Archivio Italiano di Urologia e Andrologia最新文献

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.

Introduction & objectives: Salvage vesiculectomy has been proposed by several experts to deal with isolated seminal vesicle recurrence (ISVR). Although initial research has shown that the salvage vesiculectomy is successful, there is still disagreement over its clinical efficacy and safety due to the lack of strong randomized controlled trials. To support the clinical use of salvage vesiculectomy, this study intends to assess its safety, outcome and clinical impact.

Materials and methods: Electronic databases including PubMed, Embase, Cochrane Library, and Google Scholar were widely searched for studies until 2025. The primary outcome was recurrence rate, and secondary outcomes were overall survival, complications, deaths and time to recurrence. The Joanna Briggs Institute (JBI) critical appraisal was assessed for risk of biases. The registration number in PROSPERO was CRD420251054103.

Results: According to the selection criteria, we identified 6 publications with a total of 227 patients. The results revealed that the pooled overall survival was 96% [95% CI: 0.88-1.00]. The recurrence rate was 63% [95% CI: 0.56-0.70]. The therapy-free survival was 33.15 months [95% CI: 27.45-40.03 months]. The time to recurrence was 19.59 months [95% CI: 17.63-21.78 months]. The incidence of complications rate was 14% [95% CI: 0.03-0.25], and the pooled incidence of death was 3% [95% CI: 0.00-0.07].

Conclusions: Faced with this supporting data, salvage vesiculectomy can be used as a secondary treatment for localized prostate cancer recurrence in the seminal vesicle for highly selected patients.

Background: Erectile dysfunction (ED) is a common male sexual disorder with significant psychosocial and physiological impacts. While modifiable risk factors such as body mass index (BMI), serum testosterone, and vitamin D levels have been linked to ED, regional data from the Caucasus, including Azerbaijan, are limited.

Methods: This retrospective cohort study included 965 Azerbaijani men aged 35-75 years who presented with symptoms suggestive of ED between 2019 and 2024. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5). An IIEF-5 score of ≤21 was considered as ED. Serum total testosterone, 25-hydroxyvitamin D [25(OH)D] levels, and BMI were evaluated. Correlations and multivariate logistic regression analyses were conducted to identify independent factors associated with IIEF-5-defined ED in symptomatic men.

Results: Among men presenting with ED-related symptoms, 54.4% met the IIEF-5 criteria for ED. Obesity (BMI ≥30 kg/m2) was present in 46.1% of participants and significantly more common in men with ED (58.3% vs 31.6%, p<0.001). Total testosterone levels <10 nmol/L were observed in 54.7% of men with ED vs 46.1% without (p=0.008). Spearman analysis showed inverse correlations between IIEF-5 scores and BMI (r = -0.316, p<0.001), and a positive correlation with testosterone (r = 0.108, p<0.001). No associations were found between 25(OH)D levels and ED. In multivariate analysis, obesity remained an independent factors associated with IIEF-5-defined ED (OR: 2.969, 95% CI: 2.27-3.88, p<0.001).

Conclusions: Obesity and low testosterone levels are significantly associated with ED in Azerbaijani men presenting with ED related symptoms. In contrast, vitamin D status was not an independent predictor. These findings underscore the importance of addressing weight and hormonal health in ED management strategies.

Background: Non-obstructive azoospermia (NOA) cases may have severely deficient spermatogenesis and inadequate sperm production. Despite increasing clinical investigations emphasizing the safety of mesenchymal stem cell (MSC) therapy in NOA cases, no article has recently reviewed the adverse events and carcinogenicity after transplantation.

Objective: the study was conducted to evaluate the safety and potential carcinogenic effects of autologous human bone marrow- MSCs implanted into the testes of patients with NOA.

Methods: This retrospective cohort study was conducted throughout the period from January2017 to January 2022, encompassed 100 patients aged 20-40 years with primary infertility, with NOA for at least 2 years duration who had a confirmed diagnosis of NOA, based on two separate semen analyses showing azoospermia with centrifugation, conducted at least three months apart. Patients were submitted to intratesticular transplantation of autologous bone marrow-derived mesenchymal stem cells. Records of all participants were examined to acquire the demographic data of patients, laboratory investigations including β-HCG, ECG, AFP, LDH, and scrotal ultrasound examination.

Results: there is no significant malignancy or cancer occurrence post- MSCs therapy as indicated by the normal level of the tumor marker levels for LDH (183.4 ± 31.5) u/L, AFP (3.16 ± 1.6) ng/ ml, CEA (2.27 ± 1.1) ng/ ml, and β-HCG (0.95 ± 0.2) mIU/mL. Additionally, scrotal ultrasound showed no focal findings in all cases.

Conclusions: there is no carcinogenic effect of mesenchymal stem cells implanted into testes.

Purpose: The aim of this work is to present the clinical experience and outcomes in the management and follow up of bladder diverticular neoplasm.

Methods: Following institutional board approval and informed consent obtained from each patient, a total of 10 patients, from January 2021 to December 2023, underwent robotic-assisted bladder diverticulectomy with the preservation of the bladder. All the cases were performed with a four port transperitoneal approach plus two laparoscopic ports for the second surgeon, opting for an extravesical dissection of the diverticular neck. A tailored follow up for each patient was planned with cytological examination, cystoscopy and imaging. All patients were screened to confirm localized disease and to exclude obstructive disease and LUTS to avoid high post voiding volumes.

Results: To date, all patients involved in the study have adhered to the follow up protocol and remain alive and free of recurrent disease. Catheters were successfully removed in all ten patients, after a negative cystography for leakage at seven days. Pathological examination confirmed clear surgical margins in 100% of the cases. The average length of the procedure was 112 minutes, with minimal blood loss and a mean hospital stay of 3,7 days. No major complication occurred.

Conclusions: Our case series demonstrated the safety and feasibility of this approach, achieving favourable operative times, minimal blood loss and absence of leakage. The outcomes also highlight improvement in terms of reduction of catheterization duration, hospital stay and QoL of the patients.

Introduction: To evaluate the use of urethral drug-coated balloon (DCB) in the treatmentof recurrent urethral strictures.

Materials and methods: From January 2023 to June 2025, twenty males (median 69 years) with recurrent urethral strictures were evaluated: 7/20 (35%) had urethral-bladder neck stenosis following radical prostatectomy, 11/20 (55%) and 2/20 (10%) had bulbar and anterior stenosis. All the patients previously underwent in 19/20 cases endoscopic urethrotomy (1-3 times) and in one case urethroplasty for hyospadias; median flow max was 5/ml/sec and post voiding urine residual was 150 ml; one man had suprapubic catheter. Urethral stenosis was measured by ultrasound (US) using saline water injected through the external meatus; moreover, US guided urethral dilatation was performed. Strictures were pretreated with an uncoated balloon or by stenosis incision; the inflation of Optilume®  DCB occurred for 7 min to allow complete stricture dilation and paclitaxel delivery. Finally a 18 Ch catheter was allocated in the bladder and removed five days later. Clinical outcomes included: average Qmax, International Prostate Symptoms Score (IPSS), IPSS quality of life (QoL), International Index of Erectile Function (IEFF-5) and over time rate of repeated intervention (dilation, endoscopic urethrotomy or urethroplasty).

Results: None had side effects during and following the procedure; all the patients improved their IPSS, IEEF-5 and none underwent repeated urethral treatment during the follow up. QoL improved together with sexual activity; although, IPPS score and flow max were improved but not restored to normal values all the patients had a good QoL refusing additional instrumental evaluation during the follow up. In detail, at a median 12 months of follow up IPSS, QoL and post-voiding urine residual and IEEF-score improved of 63%, 60%, 78% and 50%, respectively.

Conclusions: Although the limited number of patients evaluated and follow up, DCB demonstrated a good alternative for men with anterior and posterior urethral stenosis who have an unsuccessful endoscopic urethrotomy or dilation who want to avoid urethroplasty.

Introduction & objectives: Stress urinary incontinence (SUI) frequently affects women and can negatively impact their physical health, emotional state, and social life. In recent years, growing interest in less invasive treatment options has prompted the development of vaginal laser therapy (VLT) as a potential alternative for patients who have not responded to conventional treatments before considering more invasive procedures. However, the clinical effectiveness of VLT remains controversial across studies. This review aims to assess the effectiveness and safety of VLT in managing SUI.

Materials & methods: A comprehensive search of the literature was carried out in PubMed, ScienceDirect, and Scopus databases using appropriate keywords. The methodological quality of the selected studies was evaluated with the Revised Cochrane Risk of Bias tool (RoB 2). Data were analysed through meta-analysis using Review Manager version 5.4. The protocol of this systematic review was registered in PROSPERO (CRD420251164307).

Results: A total of seven studies involving 584 participants were analysed. The results demonstrated that VLT significantly improved ICIQ-UI SF [MD = -1.54 (-2.15 - (-0.93), p<0.00001], PISQ-12 [MD = 1.22 (0.47-1.96), p=0.001], and FSFI [MD = 1.62 (0.41-2.82), p=0.009] compared with the sham laser group. Across most studies, only minor adverse events related to the VLT intervention were reported.

Conclusions: Our study demonstrated that VLT led to a statistically significant improvement in ICIQ-UI SF, PISQ-12, and FSFI scores among patients undergoing the procedure. Additional research is needed to directly compare VLT with other therapeutic options, including urethral bulking agents and non-invasive approaches for SUI.

Background: Urinary tract infections (UTIs) are a major global health concern, particularly in resource-limited regions where antimicrobial resistance (AMR) is increasingly prevalent. This study aimed to describe the demographic characteristics, pathogen distribution, and antimicrobial resistance patterns among UTI patients, and to identify clinical predictors of multidrug-resistant (MDR) and extensively drug-resistant (XDR) infections.

Methods: A retrospective analysis was conducted on 216 clinically confirmed UTI cases processed at the Infectious Bacteriology and Biochemistry Laboratory affiliated with IBB University between January 2023 and September 2024. Data collected included patient demographics, clinical symptoms, comorbidities, bacterial isolates, and antimicrobial susceptibility profiles. MDR and XDR were classified according to internationally recognized definitions. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of MDR/XDR infections.

Results: The majority of patients were adults aged 15-65 years (83.3%, n=180), with a slight male predominance (53.2%, n=115). Escherichia coli was the most frequently isolated pathogen (29.6%, n=64), followed by Staphylococcus aureus (19.0%, n=41) and Pseudomonas aeruginosa (6.0%, n=13). A substantial proportion of isolates exhibited MDR or XDR phenotypes (80.1%, n=173). Among E. coli isolates, resistance rates to ciprofloxacin and ceftriaxone exceeded 60%. Notably, all Klebsiella pneumoniae isolates were MDR (100%), and 92.3% of P. aeruginosa isolates were MDR. Nitrofurantoin and carbapenems demonstrated relatively higher susceptibility rates. Multivariate analysis identified prior hospitalization (adjusted odds ratio [aOR] = 3.15; 95% CI:1.50-6.60; p=0.002) and E. coli infection (aOR = 2.41; 95%CI: 1.02-5.70; p=0.04) as significant predictors of MDR/XDR infections.

Conclusions: The high prevalence of MDR and XDR uropathogens, particularly E. coli, underscores the urgent need for sustained antimicrobial resistance surveillance and stewardship programs in resource-limited settings. Identifying key clinical predictors can inform empirical treatment strategies, improve patient outcomes, and help contain the spread of resistant organisms.

Introduction: Varicocele affects 10-15% of adult males, and is linked to infertility (35%) and testicular pain (10%). Microsurgical varicocelectomy (MV) is considered the gold standard treatment due to its low complication rates and superior anatomical outcomes. However, conventional MV using a 2D exoscope presents limitations in image depth and surgeon ergonomics. This study presents the use of a 3D video exoscope as a novel tool to enhance visualization and ergonomics during MV.

Materials and methods: We report a series of four patients undergoing 3D-assisted microsurgical varicocelectomy using a Zeiss microscope integrated with a 3D video exoscope system. Patients presented with either infertility, testicular pain, or both, with varicocele diagnoses confirmed by physical examination and ultrasound. Procedures were performed subinguinally with artery- and lymphatic-sparing techniques, and the ergonomics and image quality were assessed.

Results: All surgeries were successfully completed with the aid of the 3D exoscope. Surgeons reported improved ergonomics, reduced neck and back strain, and enhanced image depth and clarity. The system allowed for up to 10x optical magnification, full-screen UHD 3D visualization, and a wide field of view. No intraoperative complications were noted. Patients tolerated the procedure well, and early outcomes were favorable in terms of symptom relief and semen parameter improvement.

Conclusions: The integration of a 3D video exoscope in microsurgical varicocelectomy is a promising innovation. It offers superior image quality, improved surgeon comfort, and may enhance surgical precision. Further studies with larger cohorts and long-term follow-up are warranted to validate these findings.