Background: The integration of artificial intelligence (AI) into urological practice offers promising advancements in diagnostic, prognostic, and therapeutic decision-making, with applications spanning the field of urology. Because both patients and physicians have started adapting to AI in urology, this study examined their understanding of AI and their converging and diverging perspectives. Materials and methods: An Institutional Review Board-approved survey was created to assess awareness and perspectives on AI within the urological community across the United States. Percentages were used to quantify the comparisons, and statistical tests, as appropriate, were applied for significance, with p <0.05 considered statistically significant. Surveys were distributed via email to patients and urologists. Results: Among 380 participants (199 physicians and 181 patients), both groups shared a baseline unfamiliarity with AI in general (59.3% vs.65.7%; p = 0.2) and AI in healthcare (71.4% vs. 76.8%; p = 0.2). The majority of each group expressed optimism about AI’s clinical utility (61.3% vs. 75.0%; p = 0.005), but held mixed trust in its accuracy, with physicians showing greater mistrust (34.2% vs. 49.7%; p < 0.001). Ethical and privacy concerns were notable, with more physicians than patients emphasizing ethical issues (38.7% vs. 22.1%; p = 0.001), whereas privacy concerns did not differ significantly between groups (51.0% vs. 42.0%; p = 0.13). Both groups favored shared accountability for AI-driven outcomes (63.3% vs. 71.3%; p = 0.2) and human oversight (79.2% vs. 66.9%; p = 0.01), underscoring the need for cautious AI integration in urological practice. Conclusions: This study revealed the alignment between physicians and patients regarding the potential of AI in urological practice, along with shared concerns about its reliability, ethics, and oversight.
Renal cell carcinoma (RCC) is a common urological cancer. Despite advances in immunotherapy and targeted therapy, drug resistance profoundly compromises outcomes. Aberrant lipid metabolism critically shapes the tumor microenvironment and fosters resistance via diverse mechanisms, although the precise underlying pathological pathways remain unclear. This review provides current insights and highlights emerging trends to guide future research. Research interest in the role of lipid metabolism in therapeutic resistance in renal cancer has steadily increased over the years. Lipid metabolism influences therapeutic resistance in RCC primarily through the protein kinase B/mechanistic target of rapamycin signaling pathway, ferroptosis, autophagy, synergy with glucose metabolism, and drug efflux mechanisms. Identifying lipid metabolism biomarkers that are predictive of RCC treatment response and multi-integrating multiomics approaches to optimize therapeutic strategies are critical directions for future studies. Targeting lipid metabolism represents a pivotal nexus between targeted therapy and immunotherapy. Elucidating its interplay with programmed cell death pathways, including ferroptosis and autophagy, may help overcome resistance in RCC. However, the reliance on preclinical models limits their clinical translation. This review refines the current knowledge, identifies emerging avenues, and offers guidance for future research.
Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy after transurethral resection of bladder tumor has become the first-line treatment for high-risk nonmuscle-invasive bladder cancer. However, disease recurrence or progression occurs in some patients after BCG therapy. Radical cystectomy is the standard treatment for BCG failure; however, it is not suitable for all patients and the development of alternative therapies is crucial. In addition to traditional intravesical chemotherapy (e.g., gemcitabine and docetaxel), new emerging approaches, including modified BCG, immune checkpoint inhibitors, gene therapy, and oncolytic virus therapy, have provided alternative treatment options and improved outcomes for patients.
Background: Computational modeling of urine flow is emerging as a novel method for investigating the mechanical properties of the male lower urinary tract and simulating pathological conditions. Such models offer the potential to obviate invasive diagnostic methods, such as urethroscopy, by analyzing urine spray behavior to locate pathological strictures instead of direct visualization of the tract interior. However, current computational models fail to simulate the anatomy and dynamic properties of the male lower urinary tract accurately. We devised a modified three-dimensional (3D) computational model of the normal male lower urinary tract using a more detailed anatomical approach than that used in previous studies. Materials and methods: An idealized 3D geometry representing the male lower urinary tract system was constructed using COMSOL v4.2. Specific geometric parameters were defined for each component from the bladder to the external urethral orifice. After applying the preconditions used for computational fluid dynamics studies of the urinary tract, urine flow characteristics were studied using an idealized 3D model. Results: Our model showed that urine velocity reached its maximum at the bend of the membranous urethra and declined as it progressed toward the urethral orifice. We demonstrated the vortical flow pattern in the prostatic and membranous urethra, in addition to the normal streamlined flow. The urethral pressure field profile showed that the gradient was not uniform in the urethra and varied as urine flowed. Conclusions: Computational fluid dynamics models in urology are a growing area of interest that requires further refinement for translation into a validated diagnostic method. This study provided an updated framework for developing future computational fluid dynamics studies on the male lower urinary tract.
The aim is to provide a comprehensive review of recent advances in robot-assisted upper urinary tract (UUT) reconstruction, including surgical techniques, emerging technologies, and management strategies for complex clinical scenarios. This narrative review summarizes published evidence from randomized controlled trials, meta-analyses, cohort studies, case series, and significant case reports on robot-assisted UUT reconstruction. Key topics include the technical details and outcomes of various robotic procedures, integration of new imaging and navigation technologies, and application of robotic surgery in anomalous anatomy, redo surgeries, and posttransplant or ureteroenteric stricture cases. Robot-assisted UUT reconstruction offers significant advantages over traditional approaches, including reduced intraoperative blood loss, shorter postoperative recovery time, and improved precision, particularly in complex and anatomically challenging cases. The adoption of advanced technologies, such as three-dimensional image reconstruction, indocyanine green fluorescence imaging, and single-port robotic platforms, has further enhanced surgical planning, intraoperative navigation, and overall safety. However, the current evidence is primarily based on retrospective single-center studies, with limited large-scale or long-term data. Outcome definitions and success criteria remain heterogeneous, limiting direct comparisons and standardized recommendations. Robot-assisted UUT reconstruction is becoming a standard option, strengthened by advanced imaging and single-port platforms. To consolidate its role, multicenter prospective studies with standardized outcomes and long-term follow-up are needed to refine the indications and ensure responsible adoption.
Varicocele (VC) leads to high scrotal temperatures and inadequate testicular perfusion, resulting in pathological processes such as heat stress, oxidative stress, NO stress, and cellular ionic imbalance in the testicular microenvironment, which further lead to inflammation in the testicular microenvironment, damage to testicular somatic cells, and thereby adversely affecting sperm development. Varicocele repair, which is the current primary treatment for VC, has limitations in terms of clinical indications, efficacy assessment, and treatment decision-making in the adolescent population; therefore, conservative treatment options for VC are still necessary. The nonsurgical therapies for VC compiled in this review mainly include Western medicine, Traditional Chinese medicine, physical therapy, and lifestyle modifications. Among these, Western medicine can be further categorized into antioxidant, hormone, and anti-inflammatory therapies. These nonsurgical therapies are effective in relieving clinical symptoms, improving semen parameters, restoring testicular function, and increasing pregnancy rates in patients with VC. However, the detailed mechanisms of many of these treatments are unclear, and the therapeutic efficacy is not adequately supported by clinical data; therefore, further studies are needed to confirm their efficacy.
Background: Prostate cancer (PCa) is the second most common malignancy in men worldwide. Radical prostatectomy (RP) is a curative option; however, up to 30% of patients develop biochemical recurrence (BCR), defined as rising prostate-specific antigen levels, which increases the risk of metastasis and mortality. This study aimed to develop and validate 7 machine learning (ML) algorithms for early BCR prediction. Methods: We retrospectively analyzed 375 Colombian patients with PCa treated with RP (2016–2025). The BCR was defined as 2 prostate-specific antigen values >0.2 ng/mL. The ML algorithms (logistic regression, random forest [RF], support vector classifier, K-nearest neighbors, Gaussian naive Bayes, gradient boosting, and XGBoost) were trained using a 70/30 split with 10-fold cross-validation. Model development followed the sustainability, accuracy, fairness, and explainability principles. Interpretability was assessed with SHapley Additive exPlanations. Results: BCR occurred in 103 (27.5%) patients. The predictors significantly associated with recurrence included a higher Gleason score, extracapsular extension, seminal vesicle invasion, lymph node involvement, and positive margins. RF demonstrated the best balance of accuracy and interpretability, with an area under the receiver operating characteristic curve of 0.84, accuracy of 87%, and F1 score of 0.68. SHapley Additive exPlanations analysis identified lymph node involvement, Gleason score, and tumor invasion as the most influential features. Ensemble methods did not improve performance beyond RF. Conclusions: Interpretable ML models, particularly RF, can accurately predict BCR after RP using routinely available clinical and pathological data. These cost-effective tools may enhance patient stratification, guide timely interventions, and be integrated into health systems and digital pathology initiatives to support the evidence-based management of PCa.
Background: While the literature on benign prostatic hyperplasia (BPH) often focuses on postoperative patient-reported outcomes (PROs), less attention has been paid to preoperative symptom burden and PROs of men who ultimately undergo surgical treatment. This study provides a detailed descriptive analysis of preoperative PROs across the urinary, sexual, and quality of life domains in a large surgical cohort. Materials and methods: This retrospective analysis of a single-institution BPH database from 2021 to 2024 assessed preoperative International Prostate Symptom Score (IPSS), Michigan Incontinence Symptom Index, and Sexual Health Inventory for Men score. Descriptive statistics and Mann–Whitney tests were applied to total and subgroup PRO scores. Results: A total of 1874 patients underwent BPH surgery (average age 71.1). The mean IPSS score was 16.60 (of 35), with a quality-of-life score of 3.89 (of 6). When standardized as a percentage of maximum possible score, storage symptoms were significantly more prominent than voiding symptoms (51.3% vs. 45.4% of maximum, p < 0.0001). The distribution of IPSS severity was 15.6% mild (1–7), 44.2% moderate (8–19), and 40.2% severe (20–35). The mean Michigan Incontinence Symptom Index score was 5.81 (of 32), with 34.9% of patients meeting criteria for preoperative incontinence (total score ≥ 7). Preoperative urge urinary incontinence scores were higher than stress urinary incontinence scores (3.55 vs. 1.48, p < 0.0001). The mean Sexual Health Inventory for Men score was 15.05 (of 25), with 27% severe, 10% moderate, 14% mild-to-moderate, 24% mild, and 25% no erectile dysfunction. Preoperative IPSS storage and total scores were significantly lower in patients who underwent simple prostatectomy, and IPSS quality of life scores were significantly lower in patients who underwent holmium laser enucleation of the prostate, relative to transurethral resection of the prostate. Conclusions: Preoperative BPH patients reported moderately lower urinary tract symptoms, worse storage than voiding symptoms, more urge urinary incontinence than stress urinary incontinence, and mild-to-moderate erectile dysfunction. Understanding baseline PROs enables clinicians to better contextualize postoperative outcomes and manage patient expectations, thereby supporting both optimal care and medicolegal protection in the event of postoperative dissatisfaction.
Background: Functional results of intracorporeal orthotopic ileal neobladders (iOINs) may vary depending on the selected neobladder technique. Standardization in reporting continence outcomes is lacking, as objective measurements based on urodynamic assessment remain limited. The aim of this series was to identify urodynamic predictors of daytime and nighttime urinary incontinence for robotic iOINs performed at 2 high-volume centers. Materials and methods: We retrospectively pooled data from two prospectively maintained institutional robot-assisted radical cystectomy databases covering the period from June 2017 to May 2023. The pooled dataset was queried to identify patients who underwent iOIN reconstruction and completed urodynamic evaluation, yielding a final study population of 94 patients. Baseline data and complete urodynamic profiles were collected. Urodynamic assessment was performed between 6 and 9 months after surgery. Frequencies and proportions were reported for categorical variables, while medians and interquartile ranges were reported for continuous variables. Univariable and multivariable logistic regression analyses were used to identify predictors of daytime and nighttime urinary incontinence at last follow-up. Multicollinearity among covariates initially considered for multivariable modeling was assessed using variance inflation factor analysis. A 2-sided p < 0.05 was considered statistically significant. Results: Overall, at a median follow-up of 25 months (interquartile range, 15.5–37.5), 94 patients achieved a complete urodynamic evaluation. On multivariable analysis, female gender (OR, 4.14; 95% CI, 1.37–12.5; p = 0.01) was the only independent predictor of daytime urinary incontinence, whereas cystometric capacity <250 mL showed an association at univariable analysis only and was not retained after multivariable adjustment. Residual peristaltic neobladder activity (OR, 3.44; 95% CI, 1.02–11.5; p = 0.04) was the only independent predictor of nighttime urinary incontinence. Conclusions: At urodynamic evaluation, female gender emerged as the only independent predictor of daytime urinary incontinence, whereas residual peristaltic neobladder activity was the only independent predictor of nighttime urinary incontinence. Urodynamic assessment may provide clinically relevant insights into continence evolution after iOIN at mid-term follow-up.
Background:. Catheter-based urodynamic studies remain the standard for diagnosing lower urinary tract dysfunction, but are limited by discomfort, infection risk, and restricted monitoring duration. Emerging implantable bladder sensors offer the potential for real-time wireless pressure monitoring without the need for catheters, with promising applications in neurology. This study was aimed to systematically review and compare the performance, safety, and translational readiness of intravesical and submucosal implantable bladder sensors used for real-time urodynamic assessments in preclinical and clinical studies. Materials and methods:. A systematic literature search was conducted in PubMed, Scopus, and IEEE Xplore from their inception to July 10, 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that evaluated wireless implantable bladder pressure sensors in animal or human models were included. Data on the pressure fidelity, biocompatibility, implantation site, and signal stability were extracted and compared. Results:. Four studies met the inclusion criteria: 3 preclinical studies (rabbit or pig) and 1 human feasibility trial. Intravesical sensors showed superior pressure fidelity (correlation coefficients up to r = 0.885), minimal error (±1 cm H2O), and favorable safety with no adverse effects. In humans, the UroMonitor device demonstrated an event-detection accuracy of 98% and was well tolerated. Submucosal devices achieved high event-specific correlations (r = 0.75–0.94) but were limited by erosion and signal degradation. Heterogeneity in sensor design, implantation duration, and biocompatibility has limited direct comparisons. Conclusions:. Intravesical implantable sensors demonstrated higher accuracy, safety, and translational readiness than submucosal alternatives. The success of the UroMonitor in human feasibility studies underscores its potential for catheter-free ambulatory bladder pressure monitoring. Future studies should focus on long-term implantation, artificial intelligence integration, and comparative trials using conventional urodynamics.
Objectives:. This study aimed to investigate the role of miR34a in obesity-related glomerular disease using an experimental mouse model induced by a high-fat diet and a podocyte injury model induced by palmitic acid. Materials and methods:. An obese mouse model was established by high-fat feeding, followed by analysis of renal pathology, immunohistochemistry, and detection of miR34a and Krüppel-like factor 4 (KLF4) levels. In vitro experiments involved treating podocytes with varying concentrations of palmitic acid, performing Oil Red O staining, assessing related indicators and apoptosis, and transfection with miR34a mimics or inhibitors to evaluate their effects. The target relationship was validated using a luciferase assay. The differential expression of miR34a in clear cell renal cell carcinoma (ccRCC) and adjacent normal tissue was detected using RT-qPCR. Results:. A high-fat diet was successfully used to establish an obese mouse model, which led to a significantly increased glomerular volume. Renal tissues exhibited decreased KLF4 and nephrin levels and increased Bak and cleaved CASP9 levels. miR34a was negatively correlated with KLF4 and positively correlated with Bak, suggesting the potential induction of apoptosis through KLF4. Cell experiments demonstrated that palmitic acid upregulated miR34a, downregulated KLF4, and induced podocyte apoptosis. Furthermore, miR34a mimics exacerbated apoptosis, whereas miR34a inhibitors alleviated apoptosis. A dual-luciferase assay confirmed that miR34a targeted and inhibited KLF4 expression. miR‐34a expression was upregulated in ccRCC compared with adjacent normal renal tissues, and this tendency was more prominent in obese patients. Conclusions:. Elevated miR34a levels may contribute to podocyte injury by inhibiting KLF4, thereby promoting the progression of obesity-related glomerulopathy. miR34a may also be related to the pathogenesis of ccRCC, especially in obese patients.
