Agarwal A, et al. World J Mens Health. 2026 Jan;44:e3. https://doi.org/10.5534/wjmh.250290

Objectives: Vesicoureteral reflux (VUR) exacerbates the risk of renal scarring by establishing a ground for pyelonephritis. It is known that the inflammatory process is more influential than the direct damage caused by bacterial infection in the development of renal scars after pyelonephritis. Therefore, the present study aims to investigate the relationship between renal scarring and systemic inflammatory markers in patients with VUR.Material and methods: Hundred and ninety-two patients (116 females, 76 males) diagnosed with VUR were divided into two groups based on the presence or absence of renal scarring and into three groups according to the grade of VUR (low, moderate and high). Neutrophil count, lymphocyte count, mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) were compared among the groups.Results: Of the 192 patients, 102 had renal scarring. The age and gender distribution did not differ significantly between the groups with and without renal scarring (p > 0.05). However, the grade of reflux and lymphocyte count were significantly higher in the group with renal scarring (p < 0.05), and the NLR was significantly lower in the group with renal scarring (p < 0.05). The lymphocyte count was significantly higher (p < 0.05) and NLR was significantly lower in the high-grade VUR group (p < 0.05). However, MPV values did not differ significantly (p > 0.05) between the groups. Conclusions: NLR can be used to predict renal scarring in patients with VUR, especially in the period of 3-6 months after the first attack of infection, and may even serve as a candidate marker for treatment selection. However, larger series and prospective studies are needed.

Objective: The aim of the present study was to examine the results of antegrade JJ stent placement in upper urinary tract obstruction in patients where retrograde placement was not possible. Methods: In this retrospective study, patients who underwent antegrade JJ stent placement for malignant ureteral obstruction in the urology clinic of a university hospital between January 1, 2018 and December 31, 2020 were included in the study. JJ stent was placed under local or general anaesthesia guided by ultrasonography and fluoroscopy. Age, gender, kidney function values, pathologies causing obstruction, and complications of the patients were examined. Results: In this study, 40 patients (16 men, 24 women) who underwent antegrade JJ stent placement were included. The mean ages of the women and men included were 51 (31-91) years and 62.5 (26-81) years, respectively. In all, antegrade JJ stenting was performed in 61 renal units of these patients. Of these, 21 were bilateral, 11 in the right collecting system and 8 in the left collecting systems. Clinical and technical success was achieved in 59 of the 61 procedures (96.6%). Arteriovenous fistula developed in only one patient, whereas no serious complications such as massive bleeding, resistant hematuria or pseudoaneurysm occurred in the remaining patients. The procedure was completed in a mean time of 15-30 minutes. Conclusions: Antegrade JJ stent placement is a procedure with a high success rate and low risk of complications that can be used in patients with severe ureteral obstruction owing to malignant or benign aetiologies. This method should be applied in centres experienced in malignant ureteral obstruction and on patients where retrograde placement was not possible. Furthermore, it should be considered as an alternative treatment option to open surgery as it can be performed under local anaesthesia in patients at a high risk of anaesthesia.

Background and Objectives: Priapism is a condition characterized by a prolonged erection lasting over four hours, either independent of or following sexual stimulation. The primary treatment goal for ischemic and non-ischemic priapism is timely and appropriate intervention in order to preserve erectile function and penile length. This study aims to evaluate the management of recurrent ischemic priapism in sickle cell disease (SCD) patients in an endemic region and compare it with ischemic priapism of other etiologies. Materials and Methods: Patients admitted to our hospital with a diagnosis of priapism between January 2010 and June 2024 were retrospectively reviewed. The patients were divided into two groups: ischemic priapism due to SCD and ischemic priapism due to other etiologies. Patient characteristics, treatment management, and the need for penile prosthesis (PP) were compared. Results: A total of 40 ischemic priapism patients were included in the study; 20 of them had SCD and the other 20 had priapism cases due to different etiologies. In the SCD priapism group, the rate of comorbidity and previous history of priapism were significantly (p < 0.05) higher than in the other etiologies of priapism group. Similarly, in the SCD priapism group, the hospital admission time and the rate of fibrosis findings in MRI (magnetic resonance imaging) were significantly (p < 0.05) higher than in the other priapism groups. The PP implantation rate in the SCD priapism group was found to be significantly (p < 0.05) higher than in the other priapism group. Conclusions: This study highlights the importance of early intervention and patient awareness in SCD-related ischemic priapism, recommending educational programs to improve symptom recognition and prevent complications.

Objective: This study aims to compare two different drainage methods, percutaneous nephrostomy (PCN) and retrograde ureteral double-J (DJ) stent insertion, in patients with obstructive pyelonephritis (OP).Methods: The study included 77 patients who presented to the emergency department due to stones. Type of decompression treatment (PCN or DJ stent), fever, white blood cell count (WBC), C-reactive protein (CRP) levels, urine culture, blood culture, presence of additional diseases, and antibiotic treatment were evaluated for these patients. Emergency decompressive treatment was not randomly assigned. The clinician chose the appropriate treatment method based on the patient’s condition after obtaining an informed consent. Patients under the age of 18 were categorized into three subgroups: infants, children under 10 years, and adolescents. Results: Of the 77 patients, 31 were in the DJ stent group and 46 were in the PCN group. Patients in the PCN group exhibited significantly higher fever levels before the procedure (37.6 ± 1.0°C). Additionally, the positivity rate of urine and blood cultures was higher in the PCN group. The average time to stone treatment after infection and medical treatment, as well as fever control, was shorter in the PCN group (9 ± 2.3 days). Empiric treatment with Ceftriaxone (1 g IV) was confirmed by sensitivity results of urine or blood culture in 45% of cases. None of the patients developed advanced urosepsis after the procedure, but the resolution of infection parameters was faster in the PCN group (7 ± 3.3 days). Conclusions: Both PCN and DJ stent insertion are effective and safe methods for managing obstructive pyelonephritis. It was observed that the PCN method under local anesthesia was useful in quickly controlling fever and allowing early surgical treatment. Finally, third-generation cephalosporin antibiotics are beneficial for empiric initial treatment.

Background/Objectives: Gynecological and obstetric surgeries carry a risk of iatrogenic urinary tract injuries; however, comparative data on injury patterns, diagnostic timing, and management across different surgical indications remain limited. This study aimed to evaluate the incidence, characteristics, diagnostic timing, and outcomes of urological injuries following gynecologic and obstetric surgeries in a high-volume tertiary referral center over a 10-year period. Methods: This retrospective single-center cohort study included adult female patients who sustained intraoperative or postoperative urological injuries during gynecologic or obstetric procedures between January 2014 and December 2024. Urological injury was defined as bladder, ureteral, or genitourinary fistula injury requiring urological intervention. Patients with prophylactic or temporary ureteral stenting were excluded. Cases were classified into malignant gynecologic, obstetric, and benign gynecologic surgery groups. Injury type, timing of diagnosis, management strategies, and clinical outcomes were analyzed. Results: Among 16,100 procedures, 223 urological injuries were identified (incidence: 1.3%). Bladder injuries were the most common (62.3%) and were predominantly associated with obstetric procedures, whereas ureteral injuries (28.7%) occurred more frequently during malignant gynecologic surgeries (p < 0.05). Intraoperative recognition rates varied significantly by injury type, being highest for bladder injuries (98.6%) and lowest for fistulas (5.0%) (p < 0.001). Conclusions: Surgical indication significantly influences the pattern and timing of urological injuries. Bladder injuries are usually detected intraoperatively, whereas ureteral and fistulous injuries are more often diagnosed postoperatively, particularly in malignant and complex procedures, highlighting the need for targeted intraoperative vigilance and multidisciplinary management in high-risk cases.