Urology Journal

Purpose: To study the effect of body mass index (BMI) on 24-h urine quantitative analysis in pediatric urolithiasis, and to explore whether obesity and overweight promote the formation of urinary calculi in children.

Materials and Methods: A comprehensive search of EMBASE, PubMed, the Cochrane Library, Web of Science, and Scopus was conducted in March 2024 and updated in October 2025 to identify all related studies. BMI was used to specify body size. Predetermined inclusion and exclusion criteria were used to screen each article. Data from appropriate studies were extracted, and a meta-analysis was performed using Stata 14.0 software.

Results: Eight studies, including 1033 children with urolithiasis who underwent 24-h urine collection for chemical analysis, were included in this meta-analysis. The BMI ≥ 85th percentile group exhibited significantly higher uric acid excretion (SMD = 0.756, 95% CI = 0.092–1.420, P = .026). No statistically significant differences were found in calcium (SMD = -0.320, 95% CI = -0.600 to -0.050, P = .519), 24-h urine volume (SMD = -0.310, 95% CI = -0.790 to 0.160, P = .555), magnesium (SMD = -0.470, 95% CI = -0.820 to -0.120, P = .471), phosphate (SMD = -0.360, 95% CI = -0.610 to -0.110, P = .805), oxalate (SMD = -0.110, 95% CI = -0.390 to 0.170, P = .315), citrate (SMD = -0.190, 95% CI = -0.680 to 0.290, P = .057), or sodium (SMD = 0.200, 95% CI = -0.390 to 0.800, P = .050) excretion between the two groups. Sensitivity analyses confirmed the robustness of these findings.

Conclusion: While overweight/obese children with urolithiasis demonstrate higher urinary uric acid excretion, the absence of significant differences in other key urinary risk factors suggests that BMI alone should not be considered a separate and definitive risk factor for pediatric urolithiasis.

Purpose: The prognosis and clinical management of bladder tumors nearly occupying the entire bladder cavity remain poorly defined due to limited available data. This study aimed to evaluate the clinical features and treatment outcomes of patients presenting with bladder tumors nearly filling the bladder at initial diagnosis.

Materials and Methods: After obtaining ethical approval, a retrospective analysis was conducted on 51 patients diagnosed between 2017 and 2024 with primary bladder tumors nearly filling the bladder. All underwent transurethral resection of bladder tumor (TURBT). The clinical and pathological data were analyzed using descriptive statistics and multivariable logistic regression.

Results: The mean age was 76.24 ± 11.7 years, with a median follow-up of 9.73 months (range: 3–84 months). Hematuria was the most frequent symptom (74.5%). Muscle-invasive disease was identified in 43.1% of cases at initial diagnosis, exceeding the 25% generally reported in newly diagnosed bladder cancer cohorts (p < .001). Complete resection was achieved in 68.6%, while 31.4% required repeat TURBT (re-TURBT). Among patients initially diagnosed with non-muscle-invasive tumors, 31.1% were found to have muscle invasion upon second resection. Treatments comprised intravesical immunotherapy (48.6%), radical cystectomy (25.7%), chemoradiation (14.3%), and systemic chemotherapy (11.4%).

Conclusion: Bladder tumors nearly filling the bladder cavity are associated with high rates of muscle invasion and pose significant challenges in treatment and management. Larger, prospective multicenter studies are warranted to validate these findings and optimize management in this high-risk population.

Purpose: Acute kidney injury (AKI) is a common condition in hospitalized patients that can have a significant impact on outcomes, including an increase in overall complications and mortality rates. Criteria such as serum creatinine level, urinary output, and scoring systems such as KDIGO in acute conditions do not have acceptable specificity and sensitivity to evaluate kidney function. Therefore, this study was conducted to determine the relationship between plasma uric acid level and mortality rate in patients with sepsis and acute kidney failure.

Materials and Methods: In this descriptive-analytical (cross-sectional) study, 52 children aged from one month to 15 years with sepsis (based on qSOFA criteria) and acute kidney failure (based on serum creatinine level) admitted to the PICU of Ali Bin Abi Taleb Hospital from October 1401 to October 1402 were included and studied by the census method. Within 48 hours after admission to the ICU, blood samples were collected to check serum uric acid levels, electrolytes, albumin, complete blood count (CBC), kidney function tests, arterial blood gases, and chest x-rays. All patients were followed up until discharge or death due to progression of kidney failure. Finally, the findings of the research were analyzed using SPSS version 26 statistical software.

Results: The mean age of patients was 3.66 ± 4.92 years. The number of deaths in the hyperuricemia group was significantly higher than in the normal uric acid group (P = 0.03); an odds ratio of 3.45 indicates that a high level of uric acid is a risk factor for death. In this study, the duration of hospitalization was longer in those who survived (P = 0.02). A particularly strong predictor in our analysis was the qSOFA score (P < 0.001), highlighting its critical role in determining outcome. Serum uric acid level and qSOFA scale showed no significant difference overall (P = 0.76); subgroup analysis among surviving and deceased patients between uric acid and the qSOFA scale presented the same result (P = 0.203 and P = 0.29, respectively).

Conclusion: The level of uric acid can be considered a laboratory variable to predict the prognosis of patients.

Purpose: Diabetes mellitus is a chronic hyperglycemic condition leading to metabolic problems that cause organ damage and result in serious complications. Long-term complications of diabetes can cause serious health problems, such as sexual and reproductive dysfunction in men and women. Black pepper (Piper nigrum L.) is a medicinal plant proven to increase testosterone hormone levels, sexual function (libido), and spermatogenesis parameters in male rats. In this study, the effect of black pepper fruit extract on sexual function and reproductive function (fertility) in alloxan-induced diabetic male rats was evaluated.

Materials and Methods: A total of 30 male Sprague Dawley rats (Rattus norvegicus), aged 2.5 to 3 months and weighing 100-150 g, were divided into five groups of 6 individuals each. Group I consisted of rats given only standard feed. Group II consisted of alloxan-induced hyperglycemic rats given standard feed. Groups III and IV were alloxan-induced hyperglycemic rats given black pepper extract at 122.5 and 245 mg/kg BW, respectively, for 8 days. Group V consisted of alloxan-induced hyperglycemic rats given sildenafil therapy or zinc plus ascorbic acid. After 8 days of treatment, the erectile function and libido of the rats were assessed, followed by an evaluation of spermatozoa and testicular histology. Data were analyzed using ANOVA with significance set at p < 0.05.

Results: Alloxan-induced diabetic rats showed significant impairment in erectile function, libido, sperm quality, and testicular histology (p < 0.001 vs. control). Administration of black pepper extract at a dose of 122.5 mg/kg BW increased total penile reflexes (9.33 ± 1.03 vs. 6.00 ± 1.26 in the diabetes group, p = 0.002) and improved libido, with a decrease in courtship latency (5.50 ± 0.55 s vs. 21.00 ± 9.47 s, p = 0.013) and an increase in mounting frequency (18.05 ± 5.99 vs. 7.17 ± 1.83, p = 0.009). The extract dose of 245 mg/kg BW increased sperm concentration (158.16 ± 29.80 vs. 12.6 ± 1.3 ×10⁶, p < 0.001), progressive sperm motility (65.0 ± 35% vs. 27.0 ± 30%, p = 0.006), and normal sperm morphology (82.9 ± 5.7% vs. 35.0 ± 10.8%, p < 0.001). The number of Leydig cells increased significantly in the 122.5 mg/kg BW extract group (59.33 ± 4.08 vs. 30.50 ± 3.86; p < 0.001) compared to the diabetes group. There was no significant difference in spermatogonia count (640 ± 86.5 vs. 491 ± 37.0; p = 0.119).

Conclusion: Piper nigrum fruit extract ameliorates sexual dysfunction and reproductive impairment in alloxan-induced diabetic rats, particularly at 122.5 mg/kg BW, with significant improvements in erectile function, libido, sperm quality, and testicular histology. These findings suggest its potential as a natural therapeutic agent for diabetes-related male reproductive dysfunction.

Purpose: Varicocele is the abnormal dilatation of the veins of the pampiniform plexus, which is considered one of the most common factors related to infertility in men. The aim of the present study was to investigate whether a relationship exists between sleeping position and the presence of varicocele.

Materials and Methods: In this case-control study, 231 adult infertile men who were referred to the Kowsar Infertility Center, Yasuj, Iran, were divided into two groups: a control group including 113 infertile patients without varicocele, and a case group of 118 infertile patients with varicocele. After the first visit by the urologist and determining the presence or absence of varicocele, as well as the clinical grading of the varicocele, the patients completed demographic, clinical, and sleep position questionnaires.

Results: The findings of the current study indicated a significant relationship between the presence of varicocele and the faller-down (lying on the abdomen) sleeping position. There was also a significant positive correlation between this position and the degree of varicocele (p =0.003).

Conclusion: The faller-down or prone position during sleep has a meaningful relationship with varicocele, which may be due to increased intra-abdominal pressure. More studies are needed to confirm this hypothesis.

Purpose: Sexual dysfunction associated with psychological reasons is one of the factors impacting unfulfilled marriages. There are limited data on treatment outcomes in this context. The aim of this study was determining the treatment of unconsummated marriage in psychogenic erectile dysfunction in Iranian Couples.

Materials and Methods: A total of 66 cases were selected from individuals referred to the Family Health Clinic (from 2006 to 2019), who had unconsummated marriages and experienced psychogenic erectile dysfunction, meeting the inclusion criteria for the study. Research tools included couples' demographic information, face-to-face interviews, and the International Index of Erectile Function (IIEF). The treatment was based on couple’s therapy. In the initial session, a comprehensive assessment of the couples' condition was conducted, and research instruments were completed. Additionally, during this session, the formation of psychogenic erectile dysfunction and the lack of successful foreplay were discussed. In subsequent sessions, desensitization, instruction on foreplay, and intercourse were addressed. Treatment success was defined as the ability to achieve complete vaginal penetration. Data was analyzed using SPSS 16 software.

Results: All 66 couples continued the treatment until they achieved successful vaginal penetration. All International Index of Erectile Function (IIEF) domains improved significantly after couple-based behavioral therapy in men with psychogenic erectile dysfunction in unconsummated marriages (all p < .001; large effect sizes for most domains). No significant associations were found between educational level, place of residence, engagement duration, or marriage duration and post-treatment scores (all p > 0.05). Male age correlated negatively with overall ED (r = −.314, P = .001), erectile function (r = −.361, P = .003), intercourse satisfaction (r = −.365, P = .003), and overall satisfaction (r = −.266, P = .031). Similar negative associations were observed for female age with overall ED (r = −.371, P = .002), erectile function (r = −.354, P = .004), intercourse satisfaction (r = −.344, P = .005), and overall satisfaction (r = −.246, P = .047).

Conclusion: Psychogenic erectile dysfunction in unconsummated marriage can be addressed through couple-based therapy.