BMC Urology最新文献

Background: Benign prostatic hyperplasia (BPH) prevalence varies by ethnicity, with risk increasing in aging men. The visual prostate symptom score (VPSS) offers a practical alternative to the International Prostate Symptom Score (IPSS), especially for elderly patients, but its validation in Tanzania and correlation with IPSS remain underexplored.

Objectives: This study conducted a comparative analysis of IPSS and VPSS in Tanzanian patients, assessing lower urinary tract symptoms (LUTS) and BPH severity before and after treatment at Muhimbili National Hospital's Urology Department.

Methodology: This longitudinal observational study included both inpatients and outpatients at MNH in Dar es Salaam, examining the correlation between VPSS and IPSS for grading LUTS in BPH patients aged 40 years and above. Prostate volume was measured using transabdominal ultrasound. Participants completed Swahili versions of the 7-item IPSS and 4-item VPSS. Data were collected before treatment and at the six-month follow-up, with surgical patients and deceased patients excluded from follow-up analysis. Statistical analysis was performed using SPSS version 27.

Results: In a study of 137 BPH patients with LUTS, aged 62-76 years (median 70), prostate volume significantly decreased from 49.0 mL before treatment to 35.0 mL after treatment. Most patients (94.2%) were literate in Swahili, with significant differences in completing IPSS on the basis of literacy (p = 0.042) but no difference in completing VPSS (p = 0.999). Both the IPSS and VPSS improved significantly after treatment, with strong correlations before (r = 0.648) and after treatment (r = 0.732), confirming their reliability in assessing LUTS severity.

Conclusion: This study showed that VPSS effectively evaluates LUTS severity in BPH patients, correlating well with IPSS, even in illiterate patients. VPSS's reliability suggests its utility in routine practice, enhancing symptom monitoring and treatment outcomes in BPH management.

Background: Intrauterine device (IUD) migration is a rare but serious complication of IUD use, most often resulting from unnoticed uterine perforation. However, intravesical migration complicated by multifocal sepsis from ruptured tubo-ovarian abscess (TOA) and acute appendicitis is an exceedingly rare and complex clinical scenario.

Case presentation: A 39-year-old multiparous Asian female with history of IUD placement presented with features of sepsis. Laboratory and radiological investigations, and quick sequential organ failure assessment (qSOFA) score were promptly done. The assessment was intravesical IUD migration complicated by multifocal sepsis and septic shock due to ruptured TOA and acute appendicitis. She had resuscitation and an urgent combined minimal access surgical intervention. Her postoperative recovery was rapid, and she was discharged four days after surgery.

Conclusion: This rare case demonstrates the importance of early recognition of sepsis, the relevant diagnostic and therapeutic challenges of managing a critically ill gynecology patient with a migrated IUD complicated by multifocal sepsis and the significance of patient education and appropriate follow-up after IUD insertion.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is a size-independent and durable treatment, traditionally performed using 26-28 Fr resectoscopes. While larger scopes offer improved visualization and irrigation, they may increase the risk of urethral trauma and strictures. A 22 Fr HoLEP system has recently been introduced, aiming to minimize morbidity without compromising surgical efficiency. This study evaluates perioperative outcomes, safety, and early functional results using the 22 Fr HoLEP system for Minimally Invasive Laser Enucleation of the Prostate (MiLEP).

Methods: We conducted a retrospective review of a database of patients who underwent MiLEP between January 2022 and September 2024. Inclusion criteria were age ≥ 40, prostate volume ≥ 35 cm³, and moderate-to-severe lower urinary tract symptoms (LUTS). Preoperative, intraoperative, and postoperative data were analyzed, including IPSS, PSA, uroflowmetry (Qmax), post-void residual (PVR), complications, and need for urethral or meatal dilation. All procedures utilized the 22 Fr resectoscope with a 100 W holmium laser using an en bloc technique.

Results: All cases were successfully completed using the MiLEP system without scope upsizing or conversion. Mean prostate volume was 84.5 ± 36.3 cm³, operative time was 76.1 ± 21.6 min, and morcellation time was 20.7 ± 6.8 min. Meatal dilation was required in 4% of cases; no patients required urethral dilation. Capsular perforation occurred in 7%, and 1% experienced non-perforating bladder injury during morcellation. No blood transfusions or intraoperative conversions were required. At 3 months, IPSS improved from 24.4 ± 3.7 to 6.7 ± 1.4 (p < 0.001), Qmax increased from 9.0 ± 2.8 to 21.1 ± 6.3 mL/s (p < 0.001), and PSA decreased from 5.7 ± 3.7 to 0.48 ± 0.3 ng/mL (p < 0.001). De novo stress urinary incontinence was reported in 3% of patients. No urethral strictures or bladder neck contractures were observed.

Conclusions: MiLEP using the 22 Fr system is a feasible and effective technique for BPH treatment, offering significant improvements in LUTS and urinary flow with minimal morbidity. This approach may reduce the risk of urethral trauma and postoperative complications while maintaining surgical efficiency.

Background: This study aimed to evaluate the ability of the systemic immune-inflammation index (SII), which is tested before transrectal ultrasound-guided systematic prostate biopsy, to predict the histopathology of non-malignant and malignant prostate tissue.

Methods: Data from 1040 patients who underwent transrectal ultrasound-guided prostate biopsy between June 2019 and January 2023 due to high prostate-specific antigen levels or palpation of suspicious prostate cancer nodules via digital rectal examination were analyzed retrospectively. The patients were divided into two groups as biopsy negative and prostate cancer. The SII, platelet/lymphocyte ratio (PLR), and neutrophil/lymphocyte ratio (NLR) were compared between the two groups. Statistical analyses were performed using Student's t, Mann-Whitney U, and one-way ANOVA tests, along with ROC curve analysis and DeLong's test to assess diagnostic performance.

Results: There was no difference between the groups in terms of the SII, PLR, or NLR (p > 0.05). When evaluated according to the European Urology Association risk groups for biochemical recurrence of localized and locally advanced prostate cancer based on systematic biopsy, a significant difference was observed in the SII and PLR markers between the groups with biopsy negative and those with high-risk prostate cancer (p = 0.009, and p < 0.001, respectively). In the ROC analysis, the AUC for the SII was 0.568 (95% CI 0.523-0.628). The best limit value was determined to be 591.4, and for values ≥ 591.4, the sensitivity was determined to be 0.5, and the specificity was 0.571. For the PLR, the AUC was 0.618 (95% CI 0.559-0.676). The best limit value was 139.6, and for values ≥ 139.6, the sensitivity was 0.52, and the specificity was 0.72.

Conclusions: Hematological inflammatory parameters before prostate biopsy are not effective markers for distinguishing between biopsy negative and malignant pathologies. The inflammatory markers SII and PLR can be used as diagnostic tools in high-risk prostate cancer patients but cannot be used as markers for the detection of pathologies in low- and intermediate-risk patients.

Purpose: To present changes in our institution's antibiotic prescription patterns and resistance status over time, as well as the characteristics of the urology inpatient population and and their association with bacterial resistance.

Methods: Patients who had urinary tract infection and tested positive for blood or urine cultures were included. Patient data and demographics were recorded retrospectively. The study evaluated annual changes in bacterial resistance and first-choice antibiotics, including a linear resistance trend analysis for each antibiotics. We analyzed the frequency of resistant bacterial isolates over time and their correlations with patient characteristics.

Results: From January 2015 to December 2020, 1,092 unique patients (> 18 years old, 71% male) were included. The predominant causative agent in both urine and blood cultures was Escherichia coli (33.9% in urine and 41% in blood). Enterococcus strains were the second most frequently identified agent in urine cultures (21.4%). Cephalosporins and carbapenems were the most commonly prescribed antibiotics, with a marked increase in carbapenem use, reaching 52% in 2020. Extended Spectrum Beta-Lactamase (ESBL)-producing bacteria accounted for 44% of isolates, multidrug-resistant (MDR) bacteria for 29%, and extensively drug-resistant (XDR) bacteria for 4%. Prior antibiotic use was significantly associated with MDR isolates (p = 0.002, OR 1.61, 95% CI 1.18-2.19).

Conclusion: Urology inpatients demonstrate high rates of antimicrobial resistance. Periodic changes in antibiotic use are strongly associated with resistance patterns. These findings highlight the importance of antimicrobial stewardship programs and regular review of empirical treatment strategies.

Background: Premature ejaculation (PE) is a prevalent male sexual dysfunction with limited comparative data on pharmacological treatments. This randomized clinical trial aimed to evaluate the efficacy and safety of four active pharmacological interventions for lifelong PE.

Methods: A prospective randomized trial was conducted from June 2024 to March 2025 at Beni-Suef University Hospital. Four hundred eligible patients diagnosed with lifelong PE were randomly allocated to one of four active treatment groups (n = 100 per group): (1) citalopram 20 mg/day, (2) silodosin 4 mg/day, (3) dapoxetine 30 mg on-demand (1-3 h before intercourse), or (4) dapoxetine 30 mg daily. The primary outcome was the change in intravaginal ejaculatory latency time (IELT) measured by stopwatch. Secondary outcomes included changes in the Premature Ejaculation Profile Questionnaire (PEPQ) scores and the incidence of treatment-emergent adverse events. Statistical analysis was performed using ANOVA with post-hoc tests for continuous variables and chi-square tests for categorical data.

Results: All four treatment groups demonstrated significant within-group improvements in IELT from baseline (p < 0.001 for all). The citalopram group exhibited the greatest mean IELT increase (from 110.4 ± 31.5s to 391.2 ± 45.9s; 260% median gain), outperforming the daily dapoxetine (220%), on-demand dapoxetine (197%), and silodosin (149.5%) groups. Improvements in PEPQ scores mirrored the IELT findings, with citalopram showing a 300% improvement compared to 225%, 166.7%, and 175% in the daily dapoxetine, on-demand dapoxetine, and silodosin groups, respectively. In inter-group comparisons, citalopram was superior to silodosin in all PEPQ domains (p < 0.001) and to both dapoxetine regimens in the domain of interpersonal difficulty (p < 0.01). Adverse event profiles differed: silodosin was associated with a higher incidence of ejaculatory dysfunction (23% retrograde ejaculation), while daily dapoxetine led to more systemic effects (18% dizziness).

Conclusion: In this direct head-to-head comparison of active treatments for lifelong PE, daily citalopram (20 mg) demonstrated superior efficacy in prolonging IELT and improving psychosocial outcomes compared to daily or on-demand dapoxetine and silodosin. The findings suggest that citalopram is a highly effective first-line option, while the dose-dependent efficacy of dapoxetine and the distinct side-effect profile of silodosin provide alternative considerations for personalized treatment strategies.

Trial registration: This clinical trial was registered at ClinicalTrials.gov (Identifier NCT07113145) on 7 August 2025 after the enrollment of the first participant and is therefore retrospectively registered."