Archivio Italiano di Urologia e Andrologia最新文献

Background & objectives: Notably, 17-hydroxy progesterone (17-OHP) (17-OHP) is a precursor for testosterone (T) synthesis, and intratesticular testosterone (ITT) is essential for spermatogenesis. Varicocele (Vx) has an estimated prevalence of 15% in the general population and 35% in those with primary infertility. We aimed to evaluate the correlation between changes of serum 17-OHP after sub-inguinal micro-varicocelectomy and improvement of semen parameters.

Patients and methods: The current prospective study included 45 infertile men attending the andrology clinic form February 2021 to August 2021. Two semen analyses and hormonal profile were evaluated. Colored duplex ultasonography (CDUS) was done in standing and supine position for accurate measurements of testicular volumes and confirmation of Vx. Patients underwent sub-inguinal micro-varicocelectomy using a surgical microscope HB surgitech. We followed them prospectively up for three months following micro-varicocelectomy with serum TT and 17-OHP.

Results: Sperm concentration improved significantly from 8.36 ± 5.04 million/ml to 12.52 ± 8.42 million/ml after 3 months following sub-inguinal micro-varicocelectomy (p= 0.001), with normalization of concentration in 15/45 (33%) patients. Total motility did not improve significantly but progressive motility improved significantly from 8.62 ± 8.74% to 16.24 ± 14.45% (p=0.001). Abnormal forms significantly declined from 96.67 ± 2.03% to 95.75 ± 2.47% (p=0.009).  Serum 17 OHP and 17 OHP/total testosterone (TT) improved significantly from 1.21 ± 0.45 ng/ml and 0.26 ± 0.09 to 1.42 ± 0.76 ng/ml and 0.3 ± 0.16 (p= 0.013, p= 0.004), respectively, while serum TT did not improve significantly. A significant correlation was found between improvement in sperm concentration and both serum 17 OHP and 17 OHP/TT ratio (p=0.001, p=004). Furthermore, change in abnormal sperm forms showed significant correlations with changes in both 17-OHP and 17-OHP/TT.

Conclusion: 17 OHP and 17OHP/ TT ratio can be used as biomarkers to detect improvement in semen parameters following sub-inguinal micro-varicocelectomy.

Introduction: To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution.

Methods: We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates.

Results: In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001).

Conclusions: From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.

Purpose: Radical prostate cancer treatment is the predominant cause of iatrogenic stress urinary incontinence (SUI) in men, significantly impacting their quality of life (QoL). This prospective single-center study in Portugal aimed to evaluate the outcomes of men with moderate-to-severe SUI treated with a single-component artificial urinary sphincter (AUS).

Materials and methods: Male patients with iatrogenic moderate-to-severe SUI, determined by a 24-hour pad weight test, were included. The single-component device comprises a cuff linked to a pump unit through a kink-resistant tube. The implantation involved perineal incision for cuff placement and an inguinal incision for pump and tank positioning within the scrotum. Complications, pad usage, perioperative complications (Clavien-Dindo classification), and quality of life assessment using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire were documented.

Results: Between May 2021 and March 2023, 20 consecutive single-component AUS insertions were conducted at a Portuguese urology department. Follow-up concluded in July 2023, with a mean follow-up duration of 15 months (range: 5-27). Four patients experienced complications necessitating device revision or removal (erosion = 2, infection = 1, mechanical failure = 1). Social continence (0/1 pad/day) was achieved in 70% (14/20 patients), while 30% (6/20 patients) experienced incontinence. Perioperatively, one patient was classified as grade 2, while the remaining were grade 0/1 in the Clavien-Dindo classification. The mean ICIQ-SF score reduction was 10.5 points.

Conclusions: The single-component AUS shows promising efficacy in managing moderate-to-severe male SUI, offering a good success rate, acceptable complications, improved QoL, and a straightforward surgical procedure.

Background: The increased hypertonicity or activity of pelvic floor muscles can lead to chronic pelvic pain (CPP). It represents an aspecific and persistent pain with no apparent clinical reason, affecting an estimated 6% to 16% of women worldwide. This study aimed to evaluate with validated questionnaires the efficacy and the safeness of a new device that uses Top flat Magnetic Stimulation for the management of muscular hypertonia in women with CCP.

Methods: All patients underwent 8 treatments with a non-invasive electromagnetic therapeutic device. The device produces a TOP Flat Magnetic Stimulation with a uniform profile so, the muscle work aims to reduce pain while also inhibiting muscle activity. The PISQ-12 questionnaire was used for the evaluation of improvements. Side effects were monitored.

Results: The PISQ-12 total mean score decreases from 29,2 (±3.3) to 17 (±2). Regarding the behavioural-emotive items (1-4), a decrease from 12 (±2) to 7 (±0.9) was visible. Physical items (5-9) decrease from 10,6 (±1.8) to 6 (±1.4) and the Partner Related items (10-12) from 6,6 (±1.6) to 3,9 (±0.4).  Conclusions: The device we used in this research demonstrated to be a valid solution for the treatment of chronic pelvic pain in female patients.

Purpose: To build, train, and assess the artificial neural network (ANN) system in estimating the residual valve rate after endoscopic valve ablation and compare the data obtained with conventional analysis.

Methods: In a retrospective cross-sectional study between June 2010 and December 2020, 144 children with a history of posterior urethral valve (PUV) who underwent endoscopic valve ablation were enrolled in the study. MATLAB software was used to design and train the network in a feed-forward backpropagation error adjustment scheme. Preoperative and postoperative data from 101 patients (70%) (training set) were utilized to assess the impact and relative significance of the necessity for repeated ablation. The validated suitably trained ANN was used to predict repeated ablation in the next 33 patients (22.9%) (test set) whose preoperative data were serially input into the system. To assess system accuracy in forecasting the requirement for repeat ablation, projected values were compared to actual outcomes. The likelihood of predicting the residual valve was calculated using a three-layered backpropagating deep ANN using preoperative and postoperative information.

Results: Of 144 operated cases, 33 (22.9%) had residual valves and needs to repeated ablation. The ANN accuracy, sensitivity, and specificity for predicting the residual valve were 90.75%, 92.73%, and 73.19%, respectively. Younger age at surgery, hyperechogenicity of the renal parenchyma, presence of vesicoureteral reflux (VUR), and grade of reflux before surgery were among the most significant characteristics that affected postoperative outcome variables, the need for repeated ablation, and were given the highest relative weight by the ANN system.  Conclusions: The ANN is an integrated data-gathering tool for analyzing and finding relationships among variables as a complex non-linear statistical model. The results indicate that ANN is a valuable tool for outcome prediction of the residual valve after endoscopic valve ablation in patients with PUV.

Introduction: The aim of our study was to treat 2 similar groups of patients suffering from BPH: one group with a complex based on phycocyanin, PEA and selenium; the other group with dutasteride. So the effectiveness of these treatments was checked, especially regarding the improvement of LUTS and the reduction of PSA and prostate volume.

Materials and methods: We included 104 patients in the study. All patients aged between 50 and 70 years, PSA values between 4 and 10 ng/ml, prostate volume calculated by transrectal ultrasound between 50 and 70 cc, flowmetry with maximum flow value greater than or equal to 10 ml/s, no suspicious nodules on DRE, no suspicious lesions on MRI (PI-RADS 1-2), negative previous prostatic biopsies or never bioptied, moreover absence of diabetes mellitus or chronic renal failure (blood creatinine >2 mg/dl). We considered: -Group A of 54 men who used the complex; -Group B of 50 patients treated with dutasteride. Then we controlled all patients 6 months after starting therapy, considering the following parameters: PSA, prostate volume, flowmetry.

Results: Our results showed that both dutasteride and complex decreased PSA levels (both had a p<0.0001), with a more significant contribution of dutasteride (mean decrease of -2.743 ng/ml vs -0.971 ng/ml). Uroflowmetry also improved with both ( p<0.0001) with a mean increase in maximum flow of urine of + 3.03 ml/min for the former and + 13.02 ml/min for the latter. Lastly, dutasteride proved to be highly effective on reducing the prostate volume on TRUS (- 22.14 ml, p<0.0001) compared to Ficoxpea, which showed a mean decrease of - 10.04 ml (p<0.0001). Moreover the consistent reduction in prostate volume obtained through the use of dutasteride proved to be more intense than the one obtained by using the complex even in statistical analysis (p<0.0001).

Conclusions: Both Ficoxpea and Dutasteride showed reduction of PSA values after 6 months of treatment. The complex based on phycocyanin, PEA and selenium showed a statistically significant improvement in urinary flow, while dutasteride acts more on the volume of the prostate. However, the natural complex is a product with good efficacy on the phlogistic component and does not have the side effects of dutasteride (e.g. gynecomastia, reduced libido). Therefore, we believe it can be used by a large part of the population, in order to reduce LUTS and PSA and improve urinary flow, without side effects.

Introduction: Renal colic is the most common non-obstetric cause of abdominal pain during pregnancy and is associated with a higher risk of complications in these women. When invasive treatment is required, options are temporary drainage with ureteral stent (JJ) or percutaneous nephrostomy (PCN), or immediate definitive treatment with ureteroscopy (URS). Our goal was to review the safety and efficacy of these procedures in treating urolithiasis during pregnancy.

Methods: Adhering to the PRISMA checklist guidelines, we searched PubMed, Embase, and Scopus databases for articles on the efficacy and complications of the three procedures in pregnant women. The quality of evidence and risk of bias were evaluated using the Critical Appraisal Skills Programme and the Institute of Health Economics tools.

Results: We included 45 articles, totaling 3424 interventions in pregnant women - 2188 URS, 719 JJ, and 517 PCN. URS was the most assessed procedure, with stone-free rates comparable to the non-pregnant patients. The most frequent complications were lower urinary symptoms and infections independently of the intervention. Obstetric complications for all interventions included 167 cases of preterm labor, resulting in 24 premature births. No statistically significant differences in post-operative complications were reported between the procedures in the few comparative studies.

Conclusions: Despite the absence of high-quality studies, current evidence suggests that URS, JJ, and PCN are all safe and effective during pregnancy. As most patients submitted to temporary drainage require a second procedure post-delivery, primary URS appears more efficient. Therefore, it is the preferred option unless there are indications for temporary drainage.

Background: The actual prognostic impact of prior lupus nephritis (LN) diagnosis on end-stage kidney disease (ESKD) patients remains questionable, especially in relation to outcomes of kidney transplantation (KTx) We aim to determine the survival of the graft and recipient after the KTx procedure among patients with ESKD due to LN in comparison to non-LN.

Methods: This meta-analysis included retrospective studies from the last two decades, focusing on the KTx's outcomes among ESKD due to LN in comparison to non-LN. We establish the graft/recipient survival rate at different follow-up intervals as the primary outcome, and acute graft rejection and pooled graft failure rate as secondary outcomes. All analyses were performed with the random-effect model (REM) and were presented as odd ratio (OR; within 95% confidence interval (CI)). The protocol of this study was registered in PROSPERO: CRD42023394310.

Results: A total of 1,299 KTx (368 LN patients) from 10 studies with >10 years of follow-up were thoroughly reviewed. All checkpoints (at 1-, 5-, 10, and 15-year post-KTx) on graft survival rate demonstrated comparable outcomes in either LN or non-LN (e.g., at 10-year follow up (OR, 1.08 [0.40, 2.91]; p = 0.88). Similar findings at all checkpoints for recipient survival rate were also observed without statistically significant difference between LN and non-LN arm (e.g., at 10-year checkpoint; OR, 0.99 [0.68, 1.46]; p = 0.98). Both of our secondary analyses also presented insignificant differences (p = 0.70 and = 0.16, respectively).

Conclusions: Our findings suggested that prognosis of ESKD due to complicated LN is equal compared to ESKD associated with non-LN etiologies, suggesting the impact of LN as the inducing cause of ESKD on KTx outcome is relatively neglectable.

Background: Modifying the maternal immune system is necessary to facilitate embryo implantation. Modifying the immune system can occur in several ways, including maternal exposure to the partner's seminal plasma. Seminal plasma exposure can occur through sexual intercourse. To prove this theory, we investigate the effect of sexual intercourse on the chances of successful in vitro fertilization (IVF) in both fresh and frozen embryo transfer (ET) groups in terms of biochemical and clinical pregnancy.

Methods: This is an observational analytical study with a retrospective cohort study design. This study compared biochemical and clinical pregnancy in patient groups who had sexual intercourse with those who did not have sexual intercourse during the IVF process. This study involved 132 participants.

Results: The results of this study reported that there was no significant difference in pregnancy rates between patients who had sex before ET and those who did not have sex before ET. However, patients who experience orgasm during sex show significant rates of biochemical (p = 0.009) and clinical pregnancy (p = 0.027) rates.

Conclusions: Sexual intercourse did not show a significant difference between the groups who had sex before ET and those who did not have sex, but the experience of orgasm every time they had sex recently had a positive impact on reproductive health, especially pregnancy.

Purpose: To determine the effect of electromagnetic waves of mobile phone stations on several sperm parameters and the male reproductive system.

Methods: This observational study was performed on 216 subjects, aged 18-60 years. Two equal groups of subjects were assigned to group A (study group) if they were living close to cell phone tower stations for at least 6 months and group B (control group) formed from individuals living 100 meters away from cell phone tower stations. Every subject underwent a comprehensive history taking, a clinical assessment, and laboratory testing.

Results: Regarding morphology index in the studied groups, the exposed group exhibited a trend of reduced percentage of normal morphology compared to the non-exposed group, with no statistical difference between the two groups. Regarding the total sperm motility (A+B+C) and progressive sperm motility (A+B) in the studied groups, the exposed group showed a trend of decreased total sperm motility and of progressive sperm motility in contrast to the non-exposed group, with no statistical difference between the two groups.

Conclusions: Personal wrong lifestyles with exposure to electromagnetic waves have shown a trend towards a reduced percentage of normal morphology and reduced motility although nonstatistically significant compared with non-exposed populations.