Urology Journal最新文献

Purpose: Despite its prevalence, the etiology and pathogenesis of cryptorchidism remain poorly understood. This study aimed to identify potential biomarkers associated with cryptorchidism development using bioinformatics methodologies.

Materials and methods: We utilized three microarray datasets from the Gene Expression Omnibus (GEO) database, comparing gene expression profiles between cryptorchidism patients and control individuals. Differentially expressed genes (DEGs) were identified using statistical analysis. Subsequently, we constructed a gene co-expression network using weighted gene co-expression network analysis (WGCNA) to identify modules of genes highly associated with the cryptorchid phenotype. Hub genes within these modules were identified using cross-validation and multiple algorithms.

Results: A total of 1,539 differentially expressed genes were identified between cryptorchidism patients and controls. WGCNA revealed a gene module strongly associated with the cryptorchidism phenotype. Ten genes (CDH1, CS, G6PD, HSPA5, KEAP1, NEDD8, POLR2J, JUN, SOD2, and TXN) with the highest association to cryptorchidism were identified in this module. Single‑gene gene set enrichment analysis (ssGSEA) showed that these hub genes were mainly enriched in metabolism-, translation-, and inflammation‑related processes. Notably, several key genes are involved in oxidative stress responses.

Conclusion: This study identified a credible set of hub genes associated with cryptorchidism. Some of these genes have been shown to affect testicular development or spermatogenesis through mechanisms such as inflammation and oxidative stress, while others have not been fully studied in the context of cryptorchidism. These hub genes may provide new biomarkers for cryptorchidism risk assessment and warrant further investigation to clarify their specific roles.

Introduction: Open nephrectomy surgery in a kidney donor involves pain and many risks after the surgery, which leads to the inability to perform normal activities. For this reason, today the laparoscopic nephrectomy method is preferred in order to avoid complications and to return to normal life sooner. However, it is very critical to assess the impact of modifying the surgical technique on the outcome of kidney donation. Thus, the present study was undertaken with the following specific objective: a comparative study of the renal profile of live kidney donors who have undergone open and laparoscopic nephrectomy.

Materials and methods: The study in the present report was cross-sectional in nature. Participants included 91 kidney donors who had undergone either open nephrectomy (n = 46) or laparoscopic nephrectomy (n = 45). Data on the level of initial basic renal function, the duration of surgery, and the duration of hospitalization, together with the course of renal function in the 6 months after surgery, were collected. The data were analyzed using the Statistical Package for the Social Sciences, version 27 (SPSS version 27).

Results:  The mean age of kidney donors was 29.4 ± 4.8 years, and all patients were male (100%). Body mass index and weight were comparable between the open and laparoscopic nephrectomy groups, with no statistically significant differences (P > 0.05). The mean duration of surgery in the open nephrectomy group (2.37 ± 0.30 hours) was significantly shorter than that in the laparoscopic group (3.37 ± 0.13 hours) (P < 0.001). The mean length of hospital stay was significantly shorter in the laparoscopic group (3.31 ± 0.31 days) compared to the open group (4.06 ± 0.04 days) (P < 0.001). GFR decreased significantly in both groups at discharge and 6 months postoperatively compared to baseline (paired t-test, all P < 0.001), but there was no significant difference in GFR between groups at any time point (P > 0.05).  Both groups experienced a significant postoperative decline in hemoglobin, with a greater reduction in the open group (-1.59 ± 0.79 g/dL)  compared to the laparoscopic group (-1.05 ± 0.95 g/dL)  (P = 0.004). White blood cell counts increased postoperatively in both groups, with no significant difference between them (P = 0.118). Surgical complications included transection of the superior polar artery in 5.5% of cases.

Conclusion: In laparoscopic nephrectomy, the time of surgery is longer, but the days of hospitalization after surgery do not differ and do not negatively affect the return of donor kidney function compared to the open method. Moreover, post-surgical problems have not been very frequent and are manageable in the best way possible.

Purpose:  Varicocele is the abnormal dilatation of the veins of the pampiniform plexus, which considered one of the most common factors related to infertility in men. The aim of the present study was to investigate whether a relationship exists between sleeping position and the presence of varicocele.

Materials and methods: In this case-control study, including 231 adult infertile men who referred to Kowsar Infertility Center, Yasuj, Iran, divided into two groups: Control group including 113 infertile patients without varicocele and case group 118 infertile patients with varicocele. After the first visit by the urologist and determining the presence or absence of varicocele and clinical grading of varicocele, patients completed demographic, clinical and sleep position questionnaires.

Results: The findings of the current study indicated a significant relationship between the presence of varicocele and Faller down (lying on the abdomen) sleeping position. There was also a significant positive correlation between this position and the degree of varicocele (p=0.003).

Conclusion: Faller down or prone position during sleep has a meaningful relationship with varicocele, which may be due to increased intra-abdominal pressure. More studies are needed to confirm this hypothesis.

Purpose: The prognosis and clinical management of bladder tumors nearly occupying the entire bladder cavity remain poorly defined due to limited available data. This study aimed to evaluate the clinical features and treatment outcomes of patients presenting with bladder tumors nearly filling the bladder at initial diagnosis.

Materials and methods: After obtaining ethical approval, a retrospective analysis was conducted on 51 patients diagnosed between 2017 and 2024 with primary bladder tumors nearly filling the bladder. All underwent transurethral resection of bladder tumor (TURBT). The clinical and pathological were analyzed data using descriptive statistics and multivariable logistic regression.

Results: The mean age was 76.24 ± 11.7 years, with a median follow-up of 9.73 months (range: 3-84 months). Hematuria was the most frequent symptom (74.5%). Muscle-invasive disease was identified in 43.1% of cases at initial diagnosis, exceeding the 25% generally reported in newly diagnosed bladder cancer cohorts (P < .001). Complete resection was achieved in 68.6%, while 31.4% required re-TURBT. Among patients initially diagnosed with non-muscle-invasive tumors, 31.1% were found to have muscle invasion upon second resection. Treatments comprised intravesical immunotherapy (48.6%), radical cystectomy (25.7%), chemoradiation (14.3%), and systemic chemotherapy (11.4%).

Conclusion: Bladder tumors nearly filling the bladder cavity are associated with high rates of muscle invasion and pose significant challenges in treatment and management. Larger, prospective multicenter studies are warranted to validate these findings and optimize management in this high-risk population.

Purpose: This preliminary study aims to evaluate the immunogenicity and local immune response triggered by intravesical administration of Brucella abortus S19 (BAS19) in a tumor-free rat model, as a potential alternative to Bacillus Calmette-Guerin (BCG) in bladder cancer immunotherapy. The primary objective is to investigate immune activation and safety in the bladder, establishing a foundation for future studies assessing its therapeutic efficacy against urothelial carcinoma.

Materials and methods: Nineteen female Wistar albino rats received intravesical BAS19 instillations and were euthanized after 3 and 6 weeks. Blood samples and cystectomy tissues were collected. Systemic immune response was assessed using the Rose Bengal agglutination test, immunocapture agglutination test, and blood cultures. Bladder tissues were examined histopathologically and stained immunohistochemically to evaluate local immune responses, specifically analyzing the expression of CD4, CD8, TLR4, and TNF- α.

Results: Higher Brucella-specific immunocapture titers and increased epithelial inflammation were observed in rats treated with BAS19 for 6 weeks. Moreover, significantly enhanced staining of CD4⁺, CD8⁺, and TNF- α in inflammatory cells was detected in this group. TLR4 expression was observed in all BAS19-treated rats, regardless of exposure duration.

Conclusion: Intravesical BAS19 administration in rats induced strong local immune responses via CD4⁺, CD8⁺, TNF-α, and TLR4 expression without systemic toxicity. These results suggest that BAS19 may mimic BCG's immunological pathways, particularly through TLR4 signaling. With its safety, low cost, and immunogenicity, BAS19 emerges as a promising immunotherapeutic candidate for further bladder cancer research.

Purpose: To investigate the safety and efficacy of supine percutaneous nephrolithotomy performed completely under ultrasound guidance without fluoroscopy and ureteral catheterization in kidneys with hydronephrosis.

Materials and methods: This retrospective study analyzed the data of 30 patients (Group 1) with kidney stones larger than 2 cm and Grade 2 or higher hydronephrosis who underwent ultrasound-guided supine percutaneous nephrolithotomy without ureteral catheterization and fluoroscopy between January 2022 and November 2024. The data of these patients were compared using matched-pair analysis (1:1) with patients who underwent supine percutaneous nephrolithotomy under ultrasound and fluoroscopy guidance with ureteral catheterization (Group 2) in the same period. The groups were compared regarding access time, operation time, stone-free rates, blood loss, and complications.

Results: There were no statistically significant differences between the two groups in terms of age, gender, side, stone diameter, stone volume, stone density, hydronephrosis grade and Guy's stone score. Access time was significantly shorter in Group 1  (11.3 ± 3.9 minutes vs. 13.9 ± 4.7 minutes, respectively, 95% CI: 0.3-4.9, p = .026). The mean operation time was 64.4 ± 19.4 in Group 1 and 102.3 ± 31.2 in Group 2, and this difference was statistically significant (95% CI: 24.2-51.6, p = .001). There was no significant difference between the two groups in terms of postoperative 1st month stone-free rates (83.3% vs 86.6%, respectively, p = .723 Conclusion: Compared with standard supine mini percutaneous nephrolithotomy, totally ultrasound guided supine mini percutaneous nephrolithotomy without ureteral catheter is an effective, safe and feasible surgery.

Purpose: Müllerian anomalies are rare, and the obstructed hemivagina and ipsilateral renal anomaly/agenesis (OHVIRA) syndrome is the rarest. Its subtle and nonspecific symptoms cause delays in diagnosis, especially in prepuberty. This study aims to remind this rare anomaly and review its symptoms, clinical and radiological findings, and treatment in pre- and post-pubertal girls.

Materials and methods: We conducted a retrospective chart review of cases of OHVIRA syndrome that were diagnosed and treated between May 2018 and June 2024. We evaluated the results and reviewed relevant literature.

Results: Seven patients were diagnosed with OHVIRA syndrome during the study period. Two patients were diagnosed in the pre-pubertal period, and all post-pubertal cases, except one, underwent surgery. Five (71%) of the seven patients had left-sided obstructed hemivagina with ipsilateral renal agenesis.

Conclusion: OHVIRA syndrome is a rare condition. Its diagnosis and management depend on the patient's age, symptoms, familiarity with the syndrome, and teamwork. Although a renal anomaly is part of the triad of this syndrome, OHVIRA syndrome often remains undiagnosed during infancy, even in cases of prenatally diagnosed renal agenesis. Screening for OHVIRA syndrome and associated urinary anomalies in cases of renal agenesis, particularly in prepubertal cases, is crucial.

Purpose: Urolithiasis is the condition of forming stones inside urinary tract with diverse shape, size, and location. The sooner urolithiasis is diagnosed, the easier it is to treat and prevent complication. This study aims to propose a method for predicting urolithiasis recurrence based on machine learning methods.

Materials and methods: The proposed method uses clinical data, demographics, and CT findings of 4246 patients who were referred to the clinic once or multiple times within three years. The proposed method has three main phases of data engineering and pre-processing, machine learning prediction model development, and performance evaluation. In addition, the performance of six machine learning-based classifiers is evaluated by performance metric calculation, ROC curve analysis, calibration analysis, and decision curve analysis.

Results: The results of 10 independent repeats of the proposed method using a train/test split evaluation strategy reveal that the best-performing classifier is random forest with the area under the ROC curve, sensitivity, and positive predictive value of 0.64, 0.87, and 0.84, respectively. On the other hand, k-fold cross-validation: A comma is needed after "hand" and before "k-fold" evaluation strategy reveals that the best-performing classifier again is RF, with the area under the ROC curve, sensitivity, and positive predictive value of 0.63, 0.90, and 0.83, respectively. Moreover, the brier score of 0.18 shows that this classifier is well-calibrated among other evaluated classifiers.

Conclusion: This study presents a practical application of predictive machine learning methods for predicting urolithiasis recurrence with clinically acceptable accuracy compared to traditional scoring systems. To select the best classifier, six different predictive ML models have been evaluated using different performance metrics and analysis tools.

Purpose: Diabetes mellitus is a chronic hyperglycemic condition leading to metabolic problems causing organ damage and resulting in serious complications. Long-term complications of diabetes can cause serious health problems, such as sexual and reproductive dysfunction in men and women. Black pepper (Piper nigrum L) is one of medicinal plants proven to increase testosterone hormone levels, sexual function (libido), and spermatogenesis parameters in male rats. In this study the effect of black pepper fruit extract on sexual function and reproductive function (fertility) in alloxan-induced diabetic male-rats were evaluated.

Materials and methods: Total of 30 male Sprague Dawley rats, Rattus norvegicus, aged 2.5 - 3 months weighing 100-150 g were divided into five groups of 6 individuals each. Group 1 (I) was rats that were only given standard feed. Group 2 (II) was alloxan-induced hyperglycemic rats and given feed. Groups 3 (III) and group 4 (IV) were alloxan-induced hyperglycemic rats and given black pepper extract 122.5 and 245 mg/kg BW respectively for 8 days. Group 5 (V) is alloxan-induced hyperglycemic rats given Sildenafil therapy or Zinc plus Ascorbic acid. After treatment for 8 days the erectile function and libido of rats were assessed, followed by evaluation of spermatozoa and testicular histology. Data were analyzed using ANOVA with significance at p<0.05 Results: Alloxan-induced diabetic rats showed significant impairment in erectile function, libido, sperm quality, and testicular histology (p<0.001 vs control). Administration of black pepper extract at a dose of 122.5 mg/kgBB increased total penile reflexes (9.33 ± 1.03 vs 6.00 ± 1.26 in the diabetes group, p = 0.002) and improved libido with a decrease in courtship latency (5.50 ± 0.55 s vs 21.00 ± 9.47 s, p = 0.013) and increased mounting frequency (18.05 ± 5.99 vs 7.17 ± 1.83, p = 0.009). The extract dose of 245 mg/kgBB increased sperm concentration (158.16 ± 29.80 vs 12.6 ± 1.3 ×10⁶, p = 0.000), progresif sperm motility (65.0 ± 35% vs 27.0 ± 30%, p = 0.006), and increasing normal sperm morphology (82.9 ± 5.7% vs 35.0 ± 10.8%, p = 0.000). The number of Leydig cells increased significantly in the 122.5 mg/kgBB extract group (59.33 ± 4.08 & 30.50 ± 3.86; P = 0.000) compared to the diabetes group, There was no significant difference in spermatogonia count  (640 ± 86.5 & 491 ± 37.0; p = 0.119).

Conclusion: Piper nigrum fruit extract ameliorates sexual dysfunction and reproductive impairment in alloxan-induced diabetic rats, particularly at 122.5 mg/kg BW, with significant improvements in erectile function, libido (p<0.05), sperm quality (p≤0.04), and testicular histology (p=0.035). These findings suggest its potential as a natural therapeutic agent for DM-related male reproductive dysfunction.