Background: Lifestyle and environmental factors can negatively impact fertility by means of oxidative stress. In this context, antioxidant supplementation therapy has gained much interest in recent years, and different molecules, alone or in combination, have been studied. Objective: The purpose of the present review is to investigate the evidence regarding the efficacy of coenzyme Q10 (CoQ10) and melatonin on male infertility. Methods: A literature search using PUBMED database from 2000 to October 2022 was performed to explore the role of CoQ10 and melatonin on male reproductive function. Conclusions: The analysis involved a narrative synthesis. CoQ10, alone or in combination, appears to reduce testicular oxidative stress and sperm DNA fragmentation and to improve sperm parameters; particularly sperm motility. Moreover, CoQ10 treatment is associated with higher pregnancy rates, both naturally and through assisted reproductive technology (ART). Larger studies are needed to precisely determine its clinical efficacy. Melatonin is a known antioxidant and preclinical studies have shown its ability to modulate reproductive function through hormonal and immune system regulation and sperm cell proliferation. Regardless, clinical studies are necessary to assess its potential in male infertility.

The overall survival (OS) improvement after the advent of several novel systemic therapies, designed for treatment of metastatic urothelial carcinoma of the urinary bladder (mUCUB), is not conclusively studied in either contemporary UCUB patients and/or non‐UCUB patients. Within the Surveillance, Epidemiology, and End Results database, contemporary (2017–2020) and historical (2000–2016) systemic therapy‐exposed metastatic UCUB and, subsequently, non‐UCUB patients were identified. Separate Kaplan–Meier and multivariable Cox regression (CRM) analyses first addressed OS in mUCUB and, subsequently, in metastatic non‐UCUB (mn‐UCUB). Of 3443 systemic therapy‐exposed patients, 2725 (79%) harbored mUCUB versus 709 (21%) harbored mn‐UCUB. Of 2725 mUCUB patients, 582 (21%) were contemporary (2017–2020) versus 2143 (79%) were historical (2000–2016). In mUCUB, median OS was 11 months in contemporary versus 8 months in historical patients (Δ = 3 months; p < .0001). After multivariable CRM, contemporary membership status (2017–2020) independently predicted lower overall mortality (OM; hazard ratio [HR] = 0.68, 95% confidence interval [CI] = 0.60–0.76; p < .001). Of 709 mn‐UCUB patients, 167 (24%) were contemporary (2017–2020) and 542 (76%) were historical (2000–2016). In mn‐UCUB, median OS was 8 months in contemporary versus 7 months in historical patients (Δ = 1 month; p = .034). After multivariable CRM, contemporary membership status (2017–2020) was associated with HR of 0.81 (95% CI = 0.66–1.01; p = .06). In conclusion, contemporary systemic therapy‐exposed metastatic patients exhibited better OS in UCUB. However, the magnitude of survival benefit was threefold higher in mUCUB and approximated the survival benefits recorded in prospective randomized trials of novel systemic therapies.

Background: To assess cancer-specific mortality (CSM) and other-cause mortality (OCM) rates in patients with rare histological prostate cancer subtypes. Methods: Using the Surveillance, Epidemiology, and End Results database (2004–2020), we applied smoothed cumulative incidence plots and competing risks regression (CRR) models. Results: Of 827,549 patients, 1510 (0.18%) harbored ductal, 952 (0.12%) neuroendocrine, 462 (0.06%) mucinous, and 95 (0.01%) signet ring cell carcinoma. In the localized stage, five-year CSM vs. OCM rates ranged from 2 vs. 10% in acinar and 3 vs. 8% in mucinous, to 55 vs. 19% in neuroendocrine carcinoma patients. In the locally advanced stage, five-year CSM vs. OCM rates ranged from 5 vs. 6% in acinar, to 14 vs. 16% in ductal, and to 71 vs. 15% in neuroendocrine carcinoma patients. In the metastatic stage, five-year CSM vs. OCM rates ranged from 49 vs. 15% in signet ring cell and 56 vs. 16% in mucinous, to 63 vs. 9% in ductal and 85 vs. 12% in neuroendocrine carcinoma. In multivariable CRR, localized neuroendocrine (HR 3.09), locally advanced neuroendocrine (HR 9.66), locally advanced ductal (HR 2.26), and finally metastatic neuroendocrine carcinoma patients (HR 3.57; all p < 0.001) exhibited higher CSM rates relative to acinar adenocarcinoma patients. Conclusions: Compared to acinar adenocarcinoma, patients with neuroendocrine carcinoma of all stages and locally advanced ductal carcinoma exhibit higher CSM rates. Conversely, CSM rates of mucinous and signet ring cell adenocarcinoma do not differ from those of acinar adenocarcinoma.

Achieving stone-free status (SFS) is a key goal of endourological treatment, yet definitions of SFS and clinically insignificant residual fragments (CIRF) remain controversial. While CIRF is frequently defined as residual fragments ≤4 mm, there is no consensus on its clinical significance regarding complications and re-intervention needs. We evaluate the risk of complications and the need for re-intervention associated with the presence of CIRF following endourological treatment for urolithiasis. PubMed/Medline, Scopus, Web Of Science, and Embase databases were searched for articles relating to SFS and CIRF definitions and outcomes, in February 2025, using keyword combinations: "stone-free rate," "residual fragments," "clinically insignificant residual fragments," "urinary calculi," "urolithiasis," "complications," and "outcome". Inclusion criteria were all studies with SFS/CIRF definition and complications associated with residual fragments following treatment (shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy). Fifty-two studies met inclusion criteria. From the pooled analysis the probability of spontaneous expulsion of CIRF≤4 mm was 33% (95% CI: 12-50%; P<0.001), while regrowth occurred in 32% (95% CI: 23-40%; P<0.001). CIRF-related complications were observed in 27% (95% CI: 21-34%; P<0.001), and the re-intervention rate was 21% (95% CI: 16-26%; P<0.001). Within a variable mean follow-up ranging from 3 to 59 months. The risk of bias was moderate overall, with single-arm studies exhibiting the highest bias risk. Patients with CIRF≤4 mm should be monitored closely and informed about the non-neglectable likelihood of complications and of re-intervention. On the other hand, they have one probability out of three of spontaneous passage. Endourologist and patients should be aware of these outcomes to better plan the management, follow-up, and the "insignificant" nature of residual fragments. Hence, the aim of surgeries should be achieving the complete SFS, especially in high-risk stone former patients.

Background: Scoring metrics to assess and compare outcomes of percutaneous nephrolithotomy (PCNL) are needed. We aim to evaluate prevalence and predictors of trifecta in a cohort of patients treated with vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) for kidney stones. Methods: Data from 287 participants who underwent vmPCNL were analysed. Patients’ and stones’ characteristics as well as operative data were collected. Stone-free was defined as no residual stones. The modified Clavien classification was used to score postoperative complications. Trifecta was defined as stone-free status without complications after a single session and no auxiliary procedures. Descriptive statistics and logistic regression models tested the association between predictors and trifecta outcome. Results: After vmPCNL, 219 (76.3%) patients were stone-free, and 81 (28.2%) had postoperative complications (any Clavien). Of 287, 170 (59.2%) patients achieved trifecta criteria. Patients who achieved trifecta status had smaller stone volume (p < 0.001), a higher rate of single stones (p < 0.001), shorter operative time (p < 0.01), and a higher rate of single percutaneous tract (p < 0.01) than −trifecta patients. Trifecta status decreased with the number of calyces involved, being 77.1%, 18.8%, and 4.1% in patients with 1, 2, or 3 calyces with stones, respectively (p < 0.001). Multivariable logistic regression analysis showed that stone volume (OR 1.1, p = 0.02) and multiple calyces being involved (OR 2.8 and OR 4.3 for two- and three-calyceal groups, respectively, all p < 0.01) were independent unfavourable risk factors for trifecta after accounting for age, BMI, gender, operative time, and number of access tracts. Conclusions: Trifecta status was achieved in 6 out of 10 patients after vmPCNL. Stone distribution in multiple calyceal groups and stone volume were independent unfavourable risk factors for trifecta.