Urinary incontinence is a prevalent condition among middle-aged women, yet its relationship with activity behaviours remains underexplored. This study aimed to explore the longitudinal associations between objectively measured sedentary behaviour and physical activity intensities with urinary incontinence and its types in middle-aged Finnish women. A total of 224 women aged 47–55 years at baseline, drawn from the ERMA and EsmiRs studies were included. The prevalence of stress, urgency and mixed urinary incontinence symptoms was assessed using a structured questionnaire. Sedentary behaviour and physical activity were objectively measured using hip-worn accelerometers at baseline and at 4-year follow-up. Logistic generalized estimating equation models were used to analyse the associations between sedentary behaviour and different physical activity intensities with urinary incontinence, adjusting for potential confounders. Higher light-intensity physical activity was associated with slightly increased odds of urinary incontinence (OR = 1.004, 95
To evaluate the feasibility, acceptability, and preliminary efficacy of adding vaginal dilators (VD) to standard therapy for genitourinary syndrome of menopause (GSM). A prospective, randomized pilot trial was conducted at CHU Saint-Pierre, Brussels. Peri- and postmenopausal women with GSM were randomized to standard therapy alone or standard therapy plus VD. Assessments at baseline (T0), 4 weeks (T1), and 12 weeks (T2) included the Female Sexual Function Index (FSFI), Vaginal Health Index Score (VHIS), Visual Analog Scale (VAS) for pain, and GSM symptom questionnaires. Feasibility and acceptability were evaluated through adherence, retention, and patient-reported outcomes. Fifteen women were randomized; 11 completed 12 weeks (5 control, 6 VD). At T1, the VD group reported significant improvements in arousal (+ 32.1
Female genital fistula remains a major cause of incontinence, stigma and disability in Sub-Saharan Africa (SSA). This study aimed to describe the epidemiological, clinical and therapeutic characteristics of women operated on for genital fistula in two surgical centres in Yaoundé, Cameroon. We conducted a descriptive cross-sectional study combining a retrospective review of medical records (women operated between 2019 and 2020) and a prospective follow-up interview (conducted 7–28 January 2021, at least six months after surgery) at the Yaoundé University Teaching Hospital and the Essos Medical and Surgical Center. Women operated for genital fistula between 2019 and 2020, living in Cameroon and consenting to participate, were included. Data were analysed using Epi Info 7.2.2.6 and reported as counts, percentages, and medians with interquartile range (IQR). Fifty-four women were included; the median age was 33 years (IQR 28–40). Fistula surgery represented 5.6
To evaluate the histopathological effects of intravesical boric acid administration in a rat model of bladder cancer induced by intravesical N-methyl-N-nitrosourea. Thirty female Wistar albino rats (200–240 g) were included in the study. Bladder carcinogenesis was induced in all animals by intravesical administration of N-methyl-N-nitrosourea. The rats were randomly assigned to five groups (n = 6 per group) before initiation of the experimental protocol. All animals subsequently underwent intravesical N-methyl-N-nitrosourea administration to induce bladder carcinogenesis: untreated tumor group, saline-treated group, and three experimental groups receiving intravesical boric acid at doses of 65, 100, and 154 mg/kg for six weeks. Nine animals were lost during the experimental period; therefore, the final histopathological analyses were performed on 21 animals. The primary outcome was the normal urothelial area score based on the estimated proportion of normal urothelial areas on histopathological evaluation. Secondary outcomes included hyperplasia severity score and carcinoma in situ severity score. A statistically significant difference was observed among the groups in terms of the normal urothelial area score (p = 0.002). Post hoc analysis revealed that the boric acid 100 mg/kg and boric acid 154 mg/kg groups had significantly higher normal urothelial area scores compared to the boric acid 65 mg/kg group (p = 0.014 and p = 0.043, respectively). Although higher normal urothelial area scores were also observed in the higher-dose boric acid groups compared to the untreated tumor and saline-treated groups, these differences did not reach statistical significance. No statistically significant differences were found among the groups in terms of hyperplasia severity score (p = 0.343) or CIS severity score (p = 0.077). Intravesical boric acid administration was associated with a significant increase in the normal urothelial area score, suggesting a potential protective or regenerative effect on the urothelium rather than a direct antitumor effect. These findings should not be interpreted as evidence of antitumor efficacy. Further studies are required to clarify the underlying mechanisms and to determine the potential clinical relevance of these findings in non–muscle-invasive bladder cancer.
Benign prostatic hyperplasia (BPH) is a prevalent condition in aging men, significantly impairing health-related quality of life (HRQoL). While quantitative studies have documented symptom burden, there is limited understanding of how patients themselves conceptualize quality of life based on their lived experiences, particularly in non-Western healthcare contexts where cultural and religious values may shape the meaning of well-being. This qualitative study employed conventional content analysis based on the Graneheim and Lundman framework. Semi-structured interviews were conducted with 15 men (mean age 63.3 years) recruited from a university hospital in Kashan, Iran. Purposeful sampling ensured diversity in age, disease duration, and occupation. Data analysis was performed following this method. Content analysis revealed 4 main themes, 10 categories, and 31 subcategories from the interviews. The four themes were: (1) physical and functional consequences; (2) psychosocial consequences; (3) occupational and economic burden; and (4) restoration of well-being as quality of life. The core theme, ‘restoration of well-being as quality of life,’ captured patients’ definition of good quality of life, which encompassed independence and control, freedom in daily activities, peace of mind, and spiritual well-being. BPH profoundly affects multiple dimensions of patients’ lives beyond physical symptoms. Patients conceptualize quality of life not merely as symptom absence, but as the restoration of well-being that constitutes their definition of quality of life across physical, psychosocial, and spiritual dimensions. The findings highlight the need for culturally sensitive, holistic care that addresses patients’ religious and existential concerns, particularly in Islamic contexts where ritual purity is essential for worship.
Small cell neuroendocrine bladder cancers (SCBCs) are rare. The accurate preoperative diagnosis of SCBCs is critical because of their poor prognosis, and therapeutic approaches differ from those of urothelial carcinoma (UC). This study aimed to identify the imaging characteristics of SCBCs and determine the factors for their differential diagnosis. This was a retrospective observational study. This study enrolled 32 participants with SCBCs from September 2014 to July 2023 and 100 with UC from July 2022 to July 2023. Patient characteristics and imaging features from computed tomography (CT) and magnetic resonance (MRI) were reviewed and compared between the SCBC and UC groups. Univariable and multivariable analyses identified the predictive factors of SCBCs. Receiver operating characteristic (ROC) curve analysis was used to quantify the performance of these factors. Univariate analysis revealed significant differences in margins, serosal invasion, apparent diffusion coefficient (ADC) mean values, the invasion of the urinary meatus, ureteral invasion, hydroureter, and pelvic lymphatic metastasis between the SCBC and UC groups (p < 0.05). Compared with UC, SCBCs were more likely to present with ill-defined margins, serosal invasion, low ADC values, invasion of the urinary meatus, ureteral invasion, hydroureter, and pelvic lymphatic metastasis. In logistic regression analysis, serosal invasion and pelvic lymphatic metastasis were independent factors distinguishing SCBCs from UC, with the model showing an area under the curve of 0.791 in ROC curve analysis. SCBCs were found to exhibit distinct imaging features. A bladder tumor with serosal invasion and pelvic lymphatic metastasis on CT and/or MRI is more likely to be SCBC than UC.
To investigate the clinical value of combining systematic prostate biopsy with contrast-enhanced ultrasound (CEUS)-guided targeted biopsy in patients with serum prostate-specific antigen (PSA) levels in the gray zone. A total of 167 patients in the PSA gray zone treated at Zhejiang Provincial Hospital of Traditional Chinese Medicine from January 2022 to October 2024 were retrospectively analyzed and divided into a systematic biopsy group and a combined biopsy group. Both groups underwent transperineal biopsy under transrectal ultrasound guidance. In the combined biopsy group, CEUS was used to identify suspicious lesions for targeted biopsy, followed by reduced-core systematic biopsy in non-targeted regions; both groups received 10-core biopsies. The combined targeted biopsy group showed significantly higher detection rates for prostate cancer (PCa) (57.32
Buccal mucosa graft (BMG) urethroplasty is the gold standard for substitution urethral reconstruction but is associated with donor-site morbidity. We conducted a first-in-human prospective feasibility study to evaluate the safety and functional outcomes of an off-the-shelf acellular collagen mesh designed as an absorbable alternative for augmentation urethroplasty. This is a single-arm IDEAL stage 1 study conducted at a tertiary centre with ethics approval and ClinicalTrials.gov registration (NCT05463991) on 27th July 2022. Five adult men with anterior urethral strictures ≤ 3 cm on urethrogram underwent dorsal or ventral onlay augmentation urethroplasty using a sterile, GMP-manufactured bovine collagen mesh. The primary endpoint was device safety, defined as device-related intra- or postoperative adverse events. Secondary outcomes included International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), and need for reintervention over 24 months. All procedures were completed without intraoperative complications. No device-related adverse events (infection, extrusion, erosion, or fistula) were observed. Three of five patients required interval urethral dilatation within 12 months, whereas no patient required redo urethroplasty. At 24 months, median IPSS improved from 24.5 preoperatively to 1, QoL from 4 to 2, and Qmax from 11.1 mL/s to 19.7 mL/s. These functional outcomes reflect the final clinical status after all postoperative management, including secondary urethral dilatation where required. Limitations include the small sample size, single-centre design, and absence of routine endoscopic assessment. This first-in-human series demonstrates 2-year safety and technical feasibility of an acellular collagen mesh for substitution urethroplasty. Functional voiding outcomes were restored without need for redo urethroplasty. Larger prospective studies with structured objective follow-up are required before clinical adoption.
Although obesity has been linked to overactive bladder (OAB), the degree of weight loss needed for meaningful symptom improvement remains unknown. This study aims to evaluate the effects of behavioral weight loss (BWL) on OAB symptoms and to identify predictive threshold for clinically meaningful improvement. Women with concurrent overweight or obesity and OAB were prospectively enrolled in a 6‑month BWL program at our centre from September 2023 to January 2024. The Overactive Bladder Symptom Score (OABSS) was assessed at baseline and at follow-up. A ≥ 3‑point reduction in OABSS defined the effective group; the remaining participants were classified as the ineffective group. The baseline characteristics and the magnitude of weight loss were compared between the two groups. Correlation analysis was performed to examine the relationship between OABSS reduction and both percent weight loss and reduction in fat mass percentage (FM
Current risk stratification systems for non–muscle-invasive bladder cancer (NMIBC) rely primarily on established clinicopathological variables and do not consider the extent of tumor attachment to the bladder wall. This study evaluated whether tumor base diameter is associated with recurrence in patients with primary NMIBC. This ambispective observational study included 130 patients who underwent transurethral resection for primary NMIBC between March 2021 and September 2023. Tumor base diameter was measured intraoperatively using the 5-mm resection loop as a standardized reference. Recurrence-free survival was assessed using Kaplan–Meier analysis and compared with the log-rank test. Factors associated with recurrence were evaluated using Cox proportional hazards regression models. During a median follow-up of 24.3 months, recurrence occurred in 36 patients. In the primary multivariable Cox model, tumor base diameter was independently associated with recurrence (HR: 1.028 per mm increase, 95
Inguinal hernia (IH) is a common surgical pathology worldwide. Even though nylon darn repair is commonly used, little is known about the incidence of erectile problems post darn despite the perceived occurrence being a major deterrent of surgical intervention. This study was conducted to determine the rate, patients and hernia factors that could predict the occurrence of erectile function and quality of life post nylon darn repairs. Consecutive adult male participants with normal erection who underwent open hernia repair for primary unilateral inguinal hernia was included in the study. Data on sociodemographic, nature of hernia, complications and overall quality of life post repair was collected, analysed using Statistical Package for the Social Sciences (SPSS) version 25 and associations with erectile dysfunction determined. A total of 104, 48 (46.2
Radical cystectomy (RC) carries high postoperative complication rates. Most prior studies on sarcopenia and RC outcomes use Western-derived or 2019 AWGS SMI cut-offs, which may misclassify Asian patients and cause result heterogeneity. This study aimed to evaluate the association between CT-diagnosed low skeletal muscle mass (using Chinese population-specific SMI thresholds aligned with the 2025 AWGS framework) and 30-day postoperative complications in NAC-naïve bladder cancer patients undergoing RC. This retrospective cohort study was conducted on 198 patients who underwent RC without neoadjuvant chemotherapy at the Second Affiliated Hospital of Anhui Medical University from January 2018 to April 2025. Low skeletal muscle mass was defined as a skeletal muscle index (SMI; total skeletal muscle area at L3/height²) of < 43.13 cm²/m² for men and < 37.81 cm²/m² for women, based on abdominal CT obtained within 30 days preoperatively. Patients were divided into the low-SMI group (n = 85) and non-low-SMI group (n = 113). Baseline clinical characteristics, perioperative indicators, and 30-day postoperative complications were compared between the two groups. The primary endpoint was Clavien-Dindo grade II or higher complications. Univariable and multivariable logistic regression analyses were performed, with bootstrap internal validation. Overall, 85 patients (42.9
Laparoendoscopic single-site retroperitoneoscopic adrenalectomy (LESS-RA) has emerged as a further refinement of minimally invasive adrenal surgery. However, comparative data on perioperative outcomes and direct economic value relative to conventional retroperitoneoscopic laparoscopic adrenalectomy (RLA) remain limited, particularly within the Chinese healthcare setting. We retrospectively analyzed 65 consecutive patients who underwent LESS-RA (n = 29) or RLA (n = 36) for solitary benign adrenal tumors (maximum diameter ≤ 4 cm) at two centers between June 2022 and May 2025. Perioperative outcomes, cosmetic results assessed by the Vancouver Scar Scale (VSS), postoperative complications graded by the Clavien-Dindo classification, and Consumer Price Index-adjusted hospitalization costs were compared. A cost-effectiveness analysis was performed using the incremental cost-effectiveness ratio (ICER). All 65 procedures were completed laparoscopically without open conversion. Operative time, intraoperative blood loss, adrenal dissection time, postoperative pain scores, time to ambulation, diet resumption, and drainage duration were comparable between groups. The LESS-RA group demonstrated significantly shorter incision length (2.8 vs. 5.0 cm; P < 0.01), lower VSS scores (4 vs. 6; P = 0.011), and shorter hospital stay (5 vs. 7 days; P = 0.027). Complication rates did not differ significantly (Clavien-Dindo Grade I: 3.4
Microsurgical varicocelectomy is the preferred surgical treatment for painful varicocele. However, whether incision level influences early postoperative recovery in young men with high occupational physical demands remains unclear. This study compared early postoperative outcomes between inguinal and subinguinal microsurgical approaches. We conducted a retrospective comparative study of 98 young men with high occupational physical demands who underwent microsurgical varicocelectomy for painful left varicocele between January 2022 and July 2024. Patients were allocated to the Inguinal Group (MIV, n = 50) or the Subinguinal Group (MSV, n = 48) using a non-randomized alternating allocation sequence based on admission order. Key outcome measures included operative time, Visual Analog Scale (VAS) scores for wound pain (postoperative days 1, 3, and 5) and scrotal pain (postoperative months 1 and 3), rescue analgesia usage, and complication rates. Overall pain improvement (VAS ≤ 2 at 3 months) was achieved in 95.9
Androgen deprivation therapy (ADT) is associated with substantial metabolic deterioration in patients with prostate cancer. Metformin may attenuate ADT-related metabolic complications, although its association with longitudinal metabolic trajectories and prostate cancer outcomes remains uncertain. We conducted a retrospective cohort study emulating a target trial using a 90-day landmark design. Patients with prostate adenocarcinoma initiating ADT between 2015 and 2020 were classified according to metformin exposure during the landmark window (T₀ = Day 90 after ADT initiation). Metformin users initiated and maintained metformin treatment for at least 90 days, whereas controls had no metformin exposure. IPTW was applied to balance baseline characteristics. Longitudinal metabolic outcomes were assessed using weighted linear mixed-effects models, and progression outcomes were analyzed using weighted Cox models. Among 823 screened patients, 342 were included in the final analysis (171 metformin users and 171 controls). After IPTW adjustment, baseline covariates were well balanced. Compared with controls, metformin exposure was associated with smaller increases in HbA1c (adjusted difference − 0.34
Developing treatment strategies for bladder cancer in octogenarians remains challenging owing to concerns regarding surgical invasiveness and the risk of undertreatment. We aimed to evaluate the effect of the modified Frailty Index-5 score on treatment selection and prognosis in this population. We retrospectively analyzed 44 patients with bladder cancer aged ≥ 80 years who were candidates for radical cystectomy. The patients were stratified into three groups: robot-assisted radical cystectomy (n = 10), non-surgical treatment (n = 24), and observation (n = 10). The primary endpoint was treatment selection, and the secondary endpoint was overall survival. Multivariate analysis revealed that surgical selection was more strongly associated with the modified Frailty Index-5 status (odds ratio: 0.31) than with chronological age or sex, suggesting that frailty assessment might play a crucial role in clinical decision-making. Overall survival did not differ significantly among the groups (p = 0.11); however, the robot-assisted radical cystectomy group showed a trend toward improved survival compared with the non-surgical treatment (hazard ratio [HR] 4.93; p = 0.054) and observation (HR 2.43; p = 0.38) groups. Robot-assisted radical cystectomy appears to be a safe and feasible treatment option for carefully selected octogenarian patients. The modified Frailty Index-5 may serve as a practical and objective tool to support treatment decision-making, helping avoid undue risk aversion based solely on chronological age.
To construct a deep learning-based automatic segmentation model for upper urinary tract stones on non-enhanced CT, and to evaluate its segmentation performance, automatic quantitative consistency, and analysis efficiency in an independent test set. A total of 620 patients with upper urinary tract stones were prospectively and consecutively enrolled, including 934 lesions. They were divided at the patient level into a training set of 400 cases, a validation set of 100 cases, and an independent test set of 120 cases. Two radiologists performed independent annotations, and a manual reference standard was established after expert arbitration. A three-dimensional U-Net model was used for automatic segmentation, and segmentation performance, automatic quantitative consistency, and analysis time were evaluated in the independent test set. In the independent test set, the patient-level Dice coefficient of the model was 0.87 ± 0.13, the IoU was 0.79 ± 0.15, and the lesion-level sensitivity, precision, and F1 value were 0.931, 0.920, and 0.925, respectively. The HD95 was 1.63 ± 0.21 mm. The ICC(2,1) values for patient-level total stone volume, maximum stone diameter, and number of stones were 0.964, 0.951, and 0.982, respectively, and the complete agreement rate for the number of stones was 93.33
Biochemical recurrence (BCR) after radical prostatectomy (RP) remains a major clinical challenge, necessitating accurate preoperative risk stratification. We evaluated whether replacing digital rectal examination (DRE)-based staging with imaging-based staging improves the predictive performance of the CAPRA model. A total of 507 treatment-naïve prostate cancer patients who underwent RP between April 2015 and April 2024 were retrospectively analyzed. All patients had preoperative multiparametric MRI (mpMRI). Imaging was evaluated according to PI-RADS v2.1 by an experienced radiologist. Patients were stratified using both conventional CAPRA and imaging-based CAPRA (ibCAPRA) scores. Imaging-based staging identified a higher proportion of locally advanced disease, with T3 tumors detected in 23.9
It is unclear how sex disparities affect surgical outcomes following retroperitoneal laparoscopic adrenalectomy (RLA). Therefore, we studied whether gender could affect RLA outcomes perioperatively. A retrospective study was performed involving consecutive cases underwent unilateral RLA for adrenal disease from January 2012 to December 2021. Coarsened exact matching (CEM) was applied to balance patient groups. Logistic regression analysis was performed to assess the impact of sex on prolonged operative time and increased intraoperative blood loss. A total of 569 patients who underwent RLA were included. After CEM, 112 patients were incorporated in each group. Operative time (male: 129.47 vs. female: 95.53, P < 0.001) and intraoperative blood loss (male: 123.39 vs. female: 101.61, P = 0.009) differed statistically significantly, while equal postoperative length of stay (LOS) (6.7 d vs. 6.8 d, P = 0.686), drainage tube removal time (3.0 d vs. 3.0 d, P = 0.231) and incidence of Clavien-Dindo grade ≥ 2 perioperative complications (8.0
