Dear colleagues, I am honored to share with you the second issue of 2025 (volume 6, issue 2) of the Grand Journal of Urology (Grand J Urol) with the contributions of many respected researchers and authors. Grand Journal of Urology (GJU) aims to carry written and visualscientific urology studies to academic platforms and to make significant contributions to the science of urology. Our journal has been abstracted/indexed in Tubitak Ulakbim TR Index, EBSCOhost, J-Gate, SciLit, ResearchGate and Google Scholar international databases. As of these achievements, the Grand Journal of Urology (GJU) has taken its place among the journals indexed by national and international databases. In this issue of our journal, there are many valuable articles under the subheadings of Andrology, Endourology, General Urology, Reconstructive Urology, Urolithiasis and Urologic Oncology. I hope that these carefully prepared articles will make important contributions to valuable readers, researchers and the urology literature. On this occasion, I would like to express my heartfelt gratitude to our authors who have contributed to our journal with their articles, to our reviewers who have meticulously evaluate the articles. Respectfully yours May 2026 Assoc. Prof. Ekrem GUNER, MD Editor-in-Chief

Hematospermia (HS), characterized by the presence of blood in semen, is a relatively rare clinical finding that often causes significant concern for patients despite its typically benign nature. While a specific etiology is frequently not identified, underlying infectious, inflammatory, or—less commonly—malignant conditions may occasionally be responsible []. Although HS is often a self-limiting condition, further evaluation may be warranted based on factors such as the patient"s age, recurrence of symptoms, and the presence of accompanying findings. Diagnostic assessments may include urinalysis, urine or semen cultures, digital rectal examination, prostate-specific antigen (PSA) testing, transrectal ultrasonography, and pelvic magnetic resonance imaging in selected cases []. The 2025 guidelines of the European Association of Urology (EAU) on Male Sexual and Reproductive Health propose a structured diagnostic pathway for HS, recommending further evaluation particularly in men over 40 years of age, in cases of recurrent episodes, or when accompanied by additional urological symptoms []. Nevertheless, despite the presence of evidence-based guidelines, diagnostic and therapeutic approaches to HS remain highly variable in routine clinical settings. In Türkiye, factors such as differences in clinical experience, institutional protocols, and educational backgrounds may contribute to this variability among urologists. However, there is a lack of data on how HS is actually evaluated and managed in everyday urological practice across the country. This study aimed to assess the diagnostic and treatment approaches toward HS among practicing urologists and residents in Türkiye through a pilot cross-sectional survey involving participants from diverse institutions.

Kidney cysts are one of the most common benign acquired kidney lesions []. Autopsy studies show that about half of patients aged 50 and older have a kidney cyst []. Population-based studies indicate that simple renal cysts occur in approximately 7-10% of the general population, and their prevalence increases with age, reaching up to 30% in individuals over 50 years []. Kidney cysts are classified according to imaging methods as simple kidney cysts and complex kidney cysts []. Kidney cysts are usually asymptomatic and are diagnosed incidentally. Treatment is not necessary unless the cyst becomes infected or grows and causes symptoms. Treatment options for symptomatic benign renal cysts are cyst aspiration, surgical resection and sclerotherapy []. Although there is no evidence that any of the options is superior to the other; sclerotherapy and aspiration are associated with a higher incidence of cyst recurrence. The internet, which started to be used in the second half of the twentieth century, has become the main source of obtaining information today. Especially social media platforms are the resources that patients and health professionals often use to access health information. Video is an effective way to demonstrate some content that cannot be easily explained in text form. YouTube (Google LLC, CA, USA), one of the most widely used social media platforms where users upload billions of hours of videos every day, was launched in 2005 []. YouTube can serve as educational tools for healthcare professionals, patients and their caregivers. However, videos are uploaded to this platform without any quality control and the information provided may be incorrect and misleading []. For this reason healthcare providers are concerned about the quality and standard of information on YouTube []. As a result, it is necessary to obtain information from sources of adequate quality and standard by evaluating the quality and standards of the content on YouTube. Until this time, numerous studies in various medical fields have examined the quality and accuracy of YouTube videos, reporting that the content may range from highly informative to biased or misleading [-]. Within urology, the most popular topics seem to be urooncology and andrology [-]. Kidney cysts, which are usually detected incidentally in patients undergoing imaging for another reason, are a fairly common urological condition. Owing to their high prevalence, kidney cysts are also among the frequently searched conditions on the internet and social media platforms. Despite the growing popularity of video-based medical learning, no prior studies have systematically assessed the quality of YouTube content on kidney cysts. We hypothesized that YouTube videos related to kidney cysts would vary widely in quality and reliability, with a significant proportion lacking essential, accurate, or evidence-based information. Therefore, the aim of this study was to evaluate the content, reliability, and quality of kidney cyst-related videos available on YouTube.

Bladder cancer is the tenth most common malignancy worldwide and is associated with a high mortality rate if left untreated []. It is classified into two major categories: nonmuscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), with NMIBC accounting for the majority of cases. NMIBC includes mucosa-limited (pTa), lamina propria-invasive (pT1), and carcinoma in situ (CIS) stages. If untreated, approximately 50% of NMIBC cases progress to MIBC. Additionally, the recurrence rate after treatment remains high, ranging from 70% to 80% []. Ultrasonography (USG) and computed tomography (CT) urography are commonly used for the diagnosis of urinary tract pathologies. While USG is useful for detecting intra-bladder tumors, assessing hydronephrosis, and characterizing renal tumors, it is limited in its ability to identify upper urinary tract tumors []. CT urography is typically performed in three phases: the noncontrast phase, the nephrographic phase (with an 80–120 second delay), and the excretory phase (with a 10–15 minute delay) []. It is highly sensitive for detecting renal masses and identifying filling defects within the urinary collecting system [,]. Neoplastic tissues are known to exhibit high vascularization to support proliferation and maintain viability []. The angiogenic activity of malignant tissues is believed to have prognostic significance. Studies assessing the vascularization of bladder and renal pelvis tumors have demonstrated an association between tumoral vascularization and tumor grade, stage, and prognosis [8,9]. In these studies, vascularization was typically evaluated using immunohistochemical staining, vessel quantification, or contrast-enhanced imaging techniques [-]. Contrast enhancement techniques have emerged as valuable methods for assessing bladder cancer, offering insights into tumor aggressiveness and aiding in staging and grading. Contrastenhanced ultrasound (CEUS) has been explored for its diagnostic accuracy in differentiating between muscle-invasive and nonmuscle- invasive bladder cancer, offering a cost-effective and safe imaging alternative [,]. Contrast enhancement observed in CT urography has been demonstrated to correlate with tumor vascularization and histological grade []. This study aimed to assess the prognostic significance of contrast enhancement in CT urography for bladder cancer.

Circumcision is one of the oldest and most widely practiced surgical procedures worldwide, performed for religious, cultural, or medical reasons. It is estimated that approximately 30–33% of men aged 15 years and older have undergone circumcision globally []. The procedure involves the surgical removal of the foreskin covering the glans penis. Despite being commonly performed, circumcision should not be regarded as a simple or minor intervention. The accurate identification of excision margins, strict adherence to antiseptic principles, and the provision of adequate analgesia and anesthesia are all essential for ensuring safe and optimal surgical outcomes []. The optimal timing for circumcision remains of topic of ongoing debate in both clinical and sociocultural contexts []. Similarly, there is no universally accepted or standardized protocol regarding the choice of anesthesia []. In Freudian psychoanalytic theory the so-called "phallic stage", between three and six years of age, represents a critical developmental period during which children begin to form their gender identity, establish body awareness, and internalize attitudes toward sexuality and the body []. Although there is a lack of high-level evidence from large-scale studies or meta-analyses, a significant proportion of healthcare professionals express concern about performing circumcision during this stage due to its potential association with castration anxiety, body image disturbances, and adverse psychosexual outcomes [,]. Nevertheless, circumcision during this developmental period remains common in many cultures, particularly when performed under local anesthesia for religious or traditional reasons. In pediatric patients within this age group, the procedure may trigger feelings of fear and anxiety, which could potentially contribute to long-term psychological consequences [,]. To the best of our knowledge, this is the first study in the English-language literature to examine the long-term effect of the anesthesia type administered during circumcision in the phallic stage on adult male genital self-image.

Ureteral injuries, although relatively uncommon, represent a serious surgical complication that can result in significant morbidity, including ureteral stricture, hydronephrosis, and loss of renal function if not promptly diagnosed and managed. The vast majority are iatrogenic in nature, with the distal third of the ureter being particularly vulnerable during pelvic procedures such as gynecological, colorectal, and urological surgeries [–]. Definitive management of distal ureteral injuries typically requires surgical reconstruction to restore urinary continuity and preserve renal function. Ureteroneocystostomy is the most widely accepted approach, with several techniques described, including the Politano–Leadbetter and the extravesical Lich– Gregoir methods []. The Lich–Gregoir technique, originally developed for anti-reflux ureteral reimplantation, has become popular due to its relative technical simplicity, shorter operative time, and low complication profile []. Over time, several modifications of the Lich–Gregoir technique have been introduced to optimize outcomes, especially in complex or reoperative settings. The extravesical approach minimizes bladder dissection and avoids extensive intravesical manipulation, which can be advantageous in patients with iatrogenic injuries after major pelvic surgery. However, the evidence specifically addressing the role of the modified Lich–Gregoir technique in adult iatrogenic distal ureteral injuries remains scarce. Most previous reports have either pooled various etiologies or focused primarily on pediatric or reflux populations [,]. The objective of this study was to assess the surgical and functional outcomes of repairing iatrogenic injuries to the distal ureter using the modified Lich–Gregoir ureteroneocystostomy technique, with a focus on perioperative factors, complication rates, and long-term functional outcomes.

Peyronie"s disease is a condition characterized by the formation of fibrotic plaques within the tunica albuginea of the penis, leading to penile curvature, pain, and sexual dysfunction, thereby significantly impairing male quality of life []. Although Peyronie"s disease can occur across all age groups, it is most commonly encountered in middle-aged men. The reported prevalence of the disease in the literature varies widely, with rates ranging from 0.3% to 20%. Nevertheless, despite differences in study methodologies, the most frequently cited prevalence is approximately 9% [-]. It is well recognized that some patients avoid seeking medical care due to embarrassment or reluctance, and even when they do present to healthcare facilities, they often turn to internet-based resources to obtain additional information regarding diagnosis and treatment [,]. In recent years, online video-sharing platforms such as YouTube have become easily accessible sources of health-related information for patients. Indeed, in daily urological practice, it is frequently observed that patients actively use YouTube to acquire supplementary information about their medical conditions [-]. However, the quality of content available on YouTube is not always adequate, and the largely unregulated nature of the platform may facilitate the dissemination of misleading or inaccurate information. Although studies evaluating the content quality and reliability of English-language YouTube videos related to Peyronie"s disease are available in the literature, there is currently no study focusing on Turkish-language content []. Therefore, the aim of the present study was to comparatively evaluate Turkish and English YouTube videos related to Peyronie's disease in terms of content, quality, and reliability.

Ureteroceles are defined as cystic dilatations of the terminal ureter within the bladder and result from a congenital defect in ureteral embryogenesis []. They are classically diagnosed in pediatric populations, often associated with duplicated collecting systems and extravesical localisation (ectopic in the bladder neck or urethra). In contrast, adult ureteroceles are rare, typically intravesical (or orthotopic), and frequently discovered incidentally [,]. Clinical presentation in adults ranges from asymptomatic findings to recurrent urinary tract infections, urolithiasis, hematuria, or obstruction. Prolapse of a ureterocele through the urethra has been described only sporadically in the literature []. Management strategies include observation, endoscopic incision or resection, and open or minimally invasive ureteral reimplantation []. However, due to the rarity of this condition in adults, no consensus guidelines exist. We present a rare case of a giant prolapsed ureterocele in an adult woman treated successfully with endoscopic deroofing, and we review the relevant literature.

A 78-year-old male patient presented to our hospital with a slowly enlarging, painless right inguinal mass that had been present for 15 years. On physical examination, a non-tender right scrotal mass was palpable. Computed tomography revealed a 12-cm encapsulated cystic lesion containing a calculus (Figure 1). Blood tests showed a mildly elevated C-reactive protein (CRP) level of 0.74 mg/dL (reference range: < 0.14 mg/dL). Based on these findings, a diagnosis of right scrotal hydrocele was made, and the patient underwent right orchiectomy with hydrocelectomy. Intraoperative findings indicated that the mass was located in the scrotum and extended toward the external inguinal ring. Orchiectomy was selected because the hydrocele was firmly adherent to the testis, with chronic inflammation and fibrosis, making safe separation technically unfeasible. The resected specimen contained turbid fluid, a calculus, and a markedly thickened, inflamed, and partially necrotic cyst wall (Figure 2). Histopathological examination revealed diffuse thickening of the tunica vaginalis with dense lymphoplasmacytic infiltration and characteristic storiform fibrosis (Figure 3A). The testis itself was markedly atrophic, and the seminiferous tubules showed diffuse atrophy with thickened basement membranes and hyalinization. The hydrocele was not located within the testicular parenchyma. Immunohistochemical staining demonstrated 27-48 Immunoglobulin G4 (IgG4)-positive plasma cells per high-power field (HPF) and an IgG4-positive/IgG-positive plasma cell ratio of 25-55% (Figure 3B). Given the patient's long-standing, slowly enlarging inguinal mass without prior hospital visits, and the marked chronic inflammatory changes observed intraoperatively and pathologically, the exact origin and progression from the inguinal area cannot be determined. Figure 1. Computed tomography image. Computed tomography scan showing a 12-cm encapsulated cystic lesion with a calcified nodule in the right inguinal region Figure 2. Gross appearance of the resected specimen showing a thickened, inflamed, and focally necrotic cyst wall Figure 3. A- Histopathological examination revealing lymphoplasmacytic infiltration and storiform fibrosis (H&E ×100), B- Immunohistochemical stain highlighting numerous IgG4 positive plasma cells (×400) Serum IgG4 was within normal limits, and no involvement of other organs was observed. According to the 2019 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for IgG4- related disease [], a diagnosis of IgG4-related disease (IgG4- RD) was established. The postoperative course was uneventful, and the patient remains well on follow-up. IgG4-RD is a recently recognized, immune-mediated fibroinflammatory disorder characterized by tissue infiltration with IgG4-positive plasma cells, lymphoplasmacytic inflammation, storiform fibrosis, and frequently obliterative phlebitis []. It can involve multiple organs, most commonly the pancreas, salivary glands, and lacrimal glands, resulting in clinical entities such as autoimmune pancreatitis, sialadenitis, and dacryoadenitis. Corticosteroid therapy is considered the first-line treatment, although no randomized controlled trials have been conducted to date. In the present case, systemic therapy was not initiated because serum IgG4 was normal and there was no evidence of extra-scrotal disease. Reports of IgG4-RD involving the male reproductive system are rare, with only a few testicular cases described in the literature. To our knowledge, presentation as chronic scrotal hydrocele represents an exceptionally uncommon manifestation. This case underscores the importance of considering IgG4-RD in the differential diagnosis of long-standing scrotal masses, particularly when histological features are suggestive. Increased awareness of this entity may facilitate accurate diagnosis, appropriate management, and a deeper understanding of its diverse clinical spectrum. 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 conflicts of interest. Financial Disclosure: The authors declare that this study received no financial support.