Urology最新文献

{"title":"Evaluation of the Therapeutic Potential of Garcinia cambogia Alone or in Combination With Silodosin in the Management of LUTS/BPH: A Prospective Randomized Controlled Study","authors":"Waleed El-Shaer ,&nbsp;Adel RA Abd-Allah ,&nbsp;Mohamed F. El-Shafie ,&nbsp;Ismael M. Salama ,&nbsp;Alaa El Shaer","doi":"10.1016/j.urology.2025.04.012","DOIUrl":"10.1016/j.urology.2025.04.012","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy of <em>Garcinia cambogia</em> (hydroxy citric acid) alone or in combination with Silodosin on the clinical outcomes of lower urinary tract symptoms/Benign prostatic hyperplasia (LUTS/BPH).</div></div><div><h3>Methods</h3><div>A prospective, randomized, controlled, double-blind study conducted on patients with LUTS/BPH. Eligible patients were assigned randomly to one of three groups. Group <strong>A</strong> (33 patients) received Silodosin, 8 mg, once daily. Group <strong>B</strong> (35 patients) received <em>Garcinia</em> extract 500 mg TID. Group <strong>C</strong> (36 patients) received the combination of Silodosin, plus <em>Garcinia</em> extract. All participants were assessed for the changes in; the maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), Post-Void Residual (PVR), prostate volume (PV), and serum Prostatic Specific Antigen (PSA) levels, at the baseline and after 12 weeks of treatment.</div></div><div><h3>Results</h3><div>The baseline data regarding Qmax, IPSS, PVR, PV, and PSA showed non-significant differences between the three groups. After 12 weeks of treatment, all groups showed a significant improvement in both Qmax and IPSS (<em>P</em> &gt;.001) and group C showed the best improvement. The PVR was significantly reduced in all groups (<em>P</em> &gt;.001). The PV was significantly increased in group A (<em>P</em> = .006), whereas it was significantly reduced in groups B and C (<em>P</em> &gt;.001). The PSA showed a non-significant increase in group A (<em>P</em> = .625), while it was significantly decreased in groups B and C (<em>P</em> &gt;.001).</div></div><div><h3>Conclusion</h3><div>Treatment with <em>Garcinia</em> extract, especially in combination with Silodosin, may improve the Qmax, IPSS, PVR, PV, and PSA in patients with LUTS/BPH without any clinical significant adverse effects.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 198-205"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Outcomes in Bladder Cancer After Neoadjuvant Chemotherapy: An International Multi-Institutional Study Comparing Isolated Nodal Disease vs Persistent Muscle-Invasive Disease","authors":"Andres M. Acosta ,&nbsp;Mohammed Saad ,&nbsp;Alcides Chaux ,&nbsp;Jennifer B. Gordetsky ,&nbsp;Lan Zheng ,&nbsp;Charles Guo ,&nbsp;Mohamed Bikhet ,&nbsp;Adeboye O. Osunkoya ,&nbsp;Katrina Collins ,&nbsp;Muhammad T. Idrees ,&nbsp;Geert J.L.H. van Leenders ,&nbsp;Pilar Gonzalez-Peramato ,&nbsp;Kristine M. Cornejo ,&nbsp;Michelle S. Hirsch ,&nbsp;Chia-Sui Kao ,&nbsp;Andres Matoso ,&nbsp;Cristina Magi-Galluzzi ,&nbsp;Soroush Rais-Bahrami","doi":"10.1016/j.urology.2025.04.022","DOIUrl":"10.1016/j.urology.2025.04.022","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate clinical outcomes based on patterns of residual disease in patients undergoing cystectomy after neoadjuvant chemotherapy (NAC), focusing on those with residual tumor only in lymph nodes.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 174 patients who underwent post-NAC radical cystectomy between 2010 and 2023 at academic centers from the United States and Europe. Patients were stratified into two groups: those with isolated lymph node disease despite complete local response (n<!--> <!-->=<!--> <!-->35) and those with persistent muscle-invasive or locally advanced disease without lymph node involvement (n<!--> <!-->=<!--> <!-->139). Primary outcomes included recurrence, disease-specific mortality (DSM), and survival. Median follow-up was 27.0<!--> <!-->months (interquartile range: 9.0-60.0).</div></div><div><h3>Results</h3><div>Recurrence occurred in 33% of patients, with higher risk in patients with residual disease only in lymph nodes compared to those with persistent disease in the bladder and negative lymph nodes (adjusted OR: 0.43, 95% CI: 0.20-0.95, <em>P</em> <!-->=<!--> <!-->.036). DSM was 24%, with no significant difference between groups (adjusted OR: 0.70, 95% CI: 0.29-1.64, <em>P</em> <!-->=<!--> <!-->.407). Disease-related events occurred in 41% of patients, with lower risk in the group with residual disease in the bladder (adjusted OR: 0.46, 95% CI: 0.21-0.99, <em>P</em> <!-->=<!--> <!-->.048). Survival analyses showed no significant differences in DSM between groups (HR: 1.03, 95% CI: 0.48-2.20, <em>P</em> <!-->=<!--> <!-->0.947). Variant histology (present in 36% of cases) did not influence outcomes.</div></div><div><h3>Conclusion</h3><div>Patients with isolated lymph node disease, despite complete local response after NAC, demonstrate higher recurrence risk compared to those with persistent muscle-invasive disease, although this does not translate into survival differences. These findings suggest the need for risk-adapted surveillance strategies and consideration of additional therapeutic interventions in patients with isolated residual nodal disease.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 127-134"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of Newborn Circumcision Revision and Complication Rates Among Privately Insured Boys in the United States Between 2010 and 2022","authors":"David D. Kim ,&nbsp;Max J. Hyman ,&nbsp;Parth K. Modi ,&nbsp;Emilie K. Johnson","doi":"10.1016/j.urology.2025.02.017","DOIUrl":"10.1016/j.urology.2025.02.017","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate national trends in newborn circumcision complication and secondary procedure rates and whether clinician specialty affects these rates.</div></div><div><h3>Methods</h3><div>The Merative MarketScan Database was queried for claims from 2010 to 2022. CPT 54150 identified newborn circumcisions; CPT 54162, 54163, 54164, 54300, and 54450 identified secondary procedures; ICD-9 and ICD-10 codes identified complications. Multivariable logistic regression was performed to analyze the association between clinician specialty and circumcision revision or secondary procedure.</div></div><div><h3>Results</h3><div>A thirty-day complication was coded for 0.96% of newborns. Two- and five-year secondary procedure rates decreased from 2.90% and 3.62% in 2010 to 2.45% in 2020 and 2.89% in 2017, respectively. Compared to newborn circumcisions performed by obstetrician/gynecologists, the odds of secondary procedure within 2 years were lower for those performed by pediatricians (OR 0.73, 95% CI 0.68-0.78, <em>P</em> &lt;.001), pediatric surgeons (0.57 [0.42–0.76], <em>P</em> &lt;.001), advanced practice clinicians (APC) (0.80 [0.65-0.98], <em>P</em> = .03), and other clinicians (0.67 [0.63-0.71], <em>P</em> &lt;.001). Compared to newborn circumcisions performed by obstetricians/gynecologists, the odds of revision within 2 years were lower for those performed by pediatricians (0.46 [0.42-0.51], <em>P</em> &lt;.001), urologists (0.29 [0.19-0.44], <em>P</em> &lt;.001), pediatric urologists (0.38 [0.22-0.66], <em>P</em> = .001), pediatric surgeons (0.60 [0.36-0.98], <em>P</em> = .04), and other clinicians (0.59 [0.52-0.66], <em>P</em> &lt;.001).</div></div><div><h3>Conclusion</h3><div>Revision rates did not increase over time, and secondary procedure rates slowly declined. Compared to newborn circumcisions performed by obstetrician/gynecologists, the odds of a secondary procedure were either not different or lower for those performed by all other specialties, including APCs, suggesting that newborn circumcision workforce planning should involve training of and collaboration with APCs.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 155-162"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor on “Evaluating Noise Emissions of Endourological Lasers: A Comparative Analysis of Ho:YAG, Tm:YAG, and TFL Systems”","authors":"Hinpetch Daungsupawong ,&nbsp;Viroj Wiwanitkit","doi":"10.1016/j.urology.2025.02.019","DOIUrl":"10.1016/j.urology.2025.02.019","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 40-41"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring Cystoscopy Surveillance: Addressing the Needs of Frail Bladder Cancer Patients","authors":"Kamil Malshy ,&nbsp;Jathin Bandari ,&nbsp;Zijing Cheng ,&nbsp;Sindhuja Kadambi ,&nbsp;Edward M. Messing","doi":"10.1016/j.urology.2025.03.022","DOIUrl":"10.1016/j.urology.2025.03.022","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 2-7"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment on “Characterization of Newborn Circumcision Revisions and Complications Among Privately Insured Boys in the United States Between 2010 and 2022”","authors":"John H. Makari","doi":"10.1016/j.urology.2025.03.024","DOIUrl":"10.1016/j.urology.2025.03.024","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Page 163"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Laws and Insurance Coverage for Male Infertility","authors":"Aleksandar Popovic,&nbsp;Kunj Jain,&nbsp;Ernest Gillan,&nbsp;Meher Pandher,&nbsp;Amjad Alwaal","doi":"10.1016/j.urology.2025.03.025","DOIUrl":"10.1016/j.urology.2025.03.025","url":null,"abstract":"<div><h3>Objective</h3><div>To assess coverage of male infertility in state laws. Infertility is experienced by 12% of couples, unfortunately, however, infertility treatments are expensive and infrequently covered by insurance. Furthermore, many states lack explicit laws on fertility coverage.</div></div><div><h3>Methods</h3><div>The National Conference of State Legislatures and individual state legislature websites were used to assess fertility coverage. These were queried for health insurance mandates or fertility coverage by evaluating healthcare-related legislation.</div></div><div><h3>Results</h3><div>Less than half (21/50) of states require coverage. Among these, there is substantial variability in how infertility is defined. A minority (5/21) use the definition of 6 or 12 months of unprotected intercourse in those over or under age 35, respectively, without conception. Others have no length of time stated (7/21) or it ranges from 1 to 5 years (9/21). Some states restrict coverage to specific groups, such as NJ (coverage if under 46 years old). While 19 states include female infertility coverage, only 13 include coverage for males. Lastly, only 6 states include explicit legislation and criteria for treatment of male infertility not related to iatrogenic causes.</div></div><div><h3>Conclusion</h3><div>Male infertility coverage is lacking across the United States. Male exclusion places greater burden on females, which may lead to missed opportunities to diagnose medical conditions, and miss reversible causes of infertility. Despite recommendations that both partners undergo infertility evaluations, only 6 states have legislation for insurance coverage of non-iatrogenic infertility. Practitioners must be well-acquainted with laws and stay up-to-date in the ever-changing legislative landscape of infertility care.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 91-96"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment on “Survival Outcomes and Temporal Trends of Nonsurgical Management vs Radical Cystectomy in Non-organ-confined Urothelial Bladder Cancer”","authors":"Kazutaka Saito,&nbsp;Akinari Nakayama","doi":"10.1016/j.urology.2025.04.006","DOIUrl":"10.1016/j.urology.2025.04.006","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 114-115"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of Dorsal-Onlay and Ventral-1 Inlay Buccal Mucosal Graft Urethroplasty in Female Urethral Stricture: A Randomized Clinical Trial","authors":"Swarnendu Mandal ,&nbsp;Abhay Singh Gaur ,&nbsp;Kirti Singh ,&nbsp;Manoj Kumar Das ,&nbsp;Sambit Tripathy ,&nbsp;Vivek Tarigopula ,&nbsp;Suman Sahoo ,&nbsp;Kalandi Barik ,&nbsp;Prasant Nayak","doi":"10.1016/j.urology.2025.01.064","DOIUrl":"10.1016/j.urology.2025.01.064","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the outcomes of dorsal-onlay (DO) and ventral‑inlay (VI) buccal mucosal graft urethroplasty (BMGU). This is the first Clinical Trials Registry-India registered randomized clinical trial on female urethral stricture disease.</div></div><div><h3>Methods</h3><div>Women with USD underwent either DO-BMGU or VI-BMGU between September 2021 to July 2023. The primary objective was the success rates of the two techniques. The secondary objectives were duration of surgery, amount of blood loss, pain scores as assessed by Visual Analog Scale, and change in American Urological Association score, Qmax and postvoid residual.</div></div><div><h3>Results</h3><div>Of the 47 randomized participants, 20 patients in each group were taken up for final analysis.</div><div>The median follow‑up period was 21<!--> <!-->months and those with less than 1<!--> <!-->year follow-up were excluded. One patient in each group had failure at 1<!--> <!-->year follow-up, giving a success rate of 95% in each arm.</div><div>The median blood loss [15 mL (10-15) vs 10 mL (5-12.5), (<em>P</em> .012)] and median duration of surgery [44.5 minutes (40-52.5) vs 30 minutes (22-38), (<em>P</em> <!-->&lt;.001)] were significantly less for VI-BMGU than for DO-BMGU. The median Visual Analog Scale scores at 6 and 24 hours were significantly lower (<em>P</em> <!-->&lt;.001) for the VI-BMGU group but not at 48 hours. The VI-BMGU group required less analgesia (<em>P</em> <!-->&lt;.01) as well. Small sample size and single institutional experience are limitations.</div></div><div><h3>Conclusion</h3><div>The outcomes of VI-BMGU are similar to those of DO-BMGU, with the additional advantages of shorter operative time, lesser blood loss, and less pain.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 52-58"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Public Interest in Online Men's Health Services: A Cross-Sectional Google Trends Analysis of “Hims”","authors":"Jack Considine ,&nbsp;Shane Tinsley ,&nbsp;Amarnath Rambhatla ,&nbsp;Ali Dabaja ,&nbsp;Logan Hubbard","doi":"10.1016/j.urology.2025.03.041","DOIUrl":"10.1016/j.urology.2025.03.041","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate public interest in “Hims,” a men’s health platform, to assess its impact on healthcare access, and identify geographic trends reflecting gaps in traditional healthcare availability.</div></div><div><h3>Methods</h3><div>Relative search volume (RSV) data for erectile dysfunction and early climax terms in “Hims” were collected via Google Trends from November 2017 to December 2023 across the United States. Data were analyzed in two intervals (2017-2020 and 2020-2023) using paired <em>t</em> tests to compare RSV and Kruskal-Wallis tests to assess differences among terms. Geographic regions were examined to identify underserved regions.</div></div><div><h3>Results</h3><div>Public interest in “Hims” increased significantly, with median RSV rising from 0 (interquartile range (IQR): 0-33) in 2017-2020 to 62 (IQR: 30-95) in 2020-2023 (<em>P</em> &lt;.05). Searches related to erectile dysfunction rose from a median RSV of 18 (IQR: 0-100) to 46 (IQR: 0-100) (<em>P</em> &lt;.001), with similar growth observed in searches related to early climax. High RSV was noted in states like Colorado, Wyoming, and Maine, highlighting increased interest in regions with limited healthcare resources. A marked rise in telehealth engagement during the COVID-19 pandemic further emphasized the role of digital platforms in healthcare delivery during periods of restricted access.</div></div><div><h3>Conclusion</h3><div>The rise in search interest for “Hims” underscores the increasing demand for telehealth services to for men’s health, particularly in underserved regions. These findings highlight the potential of digital platforms to bridge gaps in healthcare access.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"200 ","pages":"Pages 223-230"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}