Dragoș Puia

Background/Objectives: Obstructive ureterolithiasis complicated by infection may progress rapidly to systemic deterioration, while microbiological confirmation is generally unavailable during initial assessment. This study evaluated the association of admission procalcitonin (PCT), National Early Warning Score 2 (NEWS2), and routine urinary parameters with positive upper urinary tract culture in patients requiring urgent urinary decompression. Methods: This retrospective single-center observational study included 240 adults admitted with obstructive ureterolithiasis who underwent upper urinary tract decompression by ureteral stenting or percutaneous nephrostomy. Demographic, clinical, laboratory, and urinary parameters obtained at admission were compared according to upper urinary tract culture status. Factors associated with culture positivity were assessed using univariable and multivariable logistic regression. Four clinically defined models were compared: a reference model containing WBC, CRP, urinary nitrites, and proteinuria; models separately adding PCT or NEWS2; and a complete model containing both. Discrimination was compared using AUCs and the DeLong test, while model fit was assessed using likelihood-ratio tests. Internal validation was performed using 1000 bootstrap resamples. Results: Positive upper urinary tract cultures were identified in 86 patients (35.8%). In the complete model, PCT per doubling (aOR 1.820; 95% CI 1.502–2.205; p < 0.001) and NEWS2 (aOR 1.167; 95% CI 1.014–1.344; p = 0.031) remained independently associated with culture positivity. The reference model had an AUC of 0.691. Adding PCT increased the AUC to 0.831 (ΔAUC 0.140; p < 0.001), whereas adding NEWS2 alone resulted in an AUC of 0.720 (ΔAUC 0.029; p = 0.085). The complete model achieved an apparent AUC of 0.839 and an optimism-corrected AUC of 0.821. After PCT was included, NEWS2 improved overall model fit (p = 0.029) and produced an additional increase in AUC (ΔAUC 0.007; p = 0.448). Conclusions: Admission PCT and NEWS2 were independently associated with positive upper urinary tract culture The combined model showed good discrimination, although external validation is required before clinical application. Urinary nitrite positivity retained an independent association only in the exploratory cut-off-based analysis.

Background: Nephrolithiasis frequently coexists with type 2 diabetes, obesity, gout, chronic kidney disease, and other cardiometabolic disorders. Sodium–glucose cotransporter 2 (SGLT2) inhibitors may influence stone formation through effects on glucosuria, natriuresis, urine volume, urinary citrate, pH, urate handling, and relative supersaturation. This review aimed to examine the current mechanistic, biochemical, and clinical evidence linking SGLT2 inhibition to nephrolithiasis, with particular attention to its relevance for urological practice. Methods: A clinically oriented narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. The final search was performed on 1 July 2026. A total of 15 studies were included. Randomised trials, pooled and post hoc analyses, observational and comparative-effectiveness studies, meta-analyses, human mechanistic studies, and relevant experimental investigations were considered. Evidence was synthesised narratively according to biological mechanisms, urinary chemistry and relative supersaturation, randomised evidence, and observational clinical outcomes. Clinical stone events were analysed separately from surrogate urinary endpoints. Results: SGLT2 inhibition is associated with reproducible increases in urinary citrate and variable effects on urine volume, urinary pH, and the excretion of calcium, phosphate, and urate. Short-term mechanistic studies suggest reductions in calcium phosphate supersaturation and, in selected uric acid stone formers, uric acid supersaturation, whereas effects on calcium oxalate supersaturation remain inconsistent. Observational studies and secondary analyses of randomised trials generally indicate fewer nephrolithiasis events among SGLT2 inhibitor users; however, most outcomes were based on adverse-event reporting or administrative codes and lacked stone composition, standardised imaging, urinary phenotyping, and recurrence adjudication. Conclusions: SGLT2 inhibitors may favourably modify selected lithogenic pathways, but their effects appear phenotype-dependent and have not yet been shown to directly prevent stone recurrence. They should not be initiated solely for the prevention of nephrolithiasis. In patients with established cardiovascular, renal, or metabolic indications, their potential urinary effects may represent an additional benefit. Dedicated long-term randomised studies with stone-specific endpoints are required.

Introduction: Male infertility is a complex global health challenge, with emerging evidence suggesting that vitamin D plays a pivotal role in testicular function and spermatogenesis. This systematic review and meta-analysis aimed to evaluate the impact of vitamin D supplementation on semen parameters and reproductive hormones in infertile men. Methods: A comprehensive search of electronic databases (PubMed, Cochrane Library, and Web of Science) was conducted to identify randomized controlled trials (RCTs) investigating vitamin D supplementation in infertile males. Primary outcomes included Follicle-Stimulating Hormone (FSH), total testosterone, and Sex Hormone-Binding Globulin (SHBG). Secondary outcomes focused on semen quality, specifically volume, concentration, and motility. Data were pooled using fixed-effects or random-effects models based on heterogeneity (I²). Results: Analysis of six trials (n = 696) revealed that vitamin D supplementation significantly increased total testosterone levels compared to controls (SMD: 0.38; 95% CI: 0.13, 0.62; p = 0.002), with no statistical heterogeneity (I² = 0%). In contrast, no significant differences were observed for FSH (SMD: 0.01; 95% CI: −0.28, 0.29; p = 0.96) or SHBG (SMD: 0.95; 95% CI: −0.12, 2.02; p = 0.08). For semen parameters, supplementation was associated with notable improvements in sperm concentration and progressive motility, whereas semen volume remained largely unchanged across the included studies. High heterogeneity in SHBG results (I² = 91%) suggests that individual study characteristics, such as baseline vitamin D deficiency, may influence hormonal responses. Conclusions: Vitamin D supplementation selectively enhances endocrine function by increasing testosterone levels and improves functional semen parameters in infertile men. These findings support the use of vitamin D as a cost-effective adjuvant therapy, though its impact on definitive fertility outcomes, such as live birth rates, requires further large-scale clinical investigation.

Background: Urolithiasis is a common condition characterized by a high risk of recurrence, although this risk varies substantially between patients. The present study aimed to quantify incidence, identify determinants, and model recurrence risk between stone composition and recurrence, and to assess the role of selected clinical and behavioral factors in a cohort of patients with confirmed stone clearance. Methods: This retrospective cohort study included adult patients with urolithiasis managed between 2017 and 2021 in a specialized referral center. Only patients with confirmed stone-free status and available follow-up were included. Stone composition was determined using morpho-spectroscopic analysis. Clinical and behavioral variables were collected from medical records. Recurrence was defined as a new stone event during follow-up. Time-to-event analysis was performed using Kaplan–Meier estimates and Cox proportional hazards models. Results: A total of 962 patients were included, with a median follow-up of over three years. During this period, recurrence occurred in approximately one-third of patients. Uric acid stones were associated with a higher risk of recurrence compared with calcium oxalate monohydrate stones, while the effect size was moderate. Previous stone history and low fluid intake were also independently associated with recurrence. Other dietary variables did not retain statistical significance after adjustment. Conclusions: Recurrence in urolithiasis appears to reflect the combined effect of compositional, clinical, and behavioral factors. While certain variables are associated with increased risk, no single determinant fully explains recurrence patterns. These findings support a more individualized approach to risk assessment and follow-up.

Background: Prostate-specific antigen (PSA) remains the primary biomarker for prostate cancer detection; however, its limited specificity leads to unnecessary biopsies. Systemic inflammatory indices derived from routine blood tests have been proposed as potential adjunctive diagnostic tools. This study aimed to evaluate the diagnostic performance of these indices in patients undergoing prostate biopsy for suspected prostate cancer. Methods: A retrospective observational study was conducted, including 307 patients who underwent transrectal ultrasound-guided prostate biopsy for elevated PSA between January 2021 and January 2023. Patients were classified as benign prostatic hyperplasia (BPH) or prostate cancer (PCa) based on histopathological findings. Inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), systemic immune–inflammation index (SII), Systemic Inflammation Response Index (SIRI), and aggregate index of systemic inflammation (AISI), were calculated. Logistic regression and receiver operating characteristic (ROC) analyses were performed to assess diagnostic performance. Results: PCa was diagnosed in 65.1% of patients. Several inflammatory indices were significantly higher in the PCa group. Among them, AISI showed diagnostic performance comparable to PSA. The integration of inflammatory indices into multivariable models improved predictive accuracy, with the combined model demonstrating the highest discriminative ability. In contrast, these markers showed limited capacity in distinguishing tumour aggressiveness. Conclusions: Systemic inflammatory indices are associated with prostate cancer presence and may enhance diagnostic performance when used alongside PSA. However, their role remains complementary, as they provide limited value in risk stratification and should not be considered standalone diagnostic tools.

Background: Renal abscesses represent a serious complication of urinary tract infections, with management decisions often being guided by abscess size and clinical parameters. However, there is no universally accepted size threshold for intervention, and the role of inflammatory markers such as white blood cell count (WBC) and C-reactive protein (CRP) in guiding treatment remains uncertain. We aimed to evaluate the relationship between abscess size, inflammatory markers, and the need for drainage in patients with renal abscesses treated in a tertiary urology clinic. Methods: A retrospective analysis was conducted on 103 adult patients diagnosed with renal abscesses between 2020 and 2025. Patients were categorized into two groups based on abscess size: Group A (Escherichia coli (38.3%) and Klebsiella spp. (21.7%). Antibiotic resistance was highest to ampicillin (79.5%), while amikacin (5.8%) and piperacillin/tazobactam (6.2%) showed the lowest resistance rates. Conservative antibiotic therapy was effective in 43 patients (42.7%), whereas 60 patients (58.3%) required percutaneous drainage. Abscess size was associated with invasive intervention, with 88.1% of drained abscesses measuring ≥50 mm compared to 9.1% in the conservatively managed group (p < 0.001). Patients with larger abscesses had significantly lower haemoglobin levels (p = 0.003), while no significant differences were observed in WBC or CRP levels. Conclusions: Abscess size was associated with the need for drainage, supporting its role in clinical decision-making. In contrast, inflammatory markers such as WBC and CRP showed limited value in predicting the need for intervention in this cohort. These findings should be interpreted in the context of the retrospective design.

The objective of this study was to identify clinical, metabolic, and compositional factors associated with stone recurrence, using morpho-spectroscopic stone analysis combined with biochemical and dietary assessment. Materials and methods: We retrospectively analyzed 1,380 patients with urinary lithiasis evaluated at the Michel Daudon Morphological and Spectroscopic Analysis Center, Iași, Romania, between 2018 and 2022. Patients were divided into first-episode (n=842) and recurrent (n=538) groups. Demographic data, metabolic profile, dietary habits, and stone composition were assessed. Multivariable logistic regression was used to identify independent predictors of recurrence. Results: Recurrent patients accounted for 39.1% of the cohort and were significantly older. Calcium oxalate monohydrate and dihydrate stones predominated in first episodes, whereas uric acid, urate-mixed, and struvite calculi were more frequent in recurrent cases. Obesity, hyperuricemia, hypertension, type 2 diabetes, and chronic kidney disease were significantly more prevalent among recurrent stone formers. Dietary assessment showed that low fruit and vegetable intake and high sodium consumption were strongly associated with recurrence. Logistic regression identified hyperuricemia (OR=2.3), obesity (OR=1.9), hypertension (OR=1.5), and chronic kidney disease (OR=1.6) as independent predictors. Conclusions: Stone recurrence is characterized by a distinct clinical and metabolic profile, compositional shifts toward uric acid and struvite calculi, and unfavorable dietary habits. These findings confirm the systemic nature of lithiasis and support the integration of morpho-spectroscopic, metabolic, and nutritional evaluation into standard urological practice.

Male infertility represents a major clinical and societal issue, with azoospermia being one of its most severe forms. Anti-Müllerian Hormone (AMH) has been proposed as a potential biomarker for predicting testicular sperm extraction (TESE) outcomes in men with non-obstructive azoospermia (NOA). This study aimed to systematically evaluate the association between AMH levels and sperm retrieval success. We included studies on men with NOA reporting TESE outcomes by AMH level, excluding those without full text or with insufficient data. When cohorts overlapped, the most complete study was used, following PICO criteria focused on AMH measurements and sperm retrieval rates (SRR). A comprehensive search identified 133 potentially relevant publications. Of these, 11 studies published between 2006 and 2023, including 1280 patients, met the inclusion criteria. Pooled analyses were performed using random-effects models. This meta-analysis was recorded in the PROSPERO database (registration ID: CRD420251065256). Reported SRRs ranged from 30.35% to 76.27%. Meta-analysis of nine studies assessing serum AMH concentrations revealed significant heterogeneity (I² = 88%). Elevated serum AMH was negatively associated with SRR (standardized mean difference [SMD] = −2.58; 95% CI: −4.73 to −0.44; p < 0.00001). In contrast, seminal plasma AMH levels (two studies) showed no significant association with SRR (I² = 82%). Similarly, preoperative FSH levels (nine studies) did not demonstrate a consistent association with SRR, despite higher mean concentrations in patients with successful TESE (p = 0.02; SMD = −4.86; 95% CI: −9.07 to −0.66). Serum AMH levels are significantly associated with TESE outcomes in men with NOA. However, the predictive value of AMH and other hormonal markers is limited by high inter-individual variability and overlapping values between successful and unsuccessful cases. These findings underscore the complexity of NOA and highlight the need to interpret hormonal markers within a broader clinical and biochemical context.

Background: Traditional tumor markers used in testicular cancer diagnosis, such as alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH), present limitations due to variable expression across tumor subtypes. Inflammatory markers derived from complete blood count (CBC), along with C-reactive protein (CRP), have emerged as potential adjuncts for diagnosis and prognosis. This study aimed to evaluate the diagnostic and prognostic utility of CBC-derived inflammatory indices and CRP in patients with testicular cancer. Methods: We retrospectively analyzed testicular cancer patients, assessing baseline CBC parameters, inflammatory ratios (including neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII]), and CRP levels. Their diagnostic accuracy was compared with classical tumor markers, while prognostic implications were assessed through survival outcomes and disease progression. Results: Inflammatory markers, particularly NLR and SII, demonstrated significant associations with tumor burden and advanced disease stage. Elevated CRP levels correlated with poorer prognostic features and worse outcomes. While classical tumor markers remained essential in diagnosis and staging, the integration of inflammatory indices provided additional discriminatory power, especially in patients with normal or equivocal AFP and hCG values. Conclusions: CBC-derived inflammatory markers and CRP represent promising, cost-effective, and easily accessible tools that complement classical tumor markers in testicular cancer. They offer both diagnostic and prognostic value, particularly in cases where traditional biomarkers are insufficient. Prospective multicenter studies are warranted to validate these findings and incorporate inflammatory indices into routine clinical algorithms for testicular cancer management.

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent condition characterized by pelvic pain and urinary symptoms with multifactorial aetiology. Standard treatments, including alpha-blockers, often have limited long-term effectiveness. This study aimed to evaluate the efficacy and safety of a standardized pollen extract (Deprox^® 500), alone or in combination with alpha-blockers, in reducing CP/CPPS symptoms and the need for rescue medication. Methods: This prospective, multicentre study included 207 male patients with CP/CPPS treated at two Romanian urology centres between January 2023 and January 2025. Patients were divided into three groups: Group A—alpha-blocker monotherapy; Group B—standardized pollen extract monotherapy; and Group C—combination therapy with standardized pollen extract and alpha-blocker. Symptom severity and treatment response were evaluated using the validated English versions of the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), and International Index of Erectile Function-5 (IIEF-5), all of which were translated into Romanian for use in this study. Results: Groups B and C both demonstrated significantly greater reductions in pelvic pain and urinary symptoms compared to Group A (p = 0.01), with marked improvements in NIH-CPSI and IPSS. Conclusions: A standardized pollen extract used alone or in combination with an alpha-blocker significantly improved CP/CPPS symptoms and reduced the need for NSAID rescue medication. These findings support its potential as a safe and effective therapeutic option.