Urology Journal最新文献

Purpose: Neuroendocrine differentiation is a recognized phenotypic change in advanced prostate cancer. Neuroendocrine-like cells may lack androgen receptor or prostate-specific membrane antigen expression, potentially contributing to treatment resistance. This study evaluated octreotide scan positivity as a surrogate marker of neuroendocrine differentiation and its association with response to 177Lu-prostate-specific membrane antigen radioligand therapy in patients with metastatic castration-resistant prostate cancer.

Materials and methods: Thirty-six patients with metastatic castration-resistant prostate cancer who were candidates for 177Lu-prostate-specific membrane antigen radioligand therapy were enrolled. Whole-body octreotide scintigraphy was performed after intravenous administration of 750 MBq of 99mTc-octreotide. Abnormal uptake was classified as mild, moderate, or severe relative to liver uptake. All patients subsequently received standard 177Lu-prostate-specific membrane antigen radioligand therapy and were followed for treatment response after at least two treatment cycles.

Results: Of the 36 enrolled patients, 8 who died within 2 months after the first treatment cycle were excluded from response assessment; therefore, 28 patients were included in the final response analysis. Among these 28 patients, 19 (67.9%) responded to treatment and 9 (32.1%) did not. Eight patients (28.6%) had negative octreotide scans, whereas 20 (71.4%) had positive scans, all showing mild uptake. Positive scans were observed in 13 of 19 responders (68.4%) and 7 of 9 non-responders (77.8%). No significant association was observed between octreotide scan positivity and treatment response (P = 1.00).

Conclusion: Octreotide scan positivity was relatively common in patients with metastatic castration-resistant prostate cancer but was not significantly associated with response to 177Lu-prostate-specific membrane antigen radioligand therapy. Larger studies are needed to confirm these findings.

Purpose: Testicular torsion is an emergency, and its long-term effects on fertility, hormonal function, and sexual function remain uncertain. We aimed to evaluate the long-term effects of surgical treatment for testicular torsion on hormonal function, testicular ultrasonographic features, and erectile function.

Materials and methods: This retrospective cohort study included patients surgically treated for testicular torsion at Labbafinejad Hospital, Tehran, Iran, from 2014 to 2022. Semen analysis and Doppler testicular ultrasonography were performed, and serum samples were collected to measure testosterone, follicle-stimulating hormone, and luteinizing hormone. Erectile function was assessed using the International Index of Erectile Function questionnaire. A P value less than 0.05 was considered statistically significant.

Results: Seventy-two patients were assessed. Fifty-four patients (75.0%) underwent orchiopexy, and 18 (25.0%) underwent orchiectomy. Patients in the orchiectomy group had higher luteinizing hormone (P < 0.001) and follicle-stimulating hormone (P = 0.009) levels and lower testosterone levels (P = 0.008), sperm counts (P < 0.001), progressive sperm motility (P = 0.002), and normal sperm morphology (P = 0.001) than patients who underwent orchiopexy. International Index of Erectile Function scores did not differ significantly between the groups (P = 0.730). In the orchiopexy group, 32 patients (59.3%) had small testes.

Conclusion: Surgical treatment for testicular torsion affects hormonal and ultrasonographic testicular findings; however, it does not appear to have a remarkable effect on erectile function.

Purpose: Urinary incontinence (UI) is characterized by any involuntary loss of urine, resulting in significant hygiene, emotional, and social challenges. This systematic review and meta-analysis aimed to update the current understanding of the prevalence of UI and overactive bladder (OAB) among Iranian women.

Materials and methods: We conducted an electronic search of PubMed, Embase, Scopus, Web of Science, Google Scholar, Medline, Cochrane, CINAHL, and Biosis from January 1990 to February 2026. Women aged 15 years and over living in Iran were targeted. A total of 23 cross-sectional studies encompassing 27,690 participants were included. Study quality was assessed using the Joanna Briggs Institute methodological guidance for systematic reviews of observational epidemiological studies. The I² index was used to estimate heterogeneity; the random-effects model was applied due to high heterogeneity. Publication bias was evaluated using Egger's test, and data analysis was performed using MedCalc software.

Results: The overall prevalence of UI was estimated at 39.98% (95% CI: 30.54-49.82). The most prevalent subtype was stress urinary incontinence (SUI) at 26.88% (95% CI: 20.00-34.37). OAB and urge urinary incontinence (UUI) affected 20.13% (95% CI: 15.70-24.95) and 17.09% (95% CI: 9.38-26.55) of women, respectively. Mixed urinary incontinence (MUI) followed, with a prevalence of 14.99% (95% CI: 6.62-25.98).

Conclusion: Given the relatively high prevalence of UI and OAB among Iranian women, further research is needed to explore underlying factors and to develop effective prevention, management, and treatment strategies. A clearer understanding of the epidemiology of UI and OAB can support health policy planning and the development of responsive healthcare services.

Purpose: To evaluate clinical, biochemical, and hematological parameters as predictors of prostate cancer (PCa) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 2 lesions.

Materials and methods: A total of 955 patients underwent multiparametric magnetic resonance imaging (mpMRI) during the study period, of whom 268 had PI-RADS 2 lesions. Among these, 147 patients with histopathological diagnoses, including 122 benign and 25 malignant cases, were included. Clinical, biochemical, and hematological parameters were compared between groups using appropriate statistical tests. Receiver operating characteristic (ROC) curve analyses were performed to evaluate diagnostic performance.

Results: Prostate-specific antigen (PSA) density (P = .044), neutrophil count (P = .019), monocyte count (P = .021), neutrophil-to-platelet ratio (NPR; P = .016), and monocyte-to-platelet ratio (MPR; P = .019) differed significantly between the malignant and benign groups. Compared with the benign group, neutrophil count, monocyte count, NPR, and MPR were lower, whereas PSA density was higher in patients with PCa. ROC analyses demonstrated moderate discriminatory performance for PSA density (area under the curve [AUC], 0.654; 95% confidence interval [CI], 0.561-0.739; P = .007), monocyte count (AUC, 0.655; 95% CI, 0.546-0.754; P = .011), MPR (AUC, 0.657; 95% CI, 0.547-0.755; P = .037), neutrophil count (AUC, 0.635; 95% CI, 0.523-0.737; P = .046), and NPR (AUC, 0.644; 95% CI, 0.536-0.743; P = .055).

Conclusion: PSA density demonstrated moderate discriminatory performance for detecting PCa in biopsied patients with PI-RADS 2 lesions. Although several hematological indices also showed moderate discriminatory performance, their clinical utility remains limited. Larger prospective studies are required to validate these findings before clinical implementation.

Purpose: Increasing evidence suggests that gut microbiota are associated with the risk of kidney stone disease; however, whether a causal relationship exists remains unclear. We used Mendelian randomization to assess the potential causal relationship between gut microbiota and kidney stone disease risk.

Materials and methods: Genetic instrumental variables for gut microbiota were identified from a genome-wide association study of 18,340 participants. Summary statistics for kidney stone disease were derived from genome-wide association studies, including 284,598 cases and 480,873 controls. The inverse-variance weighted method was used as the primary analysis. To test the robustness of the results, we further performed the weighted-median method, MR-Egger regression, and the MR pleiotropy residual sum and outlier test. Finally, reverse Mendelian randomization analysis was performed to evaluate the possibility of reverse causation.

Results: We identified suggestive associations between 4 bacterial traits and the risk of kidney stone disease: class Lentisphaeria (odds ratio: 0.82; 95% confidence interval: 0.69-0.98; P = .032), genus Oscillibacter (odds ratio: 0.79; 95% confidence interval: 0.66-0.96; P = .018), order Victivallales (odds ratio: 0.82; 95% confidence interval: 0.68-0.98; P = .034), and genus Olsenella (odds ratio: 1.26; 95% confidence interval: 1.03-1.53; P = .022). The results of sensitivity analyses for these bacterial traits were consistent. We did not find statistically significant associations between kidney stone disease and these 4 bacterial traits in the reverse analysis.

Conclusion: This systematic analysis provides evidence supporting a potential causal relationship between 4 gut microbiota taxa and kidney stone disease risk. Further studies are needed to determine how gut microbiota influence kidney stone disease development.

Renal pelvis epidermoid cysts are extremely rare and are often misdiagnosed as stones or tumors. Only one previous case has been treated using the percutaneous approach. A 67-year-old female with diabetes who was receiving empagliflozin presented with imaging findings suggestive of a staghorn calculus. During percutaneous nephrolithotomy, whitish keratinous material was found in the renal pelvis, along with a small obstructing stone. All material was evacuated through the Amplatz sheath. Urine culture was negative. Histopathological examination confirmed an epidermoid cyst. A postoperative computed tomography scan at 1 month showed complete resolution. Epidermoid cysts can radiologically mimic staghorn calculi. A fungal ball was initially suspected because of diabetes and sodium-glucose cotransporter 2 inhibitor therapy, but radiopacity, negative culture, and histopathological findings ruled this out. Percutaneous nephrolithotomy served as both a diagnostic and therapeutic procedure while preserving renal function. Renal pelvis epidermoid cysts should be considered in the differential diagnosis of opaque pelvic lesions. Percutaneous nephrolithotomy is a minimally invasive, kidney-preserving treatment that can be performed as a renal-sparing procedure.

Purpose: Sexual dysfunction associated with psychological reasons is one of the factors impacting unfulfilled marriages. There are limited data on treatment outcomes in this context. The aim of this study was determining the treatment of unconsummated marriage in psychogenic erectile dysfunction in Iranian Couples.

Materials and methods: A total of 66 cases were selected from individuals referred to the Family Health Clinic (from 2006 to 2019), who had unconsummated marriages and experienced psychogenic erectile dysfunction, meeting the inclusion criteria for the study. Research tools included couples' demographic information, face-to-face interviews, and the International Index of Erectile Function (IIEF). The treatment was based on couple's therapy. In the initial session, a comprehensive assessment of the couples' condition was conducted, and research instruments were completed. Additionally, during this session, the formation of psychogenic erectile dysfunction and the lack of successful foreplay were discussed. In subsequent sessions, desensitization, instruction on foreplay, and intercourse were addressed. Treatment success was defined as the ability to achieve complete vaginal penetration. Data was analyzed using SPSS 16 software.

Results: All 66 couples continued the treatment until they achieved successful vaginal penetration. All International Index of Erectile Function (IIEF) domains improved significantly after couple-based behavioral therapy in men with psychogenic erectile dysfunction in unconsummated marriages (all p < .001; large effect sizes for most domains). No significant associations were found between educational level, place of residence, engagement duration, or marriage duration and post-treatment scores (all p > 0.05). Male age correlated negatively with overall ED (r = -.314, P = .001), erectile function (r = -.361, P = .003), intercourse satisfaction (r = -.365, P = .003), and overall satisfaction (r = -.266, P = .031). Similar negative associations were observed for female age with overall ED (r = -.371, P = .002), erectile function (r = -.354, P = .004), intercourse satisfaction (r = -.344, P = .005), and overall satisfaction (r = -.246, P = .047).

Conclusion: Psychogenic erectile dysfunction in unconsummated marriage can be addressed through couple-based therapy.

Purpose: To study the effect of body mass index (BMI) on 24-h urine quantitative analysis in pediatric urolithiasis, and to explore whether obesity and overweight promote the formation of urinary calculi in children.

Materials and methods: A comprehensive search of EMBASE, PubMed, the Cochrane Library, Web of Science, and Scopus was conducted in March 2024 and updated in October 2025 to identify all related studies. BMI was used to specify body size. Predetermined inclusion and exclusion criteria were used to screen each article. Data from appropriate studies were extracted, and a meta-analysis was performed using Stata 14.0 software.

Results: Eight studies, including 1033 children with urolithiasis who underwent 24-h urine collection for chemical analysis, were included in this meta-analysis. The BMI ≥ 85th percentile group exhibited significantly higher uric acid excretion (SMD = 0.756, 95% CI = 0.092-1.420, P = .026). No statistically significant differences were found in calcium (SMD = -0.320, 95% CI = -0.600 to -0.050, P = .519), 24-h urine volume (SMD = -0.310, 95% CI = -0.790 to 0.160, P = .555), magnesium (SMD = -0.470, 95% CI = -0.820 to -0.120, P = .471), phosphate (SMD = -0.360, 95% CI = -0.610 to -0.110, P = .805), oxalate (SMD = -0.110, 95% CI = -0.390 to 0.170, P = .315), citrate (SMD = -0.190, 95% CI = -0.680 to 0.290, P = .057), or sodium (SMD = 0.200, 95% CI = -0.390 to 0.800, P = .050) excretion between the two groups. Sensitivity analyses confirmed the robustness of these findings.

Conclusion: While overweight/obese children with urolithiasis demonstrate higher urinary uric acid excretion, the absence of significant differences in other key urinary risk factors suggests that BMI alone should not be considered a separate and definitive risk factor for pediatric urolithiasis.

Purpose: Varicocele is the abnormal dilatation of the veins of the pampiniform plexus, which is considered one of the most common factors related to infertility in men. The aim of the present study was to investigate whether a relationship exists between sleeping position and the presence of varicocele.

Materials and methods: In this case-control study, 231 adult infertile men who were referred to the Kowsar Infertility Center, Yasuj, Iran, were divided into two groups: a control group including 113 infertile patients without varicocele, and a case group of 118 infertile patients with varicocele. After the first visit by the urologist and determining the presence or absence of varicocele, as well as the clinical grading of the varicocele, the patients completed demographic, clinical, and sleep position questionnaires.

Results: The findings of the current study indicated a significant relationship between the presence of varicocele and the faller-down (lying on the abdomen) sleeping position. There was also a significant positive correlation between this position and the degree of varicocele (p =0.003).

Conclusion: The faller-down or prone position during sleep has a meaningful relationship with varicocele, which may be due to increased intra-abdominal pressure. More studies are needed to confirm this hypothesis.