Archivio Italiano di Urologia e Andrologia最新文献

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.

Background: Accurately predicting the outcome of extracorporeal shock wave lithotripsy (ESWL) is a persistent clinical challenge. While machine learning (ML) offers potential for improved predictions, the opacity of many models hinders clinical trust and adoption. This study aimed to develop and validate an interpretable ML model to predict ESWL success using routinely available clinical data.

Patients and methods: In this retrospective cohort study, we analyzed data from 1,501 patients treated with a single ESWL session at a single institution (2022-2024). Six ML algorithms were trained on 75% of the data (n=1,125), with performance evaluated on a hold-out test set (n=376). Techniques to manage significant class imbalance were employed. Model interpretability was achieved using SHapley Additive exPlanations (SHAP).

Results: The extreme gradient boosting (XGBoost) model demonstrated the best discriminative performance, with an area under the receiver operating characteristic curve (ROC-AUC) of 0.723 (95% CI: 0.662-0.784). However, a critical trade-off was observed: the model exhibited high specificity (95.2%) but low sensitivity (35.4%), meaning it identified most successes but missed nearly two-thirds of treatment failures. Stone density and size were the most influential predictors, and SHAP analysis provided clinically plausible, individualized explanations for predictions.

Conclusions: We present a transparent, interpretable ML framework for ESWL outcome prediction. While the model aligns with clinical reasoning and offers a foundation for trustworthy artificial intelligence, its current low sensitivity limits immediate standalone clinical utility for ruling out ESWL failure. The framework highlights the imperative for future work to improve sensitivity through richer datasets and prospective validation before integration into clinical pathways.

Purpose: BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) remains a persistent challenge. This study examines Romanian urologists' clinical practices, focusing on treatment preferences and awareness of emerging therapies for BCG-unresponsive disease.

Methods: A cross-sectional, web-based survey comprising 24 items was distributed to selected urologists who manage NMIBC via professional mailing lists. Data were collected between May 15 and June 30, 2025.

Results: Out of 400 invited urologists, 216 completed the survey. Radical cystectomy (RC) was the most preferred treatment for BCG-unresponsive NMIBC, recommended by 67% of respondents, followed by tumor resection with surveillance (15%), repeat BCG instillation (14%), and intravesical chemotherapy (4%). Neither clinical trials nor intravenous checkpoint inhibitors were used. Among those using intravesical chemotherapy, gemcitabine was the most commonly used agent (85%), followed by mitomycin C (5%), gemcitabine/docetaxel (4%), gemcitabine/ mitomycin C (3%), docetaxel (2%), and valrubicin (1%). Oncological safety concerns were the main barrier to adopting bladder-sparing therapies. Awareness of FDA-approved therapies for BCG-unresponsive disease, Nadofaragene firadenovec, Nogapendekin alfa inbakicept-pmln, and Pembrolizumab, was limited; 61% of urologists were unaware of all three, and only 1% had used any. BCG shortages were reported by 93% of respondents at some point, who adapted by reducing doses and prioritizing high-grade T1 and CIS cases. Most recognized intravesical chemotherapy as an alternative and were willing to use it if needed.

Conclusions: Though RC remains the predominant approach for BCG-unresponsive cases, over half of urologists' report using intravesical chemotherapy, reflecting interest in bladder-sparing strategies rather than newly approved FDA agents.

Introduction: It is estimated that more than 150 million men worldwide have erectile dysfunction (ED) and this number will reach more than 300 million by 2025. There is strong evidence that ED increases the risk of future cardiovascular events. ED and CAD share common risk factors. High sensitivity C-Reactive Protein (hs-CRP) is an important inflammatory biomarker in subclinical atherosclerosis. Albuminuria is also a marker of widespread endothelial dysfunction and is thought to be associated with ED. This study was conducted to analyze the prevalence of ED and the relationship between hs-CRP, albuminuria, and cardiovascular risk factors with the occurrence of ED in CAD patients.

Materials and methods: From July 2024 to October 2024, 288 CAD cases from Saiful Anwar general hospital heart clinic met the inclusion criteria. Data on hs-CRP, albuminuria, and cardiovascular risk factors such as age, hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking were observed in relation to incidence of erectile dysfunction in CAD patients. Then logistic regression analysis was performed.

Results: There were 255 CAD patients (88.5%) who experienced ED. There was no significant relationship between hs-CRP and albuminuria with ED in CAD patients (p>0.05). Significant risk factors for ED in CAD patients were age (OR = 15.92; 95% CI = 4.67-54.22; p=0.000), triglycerides (OR = 2.52; 95% CI = 1.12-5.66; p=0.024), and smoking (OR = 0.29; 95% CI = 0.09-0.89;  p=0.031).

Conclusions: The prevalence of erectile dysfunction was 88.5% in patients with coronary artery disease. Hs-CRP and albuminuria did not have a significant relationship with the incidence of ED in patients with CAD. Risk factors that independently affect incidence of ED in patients with CAD are age, smoking, and hypertriglyceridemia.

Introduction: after androgen ablation treatment for prostate cancer, virtually all patients with recurrent or advanced disease develop castration resistance (CRPC). Abiraterone and enzalutamide are the most commonly used novel antiandrogen treatments in patients with castration-resistant prostate cancer (CRPC). The solute carrier transporter (SLCO2B1) enables various anticancer compounds or hormones to enter cells, including the adrenal androgen dehydroepiandrosterone (DHEAS), a precursor to the most potent androgen dihydroxytestosterone (DHT), which is the substrate binding and activating the androgen receptor in normal and prostate cancer (PCa) cells. Other substrates of SLCO2B1 are statins. An in vitro-part study showed that statins, by binding to SLCO2B1, can block the uptake of DHEAS competitively, decreasing the available intratumoral androgen and improving and extending the effect of primary ADT.

Aim: to evaluate whether the addition of statins to the new antiandrogens (abiraterone or enzalutamide) affects overall and progression-free survival in patients with metastatic castration-resistant prostate cancer.

Materials and methods: medical records of patients with mCRPC taking abiraterone or enzalutamide between December 2019 and January 2022 were reviewed in a tertiary hospital. Patients were assessed for statin use at the time of treatment initiation, progression free (PFS) and overall survival (OS), prostate-specific antigen (PSA) variations, and other variables of interest. Statistical analysis was performed using SPSS 22.0.

Results: a total of 107 patients receiving ADT (63 abiraterone - 59.4% - and 43 enzalutamide - 40.6%) for mCRPC in this time period were eligible for inclusion in this retrospective study. Patients had a mean age of 76.5 years (48-93). 26 patients had surgery with curative intent prior to the treatment (24.5%), 19 had previous pelvic radiotherapy with curative intent (17.9%) and 20 patients (18.9%) were previously treated with chemotherapy with docetaxel. Statins use was a significant prognostic factor for longer PFS, with a mean time of 13,68 months for those who do not use statins and 19,62 months for those who do (p<0.06). No statistically significant difference was found in OS or global mortality between the patients who use or do not use statins. Statins use also did not show any difference in the reduction of PSA values during the treatment with ADT.

Conclusions: Our study suggests a prognostic impact of statin use in the PFS in patients receiving abiraterone or enzalutamide for mCRPC. This may be related to the enhancement of the antitumor activity of the ADT drugs, but also to the cardioprotective effects associated with statin use.

Introduction: Hyperthermic intravesical chemotherapy (HIVeC) with mitomycin C (MMC) is an emerging strategy in the management of intermediate-risk non-muscle-invasive bladder cancer (Ir-NMIBC). By combining chemotherapy with controlled hyperthermia (43°C), this approach aims to enhance drug absorption, increase cytotoxicity, and stimulate immune activation, potentially improving efficacy compared to standard MMC. The aim of this study was to compare oncologic efficacy, adverse effects, and safety between HIVeC and standard normothermic MMC in patients with Ir-NMIBC.

Patients and methods: we conducted a retrospective cohort study including 76 patients with Ir-NMIBC treated between January 2020 and december 2023. Patients received HIVeC (n=36) or standard MMC (n=40) following complete transurethral resection of bladder tumor (TUrBT). The instillation schedule consisted of four weekly induction instillations followed by three monthly maintenance instillations. The primary endpoint was recurrence-free survival (rFs); secondary endpoints included progression-free survival (PFs), adverse events (Aes), and treatment compliance.

Results: A total of 76 patients were included: 36 received HIVeC and 40 received standard MMC. Baseline characteristics were balanced across groups, with a median age of 68 years and 86.8% male. Most tumors were unifocal (85.5%), stage pTa (88.2%), and low-grade (61.8%). At a median follow-up of 36 months (IQr 24-36), recurrence occurred in 38.9% of HIVeC patients vs 30.0% in the MMC group. Median time to recurrence was longer with HIVeC (15.0 vs 10.5 months). The 24-months recurrence-free survival was 62.2% for HIVeC and 69.4% for MMC (p=0.365). Progression to muscle-invasive disease occurred in one MMC patient (2.5%); none progressed in the HIVeC arm (PFs at 24 months: 100% vs 97.5%, p=0.343). Compliance was high in both arms (HIVeC 88.9%, MMC 87.5%). Adverse events were mild (grade 1-2) and evenly distributed; no grade ≥3 events were observed. Treatment discontinuation due to toxicity occurred in 13% of HIVeC and 7% of MMC patients (p=0.47).

Conclusions: HIVeC with MMC demonstrated comparable oncologic outcomes to normothermic MMC in Ir-NMIBC, with a longer time to recurrence and similar tolerability. These findings suggest its potential use in selected patients, but should be interpreted with caution due to the retrospective design and limited sample size.

Background: Extracorporeal shock wave lithotripsy (ESWL) is a widely utilized, noninvasive treatment for renal and ureteric stones. Accurate prediction of treatment outcomes is essential for improving patient counseling and optimizing clinical management. Established scoring systems, such as the 'Triple-D' score - which incorporates stone Density, Diameter, and skin-to-stone Distance -and the 'Quadruple-D' score - which adds factors like stone location or hydronephrosis status - are used to stratify patients by risk. However, these tools have limitations in predictive accuracy. This study aimed to evaluate and compare the predictive performances of the Triple-D and Quadruple-D scores against a novel regression-based model for ESWL outcomes.

Methods: A retrospective study was conducted on 1,000 adult patients treated with ESWL using the Dornier Compact Delta® III Pro lithotripter from May 2022 to November 2023. Key predictors of ESWL failure were identified using multivariable logistic regression with internal validation. Predictive performances were compared using receiver operating characteristic (ROC) analysis, with statistical differences assessed by DeLong's test. Model calibration and clinical utility were examined through calibration plots and decision curve analysis (DCA).

Results: ESWL treatment success was achieved in 87.5% of patients. Independent predictors of failure included prior urologic intervention (adjusted odds ratio [aOR] 2.64, 95% CI 1.75-3.99), multiple stones (aOR 0.45, 95% CI 0.24-0.77), higher stone density (per 100 Hounsfield Units increase; p<0.001), and increased skin-to-stone distance (per cm; aOR 1.18, 95% CI 1.06-1.30). The regression-based model showed superior discrimination (AUC 0.92) compared to the Quadruple-D (AUC 0.81, p=0.01) and Triple-D (AUC 0.72, p<0.001) scores. Calibration and DCA confirmed the model's improved accuracy and clinical benefit.

Conclusions: The regression-based model outperforms existing Triple-D and Quadruple-D scores in predicting ESWL failure, providing enhanced individualized risk stratification. This may facilitate better patient selection and treatment planning. Prospective validation is warranted.