International Urology and Nephrology最新文献

{"title":"TITAL: targeting renal fibrosis with sulforaphane-a promising therapeutic strategy.","authors":"Hussain Ramzan, Humaira Kousar, Azeem Rab Nawaz","doi":"10.1007/s11255-024-04352-7","DOIUrl":"10.1007/s11255-024-04352-7","url":null,"abstract":"<p><p>Renal fibrosis is a hallmark of chronic kidney disease, characterized by the excessive accumulation of extracellular matrix proteins. Sulforaphane, a potent antioxidant found in cruciferous vegetables, has shown promise in targeting renal fibrosis. By inhibiting fibrotic pathways, such as TGF-β signaling, and promoting antioxidant defenses, sulforaphane may offer a novel therapeutic strategy for mitigating kidney damage and slowing disease progression. Further research is needed to fully explore its therapeutic potential.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"1851-1852"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of in vitro exposure of first-line antiretrovirals on healthy human spermatozoa on kinematics and motility.","authors":"Sohan Zane Pinto, Natalie Aneck-Hahn","doi":"10.1007/s11255-024-04340-x","DOIUrl":"10.1007/s11255-024-04340-x","url":null,"abstract":"<p><strong>Purpose: </strong>Contemporary antiretroviral (ARV) medications are used by millions of men for HIV treatment worldwide. Limited data exist on their direct effect on sperm motility. This pilot study hypothesizes that in vitro exposure to ARVs will reduce sperm kinematic and motility parameter values.</p><p><strong>Methods: </strong>This laboratory-based experimental study analyzed sperm motility and kinematics after exposure to the ARVs Dolutegravir, Tenofovir, and Emtricitabine, individually and in combination. Each participant (n = 23) served as their experimental control. The Microptic SCA® Computer Assisted Sperm Analysis (CASA) system, Barcelona, Spain was used to generate quantitative data on sperm motility and the kinematics Straight-line velocity (VSL), Straightness index (STR), Linearity Index (LIN), Beat cross frequency (BCF), and the oscillation index (WOB).</p><p><strong>Results: </strong>VSL, STR, LIN, and WOB of the non-progressive (grade c) spermatozoa were significantly decreased after ARV treatment. BCF of the medium velocity progressive sperm population (grade b) was significantly increased 90 min after exposure in the Tenofovir arm, and a significant decrease in the proportion of grade b spermatozoa was recorded at 90 min in all the antiretroviral arms when compared to the control arm. No impaired sperm motility was observed within the first 30 min of exposure.</p><p><strong>Conclusion: </strong>Pharmacovigilance is a healthcare emergency as the fast-changing world of newer drugs leaves clinicians vulnerable. They must prescribe drugs whose long-term somatic and germline adverse effects are not fully understood. Guidelines and drugs are changing faster than we can monitor for side effects. Despite Dolutegravir being the only mainstream integrase inhibitor first-line ARV in South Africa for five years, its replacement, Cabotegravir, is already being launched. More research in this field is required, especially for commonly prescribed drugs. This preliminary pilot study concludes that the current first-line ARVs used by HIV patients and HIV-negative patients on pre-exposure prophylaxis (PrEP) can alter sperm motility and kinematics. Further research with a larger sample size is warranted to quantify its impact on human fertility, addressing the limitations of this study, before a comprehensive conclusion of the effects of ARVs on human male fertility can be drawn. Of particular importance would be to study the impact of ARVs on reactive oxygen species levels in semen and sperm DNA fragmentation.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"1715-1735"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imagining the future: the five \"Laws\" of endourethroplasty.","authors":"Dmitriy Nikolavsky","doi":"10.1007/s11255-025-04582-3","DOIUrl":"https://doi.org/10.1007/s11255-025-04582-3","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating intermediate-term functional outcomes of double-sided buccal mucosal graft urethroplasty for anterior urethral stricture.","authors":"Osama Mahmoud, Ahmed Mahmoud Reyad, Mostafa AbdelRazek, Mohamed Saber-Khalaf, Omar Mohamed, Atef Fathi","doi":"10.1007/s11255-025-04579-y","DOIUrl":"https://doi.org/10.1007/s11255-025-04579-y","url":null,"abstract":"<p><strong>Aim of the study: </strong>This study aims to evaluate the urinary and sexual outcomes following double-sided buccal mucosal graft (BMG) urethroplasty in patients with near-obliterated anterior urethral strictures.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients who underwent double-sided BMG urethroplasty between June 2017 and September 2024. We included only patients with complete perioperative data and a follow-up period of at least 6 months. The double-sided approach was utilized for nearly obliterated stricture segments (less than 6 French) during augmentation of long bulbar and bulbopenile urethral strictures (> 2 cm). The primary outcomes measured was the success rate, defined as the absence of need for secondary intervention, while the secondary outcome was the changes in erectile function assessed using the International Index of Erectile Function (IIEF).</p><p><strong>Results: </strong>The final analysis included 52 patients, median age of 42 years, with a median stricture length of 4 cm (40 patients with bulbar and 12 with bulbo-penile strictures). Among the cohort, 30 (57.7%) patients were treated via a ventral approach with dorsal inlay plus ventral onlay BMG urethroplasty, while 22 patients (42.3%) were treated with ventral inlay plus dorsal onlay grafting via either a dorsal or dorsolateral approach. There were no intraoperative complications, and only one patient (2%) experienced a major postoperative complication, namely a perineal hematoma, which required re-exploration and evacuation. Six patients showed contrast leakage on urethrograms post-catheter removal, effectively managed with additional catheterization for two weeks. A significant improvement in Q-max values was noted from baseline to six months after surgery (5 vs. 20 ml/sec, p < 0.001). After a median follow-up of 24 months (IQR 18-32 months), stricture recurrence was observed in 4 patients (7.7%), all of whom had prior failed urethroplasties and longer stricture lengths (median 8 cm, range: 5-10 cm). Additionally, IIEF scores showed preserved or improved sexual function in most patients, with only 2 (3.8%) patients.</p><p><strong>Conclusion: </strong>Double-sided buccal mucosal graft urethroplasty demonstrates favorable urinary and sexual outcomes in managing near-obliterated bulbar and bulbo-penile urethral strictures. Further long-term studies are warranted to broaden the understanding of its efficacy and sustainability in diverse patient populations.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finerenone's safety and efficacy in membranous nephropathy: an emerging perspective.","authors":"Aqsa Afzal, Ayesha Fatima, Ayesha Abdul Razzaq","doi":"10.1007/s11255-025-04557-4","DOIUrl":"https://doi.org/10.1007/s11255-025-04557-4","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current clinical management of muscle wasting in hemodialysis patients with end-stage renal disease.","authors":"Shiyu Zhang, Lingge Zhang, Hao Wu, Lu Li","doi":"10.1007/s11255-025-04563-6","DOIUrl":"https://doi.org/10.1007/s11255-025-04563-6","url":null,"abstract":"<p><strong>Objectives: </strong>Currently, the proportion of haemodialysis patients with combined sarcopenia is as high as 13.7%, and the prevalence of sarcopenia in patients over 60 years of age is 33.3%. At present, the pathogenesis of combined sarcopenia in dialysis patients and the intervention strategies are still unclear, and the aim of this paper is to explore the pathogenesis of sarcopenia in haemodialysis patients and the clinical management strategies to improve the patients' prognosis and quality of life.</p><p><strong>Methods: </strong>The relationship between sarcopenia and microinflammation and protein metabolic imbalance was analysed and the effects of nutritional supplementation, exercise and pharmacological treatment were assessed.</p><p><strong>Conclusions: </strong>The management of sarcopenia, which is critical for improving quality of life in haemodialysis patients, is associated with multiple factors, including microinflammation, reduced protein synthesis, and hormonal dysregulation. This article proposes an integrated management strategy of diet, exercise and pharmacotherapy and explores new therapeutic targets such as methylglyoxal to improve patient prognosis.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive clinical characteristics for adverse pathological outcomes in intermediate- and high-risk prostate cancer during biopsy.","authors":"Miroslav Stojadinovic, Nebojsa Jurisevic, Milorad Stojadinovic, Slobodan Jankovic","doi":"10.1007/s11255-025-04577-0","DOIUrl":"https://doi.org/10.1007/s11255-025-04577-0","url":null,"abstract":"<p><strong>Purpose: </strong>Adverse pathological features in prostate cancer (PCa) are characteristics found in biopsy tissue that indicate a more aggressive or advanced disease. This study aims to develop a biopsy-based model for assessing the risk of adverse PCa and to evaluate its performance against the European Randomized Study of Screening for Prostate Cancer (ERSPC) Risk Calculator (RC) 3/4 and PSA models.</p><p><strong>Methods: </strong>Between January 2017 and December 2022, patients with prostate-specific antigen (PSA) levels of ≤ 50 ng/mL underwent prostate biopsies. The patients' age, PSA, digital rectal exam, prostate volume, PSA density (PSAD), previous negative biopsy, number of positive cores, Gleason score, and biopsy outcomes were documented. Patients were classified into categories: no cancer, very low-risk, low-risk, intermediate-risk, and high-risk groups. We investigated the relationship between our model and adverse PCa using a binary Generalized Linear Model (GLM). We evaluated the model's discriminatory ability using the area under the receiver operating characteristic curve (AUC) and compared its predictive performance with the adverse model in terms of discrimination, calibration, and clinical utility.</p><p><strong>Results: </strong>Out of 824 patients, PCa was diagnosed in 320 (38.8%) men, and 203 (24.6%) had unfavorable PCa. The GLM demonstrated improved performance metrics, with an AUC of 0.766, compared to 0.639 for the RC 3/4 model and 0.655 for the PSA model. The GLM showed a good fit and provided a greater net benefit.</p><p><strong>Conclusion: </strong>The study identified clinical predictors of adverse PCa during biopsy, demonstrating moderate discrimination and clinical utility. Further large multicenter studies are required for validation.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of urinary tract dilation and society for fetal urology classifications in predicting indication and success of pyeloplasty in ureteropelvic junction obstruction.","authors":"Burak Elmas, Murat Yavuz Koparal, Eda Tokat, Berk Batuk, Mustafa Özgür Tan, Özdemir Serhat Gürocak","doi":"10.1007/s11255-025-04578-z","DOIUrl":"https://doi.org/10.1007/s11255-025-04578-z","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to compare the ability of the Urinary Tract Dilatation (UTD) and Society for Fetal Urology (SFU) classification systems to predict the need for treatment and the success of the applied treatment methods for ureteropelvic junction obstruction (UPJO) patients.</p><p><strong>Patients and methods: </strong>The study included 239 patients who underwent follow-up, J stent insertion, or pyeloplasty due to UPJO between 2012 and 2022, with complete long-term follow-up data. During the follow-up period, failure was defined as fractional function decrease, lack of diuretic response, t1/2 increase, persistent symptoms, or an increase in hydronephrosis degree. Treatment modality and success were compared between UTD and SFU subgroups.</p><p><strong>Results: </strong>In the study, a total of 239 patients were included, of whom 67 (28%) were female and 172 (72%) were male. The median age of the patients was 84 months (2-154.5 months), and the mean follow-up duration was 55 months (13-130 months). UPJO was observed in 99 (41.4%) patients in the right kidney and 140 (58.6%) patients in the left kidney. There were no statistically significant differences between the groups in terms of age, gender, side, and comorbidities (p = 0.165, p = 0.620, p = 0.441, and p = 0.768, respectively). We found a strong correlation between UTD and SFU classifications for patient treatment success, while a moderate correlation was observed for treatment failure (r = 0.816 and r = 0.575, respectively). Confirmed by both UTD and SFU classifications, conservative treatment was the appropriate choice for success in low-grade diseases, while pyeloplasty should be offered in high-grade diseases.</p><p><strong>Conclusion: </strong>Both UTD and SFU classification systems show similar ability to predict the success rates regarding treatment methods for UPJO with a higher degree of confidence.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of adjuvant amikacin combined with oral levofloxacin as prophylaxis for transrectal prostate biopsy in patients harboring fluoroquinolone-resistant Escherichia coli in rectal flora.","authors":"Yoshitsugu Nasu, Masanori Hanamoto, Ryota Fujisawa, Daisuke Tanaka, Noriko Kosaka","doi":"10.1007/s11255-025-04569-0","DOIUrl":"https://doi.org/10.1007/s11255-025-04569-0","url":null,"abstract":"<p><strong>Purpose: </strong>Fluoroquinolones (FQs) are commonly used as antibiotic prophylaxis before transrectal ultrasonography-guided prostate biopsy (TRPB). The presence of FQ-resistant E. coli (QREC) in the rectal flora is thought to be a risk factor for febrile complications following the TRPB, and culture-based antimicrobial selection is recommended as prophylaxis for patients with QREC. Amikacin (AMK) is a promising prophylactic agent because of its potent antimicrobial activity against QREC and excellent permeability of the prostate tissue. We evaluated the efficacy of adjuvant AMK in combination with oral levofloxacin (LVFX) as an antibiotic prophylaxis for TRPB.</p><p><strong>Methods: </strong>Between October 2016 and September 2024, 531 patients with E. coli isolated from rectal swab cultures were enrolled. Patients with diabetes, urinary tract infections, or those on immunosuppressive agents were excluded. Rectal swabs were cultured prior to TRPB. Isolated E. coli was determined as QREC when their minimum inhibitory concentration (MIC) of LVFX was 4 μg/mL or above. As antimicrobial prophylaxis for all patients, a single oral 500 mg of LVFX was administered 2 h before TRPB. For patients with QREC, AMK 400 mg was administered intravenously before the TRPB. The patients were followed up for 30 days after the TRPB and febrile infective complications were recorded.</p><p><strong>Results: </strong>Fifty-nine QREC carriers (11.1%) were identified. All QREC were sensitive to AMK. Eleven (2.1%) patients experienced febrile complications after TRPB. Four of them were QREC carriers and the others were non-QREC carriers. The incidence of febrile complications following TRPB among QREC carriers was higher than that among non-QREC carriers (6.8%, 4/59 vs 1.5%, 7/472; p = 0.025, Fisher's exact test).</p><p><strong>Conclusions: </strong>Infection control with an AMK adjuvant to oral LVFX in QREC carriers had limitations, although all QREC were sensitive to AMK. We concluded that culture-based antimicrobial prophylaxis has limitations in the complete prevention of febrile complications following TRPB. While escalation or further augmentation of prophylactic agents will reduce febrile complications in the short term, it will accelerate the increase in resistant bacteria in the long term and violate the principles of good antibiotic stewardship. For resistant strain carriers, switching to transperineal prostate biopsy should be considered.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension among PD patients.","authors":"Yanhong Guo, Silu Zhao, Xuewen Zhang, Rong Gou, Liuwei Wang, Yulin Wang, Zihan Zhai, Lu Yu, Lin Tang","doi":"10.1007/s11255-025-04580-5","DOIUrl":"https://doi.org/10.1007/s11255-025-04580-5","url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary hypertension is an independent risk factor for all-cause mortality and cardiovascular events in peritoneal dialysis (PD) patients with heart failure with preserved ejection fraction (HFpEF). However, there is still no effective treatment. The aim of this study is to evaluate the efficacy and safety of sacubitril/valsartan in PD patients with HFpEF and pulmonary hypertension.</p><p><strong>Patients and methods: </strong>145 PD patients with HFpEF and pulmonary hypertension receiving sacubitril/valsartan were recruited in this study. 38 PD patients with HFpEF and pulmonary hypertension treated with angiotensin receptor blocker (ARB) were enrolled as the control group. The follow-up time was 3 months. We evaluate efficacy and safety of sacubitril/valsartan through biochemical parameters, and echocardiographic indicators, and adverse reactions.</p><p><strong>Results: </strong>At the end of follow-up, the pulmonary artery pressure was significantly lower [33.00 (23.00, 45.50) vs 48.00 (40.00, 54.00) mmHg, P < 0.001] after the treatment of sacubitril/valsartan. The percentage change of pulmonary artery pressure after the treatment of sacubitril/valsartan was significantly higher than that of ARB [-30.00 (-48.78, -8.23) vs -8.57 (-12.80, -0.85) %, P < 0.001]. As the biomarkers of heart failure, the levels N-terminal B-type natriuretic peptide precursor and cardiac troponin I were remarkably reduced after the treatment with sacubitril/valsartan. Sacubitril/valsartan can also attenuate left-ventricular remodeling among PD patients. While, ARB does not show significant advantages compared to sacubitril/valsartan.</p><p><strong>Conclusion: </strong>Our study suggested that sacubitril/valsartan treatment might be an effective treatment for PD patients with HFpEF and pulmonary hypertension.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}