Archivio Italiano di Urologia e Andrologia最新文献

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.

Background: The Dornier Compact Delta® III Pro is a next-generation extracorporeal shock wave lithotripter featuring flat-panel detector technology for enhanced imaging and a compact modular design. This study evaluates treatment outcomes and predictors of failure for this system, representing the first published clinical experience.

Methods: We retrospectively analyzed the first 1,000 consecutive patients treated with the Dornier Compact Delta® III Pro for renal or ureteric stones between May 2022 and November 2023 at a secondary hospital. Stone-free status was assessed via radiography, ultrasonography, or computed tomography (CT) within three months post-treatment. Predictive factors for treatment failure were identified through univariate and multivariate logistic regression analyses.

Results: The cohort had a median age of 37 years (IQR: 32- 44.2) and a body mass index (BMI) of 26 kg/m² (IQR: 24-29). Key characteristics included: prior urologic interventions in 36.6% of patients, single stones in 79.8% (median size 9 mm, IQR: 7-10), a median stone density of 1000 Hounsfield Units (HU) (IQR: 760-1200), and hydronephrosis observed in 55.3% of cases. Initial ESWL success was achieved in 80.5% of cases, increasing to 87.5% following repeat sessions (mean treatments: 1.2). Multivariate analysis identified four independent predictors of treatment failure: prior urologic intervention (adjusted odds ratio [aOR] 2.64, 95% CI 1.75-4.00, p<0.001), multiple stones (aOR 0.45, 95% CI 0.24-0.77, p = 0.011), increased skin-to-stone distance (per cm: aOR 1.18, 95% CI 1.06-1.30, p<0.001), and higher stone density (per 100 HU: aOR 1.12, 95% CI 1.06-1.18, p<0.001).

Conclusions: The Dornier Compact Delta® III Pro achieved an 87.3% stone-free rate with failure predictors consistent with established lithotripsy literature. These findings support the adoption of this device as an effective ESWL system, particularly for institutions prioritizing advanced imaging and a space-efficient design.

Background: Data on complications associated with emergency ureteroscopy for ureteral stones are limited, particularly in developing countries. This study investigates factors contributing to complications in emergency ureteroscopy utilizing a pneumatic semirigid ureteroscope (URS).

Materials and methods: This retrospective analysis included 266 patients with ureteral stones who underwent emergency ureteroscopy using a pneumatic semirigid URS from 2018 to 2023. We extracted comprehensive data on patient demographics, stone characteristics, intraoperative and postoperative complications, and stone-free rate (SFR) from medical records, subsequently subjected to statistical analysis. Factors linked to complications were explored through univariate and multivariate analyses.

Results: The mean stone size was 9.1 ± 4.9 mm, with the majority (n = 181, 71.3%) located in the mid-ureter. The mean operative duration was 57.7 ± 7.3 min. The overall complication rate was 10.2%, with intraoperative complications in 16 patients (6.0%), including mucosal damage (3.4%), stone up-migration (3.0%), and one ureteral perforation (0.4%). Postoperative complications occurred in 13 patients (4.9%), primarily fever (2.6%), followed by hematuria (1.1%). Additional complications included febrile urinary tract infections (UTIs), pyelonephritis, and one mortality. The overall SFR was 85.3%, with 39 patients (14.7%) demonstrating residual stones. Significant predictive factors for complications included larger stone size (Adjusted Odds Ratio [AOR]: 1.3; 95% Confidence Interval [CI]: 1.15-1.39, p<0.0001) and proximal ureteral stones (AOR: 4.9; 95% CI: 1.31-18.23, p=0.0182).

Conclusions: Emergency ureteroscopy using a semirigid URS demonstrated favorable outcomes in treating ureteral stones, characterized by minimal complications and an acceptable SFR. Emphasizing appropriate instrument selection, surgical expertise, and technique is crucial in minimizing adverse events, particularly for large and upper ureteral stones.

To the Editor, The current grading system for prostate cancer (PCA) includes 5 Grade Groups (GG): GG1 (Gleason score ≤ 6); GG2 (Gleason score 3+4); GG3 (Gleason score 4+3); GG4 (Gleason score 4+4; or 3+5; or 5+3); GG5 (Gleason scores 4+5/5+4/5+5). The GG system is one of the most important predictors of outcome in PCA patients...

Introduction: About 20-30% of cases of infertility are attributed to male factor and males are also contributing to infertility in a further 20%. Idiopathic male subfertility is the commonest cause in most cases. D-aspartic acid (D-Asp) is an endogenous amino acid occurring in several tissues and cells of both invertebrates and vertebrates. The current study is one of the first to evaluate the in vivo supplementation of D-aspartic acid in idiopathic male infertility. Thus, we aimed in the current study to evaluate the in vivo effect of D-aspartic acid, zinc and co-enzyme Q 10 supplementation on different semen parameters and serum testosterone level in idiopathic male infertility.

Methods: A total of 75 infertile patients were recruited from the outpatient andrology clinic from March 2023 to June 2024. The current study was registered at the UMIN clinical registry trials prior to initiating the study (UMIN000050023). Group (A) included 24 infertile patients who received 2660 mg d-aspartic acid plus 200 mg of ubiquinol plus 10 mg zinc once daily for 3 months. Group (B) included 24 infertile patients who received placebo (starch granules) daily for 3 months.

Results: Interestingly, patients in group (A) who received 2660 mg d-aspartic acid plus 200 mg of ubiquinol plus 10 mg zinc once daily for 3 months showed significant improvement in progressive sperm motility after 3 months (10.63 ± 8.64 vs 15.21 ± 12.11, p=0.047). Also, they showed highly significant increase in total testosterone level (5.06 ± 1.74 vs 5.89 ± 1.62, p=0.009).

Conclusions: D-aspartic acid plus ubiquinol plus zinc are promising ingredients that showed good results when administrated once daily to infertile males.

Introduction: Recent studies have shown the therapeutic benefits of pembrolizumab in locally advanced or metastatic urothelial carcinoma (mUC). However, its high cost and variable patient responses remain challenges. This study aims to investigate the prognostic value of pre-treatment hematologic and clinical parameters in predicting outcomes in mUC patients.

Methods: A comprehensive search was conducted across five databases for relevant articles. Studies that assessed the relationship between pre-treatment hematological and clinical parameters and either progression free survival (PFS) or overall survival (OS) were included and evaluated for bias.

Results: The literature search identified 27 studies encompassing a total of 4,731 patients. Several prognostic factors linked to OS were identified, with the most adverse survival outcomes associated with hypoalbuminemia (HR 3.13, 95% CI: 2.52-3.88), ECOG-PS ≥2 (HR 2.94, 95% CI: 2.65-3.26), and the presence of liver metastasis (HR 2.44, 95% CI: 2.16-2.76). Additionally, the presence of bone, liver, or lung metastases, ECOG-PS ≥ 2, surgical excision of the primary tumor, elevated C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), and low hemoglobin levels were all correlated with unfavorable PFS and OS.

Conclusions: Patients with metastatic urothelial carcinoma and poor performance status, visceral metastases, high NLR or CRP, or low hemoglobin may have poorer survival, even with pembrolizumab. These factors may help guide clinical decisions for patients with advanced/metastatic urothelial carcinoma.

Objective: This study aimed to evaluate the influence of prior laparoscopic experience on the learning curve and surgical outcomes of robotic-assisted radical prostatectomy (RaRP).

Methods: A retrospective analysis was performed on 101 patients treated between 2021 and 2023. Two surgeons at the beginning of their robotic learning curves were compared: one with extensive prior laparoscopic experience and the other without such a background. Perioperative, oncological, and functional outcomes were assessed, with a specific focus on Pentafecta criteria. Statistical analyses and cumulative sum (CUSUM) charts were employed to evaluate performance trends and surgical outcomes.

Results: Surgeon A, with substantial prior laparoscopic expertise, demonstrated shorter operative times (p = 0.015), reduced intraoperative blood loss, and superior early functional outcomes. Specifically, patients operated on by Surgeon A exhibited higher pad-free continence rates and improved erectile function recovery at 12 months postoperatively (p < 0.01). Additionally, nerve-sparing procedures performed by Surgeon A showed a trend toward fewer positive surgical margins, although this difference did not reach statistical significance. CUSUM analysis revealed more stable and consistent performance trends for Surgeon A in achieving Pentafecta outcomes compared to Surgeon B.

Conclusions: Previous laparoscopic experience significantly contributes to shortening the learning curve for RaRP and enhancing early functional outcomes. This advantage is likely attributable to greater surgical anatomical knowledge. These findings highlight the importance of tailored training programs and the potential for skill transfer between laparoscopic and robotic approaches. Further studies are warranted to refine surgical education strategies and improve patient care outcomes.

To the Editor, Benign prostatic hyperplasia (BPH) is a highly prevalent histological condition in aging men that can commonly cause lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). BPH typically begins developing after the age of 40 and affects approximately 50-60% of men by age 60...

Objective: To compare statistical outputs from ChatGPT 4.0 and human experts in both comparative and correlation analyses in the evaluation of multiparametric MRI/ultrasound fusion-targeted biopsy plus random biopsy versus standard random biopsy alone, in terms of upstaging.

Methods: Authors performed a retrospective evaluation on 101 patients undergoing robot-assisted radical prostatectomy (RaRP) between 2021 and 2023. Patients were divided in two groups, according to the type of prostatic biopsy received: combined fusion (MRI/US) targeted and random biopsy versus standard random biopsy. Clinical and histological data were anonymized and analyzed using logistic regression models, ANOVA, and Chi-square tests. Analysis generated by ChatGPT and by an experienced human statistician were compared. The Q-EVAL and Q-EVA tools were used to assess the quality of user-formulated questions and AI-generated answers, respectively.

Results: Results revealed high concordance between statistical outputs generated by AI and expert human statistician with perfect concordance using Cohen's kappa coefficient (κ = 1.0). Logistic regression analysis demonstrated that fusion biopsy was associated with a reduced likelihood of upstaging, a consistent finding across statistical evaluations. Additionally, user interaction assessments indicated high-quality in question formulation.

Conclusions: ChatGPT (version 4.0) proved reliable for statistical analysis, showing strong concordance with human statisticians (κ = 1.0) in performing logistic regression, chi-square, and ANOVA tests. The Q-EVAL tool could reduce query errors, though ChatGPT's lack of automatic citations remains a limitation. Fusion biopsy significantly lowered upstaging risk after RaRP. In conclusion, ChatGPT is a valuable assistive tool but further research is required to optimize human-AI collaboration in clinical research.