Int Urol Nephrol [JOURNAL]
Sun
200 papers
Single‑port versus multi‑port robotic-assisted partial nephrectomy: a systematic review and meta-analysis of propensity score-matched cohort studies.
Wang R, Zhang L, Liu P … +3 more , Li D, Deng S, Zhang H
Int Urol Nephrol · 2026 Jun · PMID 42287517 · Publisher ↗
PURPOSE: The effectiveness of single-port (SP) versus multi-port (MP) robotic-assisted partial nephrectomy (RAPN) has been compared in many studies, but the comparative superiority remains unclear. The purpose of this ar...
PURPOSE: The effectiveness of single-port (SP) versus multi-port (MP) robotic-assisted partial nephrectomy (RAPN) has been compared in many studies, but the comparative superiority remains unclear. The purpose of this article is to comprehensively review the existing literature and conduct a more precise comparison of the two surgical methods. METHODS: We performed a thorough literature search in PubMed, Web of Science, Embase, and Cochrane CENTRAL databases to identify relevant studies published before April 2026. Eligible studies were strictly screened for inclusion in the subsequent meta-analysis, and their methodological quality was evaluated using the Newcastle-Ottawa Scale. For continuous outcomes, we computed the mean difference (MD) with 95% confidence intervals (CI). For dichotomous variables, the risk ratio (RR) with 95% CI was applied. RESULTS: A total of six high-quality retrospective investigations were enrolled, involving 1223 patients in total. Of these, 591 (48%) patients underwent single-port surgery, while 632 (52%) patients underwent multi-port surgery. In terms of the surgical outcomes, primary analyses indicated that SP operation was similar to MP operation. SP and MP exhibited no statistically significant differences regarding positive surgical margins, postoperative complications, major postoperative complications, and ΔeGFR at 6 months. Compared with MP, SP has less-estimated blood loss and better pain control in the early postoperative period. Exploratory sensitivity analyses suggested potential advantages of SP in operative time and hospital stay. Subgroup analysis revealed a trend toward shorter warm ischemia time in the MP group compared with the SP group. CONCLUSIONS: SP is safe and comparable to MP in oncological, safety, and short-term renal function outcomes. Primary analyses showed no significant differences in operative time, hospital stay, or warm ischemia time. SP was associated with slightly lower estimated blood loss and early postoperative pain, but these differences were small and clinically minimal. Exploratory post hoc findings suggesting advantages in operative time and hospital stay require confirmation.
Abdominal waist circumference and subcutaneous adipose tissue thickness predicts development of post-transplant diabetes mellitus.
Kanbay M, Yagmur FH, Karadeniz B … +11 more , Ozen Atalay H, Ak AB, Copur S, Orak HI, Genc NI, Hasbal NB, Cural Kula G, Durur Karakaya A, Rossing P, Covic A, Tuttle KR
Int Urol Nephrol · 2026 Jun · PMID 42287516 · Publisher ↗
BACKGROUND: Post-transplant diabetes mellitus (PTDM) is a major comorbidity affecting 10-40% of kidney transplant recipients with significant clinical consequences including diabetic microvascular and macrovascular compl...
BACKGROUND: Post-transplant diabetes mellitus (PTDM) is a major comorbidity affecting 10-40% of kidney transplant recipients with significant clinical consequences including diabetic microvascular and macrovascular complications, infectious complications, allograft loss, and mortality. Although multiple modifiable and non-modifiable risk factors have been identified for PTDM development, there is a strong need for higher quality determinants of PTDM risk for early identification of high-risk patients. We hereby aim to evaluate the efficacy of abdominal waist circumference and subcutaneous adipose tissue thickness as predictors of PTDM among kidney transplant recipients. METHODS: We have performed a single-center retrospective clinical study involving non-diabetic kidney transplant recipients between December 2018 and January 2025. Baseline demographic and clinical data, laboratory workup and pre-transplant abdominal computed tomography (CT) were utilized. Abdominal waist circumference and subcutaneous adipose tissue thickness were obtained from the abdominal CT scan. The diagnosis of PTDM was based upon the criteria established by the American Diabetes Association. RESULTS: We have included a total of 478 adult kidney transplant recipients with a mean age of 41.1 with slight female predominance (57.1%). Patients developing PTDM were more likely to be elderly, have higher body-mass index, higher abdominal subcutaneous adipose tissue thickness, higher abdominal waist circumference and higher baseline serum glucose and triglyceride levels compared to patients not developing PTDM (p value < 0.001 for all). The pairwise comparison of the ROC curve data for such variables has revealed the superiority of higher abdominal subcutaneous adipose tissue thickness and abdominal waist circumference in predicting PTDM risk over body-mass index among kidney transplant recipients. CONCLUSIONS: We have identified two independent risk factors for PTDM development as abdominal waist circumference and abdominal subcutaneous adipose tissue thickness. KEY LEARNING POINTS: What was known: Post-transplant diabetes mellitus is a major comorbidity affecting 10-40% of kidney transplant recipients with significant clinical consequences including diabetic microvascular and macrovascular complications, infectious complications, allograft loss, and mortality. This study adds: Abdominal waist circumference and subcutaneous adipose tissue thickness, measured by abdominal CT scan, predict the development of post-transplant diabetes mellitus better than body-mass index. Potential impact: Baseline measurement of abdominal waist circumference and subcutaneous adipose tissue thickness may help to predict the development of post-transplant diabetes mellitus. This may also facilitate early management of these patients.
Baseline TIR and early DKD risk in type 2 diabetes: interpreting an association for future monitoring.
Chen TY
Int Urol Nephrol · 2026 Jun · PMID 42274955 · Publisher ↗
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Complications after sentinel node biopsy and inguinal lymph node dissection in penile cancer: a Danish national cohort study.
Mølsted J, Als AB, Jensen JB … +2 more , Aagaard M, Jakobsen JK
Int Urol Nephrol · 2026 Jun · PMID 42274954 · Publisher ↗
PURPOSE: Sentinel node biopsy (SNB) and inguinal lymph node dissection (ILND) are central to penile cancer management, but ILND especially carries substantial morbidity. This nationwide study explores the extent and risk...
PURPOSE: Sentinel node biopsy (SNB) and inguinal lymph node dissection (ILND) are central to penile cancer management, but ILND especially carries substantial morbidity. This nationwide study explores the extent and risk factors of postoperative complications after inguinal lymph node surgery in Danish penile cancer patients. METHODS: We conducted a retrospective cohort study of penile cancer patients diagnosed in Denmark 2013-2025. Surgical procedures, pathological outcomes, and complications were extracted from medical records. Univariable and multivariable logistic regression with multiple imputation was used to assess predictors of complications. RESULTS: Among 745 patients, 717 underwent 1348 SNB procedures and 184 underwent 241 ILND procedures. Postoperative morbidity increased substantially with procedural extent, with complications occurring after 9% of SNB procedures and after 31% of ILND procedures. Lymphoedema developed in 47% of patients following ILND versus 9% following SNB. Increasing lymph node yield independently predicted overall complications within both SNB and ILND cohorts and was additionally associated with wound infection following SNB. For lymphoedema, ILND carried five- to nine-fold higher odds compared with SNB, while higher BMI independently predicted lymphoedema risk (OR 1.07 per kg/m, p = 0.002). CONCLUSION: Complications increase markedly with procedure extent. Increasing lymph node yield was associated with wound infection, while lymphoedema is primarily determined by procedure type. Poor predictive ability of patient characteristics limits pre-operative risk stratification.
A comparative analysis of variant histology and urothelial bladder cancer following radical cystectomy.
McMaster T, Hoskin G, Homewood D … +5 more , Attwell-Heap A, Perry-Keene J, Harrison V, Perumalla C, Chopra S
Int Urol Nephrol · 2026 Jun · PMID 42271085 · Publisher ↗
PURPOSE: To analyze the prevalence of variant histology bladder cancer subtypes and compare survival and oncological outcomes following radical cystectomy, in urothelial and variant histology cohorts, at a high-volume Au...
PURPOSE: To analyze the prevalence of variant histology bladder cancer subtypes and compare survival and oncological outcomes following radical cystectomy, in urothelial and variant histology cohorts, at a high-volume Australian center. METHOD: A five-year retrospective cohort study, including 82 patients at a tertiary center in Queensland, Australia. Inclusion criteria comprised patients over 18 years old with localized high-risk bladder cancer and who underwent open cystectomy plus ileal conduit, with curative intent. Exclusion criteria included metastatic disease, an indication other than malignancy and treatment with palliative intent. Statistical analysis was performed using R version 4.4.1, with statistical significance reported at p < 0.05. RESULTS: Variant histology comprised 26% of the study cohort with a greater proportion of highly aggressive VH subtypes observed in the data compared to current literature. On multivariable analysis, VH was not associated with a higher risk of mortality. However, muscle-invasive disease and positive lymph nodes were independently associated with a significant risk of mortality (P = 0.009 and P = 0.048, respectively). Within the VH bladder cancer group, there was a greater proportion (62%) found to be stage > T1 post-cystectomy, compared to the urothelial group (41%). CONCLUSION: This is the only Australian study examining outcomes post-radical cystectomy across multiple VH subtypes. Highly aggressive subtypes (micropapillary, plasmacytoid, sarcomatoid) were over-represented in our cohort. Improved recognition of VH guides multidisciplinary decision-making while a standard of care is yet to be established. Multicentered Australian registries with long-term follow-up are needed to enhance statistical analysis and evaluate the impact of variant histology on treatment outcomes.
Expression analysis of epithelial membrane protein 1 (EMP1) gene in kidney stone patients.
Sardar N, Raouf S, Bilal A … +2 more , Iqbal S, Tanvir F
Int Urol Nephrol · 2026 Jun · PMID 42271084 · Publisher ↗
BACKGROUND: Calcium oxalate (CaOx) nephrolithiasis is a recurrent urological disorder, and Randall's plaque (RP) of the renal papilla is widely accepted as an early site of stone nucleation. Although immune activation, e...
BACKGROUND: Calcium oxalate (CaOx) nephrolithiasis is a recurrent urological disorder, and Randall's plaque (RP) of the renal papilla is widely accepted as an early site of stone nucleation. Although immune activation, epithelial injury, and extracellular matrix (ECM) remodeling have been reported in RP, the cell-type-specific transcriptional features of Epithelial Membrane Protein 1 (EMP1) in this tissue context remain undefined. METHODS: A secondary, hypothesis-generating analysis of a publicly available single-cell RNA sequencing (scRNA-seq) dataset (NCBI GEO accession GSE176155; BioProject PRJNA735197) comprising renal papillary tissue from patients undergoing percutaneous nephrolithotomy for CaOx nephrolithiasis (RP samples) and matched normal renal papilla samples was performed. Raw FASTQ data were processed through Cell Ranger (v6.0.1) aligned to GRCh38, followed by quality control, normalization, dimensionality reduction (PCA, UMAP), graph-based clustering, and cell-type annotation in Seurat (v4.0.5) using canonical markers cross-checked against the Kidney Cell Atlas. Differential expression at the single-cell level was assessed by the Wilcoxon rank-sum test with Bonferroni correction. Coexpression, functional enrichment (GO, KEGG), and weighted gene coexpression network analysis (WGCNA) were used to characterise EMP1-associated transcriptional modules. Pseudobulk-style ANOVA and linear regression were performed as exploratory sensitivity checks at the sample level. RESULTS: At the single-cell level, EMP1 was significantly downregulated in RP-derived epithelial and stromal clusters compared with normal renal papilla (adjusted p < 0.01, log2FC ≤ -0.30). EMP1 was co-expressed with C3, RNASE1, NRG1, IFI16, S100A10, HSPA6, and FN1, and the EMP1-correlated module identified by WGCNA was negatively correlated with the RP phenotype (r = -0.72, p < 0.001). GO and KEGG enrichment showed associations with cell adhesion, integrin and heparin binding, leukocyte migration, neutrophil extracellular trap formation, and focal adhesion. Sample-level pseudobulk ANOVA and regression analyses did not reach statistical significance for most genes, consistent with the limited number of donors and the loss of cell-type resolution after pseudobulk aggregation; these results are presented as exploratory. CONCLUSIONS: This study reports an associative, hypothesis-generating link between reduced EMP1 expression in renal papillary epithelial and stromal populations and the molecular landscape of Randall's plaque. Independent transcriptomic, spatial, and functional validation will be required before EMP1 can be considered a candidate biomarker or therapeutic target in CaOx nephrolithiasis.
The extracellular matrix Piezo1 feedback loop drives renal fibrosis through compartment-specific mechanotransduction.
Gan P, Wang X, Ding Y … +4 more , Zhang Z, Luo F, Li J, Deng Q
Int Urol Nephrol · 2026 Jun · PMID 42268532 · Publisher ↗
Renal fibrosis is the final common pathological outcome of chronic kidney disease and is characterized not only by excessive extracellular matrix (ECM) deposition but also by profound and persistent alterations in tissue...
Renal fibrosis is the final common pathological outcome of chronic kidney disease and is characterized not only by excessive extracellular matrix (ECM) deposition but also by profound and persistent alterations in tissue mechanics. Among emerging mechanosensors, the mechanosensitive ion channel Piezo1 has gained attention as a direct transducer of mechanical forces into intracellular calcium signaling. This review reframes renal fibrosis as a self-reinforcing mechanobiological process driven by an ECM-Piezo1 feedback loop, rather than a purely biochemical cascade. In the kidney, pathological mechanical cues including matrix stiffening, tissue stretch, and blood pressure activate Piezo1 in tubular epithelial cells, mesangial cells, fibroblasts, and immune cells. Piezo1-mediated Ca⁺ influx interfaces with integrin-based adhesion complexes, cytoskeletal tension systems, and canonical profibrotic signaling pathways, thereby amplifying extracellular matrix synthesis, epithelial-mesenchymal transition, inflammatory activation, and metabolic dysregulation. These interactions establish a self-reinforcing mechanobiological loop in which ECM stiffening enhances Piezo1 activation, further promoting matrix remodeling and tissue rigidity. This review summarizes current knowledge of ECM composition and mechanical remodeling in the kidney, delineates the molecular mechanisms underlying Piezo1-dependent mechanotransduction, and discusses the compartment-specific roles of the ECM-Piezo1 axis in glomerular, tubular, and immune cell populations. We further highlight emerging therapeutic strategies targeting this axis, including pharmacologic modulation of Piezo1 activity, gene- and cell-based approaches, and biomaterial-guided mechanical reprogramming. Here, we provide a kidney-centered, compartment-specific synthesis of ECM-Piezo1 mechanotransduction, highlighting how progressive matrix stiffening perpetuates compartment-specific pathological signaling and revealing precision intervention points beyond global Piezo1 blockade.
B7-1 and PD-L1 crosstalk in podocyte injury: from molecular mechanisms to novel therapeutic strategies for nephrotic syndrome.
Zhang X, Wu C
Int Urol Nephrol · 2026 Jun · PMID 42268531 · Publisher ↗
Nephrotic syndrome (NS) is a clinical condition characterized by substantial proteinuria, and its global incidence is increasing. Current treatment strategies mainly rely on glucocorticoids and immunosuppressants. Nevert...
Nephrotic syndrome (NS) is a clinical condition characterized by substantial proteinuria, and its global incidence is increasing. Current treatment strategies mainly rely on glucocorticoids and immunosuppressants. Nevertheless, a proportion of patients may develop steroid resistance or suffer from disease relapse. Podocyte injury plays a central role in the pathogenesis of proteinuria in NS. Recent studies have increasingly highlighted the significance of the immune checkpoint molecules B7-1 and PD-L1 in podocytes, particularly their cis-interaction on the podocyte surface. This review systematically elaborates on the molecular basis, mechanisms of action, and the mechanisms underlying cis-interaction, as well as recent advances in targeted therapies involving B7-1 and PD-L1. It offers new perspectives for precision immunotherapy in NS, thereby promoting the translation of mechanistic insights into clinical applications. However, significant controversies remain regarding authentic B7-1 expression in podocytes, the strength of evidence for the PD-L1/B7-1 cis‑interaction in kidney disease, and the translational gaps between animal models and human NS. This review critically discusses these unresolved issues and outlines priority directions for future research.
From AKI to CKD mechanisms of maladaptive repair and disease progression.
Fan Q, Zhang K, Sang J … +3 more , Kan C, Guo Z, Sun X
Int Urol Nephrol · 2026 Jun · PMID 42268530 · Publisher ↗
Acute kidney injury (AKI) and chronic kidney disease (CKD) were traditionally regarded as distinct clinical entities, largely defined by the reversibility or irreversibility of renal dysfunction. However, growing clinica...
Acute kidney injury (AKI) and chronic kidney disease (CKD) were traditionally regarded as distinct clinical entities, largely defined by the reversibility or irreversibility of renal dysfunction. However, growing clinical and experimental evidence now supports a continuum model in which AKI serves as a major initiating event for subsequent CKD development and progression. Even when conventional indices suggest functional recovery, persistent subclinical injury may drive long-term structural, metabolic, and transcriptional alterations that predispose the kidney to chronic damage. In this review, we synthesize current clinical, epidemiological, and mechanistic evidence linking AKI to CKD, with particular emphasis on maladaptive repair. We propose that maladaptive tubular epithelial repair represents the central coordinating event in this transition. Failed redifferentiation, sustained cell cycle arrest, partial epithelial reprogramming, and metabolic inflexibility convert injured tubular cells from targets of injury into active drivers of chronic remodeling. Persistent inflammation and immune dysregulation amplify tissue injury. Meanwhile, microvascular rarefaction and endothelial dysfunction reduce oxygen delivery and promote chronic hypoxia. Moreover, mitochondrial dysfunction, lipid accumulation, defective organelle quality control, and sustained cellular stress signaling reinforce tubular vulnerability and limit regenerative capacity. Emerging evidence also indicates that epigenetic and transcriptional memory may stabilize maladaptive cellular states, thereby lowering the threshold for re-injury and accelerating CKD progression. By integrating these interconnected pathways, we present a unified framework for the AKI-to-CKD continuum and discuss key translational opportunities, including time-sensitive intervention, mechanistic stratification, and biomarker-guided risk prediction. A more precise understanding of post-AKI remodeling may enable early and individualized strategies to prevent CKD progression.
Association between TNFSF13 SNPs and progression to end-stage renal disease in IgA nephropathy patients.
Fang H, Mao S, Li R … +1 more , Jin Y
Int Urol Nephrol · 2026 Jun · PMID 42262683 · Publisher ↗
PURPOSE: IgA nephropathy (IgAN) is a leading cause of end-stage renal disease (ESRD) and exhibits considerable variability in disease progression. Genetic factors that influence disease progression remain poorly understo...
PURPOSE: IgA nephropathy (IgAN) is a leading cause of end-stage renal disease (ESRD) and exhibits considerable variability in disease progression. Genetic factors that influence disease progression remain poorly understood. METHODS: This was a retrospective nested case-control study conducted within a cohort of 312 biopsy-confirmed IgAN patients who were followed up at The Second Hospital of Jiaxing. Patients who progressed to ESRD (n = 56) were matched with non-progressors (n = 112) based on age, sex, and disease duration. Genotyping for tumor necrosis factor ligand superfamily member 13 (TNFSF13) single nucleotide polymorphisms (SNPs) was performed using TaqMan assays, and TNFSF13 mRNA expression was measured by quantitative real-time PCR. Multivariable Firth penalized likelihood logistic regression was used to assess associations between SNPs and progression to ESRD. RESULTS: Among the four TNFSF13 single nucleotide polymorphisms SNPs, only rs3803800 was significantly associated with ESRD progression. Carriers of the A allele (AG/AA) had a 2.6-fold higher risk of progression than GG homozygotes (OR = 2.902, 95% CI 1.012-8.684, P = 0.048). In addition, A-allele carriers exhibited lower baseline eGFR (55.84 ± 7.45 vs. 60.98 ± 6.13 mL/min/1.73m, P = 0.020), higher serum IgA levels (2.93 ± 0.74 vs. 1.90 ± 0.76 g/L, P < 0.001), and elevated TNFSF13 mRNA expression in the progression group, while plasma soluble APRIL levels did not differ between carriers and non-carriers. CONCLUSIONS: The rs3803800 A allele may be an independent genetic risk factor for ESRD progression in IgAN, associated with lower baseline eGFR and higher serum IgA levels. These findings suggest that TNFSF13 genetic variants, particularly rs3803800, may influence IgAN progression through dysregulated IgA-mediated immune responses, providing a basis for future research on targeted therapies for IgAN.
Comparative performance of predictive nomograms for pathological upstaging in clinical T1 renal masses: an independent external validation.
Shaked Y, Kaptzan B, Marom R … +3 more , Vainrib M, Neheman A, Schwarztuch Gildor O
Int Urol Nephrol · 2026 Jun · PMID 42260216 · Publisher ↗
BACKGROUND: Preoperative identification of pathological upstaging (≥ pT3a) in clinical T1 (cT1) renal masses is critical for surgical planning. We externally validated three established predictive models, Barra, Nocera,...
BACKGROUND: Preoperative identification of pathological upstaging (≥ pT3a) in clinical T1 (cT1) renal masses is critical for surgical planning. We externally validated three established predictive models, Barra, Nocera, and Mei, to assess their discrimination, calibration, and clinical utility in a contemporary cohort. PATIENTS AND METHODS: We retrospectively reviewed patients undergoing surgery for cT1 renal masses at our institution. The primary endpoint was pathological upstaging to pT3a. Model performance was evaluated using the Area Under the Curve (AUC) for discrimination and the Brier Score for overall accuracy. Calibration was assessed using parametric and nonparametric Loess-smoothed curves. Clinical utility was quantified using Standardized Decision Curve Analysis. RESULTS: The institutional upstaging rate was 17.1% (19/111), and clear cell histology predominated (77.5%). Nocera (AUC = 0.736) and Barra (AUC = 0.733) had higher point estimates of discriminative ability than Mei (AUC = 0.677), but the differences were not significant. All models descriptively overestimated absolute risk. However, Mei demonstrated the highest absolute calibration stability, whereas the Nocera model showed significant global unreliability (U = 0.052, p = 0.021). The Barra model achieved the lowest overall error (Brier Score = 0.122) and the highest clinical net benefit within the decisive 8%-18% decision window, although the overall accuracy differences were not statistically significant. CONCLUSION: All nomograms are useful risk-stratification adjuncts, but wide confidence intervals and low event counts mean these findings are exploratory. No single model is definitively superior. Nocera and Barra are effective for relative risk-ranking, while Mei provides superior absolute precision for patient counseling.
Charting the unseen: 3D mapping of latent prostate cancer infers its likely origin and growth patterns.
Jin S, Yang Z, Mai Z … +7 more , Chen Y, Ren M, Zhou Y, Wang W, Xiao Y, Zhou Z, Yan W
Int Urol Nephrol · 2026 Jun · PMID 42250007 · Publisher ↗
PURPOSE: Latent prostate cancers discovered at autopsy may represent the earliest, subclinical stage of the disease. This study aimed to construct three-dimensional (3D) spatial distribution maps of these tumors to infer...
PURPOSE: Latent prostate cancers discovered at autopsy may represent the earliest, subclinical stage of the disease. This study aimed to construct three-dimensional (3D) spatial distribution maps of these tumors to infer their likely origin and growth patterns. METHODS: A total of 161 tumor lesions from 230 cadaver donors were stratified by volume (V1: 0-0.05 ml; V2: 0.05-0.1 ml; V3: 0.1-0.5 ml; V4: > 0.5 ml) and registered to a standardized MRI-based reference prostate model using Advanced Normalization Tools. Two-dimensional frequency maps were generated per axial layer and stacked into a 3D map. RESULTS: The smallest tumors (V1) originated almost exclusively in the peripheral zone (83.5%), concentrated in the apical two-thirds of the gland (95.9%), with a uniform distribution across the anterior-posterior and left-right axes. As tumor volume increased (V2 to V4), three distinct growth patterns emerged: (1) increased invasion into the transition zone; (2) horizontal convergence into three "hotspots"-the anterior midline and bilateral posterolateral regions; and (3) vertical concentration within layers III to IX. A compact "susceptible region" occupying only 9.8% of the gland volume harbored 88.2% of the largest (V4) tumors. CONCLUSION: Latent prostate cancers appear to originate predominantly within the apical-to-mid peripheral zone with an initially uniform spatial distribution. Their growth is anisotropic, favoring the anterior midline and bilateral posterolateral zones while concentrating vertically within the central 20-40% of the prostatic height. These spatial patterns point to target areas that may improve biopsy strategies and focal therapy planning.
Development and validation of a machine learning-based prediction model for malnutrition risk in peritoneal dialysis patients: a multi‑center retrospective study.
Li N, Xu M, Wei X … +3 more , Qu Y, Zhang H, Liu Y
Int Urol Nephrol · 2026 Jun · PMID 42247202 · Publisher ↗
PURPOSE: To develop and validate a machine learning (ML)‑based model for predicting malnutrition risk in patients undergoing maintenance peritoneal dialysis (PD) using routinely available clinical and laboratory data. ME...
PURPOSE: To develop and validate a machine learning (ML)‑based model for predicting malnutrition risk in patients undergoing maintenance peritoneal dialysis (PD) using routinely available clinical and laboratory data. METHODS: A multicenter retrospective cohort study was conducted. Adults with end-stage renal disease who received PD for at least 90 days were enrolled from two tertiary hospitals. Malnutrition was defined by a 35-point Modified Quantitative Subjective Global Assessment (mSGA) score > 7 at 3-month post-enrollment. Candidate predictors included demographics, laboratory indices, dialysis parameters, comorbidities, and psychosocial scores. After feature selection via LASSO regression, three models-logistic regression (LR), Random Forest (RF), and eXtreme Gradient Boosting (XGBoost)-were trained and optimized. Model performance was evaluated on an internal and an independent external validation set using discrimination (AUC), calibration, and decision curve analysis (DCA). Model interpretability was enhanced with SHAP analysis and a clinical nomogram. RESULTS: Among 497 included patients, 29.8% were malnourished. Nine predictors were selected by LASSO: age, dialysis vintage, serum albumin, high‑sensitivity C‑reactive protein (hs‑CRP), hemoglobin, total weekly Kt/V, depression score (SDS), anxiety score (SAS), and diabetic nephropathy as the primary cause. XGBoost achieved the highest discrimination, with an AUC of 0.868 (95% CI 0.792-0.944) on internal validation and 0.857 (95% CI 0.805-0.909) on external validation, significantly outperforming LR (p = 0.023). Calibration was excellent (confirmed by calibration intercept, slope, and Brier score), and DCA demonstrated superior net benefit across clinically relevant risk thresholds. Serum albumin, hs‑CRP, and total weekly Kt/V were consistently the most influential predictors across all models. CONCLUSIONS: An XGBoost‑based ML model effectively predicts malnutrition risk in PD patients using readily available clinical data. With robust validation, interpretable outputs (SHAP, nomogram), and confirmed clinical utility, this tool holds promise for early identification and targeted intervention in high‑risk patients.
Human papillomavirus (HPV) and p16 expression in early-onset prostate cancer.
Avci IE, Yilmaz H, Sayan M … +2 more , Baynal EA, Yaprak Bayrak B
Int Urol Nephrol · 2026 Jun · PMID 42234298 · Publisher ↗
PURPOSE: To investigate the potential role of human papillomavirus (HPV) in early onset prostate cancer (PCa) through HPV-DNA detection and genotyping, and immunohistochemical evaluation of p16 expression. METHODS: This...
PURPOSE: To investigate the potential role of human papillomavirus (HPV) in early onset prostate cancer (PCa) through HPV-DNA detection and genotyping, and immunohistochemical evaluation of p16 expression. METHODS: This retrospective cross-sectional study included patients diagnosed with PCa at ≤ 55 years of age between 2010 and 2021. Patients with a familial history of PCa, incomplete medical records, immunodeficiency, or insufficient tissue for molecular analysis were excluded. Formalin-fixed, paraffin-embedded (FFPE) prostate biopsy samples were analyzed for HPV-DNA using the HPV 3.5 LCD-Array Kit (Chipron GmbH, Berlin, Germany), a multiplex PCR-based assay targeting 32 HPV genotypes. Immunohistochemical staining for p16 was performed to assess its expression. Clinical data, including PSA levels, Gleason score, ISUP grade, and EAU risk group, were compared between HPV-positive and HPV-negative cases. RESULTS: HPV-DNA was detected in 12 of 45 cases (26.7%), with genotype 62 being the most frequent. Multiple HPV genotypes were identified in three cases (6.7%). p16 immunopositivity was observed in 91.7% of HPV-positive tumors compared with 69.7% of HPV-negative tumors (p = 0.240). HPV-positive patients showed higher ISUP grades than HPV-negative patients (p = 0.029) and were more likely to be in intermediate or high-risk groups (p = 0.028). No significant differences were observed in PSA levels or Gleason scores. CONCLUSION: The detection of HPV-DNA in a considerable proportion of early onset PCa specimens, together with the more frequent but not statistically significant p16 positivity in HPV-positive tumors, suggests a possible association with prostate tumor biology. However, the presence of low-risk HPV genotypes and the non-specific nature of p16 expression complicate the interpretation of a direct oncogenic role.
Comparative functional, perioperative and oncological outcomes of robot-assisted and open radical prostatectomy: a systematic review and meta-analysis.
Suartz CV, Costa MSS, Matalani CFA … +18 more , da Rocha MR, Micheleto JPC, Furlam PL, Lepine HL, Lopes RI, Talizin TB, Júnior JB, Shahrour W, Shabana W, Merseburger AS, Reis LO, Cordeiro MD, Nahas WC, Toren P, Ribeiro-Filho LA, Ploussard G, Fradet V, Pouliot F
Int Urol Nephrol · 2026 Jun · PMID 42230439 · Publisher ↗
INTRODUCTION: Robot-assisted radical prostatectomy (RARP) has increasingly replaced open radical prostatectomy (ORP) based on evidence suggesting improved perioperative outcomes and faster recovery. However, few randomiz...
INTRODUCTION: Robot-assisted radical prostatectomy (RARP) has increasingly replaced open radical prostatectomy (ORP) based on evidence suggesting improved perioperative outcomes and faster recovery. However, few randomized trials directly compare both techniques. This review compares perioperative, functional, and oncological outcomes of RARP versus ORP, integrating newly available high-impact studies. METHODS: A thorough search of major databases was conducted from the inception of each database up to November 2025, adhering to PRISMA guidelines. Two reviewers independently screened studies in a three-step process-titles, abstracts, and full texts. Only randomized controlled trials (RCTs) and prospective studies comparing RARP and ORP were included. All variables were entered into a spreadsheet for analysis and cross-checked. The primary endpoints assessed were perioperative complications, functional recovery (urinary continence and erectile function), and oncological outcomes. RESULTS: A total of 27 studies comprising 38,530 patients were included. Compared with ORP, RARP was associated with significantly reduced intraoperative blood loss (mean difference [MD] : - 576.78; p < 0.01), lower transfusion rates (Odds Ratio [OR] 0.27; p < 0.0001), and shorter hospital stay (MD: - 1.44 days; p < 0.0001). RARP also demonstrated fewer postoperative complications (OR 0.59; p = 0.002). Regarding functional outcomes, RARP yielded superior urinary continence recovery at 3 months and improved erectile function recovery (OR 1.43). Additionally, RARP showed a lower biochemical recurrence rate at 24 months (OR 1.34), with no significant difference observed in short-term follow-up (< 12 months). CONCLUSION: RARP offers advantages over ORP, particularly in reducing perioperative morbidity and enhancing functional recovery while maintaining comparable or superior oncological outcomes. However, further randomized controlled trials with extended follow-up are necessary to confirm these findings. KEY MESSAGES: 1. RARP was associated with significantly reduced blood loss, lower transfusion requirements, and shorter hospitalization. 2. Functional outcomes favored RARP, including superior recovery of urinary continence and higher rates of nerve-sparing preservation. 3. Overall, the evidence supports RARP as a safe, effective, and clinically advantageous approach for localized prostate cancer.
Exploring the global, regional, and Chinese disease burden of acute glomerulonephritis from 1990 to 2021 and future trends up to 2039 based on the 2021 Global Burden of Disease Database.
Li X, Ma H, Xu H
Int Urol Nephrol · 2026 May · PMID 42223810 · Publisher ↗
PURPOSE: Acute glomerulonephritis (AGN) is a non-infectious inflammation of the glomeruli. Severe AGN can lead to acute renal failure, imposing substantial economic burdens on society. GBD database provided comprehensive...
PURPOSE: Acute glomerulonephritis (AGN) is a non-infectious inflammation of the glomeruli. Severe AGN can lead to acute renal failure, imposing substantial economic burdens on society. GBD database provided comprehensive data for analyzing global disease trends. Therefore, a thorough assessment of AGN-related burden is essential to inform mitigation strategies. METHODS: In this study, the incidence, mortality, disability-adjusted life years (DALYs), their rates, and corresponding age-standardised rates (ASR) from 1990 to 2021 were systematically described. Trends in the disease burden of AGN across different age groups and genders were further analyzed at the global, regional, and Chinese levels. Additionally, an age-period-cohort model (APCM) was constructed to predict potential future trends. RESULTS: In 2021, the incidence, mortality, DALYs, and their corresponding rates of AGN diseases declined significantly globally compared to 1990, yet China maintained relatively high levels of these indicators. Age-stratified analysis showed that individuals aged 0-14 had substantially higher AGN disease burden rates than other age groups. Projections for 2022-2039 indicate rising AGN incidence and age-standardized incidence rate (ASIR), but decreasing mortality/age-standardized mortality rate (ASMR) and DALYs/age-standardized DALYs rate (ASDR). This study highlights the need for increased attention to AGN disease burden in children aged 0-14, China, and regions with medium SDI. CONCLUSION: This study systematically described the trends of AGN disease at the global, regional, and Chinese levels from 1990 to 2021 and predicted possible future trends. The findings provided valuable tools for assessing the disease burden of AGN.
Efficacy of behavioral therapy and different dosages of mirabegron for the treatment of male overactive bladder patients.
Tsai YT, Chuang YC, Wang HJ … +2 more , Lee WC, Shen YC
Int Urol Nephrol · 2026 Jun · PMID 42223809 · Publisher ↗
PURPOSE: Behavioral therapy is the established first-line treatment for overactive bladder (OAB), followed by pharmacotherapy as the second-line intervention. Mirabegron, a β3-adrenoceptor agonist, has demonstrated compa...
PURPOSE: Behavioral therapy is the established first-line treatment for overactive bladder (OAB), followed by pharmacotherapy as the second-line intervention. Mirabegron, a β3-adrenoceptor agonist, has demonstrated comparable efficacy to antimuscarinics. This study aims to evaluate the real-world efficacy of behavioral therapy, both as a monotherapy and in combination with mirabegron, for male patients with OAB. METHODS: This pooled analysis from three studies involved 280 adult male OAB patients assigned to behavioral therapy alone or combined with mirabegron (25 mg or 50 mg) for 12 weeks. The primary outcome was the change in the Overactive Bladder Symptom Score (OABSS) from baseline to week 12. Secondary outcomes included changes in the International Prostate Symptom Score (IPSS), Patient Perception of Bladder Condition (PPBC), Quality of Life (QOL) score, maximum flow rate (Qmax), and post-void residual (PVR) volume. RESULTS: At week 12, all groups exhibited significant within-group improvements in total OABSS, with no statistically significant inter-group differences. Significant improvements were also observed in the IPSS, QOL, PPBC, urge urinary incontinence (UUI), and nocturia across all groups. Notably, behavioral therapy demonstrated substantial therapeutic potential for storage symptoms (IPSS storage sub-score), particularly regarding UUI and nocturia. No negative impacts on PVR or Qmax were observed across the three treatment arms at week 12. CONCLUSION: In real-world clinical practice, both behavioral therapy and combination therapy with varied dosages of mirabegron effectively alleviate OAB symptoms in male patients without compromising voiding function. Beyond conventional pharmacotherapy, optimizing the role of behavioral therapy remains a fundamental component of comprehensive OAB management.
Two-step enucleation combined with needle electrode: a modified TURBT technique to enhance detrusor muscle detection.
Gao F, Chen X, Gao W … +7 more , Cheng Q, Jiang B, Lu Y, Zou N, Ai Q, Li H, Zhu J
Int Urol Nephrol · 2026 May · PMID 42209909 · Publisher ↗
PURPOSE: To evaluate the safety and efficacy of a modified two-step needle-electrode enucleation technique for improving detrusor muscle (DM) detection in transurethral resection of bladder tumor (TURBT). METHODS: This r...
PURPOSE: To evaluate the safety and efficacy of a modified two-step needle-electrode enucleation technique for improving detrusor muscle (DM) detection in transurethral resection of bladder tumor (TURBT). METHODS: This retrospective study included 103 patients undergoing bipolar TURBT between 2019 and 2023, assigned to Two-step enucleation (n = 37), En bloc enucleation (n = 32), or Conventional TURBT (cTURBT) (n = 34). Inverse probability of treatment weighting (IPTW) was applied to mitigate selection bias. Weighted comparisons used survey-design-adjusted methods, including Rao-Scott chi-square tests and weighted regression models. Outcomes included DM detection, operation time, complications, recovery metrics, and short-term recurrence. RESULTS: After IPTW, the Two-Step group demonstrated a higher DM detection rate than the cTURBT group (95.8% vs. 69.4%; adjusted p = 0.03), with an odds ratio of 12.40 (95%CI 1.17-131.92; p = 0.04). No significant difference was observed between the Two-Step and En bloc groups. The Two-Step procedure required a longer operation time than En bloc enucleation (27.7% increase; 95% CI 3.1-58.2%; p = 0.03) and was associated with a longer hospital stay than cTURBT (16.6% increase; 95% CI 2.9-32.2%; p = 0.02). No other statistically significant differences were found among the three groups. CONCLUSION: Two-step enucleation with a needle electrode improves DM detection compared with cTURBT. The procedure time is slightly longer than that of En bloc enucleation. Larger prospective studies are warranted to validate these findings, the perioperative safety, and the long-term oncological outcomes.
Initial clinical experience with RADA16 as a novel therapeutic for severe haemorrhagic radiation cystitis: a preliminary feasibility case series.
Ilie PC, Carrie A, Touati Y … +9 more , Mills R, Radu C, Tanase C, Doherty R, Finch W, Manson-Bahr D, Richardson F, Dymond T, Smith L
Int Urol Nephrol · 2026 May · PMID 42209908 · Publisher ↗
BACKGROUND: Haemorrhagic radiation cystitis (HRC) is a challenging complication of pelvic radiotherapy, often resistant to conventional treatments. AIMS: To evaluate the clinical efficacy and safety of RADA16, a self-ass...
BACKGROUND: Haemorrhagic radiation cystitis (HRC) is a challenging complication of pelvic radiotherapy, often resistant to conventional treatments. AIMS: To evaluate the clinical efficacy and safety of RADA16, a self-assembling peptide, in managing severe HRC. METHODS: A preliminary feasibility case series of five consecutive patients treated at two UK hospitals. All patients had persistent haematuria despite standard interventions and received RADA16 via flexible or rigid cystoscopy. RESULTS: The findings from the cases suggest that all patients have experienced at least a partial or early resolution of haematuria and no adverse effects were reported. In most cases, two applications of RADA16 were sufficient. The longest patient followed up was still symptom free at 3 years. DISCUSSION: This preliminary feasibility case series has demonstrated early efficacy for RADA16 in the management of HRC. CONCLUSIONS: RADA16 is a potentially promising minimally invasive treatment for refractory HRC. Further trials are warranted to confirm these findings.
Association between time in range and incident early diabetic kidney disease in patients with type 2 diabetes: a retrospective cohort study.
Chen L, Zhang L, Zhou N
Int Urol Nephrol · 2026 May · PMID 42207435 · Publisher ↗
BACKGROUND: Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease in type 2 diabetes mellitus (T2DM). Time in range (TIR), a continuous glucose monitoring-derived metric, has emerged as an important...
BACKGROUND: Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease in type 2 diabetes mellitus (T2DM). Time in range (TIR), a continuous glucose monitoring-derived metric, has emerged as an important glycemic control indicator, but evidence linking TIR to incident early DKD in T2DM remains limited. METHODS: This retrospective cohort study included 498 Chinese T2DM patients with preserved kidney function at baseline who underwent continuous glucose monitoring between January 2020 and December 2022, with follow-up until December 2024. TIR and other glycemic metrics were assessed at baseline. The primary outcome was incident early DKD. Cox proportional hazards models evaluated associations between TIR and early DKD risk, with comprehensive adjustment for demographics, clinical characteristics, and medications. Subgroup and sensitivity analyses were performed. RESULTS: During a median 24-month follow-up, 62 (12.4%) patients developed early DKD. After full adjustment, TIR ≥ 70% was associated with lower early DKD risk versus TIR < 70% (HR = 0.54, 95%CI 0.30-0.96, p = 0.048). A significant dose-response relationship was observed across TIR quartiles (P for trend = 0.008), with each 10% TIR increase associated with a 16% risk reduction (HR = 0.84, 95%CI 0.73-0.98, p = 0.022). The protective association was more pronounced in patients not using sodium-glucose cotransporter 2 inhibitors (P for interaction = 0.036). Results remained consistent across sensitivity analyses. CONCLUSIONS: Higher TIR is significantly associated with reduced risk of incident early DKD in T2DM patients with preserved kidney function, exhibiting a clear dose-response pattern. TIR may serve as a valuable complementary metric for assessing renal complication risk.
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