Uro

Background/Objectives: Urinary incontinence (UI) is a common condition affecting women worldwide, with pelvic floor muscle training exercises (PFMT) recognized as the first-line treatment for UI. Supplementation with bioactive compounds, such as collagen and magnesium, may enhance the effectiveness of PFMT. This study aimed to evaluate the efficacy of combining a food supplement containing collagen and magnesium with PFMT in women experiencing stress (SUI), urge (UUI), or mixed (MUI) urinary incontinence. Methods: A pilot clinical trial was carried out on 44 women with stress, urge, or mixed urinary incontinence. The improvement in urinary incontinence was assessed, before and after 6 weeks (W6) of product use, by the Questionnaire for Urinary Incontinence Diagnosis (QUID) and the clinical assessment of the gynecologist. Quality of life (QoL) was assessed as a secondary endpoint. Results: At Week 6, the baseline median QUID score in the active group was significantly reduced by 64% (p < 0.001), with 76% finishing the study with a negative diagnosis for UI. In contrast, the placebo group showed a reduction in QUID score by only 10% (p < 0.001), with just 25% of participants achieving a negative diagnosis for UI. QoL statistically significantly (p < 0.001) improved by 76% in the active group, while no changes were observed in the placebo group. Conclusions: Supplementation with the (Dermoxen^® PelviPlus™/Dermoxen^® Gynable^® Urocollagen™) tested product significantly improved urinary symptoms and quality of life, demonstrating a greater effect than pelvic floor muscle training (PFMT) exercises alone. Dermoxen^® PelviPlus™/Dermoxen^® Gynable^® Urocollagen™ demonstrated efficacy across all three subtypes of UI. Full article

Kidney stone disease affects 12% of the global population with a prevalence that continues to increase. It is recurrent in up to 50% of patients within 5 years and is associated with major health concerns including coronary artery disease and chronic kidney disease. Thus, kidney stones pose a substantial health and economic burden. However, despite kidney stone disease being one of the oldest known and most common diseases worldwide, our understanding of the mechanisms underlying stone formation is lacking. Moreover, recent data have raised questions about the efficacy of currently used therapeutic options for calcium oxalate stones, which account for 75% of all kidney stones. Development of new therapeutics for the successful prevention and management of this disease will require improved understanding of the causes of kidney stones. Recent advancements have shed light on the nuanced contribution of diet, environment and genetics as well as the more fundamental roles of calcium oxalate crystallization, Randall’s plaque formation, inflammation and even a possible contribution of the recently discovered urinary microbiome. This review provides a comprehensive overview of our current understanding of kidney stone pathogenesis and identifies new frontiers and remaining gaps in our knowledge of this disease. Full article

Background: Bladder leiomyomas are rare benign tumors (<0.5% of all bladder tumors) arising from the bladder wall’s smooth muscle. Only 250 cases of this condition have been reported worldwide so far. While some leiomyomas present with irritative or obstructive symptoms, hematuria, or nonspecific abdominal pain, others are asymptomatic and are diagnosed incidentally. The surgical approach is based on the leiomyoma’s size and location. Given this tumor’s rarity, standardized management guidelines do not exist; however, transurethral resection of bladder tumor (TURBT), partial or radical cystectomy, or laparoscopic/robotic enucleation are viable therapeutic options. Case history: We report the case of a 64-year-old female presenting with recurrent colic and pelvic pain. An abdominal CT scan showed a 3 cm mass protruding from the posterior bladder wall toward the right vaginal fornix. A transvaginal ultrasound-guided through-cut biopsy confirmed the diagnosis of a bladder leiomyoma. Due to the tumor’s size and location, robotic enucleation was chosen to minimize the risk of bladder perforation. The mass was successfully excised via a transvesical approach. Results: The procedure was completed in 210 min without complications, with 50 mL blood loss. The patient recovered well, with resolution of symptoms and no recurrence at eighteen-month follow-up. Histopathological examination on the surgical specimen confirmed the diagnosis of bladder leiomyoma. Conclusions: This case highlights the feasibility and safety of robotic enucleation for large bladder leiomyomas, emphasizing minimal invasiveness, limited pelvic dissection, and preservation of bladder function. Further research and standardized guidelines are needed for managing this rare condition. Full article

Background/Objectives: Lower urinary tract symptoms (LUTs) are commonly reported complications of intravesical Bacillus Calmette–Guerin (BCG) instillation for non-muscle invasive bladder cancer; however, there is limited characterization of the severity of the symptoms. We aim to explore the progression of LUTs with BCG treatment for bladder cancer. Methods: Patients were given the Overactive Bladder Questionnaire Short Form (OAB-q SF) to complete prior to their weekly BCG instillation during their primary six-week induction course. Mean symptom scores were compared for weeks 2 through 6 to baseline scores (week 1) utilizing two-sample tests. Subgroup analysis was conducted to identify cohorts at increased risk for urinary symptom progression. Simple linear regression was performed to determine the change in mean symptom scores over time. Results: A total of 60 patients completed the full six-week induction course and completed the required questionaries. Intravesical BCG administration was associated with no significant change in scores across either the symptom bothers or HFQL surveys, which were taken independently or in aggregate. No statistically significant differences in symptom scores were found between subgroups created based on demographic variables, tumor characteristics, or clinical presentation. Conclusions: Although intravesical BCG may cause acute urinary symptoms, it does not seem to impact a patient’s baseline urinary symptom profile. This is important when counseling patients about the perceived chronic urinary symptom risk associated with BCG treatment. Full article

Background/Objectives: This case study presents the complex management of a neonate with concurrent posterior urethral valves (PUV) and duodenal atresia (DA), highlighting diagnostic challenges due to overlapping and atypical imaging findings. Methods: A retrospective chart review was performed with a focus on pre- and postnatal imaging and clinical findings throughout the patient’s course of care. Results: A 32-week gestational referral revealed polyhydramnios, a double-bubble sign, and hydronephrosis. DA-associated polyhydramnios masked the expected oligohydramnios and other in utero sonographic signs of PUV, complicating prenatal diagnosis. Postnatally, early urethral stenting for DA repair obscured typical PUV imaging. PUV diagnosis was confirmed by cystoscopy on day 73. Conclusions: We emphasize the importance of multidisciplinary care and appreciating diagnostic uncertainties in neonates with concurrent obstructive uropathy and intestinal obstruction. Full article

Infertility is a significant global health issue, affecting 8–12% of couples of reproductive age, with male factor infertility contributing to 30–50% of cases. Despite advances in assisted reproductive technologies, particularly intra-cytoplasmic sperm injection, male infertility remains understudied compared to female infertility. This review aims to explore the genetic underpinnings of male factor infertility, including identified genetic mutations, chromosomal abnormalities, and epigenetic factors, and to investigate the broader health implications for affected men. The emerging data suggest that male infertility is not only a reproductive issue but also a potential predictor of chronic diseases, including autoimmune disorders, cancer, and premature death. Additionally, the inheritance of male factor infertility and its potential effects on offspring health remains indeterminate. Studies have shown conflicting results regarding the impact of parental infertility and fertility treatments on the semen quality and reproductive health of offspring. This review summarizes the current understanding of the genetic causes of male infertility, highlights the impact of chromosomal disorders, reviews the spectrum of sperm quality and hormonal profiles, and discourses on the need for further research to clarify the relationships between parental subfertility, male infertility, and offspring health. By investigating these complex interrelationships, future research can help shape more effective diagnostic and treatment strategies for male infertility and its broader implications for men’s health and future generations. Full article

Background/Objectives: Prostate-specific membrane antigen (PSMA) PET/CT is more accurate than CT and bone scans for staging intermediate and high-risk prostate cancer (PCa). Fluorodeoxyglucose (FDG) PET has improved disease characterisation in metastatic castrate-resistant PCa (mCRPCa) and indicates patients with a particularly poor prognosis. The aim of this study was to assess the benefits of both PSMA and FDG PET in PCa staging by the direct intra-individual comparison of PSMA and FDG uptake patterns. Methods: Patients who underwent both PSMA and FDG PET/CT from 2015 to 2020 at our institution were identified and included if they had a histological or clinical diagnosis of PCa. Medical records were reviewed for demographic information and clinical details (including PSA, previous treatment, and disease status). Imaging interpretation was based on reporting by experienced nuclear medicine physicians. Results: Sixteen patients were identified. In 11 men with localised or hormone-sensitive PCa, PSMA-avid and FDG-avid disease was seen in 64% (n = 7) and 9% (n = 1) of patients, respectively. FDG-avid disease was present in 60% of patients with mCRPCa (n = 3/5), all of whom showed PSMA uptake. Of note, one patient showed higher initial FDG uptake that progressed in size and uptake on PSMA PET over 12 months. Conclusions: FDG PET might be useful in the assessment of patients with high clinical suspicion of metastases (e.g., high PSA, symptoms) with negative PSMA PET, particularly in castrate-resistant PCa. Full article

Background/Objectives: The American Urological Association (AUA) vasectomy guidelines’ current recommendation to obtain the first post-vasectomy semen analysis (PVSA) from 8 weeks to 16 weeks post-vasectomy is based predominantly on azoospermia rates. However, non-compliance with semen analysis after vasectomy is a known problem in this patient population. An approach that optimizes clearance and compliance is essential when adopting appropriate post-vasectomy care guidelines, specifically the scheduling of the first PVSA. We aimed to conduct a systematic review and meta-analysis of studies assessing compliance and clearance to determine the optimal time of first PVSA. Methods: Databases (MEDLINE, EMBASE, POPLINE) were searched for studies that contained the following: rate of azoospermia and rare nonmotile sperm (RNMS), compliance, recanalization, persistent RNMS, pregnancies, and incidence of repeat vasectomy. Results: A total of 28 studies were included in this review. The patient compliance was 47–100% and trended downward with increasing time to first PVSA. There was a positive trend in azoospermia rate as post-vasectomy time increased, but this plateaued at 8 weeks. Compliance and post-vasectomy semen analysis clearance (PVSAC) converged at 5.7 weeks, with rates of 74.5% and 74.6%, respectively. A proportion of 1.5% of patients exhibited persistent RNMS. Recanalization events had an incidence rate of 1.5%. Repeat vasectomies were performed in 1.6% of patients. Conclusions: Based on our study optimizing post-vasectomy semen clearance with follow-up compliance, we recommend initial PVSA between 6 to 18 weeks post-vasectomy, as this offers improved compliance over current AUA guidelines which recommend PVSA at 8 to 16 weeks and allows for the identification of instances of “subclinical recanalization” that may be missed at later time points. Full article

Background: Penile squamous cell carcinoma is an aggressive malignancy with significant physical and psychological impacts. Socioeconomic factors influence prognosis in genitourinary cancers, making the investigation of insurance status critical for reducing cancer burden and promoting health equity. Materials and Methods: Men diagnosed with primary penile squamous cell carcinoma from 2007 to 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) national database. Participants were categorized based on insurance status: privately insured, Medicaid, and uninsured. Pearson’s chi-squared test assessed the distribution of observed frequencies between the patient demographics, socioeconomic status, tumor characteristics, and surgical variables across the insurance groups. Overall and cancer-specific survival was estimated using a multivariate Cox hazards proportional model analysis. Results: The multivariate Cox hazards proportional model showed that, compared to privately insured patients, Medicaid patients had an increased risk for overall death (hazard ratio [HR] = HR 1.54; 95% CI, 1.12–2.07). For cancer-specific mortality, Medicaid patients had an increased risk of death compared to privately insured patients (HR 1.58; 95% CI, 1.11–2.25). Conclusions: Medicaid does not mitigate the differences caused by health insurance status due to health insurance disparities for overall or cancer-specific mortality. Lower Medicaid reimbursements and out-of-pocket costs lead to a narrow network of physicians, hospitals, and treatment modalities that compromise health equity. Increasing awareness of health insurance disparities and improving access to care via a clinician–community–governmental partnership can potentially lead to improved predictive outcomes. Full article

Introduction: A 51-year-old male was seen complaining of pneumaturia and bowel complaints, including blood per rectum. The patient related a history of an open left inguinal hernia repair utilizing a Kugel mesh ten years before. Case Presentation: Cystoscopy and colonoscopy demonstrated a hemorrhagic mass due to a prosthetic mesh protruding into the bladder and colon. Following colonoscopy and cystoscopy, a large inflammatory mass involving both the colon and urinary bladder was resected, which contained a rolled-up “tubular” mesh structure. After primary repair of the urinary bladder and placement of a Foley catheter, the sigmoid colon and mesh were resected, and the colonic anastomosis was completed. Outcome: Postoperatively, the patient progressed well with normal colon and bladder function after the removal of the Foley catheter. Discussion: Historically, the patient demonstrated the risk of major multiorgan surgical complications of a newer inguinal hernia repair technique, which may occur even a decade or more after the initial surgical correction and is, therefore, presented. Full article

Bladder cancer (BCa) is the fourth most common cancer in men and one of the most common urinary tract cancers, especially in developed countries. The aim of this paper is to comprehensively analyze the biology of bladder cancer, including its epidemiology, etiology, histological types, risk factors, clinical symptoms, and diagnostic methods. The paper presents the dominant histological types of bladder cancer, such as transitional cell carcinoma (TCC), which accounts for 90–95% of cases, squamous cell carcinoma (SCC), and adenocarcinoma, which is much rarer. Risk factors, such as smoking, occupational exposure to chemicals, schistosomiasis, and genetic factors, which significantly affect the pathogenesis of bladder cancer, are also discussed. The paper focuses on modern diagnostic methods, including blue light cystoscopy (BLC) and computed tomography urography (CTU), which show increased sensitivity and specificity in detecting early neoplastic changes. The importance of TNM classification and the role of neoadjuvant chemotherapy in improving patient prognosis are also discussed. Based on a review of the scientific literature, the paper emphasizes the need for early diagnosis and an individualized therapeutic approach, which may contribute to improving the survival and quality of life of patients with bladder cancer. The potential for prevention, including quitting smoking and limiting exposure to harmful chemicals, has also been demonstrated to significantly reduce the risk of disease. Patient education and monitoring high-risk groups are key to reducing the incidence of bladder cancer. Full article

The management of erectile dysfunction (ED) shows several gray zones, especially in terms of patients’ satisfaction and adherence to the treatment. The main and first-line treatment for ED is drug therapy, mainly phosphodiesterase-5 inhibitors (PDE5is), but adherence to the therapy is not optimal due to the low patient satisfaction reported in several cases. To address this issue, different administration routes and PDE5i pharmacological formulations have been introduced in the pharmacological market. The pharmaceutical market has recently seen the introduction of a novel sildenafil oral suspension. This device offers access to all therapeutic regimens in one device, releasing 0.5 mL of suspension containing 12.5 mg of sildenafil with each pulse. This formulation enables tailored dosing based on clinical requirements and the demands of ED patients. Here, we aim to give a brief narrative review of the management of this new oral suspension in order to provide readers with some suggestions to use in everyday clinical practice, on the basis of recent evidence, by using an easy and rapid-to-consult question and answer form. Also included are the conclusions of a board meeting of experienced andrologists regarding the most recent developments in this area. Full article

To date, robotic surgery has gained much popularity, impacting deeply on surgical fields such as genitourinary system branches, general surgery, and cardiac surgery. We aim to outline the landscape of robotic surgery, focusing on design improvements, which have improved both the technical skills of surgeons and the outcomes of minimally invasive technique for patients. A thorough narrative literature review was conducted on PubMed/MEDLINE, employing keywords such as “robotic surgical system”, “robotic surgical device”, and “robotics AND urology”. Furthermore, the reference lists of the retrieved articles were scrutinized. The analysis focused on urological surgical systems from the 2000s to the present day. Beginning with the daVinci^® Era in the 2000s, new robotic competitors, including Senhance^®, Revo-I^®, Versius^®, Avatera^®, Hi-notori^®, and HugoTM RAS, have entered the medical market. While daVinci^® has maintained a high competitiveness, even more new platforms are now emerging in the medical market with new intriguing features. The growing competition, driven by unique features and novel designs in emerging robotic technologies, has the potential to improve application fields, enhance diffusion, and ameliorate the cost effectiveness of procedures. Since the impact of these new surgical technologies on different specialties and healthcare systems remains unclear, more experience and research are required to define their evolving role. Full article

Retroperitoneal tumors are uncommon and may reach a large size prior to causing symptoms or being noticed by the patient or physician. A middle-aged female consulted us for care during her “terminal” illness. She had already undergone four previous retroperitoneal resection surgical procedures. She presented with a large recurrent protruding mass from the right side of the abdomen and related a history of a previous cholecystectomy, right nephrectomy, right colectomy, and repeated resection of a recurrent retroperitoneal liposarcoma. She thus came to us for consultation and terminal care in order to be away from her friends during treatment for this terminal condition. After our consultation, she elected to have repeated surgical excisions of the tumor. The surgical excisions yielded a giant recurrent tumor mass, which overflowed and covered all margins of the 21-inch-wide surgical scrub basin. Over the next eleven years, she had multiple surgical resection procedures involving both the right and left retroperitoneum (a splenectomy, a left colectomy, and a colostomy). Recovery from each of these resection procedures (the final combined resection weight was 120 pounds) was without complications. However, the tumor finally encased the pancreas and the left kidney. If the tumor encasement were to be palliated and resected, she would require hemodialysis. At this time, the patient elected to have no further resection surgeries, no dialysis, nor any palliative chemoradiation treatment. Over a period of sixteen years from her first resection and twelve years from our first resection, the patient had continued to work at her medical administrative and leadership position and led a functional life after our consultation, except for her surgical period. The patient was not cured but benefited from repeated palliative surgeries, prolonging her life and improving her job performance. Full article

Background: To compare perioperative outcomes and trifecta rates between laparoscopic and robotic partial nephrectomies (PN) using the Hugo™ RAS System, a study was conducted between October 2022 and September 2023. Methods: Twenty-two patients underwent minimally invasive PN for cystic renal tumors at our institution (group A: RAPN = 6; group B: Laparoscopic PN = 16). The trifecta was defined as the coexistence of negative surgical margin status, no Clavien–Dindo grade ≥ 3 complications, and eGFR decline ≤ 30%. Continuous variables were presented as median and IQR and compared using the Mann–Whitney U test, while categorical variables were presented as frequencies (%) and compared using the χ² test. For all statistical analysis, a two-sided p-value < 0.05 was considered statistically significant. Results: All patients successfully underwent off-clamp minimally invasive PN without the need for conversion or additional port placement. Group A showed a lower preoperative eGFR rate and a higher clinical tumor size, while group B displayed a higher number of male patients and bilateral lesions. However, these differences were not statistically significant (all p > 0.1). Regarding perioperative data, group A showed a lower operative time (79.5 vs. 134.5 min, p = 0.01), while group B showed a higher trend of benign histology (62.5% vs. 33.3%). All the other perioperative data were comparable between the two groups (all p > 0.2). The rate of trifecta achievement was 83.3% and 87.5% (p = 0.80) for group A and B, respectively. Conclusion: This study emphasizes the advantages of RAPN over laparoscopic procedures in terms of operative time. Extensive experience in Laparoscopic PN could be a key factor when approaching RAPN learning curve. Full article

Microscopic and digital whole-slide images (WSIs) often suffer from limited spatial resolution, hindering accurate pathological analysis and cancer diagnosis. Improving the spatial resolution of these pathology images is crucial, as it can enhance the visualization of fine cellular and tissue structures, leading to more reliable and precise cancer detection and diagnosis. This paper presents a comprehensive comparative study on super-resolution (SR) reconstruction techniques for prostate WSI, exploring a range of machine learning, deep learning, and generative adversarial network (GAN) algorithms. The algorithms investigated include regression, sparse learning, principal component analysis, bicubic interpolation, multi-support vector neural networks, an SR convolutional neural network, and an autoencoder, along with advanced SRGAN-based methods. The performance of these algorithms was meticulously evaluated using a suite of metrics, such as the peak signal-to-noise ratio (PSNR), structural similarity index metrics (SSIMs), root-mean-squared error, mean absolute error and mean structural similarity index metrics (MSSIMs). The comprehensive study was conducted on the SICAPv2 prostate WSI dataset. The results demonstrated that the SRGAN algorithm outperformed other algorithms by achieving the highest PSNR value of 26.47, an SSIM of 0.85, and an MSSIM of 0.92, by 4× magnification of the input LR image, preserving the image quality and fine details. Therefore, the application of SRGAN offers a budget-friendly counter to the high-cost challenge of acquiring high-resolution pathology images, enhancing cancer diagnosis accuracy. Full article

Men of all ages frequently experience erectile dysfunction (ED) or impotence, and it is a difficult health issue that adversely affects the quality of life of those who experience it. There are multiple types of treatment strategies for ED available, depending on the origin and severity of ED, as well as any underlying medical issues. However, these therapeutics are known to have a number of negative health effects. In contrast, plant-based treatments are more effective for managing diseases due to their ability to modulate biological processes like inflammation, oxidative stress, and cell signaling molecules. Many medicinal plants have been reported to be quite helpful in the improvement of ED. In this review, ED and its causes, diagnostic methods, treatment strategies, and some of the most potent plant-based interventions against ED are discussed in greater detail, along with a description of their mechanisms of action and a brief discussion of approaches to increase their efficacy, with a focus on the management of ED using herbal interventions as complementary and alternative medicines. While there is hope that medicinal plants could provide lead substances for erectile dysfunction medications, additional investigation is necessary to ascertain the efficacy and security of these prospective treatments. Full article

Introduction: Currently, there is limited evidence for the relationship of Exosome-based Prostate Intelliscore (EPI) and multiparametric magnetic resonance imaging (mpMRI) in stratifying risk for clinically significant prostate cancer. Using a retrospective cohort study design, we sought to characterize the relationship between these two noninvasive metrics and prostate biopsy outcome. Methods: Data were collected via electronic medical record for all patients who underwent EPI testing from 1 January 2019 to 3 February 2022 and had available medical records at a single mid-western university medical center. Positive test result was defined as >15.6 for EPI, ≥3 PI-RADS score and ≥3 + 4 Gleason Score for biopsy findings. Utility of EPI, mpMRI and combined use was characterized through calculation of sensitivity, specificity, positive predictive value, negative predictive value, and ROC analysis. Results: A total of 226 patients were identified as receiving EPI testing for risk stratification of clinically significant prostate cancer. Sensitivity for EPI was 91%, mpMRI was 90%, and the highest was combined use at 96%. With ROC analysis, AUC for EPI alone was 0.57 (95% CI, 0.47–0.67) and 0.78 (95% CI, 0.70–0.87) for mpMRI alone. With prior positive EPI result, AUC for combined use with mpMRI was 0.80 (95% CI, 0.71–0.89). Further subgroup analysis resulted in increased AUC values of EPI 0.67 (95% CI, 0.48–0.87), mpMRI 0.90 (95% CI, 0.76–1.0), and combined 0.90 (95% CI, 0.75–1.0) in the African American population. Discussion: We observed that the combined use of EPI and mpMRI led to an avoided biopsy in 43% of patients. Using both parameters increased the overall sensitivity and diagnostic accuracy in detecting clinically significant prostate cancer. The best test performance was observed in the African American cohort. Identifying optimal noninvasive tools to assess risk for prostate cancer is crucial to providing accurate and cost-effective care. Future study should utilize a prospective study design to further support the combined use of these metrics. Full article

A major global health concern, male infertility affects 8–12% of couples globally. Leukocytospermia is a complicated illness that is distinguished from other reasons causing male infertility by having high white blood cell counts in semen. The complex mechanisms behind leukocytospermia’s effects on sperm function and fertility are examined in this review. Leukocytospermia induces oxidative stress and reactive oxygen species (ROS) that impair DNA integrity, mitochondrial function, cytoplasmic extrusion, and sperm quality overall. Leukocytospermia is exacerbated by non-infectious factors, such as substance abuse and varicocele, even though genital tract infections are a common cause. The usefulness and dependability of diagnostic techniques range from immunochemistry to direct counting. Although there is still disagreement on the most effective course of action, clinical-care techniques, such as antioxidant supplementation and antibiotic therapy, attempt to address underlying causes and reduce ROS-induced damage. Prospectively, the combination of artificial intelligence with the latest developments in artificial reproductive technologies presents opportunities for more precise diagnosis and customized treatments. Full article