Archivio Italiano di Urologia e Andrologia最新文献

Introduction: This study aimed to evaluate the learning curve of transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy performed by a multidisciplinary team comprising a single urologist, radiologist, and pathologist. We analyzed the temporal changes in overall prostate cancer detection rates and clinically significant prostate cancer (csPCa) detection rates.

Methods: We retrospectively enrolled consecutive patients with clinically suspected prostate cancer (PCa) who underwent MRI/US fusion prostate biopsy at a single center from January 2019 to December 2022. The patients were divided into four cohorts based on the year of biopsy to assess temporal variations in the outcomes. Univariate and multivariate analyses were performed to model detection rate curves.

Results: Overall, 291 patients underwent targeted biopsy (TBx) and standard biopsy (SBx) during the study period. Multivariate analysis showed that the overall PCa diagnosis was significantly higher when prostate biopsy was performed after the first year (2019; 74 patients), particularly in 2022 (OR 11.68, CI 3.08-49.1). The csPCa detection rate increased significantly from 13.5% to 40.0%, p=0.03).

Conclusions: Cumulative experience and teamwork may increase the overall PCa detection rate, specifically csPCa detection rate. Transperineal MRI fusion-guided biopsies combined with a standard template provided a higher overall cancer and csPCa detection rate than the standard template or targeted biopsy alone. Multidisciplinary team meetings and procedure standardization are key factors in overcoming the learning curve.

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Introduction: To evaluate the use of transcutaneous perineal ultrasound to guide prostate biopsy in men previously submitted to rectal amputation.

Materials and methods: From January 2018 to January 2025, 10 men aged between 47 and 76 years (median age: 56 years) previously submitted to proctocolectomy (7 men for rectum cancer and 3 men for benign disease) were evaluated for the suspicion of prostate cancer (PCa). The indications for biopsy were PSA >10 ng/mL or PSA values between 4.1-10 ng/mL with free/total PSA <25% and/or PSA density >0.20. All the patients submitted for the first time to biopsy underwent extended scheme (ePBx: 12-18 cores); in addition, all the patients underwent multiparametric magnetic resonance (mpMRI) and in the presence of a Prostate Imaging-Reporting and Data System-version 2 (PI-RADS) score ≥3 a cognitive targeted biopsy (TPBx:  4 cores) was added to the systematic prostate biopsy. Biopsies were freehand using 18-gauge automatic biopsy needles under perineal real-time ultrasound guidance (3.5 MHz convex probe).

Results: Median PSA was 9.7 (range: 4.8-27 ng/mL); in 1/10 (10%) patient mpMRI was negative, conversely in 3 (30%) vs 3 (30%) vs 3 (30%) men, PIRADS score was 3 vs 4 vs 5, respectively. Overall, a csPCa (ISUPGrade Group > 2/Gleason score > 3+4) was found in 5/10 (50%) patients; PCa was located in the peripheric zone in 4 (80%) cases and 1 (20%) case in the anterior zone of the gland. In detail, ePBx vs. TPBx biopsies diagnosed 5/5 (100%) and 4/5 (90%) csPCa. One patient diagnosed with csPCa had negative mpMRI, 1 and 3 men had PIRADS score 4 and 5, respectively. None had clinical complications that needed hospital admission.

Conclusions: Transcutaneous perineal ultrasound-guided prostate biopsy allows for the performance of accurate systematic and targeted biopsies in men with suspicious PCa previously submitted to rectal amputation.

Background: Premature ejaculation (PE) is one of the common male sexual disorders and is associated with autonomic nervous system imbalance. P-wave dispersion (PWD), a marker of atrial electrical heterogeneity and a predictor of atrial arrhythmias, has not been previously investigated in the PE population. This study aimed to investigate PWD in patients with PE and to evaluate whether the subtypes of PE, namely acquired (APE) and lifelong (LLPE), differ in terms of atrial conduction parameters.

Methods: Seventy-eight male patients were included in the study. The distribution of patients was 40 healthy controls, 21 patients with APE, and 17 patients with LLPE. All patients underwent 12-lead electrocardiography to evaluate PWD. Echocardiographic, hormonal, and biochemical parameters were recorded to exclude confounding factors. PWD was defined as the difference between the maximum (Pmax) and minimum P-wave durations (Pmin).

Results: PWD was significantly increased in both PE groups compared to the control group (APE: 44.4 ± 4.1 ms; LLPE: 48.1 ± 2.1 ms; control: 38.2 ± 3.4 ms; p<0.001). Pmin was significantly lower in the PE groups, while Pmax remained comparable among all groups. There was no significant difference in PWD between the PE groups (p=0.38). All patients had normal echocardiographic and hormonal parameters, and there were no significant differences in age, body mass index, blood pressure, or heart rate between the groups.

Conclusions: PWD was significantly higher in patients with PE. This indicates that patients with PE are at a higher risk of developing cardiovascular diseases like atrial fibrillation.

Background: Trocar site hernia is a recognized but often underreported complication of minimally invasive surgery, including robotic-assisted radical prostatectomy. While relatively rare, trocar site hernia can lead to severe complications such as bowel obstruction, strangulation, and the need for emergency surgical intervention. Trocar size has been identified as a primary risk factor, with hernias occurring predominantly at sites where 10 mm or larger trocars are used. However, the role of fascial closure is still debated.

Methods and results: A systematic literature review (1992-2022) identified 21 cases of trocar site hernia in 13 studies. Only 8 papers provided data on the total number of RaRP procedures which were associated to the reported cases of TSH, with 15 cases of TSH identified out of 3,418 RaRP procedures. Statistical analyses were conducted to assess significant risk factors and potential prevention strategies. Specifically, of the 19 cases in which trocar size was explicitly reported, 15 hernias were associated with 12 mm trocars and 4 with 8 mm trocars (p<0.001). Fascial closure was not performed in all reported cases involving 12 mm trocars. No significant correlations were found between trocar site hernia incidence and patient-related factors such as age, body mass index, or prior hernias. Additionally, we report a case of trocar site hernia following RARP in a 67-year-old male with a BMI of 33.46 and a history of prior abdominal hernioplasty. The patient developed bowel obstruction on postoperative day 4 due to a hernia at a 12 mm trocar site, requiring emergency laparotomy and bowel resection with end-to-end anastomosis.

Conclusions: Given the strong association between TSH and 12 mm trocars, we suggest routine fascial closure at these sites to reduce the risk of postoperative complications. Further studies are necessary to confirm these findings. Additionally, other potential risk factors and mechanisms contributing to trocar site hernia development in patients undergoing robot-assisted radical prostatectomy should be investigated.

Introduction: Benign prostatic hyperplasia (BPH) significantly impairs quality of life and may lead to complications such as urinary retention and recurrent infections. While endoscopic enucleation techniques provide effective relief, they are frequently associated with loss of antegrade ejaculation. The Leonardi Ejaculation-Sparing Technique (LEST) was developed to preserve ejaculatory function during diode laser enucleation of the prostate (DILEP).

Methods: We conducted an observational, retrospective analysis of 99 men undergoing DILEP with LEST between January 2018 and June 2020. Inclusion criteria were symptomatic BPH refractory to medical therapy, prostate volume ≥40 mL, and suitability for endoscopic surgery. Functional outcomes (IPSS, Qmax, PVR), erectile function (IIEF-5), and ejaculatory status (MSHQEjD) were assessed preoperatively and at 6 months. Patient satisfaction was evaluated with a dedicated 5-item questionnaire.

Results: Mean age was 48.1 years, and median prostate volume was 67 mL. At 6 months, IPSS decreased from 21.6 to 3.8, Qmax improved from 9.1 to 25.7 mL/s, and PVR decreased from 103 to 6.8 mL (all p<0.01). Erectile function showed modest improvement (IIEF-5: 14.4 to 16.2; p<0.01). Antegrade ejaculation was preserved in 94.1% of patients. Satisfaction was high, with > 80% willing to repeat the procedure and denying regret. No major complications occurred.

Conclusions: DILEP with LEST provides excellent functional results with high rates of ejaculatory preservation and patient satisfaction. This technique may represent a patient-centered alternative for BPH surgery, especially in younger men prioritizing sexual function.

Background: Penile fracture is one of the rare urological emergencies resulting in rupture of the tunica albuginea in the penile corpora cavernosa. Sexual intercourse is known to be the most common aetiology of penile fracture, which usually happens during erection. Immediate surgical intervention is crucial to avoid any complications. Erectile dysfunction is the most feared complication after surgery. This meta-analysis aimed to analyse and determine risk factors of erectile dysfunction among patients who underwent penile fracture surgery.

Methods: Literature searching was conducted in several databases, e.g., Pubmed, Cochrane, ScienceDirect, Google Scholar and DOAJ by applying the Boolean term method. Statistical analyses and risk of bias assessment were calculated through RevMan 5.4.1 and the Newcastle Ottawa Scale (NOS), respectively. Outcomes were presented as odds ratio (OR).

Results: A total of 6 studies were included, encompassing 527 patients who were diagnosed with penile fracture and underwent surgery for repairment. Risk factors for post-surgery erectile dysfunction were calculated. Age (OR = 0.19, 95% CI [0.07, 0.52], p=0.001), location of fracture (OR = 0.43, 95% CI [0.22, 0.84], p=0.01), and side of fracture (OR = 0.06, 95% CI [0.02, 0.21], p<0.0001) have significant relations with erectile dysfunction. Whereas aetiology, urethral injury, and timing of presentation have statistically non significant effect on the incidence of erectile dysfunction.

Conclusions: This systematic review and meta-analysis showed that patients over 50 years of age, those with midshaft fracture, and those with bilateral fractures are significantly more likely to have erectile dysfunction following penile fracture surgery.

Background and aim: It is well recognized that one of the most significant public health concerns is chronic kidney disease (CKD). In a cohort of incident CKD patients without dialysis, or on hemodialysis (HD), or on peritoneal dialysis (PD), the complicated interactions between bone marrow iron, serum ferritin levels, and death rates were examined.

Materials and methods: For this prospective and observational study, 288 CKD patients who were registered in three institutions between January 2022 and December 2023 were initially recruited. The final analysis comprised 200 patients, chosen based on predetermined inclusion and exclusion criteria.

Results: The median age of all patients was 65.52 ± 8.36, with 102 patients (51%) being male. Of the patients followed up, forty (20%) died. Cardiovascular events accounted for 22.5% of deaths (9 patients), and infections accounted for 70% of deaths. An elevated ferritin level (HR 1.528, 95% CI 1.239-1.885, p < 0.001) and advanced age were important risk factors for infection-related cardiovascular disease.

Conclusions: It was demonstrated that higher blood ferritin levels were substantially linked to a higher risk of death and that the most common causes of death of CKD patients in Iraq are infection-related.

Background: Prostate cancer (PCa) is the most prevalent cancer among men in the European Union, the USA and Israel, with heritability being a key risk factor. Endogamy and kinship are known to increase the likelihood of transmitting genetic mutations associated with various cancers, as seen in populations with high levels of consanguinity, such as Ashkenazi Jews. The Ashkenazi Jewish population, with a history of genetic bottlenecks and selective migrations, has a higher prevalence of inherited mutations that predispose individuals to various diseases including cancer. This article reviews the literature examining the potential effects of founder mutations specific to Ashkenazi Jews, in enhancing the genetic risk of prostate cancer in this population.

Methods: We searched for English-language articles on DNA mutations in Ashkenazi Jewish patients of any age with prostate cancer of any grade, including various study types, using PubMed and other databases with relevant keywords, and confirmed the search was up-to-date as of January 31st, 2025.

Results: While the overall burden of PCa may not be higher than in European non-Jews, certain founder mutations in Ashkenazi Jews, especially 6174delT in BRCA2, are linked to increased risk and aggressive forms of PCa. Further research is needed to ascertain unequivocally the potential predisposing role of mutations such as 185delAG in BRCA1 or 471delAAAG in RNASEL.

Conclusions: Overall, genetic screening for PCa risk in Ashkenazi Jewish men, particularly within high-endogamy subgroups (Haredim), may be beneficial. Increasing awareness of familial hereditary prostate cancer among Ashkenazi men and healthcare providers is also crucial for early detection and better management of the condition. The complexity of PCa genetics in Ashkenazim, including the influence of multiple low-penetrance mutations, the possible confounding factor of phenocopies, and the need for larger, more diverse studies, underscores the challenges in identifying definitive genetic risk factors. Further studies are awaited investigating in-depth the aggressiveness and response to treatment of PC among Ashkenazi Jews.

Introduction: The metastatic spread of cancer to the penis is a very rare clinical entity generally associated with disseminated disease and poor prognosis. The aim of this paper was to show the outcomes of a series of patients treated for metastatic cancer to the penis and enhance the understanding and the management of penile metastasis in order to improve patients' care and outcomes.

Methods: We retrospectively analyzed the medical records of 31 patients diagnosed with metastatic cancer to the penis and treated at eight Ligurian urological departments between January 2014 and January 2024. Clinical characteristics, physical examination findings, diagnostic evaluations, treatment options and follow-up data were assessed.

Results: 27 (87%) patients had a prior history of malignancy with a metachronous metastasis. The most common primary site of malignancy was the genitourinary tract (71.1%) followed by the gastrointestinal tract (16.1%). The time interval from the diagnosis of the primary tumour to the detection of the penile metastasis was 36.0 months. The penile metastasis generally appeared with a mass (54.8%) and pain (29%), more rarely with priapism (6.5%), oedema (6.5%) and hematuria/urinary disorders (3.2%). The metastatic lesion required a total penectomy in 17 (54.8%) patients and a partial penectomy in 8 patients (25.8%). At a follow-up of 15.9 (1-75) months, 4 (18.2%) patients were still alive with disease.

Conclusions: Our data confirmed penile metastasis as a rare entity usually associated with clinical symptoms involving the penis in the context of a known primary malignancy, mainly from the neighboring pelvic organs, with a poor prognosis. The majority of our patients required a total penectomy with a negative impact on their quality of life. These aspects highlighted the importance of a penile examination and an early diagnosis of a penile metastasis during the follow-up schedule of many patients with a history of previous oncologic disease.