International Braz J Urol最新文献

{"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: Does Surgical Treatment for Benign Prostate Enlargement (BPE)-Related Bladder Outlet Obstruction (BOO) Benefit Patients with Central Nervous System Diseases? A Systematic Review.","authors":"Iago Zang Pires, Marcio A Averbeck","doi":"10.1590/S1677-5538.IBJU.2025.9908","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9908","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/PMC12052029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626598","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}

{"title":"Aldehyde free - Bovine Pericardium - A New Option of Graft in Urethral Stricture Treatment.","authors":"Luciano A Favorito, Rodrigo R Vieiralves, Arthur V Batista, Renata Palopoli Silva, Luis Octavio Hauschild, Lucas A M Uneda, José A D Resende","doi":"10.1590/S1677-5538.IBJU.2024.9928","DOIUrl":"10.1590/S1677-5538.IBJU.2024.9928","url":null,"abstract":"<p><strong>Objective: </strong>The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, bladder mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material) (1, 2). In the present video, we present a case where we used a new option of graft to treat urethral strictures: the L-Hydro® tissue treatment technology 100% aldehyde free, VIVENDI graft.</p><p><strong>Materials and methods: </strong>The present study was approved according to the ethical standards of the hospital's institutional committee on experimentation with human beings. A 57 year-old male patient developed a urethral stricture due to prolonged use of a urinary catheter during a previous hospitalization. A cystourethrogram was performed, which revealed a stenosis of the penile urethra measuring 2.5 cm in length. Urethroplasty was proposed for the surgical treatment in this case. We used a longitudinal penile incision with a ventral sagittal urethrotomy in the penile stricture. A free VIVENDI graft was placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers. The patient will receive post-operative follow-up for 3 months for clinical assessment through symptoms, uroflowmetry, urethroscopy and residual urine volume after urination.</p><p><strong>Results: </strong>No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the three-month follow-up. Four weeks after surgery, he underwent urethroscopy, which revealed a good appearance of the urethra, with no stenosis or signs of infection.</p><p><strong>Conclusion: </strong>In the present case the use of bovine pericardium graft for the treatment of penile urethral stricture had a good result and can be an option to repair complex urethral strictures. However, the results presented require a larger population group in addition to multicenter studies with longer follow-up time to ensure the findings obtained. Available at: http://www.intbrazjurol.com.br/video-section/20249928_Vieiralves_et_al.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869784","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 the Effectiveness of Self-Visualization During Flexible Cystoscopy Gender-Dependent in Patients with no Previous Cystoscopy History? A Prospective Random-ized Study.","authors":"Nurullah Hamidi, Mehmet Duvarci, Tuncel Uzel, Oguzhan Ceylan, Serhat Haluk Unal, Erdem Ozturk","doi":"10.1590/S1677-5538.IBJU.2024.0498","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0498","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of real-time self-visualisation (SV) of the procedure during flexible cystoscopy (FC) on pain and anxiety in male and female patients with no prior cystoscopy history.</p><p><strong>Patients and methods: </strong>Between Dec 2022-May 2024, 400 patients who underwent office-based FC were enrolled into prospective randomized study in accordance with CONSORT. Patients were randomised into two groups (SV and no-SV) using sequential (1:1 ratio) randomisation. To ensure equal numbers of male and female patients in each group, one consecutive male patient was assigned to the SV group, while the next male patient was assigned to the non-SV group; the same randomization was done for females. The primary endpoint was to evaluate the pain during FC (during urethral insertion of the cystoscope and bladder examination stages) of both groups. The secondary endpoint was to evaluate anxiety, patient satisfaction, and willingness to undergo the procedure of both groups.</p><p><strong>Results: </strong>In males, significant lower pain scores were detected in SV group during urethral insertion of the cystoscope (1.4 vs. 4.8, p<0.001) and during bladder examination (0.9 vs. 3.1, p<0.001). However, pain scores during urethral insertion of the cystoscope (1.9 vs. 2, p=0.38) and during bladder examination (1.2 vs. 1.3, p=0.63) were statistically similar between two groups in female patients. In both genders, significant lower anxiety levels, higher patient satisfaction and higher willingness to undergo repeat cystoscopy were detected in SV group.</p><p><strong>Conclusion: </strong>SV during FC may be beneficial in reducing pain in male patients but not in female patients. SV during FC has a positive effect on anxiety, patients' satisfaction, and willingness to undergo repeat procedures, regardless of gender.</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/PMC11884630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257130","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":"Shock Wave Therapy in the Treatment of Erection Dysfunction: How to Define Clinical Outcomes? A Comparison Between Penile Doppler Ultrasound and a New Visual Erec-tion Hardness Score (V-EHS) During a Blinded, Sham-Controlled Trial.","authors":"Mathias Ferreira Schuh, Rodrigo Ribeiro Vieiralves, Luciano Alves Favorito","doi":"10.1590/S1677-5538.IBJU.2024.9927","DOIUrl":"10.1590/S1677-5538.IBJU.2024.9927","url":null,"abstract":"<p><strong>Background: </strong>In the last decade, several studies have proven the effectiveness of low-intensity shock waves (LI-ESWT), but with several factors that make it difficult to carry out systematic reviews.</p><p><strong>Aim: </strong>To demonstrate the effectiveness of LI-ESWT and define the best tool for routine clinical assessment of erectile dysfunction.</p><p><strong>Materials and methods: </strong>Twenty-one participants with purely vasculogenic erectile dysfunction were selected and randomized to LI-ESWT or placebo. All patients underwent evaluation with The International Index of Erectile Function (IIEF-5), V-EHS (new visual scale), and standardized penile doppler ultrasound before and after shock wave therapy.</p><p><strong>Outcomes: </strong>LI-ESWT has proven effective in the treatment of moderate erectile dysfunction, and the new V-EHS has demonstrated greater accuracy than Doppler in the diagnosis and follow-up of erectile dysfunction.</p><p><strong>Results: </strong>Using the IIEF-5 as a control tool, we observed a clinical response after 1 month, with a greater increase in the shock wave therapy arm of +3.21 points compared to + 0.57 in the sham group. At six months, the treated group showed a mean increase of 4.71 points compared to baseline (p = 0.006), while those who received sham therapy had a decrease (case = +4.71 points vs. sham control = -1.0, p = 0.006). Based on this observed difference, we performed a comparative analysis between the V-EHS and penile doppler ultrasound to observe whether the test results corroborated the IIEF-5 findings. The correlation between V-EHS and IIEF-5 in the therapy group in the pre-therapy period was strong (r = 0.816, p < 0.001), and at 6 months it increased to very strong (r = 0.928, p < 0.001). Penile Doppler ultrasound did not show the same correlation strength with IIEF-5, presenting a moderate correlation at 6 months (Pearson correlation score = 0.540), as also demonstrated in the ROC curve through the V-EHS AUC = 0.963 (p = 0.001) vs. Doppler AUC = 0.713 (p = 0,290). Strengths and Limitations: The main strengths of the present study are the blinded, randomized, placebo-controlled clinical trial and the comparison between penile Doppler and a new visual classification for erection hardness score. The limitations are the number of patients and the short follow-up.</p><p><strong>Conclusions: </strong>LI-ESWT has proven effective in the treatment of moderate vasculogenic erectile dysfunction, with optimal results at 6 months. The new V-EHS offers a simple, reliable and reproducible assessment of erectile function.</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/PMC11884628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257157","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}