International Braz J Urol最新文献

Background: Knowledge of the anatomy of laboratory animals is important for experimental research. Erectile dysfunction has been studied using the penises of different laboratory animals such as rats, mice, rabbits, dogs, etc. However, these animals have penises with different characteristics to the human penis. If these differences are not taken into account, the conclusions may be questionable. The Rhesus monkey (Macaca mulatta), due to its similarities to humans, could be a good model.

Objective: To characterize and quantify the components of the penis of the Rhesus monkey (Macaca mulatta), qualifying it as a model for experimental studies.

Methods: Ten adult Rhesus monkey penises were fixed in 10% buffered formalin and processed for paraffin embedding. Histological sections 5-μm thick were made and stained using histochemical techniques. We assessed the thickness of the tunica albuginea, and in the erectile tissue, the following parameters were analyzed: in the corpus cavernosum (CC): total area, area densities of collagen fibers, muscle fibers and elastic system fibers; in the corpus spongiosum (CS): area densities of collagen fibers, muscle fibers and elastic system fibers. Histomorphometric analyses were carried out on photomicrographs by using ImageJ software.

Results: The penis of the Rhesus monkey (Macaca mulatta) has a single CC. The tunica albuginea was thicker in the dorsal region (1.11 ± 0.03 mm) than in the ventral region (0.87 ± 0.01 mm). The quantitative analysis of the CC showed the following values: total area (20.33 ± 5.67 mm²), collagen fibers (24.00 ± 4.00%), muscle fibers (31.52 ± 9.93%) and elastic system fibers (8.46 ± 3.20%). The quantitative analysis of the CS showed the following values: collagen fibers (52.50 ± 11.76%), muscle fibers (10.50 ± 6.36%) and elastic system fibers (15.07 ± 4.78%).

Conclusion: The predominance of muscle tissue over connective tissue in the corpus cavernosum, similar to what is observed in humans, qualifies the Rhesus monkey penis as a good experimental model for erectile dysfunction.

Magnetic Resonance Urography (MRU) has emerged as a powerful imaging modality in pediatric urology, offering comprehensive anatomical and functional assessment of the urinary tract without exposure to ionizing radiation. This review provides an in-depth analysis of MRU's technical aspects, clinical applications, advantages, and recent advancements. Traditional imaging techniques, such as ultrasound, voiding cystourethrography, and nuclear scintigraphy, have long been utilized for evaluating pediatric urinary tract anomalies; however, these methods have inherent limitations in anatomical resolution and functional assessment. MRU combines high-resolution anatomical imaging with dynamic functional analysis, making it particularly valuable in evaluating conditions such as hydronephrosis, ureteropelvic junction obstruction, and ectopic ureters. Advancements in MRU technology, including the use of 3T MRI for superior spatial resolution, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have enhanced its diagnostic capabilities. The ability to assess renal transit times and differential renal function allows for precise evaluation of obstructive uropathies and congenital anomalies. Despite requiring sedation in younger children and longer acquisition times, MRU has demonstrated superior accuracy compared to conventional imaging, reducing the need for multiple diagnostic studies. Recent developments in real-time MRI, faster imaging techniques, and AI-based reconstructions have further optimized MRU's efficiency and diagnostic utility. As MRU continues to evolve, its role in pediatric urology is expected to expand, potentially replacing traditional imaging modalities in select cases. This review highlights the growing significance of MRU in pediatric urinary tract evaluation, emphasizing its potential to improve clinical decision-making and patient outcomes.

Introduction: Penile cancer is a rare but aggressive malignancy, with inguinal lymph node involvement representing a key prognostic indicator (1, 2). NCCN guidelines recommend prophylactic inguinal lymph node dissection (ILND) for intermediate-to-high-risk patients (pT1b, ≥T2) with non-palpable nodes, aiming for early staging and improved outcomes (3). The SP-approach employs a single incision and advanced robotic instrumentation to enhance maneuverability, reduce morbidity, and optimize recovery. Widely used in kidney and prostate surgery (4, 5), this is, to our knowledge, its first application for ILND in Europe.

Material and methods: This video shows a novel robotic-assisted bilateral, superficial and deep ILND using the DaVinci SP™ system. In this patient, a preoperative 3D reconstruction allowed detailed visualization of lymph nodes and surrounding structures, enabling precise dissection and an improved intraoperative orientation using Tilepro feature.

Results: Compared to open techniques, robotic ILND offers similar lymph node yields with superior cosmetic outcomes and reduced postoperative pain (6). These benefits are amplified with the SP system, which excels in the constrained inguinal region by minimizing instrument interference and enhancing efficiency (7). Fewer incisions minimized risks such as wound infections and skin necrosis (8). Limitations of the SP-technique might include extended operative times, especially during the learning phase, and the absence of long-term oncological data. Additionally, complex cases requiring concurrent pelvic lymphadenectomy may necessitate repositioning the robotic system, increasing procedure time.

Conclusions: SP robotic-assisted ILND can represent a significant advancement in the surgical management of penile cancer, combining oncological safety with reduced surgical morbidity. Future studies are needed to validate these findings, compare surgical outcomes, and assess long-term efficacy.

Objectives: Radical cystectomy (RC) is a surgical procedure associated with high rates of morbidity. The aim of the study is to provide a comparison between robotic (RARC) and open RC (ORC) in patients elected to cutaneous ureterostomy (CUS).

Materials and methods: This is a retrospective single-center cohort study performed at a high-volume institution. The study involved 64 patients undergoing RC with CUS, 42 ORC and 22 RARC. The indication for RC was based on EAU guidelines and the choice of CUS was planned due to advanced oncological stage or patient's frailty. Patient allocation to the robotic or open approach for RC was casual, determined by surgeon preference and/or the availability of a robotic operating room. The Adverse events were systematically graded utilizing the Clavien-Dindo classification system.

Results: Complications of Clavien Dindo ≥ 2 occurred in 27 out of 42 (64.2%) ORC and 3/22 (13.6%) RARC (p < 0.001); complications of Clavien Dindo ≥ 3 occurred in 10/42 (23.8%) ORC and only 1/22 (4.5%) RARC, respectively (p = 0.08). Multivariable analysis revealed that robotic surgery was the only variable inversely associated with Clavien Dindo ≤ 2 complications.

Conclusions: In conclusion, RARC appears to be associated with lower morbidity and reduced incidence of complications, elements that make it particularly suitable for frail patients with an elective indication for CUS.

Purpose: To compare the external validation of four existing scoring systems for encrusted ureteral stents (EUS) and their relationship with stent indwelling time, stone-free rates, multiple surgery sessions, multimodal procedures, and prolonged operation times exceeding 120 minutes in total.

Materials and methods: The data of 208 patients who underwent surgery for EUS reviewed. All EUSs were evaluated with 4 scoring systems: ESB (encrusted stone burden), FECal (forgotten, encrusted, calcified), KUB (kidney, ureter and bladder), V-GUES (visual grading for ureteral stone burden).

Results: As the duration of stent indwelling time prolonged, a significant increase is observed in the scores of ESB, FECal, KUB and V-GUES systems (p<0.001). In multivariate logistic regression analysis, V-GUES score (p=0.025) and stent indwelling time (p=0.014) in stone-free rate, FECal grade (p<0.001) in multimodal procedure requirement, FECal (p=0.002) and V-GUES (p=0.032) scores in multiple surgery sessions, and stent indwelling time (p=0.019) and KUB score (p<0.001) in prolonged operation time were found to be predictors. When the area under receiver operating characterictic (ROC) curves (AUC) of the nomograms were examined, V-GUES score (AUC=0.685) in stone-free rate, FECal grade (AUC=0.780) in multimodal procedure requirement, FECal grade (AUC=0.845) in multiple surgery sessions, and KUB score (AUC=0.860) in prolonged operation time were found to be superior.

Conclusions: The management of EUSs is often challenging for urologists. Although the current scoring systems for EUS differ somewhat, it is important to use scoring systems to guide the management of these patients.

Introduction: Urothelial carcinomas (UC) represent the sixth most common tumor by incidence, involving the lower or upper urinary tracts (UTUC) (1). High-risk patients should be treated by nephroureterectomy with complete bladder cuff excision (2), conservative approach is reserved for low-risk UTUCs and/or imperative cases (3).

Materials and methods: We present a 70-year-old male patient, smoker, with history of urothelial carcinoma. He underwent distal ureterectomy with ileal replacement in April 2019. Since then, he has developed several UTUC recurrences bilaterally and in the bladder, which have been treated conservatively. In August 2023, CT- scan showed multiple recurrences in the left kidney and ureter. Hence, on November 2023, we performed cystoscopy, monopolar resection of bladder tumor and bilateral flexible ureteroscopy (fURS) with pulsed thulium:YAG (p-Tm:YAG) ablation of the tumors. We performed a no-touch technique fURS with Video Uretero-Renoscope FLEX-XC1 by Storz. After this, we placed an ureteral access sheath and then a biopsy by using a tipless basket. The laser fiber used was 272 µm and the laser settings were 0.8 J - 10 Hz - Long pulse Ablation (10 W).

Results: The pathological results showed UTUC bilaterally and high-grade UC in the bladder. Then, he underwent intravenous therapy with enfortumab - vedotin and the follow-ups, in February 2024 and June 2024, showed no evidence of recurrences at the multiple biopsies.

Conclusion: The p-Tm:YAG laser can be considered a valid alternative option for the conservative treatment of UTUCs. With that said, stringent follow-up remains a mainstay in the conservative treatment of imperative cases of UTUC.

Objective: This systematic review and meta-analysis aim to consolidate current evidence on the diagnosis, epidemiology, and treatment of urachal carcinoma, a rare malignancy with limited data.

Materials and methods: A systematic search of PubMed/MEDLINE was conducted up to September 2024 to identify studies involving patients with urachal carcinoma, reporting clinical epidemiological characteristics, diagnostic strategies, histopathological findings, tumor staging, treatment modalities, and oncological outcomes. Extracted data were systematically synthesized, and statistical analyses, including a single-arm meta-analysis, were performed to comprehensively evaluate oncological outcomes.

Results: Our study includes 1,901 cases of urachal carcinoma from 50 studies. The findings support the oncologic advantage of en-bloc resection with umbilectomy in localized disease, demonstrating improved survival outcomes and reduced recurrence rates. In the adjuvant setting, those receiving cisplatin-based therapy presented the best response, with 65.73% with no disease progression; similarly, in the metastatic disease, cisplatin-based regimens seem to have better responses in metastatic disease. The single-arm meta-analysis estimated a 5-year overall survival rate of 51% (95% CI: 0.49-0.54). Tumor recurrence was documented in 35% of cases (95% CI: 0.25-0.45), with local recurrence occurring in 28% (95% CI: 0.18-0.38), with the average time to recurrence of 27.6 months.

Conclusion: Our study provides the most comprehensive review of urachal carcinoma to date, providing evidence to guide clinical decisions. It underscores the oncologic benefits of en-bloc resection with umbilectomy and specific chemotherapeutic regimens. Emerging alternative therapies also show potential, highlighting the need for further research to optimize patient outcomes.

Purpose: This narrative review aims to provide the most updated knowledge regarding the treatment of adverse effects secondary to testosterone replacement therapy (TRT), such as gynecomastia, cardiovascular and hematologic risks, prostate health risk, and liver dysfunction risks.

Materials and methods: An extensive literature review was conducted, incorporating guidelines from the American Urological Association and the Endocrine Society. The studies determined common adverse effects and their most common methods of management.

Results: TRT improves the quality of life, sexual function, and mood in hypogonadal men. Possible adverse effects associated with TRT include increased estrogen levels and gynecomastia, which are usually managed with aromatase inhibitors and tamoxifen. Cardiovascular risks from TRT include hypertension and erythrocytosis, which mandate periodic hematocrit and blood pressure monitoring; therapeutic phlebotomy is indicated if the hematocrit exceeds 52%. No significant concern regarding prostate cancer has been observed in the closely monitored patient. However, TRT should not be administered to individuals with active evidence of untreated prostate cancer, except under rare circumstances such as active surveillance for very low-risk disease. Older oral forms of TRT can affect liver function; therefore, transdermal, newer oral forms and injectables are generally favored in men with a history of liver disease.

Conclusions: Monitoring and management of adverse effects are critical to maximize benefit and minimize the risks of TRT. Ongoing research will further elucidate the safety of TRT while advancing evidence-based practices in managing its associated adverse effects. Effective patient education and counseling are also essential to improve compliance and treatment outcomes.