Urologia Journal最新文献

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.

Purpose: This study aimed to develop and validate an AI-assisted framework for the automated evaluation of uroflowmetry data in patients presenting with lower urinary tract symptoms. The primary goal was to overcome the limitations of traditional manual interpretations by leveraging advanced machine learning techniques to achieve higher diagnostic accuracy, objectivity, and clinical applicability in urological assessments.

Materials and methods: A retrospective analysis was conducted using a large, de-identified dataset comprising uroflowmetry recordings, patient-reported symptom scores, and comprehensive demographic data. The data underwent rigorous preprocessing-including noise reduction, baseline correction, normalization, and feature extraction-with key parameters such as peak flow rate, voided volume, average flow rate, and voiding time being analyzed. Multiple machine learning models-including a deep neural network, support vector machine, and random forest classifier-were developed and validated through cross-validation and extensive statistical testing. Performance metrics such as accuracy, sensitivity, specificity, and area under the ROC curve (AUC-ROC) were calculated, while multivariate regression analyses were performed to explore the relationships between uroflowmetry parameters and symptom severity.

Results: The AI framework, particularly the deep neural network model, exhibited outstanding diagnostic performance with an accuracy of 92.5%, sensitivity of 90.0%, specificity of 94.0%, and an AUC-ROC of 0.96. Statistical analyses demonstrated significant correlations between key uroflowmetry parameters and clinical symptoms, with lower peak flow rates showing a strong association with increased symptom severity (p < 0.001). These findings confirm that the integration of multi-dimensional data through AI significantly enhances the objectivity and precision of urinary function evaluation compared to conventional methods.

Conclusion: The study successfully established an AI-assisted diagnostic framework that markedly improves the automated evaluation of uroflowmetry data and lower urinary tract symptoms. This innovative approach offers a robust alternative to traditional diagnostic practices by reducing subjectivity and enhancing diagnostic accuracy, thereby paving the way for more personalized and effective management of urinary disorders.

Robotic-Assisted Partial Nephrectomy (RAPN) can be performed via a transperitoneal (t-RAPN) or retroperitoneal (r-RAPN) approach. Despite the retroperitoneal route being potentially more suitable for posterior renal tumors, most surgeons prefer the transperitoneal access due to greater familiarity. This study evaluated perioperative and functional outcomes of r-RAPN versus t-RAPN for posterior renal masses performed by a surgeon without prior retroperitoneal experience. We retrospectively analyzed patients undergoing RAPN for posterior renal tumors between September 2023 and April 2025. Patient and tumor characteristics, operative time (OT), warm ischemia time (WIT), ΔeGFR, length of stay (LOS), complications, and Trifecta rate were compared. Trifecta was defined as WIT < 25 min, negative margins, and absence of Clavien-Dindo ⩾ III complications. Twenty patients were included: eight underwent t-RAPN and 12 r-RAPN. Baseline features were comparable. r-RAPN showed significantly shorter OT (125 ± 29 min vs 168 ± 37 min, p = 0.01), time on console (72 min vs 110 min, p = 0.01), and WIT (12 min vs 18 min, p = 0.048). Trifecta was achieved in all cases. Multivariate analysis identified surgical approach as the only independent predictor of console time (p = 0.024), with r-RAPN reducing it by 39 min. In conclusion, r-RAPN is feasible and safe even without prior retroperitoneal experience, offering comparable outcomes to t-RAPN with shorter operative times.

Background: In recent years, there has been a growing trend toward minimally-invasive techniques (MISTs) in men presenting symptomatic lower urinary tract symptoms (LUTS). However, direct comparisons between techniques are rare. This work compares 2-year functional outcomes and failure rates after implantable nitinol device (iTIND) and prostatic Urethral lift (Urolift).

Methods: Data of patients presenting with LUTS with an International Prostatic Symptom Score (IPSS) ⩾10, Qmax < 12 mL/s, and prostate volume < 70 mL were obtained retrospectively from two different referral centers' databases. Patients with neurogenic bladder, sphincter abnormalities, urethral strictures, post-void residual (PVR) volume > 250 mL, urinary bladder stones, and active urinary tract infections were excluded from the study. Treatment failure was defined as the need for surgical retreatment for LUTS or ejaculatory dysfunction. Postoperative uroflowmetry, PVR, IPSS, ejaculatory function, and retreatment rate were collected at 24 months follow-up.

Results: A total of 134 cases were collected. iTIND was used in 92 (68.7%) patients and Urolift in 42 (31.3%). Baseline characteristics were similar in both groups; however, Urolift patients were younger, with more significant prostate volumes and median lobe enlargement. No patients developed ejaculatory dysfunctions after the treatment, and the retreatment rate was similar in the two groups (13% vs 11.9% p = 0.8). Urolift demonstrated a shorter length of stay. Uroflowmetry, PVR volume, and symptom scores improved in both groups; iTIND cases showed significantly better symptom score reduction.

Conclusions: The 24-month failure rate was similar for iTIND and Urolift. Urolift reported a shorter hospitalization. Uroflowmetry and PVR results were comparable in both groups. iTIND cases showed slightly superior improvements in symptom scores; however, the clinical significance of this finding must be confirmed by further studies in correlation with prostate volume and median lobe shape.

Purpose: This study presents a 1-year follow-up for fragile patients with catheter-dependent urinary retention related to benign prostatic hyperplasia (BPH) treated with Rezum therapy.

Materials and methods: All patients participating in this study exhibited catheter-dependent urine retention attributable to benign prostatic hyperplasia, with a mean prostate volume of 65 ± 13.1 ml. The study only included fragile patients with a PRISMA-7 questionnaire score of ⩾3. The study excluded patients with bladder or prostate cancer, ongoing urinary tract inflammation, a history of pelvic irradiation or prostate surgery, neurogenic bladder or urethral stricture. The treatment was carried out under local anesthesia, with the possibility of sedation. Patients were asked to follow up after 1, 2, 9, and 12 months of surgery. Clinical assessments included the IPSS score, bladder scans to determine pre- and post-voiding bladder volume, and an evaluation of the requirement for re-catheterization.

Results: Eighty fragile patients with PRISMA-7 score ⩾3 underwent Rezum treatment for urinary retention due to BPH. Patients were monitored for 1 year after the procedure. Patients' IPSS improved from 14 to 9.5 (p = 0.02), while post-void residual urine decreased from 50 mL to 12 mL (p < 0.001). Prostate volume reduced from 60.5 mL to 40.9 mL (p = 0.0003) and PSA levels also dropped, from 3.5 mg/dl to 2.3 ng/ml (p = 0.03).

Conclusion: This study demonstrates that Rezum therapy is a feasible treatment option for frail patients with PRISMA-7 questionnaire score of ⩾3, presented with catheter dependent urinary retention. There were reported positive post-operative outcomes and an improvement in IPSS scores up to one year after surgery.

Introduction: Urethral stricture is common in men with anterior being more common. Number of surgical techniques are there for anterior urethral stricture depending upon location and extent of stricture. To compare one technique with another in terms of complexity, intra-op difficulty and recurrence, no standard scoring system is there. In order to quantify anterior urethral stricture disease, Weigand developed USS (UREThRAL Stricture Score) in 2012. This scoring system was based on preoperative imaging and intraoperative findings. This scoring system has not been accepted worldwide. The aim of this study is to evaluate the USS in predicting intraoperative complexity and postoperative outcome in anterior urethral stricture disease.

Methods: This ambidirectional study included patients operated for anterior urethral stricture in our institute. USS score for each patient was calculated preoperatively. Patients underwent optical internal urethrotomy (OIU), anastomotic urethroplasty or buccal mucosal graft urethroplasty (BMG). Complexity of surgery (in terms of duration of surgery and need of blood transfusion) and postoperative outcome (post op complications and recurrence) was evaluated for association with USS score.

Results: The study included 100 patients. Mean duration of surgery for overall study population was 99.39 ± 55.78 min with strong positive correlation of 0.76 (p-value < 0.001) with USS. Subgroup analysis revealed significant association between USS and postoperative complications (p-value 0.032) and recurrence of stricture (p-value 0.003) in OIU patients. There was also showed that there was significant association between USS and time to recurrence in patients who underwent OIU (p-value 0.007).

Conclusion: Our study validates the USS in predicting complexity of surgery, postoperative complications and recurrence in anterior urethral stricture disease. Higher the USS, more complex is the surgery needed for anterior urethral stricture, more chances of postoperative complications and recurrence of stricture.

Purpose: To evaluate the safety and efficacy of single-session supine bilateral percutaneous nephrolithotomy (BPCNL) in patients with bilateral renal stones.

Methods: We retrospectively identified patients from February 2019 to July 2023 with bilateral renal stones measuring >2 cm and <5 cm in their maximum dimension for each side mainly located in the renal pelvis that had been treated with single-session supine BPCNL. The stone-free rate was accepted when remaining fragments of ⩽ 2 mm were discovered by a computed tomography scan.

Results: Fifty-two patients with bilateral renal stones measuring 2:5 cm in their maximum dimension for each side who had been treated with single-session supine BPCNL were included in the study; a statistically significant difference in serum creatinine level was detected on day 1 postoperatively (p < 0.0001) compared with the baseline values that became insignificant at 1 week and 1 month postoperatively (p = 0.403 and 0.471 respectively). Also, statistically significant difference in glomerular filtration rate was detected at day 1 postoperatively (p < 0.0001) compared with the baseline values that became insignificant at 1 week and 1 month postoperatively (p = 0.95 and 0.07 respectively implicating early renal affection that shortly returned to normal values. The mean operative time for both sides was 126.5 ± 22.9 min, and the mean hemoglobin drop after the procedure was 1.9 ± 0.99 g/dl. The primary stone-free rate was 75%, with 11.6% of the remaining patients had a residual insignificant stones >2 mm but still less than 6 mm. Finally, 13.4% of the patients needed ancillary procedures.

Conclusion: Single-session supine bilateral PCNL is both safe and effective for patients with bilateral renal stones. However, this is a complex procedure that should only be performed by expert surgeons in a tertiary centers.

Trial registration number: (167) SPS/URS_008 retrospectively registered.

The optimal timing of perioperative chemotherapy in upper tract urothelial carcinoma (UTUC) remains debated. We conducted a meta-analysis to compare neoadjuvant chemotherapy (NAC) versus adjuvant chemotherapy (AC) in terms of pathological and survival outcomes. A systematic search identified eligible studies directly comparing NAC and AC in UTUC patients. Five studies with 1938 patients were included. Compared with AC, NAC achieved higher rates of pathological downstaging (OR: 2.13; 95% CI: 1.21-3.76) and a lower risk of positive surgical margins (OR: 0.59; 95% CI: 0.37-0.95). In contrast, lymph node metastasis rates and overall survival were similar between the two groups. Importantly, although renal function outcomes were not directly reported, prior evidence highlights the risk of post-nephrectomy renal decline, which may limit cisplatin eligibility-underscoring the rationale for NAC. Overall, NAC provides superior pathological benefits while maintaining comparable survival outcomes, supporting its consideration in eligible patients. Given the risk of post-surgical renal function decline, NAC should be considered in eligible patients to ensure timely delivery of cisplatin-based regimens. Future studies should incorporate renal functional outcomes to guide treatment selection.