Urology Journal

Purpose: To explore the effectiveness of vitamin E in male infertility, a systematic review and meta-analysis was conducted.
Materials and Methods: The retrieval time was from January 1947 to May 2021, without language restriction. Stata 12.0 was used for the meta-analysis.
Results: A total of 8 randomized controlled trials involving 459 patients were included. The results showed that after vitamin E treatment, semen volume was reduced (95% CI: - 0.55 to - 0.06, SMD = - 0.30, p = 0.015), total sperm count was increased (95% CI: 0.02-0.45, SMD = 0.23, p = 0.035), and the differences were statistically significant. There were no statistically significant differences in increasing sperm concentration (95% CI: -0.21-0.29, SMD = 0.04, p = 0.769), total sperm motility (95% CI: -0.01-0.42, SMD = 0.20, p = 0.061) or sperm forward motility rate (95% CI: -0.06-0.65, SMD = 0.29, p = 0.106). Subgroup analysis showed that vitamin E treatment for six months could improve sperm forward motility (95% CI: 0.46-1.14, SMD = 0.80, p <0.001).
Conclusion: Vitamin E could increase the total sperm count and reduce the volume of semen in male infertility patients, and long-term treatment could improve the forward motility rate of sperm. The decrease of semen volume may be the result of different abstinence time before and after the test.

Purpose: Upward stone migration is a significant problem during ureteroscopic lithotripsy (URSL) for upper ureteral stone, especially in absence of a ureteral occlusion device. In this study, we evaluated the novel strategy of reverse Trendelenburg position (RTP) and intraoperative diuresis for URSL without ureteral occlusion devices to avoid upward migration.
Materials and Methods: From March 2018 to May 2020, a total of 119 URSLs were performed for upper ureteral stone (6-15 mm) with 67 procedures in RTP and 52 procedures in conventional lithotomy position (CLP). 20 mg of intravenous furosemide was administered prior to stone fragmentation with holmium laser only in RTP group. Patient demographics, stone side, stone size and operative characteristics were recorded and compared between the two groups.
Results: Patient data, stone side and size were similar in the two groups. All procedures were complete without conversion to open surgery and major complications. There was no significant difference in the mean operative time (47.9 ± 7.7 min vs 45.3 ± 7.0 min, P = .062) and mean hospital stay (3.9 ± 0.9 d vs 4.0 ± 1.0 d, P = .336) between the RTP and CLP group. Stone upward migration was significantly less in RTP group (3.0%, 2/67) than in CLP group (19.2%, 10/52) (P = .005). Stone-free rate at one month after initial treatment was 92.5% in RTP group and 73.1% in CLP group (P = .004).
Conclusion: The strategy of placing the patient in RTP and intraoperative administration of intravenous furosemide is simple, feasible and cost-effective in preventing stone upward migration during URSL with holmium laser in absence of a ureteral occlusion device for upper ureteral stone.

Purpose: To explore the establishment of a scoring system that can provide a reference for clinical decision making
regarding the endoscopic treatment of 1-2 cm lower pole stones (LPS).
Materials and Methods: The data of patients with renal calculi who were treated with percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) in three hospitals from January 2013 to December 2017 were analyzed retrospectively. Multivariable logistic analysis was performed to determine the statistically significant indicators and regression coefficients, which were used to construct the scoring system. The stone-free rate (SFR) and postoperative complication rates of PCNL and RIRS within the two fractional segments of the scoring system were compared to select the optimal procedures.
Results: A total of 137 patients in the PCNL group and 152 patients in the RIRS group were included in this study.
Five factors were found to be most predictive of endoscopic treatment choice: stone number, stone diameter, infundibulopelvic angle (IPA), infundibular length (IL), and infundibular width (IW), yielding a total score ranging from
0-5. In the 0-2 segments, the RIRS group had better outcomes than the PCNL group in terms of the postoperative
complication rates (6.8% versus 18.0%, P = .026). In segments 3-5, the SFR of the PCNL group was significantly
higher than that of the RIRS group (88.5% versus 70.6%, P = .017).
Conclusion: Our scoring system was based on the patient’s preoperative imaging examination to measure the
stone number, stone diameter, IPA, IL and IW. RIRS was recommended at 0-2 segments, and PCNL was recommended at 3-5 segments. This new scoring system is expected to provide guidance for urologists to make endoscopic treatment decisions for 1-2 cm LPS.

Purpose: To explore the ccRCC clinical and immune characteristics correlated with IL-23 expression level and build pre-operative prediction models based on contrast CT scans.
Materials and Methods: The study included the cancer genome atlas kidney renal clear cell carcinoma cases to build a bioinformatics cohort. The cases with qualified contrast CT images were selected as radiographic and radiomics cohort. The IL-23 expression level groups were defined by median-based thresholding. The clinical characteristics were compared between groups. The impacts of IL-23 on immune microenvironment composition were measured via the CIBERSORT. Two radiologists evaluated the pre-operative contrast CT images. The radiomics features were automatically extracted. IL-23 group-specific radiographic and radiomics features were collected and used for prediction model establishment via Orange Data Mining Toolbox. P < 0.05 was set as statistically significant.
Results: For total, 530 ccRCC cases were included. The IL-23 group was significantly associated with survival, histologic grade, AJCC tumor stage, AJCC cancer stage, and plasma calcium level. Except for Treg and other T cells, IL-23 showed correlation with NK cell, mast cell, monocyte infiltration. Axial length was the only significant radiographic measurement between IL-23 groups. The radiomics features established an IL-23 group prediction model with the highest 10-fold cross-verification AUC of 0.842.
Conclusion: The clear cell renal cell carcinoma IL-23 expression level had prognosis and immune microenvironment correlation and could be predicted by pre-operative radiomics features.

Purpose: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care in non-metastatic muscle-invasive bladder cancer (MIBC). There are limited data regarding the alternative choices for cisplatin-ineligible patients. This study has investigated the oncological outcomes of gemcitabine plus cisplatin (Gem/Cis) and gemcitabine plus carboplatin (Gem/Carbo) in this setting.
Materials and Methods: One hundred forty consecutive patients with MIBC (cT2–T4a) receiving neoadjuvant Gem/Cis or Gem/Carbo before chemoradiation (CRT) or radical cystectomy (RC) were retrospectively evaluated between April 2009 and April 2019. Patients with ECOG performance status 2, creatinine clearance < 60 mL/min, hydronephrosis, ejection fraction < 50%, or single kidney received Gem/Carbo. The complete clinical response (cCR) and overall survival (OS) of NAC regimens were compared. Prognostic significance was assessed with Cox proportional hazards model.
Results: In total, 79 patients (56.4%) received Gem/Cis. The cCR was not significantly different between Gem/Cis and Gem/Carbo regimens (38.7% vs. 36.2%, P = .771). After NAC, 79 patients (56.4%) received CRT, and other cases underwent RC. After a median follow-up of 43 months, patients in the Gem/Cis group had significantly better OS than Gem/Carbo (median OS: 41.0 vs. 26.0 months, P = .008). Multivariable Cox proportional hazards models identified cT4a stage (95% confidence interval [95% CI]: 1.001–4.85, hazard ratio [HR] = 2.08, P = .03) and cCR (95% CI: 0.26–0.99, HR = 0.51, P = .04) as the only independent prognostic factors of OS, and ruled out the type of NAC regimen.
Conclusion: The choice of NAC (between Gem/Cis and Gem/Carbo) is not the predictor of survival and both regimens had similar cCR.

Purpose: Prostate biopsies are associated with infectious complications and approximately 80% are either benign
or clinically insignificant prostate cancer. Our aim is to develop and independently validate prediction model to
avoid unnecessary prostate biopsies by predicting clinically significant prostate cancer (csPCa)
Materials and Methods: Retrospective analysis of single-center cohort (Mount Sinai Hospital, NY) of 1632 men
who underwent systematic or combined systematic and Magnetic Resonance Imaging (MRI)/ultrasound fusion
targeted prostate biopsy between 2014-2020. External cohort (University of Miami) included 622 men that underwent
biopsy. Outcome for predicting csPCa was defined as International Society of Urologic Pathology (ISUP)
Gleason grade ≥ 2 on biopsy. Multivariable logistic regression analysis was performed to build nomogram using
coefficients of logit function. Nomogram validation was performed in external cohort by plotting receiver operating
characteristics (ROC). We also plotted decision curve analysis (DCA) and compared nomogram-predicted
probabilities with actual rates of csPCa probabilities in external cohort.
Results: Of 1632 men, 43% showed csPCa on biopsy. PSA density, prior negative biopsy, and Prostate Imaging
and Reporting Data System (PI-RADS) scores 3, 4, and 5 were significant predictors for csPCa. ROC for prediction
of csPCa was 0.88 in external cohort. There was agreement between predicted and actual rate of csPCa in
external cohort. DCA demonstrated net benefit using the model. Using the prediction model at threshold of 30,
35% of biopsies and 46% of diagnosed indolent PCa could be avoided, while missing 5% of csPCa.
Conclusion: Using our prediction model can help reduce unnecessary prostate biopsies with minimal impact on
csPCa detection rates.

Purpose: To evaluate whether there were any changes in the rates of urinary tract infection (UTI) and antibiotic resistance in pediatric patients during the pandemic period.

Materials and Methods: Urine culture samples collected due to suspected UTI were searched retrospectively from our hospital database, and the patients with growth in urine culture were identified. They were divided into 2 groups as Group A (before COVID-19, March 11, 2019- March 11, 2020) and Group B (COVID-19 period, March 11, 2020- March 11, 2021). Also, COVID-19 period was divided into 3 subgroups (March 2020– June 2020: first epidemic peak, July 2020 – November 2020: normalization process, December 2020– March 2021: second epidemic peak). We adjusted the patient age as <1, 1-6 and 7-18 years. Age, gender, microorganism strain types, and their antibiotic resistance patterns were compared between the 2 groups

Results: This cross-sectional study included 250 eligible patients (Group A, n=182 and Group B, n=68) with a mean age of 10.91 ± 5.58 years. The male/female ratio was higher in Group B than in Group A (p = .004). Incidence of UTIs was lower in the curfew and restriction periods due to epidemic peaks than normalization process (p = .001). The proportion of E.coli decreased from 80.2% to 61.8% during the pandemic period when compared to pre-pandemic period (p = .001). Group B had lower rates of resistance to ampicillin, fosfomycin and nitrofurantoin for E.coli than Group A (p = .001, p = .012 and p = .001, respectively). Also, Group B had higher rate of uncommon microorganisms and lower rate of resistance to nitrofurantoin for E.coli than Group A in patients aged 7-18 years (p = .003 and p = .023, respectively).

Conclusion: Our study demonstrates that the ongoing COVID-19 pandemic process has caused alterations in community-acquired UTIs in children. More hygienic lifestyle may be considered as the main factor in this change.

Purpose: To evaluate the associations among teenage childbearing (Age at first birth<=19 years old) with later-life risk of stress and urgency urinary incontinence (SUI, UUI) in American women using nationally representative data from America.
Materials and Methods: Data from the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2018 were merged to include 2673 women. The question, “How old were you at the time of your first live birth?” was used to assess teenage childbearing. Urinary incontinence was ascertained by self-report. Multivariable logistic regression models were used to assess the association between teenage childbearing and urinary incontinence in American women, controlling for potential confounders.
Results: Among the 2673 women with complete data, the prevalence of SUI was 27.3%, and the prevalence of UUI was 22.1%. Overall, 856 of female had given birth at or before the age of nineteen. Teenage childbearing was significantly associated with SUI (OR=1.9, 95%CI=1.5-2.3, p < 0.001), but teenage childbearing was not associated with UUI (OR=1.2, 95%CI=1.0-1.5, p = 0.0658).
Conclusion: After controlling for known risk factors, teenage childbearing seems to be signif-icantly related to female stress urinary incontinence.

Purpose: This study aimed to develop and psychometrically validate the Sexual Health Scale for Middle-Aged sexually active women (SHIMA).

Methods: This study was a sequential exploratory study consisting of two phases. In phase one, we interviewed 19 middle-aged women and reviewed the existing instruments to generate an item pool. Then, a panel of experts (n = 16) examined the items. In the second phase, the psychometric properties of the scale were assessed. For content and face validity, a panel of experts (n = 8) and a group of middle-aged women (n = 10) reviewed the items. For construct validity, a cross-sectional study was carried out on a sample of 427 married women. Finally, SHIMA’s reliability was assessed.
Results: In the first phase, the sexual health concept was explored, and a provisional scale including 60 items was generated. Next, 21 items were removed based on content and face validity. Accordingly, the results obtained from the exploratory factor analysis (EFA) indicated acceptable loading for 34 items tapping into six factors that jointly explained 48.67% of the total variance observed. The internal consistency evaluation revealed that Cronbach’s alpha and McDonald’s omega were greater than 0.7, and the average inter-item correlation was greater than 0.4, except for one factor that showed borderline results. Test-retest reliability over a 2-weeks interval was 0.90, indicating its high stability.
Conclusion: The SHIMA is a reliable and valid scale for measuring sexual health in middle-aged married women. It can be used as a sexual health screening scale by healthcare professionals and for research purposes.

Purpose: to investigate the effect of melatonin along with tamsulosin in improving BPH urinary symptoms.
Materials and Methods: A total of 108 men with BPH symptoms, age of ≥ 50 years, and International Prostate
Symptom Score (IPSS) ≥ 8 entered into the parallel group randomized, double-blind clinical trial with balanced
randomization. The treatment group received of 3mg melatonin plus 0.4mg tamsulosin and the control group received placebo plus 0.4mg tamsulosin. Patients and physicians were concealed by sealed and opaque envelopes.
Symptoms were assessed at baseline and 1 month after treatment. Finally all scores at the initial and end of the
study were compared and analyzed using SPSS software.
Results: This study showed that adding melatonin to the classic treatment of BPH patients with tamsulosin could
significantly reduce the likelihood of nocturia by 2.39 times (95% CI: 1.07-5.32, OR = 2.39, p = 0.033) and could
also reduce the frequency of urination by 2.59 times (95% CI: 1.15-5.84, OR = 2.59, p = 0.021). There was no
statistically significant difference between the two groups in IPSS, intermittency, incomplete emptying, straining,
urgency, and weak stream.
Conclusion: Melatonin plus tamsulosin treatment is associated with a significant improvement of nocturia and
frequency in patients with benign proststic hyperplasia. However, it is necessary to do more studies.