International Braz J Urol最新文献

Introduction: Male factors contribute to 30 to 50% of infertility in couples. Treatment options for male infertility are limited, so antioxidant supplementation for idiopathic male infertility is currently being studied. Alpha lipoic acid (ALA) has a high antioxidant capacity and the potential to penetrate tissues, cells, and organelles, including mitochondria, due to its water and lipid solubility properties. The recent inclusion of randomized trials in the literature has required a new systematic review and meta-analysis to evaluate the efficacy of alpha lipoic acid in sperm parameter changes.

Purpose: We aimed to perform a systematic review and meta-analysis of the currently available randomized trials comparing the effects of ALA supplementation versus placebo on sperm function in infertile male patients.

Material and methods: Pubmed, Embase, Cochrane Library, and Scopus databases were searched from inception to June 2024. A random-effects model was employed to compute mean differences and risk ratios for continuous and binary endpoints. Heterogeneity was evaluated through the prediction interval. A sensitivity analysis was conducted by systematically excluding one study at a time and recalculating the pooled effect. All statistical analysis was conducted using R software 4.4.1. The certainty of evidence was evaluated with the GRADE approach. Results were reported following the PRISMA statement guidelines. This study was registered in PROSPERO.

Results: Five randomized trials comprising 250 patients with a mean age of 28 to 40 years were included in this analysis. Over a mean follow-up time of 3 months, ALA was associated with a reduced proportion of abnormal sperm morphology (MD -0.89; 95% CI -1.48 to -0.29; p=0.003), increased total motility (MD 13.49; 95% CI 3.52 to 23.46; p=0.008), and increased sperm progressive motility (MD 12.43; 95% CI 2.89 to 21.97; p=0.01). Additionally, ALA was associated with a higher pregnancy rate in two individual studies reporting the outcome, however, no significance was found in our pooled analysis (RR 2.28; 95% CI 0.66 to 7.85; p=0.1). Finally, ALA did not change ejaculation volume (MD 0.14; 95% CI -0.54 to 0.83; p=0.6), sperm concentration (MD 11.99; 95% CI -0.67 to 24.66; p=0.06), live sperm (MD 4.42; 95% CI -3.17 to 12.02; p=0.2), or total antioxidant capacity (MD 0.43; 95% CI -0.02 to 0.87; p=0.06). No adverse events were reported.

Conclusion: In this meta-analysis, ALA was associated with a favorable change in sperm quality. However, there were no effects on pregnancy rates. ALA should be considered for patients with idiopathic infertility.

Objective: Robotic surgery has enhanced minimally invasive procedures with greater precision and control, but high costs have limited its widespread adoption. The Sentire® surgical system is hypothesized to achieve clinical outcomes comparable to those of the da Vinci® system while demonstrating superior cost-effectiveness in robot-assisted radical prostatectomy (RARP) procedures. This study aimed to compare RARP outcomes using Sentire® and da Vinci® ®, focusing on clinical efficacy and economic impact.

Materials and methods: A retrospective analysis was conducted at three high-volume urology centers in China, including 22 patients who underwent RARP with the Sentire® system and 287 patients who underwent RARP with the da Vinci® system. After 1:3 propensity score matching (PSM), 66 patients were successfully matched in the control group. Perioperative outcomes and cost metrics were assessed. Key measures included operative and console times, docking time, blood loss, recovery, positive surgical margins, surgeon evaluations of performance and comfort, and cost-effectiveness.

Results: The Sentire® group had a longer median operative time (143 vs. 112 minutes, p=0.024), while console time (85 vs. 76 minutes, p=0.323) and docking time (9.0 vs. 6.0 minutes, p=0.279) were comparable. Blood loss was also similar between the groups (p=0.093). Positive surgical margin rates were 22.7% for Sentire® and 20.0% for da Vinci® (p=1.000), and no significant differences were observed in pathological ISUP grades or prostate volumes (p=0.327 and p=0.856, respectively). At 1-year follow-up, PSA recurrence was observed in 3 patients in the Sentire® group (4.5%) and 4 in the control group (6.1%) (p=0.625), with similar median PSA levels (0.012 vs. 0.014 ng/mL, p=0.410). Urinary continence rates were also comparable at 1, 3, and 12 months (all p > 0.05). Cost-effectiveness analysis revealed lower total and direct costs in the Sentire® group, including surgery expenses ($8,750 vs. $10,500, p=0.021), although differences in consumable and indirect costs were not statistically significant. Surgeon satisfaction scores for performance and comfort were slightly better for Sentire® but did not reach statistical significance (p > 0.05).

Conclusion: This study demonstrates that the Sentire® system is well-suited for urological surgeries, offering comparable clinical outcomes and shorter hospital stays while improving cost-effectiveness compared to the da Vinci® system.

Introduction: Severe iatrogenic ureteral injuries are uncommon but challenging clinical scenarios, mostly related to abdominal and gynecological surgery (1) but lately also to spinal surgery (2). Prompt management is mandatory to avoid impaired outcomes (3). Moreover, a minimally invasive approach is desirable to minimize surgical morbidity and expedite recovery (4). Single Port robotic surgery is being implemented for a variety of indications, including ureteral surgery (5, 6).

Materials and methods: We present the case of a 48-year-old, who underwent lumbar spinal fusion surgery and 3 days after discharge was readmitted presenting abdominal pain. A CT scan revealed a large abdominal fluid collection and consequently a percutaneous drain was placed. A subsequent CT-urogram revealed a right ureteral injury at level of the ureteropelvic junction (UPJ). A percutaneous nephrostomy was inserted after unsuccessful retrograde and anterograde stent placement attempts. The patient underwent SP robotic early repair of the ureter 3 weeks after spinal surgery.

Results: SP robotic ureteral injury repair with transperitoneal approach was performed. The surgery was well tolerated without intraoperative complications, patient was discharged on post-operative day 2. Right percutaneous nephrostomy was removed after 2 weeks and ureteral stent after 4. At 6-months follow-up the patient was asymptomatic and CT-urogram confirmed symmetric contrast excretion without hydroureteronephrosis or contrast leakage.

Conclusion: SP robotic repair of the UPJ injury is safe and feasible. This procedure provides the benefits of minimally invasive surgery, and it should be considered as a valid alternative to traditional multiport robotic approach.

Purpose: To evaluate the trifecta outcomes of ultrasound-guided radiofrequency ablation (RFA) of T1a renal masses and to identify factors influencing trifecta outcomes.

Materials and methods: We retrospectively reviewed data from patients who underwent ultrasound-guided RFA at Peking University First Hospital between March 2017 and May 2024. Baseline demographics, perioperative outcomes and follow-up results were collected. The trifecta outcomes were defined as the absence of severe complications, incomplete ablation and tumour recurrence. Multivariate logistic regression analysis was performed to identify risk factors for trifecta failure.

Results: Among 270 patients (140 left-sided and 130 right-sided), the median tumour size was 1.97 (range 0.80-3.86) cm, and 32 (11.9%) patients had a history of ipsilateral partial nephrectomy. During the median follow-up of 35.6 (range 6.2-91.4) months, the rates of severe complications, tumour recurrence, and incomplete ablation were 1.1%, 7.4%, and 7.4%, respectively. The trifecta outcome was achieved in 227 (84.1%) patients. Multivariate analysis revealed that tumour size [odds ratio (OR): 2.144, p = 0.007] and history of ipsilateral partial nephrectomy (OR: 3.894, p = 0.002) independently predicted trifecta failure.

Conclusion: Ultrasound-guided RFA is a safe and effective treatment for T1a renal masses. Tumour size and a history of ipsilateral partial nephrectomy were significantly associated with trifecta failure.

Introduction: We performed the first study exploring telesurgery's teleproctoring potential while performing long-distance procedures between Orlando (USA) and Shanghai (China) over a distance of 13,000 km. The objective was to evaluate telesurgery's performance and teaching potential using the MicroPort® MedBot™ robotic platform and fiber-optic technology in real-time collaboration during urologic procedures.

Materials and methods: We simulated a real-life scenario where surgeons could communicate and send mutual inputs during telesurgery cases. A prospective study using live porcine models was conducted on July 23-24, 2024. Surgeons in Orlando and Shanghai took turns controlling the robotic system, performing nephrectomies, pyeloplasties, and ureteroureterostomies while transferring control between locations. Latency and system performance were continuously monitored, and real-time communication between the surgeons was facilitated by fiber-optic technology.

Results: Surgeons successfully completed numerous urologic procedures, including nephrectomies, pyeloplasties, and ureteroureterostomies, with seamless control transfers. Remote surgeons provided teleproctoring and assistance during the procedures. The robotic system operated without issues throughout the two-day study. The median latency was 139 milliseconds (range 137-216 ms) on the first day and 139 milliseconds (range 137-185 ms) on the second day.

Conclusions: This study demonstrates the feasibility of long-distance telesurgery and highlights its potential to improve surgical outcomes, facilitate training, and offer remote assistance for complex cases. Telesurgery could play a significant role in expanding access to specialized care and enhancing robotic surgical training globally.

Objective: To evaluate the impact of a urological neoplasm diagnosis on male sexuality and examine patient perceptions of healthcare professionals' engagement with sexuality at diagnosis.

Materials and methods: This study included adult men diagnosed with urological neoplasms across two urology cancer centers from October 2022 to April 2024. Exclusions applied to those with prior cancer treatment, inactive sexual lives, or histories of anxiety/depression treatment. Data were retrospectively gathered from medical records and individual interviews using a semi-structured questionnaire on male sexuality, relationship dynamics, and perceptions of physicians' approach to sexuality. Analysis was conducted in RStudio using chi-square tests.

Results: A cohort of 211 patients were included in this study, with an age range of 22 to 85 years (mean = 65.4). Among these patients, the diagnoses of urogenital cancer included cases of prostate (79.1%), bladder (9.9%), kidney (4.2%), testicular (3.7%), and penile (2.8%) neoplasms. Sexual activity was considered important by 90.5%, with 75.8% reporting decreased frequency post-diagnosis (99.5% were heterosexual and 72.5% were married). Anxiety or depression was reported by 46.9%, while 72% developed specific fears, primarily concerning erectile function and partner satisfaction. Only 23.2% of physicians addressed sexuality at diagnosis, with patient satisfaction significantly higher when these discussions occurred. Satisfaction levels were notably correlated with tumor site, with bladder cancer patients reporting higher satisfaction compared to those with prostate or penile cancer.

Conclusions: Sexual issues extend beyond genital urological cancers, affecting patients with kidney and bladder cancers, with impacts often beginning at diagnosis. Early discussions on sexual health, combined with empathetic support, sexual education, and multidisciplinary care, are essential for the well-being of patients and their partners.