Search Results (140)

Background and Objectives: Urinary incontinence (UI) is a prevalent condition that significantly affects quality of life but remains underreported. Understanding the factors that influence patients’ decisions to seek medical consultation is essential for improving care-seeking behavior and ensuring timely intervention. This study aimed to identify the facilitators of seeking medical consultation among individuals with UI in a Saudi secondary care setting. Materials and Methods: A cross-sectional study was conducted from December 2024 to April 2025 among adult patients with UI attending urology and urogynecology outpatient clinics at a single tertiary center. Participants completed a structured, self-administered questionnaire that comprised sociodemographic data, the ICIQ-UI SF, and 33 potential motivators for seeking care, categorized into six domains. Results: A total of 241 participants were included in the study. The 33-item scale demonstrated excellent internal consistency (Cronbach’s α = 0.945). The most influential domains were daily and physical impact, followed by emotional and psychological factors. Top facilitators included interference with prayers (66.8%), use of pads (62.2%), social limitations (63.9%), frequent clothing changes (64.7%), and fear of worsening symptoms (63.5%). Cultural factors, such as access to same-sex specialists (52.2%), were also prominent. Logistic regression identified age, marital status, and motivators from several domains as significant predictors. Key independent predictors included prayer interference, leakage frequency, and gender-concordant care. Conclusions: Help-seeking for UI is influenced by physical, emotional, social, and cultural factors. Enhancing patient education, addressing sociocultural sensitivities, and promoting physician-led discussions foster earlier care-seeking and improve health outcomes in populations with traditionally low treatment uptake. Full article

Background: Urological cancers (UCs) greatly impact global public health. While immunity plays an important role, the contribution of specific immune cell traits to the development of UCs remains unclear. In our study, we employed Mendelian randomization (MR) to elucidate the causal relationship between 731 immune cell traits and three common UCs, namely kidney cancer (KC), bladder cancer (BC), and prostate cancer (PC). Methods: In our research, we adopted and preprocessed the statistics of 731 immune cell types from the GWAS Catalog. The data of three common UCs were acquired from two databases, FinnGen and IEU. Five MR analysis models, including random-effect inverse-variance weighted, weighted median, MR Egger, weighted mode, and simple mode, were used to assess the association between 731 immune cell traits and UCs. Subsequently, a meta-analysis of the IVW method was performed, and the significant results were analyzed using the reverse MR method. Sensitivity analyses, including leave-one-out analysis, were also performed. Results: When analyzing the two datasets separately, 25, 41, and 23 immune phenotypes were found to be significantly associated with BC, PC, and KC, respectively. When applying meta-analysis, the combined results showed that a total of 18 immune cell types manifested the significant association, including 4 and 14 immune cell traits regarding BC and PC, respectively. Utilizing reverse MR analysis on the combined results, we found that two immune cell traits, namely lymphocyte absolute cell counts and CX3CR1 on CD14+ CD16- monocytes, showed a reverse causal relationship with PC. Conclusions: Our research depicts the immune landscape for these three common UCs, highlighting their strong genetic associations with immune cells. It provides valuable insights for identifying the systemic immunological context of cancer susceptibility and the development of blood-based immunological biomarkers and therapeutic targets. Full article

Multiple Sclerosis (MS) is an inflammatory autoimmune disorder that primarily affects the central nervous system, leading to significant disability in young adults, with a higher prevalence observed in women. The heterogeneous clinical presentation of MS poses substantial challenges in diagnosis and treatment. In recent years, considerable emphasis has been placed on improving the quality of life for MS patients, with sexual health being a key component of this assessment. The literature suggests that sexual dysfunctions affect between 42% and 73% of individuals with MS. While the positive effects of physiotherapy interventions on sexual dysfunction have been extensively studied, there remains a significant gap in understanding the prevalence of these disorders within the MS population and the most effective treatment approaches. This review highlights the critical need to integrate pelvic floor physiotherapists into multidisciplinary MS treatment teams. Six randomized controlled trials (RCTs) meeting the inclusion criteria were identified. These studies included patients diagnosed with MS who reported various sexual dysfunctions, such as orgasmic dysfunction, sexual arousal disorders, and dysfunctions associated with overactive bladder. The outcomes were assessed using sexual function and urological symptom questionnaires. Physiotherapeutic interventions, including manual therapy, kinesiotherapy, and physical therapy elements, have demonstrated positive effects on sexual quality of life, specifically in relation to issues such as desire, arousal, and satisfaction. However, the available data are still preliminary and warrant further investigation. By recognizing the importance of pelvic floor therapy, more targeted and holistic interventions can be implemented, ultimately improving patient outcomes and enhancing the overall standard of care. Full article

Background/Objectives: Erectile dysfunction (ED) is a prevalent condition worldwide that significantly affects men’s sexual health and overall quality of life. ED is often associated with both psychological and organic factors and may serve as an early indicator of underlying health conditions such as diabetes mellitus, hypertension, and cardiovascular diseases. This study aimed to assess the attitudes and help-seeking behaviors of patients with ED who attended primary healthcare centers for non-urological reasons. Methods: A cross-sectional survey was conducted among 384 men aged 18 years and older who attended primary care clinics. Erectile dysfunction was evaluated using a structured questionnaire designed to assess patients’ attitudes toward ED, help-seeking behaviors, and treatment preferences. Results: Approximately half of the participants (49.5%) acknowledged the necessity of seeking treatment. However, the majority (53.1%) had not consulted specialized clinics, primarily due to social stigma and a preference for self-medication. Concerning sources of information on ED treatment, 30.7% of participants relied on their partners and healthcare providers. Conclusions: The study underscores critical barriers to ED management, including social stigma and reliance on self-medication, which may impede optimal treatment engagement and access to specialized care. Full article

Background: Saudi Arabia is undertaking a comprehensive reform of its healthcare system to improve the efficiency and accessibility of public healthcare services. A key aspect of this initiative is outsourcing outpatient pharmacy services within the public health sector to retail pharmacies through an electronic prescribing platform known as Wasfaty. The National Unified Procurement Company (NUPCO) manages this platform to ensure spending efficiency and patient accessibility to essential medications. However, there has been a lack of research evaluating the adherence of the Wasfaty e-prescribing platform to established best practices for Computerized Provider Order Entry (CPOE), which are commonly used to assess the performance of various ambulatory e-prescribing systems globally. Objective: This study aimed to assess the level of adherence of Wasfaty to best practices for CPOE. Methods: This descriptive cross-sectional single-center study reviewed filled prescriptions through Wasfaty from May 2022 to December 2023. A list of 60 functional features, including but not limited to patient identification and data access, medication selection, alerts, patient education, data transmission and storage, monitoring and renewals, transparency and accountability, and feedback, was utilized to evaluate adherence. The adherence level was categorized into four groups: fully implemented, partially implemented, not implemented, and not applicable. Two pharmacy interns, a clinical pharmacist, and a researcher, reviewed the prescriptions to determine the platform’s adherence to these 60 CPOE features. Results: From May 2022 to December 2023, a total of 1965 prescriptions were filled in retail pharmacies for out-of-stock medications for 1367 patients. These prescriptions included medications for various areas, with the following distribution: gastroenterology (44.10%), cardiology (18.14%), anti-infectives (2.42%), urology (8.85%), dermatology (3.6%), hematology (0.29%), muscle relaxants (0.8%), neurology (19.17%), pulmonology (1.46%), and other categories (1.23%). Of the 60 functional characteristics a CPOE platform should include, only 19 (31.66%) were fully implemented, while 10 (16.66%) were partially implemented. Conclusions: The Wasfaty platform is deficient in several key functional features necessary for e-prescribing, which are essential for ensuring patient safety and enhancing the satisfaction of both prescribers and patients. This study underscores the importance of improving the Wasfaty platform to reduce the risk of adverse drug events. Full article

Background/Objectives: YouTube is an open-access video streaming platform with minimal regulation which has led to a vast library of unregulated medical videos. This study assesses the quality of information, understandability and actionability of videos on YouTube pertaining to sacral neuromodulation (SNM). Methods: The first 50 videos on YouTube after searching “sacral neuromodulation for bladder dysfunction” were reviewed. Thirty-eight of these videos met the inclusion criteria. These videos were reviewed by two Urology Registrars and the videos were scored using two standardised tools. The DISCERN tool assesses quality of information and the Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-A/V) tool assesses user understandability and accessibility. Results: Forty-two percent of videos were deemed to be poor or very poor, with 58% being fair, good or excellent according to the DISCERN standardised tool. For PEMAT-A/V the average score for understandability was 74% (43–100%) and actionability was 38% (0–100%). We found statistical significance comparing the duration of videos to the DISCERN groups (p = 0.02). We also found significance comparing the understandability of videos using the PEMAT-A/V score to the DISCERN groups (p ≤ 0.05). Conclusions: Forty-two percent of videos on SNM are of poor or very poor quality. The actionability score for consumers to seek out further information is also low at 38%. This raises concerns about the quality of information that is widely available on YouTube and how consumers will use this information when making decisions about their health. Full article

Smoking is a major risk factor for bladder cancer and postoperative complications. Therefore, urological guidelines strongly recommend smoking cessation. Notwithstanding, many patients continue to smoke beyond the time of diagnosis. By using the qualitative methodology, this study aimed to explore barriers, facilitators, and recommendations related to the intensive smoking cessation Gold Standard Programme (GSP) from the multi-perspective view of patients treated with transurethral resection of the bladder tumour (TURBT), their relatives, and clinicians. We conducted semi-structured individual interviews with eight patients, four relatives, and six clinicians in the urology setting. Data were analysed using the Framework Method. All participants perceived the GSP positively. Across the three groups, five categories emerged describing barriers and facilitators: perceptions of the GSP, pragmatic factors, health-related factors, psychological factors, and relational and communicative factors. Similarly, recommendations were represented in two categories: the GSP and pragmatic factors. While facilitators were relatively similar across the three groups, barriers were dissimilar or contradictory. The clinicians expressed the most challenges related to relational and communicative factors. The patients mainly had recommendations related to the GSP, while the clinicians’ recommendations focused on pragmatic factors for conducting the GSP. The potential involvement of relatives needs to be further investigated. Full article

Urogenital cancer is very common in the male population of Western countries, a problem of major concern for public health systems, and a frequent test subject for oncological research. In this narrative, we identify the main hot topics for clinics and the basic science of urological cancer in the last few years (from 2021 onwards), considering the information given in the abstracts of almost 300 original articles published in outstanding journals of pathology, urology, and basic science. Once defined, for the top ten list of hot topics (the 2022 WHO update on the classification of urinary and male genital tumors, new entities in kidney cancer, urinary cancer-omics, update on the Gleason grading system, targeted therapies and other novel therapies in renal cancer, news on non-muscle invasive urothelial carcinoma, artificial intelligence in urologic cancer, intratumor heterogeneity influence in therapeutic failures in urologic neoplasms, intratumor microbiome and its influence in urologic tumor aggressiveness, and ecological principles and mathematics applied to urogenital cancer study), each issue is independently reviewed in an attempt to put together the most relevant updates and/or useful features accompanied by selected illustrations. This review article addresses some of the most interesting and current hot spots in urogenital basic cancer research and clinics and is mainly aimed toward clinicians, including pathologists, urologists, and oncologists. Readers are invited to explore each topic for further, more detailed information, in addition to the references provided. Full article

Foreign bodies in urological patients are commonly found in the lower urinary tract, especially in the bladder and urethra. Items such as pens, pencils, wires, and cables are often inserted for erotic stimulation, typically associated with alcohol intoxication or psychiatric disorders. The aim of this study is to present the adverse events of non-conventional sexual manipulation and the harmful effects of using atypical objects for masturbation purposes. The study presents a series of case reports describing patients with self-inflicted foreign bodies in the lower urinary tract, collected over 20 years at a single medical center. Most patients were admitted to the hospital with lower urinary tract symptoms (LUTSs) and signs of infection, such as abdominal pain and fever. Only 6 out of 12 patients revealed their intention regarding foreign body insertion. Additionally, 9 out of 12 patients did not attend the follow-up visit. Self-inflicted foreign bodies in the lower urinary tract vary in type and motive. Patients may be reluctant to disclose these circumstances, complicating diagnosis and treatment, which can lead to serious health risks and a reduced quality of life. Full article

To determine the variations in the costs of the prophylaxis of recurrent urinary tract infections (RUTIs) among different prevention protocols, a prospective observational multicenter study on 1614 women receiving RUTI prophylaxis was conducted. The patient groups were as follows: Group A (n = 444): conventional suppressive antibiotic therapy; Group V (n = 732): polyvalent bacterial vaccine; and Group O (n = 438): other adjuvant measures. The variables were age, body mass index, American Society of Anesthesiologists (ASA) physical status classification scale, cost of prophylaxis, duration of the RUTI, number of visits for primary and specialized care, number of UTIs, cost of urinalysis, urine culture, urine cytology, and days of sick leave. The mean age was 57.71 years but was found to be lower in GV. The mean expenditure on UTI prophylaxis and treatment per patient was EUR 4908.07, but this found to be higher in GO. Emergency primary care visits were more frequent in GA. The ordinary scheduled visits to primary care visits were more frequent in GV and GO. The mean successive visits was 2.47 and was shown to be lower in GV. The mean expenditure on successive visits was EUR 341.64 but was found to be lower in GV. The mean number of UTIs was 4.83 at 3 months after finishing prophylaxis and 5.01 at 12 months, and it was observed to be lower in GV. Less frequent VCU usage, older age, more ASA III, more frequent use of urinalyses, urine cultures, ultrasounds, and CT scans were associated with higher costs. In GO, IVU was associated with higher costs. The total expenditure related to RUTIs is associated with older age and the number of RUTIs, a poorer general health status, and the use of urinary tract ultrasounds and CT scans. The use of VCUs instead of ultrasounds and CT scans is cost-effective in the management of RUTIs in older women. Immunoprophylaxis is more cost-effective in reducing the number of visits to the primary care emergency room, the number of successive visits to the Urology Department, the number of intercurrent infections, and the need for urinalyses, urine cultures, CT scans, and ultrasounds in the primary care emergency room. Full article

Renal masses are uncommon during pregnancy; they represent the most frequently encountered urological cancer in pregnant patients and require careful surgical planning. The introduction of robotic surgical systems aims to address these challenges by simplifying intra-corporeal suturing and reducing technical complexity. Robot-assisted laparoscopic renal surgery offers potential benefits over both open surgery and conventional laparoscopy, providing greater precision and reduced invasiveness, particularly in tumor excision and suturing. Although urological tumors during pregnancy are rare, early detection significantly improves outcomes by enabling intervention before the tumor advances and while the uterus remains relatively small. The decision regarding the timing and necessity of surgery in pregnant patients requires a careful assessment of maternal health, fetal development, and the progression of the disease. Risks for adverse pregnancy outcomes should be explained, and the patient’s decision about pregnancy termination should be considered. Radical nephrectomy or nephron-sparing surgery are essential treatments for the management of renal tumors. Effective management demands close collaboration between a multidisciplinary team and the patient to ensure individualized care. The aim of this review was to evaluate the renal tumors during pregnancy in terms of epidemiology, risk factors, diagnosis and the safety of a robot-assisted laparoscopic approach in the management of these tumors. Full article

The prevalence of kidney stones, a significant urological health concern, necessitates advancements in the management and treatment methods, particularly in the domain of ureteral stents. This study explores the feasibility and potential benefits of utilizing three biodegradable polymers—Polylactic Acid (PLA), Tough Polylactic Acid (Tough PLA), and Polylactic Acid/Poly-hydroxybutyrate (PLA/PHB)—for the fabrication of 3D-printed ureteral stents tailored to patient-specific needs. Through the integration of CAD and Fused Deposition Modeling (FDM) 3D printing technology, ureteral stents were successfully produced, demonstrating key advantages in terms of biodegradability and mechanical properties. The study involved a rigorous evaluation of the biodegradability, tensile strength, and hardness of the stents. Biodegradability tests performed in a simulated physiological environment revealed that PLA/PHB and Tough PLA stents exhibited higher degradation rates compared to PLA, aligning with the requirements for temporary urinary tract support. Tensile strength testing indicated that while PLA showed the highest strength, PLA/PHB and Tough PLA stents provided beneficial ductility, reducing the risk of blockage due to material breakage. Hardness assessments classified PLA/PHB stents as medium soft, optimizing patient comfort during the stenting period. These findings demonstrate the potential of using biodegradable polymers to produce ureteral stents that could eliminate the need for removal procedures, thereby enhancing patient recovery and comfort. Full article

Background/Objectives: Drug prescribing in elderly people with chronic diseases carries certain risks. The desire to treat several different diseases at the same time increases the risk of inadequate drug prescribing. Prostate cancer is a disease of older men and occurs in most men over the age of 65. With age, the risk of prostate cancer increases, but so does the risk of the inadequate prescription of drugs. Our research aimed to highlight the potential inadequate prescription of drugs in patients with prostate cancer, considering that it is mostly a population of older men in whom a greater number of comorbidities is expected, followed by the use of a greater number of drugs. Methods: Our investigation was designed as an observational, cross-sectional study of 334 male patients who presented at the Multidisciplinary Tumor Board (MDT) for urological cancers at the University Clinical Center Kragujevac, Kragujevac, Serbia, from 1 September to 15 December 2023. Our primary outcome was obtaining the MAI score. Results: Our study showed that a significant number of drugs per patient with a prostate cancer diagnosis were prescribed potentially inadequately. The factors associated with greater risk for PIP were the initial level of PSA, ADT meta (intermittent), and several prescribed drugs; on the other hand, secondary hormonal therapy was the reason for less frequent PIP. Conclusions: In conclusion, patients with prostate cancer are under increased risk of inappropriate prescribing when they are prescribed more medication, have high PSA, and have ADT meta (intermittent). To stop the incidence of inappropriate prescribing and its serious economic and health consequences, clinicians should take special care when prescribing new drugs to such patients. Full article

Background/Objectives: Predicting the behavior of clear cell renal cell carcinoma (ccRCC) is challenging using standard-of-care histopathologic examination. Indeed, pathologic RCC tumor grading, based on nuclear morphology, performs poorly in predicting outcomes of patients with International Society of Urological Pathology/World Health Organization grade 2 and 3 tumors, which account for most ccRCCs. Methods: We applied spatial point process modeling of H&E-stained images of patients with grade 2 and grade 3 ccRCCs (n = 72) to find optimum separation into two groups. Results: One group was associated with greater spatial randomness and clinical metastasis (p < 0.01). Notably, spatial analysis outperformed standard pathologic grading in predicting clinical metastasis. Moreover, cell-to-cell interaction distances in the metastasis-associated group were significantly greater than those in the other patient group and were also greater than expected by the random distribution of cells. Differential gene expression between the two spatially defined groups of patients revealed a matrisome signature, consistent with the extracellular matrix’s crucial role in tumor invasion. The top differentially expressed genes (with a fold change > 3) stratified a larger, multi-institutional cohort of 352 ccRCC patients from The Cancer Genome Atlas into groups with significant differences in survival and TNM disease stage. Conclusions: Our results suggest that the spatial distribution of ccRCC tumor cells can be extracted from H&E-stained images and that it is associated with metastasis and with extracellular matrix genes that are presumably driving these tumors’ aggressive behavior. Full article

High-Intensity Focused Ultrasound (HIFU) provides comparable oncologic, erectile, and urinary outcomes to standard-of-care options for localized prostate cancer. This study reports the largest United States series of HIFU in veterans for both primary and salvage therapies. We retrospectively analyzed the outcomes of 43 veterans treated at the Michael E. DeBakey Veterans Affairs Medical Center from 2018 to 2022. Primary endpoints included prostate-specific antigen (PSA) reduction and local recurrence rates. Secondary endpoints included 30-day complications, Sexual Health Inventory for Men (SHIM), and American Urological Association Symptom Score (AUASS). In our study, 31 veterans (72.1%) received primary treatment and 12 (27.9%) received salvage therapy, with a median follow-up of 23 and 25 months, respectively. Median PSA nadir was 0.16 for primary and 0.12 for salvage groups, with PSA reduction stable over 30 months. Local recurrence occurred in 16.1% of primary and 16.6% of salvage patients. SHIM scores and AUASS were not statistically different before and after HIFU therapy. Short- and intermediate-term results suggest HIFU is a safe and effective treatment option with excellent potency and preserved urinary function, as well as adequate oncological control for primary and salvage therapies for localized prostate cancer in veterans. Full article