International Urology and Nephrology最新文献

{"title":"Composite metabolic indices and calcium oxalate stone formation: a multicenter comparative study of HOMA-IR, PAI, TyG, and METS-IR.","authors":"Muhammed Arif Ibis, Rifat Burak Ergul, Selim Soytürk, Yasin Yitgin, Cagrı Akpinar, Tzevat Tefik, Omer Onur Cakır, Murat Can Kiremit, Selcuk Guven, Kemal Sarica, Mehmet Ilker Gokce","doi":"10.1007/s11255-026-05204-2","DOIUrl":"10.1007/s11255-026-05204-2","url":null,"abstract":"<p><p>Urolithiasis has been increasingly recognized as a manifestation of systemic metabolic dysfunction rather than solely a local urinary disorder. In this multicenter cross-sectional study, we evaluated and compared the associations and discriminatory performance of four commonly used metabolic indices, homeostasis model assessment of insulin resistance (HOMA-IR), plasma atherogenic index (PAI), triglyceride-glucose (TyG) index, and metabolic score for insulin resistance (METS-IR), in relation to calcium oxalate stone formation. A total of 1206 adults (666 stone formers and 540 non-stone formers) were enrolled across seven tertiary centers, and calcium oxalate stone composition was confirmed by stone analysis. Metabolic indices were calculated using established formulas. Receiver-operating characteristic analyses and multivariable logistic regression models adjusted for age, sex, body mass index, hypertension, and diabetes mellitus were performed. HOMA-IR, PAI, and METS-IR demonstrated statistically significant but very limited discriminatory capacity, with AUC values only marginally exceeding 0.50, whereas TyG did not show significant discriminatory performance. In adjusted analyses, PAI (OR 1.72, 95%CI 1.09-2.71) and METS-IR (OR 1.05, 95%CI 1.01-1.08) were independently associated with stone formation, while HOMA-IR and TyG were not. These findings suggest that composite metabolic indices integrating lipid metabolism and adiposity may better reflect the metabolic milieu associated with calcium oxalate stone disease than glucose-centered insulin resistance markers alone. Although their standalone discriminatory performance is very limited, these indices may provide pathophysiological insights and serve as hypothesis-generating tools for future research.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4721-4728"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981763","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":"Complications after sentinel node biopsy and inguinal lymph node dissection in penile cancer: a Danish national cohort study.","authors":"J Mølsted, A B Als, J B Jensen, M Aagaard, J K Jakobsen","doi":"10.1007/s11255-026-05231-z","DOIUrl":"10.1007/s11255-026-05231-z","url":null,"abstract":"<p><strong>Purpose: </strong>Sentinel node biopsy (SNB) and inguinal lymph node dissection (ILND) are central to penile cancer management, but ILND especially carries substantial morbidity. This nationwide study explores the extent and risk factors of postoperative complications after inguinal lymph node surgery in Danish penile cancer patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of penile cancer patients diagnosed in Denmark 2013-2025. Surgical procedures, pathological outcomes, and complications were extracted from medical records. Univariable and multivariable logistic regression with multiple imputation was used to assess predictors of complications.</p><p><strong>Results: </strong>Among 745 patients, 717 underwent 1348 SNB procedures and 184 underwent 241 ILND procedures. Postoperative morbidity increased substantially with procedural extent, with complications occurring after 9% of SNB procedures and after 31% of ILND procedures. Lymphoedema developed in 47% of patients following ILND versus 9% following SNB. Increasing lymph node yield independently predicted overall complications within both SNB and ILND cohorts and was additionally associated with wound infection following SNB. For lymphoedema, ILND carried five- to nine-fold higher odds compared with SNB, while higher BMI independently predicted lymphoedema risk (OR 1.07 per kg/m², p = 0.002).</p><p><strong>Conclusion: </strong>Complications increase markedly with procedure extent. Increasing lymph node yield was associated with wound infection, while lymphoedema is primarily determined by procedure type. Poor predictive ability of patient characteristics limits pre-operative risk stratification.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4799-4810"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13694304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217697","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":"Single‑port versus multi‑port robotic-assisted partial nephrectomy: a systematic review and meta-analysis of propensity score-matched cohort studies.","authors":"Ruiyan Wang, Lin Zhang, Pengxin Liu, Deling Li, Shidong Deng, Huihui Zhang","doi":"10.1007/s11255-026-05240-y","DOIUrl":"10.1007/s11255-026-05240-y","url":null,"abstract":"<p><strong>Purpose: </strong>The effectiveness of single-port (SP) versus multi-port (MP) robotic-assisted partial nephrectomy (RAPN) has been compared in many studies, but the comparative superiority remains unclear. The purpose of this article is to comprehensively review the existing literature and conduct a more precise comparison of the two surgical methods.</p><p><strong>Methods: </strong>We performed a thorough literature search in PubMed, Web of Science, Embase, and Cochrane CENTRAL databases to identify relevant studies published before April 2026. Eligible studies were strictly screened for inclusion in the subsequent meta-analysis, and their methodological quality was evaluated using the Newcastle-Ottawa Scale. For continuous outcomes, we computed the mean difference (MD) with 95% confidence intervals (CI). For dichotomous variables, the risk ratio (RR) with 95% CI was applied.</p><p><strong>Results: </strong>A total of six high-quality retrospective investigations were enrolled, involving 1223 patients in total. Of these, 591 (48%) patients underwent single-port surgery, while 632 (52%) patients underwent multi-port surgery. In terms of the surgical outcomes, primary analyses indicated that SP operation was similar to MP operation. SP and MP exhibited no statistically significant differences regarding positive surgical margins, postoperative complications, major postoperative complications, and ΔeGFR at 6 months. Compared with MP, SP has less-estimated blood loss and better pain control in the early postoperative period. Exploratory sensitivity analyses suggested potential advantages of SP in operative time and hospital stay. Subgroup analysis revealed a trend toward shorter warm ischemia time in the MP group compared with the SP group.</p><p><strong>Conclusions: </strong>SP is safe and comparable to MP in oncological, safety, and short-term renal function outcomes. Primary analyses showed no significant differences in operative time, hospital stay, or warm ischemia time. SP was associated with slightly lower estimated blood loss and early postoperative pain, but these differences were small and clinically minimal. Exploratory post hoc findings suggesting advantages in operative time and hospital stay require confirmation.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4595-4609"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251551","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":"Evaluation of lighted catheter phototherapy in endoscopic treatment of urethral strictures: a rabbit pilot study.","authors":"Benjamin Cedars, Guanqun Li, Tiffany Caza, Maithili Gopalakrishnan, Kathleen Donovan, Gennady Bratslavsky, Dmitriy Nikolavsky","doi":"10.1007/s11255-026-05203-3","DOIUrl":"10.1007/s11255-026-05203-3","url":null,"abstract":"<p><strong>Purpose: </strong>To improve the success of minimally invasive urethral stricture treatments with red and near-infrared (NIR) light emitted via catheters after direct vision internal urethrotomy (DVIU). We hypothesized that catheter-emitted light therapy would improve success rate and histologic wound characteristics.</p><p><strong>Methods: </strong>Twenty-four male New Zealand rabbits underwent stricture induction by electroresection and then were randomized into three groups: red light catheter (650 nm wavelength), NIR light (810 nm wavelength), or control (no light). After DVIU, a catheter was inserted for 7 days providing 5.4 J/cm²/day. The primary endpoint was radiographic success (as defined by > 10% improvement in urethral lumen diameter). Secondary endpoints were improvement in histologic parameters. Cystoscopy and retrograde urethrogram were performed post-operatively. Hematoxylin and eosin and Masson-Trichrome stains were used for histology evaluation.</p><p><strong>Results: </strong>One control rabbit had worsening stricture after DVIU, while no stricture in either treatment arm got worse. The red light group had 28% absolute improvement in stenosis, followed by NIR with 20%, and controls with 8% (p = 0.17). On pair-wise testing, NIR had significantly lower chronic inflammation compared to red (p = 0.024) and control (p = 0.033) groups, while red light had significantly higher vascularity compared to controls (p = 0.009).</p><p><strong>Conclusion: </strong>Catheters emitting red and NIR phototherapy after DVIU demonstrated improved reductions in stenosis, though these findings were not statistically significant. There were significant improvements in chronic inflammation with the NIR lighted catheter and in vascularity with the red light catheter. Cumulatively, these results suggest a promising adjunct to minimally invasive treatment in urethral stricture disease that warrants further investigation.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4811-4819"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251602","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":"Medical expulsive therapies for ureteric stones: an umbrella review of network meta-analyses with novel evidence grading.","authors":"Umm E Salma Shabbar Banatwala, Areesha Mansoor, Mohamed Fawzy, Shayan Ali Khan, Nadeem Bin Nusrat, Khalid Saeed Khan","doi":"10.1007/s11255-026-05243-9","DOIUrl":"10.1007/s11255-026-05243-9","url":null,"abstract":"<p><strong>Background: </strong>There is uncertainty about the ranking of effectiveness of the available medical expulsive therapies (MET) for ureteric stones, a common and painful urological condition. We comprehensively compared all currently available METs employing a novel evidence grading system to evaluate published network meta-analyses (NMA).</p><p><strong>Methods: </strong>Following prospective registration (PROSPERO CRD #42023472770), we conducted an umbrella review incorporating NMAs of randomized controlled trials (RCTs) evaluating various METs. Literature searches were performed in PubMed, Embase, and Google Scholar until January 2026. The primary outcome was the rate of ureteric stone expulsion. Calculated covered area (CCA) estimated the overlap of studies between NMAs. Evidence certainty was assessed using a novel modified GRADE methodology incorporating AMSTAR-2. Surface under the cumulative ranking curve (SUCRA) based on probability of being the best intervention was used for comparing METs.</p><p><strong>Results: </strong>Eight NMAs, comprising 147 RCTs were selected. The CCA showed high (24.5%) overall overlap. Evidence certainty was high-moderate in 5 NMAs, and low in 3. The highest-ranked METs were Naftopidil plus corticosteroids (SUCRA 91.8% and 90.6% in 1 high and 1 moderate certainty NMA) and Silodosin (SUCRA 94.8% and 82.5% in 1 moderate and 1 low certainty NMA).</p><p><strong>Conclusions: </strong>Naftopidil plus corticosteroids was the most effective MET for stone expulsion based on evidence certainty assessment, followed by Silodosin. Clinical care and future research should take into account the ranking evidence collated in this umbrella review.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4639-4656"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345284","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":"Comment on \"Dialysis versus conservative kidney management in older adults: why one size does not fit all\".","authors":"Alper Alp","doi":"10.1007/s11255-026-05119-y","DOIUrl":"10.1007/s11255-026-05119-y","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"5107-5108"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581298","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":"Association of phosphodiesterase type 5 inhibitor use with cardiovascular and renal outcomes in male kidney transplant recipients with benign prostatic hyperplasia or erectile dysfunction.","authors":"Jan Yuan-Sheng Hsu, Jian-Ri Li, Chuan-Shu Chen, Che-Jui Yang","doi":"10.1007/s11255-026-05192-3","DOIUrl":"10.1007/s11255-026-05192-3","url":null,"abstract":"<p><strong>Purpose: </strong>Phosphodiesterase type 5 (PDE5) inhibitors are commonly prescribed for erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) in kidney transplant recipients (KTRs), but their cardiovascular and renal associations in this population remain unexamined. This study evaluated these associations in male KTRs with ED or BPH.</p><p><strong>Methods: </strong>This retrospective cohort study used TriNetX Global Collaborative Network data (January 2015-December 2023). Male KTRs ≥ 40 years with ED or BPH were identified using a unified diagnosis index date in both arms, with PDE5 inhibitor exposure bounded to days 0-365. Three drug strata (tadalafil 5 mg daily, tadalafil, sildenafil) were propensity-matched 1:1 against controls on thirty covariates. Balance was assessed by standardized mean differences. Primary outcomes (all-cause mortality, MACE excluding death, MAKE excluding death) were analyzed by Cox regression and Kaplan-Meier methods. Secondary outcomes comprised individual components (AMI, stroke, and dialysis initiation).</p><p><strong>Results: </strong>All-cause mortality was inversely associated with PDE5 inhibitor exposure across all six strata (HR 0.574-0.697). MACE excluding death was inversely associated in the ED cohort for tadalafil 5 mg daily (HR 0.527) and tadalafil all doses (HR 0.620), but not sildenafil; no composite associations reached significance in the BPH cohort. Two secondary outcomes survived Benjamini-Hochberg correction: MACE excluding death and AMI in the ED tadalafil all-doses stratum (q = 0.023 and q = 0.041). Negative control outcomes near unity supported propensity score balance.</p><p><strong>Conclusion: </strong>PDE5 inhibitor exposure was associated with lower all-cause mortality in male KTRs with ED or BPH. Composite cardiovascular and renal associations were stratum-dependent. These findings are hypothesis-generating and require prospective evaluation.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4657-4672"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13694436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941508","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":"Overdiagnosis in renal cancer: the hidden consequence of modern imaging.","authors":"Katherine Vallecilla Valencia, Herney Andres Garcia-Perdomo","doi":"10.1007/s11255-026-05173-6","DOIUrl":"10.1007/s11255-026-05173-6","url":null,"abstract":"<p><p>The global burden of renal cell carcinoma (RCC) has risen substantially over the past three decades, while mortality rates have remained largely stable. This epidemiologic paradox suggests that a significant proportion of detected renal tumors may reflect overdiagnosis. This review synthesizes current evidence on the magnitude, drivers, and implications of overdiagnosis in RCC, integrating epidemiologic trends, tumor biology, imaging practices, and translational advances. The widespread use of cross-sectional imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), has markedly increased the incidental detection of RCCs, with more than 50% now diagnosed incidentally. Many of these small renal masses (SRMs) are benign or biologically indolent. While early detection may benefit patients with aggressive disease, it can also lead to overtreatment, psychological burden, and increased healthcare costs. Emerging strategies, such as active surveillance, radiomics, and artificial intelligence (AI)-based risk stratification, offer potential pathways to reduce harm. Addressing overdiagnosis is essential to advancing a more precise and clinically meaningful approach to RCC detection and management.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4569-4574"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015535","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":"A study on the association between polycyclic aromatic hydrocarbon (PAH) exposure and kidney function indicators in adolescents: an integrated research combining statistical mediation analysis and network toxicology.","authors":"Haijin Yao, Shuchang Wang, Yuling Zhang","doi":"10.1007/s11255-026-05194-1","DOIUrl":"10.1007/s11255-026-05194-1","url":null,"abstract":"<p><p>Polycyclic aromatic hydrocarbons (PAHs) are a class of environmental pollutants widely present in daily life. However, the association between mixed exposure to PAHs and kidney function remains unclear. This study aimed to analyze and evaluate the relationship between urinary PAH metabolite levels and multiple kidney function parameters in adolescents. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. The cross-sectional associations between urinary PAH metabolites and kidney parameters were examined using multiple linear regression models. In addition, weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) models were applied to evaluate the effects of mixed exposure to PAH metabolites on kidney function indicators. Statistical mediation analysis suggested that alkaline phosphatase (ALP) may play a potential mediating role. Furthermore, hypothesis-generating bioinformatics analyses were conducted using network toxicology and molecular docking approaches. A total of 1428 adolescents were included in this study. The results showed that all PAH metabolites were negatively associated with serum creatinine (Scr) (P_FDR < 0.05) and positively associated with estimated glomerular filtration rate (eGFR) (P_FDR < 0.05). Both WQS and BKMR models consistently indicated that mixed exposure to PAHs was positively associated with eGFR and negatively associated with Scr, urinary creatinine (Ucr), and serum uric acid (SUA). Bioinformatics analysis further identified five potential target proteins: albumin (ALB), epidermal growth factor receptor (EGFR), estrogen receptor 1 (ESR1), insulin-like growth factor 1 (IGF1), and peroxisome proliferator-activated receptor gamma (PPARG). Molecular docking was subsequently performed to predict the binding affinities between PAH metabolites and these candidate proteins. Our study identified an association between PAH exposure and kidney function in adolescents. These findings suggest that PAH exposure may be related to early alterations in kidney function among adolescents. However, the clinical significance and long-term health effects of these associations require further validation through longitudinal studies and mechanistic investigations. Nevertheless, our findings highlight concerns regarding the potential adverse effects of PAH metabolite exposure on adolescent kidney function and underscore its relevance for public health.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"5035-5059"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981840","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":"Testosterone-to-estradiol ratio and self-reported decreased libido among men seeking sexual medicine care: a retrospective study.","authors":"Rodrigo Freddi, Rubens Pedrenho Neto, João Pedro Gismondi, Romulo Dos Santos Sobreira Nunes, José de Bessa Júnior, Thiago Afonso Teixeira, Fabio Firmbach Pasqualotto, William Carlos Nahas, Bruno C G Nascimento, Jorge Hallak","doi":"10.1007/s11255-026-05452-2","DOIUrl":"https://doi.org/10.1007/s11255-026-05452-2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the correlation between loss of libido and hormonal profile (HP), including the Total Testosterone (T) / Estradiol (E2) ratio, at a tertiary reference center in andrology and sexual medicine.</p><p><strong>Methods: </strong>A retrospective analysis of medical records from patients experiencing sexual dysfunction in a tertiary care center was performed. Patients were systematically asked whether they perceived a loss of libido using the following question: \"Do you believe your libido or sexual desire has decreased over the last few months?\" Patients had morning (between 6:00 and 10:00 a.m.) HP checked (Total testosterone (T), Prolactin (P), Luteinizing Hormone (LH), and E2. HP was divided into four different groups: Low T (T<300 ng/dl); Normal T (T≥300 ng/dl); standard T/E2 ratio (> 10); and Low T/E2 ratio (≤ 10).</p><p><strong>Results: </strong>We evaluated 228 patients, and the mean (± SD) age was 61 ± 10 years. 30% of the patients complained about low libido. Hormone analysis showed that 21% had low T levels, while 22% had a low T/E2 ratio. Among those with low T levels, 42% reported low libido (OR 1.9; 95% IC 1.08-3.73; p = 0.01). Conversely, in the group with a low T/E2 ratio, 52% experienced a decrease in sexual desire (OR 3.47; 95% IC 1.79-6.46; p = 0.001). In multivariate analysis, after adjusting for age, the T/E2 ratio was associated with decreased libido regardless of T status.</p><p><strong>Conclusion: </strong>Low T levels and low T/E2 ratios were strongly correlated with decreased libido in our sample of men seeking care at a tertiary andrology and sexual medicine center. Further studies are needed to confirm our results as well as to evaluate the lifestyle and metabolic factors with the hormonal status of these patients with low sexual desire.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297542","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}