Aims and Scope UroPrecision offers rapid exchange on scientific innovation in urology between clinicians and researchers worldwide and provides a globally respected source of cuttingedge information as well as a platf...Aims and Scope UroPrecision offers rapid exchange on scientific innovation in urology between clinicians and researchers worldwide and provides a globally respected source of cuttingedge information as well as a platform for international collaboration.展开更多
Background:Prostate cancer(PCa)patients are at risk of developing second primary malignancies(SPMs),which can significantly shorten their survival.Understanding the risk of SPMs and associated factors is crucial to th...Background:Prostate cancer(PCa)patients are at risk of developing second primary malignancies(SPMs),which can significantly shorten their survival.Understanding the risk of SPMs and associated factors is crucial to the optimization of patient follow-up.Methods:This study focuses on PCa patients who were later diagnosed with SPMs using data from the Surveillance,Epidemiology,and End Results(SEER)database.Variables were carefully selected,and the data were analyzed using machine learning techniques combined with mul-tivariate Cox proportional hazards modeling.Subsequently,a nomogram was generated to predict the 1-,3-,and 5-year survival rates for SPMs patients.Additionally,a two-sample Mendelian randomization(TSMR)analysis was conducted to investigate the causal relationships between PCa and its top ten SPMs.Results:Among the variables,age,marital status,SPM site,M stage,American Joint Committee on Cancer(AJCC)stage,PCa surgery,and prostate-specific antigen(PSA)levels were identified as key prognostic factors through least absolute shrinkage and selection operator(LASSO)and backward stepwise regression.Based on these factors,a nomogram was developed to visually represent survival predictions,complemented by a web-based calculator for easy application.This nomogram,which serves as a supplement to traditional AJCC staging,demonstrated strong predictive power for 1-,3-,and 5-year survival,with area under the curve(AUC)values exceeding 0.85.Additionally,TSMR analysis revealed a causal link between PCa and urothelial carcinoma(UC).Conclusion:This study developed a nomogram for predicting survival in prostate cancer patients with secondary primary malignancies,enhancing prognosis accuracy.TSMR identified a causal link between PCa and UC.展开更多
Prostate cancer(PCa)is a multifaceted disease that envelops 1.41 million new cases globally.It is the second most common cancer reported in men.Its heterogeneity and indolent growth,coupled with incompetent early scre...Prostate cancer(PCa)is a multifaceted disease that envelops 1.41 million new cases globally.It is the second most common cancer reported in men.Its heterogeneity and indolent growth,coupled with incompetent early screening methods such as serum prostate-specific antigen level estimations and digital rectal examinations,contribute to its delayed detection,potentially leading to misdiagnosis or overtreatment.Despite the advancement in surgical methods,better management of PCa requires definitive diagnostics,prognostics,and therapeutics.PCa cells express microRNA(miRNA)on their surface as well as release miRNA into the bloodstream,which enables their noninvasive detection in body fluids like serum,plasma,and urine.miRNA acts as sponge for cir-culating RNA that regulates gene expression of crucial pathways in PCa pro-gression.In recent years,compelling evidence indicates that the use of miRNAs,individually or in combination,in the form of miRNA panels in both tissue and body fluids,together with clinicopathological parameters,might act as a diagnostic biomarker.This will increase the accuracy of risk stratification and early screening of PCa patients under active surveillance.These findings will help differentiate aggressive PCa from indolent and decipher novel therapeutic findings.We have put together a review of studies that have found and con-firmed miRNA panels in PCa tissue and PCa liquid biopsies(serum,plasma,and urine exosomes),with a focus on how they might help patients.展开更多
Background:Uro-genital oncology patients often face complex treatment decisions requiring multiple consultations,which can delay treatment initi-ation and lead to fragmented care.Traditional approaches are particularl...Background:Uro-genital oncology patients often face complex treatment decisions requiring multiple consultations,which can delay treatment initi-ation and lead to fragmented care.Traditional approaches are particularly challenging for patients with multiple treatment options.Multidisciplinary care models have been shown to improve patient outcomes.This project introduces a multidisciplinary joint counseling clinic(MDJCC)to enhance the quality and efficiency of uro-genital oncology care.Methods:MDJCC was piloted from May 2019 to January 2020,paused during the COVID-19 pandemic,and re-established in September 2023.Outcome measures include the percentage of patients who make final treatment decisions during or shortly after the clinic.Process measures track the number of clinics conducted monthly,and balance measures assess patient satisfaction.The target population comprises post uro-genital oncology multidisciplinary team(MDT)cases requiring surgical,medical,or radiation therapy.Results:The clinic reduced delays in traditional counseling pathways,enabling most patients to decide on treatment during the same session or within 7 days,compared to the previous 30-day standard.Consolidating disciplines into a single visit optimized resource utilization,reduced costs,and improved patient under-standing and satisfaction.Conclusion:The MDJCC significantly improved care quality,streamlined decision-making,and enhanced patient satisfaction in uro-genital oncology,highlighting its value as a care model.展开更多
Hypospadias is the most prevalent congenital anomaly of the penis,with surgical intervention being its only treatment option.There remains ongoing debate regarding the necessity,the type,and duration of urine diversio...Hypospadias is the most prevalent congenital anomaly of the penis,with surgical intervention being its only treatment option.There remains ongoing debate regarding the necessity,the type,and duration of urine diversion following hypospadias repair.Early catheter removal may alleviate dis-comfort for both the patient and their family,facilitating earlier discharge.Nonetheless,premature removal raises concerns about the potential development of complications.A systematic review was conducted to assess the impact of catheter removal timing on the occurrence of complications.Six observational studies,including 1188 cases,were included.The duration before catheter removal varied among the study groups from less than 24 h up to more than 6 weeks.Prolonged catheterization can potentially lead to better urinary flow rate and better cosmetic results,but without a significant difference in most complications.There is an existing knowledge gap re-garding the best urinary diversion and the optimal duration of catheterization in hypospadias repair.The available literature warrants further high-quality research.This includes conducting larger multicenter randomized trials to advance our understanding,aiming at improving the outcomes of hypo-spadias repair surgery.展开更多
Women live longer than males all around the world,however,the disparity varies greatly in less developed countries.In 2020,the age average of women was 82.5 years while males aged an average of 79.8 years in Qatar^([1...Women live longer than males all around the world,however,the disparity varies greatly in less developed countries.In 2020,the age average of women was 82.5 years while males aged an average of 79.8 years in Qatar^([1]).Several young or old men aren't aware of what they may do to improve their health and live longer lives.In Qatar,the male mortality rate was 41.49 per 1000 male adults in 2018,while the female mortality rate was 31.87 per 1000 female adults^([2,3]).展开更多
Background:Liquid biopsy has emerged as a non-invasive method for real-time cancer monitoring especially in genitourinary(GU)oncology.Most current studies utilize a panel-based molecular profiling ranging from 50–600...Background:Liquid biopsy has emerged as a non-invasive method for real-time cancer monitoring especially in genitourinary(GU)oncology.Most current studies utilize a panel-based molecular profiling ranging from 50–600 genes;however,a comprehensive exome-wide profiling of real-world patient samples has been lacking.Methods:Over 2000 liquid biopsy samples were analyzed in this study,including urine samples from early-stage bladder cancer and plasma samples from prostate,lung,breast,esophageal,head and neck cancers,among others.Cell-free DNA(cfDNA)was extracted from these samples and ana-lyzed using PredicineWES+^(TM),a boosted comprehensive whole-exome sequencing(WES)assay with an in-depth coverage of 600 cancer-related genes derived from the PredicineATLAS^(TM)panel.Data analysis was conducted in-house using Predicine's DeepSea bioinformatics software.Results:The PredicineWES+^(TM)assay demonstrated high sensitivity for detecting somatic mutations across the exome and showed comparable tumor mutational burden(TMB)estimates with the PredicineATLAS^(TM)panel.Interestingly,the highest tumor TMB score was observed in bladder cancer among the analyzed cancers,which is consistent with literature using tissue-based genomic profiling.The most common cancer variants include TP53,ERBB2,KRAS,PIK3CA,FGFR3,APC,among others.Conclusion:Liquid biopsy-based genomic profiling across various cancer types provides an in-depth analysis of biomarker discovery for personalized cancer care,setting the foundation for improved cancer diagnosis and per-sonalized treatment strategies for urological diseases.展开更多
Prostate cancer is the most diagnosed cancer and the leading cause of cancer-related death among men in Sweden.The natural history and risk factors of prostate cancer,particularly within hereditary populations,have be...Prostate cancer is the most diagnosed cancer and the leading cause of cancer-related death among men in Sweden.The natural history and risk factors of prostate cancer,particularly within hereditary populations,have been extensively studied in the Swedish context.Despite the absence of national recommendations for prostate-specific antigen(PSA)screening,a large pro-portion of Swedish men undergo PSA testing.This unstructured testing approach has shown limited effectiveness and imposes a considerable burden on healthcare resources.To address these challenges,many regions in Sweden began implementing organized prostate cancer testing(OPT)in 2020.OPT targets specific age groups,providing them with comprehensive information about PSA testing,including its potential benefits and harms,to support in-formed individual decision-making.Subsequent PSA testing and follow-up procedures adhere to a standardized algorithm that incorporates individual risk factors,genetic predisposition,and the natural progression of prostate cancer.This review outlines the current recommendations,implementation strategies,and emerging frontiers for prostate cancer diagnosis in Sweden.展开更多
Background:Urinary problems are common among older men.In a Swedish study of men aged 40–80 years,the prevalence of lower urinary tract symp-toms(LUTS)was 24%,but only 4%sought medical care.A Danish survey reported s...Background:Urinary problems are common among older men.In a Swedish study of men aged 40–80 years,the prevalence of lower urinary tract symp-toms(LUTS)was 24%,but only 4%sought medical care.A Danish survey reported similar prevalence rates,with over 20%of men not discussing their symptoms with anyone.The incidence of LUTS is expected to rise due to an aging population.Artificial intelligence(AI)has been proven valuable in radiology,but its use in primary care remains limited.This study aims to develop an intelligent technique(IT)solution:a user-friendly mobile app that provides individualized support for men with LUTS.The secondary aim is to enhance diagnostic quality in primary care through AI-based decision support.Methods:A retrospective patient database was created,containing patient-reported symptom scores(IPSS),urinary diaries,and timed micturition as-sessments.These data were analyzed using machine learning and Bayesian methods to develop algorithms for personalized recommendations.A pro-spective clinical study,initiated in 2021,collects data from men seeking care for LUTS to expand the database.A randomized study will test the app's efficacy.Results:The first version of the app showed high concordance between its algorithmic assessments and urologist evaluations.A prospective study en-rolled 50 patients from three primary health centers.One third of the patients did not get a recommendation at the first visit.Of the remaining less than half received the same treatment recommendation at this visit as the AI algorithm would have suggested.A web-based study is currently being initiated.Recruitment strategies include public campaigns and targeted invitations.Participants complete a digital questionnaire and are randomized if they meet the inclusion criteria.Conclusion:LUTS significantly impacts men's health,yet care-seeking remains limited.AI-based solutions,such as mobile apps for diagnosis and personalized recommendations,show promise as tools to improve healthcare for this population.展开更多
Male infertility contributes to 20%–70%of infertile couple cases worldwide.One of the key challenges in this area is asthenozoospermia or reduced sperm motility.A particular subset,known as isolated asthenozoospermia...Male infertility contributes to 20%–70%of infertile couple cases worldwide.One of the key challenges in this area is asthenozoospermia or reduced sperm motility.A particular subset,known as isolated asthenozoospermia(iASZ),in which low motility occurs without abnormalities in sperm count or shape,often goes unnoticed and is not well understood.This narrative review attempts to compile the state of knowledge regarding the etiology,diagnosis,and treatment of iA SZ and to identify knowledge gaps that need further investigation with an emphasis on physiological,genetic,and molecular mechanisms.We conducted a focused literature search using PubMed and Web of Science,covering studies published between 2000 and 2024.We included articles that explored the structure,function,diagnosis,and treatment of iASZ.We find sperm motility is influenced by multiple factors,from structural components like mitochondria and the flagellum,to biochemical signals and genetic mutations.In men with iASZ,issues such as mitochondrial dysfunction,oxidative stress,or specific gene defects may impair motility.While routine semen analysis helps flag low motility,it often fails to explain why it occurs—highlighting the need for advanced tests like DNA fragmentation tests,genetic screening,and high-resolution imaging.As regards treatment,lifestyle changes,varicocele surgery,and antioxidants can offer some benefit.Assisted reproduction techniques,especially intracytoplasmic sperm injection(ICSI),remain central for achieving pregnancy when other options fail.iA SZ deserves more attention as a distinct and treatable cause of male infertility.By improving how we diagnose and manage this condition,supported by further research,we can offer better outcomes for affected couples hoping to conceive.展开更多
Varicocele is a common entity found in 15%of men and is the most common reversible cause of male factor infertility.Guidelines have been developed to guide urologists in deciding which patients would benefit from vari...Varicocele is a common entity found in 15%of men and is the most common reversible cause of male factor infertility.Guidelines have been developed to guide urologists in deciding which patients would benefit from varicocelectomy.Yet studies published over the last decade showed the emergence of predictors of success of varicocelectomy using nomograms and other predictive models with statistical analysis.The emergence of artificial intelligence(AI)and machine learning revolutionized the clinician's approach to medicine.The virtual branch of AI,represented by machine learning,has been a very exciting topic for clinicians and researchers over the last years,especially after the launching of ChatGPT-3.5.Urology has been at the forefront of integrating advances in AI into its everyday practice.We aim to shed light on the present literature describing the use of AI in predicting the outcomes of varicocelectomy.Machine learning is being used to predict the improvement in semen parameters after varicocelectomy.These algorithms are derived from studies and data present in the literature and predictive models developed throughout the last two decades and have a superior performance to that of traditional nomograms.However,these models require further research and validation but are anticipated to surpass the accuracy of all current resources,setting forward a new era of varicocele workup and management in the years to come.This paper offers a wide review on the current evidence behind varicocele surgery and the integration of AI in medicine,urology and its use in predicting improvement in sperm parameters post-varicocelectomy.展开更多
Ten percent of infertile males have azoospermia,classified into obstructive and nonobstructive types,which require specific medical or surgical treatments.In nonobstructive azoospermia,advancements in microsurgery all...Ten percent of infertile males have azoospermia,classified into obstructive and nonobstructive types,which require specific medical or surgical treatments.In nonobstructive azoospermia,advancements in microsurgery allow for effective sperm retrieval in about half of cases.This review aimed to highlight the most recent studies utilizing whole exome sequencing(WES)and seminal/serum biomarkers aim to predict micro-dissection testicular sperm extraction(micro-TESE)outcomes and reduce failure rates.WES identifies rare genetic mutations affecting spermatogenesis that could explain micro-TESE failures,improving preoperative assessments.Despite its potential,WES is limited by high costs.Biomarkers such as Anti-Müllerian Hormone and testis-expressed sequence 101 protein can indicate spermatogenic activity,though standardization of these measurements is needed for accuracy.Additionally,microRNAs as non-invasive markers offer potential in assessing spermatogenic reserve and classifying azoospermia types,but their efficacy in identifying specific spermatogenic disorders remains under researched,necessitating further studies on multivariate miRNA models.展开更多
Erectile dysfunction(ED)is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance,affecting over 50% of men aged 50 and older.ED is often linked to lifestyle factors and comorb...Erectile dysfunction(ED)is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance,affecting over 50% of men aged 50 and older.ED is often linked to lifestyle factors and comorbidities,such as diabetes and cardiovascular disease.Although conventional treatments such as phosphodiesterase type 5 inhibitors(PDE5is)and penile prostheses are commonly used,there is increasing interest in regenerative therapies,including platelet-rich plasma(PRP),which may address the underlying causes of ED.This narrative review examines ongoing trials on intracavernosal PRP for ED to better understand its potential as a treatment and offers recommendations for future research to improve the quality of evidence supporting its use.A literature search was conducted in December 2024 across PubMed,ScienceDirect,and Scopus for articles evaluating PRP for ED.The keywords used for search were PRP,ED,and randomized controlled trial.The review focused on relevant studies,with titles,abstracts,and full texts examined for key details.Five randomized clinical trials,two metaanalyses,and a systematic review were identified,revealing significant variability in PRP preparation,dosage,and follow-up protocols,which hindered definitive conclusions about its efficacy.Although the available evidence suggests promising potential for PRP in ED treatment,methodological inconsistencies highlight the need for further research.Standardization of PRP preparation and administration protocols,along with larger and longerterm trials,is essential to establish its clinical benefits for ED treatment.展开更多
Peyronie's disease(PD)is an inflammatory andfibrotic disease which resultsin disfiguring and often distressing penile curvature deformity,affecting up toone in nine men in the United States,and between 0.3%and 13....Peyronie's disease(PD)is an inflammatory andfibrotic disease which resultsin disfiguring and often distressing penile curvature deformity,affecting up toone in nine men in the United States,and between 0.3%and 13.1%of menglobally.It progresses through an acute phase,associated with pain,as thefibrosis develops.In the quiescent phase,penile pain ceases and deformitystabilizes.The precise etiology remains unknown despite ongoing work toelucidate the biological underpinning.The diagnosis is guided by history andphysical examination.Except for ultrasonography,imaging is not routinelyrecommended.Current management is predicated on symptomatic controland slowing progression in the acute phase,and correction of bothersomecurvature in the stable phase.Most nonsurgical treatment options are poorlysupported by available evidence,with the exceptions of traction therapy andcertain intralesional injections.Surgical treatment,considered only afterstabilization,is guided by severity and the presence or absence of erectilefunction and is highly individualized.Investigations are ongoing into severalareas,including the exact biological mechanisms leading to plaque formationand failure of resolution;the effects of co‐existing systemic disease;the role ofimaging in diagnosis and surgical planning;combination and regenerativenonsurgical therapies;and improvements in surgical techniques.As diag-nostic accuracy improves and targeted treatments become available,man-agement of PD will become progressively tailored to an individual's particulardisease.In this review,we summarize the current knowledge regarding PD,including etiology and epidemiology,diagnosis,management,cutting‐edgeresearch,and future directions in care of this condition.展开更多
Testosterone plays a pivotal role in male health throughout the lifespan.Men generally exhibit higher serum testosterone levels than women,influencing critical aspects of male physiology.It drives normal sexual differ...Testosterone plays a pivotal role in male health throughout the lifespan.Men generally exhibit higher serum testosterone levels than women,influencing critical aspects of male physiology.It drives normal sexual differentiation during fetal development,promotes the acquisition of pubertal traits,and induces the development of secondary male sex characteristics.While testosterone levels naturally decline with age,this decrease varies greatly between individuals,indicating that aging alone does not account for any specific testosterone level.The interindividual variability highlights the influence of both genetic and environmental factors on testosterone production.Abnormal changes in testosterone levels,whether excessive or deficient,can have significant implications for men's health,contributing to conditions such as hypogonadism,cardiovascular disease,sexual disorders,and metabolic disorders.Precision medicine provides personalized testosterone treatment options for hypogonadism,taking into account genetic,hormonal,and lifestyle aspects to improve outcomes.This tailored approach is also relevant in dealing with broader reproductive and sexual health issues,ensuring effective and individualized care.This review focuses on testosterone's varied involvement in men's health,using biomarkers and precision medicine breakthroughs to inform tailored therapy and future research.展开更多
Background:Prostate cancer,a prevalent malignancy in men,often results in erectile dysfunction(ED),particularly following treatments like radical prostatectomy(RP)and radiotherapy,significantly affecting quality of li...Background:Prostate cancer,a prevalent malignancy in men,often results in erectile dysfunction(ED),particularly following treatments like radical prostatectomy(RP)and radiotherapy,significantly affecting quality of life.Managing ED in prostate cancer survivors is critical.Inflatable penile prosthesis(IPP)implantation is a well-established treatment for ED,yet the literature on satisfaction rates for patients with a history of androgen deprivation therapy(ADT)remains sparse.We aimed to investigate the impact of ADT on satisfaction rates in patients undergoing IPP implantation following RP or radiation therapy(XRT).Methods:A retrospective review of 529 patient charts identified 96 eligible patients who underwent IPP implantation post-prostate cancer treatment and completed the 11-item Erectile Dysfunction Inventory of Treatment Satisfaction(EDITS)questionnaire.Patients were stratified into two groups based on ADT status,and their satisfaction scores were compared.Effect sizes were used to assess clinical relevance alongside statistical significance(p=0.0344).Results:Patients receiving ADT had significantly lower EDITS scores(p=0.0344)compared to those not on ADT.RP patients reported higher satisfaction post-IPP compared to XRT patients,even after controlling for ADT.Additionally,coronary artery disease(CAD)was associated with lower satisfaction scores.Conclusion:ADT significantly lowers patient satisfaction post-IPP,with RP patients generally reporting higher satisfaction than XRT patients.These findings highlight the importance of counseling prostate cancer patients on ADT's impact on long-term sexual satisfaction and suggest areas for further research to enhance outcomes.展开更多
Background:Tubular ectasia of rete testis(TERT)is a benign condition due to dilatation of the rete testis as a consequence of multiple etiologies,including postinfectious,trauma,prior inguinal or scrotal surgeries,mec...Background:Tubular ectasia of rete testis(TERT)is a benign condition due to dilatation of the rete testis as a consequence of multiple etiologies,including postinfectious,trauma,prior inguinal or scrotal surgeries,mechanical compression of extratesticular excretory ducts,and congenital malformation.TERT is a rare and underreported condition in the medical literature.Its association with infertility is lacking in the literature.Case Presentation:We present a rare case of primary infertility and obstructive azoospermia associated with TERT.We performed extensive literature regarding the possible etiologies,associations,clinical diagnosis,and different management options of this entity.Our patient is a 33-year-old man presented with primary infertility.He was found to have obstructive azoospermia.During scrotal exploration,the diagnosis of intratesticular obstruction due to TERT was made.The couple was advised to undergo intracytoplasmic sperm injection using testicular sperms.This is the third report of TERT associated with azoospermia.Conclusion:TERT is usually asymptomatic but can occasionally be associated with pain or abnormal semen analysis,but further studies are required to confirm its effect on fertility.Fortunately,it has a benign course and typically does not require surgical intervention.It is vital to differentiate it from neoplastic conditions.展开更多
Telemedicine has rapidly integrated into healthcare,overcoming initial barriers such as regulatory restrictions and technological limitations.Its role in sexual medicine,especially urology,has been accelerated by tech...Telemedicine has rapidly integrated into healthcare,overcoming initial barriers such as regulatory restrictions and technological limitations.Its role in sexual medicine,especially urology,has been accelerated by technological advances and the COVID-19 pandemic.However,as telehealth continues to expand,key ethical challenges emerge,including concerns over privacy,healthcare equity,and informed consent.These challenges are particularly important in sexual medicine,where sensitive patient data and intimate conditions are involved.We aimed to examine the ethical implications of telemedicine in sexual medicine,focusing on data security,consent processes,and healthcare disparities.We further emphasize the importance of maintaining high ethical standards while integrating telemedicine as a complement to traditional care,ensuring that patient outcomes are not compromised.展开更多
Benign prostatic hyperplasia(BPH)is a common condition among agingmen,often leading to lower urinary tract symptoms(LUTS)of varyingseverity.Both medical and surgical treatments for BPH can negatively impactsexual func...Benign prostatic hyperplasia(BPH)is a common condition among agingmen,often leading to lower urinary tract symptoms(LUTS)of varyingseverity.Both medical and surgical treatments for BPH can negatively impactsexual function,affecting patients'overall quality of life.This has highlightedthe need for minimally invasive interventions that minimize sexual side ef-fects.Rezum,a water vapor therapy,has gained popularity in managing BPHand LUTS due to its proposed potential to preserve sexual function.Thisscoping review examines the impact of Rezum therapy on sexual function inpatients treated for BPH.The review was conducted following the JoannaBriggs Institute(JBI)methodology for scoping reviews.A comprehensivesearch was performed using the PubMed and Scopus databases up to August2024.Articles were included if they involved patients treated with Rezum forBPH and reported the effect of Rezum on sexual function using validatedscoring tools.A total of 15 studies encompassing 2,425 patients,met theinclusion criteria.Erectile function was assessed in all studies using theInternational Index of Erectile Function(IIEF)scores.Of these,seven studiesreported no significant changes in erectile function scores,six demonstratedimprovements,and two reported a significant decline.Ejaculatory functionwas evaluated using the Male Sexual Health Questionnaire(MSHQ).TheMSHQ‐Bother score was reported in seven studies,with three indicatingimprovement and none reporting deterioration.The MSHQ‐Function scorewas reported in eight studies,with only one study reporting a decline,whilethe remaining studies found no significant changes.In conclusion,Rezumtherapy for managing BPH shows favorable outcomes for sexual function or,at the very least,does not negatively impact it.Thesefindings can guidepatient counseling,especially for those seeking to preserve ejaculation.Further research is needed to compare Rezum with other treatment optionsregarding sexual function.展开更多
文摘Aims and Scope UroPrecision offers rapid exchange on scientific innovation in urology between clinicians and researchers worldwide and provides a globally respected source of cuttingedge information as well as a platform for international collaboration.
基金Student Innovation Capability Enhancement Program of Guangzhou Medical University,Grant/Award Numbers:2022 NO.67,2023 NO.7Special Funds for the Cultivation of Guangdong College Students'Scientific and Technological Innovation(“Climbing Program”Special Funds),Grant/Award Number:pdjh2023b0431。
文摘Background:Prostate cancer(PCa)patients are at risk of developing second primary malignancies(SPMs),which can significantly shorten their survival.Understanding the risk of SPMs and associated factors is crucial to the optimization of patient follow-up.Methods:This study focuses on PCa patients who were later diagnosed with SPMs using data from the Surveillance,Epidemiology,and End Results(SEER)database.Variables were carefully selected,and the data were analyzed using machine learning techniques combined with mul-tivariate Cox proportional hazards modeling.Subsequently,a nomogram was generated to predict the 1-,3-,and 5-year survival rates for SPMs patients.Additionally,a two-sample Mendelian randomization(TSMR)analysis was conducted to investigate the causal relationships between PCa and its top ten SPMs.Results:Among the variables,age,marital status,SPM site,M stage,American Joint Committee on Cancer(AJCC)stage,PCa surgery,and prostate-specific antigen(PSA)levels were identified as key prognostic factors through least absolute shrinkage and selection operator(LASSO)and backward stepwise regression.Based on these factors,a nomogram was developed to visually represent survival predictions,complemented by a web-based calculator for easy application.This nomogram,which serves as a supplement to traditional AJCC staging,demonstrated strong predictive power for 1-,3-,and 5-year survival,with area under the curve(AUC)values exceeding 0.85.Additionally,TSMR analysis revealed a causal link between PCa and urothelial carcinoma(UC).Conclusion:This study developed a nomogram for predicting survival in prostate cancer patients with secondary primary malignancies,enhancing prognosis accuracy.TSMR identified a causal link between PCa and UC.
文摘Prostate cancer(PCa)is a multifaceted disease that envelops 1.41 million new cases globally.It is the second most common cancer reported in men.Its heterogeneity and indolent growth,coupled with incompetent early screening methods such as serum prostate-specific antigen level estimations and digital rectal examinations,contribute to its delayed detection,potentially leading to misdiagnosis or overtreatment.Despite the advancement in surgical methods,better management of PCa requires definitive diagnostics,prognostics,and therapeutics.PCa cells express microRNA(miRNA)on their surface as well as release miRNA into the bloodstream,which enables their noninvasive detection in body fluids like serum,plasma,and urine.miRNA acts as sponge for cir-culating RNA that regulates gene expression of crucial pathways in PCa pro-gression.In recent years,compelling evidence indicates that the use of miRNAs,individually or in combination,in the form of miRNA panels in both tissue and body fluids,together with clinicopathological parameters,might act as a diagnostic biomarker.This will increase the accuracy of risk stratification and early screening of PCa patients under active surveillance.These findings will help differentiate aggressive PCa from indolent and decipher novel therapeutic findings.We have put together a review of studies that have found and con-firmed miRNA panels in PCa tissue and PCa liquid biopsies(serum,plasma,and urine exosomes),with a focus on how they might help patients.
文摘Background:Uro-genital oncology patients often face complex treatment decisions requiring multiple consultations,which can delay treatment initi-ation and lead to fragmented care.Traditional approaches are particularly challenging for patients with multiple treatment options.Multidisciplinary care models have been shown to improve patient outcomes.This project introduces a multidisciplinary joint counseling clinic(MDJCC)to enhance the quality and efficiency of uro-genital oncology care.Methods:MDJCC was piloted from May 2019 to January 2020,paused during the COVID-19 pandemic,and re-established in September 2023.Outcome measures include the percentage of patients who make final treatment decisions during or shortly after the clinic.Process measures track the number of clinics conducted monthly,and balance measures assess patient satisfaction.The target population comprises post uro-genital oncology multidisciplinary team(MDT)cases requiring surgical,medical,or radiation therapy.Results:The clinic reduced delays in traditional counseling pathways,enabling most patients to decide on treatment during the same session or within 7 days,compared to the previous 30-day standard.Consolidating disciplines into a single visit optimized resource utilization,reduced costs,and improved patient under-standing and satisfaction.Conclusion:The MDJCC significantly improved care quality,streamlined decision-making,and enhanced patient satisfaction in uro-genital oncology,highlighting its value as a care model.
文摘Hypospadias is the most prevalent congenital anomaly of the penis,with surgical intervention being its only treatment option.There remains ongoing debate regarding the necessity,the type,and duration of urine diversion following hypospadias repair.Early catheter removal may alleviate dis-comfort for both the patient and their family,facilitating earlier discharge.Nonetheless,premature removal raises concerns about the potential development of complications.A systematic review was conducted to assess the impact of catheter removal timing on the occurrence of complications.Six observational studies,including 1188 cases,were included.The duration before catheter removal varied among the study groups from less than 24 h up to more than 6 weeks.Prolonged catheterization can potentially lead to better urinary flow rate and better cosmetic results,but without a significant difference in most complications.There is an existing knowledge gap re-garding the best urinary diversion and the optimal duration of catheterization in hypospadias repair.The available literature warrants further high-quality research.This includes conducting larger multicenter randomized trials to advance our understanding,aiming at improving the outcomes of hypo-spadias repair surgery.
文摘Women live longer than males all around the world,however,the disparity varies greatly in less developed countries.In 2020,the age average of women was 82.5 years while males aged an average of 79.8 years in Qatar^([1]).Several young or old men aren't aware of what they may do to improve their health and live longer lives.In Qatar,the male mortality rate was 41.49 per 1000 male adults in 2018,while the female mortality rate was 31.87 per 1000 female adults^([2,3]).
文摘Background:Liquid biopsy has emerged as a non-invasive method for real-time cancer monitoring especially in genitourinary(GU)oncology.Most current studies utilize a panel-based molecular profiling ranging from 50–600 genes;however,a comprehensive exome-wide profiling of real-world patient samples has been lacking.Methods:Over 2000 liquid biopsy samples were analyzed in this study,including urine samples from early-stage bladder cancer and plasma samples from prostate,lung,breast,esophageal,head and neck cancers,among others.Cell-free DNA(cfDNA)was extracted from these samples and ana-lyzed using PredicineWES+^(TM),a boosted comprehensive whole-exome sequencing(WES)assay with an in-depth coverage of 600 cancer-related genes derived from the PredicineATLAS^(TM)panel.Data analysis was conducted in-house using Predicine's DeepSea bioinformatics software.Results:The PredicineWES+^(TM)assay demonstrated high sensitivity for detecting somatic mutations across the exome and showed comparable tumor mutational burden(TMB)estimates with the PredicineATLAS^(TM)panel.Interestingly,the highest tumor TMB score was observed in bladder cancer among the analyzed cancers,which is consistent with literature using tissue-based genomic profiling.The most common cancer variants include TP53,ERBB2,KRAS,PIK3CA,FGFR3,APC,among others.Conclusion:Liquid biopsy-based genomic profiling across various cancer types provides an in-depth analysis of biomarker discovery for personalized cancer care,setting the foundation for improved cancer diagnosis and per-sonalized treatment strategies for urological diseases.
文摘Prostate cancer is the most diagnosed cancer and the leading cause of cancer-related death among men in Sweden.The natural history and risk factors of prostate cancer,particularly within hereditary populations,have been extensively studied in the Swedish context.Despite the absence of national recommendations for prostate-specific antigen(PSA)screening,a large pro-portion of Swedish men undergo PSA testing.This unstructured testing approach has shown limited effectiveness and imposes a considerable burden on healthcare resources.To address these challenges,many regions in Sweden began implementing organized prostate cancer testing(OPT)in 2020.OPT targets specific age groups,providing them with comprehensive information about PSA testing,including its potential benefits and harms,to support in-formed individual decision-making.Subsequent PSA testing and follow-up procedures adhere to a standardized algorithm that incorporates individual risk factors,genetic predisposition,and the natural progression of prostate cancer.This review outlines the current recommendations,implementation strategies,and emerging frontiers for prostate cancer diagnosis in Sweden.
文摘Background:Urinary problems are common among older men.In a Swedish study of men aged 40–80 years,the prevalence of lower urinary tract symp-toms(LUTS)was 24%,but only 4%sought medical care.A Danish survey reported similar prevalence rates,with over 20%of men not discussing their symptoms with anyone.The incidence of LUTS is expected to rise due to an aging population.Artificial intelligence(AI)has been proven valuable in radiology,but its use in primary care remains limited.This study aims to develop an intelligent technique(IT)solution:a user-friendly mobile app that provides individualized support for men with LUTS.The secondary aim is to enhance diagnostic quality in primary care through AI-based decision support.Methods:A retrospective patient database was created,containing patient-reported symptom scores(IPSS),urinary diaries,and timed micturition as-sessments.These data were analyzed using machine learning and Bayesian methods to develop algorithms for personalized recommendations.A pro-spective clinical study,initiated in 2021,collects data from men seeking care for LUTS to expand the database.A randomized study will test the app's efficacy.Results:The first version of the app showed high concordance between its algorithmic assessments and urologist evaluations.A prospective study en-rolled 50 patients from three primary health centers.One third of the patients did not get a recommendation at the first visit.Of the remaining less than half received the same treatment recommendation at this visit as the AI algorithm would have suggested.A web-based study is currently being initiated.Recruitment strategies include public campaigns and targeted invitations.Participants complete a digital questionnaire and are randomized if they meet the inclusion criteria.Conclusion:LUTS significantly impacts men's health,yet care-seeking remains limited.AI-based solutions,such as mobile apps for diagnosis and personalized recommendations,show promise as tools to improve healthcare for this population.
文摘Male infertility contributes to 20%–70%of infertile couple cases worldwide.One of the key challenges in this area is asthenozoospermia or reduced sperm motility.A particular subset,known as isolated asthenozoospermia(iASZ),in which low motility occurs without abnormalities in sperm count or shape,often goes unnoticed and is not well understood.This narrative review attempts to compile the state of knowledge regarding the etiology,diagnosis,and treatment of iA SZ and to identify knowledge gaps that need further investigation with an emphasis on physiological,genetic,and molecular mechanisms.We conducted a focused literature search using PubMed and Web of Science,covering studies published between 2000 and 2024.We included articles that explored the structure,function,diagnosis,and treatment of iASZ.We find sperm motility is influenced by multiple factors,from structural components like mitochondria and the flagellum,to biochemical signals and genetic mutations.In men with iASZ,issues such as mitochondrial dysfunction,oxidative stress,or specific gene defects may impair motility.While routine semen analysis helps flag low motility,it often fails to explain why it occurs—highlighting the need for advanced tests like DNA fragmentation tests,genetic screening,and high-resolution imaging.As regards treatment,lifestyle changes,varicocele surgery,and antioxidants can offer some benefit.Assisted reproduction techniques,especially intracytoplasmic sperm injection(ICSI),remain central for achieving pregnancy when other options fail.iA SZ deserves more attention as a distinct and treatable cause of male infertility.By improving how we diagnose and manage this condition,supported by further research,we can offer better outcomes for affected couples hoping to conceive.
文摘Varicocele is a common entity found in 15%of men and is the most common reversible cause of male factor infertility.Guidelines have been developed to guide urologists in deciding which patients would benefit from varicocelectomy.Yet studies published over the last decade showed the emergence of predictors of success of varicocelectomy using nomograms and other predictive models with statistical analysis.The emergence of artificial intelligence(AI)and machine learning revolutionized the clinician's approach to medicine.The virtual branch of AI,represented by machine learning,has been a very exciting topic for clinicians and researchers over the last years,especially after the launching of ChatGPT-3.5.Urology has been at the forefront of integrating advances in AI into its everyday practice.We aim to shed light on the present literature describing the use of AI in predicting the outcomes of varicocelectomy.Machine learning is being used to predict the improvement in semen parameters after varicocelectomy.These algorithms are derived from studies and data present in the literature and predictive models developed throughout the last two decades and have a superior performance to that of traditional nomograms.However,these models require further research and validation but are anticipated to surpass the accuracy of all current resources,setting forward a new era of varicocele workup and management in the years to come.This paper offers a wide review on the current evidence behind varicocele surgery and the integration of AI in medicine,urology and its use in predicting improvement in sperm parameters post-varicocelectomy.
文摘Ten percent of infertile males have azoospermia,classified into obstructive and nonobstructive types,which require specific medical or surgical treatments.In nonobstructive azoospermia,advancements in microsurgery allow for effective sperm retrieval in about half of cases.This review aimed to highlight the most recent studies utilizing whole exome sequencing(WES)and seminal/serum biomarkers aim to predict micro-dissection testicular sperm extraction(micro-TESE)outcomes and reduce failure rates.WES identifies rare genetic mutations affecting spermatogenesis that could explain micro-TESE failures,improving preoperative assessments.Despite its potential,WES is limited by high costs.Biomarkers such as Anti-Müllerian Hormone and testis-expressed sequence 101 protein can indicate spermatogenic activity,though standardization of these measurements is needed for accuracy.Additionally,microRNAs as non-invasive markers offer potential in assessing spermatogenic reserve and classifying azoospermia types,but their efficacy in identifying specific spermatogenic disorders remains under researched,necessitating further studies on multivariate miRNA models.
文摘Erectile dysfunction(ED)is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance,affecting over 50% of men aged 50 and older.ED is often linked to lifestyle factors and comorbidities,such as diabetes and cardiovascular disease.Although conventional treatments such as phosphodiesterase type 5 inhibitors(PDE5is)and penile prostheses are commonly used,there is increasing interest in regenerative therapies,including platelet-rich plasma(PRP),which may address the underlying causes of ED.This narrative review examines ongoing trials on intracavernosal PRP for ED to better understand its potential as a treatment and offers recommendations for future research to improve the quality of evidence supporting its use.A literature search was conducted in December 2024 across PubMed,ScienceDirect,and Scopus for articles evaluating PRP for ED.The keywords used for search were PRP,ED,and randomized controlled trial.The review focused on relevant studies,with titles,abstracts,and full texts examined for key details.Five randomized clinical trials,two metaanalyses,and a systematic review were identified,revealing significant variability in PRP preparation,dosage,and follow-up protocols,which hindered definitive conclusions about its efficacy.Although the available evidence suggests promising potential for PRP in ED treatment,methodological inconsistencies highlight the need for further research.Standardization of PRP preparation and administration protocols,along with larger and longerterm trials,is essential to establish its clinical benefits for ED treatment.
文摘Peyronie's disease(PD)is an inflammatory andfibrotic disease which resultsin disfiguring and often distressing penile curvature deformity,affecting up toone in nine men in the United States,and between 0.3%and 13.1%of menglobally.It progresses through an acute phase,associated with pain,as thefibrosis develops.In the quiescent phase,penile pain ceases and deformitystabilizes.The precise etiology remains unknown despite ongoing work toelucidate the biological underpinning.The diagnosis is guided by history andphysical examination.Except for ultrasonography,imaging is not routinelyrecommended.Current management is predicated on symptomatic controland slowing progression in the acute phase,and correction of bothersomecurvature in the stable phase.Most nonsurgical treatment options are poorlysupported by available evidence,with the exceptions of traction therapy andcertain intralesional injections.Surgical treatment,considered only afterstabilization,is guided by severity and the presence or absence of erectilefunction and is highly individualized.Investigations are ongoing into severalareas,including the exact biological mechanisms leading to plaque formationand failure of resolution;the effects of co‐existing systemic disease;the role ofimaging in diagnosis and surgical planning;combination and regenerativenonsurgical therapies;and improvements in surgical techniques.As diag-nostic accuracy improves and targeted treatments become available,man-agement of PD will become progressively tailored to an individual's particulardisease.In this review,we summarize the current knowledge regarding PD,including etiology and epidemiology,diagnosis,management,cutting‐edgeresearch,and future directions in care of this condition.
文摘Testosterone plays a pivotal role in male health throughout the lifespan.Men generally exhibit higher serum testosterone levels than women,influencing critical aspects of male physiology.It drives normal sexual differentiation during fetal development,promotes the acquisition of pubertal traits,and induces the development of secondary male sex characteristics.While testosterone levels naturally decline with age,this decrease varies greatly between individuals,indicating that aging alone does not account for any specific testosterone level.The interindividual variability highlights the influence of both genetic and environmental factors on testosterone production.Abnormal changes in testosterone levels,whether excessive or deficient,can have significant implications for men's health,contributing to conditions such as hypogonadism,cardiovascular disease,sexual disorders,and metabolic disorders.Precision medicine provides personalized testosterone treatment options for hypogonadism,taking into account genetic,hormonal,and lifestyle aspects to improve outcomes.This tailored approach is also relevant in dealing with broader reproductive and sexual health issues,ensuring effective and individualized care.This review focuses on testosterone's varied involvement in men's health,using biomarkers and precision medicine breakthroughs to inform tailored therapy and future research.
文摘Background:Prostate cancer,a prevalent malignancy in men,often results in erectile dysfunction(ED),particularly following treatments like radical prostatectomy(RP)and radiotherapy,significantly affecting quality of life.Managing ED in prostate cancer survivors is critical.Inflatable penile prosthesis(IPP)implantation is a well-established treatment for ED,yet the literature on satisfaction rates for patients with a history of androgen deprivation therapy(ADT)remains sparse.We aimed to investigate the impact of ADT on satisfaction rates in patients undergoing IPP implantation following RP or radiation therapy(XRT).Methods:A retrospective review of 529 patient charts identified 96 eligible patients who underwent IPP implantation post-prostate cancer treatment and completed the 11-item Erectile Dysfunction Inventory of Treatment Satisfaction(EDITS)questionnaire.Patients were stratified into two groups based on ADT status,and their satisfaction scores were compared.Effect sizes were used to assess clinical relevance alongside statistical significance(p=0.0344).Results:Patients receiving ADT had significantly lower EDITS scores(p=0.0344)compared to those not on ADT.RP patients reported higher satisfaction post-IPP compared to XRT patients,even after controlling for ADT.Additionally,coronary artery disease(CAD)was associated with lower satisfaction scores.Conclusion:ADT significantly lowers patient satisfaction post-IPP,with RP patients generally reporting higher satisfaction than XRT patients.These findings highlight the importance of counseling prostate cancer patients on ADT's impact on long-term sexual satisfaction and suggest areas for further research to enhance outcomes.
文摘Background:Tubular ectasia of rete testis(TERT)is a benign condition due to dilatation of the rete testis as a consequence of multiple etiologies,including postinfectious,trauma,prior inguinal or scrotal surgeries,mechanical compression of extratesticular excretory ducts,and congenital malformation.TERT is a rare and underreported condition in the medical literature.Its association with infertility is lacking in the literature.Case Presentation:We present a rare case of primary infertility and obstructive azoospermia associated with TERT.We performed extensive literature regarding the possible etiologies,associations,clinical diagnosis,and different management options of this entity.Our patient is a 33-year-old man presented with primary infertility.He was found to have obstructive azoospermia.During scrotal exploration,the diagnosis of intratesticular obstruction due to TERT was made.The couple was advised to undergo intracytoplasmic sperm injection using testicular sperms.This is the third report of TERT associated with azoospermia.Conclusion:TERT is usually asymptomatic but can occasionally be associated with pain or abnormal semen analysis,but further studies are required to confirm its effect on fertility.Fortunately,it has a benign course and typically does not require surgical intervention.It is vital to differentiate it from neoplastic conditions.
文摘Telemedicine has rapidly integrated into healthcare,overcoming initial barriers such as regulatory restrictions and technological limitations.Its role in sexual medicine,especially urology,has been accelerated by technological advances and the COVID-19 pandemic.However,as telehealth continues to expand,key ethical challenges emerge,including concerns over privacy,healthcare equity,and informed consent.These challenges are particularly important in sexual medicine,where sensitive patient data and intimate conditions are involved.We aimed to examine the ethical implications of telemedicine in sexual medicine,focusing on data security,consent processes,and healthcare disparities.We further emphasize the importance of maintaining high ethical standards while integrating telemedicine as a complement to traditional care,ensuring that patient outcomes are not compromised.
文摘Benign prostatic hyperplasia(BPH)is a common condition among agingmen,often leading to lower urinary tract symptoms(LUTS)of varyingseverity.Both medical and surgical treatments for BPH can negatively impactsexual function,affecting patients'overall quality of life.This has highlightedthe need for minimally invasive interventions that minimize sexual side ef-fects.Rezum,a water vapor therapy,has gained popularity in managing BPHand LUTS due to its proposed potential to preserve sexual function.Thisscoping review examines the impact of Rezum therapy on sexual function inpatients treated for BPH.The review was conducted following the JoannaBriggs Institute(JBI)methodology for scoping reviews.A comprehensivesearch was performed using the PubMed and Scopus databases up to August2024.Articles were included if they involved patients treated with Rezum forBPH and reported the effect of Rezum on sexual function using validatedscoring tools.A total of 15 studies encompassing 2,425 patients,met theinclusion criteria.Erectile function was assessed in all studies using theInternational Index of Erectile Function(IIEF)scores.Of these,seven studiesreported no significant changes in erectile function scores,six demonstratedimprovements,and two reported a significant decline.Ejaculatory functionwas evaluated using the Male Sexual Health Questionnaire(MSHQ).TheMSHQ‐Bother score was reported in seven studies,with three indicatingimprovement and none reporting deterioration.The MSHQ‐Function scorewas reported in eight studies,with only one study reporting a decline,whilethe remaining studies found no significant changes.In conclusion,Rezumtherapy for managing BPH shows favorable outcomes for sexual function or,at the very least,does not negatively impact it.Thesefindings can guidepatient counseling,especially for those seeking to preserve ejaculation.Further research is needed to compare Rezum with other treatment optionsregarding sexual function.
