Grand Journal of Urology
E-ISSN : 2757-7163

Andrology (Male Sexual Disfunction, Infertility)
Case Report
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.
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.
Original Article
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 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(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 2021;1(2):49-54, DOI: 10.5222/GJU.2021.65376
Objective: The aim of this study is to investigate the effect of hyperlipidemia on the development of erectile dysfunction (ED) in hyperlipidemic patients with ED. Materials and Methods: Twenty-five patients who applied to the radiology clinic were included in the study. All patients have only hyperlipidemia as a risk factor of ED. The patients were evaluated in terms of ED by using International Index of Erectile Function (IIEF) form. Before and after oral treatment with daily doses of 10 mg atorvastatin, all parameters were measured. Paired t-test was used to compare vascular velocities between lipid profiles and Erectile Function Domain Scores (EFDS) and IIEFs, before and after treatment separately. Results: Cholesterol levels of 96% of patients were higher than 200 mg/dl and 52% of them had abnormal penile Doppler ultrasonography (PDU) findings. Patients with abnormal PDU findings had lower cholesterol levels than those with normal PDU findings. Significant differences existed between patients with normal and abnormal PDU in the high triglyceride group as for pre-, and post-treatment values . Pre-, and post-treatment EFD and IIEF scores were comparable. Conclusion: It can be said that a relationship exists between hyperlipidemia and erectile dysfunction. Therefore, lipid profile of a patient admitted with ED may be analyzed routinely
Grand J Urol 2021;1(3):116-121, DOI: 10.5222/GJU.2021.00719
Objective: Elevated uric acid (UA) and low levels of high-density lipoprotein (HDL) cholesterol are associated with cardiovascular events and mortality. Erectile dysfunction (ED) has been considered an early marker of cardiovascular disease (CVD). Therefore, this study aimed to investigate the uric acid/ HDL ratio (UHR) as a nowel marker in patients with ED. Materials and Methods: The study included 147 patients with a mean age of 50 years (range 32-76 years). Retrospective analyses were performed on the patients who were admitted to urology outpatient clinics. The laboratory parameter results were retrieved from the hospital medical records, and the UHR value was calculated. Patients were categorized into three groups according to the International Index of Erectile Function (IIEF) score. UHR was compared between groups, and its predictive value was evaluated using regression analysis and ROC curve analysis. Results: Age was found to be significantly different in all three groups (Groups 1-2, p=0.001; Groups 1-3, p=0.000; Groups 2-3, p=0.001). It was observed that the degree of ED increased with age. The values of UA and HDL were similar in all groups (p>0.05). In contrast, the UHR value was statistically significantly higher 0.15 (0.083-0.288, p =0.047) in the moderate-severe ED (Group 3). ROC curve analyses revealed that UHR predicted severe ED (IIEF 5-11) with 42.9% sensitivity and 87.3% specificity (AUC:0.66, CI 95% 0.538-0.781, p=0.019). Conclusion: UHR may serve as a severe ED indicator in patients admitted to the cardiology outpatient clinic since it has a significant association with a low IIEF score.
Clinical Image
A 74-year-old male patient was admitted to the emergency department reaching a depth of 1 cm surrounding the penis body, bleeding, and discoloration of the penis skin. It was observed that there were white-yellow rubber bands in the incision area in the examination of the patient (Figure 1). Laboratory examinations revealed no pathology. The patient was consulted at the urology clinic. It was learned that he underwent urethral surgery after trauma and he had continuous urinary incontinence and compressed his penis with these rubber bands to prevent it. 18 Fr urethral Foley catheter was inserted. It was observed in the exploration that the rubber bands lasered the penis skin laterally and dorsally to tunica albuginea, and ventrally to corpus spongiosum and urethra level. Five rubber bands were cut and removed (Figure 2). It was observed that corpus spongiosum-urethra and corpus cavernosa were intact in exploration. The penile skin was left for secondary healing after sterile cleansing of the skin and subcutaneous tissue (Figure 3). Penis was wrapped with a Coban bandage after the medical dressing. The urethral catheter was removed on the first day after the operation. The patient was prescribed broad-spectrum antibiotherapy, analgesic, anti-inflammatory, and duloxetine for continence. Kegel exercises were practically explained. The patient was referred to the psychiatric clinic before discharge. It was observed in the follow-up one week later that the penis healing was good except for mild edema and the wound healed completely (Figure 4). The penis was found to be completely normal except for skin pigment change in several areas a month later (Figure 5). The patient stated that there was intermittent continence. Written informed consent form was obtained from the patient. Figure 1: Preoperative appearance Figure 2: Removed rubber bands Figure 3: Postoperative appearance Figure 4: Control appearance after 1 week Figure 5: Control appearance after 1month Penile strangulation with a foreign material is a rare condition and was first reported by Gauthier in 1755. To date, only a few case series have been published in the literature with fewer than 100 case reports. Penile strangulation is a condition that needs to be intervened urgently, and it can lead to complications such as gangrene and amputation of the penis if not treated as soon as possible [,]. Foreign materials used for strangulation can be classified as soft and hard. In the literature, the most common hard materials for strangulation were metallic rings (49.0%), metallic tubes (14.8%), plastic bottles (12.1%), rings (9.4%) and plastic products (6.7%) and the most common soft materials for strangulation were rubber bands (67.9%), rubber strings (13.2%), threads (13.2%) and vinyl products (1.9%). The most common causes to use foreign material for penile strangulation were pranks, sexual intercourses, treatments of incontinence, and treatments of phimosis []. Complications related to penile strangulation injuries are skin erosion, laceration, infection, urethral transection, penile gangrene, and autoamputation []. Bhat et al. developed a grading system for penile strangulation injuries due to constructive objects around the penis and divided them into five categories from penis edema to gangrene. Grade I causes edema only, whereas Grade II involves penile paresthesia. Grade III includes skin and urethral damage but does not include urethral fistula. Grade IV includes the urethral fistula. It involves Grade V injury, gangrene, necrosis, or complete amputation []. The management of the patients is different according to the type of foreign body and the clinical findings of each case. There is not a standard surgical approach []. The treatment mainly aims to remove the constricting object as soon as possible to restore venous and lymphatic drainage and arterial flow by preserving the anatomy and functionality of the organ []. Thin non-metallic constricting objects are easy to remove in the treatment of penile strangulation. Successful results can be obtained by cutting such objects with simple surgical scissors or a scalpel. Orthopedic surgical instruments or non-medical instruments may be needed in metal objects or in patients with severe edema after penile strangulation []. In addition, psychological and psychosexual evaluation of these patients is a part of the treatment. 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 full or in part in form of abstracts. Peer-review: Externally peer-reviewed. Conflict of Interest: The authors declare that they have no conflict of interest. Financial Disclosure: The authors declare that this study received no financial support.