding (RPB) among our COVID-19 inpatients under anticoagulation therapy. Materials and Methods: We retrospectively analyzed 54 patients who were anticoagulated with low- molecular-weight heparin (LMWH) and developed RPB during COVID-19 treatment in the hospital, either in intensive care unit or non-intensive care unit services, between March 2020 and March 2021. The patients' demographic and clinical data were analyzed, and we compared the laboratory results at the time of admission and during episodes of RPB. The patients were divided into conservative and interventional treatment groups. We compared the size of retroperitoneal hematoma, anticoagulant doses, erythrocyte suspension transfusion rates, presence of hyperinflammation syndrome between these groups. Also, treatment modalities and mortality status were shown. The hematoma size and erythrocyte suspension transfusion rates were compared between groups, and their correlation with anticoagulant dose and age were analyzed as well. Results: In the management of RPB that developed, 48 (88.9%) patients were approached conservatively, 4 (7.4%) patients underwent angioembolization, and 2 (3.7%) patients laparotomy. Mortality was observed in 14 (25.9%) patients. Relevant laboratory parameters as lactate dehydrogenase, procalcitonin, interleukin-6 levels and lymphocyte counts were elevated exceedingly, while the hemogram test values were significantly lower during episodes of RPB (p=0.007, p=0.044, p=0.031, p=0.018 and p
Grand J Urol 2021;1(3):133-137, DOI: 10.5222/GJU.2021.43153
The possible effect or activity of the autonomic nervous system (ANS) in urogenital disorders is still controversial. Day by day, further studies that have proved the association between chronic urological situations like chronic pelvic pain, premature ejaculation, etc., and autonomic dysfunction have been published. Understanding the actual role of the autonomic nervous system on chronic pelvic disorders will be of interest soon.
Grand J Urol 2021;1(2):66-70, DOI: 10.5222/GJU.2021.39974
Objective: To investigate the value of D-dimer, a marker of fibrinolysis, in metastatic and non-metastatic prostate cancer. Materials and Methods: A retrospective analysis was performed on 138 male patients including 52 patients with prostate cancer and 86 with benign prostatic hyperplasia. Participants who had factors that altered D-dimer levels were excluded. The mean ages of the groups were similar (70 ± 8 vs 68 ± 8, p= NS). In addition, data regarding biochemical findings, prostate-specific antigen and hemostatic markers, including D-dimer, were retrieved from the database of our hospital. The cut-off point of D-dimer was 0.5 mg/L. Data from scintigraphy and magnetic resonance imaging (MRI) scans related to metastasis were also considered. Patients who showed findings of metastasis according to scintigraphy and lumbosacral MRI were accepted as having metastases. Positive findings in only scintigraphy in any area were considered suspicious for metastasis. Results: Patients with prostate cancer had higher D-dimer levels than benign prostate hyperplasia patients (p= 0.024). Sixteen patients with metastatic prostate cancer and suspicious for metastasis had markedly high D-dimer levels compared to benign prostate hyperplasia and non-metastatic prostate cancer patients. Conclusion: prostate cancer, especially when metastatic, may increase D-dimer levels.
Grand J Urol 2022;2(1):38-41, DOI: 10.5505/GJU.2022.70299
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. During the examination due to exhaustion and weight loss, multiple suspicious metastatic lesions were observed in non-contrast computed tomography. In the patient who had multiple bone metastases on the whole-body bone scintigraphy, prostate cancer metastasis was considered in the first plan due to a history of prostate cancer before transplantation. This diagnosis could not be supported with prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT) scan. Whole body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed. A hypermetabolic mass lesion in the left kidney, multiple hypermetabolic lesions in the liver, in the left aortorenal junction, and in the skeletal system were observed. A biopsy was performed from the metastatic mass in the right lobe of the liver and the result was reported as renal cell carcinoma metastasis. Immunohistochemistry evaluation demonstrated positive staining for PAX-8, CK19, CD10 and negative staining for CK7, CK20, GATA-3, NAPSIN A, TTF-1, PSAP, glutamine synthetase and arginase. With all these findings, it was thought that the primary of metastases was the 4-cm mass in the left native kidney.
Grand J Urol 2021;1(2):81-82, DOI: 10.5222/GJU.2021.09609
A 67-year-old male patient who had multiple solid masses in both kidneys in another center ultrasound examination was referred to our clinic for further examination. He had no known chronic or syndromic disease. The patient was evaluated with dynamic contrast enhanced upper abdominal magnetic resonance imaging (MRI). In MRI, homogeneous enhancing solid lesions with hypointense central stellate scar and non-enhancing cysts was seen in both kidneys. Diffusion restriction was observed in the periphery of the solid lesion in the lower pole of right kidney which was considered suspicious for malignancy and biopsy was performed from this lesion (Figure 1). Pathology result reported as oncocytoma so follow-up decision was made for the patient. In the follow-up, the masses in the left kidney increased in size and diffusion restriction developed in the upper pole of the left kidney (Figure 2). This lesion was also biopsied because of suspect imaging finding, the result was reported as oncocytoma as well. At the same time, the patient was evaluated for tuberous sclerosis and Birt-Hogg-Dube syndrome as they associated with multiple bilateral oncocytomas. There was no similar signs, semptoms and imaging findings related to these genetic syndromes in the family members of the patient. Informed written consent was obtained from the patient for this report. Figure 1: A-Homogeneous enhancing, B- Multipl solid lesions with hypointense central stellate scar and non-enhancing cysts in both kidneys, C- Diffusion restriction was observed in the periphery of the solid lesion in the lower pole of right kidney (Coronal and axial view of enhanced abdominal MRI) Figure 2: A- Although having homogeneous enhancement with hypointense central stellate scar, B- Solid lesions in the left kidney increased in size, C- Peripheral diffusion restriction developed in the upper pole of the left kidney on follow-up MRI (Coronal and axial view of enhanced abdominal MRI) Renal oncocytoma is a benign renal tumor and up to three-quarters of patients with a renal oncocytoma are asymptomatic []. So its diagnosis is incidental on abdominal imaging. Possible signs and symptoms of a renal oncocytoma include hematuria, flank pain and an abdominal mass []. Both oncocytomas and renal tumors show similar enhancement but the central scar and the inversion pattern of enhancement have been associated with oncocytomas []. The "central stellate scar" sign refers to a central zone of fibrous connective tissue, with the bands of fibrosis radiating toward the periphery of the lesion is a characteristic radiological finding described of renal oncocytoma []. Central scar cannot be distinguished on imaging from the necrosis commonly found in renal cell carcinoma []. The underlying cause of most isolated renal oncocytomas is unknown; however, multiple oncocytomas can occur in people with certain genetic syndromes such as tuberous sclerosis and Birt-Hogg-Dube syndrome. Isolated oncocytomas usually seen as a single tumor affecting one kidney, on the other hand renal oncocytomas that are part of a genetic syndrome often affects both kidneys with multipl tumors [,]. Renal oncocytomas which are part of a genetic syndrome are associated with mutations. Birt-Hogg-Dube syndrome is caused by mutations in FLCN gene while tuberous sclerosisis caused by mutations in the TSC1 or TSC2 genes []. It can be hard to distinguish oncocytoma from renal cell carcinoma with only imaging studies. Biopsy is often needed to confirm the diagnosis []. Most patients are treated with surgery to confirm the diagnosis since the distinction between oncocytoma and renal cell carcinoma can not be made with imaging methods alone. Whether oncocytoma is strongly considered, partial nephrectomy can be done as a more conservative method []. Ethics Committee Approval: N/A. Informed Consent: An informed consent was obtained from the patient. Publication: The results of the study were not published in ful lor in part in form of abstracts. Peer-review: Externally peer-reviewed. Conflict of Interest: The authors declare that they have no conflict of interests. Financial Disclosure: The authors declare that this study received no financial support.
Grand J Urol 2021;1(1):41-42, DOI: 10.5222/GJU.2021.98608
The new coronaviruses outbreak caused by SARS-CoV-2 (COVID-19) originated from the Chinese region of Wuhan in the last quarter of 2019 affected approximately 75 million people all around the world and caused over 1.6 million deaths []. COVID-19 is a highly contagious viral infection and its main routes for transmission are the person to person contact, touch, and aerosol. While it has detrimental effects on respiratory and cardiovascular systems it also can be found in digestive and urinary systems. The frequently experienced symptoms are fever, dry cough, dyspnea, fatigue, and loss of appetite []. With an ongoing effort, several researchers focused on investigating a drug or vaccine to end the pandemic. Currently, despite there is no drug specifically approved for COVID-19 treatment, there has been more than one vaccine from different nations to prevent the virus spread. Prior to the COVID-19 pandemic, virology research constituted less than 2% of all biomedical research. But this rate has been increased to 10-20% which represents the incredible adaptation potential of the research community. By the way, the COVID-19 pandemic led to a massive influx of publication not only by virologists and infectious health specialists but also by almost all medical disciplines. To facilitate early dissemination of knowledge prior to any peer-review, many articles have been uploaded preprint services []. It is not realistic to assume that a qualified and strict peer-review process could compensate for the high number of submissions. Moreover, someone must be aware that those non-peer-reviewed materials could be picked up by the media and spread to the population. Social distancing and transmission issues have also led to travel and social restrictions that resulted in many trials to be suspended or delaying in patient recruitment []. It is wellknown that generally large-scale randomized trials were not set up in time in the previous pandemic. However, the use of modern information technologies in combination with oldfashioned randomization might lead to the rapid gain of viable results nowadays. Countries might be encouraged to establish clinical-trial networks to activate and arrange large multi-center studies []. COVID-19 pandemic deeply affects not only urological patient care but also urology residency education. Work hours modified and residences redeployed to serve in pandemic services in many countries. This situation came along with the problem of interrupted urologic training and unmet minimal case requirements. Generally, online learning curricula have been well-adopted by urologists. However, recent studies have been shown that such changes caused emotionally and physically stressful situations for trainees []. In conclusion, it is obvious that Coronavirus will continue to be in our daily life for a while. Thus, maintaining research and education is vital in all disciplines of medicine. Contributing to the scientific area with respect to essential requirements and ethics will support the development of all humanity in this crisis. Hereby, We would like to congratulate you on the first issue of your journal planned to be released in such a difficult time and wish you to have significant contributions to the field of urology in a strictly scientific manner. Sincerely yours.
Grand J Urol 2021;1(1):1-5, DOI: 10.5222/GJU.2021.87597
Objective: Today, infertility is a health problem with increasing treatment seeking. Testicular sperm extraction (TESE) is the only possible procedure to offer genetic parenting to men with nonobstructive azoospermia (NOA). Our aim in this study is to present our clinical experiences that affect the success of sperm retrieval in men with NOA in the light of the literature. Materials and Methods: In our study, patients who underwent TESE with a diagnosis of NOA between 2017-2020 were retrospectively analyzed. According to the TESE procedure; the patients were divided into two groups as conventional TESE and TESE performed under microscopic magnification (micro-TESE). Medical histories, hormone values, and physical examination findings of all patients were recorded. Results: Our micro-TESE success rate was found to be 100%. A positive correlation (rho 0.714, p = 0.009) was found between the factors affecting sperm retrieval , and the application of micro-TESE, and a negative correlation was detected with FSH levels (rho -0.759, p = 0.004). Conclusion: The success of sperm retrieval increases with the micro-TESE procedure. As FSH levels increase, sperm retrieval success rates decrease.
Grand J Urol 2022;2(1):42-44, DOI: 10.5505/GJU.2022.44153
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.