Archivio Italiano di Urologia e Andrologia最新文献

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.

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.

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.

[..].

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.

Background: Internal urethrotomy is commonly used as the first treatment for urethral strictures but has a high recurrence rate. Open urethroplasty comes with the best long-term results and decreases the risk of needing any further interventions. Until now, there are no recommendations based on evidence that compare the outcome of recurrent urethral stricture when treated with internal urethrotomy and open urethroplasty. This systematic review compared those two procedures for recurrent urethral stricture.

Methods: We searched databases using PubMed, Scopus, and EBSCO for relevant literature published in English up to September 2024. The primary outcome was the recurrence rate at 12 months. Secondary outcomes are symptom relief, maximum urinary flow rate, adverse events and complications, and sexual function. We used RevMan to compare the pooled patients.

Results: We included three studies with 454 pooled patients. Data for the recurrence rate of 12 months were included for meta-analysis. The results showed a risk ratio of 5.24 (95% CI 2.89-9.53, p<0.00001), indicating that open urethroplasty has a significantly lower recurrence rate than the internal urethrotomy group. Symptoms relief in urethroplasty is better than in urethrotomy but not significantly different between the two groups. Improvement of Qmax happened in both groups with no significant difference, although urethroplasty has better improvement than urethrotomy group. Complications during a 24-month follow-up were seen in both groups, with the most common complications being urinary symptoms, urinary tract infection, and erectile dysfunction. Those complications were less frequently observed in urethroplasty but there are no significant difference between the groups. Post-procedure sexual function was comparable between the two procedures.

Conclusions: Our review shows that open urethroplasty has lower recurrence rates at 12 months compared to internal urethrotomy for recurrent urethral strictures. However, symptom relief, improvement in urinary flow rate, complications, and post-procedure sexual function were comparable between the two procedures. Further randomized controlled trials with larger sample sizes, multicenter designs, and longer follow-up periods are needed to confirm the results of our review.

Background: The mini-percutaneous nephrolithotomy (PNL) technique has introduced notable advantages, establishing it as a compelling option compared to extracorporeal shock wave lithotripsy (SWL) in managing renal stones in the pediatric population. We aimed to compare the outcomes of both techniques as regards effectiveness, morbidity, and stone recurrence.

Methods: A prospective, randomized superiority trial included 128 pediatric patients with a solitary renal stone measuring 10-20 mm. Group I included patients who underwent mini-PNL (n=65), while Group II included those managed with SWL (n=63). The primary endpoint was the stone-free rate (SFR) eight weeks after the procedure, while the secondary endpoints were operative time, hospital stay, and postoperative complications. The stone recurrence rate was assessed at 2-year follow-up.

Results: The mean age of the patients ± SD was 8.48±4.08 years, and the mean size of the stones was 17.13±2.45 millimeters. The study arms had comparable demographics and stone characteristics. The mean operative time was significantly lower in Group I than in Group II (51.38±14.02 min vs 63.70±16.90 min, respectively; p=0.001). We reported a perioperative complication rate of 26.2% in Group I, compared to 20.6% in Group II, with a statistically insignificant difference (p=0.461). SFR was 93.8% and 41.3% for groups I and II, respectively (p<0.001). The stone recurrence was reported in 4 cases (6.1%) in Group I compared to 10 cases (15.8%) in Group II (p=0.005).

Conclusions: Our study demonstrates that Mini-PNL has a higher stone-free rate than SWL for managing renal stones of 10-20 mm in children. While both techniques have comparable complication rates, mini-PNL has higher intraoperative complications and longer hospital stays. Additionally, stone recurrence is more common after SWL compared to mini-PNL.