Search Results (28)

Autologous platelet-rich plasma (PRP) has emerged as a promising regenerative therapy in various medical fields, including the treatment of stress urinary incontinence (SUI) in women. PRP promotes regeneration by delivering a concentrated dose of platelets to damaged tissues, triggering healing mechanisms such as hemostasis, revascularization, and connective tissue regeneration through the release of growth factors. Despite evidence supporting the short- and medium-term benefits of PRP, its long-term efficacy remains unclear, largely due to the limited duration of follow-up in existing studies. Furthermore, the lack of standardized protocols for both preparation and administration of PRP poses a significant challenge to accurately assessing and comparing its sustained therapeutic outcomes. This literature review utilized comprehensive searches of PubMed and Google Scholar databases to analyze current evidence regarding PRP’s role in managing SUI in women. SUI, often resulting from weakened pubo-urethral ligament or intrinsic sphincter dysfunction due to childbirth, aging, or hormonal changes, significantly impacts quality of life. PRP offers a safe, minimally invasive, and cost-effective treatment option; however, further large-scale, well-designed studies are necessary to define optimal protocols and confirm long-term benefits. Advancing understanding of PRP therapy could substantially improve clinical management and patient quality of life in SUI. Full article

Background: Hypospadias is a common congenital anomaly in boys, marked by ectopic urethral meatus and a wide range of anatomical variants such as chordee and atypical glans morphology. Despite advancements in surgical techniques, complication rates remain high and unpredictable due to heterogeneity in anatomy and a lack of standardized preoperative assessments. Retrospective studies suggest associations between specific anatomical features and postoperative complications; however, high-quality prospective, multicenter evidence is currently lacking. Methods: The PREDICT-H (Prospective Research on Essential Determinants Influencing Complication Trends in Hypospadias) study is a multicenter, prospective cohort study aiming to enroll approximately 1450 boys aged 1–12 years undergoing primary hypospadias repair at ten or more tertiary pediatric urology centers. A standardized preoperative assessment protocol will document detailed anatomical parameters, including urethral plate width and length, glans size, meatal location, chordee severity, and GMS score. Intraoperative variables and surgical techniques will be recorded. Postoperative outcomes, including urethrocutaneous fistula, meatal stenosis, and recurrent chordee, will be assessed at ≥6 months follow-up. Statistical analyses will include multivariate logistic regression and advanced modeling to identify independent predictors and develop a validated risk prediction nomogram. Interobserver reliability of anatomical assessments will also be evaluated. Results: As this is a study protocol, results are not yet available. Data collection is ongoing and will be analyzed upon completion of the planned follow-up period. The primary outcome will be the incidence of postoperative complications and the development of a predictive nomogram for individualized risk estimation. Conclusions: The PREDICT-H study is designed to provide robust, prospective evidence on the anatomical determinants of postoperative complications in hypospadias surgery. The development of a validated, clinically applicable risk prediction tool could standardize preoperative assessment and enhance individualized surgical planning. Findings from this study are expected to support evidence-based practice and inform future clinical guidelines. Full article

Background: Urethral strictures impact millions, causing significant morbidity and millions in healthcare costs. Testing new interventions is limited by the lack of inexpensive urethral healing models. We developed an ex vivo model of early urethral wound healing using explanted rabbit urethral tissue. This was used to test the impact of six growth factors (GFs). Methods: The rabbit urethra was detubularized by cutting it between the corpora cavernosa, and then it was stitched flat using a custom 3D-printed platform. The tissue was carefully scratched to produce a visible wound, and the specimens were placed in media containing growth factors at 100 ng/mL and 10 ng/mL. Images were taken at 0, 24, 48, 72, and 96 h, and the wound area was measured by blinded reviewers to determine the rate of wound contraction. Results: Specimens with IGF at 100 ng/mL showed a statistically significant difference in wound contraction when compared to those with GF-free control medium, showing that IGF-1 supports early urethral epithelization and may improve healing. Conclusions: The developed protocol provides a simple explant platform that can be used to investigate methods of enhancing early phases of urethral healing or used to investigate other areas of urethral health, including drug delivery, infection, and mechanical properties. Full article

Objectives: Strain elastography (SE) is a non-invasive ultrasound-based technique for evaluating tissue elasticity. This study investigated whether SE can reproducibly detect differences in suburethral tissue stiffness between women with stress urinary incontinence (SUI) and continent controls. Methods: In this prospective cohort study, 40 women (20 with SUI, 20 continent controls) underwent introital two-dimensional (2D) ultrasound in the midsagittal plane at rest. SE was performed at three predefined suburethral regions of interest (ROIs): the internal urethral orifice (IUO), midurethra (MU), and external urethral orifice (EUO), with the adipose layer (AL) serving as reference tissue. Group comparisons and reproducibility analyses were conducted. Results: SE enabled reliable in vivo assessment of suburethral elasticity. Women with SUI demonstrated significantly higher tissue elasticity at all three urethral levels compared to controls. The MU level showed the highest diagnostic accuracy (AUC = 0.813; sensitivity = 0.65; specificity = 0.85). Measurement reproducibility was excellent, with intraclass correlation coefficients exceeding 0.95 across all ROIs. Conclusions: SE is a feasible, reproducible imaging modality for assessing suburethral biomechanics in women with SUI. It effectively distinguishes affected individuals from continent controls, particularly at the midurethral level. Standardized protocols and diagnostic thresholds are needed to facilitate clinical integration of SE in the evaluation and management of SUI. Full article

Background: Urethral stricture disease involves fibrotic scarring that narrows the urethral lumen and can occur at any site. Sonourethrography (SUG) is increasingly used because it depicts both luminal anatomy and periurethral fibrosis, yet little is known about patient or lesion features that influence its diagnostic performance. Methods: We conducted a prospective single-center study of 170 men who underwent SUG before anterior urethroplasty between May 2016 and May 2021. Anthropometric data, comorbidities, and detailed ultrasonographic measurements were recorded and compared with intra-operative findings, which served as the reference standard. Accuracy was analyzed with Wald chi-square testing and Spearman correlation. Results: SUG length estimates matched intra-operative measurements in 139/170 strictures (81.8%). Length accuracy was higher in patients ≥ 60 years (89.2% vs. 77.0%, p = 0.03) and in those with type 2 diabetes (92.3% vs. 80.9%, p = 0.02) in conditions associated with pronounced spongiofibrosis that enhances echo contrast. Among stricture-specific factors, proximal location (63.6% vs. 84.5%, p = 0.01) and complete luminal occlusion (68.8% vs. 84.8%, p = 0.02) reduced precision, largely because deeper anatomy and absent saline flow hinder acoustic delineation. The Chiou ultrasonographic grade was the strongest determinant of performance; higher grades yielded clearer margins and better length estimation (p < 0.001). Conclusions: SUG is a reliable bedside technique for assessing anterior urethral strictures, but its accuracy varies with age, diabetes status, stricture site, degree of occlusion, and fibrosis grade. Recognizing these determinants allows clinicians to judge when SUG alone is sufficient and when complementary imaging or heightened caution is warranted. The findings support tailored imaging protocols and underscore the need for multi-center studies that include operators with diverse experience to confirm generalisability. Full article

Urethral diverticulum (UD) during pregnancy is a rare clinical condition, with limited literature available to guide standardized management. Fewer than a dozen well-documented cases have been reported, but they reflect a wide range of clinical approaches from antenatal surgery to postpartum intervention. We report the case of a 36-year-old woman diagnosed at 34 weeks of gestation with a 5.5 cm urethral diverticulum, presenting with suprapubic pain, urinary dribbling, and green vaginal discharge. Conservative management was pursued due to obstetric concerns, including multiple uterine fibroids and risk of preterm labor. Advanced ultrasonographic techniques—biplane transvaginal imaging, transperineal ultrasound, and 3D surface rendering—enabled a detailed anatomical assessment of parameters including the lesion’s size, shape, and relationship to the urethra, without resorting to invasive diagnostics. The diverticulum was found to cause 90° urethral angulation and had a C-shaped configuration, with a volume of 11.5 cm³. Following antibiotic treatment, the patient’s symptoms improved, and she remained clinically stable. She was scheduled for vaginal delivery followed by postpartum diverticulectomy. This case illustrates the diagnostic value of high-resolution ultrasound in pregnancy and supports literature recommendations favoring conservative treatment and delayed surgery to reduce maternal and fetal risk. Vaginal delivery remains a viable option in select UD cases. Full article

Stress urinary incontinence (SUI) is characterized by the involuntary leakage of urine when bladder pressure exceeds urethral closing pressure during routine activities such as physical exertion, coughing, exercise, or sneezing. SUI is the most prevalent form of urinary incontinence, with a reported prevalence ranging from 10% to 70%, and its incidence increases with age. As the global population continues to age, the prevalence and clinical significance of SUI are expected to rise accordingly. The pathophysiology of SUI is primarily driven by two mechanisms: urethral hypermobility, resulting from compromised supporting structures, and intrinsic urethral sphincter deficiency, characterized by the deterioration of urethral mucosa and muscle tone. Current treatment options for SUI include conservative management strategies, which heavily rely on patient adherence and are associated with high recurrence rates, and surgical interventions, such as sling procedures, which offer effective solutions but are costly and carry the risk of adverse side effects. These limitations highlight the urgent need for more effective and comprehensive treatment modalities. Exosomes, nano-sized (30–150 nm) extracellular vesicles secreted by nearly all cell types, have emerged as a novel therapeutic option due to their regenerative, anti-fibrotic, pro-angiogenic, anti-apoptotic, anti-inflammatory, and anti-hypoxic properties. These biological functions position exosomes as a promising alternative to conventional therapies for SUI. Exosome therapy has the potential to enhance tissue regeneration, restore urethral function, and repair nerve and muscle damage, thereby reducing symptom burden and improving patients’ quality of life. Additionally, exosome-based treatments could offer a less invasive alternative to surgery, potentially decreasing the need for repeated interventions and minimizing complications associated with current procedures. In this literature review, we critically assess the current state of research on the potential use of exosomes in treating SUI, highlighting their therapeutic mechanisms and potential clinical benefits. Full article

Stress urinary incontinence (SUI) results from complex anatomical and functional interactions, including urethral mobility, muscle activity, and pelvic floor support. Despite advancements in imaging and electrophysiology, a comprehensive model remains elusive. This study employed shear wave elastography (SWE), incorporating sound touch elastography (STE) and sound touch quantification (STQ) with acoustic radiation force impulse (ARFI) technology, to assess urethral elasticity and bladder neck descent (BND) in women with SUI and continent controls. Between October 2024 and January 2025, 30 women (15 with SUI, 15 controls) underwent transperineal and intravaginal ultrasonography at IRCCS San Gerardo. Statistical analysis, conducted using JMP 17, revealed significantly greater BND in the SUI group (21.8 ± 7.8 mm vs. 10.5 ± 5 mm) and increased urethral stiffness (Young’s modulus: middle urethra, 57.8 ± 15.6 kPa vs. 30.7 ± 6.4 kPa; p < 0.0001). Mean urethral pressure was the strongest predictor of SUI (p < 0.0001). Findings emphasize the role of urethral support and connective tissue integrity in continence. By demonstrating SWE’s diagnostic utility, this study provides a foundation for personalized, evidence-based approaches to SUI assessment and management. Full article

Background/Objectives: Primary gynecological melanomas are rare malignancies with lower survival rates compared to cutaneous melanomas. Both preclinical and clinical data support the evidence that mucosal melanomas are photon-radioresistant but responsive to carbon ion radiotherapy (CIRT). The aim of this study is to assess, in a real-world cohort, the effectiveness and tolerability of radical CIRT in patients with inoperable gynecological mucosal melanoma. Methods: This is a real-world study aimed to assess the effectiveness and the safety of CIRT in this setting. We defined as the primary endpoints the objective response rate (ORR) and the clinical benefit (CB). The secondary endpoints included the actuarial local control rate (LC) assessed after 1 year and 2 years and the toxicity scored according to CTCAE v.5. Actuarial outcomes were analyzed using the Kaplan–Meier method, while potential predictors were investigated through the Log-rank test. Results: Between 2017 and 2023, eleven Caucasian patients underwent pelvic CIRT (total dose 68.8 GyRBE) for mucosal malignant melanoma of the vulva or the vagina. With a median follow-up of 18 months, we observed an ORR of 82% and a CB of 100%. LC at 1 and 2 years was 100% and 86%, respectively, and among the factors analyzed for their potential impact on LC, age < 60 years seems to be a potential predictor (p = 0.014). The treatment was well tolerated, with only one case of acute grade 3 erythema and, in the late phase, one case of grade 3 erythema and grade 3 urethral toxicity. Conclusions: CIRT was effective and safe for gynecological melanomas. Larger collaborative cohort studies and longer follow-ups are needed to take a step forward in comprehending the correct management of this disease. Full article

Background: The Minimally Invasive Prolapse System (MIPS) device, a novel single-incision transvaginal mesh, represents recent advancements in mesh technology, providing lightweight, biocompatible support for pelvic organ prolapse while reducing erosion, allowing for customization and improving surgical outcomes. This study aimed to identify factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair using the Minimally Invasive Prolapse System device. Methods: Two hundred and eighteen women with symptomatic stage II to IV POP underwent TVM. Preoperative and postoperative assessments included urinalyses and pelvic examinations using the POP quantification (POP-Q) staging system. Results: During a follow-up period of 12–46 months, 7 of 218 (3.2%) women experienced POP recurrence. Univariate analysis was conducted to identify predictors of surgical failure, revealing no significant differences in body mass index, POP stage, or preoperative urinary symptoms between the recurrence and success groups (p > 0.05). However, functional urethral length <20 mm based on urodynamics (p = 0.011), ICI-Q scores ≥7 (p = 0.012), and the first 60 surgical cases (p = 0.018) were significant predictors of surgical failure. Multivariate logistic regression confirmed these findings. Conclusions: Functional urethral length <20 mm, ICI-Q scores ≥7, and limited surgical experience were significant predictors of TVM failure using the Minimally Invasive Prolapse System kit. POP recurrence after mesh repair is less likely beyond the learning curve. Full article

The aim of this study was to develop a novel biomimetic in vitro extraluminal migration model to observe the migration of bacteria along indwelling urinary catheters within the urethra and assess the efficacy of a prototype chlorhexidine diacetate (CHX) coating to prevent this migration. The in vitro urethra model utilised chromogenic agar. A catheter was inserted into each in vitro urethra. One side of the urethra was then inoculated with bacteria to replicate a contaminated urethral meatus. The models were then incubated for 30 days (d), with the migration distance recorded each day. Four indwelling catheter types were used to validate the in vitro urethra model and methodology. Using the biomimetic in vitro urethra model, E. coli and S. aureus migrated the entire length of a control catheter within 24–48 h (h). In the presence of a prototype CHX coating, full migration of the channel was prevented for 30 d. The results of this study support the hypothesis that catheter-associated urinary tract infections (CAUTIs) could be prevented by targeting catheter-mediated extraluminal microbial migration from outside of the urinary tract into the bladder. Full article

In recent years, decellularized extracellular matrices (dECM) derived from organs have attracted much attention from researchers due to their excellent biocompatibility, capacity to promote cell proliferation and migration, as well as pro-vascularization. However, their inferior mechanical properties, slow cross-linking, weak strengths, and poor supporting properties remain their inevitable challenges. In our study, we fabricated a novel dECM hydrogel with better crosslinking strength and speed, stronger support properties, and better mechanical properties. The hydrogel, which we named gelatin-based dECM powder hydrogel (gelatin-dECM hydrogel), was prepared by mixing dECM microparticles in gelatin solution and adding certain amount of 1-Ethyl-3-(3-dimethyl-aminopropyl-1-carbodiimide) (EDC) and N-hydroxysuccinimide (NHS). We evaluated the utility of this hydrogel by assessing the degradation rate, mechanical properties, and biocompatibility. The results showed that the gelatin-dECM hydrogel has high mechanical properties and biocompatibility and also has the ability to promote cell proliferation and migration. After injection of this hydrogel around the surgical sites of urethras in rabbits, the incorporation of dECM powder was demonstrated to promote angiogenesis as well as scarless repair by histological sections after surgery. The application of this novel hydrogel provides a new perspective for the treatment of post-traumatic urethral stricture. Full article

The aim of this opinion paper is to determine the entities that define the maximal urethral pressure (MUP) during rest and during bladder filling that is needed to guarantee continence in females. For the development of this opinion, the literature was searched for via the Pubmed database and historic sources. Animal studies indicate that the maximal urethral pressure is determined by the smooth muscle activity in the mid-urethra. Additionally, during increased smooth muscle tone development, the largest sympathetic responses are found in the middle part of the urethra. This could be confirmed in human studies that are unable to find striated EMG activity in this area. Moreover, the external urethral striated sphincter is situated at the distal urethra, which is not the area with the highest pressure. The external urethral sphincter only provides additional urethral pressure in situations of exertion and physical activity. From a physics point of view, the phasic pressure of the external striated sphincter at the distal urethra cannot be added to the tonic pressure generated by the smooth muscle in the mid-urethra. The assertion that mid-urethral pressure is the result of different pressure forces around the urethra, including that of the external striated sphincter, is not supported by basic research evidence combined with physical calculation and should therefore be considered a misconception in the field of functional urology. Full article

Background: How quickly providers adapt to new practice guidelines is not well known. The objective of this study was to evaluate temporal trends in the performance of urethral endoscopic management and urethroplasty surrounding the release of the American Urological Association (AUA) Male Urethral Stricture Guidelines in 2017. We also evaluate in parallel trends in female urethral stricture disease, where AUA guidelines are not present. We hypothesized that the ratio of urethroplasty versus urethral endoscopic management in both males and females is increasing and that guidelines do not result in immediate changes in management trends. Methods: Endoscopic management and urethroplasty data were collected from the TriNetX database on adult males and females five years before (starting 1 January 2012) and after (ending 31 December 2022) the 2017 AUA guidelines. Cohorts were built using Current Procedural Terminology (CPT) codes and grouped into urethral endoscopic management (Males: CPT 52275, 52281, 52282, 53600, 53601, 53620, 53621; Females: CPT 52270, 53660, 53661, 53665) or urethroplasty (Males: CPT 53000, 53010, 53400, 53410, 53415, 53420, 53450, 53460; Females: CPT 53430). Data on patient age, race, and geographic distribution were also collected. Results: In total, 27,623 (Males: 25,039; Females: 2584) endoscopic managements and 11,771 (Males: 11,105; Females: 666) urethroplasties were reviewed across 51 Health Care Organizations. The mean age of endoscopic management and urethroplasty patients was 67.1 and 55.7, respectively (p < 0.01). The urethroplasty-to-endoscopic management ratio decreased for males between 2012 and 2013 and then steadily increased until 2017. The ratio steadily increased for females from 2012 to 2017. The urethroplasty-to-endoscopic management ratio showed a slight decline from 2017 to 2020 across both males and females before rising again through 2022 to a study high (Males: 0.62; Females: 0.63). Regional differences were identified, with the West having the highest urethroplasty-to-endoscopic management ratios for both males and females, the Northeast having the lowest urethroplasty-to-endoscopic management ratio for males, and the Midwest having the lowest ratio for females. Conclusions: The utilization of urethroplasty for males and females is increasing. An immediate benefit on post-guideline urethroplasty rates was not observed, and the utilization of female urethroplasty increased despite the absence of AUA guidelines. These illustrate that the impact of guideline dissemination takes time and supports the need for continued provider outreach and education on urethral stricture disease and management. Full article

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. Full article