We report a case of pseudo-acute kidney injury (AKI) caused by a bladder rupture following chemoradiotherapy for uterine cancer. Bladder perforation can lead to urinary ascites, resulting in elevated renal function parameters via peritoneal reabsorption. Owing to nonspecific symptoms, this condition is often difficult to differentiate from true AKI or acute abdomen. In our case, although temporary hemodialysis was initiated, the renal parameters improved after urethral catheter drainage. A bladder rupture should be suspected early in patients with a history of pelvic radiotherapy who present with ascites and renal dysfunction.

Abstract Background Donor-specific antibodies (DSAs) against human leukocyte antigen (HLA) are a major cause of antibody-mediated rejection (AMR) after kidney transplantation. Routine pretransplant screening usually focuses on HLA typing and antibodies against HLA-A, -B, -C, -DRB1, and -DQB1. HLA-DPB1 typing is not always included because HLA-DPB1 antigens are expressed at relatively low levels and have historically been considered less immunogenic. However, emerging evidence suggests that anti-HLA-DPB1 antibodies may be sometimes clinically significant. Case presentation A 35-year-old woman with end-stage kidney disease caused by glycogen storage disease type II underwent ABO-compatible(O → A) living kidney transplantation from her mother. Pretransplant immunological evaluation revealed negative complement-dependent cytotoxicity and flow cytometric crossmatch results, and no DSA against HLA-A, -B, -C, -DRB1, or -DQB1 were detected. On postoperative day 2, the patient developed acute pancreatitis. Therapeutic drug monitoring showed trough levels of tacrolimus of 3.5 ng/mL and mycophenolate mofetil of 0.8 μg/mL. Although these levels were within the therapeutic range, drug-induced pancreatitis was suspected on the basis of the clinical course. On postoperative day 4, the patient developed anuria and Doppler ultrasonography demonstrated loss of diastolic blood flow in the transplanted kidney. Despite aggressive fluid resuscitation, graft perfusion did not improve. Graft biopsy could not be performed because cellulitis around the graft region and thrombocytopenia increased the risk of complications. HLA-DPB1 typing and DSA re-evaluation revealed a DSA against HLA-DPw5 (DPB1*05:01) with a normalized mean fluorescence intensity (nMFI) of 10,562. Retrospective analysis of the stored pretransplant serum sample revealed the same antibody with an nMFI of 2,792. Treatment with plasmapheresis and rituximab was initiated, and graft function gradually recovered to creatinine 1.0 mg/dL after approximately 3 weeks of anuria. Conclusions This case suggests that anti-HLA-DP antibodies may be sometimes clinically relevant and could be considered in selected cases, particularly those with a history of pregnancy, blood transfusions or previous transplants, or in cases where unexplained early graft dysfunction is observed.

The ARASENS trial demonstrated a significant overall survival (OS) benefit for a triplet regimen in metastatic castration-sensitive prostate cancer (mCSPC). We aimed to determine whether this benefit is synergistic or additive. Using a mathematical model of independent drug action and published data from the ARASENS and ARANOTE, we compared the observed OS of the triplet regimen to a predicted OS curve. Reconstructed individual patient data were compared using a Cox model. The observed OS was statistically superior to the predicted OS (hazard ratio [HR] 0.82, 95% CI 0.68-0.99; P = .047), indicating a clinical benefit ~18% greater than the expected additive effect. To address confounding by subsequent therapies, we analyzed time to initial subsequent anticancer therapy, which showed an even more pronounced greater-than-additive benefit (HR 0.57, 95% CI 0.44-0.74; P < .001). These findings suggest the triplet regimen provides an early therapeutic advantage that exceeds additive expectations, supporting an upfront combination strategy in mCSPC.

Autophagy-linked organelle remodeling is essential for skeletal muscle differentiation and is closely linked to the metabolic environment. The ketone body 3-hydroxybutyrate (3HB) serves as an alternative energy substrate and signaling molecule that modulates organelle function and myogenic programs. This study investigated how extracellular metabolic conditions and 3HB regulate autophagy-linked organelle remodeling in human external urethral sphincter (hEUS) myoblasts. Immortalized hEUS myoblasts (US2-KD) were differentiated under four conditions combining high-glucose Dulbecco’s modified Eagle’s medium (HG-DMEM) or low-glucose physiologically formulated minimum essential medium (LG-MEM) with or without 3HB. Metabolomic profiling revealed that the medium composition predominantly shaped energy and amino acid pathways, whereas 3HB induced subtler, context-dependent shifts in metabolites related to autophagy and mitochondrial function. At the cellular level, LG-MEM accelerated myogenic differentiation compared to HG-DMEM, with earlier induction of MYOG and MYH7 and faster maturation of myotubes. LG-MEM also altered LC3B expression patterns, while transmission electron microscopy showed fewer excess autophagosomes and autolysosomes along with more prominent myofibril-like ultrastructure, consistent with more efficient autophagic activity and organelle remodeling. These findings suggest that a physiological metabolic environment facilitates autophagy-linked organelle remodeling in hEUS myoblasts and that 3HB acts as a fine-tuning signal, potentially supporting metabolism-oriented approaches for stress urinary incontinence.

BACKGROUND:Immune checkpoint inhibitor (ICI)-induced interstitial lung disease (ILD) is a potentially fatal complication, yet practical risk stratification tools integrating systemic inflammatory markers and pre-existing pulmonary status are lacking in urological cancers. METHODS:This retrospective, single-center study included 180 patients with urological cancers who received ICI therapy between January 2018 and January 2025. Univariate and multivariate logistic regression using Firth's penalized likelihood approach identified predictors of ICI-induced ILD. A combined risk model was constructed, and patients were stratified into high- and low-risk groups using the Youden index. Between-group differences in ILD-free time were quantified using the restricted mean survival time (RMST) with a truncation time of 2100 days. RESULTS:ILD occurred in 18 of 180 patients (10.0%). In 171 patients with available baseline data, multivariate analysis identified baseline C-reactive protein (CRP; OR 1.11, 95% CI 1.01-1.20, P = .020) and a history of pre-existing ILD (OR 7.86, 95% CI 1.24-53.1, P = .033) as independent predictors, yielding a combined model area under the receiver operating characteristic curve of 0.728. The low-risk group gained over 300 days of additional ILD-free time compared with the high-risk group (RMST difference: 349.2 days, 95% CI 145.8-803.4, P = .005), with consistent findings across cancer types and treatment regimens. CONCLUSIONS:A two-factor model combining baseline CRP and history of pre-existing ILD enables clinically meaningful risk stratification for ICI-induced ILD in urological cancers. The over 300-day difference in ILD-free time between risk groups has direct implications for monitoring frequency and treatment planning.

Background Robot-assisted adrenalectomy (RAA) may overcome some technical limitations of conventional laparoscopy, but its clinical value and the optimal patient selection for RAA remain unclear. The Mayo Adhesive Probability (MAP) score has been shown to predict operative difficulty in urologic surgery, including laparoscopic adrenalectomy (LA), whereas its impact on RAA has not yet been established. Methods We retrospectively reviewed 103 transperitoneal LA cases and 39 RAA cases performed at a single tertiary referral center between April 2010 and December 2025. Baseline characteristics were compared using univariate tests. Predictors of perioperative outcomes were evaluated using univariate and multivariate regression analyses. Results Baseline characteristics were comparable between the two groups. The only significant difference in perioperative outcomes was a shorter length of hospital stay in the RAA group. No conversion to open surgery occurred in either group, and no Clavien-Dindo grade ≥ 3 complications were observed. In the LA group, a MAP score ≥ 3 was independently associated with longer operative time, longer pneumoperitoneum time, and greater estimated blood loss, whereas perirenal fat thickness (PFT) was not an independent predictor. In the RAA group, tumor size was the only independent predictor of operative time, pneumoperitoneum time, robot time and length of hospital stay, whereas neither MAP score nor PFT was associated with perioperative outcomes. Conclusions RAA may reduce the technical burden associated with complex perirenal anatomy. The association between the MAP score and operative difficulty appears to be attenuated in RAA, suggesting that RAA may be a useful surgical option for patients with high MAP scores.

OBJECTIVES:To investigate whether there are differences in treatment approaches, including complications according to the volume of treatment experience for penile cancer, and whether such differences affect patient prognosis. METHODS:We retrospectively analyzed 196 patients with penile cancer treated at 12 university hospitals and affiliated institutions (total of 32 institutions) in the Kyushu-Okinawa region from 2009 to 2020. Cancer-specific survival (CSS) was compared between patients treated at lower-volume centers (defined as institutions with fewer than five cases during the study period) and higher-volume centers (five or more cases). The underlying factors contributing to differences in CSS were also analyzed. RESULTS:Groups treated at lower-volume and higher-volume centers comprised 39 and 157 patients, respectively. No significant differences were observed in patient backgrounds. However, among patients with clinical stage 3 disease, CSS was significantly worse in the lower-volume center group. In that subgroup, significantly fewer patients underwent lymph node dissection. There were no notable differences in other treatments or complications between the two groups. CONCLUSION:A disparity in CSS was observed specifically in patients with clinical stage 3 disease. The lower rate of lymph node dissection in lower-volume centers appears to be a contributing factor to the inferior prognosis in this group. No other differences were found in treatment or complication rates, suggesting that lower-volume centers can deliver care that is comparable to that in higher-volume centers, apart from lymph node dissection.

BACKGROUND:Late-onset hypogonadism (LOH), a condition characterized by age-related testosterone decline, is associated with impaired quality of life and adverse clinical outcomes. Although endocrine abnormalities are common in patients undergoing maintenance hemodialysis (MHD), the clinical characteristics and risk factors for LOH in this population remain unclear. This study investigated the prevalence of LOH and its associated clinical factors in male patients on MHD. METHODS:Sixty-nine male patients undergoing MHD were enrolled. LOH was defined as total testosterone ≤250 ng/dL combined with an Aging Male Symptoms Score (AMSS) of ≥27. Clinical features, laboratory parameters, and medication use were compared between patients with and without LOH. Factors associated with LOH were evaluated using multivariate analysis. RESULTS:Fifteen patients (21.7%) met the diagnostic criteria for LOH. Patients with LOH had significantly higher AMSS scores, particularly in the sexual domain. In the revised multivariate analysis excluding variables used in the definition of LOH, statin use remained independently associated with LOH (odds ratio: 8.12, p = 0.017), whereas total cholesterol showed a marginal inverse association (odds ratio: 0.97, p = 0.058). CONCLUSIONS:LOH was observed in approximately 20% of male patients on MHD and was characterized mainly by sexual symptoms. Statin therapy may be associated with LOH; however, the findings should be interpreted cautiously due to potential confounding and limited sample size.

Abstract Background This study aimed to compare the percentage of local anesthetic spread into the obturator canal between the nerve stimulation-guided interadductor approach (NS-INTAD) and the ultrasound-guided interadductor approach (US-INTAD), and to evaluate anatomical factors influencing the effectiveness of the obturator nerve block (ONB). Methods Eighty patients scheduled for transurethral resection of bladder tumor were randomized to receive either NS-INTAD ( n = 40) or US-INTAD ( n = 40). In the lithotomy position, a mixture of local anesthetic and contrast medium was injected via the interadductor approach from the medial thigh. Injectate spread into the obturator canal was assessed by fluoroscopy, and the success rate and injection volume were compared between groups. Results Enhancement in the obturator canal was observed in 75% of patients in the NS-INTAD group and 90% in the US-INTAD group. Although the percentage was higher in the US-INTAD group, the difference was not statistically significant ( P = 0.139). The volume of local anesthetic used did not differ significantly between groups ( P = 0.07). In patients where the posterior branch of the obturator nerve coursed between obturator externus muscle fascicles, local anesthetic propagation into the obturator canal appeared limited. Conclusion The percentage of injectate spread into the obturator canal tended to be higher with US-INTAD than with NS-INTAD. Our findings suggest that the lithotomy-position approach facilitates more cephalad local anesthetic spread than the supine-position approach. Furthermore, the development of the superior fascicle of the external obturator muscle appears to be an anatomical factor that inhibits injectate spread into the obturator canal. Trial registration UMIN Clinical Trials Registry (UMIN-CTR) UMIN000027762; registered 15 June 2017.