Archivio Italiano di Urologia e Andrologia最新文献

Introduction and objectives: Premature Ejaculation (PE) occurs in 31% of men aged 18-59 years, leading to disappointment and avoidance of sexual relations. The current guideline of treatment for PE is Dapoxetine, which possesses several adverse effects causing the limitation of its long-term use. Silodosin, an alpha-1 blocker, has been proposed as a new option for treating PE due to its minimal side effects. Therefore, our study aims to assess the efficacy of silodosin in treating PE.

Materials and methods: This systematic review and meta-analysis was in accordance with Cochrane Handbook guidelines. Comprehensive literature search was conducted in several databases including PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials. The studies were included if they met the following criteria: (1) Involving premature ejaculation patients; (2) Intervention using silodosin; (3) Comparing placebo or other therapies for PE (4) Outcome includes the Intravaginal Ejaculation Latency Time (IELT) and reported adverse events related to the therapy. Study quality was assessed using Cochrane risk-of-bias criteria. Statistical analysis in this study was performed using Review Manager 5.4 Results: A total of four studies were included in this meta-analysis. Our study showed that patients who received silodosin had a significantly longer IELT compared to control (MD: 132.54, 95% CI 51.51-213.57, p < 0.001). However, patient treated with silodosin also possessed significantly higher risk of adverse event for developing reduced semen ejaculation (OR 10.79, 95% CI 3.46-33.67, p < 0.0001).

Conclusions: Silodosin significantly increased IELT. However, it also reduced semen ejaculation as its drug adverse effect. This result supports the clinical use of silodosin as an alternative treatment for premature ejaculation.

Background: Previous studies had shown that the neutrophils/lymphocytes (NLR) and platelets/lymphocytes (PLR) ratios could be used as markers of inflammatory load as well as prognostic factors in several medical conditions. The current study aimed to compare the effect of using daily tadalafil 5 mg/day versus daily sildenafil 25 mg/day in improving erectile function as well as their ability to reduce NLR and PLR.

Methods: One hundred and four participants were recruited. Seventy-four randomized patients with erectile dysfunction were equally divided into 2 groups. Patients in group A used daily tadalafil 5 mg for 2 months while patients in group B used daily sildenafil 25 mg for 2 months. Patients were collected from June 2022 to June 2023. Thirty healthy individuals served as controls. All patients and controls were evaluated using the validated Arabic version of the international index of erectile function (ArIIEF-5) at baseline and after 2 months of medical treatment. Five cc of venous blood sample was obtained before and after 2 months of medical treatment to compare the effect of phosphodiesterase type 5 inhibitors (PDE-5Is) intake for erectile dysfunction on PLR and NLR before and after treatment.

Results: The current study showed that there were no statistically significant differences between the cases and the controls apart from the ArIIEF-5 scores. Moreover, there was no significant difference between patients in group A and those in group B regarding PLR and NLR post administration of PDE-5Is. Interestingly, patients in group A demonstrated a highly significant difference between the ArIIEF-5 scores as well as the PLR and the NLR before and 2 months after administration of daily tadalafil 5 mg. On the other hand, patients in group B who were administrated daily sildenafil 25 mg for 2 months demonstrated only a highly significant difference between the ArIIEF-5 scores before and after administration. Meanwhile, patients in group B did not reveal any statistically significant difference in the PLR and the NLR before and 2 months after administration of sildenafil 25 mg. Further regression analysis after adjustment of different variables of the study showed a significant correlation between ArIIEF-5 and PLR in patients who received daily tadalafil 5 mg (r=0.430, p=0.004).

Conclusions: Tadalafil and sildenafil have similar clinical efficacy in treating erectile dysfunction. However, tadalafil is more effective in lowering PLR and NLR compared to sildenafil.

Introduction: Peyronie's disease (PD) is characterized by fibrosis of the penile tunica albuginea. Conservative treatment options may involve oral and/or injectable medications.

Materials and methods: This case series includes four patients with PD in the first phase. The diagnosis of PD included a medical history; penile palpation; a physical examination of the penis, documenting penile deformity (Kelâmi method); penile dynamic Doppler ultrasound (PDDU) + elastography, measuring the plaque and calculating its volume (cm3), and the deformation index (strain ratio); and the completion of the following questionnaires: IIEF to assess erectile function, VAS to assess pain, and Peyronie's Disease Questionnaire (PDQ) symptom bother to evaluate the psychosexual impact of the disease. Diagnostic follow-up evaluations were conducted before and every 6-12 months throughout the conservative treatment. The four patients were treated at our andrology clinic between January 2019 and November 2023. Our treatment included the following: bilberry, propolis, ginkgo biloba, silymarin, L-carnitine, coenzime Q-10, Boswellia, superoxide dismutase, vitamin E, vitamin C, topical diclofenac gel, propolis cream, and perilesional penile injections with pentoxifylline for cases involving penile plaques with volumes of > 0.100 cm3.

Results: Complete resorption of the PD plaque after treatment occurred in all cases. The disappearance of Peyronie's plaque occurred over a period ranging from 18 to 36 months, in relation to the volume of the plaque.

Conclusions: Despite the limited sample size in our study, these patients verifiably achieved the complete resorption of the affected disease area. Our results will provide useful insights for uroandrological clinical practice. Nevertheless, randomized controlled trials with a larger number of PD patients are needed to demonstrate the effectiveness of multimodal antioxidant treatment.

Objective: To compare the safety profile and clinical outcomes of Altieri-modified Nesbit corporoplasty using two different anesthesia methods including spinal anesthesia and local anesthesia.

Materials and methods: A total of 40 patients with congenital penile curvature (CPC) and Peyronie's disease (PD) underwent Altieri-modified Nesbit corporoplasty. Group 1 (n = 20) received spinal anesthesia, and Group 2 (n = 20) received local anesthesia. The patients were categorized into age groups (< 30 years, 31-45 years, 46-60 years, and 61-75 years) for analysis. Clinical outcomes, post-operative complications, hospital stay, pain levels, and other parameters were assessed.

Results: The results showed that 2 patients (10%) reported postoperative complications, including headache, arterial hypotension, and penile foreskin necrosis from the spinal anesthesia group. Whereas, in the local anesthesia group, 1 patient (5%) reported scar phimosis. Further, post-operative pain was predominantly very mild, with 16 patients (80%) in the spinal anesthesia group and 14 patients (70%) in the local anesthesia group experiencing minimal discomfort. Age did not significantly impact hospital stay, post-operative intestinal disorders, constipation, lower urinary tract symptoms, voiding burning, or dysuria.

Conclusions: Spinal anesthesia may lead to more post-operative complications and longer hospital stays compared to local anesthesia. Age does not significantly affect most clinical outcomes but can influence post-operative pain in patients receiving local anesthesia.

Objective: This study aimed to identify the direct effect of vitamin D on sperm DNA integrity after swim-up preparation.

Materials and methods: Normozoospermia samples were gathered from 12 men and assessed for their baseline characteristics, including DNA Fragmentation Index (DFI). Each sample was then prepared using the swim-up method. Half of the samples were incubated with vitamin D, while the other half were incubated with a standard sperm-washing medium.

Results: Vitamin D significantly reduced the DFI compared to the baseline (5.5 ± 3.4% versus 17.6 ± 4.2%; p < 0.001) and the swim-up-only group (5.5 ± 3.4% versus 12.0 ± 4.2%; p < 0.001). Microscopic examination reflected these results, showing a reduction in the number of small halos and no halos with an increased appearance of large to medium-sized halos.

Conclusions: These results suggest that vitamin D incubation is valuable in protecting sperm from DNA damage that develops during sperm preparation. However, additional investigation is warranted to explore other preparation methods and to elucidate the underlying mechanisms.

Purpose: To evaluate transperineal reanastomosis (TRPA) combined with incontinence surgery as a complex treatment for recurring vesicourethral anastomosis stenosis (VUAS) after radical prostatectomy (RP).

Methods: Retrospective analysis of 8 patients who underwent TRPA for recurring VUAS. Detailed preoperative and follow up data were assessed.

Results: Mean follow up lasted 47 months (range 17-77) with mean age being 63.4 years (range 61-70). All patients achieved patency and 87.5% (7/8) maintained it to the end of follow up. However, four of them required additional procedures to retain patency. Six underwent incontinence surgery - artificial urinary sphincter (AUS) implantation - after which one cuff erosion occurred. In the end 62.5% (5/8) of patients achieved patent urethra and continence.

Conclusions: TRPA combined with incontinence surgery is a reasonable treatment for patients with recurrent VUAS. Nonetheless, this is a set of difficult surgeries that may ultimately end in failure, i.e. the inability to restore urethral patency, urinary incontinence or urinary diversion, hence they should be performed by experienced surgeons.

Objectives: To compare the efficacy of intrathecal fentanyl and dorsal penile nerve block for postoperative pain management in patients undergoing inflatable penile prosthesis (IPP).

Patients and methods: A prospective single-center study included 80 patients amenable to IPP. Patients were divided equally into two groups. Group I included 40 patients who were managed with spinal anesthesia with intrathecal fentanyl before undergoing IPP. Group II comprised 40 patients who received spinal anesthesia with dorsal penile block before IPP. Study groups were compared regarding postoperative VAS (Visual Analog Scale) scores, total narcotics consumption, patient satisfaction levels, and perioperative complications.

Results: The study groups were comparable regarding baseline patients' criteria. The operative time was comparable between the study groups, with group I and group II having respective median times of 64 minutes (interquartile range: 55-78) and 67 minutes (interquartile range: 56-81) (p = 0.65). Additionally, both groups demonstrated similar distributions in IPP implant cylinder and reservoir size (p = 0.9). Postoperative pain was higher in group I, with a statistically significant difference (p < 0.001). Eight patients in group I (20%) called the physician's office asking for pain medication, compared to two patients in group II (5%) (p = 0.04). 85% of patients in group II were highly satisfied compared to 50 % in group I (p = 0.003). We reported a 5% complication rate in group I compared to 2.5% in group II (p = 0.6).

Conclusions: The present study found that the dorsal penile nerve block offers superior postoperative pain control and patient satisfaction compared to intrathecal fentanyl for patients undergoing inflatable penile prosthesis insertion.

Objectives: Parkinson's disease is the most common neurodegenerative disease. Combining levodopa with other drugs, including decarboxylase inhibitors (DCI) is its most effective treatment. Urinary tract infection (UTI) is the most common cause of hospitalization in Parkinson's patients, making it crucial to find an appropriate treatment to reduce the incidence of this complication. This study aimed to investigate UTIs in Parkinson's patients using levodopa with DCI supplements.

Methods: In this systematic review and meta-analysis, databases such as PubMed, Scopus, Embase, Cochrane, and Web of Science were searched up to March 2024. Only randomized controlled trials involving Parkinson's patients were included in the present study. Parkinson's patients who used levodopa along with carbidopa or benserazide were considered the intervention group, while those who used levodopa with another drug were considered the control group.

Results: Nine interventional studies were ultimately analyzed. The relative risk (RR) of UTI in patients taking DCI was 26% lower than those who did not (RR Treatment/Control = 0.74, 95% CI: 0.58-0.95, p = 0.019). Furthermore, observations at different times of follow-up showed that at 13-24 weeks and at > 24 weeks of treatment with DCI, there was a reduction in the incidence of UTI (RR = 0.68, 95% CI: 0.46-1.01 and RR = 0.77, 95% CI: 0.58-1.0, respectively). On the contrary, there was an increase of the risk of UTI in the first 12 weeks of treatment with DCI (RR = 1.11, 95% CI: 0.37-3.33).

Conclusions: The results of this study indicated that using DCI drugs is associated with a reduced relative risk of developing UTIs. The beneficial effect of the drug showed after 12 weeks of treatment after an initial negative effect on the risk of UTI.

Introduction: Percutaneous Nephrolithotomy (PCNL) has been performed in various positions, including prone position and several modifications of supine position. The Barts flank-free modified supine (FFMS) position is a newly enhanced version of the supine positions. This study aims to compare the outcomes of Barts FFMS and prone position in PCNL.

Methods: This study followed PRISMA 2020 guideline and was registered to PROSPERO CRD42024530426. Comprehensive search in PubMed, Sciencedirect, and Scopus was conducted until May 2024. Stone-free rates, complications, surgery duration, fluoroscopy duration, use of nephrostomy, and length of stay were collected. Data were analyzed using RevMan 5.4.

Results: A total of 4 studies were included in this review. There was no significant difference in stone-free rates between Barts FFMS and prone positions (OR = 1.12, 95% CI 0.64-1.95, p = 0.70). There were no significant difference in incidence of fever (OR = 0.91, 95% CI 0.38-2.18, p = 0.84), need for blood transfusion (OR = 0.46, 95% CI 0.11-1.88, p = 0.28), and urine leakage (OR = 0.41, 95% CI 0.16-1.05, p = 0.06). The surgery duration was significantly shorter in Barts FFMS position than in prone position (MD = -15.48, 95% CI [(-26.42)-(-4.55)], p = 0.006). There was no significant difference in patients requiring nephrostomy (OR = 0.19, 95% CI 0.01-3.75, p = 0.28). There were no significant difference in fluoroscopy duration (MD = 0.27, 95% CI [(-6.85)-7.40], p = 0.94) and the length of hospital stay (MD = -0.20, 95% CI [(-0.74)-0.33], p = 0.46).

Conclusions: The surgery duration was significantly shorter in Barts FFMS position than in prone position. There were no significant differences regarding stone-free rates, complications, fluoroscopy duration, use of nephrostomy, and length of hospital stay. This indicates that neither Barts FFMS nor prone position is superior, and the choice should be based on the surgeon's preference and the patient's clinical status.

Background & objectives: Notably, 17-hydroxy progesterone (17-OHP) (17-OHP) is a precursor for testosterone (T) synthesis, and intratesticular testosterone (ITT) is essential for spermatogenesis. Varicocele (Vx) has an estimated prevalence of 15% in the general population and 35% in those with primary infertility. We aimed to evaluate the correlation between changes of serum 17-OHP after sub-inguinal micro-varicocelectomy and improvement of semen parameters.

Patients and methods: The current prospective study included 45 infertile men attending the andrology clinic form February 2021 to August 2021. Two semen analyses and hormonal profile were evaluated. Colored duplex ultasonography (CDUS) was done in standing and supine position for accurate measurements of testicular volumes and confirmation of Vx. Patients underwent sub-inguinal micro-varicocelectomy using a surgical microscope HB surgitech. We followed them prospectively up for three months following micro-varicocelectomy with serum TT and 17-OHP.

Results: Sperm concentration improved significantly from 8.36 ± 5.04 million/ml to 12.52 ± 8.42 million/ml after 3 months following sub-inguinal micro-varicocelectomy (p= 0.001), with normalization of concentration in 15/45 (33%) patients. Total motility did not improve significantly but progressive motility improved significantly from 8.62 ± 8.74% to 16.24 ± 14.45% (p=0.001). Abnormal forms significantly declined from 96.67 ± 2.03% to 95.75 ± 2.47% (p=0.009).  Serum 17 OHP and 17 OHP/total testosterone (TT) improved significantly from 1.21 ± 0.45 ng/ml and 0.26 ± 0.09 to 1.42 ± 0.76 ng/ml and 0.3 ± 0.16 (p= 0.013, p= 0.004), respectively, while serum TT did not improve significantly. A significant correlation was found between improvement in sperm concentration and both serum 17 OHP and 17 OHP/TT ratio (p=0.001, p=004). Furthermore, change in abnormal sperm forms showed significant correlations with changes in both 17-OHP and 17-OHP/TT.

Conclusion: 17 OHP and 17OHP/ TT ratio can be used as biomarkers to detect improvement in semen parameters following sub-inguinal micro-varicocelectomy.