Archivio Italiano di Urologia e Andrologia最新文献

Background: Premature ejaculation (PE) affects about 30% of the male population. The European Association of Urology (EAU) guidelines state that monotherapy dapoxetine on-demand has been successfully used to treat PE throughout Europe. Several studies have stated that when dapoxetine and phosphodiesterase-5 inhibitor (PDE-5i) are used combined, sexual enjoyment and intravaginal ejaculation latency time (IELT) are increased more than when dapoxetine is taken alone. However, further investigation is needed to determine whether PDE-5i and dapoxetine can be safely consumed together.

Methods: This study was conducted using 5 randomized controlled trials (RCTs), which systematically extracted from online databases, namely Science Direct, PubMed, Google Schoolar and Cochrane Library. Included studies were assessed using Cochrane Risk of Bias (RoB) 2.0 for RCTs. The data analysis was performed using RevMan software 5.1 of the Cochrane Collaboration.

Results: Five RCTs with a total of 498 potent men with PE from the period 2013-2024 showed pooled mean difference of dapoxetine + PDE-5i was found significantly associated with higher post-treatment IELT scores compared to monotherapy dapoxetine (MD 1.08; 95% CI 0.34-1.83; p=0.004; I2 = 95%; 4 RCTs). The pooled mean difference of dapoxetine + PDE-5i also showed statistically significant association with higher post-treatment sexual satisfaction scale (SSS) scores compared to monotherapy dapoxetine (MD 0.76; 95% CI 0.49-1.04; p<0.00001; I2 = 68%; 2 RCTs). Among 10 adverse effects (headacahe, flushing, nausea, dizziness, fatigue, nasal congestion, palpitation, vomitting, sleep disturbance, and constipation), the use of combination therapy is presenting significantly higher incidence of headache, flushing, nasal congestion compared to monotherapy dapoxetine (RR 3.00; 95% CI: 1.91-4.71; p<0.00001; I2: 0%; 5 RCTs), (RR 15.78; 95% CI: 5.48-45.45; p<0.00001; I2: 24%; 5 RCTs), (RR 9.00; 95% CI: 1.17-69.01; p=0.03; I2: 0%; 2 RCTs), respectively.

Conclusions: This study demonstrates that the combination of dapoxetine and PDE-5i significantly improves post-treatment scores of IELT and sexual satisfaction compared to dapoxetine monotherapy. Despite an increased risk of certain side effects, the overall tolerability of the combination therapy remains favorable.

Dear Editor, Prostate cancer (PCa) remains one of the most common malignancies among men worldwide, representing a major healthcare burden both in terms of morbidity and economic cost...

Introduction and objective: Circumcision is the most frequently performed surgical procedure worldwide. The World Health Organization recommends that circumcisions be performed by dorsal slit incision. This study introduces the dorsal buttonhole slit, a novel modification of the conventional dorsal slit technique, and aims to evaluate its clinical outcomes and safety in a pediatric cohort.

Materials and methods: This retrospective descriptive study was conducted on 107 pediatric patients aged 1-10 years who underwent circumcision for religious reasons or phimosis between January 2022 and December 2023. Patients were divided into two groups based on the surgical technique used: dorsal buttonhole slit (n=56) vs conventional dorsal slit (n=51). The assessment parameters included intra-operative hemorrhage, operating time, healing time, postoperative complications, and parental satisfaction.

Results: The mean operative time was significantly shorter in the dorsal buttonhole slit group compared to the conventional group (293.79 vs 320.67 seconds, respectively; p=0.028). There was no significant difference in wound healing time between the two groups. No postoperative complications, such as hemorrhage or need for revision, were observed in any patient during the 1-month follow-up period. All parents reported satisfaction with the functional and cosmetic results.

Conclusions: The dorsal buttonhole slit technique was associated with a shorter operative time and excellent safety outcomes. While these results are promising, prospective randomized trials are required to definitively confirm the efficacy and safety of this method. The technique shows potential as a reproducible and reliable alternative for pediatric circumcision.

Background: Standard medical treatments for patients with uncomplicated LUTS include alpha-blockers, 5-alpha-reductase inhibitors (5ARIs), phosphodiesterase type 5 inhibitors, antimuscarinics, and beta-3 agonists. The lipido-sterolic extract of Serenoa repens (Sr) is also recommended as a therapeutic option. Our study prospectively evaluated the impact of a 6-month assumption of lipido-sterolic extract of Sr alone or in combination with Phenolmicin P3 and Bosexil medical devices suppositories on symptoms and on PSA levels in patients affected by BPO related-LUTS.

Methods: We prospectively enrolled 509 patients: 194 (group 1) were prescribed only a 6-month assumption of Sr extract, while 315 (group 2) were also prescribed a 20-day therapy with Phenolmicin P3 and Bosexil medical devices suppositories.

Results: After 6 months, 371 patients' data were registered and analyzed. Furthermore, patients' withdrawal and motivations were also considered.

Conclusions: In our clinical study, the patients treated with Sr extract (320 mg daily) showed a significant relief regarding LUTS, and the association of a 6-month assumption of Sr extract with a 20-day prescription of Phenolmicin P3 and Bosexil medical device in suppository form seems to significantly improve both efficacy on LUTS and decrease of PSA levels.

Background: diabetes mellitus (DM) is associated with testicular damage, leading to male infertility. This study investigates the effects of telmisartan, moderate-intensity aerobic exercise, and their combination on testicular histopathology in a streptozotocin-induced diabetic rat model.

Methods: male Wistar rats were divided into five groups: healthy control (K0), diabetic control (K1), telmisartan monotherapy (K2), aerobic exercise monotherapy (K3), and combination therapy (K4). Diabetes was induced using streptozotocin (STZ), and treatments were administered for 10 weeks. Testicular histopathology was assessed by evaluating Johnsen score, Sertoli cell count, Leydig cell count, and seminiferous tubule diameter.

Results: diabetic rats (K1) showed significant declines in Johnsen score, Sertoli and Leydig cell counts, and seminiferous tubule diameter (p<0.05). Telmisartan (K2) and combination therapy (K4) significantly improved all parameters, with values approaching those of healthy controls (K0). Aerobic exercise (K3) improved seminiferous tubule diameter but had limited effects on Johnsen score, Sertoli, and Leydig cells. Kruskal- Wallis, Mann-Whitney U, ANOVA, Games-Howell, and LSD tests confirmed these findings.

Conclusions: Telmisartan, either as monotherapy or in combination with moderate-intensity aerobic exercise, effectively ameliorates testicular damage in diabetic rats. Aerobic exercise alone has a partial protective effect. These findings suggest potential therapeutic strategies for preventing diabetes-induced male infertility.

Background: Khat (Catha edulis) chewing is a culturally ingrained practice in Yemen and has been associated with potential impairment of male reproductive function. However, rigorous quantitative assessments of its effects on seminal parameters are limited. This study investigates the relationship between khat consumption and semen characteristics and examines the reversibility of any adverse effects following cessation.  Methods: A prospective two-phase study was conducted at Dr. Najat Al-Malas IVF Center in Sana'a, Yemen (2019-2024). Phase 1 compared semen volume and related parameters across four age-, BMI-, education-, and socioeconomic-matched cohorts: infertile khat chewers (n=91), infertile non-chewers (n=60), fertile khat chewers (n=91), and fertile non-chewers (n=32). Phase 2 involved a three-month supervised khat cessation intervention among infertile chewers. Semen samples were obtained via standardized collection methods. Associations between khat use and seminal parameters were analyzed using univariate and multivariate regression models.  Results: Khat chewers demonstrated significantly reduced semen volumes compared to non-chewers in all comparisons. Infertile chewers had lower volumes (1.94±0.48 mL) than fertile chewers (2.36±0.52 mL; p<0.001, d=0.85) and infertile nonchewers (3.07±0.74 mL; p<0.001, d=1.72). Pooled analysis indicated that chewers (n=182) had 29.6% lower semen volumes than non-chewers (n=92) (2.15±0.89 mL vs. 3.04 ± 0.76 mL; p<0.001). Notably, cessation of khat chewing led to a 35% increase in volume among infertile chewers (from 1.94±0.48 mL to 2.62 ± 0.52 mL; p<0.001, d=1.21). Hormonal analysis (n=15) showed increased testosterone and decreased prolactin post-cessation (p<0.05).

Conclusions: Khat chewing is significantly associated with reduced semen volume and impaired seminal fluid parameters in men. Importantly, cessation of khat use leads to a marked improvement in semen volume and favorable hormonal changes, indicating partial reversibility of its adverse effects. These findings highlight khat's detrimental impact on male reproductive health and underscore the potential benefits of quitting khat for fertility restoration.

Background: Benign prostatic hyperplasia (BPH) is a common age-related condition that often results in lower urinary tract symptoms (LUTS), reduced quality of life, and sexual dysfunction. Conventional pharmacotherapies, while effective, are frequently associated with adverse effects on sexual and ejaculatory function. This study evaluated the sexual safety and clinical efficacy of a dietary supplement containing pollen extract and teupolioside, in men with BPH.

Methods: In this prospective, single-arm observational study, 25 men with moderate LUTS due to BPH received daily pollen extract and teupolioside supplementation for 90 days. The primary endpoints were sexual function (International Index of Erectile Function, IIEF-5), ejaculatory function (Male Sexual Health Questionnaire-Ejaculatory Dysfunction, MSHQ-EjD), quality of life (IPSS-QoL), and patient global impression of improvement (PGI-I). Secondary endpoints included changes in urinary flow (Qmax) and LUTS severity (International Prostate Symptom Score, IPSS). Assessments were conducted at baseline, 1 month, and 3 months.

Results: Sexual and ejaculatory functions remained stable over the treatment period, with no statistically significant deterioration observed. QoL improved significantly by the 3-month mark (IPSS-QoL median score reduced from 3 to 2; p<0.008), and PGI-I scores reflected high patient satisfaction (median 2, IQR 1). Qmax significantly increased from 12.4 mL/s at baseline to 15.5 mL/s at 3 months (p<0.001), and IPSS scores significantly declined from 11 to 8 (p<0.008), indicating improved urinary function.

Conclusions: The pollen extract and teupolioside supplementation was well tolerated and associated with improved QoL and urinary outcomes, without compromising sexual or ejaculatory function. These findings support its potential as a non-pharmacologic adjunct in the management of BPH, particularly in patients concerned about sexual side effects. Further randomized controlled studies are warranted to confirm these results.

Background: urinary incontinence (UI) and overactive bladder (OAB) are common lower urinary tract symptoms that significantly impact quality of life. Conventional pharmacologic treatments are often associated with side effects and limited efficacy, highlighting the need for alternative therapies. Vitamin D, known for its role in muscle function and its presence in the receptors of the bladder and prostate, has been proposed as a potential non-invasive intervention. This study aimed to evaluate the effectiveness of vitamin D supplementation in the management of UI and OAB.

Methods: a systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Twelve studies (six RCTs and six cohort studies) were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool. Statistical analysis was conducted using Review Manager 5.4. Standardized mean differences (SMDs) and risk ratios (RRs) were used to compare outcomes. A meta-analysis was performed using a random-effects model, which was applied due to heterogeneity, as assessed by the I² statistic. Sensitivity analysis was performed using the leave-one-out method.

Results: no significant difference was found between the vitamin D and control groups in improving UI scales (SMD = -1.04; 95% CI: -2.35 to 0.27, p=0.12) with an I² of 94%. There were no significant effects on the risk of OAB (RR = 1.03, p=0.16) or UI (RR = 0.88, p=0.59), nor on UI improvement or worsening. The sensitivity analysis revealed that excluding one unusual study resulted in more consistent results and confirmed similar patterns.

Conclusions: no substantial advantage of vitamin D was observed in UI or OAB patients compared to the control groups.

Background: People with spinal cord injury (SCI) may suffer from anejaculation due to functional obstructive azoospermia (OA). Testicular sperm extraction (TESE) may successfully overcome this problem, even if the optimal timing is controversial.

Objectives: The primary aim of this study was to report our experience with TESE in SCI, focusing on the effect of time since SCI event on the TESE outcomes.

Materials and methods: We included all consecutive people with SCI and functional OA undergoing TESE between January 2011 and December 2021 in four Italian tertiary referral centers. We recorded TESE sample parameters, sperm retrieval rate (SRR) and intracytoplasmic sperm injection (ICSI) outcomes. Logistic regression analysis was performed to assess whether time since SCI was significantly associated with these outcomes. The time since SCI was considered in three different ways: 1) continuously; 2) ≤9 years vs >9 years; 3) ≤5 years, >5 and ≤10 years, >10 years.

Results: We included 32 patients with tetraplegia and 75 with paraplegia, undergoing 107 TESE procedures. The median age at surgery and time since SCI were 33 years (IQR 29-38) and 9 years (IQR 3-14), respectively. The SRR was 81.3%. Thirty-three out of 87 patients underwent ICSI, achieving pregnancy in 63.6% after one cycle. The final live birth rate was 90.5%. Logistic regression analyses outlined that the SRR was not affected by considered variables, including time since SCI, considered both continuously and categorically.

Conclusions: Our SRR did not prove to be negatively affected by all considered variables, especially by the time since SCI. Clinicians should not deter SCI patients with functional OA from undergoing TESE after a long time since SCI.

Introduction: Urethral stricture, characterized by urethral narrowing due to fibrosis and scar tissue, is a common urological condition. It occurs in about 200 per 100,000 people, with increasing incidence over the past 50 years. Internal urethrotomy is commonly performed for short strictures, but its high recurrence rate has led to the exploration of adjunctive treatments like adjunct of triamcinolone application. This study aimed to analyze the effect of triamcinolone as adjunctive therapy for internal urethrotomy on reducing urethral stricture recurrence in urethral stricture patients.

Methods: A systematic search was conducted in PUBMED, ScienceDirect, and Google Scholar. This review was conducted according to the PRISMA guideline, and the protocol has been registered in the PROSPERO database (CRD42020202254).

Results: Six RCTs, including 373 urethral stricture patients, were eligible for this study. Pooled results of the included studies showed a significant difference between the triamcinolone and control groups, indicating a lower recurrence rate in the triamcinolone group (OR = 0.49 95% CI 0.31-0.77, p=0.002). A significant difference was seen in the ointment with clean intermittent catheterization (CIC) intervention subgroup (OR = 0.47 CI 95% 0.26-0.82, p=0.009), but not in the submucosal injection subgroup (p>0.05). The treatment and control groups had similar maximum urinary flow rate (Qmax) at six and twelve months (p>0.05).

Conclusions: Triamcinolone ointment with CIC reduced urethral stricture recurrence following internal urethrotomy, whereas submucosal injection did not. Both treatments do not increase the maximum urinary flow rate.