Translational andrology and urology最新文献

Background: Central obesity represents a well-established risk factor for stress urinary incontinence (SUI), with sagittal abdominal diameter-to-height ratio (SADHtR) recognized as a superior anthropometric indicator of visceral adiposity. However, the evidence between the SADHtR and SUI remains scarce. This study aimed to elucidate the association between SADHtR and SUI of adult women.

Methods: This cross-sectional study incorporated 4,846 women ≥20 years from the 2011-2016 cycles of the National Health and Nutrition Examination Survey (NHANES). Multivariable-adjusted logistic and linear regression models were used to investigate the relationship between SADHtR and the prevalence and severity of SUI. Smooth curve fitting methods and a two-piecewise linear regression model were employed to examine potential nonlinear relationships. Subgroup analyses and interaction tests were performed to identify potential effect modifiers. Propensity score matching (PSM) was employed to balance confounders, strengthening the robustness of the findings.

Results: A positive association was observed between SADHtR and both the prevalence and severity of SUI after adjusted for potential confounders [odds ratio (OR) =3.59; 95% confidence interval (CI): 2.75-4.69; P<0.001] (β=0.71; 95% CI: 0.23-1.19; P=0.004). The relationship between SADHtR and the prevalence of SUI exhibited non-linear dose-response, with an inflection point at SADHtR =0.14. Subgroup analyses demonstrated consistent associations across all examined cohorts and showed that the positive relationship was more pronounced among young women.

Conclusions: This study demonstrated a nonlinear positive association between SADHtR and SUI risk. Our findings establish SADHtR as a valuable anthropometric measure for SUI risk evaluation.

Renal tuberculosis is one of the main reasons for nephrectomy. Early removal of tuberculous lesions can preserve the remaining functional renal tissue and help avoid nephrectomy. Robotic-assisted surgery significantly improves the success rate of partial nephrectomy. The present study aims to introduce a modified robotic surgical approach, the 'unroofing and base excision' technique, for treating localized renal tuberculosis. Four patients with localized renal tuberculosis underwent our modified robot-assisted laparoscopic partial nephrectomy. In traditional approaches, lesions were excised at least 0.5 cm from the margin, and the lesion cavity was left intact. In the current procedure, surgery begins with opening the lesion cavity, and the cavity wall is then lifted to identify the boundary between the lesions and the surrounding normal tissue, allowing excision of the lesions approximately 0.2 cm from the cavity wall. The lesion base is removed from the interior to the exterior of the cavity. The operative times were 130, 120, 145, and 160 minutes, with corresponding warm ischemia times of 27, 25, 35, and 45 minutes. The abdominal drainage tube remained in place for 8, 7, 9, and 5 days, respectively. None of the patients experienced postoperative urine leakage, bleeding, or intraperitoneal infection. The median follow-up was 23.5 months. The preoperative serum creatinine levels were 45, 88, 130, and 55 µmol/L, which changed to 57, 83, 161, and 64 µmol/L at the last follow-up visit. The preoperative glomerular filtration rates of the affected kidneys were 28.3, 20.2, 28.1, and 29.6 mL/min, which declined to 20.5, 16.6, 26.6, and 24.9 mL/min at the last follow-up visit. Radiological imaging showed that the remaining renal tissue on the affected side retained normal morphology and structure at the last follow-up visit. Overall, our 'unroofing and base excision' technique enables the complete removal of tuberculous lesions while maximizing the preservation of functional renal tissue.

Background: The progression of prostate cancer is closely associated with dysregulation of tumor suppressor genes. P16 (CDKN2A), a key cell cycle regulator, is frequently downregulated in malignant phenotypes, yet the role of its post-translational modifications, particularly palmitoylation, remains unclear. This study aimed to investigate the regulatory mechanism of palmitoylation on P16 stability and explore the functional role of ZDHHC14 in this process, as well as its impact on the malignant behaviors of prostate cancer cells.

Methods: CDKN2A was overexpressed in prostate cancer cells (PC-3 and DU-145) via plasmid transfection. The inhibitory effects of P16 on proliferation, migration, and invasion were evaluated using quantitative real-time polymerase chain reaction (qRT-PCR), Western blot, colony formation assay, and Transwell assays. The palmitoylation modification site (Cys 72) and its regulatory role in P16 stability were analyzed through palmitoylation inhibitor [2-bromopalmitate (2-BP)] and agonist [hexadecyl acetyl phosphate (HAM)] treatments, site-directed mutagenesis (C72S), ubiquitination assays, and molecular docking. Bioinformatics screening, small interfering RNA (siRNA) knockdown, and co-immunoprecipitation (Co-IP) were employed to validate the interaction between ZDHHC14 and P16 and their functional relationship.

Results: Overexpression of CDKN2A significantly inhibited the proliferation, migration, and invasion of prostate cancer cells. Palmitoylation at the Cys 72 site enhanced P16 stability by suppressing its ubiquitination-dependent degradation. ZDHHC14 was identified as the palmitoyltransferase responsible for modifying P16, and its expression positively correlated with patient survival. Knockdown of ZDHHC14 markedly reduced P16 protein levels, and their direct interaction was confirmed to mediate the palmitoylation process.

Conclusions: This study reveals for the first time that ZDHHC14 enhances P16 stability and suppresses its ubiquitination-mediated degradation via palmitoylation at the Cys 72 residue, thereby exerting antitumor effects. These findings provide a theoretical foundation for developing therapeutic strategies targeting the ZDHHC14/P16 axis in prostate cancer.

Background: Kidney stones can cause severe kidney function. The serum glucose-to-albumin ratio (sGAR) is under investigation for its potential to assess kidney stone risk. This study explores the association between sGAR and prevalent kidney stones in a nondiabetic U.S. adult population using the National Health and Nutrition Examination Survey (NHANES) dataset.

Methods: This study analyzed data from the NHANES 2007-2014. Kidney stones were determined via questionnaires, and the sGAR was calculated based on serum glucose and albumin. The multivariate logistic regression analysis evaluated the associations of sGAR with prevalent kidney stones. A restricted cubic spline (RCS) was performed to explore underlying nonlinear relationships. Subgroup analyses were used to examine associations across different factors. Sensitivity analyses were conducted.

Results: Out of 9,549 participants, 7.71% had kidney stones. The notable link was found between sGAR and kidney stone occurrence [odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.10]. Higher tertiles of sGAR were linked to elevated odds of kidney stones, with a significant trend. A positive link was observed between the sGAR and the recurrence of kidney stones (Model 3: OR 1.08, 95% CI: 1.01-1.16). Participants in the higher sGAR tertiles were more likely to experience kidney stone recurrence. Significant trends were observed. RCS analysis ascertained the aforementioned relationships in a linear manner. No interaction effect was found between the sGAR score and kidney stone incidence across different subgroups. The relationships were consistent in the sensitivity analysis.

Conclusions: The study identified a notable link between sGAR and kidney stone prevalence. Increased sGAR levels were linked to an elevated risk of kidney stone occurrence and recurrence among nondiabetic American adults.

Background: Insulin resistance (IR) has been related to erectile dysfunction (ED). IR indices refer to calculation-based indices that estimate insulin sensitivity using routine clinical or biochemical parameters. However, there are fewer studies comparing the advantages of the relationship between different IR indices and ED. This study aimed to investigate the relationship between IR indices and the presence of ED.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2001-2004 were analyzed. The associations of estimated glucose disposal rate (eGDR), triglyceride glucose (TyG) index, Homeostatic Model Assessment of IR (HOMA-IR), and TyG-body mass index (TyG-BMI) with ED were evaluated using weighted logistic regression and restricted cubic spline analysis.

Results: There were 1,737 subjects examined. Only the eGDR was an independent predictor for ED in the model adjusted for all covariates in the weighted logistic regression analysis. Lower eGDR was associated with an increased risk of ED, even following covariate adjustment [continuous eGDR: odds ratio (OR) =0.91, 95% confidence interval (CI): 0.83-0.99, P=0.03; quartile 3 (Q3) vs. quartile 1 (Q1): OR =0.59, 95% CI: 0.37-0.95, P=0.03]. Restricted cubic spline analysis indicated a nonlinear relationship between eGDR and ED (P for nonlinearity <0.001). Subgroup analyses consistently showed that higher eGDR levels were linked to a lower risk of ED in all subgroups, with significant interactions observed in education level and physical activity subgroups.

Conclusions: eGDR was inversely associated with an increased risk of ED, suggesting that it might be as a potential and reliable predictor for ED incidence.

Background: Due to the prognosis and treatment differences between primary renal sarcomas and renal cell carcinoma (RCC), preoperative differentiation between them is important but challenging. This study aims to explore and develop a diagnostic method based on computed tomography (CT) and clinical data for preoperatively differentiating primary renal sarcomas from RCCs.

Methods: Patients pathologically diagnosed with primary renal sarcoma from two centers were retrospectively included, and RCCs were probably 2:1 compared to renal sarcomas as the control group. Clinical data, standard contrast-enhanced CT images and histological findings were obtained. A clinical model was established with independent indicators based on logistic regression analysis. The region of interest was outlined in each of the three modal CT images [unenhanced phase (UP), corticomedullary phase (CMP) and nephrographic phase (NP)] and formed 7 modal imaging datasets for deep learning (DL) models' development. Reported performance metrics included accuracy (ACC) and area under the curve (AUC).

Results: Totally, 7,482 images were obtained from 85 patients. Multivariate logistic regression showed that the independent indicators of renal sarcoma were intratumoral arteries and Gerota's fascia invasion (P<0.05). The AUC of clinical model was 0.77 [95% confidence interval (CI): 0.67-0.87], sensitivity 0.74, specificity 0.67, positive predictive value (PPV) 0.51, and negative predictive value (NPV) 0.85. The DL models yielded effective discrimination. The UP model yielded AUC of 0.95±0.09 and ACC of 0.94±0.07, and UP + NP model yielded nearly AUC =0.95±0.06, and ACC =0.94±0.07.

Conclusions: The multimodal artificial intelligence (AI) models show good performance for differentiating renal sarcomas from RCCs, which assist in individualized management.

Background: Renal allograft lithiasis (RAL) is a rare but potentially serious complication following kidney transplantation. Traditionally, ureteroscopy (URS) has been considered a second-line treatment for stones <15 mm, typically after failed extracorporeal shock wave lithotripsy (ESWL), due to concerns over challenging ureteral access. This study reviews Singapore General Hospital (SGH)'s experience and compares outcomes with published literature to evaluate efficacy and safety.

Methods: Retrospective review was conducted on RAL cases treated with URS at SGH from January 2015 to December 2023. Data collected included demographics, end-stage renal failure etiology, preoperative biochemistry, stone characteristics, and surgical details. Stone-free status and complications were assessed. Additionally, a systematic literature review was performed using five databases (PubMed, Embase, Web of Science, SCOPUS, Cochrane Library) from inception up to August 13, 2023. We included all primary studies with no restriction on study design, published in English, including conference abstracts and excluded articles on ex-vivo or pre-transplant URS. Risk of bias assessment was performed using Joanna Briggs Institute Critical Appraisal Tools.

Results: Five URS procedures were performed at SGH for RAL during the study period, yielding a stone-free rate (SFR) of 71.4%. One case involved an encrusted double-J (DJ) stent. The systematic review included 30 studies (10 case reports, 20 case series) totaling 145 URS procedures. The overall SFR was 82.3%. Thirteen complications (9.0%) were reported, including ureteral perforation (n=3), urinary tract infections (n=3), and nephrocutaneous fistula (n=2). No graft loss was reported. These rates are comparable to those seen in non-transplant URS.

Conclusions: URS appears to be a safe and effective treatment for RAL, with outcomes comparable to non-transplant populations. Increasing evidence supports URS as a first-line option in select transplant patients. The current evidence is limited by small case numbers, retrospective study designs, and lack of standardisation in defining and assessing stone-free outcomes.

Posterior urethral stenosis occurs commonly following traumatic urethral injury, treatment for prostatomegaly or prostate cancer, and pelvic radiation. Perineal reconstruction for posterior urethral stenosis can be performed via excisional urethroplasty with primary anastomosis, or via substitution urethroplasty with the use of buccal mucosa graft (BMG). This article provides a stepwise description and comprehensive review of our technique for posterior substitution urethroplasty. Helpful tips and recommendations regarding common pitfalls encountered perioperatively are also presented. Key maneuvers described include unilateral urethral mobilization, graft fixation using laparoscopic suturing devices, fibrin sealant, or a barbed-suture sewing machine, as well as the use of the RaViNi lighted urethral speculum to enhance urethral exposure. In addition to describing our technique and institutional outcomes, a brief and focused review of the literature is presented to support the utility of substitution urethroplasty in posterior urethral reconstruction. While there is a dearth of prospective data, retrospective studies from single-center and multi-institutional data report success rates for posterior substitution urethroplasty between 63% and 89%, with rates of de novo urinary incontinence ranging from 0% to 11%. Overall, substitution urethroplasty offers key advantages such as versatility and favorable rates of de novo stress urinary incontinence, making it preferable to excisional urethroplasty for posterior urethral reconstruction, when feasible.

Background: Vasectomy is currently the most effective option for male contraception. Although it is considered a relatively low-risk procedure, many questions arise amongst patients and their partners regarding potential sexual side effects. There is currently no cohesive piece of literature that addresses the effects of vasectomy on sexual function. This review summarizes the literature evaluating sexual function and satisfaction in males and females post-vasectomy.

Methods: A systematic review was performed in January 2024 with the assistance of a reference librarian, utilizing keywords relevant to sexual function and satisfaction. This search yielded 556 records. Exclusions for relevance and publication date yielded twenty records. The results were utilized to determine sexual function and satisfaction post-vasectomy.

Results: Five papers (n=553) utilized the International Index of Erectile Function (IIEF). The average IIEF scores pre- and post-vasectomy were 65.8 and 67.08, respectively. Male intercourse satisfaction was evaluated in 10 papers (n=1,805), with 3 reporting improvement, 6 reporting no change, and 1 reporting deterioration. Erectile function was evaluated in 9 papers (n=1,800), with 3 reporting improvement and 6 reporting no change. Male sexual desire was evaluated in 13 papers (n=2,611), with 3 reporting improvement and 10 reporting no change. Ejaculatory function was evaluated in 4 papers (n=1,306) with no change. Male orgasmic function was evaluated in 6 papers (n=1,140), with 3 reporting improvement and 3 reporting no change. Male sexual satisfaction was evaluated in 8 papers (n=2,315), with 3 reporting improvement and 5 reporting no change. Female intercourse satisfaction was evaluated in 4 papers (n=631), with 1 reporting improvement and 3 reporting no change. Female sexual desire was evaluated in 3 papers (n=491), with 1 reporting improvement, 1 reporting no change, and 1 reporting deterioration. Female sexual arousal was improved in 2 papers (n=150). Female lubrication and orgasm were evaluated in 2 papers (n=150), with 1 reporting improvement and 1 reporting no change.

Conclusions: This review illustrates that most domains of male and female sexual function are objectively unaffected or improved after vasectomy.

Background: Renal cell carcinoma (RCC) is a prevalent disease within the urinary system, characterized by high mortality rates. Its incidence is increasing each year, posing a significant threat to public health. Currently, the causes of RCC are not fully understood, and there are many limitations in treatment options. Recently, traditional Chinese medicine has gained considerable attention in cancer treatment. Fu Zheng Xiao Yu San Jie Decoction (FZXYSJD) is a well-established treatment for RCC, used for many years at The First Affiliated Hospital of Guangzhou University of Chinese Medicine, and is recognized for its efficacy by both physicians and patients. This study aims to employ methods such as network pharmacology and cell experiments to investigate how FZXYSJD works in treating RCC. Additionally, it seeks to identify new targets that may influence the disease's progression.

Methods: First, FZXYSJD drug serum was prepared for cell experiments, including the Cell Counting Kit-8 (CCK-8) assay and colony formation assays. Second, Gene Expression Profiling Interactive Analysis (GEPIA) was applied to explore the specific mechanism of FZXYSJD's suppressive effect in RCC. Western blot analyzed the expression level of E2F transcription factor 5 (E2F5) after treatment with FZXYSJD drug serum in RCC cells. Third, the effect of small interfering RNA targeting E2F5 (siE2F5) on RCC cell proliferation was verified using CCK-8 and colony formation assays. Fourth, the herb identification components of FZXYSJD were retrieved from the Chinese Pharmacopoeia and those components of FZXYSJD that were decocted by high-performance liquid chromatography-mass spectrometry (LC-MS) were detected. Finally, the binding potential of the active ingredient in FZXYSJD to E2F5 was confirmed through molecular docking.

Results: FZXYSJD was found to suppress the proliferation of renal clear cell carcinoma cell lines (786O, ACHN) and promote the E2F5 expression. In addition, our findings indicated that low levels of E2F5 expression promoted the proliferation of RCC. Finally, through LC-MS analysis, we found that the components that could be detected after FZXYSJD water decoction were calycosin-7-O-β-D-glucoside, rosmarinic acid, ginsenoside Rg1, liquiritin, glycyrrhizic acid, emodin and polydatin. And the binding potential between those components in FZXYSJD and E2F5 was confirmed through molecular docking.

Conclusions: FZXYSJD affects cell proliferation in RCC through the E2F5 gene.