International Braz J Urol最新文献

Purpose: To investigate the effect of chronic stress on testicular morphology in adult Wistar rats, as well as the impact of comfort food consumption on these parameters.

Material and methods: 32 Wistar rats (10 weeks old) were divided into four groups: control (C), stressed (S), control + comfort food (C+CF), and stressed + comfort food (S+CF). Chronic stress was induced by the restraint method during 8 weeks in groups S and S+CF, while groups C and C+CF were maintained under normal conditions. Groups C and S received a standard rat chow diet, while groups C+CF and S+CF received both the standard chow and comfort food (Froot Loops®). After 8 weeks of experiment, all animals were euthanized and the testes were collected for histomorphometric, immunohistochemical and gene expression analysis.

Results: Comfort food was preferred over standard chow in groups C+CF and S+CF, but this preference was more preeminent in stressed animals (S+CF). The consumption of comfort food resulted in testicular weight reduction. The seminipherous epithelium was reduced in group S in comparison to controls. While comfort food also reduced the epithelium in C+CF in comparison to controls, for group S+CF the comfort food ameliorated the stress-induced damage. The cell proliferation rate and the relative expression of StAR and BLC2 genes were similar between the groups.

Conclusion: Both chronic stress and comfort food consumption resulted in morphological alterations of the testes but the consumption of comfort foods during chronic stress partially prevented the stress-induced detrimental effects on testes.

Purpose: The external ureteral catheter (EUC) and double-J stent (DJ-stent) are frequently used for drainage in tubeless percutaneous nephrolithotomy (PCNL). This study aims to compare the outcomes and effectiveness of these two methods.

Materials and methods: We conducted a detailed literature search using relevant key words on Google Scholar, Europe PMC, Medline, and Scopus databases. Continuous variables were combined using mean difference (MD), while binary variables were analysed using risk ratio (RR) with 95% confidence intervals through random-effects models.

Results: Our analysis included nine studies. The results showed that EUC was associated with a significantly lower incidence of stent-related symptoms [RR 0.32 (95% CI 0.19 - 0.54), p < 0.0001, I² = 24%] compared to the DJ-stent. There were no significant differences between EUC and DJ-stent in terms of postoperative fever (p = 0.92), urine leakage (p = 0.21), perinephric collection (p = 0.85), haemoglobin drop (p = 0.06), transfusion rate (p = 0.27), VAS score (p = 0.67), analgesic requirements (p = 0.59), stone-free rate (p = 0.14), duration of surgery (p = 0.10), and duration of hospitalization (p = 0.50).

Conclusion: The EUC demonstrated fewer stent-related symptoms than the DJ-stent in tubeless PCNL, while both methods showed comparable safety and efficacy. The choice between EUC and DJ-stent should consider patient preferences and surgeon expertise. Further randomized controlled trials (RCTs) with larger sample sizes are needed to affirm these results.

Purpose: This prospective study aimed to identify risk factors associated with progression to stage 3 chronic kidney disease (CKD) and the occurrence of kidney stone formation or growth following nephrectomy for urolithiasis.

Materials and methods: From January 2006 to May 2013, patients undergoing nephrectomy for urolithiasis were enrolled. Renal function was assessed using estimated glomerular filtration rate (eGFR) via the Chronic Kidney Disease Epidemiology Collaboration equation, while kidney stone events were detected using computed tomography.

Results: Among 107 patients followed for an average of 83.5 months, type 2 diabetes mellitus (T2DM) significantly increased the risk of progression to stage 3 CKD by 34.79-fold (p=0.004). Age was associated with a 15% increase in the odds of developing stage 3 CKD per year (p=0.01), while higher preoperative eGFR was protective (OR=0.84, p<0.01). DMSA-99mTc values below 15% were less likely to lead to renal function deterioration. New kidney stone formation occurred in 15.9% of patients and stone growth observed in 12.1%. Contralateral kidney stones (p<0.01) and hypercalciuria (p=0.03) were identified as risk factors for kidney stone events.

Conclusions: T2DM and age were predictors of CKD progression, while higher preoperative eGFR was protective. Hypercalciuria and contralateral kidney stones increased the risk of kidney stone formation and/or growth post-nephrectomy for urolithiasis.

Purpose: The objective of this study was to evaluate whether morphological (linear measurements) and functional (ADC value) assessments of periprostatic fat can predict the aggressiveness of prostate cancer (PCa) over a 5-year follow-up period.

Material and methods: This retrospective study included patients with histologically proven PCa who underwent 3.0T MRI between July 2016 and June 2018. Clinical and demographic data collected included PSA, PSA density (dPSA), ISUP grade, clinical and pathological staging, and treatment details. MRI-derived parameters were assessed by an experienced radiologist, who measured subcutaneous and periprostatic fat thickness, and calculated ADC values from ROI plots in periprostatic fat. Clinical and MRI parameters were analyzed for associations with biochemical recurrence, systemic metastasis, and PCa-related mortality.

Results: After applying exclusion criteria, 109 patients were included. Using the Cox model, dPSA (p<0.01), systemic disease at diagnosis (p<0.01), and mean ADC (p<0.02) were independent predictors of overall survival (OS). For progression-free survival (PFS), only dPSA (p<0.01) and systemic disease at diagnosis (p<0.01) were significant predictors. In the Poisson Model for systemic recurrence risk, dPSA had a relative risk (RR) of 1.04 (95%CI 1.0-1.07, p=0.03), systemic disease at diagnosis had an RR of 63.3 (95%CI 3.7-86.4, p<0.01), and average ADC had an RR of 3.42 (95%CI 1.52-7.69, p<0.01).

Conclusions: The ADC value of periprostatic fat may serve as an additional tool for PCa risk stratification, correlating with poorer outcomes such as systemic recurrence and overall survival. If validated by external, prospective, multicenter studies, these findings could impact future therapeutic decisions.

Ischemic priapism is a true urologic emergency. Prompt intervention is required to alleviate the compartment syndrome and restore perfusion to the corporal bodies; failure to do so results in irreversible damage, fibrosis, and profound erectile dysfunction. This paper's objective is to review current literature surrounding the management options for ischemic priapism, focusing on newer surgical techniques. A PubMed database search was performed in June 2024, encompassing the terms "priapism," and "surgical management." Articles were reviewed by two authors independently and included if they were deemed to pertain specifically to management of ischemic priapism. In the acute setting (certainly for priapism lasting <24 hours), management is often successful using bedside maneuvers such as aspiration, irrigation, and injection of sympathomimetic agents. For more prolonged priapism, more aggressive intervention is often warranted. Newer tunneling techniques-including penoscrotal decompression and the corporal snake maneuver-have shown promising preliminary results, not just in terms of priapism resolution but also perhaps sexual function recovery.

Objective: To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines.

Materials and methods: A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions.

Results: A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control.

Conclusion: Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies.

Introduction: Although nerves and vessels of the penis play important role in erection, there are few studies on their development in human fetus. Therefore, the objective of the present study is to analyze, quantitatively, in the corpora cavernosa and corpus spongiosum, the development of the nerves and vessels in the fetal penis at different gestational ages.

Material and methods: Fifty-six fresh, macroscopically normal human fetuses aged from 13 to 36 weeks post-conception (WPC) were used. Gestational age was determined by the foot length criterion. Penises were immediately fixed in 10% formalin, and routinely processed for paraffin embedding, after which tissue sections from the mid-shaft were obtained. We used immunohistochemical staining to analyze the nerves and vessels in the corpus cavernous and in the corpus spongiosum. These elements were identified and quantified as percentage by using the Image-J software.

Results: The quantitative analysis showed that the percentage of nerves varied from 3.03% to 20.35% in the corpora cavernosa and from 1.89% to 23.88% in the corpus spongiosum. The linear regression analysis indicated that nerves growth (incidence) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.9421, p<0.0001) and (r2=0.9312, p<0.0001), respectively, during the whole fetal period studied. Also, the quantitative analysis showed that the percentage of vessels varies from 2.96% to 12.86% in the corpora cavernosa and from 3.62% to 14.85% in the corpus spongiosum. The linear regression analysis indicated that vessels growth (appearance) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.8722, p<0.0001) and (r2=0.8218, p<0.0001), respectively, during the whole fetal period studied. In addition, the linear regression analysis demonstrated a more intense growth rate of nerves in the corpus spongiosum during the 2nd trimester of gestation, when compared with nerves in the corpora cavernosa. In addition, the linear regression analysis demonstrated a more intense growth rate of vessels in the corpus spongiosum when compared with the corpora cavernosa, during the whole fetal period studied.

Conclusions: In the fetal period, the human penis undergoes major developmental changes, notably in the content and distribution of nerves and vessels. We found strong correlation between nerves and vessels growth (amount) with fetal age, both in the corpora cavernosa and corpus spongiosum. There is significant greater proportional number of nerves than vessels during the whole fetal period studied. Also, nerves and vessels grow in a more intense rate than that of the corpora cavernosa and corpus spongiosum areas.

Introduction: We aim to compare the safety and effectiveness of the KangDuo (KD)-Surgical Robot-01 (KD-SR-01) system and the da Vinci (DV) system for robot-assisted radical nephroureterectomy (RARNU).

Materials and methods: This multicenter prospective randomized controlled trial was conducted between March 2022 and September 2023. Group 1 included 29 patients undergoing KD-RARNU. Group 2 included 29 patients undergoing DV-RARNU. Patient demographic and clinical characteristics, perioperative data, and follow-up outcomes were collected prospectively and compared between the two groups.

Results: There were no significant differences in patient baseline demographic and preoperative characteristics between the two groups. The success rates in both groups were 100% without conversion to open or laparoscopic surgery or positive surgical margins. No significant difference was observed in docking time [242 (120-951) s vs 253 (62-498) s, P = 0.780], console time [137 (55-290) min vs 105 (62-220) min, P = 0.114], operative time [207 (121-460) min vs 185 (96-305) min, P = 0.091], EBL [50 (10-600) mL vs 50 (10-700) mL, P = 0.507], National Aeronautics and Space Administration Task Load Index scores, and postoperative serum creatinine levels between the two groups. None of the patients showed evidence of distant metastasis, local recurrence, or equipment-related adverse events during the four-week follow-up. One (3.4%) patient in Group 2 experienced postoperative enterovaginal and enterovesical fistulas (Clavien-Dindo grade III).

Conclusions: The KD-SR-01 system is safe and effective for RARNU compared to the DV Si or Xi system. Further randomized controlled studies with larger sample sizes and longer durations are required.