Translational andrology and urology最新文献

{"title":"Unraveling the hidden link: neuroticism as a risk factor for upper urinary tract calculi-insights from Mendelian randomization analysis.","authors":"Shang Gao, Renli Tian","doi":"10.21037/tau-24-379","DOIUrl":"10.21037/tau-24-379","url":null,"abstract":"<p><strong>Background: </strong>Upper urinary tract calculi (UUTC) are major risk factors for renal insufficiency and nephrectomy with psychological distress, notably depression and anxiety, being common among affected patients. Depression and anxiety are associated with heightened neuroticism. Individuals with neuroticism frequently exhibit a range of urological disorders. Given the limited research on UUTC and neuroticism, this study aims to explore this relationship using Mendelian randomization (MR) analysis.</p><p><strong>Methods: </strong>We assessed the effects of neuroticism and associated psychological traits on UUTC using a two-sample MR approach, primarily employing the inverse variance weighted (IVW) method, with additional analysis via MR-Egger and weighted median methods. To ensure robustness, we conducted sensitivity analyses using Cochran's Q test, MR-Egger intercept, and MR-pleiotropy residual sum and outlier (PRESSO). At the same time, we selected the neuroticism score for verification queue of the exposure. Furthermore, to explore the independent effects of neuroticism traits on UUTC, we performed multivariable MR analyses on phenotypes with no pleiotropy, IVW P values below 0.05, and consistent directions across all three MR methods.</p><p><strong>Results: </strong>Our MR analysis revealed a significant causal impact of neuroticism on UUTC using the IVW [odds ratio (OR) =1.15, 95% confidence interval (CI): 1.02 to 1.29, P=0.03) and weighted median (OR =1.22, 95% CI: 1.03 to 1.44, P=0.02) methods. Verification queue similarly confirmed that the neuroticism score was a risk factor for UUTC (IVW, OR =1.11, 95% CI: 1.03 to 1.19, P=0.007). Sensitivity analyses indicated no heterogeneity or pleiotropy. Additionally, IVW analyses identified experiencing mood swings (OR =1.41, P=0.047), feeling lonely (OR =6.03, P<0.001), and feeling worry (OR =1.58, P=0.03) as significantly associated with UUTC. Multivariate MR analysis showed that experiencing mood swings is a stand-alone risk factor for UUTC (OR =1.75, P=0.03).</p><p><strong>Conclusions: </strong>Our MR analysis has pinpointed neuroticism as a risk factor for UUTC, with experiencing mood swings identified as an independent risk factor for UUTC, offering new insights into the brain-kidney connection. The exact pathways driving this relationship require further study. These results highlight the necessity of vigilant urinary stone surveillance in individuals exhibiting neurotic traits.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 11","pages":"2430-2438"},"PeriodicalIF":1.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic status and new explorations in upper urinary tract urothelial carcinoma: a literature review.","authors":"Zujuan Shan, Xin Deng, Liansheng Yang, Guifu Zhang","doi":"10.21037/tau-24-326","DOIUrl":"10.21037/tau-24-326","url":null,"abstract":"<p><strong>Background and objective: </strong>Upper urinary tract urothelial carcinomas (UTUCs) are characterized by their obscure location, insidious onset, and propensity for early muscle-invasive and lymph node metastasis, resulting in a generally poor prognosis. Clinically, diagnosis primarily relies on urine cytology, computed tomography urography (CTU), and white light ureteroscopy (WL-URS). These methods, however, suffer from low sensitivity, high cost, inefficient testing, patient discomfort, surgery-related complications, and potential tumor implantation. This literature review summarizes the advantages and disadvantages of the existing diagnostic tools for UTUC and discusses promising advancements in the field.</p><p><strong>Methods: </strong>A comprehensive computer-assisted search, supplemented by literature tracing, was conducted to review publications on UTUCs diagnostics from the PubMed, Embase, and Web of Science databases covering the period from 2000 to August 2024. The research focused on synthesizing findings from the selected publications.</p><p><strong>Key content and findings: </strong>Over 100 studies were reviewed, spanning from traditional diagnostic methods like urine cytology, CTU, and WL-URS, as well as newer methods including endoscopic advances, biopsy methods, radiomics, immunocytology [urinary tumor cell (UTC) assay], urinary genetic tests (identifying chromosomal abnormalities, DNA mutations, DNA methylation, and RNA), and hematological and urinary tests for microRNAs (miRNAs) and proteins (plasma protein classifiers). While traditional methods have been extensively evaluated, they remain suboptimal in terms of effectiveness, safety, patient satisfaction, and cost. Emerging diagnostics and molecular markers show promise, such as the high sensitivity of the urinary UTC assay for early-stage tumors and the non-invasive nature of various urinary molecular tests, along with the high accuracy of plasma protein classifiers. However, these new tools generally lack thorough evaluation and are often restricted to reports from single institutions or simple differentiation of cancerous cases from controls under experimental conditions.</p><p><strong>Conclusions: </strong>Traditional diagnostic methods for UTUCs exhibit significant limitations, which newer tools and molecular markers are poised to address. However, comprehensive evaluations of these innovations are required to confirm their efficacy.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 11","pages":"2570-2586"},"PeriodicalIF":1.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First use and evaluation of a novel 6.3 Fr disposable flexible ureteroscope for stone management in duplex kidney: a case report.","authors":"Lin Xiong, Kristine J S Kwan, Xiang Xu, Geng-Geng Wei, Ming-Chi Wang, Zhen-Quan Lu","doi":"10.21037/tau-24-315","DOIUrl":"10.21037/tau-24-315","url":null,"abstract":"<p><strong>Background: </strong>Flexible ureteroscopy (FURS) is increasingly used as the first-line treatment for urological procedures. Disposable digital (dd-)FURS has been developed to overcome limitations such as durability, degradation, and repair cost of reusable scopes. The diameter of commercially-available models ranges from 7.5-9.9 Fr. This study aimed to report the first clinical application of a novel 6.3 Fr HU30M HugeMed dd-FURS.</p><p><strong>Case description: </strong>We present the case of a 61-year-old female diagnosed with a left ureteric (8 mm × 7 mm) and two renal stones (6 mm × 5 mm and 5 mm × 3 mm) located at both moieties of her duplex kidney. She was opted for elective flexible ureteroscopic lithotripsy. The 6.3 Fr dd-FURS was preferred to overcome the challenging anatomy. No intra-/peri-operative complication was observed and the patient made an uneventful recovery. Complete stone clearance was achieved based on 2-week follow-up computed tomography (CT).</p><p><strong>Conclusions: </strong>The application of the 6.3 Fr dd-FURS demonstrated its feasibility, safety, and efficacy in stone retrieval. However, a thin device has its limitations, including its stiffness and working space area. Adaptation to the device during procedures or further improvements may be necessitated. Yet, this scope has potential in the management of pediatric urology procedures and complex upper urinary tracts.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 11","pages":"2644-2650"},"PeriodicalIF":1.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bowel complications and anastomotic leak after ileocolic anastomosis in urinary diversion surgery: a comparative 12-year retrospective single-center study.","authors":"Kiarad Fendereski, Seyedeh Sima Daryabari, Ryan Stockard, Benjamin Mccormick, Jeremy B Myers","doi":"10.21037/tau-24-453","DOIUrl":"10.21037/tau-24-453","url":null,"abstract":"<p><strong>Background: </strong>There is limited data within the urologic literature regarding bowel complications and leak rates following surgery requiring ileocolic anastomoses such as right colon pouch (RCP) and continent cutaneous ileocecocystoplasty (CCIC). We aimed to establish ileocolic anastomotic leak rates in urologic reconstructive surgery and determine bowel-related complications following RCP and CCIC surgeries.</p><p><strong>Methods: </strong>We reviewed adult patients who underwent RCP or CCIC (2010-2022), investigating patient characteristics, perioperative variables, and outcomes. We used Cox Proportional Hazards analysis to compare bowel-related complications. Patients with proximal ileostomy were excluded from analysis, as well as those with less than 90 days follow-up.</p><p><strong>Results: </strong>Of 162 patients, 106 (65.4%) underwent RCP and 56 (34.6%) underwent CCIC. The mean age was 55.5 (13.1) and 40.3 (14.6) years in RCP and CCIC group (P<0.001). The leading etiology was radiation injury [34 (32.1%)] and spinal cord injury [32 (57.1%)] for RCP <i>vs.</i> CCIC. In the RCP group, there were 46 (43.4%) patients readmitted within 90 days and 12 (20.7%) in the CCIC group, (P=0.01). Survival, at a median follow-up of 30 (10.3-66.6) months, was 82.1% and 87.5% in the RCP <i>vs.</i> CCIC group (P=0.37). Anastomotic leak occurred in 8 (7.5%) patients in the RCP and 2 (3.6%) patients in the CCIC group (P=0.32). Notably, we found that the type of anastomosis, stapled reinforced lines compared to single-layered (hand sewn or stapled), significantly influenced both bowel complications [hazard ratio (HR): 0.1; 95% confidence interval (CI): 0.03-0.33] and anastomotic leaks (HR: 0.17; 95% CI: 0.04-0.75). There were no significant differences in bowel complications (HR: 0.6, 95% CI: 0.15-2.4) or anastomotic leaks (HR: 0.38, 95% CI: 0.06-2.21) between RCP and CCIC groups.</p><p><strong>Conclusions: </strong>This study establishes ileocolic anastomotic leak rates in a large urologic patient population. Our findings highlight the protective role of double-layered ileocolic anastomosis reinforced with hand-sewn sutures in reducing bowel complications and anastomotic leaks. There were no significant distinctions between RCP and CCIC in survival rates and bowel complications.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 11","pages":"2468-2481"},"PeriodicalIF":1.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling the natural history of localised prostate cancer in the post-prostate specific antigen era: implications for clinical management.","authors":"Joel Li Ji Chin, Yu Guang Tan, Alvin Wei Xiang Low, Kenneth Chen, Henry Sun Sien Ho, Christopher Wai Sam Cheng, John Shyi Peng Yuen, Kae Jack Tay","doi":"10.21037/tau-24-322","DOIUrl":"10.21037/tau-24-322","url":null,"abstract":"<p><strong>Background: </strong>Management of localised prostate cancer (PCa) remains controversial in the era of prostate-specific antigen (PSA) testing. This study aims to describe the natural history of men with PCa being followed up expectantly to evaluate disease mortality.</p><p><strong>Methods: </strong>After exclusion, clinical data of 204 patients retrieved from a prospective large PCa registry were reviewed. Competing risk analysis were performed using the Fine-Gray model.</p><p><strong>Results: </strong>The median age was 73 years old with a median follow up of 12.5 years. The median PSA was 8.85 ng/mL and the risk stratification were as follows: low (47.0%), intermediate (31.4%), and high risk (21.6%). There were 19 PCa (9.3%) and 84 non-PCa deaths (41.2%), with overall mortality at 50.5%. Multivariate analysis showed patients with high PSA values [subdistribution hazard ratio (sdHR) 7.13], poorer prostate cancer grade groups (PCGG) (sdHR 16.349), and therefore higher European Association of Urology risk group (sdHR 11.42) had greatly elevated prostate cancer mortality (PCM). Older patients greater than 75 years of age (sdHR 4.52) and high Charlson Comorbidity Index (CCI ≥6) scores had higher non-prostate cancer mortality (NPCM) (sdHR 7.87). Subgroup analysis of the high-risk group showed having a lower CCI score (≤3) had a greater risk of PCM than NPCM (sdHR 4.31 <i>vs.</i> 0.22) while the converse is observed for higher CCI scores (1.12 <i>vs.</i> 5.52).</p><p><strong>Conclusions: </strong>Overall PCM remains low in elderly men with conservatively treated PCa. Age and poorer CCI predict NPCM while PSA and PCGG predict PCM. In high-risk PCa group, CCI is a useful tool to determine which patients will benefit from radical treatment.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 11","pages":"2459-2467"},"PeriodicalIF":1.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative proteomics reveal the protective effects of Qiang Jing decoction against oligoasthenospermia via modulating spermatogenesis related-proteins.","authors":"Desheng Wang, Haiwang Lu, Bin Bin, Siwei Lin, Jie Wang","doi":"10.21037/tau-24-327","DOIUrl":"10.21037/tau-24-327","url":null,"abstract":"<p><strong>Background: </strong>According to the current situation, the treatment of oligoasthenospermia with Western medicine is still full of challenges. Qiang Jing decoction (QJD) is used for treating male infertility as a traditional Chinese medicine (TCM) prescription. In this study. we will try to uncover the molecular mechanism of QJDs in treating oligoasthenospermia based on the proteomics technology.</p><p><strong>Methods: </strong>In this study, sperm quality from oligoasthenospermia model, QJD treatment, and control rats were analyzed. Tandem mass tag (TMT) quantitative proteomics was used for the comparative analysis of protein abundance in rat testis of different treatment.</p><p><strong>Results: </strong>The therapeutic effect of QJDs on spermatogenesis function by improving sperm quality was confirmed in the present experiment. In addition, our results showed that the majority of proteins related to spermatogenesis were significantly downregulated in oligoasthenospermia model rats compared to the control group, whereas these proteins' expression levels were recovered after the QJD treatment. In the meantime, immunohistochemistry was used to determine PI3K/AKT (phosphoinositide 3 kinase/serine-threonine kinase) signaling pathway-related protein expression profiles. In brief, we think QJD improved sperm density and quality by activating spermatogenesis-related protein expression and PI3K/AKT signaling pathway.</p><p><strong>Conclusions: </strong>The results of this study may help to establish a foundation for further functional studies of key protein-mediated for improving sperm quality and alleviating oligoasthenospermia.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 10","pages":"2268-2279"},"PeriodicalIF":1.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections from practice: innovations in inflatable penile prosthesis pumps benefit both patients and physicians.","authors":"L Dean Knoll","doi":"10.21037/tau-24-353","DOIUrl":"10.21037/tau-24-353","url":null,"abstract":"","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 10","pages":"2351-2353"},"PeriodicalIF":1.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Build your own all-virtual multidisciplinary kidney stone clinic.","authors":"Michael Lin-Brande, Celia Janoff, Tyler Chase, Raghav Wusirika, Brian Duty, Ian Metzler","doi":"10.21037/tau-24-248","DOIUrl":"10.21037/tau-24-248","url":null,"abstract":"<p><strong>Background: </strong>With the dramatic rise of telemedicine in the post coronavirus disease 2019 (COVID-19) pandemic, our objective was to develop a totally virtual multidisciplinary kidney stone clinic and assess patient satisfaction of this format.</p><p><strong>Methods: </strong>The virtual multidisciplinary stone clinic began July 2021 and continued monthly. Prior to the beginning of each clinic, providers from the urology, nephrology, and dietitian teams meet virtually to discuss the patients. Patients would then log into WebEx virtual platform and providers would subsequently log into the patient's virtual room, to review radiology, laboratory results, and dietary logs then provide counseling. Patients were then sent a survey via electronic mail regarding their experience. A 5-point Likert scale was used for responses ranging from strongly disagree to strongly agree. Scores were averaged to rank results.</p><p><strong>Results: </strong>A total of 122 patients were sent surveys, and a total of 31 surveys were completed. Sixty-one percent of patients strongly agree and 13% agree that they felt comfortable using the virtual platform. When asked if they prefer using the virtual platform for their visit, 70% of patients agreed or strongly agreed and only 16% of patients disagreed or strongly disagreed. In regards to potential advantages of a virtual visit, the Likert scores were averaged and ranked from most to least important with improved timeliness (3.7) and ease of scheduling into day (3.6) the highest rated advantages. Most patients did not find any concerns using the virtual platform, however the ability to see the provider in-person and connecting personally was of highest concern with an average Likert score of 2.3. Overall, 83% of patients agreed or strongly agreed that the multidisciplinary stone clinic satisfied their kidney stone related questions regarding treatment and prevention.</p><p><strong>Conclusions: </strong>A virtual multidisciplinary kidney stone clinic can be implemented with high patient satisfaction scores and help overcome the limitations of physical clinic space and provider schedule coordination. There are few disadvantages to using the platform.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 10","pages":"2174-2179"},"PeriodicalIF":1.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose tolvaptan to control disease progression in Chinese patients with autosomal dominant polycystic kidney disease: a retrospective cohort study.","authors":"Li Zhou, Xiansen Wei, Boya Wang, Qianqian Xu, Wenge Li","doi":"10.21037/tau-24-448","DOIUrl":"10.21037/tau-24-448","url":null,"abstract":"<p><strong>Background: </strong>Tolvaptan has been shown to be effective in the treatment of autosomal dominant polycystic kidney disease (ADPKD). However, there is limited evidence regarding optimal dosing and its application within the Chinese population. In this study, we aimed to determine whether a lower tolvaptan dose could effectively control ADPKD in Chinese patients.</p><p><strong>Methods: </strong>This retrospective, single-center cohort study was conducted in a real-world setting and included all patients newly diagnosed with rapidly progressive ADPKD who initiated tolvaptan treatment and maintained it for at least 12 months. Data were collected at baseline and at 1, 2, 4, 8, and 12 months after treatment initiation. Patients began with morning/evening tolvaptan doses of 7.5 mg/7.5 mg, and the dose was subsequently adjusted based on effectiveness and tolerability. The patients were categorized by baseline estimated glomerular filtration rate (eGFR) and final daily tolvaptan dose. Changes in eGFR and other key physiological indicators after treatment were compared within each group.</p><p><strong>Results: </strong>The study included 43 patients with ADPKD, of whom 20 were female, with a median age of 34.3 years (range, 16-85 years). At 12 months, eGFR improved by 5.48 mL/min/1.73 m² [95% confidence interval (CI): 2.68-8.29] (P<0.001) compared to baseline. Significant improvements were observed in patients with baseline eGFR levels of 30-59, 60-89, and ≥90 mL/min/1.73 m² (P=0.007, 0.045, and 0.02, respectively), as well as in medium and high dose groups (P=0.002 and 0.02, respectively). At 12 months, the annual height-adjusted total kidney volume (HtTKV) growth slope decreased by -0.17 %/year (95% CI: -0.33 to -0.01) (P=0.04). Significant decreases were observed in patients with an eGFR of 30-59 mL/min/1.73 m² (P=0.008) and in the medium dose group (P=0.03). Thirst was reported in 22 (51.2%) patients, all of whom experienced mild symptoms. No liver-associated adverse events were noted.</p><p><strong>Conclusions: </strong>Tolvaptan is well tolerated at low initial doses in Chinese patients with ADPKD. Significant improvements in eGFR and reduced HtTKV growth were observed in the overall population and across various baseline eGFR and final dose groups.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 10","pages":"2307-2321"},"PeriodicalIF":1.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is low-intensity shockwave therapy for erectile dysfunction a durable treatment option?-long-term outcomes of a randomized sham-controlled trial.","authors":"Moritz Lange, David Charles, Aisha Kazeem, Marieke Jones, Fionna Sun, Soutik Ghosal, Sarah Krzastek, David Rapp, Nicolas Ortiz, Ryan Smith","doi":"10.21037/tau-24-329","DOIUrl":"10.21037/tau-24-329","url":null,"abstract":"<p><strong>Background: </strong>Low-intensity shockwave therapy (LiSWT) is an emerging non-invasive and restorative therapy for erectile dysfunction (ED) with demonstrated efficacy and few adverse events. Although LiSWT has been shown to improve erectile function amongst men with ED, few studies have examined its long-term durability. We present the long-term results of a randomized controlled trial (RCT) assessing erectile function after LiSWT.</p><p><strong>Methods: </strong>A total of 30 patients with baseline ED seen at the University of Virginia were randomized to LiSWT or sham treatment. Patients in the sham group crossed over at 1 month and were unblinded. After initial trial completion, patients enrolled in the long-term outcome study were considered one combined cohort. Patients were treated twice weekly for 3 consecutive weeks with a Storz^® Duolith™ device delivering 3,000 shockwaves at 0.1 mJ/mm² to the distal penis, the base of the penis, and the crura. Primary outcomes were changes in Sexual Health Inventory for Men (SHIM) and Erection Hardness Score (EHS) from baseline (3 months pre-treatment) up to 36 months post-treatment. Changes in SHIM and EHS scores were evaluated using linear mixed effects models. Patient satisfaction was assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index.</p><p><strong>Results: </strong>The mean baseline SHIM score was 10.8±0.94. At 12-, 24-, and 36-month assessment following treatment, the mean SHIM scores were 15.6±1.27 (P<0.001), 15.0±1.14 (P<0.001), and 12.2±1.43 (P=0.31). The mean baseline EHS score was 1.87±0.17. At 12-, 24-, and 36-month assessment following treatment, the mean EHSs were 2.70±0.24 (P<0.001), 2.66±0.21 (P<0.001), and 2.29±0.26 (P=0.10). The median [interquartile range (IQR)] EDITS score was 48.9 (22.7, 74.4), indicating moderate satisfaction with LiSWT. There were no adverse events recorded.</p><p><strong>Conclusions: </strong>Our analysis demonstrates sustained long-term improvement in erectile function after LiSWT for a heterogeneous cohort. While limited by population size, the results suggest durable improvement in erectile function for the first 2 years with a peak treatment effect at 1 year. Treatment effect appears to decline between 2 and 3 years.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT04434352.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 10","pages":"2194-2200"},"PeriodicalIF":1.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}