Objective:To explore the relationship between atrial fibrillation and the Klotho G-395A polymorphism in patients on maintenance hemodialysis (MHD). Methods:The study included 120 MHD patients (persistent atrial fibrillation, n = 30; paroxysmal atrial fibrillation, n = 30; normal sinus rhythm, n = 60) and 120 control individuals. Klotho G-395A mutations were detected by the fluorescence quantitative polymerase chain reaction. ELISA was used to detect serum soluble Klotho (sKl) and intact fibroblast growth factor 23 (iFGF23) levels, and left atrium diameters were measured by echocardiography. Correlation analysis between Klotho G-395A genotypes, clinical parameters, and biochemical indexes was performed, along with logistic regression analysis to determine the risk factors for atrial fibrillation. Results:Three genotypes of Klotho G-395A, namely, GG, GA, and AA, were detected. The frequencies of the GA/AA genotypes and A allelic genes were significantly higher in the MHD patients than in the healthy controls, and these genotypes were associated with both atrial fibrillation and persistent atrial fibrillation. Furthermore, serum sKl, serum iFGF23, and left artery diameter were significantly associated with atrial fibrillation and also showed significant differences between the persistent and paroxysmal atrial fibrillation groups. The serum sKl level was negatively correlated with serum FGF23 level and the left atrium diameter, while the serum FGF23 level was positively correlated with the left atrium diameter. The incidence of atrial fibrillation and left atrium diameter was significantly higher in those with the GA/AA genotype than in those with the GG genotype, while the serum sKl levels were significantly lower. The GA/AA genotype was associated with a 5.444 times higher likelihood of atrial fibrillation than the GG genotype. Conclusions:The A allele of Klotho G-395A may be a risk marker of atrial fibrillation in MHD patients. Moreover, sKl deficiency may contribute to the early development of atrial fibrillation in MHD patients.
Objective:To evaluate the association between prostate morphology and intraoperative blood loss during TURP. Materials and Methods:This prospective observational study included 1120 patients undergoing TURP. Intraoperative blood loss was quantitatively assessed using an endoscopic surgical monitoring system. The transverse and longitudinal diameters of the prostate were measured preoperatively by ultrasonography, and the W/L ratio was defined as the transverse-to-longitudinal diameter ratio. Univariable and multivariable linear regression analyses, nested regression models, and ROC analysis were used to evaluate the association between the W/L ratio and intraoperative blood loss. Results:The median intraoperative blood loss was 104 mL (IQR 36-214), and the median W/L ratio was 1.06 (IQR 1.02-1.18). Univariable analysis showed that the W/L ratio was negatively associated with intraoperative blood loss. In the multivariable analysis, after adjustment for age, BMI, prostate volume, operative time, Q max, 5-ARI use, and surgeon experience category, the W/L ratio remained independently associated with intraoperative blood loss (B = - 45.957, 95% CI: -89.229 to -2.684, p = 0.037). Nested regression models showed that the addition of the W/L ratio increased the model R 2 from 0.444 to 0.446, indicating statistically significant but limited incremental information. Exploratory ROC analyses yielded AUCs of 0.816 and 0.791 for intraoperative blood loss thresholds of ≥ 300 mL and ≥ 400 mL. Conclusions:A lower prostate W/L ratio was independently associated with greater intraoperative blood loss during TURP. Although its effect size was smaller than those of operative time and prostate volume, the W/L ratio may serve as an adjunctive morphometric marker that is readily available from preoperative imaging. Trial Registration: Chinese Registry of Clinical Trial: ChiCTR2400088743.
Background and Aims:Computed tomography texture analysis, powered by machine learning techniques, may differentiate clear cell renal cell carcinoma (ccRCC) from other renal tumor subtypes, such as papillary and chromophobe variants, or benign renal masses such as oncocytomas, as demonstrated here using the KiTS23 dataset. Methods:After excluding multifocal cases to avoid lesion-level labeling ambiguity and intrapatient lesion heterogeneity, 396 cases were included. Using PyRadiomics, 386 radiomics features were initially extracted from preprocessed computed tomography volumes and tumor segmentation masks. Subsequent multistage feature selection reduced the candidate feature set to 73 radiomics descriptors, and LASSO further selected six features for the primary classifier. Candidate machine-learning models were evaluated, with class-weighted Logistic Regression selected as the primary model. Threshold adjustment using the Youden index and bootstrap feature-selection stability analysis were performed. Results:The LASSO-selected class-weighted Logistic Regression model showed the best overall performance. Using the default probability threshold of 0.5, it achieved an accuracy of 76.5%, an area under the receiver operating characteristic curve of 80.4%, a precision of 91.2%, a sensitivity of 73.8%, and a specificity of 82.9% on the held-out test set. Youden-index thresholding increased sensitivity but reduced specificity; therefore, the fixed threshold of 0.5 was retained as the primary operating threshold. Bootstrap stability analysis showed that several LASSO-selected radiomics descriptors were repeatedly selected across resampled training cohorts. Conclusions:Radiomics-based machine learning shows promise for discriminating ccRCC from non-ccRCC renal tumors, but the results remain preliminary and have been evaluated internally. Given the moderate discrimination and lack of external validation, further studies using larger, multicenter datasets with standardized radiomics workflows are necessary.
Purpose:To compare Holmium: YAG laser settings for popcorn lithotripsy and evaluate the impact of MOSES modulation across stone-density groups. Materials and Methods:An in vitro bench model was used with synthetic gypsum stones prepared at three density levels (low, intermediate, and high: mean attenuation was 574, 945, and 2067 HU, respectively). For each trial, five fragments (2.8-3.3 mm) were treated using popcorn technique with Holmium: YAG laser and 272 µm fiber during a 2 min run under standardized irrigation. Five laser settings (0.3 J/80 Hz, 0.5 J/40 Hz, 1.0 J/20 Hz, 1.0 J/30 Hz, and 1.5 J/20 Hz) were tested with and without MOSES mode: each setting-by-modulation condition was repeated six times. The primary endpoint was percent mass reduction; secondary endpoints were residual fragment counts 1-2 and > 2 mm. Results are presented as mean ± SD, and ANOVA was used for comparison. Results:In the low-density group, percent mass reduction was highest overall (65%-86%), with 1.0 J/30 Hz achieving the greatest reduction, MOSES provided no additional benefit (p = 0.6). In the intermediate-density group, the greatest mass reduction was achieved with 1.0 J/30 Hz with MOSES (51% ± 5.9%), and MOSES effects were setting-dependent, and at 1.0 J/30 Hz MOSES reduced total residual fragments (5.3 vs 8.0, p = 0.04). In the high-density group, 1.0 J/30 Hz with MOSES achieved the highest mass reduction (71.5% ± 12.1%) and was associated with improved outcomes (p = 0.037). Secondary analyses of residual fragments generally paralleled these findings. Conclusions:In this in vitro popcorn lithotripsy model, 1.0 J/30 Hz provided the most consistent performance across density groups. MOSES modulation did not improve outcomes in low-density stones but was associated with improved efficiency in intermediate- and high-density stones.
Objectives:This narrative review examines intermittent catheterization (IC) for individuals with spinal cord injury (SCI) from a health systems perspective. Although IC is considered the preferred standard of care for neurogenic bladder after SCI, its long-term effectiveness depends on healthcare systems' ability to provide integrated, sustainable, and patient-centered care. The review explores system-level challenges and strategies to optimize IC delivery using the World Health Organization (WHO) Health System Building Blocks framework. Methods:A structured literature search was conducted across CINAHL, MEDLINE, PubMed, Scopus, ScienceDirect, and Google Scholar for studies published between January 2015 and June 2026. Relevant evidence addressing clinical outcomes, healthcare delivery, workforce capacity, access to catheter technologies, financing, and governance was synthesized using the WHO Health System Building Blocks framework. Key studies informing the review are summarized in Table 1. Results:Significant systemic barriers to effective IC implementation remain despite strong clinical evidence supporting its use. Key challenges included limited access to catheter supplies, inadequate workforce training, fragmented follow-up services, and inconsistent patient education. Across the reviewed literature, service delivery, workforce capacity, and access to essential technologies emerged as the most influential determinants of successful IC implementation and long-term adherence. The findings further indicated that successful IC delivery depends on the interaction and integration of multiple health system domains rather than any single component in isolation. Conclusion:Optimizing IC outcomes in SCI requires stronger health systems that support coordinated, accessible, and sustainable care. Integrating IC services into broader health system strengthening initiatives may reduce preventable complications, improve quality of life (QoL), and support Sustainable Development Goal 3 (SDG 3) on health and well-being.
Purpose:To evaluate the effect of different connector types and commonly used endourologic devices on irrigation fluid flow through the working channel of a flexible ureteroscope. Methods:Irrigation flow was measured under a 200-cm H2O pressure head using three connector types (Tuohy-Borst, UroLok, and Check-Flo) and a standard Y-set connection. Instruments tested included Piranha biopsy forceps, Segura hemisphere basket, Glidewire guidewire, and two laser fibers (200 μm and 365 μm). Each condition was repeated six times. Descriptive statistics were calculated, and one-way ANOVA was used to assess differences between groups. Results:With an empty channel, the standard Y-set connection achieved the highest mean flow (115.8 ± 4.3 mL/min), followed by Tuohy-Borst (113.0 ± 1.6), UroLok (100.2 ± 1.3), and Check-Flo (80.4 ± 0.5) (p < 0.001). Inserting instruments markedly reduced flow. The Piranha forceps and Glidewire guidewire produced the largest reduction (∼96-97%). A larger instrument diameter or the absence of a smooth coating significantly reduced flow across all connectors. With small-caliber instruments, connector design played a greater role: relative flow reduction was greatest with Tuohy-Borst (50.6%) and lowest with Check-Flo (38.0%). In absolute terms, UroLok yielded the highest median flow with laser fibers (38.7 mL/min), followed by Tuohy-Borst (37.5 mL/min) and Check-Flo (34.7 mL/min). Conclusion:Both connector choice and instrument size significantly affect irrigation flow in flexible ureteroscopy. Large-diameter instruments almost abolish flow regardless of connector, whereas with smaller instruments, connector design influences performance. These findings emphasize the importance of selecting optimal connector-instrument combinations to maintain intraoperative visibility.
Introduction:The impact of socioeconomic status (SES) on surgical outcomes is often underrecognized. Benign cystectomy (BC) for nononcologic bladder disease carries high morbidity but remains understudied. We evaluated the effect of SES on postoperative outcomes and healthcare utilization following BC. Methods:We retrospectively reviewed all BCs performed at our institution from 2012 to 2025. Neighborhood-level socioeconomic disadvantage was measured using the area deprivation index (ADI; scale 1-10), with higher scores indicating greater deprivation. Patients were stratified into deciles (ADID). ADI reflects area-level socioeconomic conditions rather than individual-level characteristics and therefore may not capture patient-specific socioeconomic factors. Surgical outcomes, emergency department (ED) utilization, and 90-day readmissions were compared across ADID groups. Results:Among 183 patients, the median ADI was 5 (IQR 4-8). Preoperative comorbidities, urinary diversion type, operative time, length of stay, and in-hospital complication rates were similar across ADID groups. ED visits and 90-day readmission rates did not differ by SES (p > 0.05). On multivariable analysis, Indiana pouch diversion was associated with higher odds of postoperative complications (OR, 4.2; 95% CI, 1.4-12.8; p < 0.05). Both Indiana pouch (OR, 4.1; 95% CI, 1.3-13.1; p < 0.05) and a neobladder (OR, 3.7; 95% CI, 1.4-9.8; p < 0.05) were associated with a greater likelihood of readmission within 90 days of discharge. Conclusions:SES, as measured by ADID, was not significantly associated with outcomes or postoperative healthcare utilization. BC carries high morbidity regardless of SES. These findings warrant prospective validation.
As ureteroscopy (URS) is increasingly utilized, preventing and managing severe postoperative infections—such as urosepsis—has become a clinical priority. Elevated intrarenal pressure (IRP) and irrigation fluid absorption (IFA) represent two core pathophysiological steps in the translocation of bacteria and endotoxins into the bloodstream. This review compares the clinical utility and technological maturity of IRP and IFA monitoring during URS. The analysis indicates that IRP is the instantaneous physical driving force for pyelovenous backflow, whereas IFA is the integrated outcome of multidimensional variables, including the pressure gradient, operative time and tissue permeability. Consequently, monitoring a single dimension may be insufficient to comprehensively assess infection risk. IRP monitoring (e.g., using a ureteral access sheath with a pressure-sensing channel or a flexible URS with an integrated pressure sensor) offers the advantage of real-time feedback, potentially playing a key role in maintaining low IRP and proactively preventing intrarenal backflow. However, it cannot account for the cumulative effect of time or changes in tissue permeability. IFA monitoring, despite its inherent lag, may provide a more comprehensive quantitative measure of the pathogenic load absorbed by the patient, suggesting potential predictive and warning value for the occurrence of infection; however, clinically validated thresholds and prospective evidence are currently lacking. In the future, with advancements in monitoring technology, the development of automated closed-loop systems integrating high-precision IRP monitoring, real-time IFA monitoring, intelligent irrigation and negative pressure suction holds promise for maximizing the balance between surgical efficacy and patient safety, provided that future studies can establish evidence-based intervention triggers.
Background and Aims:Dexamethasone, a corticosteroid, reduces inflammation, while mannitol, a diuretic, improves renal blood flow and stone clearance. This study examines the impact of dexamethasone and mannitol during surgery on infection rates, pain control, and analgesic needs in totally tubeless PCNL (TTPCNL) patients. Methods:This double-blind, controlled clinical trial at a single center involved 121 patients undergoing TTPCNL. Participants were randomly divided into four groups: control, dexamethasone, mannitol, and dexamethasone-mannitol (DM). Postoperative outcomes included pain intensity measured using the visual analog scale (VAS) at 6 and 24 hours after tubleless PCNL. Patients with moderate-to-severe pain received rescue analgesia (paracetamol and ketorolac). Additional outcomes included length of hospital stay (LOS), serum interleukin-6 (IL-6) levels, gross hematuria, stone-free rate (SFR), Clavien-Dindo grade (CDG), and postoperative complications, including sepsis, systemic inflammatory response syndrome (SIRS), hemoglobin decline, the need for angiography, hospital readmission, and acute kidney injury (AKI). Results:This study included 81 male participants (66.9%), with a mean age of 50.9 ± 12.2 years. Patients treated with dexamethasone, either alone or with mannitol, showed significant reductions in postoperative SIRS (p value < 0.001), hemoglobin drop (p value < 0.001), hospital stay duration (p value < 0.001), CDG (p value < 0.001), postoperative pain (p value < 0.001), and analgesic use (p value = 0.015). IL-6 levels in DM group were significantly lower compared to others (p = 0.002). There were no significant reductions in occurrence of AKI, readmission, angiography, sepsis, and SFR. Conclusions:The intraoperative use of dexamethasone and mannitol during TTPCNL effectively mitigated postoperative inflammatory responses. This was achieved by reducing levels of IL-6 and decreasing the occurrence of SIRS. Additionally, patients experienced a shorter postoperative hospital stay, lower VAS pain score, lower CDG, and lower analgesic consumption. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20190305042939N1.
Purpose:The goal of this study was to compare the accuracy of 18F-PSMA-1007 PET/CT to contemporary conventional imaging (contrast-enhanced CT scan of the chest, abdomen, and pelvis and a 99mTc-MDP whole body bone scan with SPECT/CT of the torso) in the setting of biochemically recurrent prostate cancer. Methods:This prospective nonrandomized Phase II cohort study clinical trial included 85 patients with biochemically recurrent prostate cancer (previous therapy). 18F-PSMA-1007 whole body PET/CT imaging was performed in all patients, with conventional imaging (contrast-enhanced CT scan of the chest, abdomen, and pelvis and a 99mTc-MDP whole body bone scan with SPECT/CT of the torso) then performed within 12 days. PROMISE criteria were used for PET/CT interpretation. After a minimum 1-year follow-up period, lesion-level and patient-level analyses were performed based on previously published reference criteria (Lawhn-Heath et al. 2019). The accuracy data were compared. Referring physicians were surveyed to help determine if the scans altered treatment. Categorical variables were compared using the McNemar test (p < 0.05 significant). Results:53 patients with a total of 72 evaluable lesions were included in the analysis. 18F-PSMA-1007 PET/CT had a higher sensitivity than conventional imaging on a lesion level (100% compared with 58.3%) and higher overall accuracy on a patient level (90.6% compared with 62.3%, p < 0.05). The referring physicians felt that the 18F-PSMA-1007 PET/CT scans were beneficial to the clinical care of the patient in 90.6% of cases. Conclusion:Overall, the findings support the use of 18F-PSMA-1007 over conventional imaging in the evaluation of patients with biochemically recurrent prostate cancer. Trial Registration: ClinicalTrials.gov.identifier: NCT04733768.
Background:Pediatric urological emergencies are potentially serious conditions that can compromise functional or even vital prognosis if not managed promptly. In sub-Saharan Africa, their true incidence and management modalities remain poorly documented, particularly in regional-level hospitals. This study aims to describe the epidemiological, clinical, therapeutic, and outcome aspects of pediatric urological emergencies managed at the Regional Hospital Center of Dédougou, Burkina Faso. Patients and Methods:A retrospective descriptive study was conducted from April 1, 2025, to March 31, 2026, in the surgery department of the Regional Hospital Center of Dédougou. All children aged 0 to 15 years admitted for a urological emergency and who received specialized care were included. Results:Twenty-eight (28) patients were identified, with a mean age of 8.22 years (range: 0-15 years) and a male-to-female ratio of 27:1. Traumatic emergencies accounted for 42.85% of cases (n = 12), dominated by scrotal trauma (n = 6), including three cases of bovine goring. Functional and vascular emergencies represented 35.7% (n = 10), mainly testicular torsions (n = 6) with a mean consultation delay of 65.3 h and an orchiectomy rate of 66.7% (4/6). Obstructive emergencies accounted for 17.85% (n = 5). Overall outcomes were favorable in all 28 patients, with no mortality recorded. Conclusion:In our setting, pediatric urological emergencies are dominated by trauma and are characterized by significant consultation delays. Strengthening community awareness, healthcare worker training, and regulation of traditional practices is essential to improve functional prognosis.
Background and Aims:Emphysematous cystitis (EC) is an uncommon but clinically important form of complicated urinary tract infection characterized by gas within the bladder wall and/or bladder lumen. Because EC may present with urinary symptoms, nonspecific systemic symptoms, or incidental computed tomography (CT) findings, its diagnostic process in tertiary hospitals remains clinically relevant. This study aimed to describe the clinical characteristics, diagnostic pathways, microbiological findings, treatment, and outcomes of EC in a university hospital. Methods:We retrospectively reviewed 45 patients diagnosed with EC based on abdominal CT findings at Teikyo University Hospital between October 2010 and March 2024. Data on clinical presentation, comorbidities, microbiological findings, treatment, and clinical outcomes were extracted from electronic medical records. Results:A total of 45 patients were analyzed, including 25 males and 20 females, with a median age of 79 years (range: 31-97 years). Diabetes mellitus was present in 21 patients. The most frequently detected urinary pathogens were Escherichia coli (n = 21), including extended-spectrum β-lactamase-producing strains (n = 7), and Klebsiella pneumoniae (n = 9). In blood culture, K. pneumoniae (n = 7), E. coli (n = 5), including extended-spectrum β-lactamase-producing strains (n = 2), and Staphylococcus epidermidis (n = 2) were detected. Most patients were managed conservatively; urinary catheter placement was performed in 35 patients. Regarding EC treatment outcomes, 34 patients recovered or improved, 10 died during the clinical course, and 1 had an unknown or unclear outcome. No deaths were judged to be directly attributable to EC itself. Retrospective review of the clinical course leading to CT detection of EC suggested four diagnostic pathways. Conclusion:EC occurred mainly in elderly patients with comorbidities and was frequently detected by CT in diverse clinical contexts. These diagnostic pathways are a descriptive summary of how EC was detected in this cohort, rather than a validated prognostic or treatment-guiding classification.
Background:This study investigates the relationship between prostate cancer (PCa) detection rates and prostate volume. Prostate volume may influence the diagnostic performance of MRI-ultrasound (MRI-US) fusion biopsy. Enlarged prostate glands present specific challenges, including reduced specificity of prostate-specific antigen (PSA), anatomical alterations of the transition zone, and potential limitations in biopsy accuracy. Material and Methods:We retrospectively analyzed 1300 consecutive patients with elevated PSA and/or abnormal digital rectal examination (DRE) who underwent MRI-US fusion-guided biopsy between 2014 and 2023. Patients were stratified into five prostate volume groups (< 30, 30-54.9, 55-79.9, 80-119.9, and ≥ 120 mL). For PI-RADS-based analyses, three volume categories (< 50, 50-100, and > 100 mL) were applied. Detection rates for overall PCa and clinically significant prostate cancer (csPCa) were assessed. Results:A total of 1203 patients were included. The overall cancer detection rate was 62.0% (746/1203), with 39.5% (475/1203) classified as clinically significant. Detection rates decreased significantly with increasing prostate volume, from 82.3% in prostates < 30 mL to 28.9% in prostates ≥ 120 mL (p < 0.01). Intermediate groups showed detection rates of 67.1%, 50.2%, and 48.5% for volumes of 30-54.9, 55-79.9, and 80-119.9 mL, respectively. A similar trend was observed for csPCa detection (59.4%, 42.3%, 27.4%, 31.5%, and 24.4%; p < 0.05). In multivariable analysis, prostate volume remained an independent predictor of cancer detection (OR: 0.99, p < 0.01). Stratified by PI-RADS category, detection rates consistently declined with increasing prostate size. For PI-RADS 5 lesions, detection decreased from 87.1% in prostates < 50 mL to 83.1% in 50-100 mL and 69.2% in > 100 mL (p < 0.01). Comparable trends were observed for PI-RADS 4 lesions (78.5%, 64.0%, and 50.0%) and PI-RADS 3 lesions (45.9%, 40.7%, and 31.8%; p < 0.05). Additionally, larger prostates were associated with a higher proportion of anterior lesions and a decreasing rate of positive DREs. Conclusion:Prostate volume is an independent determinant of cancer detection in MRI-US fusion biopsy. Larger prostate glands are associated with significantly reduced detection rates across all PI-RADS categories. These findings highlight the need to consider prostate volume in diagnostic decision-making and to adapt biopsy strategies in patients with enlarged prostates.
Background and Aims:This review aimed to assess the clinical outcomes and complications of polyvinylidene fluoride (PVDF) mesh in sacrocolpopexy (SCP). Methods:A systematic search was conducted on Google Scholar, PubMed, Web of Science, Scopus, and Embase up to October 2024. All study designs employing PVDF mesh in SCP were included. Demographic features, mesh types, surgical method, surgical outcomes, and mesh exposure, among other outcomes and complications, were extracted by two independent researchers. The registered protocol is available online on PROSPERO (ID: CRD42023405734). Results:Out of 319 studies screened, 12 were finally included in the systematic review and meta-analysis, encompassing 1093 female patients who underwent SCP. Four studies employed polypropylene (PP) as the comparator. Abdominal sacrocolpopexy (ASC) was used by six studies, five adhered to the laparoscopic method and one used both. Meta-analysis indicated pooled prevalence rates close to 0% for mesh exposure, recurrence, sexual dysfunction (SD), and reoperation in the PVDF group; however, small sample sizes and wide confidence intervals diminish the definitive conclusion. The prevalence of urge urinary incontinence (UUI) was 33%, while both stress urinary incontinence (SUI) and de novo incontinence had a prevalence of 6%. However, the differences between PVDF and PP outcomes and complications were not statistically significant. Conclusion:No significant differences were found between PVDF mesh and PP. Our findings highlight the need for further robust evidence to indicate the possible differences between PVDF and conventional materials, especially PP.
In patients with prostate cancer undergoing open radical prostatectomy, early identification of those at risk for biochemical failure (persistence or recurrence) is crucial to guide timely treatment. The aim of this study was to identify clinical, biochemical, and histopathological factors associated with biochemical failure during a 2-year postoperative follow-up and to assess their predictive value. A retrospective, cross-sectional study was conducted on patients who underwent open radical prostatectomy at a tertiary care hospital between 2008 and 2021 to evaluate patient clinical, biochemical, and histopathological characteristics. Descriptive statistics were calculated, and comparisons (Mann-Whitney U tests) or associations (chi-square tests) among the characteristics were performed and compared between patients grouped according to the absence or presence of biochemical failure. Receiver operating characteristic curves were used to evaluate predictive performance. alpha = 0.05 was used in all tests. A total of 163 patients were considered, 117 of which (age range, 50-77 years) met the inclusion criteria. Biochemical failure occurred in 48.70% of patients (24.80% persistence and 23.90% recurrence). A total of 29.06% of patients presented with extracapsular extension, which was significantly associated with biochemical failure (p = 0.027). Prostate-specific antigen density (PSAD) shows predictive value (AUC = 0.617, p = 0.029), with a cutoff point of PSAD >= 0.25, yielding 54.40% sensitivity and 65.00% specificity. The 2-year odds ratio for biochemical failure was 2.06 (p = 0.05). Overall, 48.70% of the patients experienced biochemical failure during the first 2 years of follow-up. Extracapsular extension was associated with higher risk of biochemical failure. Our findings suggest that PSAD >= 0.25 is a predictive factor for the occurrence of biochemical failure. It is important to conduct multicenter studies with larger sample sizes to validate these findings and strengthen prediction and follow-up strategies.
Introduction Perineural invasion (PNI) is an independent prognostic factor in prostate cancer (PCa) patients following radical prostatectomy (RP), although findings across studies remain inconsistent. We aimed to identify the baseline factors associated with the occurrence of PNI in RP specimens. Methods A retrospective analysis was conducted on 921 PCa patients who underwent RP at our institution between 2012 and 2022. Baseline predictors and histopathological PNI status were analyzed. Patients were categorized into PNI+ (n = 838) and PNI- (n = 83) groups. Results Among demographic variables, family history of both PCa (p = 0.001) and other cancers (p = 0.001) was correlated with PNI. Several clinicopathological variables, including average prostate-specific antigen (PSA) at diagnosis-mean biopsy PSA (p < 0.001), mean preoperative PSA (p < 0.001), prostate volume (PV) (p = 0.034), and biopsy Grade Group (GG) (p = 0.043), showed correlation with PNI. Conversely, none of the other serum parameters, including preoperative testosterone, albumin, platelets, neutrophils, lymphocytes, and hemoglobin, exhibited correlation with PNI. Logistic regression analysis showed that a family PCa history decreases the risk of PNI (odds ratio [OR] = 0.373). Conclusions We found a correlation of PNI with recognized prognostic factors (biopsy PSA, preoperative PSA, and biopsy GG) but also with other variables (PV, family history of PCa, and family history of other cancers).
Purpose: To systematically evaluate the success rate and safety of double-face buccal mucosa graft (BMG) urethroplasty for the treatment of obliterative or near-obliterative anterior urethral strictures. Methods: A systematic literature search was conducted in accordance with the PRISMA guidelines across PubMed, Web of Science, Embase, and the Cochrane Library for studies published up to October 2025. Studies reporting the surgical success rate were included. The risk of bias was assessed using the ROBINS-I tool. A single-arm meta-analysis was performed using Stata 15 to calculate the pooled success rate and its 95% confidence interval (CI). Heterogeneity was assessed using the I2 statistic. Sensitivity analysis was performed to test the robustness of the results when significant heterogeneity was detected. Publication bias was assessed using funnel plots and Egger's test. Results: A total of ten single-arm studies comprising 511 patients who underwent double-face BMG urethroplasty for obliterative or near-obliterative anterior urethral strictures were included. Quality assessment using the ROBINS-I tool rated all studies as having a moderate overall risk of bias. The pooled surgical success rate was 89% (95% CI: 0.86-0.92, p < 0.001), with no significant heterogeneity observed across studies (I-2 = 0% and p = 0.97). Sensitivity analysis confirmed the stability of this pooled estimate. Assessment of publication bias revealed a symmetric funnel plot and a nonsignificant Egger's test result (p = 0.109), suggesting low risk of publication bias. Conclusion: Double-face BMG urethroplasty demonstrates a high pooled success rate of 89% with low heterogeneity across studies, confirming its effectiveness for treating obliterative or near-obliterative anterior urethral strictures. As a nontransecting single-stage option, it should be reserved as a last-resort reconstructive strategy for complex cases where excision and primary anastomosis is not feasible and unilateral augmentation alone cannot create an adequate lumen due to a severely compromised urethral plate.
Objectives: Although adrenalectomy for primary aldosteronism (PA) corrects hypokalemia, we observed cases in which serum potassium decreased immediately after adrenalectomy, even in patients with preoperative hypokalemia. No studies have described postoperative potassium changes in PA. In contrast, recent reports have described renal function decline 1 month after adrenalectomy in PA; however, the evidence remains limited. Therefore, we aimed to clarify whether postoperative decreases in serum potassium and renal function occur in PA. Methods: We retrospectively reviewed perioperative data from patients with PA or nonfunctional adrenal tumors (NF) who underwent laparoscopic adrenalectomy between 2006 and 2023 to assess postoperative changes in serum potassium levels and estimated glomerular filtration rate (eGFR). Results: A total of 161 patients were included. The mean changes in serum potassium on postoperative Day 0 were -0.36 +/- 0.44 and -0.20 +/- 0.46 mEq/L in the PA and NF groups, respectively (p = 0.034). Multivariable regression analysis revealed that PA (p < 0.001), preoperative serum potassium levels (p < 0.001), and plasma aldosterone concentration (PAC) (p = 0.004) were associated with potassium decrease, whereas preoperative use of mineralocorticoid receptor antagonists (MRAs) attenuated this decrease (p < 0.001). The mean changes in eGFR 1 month after adrenalectomy were -10.02 +/- 12.62 and 0.44 +/- 9.63 mL/min/1.73 m(2) in the PA and NF groups, respectively (p < 0.001). Multivariable regression analysis identified age (p = 0.029), male sex (p = 0.009), PA (p = 0.009), preoperative eGFR (p < 0.001), and PAC (p = 0.006) as factors associated with eGFR decline. Conclusion: This study demonstrates that serum potassium may decrease immediately after adrenalectomy, and preoperative use of MRAs may mitigate this decrease. It also shows that renal function may decline 1 month after adrenalectomy. Patients with higher preoperative PAC may warrant closer monitoring, as elevated PAC is associated with greater postoperative decreases in potassium and eGFR.
ObjectiveThe present study aims to elucidate the molecular mechanisms underlying the association between solute carrier family 6 member 1 (SLC6A1) and the aggressive progression of prostate cancer, with a particular emphasis on its relationship with mitochondrial function.MethodsTo evaluate mitochondrial function, we detected mitochondrial membrane potential, adenosine triphosphate (ATP) production, intracellular reactive oxygen species (ROS) levels, and mitochondrial morphology in prostate cancer cell lines. Western blot was used to detect apoptosis-related proteins. Gene set enrichment analysis (GSEA) was performed using The Cancer Genome Atlas (TCGA) prostate cancer dataset.ResultsOur findings indicated that silencing of SLC6A1 decreased mitochondrial membrane potential and ATP production while increasing intracellular ROS levels, accompanied by Bax upregulation and activation of the caspase pathway. Furthermore, GSEA results suggested that low SLC6A1 expression might trigger cell apoptosis via mitochondrial disruption mediated by the interaction between potassium and calcium channels.ConclusionThese results highlighted the role of SLC6A1 in mitochondrial dysfunction associated with cell apoptosis in prostate cancer cells. This study has provided further insights into the molecular mechanisms of advanced prostate cancer and potential therapeutic targets.
ObjectivesTo evaluate the relationship between early postoperative mercaptoacetyltriglycine (MAG3) renal scintigraphy findings and short-term graft function after kidney transplantation and to assess the necessity of routine postoperative day (POD)-1 imaging.Patients and MethodsWe retrospectively analyzed 67 living-donor kidney transplantation recipients who underwent MAG3 scintigraphy on POD-1, 8, and 15 between January 2007 and April 2024. Renogram curve patterns were classified as normal, reduced excretion, or hypofunctional based on T1/2 values. Effective renal plasma flow (ERPF) was also recorded. Associations between renogram type/ERPF and graft function within 3 months were evaluated, and acute rejection events were documented.ResultsOn POD-1, renogram types were normal in 16 patients, reduced excretion in 13, and hypofunctional in 38; on POD-8, the corresponding numbers were 39, 6, and 22; and on POD-15, they were 33, 9, and 25, respectively. Regardless of POD-1 renogram type, serum creatinine and estimated glomerular filtration rate reached to <= 2.0 mg/dL and >= 40 mL/min/1.73 m2 within 3 months. No significant differences in renal function at 3 months were observed among renogram types at any time point. ERPFs on POD-1, 8, and 15 were strongly correlated. Graft function showed a similar course across ERPF levels. Acute rejection occurred in two patients within 3 months, neither predicted by scintigraphy.ConclusionsEarly graft function improved similarly across all renogram types and ERPF levels. Because routine POD-1 imaging has limited prognostic value, we propose replacing the routine multiple-scan protocol with a single baseline scan performed once the patient is hemodynamically stable. Subsequent imaging should be strictly indication-based, optimizing diagnostic utility while minimizing patient burden.
