Archivio Italiano di Urologia e Andrologia最新文献

Background: Obstructive azoospermia (OA) is a significant cause of male infertility, with iatrogenic vas deferens injury after bilateral inguinal hernia repair representing a rare etiology. Outcomes of microsurgical vasovasostomy (VV) in this setting remain poorly defined.

Methods: We conducted a retrospective case series of five patients with OA following bilateral inguinal hernia repair who underwent attempted laparoscopically assisted microsurgical VV. Inclusion criteria were azoospermia confirmed on at least two semen analyses, normal serum FSH and testosterone, preserved testicular volume, and female partners without major reproductive comorbidities. Demographic data, operative details, postoperative semen parameters, patency, and reproductive outcomes (spontaneous conception and assisted reproductive techniques - ART) were descriptively analyzed. Patency was defined as the presence of sperm in the ejaculate.

Results: Median patient age was 39 years (range 35-41), and median partner age was 35 years (range 30-40). Obstruction intervals ranged from 4 to 12 years. Four patients underwent laparoscopic dissection and bilateral VV (three two-layer, one one-layer), while one could not undergo anastomosis due to technical constraints. Operative times ranged from 150 to 420 minutes. One patient reported transient scrotal pain not requiring analgesia. Postoperative patency was achieved in three of the four anastomosed patients (75%), with sperm concentrations ranging from 3.0 Å~106/mL to 41 Å~106/mL. Four pregnancies were obtained: three through assisted reproductive techniques (ART) and one spontaneous. Among the ART cases, two required surgically retrieved sperm (patients without patency), whereas one used ejaculated sperm following VV. Importantly, a spontaneous pregnancy occurred in the patient with the highest postoperative sperm concentration (41 Å~106/mL) after a one-layer anastomosis.

Conclusions: In this small case series, laparoscopically assisted VV proved technically feasible and allowed restoration of vasal patency in selected patients with OA after bilateral hernia repair. Beyond the potential for natural conception, this approach may facilitate the use of ejaculated sperm for ART, avoiding surgical sperm retrieval in selected cases. These findings reinforce the dual role of VV: restoring natural fertility in some patients and providing ejaculated sperm for ART in others.

Background: Incidental prostate cancer (iPCa) remains a clinically relevant diagnosis in men undergoing surgery for benign prostatic hyperplasia (BPH). This study aimed to determine the incidence, characterize pathological features, and identify preoperative predictors of iPCa.

Materials and methods: We conducted a retrospective cohort study of 735 men undergoing BPH surgery between November 2020 and December 2024. Demographic, clinical, surgical, and pathological variables were analyzed. Predictors of iPCa were evaluated using logistic regression; discrimination was assessed by ROC curves and Youden-optimized cut-offs.

Results: The incidence of iPCa was 5.6%. Among iPCa cases, 48.8% were ISUP 1, while 17.1% corresponded to high-grade tumors (ISUP ≥4). Patients with iPCa had significantly higher PSA (4.8 vs 1.9 ng/mL), higher PSA density (PSAD 0.099 vs 0.029 ng/mL/cmÑ), and smaller prostates (47 vs 66 mL) (all p<0.001). In multivariable analysis including age and PSAD, only PSAD remained independently associated with iPCa (per 0.01 ng/mL/cmÑ increase). PSAD discriminated iPCa better than PSA (AUC 0.86 vs 0.80). A PSAD threshold around 0.15 ng/mL/cmÑ provided balanced performance (sensitivity ≈0.82; specificity ≈0.78). At a median follow-up of 24 months, most patients were managed conservatively (active surveillance or watchful waiting) with favorable short-term biochemical control; a minority required systemic therapy (hormonotherapy), and cancer-specific mortality was low.

Conclusions: iPCa occurred infrequently after BPH surgery, although higher-grade tumors were still observed. PSA density was the strongest preoperative predictor and should be integrated into risk stratification before BPH surgery.

Background: Horseshoe kidney (HSK) and pelvic ectopic kidney (PEK) are congenital anomalies linked to impaired urinary drainage and a higher risk of nephrolithiasis. Evidence regarding metabolic profiles and surgical outcomes in these groups remains sparse. This study assessed predictors of postoperative stone clearance and 12-month recurrence in patients with HSK and PEK undergoing endourological procedures intervention.

Methods: We conducted a retrospective analysis of 50 consecutive patients with CT-confirmed HSK or PEK treated with retrograde intrarenal surgery (RIRS) or mini-percutaneous nephrolithotomy (mini-PNL) over 12 months. All patients had a standardized 24-hour metabolic evaluation and imaging followup at 1, 6, and 12 months. Outcomes included stone-free status at one month and recurrence at one year. Predictors were assessed using univariable and multivariable logistic regression.

Results: Stone-free status at 1 month was achieved in 62% of patients, with 22% having residual fragments ≥4 mm. Residual burden was strongly associated with recurrence, which occurred in 44% of the cohort. Patients with fragments ≥4 mm had the highest recurrence rate (72.7%), compared with 35.5% among stone-free individuals (p=0.047). Age was independently associated with reduced likelihood of achieving stone-free status (B = -0.069, p=0.011). Higher 24-hour urinary volume was the only biochemical parameter protective against recurrence (OR 0.243, p=0.039). Neither malformation type nor surgical technique significantly influenced postoperative outcomes or recurrence. Metabolic abnormalities were frequent but not predictive of stone type or recurrence.

Conclusions: In HSK and PEK, postoperative residual fragments and low urine volume are the main determinants of recurrence, whereas anatomical subtype and surgical approach have limited prognostic value. Strategies focused on complete stone clearance and hydration optimization may improve long-term outcomes in this patient population.

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.