BACKGROUND:Endourologic procedures for ureteral/renal stones traditionally rely on fluoroscopic guidance. The necessity of fluoroscopy for safe and effective stone treatment remains controversial. OBJECTIVE:To perform a systematic review and meta-analysis to evaluate intraoperative, perioperative, and postoperative outcomes of fluoroless vs fluoroscopy-guided endourologic procedures for kidney and/or ureteral stones. MATERIALS AND METHODS:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched PubMed, Cochrane Central Register, and Scopus on 13th November 2025. Inclusion criterion comprised randomized trials comparing fluoroless with fluoroscopy-guided ureteroscopy (URS) or percutaneous nephrolithotripsy (PCNL). Binary outcomes were assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% confidence interval (CI), and p-values. Continuous variables were pooled using the inverse variance of the mean difference with a random effect. Statistical significance was set at p < 0.05. EVIDENCE SYNTHESIS:Eighteen randomized studies were included: 7 URS studies (1119 patients) and 11 PCNL studies (1370 patients). For PCNL, fluoroless ultrasound-guided techniques demonstrated superior safety with significantly lower overall complications (OR 0.57, 95% CI 0.42-0.78, p = 0.0004), minor complication- (OR 0.60, 95% CI 0.41-0.86, p = 0.006), and major complication- rates (OR 0.52, 95% CI 0.30-0.88, p = 0.02) compared with fluoroscopy-guided approaches. Stone-free rates (SFRs) were equivalent between groups (OR 1.03, 95% CI 0.77-1.38, p = 0.83). For URS, fluoroless approaches showed comparable overall complications (OR 1.08, 95% CI 0.81-1.45, p = 0.60), major complications, SFR (OR 0.89, 95% CI 0.65-1.19, p = 0.47), and reintervention rates. Flexible fluoroless URS demonstrated fewer minor complications (OR 2.09, 95% CI 1.43-3.06, p < 0.0001). Mean surgical time increased minimally for fluoroless URS (1.60 minutes, p = 0.03). CONCLUSIONS:Fluoroless ultrasound-guided PCNL demonstrates superior safety with maintained efficacy compared with fluoroscopy-guided techniques. Fluoroless URS shows equivalent safety and efficacy with minimal operative time differences. These findings support transitioning from fluoroscopy-dependent to fluoroscopy-optional endourology, aligning with radiation safety principles while maintaining optimal patient outcomes.

Background Several scoring systems have been developed to predict stone-free rates (SFR) after retrograde intrarenal surgery (RIRS), but their clinical utility remains limited. The pelvic stone angle (PSA) has recently been proposed as a novel anatomical parameter for evaluating lower pole stones. Objectives To evaluate the predictive value of PSA for stone-free outcomes after RIRS and compare the performance of PSA-integrated scoring systems with existing nephrolithometric models. Design Retrospective single-center cohort study. Methods A total of 198 patients who underwent RIRS between April 2018 and October 2023 were retrospectively reviewed. Patients with lower pole stones were included. Preoperative non-contrast computed tomography was used to evaluate PSA, stone burden, and other anatomical parameters. Stone-free status was assessed one month postoperatively. Four scoring systems (MS-ReSC, R.I.R.S., RUSS, and T.O.HO.) were analyzed, with PSA replacing the conventional infundibulopelvic angle where applicable. Predictive performance was evaluated using area under the receiver operating characteristic curve (AUC). Results The T.O.HO. score demonstrated the highest predictive performance for stone-free status with an AUC of 0.7080, followed by the R.I.R.S. score with PSA (0.6525), MS-ReSC (0.6147), and RUSS with PSA (0.6121). Among the evaluated models, only the T.O.HO. score showed a statistically significant improvement compared with RUSS (p = 0.0445). No statistically significant differences in overall accuracy were observed among the scoring systems. Lower pole stone burden, stone multiplicity, CT attenuation values, and multifocal stones were significantly associated with postoperative stone-free outcomes. Conclusion PSA is a practical and reliable anatomical parameter for predicting stone-free outcomes after RIRS. Integration of PSA into existing scoring systems maintained comparable predictive performance and may improve reproducibility in modern endourological practice. Although the T.O.HO. score demonstrated the best overall performance, further large-scale prospective multicenter studies are required to validate PSA-based scoring systems.

The European association of Urology (EAU) suggests a prognostic stratification of Upper Tract Urothelial Cancer (UTUC) based on high and low risk patients, with Radical nephroureterectomy (RNU) and bladder cuff resection being the gold standard for the treatment of non-metastatic High risk UTUC. However, no consensus on post-operative patient management or tools that predict who would benefit the most from a close follow-up rather than adjuvant chemotherapy regimen exist. in Machine Learning (ML) is gaining interest in Urology providing models for prognostic prediction purpose; It’s role in UTUC has not yet been investigated. We aim to develop and validate multiple supervised ML models based on patient- and tumor- related features to predict prognosis in patients with preoperative Histological or Imaging proved UTUC treated with RNU within a multiethnic large cohort. Data from an international multicenter large cohort of histologically proven UTUC patients from Asia and Europe treated with RNU were retrospectively collected. Twenty different ML-supervised predictive models were first trained and then external validate with two separate set. Nomograms were constructed based on 8 independent prognostic factors (age, gender, grading, pT, pN, presence of Carcinoma in Situ (CIS), multifocality and Lymphovascular invasion(LVI)) to predict 6 Outcomes (Overall Survival (OS), Cancer Specific Survival (CSS) and Disease Free Survival (DFS) at 3 and 5 year). Performances were compared using Area-under-curve (AUC) of Receiver-Operating Characteristics (ROC). A total of 3129 patients were enrolled: 637 Asian Patients (training cohort) and 2492 European patients (validation cohort). Upon training assessment, LR models achieved the best results, being the best model for prediction of 4/6 outcomes, with the best result in CSS both at 3 and 5 years (AUC: 0.85, 0.84, 0.81 for CSS-3y, CSS-5y and DFS-3y respectively). Upon external validation, LR(CSL) models achieve the best results, being the number 1 model for prediction of 3/6 outcomes (AUC: 0.84, 0.79, 0.77 for CSS-3y, OS-3y and OS-5y respectively). ML is a promising technology in the field of UTUC. Our model achieve favorable results in terms of prediction of prognosis after RNU, especially in terms of CSS at 3 and 5 years, moreover is the first model of prognosis taking into account the differences in epidemiology existing between European and Asian patients. Further clinical validation and verification of its reliability for the case selection of adjuvant therapy are needed to assess its use in clinical practice linked to clinical decision making. ML is an advancing technology in the field of medicine and urology, which can also be applied to the definition of the prognosis of patients with UTUC undergoing RNU. Our study represents the first experience investigating this potential.

Introduction: Shock wave lithotripsy (SWL) has declined with the expansion of endourological techniques, but remains widely available. Contemporary data on SWL utilization, technical delivery, operator models, outcome assessment, and artificial intelligence (AI)-based tools are limited. This study evaluated current SWL practice patterns among urologists involved in stone disease management. Methods: A cross-sectional web-based survey was developed by the Kidney Stones Pillar of the FUTURE collaborative group and distributed through the Endourological Society mailing list and X platform between February and April 2026. The questionnaire assessed SWL utilization, decision-making, technical parameters, operator profile, follow-up, outcome definitions, and AI use. Categorical variables were summarized as frequencies and percentages. Results: A total of 156 responses from 32 countries were analyzed. Overall, 121 respondents (77.6%) used SWL in ≤15% of stone cases, including 26 (16.7%) who did not use SWL. Among applicable respondents, 65.8% perceived a decline in SWL use over three years. Treatment selection was mainly based on guidelines and objective criteria (76.2%). Electromagnetic lithotripters were most common (51%), and most systems were ≥6 years old. Operator experience was perceived as highly influential, although formal training was inconsistent. AI access was limited, with 82.3% reporting no access and 8.5% regular clinical use. Conclusion: SWL is used for a minority of stone cases and is perceived to be declining. Contemporary practice shows variability in patient selection, technical delivery, operator models, training, and outcome assessment. Despite favorable perceptions of AI, real-world adoption remains limited.

Background/Objectives: We assessed factors affecting the oncological outcomes in upper tract urothelial carcinoma patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Taiwan, using a large domestic upper tract urothelial carcinoma collaboration database. Methods: From July 1988 to December 2019, 15 hospitals joined the Taiwan Upper Tract Urothelial Carcinoma Collaboration Group. A total of 690 patients were included, and demographic, clinical, and pathological data were compared. Factors related to overall survival, cancer-specific survival, disease-free survival, and bladder recurrence-free survival were analyzed. Results: Out of the 690 patients, 605 had CKD and 85 had ESRD. In multivariate analysis, overall survival was associated with CKD stage (p = 0.024), age > 70 years (p = 0.002), and pathological stage III/IV (p = 0.014 and <0.001). Cancer-specific survival was associated with middle ureter tumors (p = 0.041), positive surgical margin (p = 0.005), and pathological stage III/IV (p = 0.010 and <0.001). Disease-free survival was associated with middle ureter tumors (p = 0.001), lower ureter tumors (p = 0.010), and pathological stage III/IV (p = 0.039 and <0.001). Female sex (p = 0.027), lower ureter tumors (p = 0.027), coronary artery disease (p = 0.047), and arrhythmias (p = 0.044) were associated with bladder recurrence-free survival. Conclusions: The oncological outcomes of UTUC patients with CKD and ESRD in Taiwan were affected by various factors. Tumor location and advanced pathological stage were related to OS, CSS, and DFS. Cardiac diseases were possibly related to BRFS.

Purpose:To determine the most effective technique for bladder cuff excision in treating upper urinary tract urothelial carcinoma.Materials and methods:We conducted a retrospective analysis of 1172 urinary tract urothelial carcinoma patients across 19 hospitals in Taiwan between July 1988 and August 2022, focusing on surgeries performed from January 11, 2001, to November 22, 2021. Patients were divided into 3 groups: open incision, transurethral, and laparoscopic (LPS)/robotic/laparoendoscopic single-site surgery (LESS). The open incision group comprised 1056 patients, while the remaining patients were divided among the other techniques.Results:Univariate analysis revealed that LPS/robotic/LESS resulted in better overall survival compared with open incision (hazard ratio [HR] = 0.612; 95% confidence interval [CI], 0.448-0.836; P = 0.002). In terms of bladder recurrence-free survival, the transurethral group showed a lower bladder recurrence rate than the open incision group (HR = 0.697; 95% CI, 0.505-0.961; P = 0.028). However, multivariate analysis indicated that the transurethral method had worse outcomes than the open incision for cancer-specific survival (HR = 2.347; 95% CI, 1.115-4.942; P = 0.025) and disease-free survival (HR = 1.831; 95% CI, 1.079-3.108; P = 0.025). Surprisingly, the transurethral group showed better bladder recurrence-free survival (HR = 0.606; 95% CI, 0.414-0.888; P = 0.01).Conclusion:Based on these findings, LPS/robotic/LESS appeared to be the preferred choice for bladder cuff excision.

OBJECTIVE:To perform a systematic review and meta-analysis to assess the incidence of acute urinary retention (AUR)/failure to void after transurethral surgeries for benign prostatic enlargement, comparing Ablation, Enucleation, and Resection (TURP) techniques. MATERIALS AND METHODS:A systematic literature search was performed on October 13, 2025 using Cochrane Central Register of Controlled Trials, PubMed, and Scopus. We only included randomized studies comparing monopolar TURP (M-TURP) or bipolar TURP (B-TURP) vs Ablation vs Enucleation procedures. Incidence of AUR/failure to void following the index surgery was evaluated using the Cochran-Mantel-Haenszel method and reported as risk ratio (RR), 95% confidence interval (CI), and p values. Statistical significance was set at p < 0.05. EVIDENCE SYNTHESIS:A total of 61 studies were included, with 1497 patients in the Enucleation, 2512 patients in the Ablation, and 4007 patients in the TURP groups. The pooled incidence of AUR/failure to void was 3.7% (72/1944 patients) after M-TURP, 3.0% (47/1553 patients) after B-TURP, 9.0% (226/2512 patients) after Ablation, and 2.4% (36/1497 patients) after Enucleation. Meta-analysis showed no significant difference between Enucleation and TURP (RR 0.90, 95% CI 0.61-1.32, p = 0.59; I2 = 0%) in AUR/failure to void rate. Conversely, Ablation was associated with a significantly higher incidence of AUR/failure to void compared with TURP (RR 1.79, 95% CI 1.38-2.31, p < 0.001; I2 = 22%). Subgroup analyses revealed that this difference persisted for diode laser (RR 4.53, 95% CI 1.24-16.47), monopolar electrovaporization (RR 3.24, 95% CI 1.90-5.55), and Neodymium (Nd):YAG laser/RR 2.61, 95% CI 1.54-4.42) ablation techniques. No significant difference was found between M-TURP, B-TURP, and Enucleation, and between B-TURP and Ablation. Conversely, AUR/failure to void incidence favored M-TURP over Ablation (RR 1.88, 95% CI 1.40-2.52, p < 0.001). CONCLUSIONS:Enucleation procedures demonstrate comparable safety to TURP regarding postoperative AUR/failure to void, whereas Ablation procedures are associated with a significantly higher incidence of postoperative retention events, particularly with energy modalities such as monopolar electrocautery, diode, and Nd:YAG lasers.

Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with various metabolic disturbances, including calcium metabolism disorders and acid-base imbalances. Emerging evidence suggests a potential link between PA and urolithiasis; however, previous studies have been limited by small sample sizes and inconsistent findings. This study aims to investigate the association between PA and urinary stone formation using a large-scale real-world dataset. We conducted a retrospective cohort study using the TriNetX database, which includes de-identified electronic health records from over 250 million individuals. Patients diagnosed with PA were identified based on ICD-10-CM and ICD-9-CM codes, and a propensity score-matched (PSM) cohort of PA and non-PA patients with hypertension was created. The primary outcome was the incidence of urolithiasis (kidney and urinary tract stones), identified using ICD-10-CM codes (N20-N23). Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95

Background: Geographic variation may influence the urinary microbiota of patients with urolithiasis. This study compared urinary microbial profiles between Taiwan and Korea patients. Materials and Methods: This cross-national comparative study included 72 patients with clinically confirmed urolithiasis, comprising 31 patients from Taiwan and 41 from South Korea. Bladder urine samples were collected by urethral catheterization before surgery and prophylactic antibiotic administration. Full-length 16S rRNA genes were amplified using the 27F and 1492R primers and sequenced using a third-generation long-read sequencing platform. Sequence denoising and amplicon sequence variant inference were performed using DADA2, followed by taxonomic annotation and phylogenetic analysis in QIIME2. Alpha diversity, beta diversity, and differential taxonomic abundance were compared between the two groups. Results: No significant differences were observed in alpha diversity indices, including microbial richness, diversity, evenness, and phylogenetic diversity. However, beta diversity analyses demonstrated significant differences in overall urinary microbial community composition between the Taiwan and Korea groups, as shown by ANOSIM, MRPP, and perMANOVA. Differential abundance analysis identified enrichment of Proteobacteria, Shigella flexneri , and several related taxa in the Taiwan group, whereas Gardnerella swidsinskii , Prevotellaceae, and Veillonella were enriched in the Korea group. At the species level, G. swidsinskii showed significantly greater relative abundance in the Korea cohort. Conclusion: Taiwanese and Korean patients with urolithiasis exhibited distinct urinary microbial profiles despite similar alpha diversity. These findings suggest that geographic, dietary, and microbial factors may contribute to population-specific patterns of urinary stone disease.

Purpose: To analyze epidemiological data and treatment trends for upper-tract urothelial carcinoma (UTUC) in Taiwan over a 30-year period (1988–2022). Materials and methods: This retrospective, multi-institutional study conducted by the Taiwan Upper-Tract Urothelial Carcinoma Collaboration Group analyzed clinical data between 1988 and 2022 across 19 hospitals. Variables included demographics, comorbidities, risk factors, renal function, tumor characteristics, diagnostic methods, surgical approaches, chemotherapy status, pathological features, and oncological outcomes. Results: In Taiwan, UTUC showed a female predominance (56.8% women vs 43.2% men; female-to-male ratio 1.3:1), and the overall mean age was 68.7 years. Chronic kidney disease and end-stage renal disease were present in 63% and 16.7% of patients, respectively. Nephroureterectomy was performed in 88% of patients, with nearly 60% of these procedures employing either robotic-assisted or pure laparoscopy techniques during the past 5 years. Chemotherapy was administered in 25.2% of cases, including 2.4% receiving neoadjuvant chemotherapy and 15.6% receiving adjuvant chemotherapy. Postoperative intravesical chemotherapy instillation was performed in 5.3% of cases. Pathological T stages included pT1 or lower (38.8%), pT2 (17.0%), pT3 (25.5%), and pT4 (8.3%). Carcinoma in situ was present in 20.1% of cases, lymphovascular invasion in 16.8%, and positive surgical margins in 4.1%. Major postoperative complications occurred in 4.6% of cases, while 1% of patients experienced grade V complications. Conclusion: Our study demonstrates that Taiwan’s treatment outcomes for UTUC are comparable to those reported internationally, reflecting its proficiency in adopting advanced technologies and maintaining high standards of medical care. However, unique epidemiological factors, such as a higher prevalence of end-stage renal disease, pose challenges to treatment implementation, particularly in the use of nephrotoxic regimens like neoadjuvant chemotherapy.

Xanthine dehydrogenase (XDH) serves as a key enzyme in purine metabolism and plays a significant role in carcinogenesis. However, the clinical significance of XDH in urothelial carcinoma (UC) progression remains unclear. Using a transcriptomic UC database (GSE32894), we found that among the genes related to XDH activity (GO:0004854), XDH was significantly downregulated during UC progression. Therefore, we aimed to assess the prognostic value of XDH immunoexpression in urinary bladder UC (UBUC) and upper tract UC (UTUC) patients. Immunohistochemical staining for XDH was performed on 340 UTUC and 295 UBUC specimens. The association of XDH expression with clinicopathological features and patients’ outcomes, including disease-specific survival (DSS) and metastasis-free survival (MFS), was analyzed using Pearson’s chi-square test, Kaplan–Meier analysis, and multivariate Cox proportional hazards model to identify independent prognosticators. Low XDH expression was significantly associated with high tumor stage, nodal metastasis, high tumor grade, perineural invasion, vascular invasion, and a high mitotic rate (all P < 0.01). Kaplan–Meier survival curves showed that low XDH expression was associated with poor DSS and MFS (both p < 0.001). After adjusting for the standard pathological parameters, XDH expression status was an independent prognostic factor for DSS and MFS in UBUC and UTUC (all P < 0.01) in the multivariate analysis model. To associate XDH with potential functions in UC, gene co-expression examination was performed using the GO classification system. XDH upregulation was linked to pyroptosis and desmosomes. Low XDH expression correlates with aggressive pathological features and poor oncological outcomes, indicating its prognostic and therapeutic significances in patients with UC.

OBJECTIVE:To investigate sex-based differences in oncologic outcomes and prognostic factors in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU) in a large multicenter cohort from Taiwan. METHODS:We retrospectively analyzed 1,337 patients with UTUC (565 men and 772 women) who underwent RNU with bladder cuff excision across 21 hospitals in Taiwan. Survival outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), were evaluated using Kaplan-Meier analysis and Cox proportional hazards models. Overlap weighting based on propensity scores was applied to balance baseline characteristics between sexes. Sex-stratified multivariable analyses were further performed to identify prognostic factors in men and women separately. RESULTS:There were no significant sex-based differences in OS, CSS, or DFS. In contrast, female patients had significantly better BRFS than male patients on Kaplan-Meier analysis (P < 0.001), and this association remained significant after overlap weighting adjustment. In multivariable analysis, female sex was independently associated with a lower risk of bladder recurrence after RNU (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.46-0.71; P < 0.001). Established adverse prognostic factors for survival outcomes included poor Eastern Cooperative Oncology Group performance status, advanced pathological stage, lymphovascular invasion, and positive surgical margins. Sex-stratified analyses further showed differences in prognostic profiles between men and women across survival endpoints. CONCLUSIONS:In this large multicenter Taiwanese cohort, sex was not associated with OS, CSS, or DFS after RNU for UTUC. However, female patients had a significantly lower risk of intravesical recurrence, independent of clinicopathological factors. These findings suggest that sex-specific biological or clinical factors may influence bladder recurrence after RNU and support consideration of sex-informed postoperative surveillance strategies.

Urothelial carcinoma, predominantly appearing as non-muscle-invasive papillary urothelial carcinoma (NMIPUC), exhibits wide clinical variability. Accurate pathological staging and grading are essential for effective risk stratification and treatment decisions. Advancements in artificial intelligence (AI) open new opportunities to improve predictive models; however, their generalizability across diverse datasets remains to be addressed. This study developed a federated learning (FL)-based AI framework to enhance model robustness across institutions and predictive accuracy for non-muscle-invasive bladder cancer staging, grading, and a novel histological risk factor derived by clustering histological features for relapse prediction. Retrospective data, including 1437 NMIPUC cases from two institutions in Lithuania and Taiwan, were used for development and analysis. The FL models demonstrated improved robustness across participating institutions and higher accuracy compared to single-site models, achieving 86.2% accuracy for tumor stage and 79.2% for tumor grade, with minor performance variability across the datasets. Moreover, the novel histological risk factor outperformed conventional indicators of relapse-free survival (RFS) in NMIPUC patients treated with BCG immunotherapy, achieving hazard ratios of 2.7 (p = 0.0018) and 2.8 (p = 0.0208) in the Lithuania and Taiwan datasets, respectively. These findings highlight the potential of FL and histological feature-based AI models in providing robust, generalizable solutions for NMIPUC risk stratification and offer insights for personalized clinical interventions.

OBJECTIVE:To evaluate renal function trends following radical nephroureterectomy (RNU) and identify key preoperative predictors of post-RNU renal function in patients with upper tract urothelial carcinoma (UTUC). METHODS:This retrospective study analyzed 338 UTUC patients who underwent RNU between 2008 and 2022. Estimated glomerular filtration rate (eGFR) was measured preoperatively and at <3, 3-12, and 12-24 months postoperatively. Generalized linear models assessed renal function changes over time, while generalized estimating equation (GEE) models identified predictors of postoperative eGFR. RESULTS:A significant eGFR decline was observed (P < 0.001), most pronounced within three months after surgery. CKD prevalence increased from 63.91 % preoperatively to 79.29 % postoperatively. Multivariable analysis identified preoperative eGFR (β = 0.612, P < 0.001) and tumor size (β = 1.189, P < 0.001) as the strongest independent predictors of postoperative renal function, with preoperative eGFR explaining the largest proportion of variance (R² = 47.50 %). Pathological T stage and Charlson Comorbidity Index were also statistically significant. CONCLUSION:RNU significantly and adversely affects postoperative renal function in patients with UTUC. Preoperative eGFR and tumor size are the most influential predictors of postoperative renal function. The identified predictors may assist clinicians in anticipating postoperative renal outcomes, thereby informing surgical decision-making and preoperative counseling aimed at balancing oncological control and renal preservation.

Background Laser lithotripsy during retrograde intrarenal surgery (RIRS) carries potential risks of thermal accumulation and elevated intrarenal pressure (IRP). This study aimed to compare the effects of different p-Tm:YAG laser settings and ureteral access sheath (UAS) configurations on intrarenal temperature (IRT) and IRP. Methods This in vitro study utilized a simulation model to evaluate four distinct pulsed Thulium:YAG (p-Tm:YAG) laser configurations: 1.0 J × 10 Hz, 10 W;0.6 J × 20 Hz, 12 W;1.0 J × 20 Hz, 20 W;0.4 J × 50 Hz, 20 W. These settings were cross-tested using C-UAS (conventional ureteral access sheaths; UAS; Cook, 10.7/12.7 Fr and 12/14 Fr) and FANS (Flexible and Navigable Suction ureteral access sheath, Innovex, 10/12 Fr and 11/13 Fr). Both IRT and IRP were continuously monitored using a flexible ureteroscope equipped with distal-tip sensors, and measurements were recorded at 10-second intervals throughout the lasing process. Results Active suction substantially mitigated both IRT and IRP elevation compared to conventional UAS. Temperature-time regression lines showed the 20-W settings produced faster temperature increases than the 10-W settings. Among all tested configurations, the larger suction sheath (FANS; 11/13 Fr) consistently maintained the most stable thermal and pressure environments, whereas smaller sheath diameters amplified both responses across all lasing conditions. Furthermore, under active suction, IRP showed no consistent time-dependent cumulative trend; instead, intermittent pressure fluctuations may have been more closely related to transient outflow obstruction during fragment evacuation than to elapsed experimental time. Conclusion In this in vitro RIRS model, smaller sheath diameters were associated with higher intrarenal temperature and pressure, while suction sheaths effectively reduced both IRT and IRP. Thermal elevation was more evident at higher laser power, and different energy–frequency settings produced distinct thermal profiles despite equivalent total power. IRP showed no consistent time-dependent cumulative trend under standardized conditions with a non-restrictive lumen. These findings highlight the importance of simultaneous IRT and IRP monitoring and suggest that suction sheaths, particularly when combined with pressure- and temperature-sensing ureteroscopes, may enhance the safety of flexible ureteroscopy.

Purpose:Using image study, prostate cancer can be clinically staged. However, upstaging still happens to around 10% of prostate cancer patients. The aim of this study was to identify the factors impacting on upstaging.Materials and methods:A retrospective analysis of 259 individuals who underwent radical prostatectomy from 2011 to 2020 revealed instances of upstaging, defined as an elevation from clinical T (cT) to pathological T (pT) stage. Statistical tools, including chi-square, Student t test, and Cox regression models, were employed for categorical and continuous variable analysis.Results:Among the participants, with a mean prebiopsy prostate-specific antigen (PSA) of 11.19 ng/mL, 33.98% experienced upstaging post-RP. The multivariable Cox regression model identified prebiopsy PSA (adjusted odds ratio [OR] = 1.035, 95% confidence intervals [CI] = 1.015-1.055; P = 0.0006) and Gleason grade group 3 (adjusted OR = 2.429, 95% CI = 1.082-5.453; P = 0.0314) as markers for T-stage reclassification. Notably, for individuals with prebiopsy PSA exceeding 10 ng/mL, negative initial biopsies significantly increased the risk of T-stage misclassification (adjusted OR = 2.753, 95% CI = 1.067-7.1; P = 0.0362).Conclusion:This research highlights the predictive significance of prebiopsy PSA levels and Gleason grade group 3 in anticipating upstaging. Specifically, individuals with elevated baseline PSA levels and negative initial biopsies are predisposed to progressing toward advanced pathological disease.

BACKGROUND:This study aims to investigate the factors contributing to the discrepancy in between biopsy Gleason score (GS) and radical prostatectomy GS in patients diagnosed with prostate cancer. METHODS:341 patients who underwent radical prostatectomy from 2011/04 to 2020/12 were identified. 102 Patients with initial GS of six after biopsy were enrolled. Preoperative clinical variables and pathological variables were also obtained and assessed. The optimal cut-off points for significant continuous variables were identified by the area under the receiver operating characteristic curve. RESULTS:Upgrading was observed in 63 patients and non-upgrading in 39 patients. In the multiple variables assessed, smaller prostate volume (PV) (p value = 0.0007), prostate specific antigen density (PSAD) (p value = 0.0055), positive surgical margins (p value = 0.0062) and pathological perineural invasion (p value = 0.0038) were significant predictors of GS upgrading. To further explore preclinical variables, a cut-off value for PV (≤ 38 ml, p value = 0.0017) and PSAD (≥ 0.26 ng/ml2, p value = 0.0013) were identified to be associated with GS upgrading. CONCLUSION:Smaller PV and elevated PSAD are associated with increased risk of GS upgrading, whereas lead-time bias is not. A cut-off value of PV < 38 ml and PSAD > 0.26 ng/ml2 were further identified to be associated with pathological GS upgrading.

The rising incidence of kidney stone disease in children presents growing clinical challenges, particularly in managing lower pole (LP) calculi, which are anatomically difficult to treat. Flexible ureteroscopy with laser lithotripsy (fURSL) has emerged as a preferred minimally invasive treatment. However, surgical outcomes remain variable, especially in the paediatric LP stone cohort. This study aimed to apply machine learning (ML) techniques to predict surgical outcomes based on preoperative characteristics and identify key predictors of incomplete stone clearance. A retrospective analysis was conducted on paediatric patients (≤ 16 years) who underwent fURSL between January 2017 and December 2021 across eight tertiary centres. From a multicentre database of 280 patients, 91 with isolated LP stones were selected. Preoperative, intraoperative, and postoperative variables were analysed. Fifteen ML models—including ensemble algorithms and a multitask neural network—were developed to predict LP stone presence and postoperative outcomes. Model performance was evaluated using accuracy, precision, recall, F1-score, and SHAP (SHapley Additive exPlanations) values for interpretability. LP stones were present in 32.5

Objective: Clinical features of upper tract urothelial carcinoma (UTUC) vary widely across countries. We aimed to provide clinical observations and compare oncological outcomes among regions in East Asia and Europe. Methods: This retrospective study (March 2000 to July 2020) included 664 UTUC patients undergoing radical nephroureterectomy in China, Japan, the Republic of Korea, and Germany. Cohorts from China comprised patients from the Hong Kong Special Administrative Region and the Taiwan region, respectively. Demographic and clinicopathological parameters were analyzed. Continuous variables were analyzed using the Student's t-test, and categorical variables were assessed using the Pearson's chi-square test. The Cox proportional hazards model was employed to evaluate overall survival (OS), cancer-specific survival (CSS), and bladder recurrence-free survival across regions and various parameters. Results: Females had a higher proportion of patients than males only in Taiwan, China. Few patients received preoperative ureteroscopic biopsy prior to radical surgery in Seoul, the Republic of Korea. In the multivariate analysis, patients' regional origin was not associated with worse OS and CSS. Older age, multifocal tumors, high pT stage (pT4), positive lymphovascular invasion, and distant metastasis were associated with worse OS. High pT stage (pT4) and distant metastasis were independent factors leading to worse CSS. Patients' regional origin (Seoul, the Republic of Korea; Schleswig-Holstein, Germany; and Chiba, Japan) was associated with worse bladder recurrence-free survival. The preoperative ureteroscopic biopsy did not increase the intravesical recurrence. Conclusion: This international observational study revealed variations in the epidemiological distributions and practice patterns among UTUC patients in China, Japan, the Republic of Korea, and Germany. Cohorts from China comprised patients from the Hong Kong Special Administrative Region and the Taiwan region, respectively. However, ethnic and regional differences did not affect OS and CSS after radical nephroureterectomy.

Urolithiasis is a disease with high prevalence and recurrence rate. There are various risk factors impacting on stone formation including intestinal micorbiota. This study aims to investigate the relationship between urine microbiota with urolithiasis. We collected mid-stream voided urine samples from urolithiasis patients and control participants and stored them in a freezer at − 80 °C. All enrolled participants were requested to provide information about their clinical characteristics. The procedure included the extraction of the genomic DNA from the urine samples; the amplification by polymerase chain reaction (PCR); PCR product quantification, mixing, and purification; DNA library preparation; and sequencing was performed with quality control (QC) measures. Alpha diversity was indicative of the species complexity within individual urine samples, and beta diversity analysis was used to evaluate the differences among the samples in terms of species complexity. We enrolled 28 urolithiasis patients and 59 control participants who reported no recent antibiotic usage. In the beta diversity analysis, there was a significant difference between the microbiota in the samples of the urolithiasis and control groups according to ANOSIM statistical analysis. (P = 0.004). On comparing the groups, it showed Alcaligenes, Bacteroides, Blautia, Ruminococcaceae_UCG, Cutibacterium, Alistipes, Lachnoclostridium present more significant in control group than urolithiasis patients. In conclusion, our current study shows that dysbiosis of urine microbiota may be related to the development of urolithiasis. Further research targeting specific microbes to identify their role in the development of diseases is necessary and might provide novel diagnostic biomarkers and therapeutic options.