Manuela Montatore, Gianmichele Muscatella, Federica Masino, Eluisa Muscogiuri, Giuseppe Guglielmi
Androgen deprivation therapy (ADT) is a cornerstone of prostate cancer treatment and is commonly accompanied by longitudinal changes in muscle, adipose tissue, and skeletal health that may be poorly captured by conventional anthropometric measures. This study investigated whether routine oncologic computed tomography (CT) could provide an integrated longitudinal assessment of muscle, adipose tissue, and vertebral trabecular attenuation following ADT initiation. In this retrospective, single-center longitudinal study, 60 consecutive men with prostate cancer initiating ADT between January 2023 and May 2025 were screened at Antonio Perrino Hospital, Brindisi, Italy, with clinical follow-up available through July 2026. Forty patients with an eligible baseline CT obtained within 30 days before ADT initiation and a technically comparable follow-up CT at 12 ± 2 months were included. At L3, skeletal muscle index (SMI), bilateral psoas attenuation, subcutaneous adipose tissue index (SATI), and visceral adipose tissue index (VATI) were assessed. Trabecular vertebral attenuation was measured at L1–L3. Mean SMI decreased from 48.4 ± 6.9 to 45.5 ± 6.8 cm²/m² (−6.0%; p<0.001), while mean psoas attenuation decreased from 41.0 ± 5.9 to 37.8 ± 6.0 HU (−7.8%; p<0.001). SATI increased by 11.6% (p<0.001), VATI by 6.2% (p=0.018), and mean vertebral trabecular attenuation decreased by 4.4% (p=0.006). BMI changed only modestly and showed a weak relationship with SMI change. Twenty-three patients (57.5%) had an SMI decline ≥5%, a prespecified exploratory threshold. In an exploratory parsimonious adjusted analysis, lower baseline psoas attenuation was associated with subsequent SMI decline ≥5%; however, the limited sample size precludes interpretation as an independent predictive biomarker. Routine oncologic CT demonstrated concurrent longitudinal changes in muscle, adipose tissue, and vertebral attenuation following ADT initiation that were only weakly reflected by BMI. These findings support further evaluation of integrated opportunistic CT phenotyping in larger controlled cohorts.
Alexandra Wilke, Tina Hörz, Monica Pleul, Carola Hörz, Katrin Schuchardt, Guido Fitze, Christian Kruppa
The progressive loss of kidney function is a major cause of morbidity and mortality in children with neurogenic bladder dysfunction. A consequent follow-up, including repeated urodynamics combined with detection of vesicoureteral reflux (VUR) is crucial for the individual treatment of the urinary tract. The aim of our study is to investigate whether contrast-enhanced voiding urosonography -urodynamics (ceVUS-UD) can be used in routine urological diagnostics. Due to its radiation-free nature in a more comfortable environment, this would allow the examination to be performed frequently enabling more accurate monitoring of bladder function. Since January 2025, 19 patients with neurogenic bladder dysfunction have undergone simultaneous ceVUS as part of urodynamic follow-up. The children were 11.4 years old on average (9 male, 10 female) and showed one of the following underlying conditions: spina bifida, detrusor hyperactivity after spinal cord injury, caudal regression syndrome, epispadias, infantile cerebral palsy or myotonic dystrophy type 1. Two-thirds of the patients performed self-intermittent catheterization. CeVUS-UD can be safely performed as part of routine urodynamic testing without interfering with urological measurements. Previously unknown secondary VUR (sVUR) was detected in six patients (31.6%). In one case, a significant decrease of vesical pressure during the occurrence of reflux was observed. For five children, this led to a change in treatment. In this study, CeVUS-UD provides a feasible, safe and radiation-free tool for characterizing neurogenic bladder dysfunction. Whether ceVUS-UD can serve as an alternative to video urodynamics (VUD), and whether routine monitoring of sVUR translates into improved long-term kidney outcomes, remains to be established in further studies.
5-alpha-reductase inhibitors (5-ARIs), such as finasteride and dutasteride, are effective in reducing prostate volume and urinary symptoms; however, these drugs are associated with specific adverse events, including suicidal ideation, anxiety, and self-harm. A systematic review and meta-analysis of observational studies was conducted in PubMed, Embase and Web of Science on July 16, 2025, with no time restrictions. Studies involved individuals diagnosed with benign prostatic hyperplasia (BPH) or androgenetic alopecia (AGA), and experiencing suicide and neuropsychiatric events, including anxiety, depression and intentional self-harm (ISH) during the treatment with 5-ARIs. This study followed the PRISMA statement. Eleven studies were included in the systematic review, of which nine were eligible for meta-analysis. Comparisons included 5-ARI users versus non-users or alpha-blocker users. Overall, no statistically significant differences were observed between groups (HR 1.07, 95% CI: 0.76–1.51), with substantial heterogeneity across studies (I² = 59%). This meta-analysis found no significant association between 5-ARIs and the risk of suicide or neuropsychiatric events in patients with benign prostatic hyperplasia or androgenetic alopecia. Nevertheless, given regulatory concerns regarding suicidal ideation, continued real-world monitoring through active surveillance and prospective observational studies remain warranted. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251106035, identifier CRD420251106035.
Cyrille Guillot-Tantay, Sabrina de Cillis, Paolo Geretto, Luis Vale, Manuela Tutolo, Fabiana Cancrini, Véronique Phé, Nadir I. Osman, Mikolaj Przydacz
Our objective was to conduct a systematic review of studies comparing male slings (MS) and Artificial Urinary Sphincter (AUS) in terms of efficacy and safety in men with Stress Urinary Incontinence (SUI). We conducted a systematic review including all studies comparing MS and AUS in adult men with SUI. All synthetic MS were included. The primary outcome was the postoperative continence rate defined as either no pad use or one safety pad. Of 133 references screened, after exclusion of duplicates, 18 papers were eligible for a full-text analysis and 9 studies (5921 patients) were included in the qualitative synthesis. Among these, one was a randomized controlled trial and eight were cohort studies. The cure rate varied from 14% to 94% for the AUS and 11% to 69% for the MS. Of the five studies reported both devices, two (40%) reported a continence rate above 70% for AUS. Eight of the nine studies (88.9%) reported safety outcomes. Urethral erosion was less frequent after male slings than after artificial urinary sphincter implantation, whereas urinary retention was more frequent after male slings in most studies. In comparative studies, continence proportions were generally higher after artificial urinary sphincter implantation, while the complication profiles of the two devices differ, with more erosion after the sphincter and more urinary retention after the sling. Confidence in these findings is limited by clinical heterogeneity, confounding by indication and inconsistent outcome definitions. Standardised outcome reporting and randomised data are needed. https://www.crd.york.ac.uk/prospero/, identifier CRD42024539539.
Michael Enwere, Mohamed Toufic El-Hussein, Emmanuel Davies, Laurens Holmes
Azoospermia, defined as the absence of spermatozoa in the ejaculate, is a severe form of male infertility, and the potential effects of intensive lifestyle modification on sperm production remain uncertain. We describe three adult men whose available pre-intervention records reported azoospermia and who undertook a multicomponent lifestyle programme centred on a predominantly raw, whole-food, plant-based diet, prescribed hydration, progressive physical activity, sleep and stress-management guidance, reduced alcohol consumption, and avoidance of ultra-processed and animal-derived foods. Clinical records, serial semen analyses, and available hormonal assessments were retrospectively reviewed. Approximately 10 weeks after programme initiation, spermatozoa were detected in all three participants, with concentrations of 1.6, 2.0, and 2.2 × 10 6 /mL, respectively, at the first sperm-positive assessments; these values remained within a severe oligozoospermic range, and motility and subsequent trajectories varied. Two participants had previously received fertility-directed hormonal therapies, and one had undergone unsuccessful testicular sperm extraction. Participants also reported improvements in body weight, sleep, physical-activity tolerance, libido, perceived energy, and general well-being, with no major adverse events documented. Complete etiologic assessment, genetic testing, objective adherence measures, and uniform documentation of semen-analysis methods were not available for all participants. This uncontrolled case series documents a clinically notable temporal association between initiation of an intensive lifestyle programme and subsequent detection of spermatozoa in men with previously reported azoospermia. Causality cannot be established, and the individual contributions of diet and other programme components remain uncertain. Prospective controlled studies using standardized andrologic assessment, comprehensive etiologic investigation, objective adherence measures, and prespecified reproductive outcomes are warranted.
