Arab Journal of Urology最新文献

Background: Semen analysis is an essential indicator of male infertility potential. The study aims to assess the diagnostic accuracy of smartphones compared to manual microscopy for semen analysis.

Method: It is a cross-sectional analytical study with investigator blinding. Data were collected from August to September 2023. Pictures of semen analysis were captured through light microscopy and stored in a coded format on a smartphone. Later, the results of both methods were compared.

Results: A total of 50 adequate semen samples were included. The age of enrolled males was Mean±SD 29.4 ± 5.9 years. The sensitivity and specificity were 100% (95% CI 83.9%-100%) and (95% CI 88.1%-100%), respectively, for smartphones compared to light microscopy for total sperm counts. The positive predictive value (PPV) and negative predictive value (NPV) were both 100%, with (95% CI 83.9%-100%) and (95% CI 88.1%-100%), respectively. Sensitivity, specificity, PPV, and NPV for total sperm motility were 97.9%, 100%, 100%, and 66%, respectively. For normal morphology sperm, the sensitivity, specificity, PPV, and NPV of smartphones were 72.7%, 82.1%, 53.3%, and 91.4%, respectively, and for abnormal morphology sperm, they were 100%, 98%, 50%, and 100%, respectively. Smartphones exhibited a sensitivity of 98%, specificity of 100%, PPV of 100%, and NPV of 50% for assessing sperm vitality. The diagnostic agreement between smartphones and light microscopy was very good (κ value -0.6-1) for the detection of total count, vitality, and total motility of sperm.

Conclusion: Smartphone technology demonstrates high sensitivity and specificity for semen analysis compared to manual microscopy. It also shows excellent agreement with manual microscopy for most parameters in semen analysis. We recommend smartphone reporting for semen analysis in remote areas and poor resource settings.

Artificial Intelligence (AI) is rapidly transforming the field of urology, offering unprecedented advancements in diagnostics and treatment planning. This review explores the integration of AI across various urological practices, highlighting its impact on improving diagnostic accuracy, optimizing treatment strategies, and enhancing patient monitoring. We examine the role of AI in imaging, pathology, and personalized medicine, as well as its contributions to robotic-assisted surgeries and remote patient care. The article also addresses the ethical and legal challenges posed by AI, including issues of data privacy, algorithmic bias, and regulatory oversight. Despite these challenges, the potential of AI to revolutionize urology is immense, promising more precise, efficient, and patient-centered care. As AI technologies continue to evolve, their integration into urology will likely lead to significant improvements in patient outcomes and the overall quality of care.

Background and objectives: The widespread utilization of robotic surgeries in urology encouraged several teams to explore the option of performing robot-assisted partial nephrectomy (RAPN), taking advantage of its magnified stereoscopic vision and the articulating instruments that facilitate tumor resection and the reconstructive steps of hemostasis and renorrhaphy. The implementation of the CMR Versius system in RAPN, especially in complex masses, has not been explored yet. Herein, we present our initial experience in performing RAPN in complex renal masses using this novel platform.

Methods: Between July 2022 and November 2023, thirty patients who had complex renal masses and were candidates for RAPN were enrolled in this study. Tumor complexity was assessed using the preoperative aspects of the dimension used for anatomic (PADUA) nephrometry scores. Perioperative data were prospectively collected and analyzed. 'TRIFECTA' was defined as free surgical margins, warm ischemia time (WIT)< 30 minutes, and no major complications (>Clavien-Dindo II).

Results: All cases were successfully completed with no conversion to radical, open, or laparoscopic surgery. The median PADUA score was 9.5 (8-11). The mean docking time, console time, and total operative time were 9.17 ± 0.91, 149 ± 14.27, and 177.17 ± 29.53 minutes, respectively. The mean WIT was 26.67 ± 3.66 minutes. Surgical margins were free in all cases. TRIFECTA was fulfilled in 25/30 patients (83.33%). Five patients (16.66%) did not fulfill TRIFECTA; two patients had prolonged WIT > 30 minutes, two had prolonged WIT with prolonged urine leakage necessitating DJ stent insertion, and the fifth patient had only prolonged urine leakage and DJ insertion. None of the patients developed tumor recurrence or acute kidney injury during follow-up.

Conclusion: Performing RAPN with the CMR Versius platform is a feasible option in complex renal masses with slightly increased but accepted WIT and total operative time. It should be wisely restricted to well-experienced teams.

Objectives: This was an observational study aiming at providing a guide for an optimal setup of the Versius robotic system and evaluating its performance in robot-assisted radical prostatectomy (RARP).

Patients and methods: Between July 2022 and December 2022, all patients with pathologically confirmed prostate cancer candidates for radical prostatectomy were included. Patients who had previous abdominal surgeries or were unfit for pneumoperitoneum were excluded. The preoperative, intraoperative, and postoperative data were prospectively collected. RARP was performed through 5 ports (12 mm); 3 for the robotic arms, 1 for the camera, and 1 for the assistant surgeon. Repeated adjustments of the patient's position and port distribution along with the bedside unit's configuration, arrangement, and orientation were made until an optimal setup was achieved. The technical malfunctions were identified in each case and fixed in the subsequent ones. All patients were invited to the follow-up clinic for routine visits on the first and second weeks following surgery and then every month for three months.

Results: Thirty patients underwent the procedure without conversion to laparoscopy or open surgery and abided by the follow-up regimen. The first nine cases required frequent setup adjustments due to recurring alarms and arms-related conflicts. Thenceforth, the mean docking time, console time, urethro-vesical anastomosis time, and total operative time were enhanced in the last 21 cases without system alarms. No major intraoperative complications related to the robotic system utilization were reported. The postoperative course of all participants passed uneventfully. The median length of the hospital stay and catheterization time were 2 (1-2) and 7 (7-10) days, respectively.

Conclusion: The Versius system offers a promising robotic platform with a flexible surgical setup. The proposed setup provides a guide for a smooth performance in RARP with minimal instruments' collision to eschew system failure. Being the first generation of this surgical robotic system, future efforts are still needed to improve its performance and minimize its drawbacks.

Purpose: Preservation of functional renal parenchyma is one of the main targets of partial nephrectomy. We investigated the effects of suture on renal parenchyma in tumor bed and on short-term renal function.

Materials and methods: Patients with unilateral cT1 renal masses candidate for laparoscopic partial nephrectomy (PN) have been recruited. After tumor excision, medullary sutures were replaced by argon beam in Group 1, while Group 2 had conventional 2-layer renorrhaphy. Groups have been matched using propensity score. Transforming growth factor beta-1 (TGFb1) levels in urine have been measured at the 1^st and 30^th day post-PN. Glomerular filtration rate has been estimated (eGFR) at baseline and 3 months post-PN.

Results: Sixteen cases were matched in each group. There was no difference between groups regarding baseline, operative and perioperative data. Number of sutures in group 1 is nearly half that in group 2 (10 vs 19, respectively, p < 0.001). Group 1 showed lower urinary TGFb1 levels at the 1^st and 30^th day post-PN (p < 0.01 for each), higher eGFR after 3 months (p = 0.01), and less decline of eGFR from baseline (p = 0.046).

Conclusion: TGFb1 levels in urine after PN are related to the number of sutures. Reduced number of sutures in tumor bed has a positive effect on short term eGFR changes possibly by reducing tumor bed fibrogenic healing response as well as preserving renal parenchymal volume.

Objective: To compare the use of JJ and PCN tubes as initial urinary drainage methods in patients with obstructive calcular anuria.

Methods: Between January 2021 and January 2024, 239 eligible patients with obstructive calcular anuria were randomly classified into two groups. Group A (JJ group) included 121 patients and group B (PCN group) included 118 patients. Laboratory data, stone characteristics, and intraoperative and postoperative data were also collected. The time needed to normalize the serum creatinine levels, postoperative complications, and quality of life scores were assessed.

Results: The procedures had comparable success rates (86.8% vs. 90.7%; p = 0.9). The PCN group had a shorter operative time (p < 0.001). No significant differences were observed in the time required for serum creatinine to return to normal between the two groups (p = 0.669). Fever, haematuria, and LUTS were more evident in the JJ stent group. In the JJ group, the presence of upper ureteral stones and stone burden were risk factors for procedure failure, whereas the presence of upper ureteral stones and preoperative serum creatinine were risk factors for ureteral perforation. Mild hydronephrosis was a risk factor for procedural failure in the PCN group. Spontaneous stone passage was more common in the PCN group (p = 0.028). The Overall quality of life and general health scores were significantly better in the PCN group (p < 0.001).

Conclusions: Both PCN and JJ stents had comparable success rates. PCN was associated with a lower incidence of LUTS, higher incidence of spontaneous stone passage, and better quality of life scores than the JJ stent.

Objectives: The study's objective is to compare platelet-rich plasma (PRP) injections to placebo in terms of effectiveness and safety for patients with vasculogenic erectile dysfunction (ED).

Methods: This randomized placebo-controlled clinical trial was done on 50 male patients with organic vasculogenic ED and sexually active in a stable heterosexual relationship for a period of over three months. The patients were randomized into two main groups: Group (A) (n = 25) underwent PRP treatment. Group (B) (n = 25) control underwent placebo treatment.

Results: The two groups under study differed in a statistically significant way regarding the achievement of minimal clinically important differences (MCID) at 3 months and 24 months. Statistically significant variations existed between the mild subgroup and placebo regarding achieving MCID after 3 months and 24 months. The level of satisfaction was statistically significantly higher in the PRP group. A statistically significant variation was present between the mild subgroup and placebo at 3 months and 24 months in terms of changes from baseline in the erectile function domain of the International Index of Erectile Function (IIEF-EF) questionnaire score in each subgroup.

Conclusions: PRP is an effective alternative modality of treatment in cases of ED, and they offer an intermediate stage between pharmaceutical therapy and surgical interventions at least in mild and mild to moderate cases where unsatisfactory results or unpleasant side effects compel the patients to abandon all hope on medical treatment.

Male infertility is increasingly recognized as a significant global health concern, with lifestyle factors being critical contributors to declining male fertility rates. This narrative review comprehensively analyzes the impact of various lifestyle choices, including diet, physical activity, substance use, stress, sleep, weight management, sexual habits, and environmental and occupational exposures on male reproductive health. The review examines the biological and ecological mechanisms through which these lifestyle factors affect spermatogenesis and sperm quality. Furthermore, it discusses potential interventions, such as dietary modifications, weight management strategies, substance cessation programs, stress reduction techniques, and workplace policy changes to improve male fertility outcomes. Emphasis is placed on the role of oxidative stress, hormonal regulation, and DNA integrity in mediating the effects of these lifestyle factors. While lifestyle modifications can significantly enhance male reproductive health, the available evidence highlights the need for more rigorous research to establish solid guidelines and interventions for mitigating male infertility.

Introduction: to evaluate the effect of preoperative Silodosin on ureteric dilatation to facilitate ureteral access sheath (UAS) placement and reduction of ureteral wall injury in retrograde intrarenal surgery (RIRS).

Methods: one hundred and twenty patients with renal or ureteric stones were randomly allocated into 2 equal groups. Group A represents patients who received a 7-day preoperative single dose Silodosin before RIRS while Group B represents patients who received a placebo for the same regimen. Our primary outcome was to assess the success rate of (UAS) placement. Our secondary outcomes were to evaluate the perioperative complication rate, stone-free rate, hospital stay, and cost analysis.

Results: In our study, Silodosin showed a higher success rate for (UAS) insertion compared to placebo with a statistically significant difference (p-value = 0.04). Spontaneous UAS insertion in the Silodosin group was 58.3%, which was increased with active ureteric dilatation to 98.3%. Preoperative Silodosin led to less postoperative pain and analgesics requirements without impacting postoperative hospital stay or stone-free rate. There was less ureteric injury incidence in the Silodosin group compared to placebo with a statistically significant difference (p-value = 0.002).

Conclusion: Preoperative Silodosin facilitates UAS insertion with a protective role against ureteric injury compared to placebo.

[This corrects the article DOI: 10.1080/20905998.2024.2400628.].