Journal Description
Uro
Uro
is an international, peer-reviewed, open access journal on all aspects of urology and andrology, including oncology, endourology, sexual dysfunction, fertility, and infertility, published quarterly online by MDPI. The Italian Society of Andrology (SIA) is affiliated to Uro, and its members receive a discount on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 21.9 days after submission; acceptance to publication is undertaken in 3.9 days (median values for papers published in this journal in the first half of 2024).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
- Uro is a companion journal of JCM.
Latest Articles
Sildenafil Citrate Oral Suspension for Managing Erectile Dysfunction: A Systematic Review and a Consensus Report from the Italian Society of Andrology (SIA)
Uro 2024, 4(3), 136-144; https://doi.org/10.3390/uro4030011 - 30 Aug 2024
Abstract
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
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The management of erectile dysfunction (ED) shows several gray zones, especially in terms of patients’ satisfaction and adherence to the treatment. The main and first-line treatment for ED is drug therapy, mainly phosphodiesterase-5 inhibitors (PDE5is), but adherence to the therapy is not optimal due to the low patient satisfaction reported in several cases. To address this issue, different administration routes and PDE5i pharmacological formulations have been introduced in the pharmacological market. The pharmaceutical market has recently seen the introduction of a novel sildenafil oral suspension. This device offers access to all therapeutic regimens in one device, releasing 0.5 mL of suspension containing 12.5 mg of sildenafil with each pulse. This formulation enables tailored dosing based on clinical requirements and the demands of ED patients. Here, we aim to give a brief narrative review of the management of this new oral suspension in order to provide readers with some suggestions to use in everyday clinical practice, on the basis of recent evidence, by using an easy and rapid-to-consult question and answer form. Also included are the conclusions of a board meeting of experienced andrologists regarding the most recent developments in this area.
Full article
Open AccessReview
The Evolution of Robotic Surgery through the Machine Design Innovation
by
Alberto Ragusa, Francesco Prata, Andrea Iannuzzi, Francesco Tedesco, Loris Cacciatore, Aldo Brassetti, Giovanni Muto, Roberto Mario Scarpa and Rocco Papalia
Uro 2024, 4(3), 124-135; https://doi.org/10.3390/uro4030010 - 6 Aug 2024
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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
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To date, robotic surgery has gained much popularity, impacting deeply on surgical fields such as genitourinary system branches, general surgery, and cardiac surgery. We aim to outline the landscape of robotic surgery, focusing on design improvements, which have improved both the technical skills of surgeons and the outcomes of minimally invasive technique for patients. A thorough narrative literature review was conducted on PubMed/MEDLINE, employing keywords such as “robotic surgical system”, “robotic surgical device”, and “robotics AND urology”. Furthermore, the reference lists of the retrieved articles were scrutinized. The analysis focused on urological surgical systems from the 2000s to the present day. Beginning with the daVinci® Era in the 2000s, new robotic competitors, including Senhance®, Revo-I®, Versius®, Avatera®, Hi-notori®, and HugoTM RAS, have entered the medical market. While daVinci® has maintained a high competitiveness, even more new platforms are now emerging in the medical market with new intriguing features. The growing competition, driven by unique features and novel designs in emerging robotic technologies, has the potential to improve application fields, enhance diffusion, and ameliorate the cost effectiveness of procedures. Since the impact of these new surgical technologies on different specialties and healthcare systems remains unclear, more experience and research are required to define their evolving role.
Full article
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Open AccessCase Report
Giant Retroperitoneal Liposarcoma—A Renal Hazard
by
Raymond A. Dieter, Jr., George B. Kuzycz and Blake J. Carlino
Uro 2024, 4(3), 115-123; https://doi.org/10.3390/uro4030009 - 1 Aug 2024
Abstract
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.
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Retroperitoneal tumors are uncommon and may reach a large size prior to causing symptoms or being noticed by the patient or physician. A middle-aged female consulted us for care during her “terminal” illness. She had already undergone four previous retroperitoneal resection surgical procedures. She presented with a large recurrent protruding mass from the right side of the abdomen and related a history of a previous cholecystectomy, right nephrectomy, right colectomy, and repeated resection of a recurrent retroperitoneal liposarcoma. She thus came to us for consultation and terminal care in order to be away from her friends during treatment for this terminal condition. After our consultation, she elected to have repeated surgical excisions of the tumor. The surgical excisions yielded a giant recurrent tumor mass, which overflowed and covered all margins of the 21-inch-wide surgical scrub basin. Over the next eleven years, she had multiple surgical resection procedures involving both the right and left retroperitoneum (a splenectomy, a left colectomy, and a colostomy). Recovery from each of these resection procedures (the final combined resection weight was 120 pounds) was without complications. However, the tumor finally encased the pancreas and the left kidney. If the tumor encasement were to be palliated and resected, she would require hemodialysis. At this time, the patient elected to have no further resection surgeries, no dialysis, nor any palliative chemoradiation treatment. Over a period of sixteen years from her first resection and twelve years from our first resection, the patient had continued to work at her medical administrative and leadership position and led a functional life after our consultation, except for her surgical period. The patient was not cured but benefited from repeated palliative surgeries, prolonging her life and improving her job performance.
Full article
(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)
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Open AccessArticle
Laparoscopic versus Robot-Assisted Partial Nephrectomy for Renal Tumors with Cystic Features: Comparison of Perioperative Outcomes and Trifecta Achievement
by
Francesco Prata, Andrea Iannuzzi, Marco Ricci, Francesca Liaci, Francesco Tedesco, Alberto Ragusa, Angelo Civitella, Matteo Pira, Marco Fantozzi, Leonilde Sica, Roberto Mario Scarpa and Rocco Papalia
Uro 2024, 4(3), 104-114; https://doi.org/10.3390/uro4030008 - 21 Jul 2024
Abstract
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
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Background: To compare perioperative outcomes and trifecta rates between laparoscopic and robotic partial nephrectomies (PN) using the Hugo™ RAS System, a study was conducted between October 2022 and September 2023. Methods: Twenty-two patients underwent minimally invasive PN for cystic renal tumors at our institution (group A: RAPN = 6; group B: Laparoscopic PN = 16). The trifecta was defined as the coexistence of negative surgical margin status, no Clavien–Dindo grade ≥ 3 complications, and eGFR decline ≤ 30%. Continuous variables were presented as median and IQR and compared using the Mann–Whitney U test, while categorical variables were presented as frequencies (%) and compared using the χ2 test. For all statistical analysis, a two-sided p-value < 0.05 was considered statistically significant. Results: All patients successfully underwent off-clamp minimally invasive PN without the need for conversion or additional port placement. Group A showed a lower preoperative eGFR rate and a higher clinical tumor size, while group B displayed a higher number of male patients and bilateral lesions. However, these differences were not statistically significant (all p > 0.1). Regarding perioperative data, group A showed a lower operative time (79.5 vs. 134.5 min, p = 0.01), while group B showed a higher trend of benign histology (62.5% vs. 33.3%). All the other perioperative data were comparable between the two groups (all p > 0.2). The rate of trifecta achievement was 83.3% and 87.5% (p = 0.80) for group A and B, respectively. Conclusion: This study emphasizes the advantages of RAPN over laparoscopic procedures in terms of operative time. Extensive experience in Laparoscopic PN could be a key factor when approaching RAPN learning curve.
Full article
Open AccessArticle
Revolutionizing Prostate Whole-Slide Image Super-Resolution: A Comparative Journey from Regression to Generative Adversarial Networks
by
Anil B. Gavade, Kartik A. Gadad, Priyanka A. Gavade, Rajendra B. Nerli and Neel Kanwal
Uro 2024, 4(3), 89-103; https://doi.org/10.3390/uro4030007 - 27 Jun 2024
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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
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Microscopic and digital whole-slide images (WSIs) often suffer from limited spatial resolution, hindering accurate pathological analysis and cancer diagnosis. Improving the spatial resolution of these pathology images is crucial, as it can enhance the visualization of fine cellular and tissue structures, leading to more reliable and precise cancer detection and diagnosis. This paper presents a comprehensive comparative study on super-resolution (SR) reconstruction techniques for prostate WSI, exploring a range of machine learning, deep learning, and generative adversarial network (GAN) algorithms. The algorithms investigated include regression, sparse learning, principal component analysis, bicubic interpolation, multi-support vector neural networks, an SR convolutional neural network, and an autoencoder, along with advanced SRGAN-based methods. The performance of these algorithms was meticulously evaluated using a suite of metrics, such as the peak signal-to-noise ratio (PSNR), structural similarity index metrics (SSIMs), root-mean-squared error, mean absolute error and mean structural similarity index metrics (MSSIMs). The comprehensive study was conducted on the SICAPv2 prostate WSI dataset. The results demonstrated that the SRGAN algorithm outperformed other algorithms by achieving the highest PSNR value of 26.47, an SSIM of 0.85, and an MSSIM of 0.92, by 4× magnification of the input LR image, preserving the image quality and fine details. Therefore, the application of SRGAN offers a budget-friendly counter to the high-cost challenge of acquiring high-resolution pathology images, enhancing cancer diagnosis accuracy.
Full article
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Open AccessReview
A Review on Risk Factors, Diagnostic Innovations, and Plant Based Therapies for the Management of Erectile Dysfunction
by
Faris Alrumaihi, Ravindra Raut, Ehsan Ahmed Yahia, Vikalp Kumar and Shehwaz Anwar
Uro 2024, 4(2), 60-88; https://doi.org/10.3390/uro4020006 - 9 May 2024
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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
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Men of all ages frequently experience erectile dysfunction (ED) or impotence, and it is a difficult health issue that adversely affects the quality of life of those who experience it. There are multiple types of treatment strategies for ED available, depending on the origin and severity of ED, as well as any underlying medical issues. However, these therapeutics are known to have a number of negative health effects. In contrast, plant-based treatments are more effective for managing diseases due to their ability to modulate biological processes like inflammation, oxidative stress, and cell signaling molecules. Many medicinal plants have been reported to be quite helpful in the improvement of ED. In this review, ED and its causes, diagnostic methods, treatment strategies, and some of the most potent plant-based interventions against ED are discussed in greater detail, along with a description of their mechanisms of action and a brief discussion of approaches to increase their efficacy, with a focus on the management of ED using herbal interventions as complementary and alternative medicines. While there is hope that medicinal plants could provide lead substances for erectile dysfunction medications, additional investigation is necessary to ascertain the efficacy and security of these prospective treatments.
Full article
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Open AccessArticle
The Value of Adding Exosome-Based Prostate Intelliscore to Multiparametric Magnetic Resonance Imaging in Prostate Biopsy: A Retrospective Analysis
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Noah King, Jacob Lang, Sree Jambunathan, Conner Lombardi, Barbara Saltzman, Nadiminty Nagalakshmi and Puneet Sindhwani
Uro 2024, 4(2), 50-59; https://doi.org/10.3390/uro4020005 - 8 May 2024
Abstract
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
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Introduction: Currently, there is limited evidence for the relationship of Exosome-based Prostate Intelliscore (EPI) and multiparametric magnetic resonance imaging (mpMRI) in stratifying risk for clinically significant prostate cancer. Using a retrospective cohort study design, we sought to characterize the relationship between these two noninvasive metrics and prostate biopsy outcome. Methods: Data were collected via electronic medical record for all patients who underwent EPI testing from 1 January 2019 to 3 February 2022 and had available medical records at a single mid-western university medical center. Positive test result was defined as >15.6 for EPI, ≥3 PI-RADS score and ≥3 + 4 Gleason Score for biopsy findings. Utility of EPI, mpMRI and combined use was characterized through calculation of sensitivity, specificity, positive predictive value, negative predictive value, and ROC analysis. Results: A total of 226 patients were identified as receiving EPI testing for risk stratification of clinically significant prostate cancer. Sensitivity for EPI was 91%, mpMRI was 90%, and the highest was combined use at 96%. With ROC analysis, AUC for EPI alone was 0.57 (95% CI, 0.47–0.67) and 0.78 (95% CI, 0.70–0.87) for mpMRI alone. With prior positive EPI result, AUC for combined use with mpMRI was 0.80 (95% CI, 0.71–0.89). Further subgroup analysis resulted in increased AUC values of EPI 0.67 (95% CI, 0.48–0.87), mpMRI 0.90 (95% CI, 0.76–1.0), and combined 0.90 (95% CI, 0.75–1.0) in the African American population. Discussion: We observed that the combined use of EPI and mpMRI led to an avoided biopsy in 43% of patients. Using both parameters increased the overall sensitivity and diagnostic accuracy in detecting clinically significant prostate cancer. The best test performance was observed in the African American cohort. Identifying optimal noninvasive tools to assess risk for prostate cancer is crucial to providing accurate and cost-effective care. Future study should utilize a prospective study design to further support the combined use of these metrics.
Full article
(This article belongs to the Special Issue Urologic Oncology: Analysis and Treatment)
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Open AccessReview
The Clinical Management of Leukocytospermia in Male Infertility: A Narrative Review
by
Usman Hussain, Nikit Venishetty, Marwan Alkassis and Omer Raheem
Uro 2024, 4(2), 36-49; https://doi.org/10.3390/uro4020004 - 19 Apr 2024
Abstract
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
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A major global health concern, male infertility affects 8–12% of couples globally. Leukocytospermia is a complicated illness that is distinguished from other reasons causing male infertility by having high white blood cell counts in semen. The complex mechanisms behind leukocytospermia’s effects on sperm function and fertility are examined in this review. Leukocytospermia induces oxidative stress and reactive oxygen species (ROS) that impair DNA integrity, mitochondrial function, cytoplasmic extrusion, and sperm quality overall. Leukocytospermia is exacerbated by non-infectious factors, such as substance abuse and varicocele, even though genital tract infections are a common cause. The usefulness and dependability of diagnostic techniques range from immunochemistry to direct counting. Although there is still disagreement on the most effective course of action, clinical-care techniques, such as antioxidant supplementation and antibiotic therapy, attempt to address underlying causes and reduce ROS-induced damage. Prospectively, the combination of artificial intelligence with the latest developments in artificial reproductive technologies presents opportunities for more precise diagnosis and customized treatments.
Full article
(This article belongs to the Special Issue Male Infertility—Diagnosis and Treatment)
Open AccessReview
The Role of Artificial Intelligence in Male Infertility: Evaluation and Treatment: A Narrative Review
by
Nikit Venishetty, Marwan Alkassis and Omer Raheem
Uro 2024, 4(2), 23-35; https://doi.org/10.3390/uro4020003 - 25 Mar 2024
Cited by 1
Abstract
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
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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.
Full article
(This article belongs to the Special Issue Male Infertility—Diagnosis and Treatment)
Open AccessArticle
Patient Factors and Their Effect on Operating Room Time for Urologic Procedures
by
Wei-Shin Lu, Ali Zia, Nagalakshmi Nadiminty, Barbara Saltzman, Andrew B. Casabianca and Puneet Sindhwani
Uro 2024, 4(1), 12-22; https://doi.org/10.3390/uro4010002 - 4 Mar 2024
Abstract
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
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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.
Full article
Open AccessArticle
An Exploratory Study of Early Immune Response Markers for Pembrolizumab in Urothelial Tract Cancer
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Dag Rune Stormoen, Lise Høj Omland, Kent William Mouw, Zoltan Szallasi, Sisse Rye Ostrowski, Susanne Dam Nielsen and Helle Pappot
Uro 2024, 4(1), 1-11; https://doi.org/10.3390/uro4010001 - 12 Jan 2024
Abstract
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
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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.
Full article
(This article belongs to the Special Issue Urologic Oncology: Analysis and Treatment)
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Open AccessArticle
Understanding Renal Failure Mortality Trends and Determinants in the US (1999–2020): Impacts of the Affordable Care Act, Advancements, Disparities, and Challenges
by
Oscar Salichs, Sishir Doddi, Taryn Hibshman, Jama Hersi and Puneet Sindhwani
Uro 2023, 3(4), 271-281; https://doi.org/10.3390/uro3040027 - 18 Dec 2023
Cited by 1
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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,
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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.
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Open AccessBrief Report
Efficacy of Fosfomycin against Extended Spectrum Beta-Lactamase-Producing Escherichia coli Isolated from Patient Urinary Cultures in the General Reference Hospital of Niamey, Niger
by
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 and Nicolas Barro
Uro 2023, 3(4), 262-270; https://doi.org/10.3390/uro3040026 - 4 Dec 2023
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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
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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.
Full article
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Open AccessReview
Prophylactic Lymphadenectomy in Patients with Penile Cancer: Is Sooner Better?
by
Tommaso Cai, Marco Capece, Maria Grazia Zorzi, Alessandro Palmieri, Gabriella Nesi, Mattia Barbareschi and Truls E. Bjerklund Johansen
Uro 2023, 3(4), 251-261; https://doi.org/10.3390/uro3040025 - 9 Nov 2023
Abstract
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
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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.
Full article
(This article belongs to the Special Issue Andrology and Reproductive Health)
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Open AccessFeature PaperReview
Fertility Preservation Options for Transgender Patients: An Overview
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Natalie Mainland, Dana A. Ohl, Ahmed R. Assaly, Nabila Azeem, Amber Cooper, Angie Beltsos, Puneet Sindhwani and Tariq A. Shah
Uro 2023, 3(4), 239-250; https://doi.org/10.3390/uro3040024 - 8 Oct 2023
Abstract
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
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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.
Full article
(This article belongs to the Special Issue Andrology and Reproductive Health)
Open AccessReview
Urinary Artificial Sphincter in Male Stress Urinary Incontinence: Where Are We Today? A Narrative Review
by
Anna Ricapito, Matteo Rubino, Pasquale Annese, Vito Mancini, Ugo Falagario, Luigi Cormio, Giuseppe Carrieri, Gian Maria Busetto and Carlo Bettocchi
Uro 2023, 3(3), 229-238; https://doi.org/10.3390/uro3030023 - 6 Sep 2023
Abstract
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
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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.
Full article
(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)
Open AccessReview
Effectiveness of Silymarin, Sulforaphane, Lycopene, Green Tea, Tryptophan, Glutathione, and Escin on Human Health: A Narrative Review
by
Francesco Sebastiani, Carlo D’Alterio, Cristina Vocca, Luca Gallelli, Fabrizio Palumbo, Tommaso Cai and Alessandro Palmieri
Uro 2023, 3(3), 208-228; https://doi.org/10.3390/uro3030022 - 9 Aug 2023
Cited by 2
Abstract
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,
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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.
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(This article belongs to the Special Issue Andrology and Reproductive Health)
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Open AccessArticle
Efficacy and Safety of a Natural Supplement Containing Serenoa Repens, Solanum Lycopersicum, Lycopene, and Bromelain in Reducing Symptoms of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective Cohort Study in 250 Patients
by
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 and Andrea Mari
Uro 2023, 3(3), 199-207; https://doi.org/10.3390/uro3030021 - 20 Jul 2023
Abstract
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
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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.
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(This article belongs to the Special Issue Andrology and Reproductive Health)
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Open AccessArticle
The Deceased Transplant Recipients: A Forgotten Source of Organ Donors
by
Dai D. Nghiem
Uro 2023, 3(3), 187-198; https://doi.org/10.3390/uro3030020 - 3 Jul 2023
Abstract
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
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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.
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(This article belongs to the Special Issue Current Concepts in Transplantation)
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Open AccessCase Report
Adult-Type Granulosa Cell Tumor of the Testis: A Report of a Case and a Discussion of the Literature
by
Georgios Zervopoulos, Nikolaos Mitsimponas, Filippos Venetsanos and Athanasios Papathanasis
Uro 2023, 3(3), 177-186; https://doi.org/10.3390/uro3030019 - 3 Jul 2023
Abstract
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
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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.
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(This article belongs to the Special Issue Uro-Oncology: Treatment and Future Directions)
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