Archivio Italiano di Urologia e Andrologia最新文献

Background: Double J Stent is one of the procedures frequently performed in the field of urology. Forgotten DJ Stent is a problem that can cause serious complications. This systematic review aims to explore complications and management of patients with forgotten double J stents.

Methods: Scientific literature was obtained from PubMed, ScienceDirect, and Google Scholar with a publication year limited to 2013-2023. The search string included 'forgotten DJ stent, case report, complication'. Inclusion criteria were as follows: (1) case report or series, (2) available individual patient data, and (3) English language. Data are presented descriptively.

Results: Of the 210 records, 14 articles published were analyzed after the full-text assessment. Forgotten DJ stent sufferers vary from age 7 years to 88 years. Male gender was predominant. The initial symptoms were flank pain and micturition disorders. The complications experienced were encrustation, multiple stones formation, emphysematous pyelonephritis, emphysematous perinephric abscess, fragmentation, and vesical calculus. In management, it was found that procedures were selected according to patient's situation at that time and the condition of the stent. There are case reports that report management that differed from those initially planned. All the patients were alive after treatment.

Conclusions: A forgotten DJ stent can have serious consequences. The management approach requires a combination of various endourological procedures. In consideration of potential complications, urologists need to be careful in making decisions about the choice of technique used.

Background/objectives: Bladder cancer is a multifactorial disease, ranking as the 10th most common cancer globally and the fourth most common cancer in men and the ninth in women in the Western world. This bibliometric analysis aims to identify and evaluate scientific literature addressing new biomarkers for bladder cancer diagnosis, as well as to identify the most prolific organizations, authors, journals, countries, and keywords within this research domain.

Methods: An electronic search was conducted using Elsevier's Scopus database. From a total of 940 retrieved papers (published between 2019 and 2024), 493 were selected. For data analysis and visualization, the titles of articles, year of publication, countries, authors, journals, articles, and keywords were analyzed using Microsoft Excel, VOSviewer, and Biblioshiny.

Results: China published the most papers (200 articles) and received the highest number of citations, followed by the USA. While some countries, such as Egypt and India, published exclusively Single Country Publications (SCPs), others demonstrated a higher level of international collaboration, with at least half of their publications being Multi-Country Publications (MCPs). Countries with higher rates of MCPs were Greece (66.6%), Italy (53.8%), Korea, and France (50%). The journals that produced the most publications and received the highest number of citations were Cancers, International Journal of Molecular Sciences, and Frontiers in Oncology, confirming their role in producing high-impact research.

Conclusions: The consistent distribution of publications over the years considered indicates a sustained interest in this field.

Introduction: Excision and primary anastomosis (EPA) urethroplasty is the standard treatment for traumatic urethral strictures, but managing them remains challenging for urologists. Identifying factors leading to EPA urethroplasty failure benefits both patients and surgeons. This study aims to analyze risk factors for urethral stricture recurrence after one-year follow-up of EPA urethroplasty.

Materials and methods: Data on male patients undergoing EPA urethroplasty at the Urology Department of Saiful Anwar General Hospital from January 2013 until December 2023 were prospectively recorded. Successful urethroplasty, defined as the absence of additional treatment necessity, was assessed until 12 months follow-up. Demographic data, time to surgery, stricture etiology, comorbidities, prior urethral interventions, and operation steps were recorded. Univariate and multivariate Cox regression analyses were performed using IBM SPSS Statistics version 21.

Result: Total 95 patients were observed, and 89 patients were included, averaging 41.2 ± 15.59 years old. EPA urethroplasty succeeded in 91% of cases over a median follow-up of 16.3 months. Pelvic fracture urethral injury (PFUI) was the predominant etiology in 74% of cases, with an average stricture length of 25.4 ± 16.3 mm. The average time to surgery was performed on average 6.67 ± 4.07 months after diagnosis. In univariate analysis, body mass index (BMI), time to surgery, and stricture length were associated with urethral stricture recurrence. However, only time to surgery showed a significant association in multivariate analysis.

Conclusions: Obesity, the length of the stricture, and delayed surgical intervention are associated with an increased risk of urethral stricture recurrence in patients following EPA. EPA urethroplasty demonstrates a high success rate in managing traumatic urethral strictures.

Introduction: Even today, despite technological evolution, erectile dysfunction remains the most feared complication after radical prostatectomy surgery expecially for patients who report pre-existent refractory erectile dysfunction (ED) and patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3, who undergo non-nerve sparing radical prostatectomy (RP). To overcome this issue, Khoudary et al. performed the first simultaneous placement of a penile prosthesis during open RP in 1997, aiming at an early return to sexual function without any impact on oncological outcomes and without significant adverse effects. Ten years ago we performed laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) on ten patients in order to preserve the full length of the penis and to improve their satisfaction and quality of life (QoL) increasing the chances of ED resolution.

Objectives: Aim of this study is to illustrate the ten years follow up of this case series which has no terms of comparison in the world. Oncological and functional results were analyzed.

Materials and methods: In 2013 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis). Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each year thereafter. The main outcome measures were biochemical recurrence-free rate, penile length and quality of life.

Results: Eight patients with mean age 71 (range 66-75) were reached at the 10-year follow-up; one patient died of acute infarction 10 years after surgery and another one died of disease 7 years after surgery. Partners had, currently, mean age 60 (range 37-71). Mean preoperative PSA was 9.3 (6.3-13.7) and mean PSA at 10 years was 0.08 (range 0.01-1.2). International index erectile function IIEF before surgery was 11 (range 9-14) and 23 (range 22-25) at 10 years. Partner satisfaction rating increased from 7 (post-surgical) to 8 at 10 years. Penis length was unchanged after 10 years: mean intraoperative length was 9 cm (range 8.5-9.5) and mean length at 10 years was 8.8 cm (range 8-9.5).

Conclusions: In our cases, laparoscopic radical prostatectomy with the simultaneous implant of a penile prosthesis demonstrate to be an interesting option to offer to selected and highly motivated patients. Outcomes like preservation of the penis length, resuming of normal sexual activity 21 days after surgery, partner satisfaction and oncological safety at 10-year follow-up make it a valid surgical technique to be proposed in clinical practice if performed by an experienced team in prosthetic surgery.

Objective: Lactylation is a type of chemical modification involving the introduction of lactyl groups to a molecule which can affect the interactions between tumor cells and their microenvironment. This study aims to evaluate the possible role of lactylation-related gene signature in the prediction of both prognosis and immunotherapy response in bladder cancer (BLCA).

Methods: Lactylation-related genes were obtained from the published work and two subtypes (cluster A and B) were identified through unsupervised clustering. The differences including clinical features, differentially expressed genes (DEGs), pathways, and immune cell infiltration between these two clusters were thoroughly examined.

Results: By utilizing the DEGs between the two clusters, a lactylation score was identified to predict the overall survival status and the response of BLCA patients receiving immunotherapy. Our results demonstrated that patients with a high lactylation score tended to have a worse survival period and increased immune cell infiltration level. Further analysis showed that high lactylation score may be associated with higher sensitivity to immune checkpoint inhibitor (ICI) treatment which is crucial in the identification of the suitable candidates for ICI therapy.

Conclusions: Our results emphasize the possible predictive role of lactylation-related gene signature both in the survival rates of BLCA and its implications for treatment strategies.

Introduction: Hypospadias is a congenital abnormality of the urethral meatus in males. Hypospadias can be corrected by two-stage urethroplasty. Hyperbaric oxygen therapy (HBOT) can accelerate wound healing after surgery by increasing oxygenation, angiogenesis, and collagen synthesis. This study aimed to measure the effectivity of HBOT based on serum vascular endothelial growth factor (VEGF) level and Hypospadias Objective Penile Evaluation (HOPE) score in hypospadias reconstruction patients.

Methods: This was a randomized controlled trial study. Hypospadias reconstruction was performed using the Sidik-Chaula and Manset Flap techniques. Each HBOT session ranged from 30-60 minutes, administered at 1-3 atm. Twenty subjects were divided into two groups: the HBOT and control groups. VEGF serum levels were measured 1 hour after the operation and 1 hour after every HBOT session. The HOPE score was assessed at the bedside by the attending physician, consisting of six items: the position of the meatus, the shape of the meatus, the shape of the glans, the shape of the penile skin, and the shape of the penile axis, including penile torsion and penile curvature. The data were analyzed with SPSS version 28, using the Shapiro-Wilk and independent t-test methods.

Results: There was a trend of increasing VEGF levels as the number of HBOT sessions increased, with significant increase found in patients who underwent three (p=0.038), four (p=0.002), and five (p=0.008) HBOT sessions. We found a significant increase in the total HOPE score (p=0.028) and penile torsion score (p=0.006) in the HBOT group.

Conclusions: HBOT can accelerate wound healing after urethroplasty. Three or more HBOT sessions are recommended after the repair of hypospadias.

Aim: To determine the effects of oral antibiotics and anti-inflammatory agents on semen parameters and the sperm DNA fragmentation index (DFI).

Methods: Ninety-eight men with infertility diagnosis were included. The participants submitted two semen samples, before and at least two months after treatment. Macroscopic and microscopic semen parameters were evaluated following the World Health Organization (WHO) guidelines. In addition, the sperm DFI was evaluated using the sperm chromatin dispersion (SCD) technique. Subsequently, a treatment regimen was administered, including daily oral doses of ciprofloxacin (1000 mg) and doxycycline (100 mg) for 21 and 10 days, respectively. In addition, non-steroidal anti-inflammatory drugs (15 mg of meloxicam) were used for 10 days. After treatment, the same parameters were re-evaluated for new semen samples taken under the same initial conditions.

Results: After treatment, significant increases in pH, sperm count, total concentration, and normal sperm morphology were observed, but no significant differences were found in the seminal volume parameter or progressive motility. After treatment, a significant decrease in the concentration of immature cells was observed, and although not statistically significant, a reduction in the concentration of leucocytes was observed. After treatment, the mean sperm DFI significantly decreased from 28.24± 2.39% to 16.2±7.1%.

Conclusions: Treatment with antibiotics and anti-inflammatories significantly reduced the sperm DFI and improved semen quality.

In the Archivio Italiano di Urologia e Andrologia, Zeki Bayraktar presented the results of a review of all published research on the quality of life, satisfaction, patient-reported outcomes, and short- and long-term problems of patients who had gender-affirming surgery (GAS)...

Introduction and objectives: N-acetyl-cysteine (NAC) is one of the oldest and most powerful antioxidants used to treat various diseases. It plays an important role in protecting cells against oxidative damage and has the potential to improve seminal parameters in male with infertility. This systematic review and meta-analysis aim to comprehensively evaluate the efficacy and safety profile of antioxidant supplementation with NAC in male with infertility or impaired semen parameters.

Materials and methods: This systematic review and meta-analysis adhered to Cochrane Handbook guidelines. A literature search across PubMed, ScienceDirect, Cochrane Library and Scopus on February 21, 2024 of studies evaluating NAC supplementation for male infertility or impaired semen parameters was conducted. Study quality was assessed using Revised Cochrane's risk of bias (RoB 2.0) and RevMan 5.4 was used for meta-analysis.

Results: Search yielded 1.106 articles and 5 studies were included in this meta-analysis. Our study showed that patients who received NAC had statistically significant results in improving sperm volume [MD: 0.69 (0.26-1.12), P = 0.002], sperm concentration [MD: 4.43 1.50-7.36), P = 0.003], sperm total motility [MD: 9.69 (6.61-12.77), P < 0.00001], and normal sperm morphology [MD: 1.36 (0.70-2.03), P < 0.0001] compared to control. Additionally, patients given NAC had no reported side effects based on our included studies.

Conclusions: We found NAC supplementation significantly improves seminal parameters and has a favorable safety profile. These findings highlight the potential role of NAC as a safe supplementation for male with infertility or in male with impaired semen parameters.

Introduction and objectives: Being the most common disease in aged men, the etiology of benign prostatic hyperplasia (BPH) is not fully defined. Recent studies have reported that the association between BPH and metabolic genes is still inconsistent. A gene connected with BPH is SRD5AR2, whose polymorphisms, A49T and V89L, have distinct enzyme activity. This systematic review examines SRD5AR2 polymorphisms within two alleles (A49T and V89L), assessing their roles as prognostic indicators of malignancy, and response to medication.

Materials and methods: We conducted a search on six different databases, including PubMed, Scopus, Wiley, ProQuest, Cochrane Central, and Science Direct using as string of keywords (BPH) AND [(rs523349) OR (V89L)] AND [(rs9282858) OR (A49T)]. We finally selected seven articles to be extracted. Quality appraisal of clinical trials was evaluated using the Joanna Briggs Institute Approach for systematic reviews.

Results: We sorted nine clinical studies from various countries examining SRDA52 polymorphism and its association of BPH and prostate cancer. About V89L we found that the "LL" genotype, indicating reduced 5α-reductase activity, is linked to a lower BPH risk, while the "VV" genotype may slightly increase BPH risk. About A49T, compared to "AA" genotype, "AT" tends to be associated to higher risk in developing prostate cancer. A49T polymorphism does not show any effect on medical treatment while V89L showed a protective effect on the clinical progression of BPH when treated with 5a-reductase inhibitors, aadrenergic receptor antagonists, and alpha blockers.

Conclusions: SRD5A2 polymorphisms could be a good indicator for prognostic malignancy and a potential tool for personalized medicine of BPH. The findings strongly support the recommendation for further study about SRD5AR2 to enhance its use for screening and prevention and to optimize the medical treatment of BPH.