Background: Sleep disruptions, including insomnia and obstructive sleep apnea (OSA), are strongly linked to male sexual dysfunction, affecting libido, erectile function, and hormonal balance. This metaanalysis aimed to evaluate the relationship between sleep disorders and male sexual function. Methods: A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect through September 2025 identified 9 peer-reviewed studies examining the impact of sleep disorders on male sexual health. The Newcastle-Ottawa Scale was used to assess the risk of bias. A meta-analysis was performed to evaluate outcomes, including the International Index of Erectile Function (IIEF), testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels, with a subgroup analysis comparing OSA and shift work sleep disorder (SWSD). Statistical analyses were conducted using R version 4.2.2. Results: Across seven studies (n = 913), the pooled mean IIEF score was approximately 16, indicating moderate erectile dysfunction, though heterogeneity was high (I² = 97.3%). Subgroup analysis revealed lower IIEF scores in OSA patients (≈14.4) compared to SWSD patients (≈17.5), suggesting more severe dysfunction in OSA. Hormonal analysis (n = 325) showed significantly lower testosterone levels in OSA (≈7-9 nmol/L) versus SWSD (≈20 nmol/L). FSH and LH were elevated in OSA (≈3.8-5.8 IU/L and 3.3-3.9 IU/L, respectively) compared to SWSD (≈2.2 IU/L and 1.8 IU/L). High heterogeneity indicated substantial variation in study design and populations. Conclusions: Both OSA and SWSD impair sexual and hormonal function, but OSA causes greater erectile and endocrine disruption. Even mild OSA was associated with reduced erectile performance, with the severity worsening dysfunction. Despite consistent trends, high heterogeneity warrants cautious interpretation. Future research should employ standardized tools and uniform populations to clarify mechanisms linking sleep disorders to male sexual health.
Objective: To evaluate the incremental yield of clinically significant prostate cancer (csPCa) detected by systematic biopsy outside MRI-targeted lesions during cognitive fusion local anaesthetic transperineal prostate biopsy. Patients and methods: This observational cohort study included men undergoing cognitive MRI-targeted prostate biopsy with concurrent systematic sampling. Pre-biopsy MRI findings were recorded using PI-RADS. The primary outcome was csPCa detected exclusively by systematic biopsy outside MRI-targeted lesions despite a negative targeted biopsy. Secondary outcomes included csPCa detection by targeted, systematic, and combined biopsy, PI-RADS subgroup analysis, and multivariable predictors of csPCa. Results: Overall, 770 men were included, of whom 767 had evaluable paired biopsy data. Most had PI-RADS 4 lesions (636/767, 82.9%). csPCa was detected by targeted biopsy in 320/767 men (41.7%), systematic biopsy outside MRI-targeted lesions in 196/767 (25.6%), and combined biopsy in 384/767 (50.1%). Exclusive outside-target systematic csPCa detection occurred in 64/767 men (8.3%), representing 16.7% of all csPCa detected. This rate was highest in PI-RADS 3 lesions (8/30, 26.7%). On multivariable analysis, overall csPCa detection was associated with age, PSA density, and PI-RADS score, whereas exclusive outside-target detection was inversely associated with PI-RADS score and positively associated with procedures performed by urologists. Spatial analysis showed that most systematic-only csPCa lesions were anatomically distinct from the index MRI-visible lesion. Conclusions: Systematic biopsy outside MRI-targeted lesions detected additional csPCa in 64/767 men (8.3%) and frequently identified anatomically distinct lesions, supporting continued systematic sampling alongside MRI-targeted biopsy in selected patients.
Background: Equivocal prostatic needle biopsies are diagnostically challenging because minute atypical glandular foci may represent early acinar adenocarcinoma or benign mimics. This review critically examines the role of artificial intelligence (AI) in small-focus cancer detection, recognition of benign mimics, and immunohistochemistry (IHC) triage. Methods: A structured narrative search of PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar was conducted from database inception through 15 May 2026. English-language, peer-reviewed diagnostic and validation studies, consensus recommendations, and focused reviews addressing prostate needle-biopsy interpretation, benign mimics, IHC, digital pathology, and clinically relevant AI methods were included. Results: AI applied to digitized H&E slides can support cancer detection, grading, workflow prioritization, and quality assurance. In equivocal biopsies, its most credible near-term roles are localization of minute suspicious foci and safety-prioritized identification of cases in which IHC might be avoided or requested earlier. However, partial atrophy, adenosis, basal cell hyperplasia, seminal vesicle or ejaculatory duct epithelium, inflammation, treatment effects, and tissue or scanning artefacts may cause clinically important errors. Current evidence is mainly retrospective, and equivocal cases are often defined by previous IHC-ordering practice rather than uniform morphological criteria. Conclusions: AI may improve the consistency and efficiency of equivocal prostate-biopsy assessment, but it should remain an assistive triage tool. Clinical use requires mimic-enriched external validation, conservative thresholds, interpretable localization, and pathologist-led correlation with morphology and IHC.
Introduction: The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential prognostic biomarker in several solid tumors, including metastatic castration-resistant prostate cancer (mCRPC). However, its clinical utility remains controversial, particularly across different treatment modalities. Aim: To evaluate the prognostic value of baseline NLR in patients with mCRPC treated with abiraterone, enzalutamide, or docetaxel, and to assess its association with survival outcomes and PSA response. Methods: We conducted a retrospective, single-center study including patients with mCRPC treated between December 2019 and January 2022. Patients were stratified according to a prespecified NLR cut-off of 4. The primary endpoint was overall survival (OS), and the secondary endpoint was PSA progressionfree survival (PSA-PFS). PSA response at 6 months was also evaluated. Survival outcomes were estimated using the Kaplan-Meier method, and the association between NLR and OS was assessed using univariable Cox regression. Results: A total of 186 patients were included. Median age was 77.0 years, and median baseline PSA was 31.1 ng/mL. Patients with NLR ≥ 4 (26.3%) had significantly worse OS compared to those with NLR < 4, with median OS of 16 versus 30 months. NLR ≥ 4 was associated with an increased risk of death (HR 2.05, 95% CI 1.24-3.39, p = 0.005). When analyzed as a continuous variable, higher NLR was also associated with shorter OS (HR 1.12, 95% CI 1.05-1.20, p < 0.001). Patients with higher NLR showed shorter PSA-PFS (8.0 vs 10.5 months). However, no significant differences were observed in PSA response at 6 months, including PSA50 and PSA90 rates. Conclusions: Elevated NLR is associated with worse overall survival and earlier disease progression in patients with mCRPC treated with contemporary systemic therapies. While NLR does not appear to predict early biochemical response, it may reflect the durability of treatment benefit. These findings support NLR as a simple and clinically useful prognostic biomarker in mCRPC.
Introduction: Azoospermia, known as absence of sperm in ejaculation, is a major cause of male infertility, classified as pre-testicular, testicular, post-testicular. Pre-testicular and post-testicular causes allow for fertility intervention, while testicular causes are irreversible with lower success rates. Indonesia have a data scarcity to support doctors to determine the sperm retrieval success rate between different etiology. Doctors could be benefited by knowing the classifications of the causes for azoospermia and how it affects the sperm retrieval success rate. The aim of the study is to investigate the association between etiology of azoospermia and the success rate of sperm retrieval as well as the association between sperm retrieval methods utilized with the sperm retrieval success rate. Methods: We conducted a cross-sectional analysis of medical records from one public and two private hospitals in Jakarta. The data includes azoospermia patients who have undergone sperm retrieval procedures since 2009 until 2024. Azoospermia etiology was categorized into pre-testicular, testicular, and posttesticular azoospermia. Multi-factorial azoospermia (has two or more simultaneous etiology) was excluded from the analysis. Chi-square tests were used to analyse the association between etiology of azoospermia and sperm retrieval success rate. Sperm retrieval methods association with sperm retrieval success rate was also analysed with chi-square test. Results: The study included 659 patients consisting of 111 (16.9%) pre-testicular azoospermia patients, 112 (17.1%) testicular azoospermia patients, 62 (9.4.%) post-testicular azoospermia patients, and 374 (56.6%) multi-factorial azoospermia patients. There was a significant association between azoospermia etiology and sperm retrieval success rate (p = <.001). Posttesticular azoospermia has the highest sperm retrieval success rate (97.1%), followed by testicular azoospermia (27.7%), and pre-testicular azoospermia (13.2%). In addition, Percutaneous Epididymal Sperm Aspiration had the highest success rate at 94% (234/249) and TESE demonstrated the lowest success rate at 19.4% (78/402). A significant association between sperm retrieval methods and outcomes was observed. Conclusions: This study demonstrates that azoospermia etiology significantly influences sperm retrieval outcomes, with post-testicular azoospermia showing the most favorable results. These findings emphasize the importance of accurate etiological assessment to guide clinical decision-making, optimize patient counseling, and improve fertility management in azoospermic patients.
INTRODUCTION AND OBJECTIVES:Female pelvic fracture urethral injury (PFUI) with vaginal trauma following high-energy collision trauma is rare and challenging to manage, particularly in delayed presentations complicated by urinary and vaginal sequelae. This case series aims to describe the clinical presentation, management strategies, and outcomes of patients with complex PFUI associated with vaginal injury. MATERIALS AND METHODS:We retrospectively reviewed the medical records of three female patients who underwent surgical treatment for pelvic fracture urethral injury (PFUI) at our hospital. Imaging findings, operative details, endoscopic findings, and clinical outcomes were collected and analyzed. CASE PRESENTATION:Three female patients were referred to our tertiary center with complex pelvic fracture urethral injury (PFUI) associated with vaginal trauma following high-energy collision trauma. Case 1 was a 6-year-old girl who had undergone suprapubic diversion for 11 months and presented with complete urethral obliteration, urethrovaginal fistula, and vesicolithiasis. Case 2 was a 9-year-old girl with a 9-month history of suprapubic diversion due to distal urethral obliteration/stenosis and extensive vaginal synechiae. Case 3 was a 19-year-old woman with long-term suprapubic diversion complicated by posterior urethral stenosis, complete vaginal synechiae, urethrovaginal fistula, and colpolithiasis. Management was individualized: Case 1 underwent endoscopic realignment; Case 2 underwent vaginal synechiolysis and pullthrough mucosal vaginoplasty; and Case 3 underwent vaginal synechiolysis with neovaginal reconstruction using a placental graft. All patients achieved spontaneous voiding with urinary continence and maintained vaginal patency during follow-up. CONCLUSIONS:Management of female PFUI with associated vaginal injury should be individualized based on the anatomical defect and functional objectives. Staged reconstruction and longterm follow-up may be required to optimize urinary continence and vaginal function.
Dear Editor, Urinary incontinence (UI) is defined as the involuntary loss of urine and divided into 3 subtypes: stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI). These conditions are often caused by dysfunction of the pelvic floor muscles (pFM) [...].
INTRODUCTION:Renal suppurative infections (RSIs), including pyonephrosis, renal abscess, and perinephric abscess, are rare but potentially life-threatening conditions. This study aimed to evaluate the epidemiological, diagnostic, therapeutic, and outcome aspects of RSIs. MATERIALS AND METHODS:We conducted a retrospective descriptive study of patients admitted for renal suppurative infections in the urology department of CHU Yalgado Ouédraogo between November 2021 and December 2023. Epidemiological, clinical, biological, radiological, and therapeutic data were analyzed. RESULTS:Among 1.377 admitted patients, 32 cases of RSIs were identified (hospital prevalence: 2.32%). The mean age was 37.48 ± 15.68 years, with a female predominance (sex ratio 1.4). Fever-associated flank pain was the main presenting symptom (84.38%). Obstructive uropathy, particularly urolithiasis and schistosomiasis-related ureteral lesions, was the main etiological factor. Pyonephrosis was the most frequent diagnosis (68.75%). All patients underwent ultrasonography, complemented by computed tomography in 78.12% of cases. Biological findings showed anemia, leukocytosis, and impaired renal function in a substantial proportion of patients. Escherichia coli was the most frequently isolated pathogen. Management combined broadspectrum antibiotic therapy and systematic percutaneous drainage. Secondary etiological surgery was performed in 56.06% of cases. The mean hospital stay was 30.13 ± 26.83 days. The mortality rate was 12.9%, mainly associated with underlying malignancy. Conclusions: RSIs remain severe infections requiring prompt diagnosis and multidisciplinary management. Early antibiotic therapy combined with effective drainage improves outcomes; however, prognosis is strongly influenced by underlying comorbidities. Optimizing the management of obstructive uropathies and associated conditions is essential to reduce morbidity and mortality.
BACKGROUND:The recent innovation of ureteral access sheath (UAS) includes the use of flexible navigable UAS that allows pending into the collecting system and adding suction/evacuation that can improve the efficacy of fragment clearance. This study aimed to report on the experience of using navigable suction-assisted UAS (NS-UAS) for management of kidney stones through a large cohort. METHODS:A retrospective analysis was conducted for patients who underwent flexible ureteroscopy for kidney stones using navigable NS-UAS between 2022 and 2025 in a tertiary center. Perioperative outcome data regarding efficacy and safety were described. Univariate and multivariate analysis was conducted for risk factors associated with stone-free rate. RESULTS:The study included 2284 patients with mean (± SD) age of 48 (± 12.5) years. Half of the patients (49.7%) underwent prior ureteric stent placement. The mean (± SD) stone burden was 13.1 (± 3.7) mm. The mean (± SD) operative time was 95.91 (± 25.2) minutes. Stone basketing was required in 11% of patients. Approximately 70% of patients underwent intraoperative stent placement. Stone-free rate (SFR) at 1-month follow-up was 85.8%. A repeat procedure for stone clearance was required in 12% of the patients. The overall complication incidence was 9.6% with only 1.28% incidence of Clavien-Dindo grade III or IV complications. On multivariate analysis, older age (OR = 0.97 [0.96-0.98]), higher stone burden (OR = 0.45 [0.33-0.62]), and intraoperative stent placement (OR = 0.71 [0.54-0.95]) were associated with lower SFR, while the use of basketing (OR = 2.17 [1.33-3.53]) was associated with higher SFR. CONCLUSIONS:NS-UAS can be used safely and effectively in patients with renal stone disease with low rates of complications and a favorable SFR. Stone basketing may still be necessary during NS-UAS to enhance overall SFR.
Background: Multiparametric magnetic resonance imaging (mpMRI), interpreted using the Prostate Imaging Reporting and Data System (PI-RADS), is increasingly used to improve prostate cancer detection and reduce unnecessary biopsies. However, its diagnostic accuracy compared with histopathological confirmation remains variable across institutions. This study aimed to evaluate the correlation between mpMRI findings and TRUS-guided prostate biopsy results in detecting clinically significant prostate cancer (csPCa) in our patient cohort. Methods: This retrospective diagnostic accuracy study included 100 biopsy records (86 unique patients) who underwent mpMRI followed by TRUS-guided biopsy. mpMRI findings were scored using PI-RADS v2, while biopsy histopathology served as the reference standard. Clinically significant prostate cancer (csPCa) was defined as ISUP Grade Group ≥ 2. Diagnostic performance was assessed for two interpretive rules: (1) Baseline rule: PI-RADS ≥ 4 as positive; (2) Combined rule: PIRADS ≥ 4 or PI-RADS = 3 with PSA density (PSAD) > 0.15 ng/mL/mL. Sensitivity, specificity, predictive values, and area under the RoC curve (AUC) were calculated. Hierarchical logistic regression assessed the independent contribution of PSAD and clinical covariates. Results: Malignant cases showed higher PSA (median 10.0 ng/mL vs 7.0 ng/mL) and PSAD (0.32 vs 0.13 ng/mL/mL) and smaller prostate volumes (36.5 mL vs 61.0 mL) compared with benign cases. csPCa detection increased with rising PI-RADS category (3.7% for PI-RADS 3, 56.9 % for PI-RADS 4-5). At the patient level, the Baseline rule achieved sensitivity = 86.7% and specificity = 66.1%, while the Combined rule increased sensitivity to 90.0 % with specificity = 55.4%. The ordinal PI-RADS score demonstrated excellent discrimination (AUC = 0.826, 95% CI 0.713-0.924). In logistic regression, adding PSAD improved model AUC from 0.836 to 0.888 (p < 0.001), and inclusion of age and prostate volume further increased AUC to 0.900 (p = 0.044). within PI-RADS 3 lesions, the optimal PSAD threshold (youden index) was 0.163 ng/mL/mL, yielding 100% sensitivity and 76% specificity. Postbiopsy complications were within expected ranges, with mild hematuria (29%), minor rectal bleeding (23%), and UTI (7%) being most common. Conclusions: mpMRI findings strongly correlated with histopathological outcomes from TRUS-guided biopsy. Incorporating PSA density significantly enhanced the diagnostic accuracy for csPCa, particularly in equivocal PI-RADS 3 cases. Combining mpMRI and PSAD can refine patient selection for biopsy and improve early detection of clinically significant prostate cancer.
Systems of digital pathology are used to enhance diagnostic consistency and reduce workload. They cannot replace pathologists but can serve as tireless and intelligent assistants. Artificial intelligence (AI) excels at high-volume and repetitive tasks, freeing pathologists to focus on complex cases and final diagnostic decisions. The other advantages of digitization include reducing interobserver variability, use as second reader tools and for triage negative biopsies. Digital images can be used for remote consultation, external quality assessment, and education. Despite these favorable results, it must be kept in mind that AI is merely a tool to assist in pathological diagnosis and treatment that cannot replace human expertise. Ethical and legal implications must be considered in order to establish legal frameworks and ensure transparency and ethical use of AI-based tools.
Aim: Several studies have reported contradictory associations between prostate cancer (PCa), tumor grade, and anogenital distances; however, all were based on conventional transrectal ultrasound (TRUS) prostate biopsy. We aimed to investigate the relationship between Anogenital distances (AGDs)/body mass index (BMI)-adjusted AGDs and overall PCa and clinically significant prostate cancer (csPCa) detected by multiparametric magnetic resonance imaging (MRI)/TRUS fusion prostate biopsy. Materials and methods: All mp-MRI scans conducted from July 2020 to May 2024 for suspected PCa were reviewed for the study (n = 10,204). Among these, patients who underwent fusion biopsy due to Prostate Imaging-Reporting and Data System (PIRADS) 3/4/5 lesions were included in the study (n = 675). After exclusion criteria (n = 256), the remaining patients were divided into 3 groups. The study group (group-1, study group, n = 153 ) consisted of patients with cancer pathology, while the study subgroup (group-2, n = 80) included patients with csPCA. The control group (group-3, n = 266) comprised patients without cancer. The groups were comparatively analyzed with respect to demographic characteristics, clinical parameters, prostate-specific antigen (PSA)-related variables, mpMRI findings, biopsy characteristics, and pathological outcomes, AGDAnus to Penis (AGDAP), adjusted AGDAP, AGDAnus to scrotum (AGDAS), and adjusted AGDAS. Multivariable logistic regression analyses adjusted for age, prostate volume, PSA-related parameters, and PIRADS score were used to evaluate anogenital distance measures and identify independent predictors of csPCa. Results: The study group exhibited a significantly higher age compared to the control group; nevertheless, no differences were seen between the groups for BMI and metabolic syndrome. As expected, there were significant differences between the study and control group in terms of total PSA, PSA density, DRE findings, and prostate volume. There was no significant difference between the study and control groups in terms of AGDAP, adjusted AGDAP, AGDAS, and adjusted AGDAS. When the csPCa subgroup was selected as the study group, no significant difference was observed between the control group in terms of AGDs and adjusted AGDs. Multivariable logistic regression analysis identified age and PIRADS score as independent predictors of csPCa, while prostate volume showed an inverse association. Although standard AGDAP demonstrated an independent association, other AGD parameters were not significant. Conclusions: While standard AGDAP emerged as an independent predictor, BMI-adjusted AGD measures did not provide independent diagnostic value for csPCa in patients undergoing mpMRI/TRUS fusion biopsy
Introduction and objectives: Automated urinalysis offers rapid and efficient evaluation of urine sediment; however, most systems do not routinely report epithelial cell atypia. This study aimed to evaluate the clinical relevance of the atypical cell (Atyp.C) parameter generated by the Sysmex UF-4000 analyzer as an early indicator of suspected urothelial carcinoma. Materials and methods: A prospective study was conducted using the UF-4000 analyzer to detect Atyp.C in urine specimens from high-risk patients. Atyp.C results were collected simultaneously for all samples. Specimens with positive Atyp.C findings underwent urinary tract cytology, which was independently reviewed by board-certified cytopathologists and categorized into four diagnostic groups. Statistical analyses were performed using IBM SPSS version 21. Results: Among 332 specimens, 20 samples (6.02%) showed Atyp.C values > 0.0/μL. The mean Atyp.C value was 0.6/μL (95% CI 0.064-1.135) in males and 1.20/μL (95% CI 0.608- 1.791) in females, with no significant difference between sexes (p = 0.2549). Of the 20 Atyp.C-positive samples, 5 (25%) demonstrated abnormal cytology, including 2 cases of atypical urothelial cells, 1 case suspicious for high-grade malignancy, and 2 cases of confirmed high-grade urothelial carcinoma. Atyp.C values were significantly higher in abnormal compared with benign cytology (p < 0.01). Conclusions: The Atyp.C parameter may have potential as an adjunctive screening marker for urothelial abnormalities; however, further validation studies are required.
BACKGROUND:Chronic pain conditions can have a pronounced negative impact on sexual function. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), in particular, can cause severe pelvic pain, which can interfere with numerous functions such as urination, sexuality, and overall quality of life. This study aims to determine the impact of CP/CPPS on sexual function and its association with the patient's symptom burden, the full version of the International Index of Erectile Function (IIEF) and Sexual Function Index (SFI) questionnaires and the UPOINT(S) classification. METHODS:174 patients with CP/CPPS and predominantly type IIIB prostatitis (87.4%) were prospectively enrolled and received a comprehensive andrological work-up. In addition to laboratory chemical analyses, microbiological processing and semen analysis, a detailed assessment of sexual function and symptom burden was carried out using the International Prostate Symptom Score (IPSS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), IIEF and SFI questionnaires. RESULTS:The NIH-CPSI total score showed a moderate symptom burden with a median of 28 points, while the median IIEF score of 26 points was within the normal range, and the SFI score of 28 points indicated slightly impaired sexual function. In addition, 62.6% of the subjects showed an affected sexual domain in the UPOINT(S) classification. Univariate analysis revealed a significant association (p< 0.05) between IIEF scores and (i) CPSI total score, (ii) the SFI score, (iii) the number of affected UPOINT(S) domains - particularly (iv) the sexual domain (S), and (v) marital status. Multivariate analysis revealed significant associations between IIEF scores and (i) the SFI score, (ii) the UPOINTS total score and (iii) the UPOINTS sexual domain. However, the results of microbiology and inflammatory seminal parameters showed no association with items of sexual function in respective questionnaires. CONCLUSIONS:The prevalence of sexual problems was high in CP/CPPS patients in our cohort and it was shown a statistically significant association with (i) the IIEF scores, (ii) the SFI score, (iii) and the NIH-CPSI total score, so routine assessment of sexual function in patients with CP/CPPS seems reasonable.
Background: Urologic oncology procedures are resource-intensive and contribute substantially to healthcare expenditure. Enhanced Recovery After Surgery (ERAS) protocols have been proposed to optimize perioperative care, reduce morbidity, and improve economic efficiency. However, the cost impact of ERAS compared with conventional perioperative management in urologic oncology has not been comprehensively synthesized. Methods: This systematic review followed PRISMA guidelines. Database searches were performed using PubMed/MEDLINE, Scopus, Cochrane Library, SpringerLink, and Google Scholar for studies published between 2015 and 2025. Search terms included: “ERAS” AND “urologic oncology” AND “cost efficiency” OR “cost savings”. Eligible studies including adult patients who underwent oncologic urologic surgery, comparing the ERAS versus the non-ERAS protocol, and reporting cost outcomes. Data were extracted for study characteristics, ERAS components, and cost results. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: A total of 472 articles were identified, and seven studies (n = 1,247 patients) met the inclusion criteria. ERAS shows costsaving effects in six studies (85.7%) and cost neutrality in one (14.3%), with no evidence of financial harm. Reported savings ranged from USD 1,444 to USD 4,488 per patient in U.S. cohorts and up to 7,353 Y in Chinese cohorts. Cost reductions were primarily attributed to shorter length of stay, reduced complication- related expenditure, and improved perioperative resource utilization. NOS scores ranged from 6 to 7, indicating satisfactory to good quality. Conclusions: ERAS protocols provide consistent economic advantages over conventional care in urologic oncology, demonstrating cost savings or cost neutrality across diverse procedures and healthcare systems. Standardization of ERAS components, harmonized cost-reporting methods, and prospective cost-effectiveness analyses are needed to support policy adoption and establish ERAS as a cost-efficient component of value-based urologic cancer care.
PURPOSE:Premature ejaculation (PE) is one of the most common male sexual disorders and is influenced by both psychological and biological factors. Despite available treatments, including psychosexual therapy and pharmacological interventions, no definitive cure exists. In addition, various interventional approaches have been investigated for lifelong PE, such as glandular filler injections, partial dorsal nerve neurectomy, and frenulectomy. PATIENTS AND METHODS:This pilot study evaluated the effect of glandular frenulectomy in 25 married men with lifelong PE who had not responded to conventional treatments for at least six months. Participants underwent glandular frenulectomy and were assessed before surgery and three months postoperatively using Intravaginal Ejaculatory Latency Time (IELT) and the Arabic Index of Premature Ejaculation (AIPE) scores. RESULTS:No statistically significant improvement was observed in IELT or AIPE scores after surgery. The mean IELT and AIPE scores before and three months postoperatively yielded P-values of 0.058 and 0.090, respectively. CONCLUSION:In this pilot study, glandular frenulectomy did not result in significant short-term improvement in men with lifelong PE unresponsive to conventional therapy. Larger studies with longer follow-up are needed to further evaluate its therapeutic role.
BACKGROUND:Treatment with chemotherapeutic agents often causes side effects in male reproductive organs, which may lead to infertility. Identification of molecular targets to alleviate this effect is important to reduce the long-term effects of chemotherapeutic drugs on the reproductive capacity. In this study, we evaluated the effects of pharmacological targeting of the Hippo pathway on the male reproductive system following chemotherapeutic treatment with cisplatin. MATERIALS AND METHODS:This is a experimental study used 12 weeks old male Balb/c mice, divided into four groups. We observed significant reduction in the numbers of spermatocytes, spermatids, Sertoli cells, and Leydig cells in the testes following cisplatin treatment. We then used two different types of Hippo pathway modulators to treat cisplatin-induced testicular and sperm phenotypes: i) XMU-MP-1, which is a strong inhibitor of mammalian sterile 20-like kinase 1/2, and ii) TT-10, which stimulates yes-associated protein (YAP) activity. We performed the analysis using the GraphPad Prism software. If the data were regularly distributed, we would compare the means of the two groups using a parametric test called the Student's t-test. A non-parametric test (Mann-Whitney U test) was employed if the data were not regularly distributed. RESULTS:We found that treatment with XMU-MP-1 significantly increased Leydig cell numbers. However, there was no change in sperm phenotype despite a significant improvement in sperm motility. In contrast, TT-10 treatment improved sperm concentration and morphology, and increased Leydig cell number. CONCLUSIONS:Our data suggest that pharmacological modulation of the Hippo/YAP pathway may improve sperm and testicular phenotypes in mice following treatment with chemotherapeutic agents, such as cisplatin.
INTRODUCTION:Skeletal muscle wasting is a serious complication of chronic kidney disease (CKD) and is associated with increased mortality. However, the main determinants of muscle atrophy in CKD are not yet well known and may differ in the general and CKD populations. The aim of this study was to investigate the relationships between appendicular skeletal muscle mass (ASM) and anthropometric measurements, body composition parameters as well as laboratory results, and compare these associations in patients with estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and participants with eGFR ≥ 60 ml/min/1.73 m2. METHODS:Two groups of male participants were included: 33 patients with eGFR < 60 ml/min/1.73 m2 and 38 individuals with eGFR ≥ 60 ml/min/1.73 m2. Muscle mass and body composition variables, including ASM, were assessed by bioimpedance spectroscopy (BIS). Blood samples were taken to evaluate serum creatinine, urea, haemoglobin, C-reactive protein (CRP) and albumin. RESULTS:In both groups of patients ASM positively correlated with body mass, body mass index (BMI), lean tissue mass (LTM) and lean tissue indx (LTI) (p < 0.05 for all parameters). ASM positively correlated with height in individuals with eGFR ≥ 60 ml/min/1.73 m2 (p = 0.001). There was no statistically significant correlations between laboratory parameters and ASM in both groups. CONCLUSIONS:ASM is associated significantly and positively with anthropometric and body composition parameters such as body mass, BMI, LTM and LTI both in patients with eGFR < 60 ml/min/1.73 m2 and in those with eGFR ≥ 60 ml/min/1.73 m2 which suggests that the determinants of ASM are similar in CKD and in the general population.
BACKGROUND:Semen cryopreservation is vital for fertility preservation in men with oligoasthenoteratozoospermia (OAT). While cryopreservation increases sperm DNA fragmentation (SDF), patient-specific risk factors in severe OAT remain poorly defined. We aimed to quantify the change in DNA fragmentation index (DFI) and identify clinical predictors of susceptibility. METHODS:This retrospective cohort study enrolled 340 men with severe OAT (sperm count < 5 million/mL, total motility < 42%, progressive motility < 30%, morphology < 4%). DFI was assessed in fresh and post-thaw samples using the TUNEL assay. Correlations and multivariate regression analyses evaluated relationships between DFI change and age, body mass index (BMI), sperm parameters, and smoking status. RESULTS:The mean DFI increased significantly from 22.0% (IQR 15.0-29.0%) in fresh semen to 36.0% (IQR 23.0-54.0%) postcryopreservation (p < 0.001). The median absolute increase (ΔDFI) was 9.5% (IQR 6.0-25.0%). Univariate analysis identified significant correlations between the ΔDFI and higher BMI (ρ = 0.544, p < 0.001), lower sperm count (ρ = -0.638, p < 0.001), and poorer sperm morphology (ρ = -0.669, p < 0.001). In the final multivariate linear regression model, higher BMI and poorer sperm morphology remained the only significant independent predictors of a greater increase in DFI after cryopreservation (both p < 0.001). This model explained 93.7% of the variance in the ΔDFI (Adjusted R² = 0.937, p < 0.001). Age and sperm count were not independent predictors in the final model. Smoking status and varicocele grade were not significantly associated with the ΔDFI. CONCLUSIONS:Cryopreservation significantly exacerbates sperm DNA damage in severe OAT, but this effect is not uniform. Higher BMI and poorer sperm morphology are independent risk factors for greater damage, identifying a vulnerable patient subgroup. These men may benefit from personalized counseling and optimized cryopreservation protocols to mitigate DNA damage and improve future assisted reproductive technology outcomes.
Introduction: Repeat biopsy remains central to active surveillance (AS) because upgrading and tumor burden may change management. Methods: This retrospective paired workflow study included 38 men and 47 repeat biopsy sessions (2023-2025), comprising 846 biopsy cores and 871 H&E slides. Whole-slide imaging (WSI) and conventional microscopy were compared after a washout interval. QuPath was used only for pathologist-guided tumorlength and greatest percentage of cancer (GPC) documentation. Results: On the first eligible repeat biopsy, upgrading to ISUP Grade Group (GG) 2 occurred in 7/38 men (18.4%; 95% CI, 7.7- 34.3). No GG3, cribriform morphology, or intraductal carcinoma was identified. Protocol-linked reclassification occurred in 11/38 men (28.9%). Slide-level cancer-detection agreement was 856/871 (98.3%; kappa = 0.91), and raw patient-level agreement for upgrading was 36/38 (94.7%; kappa = 0.80). After adjudication, no upgraded patient remained missed. QuPathsupported measurement was interpretable in 79/101 positive core-level assessments (78.2%), with excellent agreement (ICC = 0.98) and shorter median measurement time (41 s vs 78 s). Conclusions: WSI reproduced management-relevant conventional microscopy outputs in repeat AS biopsies. Its value was organizational and documentary, not autonomous cancer detection or grading.
