Archivio Italiano di Urologia e Andrologia最新文献

Introduction: Mycoplasma genitalium and Mycoplasma hominis are urogenital mycoplasmas associated with urethritis, prostatitis, epididymitis, and pelvic inflammatory disease. In the last decade, acquired resistance to macrolides and fluoroquinolones in M. genitalium, together with intrinsic and acquired resistance to tetracyclines in M. hominis, have emerged as growing challenges in urology and sexual medicine.

Material and methods: A systematic review was conducted following the PRISMA guideline, searching PubMed, Scopus, and Web of Science (2015-2025). Clinical, epidemiological, and molecular studies describing genetic resistance mechanisms, as well as meta-analyses and clinical guidelines, were included. After applying inclusion and exclusion criteria, 42 articles were selected.

Results: In M. genitalium, macrolide resistance is associated with mutations in 23S rRNA (A2058G, A2059G), while fluoroquinolone resistance is linked to variants in parC and gyrA (S83I, D87N). In M. hominis, intrinsic macrolide resistance is complemented by the presence of tet(M), which contributes to doxycycline treatment failures. Globally, macrolide resistance in M. genitalium reaches 30-50% in Europe and the Americas, and over 60% in Asia; dual macrolide-fluoroquinolone resistance is emerging, with epidemic foci in Japan and China. In M. hominis, tetracycline resistance ranges from 10-30%, with regional variability.

Conclusions: Antimicrobial resistance in M. genitalium and M. hominis limits the effectiveness of traditional empirical therapies and requires the implementation of molecular detection and resistance testing. Resistance-guided treatment and epidemiological surveillance are essential to optimize clinical management and curb the spread of multidrug-resistant strains.

Background: The most frequent complication in subjects of a radical prostatectomy (RP) is represented by urinary incontinence (UI), which can arise following the destruction of the pelvic floor muscles.

Objectives: The aim of this retrospective analysis was to assess the effect of Flat Magnetic Stimulation (FMS) in treating male stress urine incontinence (SUI) following RP.

Materials and methods: A total of 40 patients affected by SUI after RP, with a mean age of 56.8 (± 5.7) years old, underwent eight sessions with FMS. The Incontinence Impact Questionnaire-Short Form (IIQ-7) was administered from baseline up to 3 months of follow-up (3MFU) after the last treatment session. All possible adverse events were retrospective analysed.

Results: The analysis demonstrates that the scores for each individual questionnaire item decreased from baseline up to 3MFU after the last treatment session, leading to a significant (p < 0.05) reduction in the total IIQ-7 median score from 71.35 (66.6-76.11) at baseline to 28.54 (38.05-23.78) at 3MFU after the last treatment session. No adverse events were recorded over the whole course of treatment.  Conclusions: Our findings reveal that this technology may serve as a convenient and alternative treatment option for stress-caused urinary incontinence following RP.

Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections, with Escherichia coli as the leading cause. Increasing antimicrobial resistance has reduced the effectiveness of standard empirical treatments, making continuous monitoring essential. This study evaluated the bacterial causes of community-acquired UTIs and their resistance patterns to commonlyused antibiotics.

Methods: A descriptive cross-sectional study was conducted from November 2023 to July 2025 on patients presenting with symptoms of community-acquired UTI. Demographic and clinical data were collected with a structured form, and urine samples were subjected to culture and antimicrobial susceptibility testing. Patients with recent hospitalization, urinary procedures, catheterization, anatomical abnormalities, or pregnancy were excluded. Data were analyzed using SPSS v22, applying descriptive and comparative statistics with significance set at p<0.05.

Results: Among 453 patients, 509 culture-positive samples were identified; 82% were female. Gram-negative organisms dominated (69.2%), with E. coli as the most frequent pathogen (44.4%). High resistance rates were observed to ampicillin, trimethoprim, and nalidixic acid. In contrast, carbapenem resistance remained low, and nitrofurantoin retained good activity. Staphylococcus haemolyticus showed the highest overall resistance burden. Older age, male sex, and comorbidities such as diabetes, renal insufficiency, and hypertension were significantly associated with increased antimicrobial resistance.

Conclusions: Community-acquired UTI pathogens in Sulaimani  showed high resistance to widely used oral antibiotics, while carbapenems and nitrofurantoin remained effective. Higher resistance was especially noted among older adults, men, and patients with diabetes or renal disease. These findings highlight the need for improved empirical therapy and ongoing resistance surveillance.

Background: Peyronie's disease (PD) impacts the penile albuginea, leading to deformity, pain, erectile dysfunction (ED), and an anxious-depressive state. Diagnosis of PD involves taking a detailed medical history; examining the penis by palpation; documenting any deformities; performing a dynamic Doppler ultrasound; and administering questionnaires to assess pain, erectile dysfunction (ED), and the patient's psychological status. The aim of this study was to assess the symptoms of PD and their prevalence among patients in the active phase who were seen at our andrology clinic.

Methods: The inclusion criteria were: data must be available for patients diagnosed with active PD, including a comprehensive medical history, blood test results, penile examination information, photographic evidence of the deformity, color Doppler penile ultrasound, and completed questionnaires, including visual analog scale (VAS) for pain assessment, International Index of Erectile Function (IIEF) for assessing erectile function, and psychometric test.

Exclusion criteria: Patients with PD who are in a stable phase or not having data requested for inclusion.  Results: We detected penile curvature in 90.5%, penile pain in 54%; ED in 39.3%, significative anxiety in 89.0%, significative depression in 57.6%, and bother in 93.6%.

Conclusions: Our study revealed that a large number of patients with PD experience significant levels of anxiety and depression, with 38.3% of them experiencing severe anxiety. Psychotherapy should be included as part of the treatment plan for patients with PD to enhance their quality of life and adherence to treatment.

Objective: To present our experience in the management of penile cancer (PC) in the context of a country with limited resources.

Materials and methods: This was a cross-sectional study with retrospective data collection and descriptive aim. It was conducted over a 20-year period from 1 January 2005 to 31 December 2024.

Results: The frequency was 1.05 cases per year. The mean age of the patients was 60.23±13.10 years. A proportion of 76.19% (n=16) of patients were uncircumcised. One patient was HIV positive. Ulceration of the penis was the main reason for consultation (88.23%). The average time to consultation was 11.7±11.37 months. Phimosis was observed in 2 patients. The histological type found was squamous cell carcinoma in all cases. Stage cT3 was the most common (71.42%), followed by stage cT4 in 28.58%. Twelve patients underwent surgical treatment. Total penectomy was performed in 5 patients, partial penectomy in 6 patients and emasculation in one patient. Node dissection was performed in 3 patients. The one-year survival rate was 83.33%.

Conclusions: Penile cancer is rare and consultations are made at advanced stages. Awareness of the population on risk factors remains essential for early diagnosis and prevention.

Introduction: The need for varicocelectomy for varicoceles complicated by nonobstructive azoospermia (NOA) has long been debated in the field of male infertility. In this study, we analyzed the clinical outcomes of varicocelectomies for varicoceles in patients with NOA.

Methods: We retrospectively reviewed the following data of 11 patients with NOA and varicoceles who underwent varicocelectomies: age at admission, right and left testicular volumes, operative varicocele grades, operative site, body mass index, endocrine and genetic examination results, number of semen analyses before and after varicocelectomy, sperm appearance rate in ejaculated semen after varicocelectomy, sperm retrieval rate (SRR) with microdissection testicular sperm extraction (MD-TESE), and histopathological analysis results of testicular tissue.

Results: Varicocelectomies were performed bilaterally and on the left side in 1 and 10 patients, respectively. The number of pre- and postoperative semen analyses was 1-3 and 1-7, respectively. Ejaculated semen analysis after varicocelectomy did not reveal sperm in any patient. Ten patients underwent MD-TESE; however, sperm was retrieved from only two patients (20%). Pathological examination of seminiferous tubular tissue collected by MD-TESE revealed hyalinization in one patient, Sertoli cells in eight, and hypospermatogenesis in two.

Conclusions: Sperm could not be retrieved from the ejaculated semen of patients with NOA and varicoceles who underwent varicocelectomies, and the SRR of MD-TESE was suboptimal. These results suggest that varicocelectomy should be performed cautiously in patients with NOA.

Introduction: Genital self-mutilation is an infrequent uro-psychiatric emergency in urological practice. Many authors have emphasized its rarity in the literature. In Burkina Faso, the incidence and prevalence are poorly due to under-notification and the absence of large-scale studies. We proposed this multicenter study to determine the epidemiological, diagnostic, therapeutic and evolutionary aspects of male external genitalia (MEG) self-mutilation in Burkina Faso.

Materials and methods: A retrospective multicenter study was conducted, including all patients treated for male external genitalia self-mutilation in 03 referral university hospital centers in Burkina Faso from January 1, 2018 to December 31, 2024. Penile and testicular injuries were classified according to the American Association for the Surgery of Trauma (AAST) classification.

Results: We collected 13 cases of MEG self-mutilation. The average age was 29.54 years with extremes of 18 and 62 years. All our patients were single and had a low socioeconomic standard of living. All the patients had psychiatric history. Lesion assessment revealed 3 cases of penis strangulation by metal ring, 6 cases of isolated penile section, 3 cases of testicular section + penile section and one case of isolated testicular section. AAST I penile lesions were trimmed with haemostasis and simple skin suture. Urethrostomies and stump regularizations dominated the procedures performed in cases of AAST V penile section. We noted a single penile reimplantation without magnifying glasses in a case of near-complete penile section of the penis AAST IV. Postoperative follow-up was straightforward in 12 cases and complicated by necrosis of the reimplanted segment in 1 case. Sequelae were unsightly and functional in cases of AAST IV and V section.

Conclusions: Self-mutilation lesions in MEG are varied, and their management have benefited from the contribution of microsurgery in developed countries. It remains problematic in developing countries.

Introduction: Systemic oxidative stress refers to a condition that arises when the production of oxygen-derived free radicals exceeds the capacity of the body's antioxidant defense mechanisms to neutralize them. In recent years, dynamic thiol/disulfide homeostasis has emerged as a sensitive and reversible indicator of oxidative stress. Under oxidative conditions, free thiol groups are converted into disulfide bonds and subsequently reduced back to thiols, reflecting the organism's redox status and antioxidant capacity. Therefore, thiol/disulfide homeostasis parameters are utilized to objectively assess the biochemical effects of surgical stress. In this study, we aimed to compare the effects of two commonly used procedures - percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) - on systemic oxidative stress.

Materials and methods: Eighty patients with renal stones measuring 2-3 cm were prospectively assigned to undergo either PCNL (n=40) or RIRS (n=40). Serum levels of total thiol, free thiol (SH), and disulfide (SS) were measured before and after surgery, and the ratios, SS/total thiol, SS/SH and SH/total thiol were calculated.

Results: No significant differences were observed between the groups in demographic characteristics, stone-free rates, procedure times, or complication frequencies (p>0.05). Postoperatively, both total thiol and SH levels decreased significantly, while SS levels and related ratios increased significantly (p<0.05). However, the magnitude of these changes did not differ between PCNL and RIRS (p>0.05). Patients who experienced complications had significantly lower postoperative thiol levels than those without complications (p<0.05).

Conclusions: Despite their different levels of invasiveness, both techniques elicited comparable systemic oxidative stress responses. These findings suggest that dynamic thiol/disulfide homeostasis parameters may serve as reliable biomarkers for monitoring surgery-induced oxidative stress and predicting postoperative complications.

Background: Ovarian cancer is one of the most lethal malignancies affecting women, often diagnosed at advanced stages. Bevacizumab, a novel therapeutic agent, has recently demonstrated efficacy in the management of this disease. However, its use has been associated with various adverse effects reported in clinical trials. This systematic review and meta-analysis aimed to provide a comprehensive evaluation of urinary complications linked to bevacizumab therapy in ovarian cancer patients.

Methods: This systematic review and meta-analysis involved a comprehensive search of databases such as PubMed, Scopus, Embase, Cochrane Library, Web of Science, and Google Scholar, covering studies up to October 2024. Eligible studies were randomized controlled trials (RCTs) that compared ovarian cancer patients undergoing bevacizumab treatment with those receiving other therapeutic options. The primary outcome was the relative risk (RR) of developing urinary complications, categorized based on disease grade and stage.

Results: A total of 11 interventional studies were ultimately included in the analysis. The relative risk (RR) of urinary complications in patients receiving bevacizumab in combination with chemotherapy, compared to the control group treated with chemotherapy without bevacizumab, was significantly elevated for key adverse events. The overall risk of complications, regardless of type, was 1.76 times higher (RR = 1.76, 95% CI: 1.18-2.61, p=0.005). Specific adverse events included a 6.13- fold increase in the risk of proteinuria (RR = 6.13, 95% CI: 2.84-13.25, p<0.001), a 5.03-fold increase for hyponatremia (RR = 5.03, 95% CI: 1.08-23.52, p=0.039), and a 2.41-fold increase for hyperkalemia (RR = 2.41, 95% CI: 0.57-10.22, p=0.232). Additionally, subgroup analysis based on grading revealed that the risk of proteinuria in the treatment group compared to controls was 6.35-fold higher for patients with grade ≤ 2 and 6.55-fold higher for those with grade ≥3.

Conclusions: This study demonstrated that the use of Bevacizumab in patients with ovarian cancer significantly increases the overall risk of urinary complications, particularly proteinuria. These findings could contribute to enhanced awareness, facilitating the early identification and management of these adverse effects.