Urology Journal最新文献

Purpose: Sperm cryopreservation is a valuable method for fertility preservation in men who suffer from oligozoospermia and cancer. The increase in oxidative stress during this process negatively affects sperm viability, membrane fluidity, and function. Supplementation of antioxidants to the cryopreservation medium can reduce these negative effects. This study investigated the effects of 6-gingerol as a natural antioxidant during human sperm cryopreservation on different sperm parameters, DNA fragmentation, and apoptosis.

Materials and methods: In this experimental study, semen samples were obtained from 42 normozoospermic men referred to the Royan Institute. The samples were randomly divided into fresh, control (cryopreservation), and gingerol (cryopreservation with 6-gingerol) groups. Sperm evaluations were conducted before and after cryopreservation. Sperm parameters, DNA fragmentation index (DFI), caspase-3 activity, reactive oxygen species (ROS) levels, malondialdehyde (MDA) concentration, and total antioxidant capacity (TAC) levels were assessed.

Results: Use of 6-gingerol in the cryopreservation medium resulted in recovery of a significantly higher proportion of viable sperm post-cryopreservation compared with the control group (64.1 ± 1.3% vs 56.4 ± 1.3%; P = 0.000). ROS levels were significantly lower (P = 0.000), and the percentage of sperm with intact membrane potential was significantly higher (P = 0.000) in the gingerol group (26.1 ± 0.1 RLU/s; 63.5 ± 1.4%) compared with the control group (32.1 ± 0.7 RLU/s; 53.3 ± 1.5%). Active caspase-3 (P = 0.007) and DFI (P = 0.008) were lower in the gingerol group (47.3 ± 3.6%; 37.9 ± 1.3%, respectively) compared with the control group (60.5 ± 3.6%; 42.1 ± 0.1%, respectively), though the differences for caspase-3 and DFI did not reach statistical significance where indicated by the authors.

Conclusion: Supplementation of the sperm cryopreservation medium with 6-gingerol could improve sperm quality and function and positively affect the degree of apoptosis during sperm freezing.

Purpose: Clear cell renal cell carcinoma (ccRCC), the dominant subtype of renal malignancy, has a rising global incidence and mortality. While surgery is the standard of care for localized cases, adjuvant therapy aims to improve outcomes in high-risk postoperative patients. To quantify the clinical value of adjuvant pharmacotherapy, this systematic review and meta-analysis assesses its effect on overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) in patients with ccRCC.

Materials and methods: A comprehensive search of the Web of Science, Embase, Cochrane Library, and PubMed databases was conducted for articles published up to October 2024. The search used the English keywords "clear cell renal cell carcinoma," "adjuvant drug therapy," and "randomized controlled trials," combined with a free-word search. Randomized controlled trials (RCTs) assessing the effectiveness of at least one adjuvant drug therapy in patients with ccRCC were included.

Results: The meta-analysis showed that adjuvant drug therapy did not result in a statistically significant improvement for OS or PFS compared with the control group. There was also no statistically significant difference in DFS (P > 0.05). This systematic review provides evidence on the impact of adjuvant targeted therapy on OS, DFS, and PFS for patients with clear cell renal cell carcinoma.

Conclusion: This study summarizes the effects of adjuvant drug therapy on OS, PFS, and DFS in ccRCC patients. The evidence from this meta-analysis can inform clinical decision-making, support risk stratification strategies, and encourage the integration of OS-driven endpoints in future trial designs, thereby providing valuable data for the treatment of ccRCC.

Purpose: To investigate the efficacy of the flexible vacuum-assisted ureteral access sheath (FV-UAS) combined with disposable flexible ureteroscope (FURS) versus tubeless-mini percutaneous nephrolithotomy (T-PCNL) in the treatment of renal calculi with a diameter of 2-3 cm.

Materials and methods: This retrospective analysis included 270 patients with renal calculi with a maximum diameter of 2-3 cm treated between January 2022 and July 2024. Of these, 146 cases were treated with single-use ureteroscopic lithotripsy through an FV-UAS, while 124 cases were treated by tubeless PCNL (T-PCNL group) through a 16F Amplatz sheath. Perioperative indicators and postoperative stone-free rates (SFRs) were compared.

Results: There was no significant difference in the stone-free rates (SFRs) between the two surgical methods. Using the criterion of a residual kidney stone diameter less than 4 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% confidence interval (CI), 0.56-2.28; odds ratio (OR) = 1.13; P = .724. The SFRs at 1 month postoperatively were: 95% CI, 0.417-2.60; OR = 1.041; P = .931. Using the criterion of a residual kidney stone diameter less than 2 mm, the SFRs at 3 days postoperatively were: 95% CI, 0.355-1.055; OR = 0.612; P = .076; the SFRs at 1 month postoperatively were: 95% CI, 0.374-1.320; OR = 0.703; P = .271. There was no significant difference in the incidence of systemic inflammatory response syndrome (SIRS) and the need for postoperative analgesia between the two groups (P = .813 and P = .839, respectively). The surgical duration in the FV-UAS group was significantly longer (P < .001). The decrease in postoperative hemoglobin (Hb) levels and hospital stay in the FV-UAS group were significantly lower than those in the T-PCNL group (both P < .001).

Conclusion: For treating 2-3 cm renal calculi, both FV-UAS with disposable ureteroscope and 16F tubeless PCNL yield high stone-free rates. FV-UAS-assisted FURS reduces bleeding and hospital stay, whereas 16F tubeless PCNL shortens surgery duration.

Penile incarceration with a foreign body is a rare urological emergency necessitating prompt intervention. We present a 59-year-old patient who entrapped his penis and right testicle with a metal thread reducer for sexual arousal four days prior to admission to the Emergency Room. Ultrasound revealed a significantly reduced Color Doppler signal in the right testicle and a completely absent signal in the penile artery. After admission, the metal reducer was removed using a hacksaw under analgosedation. Magnetic resonance imaging showed penile ischemic changes. The patient experienced a reduction in penile swelling, and parts of the skin highly suspected of necrosis recovered fully with preserved sensation. Despite penile ischemia on magnetic resonance imaging, the patient had a full recovery, obtaining normal erections. He was discharged six days after admission, presenting with a normal International Index of Erectile Function score on the follow-up exam.

Objective: This study aimed to investigate the potential role of systemic inflammatory markers in the management of Prostate Cancer (PCA) with variant pathology.

Materials and methods: A retrospective analysis was conducted on 302 patients who underwent radical prostatectomy between 2014 and 2023. After applying exclusion criteria, 279 patients were included: 207 with adenocarcinoma and 72 with variant pathologies. Systemic inflammatory markers such as Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), and Systemic Inflammation Response Index (SIRI) were compared between the groups.

Results: Patients in the variant group were significantly older (p = 0.005). The frequencies of lymphovascular invasion (LVI), perineural invasion (PNI), and positive surgical margins (SM) were significantly higher in the variant histology group (p < 0.001, p = 0.014, and p < 0.001, respectively), as were ISUP grades (p < 0.001). Pretreatment PSA values were also significantly higher in the variant group (p < 0.001), as was the rate of subsequent radiotherapy (p < 0.001). However, no significant differences were found in NLR, PLR, SIRI, or SII values between the groups. Recurrence rates were significantly higher in the variant group (p < 0.05), but overall mortality did not differ.

Conclusion: Systemic inflammation markers have limited value in predicting prognosis among patients with variant PCA. This highlights the complex role of inflammation in cancer progression and underscores the need for further research to identify more specific biomarkers for different PCA variants.

Purpose: This study aims to investigate the therapeutic efficacy and complications of low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept in central neurogenic bladder (CNB).

Materials and methods: This study was a prospective, randomized controlled trial. Sixty patients diagnosed with CNB without prior treatment were randomly divided into two groups: the control group (n = 30) was treated with basic rehabilitation training, and the treatment group (n = 30) was treated with basic rehabilitation training plus low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept for 4 weeks. The fixed acupuncture points selected were: Sanyinjiao (bilateral), Zhongji (unilateral), and Diji (unilateral). The study compared pre- and post-treatment clinical curative effects, urodynamic indicators, urination status, the Neurogenic Bladder Symptom Score (NBSS), the Urinary Symptom Distress Scale (USDS), the World Health Organization Quality of Life Brief Inventory (WHOQOL-BREF), and the occurrence of adverse reactions and complications between the two groups.

Results: The overall efficacy rate of 96.67% in the treatment group was significantly higher than that in the control group (86.67%) (P < 0.05). After treatment, the MBC, MFR, Pdet, DASUV, and WHOQOL-BREF scores significantly increased, while the RUV, DUF, DAUL, NBSS and USDS scores all decreased in both groups, with the treatment group showing significantly better results than the control group (P < 0.05). There was no statistically significant difference in adverse reactions and complication rates between the two groups (P > 0.05).

Conclusion: Low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept significantly improves bladder function and alleviates urinary difficulties in CNB, demonstrating good safety and considerable clinical applicability.

Purpose: Working during non-traditional hours is becoming more prevalent in modern societies and presents a significant hurdle to an individual's circadian rhythm. We examined the bladder health of shift workers in the United States by analyzing information obtained from the National Health and Nutrition Examination Survey.

Materials and methods: National Health and Nutrition Examination Survey (NHANES) datasets from 2005 to 2010 were utilized. Regression analyses were used to assess the association between shift work and bladder health (stress incontinence, urge incontinence, and nocturia) by adjusting for age, race, education, smoking, and other factors.

Results: The percentage of non-Hispanic Black individuals was notably higher among shift workers (25.8% vs. 17.8%). Among shift workers, there was a lower percentage of individuals with a college degree or higher compared to day workers. Shift work was found to be associated with nocturia in men in the unadjusted model (OR=1.2, 95%CI=1.0-1.5, p = 0.038). However, the adjusted results indicate that the connection is not statistically significant (Adjusted Model II: OR=1.2, 95%CI=1.0-1.5, p = 0.105). Similarly, no statistically significant association was observed between shift work and nocturia in women. There was also no significant relationship between shift work and Stress Urinary Incontinence (SUI) in men or women. The results from the fully adjusted model (Adjusted Model II) indicate a significant association between shift work and the prevalence of Urgency Urinary Incontinence (UUI) in women (OR=1.2, 95%CI=1.0-1.5, p = 0.041).

Conclusion: Results of this cross-sectional study indicated that shift work was associated with a higher risk of UUI in women. Further research is needed to explore this relationship.

Purpose: The surgical approach to pediatric cryptorchidism has traditionally been the inguinal pathway. However, that has changed with the increased use of scrotal incision and single-site transumbilical laparoscopy, both of which result in a scarless surgical incision. We aimed to review our experience with the combined utilization of these two methods for the treatment of pediatric cryptorchidism and evaluate the surgical outcomes.

Materials and methods: This retrospective case series included 267 children who underwent scarless orchiopexy between January 2019 and December 2022. Data were gathered from case and operative records. Testicular retraction, testicular atrophy, other complications, cosmetic outcomes, and parental satisfaction were evaluated.

Results: A total of 267 children (aged 1-7.4 years, median 1.8 years) with palpable and nonpalpable undescended testes underwent scarless orchiopexy at our center. Among them, 58 (21.7%) were treated with a scrotal incision and 209 (78.3%) underwent single-site transumbilical laparoscopic surgery. The follow-up period ranged from 6 to 53 months, with an average of 26.2 months. During the follow-up period, testicular retraction (4 cases, 1.5%) and atrophy (5 cases, 1.9%) occurred in the laparoscopic group. One child in the laparoscopic group developed a hydrocele but recovered after 3 months. In most cases (98.9%), the scars were invisible, indicating an excellent cosmetic effect.

Conclusion: The combination of scrotal incision and transumbilical laparoscopic orchiopexy can resolve cryptorchidism in children at different locations and achieve successful outcomes with a low rate of postoperative complications and good cosmetic results.

Purpose: The cellular and molecular pathophysiology of urosepsis, a condition caused by a urinary tract infection spreading to the bloodstream, involves complex epigenetic behavior. The objective of this study was to identify relevant genes and signaling pathways in adult urosepsis through a bioinformatic analysis of differentially expressed genes (DEGs).

Materials and methods: In this in silico study, the GSE69528 dataset, containing 138 total RNA blood samples from patients with sepsis and uninfected controls, was obtained from the Gene Expression Omnibus (GEO) database. Microarray data were analyzed using GEO2R tools and R software. DEGs were identified using a fold change (FC) cutoff of > 1.5 or < 0.67 and a significance level of p < 0.05. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used to determine the enriched pathways of DEGs before constructing protein-protein interaction (PPI) networks with STRING and Cytoscape.

Results: A total of 108 DEGs were identified, comprising 67 upregulated and 41 downregulated genes. GO and KEGG analyses revealed that these DEGs were significantly enriched in pathways such as the complement and coagulation cascade, neutrophil degranulation, negative regulation of interferon-gamma response, T-cell activation, and granulocyte differentiation. The PPI network analysis identified 67 nodes with 110 interactions, from which CEACAM8, MPO, and RETN were identified as hub genes. Overexpression of CEACAM8 and MPO and suppression of RETN may be associated with a better disease prognosis.

Conclusion: The identified hub genes-CEACAM8, MPO, and RETN-are predicted to be significant biomarkers in the prognosis and progression of sepsis. These genes could be targeted for the discovery of new therapeutic drugs for treating and managing urosepsis.

Purpose: To review the current literature on dorsal penile curvature (DPC) in children, including its etiology, diagnosis, and principles of treatment.

Materials and methods: A literature review was conducted on DPC in children, focusing on its etiology (e.g., skin tethering, corporal disproportion), association with other conditions such as hypospadias and epispadias, and surgical treatment methods.

Results: DPC is a rare condition, often associated with neonatal circumcision, hypospadias, or epispadias. The etiology includes skin ties, fibrotic tissues, and asymmetric corporal development. Spontaneous resolution can occur, especially in cases following circumcision. Surgical correction is typically considered for curvatures of 30° or greater that are functionally concerning. Common surgical techniques include ventral plication, wedge resection (Nesbit procedure), and grafting.

Conclusion: While mild DPC often requires no intervention, surgical correction should be considered for significant curvatures (≥ 30°) to prevent future functional issues. Cases that develop after neonatal circumcision may resolve spontaneously.