Urologia Journal最新文献

Human papillomavirus (HPV) is a prevalent sexually transmitted disease worldwide. Very little is known about the effect of HPV on men's health. It is estimated that it is one of the most critical causes of penile cancer worldwide, representing a considerable percentage of the cases. We aimed to review the information on HPV vaccination strategy plans worldwide and the effect on male genital health. Studies on the outcomes of countries that include males in HPV vaccination programs and what the result will be in those that do not indicate favorable data in terms of preventing disease and thus the cost-effectiveness of gender-neutral HPV vaccination in most high-income countries (HIC) as well as in low-to-middle income countries (LMIC), considering HPV universal vaccination as a public health strategy. Vaccination of men against HPV is an effective strategy to prevent the development of genital cancers in this population.

Objective: To assess the efficacy and safety of lithotripsy with ureteroscopy for managing ureteral stone in octogenarian patients.

Materials and methods: This retrospective study analyzed 314 patients who underwent retrograde lithotripsy with ureteroscopy for ureteral stones between January 2018 and August 2024. Patients were categorized into two groups based on age: the octogenarian group (⩾80 years) and the younger patient group (<80 years). Clinical parameters, including the stone-free rate, postoperative length of hospital stay, and postoperative complications, were compared. To minimize confounding variables, 1:1 propensity score matching was performed, resulting in 41 patients in each group.

Results: After propensity score matching, no significant differences in baseline clinical characteristics between the groups. Additionally, no statistically significant differences were observed in the stone-free rate, postoperative length of hospital stay, or postoperative complication rates between the two cohorts.

Conclusion: These findings suggest that lithotripsy with ureteroscopy is an effective and safe treatment option for ureteral stones in carefully selected octogenarian patients.

Introduction: Male urethral stricture is a common clinical condition in urology with significant socioeconomic impacts and is associated with high recurrence rates.Visual internal urethrotomy (VIU) is a widely used endoscopic treatment for short-segment urethral strictures (<2 cm). The aim of this study was to evaluate the stricture-free rates and analyze the predictive factors for recurrence after VIU, following both initial and repeated urethrotomies, with 12 months of follow-up.

Methods: This retrospective study included male patients who underwent VIU for urethral stricture disease between January 2021 and July 2023. Statistical analysis was performed using MedCalc software (version 22.00). Univariate analyses were conducted using the Chi-square test for categorical variables and the t-test for continuous variables.

Results: A total of 132 patients with a mean age of 39.8 years were included in the study, with a follow-up duration of 12 months. The mean stricture length was 12 mm, and the most common site of stricture was the bulbar urethra. The stricture-free rate following the first VIU was 59.7%, with a mean time to recurrence of 6.7 months. After the second VIU, the stricture-free rate decreased to 45.5%, with a mean time to recurrence of 5.2 months. The cumulative stricture-free rate at 12 months (following both first and second VIU) was 80.3%, with a mean time to recurrence of 7.9 months (range: 4-11 months). Patients who experienced recurrence after the second VIU underwent definitive urethroplasty. Intraoperative factors significantly influenced the outcomes of VIU, including stricture length (<2 cm vs >2 cm, p = 0.045), health of the urethral mucosa (healthy vs unhealthy, p = 0.250), presence of spongiofibrosis (present vs absent, p = 0.07), and stricture location (mid-bulbar urethral stricture in 74 patients [56.09%], penobulbar/distal bulbar urethral stricture in 50 patients [37.8%], and bulbomembranous/proximal bulbar urethral stricture in eight patients [6.09%]).

Conclusions: Although VIU is a relatively simple procedure, it yields acceptable outcomes in carefully selected patients. Stricture length and the presence of spongiofibrosis had a statistically significant impact on outcomes. Other independent predictive factors for failure of VIU included older age, obesity, and mucosal health.

Background and objective: This study aims to map the prevalence and treatment of urachal cancer (UrC) in Norway, establish survival rates, identify prognostic factors, and evaluate whether any of the three commonly used staging systems for UrC provide superior prognostic value.

Methods: In this retrospective cohort study, data from the National Cancer Register was collected to identify patients diagnosed with UrC between1997 and2022. Eligible cases (n = 43) underwent retrospective review of their individual hospital records. All patients were staged using the Sheldon, Mayo, and Limonnik-revised TNM systems. This was performed locally and then checked by the coordinating center.Key findings and limitations:The median age at surgery was 59.5 years (IQR 49-73), with 57% of patients being male. The median follow-up time for survivors was 98 months (IQR 81-153). Macroscopic hematuria was the most common presentation (67%, n = 28). Recurrence-free survival (RFS) rates at 1, 3, and 5 years were 71%, 57%, and 53%, respectively. Cancer specific survival (CSS) was 95%, 62%, 55%, and overall survival (OS) rates were 93%, 61%, 46% at the same time points. Smaller tumor size was an independent predictor of improved CSS (HR 1.3, CI: 1.01-1.6, p = 0.045). Of the three staging systems, only the Mayo system showed statistically significant differences between stages for OS, while none of the systems, including Mayo, showed significant differences for CSS. Study limitations include a small sample size and a prolonged study period of 25 years, which may affect the generalizability of the findings and introduce bias due to changes in clinical practice over time, such as advancements in surgical techniques, and oncological therapies.

Conclusions and clinical implications: Urachal cancer is frequently diagnosed at an advanced stage. Our findings suggest that the Mayo system more effectively distinguishes between localized, locally advanced, and advanced disease compared to the Sheldon and Limonnik-revised TNM systems.

Background: This study assessed the safety and efficacy of management strategies for residual upper calyceal stones (1-2 cm) following percutaneous nephrolithotomy for staghorn calculi, comparing conservative management to interventional approaches.

Methods: A randomized trial included 105 patients with residual stones, assigned to flexible ureterorenoscopic laser lithotripsy (Group A), extracorporeal shock wave lithotripsy (ESWL, Group B), or conservative management (Group C). Outcomes included the need for additional interventions, stone-free rates, complications, and cost-effectiveness. Patients were followed for 1 year to assess pain, hematuria, hospital readmission, and stone clearance.

Results: Conservative management led to a 20% intervention rate within a year, primarily due to pain, obstruction, or patient preference. A stone size ⩽ 1.4 cm predicted the likelihood of intervention. Flexible ureterorenoscopy had the highest stone-free rate (94.29%), followed by ESWL (71.43%, p = 0.023). ESWL was the most cost-effective option (10.17 × 10³ vs 39.47 × 10³ Egyptian pounds, p < 0.001) but was less effective for high-density stones.

Conclusions: While conservative management avoids immediate intervention, it carries a higher risk of future complications and delayed interventions. Early intervention with flexible ureterorenoscopy or ESWL offers better long-term outcomes, with ESWL being the most cost-effective option.

Introduction: Various nephrolithometry scoring systems have been introduced to assess the outcomes of percutaneous nephrolithotomy (PCNL) and postoperative complications. Previous studies have incorporated various variables to determine factors influencing postoperative acute kidney injury (AKI). Using separate scoring systems or nomograms to predict postoperative outcomes and AKI is cumbersome. Our study aims to find if stone scoring systems can be used to predict AKI following a PCNL procedure.

Materials and methods: A prospective observational study was conducted at Kasturba Hospital and Medical College from December 2023 to June 2024. All patients undergoing PCNL were included in the study. Scores were calculated for all patients pre-operatively using various nephrolithometry scoring systems. Patients were divided into two groups based on the presence or absence of AKI following PCNL. The various stone scoring systems were assessed for their ability to predict AKI following PCNL.

Results: Out of the 90 patients in the study, 15 (16.66%) developed AKI, and 75 (83.33%) had no AKI following PCNL. Statistical significance was found in stone size (p < 0.001), stone location (p = 0.011), Staghorn (p < 0.001), Guy's Score (p = 0.001), STONE score (0.002), CROES Score (p = 0.001), Amplatz size (p = 0.012) and energy source (p = 0.01). No statistical significance was found when comparing sex, comorbidities, number of stones, the severity of HN, puncture location and number, intraoperative hypotension, operative time, and duration of hospital stay.

Conclusion: Nephrolithometry scoring systems, in addition to assessing postoperative outcomes such as stone-free rate and complications, can also be used to predict the occurrence of AKI. The use of a limited number of scoring systems to assess all the postoperative outcomes will help simplify and facilitate their use in routine clinical practice.

Purpose: To compare the efficacy and safety of mini-percutaneous nephrolithotomy versus flexible ureteroscopy with laser lithotripsy in the management of calyceal diverticulum stones.

Methods: The study performed a prospective analysis of 91 patients with confirmed calyceal diverticulum stones in Saudi Arabia from January 2020 to June 2024. A total of 78 patients with CD (calyceal diverticulum) stones were randomly divided into two groups: Group A (n = 39) FURSL and Group B (n = 39) mini-PCNL. The study analyzed patient demographics, stone complexity, operative parameters, postoperative results, and postoperative outcomes, including stone-free rates, operative time, hospital stay, complication rates, and recovery time.

Results: Both groups showed similar baseline characteristics and surgical feasibility, with the mini-PCNL group showing a higher SFR (84.62% vs 71.79%), but not statistically significant. Hospital stay was significantly shorter in the FURSL group (17.31 ± 3.06 h vs 30.03 ± 7.18 h; p < 0.001). Patients undergoing FURSL returned to normal activity sooner (5.1 ± 1.37 days vs 8.03 ± 1.05 days; p < 0.05). Complication rates were low and nearly similar across groups.

Conclusions: Both mini-PCNL and FURSL are effective strategies for treating calyceal diverticulum stones. Notably, mini-PCNL offers superior stone-free rates, while FURSL offers shorter operative times, hospital stays, and fast recovery.

Introduction: Partial nephrectomy is the gold standard treatment for incidentally detected small renal tumors. To optimize the outcomes, use of intra operative imaging techniques like ultrasound (IOUS), OCT (optical coherence technique) and fluorescence along with augmented reality is indicated. However, these are not available in all the centers and may also not be needed for predominantly exophytic tumors with low RENAL nephrometry scores.

Aim and objective: To evaluate the oncological outcomes and efficacy of transperitoneal laparoscopic partial nephrectomy (LPN) in patients with RENAL nephrometry score of ⩽9 without the use of IOUS.

Material and methods: This was a single centered, single surgeon, retrospective, descriptive, record-based study carried out from January 2013 till December 2018 at postgraduate department of Urology GMC Jammu with a follow up 5 years. After initial evaluation by CECT abdomen with CT renal angio the patients were subjected to transperitoneal LPN and outcomes were recorded in the patient data sheet. Demographic, intra and post op data including RENAL nephrometry score and follow up was retrieved from the patient chart after taking the due clearance from Institutional Ethics Committee.

Results: Sixty-five patients were included in the study and the average age was 52.6 ± 8 years of 40 were males and 25 were females with average BMI of 23.84 ± 5. Right sided tumors accounted for 62% of cases with upper polar 38%. Total operative time was 100 ± 20 with an average warm ischemia time of 21.55 ± 2. Average size of the tumor in our series was 4.1 ± 2 cms. One patient required blood transfusion. Surgical margins were negative in all. Average follow up in our series was 5.5 ± 1 years.

Conclusion: Transperitoneal laparoscopic partial nephrectomy for low to intermediate RENAL nephrometry score (score ⩽9) without the use of IOUS is feasible and safe with acceptable surgical and oncological outcomes on long term follow up.

Objectives: This study aimed to assess the clinical outcomes of Fournier's gangrene and its predisposing factors in male diabetic and non-diabetic patients. We also evaluated the disease severity using the Fournier's Gangrene Severity Index and examined management outcomes, including mode of wound closure and complications related to the disease and treatment.

Methods: Patients with Fournier's gangrene underwent admission, with detailed history collection. Disease severity was clinically and laboratory assessed. Empirical antibiotics preceded surgical management and microbial evaluation. Wound closure involved primary suturing, skin grafting, or flaps. Patients were called for regular follow-up after discharge, and complications were identified.

Results: Our study has shown that the overall FGSI was much higher among diabetics as compared to non-diabetics, and the same goes for the mortality rate, which was much higher in diabetics, owing to the higher rate of complications among them. It was also found that the prognosis of Fournier's gangrene is worse among diabetics. The mean number of debridement's in the diabetic group (3.00 ± 1.016) was higher than the non-diabetic group (2.22 ± 1.003). The association between number of debridement's in the two groups was statistically significant (p = 0.001).

Conclusion: Early diagnosis and aggressive management are crucial to reduce Fournier's gangrene mortality. Effective diabetic control and repeated debridement are necessary to successfully manage these complex cases.

The purpose of this study is that the combination effects of Peyronie's disease (PD) therapy with Phosphodiesterase type 5 inhibitors (PDE5i) plus acetylsalicylic acid on improve curvature progression and pain in the active phase of disease. We performed a retrospective cohort study of 161 patients affected by PD in active stage and erectile dysfunction treated with tadalafil 5 mg once daily were divided in two groups. Group A(GA): 93 men treated with only PDE5i (tadalafil 5 mg) for 1 year or more and Group B(GB): 68 men that received tadalafil 5 mg plus aspirin 100 mg with the same protocol of GA. The patients of both groups were assessed at baseline and follow-up (6 months) for erectile function, painful erections, penile plaque size, and penile curvature. Six months after the treatment the patients in both groups had a non-significantly reduction of penile plaques. However, in GB patients had a clinically significant reduction of the curvature after 6 months by treatments 20.21° ± 7.20 versus 28.13° ± 8.11 (GA), (p < 0.001). In the analysis of our secondary endpoint, we demonstrated a significantly lower intensity of pain during erection in GB (1.43 ± 1.12) compared GA (1.89 ± 1.25; p < 0.001). We observed that the regular use of this therapeutic combination significantly provided more benefit in patients with active stage PD in terms of penile deformity, pain, and discomfort during penetrative intercourses.