PURPOSE:Neuroendocrine differentiation is a recognized phenotypic change in advanced prostate cancer. Neuroendocrine-like cells may lack androgen receptor or prostate-specific membrane antigen expression, potentially contributing to treatment resistance. This study evaluated octreotide scan positivity as a surrogate marker of neuroendocrine differentiation and its association with response to 177Lu-prostate-specific membrane antigen radioligand therapy in patients with metastatic castration-resistant prostate cancer. MATERIALS AND METHODS:Thirty-six patients with metastatic castration-resistant prostate cancer who were candidates for 177Lu-prostate-specific membrane antigen radioligand therapy were enrolled. Whole-body octreotide scintigraphy was performed after intravenous administration of 750 MBq of 99mTc-octreotide. Abnormal uptake was classified as mild, moderate, or severe relative to liver uptake. All patients subsequently received standard 177Lu-prostate-specific membrane antigen radioligand therapy and were followed for treatment response after at least two treatment cycles. RESULTS:Of the 36 enrolled patients, 8 who died within 2 months after the first treatment cycle were excluded from response assessment; therefore, 28 patients were included in the final response analysis. Among these 28 patients, 19 (67.9%) responded to treatment and 9 (32.1%) did not. Eight patients (28.6%) had negative octreotide scans, whereas 20 (71.4%) had positive scans, all showing mild uptake. Positive scans were observed in 13 of 19 responders (68.4%) and 7 of 9 non-responders (77.8%). No significant association was observed between octreotide scan positivity and treatment response (P = 1.00). CONCLUSION:Octreotide scan positivity was relatively common in patients with metastatic castration-resistant prostate cancer but was not significantly associated with response to 177Lu-prostate-specific membrane antigen radioligand therapy. Larger studies are needed to confirm these findings.
PURPOSE:Testicular torsion is an emergency, and its long-term effects on fertility, hormonal function, and sexual function remain uncertain. We aimed to evaluate the long-term effects of surgical treatment for testicular torsion on hormonal function, testicular ultrasonographic features, and erectile function. MATERIALS AND METHODS:This retrospective cohort study included patients surgically treated for testicular torsion at Labbafinejad Hospital, Tehran, Iran, from 2014 to 2022. Semen analysis and Doppler testicular ultrasonography were performed, and serum samples were collected to measure testosterone, follicle-stimulating hormone, and luteinizing hormone. Erectile function was assessed using the International Index of Erectile Function questionnaire. A P value less than 0.05 was considered statistically significant. RESULTS:Seventy-two patients were assessed. Fifty-four patients (75.0%) underwent orchiopexy, and 18 (25.0%) underwent orchiectomy. Patients in the orchiectomy group had higher luteinizing hormone (P < 0.001) and follicle-stimulating hormone (P = 0.009) levels and lower testosterone levels (P = 0.008), sperm counts (P < 0.001), progressive sperm motility (P = 0.002), and normal sperm morphology (P = 0.001) than patients who underwent orchiopexy. International Index of Erectile Function scores did not differ significantly between the groups (P = 0.730). In the orchiopexy group, 32 patients (59.3%) had small testes. CONCLUSION:Surgical treatment for testicular torsion affects hormonal and ultrasonographic testicular findings; however, it does not appear to have a remarkable effect on erectile function.
PURPOSE:To evaluate clinical, biochemical, and hematological parameters as predictors of prostate cancer (PCa) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 2 lesions. MATERIALS AND METHODS:A total of 955 patients underwent multiparametric magnetic resonance imaging (mpMRI) during the study period, of whom 268 had PI-RADS 2 lesions. Among these, 147 patients with histopathological diagnoses, including 122 benign and 25 malignant cases, were included. Clinical, biochemical, and hematological parameters were compared between groups using appropriate statistical tests. Receiver operating characteristic (ROC) curve analyses were performed to evaluate diagnostic performance. RESULTS:Prostate-specific antigen (PSA) density (P = .044), neutrophil count (P = .019), monocyte count (P = .021), neutrophil-to-platelet ratio (NPR; P = .016), and monocyte-to-platelet ratio (MPR; P = .019) differed significantly between the malignant and benign groups. Compared with the benign group, neutrophil count, monocyte count, NPR, and MPR were lower, whereas PSA density was higher in patients with PCa. ROC analyses demonstrated moderate discriminatory performance for PSA density (area under the curve [AUC], 0.654; 95% confidence interval [CI], 0.561-0.739; P = .007), monocyte count (AUC, 0.655; 95% CI, 0.546-0.754; P = .011), MPR (AUC, 0.657; 95% CI, 0.547-0.755; P = .037), neutrophil count (AUC, 0.635; 95% CI, 0.523-0.737; P = .046), and NPR (AUC, 0.644; 95% CI, 0.536-0.743; P = .055). CONCLUSION:PSA density demonstrated moderate discriminatory performance for detecting PCa in biopsied patients with PI-RADS 2 lesions. Although several hematological indices also showed moderate discriminatory performance, their clinical utility remains limited. Larger prospective studies are required to validate these findings before clinical implementation.
PURPOSE:Urinary incontinence (UI) is characterized by any involuntary loss of urine, resulting in significant hygiene, emotional, and social challenges. This systematic review and meta-analysis aimed to update the current understanding of the prevalence of UI and overactive bladder (OAB) among Iranian women. MATERIALS AND METHODS:We conducted an electronic search of PubMed, Embase, Scopus, Web of Science, Google Scholar, Medline, Cochrane, CINAHL, and Biosis from January 1990 to February 2026. Women aged 15 years and over living in Iran were targeted. A total of 23 cross-sectional studies encompassing 27,690 participants were included. Study quality was assessed using the Joanna Briggs Institute methodological guidance for systematic reviews of observational epidemiological studies. The I² index was used to estimate heterogeneity; the random-effects model was applied due to high heterogeneity. Publication bias was evaluated using Egger's test, and data analysis was performed using MedCalc software. RESULTS:The overall prevalence of UI was estimated at 39.98% (95% CI: 30.54-49.82). The most prevalent subtype was stress urinary incontinence (SUI) at 26.88% (95% CI: 20.00-34.37). OAB and urge urinary incontinence (UUI) affected 20.13% (95% CI: 15.70-24.95) and 17.09% (95% CI: 9.38-26.55) of women, respectively. Mixed urinary incontinence (MUI) followed, with a prevalence of 14.99% (95% CI: 6.62-25.98). CONCLUSION:Given the relatively high prevalence of UI and OAB among Iranian women, further research is needed to explore underlying factors and to develop effective prevention, management, and treatment strategies. A clearer understanding of the epidemiology of UI and OAB can support health policy planning and the development of responsive healthcare services.
PURPOSE:Increasing evidence suggests that gut microbiota are associated with the risk of kidney stone disease; however, whether a causal relationship exists remains unclear. We used Mendelian randomization to assess the potential causal relationship between gut microbiota and kidney stone disease risk. MATERIALS AND METHODS:Genetic instrumental variables for gut microbiota were identified from a genome-wide association study of 18,340 participants. Summary statistics for kidney stone disease were derived from genome-wide association studies, including 284,598 cases and 480,873 controls. The inverse-variance weighted method was used as the primary analysis. To test the robustness of the results, we further performed the weighted-median method, MR-Egger regression, and the MR pleiotropy residual sum and outlier test. Finally, reverse Mendelian randomization analysis was performed to evaluate the possibility of reverse causation. RESULTS:We identified suggestive associations between 4 bacterial traits and the risk of kidney stone disease: class Lentisphaeria (odds ratio: 0.82; 95% confidence interval: 0.69-0.98; P = .032), genus Oscillibacter (odds ratio: 0.79; 95% confidence interval: 0.66-0.96; P = .018), order Victivallales (odds ratio: 0.82; 95% confidence interval: 0.68-0.98; P = .034), and genus Olsenella (odds ratio: 1.26; 95% confidence interval: 1.03-1.53; P = .022). The results of sensitivity analyses for these bacterial traits were consistent. We did not find statistically significant associations between kidney stone disease and these 4 bacterial traits in the reverse analysis. CONCLUSION:This systematic analysis provides evidence supporting a potential causal relationship between 4 gut microbiota taxa and kidney stone disease risk. Further studies are needed to determine how gut microbiota influence kidney stone disease development.
Renal pelvis epidermoid cysts are extremely rare and are often misdiagnosed as stones or tumors. Only one previous case has been treated using the percutaneous approach. A 67-year-old female with diabetes who was receiving empagliflozin presented with imaging findings suggestive of a staghorn calculus. During percutaneous nephrolithotomy, whitish keratinous material was found in the renal pelvis, along with a small obstructing stone. All material was evacuated through the Amplatz sheath. Urine culture was negative. Histopathological examination confirmed an epidermoid cyst. A postoperative computed tomography scan at 1 month showed complete resolution. Epidermoid cysts can radiologically mimic staghorn calculi. A fungal ball was initially suspected because of diabetes and sodium-glucose cotransporter 2 inhibitor therapy, but radiopacity, negative culture, and histopathological findings ruled this out. Percutaneous nephrolithotomy served as both a diagnostic and therapeutic procedure while preserving renal function. Renal pelvis epidermoid cysts should be considered in the differential diagnosis of opaque pelvic lesions. Percutaneous nephrolithotomy is a minimally invasive, kidney-preserving treatment that can be performed as a renal-sparing procedure.
PURPOSE:Sexual dysfunction associated with psychological reasons is one of the factors impacting unfulfilled marriages. There are limited data on treatment outcomes in this context. The aim of this study was determining the treatment of unconsummated marriage in psychogenic erectile dysfunction in Iranian Couples. MATERIALS AND METHODS:A total of 66 cases were selected from individuals referred to the Family Health Clinic (from 2006 to 2019), who had unconsummated marriages and experienced psychogenic erectile dysfunction, meeting the inclusion criteria for the study. Research tools included couples' demographic information, face-to-face interviews, and the International Index of Erectile Function (IIEF). The treatment was based on couple's therapy. In the initial session, a comprehensive assessment of the couples' condition was conducted, and research instruments were completed. Additionally, during this session, the formation of psychogenic erectile dysfunction and the lack of successful foreplay were discussed. In subsequent sessions, desensitization, instruction on foreplay, and intercourse were addressed. Treatment success was defined as the ability to achieve complete vaginal penetration. Data was analyzed using SPSS 16 software. RESULTS:All 66 couples continued the treatment until they achieved successful vaginal penetration. All International Index of Erectile Function (IIEF) domains improved significantly after couple-based behavioral therapy in men with psychogenic erectile dysfunction in unconsummated marriages (all p < .001; large effect sizes for most domains). No significant associations were found between educational level, place of residence, engagement duration, or marriage duration and post-treatment scores (all p > 0.05). Male age correlated negatively with overall ED (r = -.314, P = .001), erectile function (r = -.361, P = .003), intercourse satisfaction (r = -.365, P = .003), and overall satisfaction (r = -.266, P = .031). Similar negative associations were observed for female age with overall ED (r = -.371, P = .002), erectile function (r = -.354, P = .004), intercourse satisfaction (r = -.344, P = .005), and overall satisfaction (r = -.246, P = .047). CONCLUSION:Psychogenic erectile dysfunction in unconsummated marriage can be addressed through couple-based therapy.
PURPOSE:To study the effect of body mass index (BMI) on 24-h urine quantitative analysis in pediatric urolithiasis, and to explore whether obesity and overweight promote the formation of urinary calculi in children. MATERIALS AND METHODS:A comprehensive search of EMBASE, PubMed, the Cochrane Library, Web of Science, and Scopus was conducted in March 2024 and updated in October 2025 to identify all related studies. BMI was used to specify body size. Predetermined inclusion and exclusion criteria were used to screen each article. Data from appropriate studies were extracted, and a meta-analysis was performed using Stata 14.0 software. RESULTS:Eight studies, including 1033 children with urolithiasis who underwent 24-h urine collection for chemical analysis, were included in this meta-analysis. The BMI ≥ 85th percentile group exhibited significantly higher uric acid excretion (SMD = 0.756, 95% CI = 0.092-1.420, P = .026). No statistically significant differences were found in calcium (SMD = -0.320, 95% CI = -0.600 to -0.050, P = .519), 24-h urine volume (SMD = -0.310, 95% CI = -0.790 to 0.160, P = .555), magnesium (SMD = -0.470, 95% CI = -0.820 to -0.120, P = .471), phosphate (SMD = -0.360, 95% CI = -0.610 to -0.110, P = .805), oxalate (SMD = -0.110, 95% CI = -0.390 to 0.170, P = .315), citrate (SMD = -0.190, 95% CI = -0.680 to 0.290, P = .057), or sodium (SMD = 0.200, 95% CI = -0.390 to 0.800, P = .050) excretion between the two groups. Sensitivity analyses confirmed the robustness of these findings. CONCLUSION:While overweight/obese children with urolithiasis demonstrate higher urinary uric acid excretion, the absence of significant differences in other key urinary risk factors suggests that BMI alone should not be considered a separate and definitive risk factor for pediatric urolithiasis.
PURPOSE:Acute kidney injury (AKI) is a common condition in hospitalized patients that can have a significant impact on outcomes, including an increase in overall complications and mortality rates. Criteria such as serum creatinine level, urinary output, and scoring systems such as KDIGO in acute conditions do not have acceptable specificity and sensitivity to evaluate kidney function. Therefore, this study was conducted to determine the relationship between plasma uric acid level and mortality rate in patients with sepsis and acute kidney failure. MATERIALS AND METHODS:In this descriptive-analytical (cross-sectional) study, 52 children aged from one month to 15 years with sepsis (based on qSOFA criteria) and acute kidney failure (based on serum creatinine level) admitted to the PICU of Ali Bin Abi Taleb Hospital from October 1401 to October 1402 were included and studied by the census method. Within 48 hours after admission to the ICU, blood samples were collected to check serum uric acid levels, electrolytes, albumin, complete blood count (CBC), kidney function tests, arterial blood gases, and chest x-rays. All patients were followed up until discharge or death due to progression of kidney failure. Finally, the findings of the research were analyzed using SPSS version 26 statistical software. RESULTS:The mean age of patients was 3.66 ± 4.92 years. The number of deaths in the hyperuricemia group was significantly higher than in the normal uric acid group (P = 0.03); an odds ratio of 3.45 indicates that a high level of uric acid is a risk factor for death. In this study, the duration of hospitalization was longer in those who survived (P = 0.02). A particularly strong predictor in our analysis was the qSOFA score (P < 0.001), highlighting its critical role in determining outcome. Serum uric acid level and qSOFA scale showed no significant difference overall (P = 0.76); subgroup analysis among surviving and deceased patients between uric acid and the qSOFA scale presented the same result (P = 0.203 and P = 0.29, respectively). CONCLUSION:The level of uric acid can be considered a laboratory variable to predict the prognosis of patients.
We conducted a retrospective cross-sectional analysis of 288 complaints filed against urologists between 2017 and 2023 at the Forensic Medicine Organization in Shemiranat, Tehran. The number of complaints increased steadily, peaking in 2023 (n = 66) and reaching a nadir in 2020 (n = 13), likely reflecting the impact of the COVID-19 pandemic. Most complainants were male (89.6%), and patients aged >60 years comprised the largest group (31.3%). Complaints were overwhelmingly directed at specialist urologists (97.6%), with subspecialists accounting for only 2.4%. Cases more frequently originated from public hospitals (66.3%) than from private institutions (33.7%).
PURPOSE:Diabetes mellitus is a chronic hyperglycemic condition leading to metabolic problems that cause organ damage and result in serious complications. Long-term complications of diabetes can cause serious health problems, such as sexual and reproductive dysfunction in men and women. Black pepper (Piper nigrum L.) is a medicinal plant proven to increase testosterone hormone levels, sexual function (libido), and spermatogenesis parameters in male rats. In this study, the effect of black pepper fruit extract on sexual function and reproductive function (fertility) in alloxan-induced diabetic male rats was evaluated. MATERIALS AND METHODS:A total of 30 male Sprague Dawley rats (Rattus norvegicus), aged 2.5 to 3 months and weighing 100-150 g, were divided into five groups of 6 individuals each. Group I consisted of rats given only standard feed. Group II consisted of alloxan-induced hyperglycemic rats given standard feed. Groups III and IV were alloxan-induced hyperglycemic rats given black pepper extract at 122.5 and 245 mg/kg BW, respectively, for 8 days. Group V consisted of alloxan-induced hyperglycemic rats given sildenafil therapy or zinc plus ascorbic acid. After 8 days of treatment, the erectile function and libido of the rats were assessed, followed by an evaluation of spermatozoa and testicular histology. Data were analyzed using ANOVA with significance set at p < 0.05. RESULTS:Alloxan-induced diabetic rats showed significant impairment in erectile function, libido, sperm quality, and testicular histology (p < 0.001 vs. control). Administration of black pepper extract at a dose of 122.5 mg/kg BW increased total penile reflexes (9.33 ± 1.03 vs. 6.00 ± 1.26 in the diabetes group, p = 0.002) and improved libido, with a decrease in courtship latency (5.50 ± 0.55 s vs. 21.00 ± 9.47 s, p = 0.013) and an increase in mounting frequency (18.05 ± 5.99 vs. 7.17 ± 1.83, p = 0.009). The extract dose of 245 mg/kg BW increased sperm concentration (158.16 ± 29.80 vs. 12.6 ± 1.3 ×10⁶, p < 0.001), progressive sperm motility (65.0 ± 35% vs. 27.0 ± 30%, p = 0.006), and normal sperm morphology (82.9 ± 5.7% vs. 35.0 ± 10.8%, p < 0.001). The number of Leydig cells increased significantly in the 122.5 mg/kg BW extract group (59.33 ± 4.08 vs. 30.50 ± 3.86; p < 0.001) compared to the diabetes group. There was no significant difference in spermatogonia count (640 ± 86.5 vs. 491 ± 37.0; p = 0.119). CONCLUSION:Piper nigrum fruit extract ameliorates sexual dysfunction and reproductive impairment in alloxan-induced diabetic rats, particularly at 122.5 mg/kg BW, with significant improvements in erectile function, libido, sperm quality, and testicular histology. These findings suggest its potential as a natural therapeutic agent for diabetes-related male reproductive dysfunction.
PURPOSE:Surgical management is a key component in treating adrenal masses, particularly when they are functional or large. However, the choice between partial adrenalectomy (PA) and total adrenalectomy (TA) remains controversial. Therefore, this systematic review and meta-analysis aimed to evaluate whether surgical outcomes differ between patients undergoing PA versus TA. MATERIALS AND METHODS:Following PRISMA 2020 guidelines, we systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies published up to April 2025. Nineteen studies were included, and methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted to estimate pooled outcomes. RESULTS:A total of 19 studies comprising 3,165 patients were included, of whom 1,084 underwent partial adrenalectomy (PA) and 2,081 underwent total adrenalectomy (TA). PA was associated with a significantly higher risk of tumor recurrence compared with TA (RR = 2.64, 95% CI 1.55-4.51), while no significant differences were observed for metastasis or mortality. In contrast, PA significantly reduced the risk of postoperative steroid dependence (RR = 0.44, 95% CI 0.34-0.55) and adrenal insufficiency (RR = 0.49, 95% CI 0.34-0.70). Perioperative complications were less frequent following PA (RR = 0.56, 95% CI 0.40-0.78), particularly mild complications, with no differences in severe complications. There were no significant differences in operative time or intraoperative blood loss between the two techniques. Subgroup analyses demonstrated higher recurrence rates in pheochromocytoma among patients undergoing PA, compared with Conn's adenoma. Perioperative complications were less frequent in PA in patients with Conn's adenoma. No significant differences were observed regarding surgical laterality (left vs. right) or the operative approach (transperitoneal vs. retroperitoneal laparoscopic / robotic surgery). CONCLUSION:PA offers superior preservation of adrenal function and fewer mild perioperative complications compared with TA, but shows a higher risk of tumor recurrence in pheochromocytoma patients. PA was not associated with higher recurrence in Conn's patients. Other surgical and oncological outcomes were similar, underscoring the need to individualize the choice of procedure based on tumor type and patient factors.
PURPOSE:To compare outcomes of super mini percutaneous nephrolithotomy (smPCNL) with extracorporeal shock wave lithotripsy (ESWL) for stones 1-2 cm. MATERIALS AND METHODS:After receiving ethics committee approval for this study (Date: 10/09/2021 Decision No: 2021/10-01), the files of patients who underwent smPCNL and ESWL for kidney stones between January 2017 and June 2021 by the Urology Department of Van YYU Dursun Odabaşı Medical Center were retrospectively scanned. A total of 300 patients' data were scanned retrospectively. After applying the exclusion criteria and omitting ESWL patients whose sessions were not completed, a total of 159 patients, including 82 in the ESWL group and 77 in the smPCNL group, were included in our study. RESULTS:The mean age in the ESWL group was 6.72 ± 3.71, and the mean age in the smPCNL group was 6.63 ± 3.59 (range: 1-18 years). There was no significant difference in the age profile between the groups (p = .87). Regarding the direction of the stone procedure in the smPCNL group, the procedure was performed on the right side in 42 patients (54.54%) and on the left side in 35 patients (45.46%). In the ESWL group, the procedure was performed on the right side in 38 patients (46.35%) and on the left side in 44 patients (53.65%). No statistically significant difference was found between the groups in terms of side direction (p = .38). The mean body mass index (BMI) in the ESWL group was 20.10 ± 2.01, while it was 20.23 ± 2.05 in the smPCNL group. No statistically significant difference was observed between the two groups in terms of BMI (p =.68). The mean stone size in the ESWL group was calculated as 13.74 ± 1.91 mm (10-20 mm) and 149.75 ± 45.46 mm², which would provide more accurate results. The mean value in the smPCNL group was 14.06 ± 2.6 mm (10-20 mm) and 150.87 ± 50.34 mm². No statistically significant difference was found between the groups in terms of stone size (p(mm)=.37, p(mm²)=.88). Among 82 patients treated with ESWL, 21 (25.6%) were stone-free after the first session, increasing to 40 (48.8%) by the end of the second session, and to 50 (61.0%) at the end of the third session. In terms of sedoanalgesia, 19 patients (23.20%) were exposed to 1 session, 16 (19.5%) were exposed to 2 sessions, and 31 (37.80%) were exposed to 3 sessions. Sixteen (19.5%) patients did not receive anesthesia. When evaluated in terms of the need for re-intervention, it was observed in 22 patients (26.8%) in the ESWL group and 4 patients (5.2%) in the smPCNL group (p = .0003). In the comparison of the stone-free rate of the smPCNL and ESWL groups, a statistically significant difference was observed in both the early and late periods (p = .001). When comparing the early and late periods of smPCNL (p = .79) and ESWL (p = .19) within their own groups, no statistical difference was observed. When smPCNL and ESWL were classified according to the Clavien-Dindo classification in terms of complications, no statistically significant difference was observed (p = .51). CONCLUSION:ESWL remains the preferred first-line option for many pediatric patients due to its safety and non-invasive nature. However, smPCNL provides higher single-session stone-free rates for 10-20 mm renal stones and may reduce repeated anesthesia exposure. SmPCNL should be considered a viable first-line alternative to achieve higher stone-free rates without increasing complication risks. Prospective, multicenter randomized trials are warranted.
PURPOSE:Varicocele is the abnormal dilatation of the veins of the pampiniform plexus, which is considered one of the most common factors related to infertility in men. The aim of the present study was to investigate whether a relationship exists between sleeping position and the presence of varicocele. MATERIALS AND METHODS:In this case-control study, 231 adult infertile men who were referred to the Kowsar Infertility Center, Yasuj, Iran, were divided into two groups: a control group including 113 infertile patients without varicocele, and a case group of 118 infertile patients with varicocele. After the first visit by the urologist and determining the presence or absence of varicocele, as well as the clinical grading of the varicocele, the patients completed demographic, clinical, and sleep position questionnaires. RESULTS:The findings of the current study indicated a significant relationship between the presence of varicocele and the faller-down (lying on the abdomen) sleeping position. There was also a significant positive correlation between this position and the degree of varicocele (p =0.003). CONCLUSION:The faller-down or prone position during sleep has a meaningful relationship with varicocele, which may be due to increased intra-abdominal pressure. More studies are needed to confirm this hypothesis.
PURPOSE:The prognosis and clinical management of bladder tumors nearly occupying the entire bladder cavity remain poorly defined due to limited available data. This study aimed to evaluate the clinical features and treatment outcomes of patients presenting with bladder tumors nearly filling the bladder at initial diagnosis. MATERIALS AND METHODS:After obtaining ethical approval, a retrospective analysis was conducted on 51 patients diagnosed between 2017 and 2024 with primary bladder tumors nearly filling the bladder. All underwent transurethral resection of bladder tumor (TURBT). The clinical and pathological data were analyzed using descriptive statistics and multivariable logistic regression. RESULTS:The mean age was 76.24 ± 11.7 years, with a median follow-up of 9.73 months (range: 3-84 months). Hematuria was the most frequent symptom (74.5%). Muscle-invasive disease was identified in 43.1% of cases at initial diagnosis, exceeding the 25% generally reported in newly diagnosed bladder cancer cohorts (p < .001). Complete resection was achieved in 68.6%, while 31.4% required repeat TURBT (re-TURBT). Among patients initially diagnosed with non-muscle-invasive tumors, 31.1% were found to have muscle invasion upon second resection. Treatments comprised intravesical immunotherapy (48.6%), radical cystectomy (25.7%), chemoradiation (14.3%), and systemic chemotherapy (11.4%). CONCLUSION:Bladder tumors nearly filling the bladder cavity are associated with high rates of muscle invasion and pose significant challenges in treatment and management. Larger, prospective multicenter studies are warranted to validate these findings and optimize management in this high-risk population.
PURPOSE:This preliminary study aims to evaluate the immunogenicity and local immune response triggered by the intravesical administration of Brucella abortus S19 (BAS19) in a tumor-free rat model as a potential alternative to Bacillus Calmette-Guerin (BCG) in bladder cancer immunotherapy. The primary objective is to investigate immune activation and safety in the bladder, establishing a foundation for future studies assessing its therapeutic efficacy against urothelial carcinoma. MATERIALS AND METHODS:Nineteen female Wistar albino rats received intravesical BAS19 instillations and were euthanized after 3 and 6 weeks. Blood samples and cystectomy tissues were collected. The systemic immune response was assessed using the Rose Bengal agglutination test, immunocapture agglutination test, and blood cultures. Bladder tissues were examined histopathologically and stained immunohistochemically to evaluate local immune responses, specifically analyzing the expression of CD4, CD8, TLR4, and TNF-α. RESULTS:Higher Brucella-specific immunocapture titers and increased epithelial inflammation were observed in rats treated with BAS19 for 6 weeks. Moreover, significantly enhanced staining of CD4+, CD8+, and TNF-α in inflammatory cells was detected in this group. TLR4 expression was observed in all BAS19-treated rats, regardless of the exposure duration. CONCLUSION:Intravesical BAS19 administration in rats induced strong local immune responses via CD4+, CD8+, TNF-α, and TLR4 expression without systemic toxicity. These results suggest that BAS19 may mimic BCG's immunological pathways, particularly through TLR4 signaling. With its safety, low cost, and immunogenicity, BAS19 emerges as a promising immunotherapeutic candidate for further bladder cancer research.
PURPOSE:Despite its prevalence, the etiology and pathogenesis of cryptorchidism remain poorly understood. This study aimed to identify potential biomarkers associated with cryptorchidism development using bioinformatics methodologies. MATERIALS AND METHODS:We utilized three microarray datasets from the Gene Expression Omnibus (GEO) database, comparing gene expression profiles between cryptorchidism patients and control individuals. Differentially expressed genes (DEGs) were identified using statistical analysis. Subsequently, we constructed a gene co-expression network using weighted gene co-expression network analysis (WGCNA) to identify modules of genes highly associated with the cryptorchid phenotype. Hub genes within these modules were identified using cross-validation and multiple algorithms. RESULTS:A total of 1,539 differentially expressed genes were identified between cryptorchidism patients and controls. WGCNA revealed a gene module strongly associated with the cryptorchidism phenotype. Ten genes (CDH1, CS, G6PD, HSPA5, KEAP1, NEDD8, POLR2J, JUN, SOD2, and TXN) with the highest association to cryptorchidism were identified in this module. Single‑gene gene set enrichment analysis (ssGSEA) showed that these hub genes were mainly enriched in metabolism-, translation-, and inflammation‑related processes. Notably, several key genes are involved in oxidative stress responses. CONCLUSION:This study identified a credible set of hub genes associated with cryptorchidism. Some of these genes have been shown to affect testicular development or spermatogenesis through mechanisms such as inflammation and oxidative stress, while others have not been fully studied in the context of cryptorchidism. These hub genes may provide new biomarkers for cryptorchidism risk assessment and warrant further investigation to clarify their specific roles.
PURPOSE:Acute rejection (AR) of a kidney graft in renal transplant recipients is associated with microvascular injury leading to graft dysfunction and failure. Long noncoding RNAs (lncRNAs) may serve as markers for vascular injury and AR. We aimed to identify lncRNA biomarkers associated with graft loss after renal transplantation. MATERIALS AND METHODS:We searched PubMed, Scopus, Embase, and Web of Science. Odds ratios (ORs), hazard ratios (HRs), and their 95% confidence intervals (95% CIs) were calculated to assess effect sizes. All graphical designs and statistical analyses were performed using STATA version 17 (StataCorp LP, College Station, TX, USA) and the meta package. RESULTS:Of 291 initially identified articles, 10 met eligibility criteria and were included in the systematic review; 3 provided sufficient data for meta‑analysis. The pooled area under the curve (AUC) for lncRNA measurement in diagnosing acute kidney rejection was 0.79 in adults and 0.75 in pediatric populations, indicating good diagnostic accuracy. Leave‑one‑out sensitivity analyses confirmed the stability of these findings. However, the pooled HR for the prognostic value of lncRNAs was 0.81 (95% CI: 0.63-1.04), which was not statistically significant. CONCLUSION:Assessment of lncRNA levels in plasma or urine appears promising as a diagnostic biomarker for acute kidney rejection. The prognostic value of lncRNAs in the course of acute kidney rejection requires further evaluation.
PURPOSE:To evaluate the effectiveness of contralateral testicular volume measurements in differentiating monorchidism from intra-abdominal viable testes in children with non-palpable testes (NPt). MATERIALS AND METHODS:The data of 179 patients who underwent surgery for undescended testes between January 2017 and January 2024 were retrospectively reviewed. The study included 33 patients with unilateral non-palpable testes. Testicular volumes were measured by ultrasonography 6-12 months prior to diagnostic laparoscopy, and the surgical findings were recorded. RESULTS:Diagnostic laparoscopy was performed on 33 children with non-palpable testes. For five patients, staged orchiopexy was planned due to the testes being 2 cm or more away from the internal inguinal ring. In 22 patients, inguinal orchiopexy was performed as the testes were around the internal inguinal ring (AIR). In the remaining six patients, no testes were found; the spermatic cord and vessels terminated at the internal inguinal ring (vanishing) or were atrophic (nubbin). There was a significant difference in the contralateral testicular volumes between patients with vanishing testes and those with intra-abdominal viable testes (p < 0.001). Additionally, there was a statistically significant difference in the contralateral testicular volumes between the AIR group and those with testes remote from the internal inguinal ring (RIR) (p = 0.03). CONCLUSION:The preoperative ultrasonographic measurement of the contralateral testicular volume in children with a unilateral non-palpable testis can provide valuable information about the nature of the intra-abdominal testis. The presence of a hypertrophic contralateral testis can guide surgeons prior to laparoscopy and is valuable for counseling parents about potential diagnoses.
