Purpose:Renal stone is a common global disease. Percutaneous nephrolithotomy (PCNL) is the standard treatment for large stones but may cause renal parenchymal injury. Most studies have focused on global renal function rather than localized renal changes. This study evaluated renal parenchymal volume and renal function after PCNL, hypothesizing modest ipsilateral volume loss with preserved global glomerular filtration rate (GFR). Materials and Methods:This study included 80 patients who underwent PCNL. All patients had preoperative and postoperative computed tomography (CT), with follow-up CT performed 3-6 months after surgery. Patients with postoperative complications related to stone burden were excluded. Renal parenchymal volume was measured using 3D volumetric software, and both volumetric and functional outcomes were analyzed. Results:The median age was 59 years, and 49% were male. Most patients had mild-to-moderate hydronephrosis with a median stone burden of 7.55mL. Single-tract PCNL was performed in 96% of cases, with a median estimated blood loss of 135mL. Amplatz sheath sizes of 28, 26, and 24Fr were used in 69%, 20%, and 7%, respectively. Median preoperative and new-baseline GFR values were 83.5 and 84.0mL/min/1.73m2, indicating preserved global renal function. Acute kidney injury occurred in 10%. Ipsilateral GFR decreased slightly (39.7 to 36.6mL/min/1.73m2), while ipsilateral renal volume declined from 123.7 to 115.6cm3 (median loss 5.6cm3, 4.3%). Contralateral kidney volume remained stable Larger Amplatz sheath size and female were independently associated with ipsilateral renal volume loss >15%. Conclusion:PCNL caused modest ipsilateral renal volume loss while preserving global renal function. Larger Amplatz sheath size and female were associated with significant volume loss.
Purpose:To investigate the survival of autologous lingual mucosal grafts of varying thicknesses within a rabbit bladder defect model, as well as their impact on vascularization, inflammatory response, and tissue contracture. Methods:Twelve male New Zealand white rabbits were selected to establish a bladder wall defect model. Autologous lingual mucosal patches (5.0 mm×5.0 mm) of thin, medium, and thick thicknesses were harvested, transplanted to the bladder defects, and fixed with interrupted sutures. The lingual defects were directly sutured. Animals were sacrificed at 4 days, 3 weeks, and 3 months postoperatively for gross and histological observations. Hematoxylin-eosin (HE) and Masson staining were used to evaluate graft integration, detect neovascular density, inflammatory cell infiltration, and graft surface area contracture rate. Data were analyzed using one-way analysis of variance (ANOVA) and the Tukey HSD test. Results:All three groups of lingual mucosal grafts survived in the bladder environment and formed continuous epithelial connections with the bladder mucosa. No significant differences were observed in neovascular density or inflammatory cell infiltration among grafts of different thicknesses at any postoperative time point. Neovascular density gradually increased, while inflammatory infiltration gradually decreased over time. At 3 months postoperatively, the contracture rate in the thick group (13.20%) was significantly lower than that of the thin group (35.33%) and the medium-thickness group (24.93%) (P < 0.01). Conclusion:Lingual mucosal grafts of different thicknesses can survive in the bladder environment with good vascularization and anti-inflammatory capabilities. The thickness of the graft mainly affects the tissue contracture rate. Therefore, moderately preserving submucosal tissue and avoiding excessive thinning may help improve the long-term stability of the graft.
Warit Charukumchon,1 Worapat Attawettayanon,1 Sarayuth Boonchai,1 Teeravut Tubtawee,2 Kamonwon Cattapan,2 Choosak Pripatnanont,1,3 Chanatipat Boonyok,1 Virote Chalieopanyarwong11Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; 2Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; 3Department of Surgery, Chulabhorn Hospital, Bangkok, ThailandCorrespondence: Virote Chalieopanyarwong, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand, Tel +66-891984616, Fax +66-74451241, Email vchalieopanyarwong@gmail.comPurpose: Renal stone is a common global disease. Percutaneous nephrolithotomy (PCNL) is the standard treatment for large stones but may cause renal parenchymal injury. Most studies have focused on global renal function rather than localized renal changes. This study evaluated renal parenchymal volume and renal function after PCNL, hypothesizing modest ipsilateral volume loss with preserved global glomerular filtration rate (GFR).Materials and Methods: This study included 80 patients who underwent PCNL. All patients had preoperative and postoperative computed tomography (CT), with follow-up CT performed 3– 6 months after surgery. Patients with postoperative complications related to stone burden were excluded. Renal parenchymal volume was measured using 3D volumetric software, and both volumetric and functional outcomes were analyzed.Results: The median age was 59 years, and 49% were male. Most patients had mild-to-moderate hydronephrosis with a median stone burden of 7.55mL. Single-tract PCNL was performed in 96% of cases, with a median estimated blood loss of 135mL. Amplatz sheath sizes of 28, 26, and 24Fr were used in 69%, 20%, and 7%, respectively. Median preoperative and new-baseline GFR values were 83.5 and 84.0mL/min/1.73m2, indicating preserved global renal function. Acute kidney injury occurred in 10%. Ipsilateral GFR decreased slightly (39.7 to 36.6mL/min/1.73m2), while ipsilateral renal volume declined from 123.7 to 115.6cm3 (median loss 5.6cm3, 4.3%). Contralateral kidney volume remained stable Larger Amplatz sheath size and female were independently associated with ipsilateral renal volume loss > 15%.Conclusion: PCNL caused modest ipsilateral renal volume loss while preserving global renal function. Larger Amplatz sheath size and female were associated with significant volume loss.Keywords: percutaneous nephrolithotomy, kidney function, kidney volume loss, functional loss, kidney injury
Jiahao Lin, Tianmeng Gao, Changhao Hou, Lujie SongDepartment of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lujie Song, Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China, Email ljsong@sjtu.edu.cn Changhao Hou, Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China, Email houch8158@163.comPurpose: To investigate the survival of autologous lingual mucosal grafts of varying thicknesses within a rabbit bladder defect model, as well as their impact on vascularization, inflammatory response, and tissue contracture.Methods: Twelve male New Zealand white rabbits were selected to establish a bladder wall defect model. Autologous lingual mucosal patches (5.0 mm× 5.0 mm) of thin, medium, and thick thicknesses were harvested, transplanted to the bladder defects, and fixed with interrupted sutures. The lingual defects were directly sutured. Animals were sacrificed at 4 days, 3 weeks, and 3 months postoperatively for gross and histological observations. Hematoxylin-eosin (HE) and Masson staining were used to evaluate graft integration, detect neovascular density, inflammatory cell infiltration, and graft surface area contracture rate. Data were analyzed using one-way analysis of variance (ANOVA) and the Tukey HSD test.Results: All three groups of lingual mucosal grafts survived in the bladder environment and formed continuous epithelial connections with the bladder mucosa. No significant differences were observed in neovascular density or inflammatory cell infiltration among grafts of different thicknesses at any postoperative time point. Neovascular density gradually increased, while inflammatory infiltration gradually decreased over time. At 3 months postoperatively, the contracture rate in the thick group (13.20%) was significantly lower than that of the thin group (35.33%) and the medium-thickness group (24.93%) (P < 0.01).Conclusion: Lingual mucosal grafts of different thicknesses can survive in the bladder environment with good vascularization and anti-inflammatory capabilities. The thickness of the graft mainly affects the tissue contracture rate. Therefore, moderately preserving submucosal tissue and avoiding excessive thinning may help improve the long-term stability of the graft.Keywords: lingual mucosal graft, graft thickness, tissue contracture, urinary tract reconstruction, urethroplasty
Purpose:Currently most patients with elevated PSA and suspicious MRI findings either have no cancer or clinically insignificant cancer on fusion biopsies, driving the need for developing risk to better stratify patients prior to biopsies. This retrospective pilot study demonstrates a novel approach of the glandular tissue volume within the peripheral zone (GVPZ) using pre-operative MRI measurements validated against radical prostatectomy specimens, as the majority of prostate cancer originates within the peripheral zone. Patients and Methods:MRI and clinical parameters of 68 patients were analyzed retrospectively and associated with automated imaging processing data of H&E slides obtained from the corresponding radical prostatectomy specimens. Results:The study results revealed a significant non-linear, inverse relationship between GVPZ and total prostate volume (TPV) (exp(b) = 0.963, SE = 0.008, p < 0.0001). GVPZ decreases as TPV rises, consistent with BPH-driven transition zone expansion progressively diluting glandular tissue content in the peripheral zone. Peripheral zone volume (PZV) was a significant positive predictor of GVPZ (exp(b) = 1.052, SE = 0.014, p < 0.0001). Differences in GDPZ and GVPZ were also observed across racial groups, though these findings are preliminary given the small subgroup sizes. Conclusion:Based on the presented data, total prostate volume is significantly and inversely associated with the glandular volume of the peripheral zone where most primary prostate cancer develops. These tissue-based anatomical markers represent candidate variables for incorporation into future risk calculators; prospective validation against biopsy-confirmed outcomes is required before clinical application.
Purpose:Combining MRI PI-RADS score (Prostate Imaging Reporting and Data System) with prostate-specific antigen density (PSAd) may optimize prostate biopsy (PBx) decisions. We aimed to externally validate the PROMOD strategy, combining PI-RADS with PSAd. Patients and Methods:We retrospectively included 972 men who underwent PBx, i.e. 12-core systematic, 2-4 targeted (MRI-FUSION) between 2013 and 2022, recorded in a prospectively maintained database. Patients with PSA > 20 ng/mL or prior prostate cancer (PCa) were excluded. We evaluated rates of avoided PBx, missed low-grade cancers, and csPCa (ISUP grade ≥2) according to 10 strategies. Decision curve analysis (DCA) assessed net benefit. Results:According to DCA, the highest net benefit in biopsy-naïve men was obtained by Strategies 8 (PI-RADS 4-5 or PI-RADS 3 with PSAd >0.15 ng/mL2) and 7 (PI-RADS 4-5 or PI-RADS 3 with PSAd >0.20 ng/mL2) reducing biopsies by 18-20% (95% CIs 15.5-21.2 and 16.9-22.7), missing 5-8% csPCa (95% CIs 3.8-8.4 and 4.9-10.0). Strategy 10 (PI-RADS 4-5 or PI-RADS 3 with PSAd >0.10 ng/mL2 or PSAd >0.20 ng/mL2) was more conservative, avoiding 12% PBx (95% CI 9.7-14.5) and 2% missed csPCa (95% CI 0.9-3.8). Similar patterns were observed in the previous negative biopsy group. Conclusion:The PROMOD Strategy is an effective tool allowing a tailored decision to perform PBx based on degrees of risk that both patients and clinicians are willing to accept, in the context of shared decision-making.
Purpose:To evaluate whether the superior diagnostic accuracy of non-contrast computed tomography (NCCT) translates into clinically meaningful changes in management compared with ultrasonography (US) during routine postoperative follow-up after endourological stone surgery. Patients and methods:In this prospective observational study (n=60), adult patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) were assessed at 4-6 weeks postoperatively using both US and NCCT within ≤72 hours. NCCT served as the reference standard. The primary outcome was the diagnostic performance of US. The secondary outcome was the proportion of cases in which NCCT findings led to a change in clinical management. Multivariable logistic regression was used to identify predictors of false-positive US findings. Results:Sixty patients were included (mean age 52.3 ± 18.6 years; mean BMI 26.2 ± 6.8 kg/m2). NCCT identified residual stones in 14 patients (23.4%), totaling 27 stones. On stone-based analysis, US demonstrated a sensitivity of 79% (95% CI 69-86%) and a positive predictive value of 75%. NCCT detected additional findings not visualized on US in 6 patients (10%), all of which were small (≤4 mm) and non-obstructive. Importantly, NCCT findings resulted in clinically meaningful changes in management in only 2 of 60 patients (3.3%), despite its higher diagnostic sensitivity. US demonstrated a tendency to overestimate stone size, particularly with increasing BMI, which was the only significant predictor of false-positive findings (OR 1.12 per kg/m2, p = 0.008). Conclusion:Although NCCT demonstrates superior diagnostic accuracy, it rarely results in clinically meaningful changes in management in routine postoperative follow-up after endourological stone surgery. Ultrasonography provides acceptable diagnostic performance for clinically relevant stones. These findings support a risk-adapted imaging strategy in which ultrasonography serves as first-line surveillance, reserving CT for cases where results are expected to influence management.
Introduction:To investigate the site of metastasis and progression to castration-resistant prostate cancer (CRPC) following treatment of patients with metastatic prostate cancer who were diagnosed and treated at our hospital. Methods:We retrospectively examined the metastasis status and treatment response of patients with metastatic prostate cancer who were histologically diagnosed between the opening of our hospital in June 2015 and March 2025. Results:A total of 139 patients with metastatic prostate cancer visited our hospital and were diagnosed with the condition. CRPC-free survival was significantly correlated with the bone metastasis volume (EOD 0 and 1 vs EOD 2 to 4) (P = 0.0000477), volume categories (P = 0.00196), risk categories (P = 0.00231), and PSA levels below/not below 0.2 ng/mL following ADT (P = 4.18 × 10-16); however, it was not significantly correlated with the biopsy Gleason grade group (GG) (GG5 vs GG<5) (P = 0.324) or lung metastasis (P = 0.894). None of the eight patients with lung metastases who were without bone metastases progressed to CRPC during the observation period following androgen deprivation therapy (ADT). There was a significant difference in CRPC-free survival between patients with lung metastasis but without bone metastasis (sample size: 8) and those with other metastasis sites but without lung metastasis (sample size: 131) (P = 0.025). Discussion and conclusion:In our data on patients with metastatic prostate cancer, factors influencing the prognosis were: the extent of bone metastasis and responsiveness of PSA levels to initial treatments such as ADT. Factors such as GG at the time of biopsy or presence of lung metastases did not significantly impact the prognosis. Our data suggest that patients with lung metastases, but without bone metastases, may have a relatively favorable prognosis. New prognostic evaluation indicators are needed.
Mahmoud Abbas, Alaa Alden-Natsheh, Mohammad Abu-Ahmad, Michael Pashrsnik, Boris Chertin, Ilan KafkaDepartment of Urology, Shaare Zedek Medical Center, Jerusalem, IsraelCorrespondence: Mahmoud Abbas, Department of Urology, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem, 91031, Israel, Tel +972-54-6914994, Fax +972-2-6666955, Email mahmoudab@szmc.org.ilPurpose: To evaluate whether the superior diagnostic accuracy of non-contrast computed tomography (NCCT) translates into clinically meaningful changes in management compared with ultrasonography (US) during routine postoperative follow-up after endourological stone surgery.Patients and methods: In this prospective observational study (n=60), adult patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) were assessed at 4– 6 weeks postoperatively using both US and NCCT within ≤ 72 hours. NCCT served as the reference standard. The primary outcome was the diagnostic performance of US. The secondary outcome was the proportion of cases in which NCCT findings led to a change in clinical management. Multivariable logistic regression was used to identify predictors of false-positive US findings.Results: Sixty patients were included (mean age 52.3 ± 18.6 years; mean BMI 26.2 ± 6.8 kg/m2). NCCT identified residual stones in 14 patients (23.4%), totaling 27 stones. On stone-based analysis, US demonstrated a sensitivity of 79% (95% CI 69– 86%) and a positive predictive value of 75%. NCCT detected additional findings not visualized on US in 6 patients (10%), all of which were small (≤ 4 mm) and non-obstructive. Importantly, NCCT findings resulted in clinically meaningful changes in management in only 2 of 60 patients (3.3%), despite its higher diagnostic sensitivity. US demonstrated a tendency to overestimate stone size, particularly with increasing BMI, which was the only significant predictor of false-positive findings (OR 1.12 per kg/m2, p = 0.008).Conclusion: Although NCCT demonstrates superior diagnostic accuracy, it rarely results in clinically meaningful changes in management in routine postoperative follow-up after endourological stone surgery. Ultrasonography provides acceptable diagnostic performance for clinically relevant stones. These findings support a risk-adapted imaging strategy in which ultrasonography serves as first-line surveillance, reserving CT for cases where results are expected to influence management.Keywords: ultrasonography, computed tomography, urolithiasis, postoperative imaging, ureteroscopy, PCNL, clinical decision-making
Clémentine Le Méner,1 Emmanuel Nowak,2 Alexandre Fourcade,1 Valentin Tissot,3 Audrey Zambon,1 Claire Siebert,1 Joséphine Renand,1 Laurent Doucet,4 Arnaud Uguen,4 Georges Fournier,1 Antoine Valeri11Urology Department, CHU Brest, Brest, France; 2Statistics Department, CHU Brest, Brest, France; 3Radiology Department, CHU Brest, Brest, France; 4Pathology Department, CHU Brest, Brest, FranceCorrespondence: Clémentine Le Méner, Urology Department, CHU Brest, Boulevard Tanguy Prigent, Brest, 29200, France, Email lemener.clementine@gmail.comPurpose: Combining MRI PI-RADS score (Prostate Imaging Reporting and Data System) with prostate-specific antigen density (PSAd) may optimize prostate biopsy (PBx) decisions. We aimed to externally validate the PROMOD strategy, combining PI-RADS with PSAd.Patients and Methods: We retrospectively included 972 men who underwent PBx, i.e. 12-core systematic, 2– 4 targeted (MRI-FUSION) between 2013 and 2022, recorded in a prospectively maintained database. Patients with PSA > 20 ng/mL or prior prostate cancer (PCa) were excluded. We evaluated rates of avoided PBx, missed low-grade cancers, and csPCa (ISUP grade ≥ 2) according to 10 strategies. Decision curve analysis (DCA) assessed net benefit.Results: According to DCA, the highest net benefit in biopsy-naïve men was obtained by Strategies 8 (PI-RADS 4– 5 or PI-RADS 3 with PSAd > 0.15 ng/mL2) and 7 (PI-RADS 4– 5 or PI-RADS 3 with PSAd > 0.20 ng/mL2) reducing biopsies by 18– 20% (95% CIs 15.5– 21.2 and 16.9– 22.7), missing 5– 8% csPCa (95% CIs 3.8– 8.4 and 4.9– 10.0). Strategy 10 (PI-RADS 4– 5 or PI-RADS 3 with PSAd > 0.10 ng/mL2 or PSAd > 0.20 ng/mL2) was more conservative, avoiding 12% PBx (95% CI 9.7– 14.5) and 2% missed csPCa (95% CI 0.9– 3.8). Similar patterns were observed in the previous negative biopsy group.Conclusion: The PROMOD Strategy is an effective tool allowing a tailored decision to perform PBx based on degrees of risk that both patients and clinicians are willing to accept, in the context of shared decision-making.Keywords: prostate cancer, magnetic resonance imaging, PSA density, prostate biopsy
Background:Testicular cancer (TC) is the leading cancer among adolescents and young adults (AYAs) aged 15-39 years and one of the most curable cancers. Objective:The study aims to assess epidemiology, histological classification, stage at diagnosis, prognosis, stage I risk assessment and relationship between prognosis and age in the Center of Chemotherapy and Radiotherapy at Latakia University Hospital. Methods:318 patients with testicular cancer who had been attended to the Chemotherapy and Radiotherapy Center at Latakia University Hospital from its opening in 2007 until October 2025 were included in this retrospective analysis. Results:The median age at diagnosis was 32 years. The most prevalent testicular cancer (TC) was germ cell type. Among germ cell tumors, non-seminomatous types (51.6%) were slightly more frequent than seminomatous (45.9%). The most frequent non-seminomatous subtype was: mixed germ cell tumors (29.9%). The majority of TC patients were in stage I. About two-thirds of the seminoma patients were in stage I, while it represented about half of the non-seminoma patients with a significant difference between the two types. Two (2.86%) patients with vascular invasion, 31 (44.29%) with embryonal carcinoma, both vascular invasion and embryonal carcinoma in 8 (11.43%), and no risk factors were detected in 29 (41.43%) patients in non-seminoma. In seminoma, 40 (41.24%) patients reviewed with tumor size >4cm, 5 (5.15%) with rete testis invasion, 19 (19.59%) with both, and no risk factors were detected in 33 (34.02%) patients. No significant difference in the age of patients was shown after categorizing them according to their prognosis. Conclusion:The findings align with global proportions and can support those interested in the field in reducing disease burden, but further research is needed, especially in Syria and the Middle East due to limited studies.
Cystinuria is a hereditary aminoaciduria causing recurrent cystine nephrolithiasis, impaired quality of life and potential renal function decline. Despite established treatment guidelines, real-world data reveal a persistent gap between recommended targets and clinical outcomes. Preliminary data from the EUROCYS 2024 prospective European registry (269 patients, 29 centers, 8 countries) showed that only 16.3% of patients achieved the target urinary pH range, 55.2% remained above the conventional urinary cystine threshold of 250 mg/L, and approximately 39% experienced a new stone event within the preceding 12 months, despite follow-up in specialist centers. Discontinuation rates for available thiol drugs have been reported to reach 30-50%. This narrative review, based on a structured non-systematic search of major databases and guideline repositories (2009-2026), synthesizes current evidence on cystinuria diagnosis and management and appraises emerging adjunctive interventions. Next-generation sequencing-based genetic testing and the cystine capacity assay represent key recent advances in monitoring. Thulium fiber laser lithotripsy and miniaturized percutaneous approaches offer less traumatic surgical options in this high-burden population. Oral N-acetylcysteine has mechanistic plausibility and a favorable, well-characterized safety profile in other clinical settings, making it a rational candidate for formal prospective evaluation; however, robust clinical trial evidence in cystinuria using contemporary monitoring parameters is lacking. Current standard treatment remains insufficient for a substantial proportion of patients, underscoring the need to evaluate accessible adjunctive therapies with defined mechanisms and measurable outcomes.
Objective:This exploratory study aims to develop a multimodal model predicting estimated glomerular filtration rate (eGFR) by integrating functional Magnetic Resonance Imaging (MRI) diffusion metrics and multiphase Computed Tomography (CT) hemodynamic indices in acute urinary obstruction. Methods:Thirty-five patients with acute urinary obstruction underwent multiphase CT and Diffusion-Weighted Imaging (DWI). We measured DWI-based indices-including Apparent Diffusion Coefficient (ADC), Slow Diffusion Coefficient (SDC), and normalized ratios-alongside CT-derived metrics, specifically Difference of Renal Attenuation (DRA), Corticomedullary Differentiation (CMD), and Difference in Corticomedullary Differentiation (DCMD). These indices were compared between obstructed and contralateral (normal) kidneys to assess diagnostic value Predictive models for eGFR were developed using various index combinations, selecting the optimal model based on the highest Adjusted R-squared (R2). Model accuracy was validated using Mean Absolute Error (MAE) and Root Mean Square Error (RMSE), with age and sex as fixed covariates (p<0.05). Results:Obstructed kidneys exhibited significantly lower native CT density (32.5 ± 4.2 vs 34.3 ± 2.6 HU, p= 0.011) and reduced CMD (p< 0.001) than normal kidneys. Although ADC and ADC ratios showed no significant differences (p> 0.05), the SDC and SDC ratios (rSDC) were significantly higher in obstructed kidneys (SDC: 0.14 ± 0.03 vs 0.13 ± 0.03; rSDC_Muscle: 7.05 ± 2.69 vs 6.18 ± 2.34; rSDC_Spleen: 1.70 vs 1.47; all p< 0.05). Combining diffusion metrics with multiphase CT attenuation enhanced eGFR prediction. The best model, integrating ADC, CMD, and Mean_rADC_Muscle, achieved an adjusted R2= 0.433 (p= 0.0005). The similar MAE (0.552) and RMSE (0.695) values demonstrate consistent eGFR estimation with minimal variability. Conclusion:This exploratory investigation highlights the potential of a multimodal framework that integrates CT hemodynamic indices with MRI microstructural metrics for noninvasive eGFR estimation in acute urinary obstruction. This quantitative methodology demonstrates promising capability in identifying localized renal impairment, serving to complement established laboratory diagnostics.
Purpose:Benign Prostatic Hyperplasia (BPH) is a common non-malignant prostate enlargement that contributes to bladder outlet obstruction and lower urinary tract symptoms in men as they age. Patients and Methods:In this 90-day study, ninety-five men aged 45-80 years with clinically and radiologically confirmed moderate BPH [International Prostate Symptom Score (IPSS) between 8-19] were randomly allocated (1:1) to receive either Undaria pinnatifida fucoidan (UPF) or placebo. Prostate health was evaluated using the validated IPSS (total and composite sub-scores) on days 30, 60 and 90. Potential clinically meaningful IPSS reductions were assessed as Minimum Clinically Important Difference (MCID). Urinary flow rate, post-void residual volume (PVR) and prostate-specific antigen were also assessed. Results:By day 60, the UPF group showed significant improvement in total IPSS score compared to placebo (p=0.0234), with further improvements by day 90 (p=0.0015). The mean reduction in total IPSS score from baseline to day 90 was -3.40 in the UPF group versus -0.93 in the placebo group. Voiding (p=0.0006) and storage (p=0.0150), sub-scores improved significantly by day 90 in the UPF group. Quality of life related to urinary symptoms improved continuously by day 60 and 90 (both p<0.05 vs placebo). A higher proportion of UPF-treated participants achieved MCID ≥2 (60.0%) and ≥3 points (51.1%) compared to placebo (42.2% and 28.9%), with statistical significance for ≥3 points (p=0.0314) at day 90. Urinary flow rate improved and PVR decreased in both groups; however, between-group differences, including PSA, were not statistically significant. Importantly, UPF was well tolerated. Conclusion:UPF supplementation was associated with statistically and clinically significant IPSS improvement, including voiding and storage composite scores, and enhanced prostate-related quality of life when compared to placebo. Secondary outcomes did not differ significantly between groups, and the duration (90 days) limits long-term interpretation. UPF appears safe and potentially beneficial for managing moderate BPH symptoms.
Aim:The Robosling technique is a novel autologous fascial sling which supports the urethrovesical anastomosis in robotic radical prostatectomy (RARP) and has shown promise in improving early continence. Although curative surgery for prostate cancer is uncommonly offered to elderly patients aged ≥75, increase in active surveillance and overall life expectancy challenges this paradigm, though continence remains a challenge in this cohort. We sought to investigate the role of the Robosling technique in elderly patients to promote early return of continence. Methods:Our prospective RARP database (2016-2023) was analysed, recording demographic, surgical, pathological and functional outcomes. The primary endpoint was defined as pad-free continence, 1-year post-operatively. Patients aged ≥75 undergoing RARP with or without Robosling were compared using Chi-square/Fisher-exact and t-tests with p<0.05 considered significant. Multinomial logistic regression was performed to account for confounders. Results:62 patients were included in the analysis (Robosling n=24). No significant differences were detected in surgical or pathological outcomes. Robosling was associated with improved pad-free continence rates from 6-months post-operatively (62.5% vs 30.0%, p=0.018) and sustained at 1-year (79.2% vs 30.0%, p<0.01). Mean pad-use was lower in the Robosling cohort at all time points (0.21 vs 1.0 pads at 1-year, p<0.05). On multivariate analysis, Robosling remained independently associated with improved pad-free continence (OR 0.11, 95% CI 0.03-0.37, p<0.001). Conclusion:The Robosling technique is associated with significantly improved early and sustained pad-free continence rates in the elderly population in this single-surgeon study. While patient selection remains paramount, this intraoperative technique may mitigate a key quality-of-life concern in this cohort.
Background:Postoperative systemic inflammatory response syndrome (SIRS) remains a key complication after mini-percutaneous nephrolithotomy (mini-PCNL) and is often related to elevated intrarenal pressure and bacterial translocation. Vacuum-assisted mini-PCNL (VmPCNL) has been developed to mitigate this risk through active pressure control. Objective:To evaluate the association between VmPCNL and postoperative SIRS and to identify the independent predictors of SIRS in a real-world cohort. Materials and Methods:A retrospective cohort study was conducted of patients undergoing mini-PCNL at a tertiary referral center between January 2021 and May 2025. Patients were stratified into standard mini-PCNL (SmPCNL) and VmPCNL groups. The primary endpoint was SIRS within 48 hours post-surgery. Secondary outcomes included operative time, stone-free rate (SFR), and length of hospital stay (LOS). Multivariable logistic regression was used to identify independent predictors of SIRS. Results:A total of 136 patients were included in the study (SmPCNL, n = 78; VmPCNL, n = 58). The incidence of postoperative SIRS was significantly lower in the VmPCNL group (8.6% vs 21.8%, p = 0.036). VmPCNL was also associated with shorter operative time (median 90 minutes vs 115 minutes, p = 0.038) and reduced LOS (p = 0.012). Stone-free rates were comparable between the groups, indicating no compromise in procedural efficacy. In the multivariable analysis, VmPCNL was independently associated with a lower risk of SIRS (adjusted OR [aOR] 0.44, 95% CI 0.19-0.98, p = 0.041), while a positive preoperative urine culture was an independent risk factor (aOR 2.60, 95% CI 1.01-6.60, p = 0.045). Conclusion:In this real-world cohort, VmPCNL was associated with a lower SIRS incidence and improved perioperative efficiency without compromising stone-free outcomes. The mechanism may involve improved intraoperative outflow dynamics through active suction, although direct measurement of intrarenal pressure is needed to confirm this hypothesis.
Background:Testicular volume is a critical marker of male reproductive and endocrine health; however, reference values are population-specific. In the absence of ultrasound-based normative data for Somali men, clinicians often rely on external benchmarks that may lead to the misdiagnosis of normal variants. This study aimed to establish ultrasound-derived reference intervals, determine the Minimal Detectable Difference (MDD) for asymmetry, and develop a prediction equation for contralateral volume in Adult Somali men. Methods:This retrospective study analyzed 212 sonographically normal Somali men (ages 18-84) at Sahan Diagnostic Center in Mogadishu, Somalia, from June 2022 to December 2025. Volumes were calculated using the standard ellipsoid formula. Statistical analyses included percentile-based reference intervals (2.5th-97.5th), Cohen's d for cross-population comparisons, and linear regression to derive a contralateral prediction equation. Results:Mean testicular volumes were 10.61±3.07 mL (right) and 10.19±3.02 mL (left), with a median of 10.0 mL for both. The 95% reference intervals were 5.7-18.0 mL (right) and 5.2-17.0 mL (left). The right testis was significantly larger than the left (p < 0.001), and no significant correlation with age was observed. The MDD for asymmetry was 4.1 mL. Notable differences were found compared to European (d = 1.90), West African (d = 1.88), and East and Southeast Asian (d = 0.76-2.01) cohorts. Conclusion:These findings establish the first Somali-specific ultrasound benchmarks. Incorporating these intervals and the 4.1 mL MDD into clinical practice will improve diagnostic accuracy in andrological assessments and prevent the misapplication of non-representative global norms.
Objective:To assess knowledge and awareness of urinary incontinence (UI) among Jordanian women attending a urogynecology clinic and identify sociodemographic and clinical factors associated with knowledge levels. Methods:A cross-sectional study was conducted involving 294 women aged 18 to 80 years who attended the urogynecology clinic at King Hussein Medical Center (KHMC) in Amman, Jordan, from February 2022 to April 2023. Knowledge was measured using the validated Prolapse and Incontinence Knowledge Questionnaire (PIKQ) through structured interviews. Each correct answer was awarded one point, while incorrect or "do not know" responses were scored as zero. Total scores, ranging from 0 to 12, were converted to percentages. Data normality was assessed using the Shapiro-Wilk and Kolmogorov-Smirnov tests. Associations between knowledge scores and sociodemographic or clinical variables were examined using Spearman's rank correlation coefficient. Statistical analyses were performed with IBM SPSS version 28.0, and statistical significance was set at p < 0.05. Results:The mean knowledge score was 8.77 ± 1.39 out of 12 (73.06%). Higher knowledge scores were significantly associated with greater educational level, higher income, employment in healthcare, and previous treatment for UI (p<0.05). In contrast, increasing age, higher number of children, and postmenopausal status were significantly associated with lower knowledge scores (p<0.05). No significant associations were found between knowledge scores and marital status, prior consultation with a urologist or urogynecologist, or personal history of UI. Conclusion:Women attending a urogynecology clinic in Jordan demonstrated moderate overall knowledge of UI. However, substantial knowledge gaps remain, particularly concerning treatment options and disease management. These results underscore the need for targeted educational interventions, particularly for older, multiparous, and postmenopausal women, to improve understanding, address misconceptions, and enhance clinical outcomes and quality of life.
Background:It is clinically important to identify early progressive disease (PD) during nivolumab plus ipilimumab therapy for advanced renal cell carcinoma (RCC). However, the predictors of early PD are unclarified. We evaluated the prognostic impact and baseline predictors of early PD. Materials and Methods:We retrospectively reviewed consecutive patients with advanced RCC who received nivolumab plus ipilimumab at Kyushu Cancer Center between September 2018 and January 2026. Tumor response was assessed using the RECIST version 1.1 guidelines. Early PD was defined as PD within 12 weeks from treatment initiation or PD at the first radiologic assessment. Overall survival (OS) was evaluated at the 12-week landmark. Cox regression was used to identify prognostic factors for landmark OS, and logistic regression was used to explore predictors of early PD. Results:The 12-week landmark cohort comprised 38 patients (early PD, n=14; non-early PD, n=24). Landmark OS was significantly shorter in the early PD group than in the non-early PD group (median, 12.9 vs. 66.1 months; log-rank P<0.001). In multivariable Cox regression, early PD (hazard ratio 3.67; 95% confidence interval 1.28-10.59; P=0.016) and International Metastatic RCC Database Consortium (IMDC) poor risk (hazard ratio 3.16; 95% confidence interval 1.24-8.07; P=0.016) were independently associated with worse OS. In exploratory multivariable logistic regression, non-clear cell histology was significantly associated with early PD (odds ratio 9.01; 95% confidence interval 1.45-56.20; P=0.019). Conclusion:Early PD during nivolumab plus ipilimumab identifies a high-risk population with markedly inferior survival. Non-clear cell histology was significantly associated with early PD in exploratory multivariable analysis and may help guide individualized first-line treatment selection and patient counseling in advanced RCC.
Introduction and Objectives: Hydrocelectomy is the gold standard treatment for hydrocele. European data showed complication rates between 16% and 25%, however the rate within the United States has not been assessed. We examined the postoperative complication, emergency department visit, readmission and re-operation rates after hydrocelectomy in the United States. Methods: We performed a retrospective cohort study of 27,418 individuals who underwent hydrocelectomy in the United States between 2004 and 2024 identified through the TriNetX US Network using ICD-10 and CPT codes. Patients were excluded for age <18 years, testicular neoplasm, and orchiectomy. The primary outcome was rate of any surgical complication, emergency department (ED) visit, readmission, or reoperation within 90 days of hydrocelectomy. Statistical analysis was performed with R software and using t-tests. Results: The mean age of our cohort was 51 years. The complication group had higher proportions of older (p < 0.001), African American (p < 0.001), and patients with hypertension, diabetes, and coagulation defects (p < 0.001). The risk of complications was 13% within 90 days of surgery. The ED visit rate was 6.7%, surgical complication rate of 5.6%, readmission rate of 2.6%, and reoperation rate of 2.6%. Of surgical complications, 25% were bleeding, 13% were infection, and 63% were inflammatory or unspecified complications. The median ED visit was day 14 (IQR 6-41) and the median reoperation was at day 21 (IQR 9-38). Patients had a 9.2% rate of overall complications in the first month after surgery, after which the risk decreased. Conclusion: The rate of complications after hydrocelectomy in the United States is 13%, with 9% occurring in the first 30 days. There was a 2.8% risk of surgical intervention within 90 days. We recommend close follow-up in the first month to evaluate for developing complications, especially for patients with hypertension, diabetes, or coagulation defects.
