Archivio Italiano di Urologia e Andrologia最新文献

Introduction: Tumor regression grade (TRG) is a recognized prognostic marker in several solid tumors treated with neoadjuvant therapy, but its clinical relevance in muscle-invasive bladder cancer (MIBC) remains under investigation. This study aimed to evaluate the prognostic value of TRG and its integration with pathological TNM staging in patients with MIBC treated with neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC).

Materials and methods: We conducted a retrospective analysis of 51 patients with MIBC who received platinum-based NAC followed by RC and lymphadenectomy between 2013 and 2024. TRG was assessed according to the Fleischmann classification and combined with ypTNM stage to categorize patients as complete, partial or non-responders. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier analysis, and independent prognostic factors were identified through Cox regression models.

Results: Complete response (ypT≤1, ypN0, TRG1) was observed in 43.1% of patients. Median OS was 19 months, with 3- and 5-year OS rates of 28.6% and 14.3%, respectively. Complete responders demonstrated significantly improved OS and DFS (p<0.001). On multivariable analysis, absence of nodal involvement (p=0.047) and complete response (p=0.012) were independently associated with better OS. Negative surgical margins showed a trend toward improved survival (p=0.064).

Conclusions: TRG is a reproducible and clinically meaningful histopathologic scoring system that enhances prognostic stratification when combined with pathological TNM staging. Its integration into routine post-NAC assessment may improve postoperative decision-making and help identify patients who could benefit from tailored surveillance or adjuvant strategies.

To the Editor More than a century has passed since 1903, when Professor David von Hansemann described the presence of macrophages deposited in the form of a soft plaque and coined the term of Greek origin, malakoplakia (MLP). A year later, the morphology of this cell with its own name was completed by the contribution of Michaelis and Gutmann, who pointed out the inclusions in its cytoplasm...

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.

Introduction & objectives: Renal cell carcinoma (RCC) represents the majority of kidney malignancies and is characterized by variable outcomes, even with current systemic therapies. Interleukin-6 (IL-6), a proinflammatory cytokine implicated in tumor progression and immune suppression, has been proposed as a prognostic biomarker in RCC. However, the evidence remains inconsistent due to methodological heterogeneity across studies. Therefore, our study aims to evaluate the prognostic significance of IL-6 in RCC by synthesizing data from published studies, specifically overall survival (OS) and progression-free survival (PFS).

Methods: A systematic meta-analysis was conducted to evaluate the prognostic significance of IL-6 in RCC. Eligible studies were identified through PubMed, ScienceDirect, and ProQuest up to March 2025. Inclusion criteria encompassed original articles measuring pre-treatment serum IL-6 levels in RCC patients and reporting associations with overall survival (OS) or progression-free survival (PFS). Random-effects models were used to compute pooled hazard ratios (HRs) and survival differences.

Results: Nine studies comprising 702 RCC patients were included. Patients with low IL-6 levels had significantly longer OS (difference: 5.36 months; 95% CI: 2.2-8.53; p<0.001; I² = 0%) and PFS (difference: 6.41 months; 95% CI: 1.3-11.53; p=0.01; I² = 48.5%) compared to those with high IL-6. The pooled HR for survival associated with elevated IL-6 was 2.06 (95% CI: -0.23-4.36), with considerable heterogeneity (I² = 89.19%) and borderline statistical significance (p=0.08). Despite variations in study design, sample size, and IL-6 detection methods, elevated IL-6 consistently predicted worse clinical outcomes.

Conclusions: IL-6 is a promising prognostic biomarker in RCC, with elevated levels associated with significantly poorer OS and PFS.

Background: Double J (DJ) ureteric stent encrustation is a troublesome complication that may impede its removal. The proposed study aims to investigate the effect of ascorbic acid supplementation on reducing DJ stent encrustations and identify potential risk factors.

Methods: A multi-center, non-concurrent cohort study involved patients who had DJ ureteric stents from July 2017 to January 2024. Group I comprised 359 patients who took 500 mg of ascorbic acid supplements three times daily that continued until the time of DJ removal. In contrast, Group II consisted of 483 patients who did not use the supplement. The study groups were compared in terms of patient demographics, stone criteria, double-J stent encrustations, and stent-related adverse events. The KUB grading system for stent encrustations was utilized.

Results: The study enrolled 842 patients with a prevalence of stent encrustations of 20.43%. The mean K, U, and B scores were 2.14, 1.91, and 2.15, respectively, and the mean total K.U.B. score was 6.2 ± 2.91. The study groups were comparable in terms of patient demographics; however, nine patients (2.5%) in group I had stent encrustations, compared to 163 (33.7%) in group II, with a statistically significant difference (p<0.001). Urinary tract infections (UTIs) were more prevalent in group II at 57.8%, compared to 30% in group I (p=0.02). Lack of treatment with ascorbic acid male gender, and longer duration of indwelling stents were significant predictors of stent encrustations (p<0.05).

Conclusions: Our study has demonstrated that ascorbic acid supplementation could reduce the incidence of encrustations on double- J ureteric stents. Lack of ascorbic acid administration, male gender, and prolonged stent indwelling time were significant predictors for stent encrustations.

Introduction & objectives: Prostate cancer is recognized as a global burden disease related to malignancy in men. Several fruit and plant-based supplementation have been studied to evaluate their utility for the management of prostate cancer. Ajwa dates (Phoenix Dactylifera L.) have been known to contain various beneficial compounds, which makes them a potential anti-cancer therapy. The aim of this study was to assess the effect of Ajwa dates on prostate cancer cell lines PC3 through analysis of MCL-1 levels, EGFR, and p53 expressions on apoptosis.

Materials & methods: This study was an experimental in vitro study with post-test-only control design. Groups were divided into four: control group, abiraterone group, Ajwa dates group, and combination group (abiraterone and Ajwa dates). Viability test was conducted using the CCK-8 method to determine the inhibitory concentration (IC50) of Ajwa dates after a 72-hour incubation period of PC3 cells. The MCL-1 levels were rated using ELISA, while EGFR and p53 expressions were analyzed using immunofluorescence microscopic staining. Apoptosis was measured using fluorescence-activated cell sorting (FACS). SPSS version 25 and R-studio were used for statistical analysis.

Results: This study found the IC50 for Ajwa dates was 913.3 μg/ml. Our data indicated that Ajwa dates decrease the MCL-1 levels, EGFR and p53 expression and also induced apoptosis compared to control. Furthermore, these effects became more evident when combined with abiraterone.

Conclusions: This study demonstrates the potential of Ajwa dates as a complementary therapy for prostate cancer, but further research is still needed before clinical testing is carried out.

Introduction: Urolithiasis in children has become a clinical concern because of its longterm impact on kidney function and quality of life. In previous studies, the role of urinary biomarkers in predicting the risk of urolithiasis in children was still unclear due to inconsistent findings. This meta-analysis aimed to evaluate the diagnostic potential of various urinary risk factors in children with urolithiasis.

Methods: A systematic review and meta-analysis was performed based on PRISMA 2020 guidelines, registered in PROSPERO (CRD42025644893). A total of six studies (1 cohort and 5 case-control) involving 2,060 pediatric patients (817 with urolithiasis; 1,243 controls) were analyzed. Urinary risk factors - including citrate/creatinine (Cit/Cr), oxalate/creatinine (Ox/Cr), calcium/creatinine (Ca/Cr), phosphorus/creatinine (P/Cr), magnesium/ creatinine (Mg/Cr), and urea/creatinine (Ur/Cr) - were examined. Standard Mean Differences (SMD) were calculated, and heterogeneity was assessed using the I² statistic.

Results: Significant differences were obtained in the Cit/Cr, Ca/Cr, Ox/Cr, and Mg/Cr ratios between children with urolithiasis and controls. Hypocitraturia (Cit/Cr SMD: -0.60, 95% CI: -0.90 to -0.30, p = 0.0001), hyperoxaluria (Ox/Cr SMD: 0.76, 95% CI: 0.37-1.16, p = 0.0001), hypercalciuria (Ca/Cr SMD: 0.55, 95% CI: 0.10-1.01, p = 0.02), and hypomagnesuria (SMD -0.13 (95% CI: -0.24 to -0.01), p = 0.03) were significantly associated with the formation of stones in the urinary tract. On the contrary, there were no significant relationships for P/Cr and Ur/Cr ratios.

Conclusions: This meta-analysis highlights Cit/Cr, Ox/Cr, and Ca/Cr ratios as potential urinary biomarkers to identify the risk of urolithiasis in pediatric patients. Hypocitraturia, hyperoxaluria, and hypercalciuria are the main metabolic abnormalities that contribute to urinary tract stone formation. Future studies with standardized methodology are essential to confirm these findings and guide clinical management strategies.

Background: Diabetes mellitus (DM) is a chronic disease with globally increasing prevalence, significantly impacting quality of life, including erectile dysfunction (ED). Moderate-intensity aerobic exercise has been shown to improve metabolic and cardiovascular parameters, yet limited studies have examined its effect on erectile function. This study aimed to explore the effect of aerobic exercise on the expression of alpha-smooth muscle actin (α-SMA) and endothelial nitric oxide synthase (eNOS) in the penile tissue of diabetic rat models.

Methods: This true-experimental study used 24 male Rattus norvegicus (Wistar), aged 12 weeks, randomly assigned to three groups: control (C), diabetic without intervention (NE), and diabetic with aerobic exercise (E). The aerobic exercise was performed for 60 minutes per session, 5 days a week, for 10 weeks. The expression of eNOS and α-SMA in penile tissues was analysed by immunohistochemistry and quantified by Image J Software Version 1.54p. Statistical analysis was performed using SPSS software version 29.0, including tests for homogeneity and normality, followed by one-way ANOVA with LSD or Tukey post-hoc tests for normally distributed data, or the Kruskal-Wallis test for non-normal distributions.

Results: There was no significant difference in eNOS expression among the three groups (p>0.05). However, α-SMA expression showed a significant difference among the three groups (p<0.05). Group E showed a significant increase in α-SMA expression compared to Group NE (p=0.034).

Conclusions: Moderate-intensity aerobic exercise improves α-SMA expression in the penile tissue of diabetic rats, contributing to better erectile function. Although it did not affect eNOS expression, this finding supports the potential of exercise-based non-pharmacological therapy for managing ED in diabetic patients.

To the Editor, We read the meta-analysis by Ananda et al. with great interest and congratulate the authors on their contribution...