Authors: Maria Luisa Garo Gianpasquale Gallo
Background: Celiac disease (CD) is a systemic immune-mediated enteropathy with a broad spectrum of extraintestinal manifestations driven by aberrant mucosal IgA responses and increased intestinal permeability. These same mechanisms provide a compelling biological rationale for urinary tract involvement. The aim of this systematic review was to assess whether adults with CD carry an elevated risk of IgAN, UTI, or IC/BPS compared with adults without CD. Methods: A PRISMA 2020-compliant systematic review was conducted (PROSPERO: CRD420261358537). PubMed and Scopus were searched up to April 2026. Eligible studies enrolled adults (≥18 years) with confirmed CD, reported a urinary outcome, and included a comparator group. Risk of bias was assessed using the Newcastle–Ottawa Scale and Mendelian Randomization quality criteria. Results: Fifteen studies (1987–2025) were included. For IgAN (n = 13), a register-based cohort showed an over 18-fold elevated risk in adults with biopsy-confirmed CD (adj. HR: 18.98; 95%CI: 2.29–157.63), independently corroborated by Mendelian Randomization (OR: 1.44; 95%CI: 1.17–1.78). Early cross-sectional AGA studies reflect non-specific IgA dysregulation, not true CD autoimmunity. For UTI (n = 1), no significant association was identified in a single large registry study. For IC/BPS (n = 1), no clinical observational evidence exists and genetic causal analysis found no association. Conclusions: CD is consistently associated with elevated IgAN risk across independent study designs, supporting systematic CD screening in IgAN patients and prompt GFD initiation. For UTI and IC/BPS, adequately designed prospective studies are needed.
]]>Authors: Catherine Song Karen Doo Youngmin Choi Alia Codelia-Anjum Chin Kyung Doo Byoung Kyu Han Dean Elterman Naeem Bhojani Bilal Chughtai
Background/Objectives: To evaluate the discrepancies between the International Prostate Symptom Score (IPSS) and objective measures—uroflowmetry (Qmax) and post-void residual (PVR) volume—in men with lower urinary tract symptoms (LUTS), and to assess the implications for diagnosis and treatment planning. Methods: This retrospective study analyzed data from 414 men across three urology clinics who completed both IPSS and uroflowmetry between April 2023 and September 2024. IPSS total and subscores were categorized by severity and compared with Qmax (<15 vs. ≥15 mL/s) and PVR (<250 vs. ≥250 mL). Two exploratory discordance patterns were defined: a ‘bother-dominant’ pattern (moderate-to-severe IPSS with normal Qmax or PVR) and an ‘unrecognized voiding dysfunction’ pattern (mild IPSS with abnormal Qmax or PVR). Results: Among patients with severe total IPSSs, 8.7% had Qmax ≥ 15 mL/s, consistent with a ‘bother-dominant’ pattern, and 8.7% of those with mild scores had Qmax < 15 mL/s, consistent with an ‘unrecognized voiding dysfunction’ pattern. When moderate scores were included, the ‘bother-dominant’ pattern was observed in 27.8% and the unrecognized voiding dysfunction pattern in 36.0%. For PVR, 40.1% of patients with severe IPSSs had PVR < 250 mL (‘bother-dominant’ pattern), while the unrecognized voiding dysfunction pattern with elevated PVR was rare (≤1.3%). Discrepancies were also observed across voiding and storage subscores and individual items, such as incomplete emptying and weak stream. Conclusions: There is frequent discordance between subjective symptom severity and objective urodynamic findings in men with LUTS. Sole reliance on IPSS may lead to misclassification and inappropriate treatment. Incorporating Qmax and PVR into routine evaluation may enhance diagnostic accuracy and support more personalized management strategies.
]]>Authors: Mihaela Bot Andreea Borislavschi Radu Vladareanu
Coital urinary incontinence is a frequently underdiagnosed manifestation of female pelvic floor dysfunction, characterized by involuntary urine leakage during sexual activity, particularly during vaginal penetration or orgasm. Although interest in this condition has increased in recent years, it remains insufficiently investigated in clinical practice and is often underreported by patients because of stigma, emotional distress, and the negative impact on intimate relationships and quality of life. Current evidence supports the existence of distinct pathophysiological mechanisms depending on the timing of urinary leakage. Leakage occurring during vaginal penetration is more commonly associated with stress urinary incontinence, urethral hypermobility, and pelvic support defects, whereas orgasm-associated urinary incontinence appears to be more closely related to detrusor overactivity and complex pelvic neurophysiological mechanisms. Hormonal changes associated with the peri- and postmenopausal period may further contribute to symptom progression through alterations in urethral and vaginal trophicity, local vascularization, and pelvic neuromuscular function. Clinical evaluation remains challenging because many affected women do not voluntarily report symptoms due to embarrassment or social stigma, therefore it requires targeted questioning regarding urinary leakage during sexual activity, associated lower urinary tract symptoms, and the impact on female sexual health. Therapeutic management should be individualized and tailored to the predominant underlying mechanisms, including pelvic floor rehabilitation, behavioral interventions, pharmacological treatment, local hormonal therapy, and surgical management of stress urinary incontinence or pelvic support defects. Minimally invasive and regenerative therapies, such as vaginal laser therapy, platelet-rich plasma, cellular therapies, and neuromodulation, represent promising therapeutic approaches. Greater awareness and proactive screening during urogynecological evaluation are essential for improving diagnosis, individualized treatment, sexual health, and overall quality of life in affected women.
]]>Authors: Kameliya Kostadinova Krasen Venkov Ivan Tonev Milcho Mincheff Andriyana Bankova Georgi Mihaylov
Background: High-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) is an established salvage therapy for relapsed or refractory (R/R) germ cell tumors (GCTs). Methods: We conducted a retrospective analysis of 9 patients (23–41 years of age) with relapsed/refractory (R/R) GCTs treated according to the Swedish–Norwegian Testicular Cancer Group Clinical Protocol (SWENOTECA), at the Specialized Hospital for Active Treatment of Hematological Diseases (SHATHD) in Sofia, Bulgaria. The study evaluates the efficacy and safety of HDCT followed by ASCT in R/R GCTs eligible for second-line consolidation. The cohort was predominantly high-risk, with 77.7% of patients exhibiting stable or progressive disease (SD/PD) after first-line platinum therapy. Response was assessed via RECIST 1.1 criteria and tumor marker monitoring. Results: Median OS and PFS were 8.4 and 5.9 months, respectively. While the ORR post-ASCT was 33.3% (all CR), the 2-year survival plateau (33.3%) suggests curative potential in a subset of patients. Notably, there was no treatment-related mortality (TRM). Conclusions: Tandem HDCT is a feasible salvage strategy with manageable toxicity and no TRM in this small, heavily pre-treated cohort. Although efficacy results are exploratory due to the limited number of patients, the observed long-term remissions confirm the curative potential of this standard-of-care consolidation in a real-world clinical setting.
]]>Authors: Paula María Sánchez Vicente Juliusz Jan Szczesniewski Cristina Rasines Suárez Alejandro Rodríguez Caballero María Fernanda Lorenzo Gómez Luis Llanes González
Background: Retrograde intrarenal surgery (RIRS) is a well-established minimally invasive technique for the management of renal stones. However, intraoperative physiological and anesthetic events during the procedure remain poorly characterized, particularly in the context of newer technologies such as suction-assisted systems. Objective: The objective of this study is to evaluate the occurrence of intraoperative anesthetic and physiological adverse events during suction-assisted RIRS and to assess its safety profile. Methods: We conducted a prospective, single-center observational sub-analysis of the “Trifecta factors in ureteroscopy” project. A consecutive cohort of 30 patients undergoing RIRS with suction ureteral access sheaths (sUAS) between August 2025 and January 2026 was analyzed. Baseline demographics, stone characteristics, and intraoperative anesthetic parameters—including airway pressure, Bispectral Index (BIS), and hemodynamic events—were prospectively recorded. Primary endpoints included intraoperative fever, sustained tachycardia, blood pressure alterations, and anesthetic complications. Results: The cohort had a mean age of 56.4 years with an equal gender distribution. Mean stone size was 12.9 mm, and mean operative time was 50.3 min. Intraoperative monitoring demonstrated stable anesthetic conditions, with a mean airway pressure of 16.3 cmH2O and a mean BIS of 42.6. No major anesthetic complications or significant blood pressure fluctuations were observed. Minor intraoperative events included fever in 10% of cases and sustained tachycardia in 6.7%. No cases of intraoperative anesthetic instability were recorded. Conclusions: Within this descriptive cohort, suction-assisted RIRS under general anesthesia demonstrated a favorable safety profile with stable intraoperative parameters, though larger comparative studies are required to confirm these preliminary findings.
]]>Authors: Ola Christiansen Ola Bratt Arnulf Kjos Jūratė Šaltytė Benth
Objective: Quantib® Prostate is a commercially available machine learning software (MLS) used for prostate magnetic resonance imaging (MRI), approved by the Food and Drug Administration (FDA) and Conformité Européenne (CE). We aimed to assess the agreement between biparametric MRI (bpMRI) interpretations produced by radiologists and by Quantib® alone. Material and Methods: This single-centre, retrospective, and observational study included 188 bpMRI scans from the Innlandet Hospital Trust, Norway. Radiologists’ Prostate Imaging Reporting and Data System (PI-RADS) scores were compared with scores produced by the Quantib® Prostate PI-RADS, which was used as an autonomous software. Additionally, for exploratory purposes, the PI-RADS scores were compared with biopsy findings, using the radiologist’s scorings to determine biopsy indications. Results: For PI-RADS scores generated by radiologists vs. those produced by Quantib® Prostate, the weighted kappa was 0.49 (95% CI: 0.37–0.59), and 46% of the PI-RADS scores differed by at least one unit. In the sample, 125 men (66%) had a prostate biopsy, and for male patients with PI-RADS scores of 4–5, the probability of detecting cancer grades 2–5 via biopsies was 64% (95% CI: 56–71) for radiologists and 58% (95% CI: 54–62) for Quantib® Prostate. The main limitations of this study are the retrospective, single-centre design, the small sample size, the use of Quantib® Prostate in an autonomous manner, and verification bias, as the biopsy decisions were based solely on PI-RADS scoring by radiologists. Conclusions: We identified inter-rater variability between PI-RADS scores generated by Quantib® Prostate and radiologists’ assessments, and the agreement between the two scoring groups is moderate. Our results suggest that Quantib® Prostate requires further clinical comparative studies before it is used in clinical routines.
]]>Authors: Katarzyna Sklinda Marek Kasprowicz Michał Małek Bartlomiej Olczak Tadeusz Budlewski Malgorzata Kobylecka Jerzy Walecki Martyna Rajca
[18F]-PSMA PET/CT is a high-impact modality for the staging and restaging of prostate cancer, but its wide anatomic coverage and tracer biology generate frequent incidental findings on both PET and the accompanying low-dose CT (LDCT). This narrative review is restricted in scope to fluorine-18 PSMA tracers because tracer-specific biodistribution and pitfall profiles shape what is perceived as incidentaloma: how confidently lesions can be categorized, and how often borderline findings trigger downstream testing, particularly for skeletal foci with [18F]-PSMA-1007. Specifically, [18F]-PSMA-1007 shows substantially higher rates of focal unspecific bone uptake than [68Ga]-PSMA-11—reported in multicenter studies as affecting up to 40–50% of patients—which directly inflates the pool of potential incidentalomas and creates a tracer-specific false-positive problem with no parallel in gallium-68 practice. Additionally, [18F]-DCFPyL has different urinary clearance kinetics that affect bladder and ureteral uptake patterns, altering what qualifies as physiologic versus incidental in the pelvis. These differences mean that the threshold for Category B versus C classification—and the appropriate cascade-resistant language—must be tuned to the specific tracer in use. A framework built on [68Ga]-PSMA-11 data would systematically underestimate bone pitfall frequency in [18F]-PSMA-1007 practice and could therefore paradoxically increase rather than reduce cascades if applied uncritically across tracers. These biodistribution differences have direct and concrete consequences for reporting behaviour and downstream management. In [18F]-PSMA-1007 practice, a focal bone uptake without a CT correlate in a mechanically plausible location—such as an anterior rib or vertebral endplate—should trigger Category B language in the report conclusion: the finding is documented in the body with explicit safety netting (“most consistent with unspecific uptake; no routine workup unless interval growth, new pain, or aggressive CT morphology”), and no referral to bone scintigraphy or MRI is generated. Without tracer-specific awareness, the same finding would typically prompt a reflex bone scan or whole-body MRI referral, delaying definitive prostate cancer management by weeks and adding imaging costs without diagnostic gain. By contrast, in [68Ga]-PSMA-11 practice, an equivalent focal bone uptake without a CT correlate carries a higher prior probability of true metastatic disease given the lower background rate of unspecific uptake and should more often be reported at Category B with a lower threshold for escalation or more cautious language. For [18F]-DCFPyL, the higher urinary activity in the pelvis means that ureteral segments can mimic lymph node disease; recognizing this as a physiologic variant (Category C) rather than an equivocal nodal finding (Category B) avoids unnecessary pelvic MRI referrals that would otherwise be triggered by an uncontextualized report. In practical terms, the tracer-specific calibration of the overlay therefore changes not only the category assigned but also the specific safety-netting language and the escalation trigger, which directly modifies the downstream management pathway for each affected finding type. The scanned population—predominantly older men with a high prevalence of degenerative, inflammatory, and vascular abnormalities—creates substantial background noise that can drive low-value diagnostic cascades if incidental findings are communicated without actionability context. We integrate society-endorsed frameworks (EANM/SNMMI procedure guideline 2.0; E-PSMA; PSMA-RADS; and PROMISE/miTNM with miPSMA score) and propose a cascade-aware overlay for incidental findings that can be appended to existing PSMA reporting standards rather than replacing them. The A/B/C actionability overlay is a structured expert-consensus framework informed by existing evidence-based guidelines for specific finding types and by tracer-specific cohort data; it has not yet been prospectively validated as a standalone tool, and its current level of evidence is therefore analogous to a structured expert recommendation rather than an evidence-based clinical guideline. We operationalize a three-tier actionability scheme across PET- and CT-dominant findings, provide cascade-resistant language for conclusions, and clarify why SUVmax-only “probability scales” for lymph nodes are not recommended in routine reports. Three practical tables summarize PET incidental findings, lymph node reporting frameworks, and LDCT incidental findings, and two structured report templates are provided (concise and extended), with the extended version explicitly labelling actionability tiers and escalation triggers. Finally, we outline concrete AI use cases for standardization and triage while emphasizing governance to avoid the amplification of false positives and paradoxical growth of cascades.
]]>Authors: Sindhu Sankaran Hira Bakhtiar Khan Mehwash Nadeem
Background: Bladder pain syndrome (BPS) is a chronic, debilitating condition defined by the International Continence Society as bladder-related pelvic pain accompanied by urinary symptoms in the absence of identifiable pathology. Its heterogeneous presentation, unclear pathophysiology, and variable treatment response make management challenging for general urologists. This review aims to provide a practical narrative review of current understanding of BPS, with particular emphasis on diagnosis, phenotyping, and non-operative management strategies relevant to the general urologist. Methods: A narrative literature review was undertaken using PubMed/MEDLINE, Embase, Google Scholar, and major international guideline documents to identify evidence relating to the diagnosis and non-operative management of BPS. Publications from January 2015 to December 2025 were reviewed, with selected landmark earlier studies included, where clinically relevant. Priority was given to guidelines, systematic reviews, randomised trials, and cohort studies. Owing to heterogeneity in study design, patient phenotypes, and reported outcomes, findings were synthesized narratively. Results: BPS represents a heterogeneous spectrum, including Hunner-lesion and non-Hunner phenotypes, with proposed mechanisms involving urothelial dysfunction, chronic inflammation, immune dysregulation, and central sensitisation. Diagnosis remains one of exclusion, relying on careful history, examination, symptom scoring, and selective investigations. Non-operative management is stepwise and multidisciplinary, combining lifestyle modification, pelvic floor therapy, oral agents and intravesical therapy. Available evidence suggests that symptom improvement is often modest but clinically meaningful in selected patients, supporting an individualized, phenotype-informed approach to care with realistic patient counselling. Conclusions: Bladder pain syndrome remains a chronic, multifaceted disorder with profound impact on quality of life, requiring clinicians to approach patients with empathy while recognising the physical, psychological, and social burden of the condition. Effective management requires early recognition, thoughtful phenotyping, exclusion of confusable conditions, and realistic expectation-setting within a multidisciplinary framework. For the general urologist, a structured and compassionate non-operative approach can improve symptom control, support shared decision-making, and help guide timely escalation when required.
]]>Authors: Shamima Islam Nipa David Cooper Alyaa Mostafa Mohamed Abdel-Fattah
Background/Objectives: The Novel Aberdeen Sexual Function Improvement Index (SFI-I) is a simple single-item questionnaire specifically tailored for women with urinary incontinence (UI). The objective of the study was to describe for the first time the Aberdeen SFI-I and to assess its effectiveness in identifying changes in sexual function among women undergoing surgical treatment for SUI. Methods: A secondary analysis of data from the Single Incision Mini-Slings (SIMS) study was undertaken. Pearson correlation analyses were used to examine associations between the SFI-I and changes in the PISQ-IR scores, as well as the Patient Global Impression of Improvement (PGI-I). Results: The analysis included 596 women. Among these participants, 118, 101, and 102 completed the SFI-I and the PISQ-IR at 15, 24, and 36 months, respectively. Moderate positive correlations were identified between the SFI-I and PGI-I, ranging from 0.342 to 0.435, indicating that changes in SFI-I and PGI-I tended to occur in the same direction. The inverse correlation between the SFI-I and PISQ-IR, ranging from −0.588 to −0.518, indicates that improvements detected by one instrument are consistently reflected by the other. Diagnostic performance measures showed specificity values between 0.733 and 0.871 and positive predictive values between 0.844 and 0.900, demonstrating that improvement on the SFI-I is a strong indicator of improvement on the PISQ-IR. Conclusions: The newly developed Aberdeen SFI-I is a promising, short, and patient-friendly tool that reliably reflects patients’ perceptions of the impact of SUI surgery on sexual function, which would be specifically valuable where detailed assessment of individual sexual function domains is not required. Further comprehensive psychometric evaluation encompassing reliability, responsiveness, and the determination of clinically meaningful thresholds is required.
]]>Authors: Teddy Jabbour Laurent Bairy Benoit Bihin Jean-Francois De Wispelaere Marcelo Di Gregorio
Background/Objectives: To compare real-world outcomes of transurethral resection of the prostate (TURP), transurethral vaporization of the prostate (TUVP), and prostate artery embolization (PAE) in men with symptomatic benign prostatic hyperplasia (BPH). Methods: A retrospective cohort of 203 patients undergoing TURP, TUVP, or PAE was analyzed. Outcomes included IPSS, QoL, IIEF, prostate volume, maximum urinary flow rate (Qmax), and post-void residual volume (PVR) at 12 months. Adjusted analyses used ANCOVA and propensity score weighting. Results: All groups showed improvement. TURP provided the greatest improvements in IPSS, QoL, Qmax, and prostate volume reduction. TUVP outcomes were intermediate; while symptom improvements (IPSS) were comparable in weighted models, TURP provided significantly greater improvements in Qmax and prostate volume reduction across all adjusted analyses. Conclusions: TURP remains an effective option for symptomatic BPH; TUVP and PAE offer modest benefits and remain viable alternatives in selected patients.
]]>Authors: Loris Cacciatore Gianluigi Raso Antonio Minore Simona Ruggeri Alberto Ragusa Francesco Tedesco Antonio Rosario Iannello Francesco Esperto Rocco Papalia
The advent of robotic surgery has revolutionized multiple medical fields, notably in urology, gynecology, and both general and cardiovascular surgery. This article aims to explore the journey of robotic-assisted surgery (multi/single-port) in abdomen and pelvic surgeries, tracing its historical roots, examining its current landscape, and considering the potential future impact. A comprehensive review of the literature was conducted through PubMed/MEDLINE, utilizing keywords such as “robotic surgical systems,” “robotic surgery devices,” and “robotics AND urology.” Reference lists from selected articles were also explored to ensure a broad scope of understanding. The focus was on robotic systems designed for laparoscopic urological surgeries, all of which have been granted regulatory approval for clinical use. The historical trajectory of robotic surgery is traced back to the late 1980s with early systems like the Probot®, preceding the transformative introduction of the daVinci® system in the early 2000s. In addition to daVinci®, the article introduces newer robotic platforms, including Senhance®, Revo-I®, Versius®, Avatera®, Hinotori®, Edge®, Shurui and HugoTM RAS, which are emerging as serious competitors. While daVinci® has been the dominant force in robotic surgery for over a decade, these new systems are making significant strides with innovative designs, enhanced precision, and improved cost-efficiency. The growing competition among these platforms promises to expand their potential applications, increase accessibility, and optimize surgical outcomes across various specialties. Furthermore, as new technologies continue to evolve, there is a clear need for more extensive clinical trials and real-world data to assess their long-term impact on surgical practices, healthcare delivery, and patient outcomes. It remains to be seen how these advanced systems will integrate into healthcare infrastructures and their ultimate role in shaping the future of minimally invasive surgery.
]]>Authors: Kavin Raj Cyril Thiagaraj Shwetambari V. Ingawale Hira Bakhtiar Khan Mehwash Nadeem
Background: Urinary tract infections (UTIs) are a leading cause of urine testing and antibiotic prescribing across healthcare settings. Despite established clinical guidelines, inappropriate practice such as unnecessary urine cultures, treatment of asymptomatic bacteriuria, suboptimal antibiotic selection, and excessive treatment duration remain common. These practices contribute to antimicrobial resistance, adverse drug events, and increased healthcare costs. Methods: This narrative review synthesises evidence from PubMed-indexed studies, including systematic reviews, randomised controlled trials, and implementation studies, to evaluate the impact of antibiotic and diagnostic stewardship interventions on UTI management. Studies assessing outcomes related to urine testing practices, antibiotic utilisation, and clinical safety were included. Discussion: The literature demonstrates that integrated stewardship interventions effectively reduce inappropriate urine testing and antibiotic use without negatively affecting patient outcomes. Diagnostic stewardship strategies such as limiting urine cultures to patients with appropriate clinical indications, implementing reflex testing algorithms, and improving result interpretation reduce downstream antibiotic overuse. When combined with antibiotic stewardship approaches including clinical decision support, audit-and-feedback, and bundled interventions, these strategies lead to sustained improvements in prescribing behaviour and care quality. Conclusions: Antibiotic and diagnostic stewardship are synergistic and essential components of optimal UTI management. Interventions targeting both diagnostic decision-making and antibiotic use can safely reduce unnecessary testing and treatment. Future stewardship efforts should prioritise integrated, multidisciplinary approaches supported by clinical decision support tools to enable real-time, sustainable improvements in UTI care across clinical settings.
]]>Authors: Mark Wellmann Jeff John John Lazarus
Background/Objective: To describe a novel dual-action pump (DAP) which is hypothesised to reduce mean intrarenal pressure (IRP) and increase irrigation flow during flexible ureterorenoscopy (fURS). The DAP incorporates a low-volume, user-controlled pumping/suctioning unit, to precisely control fluid boluses into the upper urinary tract via a ureterorenoscope and simultaneously draws out an identical volume of the delivered irrigant via a syphoning UAS. This human cadaveric study aims to assess the DAP’s impact on IRP and the irrigant flow rate compared to a traditional UAS. Methods: Twelve fresh frozen human cadaver renal units were studied in situ. An 11/13 UAS was placed under fluoroscopic guidance and a fURS was introduced. Continuous pressure was monitored. The DAP and syphoning UAS were compared to a conventional irrigation system in terms of IRP and irrigant flow at variable irrigant fluid heights and during fluid bolus administration. Results: The mean IRP was reduced by 79–141%. Maximum IRP was reduced by up to 180%. The mean irrigation flow rate was improved by 44–86%. The small sample size of 12 limits the results obtained. Conclusions: The novel DAP system shows promise in reducing intra-renal pressure and improving irrigant flow in flexible ureteroscopy.
]]>Authors: Alexandra Lazcano-Ornelas Daniel Ajabshir Giulia Almiron Manish Choudhary Neeraja Tillu
Bladder cancer (BCa) arises from the interaction between environmental exposures and the host’s immunity and microbiome. Once considered sterile, the urinary tract is now known to harbor a resident urinary microbiome (UM) that dynamically interacts with the immune system and is influenced by systemic immunomodulatory effects of the gut microbiome (GM) brought on by the emerging gut–bladder axis. Accumulating evidence links alterations in UM and GM leading to BCa development, progression, and recurrence. Loss of protective taxa (e.g., Lactobacillus, Bifidobacterium and Ruminococcus) and enrichment of pro-inflammatory or genotoxic bacteria (e.g., Fusobacterium, Acinetobacter, Prevotella and Enterobacteriaceae) are associated with immune evasion and systemic inflammation. Microbial metabolites, especially short-chain fatty acids (SCFAs), play a key role in shaping tumor immunity and show diagnostic and prognostic potential, with specific microbial signatures correlating with recurrence risk, survival, and treatment response. Therapeutically, growing evidence suggests that microbiome composition influences immunotherapy response, highlighting opportunities for microbiome-based interventions. This review aims to summarize the rationale to implement microbial modulation strategies (e.g., dietary modulation, probiotics, fecal microbiota transplantation (FMT), and emerging synbiotic or postbiotic approaches) while addressing their current limitations and future requirements in order to develop microbiome-guided therapies, diagnostics and prognostic tools for BCa.
]]>Authors: Mattia Sibona Marco Oderda Paolo Destefanis Davide Campobasso Francesco Maria Bracco Gabriele Montefusco Matteo Ghio Federico Vitiello Eugenia Vercelli Luca Micai Carlotta Mangione Fulvia Colucci Claudia Gozzo Gianluca Bonino Paolo Gontero
Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a bothersome condition characterized by pelvic pain and lower urinary tract symptoms (LUTS). Phytotherapy can be used to treat this challenging condition. The aim of this study was to investigate the role of an oral combination of bovine colostrum, Serenoa repens extract and other anti-inflammatory elements in the treatment of CP/CPPS patients. Methods: Our study was a prospective, observational, single-arm study that enrolled patients > 18 years with a history consistent with CP/CPPS, a Chronic Prostatitis Symptom Index (CPSI) pain domain score ≥ 5 and a Meares–Stamey microbiological test negative for bacterial infection. Pelvic or genital pain was measured via the Numeric Pain Rating Scale (NPRS) and validated questionnaires. All patients were treated with an oral combination of colostrum, Serenoa repens extract and other anti-inflammatory elements for 6 months. Follow-up visits were scheduled at 3 and 6 months. Pre- and post-treatment variables were compared by means of the Wilcoxon signed-rank nonparametric test. Results: We included 42 patients in our analysis. The median (Inter-Quartile Range, IQR) age was 42 (28–51) years. Compared with baseline, after 3 months we observed a significant reduction in pain: total CPSI score of 16 (12–21) vs. 22 (17–26), p < 0.001, −6 points (−27.3%); CPSI score of “pain” domain 7 (5–9) vs. 8 (7–11), p < 0.001, −1 point (−12.5%). Moreover, quality of life improved: CPSI “quality of life” domain 6 (4–9) vs. 8 (7–10), p < 0.001. After 6 months, a significant reduction in pain was maintained: total CPSI score 19 (10–23), p < 0.001, −3 points (−13.65%); and CPSI “pain” domain 7 (4–9), p < 0.001, −1 point (−12.5%). After 6 months, a mild reduction in urinary symptoms was also reported. During the observation period, five patients discontinued treatment, two of them because of gastrointestinal intolerance. Conclusions: The daily oral administration of bovine colostrum, Serenoa repens and other anti-inflammatory elements showed a potential in improving pain and other urinary symptoms and was generally well tolerated by patients affected by CP/CPPS.
]]>Authors: Ishaq Tantray Rani Ojha
Cancer cells rely on elevated ribosomal biogenesis and protein synthesis to sustain their rapid proliferation. This heightened translational demand imposes significant stress on the fidelity of protein synthesis, thereby necessitating ribosomal quality control (RQC) activation, which safeguards proteostasis by degrading incomplete nascent polypeptide chains. At present, RQC is no longer only a peripheral pathway, it is a decisive arbiter of proteostasis whose malfunction rewires the course of cancer progression. Emerging evidence suggests that RQC factors can function as pro-tumorigenic or anti-tumorigenic in a context-dependent manner across different cancer types. This review highlights mechanistic models of how translation stalling, ribosome collision, and ribotoxic stress response influence neurodegeneration, tumor progression, metastasis, stemness, and drug resistance. By framing RQC as a critical regulator of cancer fate, we will identify verifiable and experimentally tractable hypotheses for therapeutic targeting and biomarker discovery in cancer.
]]>Authors: Jeff John Graham Fieggen Lisa Kaestner John Lazarus
Background/Objectives: For centuries, humans have employed animal models to progress biomedical science, to understand pathological and biological processes, and to develop and test drugs, vaccines, and surgical techniques. In the field of urology, Sampaio and his colleagues from Brazil were the pioneers in proposing that the porcine model is the most accurate representation of the human kidney. We aim to describe the relevant urinary anatomy of female Landrace pigs based on endoscopy and computed tomography (CT) scans and compare differences between the urinary anatomy of pigs and humans. Methods: Four white Landrace female pigs were used for the study: two for CT imaging and two for endoscopic assessment. CT-urograms were performed using a 64-channel tomography machine with 0.625 mm thick slices. For the endoscopic procedure, the intravaginal urethral meatus was cannulated using a cystoscope, followed by complete urethrocystoscopy. The ureteric orifices were then cannulated, and a retrograde pyelogram was performed, followed by ureterorenoscopy. The analyses were performed using SPSS (Version 28), and simulated data was created using R (version 3.5.0), with the significance set at p ≤ 0.05. The data obtained from two pigs was used to simulate an empirical data with 500 observations, using the mean and standard deviations from our n = 2 to produce a random normal distribution. Results: CT and endoscopic findings showed two multirenculate multipapillate kidneys, each receiving blood supply from a single renal artery that is further divided into cranial and caudal branches. The delayed phase of the urogram showed distal ureters passing posterior to the bladder and emptying into the bladder at the base. Urethroscopy revealed an intravaginal urethral meatus ventral to the anus, positioned midway between the mucocutaneous junction of the vulva and the cervix. Endoscopic view of the bladder neck showing patulous ureteric orifices at the bladder neck with no distinct interureteric ridge or trigone. Retrograde pyelogram showed a Group B drainage pattern in both pigs. Conclusions: While there are numerous similarities between the urinary systems of humans and pigs, there are important subtle differences that urologists and researchers need to be mindful of before using the porcine model for urological research and training.
]]>Authors: Raffaella Lucchini Rodrigo Cartes Ciro Franzese Lorenzo Lo Faro Luciana Di Cristina Giuseppe Roberto D’Agostino Marco Badalamenti Andrea Girlando Rosario Mazzola Stefano Arcangeli Marta Scorsetti
Background/Objectives: Stereotactic Body Radiation Therapy (SBRT) is increasingly used for localized prostate cancer (PCa), but evidence supporting its use in high-risk PCa (HRPC) remains limited. Standard management continues to favor conventional or moderately hypofractionated radiotherapy combined with long-course androgen deprivation therapy (ADT). This systematic review aimed to synthesize current data on SBRT biochemical outcomes, toxicity, and technical aspects in localized HRPC. Methods: A systematic PubMed search was conducted on 1 May 2024, following PRISMA 2020 guidelines (PROSPERO ID CRD420251235649). Studies reporting biochemical control (BC) for HRPC treated definitively with SBRT, with or without ADT, were included. Studies not meeting these criteria or including ≤10 HRPC patients were excluded. Risk of bias was assessed through qualitative appraisal of study methodology. Substantial heterogeneity across study design, SBRT schedules, cohort composition, and ADT integration precluded a meta-analysis; data were synthesized descriptively. Results: Thirty studies contributed biochemical control data after prostate SBRT for 1354 patients meeting inclusion criteria. SBRT was delivered using diverse platforms and dose-fractionation schemes, frequently in combination with ADT. Across studies, BC was generally favorable, though follow-up duration varied widely. Toxicity profiles were acceptable, with most reports describing predominantly grade 1–2 events and low rates of severe toxicity. Marked variability was observed in target volume definition, focal-boost strategies, urethra-sparing techniques, and the use of rectal spacers. Conclusions: Although current evidence is heterogeneous and largely derived from non-randomized studies, BC and toxicity outcomes are consistently promising, supporting SBRT as a potentially effective strategy for localized HRPC. Randomized prospective trials are needed to confirm these findings and refine optimal SBRT regimens and the role of ADT. This review received no funding.
]]>Authors: Anushree Kucheria Elaina Gubbay Aoife Meabh Linzell Irfan Kar Mohammad Alomari Kimberley Chan Christine Gan Nikhil Vasdev
Objective: To evaluate the diagnostic yield of blue-light cystoscopy (BLC) compared with white-light cystoscopy (WLC) in detecting carcinoma in situ (CIS) and muscle-invasive bladder cancer (MIBC), and to assess recurrence-free survival (RFS) following BLC-HAL resection. Patients and Methods: We retrospectively analysed 238 patients undergoing BLC-HAL between July 2017 and July 2024. Seventy-two underwent primary BLC at initial resection, and 166 underwent BLC re-resection following WLC. Endpoints were CIS detection, tumour upstaging, and recurrence-free survival at 12 and 24 months using Kaplan–Meier analysis. Results: Overall, malignancy was confirmed in 113/238 patients (47%). Detection was higher in the secondary arm (55%) compared with the primary arm (29%). In the primary arm, CIS was detected in 19% and MIBC in 24%. In the secondary arm, CIS increased from 18% on WLC to 38% with BLC (p = 0.001), with 26% detected only under blue light; 10% were upstaged to MIBC (p = 0.022). Over one-third of patients were reclassified into a higher EAU NMIBC risk group. Kaplan–Meier analysis showed 12- and 24-month RFS of 71% (95% CI: 36–92%) and 67% (95% CI: 35–88%) in the primary arm, and 62% (95% CI: 49–74%) and 63% (95% CI: 43–79%) in the secondary arm. Median RFS was not reached within 24 months. Conclusions: BLC significantly enhances CIS detection and identifies MIBC and higher-risk disease not seen on WLC, directly influencing patient management. Despite improved detection, recurrence-free survival remains modest, consistent with high-risk NMIBC, supporting guideline recommendations for routine use of BLC at TURBT, particularly in suspected CIS and high-grade disease.
]]>Authors: Andrea Abramo Tommaso Ceccato Simone Botti Daniele Mattevi Nicola Mondaini Luca Gallelli Truls E. Bjerklund Johansen Michele Rizzo Giovanni Liguori Alessandro Zucchi Alessandro Palmieri Luca Boeri Tommaso Cai
Background/Objectives: Interest in the use of nutraceuticals and phytotherapy for the management of andrological diseases has increased markedly in recent years. In particular, growing attention has been directed toward the treatment of patients affected by erectile dysfunction (ED), male infertility, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and induratio penis plastica (IPP). However, several areas of uncertainty remain. This narrative review aims to examine the role of nutraceuticals and phytotherapeutic agents in the management of andrological disorders. Methods: A narrative review was conducted using PubMed, Scopus, Cochrane CENTRAL, and EMBASE to identify relevant studies published over the past 25 years. Only articles published in English and involving adult populations were included in the analysis. Results: Nutraceuticals and phytotherapeutic compounds have been extensively investigated in the current literature, and certain formulations—particularly specific combinations—have been evaluated in high-quality studies. Conversely, other compounds lack sufficient scientific evidence and therefore should not be recommended in routine clinical practice. In the management of ED, the following compounds, administered either alone or in combination, have demonstrated clinically significant effects: Panax ginseng, Tribulus terrestris, L-arginine, and Withania somnifera. L-carnitine, combined with micronutrients, antioxidants, and various traditional herbal supplements, appears to be an effective therapeutic option for male infertility and subfertility. Pollen extracts play an important role in the management of CP/CPPS, while carnitine, coenzyme Q10, silymarin, bromelain, and curcumin show promising potential in the treatment of IPP. Conclusions: Nutraceuticals and phytotherapeutic agents may provide favorable outcomes in the management of andrological diseases. Although current evidence is encouraging, larger prospective studies employing standardized protocols and treatment schedules are required to confirm long-term efficacy and to optimize therapeutic strategies.
]]>Authors: Danae Merentitis Julia Neuenschwander Beat Foerster Hubert John Lucas M. Bachmann Nicolas S. Bodmer Jure Tornic
Background/Objectives: The objective of this study is to compare nerve-sparing (NS) and non-nerve-sparing (NNS) robot-assisted radical prostatectomy (RARP) techniques used to treat localized prostate cancer. Numerous studies have evaluated the impact of NS techniques on patient-reported outcomes. However, there are unaddressed methodological issues making interpretation of results difficult. Therefore, we performed a comparison of the two techniques, accounting for methodological threats, including patient selection and confounding. Methods: We sampled 120 patients with similar disease burden who underwent RARP by the same surgeon, either with NS (n = 84) or NNS (n = 36) and assessed changes in lower urinary tract (LUT) function and bother, and bowel function/bother using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire and the six-item International Index of Erectile Function (IIEF-6) survey at 6 weeks and 12 months postoperatively. Multivariable linear regression models were used to adjust for differences in age, preoperative PSA levels, pathological tumor stage and Gleason-score of patients receiving either NS or NNS. Results: At 6 weeks postoperatively, the NNS group had a significantly larger decrease in LUT function compared to the NS group (−17.42; 95% Confidence Interval (CI): −31.31, −3.53; p = 0.0145). At 12 months, both groups recovered substantially, and no group differences were observed (p > 0.9). No significant differences were observed between the NS and NNS groups for the EPIC bowel subscores, whereas the IIEF-6 showed borderline significance at 12 months. Conclusions: The results suggest a small impact of NS vs. NNS RARP on important patient-reported outcomes when controlling for tumor biology, surgeon skill, and patient characteristics. These results need to be confirmed by larger studies using similar sampling strategies and design considerations.
]]>Authors: Vahid Mehrnoush Dhruv Lalkiya Nilanga Aki Bandara Fatemeh Darsareh Emmanuelle Rousseau Sara Paziraei Omar AbdelAziz Waleed Shabana Walid Shahrour
Background: The societal effects of prostate cancer are profound. Prostate surgeries remain one of the main treatment modalities in the care of prostate cancer, and one of the common complications associated with this procedure is postoperative erectile dysfunction (ED). ED can have a significant negative impact on men’s quality of life. The included articles from the last systematic review on effect of pre-operative pelvic floor muscle training (PPFMT) on ED after radical prostatectomy (RP) showed mixed findings but recommended the need for better exercise regime to witness better outcome. Therefore, this systematic review aims to provide further evidence from 2018 to understand the impact of PPFMT on postoperative ED and provide latest insights for future research. Methods: A systematic search was conducted on Medline, Embase, CINAHL, and Google Scholar from 2018 to June 2025, with the assistance of a subject-expert librarian. The inclusion criteria include articles which examine the effect of PPFMT on ED post prostatectomy from 2018 to June 2025 and have a minimum of two comparative groups (control vs. case). In addition, non-English articles were excluded from the study. The included articles were further assessed by two independent reviewers using Covidence, and disagreements were resolved by another independent reviewer. Results: A total of 344 articles were located and after removing duplicates, 250 articles remained. Following the abstract and title screening, nine articles were assessed for eligibility. Upon full-text review, three studies (two randomized control trials (RCTs) and one non-RCT) were ultimately included. The two RCTs showed no significant impact of PPFMT on post-operative ED. On the other hand, the non-RCT reported a significant difference in the post-operative ED rate in the case (5%) vs. control (48.6%) group. PPFMT was defined as ten pre-operative physiotherapy sessions in ten consecutive working days using anal biofeedback. Conclusions: The current study, since 2018, reveals mixed findings on the effect of PPFMT on postoperative ED. However, upon reviewing the evidence on the positive role of PPFMT in other fields (e.g., gynecology, general surgery), we noticed that the included studies may be lacking some major components like knowledge assessment, subjective and objective assessment, along with characteristics of sessions (number, duration, intensity, interval to surgery, and biofeedback) that play a crucial role in the effectiveness of the PPFMT in strengthening the pelvic floor muscle and improving the outcomes. Further research with robust designs is warranted.
]]>Authors: Nikola Jeker Matthias Walter Christian Wetterauer
Background/Objectives: The internet is a major source of health information, including prostate cancer, but the quality of such content is inconsistent and may influence patient decision-making. This study aimed to evaluate the quality of online prostate cancer information by language, location, and user mode (“Logged off” vs. “Anonymous”) using the Google search engine. Methods: We conducted a cross-sectional, observational study between 5 and 11 December 2022, evaluating Google search results for prostate cancer information across three European cities (Basel, Munich, and Paris) and three languages (English, German, and French) in both “Logged off” and “Anonymous” user modes. A total of 900 websites (450 per mode) were retrieved and classified as: (1) university, (2) hospital, (3) governmental/medical societies, (4) industrial/commercial/NGOs, or (5) other. Website quality was assessed using the validated QUEST, which evaluates authorship, attribution, conflicts of interest, currency, and evidence. Inclusion rates and QUEST scores were compared across languages, locations, and categories using Kruskal-Wallis tests with multiple comparison adjustments. A total of 900 websites (450 per mode) were retrieved in English, German, and French from searches conducted in Basel, Munich, and Paris. Websites were classified as: (1) university, (2) hospital, (3) governmental/medical societies, (4) industrial/commercial/NGOs, or (5) other. Quality was assessed using the QUEST, which evaluates authorship, attribution, conflicts of interest, currency, and evidence. Inclusion rates and QUEST scores were compared across languages, locations, and categories using Kruskal-Wallis tests with multiple comparison adjustments. Results: Inclusion rates were high for both modes (Logged off: 86%; Anonymous: 85%). Location-based differences were significant for Basel (p = 0.04) and Paris (p = 0.02), while language-based differences were not significant. In “Logged off” mode, Category 1 achieved the highest median QUEST score (18.3), followed by 3 (17.8), while Category 2 scored lowest (14.2). Differences were significant (χ2 = 50, p < 0.001), particularly between Categories 2 vs. 3 and 2 vs. 4 (p < 0.001). Similar patterns were observed in the “Anonymous” mode. Conclusions: Online prostate cancer information varies substantially in quality. French-language sites, despite high inclusion rates, were of lower quality, while English and German content more frequently met high-quality standards. University websites were the most reliable, hospital websites the least. Language, location, and site type influence the accessibility and reliability of online prostate cancer information.
]]>Authors: Alexandros Georgiou Dimitrios Triantis Maria Goulielmaki Vassilis Zoumpourlis
Despite substantial progress in the field of bladder cancer management, the disease continues to represent an important health issue characterized by increased recurrence and progression rates. This is largely attributed to cancer stem cells (CSCs), a unique cell subpopulation capable of self-renewal, differentiation and resistance to conventional anti-cancer therapies. At the same time, our understanding of cancer biology has been revolutionized by the identification of non-coding RNAs (ncRNAs), a heterogeneous group of RNA molecules that do not translate into proteins yet function as pivotal regulators of gene expression. Emerging evidence demonstrates that ncRNAs modulate key hallmarks of CSCs, including self-renewal, epithelial–mesenchymal transition and drug resistance. This review investigates the intricate interplay between ncRNAs and the core signaling pathways that underlie bladder CSC biology. Unravelling the nexus between CSCs and ncRNAs is crucial for developing novel diagnostic biomarkers, better prognostic tools and innovative therapeutic strategies for patients with bladder cancer.
]]>Authors: Alicia DuPont Caroline Little Veronica Vuong Rachael Martino Zia Flaminio Heather Ferrill Benjamin Brooks
Diurnal enuresis can significantly affect a child’s biopsychosocial well-being; however, there is a lack of diagnostic and management algorithms on the diagnosis. The purpose of this literature review is to dissect the development of the evaluation and management of diurnal enuresis. A total of 44 articles published from January 1900 to December 2024 were chosen through literature searches in PubMed, Science Direct, Embase, and Google scholar. Search terms were “Diurnal Enuresis” or “Daytime Incontinence” as Mesh terms, and subsequent terms included “pediatrics”, “urinary bladder, overactive”, and “therapeutics”. Inclusion criteria included studies involving pediatric study subjects aged 5–18 years old with a specific diagnosis of diurnal enuresis, exclusion criteria were studies before 1900 and involving night-time wetting diagnoses. A consensus among the literature and the American Academy of Family Physicians recommends a stepwise diagnostic evaluation, including history taking followed by a focused physical exam, for diurnal enuresis has proven to be the most effective. Regarding treatment, biofeedback was shown to improve symptoms in 74% of cases in one study by Wiener, while pharmacological treatment via Mirabegron (beta 3 agonist) showed a 70% improvement in one study by Fryer, but older drugs such as oxybutynin (anticholinergics) are still preferred. A multidisciplinary approach with TENS therapy, behavioral modification, biofeedback, and pharmacology can enhance effectiveness, improve reliability, and provide more successful results while minimizing the impact of diurnal enuresis on a child’s well-being. Further research is needed to optimize pharmacologic management strategies and improve adherence to increase the likelihood of reaching treatment goals.
]]>Authors: Juliusz Jan Szczesniewski Carlos Tellez-Fouz Francisco Javier Diaz-Goizueta Ana García-Tello David Esteban Diaz-Perez Luis Llanes-Gonzalez
Background/Objectives: The study aimed to find out if the patients without a reTURBT, due to changed protocol in our centre because of the COVID-19 pandemic, had presented higher rates of relapse or progression compared to patients treated by standard reTURBT protocol. Methods: A prospective study was conducted including 43 patients with high-risk T1 non-muscle invasive bladder cancer diagnosed between March 2020 and June 2021. Patients were divided into two groups: those who underwent reTURBT and those who did not, due to limitations during the COVID-19 pandemic. All patients received intravesical BCG induction therapy and were followed for 3 years. The institutional research ethics committee approved the study. Results: A total of 43 patients were included, 17 (39.5%) underwent reTURBT and 26 (60.5%) did not. No significant differences were observed in tumour characteristics between groups. Recurrence occurred in 43.8% of the reTURBT group and 15.4% of the non-reTURBT group. Tumour progression to T2G3 was observed only in the reTURBT group. Survival analysis showed no significant differences in recurrence-free survival between groups (p = 0.299). Conclusions: Omitting reTURBT in carefully selected patients did not result in significantly worse oncological outcomes; however, due to the small sample size, the study is underpowered and these findings should be interpreted with caution. Early BCG administration in the non-reTURBT group may have contributed to favourable recurrence-free survival. However, further prospective studies are needed to confirm these findings and define optimal criteria for safely omitting reTURBT.
]]>Authors: Victor Osornio Sánchez Rodrigo Pérez Becerra Gerardo Garza Sainz Luis Trujillo Ortiz Denisse García López Denise Gabriela De León Trenado Maricruz Cespedes Contreras Adrián Martínez Correa Aarón Delgado Corral Carlos Alberto Castro-Fuentes
Background: Spontaneous regression of testicular cancer with retroperitoneal metastasis is a rare phenomenon and poses challenges in its diagnosis. Methods: A 33-year-old male patient presented with severe lower back pain (10/10) of 4 months’ duration, radiating to the left lower limb, refractory to NSAIDs, and significantly impaired ambulation, accompanied by nausea and vomiting. In addition to difficulty initiating urination and defecation, with weight loss of 30 kg, he was referred to the urology service of our hospital. Results: On physical examination, the left testicle showed signs of varicocele without pain. Therefore, laboratory and imaging studies were requested, highlighting elevated β-hCG (156.4 mIU/mL) and LDH (850 IU/L). Testicular ultrasound confirmed the diagnosis of left varicocele, while computed tomography of the abdomen and pelvis with contrast revealed a conglomerated retroperitoneal mass of more than 5 cm, located in the paravertebral, retrocural, paraaortic, and intercavoaortic regions. Based on these findings, primary treatment with left radical orchiectomy was chosen, which showed regression of the seminomatous tumor. Histopathological examination revealed a seminomatous germ cell tumor (pT0, pN3, M0), clinical stage IIC, with a good prognosis. Therefore, chemotherapy was initiated with four cycles of EP (etoposide 170 mg and cisplatin 35 mg). However, despite standard chemotherapy, the disease progressed until the patient died. Conclusions: Cases of testicular tumor with retroperitoneal metastasis are rare and infrequently present with clinical, testicular, and imaging findings. Therefore, histopathology, accompanied by the intentional identification of mutations associated with the TP53 gene when therapeutic failure exists.
]]>Authors: Gamal Ghoniem William Phan Naila Javaid Mashrin Lira Chowdhury Bilal Farhan Muhammed A. Moukhtar Hammad Ahmed Ahmed David Csuka Dina Saba Mohammad Helmy Sonia Lee
Background/Objectives: Pelvic floor disorders affect up to 30% of adult females in the United States. Misdiagnosis occurs in nearly 45% to 90% of cases. Standardized pelvic anatomical measurements could improve diagnostic accuracy and treatment planning. We aimed to evaluate pelvic anatomical variations using magnetic resonance imaging (MRI). Methods: We analyzed MRI pelvic measurements from 250 women aged 20–90 years. Exclusion criteria included prior pelvic surgery (except hysterectomy), pelvic cancer, and use of alternative imaging modalities. Key measurements included anterior vaginal wall thickness (AVWT), bladder wall thickness (BWT), vaginal epithelium to bladder urothelium (VWBU), urethral length (UL), and inter-ureteral distances. A comprehensive statistical analysis was performed, including corrections for multiple comparisons. Results: While several anatomical measurements were correlated, a comprehensive analysis was performed to identify markers for clinical diagnoses. After applying Bonferroni correction for multiple comparisons, we found no statistically significant association between any of the measured anatomical parameters and a diagnosis of incontinence. Notably, an uncorrected difference in Bladder Wall Thickness (BWT) (p = 0.041) did not hold up to rigorous testing. To further assess its clinical utility, a Receiver Operating Characteristic (ROC) curve analysis for BWT as a predictor of incontinence yielded an aArea Under the Curve (AUC) of 0.19, indicating poor predictive validity. Conclusions: In this cohort, static anatomical measurements derived from MRI, including BWT, do not appear to be reliable markers for incontinence. Our findings suggest that the pathophysiology of this disorder is likely more dependent on functional or dynamic factors rather than simple static anatomical variations. Future research should focus on standardizing dynamic imaging parameters to better assess pelvic floor function.
]]>Authors: Tarak Davuluri Vivek Aslot Brayden J. Seliger Andrew Edgington Nagalakshmi Nadiminty Tariq Shah Puneet Sindhwani
Male infertility is a growing global concern with increasing prevalence in both developing and developed nations. While many associations between environmental factors and male infertility have been explored, the relationship between sleep deprivation and male infertility remains underexplored. This narrative review examines the reported effects of sleep deprivation on the Hypothalamic––Gonadal (HPG) axis, Hypothalamic–Pituitary–Adrenal (HPA) axis, oxidative stress, and testicular function, and their consequential effects on male infertility. Disruption of the HPG axis results in altered follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, leading to fluctuation in testosterone levels, negatively affecting spermatogenesis and other critical reproductive processes. Activation of the HPA axis, often due to stress, elevates cortisol levels, which, in turn, suppresses gonadotropin-releasing hormone (GnRH), impairing reproductive function. Reactive oxidative species (ROS) accumulate in periods of oxidative stress and have been shown to damage sperm and reduce their quality. The blood–testis barrier (BTB) is disrupted in states of sleep deprivation, leading to decreased sperm quality. A literature review was conducted using PubMed and Google Scholar to assess peer-reviewed studies from 1990 to 2024, revealing a complex interplay between sleep deprivation and male reproductive dysfunction. While existing studies support a link between sleep disturbances and hormonal dysregulation, further research is needed to establish causal relationships and identify potential therapeutic interventions. Addressing sleep deprivation may represent a modifiable factor in improving male fertility outcomes.
]]>Authors: Simone Botti Tommaso Ceccato Marco Cassaro Giangiacomo Sanna Lorenzo Trevisiol Tommaso Cai
Background/Objectives: Buccal mucosa graft (BMG) is increasingly utilized in reconstructive urological surgeries due to its versatility, robust integration, histological characteristics and low morbidity at the donor site. Initially employed in urethral surgery, BMG use has expanded to complex ureteral and penile reconstructive procedures. This narrative review examines BMG applications in various urological surgeries, comparing its outcomes to other graft types, with a focus on surgical techniques and patient outcomes. Methods: A narrative review was conducted using PubMed and Scopus to identify relevant studies published over the last three decades on the use of BMG in urological reconstructive surgery. Articles in English addressing BMG harvesting, applications and functional outcomes were analyzed. Results: BMG has demonstrated high success rates in every field of its application, especially in urethral reconstruction with an 83–91% efficacy rate in intermediate follow-up. Studies have also reported positive outcomes in complex ureteral and penile curvature surgeries, with patient satisfaction rates reaching up to 85%. Conclusions: BMG is an adaptable tissue graft for urological reconstructive surgeries, offering favorable outcomes with minimal morbidity. Although the current results are encouraging, larger prospective studies with standardized protocols are necessary to fully validate its long-term efficacy and optimize treatment approaches for complex urological reconstructions.
]]>Authors: Surina Patel Mehreet Kaur Chahal Scott Durham Haitham Elsamaloty Puneet Sindhwani
Introduction: Although lipomas are common benign tumors found in adults, lipomas of the bladder are extremely rare. Bladder lipomas are infrequently reported in the urologic literature, with only 19 cases published worldwide. These can present as a mass on cystoscopy and cause irritative voiding symptoms, depending on their location. Upon transurethral resection, seeing fat can be concerning for a perforation, as lipoma can be mistaken for extravesical fat. Hence, familiarity with this rare entity is of paramount importance for urologists to prevent unnecessary investigations and interventions that are needed in case of a true bladder perforation. Case presentation: This study presents a case of bladder lipoma in a 73-year-old male with end-stage renal disease who presented for pretransplant urologic evaluation due to microscopic hematuria and irritative lower urinary tract symptoms (LUTS). During cystoscopy, a bladder mass was seen, and a transurethral resection of the bladder tumor (TURBT) revealed bright yellow adipose tissue immediately underneath the bladder mucosa. Concerns about perforation were obviated when seeing intact detrusor muscle underneath, visually confirming the integrity of the bladder wall. The resection was completed, and the CT scan was re-read with the radiologist, which confirmed the presence of a lipoma that was missed pre-operatively due to patient’s oliguria and collapsed bladder. No catheter drainage or cystogram was performed based on these findings. Outcome: The patient healed without any complications. Histopathology confirmed the diagnosis of a mature lipoma. The patient was cleared for transplant from a urologic standpoint and had a successful renal transplantation without delay. Discussion: This case documents the anomalous occurrence of a lipoma within the bladder and supports maintaining a broad differential, including liposarcoma, angiomyolipoma, and other non-malignant fatty tumors during the evaluation of a bladder mass.
]]>Authors: Davide Arcaniolo Carlos Miacola Marco Bitelli Luca Boeri Tommaso Cai Carlo Ceruti Celeste Manfredi Ilaria Ortensi Fabrizio Palumbo Giorgio Piubello Chiara Polito Nicolò Schifano Alessandro Palmieri
Background: Phosphodiesterase type 5 inhibitors (PDE5i), particularly tadalafil and sildenafil, are the first-line therapies for erectile dysfunction (ED). After the patent expiration of branded tadalafil in 2017, generic formulations became available. Despite equivalent efficacy, skepticism persists regarding the effectiveness and safety of generics. The SHIFT study aimed to evaluate the non-inferiority of a generic tadalafil (Dalerpen) compared with branded and other generic tadalafil in terms of clinical efficacy and patient satisfaction. Methods: A prospective, multicenter study was conducted involving 247 patients treated with tadalafil (either 5 mg or 20 mg) for ED. Patients switched from branded or other generic tadalafil to Dalerpen. Baseline and follow-up assessments included the International Index of Erectile Function—Erectile Function Domain (IIEF-EF) (primary endpoint), Sexual Encounter Profile (SEP-2 and SEP-3), and International Prostatic Symptom Score (IPSS). A one-month follow-up was performed. Results: A total of 247 patients were included in the final analysis. After switching to Dalerpen, significant improvements were observed in both IIEF-EF (18.8 ± 5.6 vs. 16.7 ± 5.4, p < 0.001) and IPSS scores (10.4 ± 6.7 vs. 11.2 ± 6.3, p < 0.001), though the minimal clinically important difference (MCID) was not reached. SEP-3 scores also significantly increased (3 ± 1.2 vs. 2 ± 1.1, p < 0.001). Multivariate analysis identified baseline IIEF, IPSS scores, and post-treatment IPSS as predictors of IIEF-EF improvement (p < 0.001). Switching to Dalerpen was an independent predictor of both IIEF-EF and IPSS improvement. No new adverse events were reported. Conclusions: The SHIFT study demonstrates that Dalerpen is non-inferior to branded tadalafil in terms of clinical efficacy, offering a reliable and cost-effective therapeutic option. Educating patients on bioequivalence and addressing concerns regarding generic drugs are essential to facilitate therapeutic switches.
]]>Authors: Faisal H. Aljahdali Rozana Kamal Zohor Azher Ahmed S. Zugail Abdulaziz Baazeem Aboulfazl Rad Gabriela Oprea
Background/Objectives: Although biallelic pathogenic variants in different DNAH gene family members have been associated with infertility, the role of DNAH12 in this disorder is still incompletely understood. To date, few patients have been shown to have infertility due to biallelic variants in this gene. Here, we report two more unrelated patients with infertility who carry homozygous variants in DNAH12. Methods: This study included two male patients with primary infertility and oligoasthenoteratozoospermia (OAT). Patient 1 was a 32-year-old with 1.5 years of infertility and no chronic illnesses or prior assisted reproductive technologies (ARTs). Patient 2 was a 49-year-old with 24 years of infertility, a history of varicocelectomy, and the occasional use of PRN analgesics for bone pain. Using genome sequencing, we identified two homozygous variants: c.3757C>A, p. Pro1253Thr, and c.11086-1G>A, p.?, in patients 1 and 2, respectively. Results: Our findings add supportive evidence that DNAH12 is a gene implicated in rare cases of male infertility. The identification of these homozygous variants in two additional patients supports the association between DNAH12 variants and reproductive dysfunction. Conclusions: This study highlights the need for further research on the role of DNAH12, including functional studies to clarify the mechanisms contributing to infertility.
]]>Authors: Noah N. Nigro Karen M. Doersch Sasha J. Vereecken Carter Niedert Rohan G. Bhalla Brian J. Flynn
The use of ileum for ureteral reconstruction was first described in 1906. Since then, its utilization has evolved considerably. Early in the history of ileal ureters, urologists were limited by a lack of familiarity with bowel harvesting and handling. The popularization of ileal conduits for urinary diversions, however, allowed urologists to familiarize themselves with the use of ileum and paved the way for broader applications. With the emergence of laparoscopy and, later, robotic-assisted surgery, the application of ileal ureteral replacement expanded the capabilities of reconstructive urologists. This article describes the historical development of surgical techniques for ileal ureter replacement and the integration of new technologies aiding in improved outcomes, and anticipates potential future directions. In contemporary practice, robotic-assisted ileal ureteral replacement is used in cases of extensive ureteral obstruction or damage. Advantages of the robotic platform include reduced blood loss, shorter recovery time and hospital length of stay, and superior operative ergonomics. Although robotic ileal ureter replacement is a complex and challenging surgery with notable complications, studies have demonstrated the efficacy and safety of this technique in patients with an otherwise end-stage ureter. In addition, the robotic approach has provided urologists the ability to conduct complex reconstructive surgeries including bilateral ureteral replacement in conjunction with bladder augmentation or a urinary diversion. Long-term studies and continued innovation are necessary to further improve the surgical techniques, outcomes, and scope of ileal ureter reconstruction.
]]>Authors: Dominik Godlewski Sara Czech Jakub Szpara Dorota Bartusik-Aebisher David Aebisher
Bladder cancer (BC) remains a clinical challenge due to its complex etiology and high incidence, especially in developed populations. This article presents a broad analysis of the latest advances in BC treatment, offering a new perspective on the growing role of innovative therapies that are effectively changing the standards of oncological care. Focusing on targeted therapy, immunotherapy, antibody–drug conjugates, and breakthrough gene therapies, the paper shows how modern approaches can counteract resistance mechanisms and improve treatment efficacy while limiting toxicity for patients. Progress in the field of immune therapies, including checkpoint inhibitors, offers hope for significant improvement in the outcomes of patients with advanced forms of cancer, and the concept of targeted therapy tailored to the molecular characteristics of the tumor indicates the potential of personalized oncology. Gene and photodynamic therapies, in turn, offer new possibilities for precise action on cancer cells, minimizing the side effects of traditional methods. The article presents innovative therapeutic strategies and results of the latest clinical trials, showing the prospects for the development of BC treatment and highlighting the key challenges facing oncology.
]]>Authors: Anthony Galvez Dhruv Puri Elizabeth Tran Kassandra Zaila Ardines Yahir Santiago-Lastra
Advances in screening, early detection, and therapeutic innovations have significantly improved survival rates, transforming prostate cancer into a chronic condition for many men. However, these strides have also revealed persistent challenges in survivorship, including treatment-related side effects, disparities in care, and inequities in outcomes. This review explores the complex landscape of prostate cancer survivorship, with a focus on demographic disparities, barriers to care, symptom burden, and treatment patterns. Our findings highlight how factors such as race, socioeconomic status, and insurance type heavily influence patient outcomes. For instance, Black and Latiné patients often face delays in treatment initiation and are less likely to receive definitive therapies than White patients, leading to poorer survival outcomes. Furthermore, those with Medicaid or no insurance are more likely to receive systemic therapy only or no treatment at all, exacerbating existing inequities. Addressing gaps in diagnosis, treatment access, and survivorship care is essential to developing targeted interventions and policies that promote equitable, patient-centered care for prostate cancer survivors.
]]>Authors: Lubomír Mikulášek Dragana Žarković
Purpose: Urinary incontinence (UI) significantly impacts the quality of life, necessitating a range of treatments, from behavioral changes to surgical interventions. Electromagnetic muscle stimulation (HIFEM™) therapy presents an innovative, non-invasive approach to strengthening pelvic floor muscles (PFMs). Subjects and Methods: This retrospective, non-interventional case series study explores the efficacy and safety of HIFEM™ treatment in parous women experiencing stress (SUI) and mixed urinary incontinence (MUI). Nineteen women (mean age 54 ± 16) underwent six HIFEM™ sessions, with symptom progression tracked using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), along with comfort and satisfaction questionnaires. Results: At baseline, the mean ICIQ-UI SF score was 7.9 ± 4.2 points. By the final questionnaire administration, the average score had dropped to 4.7 ± 3.5, reflecting a 50.6% reduction from baseline (p < 0.001). According to ICIQ-UI SF Item 6, 21% of subjects achieved complete continence. Additionally, the percentage of subjects experiencing urine leakage before reaching the toilet declined by 40% after the sixth treatment. Post treatment, the number of subjects who leaked urine while coughing or sneezing decreased by 50%. Conclusions: The treatment has shown high efficacy in lowering the ICIQ-SF scores across the study group, with a significant number of subjects regaining entire continence.
]]>Authors: Yvette C. Cozier Nelsy Castro-Webb Kimberly A. Bertrand Miatta Ndama Toby C. Chai Bernard L. Harlow Padmasini Kandadai Shanshan Sheehy Lynn Rosenberg
Background/Objectives: Urinary incontinence (UI) is a common condition in women of all ages. Type 2 diabetes (T2D) has been associated with UI, but gestational diabetes (GD), glucose intolerance first recognized during pregnancy, has received relatively little attention as an independent risk factor for UI. We explored the roles of GD and T2D, independently and in combination, on the risk of UI in a Black Women’s Health Study (BWHS), a follow-up of Black women in the U.S. aged 21–69 at enrolment in 1995. Methods: We analyzed the 28,978 parous women who had information on GD, T2D, and UI in 2011. We estimated odds ratios (OR) and 95% confidence intervals (95% CI) using logistic regression with adjustment for several important variables, including age, parity, body mass index, and diuretic use. We also stratified analyses according to T2D status (T2D, no T2D). Results: The multivariable-adjusted ORs for women with a history of GD, compared to those without, was 1.18 (95% CI: 1.02, 1.37), for UI frequency of ≥1/week; the estimate among women with a history of T2D, compared to those without, was 1.16 (1.06, 1.27) for the same frequency. In stratified analyses, GD was associated with a 23% increased risk of weekly UI among women without a history of T2D, while there was no association observed among those with a history of T2D. Conclusions: In the BWHS, GD was positively associated with urinary incontinence, independent of T2D status. Our results suggest that women who experience GD—even without subsequent development of T2D—might be at increased risk of UI and may benefit from early intervention.
]]>Authors: Vincenzo Nobile Roberta Villa Mariella Micieli Fabio Amone Erminia D’Ambrosio Giuseppe Pulitano Camilla Schinzari Eleonora Di Campi Davide Carati
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.
]]>Authors: Reyhaneh Nazarian Neil Lin Sapna Thaker Rena Yang Gerard C. L. Wong Kymora B. Scotland
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.
]]>Authors: Giacomo Rebez Serena Sartori Fabio Vianello Elena Marcotti Rossana Bussani Giovanni Liguori Filiberto Zattoni Mariangela Mancini
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.
]]>Authors: Zorawar Singh Ananth Punyala Christina Sze Naeem Bhojani Kevin C. Zorn Dean Elterman Bilal Chughtai
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.
]]>Authors: Ihtisham Ahmad Adree Khondker Joana Dos Santos Rodrigo L. P. Romao Armando J. Lorenzo Mandy Rickard
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.
]]>Authors: Kristian Black Sofie Ølgaard Amelia A. Khoei Clara Glazer Dana A. Ohl Christian Fuglesang S. Jensen
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.
]]>Authors: Stephen McGeorge David A. Pattison Nattakorn Dhiantravan Paul A. Thomas John W. Yaxley Matthew J. Roberts
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.
]]>Authors: Conner Vincent Lombardi Jacob Lang Woojin Han Ruchika Vij Nagalakshmi Nadiminty Tariq A. Shah Puneet Sindhwani
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.
]]>Authors: Nikit Venishetty Yousef N. Rafati Laith Alzweri
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.
]]>Authors: Raymond A. Dieter
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.
]]>Authors: Dominik Godlewski Sara Czech Dorota Bartusik-Aebisher David Aebisher
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.
]]>Authors: Carlos Miacola Luca Boeri Fabrizio Palumbo Carlo Ceruti Davide Arcaniolo Marco Bitelli Giorgio Piubello Chiara Polito Tommaso Cai Alessandro Palmieri
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.
]]>Authors: Alberto Ragusa Francesco Prata Andrea Iannuzzi Francesco Tedesco Loris Cacciatore Aldo Brassetti Giovanni Muto Roberto Mario Scarpa Rocco Papalia
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.
]]>Authors: Raymond A. Dieter George B. Kuzycz Blake J. Carlino
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.
]]>Authors: Francesco Prata Andrea Iannuzzi Marco Ricci Francesca Liaci Francesco Tedesco Alberto Ragusa Angelo Civitella Matteo Pira Marco Fantozzi Leonilde Sica Roberto Mario Scarpa Rocco Papalia
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.
]]>Authors: Anil B. Gavade Kartik A. Gadad Priyanka A. Gavade Rajendra B. Nerli Neel Kanwal
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.
]]>Authors: Faris Alrumaihi Ravindra Raut Ehsan Ahmed Yahia Vikalp Kumar Shehwaz Anwar
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.
]]>Authors: Noah King Jacob Lang Sree Jambunathan Conner Lombardi Barbara Saltzman Nadiminty Nagalakshmi Puneet Sindhwani
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.
]]>Authors: Usman Hussain Nikit Venishetty Marwan Alkassis Omer Raheem
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.
]]>Authors: Nikit Venishetty Marwan Alkassis Omer Raheem
Male infertility has affected an increasingly large population over the past few decades, affecting over 186 million people globally. The advent of assisted reproductive technologies (ARTs) and artificial intelligence (AI) has changed the landscape of diagnosis and treatment of male infertility. Through an extensive literature review encompassing the PubMed, Google Scholar, and Scopus databases, various AI techniques such as machine learning (ML), artificial neural networks (ANNs), deep learning (DL), and natural language processing (NLP) were examined in the context of evaluating seminal quality, predicting fertility potential, and improving semen analysis. Research indicates that AI models can accurately estimate the quality of semen, diagnose problems with sperm, and provide guidance on reproductive health decisions. In addition, developments in smartphone-based semen analyzers and computer-assisted semen analysis (CASA) are indicative of initiatives to improve the price, portability, and accuracy of results. Future directions point to possible uses for AI in ultrasonography assessment, microsurgical testicular sperm extraction (microTESE), and home-based semen analysis. Overall, AI holds significant promise in revolutionizing the diagnosis and treatment of male infertility, offering standardized, objective, and efficient approaches to addressing this global health challenge.
]]>Authors: Wei-Shin Lu Ali Zia Nagalakshmi Nadiminty Barbara Saltzman Andrew B. Casabianca Puneet Sindhwani
Introduction: We examined three patient characteristics: body mass index (BMI), the American Society of Anesthesiologists (ASA) status, and pre-admission testing (PAT), and their effect on total operating room (OR) time for six urologic procedures, including ureteroscopy, transurethral resection of the prostate (TURP), transurethral resection of bladder tumor (TURBT), prostatectomy, nephrectomy, and kidney transplants. Methods: We investigated the effect of these patient factors on OR time using linear regression for urologic procedures from The University of Toledo Medical Center from 2015 to 2020. Results: An increase in BMI was found to correlate with a statistically significant increase in total OR time for ureteroscopy, prostatectomy, and kidney transplant. The PAT showed a decrease in OR time for TURBT cases and an increase for kidney transplant cases. We found no correlation between the ASA status and changes in the total OR time. Conclusions: A higher BMI significantly increases the total OR time for robotic-assisted prostatectomy and kidney transplant but has a minimal effect on endoscopic procedures. Our results do not support ASA status as a predictor of total OR time. Due to the lack of consistency in results for PAT for the different procedures analyzed, further exploration of the effect of this patient factor on OR efficiency is needed.
]]>Authors: Dag Rune Stormoen Lise Høj Omland Kent William Mouw Zoltan Szallasi Sisse Rye Ostrowski Susanne Dam Nielsen Helle Pappot
Background: This prospective pilot study explored the potential of the innate immune system’s response to cancer-related immuno-stimulants as a predictive biomarker for Immune Checkpoint Inhibitor (ICI) effectiveness, using pembrolizumab-treated metastatic urothelial tract cancer (mUTC) patients as the study population. Methods: We included ten mUTC patients and assessed their innate immune responses before the first and second pembrolizumab cycles with the TruCulture® immunoassay. We also executed survival analysis and compared cytokine release. Results: R848-induced IFNα and HKCA-induced IL-10 values decreased in patients with disease progression (n = 7), while these values increased in non-progressing patients (n = 3), denoting a significant difference (p = 0.00192 and p = 0.00343, respectively). Further, an increased R848-induced IFNα response correlated with extended survival (log-rank p-value of 0.048). Conclusion: Our small study identified distinct immune response patterns following pembrolizumab’s first cycle in mUTC patients, hypothesizing the potential of an increased R848-induced IFNα response for improved survival outcomes. Further confirmatory studies are in progress.
]]>Authors: Oscar Salichs Sishir Doddi Taryn Hibshman Jama Hersi Puneet Sindhwani
Introduction: Renal failure, encompassing both acute and chronic forms, stands as a formidable public health challenge with far-reaching consequences for individual well-being and healthcare systems. This study delves into the mortality rates of renal failure in the United States over two transformative decades, from 1999 to 2020. Renal failure’s significance arises from its escalating prevalence, substantial healthcare costs, and the imperative to understand the multifaceted factors that influence its outcomes. Objectives: The primary objectives of this research are to analyze temporal trends in renal failure mortality rates, explore the impact of the Affordable Care Act (ACA) and advancements in renal care practices on mortality rates, and assess demographic disparities in mortality outcomes. Methods: Utilizing CDC WONDER’s multi-cause mortality data, we assessed mortality due to renal failure (ICD-10 Codes: N17–N19). Age-adjusted mortality rates (AAMRs) were collected and stratified by sex and race. The Joinpoint Regression Program analyzed trends, calculating annual percent change (APC) and significant average annual percent change (AAPC) from 1999 to 2020. Segmented line regression models were employed for parallel pairwise comparisons. Results: Renal failure mortality rates decreased for both sexes during the late 2000s. The ACA’s enactment in 2010 coincided with improved access to healthcare, possibly contributing to the decline. Demographic disparities highlighted variations in mortality rates across racial and gender groups. Advancements in renal care practices were evident, which were driven by innovations in treatment modalities and disease management. Significant temporal trends were observed by race, with varying periods of decrease or uptrend. Conclusions: The decline in renal failure mortality rates during the late 2000s was potentially influenced by the ACA and advances in renal care practices. Demographic disparities emphasize the need for equitable healthcare access and interventions. These findings underscore the significance of healthcare policies and medical advancements in reducing renal failure mortality rates and addressing disparities. Persistent efforts to mitigate challenges such as healthcare access, cost barriers, and disparities remain crucial to enhancing renal failure outcomes.
]]>Authors: Alassane Halawen Mohamed René Dembélé Alio Mahamadou Fody Alix Bénédicte Kagambèga Hiliassa Coulibaly Frédéric François Bado Chaibou Salaou Laouali Boubou Alkassoum Ibrahim Eric Adehossi Omar Nicolas Barro
Urinary tract infection (UTI) is a common patient infection and a major public health problem today. The rapid spread of antibiotic resistance genes in Enterobacterales, particularly in Extended-spectrum beta-lactamases producing Escherichia coli (ESBL-E. coli), is compromising treatment with the antibiotics that are normally used. The aim of this study was to evaluate the level of susceptibility of uropathogenic ESBL-producing E. coli to fosfomycin as an alternative treatment. A total of 3369 samples of urine were received and processed in the Bacteriology Laboratory of the Niamey General Reference Hospital (NGRH) throughout 2021. Synergy testing was performed for phenotypic detection of ESBLs, and fosfomycin sensibility of ESBLs-producing uropathogenic E. coli isolates were determined using the Viteck-2 system. Of the 280 enterobacteria identified in the urine samples, 104 Escherichia coli isolates were positive to the synergy test. The average age of the patients was 54 ± 17. The age range of 46–65 years was the most affected by these infections. The female patients predominated over the male ones, with a prevalence of 51.90%, a sex ratio of 1.08. The ESBL-producing E. coli isolates were 0.97% resistant to fosfomycin. Fosfomycin is highly effective against uropathogenic ESBL-producing E. coli isolates. It could be used as an alternative treatment for both uncomplicated and complicated urinary tract infections.
]]>Authors: Tommaso Cai Marco Capece Maria Grazia Zorzi Alessandro Palmieri Gabriella Nesi Mattia Barbareschi Truls E. Bjerklund Johansen
Background: Management of penile cancer patients has its grey zones. In particular, no strong evidence or recommendations exist regarding the timing of prophylactic lymphadenectomy. Here, we aim to review the impact that the timing of inguinal and pelvic prophylactic lymph node dissection has on patient outcome. Methods: All relevant databases were searched following the preferred reporting items for systematic reviews and meta-analysis guidelines. A narrative review of indications for lymph node dissection and pathological considerations precede a systematic review of the impact of prophylactic lymph node dissection timing on prognosis. The primary endpoint is disease-free and overall survival in patients undergoing early or late lymph node dissection after penile cancer diagnosis. Results: Four clinical trials, all focusing on the role of inguinal lymph node dissection, are included. Despite the lack of randomized and controlled trials, this review suggests that lymph node dissection should be performed as soon as possible after diagnosis, with 3 months as a realistic cut-off. Conclusions: Survival of penile cancer patients is strictly related to the timing of prophylactic pelvic lymph node dissection. All patients at high risk of nodal metastasis should be offered lymph node dissection within three months of diagnosis, until new predicting tools are validated.
]]>Authors: Natalie Mainland Dana A. Ohl Ahmed R. Assaly Nabila Azeem Amber Cooper Angie Beltsos Puneet Sindhwani Tariq A. Shah
Fertility preservation technologies have existed for decades, and the field is rapidly advancing; limited data exist regarding the use of these technologies by transgender patients. Many options are available for transgender patients who wish to preserve fertility before transitioning. These options include the cryopreservation of gametes, embryos, or ovarian tissue. Currently, ejaculated, or testicular sperm, immature oocytes, and ovarian tissue can be preserved for later use, but no such use option exists for immature testicular tissue. Many financial, sociological, and legal barriers and a lack of awareness among physicians and patients also hinders the utilization of these fertility preservation services. While options are abundant, usage rates are relatively low. The initial data regarding the successful use of preserved tissues appears promising, with birth rates not dissimilar to non-transgender patients. Further investigations into this area are needed. In addition, counseling regarding fertility preservation options should become a significant part of the provider-patient conversation before transitioning therapies.
]]>Authors: Anna Ricapito Matteo Rubino Pasquale Annese Vito Mancini Ugo Falagario Luigi Cormio Giuseppe Carrieri Gian Busetto Carlo Bettocchi
Introduction: Urinary incontinence is a prevalent condition, especially in elderly men, with stress urinary incontinence (SUI) being a common cause after radical prostatectomy. The artificial urinary sphincter (AUS), particularly the AMS 800™ device, has been the gold-standard treatment for moderate-severe male SUI for decades. Despite some technical advancements and alternative devices like ZSI-375, Victo, and BR-SL-AS 904 being introduced, there is limited literature comparing their effectiveness to the AMS 800™. Methods: This literature review compares the AMS 800™ to the newer technologies in the management of SUI. We reviewed the current literature on urinary sphincter implant in male stress incontinence, including AMS 800™, ZSI-375, Victo, and BR-SL-AS 904. Findings: The AMS 800™ is a sophisticated system consisting of an inflatable cuff, a pressure-regulating balloon, and a control pump. Studies show continence rates ranging from 61% to 100% with AMS 800™ implants, with low infection rates and significant improvement in patients’ quality of life. The ZSI-375 sphincter is a unique single-piece cuff without an abdominal reservoir, simplifying implantation. Preliminary data show a social continence rate of 73% at six months, with lower complication rates than the AMS 800™. The VICTO® device offers adjustable pressure and a stress relief mechanism, providing conditional occlusion of the urethra. Early studies report a satisfaction rate of up to 94.2% and a complication rate of 17.6%. BR-SL-AS 904 is a newly proposed urinary sphincter, but due to the limited number of cases and a single study, its efficacy and complication rates remain uncertain. Conclusions: Overall, AMS 800™ remains the gold-standard treatment for SUI after radical prostatectomy. Alternative devices like ZSI-375 and VICTO® show promising results, but longer studies and more data are needed to establish their effectiveness and safety compared with the AMS 800™. Further research and ongoing monitoring are essential to address mechanical issues associated with AUS implants.
]]>Authors: Francesco Sebastiani Carlo D’Alterio Cristina Vocca Luca Gallelli Fabrizio Palumbo Tommaso Cai Alessandro Palmieri
Background: Recently, the role of nutraceutical compounds in the prevention of human diseases has been rapidly increasing. Here, we aim to evaluate the beneficial effect of dietary supplementation with seven active principles, i.e., lycopene, sulforaphane, silymarin, glutathione, escin, tryptophan, and green tea catechins, on human health. Methods: An extensive search of PubMed and Medline database was performed with the following keywords: “silymarin”, “sulforaphane”, “lycopene”, “green tea catechins”, “tryptophan”, “glutathione” and “escin” accompanied by the keywords “supplement”, “supplementation”, and “nutraceutics”. All preclinical and clinical trials were considered for this review. Results: One hundred and eighteen full-text articles were eligible for inclusion in this review. The papers examined presented considerable variability due to the wide heterogeneity of dosages administered, population involved, and outcomes pursued. Conclusion: Nutritional supplementation with lycopene, sulforaphane, silymarin, glutathione, escin, tryptophan, and green tea catechins appears to exert a wide range of benefits on human health, ranging from mood and cognition to cardiovascular health, fertility, metabolism, antioxidant, and anti-inflammatory capabilities, as well as potential anticancer effects. Further studies are required to better define the potential synergic effect, optimal dosage, mechanism of action, and tolerability profiles of these substances.
]]>Authors: Luca Lambertini Alessandro Sandulli Vincenzo Salamone Mara Bacchiani Sofia Giudici Eleana Massaro Anna Cadenar Riccardo Mariottini Simone Coco Laia Bardina Elena Ciaralli Marco Saladino Andrea Romano Francesca Valastro Antonio Andrea Grosso Fabrizio Di Maida Giampaolo Siena Sabino Scelzi Andrea Mari
Background: Chronic Prostatitis/Chronic Pelvic Pain syndrome NIH-class III is a widespread condition affecting men universally, with existing treatments showing limited success. This study evaluated the efficacy and safety of a natural supplement, composed of Serenoa repens, Solanum lycopersicum, lycopene, and bromelain, in managing symptoms of this condition among a substantial patient group. Methods: In this prospective study, 245 patients diagnosed with Chronic Prostatitis/Chronic Pelvic Pain syndrome NIH-class III were treated with the aforementioned supplement, alongside lifestyle alterations, such as refraining from spicy foods, alcohol, caffeine, and cycling, for a duration of three months. Patients’ progress was assessed at one and three months using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptom Index (IPSS), quality of life (QoL) scores, and changes in total prostate-specific antigen (PSA) levels. Results: The supplement was well received with no serious adverse events reported. Significant improvements were observed in NIH-CPSI scores, IPSS, QoL scores, and a substantial decrease in total PSA levels at three months compared to baseline, with a positive trend noted from one-month to three-month evaluations. This was consistent in either patients with predominantly voiding or storage urinary symptoms. Conclusions: Our results suggest that this natural supplement in conjunction with lifestyle changes could offer a safe and effective alternative treatment for patients suffering from Chronic Prostatitis/Chronic Pelvic Pain syndrome NIH-class III. However, these findings require validation through further large-scale randomized controlled trials.
]]>Authors: Dai D. Nghiem
Background: Organ transplantation is the most successful therapy for end-stage organ disease since it increases the quality of life and life expectancy. For these reasons, over 107,000 patients were on the waitlist in the United States for a transplant in 2022. Unfortunately, only 42,887 transplants were performed, and annually, over 7000 patients on the kidney list die or are too sick to transplant. To solve this severe organ shortage, the use of the deceased transplant recipients with functioning organs, whether transplanted or native, is explored as a new source of organ donors. Methods: To assess the feasibility of this option, first, we will review the rate of kidney transplant recipients dying with functioning grafts (DWGF), their re-use, the organ allocation system, the technical aspects of the organ procurement, and the transplantation of the DWGF kidneys. Then, we will consider the larger group of all deceased transplant recipients as potential donors for all functioning, native, or transplanted organs. Conclusions: (1). All functioning kidney transplants explanted from the deceased transplant recipients have excellent long-term function after re-transplantation. (2). The other functioning organs constitute a large unrecognized pool of transplantable organs. (3). The intensivists and the transplant community should be educated about these new options to improve the organ shortage.
]]>Authors: Georgios Zervopoulos Nikolaos Mitsimponas Filippos Venetsanos Athanasios Papathanasis
Testicular granulosa cell tumors (TGCTs) are rare tumors of sex cord-stromal origin. TGCTs are classified into two main categories, the adult type and the juvenile type. The adult type is extremely rare, with only 93 known cases reported in the literature. Herein, we present a report of a case of a 30-year-old male patient who presented with a testicular mass and underwent radical inguinal orchiectomy; the pathology examination revealed an adult-type granulosa tumor. Additionally, we review the literature to summarize the scientific knowledge of an entity barely described worldwide.
]]>Authors: Shinichiro Higashi Yuko Yoshio Hideki Kanda Taketomo Nishikawa Momoko Kato Yusuke Sugino Takeshi Sasaki Manabu Kato Satoru Masui Kouhei Nishikawa Takahiro Inoue
Fluoroquinolones (FQs) have been traditionally used for prophylaxis against bacterial infection. However, the rapid emergence of FQ-resistant Escherichia coli due to overuse and misuse have resulted in an increase in post-biopsy infections. We requested 723 patients undergoing transrectal or transrectal plus transperineal targeted prostate biopsy to provide preprocedure rectal swabs. The rectal swabs were plated onto deoxycholate hydrogen sulfate lactose agar culture and FQ resistance tests were conducted using the disc diffusion method following the guidelines of the Clinical and Laboratory Standards Institute. All patients undergoing biopsy were given a 1.0 g intravenous injection of cefmetazole (CMZ) 30 min before and 12 h after biopsy. Patients with FQ-resistant organisms received an additional 1.0 g intravenous injection of CMZ every 12 h for an additional 1.5 days, while those without FQ-resistant organisms received levofloxacin 500 mg for 4 days. We evaluated infectious symptoms during the 30 days after the biopsy. We also evaluated the incidence of acute prostatitis within 7 days after the biopsy and isolation rates of FQ-resistant strains. A total of 289 patients (40%) had FQ-resistant isolates on rectal swabs. The overall infectious complication rate was 0.69%. Two patients with FQ-resistant isolates and three patients without them experienced infectious episodes. One patient with FQ-resistant isolates and two patients without them suffered acute prostatitis. The difference in the rates of infectious complication and acute prostatitis rates between FQ-resistant and FQ-susceptible carriers were not significant (p = 1.0 and 1.0, respectively). Post-biopsy sepsis was identified in one patient (0.14%) who had FQ-resistant Escherichia coli. Targeted antimicrobial prophylaxis with cefmetazole based on presence of FQ-resistant isolates on rectal swabs may prevent post-prostate biopsy infectious complications, especially in geographic lesions with a high incidence of FQ-resistant strains in rectal flora.
]]>Authors: Marco Capece Giuseppe Celentano Roberto La Rocca
Peyronie’s disease is a condition characterized by the formation of fibrous plaques in the tunica albuginea, which can cause pain, curvature, and erectile dysfunction. Preclinical studies have demonstrated the potential benefits of hyaluronic acid in treating Peyronie’s disease, including antifibrotic, anti-inflammatory, and proangiogenic effects, although more research is needed to fully understand its mechanisms of action. Clinical studies have shown promising results, with hyaluronic acid injections leading to improvements in plaque size, penile curvature, and erectile function, and being well tolerated by patients. The findings suggest that HA injections could be a viable and safe treatment option for Peyronie’s disease, particularly in the early stages of the disease. However, more research is needed to determine the optimal dosage and treatment duration for HA injections, and to confirm its efficacy in the stable phase of Peyronie’s disease. Overall, hyaluronic acid is a potentially effective therapy for Peyronie’s disease, with the ability to inhibit fibrosis and promote angiogenesis, and low risk of adverse effects, making it an attractive option for patients who are unable or unwilling to undergo surgery.
]]>Authors: Dai D. Nghiem
Revascularization of the kidney transplant is classically performed by anastomosing the renal vessels to the recipient iliac vessels. This technique is not applicable when the renal vessels are very small, numerous or anomalous and aberrant. In these instances, the donor aorta and the vena cava have to be used for vascular anastomosis. It would be useful to briefly review the development and the use of the donor aorta and cava in renal transplantation during the last century and discuss the potential clinical application of this technique in xenotransplantation of the porcine kidneys in humans at the dawn of the 21st century.
]]>Authors: Angelika C. Gruessner
Since the first pancreas transplant in 1966, over 67,000 pancreas transplants have been performed worldwide and the number is growing. While the number of transplants in the US has changed only slightly over the past decade, many countries outside the US have shown strong growth in transplant numbers. The worldwide growth in numbers is due to the increasing number of patients with type 2 diabetes mellitus receiving a pancreas transplant. Only during the COVID-19 pandemic in 2020 and 2021 did transplant numbers decline, but they started to recover in 2022. The decline was especially noted for solitary transplants. This development over time was due to excellent patient and graft survival after simultaneous pancreas and kidney transplant (SPK). Patient survival at three years was >90% in SPK as well as in solitary transplants. At 3 years post-transplant, SPK pancreas graft survival was over 86% and SPK kidney graft survival over 90%. In pancreas transplants alone (PTA) and in pancreas after kidney transplants, the 3-year graft function reached 75%. The main reasons for advancement in outcome were reductions in technical failures and immunological graft losses. These improvements were due to better patient and donor selection, standardization of surgical techniques, and superior immunosuppressive protocols.
]]>Authors: Eun-mi Yu Mythri Mudireddy Ishan Patel Jeanny B. Aragon-Ching
Approximately a third of patients diagnosed with kidney cancer in the United States present with advanced disease and those who present with distant metastases historically had dismal 5-year relative survival. However, over the last several years, advancements have led to improved life expectancy and patient outcomes in those who develop advanced renal cell carcinoma. Metastatic clear cell renal cell carcinoma (mccRCC) treatment has rapidly evolved with multiple drug approvals since 2006. Moreover, multiple combination regimens including a vascular endothelial growth factor tyrosine kinase inhibitor (VEGF-TKI) plus immune checkpoint inhibitor (ICI) and the combination of ipilimumab plus nivolumab have supplanted first-line VEGF-TKI monotherapy. Thus, the insights we gained from prospective randomized controlled trials focusing on systemic therapy beyond first-line therapy in mRCC patients treated in the TKI monotherapy era quickly became less relevant with the adoption of contemporary first-line combination regimens. Herein, we will review contemporary first- and second-line therapies for mccRCC, as well as highly anticipated clinical trials looking into novel regimens beyond first-line therapy in patients who have received combination therapy.
]]>Authors: Connie Labate Andrea Panunzio Francesco De Carlo Federico Zacheo Sara De Matteis Maria Cristina Barba Umberto Carbonara Floriana Luigina Rizzo Silvana Leo Saverio Forte Pasquale Ditonno Alessandro Tafuri Vincenzo Pagliarulo
Prostate cancer is the most frequently diagnosed cancer in men in the United States. Among the different available treatment options, radiation therapy is recommended for localized or even advanced disease. Erectile dysfunction (ED) often occurs after radiation therapy due to neurological, vascular, and endocrine mechanisms resulting in arterial tone alteration, pudendal-nerve neuropraxia, and lastly fibrosis. Considering the influence of quality of life on patients’ treatment choice, radiation-therapy-induced ED prevention and treatment are major issues. In this narrative review, we briefly summarize and discuss the current state of the art on radiation-therapy-induced ED in PCa patients in terms of pathophysiology and available treatment options.
]]>Authors: Ahmad S. Abdelrazek Khaled Ghoniem Mohamed E. Ahmed Vidhu Joshi Ahmed M. Mahmoud Nader Saeed Nazih Khater Mohammed S. Elsharkawy Ahmed Gamal Eugene Kwon Ayse Tuba Kendi
The demand for genetic testing (GT) for prostate cancer (PCa) is expanding, but there is limited knowledge about the genetic counseling (GC) needs of men. A strong-to-moderate inherited genetic predisposition causes approximately 5–20% of prostate cancer (PCa). In men with prostate cancer, germline testing may benefit the patient by informing treatment options, and if a mutation is noticed, it may also guide screening for other cancers and have family implications for cascade genetic testing (testing of close relatives for the same germline mutation). Relatives with the same germline mutations may be eligible for early cancer detection strategies and preventive measures. Cascade family testing can be favorable for family members, but it is currently unutilized, and strategies to overcome obstacles like knowledge deficiency, family communication, lack of access to genetic services, and testing expenses are needed. In this review, we will look at the genetic factors that have been linked to prostate cancer, as well as the role of genetic counseling and testing in the early detection of advanced prostate cancer.
]]>Authors: Miguel Vírseda-Chamorro Jesús Salinas-Casado Jorge Matias-Guiu
Objective: To analyze the role of urodynamic dysfunctions as risk factors for recurrent urinary tract infections (rUTIs) in patients with multiple sclerosis (MS). Material and methods: We conducted a prospective cohort study of 170 patients with MS who underwent a urodynamic study due to lower urinary tract symptoms. Patients were followed for one year, and 114 (84 women [74%] and 30 men [26%]; mean age 49 years) completed the study. Clinical variables and urodynamic findings (free uroflowmetry, cystometry, and pressure-flow study results) were recorded. Results indicated rUTIs was present in 37 patients (32%). Statistical analysis was performed using Fisher’s exact test, chi-square test, Student’s t-test, and multivariate regression analysis. Results: In univariate analysis, significant differences were observed between patients with and without rUTIs for the following clinical variables: symptom progression time, MS duration, Expanded Disability Status Scale score, and MS type. Regarding urodynamic findings, significant differences were observed in maximum flow rate (Qmax) (lower in patients with rUTIs), voided volume, bladder voiding efficiency, stress urinary incontinence (SUI) (greater rUTI frequency in affected patients), detrusor pressure at maximum flow, and bladder contractility index score. Multivariate analysis identified the urodynamic factors: low Qmax [Odds Ratio (OR) = 0.90 and SUI (OR = 2.95) as the independent predictors of rUTs. Conclusions: Two urodynamic variables: Qmax and SUI, are independent risk factors for rUTIs in MS patients. These two variables might be associated with Pelvic floor dysfunctions.
]]>Authors: Pegah Taheri Adan Tijerina Sofia Gereta Safiya-Hana Belbina E Charles Osterberg
Objectives: to evaluate whether hospitalist co-management would lead to improved outcomes and value in patients undergoing urethroplasty (UPL) with a single surgeon for urethral stricture disease (USD). Material: A co-management model with hospitalists was introduced in August 2019 for all patients undergoing UPL for USD with a single surgeon in a United States teaching center. The hospitalist worked closely with the urologic surgeon and the support staff. The hospitalist managed post-operative concerns, such as pain and comorbidities, as well as conducted rounds with the urological team for disposition planning and addressing interdisciplinary needs. Retrospective analysis compared a 42-month period before initiation of co-management (Jan 2016–July 2019) with a 32-month period after initiation (Aug 2019–March 2022). Outcomes assessed were recurrence of stricture, complications, length of stay, readmission, and emergency room visits. Results: A total of 135 patients (71 surgeon-managed, 64 co-managed) underwent urethroplasty from January 2016 to March 2022. Hospitalist co-management did not affect complications, length of stay, readmission, and emergency room visits. Accounting for confounding variables using multivariable analysis, no factors were independently associated with recurrence. There were no demographic, comorbidity, or American Society of Anesthesiologists (ASA) score differences between the two groups. Conclusions: This study suggests that hospitalist care for patients undergoing urethroplasty may be non-inferior to surgeon care, based on similar outcomes between the two groups. There were no significant differences in the total length of stay or blood pressure readings, and the complication rates and hospital readmission rates were also similar.
]]>Authors: Roberto Castellucci Piergustavo De Francesco Antonio De Palma Davide Ciavarella Simone Ferretti Michele Marchioni Luigi Schips
The management of sexual complications after treatment of localized prostate cancer, such as erectile dysfunction, changes in the length of the penis, pain during sexual intercourse, and lack of orgasm, is still an unsolved problem with an important impact on patients’ quality of life. In this review, we summarize the current scientific literature about the rehabilitation of erectile dysfunction after prostate cancer treatment. The therapy for penile rehabilitation includes different types of treatments: the combination of phosphodiesterase type 5 inhibitors (PDE5-I) and the vacuum erectile device (VED) are considered first-line treatment options. When therapy begins, the duration of treatment, the dosage and the drug used all play very important roles in the treatment outcome. Intracavernous injection (ICI) therapy represents the second-line option for patients ineligible for PDE5-I therapy. Technological development has led to the emergence of devices for the stimulation of the penis without the use of drugs, such as penile vibratory stimulation (PVS) for stimulation of ejaculation in spinal cord injury and low-intensity extracorporeal shockwave therapy (LIESWT). The rapid diffusion of the latter, thanks to its easy use, attains good results without side effects. The panorama of penile rehabilitation after PC treatments is vast and many studies are needed, especially on new technologies, to find the best therapeutic regimen possible, personalized to the patient’s characteristics and the type of treatment for PC.
]]>Authors: Tommaso Cai Michele Rizzo Giovanni Liguori Michele Palumbo Alessandro Palmieri Luca Gallelli
Background: Several reports highlighted the role of nutraceutical compounds in the prevention and management of HPV-related genital lesions both in men and women, with interesting results. Here, we reviewed the effect of ellagic acid and Annona muricata for managing HPV-related genital lesions. Methods: Relevant databases were searched by using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary endpoint was the clinical cure, defined as the clinical and/or laboratory and/or histopatologically demonstrated absence of HPV-related lesions at the end of the treatment. Results: We enclosed two retrospective studies, two prospective studies and one randomized controlled trial. In men, ellagic acid and Annona muricata complex improves seminal parameters and HPV-DNA clearance. In women, it has a chemopreventive action in cervical cancer and increases the HPV viral clearance. No clinically significant adverse effects have been reported. Conclusions: In conclusion, the combination of ellagic acid and Annona muricata shows interesting and promising results in terms of HPV viral clearance and HPV related genital lesions. However, more data are necessary to confirm these results.
]]>Authors: Raymond A. Dieter George B. Kuzycz William Jacob Dieter
Historically, ureteral complications during surgery have been occurring since the earliest performances of major abdominal or pelvic surgery. In the early 1960s, few diagnostic techniques were available to diagnose ureteral injury and determine the subsequent timely treatment required. Illustrations from two different time periods of possible operative ureteral injury, ligation, or transection following major complicated surgical procedures are presented, along with the diagnostic and therapeutic approach currently followed. The first individual had apparently sustained a ureteral injury during a prior surgical procedure, which, with limited diagnostic options, was not recognized until she visited us years later—as was the case for many early ureteral injuries. Major abdominal or pelvic surgery may be extensive and complicated, especially when dense fibrosis, scarring, and benign or malignant mass formation are present. Unfortunately, surgical complications, including bleeding and ureteral concerns, may develop during these extensive procedures. A more recent patient underwent major, life-threatening retroperitoneal surgery due to a chronic aortoenteric fistula (17 months total preoperative hospitalization elsewhere), during which the left ureter was transected. In our second patient, recognition and correction of the ureteral transection during the aortic surgery, upon completion of the aortic repair, prevented a potential major renal complication. The timely diagnosis of the operative ureteral injury and the repair prior to wound closure prevented major postoperative complications. As some physicians believe that surgically induced ureteral injuries are increasing in frequency, we present this report to enhance awareness of the possibility of injury and the potential value of recognition prior to abdominal closure. In addition, current operative and postoperative strategies available to identify and reduce potential ureteral injury complications when they occur are discussed.
]]>Authors: Islam Kourampi Ioannis-Panagiotis Tsetzan Panagiota Kappi Nityanand Jain
Prostate cancer is the second most common form of cancer in men and the fifth leading cause of death among men worldwide. Men with metastatic castration-resistant prostate cancer (mCRPC) often have BRCA-1 or BRCA-2 gene mutations which can make them sensitive to poly-(ADP-ribose) polymerase inhibitors or PARP inhibitors (PARPi), such as Olaparib, Rucaparib, and Niraparib. Although significant advances have been made with PARPi and the prognosis of patients with mCRPC has improved dramatically, resistance often constitutes a challenge that frequently results in tumor escape. This present communication paper explores the role of PARPi in BRCA-positive prostate cancer and sheds light on numerous published and ongoing clinical trials that will determine the future of PARPi at various tumor stages as a monotherapy or polytherapy regime.
]]>Authors: Elizabeth J. Cartwright Margaret H. Dohnalek W. Stephen Hill
Inhibition of 5α-reductase (5αR), which blocks the conversion of testosterone to its active metabolite, dihydrotestosterone, has been shown to impact further prostate enlargement (benign prostatic hyperplasia, or BPH). Clinical trials of standardized lipidosterolic extracts of Serenoa repens (LSESr), also known as standardized extracts of saw palmetto, have demonstrated improvement in lower urinary tract symptoms (LUTS) and delayed progression of BPH. The aim of this preclinical study was to compare two standardized LSESr, a proprietary ultrahigh-pressure supercritical carbon dioxide extract of S. repens (UHP-sCESr) and the well-established hexanic extract of S. repens (HESr), for both 5αR inhibition activity and lipid profiles. UHP-sCESr and HESr had nearly identical inhibition curves and comparable IC50 values for 5αR-1 (9.25 ± 0.87 and 9.86 ± 0.11 μg/mL, respectively; p = 0.43) and 5αR-2 (7.47 ± 0.07 and 7.72 ± 0.05 μg/mL, respectively; p = 0.0544). UHP-sCESr and HESr also had comparable lipid profiles based on similar total fatty acid levels (87.7% and 91.5%, respectively), weight/weight comparisons of individual fatty acids, and individual fatty acid ratios to lauric acid. In addition, UHP-sCESr meets the standard set by the United States Pharmacopeia (USP) monograph for authenticity and purity for a supercritical carbon dioxide (SCCO2) extract of saw palmetto, whereas HESr meets the standard set by the European Medicines Agency (EMA) for a well-established medicinal product. In conclusion, based on enzyme inhibition curves and IC50 values, a standardized lipid profile is important to achieve comparable mechanisms of action for lipidosterolic extracts of saw palmetto. UHP-sCESr offers a comparable, standardized LSESr for men with LUTS/BPH in regions where the proprietary HESr is not available.
]]>Authors: Raymond A. Dieter George B. Kuzycz Robert S. Dieter Raymond A. Dieter
Motor vehicle accidents continue to cause thousands of life threatening injuries or mortality (nearly 45,000 deaths in 2021) in the United States. A sixteen year-old young man riding a motorcycle was severely injured when struck by an automobile driven by an individual under the influence of alcohol. Multiple long bone fractures, the left renal artery torn off the aorta, with non-function of the left kidney, urinary bladder rupture with cystourethral injury, thoracic aortic disruption, and splenic fracture injuries were present. Emergency repair of the thoracic aorta, splenectomy, and left renal artery bypass were all completed. Absorbable suture repair of the urinary bladder and cystouretheral junction injuries followed Foley and suprapubic bladder decompression. All long bone fractures were stabilized and corrected. Normal urinary function of the left kidney returned, and urinary bladder control accompanied the four-month recuperation. Six and twelve month follow-up showed almost normal mobility with normal bilateral renal and urinary bladder function.
]]>Authors: Uro Editorial Office Uro Editorial Office
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]]>Authors: Dai D. Nghiem
Background: It is well recognized that patient survival and quality of life are superior with renal transplantation than with dialysis. Organ availability is far outweighed by the large number of wait-listed patients. Additional stratagems are sought to expand the donor pool, and kidneys from anencephalic infants can be considered a source of organs, until now unexplored. We plan to assess the feasibility of using the kidneys from anencephalic infants for transplantation. Material and Methods: Information about anencephaly, the characteristics of the infant kidneys, the ethical, social and medico-legal aspects raised by the use of these kidneys, their procurement and their transplantation are reviewed. Conclusions: En bloc kidney transplants from infants can provide long-term normal renal function after an accelerated catch up growth. They are not subjected to hyperfiltration since they have a full complement of nephrons. They can be transplanted using the techniques currently available.
]]>Authors: Alessandro Giordano Marco Capece Carlo D’Alterio Angelo di Giovanni Assunta Zimarra Luigi Napolitano Claudio Marino Roberto La Rocca Massimiliano Creta Tommaso Cai Alessandro Palmieri
This year marks the fiftieth anniversary of the first implant of an inflatable penile prosthesis (IPP). The authors of this paper want to celebrate the event with a narrative review of the current literature. The main scopes are antibiotic prophylaxis, patient satisfaction, and future developments. The implant of the first IPP in 1973, performed by Branteley Scott was a turning point in the history of penile prosthesis, revolutionizing the treatment of erectile dysfunction (ED). Since then, the idea of an inflatable device has not changed much. However, the innovations in design, materials, surgical techniques, and perioperative management led to a more natural, durable, and reliable device featuring fewer complications and greater patient satisfaction. Currently, IPP is associated with high patient satisfaction and excellent long-term outcomes, remaining the gold standard for men with refractory ED. Several strategies are under investigation to improve the technology of penile prosthesis, and we expect in the next future the introduction of new devices that are easier to activate, discreet, comfortable when deflated, and durable in time, mimicking a more physiological erection.
]]>Authors: Mohammad Hifzi Mohd Hashim Xeng Inn Fam Hau Chun Khoo Wan Syahira Ellani Wan Ahmad Kammal Haziq Kamal
Mesotheliomas are malignancies which involve mesothelial cells, and are commonly found in the pleura, peritoneum, pericardium, and (rarely) the testis. We present a case of paratesticular mesothelioma that was excised without the testis. An elderly gentleman presented with a painless right scrotal mass, which appeared clinically benign and separable from the underlying testis. An ultrasound showed an extratesticular lesion adhered to the scrotal wall with a complex hydrocele. An excisional biopsy was conducted, and the Jaboulay procedure was performed on the right testis. Pathological examination revealed mesothelioma, showing focal invasion into the underlying stroma. A post-operative computed tomography (CT) scan evaluation manifested no local or distant metastasis. No further surgery was performed, and no chemotherapy or radiotherapy was offered to the patient. Subsequent clinical examinations and radiological scans carried out during each clinic follow-up for two years showed no new lesion or recurrence.
]]>Authors: Federico Greco Alessandro Tafuri Andrea Panunzio Bruno Beomonte Zobel Carlo Mallio
The role of androgens in body composition is well known. Androgen deprivation therapy (ADT) has shown beneficial effects in the treatment of advanced prostate cancer (PCa). Given that androgens are important for the homeostasis of different organs, the effects of ADT can affect body composition and therefore adipose tissue. Computed tomography (CT) and magnetic resonance imaging (MRI) are non-invasive methods that allow for quantification of the different fat compartments. In this review we describe the effects of ADT on abdominal adipose tissue in PCa patients.
]]>Authors: Tommaso Cai Massimiliano Lanzafame Carlo Tascini
Recurrent urinary tract infection (rUTI) management is still a challenge due to the lack of a standard approach and due to the burden of diseases both on personal and societal aspects. Consultations for rUTIs in everyday clinical practice range from 1% to 6% of all medical visits with high social and personal associated costs, such as prescriptions, hospital expenses, days of sick leave due to the disease, and the treatment of related comorbidities. Recurrent UTIs are, then, associated with anxiety and depression due to treatment failures and symptomatic recurrences. Often urologists are asked to give practical recommendations to patients regarding the everyday management of recurrent UTIs. Here, we aim to give to the physicians managing UTI some helpful suggestions for their everyday clinical practice, on the basis of the recent evidence.
]]>Authors: James Walter John Wheeler Raymond Dieter Brandon Piyevsky Aasma Khan
Spinal cord injury can either be complete with no neural communication across the injury level or incomplete with limited communication. Similarly, motor neuron injuries above the sacral spinal cord are classified as upper motor neuron injuries, while those inside the sacral cord are classified as lower motor neuron injuries. Specifically, we provide recommendations regarding the urological management of complete upper motor neuron spinal cord injuries; however, we also make limited comments related to other injuries. The individual with a complete upper motor neuron injury may encounter five lower urinary tract conditions: first, neurogenic detrusor overactivity causing urinary incontinence; second, neurogenic detrusor underactivity resulting in high post-void residual volumes; third, detrusor sphincter dyssynergia, which is contraction of striated and/or smooth muscle urethral sphincters during detrusor contractions; fourth, urinary tract infection; and fifth, autonomic dysreflexia during detrusor contractions, which produces high blood pressure as well as smooth muscle detrusor sphincter dyssynergia. Intermittent catheterization is the recommended urinary management method because it addresses the five lower urinary tract conditions and has good long-term outcomes. This method uses periodic catheterizations to drain the bladder, but also needs bladder inhibitory interventions to prevent urinary incontinence between catheterizations. Primary limitations associated with this management method include difficulties with the multiple catheterizations, side effects of bladder inhibitory medications, and urinary tract infections. Three suggestions to address these concerns include the use of low-friction catheters, wireless, genital-nerve neuromodulation for bladder inhibition, and consideration of urine egress into the urethra as a risk factor for UTI as well as egress treatment. The second management method is reflex voiding. This program uses external condoms for urine collection in males and diapers for females. Suprapubic tapping is used to promote bladder contractions. This method is not recommended because it has high rates of medical complications. In particular, it is associated with high detrusor pressure, which can lead to ureteral reflux and kidney pathology. Botulinum toxin injection into the urethral striated sphincter can manage detrusor sphincter dyssynergia, reduce voiding pressures, and risks to the kidney. We suggest a modified method for botulinum toxin injections as well as five additional methods to improve reflex voiding outcomes. Finally, the use of intermittent catheterization and reflex voiding for individuals with incomplete spinal injuries, lower motor neuron injuries and multiple scleroses are briefly discussed.
]]>Authors: Patricia Ortega Esther Benito Félix Berrocal
Background: The development of drug resistance among causative agents has resulted in the need to change the paradigm toward alternative therapeutic approaches for uncomplicated urinary tract infections (UTIs). The objective of the present study was to evaluate the efficacy of an oral medical device containing xyloglucan, hibiscus, and propolis in clinical practice with a cohort of women from Switzerland with UTI-like symptoms and the administration of concomitant drugs. Materials and Methods: This work describes an observational, prospective, and multicenter study involving 103 women attending a primary care physician for a symptomatic episode, or recurrence, of acute uncomplicated cystitis between August 2018 and June 2019. Utipro®Plus was administered orally, with patients being prescribed two capsules per day for 5 days to control discomfort symptoms or one capsule per day for 15 consecutive days per month (followed by a 15-day break for a 3-month cycle) to prevent recurrences. Results: A total of 84 women (81.6%) did not require an additional consultation, whereas 17 (16.5%) required a second one. Inadequate treatment response was found in 7 women out of the 19 who required a further consultation (36.8%): 3 women with no history of cystitis (out of 13, 23.1%) and 4 with recurrent cystitis (out of 6, 66.7%). None of the women from the study reported an adverse event. Conclusions: The studied product containing xyloglucan, hibiscus, and propolis is safe and effective for the treatment of a broad spectrum of women with acute uncomplicated or recurrent UTI-like symptoms.
]]>Authors: Robert J. Stratta Angelika Gruessner
Background: Prior to year 2000, the majority of pancreas transplants (PTx) were performed as simultaneous pancreas-kidney transplants (SPKTs) in Caucasian adults with end stage renal failure secondary to type 1 diabetes mellitus (T1DM) who were middle-aged. In the new millennium, improving outcomes have led to expanded recipient selection that includes patients with a type 2 diabetes mellitus (T2DM) phenotype, which excessively affects minority populations. Methods: Using PubMed® to identify appropriate citations, we performed a literature review of PTx in minorities and in patients with a T2DM phenotype. Results: Mid-term outcomes with SPKT in patients with uremia and circulating C-peptide levels (T2DMphenotype) are comparable to those patients with T1DM although there may exist a selection bias in the former group. Excellent outcomes with SPKT suggests that the pathophysiology of T2DM is heterogeneous with elements consisting of both insulin deficiency and resistance related to beta-cell failure. As a result, increasing endogenous insulin (Cp) production following PTx may lead to freedom checking blood sugars or taking insulin, better metabolic counter-regulation, and improvements in quality of life and life expectancy compared to other available treatment options. Experience with solitary PTx for T2DM or in minorities is limited but largely mirrors the trends reported in SPKT. Conclusions: PTx is a viable treatment option in patients with pancreas endocrine failure who are selected appropriately regardless of diabetes type or recipient race. This review will summarize data that unconventional patient populations with insulin-requiring diabetes may gain value from PTx with an emphasis on contemporary experiences and appropriate selection in minorities in the new millennium.
]]>Authors: Lorenzo Storino Ramacciotti Donya S. Jadvar Maria Sarah L. Lenon Giovanni E. Cacciamani Andre Luis Abreu Masatomo Kaneko
Focal therapy (FT) has emerged as a potential treatment for localized prostate cancer (PCa) with encouraging functional outcomes. According to the compelling evidence based on meta-analyses and recent trials, erectile function (EF) is mostly retained at 6 and 12 months after FT when compared to baseline. These findings are consistent across different energy sources reported to date. However, overall, quality of life, including impotence, was not the endpoint for most studies. Additionally, impotency has not been consistently reported in most of the recent literature. Furthermore, confounding factors such as baseline potency and usage of phosphodiesterase 5 inhibitors (PDE5-I) were also frequently undisclosed. Long-term functional outcomes are awaited. To fully comprehend how FT affects EF, more extensive long-term randomized clinical trials using EF as a primary outcome are needed.
]]>Authors: James Walter John Wheeler Aasma Khan
In 50% of typical (nonneurogenic) women, at least one urinary tract infection (UTI) will occur, with cystitis being the most common UTI, with about 25% of patients experiencing recurrence. A factor not currently included in UTI risk models is egress of urine from the bladder into the urethra during bladder filling and activities of daily living. Urinary egress, if it occurs, would shorten the distance that bacteria need to travel to gain access to the bladder. Video urodynamics with contrast medium can demonstrate urinary egress; however, the observations can be difficult to conduct. Egress can be expected to be more likely in women with lower urinary tract conditions such as urge and stress incontinence. Treatment of the incontinence also reduces UTI rates and the reduction could, in part, be due to reduced urine egress. If UTI risk remains after incontinence management, then further treatment with pelvic floor exercises and pessaries could be considered to reduce the risk from potential residual urine egress. In summary, urine egress as a risk factor for UTI needs further research and clinical consideration.
]]>Authors: Bartosz Małkiewicz Dorota Kamińska Maximilian Kobylański Małgorzata Łątkowska Wojciech Handzlik Paweł Dębiński Wojciech Krajewski Oktawia Mazanowska Paweł Poznański Mirosław Banasik Dariusz Patrzałek Dariusz Janczak Magdalena Krajewska Romuald Zdrojowy Tomasz Szydełko
(1) Background: Donor nephrectomy for living donor kidney transplantation using minimally invasive techniques is a safe procedure that has been used for more than 20 years with excellent results. The total laparoscopic approach offers decreased postoperative pain, less incisional morbidity, and a shorter recovery time. (2) Methods: We present the results of a series of 43 laparoscopic donor nephrectomies performed in a single center. The procedures were performed in a systematic approach with transperitoneal access using four ports. The main renal artery and vein were ligated using a linear stapler fixed with an alternate triple row of titanium staples. The specimen was extracted in an endoscopic bag through an additional incision. (3) Results: All procedures were performed laparoscopically without conversion to open surgery. The average warm ischemia time was 4.73 min. In all recipients, immediate kidney allograft function was observed. (4) Conclusions: Total laparoscopic living donor nephrectomy is a safe procedure. It was performed successfully in all cases with a short surgical time, low morbidity, and 0% mortality.
]]>Authors: Alessia Celeste Bocchino Andrea Cocci Alessandro Zucchi Riccardo Bartoletti Antonello De Lisa Girolamo Morelli
Gender Affirmation Surgeries (GASs), erstwhile called Sex Reassignment Surgeries (SRSs), may be necessary for transgender individuals to change their bodily sexual characteristics and thereby affirm their gender identity. GASs encompass all medically necessary interventions to relieve gender dysphoria and should be available to patients who wish to, and who meet the surgical criteria of the World Professional Association for Transgender Health (WPATH) and Standards of Care (SOC). The comprehensive clinical assessment involves many health specialists, including general practitioners, psychologists, psychiatrists, speech therapists, endocrinologists, surgeons, anesthesiologists, nurses, and other healthcare professionals. To define the patients’ complex care needs and their objectives, high-volume specialized centers, accredited training programs, skilled surgeons and health professionals specializing in transgender care within a multidisciplinary team are essential. Currently, the most prominent challenges are related to ethical issues such as the treatment of underage individuals, fertility, parenting and the potential for regret after GAS. Finally, although GAS has been practiced for more than half a century, data on long-term follow-up represents a further topic for investigation.
]]>Authors: James Walter John Wheeler Aasma Khan
Individuals with spinal cord injury and multiple sclerosis usually use intermittent catheterization for urinary management; however, many patients will also encounter a condition of neurogenic detrusor overactivity, which causes urinary incontinence. The use of muscarinic receptor antagonists is the first-line treatment to manage this condition. These drugs, however, have significant side effects. Transcutaneous electrical nerve stimulation applied to the genital nerve (GEN) is an alternative noninvasive method that produces detrusor inhibition through neuromodulation. Despite studies demonstrating bladder inhibition with GEN, more outcomes are required regarding decreased use of bladder inhibitory medications and concerns with dangling wires. It is proposed that wireless-GEN can be used in home-use studies in order to address these limitations. If needed, wireless tibial nerve stimulation could be added to improve incontinence management.
]]>Authors: Tommaso Cai Daniele Tiscione Marco Puglisi Luca Gallelli Manuela Colosimo Michele Rizzo Giovanni Liguori Sandra Mazzoli Alessandro Palmieri
Background: Human papilloma virus (HPV) has been recognized as one of the most common sexually transmitted infections and has been correlated with poor semen quality and male hypofertility. Ellagic acid and Annona muricate have been considered as fascinating compounds in the chemoprevention of HPV-related lesions of the cervix. Here, we aimed to evaluate the role of ellagic acid and Annona muricata (OASIT-k®) in managing male subjects with oligospermia and HPV-related infections. Methods: From January 2017 to January 2019, all patients attending our center for oligospermia were evaluated for HPV-DNA. All HPV-DNA positive patients underwent orally administered OASIT-k 1 tablet/day for 3 months. After 6 months, all patients underwent spermiogram, HPV-DNA analysis on seminal plasma and urological visit. The main outcome measures were HPV-DNA clearance rate and improvement of semen parameters. Results: Forty-three patients (aged 22–43 years) were enrolled and treated. At the end of the treatment, the clearance of HPV-DNA infections was 62.7% (27/43). Seminal parameters were improved by treatment in terms of the number of spermatozoa (10.6 vs. 15.8) and mobility (27.5% vs. 36.1%). Conclusions: The therapy with OASIT-K was efficient in improving the HPV-DNA clearance and seminal parameters. These promising data emphasize the importance of redirecting the immune responses in viral infections.
]]>Authors: Dai D. Nghiem
Background: The shortage of organs has called for the use of two marginal adult kidneys (MAKs) with a low nephron mass as dual adult kidneys transplanted to a single recipient. The operative techniques of the transplantation of these kidneys are still debated. Since the horseshoe kidneys have been transplanted as early as 1975, it is theorized that the technique of the en bloc transplantation of the horseshoe kidney may be applied to the MAKs. Material and Methods: The world literature search during the period 1975–2021 on the use of deceased-donor horseshoe kidneys was reviewed. The selection of the donors, the anatomy of the kidneys, the principles of organ recovery, the transplantation procedure, and the results were discussed. Finally, this technique of en bloc transplantation was applied successfully to seven pairs of MAKs and is described herein. The dual adult kidneys were simultaneously vascularized by the donor aorta and vena cava, which were anastomosed, respectively, to the recipient iliac artery and vein. Results: A total of 131 case reports of deceased horseshoe kidney donors were reviewed, of which 53 en bloc kidneys were transplanted successfully to a single recipient, and the remaining 78 were divided and transplanted as single units to 131 recipients. Twenty-five single kidneys were discarded. At the time of publication, all horseshoe kidneys had a good renal function. In the series of seven pairs of MAKs transplanted en bloc, the operative time was 3 h. There were no primary nonfunctions, no vascular thromboses, no urinary leakages, and no wound infections. Only two patients required temporary dialysis despite an average of 28.4 h of cold ischemia time. No hydronephrosis and lymphocele was experienced. Both patient and graft survival were 100%. At the time of follow-up at 36 months, serum creatinine levels averaged 1.8 mg/dL (range 1.4–1.9). Conclusions: This technique of en bloc renal transplantation using the donor aorta and vena cava for revascularization can be applied to both the horseshoe kidneys and the MAK, and improve organ utilization.
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