BACKGROUND:Magnetic resonance imaging-targeted prostate biopsy relies heavily on costly software-fusion platforms, limiting global accessibility. OBJECTIVE:We aimed to determine whether cognitive fusion (mental registration) is noninferior to software-based fusion targeted biopsy for detecting clinically significant prostate cancer (csPCa). DESIGN, SETTING, AND PARTICIPANTS:This multicenter, randomized, blinded, noninferiority trial enrolled 648 predominantly biopsy-naive men (prostate-specific antigen 4-20 ng/ml; Prostate Imaging Reporting and Data System ≥3) at nine centers in China. INTERVENTION:Participants were randomly assigned 1:1 to cognitive fusion or software-based fusion targeted biopsy, followed by systematic biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary outcome was csPCa (ISUP grade group ≥2) detection on targeted biopsy, evaluated using generalized estimating equations with a prespecified -10 percentage point noninferiority margin. RESULTS AND LIMITATIONS:In the intention-to-treat population (327 cognitive and 321 software), targeted biopsy detected csPCa in 32% and 34% of the patients, respectively. The adjusted risk difference was -1.02 percentage points (90% confidence interval [CI], -5.6 to 3.6), establishing noninferiority. Combined targeted and systematic biopsy detected csPCa in 35-39% of the patients, respectively (difference, -1.50% [90% CI, -6.4 to 3.4]). A significant body mass index (BMI) interaction was observed (p < 0.001): cognitive fusion performed best in men with BMI <24 kg/m2, whereas software-based fusion improved detection in men with BMI ≥24 kg/m2. Adverse event rates were comparable (15% vs 18%). Limitations include conducting the trial predominantly in Asian populations, necessitating cautious geographic extrapolation of specific BMI cutoffs. CONCLUSIONS:Cognitive fusion is diagnostically noninferior to software-based fusion within a prespecified -10% margin overall. However, a significant BMI interaction raises serious concerns regarding the diagnostic feasibility of cognitive fusion in obese populations, where software-based fusion is strictly superior. Future prospective trials in both Asian and Western populations must evaluate the BMI effect as a primary end point. TRIAL REGISTRATION:ClinicalTrials.gov NCT04271527.

Diabetic erectile dysfunction (DMED) is a common complication among male patients with diabetes. Therapies primarily based on phosphodiesterase type 5 inhibitors (PDE5Is) often yield suboptimal results. Extracellular vesicles (EVs) have emerged as a promising therapeutic strategy; however, their clinical translation is hindered by rapid in vivo clearance and limited inherent bioactivity. Therefore, we developed an innovative combined therapeutic approach. First, we fabricated an injectable, thermosensitive hydrogel (ECMTA-Hydrogel) by combining a decellularized porcine corpus cavernosum extracellular matrix (ECM) with tannic acid, which exhibits excellent biocompatibility and rapid gelation at body temperature (37 °C), enabling prolonged local retention of EVs within the corpus cavernosum. Second, we pretreated mesenchymal stem cells (MSCs) with pioglitazone to generate engineered EVs (PGZ-EVs) with enhanced bioactivity. Experiments confirmed that the ECMTA-Hydrogel facilitates sustained release of PGZ-EVs, extending their duration of action. In a DMED rat model, the combined ECMTA-PGZ-EVs therapy demonstrated superior efficacy, markedly improving erectile function and effectively reversing pathological phenotypic switching and apoptosis in corpus cavernosum smooth muscle cells (CCSMCs). Mechanistically, we identified that miR-203a-3p, highly enriched in PGZ-EVs, directly targets and suppresses the endoplasmic reticulum transmembrane protein TMEM33, thereby mitigating diabetes-induced endoplasmic reticulum stress (ERS). This pathway represents the key mechanism underlying the cytoprotective effects of PGZ-EVs. In summary, this study not only establishes an efficient natural matrix hydrogel-based delivery system but also augments the therapeutic potential of EVs via engineered modification. Furthermore, we elucidate a novel mechanism involving the miR-203a-3p/TMEM33/ERS axis, offering a promising therapeutic strategy for the clinical management of DMED.

ETHNOPHARMACOLOGICAL RELEVANCE:Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urological disorder characterised by persistent pelvic pain and chronic inflammation that can trigger depressive symptoms and significantly negatively affect patients' health and quality of life. Current clinical treatment outcomes are unsatisfactory. Saikosaponin D is a triterpenoid saponin that is primarily isolated from the roots of Bupleurum chinense and related Bupleurum species. Bupleurum is a traditional medicinal plant genus that is extensively utilised in East Asian ethnomedicine. SSD has been reported to possess anti-inflammatory, immunomodulatory, and antifibrotic properties. However, its therapeutic potential in CP/CPPS remains unclear. AIM OF THE STUDY:This study was designed to assess the therapeutic effect of saikosaponin D in an experimental autoimmune prostatitis (EAP) mouse model and to investigate its underlying mechanisms. MATERIALS AND METHODS:Male C57BL/6 mice were immunised with rat prostate extract emulsified in complete Freund's adjuvant to induce EAP and subsequently treated with high-dose and low-dose SSD. The pelvic pain thresholds were assessed by von Frey filaments, depressive-like behaviours by forced swim tests, and histopathological alterations by haematoxylin-eosin staining. Multiomics analyses, including RNA sequencing, RT‒qPCR, Western blotting, ELISA, immunofluorescence, and flow cytometry, were employed to profile transcriptomic changes, cytokine levels, and immune cell phenotypes. RESULTS:SSD treatment significantly increased pain thresholds, alleviated depressive-like behaviour, and reduced prostatic inflammation and tissue damage. Transcriptomic analysis revealed that NF-κB signalling is a major pathway regulated by SSD. Mechanistically, SSD suppressed aberrantly upregulated lncRNA5682 expression, thereby inhibiting NF-κB activation, reducing the number of proinflammatory monocytes/macrophages, and promoting M2 macrophage polarisation. CONCLUSION:SSD has potent anti-inflammatory, analgesic, and immunomodulatory effects on CP/CPPS through inhibition of the lncRNA5682/NF-κB axis, highlighting its potential as a promising therapeutic agent for chronic prostatitis.

OBJECTIVE:To explore the role of prostate health index (PHI) and its derivatives for early screening in patients with PI-RADS score 3 and prostate-specific antigen (PSA) levels of 4－20 μg/L. METHODS:Clinical data of 203 patients with a score of 3 on the PI-RADS v2.1 scoring system who underwent ultrasound-guided transperineal prostate aspiration biopsy from April 2021 to April 2024 from Provincial Hospital of Shandong First Medical University, Qilu Hospital of Shandong University and Weifang People's Hospital were collected. Patients who met the inclusion criteria were divided into prostate cancer (PCa) group (62 cases) and benign prostatic hyperplasia (BPH) group (141 cases). Serum total prostate-specific antigen (tPSA), serum free prostate-specific antigen (fPSA), and PSA isoform 2 (p2PSA) were routinely detected after admission. And prostate-specific antigen density (PSAD), prostate health index (PHI) and prostate health index density (PHID) were calculated with the basic personal information being collected. The efficacy of each parameter in early screening of patients with PI-RADS score of 3 and PSA level of 4－20 μg/L was assessed using ROC curve approach. RESULTS:There was no statistical difference in tPSA, fPSA and fPSA/tPSA between the two groups (P>0.05). There was a statistical difference in p2PSA, PSAD, PHI, PHID and age between the two groups (P<0.05). PHI (AUC=0.783 7, 95% CI: 0.711 3－0.856 1) and PHID (AUC=0.782 3, 95% CI: 0.708 3－0.856 4) showed a good predictive ability in the early screening of prostate cancer. In the clinically significant prostate cancer (csPCa) group, the ROC curve areas of PHI and PHID were 0.823 0 and 0.788 5, respectively, which showed better predictive efficacy of prediction of csPCa. The ROC curves of the combined diagnostic indexes were plotted on the basis of the independent ROC curves, and the area under the curve of PHI combined with age, p2PSA and PHID (AUC=0.843 6) was the largest and had the best predictive ability among all the combined diagnostic indexes. CONCLUSION:In patients with PI-RADS score 3 and PSA level between 4 and 20 μg/L, PHI and its derivatives (PHI and PHID) provide a new way for early screening of prostate cancer compared with the traditional index tPSA, which has a high value of application in reducing the over-penetration.

Erectile dysfunction (ED) is a prevalent complication of diabetes mellitus and is associated with cellular damage caused by the hyperglycemic state in the corpus cavernosum of the penis. Piperine, the primary alkaloid in Piper nigrum L., has demonstrated antioxidant and anti-inflammatory properties. This study aims to investigate the molecular mechanisms underlying the potential of piperine in improving erectile function. Intracavernous pressure (ICP) and mean arterial pressure (MAP) assays revealed that piperine improved erectile function in diabetic mellitus erectile dysfunction (DMED) rats. Masson's trichrome staining showed that piperine attenuated diabetes-induced fibrosis in the cavernous body. Piperine increased the levels of superoxide dismutase (SOD) and decreased malondialdehyde (MDA) levels, indicating that piperine modulated oxidative stress in penile tissue. The results of the Western blot analysis showed that piperine led to a decrease in the levels of pro-apoptotic proteins, including Bax and cleaved-Caspase 3 and increased the levels of the anti-apoptotic protein BCL-2. The present study utilized RNA sequencing (RNA-seq) and Western blot analysis to ascertain the effects of piperine on the PI3K/AKT pathway. The findings revealed that piperine induced the activation of this pathway. Consistent with in vivo findings, flow cytometry showed that piperine pretreatment reduced reactive oxygen species (ROS) levels and the apoptosis rate in corpus cavernosum smooth muscle cells (CCSMCs) following hydrogen peroxide (H2O2) stimulation. Immunofluorescence staining revealed that piperine improved mitochondrial function, reducing mitochondrial ROS (mtROS) accumulation and maintaining normal mitochondrial membrane potential (MMP) levels. The protective effect of piperine was blocked by the PI3K pathway inhibitor LY294002.

The improvement of the prediction of prostate cancer (PCa) is a major challenge in disease management. This study analysed a total of 147,856 cells and identified 15 distinct cell types using single-cell RNA-sequencing (scRNA-seq) and bulk RNA-seq data from TCGA and GEO databases. Of these cells, 31,256 exhibited a high telomere-related gene score and were predominantly composed of myeloid dendritic cells (mDCs). Simultaneously, pseudo-temporal analysis indicated that mDCs are in the later stages of the differentiation trajectory, suggesting the significant role of mDCs as telomere-active cells in the development of PCa. Analysis of cell-cell communication revealed significant differences, particularly an increase in communication between mDCs and CTLs, alongside a decrease in communication between mDCs and B cells. These variations may represent critical nodes influencing the development of PCa. Additionally, two hub genes were utilized to create risk models, with ROC curves confirming their predictive efficacy for 3-, 5-, and 10-year survival rates in patients. Functional analysis of these genes was conducted, and NPY siRNA transfection notably inhibited proliferation in LNCaP and DU145 cells. Furthermore, the models demonstrated that high-risk patients had poorer overall survival, greater immune infiltration, and reduced sensitivity to chemotherapeutic drugs.

Achieving targeted activation of the cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) pathway is a significant challenge for cancer immunotherapy. To address this issue, a reversible reactive oxygen species (ROS) generator/capture is prepared, defined as CZFT NPs, consisting of Zr/Fe dual-doped hollow CeO2 (CZFO) nanozyme and hypoxia-activated prodrug tirapazamine (TPZ). CZFT shows superoxide dismutase-like activity in normal physiological environments and exhibits ROS scavenging ability, which can effectively enhance its biosafety. In acidic tumor microenvironment (TME), CZFT NPs display robust peroxidase-like and glutathione peroxidase-like activities. Moreover, the doping of Zr/Fe improves their sono-carrier dynamics while giving them excellent magnetic resonance imaging (MRI) and computed tomography (CT) imaging capabilities. These processes significantly increase ROS generation within tumor cells and trigger mitochondrial damage to release endogenous mitochondrial DNA (mtDNA). Moreover, Fe ions improve the cGAS sensitivity to damaged DNA, thereby selectively activating the cGAS-STING pathway of tumors. Furthermore, sonodynamic therapy augments the hypoxia level to activate TPZ for specific chemotherapy, facilitating cancer cell immunogenic cell death. This dual-pronged strategy synergistically stimulates dendritic cell maturation, alleviates the immunosuppressive TME, and augments NK and CD8+ T cells driven immunotherapy, thereby inhibiting cancer proliferation and metastasis. In summary, CZFT NPs demonstrate a groundbreaking paradigm for overcoming critical challenges associated with conventional STING agonists.

Collecting duct carcinoma (CDC), a rare and aggressive renal malignancy originating from the medullary collecting ducts, often presents with nonspecific symptoms and rapid metastatic progression, yielding a dismal prognosis. The occurrence of a composite CDC and conventional renal cell carcinoma is rare in the literature. We report a 55-year-old female with clear cell renal cell carcinoma with collecting duct carcinoma transformation in the same kidney. Seven months postoperatively, the patient developed metastasis to the lungs. A literature review of 18 mixed CDC with other tumors highlights metastatic propensity (52% cases) and poor outcomes, emphasizing the need for molecular profiling to guide targeted therapies. This report contributes to the growing body of literature regarding the complexity of composite renal malignancies, furthering our understanding of clinical, imaging, and histological findings of this rare phenomenon.

BACKGROUND:The administration of mesenchymal stem cells (MSCs) through intracavernous injection is a potential therapeutic approach for managing diabetes mellitus-induced erectile dysfunction (DMED). However, pulmonary embolism and tumorigenicity are fatal adverse events that limit the clinical application of MSCs. In this study, we examined the therapeutic efficacy and potential mechanism of MSC-derived extracellular vesicles (MSC-EVs). METHODS:In this study, forty 8-week-old male SpragueDawley (SD) rats were utilised. In the control group, ten rats were administered an intraperitoneal injection of PBS. STZ (60 mg/kg) was intraperitoneally injected into the remaining rats to establish a diabetes mellitus (DM) model. Afterwards, the diabetic rats were divided into three groups at random: the DM group (intracavernosal injection of PBS), the EVs group (intracavernosal injection of MSC-EVs), and the EVs-200a group (intracavernosal injection of miR-200a-3p-enriched extracellular vesicles). Erectile function was determined by measuring intracavernous pressure in real time and utilising electrical stimulation of the cavernous nerves. The smooth muscle content was evaluated through the investigation of penile tissue using immunofluorescence staining, Masson's trichrome staining, and western blotting after euthanasia. Superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione (GSH) levels in the corpus cavernosum were measured via ELISA. In vitro, hydrogen peroxide (H2O2) was used to induce oxidative stress. The viability of corpus cavernosum smooth muscle cells (ccSMCs) incubated with or without H2O2 was measured using a CCK8 assay. Flow cytometry was used to assess the levels of reactive oxygen species (ROS) and apoptosis in ccSMCs. Furthermore, a dual-luciferase reporter assay was performed to validate the relationship between miR-200a-3p and Keap1. RESULTS:Reversal of erectile function was observed in the EVs groups, especially in the EVs-200a group. DM increased the MDA level and decreased the SOD and GSH levels. In the DM group, the expression of alpha-smooth muscle actin (α-SMA) and smooth muscle 22 alpha (SM22α) was decreased, and the expression of osteopontin (OPN) was increased. Western blotting revealed decreased Nrf2, HO-1, and Bcl2 expression and increased Keap1, Bax and cleaved caspase3 expression in the cavernous tissue. miR-200a-3p-enriched extracellular vesicles (EVs-200a) reversed these changes and inhibited the loss of smooth muscle content and cavernous fibrosis. In vitro, H2O2 induced high ROS levels in ccSMCs and increased apoptosis, and these effects reversed by EVs-200a. H2O2 reduced Nrf2, HO-1, and Bcl2 expression and increased Keap1, Bax and cleaved caspase-3 expression, and these effects were reversed by MSC-EVs, especially EVs-200a. The of dual-luciferase reporter assay results indicated that miR-200a-3p directly targeted Keap1 in a negative manner. CONCLUSION:MSC-EVs, especially EVs-200a, alleviated erectile dysfunction in diabetic rats through the regulation of phenotypic switching, apoptosis and fibrosis. Mechanistically, miR-200a-3p targeted the Keap1/Nrf2 pathway to attenuate oxidative stress in diabetic rats.

Sono-immunotherapy faces challenges from poor immunogenicity and low response rate due to complex biological barriers. Herein, we prepared MCTH nanocomposites (NCs) consisting of disulfide bonds (S-S) doped mesoporous organosilica (MONs), Cu-modified protoporphyrin (CuPpIX), mitochondria-targeting triphenylphosphine (TPP), and CD44-targeting hyaluronic acid (HA). MCTH NCs efficiently accumulate at the tumor site due to the overexpressed CD44 receptors on the membrane of the cancer cells. Under the function of HAase and glutathione (GSH), MCTH degrades and exposes TPP to deliver CuPpIX to the mitochondrial site and induce a reactive oxygen species (ROS) burst in situ under ultrasound irradiations, thereby causing severe mitochondria dysfunction. This cascade-targeting ability of MCTH NCs not only reinforces oxidative stress in cancer cells but also amplifies immunogenic cell death (ICD) to stimulate the body's immune response and alleviate the tumor immunosuppressive microenvironment. These NCs significantly enhance the infiltration of immune cells into the tumor, particularly CD8+ T cells, for a powerful antitumor sono-immunotherapy. The proposed cascade-targeting strategy holds promise for strengthening sono-immunotherapy for prostate cancer treatment and overcoming the limitations of traditional immunotherapy.

The primary objective of this work was to delve into the potential therapeutic advantages and dissect the molecular mechanisms of salidroside in enhancing erectile function in rats afflicted with diabetic microvascular erectile dysfunction (DMED), addressing both the whole-animal and cellular dimensions.We established a DMED model in Sprague‒Dawley (SD) rats and conducted in vivo experiments. The DMED rats were administered varying doses of salidroside, the effects of which on DMED were compared. Erectile function was evaluated by applying electrical stimulation to the cavernous nerves and measuring intracavernous pressure in real time. The penile tissue underwent histological examination and Western blotting. Hydrogen peroxide (H2O2) was employed in the in vitro trial to induce an oxidative stress for the purpose of identifying alterations in cell viability. The CCK-8 assay was used to measure the viability of corpus cavernous smooth muscle cells (CCSMCs) treated with vs. without salidroside. Flow cytometry was utilized to detect alterations in intracellular reactive oxygen species (ROS). Apoptosis was assessed through Western blotting and TdT-mediated dUTP nick-end labelling (TUNEL). Animal and cellular experiments indicate that the Nrf2/HO-1 signalling pathway may be upregulated by salidroside, leading to the improvement of erectile function in diabetic male rats by alleviating oxidative stress and reducing apoptosis in corpus cavernosum tissue.

Radical pelvic surgery is a surgical method mainly used to treat tumors in the pelvic cavity, and erectile dysfunction (ED) is a common sexual dysfunction after surgery. The incidence of ED after radical pelvic surgery is not uniformly understood due to differences in surgical approaches and methods of investigation. The main causes of postoperative ED include intraoperative neurovascular injury, psychosomatic factors and preoperative patient characteristics, with intraoperative injury to the neurovascular bundle being the most common. Studies have shown that the occurrence of postoperative ED can be prevented by active intervention, but still lack of effective treatment measures. This article reviews and summarizes the clinical epidemiological features and research progress in recent years on ED after radical pelvic surgery, and discusses specific measures for the prevention and treatment of postoperative ED.

Objective: The aim of this study was to evaluate efficacy and safety of 1470 nm diode laser enucleation of the prostate (DiLEP) and plasmakinetic resection of the prostate (PKRP) in elderly benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms.Methods: A total of 123 elderly patients with BPH were randomized to undergo either 1470 nm DiLEP or PKRP by means of a random number table from September 2020 to April 2022. The perioperative and postoperative data were studied during a 3- and 6-month follow-up.Results: The patients treated with 1470 nm DiLEP had significantly decreased operation time (74.6 & PLUSMN; 17.0 vs 98.8 & PLUSMN; 18.9 minutes, p < 0.001), hemoglobin loss (1.06 & PLUSMN; 0.49 vs 1.59 & PLUSMN; 0.60 g/dL, p < 0.001), bladder irrigation time (22.1 & PLUSMN; 8.1 vs 33.9 & PLUSMN; 10.0 hours, p < 0.001), catheter duration (3.2 & PLUSMN; 1.3 vs 5.8 & PLUSMN; 1.0 days, p < 0.001), and hospital stay (7.6 & PLUSMN; 1.4 vs 9.6 & PLUSMN; 1.3 days, p < 0.001) compared with the PKRP group. Besides, International Index of Erectile Function-5 score of 1470 nm DiLEP group at postoperative 3- and 6-month follow-up was significantly higher than PKRP group. No differences achieving statistical significance were identified in total prostate-specific antigen, maximum urinary flow rate, International Prostate Symptom Score, quality-of-life score, and the postvoid residual urine volume, transient incontinence, urethral stricture, bladder neck contracture, and retrograde ejaculation at 3- and 6-month follow-up.Conclusions: 1470 nm DiLEP is safer than PKRP, with a smaller effect on sexual function, and it is comparable with the efficacy of PKRP, thus making it more suitable for elderly BPH patients.Clinical Trial Registration number: S2021-463-01.

Abstract Background Erectile dysfunction (ED) occurs in an increasing number of patients after radical prostatectomy and cystectomy, and the phenotypic modulation of corpus cavernosum smooth muscle cells is closely related to ED. Aim To determine whether endoplasmic reticulum stress (ERS) is implicated in the phenotypic modulation of ED induced by bilateral cavernous nerve injury (BCNI). Methods In total, 36 Sprague-Dawley rats were randomly divided into 3 groups: sham, in which rats received sham surgery with bilateral cavernous nerve exposure plus phosphate-buffered saline; control, in which rats received BCNI plus phosphate-buffered saline; and experimental, in which rats received BCNI plus 4-phenylbutyric acid. Analysis of variance and a Bonferroni multiple-comparison test were utilized to evaluate differences among groups. Outcomes Erectile function, smooth muscle/collagen ratios, and the expression levels of phenotypic modulation and ERS were measured. Results Two ratios—maximum intracavernosal pressure/mean arterial pressure and smooth muscle/collagen—were decreased in the control group as compared with the sham group. In penile tissue, there was increased expression of GRP78 (78-kDa glucose-regulated protein), p-PERK/PERK (phosphorylated protein kinase R–like endoplasmic reticulum kinase/protein kinase R–like endoplasmic reticulum kinase), caspase 3, CHOP (C/EBP homologous protein), and OPN (osteopontin) but decreased expression of nNOS (neuronal nitric oxide synthase) and α-SMA (α–smooth muscle actin). As compared with the control group, erectile function was improved and pathologic changes were partially recovered in the experimental group. Clinical Translation The present study demonstrated that ERS is involved in ED caused by cavernous nerve injury, thereby providing a new target and theoretical basis for clinical treatment. Strengths and Limitations The present study demonstrated for the first time that ERS is related to ED caused by cavernous nerve injury. Inhibition of ERS reverses phenotypic modulation and improves erectile function in rats with BCNI. Additional in vitro studies should be performed to verify these conclusions and explore the specific mechanism of phenotypic modulation. Conclusion The present study demonstrated that inhibiting ERS reverses phenotypic modulation and enhances erectile function in rats with BCNI.

(1) Background: The study aimed to construct nomograms to improve the detection rates of prostate cancer (PCa) and clinically significant prostate cancer (CSPCa) in the Asian population. (2) Methods: This multicenter prospective study included a group of 293 patients from three hospitals. Univariable and multivariable logistic regression analysis was performed to identify potential risk factors and construct nomograms. Discrimination, calibration, and clinical utility were used to assess the performance of the nomogram. The web-based dynamic nomograms were subsequently built based on multivariable logistic analysis. (3) Results: A total of 293 patients were included in our study with 201 negative and 92 positive results in PCa. Four independent predictive factors (age, prostate health index (PHI), prostate volume, and prostate imaging reporting and data system score (PI-RADS)) for PCa were included, and four factors (age, PHI, PI-RADS, and Log PSA Density) for CSPCa were included. The area under the ROC curve (AUC) for PCa was 0.902 in the training cohort and 0.869 in the validation cohort. The AUC for CSPCa was 0.896 in the training cohort and 0.890 in the validation cohort. (4) Conclusions: The combined diagnosis of PHI and PI-RADS can avoid more unnecessary biopsies and improve the detection rate of PCa and CSPCa. The nomogram with the combination of age, PHI, PV, and PI-RADS could improve the detection of PCa, and the nomogram with the combination of age, PHI, PI-RADS, and Log PSAD could improve the detection of CSPCa.

Objective To compare the clinical efficacy of extraperitoneal robot-assisted radical prostatectomy（Ep-RARP） and extraperitoneal laparoscopic radical prostatectomy（Ep-LRP）.Methods The clinical data of 208 patients diagnosed with prostate cancer and underwent extraperitoneal radical prostatectomy（Ep-RP） by the same surgeon from January 2016 to December 2022 in the Urology Department of Shandong Provincial Hospital were retrospectively analyzed,of which 120 patients underwent Ep-RARP as the observation group,and the other 88 patients underwent Ep-LRP as the control group.The baseline characteristics,operation time,intraoperative blood loss,blood transfusion rate during surgery,surgical complications,gastrointestinal function recovery time,postoperative drainage tube indwelling time,postoperative length of hospital stay,and postoperative positive pathological margin rate were compared between the two groups.Results There were significant differences between the Ep-RARP group and the Ep-LRP group in intraoperative blood loss [（141.8±78.2） vs.（178.0±131.1） ml],intraoperative blood transfusion rate（1.7% vs.8.0%）,postoperative gastrointestinal function recovery time [（1.4±0.7） vs.（2.2±1.1） d],postoperative drainage tube indwelling days [（4.4±1.6） vs.（5.5±2.4） d],and postoperative hospital stay [（7.0±1.4） vs.（7.8±2.9） d]（all P＜0.05）.There were no significant differences in operation time,surgical complications,and positive rate of postoperative pathological margins between the Ep-RARP group and the Ep-LRP group（P＞0.05）.Conclusions The clinical efficacy of Ep-RARP in the treatment of prostate cancer is satisfactory,and it has the advantages of less trauma during operation and rapid postoperative recovery.

Bladder neck contracture (BNC) is a rare, late complication of transurethral resection of the prostate (TURP). Although the endoscopic procedure is the primary treatment for BNC, the recurrence rate remains high. Y-V plasty offers excellent surgical results for those individuals with refractory and recurrent BNC. Traditional open operations usually fail to provide satisfactory exposure to the operating field and lead to greater invasiveness. Interrupted sutures lead to prolonged operative time and increased anastomotic leakage. Laparoscopic modified Y-V plasty is performed through extraperitoneal access to the pelvis, which provides adequate exposure to the surgical view and avoids intra-abdominal injury. After incising the anterior bladder wall neck in a Y-shaped fashion, anastomosis is performed using two absorbable barbed sutures. The mucosa and submucosa layer of the bladder is closed to both sides with consecutive sutures in a V-shape before suturing serosa, and tunica muscularis are sutured to reinforce. The aforementioned procedures reduce leakage from the anastomosis and decrease operative time and patient trauma. Extraperitoneal laparoscopic modified Y-V plasty offers significant advantages over the open approach in terms of post-surgical recovery and invasiveness, making it a feasible and safe surgical option for patients with refractory BNC.

The adrenal gland is a frequent site for metastasis, and the majority of the metastatic lesions of the adrenal gland normally originate from lung cancer, colon cancer, renal cell carcinoma, and melanoma. However, adrenal gland metastasis from breast invasive mucinous carcinoma is extremely rare. This report described a rare case of right adrenal gland metastasis in a 48-year-old female, who was diagnosed with breast invasive mucinous carcinoma and underwent right modified radical mastectomy with axillary lymph node dissection 5 years previously. A mass located on the right adrenal gland was detected during a routine examination 2 months ago. The patient was asymptomatic and adrenal gland MRI revealed a mass in the right adrenal gland. Definitive preoperative diagnosis failed to be established. Right adrenal gland laparoscopic adrenalectomy was performed and the diagnosis of adrenal gland metastasis of breast carcinoma was confirmed by pathological and immunohistochemical examination, especially ER, PR, GATA3, and HER-2. The patient remained in good condition by the time of writing.

OBJECTIVE:To investigate the application value of RigiScan monitoring in assisting tadalafil medication.METHODS:This self-control study included 89 ED patients (IIEF-5 < 21) treated in our hospital from August 2019 to July 2020. The patients underwent audiovisual sexual stimulation (AVSS), nocturnal penile tumescence and rigidity (NPTR) test, scoring on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-Item Scale (GAD-7), blood routine test, blood biochemical analysis, and hormone secretion examination, which confirmed 21 cases of psychogenic, 28 cases of organic and 40 cases of mixed ED. We treated the patients with tadalafil at 5 mg/d for 30 days, followed by examination of their erectile function by IIEF-5 scoring and AVSS and comparison of their erectile function with the baseline. For some of the patients that responded poorly to tadalafil at 5 mg/d, we increased the dose to 20 mg and detected the efficacy by AVSS at 1 h after medication. For those with organic or mixed ED irreponsive to tadalafil at 20 mg, we performed screening for corpora cavernosal venous leakage (CCVL) by intracavernosal injectionof alprostadil and penile color Doppler duplex ultrasonography or used dynamic infusion cavernosometry and cavernosography (DICC) to confirm the diagnosis of CCVL.RESULTS:The effectiveness rates of 5 mg/d tadalafil on mild, moderate and severe ED were 85.4%, 53.1% and 43.8%, respectively, significantly higher on mild than on moderate and severe ED (P = 0.002), and its effectiveness rates on psychogenic, organic and mixed ED were 90.5%, 60.7% and 57.5%, respectively, remarkably higher on psychogenic than on organic and mixed ED (P = 0.026). For those with organic or mixed ED irresponsive to 5 mg/d tadalafil, the increased dose of 20 mg achieved an effectiveness rate of 64.3%. (P = 0.033). The results of DICC did not encourage tadalafil medication for the cases of organic or mixed ED with CCVL irresponsive to both 5 mg and 20 mg tadalafil.CONCLUSION:RigiScan monitoring plays a guiding role in tadalafil medication of ED and helps distinguish organic from psychogenic ED. Tadalafil at 5 mg/d produces a better effect on mild than on moderate and severe ED, and so does it on psychogenic than on organic and mixed ED. The dose of medication can be increased to 20 mg for organic and mixed ED irresponsive to 5 mg tadalafil, but tadalafil is not recommended for organic and mixed ED with CCVL irresponsive to both 5 mg and 20 mg tadalafil.