INTRODUCTION:Post-prostatectomy stress urinary incontinence (SUI) significantly impairs patients' quality of life. While the artificial urinary sphincter (AUS) is considered the gold standard for managing severe SUI, a subset of patients is not suitable for this intervention. This study aimed to evaluate the clinical outcomes of patients who received an adjustable transobturator male system (ATOMS) as an alternative to AUS for the treatment of SUI. METHODS:In this single-center retrospective study, we included 25 patients who received ATOMS implantation for post-prostatectomy SUI, despite being technically eligible for AUS based on incontinence severity and pelvic floor status. Primary outcomes included pad usage, continence rates, complications, and patient-reported satisfaction. A cross-sectional follow-up was conducted in using standardized questionnaires. RESULTS:Median age was 74.0 years; 60% of patients had undergone pelvic radiotherapy. Preoperative median pad usage was 6.0/day, reduced to 3.0/day postoperatively. Social continence (≤1 pad/day) was achieved in 16%, and ≥50% reduction in pad usage in 76% of patients. Complications were mostly minor. Cross-sectional follow-up data were available for 60% of patients at a median of 42 months. Patient satisfaction was high (73.3%), and 80% would recommend the procedure. According to the PGI score, 73.3% reported "very much" or "much improved" outcomes. CONCLUSION:ATOMS represents a feasible and safe treatment alternative for patients with severe SUI who are unable or unwilling to undergo AUS implantation. Despite suboptimal continence outcomes compared to AUS, high satisfaction and acceptable complication rates support its use in appropriately selected patients.
BACKGROUND:TURP and TURBT are among the most frequently performed urological procedures; laser alternatives such as HoLEP are increasingly adopted. Patients are routinely advised to restrict postoperative activity, yet recommendations conflate immediate mobilization (hours to days) with medium-term convalescence restrictions (weeks). OBJECTIVE:To map the evidence linking postoperative activity to complications and recovery after TURP, TURBT, and laser-based transurethral procedures. METHODS:PRISMA-ScR scoping review. PubMed, Scopus, Embase and ClinicalTrials.gov were searched (1 June 2026); a supplementary PubMed search (July 2026) targeted UTI, orchitis/epididymitis, anticoagulation, and frailty. Records were screened by title/abstract and charted descriptively. RESULTS:Of 263 records, 31 were charted (5 directly relevant, 26 contextual); the supplementary search added 10 contextual sources. No trial compared activity restriction with early mobilization using surgical complication endpoints. No data linked activity level to UTI or orchitis/epididymitis after transurethral resection. ERAS studies incorporating early mobilization showed improved or unchanged recovery without increased complications. All direct evidence addresses the immediate postoperative phase; no study examined medium-term convalescence restrictions. Frailty, comorbidities, and anticoagulation are relevant risk modifiers but unstudied in relation to activity. CONCLUSIONS:Direct evidence on postoperative activity after transurethral resection is absent; ERAS data support early mobilization within multimodal bundles. Future research should separate immediate mobilization from convalescence, include infectious endpoints, and incorporate patient-level factors such as frailty and anticoagulation.
OBJECTIVE:To compare the safety and efficacy of endoscopy-assisted supine percutaneous nephrolithotomy (ePNL) with standard supine percutaneous nephrolithotomy (sPNL). MATERIALS AND METHODS:This study included patients aged over 18 with a stone size of ≥2 cm, an American Association of Anesthesiology score of ≤3, and a body mass index of ≤35 who underwent ePNL or sPNL at our hospital between February 2021 and August 2021. Eligible patients, selected based on inclusion and exclusion criteria, were randomized using a computer-generated random table. Perioperative and postoperative data were compared between the two groups. RESULTS:A total of 60 patients were included in the study. Demographic data and stone characteristics were similar between the groups. The access fluoroscopy time (AFT) was comparable between the groups; however, the total fluoroscopy time (TFT) was significantly shorter in the ePNL group (31.5 seconds vs. 197.5 seconds, p<0.0001). The amount of bleeding, assessed by hemoglobin drop, was higher in the sPNL group (p=0.038). The success rate of guidewire placement into the ureter after access was higher in the supine ePNL group compared to the sPNL group (66.6% vs. 36.6%, p=0.038). There was no statistically significant difference in overall complication rates between the groups (p=0.272). Stone-free rates were 86.6% for ePNL and 80% for sPNL (p=0.488). CONCLUSION:The ePNL method is a safe and effective technique characterized by less bleeding, shorter fluoroscopy time, and successful guidewire placement into the ureter, with similar success and complication rates to sPNL.
INTRODUCTION:The assessment of neurogenic lower urinary tract dysfunction (NLUTD) should include objective and quality of life (QoL) measures, considering sex and gender differences. Thus, we investigated the sex-specific impact of NLUTD on QoL. METHODS:We evaluated consecutive outpatients with chronic NLUTD, who had completed the Short Form (SF-)Qualiveen questionnaire between 09/2024 and 01/2026 at a specialized spinal cord injury center, in a cross-sectional study. Patient characteristics and urodynamic parameters were retrieved from patient charts. Treatment success and risk for renal damage were determined based on urodynamic data. The effects of sex, age, bladder evacuation method, urinary incontinence, urinary tract infections and treatment success on SF-Qualiveen overall and domain scores were analyzed. RESULTS:Data of 113 patients (48 females, 65 males) were analyzed. Mean age was 60.6±12.9 years in females and 61.2±12.4 years in males. Mean NLUTD duration was 21.8±15.1 years in females and 22.1±16.9 years in males. In most patients, NLUTD treatment was successful (77.0%), and no risk for renal damage was present (89.4%). The median overall SF-Qualiveen score was 1.125 (0.625 / 1.844). There were no significant (p>0.11) differences between the sexes in the different QoL scores. Only urinary incontinence had a significant (p=0.04) effect on QoL scores. Patients with urinary incontinence had a significantly (p=0.01) greater overall QoL score (median 1.75, 1.125 / 2.125) compared to those without incontinence (median 1.0, 0.625 / 1.5). CONCLUSION:In patients with adequately treated NLUTD, there were no sex-specific differences in QoL. However, urinary incontinence had a negative impact on QoL.
PURPOSE:The prognostic value of the PSA ELIMination rate constant K (KELIM PSA) score was investigated in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with docetaxel in combination with ADT. METHODS:This multicenter retrospective study included 105 patients diagnosed with prostate adenocarcinoma who received first line docetaxel in combination with ADT for mCSPC. The KELIM score was calculated using PSA kinetics modeled with a nonlinear mixed-effects model. Patients with KELIM PSA<1 were categorized as unfavorable, whereas those with KELIM PSA≥1 were considered favorable. RESULTS:A total of 105 patients were included in the study. There were 53 and 52 patients in the favorable KELIM PSA and unfavorable KELIM PSA groups, respectively. Favorable KELIM PSA patients having a median OS of 44 months compared to 24 months for those with unfavorable KELIM PSA. One-, three-, and five-year OS rates were higher in the favorable KELIM PSA group. In the univariate analysis, ECOG≥2, older age, liver metastasis, and unfavorable KELIM score were associated with worse OS. However, in the multivariable analysis, only definitive treatment and advanced age remained independent prognostic factors for OS. CONCLUSION:The KELIM PSA score may serve as a simple, effective, and inexpensive prognostic tool for assessing early treatment responses and predicting disease progression in patients with mCSPC treated with docetaxel.
INTRODUCTION:Gleason score 6 prostate cancer is generally considered a low-risk disease; however, pathological upgrading after radical prostatectomy remains frequent and clinically relevant. Reliable preoperative predictors are needed to improve risk stratification and treatment decision-making, particularly in populations with limited access to advanced imaging. METHODS:We retrospectively analyzed 338 patients with biopsy-confirmed Gleason score 6 prostate adenocarcinoma who underwent radical prostatectomy between 2013 and 2025 at a tertiary referral center in Turkey. Clinical, biopsy, and imaging variables were assessed. Independent predictors of upgrading were identified using multivariable logistic regression analysis, and model performance was evaluated using receiver operating characteristic curve analysis. RESULTS:Gleason score upgrading occurred in 193 patients (57.1%). Patients with upgrading had significantly higher prostate-specific antigen (PSA) levels, higher PSA density values, and smaller prostate volumes (all p < 0.05). Adverse pathological features, including extracapsular extension, seminal vesicle invasion, and positive surgical margins, were more frequent in the upgraded group (all p < 0.01). PSA density (OR 40.07 per 1 unit increase, p = 0.001) and age (OR 1.05 per 1 year increase, p = 0.016) were identified as independent predictors of upgrading. A PSA density cut-off value of 0.125 yielded a sensitivity of 69.9% and a specificity of 48.3% (area under the curve = 0.622). CONCLUSION:Gleason score upgrading is common among patients with biopsy Gleason 6 prostate cancer. PSA density and age were independently associated with pathological upgrading, whereas traditional biopsy tumor burden parameters appeared to have limited predictive value. Although a PSA density threshold of 0.125 demonstrated only modest discriminative ability, PSA density may provide additional information as an adjunct to preoperative risk assessment among surgically treated patients.
OBJECTIVE:Non-obstructive azoospermia (NOA) primarily due to impaired spermatogenesis. Microdissection testicular sperm extraction (mTESE) is the gold standard for sperm retrieval in NOA patients. We compared sperm retrieval rates (SRR), operative time, and postoperative outcomes between classic transverse incision microTESE (CTI) and modified mini-incision microTESE (MMI). METHODS:In this retrospective study, 59 men with NOA underwent either CTI (n=33) or MMI (n=26) between 2021 and 2024. Preoperative and postoperative parameters, including SRR, operative time, complications, testosterone levels, testicular volume, and histopathology, were analyzed. Statistical analyses were performed using IBM SPSS Statistics version 21. RESULTS:SRR was 34.6% in MMI and 39.4% in CTI (p=0.706). Operative time (46.5 ± 7.9 min vs. 64.7 ± 14.5 min, p=0.001) and postoperative pain scores (VAS 2.9 ± 0.7 vs. 4.4 ± 0.5, p=0.001) were significantly lower in MMI. No complications were observed. Histology revealed Sertoli cell-only syndrome in 14 and 19 patients in MMI and CTI groups, respectively; the remainder had maturation arrest or hypospermatogenesis. No complications such as infection, sperm granuloma, or androgen deficiency were observed in either group. CONCLUSION:SRR was comparable between techniques. MMI was associated with shorter operative times and reduced postoperative discomfort.
INTRODUCTION:Robot-assisted radical prostatectomy (RARP) is one of the main options for the surgical treatment of localized prostate cancer. Following the standardization and establishment of the procedure as a routine surgical approach, formal training curricula were introduced to provide structured education for future console surgeons. However, a considerable number of surgeons continue to be trained outside of these standardized programs. This study aimed to compare the perioperative, postoperative, histopathological, and early functional outcomes of two surgeons who underwent different types of training: curriculum-based training (CC) versus non-curriculum-based (hybrid) training (non-CC). MATERIALS AND METHODS:We performed a retrospective analysis of the surgical outcomes of two surgeons trained through different pathways in two separate centers. One surgeon completed formal curriculum-based training in accordance with the EAU/ERUS guidelines for the standardized modular training for RARP, while the other followed a hybrid, non-curricular training model. We evaluated key outcome parameters through a multivariable regression analysis adjusted for age, T-status, and prostate volume. RESULTS:A total of 83 patients were included, with 47 operated by the CC surgeon and 36 by the non-CC surgeon. Baseline characteristics were comparable between groups, except for higher initial PSA levels in the non-CC group (p = 0.023) and a more favorable Gleason score distribution in the CC group (p = 0.005). In the multivariate analysis, the CC group showed a significantly shorter hospital stay (median 6 versus 8 days, p < 0.001) and superior early postoperative continence (81% versus 56%, p = 0.02). Positive surgical margins were significantly less frequent in the CC group (4.3% versus 33%, p = 0.03). No significant differences were observed in estimated blood loss, transfusion rates, or major complications. Three-month continence outcomes were similar between groups. CONCLUSION:A curriculum-based surgical training pathway can lead to improved outcomes for patients undergoing RARP. Standardized surgical education should serve as the foundation for training in the field of robot-assisted surgery. Further studies are needed due to selection bias and temporal asymmetry of the cohorts of this study.
INTRODUCTION:Holmium laser enucleation of the prostate (HoLEP) is an effective surgical method for the treatment of benign prostatic obstruction. Although transurethral resection syndrome is classically associated with hypotonic irrigation fluids, complications due to fluid absorption can also occur during HoLEP when isotonic saline is used. CASE PRESENTATIONS:We present 3 patients with large-volume benign prostatic hyperplasia (prostate volumes 113-191 mL) who developed a clinical picture mimicking bladder perforation after HoLEP. All patients developed intraoperative abdominal distension, respiratory distress, and hypoxemia. Cystoscopic and radiological evaluations excluded bladder perforation. Blood gas analysis showed hyperchloremic metabolic acidosis in all cases (pH 7.01-7.22; Cl 117-122 mmol/L). Operative times ranged from 130 to 262 min and irrigation volumes from 48 to 56 L. After supportive treatment with diuretics and ventilatory support, clinical and biochemical stabilization was achieved within 6 h. Hospital stay ranged from 5 to 10 days; no mortality occurred. CONCLUSION:Despite the use of isotonic saline, prolonged HoLEP procedures with high irrigation volumes can cause significant fluid absorption leading to hyperchloremic metabolic acidosis, abdominal distension, and pulmonary edema that can mimic bladder perforation. Awareness of this complication is essential for both surgeons and anesthesiologists managing patients undergoing high-volume HoLEP.
Acute and chronic epididymitis frequently presents with significant morbidity due to severe pain and inflammation. Standard management includes antibiotics and analgesics, yet persistent symptoms and complications often occur, sometimes leading to orchiectomy. Low-intensity extracorporeal shockwave therapy (LiESWT), proven effective in reducing inflammation and promoting tissue repair in various urological conditions, was evaluated as an adjunct treatment for epididymitis. Eleven men with ultrasound-confirmed acute or chronic epididymitis were treated with adjunct Li-ESWT in addition to guideline-based antibiotic therapy. All patients demonstrated rapid improvement of symptoms, including significant pain reduction and normalization of inflammatory markers, with no adverse events observed. LiESWT was well-tolerated, and analgesic requirements appeared reduced compared with typical clinical courses. Initial clinical experience suggests that LiESWT may represent a promising, safe, and effective adjunct treatment option for acute and chronic epididymitis, with the potential to enhance recovery and reduce symptom burden. A randomized, multicenter trial is planned to further evaluate its efficacy.
INTRODUCTION:Delayed graft function (DGF) is a frequent early complication after kidney transplantation. We systematically reviewed artificial intelligence and machine learning (AI/ML) models that use routine clinical variables to predict DGF. METHODS:This PROSPERO-registered review (CRD420261400263) followed PRISMA guidance. MEDLINE/PubMed, Embase, Web of Science Core Collection and Cochrane Library were searched for human studies, without date restriction. Studies that developed or validated AI/ML models for DGF prediction using routine donor, recipient, immunological, laboratory, ischaemia-time, transplant-process or perioperative variables were eligible. Results were synthesised narratively. Quality was assessed using PROBAST+AI and STREAM-URO. RESULTS:Of 613 records, 12 studies were included. Most were retrospective deceased-donor cohorts and three used national registries. DGF incidence varied widely (12.5-56.8%). Algorithms included neural networks, logistic and penalised regression, support vector machines, random forests, gradient boosting and stacked ensembles. Reported areas under the receiver operating characteristic curve (AUCs) ranged from 0.67 to 0.99. Recurrent predictors included donor renal-function measures, donor age and body mass index, donation after circulatory death, ischaemia time, recipient body size, dialysis exposure and human leukocyte antigen matching. Calibration, decision-curve analysis and external validation were uncommon. PROBAST+AI indicated high overall risk of bias in eight studies. CONCLUSIONS:AI/ML models show promise for DGF prediction, but their incremental benefit over conventional regression remains inconsistent. Heterogeneity across transplant eras, limited model transparency, inadequate assessment of calibration and clinical utility, and the lack of robust external validation must be addressed before these models can be implemented routinely in clinical practice.
INTRODUCTION:Acute bacterial prostatitis (ABP) is a common complication in men with lower urinary tract symptoms (LUTS). While antibiotics are the mainstay of treatment, the choice between transurethral (TC) and suprapubic (SC) catheterization remains debated. This study aimed to identify factors influencing catheterization choice and its impact on clinical outcomes. METHODS:We retrospectively analyzed 255 patients presenting with ABP between 01/2015 and 12/2024. Clinical- and infection-related parameters, including prostate volume, post-void residual urine (PVR), CRP levels, and presence of prostatic abscess, were assessed for associations with catheter type. We further evaluated these factors and catheterization approach regarding hospital stay, need for subsequent subvesical de-obstruction, and 30-day readmission rates. RESULTS:Median age was 64 years, median prostate volume 52 cc. Most patients received SC (64.3%). PVR was less frequent in the TC group (21.8% vs. 34.6%, p=0.042), while high CRP was more common (68.1% vs. 54.9%, p=0.039). Prostatic abscesses occurred more often in SC patients (8.6% vs. 3.4%, p=0.119). Median hospital stay was comparable (5 days, respectively, p=0.676). TC patients had lower 30-day readmission rates (1.1% vs. 6.8%, p=0.045), whereas SC patients more frequently required subvesical de-obstruction during follow-up through 12/2024 (21.3% vs. 11.0%, p=0.038). CONCLUSION:SC was preferred in patients with high PVR and abscesses. TC was associated with fewer readmissions, whereas SC patients more often required subsequent subvesical de-obstruction. These findings highlight the need for prospective studies to optimize catheterization strategies in ABP.
Objective: To evaluate the incidence, clinicopathological characteristics, and impact on overall survival (OS) of incidental prostate cancer (iPCa) detected in patients undergoing radical cystoprostatectomy (RCP) for bladder cancer. Materials and Methods: We retrospectively analyzed data from 395 male patients who underwent RCP for urothelial carcinoma between January 2009 and January 2022. Patients with a preoperative diagnosis of prostate cancer were excluded. iPCa was classified as clinically significant (csPCa) based on Gleason score ≥7, stage ≥pT3a, or positive surgical margins. Survival outcomes were evaluated using Kaplan-Meier methods and Multivariable Cox regression analysis to identify independent predictors of mortality. Results: Incidental prostate cancer was detected in 136 patients (34.4%). Patients with iPCa were significantly older than those without (median 66 vs. 63 years, p=0.026). The majority of tumors were organ-confined (96.3%) and clinically insignificant (80.1%). Apical tumor involvement was observed in 19.1% of cases. In univariate analysis, the presence of iPCa was associated with worse OS (median 965 vs. 1821 days, p=0.008). However, in multivariable analysis adjusting for age and tumor characteristics, iPCa was not an independent predictor of survival (HR: 1.295, p=0.077). The primary independent risk factors for mortality were advanced age, lymph node positivity, and muscle-invasive bladder cancer. Conclusion: Incidental prostate cancer is a frequent finding during radical cystoprostatectomy but is predominantly clinically insignificant and does not independently compromise overall survival. The observed survival difference in univariate analysis is primarily driven by advanced patient age rather than the prostatic malignancy itself. Management should remain conservative for low-risk cases. However, the detection of apical involvement in nearly 20% of cases warrants caution regarding prostate-sparing cystectomy techniques.
OBJECTIVES:To analyze the type and frequency druggable mutations in patients with progressive metastatic castration-resistant prostate cancer (mCRPC). PATIENTS AND METHODS:From 2018 to 2023, 311 patients with mCRPC underwent molecular panel analysis of archived prostatectomy samples (n=96) or CT-guided biopsies of progressive metastases (n=215).Mutation analysis was performed using NGS with an 18 multiplex PCR amplicon (AR, ATM, AURKA/MYC, BRCA1/2, CDK12, CTNNB1, DLL3, ETS family, FOXA1, FOXO1, MED12, PIK3CA, PTEN, RAD51C, TP53, Wnt-Pathway). Since 2023, we applied the TSO500 panel in selected cases. The HRD score was calculated by combining BRCA1 and BRCA2 mutations (Genomic ScarScore GSS) using the HANDLE HRD Focus Panel. The data were evaluated using the following thresholds: tumor cell content ≥ 30%, GScore positive at ≥ 50, HRD positive: GScore at ≥ 50 or BRCA1/2 category 4/5 mutation. MSI-high and mutations of MSH2, MSH6, PMS2, and MLH1 were analysed. The following databases were reviewed to identify druggable mutations: OncoKB, ClinVar, JAX-CKB, COSMIC, and My Cancer Genome. RESULTS:299/311 (96%) biopsies had sufficient DNA content for NGS. NGS was performed from prostate (31%), lymph node (30%), visceral (15%), and bone (24%) metastases with informative DNA retrival in 95%, 95%, 92%, and 85%, respectively. 157 patients (50.5%) had no or non druggable mutations, while 154 patients (49.5%) exhibited druggable mutations. HRD gene mutations and inactivating p53 mutations were observed in 66 patients (22%). 3 patients had p53 mutations with gain-of-function resulting in ATM inactivation. 50% of HRD gene mutations iwere pathogen and treated with PARPi resulting in a progression-free survival of 3-28 months. Activating AR mutations and inactivating PTEN/activating PIC3Ca mutations were found in 42 (14%) and 24 (8%) patients, respectively. Switch of treatment for AR mutation resulted in PFS of 6-9 months. Mismatch repair deficiency/MSI high mutations were identified in 3 cases who received pembrolizumab with a PFS of 4-8 months. CONCLUSIONS:NGS analysis in mCRPC reveals mutations in two-thirds of patients, of which 41% are already druggable. Only 50% of druggable mutations are based on BRCA1/2 or ATM. NGS analysis should be integrated into the diagnostic armentarium following failure of first-line systemic therapy for mCRPC.
INTRODUCTION:Anastomotic stricture following uretero-ileal conduit (IC) anastomosis remains a difficult clinical dilemma after radical cystectomy (RC), predisposing to upper urinary tract obstruction and renal impairment. We aimed to describe an altered nipple technique for uretero-IC anastomosis and determine its safety, efficacy, and anti-reflux effect compared with conventional techniques. METHODS:This was a single-institution retrospective series of 32 sequential patients with bladder cancer undergoing RC and IC urinary diversion with the modified nipple technique (July 2013-October 2023). All cases were performed in a tertiary academic center with adequate follow-up. RC was followed by creation of IC. The nipple valve technique was adapted, employing a trapezoidal incision and invagination to form a "nipple" anti-reflux structure at the anastomosis, to reduce stricture and maximize urine flow. Outcomes were incidence of uretero-ileal anastomotic stricture (UES), Clavien-Dindo graded perioperative complications, operating time, recovery parameters, and renal function followed up clinically and radiologically. RESULTS:Of 32 patients (31 male, 1 female), 17 underwent open RC, 14 underwent laparoscopic RC, and 1 underwent conversion to open RC. The mean follow-up was 70 ± 36 months (range: 12-110 months). Only 1 patient (3.1%) developed anastomotic stricture, successfully treated endoscopically, with no progression of hydronephrosis or clinically apparent deterioration of renal function. The overall 90-day rate of complications was 34.3%. Limitations include the retrospective single-center design, relatively small sample size, predominance of male patients, lack of standardized renal function assessment, and absence of predefined oncological outcome analyses. Therefore, the observed low incidence of UES should be interpreted with caution. CONCLUSIONS:The modified nipple technique appears to be a feasible and reproducible reconstructive option for uretero-ileal anastomosis during IC diversion. The favorable outcomes observed in this cohort warrant further validation in larger prospective multicenter studies.
BACKGROUND:To explore the predictive value of preoperative systemic inflammatory markers combined with clinical parameters for the improvement of lower urinary tract symptoms in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after surgery. METHOD:This study was a single-center observational cohort study that consecutively enrolled 180 patients with benign prostatic hyperplasia (BPH) who underwent transurethral prostate surgery. Data on preoperative inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune-inflammation index [SII], monocyte-to-lymphocyte ratio [MLR]), prostate-specific antigen (PSA), postvoid residual urine volume, etc., were collected. The primary outcome was poor symptom response at 6 months after surgery (IPSS improvement rate < 50%). Elastic net regression and the Boruta algorithm were used to screen variables, and a logistic regression model was constructed to identify independent predictors. A generalized additive model (GAM) was also applied to explore the nonlinear relationship between key variables and symptom improvement. RESULTS:Preoperative postvoid residual urine volume, MLR, and total PSA levels in the poor symptom response group were significantly higher than those in the good response group (P < 0.05). Multivariate logistic regression showed that preoperative postvoid residual urine volume (odds ratio [OR] = 1.32, 95% confidence interval [CI]: 1.11-1.57), total PSA (OR = 1.52, 95%CI: 1.08-2.13), and MLR (OR = 1.85, 95%CI: 1.28-2.67) were independent predictors of poor symptom response. GAM analysis further revealed a nonlinear association: when postvoid residual urine volume was greater than 90 mL, its negative impact on the improvement of postoperative storage symptoms was significantly intensified; the negative effects tended to ease after MLR > 0.25. The predictive effect of MLR was specific for the improvement of storage symptoms. CONCLUSIONS:Preoperative MLR, postvoid residual urine volume, and PSA level are independent factors for predicting the improvement of postoperative symptoms in patients patients with BPO.. Among them, MLR, as a biomarker reflecting the state of chronic inflammation, has specific predictive value for the improvement of storage symptoms. These preoperative parameters are helpful in identifying high-risk patients with poor postoperative symptom improvement and provide references for individualized clinical decision-making.
OBJECTIVE:This study compared the efficacy of three combined treatment regimens (biofeedback electrical stimulation [BES] combined with pelvic floor muscle training [PFMT], acupuncture combined with PFMT, and a triple therapy regimen of acupuncture, BES, and PFMT) in addressing urinary incontinence (UI) and sexual dysfunction in patients with postpartum pelvic floor dysfunction (PFD), with the aim of exploring the clinical advantages of the triple therapy regimen. METHODS:This study was designed as a randomized controlled trial, with blinding applied to both the evaluators and the data analysts. A total of 203 postpartum women with PFD were enrolled and randomly assigned to Group A (BES+ PFMT, n = 65), Group B (acupuncture + PFMT, n = 68), and Group C (acupuncture + BES + PFMT, n = 64). Pelvic floor EMG, muscle strength, MUCP, and MFR were measured at baseline and 6 months post-treatment. Leakage volume was assessed by 1-hour pad test. UI was evaluated using ICI-Q-SF and IIQ-7, and sexual function using FSFI and PISQ-31. Adverse events were recorded throughout treatment. RESULTS:All groups showed significant improvement in EMG, muscle strength, MUCP, MFR, FSFI, and PISQ-31 scores, alongside reductions in leakage volume, ICI-Q-SF, and IIQ-7 scores. Improvements were most significant in Group C. No significant difference was found between Groups A and B after treatment. Adverse event rates did not differ significantly among groups. CONCLUSION:Compared to dual-therapy approaches, triple-therapy (acupuncture + BES + PFMT) enhances postpartum pelvic floor rehabilitation, effectively improving UI and sexual function in patients with PFD.
INTRODUCTION:Active surveillance (AS) is the guideline-recommended management strategy for low-risk and favorable intermediate-risk prostate cancer (PCa). However, conventional risk stratification remains limited in predictive accuracy. Robust real-world evidence on the clinical utility of the cell cycle risk (CCR; Prolaris®) score within European healthcare settings is currently scarce. METHODS:We performed a retrospective single-center study of 60 localized PCa patients who underwent CCR testing at a tertiary academic urologic center between 2021 and 2025. We analyzed indications for testing, CCR treatment recommendations, and adherence rates using descriptive statistics. RESULTS:Median patient age was 62 years, and median prostate-specific antigen level was 5.76 ng/mL. Overall, 13.3% of biopsy cores were positive, and 93.3% of patients had a Gleason score of 6. CCR testing was performed after initial diagnosis in 61.7% of patients and during ongoing AS in 38.3%. Following CCR testing, definitive therapy was recommended in 21.7% of patients, with an adherence rate of 53.8%, whereas continued AS was recommended in 78.3% of patients, with an adherence rate of 87.2%. CONCLUSION:CCR testing demonstrated high adherence rates, particularly for AS recommendations in the real-world setting. These findings support Prolaris® as a complementary decision aid for AS patient selection and management.
INTRODUCTION:Recurrent urinary tract infections (rUTIs) are prevalent among women and substantially impair quality of life, underscoring the need for effective and safe preventive treatments. This study evaluated the efficacy, safety, and bacterial resistance rates of methenamine hippurate (MH) versus low-dose nitrofurantoin (NFT) for rUTI prevention in women. METHODS:We conducted a retrospective propensity score-matched cohort study involving female rUTI patients from our urology clinic between June 2021 and February 2024. After 1:1 matching, 50 patients each constituted the MH group and the low-dose NFT group. The treatment and follow-up period was 12 months, with assessments at 3, 6, and 12 months. A non-inferiority margin of Δ = 0.5 episodes per person-year was defined. The primary endpoint was the 12-month symptomatic UTI recurrence rate. Secondary outcomes included urine culture positivity, pathogen profile, antibiotic resistance, asymptomatic bacteriuria, IPSS, SF-36, direct costs, compliance, and adverse events. RESULTS:After propensity score matching, baseline characteristics were balanced. The 12-month recurrence rates were 18.00% for MH and 20.00% for NFT, confirming non-inferiority (p = 0.765). Urine culture positivity and pathogen profiles did not differ significantly. MH showed no detectable resistance versus 28.57% in NFT (p = 0.022) and lower asymptomatic bacteriuria (8.00% vs. 22.00%; p = 0.037). Compliance was similar. MH resulted in significantly improved IPSS and SF-36 scores (p < 0.001). Although drug costs were higher with MH, total management costs were lower (p < 0.001), with fewer adverse events (p < 0.05). CONCLUSION:MH demonstrates non-inferiority to low-dose NFT for preventing rUTIs in women, with reduced resistance, adverse events, and asymptomatic bacteriuria. Despite higher drug cost, its superior long-term benefit supports its use as an alternative in NFT-intolerant or high-risk patients.
