Uro, Volume 2, Issue 3 (September 2022) – 7 articles

(1) Background: Donor nephrectomy for living donor kidney transplantation using minimally invasive techniques is a safe procedure that has been used for more than 20 years with excellent results. The total laparoscopic approach offers decreased postoperative pain, less incisional morbidity, and a shorter recovery time. (2) Methods: We present the results of a series of 43 laparoscopic donor nephrectomies performed in a single center. The procedures were performed in a systematic approach with transperitoneal access using four ports. The main renal artery and vein were ligated using a linear stapler fixed with an alternate triple row of titanium staples. The specimen was extracted in an endoscopic bag through an additional incision. (3) Results: All procedures were performed laparoscopically without conversion to open surgery. The average warm ischemia time was 4.73 min. In all recipients, immediate kidney allograft function was observed. (4) Conclusions: Total laparoscopic living donor nephrectomy is a safe procedure. It was performed successfully in all cases with a short surgical time, low morbidity, and 0% mortality. Full article

Gender Affirmation Surgeries (GASs), erstwhile called Sex Reassignment Surgeries (SRSs), may be necessary for transgender individuals to change their bodily sexual characteristics and thereby affirm their gender identity. GASs encompass all medically necessary interventions to relieve gender dysphoria and should be available to patients who wish to, and who meet the surgical criteria of the World Professional Association for Transgender Health (WPATH) and Standards of Care (SOC). The comprehensive clinical assessment involves many health specialists, including general practitioners, psychologists, psychiatrists, speech therapists, endocrinologists, surgeons, anesthesiologists, nurses, and other healthcare professionals. To define the patients’ complex care needs and their objectives, high-volume specialized centers, accredited training programs, skilled surgeons and health professionals specializing in transgender care within a multidisciplinary team are essential. Currently, the most prominent challenges are related to ethical issues such as the treatment of underage individuals, fertility, parenting and the potential for regret after GAS. Finally, although GAS has been practiced for more than half a century, data on long-term follow-up represents a further topic for investigation. Full article

Individuals with spinal cord injury and multiple sclerosis usually use intermittent catheterization for urinary management; however, many patients will also encounter a condition of neurogenic detrusor overactivity, which causes urinary incontinence. The use of muscarinic receptor antagonists is the first-line treatment to manage this condition. These drugs, however, have significant side effects. Transcutaneous electrical nerve stimulation applied to the genital nerve (GEN) is an alternative noninvasive method that produces detrusor inhibition through neuromodulation. Despite studies demonstrating bladder inhibition with GEN, more outcomes are required regarding decreased use of bladder inhibitory medications and concerns with dangling wires. It is proposed that wireless-GEN can be used in home-use studies in order to address these limitations. If needed, wireless tibial nerve stimulation could be added to improve incontinence management. Full article

Background: Human papilloma virus (HPV) has been recognized as one of the most common sexually transmitted infections and has been correlated with poor semen quality and male hypofertility. Ellagic acid and Annona muricate have been considered as fascinating compounds in the chemoprevention of HPV-related lesions of the cervix. Here, we aimed to evaluate the role of ellagic acid and Annona muricata (OASIT-k^®) in managing male subjects with oligospermia and HPV-related infections. Methods: From January 2017 to January 2019, all patients attending our center for oligospermia were evaluated for HPV-DNA. All HPV-DNA positive patients underwent orally administered OASIT-k 1 tablet/day for 3 months. After 6 months, all patients underwent spermiogram, HPV-DNA analysis on seminal plasma and urological visit. The main outcome measures were HPV-DNA clearance rate and improvement of semen parameters. Results: Forty-three patients (aged 22–43 years) were enrolled and treated. At the end of the treatment, the clearance of HPV-DNA infections was 62.7% (27/43). Seminal parameters were improved by treatment in terms of the number of spermatozoa (10.6 vs. 15.8) and mobility (27.5% vs. 36.1%). Conclusions: The therapy with OASIT-K was efficient in improving the HPV-DNA clearance and seminal parameters. These promising data emphasize the importance of redirecting the immune responses in viral infections. Full article

Background: The shortage of organs has called for the use of two marginal adult kidneys (MAKs) with a low nephron mass as dual adult kidneys transplanted to a single recipient. The operative techniques of the transplantation of these kidneys are still debated. Since the horseshoe kidneys have been transplanted as early as 1975, it is theorized that the technique of the en bloc transplantation of the horseshoe kidney may be applied to the MAKs. Material and Methods: The world literature search during the period 1975–2021 on the use of deceased-donor horseshoe kidneys was reviewed. The selection of the donors, the anatomy of the kidneys, the principles of organ recovery, the transplantation procedure, and the results were discussed. Finally, this technique of en bloc transplantation was applied successfully to seven pairs of MAKs and is described herein. The dual adult kidneys were simultaneously vascularized by the donor aorta and vena cava, which were anastomosed, respectively, to the recipient iliac artery and vein. Results: A total of 131 case reports of deceased horseshoe kidney donors were reviewed, of which 53 en bloc kidneys were transplanted successfully to a single recipient, and the remaining 78 were divided and transplanted as single units to 131 recipients. Twenty-five single kidneys were discarded. At the time of publication, all horseshoe kidneys had a good renal function. In the series of seven pairs of MAKs transplanted en bloc, the operative time was 3 h. There were no primary nonfunctions, no vascular thromboses, no urinary leakages, and no wound infections. Only two patients required temporary dialysis despite an average of 28.4 h of cold ischemia time. No hydronephrosis and lymphocele was experienced. Both patient and graft survival were 100%. At the time of follow-up at 36 months, serum creatinine levels averaged 1.8 mg/dL (range 1.4–1.9). Conclusions: This technique of en bloc renal transplantation using the donor aorta and vena cava for revascularization can be applied to both the horseshoe kidneys and the MAK, and improve organ utilization. Full article

The overall pathogenesis of bladder cancer is still unknown. The microbiota has been shown to play a critical role in the development of different types of cancer. Nevertheless, the role of the microbiota in the development of bladder cancer is still not fully discovered. This review aims to assess the urinary, vaginal, and intestinal microbiota analyzed from the bacterial, viral, and fungal compartments of bladder cancer patients compared with the microbiota of controls to reveal possible differences. A systematic review according to the PRISMA guidelines will be performed. The findings will be presented in narrative form as well as in tables and graphs. Full article

Introduction: The effect of the lipidosterolic extract derived from Serenoa repens (commonly known as “saw palmetto extract” or LSESr) berries on benign prostatic hyperplasia (BPH) and male lower urinary tract symptoms (LUTS) has been extensively studied in the global literature. However, a lack of global consensus with regard to its effectiveness remains, resulting in differing recommendations on the role of LSESr in the BPH/LUTS treatment paradigm. Here, we describe the consensus reached by an international panel of urology experts. Methods: In an independent meeting on 24 April 2021, an international panel of urology experts convened with the goal of developing consensus statements to address the following: the differences between the AUA and EAU guidance regarding the use of LSESr for the treatment of BPH/LUTS, the proposed mechanism of action of LSESr, and data examining the efficacy and safety of LSESr. These consensus statements were developed over the course of several months after an extensive review of the global literature and a discussion thereof. Results: A total of seven consensus statements were agreed upon by the panel. These statements addressed the proposed mechanism of action of LSESr, LSESr quality, and the results from clinical trials examining the efficacy and safety of various LSESrs. Conclusion: Based on the reviewed evidence, the panel recommends that LSESr should be considered as a treatment option for men with mild-to-moderate BPH/LUTS as an alternative to watchful waiting. Full article