Archivio Italiano di Urologia e Andrologia最新文献

{"title":"Correlation between seminal α-glycerylphosphorylcholine and semen parameters in infertile patients pre- and post-sub-inguinal micro-varicocelectomy: a prospective study.","authors":"Ahmed Fathy Aboseif, Nashaat Nabil, Sameh Fayek GamalEl Din, Shaimaa Abdelkareem, Aya Ahmed Onsi, Ahmad Zaghloul, Amgad Elseginy","doi":"10.4081/aiua.2025.12832","DOIUrl":"10.4081/aiua.2025.12832","url":null,"abstract":"<p><strong>Background: </strong>Varicocele (Vx) which is the most treatable cause of male infertility, is also associated with low sperm count, decreased sperm motility and increased sperm abnormal morphology. We aimed in the current study to evaluate the correlation between seminal α-Glycerylphosphorylcholine (αGPC) and semen parameters in infertile patients pre- and post- sub-inguinal micro-varicocelectomy.</p><p><strong>Methods: </strong>The current comparative prospective study was carried out on 20 male patients who presented to Kasr Al-Ainy Hospitals from March 2022 to March 2023 as well as 20 healthy controls. The participants were divided into groups as follows: group (1) included fertile normozoospermic men (n = 20) who served as controls. Group (2) included infertile oligoasthenoteratozoospermia (OAT) men with varicocele (n = 20). Patients in group (2) were followed up to 3 months after microsurgical sub-inguinal Varicocelectomy. The examination included an assessment of Vx with scrotal Duplex. Semen analysis was done according to the 5th Edition of WHO manual for semen analysis.</p><p><strong>Results: </strong>The study demonstrates that αGPC level was significantly higher among fertile normozoospermic control group and infertile OAT men post varicocelectomy when compared to infertile OAT men preoperative (p<0.001). Moreover, it demonstrates that on follow up of infertile OAT group 3 months after sub-inguinal micro-varicocelectomy, all semen parameters showed significant improvement compared to the corresponding semen parameters pre-operatively among Vxs grade II and grade III (p<0.001, p<0.001, respectively). A significant positive correlation was found between αGPC level and semen parameters including sperm normal forms, sperm count and sperm motility. Using ROC curve, αGPC protein showed a sensitivity of (100%) and a specificity of (100%) at cut off value (≤ 1.975 pg/ml) in differentiation between infertile OAT patients with Vx and control fertile normozoospermic men (p<0.001).</p><p><strong>Conclusions: </strong>αGPC may play an important role in infertility in men with Vx and correction of Vx improves the seminal αGPC level.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"12832"},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Lady urologist</i> and male patients with prostate cancer.","authors":"Rodolfo Montironi, Antonio Lopez-Beltran, Meredith C Wasserman, Alessia Cimadamore, Liang Cheng","doi":"10.4081/aiua.2025.13343","DOIUrl":"10.4081/aiua.2025.13343","url":null,"abstract":"<p><p>To the Editor In 2022, Dr. Suzanne Koven published a book entitled Letter to a Young Female Physician, Notes from a Medical Life. W.W. Norton & Company, Inc, New York. The book starts with a letter written by the author while participating in a 2017 orientation session...</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"13343"},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with erectile dysfunction in traumatic urethral strictures following epa urethroplasty: a single center experience.","authors":"Paksi Satyagraha, Gede Wirya Diptanala Putra Duarsa, Fauzan Kurniawan Dhani, Adrianus Gupta Wijaya, Besut Daryanto","doi":"10.4081/aiua.2025.13383","DOIUrl":"10.4081/aiua.2025.13383","url":null,"abstract":"<p><strong>Introduction: </strong>Urethral repair with Excision and Primary Anastomosis (EPA) urethroplasty offers excellent outcome in managing traumatic urethral strictures. However, its impact on erectile function (EF) is largely unknown. Study to evaluate EF outcome post-operatively is still limited worldwide. We report factors associated to EF following EPA Urethroplasty performed by single surgeon in tertiary hospital. In this study, we aim to evaluate the risk of erectile dysfunction (ED) following EPA Urethroplasty.</p><p><strong>Materials and methods: </strong>This is a retrospective study on patients with traumatic urethral strictures who underwent EPA Urethroplasty from 2013 to 2023. Variables including age, body mass index, systemic disease, etiology, stricture length, prior procedures and erection hardness score (EHS) score prior and 12 months after surgery were recorded. Pre-Operative ED was determined using Penile Doppler Ultrasound, which was defined as a peak systolic velocity of less than 25 cm/s. Univariate and Multivariate logistic regression analysis were performed using IBM SPSS Statistic.</p><p><strong>Results: </strong>A total of 89 patients were included. Among them, 33 patients (33.7%) suffered from initial ED prior to surgery. Pelvic fracture urethral injury (PFUI) was the predominant etiology (74%); 29% of the patients were active smokers, and 68.5% had prior endoscopic treatment. Among the 48 patients without ED prior to surgery, 7 of them (14.6%) developed ED following surgery in 12 months of follow up. After EPA, there was a reduction of mean EHS score from 2.70 to 2.53 (p=0.176). Multivariate analysis showed that smoking status (p=0.035; OR 4.41), PFUI as the mechanism of injury (p=0.007; OR 2.89), prior urethrotomy (p=0.020; OR 4.69), and prior dilatations (p=0.046; OR 0.18) were related as risk factors of ED following EPA urethroplasty.</p><p><strong>Conclusions: </strong>Risk of ED following EPA is inevitable, although the number is not as high as expected. Smoking, PFUI and prior treatment rather than EPA, emerge as predominant risk factors associated with the development of ED subsequent to surgical repair.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"13383"},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative platelet-to-lymphocyte ratio as a predictor of inguinal lymph node metastasis in penile cancer.","authors":"Francesco Passaro, Antonio Tufano, Gianluca Spena, Alessandro Izzo, Flavio Antonino Scarlata, Biagio Barone, Luigi Napolitano, Gabriele Pezone, Pierluigi Alvino, Achille Aveta, Savio Domenico Pandolfo, Simone Cilio, Lorenzo Romano, Francesco Di Bello, Alessandro Calarco, Rosario Leonardi, Carlo Buonerba, Sisto Perdonà","doi":"10.4081/aiua.2025.13428","DOIUrl":"https://doi.org/10.4081/aiua.2025.13428","url":null,"abstract":"<p><strong>Background: </strong>Penile cancer (PC) is a rare malignancy with poor prognosis. To date, reliable preoperative biomarkers for lymph node status and prognosis are still lacking. This study aims to explore the potential role of preoperative platelet-to-lymphocyte ratio (PLR) as a predictor of inguinal lymph node invasion in PC patients.</p><p><strong>Methods: </strong>Retrospective analysis was conducted on anamnestic, clinical, and laboratory data of PC patients who underwent surgical treatment between January 2016 and October 2023. Inguinal lymphadenectomy was performed as per EAU guidelines. PLR, calculated as the ratio between platelet-to-lymphocyte values obtained from preoperative blood analyses, was assessed within 30 days before surgery. Patients were categorized into pN- (no lymph node metastasis) and pN+ (lymph node metastasis confirmed pathologically). Statistical analyses included Kruskal-Wallis and Mann-Whitney U tests, univariate logistic regression, and ROC curve analysis with Youden index, assuming p<0.05 as statistically significant.</p><p><strong>Results: </strong>Overall, 60 PC patients were retrospectively involved in the study. A total of 36 (60%) patients reported ILN metastases, confirmed by inguinal lymphadenectomy (pN+), while no ILN metastases (pN-) were reported in 24 (40%) patients. The AUC for predicting ILN metastasis by preoperative PLR was 0.71 (p=0.014). According to the ROC curve analysis and the Youden Index, a cut-off for PLR was set at 122.4. On Univariable logistic regression analysis, the presence of T stage ≥ 2 (OR = 3.21; 95% CI: 1.43-7.47, p=0.011), lymphovascular invasion (OR = 3.78; 95% CI: 1.56-5.90, p=0.003), clinical node-positive disease (OR = 19.86; 95% CI: 5.91-41.03, p<0.001) and PLR ratio > 122.4 (OR = 7.22; 95% CI: 1.41-22.71, p=0.0148) were independent predictors of pN+ disease.</p><p><strong>Conclusions: </strong>The current study confirms the relationship between cancer and inflammation. When elevated preoperatively, PLR may be associated with inguinal lymph node invasion in PC patients.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":"97 1","pages":"13428"},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical prostatectomy outcomes of prostate cancer cases: Insights from a leading surgeon's experience in Azerbaijan.","authors":"Rashad Sholan","doi":"10.4081/aiua.2024.13257","DOIUrl":"https://doi.org/10.4081/aiua.2024.13257","url":null,"abstract":"<p><strong>Objective: </strong>Prostate cancer is a significant health concern worldwide and ranks as the 4th most frequent cancer among men in Azerbaijan. While robot-assisted laparoscopic radical prostatectomy is the preferred surgical technique in many countries, open retropubic radical prostatectomy (ORP) remains the primary treatment option in Azerbaijan due to limited access to robotic surgical systems. This study aims to analyze the outcomes of ORP in patients with local and locally advanced prostate cancer.</p><p><strong>Methods: </strong>We retrospectively evaluated 95 men who underwent extraperitoneal retropubic ORP for prostate cancer at our center between May 2020 and December 2023. Comprehensive data on patient demographics, preoperative parameters, surgical details, and postoperative outcomes were collected. Statistical analyses were conducted using IBM SPSS 27.0 software.</p><p><strong>Results: </strong>The mean age of the patients was 65.9 years. The median preoperative PSA level was 14.8 ng/mL, and lymph node enlargement was identified in 29.5% of patients. A rectal injury occurred in one patient (1.1%) as the only intraoperative complication. The mean intraoperative blood loss was 330 mL, and the median hospital stay was 6 days. A positive surgical margin was observed in 38.9% of cases. Diabetes mellitus and higher intraoperative blood loss were associated with prolonged hospital stays (≥ 7 days). Erectile dysfunction was reported in 52.6% of patients 6 months postoperatively, while urinary incontinence was observed in 2.2%.</p><p><strong>Conclusions: </strong>ORP outcomes in Azerbaijan are comparable to those reported for laparoscopic and robot-assisted techniques in terms of perioperative and oncological results. Despite the absence of advanced surgical technology, ORP remains an effective treatment option for prostate cancer when performed by experienced surgeons.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":"96 4","pages":"13257"},"PeriodicalIF":1.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reassessing cardiovascular risk stratification in men with erectile dysfunction.","authors":"João Lorigo, Daniela Gomes, Ana Rita Ramalho, Edgar Silva, Patrícia Mendes, Arnaldo Figueiredo","doi":"10.4081/aiua.2024.12427","DOIUrl":"https://doi.org/10.4081/aiua.2024.12427","url":null,"abstract":"<p><strong>Background and objectives: </strong>Erectile dysfunction (ED) is an independent and strong marker of cardiovascular disease (CVD) risk. The Princeton Consensus aimed to evaluate and manage cardiovascular risk in men with ED and no known cardiovascular disease, focusing on identifying those requiring additional cardiologic work-up. It has recently been updated to the American population demographics, but European recommendations are needed.</p><p><strong>Methods: </strong>It was developed a cross-sectional investigation including erectile dysfunction patients. Data were collected from hospital registries. Two risk stratification models were employed and compared: Princeton Consensus Criteria (PC) and European Society of Cardiology (ESC) CVD Risk Criteria. The objective was to stress the importance of the changes in IV Princeton Consensus recommendations in stratifying CVD risk in men with erectile dysfunction using a model validated in European men.</p><p><strong>Results: </strong>A total of 137 patients with ED, with a mean age of 57.1 years old, were included. According to the PC criteria, 39.7% of the patients were \"Low Risk\". When using ESC criteria, the proportion of \"Low Risk\" patients were significantly lower (12%, p < 0.05). Among \"Low Risk\" patients according to the PC, 52.5% and 20% were classified as High and Very high risk according to ESC criteria, respectively. One myocardial infarction was reported. The patient was classified as \"Low Risk\" according to the PC, but the ESC criteria categorized him as \"high risk\".</p><p><strong>Conclusions: </strong>PC is less sensitive than ESC recommendations detecting CVD. It raises concerns that Urologists could be overlooking patients with undiagnosed CVD, consequently missing out on opportunities for prevention of major cardiovascular events (MACEs) and premature deaths.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":"96 4","pages":"12427"},"PeriodicalIF":1.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of El-Shazly-Buchholz's nomogram to predict postoperative complications after PCNL: A multicenter study.","authors":"Rawa Bapir, Kamran Bhatti, Mohamed El-Shazly, Juan Antonio Galan, Ahmed M Harraz, Sarwar Noori Mahmood, Renato N Pedro, Pablo Vargas, Athanasios Papatsoris, Alberto Trinchieri, Noor Buchholz","doi":"10.4081/aiua.2024.13295","DOIUrl":"10.4081/aiua.2024.13295","url":null,"abstract":"<p><strong>Introduction: </strong>A model to predict the risk of surgical complications following percutaneous nephrolithotomy (PCNL) could be a useful tool to guide clinical decision-making. The aim of this study was to develop a simple and widely applicable stratification tool to be used for patient counseling, surgical planning, evaluation of outcomes, and academic reporting.</p><p><strong>Methods: </strong>Data of patients who underwent PCNL were retrieved from the database of the collaborating centers including demographics of patients, characteristics of their stones and urinary tracts, and perioperative data. The primary outcome was the development of postoperative complications. Data were randomly split into a training dataset (85%) and a validation dataset (15%). A univariate and multivariate logistic regression analysis of the training dataset was performed to identify independent predictors of postoperative complications. Model variables were used to construct a nomogram that was internally validated on the testing dataset by measuring calibration, discrimination, and plotting the decision curve.</p><p><strong>Results: </strong>Six hundred thirty one patients (245 Males) with a median (IQR) age of 49 (37-56) years were included. Post-operative complications occurred in 147 (23.3%) patients. Significant predictors of complications included preoperative urine culture (p < 0.001), largest stone diameter (p = 0.02), and intraoperative blood loss (p = 0.002). A nomogram was developed from the predictors and applied to the validation dataset showing an area under the curve (95%CI) of 66.4% (52.2;80.6).</p><p><strong>Conclusions: </strong>This new scoring system emphasized patient characteristics and operative details rather than stone characters to predict the morbidity of PCNL. Furthermore, it should facilitate risk adjustment, enabling physicians to better define the nephrolithiasis disease continuum and identify patients who should be referred to tertiary care centers.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":"96 4","pages":"13295"},"PeriodicalIF":1.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of cognitive fusion transrectal ultrasound prostate biopsy when compared with final prostatectomy histology.","authors":"Ana Sofia Araújo, Joao Serra, Sara Anacleto, Ricardo Rodrigues, Catarina Tinoco, Andreia Cardoso, Mariana Capinha, Vera Marques, Paulo Mota","doi":"10.4081/aiua.2024.13194","DOIUrl":"10.4081/aiua.2024.13194","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Prostate cancer (PCa) is the second most commonly diagnosed cancer in men. Cognitive fusion transrectal ultrasound prostate biopsy is one of several modalities for diagnosing this disease. However, no existing studies have shown the clear superiority of one image-guided technique over another. This investigation aimed to evaluate the efficacy of targeted biopsy through cognitive guidance, as well as to assess the accuracy of multiparametric magnetic resonance imaging (mpMRI) in the detection of PCa compared to the specimen obtained by radical prostatectomy (RP).</p><p><strong>Materials and methods: </strong>We conducted a retrospective observational single-center study approved by the ethical committee, including men with prostate-specific antigen (PSA) levels between 2-10 mg/ml who underwent RP and cognitive fusion biopsy (CFB) between 2017 January and 2022 January.</p><p><strong>Results: </strong>A total of 639 patients were analyzed, 83 of whom met the inclusion criteria and were enrolled in this study. The overall rate of PCa detection with CFB was 79.5% (median of specific PCa detection was 100%), and the rate of detecting clinically significant prostate cancer (csPCa) was 74.7%. In addition, there was 42.2% agreement between the International Society of Urological Pathology (ISUP) score of the CFB and the RP specimen, which increased to 56.6% when the systematic biopsy was added. Regarding the accuracy of mpMRI, several parameters were evaluated with respect to RP sample histology. Of these, tumor location had a total match rate of 39.8% and a partial match rate of 55.4%. Moreover, regarding extraprostatic extension (EPE), the present study found a significant association between the RP specimen and mpMRI (p = 0.002), with an agreement rate of 60% if it was present in the histology and 79.5% if it was not. Additionally, larger prostates and tumors located in the transition zone were significantly associated with a lower CFB accuracy (p = 0.001 and p = 0.030, respectively). After adjusting for all variables evaluated, only prostate volume remains statistically significant (p = 0.029).</p><p><strong>Conclusions: </strong>In this study, we conclude that mpMRI is highly accurate, allowing good characterization of suspicious tumors and reasonably guiding cognitive biopsy. However, the use of both targeted biopsy through cognitive guidance and systematic biopsy increases the diagnostic accuracy for PCa. Although there is no recommendation in the current literature for one guiding technique over another, we believe that cognitive-guided biopsy should only be reserved for centers with no access to ultrasound or magnetic resonance fusion software.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":"96 4","pages":"13194"},"PeriodicalIF":1.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the top-down HoLEP learning curve: A single-center experience of two clinical fellows.","authors":"Karim Daher, Moustafa Fathy, Amr Hodhod, Parsa Nikoufar, Abdulrahman Alkandari, Loay Abbas, Ruba Abdul Hadi, Hazem Elmansy","doi":"10.4081/aiua.2024.12862","DOIUrl":"https://doi.org/10.4081/aiua.2024.12862","url":null,"abstract":"<p><strong>Introduction: </strong>Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve. The top-down technique was introduced to lessen the number of procedures required to master HoLEP. We aimed to present the experiences of two successive clinical fellows with the top-down HoLEP learning curve and compare their performance with the supervisor.</p><p><strong>Methods: </strong>We conducted a prospective study of 40 patients who underwent top-down HoLEP performed by two successive fellows at our institution from September 2020 to November 2022. Before data collection, each learner observed three top-down HoLEP procedures and assisted with seven additional cases before independently performing top-down HoLEP under supervision. We collected data from each fellow's first 20 consecutive top-down HoLEP procedures. The learners' cases were grouped according to chronological order (Cases 1-10 and 11-20). The primary outcome was defined as the number of cases before the fellow could independently complete all steps of top-down HoLEP without any major intraoperative complications. The secondary outcomes included the intraoperative and postoperative outcomes of both groups. The fellows' 40 cumulative cases were then compared against retrospective data from 148 procedures conducted by their supervisor.</p><p><strong>Results: </strong>There were no significant differences in patient demographics for both clinical fellows. Each learner performed the first 20 cases independently without needing the supervisor to intervene. No major intraoperative complications were recorded, and there were no statistically significant differences in intraoperative and postoperative outcomes between fellows' cases. There was a statistically significant difference between the fellows and their supervisor in terms of operative efficiency and enucleation efficiency (p < 0.001). We did not find a significant difference between the fellows and the supervisor regarding intraoperative complications, major postoperative complications, or postoperative subjective and objective parameters.</p><p><strong>Conclusions: </strong>Top-down HoLEP shows promising and reproducible results in shortening HoLEP's learning curve. Larger comparative and multi-institutional studies are warranted.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":"96 4","pages":"12862"},"PeriodicalIF":1.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-surgical management of BPH: An updated review of current literature and state of the art on natural compounds and medical therapy.","authors":"Guglielmo Mantica, Francesca Ambrosini, Giovanni Drocchi, Zlata Zubko, Lorenzo Lo Monaco, Angelo Cafarelli, Alessandro Calarco, Renzo Colombo, Ottavio De Cobelli, Ferdinando De Marco, Giovanni Ferrari, Giuseppe Ludovico, Stefano Pecoraro, Domenico Tuzzolo, Carlo Terrone, Rosario Leonardi","doi":"10.4081/aiua.2024.13098","DOIUrl":"https://doi.org/10.4081/aiua.2024.13098","url":null,"abstract":"<p><strong>Introduction: </strong>Benign prostatic hyperplasia (BPH) is a common urological disease that is strongly associated with the aging process and can lead to lower urinary tract symptoms (LUTS). LUTS due to BPH can significantly affect the quality of life of many patients. Among the treatments available for BPH to improve symptoms and functional outcomes, drug therapy and surgical therapy are the options of choice. However, for most patients with symptomatic BPH, medical management remains the cornerstone of treatment. Pharmacologic interventions are often preferred as a first approach, being less invasive compared to surgery. Although the medical treatment of BPH is currently defined by the algorithms of international guidelines, the need for a more personalized approach is increasingly recognized given the wide and heterogeneous range of therapeutic options available.</p><p><strong>Materials and methods: </strong>A review of medical therapy for BPH was conducted using relevant articles in PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. In this review, all drug treatments currently available on the international market whose efficacy is scientifically proven are reviewed and described (phytotherapy, alpha-blockers, muscarinic receptor antagonists, 5-alpha-reductase inhibitors, combination therapies, etc.).</p><p><strong>Results: </strong>A total of 17 randomized clinical trials were selected for review. Further, 75 studies were included for analysis and discussion.</p><p><strong>Conclusions: </strong>As the treatment landscape continues to evolve, tailoring therapy to individual patient needs and preferences is likely to become increasingly important to ensure that treatment strategies are both effective and meet patient expectations.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":"96 4","pages":"13098"},"PeriodicalIF":1.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}