Urology Journal

Purpose: Intracavitary chemotherapy is one of the current treatment options for kidney-sparing treatment of upper tract urothelial carcinoma (UTUC). The purpose of this meta-analysis was to assess the efficacy and safety of intracavitary perfusion.
Methods: We carefully selected publications for study from four databases (Embase, PubMed, Web of Science, and Scopus) up to January 2023. The R 4.0.4 software was used to calculate the pooled ratio and its 95% confidence intervals (95% CIs). The I2 score was used to test heterogeneity, and the funnel plot was used to estimate the publication bias.
Results: Thirty-four studies with a total of 788 patients were included in this study. The overall survival at a median follow-up of 26.3 months was 87.2% (95% CI 0.80–0.93). The cancer-specific survival at a median follow-up of 30 months was 94.1% (95% CI 0.89–0.98). At a median follow-up of 30 months, the recurrence rate of UTUC was 27.5% (95% CI 0.21–0.34). By subgroup analysis, we found that the recurrence rate in patients with T1 / Ta stage was 35.1% and CIS stage 29.0%. The recurrence rates of BCG, Mitomycin C, and Mitomycin Gel (UGN101) were 31.2%, 41.3% and 12.9%, respectively. The recurrence rates for anterograde and retrograde perfusion were 28.5% and 21.8%, respectively.
Conclusion: With the advent of new drugs, including UGN101, patients with UTUC have a better prognosis. Therefore, kidney preservation therapy for patients with UTUC would be promising.

Purpose: The comparison of ibuprofen with ketorolac remains controversial for the pain control of renal colic. We
therefore conduct this meta-analysis to compare the analgesic efficacy of ibuprofen with ketorolac for renal colic.
Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through
December 2022 for randomized controlled trials (RCTs) assessing the analgesic efficacy of ibuprofen in comparison
with ketorolac for renal colic. This meta-analysis was performed using the random-effect or fixed-effect model
based on the heterogeneity.
Results: Four RCTs were included in the meta-analysis. In patients with renal colic pain, intravenous ibuprofen
and ketorolac produced comparable pain scores at 15 min (MD = -0.46; 95% CI = -1.24 to 0.31; P = 0.24), 30 min
(MD = -0.81; 95% CI = -1.75 to 0.31; P = 0.09), 60 min (MD=-0.63; 95% CI = -1.40 to 0.13; P = 0.10) and 120
min (MD = -0.74; 95% CI = -2.18 to 0.70; P = 0.31), as well as adverse events (OR = 0.95; 95% CI = 0.61 to 1.49;
P = 0.83).
Conclusion: Ibuprofen can obtain comparable analgesic efficacy to ketorolac for renal colic pain.

Purpose: This meta-analysis aimed to predict the rate of spontaneous resolution and identify influencing factors
among pediatric patients with primary vesicoureteral reflux (VUR). The primary objective was to construct a nomogram to facilitate clinical decision-making in the treatment of primary VUR by assessing the rate of spontaneous resolution and its determinants.
Materials and Methods: A systematic search was conducted up to September 2023, encompassing databases such
as PubMed, Web of Science, Scopus, and the reference lists of relevant studies. Inclusion criteria comprised 33
studies with a total of 8540 pediatric patients. Data extraction was performed independently by two reviewers, with
discrepancies resolved by a third reviewer. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Form. The analysis included the assessment of various outcomes, such as the rate of spontaneous resolution, and identification of influential factors, including gender, age, laterality, and VUR grade.
Results: The pooled spontaneous resolution rate among pediatric patients with primary VUR was 0.42 (95% CI:
0.38 to 0.47, Tau2 = 0.26), demonstrating high heterogeneity (Q = 429.9, df = 32, P < 0.001, I2 = 93%). Egger's
regression test indicated no publication bias (p = 0.67). VUR grade emerged as the most significant determinant of
spontaneous resolution, with varying rates for different grades: grade 1 (0.80, 95% CI: 0.72-0.86), grade 2 (0.67,
95% CI: 0.60-0.74), grade 3 (0.49, 95% CI: 0.42-0.56), and grade 4 (0.23, 95% CI: 0.18-0.30; Tau2 = 0.28, I2 =
0.49). While differences in gender and laterality were observed, statistical significance was not evident.
Conclusion: This study provides valuable insights into the spontaneous resolution rate of primary vesicoureteral
reflux in pediatric patients. The constructed nomogram, based on VUR grading, serves as a useful tool for clinicians
in decision-making. Despite observed variations in gender and laterality, only VUR grading demonstrated
statistical significance in influencing spontaneous resolution. Further research is recommended to explore additional factors within larger populations to enhance our understanding of primary VUR resolution dynamics.

Purpose: This study aimed to evaluate the effect of Ziziphus jujuba (Z. jujuba) leaf hydroalcoholic extract on the prevention/treatment of kidney stones.
Materials and Methods: Thirty-six male Wistar rats were randomly divided into six groups: control, Sham (kidney stone induction (KSI) by ethylene glycol 1% + ammonium chloride 0.25% through drinking water for 28 days), Prevention groups 1, 2 (KSI and Z. jujuba leaf (250 and 500 mg/kg, respectively) through gavage for 28 days), and Treatment groups 1, 2 (KSI and Z. jujuba leaf (250 and 500 mg/kg, respectively) from the 15th day). On the 29th day, the rats’ 24-hour urine was assessed, the animals were weighed, and blood samples were taken. Finally, after nephrectomy and weighing the kidneys, tissue sections were prepared to examine the number of calcium oxalate crystals and tissue changes.
Results: The results indicated a significant increase in kidney weight and index, tissue changes, and the number of calcium oxalate crystals in the Sham group compared to the control; using Z. jujuba leaf considerably reduced them in experimental groups compared to the Sham. Body weight decreased in the Sham and experimental groups (except the prevention 2 group) compared to the control, while this observed reduction was lower in all experimental groups compared to the Sham. The mean urinary calcium, uric acid, creatinine, and serum creatinine in Sham and experimental groups (except the prevention 2 group) indicated a substantial increase compared to the control and decreased significantly in all experimental groups compared to the Sham.
Conclusion: Hydroalcoholic extract of Z. jujuba leaf is effective in the reduction of calcium oxalate crystals forming, and its most effective dose was 500mg/kg.

Purpose: Recent studies have provided reliable evidence for a relationship between loss of PTEN gene expression
and prognosis in patients suffering from prostate cancer, although the results have been somewhat diverse in different populations. We aimed to assess PTEN gene expression loss by immunohistochemistry in prostate cancer and also its link to tumor upgrading in a group of affected patients undergoing radical prostatectomy.
Materials and Methods: This cross-sectional study was performed on 58 tissue samples sourced from the patients
with prostate cancer and undergoing radical prostatectomy. TRUS-guided needle biopsies of the cancer
tissue samples with histological grade groups of I to IV (the Gleason scores of 6 to 8) were prepared as the study
samples. 29 patients with Gleason score (6 to 8) whose tumors on needle biopsy upgraded to Gleason score 7, 8
or 9 at prostatectomy (cases) were compared with 29 patients with Gleason scores of 6, 7 or 8 on both biopsy and
prostatectomy samples (controls). Immunohistochemistry (IHC) technique was employed to determine PTEN gene
expression status.
Results: Loss of PTEN gene expression was found in 62.1% of upgraded cases compared with 27.6% of controls,
indicating a statistically significant difference, revealing a meaningful association between the loss of PTEN gene
expression and tumor upgrading. Furthermore, we demonstrated that deletions of PTEN gene expression and increased Gleason score in control and upgraded case groups, did not reach statistical significance.
Conclusion: A high rate of PTEN gene expression loss can be detected in prostate cancer tumor tissue, and this
loss of gene expression is associated with tumor upgrading.

Purpose: Myelomeningocele is the most severe form of spina bifida. Management of urologic consequences of
spina bifida is life long, demanding and costly for both the patient and the public health system. There is a paucity
of data in the literature regarding concentration defects and their consequences on this disease. This paper aims
to describe retrospectively the effect of early onset clean intermittent catheterization (CIC) in on the severity of
urinary concentration defects in myelomeningocele patients with neurogenic bladder in a retrospective observational study.
Materials and Methods: In this 10-year retrospective cohort study, children with myelomeningocele were selected
with the Convenience sampling method. Demographic characteristics, polyuria index ratio (PIR) defined as 24
hour urine output of each patient divided by the maximum normal urine output of the same patient in a healthy
state, and nocturnal polyuria index (NPI) were compared between early starters (< 2 years old) or late starters (≥
2 years old) groups.
Results: Seven patients who underwent cystoplasty were excluded and 130 patients (63.8% male, 5.4 ± 3.2 years
old, 14.3 ± 2.83 Kg, 28.5% early onset CIC) were investigated. PIR > 1 in inset (1.7 ± 0.2 vs. 2.2 ± 0.5, P = 0.021)
and outset (1.5 ± 0.32 vs. 2.5 ± 0.7, P = 0.004) were lower in early starters group than in late starters group. NPI in
inset (0.2 ± 0.007 vs. 0.32 ± 0.10, P = 0.018) and outset (0.25 ± 0.15 vs. 0.42 ± 0.095, P = 0.007) were also lower
in the early starters group. No further adverse events were reported during the follow-up period.
Conclusion: Early onset CIC is more effective than late-onset CIC in preserving the urinary ability of kidneys in
myelomeningocele patients.

Purpose: Lower urinary tract symptoms (LUTS) are common in women, and negatively affect their lives. The aim
of this study is to determine the frequency of LUTS and its affecting factors in female graduate students in Turkey.
Materials and Methods: This descriptive, cross-sectional study consisted of 815 women attending education at
Canakkale Onsekiz Mart University. Data were; provided sociodemographic characteristics, a questionnaire, and
the Bristol Female LUTS Scale. Linear regression analysis was used to identify the risk factors associated with
LUTS.
Results: According to the data obtained, the prevalence of at least one of the LUTS was determined as 71.8%
(515/815). It was determined that the prevalence of storage symptoms was higher than that of voiding and urinary
incontinence. According to the results of the linear regression analysis, the risk factors for LUTS in female student
were hold urine at school, complaints of urinary incontinence in family, bedwetting in children, constipation, regular
drug use, obesity.
Conclusion: Consequently, LUTS is a common condition in female students. It is recommended to organize
well-attended and repeated training programs for university students on healthy living behaviors, urinary habits,
and hygiene.

Purpose: To explore the safety and efficacy of bipolar plasma-kinetic transurethral resection of the prostate in patients taking low-dose aspirin.
Materials and Methods: Benign prostatic hyperplasia (BPH) patients who underwent surgical treatment from November 2018 to May 2020 were retrospectively analyzed, and divided into two groups according to whether taking 100mg aspirin daily aspirin or not. The perioperative indexes, complications and sequelae also were used to evaluate safety. The efficacy was evaluated by the functional outcomes in 3,6,12 months.
Results: There were no statistical differences in the baseline characteristics or perioperative indicators and complications and sequelae, except for a longer operative time(90.49 ± 14.34 vs 84.95 ± 15.49; 95%CI: 0.26-10.83; P = .040) and a shorter hospital stay time(HST) (8.52 ± 1.55 vs 9.09 ± 1 .50; 95% CI: 0.21-1.11; P = .042) in the non-aspirin group. During the 12-months follow-up period, the functional outcomes of the two groups were significantly improved except International Index of Erectile Function (IIEF-5).
Conclusion: Based on our research results, PKRP a safe and effective method for patients with BPH who taking 100mg aspirin daily.

Purpose: To evaluate the efficacy of frenulum protection technique of the disposable
circumcision suture device (DCSD) in adult males.
Materials and Methods: Atotal of 53 adult males were diagnosed with redundant prepuce and underwent circumcision with DCSD using frenulum protection technique. The main preoperative and postoperative measure of the length of penile frenulum was evaluated. Other data such as edema rate, intraoperative blood loss, operation time, postoperative pain, staple falling off time, incision infection rate, and evaluation of satisfaction rate with penis
appearance were documented in the study.
Results: There was no significant difference in preoperative and postoperative frenulum length for each patient.
The mean length of the penile frenulum before and after surgery was 2.25 ± 0.36 cm and 2.23 ± 0.39 cm, respectively (p = .31). The rate of frenulum length preservation was 100%. All the patients had no excessive resection of the frenulum and no serious complication happened after surgery. The satisfaction rate of postoperative penis appearance from patients’ evaluation was 98.1% (52/53).
Conclusion: The frenulum protection technique was simple and operable, which could help the operator to accurately identify the most distal position of the frenulum and retain a sufficient
length of frenulum during DCSD circumcision.