Arab Journal of Urology最新文献

Orchiectomy, the surgical removal of one or both testicles, is often a life-changing procedure. While it is a critical treatment step for conditions such as testicular cancer, advanced prostate cancer, severe unresolving infection, trauma and gender dysphoria, the associated psychological challenges remain underexplored. Depression, anxiety, body image concerns, and diminished quality of life are prevalent but insufficiently addressed. This review synthesizes available literature to quantify these psychological impacts, explore cultural and demographic influences, and present evidence-based management strategies. The review highlights the importance of pre-operative counselling, testosterone replacement therapy (TRT), cognitive behavioural therapy (CBT), and social support networks. Future research should focus on longitudinal assessments to better understand long-term mental health outcomes post-orchiectomy.

Obesity is a common health problem affecting over a third of the population worldwide. Obesity has been correlated with many diseases, including cardiovascular disorders, diabetes, cancer, brain degeneration, and premature aging. In men, obesity can also cause issues like erectile dysfunction, poor sperm quality, and prostate problems. Factors like high insulin levels, chronic inflammation, and oxidative stress may play a role in how obesity affects male fertility. Obesity can disrupt the male reproductive system by changing hormone levels, affecting sperm production, and causing problems with metabolism. This can result in a reduction of sperm count, motility, and normal forms. Obesity can also cause sperm DNA fragmentation, increase cell death, and impact the genetic information that can be passed on to future generations. This narrative review explores how obesity impacts male reproductive health and fertility, as well as possible treatment options like weight management, lifestyle changes, medications, and alternative therapies.

Objectives: Several studies have demonstrated racial variations in various diagnostic clinical parameters in different fields of medicine including andrology. Yet, clinical andrological diagnostic is following the lower reference values recommended by the World Health Organization irrespective of the racial descent of men. Therefore, this study aimed to investigate racial differences in hormonal and semen parameters including sperm DNA fragmentation (SDF) and seminal oxidative stress in a large group of patients from Sub-Saharan, Caucasian, Central/South Asian, Middle Eastern, North African, and Southeast Asian descent.

Methods: In a total of 2,996 infertile men, testis volume, sperm concentration, total sperm count, total and progressive motility, normal morphology, sperm vitality, SDF, oxidation-reduction potential (ORP), and standard hormones were determined and compared.

Results: Significant racial differences for various parameters including the incidence of normal ranges values in the racial groups were found. The highest mean sperm concentration had men of Central/South Asian descent (median: 38.0 × 10⁶/mL) while Southeast Asian men had the lowest (median: 22.0 × 10⁶/mL; p < 0.0001). The highest total sperm motility (median: 55.0%) was observed in Caucasian, Central/South Asian, and Southeast Asian men, while Sub-Saharan African men had the lowest (median: 45.0%; p < 0.0001). For SDF, Caucasian men had the lowest sperm DNA fragmentation (median: 16.0%) and ORP values (median: 1.3 mV/10⁶ sperm/mL) as compared to Central/South Asian men (median: 28.0%; p = 0.0263) and Southeast Asian men (median: 2.4 mV/10⁶ sperm/mL; p = 0.0045), respectively.

Conclusions: Our results show not only significant racial differences for many of the parameters investigated but also for the incidence of normal values. Therefore, it might be prudent to revisit the concept of globally standardized reference values for all men. Yet, as a limitation, the small number (53) of Caucasian men needs to be mentioned. Larger studies that include functional sperm parameters need to be conducted.

Aim: To discuss a new protocol of hyaluronic acid (HA) injection in terms of safety, efficacy and long-term benefits.

Methods: In all, 80 patients, 29-54 years old, with refractory premature ejaculation were included. All patients were given three sessions of HA injection, each session 2 weeks apart. Follow-up of intravaginal ejaculatory latency time (IELT) and glans circumference was done at 3, 6 and 12 months after the last session. Post-procedural complications were recorded.

Results: IELT highly significantly increased (P-value <0.001) after HA gel injection from baseline, 94.40 ± 5.645 sec at repeated measures, IELT measures after 3-, 6- and 12-month post-injection were 201.175 ± 2.765 s, 197.731 ± 2.539 s and 196.6 ± 3.224 s, respectively, with significant increase from pre-injection baseline one and with a significant yet minimal drop of 12-month versus 3 and 6 months measures. Maximum glans circumference was highly significantly increased (P-value <0.001) after HA gel injection from baseline, 96.072 ± 0.929 mm, at repeated measures after 3-, 6- and 12-month post-injection were 107.762 ± 1.548 mm, 111.582 ± 1.522 mm and 110.677 ± 1.552 mm, respectively, with significant increase from pre-injection baseline one and with a significant yet minimal drop of 12-month versus 6 months measure. 3.8% of patients suffered from ecchymosis, 1.3% had bullae formation at site of injection. All patients suffered from pain at site of injection.

Conclusion: Our new protocol of HA injection proved both safe and efficacious with long-term benefits in terms of IELT and glans circumference decreasing the future need for repeated injections of HA.

Background: A meta-analysis was conducted to evaluate the incidence of venous thromboembolism (VTE) following radical nephrectomy and to examine the related risk factors.

Methods: We conducted a comprehensive search for primary research articles from the inception of the databases up to October, 2024 across several databases, including MEDLINE, Embase, and the Cochrane Library. We employed random effects models to determine multivariate adjusted odds ratios (ORs) along with their corresponding 95% confidence intervals (CIs).

Results: In total, 11 studies including 140,795 patients who underwent radical nephrectomy met inclusion criteria. The results showed that postoperative VTE incidence was 1.01% (95% CI = 1.01-1.02; p < 0.001) within 30 days. Moreover, diabetes, open nephrectomy, and history of VTE were related to higher odds of VTE through regression analysis. Analyses of sensitivity and meta-regression demonstrated the robustness of the study's findings.

Conclusions: The overall incidence of VTE after radical nephrectomy is 1%, occurring approximately one month after surgery, and may be related to factors such as open surgery, diabetes and history of VTE. This reminds urologists that more aggressive thromboprophylaxis may be required for these patients.

Prospero registration number: CRD42023439919.

Introduction: Ureteropelvic junction obstruction is the most common cause of pediatric hydronephrosis. Anderson Hynes dismembered pyeloplasty as the standard surgical treatment in such cases.

Purpose: To evaluate and detect factors that affect renal function changes (improvement) after successful pyeloplasty using Tc-99 m Diethylenetriaminepentaacetic (DTPA) renography in children and to predict renal scan changes after successful pyeloplasty.

Methods: This retrospective study was conducted on children ≤ 18 years of age who underwent successful pyeloplasty from May 2018 to May 2022. Pelvic-abdominal ultrasonography and radioisotope scan Tc-99 m DTPA were performed in all patients.

Results: Postoperative group showed a significant increase in renal parenchyma thickness, split renal function, and glomerular filtration rate with a decreased renal pelvis anteroposterior diameter (p < 0.05). There was a significant correlation between each postoperative decrease in the anteroposterior diameter of the renal pelvis and the postoperative increase in parenchyma thickness with the postoperative increase in split renal function. The equation used to detect postoperative split renal function and glomerular filtration rate had a high detection rate.

Conclusions: Pyeloplasty resulted in significant improvements in hydronephrosis, and renal parenchymal changes in association with renal pelvis diameter can predict Postoperative increase in split renal function and glomerular filtration rate.

Objective: Botulinum neurotoxin (BoNT) was introduced as a minimally invasive treatment option for erectile dysfunction (ED). However, there is no proven method that predicts improvement after BoNT injection. Shear wave elastography is an emerging imaging modality that evaluates tissue stiffness. This study aims to assess the reliability of SWE in predicting BoNT response in patients with ED and phosphodiesterase 5 inhibitors (PDE-5i) non-responders.

Methods: This study comprised 20 men presenting with ED and PDE-5i non-responders. Mean tissue stiffness values (TSVs) were measured by SWE, international index of erectile function (IIEF-5), erection hardness score (EHS), sexual encounter profile questions 2 and 3 (SEP-2 and SEP-3), and global assessment questionnaire (GAQ) were evaluated before and after 100 IU of BoNT injection by 6 and 12 weeks.

Results: In comparison with baseline, there was a significant improvement in IIEF-5 and EHS scores after BoNT injection at 6- and 12 weeks (p < 0.001). Similar improvements were observed in SEP-2&3 (p < 0001 & p = 0.001, respectively) and GAQ-1&2 (p = 0.008 & p = 0.006, respectively). We found that mean SWE in a penile flaccid state can predict failure of clinically significant improvement after BoNT injection using a cutoff point of 12.7 kPa (sensitivity = 100%, specificity = 54%, AUC = 0.86, p = 0.014).

Conclusion: This finding could be applied to avoid unnecessary BoNT injections in men with ED and PDE-5i non-responders.

Objective: To evaluate the efficacy of fluoxetine 20 mg, a selective serotonin reuptake inhibitor, versus the standard treatment, desmopressin 0.2 mg, in primary monosymptomatic nocturnal enuresis (PMNE) treatment.

Patients and methods: This was a single-blinded randomized controlled clinical trial. Children ≥7 years old on urotherapy and who still had severe PMNE were screened for eligibility. Children were maintained on 20 mg of fluoxetine or desmopressin 0.2 mg orally once daily for 3 months. The primary outcome for this trial was to assess the efficacy of both drugs as quantified by the change from baseline in the frequency of nocturnal enuresis at three months. The secondary endpoints were treatment-related side effects and nighttime arousal.

Results: The baseline parameters were comparable between both groups. The response to treatment at 1 month as non-responders (NR), partial responders (PR), and complete responders (CR) was 69%, 24.1%, and 6.9% versus 57.1%, 32.1%, and 10.7% in fluoxetine and desmopressin groups, respectively (p = 0.65). At the third month, the NR, PR, and CR were 69%, 31%, and 0% versus 57.1%, 32.1%, and 10.7% in fluoxetine and desmopressin groups, respectively (p = 0.18). Nighttime arousal was better in the fluoxetine group (41.4%) versus 14.3% in the desmopressin group, p = 0.02, at the first month, and it decreased to 31% in the fluoxetine group versus 14.3% in the desmopressin group, p = 0.13, at the third month.

Conclusion: Fluoxetine 20 mg, a selective serotonin reuptake inhibitor, is non-inferior to desmopressin 0.2 mg for the management of PMNE. Fluoxetine improves nighttime arousal significantly at the first month. This improvement becomes insignificant at the third month.

Male accessory gland infection (MAGI) is a significant yet often under-recognized contributor to male infertility. This review article provides a comprehensive synopsis of MAGI, distinguishing it from male genital tract infection (MGTI) and emphasizing the challenges posed by asymptomatic cases. It concisely presents the pathophysiology of MAGI, highlighting the inflammatory response characterized by leukocyte infiltration, elevated pro-inflammatory cytokines, and increased production of reactive oxygen species, which collectively impair sperm quality and fertilizing capability. The article discusses the complexities in diagnosis due to the overlap with benign conditions and presents emerging diagnostic markers. It also critically reviews the controversies surrounding the over-diagnosis and under-treatment of MAGI, emphasizing the need for improved diagnostic accuracy to encourage appropriate treatment. Current therapeutic strategies are explored, revealing variable efficacy and the importance of personalized approaches. This review aims to provide a clear understanding of the clinical implications of MAGI and to guide accurate diagnosis and effective treatment, ensuring better fertility outcomes for affected patients.

Background: Bladder urothelial carcinoma is the most prevalent malignancy of the urinary system worldwide. Accurate staging of bladder cancer, particularly distinguishing between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), is essential for determining appropriate treatment. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy, sensitivity, and specificity of the vesical imaging-reporting and data system (VI-RADS) scoring system using multiparametric MRI in differentiating NMIBC from MIBC.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Comprehensive searches were performed in PubMed, Web of Science, Embase, and Cochrane databases up to December 2023. Studies that evaluated the diagnostic accuracy of the VI-RADS scoring system using multiparametric magnetic resonance imaging (MRI) to distinguish between NMIBC and MIBC were included. Data from eligible studies were extracted to calculate pooled sensitivity and specificity, and heterogeneity was assessed using meta-regression and subgroup analyses by using STATA V17.0.

Results: A total of 31 studies, comprising 3,798 bladder cancer patients, were included in the meta-analysis. The pooled sensitivity and specificity for predicting MIBC using a VI-RADS cutoff score of ≥ 3 was 89%, with moderate heterogeneity observed across studies. Subgroup analysis revealed variations in diagnostic performance based on geographic location (North America, Europe, and Asia), MRI technical parameters, and study design. Studies utilizing 3.0 Tesla MRI scanners and those involving multiple radiologists demonstrated higher diagnostic accuracy.

Conclusion: The VI-RADS system demonstrates high diagnostic accuracy in distinguishing between NMIBC and MIBC, with a cutoff score of ≥ 3 yielding optimal sensitivity and specificity. Its integration into clinical practice has the potential to reduce the need for invasive procedures, improve staging accuracy, and expedite treatment decisions. Future research should focus on standardizing MRI protocols and further validating these findings across diverse clinical settings to enhance the utility of VI-RADS in bladder cancer management.