Archivio Italiano di Urologia e Andrologia最新文献

Objectives: To assess the effectiveness of laparoscopic varicocelectomy in patients with clinical versus subclinical varicocele concerning preoperative and postoperative seminal parameters.

Patients and methods: Between February 2021 and August 2024, a total of 162 patients diagnosed with varicocele (72 with subclinical and 90 with clinical presentation) seeking infertility advice (primary or secondary) at the author's institution underwent laparoscopic varicocelectomy and were enrolled in the study. All patients underwent history taking, clinical examination, semen analysis, and scrotal colour Doppler ultrasonography. Patients with recurrent varicocele, azoospermia, or infertility due to causes other than varicocele were excluded from the study. Semen analysis was conducted for all patients before laparoscopic varicocelectomy and 3 to 6 months after varicocelectomy.

Results: Significant improvements in seminal parameters were observed in patients with clinical varicocele (p < 0.05). Bilateral and right-sided varicoceles were more prevalent in patients with subclinical varicocele. Additionally, the incidence of secondary infertility was higher in patients with subclinical varicocele compared to those with clinical varicocele (p<0.05).

Conclusions: Our study indicates favourable outcomes of laparoscopic varicocelectomy in patients with clinical varicocele. Regarding the effects of varicocelectomy in patients with subclinical varicocele, we recommend avoiding varicocelectomy in subclinical group of patients unless no identifiable causes of semen abnormality.

Introduction: Vasectomy is one of the most effective ways of contraception. However, it still has various complications, including post-vasectomy sexual dysfunction. Some studies suggest that one of the sexual performance problems can be linked to psychological factors. However, other studies indicate that vasectomy can have positive effects on patient's sexual lives. Because of these conflicting findings, the purpose of this article is to examine the sexual outcome post-vasectomy using a systematic review of current studies.

Methods: We performed the search using electronic databases MEDLINE, Pub Med, and Science Direct. We used "vasectomy", "vasectomies", and "sexual outcome", and "sexual quality" in the text keywords. Eleven studies, six case-control studies, and five cohorts met the inclusion criteria for this review.

Results: Studies reported a significant improvement in IIEF scores, sexual desire, sexual satisfaction, and orgasm domain after vasectomy. However, a study found that low acceptance of vasectomy can lead to erectile dysfunction, and vasectomized men are slightly more likely to report problems in maintaining their erections.

Conclusions: This systematic review shows that, although rare, there are complications after vasectomy. These complications can be related to decreased sexual function for patients after vasectomy. As a urologist, it is essential to offer adequate counseling to patients before vasectomy.

Prostate-specific membrane antigen (PSMA) is expressed in most primitive and metastatic prostate cancer (PCa), and PSMA inhibitors conjugated with the radionuclides Gallium 68 (68Ga) and fluoride 18 (18F) have been evaluated to detect PCa; moreover, tumour uptake, which represents PSMA expression, is highly correlated with the aggressiveness of the primary prostatic tumour. PSMA positron emission tomography/computed tomography (PET/CT) demonstrated to be sensitive for the detection of primary prostatic lesions, regional lymphadenopathy and clinical metastases in case of biochemical recurrence. In this respect, PSMA PET/CT has been evaluated in men enrolled in clinical trials candidate to initial or repeat prostate biopsy especially in the presence of clinical high risk for PCa, Active Surveillance (AS) and/or in case of negative histology of Prostate Imaging Reporting and Data System (PI-RADS score) 4-5 targeted biopsy. Although many experimental studies reported a superimposable detection rate for PCa of PSMA PET/CT vs. mpMRI targeted biopsy, still today, the use of PSMA PET/CT is experimental and had some limitations: cost, availability, patient characteristics, local expertise and false negative rate. Although prospective and randomized studies are awaited, including a greater number of patients, PSMA PET/CT evaluation could be proposed in the presence of claustrophobia, cardiac pacemaker and severe obesity especially in men at high risk for PCa.

Objective: This meta-analysis aims to compare the efficacy and safety of tadalafil and silodosin as medical expulsive therapy (MET) for lower ureteric stones below 10 mm. The study also assesses the incidence of adverse effects associated with each drug.

Methods: A comprehensive search of electronic databases was conducted up to October, 2024. The study included randomized controlled trials (RCTs) and cohort studies that compared tadalafil and silodosin in patients with lower ureteric stones (5-10 mm). The primary outcomes assessed were stone expulsion time (SET), stone expulsion rate (SER), and adverse effects. Data were analyzed using a random-effects model for heterogeneity and a fixed-effect model for non-heterogeneity.

Results: Eight studies involving 797 patients were included. The pooled analysis showed no significant difference in SET between tadalafil and silodosin (MD = 0.15, 95% CI [-0.28, 0.57], p=0.50), with significant heterogeneity. Similarly, the pooled analysis showed no significant difference in SER between the two drugs (RR = 0.92, 95% CI [0.80 to 1.05], p=0.22), with heterogeneity. However, after excluding one study, silodosin was favored over tadalafil for SER (RR 0.88, 95% CI [0.79 to 0.98], p=0.02). There were no significant differences in headache, backache, or dizziness. Silodosin was associated with a higher incidence of orthostatic hypotension, but this was resolved by excluding one study. A significant difference for abnormal ejaculation favored tadalafil (RR = 0.16, 95% CI [0.09 to 0.29], p=0.01).

Conclusions: While the pooled results initially showed no significant difference in SET and SER, silodosin demonstrated a superior stone expulsion rate after adjusting for heterogeneity silodosin showed a trend towards shorter SET. However, silodosin was associated with a higher risk of orthostatic hypotension and abnormal ejaculation. Further high-quality RCTs with larger sample sizes are needed to confirm these findings.

Introduction and objectives: Ureteral stenosis and upper urinary tract obstruction present significant clinical challenges, especially in cases involving complex, long strictures. Traditional management options like ureteral stents and percutaneous nephrostomy tubes often result in complications and diminished quality of life. Extra-anatomical urinary diversion (EAUD) offers an alternative approach, particularly for oncologic patients requiring palliative care.

Materials and methods: From 2015 to 2019, eight patients with cancer-related ureteral strictures underwent EAUD. In all patients cancer-specific prognosis exceeded one year. The procedure was performed using a standard surgical technique.

Results: The mean patient age was 62.5 years, ranging from 22 to 82 years. The mean follow-up duration was 62.8 months. Improvement in renal function was observed in some patients, while the early complication rate was 62.5%. Notable complications included infections and encrustation of the prosthesis. Two patients experienced multiple infections of the overlying skin and soft tissue necessitated the dislodgement of the prothesis after 38 and 101 months, respectively.

Conclusions: Extra-anatomical stent placement constitutes a somewhat effective and safe option in the context of complex ureteral obstruction management in oncologic patients. The lack of external devices and its longer duration without the need for substitution compared with conventional double J stents can theoretically assure a better quality of life. However, a careful patient selection is needed in order to maximize the patients' benefit.

Purpose: With multi-institutional collaboration, the purpose of this study was to analyze geographical differences of renal cell carcinoma with tumor thrombus between patients in North America, Central/South America, and South Korea.

Materials and methods: Patients with renal cell carcinoma and a tumor thrombus who underwent nephrectomy plus thrombectomy were retrospectively analyzed. Patients were from North America, Central/South America, and South Korea. All comparisons were done based on the region where a patient had their surgery and follow-up. Chi-squared test, analysis of variance, Kaplan-Meier survival with log-rank test, and Cox regression analysis were used.

Results: A total of 478 patients were included, 212 from North America, 209 from Central/South America, and 57 from South Korea. Of note, thrombus level was different using the Neves classification system between regions (p<0.001), with a greater thrombus level in Central/South America. Surgical approach differed, with laparoscopic cases done most often in Central/South America and robotic in North America (p<0.001). Tumor grade was lowest in South Korea (p<0.001) and stage (p<0.001) greatest in Central/South America. Overall survival was greater in South Korea compared to Central/South America (p=0.026). Cancer-specific survival was greater in South Korea relative to North America and Central/South America (p=0.026).

Conclusions: Patients from North America, Central/South America, and South Korea diagnosed with renal cell carcinoma and tumor thrombus do not present the same and have different outcomes peri-/post-operatively. This includes important variables which have impacts on patient morbidity and mortality. Considering increased efforts on health equity in urology.

Introduction: Genital Lichen Sclerosus (GLS) is a chronic inflammatory disease due to autoimmune events that occurs in anogenital region. It seems to affect mostly women but both the etiology and the prevalence of the disease are largely unknown. The aim of this cross-sectional study was to examine the real-world diagnostic and therapeutic experiences of patients with GLS, focusing on their perceptions and expectations regarding disease management.

Methods: Utilizing Google Forms, we developed a questionnaire consisting of 10 items aimed at examining the diagnostic and therapeutic experiences of patients with GLS. This survey was distributed via email to all members of the Italian Association of Patients with Lichen Sclerosus (LISCLEA), which includes 564 female and 216 male members. The survey was accessible for a period of 48 hours in February 2020.

Results: Of the 780 members surveyed, 280 (36.3% response rate) completed the questionnaire, comprising 226 females (80.7%), 53 males (18.9%), and 1 respondent (0.4%) who did not declared her/his gender identity. A significant 34% of respondents waited over five years for a correct diagnosis of GLS. Diagnostic challenges were frequently reported, with a majority (78%) believing that doctors' knowledge about LS is inadequate. Moreover, 63.9% expressed a need for better medical training concerning GLS, supported by calls for more research networks (42.5%) and specialized centers (26.1%). GLS had a severe impact on sexual health and relationships; 57.3% reported anxiety due to GLS, and 39% avoided intercourse because of symptoms like pain and discomfort. The majority (95%) received local treatments, while a small percentage (5%) underwent surgical interventions such as circumcision. The diagnostic and therapeutic process was perceived as difficult by most patients (82%).

Conclusions: GLS profoundly affects patients' quality of life, causing significant anxiety, discomfort, and often hindering sexual activity. The study highlights the commonality of late diagnoses and the insufficient referral of patients to specialists, underscoring the need for greater awareness and expertise among healthcare providers. Enhancing doctor awareness and knowledge could facilitate earlier diagnosis and more effective management of GLS, thereby improving outcomes for those affected by this debilitating condition. This research advocates urgent enhancement in both medical education regarding GLS and the establishment of more specialized care pathways to better address the complexities of this disease.

Kidney stone disease, or nephrolithiasis, is a prevalent urological condition with variable pathogenesis. Among various factors, urine pH is not only considered to be a more influential factor in stone formation and can aid in the early diagnosis and management of specific stone types such as uric acid, cystine, calcium phosphate and struvite stones, but the role of urine pH in calcium oxalate stones, which comprise most cases, is more complex. Hypocitraturia in routine evaluation is another recognizable factor in lithogenesis, and administration of citrate, a widely used agent in the conservative management of stones. corrects hypocitraturia. Citrate also alkalizes the urine and can therefore be used to dissolve and prevent uric acid stones. However, citrate can induce the formation of insoluble calcium phosphate salts, such as brushite and hydroxyapatite, which can lead to mixed stones and the development of nephrocalcinosis. To address this complexity, innovative treatments that focus on a broader inhibition of lithogenesis with pH-modifying strategies may allow for more comprehensive management. In addition, modern technological tools such as pH meters and pH-tracking mobile applications can offer personalized treatment plans, potentially improving patient outcomes. The current lack of consensus on the standard and optimal management of pH measurement and modification underscores the need for further research and greater collaboration among experts. The development of evidence-based strategies will be essential to improve prevention and nephrolithiasis.

Objective: This study evaluated the primary efficacy of vacuum therapy combined with phosphodiesterase type 5 inhibitors (PDE5i) vs. PDE5i alone in improving erectile function recovery, assessed via the International Index of Erectile Function (IIEF) questionnaire, after robotic-assisted radical prostatectomy (RARP). A secondary objective was to assess the impact of the combined therapy on continence outcomes, including pad usage and continence scores. The study also explored predictors of rehabilitation success and the potential synergistic effects of the combined approach.

Materials and methods: A retrospective analysis of 101 patients who underwent RARP (2021-2023) was conducted. Patients were divided into Group 1 (PDE5i only, n=70) and Group 2 (PDE5i + vacuum therapy, n=31). Vacuum therapy was started within 20 days postoperatively and performed daily under specialist supervision. All data were completely anonymous. Primary outcomes included IIEF-5 scores for erectile function and continence recovery (pad usage, continence scores based on three levels: 0 - complete incontinence, 1 - stress incontinence and 2 - full continence). Predictive factors were analysed using repeated measures ANOVA and multivariate regression.

Results: Group 2 showed significantly higher mean IIEF-5 scores at 12 months (10.2 vs. 2.5, p<0.001) and earlier continence recovery, with better scores at 3 and 6 months (p < 0.05). Vacuum therapy and PDE5i accelerate continence recovery during the early postoperative period, with fewer pads required, compared with patients treated with PDE5i alone, at 6 months (1.32 vs. 1.62; p=0.358) and 9 months (0.54 vs. 1.08; p=0.034). Key predictors of recovery included age, BMI, nervesparing status, and preoperative continence levels.

Conclusions: This study demonstrates the benefits of combining vacuum therapy with PDE5i for improving erectile function and early continence recovery after RARP, highlighting the importance of early, individualized rehabilitation. Vacuum therapy enhances oxygenation, reduces fibrosis and complements PDE5i effects. Further research is needed to refine predictive factors for success and explore the impact of intraoperative blood loss on erectile recovery, enabling optimized, tailored strategies for post-RARP rehabilitation.

Objectives: To evaluate the outcomes of oral buccal mucosa graft (BMG) ureteroplasty in managing recurrent long-segment proximal ureteric strictures and recurrent uretero-pelvic junction obstruction (UPJO).

Methods: A single-centre prospective study included patients with recurrent long-segment proximal ureteric strictures and recurrent UPJO treated with open onlay BMG ureteroplasty from January 2022 to September 2024. Patient demographics, intraoperative and postoperative characteristics, and the percentage of stricture-free status at the last visit were documented. Complication rates were categorized according to the modified Clavien-Dindo grading system Results: The study included 21 patients, 11 males (52.4%) and 10 females (47.6%), with a mean age ± SD of 45.8 ± 13.7 years. Regarding the stricture etiology, Ten patients (47.6%) had previously undergone complicated endoscopic stone surgeries, seven patients (33.3%) had a history of open surgery for stone disease, while the remaining four (19%) had undergone previously failed pyeloplasty for congenital UPJO. The mean operative time was 145 minutes, the mean stricture length ±SD was 3.94±1.4 cm, and the mean harvested BMG length ±SD was 7.6±1.1 cm. Six patients (28.6%) developed postoperative complications of Clavien II and III grade. The follow-up duration ranged from 9 to 24 months, with a mean duration of 16.3 months. At the last follow-up visit, 18 out of 21 patients (85.7%) were stricture-free.

Conclusions: Buccal mucosa graft for onlay ureteroplasty represents an effective surgical intervention for managing recurrent, long-segment proximal ureteric strictures and recurrent cases of ureteropelvic junction obstruction.