Urology Journal

Objective: to review the literature regarding the relationship between pre- and post-transplant hypo-Albuminemia with various renal transplant-related infections.
Materials and Methods: In a systematic review, we included the following keywords in the search: (Albumin*) AND (infection*) AND ("renal transplant" OR "renal transplantation" OR "renal transplants") OR ("kidney transplant" OR "kidney transplantation" OR "kidney transplants") OR "kidney grafting") with investigating databases including ProQuest, PubMed, Scopus, and Web of Science to May 2023. All adult patients who had renal transplantation were included. Albumin levels of infected (bacterial, fungal, or viral) patients and the type of infection should be reported in the included studies. The search strategy used in this review was reported by Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension (PRISMA-S). To conduct Meta-analyses, Stata version 17 was used. Also, DerSimonian-Laird random-effects models were used for this study. In our study, heterogeneity was quantified with I2 and τ2 statistics. Inconsistency across studies is quantified by I2 statistics, and the impact of heterogeneity on the meta-analysis is assessed by this quantification.
Results: Overall, 18 studies were found to be reporting measures of association including risk ratio, odds ratio, and, hazard ratio. Among them, 10 and 8 studies reported bacterial and viral types of infection. The combined risk ratios were not statistically significant, in either type of infection. The mean (SD) of ages for bacterial and viral infections were found to be 45.3 (6.4) and 50.5 (7.6) years old, respectively.
Conclusion: Hypoalbuminemia is not related to post-transplantation infections, and it seems that with adherence to proper pretransplant screening of recipients, vaccination, and post-transplant surveillance and prophylaxis, the impact of infections may be reduced.

Background: Our study aims to address two pivotal questions: "What are the recent advancements in understanding the etiology of urological tumors through Mendelian Randomization?" and "How can Mendelian Randomization be more effectively applied in clinical settings to enhance patient health outcomes in the future?"
Methods: In our systematic review conducted in April 2023, we utilized databases like PubMed and Web of Science
to explore the influence of Mendelian Randomization in urological oncological diseases. We focused on studies
published from January 2018, employing keywords related to urological tumors and Mendelian Randomization,
supplemented with MeSH terms and manual reference checks. Our inclusion criteria targeted original research
studies, while we excluded reports and non-relevant articles. Data extraction followed a PICO-based approach,
and bias risk was independently evaluated, with discrepancies resolved through discussion. This systematic approach adhered to PRISMA guidelines for accuracy and thoroughness in reporting.
Results: From the initial 457 publications, we narrowed down to 43 full-text articles after screening and quality
assessments. A deeper understanding of Mendelian Randomization can help us explore risk factors with a clear
causal relationship to urological tumors. This insight may pave the way for future research in early diagnosis,
treatment, and management of associated diseases.
Conclusion: Our review underscores the value of MR in urogenital tumor research, highlighting its efficacy in
establishing causality and its potential to clarify disease mechanisms. Despite challenges like large sample sizes
and variant identification, MR offers new perspectives for understanding and managing these tumors, suggesting a
trend towards more inclusive and diverse research approaches.

Purpose: The exact molecular and cellular processes that cause benign urological diseases in the stromal and
epithelial components of the urinary tract are yet unknown. Reviewing and analyzing the data linking microRNAs
(miRNAs) expression in the pathophysiology of benign urological conditions, including overactive bladder
(OAB), bladder outlet obstruction (BOO), bladder pain syndrome/interstitial cystitis (BPS/IC), and Lower urinary
tract dysfunction (LUTD) is the objective of the current systematic review.
Materials and Methods: Evidence including all case-control, cohort, and cross-sectional studies that measure
participants’ MicroRNA as a biomarker for benign urological diseases has been gathered in January 2024, through
searching MEDLINE via PubMed, Scopus, Web of Science, Embase, and ProQuest databases. Studies considered
eligible that present information on the reference Gene, profile type, and serum levels of microRNA from patients
diagnosed with benign urological disease including benign prostate hyperplasia (BPH) or benign prostate enlargement (BPE), overactive bladder (OAB), and bladder outlet obstruction (BOO). These studies were appraised by the quality assessment checklist of Joanna Briggs Institute (JBI).
Results: A total of 4,587 records related to miRNAs in urological diseases were retrieved. Of these, we identified
28 records for our systematic study. The most frequently associated miRNA was 92a-3p identified which was
found upregulated in OAB diagnosis. In BOO, miR-146a-5p was identified to be upregulated. miR-146a-5p was
upregulated in BO, and for other benign conditions, different miRNAs were reported. 491-5p miRNAs were found
deregulated in OAB-related studies. We expected other miRNAs to have the same trend in the OAB studies. InSUI
miR-93 was the most frequent downregulated miRNA. The other reported miRNAs had similar frequencies.
Conclusion: When it comes to the early detection and treatment of benign urological conditions, 92a-3p, miR-21,
miR-199a-5p, and miR-146a-5p, and 491-5p have the potential to be employed as both a biomarker and a therapeutic target. The creation of pre-RNA or anti-RNA molecules within carrier vehicles that may be safely administered to patients should be made possible by technological advancements.

Purpose: To explore the efficacy and safety of a self-improved continuous bladder irrigation (CBI) sensor device
after transurethral resection of the prostate (TURP).
Materials and Methods: A total of 160 patients with benign prostatic hyperplasia who received TURP from June
2021 to May 2022 were selected. According to the envelope randomization method, patients were divided into a
control group (80 cases) and study group (80 cases). In the control group, the speed of bladder flushing fluid was
adjusted according to the clinical experience of nurses. On the basis of the control group, the self-improved CBI
sensor device was used in the study group to observe the postoperative comfort and complication rate in the two
groups.
Results: The comfort of patients in the study group was significantly higher than that of patients in the control
group (97.50% vs. 88.75%, P = .023), and the number of postoperative complications in the control group was
significantly higher than that in the study group (8.75% vs. 1.25%, P = .021). Meanwhile, the average amount of
irrigation fluid in the study group was obviously lower than that in the control group (26.4 L vs. 27.8 L, P = .011).
In addition, patients in the study group had a significantly shorter hospital stay than the controls (3.3 days vs. 3.6
days, P = .005).
Conclusion: Implementation of the new self-improved CBI sensor device for patients after TURP can improve
their awareness regarding disease-related knowledge, alleviate their fear and anxiety, improve their compliance
and comfort with treatment and nursing, and reduce the incidence of complications.

Purpose: This study aims to assess the utility of the CONUT (Controlling Nutritional Status) Score and R.E.N.A.L.
(Renal Nephrometry Score) Score in predicting tumor recurrence in patients with kidney cancer. Additionally, we
investigated which parameters contributed to these scores.
Materials and Methods: In total, 115 patients who underwent partial nephrectomy between January 2015 and
August 2023 at a single tertiary center were enrolled. After the exclusion criteria, data from 88 patients were
analyzed. Age, gender, body mass index (BMI), comorbidities (hypertension, diabetes), smoking status, tumor
characteristics, CONUT Scores, and R.E.N.A.L. scores were retrospectively recorded. Statistical analyses were
performed, and significant p was p < 0.05.
Results: The presence of diabetes and hypertension showed a statistically significant association with tumor recurrence (p = 0.033 and p = 0.003, respectively). A high BMI significantly increased the risk of recurrence (p < 0.05).
There was a strong positive relationship between the high tumor stage and positive surgical margins with recurrence (p < 0.001). Patients with high R.E.N.A.L. Scores and high CONUT Scores had a higher risk of recurrence
(42.1% and 8.7%, respectively), and this difference was statistically significant (p < 0.001).
Conclusion: CONUT and R.E.N.A.L. scores may be used to predict tumor recurrence after partial nephrectomy.
Additionally, diabetes, hypertension, high BMI, and positive surgical margin rate might affect surgical success
rate for recurrences. Clinicians should consider all these parameters and coring systems to gather more successful
results after partial nephrectomy.

Purpose: To compare the oncological outcomes of clear cell RCC (ccRCC), which is common in renal cell carcinomas (RCC), and chromophobic RCC (chRCC), which is less common, and to define the factors affecting survival in the Turkish patient population for both RCC subclassifications.

Materials and Methods: Patients with a pathologically confirmed RCC diagnosis after radical or partial nephrectomy in the Turkish Urooncology Association (TUOA), Urological Cancers Database-Kidney (UroCaD-K), were retrospectively reviewed. Patients with ccRCC and chRCC were included in the study. Primary outcomes of this study are recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) for each histological subtype.

Results: Data from 5300 patients in the TUOA UroCaD-K are reviewed and a total of 2560 patients (2225 in the ccRCC group and 335 in the chRCC group) are included in the final analysis. In the comparison of the groups, tumor size was greater both radiologically and pathologically in chRCC (p=0.019 vs 0.002 respectively). Recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) rates are worse in ccRCC subgroup. In the evaluation of risk factors; pathological stage, local invasion and Fuhrmann grade were found to be significant for recurrence in ccRCC. Age, body mass index and pathological stage were the risk factors affecting overall mortality (OM). Pathological tumor size was an independent risk factor for recurrence in chRCC, while age was analyzed as the only parameter affecting OM.

Conclusion: chRCC oncological data and OS, CSS and RFS rates were found to be better than ccRCC in the Turkish patient population.

Purpose: To share our recent experience of the pattern and demography of endemic bladder calculi in children and
the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting.
Material and Methods: This retrospective longitudinal study was carried out at a dedicated urology centre. All
patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in
this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS
v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally
distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for
categorical variables.
Results: This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients
was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was
performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cystolithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8 ± 4.34 minutes for TUCL, 36.18 ± 7.4 minutes
for open cystolithotomy, and 38.6 ± 5.2 minutes for PCCL. The most common stone composition was ammonium
urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open
cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC.
Conclusion: Paediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic backgrounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy.

Purpose: The objective of this randomized controlled trial was to investigate the impact of manual therapy (friction
massage) and pelvic floor muscle (PFM) training on erectile dysfunction (ED), pelvic floor muscle thickness,
and blood flow in the penile arteries and veins in men who have undergone prostatic adenectomy (PA).
Materials and Methods: This study employed a randomized, double-blinded, controlled trial design. Forty patients
participated and were divided into two groups: intervention and control (n=20 per group). The intervention
group received 10 sessions of pelvic floor muscle training and manual therapy, while the control group solely
underwent pelvic floor muscle training. The recovery rate was measured using the International Index of Erectile
Function 15 (IIEF-15) questionnaire and Erection Hardness Score (EHS). Sonographic factors were assessed using
simple and Doppler ultrasound.
Results: The intervention group exhibited significantly higher erectile function scores (F(1,37)=158.04, P < 0.001, η2 P = 0.810) and a higher average total (IIEF-15) score (20.52) (F(1,37)=136.76, P < 0.001, η2 P = 0.787) compared
to the control group in the post-test assessment. Comparison between the two groups revealed an increase
in ultrasonic parameters such as the thickness of the ischiocavernosus and bulbospongiosus muscles, maximum
systolic velocity, and minimum diastolic velocity of the cavernosal artery in the intervention group. However, the
maximum blood flow velocity in the posterior vein decreased.
Conclusion: PFM training and friction massage play a significant role in managing ED following PA, positioning
them as the primary treatment approach for men experiencing ED post-prostatectomy.

Purpose: Platelet-rich plasma (PRP) is enriched with active biological components which showed proliferative
and cytoprotective properties in healing different injuries in medicinal fields. This study was designed to assess
the cryoprotective effects of autologous PRP on the quality of oligoasthenoteratospermia (OAT) samples during
freezing and thawing procedure.
Materials and Methods: The present study is an experimental research. Twenty OAT semen samples were obtained
from individuals and prepared by discontinuous density – gradients technique DGC). The control group
is sperm samples after DGC. After the procedure, the specimen was divided into four groups. The Freeze group
which has no additive and the other three groups were cryopreserved with different concentrations of PRP (1×105/
μL, 0.5×105/μL and 0.25×105/μL). Autologous PRP was provided by each participant. After thawing, sperm parameters, DNA fragmentation by sperm chromatin dispersion test (SCD), protamine deficiency by (Chromomycin
A3) CMA3 staining, acrosome integrity and malondialdehyde (MDA) level were evaluated.
Results: Cryopreservation resulted in a significant decrease in all factors compared to the control group. There
were no significant changes in sperm count, morphology, non-progressive motility and acrosome reaction by
adding PRP as a cryoprotectant in comparison with the freeze group. PRP at all three concentrations showed a
significant increase in progressive motility (3.05 ± 2.01 vs. 14.05 ± 4.13, 12.35 ± 4.90 and 12.15 ± 9.65, P < 0.001)
and viability (36.85 ± 10.25 vs. 47.85 ± 5.86, 51.30 ± 5.54 and 50.05 ± 5.67, P < 0.001) compared to the sperm
samples without PRP. The percentage of immotile sperms decreased at all PRP concentrations compared to the
freeze group. Moreover, PRP at 1×105/μL concentration showed cryoprotective effects on DNA fragmentation,
protamine deficiency and MDA level compared to the other three concentrations.
Conclusion: Cryopreservation and thawing procedures may exert adverse effects on biological factors of sperm
samples. Therefore, adding PRP as cryoprotectant at all three concentrations especially 1×105/μL can be promising
strategy to reduce adverse effects of cryopreservation on OAT samples.

Purpose: Chromosome 7 open reading frame 61 (C7orf 61) was a testis-specific gene, and may be involved in the
process of spermatogenesis. This study aimed to investigate the expression of C7orf61 in the testis and determine
its role in spermatogenesis.
Materials and Methods: Reverse transcription–quantitative polymerase chain reaction, Western blot and immunofluorescence were performed to evaluate the expression characteristics of C7orf61 in mice and humans. In vitro fertilization assay was used to determine the role of the C7ORF61 protein in sperm-egg fusion.
Results: The results demonstrated that C7orf61 was a testis-specific gene; the C7ofr61 mRNA expression level
sharply increased in the fourth postnatal week and gradually increased until the adult stage. The C7ORF61 protein
was located throughout the subacrosomal area and close to the nucleus in both mouse and human sperm. The incubation with the C7ORF61 antibody significantly decreased the fertilization rate of mouse eggs.
Conclusion: The present findings suggested that the C7ORF61 protein might be involved in sperm–egg fusion,
and could serve as a useful target for contraceptives. However, further research is still needed to know the detailed
molecularmechanismofitsrole.

Purpose: The primary outcome of this study is to compare the success rates of ONB techniques performed either
with ultrasound guidance or with the blind technique. The second outcome is to compare the incidences of perioperative bleeding and the presence of recurrent tumors in the control cystoscopy performed in the 3rd postoperative month in both groups.
Materials and Methods: The study was conducted in the urology operating room of Mugla Sitki Kocman Training
and Research Hospital between December 2019 and March 2023. A total of 122 patients were included in the
study: 22 females with a mean age of 56.63 ± 12.99 years and 100 males with a mean age of 63.18 ± 8.00 years. In
one group (group 1), ONB was performed under ultrasound guidance by the same anesthesiologist, and in another
group (group 2), ONB was performed blindly based on anatomical signs by the same urologist.
Results: Adductor muscle contraction was not observed in 53 patients (91.4%) in group 1 and in 49 patients
(76.6%) in group 2 (p = 0.027).
Conclusion: The success rate of ONB was higher when using an ultrasound-guided technique than when using a
blind technique.