IntroductionTo provide a detailed analysis regarding survival, local control and toxicity of nodal/bone oligo-recurrent prostate cancer identified and treated with PSMA-PET/CT and robotic SBRT using a uniform dose/fractionation scheme. The use of ADT was excluded.MethodsRetrospective analysis of patients with initial high-risk factors presenting with nodal/bone oligo-recurrent PCA in Ga68- or F18-PSMA-PET/CT treated with 1-3 fraction robotic SBRT.Results60 patients/172 metastases were treated in 95 treatment series with 43 patients receiving >1 SBRT course. Median FU was 22 months. bPFS/SBRT-FS/ADT-FS was 6/23/32 months at 89.7% local control and 6.5/1.1% acute/late grade 1 AE. High PSA-nadir, initial pN1-status and longer time to PSA-nadir were predictive for worse bPFS/SBRT-FS.DiscussionMetastasis-Directed-Therapy using ablative focal SBRT is effective in bridging the gap between the identification of early metastases and the initiation of palliative systemic therapy. It is a fast outpatient procedure yielding high rates of local control, free of significant toxicity and repeatable if necessary. ADT could be withheld for almost 3 years. Patients with predictors for worse outcome could be identified.
Artificial intelligence (AI) and machine learning are increasingly applied across urology, with particular promise for the management of neurogenic lower urinary tract dysfunction (NLUTD) in individuals with spinal cord injury (SCI). There is also particular promise in the management of NLUTD, a complex, lifelong condition affecting individuals with SCI and also occurring in the context of multiple sclerosis, Parkinson's disease, and other neurological disorders. This article provides a comprehensive analysis of AI's current and emerging role in neuro-urology, with dedicated focus on the specific challenges and opportunities presented by NLUTD and SCI. We review the epidemiological and clinical burden of neurogenic bladder dysfunction. We further examine AI applications in uro-oncology, functional urology, digital pathology, and robotic surgery, integrating these with the specialized perspective of neuro-urology. The particular vulnerability of individuals with SCI to algorithmic bias, access inequity, and assistive technology dependency is critically discussed. We identified five key domains where AI may transform care for patients with NLUTD: automated urodynamic interpretation including detection of detrusor overactivity and detrusor-sphincter dyssynergia, predictive risk stratification for renal deterioration, closed-loop neuromodulation, remote digital monitoring, and AI-assisted rehabilitation support. Alongside the substantial opportunities, we articulate the ethical, moral, and societal responsibilities that accompany AI integration in this population, emphasizing that patients with SCI and NLUTD deserve not merely inclusion in AI development but active partnership as co-designers of the technologies that will shape their lives.
Benign prostatic hyperplasia (BPH) is a common age-related condition characterized by stromal and epithelial proliferation within the prostate and is influenced by androgen signaling, ageing, obesity, metabolic dysfunction, and inflammation. Increasing interest has focused on whether the gut microbiota may contribute to these processes through a putative gut–prostate axis. The human gut contains a complex microbial ecosystem comprising thousands of bacterial species whose metabolites and immune-modulatory activities influence host physiology. Alterations in microbial composition and function have been associated with numerous chronic inflammatory and metabolic disorders. Emerging clinical and preclinical evidence suggests that gut dysbiosis may also be associated with prostate enlargement and lower urinary tract symptoms. Proposed mechanisms include altered production of short-chain fatty acids, impaired intestinal barrier integrity with increased lipopolysaccharide translocation, Toll-like receptor signaling, changes in tryptophan and serotonin metabolism, vagal pathways, and systemic cytokine-mediated inflammation. However, current evidence remains largely associative and mechanistic, with relatively few human studies directly linking alterations in the gut microbiota to BPH pathogenesis. This narrative review examines current evidence supporting the gut–prostate axis in BPH, evaluates potential biological mechanisms such as the vagus nerve and tryptophan, discusses dietary influences on microbiota composition, and highlights limitations in the existing literature together with priorities for future research and therapeutic development.
Paratesticular tumors are uncommon in the pediatric population and can represent a wide range of benign and malignant pathologies. We report the case of an otherwise healthy 2-year-old boy who presented with an asymptomatic right scrotal mass. Serial scrotal ultrasounds demonstrated a stable, well-circumscribed extratesticular lesion adjacent to the epididymal head with internal vascularity and normal bilateral testicular architecture. Serum tumor markers, including alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase, were within normal limits. There was no family history of malignancy or urologic conditions. Given persistent diagnostic uncertainty, surgical exploration was performed. Intraoperatively, a firm paratesticular mass arising from the tunica albuginea was identified and excised with preservation of the testis. Frozen section analysis revealed bland spindle cells without malignant features, allowing for testis-sparing management. Permanent histopathology demonstrated a well-circumscribed spindle cell lesion within a loose collagenous stroma with dystrophic calcifications. Immunohistochemistry showed positivity for smooth muscle actin and negativity for desmin, myogenin, MyoD1, β-catenin, S100, and anaplastic lymphoma kinase (ALK), supporting a diagnosis of benign myofibroblastic lesion, such as fibrous pseudotumor, and excluding inflammatory myofibroblastic tumor. To our knowledge, this case represents one of the earliest presentations of a benign paratesticular myofibroblastic lesion. This case underscores the importance of considering rare benign spindle cell lesions in the differential of paratesticular lesions in young children and the use of intraoperative frozen section to facilitate testis-sparing surgery and avoid unnecessary orchiectomy through careful multidisciplinary evaluation.
BackgroundProstatic involvement by bladder urothelial carcinoma is uncommon, and prostatic stromal invasion usually indicates aggressive tumor biology and poor prognosis. Such patients may present with prostatic enlargement or a mass at the bladder neck-prostate junction, while serum prostate-specific antigen (PSA) may remain within the normal range. This diagnostic overlap may lead to clinical confusion with benign prostatic hyperplasia or primary prostatic tumors.Case presentationA 54-year-old man was admitted with urinary frequency, urgency, dysuria, and intermittent gross hematuria. Serum PSA on admission was 2.1 ng/mL. Imaging suggested a mass at the bladder neck-prostate junction with an indistinct boundary between the bladder and prostate. After transurethral resection of a bladder lesion, pathology and immunohistochemistry indicated high-grade invasive urothelial carcinoma. Tumor cells expressed CK20, GATA3, and p63, partially expressed CK7 and Uroplakin III, and were negative for PSA and NKX3.1. The patient subsequently underwent radical cystectomy, ileal conduit urinary diversion, and pelvic lymph-node dissection. Postoperative pathology revealed high-grade bladder urothelial carcinoma with invasion of the prostatic stroma and capsule, staged as pT4aN0M0, with lymphovascular invasion, perineural invasion, and a positive prostatic urethral margin. PD-L1 expression was low (TPS <1%, IC <1%), and HER2 was negative. Because no neoadjuvant systemic therapy had been given and the final pathology showed pT4a disease with a positive margin, adjuvant systemic therapy was recommended and initiated. The patient received only approximately one week of platinum-based chemotherapy plus immunotherapy; treatment was discontinued because of poor tolerance and substantial financial burden. Three months after surgery, the patient developed low back pain. Whole-body bone scintigraphy and SPECT/CT demonstrated multiple bone metastases involving the L2 and L4 vertebrae and posterior elements, bilateral iliac bones, the left acetabular rim, and the right inferior pubic ramus. He subsequently received denosumab combined with conformal intensity-modulated radiotherapy to vertebral metastatic lesions.ConclusionThis case highlights that a normal PSA level does not exclude prostatic involvement by bladder-derived urothelial carcinoma. For patients with bladder neck or prostatic masses, especially those with normal PSA but imaging evidence of bladder-prostate junction involvement, an immunohistochemical panel including GATA3, CK7, CK20, p63, Uroplakin III, PSA, and NKX3.1 should be used early for differential diagnosis. Prostatic stromal invasion combined with lymphovascular invasion, perineural invasion, and a positive surgical margin may indicate highly aggressive disease and an increased risk of early distant metastasis, requiring intensified postoperative risk assessment, systemic treatment decision-making, and close follow-up.
Hereditary leiomyomatosis and renal cell carcinoma (HLRCC), caused by germline FH mutations, is a rare autosomal dominant syndrome. This report details a 42-year-old woman with aggressive FH-deficient renal cell carcinoma (RCC) and multiple uterine leiomyomas. Radical nephrectomy and subsequent hysterectomy confirmed FH-deficient tumors via immunohistochemistry and genetic testing (FH c.1240A>G, p. Lys414Glu). Despite adjuvant immunotherapy and targeted therapy, rapid bone metastasis occurred postoperatively. This case highlights the aggressive nature of HLRCC-associated RCC, underscores challenges in therapeutic management, and emphasizes the necessity of early genetic testing and multidisciplinary surveillance to improve outcomes.
IntroductionSalvage radiotherapy (SRT) is one of the treatment options after progression following surgical management, with effectiveness varying according to patient risk and clinical-pathological characteristics.ObjectiveTo compare the effectiveness of SRT alone versus SRT combined with androgen deprivation therapy (ADT) in men with biochemical recurrence.MethodsWe conducted a systematic review with advanced searches in MEDLINE (PubMed), EMBASE, SCOPUS, Cochrane CENTRAL, and LILACS for the period 1990–2024. Two independent reviewers performed study selection (titles/abstracts and full text) and data extraction. Risk of bias was assessed with ROBINS-I and RoB 2.0. A random-effects meta-analysis was used to pool effect estimates. PROSPERO registration: CRD42025640604.ResultsThirteen studies were included. Nine reported overall survival (OS) and biochemical progression-free survival (b-PFS) respectively, four clinical progression-free survival (c-PFS), and eight metastasis-free survival (MFS). Combined SRT+ADT was associated with improved b-PFS (HR 0.51; 95% CI 0.45-0.57; I²=0%) and MFS (HR 0.71; 95% CI 0.60-0.84; I²=39%), whereas the remaining meta-analyzed outcomes showed no consistent benefit or were limited by heterogeneity. Regarding toxicity, the most frequent adverse events were endocrine and sexual, related to hormonal blockade, gynecomastia and erectile dysfunction.ConclusionsCombined SRT + ADT improves biochemical disease control and may reduce the risk of metastasis in selected patients with biochemical recurrence after radical postatectomy, whereas the effect on overall survival remains uncertain. Individualized management requires risk stratification when deciding on the addition and duration of ADT to optimize oncologic outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/, identifier CRD42025640604.
ObjectiveTo determine whether protocolized intravesical gemcitabine instillation after transurethral resection of bladder tumor (TURBT) is associated with men’s sexual quality of life, assessed using the Sexual Life Quality Questionnaire (SLQQ), compared with a single immediate postoperative instillation.MethodsWe conducted a retrospective cohort study of 244 men with non–muscle-invasive bladder cancer undergoing TURBT between January 2021 and May 2024. Patients received either protocolized intravesical gemcitabine (weekly for 8 weeks, then monthly for 6 months) or a single immediate postoperative instillation. The primary outcome was the 8-month SLQQ score. Secondary outcomes included the International Index of Erectile Function-5 (IIEF-5) and urinary symptom–related quality-of-life (QOL) score. Between-group comparisons, difference-in-differences (DID), correlation analyses, multivariable regression, and multiple-imputation sensitivity analyses were performed.ResultsBaseline SLQQ scores were comparable between groups. At 8 months, the protocol cohort had significantly lower SLQQ scores than controls (21.78 ± 8.77 vs. 37.13 ± 8.56; mean difference −15.35, 95% CI −17.54 to −13.16; Cohen’s d=−1.77; P<0.001). The decline in SLQQ was greater in the protocol cohort (DID −15.27, 95% CI −18.18 to −12.36). Postoperative IIEF-5 was strongly correlated with SLQQ (r=0.938), whereas urinary symptom–related QOL showed a weak negative correlation (r=−0.232). Sensitivity analyses consistently demonstrated an approximately 15-point between-group difference after adjustment for baseline SLQQ and additional imputed clinical covariates.ConclusionsProtocolized intravesical gemcitabine following TURBT was associated with poorer postoperative sexual quality of life. This association remained robust across multiple sensitivity analyses, supporting routine sexual-health assessment during NMIBC survivorship.
Patients with prostate cancer (PCa) undergoing androgen deprivation therapy (ADT) frequently develop cardiometabolic complications, particularly those with type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide cardiovascular and renal benefits in diabetic populations, but comparative evidence with other glucose-lowering therapies in men receiving ADT remains limited. We conducted a retrospective cohort study using the TriNetX network. Adults with T2D and PCa undergoing ADT who received GLP-1RA, dipeptidyl peptidase-4 inhibitors (DPP-4is), or sodium–glucose cotransporter-2 inhibitors (SGLT2is) between January 2005 and December 2025 were included. Propensity score matching generated balanced cohorts for two comparisons: GLP-1RA versus DPP-4i and GLP-1RA versus SGLT2i. The primary outcome was all-cause mortality; secondary outcomes were major adverse cardiovascular events (MACEs), major adverse kidney events (MAKEs), and thrombotic events. After matching, 659 patients per group were included in the GLP-1RA versus DPP-4i comparison and 1,009 per group in the GLP-1RA versus SGLT2i comparison. Compared with DPP-4i, GLP-1RA use was associated with lower all-cause mortality (HR, 0.60; 95% CI, 0.46–0.79), MAKEs (HR, 0.63; 95% CI, 0.48–0.81), and thrombotic events (HR, 0.53; 95% CI, 0.32–0.89), whereas MACEs were similar (HR, 0.87; 95% CI, 0.63–1.12). Compared with SGLT2i, GLP-1RA use was associated with lower all-cause mortality (HR, 0.76; 95% CI, 0.59–0.99), whereas no significant differences were observed for MACEs, MAKEs, or thrombotic events. These neutral findings should be interpreted cautiously because the limited number of events may have reduced statistical power to detect modest between-group differences. In conclusion, among men with PCa receiving ADT and comorbid T2D, GLP-1RA use was associated with lower all-cause mortality than both DPP-4i and SGLT2i, with additional reductions in kidney and thrombotic events versus DPP-4i. GLP-1RAs may represent a favorable therapeutic option in this metabolically and vascularly vulnerable population. Prospective studies are warranted to confirm these associations and clarify the underlying mechanisms.
Purpose:This study aimed to evaluate the safety and efficacy of a domestically developed implantable tibial neuromodulation system (iTNS) in the treatment of overactive bladder (OAB) in patients with urgency urinary incontinence (UUI). Methods:A prospective single-center open-label trial was conducted. A total of 10 participants underwent iTNS device implantation, followed by device activation at 2-4 weeks post-implantation. Follow-up evaluations were performed at 1, 3, and 6 months post-implantation, including 3-day bladder diaries, validated questionnaires, and symptom satisfaction surveys. The primary endpoint was a ≥50% reduction in UUI episodes per day at 6 months. Results:At 6 months, the iTNS system achieved a 90% response rate (9/10 patients), among whom 40% (4/10) attained ≥3 consecutive dry days. A delayed therapeutic onset was observed: a significant reduction in UUI episodes emerged at 3 months (from 3.235 to 0.766 episodes per day) and 6 months (from 3.235 to 0.632 episodes per day). Quality of life was significantly improved at 6 months, as indicated by the changes in validated questionnaires (OAB-Q: 69.5 ± 11.76 to 44.4 ± 12.06; OABSS: 9 ± 1.155 to 6.2 ± 2.394). Additionally, 80% of patients reported satisfaction with their symptoms at the 6-month endpoint. Conclusions:The domestically developed iTNS system is safe and effective for the treatment of UUI in patients with OAB. It exhibits a strong ability to significantly reduce or completely resolve UUI symptoms, with a favorable safety profile.
BackgroundClear cell adenocarcinoma of the urethra (CCAU) is an extremely rare subtype of primary urethral carcinoma. Owing to its low incidence, the optimal treatment strategy for advanced or metastatic disease remains unclear. We report a case of advanced CCAU with lymph node metastases that achieved long-term disease control following multimodal therapy.Case presentationA 60-year-old woman presented with urinary retention and was diagnosed with primary urethral clear cell adenocarcinoma (cT4N2M0) with pelvic lymph node metastases. Neoadjuvant gemcitabine plus cisplatin (GC) chemotherapy achieved a partial response and was followed by robot-assisted radical cystourethrectomy combined with hysterectomy, vaginectomy, and pelvic lymph node dissection. Pathological examination revealed ypT4N2M0 disease with negative surgical margins. Adjuvant nivolumab was initiated but was discontinued because of immune-related hypothyroidism and nodal recurrence. Comprehensive genomic profiling demonstrated microsatellite stability, a low tumor mutational burden (1 mutation/Mb), and MET and MYC amplifications. As no actionable alterations were identified, GC chemotherapy was reintroduced and again achieved a partial response. The patient remains progression-free 32 months after diagnosis.ConclusionsThis case suggests that multimodal treatment combining radical surgery and platinum-based chemotherapy may contribute to durable disease control in selected patients with advanced CCAU and lymph node metastasis. Although genomic profiling did not directly guide therapy in this case, molecular characterization may provide a basis for future individualized treatment strategies for this rare malignancy.
BackgroundRepair of vesicovaginal fistula (VVF) is highly effective, with primary success rates of 80-95%; however, recurrence is reported in 10-30% of cases. Factors influencing recurrence include fistula size and tissue characteristics.MethodsThis systematic review identifies predictive factors for VVF recurrence by reviewing 21 studies published between 1994 and 2025 that met PRISMA criteria, and by analyzing the surgical outcomes from PubMed/MEDLINE data for various etiologies of VVF. Eligible studies reporting predictors of VVF repair were assessed for bias using the modified Newcastle-Ottawa Scale.ResultsThe following factors were consistently identified as predictors of VVF recurrence: fistula size greater than 2-3cm (odds ratio [OR]: 1.0-6.0), severe peri-fistula fibrosis (OR: 2.7 to 12.0), involvement of the urethra and/or bladder neck (OR: 0.4 to 9.0) and multiple fistulas (OR: 4.0 to 8.0). The following protective factors were identified: early intervention, surgery performed in a specialist center, and the use of interposition flaps. The Goh and Panzi classifications assist in the predictive risk stratification of patients. Most studies had a low to moderate risk of bias. Due to the heterogeneous nature of the studies, there was considerable variation in study design, etiology, and surgical technique; therefore, narrative synthesis rather than meta-analysis was performed. In most cases, secondary VVF repair has been documented to improve surgical outcomes; however, results for previously failed repairs remain contradictory.ConclusionUsing validated predictive factors for preoperative risk stratification may improve global VVF surgical outcomes. Closing the gap in surgical outcomes between regions and optimizing surgical techniques will require further prospective research and the development of predictive models.
PurposeAminophylline, a methylxanthine derivative, acts as a smooth muscle relaxant through non-competitive inhibition of phosphodiesterase. It has been suggested to facilitate ureteroscopic lithotripsy by relaxing ureteral smooth muscle. The aim of this systematic review is to assess the available evidence on locally administered aminophylline in patients undergoing ureteroscopic lithotripsy and, where feasible, to perform an exploratory meta-analysis to estimate pooled effects.MethodsA systematic search was conducted through November 2025. Three randomized controlled trials (RCTs) met the inclusion criteria. The primary outcome was residual stone proportions (derived from the stone-free rate). Secondary outcomes included operative time, postoperative ureteral stenting, and auxiliary procedures. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool. This review was registered with PROSPERO (CRD420251229352).ResultsThree RCTs enrolling 310 patients (155 receiving aminophylline and 155 receiving placebo) were included. Local aminophylline was associated with significantly fewer residual stones (RR 0.3; 95% CI: 0.13, 0.69; p = 0.025; I² = 0%) and fewer auxiliary procedures (RR 0.15; 95% CI: 0.06, 0.38; p <0.001; I² = 0%). Reductions in operative time and postoperative ureteral stenting were observed in the primary analysis; however, these did not remain statistically significant after applying the Hartung–Knapp–Sidik–Jonkman (HKSJ) correction.ConclusionThis exploratory meta-analysis provides preliminary evidence that locally administered aminophylline may reduce residual stone fragments and auxiliary procedures during ureteroscopic lithotripsy. Reductions in operative time and ureteral stenting did not retain statistical significance in sensitivity analyses and should be considered hypothesis-generating. These findings should be interpreted with caution, given the low certainty of the evidence. Adequately powered randomized trials are required to validate these results.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420251229352.
IntroductionNeurogenic lower urinary tract dysfunction (NLUTD) is a frequent consequence of spinal cord injury or disease (SCI/D). It can lead to impaired bladder emptying, urinary incontinence, and recurrent urinary tract infections. For those unable to empty their bladder effectively, intermittent catheterization (IC) is the recommended first-line management. Clinical guidelines advise catheterization four to six times daily to prevent bladder overdistension (i.e., bladder volume > 500 ml), yet fixed schedules are often impractical due to fluctuating daily factors. Personalized scheduling is particularly challenging for individuals with SCI/D who lack bladder sensation. Consequently, a noninvasive and unobtrusive method for bladder volume monitoring is needed. Electrical bioimpedance (BI) is a promising solution, as it measures the impedimetric response of tissue to an applied electrical signal and should detect changes related to bladder filling. This may enable continuous, dynamic volume estimation and support individualized bladder management.Methods and analysisThis multi-center observational feasibility study evaluates a BI sensor for noninvasive bladder volume monitoring across three phases. Phase 1 assesses feasibility in individuals without SCI/D. Phase 2 includes individuals with chronic SCI/D and NLUTD to determine the difference between BI-derived bladder volume and the clinical gold standard (bladder volume determined by catheterization). Effects of abdominal adiposity and muscle activity on BI-signals will also be analyzed. Phase 3 examines the usability of a BI-based wearable during six hours of real-life use in wheelchair users reliant on intermittent catheterization. Sixty participants will be enrolled across all phases. The primary outcome is the difference in bladder volume (mL) between BI measurements and catheterized volumes in individuals with SCI/D. Secondary outcomes include physiological and motion parameters possibly affecting BI measurements. Analyses will be descriptive, focusing on signal quality, feasibility, and measurement agreement.DiscussionThis multi-phase feasibility study evaluates whether a BI sensor can measure bladder volume in individuals with SCI/D and NLUTD noninvasively and continuously. By validating BI in controlled and real-life settings, the study aims to determine its feasibility and potential as an alternative to current bladder volume assessment methods.
BackgroundThe mechanism of leptin’s role in female infertility has been demonstrated, however, the relationship between it and infertile patients with varicocele has yet to be determined. This study aimed to evaluate role of leptin in reproductive dysfunction in patients with varicocele.MethodsA computerized literature search was independently conducted by two researchers in PubMed, EMBASE, Web of Science, ScienceDirect, and Cochrane Library up to July 2025. The search terms were as follows: ‘leptin’, ‘varicocele’ and ‘infertility’. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The meta-analysis was performed using Review Manager version 5.1 and R version 4.0.5.Results36 studies were retrieved and 5 studies were included for meta-analysis. We found that the expression of leptin in seminal plasma in infertile patients with varicocele were significantly higher than controls (SMD, 2.72; 95%CI, 1.05-4.39; I2 = 96%, p=0.001). In contrast, the serum leptin levels did not show statistically significant differences (SMD, 1.26; 95%CI -0.73-3.26; I2 = 96%, p=0.21) between patients and controls. Seminal plasma leptin levels had a moderate negative correlation with sperm concentration (r=-0.54; 95%CI, -0.77 - -0.19; p<0.01). Additionally, seminal plasma leptin levels had a strong negative correlation with sperm progressive motility (r=-0.71; 95%CI, -0.93 - -0.09; p<0.01).ConclusionsThe expression of leptin in seminal plasma was significantly higher in infertile patients with varicocele. Seminal plasma leptin levels had a negative correlation with sperm concentration and progressive motility. Leptin in seminal plasma seemed to have a negative effect on the reproductive function of patients with varicocele.
ObjectTo evaluate the association between hysterectomy and the risk of developing urinary incontinence (UI) based on observational studies.MethodsWe conducted a systematic search of PubMed, Embase, and Cochrane Library for observational studies from inception to December 14, 2025, using medical subject headings (MeSH) and keywords. The risk of bias and the quality of evidence were assessed using the Newcastle-Ottawa Scale (NOS), the Agency for Healthcare Research and Quality (AHRQ) criteria, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively. To derive overall summary estimates of odds ratios (OR), a random-effects meta-analysis was performed, complemented by subgroup analyses to explore potential effect modifiers. And the presence of publication bias was evaluated through funnel plots and Egger’s regression test.ResultsThis meta-analysis is registered with PROSPERO (CRD42024587774) and follows PRISMA guidelines, including 12 studies with a cumulative total of 146,759 individuals who underwent hysterectomy. The pooled analysis revealed a significant association between hysterectomy and an increased risk of UI, yielding an OR of 1.31, (95% CI: 1.03-1.66, I2 = 88.5%, P = 0.029). Subgroup analyses showed that the risk of UI was notably higher among patients who underwent abdominal hysterectomy (OR = 1.21, 95% CI: 1.10-1.34, I2 = 0.0%, P = 0.000). Furthermore, it was observed that the incidence of UI was particularly elevated in studies conducted in Asia, while no significant association was reported for regions such as Europe and North America.ConclusionHysterectomy is associated with an increased risk of urinary incontinence, based on synthesized evidence from observational studies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024587774.
ObjectiveFocal high-intensity focused ultrasound (HIFU) is a minimally invasive treatment for localized prostate cancer. Its comparative effectiveness against active surveillance (AS) remains underexplored in patients eligible for either strategy.MethodsThis retrospective cohort study analyzed 635 men with localized prostate cancer treated between 2018 and 2023: 303 received focal HIFU and 332 underwent AS. Only low-risk and favorable intermediate-risk patients per NCCN guidelines were included (PSA <20 ng/mL, stage ≤T2b, ISUP ≤2, <50% positive cores). Multiparametric MRI and targeted biopsies confirmed eligibility. Outcomes included progression to clinically significant prostate cancer (csPC: ISUP ≥3 or ISUP 2 with PIRADS ≥4), radical treatment-free survival, PSA kinetics, and functional outcomes (IPSS, IIEF-5, continence).ResultsBaseline characteristics were comparable. At 12 months, csPC-free survival was higher with HIFU in intermediate-risk patients (95.8% vs. 84.0%, p=0.0018) and low-risk patients (97.6% vs. 88.3%, p=0.0035). At a median follow-up of 75 months, HIFU maintained superior csPC-free rates in both risk groups. Radical treatment-free survival was similar in both low and intermediate risk group 76% vs 77.1% and 83.2% vs 80.3% respectively, time to radical treatment was significantly longer in the HIFU group. PSA reductions at 3 and 6 months were greater with HIFU. Functional outcomes, including erectile function, continence, and urinary symptoms, were comparable between groups.ConclusionsFocal HIFU offers better short-term oncological control and delays the need for radical treatment compared to AS, with similar preservation of urinary and sexual function. These results support its use in selected patients seeking a balance between cancer control and quality of life.
ObjectiveThe United Nations defines sustainability as meeting needs of the present without compromising future generations. While often equated to “saving the planet”, sustainability is a diverse topic. Healthcare generates >5% of CO2 emissions worldwide, yet sustainability efforts in urology are limited. The North Central Section of the American Urological Association (NCSAUA) recently convened a Sustainability Task Force to address this topic. This study queried members on sustainability in urologic practice.MethodsFollowing literature review on sustainability in surgery/urology, a 19-item anonymous REDCap survey was developed and distributed via email to NCSAUA members (N = 1607). The survey assessed current best practice, institutional/personal sustainability, and demographics. Responses were compiled and summarized using descriptive statistics.ResultsSurvey response rate was 4.9% (79/1607). Respondents were most commonly from metropolitan areas (82%), male (71%), and in practice for 5–14 years (29%). Sustainability topics were prioritized as: (1) financial, (2) future workforce, (3) environmental. Over half (56%) reported no institutional sustainability programs or were unaware of them. Instrument (67%), computer (68%), and paper (65%) recycling were supported by a majority of respondents. However, only 28% and 29% of respondents reported current institutional use of instrument and computer recycling, respectively. Telemedicine was infrequent, with most urologists (58%) conducting 0-5% of visits virtually.ConclusionsCurrent institutional and urologic practice emphasis on sustainability is low. Respondents ranked highest sustainability priorities as financial and future workforce. Efforts to address environmental sustainability were also supported, namely reduction of disposables and waste. The findings support the development of targeted programs to advance sustainability priorities widely.
