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ObjectiveTo determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury.MethodsAdult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score.ResultsThere were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001).ConclusionIn PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.

Background To evaluate and compare the efficacy of urinary carbohydrate antigen 19-9 (CA19-9), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1) biomarkers as predictive factors to determine the surgery requirement in patients with ureteropelvic junction obstruction. Methods We obtained urine samples from 161 patients at diagnosis and evaluated their levels of the three biomarkers. The patients were under observation for 2 years; subsequently, they were divided into two groups based on their requirement of pyeloplasty. We determined the correlation between the urinary concentration of the biomarkers and surgical interventions, as well as the kidney function deterioration and sonography outcomes. Results The non-surgery group included 60 male and 22 female patients with mean age of 21 months. The surgery group comprised 58 boys and 21 girls with mean age of 26.9 months with no significant difference of age and gender between the two groups. The outcomes were indicative of higher efficacy of CA19-9 level with a sensitivity and specificity of 84.2% and 73.2% at the cutoff point of 59.09 U/ml. Also, a significant negative correlation was detected between the kidney function and the concentrations of CA19-9 and NGAL. Conclusions Our evaluations demonstrate the higher efficacy of CA19-9 to predict the requirement of surgical intervention in comparison with the other biomarkers, as well as a significant correlation between kidney function deterioration and urinary CA19-9 and NGAL. The outcomes of this investigation could pave the way for more extensive clinical application of these urinary biomarkers, besides future research determining the association between markers and kidney fibrosis., Author(s): Kiarad Fendereski [sup.1] , Amirreza Nabighadim [sup.1] , Maryam Seyedtabib [sup.2] , Seyedeh Sima Daryabari [sup.1] , Mohammad Taghi Haghi-Ashtiani [sup.3] , Abdol-Mohammad Kajbafzadeh [sup.1] Author Affiliations: (1) grid.411705.6, [...]

Objectives: Based on the recent advancements in cell therapy techniques, we aimed to evaluate the efficacy of transurethral injection of autologous adipose‐derived stem cells, muscle‐derived stem cells, and co‐cultured cells for the rehabilitation of stress urinary incontinence rat models. We hypothesized that the utilization of co‐cultured stem cells could result in enhanced therapeutic outcomes attributed to their more comprehensive environment of paracrine factors and cytokines. Methods: We performed bilateral pudendal nerve transection surgeries to simulate urinary incontinence in 25 female Wistar rats and employed urodynamic evaluations to confirm the injury. We autologously isolated and cultured adipose‐derived mesenchymal stem cells, muscle‐derived stem cells, and a mixed culture of the two types, which we subsequently injected into the urethral lumen of the damaged animals. Three weeks after the injection, urodynamic assays, histological staining, and immunohistochemical evaluations were performed to determine the efficacy of the implanted cell cultures in sphincter function improvements or structural modifications. Results: Histological evaluations suggested a regenerative process in the muscular layer of the external sphincter 3 weeks after the injection. Also, immunohistochemical analysis revealed a thickened periurethral striated muscle layer in the co‐cultured group. Postinjection urodynamic analysis indicated that the urethral pressure profile significantly increased in the co‐cultured group compared with other groups. Conclusions: The outcomes of this investigation indicated that the application of co‐cultured adipose‐derived and muscle‐derived stem cells could be associated with higher therapeutic value in stress urinary incontinence patients compared with singular‐cell treatments. [ABSTRACT FROM AUTHOR]

Introduction Approximately 15% of couples in the reproductive age are struggling with infertility which, in nearly half of them, is caused by male factors. Material and methods The present study comprised of two groups of sixteen C57BL/6 mice; each mouse received either an intraperitoneal injection of 30 mg/kg of an alkylating agent or the same amount of distilled water. Testes were harvested 30 days following the injection. Morphometric analysis of hematoxylin and eosin (H&E) stained slides including mean tubular area, diameter and intratubular particles were performed. Spermatogenesis rate was assessed by spermatogonial markers including promyelocytic leukemia zinc finger protein (PLZF) and neurogenin-3 (NGN3). Moreover, the expression rate of Wilms Tumor-1 (WT-1), A-Kinase Anchoring Protein 4 (AKAP4) and adenosine deaminase domain containing 1 (ADAD1) genes were evaluated via real-time polymerase chain reaction (RT-PCR). Results The body weight gradually increased in both groups after a period of 30 days, however, the increase was significantly (p-value = 0.023) lower in the chemically treated group. All the morphometric parameters were considerably decreased in the azoospermic mice. Also, promyelocytic leukemia zinc finger protein and neurogenin-3 expression dramatically declined (p-value <0.001 for both markers). In comparison with the negative control group, the expression rates of A-Kinase Anchoring Protein 4 and adenosine deaminase domain containing 1, two genes participating in the sperm structure, were remarkably reduced in the intervention group (p-value <0.001); however, our investigations demonstrated that the azoospermia model could induce a 5-fold upregulation in Wilms Tumor-1 gene expression. Conclusions Development of an azoospermia model can upregulate Wilms Tumor-1 gene expression in a higher rate after 30 days; however, expression of the testis-specific genes, A-Kinase Anchoring Protein 4 and adenosine deaminase domain containing 1, decreased after the intervention. To the best of our knowledge, this upregulation could be related to spermatogenesis recovery after the follow-up period. [ABSTRACT FROM AUTHOR]

Type 1 diabetes is characterized by autoimmune destruction of pancreatic cells. Organ transplantation is an acceptable treatment for native organ failure. However, it is associated with several problems due to a number of reasons, such as the lack of appropriate donors and immunosuppression. In our present study, a novel model is presented for in vivo recellularization of acellular pancreas by implanting between the host pancreas and the adjacent omental flap. In this study, the pancreases were harvested and cannulated via the common bile duct and then, the scaffolds were acellularized by a detergent‐based protocol. After that, the abdomens of 35 rats were opened and the spleen was extracted with the adjacent omentum, and placed outside the abdomen. The acellularized scaffold was stretched over the host pancreas and the omentum was wrapped around it to make a sandwich‐like structure, which was then fixed with Chromic Sutures 6–0 and marked with Prolene 4–0 on four sides. All samples were biopsied at 14, 30, 60, 90, and 120 days post‐transplantation. The result showed marked recellularization of acellularized pancreas with visible neovascularization and neoβ‐cells with minimal inflammatory response. This study provides a new approach to produces a normal‐like pancreas by allograft transplantation for pancreas tissue engineering. We observed that in vivo transplantation of acellularized pancreas can promote recellularization, proliferation, and differentiation by blood circulation. These findings support that in vivo studies can contribute to finding faster solutions for the treatment of diabetes. [ABSTRACT FROM AUTHOR]

Background Objective Materials and methods Results Conclusions Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation, while others prefer stripping of the vas deferens to preserve the vasal artery, hence preserving vasculature to the testis and possibly decreasing post‐operative congestion pain.To compare outcomes of patients with chronic orchialgia, who underwent MSCD by either stripping or ligating the vas deferens.A retrospective chart review of 85 patients who underwent MSCD from 2017–2023 was performed. Patients’ demographics including history of prior surgical procedures were recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain, or no improvement in pain.Eighty‐five patients underwent MSCD with a median (interquartile range, IQR) age of 36 (25.5–46.5) years and median duration of pain of 16 (6–31) months. Thirty‐seven patients underwent stripping of vas, while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. Twenty‐one (43.5%) patients had prior inguinal scrotal surgery in the ligation group compared to 5 (13.5%) in the stripping group, p = 0.003. The etiology of pain was similar between the groups. The response to MSCD between the two groups was similar, 67.6% of patients who underwent stripping had complete resolution of pain versus 66.7% of those who had ligation (p = 0.968), with similar rates of post‐operative complications (p‐value = 0.132).In men with intractable chronic scrotal content pain with no interest in preserving fertility, ligation, or stripping of the vas deferens yields similar outcomes with regard to pain resolution. Both techniques are safe with no reports of any testicular atrophy. [ABSTRACT FROM AUTHOR]