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: Estrogen receptor (ER) genes play key roles in male and female reproduction. Non-obstructive azoospermia (NOA) and severe secretory oligozoospermia (SOL) are the most severe and complex conditions impacting male fertility. This meta-analysis aimed to study the association between PvuII ( rs2234693, 397T>C ), XbaI ( rs9340799, 351G>A ), AluI (1730G>A, rs4986938), and RsaI (1082G>A, rs1256049) polymorphisms and spermatogenic failure.

Materials and Methods: The literature in PubMed, Medline, Embase, Web of Science, Cochrane Library, China Science and Technology Journal Database, WanFang data, and China National Knowledge Infrastructure databases were systematically searched, and a meta-analysis was conducted to investigate the association between polymorphism in estrogen receptors and spermatogenic failure. According to a set criterion, 10 studies were included for analyses.

Results: ER α XbaI polymorphism was a decreased risk of NOA. The ER α PvuII polymorphisms does not associate with NOA and SOL. ER β AluI polymorphism increased the risk of NOA in Caucasian population. ER β RsaI polymorphism was a decreased risk of NOA and SOL in Caucasian males.

Conclusion: The ER α XbaI and ER β RsaI polymorphisms are associated with the risk of NOA and SOL.

Purpose: The incidence of ureteral injury is increasing due to extensive application of the endourological procedures. In the present study, we evaluated the accuracy of imaging studies in predicting length of defect in patients with ureteral injury.

Methods: We reviewed data of all consecutive patients who underwent endourological management for ureteral injury in our institution from Jan 2020 to Jan 2023, to assess the accuracy of radiological evaluations in determining the length of ureteral defect. We compared the radiological imaging results with intraoperative findings to determine its diagnostic accuracy.

Results: We report data on accuracy of preoperative imaging and outcomes of endourological management in 5 patients who presented with apparently long ureteral defects in preoperative radiological evaluations following ureteral injury. The mean age was 42[30.5-42.5]. three of five were male. The mean time from injury to ureteroscopic management was 12.5±7.5 days. The mean follow up time was 7.3±2.2 months.  Our experience showed that radiological evaluations have the potential to overestimate the length of defect.

Conclusion: Radiological evaluations following ureteral injury have the potential to overestimate the length of defect and therefore endoscopic evaluations and intraoperative imaging studies are necessary to accurately determine the length of defect and appropriate management. However, endourological management is safe and efficient in treating patients with short segment ureteral defect/injury.

Purpose: The purpose of this combination research was to examine the relationship between systemic inflammation and the risk of prostate cancer (PCa) through the National Health and Nutrition Examination Survey (NHANES) cross-sectional study and two-sample Mendelian randomization (MR) analysis.

Materials and Methods: We incorporated NHANES data spanning the years 2001 to 2010, with exposure as systemic inflammation, evaluated using systemic immune-inflammation index (SII) and outcome as PCa, and performed multivariate logistic regression and restricted cubic spline (RCS) to test the correlation between SII and PCa. Further, two-sample MR was used to identify causal associations between specific immune cells and PCa.

Results: A total of 7706 participants (age≥40 years) were included in the analysis in the cross-sectional study, including 350 PCa cases, 7356 controls. Higher SII levels were associated with increased odds of PCa (P<.05). The odds ratio (OR) for PCa was 1.51 (95% CI 1.09-2.08) for the highest versus lowest quartile of SII levels in the fully adjusted model. Also, the RCS analysis showed a threshold effect, with SII levels above 8.90 associated with increased odds of PCa. In addition, MR results suggested a causal relationship between CD62L- monocyte, CD62L- HLA DR+ monocyte, CD14+ CD16+ monocyte, CD62L- Dendritic Cell, Monocytic Myeloid-Derived Suppressor Cell, CD28- CD8dim T cell, CD39+ resting CD4 regulatory T cell and PCa (P<.05).

Conclusion: This combination analysis provides evidence for a significant causal relationship between systemic inflammation and PCa risk. These findings highlight systemic inflammation and inflammatory immune responses as potential modifiable risk factors for PCa.

Objective: Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the results of dorsal dartos flap rotation technique in children with isolated penile torsion.

Materials and Methods: 5470 boys who applied to our clinic between 2012 and 2022 for circumcision were evaluated for congenital isolated penile torsion. They were classified according to the degree and direction of torsion and clinical findings were analyzed.  According to the degree of torsion, penile degloving or dorsal dartos flap rotation technique with circumcision was performed. Patients whose torsion corrected after penile degloving were excluded from the study. The results of dorsal dartos flap rotation technique were evaluated. 

Results: Congenital isolated penile torsion ≥60° was identified in 1.04 % (n=57) of the children. Eight patients whose torsion corrected after penile degloving were excluded from the study. 49 patients who underwent dorsal dartos flap rotation had a mean age of 4.94 years (1-9) and a mean operation time of 29.9 min (20-40). The mean degree of torsion was 77.6° (60-110). The mean operation times in the < 90° and ≥ 90° dorsal dartos flap groups were statistically significant (p<0.05).  Residual torsion was statistically significant in the < 90° and ≥ 90° dorsal dartos flap groups (p<0.05).  At the postoperative 1st and 6th month follow-ups, torsion less than 10 degrees was observed in 3 patients who underwent dorsal dartos flap rotation technique. No residual torsion was observed in other patients.

Conclusion: Isolated penile torsion cases should not be overlooked during circumcision.  It seems possible to obtain successful results with dorsal dartos flap rotation in moderate and severe torsions.

Purpose: Our study aimed to evaluate the genetic etiology of treatment-resistant nocturnal enuresis in children who have undergone at least 6 episodes of behavioral therapy, urotherapy, alarm therapy, and medical treatment.

Materials and Methods: A total of 21 patients were included in the study. Inclusion criteria for the study comprised children aged 5-18 years diagnosed with treatment-resistant enuresis according to the International Children’s Continence Society (ICCS) guidelines. The capture-based Sophia Hereditary Disease Panel by Sophia Genetics was used specifically for nocturnal enuresis, consisting of a panel of 19 genes (AGXT, AQP2, AVPR2, BNC2, CLCNKB, DLG3, ELN, FA2H, FAM20A, FOXP1, HPSE2, KCNJ10, MLXIPL, NPHP3, RNF168, SLC12A3, SLC25A13, SLC5A2, SMARCA2).

Results: Patients were analyzed for genetic variations in genes associated with nocturnal enuresis, including AGXT, AQP2, AVPR2, BNC2, CLCNKB, DLG3, ELN, FA2H, FAM20A, FOXP1, HPSE2, KCNJ10, MLXIPL, NPHP3, RNF168, SLC12A3, SLC25A13, SLC5A2, and SMARCA2. No pathogenic changes potentially explaining the etiology of the disease were detected in 20 patients. One patient exhibited a variant in the AQP2 gene at hg19:Chr12:50344908 exon 1, c.295G>A locus, classified as a Variant of Uncertain Significance (VUS) according to the American College of Medical Genetic and Genomics (ACMG) 2015 guidelines. The AQP2 gene is associated with autosomal dominant and autosomal recessive inherited nephrogenic diabetes insipidus (type 2) in the OMIM (Online Mendelian Inheritance in Man) database.

Conclusion: Our study resembles studies indicating that nocturnal enuresis cases do not have a monogenic etiology but occur with multifactorial effects and have a weak correlation between genotype and phenotype.

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: To assess the efficacy and safety of very low-power Holmium Laser Enucleation of the Prostate (HoLEP) on a 30-W holmium laser source.

Materials and Methods:  With the approval of the local ethics committee, we retrospectively analysed 60 patients treated with HoLEP. There were 30 patients in the low-power (LP) group and 30 patients in the very low-power (VLP) group. For the LP group, we used a 60-W holmium laser machine. Throughout the en bloc process, we used laser settings of 2 J and 20 Hz. We used a 30-W low-power holmium source in the VLP group. We used laser settings of 2 J and 10 Hz. All patients were operated on by an experienced surgeon. We evaluated the surgical parameters and practicality of the low-power laser vs. the very low-power laser.

Results: All patients underwent successful HoLEP in the very low-power group; it was not necessary to increase the output of the laser in any case. Mean preoperatively estimated prostate volume was 88.1 mL (range, 30-300 mL). Mean enucleation time and enucleation efficiency were 67.9 min (range, 25–150 min) and 0.99 gm/min (range, 0.8–1.8 gm/min), respectively. No patient required blood transfusion postoperatively. No stress urinary incontinence (SUI) was observed in the 3rd month postoperative follow-up.

Conclusion: The use of a low-power laser source is encouraging for the learning curve of new surgeons who will begin HoLEP surgery; it can facilitate the adoption of HoLEP in developing countries, where the initial capital investment may be a major obstacle.