Urologia Journal最新文献

Background: Overactive bladder (OAB) is a common syndrome that can negatively affect patients' daily activities, sleep patterns, mental health, sexual function, and general health. In addition to reducing the frequency of attacks, treatment of OAB can be expected to improve the psychological and sexual health of patients.

Aims: To evaluate the effects of mirabegron used in the treatment of overactive bladder (OAB) on female sexual function (FSF).

Methods: This retrospective study includes 48 sexually active women who were diagnosed with overactive bladder and treated with a daily oral dose of 50 mg mirabegron between November 2021 and March 2022. The evaluation of FSF was conducted using female sexual function index (FSFI) along with urinary parameters before the start of the treatment and at the 6th week of the treatment.

Results: In the study, out of 48 participants, 40 (83.3%) were identified with the dry type and 8 (16.7%) with the wet type OAB. The median age when diagnosed was 43.5 years. Although the decrease in the Overactive Bladder Questionnaire (OAB-V8) score did not reach statistical significance in the entire patient group after treatment (p = 0.058), a statistically significant decrease in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score was detected in the wet type OAB group (p < 0.001). During the assessment of sexual function, there was a statistically significant increase in the FSFI score, from 21.4 to 23.05, by the 6th week of treatment (p = 0.017). Specifically, the scores for desire, lubrication, and satisfaction showed a statistically significant post-treatment improvement (p < 0.001, p = 0.049, and p = 0.035, respectively).

Conclusion: The study indicates that a 6-week regimen of a daily 50 mg mirabegron dose enhanced sexual function in women. This beneficial impact of mirabegron on sexual health should be taken into account when selecting a treatment for OAB.

Introduction: Extracorporeal shock wave lithotripsy (ESWL) causes trauma to the renal parenchyma. Due to the kidney injury, free radicals are generated, and an inflammatory process develops. Inflammatory markers like interleukin's (IL), C-reactive protein (CRP), and procalcitonin (PCT) are released into the circulation. Antioxidants have the potential to mitigate the effects of the inflammatory process. Our objectives were the measurement of the effect of supplementation with Vit C and Vit E (antioxidants) and their effect on the reduction of CRP and procalcitonin and further kidney damage.

Methodology: There were two groups with 100 patients each. Group A, receiving oral Vitamin E (400 mg twice a day) and oral Vitamin C (500 mg twice a day) beginning 3 days before the lithotripsy and continuing for up to 7 days after the lithotripsy (total of 10 days). Group B served as the control group. Serum levels of CRP and procalcitonin were measured on the day of lithotripsy, day 2, and day 10 post ESWL.

Results: In Group B, CRP and PCT values are statistically significantly elevated as compared to Group A. In Group A, pre-ESWL, day 2 and day 10 CRP values are 1.23, 3.58, and 1.61. In Group B pre-ESWL, day 2 and day 10 CRP values are 1.38, 6.70, and 3.09 (p value < 0.001 in day 2 and 10). In Group A, pre-ESWL, day 2 and day 10 PCT values are 0.41, 1.42, and 0.44. In Group B pre-ESWL, day 2 and day 10 PCT values are 0.36, 3.03, and 1.10 (p value < 0.001 in day 2 and 10).

Conclusion: The serum levels of the inflammatory marker for acute renal injury are decreased when vitamins C and E are taken orally, which can help to minimize kidney damage after lithotripsy for renal stone disease.

Background: Exploring the potential of BOLA3-DT as a diagnostic biomarker in prostate cancer.

Methods: Expression of the lncRNA BOLA3-DT was analyzed between normal and tumor samples in the GDC TCGA PRAD (Genomic Data Commons: The Cancer Genome Atlas Prostate Adenocarcinoma Collection) dataset. Disease progression-related clinicopathological parameters such as serum PSA level (ng/ml) and Gleason score were associated with the expression of BOLA3-DT using the same GDC TCGA PRAD dataset. To validate these findings, the expression of BOLA3-DT was checked in our sample set of 15 PCa (prostate cancer) and 15 BPH (benign hypertrophy of the prostate) patients.

Results: In the GDC TCGA PRAD dataset, the expression of the lncRNA BOLA3-DT was significantly downregulated in prostate cancer tissue samples (n = 492) compared to adjacent normal (n = 52; p < 0.0001), and, there was a significant negative correlation between the expression of the lncRNA BOLA3-DT and the serum PSA level (p < 0.01). However, no significant association was found between the lncRNA BOLA3-DT expression and the Gleason score (p > 0.05). In this study, it was found that BOLA3-DT was downregulated in PCa tissue samples compared to BPH samples (p > 0.05). In the GDC TCGA PRAD dataset, it was revealed that BOLA3-DT could serve as an excellent diagnostic marker with a sensitivity of 86.9% and a specificity of 84.6% (AUC-0.916).

Conclusion: LncRNA BOLA3-DT, a novel long non-coding RNA, was found to be downregulated in prostate cancer. The expression of the lncRNA BOLA3-DT can serve as a diagnostic marker in prostate cancer.

This Umbrella Review aims to gather high-quality evidence on urolithiasis outcomes and complications, comparing extracorporeal shockwave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), and retrograde intrarenal surgery (RIRS). We incorporated systematic reviews, some containing meta-analyses, into two separate reports, focusing on quantitative and qualitative results. Additionally, when data permitted, a secondary meta-analysis was conducted using final effect estimates from multiple meta-analyses. Stone-free rate (SFR) served as the primary outcome, with complications, retreatment, and hospital stay as secondary outcomes. Adhering to Joanna Briggs Institute (JBI) guidelines, we initially screened 282 titles, narrowed down to 166 titles and abstracts, ultimately selecting 55 full-text articles for review. Of these, 22 met our inclusion criteria for the umbrella review. We evaluated study quality using JBI criteria, excluding five low-quality studies. Analysis showed ESWL had lower SFR compared to RIRS (RR: 0.577, 95% CI: 0.482-0.692) and URSL (RR: 0.570, 95% CI: 0.450-0.722); lower overall risk compared to ureteroscopy (RR: 0.58, 95% CI: 0.51-0.66). ESWL had fewer complications than RIRS (p < 0.001), but lower SFR than ureteroscopy. However, the need for retreatment and auxiliary procedures in RIRS and URSL were lower than that in ESWL. In contrast, individuals undergoing ureteroscopy experienced a greater frequency of complications and longer duration of operation compared to those undergoing ESWL.

Introduction: Pseudotumors are benign lesions which may mimic like a malignant tumor on conventional imaging. They are formed in kidneys which are scarred and deformed by chronic pyelonephritis, glomerulonephritis, trauma or infarction. There is a diagnostic dilemma in most of the cases as to differentiate RCC and pseudotumors. Our study shows bp-MRI (T2w, DW MRI) can distinguish pseudotumors from RCCs and offers a non-contrast non-invasive alternative in CKD patients.

Materials and methods: Prospective evaluation of 80 CKD patients (CKD IV/V), having suspicious renal mass <4 cm on Ultrasound, were subjected to bp-MRI. Two groups were defined on the basis of restriction pattern on DWI. ADC values were calculated. Group I (suspected RCC or malignant tumor) underwent surgical management according to the institutional protocol. Group II (suspected pseudotumor) were subjected to biopsy. ROC curves were drawn to find out area under curve for differentiation of groups and cut-off ADC values calculated so as to achieve highest average sensitivity and specificity. A p-value of <0.05 was considered as statistically significant.

Results: Sixty patients (Group I) had restricted pattern on DWI imaging whilst 20 had no restriction (Group II), hence ruling out malignancy. It showed a sensitivity of 81.82%, specificity 96.55% in the correct diagnosis. Mean ADC-value for CKD pseudotumors (Group II) was significantly higher than RCCs and surrounding diseased parenchyma (2.20 vs 1.52 (×10^-3 mm²/s; p < 0.0001) and 1.99 (×10^-3 mm²/s; p = 0.0001) respectively). ROC analysis for differentiating CKD pseudotumors and RCC yielded high sensitivity (85%) and specificity (99%) for cut-off ADC-value of 1.71 (×10^-3 mm²/s).

Conclusion: bp-MRI is a highly reliable imaging modality for the evaluation of renal lesions. Its ability to accurately differentiate pseudotumors from renal cell carcinomas, even in the absence of contrast administration can be a boon in the diagnostic armamentarium.

Introduction: Laparoscopic Fowler Stephens orchidopexy, single stage or two-stage, is now routinely performed in non-palpable testis. We performed second stage orchidopexy as open inguinal approach and compared the outcome of this approach to two-staged laparoscopic orchidopexy.

Methods: We performed a prospective randomized interventional study of two different approaches for intra-abdominal testis. In group A, Laparoscopic stage I (SFO) followed by open inguinal orchidopexy was compared for final outcome in group B cases, who underwent laparoscopic staged SF orchidopexy. The average duration between stage I SF and stage II SF was 6 months. All the procedures were done under GA and caudal analgesia. The pre-operative and post-operative USG dimensions were compared in cm and cm³/ml. The procedure outcome was considered successful if testis remained inside scrotum below mid-scrotal point. Any testis above the mid-scrotal point was considered as unacceptable or failure of procedure.

Results: This study was performed on 74 children with 84 testis (group 'A' 38 patients (48 testis) and group 'B' 36 patients (46 testes)), with average age was 3.3 ± 0.46 and 3.9 ± 0.58 years, respectively. In group 'A', 38 patients (48 testes) underwent lap SFO I followed by inguinal orchidopexy and in group 'B', 36 patients (46 testes) underwent laparoscopic staged SF O. The mean testicular volume pre-operative in group 'A' & 'B' was 0.28 ± 0.04 and 0.23 ± 0.06 cm², respectively. The mean post-operative testicular volume was 0.34 ± 0.07 and 0.28 ± 0.05 cm², respectively. The average follow-up of the patients in group 'A' & 'B' was 24 ± 3.67 and 20 ± 2.90 months, respectively. Testis was having good volume in 87.5% and 76.60% of these successful cases, respectively. There were (3/48) 6.25% (4/46) 8.69% testicular atrophy cases in group 'A' & 'B', respectively. The differences were not statistically significant (p < 0.05). The mean operative time in group A was 20 ± 8.07 min and group B 30 ± 7.19 min in stage II procedure.

Conclusion: The success rate in group A was more than the group B which was statistically significant (p > 0.05). Our study connotes that open stage II orchidopexy is still feasible and practicable with better final outcome of management of non-palpable cases.

Aim: To evaluate the role of preoperative neutrophils to lymphocytes ratio (NLR) as a predictor for the response to BCG in patients with non-muscle invasive bladder cancer (NMIBC).

Materials: Nighty six patients with NMIBC were prospectively included in our study. Our study population was classified into two groups, based on pre-operative (NLR) either ⩽ or > 3. After receiving BCG, patients were followed up for 3 years to evaluate the correlation between BCG failure and (NLR).

Results: Nighty two patients were evaluated at the end of our study. The NLR > 3 group of patients showed a higher age and T stage compared to the NLR ⩽ 3 group with a significant difference. BCG failure was reported to be higher in the NLR > 3 group with a failure rate of 66.7% compared to 28.3% in the other group (p-value < 0.001). Time to failure in NLR > 3 group compared to NLR ⩽ 3 group was 10.44 ± 4.3 and 15 ± 3.9 months respectively with a (p-value = 0.002). Univariate and multivariate logistic regression revealed that the most significant predictors of BCG failure were NLR > 3, Initial T stage, and age respectively.

Conclusion: BCG response is highly affected by the NLR, with a higher failure rate with NLR > 3.

Introduction: Robot-assisted radical prostatectomy (RARP) is the treatment option for localized prostate cancer. It can lead to side effects like erectile dysfunction (ED) and post-prostatectomy urinary incontinence (PPUI). This study aimed to evaluate association between dyadic adjustment, PPUI and ED.

Material and methods: Consecutive male patients who underwent RARP from January 2019 to December 2021, with at least 12 months of follow-up and preoperative International Index of Erectile Function (IIEF) 15 erectile domain questionnaire's score ⩾17 were enrolled. Demographic and surgical data were collected at baseline. Validated questionnaires were self-administered at 12-month follow-up: IIEF-15, Dyadic Adjustment scale (DAS), and Los Angeles-Prostate Cancer Index Urinary Function Score (UCLA-PCI-UFS). Univariable and multivariable analyses were performed to examine degree of association between different variables.

Results: Out of 96 enrolled patients, 37 (38.5%) were socially incontinent (>1 pad per day) at 12 months from surgery. Statistically significant association was found between incontinence and lower DAS total score (p < 0.0001), DAS consensus domain (p < 0.0001), and DAS affectional expression domain (p = 0.002). DAS total score (p = 0.002) and DAS consensus domain score (p = 0.012) were lower in impotent group (IIEF-15 erectile domain score <17). On a multivariable analysis, PPUI (beta: -0.25; 95% CI: -4.42, -0.47; p = 0.016) and post-operative ED (beta: 0.19; 95% CI: 0.002, 0.57; p = 0.048) were independent predictors of low DAS score. Pelvic lymphadenectomy (PLND) (beta coefficient: 0.25; 95% CI: 0.1, 1.2; p = 0.022), bladder neck reconstruction (beta: 0.26; 95% CI: 0.19, 1.09; p = 0.006), and ED (beta coefficient: -0.3; 95% CI: -0.07, -0.018; p = 0.001) were independent predictors of continence status.

Conclusion: PPUI following RARP is associated with lower dyadic adjustment, independently from other factors, indicating significant impact of PPUI on marital relationships. Further research should be conducted to understand better the cross-effective relationship between PPUI, potency, dyadic adjustment, and the effect of surgical treatments on incontinence and sexual function.