Urologia Journal最新文献

Purpose: Lower calyceal stones are more challenging to treat due to their anatomical position and consequences. Therapies such as Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrolithotomy often offer limited efficacy or involve significant complications. This study aimed to assess the safety and effectiveness of advanced Flexible Ureteroscopy using six specific techniques compared to conventional in situ laser lithotripsy for large lower calyceal stones 10-25 mm.

Methodology: Prospective Randomized Controlled Study Design, in which 104 patients were divided into two groups. Group A underwent FURS with six specific (tips & tricks) including Modified T-tilt position (45° Trendelenburg position, 45° lateral tilt opposit the stone side ), bendable access sheaths with suction, modern laser techniques (combination of dusting & pop-corn) using dormia basket to move the stone to renal pelvis or to align the stone with the laser if it was too large to remain in the calyx plus using thin flexible ureteroscopy 7 FR for easy maneuverability and constant irrigation to maintain visibility. Conventional in situ laser lithotripsy was performed for Group B. The primary measure was the stone-free status with analysis of operative time, complications, hospital stay, and further treatments needed and recovery.

Results: The stone-free rate was found to be better in Group A 90.38% compared to Group B 71.15% with p-value 0.025. The median operative time for Group A was longer than Group B, with a median operative time of 78 min. which statistically significant (p < 0.001). Study reports better overall outcomes for Group A, including higher stone-free rate and lower need for additional interventions.

Conclusion: Analysis of the techniques shows that their application significantly improves stone clearance rates increases the efficiency of stone removal without increasing risk of complications. These findings support integrating innovative strategies into routine clinical practice.

Purpose: Assessing the association between Testosterone (T)-level in patients with urethral stricture (US) and its effect on surgery outcome.

Methods: This prospective study includes 70 cases of developing US disease and anastomotic Urethroplasty. All patients underwent retrograde and voiding urethrography, pelvi-abdominal ultrasound, and T (free and total) measurements.

Results: A significant negative association was found between free T, age, and post-void residual volume (PVR) pre. Also, a positive association between free T and Hemoglobin (Hb) levels. Besides, an association between wound infection and total T. There was a significant lower in PVR and higher in Q-max post-urethroplasty than pre-urethroplasty. International prostate symptom score (IPSS) showed a significant decrease in post-urethroplasty and at 3 months follow up than pre-urethroplasty (p < 0.05). Diabetes mellitus, free, and total T showed significant differences between the studied groups. Also, it can predict failure results respectively at cut-off ⩽123.75 and ⩽765.8 with 85.70% sensitivity, 98.40%, and 88.90% specificity.

Conclusions: Diabetic status, wound infection, and free and total T significantly affect the success rate in patients with the US, while preoperative PVR, Q-max, and IPSS did not affect the success rate.

Context: Large adrenal tumors (LATs) pose challenges in clinical management, with varied approaches and outcomes reported.

Aims: To analyze the surgical outcomes of large adrenal tumors and compare the minimally invasive and open approaches.

Settings and design: Retrospective analysis of large adrenal tumors operated at a tertiary care center.

Methods and material: Tumors ⩾6 cm on preoperative imaging were included. Data encompassing demographics, preoperative evaluations, surgical techniques, perioperative outcomes, and histopathological findings were analyzed. Receiver Operating Characteristic (ROC) analysis was used to determine a tumor size threshold predictive of malignancy. Statistical analysis was performed using SPSS v26.0.

Results: The mean age was 46.9 years, with a female predominance (70%). Incidental findings accounted for 52.2% of cases, while pain was the most common presenting symptom. Functioning tumors comprised 52.17% of cases, with no significant association between functioning status and malignancy risk. ROC analysis identified 7.4 cm as a malignancy-predictive cutoff (AUC = 0.77, p = 0.027). Laparoscopic and open approaches demonstrated comparable outcomes, with laparoscopy associated with lesser blood loss (90 vs 232 ml, p = 0.001) and significantly fewer major complications (0% vs 17.3%, p = 0.022).

Conclusions: Our study underscores the importance of vigilant evaluation and multidisciplinary management in LATs. Tumor size emerged as a critical determinant of malignancy, with laparoscopic surgery offering safe and comparable outcomes to open surgery in selected cases. Prospective studies are needed to validate these findings.

Purpose: Differentiating prostate cancer (PCa) in the transition zone (TZ) from benign prostate hyperplasia based on MRI findings has often been challenging. This study aims to evaluate the utility of a quantitative analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using time-resolved angiography with stochastic trajectories‒volumetric interpolated breath-hold examination (TWIST-VIBE) in cases of PCa in the TZ.

Methods: In this retrospective study, we examined the biopsy findings of 23 patients with elevated prostate-specific antigen (PSA) levels (>4 ng/mL) who underwent DCE-MRI using TWIST-VIBE. The parameters analyzed included K^trans (the transfer constant), K^ep (the reflux constant), Ve (the extravascular extracellular volume fraction), and the initial area under the curve on the Tissue 4D platform (Siemens).

Results: The quantitative analysis revealed no significant differences in any of the examined parameters between positive and negative PCa in the TZ. Additionally, there were no significant differences among the histological grades of PCa in the TZ.

Conclusion: A quantitative analysis of findings obtained by DCE-MRI using TWIST-VIBE did not yield statistically significant results for differentiating the status of PCa in the TZ. However, DCE-MRI using TWIST-VIBE, an ultrafast DCE-MRI technique, may be useful for evaluating tumor hemodynamics and assessing the size dependence of prostate cancer lesions in the transition zone.

Background: Prostate cancer is the most common solid neoplasm in men, with an increasing incidence. This study describes clinical and sociodemographic features and PSA levels, and evaluate their associations with stage, risk categories, metastasis, and mortality in a public tertiary hospital in southern Colombia.

Methodology: The present retrospective cohort study included 590 patients diagnosed with prostate cancer between 2020 and 2023. Sociodemographic and clinical variables, PSA levels, pathological characteristics and risk scales were analyzed. Patients were categorized into two groups: living (n = 429) and deceased by prostate cancer (n = 109), and other causes (n = 44). Statistical analyses were performed to determine associations with mortality and presence of metastasis.

Results: PSA screening was more frequent among survivors (66.9%, n = 287) than among deceased (22.0%, n = 24; p < 0.001). Median PSA at diagnosis was higher in those who died (123 vs 16 ng/mL; p < 0.001). PSA > 100 ng/mL was associated with ~50% probability of metastatic disease, rising to >95% for PSA > 323 ng/mL. High-risk D'Amico classification was strongly associated with metastasis (RR 6.67) and mortality (OR 14.24, p < 0.001). Bone pain was the predominant presenting symptom in the deceased group (76.1%, n = 83) and showed a strong association with metastasis (RR 8.146).

Conclusions: PSA screening was strongly associated with improved survival outcomes. Elevated PSA levels, high risk D'Amico classification and the presence of bone pain were important predictors of metastasis and mortality. The need to strengthen early detection in our population is evident, given the high percentage of patients presenting at advanced stages.

Introduction: We aim to present a peculiar case of a patient we treated, who underwent surgical excision of what at first were HPV-related condylomas of the urethral meatus. The second time he underwent surgical excision of what seemed a recurrence the histology showed a low grade noninvasive papillary urothelial carcinoma.

Case description: A 56-year-old man who underwent surgical excision of multiple lesions of the gland and distal urethra in April 2023; the histological examination of the neoformations in distal urethra confirmed the presence of condyloma acuminatum. He experienced a recurrence of distal urethral lesion; therefore, he underwent to a new surgical excision in September 2023 and this time the histological examination showed a transitional cell carcinoma.

Conclusion: There is still no clear evidence of the link between HPV infection and TCC, however attention must be placed in order to enhance awareness on HPV infection prevention and on TCC screening for patient with other HPV infection related diseases.

In recent years, healthcare strategies have increasingly emphasized a holistic and comprehensive approach in patient management that extends beyond the treatment of isolated physical symptoms. In this context, the use of nutraceuticals has gained interest as a complementary approach, particularly in managing chronic conditions and age-related disorders, such as lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). A new dietary supplement, contains a blend of bio-active compounds (Drolessano^®)-including lycopene, sulforaphane, silymarin, glutathione, escine, tryptophan, and green tea extract-has been introduced in Italian pharmacopeia as food supplements in urological and andrological diseases. Here, we aim to assess the effects of Drolessano^® on serum prostate-specific antigen (PSA) levels and urinary symptoms in individuals with BPH. Fifty-five men presenting with elevated PSA values and mild lower urinary tract symptoms (International Prostate Symptom Score [IPSS] < 7) were recruited in this pilot study. All enrolled patients underwent Drolessano^® one tablet daily for 6 months. PSA concentrations and IPSS scores were recorded at baseline (T0), at 3 months (T1), and at the end of the treatment period (T2). Data at the follow-up has been compared with those at baseline. Patients enrolled experienced a statistical significance average PSA declined from 4.8 to 3.7 ng/mL (p < 0.003), as well as in improvement of quality of life, tested by patient reported outcomes. The supplement was generally well tolerated, and no serious adverse effects were reported during the study period. These preliminary data suggest that Drolessano^® may offer a supportive benefit in the management of BPH, particularly with respect to reducing PSA levels and improvement quality of life. Otherwise, controlled trials with larger sample sizes are needed to substantiate these findings and to better understand the underlying mechanisms of action.

Introduction: An intact vescio-ureteric junction (VUJ) complex is necessary to maintain its normal physiological function. A ureteric jet is produced when urine is vigorously propelled from the VUJ into the urinary bladder. The transplanted ureter lacks a normal VUJ but maintains its intrinsic peristaltic activity. this study was conducted to compare prospectively between the ureteric jet parameters in voluntary kidney donors by Doppler ultrasound of the same with patients who underwent ureteric re-implantation during a kidney transplantation procedure.

Methods: There were a total of 44 participants in the study. The outcome measurements were taken of the anteriorposterior diameter of the renal pelvis (RP-APD), the resistive index of the renal artery (RA-Ri), and ureteric jet parameters- the jet's maximum velocity, pattern, initial slope, direction, and duration. The patterns were of the following types - triphasic, biphasic, polyphasic, square, continuous, and monophasic.

Result: The biphasic and monophasic jet pattern was most common in the donor and recipient groups, respectively.

Conclusion: The Doppler waveform observed in transplanted ureters significantly differs from that seen in healthy voluntary kidney donors. This observation lends support to the theory that the native VUJ functions as a sphincter.