Urologia Journal最新文献

Introduction: Medical expulsive therapy (MET) has been shown to be a safe and effective option for the spontaneous passage of uncomplicated ureteric stones sizing ⩽10 mm in selected cases. However, there is lack of evidence on the predictors of successful MET. Our objective was to identify parameters that can accurately predict the spontaneous passage of ureteral stones during MET.

Methods: Patients receiving MET (Tamsulosin 0.4 mg once daily (OD)) for a single unilateral ureteral calculi sizing ⩽10 mm were followed after 1 month using Non contrast Computed tomography (NCCT). Various parameters such as stone-related parameters (location, density, volume and transverse, longitudinal, and sagittal diameters), ureter-related parameters (diameter, density, and wall thickness at the stone site) and grade of hydronephrosis were evaluated on CT images and analyzed by using univariate, multivariate and receiver operating characteristic (ROC) curve analyses.

Results: Of 55 patients, 31 (56.4%) passed the stone successfully within 4 weeks of MET. Univariate analysis revealed these patients tended to have lower ureteric stones (p-value- 0.048), lower longitudinal (p-value- 0.024) and transverse stone diameters (p-value- 0.006), lower stone volume (p-value- 0.015) and ureteral wall thickness (UWT; p-value- 0.001). In multivariate analysis, only UWT at the stone site (p 0.036) was a significant predictor of the successful passage of calculus. The UWT cut-off was 2.1 mm with sensitivity and specificity of 83.8% and 62.5%, respectively, with an Area Under Curve (AUC) of 0.7856.

Conclusion: The most significant predictor of successful stone passage in MET of unilateral ureteral stones was maximal UWT, with an optimal cut-off point of 2.1 mm.

Objectives: To assess the efficacy and safety of clean intermittent catheterisation (CIC) in the management of acute urinary retention (AUR) and identify factors those affect the likelihood of recovery of spontaneous urination and the development of adverse events.

Materials and methods: A prospective multicentre comparative randomised study included 129 patients hospitalised in urological hospitals with AUR due to benign prostatic hyperplasia. Patients were randomised into two groups. In group I, the classical tactics of TWOC (drainage of the bladder with a urethral Foley catheter for 3 days) were used, whereas in group II, patients underwent CIC for 3 days. A comparative assessment of the effectiveness of intermittent catheterisation was carried out and compared to the classical tactics of TWOC (trial without catheter/attempt without catheter).

Results: Normal voiding was restored in 25 (35.7%) patients in group I and 26 (44%) patients in group II. The point estimate of the probability of urination recovery on the third day of therapy in group II was 1.5 times higher than that in group I. The difference between these estimates was not statistically significant. In group II, 1 (3.8%) patient recovered spontaneous urination within 1 day, 12 (46.2%) within 2 days, and 13 (50%) by the end of 3 days. On the seventh day, AUR recurred in three (2.3%) patients: two (2.8%) in group I and one (1.7%) in group II. Statistically significant relationships were found between the probability of developing gross haematuria and patient age, as well as between possible urethrorrhagia and a history of AUR, between age and the use of α1-blockers at the time of AUR.

Conclusion: Intermittent catheterisation is an effective treatment for AUR. Its main advantages include the possibility of outpatient management, earlier recovery of spontaneous urination and significantly less severe catheter-associated lower urinary tract symptoms.

Introduction: The most prevalent cancer in men is prostate cancer (PCa). One significant discovery involves attacking tumors with mutations in DNA damage repair genes via the blockage of poly(ADP-ribose) polymerase (PARP) enzymes. In this study, we provide a summary of the present research status of PARP inhibitors in PCa, highlighting areas of interest and emerging trends.

Method: Our search covered the Scopus database for literature on PARP inhibitors in PCa up to the year 2023. We conducted a scientometric review using VOSviewer to evaluate the output across countries, institutions, authors, journals, references, and keywords.

Results: The study included 1850 articles on PARP inhibitors in prostate cancer (PCa) published until 2023, with medicine, biochemistry, and pharmacology being the most represented subject areas. The United States led in publication volume (n = 800, 43.2%), followed by the United Kingdom (n = 281, 15.2%) and China (n = 198, 10.7%), and also achieved the highest total citations and H-index. A positive correlation was identified between publication volume and gross domestic product (GDP; r = 0.843, p < 0.001). Antonarakis, E.S., from the United States, ranked as the most prolific author (49 publications) and achieved the highest H-index, while Mateo, J. was the most cited. The Institute of Cancer Research emerged as the most active institution, publishing 91 articles, and the journal Cancers contributed the highest number with 99 articles. In keyword analysis, "prostate cancer" and "PARP inhibitors" were the most used terms, forming six thematic clusters. Citation and co-citation analysis highlighted the influential role of high-impact journals like New England Journal of Medicine and Journal of Clinical Oncology.

Conclusion: The United States has taken the lead in this sector by making the largest contribution in terms of overall publications. Although international partnerships are occurring globally, there is a need for more assistance and expansion of research on PAPR inhibitors in PCa, particularly in underdeveloped nations. This study offers assistance to medical professionals, scientists, and surgery assistants on the worldwide results of PAPR inhibitors in PCa research.

Telemedicine and telesurgery emerged as transformative innovations in urology. These approaches overcome challenges such as geographic barriers, resource limitations, and increasing demand for specialized care. Telemedicine is applied across the surgical continuum, including preoperative, perioperative, and postoperative phases. Telesurgery during the perioperative phase achieves outcomes comparable to onsite guidance, while postoperative teleconsultations are well-accepted by patients, offering results equivalent to face-to-face visits. Benefits include fewer patient visits, reduced infection risks, enhanced convenience, and economic advantages. The advent of ultrabroadband 5G has significantly expanded telemedicine's scope, enabling real-time remote consultations and advanced telesurgical procedures. Robotic systems such as Toumai, Hinotori, Edge, KangDuo, and Microport Medbot demonstrate promising applications in urological surgery. Despite these advancements, telemedicine faces challenges, including data security, adherence to professional guidelines, and physician adaptability. Legal and ethical issues such as informed consent, patient privacy, licensing, and electronic documentation highlight the need for standardized frameworks. This review analyzes the current state of telemedicine and telesurgery in urology, emphasizing their benefits, challenges, and potential to transform patient care and improve outcomes.

This study aimed to evaluate functional outcomes and anterograde ejaculation rates in patients undergoing monopolar, unilateral transurethral incision of the prostate (TUIP) with "Z" shaped incision with ejaculatory sphincter sparing for primary bladder neck obstruction (PBNO) in a case series performed by a single surgeon. Between December 2018 and July 2023, data from patients who underwent monopolar, unilateral TUIP were prospectively collected. Patients with a prostate volume of less than 30 mL were included. Functional outcomes, including maximum flow rate (Qmax, mL/s), post-void residual volume (PVR, mL), International Prostate Symptom Score (IPSS), and IPSS Quality of Life (IPSS QoL) score, were assessed preoperatively and at 1, 6, and 12 months postoperatively. A total of 106 patients met the inclusion criteria, with a median age of 42 years (range: 37-57) and a median prostate volume of 27 mL (range: 20-29). The median hospital stay was 1 day, and the median catheterization time was 3 days. At 1-month follow-up, the mean Qmax increased from 10.2 ± 2.5 mL/s to 22.8 ± 3.9 mL/s, while the mean IPSS score and IPSS QoL score decreased from 16 ± 2.7 to 6.9 ± 1.5 and from 4.3 ± 0.9 to 1.9 ± 1.6, respectively (p < 0.001). The mean PVR volume decreased from 125.5 ± 16.1 mL to 27.7 ± 7.3 mL (p < 0.001). Uroflowmetry results remained statistically significant at 12 months of follow-up (each p < 0.001). Anterograde ejaculation was preserved in all cases. Unilateral monopolar TUIP confirms to be a feasible and safe procedure for the treatment of BNO in young and sexually active patients.

Background: Retrograde intrarenal surgery (RIRS) has recently made significant breakthroughs, drawing some attention to it as a secondary or alternative method of treating kidney stones.

Objectives: To compare the safety and efficacy of the percutaneous nephrolithotripsy (PCNL) in the prone position vs retrograde intrarenal surgery (RIRS) in surgical treatment of unilateral pelvic renal stones from 1.5 to 3 cm is size in adult obese patients with body mass index ⩾30.

Methods: This prospective randomized comparative study was done at Helwan University Hospital. It was conducted on 120 patients with unilateral pelvic renal stones from 1.5 to 3 cm in largest diameter who was admitted through duration to compare the two procedures' differences in terms of complications, analgesic use, hospital stay, operational time, and stone-free rates.

Results: There was no significant difference between the two groups as regard stone free rate and complications. Stone free rate was 91.1% in PCNL group while it was 84.5% in RIRS group (p-value = 0.314). The mean operative time for PCNL & RIRS groups was 96 ± 28.23 min and 119 ± 14.4 min, respectively (p-value = 0.026). Mean hospital stay was 3.16 ± 0.77 days in PCNL group while it was 1.19 ± 0.69 days in RIRS group (p-value < 0.001).

Conclusion: RIRS can be used as the first option in obese individuals with 1.5 to 3 cm renal stones is based on the satisfactory results attained in the RIRS groups.

Background: Pelvic organ descent is a common gynecological disorder called pelvic organ prolapse (POP). Conservative care and surgical repair are women's primary treatments for pelvic organ prolapse. Modifying risk factors is a crucial keystone to reducing its prevalence.

Methods: This unmatched case-control study was conducted at a Tehran referral hospital (June 15 to September 10, 2020) and involved 287 participants (139 cases, 148 controls). Structured questionnaires gathered socio-demographic, obstetric, health, and lifestyle data. Analyses encompassed univariate and multivariate logistic regression.

Results: Among cases, 69 (49.6%) had anterior prolapse, 46 (33.1%) had posterior prolapse, and 24 (17.3%) experienced complete prolapse. The mean age of participants with POP was 62.7 ± 10.7 years compared to 44.5 ± 12.7 years for controls. Risk factors significantly associated with POP included higher BMI (28.01 ± 4.7 vs 26.18 ± 4.6; p = 0.002), gravidity (4.49 ± 2.89 vs 2.18 ± 1.63; p < 0.001), vaginal deliveries (3.60 ± 2.07 vs 1.03 ± 1.57; p < 0.001), prolonged labor (12.2% vs 2.7%; OR: 4.91, 95% CI: 1.61-14.99), and comorbidities such as diabetes mellitus (30.2% vs 8.8%; OR: 4.49, 95% CI: 2.29-8.83) and hypertension (34.5% vs 6.8%; OR: 7.28, 95% CI: 3.50-15.12). Protective factors included higher education levels and a history of cesarean delivery (mean cesarean count: 0.31 ± 0.72 vs 0.78 ± 0.88; p < 0.001).

Conclusions: This study highlights key risk factors for POP among Iranian women, emphasizing the need for targeted preventive strategies. Public health interventions addressing these factors may reduce the burden of POP in developing regions.

Introduction: Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a common and challenging condition with no consensus on the best treatment. Also, based on a search in reputable scientific databases, it was found that so far, no study has been conducted to evaluate the response to treatment with concomitant use of tamsulosin, levofloxacin, and celecoxib in chronic pelvic pain syndrome in men.

Methods: Ninety six male patients under 40 years of age with chronic pelvic pain syndrome who met the inclusion criteria and exclusion criteria were included in the study. Patients (there was only one group of patients in this study) were treated simultaneously with 3 drugs tamsulosin (0.4 mg), levofloxacin (500 mg), and celecoxib (200 mg) for 1 month and after 1 month of treatment response to treatment (pain relief) according to age factors. Weight, underlying disease, smoking, BMI, prostatitis family history, and education were recorded by the researcher in preprepared data collection forms. The results and information obtained were entered into statistical software and analyzed.

Results: About 42.7% of patients experienced pain relief after treatment. Age, smoking, and family history of prostatitis showed significant relationships with pain reduction. Weight gain decreased the chances of pain reduction (OR = 0.303), while increased BMI (OR = 0.476) and smoking (OR = 0.801) also negatively influenced pain relief.

Conclusions: The results of this study showed that the concomitant use of tamsulosin, levofloxacin and celecoxib in patients with chronic pelvic pain syndrome had acceptable results in reducing the symptoms of patients.

Objective: To compare trends and incidence of surgical intervention among adults with urolithiasis in Ontario, Canada, and Israel.

Patients and methods: A retrospective analysis was conducted using administrative databases from Clalit Health Service in Israel and IC/ES in Canada. The study included adults who underwent their initial surgical treatment for urolithiasis. Descriptive statistics summarized baseline patient demographics, while comparisons were analyzed with a t-test.

Results: Between 2003 and 2018, 31,034 and 105,013 patients who underwent surgical intervention for upper urinary tract stones for the first time in their clinical history, excluding those with prior surgical treatments for the same condition, in Israel and Ontario, respectively. The number of insured at Clalit Health Services increased by 21.3%, while the population in Ontario grew by 18.5%. The total number of treated cases rose by 82% and 64.4% in Israel and Ontario, respectively. The procedures per 100,000 people increased by 51% in Israel and 34.6% in Ontario. In Israel, the proportion of females undergoing surgery decreased from 33.5% to 32%, while in Ontario, it increased from 36.3% to 49.8%. Ureteroscopy (URS) was more commonly used in Ontario, while shock wave lithotripsy (SWL) was more common in Israel. URS utilization surged by 281% in Israel and 145.5% in Ontario. Percutaneous nephrolithotripsy (PCNL) increased by 52% in Israel and 8.6% in Ontario, while SWL procedures declined by 57% in Israel and 32.5% in Ontario.

Conclusions: A significant rise in the number of patients undergoing their first stone-related procedure in both regions, particularly in Israel. There was a difference in the proportion of female patients requiring surgical intervention, with an increase in Ontario and a decrease in Israel.

Many studies reveal the presence of an effect of age, abstinence and seasons on semen parameters, but the number of patients enrolled is small and the presence of therapies unknown. We aimed to evaluate the correlation between abstinence days, age, season, and semen parameters (volume, concentration, progressive motility, total number of sperms, morphology) among men referred to our laboratory. We proceeded with a cross-sectional, observational, exploratory study in an Andrology laboratory. A population of 348 male partners of infertile couples who did not receive any treatment in the 3 months preceding semen analysis was selected. Sperm volume, concentration, total number, progressive motility and morphology of sperms were conducted strictly following the guidelines indicated in the last edition of WHO manual for semen analysis. Pearson's correlation analysis and Kendall's correlation analysis were applied. Sperm concentration, semen volume and sperm total number moderately increased as well as the abstinence, while progressive motility and morphology moderately decreased. Regarding the age, in the 20-35 age group there was a weak inverse association with concentration, total number, motility and morphology and a weak positive association with volume; in the 42-63 age group there was a moderate positive association between age and concentration, motility and morphology, but an inverse association with volume. No correlation emerged between seasonal variations and semen parameters. These results suggested the importance of correct information to patients for proper semen analysis for diagnostic and therapeutic purposes.