Grand Journal of Urology
E-ISSN : 2757-7163

Original Article
Objective: This study compared the pre-COVID-19, COVID-19, and post-COVID-19 periods of the patients in terms of urinalysis parameters and assessed the relationships between the changes in these parameters and renal functions. Materials and Methods: Four-hundred-eighty-two moderate and severe COVID-19 patients who had the data of urinalysis performed in the pre-COVID-19 period at most three months before the onset of COVID-19 diagnosis, during COVID-19 disease, and 15 days after they completely recovered from the COVID-19 disease were included in the study. Parameters of bilirubin, erythrocyte, leukocyte, protein, glucose, acidity (pH), and density were analyzed in urine samples, and the results were recorded. Results: CRP, e-GFR, fibrinogen and D-dimer values were found to be significantly different between the three groups (for all parameters p
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 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 2022;2(1):24-25, DOI: 10.5505/GJU.2022.36035
Objective: To evaluate the effect of the pandemic on the publications related to urology. Methods: All publications about urology in the PubMed database between 2016 and 2020 were reviewed. The number and the rate of change in the number of these publications issued between the years 2016- 2019, and in 2020 were recorded. The publications about urology and COVID-19 in the pandemic period were identified, their publication rates among them were examined. Results: There was a reduction of 24.33% in the rates of publications on urology during the pandemic period compared to the time interval between the years 2016, and 2019, but without any statistically significant difference (p=0.122). A statistically significant difference was found only in the number of publications related to urological surgery between 2016- 2019 and 2020 (p=0.045), but without any statistically significant difference in the number of publications on other subdiciplines of urology (p>0.05). The ratio of publications on COVID- 19 and urology to all publications on COVID-19 was 1.33 percent. The ratio of publications on COVID-19 and urology to all publications on urology in 2020 was found to be 1.98 percent. Conclusion: The COVID-19 pandemic did not make a significant difference in the number of publications on urology. Although disasters such as pandemics may not affect the number of publications, they can change the types of publications to which scientists are directed to.
Grand J Urol 2022;2(1):8-14, DOI: 10.5505/GJU.2022.58067
Objective: Benign prostatic hyperplasia (BPH)-related acute kidney injury (AKI) occurs in male patients as a natural result of aging and androgen exposure. In our study, we investigated the frequency of BPH-related AKI and its relationship with disease severity in patients hospitalized for COVID-19 pneumonia. Materials and Methods: This is a retrospective and observational study on 869 male patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. None of the patients was admitted to the intensive care unit (ICU). 55 patients out of 869 had BPH. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. BPH and non-BPH groups were statistically compared with respect to the existence, frequency, hospitalization duration and in-hospital death. Results: Median age was 70 years for BPH group and BPH patients were significantly older than the non-BPH. Hypertension, coronary artery disease and heart failure were significantly more frequent in the BPH group. On admission, compared with normal serum creatinine, serum urea was significantly higher in the BPH patients. All AKI patients with BPH had three or more comorbidities. During hospitalization, AKI occurred in 7,3% of the BPH patients compared with the non-BPH (0,98%). The incidence of AKI was significantly higher in the patients with BPH (OR:7,94, 95% CI:2,31-27,25). In-hospital death occurred in 16,4% of the patients with BPH. The mortality was significantly lower in non-BPH group (8,6%) compared with the BPH. Our final analysis showed that age, arterial hypertension, prior coronary artery disease and heart failure were independent risk factors for occurred BPH-related AKI. Conclusions: Older male patients with common comorbidities showed a higher risk for mortality from COVID-19 pneumonia. Also, AKI patients with BPH had a poorer prognosis and higher mortality than the non-BPH patients.
Grand J Urol 2021;1(3):109-115, DOI: 10.5222/GJU.2021.75047
Objective: To investigate whether tacrolimus (Tac), mycophenolate mofetil (MMF), mycophenolic acid (MPA), prednisolone (Pred) and methylprednisolone (MP) are affect the COVID-19 pathogenesis and on its progression in kidney transplantation recipients diagnosed with COVID-19 patients. Materials and Methods: Among patients hospitalized due to COVID-19, patients who had kidney transplantation were retrospectively detected on the online database of our center. Referral complaints, laboratory and radiological data at referral, applied treatment protocols, and ultimate conditions of the patients were documented. Results: Among the total of 11 patients, 73% (8) were male and 27% (3) were female. The mean age was 49.63 (27-71). Hypertension and diabetes mellitus were the most common comorbid diseases. The most common symptoms were coughing, fever and exhaustion-fatigue. High serum reactive protein and lymphopenia were detected in almost all patients. Acute renal failure was observed in seven patients (73%). While all patients were using Tac and Pred, nine patients (82%) were using MMF and two patients (18%) were using MPA. Hydroxychloroquine, favipiravir, and azithromycin were treatments for COVID-19. RT-PCR results of 11 patients were positive in 7 and negative in 4 patients. The mean hospital stay of the discharged patients was 8.8 days. Eight patients recovered and were discharged, treatment of two intubated patients continues in intensive care unit and one patient died. Conclusion: Clinical characteristics of COVID-19 in kidney transplanted patients are similar to the general population and it should be kept in mind that the disease occurs with moderate-severe pneumonia in this patient group. Disease progress can be stopped through early treatment.
Case Report
Concurrence of emphysematous pyelonephritis related to renal tuberculosis and iliopsoas abscess is exceedingly rare, and its coexistence with COVID-19 pneumonia presented as "diabetic ketoacidosis" may have fatal consequences. A 46-year-old diabetic female patient was manifesting signs of septic shock; unconsciousness, febrile episodes, tachycardia and tachypneia when she was first admitted to our emergency department. She had positive real-time PCR test results for COVID-19 four days before her admission with symptoms of abdominal pain, fever, nausea, weakness, chest tightness, and shortness of breath persisting for a week. Blood test results were consistent with diabetic keto acidosis. Computed tomography (CT) showed left-sided emphysematous pyelonephritis and iliopsoas abscess. The patient was managed using percutaneous drainage and empirical antibiotics. Besides, renal tuberculosis was identified in the patient who did not respond to the treatment offered. A poor glycemic control may cause various fatal clinical complications. Concurrence of emphysematous pyelonephritis and iliopsoas abscess may be devastating for the patient that must be promptly managed to avoid any occurrence of septic shock. As the response to the treatment offered was inadequate, the coexistence of other disease states as renal tuberculosis was contemplated.
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.
COVID-19 is a highly contagious disease. This condition affects the decision of both the patient and the surgeon about the surgery of newly diagnosed cancer patients and it may also result in delays in cancer surgeries because of the limitations in healthcare applications. In our particular case, it was aimed to present the transition of the cancer from the localized stage to distant spread stage cancer since the patient who was pre-diagnosed with RCC and who was recommended surgery, did not want to undergo surgery due to COVID-19 pandemic and its risks. Our case was a 49-year-old female patient. In her computed tomography, a 58x70 mm heterogeneously enhancing solid lesion which showed exophytic extension from the middle zone of the right kidney to the lower pole was observed. Surgery was recommended for the patient but the patient claimed that she did not want to undergo surgery due to the risk of COVID-19 pandemic. The patient made an application for the surgery 8 months later. The new magnetic resonance imaging of the patient showed that there was a mass lesion of approximately 76x76x80 mm in size, which involved middle-lower part of the right kidney and extended into the opening of the renal vein VCI by invading the renal vein. Radical nephrectomy and thrombectomy procedure was applied to the patient with RCC? tumor. Due to psychosocial problems caused by the pandemic, surgeries are delayed and an acceleration of the cancer progression from the localized stage to the distant spread stage occurs indispensably.
Letter to the Editor
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.