International Braz J Urol最新文献

{"title":"Telesurgery in Urology is the Hot Topic in this Number of International Brazilian Journal of Urology.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.03.01","DOIUrl":"10.1590/S1677-5538.IBJU.2025.03.01","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626540","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":"Advancing Surgical Management of Penile Cancer: Single Port Bilateral Inguinal Lymph Node Dissection.","authors":"Sisto Perdonà, Alessandro Izzo, Antonio Tufano, Francesco Passaro, Giuseppe Quarto, Achille Aveta, Roberto Contieri, Savio Domenico Pandolfo, Riccardo Autorino, Gianluca Spena","doi":"10.1590/S1677-5538.IBJU.2024.0663","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0663","url":null,"abstract":"<p><strong>Introduction: </strong>Penile cancer is a rare but aggressive malignancy, with inguinal lymph node involvement representing a key prognostic indicator (1, 2). NCCN guidelines recommend prophylactic inguinal lymph node dissection (ILND) for intermediate-to-high-risk patients (pT1b, ≥T2) with non-palpable nodes, aiming for early staging and improved outcomes (3). The SP-approach employs a single incision and advanced robotic instrumentation to enhance maneuverability, reduce morbidity, and optimize recovery. Widely used in kidney and prostate surgery (4, 5), this is, to our knowledge, its first application for ILND in Europe.</p><p><strong>Material and methods: </strong>This video shows a novel robotic-assisted bilateral, superficial and deep ILND using the DaVinci SP™ system. In this patient, a preoperative 3D reconstruction allowed detailed visualization of lymph nodes and surrounding structures, enabling precise dissection and an improved intraoperative orientation using Tilepro feature.</p><p><strong>Results: </strong>Compared to open techniques, robotic ILND offers similar lymph node yields with superior cosmetic outcomes and reduced postoperative pain (6). These benefits are amplified with the SP system, which excels in the constrained inguinal region by minimizing instrument interference and enhancing efficiency (7). Fewer incisions minimized risks such as wound infections and skin necrosis (8). Limitations of the SP-technique might include extended operative times, especially during the learning phase, and the absence of long-term oncological data. Additionally, complex cases requiring concurrent pelvic lymphadenectomy may necessitate repositioning the robotic system, increasing procedure time.</p><p><strong>Conclusions: </strong>SP robotic-assisted ILND can represent a significant advancement in the surgical management of penile cancer, combining oncological safety with reduced surgical morbidity. Future studies are needed to validate these findings, compare surgical outcomes, and assess long-term efficacy.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257232","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":"Editorial Comment: Epidemiology of Spinal Cord Injury in Adults in Sweden, 2016-2020: ARetrospective Registry-Based Study.","authors":"Nilson Marquardt, Marcio A Averbeck","doi":"10.1590/S1677-5538.IBJU.2025.9909","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9909","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626600","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":"Pulsed TM-YAG laser (Thulio®): a new weapon in endourologists' hand in the conservative management of imperative cases of Upper Tract Urothelial Carcinoma (UTUC).","authors":"Riccardo Scalia, Stefano Gisone, Rebeca Escobar, Silvia Proietti, Franco Gaboardi, Guido Giusti","doi":"10.1590/S1677-5538.IBJU.2024.0653","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0653","url":null,"abstract":"<p><strong>Introduction: </strong>Urothelial carcinomas (UC) represent the sixth most common tumor by incidence, involving the lower or upper urinary tracts (UTUC) (1). High-risk patients should be treated by nephroureterectomy with complete bladder cuff excision (2), conservative approach is reserved for low-risk UTUCs and/or imperative cases (3).</p><p><strong>Materials and methods: </strong>We present a 70-year-old male patient, smoker, with history of urothelial carcinoma. He underwent distal ureterectomy with ileal replacement in April 2019. Since then, he has developed several UTUC recurrences bilaterally and in the bladder, which have been treated conservatively. In August 2023, CT- scan showed multiple recurrences in the left kidney and ureter. Hence, on November 2023, we performed cystoscopy, monopolar resection of bladder tumor and bilateral flexible ureteroscopy (fURS) with pulsed thulium:YAG (p-Tm:YAG) ablation of the tumors. We performed a no-touch technique fURS with Video Uretero-Renoscope FLEX-XC1 by Storz. After this, we placed an ureteral access sheath and then a biopsy by using a tipless basket. The laser fiber used was 272 µm and the laser settings were 0.8 J - 10 Hz - Long pulse Ablation (10 W).</p><p><strong>Results: </strong>The pathological results showed UTUC bilaterally and high-grade UC in the bladder. Then, he underwent intravenous therapy with enfortumab - vedotin and the follow-ups, in February 2024 and June 2024, showed no evidence of recurrences at the multiple biopsies.</p><p><strong>Conclusion: </strong>The p-Tm:YAG laser can be considered a valid alternative option for the conservative treatment of UTUCs. With that said, stringent follow-up remains a mainstay in the conservative treatment of imperative cases of UTUC.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626539","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":"Urachal Carcinomas: A Comprehensive Systematic Review and Meta-analysis.","authors":"Caio Vinícius Suartz, Lucas Motta Martinez, Marcelo Henrique Lima Silvestre, Richard Dobrucki Lima, Pedro Henrique Souza Brito, Ketlyn Assunção Galhardo, Roberto Iglesias Lopes, Victor Hondo Silva Moraes, Caio Mazzonetto Teofilo Moraes, Luana Covatti, Maria Fernanda Dias Azevedo, Lucas Schenk Almeida, Debora Narumi Demitrol Setoue, Natália Doratioto Serrano Faria Braz, José Bessa, Fernando Korkes, Leonardo O Reis, Kátia Ramos Moreira Leite, William Carlos Nahas, Paul Toren, Leopoldo Alves Ribeiro-Filho","doi":"10.1590/S1677-5538.IBJU.2024.0665","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0665","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aim to consolidate current evidence on the diagnosis, epidemiology, and treatment of urachal carcinoma, a rare malignancy with limited data.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed/MEDLINE was conducted up to September 2024 to identify studies involving patients with urachal carcinoma, reporting clinical epidemiological characteristics, diagnostic strategies, histopathological findings, tumor staging, treatment modalities, and oncological outcomes. Extracted data were systematically synthesized, and statistical analyses, including a single-arm meta-analysis, were performed to comprehensively evaluate oncological outcomes.</p><p><strong>Results: </strong>Our study includes 1,901 cases of urachal carcinoma from 50 studies. The findings support the oncologic advantage of en-bloc resection with umbilectomy in localized disease, demonstrating improved survival outcomes and reduced recurrence rates. In the adjuvant setting, those receiving cisplatin-based therapy presented the best response, with 65.73% with no disease progression; similarly, in the metastatic disease, cisplatin-based regimens seem to have better responses in metastatic disease. The single-arm meta-analysis estimated a 5-year overall survival rate of 51% (95% CI: 0.49-0.54). Tumor recurrence was documented in 35% of cases (95% CI: 0.25-0.45), with local recurrence occurring in 28% (95% CI: 0.18-0.38), with the average time to recurrence of 27.6 months.</p><p><strong>Conclusion: </strong>Our study provides the most comprehensive review of urachal carcinoma to date, providing evidence to guide clinical decisions. It underscores the oncologic benefits of en-bloc resection with umbilectomy and specific chemotherapeutic regimens. Emerging alternative therapies also show potential, highlighting the need for further research to optimize patient outcomes.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257165","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":"Management of Adverse Effects in Testosterone Replacement Therapy.","authors":"Basheer Basheer, Vishal Ila, Rodrigo Barros, Francesco Mesquita, Leonardo Seligra Lopes, Victor Fernandes Negris Lima, Luciano A Favorito, Ranjith Ramasamy","doi":"10.1590/S1677-5538.IBJU.2025.9904","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9904","url":null,"abstract":"<p><strong>Purpose: </strong>This narrative review aims to provide the most updated knowledge regarding the treatment of adverse effects secondary to testosterone replacement therapy (TRT), such as gynecomastia, cardiovascular and hematologic risks, prostate health risk, and liver dysfunction risks.</p><p><strong>Materials and methods: </strong>An extensive literature review was conducted, incorporating guidelines from the American Urological Association and the Endocrine Society. The studies determined common adverse effects and their most common methods of management.</p><p><strong>Results: </strong>TRT improves the quality of life, sexual function, and mood in hypogonadal men. Possible adverse effects associated with TRT include increased estrogen levels and gynecomastia, which are usually managed with aromatase inhibitors and tamoxifen. Cardiovascular risks from TRT include hypertension and erythrocytosis, which mandate periodic hematocrit and blood pressure monitoring; therapeutic phlebotomy is indicated if the hematocrit exceeds 52%. No significant concern regarding prostate cancer has been observed in the closely monitored patient. However, TRT should not be administered to individuals with active evidence of untreated prostate cancer, except under rare circumstances such as active surveillance for very low-risk disease. Older oral forms of TRT can affect liver function; therefore, transdermal, newer oral forms and injectables are generally favored in men with a history of liver disease.</p><p><strong>Conclusions: </strong>Monitoring and management of adverse effects are critical to maximize benefit and minimize the risks of TRT. Ongoing research will further elucidate the safety of TRT while advancing evidence-based practices in managing its associated adverse effects. Effective patient education and counseling are also essential to improve compliance and treatment outcomes.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257237","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":"Neurophysiology of Micturition: a Narrative Review on Preventing Mismanagement.","authors":"Ricardo C Mattos, Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.9907","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9907","url":null,"abstract":"<p><strong>Introduction: </strong>The insidious interrelation between three key factors underscores the critical need to understand the neural control of the lower urinary tract (LUT): the complexity of its functioning, the epidemiology of conditions that can disrupt it, and the nonspecific presentation of related symptoms. This paper examines the importance of understanding neurophysiology of micturition to prevent mismanagement and reduce unnecessary procedures.</p><p><strong>Material and methods: </strong>This review focuses on the neurophysiology of the micturition cycle, the epidemiology of major health conditions that affect it, and the nonspecific nature of lower urinary tract symptoms (LUTS) concerning underlying pathologies. The review was conducted in accordance with the guidelines of the Scale for Assessment of Narrative Review Articles (SANRA). Only articles in English were included, while case reports, editorials, and expert opinion pieces were excluded.</p><p><strong>Results: </strong>The ability of the LUT to store and release urine requires precise coordination and is mediated by a complex network involving the brain, spinal cord, peripheral ganglia, and nerves. Epidemiological data reveal a growing global burden of diseases that impact LUT functioning (LUTF). Moreover, the nonspecific nature of LUTS often leads to diagnostic challenges, and inappropriate treatment strategies.</p><p><strong>Conclusion: </strong>The interplay between the complexity of LUTF, the widespread prevalence of conditions that can disrupt it, and the nonspecific nature of related symptoms frequently complicate urological decision-making. Overlooking associated neurological factors can result in suboptimal outcomes, diminished quality of life, and serious adverse consequences. A systematic approach is crucial to minimizing the risk of misdiagnosis and mismanagement, especially when considering invasive interventions.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494453","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":"Feasibility and Initial Outcomes of Telesurgery in Urology: a Systematic Review of the Literature.","authors":"Sávio Valadares Ferreira, Murilo Henrique Sugai, Guilherme Corrêa Nascimento, Antonino Caetano Souza, Gustavo Colombo Cabrini, Fernando Martins Rodrigues, Cleverson Luiz Rocha D'Avila, Geovanne Furtado Souza, Ricardo Vieira Zerati, Miguel Zerati","doi":"10.1590/S1677-5538.IBJU.2024.0494","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0494","url":null,"abstract":"<p><strong>Introduction: </strong>Telesurgery allows the procedures to be carried out over long distances, however due to lack of data, its feasibility has not been consolidated yet. Since it is a promising modality, it is important to illustrate the current scenario on this subject.</p><p><strong>Objective: </strong>To review the literature aiming at the surgical success rate as a primary objective, and secondly, the most important patient outcomes and the network system.</p><p><strong>Materials and methods: </strong>In June 2024, we followed PRISMA guidelines to research trials on urological robotic surgery in humans. We used as exclusion criteria: editorials, specialist's opinions, tele-mentoring, tele-training, small procedures, non-remote surgeries, absence of interest outcomes, telesurgeries in non-humans or in cadaver.</p><p><strong>Results: </strong>Five hundred and ninety eight studies were identified with peer review and a third reviewer for divergencies, both directed by previously established inclusion and exclusion criteria, selecting 6 studies after the exclusions. We found 54 patients who underwent urological telesurgeries; all of them were accomplished with no complications or need for conversion to open surgery. Almost all the procedures were carried out in China (98.14%) and the most used robotic model was MicroHand S (83.33%). Nephrectomy was the procedure of choice (57%). Mean surgical time was 66.2 (IQR) 56.6 minutes. Intraoperative bleeding time was 68.6 ± 76.7 milliliters. Hospital stay was 5.5 (IQR) 5 days. The distance between main surgeon and the patient was between 2,581.5 (IQR) 2,871 kilometers. 5G network was used the most (98.14%). The total network latency time was 176 (IQR) 10.9 milliseconds.</p><p><strong>Conclusion: </strong>Despite its limitations, there was evidence demonstrating that robotic surgery in the genitourinary system is safe and feasible, however it is a subject that must be well discussed, and further studies must be carried out.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626534","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":"Editorial Comment: Assessment of Factors Responsible for Stone-Free Status After Retrograde Intrarenal Surgery.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.9901","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9901","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257120","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":"Efficacy and Safety of Mirabegron Compared to Solifenacin in Treatment of Non-neurogenic Overactive Bladder in Children: A Randomized Controlled Trial.","authors":"Islam Mansour, Mahmoud Laymon, Ahmed Abdelhalim, Mohamed S Dawaba, Ahmed S El-Hefnawy","doi":"10.1590/S1677-5538.IBJU.2024.0425","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0425","url":null,"abstract":"<p><strong>Purpose: </strong>Non-neurogenic overactive bladder (OAB) is a common problem in children. Antimuscarinics have been widely used as first-line medical treatment. However, their frequent side effects necessitate searching for therapeutic alternatives. We aimed to assess the efficacy and safety of the beta 3 agonist, mirabegron.</p><p><strong>Materials and methods: </strong>A randomized controlled trial enrolled child with non-neurogenic OAB refractory to behavioral urotherapy. Patients were randomized to receive either Mirabegron 25/50 mg based on a 40-kg body weight cutoff or solifenacin 5 mg for 12 weeks. Patients were assessed using Dysfunctional Voiding Scoring System questionnaire (DVSS), 3-day voiding diary and uroflowmetry. Vital signs and adverse effects were recorded at baseline and follow-up. The study primary endpoint was ≥50% reduction of the baseline DVSS.</p><p><strong>Results: </strong>Among 128 patients screened, 72 patients (36 in each group) completed the study with a mean age of 9.2±2.3 years. Both groups had significant improvement of DVSS and voiding diary (p<0.001) at 12 weeks. In mirabegron group, 94.4% (34/36) had greater than 50% improvement of DVSS compared to 75% (27/36) of solifenacin group (P=0.02). Complete symptom resolution was observed in 22.2% (8/36) patients on mirabegron versus 8.3% (3/36) on solifenacin (P=0.1). Patients on mirabegron had less adverse effects (19.4% vs 47.2%; p=0.01).</p><p><strong>Conclusion: </strong>Mirabegron is more effective with fewer adverse effects than solifenacin for treatment of children with OAB. Mirabegron treatment improves daytime symptoms and nocturnal enuresis with less risk of constipation. It may be considered as first-line pharmacotherapy in this patient population.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257124","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}