Uro, Volume 3, Issue 1 (March 2023) – 11 articles

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. 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

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article