Urology Journal

Purpose: The prevalence of kidney stone disease and associated events is rising, with modern surgical approaches emphasizing minimally invasive techniques like ambulatory percutaneous nephrolithotomy (PCNL). This strategy offers potential benefits such as reduced costs, improved efficiency, and high patient satisfaction. However, its safety and feasibility require further evaluation.

Methods: A systematic review was conducted following PRISMA guidelines. Databases including PubMed, Embase, Scopus, and the Cochrane Library were searched for studies on ambulatory PCNL published between 1986 and 2024. Out of 2381 identified studies in the initial pool, 17 met the inclusion criteria. Data were analyzed regarding patient selection, technical modifications, surgical outcomes, and complications.

Results: The review included 456 patients undergoing 459 procedures. Ambulatory PCNL was feasible for highly selected patients meeting strict criteria (ASA <3, BMI <35 kg/m², no major comorbidities, and minimal stone burden). Mean operative time was 103 minutes, with an average hospital stay of 6.4 hours. The procedure achieved a 93% stone clearance rate, with 15% experiencing mild complications (Clavien-Dindo grade 1-2) and 4.6% readmissions. Severe complications (grade 3-4) were rare (0.4%).

Conclusion: Ambulatory PCNL is a safe, efficient option for select patients, optimizing healthcare resources and improving patient outcomes. Wider adoption requires standardized protocols and multicenter studies to expand its application.

Purpose: To investigate the efficacy of the flexible vacuum-assisted ureteral access sheath (FV-UAS) combined with disposable flexible ureteroscope (FURS) versus tubeless-mini percutaneous nephrolithotomy(T-PCNL) in the treatment of renal calculi with a diameter of 2-3 cm.

Materials and methods: This retrospective analysis included 270 patients of renal calculi with a maximum diameter of 2-3 cm treated between January 2022 to July 2024. Of these, 146 cases were treated with single use ureteroscopic lithotripsy through a FV-UAS while 124 cases were treated by tubeless PCNL (T-PCNL group) through 16F amplatz sheath. Perioperative indicators and postoperative stone-free rates (SFR) were compared.

Results: There was no significant difference in the stone free rates（SFRs） between the two surgical methods. Using the criterion of a residual kidney stone diameter less than 4 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% confidence interval (CI): 0.56-2.28, odds ratio (OR) = 1.13, P = .724; the SFRs at 1 month postoperatively were compared: 95% CI: 0.417-2.60, OR = 1.041, P = .931. Using the criterion of a residual kidney stone diameter less than 2 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% CI: 0.355-1.055, OR = 0.612, P = .076; the SFRs at 1 month postoperatively were compared: 95% CI: 0.374-1.320, OR =.703, P = .271. There was no significant difference in the incidence of systemic inflammatory response syndrome (SIRS) and the need for postoperative analgesia between the two groups (P=0.813, P=0.839, respectively). The surgical duration in the FV-UAS group was significantly longer (P<0.001). The decrease in postoperative hemoglobin(Hb) levels and hospital stay in the FV-UAS group were significantly lower than those in the T-PCNL group (P<0.001).

Conclusion: For treating 2-3 cm renal calculi, both FV-UAS with disposable ureteroscope and 16F tubeless PCNL yield high stone-free rates. FV-UAS-assisted FURS reduces bleeding and hospital stay, whereas 16F tubeless PCNL shortens surgery duration.

Purpose: The surgical approach to pediatric cryptorchidism has traditionally been the inguinal pathway. However, that has changed with the increased use of scrotal incision and single-site transumbilical laparoscopy, both of which result in a scarless surgical incision. We aimed to review our experience with the combined utilization of these two methods for the treatment of pediatric cryptorchidism and evaluate the surgical outcomes.

Materials and Methods: This retrospective case series included 267 children who underwent scarless orchiopexy between January 2019 and December 2022. Data were gathered from case and operative records. Testicular retraction, testicular atrophy, other complications, cosmetic outcomes, and parental satisfaction were evaluated.

Results: A total of 267 children (aged 1–7.4 years, median 1.8 years) with palpable and nonpalpable undescended testes underwent scarless orchiopexy at our center. Among them, 58 (21.7%) were treated with scrotal incision and 209 (78.3%) underwent single-site transumbilical laparoscopic surgery. The follow-up period ranged from 6 to 53 months, with an average of 26.2 months. During the follow-up period, testicular retraction (4 cases, 1.5%) and atrophy (5 cases, 1.9%) occurred in the laparoscopic group. One child in the laparoscopic group developed a hydrocele, but recovered after 3 months. In most cases (98.9%), the scars were invisible, indicating an excellent cosmetic effect.

Conclusion: The combination of scrotal incision and transumbilical laparoscopic orchiopexy can resolve cryptorchidism in children at different locations and achieve successful outcomes with a low rate of postoperative complications and good cosmetic results.

Background: Metabolic syndrome is considered a risk predictor for erection dysfunction (ED). However, the effect of serum uric acid (UA) on the development of ED is little known.

Methods: We adopt propensity score matching analysis (PSM) to adjust multitudinous confounding factors such as age, metabolic syndrome, sex hormone and some blood measurements. The members of the normal UA and high UA participator were matched at a 1:1 ratio by propensity score. And we used two diagnostic methods IIEF-5 and nocturnal penile tumescence and rigidity (NPTR) to assess and diagnose ED.

Results: Before PSM, total 120 participators were included, compared with participants with normal serum UA (n=61), those with high serum UA(n=59) had statistic difference in some baseline information (BMI 27.8 ± 7.4 vs 24.4 ± 5.1 kg/m², p = 0.004; TG 2.1 ± 1.8 vs 1.5 ± 0.9 mmol/L, p = 0.015; creatinine 70.5 ± 9.9 vs 66.3 ± 10.7 umol/L, p = 0.03; T 450.9 ± 181.0 vs 598.2 ± 186.3 ng/dL, p < 0.001). After PSM, total 82 participators were included, with high level of serum UA (n = 41, Group A) and normal serum UA (n = 41, Group B). On the result of IIEF-5, 40 of 41 participants (97.6.0%) with high UA diagnosed ED, whereas 39 of 41 participants (95.1%) with normal UA diagnosed ED, the incidence has no statistical significance between two groups (p > 0.999). On the result of NPTR, the mean number of erections in Group A was 4.1 ± 2.0, was significantly less than the same parameter in Group B (5.3 ± 1.9, p = 0.004); 9 of 41 participants (22.0%) with high UA develop ED, whereas 14 of 41 participants (34.1%) with normal UA develop ED, the incidence has no statistical significance between Group A and Group B (p = 0.326).

Conclusions: Our study revealed that high UA did decrease the number of erections in night, which was diagnosed by NPTR. High uric acid may be a potential risk factor for ED and more large studies are needed.

Purpose: Sperm cryopreservation is a valuable method for fertility preservation in men who suffer from oligozoospermia and cancer. The increase of oxidative stress during this process negatively affects the sperm viability, membrane fluidity, and function. Supplementation of antioxidants to the cryopreservation medium can reduce these negative effects. This study investigated the effects of 6-Gingerol as a natural antioxidant during human sperm cryopreservation on different sperm parameters, DNA fragmentation, and apoptosis.

Material & Method: In this experimental study, semen samples were obtained from 42 normozoospermic men referred to the Royan Institute. The samples were randomly divided into Fresh, Control (cryopreservation), and Gingerol (cryopreservation with 6-Gingerol) groups. Sperm evaluations were conducted before and after cryopreservation. Sperm parameters, DNA fragmentation index (DFI), caspase-3 activity, reactive oxygen species (ROS) levels, malondialdehyde (MDA) concentration, and total antioxidant capacity (TAC) levels were assessed.

Results: Use of 6-gingerol in the cryopreservation medium resulted in the recovery of a significantly higher viable sperm post-cryopreservation compared to the control group (64.1 ± 1.3 % vs 56.4 ± 1.3 %; P = 0.000). The ROS levels were significantly lower (P = 0.000), and percent sperm with intact membrane potential was significantly higher (P = 0.000) in the gingerol group (26.1 ± 0.1 RLU/s, 63.5 ± 1.4 %) compared to the control group (32.1 ± 0.7 RLU/s, 53.3 ± 1.5 %).  Active caspase-3 (P = 0.007) and DFI (P = 0.008) were non-significantly lower in the gingerol group (47.3 ± 3.6 %, 37.9 ± 1.3 %, respectively) compared to the control group (60.5 ± 3.6 %, 42.1 ± 0.1 %, respectively).

Conclusion: Supplementing sperm cryopreservation medium with 6-Gingerol could improve sperm quality and function, and positively affect the degree of apoptosis incidence during sperm freezing.