UNLABELLED:Male genital lymphedema is a rare condition characterized by progressive enlargement of the scrotal and penile tissues. It is associated with substantial physical and psychological morbidity, frequently impairing urinary and sexual function, hygiene, and ambulation. Genital lymphedema may result from secondary lymphatic obstruction to infectious, inflammatory, neoplastic, congenital, or iatrogenic causes. Despite its clinical impact, no standardized diagnostic or therapeutic algorithm has been established to date. UNLABELLED:Herein, we present our diagnostic approach and describe a surgical technique involving excision of penoscrotal lymphedematous tissue followed by genital reconstruction using local flaps. UNLABELLED:The management of massive genital lymphedema remains surgically challenging, with multiple reconstructive options available depending on the extent of the disease and patient characteristics. Reconstructive surgery is generally associated with favorable functional and aesthetic outcomes, leading to significant improvements in quality of life.
OBJECTIVE:To compare the efficacy and safety of thulium fibre laser (TFL) and holmium:yttrium aluminum garnet (Ho:YAG) laser in flexible ureteroscopic lithotripsy for 1-2 cm lower pole kidney stones. METHODS:This retrospective analysis included 160 patients with 1-2 cm lower pole stones (LPSs) admitted to our hospital between January 2024 and December 2025. Patients were assigned to a TFL group and a Ho:YAG group according to the surgical technique used. After applying propensity score matching (PSM), two matched groups with 60 cases each were obtained. Outcome variables included surgery-related indicators, postoperative recovery indicators, stone-free rate (SFR), and postoperative complications. RESULTS:The operation time, lithotripsy time, hospital stay, first ambulation time, and urethral catheter indwelling time in the TFL group were significantly shorter than those in the Ho:YAG group (all p < 0.05). The incidence of intraoperative stone retropulsion and the visual analogue scale (VAS) score at 24 h postoperatively were significantly lower in the TFL group than in the Ho:YAG group (both p < 0.05). At 4 weeks postoperatively, the SFR was significantly higher in the TFL group than in the Ho:YAG group (93.33% vs. 80.00%; p < 0.05), and the overall complication rate was significantly lower in the TFL group than in the Ho:YAG group (6.67% vs. 20.00%; p < 0.05). Stratified analysis showed that TFL was associated with shorter operation time and lithotripsy time across different stone sizes and densities. Furthermore, in patients with a diameter ≥1.5 cm, the SFR was higher in the TFL group than in the Ho:YAG group. The SFR in the Ho:YAG group was significantly lower in large-diameter stones than in small-diameter stones, whereas the TFL group showed consistently high SFR (>90%) across all subgroups. CONCLUSIONS:Compared with Ho:YAG laser, TFL was associated with better efficiency and perioperative outcomes in flexible ureteroscopic lithotripsy for 1-2 cm LPSs. TFL may provide more consistent fragmentation efficacy in larger stones and may reduce the risk of stone retropulsion and postoperative complications.
BACKGROUND:Elevated intrarenal pressure during mini-percutaneous nephrolithotomy (mini-PCNL) may worsen systemic inflammation and affect stone clearance. This study compared stone-free rates and incidence of systemic inflammatory response syndrome (SIRS) between intelligent pressure-controlled and conventional mini-PCNL after propensity score matching (PSM). METHODS:This retrospective cohort study included patients undergoing primary mini-PCNL for kidney stones (April 2022-April 2025). After PSM, patients were divided into a conventional mini-PCNL group (n = 136) and an intelligent pressure-controlled group (n = 136). Primary outcomes included stone-free rates (residual fragments <4 mm) at postoperative day 1, month 1, and month 3, and SIRS incidence. Secondary outcomes included operative time, blood loss, hospital stay, pain scores, inflammatory markers, and complications. RESULTS:The intelligent pressure-controlled group had a significantly higher immediate stone-free rate (p < 0.001), lower SIRS incidence (p = 0.040), shorter operative time (p = 0.006), less blood loss (p = 0.002), shorter hospital stay (p = 0.022), lower pain scores (p = 0.008), and lower postoperative C-reactive protein and procalcitonin levels (all p < 0.001). Total complication rate was lower in the intelligent pressure-controlled group than in the conventional group (11.76% vs. 25.00%, p = 0.005). CONCLUSIONS:Intelligent pressure-controlled mini-PCNL was associated with higher immediate stone-free rates, lower SIRS incidence, and better perioperative outcomes than conventional mini-PCNL in this retrospective matched comparison. Causality cannot be inferred due to the retrospective, non-randomised design. Findings warrant confirmation in prospective randomised trials.
BACKGROUND:Complex and refractory urolithiasis represents a growing clinical challenge, characterised by a large stone burden, recurrent disease, anatomical abnormalities, infection, and metabolic risk factors, all of which complicate management and increase morbidity. Contemporary management has shifted toward risk-stratified, minimally invasive strategies supported by advances in endourology, perioperative optimisation, and individualised patient assessment. To synthesise current evidence on the diagnostic evaluation, risk stratification, minimally invasive management, perioperative optimisation, special population management, and emerging techniques relevant to complex and refractory urolithiasis. METHODS:A structured narrative review of the published literature and contemporary guideline recommendations was conducted, focusing on comparative outcomes of extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and endoscopic combined intrarenal surgery (ECIRS), along with perioperative care principles and technological innovations. Evidence from recent clinical studies, systematic reviews, and international guidelines was synthesised qualitatively. RESULTS:ESWL retains a limited role in carefully selected low-complexity stones, whereas URS provides effective management for ureteric and moderate sized renal calculi. PCNL-based approaches demonstrate the highest stone-free rates for stones >20 mm, staghorn calculi, and anatomically complex disease, with miniaturised techniques and ECIRS offering potential morbidity reduction in selected cases. This review integrates surgical, perioperative, and preventive strategies into a unified clinical framework for high-risk stone disease. Outcomes are strongly influenced by perioperative infection control, metabolic optimisation, anticoagulation management, and structured postoperative surveillance. Management of special populations including patients with a solitary kidney, chronic kidney disease (CKD), paediatric patients, pregnant women, anatomical abnormalities, and those receiving anticoagulant therapy, requires individualised multidisciplinary care. Emerging technologies such as artificial intelligence-assisted imaging, augmented-reality guidance, single-use URS, and advanced laser technologies remain promising but investigational due to limited prospective evidence. CONCLUSIONS:Optimal management of complex and refractory urolithiasis depends on accurate risk stratification, appropriate selection among minimally invasive modalities, comprehensive perioperative optimisation, and individualised care in vulnerable populations. Future progress requires prospective comparative studies, standardised outcome reporting, and patient-centred evaluation of emerging technologies to ensure evidence-based improvement in long-term renal outcomes and quality of life.
BACKGROUND:To evaluate the effects of adding structured bladder function training to usual glycaemic and urological management on urinary tract infection (UTI) in patients with type 2 diabetes mellitus (T2DM) and neurogenic bladder. METHODS:This retrospective cohort study included 97 patients treated between April 2022 and April 2025. According to documented management pathways, patients received either usual care (usual glycaemic and urological care) alone (n = 47) or usual care plus structured bladder function training (n = 50) and were followed for 6 months. Glycaemic indices [fasting plasma glucose (FPG), 2-hour plasma glucose (2h PG), glycated hemoglobin A1c (HbA1c)], post-void residual urine volume (PVR), urodynamic parameters (Qmax, Qave, voided volume), and recurrent symptomatic UTI were analysed. RESULTS:Both groups showed significant improvements in glycaemic indices over time. Because glycaemic management was similar between groups, glycaemic results were interpreted as reflecting routine diabetes care rather than the effect of bladder function training. PVR decreased significantly, with significant group, time, and interaction effects (all p < 0.001), and remained lower in the bladder function training group during follow-up. Urodynamic parameters improved in both groups, with greater improvements in the bladder function training group. The cumulative recurrent symptomatic UTI rate was significantly lower in the bladder function training group (8.00% vs. 25.53%, p = 0.008). CONCLUSIONS:In this retrospective cohort, adding structured bladder function training to usual glycaemic and urological management was associated with improved voiding function and reduced UTI in patients with T2DM and neurogenic bladder.
BACKGROUND:To investigate the clinical characteristics and associated factors of urinary tract infections (UTIs) in infants and toddlers from a paediatric urological perspective. METHODS:This single-centre retrospective case-control study included 54 children with UTI and 54 hospital-based unmatched controls treated between January 2023 and December 2025. Perinatal factors, feeding patterns, constipation, clinically relevant external genital abnormalities, diaper changing, and perineal hygiene were compared between groups. Clinical manifestations, pathogens, antimicrobial susceptibility, recurrence, and ultrasound findings were analysed in the UTI group. Firth-corrected logistic regression was used to reduce small-sample estimation bias. RESULTS:The UTI group had higher proportions of low birth weight, non-exclusive breastfeeding, constipation, clinically relevant external genital abnormalities, infrequent diaper changing, and improper perineal hygiene than the control group (all p < 0.05). Multivariate analysis showed that low birth weight, non-exclusive breastfeeding, constipation, and improper perineal hygiene were independently associated with UTI (all p < 0.05). Fever, irritability, poor feeding, and voiding abnormalities were common presentations. Escherichia coli was the predominant pathogen, with high resistance to ampicillin, whereas susceptibility to nitrofurantoin, amikacin, and imipenem exceeded 95%. Ultrasound-detected urinary tract structural abnormalities may be associated with recurrence, but this result should be interpreted cautiously because of the small sample size. CONCLUSIONS:UTIs in infants and toddlers often present with non-specific symptoms; therefore, standardised urine specimen collection combined with comprehensive testing is crucial for early identification. Low birth weight, non-exclusive breastfeeding, constipation, and improper perineal hygiene were associated with UTI, among which feeding pattern, bowel habits, and perineal care are potentially modifiable. For empirical anti-infective therapy, cephalosporins or nitrofurantoin may be preferred. Further imaging evaluation should be individualised, with ultrasonography as the first-line assessment and voiding cystourethrography or dimercaptosuccinic acid scintigraphy reserved for selected children with recurrent febrile UTI, abnormal ultrasound findings, poor treatment response, or suspected renal scarring. Strengthening breastfeeding, constipation management, and perineal care may help reduce UTI occurrence.
OBJECTIVE:To investigate the association between perioperative tamsulosin use and outcomes of flexible ureteroscopic holmium laser lithotripsy (FURL). METHODS:This retrospective cohort study was performed on 122 patients who underwent FURL at Cixi People's Hospital, Wenzhou Medical University. Patients were divided into an observation group (perioperative tamsulosin + FURL, n = 62) and a control group (FURL alone, n = 60) according to routine clinical protocols and patient preference. Operation time, stone clearance rate at 4 weeks postoperatively, renal function indicators, inflammatory markers, and complication rates were compared between the two groups. RESULTS:Compared with the control group, the observation group had shorter operation time (51.34 ± 9.28 vs. 58.62 ± 10.35 min, p < 0.001), shorter postoperative hospital stay (3.62±1.05 vs. 4.85±1.23 days, p < 0.001), and a higher stone clearance rate (93.55% vs. 75.00%, p = 0.005). On postoperative day 1 and at week 1, renal function indicators were significantly lower in the observation group (all p < 0.05). Serum inflammatory marker levels on postoperative days 1 and 3 were also significantly lower in the observation group (all p < 0.001). The total complication rate was lower in the observation group (8.06% vs. 21.66%, p = 0.036). CONCLUSIONS:In this retrospective study, perioperative tamsulosin combined with FURL was associated with shorter operation times, higher stone clearance, and lower renal function, inflammatory, and complication markers. However, due to potential selection bias, these associations require confirmation via prospective randomized controlled trials.
BACKGROUND:Renal ultrasound is the first-line imaging method for postnatal hydronephrosis, but its severity grading remains partly reader dependent. Although previous studies have applied artificial intelligence (AI) to pediatric hydronephrosis assessment, the clinical feasibility of a simplified two-still-image workflow in a homogeneous infant cohort remains insufficiently defined. METHODS:This retrospective single-center proof-of-concept diagnostic accuracy study was conducted among 186 infants younger than 12 months with unilateral hydronephrosis who had one protocol-compatible transverse and one sagittal renal ultrasound image. The AI workflow classified hydronephrosis as mild, moderate, or severe using a two-branch convolutional neural network (CNN). Model performance was assessed using stratified patient-level five-fold internal validation. The reference standard was expert consensus based on the complete ultrasound examination. Study categories were aligned descriptively with accepted Society for Fetal Urology (SFU) and Urinary Tract Dilation (UTD) severity concepts but were not intended to replace these systems. RESULTS:A total of 186 infants were included. Expert consensus classified 79 cases as mild, 62 as moderate, and 45 as severe. The AI-assisted workflow showed exact agreement with expert consensus in 159 of 186 infants, corresponding to 85.5%, with a linear weighted kappa of 0.83. For clinically significant hydronephrosis, defined as moderate or severe disease, the AI workflow showed a sensitivity of 92.5%, a specificity of 86.1%, an accuracy of 89.8%, a positive predictive value of 90.0%, and a negative predictive value of 89.5%. The ordinal-score area under the curve (AUC), which is based on class labels rather than calibrated probability outputs, was 0.92 for clinically significant hydronephrosis and 0.96 for severe hydronephrosis. Because patient-level probability outputs were unavailable, formal calibration, decision curve analysis, threshold adjustment, and individualized risk estimation could not be performed. CONCLUSIONS:This single-center proof-of-concept internal validation study suggests that a simplified two-plane AI-assisted workflow could closely match expert consensus grading in selected infants with unilateral hydronephrosis. The workflow should be considered a research-only ordinal class assignment tool. This study does not establish clinical readiness, external generalizability, calibrated risk prediction, or diagnostic superiority over routine reporting. Prospective multicenter validation with preserved probability outputs and formal calibration is needed before any clinical implementation.
BACKGROUND:Complex ureteral strictures, irrespective of their aetiology, constitute a therapeutic challenge in everyday clinical practice. They are usually managed with antegrade or retrograde ureteral stent or double-J stent insertion, or the placement of a nephrostomy tube. The Detour® extra-anatomical stent (EAS) is a subcutaneous pyelovesical bypass proposed as an alternative solution for urinary diversion. The aim of this systematic review and narrative synthesis was to evaluate the safety and effectiveness of Detour EAS. METHODS:A literature search of MEDLINE, Scopus and Web of Science databases was performed using the following terms: Ureter* AND ("Subcutaneous pyelovesical bypass" OR "Extra-anatomical stent*" OR "Detour" OR "Artificial ureter" OR "Nephrovesical bypass"). Published observational and interventional studies evaluating the efficacy of Detour subcutaneous pyelovesical bypass placement in the management of complex ureteral stenosis were included. The primary outcome was functional stent success, whereas secondary outcomes included complications. RESULTS:Of 182 records identified, 25 studies including 344 unique patients were analysed. Functional success rate in most of the studies exceeded 85% at follow-up, ranging from 0% in a cohort of patients with ileal conduits to 100% in case reports and poor-quality case series. The most common complications included urinary tract infections, encrustation, infection of the overlying skin and dislodgement of the stent's vesical end. The EAS had to be removed in a total of 50 patients, while five deaths occurred, three due to prosthesis-related septic events, one due to palliative care cessation and one due to abdominal abscess-related sepsis. Despite these risks, Detour placement seemed to improve both renal function and quality of life in most cases. CONCLUSIONS:In selected patients Detour EAS might be considered as an alternative but its safety and efficacy need further investigation. Careful patient selection and surgical procedure optimisation are essential to improve its safety-related results.
BACKGROUND:This study aimed to adapt the peyronie's disease (PD) questionnaire into Turkish, psychometrically evaluate its validity, and explore its correlations with patient demographics and disease-specific characteristics. METHODS:The PD questionnaire (PDQ) is a 15-item, self-administered, disease-specific, and multidimensional tool developed to quantify the psychosexual symptoms of PD. This observational study enrolled 95 patients from four healthcare centers in Türkiye. Following translation according to the consensus-based standards for the selection of health measurement instruments, all participants were asked to complete the PDQ during two separate visits. The test-retest reliability of the PDQ and the internal consistency of its subscales were assessed. RESULTS:The intraclass correlation coefficients were 0.96, 0.95, and 0.98 for the psychological and physical symptoms, symptom bother, and penile pain subscales, respectively. Exploratory factor analysis was conducted to evaluate construct validity. The factor analysis revealed a three-factor structure, explaining 70.34% of the total variance. A penile curvature angle >60° was associated with PDQ symptom scores and International Index of Erectile Function-5 scores (p = 0.047 and p = 0.001, respectively). A body mass index <25 kg/m2 and the absence of comorbidities were also associated with PDQ scores. CONCLUSIONS:The Turkish translation and validation of the PDQ were found to be a reliable and useful assessment tool for Turkish individuals with PD. The introduction of the Turkish PDQ may facilitate treatment initiation and follow-up by providing a more reliable and comprehensive evaluation of patients with PD. CLINICAL TRIAL REGISTRATION:The study was registered at clinicaltrials.gov after ethical approval (NCT06621420; https://clinicaltrials.gov/study/NCT06621420).
Benign prostatic hyperplasia (BPH) is a common disease among middle‑aged and older men worldwide and tends to progress over time. For patients with severe BPH, surgery is still the main treatment and is generally considered the most definitive option. With the growing use of various surgical techniques, such as transurethral resection of the prostate (TURP) and laser enucleation, the prevention and management of postoperative complications have become key determinants of patient outcomes. This narrative review aimed to explore the mechanisms and risk factors for common complications after BPH surgery, including bleeding, urinary incontinence, urethral stricture, bladder neck contracture (BNC), urinary tract infection (UTI), and deep vein thrombosis (DVT). Furthermore, prevention strategies and nursing interventions are summarised from two perspectives. Current evidence suggests that the nursing approach has shifted from simply monitoring for problems to active prevention. Going forward, precision nursing based on risk assessment, evidence‑based practice, and smart healthcare technologies represents an important direction for postoperative care in BPH. Future efforts should focus on integrating preoperative prehabilitation, meticulous intraoperative management, dynamic postoperative management, and remote follow-up into a comprehensive nursing pathway, while conducting multicentre studies to validity its clinical value.
BACKGROUND:To examine whether depressive symptoms and multi-domain cognition predict 4-year all-cause mortality among men with survey-defined late-stage prostate cancer (PCa), and to evaluate an attention-based discrete-time survival model for short-horizon risk stratification in this urologic oncology setting. METHODS:Men ≥ 45 years in China Health and Retirement Longitudinal Study (CHARLS) 2011-2015 were assembled; incident PCa with ≥1 survey-available systemic/palliative indicator was used to approximate a late-stage phenotype (n = 21) and compared with cancer-free controls frequency-matched by age band and province (n = 600; N = 621). Exposures were the 10-item Center for Epidemiologic Studies Depression Scale (CES-D) and a global cognitive z-score. A tabular transformer modeled discrete-time hazards with isotonic calibration and was compared with discrete-time logistic survival and Cox models. Province-blocked internal-external validation and decision-curve analysis evaluated discrimination, calibration, transportability, and clinical utility. RESULTS:Over four years, 51 deaths occurred (late-stage PCa 33.3% vs controls 7.3%). The calibrated transformer achieved an area under the receiver operating characteristic curve (AUC) at 4 years of 0.828 (Integrated Brier Score (IBS) 0.057) and outperformed benchmarks (AUC ≤ 0.774). Leave-one-province-out testing showed median AUC at 4 years 0.832 with stable error. Higher CES-D and lower cognition were associated with higher discrete-time mortality hazard; estimates among late-stage cases were directionally similar but imprecise. CONCLUSIONS:Depressive symptoms and cognition may provide urology-relevant prognostic signal for near-term mortality among men with late-stage PCa. An attention-based discrete-time survival model demonstrated good discrimination and calibration in CHARLS; external validation in clinically staged advanced PCa cohorts is needed before clinical use.
BACKGROUND:To investigate the associations of preoperative neutrophil-to-lymphocyte ratio (NLR), leukocyte count, and platelet count with postoperative urosepsis in older adults with type 2 diabetes mellitus (T2DM) and ureteral calculi, and to explore their within-sample discriminative performance. METHODS:This retrospective matched case-control study included 85 older adults with T2DM and ureteral calculi who developed urosepsis after laser lithotripsy between January 2021 and December 2025. From 1530 eligible surgical patients without postoperative urosepsis, 85 controls were selected by 1:1 matching on age and sex. Conditional logistic regression was used to evaluate factors associated with urosepsis. Receiver operating characteristic (ROC) analysis, pairwise DeLong tests, and 1000-resample bootstrap validation were used to assess the discriminative performance of NLR, leukocyte count, platelet count, and a combined indicator derived from a binary logistic regression model including all three markers. RESULTS:Age and sex were balanced between the two groups after matching (both p > 0.05). Compared with the control group, the urosepsis group had higher NLR, leukocyte count, platelet count, stone computed tomography (CT) value, and urinary leukocyte positivity, and a higher prevalence of staghorn calculi (all p < 0.05). Conditional logistic regression showed that stone CT value, NLR, leukocyte count, platelet count, and staghorn calculus were associated with postoperative urosepsis (all p < 0.05). The areas under the curve (AUCs) for NLR, leukocyte count, platelet count, and the combined indicator were 0.742, 0.811, 0.681, and 0.872, respectively. The AUC of the combined indicator was larger than that of each individual marker by pairwise DeLong testing (p = 0.028 for leukocyte count; p < 0.001 for the other comparisons), and its optimism-corrected bootstrap AUC was 0.854. CONCLUSIONS:Preoperative NLR, leukocyte count, and platelet count were associated with postoperative urosepsis in older adults with T2DM and ureteral calculi. Their combination showed improved discrimination within the matched sample; however, the sample-derived cut-off values and performance measures should not be interpreted as universal screening thresholds without external validation.
BACKGROUND:Cutaneous ureterostomy is frequently selected for frail patients undergoing radical cystectomy due to its reduced operative complexity. However, long-term complications such as urinary tract infections (UTIs), stomal stenosis, and catheter dependence are common. Delayed conversion to ileal conduit has been proposed as a reconstructive strategy after clinical stabilization. CASE PRESENTATION:Five frail patients underwent radical cystectomy with cutaneous ureterostomy followed by delayed conversion to ileal conduit. Conversion occurred 10-36 months later due to recurrent complications or improvement in clinical status. Postoperative complications occurred in four patients (80%), including UTIs requiring antibiotics (Clavien-Dindo II), urinary fistula (Clavien-Dindo I), and ureteroileal stricture requiring surgical revision (Clavien-Dindo IIIb). CONCLUSIONS:Delayed conversion is feasible but is associated with significant morbidity and should remain individualized.
BACKGROUND:This study aimed to explore the diagnostic value of a machine learning model based on ultrasound image features for prostate cancer. METHODS:600 patients with prostate tumours detected by transrectal ultrasound (TRUS) at Quzhou People's Hospital between July 2023 and June 2025, and with corresponding pathological results, were selected. Based on these results, the patients were divided into prostate cancer and benign lesion groups. Stratified random sampling was then used to divide these groups into a training group (n = 420) and a validation group (n = 180) at a ratio of 7:3. Regions of interest were manually delineated by sonographers and radiomics features were extracted using Pyradiomics software. Using pathological results as the gold standard, the radiomics features with the highest diagnostic value in differentiating between benign and malignant lesions were selected. Based on the selected features, a support vector machine (SVM) algorithm model was then constructed, and the efficacy of the SVM and fusion models in diagnosing prostate cancer was evaluated using receiver operating characteristic curves. RESULTS:In the validation group, the SVM model based solely on ultrasound features achieved an accuracy of 73.06%, a sensitivity of 82.59%, a specificity of 65.50% and the area under the curve (AUC) of 0.729 [95% confidence interval (CI): 0.666-0.792] in diagnosing prostate cancer. After incorporating clinical features such as age, total prostate-specific antigen and prostate volume, the combined model improved the accuracy to 85.00%, sensitivity to 86.61%, specificity to 82.35%, and the AUC to 0.824 (95% CI: 0.785-0.863). Calibration and decision curve analyses further confirmed the model's good calibrability and net clinical benefit. CONCLUSIONS:A machine learning fusion model based on whole-gland TRUS radiomics features and combined with clinical indicators demonstrates good performance in estimating patient-level risk for prostate cancer. It may serve as a potential non-invasive decision support tool for risk stratification, but its clinical utility requires further external validation.
OBJECTIVE:To compare the clinical outcomes and urodynamic parameters of the three-lobe and two-lobe techniques of holmium laser enucleation of the prostate (HoLEP) in elderly patients with benign prostatic hyperplasia (BPH). METHODS:This retrospective study included 150 elderly patients with BPH admitted to Lishui People's Hospital between May 2021 and May 2025. Patients were divided into a control group (three-lobe technique, n = 72) and an observation group (two-lobe technique, n = 78) according to different surgical techniques. Baseline characteristics, perioperative outcomes, urodynamic parameters, health economics indicators (total hospitalisation cost and material cost), and complication rates were compared between the two groups. Univariate and multivariate linear regression analysis were used to adjust for confounding factors, including age, body mass index, preoperative prostate volume, comorbidities, and surgeon experience, and to evaluate the independent impact of the surgical technique on each outcome. RESULTS:The observation group showed better results than the control group in terms of operation time, intraoperative blood loss, hospital stay, and resected prostate weight. At 6 months postoperatively, both groups showed significant improvements in International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores compared with preoperative values. The observation group showed better urodynamic parameters and a trend toward a lower complication rate, but there was no significant difference compared with the control group (p = 0.054). There was no significant difference in total hospitalisation costs and material costs between the two groups (p > 0.05). Multivariate linear regression analysis revealed that, after adjusting for confounding factors, the two-lobe technique was significantly superior to the three-lobe technique in terms of operation time, hospital stay, bladder compliance (BC), maximum cystometric capacity (BCC), and maximum urine flow rate (Qmax). CONCLUSIONS:Compared with the three-lobe technique, the two-lobe HoLEP technique has certain advantages in terms of operation time, hospital stay and postoperative urodynamic parameters when treating elderly BPH. There was no statistical significance in intraoperative blood loss and complication rate. Further verification is needed in the future.
BACKGROUND:Post-prostatectomy urinary incontinence (UI) is a major functional complication of radical prostatectomy (RP), and preoperative membranous urethral length (MUL) has been established as an independent predictor of recovery. Magnetic resonance imaging (MRI) remains the standard for MUL measurement; however, access constraints and operator dependency limit its applicability. Transperineal ultrasound (TPUS) represents a promising alternative. This study aimed to evaluate the inter-operator reliability of TPUS-based pelvic floor measurements performed by urologists and their concordance with preoperative MRI in patients scheduled for robot-assisted radical prostatectomy (RARP). METHODS:A prospective observational cohort study was conducted. Fifty-one patients scheduled for RARP underwent preoperative TPUS performed by two urologists, blinded to each other's measurements. Eight pelvic floor parameters were recorded: MUL, prostatic height (PH), prostatic width (PW), prostatic depth (PD), urethral width (UW), urethra-prostate angle (UPA), prostatic urethral length (PUL), and total urethral length (TUL). Preoperative MRI served as the reference standard. Interoperator reliability and transperineal ultrasound-magnetic resonance imaging (TPUS-MRI) concordance were assessed. RESULTS:Inter-operator reliability for TPUS ranged from moderate to substantial across all variables (intraclass correlation coefficient (ICC) range 0.57 to 0.74), with the strongest agreement observed for PD (ICC 0.74; 95% confidence interval (CI) 0.59 to 0.84) and MUL (ICC 0.73; 95% CI 0.57 to 0.84). Concordance between TPUS and MRI was strongest for MUL (ICC 0.47; 95% CI 0.23 to 0.66) and PH (ICC 0.47; 95% CI 0.22 to 0.66), both in the moderate range; UW and TUL showed statistically significant but only fair concordance, whereas the remaining four parameters showed no significant concordance. CONCLUSIONS:TPUS performed by urologists demonstrates reproducible inter-operator agreement for pelvic floor parameters, particularly MUL. Significant, though modest, concordance with MRI (moderate for MUL and PH and fair for UW and TUL) together with small absolute mean differences for the key parameters, suggests that TPUS provides clinically reasonable estimates despite limited individual-level interchangeability with MRI. TPUS is a reproducible tool with acceptable inter-operator reliability for key pelvic floor parameters, particularly MUL, and may serve as a complement to MRI or an accessible alternative. However, its individual-level interchangeability with MRI remains limited, and its predictive value for post-prostatectomy urinary continence has not yet been established and requires confirmation in prospective studies.
BACKGROUND:The aim of this study is to explore the effectiveness of a WeChat-based continuous nursing programme for patients discharged with a single-J stent after radical cystectomy. METHODS:In this retrospective study (October 2021-August 2023), 100 patients were selected via propensity score matching, with 50 patients in each group. The convention group received standard urological nursing care and regular telephone follow-ups. The continuous nursing group received additional structured care via a WeChat integrated care platform based on the convention group. The two groups were compared at baseline and at 3 and 6 months post-discharge regarding self-management, complications, satisfaction, psychological status and quality of life. Additionally, the following were evaluated: renal function (serum creatinine, blood urea nitrogen and estimated glomerular filtration rate (eGFR)); stent removal outcomes (on-time completion and patency); readmission rates; and specialist-classified complications. RESULTS:At 3 and 6 months post-discharge, the continuous nursing group showed significantly higher self-management (111.92 ± 5.40/127.20 ± 4.99 vs. 107.40 ± 3.76/121.08 ± 4.62) and quality of life scores (72.58 ± 4.78/80.22 ± 5.10 vs. 68.72 ± 4.51/73.40 ± 4.85), as well as lower anxiety/depression levels than the convention group (all p < 0.05). The continuous nursing group also showed superior renal function (lower serum creatinine/blood urea nitrogen, and a higher eGFR), better stent outcomes (on-time removal: 92.0% vs. 70.0%; patency: 96.0% vs. 78.0%), fewer symptoms of urinary irritation (10.0% vs. 32.0%), lower readmission rates (8.0% vs. 26.0%), and fewer complications (22.0%/10.0% vs. 42.0%/28.0%) (all p < 0.05). Nursing satisfaction was also significantly higher in the continuous nursing group. CONCLUSIONS:In this single-centre retrospective cohort study, WeChat-based continuous nursing care was associated with improved self-management and quality of life, as well as lower complication rates in selected patients with single-J stents. This study used WeChat exclusively as the nursing protocol platform. The applicability of this nursing model to other mobile health tools remains hypothetical and requires future research. Causal inferences cannot be drawn due to study design limitations.
OBJECTIVE:This study aimed to compare the diagnostic performance of two-dimensional ultrasound (2D-US) and colour Doppler flow imaging (CDFI) for ureteral stones of different diameters, and to analyse CDFI-associated sonographic features. METHODS:A retrospective analysis was conducted on the clinical data of 150 patients with suspected ureteral stones who were admitted to the urology department of our hospital between January 2022 and December 2025. All patients underwent both 2D-US and CDFI examination, with non-contrast computed tomography (NCCT) as the gold standard. The overall diagnostic performance of the two ultrasound modalities was compared, including the detection rate and CDFI-associated sonographic features of stones of different diameters. In addition, the correlation between stone diameter, twinkling artifact intensity, and ureteral jet abnormalities were analysed. RESULTS:Among 150 suspected patients, 104 were diagnosed with ureteral stones by NCCT, and 46 were negative. The 104 stone-positive patients were classified into small-diameter (<6 mm), medium-diameter (6-8 mm), and large-diameter (>8 mm) stone groups. CDFI improved paired diagnostic accuracy by 14.0 percentage points (95% confidence interval, 6.6-21.4; exact McNemar p < 0.001). Detection rate of CDFI was higher for stones <6 mm (95.83% vs 62.50%, p = 0.008) and 6-8 mm (87.88% vs 72.73%, p = 0.002), whereas no difference was observed for stones >8 mm (92.86% vs 100.00%, p = 1.000). Twinkling artifact intensity (H = 12.428, p = 0.002) and ureteral jet abnormalities (H = 9.877, p = 0.007) differed among the three stone-diameter groups. Maximum stone diameter correlated positively with twinkling artifact intensity (Spearman r = 0.582, p < 0.001) and ureteral jet abnormalities (r = 0.543, p < 0.001). CONCLUSIONS:CDFI has advantages over 2D-US in diagnosing ureteral stones, especially for small-diameter stones. Twinkling artifact intensity and abnormal ureteral jet signals at the ureteral orifice are closely associated with stone diameter and can serve as important auxiliary indicators for diagnosing ureteral stones of different diameters.
OBJECTIVE:This study aimed to develop and internally validate a risk prediction model for postoperative urinary retention (POUR) after radical hysterectomy for cervical cancer by integrating preoperative urodynamic parameters and clinical indicators. METHODS:Clinical data of 295 patients with cervical cancer undergoing radical hysterectomy at our institution (July 2023-June 2025) were retrospectively analysed. Patients were assigned to a training cohort (n = 207) and an internal validation cohort (n = 88) at a ratio of 7:3. All underwent preoperative urodynamic examinations documenting first sensation of filling (FSF), maximum cystometric capacity (MCC), maximum flow rate (Qmax), detrusor pressure at Qmax (PdetQmax), and bladder compliance (BC). In the training cohort, patients were divided into urinary retention and non-retention groups based on postoperative urinary retention status. Multivariate logistic regression identified influencing factors and developed a nomogram prediction model, whose performance was evaluated by receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curve. RESULTS:The POUR group had a higher prevalence of diabetes and higher postvoid residual volume (PVR), but lower Qmax, FSF, MCC, BC, and PdetQmax than the non-POUR group (all p < 0.05). Multivariate logistic regression identified diabetes history, Qmax, FSF, MCC, BC, PdetQmax, and PVR as independent factors for POUR (p < 0.05). The nomogram achieved under the curves (AUCs) (95% confidence interval (CI)) of 0.901 (0.859-0.942) in the training cohort and 0.883 (0.804-0.931) in the validation cohort. DCA showed a positive net benefit across all thresholds, exceeding both default strategies. Internal validation revealed close alignment of the calibration curve with the ideal curve (Hosmer-Lemeshow χ2 = 5.841, p = 0.557). CONCLUSIONS:A nomogram incorporating preoperative urodynamic parameters and clinical features was successfully developed and validated. This model demonstrated good discrimination, calibration, and clinical utility for predicting the risk of POUR following radical hysterectomy for cervical cancer. It may facilitate the early identification of high-risk patients and support personalized management strategies.
