International Braz J Urol最新文献

{"title":"Applied Anatomy of Bulbospongiosus Muscle: a Narrative Review.","authors":"William Lannes, Jorge L Alves-Pereira, Eduardo M Ribeiro, Edilaine F Alves, Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.9917","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9917","url":null,"abstract":"<p><p>This review aims to provide a comprehensive analysis of the anatomy of the bulbospongiosus muscle (BSM) in males, highlighting its morphological features, anatomical variations, and clinical implications in ejaculatory process and urethral surgery. We analyzed papers published in the past 70 years in the databases of Pubmed, Embase and Scielo. We excluded case reports, editorials and opinions of specialists. Studies were excluded if they lacked clear anatomical descriptions of the BSM, if full-text access was unavailable, or if they were published in languages other than Portuguese, English, or Spanish. The BSM is part of the superficial muscular layer of the perineum The perineal arteries provide vascular supply to BSM and, toward the end of their path, give rise to several posterior scrotal branches that supply the skin and dartos muscle of the scrotum. The deep branch of pudendal nerve is primarily muscular and innervates the superficial transverse perineal, bulbospongiosus, ischiocavernosus, deep transverse perineal, and sphincter muscles of the membranous portion of the urethra. This revision concluded that the BSM is a paired skeletal striated muscle that originates from the perineal body enveloping the bulbar portion of the urethra. Stimulation of the dorsal nerve of the penis leads to BSM contraction that provides an indication of anatomic sacral nerve pathway integrity. BSM has some important clinical applications. The bulbar urethral stricture causes minimal alterations in the structure of the BSM during the surgical procedure and the BSM is highly sensitive to androgen and could be used in common androgenic activity evaluation.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208035","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":"Fourteen-Year Analysis of Percutaneous Nephrolithotripsy Outcomes: Evolution of Technique and Future Perspectives.","authors":"Fabio C Vicentini, Carlos A Batagello, Giovanni S Marchini, Fabio C M Torricelli, Artur Brito, Alexandre Danilovic, Guilherme Gentile, Henrique Lepine, Priscila Kuriki Mota, Daniel Beltrame Ferreira, Rodrigo Perrella, David Cohen, Claudio B Murta, Valter Cassao, Joaquim A Claro, William Nahas, Eduardo Mazzucchi","doi":"10.1590/S1677-5538.IBJU.2025.0403","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0403","url":null,"abstract":"<p><strong>Purpose: </strong>The treatment of kidney stones has undergone continuous evolution. Despite the evolution of retrograde intrarenal surgery, percutaneous nephrolithotomy (PNL) remains the gold standard treatment for large and complex stones. We aimed to evaluate and analyze the temporal evolution of the results of the PNLs conducted at two teaching hospitals.</p><p><strong>Results: </strong>Data from 2660 patients were studied between 2009 and 2022. The rate of complex stones (Guy's 3 and 4) was 55.3%. Supine position was used in 82.1% of the cases. In 74.7% of cases, only 1 puncture was performed. The median surgery time was 120 min (15-240 min). The overall complication rate was 12.2%, the transfusion rate was 4.5%, and the success rate was 59.8%. Regarding temporal evolution, the use of the supine position increased from 73% in 2009 to 100% in 2022 (p < 0.001). The use of nephrostomy dropped from 81.8% to 26.5% (p<0.001), the median duration of surgery dropped from 145 to 130 min, the median time of use of fluoroscopy went from 12 to 8 min, the rate of blood transfusions dropped from 11.5% to 2.8% (p= 0.009), and the complication rate dropped from 18.2% to 12% (p= 0.002), while the average length of stay dropped from 81.8 hours to 50 hours.</p><p><strong>Conclusions: </strong>PNL is an effective surgical option for treating complex kidney stones. The implementation of several technical aspects, along with the standardization of the procedure, led to a significant improvement in most outcomes, reducing complication rates but leaving room for technique improvements in terms of success rates.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976105","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":"Robot-assisted Radical Prostatectomy in the Brazilian Unified Health System (SUS): A Landmark in Surgical Public Health.","authors":"Leonardo O Reis","doi":"10.1590/S1677-5538.IBJU.2025.9918","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9918","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304130","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":"Survival Without Reintervention of Second Artificial Urinary Sphincter Implants in Men: A National Healthcare Data System-Based Study in France.","authors":"Elliot Tokarski, Yoann Taillé, Emmanuel Chartier-Kastler, Bertrand Lukacs, Thomas Seisen, Morgan Roupret, Aurélien Beaugerie, Eric Vicaut, Pierre C Mozer, Louis Lenfant","doi":"10.1590/S1677-5538.IBJU.2025.0374","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0374","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial urinary sphincter (AUS) is the gold standard treatment for severe male stress urinary incontinence (SUI). While survival outcomes after primary implantation are now well established, the prognosis following reintervention remains poorly understood. We aimed to assess long-term reintervention-free survival after a second AUS implantation and to compare outcomes between device replacement and reimplantation after removal.</p><p><strong>Materials and methods: </strong>We performed a nationwide, population-based, retrospective cohort study including all men aged ≥18 years in France who underwent a second AUS implantation between 2006 and 2018 for SUI following prostate cancer or benign prostatic hyperplasia treatment. AUS procedures were identified through a unique device identifier. Of 5,132,311 eligible men, 8,475 received a first AUS and 1,619 a second AUS: 1,165 after device replacement and 454 after reimplantation following removal. The primary outcome was reintervention-free survival, estimated by Kaplan-Meier analysis. Secondary outcomes included replacement and removal rates. Predictors of reintervention were identified using multivariable Cox regression.</p><p><strong>Results: </strong>Median follow-up was 53 months (IQR 26-81). Reintervention-free survival after second AUS was 81% (95% CI 79-83) at 2 years, 68% (95% CI 65-71) at 5 years, and 61% (95% CI 57-64) at 10 years. Device replacement achieved significantly better survival than reimplantation after removal (p <0.001). Notably, only 21% of patients whose first AUS was removed underwent reimplantation.</p><p><strong>Conclusions: </strong>Second AUS implantation provides durable long-term outcomes, approaching those of primary implants. The indication for reintervention critically influences prognosis, with replacement outperforming reimplantation after removal. The low reimplantation rate after AUS removal provides a clinically relevant piece of information to counsel patients requiring device removal.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066238","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":"Gender Affirming Revision Vaginoplasty Utilizing Decellularized Fish Skin Xenograft: Surgical Technique and Outcomes.","authors":"Seyed Sajjad Tabei, Alex J Xu, Rachel Pope, Kyle Scarberry, Kirtishri Mishra, Shubham Gupta","doi":"10.1590/S1677-5538.IBJU.2025.0340","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0340","url":null,"abstract":"<p><strong>Purpose: </strong>Tissue availability for revision vaginoplasty in trans feminine individuals is often limited, creating challenges in cases with prior surgery or inadequate local tissue. While not yet extensively studied in genital reconstruction, Kerecis SurgiClose®, a decellularized fish skin xenograft, has shown promise as a skin substitute in other surgical contexts, including burn care and chronic wound management. This study aims to describe the surgical technique and evaluate the short-term clinical outcomes of revision vaginoplasty using decellularized fish skin xenograft (FSXRV) in trans feminine individuals.</p><p><strong>Materials and methods: </strong>A retrospective review of 27 trans feminine patients who underwent FSXRV between February 2023 and December 2024 was conducted. Data on preoperative characteristics, intraoperative details, and postoperative outcomes were collected from electronic medical records and analyzed.</p><p><strong>Results: </strong>The median age was 36 years, and the median BMI was 27 kg/m². Median postoperative follow-up was 261 days. Indications for FSXRV included loss of neovaginal depth (81.5%), proximal introital narrowing (14.8%), and devitalized neovaginal grafts (3.7%). The xenograft was applied in various configurations and anatomical locations using either a perineal-only or combined perineal-robotic approach. No intraoperative or major (Clavien-Dindo ≥II) complications occurred within 30 days postoperatively. Five patients (18.5%) underwent subsequent canal revision after FSXRV. Positive outcomes were reported in 74% of patients using the Patient Global Impression of Improvement scale.</p><p><strong>Conclusion: </strong>Fish skin xenograft revision vaginoplasty demonstrated early safety and feasibility for revision neovaginal lining and appeared to reduce reliance on autologous grafts or flaps in complex revision settings.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976067","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":"International Brazilian Journal of Urology Congratulates the 2025 Best Reviewers.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2026.01.02","DOIUrl":"10.1590/S1677-5538.IBJU.2026.01.02","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607158","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":"Distribution of Neuroendocrine Cells and Hormone Receptors in the Male Proximal Urethra: Implications for Sensory Function and the Impact of Aging.","authors":"Juan Andrés Venegas, Carlos Gallegos, Paola Ochova, Carlo Lozano, Valentina Pozo, Ivanny Marchant, Pablo Olivero","doi":"10.1590/S1677-5538.IBJU.2025.0402","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0402","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the distribution of neuroendocrine cells in the male penile urethra and the influence of age and estrogen therapy.</p><p><strong>Materials and methods: </strong>A retrospective immunohistochemical cohort study was conducted on 26 penile urethras obtained during feminizing genitoplasty. Three anatomical regions were analyzed: bulbar, distal, and glans urethra. Neuroendocrine cells were identified by double immunohistochemistry and quantified as chromogranin A-positive cells per mm² of epithelium.</p><p><strong>Results: </strong>Patients were divided according to estrogen exposure: Group 1 (n=12, median age 23.5 years, estrogen 5.5 years) and Group 2 (n=14, median age 43.0 years, estrogen 18.0 years). A clear gradient of neuroendocrine cell density was observed, with the bulbar urethra showing the highest values compared to distal urethra and glans. Group 2 had significantly higher bulbar urethral cell density than Group 1 (p<0.005). A negative correlation between age and bulbar density was observed.</p><p><strong>Conclusions: </strong>This study provides evidence of a neuroendocrine cell gradient in the human male urethra, concentrated in the bulbar region. Cell density declines with age but is preserved by long-term estrogen therapy. These findings underscore the bulbar urethra as a key sensory structure that should be preserved during surgery and suggest that hormone therapy may mitigate age-related sensory decline.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208112","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":"Acute Kidney Injury Following Mini Percutaneous Nephrolithotomy for Renal Stones: predictors and Follow-up Evaluation in Real-life Setting.","authors":"Federica Passarelli, Ludovico Maria Basadonna, Fabio Ciamarra, Edoardo Bonacina, Giorgio Graps, Edoardo Sorba, Valentina Parolin, Gianpaolo Lucignani, Francesco Ripa, Stefano Paolo Zanetti, Fabrizio Longo, Elisa De Lorenzis, Giancarlo Albo, Emanuele Montanari, Luca Boeri","doi":"10.1590/S1677-5538.IBJU.2025.0453","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0453","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the prevalence, predictors, and progression of acute kidney injury (AKI) in patients undergoing mPCNL for nephrolithiasis.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed data from 569 patients who underwent mPCNL at a single tertiary academic center (01/2016-10/2024). AKI was defined per KDIGO criteria as sCr increase >0.3 mg/dL or ≥1.5× baseline. Stone-free status was no residual stones on CT at 3-month follow-up. Complications were classified using the modified Clavien system. Kidney function was reassessed 30-90 days post-op. Descriptive statistics, logistic regression, and Cox regression were applied.</p><p><strong>Results: </strong>Median (IQR) age and stone volume were 57 (48-66) years and 2.1 (0.9-4.2) cm³. Median preoperative sCr and operative time were 0.9 (0.7-1.1) mg/dL and 90 (73-120) minutes. Post-mPCNL, 40 patients (7.0%) developed AKI. Complications occurred in 138 (24.2%) patients; 449 (78.9%) were stone-free. AKI patients had higher CCI (1.3 vs. 0.5, p=0.04), pre-op sCr (1.1 vs. 0.8 mg/dL, p<0.01), stone volume (5.7 vs. 2 cm³, p=0.02), and longer operative time (130 vs. 90 min, p=0.01). Complications were more frequent in AKI patients (42.5% vs. 22.8%, p=0.01). At multivariate analysis, operative time (OR 1.1, p=0.03), pre-op sCr (OR 3.8, p=0.001), and early complications (OR 2.5, p=0.02) were independently associated with AKI. AKI persisted in 9 (22.5%) patients, mainly those with complications (88.9% vs. 38.7%, p=0.01). On Cox analysis, lower BMI (HR 0.8, p=0.02) and absence of complications (HR 0.3, p=0.01) predicted faster AKI recovery.</p><p><strong>Conclusion: </strong>Acute kidney injury remains a clinically significant complication following mPCNL.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208028","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":"Robot-Assisted Bladder Neck Reconstruction in Refractory Vesicourethral Anastomot-ic Stenosis - A Single-Center Experience from a Specialized Urinary Tract Repair and Reconstruction Center.","authors":"Jianwen Huang, Changhao Hou, Song Li, Xiaoyong Hu, Ranxing Yang, Ying Wang, Nailong Cao, Jiong Zhang, Lujie Song, Qiang Fu","doi":"10.1590/S1677-5538.IBJU.2025.0385","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0385","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the efficacy and safety of robotic-assisted bladder neck reconstruction in patients with refractory vesicourethral anastomotic stenosis (VUAS) following radical prostatectomy (RP) or radical cystectomy (RC) with orthotopic neobladder (ONB) reconstruction.</p><p><strong>Methods: </strong>The clinical data from patients with VUAS who underwent robot-assisted bladder neck reconstruction at our center from August 2022 to February 2025 were retrospectively analyzed. The minimum postoperative follow-up period was 3 months, and bladder neck patency was defined as either the passage of a F16 flexible cystoscope or a maximum urinary flow rate (Qmax)>15 mL/s.</p><p><strong>Results: </strong>A total of 27 patients were analyzed, including 25 with a history of RP and 2 with a history of RC with ONB reconstruction. The median operative time was 210 min (interquartile range [IQR]:168-259), with a median estimated blood loss of 152 mL (IQR: 80-255) and a median postoperative hospital stay of 3.5 d (IQR: 3-6 d). At the median follow-up of 11 months (IQR: 3-34), 20 patients (74.1%) achieved patent reconstruction and 9 patients (75%) remained continent in 12 patients without preexisting stress urinary incontinence (SUI) at last follow-up. Postoperative complications occurred in five patients (18.5%), including two cases of Clavien-Dindo grade Ӏ and three cases of grade ӀӀ.</p><p><strong>Conclusions: </strong>Robotic-assisted bladder neck reconstruction represents a safe and effective surgical option with high patency and low de novo SUI rates for refractory VUAS following RP or RC with ONB reconstruction.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304165","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":"Bridging Methodology and Clinical Relevance: Toward More Robust Evidence for Antiox-idant Therapy in Male Infertility.","authors":"Shengyi Chen, Yuekun Fang, Bin Cheng","doi":"10.1590/S1677-5538.IBJU.2025.0407","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0407","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785782","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}