Translational andrology and urology最新文献

Background: Endometriosis is a common gynecological disorder, with rising incidence rates and a decreasing age of onset, significantly affecting patients' quality of life and overall health. Urinary tract endometriosis (UTE) is a rare and invasive form of endometriosis that often leads to urinary obstruction and can even result in renal failure. The clinical significance of diagnosing and treating UTE is increasingly recognized. However, there is currently a lack of systematic bibliometric analysis to provide an overview of this field. The purpose of this study is to comprehensively summarize the research status in this field over the past 30 years and predict future development trends to address diagnostic and therapeutic challenges.

Methods: A comprehensive analysis was conducted on literature related to UTE published in the Web of Science Core Collection from 1995 to 2024. Research trends in this field were thoroughly analyzed and visualized using VOSviewer, CiteSpace, and the Bibliometrix R package.

Results: A total of 361 publications were analyzed, sourced from 122 journals, authored by 1,699 scholars affiliated with 610 institutions across 48 countries. Notably, Charles Chapron, Pietro Santulli, and Bruno Borghese from France led in publication volume. The University of Paris emerged as a prominent institution in this research area. Co-occurrence and co-citation analyses indicated that Charles Chapron holds the top position among global authors, demonstrating significant influence in the field. Future key research directions include studying the pathogenesis of the disease, conducting epidemiological studies, and developing comprehensive management strategies, with particular emphasis on renal and urethral endometriosis.

Conclusions: This study represents the first bibliometric analysis of UTE, summarizing its key values and emerging trends. The treatment approach for UTE has undergone significant changes due to ongoing research, shifting from surgical interventions to integrated management strategies. This evolution encompasses early diagnosis, treatment options, preoperative assessment and preparation, and long-term postoperative follow-up. The importance of enhanced collaboration among specialists in urology, gynecology, and other multidisciplinary areas is emphasized to promote effective diagnosis and treatment of UTE.

Background: Cryptorchidism increases the risk of testicular torsion, a condition requiring urgent intervention. However, the atypical presentation in these cases makes diagnosis challenging, necessitating improved clinical awareness and management strategies. This study aims to analyze the clinical characteristics, diagnostic methods, and treatment outcomes of testicular torsion in children with cryptorchidism. The goal is to enhance the understanding of this rare condition and provide valuable insights into its diagnosis and management, based on clinical and surgical findings.

Methods: A retrospective analysis was conducted on the clinical data of 21 children with cryptorchidism who experienced testicular torsion and were treated at Anhui Provincial Children's Hospital from January 2015 to June 2024. Among the 21 patients, five had bilateral cryptorchidism, all of which involved unilateral testicular torsion, with 16 cases on the left side and five on the right side. The median age of the patients was 48 months [interquartile range (IQR): 8.5-117.5 months]. The median onset time, defined as the time interval between the onset of symptoms and surgical intervention, was 24 hours (IQR: 12-72 hours).

Results: All patients underwent surgical exploration. The average surgery time was 60.9 [standard deviation (SD): 25.1] minutes, with an average blood loss of 4.5 (SD: 2.3) mL. The median torsion angle was 540° (IQR: 270°-720°). Intraoperatively, 18 testes were found to have irreversible necrosis and were removed, while three were successfully detorsed and preserved with good blood supply. Postoperative follow-up for an average of 50.4 (SD: 18.3) months showed no atrophy in the surviving testes, and the contralateral fixed testes developed well without recurrent torsion.

Conclusions: Testicular torsion in children with cryptorchidism is rare and often presents with subtle symptoms. Early diagnosis and treatment are crucial. Ultrasound plays a significant role in the diagnosis of testicular torsion in cryptorchidism. The degree of torsion and the time of onset are critical factors for improving testicular survival rates. It is recommended that surgical intervention be performed early in cryptorchid patients older than six months to reduce the risk of testicular torsion.

Background: Y chromosome microdeletion is one of the major causes of male infertility, and obtaining mature spermatozoa in complete azoospermic factor (AZF)b deletion cases is difficult because germ cells maturation has arrested. However, there are very few reports on spermatogenesis in partial deletions of the AZFb region. We herein report a case of partial AZFb deletion in which sperm were successfully recovered by microdissection testicular sperm extraction (micro-TESE).

Case description: A 34-year-old man with cryptozoospermia was referred to Reproduction Center, Yokohama City University Medical Center. Both testicular sizes were normal, and the seminal tract had no abnormalities. Serum testosterone and follicle-stimulating hormone levels were also normal. The karyotype was 46,XY, and the Y chromosomal microdeletion test showed no amplification of the sequence-tagged site marker sY1024, which is the proximal part of the AZFb region. We performed micro-TESE, and subsequently identified and cryopreserved many malformed immotile spermatozoa. Intracytoplasmic sperm injection was performed using frozen-thawed testicular sperm that showed slight mobility, but the embryos rarely reached the good blastocyst stage. Although two frozen-thawed embryo transfers were performed, no pregnancies resulted.

Conclusions: In cases of partial AZFb deletion, spermatogenesis may be preserved, and surgical sperm retrieval should be considered even in cases of azoospermia.

Background: The causal association of insomnia with multiple urological and reproductive conditions still lacks clarity. Our aim was to assess this relationship by examining impact of insomnia on 10 urological and reproductive conditions using Mendelian randomization (MR) designs.

Methods: Summary statistics for insomnia and 10 urological and reproductive conditions were acquired from the UK Biobank, 23andMe, FinnGen, and genetic consortia. Inverse variance weighted approach was utilized as the main MR analysis. Sensitivity analyses were performed employing MR-PRESSO (Pleiotropy Residual Sum and Outlier), maximum likelihood, MR-Egger, and weighted median methods to examine the robustness of the estimates.

Results: Genetically determined insomnia showed an elevated risk of cystitis [odds ratio (OR) =1.81; 95% confidence interval (CI): 1.47-2.24; P<0.001], and prostatitis (OR =3.53; 95% CI: 1.73-7.18; P<0.001) after Bonferroni correction. Suggestive evidence of an association was found between insomnia and a heightened risk of prostate cancer (OR =1.30; 95% CI: 1.00-1.67; P=0.046), alongside a decreased risk of bladder cancer (OR =0.48; 95% CI: 0.26-0.90; P=0.02). No causal effects were observed for kidney cancer, kidney and ureter calculus, neurogenic bladder, benign prostatic hyperplasia (BPH), male infertility, or female infertility.

Conclusions: Findings support insomnia as a potential causal risk factor for cystitis and prostatitis. This highlights insomnia as an important target for reducing the risk of these diseases.

Background: In clinical practice, we observed that some patients with larger prostate volume (PV) and prostate-specific antigen (PSA) values below 20 ng/mL still yielded negative biopsy results. We aim to establish a more precise volume range for guiding biopsies in patients with enlarged prostate glands.

Methods: We conducted a retrospective analysis of 424 cases involving patients who underwent prostate biopsy. The patients were categorized into three groups based on their body mass index: small (PV <45 cm³), medium (45 cm³≤ PV <70 cm³), and large (PV ≥70 cm³). Logistic regression, receiver operating characteristic (ROC) curves, restricted cubic spline (RCS) curves, and decision trees were employed for comparison purposes.

Results: In the multivariate logistic regression analysis, a statistically significant association was observed between prostate-specific antigen density (PSAD) ≥0.15 ng/mL/cm³ and the need for biopsy to confirm prostate cancer diagnosis when the volume was less than 45 cm³ [odds ratio (OR) =4.587; 95% confidence intervals (CI): 1.667-15.091; P=0.006]. The point of intersection between the RCS curve and the reference line occurred at PV =45 cm³, indicating a higher risk of prostate cancer (PCa) increased with decreasing PV size. After constructing a decision tree model, it was found that when the volume was less than approximately 26 cm³, there was a significantly increased probability (approximately 69%) of having prostate cancer after biopsy.

Conclusions: The likelihood of developing prostate cancer is higher in patients with small PVs (PV <45 cm³), especially those with (PV <26 cm³), when PSAD exceeds 0.15 ng/mL/cm³. Patients with larger volumes (PV ≥70 cm³) can be regularly monitored and followed up.

Background: While ongoing research continues to identify new causes for decreased sperm counts and idiopathic infertility, little objective data are known regarding public knowledge and perception of male infertility. In this study, we aim to better characterize male infertility knowledge across educational status, personal experience with infertility, socioeconomic characteristics, and income level.

Methods: Participants were asked to identify, among other factors, out-of-pocket treatment cost, insurance coverage, and potential risk factors for infertility. Then, a scoring system was developed to objectively quantify overall understanding of male infertility and named Knowledge of Male Fertility (KM-Fert). Results were compared by socioeconomic status and education level, with a sub-analysis of healthcare professionals (HCPs).

Results: A total of 242 respondents completed the survey. Only 67.4% of respondents (n=163) identified testosterone therapy as a risk factor for male infertility, while other commonly understood risk factors (e.g., smoking or obesity) were correctly identified by a large majority. Median KM-Fert score of reproductive urology subspecialists was a perfect score of 10. This was significantly higher than other respondents {10 [interquartile range (IQR): 9.25, 10] vs. 7 (IQR: 5, 8), P<0.001}. Education level influenced KM-Fert score (P<0.001). Post-hoc analysis demonstrated a significantly higher median score for medical school graduates versus all other education levels except for nurse practitioner or physician assistant graduates (P=0.28).

Conclusions: The general population has variable knowledge surrounding male fertility, and there is an opportunity for non-urology providers to improve their knowledge, screening, and referrals for reproductive-aged males. Reproductive urologists may be the ideal group to educate fellow HCPs.

Background: Previous studies have demonstrated the ability of the R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score to predict perioperative outcomes, but those studies have not considered the impact of different surgical approaches on predictive accuracy. Therefore, this study aimed to evaluate whether different minimally invasive surgical techniques affect the accuracy of the R.E.N.A.L. score in predicting perioperative outcomes, particularly the achievement of trifecta.

Methods: We conducted a retrospective analysis of clinical data from 623 patients who underwent robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in our clinical institution. Correlations between the R.E.N.A.L. score and operative time (OT), length of stay (LOS), estimated blood loss (EBL), change in estimated glomerular filtration rate (eGFR), postoperative complications, and time of drain removal were calculated. Logistic regression analysis was used to identify predictors of achieving trifecta outcomes in both surgical groups. The Simplified PADUA REnal (SPARE) nephrometry system was used as a control to compare with R.E.N.A.L. score.

Results: In the RAPN group, both the R.E.N.A.L. score and grade showed a strong correlation with postoperative outcomes. However, in the LPN group, R.E.N.A.L. grade was not statistically correlated with OT (P=0.07) or postoperative complications (P=0.08), and the SPARE score showed no correlation with change in eGFR (P=0.69). Additionally, SPARE grade was not correlated with change in eGFR (P=0.57) or postoperative complications (P=0.28). In both univariate and adjusted multivariable logistic regression models, the R.E.N.A.L. score was an independent predictor of achieving trifecta in the RAPN group, but it was not a predictor in the LPN group. The SPARE score exhibited similar differential predictive validity between the two surgical techniques. In the RAPN group, the area under the receiver operating characteristic (ROC) curves (AUCs) for predicting trifecta achievement were 0.643 for the R.E.N.A.L. score and 0.613 for the SPARE score.

Conclusions: The R.E.N.A.L. score is an effective tool for preoperatively assessing the complexity of renal masses. However, different surgical techniques can influence the predictive accuracy of the R.E.N.A.L. score, with it being more accurate in predicting trifecta achievement following RAPN compared to LPN.

Background: Delayed migration of non-absorbable surgical clips into the urinary tract is a rare but potentially morbid complication that may lead to pain, infection, stone formation, and urinary obstruction. The literature on clip erosion into the upper tracts are limited to a handful of case reports of case reports. The purpose of our study was to review outcomes of robotic ureteral reconstruction (RUR) of non-absorbable clip erosion into the ureter.

Case description: We retrospectively reviewed all patients who underwent RUR for management of clip erosion into the ureter between September 2022-April 2024 at our tertiary academic center. Indication for surgery was ureteral obstruction. Six patients underwent RUR for clip erosion into the ureter. All patients had non-absorbable clip erosion from a prior urologic surgery. The median length of time between placement of non-absorbable clip and diagnosis of erosion was 90.5 months (IQR, 48.4-219.1). When clip erosion involved ≥80% of the circumference of the ureter, we utilized a transecting technique. As such, two patients underwent ureteral reimplantation with adjunctive maneuvers such as a psoas hitch or Boari flap. When clip erosion involved <80% of the circumference of the ureter, we utilized a non-transecting technique utilizing buccal mucosa graft for four patients. The median operative time was 157 minutes (IQR, 132-318), estimated blood loss was 50 cc (IQR, 31.25-318) and length of stay was 1 day (IQR, 1-1). There were no major (Clavien >2) postoperative complications. At a median follow up of 14.8 months (IQR, 10.1-18.7), all patients achieved surgical success, defined as the absence of obstructive flank pain and ureteral obstruction on functional imaging.

Conclusions: Diagnosis of clip erosion into the ureter is generally delayed. RUR for non-absorbable clip erosion into the ureter is associated with low morbidity and excellent outcomes. When possible, we recommend utilization of interposing a fat flap to minimize the risk of erosion into the upper tracts.

Background: The treatment paradigm of metastatic bladder cancer has remained largely unchanged for decades and the prognosis is extremely poor. This study aimed to evaluate the role of cystectomy in patients with single-site oligometastatic bladder cancer.

Methods: Patients with single-site distant metastasis at the time of bladder cancer diagnosis from 2010-2017 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Cohorts were defined by target organ [bone, brain, lung, liver, distant lymph nodes (DLNs)] and then stratified by local treatment received [no surgery, transurethral resection of bladder tumor (TURBT) and cystectomy]. Patients not receiving chemotherapy were excluded. Two-year cancer specific survival (CSS) was assessed using Kaplan-Meier (K-M) analysis and multivariable Cox proportional hazards analysis, adjusting for demographic, clinical and pathologic factors.

Results: A total of 1,381 patients met study criteria. K-M analysis indicated that cystectomy was associated with improved survival when compared to no surgery in patients with bone and DLNs metastasis. In multivariable analysis, patients with bone [hazard ratio (HR) =0.58; P=0.03] or DLNs (HR =0.51; P=0.005) metastasis who underwent cystectomy had a significant survival advantage over those receiving systemic therapy only. And patients with liver (HR =0.40; P=0.07) and lung (HR =0.84; P=0.58) who underwent cystectomy failed to exhibit superior survival than those receiving chemotherapy only. Patients with brain metastasis were omitted in subgroup analysis due to the limit of small sample size (n=20). In addition, the advent of immune checkpoint inhibitors improved the survival of patients, with HR of 0.78, indicating the reduction of death risk by 22%.

Conclusions: Cystectomy in the setting of multimodality protocols may prolong survival in bladder cancer patients with single-site metastasis of the bone and DLNs. It should be considered in a multidisciplinary setting.

The integration of wearable technology into healthcare has transformed patient monitoring, particularly in urology. Wearable penile devices (WPDs), such as the FirmTech TechRing, offer real-time data on erectile function, providing critical insights into nocturnal penile tumescence (NPT) patterns that can indicate underlying health issues. This piece highlights the potential of the FirmTech TechRing, a WPD, to advance erectile function monitoring by providing real-time data on NPT and intra-coital activity. It explores its promise in detecting early dysfunction, assessing cardiovascular risk, and enhancing proactive health management. By measuring parameters like firmness, girth expansion, and the frequency of erections, the TechRing enables proactive monitoring of erectile health, potentially predicting conditions like erectile dysfunction (ED) and cardiovascular disease earlier than traditional methods. In comparison to conventional diagnostic tools like RigiScan, the TechRing is a cost-effective alternative aimed at consumers, facilitating personal health tracking without the need for clinical environments. Future advancements may include enhanced sensors for assessing blood flow dynamics, measuring penile diameter, and detecting vascular conditions, potentially leading to improved diagnostic accuracy and personalized treatment plans. The TechRing exemplifies the potential of WPD to significantly enrich sexual medicine, providing clinicians and patients with valuable data to inform health decisions, ultimately enhancing patient care and quality of life. The convergence of these technologies marks a promising evolution in erectile health management, empowering users and healthcare professionals alike with actionable insights for informed interventions.