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Results in Journal Grand Journal of Urology: 34

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Murat Koser, Nilgün Işıksaçan, Ramazan Korkusuz, Gülçin Şahingöz Erdal, Pınar Atar, Fatih Akkaş, Ekrem Güner
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.36855

Abstract:
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.
Deniz Noyan Özlü, Kamil Gökhan Şeker, Emre Sam, Yusuf Arıkan, Joshgun Hüseynov, Yurdagül Çetin Şeker, Emel Sam, Fatih Akkaş, Nadir Kalfazade
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.97269

Abstract:
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.
, Ekrem Güner
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.14633

Abstract:
Objective: Applications are made to health boards for age assessment, gender determination, employment in some occupational groups and detection of disability. The aim of our study is to determine the defined urological pathologies and their incidence rates in the patients who applied to the health board of our hospital. Materials and Methods: Our study included patients who applied to the urology outpatient clinic of the health board between January 2015 and December 2020 for the purpose of employment in some occupational groups, determination of age, gender, disabilities and obtaining a general health report. Patients were investigated in two different groups, according to their indications for their applications as detection of disabilities and other indications, and the diagnoses were classified under the subheadings of stone diseases, malignancies, neurourology-incontinence, andrology and benign prostatic hyperplasia (BPH). Results: A total of 1453 cases were included in the study. Hundred and fifty-one (10.4%) patients applied for the detection of disability. A total of 206 (17%) patients, including 70 (46.3%) cases in the disability detection group and 136 (10.4%) in the other group had a urological diagnosis. The most common pathology was malignancies with 65 (4.4%) cases, in order of frequency; testicular cancer (n=25: 38.4%), bladder cancer (n=15: 23%), prostate cancer (n=13: 20%), kidney cancer (n=11: 16.9%) and penile cancer (n=1: 1,5%). The second most frequently seen diagnostic group was the stone disease group (n=55: 3.7%), and 17 (30.9%) of them required further investigation after diagnosis. Consequently ESWL (n=6: 10.9%), and surgical intervention (n=4: 7.3%) were planned for the indicated number of patients. Conclusion: Urogenital system malignancies and urinary tract stones have been identified as the most common pathologies in patients who applied to the health board. The fact that some diseases, especially urolithiasis were followed by further examination and treatment, shows the contribution of the health board examinations to the treatment as well as the health status determination feature.
, Halil Uzundal, Turker Soydaş, Asım Özayar, Arslan Ardıçoğlu, Aydan Kılıçarslan
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.22931

Abstract:
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.
, Işıl Kibar Akıllı, Müge Bilge, Esra Canbolat Unlu, Şebnem Izmir Güner, Ekrem Güner, Kadriye Kart Yaşar
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.79188

Abstract:
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.
Mehmet Yılmaz, Mustafa Karaarslan, Cavit Ceylan, Şenol Tonyalı
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.43531

Abstract:
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<0.05). Conclusion: We found that PDW is significantly higher in varicocele patients compared to controls. Thus, PDW might be a practical tool in the confirmation of varicocele diagnosis and also be utilized at follow-up after varicocelectomy.
Ramazan Azar, Yurdagül Çetin Şeker, Kamil Gökhan Şeker, Ismail Taşkent
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.66376

Didem Karaçetin
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.54264

Abstract:
Prostate cancer is one of the most common tumor in males. Radical prostatectomy, radiotherapy and watchful waiting are the main treatment options in localized disease. Radiotherapy together with hormonotherapy is accepted as the standard of care in patients with advanced stages. Surgery or radiotherapy has comparable local control and survival outcomes in localized disease. During recent years a significant reduction in the rate of serious side effects has been achieved due to the development of modern radiotherapy techniques. With the use of these techniques such as Intensity-modulated radiotherapy (IMRT), Image-guided radiotherapy (IGRT), Stereotactic body radiotherapy (SBRT), high doses can be given safely and the rates of serious short - or long-term side effects have not exceeded 1 percent. Modern radiotherapy techniques allow dose escalation for the target volume, and due to its achievement of sharp dose gradient around the target volume and enable to increase radiation doses homogeneously within the target volume without exceeding the tolerance doses in organs at risk. In the last few years hypofractionation has gained popularity in the curative radiotherapy of prostate cancer
Şebnem Izmir Güner, Mustafa Teoman Yanmaz, Ekrem Güner, Pınar Seymen, Melike Nalbant Moray, Işın Kılıçarslan
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.25743

Abstract:
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.
Kadir Karkin, Hakan Erçil, Umut Ünal, Güçlü Gürlen, Ferhat Ortoğlu, Ediz Vuruşkan
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.00710

Abstract:
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.
Serdar Karadağ, , Emre Sam, Mithat Ekşi, Yunus Çolakoğlu, Kadriye Kart Yaşar
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.75047

Abstract:
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.
, Mustafa Gürkan Yenice
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.00719

Abstract:
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.
Aykut Başer, Muhammet Ihsan Öztürk, Mücahit Doğan, Musa Ekici, Muhammet Yaytokgil, Mehmet Murat Baykam
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.87597

Abstract:
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.
Gulçin Şahingöz Erdal, Feyzi Sinan Erdal
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.47955

Abstract:
Objective: In our study, we aimed to examine the effects of body mass index (BMI) and multiple drug use on urinary incontinence (UI) in diabetic geriatric patients. Materials and Methods: Our study included 246 type 2 diabetes mellitus patients aged 65 and over who applied to our outpatient clinic between October and December 2019 and remained after the exclusion criteria were applied. The relationship between the frequency of UI and age, diabetes age, HbA1c, BMI, number of drugs and gender was investigated. UI described as any involuntary incontinence complaint. The questionnaire contained socio-demographic questions and the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). Results: Most (82.2%) of the patients with UI were women. Diabetes age and HbA1c level did not differ significantly between those with and without UI. There was a statistically significant relationship between BMI and the number of drugs used with the indication of UI (Mann-Whitney U; p <0.05). Incontinence was more common in those with high BMI (average BMI 30.27 kg/m2 ). While 47.7% of those with UI were obese patients. The number of drugs used was found significantly higher in those patients with UI (p=0.008). Conclusion: UI causes social isolation, depressive mood and introversion. In our study, we found that obesity and polypharmacy are associated with incontinence and triggered urinary incontinence. This indicates that UI is a problem that needs to be questioned and focused on in this patient population.
Mustafa Orhan Nalbant, Ömer Yıldız, Elif Hocaoğlu, Ercan Inci
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.09609

Kamil Gökhan Şeker, Emre Sam, , Ahmet Hacıislamoğlu, Abdulmuttalip Şimşek, Volkan Tuğcu
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.03511

Abstract:
Objective: We aimed to evaluate the results of our minimally invasive (laparoscopic and robotic) sacrocolpopexy operations in patients with pelvic organ prolapse (POP). Materials and Methods: Demographic characteristics, intraoperative and postoperative data of 15 patients for whom we applied laparoscopic or robotic sacrocolpopexy due to symptomatic Grade 2 or higher apical POP based on POP-Q classification between September 2014 and September 2018. Treatment success was defined as Grade 0 or 1 POP in POP examination in the final surveillance. Results: Mean age of the patients was 60.4 ± 8.3 (49-82) years. Four patients (26.7%) were operated using robotic and eleven patients (73.3%) using laparoscopic methods. Uterus conservative surgery was applied in all patients excluding one. Mean operative time was 183.3 ± 21.4 (145-220) minutes and mean hospital stay of the patients was 2.8 ± 0.7 (2-4) days. Intraoperative and postoperative complications developed in a total of two patients (13.3%). Mean duration of follow-up was calculated as 12.1 ± 4.8 (8-24) months. De novo urgency urinary incontinence developed in two patients and stress incontinence in one patient. Based on the physical examination in the follow-ups, 14 patients (93.3%) had Grade 0 and one patient had (6.7%) asymptomatic Grade 2 anterior POP. Conclusion: Minimally invasive sacrocolpopexy is an efficient and safe surgical option for prolapse repair in symptomatic advanced stage POP cases.
, Emre Tokuç, Semih Türk, Abdullah Hızır Yavuzsan, Sedat Çakmak, Sinan Levent Kireçci, Kaya Horasanlı
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.40085

Abstract:
Objective: To specify the prognostic factors predicting complication rates and postoperative renal function in patients operated with partial nephrectomy. Materials and Methods: Our health center"s archive system was scanned retrospectively for the time interval between January 2006- January 2021 for patients operated with partial nephrectomy for renal mass. History, comorbidities and laboratory results, operational information, tumor morphologies in radiographic images and its specified scores (R.E.N.A.L. score, PADUA score, C-index), peroperative and postoperative complications and pathology results of 148 regularly followed-up patients were analyzed. Results: Mean age of the patients was 55.04±10.91 years, ratio of male to female was 1.27 and mean tumor size was 3.56 cm. Mean follow-up period was 55.53±42.26 months. Postoperative creatinine value in the 6th month showed an increase of 0.18 mg/dl compared to preoperative value. Estimated glomerular filtration rate (eGFR) also decreased by an average of 18.3%. Operation of grade 4 tumors significantly affected the postoperative renal function. PADUA score (p=0.023) had a significant effect on postoperative GFRs and duration of ischemia. Also, difference in pre-and postoperative GFRs and its percentage change were significantly affected by C-index (p=0.035, p=0.042). Pathological size (p=0.038), R.E.N.A.L. score (p=0.001), PADUA score (p<0.001), duration of ischemia (p=0.045) had a positively and C-index (p=0.001) had a negatively significant correlation with Modified Clavien-Dindo Complication Scoring System. Conclusion: All nephrometry scores, duration of ischemia and tumor size were associated with the complication rates according to Clavien classification. Tumor grade, PADUA score and C-index are valuable parameters for predicting renal dysfunction after partial nephrectomy.
Alper Bitkin, Mustafa Aydın, Inci Yavuz, Ramazan Inan, Lokman Irkilata
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.98609

Abstract:
Retroperitoneal liposarcoma (RPLS) is a rare tumor. Early diagnosis and treatment are difficult due to absence of specific clinical presentations. We report a case of a 66-years-old woman who succesfully underwent complete surgical resection for a giant retroperitoneal liposarcoma. The complete surgical resection is the most important predictor of local recurrence and overall survival. We believe that complete surgical resection involving adjacent organs is a curative treatment to increase overall survival, especially in the presence of invasion of large tumors.
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.87598

Abstract:
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.
, Onur Memik, Onur Karslı, Murat Üstüner, Levent Özcan
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.10820

Abstract:
Objective: We aimed to investigate the efficacy of silodosin in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) refractory to previous α-adrenergic receptor (AR) blocker therapy. Materials and Methods: Patients who did not benefit from alpha-blocker therapy but avoided surgical treatment constitute the population of our study. Seventy-five patients were studied in each group; Group 1 was given 8 mg of silodosin, while Group 2 continued the previous alpha-blocker treatment. Results: The initial mean international prostate symptom score (IPSS) was calculated as 20.81±0.97 in Group 1, in the third month there was a decrease of 17.12±1.25 (p<0.05). No significant change was observed in Group 2. In addition, a significant decrease was observed in IPSS subscores (storage and voiding symptoms) in Group 1 compared to baseline at the third month. There was an improvement in residual urine in the silodosin group and no improvement in the other group. Conclusion: In patients with BPH who refuse surgical treatment and could not achieve adequate symptom relief with other α-blockers in routine practice, silodosin was found superior in terms of LUTS recovery. Silodosin is also an effective option in patients who cannot undergo surgical treatment due to comorbidities.
Okan Alkış, Bekir Aras, Mehmet Sevim
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.57966

Abstract:
Overactive bladder is a serious condition that can significantly impair quality of life. Antimuscarinic agents are recommended as second-line therapy in patients who do not benefit from behavioral therapy. However, the therapeutic efficacy of antimuscarinic agents is limited. Alternative treatment methods to medical treatment have been developed due to its limited effectiveness and frequent side effects. Posterior tibial nerve stimulation (PTNS), transcutaneous tibial nerve stimulation (TTNS), sacral neuromodulation (SNM), intravesical Botulinum toxin-A (BoNT/A) are prominent among these minimally invasive treatment methods in refractory OAB. All these methods have been demonstrated to be effective in the literature. BoNT/A and SNM are more effective, but have been reported to cause more side effects. In refractory OAB, any of these methods can be applied by considering the medical condition and request of the patient.
Mehmet Sevim, Barış Şengül, Okan Alkış, Bekir Aras, Şahin Kabay
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.65375

Abstract:
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.
Eda Çelebi Bitkin, Alper Bitkin, Ender Cem Bulut, Oğuz Tuncer
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.47956

Abstract:
Objective: Hypospadias is one of the most common congenital defects in boys. Multifactorial factors such as genetic predisposition and environmental factors play a role in the etiology of hypospadias. In this study, we investigated the risk factors of patients diagnosed with hypospadias. Materials and Methods: Thirty-six patients who applied to the pediatric endocrinology and urology outpatient clinics with the diagnosis of hypospadias were evaluated retrospectively. Risk factors were evaluated by recording the parental ages, exposure to environmental factors, the maternal BMI, history of pregnancy, drug use, and the father’s fertility status. Results: The mean age of the patients was 3.5 ± 2 years. The patients had anterior (n:27 : 75%), middle (midshaft) (n:8 ; 22.2%), and posterior (n:1 ; 2.8%) hypospadias. The mean body mass index (BMI) of the mothers was 24 ± 4.1 kg/m2. Eight (22.2%) mothers were overweight and six (16.6%) mothers were obese. There was a history of hypospadias in the family of 4 (11%) patients. Conclusion: Although combinations of environmental and genetic factors play a role in the etiology of hypospadias, many unexplained factors are responsible for this disease.
Mecit Çelik, Muhammed Emin Polat, Çağlar Sarıoğlu, Buğra Bilge Keseroğlu
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.36844

Abstract:
Inguinal bladder herniation is seen in 1% -4% of all inguinal hernia cases; most of them are asymptomatic and come up with swelling in the groin. In symptomatic cases, nonspecific findings such as lower urinary tract symptoms or pain due to strangulation of the hernia sac are seen. Two-stage micturition (manual pressure to the scrotum to empty residual urine) is a pathognomonic sign for the advanced case. Vesicoureteral reflux (VUR), bilateral hydronephrosis, urinary tract infection, acute kidney failure and bladder wall necrosis are complications that may be seen if the problem is not appropriately managed. Preoperative diagnosis rates are low (<7%) and 16% of the cases are diagnosed in the postoperative period, and most cases are detected intraoperatively. Radiologic examination performed for other indications such as non-contrast abdominal computed tomography (CT) may diagnose the bladder herniation. CT, cystography and ultrasonography are the techniques that can be used in the diagnosis and differential diagnosis. Intraoperatively, reduction of the herniated bladder with herniorrhaphy is a routine procedure. Partial cystectomy has to be made in case of bladder wall necrosis, presence of a tumor in the herniated bladder and narrow bladder neck which don"t allow reduction. In this case report, our aim is to explain the management of left inguinoscrotal complete bladder herniation and postoperative voiding problem.
, Yusuf Ilker Çömez, Hasan Kerem Alptekin, Ali Veysel Özden
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.43153

Abstract:
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.
, Mert Ali Karadağ
Grand Journal of Urology, Volume 1; https://doi.org/10.5222/gju.2021.53825

Abstract:
Objective: To investigate the effect of ureterorenoscopic stone removal timing on kidney function in unilateral ureteral stones. Materials and Methods: Hundred and eighty-seven patients included in the study were divided into two groups: 98 patients who underwent surgery ≤14 days after the stone diagnosis constituted the Early Surgery Group and 39 patients who were operated >14 days after the stone diagnosis comprised the Late Surgery Group. Preoperative serum levels of creatinine, blood urea nitrogen (BUN), and glomerular filtration rates (GFR) were recorded for the patients in both groups. In the postoperative first month, serum creatinine, BUN, and GFR were again recorded and compared with the preoperative values. Results: The mean preoperative serum creatinine, GFR, and BUN levels in the Early Surgery Group were 1.25 ± 0.65μmol/L, 80.04 ± 33.6ml/min/1.73m2, and 50 ± 16.6mmol/L, respectively. A decrease was observed in serum creatinine (0.82 ± 0.22μmol/L, p< 0.001) and BUN (14.08 ± 7.25mmol/L, p< 0.001) levels one month after surgery, whereas GFR increased (105.33 ± 21.6ml/min/1.73m2, p< 0.001). In the Late Surgery Group, postoperative levels of serum creatinine (0.94 ± 0.33 vs. 0.95 ± 0.30μmol/L, p= 0.102), and BUN (17.38 ± 9 vs. 17.92 ± 8.8mmol/L, p= 0.283), increased minimally, also a minimal decrease was observed in GFR (95.15 ± 27.3 vs. 93.77 ± 24.3ml/min/1.73m2, p= 0.338) without any statistically significant difference. Conclusion: We believe that surgical treatment should be planned within two weeks at the latest, as prolonged obstruction may result in kidney damage.
Mustafa Taşdemir, Ünal Öztekin, Mehmet Canikoğlu, Hafize Aktaş
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.65376

Abstract:
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
Oğuzhan Yusuf Sönmez, Mehmet Sevim, Halil Ibrahim Ivelik, Burak Işler, Bekir Aras
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.25745

Abstract:
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.
Hasan Salih Sağlam, Hacı Bayram Çimen
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.39974

Abstract:
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.
Yusuf Kasap, Emre Uzun, Buğra Bilge Keseroğlu, Sedat Tastemur, Cavit Ceylan, Muhammed Emin Polat
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.58066

Abstract:
Objective: Levels of insulin-like growth factor 1 (IGF-1) have been associated with prostate carcinoma. We have investigated whether IGF-1 level has an early predictive value for the biochemical relapse in the prostate carcinoma patients with a negative surgical margin who underwent curative surgery. Materials and Methods: We retrospectively analyzed 82 patients who were followed-up regularly and did not receive neoadjuvant or adjuvant chemotherapy. We classified patients as having Gleason scores ≥7 and <7, PSA values ≥10 ng/ml and <10, biochemical relapse positive or negative, T stages ≥T2 and
Joshgun Hüseynov, Nadir Kalfazde, Ekrem Güner
Grand Journal of Urology; https://doi.org/10.5222/gju.2021.47966

Abstract:
Objective: We aimed to compare outcomes of percutaneous nephrolithotomy (PNL) surgery in patients who had and had not undergone renal stone surgery before PNL. Material and Methods: We retrospectively analyzed the medical records of all patients who underwent PNL in our department between 2010 and 2019. Examined parameters consisted of patient demographics, medical and surgical history, stone size, stone density, stone site, estimated intraoperative blood loss, duration of operation, hospital stay and stone-free status. Results: A total of 193 patients were included the study. The mean age of the patients was 45±13 years. The mean duration of surgery was 69±11.5 minutes. The mean stone area was 720.2±600.4 mm2 and the mean stone attenuation was 982.8±327.7 HU. The mean postoperative hemoglobin decrease was 1.8±1.3 g/dL. 66 patients had previous stone surgery including open stone surgery, PNL and retrograde intrarenal surgery (RIRS). There was no statistically significant difference between patients who had and had not previousşy undergone renal stone surgery in terms of age, gender, body mass index and stone area. Operative time, estimated intraoperative blood loss, postoperative hemoglobin decreases and hospital stay were comparable between patients who had, and hed not undergone previous renal stone surgery. Stone-free rate was significantly higher in primary PNL patients compared to patients with a history of renal stone surgery (92.1% vs 77.3%, p=0.006). Conclusion: PNL has a similar complication rate in patients with and without previous kidney stone surgery. However, achieving stone-free status may be challenging in patients with a history of ipsilateral renal stone surgery.
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