Archivio Italiano di Urologia e Andrologia最新文献

Purpose: Hypospadias, one of the congenital anomalies commonly associated with some degrees of ventral penile curvature that may arise from malformation of dartos fascia, the chordee. Our study aims to determine the correlation between the histopathology properties of dartos fascia and the severity of ventral penile curvature in hypospadias.

Materials and methods: One hundred hypospadias patients with various degrees of ventral penile curvature were included in this cross-sectional analytical study from 2020 to 2022. During hypospadias repair, ventral dartos fascia was excised and analyzed for the degree of collagen thickness and the severity of the fibrotic condition.

Results: Out of 100 patients, the mean age was 6.58 + 4.28 years, who were classified as mild to moderate (66%) and severe (34%) ventral curvature cases. The analyses showed significant differences in the severity of fibrotic condition and collagen thickness of dartos fascia to the severity of penile ventral curvature with p-values of 0.002 and 0.017, respectively.

Conclusions: The difference in histopathology properties of dartos fascia may affect the severity of penile curvature in hypospadias patients.

Objective: This study aims to compare two different drainage methods, percutaneous nephrostomy (PCN) and retrograde ureteral double-J (DJ) stent insertion, in patients with obstructive pyelonephritis (OP).

Methods: The study included 77 patients who presented to the emergency department due to stones. Type of decompression treatment (PCN or DJ stent), fever, white blood cell count (WBC), C-reactive protein (CRP) levels, urine culture, blood culture, presence of additional diseases, and antibiotic treatment were evaluated for these patients. Emergency decompressive treatment was not randomly assigned. The clinician chose the appropriate treatment method based on the patient's condition after obtaining an informed consent. Patients under the age of 18 were categorized into three subgroups: infants, children under 10 years, and adolescents.

Results: Of the 77 patients, 31 were in the DJ stent group and 46 were in the PCN group. Patients in the PCN group exhibited significantly higher fever levels before the procedure (37.6 ± 1.0°C). Additionally, the positivity rate of urine and blood cultures was higher in the PCN group. The average time to stone treatment after infection and medical treatment, as well as fever control, was shorter in the PCN group (9 ± 2.3 days). Empiric treatment with Ceftriaxone (1 g IV) was confirmed by sensitivity results of urine or blood culture in 45% of cases. None of the patients developed advanced urosepsis after the procedure, but the resolution of infection parameters was faster in the PCN group (7 ± 3.3 days).

Conclusions: Both PCN and DJ stent insertion are effective and safe methods for managing obstructive pyelonephritis. It was observed that the PCN method under local anesthesia was useful in quickly controlling fever and allowing early surgical treatment. Finally, third-generation cephalosporin antibiotics are beneficial for empiric initial treatment.

To the Editor, What are the male anatomical structures that trigger the so-called "desire" to have sex? What are the male anatomical structures that determine the perception of arousal in men?

Introduction: In ureterolithiasis, the prediction of spontaneous passage poses a challenge for urologists. Moreover, there is controversy surrounding the preferred management approach, whether medical or surgical, as each approach has its disadvantages. Procalcitonin and other inflammatory markers were studied for predicting stone passage spontaneously, but their significance remains controversial. This study aims to assess the association between these markers, especially procalcitonin, and spontaneous ureteral stone passage.

Materials and methods: In this multicenter prospective cohort study from March 2022 to October 2023, consecutive patients with a single unilateral distal ureteric stone less than 10 mm were enrolled. Exclusion criteria were specified. Patients underwent medical expulsive therapy (MET) and were monitored for stone passage. The significance level was set at p < 0.05.

Results: Out of 94 patients enrolled, 72.3% were male and 27.7% were female, with a mean age of 38.84± 10.41 years. Stone sizes varied, with the most common range being 4 mm- 5.9 mm. Participants were categorized based on spontaneous stone passage as spontaneous stone passage (SSP) and non-SSP. No significant differences were observed in most demographic and laboratory variables. However, serum procalcitonin and C-reactive protein showed significant differences between the SSP and non-SSP groups.

Conclusions: Although several inflammatory markers were studied to predict the spontaneous passage of the ureteral stone, the current study concluded that only elevated procalcitonin, C-reactive protein, and large stone diameter decrease the chance of spontaneous ureteral stone passage.

Theobromine (or 3,7-dimethylxanthine) is a natural alkaloid present in cocoa plant and its derivatives, such as chocolate. About 20% of ingested theobromine is excreted unchanged in the urine. Theobromine also derived from caffeine that is metabolized into theobromine by 12%. The primary metabolites of theobromine are 3-methylxantine, 7-methylxantine, 7-methyluric acid and 3,7-dimethyluric acid. Theobromine has an inhibitory activity of uric acid crystallization, because it has a structural pattern very similar to uric acid and can substitute uric acid molecules in the corresponding uric acid crystals, making them longer and thinner and decreasing their growth rate. Theobromine also favors the dissolution of crystals by decreasing supersaturation of uric acid by forming aggregates with uric acid through hydrogen bonds and aromatic stacking interactions (-stacking bonds) increasing urinary solubility of uric acid. Theobromine can be used for uric acid stone dissolution in combination with alkalinization to reduce the dose of citrate, thus preventing excessive alkalinization and the risk of formation of sodium urate crystals. Theobromine could also be used to treat patient with xanthine stones that cannot be dissolved by alkalinization because the solubility of xanthine is relatively independent of urinary pH. A metabolite of theobromine, 7-methylxanthine, has the potential to be used for the prevention of the formation of sodium urate crystals in the synovial fluid of gouty patients.

Introduction: Since percutaneous nephrolithotomy (PCNL) was introduced in 1976, it has been the standard procedure for large renal stones. Over time, the PCNL technique changed and developed into various techniques. We introduce single-site multipuncture supine (SMS) PCNL to give a cosmetic advantage due to less tissue injury in complex renal stones. This study aimed to determine the outcome of SMS PCNL procedure in patients with complex renal stones diseases.

Materials and methods: This study was a retrospective study including all patients with kidney stones who had undergone SMS PCNL at the Urology Department of Saiful Anwar General Hospital from March 2019 until December 2022. All SMS PCNL procedures were performed by a single operator. The patients were divided into three groups that included that were treated with 2, 3, and 4 punctures. The data were collected using SPSS ver. 25.

Result: Ninety-three patients were included in this study. The characteristics of the patient, such as gender, age, and BMI, were not significantly different among the groups. The outcome of the SMS PCNL procedure showed a low complication rate during operation in 2-,3-, and 4-puncture groups (3.2%, 7.4%, and 0%, respectively). The Stone Free Rate (SFR) showed no significant difference between the 3 groups (p = 0.496). The SFR was 85.7% in 2-puncture, 77.8% in 3-puncture, 66.7% in 4-puncture group. The AUC of Guy's Stone Score with cut-off value was 3.5 (AUC = 0.549, p-value = 0.541, CI 95%).

Conclusions: Single-Site Multi Puncture PCNL is a safe and efficient approach to complex renal stones. Single-Site Multipunctures Supine PCNL is comparable with other techniques of PCNL and gives minimal tissue injury that would benefit for cosmetic.

Introduction: This study is based on the hypothesis that, in men, the initial sexual response to erotic stimuli is triggered by a psycho-sensory pelvic reflex, mediated by the contraction of the pelvic floor muscles (PFM), rather than by an erection.

Objective: The objective is to determine, using a questionnaire that evokes an erotic image, whether there is a correlation between an erotic psycho-sensory stimulus and PFM contraction in men and females and whether this contraction encourages the subject to seek sexual activity.

Materials and methods: An online questionnaire was administered to 270 respondents (134 males, 136 females; mean age = 36.53, SD = 10.7; range 19-63). The questionnaire assessed the relationship between the perception of anterior PFM contraction and an evocative erotic image.

Results: The results show that following an evoked erotic stimulus, there is a significantly higher prevalence of perceived genital sexual responses in males compared to females through PFM contraction. A statistically significant difference was also observed in the desire to engage in sexual activity when perceiving PFM contraction (mean: Males 2.04 ± 0.95 vs. Females 1.02 ± 0.88; p < 0.001).

Conclusions: In this sample, an evocative erotic image triggers the perception of the genital sexual response via PFM contraction in more males than females. Additionally, PFM contraction, when perceived, prompts more males to seek sexual activity. These findings support the hypothesis that Pelvic Floor Muscles contraction is the initial response to psycho-sensory stimulation in men and a trigger for male sexual behaviour.

Background: Ureteral stents are one of the most used devices in Urology, allowing drainage of the upper urinary system, and can be used either in elective or emergency procedures. However, as a foreign body inside the urinary system, they are subject to encrustation. Encrustation is one of the burdens seen with double-J stents and, to date, there is no consensus about its best management. This study aims to prove that Endoscopic Combined Intra-Renal Surgery (ECIRS) is the best choice when there's an encrusted proximal loop of a ureteral stent.

Methods: The authors conducted a retrospective cohort study of patients with an encrusted proximal loop of the ureteral stent who underwent surgery at a single center, comparing ECIRS with other procedures.

Results: Between July 2011 and June of 2024, 33 patients (18 females and 15 males) were submitted to surgery. The median indwelling time of the stent was 11 (8-19) months and a stentfree rate of 100% was achieved. The authors demonstrated a significant stone-free rate of 61.1% following ECIRS compared to merely 20% with other procedures (p = 0.023). Notably, while the complication rate was low across all procedures, the ECIRS group exhibited fewer complications (5.6%) than those undergoing alternate techniques (13.3%), though this difference was not statistically significant (p = 0.439).

Conclusions: Our study advocates for ECIRS as the preferred initial treatment for encrusted proximal ureteral stents, as it facilitates superior stone clearance, minimizes complications, and maintains comparable operative efficiency. This research contributes valuable insights into the management of challenging cases involving encrusted ureteral stents, calling for future studies to further validate these findings.

Introduction: Despite the increasing trend of utilizing robotic techniques in pyeloplasty, little is known about the learning curve for robot-assisted pyeloplasty (RAP) amongst urologists with no prior robotic experience. Therefore, the present study aimed to evaluate the learning curve of residents in the last year or recently appointed urologists performing RAP using an ex-vivo model.

Methods: A prospective ex-vivo model study was conducted including participants who were either residents in the last year or recently appointed urologists. All participants had obtained the E-BLUS certification, or they were able to complete its 4 tasks successfully in a dry lab, without prior robotic experience. Each participant performed four consecutive RAPs using the avatera system on an ex-vivo porcine model. The primary endpoint of the present study was the change in the average time to complete the anastomosis from the first to the fourth attempt.

Results: Nine urologists and 8 residents were enrolled in this study. Each surgeon demonstrated a reduction in the time to complete anastomosis from the 1st to 4th attempt with an average of value of 4.41 ± 1.06 minutes (p = 0.003). The decrease in time was statistically significant in both urologists and residents subgroups (4.5 ± 1.41 minutes p = 0.049 and 4.33 ± 0.71 minutes p = 0.035 respectively).

Conclusions: The training on the ex-vivo model could lead, in only a few attempts, to a significant improvement in skills and in the required time of experienced-naïve surgeons to complete an RAP.

Introduction: To evaluate the detection rate for prostate cancer (PCa) performing multiparametric magnetic resonance imaging (mpMRI) fusion targeted biopsy (TPBx) combined only with ipsilateral systematic prostate biopsy (SPBx).

Materials and methods: From January 2023 to December 2023, 495 men with clinical suspicion of PCa underwent transperineal SPBx plus TPBx in the presence of PI-RADS score lesions ≥ 3.

Results: In 250/495 men (50.5%) a PCa was found, while 36/250 (14.4%) men had negative mpMRI. In comparison to TPBx, SPBx diagnosed a higher number of indolent PCa, 38.5 vs. 5.8%, respectively; conversely, SPBx demonstrated a higher detection rate for clinically significant PCa (97.3 vs. 85.4%) in the presence of ISUP Grade Group 2 (GG2). In details, rates were higher in the presence of GG2 (100 vs. 76%), GG3 (85.7 vs. 75.8%) and GG4 (100 vs. 86.4%) tumors. However, in GG5, both SPBx and TPBx diagnosed 100% of csPCa. Furthermore, 89.4% of the cases showed csPCa on the negative mpMRI side.

Conclusions: SPBx combined with TPBx maximized csPCa diagnosis; the use of reduced biopsy scheme limited to ipsilateral side of mpMRI lesion plus TPBx missed 11.6% csPCa. Only in the presence of PI-RADS score 5 SPBx and TPBx diagnosed both 100% of csPCa.