Archivio Italiano di Urologia e Andrologia最新文献

Objective: This study aimed to evaluate the influence of prior laparoscopic experience on the learning curve and surgical outcomes of robotic-assisted radical prostatectomy (RaRP).

Methods: A retrospective analysis was performed on 101 patients treated between 2021 and 2023. Two surgeons at the beginning of their robotic learning curves were compared: one with extensive prior laparoscopic experience and the other without such a background. Perioperative, oncological, and functional outcomes were assessed, with a specific focus on Pentafecta criteria. Statistical analyses and cumulative sum (CUSUM) charts were employed to evaluate performance trends and surgical outcomes.

Results: Surgeon A, with substantial prior laparoscopic expertise, demonstrated shorter operative times (p = 0.015), reduced intraoperative blood loss, and superior early functional outcomes. Specifically, patients operated on by Surgeon A exhibited higher pad-free continence rates and improved erectile function recovery at 12 months postoperatively (p < 0.01). Additionally, nerve-sparing procedures performed by Surgeon A showed a trend toward fewer positive surgical margins, although this difference did not reach statistical significance. CUSUM analysis revealed more stable and consistent performance trends for Surgeon A in achieving Pentafecta outcomes compared to Surgeon B.

Conclusions: Previous laparoscopic experience significantly contributes to shortening the learning curve for RaRP and enhancing early functional outcomes. This advantage is likely attributable to greater surgical anatomical knowledge. These findings highlight the importance of tailored training programs and the potential for skill transfer between laparoscopic and robotic approaches. Further studies are warranted to refine surgical education strategies and improve patient care outcomes.

To the Editor, Benign prostatic hyperplasia (BPH) is a highly prevalent histological condition in aging men that can commonly cause lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). BPH typically begins developing after the age of 40 and affects approximately 50-60% of men by age 60...

Objective: To compare statistical outputs from ChatGPT 4.0 and human experts in both comparative and correlation analyses in the evaluation of multiparametric MRI/ultrasound fusion-targeted biopsy plus random biopsy versus standard random biopsy alone, in terms of upstaging.

Methods: Authors performed a retrospective evaluation on 101 patients undergoing robot-assisted radical prostatectomy (RaRP) between 2021 and 2023. Patients were divided in two groups, according to the type of prostatic biopsy received: combined fusion (MRI/US) targeted and random biopsy versus standard random biopsy. Clinical and histological data were anonymized and analyzed using logistic regression models, ANOVA, and Chi-square tests. Analysis generated by ChatGPT and by an experienced human statistician were compared. The Q-EVAL and Q-EVA tools were used to assess the quality of user-formulated questions and AI-generated answers, respectively.

Results: Results revealed high concordance between statistical outputs generated by AI and expert human statistician with perfect concordance using Cohen's kappa coefficient (κ = 1.0). Logistic regression analysis demonstrated that fusion biopsy was associated with a reduced likelihood of upstaging, a consistent finding across statistical evaluations. Additionally, user interaction assessments indicated high-quality in question formulation.

Conclusions: ChatGPT (version 4.0) proved reliable for statistical analysis, showing strong concordance with human statisticians (κ = 1.0) in performing logistic regression, chi-square, and ANOVA tests. The Q-EVAL tool could reduce query errors, though ChatGPT's lack of automatic citations remains a limitation. Fusion biopsy significantly lowered upstaging risk after RaRP. In conclusion, ChatGPT is a valuable assistive tool but further research is required to optimize human-AI collaboration in clinical research.

Nephrolithiasis (KS) and metabolic bone diseases (MBDs) not linked to parathormone (osteoporosis, Paget's disease of bone and renal phosphate leak) are related as demonstrated by epidemiological and experimental data. Moreover, patients affected by monogenic kidney stone disorders (idiopathic hypercalciuria, primary hyperoxaluria, hypocitraturia, cystinuria and defects in purine metabolism) showed a bone phenotype. A significant economic and social burden is associated with KS and MBDs, due to high mortality and morbidity rate. Concerning this point of view, an integrated screening could be a cost-saving strategy. We suggest a new clinical management for patients affected by KS and MBDs. The assessment of bone mineral density by Dual X-ray absorptiometry and bone turnover markers should be proposed in KS patients. On the contrary, the evaluation of KS-related metabolic risk factor and an abdomen ultrasound exam should be offered to MBD patients. Moreover, in patients with early and/or recurrent KS, an extended gene-panel should be suggested.

Introduction and objectives: Prostate cancer (PCa) is a significant concern and burden worldwide. Several studies suggest that flavonoids have a significant potential as an anti-cancer agent, but the evidence remains controversial. This study aims to assess the effect of flavonoids and its subclasses supplementation on PCa risk parameters in men with biopsy-proven diagnosis of PCa or clinically determined to have a high risk of PCa.

Materials and methods: This systematic review and meta-analysis adhered to PRISMA guideline. A literature search was conducted across PubMed, ScienceDirect, Scopus and Cochrane utilizing PICO framework. Revised Cochrane's risk of bias tools (RoB2) was used for quality analysis. Review manager 5.4 was used for statistical analysis.

Results: Out of 1.117 articles, nine final studies (involving 420 patients) were included. Regarding total PSA, flavonoid provided a reduction of total PSA (MD: -0.64, p<0.05), and sub-group analysis based on the supplementation duration showed flavonoid administration with a duration of ≥12 weeks significantly reduced total PSA compared to administration of <12 weeks (p<0.05). Meta-analyses of four studies, including men clinically at risk of PCa, revealed that flavonoid supplementation was associated with a significantly lower risk of developing PCa at endpoint (OR 0.41, p<0.05). However, our results indicated no favorable effect on hormonal parameters.

Conclusions: The results of this meta-analysis suggest there may be a potential role for flavonoid in PCa risk reduction. Flavonoids supplementation also have been proven to be safe. However, further investigation is necessary to gain a clear understanding of the flavonoid impact on PSA and sex hormone parameters.

Background: The lack of a cohesive diagnostic and therapeutic framework for muscle-invasive bladder cancer (MIBC) in Yemen has resulted in significant variability in patient care. This study evaluates oncological outcomes and survival rates after radical cystectomy (RC) for MIBC patients in Yemen.

Methods: We conducted a retrospective analysis of 300 MIBC patients who underwent RC between 2006 and 2020. Demographics, histopathological findings, and survival data were meticulously collected. Kaplan-Meier survival analysis estimated survival probabilities, while prognostic factors were evaluated using the log-rank test.

Results: The median patient age was 67 years (IQR 65-70), with a male predominance (n=184, 61.3%). Ileal loop reconstruction was the primary method of urinary diversion (n=234, 78.0%). Urothelial carcinoma was the predominant diagnosis (n=246, 82.0%), followed by squamous cell carcinoma (n=42, 14.0%). Postoperative complications occurred in 93 patients (31.0%), primarily Grade I (n=61, 20.3%). Overall survival was 71.7% (n 215), with 28.3% mortality due to non-cancer-related (n=43, 14.3%) and bladder cancer-related causes (n=35, 11.7%). The median overall survival was 191 months, with 1-year, 3-year, 5-year, and 10-year survival rates of 99%, 93%, 88%, and 82%, respectively. In the multivariate analysis, non-ileal conduit diversion (Hazard Ratio [HR] 5.21, 95% Confidence Interval [CI]: 1.80-15.00, p=0.003), Stage IV disease (HR 2.76, 95% CI: 1.01-7.61, p=0.050), lymph node positivity (HR 2.92, 95% CI: 1.15-7.42, p=0.022), and squamous cell carcinoma (HR 3.09, 95% CI: 1.25-7.63, p=0.022) were identified as predictors of mortality.

Conclusions: This study highlights the urgent need for improved bladder cancer care in Yemen. Late-stage diagnosis and suboptimal surgical methods critically affect survival. Addressing these issues requires prioritizing early detection and standardized surgical techniques to develop effective care pathways for MIBC patients.

Background: Inguinal hernia repair is a frequently performed surgical procedure that generally employs prosthetic mesh. However, alternative techniques, notably the reinforcement of the posterior inguinal wall through aponeuroplasty, have not been sufficiently explored, particularly in resource-constrained environments. This study aims to evaluate and compare the efficacy and outcomes of aponeuroplasty against traditional mesh repair in adult patients with inguinal hernias.

Methods: A randomized controlled trial was conducted from April 1, 2019, to May 22, 2024, enrolling 200 adult patients diagnosed with inguinal hernias. Participants were randomized into either Group A (Lichtenstein technique with prosthetic mesh repair, n=96) or Group B (posterior inguinal wall aponeuroplasty, n=104). Patients were monitored for a minimum of two year postoperatively. The aponeuroplasty technique required meticulous dissection of the external oblique and transversus abdominis aponeuroses, ensuring tissue integrity and securing the tissue to the inguinal ligament and muscle arch. Complications, recurrence rates, and other surgical outcomes were systematically analyzed.

Results: Demographic analyses revealed no significant differences between groups. Group B demonstrated significantly shorter operative times (30 ± 9.43 min vs. 38 ± 12.55 min, p=0.004) and lower postoperative pain levels (p=0.031). Over the follow-up period of two years, hydroceles were documented in 9 patients (4.5%), with a notably lower incidence in Group B (1 case, 1.0%) compared to Group A (8 cases, 8.3%, p=0.030). Recurrence rates were similar in both groups (3 in Group A and 2 in Group B, p=0.613).

Conclusions: Strengthening the posterior inguinal wall via aponeuroplasty offers superior outcomes compared to prosthetic mesh repair, particularly regarding postoperative pain and operative time. These findings advocate for the consideration of aponeuroplasty as an effective surgical alternative for inguinal hernia repair in low-resource settings. Future studies are warranted to validate these conclusions across diverse and larger populations.

Background: Renal trauma represents a critical injury requiring precise management with the length of hospital stay (LOS) serving as a key metric for trauma care. Recognizing the factors contributing to extended LOS is essential for optimizing treatment strategies and enhancing patient outcomes. This study aims to analyse the risk factors influencing LOS in patients with renal trauma.

Methods: This retrospective cohort study was conducted at Dr. Saiful Anwar General Hospital, Malang, analysing medical record data of renal trauma patients from 2013 to 2023. Collected variables included demographics, mechanism of injury, associated injuries, hemodynamic status upon admission, injury severity, haemoglobin levels, LOS, management approach, and mortality outcomes. Univariate and multivariate analyses were performed to assess the impact of each variable on LOS.

Results: 119 renal trauma patients were included. The average age was 40.1 ± 16.86 years, and 77.3% of the participants were male. The average LOS was 6.85 ± 3.85 days. Blunt renal trauma was the predominant mechanism, accounting for 95.8% of cases, while associated injuries were observed in 53.1% of patients. Upon hospital admission, 66.4% of cases presented with stable hemodynamic status, and non-operative management was employed in 92.4% of cases. Prolonged LOS was significantly associated with age, blunt trauma, associated injuries, hemodynamic instability, and low haemoglobin levels in both univariate and multivariate analyses.

Conclusions: Age, mechanism of injury, associated injuries, hemodynamic status at admission, and haemoglobin levels significantly impact LOS in renal trauma patients. Identifying these factors may aid in improving patient management and reducing hospitalization duration.

Introduction: Hemorrhagic cystitis is defined by the presence of hematuria, lower urinary tract symptoms and cystoscopy findings indicative of underlying urothelial damage. It is common in patients with prior radiotherapy for pelvic malignancies. The severity of the bleeding can vary from mild to severe hematuria refractory to conservative therapy and with a continuous need for transfusions. Treatment can be challenging not only by the lack of clear guidelines but also the multiple comorbidities of these patients. Urinary diversion with or without cystectomy should be reserved for those who have failed all the previously available therapy, because of the morbidity/mortality associated with this type of procedure. Supratrigonal cystectomy can be an option in patients with intense fibrosis of the pelvic region. The purpose of this article is to present the results of our institution with supratrigonal cystectomy with urinary diversion as a last line treatment for radiation-induced hemorrhagic cystitis.

Materials and methods: We retrospectively analyzed 17 patients who underwent supratrigonal cystectomy and bladder mucosa fulguration with urinary diversion for refractory radiation-induced hemorrhagic cystitis in our institution from January 2010 to December 2020.

Results and discussion: Median patient age at time of cystectomy was 69 years and 64.7% (11) were females. The most common etiology was prior radiation therapy for gynecologic malignancies (11-64.7%). All the patients had prior therapy with bladder irrigation and fulguration. Besides that, 29.4% (n=5) received intravesical therapy with formalin, 11.8% (n=2) hyperbaric oxygen therapy and 5.9% (n=1) prior urinary diversion. Median time between radiation therapy and cystectomy was 65 months. Median ASA score of 3, median preoperative hemoglobin was 9,6mg/dl and 10.5 mg/dl at time of discharge after surgery. Ileal conduit was used in 52.9% (9), cutaneous ureterostomy in 41.2% (7) and ureterosigmoidostomy in 5.9% (1). Majority of patients (10-58.8%) did not require any blood transfusion during surgery or during their stay. Clavien-Dindo complications grade III or higher occurred in 29,4% (5). Median hospital stay postoperative was 12 days. No mortality was reported in the 30 days after surgery. Median follow-up after cystectomy was 28 months, with a 1-year survival of 93.3% (14 of 15) and 3-year survival of 83.3% (10 of 13). There was no difference in the presence of postoperative complications or overall survival between the types of urinary diversion.

Conclusions: This represents one of the largest series on cystectomy in hemorrhagic cystitis, that we found to this date. Supratrigonal cystectomy is a valid option as a last line treatment for radiation-induced hemorrhagic cystitis, reducing the risks associated with simple cystectomy in patients with prior pelvic radiation.

Introduction: Cryptorchidism, or undescended testis (UDT), is a congenital anomaly linked to an increased risk of infertility. The laterality of UDT, whether unilateral or bilateral, may influence post-orchidopexy outcomes. This meta-analysis compares testicular function and azoospermia rates between patients with bilateral and unilateral UDT post-orchiopexy.

Materials and methods: A comprehensive literature search was performed using PubMed, ScienceDirect, and Google Scholar databases up to March 2025. Statistical analyses were conducted using Review Manager (RevMan).

Results: Ten eligible studies were included in the analysis, comprising 563 bilateral UDT post-orchidopexy and 1259 unilateral UDT post-orchidopexy cases. Populations post bilateral orchidopexy have significantly higher FSH level (MD: 3.77 UI/L [95% CI: 1.65 - 5.89]), significantly higher LH level (MD: 1.27 UI/L [95% CI: 0.27 - 2.26]), lower inhibin B level (MD: -44.86 pg/mL [95% CI: -69.58 - -20.15]), and higher frequency of azoospermia (OR 2.3 [95% CI: 1.57 - 3.37]) compared to unilateral UDT post orchidopexy.

Conclusions: Bilateral UDT post-orchidopexy exhibits poorer testicular function with significantly higher FSH and LH levels, reduced inhibin B levels, and a greater incidence of azoospermia compared to unilateral UDT post-orchidopexy.