Urology Journal

Purpose: Clear cell renal cell carcinoma (ccRCC), the dominant subtype of renal malignancy, has a rising global incidence and mortality. While surgery is the standard of care for localized cases, adjuvant therapy aims to improve outcomes in high-risk postoperative patients. To quantify the clinical value of adjuvant pharmacotherapy, this systematic review and meta-analysis assesses its effect on overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) in patients with ccRCC.
Materials and Methods: A comprehensive search of the Web of Science, Embase, Cochrane Library, and PubMed databases was conducted for articles published up to October 2024. The search used the English keywords “clear cell renal cell carcinoma,” “adjuvant drug therapy,” and “randomized controlled trials,” combined with a free-word search. Randomized controlled trials (RCTs) assessing the effectiveness of at least one adjuvant drug therapy in patients with ccRCC were included.
Results: The meta-analysis showed that adjuvant drug therapy did not result in a statistically significant improvement for OS or PFS compared with the control group. There was also no statistically significant difference in DFS (P > 0.05). This systematic review provides evidence on the impact of adjuvant targeted therapy on OS, DFS, and PFS for patients with clear cell renal cell carcinoma.
Conclusion: This study summarizes the effects of adjuvant drug therapy on OS, PFS, and DFS in ccRCC patients. The evidence from this meta-analysis can inform clinical decision-making, support risk stratification strategies, and encourage the integration of OS-driven endpoints in future trial designs, thereby providing valuable data for the treatment of ccRCC.

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 with renal calculi with a maximum diameter of 2–3 cm treated between January 2022 and July 2024. Of these, 146 cases were treated with single-use ureteroscopic lithotripsy through an FV-UAS, while 124 cases were treated by tubeless PCNL (T-PCNL group) through a 16F Amplatz sheath. Perioperative indicators and postoperative stone-free rates (SFRs) 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: 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: 95% CI, 0.355–1.055; OR = 0.612; P = .076; the SFRs at 1 month postoperatively were: 95% CI, 0.374–1.320; OR = 0.703; 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 = .813 and P = .839, respectively). The surgical duration in the FV-UAS group was significantly longer (P < .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 (both P < .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: To compare general anesthesia (GA) with spinal anesthesia (SA) regarding postoperative pain and satisfaction after ureteroscopic lithotripsy (URSL).
Materials and Methods: Two hundred twenty-nine patients were analyzed in the study. Patients were assigned to two groups—SA and GA. Demographic data, stone characteristics, operation time, and frequency of opioid analgesic use during the admission period were collected from hospital medical records. Visual analogue scale (VAS) scores at 6 hours and 24 hours after URSL were recorded. Complications according to the Clavien–Dindo classification and the experience of headaches after surgery (Yes/No) were documented after one month. Participants and surgeons were asked to rate their satisfaction on a scale of 1 to 10.
Results: Of 237 eligible patients, 229 completed the study. The incidence of headaches and VAS scores (at 6 h and 24 h) were significantly higher in the SA group (P < 0.001). Patient and surgeon satisfaction in the GA group were significantly higher (P < 0.001). Multivariate analysis showed that female sex was associated with lower opioid analgesic use during the admission period (odds ratio [OR] = 0.47), and surgery time correlated with frequency of opioid use and headache (OR = 1.12 and OR = 1.11, respectively).
Conclusion: GA was associated with better postoperative pain control after URSL and higher satisfaction levels for both surgeons and patients.

Purpose: To describe our integrated pelvic fascial structure-sparing (IPFSS) technique for robotic-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder (ONB) reconstruction and to evaluate its impact on urinary continence and sexual function in male patients.
Methods: This retrospective observational study was conducted at a single high-volume center. Male bladder cancer patients who underwent IPFSS RARC with ONB were included. Demographic, clinical, and pathological data were collected. Functional outcomes were evaluated and compared with a cohort of patients who underwent conventional non–nerve-sparing RARC.
Results: Thirty-six patients were included in the IPFSS group and 42 in the conventional group. RARC with intracorporeal urinary diversion was successfully completed in all patients without open conversion. The mean total operative time was 387.9 minutes in the IPFSS group and 392.0 minutes in the conventional group (p = 0.465). At 3 months post-surgery, 30 patients (83%) in the IPFSS group achieved daytime continence (0–1 pads), compared to 14 patients (33%) in the conventional group. By 6 months, daytime continence increased to 35 patients (97%) in the IPFSS group, while 28 patients (67%) in the conventional group achieved similar results. At 6 months, 30 patients (83%) in the IPFSS group reported full potency with or without phosphodiesterase type 5 (PDE5) inhibitors, compared to only 3 patients (7%) in the conventional group.
Conclusion: We present a feasible surgical technique for RARC that involves holistic preservation of the pelvic fascial architecture. This approach is associated with a rapid recovery of daytime continence and sexual function in male patients.

Purpose: This study was designed to evaluate the effectiveness of dynamic neuromuscular stabilization (DNS) training in children with non neurogenic lower urinary tract dysfunction (LUTD) and compare it with biofeedback (BF) treatment.
Materials and Methods: A total of 15 participants aged 6–15 years with non neurogenic LUTD were divided into three groups: Group I, DNS exercise training; Group II, BF training; and Group III, DNS plus BF training. Dysfunctional Voiding and Incontinence Scoring System (DVISS) scores, uroflowmetry parameters, uroflow curve, post void residual (PVR) values, and deep trunk muscle strength were evaluated at baseline and at 4, 8, and 12 weeks after treatment.
Results: Total DVISS scores significantly decreased after 12 weeks in Groups I and III, while Group II showed
significant decreases at 4 and 8 weeks (P < .05). Improvements in deep trunk muscle strength at 4 and 8 weeks were significantly greater in Groups I and III than in Group II (P < .05). In Group I, average flow rate increased at 4 weeks and flow time decreased at 12 weeks (P < .05). PVR decreased significantly at 12 weeks in Group I and at 8 weeks in Group III (P < .05).
Conclusion: DNS and BF training are effective in improving symptoms in patients with non neurogenic LUTD; however, groups receiving DNS exercises were superior for several parameters.

Purpose: Men with lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) often experience erectile dysfunction (ED). While transurethral resection of the prostate (TURP) can improve ED, new onset ED remains a concern. This study compares monopolar (M TURP) and bipolar (B TURP) techniques, with a subgroup analysis based on phosphodiesterase 5 inhibitor (PDE5i) use.
Materials and Methods: This randomized clinical trial included candidates for TURP aged over 50 years. Patients were divided into M TURP and B TURP groups. Erectile function was assessed using the International Index of Erectile Function 15 (IIEF 15) at baseline, six weeks, and six months post surgery.
Results: A total of 205 patients were analyzed (102 M TURP, 103 B TURP). Baseline characteristics, perioperative findings, and surgical complications were similar. IIEF 15 scores were comparable between groups at all time points. In the PDE5i user subgroup, M TURP showed a slight short term decline in erectile function and total scores at 6 weeks, but both groups demonstrated no significant long term changes at 6 months.
Conclusion: No significant difference was observed between M TURP and B TURP on erectile function during medium term follow up. Patients with prior PDE5i use may experience fewer short term adverse effects on erectile function from B TURP.

Purpose: Sperm cryopreservation is a valuable method for fertility preservation in men who suffer from oligozoospermia and cancer. The increase in oxidative stress during this process negatively affects 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.
Materials and Methods: 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 recovery of a significantly higher proportion of viable sperm post-cryopreservation compared with the control group (64.1 ± 1.3% vs 56.4 ± 1.3%; P = 0.000). ROS levels were significantly lower (P = 0.000), and the percentage of 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 with 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 lower in the gingerol group (47.3 ± 3.6%; 37.9 ± 1.3%, respectively) compared with the control group (60.5 ± 3.6%; 42.1 ± 0.1%, respectively), though the differences for caspase-3 and DFI did not reach statistical significance where indicated by the authors.
Conclusion: Supplementation of the sperm cryopreservation medium with 6-gingerol could improve sperm quality and function and positively affect the degree of apoptosis during sperm freezing.