Background Urosepsis, a life-threatening complication of urinary tract infection (UTI), is a major global health challenge. Its impact is particularly severe in resource-limited healthcare systems, where antimicrobial resistance (AMR) and delayed source control worsen outcomes. Epidemiological data remain scarce in such contexts. Objectives To describe the epidemiology, risk factors, microbiological patterns, and outcomes of urosepsis in Palestine, and to examine variables associated with severity, intensive care unit (ICU) admission, hospital stay, and mortality. Design Retrospective multicenter cohort study. Methods Medical records of adults (≥18 years) diagnosed with urosepsis between January 2015 and December 2025 were reviewed across four hospitals in the West Bank. Results A total of 168 patients were included (median age 60 years; 46.4% female). Obstructive urolithiasis was the most frequent etiology, followed by post-ureteroscopy infection. Severe sepsis and septic shock were more frequent among patients with larger stones (p < 0.001), prolonged catheterization (p = 0.016), anemia (p < 0.001), and elevated C-reactive protein (CRP) (p = 0.002). A higher number of stones was significantly linked to longer hospital stay (β = 0.222, B = 0.874, p = 0.022). Regression showed that older age was associated with ICU admission (B = 0.023, p = 0.018, OR = 1.02, 95% CI: 1.00–1.04), alongside elevated CRP (B = 0.004, p = 0.034, OR = 1.00, 95% CI: 1.00-1.01). In-hospital mortality among admitted patients was 8.3%. Regression showed that extended hospital stay was significantly associated with higher odds of death (B = 0.106, p = 0.043, OR = 1.11, 95% CI: 1.00–1.23). ESBL-producing Escherichia coli and vancomycin-resistant enterococci (VRE) were observed as notable resistance findings. Conclusion Obstructive urolithiasis and catheterization may be important contributors to severity, while advanced age, comorbidities, hypotension, altered mental status, and ESBL-producing E. coli were associated with poorer outcomes.
Background Cognitive and software-assisted MRI–ultrasound registration guide transperineal prostate biopsy, but comparative evidence for clinically significant prostate cancer (csPCa) detection remains inconclusive. Objectives To compare csPCa detection, biopsy core numbers and biopsy-to-prostatectomy Grade Group concordance during cognitive and software fusion biopsy periods. Design Retrospective, non-randomised observational study. Methods Patients undergoing MRI-targeted transperineal prostate biopsy at a district general hospital were assessed during a cognitive fusion period in 2022 and a software fusion period in 2023. Of 300 patients assessed, 249 were eligible: 122 in the cognitive fusion cohort and 127 in the software fusion cohort. Targeted biopsy was followed by systematic transperineal sampling. The primary outcome was csPCa detection, defined as the highest International Society of Urological Pathology Grade Group ≥2 identified in either biopsy component. Multivariable logistic regression adjusted for age, PSA density and PI-RADS category. Targeted and systematic biopsy results were compared using the exact McNemar test. Results: csPCa was detected in 57/122 patients (46.7%) during the cognitive fusion period and 76/127 (59.8%) during the software fusion period (unadjusted p=0.038). After adjustment, the association between the software-fusion period and csPCa detection was not statistically significant (adjusted odds ratio 1.75, 95% confidence interval 0.97–3.16; p=0.06). PI-RADS category was associated with csPCa detection (overall p<0.001), with higher adjusted odds for PI-RADS 4 and 5 than PI-RADS 3 lesions. Median targeted core counts were five in both cohorts; median systematic core counts were 19 and 10, and total core counts were 24 and 15, during the cognitive and software fusion periods, respectively. Among 56 patients undergoing radical prostatectomy, Grade Group concordance was 65.4% during the cognitive fusion period and 80.0% during the software fusion period (p=0.218). Conclusion Unadjusted csPCa detection was higher during the software fusion period, but the adjusted association was not statistically significant. Fewer systematic and total cores were obtained during that period. Because the cohorts were non-contemporaneous and sampling was not standardised, differences cannot be attributed solely to fusion technique. Systematic sampling continued to identify csPCa missed by targeted biopsy.
Background Accurate staging is essential in urothelial carcinoma (UC), yet the utility of [ 18 F]FDG PET/CT (FDG) is limited by high physiologic urinary excretion, which obscures primary lesions and regional nodes. Non-FDG tracers with lower urinary clearance may improve pelvic and metastatic detection, informing treatment selection such as bladder-sparing strategies versus cystectomy. Objectives To map the clinical evidence on non-FDG PET tracers in UC staging and to chart their reported performance against FDG and conventional imaging. Eligibility Criteria In-human clinical studies reporting accuracy or lesion-detection metrics for non-FDG PET/CT in UC that used [ 18 F]FDG PET/CT as comparator, with histopathology or conventional imaging as additional reference where reported. Sources of Evidence MEDLINE (PubMed), Cochrane Library and Scopus, last searched 31 st August [2025]. Forty-two articles were screened, 25 met predefined inclusion criteria. Charting Methods Data were charted using a predefined form covering study design, population, tracer, reference standard and performance measures. Findings were grouped by tracer class. Heterogeneity was too high for meta-analysis. Results Six tracer classes were identified. FAPI consistently outperformed FDG, with sharper tumor-to-background contrast, up to 30 % more lesions detected and markedly higher nodal sensitivity at preserved specificity. [ 11 C]Choline and [ 11 C]acetate showed negligible urinary excretion and the highest sensitivity for primary-tumor visualization, but only modest gains over FDG for nodal or distant staging. In one prospective comparison, [ 64 Cu]CuCl 2 surpassed FDG and contrast-enhanced CT on lesion-based analysis and improved nodal specificity. PSMA ligands, [ 18 F]Fluciclovine and immuno-PET agents targeting Nectin-4 or uPAR offered target-specific benefits but were not consistently superior. Conclusion Evidence remains in an early validation phase. FAPI is the most consistently promising tracer, particularly for nodal staging, while choline, acetate and fluciclovine may suit selected pelvic applications. Small, heterogeneous studies with variable reference standards dominate, and head-to-head comparisons with standardized protocols and pathological validation are needed before routine use.
Background Managing high-burden multiple renal stones remains a significant challenge. While retrograde intrarenal surgery (RIRS) is common, it often requires multiple stages for large stone burdens. Objectives To evaluate the comparative outcomes, specifically efficacy and safety, of Ultramini-endoscopic combined intrarenal surgery (ECIRS) using a 12 Fr percutaneous sheath versus RIRS for high-burden multiple renal stones. Design Single-center retrospective propensity score-matched (PSM) cohort study. Methods We reviewed adult patients with high-burden multiple renal stones (≥3 stones, largest stone length >10 mm) who underwent Ultramini-ECIRS or RIRS between January 2020 and November 2024. PSM yielded 49 patients per group, balanced for stone area, length, density, and the presence of lower calyx stones. The primary outcome was the one-month stone-free rate (SFR), defined as the absence of residual fragments >4 mm. Assessment was performed via computed tomography (CT) for radiolucent stones and plain radiography (KUB) or CT for radiopaque stones. Results Ultramini-ECIRS was associated with significantly higher primary SFR (81.6% vs. 34.7%; OR: 12.50; 95% CI: 2.96–52.77; p <0.001) and final SFR (85.7% vs. 51.0%; OR: 5.25; 95% CI: 1.80–15.29; p <0.001). The stone reduction rate was also higher in the Ultramini-ECIRS group (97.5% vs. 71.6%, p <0.001). Subgroup analysis of lower calyx stones demonstrated a consistent clearance advantage for the combined approach. No significant differences were observed in operative time, hospital stay, hemoglobin decrease, or renal function changes. The incidence of postoperative Clavien–Dindo grade II or higher complications was comparable between Ultramini-ECIRS and RIRS group (24.5% vs. 36.7%, p =0.188). Conclusion In this propensity score-matched cohort, Ultramini-ECIRS was associated with higher single-session SFR compared to RIRS for selected high-burden multiple renal stones with a comparable safety profile. These results suggest a potential role for Ultramini-ECIRS in managing complex stone distributions, particularly those involving the lower calyx. Further prospective randomized trials are warranted to further validate these findings.
