Arab Journal of Urology最新文献

{"title":"Implementing VIRADS score for image-guided assessment of muscle invasiveness in bladder cancer pre-TURBT: An updated meta-analysis.","authors":"Ahmad R Al-Qudimat, Doaa Sabir, Muna Elamin, Mica Ching, Seif B Altahtamouni, Kalpana Singh, Ibrahim A Khalil, Khalid Alrumaihi","doi":"10.1080/20905998.2024.2442256","DOIUrl":"10.1080/20905998.2024.2442256","url":null,"abstract":"<p><strong>Background: </strong>Bladder urothelial carcinoma is the most prevalent malignancy of the urinary system worldwide. Accurate staging of bladder cancer, particularly distinguishing between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), is essential for determining appropriate treatment. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy, sensitivity, and specificity of the vesical imaging-reporting and data system (VI-RADS) scoring system using multiparametric MRI in differentiating NMIBC from MIBC.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines. Comprehensive searches were performed in PubMed, Web of Science, Embase, and Cochrane databases up to December 2023. Studies that evaluated the diagnostic accuracy of the VI-RADS scoring system using multiparametric magnetic resonance imaging (MRI) to distinguish between NMIBC and MIBC were included. Data from eligible studies were extracted to calculate pooled sensitivity and specificity, and heterogeneity was assessed using meta-regression and subgroup analyses by using STATA V17.0.</p><p><strong>Results: </strong>A total of 31 studies, comprising 3,798 bladder cancer patients, were included in the meta-analysis. The pooled sensitivity and specificity for predicting MIBC using a VI-RADS cutoff score of ≥ 3 was 89%, with moderate heterogeneity observed across studies. Subgroup analysis revealed variations in diagnostic performance based on geographic location (North America, Europe, and Asia), MRI technical parameters, and study design. Studies utilizing 3.0 Tesla MRI scanners and those involving multiple radiologists demonstrated higher diagnostic accuracy.</p><p><strong>Conclusion: </strong>The VI-RADS system demonstrates high diagnostic accuracy in distinguishing between NMIBC and MIBC, with a cutoff score of ≥ 3 yielding optimal sensitivity and specificity. Its integration into clinical practice has the potential to reduce the need for invasive procedures, improve staging accuracy, and expedite treatment decisions. Future research should focus on standardizing MRI protocols and further validating these findings across diverse clinical settings to enhance the utility of VI-RADS in bladder cancer management.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 2","pages":"97-108"},"PeriodicalIF":1.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted partial nephrectomy in complex renal tumors using the Versius platform: An initial but promising experience.","authors":"Mahmoud A Abdelhakim, Mohamed Abdelwahab","doi":"10.1080/20905998.2024.2442268","DOIUrl":"10.1080/20905998.2024.2442268","url":null,"abstract":"<p><strong>Background and objectives: </strong>The widespread utilization of robotic surgeries in urology encouraged several teams to explore the option of performing robot-assisted partial nephrectomy (RAPN), taking advantage of its magnified stereoscopic vision and the articulating instruments that facilitate tumor resection and the reconstructive steps of hemostasis and renorrhaphy. The implementation of the CMR Versius system in RAPN, especially in complex masses, has not been explored yet. Herein, we present our initial experience in performing RAPN in complex renal masses using this novel platform.</p><p><strong>Methods: </strong>Between July 2022 and November 2023, thirty patients who had complex renal masses and were candidates for RAPN were enrolled in this study. Tumor complexity was assessed using the preoperative aspects of the dimension used for anatomic (PADUA) nephrometry scores. Perioperative data were prospectively collected and analyzed. 'TRIFECTA' was defined as free surgical margins, warm ischemia time (WIT)< 30 minutes, and no major complications (>Clavien-Dindo II).</p><p><strong>Results: </strong>All cases were successfully completed with no conversion to radical, open, or laparoscopic surgery. The median PADUA score was 9.5 (8-11). The mean docking time, console time, and total operative time were 9.17 ± 0.91, 149 ± 14.27, and 177.17 ± 29.53 minutes, respectively. The mean WIT was 26.67 ± 3.66 minutes. Surgical margins were free in all cases. TRIFECTA was fulfilled in 25/30 patients (83.33%). Five patients (16.66%) did not fulfill TRIFECTA; two patients had prolonged WIT > 30 minutes, two had prolonged WIT with prolonged urine leakage necessitating DJ stent insertion, and the fifth patient had only prolonged urine leakage and DJ insertion. None of the patients developed tumor recurrence or acute kidney injury during follow-up.</p><p><strong>Conclusion: </strong>Performing RAPN with the CMR Versius platform is a feasible option in complex renal masses with slightly increased but accepted WIT and total operative time. It should be wisely restricted to well-experienced teams.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 2","pages":"145-151"},"PeriodicalIF":1.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted radical prostatectomy with the Versius surgical platform: An objective criticism and a guide for an optimal surgical setup.","authors":"Mahmoud A Abdelhakim, Mohamed Abdelwahab","doi":"10.1080/20905998.2024.2442267","DOIUrl":"10.1080/20905998.2024.2442267","url":null,"abstract":"<p><strong>Objectives: </strong>This was an observational study aiming at providing a guide for an optimal setup of the Versius robotic system and evaluating its performance in robot-assisted radical prostatectomy (RARP).</p><p><strong>Patients and methods: </strong>Between July 2022 and December 2022, all patients with pathologically confirmed prostate cancer candidates for radical prostatectomy were included. Patients who had previous abdominal surgeries or were unfit for pneumoperitoneum were excluded. The preoperative, intraoperative, and postoperative data were prospectively collected. RARP was performed through 5 ports (12 mm); 3 for the robotic arms, 1 for the camera, and 1 for the assistant surgeon. Repeated adjustments of the patient's position and port distribution along with the bedside unit's configuration, arrangement, and orientation were made until an optimal setup was achieved. The technical malfunctions were identified in each case and fixed in the subsequent ones. All patients were invited to the follow-up clinic for routine visits on the first and second weeks following surgery and then every month for three months.</p><p><strong>Results: </strong>Thirty patients underwent the procedure without conversion to laparoscopy or open surgery and abided by the follow-up regimen. The first nine cases required frequent setup adjustments due to recurring alarms and arms-related conflicts. Thenceforth, the mean docking time, console time, urethro-vesical anastomosis time, and total operative time were enhanced in the last 21 cases without system alarms. No major intraoperative complications related to the robotic system utilization were reported. The postoperative course of all participants passed uneventfully. The median length of the hospital stay and catheterization time were 2 (1-2) and 7 (7-10) days, respectively.</p><p><strong>Conclusion: </strong>The Versius system offers a promising robotic platform with a flexible surgical setup. The proposed setup provides a guide for a smooth performance in RARP with minimal instruments' collision to eschew system failure. Being the first generation of this surgical robotic system, future efforts are still needed to improve its performance and minimize its drawbacks.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 2","pages":"152-159"},"PeriodicalIF":1.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary transforming growth factor beta-1 levels correlate with the effect of renorrhaphy on functional outcomes post-laparoscopic partial nephrectomy: A pilot-study.","authors":"Aly M Abdel-Karim, Ahmed M Bakr, Mustafa A Shamaa, Mokhtar A Metawee, Ahmed I El-Sakka","doi":"10.1080/20905998.2024.2432702","DOIUrl":"10.1080/20905998.2024.2432702","url":null,"abstract":"<p><strong>Purpose: </strong>Preservation of functional renal parenchyma is one of the main targets of partial nephrectomy. We investigated the effects of suture on renal parenchyma in tumor bed and on short-term renal function.</p><p><strong>Materials and methods: </strong>Patients with unilateral cT1 renal masses candidate for laparoscopic partial nephrectomy (PN) have been recruited. After tumor excision, medullary sutures were replaced by argon beam in Group 1, while Group 2 had conventional 2-layer renorrhaphy. Groups have been matched using propensity score. Transforming growth factor beta-1 (TGFb1) levels in urine have been measured at the 1^st and 30^th day post-PN. Glomerular filtration rate has been estimated (eGFR) at baseline and 3 months post-PN.</p><p><strong>Results: </strong>Sixteen cases were matched in each group. There was no difference between groups regarding baseline, operative and perioperative data. Number of sutures in group 1 is nearly half that in group 2 (10 vs 19, respectively, <i>p</i> < 0.001). Group 1 showed lower urinary TGFb1 levels at the 1^st and 30^th day post-PN (<i>p</i> < 0.01 for each), higher eGFR after 3 months (<i>p</i> = 0.01), and less decline of eGFR from baseline (<i>p</i> = 0.046).</p><p><strong>Conclusion: </strong>TGFb1 levels in urine after PN are related to the number of sutures. Reduced number of sutures in tumor bed has a positive effect on short term eGFR changes possibly by reducing tumor bed fibrogenic healing response as well as preserving renal parenchymal volume.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 2","pages":"139-144"},"PeriodicalIF":1.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous nephrostomy tube versus double J ureteric stent for the management of non-septic calcular anuria in adults: Prospective randomized study.","authors":"Ahmed Mahmoud Hasan, Ahmed Mamdouh Abdelhamid, Mostafa Abdelrazek Ahmed, Ahmed Mahmoud Reyad","doi":"10.1080/20905998.2024.2432703","DOIUrl":"10.1080/20905998.2024.2432703","url":null,"abstract":"<p><strong>Objective: </strong>To compare the use of JJ and PCN tubes as initial urinary drainage methods in patients with obstructive calcular anuria.</p><p><strong>Methods: </strong>Between January 2021 and January 2024, 239 eligible patients with obstructive calcular anuria were randomly classified into two groups. Group A (JJ group) included 121 patients and group B (PCN group) included 118 patients. Laboratory data, stone characteristics, and intraoperative and postoperative data were also collected. The time needed to normalize the serum creatinine levels, postoperative complications, and quality of life scores were assessed.</p><p><strong>Results: </strong>The procedures had comparable success rates (86.8% vs. 90.7%; <i>p</i> = 0.9). The PCN group had a shorter operative time (<i>p</i> < 0.001). No significant differences were observed in the time required for serum creatinine to return to normal between the two groups (<i>p</i> = 0.669). Fever, haematuria, and LUTS were more evident in the JJ stent group. In the JJ group, the presence of upper ureteral stones and stone burden were risk factors for procedure failure, whereas the presence of upper ureteral stones and preoperative serum creatinine were risk factors for ureteral perforation. Mild hydronephrosis was a risk factor for procedural failure in the PCN group. Spontaneous stone passage was more common in the PCN group (<i>p</i> = 0.028). The Overall quality of life and general health scores were significantly better in the PCN group (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Both PCN and JJ stents had comparable success rates. PCN was associated with a lower incidence of LUTS, higher incidence of spontaneous stone passage, and better quality of life scores than the JJ stent.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 2","pages":"131-138"},"PeriodicalIF":1.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy evaluation of intracavernosal injection of platelets rich plasma in treatment of vasculogenic erectile dysfunction.","authors":"Mohammed Abdou Abdel-Rassoul, Amr Amin Mohamed Ragab, Amr Mostafa Ibrahim, Mohamed Abdelwahab, Khaled Mursi Hammoud, Galal Mohamed El Shorbagy","doi":"10.1080/20905998.2024.2424459","DOIUrl":"10.1080/20905998.2024.2424459","url":null,"abstract":"<p><strong>Objectives: </strong>The study's objective is to compare platelet-rich plasma (PRP) injections to placebo in terms of effectiveness and safety for patients with vasculogenic erectile dysfunction (ED).</p><p><strong>Methods: </strong>This randomized placebo-controlled clinical trial was done on 50 male patients with organic vasculogenic ED and sexually active in a stable heterosexual relationship for a period of over three months. The patients were randomized into two main groups: Group (A) (<i>n</i> = 25) underwent PRP treatment. Group (B) (<i>n</i> = 25) control underwent placebo treatment.</p><p><strong>Results: </strong>The two groups under study differed in a statistically significant way regarding the achievement of minimal clinically important differences (MCID) at 3 months and 24 months. Statistically significant variations existed between the mild subgroup and placebo regarding achieving MCID after 3 months and 24 months. The level of satisfaction was statistically significantly higher in the PRP group. A statistically significant variation was present between the mild subgroup and placebo at 3 months and 24 months in terms of changes from baseline in the erectile function domain of the International Index of Erectile Function (IIEF-EF) questionnaire score in each subgroup.</p><p><strong>Conclusions: </strong>PRP is an effective alternative modality of treatment in cases of ED, and they offer an intermediate stage between pharmaceutical therapy and surgical interventions at least in mild and mild to moderate cases where unsatisfactory results or unpleasant side effects compel the patients to abandon all hope on medical treatment.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 2","pages":"160-166"},"PeriodicalIF":1.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of preoperative Silodosin on facilitating access sheath placement in retrograde intrarenal surgery. A randomized controlled studys.","authors":"Ahmed Higazy, Mohamed Samir, Ahmed AbdelGhani, A M Tawfeek, Ahmed Radwan","doi":"10.1080/20905998.2024.2414134","DOIUrl":"10.1080/20905998.2024.2414134","url":null,"abstract":"<p><strong>Introduction: </strong>to evaluate the effect of preoperative Silodosin on ureteric dilatation to facilitate ureteral access sheath (UAS) placement and reduction of ureteral wall injury in retrograde intrarenal surgery (RIRS).</p><p><strong>Methods: </strong>one hundred and twenty patients with renal or ureteric stones were randomly allocated into 2 equal groups. Group A represents patients who received a 7-day preoperative single dose Silodosin before RIRS while Group B represents patients who received a placebo for the same regimen. Our primary outcome was to assess the success rate of (UAS) placement. Our secondary outcomes were to evaluate the perioperative complication rate, stone-free rate, hospital stay, and cost analysis.</p><p><strong>Results: </strong>In our study, Silodosin showed a higher success rate for (UAS) insertion compared to placebo with a statistically significant difference (p-value = 0.04). Spontaneous UAS insertion in the Silodosin group was 58.3%, which was increased with active ureteric dilatation to 98.3%. Preoperative Silodosin led to less postoperative pain and analgesics requirements without impacting postoperative hospital stay or stone-free rate. There was less ureteric injury incidence in the Silodosin group compared to placebo with a statistically significant difference (p-value = 0.002).</p><p><strong>Conclusion: </strong>Preoperative Silodosin facilitates UAS insertion with a protective role against ureteric injury compared to placebo.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 2","pages":"117-123"},"PeriodicalIF":1.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/20905998.2024.2410099","DOIUrl":"https://doi.org/10.1080/20905998.2024.2410099","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1080/20905998.2024.2400628.].</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 1","pages":"95"},"PeriodicalIF":1.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic direct oral anticoagulants vs. low molecular weight heparin after urological surgery: A systematic review and meta-analysis.","authors":"M Ramadhan, A AlMehandi, A Al-Naseem, J Hayat, A Almarzouq","doi":"10.1080/20905998.2024.2395202","DOIUrl":"https://doi.org/10.1080/20905998.2024.2395202","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the outcomes of using prophylactic direct oral anti-coagulants (DOAC) and low-molecular-weight heparin (LMWH) after major urologic surgery.</p><p><strong>Materials and methods: </strong>Systematic literature searches of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL were performed up to 9 November 2023, and protocols were registered on PROSPERO (CRD42024494424). The primary outcomes were post-operative incidence of VTE and bleeding. The secondary outcomes included re-admissions and transfusions needed, post-operative complications and exploring the radical cystectomy sub-group. Outcomes were reported in 30 and 90 days where feasible with sub-group analysis.</p><p><strong>Results: </strong>Searches yielded four studies that included 856 patients and the outcomes were reported within 30 and 90 days, with sub-analysis performed for each time-interval. We found no statistically significant differences between DOAC and LWMH within neither primary nor secondary outcomes; VTE events (RR 0.36; <i>p</i> = 0.06); bleeding events (RR 0.64; <i>p</i> = 0.45); re-admissions (RR 1.14; <i>p</i> = 0.39); transfusions (RR 0.42; <i>p</i> = 0.05) within 0-90 days and post-operative complications within 30 days (RR 0.76; <i>p</i> = 0.17). Similar results were found when exploring radical cystectomy sub-group: VTE risk (RR 0.42, <i>p</i> = 0.15), bleeding risk (RR 1.09; <i>p</i> = 0.90), and re-admissions to hospital (RR 1.18, <i>p</i> = 0.35). Limitations include small sample size, and difficult generalization to all urological surgery as most of the analyzed cohort underwent radical cystectomy.</p><p><strong>Conclusion: </strong>DOACs may be a safe and possibly cost-effective alternative to LMWH as post-operative thromboprophylaxis. However, these findings should be interpreted with caution due to limitations; therefore, more randomized studies are needed to ascertain our findings.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 1","pages":"84-94"},"PeriodicalIF":1.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Varicocele repair for severe oligoasthenoteratozoospermia: Scoping review of published guidelines, and systematic review of the literature.","authors":"Andrian Japari, Walid El Ansari","doi":"10.1080/20905998.2024.2400629","DOIUrl":"10.1080/20905998.2024.2400629","url":null,"abstract":"<p><strong>Background: </strong>The outcomes of varicocele repair (VR) for severe oligozooasthenoteratozoospermia (OAT) have not been widely examined.</p><p><strong>Methods: </strong>Assessment of outcomes of VR after severe OAT, employing scoping review of published guidelines, and systematic review of literature. The Newcastle-Ottawa scale appraised the quality of included studies. Findings from both reviews were used to identify knowledge gaps and ways to enhance the evidence base.</p><p><strong>Results: </strong>No published guidelines exist specifically on VR for severe OAT. Of 731 articles retrieved, 15 were included, indicating a scarcity of studies appraising the topic. Most included studies exhibited high risk of bias and low-level evidence. Studies focused on basic sperm parameters; fewer examined hormonal/testicular volume changes, or pregnancy/live births. Studies suggested some post-VR sperm parameters improvements but mostly no changes in hormone levels/testicular volume. We identified four knowledge gaps: methodological issues; narrow scope of research and measurement aspects; lack of genetic considerations; and scarce economic/cost-effectiveness appraisals. We propose some precautions, remedies, and research questions to enhance the thin evidence base.</p><p><strong>Conclusions: </strong>VR for severe OAT has potential to improve sperm parameters. Scarcity of studies, high risk of bias, low-level evidence, and other limitations mitigate against drawing solid conclusions. Future research is required.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"23 1","pages":"33-52"},"PeriodicalIF":1.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}