Archivio Italiano di Urologia e Andrologia最新文献

Objective: To provide an updated national overview of the clinical management of congenital and acquired penile curvature (PC) in Italy, evaluating current diagnostic and therapeutic practices among Italian urologists.

Materials and methods: A 23-item anonymous digital survey was distributed by the Italian Society of Urology (SIU) to 2034 affiliated urologists between 2024 and 2025. The survey includes demographic data, diagnostic approaches, and treatment strategies for PC, including Peyronie's disease (PD). Participants were categorized by practice setting and geographic region. SPSS software was used to conduct descriptive and comparative analyses.

Results: Overall, 442 urologists had completed the survey (response rate: 21.7%). Most participants were affiliated either with university hospitals (34.6%) or public non-university hospitals (32.8%). The major incidence of PD cases, as reported by 310 (70.1%) respondents, were in patients between 45-60 years old and the most frequent presentation was a dorsal curvature (223 responses, 50.5%). The routine clinical practice, as reported by respondents, includes anamnestic data with photographs collection and penile ultrasound (in 261 (59%) and 188 (42.5%) of respondents, respectively), while penile dynamic CCDU was mainly used in patients with erectile dysfunction. In regard to therapeutic strategies, 142 (32.8%) of urologists used Clostridium Collagenase Histolyticum (CCH) for intralesional therapy; a similar proportion used verapamil/nicardipine, despite limited supporting evidence. Interestingly, surgical approaches varied widely: tunica plication was preferred in non-complex cases by 169 (38.2%), while penile prosthesis was offered in complex cases by 129 (29.2%) urologists. Finally, penile prosthesis implantation was offered in patients with severe ED unresponsive to pharmacological therapy, regardless of penile curvature only by 176 respondents (39.8%), meanwhile, 177 respondents considered penile prothesis only for severe PC over >60 degrees associated with ED.

Conclusions: This nationwide survey reveals a significative heterogeneity in PC and PD management in Italy, with frequent reliance on off-label treatments and variable adherence to international guidelines. Economic limitations and regional differences appear to be a primary factor influencing clinical decisions and clinical practice. These findings underline the need for a major dissemination of evidence-based guidelines associated with national healthcare strategies aimed at standardized care and improving patient outcomes.

Objective: Isotretinoin is a retinoid widely used for severe acne, known for its teratogenicity, but with an unclear impact on male fertility and the risk of fetal exposure through semen. This study evaluated in vitro the effect of different concentrations of isotretinoin (therapeutic and extremely high) on the motility, vitality, and integrity of human sperm DNA.

Methods: For this purpose, human semen samples (n=17) were exposed to isotretinoin concentrations of 22 nM, 660 nM, 66,000 nM, and 660,000 nM. Sperm motility and vitality were assessed up to 5 hours post-exposure, while DNA fragmentation was evaluated at 2 hours.

Results: Concentrations of 22 nM, 660 nM, and 66,000 nM did not significantly affect the sperm assessed parameters. However, the highest concentration (660,000 nM) induced immediate cytotoxicity in human sperm, resulting in 100% immotile and nonviable sperm cells, as well as increased sperm DNA fragmentation.

Conclusions: Knowing that the concentrations achieved clinically in semen and blood are considerably lower than the cytotoxic concentration, these findings suggest that treatment with therapeutic doses of isotretinoin does not compromise human sperm function in vitro.

Background: MicroRNAs (miRNAs) have shown promise as diagnostic biomarkers for prostate cancer (PCa). This study aimed to evaluate the expression of miR-107, miR-134-5p, miR-149-5p, miR-370-3p, and miR-221 in whole blood to distinguish PCa from benign prostatic hyperplasia (BPH) and potentially reduce unnecessary biopsies.

Methods: Whole blood samples were collected from 20 PCa patients, 17 histologically-confirmed BPH patients (all with PSA >4 ng/mL), and 20 healthy controls over 60 years without symptoms suggesting prostatic disease and PSA <4 ng/mL. miRNA levels were quantified using qRT-PCR. Diagnostic potential was assessed via correlation analyses with clinical parameters and ROC curve evaluation. Statistical significance was set at p<0.05.

Results: miR-107, miR-134-5p, miR-149-5p, and miR-370-3p were significantly overexpressed in PCa patients compared to BPH (p<0.0001). ROC analysis identified miR-134-5p (AUC: 0.94) and miR-149-5p (AUC: 0.93) as strong predictors of PCa. Additionally, miR-149-5p showed a positive correlation with PSA levels (r = 0.2627, p<0.05).

Conclusions: This preliminary study demonstrated that miR-107, miR-134-5p, miR-149-5p, and miR-370-3p were significantly overexpressed in PCa patients compared to the BPH group. ROC analysis highlighted their diagnostic potential in distinguishing BPH from PCa. Despite the limited sample size, these findings provide early evidence to guide future research on the diagnostic value of miRNAs in prostate cancer.

Background: The erectile dysfunction (ED), represents a very common complaint for men over forty years old.

Aim: The purpose of the study was to evaluate if flat magnetic stimulation (FMS) technology could help individuals with symptomatic erectile dysfunction.

Methods: A total of 40 patients with a mean age of 43 (±10.4) (range 21-53) affected by erectile dysfunction, underwent eight sessions of about 30 min each in a twice a week frequency with the study device. During treatments, every potential side effect was monitored. The International Index Erectile Function (IIEF) and Erection Hardnes Score (EHS) (range 0-4) were selected and analysed before, at the end of the treatment, at 1 month follow up (1MFU) and at 3 months follow up (3MFU).

Results: The IIEF mean value significantly (p<0.001) increased from 22.6 (±2.4) at baseline to 26.4 (±2.7) at 3MFU. The EHS mean score significantly (p<0.001) increased from 2.7 (±0.4) at baseline to 3.4 (±0.6) at 1MFU and the improvement persists for up to 3MFU, thus supporting the clinical usefulness of this treatment.

Conclusions: As compared to other previously employed techniques, this technology has the potential to successfully restore erectile function. This research had limitations as the absence of a control group, a long term follow up and the lack of objective assessments of penile hemodynamics. The study findings showed that FMS represents a promising treatment option for individuals affected by symptomatic erectile dysfunction.

Introduction: VED is a handheld pump that creates negative pressure around the penis to draw blood into the corpora cavernosa. Although included in guidelines as a noninvasive option, its uptake is limited by fragmented evidence. Current Grade C recommendations are largely based on post-prostatectomy studies, and no systematic review/meta-analysis has evaluated VED across other ED etiologies (diabetic, cardiovascular, idiopathic) or compared it head-to-head with pharmacotherapy using the IIEF.

Methods: We searched PubMed, ScienceDirect, and Cochrane Library using relevant keywords to identify studies assessing VED's effects on erectile dysfunction patients. The primary outcome we assessed in this systematic review was erectile function based on the International Index of Erectile Function (IIEF). Study quality was assessed using the Revised Cochrane Risk of Bias tool (RoB2) for Randomized Controlled Trial (RCT) studies and using ROBINS-I for non-RCT studies. Meta-analyses were conducted using Review Manager 5.4.

Results: The meta-analysis results of this study showed that when VED was used as a single therapeutic modality compared with Phosphodiesterase-5 (PDE5) inhibitors (PDE5Is), there was no significant difference (p=0.77). However, when compared with the placebo group (no intervention), VED provided significantly better outcomes [MD: 4.44 (95% CI: 3.04-5.84) p<0.001). Similarly, when VED was combined with PDE5i, its effectiveness was significantly better than PDE5i therapy alone [MD: 4.19 (95% CI: 0.81-7.57; p<0.001)]. In terms of safety, VED is also relatively safe and has mild and reversible side effects.

Conclusions: VED is effective as a therapy either alone or as an adjunct to PDE5i therapy in patients with erectile dysfunction.

Background: Prediabetes, defined as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), is recognized as an increasing metabolic disorder globally. Although its vascular and metabolic implications are well established, the link between prediabetes and male sexual dysfunction is uncertain. This meta-analysis was performed to summarize available evidence on the relationship between prediabetes and sexual dysfunction in men.

Methods: A systematic literature search of PubMed, Embase, and Scopus from inception to July 2025 was undertaken to retrieve observational studies reporting sexual dysfunction outcomes (erectile dysfunction or premature ejaculation) in prediabetic men. The eligibility criteria were adult men with prediabetes and comparative data with normoglycemic controls. Studies were screened by two independent reviewers who also extracted data and evaluated study quality using the Newcastle-Ottawa Scale (NOS). Meta-analysis with random effects model was employed to combine effect sizes and assess heterogeneity on the basis of I² statistic. Funnel plots and Egger's test were employed to investigate publication bias. GRADE approach was applied to grade the certainty of the evidence according to risk of bias, inconsistency, indirectness, imprecision, and publication bias.

Results: A total of ten studies with 11,000 participants were available for analysis. Combined odds ratio (OR) of sexual dysfunction in prediabetic men compared to normoglycemic men was 2.50 (95% CI: 1.35-4.64), indicating significant association with high heterogeneity (I² = 87.9%, p<0.001). Funnel plot asymmetry was checked by visual inspection and confirmed by Egger's regression test for publication bias, which was not significant (p=0.275). According to GRADE, the quality of evidence was generally low, downgraded for high heterogeneity and imprecision but upgraded for large effect size.

Conclusions: We found that men with prediabetes have approximately 2.5-fold higher odds of sexual dysfunction than men with normoglycemia. Due to the high pooled effect size, although with low certainty of evidence, additional high-quality prospective studies are needed to replicate findings and explore the underlying mechanisms.

Background: Bladder cancer (BC) exhibits a wide range of clinical behaviors, with survival outcomes depending on tumor biology, treatment choices, and patient characteristics. This study measured survival across different stages of the disease, compared the effectiveness of treatments, and identified prognostic factors in BC patients at a Tertiary Center.

Patients and method: We reviewed 65 patients diagnosed with BC at the King Khaled Hospital in Najran, Saudi Arabia, from September 2014 to February 2025. Data on demographics, clinical presentation, pathology, treatment, and survival outcomes were collected. We used the Kaplan-Meier method to generate survival estimates and identified independent prognostic factors using multivariate Cox proportional hazards regression.

Results: The median overall survival (OS) was 23.4 months (95% confidence interval [CI], 19.8 to 27.1), with significant differences in survival based on disease stage: localized (median OS, 36 months; 95% CI, 30.2 to 41.8), locally advanced (22 months; 95% CI, 18.5 to 25.5), and metastatic (8 months; 95% CI, 6.2 to 9.8) (log-rank p < 0.001). The 1-year and 3-year OS rates were 72% (95% CI, 63-81%) and 41% (95% CI, 31-51%), respectively. Radical cystectomy provided the best survival outcomes (3-year OS, 64% compared to 38% for TURBT alone; adjusted hazard ratio [HR] 2.10, 95% CI 1.21 to 3.62). Multivariate analysis identified metastatic disease (adjusted hazard ratio [HR] 4.12, 95% CI 2.48 to 6.85), ECOG performance status ≥2 (HR 3.21, 95% CI 1.82 to 5.66), and lack of radical treatment (HR 1.97, 95% CI 1.19 to 3.27) as independent predictors of mortality.

Conclusions: Survival in BC is closely linked to disease stage, treatment type, and patient performance status. Radical cystectomy remains the main treatment for curing the disease, whereas cisplatin-based chemotherapy is the preferred option for advanced cases. These findings encourage personalized treatment strategies that consider performance status to improve outcomes.

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Introduction: Male infertility is a multifactorial condition influenced by genetic, physiological, and environmental factors. While semen analysis is the cornerstone of diagnosis, additional tests like sperm DNA fragmentation (DFI) assessment and genetic testing are increasingly recognized for their diagnostic and prognostic value. This study investigates the relationships between DFI, semen parameters, and genetic abnormalities in Iranian men.

Methods: A retrospective cross-sectional study analyzed 6,397 men (5,196 infertile and 1,201 fertile controls) at the MOM Infertility Center between December 2022 and August 2023. Semen analysis evaluated sperm concentration, motility, morphology, Y chromosome AZF microdeletion testing, and whole-exome sequencing (WES) on subsets of infertile men. Correlations between age, sperm parameters, and DFI were assessed, and logistic regression evaluated the likelihood of abnormal sperm conditions.

Results: Infertile men showed significantly lower sperm concentration, motility, and morphology, along with higher DFI, compared to controls. DFI was negatively correlated with sperm concentration, motility, and morphology. Age was positively correlated with DFI and negatively correlated with motility and morphology. Genetic abnormalities, including chromosomal anomalies, AZF deletions, and WES-detected mutations, were identified in subsets of infertile men, underscoring the value of genetic testing.

Conclusions: This study highlights significant associations between DFI, age, semen parameters, and genetic abnormalities in male infertility. Incorporating advanced diagnostic tools, such as DFI assessment and genetic testing, into clinical practice can improve diagnostic accuracy and guide personalized treatment strategies for infertile men.

Background: Phosphodiesterase type-5 inhibitors (PDE5i) are the first-line therapy for erectile dysfunction (ED), offering high efficacy and favorable safety profiles. However, data on how long PDE5i remain effective before the need for penile prosthesis (PP) surgery are limited. This study evaluates the duration from PDE5i initiation to PP surgery and identifies predictors of this interval.

Methods: We conducted a retrospective review of patients with ED who initiated PDE5i therapy and subsequently underwent PP surgery between January 2019 and August 2022. Clinical characteristics, laboratory results, and duration of PDE5i use were extracted from hospital records.

Results: A total of 98 patients were included, with a mean age of 56.1 ± 11.5 years and a mean body mass index (BMI) of 29.8 ± 4.4 kg/m². Comorbidities were present in 88.8 % of patients, including diabetes mellitus (75.5 %), hypertension (54.1 %), and smoking (31.6 %). The mean time from PDE5i initiation to PP surgery was 34.9 ± 24.8 months (≈ 2.9 years). Lower testosterone levels were associated with earlier surgery, while comorbidities were not.

Conclusions: The average duration of PDE5i use prior to PP surgery was approximately three years. Lower testosterone levels may predict earlier surgical intervention, whereas comorbidities did not show a significant association. These findings may assist clinicians in counseling patients and planning treatment strategies.