Dismembered pyeloplasty is the reference standard for ureteropelvic junction obstruction (UPJO). Two-dimensional (2D) laparoscopy is limited by the loss of stereoscopic depth perception; robotic pyeloplasty and three-dimensional (3D) laparoscopy were developed to address this. Three-arm comparisons including 3D laparoscopy as a distinct intermediate technology, particularly from resource-constrained settings, remain scarce. We retrospectively analysed 109 consecutive patients undergoing primary Anderson–Hynes dismembered pyeloplasty between January 2018 and June 2022, performed by a single surgical team: 2D laparoscopic (n = 27), 3D laparoscopic (n = 27) and robotic (n = 55). Patients were not randomised, and the groups reflect the modality actually used, with robotic procedures performed on the da Vinci Xi and 3D procedures on an Olympus system. Continuous variables were compared by one-way ANOVA with Tukey post-hoc testing, and categorical variables by the chi-square or Fisher–Freeman–Halton exact test. Complications were graded by the Clavien–Dindo classification. Treatment success was a six-month composite of symptom resolution, unobstructed renographic drainage and preserved differential renal function. Multivariable logistic and linear regression were used to adjust for pre-specified confounders. Effect estimates are reported with 95
Abstract Background and objective The optimal sequence of ureteral and vascular control during laparoscopic nephroureterectomy (LNU) for non-muscle-invasive (≤ pT1) upper tract urothelial carcinoma (UTUC) remains controversial. We compared distal-first (initial ureteral ligation) and proximal-first (initial renal pedicle control) approaches regarding perioperative safety and intravesical recurrence. Methods Consecutively treated patients with non-muscle-invasive UTUC (≤ pT1) who underwent LNU from 2019 to 2023 were retrospectively enrolled. Exclusion criteria included prior ureteroscopic manipulation, concomitant bladder cancer, stage ≥pT2, incomplete data, or loss to follow-up. Based on operative records, 57 patients underwent a proximal-first and 67 a distal-first approach. All received a single immediate postoperative intravesical instillation of pirarubicin or gemcitabine according to institutional protocol and were followed for up to 2 years. Intravesical recurrence-free survival was estimated by Kaplan-Meier analysis and compared with the log-rank test. A multivariable Cox regression model was used to adjust for age, tumor location, and tumor grade. Results Baseline characteristics were well balanced between groups. Perioperative outcomes, including operative time, estimated blood loss, and hospital stay, did not differ significantly (all P > 0.05). No major complications occurred in either group; minor complications (Clavien-Dindo I–II) were comparable (proximal-first: 14.0% vs. distal-first: 13.4%, P = 0.923). During the 24-month follow-up period, intravesical recurrence occurred in 17 of 57 patients (29.8%) in the proximal-first group versus 11 of 67 (16.4%) in the distal-first group (absolute risk reduction, 13.4%; number needed to treat, 8). The distal-first approach was associated with a numerically lower recurrence rate, but the difference did not reach statistical significance (HR, 2.06; 95% CI, 0.96–4.43; log-rank P = 0.064). The wide confidence interval, which narrowly crosses unity, reflects the limited precision of this estimate. In the pre-specified renal pelvic/upper ureteral tumor subgroup (n = 63), recurrence rates were 28.6% (8/28) versus 11.4% (4/35), yielding an absolute risk reduction of 17.1% and a number needed to treat of 6 (HR, 2.78; 95% CI, 0.87–8.87; log-rank P = 0.085). After multivariable adjustment, the association was attenuated (aHR, 1.27; 95% CI, 0.57–2.83; P = 0.561). Conclusions In this retrospective cohort study, both distal-first and proximal-first LNU achieved comparable perioperative safety. The distal-first strategy, by ligating the terminal ureter at the bladder insertion before renal mobilization, better adheres to the no-touch principle. Although a trend toward reduced intravesical recurrence was observed, this did not reach statistical significance and was attenuated after multivariable adjustment. The wide confidence intervals preclude definitive conclusions regarding the magnitude of clinical benefit. These findings warrant prospective validation in a multicenter randomized trial.
Erectile dysfunction (ED) is highly prevalent in men with end-stage renal disease (ESRD) and significantly affects quality of life. Renal transplantation may improve erectile function; however, recovery is often incomplete and influenced by multiple clinical factors. To evaluate changes in erectile function following renal transplantation and to identify factors associated with recovery. This observational study included 41 male renal transplant recipients at a tertiary care center. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire before transplantation and at six months post-transplant. Patients were stratified based on baseline ED severity. The association of comorbidities such as diabetes mellitus, hypertension, smoking status and duration of dialysis with post-transplant erectile outcomes was analyzed. Mean IIEF-5 scores improved significantly from 14.6 ± 5.7 before transplantation to 19.1 ± 5.6 at six months post-transplantation (p < 0.001). The proportion of patients without ED increased from 7.3
A leaking Continent Cutaneous Catheterizable Channel (CCCC) is a significant and frustrating complication that may need more than one revisional surgery for management. Moreover, some patients are still incontinent after these surgeries. Total channel substitution is required in case of complete disruption of the channel or continence mechanism. However, treatment options are limited. The aim of this study is to illustrate a new outlet mechanism suitable for correcting a leaking CCCC in children. Initially, it was described for urinary conversion in cases of urethral recurrence following radical cystectomy and orthotopic urinary diversion for bladder cancer. The proposed technique was performed in two selected cases. The first one was an 11-year-old boy with a diagnosis of neuropathic bladder due to meningomyelocele. He presented with urinary incontinence via the urethra with a leaking CCCC after previous augmentation ileocystoplasty and bladder neck reconstruction with appendicovesicostomy CCCC. The second case was an 8-year-old boy who was a known case of neuropathic bladder post abdominoperineal rectal pull-through surgery for imperforate anus, which was managed by augmentation ileocystoplasty and bladder neck reconstruction with Monti CCCC. He developed a leaking CCCC after a history of traumatic failed catheterization. Total channel substitution was performed using a spiral Monti tube with a serous-lined extramural tunnel continence mechanism via longitudinal opening of only the anterior wall of the pouch. A 6 cm ileal segment was used. No major complications were recorded. At the last follow-up, the channel was still continent with normal upper tract sonographically. The proposed technique may be a valuable option for the management of a leaking CCCC in children. It allows the use of a short ileal segment in this challenging cohort of patients. Further prospective studies on a larger number of patients and longer follow-up are recommended.
Abstract Objective To evaluate the clinical outcomes of flexible ureteroscopic management of calyceal diverticular stones and to validate the novel L.E.N.S.O. Radiological Complexity Score as a predictor of procedural difficulty and stone-free outcomes. Methods This retrospective observational study included 52 consecutive symptomatic patients with calyceal diverticular stones who underwent retrograde intrarenal surgery (RIRS) with laser infundibulotomy between January 2020 and January 2026. Preoperative radiological parameters including diverticulum location (L), excretion (E), neck visibility (N), stone size (S), and orientation (O) were scored to calculate the L.E.N.S.O. score (range 5–10). Patients were categorized as low (score ≤ 6), moderate (score 7–8), or high complexity (score ≥ 9). Primary outcomes included stone-free rate (SFR) and technical success. Secondary outcomes included operative time, complications, hospital stay, and need for auxiliary procedures. Results The overall stone-free rate at 3 months was 69.2%. The L.E.N.S.O. score demonstrated significant correlation with SFR at 1 month ( p < 0.001) and 3 months ( p < 0.001), operative time ( p = 0.002), and need for auxiliary procedures ( p < 0.001). Low-complexity patients ( n = 19, 36.5%) had SFR of 94.7% at 3 months with no auxiliary procedures, while high-complexity patients ( n = 8, 15.4%) had SFR of 25.0% and 75.0% required auxiliary procedures. Multivariate analysis identified poor excretion (OR 0.24, p = 0.01) and non-visible neck on imaging (OR 0.26, p = 0.02) as independent predictors of treatment failure. Conclusion Flexible ureteroscopic management is effective for calyceal diverticular stones, particularly in selected patients with favorable anatomy. The L.E.N.S.O. Radiological Complexity Score is a simple, reproducible tool that reliably predicts procedural difficulty and stone-free outcomes, enabling personalized surgical planning and patient counselling.
The impact of upper urinary tract drainage on survival in patients with cervical cancer complicated by obstructive renal failure remains controversial. The objective of this study was to evaluate the prognostic impact of upper urinary tract drainage on overall survival and the evolution of biological parameters in these patients. Prospective single-center study over 18 months (January 2024-May 2025) including 55 patients presenting with cervical cancer with obstructive renal failure at Conakry University Hospital. Drainage modalities (double-J stent, percutaneous nephrostomy) were analyzed. Outcome criteria included overall survival (Kaplan-Meier), evolution of creatininemia and hemoglobin. Logistic regression and Cox model identified independent prognostic factors. Mean age was 56.3 years. Stage IIIB predominated (65.5
Abstract Background This review synthesised current evidence on emerging serum and urine protein biomarkers with diagnostic, prognostic, and predictive relevance for non-invasive PCa detection and risk stratification. Methods A systematic search of PubMed, Scopus, and ScienceDirect was conducted for studies published between January 2006 and December 2025. Study selection was performed independently by two reviewers, with disagreements resolved by an additional reviewer. Eligible cohort, case-control, and cross-sectional studies reporting diagnostic performance were included. Study quality was assessed using the QUADAS-2 tool, and findings were synthesized narratively. Results Out of 1,543 records identified, sixteen studies met the inclusion criteria with moderate-to-low overall risk of bias. Our analysis highlights several biomarkers that demonstrate superior diagnostic performance compared to PSA models. These key serum-based potential markers include the PSA derivatives, particularly Prostate Health Index (PHI), which consistently improves prediction of significant PCa and tumor volume; the GDF15 propeptide, which reliably detects bone metastasis in castration-resistant PCa; and the MiCheck panel (IL-7, VEGF, GPC-1), which effectively differentiates aggressive from non-aggressive PCa. Furthermore, the serum PSP94/PSA ratio shows strong potential to distinguish PCa from benign prostatic hyperplasia (BPH). Notable urine-based markers include ANXA3, which significantly enhances diagnostic performance in the PSA “gray zone” (4–10 ng/mL), and panels of uromodulin peptides, which demonstrate high specificity in differentiating PCa from controls. The integration of these novel markers into multivariable models significantly increases diagnostic accuracy, with some combinations achieving AUCs as high as 0.979. Exosomal PSA demonstrated good diagnostic performance compared with conventional serum PSA; however, these findings should be interpreted with caution, given the small sample size and lack of external validation. Conclusion Serum and urine protein biomarkers may complement PSA-based testing to improve non-invasive PCa detection and risk stratification, thereby minimising PSA-associated overdiagnosis and avoiding unnecessary biopsies.
Abstract Background Male infertility contributes to nearly half of all infertility cases among couples, and azoospermia accounts for about 10–15% of these. Non-obstructive azoospermia (NOA) results from testicular failure to produce sperm rather than physical obstruction. Micro-dissection testicular sperm extraction (micro-TESE) is currently the most effective technique for sperm retrieval in NOA, yet its outcome remains variable. Identifying reliable predictive factors could improve patient counseling, optimize selection, and reduce treatment costs. Objective To identify clinical, hormonal, and histopathological predictors associated with successful micro-TESE outcomes in men with NOA. Methods A prospective study was conducted on 600 men with NOA at Qena University Hospital (May 2022 – May 2024). All patients underwent detailed clinical assessment, hormonal evaluation, scrotal ultrasonography, and micro-TESE under an operating microscope. Variables analyzed included age, testicular volume, hormone profile (FSH, LH, testosterone, estradiol, prolactin), Outcomes were compared between successful and failed micro-TESE procedures. Statistical analyses employed Mann–Whitney U (MWU), chi-square (χ 2 ), Fisher’s exact (f) tests, logistic regression, and receiver-operating-characteristic (ROC) curves. Results Successful sperm retrieval occurred in 62.7% (376/600) of patients. Predictors of success included larger testicular volume, prior infertility treatment, lower FSH, LH, estradiol, and prolactin levels, and higher testosterone levels (all p < 0.05). Multivariate regression analysis identified hormonal profile and testicular volume as significant predictors. ROC analysis showed excellent performance for testosterone > 4.8 ng/mL (AUC = 0.94, 90.6% sensitivity) and Johnsen score > 1.5 (AUC = 0.98, 97.2% sensitivity). Conclusion Hormonal profile, testicular size, prior treatment, and histopathology significantly influence micro-TESE outcomes in NOA. Incorporating these parameters into pre-operative evaluation may improve patient selection and success rates.
Neurogenic lower urinary tract dysfunction after spinal cord injury is associated with bladder cancer which is characteristically diagnosed at a younger age, at an advanced stage, and with a disproportionate squamous component. Existing syntheses have not integrated spinal cord injury, spina bifida, and augmentation-cystoplasty substrates, or considered their implications for sub-Saharan Africa, where an independent schistosomal squamous pathway and constrained surveillance infrastructure may coexist. We aimed to provide an updated pooled estimate of bladder cancer occurrence, characterise the histological pattern in neurogenic populations, and appraise the surveillance evidence with explicit regional interpretation. We conducted a systematic review reported in accordance with the PRISMA 2020 statement. MEDLINE/PubMed, Embase, Scopus, and Web of Science were searched from inception to the most recent full month, supplemented by a citation search. Studies reporting bladder cancer occurrence, histology, stage, mortality, risk factors, or surveillance yield in adults with neurogenic lower urinary tract dysfunction were eligible. Two reviewers screened, charted, and appraised studies independently via the Joanna Briggs Institute critical appraisal tools. The cumulative proportions were pooled via Freeman–Tukey double-arcsine transformation within a DerSimonian–Laird random-effects model, with heterogeneity quantified by I². Fourteen studies were included, five of which contributed to the primary quantitative synthesis. The pooled cumulative proportion of patients with bladder cancer among the patients in the spinal cord injury cohorts was 0.35
Prostate cancer (PCa) is the second most common malignancy diagnosed in men worldwide, with approximately 1.47 million new cases reported in 2022. Biochemical recurrence (BCR), defined as a rising prostate-specific antigen (PSA) after radical treatment, is the first clinical sign of disease relapse and a harbinger of metastasis and cancer-specific mortality. Accurate, non-invasive prediction of BCR is essential for guiding individualized treatment decisions and optimizing long-term outcomes. This narrative review critically evaluates the current evidence on artificial intelligence (AI)-based approaches—encompassing radiomics, machine learning (ML), and deep learning (DL)—applied to multiparametric magnetic resonance imaging (mpMRI) for the prediction of BCR in PCa following radical prostatectomy (RP) or radiation therapy (RT). The review further examines multimodal AI approaches integrating mpMRI with prostate-specific membrane antigen positron emission tomography (PSMA-PET), digital pathology, and genomic data. This manuscript is a narrative review; no systematic protocol was registered. Among the reviewed studies, mpMRI-based radiomics models achieved area under the receiver operating characteristic curve (AUC) values ranging from 0.72 to 0.97 for BCR prediction, though this wide range reflects substantial methodological and population heterogeneity. Deep learning models, particularly those combining mpMRI features with clinical parameters, demonstrated C-index values up to 0.83. Because the area under the receiver operating characteristic curve (a discrimination metric for binary classification) and the C-index (for time-to-event survival analysis) are distinct statistical measures, radiomics AUC and deep-learning C-index values are reported separately here and are not directly comparable or interchangeable. AI-powered mpMRI analysis holds substantial promise for non-invasive, accurate BCR prediction in PCa. Integration of radiomics and DL with clinical and multi-omics data within standardized, multi-center frameworks represents the most promising future direction. Regulatory-compliant, externally validated models with demonstrated calibration are required before routine clinical implementation.
Abstract Background Prostate cancer remains a leading cause of cancer morbidity and mortality among men globally, with the highest death rates observed in low- and middle-income countries (LMICs). Although therapeutic advances have substantially improved outcomes in high-income settings, their impact in LMICs has been limited by late presentation, diagnostic constraints, restricted access to effective treatments, and health system fragility. Metastatic prostate cancer therefore dominates clinical practice in many LMICs, necessitating context-adapted diagnostic and management strategies. Methods This narrative review synthesizes evidence from population-level datasets, international clinical trials, observational studies, and global oncology policy literature to examine the diagnosis and management of metastatic prostate cancer in low- and middle-income countries, with particular emphasis on sub-Saharan Africa where the burden of late-stage disease and the implementation constraints are most consistently documented. Evidence was selected for clinical relevance, feasibility, and health system applicability rather than for statistical pooling. Results Across many LMIC settings, 40–70% of men with prostate cancer present with metastatic disease at diagnosis, contributing to five-year survival rates below 40%, compared with over 90% in many high-income countries. Diagnostic pathways are constrained by limited access to Prostate-Specific Antigen (PSA) testing, pathology services, conventional imaging, and advanced staging technologies, necessitating risk-stratified and symptom-directed approaches. In metastatic castration-sensitive prostate cancer, reliable androgen deprivation therapy remains the treatment foundation, with surgical orchiectomy offering a durable and cost-effective option where medical castration is unaffordable or unreliable. Docetaxel provides meaningful survival benefit in selected fit patients but requires minimum supportive care capacity, while access to androgen receptor pathway inhibitors remains highly variable. In metastatic castration-resistant disease, most patients depend on chemotherapy, symptom control, and palliative care. Cross-cutting barriers include financial toxicity, workforce shortages, fragmented referral pathways, and unreliable medicine supply chains. Nonetheless, implementation models from several LMICs demonstrate measurable improvements in access, continuity of care, and affordability through integrated financing, task-shifting, and centralized procurement. Conclusion Outcomes for men with metastatic prostate cancer in LMICs are shaped more by health system capacity than by therapeutic efficacy alone. The evidence supports a tiered approach that prioritizes timely diagnosis, uninterrupted androgen deprivation therapy, selective treatment intensification, and accessible palliative care. Lessons from sub-Saharan Africa show that measurable gains are achievable through task-sharing, simplified referral pathways, centralized procurement, and financial protection for essential cancer services.
Abstract Background Augmentation cystoplasty (AC) is traditionally reserved for end-stage small-capacity bladders. Increasing evidence suggests that earlier intervention in patients with borderline bladder capacity may preserve bladder function and protect the upper urinary tract. We evaluated long-term functional, urodynamic, renal, and quality-of-life outcomes of early augmentation cystoplasty in adults with borderline bladder capacity. Methods This retrospective observational study included 40 adult patients with borderline bladder capacity (100–170 mL) who underwent open ileocystoplasty at a tertiary referral center between 2015 and 2024. All patients had refractory storage lower urinary tract symptoms despite maximal medical therapy. Pre- and postoperative assessments included urodynamics, renal function, vesicoureteral reflux (VUR), continence status, need for clean intermittent catheterization (CIC), and validated quality-of-life questionnaires. Mean follow-up duration was 6 years. Results The mean age was 41.2 years; etiologies included neurogenic bladder (45%), genitourinary tuberculosis (42%), post-radiation cystitis (7.5%), and others. Mean bladder capacity increased from 139.6 ± 16.6 mL to 282 ± 12.4 mL ( p < 0.05), and compliance improved from 17 to 40 mL/cm H₂O ( p < 0.05). Mean detrusor filling pressure decreased from 46 to 13.6 cm H₂O ( p < 0.05). Continence was achieved in 95% of patients; 67.5% voided spontaneously and 32.5% required CIC. Serum creatinine improved significantly (1.77 to 1.41 mg/dL; p < 0.05), with no deterioration in renal function during follow-up. Among patients managed without ureteric reimplantation, VUR resolved in 81.3% and downgraded in the remainder. Late complications included bladder stones in 10% and recurrent urinary tract infections in 5%. No malignancy or significant metabolic complications were observed. Conclusions Early augmentation cystoplasty in adults with borderline bladder capacity provides durable improvement in bladder function, continence, and quality of life, while preserving renal function and effectively resolving pressure-dependent vesicoureteral reflux. Timely surgical intervention, rather than delayed treatment in end-stage disease, may prevent irreversible bladder and renal damage with acceptable long-term morbidity.
Abstract This letter is a response to the study by Masoud et al. on post furosemide ultrasonography predicting the need for pyeloplasty in children with prenatally detected pelvi ureteric junction like hydronephrosis. While commending the efforts of the authors to identifya non-invasive alternative to diuretic renography, we raise few methodological concerns which may affect the interpretation of the results. We also propose a simpler, injection free alternative based on comparison of anteroposterior diameter in supine and prone position and present a methodology which classifies drainage of the pelvicalyceal system as good, partial or poor based on ultrasonography findings and which guides further management.
Abstract Background Apparent clinical complete response after neoadjuvant or multidisciplinary therapy in non-metastatic muscle-invasive bladder cancer has renewed interest in omitting or deferring radical cystectomy for selected patients. The central uncertainty is whether favorable endoscopic, cytologic, pathological sampling, and imaging findings can exclude both residual intravesical disease and occult systemic minimal residual disease with sufficient confidence to justify de-escalation. Main body We performed a decision-focused structured narrative review, updated through 5 June 2026, and an aggregate-data Bayesian calibration analysis. The review was designed to examine the post-treatment pre-omission decision point, not to establish a validated clinical pathway. Recent systematic evidence shows that clinical complete response definitions are heterogeneous and that concordance between clinical and pathological complete response is moderate. Using the pooled cCR-pCR concordance estimate as a pretest anchor, the residual probability of pathological disease after apparent cCR is approximately 49%. A negative molecular restaging layer would therefore need a negative likelihood ratio of about 0.12 to reduce residual disease probability below 10%, about 0.18 to reduce it below 15%, and about 0.26 to reduce it below 20%. Organ-preservation cohorts, trimodality therapy experience, and emerging immune-checkpoint-inhibitor strategies show feasibility, but they do not remove the need for stringent local reassessment, histology-aware selection, advanced imaging where appropriate, rapid salvage pathways, and prospective validation. Plasma circulating tumor DNA and urine tumor DNA should be interpreted as complementary, non-interchangeable readouts: plasma is more closely aligned with systemic molecular residual disease, whereas urine more directly samples intravesical tumor shedding. Conclusions Clinical complete response should be treated as a residual-risk state rather than proof of cure. Dual-negative plasma and urine tumor-DNA results may provide the strongest biological support for surveillance, but only within expert multidisciplinary programs or prospective protocols. Urine-positive-only, plasma-positive-only, dual-positive, and indeterminate states require prespecified actions before dual-compartment restaging is used routinely.
Abstract Objectives To compare functional outcomes and complications of HoLEP using 22–26 F sheath. Patients and Methods This retrospective analysis included data from patients who underwent HoLEP between May 2023 and September 2024. Patients were divided into two groups: Group 1 (22 F sheath) and Group 2 (26 F sheath). Functional outcomes assessed included International Prostate Symptom Score (IPSS), maximum flow rates (Q-max), and postvoid residual (PVR). Assessed complications were incidence of stress and urge incontinence, and urethral stricture. Follow-up was done at 1, 3, 6, and 12 months. Results A total of 190 patients were included (94 in Group 1 and 96 in Group 2). Intraoperative complications (two patients in group 2) and re-admission rates (one patient for each group for clot retention) were comparable. No major complications were reported. Group 1 demonstrated significantly lower IPSS scores at all follow-up intervals. Starting from third month follow-up, Q-max was significantly better for group 2. PVR was significantly better in group 2 in all follow-up intervals. Transient stress urinary incontinence rates were lower in group 1 at one and three months (P < 0.001 and 0.045 respectively). Then both groups had comparable results. Urge urinary incontinence rates were lower in group 1 at one month (P = 0.001), then they became comparable. Urethral stricture rates were 3.2% for 22 F group versus 6.2% for 26 F group, P = 0.321. In multivariate analysis, Sheath size was the only independent predictor of overall complications where odds ratio for 26 F sheath was 3.123, 95%CI: 1.15–8.48, P = 0.025). Conclusions The use of 22 F sheath in HoLEP showed improving IPSS and better early continence. The use of 26 F sheath resulted in better urine flow but was associated with more overall complications.
Abstract Background To assess long-term trends in mortality and disease burden from prostate cancer in Albania during 1990–2023 in comparison to other Southeastern European countries and broader European regions. Materials and methods An analysis of mortality and morbidity estimates of prostate cancer was conducted based on data available from the Global Burden of Disease (GBD) studies. Crude and age-standardized mortality rates, proportional mortality, and Disability-Adjusted Life Years (DALYs) of prostate cancer were analysed for Albania. Furthermore, age-standardized estimates of Albania were compared with Southeastern European countries and with Eastern, Central, and Western European regions. Results From 1990 to 2023, prostate cancer mortality and DALYs in Albania increased modestly in absolute terms, whereas age-standardized rates remained relatively stable. Conversely, proportional mortality and DALYs increased, due to population ageing. Compared with Southeastern Europe, Albania exhibited lower or comparable age-standardized rates, with smaller increases than several neighbouring countries. By 2023, Albania’s prostate cancer burden, which increased modestly since 1990, remained nevertheless the lowest across European regions, despite Western Europe’s sharp decline. Conclusion Notwithstanding the lowest burden in Europe, prostate cancer in Albania exhibits a growing proportional impact on public health which is a cause of concern. Importantly though, Albania’s lowest prostate cancer mortality and disease burden compared with all European regions may reflect under-reporting, warranting extreme caution in interpreting its comparatively favourable position and highlighting the importance of strengthening cancer surveillance and prevention strategies to ensure accurate monitoring and sustained public health gains.
Abstract Objective To prospectively evaluate the technical success rate, safety profile, and clinical outcomes of using air pyelogram to guide percutaneous access in percutaneous nephrolithotomy (PCNL). Materials and methods This prospective observational study included 350 consecutive patients undergoing PCNL between July 2025 and December 2025. A standardized air pyelogram protocol was followed with a maximum of 10 mL room air instilled retrogradely. Primary outcomes were technical success of calyceal visualization and incidence of complications, particularly venous air embolism (VAE). Secondary outcomes included stone-free rate (SFR), fluoroscopy time, and comparison between air-only and air-contrast groups in which air pyelogram failed and contrast was needed. Results Air alone provided adequate visualization in 318 patients (90.9%), with only 32 (9.1%) requiring conversion to contrast. Upper calyx visualization was achieved in 98.6% of cases. Overall SFR at 4 weeks was 91.7%. Major complications (Clavien-Dindo ≥ 2) occurred in 6% of patients, with no clinical evidence of venous air embolism. The air-only group demonstrated significantly superior outcomes compared to the air-contrast group: higher SFR (92.8% vs. 81.3%, p = 0.024), fewer access attempts (1.15 ± 0.42 vs. 2.19 ± 1.2, p < 0.001), shorter fluoroscopy time (308.1 ± 105.1 vs. 481.5 ± 157.4 s, p < 0.001), and shorter operative time (35.8 ± 17.5 vs. 45.9 ± 21.6 min, p = 0.014). Conclusion Air pyelogram with a standardized low-volume protocol is a safe, effective, and radiation-sparing technique for guiding percutaneous access in PCNL. It provides excellent visualization of posterior calyces with no demonstrable risk of venous air embolism when strict volume limits are observed.
Abstract Background In the present era of cost containment an analysis of various clinical investigations including histopathological analysis becomes important with the to improve health care system by proper utilization of financial resources especially in minimal invasive procedures where cost of instrumentation is high. Pyeloplasty remains one of the most performed procedure in pathology in both pediatric and adult urology with pathological assessment of resected PUJ being routine practice. We hypothesized that routine histopathological examination in patients undergoing pyeloplasty does not provide any significant new diagnosis which can affect further patient management. Methods Medical records of 142 renal units undergoing Anderson–Hynes dismembered pyeloplasty were reviewed. Operative findings, pathological reports, and postoperative outcomes were analyzed to determine the diagnostic utility of HPE. Cost data were retrieved from institutional billing and pathology records. The cumulative carbon footprint and manhours saved from omitting routine HPE were estimated. Results Histopathology demonstrated chronic inflammation with fibrosis in 94 (66%), smooth muscle hypertrophy in 25 (18%), increased elastin in 13 (9%) and smooth muscle atrophy in 10 (7%) cases. No pathological diagnosis altered postoperative management. Redo pyeloplasty was required in 4 cases, all attributable to anatomical or technical factors, not histological abnormalities. Routine HPE generated a total cost of USD 28,400 Eliminating this practice would save approximately 700–1,000 pathology man hours and reduce 50–120 kg of CO₂ emissions annually in comparable surgical volumes. Conclusion The routine HPE in pediatric pyeloplasty yields no clinical benefit, adds unnecessary cost, consumes manpower, and contributes to the carbon footprint. A selective HPE strategy appears to be more safe and more sustainable.
Abstract Background Prostate cancer is one of the most frequently diagnosed malignancies among men worldwide and remains a major contributor to cancer-related mortality. Conventional diagnostic tools such as prostate-specific antigen (PSA) testing and transrectal ultrasound (TRUS)-guided biopsy have notable limitations in sensitivity and specificity. Recent advancements in imaging, including biparametric magnetic resonance imaging (bpMRI) and strain elastography, have demonstrated improved diagnostic performance in identifying clinically significant prostate cancer. Objective To evaluate the diagnostic accuracy of combining TRUS with strain elastography and biparametric MRI in enhancing cognitive targeting for prostate cancer detection. Methods This retrospective study included 32 patients presenting with elevated PSA levels or abnormal digital rectal examination findings. All patients underwent bpMRI followed by TRUS with strain elastography prior to biopsy. Imaging findings were correlated with histopathological outcomes. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), with significance assessed using chi-square and t-tests. Results Malignancy was detected in 56.25% of patients. Strain elastography demonstrated a statistically significant association with malignancy (p = 0.015), with stiff (blue) areas correlating strongly with cancerous lesions. bpMRI showed high diagnostic performance, particularly in PI-RADS 4 and 5 lesions. The combined approach improved specificity and lesion localization, although this was associated with a reduction in sensitivity due to the use of a concordance-based diagnostic strategy. Conclusion The combined use of biparametric MRI and TRUS strain elastography improves specificity and lesion localisation in prostate cancer detection and may support cognitive targeting in settings where fusion-guided biopsy is not available. However, this approach is associated with a trade-off in sensitivity, and findings should be interpreted cautiously given the small sample size. Further prospective studies with larger cohorts are required to validate these results.
Abstract Background Sperm DNA fragmentation (SDF) is a clinically relevant marker of male reproductive potential and is frequently elevated in men with oligozoospermia. Impairment of DNA damage response and repair pathways has been implicated in increased SDF. The NBN (nibrin) gene, a core component of the MRE11–RAD50–NBN (MRN) complex, plays a critical role in the detection and repair of DNA double-strand breaks. However, the contribution of pathogenic NBN variants to sperm DNA integrity in oligozoospermic men remains unclear. This study aimed to evaluate whether increased SDF in oligozoospermia is associated with pathogenic variants in the NBN gene. Methods In this case–control study, 50 infertile men with oligozoospermia and 50 age-matched fertile normozoospermic controls were enrolled. SDF and chromatin condensation abnormalities were assessed using the TUNEL assay and aniline blue staining, respectively. Targeted Next-generation sequencing (NGS) was performed on peripheral blood–derived genomic DNA to analyse all coding regions and exon–intron boundaries of the NBN gene. Identified variants were classified according to American College of Medical Genetics and Genomics guidelines. Results Men with oligozoospermia exhibited significantly higher levels of SDF and chromatin condensation defects compared with fertile controls (p < 0.001). No pathogenic or likely pathogenic variants in the NBN gene were identified in either group. Common benign variants were observed but did not correlate with semen parameters or DNA fragmentation levels. Conclusions These findings suggest that no significant association was detected between increased SDF and pathogenic NBN gene variants within this specific cohort. The results argue against a major independent role of NBN in isolated oligozoospermia-associated sperm DNA damage and suggest that alternative DNA repair pathways, epigenetic mechanisms, or non-genetic factors may contribute to impaired sperm DNA integrity. Assessment of SDF may therefore provide clinically relevant information beyond conventional semen analysis in the evaluation of male infertility.
